Hello

Your subscription is almost coming to an end. Don’t miss out on the great content on Nation.Africa

Ready to continue your informative journey with us?

Hello

Your premium access has ended, but the best of Nation.Africa is still within reach. Renew now to unlock exclusive stories and in-depth features.

Reclaim your full access. Click below to renew.

Stomach cancer on the rise in Western Uganda

Dr Noleb Mugisha, the in-charge of the National Cancer Control Planning

What you need to know:

  • For many people, due to late diagnosis and commencement of treatment, cancer detection is a death sentence.
  • A recently published population-based survey shows that stomach cancers and ovarian cancer are on the rise, as are lifestyle cancers.
  • Tomorrow, as Uganda joins the rest of the world to commemorate World Cancer Day, Gillian Nantume and Beatrice Nakibuuka bring you this report on Uganda’s cancer profile. 

In 2020, while the world was grappling with the devastating Covid-19 pandemic, Deus Sebarenzi was diagnosed with stomach cancer. His son, Joseph Mugisha, narrates his father’s ordeal.

“There was a time when he had a burning pain in his stomach, which increased whenever he had a meal. At first, we thought it was indigestion. Then, we thought he had a case of terrible ulcers,” he says.

When the two visited a hospital, the doctors did some tests that confirmed that his father had ulcers. He was put on treatment but after a few months, the pain in his stomach worsened. 

“When we returned to the hospital, we were told that he had appendicitis. The doctors even suggested that they should operate on him, but a friend advised us to request a biopsy to rule out cancer. By this time, my father had lost so much weight because he could not stand the pain he had to endure whenever he ate food,” Mugisha adds.

After the biopsy, Sebarenzi was diagnosed with stage three stomach cancer. He underwent chemotherapy and treatment for 18 months. He died in 2023. 

According to The regional cancer spectrum in Uganda: a population-based cancer survey by sub-regions, published last year in ecancermedicalscience, an open-access cancer journal focused on under-resourced communities, stomach cancer is emerging among the most common cancers in both males and females in the Kigezi and Ankole sub-regions.

The population-based survey was conducted to assess the burden of cancer in all the sub-regions of Uganda by site, sex, and age group to accurately determine the cancer profile of Uganda for a tailored intervention to mitigate cancer risk factors and burden.  

In Mbarara district, stomach cancer is also more common than in all other districts in the region. Dr Noleb Mugisha, the in-charge of the National Cancer Control Planning and the head of the Comprehensive Community Cancer Program (CCCP) at the Uganda Cancer Institute (UCI), says the gastrointestinal malignancy in the region could be associated with the prevalent diet. 

“One of the reasons we think stomach cancer is common in the west is that they use a lot of rock salt. They use when preparing bean sauce and eshabwe, both of which are favourite foods in the region, and other foods. That rock salt is not purified and therefore, contains many heavy metals,” he says. 

Rock salt is also known as raw lake salt. In the local language, it is called kihonde, mahonde or ekisula. Kihonde is one of the important ingredients when making eshabwe (white ghee sauce). It is also used in cooking beans to make them soften quickly.   

Dr Mugisha adds that another reason for the prevalence of stomach cancer in the region could be the distribution of Helicobacter pylori, a bacteria. 

“H. pylori causes ulceration in the stomach. When someone has ulcers for a long time, they will eventually develop stomach cancers. However, many of the results of the study need further investigation. Like for instance, why is skin cancer common in mountainous areas?” he asks.

Uganda's cancer registration coverage status is 11.90 percent and is not uniformly distributed in all regions of the country. However, the study found that in the Rwenzori, Kigezi, and Bugisu regions, there seems to be an increased risk of developing skin cancers in females, while stomach cancers have been reported in both males and females.

The study also shows that the average crude cancer incidence rate in all the sub-regions is 35.4 per 100,000, with the central region having the highest cancer incidence at 63.8 and Karamoja having the least at 12.8. Overall, the top five high cancer burden districts by crude cancer incidence rates are Kampala at 86.6, Gulu at 73.6, Kabale at 68.1, Iganga at 62.2, and Bushenyi at 56.0 cancer cases for every 100,000 people.

“Cancer is high in Kampala because it is a capital city that hosts a high population and also, there are many hospitals in Kampala. So many people who have cancer are more likely to come here for treatment. The other reason that could account for the high numbers, though, is that environmental risk factors for cancer are likely to be higher in cities than in rural areas,” Dr Mugisha explains. 

These risk factors include exposure to chemicals, pollutants, and radiation. The chemicals could include asbestos, drinking waters with high levels of arsenic, and pesticides. Others include air pollution, industrial waste, diesel exhaust fumes, and tobacco smoke. 

