Background: Colorectal carcinoma usually arises from an adenomatous polyp and observational studies suggest that the adenoma-to-carcinoma sequence takes approximately 10 to 15 years. Risk factors are adoption of weste...Background: Colorectal carcinoma usually arises from an adenomatous polyp and observational studies suggest that the adenoma-to-carcinoma sequence takes approximately 10 to 15 years. Risk factors are adoption of westernized diets, obesity, cigarette smoking, and alcohol and reduced physical activity. Clinical Presentations are blood per rectum, abdominal pain, Anemia, change in bowel habits and bowel obstructive symptoms. The treatment of colorectal cancer is a dependent stage which includes chemotherapy, radiotherapy, surgery or both. Objective: This study aims at describing the clinical pathological characteristics of colorectal carcinoma and factors influencing survival among patients treated at Ocean Road Cancer Institute. Methods: This was a cross sectional study that involved histological confirmed colorectal carcinoma treated at Ocean Road Cancer Institute from 2010-2015. Results: Among 100 files extracted, 63% were males and 37% females. 21% were below 40 years of age. Left-sided tumor accounted for 46%. Abdominal pain, rectal bleeding and constipation were 72%, 68% and 55% respectively. Moderately differentiated adenocarcinoma accounted for 80%. Patients presented at stage III and IV were 37% and 56% respectively. Colostomy was the most surgical procedures performed. Folinic acid, Fluorouracil and Oxaliplatin were the most common chemotherapies used. Median overall survival was estimated to be 9.4 months. Conclusion: A significant proportion of patients in this study population are young. Survival from colorectal cancer is poor owing largely to the late presentation seen in this study group.展开更多
AIM:To estimate the incidence of esophageal cancer(EC)in Kilimanjaro in comparison to other regions in Tanzania.METHODS:We also examined the clinical,epidemiologic,and geographic distribution of the 1332 EC patients d...AIM:To estimate the incidence of esophageal cancer(EC)in Kilimanjaro in comparison to other regions in Tanzania.METHODS:We also examined the clinical,epidemiologic,and geographic distribution of the 1332 EC patients diagnosed and/or treated at Ocean Road Cancer Institute(ORCI)during the period 2006-2013.Medical records were used to abstract patient information on age,sex,residence,smoking status,alcohol consumption,tumor site,histopathologic type of tumor,date and place of diagnosis,and type and date of treatment at ORCI.Regional variation of EC patients was investigated at the level of the 26 administrative regions of Tanzania.Total,age-and sex-specific incidence rates were calculated.RESULTS:Male patients 55 years and older had higher incidence of EC than female and younger patients.Of histopathologically-confirmed cases,squamous-cell carcinoma represented 90.9%of histopathologic types of tumors.The administrative regions in the central andeastern parts of Tanzania had higher incidence rates than western regions,specifically administrative regions of Kilimanjaro,Dar es Salaam,and Tanga had the highest rates.CONCLUSION:Further research should focus on investigating possible etiologic factors for EC in regions with high incidence in Tanzania.展开更多
Background: The majority of breast cancer patients in Tanzania present with advanced disease, and a significant proportion has metastatic breast cancer (MBC) on presentation or develops it during the course of their f...Background: The majority of breast cancer patients in Tanzania present with advanced disease, and a significant proportion has metastatic breast cancer (MBC) on presentation or develops it during the course of their follow-up. With few treatment options to choose from, such patients often benefit from empathic support and access to information to help them make treatment decisions based on their individual circumstances and needs. Patients with MBC have been shown to present with unique physical, social and psychological needs that require additional time, counselling and availability of health care providers in addition to the routine options available to other patients. In resource-limited settings, the needs of such patients are often unknown and unaddressed, which adds to the anxiety associated with the diagnosis and its treatment. Materials and methods: This descriptive qualitative study was conducted using 3 focus group discussions with a total of 17 participants with metastatic breast cancer (MBC) attending Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Participants were purposively selected for the study from outpatient clinics and inpatient wards. A semi-structured FGD guide was used to moderate discussions and analysis was done using a thematic approach. Results: The median age of participants was 51 (range 33 - 81 years) with an average of 4 months (range 1 - 12 months) from diagnosis of BC to the interview. 