Breast Cancer Profile in a Group of Patients Followed up at the Radiation Therapy Unit of the Yaounde General Hospital, Cameroon.

Objective. To describe the profile of breast cancer in the patients attending the radiation therapy unit of Yaounde General Hospital. Method. From 1989 to 2009, we conducted a descriptive retrospective study based on the register and medical records of patients. Results. During the study period, 531 breast cancer patients were recorded of which 0.75% were male. Age range was 18 to 82 years, with a mean of 45.17 years. Out of these, 66.1% were less than 50 years old and 31.9% less than 40. Self detection was the discovery method in most cases (95.34% of patients). Mean delay before presentation at hospital was 10.35 months, and 54.94% had used traditional medicine before medical evaluation. Metastasis and locally advanced breast cancer at diagnosis were present in 08.13% and 62.78%, respectively. Mastectomy was used in 88.08% of patients. Conclusion. The study reinforces the position occupied by late presentation and advanced stage at diagnosis of breast cancer profile in developing countries.

An advanced case of double primary malignancy involving the breasts and uterine cervix: satisfactory response to non-surgical management.

Double primary cancers are fairly rare. We report here a case of metachronous lesions; advanced cancer of the breasts and squamous cell carcinoma of the cervix. What is peculiar in this case is the rather unusual positive response to conservative treatment. Despite widespread metastases even to the liver, the patient is well and active more than six years after breast cancer was first diagnosed. Treating such advanced cases may be rewarding at times.

[The value of medical imaging in the diagnosis and assessment of local and regional extension of cancers of the cavum at Yaounde]. / Apport de l'imagerie médicale dans le diagnostic et le bilan d'extension loco-régionale des cancers du cavum à Yaoundé.

In this work, we aimed to provide a clear description of the contribution to and role of major imaging techniques in the diagnosis of cancers of the cavum and assessment of their local and regional expansion. This should provide doctors with a useful guide for decisions concerning the imaging technique to be used. This is a retrospective analysis of 41 cases of cavum cancer, all confirmed by histology. The series consisted of 29 male patients (70%) and 12 female patients (30%), giving a sex ratio of 2.4. The mean age of the patients was 42 years (range: 11 to 71 years). All patients were examined and treated in the Radiology and Oncological Radiotherapy Department of Yaounde General Hospital over a period of eight years (December 1988 to November 1996 inclusive). All data relating to diagnosis, assessment of local and regional expansion and the response of the tumor to treatment were retrieved from the medical files and analyzed. We found that clinical diagnosis of cancer of the cavum was difficult and this cancer was often diagnosed late. It was therefore often necessary to resort to paraclinical means of diagnosis and assessment of expansion, such as endoscopy, conventional X rays and tomography. Endoscopy and conventional X rays give poor results but may be used if there is a lack of equipment or for an initial examination, to be followed by assessment using other methods. Tomography remains the most effective technique and is recommended for the diagnosis of cancers of the cavum and for assessment of their local and regional expansion.

[Therapeutic management of primary digestive lymphomas at Yaoundé: analysis of a series of 46 cases]. / Prise en charge thérapeutique des lymphomes digestifs primitifs à Yaoundé: analyse d'une série de 46 cas.

The aim of this study was to identify the principal deficiencies and difficulties associated with the treatment of primary digestive lymphomas at Yaounde. We analyzed the medical records of 46 patients treated at Yaounde General Hospital over a period of 7 years (January 1989 to December 1996). The study population consisted of 24 men (52%) and 22 women (48%), giving a sex ratio of 1.08. The mean age of the patients was 49 years (range: 18 to 80 years). The treatment of these patients was not always optimal, due largely to socioeconomic and technical factors. We observed cases of very late diagnosis in which the histological data were imprecise or incomplete, in the absence of modern histological techniques. Assessment of the expansion of tumors was frequently inadequate, due to the absence of scanners or the inability to pay for their use. These problems, and the high cost of chemotherapy and radiotherapy, have severely limited the efficacy of treatment, resulting in poorer responses to treatment than reported elsewhere. In conclusion, national solidarity and cooperation at the regional and international levels seem to be necessary in these clinical conditions, to overcome these obstacles and to improve the quality of treatment for patients in general, and for those with primary digestive lymphomas in particular.

