A total of 777 oesophageal cancer patients’ cards, diagnosed between 2012- 2017, were reviewed for this study. Out of the total number of patients’ cards reviewed, fifty five percent of the patients were male, the mean age of the patients whose card was reviewed was 52.9 years, 90.6 % of oesophageal cancer cases patients came to the hospital with complaint of difficulty of swallowing, from the analysed histopathological findings 56.7% were squamous cell type of carcinoma, 50% of oesophageal cancer cases were reported from Oromia region and at the time of presentation 80% of patients were diagnosed at late stage.
In most cases oesophageal cancer is three to four times more common in male than females [25, 26]. A systematic review conducted in sub-Saharan African countries also showed that male predominance in oesophageal cancer cases with ratio of 2:1 . A systematic review and a meta-analysis conducted in 36 African countries revealed that being male was a risk factor for oesophageal cancer cases (1.7; 95% CI: 1.4, 2.0) . In opposite to these findings, a study conducted in Sudan showed that 1:1.8 male to female ratio of oesophageal cancer cases . In the present study male to female ratio is 1: 1.3 which was not as high as studies conducted in many developed countries and African countries. The difference could be in most countries the risk factor for oesophageal cancer is tobacco smoking and alcohol. While the prevalence of cigarette smoking and alcohol consumption were low among oesophageal cancer patients in Ethiopia with 5% and 2% respectively .
While most oesophageal cancer patients in Ethiopia were not smokers and alcohol users. Based on this study finding, the reason why still a high proportion of men were diagnosed for oesophageal cancer could be related to better health seeking behaviour of men compared to females.
This study indicated that the mean age of the study participants was 52.9 years. A systematic review in Sub Sahara Africa region indicated that the median age of the oesophageal cancer patients was 59 years . Another study conducted in Ghana indicated the mean age of the oesophageal cancer patients was 57.8 years . This finding can be explained by the fact that the chance of getting oesophageal cancer cases increase with age. However, generally the mean age of oesophageal cancer patients can vary from country to country as often the mean age highly depends on the underlying population structure.
In the present study, of the 118 results analysed for histopathological subtype, squamous cell carcinoma consists of 67 (56.7%). This finding is consistent with studies conducted in Kenya, North Sudan, Uganda which all showed a higher prevalence of ESCC as compared to Adenocarcinoma [31, 32]. A systematic review in Africa region showed that squamous cell sub type is the pre-dominant histology in Africa . Generally, from the two common sub-types of oesophageal cancer, squamous cell carcinoma is the commonest worldwide and especially it is common among black men .
In this study almost 50% of oesophageal cancer cases were found from Oromia region in which for this study data were collected from Bale, Arsi and Wellega. Ethiopia is one of oesophageal cancer belt countries; Arsi and Bale are part of hot spot areas  which is similar to the study done at Tikur Anbessa hospital where most oesophageal cancer cases were higher among patients from Arsi and Bale areas as compared to other regions . In Ethiopia most oesophageal cancer patients come from rural area mainly from South and Eastern part of Ethiopia. Most of the risk factors indicated for oesophageal cancer like smoking and alcohol were not present in most oesophageal cancer cases in Ethiopia . This could indicate potentially preventable nutritional factors such as porridge and kocho as a cause. This could be the main reason why most cases are from the similar region and it needs a further study for the risk factors of the diseases in these places.
Of the patients who underwent endoscopy, the majority of patients 209 (66.1%) site of mass was located. Of the site of mass located, oesophageal cancers were found in the middle thoracic in 98 (31%) and this finding is similar with five years card review study at Tikur Anbessa Hospital where the middle lower part was the site for the mass in 49% of oesophageal cancer cases . The approximate anatomical distribution of tumours within the oesophagus is <20% in the upper third, 30–70% in the middle third and 20–50% in the lower third [35–36]. The middle third of the oesophagus is the commonest site for squamous cell carcinoma and the lower third is the commonest site for adenocarcinoma [37–40]. In contrary to this a study in Ghana showed that 84.9% of cases anatomical site for oesophageal cancer, the mass was found at the distal third part .
Of the total patients seen during the study period, 692 (90.6%) presented to the hospital with complaint of difficulty of swallowing, followed by weight loss 374 (49%). Studies in different part of Africa, including Ethiopia revealed that most patients come to health facility with difficulty of swallowing and weight loss [37–38]. The disease is asymptomatic at early stage and most patients seek health care after experiencing increase of clinical manifestation. This is also true for other type of cancers, especially in country where awareness and access to health facilities is low.
From the patient whose cancer stage was recorded, 98(80%) of the patients were at the stage 3 and 4 during their first-time presentation. This finding is similar with the study in Kenya where 70–80% of patients diagnosed at late stage . This could be because most oesophageal cancer were asymptomatic at early stage and diagnosed at late stage when the outcome of the treatment is poor . A review on data from the six continents indicated that more than 50% of oesophageal cancer patients come to the health facilities when they have metastatic disease . In Ethiopia patients diagnosed at black lion hospital also revealed the same problem. A five-year review of the oesophageal cancer showed that 56% were operated and only 24% were suitable for esophagectomy; and the mortality after operation was 28% .