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Gastrointestinal Cancers in Sub-Saharan Africa

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Cancer in Sub-Saharan Africa

Abstract

Surgery is the mainstay of achieving cure in gastrointestinal cancers. While health expenditure per capita (HEpC) has increased from 41 US$ in 1995 to 97 US$ in sub-Saharan Africa (SSA) in 2014, it remains well below the world HEpC of 1061 US$ or the European union HEpC of 3612 US$ in 2014. Cancer appears to be a low public health priority in SSA, and this may in part be attributable to the burden of communicable disease such as Human Immunodeficiency Virus, malaria and tuberculosis. However, by 2030, the incidence of gastrointestinal cancers is set to increase by 73% in SSA compared to 59% worldwide. Over 90% of all GI cancers in SSA present late and the peak incidences occur about a decade earlier than in the West. The younger age at presentation could be the result of yet undefined molecular and biological differences, and environmental factors. For the few who present early, lack of infrastructure and expertise lead to poor therapeutic options and inevitable poorer outcomes. This chapter will give an overview of oesophageal, liver, gastric, and colorectal cancers pathways in sub-Saharan Africa.

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References

  • Abdel-Wahab M, et al. Status of radiotherapy resources in Africa: an International Atomic Energy Agency analysis. Lancet Oncol. 2013;14(4):e168–75.

    Article  PubMed  Google Scholar 

  • Abdulkareem FB, et al. Malignant gastrointestinal tumours in south western Nigeria: a histopathologic analysis of 713 cases. West Afr J Med. 2009;28(3):173–6.

    CAS  PubMed  Google Scholar 

  • Abdulkareem FB, et al. KRAS and BRAF mutations in Nigerian colorectal cancers. West Afr J Med. 2012;31(3):198–203.

    CAS  PubMed  Google Scholar 

  • Abdulkareem FB, Beggs A, Nnaji M et al. Geographical variation in DNA methylation in colorectal cancer. Presentation at the Association of Coloproctology of Great Britain and Ireland. Edinburgh. 4–6 July 2016. (2016).

    Google Scholar 

  • Adesina A, et al. Improvement of pathology in sub-Saharan Africa. Lancet Oncol. 2013;14(4):e152–7.

    Article  PubMed  Google Scholar 

  • Ahmed AA. The surgical management and outcome of oesophageal cancer in Addis Ababa. Ethiop Med J. 2000;38(3):147–52.

    CAS  PubMed  Google Scholar 

  • Asombang AW, Kelly P. Gastric cancer in Africa: what do we know about incidence and risk factors? Trans R Soc Trop Med Hyg. 2012;106(2):69–74.

    Article  PubMed  Google Scholar 

  • Asombang AW, Rahman R, Ibdah JA. Gastric cancer in Africa: current management and outcomes. World J Gastroenterol. 2014;20(14):3875–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ayandipo OO, Irabor DO, Afuwape OO, et al. Abdomino-perineal resection for low rectal and anal malignancies in Ibadan, Southwest Nigeria. J West Afr Coll Surg. 2013;3(3):88–101.

    PubMed  PubMed Central  Google Scholar 

  • Buffart TE, Louw M, van Grieken NCT, et al. Gastric cancers of Western European and African patients show different patterns of genomic instability. BMC Med Genet. 2011;4:7.

    CAS  Google Scholar 

  • Clinical Outcomes of Surgical Therapy Study, Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350(20):2050–9.

    Article  Google Scholar 

  • Colon Cancer Laparoscopic or Open Resection Study, Group, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009;10(1):44–52.

    Article  PubMed  Google Scholar 

  • Cronjé L, Paterson AC, Becker PJ. Colorectal cancer in South Africa: a heritable cause suspected in many young black patients. S Afr Med J. 2009;99(2):103–6.

    PubMed  Google Scholar 

  • Dandara C, Robertson B, Dzobo K, et al. Patient and tumour characteristics as prognostic markers for oesophageal cancer: a retrospective analysis of a cohort of patients at Groote Schuur Hospital. Eur J Cardio-Thoracic Surg. 2016;49:629–34.

    Article  Google Scholar 

  • Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray, F. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr.

  • Ferlay J, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86.

    Article  CAS  PubMed  Google Scholar 

  • Govender M, Aldous C, Ferndale L, et al. Self-expanding metal stent placement for oesophageal cancer without fluoroscopy is safe and effective. S Afr Med J. 2015;105(10):858–61.

    Article  PubMed  Google Scholar 

  • Gyedu A, Shrauner WR, Kingham TP. No patients to resect or transplant: an analysis of patients with hepatocellular carcinoma admitted to a major African referral hospital. World J Surg. 2015;39:231–6.