[Problems with the approach to diagnosis and treatment of testicular cancer in a developing country: the case of an eight-year-old boy from Cameroon]. / Difficultés de l'approche diagnostique et thérapeutique des cancers du testicule dans un pays en développement: à propos d'un cas chez un enfant camerounais de 8 ans.

Testicular cancer is believed to be rare among members of the black sub-Saharan population and has therefore been little studied in Africa. This may account for the problems encountered in the treatment of this condition, which are perfectly illustrated by this clinical case. We present here a brief report of the optimal diagnostic methods and therapeutic indications for this malignant disease.

[Anatomical-clinical presentation and prognostic factors in cancers of the cervix at the General Hospital of Yaounde]. / Presentations anatomo-cliniques et facteurs pronostiques des cancers du col uterin a l'hôpital General de Yaounde.

The objective of this work was to search for and precise all the facts related to clinical anatomo and the prognosis capable of individualising the sick in our midst. We proposed to analyse 111 files of cases treated for the cancer of the uterine neck in the gynaecology services and cancerology-radiotherapy in the General Hospital, Yaounde. All the facts related to the clinical anatomo presentations of the patients were noted as well as the therapeutic results in accordance with the facts and the technical means of treatment. All these facts have been compared to the ones of the literature. We established that the clinical anatomo presentation of the cases in our series is comparable to the one of the literature taking into account the previous history, the general state, the symptoms and the clinical signs. On the other hand, it differs relatively by the important proportion of the young, the long diagnosis delay, the importance of the extensive stages and the additional prognosis factors in relation with the inadequacy of technical means of treatment. In conclusion, a lucid reorientation of our policy to fight against cancers in general and of cancer of the uterine neck in particular that takes into account the reality of the data based on the clinical and prognosis facts of our patients is needed.

[Treatment of early T1 small T2N breast cancers. Our experience at the Yaounde General Hospital. 21 cases]. / Traitement des cancers du sein aux stades précoces T1 petit T2 N-notre experience a l'Hôpital Général de Yaoundé. A propose de 21 cas.

From February 1989 through February 1993, a group of 23 patients suffering from T1 mammary carcinoma small T2 N-MO was treated in the radiotherapy department of the Yaoundé General Hospital, according to a simplified procedure. A first conservative surgery of tumorectomy type (3 cases) and quandrantectomy type (4 cases) was carried out, followed by a postoperative irradiation. In 14 cases, a Patey type radical surgery preceded a local/regional radiotherapy. The general treatment was made up of only a hormonotherapy without chemotherapy. After a 4-year decline, there were 5 cases--i.e. 23.8%--of ganglionic and/or metastatic relapse. In the light of research data, we are analysing the reasons for these unexpected therapeutic failures in this group of tumor considered as favorable prognosis. We raised the problem of the inability of the prognosis factors, presently defined by means of histological and biological factors, to detect all the especially aggressive cancers. We carried out a general review of the new factors defined essentially from molecular and genic bases. We offered an approximative solution which makes it possible to by-pass the technological difficulties in having access to the new factors.

Superior vena cava tumoral thrombosis revealing a Burkitt's lymphoma and a lymphoblastic non-Hodgkin's lymphoma. A case report.

Superior vena cava thrombosis (SVCT) is a rare pathology, though of great significance since it implies the development of a malignant process. The most common etiologies are basically bronchopulmonary and mediastinal tumors. Observations involving 2 patients presenting with superior vena cava syndrome (SVCS) are reported in this study, in which radiologic investigations (chest roentgenogram, computed tomography scan of the thorax, and superior vena cavography) revealed thrombosis of the SVC disclosing in both cases a non-Hodgkin's lymphoma. The first case was a mediastinal Burkitt's lymphoma in a thirty-eight-year-old man (exceptional form) and in the second case a lymphoblastic non-Hodgkin's lymphoma in a nine-year-old girl. In the patient with Burkitt's lymphoma healing was satisfactory twenty-four months after treatment by surgery, chemotherapy, and radiotherapy. The second patient died suddenly. In both cases the SVCT revealed the tumor. The causes of SVCT are reviewed and discussed.

