Cancer is a disease characterized by the anarchic and uncontrolled proliferation of cells, associated with an escape from the regulatory mechanisms that ensure the harmonious development of our organism
[1]
. Cancers of the upper aerodigestive tract (UADT) are malignant tumors of the oral cavity, pharynx (oropharynx, nasopharynx, hypopharynx), larynx, salivary glands, esophagus, and paranasal sinuses
[2]
. They represent a significant burden; collectively ranking fourth for cancer incidence and second for cancer mortality worldwide
[3]
. There are a number of factors that can increase the risk of a person developing upper aerodigestive tract cancer, including smoking, moderate to heavy alcohol consumption, exposure to asbestos and other toxic substances, and genetic/family history of cancer
[4]
. The diversity of etiological factors and the high mortality rate of upper aerodigestive tract cancers motivated the choice of our study, whose general objective was to study the epidemiological and histopathological aspects of upper aerodigestive tract cancers in the Ear, Nose, and Throat (ENT) and Head and Neck Surgery Department of Ignace Deen National Hospital.
Overall, these cancers are responsible for significant morbidity and mortality, with notable variations in incidence and survival rates across different geographic regions and demographic groups.
Previous research on UADT cancers has primarily been conducted in high-income regions, where access to healthcare and screening programs is more developed. However, there is a growing need for data from low- and middle-income countries, where epidemiology and clinical outcomes may differ due to variations in risk factor exposure and available resources for diagnosis and treatment. This study aims to fill this gap by providing detailed data on the epidemiology and histopathology of UADT cancers in a specific population in Guinea, thereby contributing to the global understanding of these diseases and improving local public health interventions.
The Ignace Deen National Hospital, located in Conakry, is a key institution in the Guinean healthcare system, offering specialized services in otorhinolaryngology and cervicofacial surgery. This descriptive retrospective study, covering a five-year period, focuses on patients diagnosed and treated for UADT cancers at this institution.
2. Methodology2.1. Study Setting
Our study was conducted in the Ear, Nose, and Throat (ENT) and Head and Neck Surgery Department of Ignace Deen National Hospital. It is a public service with a triple vocation: care, continuing education, and scientific research.
2.2. Materials
Our material consists of all the medical records of patients hospitalized in the department.
We designed a questionnaire that allowed us to gather information contained in patient files (Data Collection Form).
2.3. Methods
This is a retrospective descriptive study spanning 5 years from September 1, 2016, to September 30, 2021.
It encompassed all patient records hospitalized in the Ear, Nose, and Throat (ENT) and Cervicofacial Surgery Department of the Ignace Deen National Hospital.
The study focused on the records of patients admitted for cancers of the upper aerodigestive tract confirmed by histology.
- Inclusion Criteria:
We included in this study all patient records, of any age, admitted to our service for histologically confirmed upper aerodigestive tract cancers and followed up at the ENT department of Ignace Deen National Hospital.
- Exclusion Criteria:
Incomplete records, patients lacking histological evidence, and patients hospitalized for other cancers were excluded.
We conducted a comprehensive sampling of all patient records meeting our selection criteria.
We compiled patient records meeting our selection criteria.
Our variables were both qualitative and quantitative.
Epidemiological Data:
Marital Status:
Educational Level:
Predisposing Factors/Lifestyle:
Symptoms at Diagnosis:
Clinical Examination:
Tumor Site:
TNM Classification:
Anatomopathology:
Length of Hospital Stay:
Text, table, and figure processing were performed using Word, Excel, and PowerPoint software from the Office 2016 suite. Data entry and analysis were conducted using EPI Info software version 7.2.2.
Good medical practice was observed, meaning adherence to medical ethics and confidentiality, and the collected data were used purely for scientific purposes.
The Main limitations of Our Study Include
By proactively addressing these limitations, we can strengthen the validity and reliability of our study’s conclusions, thereby contributing to a better understanding and management of upper aerodigestive tract cancers.
3. Results
During our study, out of a total of 2326 records, we collected 426 cases of tumors (benign and malignant). Among these 426 cases, forty-three were cancers of the upper aerodigestive tract, representing a hospital frequency of 1.85% (
Figure 1
). It is noteworthy that cancers of the upper aerodigestive tract accounted for 10.09% of all tumors in the ENT and Cervicofacial Surgery Department of Ignace Deen National Hospital.
Figure 1. Frequency of upper aerodigestive tract cancers in our series.
