Survie actuarielle comparée des malades atteints de cancer du sein et de l'estomac

Le cancer de l'estomac atteint un organe profondément situé, dont l'accessibilité n'est rendue possible que par l'endoscopie. Par contre le sein est un organe accessible à l'examen clinique mais chargé de symbolismes : féminité, maternité, sexualité. Cette différence dans l'apparence nous a conduits à en évaluer la survie globale à cinq ans, à partir des données du Registre des cancers de Brazzaville. Nous avons alors utilisé la méthode actuarielle pour construire les courbes de survie qui ont été comparées par la suite selon le test du log-rank. Ces différents calculs nous ont permis de constater l'absence de différence statistiquement significative entre les survies globales des malades atteints de ces cancers d'apparence si dissemblable

Three weekly irinotecan and bolus 5-fluorouracil combination in the first line treatment of advanced gastric cancer - a single institution experience

Background: The goal of this study is to determine the efficacy and toxicity of a non-platinum based chemotherapy combination using irinotecan associated to bolus 5-FU as first line treatment in advanced gastric cancer. Materiel and methods: Retrospective analysis of a population of patients treated for metastatic and locally advanced gastric cancer with irinotecan and 5-FU as upfront chemotherapy. Results: Thirteen patients were enrolled. The median age was 56 years. Seven patients were males and six were of females. Ten patients had a metastatic disease and three patients had a locally advanced disease. Patients received a total number of 43 cycles of chemotherapy. Overall response rate was 38,4%, median time to progression (TTP) was 3 months, and median overall survival was 4 months. Three patients (23,1%) presented grade 3 /4 neutropenia complicated with an infectious episode with fever in two cases, three patients (23,1%) required blood transfusion for a grade 4 anemia, and one patient (7,6%) was hospitalized for a severe episode of diarrhea. Conclusion: Three weekly irinotecan and bolus 5-FU is an interesting combination as first line treatment of advanced gastric cancer; designed clinical trials are needed to confirm the activity of this combination

Cancer gastrique et infection à Helicobacter pylori en RD Congo. Aspects épidémiologiques

Objectif: Décrire le profil épidémiologique des lésions pré-cancéreuses et cancéreuses gastriques et la fréquence de leur association à l'infection à Helicobacter pylori.Matériel et méthodes: Enquête documentaire couvrant la période de 2001 à 2011,issue des registres reprenant les protocoles anatomopathologiques des analyses des biopsies gastriques effectuées dans les laboratoires d'anatomie pathologique des Cliniques Universitaires de Kinshasa, du centre Lomo Médical, de l'Institut National de Recherche Biologique (INRB), et de l'Hôpital Général de référence de Bukavu. La fréquence de lésions et l'association à l'infection à H. pyloriont été déterminées. Résultats: Cent dossiersdes patients avec lésions pré-cancéreuses ou cancéreuses gastriques ont été analysés. Leur âge moyen était de 54,8 ±13,3 ans. La fréquence du cancer a paru plus élevé dans les provinces de l'Est du pays (p = 0,005); avec l'adénocarcinome gastrique comme la forme la plus fréquente (83%). L'infection à Helicobacter pylori n'a été observée que chez 20% des patients. Conclusion: Le cancer gastrique, surtout l'adéno-carcinome est un cancer fréquent, prédominant surtout dans les régions orientales de la R D Congo. Ce cancer touche des sujets relativement jeunes. Des mesures préventives ciblées s'imposent

Genetic Determinants and Clinico-Pathological Outcomes of Helicobacter Pylori Infection

Helicobacter pylori is a spiral Gram-negative bacterium with a relatively small genome and is known to be the most common human bacterial infection worldwide; infecting about half of the world's population. The bacterium represents one of the most successful human pathogens; inducing severe clinical symptoms only in a small subset of individuals; thus signifying a highly balanced degree of co-evolution of H. pylori and humans. The prevalence of Helicobacter pylori infection varies greatly among countries and among population groups within the same country; but is falling in most developed countries. The clinical course of H. pylori infection is highly variable and is influenced by both microbial and host factors including genetic susceptibility while the pattern and distribution of inflammation correlate strongly with the risk of clinical sequelae; namely duodenal or gastric ulcers; mucosal atrophy; gastric carcinoma; or gastric lymphoma. Cytokine gene polymorphisms directly influence inter-individual variation in the magnitude of cytokine response; and this clearly contributes to an individual's ultimate clinical outcome. Polymorphisms in genes coding for innate immune factors have also been incriminated in the pathogenesis of H. pylori related disease; while promoter hypermethylation of tumor suppressor genes is considered an important factor in carcinogenesis and known to be present in H. pylori associated gastric tumors. Functional genomics may fill many of the gaps in our understanding of the pathogenesis of H. pylori infection and accelerate the development of novel therapies; including H. pylori specific antimicrobial agents