The districts with the lowest cancer burden are Sironko at 13.5, Bundibugyo at 13.4, Arua at 12.8, Kanungu at 10.5, and Kole at 10.2 cancer cases per 100,000 inhabitants.

Women carrying cancer burden
At the time of her death, Christine Nalubwama was 58 years old. In 2021, the resident of Namayumba town in Wakiso District experienced vaginal bleeding, six years after commencing menopause.

For a long time, she did not tell anyone about her condition, but when the bleeding changed to a brown smelly discharge, she informed her sister. She also had a poor appetite and was bloating. Capitallina Nanyanzi, who is a breast cancer survivor and Nalubwama’s neighbour, was informed of her condition.

“Her sister had advised her to go to the hospital but she refused. For over a year, Nalubwama isolated herself for fear that people would stigmatise her due to the stench coming out of her. I advised her to go for cancer screening so that she can access treatment,” she says.

Nalubwama was diagnosed with stage 3B ovarian cancer at UCI. The doctors said her cancer was at a late stage but they would try to treat her. She was started on radiotherapy and when she was told that her entire uterus would be removed, she stopped the treatment for several months.

“I looked for Nalubwama again and encouraged her to meet with some cancer survivors at the Uganda Women's Cancer Support Organisation (UWOCASO). These women had had their breasts or uteruses removed. After listening to their experiences, she agreed to have her uterus removed,” Nanyanzi says.

Nalubwama was then started on chemotherapy and completed it. However, after six months, she had a relapse. 

“She lost hope and no matter how much I encouraged her to go back to UCI for more chemotherapy, she refused. We lost her in December 2024,” Nanyanzi laments.

In the study, it emerged that a total of 25,576 cancer cases were registered. Of these, 14,322 (56 percent) were female while male cancers were 11,254 (44 percent). 

The top five female cancers in all the sub-regions included cervical cancer (43 percent), breast cancer (22 percent), esophagus (5.6 percent), ovary (5.2 percent), Kaposi sarcoma (4.7 percent), and other less common cancers (18.5 percent). 

“Cancer is more prevalent in women because the commonest cancers in Uganda are cancers that affect females. For instance, the top most cancer is cervical cancer, which accounts for over 20 percent of all cancers in the country. Breast cancer, which is the third most common cancer in Uganda, is 100 times more common in women than in men,” Dr Mugisha explains.  

In males, the top five cancers included prostate cancer 25.1 (percent), esophagus 15.1 (percent), Kaposi sarcoma (12.4 percent), liver (percent), stomach 4.8 (percent), and other less common male cancers accounting for 33.8 (percent). These results show that wherever there are cancer patients, the majority are likely to be women. 

Pauline Ofong, a retired civil servant and mother of five, was first misdiagnosed with ovarian cancer in 2013. At the time, she was experiencing persistent stomach upsets, bloating, and constipation. Despite seeking medical help from various clinics in Kampala, her condition was wrongly attributed to bacterial infections and stomach worms. 

“It was not until further tests were conducted and a suspicious mass detected in my abdomen, that the possibility of ovarian cancer surfaced. A gynaecologist at Kibuli Muslim Hospital recommended urgent surgery and the mass was removed. However, the condition could not be confirmed so I was advised to seek further tests abroad,” she says.

Ofong traveled to India and was checked into BLK-Max Super Specialist Hospital in New Delhi. She underwent a PET/CT scan, which confirmed that she had stage-three ovarian cancer. Despite her fear and uncertainty, she received counseling to prepare for an intensive treatment plan involving chemotherapy and surgery to remove her ovaries.

“I was terrified of the word ‘cancer’ because I had seen so many people suffer and die from it. However, I persevered through six cycles of chemotherapy. I lost my hair in the process. Then, I underwent a grueling nine-hour surgery to remove my ovaries in November 2013,” Ofong recalls.

After completing her initial treatment and receiving hopeful results in 2014, Ofong returned to Uganda. However, her optimism was short-lived for in February 2015, she experienced a relapse, marked by abdominal bloating, back pain, and fluid accumulation. Once again, she underwent chemotherapy at the UCI.

According to the study, ovarian cancer has emerged as one of the most common female cancers in all subregions of Uganda, except for Ankole, Rwenzori, Busoga and Karamoja. It was noted that ovarian cancers were among the top five cancers in the Central and Mid-Northern regions.  

“Cancer of the ovary is highly associated with unbalanced estrogen. Usually, when a woman is pregnant, her estrogen levels are low, because her body has taken a break from producing the hormone. But when she does not conceive, the estrogen levels are high,” Dr Mugisha says.

