Epidemiological and Histopathological Characteristics of Gynecological Cancers in Somalia

Epidemiological and Histopathological Characteristics of Gynecological Cancers in Somalia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Epidemiological and Histopathological Characteristics of Gynecological Cancers in Somalia Ahmed Issak Hussein, Abdikarim Ali Omar, Hiba Bashir Hassan, Ismail Mohamud Abdullahi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2335131/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Gynecological malignancies are prevalent, with a high mortality rate. The present is the first report from Somalia regarding the epidemiological and histopathological characteristics of gynecological cancers. Methods: This study reviewed all pathology results obtained from gynecologic patients who underwent various procedures and biopsies over seven years. The investigated parameters were sociodemographic features, histopathological characteristics, and management options, including surgical interventions. Results: The prevalence of gynecological cancers in our study was 7.1%. Among 225 cases with histopathologically confirmed primary gynecological malignancies, cervical and endometrial cancers were the most common (n= 137 and 42, 61% and 18.6%), respectively. Squamous cell carcinoma was the most common histologic type in cervical, vaginal and vulvar cancers. All patients diagnosed with cervical cancer had no history of cervical screening. Approximately 70% of the patients presented in the late stages of the disease. More than half (n=28, 67%) of patients with Endometrioid adenocarcinoma have been found to have other comorbidities, including diabetic Mellitus (n=17, 60.7%) and hypertension (n=11, 39.3%). Total abdominal hysterectomy and bilateral salpingo-oophorectomy without pelvic lymphadenectomy were performed in 35/42 patients with endometrial cancer. Conclusions: Cervical carcinoma was the most frequently observed gynecological malignancy during the study period. Majority of our patients presented in the late stages of advanced disease. Lack of adequate knowledge of the disease, poor socioeconomic status, limited resources, and inadequate expertise is believed to be the causes of the late presentation of the patients. Since cervical cancer is a preventable disease, national screening and awareness programs are necessary to reduce the burden of cancer and improve women's health in Somalia. Gynecological cancers cervical cancer Screening Sub-Saharan Africa Introduction Cancer is a leading cause of death and a significant impediment to increasing life expectancy in every country( 1 , 2 ). Cancer is expected to increase globally due to population growth and aging, especially in developing countries, where 82% of the global population lives( 3 , 4 ). Worldwide, an estimated 19.3 million new cancer cases and almost 10.0 million cancer deaths occurred in 2020, and the predicted global burden will double to about 29–37 million new cancer cases by 2040, with the greatest increases in low and middle-income countries( 5 ). Gynecological malignancies are prevalent with high global mortality ( 6 ). Gynecologic cancers can develop in several areas of the female reproductive tract, including cervical, ovarian, uterine, vaginal, vulvar, and (very rarely) fallopian tubes ( 7 ). Its prevalence varies from 12.7–13.4% in North America to 31.6–35.0% in sub-Saharan Africa( 8 , 9 ). In the developed world, women with gynecologic cancers have decreased dramatically over the past half-century. It is believed that the advancements in screening techniques, safe surgery and cancer care, chemotherapy, and radiotherapy, are crucial to reducing the prevalence of gynecological cancers. However, these gains have not been realized in low- and middle-income countries (LMICs)( 10 ). Cervical, ovarian, and uterine cancers are among the top seven most common cancers in women, though their relative frequency varies significantly across the countries( 1 , 11 ). Cervical cancer is the second most common cancer in women and the most common of the gynecological cancers, affecting 530,000 women worldwide each year; however, it is now primarily a disease in developing countries, accounting for 87% of all new cases( 11 ). To date, there have been no population-based cancer incidence studies reported from Somalia since there is no national cancer registry system. The present is the first study aimed at evaluating the epidemiological and histopathological characteristics of gynecological cancers at a tertiary hospital (the sole tertiary and referral hospital and the only cancer center) in Somalia. Methods This study reviewed all pathology results obtained from gynecologic patients who underwent various procedures and biopsies at our hospital over seven years, from 1 January 2015 to 31 December 2021. Moreover, we selected histopathologically proven gynecological malignancies by retrieving data from the pathology department's archives in the hospital information system (HIS). All adult patients (i.e., > 18 years) diagnosed with gynecological malignancies were included in this study. Patients whose data or variable of interest was not complete during data collection, patients with benign and borderline gynecological tumors, those without histological diagnoses, and pediatric patients were excluded from this study. Investigated parameters of the patients included epidemiological characteristics such as age, parity (nullipara, para 1, and multipara), marital status, menopausal status (premenopausal and postmenopausal), and clinical presentations. Histopathological findings such as type and stage of gynecological malignancies, and management options, including surgical interventions, were also collected. If more than one organ biopsy was available from the same patient (i.e., biopsies from organs other than female reproductive organs), the sample relevant to gynecology was used. Patients with distant metastasis were evaluated based on clinical manifestations, physical examinations, imaging such as magnetic resonance imaging (MRI) and computed tomography (CT) findings, and surgical intervention. Cervical punch biopsies were performed on all patients suspected of cervical cancer clinically or with an abnormal cervical Pap smear test. Endometrial biopsy was the method of diagnosis of majority of patients with endometrial cancer. All women suspected of Choriocarcinoma and Germ cell tumors had an initial abdominopelvic ultrasound assessment, tumor markers, serum βhCG levels, Alpha-fetoprotein (AFP), serum lactate dehydrogenase (LDH), and radiological imaging such as computed tomography of the chest, abdomen, and brain, and pelvic MRI. Patients with Choriocarcinoma were applied to the FIGO 2000 scoring system for management. Patients with vulvar and vaginal mass had an initial biopsy. The ethical research board committee of Mogadishu Somalia Turkish Training and Research