Aspects épidemiologiques et anatomocliniques des cancers de l'estomac à Bamako

Dans le but determiner les aspects épidémiologiques et anatomo-cliniques des cancers de l'estomac à Bamako, les auteurs ont entrepris une etude prospective transversal d'avril 2006 à décembre 2007 dans le Service de Gastroentérologie du CHU Gabriel Touré de Bamako et dans deux cliniques de la place. Au total 90 cas ont été diagnostiqués dont 62 hommes et 28 femmes (soit un sex ratio de 2,10). La moyenne d'âge était de 54,88 +/- 14,29 ans, avec des extrêmes de 18 et 85 ans. Les paysans et les ménagères ont été les plus atteints. Les manifestations cliniques les plus fréquentes étaient : l'épigastralgie (52,22 %), les vomissements (15,55 %) et l'amaigrissement (11,11 %). La localisation antrale (67,8 %), l'aspect ulcéro-bourgeonnant (61 %) et l'adénocarcinome bien différencié (37,8 %) sont les éléments caractéristiques de notre échantillon

Epidemiology of Gastric Cancer in Jos University Teaching Hospital Jos a 20 Year Review of Cases

Gastric cancer believed to be rare in the past in Africa; is now one of the leading cancer morbidity and mortality. It is now known gastric cancer is 2-3 times higher in males than females living in the same environment. We aim to describe the comprehensive histological characteristics of gastric cancer with age and sex distribution. Methods: The study site was Jos University Teaching Hospital situated in the capital of Plateau State. The hospital has a bed capacity of 530. The study materials were obtained from all stained specimens of gastric cancer recorded in the histopathology laboratory of the teaching hospital between 1985 to 2004. The biopsy site was noted. These were divided into the following groups: Cardia; body and an thrum/pyloric regions respectively. Or the information included age and sex of the patients. Results: There were a total of 205 gastric cancer histological confirmed; out of 5705 malignant tumours recorded in the same period. There were a total of 145 cases in male and 60 in females giving a male: female ratio 2.4:1. The highest frequencies of gastric cancers were located in the anthral and cardia regions which accounted for 79of all the tumours. Well differentiated adenocarcinoma (intestinal type) was the most frequent histological subtypes 51.2); this was followed by poorly and diffusely infiltrating carcinoma. Other cancers included signet ring carcinoma; Non- Hodgkin's lymphoma and leiomyosarcoma in that order. The study has also demonstrated H pylori at the background of intestinal type adenocarcinoma which was seen in the body and an thrum. Conclusion: The study has shown that gastric cancer is not only common but it occur more males than females. The high proportion of H pylori in our environment might indicate a possible aetiological association. Therefore eradication of H pylori might reduce the prevalence of gastric carcinoma

Clinico-pathological review of malignant gastric tumours in Lagos, Nigeria

Gastric cancer is one of the most common cancers and the 2d most common cause of cancer deaths worldwide. Contrary to earlier reports from Africa;prevalence of this cancer has been found to be comparable to that of other parts of the world.To describe the clinico-pathological features of gastric cancer diagnosed in Lagos and determine the prevalence of H. pylori infection in gastric adenocarcinoma.This was a retrospective histopathological study of all gastric cancer seen between 1995 and 2007 in the Morbid Anatomy Department of Lagos University Teaching Hospital as well as two other private histopathology laboratories in Lagos (2002-2007). The blocks and slides of gastric cancer tissue were the materials used for the study. The patients' bio data and relevant clinical details were extracted from the demographic records.There were 105 cases of gastric cancer (M:F = 2:1; mean age-55.3 years); 81of which occurred above 45 yrs. There were 95 cases (90) of adenocarcinomas; 8 (7.6) mesenchymal tumours with one case each of small cell non-Hodgkin's lymphoma and carcinoid tumour. H. pylori was detected in 15.5of 45 cases of adenocarcinoma with 36 showing evidence of chronic gastritis in adjacent non cancerous gastric tissue. All patients with clinical data had one or more alarm features; most recurring being abdominal fullness; recurrent vomiting; anorexia and weight loss.This study suggests that gastric malignancies are not uncommon in Lagos and often manifest with alarm features which should raise a suspicion particularly in our setting with poor diagnostic endoscopic facilities

