RECTAL CANCER: A STUDY OF 40 CASES FROM THE NATIONAL RADIOTHERAPY CENTRE ACCRA - GHANA AUTHORS: DR VERNA VANDERPUYE,: vanaglat@yahoo.com DR JOEL YARNEY,: kwodwoahen@gmail.com FRANCIS ASAMOAH: fasamoah@gmail.com ADDRESS: NATIONAL CENTER FOR RADIOTHERAPY, KORLE BU TEACHING HOSPITAL PO BOX KB 369, ACCRA GHANA

Purpose: To evaluate presentation and management of rectal cancer cases in Ghana. Materials and methods 40 patients with rectal cancer presenting to the Radiotherapy Centre from 2001 – 2003 were analyzed. The age range, sex, stage ,histology, treatment and time to presentation were studied.

Results Most common pathology was adenocarcinoma in 34 patients (84%) Age distribution bimodal peaks at 44-50yrs and 61-70yrs

The male to female ratio was 1.2: 1.0. Staging was by clinical exam and CT scan. Patients presented between 3 - 24 month of initial symptom with half presenting >12months Median follow up was 13 mths( 0- 96mths) 25% had prior surgery 25% were for neoadjuvant chemort

> 25% of patients were noncompliant of recommended treatment. 10% had RT only, 60% chemoradiation, 20% had chemo only 10% no treatment at all. 30% received palliative treatment( monotherapy with RT or chemotherapy ) > 25% of patients were noncompliant of recommended treatment. RT- RADIOTHERAPY CT – CHEMOTHERAPY CRT- CHEMORT

In the chemoradiation group 9 patients (25%) had Capecitabine 20 patients (50%) had Flourouracil/Leucovorin Median cycles of chemotherapy was 3(range 1-9) less than 30% completing 6 months of chemotherapy. Dose of palliative radiotherapy was 30Gy/10fx 54Gy/27fx for curative intent with chemotherapy. Less than 70% could be followed up due to incomplete information.

DISCUSSION 5yr survival rates in the literature is 90- 70% for early stages 57% for stage 3 7% for stage 4 Staging tools include MRI, endorectal Ultrasound,CT Standard of care is neoadjuvant chemort or postop (5fu based) for locally advanced cases Chemort is recommended in adjuvant postop setting for adverse prognostic pathological indicators Adjuvant chemotherapy after neoadj chemort may ↑survival Palliation involves surgery, chemotherapy, radiation or a combination of all

DISCUSSION In US accounts for 10% cancer and 3rd cause of cancer deaths Delay in diagnosis is a result of nonspecific symptoms for minority of patients in the developed world In the developing world delay could be attributed to underdiagnosis and ignorance of patient, alternative tx The average time to presention was > 1 yr Most common pathology is adenocarcinoma (84%) Male to female ratio is almost equal 72yrs as median age at presentation in US data, We noticed a peak at 41-50yrs and 61-70yrs

DISCUSSION More than 50% present with locally advanced stage Common chemotherapy used was bolus 5FU/LV A few could afford Capecitabine + RT Very few could afford irinotecan or oxaloplatin + 5fu adj Again very few patients could complete adjuvant chemotherapy as they were lost to followup ESPECIALLY in the neoadjuvant setting A quarter either did not receive any treatment or absconded before completion Over the past few yrs neoadjuvant chemort more popular but depends on surgeon Intraop fibrosis due to long delay between rt and surgery and also use of low energy RT

SUMMARY We have an equal male to female ratio. Adenocarcinoma is most common histological type More than half present later than 1 yr of initial symptoms. At least half have locally advanced disease At least a quarter do not follow treatment recommendations. Limiting factors in this study are small numbers, loss to follow up and staging limitations( under and over staging). There may be a need for increased awareness through education of this curable disease in GHANA

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