If you are not aware, hear it from me now – you are a potential cancer patient.
After losing my mother to endometrial cancer in February, I started researching about the condition and it was then that I realised that most of us don’t understand what cancer is, much less realise that it could creep up on anyone. When people succumb to cancer, some people even believe that maybe they were bewitched.
“That person even went to the hospital but the doctors couldn’t do anything, ‘ba naba lowa (they were bewitched)’,” people usually say, some said this about my mother actually. And this is sad, we all need to understand cancer.
I was also saddened that most of the content which fed me knowledge was foreign, it was then that I decided my career had to take a bit of a turn; I decided that I would do something, in my own small way, to enhance cancer awareness initiatives in Zambia.
So, friends, join me on this journey so that we can learn how best to reduce the risk of getting cancer, how to I recently sat down with Dr Kalima Munalula who is a gynaecologic oncologist at the University Teaching Hospital. I share part of our enlightening chat below:
Q. What is cancer in simple terms? I ask this because it appears most people don’t understand what cancer is. So, I thought we could bring this question to you so that you can explain, what is cancer in the most basic terms?
A. The body has a way that it functions and works and controls its cells. So, every cell in the body has a lifespan. So, the body is able to determine that okay, this cell has reached the end of its lifespan and then mechanisms come in that remove that cell and destroy it. So, cancer, or cancerous cells are cells that are no longer responding to that control by the body so instead of reaching a point where they die, cancer cells continue to live and they grow and it’s like infinity. So really, in very basic terms, cancer happens when body cells stop responding to the control mechanisms that the body has to eliminate and remove cells that are not functioning properly. So, cancer cells escape that and they continue to exist, they become immortal, so that’s what cancer is, in very basic terms.
Q. Would you say it’s when a cell decides to go rogue and everything goes haywire?
A. Exactly. So, rouge cells are cancer cells, they don’t obey instructions to be removed or to be eliminated or to die, they become indestructible.
Q. How many types of cancer exist for women?
A. I’m a gynacologic oncologist so that means I only handle cancers that affect only women. So most of them are in the reproductive organs and as far as gyn cancers are concerned, we have cancers of the vulva, so this is the structure of the reproductive system that are outside on the body and then we have cancer of the vagina, we have cancer of the cervix, cervical cancer is at the opening of the uterus and then we have cancer of the uterus itself and then we can also get cancer of the ovaries and then there is another type of cancer in women that is associated with pregnancy that’s called gestational trophoblastic neoplasia, that’s a different kind of cancer that’s associated with pregnancy. So, the cancers mostly are in the reproductive organs, the vaginas, the cervix, the uterus and the ovaries.
Q. Which ones are the most prevalent in Zambia?
A. By far the most common cancer in Zambia is cancer of the cervix, followed by cancer of the vulva, ovaries and then endometrial cancer or cancer of the uterus is the fourth.
Q. I hear cervical cancer can be prevented?
A. Yes, cervical cancer has what we call a pre-cancer stage so that cancer stage is one that can be picked if one goes to a health facility and has cervical cancer screening. It is possible for us to determine that she has a pre cancer condition that can then be dealt with. So, with cervical cancer, because of that, there is a lot of campaigns for women to go for screening because you are better off being caught with a pre cancer disease that is easily managed and in fact, sometimes it can even be done the same day that you are seen in a clinic. So you go to a facility where cervical cancer screening is done, if the nurses or health care practitioners find that you have a pre cancer lesion, they are able to do something about it on the spot and you don’t have to come back for it to be done. Sometimes they need to refer you to a higher level but most of the time, they are able to deal with what they find on the spot. So they see and treat, so that’s what we call the system that we are using where you see a patient and you treat them on the spot. So it is very important for women to be caught early on in the cycle because it is cheaper to treat a pre cancer than to treat a woman that actually has cancer.
