tag:theconversation.com,2011:/africa/topics/cancer-in-africa-35573/articlesCancer in Africa – The Conversation2017-02-02T14:27:00Ztag:theconversation.com,2011:article/722202017-02-02T14:27:00Z2017-02-02T14:27:00ZHodgkin’s lymphoma: an uncommon cancer that’s easily missed in Africa<figure><img src="https://images.theconversation.com/files/155468/original/image-20170203-13978-1nsa2tl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In the early stage of Hodgkin's Lymphoma the disease is curable in more than 90% of the cases</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>Hodgkin’s lymphoma is an uncommon cancer that targets the immune system. It starts off as a painless swelling in the neck, armpit or groin. The Conversation Africa’s health editor Joy Wanja Muraya asked Professor Nicholas Abinya to explain the disease, its stages of development and treatment.</em></p>
<p><strong>What is Hodgkin’s disease?</strong></p>
<p>Hodgkin’s disease, also known as Hodgkin’s lymphoma, is a type of cancer that affects a part of the immune system known as the <a href="http://www.cancerresearchuk.org/about-cancer/what-is-cancer/body-systems-and-cancer/the-lymphatic-system-and-cancer">lymphatic system</a>. It accounts for about 4% of <a href="https://seer.cancer.gov/statfacts/html/hodg.html">all cancerous growths</a>. But there are marked differences among communities and countries.</p>
<p>I have conducted a great deal of <a href="https://profiles.uonbi.ac.ke/nabinya/publications/othieno-abinya-na-abwao-ho-opiyo-njuguna-e-maina-jm-nyabola-lo-hodgkins-lymphom">my research</a> about cancer in Kenya. The incidence of Hodgkin’s lymphoma in the country is not known, but the <a href="http://afcrn.org/membership/membership-list/85-nairobi-kenya">Nairobi</a> and <a href="http://afcrn.org/membership/members/101-eldoret">Eldoret</a> cancer registries are beginning to shed some light on its prevalence.</p>
<p>The disease is more common in men with a ratio of about 4:3 noted in <a href="http://www.cancer.net/cancer-types/lymphoma-hodgkin/risk-factors">most reports</a>. But this varies between communities. <a href="https://www.ncbi.nlm.nih.gov/pubmed/16122093">A study</a> we carried out on Hodgkin’s disease at the Kenyatta National Hospital in the 1990s showed that there was a male to female ratio of 2:1 with 87% of the patients who were younger than 20.</p>
<p>The higher number of men with the disease compared to their female counterparts is <a href="http://onlinelibrary.wiley.com/doi/10.1002/1097-0142(19800701)46:1%3C186::AID-CNCR2820460131%3E3.0.CO;2-E/full">evident</a> in most black communities globally. But it’s interesting to note that its age of occurrence is known to have <a href="http://www.webmd.com/cancer/lymphoma/understanding-hodgkins-disease-basic-information">two peaks</a>; between the ages of 15 and 30 and between 50 and 70.</p>
<p><strong>What causes it?</strong></p>
<p>The cause of the disease is <a href="http://www.leukaemia.org.au/blood-cancers/lymphomas/hodgkin-lymphoma">largely unknown</a>, though certain conditions are known to put people at higher risk.</p>
<p>Reports from developed countries indicate that the main risks for developing it are family history and a previous infection by a virus known as <a href="http://www.uptodate.com/contents/the-role-of-epstein-barr-virus-in-hodgkin-lymphoma">Epstein-Barr Virus</a>. This belongs to the herpes family of viruses. Sadly, this kind of association of the virus with cancer may go undetected in developing countries where health research is not a priority.</p>
<p>Some observations in the US have suggested a link with <a href="https://books.google.co.ke/books?id=T3DSBwAAQBAJ&pg=PA88&lpg=PA88&dq=urban+affluence+and+hodgkin+lymphoma&source=bl&ots=9Xn4dnBjIu&sig=q-X87HUsBzF8rvutcHmJV6S4c5Q&hl=en&sa=X&redir_esc=y#v=onepage&q=urban%20affluence%20and%20hodgkin%20lymphoma&f=false">urban affluence</a> as opposed to a rural farming childhood influence. Survivors of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3875218/">atomic bomb explosions in Japan</a> during the Second World War reported more cases of Hodgkin disease than those who were far away from the explosions’ epicentre.</p>
<p>An unpublished study that we carried out in Kenya in the 1990’s suggested that this disease clustered in the country’s highland, high potential agricultural areas especially those that grow tea. This suggests that a virus – or a cancer causing chemical relating to tea or tea growing – may be responsible.</p>
<p><strong>What are the symptoms?</strong></p>
<p>Most patients will seek a doctor’s consultation with a <a href="http://www.cancer.net/cancer-types/lymphoma-hodgkin/symptoms-and-signs">painless, unbalanced, firm and discrete growth</a> of the lymph nodes on the neck. It can also occur in other places where lymph nodes are situated such as above the diaphragm. But it’s important to note that the disease is not restricted to lymph nodes and may involve other body organs.</p>
