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Udo IA, Ugochukwu O. Acute Intestinal Obstruction: A 1-Year Prospective Audit into Causes. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2023; 13:6-9. [PMID: 37538209 PMCID: PMC10395853 DOI: 10.4103/jwas.jwas_213_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/24/2023] [Indexed: 08/05/2023]
Abstract
Background Intestinal obstruction is a common general surgical emergency with high morbidity and mortality. Its aetiology varies widely between and within geographic regions, with gender, age, and time. Obstructed inguinal hernia is still considered the most common cause of intestinal obstruction in Sub-Saharan Africa and other low-income countries, but its incidence appears to be on the decrease as other causes of intestinal obstruction become more common in a particular society. Aim To examine the spectrum of causes of intestinal obstruction in a tertiary hospital in southern Nigeria and compare the results with earlier studies in the region and Nigeria. Materials and Methods A cross sectional, single-hospital study of adults diagnosed with and having clinical and radiological features of acute intestinal obstruction. Results Seventy patients were enrolled in the study, comprising of 35 (50%) males and 35 (50%) females, M:F = 1:1. The mean patient age was 44.8 years. Two peak age incidences of intestinal obstruction were observed in the 36-45 and 56-65 years age groups. Post-operative adhesion 13 (18.5%), obstructed external abdominal hernia 13 (18.5%), colonic cancer 11 (16%), and intussusception seven (10%) were the primary causes of intestinal obstruction. Obstructed inguinal hernia was commonly encountered in males while adhesions and colonic cancers were common in females. Conclusion Obstructed external abdominal hernias and post-operative adhesion are at par as the main primary causes of intestinal obstruction. Colon cancer and intussusception are increasingly causing more obstructions.
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Affiliation(s)
- Isaac Assam Udo
- Department of Surgery, University of Uyo Teaching Hospital, University of Uyo, Uyo, Nigeria
| | - Odionyeme Ugochukwu
- Department of Surgery, University of Uyo Teaching Hospital, University of Uyo, Uyo, Nigeria
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2
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Zhang L, Zheng J, Ismond KP, MacKay S, LeVatte M, Constable J, Alatise OI, Kingham TP, Wishart DS. Identification of urinary biomarkers of colorectal cancer: Towards the development of a colorectal screening test in limited resource settings. Cancer Biomark 2023; 36:17-30. [PMID: 35871322 PMCID: PMC10627333 DOI: 10.3233/cbm-220034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND African colorectal cancer (CRC) rates are rising rapidly. A low-cost CRC screening approach is needed to identify CRC from non-CRC patients who should be sent for colonoscopy (a scarcity in Africa). OBJECTIVE To identify urinary metabolite biomarkers that, combined with easy-to-measure clinical variables, would identify patients that should be further screened for CRC by colonoscopy. Ideal metabolites would be water-soluble and easily translated into a sensitive, low-cost point-of-care (POC) test. METHODS Liquid-chromatography mass spectrometry (LC-MS/MS) was used to quantify 142 metabolites in spot urine samples from 514 Nigerian CRC patients and healthy controls. Metabolite concentration data and clinical characteristics were used to determine optimal sets of biomarkers for identifying CRC from non-CRC subjects. RESULTS Our statistical analysis identified N1, N12-diacetylspermine, hippurate, p-hydroxyhippurate, and glutamate as the best metabolites to discriminate CRC patients via POC screening. Logistic regression modeling using these metabolites plus clinical data achieved an area under the receiver-operator characteristic (AUCs) curves of 89.2% for the discovery set, and 89.7% for a separate validation set. CONCLUSIONS Effective urinary biomarkers for CRC screening do exist. These results could be transferred into a simple, POC urinary test for screening CRC patients in Africa.
