ObjectiveFive-year overall survival rate of breast cancer in low-income countries (LICs) is significantly lower than in high-resource countries. This study explored clinical and pathological factors influencing mortality in the Eastern region of Ghana.MethodsWe performed a retrospective medical chart review for patients undergoing surgery and chemotherapy for breast cancer at a regional hospital in Ghana from January 2014 to January 2017. Descriptive and survival analysis was done.ResultsOne hundred and twenty-nine patients were included in the study. The median age at presentation was 51 years. Sixty percent of patients presented with poorly differential histological grade III. The most common histological type was invasive ductal carcinoma (83%). Based on stage assessment using only tumor size and lymph node status, 60% presented at stage 3. Only 25% were tested for hormone receptor proteins and HER2 status. Of these, 57% had triple-negative breast cancer (TNBC). The 3-year overall survival rate was only 52%.ConclusionThe cumulative 3-year survival was 52%. Despite success in reducing cancer mortality in northern Africa, survival in sub-Saharan Africa remains poor. A significantly higher percentage of GIII and TNBC is found in breast cancers seen in Ghana. When combined with limited capacity for accurate diagnosis, cancer subtype analysis, adequate therapy, and follow-up, late-stage presentation leads to poor outcomes. Future studies should emphasize the identification of barriers to care and opportunities for cost-effective and sustainable improvements in diagnosing and treating breast cancer in LICs.
ObjectiveTo estimate the surgical burden of malignant disease in the Eastern Region of Ghana.DesignDescriptive cross-sectional study.SettingRegional hospital in the eastern region of Ghana.ParticipantsPatients treated by the surgery department at Eastern Regional Hospital in Koforidua, Ghana.InterventionsNone.Primary and secondary outcome measuresPrimary outcome was incidence of malignancy and secondary outcome descriptive differences between patients who had a benign indication for surgery compared with those with a malignant indication for surgery.ResultsA total of 1943 inpatient surgical procedures were performed from 2015 to 2017 with 13.4% (261) of all procedures ultimately performed for malignancy. Of all breast procedures performed, 95.2% of procedures resulted in a malignant diagnosis. The remaining subtypes of procedures had rates ranging from <1% to 41.2% of procedures performed for malignant disease. Additionally, this study found over 13% of patients admitted to the surgical service for breast cancer ultimately did not undergo a surgical procedure.ConclusionThis is the first study investigating the burden of malignant disease in the Eastern Region of Ghana. We found a substantial prevalence of malignant disease in the surgical population in this region. This information can be used to aid in future medical resource planning in this region.
Gastric glomus tumours (GGTs) are rare predominantly benign, mesenchymal neoplasms that commonly arise from the muscularis or submucosa of the gastric antrum and account for <1% of gastrointestinal soft-tissue tumours. Historically, GGT has been difficult to diagnose preoperatively due to the lack of unique clinical, endoscopic and CT features. We present a case of an incidentally identified GGT in an asymptomatic man that was initially considered a neuroendocrine tumour (NET) by preoperative fine-needle aspiration biopsy with focal synaptophysin reactivity. An elective robotic distal gastrectomy and regional lymphadenectomy were performed. Postoperative review by pathology confirmed the diagnosis of GGT. GGTs should be considered by morphology as a differential diagnosis of gastric NET on cytology biopsy, especially if there is focal synaptophysin reactivity. Additional staining for SMA and BRAF, if atypical/malignant, can help with this distinction. Providers should be aware of the biological behaviour and treatment of GGTs.
Introduction Cancer is the leading cause of non-accidental death among children worldwide. The most common types of paediatric cancers include sarcomas: a group of cancers that are difficult to manage due to their heterogeneity and lack of defining features. We have designed an international multicentre cohort study to assess the management of paediatric sarcomas at tertiary healthcare centres in Nigeria, Pakistan and the UK. Methods and Analysis The centres will screen patient databases to identify eligible patients under the age of 18 with a clinical or histological diagnosis of sarcoma. Data will be extracted from the patient notes through an anonymized form. Patients will be recruited consecutively into the study from January 2015 to January 2021, with a minimum 12-month follow up period. The primary objectives of the study will be to determine all-cause mortality rates at 30 days, 90 days, 12 months and 3 years. Significant differences in mortality rates between countries will be determined using χ2 analysis or Fisher’s exact test. Univariate and multivariable logistic regression will be used to examine the influence of different factors and patient characteristics on outcomes. Ethics and Dissemination At the host centre, this study was deemed to be exempt from ethical committee approval due to the use of anonymized data. At other centres, participating collaborators have gained local approvals in accordance with institutional ethical regulations. Collaborators will present the data to inform decision makers about how sarcoma management may be improved. The results will be submitted for publication in a peer-reviewed journal.
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