Q. Is there any other cancer that can be prevented?
A. Another cancer that technically can be prevented is vulva cancer. The organism that causes vulva cancer and cervical cancer is the same, most of the time it is human papilloma virus (HPV). So women that develop vulva cancer may have a condition before they develop vulva cancer so if you attend a health care facility and you are having cervical cancer screening for example, most of the nurses, all the health care providers have to inspect the vulva as well, to see what is happening on the outside as well and not focusing only on what is happening on the inside and a lot of the patients that we see here at women and newborn hospital have been referred from facilities which have seen that maybe they have got vulva warts or something then they come to see us and then when we examine them and we investigate them, we see that actually, they don’t have cancer but they have something that we can treat them for so that they don’t develop cancer. So it’s possible also in vulva cancer to prevent a woman developing the actual invasive disease if we catch them early.
A. For the rest of them? Nothing can be done?
Q. For the rest of them, unfortunately, for cancer of the uterus, there is no screening method, cancer of the ovaries again, there is no screening but as far as cancer of the uterus is concerned, it usually affects old women and the first thing they will notice is that they have abnormal bleeding so women that have endometrial cancer or cancer of the uterus are women who have stopped having their periods. Maybe they are over 50. So if you are a woman, you are over 50, and you start bleeding, even if it’s just bleeding one day, you have to go to the hospital because it is not normal at all for a woman who has stopped having menses to then bleed. So most of the time, women that are over 50 and are bleeding, the first thing that we think about when they come to the hospital is do they have cancer of the uterus? So we examine them, we talk to them and then we see if it’s on the cervix or if it’s in the uterus. But because of the fact that most women are uncomfortable when they bleed, they come to the hospital and they say “oh, I bled maybe once or twice and it’s been going on for a month” because they know it’s unusual.
A. I’m sorry to cut you but for my mother, what you are saying is so true because for mum, the first time she bled post menopause was when I was arrested in 2014 and she brushed it aside as “I think I was just stressed because you were arrested”, but now, listening to you, and that is the message we are trying to put across that never brush anything off and say I was stressed and that’s why I am bleeding because some of these things are abnormal and we must listen to the doctors.
Q. Yes, so endometrial cancer, we usually catch it early because most women will be suspicious about abnormal bleeding once they have gone into menopause so we are able to catch women that have uterine cancers early on. For the ovarian cancers, unfortunately, a lot of women come to us when the cancer is advanced and that is because ovarian cancer, like I said, there is no screening test for ovarian cancer and the symptoms that people present with are not specific to ovarian cancer. Maybe they will say they have diarrhea on and off, vomiting on and off, maybe they eat and they feel full quickly, so these symptoms happen in a lot of other things. So you can have diarrhea on and off and you may think ‘maybe it is something I ate’, and you’ll have a bloated feeling and you say maybe it is something I ate so the time we see a lot of the patients that have ovarian cancer, the diseases have already advanced. But for endometrial cancer, we usually catch them early because most women are usually uncomfortable when they bleed after menopause, they see attention when that happens.
Q. For ovarian cancer, is it also more common in the older women or it cuts across?
A. For ovarian cancer, interestingly, it affects children as well as grown women. So there are some cancers that are specific so to speak, quote on quote, for young children. A few months ago, we operated on a 15-year-old who had cancer in the ovary. So, there are different types of ovarian cancers that affect women so some are specifically for younger girls and then some are more common in older women. But the thing with medicine is that we say never say never so you can have a young girl having a cancer that we usually see in older women and it is difficult to understand why that would be the case but it does happen. And sometimes we have women in their reproductive age or towards the end of their reproductive life that are presenting with cancer that would normally be seen in a younger girl. So for ovarian cancer, anybody can get it. There are some which are specifically for younger girls and some that cut across age range.
Q. Are you able to make projections from the population to say how many women cancer affects?
A. No, you can’t really make projections as such because remember we said at the beginning, to use your term, that cancer is like rogue cells…
We will end here for today. Next week, we find out why some families are at a higher risk of getting certain types of cancers and the drastic measures which some people take to reduce this risk in developed countries. We also find out how feasible some of these drastic measures are in Zambia? Plus much more!
Until next week friends. For now, bekind grabyourbestfriendandgoforcheckups
PS: If you want to watch this interview in full, head over to my Youtube Channel, Chat With Mukosha 🙂
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