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Affiliation(s)
- Lun Zhang
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jiamin Zheng
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | | | - Scott MacKay
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - Marcia LeVatte
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jeremy Constable
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Olusegun Isaac Alatise
- Department of Surgery, Obafemi Awolowo University and Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David S. Wishart
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
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Ezenkwa US, Okolo CA, Ogun GO, Akere A, Ogunbiyi OJ. Cyclooxygenase-2 expression in colorectal carcinoma, adenomatous polyps and non-tumour bearing margins of resection tissues in a cohort of black Africans. PLoS One 2021; 16:e0255235. [PMID: 34314467 PMCID: PMC8315556 DOI: 10.1371/journal.pone.0255235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/12/2021] [Indexed: 01/17/2023] Open
Abstract
Background Emerging data suggest a negative role of cyclooxygenase-2 (COX-2) in colorectal carcinomas (CRC). Investigating this in developing communities such as ours helps to contribute to existing understanding of these lesions. Methods and findings Formalin-fixed paraffin-embedded CRC colectomy tissues and their corresponding non-tumour margins of resected tissues were sectioned and stained with COX-2 antibody. Adenomatous polyp tissues from non-cancer bearing individuals were similarly processed for comparison. COX-2 expression was scored for percentage (< 5% = 0; 6%-25% = 1; 26%-50% = 2; 51%-75% = 3; 76%-100% = 4) and intensity (no staining = 0; yellow = 2; yellowish-brown = 3, brown = 4). Total immunoscore (percentage + intensity score) ≥ 2 was regarded as positive COX-2 expression. Outcome was statistically evaluated with clinicopathological data to determine COX-2 expression-associated and predictor variables. Ninety-five CRC cases and 27 matched non-tumour tissues as well as 31 adenomatous polyps met the inclusion criteria. Individuals with CRC had a mean age of 56.1 ± 12.6 years while those with adenomatous polyps had a median age of 65 years (range 43–88). COX-2 was differentially overexpressed in CRCs (69/95; 72.6%) and in adenomatous polyps (17/31; 54.8%) than in non-tumour tissues 5/27 (18.5%); p < 0.001). The difference in COX-2 expression between CRC and polyps was non-significant (p > 0.065). Tumour grade, advanced pT-stage, tumour-infiltrating lymphocytes, and dirty necrosis were also significantly associated with COX-2 expression (p < 0.035; 0.043, 0.035 and 0.004, respectively). Only dirty necrosis and Crohns-like lymphocytic aggregates predicted COX-2 expression (p < 0.05). Conclusion This study showed a progressive increase in COX-2 expression from normal to adenomatous polyp and CRC tissues, this being associated with poorer prognostic indicators. Although COX-2 appears early in CRC, it may play a secondary role in promoting tumour growth and invasiveness.
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Affiliation(s)
| | - Clement Abu Okolo
- Department of Pathology, University College Hospital, Ibadan, Nigeria
| | | | - Adegboyega Akere
- Gastroenterology Unit, Department of Internal Medicine, University College Hospital Ibadan, Nigeria
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Sharma A, Alatise OI, Adisa AO, Arowolo OA, Olasehinde O, Famurewa OC, Omisore AD, Komolafe AO, Olaofe O, Katung IA, Ibikunle DA, Egberongbe AA, Olatoke SA, Agodirin SO, Adesiyun AO, Adeyeye A, Ibrahim K, Kolawole OA, Idris OL, Adejumobi MO, Ajayi IA, Olakanmi A, Constable JC, Seier K, Gonen M, Brennan M, Kingham T. Treatment of colorectal cancer in Sub-Saharan Africa: Results from a prospective Nigerian hospital registry. J Surg Oncol 2020; 121:342-349. [PMID: 31742699 PMCID: PMC7405945 DOI: 10.1002/jso.25768] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/02/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most common cancer worldwide. Mortality for CRC is improving in high income countries, but in low and middle income countries, rates of disease and death from disease are rising. In Sub-Saharan Africa, the ratio of CRC mortality to incidence is the highest in the world. This study investigated the nature of CRC treatment currently being offered and received in Nigeria. METHODS Between April 2013 and October 2017, a prospective study of consecutively diagnosed cases of CRC was conducted. Patient demographics, clinical features, and treatment recommended and received was recorded for each case. Patients were followed during the study period every 3 months or until death. RESULTS Three hundred patients were included in our analysis. Seventy-one percent of patients received a recommended surgical operation. Of those that didn't undergo surgery as recommended, 37% cited cost as the main reason, 30% declined due to personal reasons, and less than 5% absconded or were lost to follow up. Approximately half of patients (50.5%) received a chemotherapy regimen when it was recommended, and 4.1% received radiotherapy when this was advised as optimal treatment. With therapy, the median overall survival for patients diagnosed with stage III and stage IV CRC was 24 and 10.5 months respectively. Overall, we found significantly better median survival for patients that received the recommended treatment (25 vs 7 months; P < .01). CONCLUSIONS A number of patients were unable to receive the recommended treatment, reflecting some of the burden of untreated CRC in the region. Receiving the recommended treatment was associated with a significant difference in outcome. Improved healthcare financing, literacy, training, access, and a better understanding of tumor biology will be necessary to address this discrepancy.
