Chimiotherapie des cancers du col de l'uterus au stade IV a vesical a l'Institut Curie de Dakar

Les cancers du col de l'uterus au stade IV ne relevent plus de la combinaison standard radio-chirurgicale. Aussi dans notre contexte marque par les difficultes de tous ordres pour correctement appliquer la chimiotherapie; nous avons pense opportun de retracer notre experience dans l'utilisation de moyen therapeutique dans les cancers du col uterin classes IVa vesical a Dakar. Sur 91 dossiers retenus; 80 ont concerne la mise en oeuvre de la combinaison chimiotherapie et radio-therapie selon diverses modalites. Les resultats enregistres dans la pratique de cette modalite nous poussent a proposer la procedure chimiotherapie neoadjuvante suivie de radiochimiotherapie dans notre contexte en l'absence de curietherapie pour ameliorer la survie

[Primary lymphoma of the thyroid: a case report]. / Lymphome primitif de la thyroïde: a propos d'un cas.

Primary lymphoma of the thyroid is an uncommon disease. It diagnosis is difficult without immunohistochemestry. We report a case of thyroid lymphoma diagnosed at the A. Le Dantec Hospital of Dakar. A 22-year old young man presented anterior neck mass. Clinical examination showed a thyroid mass with a susclavicular palpable lymph node. The scintigraphy demonstrated that the mass was cold. Total thyroidectomy with cervical lymphadenectomy was the first treatment. Histological examination of the surgical specimen concluded that the mass was an anaplastic lymphoma (large cells type) involving the sus clavicular lymph nodes (stage IIE). Chemotherapy was administrated after one month with C-MOPP schedule. The patient presented no recurrent sign after 30 month. Fine needle aspiration and immunocytochemestry of the thyroid cold masses will contribute in an accurate diagnosis and the management of disease in our institution.

Cancer du sein chez l'homme africain : 46 observations dakaroises

Il s'agit d'une etude retrospective de 46 cas de cancers du sein survenus chez l'homme et colliges a l'institut du Cancer de Dakar de 1957 a 1999. L'age moyen des malades etait de 60;7 ans et la duree moyenne des symptomes etait de 37;5 mois. La repartition des malades selon la classification TNM de l' UICC revelait : 1T1; 1T2; 4T3; 40T4; 40N1; 1N2; SN3; 10M1 PUL; 8M1 OSS et 2M1 HEP. Le carcinome canalaire invasif representait 78;2 pour cent de l'ensemble des lesions histologiques. Nous avons realise 32 mastectomies dont 23 etaient associees a un curage axillaire. La chirurgie etait associe a une chimiotherapie dans 25 cas et a une radiotherapie dans 14 cas. Le traitement hormonal au Tamoxifene fut institue dans 7 cas. Le suivi moyen des malades etait de 24 mois. Le pronostic de ces cancers pourrait etre ameliore par une meilleure education et un diagnostic plus precoce

[Complications of colpohysterectomy with lymph node dissection in the cervix carcinoma at the Cancer Institute of Dakar: report of 412 cases]. / Les complications des colpohystérectomies élargies avec lymphadénectomie pour cancer du col utérin à l'Institut du Cancer de Dakar: à propos de 412 cas.

The wertheim complications are dominated by the urinary dysfonction and the lymphocele which are linked at this procedure. This study reported 412 Wertheim associated to the radiotherapy. The purpose was to evaluate the complications among patients who underwent the Wertheim and to analyse the differents factors promotions the complications. The diagnosis was always late and the disease stage was advanced. The stages II, III and IV represented more than 80%. We found 86 complications (20.87%) distributed as follow: 17 urinary (19.76%), 30 secondary infections (34.88%), 8 colonic fistula (9.30%), 7 hemorrage (8.13%), 6 lymphedema (6.97%), 3 occlusions (3.48%), 1 phlebitis (1.16%), 1 lymphocele (1.16%). among all patients, 17 died, the mortality rate was 4.12%. A very good dissection preceded by radiotherapy may reduce the complications rate.

[Cancer of the uterine cervix in pregnancy: report of 50 cases]. / Cancer du col de l'utérus et grossesse: à propos de 50 cas.

