Poorly differentiated oesophageal squamous cell carcinoma in Western Kenya: A case report

Abstract

Cancer of the oesophagus is the eighth (some articles put it as sixth) most common cancer in the world. Squamous cell carcinoma is the predominant histological type with the highest incidence in the ‘Asian oesophageal cancer belt’.1 A recent study documented the unusual findings of oesophageal cancer in young Kenyans from Western Kenya and suspected genetic or familial risk factors could be involved.2 The suspected genetic risk has been documented in studies conducted in Asia where the condition is prevalent.3,4,5,6,7,8 Patients with oesophageal cancer tend to present to rural hospitals in sub-Saharan Africa when it is too late (usually when the advanced disease has made it difficult for them to swallow even saliva). The outcomes of care are limited by the late presentation, unavailability of diagnostic and healthcare resources in these rural district hospitals and poverty in amongst local people. In most cases all we can do is a barium swallow to strengthen our clinical suspicion, because endoscopic and histology services are located far from these hospitals. Those patients that can afford the histology will, in nearly all cases, find it difficult to pursue further specialised care. This implies that the clinical suspicion of oesophageal cancer in these facilities translates to certain death within weeks. Consequently, we would like to present this case and compile a literature review on risk factors for oesophageal squamous cell carcinoma (OSCC) to highlight this dilemma. We also want to demonstrate our limitations in managing this severe disease which affects young patients who do not seem to have been exposed to the traditionally cited risk factors in other parts of the world where oesophageal carcinoma is prevalent.