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Affiliation(s)
- A. Sharma
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - A. O. Adisa
- Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | | | | | | | - O. Olaofe
- Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | | | | | | | | | - A. Adeyeye
- University Teaching Hospital, Ilorin, Nigeria
| | - K. Ibrahim
- University Teaching Hospital, Ilorin, Nigeria
| | | | - O. L. Idris
- Lautech University Hospital, Osogbo, Nigeria
| | | | - I. A. Ajayi
- Lautech University Hospital, Osogbo, Nigeria
| | - A.O. Olakanmi
- Department of Surgery, University of Medical Sciences Teaching Hospitals’ Complex, Ondo, Nigeria
| | - J. C. Constable
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - K. Seier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M. Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M.F Brennan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T.P Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Yorke J, Acheampong E, Batu EN, Obirikorang C, Yeboah FA, Asamoah EA. Quality of life of colorectal cancer survivors in a Ghanaian population. BMC Res Notes 2019; 12:781. [PMID: 31783908 PMCID: PMC6884899 DOI: 10.1186/s13104-019-4817-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 11/18/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We collected data to evaluate the quality of life of patients who have survived between one and 8 years from the diagnosis of colorectal cancer. DATA DESCRIPTION We collected quality of life (QoL) data from colorectal patients who were diagnosed between 2009 and 2015 at the Komfo Anokye Teaching Hospital (KATH) and have survived until January 2017. The dataset consists of patients' demographic data, clinicopathological characteristics, and QoL data. The validated QoL instruments for data curation was an adopted version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-CR29. The QLQ-C30 was a 30-item general cancer instrument with 5 functional subscales, and 9 symptom subscales, whereas the QLQ-CR29 was a 29-item scale that consisted of 3 functional QOL subscales and 14 symptom subscales, that are associated with colorectal cancer and its treatment. The QoL instrument was coded such that higher scores indicated increased function and better QoL, and higher symptom scores represent worse symptoms.
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Affiliation(s)
- Joseph Yorke
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Emmanuel Acheampong
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
| | - Emmanuella Nsenbah Batu
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Christian Obirikorang
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Francis Agyemang Yeboah
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Evans Adu Asamoah
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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Kayamba V, Nicholls K, Morgan C, Kelly P. A seven-year retrospective review of colonoscopy records from a single centre in Zambia. Malawi Med J 2018; 30:17-21. [PMID: 29868154 PMCID: PMC5974381 DOI: 10.4314/mmj.v30i1.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction Colorectal disease is common throughout the world, but the spectrum of diagnoses across Africa remains largely unexplored. There is anecdotal evidence of changing colorectal disease but this has not been systematically investigated. The aim of this study was to enhance our insight into the spectrum of colonoscopic diagnoses in Zambia. Methods We retrieved written colonoscopy reports from January 2008 to December 2015. Collected data were coded by experienced endoscopists and analysed by age, sex, referral source, indication and diagnosis. Results Included in this analysis were 573 colonoscopy reports. The most common diagnosis was haemorrhoids (n=151, 26%), followed by tumours (n=96,17%). Over this time period, the proportion of normal colonoscopies decreased by 32% (P<0.001), presumably due to introduction of screening of all requests, while the rate of polyp detection increased from 5% to 10% (P=0.006). The detection of polyps was highest in patients less than 16 years (OR 8.4; 95% CI 2.4–26.2, P<0.001). Of those with colorectal tumours, 33/96 (35%) were less than 45 years although the occurrence was higher with advancing age (P=0.02). Diverticular disease was more common in older age groups (median (IQR) age 70 (60–75) years, versus 47 (34–62) years for those without the disease; P=0.0001). Conclusion This audit has shown that more than a third of colorectal tumours seen during colonoscopy are in patients below the age of 45 years, with the occurrence of polyps being highest in those below 16 years. Diverticular disease is most common in older age groups.
