Oncology in Cambodia.

Cambodia, a country of 14 million inhabitants, was devastated during the Khmer Rouge period and thereafter. The resources of treatment are rare: only one radiotherapy department, renovated in 2003, with an old cobalt machine; few surgeons trained to operate on cancer patients; no hematology; no facilities to use intensive chemotherapy; no nuclear medicine department and no palliative care unit. Cervical cancer incidence is one of the highest in the world, while in men liver cancer ranks first (20% of all male cancers). Cancers are seen at stage 3 or 4 for 70% of patients. There is no prevention program - only a vaccination program against hepatitis B for newborns - and no screening program for cervical cancer or breast cancer. In 2010, oncology, recognized as a full specialty, was created to train the future oncologists on site at the University of Phnom Penh. A new National Cancer Center will be built in 2013 with modern facilities for radiotherapy, medical oncology, hematology and nuclear medicine. Cooperation with foreign countries, especially France, and international organizations has been established and is ongoing. Progress is occurring slowly due to the shortage of money for Cambodian institutions and the lay public.

[Diagnosis and treatment of invasive cervical cancer in Cambodia (apropos of 35 cases)]. / Diagnostic et traitement du cancer invasif du col utérin au Cambodge (a propos de 35 cas).

Uterine cervix cancer is an important public health problem in developing countries. In Cambodia, incidence (24. 10-5) and mortality (12,77. 10-5) rates due to this cancer are higher than in other southeast Asian countries. 35 consecutive women with a diagnosis of invasive cervical cancer were identified from the histology laboratory of the Institut Pasteur in Phnom Penh. Information on history, clinical findings, ancillary investigations and treatment were obtained by clinical files review. Patients were from Phnom Penh, the main city and from outlying provinces. The mean age was 50 years, 2 months. They all presented with clinical symptoms at the time of diagnosis, and lesions had spread beyond the uterus in nearly half of the cases. Squamous cell carcinoma (80%) was more frequent than adenocarcinoma (14%). Microinvasive squamous cell carcinomas were rare (2.8%). Treatment was mainly surgical, but lacked standardization, as radical hysterectomy including lymphadenectomy was not systematic, even when the tumor spread beyond the uterine cervix. Few women that required adjuvant radiotherapy received it as this technique has only recently been introduced in Cambodia. Many patients were lost to follow-up. None of the cases was detected by pap smear. This technique is not in general use in the country. Cervical cancer screening could be carried out by visual inspection of the cervix with acetic acid wash that is less expensive and nearly as sensitive as pap smear. Treatments are still insufficiently standardized, due to the lack of technical means, and lack of patient compliance.