Browsing by Author "Onyango, J.F."
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Publication Open Access Delays in diagnosis, referral and management of head and neck cancer presenting at Kenyatta National Hospital, Nairobi(East African Medical Journal, 2006-09-12) Onyango, J.F.; Macharia, I.M.Background: The most important prognostic factor in head and neck cancer is the stage of the disease at presentation. Early cancer has an excellent prognosis following treatment. Unfortunately most patients present with late disease that requires radical treatment with considerable morbidity and mortality. Clinical experience at Kenyatta National Hospital (KNH) shows that most patients present with late disease. Objective: To determine the causes of late presentation of head and neck cancer. Design: A prospective descriptive study. Setting: Kenyatta National Hospital, Nairobi. Results: Forty four cases were seen among whom 34 were males and 10 were females. The age range was 20 to 90 years with a peak incidence between 50 and 60 years. Most of the patients had little or no education and the majority lived in the rural areas. Seventy one percent of the patients came from the Central and Eastern provinces. Tobacco and alcohol use were the most common risk habits. The larynx was the most common site affected followed by the tongue. In 61% of the cases the size of the tumours at presentation was unknown. In 14% the size was 1-2cm, in 7% of the cases it was 2-4 cm while in 5% of the cases it was 4-6 cm. In 14% of the cases the tumour size was over 6 cm. The most common presenting symptom was hoarseness followed by swelling. The majority of the patients attended a public health facility nearest them. For most patients the facility lay within 5 km and could be accessed by walking. However, most of the patients went through multiple referrals to get to KNH. By the time the patients reached KNH, 35 patients (77%) had been treated with unspecified medications, two (4%) had had tooth extraction, and seven (16%) had had biopsies done. The time-lapse between the first symptom and consultation ranged from zero and eight months. Forty five percent of the patients presented to a medical facility within one month of their symptom and 45% presented after three months. The time lapse between referral and attendance at KNH ranged from zero and thirteen weeks and 45% of the patients presented to KNH within two weeks of referral. The overall duration of symptoms by the time of diagnosis ranged from zero months to unspecified years. Thirty two percent of the cases had experienced symptoms for six months or less by the time of diagnosis. However, a number of patients had had their symptoms for a number of years by the time of diagnosis. The distribution of the tumours by stage at the time of final diagnosis were as follows: stage I were 2%, stage II 6%, stage III 14% and stage IV 56%. Conclusion: This study showed that the referral system was the main cause of delayed presentation of head and neck cancer to Kenyatta National Hospital.Publication Open Access Morbidity and quality of life among head and neck cancer patients treated with radical radiotherapy(East African Medical Journal, 2009-04) M.M. Solomon; Onyango, J.F.; Nyabolo, L.O.; Opiyo, A.; Chindia, M.L.Objectives: To determine the relative frequency of acute radiation morbidity and their perceived effect on quality of life among head and neck cancer patients treated with radical radiotherapy. Design: A cross-sectional study. Setting: Kenyatta National Hospital, Nairobi. Subjects: Thirty eight patients comprising 28 males and 10 females with ages ranging between 21 and 69 years were evaluated. Results: Most of the tumours occurred in the nasopharynx (38.6%). The rest of the tumours were equally divided between the oral cavity and larynx (31.6%). All tumours except two were carcinomas. The two exceptions were a glomus tumour and a malignant melanoma. The patients had received doses of radiotherapy ranging between 58.5 Grey and 75.5 Grey. Of the 38 patients, 22 (53%) completed their treatment in the prescribed time while 16 (47%) had treatment interruption on account of radiation morbidity. The cumulative radiation done at the time of interruption ranged between 20 and 46 Grey. The most frequent symptom was dryness of the mouth while the most troublesome symptom was difficulty in tasting foods. The quality of life (QOL) did not vary by age, gender or tumour site. Patients who had treatment interruption had a better QOL than those who did not. Conclusion: This study provides information that should aid in communicating with the head and neck cancer patients scheduled for radiotherapy and in the design of preventive and interventional strategies aimed at enhancing patient support and rehabilitation.Publication Metadata only Pattern of occurrence of head and neck cancer presenting at Kenyatta National Hospital, Nairobi(East African Medical Journal, 2006-09-12) Onyango, J.F.; Awange, D.O.; Njiru, A.; Macharia, I.M.Currently there is a dearth of data on the pattern of occurrence of head and neck cancers in Kenya. To provide a comprehensive analysis of the pattern of occurrence of head and neck cancers in a Kenyan population. Retrospective hospital-based descriptive study. Kenyatta National Hospital, Nairobi. A total of 793 cases were recorded consisting of 507 male and 286 female (M: F = 2:1). Most of the lesions arose from the upper aerodigestive pathway. The larynx was the most common site for aerodigestive malignancies. This was followed in order of frequency, by the tongue, the mouth, and the nasopharynx. Outside the aerodigestive pathway the eye was the most commonly affected site followed by the thyroid. Squamous cell carcinoma was the most common malignancy. Sarcomas were typically rare. Gender and age distribution showed an overall male preponderance and a wide age range. However, specific tumour sites and tumour types showed varying patterns of gender and age distribution. This study confirms the relative prominence of laryngeal, oral and nasopharyngeal cancers in the African population. It is, however, at variance with other African studies regarding the relative frequency of nasal and paranasal cancers.Publication Open Access Reactive localised inflammatory hyperplasia of the oral mucosa(East African Medical Journal, 2009-02) Awange, D.O.; Wakoli, K.A.; Onyango, J.F.; Chindia, M.L.; Dimba, E.O.; Guthua, S.W.Objective: To document the histopathological pattern and distribution of reactive localised inflammatory hyperplastic lesions of the oral mucosa diagnosed at the University of Nairobi Dental Hospital over a 14 year period. Design: A retrospective, cross-sectional descriptive study. Setting: Division of Oral Pathology and Oral Medicine, histopathology laboratory, School of Dental Sciences, University of Nairobi. Subjects: A total of 3135 oral biopsies were accessioned in the oral diagnostic histopathological Laboratory registry over a period of 14 years from March 1991 to December 2005. Results: Three hundred and thirty three cases were histopathologically diagnosed as reactive inflammatory hyperplasias of the oral mucosa. This constituted 10.6% of the total oral biopsy specimens analysed during this period. Fibrous epulis was the most common histological sub-type with 129 cases (38.7%) followed by pyogenic granuloma with 94 (28.3%) cases. Six (1.8%) caseswere peripheral giant cell granuloma and three cases(0.9%) were those of denture irritation hyperplasia. The age distribution ranged from 2 to 78 years( mean=30.5 years) with a peak at 20-29 years. Gender distribution showed that 107 (32%) cases occurred in males and 226 (68%) cases females. Similar trends were observed in most of the histological sub-types. Fibrous epulis occurred in 41 male (31.8%) cases and in 88 (68.2%) females with an age range of 2 to 78 years ( mean = 30.5 years). As for the pyogenic granuloma, 26 (27.7%) lesions occurred in males and 68 ( 72.3%) in females with an age range of 2 to 75 years ( mean = 30.1 years). Among all the histopathological sub-types it was shown that 223 (67.0%) cases were fibrous, 104 (31.2%) vascular and six (1.8%) peripheral giant cell granuloma. Gingival lesions were the most common with 257 (77.2%) cases followed by 28 (8.4%) in the tongue, 16(4.8%) lips, 15 (4.5%) cheek, six (1.8%) palate and the rest on the floor of the mouth and other mucosal sites. The duration of these lesions was recorded in 182 (54.7%) cases and ranged from 1 week to 16 years (mean=1.8 years).Only 15 (4.5%) cases were reported to have recurred and all of them were gingival lesions. Conclusion: The present study has shown that the prevalence of reactive localised inflamatory hyperplasia (RLIHs) of the oral mucosa was 10.6% with fibrous epulis and pyogenic granuloma having been the most common histopathological sub-types predominantly affecting females. Although RLIHs are distinguished on clinical or histopatholocal grounds, it is important to appreciate that they are variations of the same basic process.Publication Open Access Treatment interruption among head and neck cancer patients undergoing radical radiotherapy(East African Medical Journal, 2009-12) M.M, Solomon; Onyango, J.F.; Nyabola, L.O.; Opiyo, A.; Chindia, M.L.Objective: To determine the incidence of treatment interruption among head and neck cancer patients undergoing radical radiotherapy. Design: Prospective study Setting: Kenyatta National Hospital (KNH), Nairobi. Subjects: Twenty six (M=16, F=10) patients undergoing radiotherapy for head and neck cancer between March and June 2006. Main outcome measures: Frequency of radiation morbidities and treatment interuptions. Results: There were 26 patients consisting of 16 males and 10 females aged between 21 and 70 years (mean = 49.6 years). Among these patients 12 (46.2%) had tumours in the oral cavity, six (23.1%) had nasopharyngeal tumours, two (7.7%) had pharyngeal tumours, and six (23.1%) had laryngeal tumours. All tumours were primary carcinomas except two pharyngeal tumours which were metastatic. Among the 26 patients, 13(50%) completed the course of radiotherapy within the prescribed duration while another 13(50%) had treatment interruption. Of the 13 patients who had treatment interruption, one patient had a treatment gap of four days, seven patients had treatment gaps ranging between six and ten days, and five patients had treatment gaps of over ten days. The duration of treatment gaps ranged between four and 30 days. At the time of treatment interruption the cumulative radiation dose ranged from 22 to 58 Grey with a mean of 38 Grey (Mode = 44 Grey). The most common side effect was xerostomia (92%). This was closely followed by mucositis (88.5%), skin reactions (88.5%) dysphagia (84.5%) pain and suffering (76.9%). Loss of taste (61.5%), trismus (34.6%) and voice change (30.89%) were relatively less common. Conclusion: Our findings show that the probability of cancer control and cure among head and neck cancer patients treated at KNH could be severely eroded by treatment interruptions as a result of severe radiation morbidity.