Cancer: Ever-increasing dread in Ghana

The fourth of February is World Cancer Day.

It is a day set aside to remind us of the untold suffering unleashed by this dreadful disease which has become prominent in our morbidity and mortality statistics in Ghana.

Nobody is exempt from this disease.

What is Cancer?

It is a disease caused by an uncontrolled division of abnormal cells in a part of the body that competes with it for nutrients and energy resources; depriving the body of the much-needed sustenance. 

It can occur in any part of the body and once it gains root can expand and cause a mass or growth and move through the lymphatic into local and regional lymph nodes or through the bloodstream to distant parts.

The commonest sites in Ghana are females: breast, cervix, ovary and uterus; males: prostate, liver, stomach and rectum.

Children: Embryonal germ cells and blood cells.

The embryo arises from the union of the egg and sperm which ultimately leads to the formation of all parts of the body.

No age or site is exempt but the older one gets, the more likelier it is to have cancer.

Causes

The direct causes of cancer(s) are unknown and why A gets it and not B remains unclear, but there are common associations that make cancers more likely.

Recent evidence points to the role of what has been described as endocrine disruptors; chemicals in hair straightening creams used by people of African origin to straighten the kinky hair.

It is used often, even in children, and cumulatively adds up to disrupt the normal functioning of the female hormones. 

We have known for years that female cancers in Ghana occur 10-15 years earlier than their Caucasian or white counterparts.

Our ladies go to salons several times more than the Whites and use enhanced strength chemicals to get the desired results of straight hair.

Some viruses and bacteria can also lead to cancer. 

Human Papillomaviruses subtype 16 and 35 can cause cervical cancer and also cancer of the penis, mouth, throat and anus; through sexual intercourse, including oral and anal sex.

Other viruses, such as the Epstein Barr and types of Herpes virus can lead to Lymphomas and Kaposi sarcoma. 

Helicobacter pylori from poultry is implicated in some stomach cancers and Lymphomas.

Polyhydrocarbons in cigarette smoking can cause Lung cancer.

Smoked meat and fish can also, through the polyhydrocarbons, cause cancer of the mouth, gullet, stomach and also the cervix and bladder.

Some inheritable genes make some families prone to certain types of cancers such as cancers of the breast and colon.

Presentations

Cancers usually start undetected and may be symptomless until picked up in routine examinations.

It may form masses or growths, causing pressure symptoms and sores or ulcers which may lead to pain and or bleeding.

Depending on where the cancer is, it may be easy to pick up as in routine self-breast examinations or routine cervical screening.

Some cancers produce hormones which can be detected on blood examinations.

Invariably loss of weight will trigger a search for cancer.

Diagnosis

Diagnosis begins with the identification of a mass in any part of the body.

However, all masses are not necessarily cancers.

Benign masses may also be present and, therefore, a need for imaging tests and tissue diagnosis.

Imaging techniques include standard X-rays, ultrasound scans, Computerised tomography (CT) scans and more sophisticated types, such as Magnetic Resonance Imaging (MRI) scans and positron emission tomography (PET) scans, which can identify the growing mass and trace any spread.

For tissue diagnoses, there must be an invasive procedure to take a needle or core bit of tissue sometimes under the guidance of an imaging technique or the mass is removed as a whole or a part thereof.

The essence is for a Pathologist to examine the tissue, produce slides from the tissue and examine it under the microscope; which is what leads to a definitive diagnosis.

In some cases, fluid from the tumor which can more easily be obtained, is examined for cancer cells.

Although a cancer diagnosis is made, the cancer must be graded, determined the potential to spread, and if possible staged (identify how far it has spread) to enable the surgeon and subsequently the Oncologist (cancer specialist) to treat the patient.

Increasingly, the tissue diagnosis may not be enough and further tests must also be done to enable more precise targeted treatment to be provided.

In the more advanced countries, antibodies are raised to the cancer cells or portions of them to make their detection easier. 

More and more of such antisera are raised to genetic abnormalities which are at the heart of the abnormal growth of cancer cells.

Such antibodies or antisera – a bit like vaccine production, can detect even little bits of the cancer and make treatment complete. 

Again, as in Star Wars, some treatment modalities are linked to the antisera and injected into the body to search for the cancer cells and destroy them. Fortunately, that is the level of sophistication in cancer treatment.

Sub-typing

It is the antibodies and antisera that are used for sub-typing; to determine all the components of the cancer, that we in Ghana find it difficult to procure and therefore have to send cases to outside laboratories for such tests to be done. It delays the report and therefore affects the early and proper treatment and recovery of patients.

We have the trained manpower in Ghana to do most if not all the tests but we require assistance in the purchasing of the antisera from outside Ghana.

We can make cancer patients live as near normal lives as possible with the right diagnosis, sub-typing and mix of treatment modalities. 

Elsewhere, cancer diagnosis is not a death sentence. 

Call to action

Corporate Ghana can assist the Ghana Standards Authority in providing a lead service in cancer diagnosis and sub-typing to benefit all in Ghana.

It will also serve as a good training ground for all Doctors, Laboratory Scientists, Radiographers and Oncology nurses involved in the management of Cancer patients.

Nobody is exempt from cancer. 

Today it is someone, but tomorrow it could be you, or a loved one. Help in the management of cancer today and you may benefit from it tomorrow.

The writer is a Council Member, 
African Cancer Organisation.