Clinicopathologic Pattern and Outcome of Management of Pancreatic Carcinoma in Ibadan, Nigeria
Keywords:
pancreatic cancer, clinicopathologic pattern, Ibadan-Nigeria
Abstract
Background: Pancreatic cancer is one of the most challenging tumor entities worldwide, characterized as a highly aggressive disease with dismal overall prognosis and an incidence rate equaling mortality rate.
Objective: In order to have an up-to-date data on pancreatic cancer incidence and trend in Nigeria, West Africa, we conducted an epidemiological analytical review of the pattern, management, and management outcome of pancreatic cancer in Ibadan, Nigeria.
Methods: We performed a retrospective hospital-based study in which we analyzed the records of 126 pancreatic cancer patients registered, evaluated, and treated in the University College Hospital, Ibadan, a major referral tertiary Hospital in the south western region of Nigeria, West Africa from January 1999 to January 2013.The data obtained include bio-data, clinical presentation, treatment and outcome that were analyzed with descriptive statistics using SPSS 22.
Results: During the period of study, 126 patients were diagnosed with pancreatic cancer, with a mean age of 60.2 years and a male-to-female ratio of 1.52:1; other parameters such as a medical history of smoking and alcoholism, tumor site, histological type, as well as the stage of diagnosis were also considered at the time of the enrolment in the study. Our statistical analyses reported a very significant correlation between patients who belonged to the age group of 30–45 years and the advanced stage of diagnosis (based on TNM classification) with P = 0.02.
Conclusion: Pancreatic cancer is increasingly diagnosed in young adults at an advanced stage in the West African sub-region. Most patients present with advanced condition only amenable to palliative measures. There are significant challenges in the area of diagnosis, screening, treatment and research. The role of public health campaign to educate the populace on the disease and early presentation cannot be overemphasized.
References
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[51] Odusanya, O. O. and Babafemi, J. O. (2004). Patterns of delays amongst pulmonarytuberculosis patients in Lagos, Nigeria. BMC Public Health, vol. 4, p. 18.
[52] Adegboyega, A. A., Onayade, A. A., and Salawu, O. (2005). Care-seeking behaviourof caregivers for common childhood illnesses in Lagos Island Local Government Area, Nigeria. Nigerian Journal of Medicine, vol. 14, pp. 65–71.
[53] Ozawa, F., Friess, H., Tempia-Caliera, A., et al. (2001). Growth factors and their receptors in pancreatic cancer. Teratogenesis, Carcinogenesis, and Mutagenesis, vol. 21, pp. 27–44.
[54] Tessler, D. A., Andrew Catanzaro, A., Velanovich, V., et al. (2006). Predictors of cancer in patients with suspected pancreatic malignancy without a tissue diagnosis. The American Journal of Surgery, vol. 191, pp. 191–197.
[55] Postier, R. G. (2003). The challenge of pancreatic cancer. The American Journal of Surgery, vol. 186, pp. 579–582.
[56] Rosch, T., Braig, C., Gain, T., et al. (1992). Staging of pancreatic and ampullary carci- noma by endoscopic ultrasonography. Comparison with conventional sonography, computed tomography, and angiography. Gastroenterology, vol. 102, pp. 188–199.
[57] Fisher, W. E., Andersen, D. K., Bell, R. H., et al. (2005). Pancreas. In: F. C. Brunicardi, D. K. Andersen, T. R. Billiar, et al. (eds.) Schwartz’s Principles of Surgery, 8th edition, pp. 1221–1296. New York, NY: McGraw Hill Medical Publishing Division.
[2] World Health Organization. (2012). World Health Organization Statistical Information System. WHO Mortality Database. Retrieved from: http://www-dep.iarc.fr/WHOdb/WHOdb.htm.
[3] Curado, M. P., Edwards, B., Shin, H. R., et al. (eds.). (2007). Cancer Incidence in Five Continents, vol. IX. Lyon: IARC Scientific Publication.
