Clinical, imaging and pathological characteristics of pancreatic tumors among adult patients at Moi Teaching and Referral Hospital in Eldoret, Kenya

Abstract

Background: Pancreatic cancer is a leading cause of cancer-related death globally. Kenya reports a uniquely high incidence of pancreatic cancer in the East-African region. Increased recognition of mass forming chronic and autoimmune pancreatitis in surgical specimens in other populations has led to increased uptake of preoperative pancreatic biopsy. Pancreatic tumors have hitherto not been studied to guide approach to patient management in our setting. Objective: To describe the clinical, imaging and pathological characteristics of pancreatic tumors among adult patients at Moi Teaching and Referral Hospital. Methods: This was a cross sectional study conducted among 39 adult patients who presented with pancreatic tumors at Moi Teaching and Referral Hospital (MTRH) between August 2018 and July 2019. All study participants underwent imaging guided pancreatic biopsy except one who underwent pancreatic resection. Demographics, clinical signs and symptoms, preoperative imaging and histological findings for all participants were collected for description, analysis and discussion. Mean, median, frequencies and percentages were used to describe the clinical, imaging and laboratory characteristics of pancreatic tumors. Results: Twenty-one (54 %) of the participants were male and eighteen (46 %) were female. The mean age was 55.8±13.5 years and median age was 58 years (IQR 49 -67 years). There was a low incidence of smoking, alcohol use, family history of cancer, individual history of cancer and pancreatitis. The most common symptoms were abdominal pain at 89.5 % (n = 35), mostly in the epigastrium and right upper quadrant, and yellowness of eyes at 79.5 % (31). The mean duration of symptoms was 3.5 months with a median duration of 2 months. About 71 % (n = 28) of all tumors were of the head and 87 % (n = 34) were solid. Seventy-four percent (74 %, n = 29) of tumors were more than 4 cm. Seventy-nine percent (79.5 %, n = 31) of tumors were pancreatic cancer, 8.6 % (n=3) were metastases to the pancreas and 10.3 % (n = 4) were benign conditions. Among the subgroup with pancreatic cancer, 19 % were below the age of 50 years. Conclusions: Majority of the patients presented with advanced pancreatic cancer at a younger age than the global average. Large pancreatic head masses comprised the vast majority of tumors. Despite the bulk of tumors being primary pancreatic cancers, there was a significant proportion of metastatic cancers and benign conditions. Recommendations: Further studies to look at why patients with pancreatic cancer are presenting at a younger age and with advanced disease. Tissue diagnosis should be sought for all patients with pancreatic tumors to enable individualized patient care.