BACKGROUND Chemoradiation is the standard of care for management of locally advanced cervical cancer. Cancer in low resource settings is generally characterized by late presentation. Over 80% of cervical cancer in Nigeria presents at stages where chemoradiation is the best evidence-based management option. Unfortunately, radiotherapy services are not readily available in low resource settings. We therefore surveyed outcome of referral for chemoradiation in other to gain insight into how patients navigate the challenges in accessing radiotherapy services
METHODOLOGY A cross sectional survey through telephone interview of patients diagnosed of cervical cancer at university of Abuja Teaching Hospital over a 30 months period from July 2016 to December 2018. The names and hospital numbers of cases of cervical cancer diagnosed in the institution over the study period were extracted from gynaecology register and their folders were subsequently retrieved for clinical details and their contact phone number. A telephone interview was subsequently conducted using a semi structure questionnaire.
RESULT Out of the 1796 total gynaecological admissions during the study period, 67 were cervical cancer giving a prevalence of 3.73%. Only 53 case notes were retrieved out the 67 cases managed giving a retrieval rate of 79.1%. Only 28 patients or their next of kin could be reached for the study of which majority 22(79%) have not access treatment as of the time of study. Amongst the 6 (21%) that reported they have received treatment 5 had treatment in Nigeria while 1 had in India. None (0%) of those treated in Nigeria had brachytherapy.
CONCUSION Radiotherapy services are not readily accessible in Nigeria with attendant frustration to the patients and their care givers. Clinicians referring patients for radiotherapy should at the very least regularly update themselves of functional status of radiotherapy centres across the nation and avail patients with such information.

OBJECTIVES Multidisciplinary approach to the management of tumours is the standard practice worldwide. The Federal Teaching Hospital Gombe, Gombe State University and collaborating organisations established a pragmatic multidisciplinary tumour board (MDTB) with the aim of discussing all categories of tumours and to harmonise professionals and patient’s treatment to imaging, pathology, immunology, surgery, medicine, radiation therapy, chemotherapy and pharmacy, nursing, psychology, physiotherapy, social welfare, dietetics, community and public health, chaplaincy, patient support groups, administrators and the media for first-class performance.
METHODS The group comprises of representatives of the respective departments and institutions above. The group usually meets forth nightly. Our mode of operation includes: review of cases; consensus of opinion on line of management; breakout into 6 multidisciplinary teams (MDTs) – Breast/GIT, Head & Neck/CNS, MSS, Haematology, Paediatric and Gynae/Urology; case presentations; protocol development; presentation of specific topics; observing world cancer days with the public including cancer education, advocacy and free screening; pink months, World HPV days, fund raising; and liaison with Nigerian cancer society, pharmaceuticals, regional and international hospitals and experts.
RESULTS Over the past 3 years, we had more than 70 meetings. About 40 cancer patients/cases were discussed: Breast (n=9), Gynaecological (n=8), Head and Neck (n=8), Haematological (n=5), paediatric (n=4), Urology (n=2), GIT (n=2) and multiple primary (n=3). We have screened about 400 men and women: mammography, Pap smear, PSA, DRE and HbsAg. Our accomplishments so far includes improved collaborations and coordination in patients’ management; reduced waiting time; funding of patients’ treatment and obtaining fee waivers; logistics support; training and research; value-added advocacy, education and outreach. The highlight of this presentation will be our achievements, challenges and the way forward.
CONCLUSION Our tumour board was a success, it resulted in improved coordination of care and collaboration between experts and hence improved patients' quality of life and survival.

In Nigeria like many developing countries in Africa, about 100,000 new cancer cases are diagnosed annually with paucity of Oncologist and Radiotherapy facilities to meet up with the increasing demand for Radiotherapy and Oncologist services leading to long distance travel to access the services and long waiting time to commence treatment which subsequently worsens the outcome.
OBJECTIVE The purpose of this study was to identify the pattern of referral for radiotherapy services to the Lagos university Teaching Hospital with the aim of providing information on accessibility to Radiotherapy facilities in Nigeria and to inform future health planning and budgeting.
METHOD This is a retrospective study of all the new cases referred to the Radiotherapy department of Lagos University Teaching Hospital (LUTH) between April and September 2017. For each referral we collected the demographic data, cancer type, reasons for referral, where they were referred from and time to presentation. This information was analysed and presented in frequency tables and charts.
RESULTS A total of 156 case notes were analyzed during the study period with 117(75%) females and 39(25%) male with age range between 6 and 89 years. The common cancer cases seen were breast (41.7%), cervix (16.0%), head and neck cancers (12.8%) and prostate cancer (7.7%). The Referrals from within Lagos state was 80(51.3%) and 76 (48.7%) from outside the state consisting of 27.6% from other south- western states, 28.9% each from South –east, and south- south Zones, 9.2% from North central and 2.6% from North- West zone. The distance travelled from referral states to Lagos state ranged between 62Km and 1107km with a mean distance of 553km. The time from diagnosis to referral was less than 1 month in 122 patients, between 1 to 6 months in 29 patients and over 6 months in 5 patients.
CONCLUSION Radiotherapy services in Nigeria is inaccessible which in turn worsens the cancer prognosis and so there is need for Government, policy makers and private investors at all levels to jointly form an alliance that will alleviate the suffering of patients who travel from far and near to access these scarce resources , reduce the waiting period and improve the prognosis.

Genetic testing has become a pathway to personalized medicine which is also being embraced in Nigeria. However, little is known about how demographics and perceptions influence individuals’ willingness-to-pay for cancer GT. This study aimed at assessing the acceptance, perceived benefits of genetics and willingness-to-pay for genetic testing among patients with cancer in Ibadan as a catalyst for sustainability of Cancer Risk Management Programme. Cross-sectional study using a semi-structured questionnaire. Unselected patients with breast, ovarian, endometrial and prostate cancers were seen in Surgical Out-patient, Radiation Oncology, Gynaecology and Radiology Department of University College Hospital (UCH), Ibadan received genetic counselling (GC) and were offered subsequent GT. Primary outcome variable was willingness to undergo genetic testing to determine the risk of cancer from a genetic mutation and the secondary variables were age, educational level, perception about GT and concerns about cancer in relatives. Ethical approval was obtained from the UI/UCH Ethics Committee. Data of first 100 patients tested in the ongoing study were analysed. Patients’ ages ranged from 33 to 77 years with majority (83.0%) of the patients having breast cancer. Respondents’ monthly income averaged N40,940. Majority of the patients (83.0%) had positive perception of benefits of GC. About three-quarter of them (72.0%), had concerns about their relatives getting cancer while most of the patients (95.0%) would want their relatives to have cancer GT. Benefit of cancer genetics and risk assessment in relatives was perceived by most of the patients (86.0%) to help with early detection of cancer while most (80.0%) viewed cost as the major barrier to GT. All of the patients were willing to test for mutations but 66.0% were willing to pay for the service out of which 35.0% offered to pay between N10,000 and N30,000 compared to $250 in the US. There were significant associations between age, educational level, income, perceived benefits with willingness to pay. Learning clinically relevant details toward cancer prevention to inform health-related decisions in patients and relatives is a motivator for willingness to pay for genetic testing in low- and middle-income country. Increased awareness may influence the outcomes of cancer risk management.

BACKGROUND Hormonal factors influence mammographic density and responsible for differences in mammographic density in premenopausal compared with postmenopausal women. High mammographic density is an independent marker for breast cancer, reducing visibility of cancerous masses in the breast with lower rates of cancer detection and higher stages at presentation. Recent studies in Nigeria show increasing incidence of breast cancer among young premenopausal women; in contrast to more westernised societies with higher incidence among postmenopausal women.
OBJECTIVE To determine the distribution of mammographic breast patterns and significant reproductive and anthropometric factors associated with high-density breast patterns in premenopausal women in Ibadan.
METHOD A prospective cross-sectional study of 355 premenopausal women who presented for screening/ diagnostic mammography at the University College Hospital and Access to Basic Care Foundation Ibadan. Relevant socio-demographic data and other relevant medical history were obtained using an interviewer administered questionnaire. Anthropometric measurements were taken and mammography examinations performed. The breast pattern and final Breast Imaging Reporting and Data Base System (BI-RADS) category were assessed and documented using the American College of Radiologists (ACR) classification 5th edition.
RESULTS The mean age of the participants was 46.3+ 4.2 years (range 35 - 57 years). Most women (95.2%) were parous while <5% were nulliparous. All the parous women had positive breastfeeding history with a median cumulative duration of 36 months (IQR=30 months). The scattered fibroglandular density was predominant 157 (44.2%), followed by the heterogeneously dense 115 (32.4%) and almost fatty replaced pattern 41 (11.6%). The Final BI-RADS category showed that slightly over a third 138 (38.9%) of participants had inconclusive mammograms, 52 (14.6%) were negative, 111(31.3%) were benign, while 54 (15.2%) had equivocal to highly suggestive of malignancy. Factors that were significantly associated with high-density breast pattern (heterogeneously dense and extremely dense breast patterns) were younger age (p=0.026), high educational status (p=0.02), lower age at menarche (p =0.034), nulliparity or low parity (p <0.001), older age at first childbirth (p <0.001), negative or short breastfeeding history (p <0.001) and body mass index < 25kg/m2 (p<0.001). Previous multiple births was significantly associated with low-density breast pattern (p=0.033) while a final BI-RADS assessment category of 0 (inconclusive) or 4 to 6 BI-RADS was associated with high-density breast pattern. (p<0.0001). BMI, parity and cumulative duration of breastfeeding as factors independently associated with breast density.
CONCLUSION High-density breast pattern is independently associated with low parity, short breastfeeding period and low BMI in premenopausal women.

BACKGROUND Childhood cancers as a growing public health challenge and is increasingly being recognized worldwide, including the developing nations. Tremendous progress has been made in the treatment and cure of childhood cancers mostly in the developed world, most cases die of childhood cancers in our society. Childhood cancers had a 14-times lower mutations rates than adult cancers with different genes mutated in childhood compare with adult cancers. Small round cell tumours (SRCT) is a term used for tumours composed of malignant round cells that are slightly larger or double the size of red blood cells in air-dried smears.1 Small Round cell tumour (SRCT) of childhood is a diverse group of cancers that have considerable overlap in epidemiology, morphology and immunophenotype. They are characterized by small round undifferentiated primitive cells. They include Ewing Family Tumours, rhabdomyosarcoma, synovial sarcoma, Non- Hodgkin’s lymphoma, retinoblastoma, neuroblastoma, mesenchymal chondrosarcoma, medulloblastoma and nephroblastoma.2 Others include small cell osteogenic sarcoma, undifferentiated hepatoblastoma, granulocytic sarcoma, and intraabdominal desmoplastic small round cell tumour. Most patients die within 1 years of chemotheraphy/radiotherapy from complications of the drugs while others are lost to follow up due to financial burden.
METHODS Twenty-two cases of SRCT of childhood were reviewed over a two-year period (2017-2018). Parrafin blocks were cut and stained with H&E, six antibodies were used for immunohistochemistry namely CD99, Desmin, CD10, CD20, BCL2 and chromogranin.
RESULTS Patient’s age ranges from 6months to 9 years with a male female ratio of 3:2. The commonest SRCT was Burkitt Lymphoma 7(31.8%), retinoblastoma 5 (22.7%), alveolar rhabdomyosarcoma 4(18.1%), follicular lymphoma 2 (9.1%), ES/PNET 2 (9.1%), nephroblastoma 1 (4.5%) and neuroblastoma 1 (4.5%). Almost 70% (15) patients die within one year of starting chemotherapy/radiotherapy with the highest mortality seen in patients with Burkitt’s, alveolar and ES/PNET.
CONCLUSION While tremendous progress has been made in the treatment of childhood cancers in the developed world, it still remains an important health problem in our societies largely because of multifactorial reasons, one of which is lack of identification of common mutational genes in our environment for possible targeted therapy.

INTRODUCTION Breast cancer is the second most common cancer among women in Uganda. First degree relatives have a twofold to threefold increase in the risk of breast cancer development. Breast cancer screening is considered one of the effective tools for reducing breast cancer mortality.
OBJECTIVE To determine the self-perceived risk of breast cancer and breast cancer screening among first-degree female relatives of breast cancer patients attending Uganda Cancer Institute
METHOD We conducted a cross-sectional study using a pre-coded questionnaire among 179 first degree female relatives aged 18 years and above with no known personal history of breast cancer. Data was entered into Epidata version 3.1 and was then exported to STATA version 13 for analysis.
RESULTS Majority of the participants (56.2%) perceived themselves to have a low risk of developing breast cancer. The most performed breast cancer screening method was Breast Self-Examination (60.3%) followed by Clinical Breast Examination (26.3%) and the least being an Ultrasound Scan (8.9%). For women aged 40 years and above, (6.7%) had done mammography. Of the participants that performed Breast Self-Examination, 36.9% last performed it less than a month ago. In addition, most participants started Breast Self-Examination at 35 years (Mean 30.1±10.9) ranging from 12 years to 60 years. There was no significant association between risk perception and breast cancer screening.
CONCLUSIONS Generally, first degree relatives have low breast cancer risk perception and low engagement in breast cancer screening services. There is a need for programs targeting uptake of screening services in this population in order to reduce late-stage presentation with breast cancer.

BACKGROUND Evidence based practice is increasingly becoming a pre-requisite to high quality cancer care. This calls for the use of high quality locally generated/relevant evidence to inform and improve treatment outcomes in Sub-Saharan Africa (SSA). However, it is believed that research in cancer palliative care has not been given the attention it demands in SSA and treatment decisions are in most cases based on research evidence from developed countries.
AIM We sought to assess the trends, magnitude and outcomes of research in palliative care for cancer in SSA over a 10-year period (2008-2018).
METHODS We carried out a rapid literature review of research done in sub-Saharan Africa (49 countries recognized by UN to be in SSA) in Palliative Care (PC) for cancer patients from 2008 to 2018. Literature was searched between January-February 2019 using Embase, Medline, Cinahl and Cochrane databases. The last search was run on 18 February 2019.
RESEARCH PROCESS Highly sensitive search strategies were developed to retrieve as many relevant studies as possible, using the following search terms; Palliative Medicine, Pain Management, Hospices, Humans, Neoplasms and cancer patients in addition to all sub-Saharan countries. Two independent researchers against inclusion and exclusion criteria did selection of relevant articles, data extraction and data analysis. Disagreements were resolved by discussion and consensus between the two researchers.
RESULTS Of the 1088 articles identified, 10 met the inclusion criteria, which is relatively a small number. However, research into PC for cancer has been increasing from 10% in 2008 to 20% in 2018. (Five) 50% of the studies done assessed the PC needs of cancer patients, (2)20% evaluated knowledge of cancer pain management among clinicians and another (2)20% assessed models of palliative service delivery for cancer in SSA, and 1(10%) the effectiveness of PC medicine for cancer pain management.
CONCLUSION This advocates for more research into PC for cancer patients in sub-Saharan Africa so that treatment decisions are based on local data/evidence. It is also recommended that PC research assess the ultimate goal of improved quality of life to inform the planning/evaluation of PC strategies in Sub-Saharan Africa. Training of oncologists, increased funding, and public awareness in cancer palliative care research is a critical path to this.

REVIEW QUESTION To determine the diagnostic accuracy of [-2]ProPSA (p2PSA) and Prostate Health Index (PHI) compared to the Gleason score in determining the aggressiveness of prostate cancer.
INTRODUCTION Prostate cancer (PCa) is the most commonly diagnosed cancer in men. However, the utility of currently available biomarkers for determining the aggressive form of disease remains unknown. This review sought to determine the diagnostic accuracy of two new biomarkers in determining the aggressive form of prostate cancer.
INCLUSION CRITERIA Diagnostic accuracy studies that enrolled men with histologically confirmed prostate cancer in which PHI and p2PSA were assessed in comparison to Gleason score for the determination of aggressive prostate cancer.
METHODS A three step search strategy was utilized to identify both published and unpublished studies in the English language. Databases were searched from inception to January 2019. Study selection, critical appraisal, data extraction and data synthesis were done according to the approach recommended by the Joanna Briggs Institute.
RESULTS A total of 12 studies (n=7,910) that recruited men with aggressive PCa were considered in this review. Majority of included subjects had a total prostate specific antigen (PSA) level of 2-10ng/ml. The sensitivity of PHI ranged from 67-97% while specificity ranged from 6-64%. At a PHI threshold of 25 and below, pooled sensitivity was 97% (95% confidence interval (CI) 95-98%) and specificity was 10% (95% CI 6-16%). At a PHI threshold of between 26 and 35, pooled sensitivity was 87% (95 % CI 81-91%) and specificity was 45% (95% CI 39-50%). At a PHI threshold of 36 and above pooled sensitivity was 72% (95% CI 64-79%) and specificity was 74% (95% CI 68-80%). Only one study assessed p2PSA. Sensitivity ranged from 80-95% and specificity ranged from 9.9-27.9% with increasing threshold values from 7.9-10.9ng/ml.
CONCLUSIONS Overall, both PHI and p2PSA have acceptable accuracy for the determination of aggressive PCa. However, the inverse relationship between sensitivity and specificity makes it difficult to determine an optimum cut off value for positivity. Further, both tests demonstrate high false positive rates that may lead to unnecessary intervention.

OBJECTIVE To identify performance and outcome indicators and targets for screening cervical pre-cancerous lesions in Southern African countries with the highest HIV prevalence (≥ 10%).
METHODS We identified policies through website searches on https://www.iccp-portal.org/map and expert consultation. We reviewed them and examined consistency in performance and outcome indicators and targets for screening of precancerous lesions in nine Southern African countries: Lesotho (LS), Mozambique (MZ), South Africa (ZA), Swaziland (SZ), Zimbabwe (ZW), Zambia (ZM), Botswana (BW), Namibia (NA) and Malawi (MW).
RESULTS All countries reviewed had cancer control policies (9/9). Less than half (4/9) had standalone policies for cervical cancer (CC) prevention. Screening coverage was a common performance indicator across policy documents except for ZW and SW, with six of them defining 80% targets for the general population (LS, MZ, ZM, MW, NA, BW). Only two policies (LS and ZA) specified screening intervals for women living with HIV although specific targets for this population were lacking. Percentage of women with a positive screen was highlighted as a performance indicator in three policies (LS, MZ and MW), and disaggregated by HIV status in two (MZ, LS). Treatment rate of screen-positive women was a performance indicator mentioned in five policy documents (LS, MZ, ZM, MW, ZA). Only three documents (LS, MZ, ZA) included definitions for intervals to re-screening women treated for precancerous lesions, however, indicators and targets were generally lacking. CC incidence and mortality were common outcome indicators across policies and five policies clearly stated specific targets (LS, ZM, MW, ZA, BW).
CONCLUSIONS This review highlights variability in monitoring indicators and targets across these countries. Despite the high HIV prevalence, HIV-specific indicators were absent in most policy documents. There is need for harmonized monitoring indicators across similar settings to permit interoperability of data systems for comprehensive assessment of programs, ideally disaggregated by HIV-status.

OBJECTIVE The purpose of this study was to evaluate the performance of a newly commissioned IMRT treatment planning and delivery systems against the results of the American Association of Medical Physicists in Medicine (AAPM) Task Group 119.
METHOD Structure contained in the DICOM-RT set developed by the Task Group were transferred onto a CT image set of our local phantom. IMRT plans were created with beam arrangements and dose-volume constraints stipulated in the TG-119 report. Field-by-field fluence measurement of delivered dose distributions was performed on an Electronic Portal Imaging Device, while in-phantom point-doses at specific locations were measured with a small-volume ionization chamber at specific points in high and low dose regions. Gamma evaluation with passing criteria of 3%/3mm – reporting the percentage of points with gamma ≤ 1, was done using a Portal Dosimetry software package.
RESULTS The mean deviations from point-dose measurements in the high and low dose regions were 0.031Gy (standard deviation 0.020) and 0.025Gy (standard deviation 0.018) respectively. The corresponding confidence limits were 0.0702 and 0.060 respectively for high and low dose regions. The average pass rate from the gamma evaluation was 95% (standard deviation 0.017) with confidence limit of 3.61.
CONCLUSION Point dose measurements and gamma evaluation were better than results reported by the AAPM TG-119 task group, and thus our IMRT system exceeds the minimum performance requirements recommended by the Task Group.

OBJECTIVE There is limited published data on oesophageal cancer in Zambia and none evaluating patients at the only in-country Cancer Disease Hospital (CDH). The aim of our study is to evaluate the demographics and clinicopathologic features of patients presenting with oesophageal cancer at time of diagnosis.
METHODS A retrospective analysis of the CDH database was conducted on patients diagnosed with oesophageal cancer from time of CDH inception (2007) to December 2018. Patients were identified using the search terms “esophageal cancer” “Oesophageal cancer” “cancer of esophagus” “cancer of oesophagus”. Medical records were manually retrieved using the medical record numbers and reviewed. The following were extracted: demographics (age at presentation, gender, residence, occupation), clinicopathologic features (symptoms at presentation, mode of diagnosis, stage, histologic type) and mode of treatment (chemotherapy, surgery, palliation). A coding sheet was created a priori, data analysed using SAS.
RESULTS A total of 396 medical records were identified, 306 manually retrieved, 90 classified as missing. Of the 306 reviewed, 26 files were excluded for being other organ cancers and 2 for containing no details. The final analysis included 278 medical charts, 66% were males, mean age was 55 years, 27% were in 40-49 age range, 56 % from Lusaka, the location of CDH. The age-standardized incidence is 5.5 per 100 000 people (95% CI, 4.3 - 6.6). The most common symptom was dysphagia (83 %), 97% diagnosed endoscopically, 90% squamous cell carcinoma, followed by adenocarcinoma (8.3%), 65 % received treatment. One hundred twenty-four charts had missing staging data. Of the 154 patients, 98 (35 %) were diagnosed at stage 4, 33 % were between 40 and 49 years.
CONCLUSION Patients presenting with oesophageal cancer are predominantly between the age of 40-49, males and late stage at time of diagnosis. Robust prospective research and improved data recording is warranted.

INTRODUCTION Difficulties in accessing appropriate accommodation and transport is a well-documented as a major stress factor for cancer patients seeking care at Uganda Cancer Institute (Young, 2010). A recent assessment of the needs of cancer patients at Mbarara University Cancer Center revealed similar challenges (UCF, 2016). This limits access to cancer treatment services and negatively affects the quality of life of cancer patients. The Union for International Cancer Control (UICC) recommends establishment of “Hope Lodges” as a way of enabling cancer patients to access treatment who would otherwise be prevented by transport and accommodation challenges (UICC, 2014).
METHODS Five Cancer Patients hostels have been established in Kampala. The hostels provide accommodation and meals to cancer outpatients and their carers as they wait for / receive treatment at Uganda Cancer Institute. In addition, clinical navigators travel with patients from the hostels to the Uganda Cancer Institute and navigate them through different care access points. Priority is given to cancer patients who come from upcountry as they wait for laboratory results or receive chemotherapy and radiotherapy.
RESULTS About 120 patients’ and 120 carers’ beds are available each night in Kampala. Three meals are served to each patient and carer daily. Patients from up country can access cancer treatment without worrying about accommodation and meals.
CONCLUSIONS There is need to establish more patient hostels to cater for increasing number of cancer patients in Uganda.

BACKGROUND Misdiagnosis of Lung cancer remains a major challenge in Kenya due to lack of a high index of suspicion for clients presenting at health facilities. Besides technicalities related to screening and diagnostic procedures, similarities in clinical manifestations with pulmonary tuberculosis have largely contributed to most patients being mismanaged. The aim of this study was to establish the clinical presentations of lung cancer prior to diagnosis as seen at AMPATH Kenya.
METHODS A review of all cases presenting at the Lung Cancer clinic was done and documentation of symptoms made. On diagnosis, a retrospective analysis was made to establish the presenting complaints about every patient with lung cancer. Percentage occurrence for every symptom was made and tabulated to give a reflection of the most common and less common since the inception of the program in November 2017 to March 2019.
RESULTS The following were the findings of the 64 patients diagnosed with Lung cancer: Chest pains had percentage occurrence of 87.5%, cough 73.4%, difficulty in Breathing 53.1%, Weight loss 40.6%, haemoptysis 37.5%, shortness of Breath 31.3%, Other Symptom's 31.3%, Fatigue 18.8%, Back pain 14.1% It was noted that patients presented with more than one symptom at the clinic. Chest pain was the most common symptom accounting for 87.5% of all cases while back pain accounted for the least at 14.1%. Other symptoms included hoarseness of voice, general body malaise, abdominal pain, hemiplegia, nausea & vomiting and neurological symptoms that together accounted for 31.3%.
CONCLUSION Chest pains, cough and difficulty in breathing are the most outstanding symptoms related to lung cancer. For a high index of suspicion, healthcare providers should identify clients with such symptoms and consider further investigations. These symptoms should also be part of community health workers training to ensure prompt referrals are done and outcomes are improved.

BACKGROUND Lung cancer diagnosis remains a challenge in Kenya due to the technicalities related to diagnostic procedures and optimal care. The burden in adult population is largely unknown as most patients are managed for Pulmonary Tuberculosis. The Eldoret Cancer Registry (ECR) provides statistics and epidemiological profile across western Kenya. This study aims at establishing lung cancer incidences in relation to year of diagnosis, age, gender and stage upon diagnosis.
METHODS A retrospective review of cases diagnosed at Moi Teaching and Referral Hospital (MTRH) from 2012 to 2016 were identified from ECR. This was before the Multinational Lung Cancer Control Program (MLCCP) began. Data on year of incidence, age, gender and stage at diagnosis were analyzed.
RESULTS Out of the 60 patients diagnosed, the findings were: In 2012 there were 11 cases representing 18.3%, 2013 10 cases (16.7%), 2014, 12cases (20%), 2015 12cases (20%) and 2016, 15cases (25%). Incidences by age were in the following cohorts; 0-27years 1case representing 1.7%, 30-39years (4) 6.7%, 40-49years (8) 13.3%, 50-59years (17) 28.3%, 60-69years (12)20%, 70-79years (15)25%, above 80years (3) 5%. Incidences by gender: Male had 38cases at 63.3% and Female had 22cases at 36.7%. Incidence by stage at diagnosis; Stage IV (6) 10%, Unknown Stage (54) 90%.
CONCLUSION 2016 had the highest incidence and may be associated with increased awareness of services at AMPATH/MTRH. Most cases were between 50-79 years. Males had higher incidences and may be related to susceptibilities to risks factors like smoking and occupational hazards. Since the inception of MLCCP in 2018, 64 new lung cancer cases were diagnosed which is more than the previous 5 years combined. There’s need for creating awareness and ''screening” of clients presenting with associated signs and symptoms to enable early diagnosis of lung cancer. Disease staging is essential as most cases were of unknown stage.

OBJECTIVE We are establishing the framework for a Radiation Oncology education training program in Global Health. We will investigate partnership with industry to offer an education program which coincides with the purchase of radiotherapy equipment for LMICs. The education program would focus on treatment issues in Africa by integrating education, training and information/communication technologies (ICTs) to enhance impact to have a major impact in building radiation oncology capacity in East Africa. The establishment of an advanced information and communications technology platform will avail remote quality assurance and treatment planning, enhancing patient safety in the use of radiation technologies, while complementing capacity building in research and education.
METHODS We developed a dedicated workshop to serve as the framework to develop of an education program in Global Health, with industry partners, which coincides with the purchase of new equipment. This will assure continued growth as technology advances. We tested and evaluated a virtual USA-Africa ICT-powered Radiation Oncology Core (IROC). The significance of this activity alone will be major for East Africa with plans to adapt and scale this to other African countries. This program can significantly improve patient safety in the use of radiation medicine technologies. The online platform could also be readily adapted for use as a multi-centre clinical trial system for quality assurance. It could also double serve as a population-based cancer patient registry and potentially connect other arrays such as genetic or pathology information to appropriate research databases.
RESULTS Focusing on “Training the Trainers”, understanding barriers and identifying key factors to expanding radiotherapy care in east Africa will strengthen our development in creating an education program with long term sustainability. A developed IROC will serve as the first of its kind ICT-powered QA, treatment planning, and incident learning system in East Africa, extendable to other sub-Saharan African countries facing the ongoing crises in radiation medicine
CONCLUSIONS Building on current partnerships we are strengthening our engagement by providing a roadmap for medical physics training. Our long-term goal is to develop a USA/Africa Radiation Oncology Core (ROC), with both practical (PROC) and virtual (IROC) components, dedicated to Research Education/training in Radiation oncology in East Africa.

INTRODUCTION Hereditary breast and ovarian cancers (HBOC) can result from inherited mutations in the genes involved in DNA repair in 20% of cases. Knowledge of the index patients’ germline gene mutation status has therapeutic, prevention and financial benefits. Despite availability of genetic testing in global medical practice and its potential benefits, most low- and middle-income countries (LMIC) like Nigeria are over 20 years behind in implementation. The implications of this is the missed improved therapeutic opportunities and persistence of HBOC as the most lethal of women cancers and loss of preventive opportunities for the eligible first-degree relations (FDRs) of the patients.
OBJECTIVE This paper describes the findings from pilot feasibility study on genetic testing to determine the gene mutation status of HBOC patients with overall aims of institutionalising personalised treatment and identification of at-risk relations for risk-reduction preventive interventions.
METHODS We counselled and screened histologically confirmed HBOC patients for gene-deletion in our oncology practice using a multi-disciplinary team approach. Also, the family pedigrees were constructed to have records of identified FDRs that might benefit from risk-reduction interventions (RRI).
RESULTS We have enrolled 96 cases of HBOC with results for 93 patients with breast and ovarian cancers since July 2018. The mean age of the patients was 48.4 years. Family pedigree showed that the modal parity was 3. Testing results showed 15 (16.2%) pathogenic mutations [ 13.4% (11/82) in breast cancer] and [36.4% (4/11) in ovarian cancer], 27 VUS and 55 no mutation cases.
CONCLUSIONS Our study showed that 16.2% of our patients stand to benefit from targeted therapy from emerging new drugs like PARP inhibitors while, at least, 45 biological FDRs will be eligible for screening for RRI. Institutionalising and expanding this study to other facilities will enhance therapeutic outcomes for these patients and form preventive measures for the FDRs and improvement in women health generally.

OBJECTIVE Male breast cancer accounts worldwide for approximately one per cent of new breast cancer cases. Treatment protocols are often extrapolated from female breast cancer, but controversy remains if this is appropriate. We describe the demographic and clinical profile of men diagnosed with breast cancer at our institution.
METHODS Electronic data of males diagnosed with breast cancer at the Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto, South Africa from 2006-2018 were extracted. Demographics, clinical features, treatment and outcome are described.
RESULTS 39 patients were diagnosed with breast cancer. The median age (interquartile range) at diagnosis was 64 (54-71) years, and 36 (92.3%) were black Africans. The majority, 24 patients (61.5%) presented with advanced disease (stages III & IV), while 15 (38.5%) had early disease (stages 0-II). 38 (97.4%) were invasive carcinomas and 1 (2.6%) was a ductal carcinoma-in-situ (DCIS). 36 (92.2%) had oestrogen and/or progesterone receptor positive breast cancer, 1 (2.6%) was HER2 enriched, 1 (2.6%) was triple negative and 1 (2.6%) patient had missing receptor status. The primary treatment modality was neoadjuvant hormonal therapy in 21 (53.8%) of the patients, 12 (30.8%) had primary surgery, 5 (12.8%) had neoadjuvant chemotherapy and 1 (2.6%) had palliative radiotherapy. 21 men (53.9%) died during follow up, 11 (28.2%) were alive and 7 (17.9%) were lost to follow-up. The median follow-up time (IQR) was 23 (9-43) months, median time to death (IQR) was 18 (12-24) months, the 2- years survival rate was 59.4% and 5-year survival rate was 18.5%.
CONCLUSION The epidemiology and biology of male breast cancer was found to differ from breast cancer in females. Most of our patients received neoadjuvant endocrine therapy. Further research is needed on how to best manage this rare disease in a resource limited environment.

OBJECTIVES The specific objectives of this study were to determine the stage at presentation and the type of surgery offered to patients with breast cancer who participated in the study.
METHODS The study was conducted at Surgery department of Aminu Kano Teaching Hospital, Kano, Nigeria, from June 2017 to May 2019. It was a prospective descriptive study of consecutive patients with breast cancer who met the inclusion criteria. Patients were recruited only after obtaining informed consent. Information obtained include Age, Menopausal status, Stage at presentation, neodjuvant chemotherapy offered, type of surgery offered, histopathological profiling and complications of the surgery. Statistical and comparative analysis was made using SPSS version 21
RESULTS A total of 193 patients with breast cancer were seen at the General Surgery Outpatient Department during the period of the study. Out of these patients, only 107 met the inclusion criteria, were recruited and completed the study. The age range of 27 to 70 years and mean age of 46.9 ± 11.2 years were recorded. Sixty three (58.9%) patients were premenopausal. Eighty six (80.4%) patients had locally advanced disease at presentation. Eighty nine (83.2%) patients had neoadjuvant chemotherapy or hormone therapy. Immmunohistochemistry was done in only seventy five (70.1%) patients. Out of these patients that had immunohistochemistry, only 42 (56%) patients had treatment based on receptor status and biological classification of the tumour. Total mastectomy with axillary clearance was offered to 92 (85.9%) patients. Post operative complications were seen only in 13 (12.2%) patients who had surgery.
CONCLUSION Locally advanced breast cancer was still the predominant cancer in our environment with majority of the the patients offered modified radical mastectomy with its complications including bridled scar. There is therefore a need for increased awareness for early detection and treatment of breast cancer in North Western Nigeria.

BACKGROUND Many cancer patients in Low-and Middle-Income Countries (LMICs) suffer and die in pain without accessing Palliative Care (PC) despite PC being available. Integrating PC into national Primary Health Care (PHC) systems could improve access and minimize unnecessary suffering.
AIM To search existent literature on the integration of Palliative Care into Primary Health Care in LMICs and to clarify the approaches for that integration.
METHODS A systematic review was undertaken following a protocol. Systematic searches were conducted on PubMed, CINAHL, EMBASE, PsycINFO and MEDLINE OVID using text words and Medical Subject Headings related to Palliative Care integration in LMICs. Additional publications were obtained by searching reference lists from selected manuscripts. Published peer reviewed English journal articles of primary and secondary research were included and data abstraction was guided using the Primary Health Care Performance Initiative (PHCHI) Framework. All grey literature was excluded from the review.
RESULTS Eleven articles were included in the review and 39 LMICs were represented. Many LMICs countries were struggling to integrate PC into PHC as the concept was still relatively new in some regions. Approaches of integrating PC into PHC included; lobbying for government support, training and education, availing essential medicines, incorporating PC in existing healthcare services, building partnerships, establishing separate PC infrastructures, task-shifting, involving community volunteers in home-based care and empowering them to own the service, undertaking research to guide policy and clinical practice.
CONCLUSION The Review highlighted that there several contextual approaches to the integration of PC into PHC and that some countries fare better than others with the integration of PC into PHC, while others are still at the early stages of integration. The integration of PC into PHC, if fully adopted, has the ability to address a nation’s social determinants of health and to promote universal health coverage.

BACKGROUND Palliative Care (PC) is an important aspect in cancer care yet it is absent in many African countries. International Programmes (IP) is a Programme of Hospice Africa (HA) which supports initiation and expansion of Palliative Care (PC) in Africa through training, clinical mentorship, sensitization and advocacy, fostering sustainability. Hospice Africa Uganda (HAU) is our model to enable countries to develop culturally appropriate, affordable and accessible PC for their country.
METHODS Training: Short courses in PC are held in English and French in Uganda. The maximum period of training is five weeks, including 2 weeks mobile rounds in the home. A few countries, with a similar clinical services adapted to their own culture and economy, have their own in country course with IP support. Visiting parties come to Uganda for clinical experience, and see how liquid morphine is made, using a very simple and affordable formula.
SENSITISATION AND ADVOCACY The IP team helps partners to identify PC gaps in health care. Meetings with Governments, Health Care institutions are arranged during in country visits.
FOLLOW UP is through emails, phone calls, social media and in country visits.
RESULTS Over thirty African countries have initiated PC and thirty-five now declare they have it in their country. A few countries have established National Palliative Care associations to advocate and coordinate PC services in their countries. Some countries have integrated PC in the country mainstream health care in various ways; for example Rwanda has a national Palliative Care Policy. Other countries like Malawi run their own PC courses adapted from the HAU initiators’ course. Twenty-two African countries now have affordable oral liquid morphine compared to only 3 in 1993 when HA commenced, some of which manufacture it internally.
CONCLUSION Empowering other African countries to provide PC alleviates unnecessary suffering, increases access to PC and promotes universal health coverage. Countries need to take responsibility to initiate and/or integrate PC in their health care system to minimize the unnecessary suffering for cancer patients. Are we ready “Not to leave anyone behind” in Africa?

OBJECTIVES To evaluate the clinical and surgical response and disease-free survival of neoadjuvant chemotherapy (NACT) followed by radical hysterectomy in patients with locally advanced cervical cancer at Kigali University Teaching Hospital in Rwanda.
METHODS A retrospective descriptive study was performed, and data collected on eligible patients with FIGO stage IB2-IIA2 and some exceptional stage IIB cases. Patients were treated with neoadjuvant carboplatin and paclitaxel chemotherapy once every 3 weeks for 3-4 cycles before radical hysterectomy.
RESULTS Between May 2016 and October 2018, 57 patients underwent NACT and 43 (75.4%) were felt to be candidates for radical hysterectomy after clinical assessment only. Median age was 56 years. Thirty-nine (96%) patients received 3 cycles of NACT while 4(4%) received 4 cycles. Pre-operative mean haemoglobin was 12.2g/dl and mean platelets count was 243K. Only 14% were HIV positive. FIGO stages were 1B2 (32.6%), IIA1 (30.2%), IIA2 (27.9%) and IIB (9.3%). Mean tumour size before and after neoadjuvant chemotherapy was 5.9 cm and 2.07 cm, respectively. Thirty-eight (88%) patients underwent radical hysterectomy as planned and 5 (12%) had surgery aborted due to metastatic disease. Of those who underwent hysterectomy, 5 (13.1%) showed no residual disease on final pathology. Four (10.5%) patients had microscopic metastasis. Nine (20.9%) patients were referred for adjuvant chemotherapy and radiation. Mean time for follow-up was 21months. At follow-up, 34 (79%) patients showed no evidence of recurrence, 13.9% had documented recurrence and 6.9% were lost to follow-up.
CONCLUSIONS Neoadjuvant chemotherapy and radical hysterectomy are a feasible treatment option for locally advanced cervical cancer in low-resource settings. It can be an alternative treatment option in countries without radiation facilities if gynaecologists skilled at radical surgery are available. The addition of routine radiographic imaging, when feasible, prior to patient selection, would likely improve selection and outcomes.

OBJECTIVE To assess factors in the healthcare system that cause delayed cervical cancer diagnosis at the primary healthcare level in Rwanda.
METHODS This was a descriptive study evaluating healthcare providers involved in the outpatient clinics at 10 selected health centres (HC) in Kigali city and Eastern province of Rwanda. Health care providers attending outpatient clinics at the selected HC completed a survey questionnaire.
RESULTS In total, 87 health care providers consented to participate in the study. Of the respondents, 85 (97.7%) were nurses and midwives, the majority being nurses at 81.6%. Only 15 (17.2%) received training on visual inspection with acetic acid (VIA) cervical cancer screening, in 6 out of the 10 HC surveyed. However, 75.9% of respondents reported there was at least one person trained in VIA screening at their HC. The necessary basic equipment needed for cervical cancer evaluation was reported to be available. However, our study did not assess the quality, quantity and functional status of this equipment. All providers reported that at times they do not provide necessary pelvic exam for cervical symptoms due to time constraints, or lack of materials or experience. Overall, 49 (56.3%) participants were found to have adequate basic knowledge on cervical cancer symptoms and the appropriate next step in case of symptoms. There was no association between knowledge level and respondents’ profession, education level, work experience or reported past training on VIA cervical screening (p= 0.592, 0.384, 0.174 and 0.404, respectively).
CONCLUSIONS There is a gap in the number of care providers with skills to perform cervical cancer screening in Rwandan HC. As HC are the first point of entry of patients into the healthcare system, there is a need to empower them with human resources and infrastructure if an effective cervical cancer screening and prevention program is to be established.

OBJECTIVES Delay in diagnosis contributes to increased mortality from cervical cancer in Rwanda. Rwandan health care is a multi-tier system requiring transfer from health centre (HC) to district hospital (DH) and ultimately to tertiary or referral hospital to obtain cervical cancer diagnosis and treatment. This study aims to determine how access to medical services in the current health system may lead to delays in the diagnosis of cervical cancer.
METHODS This is a prospective descriptive study conducted from June 2017 to December 2017. Patients with a pathologically confirmed diagnosis of cervical cancer seeking care in the outpatient gynaecology department at University of Rwanda teaching hospital (KUTH), one of three main referral hospitals in Rwanda, were invited to participate. Demographic and clinical data were collected based on one-on-one interviews.
RESULTS Ninety-five patients with cervical cancer were recruited; 10 (10.5%) Stage I, 42 (44.2%) Stage II, 36 (37.9%) Stage III and 7 (7.4%) Stage IV. The majority of patients (85.3%) had no knowledge of cervical cancer symptoms prior to presentation. At the HC level, 40 (42.1%) women had a genital exam, 9 (9.5%) had speculum exam and no biopsies were performed. 42 women (44%) had ≥3 visits at HC prior to transfer to DH. Once referred to the DH, 88 (92.6%) patients had a genital exam, speculum exam performed on only 49 (51.6%) and 50 (52%) received a medication for their symptom. At the DH 55 women (57%) required ≥2 visits prior to transfer to referral hospital for biopsy.
CONCLUSIONS Early diagnosis of cancer is necessary to improve cervical cancer control in settings with limited access to cervical cancer screening. More than 45% of our patients were diagnosed in stage III or IV, a poor prognostic factor. National cancer control strategies are needed to improve early diagnosis for cervical cancer in Rwanda.

INTRODUCTION Clinical decision tools are needed in settings where trainees and general paediatricians without formal paediatric oncology training are tasked with the care of children with cancer. To support healthcare workers in low- and middle-income countries (LMIC) where staffing is limited, we developed a prototype application to facilitate easy access to relevant guidelines.
METHODS A prototype clinical decision tool, ARIA, was designed using a design-based approach consisting of three steps: definition of content, prototyping and testing. The underlying design principles were simplicity of use and rapid access to evidence-based information. Content requirements were determined using data output from a multistage peer-reviewed comprehensive adapted treatment guideline initiative coordinated by members of the St. Jude Global sub-Saharan Africa Regional Program. The prototype program was developed using Microsoft Access 2012. Testing was conducted in two phases: content review from a panel of paediatric oncologists and regional review by trainees, paediatricians and paediatric oncologists in Zimbabwe and Zambia.
RESULTS ARIA is a scalable program that architecturally includes 19 tables and 15 forms linked together through 78 query-based reports and can run on any Windows-based computer. The database currently includes a total of 17 paediatric oncology guidelines and 72 treatment bundles. To facilitate user navigation, the program has a front-end menu with clickable categories. Based on user selection, curated forms provide detailed information on diagnostic evaluations, treatment summaries, roadmaps, dosage calculators for chemotherapy and antibiotics, local control guidelines for surgery and radiation oncology, toxicity monitoring/modifications and other supportive care guidance. Users can also directly print guideline-specific roadmaps and chemotherapy calendars from the program.
CONCLUSION We have created a prototype decision aid application for healthcare workers in resource limited settings designed to make clinically relevant evidence-based information rapidly accessible. Next steps include development as a mobile-friendly health application and adding additional guidelines to the database.

BACKGROUND Published adapted treatment regimens lack detailed guidance for physicians taking care of children with cancer in resource-limited settings. In response to needs at Cancer Diseases Hospital, Zambia and Parirenyatwa Hospital, Zimbabwe, we designed a novel approach to comprehensive, resource adapted treatment guideline (ATxG) development.
METHODS A two-phase approach to maximize simplicity, ensure evidence-based decision-making and generate multi-stakeholder consensus was framed. First, a three round modified Delphi was conducted to identify appropriate circumstances for early palliative referral. Thirty-three cancer sub-groups, defined using the International Classification of Childhood Cancer-3 and Toronto Staging System (TSS), were scored by treatment intention: curative intent, palliative-metronomic therapy, or pallitiative-symptomatic care only. Simultaneously, a scoping review of protocols/guidelines/regimens from the International Society of Paediatric Oncology, International Network for Cancer Treatment and Research, St. Jude (SJ), Children’s Cancer and Oncology Groups, and other published country/regional regimens was completed. Using abstracted treatment data, fixed doses and cytotoxic drug schedules were standardized across solid tumor categories. Second, a three-tier review process was conducted: primary development by a SJ team; secondary review by a physician panel with regional and multi-disciplinary (paediatrics, paediatric oncology, surgery, radiation oncology, palliative care) representation; and tertiary review by external content experts.
RESULTS The approach was piloted with the development of a rhabdomyosarcoma ATxG. As both hospitals have access to radiation, surgery, and chemotherapy, all treatment modalities were included. Cytogenetics were assumed unavailable. During the review process, the TSS rhabdomyosarcoma categories of local/metastatic were further refined into six strata through inclusion of the Oberlin clinical scoring system. The final rhabdomyosarcoma ATxG includes 16 sections with appendices representing a standard ATxG template.
CONCLUSIONS With multi-stakeholder input, we successfully piloted a structured approach for ATxG development. Ongoing work includes development of 16 additional guidelines, monitoring ATxG implementation outcomes, and refinement of a clinical decision tool for mobile devices.

OBJECTIVES The current study evaluates the impact of immunohistochemistry (IHC) on diagnostic accuracy for pediatric cancer in Tanzania and identifies the most common biomarkers used for diagnostic differentiation.
METHODS Pathology samples for children diagnosed with cancer at Bugando Medical Centre (Mwanza, Tanzania) in 2018 were evaluated using H&E staining. Basic demographic information from histology form was recorded, including patient age, sex, and sample collection, as well as the reported histopathology results from BMC. Additional tissue from histology block was sent to Muhimbili National Hospital for IHC review. The histopathology results were compared for diagnostic agreement, change in diagnosis, and identified which reagents/biomarkers were necessary for diagnostic confirmation.
RESULTS Eighty-four paediatric cancer patients were reviewed. 50 (59.5%) were female with median age of 6 years (IQR 3-9 years). Histology concordance between H&E and IHC was 57.5%. Diagnostic specificity (e.g NHL to diffuse large B cell lymphoma) improved for 18.2% (n=15), and diagnosis was changed following IHC in 30.3% (n= 26). A total of 15 biomarkers were used to differentiate all types of pediatric cancer histology. The most commonly used biomarkers included CD20-33%, Ki67-33%, c-myc-30%, CD10-30%, BCR-ABL 24.2%, CD30-15.1%, CD15-9%, MUM1 9%, and PAX5-9%.
CONCLUSIONS Immunohistochemistry is critically important for accurate diagnosis of paediatric cancer, with over 30% of all cases identified as having treatment changing diagnoses. IHC training is critical and a limited common biomarker panel can successfully be used in low resource countries to improve treatment selection.

