Colon cancer war is not being won fast enough and this is why

Late detection, prevention and treatment has driven up Kenya’s colon cancer numbers, say experts.

Dr Mansoor Saleh, the founding chairperson of the hematology and oncology department at Aga Khan University Hospital, says young adults of 40 years are now testing positive for colon cancer as per their data.

“This country lacks proper data because we do not collect it. In Kenya, in both men and women, colon cancer is among the top five cancers and also within the same range globally. But, the difference is that in Kenya we have started seeing young people get it much earlier,” he said.

Last year’s data indicates that the country recorded 42,116 new cancer cases with the number of deaths rising to 27,092.
He said doctors are also failing in informing their patients about colon cancer screening.

“Around the country, less than 10 per cent of physicians will inform their patients about colon cancer screening. But, in places like North America those above 50 years are subjected to stool tests and colonoscopy. If we can advocate screening and target young adults, we will lower the colon cancer numbers,” he said.

Environments role

Dr Saleh also said the environment played a major role in terms of cancers, generally.

In addition to the environment, diet could also be a factor. “Many people have shifted from home-grown foods to Western diets that are prepared and preserved with additives and chemicals.

Therefore, we have started seeing an increase in colon cancer numbers. We are also seeing an increase because people are becoming obese and obesity is a risk factor in colon cancer.

Most people are not eating fruits or fibre-rich diets,” he added.
While the government has outlined screen tests, colonoscopy and stool tests in its national cancer management frameworks, citing early detection as our best guard against the disease, Dr Saleh believes we do not apply them.

According to Dr Saleh, there is a progressive and very well described growth phase for colon cancer. It starts with a polyp, which is a very small pimple or bump in the colon after which there is a mutation that results in cells growing that replicate and mutate.

The lining of a healthy colon is continually updating itself, replacing older cells, as they break down, with new ones. The old cells are then sloughed off into the stool.

If something disrupts the normal sloughing, an abnormal group of these older cells can collect and form a polyp.

The progression may take up to ten years, which explains why when detected early and the polyps pulled out while still young there is a 100 per cent chance of getting cured. When it becomes an adenoma which is a tumour that is not a cancer and starts in gland-like cells of the epithelial tissue, the cure-rate is still 100 per cent.

However, when it gets to carcinoma, a common type of cancer that begins in the epithelial tissue of the skin, or in the tissue that lines internal organs, such as the liver or kidneys, the cure-rate drops.

Dr George Njoroge, the chief scientific advisor at Kenyatta University Teaching, Referral and Research Hospital, explained that it was not clear exactly why colorectal cancer develops in some people and not in others.

Dr Njoroge, however, said there were a number of possible risk factors including age, a diet high in animal protein, saturated in fats and calories, high alcohol consumption, having previously had breast, ovary or uterine cancer, a family history of colorectal cancer, smoking and lack of physical activity.

Lack of equipment and radiotherapy services, understaffing, and erratic supply of drugs are among the many challenges the medical officer says they have to grapple with.