Delayed Presentation of Bone and Soft Tissue Sarcoma of the Extremity in Makurdi: Do Traditional Bone Setters Play a Role?

Background: Soft tissue and bone sarcomas are rare but are associated with high mortality rate when they occur. This is partly due to delay in presentation to a specialist center .Some guidelines have been introduced to aid early diagnosis of these tumours, however, these guidelines are not always observed as required. This study is aimed at highlighting the emerging role traditional bone setters may be playing in delaying presentation of patients with sarcomas of the extremity.

Methods: A 5 year retrospective review of histologically confirmed soft tissue and bone sarcoma patients was conducted at our hospital. Data obtained included socio-demographic characteristics, date symptoms were first noticed, date of first consultation with a specialist, date of first specific treatment and history of traditional intervention. Tumour size, location on the limb, fungation/ ulceration at presentation as well as type of treatment were noted. Descriptive statistics was done to display frequency and measures of central tendency.

Results: There were 16 patients between ages 3 and 65 years. Fifteen had soft tissue sarcoma while one was an osteosarcoma. There were 10 males and 6 females giving a male to female ratio of 1.6:1.Mean Patient Delay was 56.4 weeks and Mean tumour size was 25.3 cm. There were 12(75%) rhabdomyosarcomas and 2(12.5%) Kaposi sarcomas. Seven of the tumours were located in the thigh (43.7%), 2(12.5%) each in the gluteal region, knee and leg. Out of the 6 that ulcerated, 5(83.3%) had traditional bone setters intervention with incisions made. Seven had Wide local excision and 2 had amputation after biopsy. Four patients had adjuvant chemotherapy with one year survival in one.

Conclusion: Delay in presentation of sarcoma is noticed more commonly among patients with small size tumours and those who have had traditional bone setters treatment.