BACKGROUND Cameroon, located in Central Africa, is a developing country with a population of approximately 22,000,000 millions. Cameroon's Public Health Care System includes:
• 1 University teaching hospital established 40 years ago;
• 8new faculties for medical studies established in the last 5 years,
Cancer Facts in Cameroon:
• Liver cancer is the a common cancer in Cameroon, with virtually a 100% mortality rate.
• Cervical cancer and breast cancer each represent 11% of the total cancer cases in the population.
• Only 10% of all cancer cases are confirmed through microscopy. 90% of cancer cases go undiagnosed either due to a lack of money or, in rural areas, as pathology facilities are not available.
• There are fewer than 10 pathologists and 10 oncologists for the whole population of Cameroon who are not trained in modern pathology.
• 80% of undiagnosed cancer patients end up with late-stage cancer, with no palliative care available.
In developed countries, digital pathology and molecular techniques such as immunohistochemical staining are widely used in the diagnosis of abnormal cells such as those found in cancerous tumors and are now introduced in the new WHO classification of diseases. Most of these techniques can be used on paraffin-embedded specimens.
METHODS In Cameroon, the above techniques are not available. We established a collaboration with few laboratories in developed countries including National Cancer Institutes, USA, Switzerland, and France. Paraffin blocks of diagnosed cancers have been sent abroad each year. Immunohistochemistry has been performed free of charge in our serie.
RESULTS A series of 100 cancer patients are reported in this new serie. There were 30 malignant lymphomas, 10 soft tissue tumours, 20 breast cancers and 40 cases of other cancer subtypes. 10 cases were found in children of less than 15 years old with 3 Hodgkin’s lymphomas amongst them. The delay of sending specimens and receiving results via regular mail was one month. Last year, an NGO based in France (ALLIANCE Mondiale Contre le Cancer) offer to us a Microscope with a Leica numeric Camera which now help us to exchange our slides with a software (IPATH) supported by the International Network for Cancer Research and treatment.
CONCLUSION Apart from classifying and clarifying their diagnosis, none of these patients is now receiving target treatment like Trastuzumab, Rituxumab etc… after the immunohistochemistry result to date as drugs are either expensive or not available in our environment.

Résumé
L’objectif de cette mise au point est d’évaluer les différents travaux d’imagerie quantitative de la littérature, qui ont tenté de prédire un phénotype des cancers du sein à partir des images médicales.
Méthodologie Elle a consisté à la recherche des articles dans les bases de données suivantes : «PubMed, Google Scholar, Science.gov, WorldWideScience , avec des expressions telles que radiomic breast cancer, radiogenomic breast cancer et quantitative imaging breast cancer. Seuls les travaux ayant pour objectif la prédiction d’un phénotype histologique ou immunohistologique, métastasique, de la résistance à un traitement et de la récidive ont été retenus.
Résultat Au total 37 travaux de radiogénomiques ont été identifiés avec 78,37 % qui ont utilisés les images Imagerie par Résonance Magnétique (IRM); 5,40 % les images échographiques ; 10,81% le Tomographie par Emission de Positon (TEP) et 5,40% les images mammographiques. Les biomarqueurs d’imagerie recherchés sont en rapport avec : les grades histologiques, les statuts moléculaires (Récepteurs Hormonaux, Her2, Triple Négatif), la présence de ganglions axillaires, la réponse biologique à un traitement et la possibilité de récidive.
Conclusion L’utilisation de la radiomique offre des perspectives pour la prédiction des phénotypes qui seront utiles à toutes les étapes de la prise en charge des cancers du sein. Elle reste une technologie à améliorer surtout du point de vue standardisation du choix des descripteurs et de normalisation si possible des images à utiliser.
Mots clés : Radiomique, Imagerie, Cancer

INTRODUCTION La (RCMI) est une évolution majeure de l’irradiation du cancer du cavum.
OBJECTIF décrire la technique de RCMI et rapporter ses résultats thérapeutiques.
Matériels et méthode : étude rétrospective, du janvier 2016 au Décembre 2017, au service de radiothérapie du CHU Hassan II de Fès incluant 163 patients porteurs de cancer du cavum et irradiés par IMRT.
RÉSULTATS l’âge moyen était de 45,85 ans (12-85), le sex-ratio de 1,53 (prédominance masculine). Les signes rhinologiques présents chez 64.79% des patients. Le carcinome indifférencié de type nasopharyngé prédominant (94,37% des cas). 1,5% des patients étaient de stade I, 14% de stade II, 47% de stade III, et 37,5% de stade IV. La RCMI a été réalisée chez tous nos patients en technique du boost intégré simultané, avec un étalement sur 54 jours en moyenne, selon le protocole de chao en 3 niveaux de dose ; le PTV haut risque (70Gy), PTV risque intermédiaire (63Gy) et PTV bas (56Gy), en 35 fractions. Sur les histogrammes dose-volumes, la D2% était de 75.128 +/- 0.9 (72,9 – 76,6), la D98% de 66.05 +/- 2 (58,8 – 69,8), la D50% de 70Gy, l’Indice d’homogénéité de 0.125 +/- 0.03 (0,08-0,3), l’indice de conformité de 1.33 +/- 0.13 (0,96 - 1,85) et le nombre d’Unités moniteurs de 1512.7 +/- 269 (812– 2070). Sur les organes à risque la Dmean de la parotide homolatérale était de 31.3Gy (écart type à 7.13), Dmean de la parotide controlatérale de 26.4Gy (écart type à 2.2), D2% et Dmax de la moelle épinière étaient respectivement à 35.5Gy (écart type à 2.9) et 39.7Gy (écart type à 2.4), D2% et Dmax du tronc cérébral respectivement à 52.18Gy (écart type à 3.14) et 58.4Gy (écart type à 3.4), Dmax de la cochlée homolatérale de 57.9Gy (écart type à 12.5) et Dmax de la cochlée controlatérale de 52Gy (écart type à 10). Au cours de l’irradiation 92,95% ont présenté une toxicité aigüe dont 43.66% ont présenté une dysphagie, 54,93% une épidermite et 80% une mucite. À 3 mois 29,57% de nos patients ont présenté une toxicité dont 25,35 % une xérostomie et 9,86 % une hypoacousie. Après un recul moyen de 28,4 mois, 93% des patients sont en bon control locorégional, 2,81% patients sont en progression métastatiques et 4.19% perdu de vue.
CONCLULSION l’irradiation des cancers du cavum par RCMI permet de diminuer de façon significative les toxicités au long terme.

INTRODUCTION Depuis de nombreuses années, la curiethérapie joue un rôle important dans la prise en charge thérapeutique de certaines tumeurs solides. Dans le cadre du cancer du sein, la curiethérapie est essentiellement utilisée comme complément d’une radiothérapie externe postopératoire.
OBJECTIF mise au point sur le rôle de la curiethérapie en termes de contrôle local.
METHODES étude rétrospective menée au sein du service de radiothérapie du CHU Hassan II de Fès sur la période étalée du janvier 2012 au décembre 2017 et portant sur 26 patientes avec traitement conservateur du cancer du sein ayant bénéficié d’un complément d’irradiation par curiethérapie interstitielle. RESULTAT L’âge moyen était de 40ans (28-69 ans). Le nodule du sein était le motif de consultation le plus fréquent dans 95,2% des cas. Une écho-mammographie a été réalisée chez 100% des patientes dont 50.6% étaient classée ACR 4, 32.2% ACR 5 et 17.2 % ACR 6. Le type histologique prédominant était le Carcinome Canalaire infiltrant chez 81,5% des patientes, et les types luminaux sont les plus fréquents dans 74,3% de cas. 13% étaient triple négatif. 84,1% de nos patientes ont bénéficié d’une tumorectomie et 15.9% d’une quadrantectomie. Toutes nos patientes ont bénéficié d’une radiothérapie externe tridimensionnelle ; 30.76% à une dose totale de 50Gy en fractionnement standard étalée sur 5 semaines et 69.23% à une dose totale de 42Gy en hypofractionnement à raison de 2.8Gy/fraction étalée sur 3 semaines. La surimpression de dose (boost) au niveau du lit tumoral a été faite par curiethérapie interstitielle par implant iridium-192 à haut débit de dose, à une dose de 10Gy en 2fractions chez toutes nos patientes. Après un recul moyen de 42.3 mois la survie globale et la survie sans récidive étaient à 96.16% et le control locorégional était à 100% chez nos patientes.
CONCLUSION La curiethérapie reste une technique très performante, elle doit trouver sa place dans l’arsenal thérapeutique du cancer du sein en association avec la radiothérapie externe.

OBJECTIVE The presence of brain metastases of solid carcinomas is associated with a poor prognosis. Standard treatment is whole-brain radiation (WBI). However, for some patients, survival remains limited to a few weeks. The purpose of this analysis is to identify patient populations that will not benefit from WBI because of the remaining short survival time.
METHODS We analysed a total of 339 patient records with brain metastases treated with whole brain radiotherapy from January 2009 to January 2016. External beam radiotherapy techniques were used to deliver 33 Gy in 11 fractions (4 fractions per week) to the whole brain. Eight clinical factors with a potential influence on survival were investigated using the Kaplan-Meier method. All factors with a P < 0.05 in univariate analysis were entered into multivariate analysis using Cox regression.
RESULTS The median survival time in this series of 339 patients was 2.5 months (M; range, 0 - 61 months). Four identified risk factors (Karnofsky Performance Score (KPS)<70, age>70, >3 of metastases in cranial, uncontrolled primary tumour) were significant and negatively correlated with survival. Patients with no risk factors had a median survival of 4.7 M; Patients with one risk factor, 2.5 M; Patients with two risk factors, 2.3 M; and Patients with 3-4 risk factors, 0.4 M (p<0.00001).
CONCLUSION Risk factors were identified which have significant influence on the survival of patients with brain metastases. Despite WBI, patients with 3 or 4 risk factors have a very short survival time. For these reasons, this group of patients should not be irradiated.

INTRODUCTION The overarching need for palliative care across Africa remains a mammoth task basically because priority is given to preventative and curative services. Whether refugees make a significant contribution to national economy or not, they are largely excluded from social services mainly because they are often considered either to be criminals or illegal settlers. The aim of this study was to explore health workers’ Challenges and Opportunities for integrating palliative care services into humanitarian health interventions in Uganda.
METHODS This was a cross sectional qualitative study applying Focus Group Discussions with health care workers working with United Nations High Commissioner for Refugees implementing partners within refugee operational areas in Uganda. We recruited a total of 36 participants and conducted three focus group discussions with 12 participants each. Participants were stratified into three categories (Nurses, Clinical Officers and Doctors). Analysis was approached by data familiarization, identification of thematic frame works, indexing, charting and interpretation.
RESULTS No humanitarian organization providing health interventions among refugees were found to be offering palliative care services. This reflects the global situation where very many health workers engaged in humanitarian development are neither trained in palliative care nor offering it. Respondents experienced challenges unique to working with refugee communities including disjointed referral systems, language barrier, limited palliative care knowledge, infrastructural restrictions and limited morphine access.
CONCLUSION Findings indicate that access to palliative care services for refugees in Uganda falls far short of even the host community needs. There is need for an improved referral system, additional skilled human resource work force for palliative care, a health system strengthening approach for improved availability of oral liquid morphine and access to quality palliative care services within refugee host districts.

OBJECTIVOS Avaliar a conscientização sobre o cancro do colo do útero e infecção por vírus papiloma humano e a aceitabilidade antecipada da vacina contra o vírus papiloma humano entre adolescentes.
MÉTODOS Um estudo quantitativo transversal foi realizado em três distritos de Moçambique (Manhiça, Kha-Mavota e Mocímboa da Praia) antes do primeiro ciclo de vacinação contra o vírus papiloma humano. O estudo teve como alvo adolescentes de 10 a 19 anos identificadas em escolas e comunidade. Entrevistas estruturadas foram conduzidas para avaliar o conhecimento sobre o cancro do colo do útero, prevenção do vírus papiloma humano e a aceitabilidade de vacinar contra o vírus papiloma humano.
RESULTADOS Um total de 1147 adolescentes foram selecionadas. Quando perguntadas se aceitariam ser vacinadas se uma vacina estivesse disponível em Moçambique, 91% (1025/1130) das meninas responderam positivamente, sendo o centro de saúde identificado como espaço preferido pelas meninas adolescentes para serem vacinadas. Factores associados a aceitabilidade foram: idade, nível de escolaridade, e conhecimento prévio sobre cancro do colo do útero e sua prevenção.
CONCLUSÃO O estudo antecipou uma alta aceitabilidade de vacinar contra o vírus papiloma humano entre as adolescentes. Estes resultados sugerem que os programas de educação em saúde são crucias para a aceitação de novas ferramentas para prevenir o cancro do colo do útero, e se encorajam para avançar na redução da mortalidade e morbidade relacionada ao cancro do colo do útero em Moçambique.

OBJECTIVO Estimar a viabilidade da integração da vacinação contra o Papiloma Vírus Humano (HPV) nos programas de saúde escolar e do adolescente em Moçambique.
MÉTODO O estudo consistiu em um exercício teórico que combinou um painel de discussão com os principais intervenientes do programa alargado de vacinação (PAV) com uma análise situacional dos programas existentes de saúde escolar e do adolescente e consultas individuais a decisores e formuladores de políticas e implementadores ao nível local.
RESULTADOS A abordagem mais viável a ser acoplada pela vacinação contra HPV nas escolas é a vacinação contra tétano (VAT) para abranger a faixa etária elegível (9 a 13 anos) na primeira dose. Dado que não foi identificada uma intervenção que tenha um período específico durante o ano que coincida com a segunda dose da vacinação contra HPV, a abordagem proposta deve ser complementada pelo reforço das campanhas e brigadas móveis e pela disponibilidade de vacinas nas unidades sanitárias ao longo do ano. Este modelo de integração sugere a coordenação entre os ministérios da Saúde, Educação e Desenvolvimento e o Instituto Nacional de Estatística. Caberia ao PAV o papel de implementar a vacinação ao programa de saúde escolar e do adolescente coordenar, planificar e monitorar as actividades.
CONCLUSÃO A proposta da integração da vacina contra o HPV nos programas de rotina de saúde escolar e do adolescente tem o grande desafio do calendário desta vacina não coincidir com os calendários das intervenções existentes. No entanto, constitui uma oportunidade para o PAV partilhar a responsabilidade de coordenação com outros sectores, que devem organizar-se de forma a rotinizar melhor as suas intervenções de saúde nas escolas.

OBJECTIVOS Este estudo teve como objectivo estabelecer um sistema de vigilância para garantir a monitoria de eventos adversos após a imunização com a vacina contra o HPV.
MÉTODO A implementação do sistema de monitoria de eventos adversos decorreu em simultâneo com a administração da vacina. Foram usados três métodos de notificação dos eventos: notificação espontânea; vigilância activa de eventos adversos graves (SAE) e eventos adversos de interesse especial (AESI) e uso de uma linha radiofónica (Alô vida) para sensibilizar os vacinadores e vacinados sobre o programa e os meios de comunicação em caso de evento de adverso. Foi definido um fluxo de comunicação e referência tendo em conta que a vacinação ocorria na escola, foram formados os profissionais da saúde e da educação na detecção dos casos e foram distribuídas fichas de notificação de eventos adversos. As escolas e as unidades sanitárias receberam termómetros para registo de febre pós vacinal. Um inquérito pós-introdução da vacina foi realizado.
RESULTADOS Foram treinados 67 profissionais de saúde e educação na detecção de casos de eventos adversos. Do total das 6.945 doses de vacina contra HPV administradas em 2014 no distrito da Manhiça um evento adverso grave foi notificado de acordo com o protocolo estabelecido. O caso foi revisto e foi confirmado caso de malária grave e classificado como não relacionado com a vacina. No inquérito pós-introdução 3 adolescentes referiram eventos ligeiros (dor no braço até 7 dias após a vacinação) e os profissionais de saúde referiram 2 casos de AESI, ambos não relacionados com a vacina, sendo que um coincidia com o registado no sistema. Não foi reportado rumor relativo a ocorrência de eventos adversos.
CONCLUSÃO O sistema estabelecido permitiu a notificação de um evento adverso grave não relacionado com a vacina. Os eventos adversos ligeiros não foram notificados. Há necessidade de reforçar o sistema de monitoria de eventos adversos a vacinas, pois um dos casos de AESI não foi notificado. Métodos inovadores podem ser úteis para melhor educação e comunicação sobre os eventos adversos como foi o caso do uso da linha “Alô vida”.

OBJECTIVO Avaliar em que medida as percepções leigas do CCU se alinham com o conhecimento biomédico do ponto de vista de saúde sexual e reprodutiva.
MÉTODOS 10 Discussões em Grupos Focais (DGF) foram realizadas com 10 grupos-alvo variados (de meninas adolescentes a vendedores informais de fármacos). No total participaram 116 respondentes. A DGF foi usada para obter informações verbais e desencadear debates em torno de crenças e atitudes sobre o cancro do colo do útero (CCU), bem como para explorar noções de transmissão e etiologia da doença. As discussões foram gravadas para posterior transcrição e análise, seguindo uma combinação de análise de conteúdo e temática.
RESULTADOS Os participantes estavam familiarizados com o termo biomédico "cancro do colo do útero", mas o conhecimento de sua etiologia e transmissão era limitado. O CCU foi prontamente associado à transmissão sexual e a infecções sexualmente transmissíveis, e foi concebido como uma "ferida que não cura". O termo "cancro" causou confusão, pois foi percebido como ocorrendo apenas na pele e nos membros (posteriores e inferiores), entendido como hereditário, não transmissível e como uma doença do Ocidente.
CONCLUSÃO As percepções leigas de CCU alinham-se em grande parte com as biomédicas. No entanto existem noções pré determinadas sobre o cancro em geral, que distanciam as pessoas de se identificarem com a doença. Não obstante, há um terreno comum para enquadrar futuras intervenções de controle do CCU do ponto de vista da saúde sexual e reprodutiva.

OBJECTIVE As Tanzania continues to develop clinical programs to combat the increasing breast cancer incidence, understanding women’s perspectives on breast cancer and care-seeking are key to successful cancer control.
METHOD A community-based survey was administered to conveniently sampled women aged 30 and older to assess awareness and knowledge of breast cancer and perspectives on care-seeking.
RESULTS Among 1,129 women, median age 37 (IQR: 31-44), 59% of women have heard of breast cancer, 16% have been checked for breast cancer, and 10% have received previous breast health education. Women self-evaluated their knowledge of breast cancer (from 1-none to 10-extremely knowledgeable) with a median response of 3 (IQR: 1-4). Only 14% felt they knew any signs or symptoms of breast cancer. Encouragingly, 56% of women were fairly-to-very confident they would notice personal breast changes, with 24% of women practicing self-breast examination. Overall, 74% said they’d be somewhat-to-very likely to seek care if they noticed a change, with 96% noting severity of symptoms as a motivator. However, fear of losing a breast (40%) and fear of a poor diagnosis (38%) were most frequent barriers to care seeking. In assessing knowledge of risk factors, about 50% of women did not know any presented risk factors whereas 42% of women believed long term contraceptive use a risk factor but 37% and 35% of women did not think that family history or being older were factors, respectively.
CONCLUSION The success of efforts to improve early diagnosis depends on women being aware of breast cancer signs and symptoms, risks, and ultimately seeking care for concerns. Fortunately, most women said they would seek care if they noticed a change in their breasts, but the low levels of cancer knowledge, symptoms, and common risk factors highlight the need for targeted community education and awareness campaigns.

OBJECTIVE The number of HIV-infected breast cancer (BC) patients in Africa is increasing, partly due to long-term survival with expanded access to anti-retroviral therapy. We examined the effect of HIV status on pathways to BC diagnosis with a view to informing down-staging strategies.
METHODS A multi-country (Namibia, Nigeria, South Africa, Uganda and Zambia) hospital-based BC cohort study was recruited in 2014-2017. Women diagnosed with BC were interviewed to determine key dates in their pre-diagnostic journey. Time to diagnosis (TD) was estimated from self-reported date when a woman first recognized BC-related symptoms to date of diagnosis. We employed logistic regression to investigate correlates of delayed TD (i.e. ≥3 versus <3 months).
RESULTS Among 1,506 women included in preliminary analyses, median TD was 7 (IQR=3-19) months, with 75% patients having TD ≥3 months. HIV+ patients (150 (10%)) were younger (mean age=46 (SD=9) years) than HIV-/unknown patients (mean=51; SD=14) (p<0.0001). In crude analyses, longer delays to diagnosis were experienced by women who were HIV+ (odds ratio (OR)=1.50; 95% CI: 0.98-2.31), from Uganda, Black, with no formal education, unemployed, not currently married, rural residents, than their counterparts (p<0.05 for all). Having never heard of BC, lower BC knowledge and not believing BC is curable were also associated with longer delays to diagnosis (p<0.01 for all). In mutually-adjusted analyses restricted to Black women, HIV status was no longer associated with TD (aOR=1.35; 95% CI: 0.85-2.14); only being uneducated (aOR=1.86; 95% CI: 1.08-3.23) and being from Uganda (aOR: 2.30; 95% CI: 1.40-3.78) were found to be associated with longer delays to diagnosis.
CONCLUSIONS In a large study of HIV and BC, we found substantial delays in BC diagnosis. However, HIV-status was not independently associated with time to diagnosis. Final analyses will include additional data from Botswana Prospective Cancer Cohort (BPCC), and will examine HIV treatment status.

OBJECTIVE To determine barriers to cancer surveillance in sub-Saharan. Africa (SSA).
METHODS During a three-week cancer registration training in March 2019, in Eldoret, Kenya, 16 cancer registries from SSA were represented. Each cancer registry (CR) was instructed to list the barriers experienced in their cancer registries in the course of cancer surveillance. These were presented and discussed among all participants. Of the 16 CRs, 10 were population-based Cancer Registries (PBCRs) and 6 were Hospital Based Cancer Registries (HBCRs). The data presented was from PBCRs only. Responses were grouped into similar themes and tabulated based on frequency of occurrence.
RESULTS The PBCRs registered similar barriers as follows; Inconsistent funding; lack of or unimplemented government policy on cancer; Inadequate staffing; Poor medical records in health facilities; Lack of adequate basic infrastructure; Denied access to health facilities for cancer data collection; Politics; and a lack of ownership of the cancer registry. The most prevalent themes were Inadequate Staffing at 100% while, Inconsistent funding; lack of or unimplemented government policy on cancer followed at 90%, Poor medical records in health facilities; Lack of adequate basic infrastructure; were a challenge for 70% of the CRs while other themes scored less than 20%.
CONCLUSION Cancer surveillance being a continuous process and a critical pillar for cancer control efforts in SSA, needs to be coined and implemented inform of policy or act of parliament and supported through the ministries of health and consistent government budgetary allocation. This is lacking in most SSA countries. Technically, this would solve the major barriers experienced by cancer registries by a huge margin. Proper record keeping practices in health facilities remains to be a challenge, electronic medical records systems adoption should be looked into as a means to improved quality and consistency of output in support for proper documentation in cancer surveillance. A lack of fully dedicated staff or in other cases inadequate staff ultimately impacts on the quality and timeliness of data measures should be put in place in terms of sensitization and advocacy for stakeholders to understand the importance of cancer surveillance in the fight against cancer.

Organized cancer screening programmes are rare in LMICs. Early detection and advancements in medicine have contributed to an overall decrease in mortality rates resulting from cancer diagnoses. Despite this improvement in global health status, Nigerians continue to be diagnosed at a later stage. It is important therefore to identify and target specific groups that may be less willing to present for early cancer screening.
AIM To understand the characteristics of people who are likely or not likely to present for early cancer screening among Nigerians, and to address the use of mechanisms by which to ensure a timely diagnosis of preventable cancers among Nigerians.
METHODS Adult Nigerians (N=144),18-71years of age who presented for clinical breast exam (CBE), visual inspection with acetic acid (VIA) and prostate specific antigen test (PSA) screenings after an awareness exercise; completed survey forms which included a personality inventory, Early Cancer Detection Behavior Scale and a demography profile. Multiple regression and ANOVA were used to examine predictive patterns as well as differences between and within groups.
RESULTS Results showed income (b = 0.18, p<.05) to be a significant determinant of early cancer detection behavior, such that higher income earners were more likely to go for screening. There were also significant gender differences in current cancer detection behavior between males (M= 0.15,SD = 0.51) and females (M= 0.47,SD = 0.80); males are less likely to engage in early detection behavior (F(1,145) = 4.76, p=.03). Data further show differences between older (>41) and younger (<40) participants in intention to screen for cancer, with older participants reporting more willingness to engage in cancer screening. Our finding enhances our understanding of the profile of the groups who are less likely to screen for cancer. Also, it suggests that awareness campaign and free screening exercises should target these at-risk groups in Nigeria.

OBJECTIVE To determine the effect of population cervical cancer screening using visual inspection with acetic acid (VIA) plus immediate cryotherapy on the population burden of cervical pre-cancers.
METHOD This was a prospective pragmatic population intervention study. The intervention was population cervical screening with VIA and immediate treatment of VIA positive cases with cryotherapy’. Four rural communities in two states of southeast Nigeria were selected through a multistage random selection process. The women were screened with VIA. Women who tested positive to VIA were offered immediate cryotherapy or large loop excision of transformation zone (LLETZ) based on predetermined eligibility criteria. Cervical biopsies were taken before cryotherapy to confirm the presence of high grade squamous intraepithelial lesions. Participants were re-screened 1 year later. Main outcome measure was population prevalence of high grade cervical squamous intraepithelial lesion (HSIL) before and after intervention. McNemar Chi square was used to compare the proportions.
RESULTS A total of 653 women participated in the study. The population prevalence of all grades of cervical SIL before the intervention was 8.9%. The prevalence 1 year later was 1.4% (p < 0.0001). The population prevalence of high grade SIL reduced from 4.1% preintervention to 0.5% at 1-year postintervention (p < 0.0001).
CONCLUSIONS Population cervical cancer screening using VIA plus immediate cryotherapy for positive cases leads to significant reduction in the population burden of cervical pre-cancers. The results of this study, which represents the first to evaluate the impact of VIA-cryotherapy screening model on real-time population burden of histologically confirmed HSIL, shows that the model is effective for large scale population prevention of cervical cancer in low‑income populations.

OBJECTIVE With an intense HIV epidemic, Hodgkin and non-Hodgkin lymphomas are common cancers in Botswana. However, subtype diagnosis is challenging in resource-constrained pathology labs. We sought to analyse the diagnostic accuracy of specimens classified as lymphoma.
METHODS We prospectively collected data from 70 adult patients, who were diagnosed with either classic Hodgkin’s Lymphoma (CHL) or non-Hodgkin’s lymphoma (NHL) and treated at 3 large hospitals in Botswana between 2010 and 2016. Initial pathologic review in Botswana relied on histology with sporadic access to immunohistochemistry. Secondary pathologic review with additional staining was performed by a hematopathology's at Massachusetts General Hospital (MGH), USA and was considered the gold standard.
RESULTS In total, 70 patient specimens were analysed, 42 (60%) of whom were originally classified as NHL and 28(40%) as HL. On secondary review at MGH, 47(67%) were determined to be NHL, and 20(28%) as HL. The overall reclassification rate among all cases 19(27%). By subtype, 6 cases that were diagnosed as diffuse large B-cell lymphoma (DLBCL) at MGH, had been diagnosed as CHL in Botswana. Three additional cases initially classified as CHL, were determined to be follicular lymphoma, large cell lymphoma, and poorly differentiated neoplasm at MGH. Eight cases diagnosed as DLBCL in lymphoma were determined to be plasmablastic lymphoma (3), Burkitt’s Lymphoma (3), small lymphocytic lymphoma (1) and peripheral T-cell lymphoma (1) following MGH review. One case of mantle cell lymphoma was reclassified as small lymphocytic lmphoma and an additional specimen classified as reactive lymphoid hyperplasia was diagnosed as peripheral T-cell lymphoma at MGH. None of the three cases of Burkitt’s lymphoma were detected in Botswana.
CONCLUSIONS More than a quarter of lymphoma cases were misclassified in this single prospective cohort. Limited access to molecular pathologic methods impairs treatment decisions and patient outcomes.

BACKGROUND Cervical cancer is a major global public health concern, with 85% of cases occurring in low- and middle-income countries. In South Africa, it is the second most common cancer amongst women. This research determines the associations between women’s beliefs about cervical cancer and screening and the uptake of Pap smears in Johannesburg, where cervical screening uptake is suboptimal.
METHODS This cross-sectional analytical study applied a validated measurement scale based on the Health Belief Model (HBM), to describe health beliefs regarding cervical cancer and screening using an interviewer-administered questionnaire among 280 women aged 30 years and older attending Johannesburg primary healthcare facilities in 2017. Logistic regression models with robust estimation of variance were fitted to identify health beliefs associated with ever having had a pap smear (uptake), while controlling for potential confounders.
RESULTS Of the 280 women, 177 (63.2%) had ever been screened, 180 (64.3%) were never married, 199 (71.1%) attained secondary education and 133 (47.5%) were employed full time. The multivariable logistic regression showed that the health beliefs associated with Pap smear uptake were perceived severity and perceived barriers. Women of older age (AOR=1.6 for a 5-year increase in age; 95% CI: 1.3-1.9, P<0.001), with higher knowledge scores (AOR=2.5 for a 5-point increase in knowledge score; 95% CI:1.0-6.3 ;P=0.051 ), with lower perceived barriers scores (AOR =0.4 for a 5-point increase in barriers score; 95% CI:0.3-0.5; P<0.001) and higher perceived severity scores (A0R=1.3 for a 5-point increase in severity score; 95% CI:1.0-1.6; P=0.017) were more likely to have had a Pap smear.
CONCLUSIONS This study shows that women who take up screening are older, knowledgeable regarding cervical cancer and screening, less likely to perceive screening barriers, and more likely to perceive cervical cancer as a severe disease. This highlights that for public health interventions to increase screening uptake, the focus should include tailored behaviour change communication strategies that addresses women’s beliefs regarding screening barriers and emphasize the severity of cervical cancer.

BACKGROUND Traditional medicine men and women are a major source of health care in the communities in Western Kenya especially for chronic or “unexplained” diseases. It is estimated that more than 75% of the population consults traditional healers before diagnosis, during treatment or after their cancer treatments. However, there is very little research on the role of traditional healers in cancer and chronic disease care.
METHODS This qualitative study was designed to identify the roles the traditional healers believe they play in cancer management from diagnosis, treatment and family support, with a view to mitigate the barriers in cancer care and develop a white paper for the policy makers on role of traditional healers in cancer care in Kenya. Focus group discussions and in-depth interviews were conducted with three cohorts of traditional healers in Western Kenya. 18 cancer survivors, who interacted with traditional healers, were also interviewed.
RESLUTS A total of 80 traditional healers participated. Cohort 1 had 25, Cohort 2 had 35 and Cohort 3 had 20 participants drawn from communities in Western Kenya. 18 cancer survivors were interviewed separately. The traditional medicine men/women were a mixture of herbalists, prayer-healers, witchdoctors and diviners. Most of the participants multi-tasked and had multiple roles in the community. However, their roles fell into five major categories: Medicinal healing using traditional herbs, comforting the patient & family, provision of palliative treatments, spiritual guidance/divine intervention (including blocking evil spirits & atonement) and bereavement support. They reported some challenges in their work which included lack of recognition, encroachment of farming on the herbs/forest lands, inability to make “proper” diagnosis and loathing from the hospital doctors/conventional practitioners. The 18 cancer survivors interviewed gave four major reasons for going to traditional healers: accessibility (close, available, friendly, wide-range-of-services & welcoming), easy to understand them (cultural compatibility and “sensible”), Cost (cheaper, pay-over-time, pay-in-kind) and “tired of the hospital doctors/nurses with bad attitudes”.
CONCLUSIONS There is definitely a role for the traditional medicine/women in cancer and chronic disease care continuum, however, the specific roles and regulation of the practice needs to be further interrogated. They, if selected well and trained, can help in early referral for diagnostics and treatments at cancer centres, offer emotional support to the families and be involved in cancer awareness and screening messaging as per the local communities but with regulated oversights.

OBJECTIVE As part of MLCCP to establish a baseline of lung cancers in Kenya.
METHODS
Setting I: A Retrospective review of lung cancer diagnosis at Eldoret Cancer registry 1995-2017; 310 analyzed.
Setting II: All those with lung masses at radiology unit from 2014- 2018 ;78 lung masses noted.
Setting III: Data from a large private laboratory group- 514 cases that were biopsied, 279 malignant vs 235 others.
RESULTS Setting I: 310 lung malignancies. Primary lung 102 (32.9%) . M: F was 1:1. Mean age, and range in years was 60.3±1.2 and 29-98. NSCLC 81.4% and SCLC 18.6%. Adenoca 62.7%, SCC 21.7%, large cell carcinoma 6.0%. Staging on 18 patients, 14 had stage IV disease. Age 55-74 accounted for 61.7%. Setting II: From Rad unit Biopsies done mainly by CT-guidance (31/73), Ultrasound guidance (20/73), bronchoscopy (19/73) and Thoracotomy (3/73).
Of 78 cases, 50 (64.1%) were malignancies. Lung cancer had 34 of the 50. Mean age 57.1 range 32-84 yrs with median 61. Males were 21 (67.8%) and females were 13 (38.2 %) NSCLC was 83.4% and SCLC was 17.6%. Adenoca accounted for 82.14% of NSCLC. Clinical data was available on 10 of the 34 cancer patients and indicated Stage IV in 80% of them. Setting III: Of the 279 malignant cases from the private lab facility, Primary lung cancer had 209 patients (74.9%). Other metastatic cancers;Metastatic carcinoma 4.7%, CUP 4.3%, Neuroendocrine 3.6%, Carcinoid tumour 1.8%, sarcoma, spindle cell tumour, lymphoma and others. M:F 116 (55.5%) vs 86 (41.2%). 61 av. age at diagnosis, range 23-94 yrs. NSCLC was 91.8% of all cases, SCLC was 8.2%. In NSCLC, Adenocarcinoma 129 (61.7%), SCC 20% and others 20%. Others-TB, Pna, Aspergillosis, Benign tumours, Fibrosis, Bronchiolitis Obliterans etc.
CONCLUSION High index of suspicion, education and training is needed to improve diagnostics in Lung cancer in Kenya. Bio-banking of tissue and more research i.e evaluation of mutations; EGFR, ALK, ROS1, MET, BRAF, HER2, PDL1, MAPK, PI3K signalling pathways may be useful to define mechanisms of drug sensitivity and potential molecular targets in our setting. There is a need to fully characterize, optimally treat and measure outcomes of lung cancer in Kenya.
ACKNOWLEDGEMENTS MLCCP is a Multi-National Lung Cancer Control Program with Dr. Asirwa the overall PI for Kenya, Tanzania, Swaziland and South Africa. Funding for the program has been provided by Bristol Myers Squib Foundation (BMSF). MLCCP Team is the Team for this Kenya Program Component.

OBJECTIVE Children with Burkitt Lymphoma (BL) in Liberia are dying despite high survival rates in high-income countries. The reasons for this are multi-factorial. We conducted a prospective cohort study to identify clinical characteristics and barriers to diagnosis and treatment for these children.
METHODS Children age 0-15 years with suspected BL presenting to three hospitals in Liberia were recruited. Barriers to diagnosis and treatment were gathered through semi-structured interviews with parents/guardians and primary health care providers. In addition, we developed a costing tool to estimate facility-based costs using risk category, current chemotherapy and monitoring protocol, and hospital fee schedule.
RESULTS 22 children were enrolled in this study and the majority had advanced disease at diagnosis. Median total delay from symptom onset to diagnosis was 8 weeks (IQR 7), median caregiver- delay (symptom onset to first visit to health facility) was 2 weeks (IQR 1); median health system delay (time from first visit to health facility to diagnosis) was 6 weeks (IQR 11.5). Most children visited multiple primary level facilities prior to arriving at a health facility where BL was investigated. Many primary health providers do not include paediatric cancer in their differential diagnosis. Overall knowledge of cancer among both parents/guardians and health providers is low. Costs of treatment, challenges with transportation and distance from family were the primary barriers identified. Cost for chemotherapy and hospital care to treat BL is between 400-900 US dollars.
CONCLUSIONS While Liberia has the capacity to both diagnose and treat BL, there are many ongoing challenges impacting treatment access and outcomes. There are significant health systems delays, largely due to low awareness of BL among providers and limited diagnostics. Access to affordable and high-quality chemotherapy and supportive care, and long-term follow-up of patients from a dispersed geographic area are additional challenges to improving BL survival in Liberia.

OBJECTIF Au Sénégal avec l’augmentation de l’espérance de vie et de la prévalence des maladies non transmissibles, le besoin d’accéder aux soins palliatifs est certainement important. Il nous fallait faire l'état des lieux des soins palliatif au Sénégal et identifier divers obstacles pour leur développement afin de proposer des stratégies de plaidoyer.
MÉTHODES Différentes enquêtes ont été menées dans plusieurs hôpitaux de la capitale et en périphérie, dans les régions:
- auprès des patients porteurs de pathologies de maladies chroniques, surtout le cancer, sur leurs connaissances en soins palliatifs
-auprès des professionnels de santé sur leurs connaissances, leurs attitudes et leurs pratiques en matière de soins palliatifs et surtout de prise en charge de la douleur chez les malades porteurs de pathologies chroniques.
- sur la disponibilité et l'utilisation des médicaments opiacés
RÉSULTATS Les besoins en soins palliatifs sont une réalité quotidienne au Sénégal à tous les niveaux de la pyramide sanitaire. Les patients et leurs proches sont abandonnés dans leurs souffrances car la majorité des professionnels de santé n’ont jamais reçu de formation sur les soins palliatifs. De nombreux professionnels en exercice n'ont reçu aucune formation dans le domaine de la gestion de la douleur et sur l'utilisation des analgésiques opiacés. Par ailleurs les rares professionnels qui assurent la gestion de la douleur sont confrontés aux problèmes des analgésiques opiacés qui ne sont pas disponibles sur tout le territoire national et qui sont souvent en ruptures de stocks dans les hôpitaux où ils sont disponibles. Le manque de connaissances aux techniques d'approvisionnement en analgésiques opiacés aboutit à l'échec de tentatives d'acquisition, avec des conséquences dramatiques pour les malades.
CONCLUSIONS Les soins palliatifs devraient être mieux intégrés dans le programme de santé et à tous les niveaux de la pyramide sanitaire du Sénégal.
Les professionnels de santé qui traitent fréquemment des malades porteurs de pathologies chroniques ont besoin de formation en soins palliatifs.
Tous les personnels de santé devraient avoir accès à des directives écrites permettent soit de traiter la douleur de manière appropriée, soit de recommander les malades à des centres de soins capables de traiter la douleur. Les antalgiques opiacés devraient être disponibles à tous les niveaux de la pyramide sanitaire pour réduire les souffrances des malades et le désarroi des professionnels de santé. L’élaboration de textes réglementaires au niveau national concernant les soins palliatifs serait un élément fondamental pour le suivi des directives de l’OMS.

OBJECTIVE To fully automate radiotherapy planning and QA tasks to improve access to and quality of radiation therapy throughout the world.
METHODS We use a combination of in-house software and commercially available treatment planning software (Eclipse, Varian Medical Systems) to fully automate the treatment planning process, including contouring, field definition (3DCRT), and optimization (VMAT). All tasks are performed automatically using a primary algorithm for the treatment plan and a secondary independent algorithm to verify the primary algorithm. The only manual intervention is delineation of the GTV for head and neck (H/N). For H/N VMAT cases, normal tissues and lymph node targets are automatically delineated using a multi-atlas segmentation. A deep learning approach is used for the segmentation verification algorithm. RapidPlan is used to create a VMAT plan. For cervical cancer 4-field box treatments, field apertures (jaw and MLC positions) are automatically calculated based on bony anatomy automatically delineated using the in-house multi-atlas segmentation tool and verified using a deep learning approach. For post-mastectomy irradiation of the chest wall (tangents+SCV), the beams are setup and the dose is optimized using a combination of automatic delineation (using our in-house tool), beam setup algorithms using support-vector machines and deep learning to determine field borders, and automatic field-in-field optimization.
RESULTS Algorithms have been developed and undergone quantitative testing and physician review for H/N, cervix, and chest wall. We have demonstrated that the verification algorithms can successfully flag suspicious/failing cases. Several of these RPA tools are now in routine clinical use at MD Anderson (H/N contouring and cervix field definition). We expect to clinically deploy the automated contouring and planning for H/N, cervix, and chest wall in South Africa in 2019.
CONCLUSIONS We have achieved full automation of radiation planning for cancers of the H/N, cervix, and chest wall. Clinical deployment at partner sites will start soon. We are actively expanding this work to other anatomies and treatment modalities, including contouring and VMAT for cervix, intact breast, and prostate cancers.

BACKGROUND A pilot survey conducted through the AORTIC network in 2013 evaluated the state of breast cancer management in sub-Saharan Africa (SSA). Five years on, a follow up survey to document progress and persistent bottlenecks was deemed necessary to serve as a benchmark for future improvements.
METHODOLOGY An anonymous online survey of breast cancer management in SSA was conducted among AORTIC members, using a structured questionnaire in English, French and Portuguese. Responses were summarized and stored in Microsoft excel, and analysis demonstrated in table or graphs where appropriate.
RESULTS There were thirty-seven respondents from 30 facilities in 21 SSA countries. 91% oncologists versus 54% in the previous survey. Twenty-four (80%) facilities conduct breast multidisciplinary tumour boards (MDT) indicating a 20% increase over the 5 years. Only 3 institution did not use any form of treatment guideline. One third of institutions did not have radiotherapy. 22% record frequent downtime and 61.2% use conformal planning. Majority have access to CAF(90%), Tamoxifen (100%) and Zoledronic acid ( 89.5%). Availability of Taxanes and Trustuzumab have increased by 74% and 13% respectively. Out of pocket payments is required in 60% of cases and less than 10 % of patients can afford Trastuzumab in most centres. Bone scan facilities continue to be scarce (20%). The average waiting time for histopathology report is 1-3 weeks. More than half (80%) have a time interval between Surgery and chemotherapy of less than 8 weeks and two thirds had more than an 8-week time interval between surgery and radiotherapy. Advanced stage and socioeconomic status remain the major determinants of treatment outcome.
CONCLUSION Positive strides continue to be made in the management breast cancer in SSA. However, the challenge of late presentation, inadequate radiotherapy services and lack of political will power to support cancer treatment continues to be a severe handicap requiring urgent intervention.

OBJECTIVE We aim to describe delays in treatment of cervical cancer patients in Botswana.
METHODS Prospective cohort study of cervical cancer patients presenting to multidisciplinary treatment (MDT) clinic at Princess Marina Hospital, Gaborone, Botswana from January 2016 to July 2018. Delay periods were defined as days between key steps in diagnosis and treatment, and median delays were stratified by HIV status, residential distance from clinic, and year of first visit. Wilcox rank sum and Chi-squared were used for comparisons.
RESULTS The study included 230 patients (176 treated, and 54 untreated). There was no difference in baseline characteristics of treated vs. untreated patients. For these patients, median (IQR) days between: biopsy performed to pathology report was 28 (20,42), pathology report to first MDT visit was 23 (9,69), and prescription written to approved was 5 (2,22), with no differences stratified by HIV status or residential distance. Patients presenting after year 1 of MDT clinic had lower delay days between prescription written and approved (6 vs. 1, p=0.002). Patients who received no treatment had greater delay day at each period vs. those who received treatment, with statistically significant higher delays between biopsy performed to pathology report (57 vs. 23, p<0.001). Of untreated patients, 35 (67%) were deceased, 5 (10%) could not be contacted, and 11 (22%) were followed-up of whom 6 were unaware they needed treatment. For treated patients, greatest delay of 63 (48,77) was between prescription written and treatment initiated; total delay between biopsy and treatment initiation was 104 (85,143). Of treated patients, 46 (36.2%) were upstaged.
CONCLUSIONS Of all patients, the greatest delay was between biopsy performed to pathology report. Patients who received no treatment had greater delays for all periods and the majority were deceased when contacted. Of treated patients, greatest delay was between prescription written and treatment initiated.

OBJECTIVES Hepatocellular carcinoma (HCC) has a high mortality in Africa. However, little is known about the current approaches to therapy in the region. We aimed to understand practice and outcomes of HCC in Ethiopia.
METHODS Retrospective chart review of individuals that presented with HCC at a major referral clinic in Addis Ababa. HCC was diagnosed via biopsy or imaging criteria as established by international guidelines. Survival was determined as date of last visit and calculated in days from initial diagnosis visit.
RESULTS A total of 46 individuals were included and 50% of them were females. Median age was 54 years (IQR 45-62). Forty-one percent of individuals had hepatitis B (HBV) as underlying liver disease. Of these, all had underlying cirrhosis, and complete data was available in 15 (78%). Median age of HCC diagnosis in HBV-infected patients was 48 years (IQR 19-38) and 57% had AFP levels above 400 ng/ml at the time of diagnosis. Thirty-one percent of HBV-patients (N:6) were diagnosed before age 40. Being on HBV antiviral treatment correlated with longer survival (median of 46 vs 34 days) despite having larger tumour-size (median 7.3cm vs 6cm). Twenty percent of all patients were treated with sorafenib (N:9). Median survival in this group was 92 days (IQR 24-121), despite almost all of them having AFP >400ng/ml. Over half of these patients (5/9) were HBV-positive. Interestingly, a neutrophil-to-lymphocyte ratio (NLR) of <2.5 correlated with better survival (109 days vs 68 days for those with NLR >2.5).
CONCLUSIONS Our study shows earlier diagnosis of HCC in individuals infected with HBV, and a trend towards better survival in those with HBV-antiviral treatment. A small sub-group of individuals treated with sorafenib showed a reasonable survival benefit with a positive correlation to NLR.

OBJECTIVE Widely accepted international clinical ethics standards and Tanzania’s National Health Research Guidelines mandate that healthcare providers give patients information they want or need in an understandable way. However, adherence to these standards is low particularly in developing countries. In Tanzania, little is known regarding the views and practice of disclosure of diagnosis and prognosis to cancer patients. This study aimed to examine the factors influencing truth telling by providers to terminally ill cancer patients at Ocean Road Cancer Institute (ORCI).
METHODS We conducted semi-structured interviews with a purposive sample of healthcare providers (n=13) and terminally ill cancer patients (n=8) in English and Swahili. The sample included oncologists, palliative care specialists, nurses, and terminally ill cancer patients. The interviews were recorded, transcribed verbatim, and translated to English. Transcripts were coded and thematic analysis was applied.
RESULTS Participants generally acknowledged that truth telling is unsatisfactory according to international ethical standards. Fear of causing distress or hopelessness was a commonly cited barrier to truth telling, whereas rapport-building and principles of honesty were facilitators. Many providers emphasized systems-level barriers including: limited time, high volume of patients, a lack of private rooms for communication, absence of multi-disciplinary communication in care planning, lack of formal guidelines, and lack of communication skills training. Patients’ preferences, readiness to receive information, and religious faith were identified as both barriers and facilitators. Stigma due to traditional associations of cancer with witchcraft, communalism, and family collusion also influence truth telling.
CONCLUSIONS Participants recommended measures for improved truth telling: ongoing trainings to equip healthcare providers at ORCI in clinical ethics knowledge and communication skills, designated spaces to enhance privacy, freedom of sharing and listening, well stipulated guidelines for a multi-disciplinary team, and deliberate efforts to employ enough providers to care for increasing volumes of patients.

