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

2. 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.

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

4. The male to female ratio was 1.2: 1.0.
Staging was by clinical exam and CT scan.
Patients presented between 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

5. > 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

6. 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.

7. 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

8. 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

9. 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

10. 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

11. References
B M Alexander et al Harrison,s Manual of Oncology (2008) chapter 11 :
Camma C et al (2000)JAMA 284:
Colorectal cancer collaborative group (2001) lancet 358:
Swedish rectal cancer trial (1997) N ENG J MED336(14):
Sauer R et al (2004) N ENGL J MED 351(17):
Kim MK et al (2006) Ann Surg 244:
Smalley SR et al J Clin Onc 24 (220) :
Wolmark N et al(2000) J Natl Cancer Inst 92(5):
Lahaye MJ et al (2005) Semin Ultrasound CT MR 26(4);
Bosset JF et al(2006) N Engl J Med 355: