Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 248
  • Home
  • Print this page
  • Email this page


 
 Table of Contents  
ORIGINAL RESEARCH REPORT
Year : 2017  |  Volume : 14  |  Issue : 3  |  Page : 113-118

Head and neck cancers: An histopathologic review of cases seen in three Tertiary Hospitals in Northwestern Nigeria


1 Department of Oral and Maxillofacial Pathology/Biology, Lagos College of Medicine University of Idi-Araba, Lagos, Nigeria
2 Dental and Maxillofacial Surgery, College of Health Sciences Surgery Usmanu Danfodiyo University, Sokoto, Sokoto State, Nigeria
3 Department of Pathology, Usmanu Danfodiyo Universty Teaching Hospital, Sokoto, Sokoto State, Nigeria
4 Department of Laboratories Gusau, Federal Medical Center Gusau, Maiduguri, Borno, Nigeria
5 Department of Histopathology, University of Maiduguri Medical College, Maiduguri, Borno, Nigeria

Date of Web Publication17-Aug-2017

Correspondence Address:
Abdul-Warith Olaitan Akinshipo
Department of Oral and Maxillofacial Pathology/Biology, Faculty of Dental Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcls.jcls_18_17

Rights and Permissions
  Abstract 


Context: Head and neck cancers (HNCs) display variable biological and geographical variations even within the same country. Aims: This study aims to determine the histopathologic pattern of HNCs in three Northwestern states of Kebbi, Sokoto, and Zamfara in Nigeria. Settings and Design: This was an hospital-based descriptive retrospective study carried out at Federal Medical Centre, Birnin Kebbi; Federal Medical Centre, Gusau; and Usmanu Danfodio Teaching Hospital, Sokoto. Subjects and Methods: Medical and histopathologic records of all HNCs seen at these centers between January 2006 and December 2013, were reviewed, and data on time of presentation, sociodemographic, anatomic site, and histology were collected and analyzed using the Statistical Package for the Social Sciences (version 20) (SPSS Inc., Chicago, IL, USA) statistical software. Quantitative data were summarized using simple descriptive statistics of means and standard deviation (SD). Chi-square tests were used to analyze the nonparametric variables. Statistical significance was inferred at P ≤ 0.05. Results: Three hundred and eighty-one malignant HNCs were seen over a period of 8 years with an annual frequency of 47 cases. There was a male to female ratio of 1.2:1, and the mean age was 39.5 ± 19.2 (±SD). About 70.3% of cases were carcinomas, 15.0% were sarcomas, and 8.7% were lymphomas. Squamous cell carcinoma (34.9%) was the highest carcinomas while non-Hodgkin's lymphomas (6.6%) and rhabdomyosarcoma (4.2%) were the most common lymphomas and sarcomas observed, respectively. The most common sites were those of the lips, oral cavity, and pharynx International Statistical Classification of Diseases-10 (C00–C14). Conclusions: This present study demonstrates the rising trend of HNCs in these regions and highlights the urgent need for adoption of grass root policies that would incorporate public participation especially those under 40 years, in the awareness on the harmful use of carcinogenic substances such as tobacco and alcohol and dangerous sexual habits. There should also be concerted promotion of targeted preventive strategies, early screening, treatment, support, and lifelong rehabilitation.

Keywords: Head and neck cancers, histopathologic, Northwestern Nigeria


How to cite this article:
Akinshipo AWO, Taiwo AO, Abdullahi K, Fatimah AY, Sahabi SM, Ahmed MA. Head and neck cancers: An histopathologic review of cases seen in three Tertiary Hospitals in Northwestern Nigeria. J Clin Sci 2017;14:113-8

How to cite this URL:
Akinshipo AWO, Taiwo AO, Abdullahi K, Fatimah AY, Sahabi SM, Ahmed MA. Head and neck cancers: An histopathologic review of cases seen in three Tertiary Hospitals in Northwestern Nigeria. J Clin Sci [serial online] 2017 [cited 2017 Oct 23];14:113-8. Available from: http://www.jcsjournal.org/text.asp?2017/14/3/113/213082




