THE DISTRIBUTION, HISTOLOGIC PROFILE AND CLINICAL PRESENTATION OF GASTROINTESTINAL MALIGNANCIES IN LAGOS, NIGERIA.

BACKGROUND: Gastrointestinal malignancies have continued to record higher incidence and therefore pose significant public health burden in terms of morbidity and mortality. AIM: To evaluate the sociodemographic, histologic and clinical distribution of patients with gastrointestinal malignancies diagnosed between July 2009 and March 2016. SETTING: Lagos University Teaching Hospital, Idi-Araba, south-west Nigeria. METHODOLOGY: Using a retrospective study design, all the patients with histologic diagnosis of gastrointestinal malignancies were recruited and their bio-data, clinical, histologic and treatment data were extracted from their hospital records. RESULTS: Of the 106 cases of gastrointestinal malignancies in this study, the age range was 30-82 years with a mean of 55.9±13 years and a peak age bracket of 50-59 years; the male/female ratio was 1.2:1. The most common sites were colorectum (79.3%), stomach (7.6%), anus (6.6%), liver (4.7%), and pancreas (0.9%). Adenocarcinoma was the most common histologic subtype (89.62%), followed by squamous cell carcinoma (2.83%) and gastrointestinal stromal tumors (1.89%). The most common complaints were abdominal pain (54.7%), constipation (38.7%), palpable abdominal swelling/masses (35.9%), bleeding (33.0%), and weight loss (17.0%). The tumors were treated with chemotherapy, surgery, and radiotherapy, either singly or in combination, in 97.2%, 83.0%, and 30.2% respectively. CONCLUSION: In this study, colorectal cancers are still the most prevalent type of gastrointestinal malignancies with a male preponderance, and individuals between 40-59 years are at greater risk. The significant involvement of individuals who constitute the bulk of the workforce and are the most productive labor in the country points at the need to develop strategies aimed at reducing the incidence of gastrointestinal malignancies.

Incidence of Hydronephrosis in Cervical Cancer Patients in A Tertiary Hospital Lagog, Nigeria.

BACKGROUND: Cervical cancer is still a global health challenge that affects women of reproductive age group and consequently causes a drawback on the social and economic stability of nations. Developing countries suffer a greater burden of the disease because of several factors such as poverty, multiple sexual partners, unbalanced diet, poor knowledge and attitude to prevention of diseases and late-presentation. OBJECTIVE: The aim of this study is to evaluate the incidence of hydronephrosis in cervical cancer patients in Lagos University Teaching Hospital (LUTH), Lagos, Nigeria for the period of 3 years (2010-2012). METHOD: This study is a cross sectional study carried out among cervical cancer patients seeking treatment in the Radiotherapy department of the Lagos University Teaching Hospital (LUTH), between the year 2010 and 2012, to find out the incidence of hydronephrosis using abdominopelvic ultrasonography. RESULTS: The incidence of hydronephrosis during the 3years period studied was 43.7%. A rise in the incidence of hydronephrosis of 5.4% in 2011 and 13.3% in 2012 was noted. The mean age of the patients was 55.5 years. 122 (56.7%) were grand multiparous and 123 (57.2%) had multiple sexual partners. An increase of 8.3% in 2011 and 9.3% in 2012 was noted in the incidence of cervical cancer cases studied. 107 (49.8%) presented at stages III and IV. CONCLUSION: Late presentation of patients is still a major challenge affecting treatment outcomes. The presence of hydronephrosis was noticed at staging, during or after treatment, resulting in the need to separate this population from current Stage IIIB classification. The presence of hydronephrosis may or may not be related to the disease and so adequate staging is important.

DESMOPLASTIC SMALL ROUND BLUE CELL TUMOUR OF THE ABDOMEN - A CASE REPORT.

