Gastric cancer at a university teaching hospital in northwestern Tanzania: a retrospective review of 232 cases

Abstract

BackgroundDespite marked decreases in its incidence, particularly in developed countries, gastric cancer is still the second most common tumor worldwide. There is a paucity of information regarding gastric cancer in northwestern Tanzania. This study was undertaken to describe our experience, in our local setting, on the management of gastric cancer, outlining the clinicopathological and treatment outcome of these patients and suggesting ways to improve the treatment outcome.MethodsThis was a retrospective study of histologically confirmed cases of gastric cancer seen at Bugando Medical Centre between January 2007 and December 2011. Data were retrieved from patients’ files and analyzed using SPSS computer software version 17.0.ResultsA total of 232 gastric cancer patients were enrolled in the study, representing 4.5% of all malignancies. The male to female ratio was 2.9:1. The median age of patients was 52 years. The majority of the patients (92.1%) presented late with advanced gastric cancer (Stages III and IV). Lymph node and distant metastasis at the time of diagnosis was recorded in 31.9% and 29.3% of cases, respectively. The antrum was the most frequent anatomical site (56.5%) involved and gastric adenocarcinoma (95.1%) was the most common histopathological type. Out of 232 patients, 223 (96.1%) patients underwent surgical procedures for gastric cancer of which gastro-jejunostomy was the most frequent performed surgical procedure, accounting for 53.8% of cases. The use of chemotherapy and radiotherapy was documented in 56 (24.1%) and 12 (5.1%) patients, respectively. Postoperative complication and mortality rates were 37.1% and 18.1%, respectively. According to multivariate logistic regression analysis, preoperative co-morbidity, histological grade and stage of the tumor, presence of metastases at the time of diagnosis was the main predictors of death (P <0.001). At the end of five years, only 76 (32.8%) patients were available for follow-up and the overall five-year survival rate was 6.9%. Evidence of cancer recurrence was reported in 45 (19.4%) patients. Positive resection margins, stage of the tumor and presence of metastasis at the time of diagnosis were the main predictors of local recurrence (P <0.001).ConclusionsGastric cancer in this region shows a trend towards relative young age at diagnosis and the majority of patients present late with an advanced stage. Lack of awareness of the disease, poor accessibility to health care facilities and lack of screening programs in this region may contribute to advanced disease at the time of diagnosis. There is a need for early detection, adequate treatment and proper follow-up to improve treatment outcome.

Comparative Study of Platelet Indices in Normal Pregnant and Non-Pregnant Women in a Tertiary Care Hospital in Northern India

“…Majority of the people having gastric malignancy were in the age group of 41-60 years, which is similar to the study by Khandige et al [10] and Mabula et al [14] . Males were predominantly affected in gastric malignancies with M:F ratio of 3.2:1.…”

“…Males were predominantly affected in gastric malignancies with M:F ratio of 3.2:1. Similar male predominance was seen in the study by Khuroo et al [9] , Mabula et al [14] , and Sheikh et al [8] .…”

Impact of delayed care on surgical management of patients with gastric cancer in a low‐resource setting

“…By comparison, in the United States between 2004 and 2009, over 30% of all stomach cancers were diagnosed at an advanced stage . Patients elsewhere in sub‐Saharan Africa, in similarly low‐resourced settings, also suffer from delayed presentation and depend primarily on surgical management for the treatment of gastric cancer …”

“…10 Patients elsewhere in sub-Saharan Africa, in similarly low-resourced settings, also suffer from delayed presentation and depend primarily on surgical management for the treatment of gastric cancer. [11][12][13][14] Age-standardized rates of stomach cancer in Eastern Africa have been estimated at 5.2 and 3.9 per 100 000 for men and women, respectively. 15 There are very few prior studies evaluating gastric cancer epidemiology or management in Rwanda.…”

The surgical pathology laboratory in Mwanza, Tanzania: a survey on the reproducibility of diagnoses after the first years of autonomous activity

“…In the early 1990s, female breast cancer represented about 8.1% of all cancers in women, but it is now on the rise, and women present at a younger age than in Western countries [2, 17]. Non-Hodgkin lymphoma, Kaposi sarcoma, foot melanoma, and cancers of the bladder, esophagus, stomach, and prostate are the most common tumours in men [7, 14, 17]. Given this rise in disease, the BMC surgical pathology laboratory has the potential to play a key role in providing cancer statistics, and to contributing to secondary cancer prevention and cancer control nationwide.…”