Hospital approved the research (REF. MSTH/10149). In addition, all study participants previously consented to use their medical and surgical data in this study. This study was carried out in accordance with the Helsinki Declaration's contents. The data were analyzed using descriptive univariate analysis, using the Statistical Package for Social Sciences (SPSS v26, IBM, Armonk, NY, USA) software. The frequencies and percentages were reported as point estimates for categorical variables, while quantitative variables, the mean ± (SD), were used whenever possible. Continuous variables were compared using Student's t-test, whereas categorical variables were compared using Pearson's chi-square (χ2) or Fisher's exact test. P value < 0.05 was considered statistically significant. Results Our study reviewed 3163 pathology reports of gynecologic patients; 225 (7.1%) cases had histopathologically confirmed primary gynecological malignancies. All included patients had complete data. Demographic Characteristics Cervical and endometrial cancers were the most common gynecological malignancies in the present study (n = 137 and 42, 61% and 18.6%), respectively. The overall mean patient age was 56.3 ± 10.4 years. There was a statistically significant association between age, body mass index (BMI) and type of gynecological cancers. Patients with vaginal, endometrial, and vulvar cancers had higher mean ages compared to cervical and ovarian cancer patients (p < 0.001). In addition, patients with endometrioid adenocarcinoma had higher body mass index (BMI) exceeding 30 kg/m2 compared with other gynecologic cancer patients (p < 0.001). Approximately more than two-thirds (80.4%) were multipara; 97.8% (n = 134/137) of patients with cervical cancer were multiparous. In contrast, 57.1% of endometrial cancer patients were nulliparous (p = 0.02). Regarding menstrual status, 80.9% (n = 182) of the patients were postmenopausal, while 19.1% (n = 43) were premenopausal. Of 43 women with premenopausal status, 33 had cervical cancer (p = 0.006). Table 1 shows the distribution of gynecological cancers based on patient characteristics. Clinical Manifestations The most common presenting symptoms of patients with cervical cancer were abnormal vaginal bleeding (n = 63, 46%), Posticoital bleeding (n = 37, 27%), and cervical erosion and discharge (n = 24, 17.5%). All patients diagnosed with cervical cancer had no history of cervical screening. Postmenopausal bleeding, abnormal uterine bleeding, and chronic pelvic pain were the most frequent presentations in patients with Corpus uteri cancer. More than half (n = 28, 67%) of patients with Endometrioid adenocarcinoma have been found to have other comorbidities, including diabetic Mellitus (n = 17, 60.7%) and hypertension (n = 11, 39.3%). In addition, 39 (93%) cases of endometrial carcinoma had an initial endometrial biopsy. Three patients with severe cervical stenosis secondary to a history of traditional cervical cauterization did not undergo an initial biopsy. The most common presenting symptoms of patients with ovarian cancer were chronic pelvic pain, pelvic mass, lower abdominal pain, abdominal distension, and urinary complaints. Type And Stage Of Gynecological Cancers Squamous cell carcinoma was the most frequent histologic type of cervical cancer (n = 114, 83.2%), followed by adenocarcinoma (n = 23, 16.8%) (Table 2). More than 85% of these patients presented in the late stages of the disease (stages 3, n = 74, 54%, and stage 4, n = 45, 32.8%). Endometrioid adenocarcinoma (n = 35, 83.3%), Choriocarcinoma (n = 6, 14.3%), and Leiomyosarcoma (n = 1, 2.4%) was the most common uterine corpus carcinomas. Approximately 95% of cases of endometrial carcinoma presented in stages one and two (57.1% and 38.1%, respectively) (Table 3). Regarding ovarian cancer, epithelial tumors were the most predominant histological subtype in 74.3%, followed by Germ cell tumors (n = 6, 17.1%) and Sex cord tumors (n = 3, 8.6%) (Table 4). All valvar cases were squamous cell carcinoma (n = 8, 100%) (Table 5). Management Approach The majority of patients with cervical, vulvar and vaginal cancers presented in the late stages of the disease, and no interventions were proceeded due to the unavailability of oncology centers and limited expertise. Two cervical carcinoma cases with stage 1 disease underwent a simple hysterectomy and bilateral salpingo-oophorectomy. Total abdominal hysterectomy and bilateral salpingo-oophorectomy without pelvic lymphadenectomy were performed in 35/42 patients with endometrial cancer. Four of the six patients with Choriocarcinoma scored seven and more according to the FIGO classification system, required multi-agent chemotherapy, and were sent abroad for further management. The remaining two patients had a FIGO score of less than six, single-agent chemotherapy with methotrexate was started, and monthly follow-up for a year with serum βhCG levels. Their management was successful. Patients with an epithelial type of ovarian cancer (n = 21, 80.8%) underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and peritoneal cytology. The remaining five (19.2%) patients had inoperable tumors at the surgery. In patients with adult granulosa cell tumors (n = 3, 8.6%), two (60 and 50 years old) had a total abdominal hysterectomy with bilateral salpingo-oophorectomy. The remaining patient (35 years old) had a unilateral left salpingo-oophorectomy. Patients with Germ cell tumors (n = 6, 100%) had unilateral salpingo-oophorectomy. Discussion Female genital cancers are prevalent in Africa, with the Sub-Saharan African countries (SSA) representing 22% of all cases( 12 ). This concern is exacerbated by the scarcity of effective care( 13 ). No previous studies have been reported from Somalia regarding the prevalence of gynecological cancers. This study aimed to evaluate the epidemiological and histopathological characteristics of gynecological cancers in a tertiary care hospital in Somalia. Cervical cancer is the fourth most common cancer in women and the fourth leading cause of cancer death, with an estimated 604,000 new cases and 342,000 deaths globally in 2020( 1 ). Around 85% of cervical cancer deaths worldwide occur in developing or underdeveloped countries, and the death rate is 18 times higher in low- and middle-income nations compared to western countries( 14 ). Cervical cancer rates are declining in many industrialized countries due to aggressive screening programs and vaccination campaigns against human papillomaviruses (HPV)( 15 ). According to the World Health Organization (WHO), the incidence of cervical cancer in Somalia ranked second after breast cancer in 2018, with an incidence of 24/per 100,000 and a mortality rate of 21,6/100,000( 4 ). A recent study by Tahtabasi et al. about the distribution of all cancers in Somalia found that cervical cancer was the 2nd most observed after esophageal cancer and the most frequent