4 (24%) were diagnosed with MBC on first presentation (denovo). Participants spoke about the importance of accurate BC-related information in allowing timely referral and treatment both in the community and within the health system. They recognized the role of mass and social media in increasing awareness about BC and identified myths surrounding cancer treatment especially mastectomy. Correct and timely information at points of care, through media platforms and via ambassadors/patient support groups was perceived as a means to avoiding delays and securing early and effective treatment. Conclusion: Patients with MBC in Tanzania have many unmet informational needs in relation to their disease. Accurate BC-related information is important in allowing early detection and diagnosis. At the community level, provision of information through established media platforms and the use of patient advocates may help to enable early referral and treatment of patients.展开更多
Pain is one of the most common and distressing symptoms experienced by cancer patients and can cause significant physical and psychological complications for patients and their families. Adequate pain management requi...Pain is one of the most common and distressing symptoms experienced by cancer patients and can cause significant physical and psychological complications for patients and their families. Adequate pain management requires an understanding of pain, its assessment, and the use of analgesics according to the WHO analgesic ladder;information that is often lacking in routine medical education. Understanding the level of knowledge, attitudes and practices of clinicians who treat cancer pain can help us prepare relevant educational programs to address this need. A cross-sectional descriptive study was conducted among randomly selected eligible clinical staff using self-administered questionnaires that contained close-ended and open-ended questions testing factual knowledge on pain, attitudes towards pain management, and practices related to pain management and opioid use. Results were analyzed using SPSS Version 28. Of 66 participants of this study, 78% were female and 65% were nurses. Only 10% had received any additional training in pain management. Knowledge on pain was found to be adequate in some areas, but deficient in others such as “types of pain” and “adjuvant drugs” (35% and 26% respectively). A significant proportion of responses (73%) showed incorrect attitudes towards pain and opioid use. Recommended practices such as prescribing laxatives with opioids were prevalent (72%), however using a tool to assess pain or the WHO ladder to prescribe analgesics was not as common. The results of this study show that despite being a key component of clinical care, pain management is not adequately understood by many clinicians. Gaps in knowledge, and incorrect attitudes could contribute to inadequate pain management for patients. This study provides valuable information for an educational workshop planned on pain management.展开更多
Background: The profile of primary brain tumors and treatment modalities employed in Tanzania remains largely unknown. The study aimed to describe the baseline clinical-pathological profile and treatment modalities fo...Background: The profile of primary brain tumors and treatment modalities employed in Tanzania remains largely unknown. The study aimed to describe the baseline clinical-pathological profile and treatment modalities for primary brain tumors in adults treated at the Ocean Road Cancer Institute (ORCI) from 2017 to 2020. Materials and Methods: This was a retrospective study conducted at ORCI by reviewing 61 medical records of patients with primary brain tumors over the age of 15 from January 2017 to December 2020. A structured questionnaire was used to retrieve information on sociodemographic, clinical-pathological characteristics, and treatment modalities. The 2007 WHO classification system and the International Classification of Cancer Diseases (ICD-0-3) were used for classification and diagnosis. The X<sup>2</sup> test and Fisher’s exact test were used to compare the proportions and an independent t-test was used to compare the means. A P-value less than 0.05 was deemed statistically significant. The Results: The mean age of the females was 41.8 years and the mean age of males was 42.9 years. Overall M: F ratio was 1:1.2. Meningioma was the only tumor that was more commonly found in women with M:F of 1:2.1. The most prevalent symptom was headache (57.4%). Glioblastoma (GBM) was