<p>Other non specific symptoms include fever, sweating – especially at night, itching, severe pain in one or more lymph node chains several minutes after drinking alcohol or non alcoholic beverages.</p>
<p><strong>How is the disease diagnosed?</strong></p>
<p>Choosing the most appropriate treatment depends on when it is diagnosed. Other factors that influence the outcome of treatment include a person’s gender, their age (specifically if they are over 40) and if they have anaemia at the time of diagnosis.</p>
<p>For <a href="http://www.cancer.net/cancer-types/lymphoma-hodgkin/diagnosis">diagnosis</a> a thorough physical examination is important. Laboratory tests are also important to measure the levels of red blood cells, white blood cells and platelets. Others are liver function tests, kidney function assessment and screening for hepatitis B and C viruses, and also HIV.</p>
<p>It may also be necessary to carry out a <a href="http://www.healthline.com/health/bone-marrow-biopsy">bone marrow biopsy</a>. This involves the removal and examination of marrow to see if the cancer has spread. X-rays and scans of the neck, chest, abdomen and the pelvis are also necessary because they may detect the diseased areas.</p>
<p>The most popular <a href="http://thehealthconnections.com/New-Cancer-Guide/cancers_view.php?editid1=Lymphomas+in+Adults">staging classification</a> for Hodgkin disease is the Cotswold’s modification of the Ann Arbor staging classification. Stage One: the disease is in a single lymph node region or a structure with lymph nodes like the spleen and other body parts. Stage two: two or more lymph nodes on the same side of the diaphragm are affected. It may also mean that cancer was found in one lymph node region as well as in a nearby non lymphoid organ. Stage three: lymph node regions or structures on both sides of the diaphragm are affected. Stage four: the cancer is found outside the lymph nodes and has spread to other parts of your body.</p>
<p>The disease is also further staged as A or B. When there are no symptoms, it is graded as A and when symptoms like fever, weight loss or drenching sweats are present, it is staged as B.</p>
<p><strong>What treatments are available?</strong></p>
<p>For years, poor quality equipment hampered effective treatment. The first evidence that it was responsive to <a href="http://www.lymphomainfo.net/hodgkins/timeline.html">nitrogen mustards</a> was in 1943 but the results were only published after the Second World War.</p>
<p>Today treatment depends on the stage the disease has reached. The main options are radiation and chemotherapy.</p>
<p>With the current treatment, the early stage of the disease is curable in more than 90% of <a href="https://www.cancer.org/cancer/hodgkin-lymphoma/detection-diagnosis-staging/survival-rates.html">cases</a>.</p>
<p>There are also emerging treatments in <a href="http://www.cancer.net/cancer-types/lymphoma-hodgkin/about-clinical-trials">clinical trials</a> that have shown impressive results in treating Hodgkin’s lymphoma.</p>
<p>It’s very important to note that if treatment is not planned and executed professionally, resistance develops and cure is impossible.</p>
<p><em>This is an edited version of a chapter in the book Drug management of haematologic neoplasms by Professor Nicholas Anthony Othieno-Abinya</em></p><img src="https://counter.theconversation.com/content/72220/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas A. Abinya receives research grants from Roche Pharmaceuticals and received research grants from International Network for Cancer Treatment and Research. He is affiliated with the Nairobi Hospital and is chairman of Cancer Research and Communications Organization.</span></em></p>The incidence of Hodgkin’s lymphoma in Kenya isn’t known, but new information is emerging to shed light on its prevalence.Nicholas A. Abinya, Professor of Medicine, section of Haematology and Oncology, University of NairobiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/719472017-01-31T15:52:58Z2017-01-31T15:52:58ZHow the landscape has changed in the search for a cure for breast cancer<figure><img src="https://images.theconversation.com/files/154957/original/image-20170131-13238-b00n65.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Advances in breast cancer research in the last decade has introduced new treatment regimes.</span> </figcaption></figure><p>Today nearly every women’s magazine carries articles on breast cancer. The month of <a href="http://www.who.int/cancer/events/breast_cancer_month/en/">October</a> – as the official breast cancer awareness month – brings thousands of people together for breast cancer walks, races, pink ribbon awareness luncheons, and educational seminars, all targeting the disease. </p>
<p>The goal is always to raise funds for <a href="https://www.bcrfcure.org/">research</a> and for better treatments and an eventual cure.</p>