gynecologic cancer in Somalia ( 4 ). In our study, cervical cancer was the most frequent of all gynecological malignancies during the study period. A systematic review in 10 population-based cancer registries across eight SSA countries, including 21,990 cases of cervical cancer, by Agba et al. examined the incidence of cervical cancer for 10–25 years. These authors found that cervical cancer was leading cancer in half of the countries in SSA and responsible for 21.7% of all cancer deaths in SSA women( 16 ). The higher rate of cervical cancer in SSA, including Somalia, is attributable to the fact that this region has no organized cervical screening and vaccination programs, poor sanitary conditions, multiple partners, high prevalence of sexually transmitted diseases (STDs), high parity, and immune suppression due to malnutrition and Human Immunodeficiency Virus (HIV). In addition, lack of knowledge of the disease, lack of early detection, and effective management of precancerous lesions are also factors to consider ( 3 , 4 , 6 , 8 , 12 , 13 , 17 , 18 ). Cervical cancer, only cancer that is nearly entirely preventable and curable if detected early, primarily affects women in their middle years (30 to 50 years)( 19 ). According to our study, the mean age of women with cervical cancer was 54.9 ± 8.2. Although most cervical cancer patients in the current study presented at the late stage of the disease at an advanced age, we believe that the disease has already started in their middle ages. Our study also found that majority of patients with cervical cancer presented in the late stages of the disease. Similar findings was reported from most of the studies in SSA region including Ethiopia( 9 ), Kenya( 20 , 21 ), Eritrea( 6 ), Ghana( 13 ), Cameroon( 17 ) and Nigeria( 8 , 22 ). This may be due to a lack of cervical cancer screening programs, adequate knowledge of the disease, false sociocultural and religious beliefs, screening costs, and a lack of trained service providers. The rising incidence of cervical cancer and the late presentation in countries in the SSA region is in contrast to developed countries where cervical cancer incidence has declined in recent decades ( 16 , 19 , 23 , 24 ). Ovarian and endometrial malignancies were the second and third most observed gynecological cancers after cervical cancer in Sub-Saharan African countries ( 6 , 9 , 22 , 25 – 30 ). In the present study, endometrial cancer was the second most frequent gynecologic tumor after cervical cancer. Similar studies were reported from Cameroon and Nigeria( 17 , 31 ). Endometrial cancer is the most common gynecological malignancy of the female, and the sixth most common cancer in women, accounting for 417,000 new cases and 97,000 deaths in 2020( 1 , 32 ). Endometrial cancer has historically primarily affected older, postmenopausal women, with an average age at diagnosis of 61 years. Approximately 85% of all incident cases are diagnosed in women over 50, and 95% of cases are diagnosed in women over 40( 33 ). The mean age of the patients in our study was 62.2 ± 8.7 years. A recent study by Lortet et al. about endometrial Cancer incidence from population-based cancer registries in 43 different countries globally from 1978 to 2013 found that within-country incidence was 4 to 20 times higher in postmenopausal women (age 50 years and older) compared with premenopausal women (age 25–49 years)( 34 ). Endometrial biopsy was the main method of diagnosis of endometrial cancer in our setting. This simple diagnosis and early presentation of patients with uterine corpus cancer facilitated the detection of the disease in its early stages. Endometrioid adenocarcinoma is the most common histologic type of uterine corpus cancer ( 6 , 7 , 36 , 37 , 9 , 12 , 25 , 29 – 31 , 34 , 35 ), and this agrees with our study findings. Regarding ovarian cancer, the second most frequent gynecologic malignancy diagnosed in SSA( 6 , 9 , 22 , 26 – 28 , 38 – 41 ), was the third gynecologic cancer in our study. Epithelial tumors were the most frequent histological subtype of ovarian cancer in our study. This finding matches with other studies in the literature( 26 – 28 , 35 , 38 , 40 – 42 ). Managing gynecological cancers in the SSA region, including Somalia, is challenging due to restricted resources and inadequate expertise( 13 , 38 ). Despite the ease with which disease progression can be prevented, most of our cases are presented in advanced stages. Lack of access to cancer screening, the cost of treatment, and the unavailability of oncology centers are all factors to consider. Strength and limitations This study has certain limitations, including, first, it is a retrospective single-center-based study, although our hospital is the sole tertiary and referral hospital and the only cancer center. Second, curative and adjuvant treatments, including chemotherapy and radiotherapy, were not feasible in our country. Third, this study did not provide short and long-term follow-up data due to the patient's socioeconomic status and rural distribution, which limits the periodic follow-up appointments. Besides these limitations, the present is the first report from Somalia regarding the epidemiological and histopathological characteristics of gynecological cancers. We believe that the results from this study are valuable and provide significant contributions to cancer control and prevention in Somalia. Conclusion Cervical carcinoma was the most frequently observed gynecological malignancy during the study period. Most of our patients presented in the late stages of advanced disease. Lack of adequate knowledge of the disease, poor socioeconomic status, limited resources, and inadequate expertise are believed to be the causes of the late presentation of the patients. Since cervical cancer is a preventable disease, national screening and awareness programs are necessary to reduce the burden of cancer and improve the health of women in Somalia. Abbreviations AFP: Alpha-fetoprotein; BMI: Body Mass Index; CT: Computed tomography; HPV: human papillomaviruses; HIV: Human Immunodeficiency Virus; LMICs: low- and middle-income countries; LDH: Lactate dehydrogenase; MRI: Magnetic resonance imaging; STDs: sexually transmitted diseases; SSA: Sub-Saharan Africa; WHO: World Health Organization Declarations Acknowledgments: None. Author contributions : Study concept, design, and interpretation, A.I.H., A.A.O., SH.H.M., I.M.A., H.B.H., and O.B.; drafting of the manuscript, A.I.H., A.A.O., S.H.M., I.M.A., and O.B. All authors read and approved the final manuscript. Funding : The authors declare that this study has not received any funding resources. Availability of data and materials : All data generated or analyzed during this study are included in this published article and are available from the corresponding author upon request. Ethics approval and consent to participate : The ethical research board committee of Mogadishu Somalia Turkish Training and Research Hospital approved the research (REF. MSTH/10149). Informed consent was obtained from all the participants. This study was carried out in accordance with the Helsinki Declaration's contents. Consent for publication : Not applicable. Competing interests : The authors declare no conflict of interest associated with this publication. References Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49. Ott JJ, Ullrich A, Mascarenhas M, Stevens GA. 