the most common tumor among adults (38%), followed by astrocytomas (23%) and meningioma (18%). Approximately 91.8% of all tumors occurred in the supratentorial region. The Frontal lobe was the most common site (29.5%). Approximately 81.9% of patients received surgery. The gross tumor resection (GTR) rate was 26.2%, and the subtotal tumor resection (STR) rate was 55.7%. Roughly 18% of the tumors were inoperable. An estimated 80.3% of respondents received radiation therapy. The radiotherapy technique was 3DCRT in two-thirds of the patients and the rest received conventional 2D radiotherapy. The mean equivalent dose in the 2 Gy fractions (EQD2) was 43.9 Gy. Respondents with low-grade intracranial tumors were treated with a mean EQD2 of 47.3 Gy, while those with high-grade intracranial tumors were treated with a mean EQD2 of 44.3 Gy and the difference was statistically significant. Only half of the patients who received adjuvant radiotherapy received it concurrently with chemotherapy. Temozolomide was the most widely used cytotoxic medication. Conclusion: Mean age of the patients was 41 years old. Most tumors were in the supratentorial area and GBM was the most common tumor. Only meningioma was a bit more common amongst females. Overall, radiotherapy doses and the gross tumor resection rates were low. Concurrent chemotherapy with radiotherapy was given to a few patients.展开更多
The immune system plays an important role in protecting the body against malignancy.During cancer immunoediting,the immune system can recognize and keep checking the tumor cells by down-expression of some self-molecul...The immune system plays an important role in protecting the body against malignancy.During cancer immunoediting,the immune system can recognize and keep checking the tumor cells by down-expression of some self-molecules or by increasing expression of some novel molecules.However,the microenvironment created in the course of cancer development hampers the immune ability to recognize and destroy the transforming cells.Human Leukocyte Antigen G(HLA-G)is emerging as immune checkpoint molecule produced more by cancer cells to weaken the immune response against them.HLA-G is a non-classical HLA class I molecule which is normally expressed in immune privileged tissues as a soluble or membrane-bound protein.HLA-G locus is highly polymorphic in the non-coding 3′untranslated region(UTR)and in the 5′upstream regulatory region(5′URR).HLA-G expression is controlled by polymorphisms located in these regions,and several association studies between these polymorphic sites and disease predisposition,response to therapy,and/or HLA-G protein expression have been reported.Various polymorphisms are demonstrated to modulate its expression and this is increasingly finding more significance in cancer biology.This review focuses on the relevance of the HLA-G gene and its polymorphisms in cancer development.We highlight population genetics of HLA-G as evidence to espouse the need and importance of exploring potential utility of HLA-G in cancer diagnosis,prognosis and immunotherapy in the currently understudied African population.展开更多
文摘Background: Colorectal carcinoma usually arises from an adenomatous polyp and observational studies suggest that the adenoma-to-carcinoma sequence takes approximately 10 to 15 years. Risk factors are adoption of westernized diets, obesity, cigarette smoking, and alcohol and reduced physical activity. Clinical Presentations are blood per rectum, abdominal pain, Anemia, change in bowel habits and bowel obstructive symptoms. The treatment of colorectal cancer is a dependent stage which includes chemotherapy, radiotherapy, surgery or both. Objective: This study aims at describing the clinical pathological characteristics of colorectal carcinoma and factors influencing survival among patients treated at Ocean Road Cancer Institute. Methods: This was a cross sectional study that involved histological confirmed colorectal carcinoma treated at Ocean Road Cancer Institute from 2010-2015. Results: Among 100 files extracted, 63% were males and 37% females. 21% were below 40 years of age. Left-sided tumor accounted for 46%. Abdominal pain, rectal bleeding and constipation were 72%, 68% and 55% respectively. Moderately differentiated adenocarcinoma accounted for 80%. Patients presented at stage III and IV were 37% and 56% respectively. Colostomy was the most surgical procedures performed. Folinic acid, Fluorouracil and Oxaliplatin were the most common chemotherapies used. Median overall survival was estimated to be 9.4 months. Conclusion: A significant proportion of patients in this study population are young. Survival from colorectal cancer is poor owing largely to the late presentation seen in this study group.