<p>When I’m feeling down because a patient I have become close to has succumbed to this disease, I only need to visit the breast cancer Research Labs at <a href="http://www.hopkinsmedicine.org/research/centers.html">Johns Hopkins </a> in Baltimore in the US to feel hopeful for future patients.</p>
<p>I have been involved in cancer research for the last 12 years, specifically looking at <a href="https://www.researchgate.net/profile/Ronald_Wasike/citations?sorting=citationCount&page=1">advances in breast cancer treatment</a>. I have recently published a book – Breast cancer: what we all need to know – which is aimed at people diagnosed with breast cancer as part of an effort to help them and their families cope better.</p>
<p>Great <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860343/">progress</a> has been made in the fight against breast cancer over the last three decades. It’s important not to lose sight of these. </p>
<h2>Major developments</h2>
<p>There have been breakthroughs ranging from the diagnosis to the treatment including <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa020989#t=article">new surgical techniques</a> and drug combinations in the management of breast cancer in the last two decades.</p>
<p>These include</p>
<ul>
<li><p>Targeted therapy is being developed to increase survival odds for women with aggressive, difficult to <a href="http://www.breastcancer.org/treatment/targeted_therapies">control tumours</a>. These therapies block the growth and spread of cancer by interfering with specific molecules that encourage the growth and spread of the cancer.</p></li>
<li><p>Genetic testing is being made available for <a href="https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet">breast cancer genes</a> that predispose an individual to getting the disease. About 5% to 10% of the breast cancer in some women is due to changes in the structure of a number of genes that may run in <a href="http://ww5.komen.org/BreastCancer/GeneMutationsampGeneticTesting.html">generations of families</a> . This means that women from families where breast cancer has been diagnosed can be tested and preventive measures can be taken.</p></li>
<li><p>More clinical trials have been developed and completed showing benefits of specific chemotherapy agents and what combinations could be more <a href="http://ww5.komen.org/BreastCancer/TheChemotherapyDrugs.html">useful</a>. When drugs are developed and tested in laboratories and animals, the next stage is to test them on people with the disease under well controlled environment to gauge their efficacy and side effects before they are released.</p></li>
<li><p>Shortened radiation therapy <a href="https://www.ncbi.nlm.nih.gov/pubmed/24479632">techniques</a> have been developed. Instead of patients being placed under an external beam of radiation for 20 to 30 days, rods, beads or small balls containing radiation materials are inserted in the operation site for a few hours or days. This is done during operation for breast or prostate cancer.</p></li>
</ul>
<p>These are only a partial list of breakthroughs that have happened in a little more than a decade.</p>
<h2>More research underway</h2>
<p>In addition to these breakthroughs there are other treatments that are in their clinical trial stages. These include:</p>
<ul>
<li><p>Newer chemotherapy combinations that promise to improve breast cancer survival. They include newly developed anti cancer drugs that <a href="http://www.webmd.com/breast-cancer/features/new-treatments-for-breast-cancer">prevent tumour cells </a> from dividing further.</p></li>
<li><p>Breast <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192521/">conservation surgery</a> : previously a decision would have been made to remove a woman’s breast if she had a big tumour. But the aim is increasingly to remove the tumour without removing the breast. In addition, it’s often better to treat a patient with chemotherapy first to target possible circulating cancer cells and to help shrink the tumour before surgery.</p></li>
<li><p>The administration of chemotherapy directly into the ducts of the breast to destroy the source of the disease, and </p></li>
<li><p>a range of new hormonal therapies and vaccine therapies that are being tested.</p></li>
</ul>
<h2>A cure in our lifetime</h2>
<p>We are developing a better understanding of why and how breast cancer spreads recognising that if we could prevent it from ever spreading, frankly, no one would die of this disease.</p>
<p>In laboratories, petri dishes breast cancer cells are being studied to further understand what stimulates them to grow and thrive. There’s also exciting research looking at ways to prevent breast tissue from ever allowing cells to mutate into a breast cancer cell.</p>
<p>I am confident that in our lifetime we will have the opportunity to see this disease listed in medical books in the chapter under “cured diseases” where polio is listed today. Until then, I’ll be looking for you at future breast cancer events, proudly wearing your pink hat or T-shirt proclaiming that you are a breast cancer survivor.</p>
