|Year : 2016 | Volume
| Issue : 4 | Page : 182-187
Pattern of urological cancers in Kano: North-western Nigeria
Abubakar Abdulkadir1, Sule A Alhaji2, Haruna M Sanusi3
1 Urology Unit, Department of Surgery, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Pathology, Bayero University, Kano; Urology Unit, Department of Surgery, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Morbid Anatomy Forensic Medicine, Usmanu Danfodiyo University, Sokoto; Urology Unit, Department of Surgery, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||11-Jul-2017|
Department of Surgery, Bayero University, Kano
Background: The ubiquity of urological malignancies is evident in the epidemiological surveys despite the existing peculiarities in the pattern of their distribution among the different domains. There is, however, no publication on the foregoing for unified urological cancers from North-western Nigeria. This study, therefore, aimed to describe the spectrum, the frequency, the patient’s age and sex distributions of urological malignant tumours in Kano.
Materials and Methods: This was a 15-year retrospective review from 2nd January 2001 to 31st December 2015 of all the urological malignancies histologically diagnosed in Kano, Northern Nigeria. The analyzed variables included the patient’s age, sex, the organs involved and the histopathological category.
Results: Nine hundred and eight urological malignancies were diagnosed in the 15 year period under review; the male-to-female ratio was 16:1. Adult and paediatric patients added up to 880 (96.9%) and 28 (3.1%), respectively. The organs involved were the prostate (514; 56.6%), the bladder (327; 36.0%), the kidney (47; 5.2%), the testes (9; 1.0%), the penis (6; 0.7%), the urethra (4; 0.4%) and the ureter (1; 0.1%). The predominant prostate histological variant was adenocarcinoma (98.1%). Urothelial carcinomas constituted 48.0% of bladder cancers, whereas 55.3% of renal malignancies were nephroblastomas.
Conclusion: study unveiled high prevalence of urological cancers, particularly prostate and bladder cancers in the populace; consequently, the urge for greater commitment to a comprehensive urological cancer prevention and treatment plans.
Keywords: Bladder, kidney, prostate, urological cancers
|How to cite this article:|
Abdulkadir A, Alhaji SA, Sanusi HM. Pattern of urological cancers in Kano: North-western Nigeria. Sub-Saharan Afr J Med 2016;3:182-7
|How to cite this URL:|
Abdulkadir A, Alhaji SA, Sanusi HM. Pattern of urological cancers in Kano: North-western Nigeria. Sub-Saharan Afr J Med [serial online] 2016 [cited 2017 Sep 19];3:182-7. Available from: http://www.ssajm.org/text.asp?2016/3/4/182/210205
| Introduction|| |
Urological cancers are the malignant tumours of the genitourinary and urinary system in male and female, respectively. The ubiquity of these tumours is evident in epidemiological studies, and they equal 14% global cancer prevalence., The pattern of urological cancer distribution, natural history and treatment outcome often varied with the era of the study likewise in between racial and socio-economic groups amid other different domains. These dissimilarities are inferred to be due to genetic proclivity and environmental determinants., As with many other cancers, ageing, hormonal factor, cigarette smoking, family history, obesity, hypertension, analgesic abuse, exposure to chemicals and heavy metals are the risk factors associated with increased prevalence.,,
Urological cancers are common in Nigeria. A 10-year retrospective review of the cancer registry in Kano revealed prostate and bladder cancers as the first two most common in the male cancer profile, whereas bladder cancer was within the profile of 12 most common female cancers. Urological cancers contribute a major share in cancer morbidities and mortalities, and it was projected that prevalence and cancer mortality will continue soaring, especially in the developing world, adding to the endemic infections and infestation as a major health problem.,
There are several published studies on malignancies arising from distinctive organ components of the genitourinary system in North-western Nigeria.,, There is, however, no unified study on urological cancers in Kano, North-western Nigeria. This study, therefore, aimed to analyze the frequency, the patient’s age, sex distribution and the morphological patterns of urological cancers in Kano, the largest city in Northern Nigeria.
| Materials and Methods|| |
This was a 15-year retrospective review of a single subject’s histological entering on patients with urological cancers from 2nd January 2001 to 31st December 2015. The study was conducted in the only institution that provides histological diagnosis in Kano − Aminu Kano Teaching Hospital, Kano. The following variables were recorded: the patient’s age, sex, the organs involved and the histopathological variant of the malignancies.
Ethical clearance was obtained from the hospital ethics and scientific committee. Histological slides in all cases were retrieved and reviewed by the authors. Fresh sections were cut from archival paraffin blocks when slides could not be retrieved. All specimens had been previously fixed in 10% formal saline, ahead of the routine paraffin embedding. Microtome sections were 4 μm thick, and the prepared slides were stained with haematoxylin and eosin (H&E). Immunohistochemistry such as p63 was deployed where necessary. The diagnosis was based on the World Health Organization’s classification of varied urological cancers.
| Results|| |
Nine hundred and eight cases of urological malignancies were diagnosed during the 15-year study period, with a male-to-female ratio of 16:1. Adult and paediatric patients added up to 880 (96.9%) and 28 (3.1%), respectively. [Table 1] depicts the frequency distribution of urological malignancies and the peak age of presentation in the study population. The organs afflicted were the prostate (514; 56.6%), the bladder (327; 36.0%), the kidney (47; 5.2%), the testes (9; 1.0%), the penis (6; 0.7%), the urethra (4; 0.4%) and the ureter (1; 0.1%).
