By Randy Hurley MD, cTropMed
HealthPartners and Regions Hospital Cancer Care Centers
Global Health Faculty, University of Minnesota
May 19, 2022
Three Tanzanian cases were discussed during the KCMC-Minnesota multidisciplinary tumor board today that all required surgical oncology input. Three surgical oncologists, in addition to medical and radiation oncologists from Minnesota were able to provide recommendations to the KCMC team on rather challenging cases.
One case involved a man with a locally advanced colon cancer with perforation and abdominal wall abscess formation in the setting of active tuberculosis. The abscess had been drained and plans were developed to perform a diverting colostomy prior to neoadjuvant chemotherapy and eventual surgical resection.
A second case involved a patient with a distal esophageal adenocarcinoma. Esophageal cancer is rather common in East Africa but is typically of squamous cell histology. Typically, this adenocarcinoma would be treated with neoadjuvant chemotherapy and radiation prior to surgery. Radiation is not yet available at KCMC and thus this patient was to be referred to Dar Es Salaam, 500km away.
The final case involved a 70-year-old woman with advanced gall bladder cancer that had been evaluated with CT scan and laparoscopy with biopsy. Gall bladder cancer is rare in Tanzania. In the United States it is often identified incidentally at the time of cholecystectomy for gall stone disease. Historically, there is a female predominance for gall stone disease and gall bladder cancer. There is a variation, worldwide, in the prevalence of gall bladder cancer with the highest rates in South American countries such as Chile and Bolivia as well as in India and parts of Asia (Globocan data). This correlates with the prevalence of gall stone disease but also the prevalence of salmonella typhi infection worldwide. (Dutta U, et al; Am J Gastroenterol 2000). It is postulated that chronic irritation from gall stone disease and inflammation from infection can act as a promotor for malignant transformation. Unfortunately, locally advanced gall bladder cancer has a grim prognosis; goals of care emphasizing palliation were advised.