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Tables Table 1: Distribution of gynecological cancers by demographic features Variable No of patients (225) Cervical (n=137) Endometrial (n=42) Ovarian (n=35) Vulvar (n=8) Vaginal (n=3) p value Age (years) 10-20 21-30 31-40 41-50 51-60 >60 56.3±10.4 2 (0.88%) 4 (1.77%) 2 (0.88%) 52 (23.1%) 89 (39.5%) 76 (33.8) 54.9 ±8.2 0 0 0 49 55 33 62.2 ± 8.7 0 0 2 1 18 21 54.9±16.3 2 4 0 2 11 16 59.3 ±15.7 0 0 0 0 3 5 65.3 ±8.6 0 0 0 0 2 1 <0.001 Parity Nulliparous Para 1 Multipara 27 (12.0%) 17 (7.55%) 181(80.4%) 1 4 134 24 8 10 2 3 30 0 1 5 0 1 2 0.02 Marital status Single Married Divorced 26 (11.6%) 151(67.1%) 48 (21.3%) 4 105 28 16 22 4 5 19 11 1 3 4 0 2 1 0.34 Menstrual status Premenopausal postmenopausal 43 (19.1%) 182 (80.9%) 33 104 4 38 6 29 0 8 0 3 0.006 Table 2: Histopathological classification of cervical cancer Table 3: Histopathological features of endometrial cancer Table 4: Histopathological classification of ovarian cancer Table 5: Histopathological classification of Vaginal and Vulvar cancers Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2335131","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":159624330,"identity":"e385934a-1140-4146-af03-00f829abdd76","order_by":0,"name":"Ahmed Issak Hussein","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYDCCA2BSgoeNvQFIG1gQqyXBQo6fB8QykCBaS4Wx5IwEsHWEdfAdP/zww88fEokbbj6/uuFHgQQDf3t3Al4tkmfSjCV7EoBabueU3ewBOkzizNkNeLUYHEgwY+CBaEm7wQPUYiCRS0DL+effGP+AtNw8k3bzD1FabuSYMQNtAXqf/dhtomyRvPGmWFomTQIYyDlst2UMJHgI+oXvfPrGj29s6oBRefzZzTd/bOT423vxa0ECPAZgkljlIMD+gBTVo2AUjIJRMIIAAMpISjD8VFAXAAAAAElFTkSuQmCC","orcid":"","institution":"Mogadishu Somalia Turkish Training and Research Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"Issak","lastName":"Hussein","suffix":""},{"id":159624331,"identity":"5a5a958e-aa65-472f-b9f6-9f41f5104065","order_by":1,"name":"Abdikarim Ali Omar","email":"","orcid":"","institution":"Mogadishu Somalia Turkish Training and Research Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abdikarim","middleName":"Ali","lastName":"Omar","suffix":""},{"id":159624332,"identity":"539dc452-c772-4d5a-9e38-536eb5e746b3","order_by":2,"name":"Hiba Bashir Hassan","email":"","orcid":"","institution":"Mogadishu Somalia Turkish Training and Research Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hiba","middleName":"Bashir","lastName":"Hassan","suffix":""},{"id":159624334,"identity":"319f1c80-b0a2-4b2e-9150-6d53e2b81b8c","order_by":3,"name":"Ismail Mohamud Abdullahi","email":"","orcid":"","institution":"Mogadishu Somalia Turkish Training and Research Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ismail","middleName":"Mohamud","lastName":"Abdullahi","suffix":""},{"id":159624336,"identity":"de0864e9-f77f-45f9-88fe-4116c863e9a9","order_by":4,"name":"Shamsa Hussein Mohamed","email":"","orcid":"","institution":"Mogadishu Somalia Turkish Training and Research Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shamsa","middleName":"Hussein","lastName":"Mohamed","suffix":""},{"id":159624338,"identity":"0aba70bf-e9b6-4b46-89fe-6bd9af7d3853","order_by":5,"name":"Ozer Birge","email":"","orcid":"","institution":"Mogadishu Somalia Turkish Training, and Research Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ozer","middleName":"","lastName":"Birge","suffix":""}],"badges":[],"createdAt":"2022-12-01 20:59:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2335131/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2335131/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":37359034,"identity":"677dab67-48c3-4504-8042-99a45ab57bab","added_by":"auto","created_at":"2023-05-23 05:29:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":363876,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2335131/v1/e99e26f7-d2fb-4db5-8702-5b7223f3c3fb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiological and Histopathological Characteristics of Gynecological Cancers in Somalia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCancer is a leading cause of death and a significant impediment to increasing life expectancy in every country(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Cancer is expected to increase globally due to population growth and aging, especially in developing countries, where 82% of the global population lives(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Worldwide, an estimated 19.3\u0026nbsp;million new cancer cases and almost 10.0\u0026nbsp;million cancer deaths occurred in 2020, and the predicted global burden will double to about 29\u0026ndash;37\u0026nbsp;million new cancer cases by 2040, with the greatest increases in low and middle-income countries(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGynecological malignancies are prevalent with high global mortality (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Gynecologic cancers can develop in several areas of the female reproductive tract, including cervical, ovarian, uterine, vaginal, vulvar, and (very rarely) fallopian tubes (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Its prevalence varies from 12.7\u0026ndash;13.4% in North America to 31.6\u0026ndash;35.0% in sub-Saharan Africa(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In the developed world, women with gynecologic cancers have decreased dramatically over the past half-century. It is believed that the advancements in screening techniques, safe surgery and cancer care, chemotherapy, and radiotherapy, are crucial to reducing the prevalence of gynecological cancers. However, these gains have not been realized in low- and middle-income countries (LMICs)(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCervical, ovarian, and uterine cancers are among the top seven most common cancers in women, though their relative frequency varies significantly across the countries(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Cervical cancer is the second most common cancer in women and the most common of the gynecological cancers, affecting 530,000 women worldwide each year; however, it is now primarily a disease in developing countries, accounting for 87% of all new cases(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo date, there have been no population-based cancer incidence studies reported from Somalia since there is no national cancer registry system.