  Introduction Top


The head and neck are randomly defined as the area from the clavicles to the sella turcica. It is an intricate anatomic site due to the range of tissues found in the region. Biopsies from the region are often small, frequently distorted, and difficult to orient for paraffin embedding, all of which impact on evaluation and diagnosis.[1] Conventionally, head and neck cancers (HNCs) refer to a heterogeneous group of primary cancers originating from the upper aerodigestive of which 90% are squamous cell carcinomas (SCCs).[2] Eighteen different cancer sites may be categorized as HNCs and as such several studies have either included or excluded malignancies of the eyes, skin, thyroid, salivary glands.[3],[4],[5] This is because the various organs are a few inches apart with the same tissue types, and pathologist finds it difficult to focus on one organ and neglect the nearby organs. Epidemiologically, HNC is the sixth most common cancers worldwide with approximately 560,000 new cases and 300,000 deaths with increasing incidence in developing countries.[6] Accounting for 5%–50% of all cancer globally, South Asia and parts of central and southern Europe have the highest incidences [7] with approximately 30% of all cancers in India, 3.3% of all cancers in the United States, 4.2% in Europe, and about 1.2% in Nigeria.[6],[7]

The etiology of HNCs like most cancers is not clear. However, several risk factors are associated with them, of which, tobacco use and alcohol consumption independently or in combination are associated with increased incidence.[8] Other observed risk factors are human papillomavirus infection in tongue, tonsil, and oropharyngeal HNCs particularly in nonsmoking cases of HNC.[9] The use of bidis is strongly associated with cancer of the hypopharynx and larynx and betel quid with oral cancer.[10] Clinically, HNCs are associated with significant loss of vital functions such as breathing, speech, and swallowing. Definitive diagnosis is through histology while imaging is used for staging and treatment. Patients in this environment usually present late, and treatment is financially and psychologically demanding.[3]

The gold standard for HNC treatment is multimodal with the use of surgery, radiotherapy, and chemotherapy and often involves the maxillofacial surgeons, otolaryngologists, histopathologist, dentists, nurses, psychiatrists, therapists, social workers, and others.[11] In most centers in low- and middle-income countries, surgery is principally the mainstay of treatment as few places possessed the facilities for chemotherapy and radiotherapy. Ironically, reconstructive surgery is also financially out of reach for most patients even when suitable technical expertise is available, as more than 60% of Nigerian pay out of pocket for their health care compared to 16.8% in the United Kingdom.[12] In spite of several decades of progress and improvements in treatment and supportive care, the prognosis has remained unacceptably low for this group of patients stagnating at about 50% 5 years survival rate.[11]

The World Health Organization International Statistical Classification of Diseases-10 (ICD-10) classification system used for this study helps to standardize and serves as useful reference for assessment and monitoring of mortality, morbidity, and other relevant parameters related to HNC tumors and other health issues.[13]

Sokoto, Kebbi, and Zamfara are three states in Northwestern Nigeria. Before 1991, Sokoto state included Zamfara and Kebbi states. Currently, each of these three states has a referral hospital catering for a combined population of 10.2 million people with the largest center in Sokoto.[14] Since these states share health care personnel and other resources, it was deemed necessary to review the pattern of HNCs in these three centers together as the spectrum of HNCs varies from place to place even in the same country.[3] Furthermore, provision of accurate data on prevalence, common anatomic sites, and histologic types will serve as a baseline for further studies. In addition, it will serve as an important strategy for developing policies and planning resources to manage this group of pathologies in any population. We studied pathology and clinical charts in three tertiary health institutions in Kebbi, Zamfara, and Sokoto state to determine the demographic and histopathologic pattern of primary head and neck malignant tumors and to compare the demographic and histopathologic patterns of HNC with other Nigerian centers and some developing countries.


  Subjects and Methods Top


The present histopathologic retrospective study of HNCs was performed at the Federal Medical Centre, Birnin Kebbi, Federal Medical Centre, Gusau, and Usmanu Danfodio Teaching Hospital, Sokoto, together with a 2150 capacity bed space. A review of records of all patients with HNCs between January 2006 and December 2013, was obtained from the histopathology department of these hospitals. The total numbers of malignancies were also obtained from the records. The cases were identified and classified based on anatomy and invasiveness using ICD-10 3rd edition, categories C00–C97. Medical records of identified cases were reviewed, and information on the date of diagnosis, primary site, histology, and demographic data were retrieved. Duplicate cases were eliminated by cross-checking name, address, age, sex, and hospital number of each patient. In situ carcinoma and precancerous lesions were excluded from the study. Data were entered and analyzed using Statistical Package for the Social Sciences version 21 (SPSS Inc., Chicago, IL, USA). Quantitative data were summarized using simple descriptive statistics of means and standard deviation (SD). Chi-square tests were used to analyze the nonparametric variables. Statistical significance was inferred at P ≤ 0.05.


