Pregnancy that wasn't: Eldoret woman had cancerous tumour, not a baby

The cancer spread to her brain, she eventually stopped treatment and died.

Such cancers are highly treatable if detected early and appropriately. Mortality is high in low-and middle-income countries where knowledge of this kind of cancer and treatment is limited, treatment costs high.

Doctors said although she had an incomplete abortion two months earlier and was therefore bleeding, they did not rule out pregnancy due to her age.

“Due to the patient’s age, a consideration of a normal pregnancy can still be entertained,” Dr Philip Tonui, a gynaecologic oncologist at Moi University, said.

However, ultrasound tests did not find a baby. Tests confirmed she was not expecting but had a rare cancer that mimics pregnancy.

It causes high human chorionic gonadotropin (HCG) levels, aka pregnancy hormones, which cause positive pregnancy tests and makes it seem that someone is pregnant.

“This patient was staged as having low-risk disease and therefore she was started on intravenous single-agent bi-weekly actinomycin (chemotherapy),” Dr Tonui said.

The case was reported in the current edition of the International Journal of Gynaecological Cancer.

This type of cancer is called gestational trophoblastic neoplasia (GTN), a tumour that forms inside a woman's uterus.

Dr Tonui said GTN is common in low and middle-income countries largely affecting young women of reproductive age.

“It is highly curable when managed in a timely and appropriate manner. It still causes significant morbidity and mortality in low and middle-income countries where its management is fraught with various challenges,” he said.

Because of massive bleeding, the medics had no choice but to remove the uterus and fallopian tubes, through an incision in the lower abdomen.

Dr Kibet Keitany, a consultant pathologist at Moi Teaching and Referral Hospital, who also contributed to the management of the patient, said the tumour was already beginning to rot.

He said, “Grossly, the uterine cavity had a bulky, destructive, soft and fleshy tumour with extensive central haemorrhage and large areas of necrosis (rot).”

The patient was also seen at a different facility where a brain MRI revealed the cancer had spread there.

She received whole brain radiation but it was not clear why it was so extensive.

“Following the cranial radiotherapy, she was to resume chemotherapy but her family decided against further systemic treatment. Consequently, she passed away two months after brain radiation,” Dr Kibet said.

The case study of the rare cancer is titled, 'The Pregnancy that Wasn’t: Challenges of Gestational Trophoblastic Neoplasia Management in Low- and Middle-Income Countries.”

Other contributors to the report are Dr Anisa Mburu, a gynaecologic oncologist at the Aga Khan Hospital; and Raymond Osborne, an oncologist from the University of Toronto.

Dr Tonui said Kenya has limited personnel with specialised knowledge of this type of gynaecologic cancer.

“Subsequently, GTN cases are managed by generalists or lower cadre professionals and such management is usually suboptimal and results in poorer outcomes,” he said.

The majority of GTN patients present at tertiary centres late and in the advanced stages of the disease.

“Additionally, due to the high cost of laboratory and imaging evaluations, limited choice and frequent stockouts of chemotherapeutic agents, coupled with inadequate supportive management of therapeutic side effects, they ultimately receive suboptimal care,” he explained.

The medics called for increased awareness among patients, midwives and physicians of the importance of quickly recognising the possible significance of unexplained postpartum bleeding more than four weeks after delivery.

“Perhaps a patient education booklet that describes GTD/GTN and the high likelihood of cure with appropriate, active management might be useful,” Dr Osborne said.

(Edited by V. Graham)

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