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Baldwin M, Niyibizi BA, Rangira D, Rangira B, Kazindu MK, Seifu D, Stefan CD, Rugengamanzi E, Manirakiza AVC. Colorectal cancer disease profile and treatment patterns at an urban tertiary hospital in Rwanda. Ecancermedicalscience 2024; 18:1687. [PMID: 38566760 PMCID: PMC10984839 DOI: 10.3332/ecancer.2024.1687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Indexed: 04/04/2024] Open
Abstract
Background The incidence of colorectal cancer (CRC) in sub-Saharan Africa (SSA) is rising, due to improving cancer registration efforts on one hand and an increasing westernisation of diets and lifestyle on the other as well as increasing rates of comorbidities. Methods We present data for the clinical characteristics, pathology, treatments received, and survival outcomes of patients diagnosed with CRC at King Faisal Hospital (KFH) between January 2019 and May 2023. KFH is an urban tertiary hospital in Rwanda that provides chemotherapy and surgery to cancer patients. The data were extracted from electronic medical records, imaging and histopathology reports from the patient's time of diagnosis. We plotted Kaplan-Meier estimation of survival, defined as the time from presentation to death, within the study period (2019-2023). Results Seventy-four patients diagnosed with CRC with complete information were identified in the KFH oncology records. The mean age at diagnosis was 54.6 years, with ages ranging between 22 and 81 years. At diagnosis, 24 (32.4%) patients were less than 50 years old and 29 (39.2%) were females. The rectum (36.5%) was the most common tumour location, and 58.1 tumours were left-sided. Most patients presented with Stage III (41.9%) or IV (35.1%) disease. Adenocarcinoma was the most common histological type (98.6%) including adenocarcinoma not otherwise specified (NOS) (86.5%), mucinous adenocarcinoma (10.8%), signet ring cell carcinoma (1.4%) and followed by squamous cell carcinoma (1.4%). In terms of treatment, 19 (25.7%) patients received only chemotherapy, 43 (58.1%) patients received neo-adjuvant or adjuvant chemotherapy, 9 (12.2%) of patients received both neo-adjuvant and adjuvant chemotherapy, 49 patients (66.2%) underwent surgery and 17 (23%) patients also received radiation. At the end of the follow up period, 63 (85.1%) patients remained in surveillance, 10 (13.5%) patients died, and 1 (1.3%) patient was lost to follow up. Mean overall survival was 45.5 (SD ± 2.0) months. Conclusion CRC patients presented at an advanced stage and required complex treatment regimens at KFH. Further epidemiologic and molecular research is needed to characterise CRC incidence and presentation at a national level in Rwanda as increasing westernisation continues to change the face of CRC in urban areas of SSA.
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Affiliation(s)
- Margaret Baldwin
- UT Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9003, USA
| | | | - Daniella Rangira
- Rwanda Cancer Relief, P.O BOX 4016, Kigali, Rwanda
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, Canada
| | - Benita Rangira
- Rwanda Cancer Relief, P.O BOX 4016, Kigali, Rwanda
- Wayne State Center for Urban Studies, 5700 Cass Ave, Detroit, MI, USA
| | - Madeleine K Kazindu
- Rwamagana Provincial Hospital, P.O.Box 06, Rwamagana, Eastern Province, Rwanda
| | - Daniel Seifu
- School of Medicine, University of Global Health Equity, P.O.Box 6955, Kigali, Rwanda
| | - Cristina Daniela Stefan
- SingHealth Duke NUS, Singapore 169857, Singapore
- University of Medicine and Pharmacy C Davila, Dionisie Lupu Street, no. 37, Sector 2, Bucharest, 4192910, Romania
- African Medical Research and Innovation Institute, Tafelberg Rd 73, Cape Town 7550 SA
| | - Eulade Rugengamanzi
- Butaro Cancer Center of Excellence, Burera District, PO Box 59, Musanze, Rwanda
| | - Achille V C Manirakiza
- Oncology Unit, Department of Medicine, King Faisal Hospital, KG 546 St, PO Box 2534, Kigali, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, PO Box. 3286, Kigali, Rwanda
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Akoko L, Brand N, Kotecha V, Byabato S, Ndumbalo J, Mwashambwa M, Mwakigonja A, Lowry A. Colorectal cancer in Tanzania: the current status and future directions. Ecancermedicalscience 2023; 17:1564. [PMID: 37396097 PMCID: PMC10310332 DOI: 10.3332/ecancer.2023.1564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Globally, colorectal cancer (CRC) is the third most common malignancy and the second most common cause of cancer death. By 2030, the incidence is expected to increase to reach 2.2 million cases and 1.1 million deaths. In Sub-Saharan Africa, accurate cancer incidence data is limited, but anecdotally, clinicians note a significant rise in the incidence of CRC in the past decade. To educate clinicians on the growing burden of CRC, the Tanzanian Surgical Association hosted a 4-day CRC symposium from 3rd to 6th October 2022. Following the meeting, a group of multidisciplinary stakeholders created a working group whose first task was to assess the epidemiology, presentation and available resources for CRC care in Tanzania. The findings of that assessment are described in this article. Findings The true incidence of CRC in Tanzania is currently unknown. However, individual high-volume centres have noted a dramatic rise in cases of colon and rectal cancer on their wards. A review of the published data on CRC in Tanzania showed that most patients present with CRC late and the limited availability of endoscopic and diagnostic services poses a challenge for accurately staging these patients prior to treatment. Multidisciplinary care, including surgery, chemotherapy and radiation, is available for the treatment of CRC in Tanzania, although the capacity and quality of these services vary throughout the country. Conclusion There is a substantial burden of CRC in Tanzania that appears to be increasing. While there is capacity in the country to provide all aspects of multidisciplinary care, late presentation, limited access to diagnostic and treatment services and poor coordination continue to be significant barriers to providing optimal treatment to these patients.
