Edgar R. Batte
4 September 2008
column
On Monday, the country woke up to the news of the death of the Kyabazinga of Busoga Kingdom, Henry Wako Muloki.
At the age of 87, Uganda's longest surviving king succumbed to cancer of the oesophagus at Mulago Hospital Cancer Institute, after more than half a decade of being in and out of hospital over the terminal illness. Muloki has been admitted several times in Padova Hospital in Italy where he had undergone a throat operation.
Cancer of the oesophagus, Dr Henry Wabingira- the director of Kampala Cancer Registry says, is currently one of the commonest among cancer patients and continues to suffer poor facilitation.
The oesophagus is part of the body's digestive system, the tube which links the stomach to the mouth. Muscles in the oesophagus push food down into the stomach during the swallowing process and according to Dr Vincent Karuhanga, cancer of the oesophagus occurs when the cells lining the oesophagus change and turn cancerous. The cancer is common among men over 50 years of age and risk factors include old age, taking strong spirits like Waragi and smoking.
In tobacco users, Dr Karuhanga adds, this involves both smokers and those who chew the tobacco (commonly known as the kacama) and for the smokers, this could cause them throat damage or at worst-throat cancer. Cancer of the oesophagus is also frequent among obese people and those who lack minerals especially iron in one's diet.
Foods rich in iron include beef, green leafy vegetables like spinach, asparagus, broccoli and cabbage among others.
"These days, cancer of the oesophagus has also been linked to the human papillomavirus (HPV) which also causes cancer of the cervix. Oral sex can also play a role in perpetuating the cancer of the oesophagus," Dr Karuhanga adds.
According to bbc.com, if undiscovered, oesophageal cancer can spread to the stomach, lungs and liver, as well as nearby parts of the body's lymphatic system called lymph nodes. Unfortunately, it is also one of the more difficult cancers to treat.
Dr. Jackson Oryem, the director of Uganda Cancer Institute at Mulago, says the difficulty in treatment could be due to patients visiting hospital when the cancer is already in the advanced stages.
Professor David Cunningham, an expert in oesophageal and stomach cancers from the Royal Marsden Hospital in London adds, "Cancers higher up in the oesophagus may be associated with cigarette smoking and excessive drinking of alcohol."
The earlier symptoms, Dr Karuhanga adds, would be pain or having difficulties while swallowing food or voluntary vomiting of blood and food stuffs which has not been digested. Other signs could also include a bad cough (sometimes with blood) which shows that cancer has started spreading to the wind pipe.
"People above 50 who complain of difficulties in swallowing, ought to be screened. This can be done through direct viewing using a (lit) tube into the oesophagus to a remove a piece of meat cut the affected area (biopsy) which is taken to the laboratory for testing," Dr. Karuhanga explains.
On the other hand, the cancer could be avoided though avoiding strong alcohol, cutting out cigarette smoking of any form and living a healthier lifestyle with a balanced diet with particular interest in food rich in minerals as well as taking care when having oral sex.
However, the BBC cautions that early detection of oesophageal cancer is unlikely because smaller tumours produce fewer symptoms. In later cases, many of the treatments offered aim to extend life and relieve symptoms rather than cure.
Surgery is therefore a key option where often the tumour is removed, along with nearby lymph nodes and other tissues. The tube is then repaired so that the patient can comfortably swallow food.
Alternative on this procedure include using a section of the lower intestine to replace the removed part (biopsy), or to bypass a whole area of oesophagus if the tumour is too large.
Sometimes the main aim is to simply make sure the tube stays open by inserting a man-made tube inside it, bbc.com further elaborates, adding that some doctors will choose to use a dose of radiotherapy to shrink a tumour before operating.
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