[4] Forman, D., Bray, F., Brewster, D. H., et al. (eds.). (2014). Cancer Incidence in Five Continents, vol X. Lyon: IARC Scientific Publication.
[5] Awodele, O., Adeyomoye, A. A., Awodele, D. F., et al. (2011). Cancer distribution pattern in South-Western Nigeria. Tanzania Journal of Health Research, vol. 13, no. 2, pp. 1–7.
[6] American Cancer Society. (2013). American Cancer Society, National Cancer Institute, and Texas Cancer Registry. Texas Oncology. Retrieved from: http://www. texasoncology.com/media-center/fact-sheets/pancreatic-cancer.aspx
[7] American Cancer Society. (2014). Cancer Facts & Figures 2014. Atlanta: American Cancer Society. Retrieved from: http://www.cancer.org/research/ cancerfactsstatistics/cancerfactsfigures2014/
[8] National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer Stat Fact Sheets. Retrieved from: http://seer.cancer.gov/statfacts (last accessed August 6, 2014).
[9] Ahlgren, J. (1996). Epidemiology and risk factors in pancreatic cancer. Seminars in Oncology, vol. 23, pp. 241–250.
[10] Kemery, G. (2006). Pancreatic cancer: epidemiology and pathology. Practical Gastroenterology, vol. 30, no. 4, pp. 22–32.
[11] World Health Organization Classification of Tumours. (2000). Serous cystic neoplasms of the pancreas. In: Stanley R. Hamilton and Lauri A. Aaltonen (eds.)Pathology and Genetics of Tumours of the Digestive System, pp. 219–222. IARC Press Lyon.
[12] Warshaw, A. L., Fernandez-del Castillo, C. (1992). Pancreatic carcinoma. New England Journal of Medicine, vol. 326, pp. 455–465.
[13] Wanebo, H. J. and Vezeridis MP. (1996). Pancreatic carcinoma in perspective: a continuing challenge. Cancer, vol. 78, pp. 580–591.
[14] Li, D., Xie, K., Wolff, R., et al. (2004). Pancreatic cancer. Lancet, vol. 363, 1049–1057.
[15] Anderson, K. E., Potter, J. D., and Mack, T. M. (2005). Pancreatic cancer. In: D. Schottenfeld and J. F. Fraumeni (eds.) Cancer Epidemiology and Prevention, pp. 725–771. New York: Oxford University Press.
[16] Lo, A., Soliman, A. S., El-Ghawalby, N., et al. (2007). Lifestyle, occupational, and reproductive factors in relation to pancreatic cancer risk. Pancreas, vol. 35, pp. 120– 129.
[17] Soliman, A. S., Wang, X., Stanley, J. D., et al. (2006). Geographical clustering of pancreatic cancers in the Northeast Nile Delta region of Egypt. Archives of Environmental Contamination and Toxicology, vol. 51, pp. 142–148.
[18] Sellam, F., Harir, N., Khaled, M. B., et al. (2015). Delayed diagnosis of pancreatic cancer reported as more common in a population of North African young adults. Journal of Gastrointestinal Oncology, vol. 6, no. 5, pp. 505–510.
[19] Alatise, O. I., Lawal, O. O., and Ojo, O. T. (2010). Challenges of pancreatic cancer management in a resource scarce setting. East and Central African Journal of Surgery, vol. 15, no. 2, pp. 52–58.
[20] Solanke, T. F. (1967). Carcinoma of the pancreas in university college hospital, Ibadan Nigeria. Analysis of 47patients. West Africa Medical Journal, vol. 16, p. 92.
[21] Ajao, O. G. and Abioye, A. A. (1980). Pancreatic carcinoma. Journal of the National Medical Association, vol. 72, p. 589.
[22] Olumide, A. and Adesola, A. O. (1976). Carcinoma of the pancreas at Lagos University Teaching Hospital. Nigerian Medical Journal, vol. 6, p. 428.
