Pattern of paediatric solid cancers seen in radiotherapy and oncology department, Ahmadu Bello University Teaching Hospital, Zaria - Nigeria.

UNLABELLED: Summary AIMS AND OBJECTIVES: To evaluate the Pattern of Paediatric solid cancers seen over 5 years in the Radiotherapy and Oncology Department of Ahmadu Bello University Teaching Hospital, Zaria-Nigeria. MATERIALS AND METHODS: The study involved patients aged 16 years and below diagnosed with solid cancers referred to the Radiotherapy and Oncology Centre for further management. Between January 2006 and December 2010, a total of 136 new patients with paediatric solid cancers were seen and evaluated. Only patients with histological confirmation were included in the study (136 out of 141 patients) irrespective of cancer type, sex, co-morbidity and performance status. Patients' folders were reviewed retrospectively with a structured pro forma. Information retrieved from patients folder included age, sex, histological type, stage and types of treatments received. Results were presented in tables. RESULTS: A total of 136 patients were evaluated with a mean age of 6.9 years (median of 5 years, age range 1.5 - 16 years). 74 patients (54.4%) were 5 years and below and 98 patients (72%) were 10 years and below. The sex ratio M:F was 1.3:1. At presentation at the Radiotherapy and Oncology centre, only 4 (3%) patients had early stage disease, 100 (73.5%) with locally advanced disease and 32 (23.5%) with metastatic disease. Retinoblastoma 48 (35.3%) was the commonest cancer seen followed by soft tissue sarcoma 20 (14.7%, all rhabdomyosarcoma), lymphomas 15 (11%) (9 Burkitt's and 6 Hodgkin's lymphoma), nephroblastoma 13 (9.6%), bone sarcoma 12 (8.8%) (8 Osteosarcoma and 4 Ewing's sarcoma), nasopharyngeal cancers 8 (5.9%), brain cancer 6 (4.4%), sacrococcygeal tumours 6 (4.4%) and other cancers accounted for 8 (5.9%). 116 (85.3%) patients received chemotherapy, 86 (63.2%) patients were scheduled for radiotherapy but only 21 (15.4%) received local field irradiation due to financial constraints and 43 (31.6%) had definitive surgery. Palliative care with medications was done in 22 (16.2%) patients. Of 48 patients with retinoblastoma, 30 affected left eye, 16 affected right eye and 2 patients were with bilateral retinoblastoma. The mean age for retinoblastoma was 3.8 years (median age of 3 years and mode is 3 years). The mean age for rhabdomyosarcoma was 8.7 yr (median age of 6.5 years). CONCLUSION: Paediatric solid cancers were found to be more common in males than females with more than half being diagnosed in children aged 5 years and below. Retinoblastoma and rhabdomyosarcoma were the most common neoplasms. Most patients presented with locally advanced and metastatic cancers. Geographic variation exists with histological types.

Clinico-pathologic characterisation of metastatic prostate cancer in the Radiotherapy and Oncology Department, Ahmadu Bello University Teaching Hospital, Zaria-Nigeria: 2006-2009.