    Article  PubMed  Google Scholar 

  • Herbert JR, Daguise VG, Hurley DM, et al. Mapping cancer mortality-to-incidence ratios to illustrate racial and sex disparities in a high risk population. Cancer. 2009;115(11):2539–52.

    Article  Google Scholar 

  • IARC (International Agency for Research in Cancer). GLOBACON 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. 2016. http://globocan.iarc.fr/Pages/bar_site_sel.aspx. Accessed June 2016.

  • Irabor D, Adedeji OA. Colorectal cancer in Nigeria: 40 years on. A review. Eur J Cancer Care (Engl). 2009;18(2):110–5.

    Article  CAS  Google Scholar 

  • Irabor DO, Arowolo A, Afolabi AA. Colon and rectal cancer in Ibadan, Nigeria: an update. Color Dis. 2010;12(7 Online):e43–9.

    CAS  Google Scholar 

  • Irabor DO, Afuwape OO, Ayandipo O. The present status of the management of colon and rectal cancer in Nigeria. J Cancer Res. 2014;2014:1–7.

    Article  Google Scholar 

  • Ismaila BO, Misauno MA. Gastrointestinal endoscopy in Nigeria – a prospective two year audit. Pan Afr Med J. 2013;14:22.

    PubMed  PubMed Central  Google Scholar 

  • Jaka H, et al. Gastric outlet obstruction at Bugando Medical Centre in Northwestern Tanzania: a prospective review of 184 cases. BMC Surg. 2013;13:41.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jayne DG, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007;25(21):3061–8.

    Article  PubMed  Google Scholar 

  • Jemal A, et al. Cancer burden in Africa and opportunities for prevention. Cancer. 2012;118(18):4372–84.

    Article  PubMed  Google Scholar 

  • Jeremic B, et al. Patterns of practice in palliative radiotherapy in Africa – case revisited. Clin Oncol (R Coll Radiol). 2014;26(6):333–43.

    Article  CAS  Google Scholar 

  • Kachala R. Systematic review: epidemiology of oesophageal cancer in sub-Saharan Africa. Malawi Med J. 2010;22(3):65–70.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kayamba V, Sinkala E, Mwanamakondo S, et al. Trends in upper gastrointestinal diagnosis over four decades in Lusaka, Zambia: a restrospective analysis of endoscopic findings. BMC Gastroenterol. 2015;15:127.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kew MC. Hepatocellular carcinoma in developing countries: prevention, diagnosis and treatment. World J Hepatol. 2012;4(3):99–104.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kew MC. Epidemiology of hepatocellular carcinoma in sub-Saharan Africa. Ann Hepatol. 2013;12(2):173–82.

    PubMed  Google Scholar 

  • Khashab M, et al. Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Surg Endosc. 2013;27(6):2068–75.

    Article  PubMed  Google Scholar 

  • Ladep NG, et al. Problem of hepatocellular carcinoma in West Africa. World J Hepatol. 2014;6(11):783–92.

    Article  PubMed  PubMed Central  Google Scholar 

  • Laiyemo AO, et al. Toward colorectal cancer control in Africa. Int J Cancer. 2016;138(4):1033–4.

    Article  CAS  PubMed  Google Scholar 

  • Mabula JB, et al. Gastric cancer at a university teaching hospital in northwestern Tanzania: a retrospective review of 232 cases. World J Surg Oncol. 2012;10:257.

    Article  PubMed  PubMed Central  Google Scholar 

  • McHembe MD, et al. Endoscopic and clinicopathological patterns of esophageal cancer in Tanzania: experiences from two tertiary health institutions. World J Surg Oncol. 2013;11:257.

    Article  PubMed  PubMed Central  Google Scholar 

  • Meara JG, Leather AJM, Hagander L, et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569–624.

    Article  PubMed  Google Scholar 

  • Ndububa DA, et al. Primary hepatocellular carcinoma in Ile-Ife, Nigeria: a prospective study of 154 cases. Niger J Med. 2001;10(2):59–63.

    CAS  PubMed  Google Scholar 

  • Osime OC, et al. Gastric carcinoma – a big challenge in a poor economy. J Gastrointest Cancer. 2010;41(2):101–6.

    Article  PubMed  Google Scholar 

  • Parkin DM, et al. Cancer in Africa 2012. Cancer Epidemiol Biomark Prev. 2014;23(6):953–66.

    Article  Google Scholar 

  • Pennathur A, et al. Oesophageal carcinoma. Lancet. 2013;381(9864):400–12.

    Article  PubMed  Google Scholar 

  • Raskin L, et al. Distinct molecular features of colorectal cancer in Ghana. Cancer Epidemiol. 2013;37:556–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Robertson B, Shepherd L, Abratt RP, et al. Treatment of carcinoma of the anal canal at Groote Schuur Hospital. S Afr Med J. 2012;102(6):559–61.

