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Introduction
Head and neck squamous cell carcinoma is the seventh most frequent type of cancer in the world, but its prevalence in African countries is about two-to four-folds higher than the developed countries. Despite improved surgical technique, chemotherapeutic and radiation intervention, the mean five-year survival remains one of the lowest a...
Contexts in source publication
Context 1
... did not differ significantly between men (53.98 ± 15.79) and women (56.01 ± 16.94) (t = 0.906; p = 0.37). The age distribution of the patients is shown in Table 1. Of the 159 patients whose history on smoking was obtained, 66% confessed to the habit. ...
Context 2
... this sample is consistent with the expected patterns for mean age 58.87 ± 16.29. As shown in Table 1 and 3, the peak age group was 51-60 closely followed by 41-50. Forty years and below age group contributed 17%, which closely approximates with findings from Zimbabwe and Nigeria, but is higher than that reported from north India and lower compared to that of Hajja Yemen (P > 0.05). ...
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Background:
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Citations
... Therefore, the reducing cancer morbidity and mortality rate in the most affected developing countries remains a priority (Miranda-Filho and Bray, 2020). In general, the methods available for preventing, detecting and treating of these cancers are ineffective in reducing their high incidence and mortality rates (Kakande and Kamulegeya, 2010). This justifies the need for the study to better understand the epidemiological profiles of OCCs in Senegal. ...
... The commonest histological type is squamous cell carcinoma (SCC) accounting for more than 90% of HNC [2]. Globally and locally, more than half of these cancers arise from the oral cavity/ oropharynx [1,3]. ...
Background:
Cancer burden in sub-Saharan Africa is on the rise with one-third of cancers estimated to be caused by infectious agents. Head and neck squamous cell cancer (HNSCC) is the sixth most common malignancy in sub-Saharan Africa and includes tumors in the Upper Aero-digestive Tract (UADT). The established risk factors are tobacco and alcohol exposure with a recent recognition of the role of Human Papilloma Virus (HPV). The HPV related HNC is seen predominantly in the oropharynx, presents at a younger age and has a better prognosis. With a rapidly increasing incidence of these cancers in the developed world, it was important to study HPV in HNC in Uganda. The HPV can be detected using P16 immunohistochemistry as a surrogate marker thus making it suitable for screening. The study aimed at establishing the presence of HPV and the commonly affected sites in UADT squamous cell carcinoma (SCC) at Uganda Cancer Institute (UCI) using P16 immunohistochemistry.
Methodology:
This was a cross sectional study in which 59 patients with histologically proven SCC from the oral cavity, oropharynx, larynx and hypopharynx were recruited. These patients' demographics and clinical data were collected. Tissue sections from retrieved histology samples were stained by Haematoxylin and Eosin to reconfirm SCC. Subsequently, P16 expression was determined using P16 immunohistochemistry.
Results:
Seventy-one patients were enrolled and 59 patients with confirmed SCC of the sites of interest were analyzed. The majority (79.7%) of the participants were male and over 50 years. 59.3% were tobacco smokers, 66.1% used alcohol, 52.2% used both. Only 27.1% used none of the substances. Only 27.1% of the participants were HIV positive. Most of the tumors were in the larynx (37.3%) and 64.4% were overall TNM stage 4. The overall prevalence of HPV in UADT SCC at UCI was 20.3, 95%CI 10.9-32.8. The oropharynx had the highest prevalence (30.8%).
Conclusion:
The prevalence of HPV in UADT SCC at UCI is significant at 20.3%. The most affected site, is the oropharynx. Vigilant HPV screening of these sites with confirmation where possible is recommended.
... Additionally, disparities in survival have been reported on the basis of ethnicity, income levels and developed versus developing countries [3,4]. In Uganda, patients with head and neck cancers have been shown to report with advanced stages of the disease, further disadvantaging their outcomes [5]. ...
Introduction: Despite the fact that treatment for oral cancer has greatly improved over the last two
... This was consistent with other studies [21] but different from others [9,11,14]. The possibility of misclassification of original OSCC site is high given the complex anatomy of the oral cavity coupled with delayed presentation seen among our patients [22]. In advanced stages, there could be an overlap of oral tumours that arise from adjacent structures leading to misclassification. ...
... The differences in survival by tumour site could arise from the ease of early diagnosis, accessibility for excision of the tumour with sufficient surgical margin and the different lymph node involvement that each site presents. However, given the previously reported late presentation among our patients [22], tongue carcinomas may progress into the floor of the mouth making it hard to know the original site. In addition, some anatomic sites manifest greater metastatic capacity due to high lymphatic drainage [17]. ...
Background
Despite improvements in diagnosis and patient management, survival and prognostic factors of patients with oral squamous cell carcinoma (OSCC) remains largely unknown in most of Sub Saharan Africa.