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Affiliation(s)
- Larry Akoko
- Department of Surgery, Muhimbili University for Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
- Larry Akoko and Nathan Brand contributed equally and are designated as co-first authors
| | - Nathan Brand
- Department of Surgery, Muhimbili University for Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
- Department of Surgery, University of California San Francisco, San Francisco, CA 94115, USA
- Larry Akoko and Nathan Brand contributed equally and are designated as co-first authors
| | - Vihar Kotecha
- Department of Surgery, Catholic University for Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania
| | - Sam Byabato
- Department of Surgery, Catholic University for Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania
| | - Jerry Ndumbalo
- Clinical Oncology Department, Ocean Road Cancer Institute, PO Box 3592, Dar es Salaam, Tanzania
| | - Masumbuko Mwashambwa
- Department of Surgery, University of Dodoma School of Medicine and Dentistry, Dodoma 41218, Tanzania
| | - Amos Mwakigonja
- Department of Pathology, Muhimbili University for Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Ann Lowry
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
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Anugwom C, Braimoh G, Sultan A, Johnson WM, Debes JD, Mohammed A. Epidemiology and genetics of early onset colorectal cancer—African overview with a focus on Ethiopia. Semin Oncol 2023:S0093-7754(23)00040-4. [PMID: 37032270 DOI: 10.1053/j.seminoncol.2023.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
Colorectal cancer (CRC) is a common cause of cancer-related death worldwide, with high rates of late diagnosis and increased mortality in sub-Saharan Africa. Furthermore, there is an alarming uptrend in the incidence of early onset colorectal cancer (EOCRC) across the globe, thus necessitating the need for early screening in general and special populations. There is, however, limited data available on the incidence and genetic characteristics of EOCRC from resource-poor countries, particularly Africa. Moreover, there is lack of clarity if recommendations and mechanisms proposed based on data from resource-rich countries applies to other regions of the world. In this review, we appraise the literature on EOCRC, its overall incidence, and genetic components as it pertains to sub-Saharan Africa. In addition, we highlight epidemiologic and epigenetic findings of our EOCRC cohort in Ethiopia.
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Guo Q, Qin H, Liu X, Zhang X, Chen Z, Qin T, Chang L, Zhang W. The Emerging Roles of Human Gut Microbiota in Gastrointestinal Cancer. Front Immunol 2022; 13:915047. [PMID: 35784372 PMCID: PMC9240199 DOI: 10.3389/fimmu.2022.915047] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/16/2022] [Indexed: 12/14/2022] Open
Abstract
The gut microbiota is composed of a large number of microorganisms with a complex structure. It participates in the decomposition, digestion, and absorption of nutrients; promotes the development of the immune system; inhibits the colonization of pathogens; and thus modulates human health. In particular, the relationship between gut microbiota and gastrointestinal tumor progression has attracted widespread concern. It was found that the gut microbiota can influence gastrointestinal tumor progression in independent ways. Here, we focused on the distribution of gut microbiota in gastrointestinal tumors and further elaborated on the impact of gut microbiota metabolites, especially short-chain fatty acids, on colorectal cancer progression. Additionally, the effects of gut microbiota on gastrointestinal tumor therapy are outlined. Finally, we put forward the possible problems in gut microbiota and the gastrointestinal oncology field and the efforts we need to make.
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Affiliation(s)
- Qianqian Guo
- Department of Pharmacy, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
- *Correspondence: Qianqian Guo, ; Wenzhou Zhang,
| | - Hai Qin
- Department of Clinical Laboratory, Guizhou Provincial Orthopedic Hospital, Guiyang City, China
| | - Xueling Liu
- Department of Pharmacy, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Xinxin Zhang
- The Second Clinical Medical School of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Zelong Chen
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Henan Province Engineering Research Center of Artificial Intelligence and Internet of Things Wise Medical, Zhengzhou, China
| | - Tingting Qin
- Department of Pharmacy, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Linlin Chang
- Department of Pharmacy, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Wenzhou Zhang
- Department of Pharmacy, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
- *Correspondence: Qianqian Guo, ; Wenzhou Zhang,
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LaCourse KD, Johnston CD, Bullman S. The relationship between gastrointestinal cancers and the microbiota. Lancet Gastroenterol Hepatol 2021; 6:498-509. [PMID: 33743198 PMCID: PMC10773981 DOI: 10.1016/s2468-1253(20)30362-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023]
Abstract
The contribution of the microbiota to disease progression and treatment efficacy is often neglected when determining who is at the highest risk of developing gastrointestinal cancers or designing treatment strategies for patients. We reviewed the current literature on the effect of the human microbiota on cancer risk, prognosis, and treatment efficacy. We highlight emerging research that seeks to identify microbial signatures as biomarkers for various gastrointestinal cancers, and discuss how we could harness knowledge of the microbiome to detect, prevent, and treat these cancers. Finally, we outline further research needed in the field of gastrointestinal cancers and the microbiota, and describe the efforts required to increase the accuracy and reproducibility of data linking the microbiome to cancer.
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Affiliation(s)
- Kaitlyn D LaCourse
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Christopher D Johnston
- Vaccine and Infection Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Susan Bullman
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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