The average age of our patients was 45.21 years ± 13.23 years, with a range from 5 years to 64 years (
Table 1
).
<xref ref-type="bibr" rid="scirp.134615-"></xref>Table 1. Distribution of patients according to age groups of the 43 patients with upper aerodigestive tract cancer from September 1, 2016, to September 30, 2021, at the ENT department of Ignace Deen National Hospital.
Age group
Number
Percentage
[5 – 20[
1
2.33
[21 – 35[
8
18.60
[36 – 50[
16
37.21
[≥ 51[
18
41.86
Total
43
100
Average age: 45.21 ± 13.23 years; Extremes: 5 and 64 years old.
In our study, males were predominant with a sex ratio of 1.8 (
Figure 2
).
Table 2
shows the distribution of patients according to profession, revealing that homemakers, farmers, and workers were the most affected, accounting for 27.90%, 23.26%, and 20.93%, respectively.
Figure 2. Distribution of patients by gender.
<xref ref-type="bibr" rid="scirp.134615-"></xref>Table 2. Distribution by profession of the 43 patients with upper aerodigestive tract cancer from September 1, 2016, to September 30, 2021, at the ENT department of Ignace Deen National Hospital.
Profession
Number
Percentage
Housewife
12
27.90
Farmer
10
23.26
Worker
9
20.93
Merchant or Shopkeeper
8
18.60
Teacher
2
4.65
Seamstress
1
2.33
Plumber
1
2.33
TOTAL
43
100
Figure 3
depicts the level of education among the 43 patients with cancers of the upper aerodigestive tract admitted to our service during the study period.
In our series, tobacco and alcohol emerged as the most common predisposing factors, at 37.21% and 34.88% respectively, closely followed by poor oral hygiene at 25.58% (see
Table 3
). We observed that hypertension and diabetes were the most frequently encountered comorbidities in our series, at 18.60% and 9.30% respectively (
Table 4
). Initial symptoms observed included pain in 23 cases (53.49%), dysphonia in 22 cases (51.16%), dyspnea in 17 cases (39.53%), cervical swelling in 11 cases (25.58%), hypersalivation in 5 cases (11.63%), bleeding in 4 cases (9.30%), general deterioration in 3 cases (6.98%), ulceration in 3 cases (6.98%), dysphagia in 3 cases (6.98%), and functional aesthetic impairment in 1 case (2.33%). Thirty-seven patients, representing 86.05%, were classified as stage I according to the World Health Organization, indicating good overall health.
The distribution of lesions was as follows: larynx with 15 cases, accounting for 34.88%; oral cavity with 8 cases, accounting for 18.60%; esophagus with 6 cases, accounting for 13.95%; salivary gland with 4 cases, accounting for 9.30%; hypopharynx with 3 cases, accounting for 6.97%; palatine tonsil with 3 cases, accounting for 6.97%; maxillary sinus with 2 cases, accounting for 4.65%; nasopharynx with 1 case, accounting for 2.32%; and nasal fossa with 1 case, accounting for 2.32%.
Figure 3. Distribution of patients by level of education.
<xref ref-type="bibr" rid="scirp.134615-"></xref>Table 3. Distribution according to predisposing factors of the 43 patients with upper aerodigestive tract cancer from September 1, 2016, to September 30, 2021, at the ENT department of the Ignace Deen National Hospital.
Predisposing factors
Number
Percentage
Tobacco
16
37.21
Alcohol
15
34.88
Poor oral hygiene
11
25.58
Pre-cancerous lesions
7
16.28
Cannabis
1
2.33
<xref ref-type="bibr" rid="scirp.134615-"></xref>Table 4. Distribution according to associated comorbidities of the 43 patients with upper aerodigestive tract cancer from September 1, 2016, to September 30, 2021, at the ENT department of the Ignace Deen National Hospital.
Associated comorbidities
Number
Percentage
Hypertension
8
18.60
Diabetes
4
9.30
Heart disease
2
4.65
Asthma
1
2.33
Pneumonia
1
2.33
Acute rheumatic fever
1
2.33
Table 5
illustrates the distribution of patients according to the site of lymphadenopathy and their number. According to the results of histopathological examination, squamous cell carcinoma was the most frequent histological type, with 32 cases representing 74.41%. It was followed by diffuse large B-cell lymphoma with 8 cases, accounting for 18.60%. Other histological types included adenoblastoma with 1 case (2.33%), adenoid carcinoma with 1 case (2.33%), and mucoepidermoid carcinoma with 1 case (2.33%).
