Pattern of Head and neck malignancies in Central Sudan-(study of 314 cases)

Objective: The objective of this work is to study the patterns of head and neck malignancies (HNM) in central Sudan and to compare it with international published series. Methods: This is a retrospective study conducted at the Institute of Nuclear Medicine, Molecular Biology and Oncology (INMO)-University of Gezira; Wadmedani, Sudan. The data were collected through reviewing of patients records over 6 years. Parameters analyzed were age, sex, topography and tumor histology. Results: The total number of patients records reviewed was 314. Age distribution ranged from 11 to 90 years with mean age of 48.79 and median age of 50 years. The male to female ratio was 1.7:1. The most common affected sites in order of frequency were nasopharynx (41.1%), hypopharnx (20.4%), larynx (11.2%), oral cavity (10.5%), salivary glands (4.8%), lips (4.5%), tongue (4.1%) and paranasal sinuses (3.5%). The most common histological types were squamous cell carcinoma (90.77%) followed by salivary gland tumors and lymphomas. Conclusion: HNM are common in Sudan, affecting all age groups with predominance in males. Nasopharynx is the commonest site. Further studies for identification of possible risk factors are recommended. Population-based cancer registry is recommended to reflect on the epidemiology of cancer in Sudan. Keywords: Nasopharynx, oropharyngeal, squamous, carcinomas, epidemiology, snuffed tobacco.Sudan Journal of Medical Sciences Vol. 3 (2) 2008: pp. 105-10

Pattern of thyroid diseases in central Sudan: Nuclear medicine perspective

Thyroid scintigraphy using Tc-99m pertechnetate is a frequently performed procedure in routine nuclear medicine practice in addition to thyroid hormonal assay by radioimmunoassay (RIA). There is no clear description of thyroid diseases pattern in Sudan using nuclear medicine as a diagnostic tool. The aim of this retrospective study is to determine the pattern of thyroid diseases using the nuclear medicine facilities in our institute during a period (2001-2003). Methods: All patients referred to the department of nuclear medicine for thyroid scan from January 2001 to December 2003 were included in this study and the thyroid function test when available. Data were analyzed by SPSS software. Results: A total of 2070 patients were referred to the department and only 1605 (77.5%) have thyroid function test results available for scan reporting. Female to male ratio is 9:1. The mean age is 34 ±13.36 (1-86 years old). The most common pattern is simple multinodular goiter 784 (37.8%) and the second is solitary thyroid nodule 506 (24.4%), followed by simple diffuse goiter 415 (20%). From a total of 1605 thyroid function test results, 1377 patients (85.8%) were euthyroid, 168 (10.5%) were having hyperthyroidism while only 60 (3.7%) were having hypothyroidism. Conclusion: The vast majority of patients in this study were young females with simple goiter and normal radionuclide uptake. No more information gained particularly when the patient is known clinically and biochemically to have a simple goiter. A solitary cold nodule is also common.Keywords: Thyroid scan, goiter, cold nodule, iodine deficiency, thyroid disease

Pathological response for neoadjuvant chemotherapy in locally advanced breast cancer at NCI, Sudan: 6 years’ experience

Background: Breast cancer is the leading cancer in Sudanese females.Objectives: This study was done to evaluate the clinical response to neoadjuvant chemotherapy for patients treated at National Cancer Institute (NCI) and to compare it with the published literature.Methods: This is a retrospective study conducted in National Cancer Institute (NCI), Gezira State, Sudan during the period from April 2005 to August 2011. We studied the data for all patients who have locally  advanced breast cancer and treated at NCI during study period. Patients who remained inoperable after treatment were considered as having no response to therapy. Data were introduced and analyzed using SPSS software. Data evaluated includes Patient age, disease stage,  chemotherapy regimens, and number of cycles, tumor histology, grade and histopathology after chemotherapy.Results: A total of 110 patients who received neoadjuvant chemotherapy and fulfilled criteria for inclusion during the period 2005 to 2011 were evaluated. Majority of patients were between 30-50 years of age (63%). Patients who achieved response and had surgery were 65%. Among those who underwent surgery 22% have complete pathological response. Most of patients who achieved complete histopathological response had six cycles of chemotherapy.Conclusion: this study demonstrated that neoadjuvant systemic therapy is an accepted approach for women with locally advanced breast cancer for whom immediate surgery is inappropriate, and we achieved results similar to the international literature.Key words: breast cancer, neoadjuvant, chemotherapy, response, NCI, Sudan

A successful clinical pilot registry of four radiation oncology practices in Africa and Ontario

A journal article on radiation oncology practices in Africa and Ontario, Canada.Cancer is a major disease category in higher-income countries (HIC), In HIC, health resources are substantial, with budgets for health care exceeding 10% of Gross Domestic Product of large economies. This resourcing is many times higher than that in low- and-middle-income countries (LMIC) where there are fewer infrastructures and less political and sociocultural support. However, cancer is an increasing concern in LMIC's due to improving longevity and the changing prevalences of etiological agents and broader determinants of disease. Indeed, global mortality from cancer exceeds that from tuberculosis, malaria and HIV-AIDS combined2, and there are many more cancer cases in LMIC than in HIC

PREGNANCY AFTER TREATMENT OF CHORIOCARCINOMA - CASE REPORT

Abstract: This is the first case report from its kind to be reported from the Institute of nuclear medicine, Molecular Biology University of Gezira. It is a case report of a 30-years old lady diagnosed as having choriocarcinoma, gestational trophoblastic tumor, and treated with multiple agent chemotherapy for three months. She was advised not to get pregnant during the first two years following chemotherapy. She was on regular follow up for one year after which she disappeared and discontinued the contraceptive pills. Seven months later she presented with a viable pregnancy and was followed till she delivered a normal viable alive boy. Both the lady and her baby are in a good health after six months from delivery

