FCCT Blog Post #24
By Randy Hurley MD, cTropMed
Retired, HealthPartners and Regions Hospital Cancer Care Centers
University of Minnesota, Global Health Faculty
FCCT Blog Post #24
September 16, 2026
KCMC-FCCT Tumor Board
Three cases were presented at the September KCMC-Minnesota tumor board.
A 38-year-old Massai female presented with dysphagia from a locally advanced squamous cell cancer of the cervical esophagus. Her case was complicated by the fact that she was 22 weeks pregnant with a twin pregnancy. Eastern Africa has a high incidence of squamous cell cancer of the esophagus, but the epidemiology remains uncertain. This patient did not smoke or consume alcohol. The median age at diagnosis of esophageal cancer in Tanzania is 60 years with a male predominance. In one series of 738 cases, 13% were under the age of 40 (1). The discussion revolved around the safety of treating with chemo-radiotherapy to save the mother’s life. Typical regimens for management of unresectable squamous cell carcinoma of the esophagus in western countries could include weekly carboplatin and paclitaxel with radiation or infusional 5-flurouracil and cisplatin with radiation (2)
- Mmbaga EJ, et al. Characteristics of esophageal cancer in Tanzania. J Global Oncol 2018;1-10
- Xie SH, et al. Esophageal Cancer; N Engl J Med 2026; 395:1100.
A 65-year-old man presented with a large 16 cm left breast and chest wall mass from a mucinous adenocarcinoma of presumed breast origin. Four years earlier, he had surgical removal of a left breast mass at an outside institution, however histology was not performed. The current tumor was negative for estrogen receptor, progesterone receptor and Her2/neu (triple negative). The patient had presented with a slowly enlarging mass with pain and left arm lymphedema. A CT scan was concerning for two small lung nodules and there was a question of possible small volume retroperitoneal adenopathy. The patient had no response to four cycles of neoadjuvant doxorubicin and cyclophosphamide chemotherapy. The plan was to changed his regimen to carboplatin and paclitaxel. Male breast cancer is increasingly being recognized in Tanzania (1). Over 80% of the recently reported cases were infiltrating ductal carcinoma with luminal A histology accounting for 60% and triple negative accounting for 20% of cases. The mucinous histology in this case was unusual. In western countries, neoadjuvant doxorubicin/cyclophosphamide and carboplatin/paclitaxel chemotherapy has very high response rates in triple negative breast cancer and is enhanced with the addition of pembrolizumab (2). In advanced triple negative breast cancer, the addition of pembrolizumab primarily benefits patients with high tumor PDL1 expression.
- Kivuyo N, et al. Male breast cancer: experience from a quaternary hospital in Tanzania. Pan Afr Med J 2026;53:149.
- Schmid P, et al. Pembrolizumab for early stage triple negative breast cancer. N Engl j Med 2020;382:810.
A 20-year-old woman with HIV acquired at birth and a CD4 count <200 was diagnosed with a chondroblastic osteosarcoma of the left mandible. She had presented with dental pain and a jaw mass. She underwent a partial mandibulectomy with removal of a 5cm mass. She began adjuvant doxorubicin-cisplatin chemotherapy but her first course was complicated by severe febrile neutropenia requiring a prolonged recovery. Shortly thereafter she presented with headache and left arm weakness. She was found to have a large extra-dural cranial recurrence with extension into the right parietal lobe of the brain. There was mass effect and increased intracranial pressure identified on the head CT and brain MRI. This was felt to be surgically unresectable and thus recommendations for palliative whole brain radiation therapy were given. High dose methotrexate with leucovorin rescue is not available in Tanzania. Osteosarcoma is the most common malignant bone tumor in children and young adults in Tanzania (1). Although there is not a direct correlation with osteosarcoma and HIV infection, KCMC has documented an increasing prevalence of “non-AIDS-defining” malignancies in their HIV population. The prevalence of cancer in the HIV-infected population was 9% with esophageal cancer having the highest incidence (2).
- Ghert M, et al. Primary bone tumors in children and adolescents treated at a referral center in northern Tanzania. J Am Acad Orthop Surg Glob Res Rev. 2019; 3
- Mremi A, et al. Cancer spectrum in HIV-infected patients: A zonal hospital experience in Tanzania. Cancer Treat Res Commun. 2020;25:
