By CHIOMA OBINNA

Nigeria is facing a double burden of  infectious and chronic diseases. One of such dieseases is Cancer.

Today in Nigeria, cancer is seen as a death sentence. Before now, cancer is believed to be the disease of the white man but today, the whole story has taken another dimension as  the incidences of cancer is fast gaining ground among Nigerians. Presently, cancer is among the leading cause of deaths in Nigeria.  It is now obvious that the burden of cancer in Nigeria is appreciable.

In the last few years, so many prominent Nigerians have lost their lives to cancer, the latest is the  Managing Director / Chief Executive Officer of Guaranty Trust Bank, Mr. Tayo Aderinokun.

No one needs a soothsayer to tell that cancer and its destructive effects is very much in the country.

According to the World Health Organisation (WHO) there are an estimated 100,000 new cancer cases in the country annually,  although observers believe the figure could become as high as 500,000 new cases each year.

More worrisome is that experts have predicated that by 2020, the number of cancer patients in Nigeria is going to rise from 24 million to 42 million as speculated 21 years ago. It is also feared that by same 2020, death rates from cancer in Nigerian males and females may reach 72.7/100,000 and 76/100,000 respectively.

Cancer is a class of diseases in which a group of cells display uncontrolled growth, invasion that intrudes upon and destroys adjacent tissues, and sometimes metastasis, or spreading to other locations in the body via lymph or blood. There are various types of cancer, cervical, ovarian, breast, lung, cancer of the blood, and prostrate cancers, among others. However, the most common type of cancer in Nigeria today are breast cancer, cervical and ovarian.

There are two major causes of cancer;  environmental factor and others caused by hereditary genetic. Some of the common environmental factors leading to cancer as indicated  include: tobacco, bad dieting, especially calories,  infections, radiation, lack of physical activity, and environmental pollutants. These environmental factors, according to experts cause or enhance abnormalities in the genetic material of cells.

Although, cancer has been described as a killer disease, experts say when detected early, patients diagnosed with these cancers may be cured.Unfortunately, the health seeking behaviour of Nigerians has continued to hinder successful treatment of cancer.  According to the National Coodinator, National Cancer Prevention Programme (NCPP), Dr. Kin J- Egwuonwu,  cancer  is both preventable and curable and early detection can increase the number of survivors.

Unfortunately, when a Nigerian is diagnosed of cancer, his friends and relatives including the patient has concluded that the patient is marking time waiting for the D- day.

According to Egwuonwu, the situation in the country seems that the nation has surrendered to the cancer scourge.

Corroborating his views, the Permanent Secretary, Lagos State Ministry of Health, Dr Femi Olugbile, said cancer patients in Nigeria present their cases at the hospitals late.

According to him many of the patients present present their cases at late stages (stage four) and this he said, has made it more difficult to improve on successful cure rates in the country.

With a dismal public health infrastructure and late detection of the various cancers, critical observers say this has led to worrisome increase in mortality. The dilemma faced by cancer patients in this setting is further brought into sharp focus with the realisation that treatment of the disorder in this environment would require just 5 per cent of the life-saving cytotoxic drugs, which the manufacturers prefer to market in the richer nations which account for only 39 per cent of cancer cases.

Unfortunately, the WHO  2008 World Cancer Report says that only the adoption of healthy lifestyles by the populace, and concerted public health action could stem the tide. Except urgent action is taken, cancer rate is set to increase  more alarmingly.

In the views of Mrs Margaret Rose Adetutu Adeleke, Chairman of the Governing Council of NCCP,  one out of every 3 persons will have cancer in their life time and a total of 400,000 people are diagnosed in Nigeria annually.  She said WHO estimates that one third of all cancer cases can be prevented and another one third can be cured and the remaining can be managed. 

 But experts are worried that with a population of over 140 million people, there are fewer than 200 practicing oncologists and a handful of centres exclusively focused on cancer treatment and research, how would these one third be taken care of?.  To them, there is no doubt that cancer is a major health problem that requires urgent attention in Nigeria.

It is no longer news that cancer diagnosis and treatment leaves  much to be desired in the country.  Facilities, equipment and manpower are grossly inadequate in scope and spread.

According to a Professor of Anaesthesia, Olaitan Soyannwo, of the College of Medicine, University of Ibadan, bureaucratic bottlenecks  had continued to delay the importation and accessibility of cancer pain killer, Opioids.

Medical records indicate that cancer registration in the country officially began in 1960 but it was not until 1990 that a national headquarters of Cancer Registries was established in Ibadan.

Only very few hospitals operate screening programmes  for cervical cancer, even then, they are poorly funded, unsystematic, and incomprehensive. The country lacks an established national mammographic screening programme and available mammographic services are hard to come by.

Problems of impeded access to health care, ignorance, poverty and a general lack of coordination of issues of health education complicate matters. There are no definite figures, but the number of active radiotherapy centres across the federation are few and far between giving a ratio of roughly one machine to over 30 million people, as against the recommendation of one machine to 250,000 persons.