[Cancer localisation in men and women aged over 50 in Cameroon]. / Localisations des cancers chez les hommes et les femmes âgés de plus de 50 ans au Cameroun.

The aim of this study was to present the sites of cancers diagnosed in men and women aged 50 years and above in Cameroon. From the registries of the pathology laboratory of the Yaoundé Central Hospital which at the national level receives the majority of samples sent for histopathology analysis, we recorded all cases of cancers diagnosed in people aged 50 years and above, during the period from 1st January 1987 to 31st August 1996 (9 years 8 months). 1,925 cancers were recorded: -1,005 of these (52.2%) were issued from men aged fifty years and above. These 1,005 cancers came from seventeen sites, the most common being: liver (226 cases = 22.49%), prostate (222 cases = 22.09%), skin (195 cases = 19.40%) and ENT (100 cases = 9.95%); that made 73.93% (above 3/4) of cancers observed in men aged fifty years and above from this study. -920 of these (47.8%) were diagnosed from women aged fifty years and above. These 920 cancers came from twenty-two sites, the most common being: uterine cervix (292 cases = 31.74%), breast (170 cases = 18.48%), skin (111 cases = 12.07%) and liver (90 cases = 9.78%); that made 72.07% (about 3/4) of cancers observed in women aged fifty years and above, from this study.

[Management of cervical cancers in Yaounde. 111 cases]. / Prise en charge thérapeutique des cancers du col uterin à Yaoundé. A propos d'une série de 111 malades.

Over a 3-year period, 111 patients presenting histologically documented cervical carcinoma were treated in the Department of Cancerology and Radiotherapy at the General Hospital in Yaounde, Cameroon. Available therapeutic modalities included surgery and radiation therapy with a mean energy of 1.25 Mev of cobalt 60 which were used alone or in combination. Therapeutic strategies had to be adapted to these poor facilities based on poor pretreatment assessment of involvement. Thirty-two patients were not treated using both surgery and radiation therapy due to either insufficient financial resources or advanced disease. Seventy-nine patients were treated with both surgery and radiation therapy in various combinations depending on initial disease stage. The low quality of results was directly related to poor pretreatment assessment of extent and the unavailability of endobrachytherapy.

[Social, economical and educational causes of late diagnosis and treatment of cancer in Cameroon]. / Causes sociales, économiques et éducationnelles du diagnostic et du traitement tardif des cancers au Cameroun.

The aim of the study was the identification of the social, economical and educational causes of late diagnosis and treatment of cancer in Cameroon. The interview of 200 consecutive patients with histologically proven cancer was performed between November 1988 and November 1990 in the Department of Radiotherapy at the University of Yaoundé Hospital. The interview followed a pre-written questionnaire. There were 12% early stages and 88% advanced diseases. The median time interval between the first symptom and the first consultation was 10 months (extremes: 3 weeks-5 years). The median time interval between first consultation and diagnosis was two months (extremes: 7 days-7 years). Finally the time interval between diagnosis and treatment was one month (extremes: 7 days-3 months). The major reasons for consultation delay were: cost, inaccessibility of health structures, ignorance, fear and attempts of traditional medicine. The major causes of diagnosis delay were cost of procedures and misdiagnosis. The reasons for late treatment were the cost of treatment and lack of confidence of patients on treatment results. It is concluded that advances in cancer treatment results in Cameroon require educational efforts, health care reorganization, and development of regional and international cooperation.

[Rare association of a non-functional retroperitoneal paraganglioma and nephrotic syndrome]. / Association rare d'un paragangliome rétropéritonéal non fonctionnel et d'un syndrome néphrotique.

Non functional retroperitoneal paragangliomas are rare: less than 50 cases in literature. They are usually asymptomatic and can attain reasonable dimensions. The association with nephrotic syndrome is exceptional. The authors report a clinical observation of non-functional paraganglioma in a 45 year old woman, with repeated surgical abstention. Literature was reviewed and therapeutic indications discussed.