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Affiliation(s)
- Violet Kayamba
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Kate Nicholls
- Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, United Kingdom
| | - Catrin Morgan
- Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, United Kingdom
| | - Paul Kelly
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia.,Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, United Kingdom
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Agyemang-Yeboah F, Yorke J, Obirikorang C, Batu EN, Acheampong E, Frempong EA, Anto EO, Amankwaa B. Patterns and presentations of colorectal cancer at Komfo-Anokye teaching hospital Kumasi, Ghana. Pan Afr Med J 2017. [PMID: 29515739 PMCID: PMC5837135 DOI: 10.11604/pamj.2017.28.121.12927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction Colorectal cancer is a major cause of morbidity and mortality globally and its incidence is increasing in developing countries. This study determined the incidence, clinical features and the histopathological patterns of colorectal cancer at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Methods A retrospective review of all colorectal cancer cases over a six year period from (2009-2015) presented to the Surgical and Oncological Department of KATH. Patients' records were retrieved and information on their demographics, clinical and pathological presentations recorded. Results In all, 221 cases of colorectal cancer were identified over the study period. The mean age was 54 ± 16.8 and ranged from 16 to 90 years. Sixteen (7.24%) had family history of cancer and the prevalence of comorbidities was (24.89%). The commonest clinical symptoms presented were weight loss (44.80%), bleeding per rectum (39.82%) and abdominal pain (38.91%) Majority of the patients presented with rectal cancers (48.87%). Microscopically, adenocarcinoma (68.33%) was the most common histopathological type. According to Tumour Node Metastasis (TNM) staging of cancer, majority of the patients 89(40.27%) were identified as being in late stage (TNM Stage III). The overall crude annual incidence was 4.62 per 100000 populations. The age specific standardized incidence rate was 7.93 per 100,000 population Conclusion This study has clearly showed a high incidence in colorectal cancer at KATH, with similar trends in clinico-pathological patterns comparable to that of most African countries. These include predominance of rectal cancers, high incidence among younger people and delayed presentation of the disease at advanced stage.
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Affiliation(s)
- Francis Agyemang-Yeboah
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Joseph Yorke
- Department of Surgery, School of Medical Science Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Christian Obirikorang
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Emmanuella Nsenbah Batu
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Emmanuel Acheampong
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | | | - Enoch Odame Anto
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Bright Amankwaa
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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Abstract
It seems not too long ago that colon and rectal cancer is a "rare" disease in rural Africa; however, over the last 30 years in West Africa, published evidence has shown decade by decade increases in the incidence of colorectal cancer (CRC). Therefore, CRC should now be accepted as a recognized disease in native Africans; nevertheless, we must acknowledge that the incidence is a fraction of what obtains in the developed countries of Europe and America. This presentation will attempt to examine the emergence of CRC within the West African axis over the last four decades.