    Article  CAS  PubMed  Google Scholar 

  • Rotimi O, Abdulkareem FB. Fifty-three years of reporting colorectal cancer in Nigerians – a systematic review of the published literature. Niger Postgrad Med J. 2014;21(1):68–73.

    PubMed  Google Scholar 

  • Saluja S, et al. A comparison of colorectal cancer in Nigerian and north American patients: is the cancer biology different? Surgery. 2014;156(2):305–10.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schaafsma T, et al. Africa’s oesophageal cancer corridor: geographic variations in incidence correlate with certain micronutrient deficiencies. PLoS One. 2015;10(10):e0140107.

    Article  PubMed  PubMed Central  Google Scholar 

  • Taha MO, Abdalla AAE, Mohamed RS. Pattern & presentation of colorectal cancer in Central Sudan, a retrospective descriptive study, 2010–2012. Afr Health Sci. 2015;15(2):576–80.

    Article  PubMed  PubMed Central  Google Scholar 

  • Thumbs A, Borgstein E. Commentary: managing oesophageal cancer in a resource poor setting – a Malawian example. BMJ. 2010;341:c6723.

    Article  PubMed  Google Scholar 

  • Thumbs A, et al. Improving palliative treatment of patients with non-operable cancer of the oesophagus: training doctors and nurses in the use of self-expanding metal stents (SEMS) in Malawi. Malawi Med J. 2012;24(1):5–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Tognarelli J, et al. Reasons why West Africa continues to be a hotbed for hepatocellular carcinoma. Niger Med J. 2015;56(4):231–5.

    Article  PubMed  PubMed Central  Google Scholar 

  • UNDP (United Nations Development Programme). Human Development Index Reports. 2015. http://hdr.undp.org/en/composite/HDI. Retrieved 4 June 2016. http://hdr.undp.org/en/content/table-1-human-development-index-and-its-components

  • van Hagen P, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074–84.

    Article  PubMed  Google Scholar 

  • Van’t Hof A, Gilissen K, Cohen RJ et al. Colonic cell proliferation in two different ethnic groups with contrasting incidence of colon cancer: is there a difference in carcinogenesis? Gut. 1995;36(5):691–95.

    Google Scholar 

  • Vostakolaei FA, Karim-Kos HE, Janssen-Heijnen MLG, et al. The validity of the mortality to incidence ratio as a proxy for site-specific cancer survival. Eur J Pub Health. 2010;21(5):573–7.

    Article  Google Scholar 

  • Williams AO, Chung EB, Agbata A and Jackson MA. Intestinal polyps in American Negroes and Nigerian Africans. Br J Cancer. 1975;31(4):485–91.

    Google Scholar 

  • World Bank. Health expenditure per Capita (current US$). 2016. http://data.worldbank.org/indicator/SH.XPD.PCAP/countries/ZG-1W?display=graph

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Author information

Authors and Affiliations

  1. West Midlands Deanery, University Hospital Birmingham, Birmingham, UK

    Pritam Singh MBBS, MA, MRCS, PhD

  2. Department of Upper Gastrointestinal and General Surgery, University Hospitals Birmingham, Birmingham, UK

    Ewen Griffiths MD, FRCS

  3. Department of General Surgery, University College Hospital, Ibadan, Oyo State, Nigeria

    David Irabor MBBS, FWACS

  4. Consultant Colorectal Surgeon, Department of Colorectal Surgery, University Hospital Birmingham, Birmingham, UK

    Olufunso Adebola Adedeji MBBS, MD, FRCSEd

  5. Honorary Senior Clinical Lecturer, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK

    Olufunso Adebola Adedeji MBBS, MD, FRCSEd

Authors
  1. Pritam Singh MBBS, MA, MRCS, PhD
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  2. Ewen Griffiths MD, FRCS
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  3. David Irabor MBBS, FWACS
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  4. Olufunso Adebola Adedeji MBBS, MD, FRCSEd
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Corresponding author

Correspondence to Olufunso Adebola Adedeji MBBS, MD, FRCSEd .

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Editors and Affiliations

  1. Consultant Colorectal Surgeon, Department of Colorectal Surgery, University Hospital Birmingham, Birmingham, United Kingdom

    Olufunso Adebola Adedeji

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Singh, P., Griffiths, E., Irabor, D., Adedeji, O.A. (2017). Gastrointestinal Cancers in Sub-Saharan Africa. In: Adedeji, O. (eds) Cancer in Sub-Saharan Africa. Springer, Cham. https://doi.org/10.1007/978-3-319-52554-9_9

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  • DOI: https://doi.org/10.1007/978-3-319-52554-9_9

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-52554-9

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