Carcinoma of the oesophagus and stomach

For some years we have been able to perform gastroscopies in Chaaria.

One data which has come to our observation quite early in our statistics is the high incidence on carcinoma of the oesophagus, followed closely by the carcinoma of the stomach.

According to the geography of our clients we have also realized a higher number of carcinoma of the oesophagus in the populations living in the North: the impression is that from Isiolo, Marsabit,

Rendille, Samburu, Turkana and Moyale the percentage of patients coming for a gastroscopy and actually having a carcinoma of the oesophagus is very high.

Many times they come very late and already they are in the final stage of disease: they have a complete stricture of the oesophagus and cannot swallow anything, including saliva. We always perform a biopsy during endoscopy, and the histopathology normally confirms the presence of the malignancy.

For the majority of our patients even a stent is no more an option (although very few would have the money for that!), because the stenosis is too advanced.

We normally a propose a gastrostomy which is a minor operation in which we insert a tube directly in the stomach, therefore bypassing the stricture caused by the tumour. The patient learns later how to feed himself through the gastrostomy tube. 

The operation is palliative, but allows the patients to survive much longer and to avoid dying of starvation. We have got patients surviving up to 2 years in relative good conditions with a gastrostomy.

The carcinoma of the oesophagus is more common in men than in women (although we see also a great number of female clients with such a malignancy, and tomorrow for instance we will perform a gastrosstomy for a 50-year-old woman); the pick of incidence is after the age of 50 years.

Nobody knows the reason why in the North there is such an enormous number of malignancies of the oesophagus (a silent epidemic according to me): surely research is to be done in order to understand if the cause is in the environment or in some cultural practice (like taking tea extremely hot, pollutants in the water sources, smoke in the houses,etc).

Majority of the cancers of the oesophagus involve the middle or the lower 1/3 and histologically they are squamous cell carcinomas; the carcinoma of the upper 1/3 is very rare, while we have a certain number of carcinomas of the oesophago-gastric junction, which generally are adenocarcinomas.

Carcinoma of the stomach is also quite common in our statistics, but in this case we cannot see the sharp increase of incidence in the populations of the North: for the carcinoma of the stomach the patients from Meru and the ones coming from further North have similar prevalence.

Histologically we get adenocarcinomas, but also GIST is becoming a relatively frequent finding.

Differently from the carcinoma of the oesophagus, for the malignancies of the stomach sometimes we are able to perform partial gastrectomies with good surgical outcomes and high hopes of radicality.

In Kenya so far there is no cancer registry. Only Nairobi has one.

According the the "Nairobi Cancer Registry Report 2004-2008" carcinoma of the oesophagus is the second in prevalence for males (the fmost prevalent being the carcinoma of the prostate), while is the third in prevalence for females (after breast and cervix cancer).

in the same document carcinoma of the stomach is forth for males and fifth for females.

For the first time we have been recently visited here in Chaaria by a team from KEMRI. They have highly appreciated our statistics (which are already in "excell" and include data and graphs non only of the endoscopy results from 2009 onward, but also of the biopsy reports).

The idea is to work towards the creation of a National Cancer Registry, and Chaaria Mission Hospital will be very willing to offer full support and collaboration to KEMRI.

Bro Dr Beppe Gaido