Worse still, the available spectrum of anti-cancer drugs is very limited and such drugs are not readily available. Imaging facilities for staging patients with cancer, such as computerized tomography (CT) and Magnetic Resonance Imaging (MRI), are difficult to come by, and when available the cost of such studies are prohibitive – putting them out of reach of the average citizen.

Even of more concern is the fact that clinical services for cancer are grossly inadequate and poorly distributed. Only a few centres have functioning radiotherapy equipment. Radiologic services are generally available, but access is seriously limited by high cost.

Essentially, complex diseases such as cancer are fast emerging as an important health care priority for the future.

In an interview, Professor Clement Adebamowo, a Professor of Surgery at the University of Ibadan,  during a cancer workshop in Abuja, said there is need to create greater awareness of cancer and improved access to health care although there is  increasing awareness of modern palliative care and pain management in Nigeria.
He said as much as cancer patients need care and love, cancer diseases can never be conquered nor quelled by emotions or wailing but can only be conquered by proper awareness and human will.

Overview of cancer
Cancer is a proliferation of cells whose unique trait-loss of normal controls-results in unregulated growth, lack of differentiation, local tissue invasion, and metastasis.

Cancer (malignancy) can develop in any tissue of any organ at any age. Most cancers are potentially curable if detected at an early stage. By performing self-examinations, patients can help recognise early signs of some possible malignancies. Diagnostic testing and therapy are essential for optimal results. When cure or reasonable palliation is likely, physicians must discuss all therapeutic options.

Diagnosis and Screening
A complete history and physical examination are prerequisites to early diagnosis. Physicians must be aware of predisposing factors and must specifically ask about familial cancer, environmental exposure, and prior illness (eg, autoimmune diseases, previous immunosuppressive therapy, AIDS).

The physical examination should direct particular attention to skin, lymph nodes, lungs, breasts, abdomen, and testes and to the prostate, rectal, and vaginal examinations.  Screening procedures that have decreased cancer mortality are the Papanicolaou (Pap) smear (cervical cancer) and breast self-examination and mammography (breast cancer).

Complications
Malignancy may lead to pain, wasting, neuropathy, nausea, anorexia, seizures, hypercalcemia, hyperuricemia, obstruction, and organ failure.  Cardiac tamponade often occurs precipitously. The most common causes are breast and lung cancer and lymphoma.

Pain in patients with metastatic cancer frequently results from bone metastases, nerve or plexus involvement, or pressure exerted by a tumour mass or effusion.

Paraneoplastic syndromes: The paraneoplastic syndromes may be a result of excessive or ectopic hormones synthesised by a tumour, immune complexes, ectopic receptor production, release of physiologically active compounds, or unknown causes.

Other miscellaneous paraneoplastic complications include fever, lactic acidosis (leukemia, lymphoma), hyperlipidemia (myeloma), and hypertrophic pulmonary osteoarthropathy (lung cancer or lung metastases from renal cancer, thymoma, sarcoma, and Hodgkin’s disease).

Prevention
Don’t use tobacco: Using any type of tobacco puts you on a collision course with cancer.

Eat a healthy diet: Although making healthy selections can’t guarantee cancer prevention, it may help reduce your risk. Consider these guidelines:  Eat plenty of fruits and vegetables.

Base your diet on fruits, vegetables and other foods from plant sources – such as whole grains and beans.

Limit fat. Eat lighter and leaner by choosing fewer high-fat foods, particularly those from animal sources.

 High-fat diets tend to be higher in calories and may increase the risk of overweight or obesity – which can, in turn, increase cancer risk.

 If you choose to drink alcohol, do so only in moderation. The risk of various types of cancer – including cancer of the breast, colon, lung, kidney and liver — increases with the amount of alcohol you drink and the length of time you have been drinking regularly.

Maintain a healthy weight and include physical activity in your daily routine. Maintaining a healthy weight may lower the risk of various types of cancer, including cancer of the breast, prostate, lung, colon and kidney.

Physical activity counts, too. In addition to helping you control your weight, physical activity on its own may lower the risk of breast cancer and colon cancer. As a general goal, include at least 30 minutes of physical activity in your daily routine — and if you can do more, it is even better. Try a fitness class, rediscover a favourite sport or meet a friend for daily brisk walks.

Cancer prevention: 7 tips to reduce your risk
Protect yourself from the sun:  Skin cancer is one of the most common kinds of cancer – and one of the most preventable. Try these tips:  Avoid midday sun. Stay out of the sun between 10 a.m. and 4 P.M. when the sun’s rays are strongest. 

 Stay in the shade. When you are outdoors, stay in the shade as much as possible. Sunglasses and a broad-rimmed hat help too.

Cover exposed areas. Wear tightly woven, loosefitting clothing that covers as much of your skin as possible.
Get immunised: Cancer prevention includes protection from certain viral infections.

Avoid risky behaviours: Avoid risky behaviours that can lead to infections that in turn, may increase the risk of cancer. For example: Practice safe sex.

Take early detection seriously:  Regular self-examination and professional screening for various types of cancers – such as cancer of the skin, colon, prostate, cervix and breast – can increase your chances of discovering cancer early, when treatment is most likely to be successful and affordable.