OBJECTIVE Childhood cancer treatment in LMIC is hampered by limited access to chemotherapy, due in part to a lack of quality data on the amount of drug needed and associated costs. To enable reliable and efficient procurement of childhood cancer drugs, the ACCESS project has developed a model to forecast chemotherapy demand in LMIC, enabling rigorous estimates of the annual volume and cost of essential drugs required to treat childhood cancer in Africa.
METHODS We developed a paediatric-specific model (ACCESS FORxECAST) that forecasts required drug quantity and cost for 18 common paediatric cancers, customizable to geographic region, regimen, cancer stage and drug price. Chemotherapy protocols were referenced from SIOP adapted treatment regimens, with input from disease experts working in LMIC. The model incorporates microsimulation estimates on incidence through extrapolation of existing registry data. Drug prices were derived from MSH’s International Medical Products Price Guide. We calculated the quantity and cost of essential drugs required to treat childhood cancer across Africa, based on both diagnosed cases and estimates of population-based incidence.
RESULTS The projected annual cost of treating the present burden of childhood cancer in Africa is USD 28.7M (95%CI 10.2-40.1). The estimated cost of treating all cases of childhood cancer (including undiagnosed cases) is USD 63.5M (22.7-88.0). The most expensive type of cancer to treat is acute lymphoblastic leukemia (median USD 11.7M). The most expensive individual medication is mercaptopurine (mean USD 16.9M). We provide detailed estimates of drug need and price by chemotherapeutic agent, country and diagnosis.
CONCLUSIONS Our results enable evidence-based forecasting of childhood cancer drug need and cost to inform health system planning in a wide range of African countries. The FORxECAST model is adaptable to setting, diagnosis, and treatment approach, allowing decision-makers to generate results specific to their context and needs. The ACCESS project will employ these summary estimates of need and cost to advance innovative strategies to improve drug access for children with cancer in Africa and globally.

OBJECTIVE Childhood cancer treatment is often assumed to be costly and ineffective in African settings, limiting advocacy and policy efforts. We therefore determined the cost and cost-effectiveness of maintaining childhood cancer centres across four hospitals throughout Sub-Saharan Africa.
METHODS Within hospitals representing four countries (Kenya, Nigeria, Tanzania, Zimbabwe), costing data were gathered for all inputs related to operating a paediatric cancer unit. Cost and volume data for relevant clinical services (e.g. laboratory, pathology, medications) were obtained retrospectively or prospectively. Other costs included those associated with salaries, inpatient bed use, outpatient clinic use, administrative fees, and overhead. Costs were summed for a total annual operating cost. Cost-effectiveness was calculated based on annual newly diagnosed patients, survival rates, and life expectancy.
RESULTS The four treatment centres varied in size and services delivered, seeing 40-170 new diagnoses annually. The cost per new diagnosis ranged from $2300 to $31,000, with differences attributable to variance in centre size, case mix, and abandonment rate, which also affected survival. The most expensive cost input was that associated with medication in Kenya, and medical personnel in the other three centres. The cost per disability-adjusted life-year (DALY) averted was less than the national per capital Gross National Income, and thus very cost-effective by World Health Organization standards. In all four centres, abandonment of therapy remained a significant cause of treatment failure; modelling exercises suggest that public funding of treatment and/or hiring of psychosocial personnel would increase survival rates while maintaining or even improving cost-effectiveness.
CONCLUSIONS This study indicates that among centres representing a range of sizes and settings across Sub-Saharan Africa, childhood cancer treatment units represent very cost-effective interventions. Additional cost outlays aimed at decreasing abandonment will increase survival and may further improve cost-effectiveness. These results will inform national childhood cancer strategies across Africa.

BACKGROUND Cervical cancer is the second commonly diagnosed cancer and the second leading cause of cancer death in women in Ethiopia, with rates among the highest worldwide. However, there are limited data on cervical cancer treatment patterns and survival in the country. Herein, we examine treatment patterns and survival of cervical cancer patients treated in Tikur Anbessa Hospital Radiotherapy Center (TAHRC), the only hospital with radiotherapy facility in the country.
METHODS Women with histologically verified cervical cancer who were seen in 2014 at TAHRC were included. Information about clinical characteristics and treatments were extracted from the patients’ medical record files. The information on vital status was obtained from medical chart and through telephone calls.
RESULT Of the 349 cervical cancer patients treated in 2014 in TAHRC, medical records were retrieved for 242 patients. The median age at diagnosis was 48 years. The median waiting time for radiotherapy was 5.58 months. Stage migration occurred in 13% of patients while waiting for radiotherapy. Consequently, the proportion of patients with stage III or IV disease increased from 66% at first consultation to 74% at the initiation of radiotherapy. Among localized advanced cancer patients, only 14% of the patients received concurrent chemotherapy while the reaming patients received radiotherapy alone. Radiotherapy was administered as curative intent in 62% of the patients. Fifty-two months overall survival rate was 21.5% (14.6% in the worst-case scenario). As expected, survival was lower in patients with advanced stage at initiation of radiotherapy and in those treated as palliative care.
CONCLUSION The survival of cervical cancer patients remains low in Ethiopia because of late presentation and delay in receipt of radiotherapy. Concerted and coordinated multisectoral efforts are needed to promote early presentation of cervical and to shorten the unacceptable, long waiting time for radiotherapy.

OBJECTIFS Evaluer notre pratique de la résection hépatique pour carcinome hépato-cellulaire (CHC).
MATÉRIELS ET MÉTHODE Il s’agissait d’une analyse rétrospective de 114 dossiers de CHC sur cirrhose réséqués de Janvier 2006 à Décembre 2016. Nous avons analysé le profil des patients, les résultats chirurgicaux et leur suivi.
RÉSULTATS Il s’agissait de 83 hommes et 31 femmes, d’âge moyen 44 ans ± 13,48 avec des extrêmes de 16 et 71 ans. 81,8% des patients était porteuse d’une hépatite B, 4,5 % l’hépatite C et une co-infection chez un patient. Le taux d’alpha foeto-protéine était supérieur à 400 dans 74,2%. Il s’agissait de 73 tumeurs du foie gauche et 41 tumeurs du foie droit. La taille moyenne est de 12,5 ± 4,6 cm Tous nos patients étaient Child A, sans envahissement veineux. Les résections étaient anatomiques dans 88,6% des cas. Le temps de clampage moyen est de 27,5 ± 15,5 minutes. La section parenchymateuse était faite par kellyclasie ou par ultraciseur. La durée moyenne d’intervention est de 115,2 ± 32,5 minutes. La perte sanguine moyenne est de 784 ± 806,4 ml. La mortalité opératoire immédiate était de 6,14% par insuffisance hépato-cellulaire. La médiane de suivi était de 18mois (extrêmes 1et 48 mois). La survie sans récidive à 24 mois et 36 mois était respectivement de 21,7% et 10,5%.
CONCLUSION Le meilleur traitement du carcinome hépato-cellulaire est la greffe hépatique. Quand elle n’est pas possible, la résection hépatique reste une alternative valable chez des patients sélectionnés pour allonger la survie.
MOTS CLÉS Carcinome hépato-cellulaire, résection.

OBJECTIFS Les objectifs étaient d’identifier les mutations du gène BRCA1 et BRCA2 impliquées dans la prédisposition du cancer du sein héréditaire au Sénégal et de rechercher l’effet fondateur de mutations récurrentes identifiées.
MÉTHODES 27 cas index atteintes de cancer du sein et ayant une histoire familiale de cancer du sein associé ou non à un cancer de l’ovaire ont été recrutées à l’institut Joliot Curie et à l’Unité de sénologie du service de Gynécologie de l’HALD. La recherche de mutation du gène BRCA1 a été réalisée par PCR Séquençage. Apres identification d’une mutation récurrente du gène BRCA1, sept microsatellites encadrant le gène ont été génotypés chez 10 cas index et 15 témoins indemnes de tout cancer. L’analyse haplotypique a été fait manuellement et l’âge de la mutation estimé en calculant le nombre de générations.
RÉSULTATS Nous avons identifié une mutation récurrente correspondant à une duplication de 10 nucléotides entraînant un frameshift : c.815_824dupAGCCATGTGG p. (Thr276Alafs), situé au niveau de l’exon 11 du gène BRCA1. Elle a été détectée chez 15 cas index, (55.5%,) mais également chez des apparentées saines dans certaines familles. L’analyse haplotypique et l’estimation de l’âge ont montré son effet fondateur chez la population sénégalaise et son origine Ouest-Africaine. Un test génétique permettant la rechercher chez les femmes à risque a été mis en pratique dans notre laboratoire. Pour le gène BRCA2 nous avons identifié une nouvelle mutation c.5219T>G (p.Leu1740Terfs) chez un cas index ainsi que chez certaines apparentées saines.
CONCLUSION Cette étude a permis d’identifier pour la première fois, une mutation fondatrice du gène BRCA1 prédisposant au cancer du sein familial au Sénégal et la mise en place d’un test génétique pour sa recherche chez les femmes à risque. Cette étude a permis aussi l’identification d’une mutation du gène BRCA2 dans une famille sénégalaise.

INTRODUCTION Sur les 10 millions de nouveaux cas de cancers et environ 6 millions de décès recensés chaque année, plus de la moitié surviennent dans les pays en développement. Un registre national des cancers a été mis en place en 2010 au Sénégal. Cette étude avait pour but d’évaluer la prévalence des cancers dans une structure de Dakar; l’Hôpital Général Grand-Yoff après cinq ans d’enregistrement.
MATÉRIEL ET MÉTHODE Il s’agit d’une étude longitudinale, de tous les cas de cancers confirmés et enregistrés dans le registre de l’Hôpital Général Grand-Yoff sur une période de cinq ans s’étalant du 1er Janvier 2010 au 31 Mars 2015.
RÉSULTATS Nous avons recensé 835 cas de cancers. Les 61% des patients étaient de sexe masculin et 39% de sexe féminin (sexe ratio de 1,57). L’âge moyen était de 55 ans +/- 9. Les localisations les plus fréquentes pour tous sexes confondus étaient digestives (24,48%), urologiques (23,83%) et ORL (13,26%). Chez l’homme, les cancers de la prostate et du foie prenaient les premières places avec respectivement 15,7% et 15%. Chez la femme les cancers de l’appareil gynécologique et du sein représentaient les premiers avec respectivement 15% et 10%. Le carcinome épidermoïde était le type histologique le plus représenté (54%), suivi de l’adénocarcinome (29,40%). Presque tous les malades 72% étaient diagnostiqués aux stades avancés III et IV.
CONCLUSION Le cancer est une réalité au Sénégal. Le registre reste l’outil de base pour apprécier la prévalence réelle des cancers afin de planifier les stratégies de prise en charge.
MOTS CLÉS registre des cancers – Sénégal.

OBJECTIVE To determine the number of cervical cancer patients diagnosed and initiated to treatment services.
METHODS A purposive sampling was done to collect information on cancer cases diagnosed from 2016 to 2018, in all the regional hospitals which have diagnostic equipment and able to manage cervical cancer patient. The source of the data included medical records, referral records, disease index cards, death certificates mentioning cancer as the contributory cause of death and patient-care registers. Data was captured in CanReg 5 software, multivariate generalized linear mixed regression models were used to assess the association between patient diagnosed with cervical cancer variables and unmet need for treatment
RESULTS A total of 1252 women were diagnosed with cancer among the top five cancers of which 60.4% (95% CI: 40.1%, 65.7%) had invasive cervical cancer. Of these diagnosed for cervical cancer only 31.6% were able to access treatment (chemotherapy and/or radiotherapy) whilst the majority 68.4% were either on palliative care or had succumbed to death. Higher odds [AOR= 17.1(95% CI: 15.3%, 21.9%)] of women diagnosed with cervical cancer and on treatment were observed in women aged 40 -49 years whereas lower odds [AOR= 1.2 (0.1%, 1.8%)] were among the women aged 50> compared to 35-49 years. Most of the cervical cancers recorded in the cancer registry are diagnosed at stage 2b.
CONCLUSION Despite limited resources, most patients were able to be diagnosed for cervical cancer, however only few were able to access curative treatment. The existing infrastructure of cervical cancer awareness and screening may only provide the ideal framework for scale-up of cervical cancer prevention in resource-constrained countries.

BACKGROUND Empirically, cancer is a challenge for low-and middle-income countries. Over 30 percent of those in need of palliative care worldwide suffer from cancer and 80% of the patients in low and middle-income countries are diagnosed at advanced stages and can only benefit from palliative care services. The aim of this study was to determine factors influencing palliative care among patients with cancer.
METHODS A cross-sectional descriptive study was carried aimed at assessing factors influencing palliative care among patients with cancer in the targeted health care facilities and hospices. This study was conducted at Inkosi Albert Luthuli Central Hospital, Addington, Pietermaritzburg Grey’s hospital, uMsunduzi and Chatsworth hospice. Participants were recruited through systematic random sampling and structured questionnaires were administered to a total of 394 patients with cancer. Data from the questionnaires were entered into REDcap (v8.11.7) and exported to IBM SPSS Statistics (v.25) for analysis.
RESULTS A total of 394 participated in the study. The mean (± standard deviation [SD]) age for enrolled participants was 14.675 (± 51.89) years. About 42.4% (n=167) between the age of 41-60 years old. Majority of the participants were females 77.7% (n=306), 64.5% (n=254) had primary education as the highest level of education. Over 82%(n=326) of the participants were unemployed, 55.8% living (n=220) in the urban areas, 59.1% were single (n=233) and 79.4% were black (n=313). A majority (n=156, 39.6%) reported lack of knowledge about cancer symptoms, treatment options available and palliative care services. Stigma (n=116, 29.4%), long waiting periods (n=40, 10.2%) for (results of accurate diagnosis, to be attended to by the doctor and for the next appointment), limited resources (n=33, 8.4%) and other barriers (n=186, 47.2%) which included, bad attitude from the healthcare providers, transport issues, unemployment, culture and religion.
CONCLUSION Awareness and knowledge about cancer, treatment options available and palliative care services need to be improved in especially among patients with cancer (particularly those from low socio-economic backgrounds) hence utilization of palliative care could be maximized thereby providing a good quality of life by the sufferers and their families until the end of the journey.

OBJECTIVE To guide efforts to reduce breast cancer mortality, we evaluated a clinical breast exam screening program led by a Botswana-based NGO to determine number needed to screen to detect breast cancer, and clinical resources required for these diagnoses.
METHODS We performed a retrospective review of records from a large clinical breast exam screening program (2015-2018) that were conducted by Journey of Hope Botswana. Screening events were held in communities throughout rural and peri-urban Botswana, with clinical breast exams performed by volunteer nurses or physicians on women 18 and up. Individuals with detected abnormalities were referred for further testing and followed by the NGO until definitive diagnosis or loss to follow-up.
RESULTS Of 6120 screened women (50 men excluded), 371 (5.83%) were referred for further evaluation; 257 ultrasounds, 100 FNAs, 58 mammograms, and 31 biopsies were performed. In total, 6017 were determined to not have cancer, 92 were lost to follow-up (79 for <50 years and 13 for >50 years), and 11 were diagnosed with cancer (4 for <50 years and 7 for >=50 years). Overall breast cancer prevalence was calculated to be 18/10,000 (95%CI 8-29/10,000). Number needed to screen to detect one breast cancer was 1236 (95% CI 624 to 61576) for women <50 years and 168 (95% CI 97 to 646) for women ≥50 years. Number of diagnostic procedures per breast cancer detected was 88 for women <50 years and 13.4 for women ≥50 years. The median time to diagnosis for all women was 17 [1-24] days. Screening-detected tumors were smaller than tumors presenting through standard care, but this difference was not statistically significant.
CONCLUSIONS In a previously unscreened population, yield from community-based clinical breast exam screening was high and required relatively modest diagnostic resources. The strategy has the potential to reduce breast cancer mortality.

OBJECTIVE Incidence data from the population cancer registry of Cotonou (Benin) for the three-year period 2014–2016 are presented.
METHODS The population covered by the registry is comprised of all individuals normally resident in the city of Cotonou (Benin). The mean average population for the period 2014–2016 was 719,712 (378,745 women and 340,967 men). Incidence rates are calculated based on all malignant invasive cancers. The data are processed and analysed using the software R. The frequency and incidence tables are produced using the CanReg 5 software, and Excel 2010. The results are presented as the number of cases recorded, crude, age standardised (ASR) and cumulative (0–74) incidence rates for a period of 3 years (2014–2016). Age standardisation was carried out by the direct method, using the world standard population.
RESULTS 1086 cancer cases were recorded, 608 cases (56.0%) in women (corresponding to an age standardized incidence rate (ASR) of 78.4 per 100,000) and 478 cases (44.0%) in men (ASR 91.8 per 100,000). Breast and cervical cancer accounted for 49.2% of all cancers in women. Breast cancer (ASR 22.6 per 100,000) was more common than cervical cancer (ASR 14.9 per 100,000) and the mean age of cases was lower. The incidence of prostate cancer (one quarter of all cancers in men), 30.5 per 100,000, was similar to that in other West African registries. Cancers of the liver and digestive tract were also relatively common in both sexes.
CONCLUSION These are the first data on cancer incidence in Benin and will be invaluable for the development and evaluation of the National Cancer Control plan.

OBJECTIVE To evaluate the trend in cancer incidence rates over two periods, 2009-2013 and 2016-2017 at a population-based cancer registry in Calabar, Nigeria.
METHODS Data from the Registry, for above periods were studied. The population covers two local government areas: Calabar Municipality and Calabar South (375,196 inhabitants in 2006, National Population Commission) and (510,532 inhabitants in 2017, National Population Commission and National Bureau of Statistics estimates.) Information on cancer cases was actively collected from designated health institutions in the defined population. Using IARC CanReg-5 software, abstracted information on registration forms were checked for duplicate registrations as well as validity of recorded information during data entry. Tumour topography and morphology were coded using the ICD-0 3 and converted to appropriate ICD-10 code for data analysis.
RESULTS In 2009-2013, 719 cancers were recorded, with an annual rate of 143 cases, about 12 cases monthly. 320 (45.5%) and ASR 78.8 per 100,000 occurred in males and 399 (55.5%) and ASR 86.9 per 100,000 in females. 374 cancers were recorded in 2016-2017, with 187 cases reported annually, approx. 16 (sixteen) cases seen monthly, suggesting an increase in the cancer incidence rates. 137 (36.6%) and ASR 56.9 per 100,000 occurred in males while 237(63.4%) ASR 106.4 per 100,000 affected females. Top five cancers in males in 2009-2013, were: Prostate (46%), Hodgkin’s Lymphoma (5.0%),Kaposi’s Sarcoma (4.5%), Colorectal and NHL (4.0% respectively) and Eye (3.5%). In females, the top five cancers were: Breast(39.2%), Cervix uteri(19.0%), Hodgkin’s lymphoma(4.0%),Eye(3.4%)and Ovary(3.2%). Comparatively in 2016-2017, the five top cancers in males were: Prostate (35.8%), Lymphoma (12.4%), Eye (8%), Non-melanoma Skin (6.6%) and Colon, rectum and Anus (5.8%). Among females, the top five were: Breast (30.4%), Cervix uteri (23.6%),Lymphoma (11%), Ovary (4.6%) and Vulva/Vagina (4.2%)
CONCLUSION A changing trend in the cancer incidence rates in Calabar observed over the period 2009 -2017, shows some variation in frequency and pattern of common cancers among both sexes in Calabar, Nigeria.

INTRODUCTION Ovarian cancer is the third most frequent cause of death amongst gynaecological cancers both locally and globally. It presents with vague nonspecific symptoms and is histologically heterogeneous. Management is primarily surgical followed by adjuvant chemotherapy depending on the histological type and the surgical stage.
OBJECTIVES To determine the clinical-pathological presentation, treatment and outcomes of ovarian cancer patients at Moi Teaching and Referral Hospital (MTRH), Eldoret.
METHODS Retrospective chart review of ovarian cancer patients managed between January 2010 and August 2017 at MTRH was done. Data were analysed using STATA version 15. Survival trends were generated using Kaplan Meier method.
RESULTS A total of 124 medical charts of patients with ovarian cancer were retrieved, 29 had incomplete data and were excluded, and 95 were evaluable and included in this review. Over half, (63%) presented in stage 3 and 4 though there was no significant association between histology and stage of disease [X2(6) =4.72, p=0.58]. The median age at diagnosis was 47 years with 55-80 years being the modal age group (36%). Majority (57%) were married and 83.9% were unemployed. Only 66% had documented histopathology, with Epithelial Ovarian Cancer (EOC) being most common (70%), [serous (50%) and mucinous (11.4%)]. Sex cord stromal tumours 11%. Germ cell tumours amounted to 11% (dygerminomas 50%and Yolk sac tumours (25%) Bivariate analysis revealed significant association only between histology and parity [X2 (6) = 28.8, p<0.001]. Those reviewed contributed a total of 138.2 person-years to the study and 11(12%) died, giving a disease-specific mortality rate of 79.6 per 1,000 person years (95% CI: 44.1-143.8). Mortality was highest among those with epithelial histology 109 (95% CI: 48.8-241.9) per 1,000 person years and those who had neoadjuvant chemotherapy then surgery as a treatment option, 373.1 (95% CI: 93.3-1491.8) per 1,000 person years. Those who underwent upfront surgery followed by adjuvant chemotherapy and sex cord stromal cancer had higher survival probability.
CONCLUSION Ovarian cancer at MTRH is diagnosed at advanced stages III and IV of disease and has a lower median age at presentation. EOC is the commonest and serous subtype is the most lethal. Mortality was highest among those with EOC and those who underwent neoadjuvant chemotherapy. Granulosa cell tumour is the only sex cord stromal type reported and it exhibited a higher survival probability. Germ cell tumours were mainly found in nulliparous women.
LIMITATIONS The main limitation was inadequate documentation.

OBJECTIVE The 2016 International Tumour Budding Consensus Conference (ITBCC) proposed tumour budding as a prognostic biomarker in colorectal carcinomas (CRC). Given scarce survival data, this study determined the pattern and utility of tumour budding among Nigerian patients using the ITBCC guidelines.
METHODS H&E-stained slides of resected CRC tissues at the University College Hospital, and a private laboratory, both in Ibadan Nigeria from January 2008 to December 2017 were reviewed. Patient age, gender, and tumour size were obtained from archived surgical pathology records. Tumours were graded and staged according to the 2010 WHO and the 2017 UICC protocols respectively. Tumour budding was determined at X20 objective lens with a 20mm eyepiece field number diameter. Descriptive, Mann-Whitney and Chi-square test statistics were applied using SPSS 20; p < 0.05 was considered significant.
RESULTS Fifty-one (53.1%) of the 96 tumours included in this study showed tumour budding. There were 42 (43.8%) females and 54 (56.3%) males. Tumour bud count was low (0-4) in 66 (68.8%), intermediate (5-9) in 12 (12.5%) and high (≥10) in18 (18.8%) tumours. Four tumours had pT1stage, 35 pT2, 37 pT3 and 20 pT4. Forty-three (44.8%) tumours were lymph node positive, and 10 (10.4%) had metastasis. Tumour budding occurred more with increasing pT and TNM stage. Patients' age and tumour size distribution were similar in the tumour budding and non-budding groups (52.4±17.1/58.5±13.9 years and 6.6±2.9/6.6±2.8cm, respectively). There was significant association between tumour budding and tumour grade (p < 0.008), pT stage (p < 0.000), lymph vascular permeation (p < 0.000), perineural invasion (p < 0.003), and nodal status (p < 0.034), but not with gender, metastasis, and TNM stage (p > 0.05).
CONCLUSIONS Tumour budding prevalence is high among our CRC patients and is associated with poor prognostic factors. Its use is supported for patient stratification and follow-up.

OBJECTIVE Most colorectal carcinomas (CRCs) show overexpression of cyclooxygenase-2 (COX-2) with variable effect on prognosis. This study determined COX-2 expression in colorectal adenomatous polyps (CRAs) as precursors of CRC.
METHODS Archived H&E stained slides of all adenomatous colorectal polyps diagnosed from January 1 2013 to December 31 2017 were reviewed retrospectively. Adenomas and degree of dysplasia were classified according to the World Health Organization criteria. Formalin fixed paraffin-embedded tissue blocks of eligible cases were retrieved and sectioned at 3μm thickness for COX-2 immunostaining using rabbit anti-human COX-2 antibody. COX-2 expression was scored semi quantitatively for intensity (absent (0)); faintly yellow (weak, 1); brownish-yellow (moderate, 2); brown (strong, 3). Absent or weak expression was considered negative while moderate and strong expression was considered COX-2 positive (overexpression). Other data included age, gender, polyp size and location within the colon and rectum. Polyp size was further categorized into < 10mm and ≥ 10mm (advanced polyp). Statistical test for frequencies, mean, and associations between variables was done using SPSS version 20. p < 0.05 was regarded as significant.
RESULTS Thirty-one adenomatous polyps (23 tubular, 4 villous, 4 tubulovillous) were retrieved from 31 patients, 17 males and 14 females with a mean age of 64.3±12.0 years. Polyp size ranged from 2mm to 27mm (median size 7mm). Overall, twenty-two polyps were in the left colon and rectum, 11 (39.3%) were advanced polyp, and 16 (51.6%) showed high grade dysplasia. Fourteen (45.2%) polyps showed positive COX-2 expression; 10 (71.4%) of these were from men, 11(78.6%) were from left colon, 8 (57.1%) each were among high grade dysplastic and advanced polyps. Associations between COX-2 expression and gender, polyp location, size, and dysplasia grade were non-significant (p > 0.05).
CONCLUSIONS Male gender, Left-sided, advanced and high grade dysplastic CRAs show more COX-2 expression. Increased sample size is required to evaluate these observations further.

OBJECTIFS Analyse rétrospective des effets antalgiques, décompressifs après radiothérapie de métastases vertébrales d'origine mammaire.
MATERIELS ET METHODES De janvier 2012 à décembre 2017, cents (100) patientes ayant un cancer du sein ont été irradiées au service de radiothérapie du CHU Hassan II de Fès pour une première localisation vertébrale. L'indication de la radiothérapie était antalgique dans 75% des cas et décompressive dans 25% des cas. La dose délivrée était le plus souvent de 30 Gray en 10 fractions à raison de 3Gray/fraction.
RESULTATS L'efficacité antalgique a été jugée complète ou quasi complète dans 85 %, modérée dans 12 % ou nulle dans 3 %. Le délai moyen d'obtention de l'effet antalgique maximal était de 30 jours. La durée de l'effet antalgique et la recalcification de la lésion osseuse n'ont pas pu être évaluées rétrospectivement par manque de données suffisantes. L'efficacité de la décompression a été complète dans 80% des cas et nulle dans 20% des cas. Une nouvelle irradiation vertébrale en dehors du territoire irradié a été nécessaire chez 10% des cas. Une compression médullaire est survenue en dehors du territoire irradié dans 5% des cas et en territoire irradié dans 2% des cas.
CONCLUSION La radiothérapie des métastases vertébrales du cancer du sein reste un traitement palliatif, surtout antalgique. L'indication d'une radiothérapie décompressive est rare. Cependant, l'évaluation du risque compressif conduit à discuter l'apport de l'imagerie par résonance magnétique dans le bilan préthérapeutique et la place d'un geste préalable (vertébroplastie ou ostéosynthèse).

INTRODUCTION The primary brain tumours are rare in adults; they represent 2% of malignant tumours in adults and 20% of those in children.
The aim of our study is to highlight the epidemiological, clinical, histological, and therapeutic of brain tumours.
MATERIALS AND METHODS This is a retrospective study on 192 patients with brain tumours treated in the radiotherapy department of Fez, over a period of 6 years; January 2012 to December 2017.
RESULTS The median age was 45.6 (20-76), with a male predominantly; the sex ratio is 1,7. The clinical picture is dominated by intracranial hypertension observed in all patients; associated with a sensory motor deficit in 63.6%. The average time between the onset of clinical signs and diagnosis is 6 months. All patients underwent a CT brain scan with injection of contrast; more brain MRI in 85% of cases. The resection was complete in 26% of cases, partial in 53,7% of cases, and a stereotactic biopsy in 20.3% of cases, the histological types of brain tumours vary from these: the glioblastoma observed in 53.7% cases; the anaplastic astrocytoma grade III of WHO in 18.5% of cases; oligodendroglioma in 16.5% of cases, and medulloblastoma in 7.5% of cases. Therapeutically all patients received external radiotherapy. Local control was achieved in 33%, 16% lost sight and 51% of deaths; after hindsight of 8 months.
CONCLUSION The treatment of brain tumours is multidisciplinary, despite improved surgical and radiotherapeutic techniques, the results are strong disappointing. The discovery of new molecules, genomic and molecular biology study are promising research pathways.

INTRODUCTION Les sarcomes des tissus mous sont rares, de groupe hétérogène et dont la prise en charge doit être pluridisciplinaire, associant une chirurgie, une radiothérapie ainsi qu’une éventuelle chimiothérapie. Notre objectif est de faire la mise au point sur les aspects thérapeutiques, évolutifs et pronostics dans la prise en charge des sarcomes des parties molles.
MATERIELS ET METHODES Notre étude porte sur l’analyse de 40 dossiers de patients présentant des sarcomes de tissus mous colligés entre Janvier 2012 et décembre 2017 au sein du service de radiothérapie CHU HASSAN II de Fès.
RESULTAT L’âge médian de nos patients était de 48,8 ans avec des extrêmes de 11-85 ans. Une prédominance féminine (67.7%). le délai moyen de consultation était de 17 mois et le signe clinique majeur était une masse chez 93.5%. L’IRM a été réalisée chez 22 patients et la TDM chez le reste. L’atteinte du membre inferieur a été notée chez 31 cas, le membre supérieur chez 5 cas, les tissus mous du cou chez 2 cas et la paroi du tronc dans 2 cas. Après bilan d’extension le traitement consistait à une chirurgie chez tous les patients, dont 12 cas étaient des récidives après une chirurgie antérieure. A l’examen anatomopathologique les marges d’exérèse étaient R0 dans 13 cas, R1 dans 20 cas et R2 dans 7 autres. Le type histologique prédominant était le liposarcome dans 22 cas, leiomyosarcome dans 10 cas et le synovialosarcome dans 8 cas. La taille tumorale moyenne était de 8cm. Une radiothérapie a été délivrée chez 38 patients. La dose variait entre 50-66 Gy. La chimiothérapie néoadjuvante chez 6 cas et adjuvante chez 3 cas. Le délai moyen de suivi était de 39 mois, avec survenue d’une récidive locale chez 3 cas, une deuxième localisation chez un malade (Jambe puis épaule) une métastase pulmonaire chez 2 cas, tandis que 34 patients sont en bon control locorégional et à distance.
CONCLUSION Dans les sarcomes des tissus mous, la qualité de l’exérèse chirurgicale reste le pilier du traitement quel que soit la localisation et le type histologique. La radiothérapie locorégionale améliore le taux de contrôle local.

INTRODUCTION Le cancer du col utérin pose un véritable problème de santé publique dans les pays en voie de développement. Au Maroc, il constitue le deuxième cancer le plus fréquent chez la femme après le cancer du sein. La radio-chimiothérapie concomitante (RCC) est l’arme thérapeutique majeure.
MATERIELS ET METHODES Il s’agit d’une étude rétrospective étalée du Janvier 2012 au Décembre 2017, portant sur 854 patientes traitées pour cancer du col utérin par RCC, réalisée au service de radiothérapie du CHU HASSAN II de FES.
RESULTATS L’âge médian de nos patientes était de 53ans (28-89ans). L’intervalle moyen entre les symptômes et la première consultation était de 6,5 mois. Les métrorragies étaient le symptôme principal retrouvé chez 91,2% des cas. La taille tumorale moyenne était de 5,43cm (1-9cm). Une scanographie abdomino-pelvienne a été réalisée dans 81% des cas, 23% des patientes ont bénéficié d’une IRM pelvienne. Selon la stadification de la FIGO, Le cancer était classé IB dans 6% des cas, IIA dans 13.6 % des cas, IIB dans 41.1%, IIIA dans 12.4%, IIIB dans 23.3% et IVA chez 3.6 % des cas. La biopsie a objectivé un carcinome épidermoïde dans 94.2 % des cas, un adénocarcinome dans 4.6% des cas. Une radiochimiothérapie concomitante a été prescrite dans 92.7% des cas et une radiothérapie exclusive a été délivrée dans 7.3% des cas. La dose de radiothérapie reçue était de 46 Gray en 4–5 semaines, la chimiothérapie concomitante a consisté en une dose hebdomadaire de cisplatine de 40 mg/m2 chez 89% des cas et de carboplatine AUC2 chez 11% des cas. La radiothérapie externe était suivie d’une dose complémentaire sur les paramètres quand ils étaient envahi et d’une curiethérapie utéro-vaginale type haut débit de dose (4 séances hebdomadaires de 7Gray/semaine) dans 79.7% des cas. Le complément 4 champs se faisait par irradiation externe à la dose de 24 Gy chez 21.3% des cas. Après un recul moyen de 41 mois, le taux de rémission complète est de 77.2%. L’évolution a été marquée par l’apparition de récidive locorégional dans 9.3% des cas, et récidive avec métastases à distance dans 8.4% des cas, par contre 51% étaient perdu de vue.
CONCLUSION Dans notre contexte, le cancer du col utérin localement avancé est encore fréquent. Quoi que la radiochimiothérapie concomitante soit un standard, le pronostic reste défavorable d’où l’intérêt d’un dépistage précoce et d’une prise en charge rapide et bien codifiée.

INTRODUCTION Bone solitary plasmocytoma is a rare entity characterized by the proliferation of malignant plasmocytes derived from a single clone of B lymphocytes, located at a bone segment without diffuse medullar invasion. It is mainly of interest to the dorsolumbar spine; costal involvement is rarely described.
OBJECTIVE To evaluate the clinical response and effectiveness of radiotherapy in patients with single bone plasma cell tumours.
MATERIAL AND METHODS From January 2012 to December 2017, six patients were treated by irradiation for a solitary plasmocytoma confirmed by histological examination in the radiotherapy department of the Hassan II University Hospital in Fez.
RESULTS These were four women and two men aged 32 to 68 years (average: 50.3 years). All our patients had a solitary bone plasmocytoma; five in the dorsolumbar spine and one in the hip. Clinical symptomatology was dorsolumbalgia in four cases, spinal cord compression in one case and hip pain in one case. Three patients received chemotherapy and/or immunotherapy before radiotherapy with no response for two and progression for one. All our patients received three-dimensional conformational external radiotherapy at a conventional dose of 40 Gy for five patients and 50Gy for one in conventional fractionation with 6-18 MV photons. The median duration of monitoring was 40.16 months (extremes: 9-76 months) after the end of the irradiation. The immediate result of the radiotherapy was excellent with a decrease in symptoms and tumour volume in four patients. A progression to myeloma was observed in two cases of solitary bone plasmocytomas with a median delay of 3 months.
CONCLUSION Radiation therapy in its place in the treatment of solitary plasmocytomas, making it possible to control symptoms in most cases of solitary bone plasmocytomas.

INTRODUCTION Le cancer du sein, reste la première pathologie maligne chez la femme et son diagnostic chez la femme âgée est tardif. Le but de notre travail est d’évaluer l’efficacité de la radiothérapie hypofractionnée dans le traitement du cancer du sein chez la femme âgée.
MATÉRIELS ET MÉTHODES Etude rétrospective, portant sur 171 patientes âgées de plus de 65 ans suivies pour un cancer invasif du sein et ayant reçu une radiothérapie adjuvante hypofractionnée au service de radiothérapie de CHU Hassan II Fès du janvier 2012 au décembre 2016.
RÉSULTATS La fréquence du cancer du sein chez la femme âgée de plus de 65 ans était de 7,31%. La moyenne d’âge de nos patientes était de 70 ans (65-88ans) dont 40% âgées de plus de 70 ans. 8,5% avaient un antécédent familial de cancer mammaire. Le délai de consultation était de 10 mois. Un nodule de sein était le signe révélateur chez toutes les patientes avec des signes inflammatoires chez 4,6% ; des adénopathies axillaires ont été retrouvées chez 20% des patientes. Tous les cancers ont été prouvés histologiquement. Le cancer est canalaire infiltrant dans 90% des cas. 27% des tumeurs étaient de grade Scarff-Bloom et Richardson I, 45% grade II, 30% grade III. Les récepteurs hormonaux sont exprimés chez 77% et HER positive chez 10% des patientes. 83% ont bénéficié d’une mastectomie avec curage ganglionnaire suivi d’une radiothérapie adjuvante selon le protocole hypo fractionné : dose totale de 42Gy sur la paroi dont 32 % des patientes ont également reçu une irradiation ganglionnaire, fractionnement 2,8Gy/ Fr en 15 séances, étalée sur 19 jours. 17% des patientes ont eu une chirurgie conservatrice associée à une radiothérapie externe adjuvante sur le sein selon le même schéma avec boost de 11,8Gy sur le lit tumoral, étalée sur 25 jours. Après un suivi médian de 5 ans, cinq patientes ont présenté des métastases pulmonaires, trois autres ont développé des métastases cérébrales et une récidive locorégionale a été observé chez trois malades ; et une rémission complète dans 94%. La toxicité aiguë a consisté en une radio dermite chez 81% des patientes, et la fibrose post radiques chez 15% patientes, et aucune toxicité cardiaque ni pulmonaire à long terme n’ont été observés.
CONCLUSION Pour les patientes âgées, l’irradiation hypofractionnée adjuvante semble une bonne alternative, avec un bon taux de contrôle local, et sans majoration de la toxicité.

INTRODUCTION Le cancer du cavum est fréquent au Maroc et son incidence mondiale est géographiquement dépendante. L’objectif de notre étude était d’analyser les caractéristiques épidémiologiques, cliniques et thérapeutiques de cette pathologie.
PATIENTS ET MÉTHODES Étude rétrospective de 856 cas de cancers du cavum menée au cours d’une période de 6 ans (janvier 2012 au décembre 2017) au sein du service de radiothérapie du CHU Hassan II de Fès. Le bilan initial a comporté un examen clinique et endoscopique, une scanographie, une échographie abdominale et une scintigraphie osseuse. Le diagnostic histologique a été établi par une biopsie du cavum et ou d’un ganglion cervical.
RÉSULTATS L’âge moyen était de 45 ans (19–88 ans), le sex-ratio était de 1,84 avec prédominance masculine. Le délai moyen de consultation était de neuf mois. Les signes révélateurs étaient rhinologiques chez 47,5%, otologiques chez 34.5% et neurologiques chez 18%. Des adénopathies étaient présentes dans 76% des cas. Le type histologique prédominant est représenté par le carcinome indifférencié (UCNT) dans 89 % des cas. Les tumeurs ont été classées selon la classification de l’American Joint Committee on Cancer (AJCC) de 2010 au stade I dans 3.11%, stade II dans 10.76%, stade III dans 52.3%, stade IVa dans 9.23%, stade IVb dans 13.84% et stade IVc dans 10.76%. Le traitement était curatif chez 79.8 % des cas, dont 30.6% ont reçu une chimiothérapie néoadjuvante suivie d’une chimioradiothérapie concomitante et 69,38% ont bénéficié d’une chimioradiothérapie concomitante d’emblée. Cependant 14,4% ont reçu un traitement palliatif et 5.8 % des malades ont été perdus de vue avant tout traitement. Avec un recul moyen de 48 mois, 75 % des patients étaient en bon contrôle locorégional, 5% ont présenté une récidive locale, 12,7% ont développé des métastases et 7,3% ne sont pas présentés à la consultation de contrôle.
CONCLUSION Le cancer du cavum est un cancer des voies aérodigestives supérieures qui constitue un problème cancérologique au Maghreb et en Asie du sud-est. Son diagnostic est souvent tardif et se base sur un bilan radiologique complet. Son traitement repose essentiellement sur la radiothérapie, pierre angulaire du traitement, et sur la chimiothérapie.

INTRODUCTION Le cancer de l’endomètre est le troisième cancer gynéco-mammaire au service de radiothérapie-curiethérapie du CHU Hassan II de Fès. Son traitement de référence est la chirurgie et la place de la curiethérapie dans sa prise en charge est indéniable permettant d’obtenir des taux élevés de contrôle local.
OBJECTIF Préciser le profil épidémiologique, histologique et thérapeutique ainsi que l’évolution des patientes traitées par curiethérapie endo-vaginale postopératoire pour cancer de l’endomètre.
MATERIEL ET METHODE Il s’agissait d’une étude rétrospective portant sur 207 cas de cancers de l’endomètre opérés, colligés au service de Radiothérapie CHU Hassan II de Fès entre Janvier 2012 et Décembre 2017.
RESULTATS L’âge moyen de nos patientes était de 64 ans (39-88). Le type histologique prédominant était le carcinome endométroide, avec deux cas de carcinosarcome et un cas de carcinome mucineux. Toutes les patientes ont été opérées dont 59 ont bénéficié d’une hystérectomie totale, 147 patientes ont bénéficié d’une colpo-hystérectomie et 1 patiente a bénéficié d’une hystérectomie subtotale d’hémostase. 79% des patientes ont bénéficié d’un curage ganglionnaire. Le stade était Ia chez 38% des cas, Ib chez 32% des cas, II chez 11% cas, IIIa chez 13% cas, IIIb chez 6 % des cas. En ce qui concerne les différents protocoles utilisées dans notre série : 51 % des cas ont reçu une radiothérapie externe en postopératoire à la dose de 46-50Gy suivie d’une curiethérapie vaginale à haut débit de dose (HDR) avec un applicateur MIAMI en 2 séances de 5Gy hebdomadaires; alors que 45% des cas n’ont reçu que la curiethérapie endo-vaginale (HDR) seule en 3 séances de 7Gy ; et enfin 4 % des cas dont les limites de résection sont tumorales et ayant reçues une radiothérapie externe ont bénéficié de 4 séances de 7Gy. La dosimétrie était tridimensionnelle chez toutes les malades. Parmi nos patientes 15%, 13% et 32 % ont souffert de complications tardives respectivement urinaires, digestives et vaginales. Sur le plan évolutif parmi les 153 patientes ayant fait le suivi dans notre formation 91,2% étaient toujours suivies en situation de bon contrôle de leur maladie, 5,5% ont eu une récidive locorégionale et 3,3% avaient des métastases à distance avec un recul moyen de 42 mois.
CONCLUSION La curiethérapie HDR possède une place importante dans la stratégie thérapeutique du cancer de l’endomètre, elle permet une amélioration du contrôle local en diminuant les récidives vaginales.

INTRODUCTION After surgery for squamous cell carcinoma of the lip classified T1T2 N0N-, additional treatment is necessary only in case of insufficient or borderline resection. Post-operative radiotherapy has been proven for these patients, but its sequelae are not negligible. In addition, in the case of a second primary cancer, the different therapeutic options are reduced taking into account the territory previously irradiated.
OBJECTIVE Analyse a method to avoid surgical reoperation or external postoperative irradiation.
MATERIALS AND METHODS Between January 2012 and December 2017, eight patients had exclusive post-operative HDR brachytherapy for squamous cell carcinoma of the lower lip with an affected section slice or high risk of recurrence. The average age was 60.14 years (extreme: 40-88 years) and the sex ratio was 2.5 with male dominance. The average consultation time was 9 months. All patients underwent surgical excision with lymph node cleaning (which was negative) in 37.5%. Among our patients 75% were classified T1 and 25% T2, 100% N0. Post-operative brachytherapy was performed on average 33.28 days after surgery (extreme: 14-60 days). The technique used consisted in placing vector needles in the operating bed that were secondarily loaded by high dose rate sources of iridium 192. The mean dose was 43.07Gy (extremes: 24-60Gy) on the reference isodose. All patients had leaded protection of the dental arches.
RESULTS The average decline was 30.85 months with a minimum of 13 months. Of our patients, 6 were followed up in our centre and 3 were referred back to their treating physicians (at the request of the patients). Overall survival and local control rate are 100% in the 6 diseases followed in our country. One patient had depigmentation of the tumour bed and another patient had grade I skin fibrosis of the lower lip. No patients showed grade II-III toxicity. Aesthetic results are excellent in 67% of patients.
CONCLUSION HDR interstitial brachytherapy after surgery for squamous cell carcinomas of the lower lip T1T2 N0N- with affected or at risk section slices avoids further surgery with functional and cosmetic disorders, ensures a high local control rate and avoids the side effects of high-dose external irradiation (xerostomia, dysgeusia, fibrosis).

INTRODUCTION Breast cancer is the most common cancer and is the second leading cause of death in the world. A molecular classification of this cancer has recently been established. The molecular classification of breast cancers based on gene expression and then protein profile made it possible to distinguish five molecular groups: luminal A, luminal B, Her2/neu, basal-like and unclassified.
OBJECTIVE The objective of this study carried out in the radiotherapy department at the Hassan II University Hospital of FES is to classify 1167 cases of breast cancer infiltrating into molecular groups, then to correlate them with clinical-pathological characteristics.
MATERIALS AND METHODS This is a retrospective study conducted within the radiotherapy department of the Hassan II University Hospital of FES, spread over a period from January 2012 to December 2017 involving 1167 patients. Tumours are histologically analysed and classified after an immunohistochemical study into five groups: luminal A, luminal B, Her2+, basal-like and unclassified.
RESULTS All cases included in this study are female. The average age was 45.6 years. Clinical symptomatology was dominated by the breast nodule in 98% of cases. 23% of patients had a lumpectomy with axillary lymph node cleaning, while 77% of cases had a mastectomy with lymph node cleaning. All patients received adjuvant external radiotherapy. All cases were treated with chemotherapy except for patients who were classified as luminal A. Of the 1167 tumours analysed, 21% were classified as luminal A, 61% as luminal B, 17% as basal and 1% as Her-2. Luminal subtype A was correlated with a low histological grade, whereas luminal subtype B was characterized by a higher histological grade than the previous type. The Her-2 subtype had the highest tumour size represented by a rate of 78% whose size was greater than 2cm, with a high rate of axillary lymph node invasion of 67%. For basal tumours, there was a high prevalence of histological types of poor prognosis, with a high SBR grade including 66.66% of cases with grade III SBR. In addition, there is a strong association with the presence of distant metastases in this group, including 70.17% of patients with cerebral metastases.
CONCLUSION This study confirmed the aggressive nature of basal and Her-2 tumours compared to luminous tumours, which are characterized by morphological and clinical characteristics of poor prognosis. The clinicopathological characteristics are consistent with the molecular profile and should therefore be considered as prognostic factors.

L’objectif de notre étude était la mise au point sur les aspects thérapeutiques évolutifs et le devenir des patientes porteuses des cancers du vagin.
MATÉRIEL ET MÉTHODE notre étude porte sur l’analyse de 10 dossiers de patientes présentant un cancer du vagin colligés au sein du service de radiothérapie du CHU Hassan II de Fès durant la période étendue du janvier 2012 à décembre 2017.
RÉSULTATS il s’agit de 10 patientes porteuses d’un cancer du vagin, dont l’âge moyen était de 62.4 ans avec des extrêmes de 33-81 ans. 7 étaient ménopausées et trois en période d’activité génitale. Les signes cliniques révélateurs étaient dominés par les leucorrhées (50%), le saignement (30%), le prurit (10%) et la découverte en per-accouchement (10%). Le type histologique prédominant était le carcinome épidermoïde (100%). Les tumeurs ont été classées T4 dans 40 % des cas. La TDM TAP a été réalisée chez 6 patientes. L’IRM pelvienne chez 3 patientes. Toutes nos patientes ont reçu une radiothérapie externe pelvienne de 46 Gy en cinq semaines avec une irradiation inguinale bilatérale. 8 patientes d’entre eux ont reçu un complément de dose par radiothérapie externe sur la tumeur par 4 champs jusqu’à une dose totale de 70Gy, une patiente a bénéficié d’une curiethérapie vaginale à haut débit de dose après une réponse complète à la 1ère série (4*7Gy) et une autre patiente a été adressée en chirurgie après la 1ère série. Une chimiothérapie concomitante a été administrée à toutes nos patientes. La toxicité aigüe à type de radiodermite grade I est survenue chez 7 patientes, grade II chez 2 patientes et grade III chez une patiente, troubles digestifs à type de diarrhée grade I chez 9 patiente et grade II chez une patiente. La toxicité tardive à type d’hématurie et pollakiurie est survenue chez 2 patientes, une rectite post-radique chez une patiente. Le délai moyen de suivi était de 41 mois, avec une réponse complète chez 5 patientes, une progression locale chez 2 patientes, une progression locale et à distance chez une patiente et la survenue de métastases cérébrales chez une patiente.
CONCLUSION Le pronostic des cancers du vagin reste défavorable, souvent lié à une tumeur localement évolué qui sont très fréquents chez la femme âgée, et la radiothérapie occupe une place importante dans la prise en charge de ces tumeurs le plus souvent non résécables.