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Affiliation(s)
- David O. Irabor
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Ayandipo O, Irabor DO, Afuwape O, Ladipo J, Abdurrazzaaq A. Abdomino-Perineal Resection for Low Rectal and Anal Malignancies in Ibadan, SOUTHWEST NIGERIA. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2013; 3:88-101. [PMID: 25717465 PMCID: PMC4337207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Colonic tumours are the third most common tumours in the Nigerian cancer registry after breast and cervical carcinoma. Tumours involving the distal rectum and anus are increasingly a significant portion of all colorectal and anal malignancies in Nigeria. The patients frequently present with advanced disease. Abdomino-Perineal resection (APR), is thus an essential modality of treatment alongside chemo-radiation. The aim of the study was to review the surgical outcomes of APR done for low rectal and anal malignancies in a resource poor setting in sub-Saharan Africa. MATERIALS AND METHODS The demographic data, clinical features, management offered and outcomes of all patients who had had abdomino-perineal resection for colonic and anal malignancies at the University College Hospital, Ibadan, Nigeria between 2007 and 2013 were included in this study. RESULTS Over the 6-year period, 61 patients had abdomino-perineal resection for low colonic and anal malignancies in our institution. The indications were primary rectal carcinoma in 46 (75.4%) patients and anal carcinoma in 15 (24.6%) patients. The age ranged from 19-77 years with a mean of 48 years and median of 54 years. Majority were males in 33 (54.1%) patients. A fifth (20%) of the patients presented as emergency with large bowel obstruction that necessitated initial colostomy. Bleeding per rectum in 45 patients (73.8%), Weight loss in 26 patients (42.6%) and Tenesmus in 16 patients (26.2%) patients were the predominant complaints. All the patients were at stage AJCC 2A-3C (Duke Stage C or D) at presentation. Almost a third (66%) of the patients was incontinent of feaces. Palliative surgery was done for all the patients. The duration of follow up was between 3-36 months with a mean of 22 months. A total of 53 (86.9%) patients are alive after an average post-operative duration of 24 months, with 14 pts (23%) having local recurrence, and 22(36.1%) patients with hepatic metastases. Lymph nodal involvement was statistically significantly related to the survival status of the patients. Neo-adjuvant and adjuvant chemo-radiation did not affect outcomes in terms of local recurrence and survival. CONCLUSION Abdomino-perineal resection is still the option of treatment in this environment for low rectal and anal malignancies in this environment. Early presentation and effective treatment shall improve the outcome.
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Colorectal carcinoma: why is there a lower incidence in Nigerians when compared to Caucasians? J Cancer Epidemiol 2011; 2011:675154. [PMID: 22253627 PMCID: PMC3255166 DOI: 10.1155/2011/675154] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 10/31/2011] [Accepted: 11/14/2011] [Indexed: 01/28/2023] Open
Abstract
Carcinoma of the colon and rectum is the 2nd commonest cancer in the United States; the leading cancer being lung cancer. It has been estimated that 130,200 new cases of colorectal cancer will be diagnosed annually while 56,300 sufferers will die from the disease (Murphy et al., 2000). In developing countries especially West Africa, the rate has not yet reached such magnitude. This suggests that there may be factors either anthropomorphic or environmental which may be responsible for this. The paper acknowledges the reduced incidence of colorectal cancer in native West Africans living in Africa and endeavours to highlight the various factors that produce this observation in medical literature. A diligent search through available literature on the aetiology, epidemiology and comparative anthropology of colorectal cancer was done. Internet search using PubMed, British Library Online and Google Scholar was also utilized. The rarity of adenomatous polyposis syndromes in the native West African contributes to the reduced incidence of colorectal cancer. Cancer prevention and cancer-protective factors are deemed to lie in the starchy, high-fiber, spicy, peppery foodstuff low in animal protein which many West African nations consume.
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Osuagwu CC, Okafor OC, Ezeome ER, Uche CE, Ememonu C, Kesieme E. Familial Adenomatous Polyposis with Synchronous Invasive Colonic Carcinomas and Metastatic Jejunal Adenocarcinoma in a Nigerian Male. Rare Tumors 2010. [DOI: 10.4081/rt-2010-4-e66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Familial adenomatous polyposis is rare. Three cases were previously reported in Nigeria. An intriguing feature of this case is an ulcerated jejunal carcinoma which was metastatic rather than synchronous carcinoma. This patient presented with partial large bowel obstruction and the pathological analysis revealed 4 invasive adenocarcinomas, 3 in the colon and 1 in the jejunum (Dukes stage D). Palliative pancolectomy and jejunal tumour resection with chemotherapy was offered to him. He died eight months after surgery from disease progression. The challenges of managing a hereditary cancer syndrome in a resource poor country are highlighted.
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Affiliation(s)
| | - Okechukwu C. Okafor
- Department of Morbid Anatomy, University
of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
| | - Emmanuel R. Ezeome
- Department of Surgery, University of
Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
| | - Chrisogonus E. Uche
- Department of Surgery, Imo State
University Teaching Hospital, Orlu, Imo state, Nigeria
| | - Charles Ememonu
- Department of Surgery, Imo State
University Teaching Hospital, Orlu, Imo state, Nigeria
| | - Emeka Kesieme
- Department of Surgery, Imo State
University Teaching Hospital, Orlu, Imo state, Nigeria
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