  Results Top


During the 8-year study period, a total of 1481 patients with head and neck lesions were seen; of which, 381 were malignant, constituting 25.7% prevalence. The highest number of cases presented in 1 year was in 2013 with 83 cases (21.8%) [Table 1]. There were 211 males (55.4%) and 170 females (44.6%) with a male to female ratio of 1.2:1. Their age ranged from 2 to 82 years with mean age of 39.50 years (SD = 19.2). The mean age for males was 41.00 years (SD = 19.45) and for females was 37.65 years (SD = 18.84). The most common age group was 45–64 years group with 145 (38.1%) cases [Figure 1]. Two hundred and sixty-eight patients (70.30%) had carcinomas followed by 57 (15.0%) cases of sarcomas [Table 2], [Figure 2]. According to ICD-10 classification system used in this study, the most common head and neck malignancy were C00-C14 consisting of cancers of the lips, oral cavity, and pharynx (n = 145, 38.1%) [Table 3].
Figure 1: Age distribution of head and neck malignancies

Click here to view
Figure 2: Malignant tumor of the chin in an elderly man

Click here to view
Table 1: Yearly presentation of neoplasms of the head and neck

Click here to view
Table 2: Broad histologic classification of head and neck malignancies according to gender ratio and mean age

Click here to view
Table 3: Frequency, mean age, and gender distribution of head and neck cancers according to International Statistical Classification of Diseases-10 classification

Click here to view


(The majority of the carcinomas were SCC (133;34.9%) followed by adenoid cystic carcinoma (23; 6.0%) while non-Hodgkin's lymphoma (25; 6.6%) and rhabdomyosarcoma (16; 12.0%) were predominant among the lymphomas and sarcomas, respectively [Table 4] and [Table 5].). Comparative analysis among males and females revealed a gender difference in the anatomic distribution of HNCs according to ICD-10 classification (P = 0.007) [Table 3]. There was also a statistical difference between gender and broad histologic types [Table 4].
Table 4: Distribution of broad histological types of head and neck cancer according to International Statistical Classification of Diseases-10 classification

Click here to view
Table 5: Frequency distribution, mean age, and gender ratio of the ten most common histologic types of head and neck malignancies

Click here to view



  Discussion Top


The epidemiology of HNCs in Nigeria is difficult to ascertain since most of the studies rely on data from clinical and histopathological records of hospitals.[15] Nonexistence or nonfunctional centralized tumor registry is the main reason for the lack of precise statistical data about prevalence and incidence of cancer.[15] Regional and institution-based registry systems from different centers including these centers are providing scattered but useful information regarding the prevalence of cancer. However, regional multicenter study utilized in this study is a better alternative to determine the true picture of HNCs than the latter.

The male to female ratio of 1.2:1 in this study is within the range of 1:1–2.3:1 in a review of Nigerian studies by da Lilly-Tariah et al.[3] Our result is also comparable to other African studies.[5],[16],[17],[18],[19] However, studies from Brazil,[20],[21] Korea [22] and India [23] showed a much higher male to female gender ration of 3.9:1, 3.6:1, 5:1, and 2.9:1 respectively, when compared to findings in our study. These discrepancies revealed the importance of looking into the role of etiological factors, as these regions might have more men exposed to high-risk etiologic factors of smoking, alcohol consumption, human papillomavirus, and other risk factors associated with cancer incidence. A study from Ilorin, North Central Nigeria, had more females affected than males.[24] The reason for this was not stated by the investigators.