Through a retrospective study of 50 cervix carcinoma during pregnancy, the authors determine the epidemiology, discuss the therapeutic and the pronostic. The mean age of patients were 36 years and the clinical staging of FIGO found : 3 stages Ia, 3 Ib, 7 IIa, 14 IIb, 7 IIIa, 7 IIIb, 4 IVa, 5 IVb The diagnosis of carcinoma was in 6 cases(12%) at first trimester, in 6 cases(12%) at midtrimester, in 13 cases(27%) at third trimester, in 19 cases(28%) after delivery. The termination of pregnancy was an abortion in 6 cases(12%). The treatment was: 29 delivery whose 12 followed bycolpohysterectomy,1 byconisation and 16 had not a colpohysterectomy. 5 cesarean section whose 2 followed by colpohysterectomy in the same time and 3 in the second time. The radiotherapy was neoadjuvant in 3 cases and adjuvant in 3 cases. The mortality was 4 % and the global survival at 5 years was 30%. The prognostic of the cervix carcinoma during pregnancy would get better by Pap test which must be systematic at the pregnant woman.

[Breast cancer and pregnancy: about 60 cases collected at the Cancer Institut of Dakar]. / Cancer du sein et grossesse: à propos de 60 cas colligés a l'Institut du Cancer de Dakar.

The purpose of this retrospective study of 60 breast carcinoma during pregnancy collected at the Cancer Institut of Dakar from 1962 to 1998 was to determine the epidemiology, the clinical appearance and to discuss the pathogeny, the diagnosis, the prognosis and the treatment. The mean of age of patients was 34.5 years. The number of parity was 5 and the first pregnancy at 20 years. The authors arrived at diagnosis in the post partum in 28 cases (47.45%), in the first trimester in 8 cases (13.55%), in the midtrimester in 13 cases (22.03%) and in the third trimester in 11 cases (18.64%). The polychemotherapy preceded the surgery in 30 cases and succeded in 16 cases. The hormonotherapy with Tamoxifen prescribed in 17 cases after the delivery. The mastectomy and axillary lymphadenectomy was realised in 26 cases in the post partum. The adjuvant radiotherapy was done in 12 cases. The mortality was 31% and the global survival at 2 years, 34.6%.

[Vulvar cancers. Retrospective study of 23 cases at the Cancer Institute of Dakar]. / Les cancers de la vulve. Etude rétrospective à propos de 23 cas colligés à l'Institut du Cancer de Dakar.

The vulvar cancer is an uncommon disease which is beginning mostly on vulvar intraepithelial neoplasma and it keeps a very bad prognostic. The purpose of this study is to report the epidemiological, the anatomo-clinic and and to discuss the treatment. We tell about 23 vulvar cancer from 1956 to 1995 which were followed at the cancer Institut of Dakar. The mean age of patients is 47 years and they are on menopause in 78.6%. The most of the tumors are ulcerate (96%). The clinical investigation find according the staging of FIGO: 15 tumors (T2), 8 tumors (T3), 6 tumors (N1), 9 tumors (N2) and 1 tumor (M1b). The surgery is the principal treatment with 6 radical vulvectomy and 17 palliative vulvectomy. The surgery was associated with radiotherapy and chemotherapy. So the vulvar cancer is uncommon in our country and concern the young wives. The vulvectomy with lymphadenectomy is the principal treatment; the prognostic still very bad because the diagnostic is often later.

[Epidemiological and therapeutic aspects of rectal cancer in Senegal: 74 cases at the Cancer Institute of Dakar]. / Aspects épidémiologiques et thérapeutiques des cancers du rectum au Sénégal: à propos de 74 cas colligés a l'Institut du Cancer de Dakar.

Through a retrospective study of 74 cancer of rectum the autors determine the epidemiology, the anatomic appearance and discuss the treatment, the prognostic. The mean age of patients was 48 years and the Duke's staging found: 16 stages B, 46 stages C and 12 stages D. The pathological anatomy showed: 58 adenocarcinoma, 9 colloïdal adenocarcinoma, 4 epidermoïdal carcinoma, 2 lymphosarcoma, 1 anaplasic adenocarcinoma. The operability rate was 66.2%, the resectability was 40.8% and the sphincteral preserving was 8.1%. The radiotherapy preceded the surgery in 6 cases and associated the chemotherapy. The chemotherapy preceded the surgery thein 14 cases and succeeded in 2 cases. The mortality was 24.4% and the recidivation 35%. The global survival 5 years was 32%. The prognostic could better by an earlier diagnostic and a multidisciplinary treatment.

