Why cancer is more lethal

Following the rise in cancer deaths that have claimed three media personalities in less than three months; medical experts have come out to advise the public to embrace wellness checks which can lead to early detection of various illnesses.
“For a wellness check, you need to walk into a hospital even if you are healthy and just demand for an entire body check,” says Stella Ojinga, a hospital administrator at Nsambya Hospital.
She advises that a patient can ask to have a few body organs examined such as heart, lungs, kidneys, liver, and brain – this can be done upon a doctor’s request and advice.
Ojinga’s advice to the public comes at a time when the country is still mourning NTV’s pioneer news anchor, Rosemary Nankabirwa, who succumbed to adrenocortical carcinoma, cancer of the adrenal gland, at the Aga Khan Hospital in Nairobi.
Nankabirwa had a rare type of cancer, which was detected while at stage four. This means the cancer had spread to the other organs of the body including her liver and lungs.
Dr Othiniel Musana, the head of obstetrics and gynaecology at Nsambya hospital said some cancers are curable once detected early through screening.
“As a gynaecologist, I advise women to always have screening for cervical cancer, which is common in Uganda, and breast cancer which remains the leading cancer in women in the world,” says Dr Musana.
At the Uganda Cancer Institute (UCI) at Mulago hospital, few people go for cancer screening which is done free of charge every Wednesday and Friday.
Dr Musana recommends that government should come up with a policy to have a national cancer screening programme, adding that in the absence of a national screening programme, government should adopt use of mobile cancer screening units which reach out to many people at once.
The Government Chief whip, Ruth Nankabirwa also urged Ugandans to go for wellness checks even when they feel healthy.
“The government is setting up a centre of excellence to treat cancers but it will not help us if we do not go for checkups, especially cancer screening,” said Nankabirwa.
Earlier this month, the State minister for Primary Health Care, Sarah Opendi, said government was planning to roll out a nationwide cervical cancer vaccination campaign, but due to vaccine storage problems, which are being addressed, the campaign will run in August this year.

Cancer screening tests
Cervical cancer is caused by the Human Papilloma Virus which is sexually transmitted.
It can also affect the throat for people who practise oral and anal sex. Explaining how the cancer develops in the cervix, throat and anus, Dr Musana says that the HPV causes the body cells to undergo various changes known as pre-cancer, so the screening helps to detect cancer while still at this stage.
“We use pap smear test. Here, cell samples are taken from the cervix. It shows the development of abnormal cells,” he says.
However, Dr Musana says the Pap smear which takes two weeks for results to come out, is relatively expensive, costing about Shs17,000 where it is subsidised.
The cheapest method is the visual inspection with Acetic acid (VIA), where vinegar is applied on the cervix for a minute.
“One bottle of vinegar when diluted can screen about 500 people and gives results in a minute,” says Dr Musana, adding it can be conducted by any health worker and is free of charge.
Cervical cancer vaccination can protect adolescents from the cancer, provided they have not had sexual intercourse. A dose of the HPV vaccine costs about Shs150, 000.
Breast Cancer
A clinical examination is recommended once the breast has an abnormal shape.
“Self-breast examination is highly recommended. An individual can also feel her breast for lumps. Alternatively, a mammography examination can be done. A dye is pushed into the blood vessel, circulates in the breast and an x-ray is done,” Dr Musana adds. Mammography examination costs about Shs80, 000 at a private hospital.

Prostate Cancer
The cancer, which mainly affects males in their fifth decade (40 years and above), can be screened in different ways but most common is by removal of a blood sample to do a Prostate Specific Antigen (PSA) test. It can also be screened through a rectal examination – to tell where the prostate gland is enlarged or abnormal. PSA costs about Shs40,000. Prostate cancer is curable once it has not exceeded a certain range.

Cancer of the esophagus
Cancer of the esophagus affects the tube that moves food from the mouth to the stomach. Endoscopy, a nonsurgical procedure used to examine a person’s digestive tract, can assist in detecting this cancer. People with this cancer normally complain of ulcers and persistent challenges in swallowing food and beverages.
Using an endoscope, a flexible tube with a light and camera attached to it, the doctor can view pictures of your digestive tract on a colour TV monitor. The test costs about Shs350,000. Dr Musana says with colonoscopy, the doctor is able to look at the inner lining of your large intestine (rectum and colon). He or she uses a thin, flexible tube called a colonoscope to look at the colon. A colonoscopy helps find ulcers, colon polyps, tumours and areas of inflammation or bleeding. It also costs about Shs350,000.
While the cost and effort of screening for cancer may seem prohibitive, the cost of treatment is higher and the chance of death more certain with late diagnosis.

The cancer burden in Uganda

According to Dr Fred Okuku, a medical oncologist at Uganda Cancer Institute (UCI), statistics available indicate that 2800 new cancer cases were registered in 2012 compared to 1800 in 2011, implying an increment of 1000 new cases in one year.
He says an estimated total of 60,000 people are living with cancer in the country and out of which 20 to 40 per cent seek medical attention at UCI.
In 2013, the facility registered about 45, 000 cancer-patient visits which increased to 70,000 visits by the end of 2014. More than 60 per cent of the patients present in advanced stages of the disease.
A study conducted on the cancer trends by the Kampala Cancer Registry (KRC) between 1991 and 2010 indicates that prostate cancer remains the most common cancer in men at an incidence of 50 cases per 100,000 of the population.
Prof Henry Wabinga, the KRC manager says: “Cervical cancer remains the leading cancer in females at an incidence rate of 60 cases per 100,000 of the population. It’s closely followed by breast cancer at 32 cases per 100,000 and Kaposi sarcoma at 20 cases per 100,000 people.”
The 20-year trend indicates that previously, Kaposi sarcoma was the most common cancer in men but has since been overtaken by prostate cancer which has increased at an average annual rate of 5.2 per cent.
In females, the most frequent has been cervical cancer with an overrall trend of 1.8 per cent annually, although it was highest in 2006.
Prostate cancer is largely associated with age and its increase is closely attributed to poor medical-checkup culture and the current increase in life expectancy.
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