INTRODUCTION The elderly woman is defined in the literature as an age equal to or greater than 70 years. The diagnosis of breast cancer in these elderly women is often late.
OBJECTIVE To study the epidemiological, clinical, histological, therapeutic and progressive features of breast cancer in older women.
MATERIAL AND METHODS Retrospective study conducted from January 2012 to December 2017 on 46 patients over 70 years of age with breast cancer.
RESULTS The average age was 78 years (70-89), with 16 patients over 75 years of age (35%), and the average time between the onset of symptoms and consultation was 12 months. A breast nodule was the revealing sign in all patients, with inflammatory signs in four patients. Axillary adenopathies were found in 26 patients (56.65%) and 6 patients (13%) had a locally advanced tumor. Two patients were immediately metastatic, the first had supra- and retro-clavicular contralateral lymph node metastases; and the second had bone metastases. all cancers were histologically proven. Invasive ductal carcinoma was the predominant histological type in 96% of cases. It was in 7 Scarff-Bloom and Richardson (SBR) grade 1 cases, in 23 cases grade 2 and in 16 cases grade 3. Hormone receptors are expressed in 82.6% and HER2 positive in 58% of patients. Nine patients received conservative treatment combined with external radiotherapy on the breast with a dose overprint (Boost) on the tumor bed in 5 patients. 37 of the patients received mastectomy with lymph node cleaning with hormone therapy, including 32 cases receiving adjuvant radiotherapy according to the hypofractionated protocol: total dose of 42 Gy at 2.8 Gy/fraction in 15 sessions over 3 weeks. Chemotherapy was prescribed in only 33 patients. The evolution was marked by a complete remission after a year's decline in 98% of cases.
CONCLUSION Breast cancer in older women is not common enough in Morocco. Although this cancer is discovered at a late stage, its biological characteristics make it a less aggressive cancer. Age should not be a limiting factor for therapeutic indications.

OBJECTIVE Breast cancer (BC) is now the most common female cancer in sub-Saharan Africa (SSA). However, survival from the disease in SSA is among the lowest in the world. Downstaging efforts are key to improving survival but they will only succeed if timely and adequate treatment is assured. Data on barriers to BC treatment access in SSA are, however, limited.
METHODS Data from the prospective multi-country ABC-DO study were analysed to examine percentage of newly diagnosed BC patients who received curative treatment (i.e. systemic, surgery and/or radiotherapy) across different healthcare settings in Uganda, Nigeria and Namibia, and identify its socio-demographic and clinical determinants. Treatment data were systematically extracted from medical records and regular patient follow-up interviews to generate a binary indicator of treatment received within 12 months of diagnosis, which was analysed via logistic regression.
RESULTS Of 1325 women, 227 (17%) had not started treatment within one year of diagnosis, including 185 (14%) women presenting at TNM stages I-III. Untreated percentages were highest in two regional hospitals in Nigeria (38% of 314 women; 32% amongst stage I-III women) and in the national referral hospital in Uganda (18% of 430 women; 15% amongst stage I-III), i.e. in settings where women paid healthcare expenses out-of-pocket. In contrast, in Namibia, where free treatment is universal, all non-black (100%) and almost all (98.7%) black women had initiated treatment. Percentages of treated BC were lower in women from lower socioeconomic groups (10% absolute difference) and in those who were aged <40 years (7%), believed in traditional medicine (11%) and were HIV+ (16%).
CONCLUSIONS The marked between-country divide in the proportion of untreated patients, coupled with within-population socio-economic differentials in treatment access, highlights the need to ensure free access to BC treatment in SSA as being critical to improving survival from the disease in the region.

INTRODUCTION Globally 12% of all deaths among adults aged 30 years and over were attributed to tobacco. To address this attributable mortality, The University of Texas MD Anderson Cancer Center has engaged its Global Academic Program's (GAP) Sister Institutions by conducting an inaugural tobacco control assessment Survey. This baseline will serve as a mechanism to develop a tobacco prevention and control strategy within a global cancer centre network.
METHODS Qualtrics was used to administer a 27-item survey to our Global Academic Program (GAP) Sister Institutions from April - October 2017. Survey questions focused on key areas of tobacco prevention and control: policy, tobacco use screening, and cessation services. A survey link was emailed to 34 institutions in 23 countries.
RESULTS Of the 34 GAP Sister Institutions, 25 responded to the survey (74% response rate). Key findings among the 25 responding institutions: Policy - 96% are located in cities with laws regulating the sale and/or use of tobacco products by minors and 76% of the cities have laws regulating the use of tobacco in the workplace; 44% of the campuses have designated smoking areas; Tobacco use screening - 64% screen for and document patients' tobacco status, however only 24% screen “all the time”; Cessation Services - 16% offer telephone counselling as a cessation service; 40% offer cessation services to the community; 44% offer cessation services to employees. (A follow up survey is in progress and results will be included.)
CONCLUSIONS A baseline assessment identified areas of institutional needs: cessation services and campus policies. The GAP institutions will convene in May 2018 to share tobacco control best practices across the network and identify resources and supports to strengthen tobacco control efforts at each institution. We will build collaborations aimed at progressive actions in tobacco control policies, educational programs and cessation services culturally appropriate to the needs and resources of the GAP network.

OBJECTIVE Breast cancer is a leading cancer among women in Kenya. Screening and early diagnosis is highly recommended and upon diagnosis, access to quality treatment and palliative care is critical. Not many studies have been carried out on women with and without a cancer diagnosis. Our objective was to gain an in depth understanding of barriers and facilitators to breast cancer screening, treatment and palliative care from the perception of women with and without a breast cancer diagnosis.
METHODS Barriers and facilitators to breast cancer screening, treatment and palliative care were derived from the knowledge and perceptions of women with and without a diagnosis of breast cancer in Nairobi county of Kenya and its environs. We conducted four focus group discussions with 6 -11 women aged 30 – 60 years in each. Groups were classified according to breast cancer diagnosis and socio-economic status. The transcribed discussions were coded independently by two investigators and emergent themes were identified.
RESULTS Barriers were costs, delayed diagnosis or misdiagnosis, misconceptions or inadequate knowledge of signs, symptoms, cancer treatment and prognosis, stigma, distance to healthcare facilities, communication with health care providers, medicines stockouts, striking health care providers, few healthcare providers and long waiting periods, limited or no counseling at diagnosis, vulnerability of patients and limited access to rehabilitation items. Facilitators were dependable social support, hope from religious affiliations, periodical access to subsidized costs of awareness and screening services, friendly caregivers and male person influence. We found no marked differences in perceptions between groups by socioeconomic status.
CONCLUSION Enhanced education for healthcare providers and the public, access to care facilities and resources, targeted awareness and screening services with onsite counseling, involvement of religious leaders in the continuum of care, and mitigation of costs may enhance breast cancer outcomes.

INTRODUÇÃO A Depressão é um transtorno mental, causado por uma complexa interacção entre factores orgânicos, psicológicos, ambientais e espirituais, caracterizado por angústia, diminuição do humor e perda de interesse. O cancro por ser uma doença agressiva e de difícil adaptação quer individual, familiar e comunitária e se beneficia de terapêuticas múltiplas. O conjunto das diversas psicoterapias, isto é, a psicoterapia breve, a psicoeducação, a egoterapia, a psicoterapia cognitivo-comportamental e a psicoterapia sistémica, são capazes de promover benefícios importantes ao paciente, indirectamente aos seus familiares e ao tratamento quimioterápico.
OBJECTIVO este estudo pretende-se avaliar os níveis e as estratégias de coping usadas pelas pacientes, e verificar o que difere relativamente ao estilo de vida.
METODOLOGIA Foi feito estudo descritivo, qualitativo e transversal às doentes pós mastectomizadas.
RESULTADO O transtorno depressivo afecta todas as dimensões da qualidade de vida, mesmo quando controlado com outras variáveis como a idade. Os indivíduos com depressão maior ou subssindrômica apresentam níveis maiores de tensão em actividades domésticas, assim como irritabilidade social, stress financeiro, limitações no funcionamento ocupacional, pior status de saúde e mais dias perdidos de trabalho do que sujeitos sem sintomas.
CONCLUSÃO O grande desafio de hoje é associar todos os sintomas físicos a um específico factor causador do transtorno e isolar os genes vinculados à depressão, alcançando, assim, respostas farmacológicas para um tratamento mais eficiente e com menos efeitos colaterais. Deste modo, conclui-se que a doença crónica causa um grande sofrimento e mudanças de hábitos.

OBJECTIVE Cervical cancer is the most common cancer among women in Kenya. However, only 3% of women are screened every three years. This study aimed to assess women’s knowledge and attitudes around cervical cancer in Isiolo and Tharaka Nithi Counties of Kenya.
METHODS We conducted a cross-sectional quantitative survey between January and March 2017. In total, 451 women aged 18 years and over were sampled using multistage cluster sampling. The questionnaire collected demographic information, knowledge of risk factors and attitudes towards cervical cancer. Composite scores were developed for knowledge and attitudes. Bivariate and multivariate analysis of cervical cancer knowledge and demographic characteristics was conducted. Attitudes were assessment through descriptive statistical methods.
RESULTS Two-thirds of the women came from Tharaka Nithi county (n=318). Participants had a median age of 32, 70.6% were married and 35.0% had primary education. Eighty percent of participants had heard of cervical cancer, 25.6% of whom had previously had a cervical screen, and 44.4% had above-average knowledge of risk factors of cervical cancer. Knowledge of cervical cancer was significantly associated with employment (adjusted Odds Ratio (aOR) 1.7; 95% Confidence Interval (CI): 1.1-2.7 and coming from Tharaka Nithi county (aOR = 3.8; 95% CI: 1.7-5.1). Eighty nine percent of women had negative attitudes towards cancer, with no difference between counties.
CONCLUSION Interventions to increase cervical cancer knowledge are needed in these counties. Interventions should also aim to address negative attitudes towards cervical cancer screening. Strategies to effectively educate women around cervical cancer and to increase uptake of cervical cancer screening services among women with little education in poor, hard-to-reach contexts in Kenya need to be developed and evaluated.

BACKGROUND Breast cancer is the most frequently diagnosed cancer among women world-wide, and almost half of all breast cancer cases and over half of all deaths occur in low and middle-income countries. Patients from these countries are often diagnosed with late-stage disease (stage III and IV), which is associated with high mortality. Studies have identified factors associated with late-stage breast cancer diagnosis in many African countries, however, little is known about the factors associated with late-stage diagnosis in rural Ethiopia. We sought to determine the occurrence of late-stage disease diagnosis and associated factors in rural south and southwestern Ethiopia.
METHODS We conducted a retrospective study of breast cancer patients diagnosed February-April 2018 from six hospitals in south and southwestern Ethiopia to identify factors associated with late-stage disease diagnosis. Descriptive statistics and binary and multivariable logistic regression identified factors associated with late-stage disease diagnosis. Adjusted odds ratio (AOR) with 95% confidence intervals described predicting factors with statistical significance at p-value <0.05.
RESULTS Overall, 426 breast cancer patients were identified, 72.5% were diagnosed with late-stage disease. Mean patient age was 42.78±13.4 years. Of 426 cases reviewed, 383 (89.9%) patients had breast lump at presentation and 311 (73%) had patient delay of >3 months. Median delay for a patient to seek medical attention was 120 days. Median delay to provide care was 32 days. Median total delay from patient awareness of symptoms to pathology disease confirmation was 184 days. Factors associated with late diagnosis were patient delay to seek care (AOR=2.50; 95% CI: 1.51-4.16); health system delays (AOR=1.62; 95% CI: 1.02-2.59); female sex (AOR=3.46; 95% CI: 1.50-7.98); rural residence (AOR=2.37; 95% CI: 1.45-3.86); chief complaint of breast lump (AOR=3.01; 95% CI: 1.49-6.07); and history of comorbidities (AOR=1.72; 95 % CI: 1.02-2.91).
CONCLUSION Increasing public and health provider awareness to promote early breast cancer diagnosis are needed in rural Ethiopia. There is a general lack of breast self-awareness among patients with late-stage disease, specifically the misperception that breast lumps were not serious problems. Opportunities exist to decrease misdiagnosis and increase screening in regional health care facilities.

OBJECTIVES Carcinoma of the vulva is a rare tumour, representing about 4%of gynaecological malignancies. For locally advanced vulvar cancer, surgery often involves exenteration with colostomy or urinary diversion causing significant physical and psychological morbidity. Neoadjuvant or primary chemoradiation is an acceptable treatment option for these patients to reduce the tumour size and minimize the extent of surgery. The purpose of the study was to determine the socio-demographic features and treatment outcomes in patients with vulvar carcinoma in a single institution.
METHODS A quantitative retrospective cohort study was done of all women diagnosed with vulvar cancer referred for radiotherapy from 1 January 2015- 31 December 2017. Demographic and clinical data, treatment time, and radiotherapy fractionation were noted. The primary end point was local control (LC) and overall survival (OS), defined as date of start of RT to date of relapse, secondary primary or death related to cancer (which ever came first).
RESULTS 33 women were eligible for inclusion in the study. There were 22 patients who received curative treatment: definitive CRT/RT (N=17), adjuvant RT (N=5). Of the 22 patients, 11 were in remission, 3 with documented local recurrence and 8 died due to unknown cause. Twelve patients received palliative treatment. The overall survival at twelve months showed that dual modality treatment resulted in a 100% survival outcome for the patients who received primary surgery followed by adjuvant radiotherapy. There was, however, no significant difference between the survival for the definitive CRT/RT (57%) and high dose palliative RT (52%). The dose of radiotherapy was significant; women who received a total dose greater than 60Gy had better local control compared to those who received a total dose of less than 45Gy.
CONCLUSION Dual modality treatment had superior overall survival outcome over definitive chemoradiation or radiotherapy alone in this small cohort.

BACKGROUND AND OBJECTIVE Although the frequency of metastases to the kidney in cancer patients is 7–13% in large autopsy series, incidental discovery of a renal metastasis as the first manifestation of a primary tumor is a very rare event. The most common primary malignancy to involve the kidney is bronchogenic carcinoma, followed by breast and gastrointestinal cancers. Here, we report a case with renal metastasis of digestive primary.
CASE PRESENTATION A 45-year old man consulted in urology for a pain of the left lumbar fossa. The physical examination showed a left supraclavicular adenopathy of 2.5 cm. There was no palpable abdominal mass. Abdominal ultrasound showed a left kidney mass and suspected hepatic nodules. The CT scan showed a heterogeneous tissue mass of the left kidney of 85 × 83 × 110 mm with multiples liver and lung metastases.
A left radical nephrectomy was performed in May 2014. Histopathological examination revealed a renal metastsis of a poorly differentiated mucinous adenocarcinoma with some ring cells. At immunohistochemistry analysis, the neoplastic cells were CK903 negative, CK7 and CK20 positive. An oeso-gastro-duodenal fibroscopy and a colonoscopy were performed but they were totally normal. Tumor marker were determined : CEA level was normal but CA19-9 was increased to 374 U/ml. Thus, the diagnosis of a métastatic gastrointestinal cancer with no obvious primary was carried. Chemotherapy consisting of 5-fluorouracil, folinic acid and oxaliplatin was given. A month later, the patient no longer consulted.
CONCLUSION Kidney metastases from solid tumors have received little attention in the medical literature because they usually occur in a setting of advanced systemic disease, and renal involvement is a relatively minor cause of symptoms.

OBJECTIVE Renal cell carcinoma (RCC) is a rare but aggressive disease. About 30% of RCCs are metastatic (m) at diagnosis. Many factors have been recognised as having prognostic value in mRCC and have been used in different prognostic models in order to guide the therapeutic approach. The purpose of this study was to identify the prognostic factors (PF) associated with the overall survival (OS) of patients with de-novo mRCC .
METHODS We conducted a retrospective study of all patients of Salah Azaiez Institute diagnosed with de-novo mRCC between November 2007 and July 2016. The OS was assessed via Kaplan Meier estimates. Univariate associations were examined by Log-rank tests.
RESULTS Among the 37 illegible patients, pathology was performed by metastasis biopsy in 43.2% and operative specimen in 37.8%. Clear RCC accounted for 75.7 %. Median OS (mOS) was 9 months (ms). One-year and 3-year survival rates were 40% and 5% respectively. Survival was significantly correlated to hystological subtype (mOS: clearRCC:13 ms, Pappilary: 7 ms , Sarcomatoid: 6 ms ; p<0.001). Radical nephrectomy was performed in 43.2% with negative margin in 80% of cases. It was significantly associated with better survival (mOS: 13 vs 7 ms, p= 0.001). Patients were startified according to MSKCC model as follow: favorable: 5.4%, intermediate: 40.5% and unfavorable: 54.1% with respective mOS of 20, 13 and 7 ms (p<0.001). Performans Status ≥ 2 (p= 0.003) and hemoglobin level ≤ 10g/dl (p= 0.009) were independant PF. Metastasis affected the lung, bone, lynph nodes, adrenal gland, liver and brain in respectively 73%, 54.1%, 21.6%, 13.5%, 13.5% and 5.4%. Patients with liver metastases had worse OS ( 6 vs 10 ms, p= 0.007). Only 10.8% of our patients had metastasis-surgery which improved their prognosis (mOS: 24 vs 9 ms, p= 0.012). First line systemic therapy was received by 75.7 % of cases. It included sunitinib in 53.6% and chemotherapy-interferon alpha in 46.4%. Second line treatment was administered in only 20% of progressing patients. The use of sunitinib even in the second line was associated to a better survival (mOS 14 vs 6 ms, p<0.001).
CONCLUSION Our study found PF comparable to those of the literature. However our survival rates are lower due to the lack of access to targeted therapies.

OBJECTIVE Adrenocortical carcinoma (ACC) is a rare endocrine malignancy accounting for 07-2.0 cases/million people per year with an increased incidence in the first and fourth-fifth decades of life. Women are the most affected. The aim of the study was to report our experience in the management of this rare malignancy.
METHODS This study involved 4 cases of ACC admitted in the department of medical oncology in Salah Azaiez Institute between 2012 and 2015.
RESULTS Three patients were male. Mean age at diagnosis was 43.75 years [40-50]. Incidentally discovered mass in only one case. Two patients complained from abdominal pain and the last patient presented with a flank mass. Computed tomography scan was the initial imaging test in 75%. The tumor was located on the right adrenal in 2 cases. Median radiological size was 17.5 cm [12-22]. Only one patient had functioning tumors (hypercortisolism). According to the European Network for the Study of Adrenal Tumors, initial Stage was III in all cases (T3N0M0). Surgery was performed in 3 patients, 2 of whom had a radical nephrectomy and one underwent conservative surgery. The fourth patient had an unresectable tumor. He had a transparietal biopsy of his abdominal mass to confirm the diagnosis of ACC. Mean Weiss score was 4.25 [3-6]. None of the operated patients had adjuvant mitotane chemotherapy. They presented distant metastases along the clinical course of the disease with an average relapse time of 4 months [3-5]. Two patients had lung and liver metastases. The third case had a bone relapse discovered by a malignant hypercalcemia. All patients were treated with Etoposide (E) and cisplatine (P) chemotherapy in the first line, including the patient with unresectable tumor. Two progressed under first line chemotherapy, one of them received doxorubicin chemotherapy in second line but progressed after 3 cycles. The patient with bone metastases and the one with unresectable tumor had respectively, disease stabilization and partial response after 6 cycles EP. Currently, they are still progression free. Median OS and PFS were respectively 15 and 6 months.
CONCLUSION Despite the enormous progress achieved in the biological knowledge of this tumor, ACC remains burdened by a high mortality. Future efforts should be made to investigate innovative therapies in the clinical field.

BACKGROUND AND OBJECTIVE Wilms’ tumor (WT) is the most common renal cancer in children. Tumor stage is a major determinant of therapy, with a significant intensification in stage III tumors compared with localized stages. Here in , we present our experience with stage III wilms Tumors.
METHODS We performed a retrospective study of 21 patients treated in Salah Azaiez Institute of Tunis for stage III WT over a 21-years period between January 1994 and December 2014.
RESULTS Stage III accounted for 29.2% of the WT treated during the study period. The average age was 3.8 years [1.33-9]. Sex ratio was 0.61 (Females:61.9%). Only 9.5% of patients had congenital malformations and 4.8% had a family history of nephroblastoma. Palpable abdominal mass was inaugural in 42.9%. Preoperative biopsy was performed in 19% of cases. Histology found a mixed subtype in 42.9% and a blastemal-type in 28.6% of cases. The tumor was classified as high risk in 57.1%. Lymph node invasion was found in 28.6% and microscopic residual disease in 33.3%. Tumor rupture was noted in 47.6%.
Preoperative chemotherapy was administered in 90.5% of cases. All patients had radical nephrectomy and postoperative chemotherapy. The protocol consisted of a triple-agent chemotherapy (Actinomycin+Vincristine+ anthracycline) in 40%. The median duration of postoperative chemotherapy was 27 weeks. Radiotherapy was performed in 81% of patients targeting mainly the renal lodge. Ten-year overall survival and relapse-free survival were respectively 61% and 62%. A poor prognostic was associated to local relapse (p = 0.009), pulmonary relapse (p = 0.008) and hepatic relapse (p = 0.006). Grade 4 febrile neutropenia was also associated with poorer survival (p=0.002). Radiation therapy improves overall survival (p = 0.002).
CONCLUSION Prognosis of stage III WT is variable. Future studies that prescribe different therapies for different types of stage III disease should be considered.

INTRODUCTION Population-based cancer registries provide critical information on cancer burden to inform cancer control programs. However, only 1 in 5 low- and middle-income countries have cancer registries; most of these are owned by research institutions or hospitals, causing sustainability constraints. A population-based cancer registry (PBCR) was established in 1991 in Rwanda and continued up to April 1994 when it was interrupted because of the genocide against the Tutsi. It resumed in 2010 with funding from a research project, and again halted in 2014. In July 2018, the Ministry of Health (MOH) through Rwanda Biomedical Center (RBC) in collaboration with partners including NCI/NIH, the Einstein-Rwanda Research and Capacity Building Program, and ECSA Health Community, re-established a government-owned National Cancer Registry (NCR) to ensure sustainability.
METHODS The Rwanda NCR covers the population of Kigali city with an estimated population of 1.2 million people in 2018. The registry is housed in the RBC with 4 experienced permanent staff and 37 trained focal persons supporting cancer registration activities as part of their work at the 28 health facilities included in the registry. Sources of data include electronic medical record systems, patients’ files, pathology reports, register books and death registries. Data were retrospectively abstracted from 5 facilities (KFH, CHUK, CHUB, RMH and Butaro) since 2007 using the Rwanda cancer abstraction form. Data were entered into CanReg5 version 43 software and analysed using IARC check program in CanReg5.
RESULTS Retrospective data collection from 2007-2018 yielded 13,889 preliminary provisional cancer cases. In 2018, 1593 cases were obtained and among them, 63.5% were fin women and 36.5% were in men. The top cancers among women were breast (23.6%), cervix (22.9%), stomach (8.4%), non-Hodgkin lymphoma (NHL) (3.8%), and ovary (3.5%). The top cancers among men were prostate (15.2%), stomach (9.8%), bone (4.7%), liver (4.2%) and NHL (4%). Most of the cancers occurred between ages 50 to 59 years in both sexes (36.9% in males and 40.9% females).
CONCLUSION Government ownership of cancer registration activities is the cornerstone for cancer registry sustainability. The Rwandan NCR is an integral part of Rwanda’s health system surveillance under the MOH and is an essential tool to provide a reliable database that meets international standards and meaningfully informs cancer control programs.

INTRODUCTION Complexity associated with conducting standard craniospinal irradiation (CSI) at target to skin distance (TSD) of 100 cm such as matching and shifting of junctions and dose in homogeneity along the spinal fields has led to an alternative method of using extended TSD at either 140 cm or 150 cm in some Radiotherapy centres.
OBJECTIVES To compare a standard TSD using two fields technique at 100 cm with single extended TSD on dose distribution to target area and surrounding normal structures.
METHODS Three patients (2 males and 1female), with age range between 5 to 20 years were simulated using computed tomography (CT) simulator in prone position for craniospinal irradiation, 36 Gy in 20 fractions was given to its entirety with posterior fossa boost of 18 in 10 fractions. Clinical target volume (thecal sac and contents) and organs at risk like mandible, thyroid gland, heart, lungs and liver were contoured on each slide. Dose-volume histograms (DVHs) were displayed and studied for the contoured structures. The two techniques (standard and extended) were referred to as A and B respectively for easy descriptive purpose.
RESULTS The average mean doses for technique A to the thyroid gland, heart, liver, lungs and mandible were 58.3%, 47.7%, 24%, 18.2% and 11% respectively as against to 72.7%, 53%, 24%, 20.5% and 15% seen in Technique B. In addition, the average mean doses to target areas in technique A and B were (103.7, 110.3) and (104, 105.3) for brain and spinal cord respectively.
CONCLUSION Although, technique B delivered more homogenous dose to the spine, easier to plan and less challenging during the set up for treatment but it has a risk of higher dose to organs at risk compared to technique A. We therefore recommended the use of standard technique A in CSI to minimize the feature risk of stochastic effect of radiation in potential long-term survivors.

OBJECTIVE Pain medicines remain under-prescribed, particularly among patients reporting moderate to severe pain .Rwanda’s Ministry of Health (MOH) is partnering with the American Cancer Society (ACS) to integrate pain treatment into service delivery through the Pain Free Hospital Initiative (PFHI).It is a one-year program to integrate effective pain treatment into hospital-based services by motivating clinicians to evaluate and treat pain, supplying appropriate drugs to treat pain, equipping clinicians with the skills and tools to effectively treat pain, measuring the impact of the program and communicating the impact of the program.
METHODOLOGY We collected data sent by Pain Free Hospital Initiative (PFHI) staff champions starting from December 2018 to February 2019, and we compared it to the baseline assessment data collected before the launch of PFHI within five implementing hospitals to look for any improvement on pain score and oral morphine solution consumption.
RESULTS Pain Free Hospital Initiative launched in 2018 in five hospitals. Pain score baseline data prior to onsite training showed 80% of patients in implementing hospitals were in severe pain, while 20% were in moderate pain. Pain scores from December 2018 to February 2019 following the launch of onsite training at each hospital, show 60% of patients at implementing hospitals reported mild pain, while 40% reported moderate pain.
For consumption of oral morphine solution during 3 months after initiation of onsite training, it has improved more than twice (266 bottles to 582bottles) compared to consumption in the 3 months prior to PFHI onsite training. For training, seventeen staff champions have been trained as trainers and 321 health care providers have been trained within implementing hospitals through onsite training
CONCLUSION Onsite training on pain assessment and management among health care providers has resulted in a significant increase in the consumption of oral morphine solution and a decrease in patients reporting pain scores indicating moderate and severe pain. Regular supply of analgesics, hospital leadership involvement, and initiating PFHI in other hospitals may continue to improve and strengthen an effective pain management for all in need.

OBJECTIVE Patients with cancer may develop body image concerns during their disesase because of cancer itself or its treatments and toxicities. This may impact patient’s appearance and body integrity. This study was performed to assess body image changes and its social and psychological impact in patients undergoing chemotherapy.
METHODS This prospective study included 100 patients aged 18 years and older, treated with chemotherapy in the medical oncology department of the Salah Azaiez institute between 01/03/2018 and 31/03/2018. Demographic and disease data were collected. Changes in appearance caused by chemotherapy and their psychological and social impact were assessed with dimensional questioner with 24 items.
RESULTS Median age was 50 years old [Range 20-65], 28 % were men and 72% women.84% had no university education. The most frequent complaints were fatigue (93%), alopecia (75%), mucositis (75%) and weight loss (64%), while the most troublesome symptoms were alopecia and paresthesia. Physical changes have negatively affected the psychological status of patients. 40% declared being most of the time dissatisfied with their body. 78% reported a loss of bodily integrity and 83% reported a low self-esteem. Social functioning was also negatively impacted by changes in appearance. 50% avoided people most of the time because of the way they felt about their appearance and 62% reported having familiar problems.
CONCLUSION Many cancer patients experienced body image disturbances during treatment which impacted their mental health as well as their social life. Therefore, we should promote the involvement of strategies and actions that may assist in the maintenance of self-esteem and body image.

OBJECTIVE Pain is an unpleasant physiological phenomenon that negatively impacts on a person’s quality-of- life. Pain is often unavoidable among cancer patients with advanced disease stages and most die with unrelieved pain. Nurses as major players in pain management, need pain assessment skill as the first step to effective pain management. However, nurses’ knowledge and use of pain assessment tools has been understudied in Africa. This study assessed nurses’ knowledge and use of pain assessment tools in two selected federal teaching hospitals in Abuja, Nigeria.
METHODS This descriptive cross-sectional study enlisted 319 out of 1051 nurses employed in the two hospitals using multi-stage sampling technique. Data were collected using 34-item researcher-developed questionnaire which had a reliability coefficient of 0.78. Data were analysed using proportions, means for descriptive and t-test and Spearman rho Correlation for inferential statistics at alpha level of 5%.
RESULTS Most (298) respondents had average knowledge (6-10 correct responses) of pain assessment tools. Respondents’ use of pain assessment tools was poor (18.4%). The most common tools used were visual analog scale (47.3%) and verbal descriptor scale (22.0%)., Lack of skill in utilization, inadequate training/expertise , non-availability of the pain assessment tools in the wards and nursing workload, were the barriers to the use of pain assessment tools. There was no significant difference (p > 0.05) in the nurses’ knowledge and use of pain assessment tools between the two institutions. There was no correlation between the nurses’ knowledge and use of pain assessment tools (p> 0.05).
CONCLUSION There is need for capacity building of nurses in the knowledge and use of pain assessment tools. Also, institutional policy guidelines and provision of pain assessment tools would enhance their use in clinical practice.

OBJECTIVE Data management remains a challenge in many health care systems in Africa. Diabetes mellitus like cancer, is a chronic illness classified among the Non-communicable diseases (NCDs) by the WHO. Major tools in diabetes care include proper diabetes registries and lifelong diabetes education for patients. In recent times, eHealth tools have been championed as an easy and effective way for data gathering, research and improved patient self-care. In addition, applications which can run on mobile devices including tools such as using SMS and USSD functions have gained popularity for patient management among both patients and health care providers.
METHODS The BlueCircle TM app is such a tool recently developed to help with essential data collection in patients with diabetes mellitus managed at various tertiary health facilities in Nigeria. It runs on Android devices and data collected are stored both offline & online. Features of the application include: data security, privacy and control as well as sms notifications (which can serve as health educational tips to enrolled patients). The App works primarily offline and allows a central & collaborative approach to patient enrolment. It is endowed with several offline and online features to mitigate against duplication of entry in the setting of an error on the enrollers part or due to patient migration, hence it's effective use as a hospital based or population-based registry. The platform is highly customizable into any disease registry and is currently being adapted into an oncology eRegistry. It comes with several features that allow for utilization of data, including several charting features, a user notification feature on appointments/tests etc and a targeted SMS feature (that allows for target group specific engagement).
CONCLUSION The BlueCircle App is a robust app which has been deployed successfully in DM management with easy application and adaptation to other chronic illnesses (e.g. Cancer) and NCDs

OBJECTIVE
Consistently increased cervical cancer incidence observed in this selected population is difficult to associate either with increased availability of the free cytology screening or other factors. The objective of this study is to investigate trends in the age-standardised and age-specific incidence rates in two distinct regions (the northern and southern areas) covered by the Eastern Cape Cancer Registry.

METHOD
1998-2012 data of all women with topography C53.0-C53.9 were extracted from the registry database. The annual cervical cancer incidence trends were calculated for the period 1998-2012, a 15-year period encompassing the initiation of the national cervical cancer free cytology screening programme in South Africa. Information on age and stage distribution assessed, proportion of cases with pathologically verified diagnoses checked. In addition, trends in coverage of the cervical cancer screening programme were assessed using the routine health service data.

RESULTS
Annual age-standardized incidence rates per 100,000 population increased significantly in the northern area from 24.0 (95%CI: 21.1-27.0) in 1998-2002 to 39.0 (95%CI: 35.6-42.5) in 2008-2012 with a screening coverage rate of 15% by 2012. In contract, no increase was observed in the southern area with rates of 20.0 (95%: 18.5-21.4) in 1998-2002 and 18.8 (95%CI: 16.2-21.4) in 2008-2012, with a higher screening coverage of 41% in 2012. Percentage distribution of stage at diagnosis showed that 28.5% of cases were diagnosed at stages I and II, 35% III and IV and 36% of missing stage information, 77% were histologically verified of which only 12.3% were by cytology.

CONCLUSION
The significant increase in the incidence in the northern area does not appear to be directly related to the screening programme but may portend increases associated with the widespread provision of highly active ante-retroviral therapy.

BACKGROUND Increasing cancer incidence in South Africa is a reality and public health problem that needs urgent attention. During November 2018, experts in the continuum of cancer care and treatment including research had a seminar to design a provincial specific cancer prevention and control plan. The presence and input of the National Health Ministry and Non-communicable Disease Directorate in this important three-day seminar endorsed the commitment of the South African Government in responding to this urgent need. The following objectives in the cancer control plan that was designed included:
• To reduce the incidence of most common cancers through primary prevention
• To improve early detection of most common cancers through availability and accessibility of free screening
• To pay attention to childhood cancers with regards to improved diagnosis and treatment
• To strengthen cancer surveillance as a pillar to cancer intervention and control programmes
• To promote appropriate research for most common cancers in the province
• To improve access to cancer treatment and follow up services
• To improve survivorship and palliative care; with a focus to community and home-based care
OUTCOME Four commissions were identified with champions to lead and they include;
• Prevention, screening and early detection
• Early diagnosis and treatment of cancer
• Survivorship and palliative care
• Cancer surveillance
CONCLUSION The presenting author will share with the audience some developments and progress made on this cancer control plan after a year of inception.

INTRODUÇÃO os tumores malignos da cabeça e pescoço são o sexto tipo de cancro mais comum e um dos que apresenta pior taxa de sobrevivência. São diagnosticados anualmente à escala mundial cerca de 550 mil novos casos sendo responsável por cerca de 300 mil mortes por ano (Estevão et al, 2016) (1). Em áfrica e em particular em Moçambique a falta de registo constiui um desafio para a dimensão do Problema(2).
Em 2018 o serviço de Oncologia do HCM registou cerca de 810 novos casos de cancro no periodo de maio de 2018 a Abril de 2019, dos quais pouco mais de 22 pacientes são de tumores de cabeça e pescoço.
Os tumores de cabeça e pescoço acometem regiões imprescindíveis à alimentação e em muitos casos pode levar a desnutrição, com a prevalência entre os pacientes de 30 a 80%, influenciando na resposta ao tratamento, na qualidade de vida, aumentando a morbimortalidade, o tempo de internamento e o custo hospitalar (3).
OBJETIVO GERAL identificar os pacientes com indicação de Tratamento Nutricional Enteral (TNE).
OBJECTIVOS ESPECÍFICOS avaliar o suporte nutricional oferecido; avaliar a toxicidade segundo o esquema de quimioterapia feito; comparar a situação nutricional antes e pós-quimioterapia.
METODOLOGIA trata se dum estudo prospectivo e observacional, de pacientes com tumores malignos de cabeça e pescoço em tratamento com quimioterapia do 2º semestre de 2018 ao 1º semestre de 2019.
ANÁLISE ESTATÍSTICA dados do IMC, percentagem de perda de peso, grau de toxicidade da quimioterapia, percentagem de pacientes com via alimentar alternativa e estado Nutricional.

OBJECTIVE The quality of information in a pathology report is crucial for the management of patients with cancer. In 2017 we introduce a synoptic template for pathology reports adapted from the College of American Pathologists (CAP). We aimed to evaluate the effect of the use of this template (2017 – 2018) in the quality of the reports of breast cancer in mastectomy specimens in Maputo Central Hospital (MCH) compared with the previous phase (2015 – 2016) before the introduction of the CAP template.
METHOD All pathologic reports of mastectomy specimen for breast cancer from 2015-2018 were retrospectively accessed from the database of Pathology Department of MCH. We evaluated the availability of information about prognostic factors, such as tumour size, grade, margins status, histologic subtype, linfovascular invasion (LVI) and immunohistochemistry for oestrogen receptor (ER).
RESULTS We analysed 237 mastectomy specimens reports for breast cancer (98 from 2015-2016 and 139 from 2017-2018). Most (97.5%) were female, 51.5% from left breast and 92.0% were Non-Special Type. Information about tumor size, histologic subtype, grade, LVI, margin status and ER were missing in 5.9%, 0.4%, 6.8%, 8.4%, 8.9% and 29.1%, respectively. Prior to the introduction of synoptic template, 11.2% of the reports did not contain histological grade compared with 3.6% in the period after. Missing information of margins status and LVI were in 12.2% and 16.3% in 2015-2016 and reduced to 6.5% and 2.9% in 2017-2018, respectively. Cases without ER information reduced from 55% in 2015-2016 to 10.8% in 2017-2018.
CONCLUSIONS The important reduction of incomplete information after the introduction of synoptic report templates for mastectomy specimens of breast cancer, emphasizes the importance of the use of this type of instruments oriented to routine activities in pathology laboratory, for better patient management. Training, capacity building and systematic quality control of the reports is still required.

INTRODUCTION The main postoperative complication of mastectomy and axillary dissection is seroma which can last several months.
OBJECTIVES The aim of this study is to analyse risk factors for seroma the role of padding in its prevention.
METHODS Sixty-one patients were included in the study. The patients were followed for 6 months after surgery. All patients underwent mastectomy and axillary dissection according to Madden procedure between January and June 2018. The quantities of seroma drained and punctured were reported. We collected various parameters related to the patient, to the disease and to the treatment, including clinical features, biology and pathological examination.
RESULTS Twenty-five patients (25) had padding and 36 had only axillary drainage without padding. In the padding group, patients produced, at 6 months, a seroma quantity equal to half that of the control group (761.83 ml vs. 1373.60 ml; p=0.02). Quantities of seroma produced during hospital stay were (362.80 ml vs. 630.83 ml; p<0.01). The hospital stay and therefore the duration of drainage was lower for the padding group (3.72 days vs. 5.14 days; p=0.01). However, Pain at 6 months was more important (0.26 vs. 0.10; p=0.04). Obesity is accompanied by a greater quantity of seroma. For the TCK ratio, the more it increases the more seroma is important. An extensive axillary dissection is accompanied by greater production. We also note that a weight between 1001 and 1250 grams of the operating piece have the largest production. A compression bandage reduces the quantity of seroma. On the other hand, longer suction drainage is accompanied by greater production.
CONCLUSION Postoperative seroma production is heterogeneous and varies from one individual to another. This production is largely influenced by several factors related to the patient, to the disease and to the treatment. Padding can significantly reduce this quantity of seroma and hospital stay.

Child Life (CL) services are considered an indicator of excellence in paediatric care in most high-income countries. Among children with cancer, the uncertainty and fear of the unknown is deeply frightening to both the child and their family. Moi Teaching and Referral Hospital’s Child Life program (MTRH-CLP) in Kenya strives to make hospitalization less stressful for children and their families.
OBJECTIVES To describe the development of child life services in the care of children with cancer in Moi Teaching and Referral Hospital.
METHODS This is a retrospective review of the establishment of CL services at a Kenyan tertiary public hospital. MTRH-CLP began as a play program in 2000 with the first playroom opened in 2005. MTRH-CLP has developed to become a model CL program in Kenya where work with children and families focuses on building therapeutic relationships utilizing a play-based approach that broadens patient’s understanding of childhood cancer. A skilled CL team assesses, then plans interventions that meet unique needs of children and family members by considering diagnosis, growth and development and coping skills within a family system. Parents are proactively engaged in the direct care of the child during cancer treatment hence the need for family centred care approach.
RESULTS Following planned interventions there is increased and better coping by children during distressing and recurrent medical procedures like intravenous cannulation and intrathecal chemotherapy, improved overall health experience, improved quality of life for children with cancer and their families.
CONCLUSION The medical and CL teams should support family-centred care and the implementation of CL supports as more children receive a cancer diagnoses. Integration of CL services in the multidisciplinary paediatric oncology care teams in low income countries is feasible.

OBJECTIVE Oesophageal cancer (OC) is the third commonest cancer in Malawi. Despite significant morbidity and mortality, little is known about disease outcomes. We assess post-diagnosis survival of OC in Malawi.
METHODS We report on OC cases enrolled in a matched case control study at Kamuzu Central Hospital in Lilongwe from 1 August 2017 to data censoring on 31 July 2018. Suspected cases completed a questionnaire interview, provided blood, urine and saliva specimens, and underwent a tumour biopsy for histologic confirmation. Cases were followed up by phone every three months. We evaluated overall survival for cases only. Time from diagnosis to death was assessed using Kaplan Meier methods. Differences in mortality between patients on palliation alone, those who received a stent and those receiving chemotherapy were assessed using the log-rank test.
RESULTS There were 43 confirmed OC cases enrolled during the study period, of which 36 (84 %) had known vital status at censoring date and 7 (16%) were lost to follow-up. Of the 36 with known vital status at censoring, median age at enrolment was 57 years (range: 29-86) and 19 (53 %) were male. Median follow-up time was 117 days (range: 5-399). Twenty-seven (75%) died and median overall survival was 138 days (95% CI 81-165). Ten patients received palliative chemotherapy and six received a stent. No patients received both chemotherapy and stent. There was a significant difference in survival between those who received palliation only (median 63 days) and those who received chemotherapy or a stent (median 202 days, p=0.003).
CONCLUSION Survival following diagnosis of OC was poor. Chemotherapy or stent placement were associated with improved survival compared with palliation alone. Greater emphasis should be placed on early detection of OC, as well as prevention once key modifiable risk factors in Malawi are identified through ongoing studies in Malawi.

OBJECTIVE Tumours in children, benign or malignant, can be attributed to a variety of causes ranging from genetic to environmental. Histopathological diagnosis, classification and staging with or without ancillary investigation is an important tool for patient care as well as surveillance. The Kamuzu Central Hospital (KCH) pathology laboratory was established in 2011 and serves almost half of the 18million population of Malawi. We describe the spectrum of paediatric tumours at KCH pathology laboratory.
METHODS This is a retrospective case series of tumours in children diagnosed at KCH pathology laboratory between 2011 and 2018 within the age range 1-12years. Our data includes excisional, incisional biopsies and FNA. Demographic, clinical and pathologic data were extracted from the laboratory database. Histopathologic tumour diagnosis where applicable was aided by a limited panel of immunohistochemical antibodies available in the KCH laboratory which at minimum is able to categorise solid tumours into carcinoma, neuro derived tumours and lymphoma.
RESULTS 3768 paediatric specimens were received between 2011 and 2018 of which 2450 (65%) were histology and 35% were cytology. 2928 cases (78%) were benign, 811(21%) malignant, 29 (1%) nondiagnostic. The most common malignant neoplasm was Burkitts Lymphoma, 210 representing 26% of the malignant diagnoses. The other tumours in order of frequency were NHL, retinoblastoma, Hodgkin lymphoma, Wilms tumour, Kaposi sarcoma, Acute leukaemia, sarcoma NOS, rhabdomyosarcoma, small round blue cell tumours and neuroblastoma. 40 (5%) tumours could not be classified and all other tumours comprised 12.5%.
CONCLUSION The most common paediatric tumours in our laboratory are haematolymphoid of which Burkitts is the commonest. There is need to expand our IHC panel to aid in the diagnosis of sarcomas and small blue cell tumours.

OBJECTIVES There is evidence that 15 % of gastric cancer patients in Zambia survive more than one-year after diagnosis. The major contributing factor to these poor outcomes is late case detection. We endeavoured to analyse the time frames from the onset of symptoms to clinical diagnosis of gastric cancer in order to establish the contributors to late diagnosis.
METHODS The study was conducted at the University Teaching Hospital, in Lusaka. Consenting patients presenting to the endoscopy unit were enrolled and their endoscopic findings recorded. An interviewer-administered questionnaire was used to collect information on basic characteristics, presenting symptoms and duration.
RESULTS We enrolled 388 patients, 92 (24%) of whom had gastric cancer. Among the gastric cancer patients, the median age was 58 years, (IQR 46-70 years). 49/92 (53%) were female. About two-thirds of the gastric cancers were located in the distal part of the stomach. The main presenting symptoms for gastric cancer patients were abdominal pain 48/92 (52%), vomiting 14/92 (15%), blood loss 12/92 (13%), dysphagia 10/92 (11%) and anaemia 3/92 (3%). The median time to endoscopic gastric cancer diagnosis was 12 weeks, IQR 4-32 weeks after the first health care consultation. This was despite gastric cancer patients seeking healthcare attention within a median of 2 weeks, IQR 0-4 weeks of noticing the symptoms. Patients presenting with persistent vomiting or evidence of blood loss had significantly shorter delays than those with abdominal pain (p<0.05 and p<0.001 respectively).
CONCLUSIONS Delayed referral for diagnostic endoscopy is a contributing factor to late gastric cancer diagnosis in Zambia. There is, therefore, an urgent need for affordable and non-invasive diagnostic tools that will aid clinicians identify early gastric cancer.

OBJECTIVE The sero-prevalence of Helicobacter pylori (H. pylori) infection among Zambian adults is over 80%, but little is known about specific bacterial characteristics influencing gastric carcinogenesis in this population. The aim of this study was to evaluate the associations between pre-selected H. pylori antibodies with gastric cancer, premalignant lesions and active gastritis.
METHODS Patients with gastric cancer (GC) or gastric premalignant (GP) lesions were compared to those without these lesions (controls), including patients with either active or chronic gastritis. A fluorescent bead-based antibody multiplex serology assay was used to quantify antibodies to thirteen immunogenic H. pylori antigens. Logistic regression models were used to examine the associations.
RESULTS Included were 295 patients: 59 GC, 27 GP lesions and 209 controls. Compared to those without the infection, H. pylori seropositivity was not associated with sex, age, body mass index, socio-economic status, HIV infection, alcohol consumption or cigarette smoking (p-values all above 0.05). When compared to the controls, the presence of catalase and cinnamyl alcohol dehydrogenase (Cad) antibodies was positively associated with GP lesions (OR 3.53; 95% CI 1.52-8.17 and OR 2.47; 95% CI 1.08-5.67 respectively). However, Cad was significantly lower in GC patients than in the controls (OR 0.28; 95% CI 0.09-0.83). Compared to chronic, active gastritis was significantly associated with (p<0.05) H. pylori sero-positivity (OR 9.46; 95% CI 1.25-71.52) and specific antibodies including cytotoxin-associated gene A, vacuolating cytotoxin A, Helicobacter cysteine-rich protein C, hypothetical protein HP0305 and outer membrane protein HP1564.
CONCLUSIONS Among Zambian patients, specific H. pylori antibodies are associated with active gastritis but not GC.