|Table 1: Frequency distribution of urological malignancies and the peak age of presentation|
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[Table 2] shows the histological types of urological malignancies in Kano. The overall age range of the patients with prostate cancers in this study was 36–95 years, and the peak incidence was seen in the 60–69 years age group; the majority of the prostate cancers were adenocarcinomas (98.1%). The age of the patients with bladder cancers ranged from 2 to 90 years, with the highest occurrence in the sixth decade of life and a male-to-female ratio of 7.6:1. Urothelial carcinomas constituted 48.0% of all the bladder cancers. Kidney cancers were 55.3% nephroblastomas in children that mostly occurred within the first decade of life and peaked in the 2–4 years age group, with a male-to-female ratio of 2:1. The renal cell carcinomas (RCCs) were, however, the most common in the sixth decade of life. Most of the testicular tumours occurred within the second to the fourth decade of life. The youngest patient was 3 years old, whereas the oldest was 49 years old, and germ cell tumours constituted 88.9%. The age range of the patients with penile cancers was from 50 to 75 years, and all the cases were squamous cell carcinomas (SCCs).
|Table 2: Histological types of urological malignancies at the different site|
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6] show photomicrographs of adenocarcinoma (H&E), adenocarcinoma (p63), urothelial carcinoma, well-differentiated SCC, RCC and nephroblastoma, respectively.
|Figure 4: Well-differentiated squamous cell carcinoma of the urinary bladder (H&E ×10)|
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| Discussion|| |
There were 908 cases of histologically confirmed urological malignancies, which represented 17.1% of all cancers diagnosed during the 15-year study period. This was comparable with other studies within the country, Europe and the USA.,, Prostate cancer constituted 56.6% in this review, which is in keeping with its global dominance among urological malignancies.,,, This also supported the earlier 10-year review from the same institution. It, however, disputed the assertions that prostate cancer is relatively rare among indigenous Black Africans. A high rate was observed among African-Americans in the USA, whereas the lowest rate was in China., This buttresses racial differences and environmental determinants as risk factors. The patients in our appraisal were predominantly in the 60–69 years age category. This parallel reports from other parts of Nigeria plus Cameroon and India. The Caucasians have 70–79 years as the dominating age group., Shorter life expectancy and unexplained environmental determinants could be the reasons for the variation. Most lesions are adenocarcinomas and comprised 98.1% which concurred with findings in the literature.,
Bladder cancer is the next most common urological malignancy. The median age of the fifth decade of life in our study was found to be similar with the reports from Zambia, Egypt and Iraq.,, The median age in England and Wales, however, was in the seventh decade of life but 65 years in the USA., This may be due to differences in life expectancy and high schistosomiasis prevalence in the developing world., In our study, the male-to-female ratio was 7.6:1, and hence, was less than 11.1:1 in Sokoto, but greater than 4:1 in Maiduguri, 2:1 in Jos and 2–3:1 in Ibadan.,,,,, This male dominance was attested in other parts of the world; males are generally more prone to most of the risk factors. Initial appraisal in our setting showed SCC as the most common histological type. However, in this review, transitional cell carcinoma and SCC were 48 and 44.6%, respectively, which was not far from the findings in Jos and Ibadan., This could be as a result of increasing awareness of the risks of untreated childhood haematuria from schistosomiasis in the study population.
Renal cancers were 5.2% of urological malignancies in our study, and it was 17.3% in Jos. These were lower than in Caucasians. Nephroblastoma comprised 55.3% of all renal cancers, with the peak age of 2nd to 4th year, which is comparable to those of other African series., RCC is usually seen in adults worldwide as revealed in our review. The age of 18–80 years in this study was similar to the worldwide age range.,,
Testicular cancer accounted for 1.0% of urological malignancies in our review, and this concurred with reviews from other parts of African, the Caribbean and the Asian communities., The patient’s age range was from 3 to 49 years with a peak in the third decade of life. Germ cell tumours comprised 88.9%, and hence, this conformed to what was obtained in literature.,, Likewise, penile cancer comprised 0.7% of all urological malignancies. This was close to the 1% reported in Jos and 0.4–0.6% in Europe and the USA. It is, however, lower than 4.4% in Swaziland and 2.9% in Rwanda. The low prevalence in our population may not be detached from the tradition of circumcision in our populace cited as protective against penile cancer. All cases were SCC, which was the main histological type reported in other series., Cancers of the urethra and ureter are distinctly rare.,
Furthermore, the study affirmed a gradual overall increase in frequencies of urological malignancies particularly with bladder and prostate cancers [Figure 7]. This may be due to increased awareness of the risk factors, improved documentation, the introduction of prostate-specific antigen screening, newer needle biopsy techniques, improved imaging techniques and increasing cystoscopy among centres. However, increasing urbanization and changing lifestyle may have increased environmental risk and accounts for the rising prevalence.
|Figure 7: Graph of frequency distribution of urological malignancies in Kano from 2001 to 2015|
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This appraisal is not free from shortcomings of retrospective hospital-based reviews. Due to a significant number of patients presenting with an advanced stage tumor and strong societal disapproval of autopsy in our setting, a substantial number of yet to be biopsied cancer-specific mortalities are unaccounted for. Likewise, not all the tissues get to our institution because of the vastness of the study domain and attached cost that histology incurred, however, considering its 17.1% of the malignant tumours histologically diagnosed in the institution implied high prevalence among malignancies.
In conclusion, urological cancers are common in Kano, Northern Nigeria. In this review, prostate and bladder cancers are the predominant group. Long-term prospective studies with long-term follow-up may add to our understanding of the epidemiology and prognostic makers. This will be an added pillar to comprehensive cancer prevention and treatment plans.
We are grateful to the Chief Laboratory Scientist of Aminu Kano Teaching Hospital and Mr. Sani Abubakar for his help in the laboratory technical work.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2]