AIMS AND OBJECTIVES: To evaluate the Clinico-pathologic Characteristics of Metastatic prostate cancer patients seen in the Radiotherapy and Oncology Department, Ahmadu Bello University Teaching Hospital, Nigeria. MATERIALS AND METHODS: Between January 2006 and December 2009, a period of 4 years, 72 new patients with prostate cancers were seen of which 43 patients had distant metastases. Only patients with histologic confirmation of prostate cancer and having metastases were included in the study irrespective of age, co-morbidity and performance status. Patients' folders were reviewed retrospectively with a structured pro forma. Information retrieved from patient's folder included age, histology, Gleason score, co-morbidities, interval between diagnosis and referral to oncology unit, interval between referral and presentation at oncology unit, PSA at diagnosis and presentation at oncology unit, sites of metastases, bones sites involved in bone metastases, types of treatment received and follow up status. Results were analysed using Epi Info soft ware Version 3.4.1; 2007 Edition. RESULTS: 43 patients had distant metastases from prostate cancer during initial evaluation at presentation in the radiotherapy and oncology centre. The mean age was 66.2 years (range, 47-82 years, median age 66 years and modal age group was 65-69 years). Co-morbidity was seen in 18 patients, with hypertension being the commonest (HT=14, DM=2 and HIV 2 patients). No morbidity seen in 25 patients. The range of duration from diagnosis to referral was 1-84 months. Only 20 patients presented at radiotherapy and oncology centre within 6 months of diagnosis and 18 patients presented after 12 months of diagnosis. 33 patients presented within 1 month of being referred for further management. 6 patients reported within 2 months and 2 patients within 3 months and another 2 patients within 4 months. Only 27 patients had PSA done at diagnosis. No PSA was done in 16 patients. The PSA range at diagnosis was 10.0-232 ng/ml, mean PSA was 67.46 ng/ml while only 40 patients did PSA on presentation for further management with a range of 1-245 ng/ml and a mean of 57.95 ng/ml. The histology report revealed adenocarcinoma and transitional carcinoma in 42 and 1 patients respectively. The Gleason score range was 6-10, with a mean score of 7.8. The Gleason score was not reported in 3 patients. Multiple organs involvement by metastases was seen in 16 patients. Bone metastases was the commonest (35), followed by lungs (8), liver (7), Virchow's lymph nodes (6), brain (5), and soft tissue (5). The lumbar vertebrae was the commonest site of bone metastases (32) followed by the sacrum (17), pelvis (11), and long bones (7). 3 patients had metastases to the ribs and 2 patients each to the skull, sternum and cervical spines. All the patients received hormonal therapy, 30 patients received palliative radiotherapy, 29 patients had surgical castration, 25 patients had radical radiotherapy to pelvis, 18 patients had systemic chemotherapy and definitive surgery was done in 16 patients. Only 6 patients received Ibandronate due to cost. 13 patients are alive and attending follow up, 11 confirmed dead and 19 lost to follow up. CONCLUSION: The patients were referred for management late after surgery. Bones, predominately the lumbosacral spines was the commonest organ involved in metastases. Skeletal survey with bone scan and plain x-rays especially lumbosacral spines should be part of the staging investigation for all patients with advanced stage. There is need for more awareness on other treatment modalities emphasizing the multidiscipline and multimodality management of prostate cancer.

Pattern of oncologic emergencies seen in adult cancer patients attending the Radiotherapy and Oncology Centre, Ahmadu Bello University Teaching Hospital, Zaria - Nigeria.

AIMS AND OBJECTIVES: To evaluate the Pattern of Oncologic Emergencies seen in Adult cancer patients and the treatment modalities used. MATERIALS AND METHODS: Between January 2004 and December 2008, a total of 1824 (M:F = 1:1.8) new patients were seen. 196 (M:F = 1:1.4) consecutive patients with histologically confirmed malignancies presenting with or having oncologic emergencies were treated and have been reviewed. Patients' folders were reviewed retrospectively with a structured pro forma. Results were analysed using Epi Info soft ware Version 3.4.1; 2007 Edition. RESULTS: The median age was 49 years and mean age of 42 years (range, 15 - 82 years). M: F = 1:1.4. 162 patients had oncologic emergencies at presentation while 21 during treatments and 13 during follow up. At the time of diagnosis of oncologic emergency, 126 were not on any treatment, 42 patients on hormonal therapy and 28 patients were on diverse chemotherapy. All the patients presented late with 108 patients presenting with metastatic disease and 88 patients with locally advanced disease. Only 35 patients were treated within 1 week of onset of emergency. 59 patients had cervical cancer, 31 patients with breast cancer and 28 patients with prostate cancer. Tumour haemorrhage wass the commonest oncologic emergency seen in 107 patients followed by bone pain with imminent cord compression from bone metastases in 59 patients. Of 107 patients with tumour haemorrhage, 54 patients had cardiovascular collapse with 7 having acute renal failure. Similarly, of the 107 with tumour haemorrhage, 56 patients bled from cervical cancer, 12 patients from breast cancer and 8 patients from urinary bladder. 129 patients were treated with teletherapy, 31 patients had chemotherapy, 27 patients had emergency surgery and 5 patients had chemoradiation. Oncologic emergencies were corrected in 126 patients. CONCLUSION: Tumour haemorrhage is the commonest oncologic emergency in this environment and teletherapy is the commonest therapy used. More radiotherapy centres are needed for prompt treatment and their usefulness in managing emergencies should be made known. Oncologic emergencies are commonly seen in metastatic and locally advanced disease.

The pattern of chest radiographs findings in metastatic cancer patients seen in a tertiary hospital in northern Nigeria.

