A Review of the Current Profile of Gastric Cancer Presentation in the University College Hospital Ibadan, a Tertiary Health Care Institution in the Tropics

Abstract

Gastric cancer is the fourth commonest malignancy and the second leading cause of cancer-related death. Although gastric carcinoma is less common throughout Africa than in Europe, there are considerable variations in its incidence and pattern. It accounts for about 5% of cancer-related death. It is characterized with significant morbidity and mortality mainly because of late presentation in developing and poor countries. Previous studies on gastric cancer in Ibadan and other West African centres demonstrated the preponderance of distal (pyloric antrum) gastric lesions when compared to proximal (cardia, fundus) lesions. Nevertheless, recent studies in developed nations show that distal gastric lesions are on the decline while there is an increase in the proportion of proximal gastric lesions. The objective of this study is to review the pattern of presentation of patients with gastric carcinoma managed in our surgical division over a 5-year period and to determine changes in the trend in our environment. A retrospective study of all patients with gastric carcinoma between November 2004 and October 2009 was carried out. Simple descriptive analysis was used to characterize the patients' demographic parameters, symptomatology, clinical and investigative findings along with treatment and outcome modalities. There were 49 cases managed by the division over the period under review. The male to female ratio was 1.45:1 with a mean age of 56 years at presentation. Duration of symptom was less than 5 months (20 weeks) in 47.9% of the patients. Dysphagia was present in 12.2% while 52.6% had a history of suspected peptic ulcer disease. There was electrolyte derangement in 31.7% of the patients while 52.6% had anaemia at presentation. Proximal tumours of the gastro-oesophageal region, cardia and the body constituted 51% of the cases; 51.4% of the patients were blood group O as opposed to 28.6% and 20%, respectively, with blood A and B. Thirty-six patients (73.5%) had a histological diagnosis of adenocarcinoma, five patients (10%) had signet ring variant of adenocarcinoma carcinoma, while three patients (6.1%) were each had gastrointestinal stromal tumours or lymphomas. Our review shows a peak age in the sixth and seventh decades at presentation. There is a significant increase in the proportion of proximal gastric lesions and a predominance of blood group O. Gastrointestinal stromal tumour and lymphoma should be considered as differential diagnosis. Patients still present late with advanced diseases, and curative treatment is often impossible.