Pancreatic cancer in Nigeria: Past, present and future

Abstract

Pancreatic cancer remains a lethal disease worldwide despite an improved understanding of the disease. The main risk factors are age, smoking and genetic factors, however, the primary causal factors for pancreatic cancers are poorly understood. Advances in molecular biology have, however, greatly improved understanding of the pathogenesis of pancreatic cancer. Many patients have mutations of the K-ras oncogene, and various tumor-suppressor genes are also inactivated. Growth factors also play an important part. Obviously, little is known about the cancer in Nigeria. Patients usually present late hence, surgical bypass is the main procedure performed in majority of the patients. Managements of pancreatic cancer in Nigeria is quite challenging due to lack of awareness of the disease, which lead to late presentations, lack of appropriate investigating modality, unavailability of super specialist skill in complex pancreatic surgery, absence of proper palliative measures, and lack of clinical and basic research in pancreatic cancer. On top of all this is the issue of poverty which made it difficult for most patients to access the available facility. This review is aimed at reviewing the current knowledge about pancreatic cancer, highlighting the current practice and limitation in Nigeria.

Material and method: We performed a literature search for all English-language articles dealing with pancreatic cancers by combining the keywords “pancreatic cancer” with the following topics: Nigeria, sub Saharan Africa, carcinogenesis, angiogenesis, progression, metastasis, pathology, pathobiology, pathophysiology, molecular genetics, and genetics, published from 1980 to 2010. Databases searched included MEDLINE, PreMEDLINE, African Journal Online (AJOL), and the Cochrane Database of Systematic Reviews, the google search, the Database of Abstracts of Reviews of Effectiveness, and the Cochrane Central Registry of Controlled Trials. Additional references were obtained from the bibliographies of selected articles. We selected pertinent studies emphasizing randomized controlled trials to formulate this technical review.