<xref ref-type="bibr" rid="scirp.134615-"></xref>Table 5. Distribution according to the anatomical site of lesions of the 43 patients with upper aerodigestive tract cancer from September 1, 2016, to September 30, 2021, at the ENT department of the Ignace Deen National Hospital.
Oral cavity
number
Percentage
Salivary glands
4
9.30
Floor of the mouth
2
4.65
Gum
2
4.65
Palate
1
2.33
Retromolar trigone
1
2.33
Base of the tongue
1
2.33
Free border of the tongue
1
2.33
Nasal cavity
Maxillary sinus
2
4.65
Nasal cavity
1
2.33
Oropharynx
Palatine tonsil
3
6.98
Hypopharynx
Piriform sinus
2
4.65
Retrocricoid-arytenoid region
1
2.33
Esophagus
6
13.95
Larynx
Glottis
10
23.26
Subglottic area
4
9.30
Supraglottic area
1
2.33
In our study, squamous cell carcinoma accounted for 74.42%, followed by diffuse large B-cell lymphoma as the most frequently cited histological types.
4. Discussion
In our study, among the 2326 records examined, we identified 426 cases of tumors, whether benign or malignant. Among these cases, 43 were cancers of the upper aerodigestive tract, representing a hospital frequency of 1.85%. It is worth noting that upper aerodigestive tract cancers represent 10.09% of all tumors diagnosed at the Ear, Nose, and Throat (ENT) department of Ignace Deen National Hospital. In a study conducted by Amana B et al.
[5]
in Togo, involving a sample of 401 cases of primary cancers of the upper aerodigestive tract and the cervicofacial region diagnosed histologically, these types of cancers represented 0.48% of all consultations and 15.3% of all diagnosed tumors in that region. In France, the frequency of squamous cell carcinomas of the upper aerodigestive tract is estimated at 16,000 new cases in men out of a total of 120,000 new cases of cancer per year, and 1800 new cases in women out of a total of 80,000 new cases of cancer per year
[6]
. In their study, Morris J et al.
[4]
indicated that cancers of the upper aerodigestive tract represent about 4% of all malignant tumors.
The mean age (45.21 ± 13.23 years) observed in our study was lower than that reported by Diallo AO et al. in 2020, who noted a mean age of 53.7 ± 4 years with extreme values ranging from 13 to 80 years
[7]
, as well as that of Riley CA et al.
[3]
in 2018 in France, who reported a median age of 74 years with extreme values ranging from 66 to 99 years.
In a study conducted in France by Auperin A et al.
[8]
, it was found that cancers of the upper aerodigestive tract were very rare before the age of 35. Their incidence was highest between 50 and 59 years old, but remained high until 84 years old. It appears from our study that the onset age of upper aerodigestive tract cancers in our study population occurs earlier than in European countries, which could be due to local dietary habits characterized by a low intake of trace elements. In our study, men were predominant, accounting for 65.12%, while women accounted for 34.88%. This finding is consistent with that of Oudjehih M et al.
[9]
, who observed a prevalence of 76.6% in men.
We observed a predominance of housewives, accounting for 27.90%, followed by farmers with 23.26% and traders/merchants with 18.60%. This observation differs from that reported by Carton M in France
[10]
in 2017, where the respective percentages were as follows: employees 54.1%, workers 22.7%, intermediate professions 10.1%, and executives 6.9%.
The high prevalence of housewives in our study could be due to the modest income of these patients, who typically present at an advanced stage of the disease. The predominance of uneducated individuals
Dans our study, out of the 2326 records examined, we identified 426 cases of tumors, whether benign or malignant. Among these cases, 43 were cancers of the upper aerodigestive tract, representing a hospital frequency of 1.85%. It is worth noting that upper aerodigestive tract cancers represent 10.09% of all tumors diagnosed at the Ear, Nose, and Throat (ENT) department of Ignace Deen National Hospital. In a study conducted by Amana B et al.
[5]
in Togo, involving a sample of 401 cases of primary cancers of the upper aerodigestive tract and the cervicofacial region diagnosed histologically, these types of cancers represented 0.48% of all consultations and 15.3% of all diagnosed tumors in that region.
In France, the frequency of squamous cell carcinomas of the upper aerodigestive tract is estimated at 16,000 new cases in men out of a total of 120,000 new cases of cancer per year, and 1800 new cases in women out of a total of 80,000 new cases of cancer per year
[6]
. In their study, Morris J et al.