文摘AIM:To estimate the incidence of esophageal cancer(EC)in Kilimanjaro in comparison to other regions in Tanzania.METHODS:We also examined the clinical,epidemiologic,and geographic distribution of the 1332 EC patients diagnosed and/or treated at Ocean Road Cancer Institute(ORCI)during the period 2006-2013.Medical records were used to abstract patient information on age,sex,residence,smoking status,alcohol consumption,tumor site,histopathologic type of tumor,date and place of diagnosis,and type and date of treatment at ORCI.Regional variation of EC patients was investigated at the level of the 26 administrative regions of Tanzania.Total,age-and sex-specific incidence rates were calculated.RESULTS:Male patients 55 years and older had higher incidence of EC than female and younger patients.Of histopathologically-confirmed cases,squamous-cell carcinoma represented 90.9%of histopathologic types of tumors.The administrative regions in the central andeastern parts of Tanzania had higher incidence rates than western regions,specifically administrative regions of Kilimanjaro,Dar es Salaam,and Tanga had the highest rates.CONCLUSION:Further research should focus on investigating possible etiologic factors for EC in regions with high incidence in Tanzania.
文摘Background: The majority of breast cancer patients in Tanzania present with advanced disease, and a significant proportion has metastatic breast cancer (MBC) on presentation or develops it during the course of their follow-up. With few treatment options to choose from, such patients often benefit from empathic support and access to information to help them make treatment decisions based on their individual circumstances and needs. Patients with MBC have been shown to present with unique physical, social and psychological needs that require additional time, counselling and availability of health care providers in addition to the routine options available to other patients. In resource-limited settings, the needs of such patients are often unknown and unaddressed, which adds to the anxiety associated with the diagnosis and its treatment. Materials and methods: This descriptive qualitative study was conducted using 3 focus group discussions with a total of 17 participants with metastatic breast cancer (MBC) attending Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Participants were purposively selected for the study from outpatient clinics and inpatient wards. A semi-structured FGD guide was used to moderate discussions and analysis was done using a thematic approach. Results: The median age of participants was 51 (range 33 - 81 years) with an average of 4 months (range 1 - 12 months) from diagnosis of BC to the interview. 4 (24%) were diagnosed with MBC on first presentation (denovo). Participants spoke about the importance of accurate BC-related information in allowing timely referral and treatment both in the community and within the health system. They recognized the role of mass and social media in increasing awareness about BC and identified myths surrounding cancer treatment especially mastectomy. Correct and timely information at points of care, through media platforms and via ambassadors/patient support groups was perceived as a means to avoiding delays and securing early and effective treatment. Conclusion: Patients with MBC in Tanzania have many unmet informational needs in relation to their disease. Accurate BC-related information is important in allowing early detection and diagnosis. At the community level, provision of information through established media platforms and the use of patient advocates may help to enable early referral and treatment of patients.
文摘Pain is one of the most common and distressing symptoms experienced by cancer patients and can cause significant physical and psychological complications for patients and their families. Adequate pain management requires an understanding of pain, its assessment, and the use of analgesics according to the WHO analgesic ladder;information that is often lacking in routine medical education. Understanding the level of knowledge, attitudes and practices of clinicians who treat cancer pain can help us prepare relevant educational programs to address this need. A cross-sectional descriptive study was conducted among randomly selected eligible clinical staff using self-administered questionnaires that contained close-ended and open-ended questions testing factual knowledge on pain, attitudes towards pain management, and practices related to pain management and opioid use. Results were analyzed using SPSS Version 28. Of 66 participants of this study, 78% were female and 65% were nurses. Only 10% had received any additional training in pain management. Knowledge on pain was found to be adequate in some areas, but deficient in others such as “types of pain” and “adjuvant drugs” (35% and 26% respectively). A significant proportion of responses (73%) showed incorrect attitudes towards pain and opioid use. Recommended practices such as prescribing laxatives with opioids were prevalent (72%), however using a tool to assess pain or the WHO ladder to prescribe analgesics was not as common. The results of this study show that despite being a key component of clinical care, pain management is not adequately understood by many clinicians. Gaps in knowledge, and incorrect attitudes could contribute to inadequate pain management for patients. This study provides valuable information for an educational workshop planned on pain management.