Some lifestyle factors can increase the risk of developing the disease, such as obesity, smoking, diet, and exposure to pesticides and herbicides. The current trend of women having their first child later in life is also a risk factor.

“Many women nowadays take a long time to have their first child. This means they have a longer period of their lifetime where they have high levels of estrogen in their blood. That increases their risk for ovarian and breast cancers. Actually, if a woman has her first child after the age of 40, their risk of both cancers is higher than if she had their first child below the age of 30,” Dr Mugisha explains.

Lifestyle cancers on the rise
Last year, Mary Tusiime, a 45-year-old farmer, began feeling fatigued and noticed unusual swelling in her abdomen. Initially attributing her symptoms to exhaustion from working in the fields, Tusiime did not immediately seek medical attention.

A few months later, she developed abdominal pain. The condition was accompanied by the yellowing of the eyes and the passing of dark urine. When she went to the hospital, she was diagnosed with Hepatitis B. 

“I started treatment but my condition did not improve. When I went back to the hospital for a drug refill, the doctor recommended a liver function test and then a biopsy. The results showed that I have liver cancer,” Tusiime says.

Cancers of the esophagus and liver are common in both males and females in Uganda, but males have a higher proportion than their female counterparts. Esophageal and liver cancers are associated with tobacco use and consumption of harmful alcohol.

“Liver cancer is highly associated with Hepatitis B infection, which we are now immunising our children against. With time, we should have that risk factor under control. However, Uganda has one of the highest per capita consumption of alcohol. So even if we vaccinate against Hepatitis B we cannot significantly reduce the risk of liver cancer if we still have high levels of alcohol consumption,” Dr Mugisha advises.          

Cancer of the esophagus is more associated with tobacco consumption, as the youth are increasingly being lured into the vice. By 2020, about 806,272 adult men were smokers compared to 141,458 adult women.       

“The tobacco industry is coming up with creative ways of packaging their products that even when you think you are not smoking, you are smoking,” Dr Mugisha says.

The cancer burden
No study has been carried out to determine the financial burden of cancer on the country. However, in Uganda, non-communicable diseases (NCDs) account for 33 percent of mortalities every year and cancers contribute about one-third (9 percent) of these deaths. 

Ofong’s experience at UCI was that although the institute was supportive, patients faced overcrowded conditions, limited resources, and long waits to access health workers or treatment. 

“However, I credit my survival to the unwavering support of my family and friends, the dedication of the doctors at UCI, and the dietary changes I had to make. I now avoid red meat and most dairy products, focusing on vegetables and natural remedies. I have accepted to live with cancer and I am hoping to outlive it. I also hope a cure will be found someday,” she says.

Dr Mugisha appeals to the public to embrace cancer screening even when they are not feeling sick because cancer is on the rise in Uganda due to the lifestyle changes people have taken on.

“The big risk for cancer is a sedentary lifestyle. People are not doing physical exercises. However, cancer treatment has improved dramatically. We can now treat and cure many cancers without the patient going abroad. For men, with early diagnosis, we can treat prostate cancer without surgery. And, we can preserve a man’s sexual function up to 85 percent,” he says. 

According to the study, cancer-related mortalities and survival at Uganda Cancer Institute are 80 percent and 20 percent, respectively. Statistics on cancers in 2020 indicate that over 34,008 new cancers and 22,992 deaths were estimated using the Kampala and Gulu population-based cancer registries.

Utility 
The study found that the proportion of childhood cancers is higher in male children compared to female children at a ratio of 1.3:1. In children, the top three cancers included lymphoma, 33.9 (percent); soft tissue sarcomas, 20.8 (percent); malignant bone tumors 15.8 (percent); myeloid-type leukemia, 13.8 (percent); other less common childhood cancers combined 15.7 (percent). 

“For anyone to suffer from cancer, there must be a genetic error that has led to the cell becoming a cancer cell. A boy child has an X and Y chromosome. The X chromosome has more genes than the Y chromosome. Girls have two X chromosomes, so when one gene has a problem, the normal gene will outbalance it. But if you have only one X gene (as boys do) and it has an error, there is no opportunity for outbalancing that error,” Dr Mugisha explains.

In 2022, the crude cancer incidence rates in Uganda were 74.30, Kenya 79.60, and Tanzania 71.0 per 100,000. The crude incidence rates of male cancers in East Africa are 57.6 in Tanzania, 58.5 in Kenya, and 64.7 per 100,000 in Uganda. The crude incidence rates of female cancers range from 84.4 in Tanzania, 100.3 in Kenya, and 83.4 per 100, 000 in Uganda).