OBJECTIVE The incidence of breast cancer has increased by 80% in Nigeria over the last four decades. The cost of cancer care can be significant and in Nigeria the majority of healthcare spending is out-of-pocket. This study quantified the cost of breast cancer management and the associated rate of catastrophic healthcare expenditure (CHE) at a public hospital in Ife, Nigeria.
METHODS Patients treated between January 2018-August 2018 were identified from a prospective breast cancer database. A questionnaire was developed to capture socioeconomic information and direct and indirect treatment related costs. A commonly used threshold for a CHE (40% capacity-to-pay) was used in this analysis. Local currency was converted to purchasing power parity (2016 Intl$).
RESULTS Complete data was collected on 18 of 72 eligible patients. The majority (72%) had locally advanced disease. Annual mean non-food household expenditure (capacity-to-pay) was 5,866 (Intl$), which was above the average for the region (2,172 Intl$). The relative affluence of the cohort was reflective of the proportion of individuals with higher education (89% ≥ secondary education). The mean cost of diagnosis and treatment was 3,440 (Intl$), with the cost of chemotherapy alone accounting for 41%. At a threshold of 40% capacity-to-pay, 81% of patients experienced a CHE. Twelve of 18 (67%) had no form of health insurance. None of the patients eligible to receive radiotherapy underwent treatment owing to cost and availability. Financial constraint precluded surgery for resectable disease in 3/18 (17%).
CONCLUSION Our cohort was more affluent than regional and national averages. However, the out-of-pocket cost of breast cancer care at a public hospital in Nigeria remains high and resulted in a CHE for over 80% of individuals. Greater financial protection is essential as the burden of breast cancer increases in Nigeria.

OBJECTIVE The faecal immunochemical test (FIT) for haemoglobin is recommended for colorectal cancer (CRC) screening in resource-limited environments. However, there are several unique variables that may alter FIT performance in this setting, including endemic intestinal parasites and high ambient temperature. This prospective study evaluated the performance of FIT in asymptomatic, average-risk individuals of screening age in rural Nigeria.
METHODS Three hundred and twenty-four community volunteers completed a questionnaire and provided stool specimens for parasitology and microbiome analysis. Specimens were frozen and stored at -80oC. Of 324 subjects, 139 met criteria for average-risk CRC screening and had a stool sample for analysis. These were thawed and tested with a qualitative FIT. Specimens positive for occult-blood were re-tested every two days to evaluate the impact of time and temperature on test performance.
RESULTS Of 139 individuals, 69 (49.6%) were positive for intestinal parasites and 10 (7.2%) were positive for occult blood. The most common pathogen was Cryptosporidium (40.6%). Among patients with intestinal parasites, 10.1% (7/69) had a positive FIT. Only 4.3% (3/70) of patients without parasites had a positive FIT (p=0.208). On bivariate analysis, sociodemographic variables were not associated with a positive FIT result. Thirty percent (3/10) of the FIT-positive specimens became FIT-negative with routine storage.
CONCLUSIONS Although a positive FIT result was more common in those with parasitic infection, the relationship was not significant in this small cohort. The impact of high ambient temperature on test positivity may necessitate shorter processing time guidelines for equatorial countries. Additional prospective studies are needed to validate FIT performance in Nigeria.

OBJECTIVES
• To describe current access to pharmacologic options for the management of cancer pain in semi-rural Nigeria through a workshop with nurses and pharmacists.
• To identify non-pharmacologic treatments for cancer pain in limited resource settings.
BACKGROUND The African Research Group for Oncology (ARGO) is a National Cancer Institute recognized cancer consortium. Prior to the 6th Annual ARGO Symposium in April 2019, nurses and pharmacists expressed an interest in a workshop on palliative care. Symptom management is an important aspect of palliative care with cancer pain being a common symptom. Cancer pain occurs in 20 – 50 % of patients and about 80% of patients with advanced cancer have moderate to severe pain. The treatment of cancer pain often relies on the use of opioids, however, access to opioids in resource limited settings is challenging. Therefore, there is a need to think about innovative pain management solutions including non-pharmacologic options. Audience feedback response during and after the workshop were explored.
METHODS The workshop led to an exploration of current practices and areas that clinicians identify as being challenging aspects of pain management. Through dialogue prior to, during and after workshop session at ARGO, a list of recommendations highlighting potential areas of change were identified.
RESULTS Participants highlighted some of the challenges associated with:
1)Limited access to long-acting opioid formulations for chronic pain.
2)Potential incorporation of other non-pharmacologic pain management including psychosocial support to assist with family and financial distress.
Other suggestions made in the literature were reiterated and included:
1)Need to change legislation and regulation with regards to access to opioids.
2)Further education and training of clinicians in interdisciplinary pain management practices.
CONCLUSIONS Participants expressed an interest in developing other practical options for pain management such as potential low cost long acting morphine formulations as well as other practical non-pharmacologic options.

OBJECTIVE Kenyatta National Hospital (KNH), the only public hospital in Kenya delivering comprehensive cancer care to patients from throughout the country, launched a patient navigation program in 2017 with support from the American Cancer Society. This program addresses identified barriers to cancer care and seeks to ensure patients diagnosed with cancer are well informed, receive timely access to quality cancer treatment, and improve treatment adherence and completion. This presentation summarizes the routine program data that describe patient demographics, medical information, barriers to care, and navigation actions to support patients seeking treatment at KNH’s Cancer Treatment Centre through June 2019.
METHODS Navigators collected routine program data using standardized intake forms during every patient navigation encounter. These data were analysed in EpiData and reports used for program management, improvement, documentation of achievements and for learning. Quantitative data were analysed using descriptive analysis and correlations tested using Chi-square tests and logistic regression. Thematic analysis was performed for qualitative data.
RESULTS Approximately 4,400 patients have been navigated at KNH. The preliminary results indicate that patients are predominantly from counties surrounding Nairobi and are female aged 50 years and above with late stage of cancer. Cancer of the cervix is the leading diagnosis followed by cancer of the breast and then oesophagus. Most of these patients receive basic cancer education and face multiple challenges accessing treatment. Navigators have been successful in educating the patients to enrol in the national health insurance program and linking patients to services within and outside of KNH.
CONCLUSIONS The routine program data has been instrumental to better understand the population KNH is serving, age and gender, the most prevalent cancers services provided by the navigation team, and main barriers to care .It has also been used to build the case for navigation and gain buy-in and support from both hospital management and providers. The development of this data collection/tracking system has ensured efficient program delivery, coordination with other departments, and timely patient follow-up.

OBJECTIVE The prognosis of hepatocellular carcinoma (HCC) on cirrhosis is generally poor and varies according to the hepatocellular function and the stage at which the tumor is diagnosed. It is a cancer with a poor prognosis whose progression is unpredictable. The main objective of our study is to determine the predictive factors of progression at the time of diagnosis of HCC.
METHODS This is a retrospective and prospective study of patients with HCC on liver cirrhosis included from January 2010 to July 2018. Multivariate analysis was performed with a binary logistic regression model to identify prognostic factors associated with progression. We considered significant p <0.05.
RESULTS We collected 110 cases of HCC on liver cirrhosis during the study period. The average age was 62 +/- 14.54 years old with female predominance (sexe ratio F / H = 1.14). The etiology of cirrhosis was viral B and C in 69.6%. The Child's score was ≥ B8 in 17% of cases. The level of alpha fetoprotein was positive in 66.39% and it was > 400 ng / ml in 24.5%. The extension assessment revealed metastases in 19% of our patients. Among 110 patients, only 25,4% patients received curative treatment while 10% of our patients were beyond any therapeutic resource. The evolution was marked by the progression at the first year in 63% vs 29.5% of response. Tumor progression is related to the general condition of the patient (p = 0.0001), advanced child (p = 0.002), AFP level> 400 ng / ml (p = 0.023) and presence of metastases at the time diagnosis with p = 0.005.
CONCLUSION Our study shows that HCC is an aggressive tumor. Progression factors are general patient status, advanced child, AFP> 400 ng / ml, and the presence of metastases at the time of diagnosis.

OBJECTIVES Hepatocellular carcinoma (HCC) is the most common primary liver tumor with a high mortality rate, ranking in the second place worldwide in terms of cancer-specific mortality. In the present study we review our experience in terms of treatment of HCC to illustrate the epidemiological and clinical profile and to analyze and discuss the results of different treatment procedures and their limitations in the absence of a national strategy of liver transplantation.
METHODS It is a retrospective study including 122 patients diagnosed with hepatocellular carcinoma on in the hepato gastroenterology department between January 2009 and august 2018. The diagnosis of HCC was based on non-invasive criteria and on histology for doubtful cases. The analysis of the results was done with the software Package for Social Science (SPSS version 20) for Windows. Quantitative variables were expressed as average ± standard deviation. Qualitative variables were expressed in number and percentage (%). Survival was estimated by the Kaplan-Meier curve.
RESULTS The average age of our patients was 62 years (17; 86) with a female predominance. HCC occurred in cirrhotic patient in 93%. The etiology of cirrhosis was viral B and C in 69.6%. Screening revealed the tumor in more than a half of the cases (68%).The diagnosis of HCC was assessed based on morphological criteria in 88%. Among 122 patients, only 25,4% patients received curative treatment while 10% of our patients were beyond any therapeutic resource. The average survival duration was 8,18 ± 16,28 months. Survival at one year was 71,3%, and 26,2% at 5 years.
CONCLUSION Our study confirms that hepatocellular carcinoma remains a cancer of poor prognosis. More than two-thirds of our patients died at the end of the study.

OBJECTIVES Hepatocellular carcinoma (HCC) is the most common primary liver tumor with a high mortality rate. Alpha fetoprotein (AFP), the only validated HCC tumor marker, is no longer recommended by several lsocieties for screening for lack of sensitivity. However, it is widely debated and cited as a prognostic factor in several studies in case of small HCC. Our objective is to evaluate the prognostic impact of the AFP rate at diagnosis on the overall survival of patients with a small HCC (<3cm).
METHODS All patients diagnosed with HCC less than 3 cm in size between 2010 to 2018 were included. The clinico-biological characteristics were analyzed retrospectively and prospectively. The diagnosis of HCC was based on non-invasive criteria and on histology for doubtful cases. Alpha fetoprotein was determined at the time of HCC diagnosis. The patients were divided into 2 groups: group I with negative AFP and group II with AFP> 10 ng / ml.
RESULTS In 122 patients with HCC, 49 patients were less than 3 cm at diagnosis, including 40,8% (N 20) patients with AFP negative (group I) and 59,18% (N 29) with AFP> 10 ng / ml (group II). Both groups of patients were comparable for age, presence of cirrhosis and OMS status (0 or 1). The Child score was more advanced in group II. Palliative treatment was received in 55% of patients in group II (N 16) vs 40% (N 8) in group I. The survival at 5 years was 35.7% in group 1 vs 12.3% in group 2. The AFP level was identified as an independent prognostic factor ,p= 0.001 and COX at 0.031.
CONCLUSION An elevation of AFP above 10 ng / mL in a patient with a small HCC (<3cm) has an independent prognostic value and should be considered in the therapeutic strategy.

OBJETIVO A esperança média de vida em Cabo Verde para o género feminino é de 73,8 anos e 69,1 anos para o género masculino. Este facto e a adoção de comportamentos de risco são fatores que contribuem para o aumento dos casos de cancro em Cabo Verde. O Hospital Agostinho Neto trata a maioria dos casos de cancro de Cabo Verde. Pretende-se, estudar as características clínicas de doentes com Cancro da Mama (CM) admitidos neste hospital.
MÉTODOS Entre 2002 e 2016, os dados demográficos e clínicos de 258 casos de CM diagnosticados e tratados consecutivamente no Hospital Agostinho Neto foram estudados. A análise estatística descritiva foi posteriormente realizada.
RESULTADOS Neste estudo, os doentes com CM eram na sua maioria provenientes da região de São Tiago (77,9%), 254 eram mulheres e 4 homens, a idade mediana da amostra foi de 52 anos (mínimo: 28; máximo: 94 anos). O Carcinoma ductal invasor foi o tipo histológico mais frequente (86,4%). O estádio no momento de diagnóstico foi em 1,9% estádio 0, em 18,6% estádio I, 28,7% estádio II, 29,1% estádio III, 12% estádio IV e em 9,7% o estádio da doença era omisso. A Mastectomia radical modificada foi o tratamento cirúrgico mais utilizado (71.7%), 191 casos (74%) foram submetidos a quimioterapia, 133 casos (51,6%) hormonoterapia e 94 casos (36,4%) radioterapia. A mortalidade específica observada foi de 9,3%, estavam perdidos para o seguimento 5,2% dos casos.
CONCLUSÕES Em São Vicente (Cabo Verde), o diagnóstico de CM, ao contrário da maioria dos países africanos, é realizado, em grande medida, em estádios iniciais. Estes dados revelam a urgência em adotar estratégias que permitam o tratamento conservador do CM, nomeadamente a radioterapia e implementar o tratamento guiado pelo fenótipo dos tumores, após o estudo por imunohistoquímica.

OBJECTIVO O cancro do esófago é o tumor digestivo mais frequente admitido e tratado no Hospital Central de Maputo em Moçambique, em ambos os géneros. Na sua maioria, estes doentes são admitidos em estádio avançado. Geralmente, nestes doentes, realiza-se gastrostomia de alimentação como tratamento paliativo. Nos casos localmente avançados potencialmente ressecáveis e de acordo com o estado geral do doente realiza-se tratamento neoadjuvante com quimioterapia (QT – cisplatina e 5 FU) e cirurgia. Nos casos ressecáveis sem condições para QT a cirurgia é realizada. Após recuperação nutricional e caso haja condições clínicas realiza-se quimioterapia pós-operatória. Neste estudo pretende-se avaliar os resultados deste protocolo terapêutico.
METODOLOGIA Durante Janeiro de 2016 a abril 2018 foram admitidos e tratados cirurgicamente 23 doentes segundo este protocolo no HCM. Foram estudadas as características demográficas, clínicas, patológicas e o tratamento realizado. Estudou-se a evolução destes doentes.
RESULTADO Na série estudada 12 (52.2%) doentes eram mulheres e 11 (47,8%) homens. A idade mediana era de 50 anos (mínimo 27 e máximo 74 anos). A maioria (65,2%) era natural de Maputo. A localização das neoplasias era no terço superior num 1 doente, em 11 no terço médio e 11 no terço inferior. Vinte e um casos eram espinocelulares. Todos dos doentes foram operados (Ivor Lewis). Nove doentes fizeram QT neoadjuvante (5 neoadjuvante e pós-operatória) e 3 QT pós-operatória. A sobrevivência mediana foi de 27 meses (mínimo 1 e máximo 45 meses). Os falecimentos (n=4) ocorreram na sua maioria no grupo tratado apenas com cirurgia.
CONCLUSÕES No nosso meio a resseção cirúrgica dos tumores localmente avançados do esófago, sempre que possível, deve ser realizada e associada à quimioterapia neoadjuvante. Nos doentes sem condições para quimioterapia mas com tumores ressecáveis devem ser operados associando-se, posteriormente e após a recuperação nutricional, quimioterapia pós-operatória.

OBJECTIVO O aumento da esperança média de vida e a adoção de comportamentos de risco, associam-se a um incremento das doenças oncológicas em África. O cancro da mama (CM) constitui uma das maiores ameaças e tem um elevado rácio mortalidade/incidência neste continente. Com este estudo, pretende-se conhecer as características clínicas de doentes com CM, tratadas no Hospital Central de Maputo (HCM), Moçambique e auditar a qualidade dos dados clínicos.
MÉTODOS Entre fevereiro de 2014 e março de 2019, os dados demográficos e clínicos de 219 casos de CM diagnosticados no HCM e a taxa da informação clínica disponível, foram estudados. Todos os casos foram confirmados histológicamente.
RESULTADOS Dos casos estudados, 96.8% eram de raça negra (3.2% omissos) e maioritariamente naturais de Maputo. Relativamente ao género, 94.5% dos indivíduos correspondiam ao género feminino (n=207), e cerca de 1.8% eram do género masculino (n=4) (3.7% omissos). A idade mediana foi de 49 anos (mínimo: 18; máximo: 92; 0.5% omissos). A informação clínica refere a doença localmente avançada em 80 % dos doentes. Dos casos com informação precisa relativa ao estadiamento TNM, 11.9% apresentam tumores T4 (71.7% omissos), 14.2% N1 (77.2% omissos) e 11.0% M0 (88.1% omissos). A mastectomia radical modificada foi o tratamento cirúrgico mais realizado (71.2%) e 71 casos foram submetidos a quimioterapia (na sua maioria neoadjuvante, havia 67.6% de omissos). Não havia referencia a tratamentos de radioterapia. À data da análise dos dados, não foi reportado qualquer óbito.
CONCLUSÕES Neste estudo foi possível concluir que, em Maputo (Moçambique), o diagnóstico de CM é feito em idades consideravelmente jovens e já em estádio avançado. A cirurgia e a quimioterapia (na sua maioria neoadjuvante) são as terapêuticas oferecidas. Estes dados revelam a urgência em adotar estratégias de diagnóstico precoce do CM. É fundamental incluir a radioterapia no tratamento destes doentes e melhorar a qualidade do registo clínico.

OBJECTIVO Atualmente, o cancro da mama (CM) é encarado como um dos mais frequentes tipos de cancro a nível mundial e as terapêuticas atuais aumentaram a sobrevivência. No continente africano, contudo, as taxas de incidência desta neoplasia são consideravelmente baixas, apesar de se destacar como uma das regiões mundiais com as mais elevadas taxas de mortalidade reportadas, devido, sobretudo, a um diagnóstico tardio e terapêuticas menos eficazes. Este estudo foi realizado com o objetivo de clarificar os padrões moleculares do CM em Luanda, Angola, pretendendo contribuir para o desenvolvimento de novas abordagens de diagnóstico e de terapêutica neste país.
MÉTODOS Foram estudados cuidadosamente os relatórios anatomopatológicos e imunohistoquímicos (IHQ) (recetor de estrogénio, RE; recetor de progesterona, RP; recetor de tirosina cinase HER2, HER2 e marcador de proliferação celular Ki-67) de 219 casos consecutivos de CM invasivos microscopicamente confirmados entre janeiro de 2011 e dezembro de 2018 e provenientes do Instituto Angolano Contra o Cancro e a Clínica Sagrada Esperança em Luanda, Angola.
RESULTADOS Dos 219 casos incluídos no presente estudo, 99.1% (n=217) eram do género feminino e 0.9% (n=2) do género masculino, com uma idade mínima de 24 anos e máxima de 94. Maioritariamente eram carcinomas NST (91,4% ) e grau 2 (57.5%; n=126). Relativamente às características moleculares (com base na IHQ dos tumores analisados), 23.7% eram do subtipo Luminal A; 25.1% e 7.3% apresentavam características do subtipo Luminal B HER2 negativo e HER2 positivo, respetivamente; 14.2% eram HER2 positivo e 29.7% do subtipo Triplo Negativos (TN).
CONCLUSÕES Nesta amostra de Angola os tumores hormono-sensíveis são os mais frequentes, os subtipos moleculares mais incidentes são os subtipos Luminal B HER2 negativo e TN. A taxa de tumores HER2 é de 21,5%. O correto diagnóstico por IHQ poderá melhorar o prognóstico do CM, caso a terapêutica adequada estiver disponível para o tratamento.

OBJECTIVO As neoplasias malignas estão a aumentar em Moçambique. Os registos oncológicos de base populacional de Maputo e o da Beira referem que a taxa de incidência bruta para o cancro colorectal (CCR) é de 1.9/100000 e 0.9/100000 habitantes, para ambos os géneros, respectivamente. Segundo o Globocan (2018) esta é de 1.8/100.000 habitantes correspondendo a cerca de 560 novos doentes por ano em Moçambique. Pretendemos perceber qual é o perfil dos doentes com CCR tratados Hospital Central de Maputo (HCM).
MÉTODOS Com base nos registos do Departamento de Cirurgia do HCM de janeiro de 2014 a dezembro de 2016 foram admitidos e tratados 22 doentes com cancro colorectal. Os dados demográficos e clínicos foram estudados.
RESULTADOS Os CCR maioritariamente são provenientes da região de Maputo (59,1%), 9 eram mulheres e 13 homens, a idade mediana foi de 47 anos (mínimo: 24; máximo: 83 anos). O adenocarcinoma foi o tipo histológico mais frequente (86,4%), destes 6 doentes tinham idade inferior a 50 anos. O tumor era localizado ao recto em 68,1% dos casos. A doença no momento de diagnóstico era avançada em 88,1% dos casos. O tratamento cirúrgico na maior parte dos casos foi paliativo (77,3%), foi realizado a resseção do tumor em 7 (31,7%) doentes (um curativo), apenas 18,2% foram submetidos a quimioterapia (5FU e irinotecano, 5FU e cisplatina ou o esquema Mayo Clinic). Dois anos após o diagnóstico apenas 6 (27,3%) doentes estavam vivos e apenas um sem doença.
CONCLUSÕES O CCR no HCM é diagnosticado tardiamente conferindo um prognóstico sombrio. São necessárias ações de diagnóstico precoce, é importante avaliar o risco de cancro familiar nos doentes jovens, caracterizar molecularmente estes tumores, introduzir a radioterapia no tratamento do cancro do recto e optimizar o tratamento sistémico.

OBJECTIVE Standard of care (SoC) is the level of care a reasonably competent skilled health care professional is expected to deliver. Given that there is no institutionalized SoC guideline for the management of common malignancies in Nigeria and the current practice is sub optimal, we developed a SoC guideline at University of Nigeria Teaching Hospital Enugu for breast cancer with the involvement of key opinion leaders, stakeholders and end users of the guideline using evidenced based practices from the developed world. Due to the limited resources in our environment, the developed guideline was adapted to be culturally acceptable, feasible and easily adhered to. The objective of this study is to assess the adoption of the guidelines in clinical practice by healthcare providers.
METHODS We conducted a pilot qualitative survey to assess the perception, feasibility and the consistent use of the designed standard of care guideline. Informal one on one discussion was conducted with clinical oncologist, surgical oncologist, palliative care physician and physiotherapist practicing directly impacted by this evidenced based interventional tool. We used inductive approach to analyse responses. We then transcribed, analysed and coded the data retrieved to better describe responses.
RESULTS Most common responses noted were difficulty in changing old habits, limited time, need for reminders, no training in its use, difficulty in getting informed consent, poor referral system, poor collaboration amongst healthcare workers, poor communication with patients and the use of guidelines not being part of our training from medical school.
CONCLUSIONS Healthcare workers continue to offer suboptimal care despite the provision of SoC guidelines. This study overstates the need of multi-level implementation strategy particularly in LMIC to guide the use of evidence-based practices with the goal of improving quality of care.

OBJECTIVES To determine the chronic illness, cancer burden and PC need amongst refugees in Adjumani District as part of a wider situational analysis using Rapid Participatory Appraisal. Palliative care (PC) is an essential component of healthcare provision in humanitarian settings and WHO and SPHERE Guidelines indicate the need for evidence and integration. Uganda hosts the largest refugee population in Africa, with Adjumani District home to 250,000 refugees, mostly South Sudanese, in 18 settlements. The host population is 250,000. Little is known about the PC and cancer needs of this refugee population.
METHODS 75 Village Health Teams (VHTs), supported by health centres with PC trained Health Care Workers, received a 3-day training in PC. 24 trained VHTs, from 11 refugee settlements, then supported a household survey identifying 331 potential individuals with PC need. After screening, consent was sought from individuals (> 17) or parents (> 8), with assent from children >10 years. Structured interviews were conducted with 110 individuals (96 adults, 14 children) including the APCA-POS (or C-POS), POS-S, ECOG and socio-demographic variables.
RESULTS 29% of potential participants were not available to survey; many had travelled outside the district. Musculoskeletal conditions 38% were most prevalent, then organ failure 22%, HIV 19%, neurological conditions 13% and cancer 9%. 89% had lived with their condition > 1 year. There was significant symptom burden; median number of symptoms 5, 67% reporting pain scores 4-5/5. Only 7% had access to oral morphine and 14% received PC. Median total APCA-POS score was 18 out of 35; reflecting unmet holistic PC needs. Social demographics revealed huge challenges including access to running water, sufficient food and paid employment.
CONCLUSIONS There is a significant burden of chronic disease, cancer and unmet PC care need amongst refugees in Adjumani district. Cancer burden may be underestimated as due to referral outwith the settlements for treatment. Chronic pain needs further review as it may be linked to complex trauma. VHTs as community representatives are key in identifying those in need and supporting referrals and in addressing issues such as stigma and poor health education. Stakeholder engagement and a health systems strengthening approach is needed to ensure the implementation of PC through government led multi-sectoral planning. Uganda is a leader in palliative care, cancer tratemnet and refugee welfare and may now be able to implemnet integrated interventions to the over 1 million refugee population and offer leadership to other settings.

BACKGROUND Hepatocellular carcinoma (HCC) is a leading cause of morbidity and mortality in Uganda. A previous qualitative study showed the multidimensional needs. It was important to ascertain these needs and the patient outcomes. This study aims to determine the PC needs and outcomes of patients with HCC at Uganda Cancer Institute (UCI) and Mulago National Referral Hospital (MNRH).
METHODS A longitudinal, quantitative, descriptive study was conducted from eligible in patients using convenience sampling who had a clinical diagnosis of HCC and were aged >18. A structured questionnaire using validated tools was administered by face to face interview at baseline then by telephone follow up at 1, 2 and 3 months. This tool includes socio-demographic and disease information, APCA POS and symptom assessment. Ethics approval was granted.
RESULTS All results will be complete by August 2019 with compete results from the baseline available now. 50 participants have been recruited show 74% male of whom with 70% <45yrs. 80% had 3 moderate to severe pain with only 48% accessing morphine and 30% accessing a specialist in PC. Abdominal fullness was the main other symptom reported in 50%. Degree of insight into the illness was 10% ‘full’, 60% ‘some’ and 30% ‘none’. 68% of patients expected a cure while 30% felt hopeless. 42% reported insufficient spiritual support. Follow up data collection is ongoing and shows high attrition rates (>60% at 1 month) mainly due to high mortality.
CONCLUSIONS The majority of patients are young men presenting with late stage disease. This represents a huge shock and then significant challenges for planning and income for the whole family. The late presentations indicated the need for strong public education about prevention and early identification of HCC including availability of Hep B vaccination. There are significant unmet needs including pain which require further strengthening of PC within the medical and oncology services. Heightened existential distress and lack of clear information or goal setting may contribute to unmet spiritual needs. Excellent communication and clear referral pathways are needed to ensure early PC and multidisciplinary support.

OBJECTIVE In 2015, the sustainable development goals were adopted with Goal 3 specifically aimed at combatting non-communicable diseases (NCDs) globally.1 The burden of increasing incidence and mortality from cancer weighs heavily on low and middle-income countries where resources are least available to deal with this expanding crisis.4,5 On August 22nd 2018, the first National Cancer Policy in the history of Liberia was validated. The journey to completion of the policy and subsequent validation began in 2013; this abstract depicts the pre-planning activities taken from 2013 to 2017 to achieve this historic step.
METHODS Specifically, the pre-planning activities focused on assessing work force capacity, policy, and infrastructure in the cancer care continuum: prevention, screening, diagnosis, treatment and palliation. Further, the National Cancer Committee was formed which identified a radiation safety committee, reactivated the cancer registry and began to draft the National Cancer Control Policy. Pilot programs for both HPV vaccine and cervical cancer screening began.
RESULTS No policy regarding the cancer continuum existed. The assessment showed that prevention was limited in workforce capacity and infrastructure; screenings were limited to pilot programs with limited workforce capacity. Diagnosis was present with one fine needle aspiration lab in the country, headed by an expatriate doctor with limited workforce capacity and non-evidence-based treatment existed with extremely limited workforce and very little infrastructure. Palliation was offered informally with no narcotics available.
CONCLUSIONS Development and implementation of cancer programs in LMICs is a complex undertaking that should be guided by the countries’ available resources and infrastructure. Knowing the cancer burden and defining and monitoring are key outputs of a cancer registry that can guide public health efforts in management of cancer. Input from the International Atomic Energy Agent was vital in setting realistic goals proposed through their integrated mission of Program Action for Cancer Therapy (imPACT).

OBJECTIVE Radiation-induced xerostomia is the most common complication of head and neck radiotherapy. A non-invasive and accurate assessment of parotid changes is needed to provide a better understanding of the cause and severity of xerostomia. This study’s purpose is to provide evidence supporting the use of ultrasound imaging in assessment of radiation-induced early and late parotid toxicity associated with head and neck radiotherapy.
METHODS In this prospective imaging study, we enrolled seven patients receiving intensity-modulated radiotherapy for cancers of the head and neck. Ultrasound images and toxicity surveys were obtained prior to treatment and during early and late follow-up. The prescription dose ranged from 60 to 70 Gy and the median dose to the parotid gland was 25 Gy. Patient-reported toxicity surveys were administered, and the bilateral parotid glands were scanned longitudinally during each follow-up visit. These ultrasound images were qualitatively assessed by two observers and were then interrogated for a relationship with patient-reported toxicity scores over time.
RESULTS Patient-reported toxicity increased significantly following treatment, with changes observed in xerostomia, saliva viscosity, and summative composite score demonstrating statistical significance (p < 0.05). Parotid glands showed homogeneous echotexture at baseline in all patients. Radiographic evaluation of pre- and post-treatment images detected differences in pre- and post-treatment parotid glands (p < 0.01) occurring in parallel with increases in patient-reported toxicity.
CONCLUSIONS This preliminary longitudinal study identifies qualitative ultrasound features that may be used to assess radiation-induced parotid damage following radiation therapy. The morphological changes observed follow the trajectory of patient-reported xerostomia and other toxicity domains related to parotid function. Ultrasound imaging could be used to provide early and accurate assessment of parotid damage for better management of head and neck radiotherapy toxicity and possibly facilitate adaptive treatment planning.

OBJECTIVES Cervical cancer is the leading cause of cancer mortality in Low- and Middle-Income Countries (LMIC). Interstitial needles (IN) improve outcomes but the resources required has impeded uptake in endemic regions. We conducted a retrospective review of the utilisation of IN in the management of cervical cancer and simulated 2D standard Manchester loaded (ML) plans to explore the magnitude of benefit that interstitial needles provide
METHODS 72 brachytherapy plans of 18 patients who had undergone treatment with utilization of IN were reviewed. ML plans prescribed to point A were generated to represent a 2D scenario, but the known HR-CTV was taken into consideration and its dosimetric outcomes were compared to those of the 3D based plans
RESULTS The median tumour volume was 23 cm3. IN was used in 82 % of the insertions. The median number of IN was 2 (range 0 – 6) with median percentage of IN dwell time 6.6 % (range 0.68 – 38.5). V100 was excellent 98.2% for ML 97.3% for 3D IN and 98.7% for 3D non-IN plans. The median HRCTV D90 was 8.5 Gy/fraction (cumulative EQD210 101.4 Gy) for ML plans and 8.0 Gy/fraction (cumulative EQD210 91.4 Gy) for 3D plans. The ML plans failed to meet the OAR goals except for the rectum. The median bladder, sigmoid and small bowel doses were 24% above the recommended constraint in the individual plans and 15% cumulative EQD2. A statistically significant relationship was found between the needles utilised, tumour volume (p < 0.001) and coverage (p = 0.006) but not delivered dose (p < 0.068).
CONCLUSION 2D brachytherapy can provide adequate dose coverage for most tumours but IN provide therapeutic ratio benefit. This justifies investment in resources for uptake of interstitial needles to increase access to optimal treatment of cervical cancer for women in LMIC.

OBJECTIVE Data regarding breast cancer (BC) presentation, treatment, and prognosis is still scarce among women living with HIV (HIV+) in developing countries.
METHODS This prospective cohort included BC patients diagnosed at the Maputo Central Hospital, Mozambique, from Jan-2015 to Mar-2017. Data on demographics, co-morbidities, treatment, and survival were prospectively collected. Chi2 and t tests were used to compare categorical and continuous variables, respectively. Time-to-event outcomes were estimated using Kaplan-Meier methods. Survival estimates were compared using log-rank test and Cox proportional hazards models. All tests were two-tailed and results were considered significant if p-value was <.05.
RESULTS Among 205 pts included, 52 (25%) were HIV+. HIV+ patients were younger than HIV- patients (median age: 44.5 vs 51.0 years respectively, p=.002), and most had stage III/IV BC (81% vs 71%, p=.204). Among HIV+ patients, 90% had a CD4+ cells count >200/μL. HIV+ had a higher proportion of triple-negative BC (TNBC) compared to HIV- patients (37.5% vs 20.5%, p=.029). Among pts with early BC (EBC), HIV+ tended to receive a lower chemotherapy (CT) dose-intensity (DI) compared to HIV- patients (DI<85%: 69.4% vs 50.0%, p=.057). Median overall survival (OS) was 31.0 months in HIV+ and 34.0 months in HIV- pts (unadjusted hazard ratio [HR] 1.52, 95% confidence interval [CI] 0.92-2.51). In EBC pts, median disease-free survival was 27.0 months in HIV+ and 31.0 months in HIV- pts (HR 1.37, 95%CI 0.81-2.31).
CONCLUSIONS Our results show that in Mozambique the proportion of HIV+ women among BC patients is very high. They were diagnosed at a younger age and had a significantly higher proportion of TNBC compared to HIV- patients. Their survival was worse as compared to HIV- patients, although not statistically different. This highlights the need for better understanding BC biology in HIV+ patients and to provide effective cancer care to this underserved population.

INTRODUCTION Cancer is a public health problem in Mozambique, according to WHO-Globocan 2018, Mozambique has an incidence of 25,631 new cases per year of cancer patients and a high mortality rate, due to the lack of infrastructure and resources for the cancer treatment. Radiotherapy is a treatment whose cost - benefit is the best compared to other therapies in cancer control. The IAEA considers cancer control in Africa a priority, supporting the opening of new radiotherapy centres, guaranteeing the establishment and installation of new treatment units and the guarantee of sustainability in countries with scarce resources. In 2006, Mozambique became a member of the IAEA, and then the Ministry of Health of Mozambique jointly with IAEA signed the Project MOZ6003, whose main objective was to establish the first radiotherapy service in country.
OBJECTIVE To describe, step by step, the implementation of the first Radiotherapy Service in Mozambique with LINAC.
MATERIAL AND METHODS Descriptive analysis of the Project MOZ6003, in view of the programs implemented and the step-by-step establishment of the first radiotherapy service.
CONCLUSION The project MOZ6003 for the establishment of the first Radiotherapy Service in Mozambique involved the creation of internal regulatory bodies, training of personnel, infrastructure works and quality control, carried out in approximately 5 years, with the optimization of local resources and the support of the IAEA. The project MOZ6003 is applicable, cost-effective and recommended in the context of developing countries in which the radiotherapy service is not available.

OBJECTIVE This study seeks to determine whether a clear understanding of the costs and potential benefits of Prostate Cancer (CaP) screening in sub-Sahara Africa (SSA) will contribute to the development of evidence-based policies to reduce disparities and improve access to timely CaP screening and treatment policies for SSA. Study aims include: 1) identifying SSA’s current CaP screening practices; 2) understanding how SSA’s health systems and costs affect CaP screening and treatment services; 3) identifying factors and potential solutions for consideration in designing CaP screening programs in SSA.
METHODS A mixed method approach was used to collect data from key informants and secondary sources. Purposive sampling was used to recruit participants comprising of policy makers and clinicians providing CaP screening, diagnosis and treatment services in 12 SSA countries. Secondary data will be obtained from literature, databases and health facilities in participating countries.
RESULTS Preliminary analysis indicates 60% of participating countries have national guidelines for CaP screening and over 90% of the screening is performed by general practitioners and urologists. PSA tests (100%) and digital rectal exams (DRE) 80% are the most common screening methods. Men ages of 55-65 years comprise majority (95%) of those screened. Diagnostic procedures include prostate biopsies and DRE in over 80% of cases with a smaller (73%) use of transrectal ultrasonography.
Screening costs range from 0$ to 40 US$. Surgical treatments cost between 465 US$ and 22,000 US$. Majority (48 %) of the payments are made out-of-pocket followed by public (26%) and private insurance (10%). Culturally relevant community-based education on CaP and evidence-based policies were reported among factors for consideration when developing national CaP screening guidelines.
CONCLUSION Preliminary results indicate variations in screening practices and costs across and within the participating SSA countries. Resource-appropriate CaP screening and treatment guidelines could reduce disparities in CaP practices in SSA.

OBJECTIVE To develop and pilot test an educational program involving men to enhance cervical cancer screening.
METHOD An intervention design was used. The primary outcome was presenting for cervical cancer screening and the secondary outcome knowledge. Knowledge was assessed using an one-group post-test approach. One hundred and twenty (n=120) men, 18 years and older, living in a semi-rural community, attended the educational program; referral notes were handed to all. A telephone survey was conducted two months after attending the program to assess participants’ knowledge; 20 (n=20) were lost to follow up. Pap smears were available to women at a primary health clinic on specific days for three months; interviews were also conducted.
RESULTS Only 30 women, primarily between the ages 30 and 39 years (56.7%; n = 17), presented for screening, 60% (n=18) indicated they were “sent by their husbands.” Most (56.7%; n=17) had not been screened before; the main reason not being aware of the Pap smear (30%; n=9). The men were primarily younger than 40 (48.3%; n =58) and from the Zulu cultural group (27.5%; n = 33). Most (82.5%; n = 99) agreed that cervical cancer can be prevented whilst 75.8% (n=91) agreed that women could be checked for the disease at a local primary health clinic. Only 55% (n=66) indicated they had informed their female partners or family members about cervical cancer. Various reasons were mentioned why these conversations did not take place of which cultural taboos were the most common (50%; n=17).
CONCLUSION The study had mixed results. Although the men’s knowledge of cervical cancer improved compared to a pre-intervention survey conducted in the same setting, the small percentage of men who informed their female partners and family members, as well as the small number of women who presented for screening, were disappointing. This questions the success of the educational intervention. Cultural taboos and ways to overcome this barrier should be investigated before refining the educational intervention.

OBJECTIVE The diagnosis between Burkitt lymphoma (BL) and High-grade B-cell lymphoma (HGBCL) is very difficult or impossible based on conventional morphological study. In the current WHO classification, very restrictive criteria are established based on molecular techniques such as FISH that are not universally available.
METHODS A total of 10 lymphomas with morphology similar to Burkitt are studied. In all cases, a complete immunohistochemical study was carried out (CD10, CD20, CD3, BCL6, BCL2, Ki67). All cases are studied for Epstein-Bar virus by EBER. In all cases, the MYC translocation is studied using FISH. In positive cases, the study is completed by BCL2 and BCL6 by FISH method.
RESULTS Based on the immunohistochemistry and FISH studies, 7 of the lymphomas studied corresponded to BL and 3 to HGBCL (double hit). After the reevaluation by two expert pathologists of the cases studied, small morphological differences are identified that may help to suspect high grade lymphoma. However, they are difficult to standardize since they lend themselves to subjective evaluation.
CONCLUSIONS Given that BL has a good response to intensive treatments, it is advisable to confirm the diagnosis with FISH studies if there is an adequate therapeutic option.

BACKGROUND Cancer diseases are among the leading causes of morbidity and mortality worldwide, with 20 million new cases of cancer predicted by with 80% of the burden falling on low and middle-income countries (LMICs). Population-based cancer registries are the best option to measure and understand the cancer burden in the country. Only 1 in 5 LMICs have functional cancer registries either hospital based, or population based. Only less than 10% of the population in East Africa was covered by population-based cancer registries (PBCR) at the start of the initiative in 2017.
OBJECTIVE The aim of the initiative was to strengthen capacity for collecting, analyzing and sharing data on cancers in the five East Africa member states
METHODOLOGY The program organized and facilitated basic training on cancer registration for the cancer registrars in Burundi, Kenya, Rwanda and Uganda after providing the essential elements to facilitate cancer registration. Countries were also provided with the tools and facilitated for retrospective data collection, entry and analysis using CanReg5 software. An advanced training on data analysis was also carried out. Exchange visits were supported to build further the capacities and increase data quality.
RESULTS A total of 82 cancer registrars have been trained on basic and advanced cancer registration and statistical analysis (Burundi-21, Kenya 26, Rwanda-24, Tanzania-3, and Uganda -18). Five population-based registries were established in Burundi (Bujumbura PCBR, 0.5 million); Rwanda (Kigali PBCR, 1.13 million), Tanzania (Dar es Salaam PBCR, 1.7), and Uganda (Mayuge, PCBR, 2.3 million) people. Kenya established a National Cancer registry covering the cancer statistics from the already established population-based registries in Nairobi and Eldoret; and eight Cancer treatment centers in the country. Breast and cervical cancer were the most registered cancers in females while prostrate and esophageal cancers topped the list for males.
CONCLUSION Capacity building and regional knowledge exchange under the initiative were instrumental in the establishing population-based cancer registries and enhancing expansion of the population covered by PBCR in the region.

OBJECTIVE The outcome of paediatric Burkitt’s Lymphoma is better in developed countries. Limited data on survival of Burkitt’s Lymphoma is available in Africa. This study aims to address the gap.
METHODS A retrospective observational study using medical records including all patients under the age of 15 years diagnosed with Non-Hodgkin’s lymphoma (NHL) at AMPATH/Moi Teaching and Referral Hospital (MTRH) between January 2016 and June 2018. Data on socio-demographic and clinical information as well as treatment outcomes was abstracted using structured questionnaires. Demographic variables and chief complaints were analysed descriptively. The Kaplan-Meier method was used to estimate overall survival.
RESULTS A total of 70 patients were enrolled. Of these, 77.1% (54) had Burkitt's Lymphoma. The Burkitt’s patients were predominantly male (61.1%) with advanced disease (stage III, IV; 76%). Majority (75.9%) were HIV negative. The commonest lesion site was the abdomen (38.9%) followed by the jaw (29.6%).There was no association between late stage presentation and age or gender. Overall, 23 patients died, 16 of them Burkitt’s subtype. During a median follow up of 7.3months, Kaplan-Meier 1-year overall survival rate was 59.7% for Burkitt’s subtype. Only early stage (I&II) presentation tended to have a positive correlation with overall survival.
CONCLUSION Patients at AMPATH/MTRH treated for Burkitt’s Lymphoma were affected at a young age with male predominance, late stage presentation, abdominal and jaw masses and majority were HIV negative. Since early stage presentation is a positive indicator of better outcome, it is imperative to enhance early diagnosis through creation of community awareness of symptoms and training of health care providers on lymphoma care.

OBJECTIVES
1. To highlight the difficulties in rural oncologic healthcare including cost implications for patients and oncology programs.
2. To highlight the advantages on the use of Telemedicine in improving oncologic healthcare.
3. To highlight the cost analysis and show the advantages of setting up a telemedicine centre towards bridging the gaps in between rural and urban oncologic healthcare.
METHODS
1. Analysis on travel to clinic appointments vs wages of patients with burden.
2. Analysis of Distance of rural clinic to urban clinic in Eldoret, Kenya, vs time travel to the clinics.
3. Analysis of cost operations vs cost personnel (Oncologist)
4. Costs for the operations budget for the seventeen rural outreach clinics include the costs of hardware, solar networking setup, and internet
5. Analysis of cost of setting up a telemedicine centre vs the maintenance cost vs sustainability comparisons.
RESULTS Estimated costs for the operations budget for the seventeen rural outreach clinics include the costs of hardware, solar networking setup, and internet at a total $3,400/week. This will decrease after the first year to $1,700 for maintenance costs of equipment. Personnel consists of 1 local person to support the system and will be a weekly cost of $1,870. Lost time for physicians due to road travel totals ~100 hours weekly. Estimated salaries for an oncologist at $30/hour leads to a cost of $3,007/week in lost productivity. It should be noted that lodging and per diem expenses are not included in the estimated expenses that total $6,114/week. Shown in the chart below is the savings that will occur by doing telemedicine at the rural clinics in an ideal 48 workable week situation. The savings of $528k is a clear evidence that this is financially feasible solely based on travel savings over 5 years. For numerous reasons, it is expected that telemedicine would only be used every other week at the clinics. For this reason, the actual savings is around $264k and still makes a strong argument for this being the right move.
CONCLUSION In conclusion, telemedicine is a viable and necessary resource for developing oncologic care in rural Kenya. Telemedicine helps maximize the limited physician resources and allows them to reach a larger audience without tying up their time in lengthy commutes. Last, telemedicine should assist patients to overcome the barriers of cost and time that limit their treatment.

OBJECTIVES Empower community health workers and volunteers through a community led-community owned program, with knowledge and skills to enable them navigate patients with palliative care needs who transition to home care at community level.
METHODS Kiambu Cancer Support Group identified a gap in care and follow-up of palliative care patients at community level and designed a participatory empowerment project to train existing community health volunteers to be patients navigators at community level. Connecting patients who are discharged from hospitals to community resources. The project used a participatory approach involving nurses from health facilities and community health volunteers as well as members of the support group. A training module was developed focusing on the needs of patients after discharge from hospital and how they can be navigated to access resources at community level. This include connecting them to support groups. The training module was incorporated into existing palliative care training curriculum for community health workers.
RESULTS 25 community health volunteers were trained in a two-day training using a variety of teaching methods with emphasis on experiential sharing though group work. The participants were allocated their home village area as the geographical location of their work to seek out patients needing community support and navigate them. All participants reported that this is a timely program.
CONCLUSIONS Patient navigation should not stop at the hospital level. There should be a seamless navigation process to link patients with community resources. Community health volunteers are the best suited to play the role of patient navigators at community level.

INTRODUCTION Female ovarian growing teratoma syndrome is a rare clinical entity seen in young women during or after chemotherapy for malignant ovarian germ cell tumours. Due to the limited absolute comprehension of its pathophysiology, the phenomenon has undergone a metamorphosis in its definition and diagnostic criteria. In low resource setting, it presents a diagnostic challenge due to limited access to advanced investigations such as immunohistochemistry and positron emission tomography. Though benign, it is rapidly growing with propensity to mortality if not resected in good time and can be confused with a metastatic recurrence resulting in unnecessary chemotherapy and/or radiotherapy to which it exhibits limited response to. It is therefore imperative to have the correct diagnosis in order to implement timely management.
CASE PRESENTATION We present a case of a 26-year-old who presented with an increasing abdominal mass following completion of chemotherapy for an ovarian endodermal sinus tumour. The patient's tumour markers (alpha feto-protein and beta human chorionic gonadotropin) had significantly reduced following her first surgery and remained undetectably low during chemotherapy and in the seven months of follow-up. Intra-operatively, the mass originated from her remaining ovary, completely obliterating it and encroaching into the uterus with mass effect on the bladder, rectum and sigmoid colon. Complete surgical resection of the mass was done and thorough exploration for additional masses. Biopsy of the resected mass revealed a mucinous cystadenoma.
DISCUSSION Based on Logothetis criteria, growing teratoma syndrome is diagnosed following discovery of new masses following appropriate chemotherapy for nondysgerminomatous germ cell tumours, normalizing serum tumour markers and mature teratoma in the resected specimen. Surgical management is the only option if carried out before the tumour becomes extensive and therefore inoperable. In this case, the resected mass was benign but not a mature teratoma begging the question of whether this was an incidental finding or requires exploration as a potential for the phenomenon that is the growing teratoma syndrome (GTS). Literature review shows cases of benign growths following appropriate management of germ cell tumours thus there's a possibility that GTS should not be limited only to mature teratoma.
CONCLUSION There is need to explore GTS to include other benign components in the resected tissues and this could mean changing the name of the phenomenon as well.

