Malignant disease conditions
Cancer is a term covering a wide range of malignant diseases, which contribute significantly to the overall morbidity and mortality of people worldwide. In this section you will learn about common malignant conditions in Africa and their management
Vaginal cancer
Vaginal cancer is mostly squamous cell carcinoma of the upper posterior vagina, linked to HPV, previous abnormal Pap smears and smoking, presenting with abnormal (often post-coital) bleeding, discharge or a mass. Diagnose by biopsy with imaging and treat by stage with surgery, external beam radiotherapy and brachytherapy, using weekly cisplatin as a radiosensitiser.
Pancreatic cancer
Pancreatic cancer is mostly ductal adenocarcinoma, linked to smoking, alcohol, fatty diet and BRCA/Lynch mutations, presenting with jaundice, weight loss, new diabetes, gastric outlet obstruction or pain. Resectable disease is treated with Whipple's operation and adjuvant gemcitabine-based chemotherapy; advanced disease with FOLFIRINOX or gemcitabine-based chemotherapy, stenting and palliative care.
Testicular cancer
Testicular cancer is mostly germ cell tumour – seminoma or non-seminoma – presenting as a testicular lump, assessed with ultrasound, β-hCG, AFP, LDH and CT. All patients have radical inguinal orchidectomy, followed by surveillance, radiotherapy or carboplatin for early seminoma, RPLND for early non-seminoma, and EP or BEP chemotherapy for advanced disease.
Renal cell carcinoma
Renal cell carcinoma, mostly clear-cell, is linked to smoking, obesity, cadmium or asbestos exposure and acquired cystic kidney disease, and is resistant to radiotherapy and conventional chemotherapy. Treat localised disease by partial or radical nephrectomy and metastatic disease with targeted therapy (sunitinib, pazopanib, axitinib, sorafenib or bevacizumab) and palliative care.