Gastric Cancers at Kibogora Hospital

Background: Epigastric pain is very common in our patients of both sexes and upper GI endoscopy is offered in very few hospitals. Antacids are routinely prescribed countrywide. Helicobacter pylori is very common in our region. Not only most clinicians lack the means to diagnose this infection; but they also cannot confirm its eradication. Many of our patients present with advanced gastric cancer with no prospective for cure. The aim of this study was to determine the frequency; the clinical presentations; the anatomical and pathological aspects and the management of gastric cancers at Kibogora hospital. Methods: This was a retrospective descriptive study of gastric cancer patients seen over a 1 year period from July 2006 to June 2007 at Kibogora hospital. Data was collected from records of patients with diagnoses of gastric cancers. Results: Thirty five subjects were diagnosed with gastric cancer during the study period. Their age ranged from 30 to 80 years with a mean of 55.8 years. There were more females 20 (57.1) than males 15(42.9) (F: M ratio = 1: 0.7). The commonest presenting complaints were epigastric pain (100); vomiting (94.3) and marked wasting (82.9). The physical findings included features of gastric outflow obstruction (60); epigastric tenderness (82.9) and epigastric mass (37.1). Diagnosis of advanced gastric cancer was made at endoscopy in 29(82.9). Palliative surgery was done for 34 (97.1) patients. Twenty seven (77.1) patients markedly improved their quality of life and were discharged home. Only one patient died in hospital. The hospital stay ranged between 7 and 32 days with a mean of 14 days. All the specimens sent for pathology were reported as gastric adenocarcinoma of the intestinal type. Conclusion and recommendations: Gastric cancer is an important public health problem in our region. Clinicians need to adequately diagnose and eradicate H. pylori infection if the incidence of gastric cancer is to be reduced in this region. Surgery can only offer emporary palliation for advanced gastric cancer. There is a need for palliative care in this country

Tumeur benigne de l'estomac : a propos d'un cas a developpement exogastrique. Revue de la litterature

Nous rapportons le cas d'une tumeur benigne exogastrique revelee par la palpation d'une masse abdominale dans le flanc gauche d'un patient asymptomatique age de 47 ans et en bon etat general.C'est une affection rare a. predominance masculine.L'echotomographie et la tomodensitometrie localisent cette masse d'aspect heterogene dans l'hypocondre gauche.La tomodensitometrie precise l'origine gastrique de la tumeur en mettant en evidence un fin pedicule la reliant a l'estomac.La laparotomie permet l'exerese de la tumeur dont l'evolution peut-etre prolongee en l'absence de metastase.L'etude histologique de la piece operatoire met en evidence un leiomyome. Le diagnostic de certitude de leiomyome exogastrique est ainsi portes.L'evolution post-operatoire est favorable

Mucin secretion by gastric carcinoma cells: PAS alcain blue stain study

Thirty cases of gastric cancer were studied. Slides were stained with PAS Alcian Blue. The staining characteristics of the mucin were correlated with gross characteristics of the tumours and histological types. Due to the few cases studied; there was no observed statistical significance between the various mucin staining characteristics with the histological type; sex site of tumour and ethnicity. In 84of cases the tumour cells secreted either neutral or mixed mucins. Acid mucins were demonstrated in 5 cases only. neutral mucin is normally secreted by gastric epithelium and neck cells of gastric glands. The observation in this study suggests that those tumours which secrete neutral and mixed mucin probably arise from gastric epithelium; neck cells of gastric glands or colonic metaplasia. In those cases where the tumour produces acid mucin it is possible the tumour arose from areas of intestinal metaplasia

