Clinical presentation, investigations, and treatment modalities of gastric cancer at Muhimbili National Hospital

Abstract

Background: Gastric cancer is the 7th most diagnosed malignancy in Tanzania and the 6th cause of cancer-related deaths in 2018. The disease is associated with a high mortality rate in the country. This is partially attributed to the fact only a small proportion of patients with gastric malignancies undergo gastric resection in Tanzania. Objective: To investigate patient social demographic and clinical characteristics in relationship to treatment modalities pursued in patients with gastric cancer at Muhimbili National Hospital. Materials and Methods: A retrospective analytical study was conducted at MNH involving patients treated between 2015 and 2019 with gastric adenocarcinoma. Patients' case record files were accessed, and demographic and clinical data were extracted. Data were entered into SPSS and analyzed. Association was tested using the chi-square method with a p-value of 0.05 accepted for significance. Results: There were 122 patients with gastric adenocarcinoma who were reviewed. The mean age of respondents was 59.3±14.27 years with a male to female ratio of 1.5:1. Most patients presented with symptoms of advanced disease with a median duration of symptoms of 4 months. Most tumors were in the distal stomach. About 60% of the respondents had metastatic disease at the time of diagnosis with the liver and peritoneal surfaces being the commonest sites for metastasis. About 30% of the patients underwent gastric resection. Having medical insurance or making private payments, age between 50 and 70 years and polypoid tumors positively influenced patients to undergo gastric resection. Conclusion: Gastric cancer mostly affects people in the 5th and 6th decades of life. Most of the patients have advanced disease at the time of diagnosis. Only a small proportion of patients undergo gastric resection. Having advanced disease and young age at diagnosis are associated with low gastric resection rates. Recommendations: Studies to investigate factors that lead to late presentation of patients with gastric cancer. Primary care health facilities should build the capacity of diagnosing gastric cancer to enable early diagnosis and referral to tertiary facilities.