The challenges of treating laryngeal carcinoma in jos, Nigeria.

BACKGROUND: Laryngeal cancers are not uncommon with several factors affecting its management in our environment compared to the developed countries. Such factors include the time of presentation and diagnosis, co-morbid disease, finance, consent, treatment options, surgical expertise and the problems of follow up. Thus this results to a lot management challenges to both the patients and the care givers. AIM: The aim of this paper is to highlight the challenges encountered in the management of laryngeal cancers at the Jos University Teaching Hospital, Nigeria. DESIGN OF STUDY: it is a retrospective study.
SETTING: The study was carried out at the ENT department of the Jos University Teaching Hospital and Bingham (ECWA Evangel) Hospital Jos Nigeria.
METHOD: This was a 48-month (October 2005 - September 2009) review of laryngeal cancers seen and treated in these hospitals. Data extracted included age, gender, histologic diagnosis and treatment modality. Data was analyzed using simple descriptive method and the result presented in tabular forms. RESULT: A total of twenty one (21) cases consisting of 20 males and a female were seen during the period. The age range was 30 years to 70 years. The average age was 56.14 years. The time of presentation ranged from 3 months (earliest) to 2years. Twenty cases (95.24%) were advanced diseases with only one early disease. The histological types were 6 each for well and moderately differentiated squamus cell carcinoma respectively, 2 each for poorly differentiated and squamus cell carcinoma (uncharacterized) and 1 carcinoma insitu. Two patients (a male and female) were seropositive for HIV type I. Twenty (95.24%) of the patients had tracheostomy at presentation with two having peristomal spread in the course of the disease. Eight (38.10%) patients had total laryngectomy out of which one was a salvage laryngectomy with subsequent right pectoralis major myocutaneous flap; 6 had concomitant chemoradiotherapy with one discontinuing after the first course and while the sixth total laryngectomee had no chemoradiotherapy. Three (14.29%) had primary radiotherapy; 2 of the cases were advanced diseases and one early disease. Eight (38.10%) had no treatment. Of the 6 laryngectomees, three had tracheo-oesophageal fistula post-operatively while one had disease recurrence and died. The first laryngectomy case is still on follow-up, disease free four years now while the rest have been lost to follow up.
CONCLUSION: Education and provision of standard oncologic treatment centres with trained personnel will help in alleviating theses challenges by providing treatment, data for assessment and improving the standard of our treatment.