<p><em>This is an edited version of a chapter in the book Breast cancer: what we all need to know by Professor Ronald Wasike.</em></p><img src="https://counter.theconversation.com/content/71947/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ronald Wasike does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The chances of surviving breast cancer are improving everyday due to advanced research and new treatment techniques.Ronald Wasike, Professor & Consultant Breast Surgeon, Aga Khan University Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/717632017-01-30T15:18:03Z2017-01-30T15:18:03ZHow Africa can win the fight against childhood cancer<figure><img src="https://images.theconversation.com/files/154521/original/image-20170127-30419-13g2n8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Better technologies should be adopted in sub-Saharan Africa to deal with childhood cancer.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>World Cancer Day is celebrated globally on February 4 under the tag line “We Can. I Can”. Increased awareness and education about childhood cancers means that more lives are saved. The Conversation Africa’s Health and Medicine Editor Joy Wanja Muraya spoke to Jessie Githanga on the challenges of diagnosing and treating childhood cancer in Kenya.</em></p>
<p><strong>What are the top cancers in Kenya, regionally and in Africa? What are the most likely causes?</strong></p>
<p>In Kenya, accurate data about the most common forms of cancer is unavailable because the country doesn’t have an updated population based <a href="http://afcrn.org/membership/members/101-eldoret">cancer registry</a>. It therefore has to rely on regional registries that are largely <a href="http://afcrn.org/membership/membership-list/85-nairobi-kenya">hospital based</a>. Though not comprehensive, it’s nevertheless still useful as most patients with cancer will eventually go to a hospital where data will be collected. </p>
<p>The top <a href="http://www.ajhsjournal.or.ke/?p=1120">childhood cancers</a> are lymphoma (a form of cancer affecting the immune system), cancers of the blood (leukaemia), brain, eye, kidney and muscle cells.</p>
<p>Regional differences in the top cancers is seen in <a href="https://www.ncbi.nlm.nih.gov/pubmed/25724211">countries</a> like Mozambique, Uganda, Zambia and Malawi where childhood HIV/AIDS is more common. This leads to AIDS related cancers like Kaposi’s sarcoma (a cancer of the blood vessels) and certain types of lymphoma.</p>
<p>In countries with high rates of malaria infection, Burkitt’s lymphoma is the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207091/">most common childhood cancer</a>. It’s less common in the developed world where signs and symptoms differ.</p>
<p><strong>Are childhood cancers different from adult cancers?</strong></p>
<p>Adult cancers are strongly associated with lifestyle related <a href="https://www.cancer.org/cancer/cancer-in-children/risk-factors-and-causes.html">risk factors</a> like unhealthy eating, being overweight and obesity, lack of exercise as well as increased tobacco and alcohol use.</p>
<p><strong>Are children in Africa receiving appropriate treatment? What are the challenges on the continent?</strong></p>
<p>In developed countries a child diagnosed with cancer has an 80% <a href="http://www.gov.za/childhood-cancer-awareness-month-2015">chance</a> or more of surviving whereas the <a href="https://www.researchgate.net/publication/223957025_Challenge_of_pediatric_oncology_in_Africa">survival rate</a> of children in Africa is less than 20%. </p>
<p>The causes are many and interrelated. One is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849966/">late diagnosis</a> due to lack of awareness of cancer in children among guardians, health care workers and the general population coupled with poor access to treatment facilities.</p>
<p>There’s also inadequate diagnostic capability and a disturbing paucity of <a href="https://www.ncbi.nlm.nih.gov/pubmed/22475119">treatment facilities</a> especially those designed for childhood cancer in most sub Saharan African countries. </p>
<p>The prohibitive cost of chemotherapy drugs, few <a href="https://qz.com/692584/cancer-is-on-the-rise-in-africa-just-as-some-of-the-few-radiotherapy-centers-fall-apart/">radiotherapy facilities</a> as well as a lack of bone marrow transplantation technology, compounds the problem making treatment expensive. </p>
<p>The problem of insufficient health care workers trained in paediatric cancer, especially oncologists, pathologists, surgeons, nurses, pharmacists and palliative care experts needs urgent attention. </p>
