Journal of Cancer EpidemiologyVolume 2011 (2011), Article ID 319872, 7 pagesdoi:10.1155/2011/319872

Clinical Study

Cancers in Togo from 1984 to 2008: Epidemiological and Pathological Aspects of 5251 Cases

Koffi Amégbor,1,2 Tchin Darre,¹ Koffi Didier Ayéna,³ Essohana Padaro,⁴ Kodjo Tengué,⁵  Anani Abalo,⁵ and Gado Napo-Koura¹

¹Laboratoire d'Anatomie et Cytologie Pathologiques, CHU Tokoin, Lomé, Togo²Faculté Mixte de Médecine et de Pharmacie, Université de Lomé, BP 1515, Lomé, Togo³Service d'Ophtalmologie, CHU Kara, Togo⁴Laboratoire d'Hématologie Clinique, CHU Tokoin, Lomé, Togo⁵Pavillon Militaire, Service de Chirurgie, CHU Tokoin, Lomé, Togo

Received 5 April 2011; Revised 26 July 2011; Accepted 10 August 2011

Academic Editor: Carmen J. Marsit

Copyright © 2011 Koffi Amégbor et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract.

Objective. To describe the epidemiological and histological aspects of cancers in Togo. Materials and Methods. We made a retrospective review of the epidemiological and pathological features of cancers observed from 1984 to 2008 at the laboratory of pathology of CHU-TOKOIN in Lomé, Togo. Results. During our study period, we found 5251 cases of cancers with an annual average frequency of 210 cases. The sex ratio, male/female, was 0.9 and the average age of occurring was 45.3 years. This average age was 46.9 years for men and 43.8 years for women. The most frequent cancers for men were prostate cancer (12.9%), nonmelanoma skin cancer (10.4%), and gastric cancer (10.3%). For women it was breast cancer (27.1%), cervix cancer (11.2%) and non-Hodgkin lymphoma (6.3%). Histologically, it was carcinomas in 68.1% of the cases, sarcomas in 11% of the cases and non-Hodgkin lymphomas in 12.6% of the cases. Children cancers were primarily Burkitt lymphoma (27.9% of cases) and retinoblastoma (8.5% of cases). Conclusion. This study shows that cancers are frequent in Togo and emphasizes on the necessity of having a cancer register for the prevention and the control of this disease in Togo.

1. Introduction

The global burden of cancer weighs more each day. Currently, there are more than 22 million cases in the world with more than half in developing countries [1, 2]. Togo, following the example of most countries in the WHO African region, has no data on the extent and global characteristics of cancer [3].

The aim of our study was to describe the epidemiological and histopathological aspects of cancers diagnosed in the laboratory of pathology of CHU-TOKOIN in Lomé, in order to promote the establishment of a cancer register in Togo. Togo is indeed a small country in the West African coast of 56600 km² with 6,145,000 inhabitants. It has a population growth rate of 2.7% and life expectancy at birth is 54 years. The population is very young (60% under 20 years and only 3.1% over 64 years) and the seroprevalence rate of HIV passed from 6% in 2000 to 4.5% in 2004 [4]. The economy of the country relies on agriculture, breeding, and export of phosphate.

2. Materials and Methods

This was a retrospective and descriptive study carried on all cancer cases diagnosed from January 1984 to December 2008 (25 years) in the only laboratory of pathology of Togo, located inside CHU-TOKOIN in Lomé (Togo). These cases were compiled from records of that laboratory. The study material consisted of biopsies and surgical specimens fixed in formalin at 10% and came from various medical structures in Togo. These samples were processed by conventional histological techniques. Studied variables were frequency, sex, age, cancer site, and its histological nature. For the distribution of different anatomical sites of cancers we used the international classification of diseases adopted by WHO in 2002 (ICD-10). Statistical processing and data analysis were performed by using SPSS software.

3. Results

3.1. Epidemiological Aspects

We have collected during our study period 5251 cases of cancer histologically confirmed, with a yearly average of 210 cases. We observed a decrease of cancer incidence in the last ten years (from 1999 to 2008) with 163 cases yearly. Men were affected in 2565 cases and women in 2686 cases, representing, respectively, 48.8% and 51.2% of cases with a ratio of 0.9.

The average age of patients was 45.3 years with extremes of 10 days and 98 years. This average was 43.8 years for women and 46.9 years for men. Figure 1 shows the distribution of cancers according to sex and age. The most affected age bracket was 45–54 years for women (21%) and over 64 years for men (23.2%).

