CANCER

A HYDRAHEADED FOE AND THE PLACE OF THE MINISTRY OF HEALTH AND WORLD HEALTH ORGANIZATION (WHO).

Presented at The Maiden Annual Symposium Of The Young Medical Laboratory Scientist Forum

By:

DR. CHIJIOKE OKE MANDAH

Outline:

• Introduction
• History
• Statistics
• Classification
• Predisposing factors (environment, sociocultural and diet).
• MANAGEMENT
• Clinical picture
• Detection
• Screening
• Diagnosis

• TREATMENT

-preventive measures

-surgery

- chemotherapy

-radiotherapy

-Gene typing/genomics

-Nutrition.

• Challenges
• Role of the Ministry of Health and World Health Organization (WHO)

What comes to mind when you hear the word "cancer"?

Cancer is a group of diseases involving abnormal cell multiplication with potential to spread to other parts of the body.

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• All cancers begin in cells, the body's basic unit of life.

The healthy body:

• The body is made up of many types of cells.
• These cells grow, divide (form new cells) and die inan orderly fashion.

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The body with cancer

• The cancer cell does not die, they multiply and continue to divide in a disorderly fashion, and may spread to other cells causing severe physical and functional damages. The cellular growth is uncontrollable.

History

• The earliest known descriptions of cancer appear in several scrolls from Ancient Egypt written around 1600 BC or even earlier.
• These scrolls contain descriptions of cancer, as well as procedure to remove breast tumors.
• The word hydra was coined after the monster - lernean hydra in Greek mythology.
• Hippocrates coined the term cancer. The Greek physician Galen described several kinds of cancer.

• Through the centuries it was discovered that cancer can occur anywhere in the body.

• Cancer is now a significant economic burden and the third leading cause of death globally.

Statistics

WHO – in 2020 stated that cancer was responsible for 78,800 deaths.

• In Nigeria, cancer leads to over 72,000 deaths per annum (most of which occurring in females than males). Breast and cervical cancer are responsible for most cancer deaths in Nigeria.
• Cancer can occur at any age but 67% of cancer deaths occur in the elderly.
• This number may increase given that about

102,000 new cases of cancer occur yearly.

• The incidence of cancer is increasing in most regionsof the world, but there are huge inequalities between developed and developing countries like Nigeria. This is mainly due to our poor health systems.

Classification:

This may be by:

A.) Site

B.) Histology

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A. Site:

Primary: Those that stay in their primary locationwithout invading other locations of the body.

Metastatic: Those that grow uncontrollably and spread locally and to distant locations. This spread may be via the bloodstream, the lymphatic system and invasion.

B. Histological Classification:

This is the international standard for the clarification and nomenclature for oncology.

There are six major categories:

1.) Carcinoma - these are malignant neoplasia of internal or

external linings of the body organs e.g. Ca. Cervix, breast.

2.) Sarcoma-originates from supportive tissues of the body

e.g. osteosarcoma, chondrosarcoma, leiomyosarcoma 3.) Myeloma - originates from the cells of the bone marrow. 4.) Leukaemia- liquid or blood cancer.

5.) Lymphoma- from glands or lymphatic cells e.g. spleen, tonsils, thymus.

6.) Mixed types- cuts across the various histological types e.g. adenosquamous carcinoma.

Suffices to say that further clarification exists for clinical and research purposes.

Cancer Risk Factors and the Interplay with Environment

• Environmental factors, whether linked to lifestyle issues such as smoking and diet or exposure to carcinogens in the air and water, as is our case with SOOT (resulting from oil bunkering that we are still contending with) is thought to be linked to an estimated 80% to 90% cancer cases,according to the National Cancer Institute.
• Occupational exposure-dye, rubber
• Chemicals
• Bacteria and parasitic infection

• Viral infection-HBV, HCV, HPV
• Poor quality diet
• Exposure to radiation
• Drugs -hormones, synthetics, antibiotics, antihypertensive etc.

Clinical Presentation

• Cancer presents in varying fashions; it could be generalized or localized (site of the tumor) symptoms.
• Generalized:
1. Weight loss
2. Heavy night sweat
3. Fatigue/malaise
4. Frequent infections (poor immunity)
5. Others.

• Localized:
1. Pain from compression at site.
2. Cough, dyspnea, hemoptysis, - lungs.
3. Jaundice, hepatomegaly, - liver.
4. Altered bowel habit, haematochexia, haematemesis,

- Intestines.

• Hyper/hypopigmentations, blisters, ulcers, lumps, -- skin.
• Neurological deficit, irrational behavior, depression, mania, - brain.
• Urinary dysfunction, hesitancy, urgency, incomplete

voiding haematuria, - Prostate.

8. Lumps, discharge, nipple retraction etc., - Btest.
9. Dyspareunia abnormal vagina discharge, post coital bleeds, -Cervix.