Desmoplastic Small Round Cell Tumour (DSRCT) is an uncommon malignant type of Small Round Blue Cell tumours with less than 200 cases reported in literature. Notorious for its aggressiveness, its commonest site of affectation is the abdomen, with a predilection for peritoneal cavity and prone to spread to multiple organs. We report a case of a 26-year old male undergraduate who presented with a 6-month history of progressive abdominal swelling associated with abdominal pain, weight loss, and change in bowel habits. He was cachectic with dyspnoea, bilateral pitting pedal oedema, a grossly distended and a palpable huge firm mass measuring 20 x 15cm. Immunohistochemisttry confirmed a diagnosis of DSRCT. An abdominopelvic Computed Tomography (CT) scan showed extensive abdominal and pelvic disease with pulmonary and liver metastases. He could only tolerate one course of chemotherapy due to deteriorating renal function. It ran an aggressive course of 9 months from onset of symptoms to eventual demise of the patient. CONCLUSION: Desmoplastic Small Round Blue Cell Tumour is an uncommon and fatal disease, with no significant improvement in survival despite aggressive multimodality therapy. A high index of suspicion and Immunohistochemistry for accurate diagnosis as well as prompt and effective treatment will improve outcome.

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.

Carcinoma of the penis: experience from the Lagos University Teaching Hospital Lagos, Nigeria.

BACKGROUND: Carcinoma of penis is rare in countries where neonatal mate circumcision is the tradition and in Nigeria it is a common practice amongst almost all the tribes. OBJECTIVE: This is to document the prevalence, age distribution, site and histologic types of penile carcinoma at the Lagos University Teaching Hospital Idi-Araba over a 20 year period. METHODS: Cases of the penile carcinoma recorded in the surgical pathology register of the Department of Morbid Anatomy, the Cancer Registry and the Medical Records Department of the Lagos University Teaching Hospital over a twenty year period were reviewed. Information extracted included the age, site of lesion, and histopathologic type. The histopathology slides were reexamined to confirm the diagnosis and to grade the lesion. The data was analyzed using simple statistical methods. RESULTS: There were 7 cases of carcinoma of the penis accounting for 1.9% of malignant lesions of the male genital tracts in LUTH, 3 (42.85%) of which were on the shaft of the penis. The ages of the patients ranged from 42-79 years with a mean of 52.2 years, majority (42.92) of the cases were inthe 5th decade. All the cases were well differentiated squamous cell carcinomas. CONCLUSION: Carcinoma of the penis is rare in Lagos, Nigeria. This may be attributed to the common practice of neonatal male circumcision in Nigeria.

Clinico-pathological review of malignant gastric tumours in Lagos, Nigeria.

BACKGROUND: Gastric cancer is one of the most common cancers and the 2d most common cause of cancer deaths worldwide. Contrary to earlier reports from Africa, prevalence of this cancer has been found to be comparable to that of other parts of the world. OBJECTIVE: To describe the clinico-pathological features of gastric cancer diagnosed in Lagos and determine the prevalence of H. pylori infection in gastric adenocarcinoma. METHODS: This was a retrospective histopathological study of all gastric cancer seen between 1995 and 2007 in the Morbid Anatomy Department of Lagos University Teaching Hospital as well as two other private histopathology laboratories in Lagos (2002-2007). The blocks and slides of gastric cancer tissue were the materials used for the study. The patients' bio data and relevant clinical details were extracted from the demographic records. RESULTS: There were 105 cases of gastric cancer (M:F = 2:1, mean age-55.3 years), 81% of which occurred above 45 yrs. There were 95 cases (90%) of adenocarcinomas, 8 (7.6%) mesenchymal tumours with one case each of small cell non-Hodgkin's lymphoma and carcinoid tumour. H. pylori was detected in 15.5% of 45 cases of adenocarcinoma with 36% showing evidence of chronic gastritis in adjacent non cancerous gastric tissue. All patients with clinical data had one or more alarm features; most recurring being abdominal fullness, recurrent vomiting, anorexia and weight loss. CONCLUSION: This study suggests that gastric malignancies are not uncommon in Lagos and often manifest with alarm features which should raise a suspicion particularly in our setting with poor diagnostic endoscopic facilities.