[Cancers of the anus: 32 cases]. / Les cancers de l'anus: à propos de 32 cas.

The purpose of this retrospective study about 32 anal carcinoma was to determine the epidemoilogy, to discuss the therapeutic indications. The mean age of patients was 56.42 years and the protologic antecedent was 14%. According to the clinical staging: 1 patient was T1, 2 T2, 19 T3, 10T4; 1 No, 2 Nx, 7 N1, 10 N2, 12 N3; 25 M x, 5 MO, 2 M1. The histologic classification of OMS found: 17 epidermoid carcinoma, 12 glandular carcinoma, 1 transitional cell carcinoma, and 1 non classify cancer. 14 radical resection and 3 local resection were realised, 8 patients had an exclusive radiotherapy: 2 curative radiotherapy and 6 palliative. The morbidity was 9.37% and dominated by perineal suppuration and the mortality was 3.12%. The adjunctive radiotherapy must be the first treatment of the anal cancer in our countries.

[Epidemiological factors, treatment and prognosis of uterine sarcomas: 14 cases at the Cancer Institute of Dakar]. / Etude des facteurs épidémiologiques, du traitement et du prognostic des sarcomes de l'utérus: à propos de 14 cas colligés à l'Institut du Cancer de Dakar.

The study of uterus sarcoma took in interest because these tumors were unrecognized and sat nowadays many questions. The purpose of this study is to review the epidemiological factors, the problems of treatment and prognostic of uterus sarcoma. It's a retrospective study of 14 sarcomas of uterus reported from 1959 to 1997. The mean age of the patients was 54 years and they were on menopause in 78.6%. The clinical investigation found according the FIGO staging: 6 stage I (42.6%), 4 stage II (28.4%), 1 stage III (7.1%) and 3 stage IV (21.4%). The leiomyosarcoma (42.6%) appeared as the more frequent histologic lesion. Surgery was the principal treatment: it was alone on 3 cases (24.9%), associated with chemotherapy on 8 cases (66.8%) and one patient had an association surgery, chemotherapy and radiotherapy. The global survival was 21.4% at 2 years and all the patients were dead at 5 years and it seemed that it would be better when the patients were treated by radical surgery associated with chemotherapy and radiotherapy.

[Cancers in the scars of thermal burns (apropos of 67 cases)]. / Les cancers sur cicatrices de brulures thermiques: (àpropos de 67 cas).

Burns are very frequent. Skin cancer on burns scars are one of the known complications. The mechanisms and the risk factors of this disease are not very well known. To review the risk factors and the mechanisms of transformation of burn scars into cancer, we analyzed 67 retrospective cases of Marjolin's ulcer to describe the epidemiological features of the disease in our practice and identify the factors of relapse. Our patients are young (means age 41), mainly male (54%), with disease localized on arms and legs (88%). The initial burn was from flames (54%), charcoal or hot cooking oil (19.5%) and never from ionizing radiation. It was never a superficial burn and covered from 4 to 37% of the body surface (mean 14%). The initial treatment was medical in only 9% of cases and ended with 85% of complete healing. After 4 to 67 years of evolution, 95% of re-ulceration occurred. Abnormal lymph node and distant metastasis were diagnosed in respectively 68 and 7% of the cases. Amputation and groin dissection were respectively done in 63 and 50%. One third of patients were lost during the follow up. 25% of the cases are still alive and free of disease. We found 30% of local recurrence and 17.5% of regional recurrence. By univariate analysis we found that the factors significantly associated to loco-regional relapse are: male status (p = 0.0327), burns by cooking oil (p = 0.0118), lack of treatment during initial burn (p = 0.0001), sclerous scar (p = 0.0281), supra regional lymph nodes (p = 0.028) lack of treatment during re ulceration (p = 0.0308). Squamous cell carcinomas on burn scars are rare diseases and of bad prognosis. Mainly associated to domestic accidents they frequently occur on limbs and arms on an articulation. Metastasis is not frequent. Conservative treatment is associated with 30% of recurrence. In our practice, the relapse risk factors are male status, burns by cooking oil, lack of treatment during the initial burn, sclerous scar, supra regional lymph nodes, lack of treatment during re ulceration.