Figure 1: Distribution of cancers according to age and sex. *unk: unknown.

The distribution of cancers by site and sex is presented in Table 1, which shows a predominance of breast cancers (14.4%), non-Hodgkin lymphoma (7.8%) and nonmelanoma skin cancers (7.6%). This table shows also that in men, prostate cancer (12.9%), nonmelanoma skin cancer (10.4%) and stomach cancer (10.3%) predominated, while in women, it was breast cancer (27.1%), cervix cancer (11.2%), and non-Hodgkin lymphoma (6.3%) that were more observed.

Table 1: Distribution of cancers by site and sex.

ICD-10
Site
Male
%
Female
%
Both sexes
%

Nb** of cases
Nb** of cases
Nb** of cases

C0–C06
Mouth
80
3.1
39
1.5
119
2.3

C07-C08
Salivary gland
77
3.0
39
1.5
116
2.2

C9–C14
Pharynx
52
2
22
0.8
74
1.3

C15
Oesophagus
129
5.0
49
1.8
178
3.4

C16
Stomach
264
10.3
115
4.3
379
7.2

C17
Small intestine
19
0.7
14
0.5
33
0.6

C18–C21
Colon, rectum, anus
115
4.5
61
2.2
176
3.4

C22
Liver
74
2.9
42
1.6
116
2.2

C23-C24
Gallbladder, and so forth.
3
0.1
5
0.2
8
0.2

C25
Pancreas
16
0.6
5
0.2
21
0.4

C30-C31
Nose, sinuses, and so forth.
31
1.2
10
0.4
41
0.8

C32
Larynx
95
3.7
12
0.4
107
2.0

C33-C34
Trachea, bronchus and lung
40
1.6
12
0.4
52
1.0

C38
Pleura
23
0.9
31
1.2
54
1.0

C40-C41
Bone
160
6.2
99
3.7
259
4.9

C43
Melanoma of the skin
48
1.9
25
0.9
73
1.4

C44
Other skin cancers
268
10.4
134
5.0
402
7.6

C45
Mesothelioma
2
0.0
5
0.2
7
0.2

C46
Kaposi’s sarcoma
92
3.6
133
5.0
225
4.3

C49
Other soft tissue
13
0.5
14
0.5
27
0.5

C50
Breast
25
1.1
729
27.1
754
14.4

C51
Vulva
—
—
20
0.7
20
0.4

C52
Vagina
—
—
27
1.0
27
0.5

C53
Cervix
—
—
302
11.2
302
5.8

C54
Uterus
—
—
112
4.2
112
2.1

C56
Ovary
—
—
132
4.9
132
2.5

C57
Fallopian tube
—
—
3
0.1
3
0.1

C58
Placenta
—
—
43
1.6
43
0.8

C60
Penis
13
0.5
—
—
13
0.2

C61
Prostate
332
12.9
—
—
332
6.3

C62
Testis
21
0.8
—
—
21
0.4

C64
Kidney
29
1.1
22
0.8
51
1.1

C65
Renal pelvis
4
0.2
1
0.0
5
0.1

C67
Bladder
43
1.7
21
0.8
64
1.2

C68
Ureter
1
0.0
0
0.0
1
0.0

C69
Eye
70
2.7
62
23
132
2.5

C70–C72
Brain, nervous system
2
0.1
4
0.1
6
0.1

C73
Thyroid
23
0.9
62
2.3
85
1.6

C76
Other and unspecified
13
0.5
9
0.3
22
0.4

C77–C80
Metastasis
55
2.1
41
1.5
96
1.9

C81
Hodgkin disease
62
2.4
30
1.1
92
1.8

C82–C85
Non-Hodgkin Lymphoma
237
9.2
170
6.3
407
7.8

C90
Myeloma
5
0.2
1
0.0
6
0.1

C91–C95
Leukaemia
29
1.1
29
1.1
58
1.1

All sites
2565
100
2686
100
5251
100

Nb**: Number.

Tables 2 and 3 show, respectively, the distribution of the different sites of cancer according to age for men and women.

Table 2: Distribution of cancers by site and age in men.