The overall mean age of 39.5 years (SD = 19.2) seen in this study is lower than those seen in most Nigerian [25],[26],[27] and African studies.[5],[16],[17],[18] The reason for this low average is unknown; but, worldwide, there is an increasing incidence of HNC in younger age groups which is thought to be associated with changing sexual habits and exposure to unknown carcinogen in addition to the strong etiologic factors of smoking and alcohol consumption.[7] Furthermore, a peak incidence of 50–59 years which was observed in this study is similar only to the study of Onotai and Nwogbo [26] but higher than other studies from Nigeria [4],[24],[25],[28],[29] However, this present study is in agreement with the general observation that HNCs tend to occur at a younger age group in sub-Sahara Africa compared to Caucasians with evidence suggesting increasing incidence among young people worldwide.[30],[31] Widespread poverty, unemployment among young people also creates some concern as HNCs affect those with the lowest income and least education.[31]

The frequency of malignant head and neck neoplasm in this study was about 47 cases/year with an increasing trend. This figure is greater than those published from Jos,[4] Ife,[32] and Gombe.[33] This is considerably low for the three centers combined, and reasons for this may include harvesting phenomenon from late presentation due to barriers such as preference for traditional medicine, financial, structural, and institutional impediments.[31] Recent expansion in specialist services preventing referrals of cancer cases outside the region might have contributed to the rising trend in number of cases presenting in these facilities.

Carcinomas were the most common HNC type in this present study, which is in agreement with various studies worldwide.[3] However, a study from Ile-Ife Nigeria [32] reported lymphoma as the most frequently diagnosed HNC. In this study, carcinoma accounts for 70.3% of cancers reported which was below the reported range from Nigeria, of between 73.5% and 91%.[3],[25],[26],[27] SCC was the most frequently seen of the carcinomas types in most series.[5],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31] SCC constituted 34.9% of all carcinomas in this study which is comparable with findings from studies in Sokoto, Gombe, and Ilorin, incidentally all in Northern Nigeria [24],[29],[32] but lower than published figures across Southern Nigeria,[25],[26],[27] Sub-Saharan Africa,[5],[6],[16],[17],[18] Brazil,[21] India,[23],[30] and some western countries.[6],[7] These variations in geographic prevalence need further investigation as it could reflect differences in exposure to HNC carcinogens.

Sarcomas were the second most common histologic type in this study similar to research from Port Harcourt.[26] It, however, refutes data from many centers across Nigeria, Ghana, and Western countries that found lymphomas to be the second most common histologic type.[3],[18],[25],[27],[29] Rhabdomyosarcoma was the primary sarcoma in this current study in consonance with the study from Ibadan.[34] Rhabdomyosarcoma is considered the most common soft tissue sarcoma in children.[34] However, most studies of childhood malignancies in Nigeria observed lymphomas to be the most common childhood malignancy in their studies.[35]

Retinoblastoma constituting 5.2% of HNC was the most common neuroendocrine tumors in this study. A range of 2.6% to 13% has previously been reported in Nigeria.[28],[29],[35]

This study showed categories C00–C14, consisting of malignant neoplasm of the lips, oral cavity, and pharynx (38.1%) to be the most common group of malignant lesions in the head and neck, followed by lesions of the respiratory system consisting of the nasal cavity, sinuses, and larynx (C30–C39), with 21.0% of cases. A study in Ghana which used the ICD-10 also observed categories C00–C06 and C10 to be the most common group of lesion seen in their study.[17] However, a previous study from Sokoto [29] which used the ICD-9 classification and another one from Jos [4] which used ICD-10 observed the eyes (C69–C72) to be the most common site of malignant tumors.

Lesions of the eyes were not included in some studies from Nigeria.[3] In contrast to Nigerian studies, oral cavity cancers followed by laryngeal carcinoma were the most common HNCs in the western world.[6] Oral cavity cancers were also the most common HNCs from studies in Ghana [17] and Brazil.[20],[21]

Despite this clear and present danger in limitations of personnel, equipment, and poor control of risk factors associated with HNC, the government has not shown enough political will to tackle these problems. Government and private agencies including health maintenance organization. (HMOs) are being urged to properly equip treatment centres and subsidize the diagnosis, treatment and rehabilitation of HNCs.

Our study was limited by the fact that it was an interpretation of data from hospitals, which reflects our specific patient population reporting to the hospital and not the community as a whole. Furthermore, being a retrospective study, the specific histological subtype could not be correlated with risk factors and prognostic factors. A prospective study of risk factors, clinical parameters, and prognostic factors is important in understanding the prevalence and pattern of HNC in our environment which will aid in allocating necessary resources.