OBJECTIVE The Low-cost Universal Cervical Cancer Instructional Apparatus (LUCIA) is a low-cost simulation model that provides hands-on training in cervical cancer prevention, including Visual Inspection with Acetic Acid (VIA), Pap and HPV sample collection, colposcopy, endocervical curettage (ECC), cervical biopsy, cryotherapy, and Loop Electrosurgical Excision Procedure (LEEP). Training is accomplished using different 3D-printed and gel cervical models. Our goal was to improve the LUCIA model to make training more realistic and increase its robustness for travel and repetitive use.
METHODS The 3D-printed cervical models were improved by adding more realistic details using the skills of professional Malawian artists. These details included adding a squamocolumnar junction, more realistic vessels on vascular models, more notable changes on the cancer models, and developing two new models simulating benign polyps. The pelvic model was redesigned by introducing detachable components for easy assembly, travel, and storage. A new cervical model holder was also developed so one single holder could be used for all cervical models (3D-printed and gel models). The new design includes a large earthing contact to effectively ground the gel models used during LEEP training. Cervical model placement within the vaginal canal is now better controlled using an adjustable rod.
RESULTS LUCIA has continued to be used in cervical cancer prevention education courses globally. Courses were held in the United States (Austin, Texas; Brownsville, Texas; Houston, Texas), Port of Spain, Trinidad and Maputo, Mozambique. User feedback was collected, with an average score of 4.2/5 on usefulness, 4.4/5 for skill improvement, and 4.2/5 for ability to easily self-evaluate, similar to previous evaluations.
CONCLUSION Currently 50 kits are being mass produced at the Polytechnic Malawi, which will be distributed globally to generate further feedback for continued improvement. With proper coordination between gynaecologists and design engineers, LUCIA can continue to provide important training in cervical cancer prevention at low-cost.

OBJECTIVES
1. To describe the different medical record systems used for care provision to patients with cervical and breast cancer in public health facilities in Busia and Trans-Nzoia Counties.
2. To describe the determinants of choice of health record system for the facilities.
METHODS A cross sectional survey was conducted in all the 74 facilities included in the NCD Pilot Project (PIC4C). An interviewer administered questionnaire was administered to facility and health records managers. The questionnaire included fields for direct observation by the research assistants on use/availability of patient files, patient books, Ministry of Health (MOH) daily registers, pieces of paper and electronic medical records system (EMR) as sources of screening and treatment data for Breast and cervical cancer. Data was entered into a redcap database and analyzed using SAS.
RESULTS Four types of data formats were identified; EMR, file-based records, patient books and pieces of paper. 16% of facilities used an EMR, 91% used patient books, 1% used pieces of paper and 93% used MOH daily registers. Facilities chose what to use depending on partner support, level of facility, support infrastructure and patient load.
CONCLUSION The use of electronic records system (EMR) for Breast and Cervical cancer care provision in the two counties is very low and will need improvement to increase efficiency in management of patient data and reporting. The PIC4C project plans to train health care providers in all levels of care on the use of a standardized EMR in the collection of screening and treatment data for breast and cervical cancer to improve facility and national level reporting and linkage, and to inform policy makers in decision making. AMPATH has an EMR that has been used since HIV care inception which has over 200,000 patients under care. We aim to work with the counties to institute this model of care. The NCD Pilot project (PIC4C) is a world bank funded grant.

OBJECTIVE Of the 200,000 children diagnosed with cancer worldwide each year, 80% live in low-and middle-income countries (LMIC) of which 20% or less survive. One of the leading causes of pediatric cancer mortality is infection and sepsis. This project examines and documents the way that an interdisciplinary team in engineering, public health, and medicine collaborated to tackle developing technological solutions to this global health challenge.
METHODS Design problem-solving theory was used as the theoretical framework. A thorough literature review, brainstorming sessions with diverse users, consensus-building exercises, and interviews with multidisciplinary pediatric oncology experts (clinicians, nurses, nutritionists, psychosocial providers, administrators) were conducted. Design process balanced trade-offs throughout the project to achieve highest impact for the most striking need.
RESULTS Three phases in the process were implemented: investigate (problem exploration, identification, definition), ideate (concept selection, design specification), and create (prototyping, testing, feedback). The final solution -- a wearable vital monitor that measures heart rate, respiratory rate, and body temperature -- was chosen and refined through several iterations of feasibility analysis and was presented with quantifiable design specifications and preliminary data on prototype accuracy. Feedback from all team members was continuous to ensure viability and applicability, and increase buy-in.
CONCLUSIONS Collaboration within medical and engineering disciplines is essential in designing devices to address global health issues. This device holds potential to improve the quality and treatment of pediatric cancer care in LMIC by providing technologically independent and affordable vital monitoring. Next steps include refinement and piloting the device, and continuation of the partnership.

OBJECTIVE Cancer treatment guidelines are important for improving survival outcomes, by promoting high-quality care delivery that minimizes treatment variation. The “WHO Choosing Interventions that are Cost-Effective” team assessed that systemic treatment for breast cancer in Sub Saharan Africa (SSA) is cost effective. Subsequently, rigorous resource-stratified guidelines have been developed, but there is a critical lack of real-world data on the adoption of these guidelines. We aim to identify provider barriers to and facilitators of breast cancer guideline adherence at Princess Marina Hospital (PMH) in Botswana.
METHODS We will use a modified Consolidated Framework for Implementation Research (CFIR) qualitative interview guide to conduct semi-structured interviews with 30 oncology healthcare providers at PMH. The final number of study participants depend on thematic saturation. All interviews will be recorded, transcribed and uploaded in NVivo for analysis. An integrated analysis approach will be used using a combination of a priori codes informed by the CFIR construct and emerging themes. Interviews will be completed and analysed for presentation at AORTIC.
RESULTS We will identify actionable targets, using the CFIR model, for improving implementation effectiveness of resource-stratified guidelines. For example, we may find barriers related to 1) care delivery characteristics (e.g. complexity of the guidelines) or 2)outer setting (e.g. factors related to limited social support for patients or inadequate patient coping strategies).
CONCLUSIONS The study will provide a systematic approach for continuous evaluation and monitoring of resource-stratified treatment guideline adherence using a well-established implementation science approach that can be scaled up and replicated in other countries in SSA. Ultimately the results will inform actionable targets for interventions to maximize adherence and implementation effectiveness of treatment guidelines. This will promote high-quality care by ensuring consistent care delivery, enhancing nursing familiarity with standard regimens, providing reliable data for medicine stocking and enabling rigorous assessment of breast cancer outcomes.

OBJECTIVES Systematic and comprehensive case-finding is essential for population-based cancer registration. The study aimed to improve the completeness of data for the newly established Ekurhuleni Population-Based Cancer Registry (EPBCR) in South Africa.
METHODS Our epidemiologist visited the Zimbabwe National Cancer Registry (ZNCR) through the Union for International Cancer Control (UICC) fellowship to learn best practices for population-based cancer registration. We developed a strategic plan to improve case-finding in the EPBCR which included; stakeholder engagement, identification of new active and passive surveillance data sources, and tracing of cancer patient flow in existing sources. The plan was presented to cancer surveillance officers at one day workshop and implemented. We conducted a record linkage of the national pathology-based cancer registry database for 2017 and EPBCR database for 2017 to identify laboratory cancer records from Ekurhuleni district which were not in the EPBCR database. The laboratory records of Ekurhuleni residents which were not in the EPBCR database were allocated to surveillance officers for tracing and notification.
RESULTS Overall case-finding increased by 62.1% from 2080 records on 31st August 2018 to 3371 records by 31st January 2019. Prior to the study, only 14 data sources were covered by EPBCR, an additional 4 sources were included after the enhanced case-finding effort. Record linkage with the pathology-based registry identified 526 cases that had not been previously reported.
CONCLUSION The regional knowledge transfer within the African community is crucial for establishing quality population-based cancer registration. Systematic mapping of both active and passive data sources is essential for completeness in cancer registries.

BACKGROUND Breast cancer is the major cause of morbidity and mortality in sub-Saharan Africa (SSA). There is evidence that the pathologic characteristics of the disease differ from those seen in women of European descent. Despite the burden of disease, data on standard pathologic features in SSA is limited and often contradictory. There is almost no data about newer potential biomarkers like tumour infiltrating lymphocytes (TILs). Lack of information makes difficult to prioritize resource use in efforts to improve breast cancer outcomes in the region. We sought to characterize the pathologic features of breast cancer in a Tanzanian population (TZ) compared to African American (AA) and White American (WA) populations, including TILs and determine whether TILs are associated with other pathologic and clinical features.
DESIGN We examined consecutive cases of breast cancer in TZ (n=85) at KCMC and BMC, AA (n=120) and WA (n=120) women from Duke University Medical Center for tumour type, grade, mitotic count, and TIL involvement. Cases that were equivocal for HER 2 by immunohistochemistry were evaluated for HER amplification by fluorescent in situ hybridization. Demographic information and gross tumour characteristics were extracted from the subjects’ medical records. Chi-square tests were used to compare categorical factors, and Kruskal-Wallis tests were used to compare continuous factors.
RESULTS The Tanzanian subjects were younger, had larger tumours, and more likely to have skin ulceration than the subjects in either American group. Tumors from all three groups were predominantly ductal carcinoma. Breast cancers in TZ and AA groups were more likely to be high grade (p=0.011), ER-negative (p<0.001), and high mitotic rate (p<0.0001) than the tumours in White American group. Higher levels of TIL involvement were seen among Tanzanian and African American subjects compared to White American subjects (Figure 4, p=0.0004). Among all subjects, TIL levels were higher in tumours with a high mitotic rate. Among Tanzanian and African American subjects, TIL levels were higher in ER-negative tumours.
CONCLUSIONS TZ and AA subjects are more likely to have tumours with aggressive features, higher rate of TIL than WA subjects, likely related to the increased frequency of ER-negativity. Based on high mitotic rates and high levels of TILs, many TZ patients would be expected to benefit from cytotoxic chemotherapy in general and neo-adjuvant chemotherapy in particular. Further investigation into the molecular basis for high mitotic rates may yield insight into breast cancer biology in TZ and African AA.

OBJECTIVE Cancer registries have been demonstrated to be critical for the determination of cancer burden, conduct of research, and in planning and implementation of cancer control interventions. Cancer registration though crucial is often paid little attention owing to competing demands for resources in healthcare. We report the Tanzanian experience in establishment of population-based cancer registry (PBCR) in Dar-es-salaam as a guide for other low-income countries wishing to develop cancer registration.
METHODS The ministry of health (MoHCDGEC) in collaboration with implementing partners led the establishment of PBCRs. ECSA through support from World Bank enabled the Tanzanian government to conduct a needs assessment, develop a strategic plan for national cancer registry (2019 – 2022), adoption of cancer registry tools, identification of geographical region for the registry, capacity building, mentoring, monitoring, and data collection process.
RESULTS The Dar es Salaam PBCR was successfully equipped and capacitated from existing facilities within Ocean Road Cancer Institute (ORCI) with almost universal acceptance rate for all sources approached. A total of 5 staff have been trained; 3 medical doctors and 2 medical records personnel, and 3200 cases abstracted between 2017 and 2018. Despite some challenges such as lack of unique identifiers to track patients and limited utilization of electronic medical records, the pre-existence of a national cancer control strategy in the context of a strong health care referral system for cancer, paved the way for adoption of strategies complementing national priorities.
CONCLUSION MoHCDGEC has been instrumental in the building of cancer registries within the country through the close involvement of partners resulting from the historic custodianship that ORCI has on cancer. This approach, modelled from past experience with failed attempts at cancer registration, is an important lesson on national level advocacy to set as national health agenda and engagement development partners when executing these programs

OBJECTIVE The main objective of this study was to determine the benefits of active versus passive data collection for cancer registration in resource-limited areas by assessing the completeness and quality of the data generated through these two methods.
METHODS Four hospitals were selected; two peripheral and two referral hospitals, submitting data to the Eastern Cape Cancer Registry in South Africa through booth, active and passive case finding. Separate data sets were created for each collection method, consisting of notification forms abstracted for all new cancer cases identified in these hospitals between January 2014 and December 2015. To assess completeness of cancer registration, independent case ascertainment was used to determine agreement and differences between the two data sets. To assess the accuracy of recordings, an audit was carried out on a random sample of 10% of the cases identified in both data sets. Three reviewers independently scrutinized each of the sampled cases for a degree of comparison with regards to tumour topography and morphology.
RESULTS Overall, combined for the two peripheral hospitals, active vs. passive case finding covered 95% vs. 71% of the total number of cases identified, respectively. In contrast, for the two referral hospitals, the proportion of cases captured was very similar for both methods (88% vs 83%). Moreover, lower completeness was observed in reporting through passive method in peripheral hospitals vs. referral; 71% vs 88%, respectively revealing large resource constraints.
CONCLUSION Neither of the two methods alone identified all patients registered. However, for the local hospitals, active case finding resulted in markedly better case reporting than passive.

OBJECTIVE The purpose of this study was to determine the prevalence of epidermal growth factor receptor (EGFR) in patients diagnosed with esophageal squamous cell carcinoma (ESCC) as well as addressing correlation of overexpression of EGFR with age, gender and tumor grade of the cases.
METHODS This was a cross-sectional analytical study conducted in the pathology laboratory at the department of pathology, Makerere College of Health Sciences, Kampala- Uganda. A sample of 127 archival tissue blocks from patients with ESCC diagnosed between the years 2010 and 2012 were retrieved from the tissue repository and used to assess overexpression of EGFR using monoclonal mouse Anti-human wild type EGFR antibody. For association between age and overexpression of EGFR Kruskal- Wallis H test was used and for tumor grade and sex and EGFR, Chi-square test was performed using SPSS version 16.0. P < 0.05 was considered statistically significant.
RESULTS The age range of patients with ESCC in this study was 35 – 99 years with a mean of 59.55 years. The peak age of cases was 55-64 years. Males and females were 68.5% and 31.5% respectively. Moderately differentiated tumors dominated by comprising 59.9%. The prevalence of overexpression of EGFR was 61.4%. The highest overexpression of EGFR was seen in cases with grade 2 compared to grade 1 and 3 but not statistically significant (P = 0.255). Overexpression of EGFR was relatively higher in cases with age ≥ 50 years, but the difference was not statistically significant (P = 0.931). Males expressed relatively higher EGFR than females, however; the difference was not statistically significant (P = 0.944)
CONCLUSION Majority of patients with ESCC in Uganda have moderately differentiated tumor and a significant number of them tend to show overexpression of EGFR antigen and can therefore benefit from targeted therapy.

OBJECTIVES Point of care is an electronic health record system which is a digital version of a patient’s paper chart. This system is real-time, information is available instantly, patient centred, and securely to authorized users. The digital system helps care providers by minimizing time spent on manual documentation and allow access to evidence-based tools that providers can use to make decisions hence maximizing time for patient care. Over the past 10 years, patient information has all been captured manually on the patient chart. Due to this method of information collection, patient’s vital information was missing in the charts. This information could not be shared among various care providers and among facilities providing care.
METHODOLOGY This paper aims is to showcase how to develop a system that is patient centred, and a system built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care such as demographics, medical history, diagnoses, treatment plans, allergies, radiology images, laboratory, test results and other plans. The system is built to interlink interdepartmental and facilities providing cancer care.
RESULTS In Ampath cancer centre, 70% of patients' charts is now digitalized. A retrospective data entry from the manual charts was done during the implementation process. Currently information is available whenever and wherever it is needed. The system has been linked to remote cancer screening clinics hence during patient referral the screening findings is already available for diagnostic procedure and treatment at the cancer center. Sharing of patient information to non-Ampath cancer centre during referrals for further management is impossible since those centres use incompatible systems.
CONCLUSIONS Since with Point of care (POC) information is available whenever and wherever it is needed, there is need to interconnect facilities providing cancer care. Providers will be able to access all patient information hence there will be optimal cancer care.

INTRODUCTION Non-surgical topical therapies have been assessed in the treatment of precancerous lesions of the cervix. Antiviral AV2 is a mixture of natural essential oils (eugenol, carvone, nerolidol, geraniol) in olive oil, and has a broad spectrum anti-viral activity. The purpose of this study was to evaluate the efficacy of AV2 over placebo in the topical treatment of HPV-associated cervical lesions.
METHODS Women aged 25 years and older were included and underwent cytology screening, HPV testing and visual inspection of the cervix with 5% acetic acid (VIA). VIA-positive women were randomized to one of two groups to receive treatment by either AV2®or placebo. The treatment consisted of 2 puffs of spray of the investigational drug directed to the cervix. Participants were subjected to repeat examinations two months and six months later for assessment of outcomes. The primary outcome was the change of lesions on VIA at 2 months after application of the investigational drug. Secondary outcomes were: HPV clearance and cytologic regression at 2 months and 6 months, and number of participants with AEs
RESULTS A total 327 VIA positive women were randomized in two groups (168 in AV2 group and 159 in placebo group). Women in the 2 groups were similar with respect to baseline demographics and clinical characteristics. At 2 months, regression of lesions on VIA was observed in 127 (89.4%) out of 142 women in AV2 group compared to 120 (91.6%) out of 131 women in placebo group (P = 0.7). On cytology, regression of lesions occurred in 14 (56%) out of 25 women in the AV2 arm and in 13 (48.1) out of 27 women in the placebo arm (p= 0.7), and HPV clearance rates were 34,1% and 35% in AV2 group and placebo group respectively (p= 0.8). At 6 months cytologic regression was observed in 64.7% of women in AV2 group and 45.8% in placebo group (p=0.2), while HPV clearance occurred in 11 (51.9%) out of 17 women in AV2 arm versus 11 (34.4%) in placebo arm (p= 0.3).
Some local side effects (burning, itching, irritation) were similarly noted in the 2 groups but they were mild and transitory.
CONCLUSION A topical application of AV2 onto the cervix can induce the regression of cervical precancerous lesions, but its efficacy does not significantly differ with that of placebo. Further evaluation of the effects of AV2 with different diagnostic methods and treatment regimen and arms is warranted.

OBJECTIVE To address barriers of cancer care resulting in improved access to screening and diagnostic services for breast and cervical cancer in Kenya.
METHODS AMPATH (Academic Model Providing Access to Health care) breast and cervical cancer control program works with communities and county governments. Between October 2017 and September 2018, we met county and national government officials to disseminate cancer information, carried out mass screening events, trained nurses on how to screen for the two cancers and to refer appropriately. In addition, we also created and distributed public education materials on cancer, developed data collection tools, establish electronic data collection, started cancer registries in county hospitals, and developed telemedicine connectivity with rural hospitals both for training and discussion of patients on care.
RESULTS We had 24 mass screening events in that period with 9,716 persons screened, 5,049 for breast cancer and 4,667 for cervical cancer. During the same period, 11 AMPATH routine screening clinics in the region screened 25, 889 clients (7,546 for breast cancer and 18, 343 for cervical cancer). Twenty-eight community meetings were held with county government officials to disseminate information and four remote sites were connected via telemedicine. Electronic patient encounter forms have been developed resulting in real time entry of screening data and transmission to the server. We have also held four cancer survivor meetings over the same period. At the end of the year, we held a meeting with stake holders and shared data generated from program activities
CONCLUSIONS At the end of the program, we hope to have increased awareness in the population being served, increased screening uptake, increased early diagnostics and referral, and mitigated barriers to cancer care.

OBJECTIVE In 2019, Tanzania’s Ministry of Health will release the country’s first National Cancer Treatment Guidelines. In coordination with this initiative, Ocean Road Cancer Institute (ORCI), the national cancer referral centre, will pilot an innovative theory-informed guideline implementation strategy. We aimed to develop a novel framework for evaluating the effect of this implementation strategy on clinical practice and outcomes among breast cancer (BC) patients at ORCI.
METHODS This study will be carried out through a two-phase study design comparing clinical practice metrics and patient outcomes pre- and post-guideline implementation. The pre-intervention phase is comprised of a retrospective review of all BC cases seen at ORCI from 2016 to 2018. During the post-intervention phase, we will prospectively assess all BC cases seen at ORCI following dissemination of the Tanzania National Cancer Treatment Guidelines and initiation of ORCI’s implementation strategy. Data will be collected on clinical and demographic characteristics, treatments prescribed and received, and overall survival. Guideline concordance will be assessed using pre-specified criteria.
RESULTS We developed a novel methodology for evaluating the clinical effects of a guideline implementation strategy. We will measure guideline concordance using internationally recognized quality metrics and evaluate survival of BC patients at ORCI pre- and post-intervention. Preliminary results of the clinical data analysis will be presented.
CONCLUSIONS Improving adherence to standard treatment guidelines is an essential component of addressing global disparities in cancer mortality. Though several international groups have developed resource-stratified cancer treatment guidelines, little research has been published on best practices for guideline implementation, particularly in Africa. Evaluation of the clinical effect of guideline implementation strategies is key to establishment of best practices.

INTRODUCTION Head and Neck Cancers (HNCs) constitute a major public health concern worldwide. The incidence is approximately two times more in less-developed regions as compared to more developed regions. The estimated incidence in sub-Saharan Africa is 27593 per 100000 with a cumulative risk of 0.66. We evaluated patient demographics, risk factors, tumours characteristics, prognostic factors, disease stage, treatment intent and treatment modality in a cohort of patients with HNC in Cape Town, SA.
METHODS Records of all HNC patients that presented to Tygerberg Hospital oncology department between 1 January 2015 and 31 December 2017 were reviewed. The following variables were described: patient demographics, which include age, sex, HIV status, and socio-economic status as well as tumour characteristics, risk factors, treatment intent and treatment modalities.
RESULTS Data was collected from 854 patients seen between 2015 and 2017. There were 603 (71%) male and 251 (29%) female. The male to female ratio was 2.4:1. The age range was 10-89 years (median age 58 years). Smoking was a risk factor in 737 (86.3%) and alcohol in 634 (74.2%) of patients. Eleven patients (2.22%) were HPV positive, of these 73.68% were in the oropharynx The most common site was the oral cavity (n=320) and the most common sub-site was the anterior tongue (n=137). Eleven patients had two separate primaries at the time of diagnosis. In total, 466 patients (53.87%) presented with locally advanced, stage IVA disease.
CONCLUSIONS The median age of diagnosis, the most predominate primary site; histological subtype and stage at presentation were consistent with that reported in the literature. The incidence of p16 positive oropharyngeal lesions differs greatly from the changing worldwide etiological trends of SCC of the oropharynx.

OBJECTIVE Since opening in September 2016, New Hope Children’s Hostel at Kawempe Home Care (KHC) has enabled 414 children to proceed with their cancer treatment. Children, mainly from rural parts of Uganda, stay at the Hostel with one caretaker (e.g. a relative) during their medical treatment at Uganda Cancer Institute (UCI). A child’s cancer disease is a significant psychosocial burden to patients and their families, often related to anxiety, trauma and depression (Kreitler et al.,2012). Thus, we provide free psychosocial care for all hosted clients. We aim to evaluate the psychosocial services provided by KHC and to give future directions for research and practice.
METHOD At KHC, the social worker and psychotherapist assess and manage psychosocial stressors through counseling, spiritual care, informative sessions for children and caretakers, play and music therapy for children. Pain management is done through proper administering of morphine and other medicines prescribed by UCI. The hostel’s psychosocial care is evaluated with the Palliative Outcome Scale (POS-C; APCA, 2012). POS-C is a standardized tool to assess for disease-related quality of life and track possible changes over time for children and their caretakers in palliative care settings. At KHC, assessment with POS-C is accomplished at four visits within a child’s stay, with the first interview upon admission and repetition after every two weeks. The current dataset includes complete filled POS-C questionnaires of 86 children and their caretakers from 2016 until April 2019.
RESULTS Descriptive analysis using average scores suggests that for children and caretakers disease-related quality of life improved throughout their stay at KHC. Children show improved physical and mental wellbeing, indicated by reduced pain, symptoms and crying and increased feeding, knowledge, happiness and motivation to play. Caretakers show positive emotional adjustment to their situation, improved knowledge and aspirations for the future. While all other indicators show constant improvement throughout four times of measurement, body problems in children and worries about their child’s illness in caretakers increased slightly at visit three and then decreased further.
CONCLUSION Our results support the general notion that through holistic palliative care the psychosocial wellbeing of cancer affected families can be improved. The slight temporary increase in body problems and caretakers’ worries, which might be attributed to the side effects of chemotherapy, indicates that following diagnosis constant psychosocial monitoring is needed to help cancer affected families through the hardship. Overall, we call for a strengthening of psychosocial support in palliative care settings.

OBJECTIVE Burkitt’s lymphoma (BL) is a virus associated childhood B-cell cancer common in eastern Africa. Continued survival of B-cells in germinal centres depend on expression of high affinity immunoglobulins (Ig) to complementary antigens by somatic hypermutation of Ig genes. Cellular microRNAs, non-coding RNAs have been reported to play role in cell cycle regulation. Both viral antigen dependent mutation and micro-RNA expression maybe involved in BL pathogenesis. We describe immunoglobulin heavy variable (IgHV) rearrangement and micro-RNA expressions in BL tumours.
METHODS Genomic DNA were extracted and purified from BL tissue blocks at Moi Teaching and Referral Hospital, before amplification using IgHV consensus primers and sequencing. The sequences were then aligned with germline alleles in IMGT/V-QUEST® database. Total RNA extracted from tissue blocks and cell lines were used to determine relative expression of hsa-miR-34a and hsa-miR-127.
RESULTS In all tumours, allele alignment scores and number of mutations range were 89.2-93.2%, 15-24 respectively. The range of IgHV amino acid changes were higher in EBER-1+ (15-25) than EBER-1- (9-15). In MYC+ tumours, the relative expression was: hsa-miR-127(2.09); hsa-miR-34a (2.8) and MYC- hsa-miR-127 (1.2), hsa-miR-34a (1.0).
CONCLUSIONS B-cell in BL contained somatic mutated IgHV gene and upregulated cellular microRNAs with possible pathogenetic role(s).

BACKGROUND Non-melanoma skin cancers (NMSCs) are the most frequently diagnosed cancers worldwide. The NMSCs comprise of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and other rare skin cancers (RSC). This study aims to describe NMSCs distribution of histological subtypes and anatomical sites by sex and population groups in South Africa.
METHODS NMSCs reported to the pathology-based National Cancer Registry (NCR) from 1993-2014 were analyzed. Proportions and frequencies were used to describe NMSCs by ethnicity and anatomical site.
RESULTS Out of 1220964 pathology-diagnosed cancers reported to the NCR in the study period, 27% (n=330162) were NMSCs. The proportion of males with NMSCs was significantly higher (58%) compared to females. Caucasians were over-represented in both females (79%, n=106766) and males (81%, n=156058), followed by coloured, asian and black populations. The proportions of histological subtypes of NMSCs in asian, coloured and white populations (n=291999) were; BCC (73%), SCC (26%), then RCS (1.5%). The proportions of histological subtypes of NMSCs in blacks (n=24141) were; SCC (48%), BCC (37%), then RSC (15%). The anatomical site of distribution of NMCSs in the non-black populations (asian, coloured, and white) (n=162462) showed the following proportions; head and neck (59.0%), upper limbs (16.4%), trunk (13.5%), lower limbs (10.3%), and overlapping sites (0.9%). The black population (n=15429) showed the following proportions; head and neck (54%), trunk (22%), lower limbs (13%), upper limbs (11%), and overlapping sites (<1%).
CONCLUSION Men and Caucasians are more susceptible to NMSCs. The non-black populations are more susceptible to BCC, but blacks are more susceptible to SCC. NMSCs frequently occur on exposed skin areas such as head and neck, and upper limbs for non-black populations. In black populations however, NMSCs commonly occurred on the trunk and lower limbs. Risk factors for NMSCs in black populations might be unique, requiring further exploration.

OBJECTIVE Tanzania and other low-income countries (LICs) face a growing burden of cancer and a pressing need to strengthen cancer care delivery systems. The overall case fatality from cancer is disproportionately higher in LICs, and adherence to standard treatment guidelines is a critical component of addressing disparities in outcomes. In 2017, Tanzania’s Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) commissioned leaders at Ocean Road Cancer Institute (ORCI) to develop Tanzania’s first National Cancer Treatment Guidelines.
METHODS In 2017, we convened stakeholders to form a technical working groups (TWGs) which were organized according to disease-specific categories and comprised of representatives from relevant disciplines, including surgeons, gynecologists, pediatricians, general medical officers, radiologists, pathologists, oncologists, social workers, dieticians, and nurses. Each TWG conducted a review of current literature and prepared a summary of the epidemiology, diagnostic and staging procedures, options for management with therapies currently available in Tanzania, and essential medicines. In 2018, following multiple revisions and meetings of each TWG, the guidelines underwent external review with two oncologists from Tanzania participating in in-person consultations with disease-specific experts at UCSF.
RESULTS Guidelines were developed for a total of 70 diseases. The Guidelines are intended to be facilitative, enabling, and foundational, providing bases for the attainment of high standards in the management of cancers in a resource-constrained setting. Guidelines were formatted for dissemination in both hard copy and in soft copy using the AgileMD platform.
CONCLUSIONS In 2019, Tanzania’s MOHCDGEC will systematically disseminate its first-ever National Cancer Treatment Guideline. Following dissemination, MOHCDGEC will implement a monitoring and evaluation strategy that ensures and promotes the use of the Guidelines in both public and private sectors. We are working on development of a theory-informed implementation strategy that focuses on education, workflow modifications, and behavior change, which will be piloted at ORCI.

BACKGROUND Fine needle aspiration biopsy (FNAB) is a cost-effective diagnostic technique with broad applications in low-resource settings. The addition of ultrasound-guidance (USG) allows for targeting of non-palpable lesions and ensures accurate sampling. A major limitation of FNAB is that the ability to perform accurate and adequate sampling is dependent on formal training. An initial workshop for training in USG-FNAB was hosted in Tanzania by Muhimbili University of Health and Allied Sciences (MUHAS) in September 2017. We aimed to assess the efficacy of a repeat intensive USG-FNAB workshop in Tanzania in January 2019.
METHODS A team of pathologist and radiologist trainers led a 3-day workshop involving lectures and hands-on practicum, inviting new and returning participants. Pre- and post-workshop surveys on prior experiences with USG-FNAB were administered to participants. In addition, participants underwent pre and post-workshop practical assessments on USG-FNAB technique and slide smearing skills. McNemar's chi-squared test was applied to test if there were any significant changes from pre to post-workshop. All the analyses were performed by R.
RESULTS A total of 32 participants (pathologists, radiologists, and residents) enrolled. Participants significantly improved in nearly areas of measured assessment. After training, participants were able to apply an appropriate amount of material onto the slide, divide a sample using acceptable technique, successfully create a smear using correct technique, measure a lesion in 3 dimensions using the ultrasound, and successfully perform a USG-FNAB using parallel and perpendicular approaches with statistically significant improvements (p<0.001). No improvement was noted in ability to identify a lesion by USG (p=0.48).
CONCLUSION An intensive practical workshop was an effective method for teaching USG-FNAB and slide smearing skills in Tanzania. This workshop demonstrated the efficacy of dedicated tutorials for specialized skills transfer for capacity-building for cancer diagnostics amongst pathologists and radiologists in a university setting in East Africa.

BACKGROUND Nearly forty thousand cancer patients in Tanzania who would benefit from palliative care do not get that service. Most of these patients die with agonizing pains and other uncontrolled symptoms. The lack of access to effective palliative care in Tanzania is a public health problem which needs to be addressed urgently. In this study our hypothesis is that since mobile phone use is ubiquitous in Tanzania, it can be used to improve access to high quality palliative care by using a mobile device-based symptom assessment/control communication system (m-Palliative Care Link; mPCL) which links palliative care specialists to patients and caregivers to reduce symptom burden in late-stage cancer patients.
METHODS Study design: A cross sectional mobile device feasibility and usability study where a mobile platform was created, and its usability tested among late stage cancer patients. Study population: All late stage cancer patients seen at Ocean Road Cancer Institute (ORCI). Study area: The study is conducted in Dar es Salaam. Data collection procedures: An electronic version of APCA POS (hereafter named POS) was adapted as an electronic form for a patient and caregiver to self-administer on the patient’s study-supplied mobile device. All existing APCA POS measures, including 7 patient-directed items and 3 caregiver questions were used.
RESULTS We have so far recruited 20 study patients and 21 controls out of the intended total number of 90 patients (45 study patients and 45 controls) to be recruited. The collected qualitative data from these patients will be transcribed and translated by experienced research assistants after completion of the study. The data will undergo software assisted coding and analysis using NVivo® and qualitative techniques to generate thematic content analysis. The cost effective analysis of the platform will be evaluated.
CONCLUSION This mPCL study promises to remotely assess symptom control needs of late-stage patients and the adjustments of medications and doses required using a mobile device-based symptom assessment/control communication system (m-Palliative Care Link; mPCL) which links palliative care specialists to patients/caregivers to reduce symptom burden in late-stage. Since the the mPCL approach relies on existing technology, resources and personnel it is expected to be sustainable, scalable and cost effective for use in patients with cancer and other chronic diseases.

INTRODUCTION Au Sénégal, les pathologies cancéreuses sont aujourd’hui au sommet des causes de décès. Le cancer du col de l’utérus est en augmentation constante en Afrique subsaharienne, avec plus de 75 000 nouveaux cas et près de 50 000 décès par an (Mboumba et al., 2017). Le papillomavirus humain (VPH) est le principal agent causal du cancer du col de l’utérus (Steenbergen et al., 2005).
OBJECTIF Le but de cette étude est d’étudier la répartition des HPV chez les sénégalaises atteintes de cancer du col utérin.
MÉTHODOLOGIE Pour découvrir les types de HPV oncogènes responsables de l'apparition du cancer du col utérin au Sénégal et voir leur corrélation avec les facteurs de risque dans cette étude, des biopsies cervicales ont été réalisées chez des femmes atteintes d'un cancer du col utérin. Les types ont été détectés en utilisant 3 méthodes: la technique de génotypage par séquençage, la technique de génotypage par PCR en temps réel (kit HPV 16 & 18Real-Time PCR) et la technique de génotypage (kit HPV 3.5 LCD-Array).
RÉSULTATS Il a été noté que toutes nos patientes présentaient des infections multiples (co-infections) dont la majorité étaient des HPV-HR. Les types de HPV les plus courants par ordre décroissant dans notre population étaient: 16 (34,37%), 18 (23,29%), 45 (10,75%), 33 (9,94%)), 59 (9,09%), 35 (3,97%) et 31 (3,69). Parmi les co-infections détectées dans les différentes régions du Sénégal chez les femmes atteintes de cancer du col utérin, nous avons constaté que les types de HPV 16 et 18 avaient la prévalence la plus élevée. Dans la région de Dakar, qui comptait le plus grand nombre de cas, une prévalence de 17,89% de co-infections dues à HR-HPV a été notée.
CONCLUSION La polygamie représente un cofacteur dans la survenue d'un cancer du col utérin de l'utérus chez les femmes sénégalaises. Nous avons également remarqué qu'il n'y avait pas d'association entre plusieurs co-infections HP-HPV et le stade de la maladie.

OBJECTIVE Recently, there has been a growing interest in the cooperative practice between traditional health practitioners (THPs) and radiation oncologists (ROs) in the treatment of patients with cancer. The study sought to describe communication that will facilitate the continuity of care in those patients. It aims is to explore and understand communication in the cooperative treatment of patients with cancer, as perceived by THPs and ROs in KwaZulu-Natal province, South Africa.
METHODS This was an exploratory case study involving public hospitals and THPs who treat patients with cancer. It was conducted on 28 practising THPs and four ROs. In-depth, face-to-face, one-on-one and focus group interviews, utilising semi-structured questions, were employed to collect data from the two groups of participants. Data was audio-recorded with the permission of participants and transcribed verbatim before content analysis.
RESULTS The study found that currently there is lack of communication between THPs and ROs in the treatment of patients with cancer because those health practitioners do not know each other. As patients move between the two groups, they do not provide details of treatment with the other health practitioner. Both groups believe that mutual respect for the expertise of all members in the groups is important for effective communication. Themes that emerged from the analysis were: two-way communication between THPs and ROs to facilitate sharing of patient information, details of treatment related information to be communicated between the two groups, and patient’s responsibility in the communication.
CONCLUSIONS Communication facilitates referral of patients between the two groups. The patients have the responsibility to make decisions regarding choice of treatment, type of the health practitioner to treat them and referral between the THP and RO. They should be educated on how they will be referred between the two groups and to improve their communication skills.

INTRODUCTION Burundi lacks a systematic program that collects and collates cancer data (absence of anatomopathology laboratory and lack of any means of treatment except palliative care).
METHODS In 2018 the cancer control strategy was developed, after which mapping was done on possible facilities that manage and refer cancer patients from Bujumbura to various countries where treatment and diagnosis is available. Population-based cancer registration will be the preferred type, concentrating on cases resident in Bujumbura City.
RESULLTS The total number of new cancer cases registered from September 2018 to February 2019 (6 months) in 5 health facilities of Bujumbura city is 135, comprising 55 males and 80 females. The leading cancer in males is prostate (32) and in females, cervix (60) is the most frequent cancer.
CONCLUSION The profile of cancer reported during this period is consistent with that observed in neighbouring countries, and that reported in WHO/IARC Globocan estimates (2018).

INTRODUCTION Trop souvent tabous, les difficultés sexuelles et l’intimité du couple restent rarement abordées par les patients et encore moins par les praticiens. Il semblerait que face à l’enjeu vital de la maladie, ce genre de préoccupation leur paraisse futile, voire honteux à aborder.
OBJECTIF Evaluer les troubles sexuels chez les patients atteints de cancer dans le service d’oncologie médicale.
MATÉRIEL ET MÉTHODES Il s’est agi d’une étude transversale prospective, couvrant la période du 1er Avril au 31 Juillet 2018. Tous les patients atteints de cancer âgés d’au moins 18 ans avec un status performans de l’OMS entre 0-2 ans ont été inclus.
RÉSULTATS Le trouble sexuel le plus retrouvé est celui du désir dans les deux sexes, puis celui de l’orgasme. La présence de certains troubles avait un lien avec la survenue du cancer (p˂5). Près de 64,7% des femmes atteintes de cancer gynéco-mammaire et 22,5%, digestifs présentaient une dysfonction sexuelle. Les hommes par contre qui présentaient un grand nombre de troubles sexuels, étaient de cancers digestifs (47,6%), urogénitaux (22,6%), et des tissus mous (19%). La chirurgie-chimiothérapie (femmes: 42,2% vs 22% : hommes), la chimiothérapie (16,7% vs 21,4%), la chirurgie (16,7% vs 19%) constituaient en grande partie la prise en charge de ces patients.
CONCLUSION Il ressort de ce travail que, la fréquence des troubles sexuels chez les patients atteints de cancer dans le service d’oncologie médicale est de 98,4%. Il est important de tenir compte de ces troubles au cours de la prise en charge des patients cancéreux, leur fréquence et leur retentissent sur la qualité de vie quel que soit la période de l'évolution du cancer. La prise en charge de ces difficultés sexuelles nécessite une approche pluridisciplinaire entre oncologues, gynécologues, psychiatres et sexologues.

OBJECTIVE There is higher mortality and morbidity from cancer in low and medium income countries (LMICs) compared with high income countries (HICs). Clinical trial activities have been partly responsible for the low mortality associated with cancer in HICs. Clinical trials are low in sub-Sahara Africa (SSA) due to poor infrastructure and death of experienced personnel to execute clinical trials. There is need to improve on clinical trial activities in order to find locally relevant evidence-based methods for cancer treatment in SSA. This report is on collaborative efforts to implement oncology clinical trials in Nigeria and can be a model for improving clinical trial facilities and personnel in SSA.
METHODS There was a site assessment of clinical trial facilities in four cancer centers in South West Nigeria using a check list comprising information on various aspects of clinical trial activities. The centers were The University College Hospital Ibadan, Lagos State University Teaching Hospital Ikeja, Obafemi Awolowo University Teaching Hospital Ile - Ife and Lagos University Teaching Hospital Idiaraba. The gaps identified were addressed using resources and funds sourced under the leadership of HIC institutions in collaboration with the local institutional management.
RESULTS Infrastructural and skills deficits identified were in areas of patients’ care such as availability of standard clinical and research laboratories and diagnostic facilities, regular clinical equipment maintenance including regular calibrations, trained personnel for clinical trial activities (good clinical practice, ethical conduct of research and informed consent procedures), investigational products handling and disposals and lack of standard operating procedures for clinical activities. Interventions were instituted to address the observed deficits in the four sites. Extensive training on all aspects of clinical trial was provided. The sites are now well prepared to undertake clinical trials in oncology with the first trial starting very soon.
CONCLUSION Partnerships with institutions in HICs can successfully address infrastructural deficits for clinical trial implementation in LMICs. The HICs lead in sourcing funds and providing mentorship and training for LIC institutions towards improving facilities and manpower for clinical trials.

BACKGROUND Breast cancer (BC) is the most prevalent cancer in women and the leading cause of women’s cancer related mortality worldwide. In Rwanda, the majority of breast cancer patients are young, premenopausal women, presenting late, with advanced stages and poor outcomes. Surgery is generally the first line of breast cancer treatments and when delayed it impact on timing of adjuvant medical and/or radiation therapies, influencing negatively outcomes.
OBJECTIVES The objective of this study was to identify barriers to timely surgery and describe early surgical outcomes for patient operated for breast cancer at two tertiary hospitals in Rwanda.
METHODS A cross-sectional study was conducted at the University Teaching Hospital of Kigali and Rwanda Military Hospital over 12 months’ period from May 2016 to May 2017. All patients diagnosed and surgically treated for breast cancer were included. Percentages and means have been used for descriptive statistics, chi-square test to compare proportions and t-test was used for means comparisons. A p-value less than 0.05 will be considered statistically significant.
RESULTS 74 patients have been operated for breast cancer during the study period. 69 patients met inclusion criteria. The median age was 48 years (mean: 53.20 years, range 24 - 82 years). 74.16% of patients ≤ 60 years, 58% of them being premenopausal. 69,5% of patients presented with locally advanced stages. The mean duration of symptoms was 10.9 months (range 3 - 40 months) before initial consultation. However, after the first hospital visit, patients had to wait 91 days (3 months) ranging from 17 to 206 days with 3.3 visits (range 2-7) before surgery. The mean hospital stay was 5 days after surgery and 98.9% of patients underwent modified radical mastectomy. No major complications reported. Socio-economic status (p=0.0002), level of education (p=0.000), traditional healer’s consultation (p=0.0001), were associated to the timing of first hospital visit. However, the level of first heath facility consulted (P=0.00045), number of breast surgeon (p=0.0000), pathology report availability, (p=0.0004) and imaging availability (p=:0.0006) were associated with delayed timing of surgery.
CONCLUSION Delays to surgery are both patient and system related. Patients with breast cancer present 10 months after onset of symptoms. In average, they spent 3 months within health care system before accessing surgery. Increased awareness, surgical outreaches and task sharing with non-breast surgical specialist may decrease delays to surgery and increase timely access to subsequent adjuvant therapies for better outcomes.

OBJECTIVES Despite international efforts to develop resource-stratified cancer treatment guidelines, little research has been done on strategies for implementation. Ocean Road Cancer Institute (ORCI), in collaboration with Tanzania’s Ministry of Health, developed National Cancer Treatment Guidelines to standardize cancer treatment within the country. We hypothesize that a theory-informed implementation strategy is the optimal way to ensure consistent use of guidelines. We aim to develop an implementation strategy for guideline-based practice at ORCI and evaluate its feasibility, adoption, and early effectiveness.
METHODS The COM-B/BCW (Capability, Opportunity, Motivation and Behaviour/Behaviour Change Wheel) framework was used to derive an implementation strategy. We then created a Logic Model to identify relevant indicators for program evaluation and classified them using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Next, we developed a program evaluation plan using a pre-post design with mixed methods approach consisting of focus groups, field observation, and questionnaires. Focus groups will address the role of care delivery systems in guideline adherence. Direct observation will measure the activities and outputs of our intervention. Questionnaires will assess provider perceptions, attitudes, and motivations. Qualitative and quantitative data will be analyzed using the Framework Method and descriptive statistics, respectively.
RESULTS The phased implementation strategy will include: 1) guideline dissemination as hard and soft copies along with publicity campaign; 2) knowledge and skills training at a National Cancer Treatment Guideline Summit in 2019; 3) ongoing reinforcement through environmental restructuring, point-of-care clinical forms, and behavior modeling by champions. Results of the program evaluation will be presented.
CONCLUSION In Tanzania and other African countries, shifting to guideline-based practice requires modifications to clinical practices and provider behaviours; guideline publication alone is unlikely to result in meaningful change. Program evaluation of a theory-informed implementation strategy for guideline-based practice will facilitate dissemination and adaptation to other settings.

OBJECTIVE A presentation by the Multidisciplinary breast tumour board (MDT) domicile in the University College Hospital in Ibadan, South West Nigeria. It aims at highlighting the socio-economic challenges of breast cancer imaging experienced by the cohort of women managed in that community.
METHODS Records of all the women seen from inception of the board in 2008 to 2012 were analyzed for demography, social status, educational level and challenges experienced during the course of imaging and management.
RESULTS Socio- economic challenges were reported at the various levels of management namely; screening, imaging and the definitive management. Some of the important challenges reported during screening were; ignorance, non-accessibility and high cost of mammography. Denial, cost of transportation and the preference for non-orthodox method of treatment were top on the list of the cohort’s hardship during imaging. However, during the definitive management, the study identified, the current cost of surgery and drugs (adjuvant and neoadjuvant therapy), the fear of mastectomy and the non-availability of radiotherapy centers as the major hurdles experienced by the women.
CONCLUSION The Ibadan MDT proffered the following solutions to improve breast cancer imaging and overall management in women in Ibadan. They include: improved breast cancer awareness programs, widespread use of Sono-mammography to avail screening to many more women, a reduction in mammography fees, subsidization of breast cancer drugs, counselling on the benefits of early detection and presentation as well as the need for a robust family and religious body support. The long-term solution proffered by the MDT was; increased future participation by the government in breast cancer management.

