Management of laryngeal cancer in an ENT Service in subSaharan Africa

Abstract

The management of cancers of the larynx remains a challenge to most ENT specialists in Cameroon due to a multitude of factors linked to their management. The aim of this study is to identify the important factors that militate against the proper management of these cancers and to propose solutions. A retrospective study was carried out in the ENT service of the General Hospital of Douala over six years (April 1998 to June 2006). Eighteen cases of epidermoid cancers of the larynx were identified. Only 10 of the clinical records could be reviewed because the remaining patients refused to be treated in our unit immediately after they were informed of the diagnosis. All the cases were males with a mean age of 53. Most of the cases diagnosed were at the advanced stage of the disease (7T4, 2T3, 1T2). Six patients were treated with radiotherapy only, one with chemo-radiotherapy. Three patients had a full laryngectomy followed by radiation therapy in two cases. One of the cases operated developed a pharyngeal fistula. By the end of the third year only 30% of our patients still continued their follow-up. The therapeutic protocols used took into consideration the socio-economic status of the patients, the experience of the personnel in the management of laryngeal cancers and the treatment techniques and modes available in our hospital. Because of these factors, standard European and American recommendations for the management of laryngeal cancers could not be used. Government intervention to offer subventions for the high cost of work-up and treatment of these patients is a must for better results to be obtained. There is also a need for the creation of training, prevention and treatment centres for cancers of the larynx.