Objective
To establish survival and associated factors among patients with oral squamous cell carcinoma treated at Mulago Hospital Complex, Kampala.
Methods
We conducted a retrospective cohort study among histologically confirmed oral squamous cell carcinoma (OSCC) patients seen at our centre from January 1st 2002 to December 31st 2011. Survival was analysed using Kaplan-Meier method and comparison between associated variables made using Log rank-test. Cox proportional hazards model was used to determine independent predictors of survival. P-values of less than 0.05 were considered statistically significant.
Results
A total of 384 patients (229 males and 155 females) were included in this analysis. The overall mean age was 55.2 (SD 4.1) years. The 384 patients studied contributed a total of 399.17 person-years of follow-up. 111 deaths were observed, giving an overall death rate of 27.81 per 100 person-years [95% CI; 22.97–32.65]. The two-year and five-year survival rates were 43.6% (135/384) and 20.7% (50/384), respectively. Tumours arising from the lip had the best five-year survival rate (100%), while tumours arising from the floor of the mouth, alveolus and the gingiva had the worst prognosis with five-year survival rates of 0%, 0% and 15.9%, respectively. Independent predictors of survival were clinical stage (p = 0.001), poorly differentiated histo-pathological grade (p < 0.001), male gender (p = 0.001), age > 55 years at time of diagnosis (p = 0.02) and moderately differentiated histo-pathological grade (p = 0.027). However, tobacco & alcohol consumption, tumour location and treatment group were not associated with survival (p > 0.05).
Conclusions
The five-year survival rate of OSCC was poor at 20.7%. Male gender, late clinical stage at presentation, poor histo-pathological types and advanced age were independent prognostic factors of survival. Early detection through screening and prompt treatment could improve survival.
... A report from Kampala covering the time frame 2004 to 2009 reported that 219 patients had HNSCC, of which 56.2% had lymph node involvement and 6.8% had distant metastases at diagnosis. 12,13 We aimed to describe the characteristics and stages of patients with HNSCC and document their prognosis from clinical experience in a rural setting in western Uganda. ...
Objectives
Patients with head and neck squamous cell carcinoma (HNSCC) have symptoms that masquerade as benign conditions, resulting in late presentations. The objective is to describe characteristics and stages of patients with HNSCC and document their prognosis from clinical experience in western Uganda.
Study Design
Cross-sectional study with clinical follow-up.
Setting
Mbarara Regional Referral Hospital.
Subjects and Methods
Fifty-one participants were recruited from February to July 2016. A questionnaire was used for patient characteristics, and staging, serologic studies, biopsy for histopathology, and immunohistochemistry were investigated. Staging was subclassified as early (stage I and II) and late (stage III and IV). Analysis was done with Fisher’s exact test.
Results
Of 51 participants, 44 (86.5%) were male; the group had a mean age of 57.7 years, and 41 (80.1%) presented with late stage. Of 10 participants who presented with early stage, 6 (60%) had laryngeal HNSCC. The pharynx was ranked as the highest subsite (n = 19, 37.3%), followed by the oral cavity (n = 9, 17.6%), the larynx (n = 9, 17.6%), an unknown primary (n = 8, 15.7%), and sinonasal area (n = 6, 11.8%). Tobacco smoking, alcohol consumption, and prior use of traditional remedy were common characteristics among participants. Moderate differentiation was the most common grade (n = 23, 45.1%). Helicobacter pylori, Epstein-Barr virus, human immunodeficiency virus, and human papilloma virus type 16 were identified among 51 participants. However, none could afford referral for radiotherapy; hence, 1-year survival was 4%.
Conclusion
The majority of our patients with HNSCC present at late stage, and the prognosis is poor. There is great need for preventative community-based education and early screening services to save our population.
... In this study, 51 (28.8%) of the total cases were 51-60 years of age, followed by 40-50 year age group at 23.7%. This is similar to an earlier study done in Uganda so no change in age distribution [25]. As expected due to matching on age and gender, there was neither statistically significant difference between male and female distribution nor between HIV positive and negative patients as per age groups (P=0.09 ...
... χ 2 10.7 df 6) (p=0.97 χ 2 =1.23 df 6) respectively. The combined male to female ratio was 1.7:1 in contrast with 1.3:1 in an earlier study [25] but close to what was reported from Egypt [26]. However, the ratio is lower than what has been reported from most developed countries [27]. ...