\u003c/p\u003e \u003cp\u003eThe present is the first study aimed at evaluating the epidemiological and histopathological characteristics of gynecological cancers at a tertiary hospital (the sole tertiary and referral hospital and the only cancer center) in Somalia.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e This study reviewed all pathology results obtained from gynecologic patients who underwent various procedures and biopsies at our hospital over seven years, from 1 January 2015 to 31 December 2021. Moreover, we selected histopathologically proven gynecological malignancies by retrieving data from the pathology department's archives in the hospital information system (HIS). All adult patients (i.e., \u0026gt;\u0026thinsp;18 years) diagnosed with gynecological malignancies were included in this study. Patients whose data or variable of interest was not complete during data collection, patients with benign and borderline gynecological tumors, those without histological diagnoses, and pediatric patients were excluded from this study.\u003c/p\u003e \u003cp\u003eInvestigated parameters of the patients included epidemiological characteristics such as age, parity (nullipara, para 1, and multipara), marital status, menopausal status (premenopausal and postmenopausal), and clinical presentations. Histopathological findings such as type and stage of gynecological malignancies, and management options, including surgical interventions, were also collected.\u003c/p\u003e \u003cp\u003eIf more than one organ biopsy was available from the same patient (i.e., biopsies from organs other than female reproductive organs), the sample relevant to gynecology was used. Patients with distant metastasis were evaluated based on clinical manifestations, physical examinations, imaging such as magnetic resonance imaging (MRI) and computed tomography (CT) findings, and surgical intervention.\u003c/p\u003e \u003cp\u003eCervical punch biopsies were performed on all patients suspected of cervical cancer clinically or with an abnormal cervical Pap smear test. Endometrial biopsy was the method of diagnosis of majority of patients with endometrial cancer. All women suspected of Choriocarcinoma and Germ cell tumors had an initial abdominopelvic ultrasound assessment, tumor markers, serum βhCG levels, Alpha-fetoprotein (AFP), serum lactate dehydrogenase (LDH), and radiological imaging such as computed tomography of the chest, abdomen, and brain, and pelvic MRI. Patients with Choriocarcinoma were applied to the FIGO 2000 scoring system for management. Patients with vulvar and vaginal mass had an initial biopsy.\u003c/p\u003e \u003cp\u003eThe ethical research board committee of Mogadishu Somalia Turkish Training and Research Hospital approved the research (REF. MSTH/10149). In addition, all study participants previously consented to use their medical and surgical data in this study. This study was carried out in accordance with the Helsinki Declaration's contents.\u003c/p\u003e \u003cp\u003eThe data were analyzed using descriptive univariate analysis, using the Statistical Package for Social Sciences (SPSS v26, IBM, Armonk, NY, USA) software. The frequencies and percentages were reported as point estimates for categorical variables, while quantitative variables, the mean \u0026plusmn; (SD), were used whenever possible. Continuous variables were compared using Student's t-test, whereas categorical variables were compared using Pearson's chi-square (χ2) or Fisher's exact test. P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOur study reviewed 3163 pathology reports of gynecologic patients; 225 (7.1%) cases had histopathologically confirmed primary gynecological malignancies. All included patients had complete data.\u003c/p\u003e\n\u003ch3\u003eDemographic Characteristics\u003c/h3\u003e\n\u003cp\u003eCervical and endometrial cancers were the most common gynecological malignancies in the present study (n\u0026thinsp;=\u0026thinsp;137 and 42, 61% and 18.6%), respectively. The overall mean patient age was 56.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4 years. There was a statistically significant association between age, body mass index (BMI) and type of gynecological cancers. Patients with vaginal, endometrial, and vulvar cancers had higher mean ages compared to cervical and ovarian cancer patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In addition, patients with endometrioid adenocarcinoma had higher body mass index (BMI) exceeding 30 kg/m2 compared with other gynecologic cancer patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Approximately more than two-thirds (80.4%) were multipara; 97.8% (n\u0026thinsp;=\u0026thinsp;134/137) of patients with cervical cancer were multiparous. In contrast, 57.1% of endometrial cancer patients were nulliparous (p\u0026thinsp;=\u0026thinsp;0.02). Regarding menstrual status, 80.9% (n\u0026thinsp;=\u0026thinsp;182) of the patients were postmenopausal, while 19.1% (n\u0026thinsp;=\u0026thinsp;43) were premenopausal. Of 43 women with premenopausal status, 33 had cervical cancer (p\u0026thinsp;=\u0026thinsp;0.006). Table\u0026nbsp;1 shows the distribution of gynecological cancers based on patient characteristics.\u003c/p\u003e\n\u003ch3\u003eClinical Manifestations\u003c/h3\u003e\n\u003cp\u003eThe most common presenting symptoms of patients with cervical cancer were abnormal vaginal bleeding (n\u0026thinsp;=\u0026thinsp;63, 46%), Posticoital bleeding (n\u0026thinsp;=\u0026thinsp;37, 27%), and cervical erosion and discharge (n\u0026thinsp;=\u0026thinsp;24, 17.5%). All patients diagnosed with cervical cancer had no history of cervical screening. Postmenopausal bleeding, abnormal uterine bleeding, and chronic pelvic pain were the most frequent presentations in patients with Corpus uteri cancer. More than half (n\u0026thinsp;=\u0026thinsp;28, 67%) of patients with Endometrioid adenocarcinoma have been found to have other comorbidities, including diabetic Mellitus (n\u0026thinsp;=\u0026thinsp;17, 60.7%) and hypertension (n\u0026thinsp;=\u0026thinsp;11, 39.3%). In addition, 39 (93%) cases of endometrial carcinoma had an initial endometrial biopsy. Three patients with severe cervical stenosis secondary to a history of traditional cervical cauterization did not undergo an initial biopsy. The most common presenting symptoms of patients with ovarian cancer were chronic pelvic pain, pelvic mass, lower abdominal pain, abdominal distension, and urinary complaints.