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KENYATTA NATIONAL HOSPITAL

Cancer Resource Guide

What is Cancer?

Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues.  It is not just one disease but many diseases with more than 100 different types named for the organ or type of cell they begin in.
 

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Causes

Cancer results from internal and external risk factors working together and/or in sequence to trigger the process. People may be exposed to risk factors or cancer-causing agents in their environment and/or from their lifestyles.
 

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Types of Cancer

Some of the known types of cancer include:

  • Breast Cancer
  • Central Nervous System (CNS) Tumours
  • Gastrointestinal Cancers
  • Oesophageal Cancer
  • Gastric Cancer
  • Biliary Tract Cancer
  • Hepatocellular Carcinoma
  • Pancreatic cancer
  • Colon Cancer
  • Rectal Cancer
  • Gastrointestinal Stromal Tumour (GIST)
  • Gynaecological Cancers
  • Cervical Cancer
  • Endometrial Cancer
  • Ovarian Cancer
  • Vulvar Cancer
  • Gestational Trophoblastic Diseases (GTD)
  • Haematological Neoplasms
  • Leukaemia
  • Lymphomas
  • Myeloma
  • Head and Neck Cancers
  • Nasopharyngeal cancer
  • Oral Squamous Cell Carcinoma
  • Lung Cancer
  • Malignant Pleural Mesothelioma
  • Prostate Cancer
  • Soft Tissue and Bone Sarcomas
  • Skin cancer
  • Nephroblastoma (Wilm’s Tumour)
  • Neuroblastoma
  • Retinoblastoma
  • Bone Tumours
  • Kaposi’s Sarcoma
  • Soft Tissue Sarcomas
  • Rhabdomyosarcoma

 

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Cancer Prevention

Prevention means eliminating or minimizing exposure to the causes of a disease, and includes reducing individual susceptibility to the effect of such causes.  Approximately 40% of cancers are preventable through interventions such as tobacco control, environmental controls, promotion of healthy diets and physical activity. Prevention offers the most cost-effective long-term strategy for the control of cancer. Prevention of cancer can be categorised into two: primary prevention and secondary prevention.

Primary prevention refers to a set of interventions that keeps a cancerous process   from developing and includes health counselling, education and environmental controls. ™
Secondary prevention is that set of interventions leading to the discovery and  control of cancerous or precancerous lesions.
 

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Screening

Early detection of cancer greatly increases the chances for successful treatment. It comprises early diagnosis in symptomatic populations and screening in asymptomatic high risk populations. Screening refers to the use of simple tests across a healthy population in order to identify individuals who have disease, but do not yet have symptoms. Based on existing evidence, mass population screening is advocated for breast and cervical cancer. Other cancers that are commonly screened for include prostate and colon.
 

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Diagnosis

Diagnostics include:

  • Imaging
    • Conventional Radiography and Fluoroscopy
    • Mammography
    • Ultrasonography
    • Computerised Tomography (CT)
    • Nuclear Medicine
    • Magnetic Resonnance Imaging (MRI)
  • Laboratory Work-up
    • Biochemistry analysers
    • Immunoassay analysers (Serology & Tumour Markers)
    • Haematology Analysers
    • Bone marrow kits
    • Histopathology and cytopathology equipment
    • Immunohistochemistry set-up
    • Flow cytometry
    • Molecular PCR platforms

 

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Staging

The value of carrying out staging in cancer is to determine how wide the cancer has spread. Staging information assists the clinician in several ways including:

  • For selection of modalities of therapies
  • For prognostication purposes
  • Evaluating the success of therapy on patient’s disease
  • Facilitating the sharing of information between practitioners and treatment centres
  • Contributing to the enhancement of local knowledge base about cancer

Globally there are a number of staging systems that are used in clinical practice. Generally they all provide information on the tumour extent which also determines treatment options and guides the prognosis of the disease. Of the available systems the most widely applied is the TNM System developed by UICC(International Union Against Cancer).
 

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Treatment

Cancer treatments include:

  • Surgery
  • Chemotherapy
  • Radiotherapy
  • Immunotherapy
  • Targeted therapy
  • Hormone therapy
  • Stem cell transplant

 

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Coping

Nutritional care

Nutrition plays a major role in many aspects of cancer development and treatment. Malnutrition is a common problem in cancer and an important component of adverse outcomes, increased morbidity and mortality and decreased quality of life.
Poor nutrition practices lead to under nutrition, contribute to the incidence and severity of treatment side effects, and increase the risk of infection, thereby hampering chances of survival.

These are general recommendations for adults which should be adjusted to individual patient needs

  • Energy: Persons with a normal nutritional status have an increase of 110 – 130% of the usual energy requirement. On the other hand if the individual is malnourished, 130 – 150% of normal energy requirement is needed.
  • Protein: If the person with cancer has a normal nutritional status, the protein requirement is 1 - 1.25 g/kg body weight (current weight) compared to the malnourished person’s need of 1.5 – 2 g/kg.
  • Fats: Monounsaturated and polyunsaturated fats are preferred to saturated fats or transfats. Monounsaturated fats are found mainly in vegetable oils like olive, canola, and peanut oils, whereas polyunsaturated fats are found mainly in vegetable oils like safflower, sunflower, corn, and flaxseed.
  • Vitamins and minerals: The needs of these depend on the type of therapy used and the presence and the severity of complications. All individuals should be carefully monitored for early signs of nutrient deficiencies. Multivitamins/minerals should be supplemented in most persons with cancer, while guarding against excessive supplementation.
  • Antioxidants: Patient should be advised and encouraged to eat a variety of fruits and vegetables. Commercial antioxidants under prescription are recommended if the patient intake of fruits and vegetables is poor.

Patient support groups

Formation of patient support groups should be encouraged. This forms an integral part of survivorship care.

Spiritual and psychosocial counseling

With a cancer diagnosis, patients and families often look more deeply for meaning in their lives and feel the need to mend broken relationships like forgiving and being forgiven. Spiritual care involves being a compassionate presence to patients and it recognizes that healing can take place even though a physical cure is impossible.

Patients and their families should be assessed for psychosocial issues such as anxiety and depression since psychiatric co-morbidity has been reported to occur in about one third of the cancer patients. This necessitates the cancer treatment team to work closely with mental health workers in order to comprehensively address the needs of cancer patients. Psychosocial support groups for all patients with life threatening illnesses, including cancer, are therefore necessary to meet patients’ psychosocial needs.

Palliative care

Palliative Care is an approach that improves the quality of life of patients and their families facing the problems associated with a life-threatening illness. It involves the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Pain management

Pain associated with cancer increases with progression of the disease. Cancer pain has many dimensions including psychological, physical, social and spiritual which must be addressed in order to improve quality of life. Pain should be assessed in terms of pain intensity, quality, location, radiation, mode of onset, timing, exacerbating factors and relieving factors of pain. The patient should be the prime assessor of his or her pain where possible. The intensity of pain and the treatment outcomes should be regularly assessed using standardized assessment tools.

Analgesia are given as follows:

  • Mild pain ---- Paracetamol
  • Moderate pain ---- Weak opioids
  • Severe pain --- Strong opioids

End-of-life care

End-of-life care refers to medical care not only of cancer patients in the final hours or days of their lives, but more broadly, medical care of all those with cancer that has become advanced, progressive and incurable. When a patient’s health care team determines that the cancer can no longer be controlled, active cancer treatment should stop, but other forms of care should continue.
 

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References

Office of the Director of Medical Services, Ministry of Health. National Guidelines For Cancer Management Kenya. 2013