文摘Background: The profile of primary brain tumors and treatment modalities employed in Tanzania remains largely unknown. The study aimed to describe the baseline clinical-pathological profile and treatment modalities for primary brain tumors in adults treated at the Ocean Road Cancer Institute (ORCI) from 2017 to 2020. Materials and Methods: This was a retrospective study conducted at ORCI by reviewing 61 medical records of patients with primary brain tumors over the age of 15 from January 2017 to December 2020. A structured questionnaire was used to retrieve information on sociodemographic, clinical-pathological characteristics, and treatment modalities. The 2007 WHO classification system and the International Classification of Cancer Diseases (ICD-0-3) were used for classification and diagnosis. The X<sup>2</sup> test and Fisher’s exact test were used to compare the proportions and an independent t-test was used to compare the means. A P-value less than 0.05 was deemed statistically significant. The Results: The mean age of the females was 41.8 years and the mean age of males was 42.9 years. Overall M: F ratio was 1:1.2. Meningioma was the only tumor that was more commonly found in women with M:F of 1:2.1. The most prevalent symptom was headache (57.4%). Glioblastoma (GBM) was the most common tumor among adults (38%), followed by astrocytomas (23%) and meningioma (18%). Approximately 91.8% of all tumors occurred in the supratentorial region. The Frontal lobe was the most common site (29.5%). Approximately 81.9% of patients received surgery. The gross tumor resection (GTR) rate was 26.2%, and the subtotal tumor resection (STR) rate was 55.7%. Roughly 18% of the tumors were inoperable. An estimated 80.3% of respondents received radiation therapy. The radiotherapy technique was 3DCRT in two-thirds of the patients and the rest received conventional 2D radiotherapy. The mean equivalent dose in the 2 Gy fractions (EQD2) was 43.9 Gy. Respondents with low-grade intracranial tumors were treated with a mean EQD2 of 47.3 Gy, while those with high-grade intracranial tumors were treated with a mean EQD2 of 44.3 Gy and the difference was statistically significant. Only half of the patients who received adjuvant radiotherapy received it concurrently with chemotherapy. Temozolomide was the most widely used cytotoxic medication. Conclusion: Mean age of the patients was 41 years old. Most tumors were in the supratentorial area and GBM was the most common tumor. Only meningioma was a bit more common amongst females. Overall, radiotherapy doses and the gross tumor resection rates were low. Concurrent chemotherapy with radiotherapy was given to a few patients.
文摘The immune system plays an important role in protecting the body against malignancy.During cancer immunoediting,the immune system can recognize and keep checking the tumor cells by down-expression of some self-molecules or by increasing expression of some novel molecules.However,the microenvironment created in the course of cancer development hampers the immune ability to recognize and destroy the transforming cells.Human Leukocyte Antigen G(HLA-G)is emerging as immune checkpoint molecule produced more by cancer cells to weaken the immune response against them.HLA-G is a non-classical HLA class I molecule which is normally expressed in immune privileged tissues as a soluble or membrane-bound protein.HLA-G locus is highly polymorphic in the non-coding 3′untranslated region(UTR)and in the 5′upstream regulatory region(5′URR).HLA-G expression is controlled by polymorphisms located in these regions,and several association studies between these polymorphic sites and disease predisposition,response to therapy,and/or HLA-G protein expression have been reported.Various polymorphisms are demonstrated to modulate its expression and this is increasingly finding more significance in cancer biology.This review focuses on the relevance of the HLA-G gene and its polymorphisms in cancer development.We highlight population genetics of HLA-G as evidence to espouse the need and importance of exploring potential utility of HLA-G in cancer diagnosis,prognosis and immunotherapy in the currently understudied African population.
