SMJ Current Issue


 
ORIGINAL ARTICLES
 
The pattern and distribution of malignant neoplasms among Yemeni patients
 
  Abdullae K Al-Thobhani,  Yahia A Raja`ae,  Tariq A Noman
 
ABSTRACT
 

Objectives: This research was aimed at describing the pattern of malignancies among 1,491 patients during 1996 through to 2000 and to explore association with age, sex and site of cancers.
 
Methods: A research was carried out at a Histopathology Center in Sana’a, Republic of Yemen between the period August 1996 through to August 2000. All specimens were diagnosed by one pathologist based on the International Classification of Disease for Oncology.
 
Results: Results revealed comparable male: female ratio (1:0.92) and mean age of 46.1 +/- 22.8 in males and 44.2 +/-18.3. The most common cancers were the gastrointestinal tract malignancies, 22%. Lymph node cancers constituted 16%, followed by head and neck malignant tumors 12%, skin 10%, urinary tract 8%, bone and soft tissue 8%, breast 8%, female genital system 5%, thyroid gland 2% and finally male genital system, bone marrow and central nervous system/eye 2% each. For female patients breast cancers and gastointestinal tract cancers were equally the most frequent malignancies. Skin cancers, followed by gastrointestinal tract and male genital system affected mostly older age patients. While bone marrow followed by central nervous system and eye, then bone and soft tissue cancers were mostly diagnosed in young age patients. Within the gastrointestinal tract liver was the most affected site 33% and adenocarcinomas were the most frequent diagnosed type 42%. Among lymph nodes malignancies non-Hodgkin’s lymphoma constituted 42%. Oral cavity cancers constituted 73% of head and neck malignancies, where squamous cell carcinoma constituted 65%.
 
Conclusions: Gastrointestinal tract in general with breast in females, were the most frequent sites of malignancies in the Republic of Yemen. Adenocarcinoma and squamous cell carcinoma were the most frequent types.

 
 
Saudi Medical Journal 2001; Vol.  (10): 910-913 doi: http://dx.doi.org/
 

 

Cancer is still one of the major health problems worldwide with increasing frequency, especially with increased modernization, increased exposure to radiation and predisposition to a large number of carcinogenic agents.1 In 1985 the World Health Organization (WHO) reported 9 million new cases of cancers and 5 million deaths worldwide annually,2 5% of the new cases had occurred in the Eastern Mediterranean Region.3 Although a national cancer register is not available in the Republic of Yemen, new cases of cancers are estimated to be around 17,000 per annum2 according to 1999 estimations There are only few, published studies of the pattern of cancers or some malignancies in some parts of the Republic of Yemen.4,5,6,7 Cancer incidence and pattern of malignancies vary widely from region to region.8 In the United States of America (USA) breast cancer ranked first in female patients 24%, followed by gastrointestinal tract malignancies (GIT), both sexes combined 18%, female genital system 11.5%, urinary tract cancers 10% and male genital system malignancies 9%.9 In a study conducted in the Kingdom of Saudi Arabia GIT malignancies represented 24%, followed by Hodgkin’s disease non-Hodgkin’s lymphoma 15%, thyroid cancer 7% bone marrow 6%, skin cancers 6% and breast 5%.10 In southeastern governorates of the Republic of Yemen, GIT malignancies were the most prevalent 14%, followed by breast cancers then lymphomas 12%, female genital system 12%, head and neck 10%, bone soft tissue 9% and finally thyroid cancers 8%.4 Distribution of cancers based on sex, males accounted for 56% and females 44% in Oman.11 In a study from the Kingdom of Saudi Arabia 58% were males and 42% were females.10 In Yemeni patients from the southeastern governorates the percentages were 53% female patients and 47% males patients.4 In the USA 61% were females and 39% were males.9 The purpose of this study was to describe the pattern of malignancies in the Republic of Yemen. Most cancer patients are referred to Sana’a for further investigations and therapy, where most of the histopathologists and all oncologists are practicing. Therefore, this study would serve as a baseline description of cancers in the Republic of Yemen. Furthermore, to explore association of cancers with age and sex of patients in comparison with literature.P> FONT>

Methods.FONT> FONT>One thousand four hundred and ninety one patients from different hospitals in Yemen, were referred to one Histopathology Center in Sana’a, and were diagnosed to have cancer during the period August 1996 through to August 2000. The International Classification of Diseases for Oncology (ICD-O) of the WHO was adopted by the anatomic and histopathologic classification of malignancies. Verification of some selected diagnoses was made through a control program with the Department of Pathology in the University of Graz in Austria. The results were compared with other local, regional and international studies. The site of cancer, age and sex of patients was fed into a computerized data sheet (Excel). Data were analyzed by SPSS, to find means, SD, Chi Sq test and T-test. Significance level of <= 0.05 was used. Effort was made to avoid case duplication. P> FONT>

Results.FONT> FONT>Out of 1491 cancer patients 52% were males and 48% females. The mean age of male patients was 46.1 +/- 22.8 years, while that of female patients was 44.2 +/- 18.3 years. These mean ages were found statistically comparable (P=0.08). Gastrointestinal tract malignancies (n=322) were the most common (Table 1). Lymph node, head and neck, urinary tract, skin and bone soft tissue malignant tumors, followed in male patients. While breast cancers in female patients together with GIT malignancies ranked

 

From the Department of Pathology (Al-Thobhani), Department of Community Medicine (Raja’a), Department of Surgery (Noman), Faculty of Medicine and Health Sciences, Sana’a University, Republic of Yemen.