Clinico-pathological review of malignant gastric tumours in Lagos, Nigeria

Gastric cancer is one of the most common cancers and the 2d most common cause of cancer deaths worldwide. Contrary to earlier reports from Africa;prevalence of this cancer has been found to be comparable to that of other parts of the world.To describe the clinico-pathological features of gastric cancer diagnosed in Lagos and determine the prevalence of H. pylori infection in gastric adenocarcinoma.This was a retrospective histopathological study of all gastric cancer seen between 1995 and 2007 in the Morbid Anatomy Department of Lagos University Teaching Hospital as well as two other private histopathology laboratories in Lagos (2002-2007). The blocks and slides of gastric cancer tissue were the materials used for the study. The patients' bio data and relevant clinical details were extracted from the demographic records.There were 105 cases of gastric cancer (M:F = 2:1; mean age-55.3 years); 81of which occurred above 45 yrs. There were 95 cases (90) of adenocarcinomas; 8 (7.6) mesenchymal tumours with one case each of small cell non-Hodgkin's lymphoma and carcinoid tumour. H. pylori was detected in 15.5of 45 cases of adenocarcinoma with 36 showing evidence of chronic gastritis in adjacent non cancerous gastric tissue. All patients with clinical data had one or more alarm features; most recurring being abdominal fullness; recurrent vomiting; anorexia and weight loss.This study suggests that gastric malignancies are not uncommon in Lagos and often manifest with alarm features which should raise a suspicion particularly in our setting with poor diagnostic endoscopic facilities

Potential health risks due to telecommunications radiofrequency radiation exposures in Lagos State Nigeria.

BACKGROUND: The global system mobile telecommunications system (GSM) which was recently introduced in Nigeria is now being used by over 40 million people in Nigeria. The use of GSM is accompanied with exposure of the users to radiofrequency radiation (RFR), which if significant, may produce health hazards. This is the reason why many relevant national and international organizations recommended exposure limits to RFR and why it is made compulsory for GSM handsets to indicate the maximum power output as a guide to potential consumers. OBJECTIVE: This study was conducted to measure the RFR output power densities (S) from the most commonly used GSM handsets used in Lagos State and compare with the limit recommended for safety assessment. METHODS: Over 1100 most commonly used handsets of different makes and models as well as wireless phones were sampled and studied in all over the local government areas of the State. An RFR meter, Electrosmog from LESSEMF USA was used for the measurements. The handsets were assessed for health risks using the reference value of 9 Wm(-2) as recommended by the International Commission on Non-Ionizing Radiation Protection (ICNIRP). RESULTS: The range of the S-values obtained varied from a minimum of 1.294 0.101 Wm(-2) with Siemens model R228 to a maximum of 16.813 +/- 0.094 Wm(-2) with Samsung model C140*. The results from wireless telephones showed very low S-values ranging from a minimum of 0.024 +/- 0.001 Wm(-2) with HUAWEI and ST CDMA 1 to a maximum of 0.093 +/- 0.002 Wm(-2) with HISENSE. CONCLUSION: The results showed that the population in Lagos State may be at risk due to significant RFR exposures resulting principally from the use of GSM. Quite a number of handsets emit power above the ICNIRP recommended value. Measured RFR power close to Radio and Television masts and transmitters are within tolerable limits in most cases, only that the public should not reside or work close to RFR installations. Phone calls with GSM should be restricted to essential ones while youths and children that are more susceptible to RFR hazards should be supervised in their use of GSM. Wireless phones are quite safe.

Metastatic alveolar rhabdomyosarcoma to the breast: a case report.

OBJECTIVE: To present the unusual occurrence of a Metastatic Alveolar Rhabdomyosarcoma to the right breast in a young woman, six years after the primary in the right thigh had been surgically excised and treated. A search of the literature from this part of the world showed that this is quite rare as no report of a similar case was found. METHODOLOGY: Breast lumpectomy samples submitted were routinely processed to obtain paraffin sections which were then stained routinely with haematoxylin and eosin. Reticulin stain and immunohistochemistry were used to exclude an epithelial lesion. CONCLUSION: Metastatic Rhabdomyosarcoma to the breast is a rare condition and is almost exclusive to adolescent females. Routine breast examinations should be mandatory for long term female survivors of primary Rhabdomyosarcomas.