[Benign sacro-coccygeal teratoma. A case report in Yaounde, Cameroon]. / Tératome sacro-coccygien bénin. A propos d'un cas observé à Yaoundé, Cameroun.

The authors describe a cases of sacrococcygeal teratoma observed in an infant after pregnancy without ultrasound surveillance. The mass was located in the buttock with a mainly exo-pelvic extension. There was no other malformation. Ultrasound examination revealed a heterogeneous structure with solid and liquid areas. Alphafoetoprotein level was high but the beta-HCG level was normal. The surgical specimen weighed 1990 grams and presented microcystic cavities and calcifications. Histological examination confirmed the diagnosis of benign complex multitissue teratoma. Postoperative recovery was uneventful and development of the child was normal 45 months after the procedure. The authors review the histologic, diagnostic, and prognostic features of teratomas and emphasize the importance of early surgical management, which is usually feasible in Africa.

[Problematic management of tumors with a very high proliferation coefficient: a case of an embryonal rhabdomyosarcoma of the right orbit in an eleven-year-old child]. / Problèmatique de l'approche thérapeutique des tumeurs à coefficient de prolifération très élevé: a propos d'un cas de rhabdomyosarcome embryonnaire de l'orbite droit chez un enfant de 11 ans.

We propose through the retrospective analysis of this document, to explain the inefficiency of the action of chemo and radiotherapy on tumours with a high proliferation coefficient but which are however known to be highly sensitive as well as curable with chemo and radiotherapy. This study shows the technical conditions and dispositions for a better therapeutic approach in these tumours with a rapid growth.

[Benign giant epignathic teratoma in the newborn. Apropos of an unusual clinical case]. / Tératome épignathe géant bénin chez le nouveau-né. A propos d'une observation clinique exceptionnelle.

A rare case of giant epignathus teratoma with intracranial extension is reported in a male newborn. Pre-operative diagnosis of teratoma was made or suspected on radiological evidence of calcification within the tumor and increased level of alpha-foetoprotein. Optimal treatment consisted in complete surgical resection. The literature is revisited and surgical indications are discussed.

Is cancer of the prostate rare in tropical (black) Africa? Case series from the Centre Hospitalier et Universitaire and the Hospital General de Yaounde from 1986 to 1990.

The objective of this study was to determine the crude incidence of cancer of the prostate in a hospital-based population. Patients presenting at urological clinics were studied using a standard proforma. The settings included the urological outpatient clinics and hospital wards of the University Hospital Center (CHU) and the Yaounde General Hospital (HGY)--Institutions of the University of Yaounde I, Faculty of medicine and biological sciences, Centre Pasteur de Yaounde. Included were 447 new male patients over age 40, observed over a five-year period. All patients underwent standard clinical evaluation, laboratory and radiological studies. Patients with abnormal prostates, enlarged lymph nodes, metastatic bony lesions had tissue removed for histology. Seventy-two patients with abnormal prostates had them biopsied. Five had excisional biopsy of enlarged supraclavicular lymph nodes in addition to abnormal prostates. Six patients with bony lesions, elevated prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) did not have tissue diagnosis. Thirty-three patients were treated with orchidectomy and fefosterol (ST-52) and 12 with ST-52 only. Seventy-eight out of 447 patients had abnormal clinical findings. 39 of these had a tissue diagnosis of adenocarcinoma of the prostate. Six others with probable cancer of the prostate did not have a tissue diagnosis. All but one patient with stage C disease had stage D disease. The calculated age-adjusted incidence of cancer of the prostate is 93.8 cases per 100,000. Cancer of the prostate is common in the blacks of Cameroon and its incidence is increasing annually.

[Solitary extra-osseous ovarian plasmacytoma. Apropos of an unusual case in a 12 year old child]. / Le plasmocytome solitaire extraosseux ovarien. A propos d'un cas exceptionnel chez une enfant de 12 ans.

A rare case of extramedullary or solitary ovarian plasmocytoma in a 12 years old patient is reported. Surgery consisted of left adnexectomy associated with omentectomy. Chemotherapy with abdomino-pelvic iradiation were effectuated afterwards. Review of literature and therapeutic indications are discussed.