KUTRRH has been conducting a research on esophageal cancer in conjunction with Manchester University. The project began in 2022 following funding from the National Institute of Health Research (NIHR). The research studies oesophageal cancer, establishing the cancer spread in the country, its causes, and the best treatment for best outcomes.
The areas of focus for the project include:
- Community engagement and sensitization.
- Early detection and screening using mobile endoscopy units.
- Advanced molecular pathology to inform risk factors of oesophageal cancer.
- Research capacity strengthening.
- Training and capacity building of endoscopists, pathologists, and clinical fellows.
Although present-day therapeutic interventions of surgery, chemotherapy, and radiotherapy can positively influence disease prognosis, cancer of the esophagus remains a highly lethal disease in Kenya. Esophageal cancer is the fourth most common cancer, with a fatality rate of 99.3% due to late recognition of symptoms by both patients and healthcare workers.
Most esophageal cancers are discovered when they have become locally advanced and are due to a non-specific initial presentation like heartburn or abdominal bloating. Therefore, as few as one out of eight esophageal cancers are detected at an early stage.
What is Esophageal Cancer?
This is a condition where cancerous cells develop in the esophagus, the tube connecting the throat to the stomach. Esophageal cancer is an increasing health problem in Kenya, especially in the Central and Western parts of Kenya, with over 3,000 cases reported in 2022, making it the fourth commonest cancer in the country.
Esophageal cancer can be:
- Squamous cell carcinoma
- Adenocarcinoma
These types affect different parts of the esophagus.
Risk Factors and Causes
The exact cause of esophageal cancer remains unclear, but several risk factors have been identified:
- Dietary Factors: Consumption of very hot drinks and traditional fermented porridge, which may contain carcinogenic compounds.
- Tobacco and alcohol use.
- Genetic Predisposition: Family history of cancer can increase risk.
- Infections: Human Papillomavirus (HPV) and other infections have been associated with esophageal cancer.
- Environmental Factors: Exposure to certain chemicals and poor socioeconomic conditions may also contribute.
Symptoms and Diagnosis
Esophageal cancer often presents with symptoms such as:
- Difficulty and pain in swallowing (dysphagia): Especially when consuming solid foods like meat, bread, or raw vegetables can be a common early symptom of esophageal cancer. In advanced disease, swallowing semi-solids or even liquids becomes difficult.
- Chest pain: Pressure or burning sensations in the chest may be experienced by individuals with esophageal cancer. Pain behind the breastbone or in the throat can also be a symptom of this condition.
- Persistent hoarseness and coughing: Especially as the tumor progresses and affects nearby structures.
- Indigestion and heartburn.
- Weight loss: This is often due to swallowing difficulties that hinder adequate food intake.
- Vomiting: Particularly if the vomit contains blood, can be a symptom of advanced esophageal cancer.
Other symptoms may include frequent choking on food, bone pain (if cancer has spread to the bone), and bleeding into the esophagus leading to black stools and anemia.
Esophageal cancer poses significant health risks and requires timely diagnosis through imaging tests such as CT scan, MRI, and PET/CT, which provide detailed images of the esophagus, thus detecting tumor spread. Endoscopic Ultrasound (EUS), Biopsy, and molecular testing can also be done on a patient to determine what therapy options would work.
Treatment Options
Treatment options for esophageal cancer in Kenya include:
- Surgery
- Chemotherapy
- Radiotherapy
The choice of treatment depends on the stage of cancer and the patient’s overall health.
Preventive Strategies
- Avoid risk factors like smoking, excessive alcohol consumption, and maintaining a healthy diet.
Conclusion
By understanding the key aspects of esophageal cancer, individuals can take proactive steps toward prevention, early detection, and appropriate treatment, thus enhancing their overall health and well-being.
Addressing this challenge requires a multi-faceted approach, including Public Health education, improved healthcare infrastructure, and policy support to ensure early detection and treatment due to its non-specific nature of symptoms.