ICD-10
Site
Unk
0–14
15–24
25–34
35–44
45–54
55–64
65+
All
%

C0–C06
Mouth
1
1
3
7
12
20
22
14
80
3.1

C07-C08
Salivary gland
1
6
10
12
12
9
16
11
77
3.0

C9–C14
Pharynx
1
3
4
3
6
12
7
16
52
5.2

C16
Stomach
8
1
9
16
48
64
44
74
264
10.3

C17
Small intestine
0
1
5
2
3
0
4
4
19
0.7

C18–C21
Colon, rectum, anus
0
3
5
12
25
31
20
19
176
4.5

C22
Liver
1
4
5
20
11
17
9
7
74
2.9

C23-C24
Gallbladder, and so forth.
0
0
0
0
2
1
0
0
3
0.1

C25
Pancreas
0
0
1
2
2
2
6
3
16
0.6

C30-C31
Nose, sinuses, and so forth.
1
1
5
2
3
6
5
8
31
1.2

C32
Larynx
1
0
0
4
16
38
25
11
95
3.7

C33-C34
Trachea, bronchus and lung
0
0
3
4
7
13
5
8
40
1.6

C38
Pleura
0
0
2
2
1
6
6
6
23
0.9

C40-C41
Bone
2
51
21
17
15
25
10
19
160
6.2

C43
Melanoma of the skin
0
0
0
7
11
8
8
14
48
1.9

C44
Other skin cancers
5
4
4
66
50
48
30
31
268
10.4

C45
Mesothelioma
0
0
0
1
0
0
1
0
2
0.0

C46
Kaposi’s sarcoma
3
10
3
16
21
13
9
17
92
3.6

C49
Other soft tissue
1
5
3
0
0
0
4
0
13
0.5

C50
Breast
0
0
0
2
4
5
2
12
25
1.1

C60
Penis
0
0
0
0
1
1
8
3
13
0.5

C61
Prostate
3
0
0
0
2
26
73
228
332
12.9

C62
Testis
0
6
3
2
1
3
2
4
21
0.8

C64
Kidney
0
11
5
2
0
3
5
3
29
1.1

C65
Renal pelvis
0
0
0
0
0
2
2
0
4
0.2

C67
Bladder
0
1
0
1
15
5
10
11
43
1.7

C68
Ureter
1
0
0
0
0
0
0
0
1
0.0

C69
Eye
1
24
9
7
11
7
7
4
70
2.7

C70–C72
Brain, nervous system
0
0
0
1
0
1
0
0
2
0.1

C73
Thyroid
0
0
1
4
7
4
4
3
23
0.9

C76
Other and unspecified
0
0
1
2
3
3
2
2
13
0.5

C77–C80
Metastasis
3
0
4
6
8
20
7
7
55
2.1

C81
Hodgkin disease
0
23
17
9
7
3
2
1
62
2.4

C82–C85
Non-Hodgkin Lymphoma
4
61
38
29
31
38
18
18
237
9.2

C90
Myeloma
0
0
0
1
0
2
2
0
5
0.2

C91–C95
Leukaemia
1
2
3
5
5
4
5
4
29
1.1

All sites
39
219
195
268
353
482
413
596
2565
100

Table 3: Distribution of cancers by site and age in women.

