Today as Rwanda joins the rest of the world to mark the International Head and Neck Cancer Day, medics are still grappling with a bulk of stumbling blocks to provide a single cure for the disease. For that matter, growing fear among patients and caretakers has yielded several myths about the disease and some people say that when you have cancer you are as good as dead!

However, medics refute these claims and instead blame late interventions such as late screening for the increasing cancer cases.

According to Dr Jatin Shah, the Chief of Head and Neck Service at Memorial Sloan Kettering Cancer Centre and chairman of International Head and Neck Oncological Society( IFHNOS), head and neck cancer (head and neck squamous cell carcinoma) is the leading cause of death and disability in many parts of the world yet it can be prevented or cured.

"The vast majority of these cancers can be prevented or can be cured if detected early; however, millions suffer from delayed diagnosis, inadequate treatment, inappropriate rehabilitation and palliation,” Dr. Shah says.

Currently the annual burden of all cancers in Africa stands at 650,000 people but in Rwanda, Butaro Cancer Centre has treated about 3000 cancer patients since its establishment a few years ago.

In fact research shows that 10 per cent of early screening cases are successfully treated.

Despite 20 per cent of cancers being ignored to reach an untreatable stage of swellings or even death, even 60 per cent of the advanced cases remain treatable.

How head and neck cancer develops

Unlike normal cells that grow exponentially, cancerous cells grow rapidly as a result of mutations and form growths in different parts of the body.

A person suffering from head and neck cancer will have any but not limited to the following symptoms: swelling of the thyroid gland, nasal blockage, bleeding, pain in the mouth, ulcers, swellings in throat, pain while swallowing food, difficulty in breathing, change in the voice that results into coarseness, difficulty in swallowing and difficulty in breathing.

"Once any of those symptoms happens for more than three weeks, it is advisable for individuals to turn up to the hospitals for cancer screening,” says Dr Rajab Mugabo, a consultant of Ear, Head and Nose surgery at King Faisal Hospital before warning that all rare swellings above the shoulder bones are likely to be signals for head and neck cancer.

Although head and neck cancers may happen at any stage of life, there are predisposing factors that increase one’s chances of getting this type of cancer. Predisposing factors

Dr Joseph Kamugisha, an oncologist at Rwanda Military Hospital, Kanombe explains that people who smoke stand high chances of getting the illness.

"Since smoke contains carcinogens, the more one exposes himself to these cancer causing compounds the more they risk contracting cancers of the upper respiratory system,” Kamugisha explains.

He also adds that chronic viral infections predispose individuals to submandibular cancers that may be below or above the tongue.

"Continuous exposure to viral infections causes inflammation which when neglected is likely to upgrade into grave cancers such as paltid gland tumors,” Kamugisha says.

Kamugisha, however, points out that although genetic factors may determine the chances of getting head and neck cancer, individuals with excess alcohol consumption and allergic reactions are at high risks.

"Allergic reactions cause inflammation, whereas alcohol is associated with cancers of the pharynx or the oesophagus,” Kamugisha adds. Complications

Dr Mugabo, who operates between 4 to 5 patients each week, says all rare swellings should be dealt with at an early stage.

He points out that the head and neck being associated with many functions of the body, it is very difficult to perform similar cancer operations just like in other parts especially when the disease has reached an advanced stage.

"Treating cancer may require removing certain parts in combination with chemotherapy but you realize most parts between the head and necks are highly vascularized and very important. This makes it very difficult to remove a part while maintaining functionality,” he says.

Mugabo advises people always to seek early screening once they experience strange signs and symptoms on their bodies.

"Swellings that either grow on the ears, nose, face, lips, scalp, mouth, throat and cause a lot of discomfort to the patient may be early signs for growing head and neck cell squamous carcinoma,” Dr Mugabo explains.

When most people suffer from swellings in the neck region, their conclusions are always centred on goiter.

Dr Mugabo however warns that all growths in the neck region should not be considered as goiter since there is also another possibility of suffering cancer within this area.

"Goiter is not cancer but cancerous growths in the neck area position within the food passage or the air pipe and are likely to be confusing by mere personal judgment,” he says.

Treatment of cancer is very expensive and since most patients turn up at a later stage, it is also difficult to manage the illness. Fortunately, health experts maintain that early detection of cancers contributes to successful treatments compared to individuals who turn up when the sickness has already goaded.

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Nutrition tips for patients receiving head and neck radiation therapy

Radiation therapy can cause many side effects that may contribute to inadequate calorie and protein intake.

These side effects include lack of appetite, taste changes or lack of taste, painful chewing and swallowing, dry mouth, early satiety, diarrhea, nausea and disinterest in food and eating. The type and severity of side effects usually depends on the location of the radiation.

Calorie and protein needs are increased in patients receiving treatments for cancer. These increased needs, combined with the many possible side effects, may lead to weight loss. It is very important to try and maintain your weight while receiving radiation. Find ideas for maintaining good nutrition here and ask your dietitian for additional advice and support.

This handout is directed toward patients with side effects preventing the intake of solid foods. If you are still able to eat solids, ask your dietitian for guidance.

Basic Principles