title: Head and neck cancers: a clinico-pathological profile and management challenges in a resource-limited setting.
abstract: BACKGROUND
  Head and neck cancer (HNC) is one of the most common cancers worldwide and its incidence is reported to be increasing in resource-limited countries. There is a paucity of published data regarding head and neck cancers in Tanzania, and Bugando Medical Centre in particular. This study describes the clinicopathological profile of HNC in our local setting and highlights the challenges in the management of this disease.
  
  
  METHODS
  This was a retrospective study of histopathologically confirmed cases of head and neck cancers treated at Bugando Medical Center between January 2009 and December 2013.
  
  
  RESULTS
  A total of 346 patients (M:F = 2.1:1) were studied representing 9.5 % of all malignancies. The median age of patients was 42 years. Cigarette smoking (76.6 %) and heavy alcohol consumption (69.9 %) were the most frequently identified risk factors for head and neck cancer. The majority of patients (95.9 %) presented late with advanced stages. Twenty-five (7.2 %) patients were HIV positive with a median CD4+ count of 244 cells/μl. The oral cavity (37.3 %) was the most frequent anatomical site affected. The most common histopathological type was carcinomas (59.6 %) of which 75.7 % were squamous cell carcinoma. A total of 196 (56.6 %) patients underwent surgical procedures for HNC. Radiotherapy and chemotherapy was reported in 9.5 and 16.8 % of patients, respectively. Only 2 (0.6 %) patients received chemo-radiation therapy. The mortality rate was 24.4 %. The overall 5-year survival rate (5-YSR) was 20.6 %. The predictors of overall 5-YSR were age of patient at diagnosis, stage of disease, extent of lymph node involvement, HIV seropositivity and CD4+ count <200 cells/μl (P < 0.001). Local recurrence was reported in 22 (23.4 %) patients and this was significantly associated with positive resection margins, stage of the tumor and presence of metastasis at diagnosis and non-adherence to adjuvant therapy (P < 0.001).
  
  
  CONCLUSIONS
  Head and neck cancers are not uncommon at Bugando Medical Centre and show a trend towards a relative young age at diagnosis and the majority of patients present late with advanced stage cancer. Therefore, public enlightenment, early diagnosis, and effective cost-effective treatment and follow-up are urgently needed to improve outcomes of these patients in our environment.
authors.affiliation: Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania. drgilyoma2@yahoo.com.
authors.forename: Japhet M
authors.initials: JM
authors.lastname: Gilyoma
authors.affiliation: Department of Pathology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania. prambau@bugando.ac.tz.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Rambau
authors.affiliation: Department of Oncology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania. nmasalu4@gmail.com.
authors.forename: Nestory
authors.initials: N
authors.lastname: Masalu
authors.affiliation: Department of Paediatrics, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania. n_eema@yahoo.com.
authors.forename: Neema M
authors.initials: NM
authors.lastname: Kayange
authors.affiliation: Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania. drphillipoleo@yahoo.com.
authors.forename: Phillipo L
authors.initials: PL
authors.lastname: Chalya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D006295:Health Resources / Q000592:standards / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult