Onyango J F, Macharia I M
Department of Oral and Maxillofacial Surgery, School of Dental Sciences, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya.
East Afr Med J. 2006 Apr;83(4):85-91. doi: 10.4314/eamj.v83i4.9421.
The most important prognostic factor in head and neck cancer is the stage of the disease at presentation. Early cancer has an excellent prognosis following treatment. Unfortunately most patients present with late disease that requires radical treatment with considerable morbidity and mortality. Clinical experience at Kenyatta National Hospital (KNH) shows that most patients present with late disease.
To determine the causes of late presentation of head and neck cancer.
A prospective descriptive study.
Kenyatta National Hospital, Nairobi.
Forty four cases were seen among whom 34 were males and 10 were females. The age range was 20 to 90 years with a peak incidence between 50 and 60 years. Most of the patients had little or no education and the majority lived in the rural areas. Seventy one percent of the patients came from the Central and Eastern provinces. Tobacco and alcohol use were the most common risk habits. The larynx was the most common site affected followed by the tongue. In 61% of the cases the size of the tumours at presentation was unknown. In 14% the size was 1-2cm, in 7% of the cases it was 2-4 cm while in 5% of the cases it was 4-6 cm. In 14% of the cases the tumour size was over 6 cm. The most common presenting symptom was hoarseness followed by swelling. The majority of the patients attended a public health facility nearest them. For most patients the facility lay within 5 km and could be accessed by walking. However, most of the patients went through multiple referrals to get to KNH. By the time the patients reached KNH, 35 patients (77%) had been treated with unspecified medications, two (4%) had had tooth extraction, and seven (16%) had had biopsies done. The time-lapse between the first symptom and consultation ranged from zero and eight months. Forty five percent of the patients presented to a medical facility within one month of their symptom and 45% presented after three months. The time lapse between referral and attendance at KNH ranged from zero and thirteen weeks and 45% of the patients presented to KNH within two weeks of referral. The overall duration of symptoms by the time of diagnosis ranged from zero months to unspecified years. Thirty two percent of the cases had experienced symptoms for six months or less by the time of diagnosis. However, a number of patients had had their symptoms for a number of years by the time of diagnosis. The distribution of the tumours by stage at the time of final diagnosis were as follows: stage I were 2%, stage II 6%, stage III 14% and stage IV 56%.
This study showed that the referral system was the main cause of delayed presentation of head and neck cancer to Kenyatta National Hospital.
头颈部癌症最重要的预后因素是就诊时疾病的分期。早期癌症经治疗后预后良好。不幸的是，大多数患者就诊时已处于晚期疾病阶段，需要进行根治性治疗，且伴有相当高的发病率和死亡率。肯雅塔国家医院（KNH）的临床经验表明，大多数患者就诊时已处于晚期疾病阶段。
确定头颈部癌症就诊延迟的原因。
前瞻性描述性研究。
内罗毕肯雅塔国家医院。
共观察到44例病例，其中男性34例，女性10例。年龄范围为20至90岁，发病高峰在50至60岁之间。大多数患者受教育程度低或未受过教育，且大多数居住在农村地区。71%的患者来自中部和东部省份。吸烟和饮酒是最常见的风险习惯。喉是最常受累的部位，其次是舌。61%的病例就诊时肿瘤大小未知。14%的病例肿瘤大小为1 - 2厘米，7%的病例为2 - 4厘米，5%的病例为4 - 6厘米。14%的病例肿瘤大小超过6厘米。最常见的就诊症状是声音嘶哑，其次是肿胀。大多数患者前往离他们最近的公共卫生机构就诊。对大多数患者来说，该机构距离在5公里以内，步行即可到达。然而，大多数患者要经过多次转诊才能到达肯雅塔国家医院。患者到达肯雅塔国家医院时，35例（77%）已接受未明确的药物治疗，2例（4%）已拔牙，7例（16%）已进行活检。从出现首个症状到就诊的时间间隔为零至八个月。45%的患者在出现症状后一个月内前往医疗机构就诊，45%的患者在三个月后就诊。从转诊到在肯雅塔国家医院就诊的时间间隔为零至十三周，45%的患者在转诊后两周内前往肯雅塔国家医院就诊。到诊断时症状的总持续时间从零个月到未明确的年份不等。32%的病例在诊断时症状出现时间为六个月或更短。然而，一些患者在诊断时症状已持续多年。最终诊断时肿瘤按分期的分布如下：I期占2%，II期占6%，III期占14%，IV期占56%。
本研究表明，转诊系统是头颈部癌症患者延迟到肯雅塔国家医院就诊的主要原因。