BACKGROUND The global cancer burden increases with rising population growth and age. The proportion of cancer occurrences is roughly 12 times higher in Africa than in Europe. In Africa about 4.8% of cancers are in children less than 15 years compared with 0.4% in Europe. South Africa is the only dedicated children’s cancer registry in Africa. There are two population-based cancer registries in Kenya covering less than 20% of the population. The incidence of malignant disease outside of these population is largely unknown in the country.
Problem Statement - Although there is a formal referral process in the public health sector in Kenya, many times the patients who present at Kijabe hospital are exiting that process due to long queues and inefficiencies within the public system. this study will make a retrospective review of pediatric malignant tumors seen in the pathology department at Kijabe Hospital over a ten-year period.
OBJECTIVES To describe incidence patterns of childhood(0-14yrs) malignant tumors presenting in a tertiary health facility in a rural population in Kenya and to compare the incidence to that reported in the Nairobi cancer registry.
METHODS Random stratified research design was employed for the study. A total of 502 histologically confirmed biopsies of malignant tumors comparing with 942 in the NCR were sampled from the hospital data base for period between Jan 2007-Dec 2016 including Malignant tumors for (0-14yrs), demographic date of surgery, date of diagnosis, gross and microscopic description of pathological samples and final diagnosis. Data was analyzed by descriptive statistics and presented in tables, bar graphs and pie charts.
RESULTS AND DISCUSS 502 histologically verified tumors in children 0-14 and 942 in NCR. The male to female was 1;2 compared to 1;4 in the NCR. Leukemia's, soft tissue sarcoma and bone tumors were common in the National cancer registry as compared to the tertiary hospital by 15.9% 11.4% and 3.5% respectively. Brain tumors and nephroblastomas were 5.2% and 3.2% respectively, higher than in the national cancer registry. No retinoblastoma cases were reported in our hospital This shows a generally slightly higher risk of malignant tumors in male children in both settings., and this difference was not significant.
CONCLUSION The study showed a difference in pattern distribution of childhood tumors between the hospital and NCR.
RECOMMENDATIONS The ministry to institute compulsory cancer registration to increase awareness of the growing burden of cancer and encourage private medical institutions to report their cases.

BACKGROUND Worldwide, there are more than 1.8 million new cases of Lung Cancer every year and also Lung Cancer accounts for the highest cancer-related mortality. Despite this, many African countries lack information regarding the epidemiology of lung cancer and its control.
OBJECTIVE To raise awareness, quantify the true burden of Lung Cancer disease in the region and validate tools for case finding in high-risk groups for lung cancer in the community.
METHODOLOGY Since January 2018, case finding for lung cancer using a community engagement approach, at its earliest stage has been the main objective. This has been so due to the fact that diagnosis at an advanced stage remains the main challenge for many low-income settings, as is our case. A model that utilizes education, awareness, and demand for lung cancer services, making good use of the community has been adopted as a strategy to ensure the communities embrace preventive measure to lung cancer and seeks services for early diagnosis in cases of signs and symptoms. For this reason, the program at Academic Model Providing Access to Healthcare (AMPATH) has made efforts to disseminate tools developed for case finding in high-risk clients through cough monitors and chest/TB clinic. This is aimed at integrating them within the service delivery areas for adoption and use for clients presenting with signs and symptoms associated with Lung Cancer or other pulmonary diseases including Tuberculosis (TB).
RESULTS The integration of Lung Cancer awareness measures with TB activities and the community strategy approach involving cough monitors adopted by AMPATH Oncology has significantly improved the need for further screening as well as the attitude on good lung health by the community. Since January 2018, AMPATH Oncology has supported a significant number of clients in achieving optimal lung cancer care. This has led to an increase in the number of clients who have undergone case finding and identified with lung masses.
CONCLUSION Community engagement in Lung Cancer care is a key strategy for realizing an early diagnosis. This is mainly through the case finding approach as well as sensitization of the members of the community to be able to recognize the signs and symptoms.
ACKNOWLEDGEMENTS Funding for this program is provided by the Bristol - Myers Squibb Foundation (secure the future) / under the Multinational Lung Cancer Control Program (MLCCP).

OBJECTIVE Magnetic resonance imaging (MRI) of the spine is an indispensable tool for diagnosis, severity assessment and follow up of spinal tumours. In resource constrained settings, low-field MRI systems are used for spinal evaluation. We retrospectively reviewed the findings in patients with suspected spinal tumours in one of the largest teaching hospitals in Nigeria.
MATERIALS AND METHOD A low-field MRI scanner, Mindray MagSense360, 0.36T was used for imaging the spine of 461 patients aged between 2 and 89 years from 2013 to 2018. The findings were analyzed with clinical and demographic data using descriptive statistics.
RESULTS Forty-seven patients (27 males and 20 females) with spinal tumours were reviewed with a mean age of 49.8±21.8 years. More than one spinal region was examined in 26 (55.3%) patients. Of the total spinal studies, thoracic MRI (31.9%) was the most commonly performed examination followed by thoracolumbar (25.5%), cervical and lumbosacral (12.8% each) thoracolumbosacral (8.51%), cervico-thoracic (6.4%) and cervicothoracolumbar (2.1%). Low back pain was the most common indication,11(22.9%). More than half (53.2%) of the spinal MRI revealed extramedullary tumours, 19.1% were intramedullary, 8.5% showed extradural extramedullary lesion, while 4.3% showed extradural with intramedullary extension, 8.5% showed intradural extramedullary lesion, 2.1% was intradural and 4.3% intramedullary. The distribution of radiological diagnosis included: metastases 21 (44.7%), ependymoma 6 (12.8%), astrocytoma 3 (6.4%), hemangiomas 4 (8.5%), neurofibromatosis/schwanoma 4 (8.5%), lymphoma 3 (6.38%), meningioma 4 (8.51%), myelitis 1 (2.1%) and dermoid 1(2.1%).
CONCLUSION Our results are comparable with other regional studies using high-field MRI for spinal tumour diagnosis globally. Low-field MRI systems represent a useful tool in diagnosis of spinal tumours in low-income and resource-limited countries. Its ability to non-invasively demonstrate compartments of spinal tumours is a significant contribution to clinical and surgical management of patients in Sub-Saharan Africa.

OBJECTIVE As a regional center of excellence, the Uganda Cancer Institute (UCI) receives a huge number of inward patient referrals for cancer treatment. There is however lack of clarity on care pathways for newly referred patients. This ambiguity makes it difficult to identify stages associated with long delays and makes planning for care difficult for patients. We thus aimed to map care pathways and their associated ideal turnaround times to inform the improvement of timeliness in initiating treatment.
METHODS We conducted focus group discussions with key stakeholders at the facility to map the care pathways and the associated ideal turnaround times. The processes pathway was piloted with four patients and modified as appropriate. It was then used longitudinally with fifty patients (n=50) newly referred adult patients, from the point of referral to treatment initiation. We computed average duration by process level and compared it to the ideal turnaround times.
RESULTS Key stages were mapped for patients seeking cancer treatment from referral to UCI to receiving initial treatment with average timelines. These were: confirmation of diagnosis (1 day), registration (1 day), initial clerking (2 days), investigations (2 weeks), senior doctor review (2 weeks) and treatment initiation. The longest periods were taken during investigations and after senior review before actual treatment initiation, mainly due to institutional and financial factors.
CONCLUSION These findings inform quality improvement initiatives as drivers for delays in early treatment initiation are highlighted. It also eases patient navigation and communication as they know what to expect at what level and within what time, for budgeting and planning purposes.

OBJECTIVE The Luo Nyanza is a hub for high statistics of conditions that benefit from palliative care, thus, introducing palliative care in a way that makes it appear cognizant with the Luo may promote its acceptance and uptake. The study sought to explore the perceived meaning and explanation of palliative care among the Luo residents within the three community units linked to Chulaimbo Sub County Hospital, and their utilization of palliative care. One objective was to explore the understanding of illnesses that endanger life, are chronic or are incurable by the Luo community.
METHODS The study took on an Interpretive Phenomenological Analysis approach to exploring the lived and observed experiences of the Luo conditions that needed palliative care and their families. Data was collected through review of secondary data, undertaking structured interviews, key informant interviews, focus group discussions and participant observation and analysed under the thematic areas of the research questions. A total of 43 participants were interviewed.
RESULTS Suggestions were made for definitions and descriptions of palliative care as well as slogans to help increase awareness about palliative care. The descriptions omitted the word ‘Cure’ which indicated that there was understanding that palliative care interventions would not necessarily cure.
CONCLUSION The study population see palliative care as a grey area embedded between the ethno medical and biomedical views of disease causation and treatment. There are opportunities to contextualize the newer conditions in ways that the Luo community can relate with. Anthropological studies should be considered to improve emic understanding of the non-communicable diseases like diabetes, cancer and hypertension.

OBJECTIVES This study was aimed to determine the relationship between vitamin D deficiency and the risk of ovarian cancer among women treated at the gynaecological oncology units of two foremost public tertiary hospitals in Lagos, Nigeria.
METHODS We conducted a case-control study involving 35 women with primary epithelial ovarian cancer (EOC) and 35 cancer-free control women from August 2016 to May 2017. The participants’ sera were then analysed for 25-hydroxyvitamin D levels using the CALBIOTECH® 25(OH) vitamin D ELISA kit. Descriptive statistics were carried out for all relevant data and binary logistic regressions were utilised to determine the relationship between vitamin D deficiency and the risk of EOC after controlling for all confounders.
RESULTS We reported that the odds of having EOC among women with vitamin D deficiency (≤30ng/ml) was not statistically higher than in women with adequate vitamin D levels (P=0.094). The family history of cancers was the only other independent risk predictor of EOC among the study participants (P=0.013).
CONCLUSION This study provided no evidence that low circulating levels of 25(OH)D are associated with increased risk of EOC. Therefore, on this basis, there is no justification for recommending early prophylactic vitamin D supplementation in women with increased risk of EOC. However, there may be a need for a future robust and prospective cohort study of vitamin D levels and EOC occurrence.

OBJECTIVE This study is designed to assess;
1. The cost of cancer treatments
2. To identify the indirect cost of cancer care
3. To determine the major areas of expenditure in cancer care
4. To assess the cost effectiveness of cancer treatment
5. To obtain the annual income of the patients
METHOD This is a one (1) year prospective study design carried out in University of Nigeria Teaching Hospital, Enugu. The study was done using a well-structured interviewer administered questionnaire to obtain the patients’ socio-demographic background information, the cost per session of treatment, the cost of loss of productivity because of illness and cost of other cancer related expenses. Data analysis was performed using IBM SPSS version 20.
RESULT A total of fifty-four (54) cancer patients were interviewed during the period of the study from March 2017 to July 2018. The age range of the patients was from 17 years to 89 years with mean age of 52.3 years. Greater percent of the participants (37%) were traders, followed by civil servants (24.1%) and farmers (20.4%). The mean annual income of the respondents was ₦712,500 (valued in naira). The cost of household living expenses was ₦350,529.49. The mean cost of surgery, chemotherapy and radiotherapy were ₦641, 561.43, ₦287,687.91 and ₦402,530.70 respectively. The average cost of diagnostic care was ₦69,268.80. The mean cost of surgery for breast cancer was 775,880.40 and the mean cost of surgery for prostate and head and neck cancers were ₦258,000 and ₦390,414.30 respectively. The mean cost of radiotherapy for breast cancer, head and neck and cervical cancers were 259,325.00, 303,000.00 and 577,351 respectively. The mean cost of chemotherapy for breast cancer, head and neck and cervical cancers were ₦259,374.00, ₦170,050 and ₦529,757.10 respectively.
CONCLUSION Patients income is disproportionate to the cost of cancer care and there is urgent need for health insurance to cover cancer treatments.

BACKGROUND The burden of cancer will be borne more by developing nations like Nigeria. Breast cancer, the leading cancer among women in Nigeria, will contribute a greater proportion of this burden. It is imperative that a preventive approach to breast cancer through sound knowledge of its risk factors be adopted to reduce the incidence of this disease and its burden. Dietary fat intake and body mass index are known modifiable risk factors of breast cancer. However, objective indices of fat metabolism including lipid profile, percentage body fat and other anthropometric indices and their associations with breast cancer have not been definitively explored in our setting. Furthermore, studies among Africans especially Nigerians are few and far in between.
OBJECTIVE This comparative cross-sectional study aimed to determine the association between lipid profile and anthropometric measurements of breast cancer patients (cases) attending the radiation and surgical oncology clinics at the University College Hospital in Ibadan with apparently healthy age-matched controls.
METHODS The lipid profile, anthropometric indices and percentage body fat of 70 cases of breast cancer and 71 age-matched controls were obtained. The variables of the cases and controls were compared using statistical tests of significance.
RESULTS This study recruited 70 women with breast cancer and 71 age-matched women as controls. The mean age of the study sample was 52years. Over 88% of the cases presented at advanced stage of the disease. Similarly, only 7.5% of cases presented with grade 1 disease. There was a significant association between unemployment and breast cancer. However, this did not remain significant with multivariate analysis. There was an inverse relationship between most of the mean values of anthropometric measures and breast cancer risk. Low percentage body fat remained an independent associated factor on multivariate analysis. The cases of breast cancer had statistically significantly higher serum triglyceride and very low-density lipoprotein cholesterol. These proved to be independent risk factors for breast cancer on multivariate analysis. This indicated every 1mg/dl increase in serum triglyceride increases the odds (risk) of breast cancer by 5.1%
CONCLUSION The patients with breast cancer in this environment present at advanced stage. This was the most likely reason for the inverse relationship between the anthropometric indices along with percentage body fat and breast cancer. The potential for serum triglyceride and very low-density lipoprotein cholesterol to serve as markers for an at-risk group for breast cancer needs to be confirmed by further prospective/longitudinal studies.

BACKGROUND Palliative care is an essential component of the sexual and reproductive health rights of women dying from Gynaecological cancers. There is a global shift towards offering palliative care outside the hospital setting for cancer patients. The place or institution of death is a proxy for the quality of palliative care in a country.
OBJECTIVE We evaluated the trend and predictors of the Place of Death (PoD) of gynaecological cancer patients in South Africa (SA) from 1997 to 2015.
Methods Temporal trend analysis of the annual proportion of gynaecological cancer deaths (ICD-10: C51-C58) that occurred in a PoD (Home/hospice vs Hospital) was conducted with the aid of Join point regression modelling software (version 4.5.0.1), based on data from Statistics South Africa. Multivariable logistic regression was conducted to evaluate the predictors of PoD.
RESULTS Only 27.3% of the 73,286 reported gynaecological cancer deaths occurred at home/hospice and younger women (mean age 56.3±14.7 Vs 60.6 ±15.7, P <0.001) died in the Hospital. There was an initial non-significant increase in proportion of death at home/ hospice from 0.2% in 1997 to 32.5% in 1999 (AAPC= 252.6,P=0.3), followed by a plateau from 1999 to 2005 (from 32.5%-34.6%, AAPC= -0.31%, P=0.8) and then a decline from 2005 to 2015 (AAPC= -5.0%, P<0.001). Having tertiary education (OR=1.3, P=0.006) or cervical cancer (OR=3.7, P=0.001) increased the odds of dying at home/hospice. The odds of dying at home/ hospice was increased (OR=1.3-2.4) in four provinces and decreased (OR=0.4-0.8) in four others.
CONCLUSION A significant decline in the proportion of gynecological cancer deaths at home/hospice occurred in SA from 2005 to 2015 and there was marked provincial variation in the likelihood of dying at home/hospice. The study highlights the need for targeted improvement in palliative care of gynecological cancers in the country. Exploratory studies on PoD preferences and the unmet needs for palliative care among cancer patients is warranted.

OBJECTIVE To determine the histopathological pattern of nodular thyroid lesions in Lokoja metropolis.
MATERIALS ANSD METHODS This is a 12-months retrospective study carried out in the Department of Pathology, Federal Medical Centre, Lokoja, Kogi State from July 2007 to June 2008. All the Haematoxylin &Eosin stained slides and paraffin embedded blocks were retrieved and studied. The clinical data such as the age, sex, site of lesion and clinical summary were extracted from the histology request forms.
RESULTS A total of 21 patients were studied. All the patients were females. The age range is 25-56 years, with the mean age of 40.5 years. The peak age at diagnosis is in the fourth decade. The most common non-neoplastic lesion is nodular goiter which accounted for 13 (61.9%) cases, this is followed by follicular adenoma 3 (14.3%), and thyroglossal cyst 1 (4.8%). The malignant lesions in this study are follicular carcinoma 2 (9.5%), and medullary carcinoma 2 (9.5%). There are no male patients in this study as compared to many studies done in other geopolitical regions of Nigeria.
CONCLUSION Nodular thyroid lesions are common in our environment as it is reported in similar studied across the geopolitical zones in Nigeria. However, this study is unique in the sense that no male patients was found during the period of this report. Thus, there is need to increase the level of awareness and surveillance of this disease among the men in our environment.

BACKGROUND Breast artery calcification (BAC) has been associated with cardio-vascular risk factors (CVRFs). Given the already established relationship between CVRFs and carotid atherosclerosis (CA), this study sought to determine if a similar relationship exists between BAC and CA by measuring common carotid intima-media thickness (CCIMT) among women with BAC on their screening mammogram in the pink month of 2018.
METHODS Eighty-one women with BAC on their mammogram had their CCIMT measured with B-mode ultrasound. Socio-demographic and anthropometric data, history of CVRFs (age, hypertension, diabetes mellitus, smoking, alcohol intake) and risk factors associated with breast cancer (parity, menopausal status, menarche, oral contraceptives, hormone replacement therapy) were recorded. Blood sample was collected for fasting serum total cholesterol and fasting blood glucose. Data were analysed using SPSS version 20.
RESULTS Breast artery calcification was equally distributed in both breasts and there was no predilection for any quadrant (p≥0.05). The prevalence of CA among women with BAC was 59.3%. The CVRFs associated with BAC were age, postmenopausal status, hypertension, diabetes and hypercholesterolemia while CVRFs associated with CA were age, hypertension, obesity and hypercholesterolemia. The independent predictors of BAC were age and CCIMT while those of CA were age and presence of BAC. Women with BAC having 3 or more CVRFs were almost 3 times at risk of CA when compared to women with fewer CVRFs (Odds ratio 2.5; 95% CI: 1.2 to 5.3: p = 0.02).
CONCLUSION Cardiovascular risk screening may be simultaneously assessed during screening mammography. This may provide additional motivation for promoting mammography screening in our setting.

Human papillomavirus (HPV) infection is responsible for nearly all cervical cancer cases. The lengthy progression from infection to cancer makes screening highly effective in reducing cervical cancer cases and related deaths. Cytology-based screening programs have significantly reduced the burden of cervical cancer in developed regions. However, cytology-based screening must be performed frequently and is poorly suited to low-resource settings, where the vast majority of cervical cancer cases and deaths occur. Molecular HPV diagnostics are gaining usage but they are expensive and use is generally limited to centralized laboratories. For screening programs to achieve the same level of success in low-resource settings, an assay with high sensitivity and predictive value over a long period is imperative. Global Good and QuantuMDx are developing a point-of-care molecular diagnostic for the detection and genotyping of thirteen individual high-risk HPV (HR-HPV) types. The cassette-based assay is fully integrated, enabling sample to result in under one hour. The cassette runs on a portable, low-cost, battery-operated device. A vaginal or cervical swab is collected from a patient, the swab is placed in liquid medium, and a portion of the sample is loaded onto the cassette. Sample processing, target amplification, and target detection via DNA microarray hybridization occur on cassette without further user interaction. The assay detects a cellular control and genotypes thirteen HR-HPV types if present, which allows for risk stratification. To date, we have assessed assay performance using contrived and patient samples, including vaginal and cervical swabs from two cohorts. Limit of detection is at or below 50 copies per reaction for each HR-HPV type in patient samples, no cross-reactivity has been detected with low-risk HPV types or non-HPV DNA, and assay performance is comparable with vaginal and cervical samples. Preliminary patient data are concordant with clinically approved reference methods. In a study with 94 Peruvian women, sensitivity was 93% and specificity was 100%. We expect the simplicity, affordability, and risk stratification provided by this assay to enable same day diagnosis and management at point-of-care.

OBJECTIVE Availability and affordability of cervical cancer screening is an issue causing low uptake of community screening services amongst African women, this is due to several reasons such as; the wrong perception towards screening, low awareness, cost of screening and treatment interventions, etc.
The TimeToScreen (TTS) initiative by Sebeccly Cancer Care is a comprehensive breast/cervical screening and treatment campaign. The goal of this initiative is to improve awareness and increase access to breast/cervical screening and treatment amongst women in rural and urban communities.
This study analyses the screening findings of the TTS initiative.
METHOD The TTS program conducted 20 free in-house clinics and 25 communities across SouthWest Nigeria. In 14 months, a total of 4,422 African women were screened for breast and cervical cancer. Baseline and follow-up data were used to access the screening outcome.
RESULT The uptake of cervical cancer screening services amongst the participants was 84% (3,698 women). Visual Inspection with Acetic Acid(VIA) was the primary screening method for 98.38% (3,639 women),1.5% (55 women) conducted pap smear and 0.14% (5 women) conducted Human Papilloma Virus DNA. Only 3.27% (121 women) of the participants had a positive acetowhite lesion on VIA testing of which diagnostic colposcopy was conducted for 57.02% (69 women) of the participants. A total of (30.43%) 21 women were diagnosed with Cervical Intraepithelial Neoplasm and treated with cryotherapy. About 3.31% (4 women) were diagnosed with invasive cervical cancer.
CONCLUSION This study shows that there is a relatively high level of screening uptake by African women when available and made affordable. There is a need for more community education, screening, and treatment campaigns amongst African women.

OBJECTIVE Sonomammography (Breast ultrasound) is a known adjunct to mammography but invaluable in the evaluation of mammographically dense breasts with palpable masses. In diagnostic work up of breast lesions, it can characterize masses into low, intermediate and high probability of malignancy. This study aims to describe the clinical, imaging and pathologic findings in women who underwent diagnostic Sonomammography in University College Hospital, Ibadan.
METHODS AND MATERIAL A descriptive study conducted at the Radiology Department of UCH Ibadan over a period of one year. Ethical approval was obtained from the joint Institutional review board of the UCH and UI. All patients for a diagnostic Sonomammography were recruited into the study after obtaining informed consent. Sonomammography was performed with BIRADS (Breast Imaging Reporting And Data System) categories assigned at the end of the scans. Patients with masses had tru-cut biopsy performed. Clinical data were obtained from patients’ request cards. The sonomammogram images were obtained from the LOGIC General Electric Ultrasound machine.
RESULTS A total of 128 patients who had diagnostic sonomammography performed were studied. They were predominantly female 127 (99.2%) with age range of 15 – 75 years. More than half (56.3%) were in the 30-49 age group. Most of the symptoms in the patients were breast pains and lumps. Close to half of the patients 57/128 (44.5%) had no parenchymal lesions. Majority of the Sonomammographic findings in all age groups ranged from normal to probably benign findings. Final BIRADS Categories of 1-3 were predominant in younger age group, however Final BIRADS Category 4 and 6 were recorded in the older age group. There is positive association between the Final BIRADS category on Sonomammogram and Histology findings.
CONCLUSIONS In Nigeria, the absence of state of the art imaging modalities makes sonomammography an attractive diagnostic tool. Although breast cancer incidence is increasing on the continent, however, the majority of breast diseases are benign and primarily seen in women of reproductive age. The various Sonomammogram features are useful in distinguishing benign from malignant lesion.

OBJECTIVE Diffuse large B-cell lymphoma (DLBCL) is common in Africa, and often curable, but treatment costs and cost-effectiveness are key considerations; we sought to assess the cost-effectiveness of DLBCL with CHOP chemotherapy (cyclophosphamide, vincristine, doxorubicin, and prednisone).
METHODS We used a decision tree model to conduct a cost-effectiveness and budget impact analysis from a health systems perspective in Malawi (2017 GDP per capita $340). Comparisons were made between CHOP vs. palliative care with diagnosis (PC+D), and palliative care without diagnosis (PC-D). Microcosting was conducted for purposes of this study and clinical outcomes were derived from previously published prospective data. Costs reflect treatment and 2 years of follow-up. Outcomes reflect a lifetime time horizon. Life expectancies were derived from UN data, and disability-adjusted life year (DALY) weights from the Global Burden of Disease Study. Costs were analyzed in 2017 US $, and costs and outcomes were discounted at 3% annually. Annual estimates for new DLBCL cases (n=161) were used as input incidence. Probablistic sensitivity analysis was conducted using Crystal Ball software over 1000 simulations.
RESULTS In the base case scenario, under treatment with CHOP, 64 deaths and 1260 DALYs were averted compared to palliative care alone. The total cost of DLBCL treatment for 161 cases annually was $306,221 for CHOP, $117,098 for PC+D, and $53,958 for PC-D. For the base case, the incremental cost-effectiveness ratio (ICER) of CHOP versus PC+D is $150/DALY averted, and versus PC-D is $200/DALY averted. The ICER was stable across a wide range of sensitivity analyses. The ICER varied most across the range of progression-free survival estimates ($117-209), and range of costs for CHOP plus follow-up ($71-308). CHOP was extremely cost-effective by the WHO definition in 99% of simulations versus PC+D, and 94% of simulations versus PC-D. In the base case, total annual cost of DLBCL treatment with CHOP in Malawi was $306,221.
CONCLUSIONS This is one of the first rigorous cost-effectiveness and budget impact analyses for cancer treatment in a low-income country. CHOP is extremely cost-effective compared to palliative care, with ~$300,000 needed annually to treat all DLBCL cases in Malawi. These findings merit external validation, and support continued regional investments in cancer care.

OBJECTIVE Tobacco use, the leading preventable risk factor for cancer worldwide, is increasing on the African continent. We assess current efforts and barriers to tobacco control and connections within the tobacco control community in Africa to identify opportunities to strengthen tobacco control efforts.
METHODS An online survey was sent to individuals, coalitions, and organizations working in tobacco control in the African continent and a snowball sample design was employed to achieve saturation. The survey was administered in English, French, and Arabic and included basic demographics, FCTC articles of focus, barriers to tobacco control, and current tobacco control activities. Social network questions assessed connections between individuals and organizations and perceptions of influence in the region.
RESULTS The survey was completed (n=221) in English (77.4%) and French (22.6%) with nearly 90.0% from an African country, and 10.7% from a non-African country. Most respondents were working in tobacco control research (38.0%), capacity building (10.0%), patient care/treatment (10.9%), and advocacy (12.2%). Barriers to tobacco control frequently cited were weak funding, tobacco industry interference, and research being a low priority. Significant differences by country were seen for work on the following FCTC articles: Protect (F36,175=1.63, p=0.021), Warn (F36,175=1.64, p=0.019), Enforce (F36,175=1.90, p=0.003), Raise (F36,175=1.59, p=0.026), and Industry Interference (F36,175=1.61, p=0.023). The collaboration network included 515 individuals with 702 connections between nodes. Individuals in the collaboration network were from 52 unique countries, with the largest numbers from Nigeria (14.7%), South Africa (7.1%), United States (6.9%), Tunisia (6.2%), Kenya (5.8%), and Uganda (5.6%).
CONCLUSIONS There is an active tobacco control community in Africa, which has been advanced through the FCTC process. However, there remain substantial disparities in tobacco control efforts across African countries and research topics. Future tobacco control efforts could benefit from enhancing and building new collaborations across the region and with local and international partners.

OBJECTIVE Cervical cancer is preventable with vaccination and effective screening, yet is responsible for many unnecessary deaths across Africa. Specific high-risk subtypes of human papilloma virus (HR-HPV) are established as the cause of cervical cancer. Our objective to compare the effectiveness of two community-based cervical cancer screening models using self-collected HPV testing: 1) Community health worker recruitment (door-to-door); and 2) community health meetings.
METHODS A pragmatic cluster randomized controlled trial design in Mayuge district; 31 villages will be randomized to one of two treatment arms. Women will be eligible to participate if they have no previous hysterectomy or treatment for cervical cancer or pre-cancer and are aged 25-49 years old. All participants will receive an integrated package of cervical cancer screening and education. Samples will be tested using GeneXpert point of care testing for HPV. All women who test positive for HR-HPV types will be referred to a designated health centre for follow-up by visual inspection with acetic acid (VIA) and treatment, when indicated. The primary outcome is rate of attendance for VIA follow-up after a positive HR-HPV test among all screened women. Secondary outcomes include screening uptake; HPV incidence; and CCS knowledge and patient reported experience. Cost-effectiveness analysis and process evaluation informed by the RE-AIM framework will also be completed to understand best practices for implementation of CCS in communities.
DISCUSSION The integration of a self-collected cervical cancer screening program using HPV testing within community-based health systems could increase access to screening and reduce cervical cancer rates among Ugandan women. Results from this study will inform the national scale-up of cervical cancer screening in Uganda, aligning with the WHO’s target of achieving cervical cancer elimination through the pillar of increased HPV screening coverage.
Trial Registration: ISRCTN12767014

PURPOSE Breast cancer is the most common cancer in women and a leading cause of cancer-related mortality worldwide. South Africa has the largest global burden of HIV infection and the largest anti-retroviral treatment (ART) program. This study aimed to analyse the association of HIV and ART use with breast cancer clinico-pathological characteristics.
METHODS Study participants were females, newly diagnosed from May 2015 through September 2017 with invasive breast cancer at two academic Surgical Breast Units in Johannesburg, South Africa at the Charlotte Maxeke Johannesburg Academic Hospital and Chris Hani Baragwanath Academic Hospital. We compared HIV-positive and HIV negative patients’ demographic and clinical-pathological characteristics at the time of breast cancer diagnosis.
RESULTS Of 1050 patients enrolled, 1016 (96.8%) had known HIV status, with 226 (22.2%) being HIV positive. HIV positive patients were younger (median (IQR) age 45 (40-52) years), than HIV-negative patients (median (IQR) age 57 (46-67)) (p<0.001). HIV positive patients were more likely to be diagnosed with late stage breast cancer(p=0.01). However, HIV positive patients receiving ART at the time of breast cancer diagnosis were less likely to present with metastatic disease than those not on ART (p=0.05).
CONCLUSION HIV-positive patients present with breast cancer at a younger age and later stage disease than HIV-negative patients. Neither the duration of HIV infection nor ART use was associated with clinico-pathological characteristics of breast cancer.

OBJECTIVE Image guided brachytherapy has been demonstrated to improve overall dosimetry and treatment outcomes. CDH is in the process of introducing ultrasound as a guiding mechanism in intracavitary brachytherapy application. A change in protocol requires that evidence is generated to show increased benefit of a new system. The aim of the study was to evaluate the new system in order to generate evidence that supports implementation.
METHODS A total of 44 patients with stages 1-4 cervical cancer were randomly recruited into two equal arms. One arm utilised ultrasound as image guidance whilst the other used screening with only a C’arm fluoroscopy unit. Insertions in the latter were evaluated as either successful or not by using an ultrasound to assess if applicator had been inserted correctly. Data was analysed using Stata 13 and grapfpad prism.
RESULTS The mean age for the cohort was 50.4 years (SD 11.53). A total of 49 % were married whilst 29% were widowed. Slightly over half (55%) were HIV positive. In terms of tumour size mean area was 25cm2 (SD 14.17) at initial assessment. At time of first brachytherapy 61% had a good tumour response. There was no significant difference in the time taken to complete the procedures. Overall 68% of all applications were considered successful. When Fisher’s exact test was done, initial tumour stage, age, marital status, and applicator size had no effect on the successful application (p>0.05). Tumour size at application and use of ultrasound had an association with successful application (p<0.05). Regression module with the above variables was generated (R-squared 0.662). Ultrasound use was found to be a critical component (p<0.0001) in the model.
CONCLUSION The use of ultrasound is associated with better application outcomes compared to use of C’arm only as image guidance.

INTRODUCTION Palliative Care remains limited, inaccessible or even absent in Low and Middle Income Countries. Although still challenging, diagnostic information, breaking bad news, and end-of-life decision making remain an essential part of medical practice.
OBJECTIVE to evaluate the knowledge, attitudes and practices of Mozambican’s physicians in PC.
METHODS A cross - sectional study was conducted between 08/2018 and 01/2019 to physicians from different departments in 4 hospitals in Mozambique, after approval by the Institutional Committee of Bioethics in Health of the Faculty of Medicine / Central Hospital of Maputo (CIBS FM & HCM). Data was collected by a questionnaire and introduced and analyzed with SPSS Statisticssoftware (version 25).
RESULTS From a total of 306 physicians, 207 answered the questionnaire. The median age of respondents was 38 years with 9 years of working experience, in average. There was a predominance of females, resident physicians and surgery specialists. Of these 207 answered questionnaires: 83.8% answered that PC should be considered when patients cannot be submitted to surgery, radiotherapy, chemotherapy or other anti-cancer therapies; 87.3% believed that early integration of PC can improve patients’ quality of life; 72.7% informs the patient about the cancer’s diagnosis; 60.1% prefers to inform the diagnosis and prognosis to the family / caregivers; 50% knows what is a do-not-resuscitate order, and 51.3% know what palliative sedation is. But only 25% participants had correct answers general knowledge, and 24% of them knew all answers about euthanasia and related issues.
CONCLUSION Mozambican physicians have insufficient knowledge toward PC and related issues. More interventions and training should be done to improve PC in Mozambique.

BACKGROUND Palliative Care is not integrated into the national health system in Mozambique, however, physicians deal with patients who need these care every day.
AIM To identify the care offered to patients in palliative care, and the challenges that physicians face in their daily practice, in the main hospital in Mozambique.
METHODS A qualitative, descriptive and exploratory study was conducted between December 2018 to January 2019 in Maputo Central Hospital. Data was collected by an individual interviewees survey directed to physicians in Oncology, Gastroenterology, Nephrology and Neurology. The sample was the intentional type, determined by saturation of responses in services with oncological patients. The analysis of the results was analysis' content method, Bardin’s technique.The study was approved by the Institutional Committee of Bioethics for Health of the Faculty of Medicine & Maputo Central Hospital and by the Bioethics Committee of the School of Medicine of Porto´s University.
RESULTS Fourteen physicians surveyed participated in the interview, the mean age was 38 years and 13 years of working experience. Most of them (64.3%) were specialists. All interviewees deal with palliative care patients daily, but the majority of them (64%) hadn’t training in palliative care. The care offered to these patients is focused on control of physical symptoms and psychosocial support. The main barriers were: lack of training in palliative care, difficulty in breaking bad news, lack of medication, excessive regulation in opioids’ prescription, and lack of integration of palliative care in the education curricula and in the national health system.
CONCLUSION Mozambican's physicians do not have a holistic approach to palliative care patients, and they face enormous challenges in providing this care. The main barriers begins from training to access to essential medicines.

OBJECTIVE The objective of this study is the identification of specific miRNAs, which are able to modify retinoblastoma progress through their transport by exosomes. Co-culture of monocytes with CHLA-215 retinoblastoma cell line, showed a significant growth decrease. Given the interaction between the retinoblastoma cells and monocytes we investigated the role of the supernatant in the exchange between the cell lines, by taking the product of the co-culture and then using it as a culture medium of the RB cells, analyzing afterwards the growth curve of CHLA-215 in order to assess a possible influence of the elements which were present in the supernatant.
METHODS After CHLA-215 culture with the above-mentioned medium, we determined that, even if monocytes were absent, the co-culture supernatant continued inhibiting the growth of RB. For these reasons we isolated the medium’s exosomes with SEC (Size Exclusion Chromatography) and we further identified the enriched fractions to be analyzed through NANOSIGHT. Then, we performed a microArray miRNAs profiling of CHLA-215 and exosomal RNA derived from co-culture supernatant.
RESULTS As a result, two miRNAs (miR-142-3p and miR150-5p) showed to be particularly over-expressed both in the CHLA215 and in the medium used for their culture, comparing to their control cell line and to the normal supernatant respectively. Therefore, we provided evidence that miR-142-3p and miR150-5p were released by monocytes in the co-culture medium and that they were subsequently up-taken by RB cells within exosomes.
CONCLUSIONS We assume that miR-142-3p and miR150-5p are strictly related to the inhibition of the proliferative capacity of retinoblastoma cell line participating eventually to pathways associated to cell cycle progression. This study highlights the role of exosomic miRNAs and identifies new molecular targets of the microenvironment, which are able to control tumour progress.

INTRODUCTION Cisplatin is a potent chemotherapeutic agent that is commonly used to treat a wide variety of tumours. Although highly effective, its administration is complicated by its ototoxic effect, a well known side effect that occurs in a significant number of patients. The hearing loss observed is typically irreversible, progressive, bilateral, high frequency sensorineural hearing loss associated loss associated with tinnitus. At present there is no approved method for protecting or remedying against deterioration of hearing status, therefore the detection and appropriate management of cisplatin induced Ototoxicity is reliant on effective audiological monitoring.
AIM To determine the hearing threshold/ pure tone averages and pattern of hearing loss among patients with nasopharyngeal/ laryngeal/ sinonasal cancers before and after undergoing cisplatin based chemotherapy.
METHODOLOGY This hospital based longitudinal study involved 54 participants attending oncology treatment centre of the Ahmadu Bello University Teaching Hospital Zaria. The study investigated the hearing thresholds, types and degree of hearing loss, through pure tone audiometry, before commencement of treatment and repeated at 3 months and 6 months after undergoing cisplatin based chemotherapy matched with control. The data was analysed using Statistical Package for Social Science version 20.
RESULTS Seventy two participants were recruited into the study but fifty four participants concluded the study. Eighteen of the participants for various reasons dropped out of the study. Of those that completed the study 31 had nasopharyngeal tumour, 14 had Sinonasal tumour and 9 had Laryngeal tumour.
Among the study group there are 39 males (72.2%) and 15 females (27.8%) with a M: F ratio of 2:6:1. The age of participants ranged from 13-68 years. (M=40.3years. SD=13.6).
In the better hearing ear 22 (40.7%) subjects and 6 (11.1%) controls have hearing loss pretreatment. There were 32 ears that showed changes in PTA after 3 months of cisplatin therapy and 68 ears showed changes at 6 months of therapy .These changes were either new onset SNHL or changes in severity of pre existing SNHL. The overall prevalence of Ototoxicity after 6 months of therapy was 62.9%.
CONCLUSION This study found that a significant number of patients with head and neck cancer have hearing impairment even before commencement of chemotherapy. Cisplatin treatment resulted into changes in pure tone averages either as new onset sensorineural hearing loss or worsening of existing hearing loss; this hearing loss appeared to progressively worsen over 6 months of this study.

OBJECTIIVES Although cervical cancer has a higher prevalence in Mozambique, vulvar cancer is the fourth most common gynecologic cancer and contains 5% of all malignancies of the female genital tract. The objective of this study is to describe the surgical treatment and the outcomes of the vulvar cancer patients at Maputo Central Hospital.
METHODS It is a retrospective study describing the vulvar surgical cases, performed as part of the fellows International Gynecologic Cancer Society (IGCS) Global Curriculum training in Maputo, Mozambique. From October 2016 to February 2019 medical records, clinical charts, and operative records of vulvar cancer patients were reviewed.
RESULTS Since the program started, we have done 16 surgeries for vulvar cancer: 11 radical vulvectomies with inguinal linfadenectomy, three simple vulvectomies and two wide vulvar resection. Four patients required vulvar flap reconstruction. No flap necrosis was reported and despite a partial wound breakdown in 6 (38%), all patients had satisfactory post-operative outcomes.
CONCLUSION We have been able to treat women with vulvar cancer mentored and supervised by the international mentors even when the patients needed flap reconstruction in vulvar excisions. This approach results in adequate cosmetic outcomes and good functionality of the vulva.

PURPOSE Radiotherapy (RT) is an essential component of cancer treatment. There is a lack of RT services in Sub-Saharan Africa as well as limited knowledge regarding clinical practices. The purpose of this study was to identify and describe the patterns for RT treatment in Ethiopia.
MATERIALS AND METHODS We retrospectively evaluated charts of 1823 patients treated with Cobalt RT at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia, from May 2015 through January 2018. Paper charts were reviewed for patient and treatment characteristics. Descriptive statistics were computed using SPSS.
RESULTS Among treated cancer patients, 98% were adults (n=1784), 78% female (n=1426), 5% HIV positive (n=85), 30% were from Addis Ababa (n=555), and the median age was 48 years (IQR 38-58). Cervical cancer was the most frequent cancer treated (47%, n=851) followed by breast cancer (15%, n=274), and head and neck cancer (10%, 184). Seventy-three percent (n=1339) of patients presented at late stage and 62% received palliative RT (n=1138). The most frequent palliative RT regimen was 20 Gy in 2 fractions for cervical cancer and 20 Gy in 5 fractions for many other late stage cancers (n=672, 37%). The wait times were the shortest for patients receiving palliative treatment (median 0 days, IQR 0-15 days, n=1138), compared to long wait times for curative treatment (median 150 days, interquartile range 60-210 days, n=685). Three percent (n=56) had documented grade 3-4 toxicity; of these 59% were head and neck cancer (n=33).
CONCLUSIONS Cervical cancer accounted for half of patients treated thus a majority of patients were adult females. Most patients had advanced stage cancer and goals of care were palliative. Wait times were long for patients with curative intent cancer due to low capacity for RT services.

OBJECTIVE Data on cancer development and treatment have largely been propelled by studying the underlying genetics of cancer in non-African nations. This has resulted in a dearth of knowledge on the cancer genetics of African people. There is, therefore, need to assess the state of cancer genetics and genomics research and the capacity for such research in Africa.
METHODS We performed a meta-analysis by reviewing publications on cancer genomics, genetics or molecular biology conducted by Africans on African populations. Pubmed meta-data of the relevant publications from 1990 to March 2019 were retrieved using R text mining packages, RISmed and Pubmed.mineR.
RESULTS The data showed that only 0.51% of nearly 2.5 million cancer publications globally were generated in Africa and only 0.07% were pertaining to cancer genomics studies conducted by African institutions. About 16.5% of the 11,459 authors had a USA affiliation. The African countries with the greatest number of affiliations were Tunisia (16.4%), Egypt (13.3%), Morocco (6.2%) and South Africa (5.6%). However, there were more authors from non-African countries than there were from within Africa with the USA contributing more authors than other non-African countries. Twenty-one countries in the Sub-Saharan region (40%) had no contributing author in any of the publications reviewed. Next, we sought to normalize the number of contributing authors to each country’s cancer incidence as reported in Globocan 2018. This analysis demonstrated that Tunisia had the greatest ratio of authorship to incidence than any other African country. Although the most prevalent cancers in Africa are breast, cervical and prostate cancer, publications related to breast, liver and colorectal cancers were the most numerous, suggesting that the most burdensome cancers are not being studied adequately. Lastly, our analysis revealed that the most frequently mentioned genes in the existing literature were BRCA1, BRCA2, TP53, and EGFR, illustrating the extreme gap in knowledge and need to further study cancer genetic determinants of Africans.
CONCLUSIONS This study highlighted the paucity of research on cancer genetics conducted by and on African populations. There is a need for concerted efforts to educate and equip African nations to study either solely or collaboratively the growing cancer problem and its underlying genetic causes.

OBJECTIVE Retinoblastoma (RB) is the most common primary intraocular malignancy of childhood. The main objective of this study was to describe the pathologic characteristics of enucleated eyes of patients diagnosed with RB, focusing on features related to high-risk of metastatic spread.
METHODS We conducted a retrospective review of all enucleated eye samples received in our pathology unit from January 2015 to October 2018. Information was extracted from our pathology reports and sample submission forms. Tissue blocks and glass slides were also reviewed where necessary. Data entry and analyses were performed using SPSS Version 16.0 software.
RESULTS A total number of 118 patients with RB were identified (56% male and 44% female). The median age at enucleation was 24 months and 89% were below 5 years. Unilateral disease was predominant at 95.5% and bilateral eye involvement was seen in 8.5% of cases. No trilateral cases were identified. The majority (90.7%) of patients had enucleation while 9.3% underwent exenteration procedure due to advanced disease. Most patients (92%) fell within Group E (very high-risk category), according to the International Classification of Intraocular Retinoblastoma. Pathologic high-risk characteristics were present as following: anterior chamber invasion (20%), massive choroid invasion (65%), optic nerve invasion (prelaminar: 6%, retrolaminar: 26%, resection line involvement: 22%) and extraocular extension at 34%).
CONCLUSIONS Our patients tend to present with characteristics for high risk of metastatic disease, probably due to late presentation. This may reflect a lack of awareness about early signs of RB in primary health care and the Rwandan population. Raising awareness about RB is needed.

BACKGROUND The gastrointestinal tract and the accessory organs of digestion are responsible for more cancers and more deaths from cancer than any other system in the body.Yet, there is significant geographic variation in the rates of different gastrointestinal cancers worldwide.
AIM This study was undertaken to determine the relative frequencies and histopathological characteristics of gastrointestinal malignancies seen in a tertiary Hospital in Northwest Nigeria.
METHODOLOGY The material used for this study consisted of paraffin embedded tissue blocks, histology glass slides and histology report forms of all malignancies of the gastrointestinal system received between January 2006 to December 2015 in the Department of Histopathology, Usmanu Danfodiyo University Teaching Hospital. Data were analyzed using SPSS version 20 and expressed as simple frequency tables with percentages.
RESULT There were a total of 398 cases of gastrointestinal malignancies histologically confirmed out of 3933 malignancies during the study period, these constituted 10.12% of all the malignancies in the same period. The mean age of patients was 45.5±16.7, with an age range of 3-90 years. The peak age incidences are 6thand 7th decade of life which constituted 43.7%. Two hundred and eighteen (54.8%) were males, and 180(45.2%) were females, with a male to female ratio of 1.2:1. About 48.7% (194 cases) of gastrointestinal malignancies were adenocarcinoma. Out of 194 cases, 49.% (95) were well differentiated, 41.2% (80 cases) were moderately differentiated, and 9.8%(19 cases) were poorly differentiated. The commonest anatomical site affected was Colorectum 174(43.7%), followed by Anal 76(19.1%), Gastric 53(13.3%), Peritoneum 42(10.6%) and Oesophagus 23(5.8%)
CONCLUSION Colorectal adenocarcinoma remains the commonest GIT malignancies in our center. However, our review highlights the need for incidence data in many regions of the world, particularly from developing countries. Future genetic studies in these regions are required to provide further insight into the genetic basis of these GIT malignancies.

INTRODUCTION Gynaecological malignancies constitute the largest group of cancers in females. With the introduction of screening centres for cervical cancer in most teaching/specialist hospitals in Nigeria, it is hoped that the incidence of cancer of the cervix and other gynaecological cancers will be reduced.
OBJECTIVES The aim of this study was to determine the pattern and relative frequencies of gynaecological malignancies as seen at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
METHOD This was a retrospective study of all female patients who were histologically confirmed to have malignancies of the genital tract at Histopathology Department of Usmanu Danfodiyo University Teaching Hospital, Sokoto from January 2010 to December 2015. Information was obtained from database of Department using histology request cards, histology and cytology registers. The data were validated using Microsoft Excel and exported to SPSS for analysis. The data was analysed for age, sex and histological types using SPSS version 20 software. The results are presented in form of simple frequency, percentages and tables.
RESULT There were a total of 444 cases of gynaecological malignancies seen during the study period. The mean age of female patient was 47.4 with SD±16.5, and age range of (3 – 92). 248(55.9%) had cervical cancer, followed by ovarian cancer 105(23.6%), uterine cancer 76(17.1%), cancer of the Vulva 10(2.3%), and vagina 5(1.5%) respectively.
CONCLUSION Cancer of the cervix uteri ranked highest and it remained the most common female genital tract malignancy in our study. Health education and public enlightenment on the importance of routine screening and treatment of pre -malignant lesions of the cervix are necessary tools to reduce the incidence, morbidity and mortality associated with this disease.

