Esophageal cancer is emerging as an increasingly serious health concern in Rwanda, with new cases persistently rising over the past five years.

According to data from the Rwanda Biomedical Center (RBC), approximately 70 new cases were recorded in 2020, increasing to 87 in 2021, 85 in 2022, and 96 in 2023.

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"Most of these patients, however, arrive at hospitals when the disease is already too advanced for curative treatment. This shows a real increase in both prevalence and incidence, but the most worrying part is that over 70 percent present at locally advanced stages, meaning the treatment we can offer often won’t save them,” said Dr. Theoneste Maniragaba, Director of the Cancer Programme at RBC.

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Esophageal cancer rarely presents early symptoms. For most patients, the first noticeable sign is difficulty swallowing. By this stage, tumors have usually invaded surrounding tissues or spread to other organs. More than 60 to 70 percent of patients die within the first year after diagnosis, he added.

Dr Maniragaba explained that in Rwanda, the disease affects men more than women, with men twice as likely to be diagnosed. Most patients are between the ages of 45 and 65, although some younger cases have been reported. The middle segment of the esophagus, located behind the lungs, is most commonly affected.

"Alcohol and tobacco use are the main risk factors for esophageal cancer in Rwanda, unlike in Western and Asian countries where very hot drinks, spicy diets, or infections such as human papillomavirus (HPV) play a larger role. In those regions, HPV infection is often linked to oral sex.”

Esophageal cancer is often given less attention in public health campaigns compared to cancers such as breast and cervical cancer, which benefit from national screening programs and education initiatives, he added.

"We have not yet prioritised esophageal cancer because it is less common than other cancers, however, it remains a challenge due to its rapid progression and high mortality,” Maniragaba said.

He explained that diagnosis requires imaging, such as CT scans, and tissue sampling for confirmation. These services are mostly available in referral hospitals, and a lack of awareness among primary care providers can delay referrals and testing.

However, as CT scanners become more available in district hospitals, some cases are now detected earlier than before, the oncologist stated.

He added that treatment depends mainly on the stage at diagnosis. For small, early-stage tumors confined to the inner lining of the esophagus, surgery can potentially remove the disease entirely. Such operations require highly trained surgeons and specialised equipment, and truly early-stage diagnoses are rare.

According to him, when the disease is locally advanced but has not spread, treatment usually combines chemotherapy and radiotherapy to shrink tumors and alleviate symptoms. If the cancer has spread, radiotherapy may help patients swallow, and some receive feeding tubes to prevent severe malnutrition.

"Rwanda currently has only one radiotherapy center, located in Kigali. Patients from other regions often face long travel and waiting times. Plans are underway to open new centers in the north and south within the next five years to improve access,” he said.

Dr Maniragaba noted that surgical capacity is also limited because only one or two cardiothoracic surgeons in Rwanda can perform complex esophageal cancer surgeries, which makes them easily become overwhelmed, resulting in some patients having to wait or travel abroad for treatment.

He added that cost is less of a barrier as the Community-Based Health Insurance scheme (Mutuelle de Santé), covers both surgery and radiotherapy, with national coverage now exceeding 95 percent. This support helps many families avoid catastrophic healthcare expenses.

"Unlike cervical cancer, which can be prevented through HPV vaccination, there is no vaccine for esophageal cancer. Prevention focuses on reducing known risk factors, especially alcohol and tobacco use. People can lower their risk by drinking less alcohol and avoiding smoking,” Dr. Maniragaba said.

Regular health checks and attention to early symptoms is necessary, for high-risk groups, simple endoscopy or imaging could detect the disease before it advances, although routine national screening programs for esophageal cancer do not yet exist, he adds.

"Efforts are underway to train more surgeons, expand radiotherapy services, and introduce awareness campaigns covering esophageal and other gastrointestinal cancers. These measures may help more patients seek care earlier, when treatment can be more effective.

According to him, the silent nature of esophageal cancer and the lack of awareness continue to impact patient outcomes since most individuals seek medical help only once swallowing becomes painful. By this time, the disease has often advanced extensively.

Dr. Maniragaba says the public should reduce risk factors, recognise warning signs, and not delay seeking care, adding that even if it turns out to be nothing, it’s better to check early than wait.