[23] Abdulkareem, F. B., Faduyile, A. O., Daramola, O., et al. (2009). Pattern of malignant gastrointestinal tumours in Lagos and Shagamu, South-west Nigeria. West African Journal of Medicine, vol. 28, no. 3, pp. 173–176.
[24] Onyekwere, C. A. and Ojukwu, J. C. (2008). The epidemiologic profile of pancreatic cancer and management outcome in Lagos, Nigeria. Pakistani Journal of Medical Sciences, vol. 24, no. 2, pp. 340–343.
[25] American Cancer Society. (2006). Cancer Facts and Figures 2006. Atlanta, GA: American Cancer Society;
[26] Jemal, A., Murray, T., Samuels, A., et al. (2003). Cancer statistics 2003. A Cancer Journal for Clinicians, vol. 53, pp. 5–26.
[27] Ries, L. A., Wingo, P. A., Miller, D. S., et al. (2000). The annual report to the nation on the status of cancer, 1973-1997, with a special section on colorectal cancer. Cancer, vol. 88, pp. 2398–2424.
[28] Ries, L. A., Eisner, M. P., and Kosary, C. L. (2005). SEER Cancer Statistics Review, 1973-1999. Bethesda: National Cancer Institute.
[29] Conlon, K. C., Klimstra, D. S., and Brennan, M. F. (1996). Long-term survival after curative resection for pancreatic ductal adenocarcinoma. Clinicopathologic analysis of 5-year survivors. Annals of Surgery, vol. 223, pp. 273–279.
[30] Anderson, K. E., Potter, J. D., and Mack, T. M. (2005). Pancreatic cancer. In: D. Schottenfeld and J. F. Fraumeni (eds.) Cancer Epidemiology and Prevention, pp. 725–771. New York: Oxford University Press.
[31] Schiffman, S. C., Chu, C. K., Park, J., et al. (2011). Is prior cholecystectomy associated with decreased survival in patients with resectable pancreatic adenocarcinoma following pancreaticoduodenectomy? The American Journal of Surgery, vol. 201, pp. 519–524.
[32] Raimondi, S., Maisonneuve, P., and Lowenfels, A. B. (2009). Epidemiology of pancreatic cancer: an overview. Nature Reviews Gastroenterology & Hepatology, vol. 6, pp. 699–708.
[33] Bonelli, L., Aste, H., Bovo, P., et al. (2003). Exocrine pancreatic cancer, cigarette smoking, and diabetes mellitus: a case-control study in northern Italy. Pancreas, vol. 27, pp. 143–149.
[34] Lin, H., Li, S. D., Hu XG, et al. (2006). Primary pancreatic lymphoma: report of six cases. World Journal of Gastroenterology, vol. 12, pp. 5064–5067.
[35] Kalser, M. H., Barkin, J., and MacIntyre, J. M. (1985). Pancreatic cancer. Assessment of prognosis by clinical presentation. Cancer, vol. 56, pp. 397–402.
[36] Shibata, A., Mack, T. M., Paganini-Hill, A., et al. (1994). A prospective study of pancreatic cancer in the elderly. International Journal of Cancer, vol. 58, pp. 46–49.
[37] Perez, E. A., Gutierrez, J. C., Koniaris, L. G., et al. (2009). Malignant pancreatic tumors: incidence and outcome in 58 pediatric patients. Journal of Pediatric Surgery, vol. 44, pp. 197–203.
[38] Lüttges, J., Stigge, C., Pacena, M., et al. (2004). Rare ductal adenocarcinoma of the pancreas in patients younger than age 40 years. Cancer, vol. 100, pp. 173–182.
[39] Brand, R. E., Greer, J. B., Zolotarevsky, E., et al. (2009). Pancreatic cancer patients who smoke and drink are diagnosed at younger ages. Journal of Clinical Gastroenterology and Hepatology, vol. 7, pp. 1007–1012.
[40] Berry, L. (2014). Pancreatic cancer diagnosis delayed in people under 55. Cancer Nursing Practice, vol. 13, p. 7.