  Conclusion Top


This study showed that HNCs in three states of Northwestern Nigeria commonly involve the eyes, oral cavity, nasal and paranasal structures, the younger age group when compared to the western world and are majorly carcinomas. It highlights the need for structured data collection of HNC epidemiology in Nigeria to get the true demographic pattern of cancer problem in Nigeria and to investigate further on the specific risk factors that accounted for the younger age occurrence including the role of human papillomavirus.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Barnes L, Chiosea S, Seethala R. Head and Neck Pathology. New York: Demos Medical Pub.; 2011.  Back to cited text no. 1
    
2.
Tobias JS. Cancer of the head and neck. BMJ 1994;308:961-6.  Back to cited text no. 2
    
3.
da Lilly-Tariah OB, Somefun AO, Adeyemo WL. Current evidence on the burden of head and neck cancers in Nigeria. Head Neck Oncol 2009;1:14.  Back to cited text no. 3
    
4.
Otoh EC, Johnson NW, Mandong BM, Danfillo IS. Primary head and neck cancers in Jos, Nigeria: A re-visit. West Afr J Med 2006;25:92-100.  Back to cited text no. 4
    
5.
Onyango JF, Awange DO, Njiru A, Macharia IM. Pattern of occurrence of head and neck cancer presenting at Kenyatta National Hospital, Nairobi. East Afr Med J 2006;83:288-91.  Back to cited text no. 5
    
6.
Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11. V.1.0. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://www.globocan.iarc.fr. [Last accessed on 2016 Oct 22].  Back to cited text no. 6
    
7.
Davies L, Welch HG. Epidemiology of head and neck cancer in the United States. Otolaryngol Head Neck Surg 2006;135:451-7.  Back to cited text no. 7
    
8.
Blot WJ, McLaughlin JK, Winn DM, Austin DF, Greenberg RS, Preston-Martin S, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 1988;48:3282-7.  Back to cited text no. 8
    
9.
El-Mofty SK. Human papillomavirus-related head and neck squamous cell carcinoma variants. Semin Diagn Pathol 2015;32:23-31.  Back to cited text no. 9
    
10.
IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Betel-quid and areca-nut chewing and some areca-nut derived nitrosamines. IARC Monogr Eval Carcinog Risks Hum 2004;85:1-334.  Back to cited text no. 10
    
11.
El Din KK, El-Fetouh MA, Ahmed S, Hegazy AH. Clinical outcome and survival of head and neck cancer patients treated at clinical oncology department, Menoufia University. Menoufia Med J 2014;27:359-62.  Back to cited text no. 11
    
12.
World Health Organization. WHO global health expenditure atlas. Spending on health. A global overview, Geneva. Global Health Expenditure Atlas 2012:224. Available from: http://www.who.int/nha/atlas.pdf. [Last accessed on 2017 Jan 27].  Back to cited text no. 12
    
13.
World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010. Available from: http://www.apps.who.int/classifications/icd10/browse/2010/en#/VI. [Last accessed on 2014 Jan 27].  Back to cited text no. 13
    
14.
WHO. Population Distribution by Age and Sex: 2006 Census Priority Tables. Vol. 4. National Population Commission Abuja Nigeria; 2006. Available from http://www.population.gov.ng/index.php/component/content. [Last accessed on 2015 Apr 29].  Back to cited text no. 14
    
15.
Jedy-Agba E, Curado MP, Ogunbiyi O, Oga E, Fabowale T, Igbinoba F, et al. Cancer incidence in Nigeria: A report from population-based cancer registries. Cancer Epidemiol 2012;36:e271-8.  Back to cited text no. 15
    
16.
Mwansasu C, Liyombo E, Moshi N, Mpondo B. Pattern of head and neck cancers among patients attending Muhimbili National Hospital Tanzania. Tanzan J Health Res 2015;17:1-6.  Back to cited text no. 16
    
17.
Abdulai AE, Nuamah IK, Avogo D, Gyasi RK, Dakora TK. Primary malignant head and neck tumours in Ghana: A survey of histopathological charts over two decades. Int J Med Biomed Res 2013;2:75-83.  Back to cited text no. 17
    
18.
Larsen-Reindorf R, Owusu-Afriyie O, Acheampong A, Boakye I, Awuah B. A six-year review of head and neck cancers at the Komfo Anokye teaching hospital, Kumasi, Ghana. Int J Otolaryngol Head Neck Surg 2014;3:271-8.  Back to cited text no. 18
    
19.
Abuidris DO, Elhaj AH, Eltayeb EA, Elgayli EM, Mustafa OM. Pattern of head and neck malignancies in Central Sudan-(study of 314 cases). Sudan J Med Sci 2008;3:105-8.  Back to cited text no. 19
    