Post irradiation hearing loss in head/neck patients in Lagos; Nigeria

A prospective study was conducted at Lagos University Teaching Hospital on patients with malignancies of the head and neck region treated with external beam irradiation type and severity of hearing loss. Each patient had a preirradiation and post irradiation pure tone audiogram at 3 weeks; 8 weeks and 6 months. Following completion of radiotherapy serial post irradiation audiogram threshold was compared with pre-treatment threshold. An increase of 10 dB HL (decibel hearing level) or greater was considered significant. Radiation dose ranged from 45-55Gy in twenty to twenty-five fractions per weeks over four to five weeks treatment. Patients that received chemotherapy as adjunctive to therapy during the period of the study were excluded. A total of 40 patients (80 ears) completed the audiological follow up out of ninety four patients seen during the study period .Age ranged between 4-79 years. The tumor site distribution showed 20

Pattern of head and neck cancers among Nigerians in Lagos.

Three hundred and eight-one cases of head and neck cancers were studied over a 10 year period (1988 - 1998) at the Lagos University Teaching Hospital, Lagos. The aim was to assess the various sites of primary lesion, gender and age distribution and histopathological types. The International Classification of Diagnosis Oncology's (ICDO) 9TH version was used to categorize sites of primary lesion. A yearly incidence of 38 cases was noted with an overall male preponderance. Forty-five percent of the patients with head and neck cancers were in their forth and fifth decades of life. The nasopharynx was the commonest site of primary lesion (16.8%) followed by the nose, paranasal sinuses and middle ear (ICDO - 160) with 13.6%. Laryngeal cancer ranked third accounting for 12.1% of the cases. Other common sites of primary lesion were: the skin (9.2%), the salivary glands (7.6%), the mandible (7.3%) and the thyroid gland (7.3%). Metastatic cancer in the neck with unknown primary lesion was seen in 2.9% of the patients. Cancers associated with heavy tobacco use e.g. laryngeal cancers, lip and tongue cancers showed a very high male predilection with M:F ratios of 10.5:1, 8:1 and 6:1 respectively. 91% of the head and neck cancers were of epithelial tissue origin while sarcomas accounted for only 6.6% of the cases. The results show that head and neck cancers affect Nigerians especially males at the prime of their working life. The devastating psychosocial effects on the individual, the family and the society are enormous. Emphasis on cancer prevention is recommended.

Fear of mastectomy: the most common factor responsible for late presentation of carcinoma of the breast in Nigeria.

Of 2154 Nigerian breast cancer patients of all ages and socio-economic groups, 87% presented in Stages III or IV and only 13% in Stages I or II. All were questioned on their reasons for not attending hospital sooner. Questionnaires were used and were adequately translated to illiterate patients. The most common reason for delay (963 patients, 44.7%) was fear of mastectomy. Other reasons given include preference for prayer houses or spiritual healing homes in 291 patients (13.5%) a belief that the lesion was inflammatory in 183 (8.5%), preference for native doctors or herbalists in 497 (23.1%) and economic reasons in 220 (10.2%).

Chemotherapy of breast cancer in Nigerians: side-effects and quality of life.

Fifty-seven breast cancer patients under follow-up between 1987 and 1988 at the Radiotherapy Department, Lagos University Teaching Hospital following mastectomy and radiotherapy were given combination chemotherapy as adjuvant therapy or as a result of recurrent disease. With the use of a detailed questionnaire the side-effects and reactions to chemotherapy were assessed. Apart from disturbances of menstruation in 24 (53.3%) of the 45 premenopausal patients, the majority of patients tolerated treatment very well, whilst the side-effects that occurred were limited. Nigerian women may be more tolerant to the side-effects of chemotherapy than those women living in developed countries.