[4]
indicated that cancers of the upper aerodigestive tract represent about 4% of all malignant tumors.
The mean age (45.21 ± 13.23 years) observed in our study was lower than that reported by Diallo AO et al. in 2020, who noted a mean age of 53.7 ± 4 years with extreme values ranging from 13 to 80 years
[7]
, as well as that of Riley CA et al.
[3]
in 2018 in France, who reported a median age of 74 years with extreme values ranging from 66 to 99 years. In contrast, our result is similar to that of Spero H. Raoul Hounkpatin et al.
[11]
in Benin, who reported an average age of 45.3 years ± 18.7 years, with extremes ranging from 1 year to 91 years.
In a study conducted in France by Auperin A et al.
[8]
, it was found that cancers of the upper aerodigestive tract were very rare before the age of 35. Their incidence was highest between 50 and 59 years old, but remained high until 84 years old. It appears from our study that the onset age of upper aerodigestive tract cancers in our study population occurs earlier than in European countries, which could be due to local dietary habits characterized by a low intake of trace elements. In our study, men were predominant, accounting for 65.12%, while women accounted for 34.88%. This finding is consistent with that of Oudjehih M et al.
[9]
, who observed a prevalence of 76.6% in men.
We observed a predominance of housewives, accounting for 27.90%, followed by farmers with 23.26% and traders/merchants with 18.60%. This observation differs from that reported by Carton M in France
[10]
in 2017, where the respective percentages were as follows: employees 54.1%, workers 22.7%, intermediate professions 10.1%, and executives 6.9%.
The high prevalence of housewives in our study could be due to the modest income of these patients, who typically present at an advanced stage of the disease. The predominance of uneducated individuals, with 41.86% in our study, was similar to that reported by Oudjehih M
[9]
in Algeria in 2020, who noted that the majority of participants were illiterate (49%) or poorly educated (32%).
This observation reflects the situation in Africa. In 2020, the literacy rate in Guinea was 30.40%.
Regarding risk factors, our data are comparable to those of Amana B et al.
[5]
in Togo, who reported a prevalence of 38% for alcohol intoxication, 21% for smoking, combined alcohol and tobacco intoxication found in 29 patients, and 13% for poor oral hygiene. Smoking or tobacco use accounts for more than 30% of all cancers, mainly those affecting the upper aerodigestive tract, including the lungs and bronchi, the larynx, the pharynx, and the oral cavity
[12]
. Diallo AO et al. also found that alcohol intoxication was the main risk factor, with a prevalence of 52.4%
[7]
. Our findings regarding past medical history and associated pathologies are similar to those of ZAIDI MK
[13]
in Morocco in 2016, who reported a prevalence of 14% for hypertension, 8% for diabetes, and 7% for heart diseases. The prevalence of pain, swelling, dysphonia, and dyspnea could result from the compression of the recurrent nerve by the tumor, thus affecting the vocal cords and airways. In the literature, it is observed that among head and neck cancers, the locations are distributed as follows: oral cavity, representing 30 to 35% (including mobile tongue: 15%, floor of the mouth: 6%); oropharynx, representing 20 to 25% (including tonsil: 15%, soft palate: 5%, base of tongue: 5%); hypopharynx, representing 10 to 15% (mainly piriform sinus); larynx, representing 25 to 30% (including glottis: 10%, supraglottic: 10%)
[6]
. Similarly, Riley CA et al.
[3]
noted 60.5% laryngeal tumors, 5.4% hypopharyngeal, 5.2% oropharyngeal, 14.4% tonsillar, 5.5% nasopharyngeal, and 9.0% paranasal sinus.
5. Conclusion
Upper aerodigestive tract cancers remain relatively common in our country. All age groups are affected, with a predominance in the fifties. Men are the most affected, but there is a significant proportion of women. Housewives and farmers with a low socioeconomic status and low education level were predominant. Poor oral hygiene, alcohol consumption, and smoking have been identified as risk factors. The most frequent locations were the larynx, pharynx, oral cavity, and nasal cavity. The positive diagnosis of cancers is mainly histological, and squamous cell carcinoma and large-cell lymphoma were the most cited histological types. Improving this prognosis would depend on early diagnosis of the condition, resuscitation means, and prompt management.
Appendix
Data Collection Sheet
Sheet Number /…………/ Date of Admission …………/………/………….