20.
Ruback MJ, Galbiatti AL, Arantes LM, Marucci GH, Russo A, Ruiz-Cintra MT, et al. Clinical and epidemiological characteristics of patients in the head and neck surgery department of a university hospital. Sao Paulo Med J 2012;130:307-13.  Back to cited text no. 20
    
21.
Alvarenga Lde M, Ruiz MT, Pavarino-Bertelli EC, Ruback MJ, Maniglia JV, Goloni-Bertollo M. Epidemiologic evaluation of head and neck patients in a university hospital of Northwestern São Paulo State. Braz J Otorhinolaryngol 2008;74:68-73.  Back to cited text no. 21
    
22.
Kim KM, Kim YM, Shim YS, Kim KH, Chang HS, Choi JO, et al. Epidemiologic survey of head and neck cancers in Korea. J Korean Med Sci 2003;18:80-7.  Back to cited text no. 22
    
23.
Bhattacharjee A, Chakraborty A, Purkaystha P. Prevalence of head and neck cancers in the North East – An institutional study. Indian J Otolaryngol Head Neck Surg 2006;58:15-9.  Back to cited text no. 23
    
24.
Ologe FE, Adeniji KA, Segun-Busari S. Clinicopathological study of head and neck cancers in Ilorin, Nigeria. Trop Doct 2005;35:2-4.  Back to cited text no. 24
    
25.
Adeyemi BF, Adekunle LV, Kolude BM, Akang EE, Lawoyin JO. Head and neck cancer – A clinicopathological study in a tertiary care center. J Natl Med Assoc 2008;100:690-7.  Back to cited text no. 25
    
26.
Onotai LO, Nwogbo AC. Primary head and neck malignant tumours in Port Harcourt, Nigeria: A revisit. J Med Med Sci 2012;3:122-5.  Back to cited text no. 26
    
27.
Adisa AO, Adeyemi BF, Oluwasola AO, Kolude B, Akang EE, Lawoyin JO. Clinico-pathological profile of head and neck malignancies at University College Hospital, Ibadan, Nigeria. Head Face Med 2011;7:9.  Back to cited text no. 27
    
28.
Ahmad BM, Pindiga UH. Malignant neoplasms of the ear, nose and throat in North Eastern Nigeria. Highland Med Res J 2004;2:45-8.  Back to cited text no. 28
    
29.
Iseh KR, Malami SA. Pattern of head and neck cancers in Sokoto – Nigeria. Niger J Otolaryngol 2006;3:77-83.  Back to cited text no. 29
    
30.
Mishra A, Meherotra R. Head and neck cancer: Global burden and regional trends in India. Asian Pac J Cancer Prev 2014;15:537-50.  Back to cited text no. 30
    
31.
Johnson NW, Warnakulasuriya S, Gupta PC, Dimba E, Chindia M, Otoh EC, et al. Global oral health inequalities in incidence and outcomes for oral cancer: Causes and solutions. Adv Dent Res 2011;23:237-46.  Back to cited text no. 31
    
32.
Amusa YB, Olabanji JK, Akinpelu VO, Olateju SO, Agbakwuru EA, Ndukwe N, et al. Pattern of head and neck malignant tumours in a Nigerian teaching hospital – A ten year review. West Afr J Med 2004;23:280-5. Erratum in: West Afr J Med 2005;24:183.  Back to cited text no. 32
    
33.
Akinmoladun V, Pindiga U, Akintububo O, Kokong D, Akinyamoju C. Head and neck malignant tumours in gombe, Northeast Nigeria. J West Afr Coll Surg 2013;3:1-15.  Back to cited text no. 33
    
34.
Fasunla AJ, Daniel A. Retrospective review of soft tissue sarcoma of head and neck in a West African hospital. Alexandria Med J 2013;49:43-8.  Back to cited text no. 34
    
35.
Shehu UA, Adegoke SA, Abdulsalam U, Ibrahim M, Oyelami OA, Adeodu OO. Pattern of childhood malignant tumours in two tertiary teaching hospitals in Nigeria: Comparative study. Niger J Paediatr 2013;40:175-8.  Back to cited text no. 35
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Subjects and Methods
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed81    
    Printed1    
    Emailed0    
    PDF Downloaded24    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]