Pattern of occurrence of head and neck cancer presenting at Kenyatta National Hospital, Nairobi.

BACKGROUND: Currently there is a dearth of data on the pattern of occurrence of head and neck cancers in Kenya. OBJECTIVE: To provide a comprehensive analysis of the pattern of occurrence of head and neck cancers in a Kenyan population. DESIGN: Retrospective hospital-based descriptive study. SETTING: Kenyatta National Hospital, Nairobi. RESULT: A total of 793 cases were recorded consisting of 507 male and 286 female (M: F = 2:1). Most of the lesions arose from the upper aerodigestive pathway. The larynx was the most common site for aerodigestive malignancies. This was followed in order of frequency, by the tongue, the mouth, and the nasopharynx. Outside the aerodigestive pathway the eye was the most commonly affected site followed by the thyroid. Squamous cell carcinoma was the most common malignancy. Sarcomas were typically rare. Gender and age distribution showed an overall male preponderance and a wide age range. However, specific tumour sites and tumour types showed varying patterns of gender and age distribution. CONCLUSION: This study confirms the relative prominence of laryngeal, oral and nasopharyngeal cancers in the African population. It is, however, at variance with other African studies regarding the relative frequency of nasal and paranasal cancers.

Kaposis sarcoma in a Nairobi hospital.

BACKGROUND: Kaposi's sarcoma (KS) is associated epidemiologically with HIV infection and a number of countries have reported a dramatic increase in the incidence of KS with the advent of AIDS. Although AIDS is prevalent in Kenya, no studies on the impact of AIDS on the pattern of KS has been carried out. OBJECTIVE: To determine any changes in the pattern of KS that might have occurred since the advent of AIDS in the country. DESIGN: Retrospective descriptive study. SETTING: Kenyatta National Hospital (KNH). METHOD: Pathology records of cases of KS diagnosed at KNH from 1968 to 1997 were analysed with respect to relative frequency, age, sex and site distribution; and trend. The period was divided into the pre and post AIDS era from 1983, which is the time the first AIDS patient was reported in the country. RESULT: A total of 1108 cases of KS consisting of 911 males and 197 females were recorded. The relative frequency of KS ranged between 2% to 5% of the total malignancies. There was a gradual decline in the male to female ratio from about 10:1 in the sixties to about 2:1 in 1997. There was no dramatic difference in the age distribution in the pre and post AIDS era, although a large number of cases were recorded as adults without age specification in the post AIDS era. Site distribution was characteristic of the disease with most of the cases having the lesions occurring in the lower limbs and involving the skin. CONCLUSION: Although these findings do not demonstrate a dramatic alteration in the pattern of KS in the post AIDS era there were indications that such changes may have been obscured by under-reporting. The fall in the male:female ratio is a strong indication of a rise in KS among female patients. A further study is necessary to elucidate the true impact of AIDS on the pattern of KS in the country.

Oral cancer at Kenyatta National Hospital, Nairobi.

BACKGROUND: The epidemiology of oral cancer in the African population is still uncertain. Earlier reports suggested a relatively low incidence of oral cancer among Africans. However, there have been recent reports of an upward trend in the incidence of oral cancers in developing countries as a consequence of changes in life style and the emergence of new diseases. It is, therefore, reasonable to expect changes in the pattern of oral cancer in Kenya in view of these changes. OBJECTIVE: To determine changes in the pattern of oral cancer in the past 20 years. DESIGN: Retrospective descriptive study. SETTING: Kenyatta National Hospital, Nairobi. METHOD: Pathology records of cases of oral cancer diagnosed at Kenyatta National Hospital from 1978 to 1997 were analysed for relative frequency, age, sex and site distribution. RESULTS: Of a total 22,788 malignancies 821 cases (3.6%) were oral cancer. Yearly relative frequency of oral cancer ranged between 1.5% of the total malignancies. There was a small male predominance (M:F = 1.3:1). The most preferred site for oral cancer was the tongue but with a significant number involving the maxilla and mandible. Comparison with a previous study did not demonstrate a dramatic change in the pattern of oral cancer in Kenya. An overall gradual decline of cancers diagnosed at Kenyatta National Hospital was noted. This decline could not be accounted for in this study. CONCLUSION: This study does not show any increase in the frequency or change in the pattern of oral cancer in this population despite changes in life style and the emergence of AIDS disease in the country.