Age in years /………./ Sex: M /….../ F /….../Residence: Urban area /….../ Rural area /….../
Cervical lymphadenopathy /….../ Discovered at the metastatic stage /….../ Hoarseness /….../ Shortness of breath /….../ Functional and aesthetic discomfort /….../Bleeding from the ENT sphere/….../
Others /………………………………………………………………/
Clinical examination:
General examination: WHO Classification of General Health: 0 /….../ 1 /….../ 2 /….../ 3 /….../ 4 /….../
Weight in kg /………/ Height in meters /………/ Body Mass Index /………/
Site of the tumor:
Oral cavity: Tip of the tongue /….../ Free border of the tongue /….../ Base of the tongue /….../ Floor of the mouth /….../ Palate /….../ Retro-molar trigone/….../ Gum /….../
References
Ligue contre le cancer (2022) Le cancer définition et chiffres.
Hua, R., Liang, G. and Yang, F. (2020) Meta-Analysis of the Association between Dietary Inflammatory Index (DII) and Upper Aerodigestive Tract Cancer Risk. Medicine, 99, e19879. >https://doi.org/10.1097/MD.0000000000019879
Riley, C.A., Wu, E.L., Hsieh, M.-C., Marino, M.J., Wu, X. and McCoul, E.D. (2018) Association of Gastroesophageal Reflux with Malignancy of the Upper Aerodigestive Tract in Elderly Patients. JAMA Otolaryngology-Head&Neck Surgery, 144, 140-148. >https://doi.org/10.1001/jamaoto.2017.2561
Morris, J., Fang, Y., Mukhopdhyay, K.D. and Wargovich, M.J. (2016) Natural Agents Used in Chemoprevention of Aerodigestive and GI Cancers. Current Pharmacology Reports, 2, 11-20. >https://doi.org/10.1007/s40495-016-0047-0
Amana, B., Foma, W., Pegbessou, E., Bissa, H., Adam, S., Amana, E., et al. (2016) Cancers primitifs oto-rhino-laryngologiques et cervico-maxillo-faciaux: Aspects épidémiologiques et histopathologiques. Pan African Medical Journal, 25, Article No. 47. >https://doi.org/10.11604/pamj.2016.25.47.9953
Bonfils, P., Laccourreye, O. and Couloigner, V. (2011) Le livre de l’interne ORL. Lavoisier.
Diallo, A.O., Diallo, O.R., Diallo, O.A., Bah, A.T., Traoré, M., Sinayoko, A., et al. (2020) Epidemiology of Cancers of Upper Aerodigestive Tract at Conakry University Hospital. Annals of Otolaryngology and Rhinology, 7, Article 1234.
Auperin, A., Melkane, A., Luce, D. and Temam, S. (2011) Épidémiologie des cancers des voies aérodigestives supérieures. La Lettre du Cancérologue, 20, 102-106.
Oudjehih, M., Deltour, I., Bouhidel, M.L., Bouhidel, A., Marref, A., Luzon, V., et al. (2020) Smokeless Tobacco Use, Cigarette Smoking, and Upper Aerodigestive Tract Cancers: A Case-Control Study in the Batna Region, Algeria, 2008-2011. Tobacco Use Insights, 13, 1179173X20902239. >https://doi.org/10.1177/1179173X20902239
Carton, M. (2017) Facteurs de risque professionnels des cancers des voies aérodigestives supérieures chez les femmes: Analyse des données de l’étude Icare. Ph.D. Thesis, Université Paris Saclay.
Hounkpatin, S., Brun, L., Balle, M., Bouraima, F., Bossou, T., Amegan, N., Flatin, M. and Akélé-Akpo, M. (2020) Histo-Epidemiological Profile of Head and Neck Cancers in Benin. International Journal of Otolaryngology and Head&Neck Surgery, 9, 19-29. >https://doi.org/10.4236/ijohns.2020.91004
Amin, A.R.M.R., Haque, A., Rahman, M.A., Chen, Z.G., Khuri, F.R. and Shin, D.M. (2015) Curcumin Induces Apoptosis of Upper Aerodigestive Tract Cancer Cells by Targeting Multiple Pathways. PLOS ONE, 10, 124-218.>https://doi.org/10.1371/journal.pone.0124218
Zaidi, M.K. (2016) Les Cancers De La Sphère ORL Expérience Du Service D’oncologie Médicale. Ph.D. Thesis, Université Sidi Mohamed Ben Abdellah.