ICD-10
Site
Unk
0–14
15–24
25–34
35–44
45–54
55–64
65+
All
%

C0–C06
Mouth
0
3
3
7
10
9
3
4
39
1.5

C07-C08
Salivary gland
1
2
6
9
7
5
2
8
39
1.5

C9–C14
Pharynx
0
1
2
6
2
3
3
4
22
0.8

C15
Oesophagus
0
0
2
6
7
8
16
10
49
1.8

C16
Stomach
0
0
5
4
14
30
23
39
115
4.3

C17
Small intestine
0
3
1
4
2
3
0
1
14
0.5

C18–C21
Colon, rectum, anus
0
1
6
8
11
12
9
14
61
2.2

C22
Liver
0
4
4
7
8
7
3
9
42
1.6

C23-C24
Gallbladder, and so forth.
0
0
0
0
1
1
1
2
5
0.2

C25
Pancreas
0
0
0
1
0
2
0
2
5
0.2

C30-C31
Nose, sinuses, and so forth.
0
1
2
0
3
1
3
0
10
0.4

C32
Larynx
0
1
0
0
3
1
1
6
12
0.4

C33-C34
Trachea, bronchus and lung
1
1
0
0
2
4
1
3
12
0.4

C38
Pleura
1
0
1
2
4
4
6
13
31
1.2

C40-C41
Bone
1
21
17
13
8
8
10
21
99
3.7

C43
Melanoma of the skin
0
0
0
3
5
6
8
3
25
0.9

C44
Other skin cancers
1
0
6
25
17
20
27
38
134
5.0

C45
Mesothelioma
1
2
0
0
2
0
0
0
5
0.2

C46
Kaposi’s sarcoma
4
10
30
34
15
19
8
13
133
5.0

C49
Other soft tissue
0
3
2
0
2
3
0
4
14
0.5

C50
Breast
5
0
17
127
215
196
99
70
729
27.1

C51
Vulva
0
3
1
3
2
2
5
4
20
0.7

C52
Vagina
0
4
2
6
2
3
6
4
27
1.0

C53
Cervix
1
0
5
32
77
90
56
41
302
11.2

C54
Uterus
2
1
4
5
15
31
28
26
112
4.2

C56
Ovary
1
17
21
16
19
29
16
13
132
4.9

C57
Fallopian tube
1
0
0
0
2
0
0
0
3
0.1

C58
Placenta
0
0
8
17
10
5
3
0
43
1.6

C64
Kidney
0
8
1
4
3
1
1
4
22
0.8

C65
Renal pelvis
0
0
0
0
0
0
0
1
1
0.0

C67
Bladder
0
0
1
2
7
4
5
2
21
0.8

C69
Eye
1
14
6
14
12
5
4
6
62
2.3

C70–C72
Brain, nervous system
0
2
0
0
0
1
0
1
4
0.1

C73
Thyroid
1
0
14
8
12
14
10
3
62
2.3

C76
Other and unspecified
0
0
1
2
2
2
0
2
9
0.3

C77–C80
Metastasis
0
1
0
8
10
12
9
1
41
1.5

C81
Hodgkin disease
0
6
1
9
6
5
1
2
30
1.1

C82–C85
Non-Hodgkin Lymphoma
2
36
38
33
19
16
14
12
170
6.3

C90
Myeloma
0
0
0
0
0
1
0
0
1
0.0

C91–C95
Leukaemia
0
1
9
7
5
2
3
2
29
1.1

All sites
24
146
216
422
541
565
384
388
2686
100

3.2. Histopathological Aspects

The 5251 cases of cancer were subdivided in 3574 carcinomas (68.1%), 833 hematopoietic tissue cancers (15.9%), 581 sarcomas (11.0%), 143 embryonic and placental malignant tumors (2.7%), and 120 other histological types (2.3%) as shown in Table 4.

Table 4: Distribution of cancers by histological nature.

Histological group
Histological type
Nb** of cases
%

Carcinomas 3574 cases; 68,1%
Adenocarcinomas
2099
40.0

Squamous cell carcinoma
1238
23.6

Carcinoma NOS*
155
2.9

Urothelial carcinoma
35
0.6

Medullar carcino ma
31
0.6

Basaloid carcinoma
19
0.4

Hematopoietic tissue Cancers 833 cases; 15.9%
Non-hodgkin lymphoma
663
12.6

Hodgkin disease
97
1.9

Leukaemia
58
1.1

Myeloma
15
0.3

Sarcomas 581 cases; 11.0%
Kaposi sarcoma
225
4.3

Fibrosarcoma
146
2.8

Leiomyosarcoma
38
0.7

Rhabdomyosarcoma
35
0.6

Osteosarcoma
30
0.5

Chondrosarcoma
28
0.5

Liposarcoma
27
0.5

Angiosarcoma
19
0.4

Malignant fibrous histiocytoma
19
0.4

Ewing sarcoma
4
0.1

Sarcoma NOS*
10
0.2

Embryonic and placental malignant tumors 143 cases; 2.7%
Choriocarcinoma
50
1.0

Retinoblastoma
38
0.7

Wilms tumor
19
0.4

Malignant teratoma
10
0.2

Yolk sac tumor
6
0.1

Hepatoblastoma
5
0.1

Seminoma
5
0.1

Glioblastoma
5
0.1

Gonadoblastoma
3
0.0

Other
2
0.0

Other specified cancers 120 cases; 2.3%
Melanoma
83
1.6

Granulosa tumor
19
0.4

Mesothelioma
7
0.1

Malignant schwannoma
8
0.2

Carcinosarcoma
3
0.0

All
5251
100

*NOS: not otherwise specified. **Nb: Nomber.

3.3. Children Cancers (under 15 Years)

The children cancers were observed in 365 cases representing 7% of all cancers recorded, with a yearly average of 14.6 cases. Boys were affected in 218 cases and girls in 146 cases, with a sex ratio of 1.5. The average age of these children was 8.1 years old.

Histologically, we noted a predominance of lymphomas (219 cases, 60%) including 102 cases of Burkitt lymphoma, retinoblastoma (31 cases, 8.5%), and nephroblastoma (17 cases, 4.7%).

4. Discussion

Our study focused on epidemiological and histopathological analysis of cancers diagnosed during 25 years in Togo. It brings together all histologically confirmed cases across the country because the laboratory of pathology of CHU-TOKOIN, is the only one in Togo for all requests of histopathological examination. So our study must put cancer in its epidemiological framework in Togo and constitute a basis for the establishment of a cancer register in our country.

We then observed during our study period 5251 cases of cancers proved histologically with a yearly average of 210 cases. This value is comparable to those observed in most African countries particularly Burkina Faso, but clearly inferior to those of western countries [1, 5, 6]. These differences are in part related to the unequal distribution of cancer throughout the world but also to the size of the populations investigated. They could also be explained by the weak frequentation of the health centers in developing countries, and where women are more affected by cancer. The sex ratio in our study is similar to those observed in Uganda, Algeria, and Brazil [1, 5]. This female predominance is even more pronounced in some countries such as Cameroon and Nigeria with a sex ratio of 0.7 [5, 7], contrary to the observations made in European countries or Asia where there is a clear male predominance [1, 8]. This female predominance of cancer in our countries is explained by the large proportion of breast and cervix cancers.

The average age of our patients is comparable to that of developing countries but lower than those observed in developed countries. This would be related to the longer life expectancy of these countries. The most common cancers for both sexes in our study (breast cancer, non-Hodgkin lymphoma, and nonmelanoma skin cancer) were different from those estimated by IARC Globocan where breast, cervix uteri, and prostate predominated [9]. Moreover Globocan estimated prostate and liver cancers the two main cancers in men. These estimations are different from our observations and may be due to the case of many patients who, after having wasted an invaluable time near the healers, consult the medical practitioner only at the final stage of their illness. For these cases, most practitioners had found any samples for histological confirmation useless. It was mainly the case of liver cancer that account only for 2.2% of cases (11th overall). This frequency of liver cancer in our study reflects a little the real impact of this cancer in Togo. The diagnosis of the disease is most often based on clinical findings, especially when patients come to a very advanced stage of their disease. So, the histological diagnosis of such patients does not appear in our records and this would let think that liver cancer is rare in Togo, compared to some African countries like Mali, Cameroon, and Senegal, where liver cancer represents respectively 42.1%, 38.2%, and 36.8% of recorded cancers and where it occupies the first rank [5]. Indeed, Africa is a region with high incidence of liver cancer, but with very large variations from one country to another [3, 5, 6]. The establishment of a cancer register will help to catch up these cases for a better cancer assessment in Togo. For women, breast and cervix uteri cancers were more frequent corroborating data from the literature [1, 5, 9]. In our study we observed a decrease of cancer incidence in the last ten years. This may be due to sensitization on cancer prevention. We have no data on the survival estimation from cancer as it was a retrospective laboratory work.

Histologically we noted a predominance of carcinomas as in the study of Goumbri-Lompo in Burkina Faso where carcinomas represented 75.5% of cases [6]. The non-Hodgkin lymphoma accounted for 12.6% of cases, a value exceeding that of world literature. Indeed, the non-Hodgkin lymphoma represents 2.9% of cancers worldwide, 3.9% of cancers in Africa, and 5.1% in Sub-Saharan Africa but with significant variations of the frequency from one country to another [1, 5]. The high incidence of non-Hodgkin lymphoma in some parts of Africa is linked to infectious causes including viral and parasitic infection implicated in the genesis of some of the non-Hodgkin lymphoma including Burkitt lymphoma [10, 11]. Burkitt lymphoma accounted in fact for the most common children cancer, followed by retinoblastoma and Wilms tumor, as in most African countries [12–14].

5. Conclusion

Our retrospective study aimed to describe the epidemiological and histopathological aspects of cancers in Togo. It covered 5251 cases occurring at a mean age of 45.3 years with a slight female predominance. The most frequent cancers in this study were those of prostate for men and breast for women. For children, it was essentially Burkitt lymphoma and retinoblastoma. The high incidence of cancers in Togo shows the importance of this study and emphasizes on the necessity of the establishment of a cancer register, which is necessary to a national policy of prevention and fight against cancer in Togo.

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