Detection

This has a lot to do with the individual, society and government.

Advances in technologies have made detection easier. First, quality information, self-awareness, quick and early

and informed intervention are key.

• Diagnosing cancer at its earliest stages often provides the best chance for a cure.

• Cancer screening:

Examples

• Self-examination (in breast cancer)
• PAP smear (in cervical cancer)

We are glad, a lot of NGOs, Social groups, and professional bodies are latching on the opportunities provided by early screening.

DIAGNOSIS

Good clinical history and physical examination are key.

• Physical exam:
• Your doctor may feel areas of your body for lumps that

may be pointer to cancer. During a physical exam, your doctor may look for abnormalities, such as changes in skin color or enlargement of organ(s), that may indicate the presence of cancer.

• Laboratory tests:

Simple Laboratory tests, such as urine and blood tests, may reveal a lot.

• Imaging tests:

Advances in diagnostic imaging are aiding quick and accurate diagnosis; from simple x-rays to Computerized Tomography (CT) scan, Magnetic Resonance Imaging (MRI), positron emission tomography (PET) scan, Ultrasound and Mamogram.

HISTOLOGY

This is the main stay in diagnosis.

• Biopsy: During a biopsy, your doctor collects samples of cells for various testing/cytology in the laboratory.
• Genetic Biomarker:

Samples are collected to look for genes, proteins,and other substances (called biomarkers or tumor markers) that can provide information about cancer.

TREATMENT

Surgery.

Has been the mainstay particularly for cure when applied early and correctly. Surgery is one of the oldest and most classical form of treatment.

• Used for both diagnosis and therapy.
• The removal of suspected neoplasm or portion of cancer cell is call biopsy.

RADIOTHERAPY:

• Very effective and can be used after surgery, alone or with chemotherapy.

It works by damaging the cancer cells, but can also affect normal cells.

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MARROW (STEM CELL) TRANSPLANT

• Treatment is achieved by transferring healthy cells from bone marrow or blood to restore body's ability to create new normal cells.
• Most often used in blood cancers.

IMMUNE THERAPY

• It is the stimulation of the body's own immune defense with immunoglobins, drugs/antibodies specific fortumor.

HORMONE THERAPY

• It's a method that helps to slow or stop the growth

of cancers that depend on specific hormones to thrive. By blocking these specific hormones.

CHEMOTHERAPY

• It is the use of chemotherapeutic agents to destroy cancer cells. This type of cancer treatment works by keeping cancer cells from growing, dividing, and making more

cells.

• Most useful for metastasis cases of cancer.

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Biological, targeted therapy/ Genomics.

This is relatively new. It takes advantage of recent technology and advances in the study of human genome (DNA)- Sequencing the DNA and the RNA cells and then comparing the normal with the cancerous ones with an aim to effect cure. There are still some hurdles to pass in this area.

Challenges

• Inadequate cancer treatment centers. Nigeria's population of about 218,807,378 million. It will require at above 170 cancer centers according the World Health Organization to take care of our cancer population.
• Nigeria currently has about 9 cancer centres, if you add the signature project of this administration- THE DR PETER ODILI CARDIOVASCULAR, CANCER AND RADIOTHERAPY CENTER that makes it TEN (10).
• Put together they provide at least 7,000 treatments a year in radiation and chemotherapy for cancer patients.

• 50% of cancer patients are indigent and may not be able to afford care. This in effect increases morbidity and mortality rate.
• Medical insurance in Nigeria does not cover cancercare comprehensively.
• Poor awareness on prevention, early detection and diagnosis for the general public.
• Shortage of healthcare workers.

This is a major problem. As at the last count over 500 Medical Consultants and about 1,000 of other doctors in all have left Nigeria in the last one year (2021-2022) in search

for better working conditions. This story may not be different for other health professionals. We hope it doesn’t get worst.

Role of Ministry of Health and WHO

The Ministry of Health and WHO need to do more in the areas of:

1.) Good policies on cancer management

2.) Develop workable standards, rules and regulations, human capacity and facility development as a matter of urgency.

3.) Budget adequately for health, Currently (4.2%). 4.) Fund research in our universities and healt related institutions.

5.) Develop a strategic frame work for cancer management.

6.) Create sufficient awareness.

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The WHO states that there are four key components to cancer control: cancer prevention, early detection,diagnosis and treatment and palliation.

• To develop targeted and effective anti-cancer initiatives and awareness in the region, patient behaviors and existing cancer-control and treatment resources must be better understood.
• Involvement of other stakeholders like the insurance sector to help reduce the relative high cost of cancer

treatment is key.

• Establishing adequate and prompt cancer screening in the primary healthcare centres for early detection should be gold standard.

THANK YOU