Abstract:
Background: American Joint Committee on Cancer defines Head and neck oncology
as malignancies arising from epithelial lining of: oral cavity, nasal cavity, pharynx,
larynx, paranasal sinuses and salivary glands. Global Cancer Statistics 2018 data,
shows proportion of head and neck cancer to all cancers being 4.9% globally, while in
Kenya it is 6%. Mortality rates globally are at 51%, while in Kenya it is at 73.4%.
Research has shown the role of various high risk - Human papillomavirus (hr-HPV)
genotypes in the rising incidence of head and neck cases globally. Several trials have
shown that patients with Human papillomavirus positive head and neck cancer have
better overall survival compared to the Human papillomavirus negative patients
attributed to increased sensitivity to chemo-radiation therapy. Alexandria Cancer
Centre and Palliative Care Hospital is one of the major cancer facilities in Western
Kenya Region that is accredited by National Hospital Insurance Fund (NHIF) thus,
making it accessible to people of all walks of life. Fortunately, samples are processed
at Pathologist Lancet Laboratories which is a well-established institution with
equipment and protocols in place for use in the present study.
Objectives: The broad objective was to assess the genotypes and occurrence of highrisk
Human papillomavirus among patients diagnosed with head and neck cancer at
Alexandria Cancer Centre and Palliative Care Hospital, Eldoret between January 2017
and December 2018.
Methods: This was a retrospective study with laboratory analysis between January
2017 and December 2018. Patient files were reviewed. Stored tissues were retrieved
and: repeat microscopy, p16 Immunohistochemistry and Human papillomavirus
Polymerase Chain Reaction were carried out. Data was analyzed by use of Microsoft
Excel (2016).
Results: Head and neck cancer accounted for 8.8% (89/1016) of all malignancies at
Alexandria Cancer Centre and Palliative Care Hospital. There were more males (64%)
than females (36%), with a mean age of 50.9 ± 17.6 years. Most patients came from
Western Kenya Region. About one third (35.7%) were farmers and students
combined. A total of 16 samples (16/29) (55.2%) tested p16 positive, of these 2
(12.5%) tested positive with HPV PCR. One of these was from an 87-year-old female
diagnosed with tongue cancer. Molecular analysis revealed the genotype to be HPV
52. The other one was from a 49-year-old male with cancer of the post nasal space
who had multiple co-infections with HPV: 35, 52 and 59 genotypes. It is important to
note that these genotypes have been rarely isolated elsewhere.
Conclusion: The prevalence of head and neck cancer at Alexandria Cancer Centre
and Palliative Care Hospital is above both the global and national average pointing to
a likely higher prevalence in this region. The potential role of the unique Human
papillomavirus genotypes identified in this study require further investigations.
Recommendations: Further prospective studies with a larger sample size in order to
try and gain a better understanding of the prevalence of Human papillomavirus and
high-risk genotypes associated with head and neck cancer in Kenya. Additional data
will allow to close the gap of knowledge between Western countries and the sub-
Saharan African region, especially in Kenya which has a high burden for head and
neck cancer. This could play a big role in assisting health authorities in implementing
public health strategies like vaccinations and will aid in allocating necessary
resources.