Rwanda yesterday joined the rest of the world to mark World Cancer Day under the theme ‘We can, I can’. According to the the head of the cancer unit at Rwanda Biomedical Centre (RBC), Dr Francois Uwinkindi, the objective was to raise awareness about cancers in the country.

"It’s an opportunity to make the population aware about the risk factors and early detection, and remember people and families affected by this disease, as well as salute those that have fought to reduce stigma and improve healthy behavior,” he said.

Uwinkindi noted that campaigns prior to the event included sensitisation on cancer prevention and early diagnosis through mass media, awareness campaign on cancer diseases, breast clinical examination, as well as lighting Kigali Convention Centre in purple - a color for general cancer awareness.

Available data shows that the survival rate of patients diagnosed with cancers is appallingly low in the developing world, including Rwanda, because cancer management facilities are inadequate and people are diagnosed at very advanced stages.

Cancer control strategies in Rwanda are challenged by the ignorance, myths and poor awareness in the general population about cancer risk factors, cancer prevention, early detection and treatment.

Speaking of myths and poor awareness concerning treatment, some patients diagnosed with cancer shun chemotherapy, one of the treatments for cancer.

Karen Bugingo, 24, was diagnosed with severe lymphoma cancer. Fortunately, she was able to overcome the disease through the medication she got from India and here in Rwanda. And like many other cancer patients, Bugingo underwent chemotherapy.

"Although chemotherapy is not painful, the most fearful part was during getting the injections since they are always given through an intravenous line. I think this is one reason why someone may shun the treatment,” she says.

Bugingo was able to cope up with chemotherapy by staying hydrated, drinking at least three litres of water daily, among others.

However, not all patients are comfortable with undergoing chemotherapy as some are misled about the effects of this form of treatment. Medics advise that chemotherapy is vital for everyone suffering from cancer to ensure complete healing.

What is chemotherapy?

Achille Manirakiza, a training clinical oncologist at Ocean Road Cancer Institute in Tanzania, says any use of chemical compounds for medical purpose can be called chemotherapy.

"It is just a mouthful that we in the world of cancer chose to use to make it sound sophisticated. For cancers, chemotherapy is the therapeutic use of anti-cancer drugs to treat cancers. It is used in almost all possible cancers, depending on the stage,” he says.

Manirakiza notes that chemotherapy is important to either help before or after a surgery on a cancerous mass. And that it can be used together with radiotherapy or alone, for many cancers, and treats quite successfully.

Just like Manirakiza, Rachna Pande, an internal medicine specialist, says chemotherapy is group of drugs which help to destroy cancer cells using various mechanisms. They are necessary to prevent spread of cancer and curing it.

"In early stages it is possible to reverse many cancers like breast or brain cancer. Sometimes chemo is combined or given before or after surgery with radiotherapy for better results,” she says.

Also depending on the time of diagnosis, cancer can still reproduce (mitosis) and also spread to other parts of the body.

Uwinkindi notes that at an early stage (stage 1) of cancer, surgery can be enough for the healing, but the case is different when it has migrated to other parts of the body, although the surgery will be also needed.

"Combining chemotherapy with radiotherapy is ideal to ensure all the cells are killed, in case they were not eliminated during chemotherapy,” he adds.

He notes that depending on the type of cancer and the stage, the type of treatment can be ruled out by an oncologist.

"For instance, for blood cancers like leukemia, the main treatment is chemotherapy and radiotherapy, but also chemotherapy and radiotherapy is needed to prevent it from recurring. Basically, all three are key when it comes to cancer treatment. Sometimes it’s hard for medics to rule out whether the cancer is at stage one or two, and that’s why it is important to combine all three treatments,” explains Uwinkindi.

On the other hand, Pande says chemotherapy destroys proliferating cancer cells by various mechanisms. "Sometimes it can cure cancer, as in breast cancer or brain tumors. Sometimes in early stages, surgery may cure cancer and chemo may not be given immediately and not considered necessary,” she says.

Side effects

However, Manirakiza says chemotherapy has a large array of side effects. Most notoriously, it is linked with immunity suppression; inflammation of the gastro-intestinal system, mainly in the mouth, heart and lung toxicity, and in the long run, some drugs would cause secondary cancers, years after use.

"The cause of these side effects is because traditional chemotherapy drug is supposed to be a (cancer) cell killing drug, but does not discriminate and can kill other (normal) cells, which is unfortunate,” he says.

According to Mark Hangenimana, senior officer at the Cancer Diseases Unit (CDU) at Rwanda Biomedical centre, chemotherapy is an effective way to treat many types of cancer, but on the other hand, the treatment also comes with side effects.

"Some of the side effects can be mild while others can be life threatening. In some patients, chemotherapy can even lead to other serious complications,” he says.

At this point, Hangenimana says the patient may be stopped from the drugs they are taking. For instance, life threatening side effects like serious anemia, continuing with medication can lead to death not even immediately, but after sometime due to anemia.

He notes that people should know that, chemotherapy is not for life, but there is duration for it depending on stage and the type of cancer.

"All chemotherapy drugs are toxic, can cause loss of hair, anemia, stiffness of joints, fall in platelets and general body weakness as side effects,” adds Pande.

How to cope up

Hangenimana says healthy tissues can be damaged in the process of chemotherapy, especially those in the born marrow which makes blood cells for the digestive system and hair follicles.

He notes that that’s why most patients undergoing chemotherapy lose their hair, can become anemic, experience a fall in platelet count causing bruising and have bleeding tendency as well as experiencing joint pain and stiffness.

"Nausea, anemia, infections and vomiting are just some of side effects one can experience, but not for everyone,” says Hangenimana.

He advises that in case of anemia as a side effect, medications or blood transfusion is ideal, while fatigue can be improved through small exercises.

Additionally, Hangenimana says in case of infections, practicing good hygiene is essential. Some drugs can lead to one producing fewer white blood cells, which puts one at a high risk of infections.

Other than that, Uwinkindi says close follow-up should be made to make sure that the liver and bone marrow are still normal.

He notes that counseling is also needed to educate the patients on the likely side effects that can happen during treatment.

Uwinkindi explains that in some cases, cancers are known to relapse, even after good treatment, thus regular checkups are important after treatment to prevent reoccurrence.

He points out that to be sure that one is healed completely; one should not exhibit any dangerous signs five years after cancer treatment.

"There are some drugs that can be more dangerous to children than adults. This is because they are still growing up, but most of the time they respond well to treatment more than adults, since most of their organs such as the liver and kidney are still well functioning compared to those of grown-ups,” he says.