Gastric carcinoma--a big challenge in a poor economy

Gastric Cancer at a Nigerian Tertiary Referral Center: Experiences With Establishing an Institutional Cancer Registry

BACKGROUND

In Nigeria, gastric cancer is the 10th most common and 9th most deadly malignancy. The limited availability of robust data makes further characterizing it challenging. The objective of this study was to assess the presentation, and management of gastric cancer in Nigeria using an institutional cancer registry.

METHODS

We reviewed a prospective database of patients diagnosed with any gastric cancer at a single tertiary referral center over 15 years (2007-2022). Patients with suspected gastric cancer were surveyed for sociodemographics and then added to the institutional gastric cancer registry. Thereafter, periodic chart review and phone call was used to obtain investigation results, and survival data, respectively. Only patients with complete histopathology were included in analysis.

RESULTS

138 patients met inclusion criteria (mean age 55.3 years, 68.8% male). Patients typically presented with weight loss (119, 86.2%) and anorexia (92, 66.7%). Blood work (132, 95.7%) and ultrasound (80, 57.9%) were the most common investigations. Most fully staged patients presented with metastatic disease (39, 90.2%). Patients underwent at least one treatment modality (109, 79.0%), and most 54 (49.5%) underwent both chemotherapy and surgery. Patients undergoing surgery usually had resection of their tumor (58, 67.4%). The median time of follow-up was 45.6 months, and 51.4% (71) of patients were dead at that time point.

CONCLUSION

Our gastric cancer database identified that most patients present with advanced disease and are undergoing at least one treatment modality. The next steps include initiatives to strengthen the quality of registry data, identify high-risk patients, and provide timely treatment.

Impact of delayed care on surgical management of patients with gastric cancer in a low-resource setting

BACKGROUND

Gastric cancer is the fifth most common cancer in Eastern Africa. Diagnostic delays in low-resource countries result in advanced disease presentation. We describe perioperative management of gastric cancer in Rwanda.

METHODS

A retrospective review of records at three hospitals was performed to identify gastric adenocarcinoma cases from January 2012 to June 2016. Multiple perioperative and tumor-related variables were collected. Descriptive and bivariate analyses were performed.

RESULTS

The final analysis included 229 patients with gastric cancer. Median age was 58 years (interquartile range [IQR] 49-65) and 49.6% were female (n = 114). Patients reported symptoms (ie, weight loss, epigastric pain) for a median time of 12 months (IQR 7.5-24). On presentation, 18.8% ( n = 43) had gastric outlet obstruction; 13.5% ( n = 31) had a palpable mass. Fifty-one percent ( n = 117) underwent an operation; of these, 74% ( n = 86) received gastrojejunostomy or were inoperable; and 29% ( n = 34) underwent curative resection. Palliative care referrals were made for 9% ( n = 20). Pathology reports were available for 190 patients (83.0%). Only 11.3% ( n = 26) had Helicobacter pylori ( H. pylori) testing of which 65.4% tested positive ( n = 17).

CONCLUSIONS

A majority of patients presented with advanced disease. Very few patients had a curative resection. Significant advances in diagnosis and treatment are needed to improve the care of gastric cancer patients in Rwanda.

Gastric cancer in Africa: Current management and outcomes

Gastric cancer is the fourth most common cancer and second most common cause of cancer death worldwide. Globally, gastric cancer poses a significant public health burden - both economically and socially. In 2008, the economic burden from premature cancer deaths and disability was $895 billion and gastric cancer was the second highest cancer responsible for healthy life lost. With the expected increase in cancer deaths and non-communicable diseases, these costs are expected to rise and impact patient care. World Health Organization, estimates a 15% increase in non-communicable disease worldwide, with more than 20% increase occurring in Africa between 2010 and 2020. Mali, West Africa, is ranked 15^th highest incidence of gastric cancer worldwide at a rate of 20.3/100000, yet very scarce published data evaluating etiology, prevention or management exist. It is understood that risk factors of gastric cancer are multifactorial and include infectious agents (Helicobacter pylori, Epstein-Barr virus), genetic, dietary, and environmental factors (alcohol, smoking). Interestingly, African patients with gastric cancer are younger, in their 3^rd-4^th decade, and present at a late stage of the disease. There is sparse data regarding gastric cancer in Africa due to lack of data collection and under-reporting, which impacts incidence and mortality rates. Currently, GLOBOCAN, an International Agency for Research on Cancer resource, is the most comprehensive available resource allowing comparison between nations. In resource limited settings, with already restricted healthcare funding, data is needed to establish programs in Africa that increase gastric cancer awareness, curtail the economic burden, and improve patient management and survival outcomes.

Treatment of cancer in sub-Saharan Africa

Cancer is rapidly becoming a public health crisis in low-income and middle-income countries. In sub-Saharan Africa, patients often present with advanced disease. Little health-care infrastructure exists, and few personnel are available for the care of patients. Surgeons are often central to cancer care in the region, since they can be the only physician a patient sees for diagnosis, treatment (including chemotherapy), and palliative care. Poor access to surgical care is a major impediment to cancer care in sub-Saharan Africa. Additional obstacles include the cost of oncological care, poor infrastructure, and the scarcity of medical oncologists, pathologists, radiation oncologists, and other health-care workers who are needed for cancer care. We describe treatment options for patients with cancer in sub-Saharan Africa, with a focus on the role of surgery in relation to medical and radiation oncology, and argue that surgery must be included in public health efforts to improve cancer care in the region.