Introduction: Previous Challenges

– Late presentation

– Limited facilities (2 bone scans for 170 million population)

– Limited number of specialists and inadequate funding

– Services divided along geographical lines

Introduction – Lagos

– Coastal city on West Africa coast

– Most populous city in Africa (17 million people)

– No dedicated sarcoma MDT prior to 2012

Naked Truth About Musculoskeletal Tumours

– Deemed a forgotten cancer because of rarity

– Most common primary cancers in ortho clinic

– 50 different subtypes

– Dearth of national data from Nigerian registries

Clinical Presentation

– Size matters! Lumps >4 cm should be treated as sarcoma (Grimer RJ)

– Patients often present late (2–240 weeks)

– Mean duration malignant: 18.3 weeks

– Mean duration benign: 36.7 weeks

– Significant delay in general and private hospitals

Narrative Review of STS in Nigeria

– 236 articles reviewed (1940–present)

– 1064 patients from 9 studies

– Most patients in 4th–5th decade (avg 34.4 yrs)

– Duration of symptoms: 21.3–58.7 months

Common Histotypes

– Rhabdomyosarcoma

– Liposarcoma

– Fibrosarcoma

– High incidence of advanced disease due to poor infrastructure

Osteosarcoma Studies

– Abdulkareem et al: 77 cases – osteosarcoma 9% of all MS tumours

– Inuwa et al: 65 cases – osteosarcoma 32% of MS tumours

– Case example: 10‑year‑old with huge femoral osteosarcoma requiring amputation

Regional Studies – South Africa

– Ferreira & Malais: 67% mets at diagnosis; limb salvage 8%

– Lisenda et al: 26% mets, limb salvage 21%, 5‑yr survival 38%

Biopsy Studies

– Nnodu et al: 96 patients – FNAC accuracy 88%

– Accuracy higher with immunohistochemistry

LAMON – Lagos Musculoskeletal Oncology Network

– A model for cancer care in resource‑poor countries

– Improved patient pathway

– Efficient use of scarce resources

– Supports adherence to guidelines

– Multidisciplinary decision‑making

LAMON Data

– 212 patients reviewed in first 30 months

– Definitive histological diagnosis in 91%

– Age range: 3–95 years

– Tumour locations: Extremity 82%, Central 18%

– Diagnosis breakdown: Osteosarcoma 22%, GCT 13%, STS 11%, MBD 8%

– Limb preservation rate: 67%

– Local recurrence rate: 8.5%

Endoprosthesis Experience

– Various brands used

– Currently shifting towards Chunli tumour prosthesis in Nigeria

Ongoing Challenges

– Need formal referral pathways

– Need NGO funding for MDT (e.g., MONSUF)

– Need improved diagnostic capability

– Need specialist training funding

Summary

– Outcome can be good with the right approach

– MDT network improved diagnosis and limb salvage

– Communal tumour boards like LAMON may be a model for cancer care in resource‑poor countries