Presentation, management and outcome of pancreatic cancer as seen at Kenyatta National Hospital (2003-2004)

Abstract

This was a prospective study of patients with pancreatic cancer seen and managed at Kenyatta National Hospital during the period 1st November 2003 to 31st October 2004. A total of 42 patients were seen at Kenyatta National Hospital over the oneyear period. The incidence of pancreatic cancer in Kenyatta National Hospital during this period was 31.7 per 100,000 admissions. The peak age incidence for patients with pancreatic cancer was 51-60 years. The mean age was 55.86 years with a range of25 to 87 years. The average age in the female patients was 55.35 years and in the male patients 56.35 years. There was a male predominance with a male to female ratio of 1 .2: 1.0. Most of the patients presented with advanced disease. The commonest presenting symptom was jaundice; foIIowed by abdominal pains, weight loss, pruritus, vomiting, altered bowel movements, general malaise and back pam. Over 50% of the patients were either housewives or fanners. Twenty four percent of the patients had a history of cigarette smoking and alcohol consumption. The most common physical findings were jaundice, abdominal distension, hepatomegally and palpable gall bladder.

Abdominal Ultrasound was performed in 69% of the patients. Computerised Tomography-Scan was performed in 47% of the patients. Seventy four percent of the patients with pancreatic cancer underwent surgery. Most surgical procedures were palliative. Ten patients (23.8%) had single bypass procedure, (6) 14.3% had double bypass procedure, (10) 23.8% had Triple bypass procedure, (4) 9.5% had exploratory laparotomy without any bypass, (1) 2.4% had Whipple procedure. One patient received adjuvant post-operative radiation therapy, while two patients were given post-operative chemotherapy. The outcome of patients who had pancreatic cancer and underwent management at KNH during this one-year period was varied Forty eight percent of the patients had relief from symptoms and had an improved quality of life after surgery. Twenty one percent of the patients did not experience any improvement. 31% of the patients died during the study. Most patients were followed up in the surgical outpatient clinic or in the Nairobi Hospice while some patients were referred to the district hospitals for terminal care.