Associate Consultant Radiation Oncologists from HCG Specialist Cancer Centre in India, Dr. Nagaraju Madhusudhan, who recently visited Nigeria, spoke of new methods of treating cancer, even as he blamed the high mortality rate of cancer in the country on poor awareness and obsolete methods and equipment. He spoke to Medinat Kanabe.
WHAT are the common cancers in Nigeria?
In Nigeria the most common cancer in women is breast cancer, followed by cervical cancer; but in men it is prostate cancer followed by colon cancer.
How much mortality from cancer do we record in Nigeria?
In Nigeria, the cancer patients we see are in worse case than patients from other countries. People here are not educated about the signs and symptoms of cancer. Even if they detect some lumps, they feel it is a normal lump, then they go to some quacks or they go for alternative or for some herbal medicines. In that process, they will lose some useful time. That is why there is a high mortality rate of cancer in Nigeria than other countries; so we need to create awareness to the people.
What are the symptoms of cancer?
Generally speaking, cancers do not have their own specific symptoms. Take for example the breast cancer, a lump can be cancerous or non cancerous. For any woman in the reproductive age group who has a breast lump, it has to be examined by a physician. It could be cancerous or non cancerous. It is very difficult for the woman herself to say it is cancerous or non cancerous. We are to consider many factors- age of the patient, previous family history of cancer and many other factors, which are very important in deciding whether a lump is cancerous or non cancerous. Any newly detected lump in the breast has to be evaluated properly and then the symptoms include a fever, weight loss, continuous sweating for prolonged duration of about three to four weeks, which the doctors are unable to diagnose.
Then there are blood cancers like the leukaemia and lymphoma. When it comes to the brain, you should consider headache of recent onset that is increasing even after you take the normal tablets.
When it comes to lung cancer, we have those with smoking history and those without smoking history. Not all smokers will have lung cancer and lung cancer is not always because of smoking. About 20 per cent of those down with lung cancer don’t smoke. It affects females who never smoked too. So we should have a high suspicion of patients with chronic cough, weight loss, cough for more than six weeks duration and not responding to normal antibiotic s and other drugs.
How is cancer detected?
It is very difficult to detect it through an x-ray in the early stages, even if you want to do a screening for a lung cancer it can’t be done on just x-rays. Screening means we have to detect a tumour in the earliest stage to get a benefit of detecting it out. Test x-ray is done to detect a cancer when the cancer is at a considerable size. You can’t take a test x-ray as a screening modality. If you want to do a screening for lung cancer, you have to do a CT scan, which doesn’t have any side effects or cause harms to the body.
So there should be a screening programme in Nigeria. Since in Nigeria breast cancer is the number one cause of death and number one cancer among the women, we should have a high suspicion of breast cancer when a new woman comes in with a breast lump. Before the age of 40, patients have to do self breast examination and once in a year, the women have to get checked by a physician. Those with family history of cancer have to start the check-up 10 years before their family members who had cancer were discovered.
Although mammogramers advise age of 45, but I adopted 40 because in countries like India, US and UK where they use 45, they don’t have a high rate of breast cancer like Nigeria..
For cervical cancer, once the women start sexual activities at say 21 years, they should get screened once in 2 to 3 years until the age of 35.
How is it treated?
Once we diagnose that a patient is having cancer, we evaluate properly. For example if it is breast cancer, we don’t just start treatment for the patient when we find it out. First we evaluate properly, do some molecular analysis on her. Find out what types of molecular defects are there in the body because for the breast cancer, it is not just diagnosis to show that there is a cancer in the body but a need to see the hormone status. There are many factors we need to consider before we start a chemotherapy or a surgery.
We also need to consider the stage of the cancer. For proper staging, a whole body CT scan is required but at present this scanning is not available in the whole of Africa except in South Africa because it is a little bit costly. Without doing a proper staging and evaluation, we can’t just start chemotherapy, surgery or any other thing. Supposing the patient is having Metastasis to the bone or liver? The chemotherapy will make it increase and we would have lost too much time before we realise this.
In cases where we feel the tumour is advanced and metastised, we start with the chemotherapy fast. We try to shrink the tumour, kill the too much cells in the blood and then give chemotherapy and radiation. If after staging we feel that it is very localised to the tumour, we have to do surgery and chemotherapy first and then we have to do something else.
Ways of treating cancer includes surgery, chemotherapy and radiation. Surgery is like removing the tumour; radiation includes doing x-rays while chemotherapy is use of injections and tablets. In the chemotherapy we have new treatments targeted at biological tracks. You can call it biological tracts. These biological tracts specifically target the tumour cells. They have very less effect on the normal cells because the chemotherapy usually don’t only affect the tumour cells but the other cells in our body unlike this one that acts on the tumours cells alone and have very little side effects.
Even in radiation therapy we are not practising the old aged methods anymore. The problem in Nigeria is that we are still using the 1950’s Cobalt machine; even if the linear accelerators machine is available it is not in working condition anywhere and we have all gone beyond the Cobalt and the Linear accelerator machines.
We now have three dimensional therapy, Image guided radiation therapy, intensity modulated radiation therapy, tumour therapy radiation, cybernet radio sensory. So there are many things that have come up in the new technological advancement in radiation. Even though radiation is same from 1900, the way we give it is now different. Just like the chemotherapy that is targeted at the tumour cells, the radiation is also targeted at avoiding toxicity to the normal cells. We are giving treatment only to the cells where it is necessary. But we are lacking these machines in Nigeria.
When it comes to the breast surgery, people in Nigeria still practise the removal of the whole breast, but this is no longer required except in very few instances where it has totally invaded the breast tissues and there is nothing you can do. What you should do is give chemotherapy, shrink and remove only the tumour. Or remove only tumour and give radiation. That is as good as removing the whole breast.
If you remove a woman’s breast she becomes depressed and loses her social life. Removing the entire breast is no longer necesary even in stage 4 tumour.
Same for the colon or erectile cancers; try to give some treatment first, shrink the tumour, remove the tumour and save the anus.
Who is at risk of having cancer?
It is very difficult to say that some agent can cause this type of cancer. There are multiple factors that work synegically to cause cancer. There are risk factors though. For example, a woman who has not breastfed, or a woman who has never had children and a woman with a long menstrual period and late menopause has a high risk of developing breast cancer because the patient breast is exposed to more amount of estrogen than progesterone. But it doesn’t mean that definitely a person with all these factors will have breast cancer.
We say living sedentary life, eating too much of red meat, eating less vegetables, eating saturated foods or roasted foods or fried food are high risk factors for cancer but it also doesn’t mean that they will (automatically) have cancer.
What advice do you have for Nigerians?
We have to modify our diet and lifestyle. The government in partnership with the private sector should create awareness for the public because they need to know how to detect a cancer. They should avoid going to the quacks because they will be delaying treatment which will give room for the tumour to spread and become very difficult to treat. Our doctors also should be educated about the new treatments and machines available in other parts of the world. Cancer is not like typhoid or malaria where you get a second chance at treating it. It will spread and the patient’s life will be in danger.
