Medical Science: Updates and Prospects Vol. 11

Oesophageal squamous cell carcinoma (ESCC) represents a major source of cancer-related morbidity and mortality in Eastern Africa. The vast majority of regional patients present with advanced-stage disease at diagnosis. Current palliative strategies in the region include chemotherapy, radiation therapy (with or without concurrent chemotherapy), and self-expandable metallic oesophageal stents. However, the comparative effectiveness of these modalities within a low-resource framework has yet to be evaluated. This narrative literature review highlights the increasing burden of oesophageal carcinoma and the risk factors responsible for the histological differences observed in this part of the world. The benefits associated with different treatments in East Africa are also outlined. Oesophageal cancer (OC) varies geographically; over 80% of global cases and deaths occur in developing countries. The oesophageal cancer burden in four urban Eastern African registries (2004–2008) was evaluated to characterise this high-incidence region. The cohorts included: Blantyre, Malawi (351 males [59%], ASR 47.2; 239 females [41%], ASR 30.3); Harare, Zimbabwe (213 males [61%], ASR 33.4; 134 females [39%], ASR 25.3); Kampala, Uganda (196 males [59%], ASR 36.7; 137 females [41%], ASR 24.8); and Nairobi, Kenya (323 males [57%], ASR 22.6; 239 females [43%], ASR 21.6). Median age at diagnosis ranged from 50 years (Blantyre) to 65 years (Harare). Male incidence significantly exceeded female incidence at all sites except Nairobi. Squamous cell carcinoma predominated universally. Because these regional ASRs substantially exceed global averages, further research into local environmental, dietary, and lifestyle risk factors is critical. This review will also help clinicians in resource-limited settings define optimal management strategies for oesophageal squamous cell carcinoma in East Africa.