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

2. 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.

3. 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 with ASR 12.3%

4. 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

8. 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.

9. 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

10. 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

11. 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

12. 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%).

13. 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

14. 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

15. 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

16. 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.

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

18. 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.