\u003c/p\u003e\n\u003ch3\u003eType And Stage Of Gynecological Cancers\u003c/h3\u003e\n\u003cp\u003eSquamous cell carcinoma was the most frequent histologic type of cervical cancer (n\u0026thinsp;=\u0026thinsp;114, 83.2%), followed by adenocarcinoma (n\u0026thinsp;=\u0026thinsp;23, 16.8%) (Table\u0026nbsp;2). More than 85% of these patients presented in the late stages of the disease (stages 3, n\u0026thinsp;=\u0026thinsp;74, 54%, and stage 4, n\u0026thinsp;=\u0026thinsp;45, 32.8%). Endometrioid adenocarcinoma (n\u0026thinsp;=\u0026thinsp;35, 83.3%), Choriocarcinoma (n\u0026thinsp;=\u0026thinsp;6, 14.3%), and Leiomyosarcoma (n\u0026thinsp;=\u0026thinsp;1, 2.4%) was the most common uterine corpus carcinomas. Approximately 95% of cases of endometrial carcinoma presented in stages one and two (57.1% and 38.1%, respectively) (Table\u0026nbsp;3). Regarding ovarian cancer, epithelial tumors were the most predominant histological subtype in 74.3%, followed by Germ cell tumors (n\u0026thinsp;=\u0026thinsp;6, 17.1%) and Sex cord tumors (n\u0026thinsp;=\u0026thinsp;3, 8.6%) (Table\u0026nbsp;4). All valvar cases were squamous cell carcinoma (n\u0026thinsp;=\u0026thinsp;8, 100%) (Table\u0026nbsp;5).\u003c/p\u003e\n\u003ch3\u003eManagement Approach\u003c/h3\u003e\n\u003cp\u003eThe majority of patients with cervical, vulvar and vaginal cancers presented in the late stages of the disease, and no interventions were proceeded due to the unavailability of oncology centers and limited expertise. Two cervical carcinoma cases with stage 1 disease underwent a simple hysterectomy and bilateral salpingo-oophorectomy.\u003c/p\u003e\n\u003cp\u003eTotal abdominal hysterectomy and bilateral salpingo-oophorectomy without pelvic lymphadenectomy were performed in 35/42 patients with endometrial cancer. Four of the six patients with Choriocarcinoma scored seven and more according to the FIGO classification system, required multi-agent chemotherapy, and were sent abroad for further management. The remaining two patients had a FIGO score of less than six, single-agent chemotherapy with methotrexate was started, and monthly follow-up for a year with serum \u0026beta;hCG levels. Their management was successful.\u003c/p\u003e\n\u003cp\u003ePatients with an epithelial type of ovarian cancer (n\u0026thinsp;=\u0026thinsp;21, 80.8%) underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and peritoneal cytology. The remaining five (19.2%) patients had inoperable tumors at the surgery. In patients with adult granulosa cell tumors (n\u0026thinsp;=\u0026thinsp;3, 8.6%), two (60 and 50 years old) had a total abdominal hysterectomy with bilateral salpingo-oophorectomy. The remaining patient (35 years old) had a unilateral left salpingo-oophorectomy. Patients with Germ cell tumors (n\u0026thinsp;=\u0026thinsp;6, 100%) had unilateral salpingo-oophorectomy.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFemale genital cancers are prevalent in Africa, with the Sub-Saharan African countries (SSA) representing 22% of all cases(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). This concern is exacerbated by the scarcity of effective care(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). No previous studies have been reported from Somalia regarding the prevalence of gynecological cancers. This study aimed to evaluate the epidemiological and histopathological characteristics of gynecological cancers in a tertiary care hospital in Somalia.\u003c/p\u003e \u003cp\u003eCervical cancer is the fourth most common cancer in women and the fourth leading cause of cancer death, with an estimated 604,000 new cases and 342,000 deaths globally in 2020(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Around 85% of cervical cancer deaths worldwide occur in developing or underdeveloped countries, and the death rate is 18 times higher in low- and middle-income nations compared to western countries(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Cervical cancer rates are declining in many industrialized countries due to aggressive screening programs and vaccination campaigns against human papillomaviruses (HPV)(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). According to the World Health Organization (WHO), the incidence of cervical cancer in Somalia ranked second after breast cancer in 2018, with an incidence of 24/per 100,000 and a mortality rate of 21,6/100,000(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA recent study by Tahtabasi et al. about the distribution of all cancers in Somalia found that cervical cancer was the 2nd most observed after esophageal cancer and the most frequent gynecologic cancer in Somalia (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In our study, cervical cancer was the most frequent of all gynecological malignancies during the study period. A systematic review in 10 population-based cancer registries across eight SSA countries, including 21,990 cases of cervical cancer, by Agba et al. examined the incidence of cervical cancer for 10\u0026ndash;25 years. These authors found that cervical cancer was leading cancer in half of the countries in SSA and responsible for 21.7% of all cancer deaths in SSA women(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The higher rate of cervical cancer in SSA, including Somalia, is attributable to the fact that this region has no organized cervical screening and vaccination programs, poor sanitary conditions, multiple partners, high prevalence of sexually transmitted diseases (STDs), high parity, and immune suppression due to malnutrition and Human Immunodeficiency Virus (HIV). In addition, lack of knowledge of the disease, lack of early detection, and effective management of precancerous lesions are also factors to consider (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCervical cancer, only cancer that is nearly entirely preventable and curable if detected early, primarily affects women in their middle years (30 to 50 years)(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). According to our study, the mean age of women with cervical cancer was 54.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2. Although most cervical cancer patients in the current study presented at the late stage of the disease at an advanced age, we believe that the disease has already started in their middle ages.\u003c/p\u003e \u003cp\u003eOur study also found that majority of patients with cervical cancer presented in the late stages of the disease. Similar findings was reported from most of the studies in SSA region including Ethiopia(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), Kenya(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), Eritrea(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), Ghana(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), Cameroon(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and Nigeria(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This may be due to a lack of cervical cancer screening programs, adequate knowledge of the disease, false sociocultural and religious beliefs, screening costs, and a lack of trained service providers. The rising incidence of cervical cancer and the late presentation in countries in the SSA region is in contrast to developed countries where cervical cancer incidence has declined in recent decades (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOvarian and endometrial malignancies were the second and third most observed gynecological cancers after cervical cancer in Sub-Saharan African countries (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan additionalcitationids=\"CR26 CR27 CR28 CR29\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In the present study, endometrial cancer was the second most frequent gynecologic tumor after cervical cancer. Similar studies were reported from Cameroon and Nigeria(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Endometrial cancer is the most common gynecological malignancy of the female, and the sixth most common cancer in women, accounting for 417,000 new cases and 97,000 deaths in 2020(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEndometrial cancer has historically primarily affected older, postmenopausal women, with an average age at diagnosis of 61 years. Approximately 85% of all incident cases are diagnosed in women over 50, and 95% of cases are diagnosed in women over 40(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The mean age of the patients in our study was 62.