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Abstract
Introduction The incidence and mortality of cancer are predicted to rise in sub-Saharan Africa (SSA), with a projected increase in cancer deaths to approximately 1 million per year by 2030. We present the management of an aggressive choriocarcinoma with two main aims: first, to raise the awareness on gynecological cancers in SSA, as clinicians in this context seldom face this diagnosis; second, to highlight the need of expansion of cancer care facilities in these settings.
Methods Our setting is Matany Hospital, Region of Karamoja, Northern Uganda. A 29-year-old woman presented with intractable vaginal bleeding, dyspnea, and low abdominal pain, ultimately diagnosed with choriocarcinoma after endometrial biopsy. Despite advice for immediate referral for chemotherapy at a cancer institute, the patient refused due to economic reasons and subsequently died from pulmonary embolism.
Results This presentation highlights the frustration associated with cancer management in rural settings in developing countries and emphasizes the need for expansion of cancer care facilities in these regions. Chorioncarcinoma is a curable disease; therefore is unaccettable that a young woman could die today because she is not guaranteed access to cancer treatment.
Conclusion/Implications Universal health coverage is advocated to reduce out-of-pocket costs for essential cancer therapy and promote equitable access to screening, diagnosis, and management, ultimately reducing deaths from gynecological cancers in SSA. Paradigmatic shifts in governmental policies and engagement with traditional, complementary, and alternative medical practices are necessary to reduce missed diagnoses and late referrals. Tailored context-based guidelines for cost-effective cancer management algorithms are encouraged to be developed by interdepartmental working groups.