[41] Bien, E., Godzinski, J., Dall’igna, P., et al. (2011). Pancreatoblastoma: a report from the European cooperative study group for paediatric rare tumours (EXPeRT). European Journal of Cancer, vol. 47, pp. 2347–2352.
[42] Gulliford, M. (2012). Primary care and diagnosis of cancer. The Lancet Oncology, vol. 13, pp. 321–323.
[43] Kuvshinoff, B. W. and Bryer, M. P. (2000). Treatment of resectable and locallyadvanced pancreatic cancer. Cancer Control, vol. 7, pp. 428–436.
[44] Jemal, A., Murray, T., Ward, E., et al. (2005). Cancer statistics, 2005. CA: A Cancer Journal for Clinicians, vol. 55, pp. 10–30. Erratum in: CA: A Cancer Journal for Clinicians, vol. 55, p. 259.
[45] Hsu, J.-T., Chen, H.-M., Wu, R.-C., et al. (2008). Clinicopathologic features and outcomes following surgery for pancreatic adenosquamous carcinoma. World Journal of Surgical Oncology, vol. 6, no. 95, pp. 1–623.
[46] Levin, D. L., Connelly, R. R., and Devesa, S. S. (1981). Demographic characteristics of cancer of the pancreas: mortality, incidence, and survival. Cancer, vol. 47, pp. 1456–1468.
[47] Büchler, M. W., Kleeff, J., and Friess, H. (2007). Surgical treatment of pancreatic cancer. Journal of the American College of Surgeons, vol. 205, pp. S81–S86.
[48] Seelig, S. K., Burkert, B., Chromik, A. M., et al. (2010). Pancreatic resections for advanced M1-pancreatic carcinoma: the value of synchronous metastasectomy. HPB Surgery, vol. 2010, pp. 579–672.
[49] Picozzi, V. J., Kozarek, R. A., and Traverso, L. W. (2003). Interferon-based adjuvant chemoradiation therapy after pancreaticoduodenectomy for pancreatic adenocarcinoma. The American Journal of Surgery, vol. 185, pp. 476–480.
[50] Eloubeidi, M. A., Desmond, R. A., Wilcox, C. M., et al. (2006). Prognostic factors for survival in pancreatic cancer: a population-based study. The American Journal of Surgery, vol. 192, pp. 322–329.
[51] Odusanya, O. O. and Babafemi, J. O. (2004). Patterns of delays amongst pulmonarytuberculosis patients in Lagos, Nigeria. BMC Public Health, vol. 4, p. 18.
[52] Adegboyega, A. A., Onayade, A. A., and Salawu, O. (2005). Care-seeking behaviourof caregivers for common childhood illnesses in Lagos Island Local Government Area, Nigeria. Nigerian Journal of Medicine, vol. 14, pp. 65–71.
[53] Ozawa, F., Friess, H., Tempia-Caliera, A., et al. (2001). Growth factors and their receptors in pancreatic cancer. Teratogenesis, Carcinogenesis, and Mutagenesis, vol. 21, pp. 27–44.
[54] Tessler, D. A., Andrew Catanzaro, A., Velanovich, V., et al. (2006). Predictors of cancer in patients with suspected pancreatic malignancy without a tissue diagnosis. The American Journal of Surgery, vol. 191, pp. 191–197.
[55] Postier, R. G. (2003). The challenge of pancreatic cancer. The American Journal of Surgery, vol. 186, pp. 579–582.
[56] Rosch, T., Braig, C., Gain, T., et al. (1992). Staging of pancreatic and ampullary carci- noma by endoscopic ultrasonography. Comparison with conventional sonography, computed tomography, and angiography. Gastroenterology, vol. 102, pp. 188–199.
[57] Fisher, W. E., Andersen, D. K., Bell, R. H., et al. (2005). Pancreas. In: F. C. Brunicardi, D. K. Andersen, T. R. Billiar, et al. (eds.) Schwartz’s Principles of Surgery, 8th edition, pp. 1221–1296. New York, NY: McGraw Hill Medical Publishing Division.