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7 years. A recent study by Lortet et al. about endometrial Cancer incidence from population-based cancer registries in 43 different countries globally from 1978 to 2013 found that within-country incidence was 4 to 20 times higher in postmenopausal women (age 50 years and older) compared with premenopausal women (age 25\u0026ndash;49 years)(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEndometrial biopsy was the main method of diagnosis of endometrial cancer in our setting. This simple diagnosis and early presentation of patients with uterine corpus cancer facilitated the detection of the disease in its early stages. Endometrioid adenocarcinoma is the most common histologic type of uterine corpus cancer (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), and this agrees with our study findings.\u003c/p\u003e \u003cp\u003eRegarding ovarian cancer, the second most frequent gynecologic malignancy diagnosed in SSA(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan additionalcitationids=\"CR39 CR40\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), was the third gynecologic cancer in our study. Epithelial tumors were the most frequent histological subtype of ovarian cancer in our study. This finding matches with other studies in the literature(\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eManaging gynecological cancers in the SSA region, including Somalia, is challenging due to restricted resources and inadequate expertise(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Despite the ease with which disease progression can be prevented, most of our cases are presented in advanced stages. Lack of access to cancer screening, the cost of treatment, and the unavailability of oncology centers are all factors to consider. Strength and limitations\u003c/p\u003e \u003cp\u003eThis study has certain limitations, including, first, it is a retrospective single-center-based study, although our hospital is the sole tertiary and referral hospital and the only cancer center. Second, curative and adjuvant treatments, including chemotherapy and radiotherapy, were not feasible in our country. Third, this study did not provide short and long-term follow-up data due to the patient's socioeconomic status and rural distribution, which limits the periodic follow-up appointments. Besides these limitations, the present is the first report from Somalia regarding the epidemiological and histopathological characteristics of gynecological cancers. We believe that the results from this study are valuable and provide significant contributions to cancer control and prevention in Somalia.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCervical carcinoma was the most frequently observed gynecological malignancy during the study period. Most of our patients presented in the late stages of advanced disease. Lack of adequate knowledge of the disease, poor socioeconomic status, limited resources, and inadequate expertise are believed to be the causes of the late presentation of the patients. Since cervical cancer is a preventable disease, national screening and awareness programs are necessary to reduce the burden of cancer and improve the health of women in Somalia.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAFP: Alpha-fetoprotein; BMI: Body Mass Index; CT: Computed tomography; HPV: human papillomaviruses; HIV: Human Immunodeficiency Virus; LMICs: low- and middle-income countries; LDH: Lactate dehydrogenase; MRI: Magnetic resonance imaging; STDs: sexually transmitted diseases; SSA: Sub-Saharan Africa; WHO: World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments: None.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e: Study concept, design, and interpretation, A.I.H., A.A.O., SH.H.M., I.M.A., H.B.H., and O.B.; drafting of the manuscript, A.I.H., A.A.O., S.H.M., I.M.A., and O.B. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: The authors declare that this study has not received any funding resources.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: All data generated or analyzed during this study are included in this published article and are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: The ethical research board committee of Mogadishu Somalia Turkish Training and Research Hospital approved the research (REF. MSTH/10149). Informed consent was obtained from all the participants. This study was carried out in accordance with the Helsinki Declaration\u0026apos;s contents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare no conflict of interest associated with this publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOtt JJ, Ullrich A, Mascarenhas M, Stevens GA. Global cancer incidence and mortality caused by behavior and infection. 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Avicenna J Clin Med. 2021;28(1):42\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Distribution of gynecological cancers by demographic features\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"726\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.355371900826448%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.702479338842975%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo of patients\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(225)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCervical\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(n=137)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.049586776859504%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEndometrial\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(n=42)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOvarian\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(n=35)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.570247933884298%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVulvar\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(n=8)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVaginal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(n=3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.090909090909092%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.355371900826448%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e10-20\u003c/p\u003e\n \u003cp\u003e21-30\u003c/p\u003e\n \u003cp\u003e31-40\u003c/p\u003e\n \u003cp\u003e41-50\u003c/p\u003e\n \u003cp\u003e51-60\u003c/p\u003e\n \u003cp\u003e\u0026gt;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.702479338842975%\"\u003e\n \u003cp\u003e56.3\u0026plusmn;10.4\u003c/p\u003e\n \u003cp\u003e2 (0.88%)\u003c/p\u003e\n \u003cp\u003e4 (1.77%)\u003c/p\u003e\n \u003cp\u003e2 (0.88%)\u003c/p\u003e\n \u003cp\u003e52 (23.1%)\u003c/p\u003e\n \u003cp\u003e89 (39.5%)\u003c/p\u003e\n \u003cp\u003e76 (33.