THE IMPACT OF TRUS IN DETECTION OF PROSTATE CANCER IN GEZIRA, SUDAN

Introduction:  Prostate cancer (P ca) is the most commonly diagnosed visceral cancer worldwide. It is the second cause of cancer death in men. Objective: To study the impact of introducing transrectal ultrasound (TRUS)-guided biopsy in detection of Prostate cancer in Central Sudan. Methods: This was a retrospective hospital based study. A review was done for data of prostate cancer patients treated in the Institute of Nuclear Medicine and Oncology & Gezira Hospital of Renal Diseases & Surgery (GHRD&S), Wad Medani, Sudan during the years 2002-2007. Comparison was done between the data available before and after introduction of trans rectal ultrasound biopsy, TRUS in 2005. Results: Prostate cancer cases were contributing for only 8% of all cancers during the time period before TRUS introduction. During the year 2007 the figure increased to 14%. The leading cancer in males now is the P ca. previously it was the third registered cancer before TRUS was introduced. The detection of new cases per year increased dramatically after the introduction of TRUS service. Conclusion and recommendation: Prostate cancer was found to be the most common cancer in Sudanese males. TRUS guided biopsy contributed significantly in early detection of prostate cancer in this region. Distribution of this facility with adequate training of the staff optimizes a proper and early detection of prostate cancer

A pilot course for training-in-context in statistics and research methods: Radiation oncology

Objectives. Inadequate training of investigators in statistics and research methods in Africa contributes to having limited local evidence and infrastructure to support multi-centre international trials. Methods of teaching junior oncology professionals tend not to emphasise research discovery, or the roles of emotional engagement and social networking in facilitating effective and efficient learning. We developed a strategy for teaching research methods and statistics in-context, centred on a shared international and practical research project. Design. An African research network (AFRES) was created and members conducted a pilot clinical registry study to acquire real-time data over a 4-month period in 2011. Following study closure, a proto-course consisting of 7 modules, each orientated to a practical topic in study development, implementation and reporting was administered over 18 weeks to all eight AFRES members. A survey of participants was conducted to evaluate the impact of this training strategy. Results. This strictly voluntary project had 5 of 8 AFRES members engaged in the process. Within one year, we generated and submitted two manuscripts and two news items for publication. Participants reported an increased understanding of the principles of evidence-based practice, research methods and interest in pursuing future research initiatives.Conclusion. A novel strategy to build international research infrastructure in Africa, grounded in a practical and relevant project, and which is collaborative and engaging, appears to be efficient and effective

Primary Fibrosarcoma of the Testicle with Puzzling Post-surgery Presentation: Mimicking Recurrence

Sarcomas of the testis are extremely rare tumors, their incidence being difficult to assess accurately. The authors report a case of a 21-year-old male, presented with painless scrotal swelling that increased in size insidiously within three months. The examination revealed a 10 cm right testicular swelling—hard, not tender and oval in shape. Testicular ultrasound revealed right heterogenous testicular mass. Tumor markers (Human chorionic gonadotrophin (HCG) and alpha fetoprotein) were normal. CT chest and abdomen were normal. Radical orchidectomy was done through an inguinal approach. Histopathology showed testicular fibrosarcoma with spindle cells. After one month, the patient noticed reappearance of a swelling in the right hemiscrotum. Right inguinal exploration with massive resection of the recurrent scrotal mass was done. Histopathology revealed inflammatory process dominated by stitch granuloma. In conclusion, the recurrence rate of testicular sarcomas is high following radical orchidectomy, but still there was a place of non-malignant massthat looks like recurrence; it might occur like nonspecific inflammatory mass and stich granuloma

Gynecological Malignancies Managed in The Institute of Nuclear Medicine and Oncology, Wadmedani-Sudan During 1999-2005

Introduction: Gynecological malignancies (GMs) are one of the most prevalent cancers in Africa. Objective of this work is to review data of patients with GMs treated in Institute of Nuclear Medicine, Molecular Biology and Oncology (INMO)-University of Gezira -Wadmedani- Sudan, and reflect on characteristics of GMs in Central Sudan. Material and Methods: A retrospective hospital-based descriptive study was conducted to review GMs patients records treated in INMO from year 1999-2005. Analysis included age, residence, stage, topography and morphology of the cancer. Results: During study period GMs constituted about 20.5 percent of all women malignancies and it is the second commonest female cancer preceded by breast (36.7%). Most of the patients were housewives from rural areas of Gezira and nearby States.  The sites were ovary, 41%, cervix, 34%, uterus, 13.8%, uterine choriocarcinoma, 7.9%, vulva cancer, 2.9% and no single case of vaginal carcinoma was reported. The mean age of all patients was 52.45 years, Median age for ovarian cancer was, 50, cervix 55, uterus 55, Choriocarcinoma of the uterus 35 and vulva 60 years of age. Almost all varieties of histopathological types were seen. Fifty eight percent of patients presented with stage III & IV. Conclusions: GMs are common and present in late stages. The commonest GMs was ovarian cancer which affect relatively young patients. Cervix was the second common site and affect relatively older age group. Vulvar cancer was relatively rare and vaginal cancer was not seen. For the improvement of the outcome early detection, management guidelines and financial support are highly recommended