Received 17th February 2001. Accepted for publication in final form 10th June 2001.

Address correspondence and reprint request to: Dr. Abdulla K. Al-Thobhani, Head of Department of Pathology, Faculty of Medicine and Health Sciences, Sana’a University, PO Box 13849, Sana’a, Republic of Yemen. Tel/Fax. +967 (1) 249302. Email: yahiarajaa@yahoo.com

 

References

1. Alwan A. Noncommunicable diseases: a major challenge to public health in the Region. Eastern Mediterranean Health Journal, 1997; 3: 6-16. P>

2. World Health Organization. National cancer control programmes. Policies and managerial guidelines. Geneva: WHO; 1995.P>

3. Bedwani R. Pattern of cancer in Arab countries. Proceedings of the International Epidemiology Association Eastern Mediterranean Meeting; 1995; Alexandria, Egypt.P>

4. Bawazir AA, Abdul-Hamid G, Morales E. Available data on cancer in the southern-eastern governorates of Yemen. Eastern Mediterranean Health Journal, 1998; 1: 107-113.P>

5. Nasr AH, Khatri ML. Head and neck squamous cell carcinoma in Hajjah, Yemen. Saudi Med J 2000; 21: 565-568.P>

6 Makki I. Oral carcinomas and their relationship to kath and shamma abuses [dissertation]. Germany: The university of Heidelberg; 1975. P>

7. Al-Hureibi AA, Qirbi AA, Basha YBY. Thyroid swelling in the Yemen Arab Republic. Saudi Med J 1990; 11: 203-207.P>

8. Doll R. The geographical distribution of cancer. Br J Cancer 1989; 23: 1-8.P>

9. National Cancer Institute (US). The prevalence of cancer: Estimated Number of Persons Diagnosed With Cancer. United States: The Institute; 1995.P>

10. Akhtar SS, Reyes LM. Cancer in Al-Qassim, Saudi Arabia: a retrospective study (1987-1995). Annals of Saudi Medicine 1997; 17: 595-600.P>

11. Al-Lawati JA, Santhosh-Kumar CR, Mohammed AG, Jaffer MA. Cancer incidence in Oman, 1993-199. Eastern Mediterranean Health Journal 1999; 5: 1035-1041.P>

12. Al-Seigh AAH, Allam MM, Khan KA, Al-Hawsawi ZM. Pattern of cancer in Madina Al-Munawara region. Annals of Saudi medicine 1995; 15: 350-353.P>

13. Parkin DM, Pisani P, Ferlay J. Estimates of the worldwide incidence of eighteen major cancers in 1985. International Journal of Cancers, 1993; 54: 594-606.P>

14. Al-Radi AO, Ayyub M, Mashat FM, Barlas SM, Al-Hamdan NA, Ajarim DS et al. Primary gastrointestinal cancers in the Western Region of Saudi Arabia, Is the pattern changing? Saudi Med J 2000; 21: 730-734. P>

15. Koreich OM, Al-Kuhaymir R. Cancer in Saudi Arabia, Riyadh Al-Kharj Hospital Program Experience. Saudi Med J 1984; 5: 217-223.P>

16. Ajarim DS. Pattern of primary gastrointestinal cancer: King Khalid University Hospital experience. Annals of Saudi medicine 1996; 16: 386-391. P>

17. Al-Mofarreh MA, Afzal M, Al-Kraida AA, Al-Qassabi QO, Fakuncle YM Abdul-Quasem et al. Pattern of primary gastrointestinal tract malignancy among Saudi Nationals a retrospective study. Annals of Saudi Medicine 1991; 11: 15-18. P>

18. Toandon P, Pathak V, Zaheer A, Chatterjee A, Walford N. Cancer in Jizan province of Saudi Arabia. Annals of Saudi Medicine 1995; 15: 14-20. P>

19. Offner FA. Aetiologie, Molekularbiologie and Pathologie des Plattenepithelkarzinoms des Oesophagus. Der Pathologe 2000; 21: 349-357.P>

20. Ezzat A, Raja M, Te O, Michels D, Bazarbashi S. Frequency and distribution of 22,836 adult cancer cases referred to King Faisal Specialist Hospital and Research Center. Annals of Saudi Medicine 1996; 16: 152-158. P>

21. Sofi HE, Kameswaran M, Malatani T. Kath and oral cancer. J Laryngol Otol 1991; 105: 643-645.P>

22. Khan AR, Hussain NK, Al-Saigh A, Malatani T, Sheikha AA. Pattern of cancer at Asir Central Hospital, Abha, Saudi Arabia. Annals of Saudi Medicine 1991, 11: 285-288.P>

23. Archibong EI, Sobande AA, Sadek AA, Ajao OG, Khan AR, Fawehinmi O. The changing pattern of malignant neoplasms among females in Asir region of Saudi Arabia. Saudi Med J 2000; 21: 869-872.P>

24. Kumar V, Cotran RS, Robbins SL. Basic Pathology. 6th ed. Philadelphia (PA): WB Saunders Company; 1997. p. 142.P>

25. Devi KR, Kuruvila S, Musa MM. Pattern of breast neoplasm in Oman. Saudi Med J 1999; 20: 38-40.P> <



Saudi Medical Journal is copyright under the Berne Convention and the International Copyright Convention. All rights reserved. Saudi Medical Journal is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). Readers may copy, distribute, and display the work for non-commercial purposes with the proper citation of the original work. Electronic ISSN 1658-3175. Print ISSN 0379-5284.