[Risk factors for lymphedema of the arm after mastectomy for breast cancer]. / Les facteurs de survenue des lymphoedèmes du membre supérieur après mastectomie pour cancer du sein.

Postmastectomy lymphedema of the arm is frequently associated to different factors including axillary node involvement and local and regional treatment of breast cancer. Our aims was to identify risk factors of postmastectomy lymphedema. From a retrospective analysis of 735 breast cancers treated in our institute, we found 61 lymphedema of the arm. We then describe our study population and identify by univariate et multivariate analysis the factors significantly associated to the disease. The majority of the patients were young black African female found to have locally advanced breast cancers (88% of T3 et T4 UICC 1988), inflammatory diseases (46% of PEV 2 and 3 of Gustave ROUSSY Institute classification of inflammatory breast cancers). Ulceration is found in half of the patients, metastasis in 20%. The patients first underwent chemotherapy mainly with cyclophosphamide alone (56%). Only 59 patients (8%) had preoperative radiation. Surgery consisted mainly in modified radical mastectomy and lymph node dissection (95%). Residual disease is left in 50% of the cases. Only 35% had post-operative chemotherapy and 9% postoperative external beam radiation therapy. From that population, during the follow up, 61 patients were found to have postmastectomy lymphedema. The disease was asymptomatic in 60% of the cases and painful in 26%. 30% of all the patients spontaneously partially regressed. From univariate analysis we found 7 factors associated with lymphedema: The big size of the tumor (p = 0.005), clinically involved axillary lymph nodes (p = 0.001), metastatic disease (p = 0.0046), traditional or inadequate surgery out of the Institute (p = 0.001), lack of post-operative chemotherapy (p = 0.002), postoperative external beam radiations (p = 0.005), relapse (p = 0.002). From logistic regression analysis three independent factors were found: clinically involved axillary lymph nodes (p = 0.0267), metastasis (p = 0.0002) and local or regional relapse (p = 0.0405). In our practice we found that advanced disease, treated by traditional healers or surgery nurses who had relapsed after mastectomy and external beam radiations without chemotherapy have higher risks of lymphedema.

[Limits to the practice of craniofacial oncology in Black Africa: the example of cancer of the larynx]. / Limites á l'exercice de la carcinologie cervico-faciale en Afrique Noire: l'exemple des cancers du larynx.

Cervico-facial carcinology is currently one of the major concerns of oto-rhino-laryngologists. The authors have chosen laryngeal cancers to determine the limits of the practice of such cervico-facial carcinology in the topics. Over a 10-year period, 61 patients with a suspected malignant laryngeal disease were examined at the E.N.T. Clinic of the University Hospital in Dakar. Histological confirmation was found in only 38 patients, and a curative treatment was undertaken with 27 patients. No significant differentiation could be found from the results as far as sex, age and histology were concerned. On the other hand, the TNM breakdown of our 36 carcinomas revealed that in 78% of the cases large tumours (T3, T4) were involved. In the vast majority of these cases (18/27), treatment was purely surgical, with a total laryngectomy in 90% of the cases. Pharyngostomas accounted for the majority of the early postoperative complications (6/14). Over 10 years of practice, 70% of our patients have died or have been lost from sight. These poor results are due to numerous factors, including late consultation, the lack of specialists and the insufficiency of technical facilities. To improve results, the authors recommended the setting-up of proper cancer institutes.

[Apropos of 2 cases of female genital tuberculosis discovered at operation]. / A propos de deux cas de tuberculose génitale féminine de découverte opératoire.

The authors report two cases of female, genital tuberculosis with predominantly abdominal symptomatology, which required a laparotomy. In one case, the affliction was discovered during the gynecological period, whereas the second was found during the gravidic period and led to an abortion. The authors cover the classical clinical, biological and radiological aspects of this affliction, which is still current in their region. They stress the need to intensify anti-tubercular prophylaxis as the only means of improving obstetrical prognostic for the genital localization.