Increased availability of highly active anti-retroviral therapy (HAART) has led to a change in the spectrum of
neoplastic diseases affecting people living with HIV. Some cancers such as invasive cervical carcinoma and anal cancers have
not changed or instead risen while others such as Kaporsi’s sarcoma have seen a sharp decline. The aim of this study was to
compare clinical findings at presentation between HIV positive and Negative patients with head and neck cancers using a
retrospective case control design. The study was done at the Uganda cancer Institute by performing a manual match of records
in the head and neck cancer database at a ratio of 1:2 cases: controls. The matching was done on the age group, gender and
diagnosis. Clinical and demographic characteristics between HIV positive and HIV negative head and neck cancer patients
were compared using chi square and a multinomial model including ECOG performance score, stage, grade and duration group
was run. In the multinomial regression only duration group was significant with the HIV positive patients being more likely to
present after a longer duration of the symptoms than HIV negative patients (OR=0.42 CI 0.20-0.86 p=0.02). The data does not
show statistically significant difference between HIV positive and HIV negative head and neck cancer patients in terms of
presentation at time of diagnosis except for duration of symptoms group. This study clearly demonstrates the need for more
research on head and neck cancer in Africa in the context of HIV/AIDS, since the reasons for the high HIV prevalence among
this cohort of patients hasn’t been established.
... In this study, 51 (28.8%) of the total cases were 51-60 years of age, followed by 40-50 year age group at 23.7%. This is similar to an earlier study done in Uganda so no change in age distribution [25]. As expected due to matching on age and gender, there was neither statistically significant difference between male and female distribution nor between HIV positive and negative patients as per age groups (P=0.09 ...
... χ 2 10.7 df 6) (p=0.97 χ 2 =1.23 df 6) respectively. The combined male to female ratio was 1.7:1 in contrast with 1.3:1 in an earlier study [25] but close to what was reported from Egypt [26]. However, the ratio is lower than what has been reported from most developed countries [27]. ...
Increased availability of highly active anti-retroviral therapy (HAART) has led to a change in the spectrum of
neoplastic diseases affecting people living with HIV. Some cancers such as invasive cervical carcinoma and anal cancers have
not changed or instead risen while others such as Kaporsi’s sarcoma have seen a sharp decline. The aim of this study was to
compare clinical findings at presentation between HIV positive and Negative patients with head and neck cancers using a
retrospective case control design. The study was done at the Uganda cancer Institute by performing a manual match of records
in the head and neck cancer database at a ratio of 1:2 cases: controls. The matching was done on the age group, gender and
diagnosis. Clinical and demographic characteristics between HIV positive and HIV negative head and neck cancer patients
were compared using chi square and a multinomial model including ECOG performance score, stage, grade and duration group
was run. In the multinomial regression only duration group was significant with the HIV positive patients being more likely to
present after a longer duration of the symptoms than HIV negative patients (OR=0.42 CI 0.20-0.86 p=0.02). The data does not
show statistically significant difference between HIV positive and HIV negative head and neck cancer patients in terms of
presentation at time of diagnosis except for duration of symptoms group. This study clearly demonstrates the need for more
research on head and neck cancer in Africa in the context of HIV/AIDS, since the reasons for the high HIV prevalence among
this cohort of patients hasn’t been established.
Sub-Saharan Africa comprises 48 countries, with a total population of about
850 million [25.24]. The age-standardized incidence rate for cancer in this region
is 121.0 per 100 000 people [25.3], implying more than one million new cancer
cases annually. It is expected that over 50% of cancer patients would benefit from
radiotherapy, either alone or in combination with surgery and/or chemotherapy
[25.25], meaning that about 500 000 patients per year would require radiotherapy
in sub-Saharan Africa. Sub-Saharan Africa is faced with numerous socioeconomic and political
challenges. These significantly influence the delivery of health services,
including radiotherapy. The availability of radiotherapy service in a country
does not necessarily mean that its population can access that service. Financial
constraints, lack of awareness and poor road infrastructure influence accessibility.
For example, the Democratic Republic of the Congo is a vast country with only
one centre in Kinshasa, and it is very difficult for people in the eastern part of
the country to access it. Late presentation of patients for cancer management is
another formidable challenge, aggravated by the issues mentioned above. The
countries in this region have to address the problem of increasing cancer burden
and the increasingly important role of radiotherapy in cancer management. There
is an urgent need for the establishment of radiotherapy centres that are distributed
widely across the region, accompanied by the training of more personnel. On
the positive side, several countries in this region, e.g. Eritrea, Malawi and Niger,
are in the process of establishing radiotherapy facilities in cooperation with the
IAEA. Others, such as Ghana, Nigeria and the United Republic of Tanzania, are
in the process of expanding the existing services. The countries in this region
should address the late presentation problem by increasing awareness and
establishing effective prevention and early detection programmes as part of their
national cancer control strategies. They should also develop appropriate cancer
policies with the continued support of international organizations such as the
IAEA and the World Health Organization (WHO).