Ulceres et cancers gastriques: a propos de 187 cas

Les objectifs etaient de determiner la frequence et les facteurs influencant les suites operatoires des ulceres et des cancers gastriques. Les dossiers des malades de 1979 a 1989 ont ete consultes et les patients et leurs sujets contacts ont ete enquetes a domicile a Bamako. Au total 187 cas dont 10 ulceres et 177 cancers gastriques ont ete colliges. La duree moyenne des symptomes a ete de 8 ans. Plus de la moitie des cas etaient au stade de complications. 4 techniques chirurgicales ont ete realisees : vagotomie suppraselective; vagotomie tronculaire; suture; gastrectomie. les suites operatoires ont ete compliquees dans 23;69 pour cent des cas avec une mortalite de 10 pour cent. 51 pour cent des cancereux n`ont beneficie d`aucune chirurgie. Le taux d`operabilite a ete au stade III. Le taux de resectabilite etait de 29;9 pour cent dont seulement 19;7 pour cent a visee curative et 20;9 pour cent de mortalite. La survie etait de 28 pour cent a 5 ans apres resection curative; mais moins de 6 mois pour toute autre attitude therapeutique

Les cancers gastriques au CHU de Brazzaville : a propos de 31 cas operes

Les auteurs rapportent 31 cas de cancers gastriques operes dans le service de Chirurgie Digestive du CHU de Brazzaville du 1er juillet 1986 au 30 juin 1992 soit 6 ans. On compte 21 hommes et 10 femmes. L'age des patients est compris entre 21 et 71 ans avec une moyenne de 49 ans. La symptomatologie; pylomorphe; est dominee par les signes tardifs (alteration de l'etat general et signes de stenose antro-pylorique). Le traitement chirurgical; palliatif dans plus de la moitie des cas est realise pour le confort des malades; compte tenu des stades tres evolues de ces patients. L'evolution est decevante avec une survie moyenne allant de 3 a 18 mois

"Devenir des gastrectomises pour cancer gastrique en chirurgie ""B"" a l'hopital du Point ""G"" - Bamako"

"En 10 ans; les auteurs ont collige 177 cas de cancers gastriques sur lesquels 53; soit 29;9 pour cent ont pu beneficier d'une resection (curative ou palliative). Le taux de resection a visee curative a ete de 19;7 pour cent et celui de resection a visee palliative de 10;2 pour cent. Il ressort de ces chiffres que les taux d'operabilite et de resecabilite en chirurgie ""B"" sont nettement inferieurs a ceux des pays developpes. Par contre pour les patients ayant pu beneficier d'une resection curative; le taux de survie a 5 ans est de 28 pour cent; chiffre comparable a ceux des series occidentales. Les auteurs recommandent un diagnostic precoce des cancers gastriques."

"Pronostic des cancers avances de l'estomac dans le Service de chirurgie ""B"" a l'Hopital du Point ""G"""

Sur une serie de 177 tumeurs gastriques; les auteurs ont etudie la frequence et le pronostic des cancers depasses de l'estomac. Il ressort de l'etude que la proportion de tels cancers est significativement plus elevee en chirurgie B que chez d'autres pays africains et occidentaux. Les types histologiques retrouves sont l'adenocarcinome surtout; puis les lymphomes et les sarcomes. Le pronostic est sombre quelle que soit l'attitude therapeutique. Les auteurs recommandent la sensibilite des patients et les medecins pour l'investigation endoscopique de toute epigastralgie

Le cancer de l'estomac: a propos de 51 cas observes au CHNU de Cotonou

Une etude retrospective a analyse 51 cas des cancers de l'estomac observes en 11 ans au CHNU de Cotonou. L'affection atteint plus souvent l'homme que la femme (sex-ratio = 1;43) et predomine dans la tranche d'age de 57 a 70 ans (68;62 pour cent des cas). La duree de l'evolution avant le diagnostic explique la frequence des complications (stenose 4 fois sur 10; hemorragies digestives 1 fois sur 10) et des metastases principalement ganglionnaires (3 cas sur 4); hepatiques (1 fois sur 2) et peritoneales (un tiers des cas). Cela explique le taux d'operabilite et de resecabilite (respectivement de 82;35 pour cent et 41;85 pour cent) et le mauvais pronostic de ces cancers (taux de survie a 1 an et a 5 ans respectivement de 11;90 pour cent et 2;38 pour cent)