8 October 2015

Uganda: Number of Cervical Cancer Victims Overwhelm Masaka Hospital

The reality throughout Uganda is that cancer cases have become a common health challenge many people have to worry about.

With cervical cancer being the commonest type in Uganda, medical studies have established that many victims have either succumbed or suffered from deadly infections at their homes, even when there would be higher chances of healing or prevention through medical attention.

Dr Herbert Kalema, a senior gynaecologist at the Masaka Regional Referral Hospital, who has attended to cervical cancer patients for more than a decade, says all sexually active women in their reproductive age are potential victims of the disease. He says the facility has the capacity to effectively attend to this type of cancer but only when it is detected in it's early stages.

Cervical cancer is acquired when a woman gets exposed to the Human Papilloma Virus (HPV), in her reproductive system particularly on the outer part of the cervix. As the infection spreads, it causes abnormal tissue growth and other changes to cells within the victim's cervix.

Dr Kalema explains that because the virus is sexually transmitted, many women can survive with it for years and if undetected, it eventually leads to conversion of normal cells on the surface of the cervix into cancerous cells.

In most cases, this type of cancer has few definite signs until it is in advanced stages.

"What we are doing is to encourage all women of reproductive age to turn up for our mass cervical cancer screening services such that they can know their status and seek appropriate treatment before it is too late," says Dr Kalema.

On the other hand, Dr Kalema adds that not all cancers are infection-related. He says some cancers such as breast, prostate and liver usually manifest at a younger age in Africans and progress faster compared to the Europeans . "It is believed to be a result of genetic differences, environmental differences and too many infections.

Given our environment, our immune system is damaged by infections such as malaria so we develop the cancer earlier ," he explains.

Cases registered

On average, records from Masaka Regional Referral hospital's maternity department indicate that 16 cervical cancer cases are registered per month and majority get there already in their late stages and the only option is to refer them to the Uganda Cancer Institute in Mulago, Kampala.

According to Dr Kalema, the cardinal signs one should get suspicious of are; foul vaginal discharge, constant bleeding that occurs during sex or bathing and after some time, the bleeding becomes spontaneous.

However, many victims tend to ignore these signs until the late stages when they start feeling abdominal pain, difficulty in passing urine or when they experience weight loss and general body weakness.

Dr Kalema says besides the regular massive cancer screening, universally offered at the hospital's department of antenatal, child health and gynaecology, other HIV/Aids healthcare service providers in the area also do screening and basic treatment at their facilities.

He explains that this type of cancer (cervical) has a close link to HIV/Aids and that infected mothers are more prone to it.

"The process of screening is a simple exercise the victims should not fear to undertake. It requires not more than five minutes and it is done by visual inspection and treatment is available at no cost in public health facilities," he affirms.

Treatment options

Once the cancer is detected early, the victim undergoes cryotherapy treatment that involves freezing all cancerous cells by the use of nitrous oxide gas that eventually kills the virus.

In his experience, Dr Kalema says the treatment is not painful and is bearable to the victims, thereby urging them not to hesitate in seeking the services once recommended to reduce on their chances of undergoing surgical operation.

Once the cervical cancer advances, patients are recommended to seek radiotherapy from the Uganda Cancer Institute in Mulago hospital.

But patients that have been there before claim the services are offered at a cost not less than Shs 300,000 per month.

However, due to financial constraints, several victims have often failed to get admission at Mulago, hence unknowingly standing higher chances of death deep in the villages.

Experts advise that having advanced cervical cancer does not automatically mark the end of one's life. "Doctors can opt to have the uterus removed to prevent the virus from spreading to other parts of the body," he says.

There is even an alternative to be enrolled on palliative care to contain the pain which comes along with the disease, on top of comprehensive counselling to patients.

Sister Ruth Nanyonga, a cervical cancer screening specialist in the department of antenatal, child health and gynaecology at Masaka Referral Hospital, says several victims even collapse on the floor after learning that they have cancer.

"We take time to counsel them such that they don't completely lose hope, and turn up for the recommended treatment. The same experience is cited whenever we go out for cancer screening outreaches around this area," she says.

Her medical advice to all women in the reproductive age group is to shun having multiple sexual partners, seek regular screening services even when they have not got the suspicious symptoms, explaining that men are the major carriers through sex.

"Men should as well be supportive of their wives in case they are diagnosed with this cancer," she urges.

Sister Nanyonga observes the need to increase cancer awareness to save more lives of the already committed and future mothers.

Expert reveals that being the commonest type in Uganda, cervical cancer is the leading killer cancer in the country followed by other types such as breast and prostrate cancer.

Among the other available cancer preventive modalities, Dr Kalema highlights immunisation given to girls between ages of 10 and 12 years, at a time when it is expected that they have not yet started having sex.

Although the approach is considered the best preventive alternative, the cancer vaccination service is not widely accessible across the country and in most places, it is offered at high cost.

Breast cancer

Detecting breast cancer usually involves the use of ultra sound CT scan, a mammogramm (x-ray of the breast) or a biopsy. There are four basic ways of treating breast cancer, and different cancers respond differently to these treatment options.

"Usually , the surgery involves removing the lump or cutting off the affected breast. This operation stops cancer cells from spreading to the rest of the body," says Dr Kalema.

After surgery, the wound is left to heal, and a month later, the patient starts chemotherapy. Chemotherapy is followed by radiotherapy. This is a process where the suspected cancerous area is exposed to radiations to kill the cancer cells. The number of exposures a patient goes through depends on the intensity of the cancer cells in the body.

Hormonal therapy

Another treatment for breast cancer is hormonal therapy, which blocks hormonal secretion. Hormonal therapy may be administered before or after radiotherapy. However, Dr Kalema says, some types of cancer may not respond to hormonal therapy. This is because the type of breast cancer common among most African women is aggressive and spreads faster to the rest of the body.

"After treatment, it takes about five years to declare a victim completely cured, and during this period , we examine them twice a year for any re-occurrence of cancer cells," adds.

Dr Kalema says more public awareness about cancers should be promoted and commended Daily Monitor for championing this cause through running stories on various types of the disease focusing on the causes, treatment, statistics and methods of prevention.

"This is the way to go and we pray that our media outlets borrow a leaf from Monitor and sustain this campaign throughout the year," he says.

Where to get treatment in Masaka area:

Services on cancer can only be accessed at the department of antenatal, child health and gynaecology at Masaka Referral Hospital, preferably when the disease is still in its early stages. Most of the cases are referred to Uganda Cancer Institute in Mulago hospital.


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