<p><a href="https://www.karger.com/Article/Pdf/315586">Treatment protocols</a> are rarely standardised, evidence based or adapted for each developing country’s capacity. There’s little research into local childhood cancers and especially <a href="https://www.ncbi.nlm.nih.gov/pubmed/22844968">clinical trials </a>. This is a sorry state of affairs given that the best treatments in cancer are often in the context of a clinical trial. </p>
<p>Current evidence shows that even where the types of cancer may be similar to those in developed countries there are <a href="https://www.ncbi.nlm.nih.gov/pubmed/26274016">biological differences</a> that have a significant impact on the treatment choices and outcomes. </p>
<p>It’s therefore imperative that further research including clinical trials to identify suitable treatments are done to improve treatment outcomes.</p>
<p><strong>What is Kenya doing about the gaps?</strong></p>
<p>Kenya has now woken up to the fact that cancer is a serious problem. Even though most attention has been given to the common adult cancers, such as those of the male and female reproductive tracts (breast, cervical and prostatic cancers), more attention is now being paid to childhood cancers through efforts of the government, Non-Governmental Organisations, professional bodies and civil society. </p>
<p>Some of these initiatives include the collaborative efforts by the <a href="http://www.health.go.ke/">Ministry of Health</a> and the <a href="https://www.cancer.gov/">National Cancer Institute</a> in the US, Kenya Network of <a href="https://kenyacancernetwork.wordpress.com/kenya-cancer-facts">Cancer Organisations</a> , Kenya Hospices and <a href="http://kehpca.org">Palliative Care</a> Association, <a href="http://kesho-kenya.org/">Kenya Society for Haematology and Oncology</a> and various independent donors and well-wishers. </p>
<p>Groups specifically targeting children have been set up, like the <a href="http://wechope.org/kenya/contact-kecct/">Kenya Childhood Cancer Trust </a> and <a href="http://hope4cancerkids.org/">Hope for Cancer Kids</a>. Health care financing for all aspects of treatment of childhood cancers are now being considered by the <a href="http://www.nhif.or.ke/healthinsurance/">National Health Insurance Fund</a>. </p>
<p>Studies in public hospitals have shown that children with cancer who have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710438/">health insurance funding</a> have better chances of survival than those who don’t. While there’s still much to be done, these efforts will yield fruit with time. More coordination of the various stakeholders needs to be made to avoid duplication of efforts.</p>
<p><strong>What is the way forward for Africa in dealing with cancer?</strong></p>
<p>Advocacy and creating public awareness are key points if Africa is to move towards <a href="https://www.ncbi.nlm.nih.gov/pubmed/23434340">tackling childhood cancers</a>. </p>
<p>Holding international and national cancer awareness days should be coupled with continuous awareness efforts. </p>
<p><a href="http://www.cancercontrol.info/cc2016/world-child-cancer-supporting-partnership-models-in-paediatric-oncology/">Twinning programmes</a> linking centres in resource-rich countries with those in resource-limited ones have worked well in <a href="http://www.cancercontrol.info/cc2013/challinor/">Ethiopia</a> and <a href="https://www.worldchildcancer.org/blog/twinning-visit-ghana-%E2%80%93-may-2015">Ghana</a> to improve capacity and patient survival.</p>
<p><a href="http://www.nature.com/nrclinonc/journal/v10/n10/abs/nrclinonc.2013.137.html">Clinical trials</a> that can improve survival as well as enhance capacity need to be performed.</p>
<p>The International Society for Paediatric Oncology offers <a href="http://www.cancerpointe.com/">training information</a>. Training can be more cheaply offered in other African countries with established training programmes including <a href="http://www.choc.org.za/childhood-cancer/awareness-and-detection.html">South Africa</a>, <a href="http://egyptcancernetwork.org/achievements-5/fellowship-program/">Egypt</a> and <a href="http://aslanproject.org/what-we-do/our-programs/12-programs/28-pediatric-cancer-program-at-jimma-university.html">Ethiopia</a>. <a href="http://www.cancercontrol.info/cc2015/a-partnership-model-for-the-training-and-professional-development-of-health-care-staff-in-low-resource-settings/">Twinning</a> could also help <a href="https://www.worldchildcancer.org/blog/twinning-visit-ghana-%E2%80%93-may-2015">less well established programmes</a> in other African countries.</p><img src="https://counter.theconversation.com/content/71763/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessie N. Githanga does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Better technology to diagnose, treat and manage the disease early enough is needed to improve the survival rates of childhood cancer in sub Saharan Africa.Jessie N. Githanga, Prof, Haematology and blood transfusion, University of NairobiLicensed as Creative Commons – attribution, no derivatives.