The Uganda Cancer Institute Experience Walusansa Victoria. Thoracic Malignancy The Uganda Cancer Institute Experience Walusansa Victoria.

Thoracic malignancies Group of cancers of the chest that include Lung cancers, Mesothelioma, Esophageal cancer, Chest wall, airway tumors & mediastinal tumors, Thymic carcinomas and tracheal cancer.

Uganda Kampala Epidemiology The KCR, incidence of ca Lung 321 new cases The Age standardized survival rate 2.2% ca Esophagus has an incidence rate of 1529 with ASR 12.3%

UCI Thoracic malignancies Reviewed records for last 1 year found 54 patients with primary thoracic malignancies. 40% were Baganda 11.1% were Banyankole 7.4% were Itesots

Lung Cancer Majority 95% are NSCLC Mean age at presentation was 54yrs for both women and men Range 27-90yrs Probably the more aggressive SCLC is missed and may often not make it to the UCI.

Exposure Worldwide approximately 15% of lung cancers in men and 5% of lung cancers in women are caused by occupational exposures. Mesothelioma, a rare neoplasm is linked to exposure to asbestos. Cigarette smoking

Exposure ctd The majority of men(90 %) with lung cancer have associated history of Cigarette smoking In women the history of cigarette smoking (even passive smoking) was not present The women tended to be obese, prior to onset of symptoms

presentation Majority 62% Of Lung Cancers presented as pleural effusions associated with non specific chest pain Only 12% had hemoptysis as the index complaint Majority 60 % have been initiated on TB treatment at the time of referral Failure of response to the TB treatment is what prompts further investigations leading to diagnosis

By the time they are referred to the UCI the majority were tumors are advanced. Hence the poor outcome only one had stage IB disease Time to diagnosis on average 4 months (Mortality of 90%).

Assessment History/PE CXR, PA Lateral CT Scan of Chest and upper abdomen and the adrenals Blood work up May need mediastinoscopy, thoracoscopy, Transbrochaial needle aspiration Endoscopic ultrasound to assess the LN grps

treatment Surgery is the Tx of choice for stage I-II, NSCLC consolidated by Rx Neo-adjuvant Chemotherapy for IIIB disease Adjuvant Chemotherapy IIb-IIIA Platinum based regimens

Mortality rate for Lung cancer at the UCI is high 90% died at the UCI Many attributing factors but basically Delayed diagnosis High stage at presentation Availability and quality of drugs

Way forward, Early diagnosis Screening CT scans mediastinoscopy, thoracoscopy, Trans-bronchial needle aspiration Endoscopic ultrasound Endoscopy (BAL)Cytology and cell blocks By the time the Pleural effusions occur this is advanced lung ca.

Improve CARE Set Multi disciplinary team- - Chest physicians - Chest surgeons, - Radiotherapy, - Oncology team

Prevention Smoking cessation. Pneumoconiosis watch out. We need further epidemiological studies to explain why we have an increase in the Lung cancer/ esophageal cancer diagnoses.