The laborious whirring of tired life support machines in the ward annoyingly signified the importance of life to us. We had learnt to measure time from the beep of the heart rate monitor and the incessant drip of chemo from a suspended IV bag into the plastic tubing connected to her hand. The unending smell of hospital detergent filled our lungs, while our minds wrestled with an unending stream of philosophical questions on life and death. The pale patient lay unconscious on the crisp, unruffled hospital bed, a frightening face of exhaustion reflecting the fight going on within her blood vessels.
We all remembered vividly the gratuitous celebration held in pomp and splendor for family, friends and foes alike to rejoice the remission of leukemia after six months of treatment. Now, the uninflected voice of the dutiful doctor who had warned us of the possibility of recurrence boomed back to me, painfully bringing me to terms with the disease. After only two months, the leukemia cells were back, baying for blood cells and ready to finish what they had begun. As if a replication of my thoughts, the eyes of my siblings in the room painted a pit of deep, dark despair, where any and all optimism could only be regarded with equal caution.
When my friend told me of his worries on cancer, I slightly grasped what we are facing. ‘’Nature has a way to regulate itself, a system to contain only what it can handle. In the barbaric times, war deaths, polio and plagues were there. Then came smallpox, malaria and HIV. I think this time it’s cancer.’’ Cancer is now ripping lives apart, a torturous silent killer, greedily eating away society. For this series, I will risk diving into a few of the big biochemistry books of my college classes, gracious Google and professional opinion to cover causes, risk factors, diagnosis and treatment of cancer, especially in Kenya.
Causes and Risk Factors
Cancer and Genetics
Genetic disorders may be inherited from parents. When expressed in childhood, diseases such as Down’s syndrome, Turners and sickle-cell anemia may result. These are due to gene and chromosomal problems in parents and older generations. However, during our growth and development, a lot of genomic replication takes place, exposing our genes to mutations. Mutations in the genetic makeup may lead to defects in cells of any part of the body. These defects may result in direct illnesses, especially if they affect critical body systems. Such mutations may however remain in the cells, potent but not expressed to affect us.
Spontaneous mutations may also occur during daily growth and multiplication of cells, presenting new conditions to the body. Therefore, it is theoretically possible to live with a potential disease.
Rather than causes, cancer can best be understood through trigger factors. Exposure to radiation, carcinogenic chemicals, excess hormones, smoking and even lack of exercise may trigger normally hidden mutations to be expressed. For cancer, the mutation makes the cells immortal. And you thought immortal was good!
All normal cells die through the process called apoptosis (controlled cell death). Cancer cells don’t and continuously replicate fast, invading the surrounding tissue and resulting in a tumor- except in leukemia. Some small tumors are however benign- not spreading beyond a few cells and mostly inconsequential. Malignant tumors are very hungry, so to say. The cells of the tumor need to replicate fast, spreading to neighboring cells, tissue and even blood vessels to acquire more nutrients to fuel their growth. They may produce signals and enzymes that encourage the blood vessels to grow into the tumor to supply more nutrients, a process called angiogenesis. If not enough, the cells may translocate to other parts of the body in their quest for growth, medically called metastasis.
Diagnosis and Epidemiology
Cancer screening uses targeting to detect tumor cells in the body. X-rays and biopsies are often used to diagnose cancerous cells and determine whether they are malignant. In Kenya, 70-80% of cancer cells are diagnosed late due to lack of awareness and resources which make it even harder to treat. High costs of treatment have orchestrated unchecked growth of this malevolent monster, as I am sure you have- or are- attending a fundraiser for cancer treatment.
More than 100 types of cancers exist, depending on the part of the body affected. In men, cancer of the prostate gland is the most common, followed by lung cancer and colo-rectal cancer. For women, breast cancer leads the list, followed by cervical, colorectal and cancer of the uterus in that order. In children, leukemia, lymphoma and brain tumors are common.
The mode of treatment adopted depends on the progression of the disease between stage I to IV, although it generally involves killing or removing the cancerous cells. When discovered in early stages, surgery is often the best option, where the cancer cells and neighboring are removed before they spread. Radiation therapy uses high energy radiation to kill the cancer cells. Derivatives such as radio-immunotherapy uses special targeting mechanisms to identify and destroy cancer cells. Chemotherapy uses a mixture of chemicals that target fast growing cells in the body. Due to poor specificity, the treatment kills cancer cells, hair, nails and other fast growing cells. Most times, oncologists suggest a mixture of these treatment options for higher success rates.
Cancer centers and Palliative care in Kenya- Where we are.
There are about eight cancer treatment centers in Kenya, seven of them in Nairobi. Only Kenyatta National Hospital is fully equipped to deal with patients, with three radiotherapy machines, serving up to 200 patients a day. One patient may require up to 30 sessions in early stages, a capacity that KNH cannot handle. Several county hospitals have minor chemotherapy equipment, with no major equipment for cancer care- only plans.
Private hospitals; Nairobi hospital, MP Shah, Aga Khan and Karen Hospital together with dedicated cancer clinics such as Texas and Beacon, all in Nairobi also offer cancer care, albeit at very high costs. More on these here.
Cancer and lifestyle- Where we are headed.
While there have been efforts to declare cancer a national disaster, and honestly there’s more debate on the issue, managing it goes beyond planning to proper execution. Our health policy needs to be seriously reviewed- from funding, to health insurance and even medical ethics.
We all have a responsibility, first, to review lifestyle practices that may expose us to the numerous trigger factors. Avoiding direct contact with chemicals, touching and inhaling is important. Asbestos has been banned in Kenya but is still in use, so it is vital to confirm we don’t drink water collected from asbestos roofing. On food, we should check our diets- as a country we need to review the sourcing of our food. What drugs are used in growing fruits and vegetables and rearing animals, especially in large scale. We need as a country to determine what are acceptable chemical residue levels in meats and vegetables in the market. If you can afford to grow your food, now would be the time to start and organic farming would be the way to go.
All of us have an obligation to take care of our bodies- get healthy and exercise more. Check-ups are vital in preventing cancer and self-inspection is the first stage. Check for lumps in the body or any abnormal developments health wise- they may reflect deeper problems. Also, we have a duty to spread awareness in our communities. For us at Swimaholics, this post is our small step to greater wins in raising cancer awareness. What will yours be?