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e54.9 \u0026plusmn;8.2\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.049586776859504%\"\u003e\n \u003cp\u003e62.2 \u0026plusmn; 8.7\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e54.9\u0026plusmn;16.3\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.570247933884298%\"\u003e\n \u003cp\u003e59.3 \u0026plusmn;15.7\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e65.3 \u0026plusmn;8.6\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.090909090909092%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.355371900826448%\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNulliparous\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePara 1\u003c/p\u003e\n \u003cp\u003eMultipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.702479338842975%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27 (12.0%)\u003c/p\u003e\n \u003cp\u003e17 (7.55%)\u003c/p\u003e\n \u003cp\u003e181(80.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.049586776859504%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.570247933884298%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.355371900826448%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eDivorced\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.702479338842975%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e26 (11.6%)\u003c/p\u003e\n \u003cp\u003e151(67.1%)\u003c/p\u003e\n \u003cp\u003e48 (21.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.049586776859504%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.570247933884298%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"17.355371900826448%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMenstrual status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePremenopausal\u0026nbsp;\u003c/p\u003e\n \u003cp\u003epostmenopausal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.702479338842975%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e43 (19.1%)\u003c/p\u003e\n \u003cp\u003e182 (80.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.049586776859504%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.570247933884298%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.743801652892563%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Histopathological classification of cervical cancer\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\" style=\"width: 576px; height: 340.253px;\" width=\"576\" height=\"340.253\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Histopathological features of endometrial cancer\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\" style=\"width: 582px; height: 355.829px;\" width=\"582\" height=\"355.829\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Histopathological classification of ovarian cancer\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\" style=\"width: 535px; height: 607.542px;\" width=\"535\" height=\"607.542\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u003c/strong\u003e Histopathological classification of Vaginal and Vulvar cancers\u003c/p\u003e\n\u003cp\u003e\u003cimg 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cervical cancer, Screening, Sub-Saharan Africa","lastPublishedDoi":"10.21203/rs.3.rs-2335131/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2335131/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Gynecological malignancies are prevalent, with a high mortality rate. The present is the first report from Somalia regarding the epidemiological and histopathological characteristics of gynecological cancers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This study reviewed all pathology results obtained from gynecologic patients who underwent various procedures and biopsies over seven years. The investigated parameters were sociodemographic features, histopathological characteristics, and management options, including surgical interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The prevalence of gynecological cancers in our study was 7.1%. Among 225 cases with histopathologically confirmed primary gynecological malignancies, cervical and endometrial cancers were the most common (n= 137 and 42, 61% and 18.6%), respectively. Squamous cell carcinoma was the most common histologic type in cervical, vaginal and vulvar cancers. All patients diagnosed with cervical cancer had no history of cervical screening. Approximately 70% of the patients presented in the late stages of the disease. More than half (n=28, 67%) of patients with Endometrioid adenocarcinoma have been found to have other comorbidities, including diabetic Mellitus (n=17, 60.7%) and hypertension (n=11, 39.3%). Total abdominal hysterectomy and bilateral salpingo-oophorectomy without pelvic lymphadenectomy were performed in 35/42 patients with endometrial cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eCervical carcinoma was the most frequently observed gynecological malignancy during the study period. Majority of our patients presented in the late stages of advanced disease. Lack of adequate knowledge of the disease, poor socioeconomic status, limited resources, and inadequate expertise is believed to be the causes of the late presentation of the patients. Since cervical cancer is a preventable disease, national screening and awareness programs are necessary to reduce the burden of cancer and improve women's health in Somalia.\u003c/p\u003e","manuscriptTitle":"Epidemiological and Histopathological Characteristics of Gynecological Cancers in Somalia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-12-16 20:32:06","doi":"10.21203/rs.3.rs-2335131/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7fb2a37c-57a0-437f-85be-938dec8ccd87","owner":[],"postedDate":"December 16th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-05-23T05:29:18+00:00","versionOfRecord":[],"versionCreatedAt":"2022-12-16 20:32:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2335131","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2335131","identity":"rs-2335131","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}