AIMS AND OBJECTIVES: To evaluate the pattern of chest radiographs findings in metastatic cancer patients at first presentation in a tertiary hospital in northern Nigeria with a view to contributing to existing literature and making recommendation for optimal patients care in Nigerian hospitals. PATIENTS AND METHODS: From January 2002 to December 2007, 712 new patients were seen and 688 patients' chest radiographs excluding children (below 16 yr) were reviewed of which 118 were considered abnormal due to pathology arising from primary cancer. Those Chest radiographs showing pathology not related to cancer were excluded. Results were analysed using EPI-Info, version 3.4.1. 2007. RESULTS: 118 (17%) patients' chest radiographs (CXR) were having evidence of metastases from primary cancer. The sex ratio is M: F = 1: 1.7 with a mean age of 48.1 years (Range 16 - 82 yrs). Breast cancer was the commonest cause of metastatic spread to the lungs seen in 44 (37.3%) patients followed by colorectal 10 (8.5%), soft tissue sarcoma 9 (7.6%), and bone sarcoma 8 (6.8%). Cervical cancer which was the commonest type of malignancies seen at presentation accounted only for 8 (6.7%) cases. Both lungs were involved in 62 (52.5%) patients, followed by right lung alone in 42 (35.6%) cases and left lung alone in 14 (11.9%) cases. The mid zone was the commonest site of lung metastases 102 (86.4%) followed by lower zone 42 (35.6%). Pleural effusion seen in 26 (22%) patients affected both lungs equally. Multiple lung metastases were the predominant pattern of metastases seen in 94 (80%) cases. Majority 82 (69.5%) of lungs metastases were of sizes less than 2cm. CONCLUSION: Multiple lung metastases were the commonest pattern of lung metastases. Both lungs and mid zone were mainly affected. Lung metastases were very common from breast, colorectal, bone sarcoma, prostate cancers but relatively rare from cervical, head and Neck cancers and lymphomas. Chest radiographs should be part of initial evaluation of all cancer patients.

Liver function tests profile in cancer patients on cytotoxic chemotherapy: a preliminary report.

AIMS AND OBJECTIVES: To assess liver function in Nigerian cancer patients undergoing cytotoxic chemotherapy, with a view to contributing to the existing literature and possibly making recommendations for better management of the affected patients in Nigerian hospitals. PATIENTS AND METHODS: Serum levels of total bilirubin (TB), alanine amino transferase (ALT), aspartate amino transferase (AST), alkaline phosphatase (ALP), total protein (TP), albumin (ALB) and De Ritis ratio (AST/ALT) were determined in 50 cancer patients both before and after chemotherapy and 50 age- and sex-matched control individuals. The data obtained were analysed using Microsoft Office Excel 2003. Two-tailed student's t- test for matched samples and Pearson's linear correlation statistical methods were employed for the analyses. RESULTS: The levels of serum ALT, AST, ALP and TB, ALB, TP and AST/ALT were significantly higher in cancer patients than in controls both before and after chemotherapy, with more pronounced elevations after chemotherapy. There were positive and significant correlations between cycles of chemotherapy and the serum liver function tests. CONCLUSION: The findings from the present study conclude that there is slight difference when compared to controls in liver function test profile in cancer patients even before commencement of chemotherapy with a worsening of the profile of patients after chemotherapy. This difference in liver function also increases with the cycles of chemotherapy.

Sociodemographic and clinicopathologic characterization of cervical cancers in northern Nigeria.

OBJECTIVE: To evaluate the sociodemographic and clinicopathological characteristics of patients with cervical cancer seen in a tertiary referral center in northern Nigeria. MATERIALS AND METHODS: Between January 2002 and December 2004, 70 consecutive patients with histologically confirmed cervical cancer, with a median age of 48 years (range, 30-75 years), were interviewed on the basis of a structured pro forma. RESULTS: Of these patents, 39 (56%) had had no formal education, and 36 (51%) were unemployed housewives. Sixty (86%) had become sexually active before 17 years of age; 44 (63%) were in polygamous families, and 25 (36%) patients were in at least a second marriage. There was an average of 6.8 live births per patient. Vaginal bleeding was seen in all patients, and 55 (79%) had vaginal discharges; 50 (71%) had a bulky cervical mass, and 46 (66%) presented with at least Stage IIIA disease. Squamous cell carcinoma was the commonest histology. The three HIV-seropositive patients were young and had advanced disease. CONCLUSION: Sociodemographic factors, such as low socioeconomic level, early age at first sexual intercourse and multiple sexual partners, place women at high risk of developing cervical cancer in northern Nigeria. Late presentation with advanced disease predominates.