OBJECTIVE Ovarian cancer is the second most common female genital cancer in Nigeria. This study aimed to determine the association between serum vitamin D level and risk of ovarian cancer in women in Lagos, Nigeria.
METHODS We conducted a cross-sectional study carried out from the 1st August 2016 to 31st May 2017. Demographic characteristics including type of clothing, average number of hours spent outdoors and skin complexion of 35 women with primary epithelial ovarian cancer and 35 apparently healthy women were obtained using a questionnaire. Venous blood was taken from each participant to determine serum 25-hydroxyvitamin D [25(OH)D] level using the Calbiotech 25(OH) vitamin D ELISA kit. Mann-Whitney U and Pearson’s Chi square tests were used to compare the median vitamin D levels among the two groups of participants Univariate and multivariate binary logistic regression analysis were conducted to evaluate the relationship between vitamin D levels and the risk of ovarian cancer. Vitamin D deficiency was defined as: vitamin D serum levels ≤20ng/ml. Stata Version 13 statistical package was used for the statistical analysis.
RESULTS The mean age of the participants was 50.6(±11.1) years. The incidence of vitamin D deficiency among all the participants was high (62.9%) but the median vitamin D level in the ovarian cancer patients was lower as compared to the apparently healthy women (13.5 ng/ml, 95%CI: 9.2 –21.2 vs 20.0 ng/ml, 95% CI: 13 - 37.2, p-value = 0.0061 respectively). Vitamin D deficiency was associated with a four-fold risk of developing epithelial ovarian cancer (p-value =0.049).
CONCLUSION This study revealed that low circulating 25(OH)D levels may be associated with the risk of epithelial ovarian cancer. It is recommended that larger studies are done in the future to evaluate the association between serum vitamin D levels and epithelial ovarian cancers in women in Nigeria.

OBJECTIVE Brachytherapy plays a crucial role in the treatment of cervical cancer. In 2014, our institution transitioned from low dose rate (LDR) brachytherapy to high dose rate (HDR) brachytherapy. We report the clinical outcomes for cervical cancer patients treated with curative intent with LDR vs. HDR brachytherapy at our institution from 2008-2017.
METHODS This is a retrospective study of stage IB–IIIB cervical cancer patients, treated with primary radiotherapy from 2008–2017. Clinical and treatment prognostic factors including age, stage, relevant radiation doses, chemotherapy use, duration of treatment and toxicity data were recorded. The linear-quadratic formula was used to calculate the LDR dose-equivalent to Point A for the HDR treatments.
RESULTS Over the 10-year period, 284 LDR (2008 –mid-2014) and 136 HDR (mid-2014-2017) patients fit the inclusion criteria. The average follow-up was 82.29 vs. 17.97 months in LDR vs. HDR group respectively. For all stages combined, the 2-year local control (LC) rates were comparable between the LDR and HDR groups (80.6% and 77.9% p=0.520) respectively. For stages IB, IIA, IIB, IIIA and IIIB disease, the 2-year LC rates for LDR vs. HDR were 65.4% vs. 64.3% p= 0.409, 86.3% vs. 90.0% p=0.680, 86.4% vs. 88.0% p=0.798, 66.0% vs. 60.1% p=0.674 and 77.0%vs 40.4% p= 0.004 respectively. Acute and Chronic toxicities for LDR vs. HDR were 30.3% vs. 31.6% p=0.781 and 43.7%vs.27.2%, p=0.001 respectively. The overall survival is pending.
CONCLUSIONS Comparable LC was observed for IB, IIA, IIB and IIIA patients treated with LDR or HDR brachytherapy. Also the chronic toxicity was better in the HDR group. It can therefore be concluded that HDR brachytherapy for the treatment of cervical cancer is a viable alternative to conventional LDR. However, poorer the LC rate observed for IIIB patients treated with HDR brachytherapy highlights the need for continued refinement of HDR methods at this institution.

INTRODUÇÃO O carcinoma coloretal (CCR) é a doença cancerosa que afeta o intestino grosso e/ou o recto com maior disseminação mundial, e é a terceira causa mais frequente de mortalidade por câncro no mundo. Vários estudos sobre o CCR tem sido conduzidos em países de renda alta a média, porém, nenhum estudo foi conduzido em Moçambique. O objectivo deste estudo é de descrever as características clínicas e anatomo-patológicas dos doentes operados por carcinoma colorretal no Hospital Central de Maputo de Janeiro de 2012 a Dezembro 2014.
MATERIAL E MÉTODOS Foi realizado um estudo descritivo, transversal e retrospectivo, com recurso a dados secundários, onde foram descritas as características demográficas, clínicas e anatomo-patológicas, encontradas nos processos clínicos, relatórios anatomo-patológicos de todos doentes submetidos a tratamento cirúrgico e internados na enfermaria de cirurgia do Hospital Central de Maputo, no período entre Janeiro de 2012 e Dezembro de 2014.
RESULTADOS No período entre 2012 e 2014, foram registados 33 casos de cancro colorectal, dos quais 15 (45,5%) em 2012, 2 (6,1%) em 2013 e 16 (48,5%) em 2014. Dos 33 casos, a idade variou dos 20 a 76 anos com uma idade média de 46 anos (DP = 14,9). Vinte e cinco por cento dos pacientes com CCR tinham idade inferior a 32 anos. Dos 33 casos 67% eram do sexo masculino. O tamanho mediando do tumor foi de 3,0cm x 3,0cm x 2,0cm. Dos 31 pacientes com registo da localização do tumor, a maior parte (35,5%) foi no recto, seguido de colon ascendente (19,4%). Dos 11 pacientes com registo do estadiamento clínico de Dukes, a maior parte (54,5%) esteve no estadio B. Dos 26 pacientes com registo de características macroscópicas, 18.5% eram ulcerativos e úlcero-infiltrativos. Dos 33 pacientes com registo de informação do tipo histológico de cancro colorectal, a maior parte (66,7%) foi do tipo adenocarcinoma.
CONCLUSÕES Neste estudo o CCR afectou pacientes, de ambos sexos, na faixa etária dos 20 aos 76 anos, em que a maior parte estão localizados no recto. A maior parte dos CCR são do tipo histológico adenocarcinoma. Falhas no registo de informação importante foram observadas em várias variáveis clínicas e anatomo-patológicas.

OBJECTIVE Radiotherapy (RT) is an essential component of effective treatment for many cancers, yet many African countries do not have adequate RT capacity to serve their populations. In the setting of limited resources, RT may be rationed implicitly based on factors such as ability to pay, or explicitly based on agreed-upon prioritization methods. The oncology team at Butaro Hospital in Rwanda has developed, implemented, and revised RT prioritization guidelines with the goal of maximizing clinical benefit. Here we aim to describe this process and share our guidelines with others facing limited RT resources.
METHODS In 2016 our team established preliminary RT prioritization guidelines through expert opinion. Patients were categorized by disease, stage, age, and other relevant factors, and prioritized based on estimates of potential survival benefit from RT. After two years of practical experience using these guidelines, we sought to revise them through a three-step process. First, we performed a comprehensive literature review to compile evidence that facilitates objective comparison across cancer types. Second, we held an external consultation session with global radiation oncology experts to discuss application of this evidence to RT prioritization. Third, the Butaro oncology team convened to finalize revisions of the guidelines using fair deliberative process, drawing upon the literature review, expert recommendations, and qualitative data indicating the beliefs of program stakeholders about non-clinical factors and values that supplement objective clinical criteria.
RESULTS After a thoughtful and consultative multiphase revision process we established new radiotherapy prioritization guidelines which are more evidence-based and consider both clinical and non-clinical criteria, which will be summarized in our presentation.
CONCLUSIONS This process highlighted the complexities of prioritizing radiotherapy patients in a country with limited resources, the importance of international collaborations, and the need for ongoing revision of guidelines using an evidence-based approach.

OBJECTIVE High-rates of lost to follow up is a major challenge to providing cancer care in low-resource settings. This study aimed to evaluate the impact of a call back system implemented at Rwanda’s Butaro Cancer Center of Excellence (BCCOE) on patient retention among those who miss scheduled oncology clinic or chemotherapy appointments.
METHODS BCCOE uses an electronic medical record (EMR) system to manage patient schedules and track visits. Historically, patients who do not present within two days of a missed appointment are unlikely to return within six months. A call back system was implemented since December 2017 where lists of patients who missed an appointment are generated weekly by EMR and used by nurses to call patients to reschedule the appointment. Information from the call are documented in a standardized form. Data from all calls made and all oncology visits between December 2017 and April 2019 were extracted from EMR. Descriptive statistics were used to analyze these data.
RESULTS 787 calls were made to 666 oncology patients who missed an appointment. Of those with documented reasons (n=267), patients most commonly missed appointments because they were being seen or waiting to be seen at a different health facility (34.8%), too unwell to travel (15.4%), or unable to afford transport (14.2%). After the call, 300 patients who missed their appointment had it rescheduled (38.1%), 173 of which (57.7%) returned to care within two weeks of the appointment.
CONCLUSIONS A call back system can be a useful tool to understand and address challenges patients face in respecting their appointments. When patients were reached and their appointment rescheduled, most do return to care. More timely calls following missed appointments and better documentation of reasons for missing an appointment will continue to inform programmatic changes to decrease barriers to attending appointments and improve patient retention.

OBJECTIVE Endemic Burkitts Lymphoma (eBL) is an aggressive B cell lymphoma, which is a common childhood cancer in areas with high and early Epstein-Barr virus exposure and intense transmission of Plasmodium falciparum parasites. Early and accurate diagnosis is a prerequisite for successful therapy, but it optimally involves advanced laboratory investigations. These are technologically demanding, expensive, and often difficult to implement in settings where eBL is prevalent. Diagnosis is therefore generally based on clinical assessment and morphological examination of tissue specimens from tumour biopsies or cells in fine-needle aspirates (FNAs). The purpose of the present study was to assess retrospectively the accuracy of eBL diagnosis at two tertiary hospitals in Ghana.
METHODS We studied FNAs from 29 eBL patients and 21 non-eBL lymphoma patients originally diagnosed in 2018. In addition, we examined 111 archival formalin-fixed and paraffin-embedded (FFPE) tumour biopsies from Ghanaian patients originally diagnosed as eBL (N=55) or non-eBL (N=56) between 2010 and 2017. Availability-based subsets of samples were subjected to haematoxylin-eosin or Giemsa staining, C MYC immunohistochemistry (IHC), and fluorescence in situ hybridisation (FISH) analysis of c myc abnormalities.
RESULTS Retrospective assessment of FNAs by cell morphology and FISH documented high accuracy of the original diagnoses based on clinical presentation and local laboratory examination of FNAs. Retrospective assessment of FFPE sections revealed no evidence of increased C-MYC expression (by IHC) or c-myc translocation (by FISH) in some patients originally diagnosed as eBL.
CONCLUSIONS In general, we found a good correlation between original diagnoses based on clinical presentation on cell/tissue morphology and subsequent retrospective assessment of samples, although there was some indication of eBL over-diagnosis. Poor preservation of some archival samples precluded reliable retrospective assessment, and greater care in preservation of samples for long-term storage would improve opportunities for future research. The main clinical eBL problems in Ghana remain late diagnosis and inadequate compliance.

OBJECTIVE A high level review of the role artificial intelligence (AI) is increasingly playing in medicine and how these cheap, high-performance algorithms can be applied to cancer control and care in Africa.
METHODS AI is the computer science field focused on training machines to perform tasks believed to require a not insignificant cognitive load in humans. Recently deep learning neural networks, a sub-field of AI, have begun outperforming human physicians in narrow tasks across medicine. Convolutional neural networks, previously used to recognize cats in images, can now identify dysplastic cells on pap smears, diagnose chest x-rays, grade tumours on histopathology slides, and classify melanoma as benign or malignant. Natural language processing neural networks can now provide personalized, targeted cancer therapy recommendations from the entire scientific literature and predict inpatient mortality or 30-day readmission from a fast healthcare interoperability resource (FHIR) patient chart.
RESULTS In each of these cases the AI performs at a greater sensitivity and specificity than its board-certified human clinician equivalent. The cost to train a melanoma or pap smear classifier is quickly falling to the cost to obtain a high-quality training dataset. Further, the cost of the hardware necessary to run a trained classifier is falling exponentially, many smartphones today have the necessary compute.
CONCLUSIONS The increasing capabilities of AI in healthcare combined with the exponentially decreasing hardware costs necessary to train and run it are an obvious win for regions with limited healthcare resources, particularly specialists. With adequately large and representative training datasets, proven AI architectures could be retrained for use in cancer control and care in Africa exponentially more quickly and cheaply than equivalently trained human clinicians.

OBJECTIVO Descrever caso raro de tumoração da mama em mulher jovem.
MÉTODOS Colheita de história clínica, mastectomia e estudo histológico
RESULTADOS Sarcomas de mama pertencem ao raro grupo heterogéneo de neoplasia maligna da mama de origem não-epitelial.Embora a caractéristica clinica de sarcoma da mama seja similar a do carcinoma da mama, a terapia e o prognóstico diferem-se em vários aspectos. Ocorre em menos de 1% de todas neoplasias malignas e <5% de todos sarcomas dos tecidos moles. Fibrossarcoma é uma variante histológica do sarcoma mamário que corresponde a 16% de todos sarcomas da mama.Outros subtipos referidos são fibrohistiocitoma (44%), lipossarcoma (24%), sarcoma das células claras, sarcoma neurogênico, leiomiossarcoma, sarcoma alveolar ds tecidos moles acometendo 4% cada . No Hospital Central da Beira nos últimos 5 anos so foi diagnosticado 1 caso de sarcoma da mama. Caso clínico: 32 anos, feminina, negra. História de tumoração indolor na mama esquerda com com 3 meses de evolução, de rápido crescimento, sem outros sintomas associados.Gesta2Para 2 Abortos0 Filhos vivos 2.
• Aleitamento materno: 12 meses
• Sem história familiar de Ca mama
• Sem antecedentes de uso de anticonceptivos orais
Objectivamente: aumento do volume da mama esquerda a custa de tumoração envolvendo toda a mama, com retracção mamilar e áreas de circulação colateral. A palpação apresentava consistência dura e com áreas de flutuação.
• Axilas, fossas supra e infraclaviculares: sem gânglios palpáveis
• Rx tórax e Ecografia abdominal: sem imagens sugestivas de metástases;
Levado ao Bloco operatório onde no intra-operatorio foi feita congelamento onde revelou tecido neoplásico com característica sugestiva de neoplasia maligna mesenquimal e de seguida feita mastectomia simples e a peça enviada a serviço de Anatomia patológica. Cujo resultado-TUMOR FUSOCELULAR MALIGNO DE ALTO GRAU ( CARCINOMA SARCOMATÓIDE?). Nota: Neoplasia Não Tem Padrão Clássico Dos Tumores Da Mama. Sugere-se Realização IHQ Para Melhor Caracterização da lesão. Como o Hospital Central da Beira não tinha reagentes para fazer imunohistoquimica, os blocos foram enviados ao Hospital Central de Maputo ( dista-se a mais de mil Km) tendo confirmado tratar-se de FIBROSSARCOMA DA MAMA.
CONCLUSÃO fibrossarcoma da mama é geralmente diagnosticado por exclusão. Dermatofibrossarcoma é uma variante rara da fibrossarcoma, podendo ocorrer 5/ 1.000.000 casos. Podem ocorrer em qualquer idade mas sendo mais comum entra os 40-50 anos. Não apresenta característica clínica que difere dos outros tumores mamários. Recomenda-se como tratamento a mastectomia simples e não esta comprovado o papel de quimioterapia no seu tratamento.

OBJECTIVE Consistently increased cervical cancer incidence observed in this selected population is difficult to associate either with increased availability of the free cytology screening or other factors. The objective of this study is to investigate trends in the age-standardised and age-specific incidence rates in two distinct regions (the northern and southern areas) covered by the Eastern Cape Cancer Registry.
METHOD 1998-2012 data of all women with topography C53.0-C53.9 were extracted from the registry database. The annual cervical cancer incidence trends were calculated for the period 1998-2012, a 15-year period encompassing the initiation of the national cervical cancer free cytology screening programme in South Africa. Information on age and stage distribution assessed, proportion of cases with pathologically verified diagnoses checked. In addition, trends in coverage of the cervical cancer screening programme were assessed using the routine health service data.
RESULTS Annual age-standardized incidence rates per 100,000 population increased significantly in the northern area from 24.0 (95%CI: 21.1-27.0) in 1998-2002 to 39.0 (95%CI: 35.6-42.5) in 2008-2012 with a screening coverage rate of 15% by 2012. In contract, no increase was observed in the southern area with rates of 20.0 (95%: 18.5-21.4) in 1998-2002 and 18.8 (95%CI: 16.2-21.4) in 2008-2012, with a higher screening coverage of 41% in 2012. Percentage distribution of stage at diagnosis showed that 28.5% of cases were diagnosed at stages I and II, 35% III and IV and 36% of missing stage information, 77% were histologically verified of which only 12.3% were by cytology.
CONCLUSION The significant increase in the incidence in the northern area does not appear to be directly related to the screening programme but may portend increases associated with the widespread provision of highly active ante-retroviral therapy.

OBJECTIVO Pretende-se apresentar um caso clínico de angiossarcoma da perna tratado apenas com Radioterapia externa com boa resposta clínica.
MÉTODOS Doente de 86 anos de idade, sexo feminino, antecedentes de cardiopatia isquémica e linfedema da perna esquerda, que recorreu à consulta de Dermatologia com múltiplas pápulas violáceas hemorrágicas, úlcera na face antero-externa e nódulo com 20x20mm na face anterior da perna esquerda com oito meses de evolução. Foi submetida a biópsia por shaving do nódulo, cuja histologia revelou um Angiossarcoma de alto grau de padrões epitelióide e fusiforme. Por apresentar doença localmente extensa, mas sem metastização à distância nos exames complementares de diagnóstico, foi referenciada à consulta de cirurgia com a proposta de amputação da perna esquerda, o que foi recusado pela doente. Foi orientada para tratamento com Radioterapia externa 3D-CRT, tendo recebido a dose de 50.4Gy/28fr/5.5s (1.8Gy/fr/dia) sobre as lesões com margem, seguido de boost à maior lesão com margem com a dose de 16Gy/8fr/1.5s (2Gy/fr/dia). Foram utilizados fotões de 6 MV e electrões de 6Mev respectivamente. O tratamento teve uma periocidade diária e decorreu de 19/06/18 a 27/08/18 com boa tolerância da doente.
RESULTADOS A Radioterapia externa induziu a regressão completa das lesões cutâneas, mantendo-se a doente sem doença até ao último follow-up 5 meses após o final do tratamento.
CONCLUSÕES O angiossarcoma é uma neoplasia vascular agressiva e rara com origem nas células epiteliais, caracterizada por altas taxas de recidiva local e metastização precoce. O tratamento standard consiste em cirurgia seguida de Radioterapia pós-operatória. Contudo, a Radioterapia a título exclusivo pode ser eficiente em alguns doentes.

OBJECTIVO O tratamento padrão para o carcinoma basocelular é a cirurgia, sendo a radioterapia uma opção para tratamento adjuvante ou exclusiva em tumores recorrentes, inoperáveis ou em caso de defeito pós-operatório desfigurante ou incapacitante funcionalmente. No carcinoma localmente avançado o Vismodegib apresenta respostas em cerca de 43% doentes porém existem poucos estudos a longo prazo. Pretende-se demonstrar a importância da radioterapia VMAT (volumetic arc therapy) na administração de uma dose alta, num caso clínico de carcinoma basocelular localmente avançado que progrediu sob Vismodegib.
MÉTODOS Trata-se de uma doente do sexo feminino, com 69 anos de idade, submetida em 2011 a exérese de lesão na pálpebra esquerda, cuja histologia revelou um carcinoma basocelular com margens positivas. Posteriormente foi submetida a múltiplas cirurgias por doença recorrente. Em Junho de 2016, por apresentar doença irresecável na região orbito naso etmoidal esquerda foi referenciada para tratamento com radioterapia, que a doente recusou devido ao risco de cegueira. Na consulta de oncologia iniciou tratamento com Vismodegib em outubro de 2016. Contudo, por apresentar progressão de doença, o tratamento foi suspenso em março de 2018. A doente foi então novamente orientada para consulta de radioterapia. Ilustra-se os diferentes passos inerentes ao planeamento de radioterapia, desde a imobilização, a definição dos volumes alvo a tratar (fusão RM com TAC de planeamento), a dosimetria e o controlo de qualidade.
RESULTADOS O tumor apresentou uma boa resposta ao tratamento com diminuição da lesão. A dose aos órgãos de risco foi minimizada (ex: olho direito), encontrando-se a doente livre de doença seis meses após o tratamento, porém sem visão do olho esquerdo.
CONCLUSÕES O tratamento do carcinoma basocelular localmente avançado constitui um desafio que deve ser abordado no âmbito de uma equipa multidisciplinar e em que a Radioterapia pode ser uma opção terapêutica.

OBJECTIVO Pretende-se comparar os resultados do tratamento de doentes portadores de carcinoma localmente avançado da orofaringe tratados com Quimioradioterapia concomitante (QRT) intensiva versus Quimioterapia de indução (QI) seguida de QRT retrospectivamente.
MÉTODOS Os doentes portadores de carcinoma da orofaringe localmente avançado, estadio III e IV sem doença à distância, foram avaliados em consulta multidisciplinar de cabeça e pescoço de Fevereiro de 2009 a Fevereiro de 2019 e propostos para Quimioradioterapia concomitante (QRT) intensiva ou para Quimioterapia de indução (QI) seguida de QRT em casos de doentes com grandes volumes tumorais rapidamente progressivos e sintomáticos. A QI consistiu em TPF (Taxotere, Cisplatina e 5-FU), PF (Cisplatina, 5-FU) e TP (Cisplatina Taxotere). A Quimioterapia concomitante com a Radioterapia na maioria dos doentes foi a cisplatina administrada nos dias 1, 22 e 43. Os tratamentos foram realizados com Radioterapia Conformacional 3D até Novembro de 2017 e posteriormente com a técnica VMAT (Radioterapia em arco volumétrico). Os eventos adversos foram avaliados de acordo com Common Terminology Criteria for Adverse Events (CTCAE v.5.0) e as sobrevivências foram estimadas pelo método de Kaplan-Meier.
RESULTADOS Foram tratados 93 doentes, 55 (59,1%) com QRT e 38 (40,9%) com QI seguida de QRT e o follow-up médio foi de 28,4 meses. Aos 5 anos a sobrevivência global (SG) para QRT versus QI seguida de QRT foi de 41,2% vs 15,7% respectivamente (p=0,004). O controlo local (CL) aos 5 anos é de 55% no grupo que fez QRT e 30% nos doentes que realizaram indução (p=0.008). A toxicidade foi semelhante em ambos os grupos com 63,4% do total dos doentes a completarem a QRT sem interrupções (p=0,04)
CONCLUSÕES Os dados sugerem que a QRT apresenta SG, CL, sobrevivência livre de doença superior à QI e que esta não melhora o controlo à distância.

BACKGROUND Pain management is a critical component of comprehensive care for patients with cancer and prior studies have shown that doctors and nurses are key mediators of effective pain management. Though palliative care is growing in Rwanda there have been no prior studies measuring the knowledge attitudes and practice of managing pain among doctors and nurses at District hospital. Such information is essential to design relevant and effective intervention to address this important component of palliative care in Rwanda.
OBJECTIVE The primary aim was to establish baseline data on the knowledge, attitudes and practice of pain management in patients with cancer among doctors and nurses at district hospital. The secondary aim was to investigate the specific barriers to effective pain management in order to make future recommendations that will target these barriers and help to improve the care of patients with cancer throughout Rwanda.
METHODS A cross sectional, descriptive study, aimed at evaluating the knowledge, attitudes and practice of pain management among doctors and nurses at Kibagabaga hospital was conducted. A modified version of the validated Knowledge Attitude Survey regarding Pain tool and demographic questionnaire was used as the primary outcome measure.
RESULTS A total of 28 doctors and 107 nurses were included in the study. The results revealed a widespread knowledge deficit and poor attitude focused in the area of pain assessment and pharmacological management of pain. Even though 92.0% of doctors and 88 % of nurses in our study strongly believed that pain relief is an essential part of care for patients with advanced disease, a large number of respondents incorrectly answered questions regarding the specific management of pain. This included 43% of respondents stating that vital signs are the best indicator of the presence of pain, and 63.7% of respondents failing to recognize that aspirin and other nonsteroid anti-inflammatory drugs are effective treatment for bone pain. Knowledge deficits were also present for the use of morphine, as 60.8% of respondents did not know the time to peak effect of morphine, 54.2% did not know the usual duration of analgesia of IV morphine, and 35.5% did not know how to correctly convert IV morphine to PO morphine.
CONCLUSION There was a widespread knowledge deficit and poor attitude of doctors and nurses regarding pain management at one district hospital with palliative care unity in Rwanda. Further education and quality improvement initiatives are needed to improve the pain management in Rwanda.

OBJECTIVE Colorectal cancer is a major source of morbidity and mortality in the world. It accounts for 10.2% of cancer incidence globally with a mortality of 9.2%. It ranks third in incidence but second in terms of mortality. Colorectal cancer is not uniformly common throughout the world. Its incidence is increasing in developing countries. The aim of this study was to determine the pattern of patients with colorectal cancer seen in the department of Surgery, Radiotherapy and Oncology Centre, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria over a ten-year period.
METHODOLOGY In this retrospective study, data was collected from the case files and treatment cards of one hundred and twenty-two (122) patients with colorectal cancer managed at the Surgical, Radiotherapy and Oncology department of ABUTH Zaria, from January 2006 to December 2015. Data items analyzed included Age, Sex, Residential area, Occupation, Duration of symptoms, presenting complaints, Subsite, Histological type, Grade, Stage. All analyses were performed using SPSS version 20.
RESULTS An annual incidence of 12.2 cases/annum was seen. Seventy (57.4%) were males, and fifty-two (42.6%) females. Male: female ratio 1.3:1. Age range was between 12years-78years, majority were between 31-40 years (24.6%), with a mean age of 42.2 years, median age of 41 years. It was found to be commoner among the urban dwellers with the public/civil servants being the most affected (36.0%). The duration of presenting complaints ranged from 3 weeks to 10 years, most patients presenting at 7-10 months with more than one symptom. Bleeding per rectum was the commonest symptom seen. Adenocarcinoma was the predominant histology seen in 73% (n=89). The rectum was the commonest subsite, while left sided lesions (20%) were commoner than right sided lesions (17%). 18% (n=22) had distant metastasis.
CONCLUSION The study showed that colorectal cancer was commoner among the younger age group with a slight male preponderance. They were mostly urban dwellers and civil/public servants. Bleeding per rectum being the commonest complaint, majority of the cases presented at an advanced stage. Early detection through public health education, screening programs, affordable and effective treatment and follow up will help reverse this trend.

INTRODUCTION childhood acute myeloiblastic leukemia is a rare malignancy whose outcome is very dismal in Sub saharan Africa.
OBJECTIVE to assess the treatment results in newly diagnosed children with acute myeloid leukemia in our facility.
METHODS in December 2016, we elaborate a protocol in collaboration with Guy Leverger Trousseau Paris, tailored to our environment to treat children with newly diagnosed acute myeloid leukemia in Bamako. This protocol includes an induction (2 courses for 14 days of aracytine 10 mg/kg twice a day in subcutaneous injection, valproic acid 40 mg/kg /day and allopurinol 10 mg/kg /day) and a consolidation: 4 courses with the same drugs and same duration. CNS prophylaxis with aracytine is done during the first course of chemotherapy.
RESULTS 16 patients have been treated with a median age of 8 years. The sex-ratio (M/F) was 1,2.
Sixty two percent were from poor families. Hemorrhagic syndrome was present in 69% of patients at diagnosis and CNS involvement was noted in 94 % of patients. Half of the patients were from Bamako meaning that many children in the countryside die without diagnosis. Hematologic toxicity was present in 94% of patients during the first course. By December 2018, all our patients by progressive disease.
CONCLUSION childhood acute myeloid leukemia has a very poor prognosis in our country, and we have to tailor an other intensive protocol to treat our patients with acute myloid leukemia in order to save some of them.

INTRODUCTION Non hodgkin Lymphomas (NHL) are with retinoblastoma; the most frequent malignances in our pediatric oncology center in Bamako Mali.
OBJECTIVE the aim of our study was to assess the different aspects of NHL cases.
PATIENTS AND METHOD it was a retrospective and descriptive study over a 10 years period from January 2005 to December 2015. Chemotherapy was based on French LMB01 protocol modified.
RESULTS during the study period, 1295 cancer cases have been recorded. Among them 274 cases of NHL (21, 16 %). The age group 6-10 was the most represented (46, 4 %). The male sex was predominant with a sex- ratio of 1.08; digestive signs were the most common signs (44.2%) followed by maxillary swelling (42.7%); the majority of patients (52.9%) consulted between 1 and 3 months after the onset of signs; the malnutrition rate was 39.8%, of which 24.1% were severe cases and 15.7% were moderate cases. Abdominal localization was the most common (43.1%) followed by maxillofacial localization (33.9%). The most frequent histologic type was classical Burkitts followed by large B cell lymphoma and lymphoblastic lymphoma. Late diagnostic was frequent with Murphy stage III of 73.4%. The majority of our patients (96%) had received chemotherapy. After a mean follow time of 5 years, 150 (54, 74 %) patients were alive. We recorded 61 deaths (22, 26 %), 38 (13, 86 %) abandonments and 25 (9, 12 %) loss of follow-up. The main cause of death was tumor progression.
CONCLUSION late presentation with advanced diseases was the rules making the prognosis dismal in our context.

OBJECTIVE To comprehensively characterize breast cancer in Malawian women with respect to risk factors, clinicopathologic features, and survival in a high HIV endemic setting while receiving standard of care.
METHODS Women aged 18 years or older with newly diagnosed, pathologically confirmed breast cancer were enrolled during a 2-year period (2016-2018). Interviews for demographic and risk factors data were conducted at baseline. Tumours were evaluated for ER, PR, HER2, Ki67 and subsequently molecular subtypes via immunohistochemistry. Patients were clinically evaluated and staged to determine treatment options which included either curative or palliative intent and followed up for outcomes.
RESULTS 100 women with newly diagnosed breast cancer were enrolled. Median age was 49.2 (range, 21-80), 19 were HIV-positive with median CD4 count 466 cells/L (range, 101-737). 17 patients had a family history of cancer of which 4 were breast cancers. 94 women reported ever breastfeeding while 17 had ever used combined oral contraception. 78 patients presented with palpable masses greater than 5cm. Of the 91 patients staged, 75 (82.5%) had stage III/IV disease, including 64 (70.3%) with T4 tumours, 77 (84.6%) with nodal involvement. 37 tumours were grade 3 and 35 were grade 2. 49, 40 and 23 tumours were ER, PR and HER2 positive respectively. 49 tumours demonstrated a Ki67 proliferation index >15%. 23, 27, 18 and 25 tumours were luminal A, luminal B, HER2 enriched and triple negative, respectively, while 7 tumours could not be classified. 69 women received curative-intent treatment including 41 with modified radical mastectomy with either adjuvant or neoadjuvant chemotherapy while 27 women were placed on palliative-intent treatment. 25 women died and there was no difference in overall survival between HIV positive and negative patients.
CONCLUSION Our results demonstrate that women with breast cancer in Malawi are younger, present with advanced and biologically aggressive disease, findings similar to SSA and African-Americans.

OBJECTIVE The epidemiological transition is reflected in developing countries such as Burkina Faso by a still high prevalence of cancers in adult population but also by the emergence of these pathologies in very young population. The prevalence of cancer in children is still high. However, there is a golden opportunity to cure these diseases if interventions in the fight against this scourge are better planned. The objective of the present research is to evaluate the epidemiological profile of cancers in the pediatric population in Burkina Faso.
METHODS Our analysis uses data from the national pediatric cancer registry of Burkina Faso. It is a cancer registry based on population. The pediatric cancer case is actively collected across the country. All the structures where the diagnosis of cancer head the child can be done have regularly visited. The data collected using a pre-established form concerned the period from 2016 to 2018. The CanReg5 software was used for data entry and analysis.
RESULTS As of March 5, 2019, 799 cases of childhood cancer have been registered. A crude rate was 30 per million in Burkina Faso. Central Region leads with 121 cases. CHU-Yalgado Ouedraogo is the place where childhood cancer is more diagnosed with 282 cases. The sex ratio was 1.2. Lymphomas accounted for 26.8%, leukemias 26.2% and nephroblastomas 14.4 %.
CONCLUSIONS Childhood cancers are common in Burkina Faso. Good planning to combat this scourge must be put in place to overcome this disease in children.

INTRODUCTION Ophthalmic tumours are fairly rare and diverse and their diagnosis and treatment usually requires special expertise and equipment, including patient care by a multidisciplinary team. Brachytherapy is the preferred radiation treatment modality for various intraocular tumours and the most commonly used radionuclide is I-125. The “Claws” is a gold applicator that is loaded with I-125 seeds for localized whole-eye radiotherapy, particularly for stage 0 retinoblastoma.
METHOD Under general anaesthesia, a pericorneal ring is attached to the four extra-ocular muscles, and four appendages, each loaded with I-125 seeds, are inserted beneath the conjunctiva in-between each pair of muscles and attached anteriorly to the ring. The applicator has an inside diameter of 22 mm. Current dose calculations approximate each I-125 seed as a point source, and a project is underway to improve the dose calculations, and particularly the dose to critical structures in and around the eye, based on Monte Carlo calculations.
RESULTS The applicator irradiates the eye with minimal dose to the surrounding bony orbit, extraocular optic nerve, eyelids and lacrimal gland. Certain seeds may be omitted to reduce the dose to the unaffected parts of the eye. A typical treatment prescription is 40 Gy given over four days to the centre of the eye. General anaesthesia is also required for the removal of the applicator.
CONCLUSION The applicators are cost-effective because they can be re-used. The I-125 seeds are regularly used for other eye plaques and implants. The eye does not need fixation during treatment and cosmesis is excellent.

OBJECTIVE Cancer patients experience high levels of cancer-related distress, which may negatively impact on their clinical outcomes, such as survival and quality of life. Distress brain study, aims to examine the associations between psychosocial variables, specific brain regions, and inflammatory processes in metastatic breast cancer (mBC) patients, an understudied group. The present investigation aims to characterize this population in terms of the prevalence of distress, anxiety, depression, psychological morbidity, self-management skills, affect, social and familiar well-being, and psychosocial needs, to better understand their needs and what resources are needed.
METHODS Participants are mBC patients in the initial stage of treatment at our center, with no CNS impairment and 0-1 ECOG. Psychosocial variables were assessed using the Distress thermometer and Problem List (DT; NCCN 2018), Hospital and Anxiety Depression Scale (HADS; Zigmond & Snaith,1983), Brief Symptom Inventory (BSI; Derogatis, 1993), the Measure of Current Status/S1 (MOCS/S1; Carver, 2005) for measuring perceived self-management skills, Positive and Negative Affect Scale (PANAS/SF; Galinha et al, 2014), and the Social and Family well-being (FACT-SWB scale; Cella et al, 1993).
RESULTS The study is ongoing and recruiting patients attending the Breast Unit of the Champalimaud Clinical Centre in Lisbon. 100 eligible patients with mBC under treatment undergoing a whole body FDG-PET study including brain data acquisition as part of their work-up and best clinical practice are being recruited and will complete this full set of psychological measures. Preliminary findings with 30 patients indicate that 56,7% of mBC patients reported moderate to high levels of distress, 26,7% depression and 34,5% anxiety. We intend to present the final results at the congress.
CONCLUSIONS mBC is a highly demanding phase in patients' lives, with an uncertain path and difficulties presenting a challenge to adjustment. Preliminary findings suggest high psychosocial needs in these patients and justify providing psychosocial care and interventions to reduce their emotional burden and improve their coping resources.
ACKNOWLEDGEMENTS The current study is funded through state government funds competitively awarded by the Portuguese research funding agency (FCT: www.fct.pt; PTDC/MHC-PSC/3897/2014) (2016-2019).

OBJECTIVE Access to radiotherapy facilities is limited in Nigeria. This leads to delays in treatment with long waiting time. This innovative study describes the trend of radiotherapy waiting time at a publicly funded tertiary radiotherapy facility in Northern Nigeria.
METHODS This was a retrospective cohort study of patients who were managed with radiotherapy between 2010 and 2014. Data included diagnosis, travel distance to facility, and treatment provided. Wait-time was categorized into intervals (1) between diagnosis and first radiation consultation; (2) first consultation to radiotherapy treatment; (3) diagnosis to treatment and; (4) decision-to-treat to treatment. Data analysis involved descriptive statistics, T-tests and chi-square tests.
RESULTS A total of 258 cases were involved, including cervical (50%; 129/258), breast (27.5%; 71/258), nasopharynx (12.8%; 33/258), colorectal (5%; 13/258) and prostate cancers (4.7%; 12/258). The mean age was 48 (±12.9) years. Treatment with radical intent comprised 67% (178/258) of cases while 33% (80/258) had palliative treatment. The median time from diagnosis to first radiation consultation was 40 (IQR:17-157.75) days for all patients, with prostate cancer having the longest 305 days (IQR:41- 393.8). Median time between the first radiation oncology consultations and first radiotherapy treatment was 130.5 (IQR:14-211.5) days; cervical cancer patients waited a median of 139 (IQR:13-195.5)] days. The median time between diagnosis and first radiotherapy for breast cancer patients was 329(IQR:207-464)] days, compared to 213(IQR:101.5-353.5)] days for all patients. Only 27.5% (49/178) of cases who needed radical treatment and 53.8% (43/80) of palliative treatments where done within the recommended duration by the International Atomic Energy Agency of ≤30 days or ≤10 days, respectively.
CONCLUSION Study shows that waiting time for radiotherapy in Nigeria was generally longer than what is recommended internationally. Waiting time varied by diagnosis and treatment intent. This reflects the need to improve access to radiotherapy in Nigeria.

INTRODUCTION In 1994, Rwanda’s first population-based cancer registry halted due to the Genocide Against the Tutsi. In 2010, the registry was re-initiated and retrospective data collection from 2007 going forward was conducted. Yet in 2014, when external funding phased out, the registry stopped. In July 2018, the Ministry of Health through Rwanda Biomedical Center (RBC), in collaboration with partners, started a phased-based approach to build back the National Cancer Registry as a government-owned initiative. Aiming to build a sustainable system to provide reliable cancer epidemiology data in the country. The first phase was the creation of the Kigali Population-Based Cancer Registry (KPBCR), hosted in RBC under the Cancer Control Unit.
METHODOLOGY Data collection is being done at 29 health facilities in and around Kigali. After data from facility-based oncology patient files, electronic medical records, and register books is pulled using a standard abstraction form, data is entered and analyzed using CanReg5 software version 43.
RESULTS Over the course of 9 months; retrospective data collection has thus far identified 16,313 cases from 4 main cancer sites. 8,173 (50%) have been entered into CanReg5, adding to the 5,716 cases already in the system; CanReg5 now holds 13,889 cases spanning from 2007 to 2018. According to primary disease site, the two predominant cancers are breast and cervix, with 1,874 (13.5%) and 1,757 (12.7%) respectively. Among the 5,573 total male cases, the top cancers are stomach (11.3%), prostate (10.8%), Non-Hodgkin Lymphoma (6.6%), liver (6.3%), and Kaposi sarcoma (4.4%). Among the 8,316 total female cases, the top cancers are breast (22.5%), cervix (21.1%), stomach (7.9%), ovary (3.5%), and Non-Hodgkin Lymphoma (3.1%).
CONCLUSION Preliminary results show great promise that establishing the KPBCR will provide the solid basis of data needed for evidence-based planning, monitoring, and evaluation of cancer control program. Through its phased-based implementation approach, Rwanda is laying the strong foundation to establish a sustainable National Cancer Registry.

OBJECTIVE The histopathological features of penile squamous cell carcinoma (SCC) in Africa have not been studied well. The aim of this study was to describe the histopathological characteristics of penile SCC in resection specimens in a tertiary hospital in Cape Town, South Africa.
METHODS Consecutive cases of penile SCC in the period from January 2008 to August 2015 were identified using the laboratory information system. Referred cases, cases without a resection specimen (i.e. biopsy only) and cases with missing tumour blocks were excluded. The following parameters were reviewed and recorded by an anatomical pathologist: tumour site, SCC subtype, grade, precursor lesions, lichen sclerosus, perineural invasion, lymphovascular invasion and lymph node status. SCC subtyping was done according to the 4th edition of the WHO Classification of Tumours of the Urinary System and Male Genital Organs. Grading was performed according to the College of American Pathologists guidelines. The results were recorded and analysed using Microsoft Excel (Washington, USA).
RESULTS 42 cases were included. The average age was 53.4 years (median: 53.5 years; range: 29 to 75 years). 14% of the patients were infected by HIV, 60% were HIV negative and the HIV status was unknown in the remainder (26%). The HIV-infected patients were on average 16 years younger than the HIV negative patients. 45% of the cases showed an HPV-related histological subtype. Five of the 6 HIV-infected patients had an HPV-related subtype. Nine of the 10 cases that showed perineural invasion and had an inguinal lymph node dissection, had lymph node metastasis. High grade and lymphovascular invasion were also associated with inguinal lymph node metastasis.
CONCLUSIONS High-risk HPV appeared to play a role in a significant number of penile SCCs in our study population. This will need to be confirmed with tests that are more specific for HPV. HIV infection seemed to play a synergistic role with high-risk HPV in the development and progression of penile SCC but the small number of HIV-infected cases in this study limited interpretation. The importance of perineural invasion, lymphovascular invasion and high grade as predictors of inguinal lymph node metastasis was confirmed.

OBJECTIVO O objectivo deste estudo foi avaliar o correcto dimensionamento das barreiras de protecção contra radiações ionizantes do Serviço de Radioterapia do Hospital Central de Maputo (SRTHCM), onde se encontra instalado um acelerador linear de electrões, de energia fotónica máxima de 15 MV e um tomógrafo, com tensão de ampola máxima de 130 kVp.
MÉTODOS Para a avaliação das barreiras de protecção radiológica foram feitas medições instantâneas dos débitos de equivalente de dose ambiente transmitida através das barreiras de protecção, para a sala do acelerador linear e de kerma no ar, para a sala do tomógrafo. Para o acelerador linear, foram ainda realizadas medições dos débitos de equivalente de dose ambiente para a radiação de neutrões, em diferentes pontos da área adjacente à porta de acesso à sala de tratamento. Para todas as medições, tanto o acelerador como o tomógrafo, foram colocados em funcionamento nas condições de irradiação consideradas mais desfavoráveis em termos de protecção radiológica.
RESULTADOS Para a estimativa da dose efectiva a que estão expostos profissionais e membros do público numa determinada zona de trabalho, foi considerada uma carga de trabalho de 231500 MU/semana, para o acelerador e de 258750 mA.s/semana, para o tomógrafo. Apresentamos como exemplo, os resultados obtidos para a estimativa de dose efectiva anual na consola: 1,16 mSv, para o acelerador e 0,01 mSv, para o tomógrafo, sendo a restrição de dose para esta zona de 6 mSv/ano.
CONCLUSÃO Com base nos resultados obtidos neste estudo e face aos riscos de exposição às radiações ionizantes, é possível estabelecer a classificação das áreas de trabalho. Os resultados permitem concluir que o SRTHCM apresenta condições de segurança adequadas no que se refere à protecção de profissionais e membros do público contra o risco de exposição às radiações ionizantes e em conformidade com os limites de dose aplicados pelos organismos internacionais.

OBJECTIVE Burkitts Lymphoma (BL) is the commonest pediatric cancer in Sub-Saharan Africa (SSA), with poor outcomes compared to resource-rich settings. High-dose methotrexate (HD-MTX) is a pillar of effective BL treatment, but reports of HD-MTX based regimens in SSA show marked variability in safety and efficacy.
METHODS We prospectively enrolled children <18 years with pathologically confirmed high-risk BL diagnosed from 2013-2018 at Kamuzu Central Hospital. Before 2016, children were treated with moderate-intensity CHOP. After 2016, children were increasingly treated with high-intensity regimens incorporating HD-MTX at doses 1-3 g/m2 as institutional practice shifted. Similar to most SSA centers, real-time monitoring of MTX levels was unavailable. We examined the outcomes of high-risk BL cases, defined as stage III/IV or lactate dehydrogenase (LDH) >2x normal.
RESULTS Of 170 high-risk cases, 103 (61%) received CHOP, 56 (33%) received HD-MTX, 11 (6%) died before intensive-treatment. Median age was 9 years (IQR 6-12), 104 (61%) were male, 108 (64%) had moderate-severe malnutrition, 157 (92%) had stage III/IV, median LDH was 900 (IQR 572-1,958). Children received a median of 5 (IQR 2-7) chemotherapy cycles [CHOP 5 (IQR 2-7), HD-MTX 4 (IQR 3-6)]. In February 2019, vital status was known for all but 8 (5%) children. HD-MTX significantly improved 12-month OS (53%, CI 38-66%) compared to CHOP (34%, CI 25-44%, p=0.02). Mortality was associated with poor performance (Hazard Ratio (HR) 0.42 CI 0.2-0.7%], age >9 years (HR 1.7, CI 1.1-2.7%), and LDH >900 (HR 2.1, CI 1.3-3.1%), but not gender or malnutrition. Treatment-related mortality appeared comparable for CHOP 25/103 (24%) and HD-MTX 9/56 (16%), especially given supportive-care improvements over-time.
CONCLUSION Chemotherapy regimens incorporating HD-MTX may improve 12-month OS compared to CHOP among children with high-risk BL in Malawi. There is a continued need for controlled, multicenter trials to define best practices in SSA, including optimization of MTX application, to improve outcomes.

OBJECTIVE 50-60% of cancer patients require radiotherapy as important (and cost effective) part of their treatment. The majority of people in Africa suffering from cancer has no or limited access to radiotherapy technology due to the financial deficit in their countries. State of the art radiotherapy machines (linear accelerators) need (uninterruptable) electrical power. Furthermore, the education of experienced staff for this technology is running behind the expectations. Some possible starting projects were considered. Status Quo: Several Radiotherapy-initiatives were born during the last years. Stakeholders were governments, Ministry of Health, private investors and Universities. Mostly the problem is not financing the big capital for such a site, but the running cost of uninterruptable power supply and the experienced staff-numbers. Brain-drain, when staff expectations were not met, leaving the site means a very high-risk for the health management. Even the role of supporting disciplines like surgeons in gyn, uro, lung, gastro-intestinal, Onco-nursing are under-represented with their hand-in-hand working capacities. Automatism in Radiotherapy, dropping staff numbers without increasing risk for patients? The investigations in automatism, iT and machine learning projects have been increased in the last years. Right now, all of those island-projects needs a lot of man-time for proof of concepting, setting up and testing. New RT startUps like in Afrika need mass-production of such iT-systems and (if wished) more or less supervising technology and partner-sites in foreign countries. It can be shown with an iT-platform like “hol.ger” that all relevant subsystems (biometric face-detection, Realtime-dosimetry, portal-dosimetry, central process-documentation, predictive Risk-analysis) can be integrated for the decreasing of staff numbers. 400h/year of QA-TPS-planning, 100h/year overtime Linac running, 600-800h/year staff-time can be saved. Together with cloud-based targeting of tumors, auto-planning of the plans and “hol.ger” delivery control -> the number of RadOnc and Medical Physicists can be cut in half without increasing the security-risk of the patients. Ideal for start-ups in Africa! Planning procedure and aspects for setting up sustainable, solar-autarkic RadioTherapy. It is some like easy to summarize all power consumers like Linacs, CTs, MRs, iT, cooling and try to evaluate number of panels, accu-storage (for buffering high-power without compromising the usage of the power). Dimensioning of linac´s energy-flow, adapted to patient-related workload, number of staff, air-conditioning, number of windows (hopefully sun-shielded), geographical position of the site are high valuable factors for the investment in solar-autarkic solutions. And exactly these factors are one of the “forcing up prices” for the linac-treatment costs.