Cancer management needs vibrant approach - Dr Kamugisha

October was breast cancer awareness month and Healthy Times sought out Dr Joseph Kamugisha, who has been a resident oncologist in Jerusalem, Israel but recently returned home and is based at Rwanda Military Hospital, Kanombe. He talked to Donah Mbabazi about oncology – the branch of medicine concerned with the study and treatment of tumours – cancer management and treatment and comparative medical practices in Israel and Rwanda. Excerpts;- You have been in Jerusalem for some time, what are the comparative medical practices in cancer treatment today in Israel and in Rwanda. What lessons have you got from there in relation to cancer treatment that can be applied in Rwanda? Cancer management needs the multi-disciplinary approach, that is, you need to have oncologists and pathologists. Oncologists do the treatment of cancer, they plan and decide. Pathologists test the cancer and then decide what really needs to be dissected, the tissue to be operated or to remove the cancer by surgery because the treatment of cancer involves surgery and radio therapy. In addition you need to have pathologists alongside, imaging is also very important in cancer management, imaging involves chest X-ray, CT scan radiology and all that because you will be able to see the size of the tumour and the spread of the lymph nodes through the petty scan. What I learnt from Israel is that cancer is a disease like other diseases, it’s manageable and controlled. You only need to have an aggressive approach, and this involves the multi-disciplinary approaches that have to be fast and at the required time. When you compare Rwanda and Israel in regards to medical practice management, they are not on the same level, of course, because Israel is advanced. They have modern facilities for caner management. So they have adequate modalities of cancer treatment which we don’t have here. What we need is to develop a multi-disciplinary approach for cancer management. Another thing is to improve on the expertise for cancer management because a doctor here can handle 10 patients of different cancer illnesses. This is a little abnormal because cancer needs focus and a lot of time is needed to help a cancer patient, and this is something that we really need to focus on. And by ‘aggressive approach’ I don’t mean we increase the dose, but rather to be vibrant in what we do. What is the current situation of cancer in Rwanda and what is the most predominant cancer in the country? The most predominant cancer in the country is breast cancer. When I compare with European countries, the current situation in the country is fair; it’s just the economic burden that makes it worse because most people cannot afford chemotherapy. The other problem is the awareness; people are still ignorant about cancer. Even health practitioners have limited knowledge about cancer; not everyone can understand cancer because, like myself, before I went for my specialisation course,I had just little knowledge about it. What major challenges impinge on efforts to fight cancers in the country? Lack of adequate modern facility. For example, in Kanombe, we are supposed to have chemotherapy but we don’t; we are always forced to transfer patients to Butaro [Cancer Centre]. We used to manage some here but sometimes drugs run out of stock and we end up sending patients to Butaro, only two hospitals have chemotherapy: King Faisal Hospital, Rwanda, and Butaro Cancer Centre. Are all tumours cancer and could we also say all cancers are tumours? Not all tumours are cancers and not all cancers are tumours. Some tumours are benign, meaning a cell is there in the body but at the same time it’s not harmful. To a lay man, what do doctors mean when they talk of benign and malignant tumours? Benign means the cells are there but are not harmful to the body, though sometimes they could be uncomfortable to the body because you know one organ of the body is related to another. A tumour could be in the stomach and compressing the pancreas, so doctors need to realise that this tumour is benign and it’s the one causing this discomfort and pain, because if benign tumours are to affect the body, they do it in a compressive manner. With malignant tumours, they contain cells that are destructive, cells that destroy others, meaning that if they come into contact with other cells, they destroy them and they are the ones which cause cancer. They are sometimes called neoplasm. Many people know about cancers, but they do not know exactly what causes them. For instance, liver cancer or even breast cancer; what would cause them? There are many causes, for example, with liver cancer, one cause is hepatitis. This is a virus that attacks the liver and it is transmitted through blood and it feeds through the vessels and the cells in the liver. Another cause is alcohol consumption; the toxins from alcohol easily destroy the liver due to increased toxicity and less elimination. Liver cancer can also be caused by other illnesses like having self-destructive cells in the blood, it’s a genetic disease. Another cause proved recently is the fungal infection. For the breast cancer, it’s mostly a genetic disease, secondly, the contraceptive pills because they contain estrogen and progestrogen. One of the ways they cause cancer is imbalance and this could be as a result in a deficit in either normal reproductive ways like menses. When taking pills, one increases the quantity of these hormones, because the body also produces them to have some specific natural functions. When you add in pills, you either increase their function or increase their level in blood, and once the levels go beyond the required one then they become harmful. There are some minor things like obesity because the proteins and the hormones have a close link, so one can easily add to hormonal function when you become fat. Breast cancer is screened but what about other cancers, how can one detect them earlier? For breast cancer screening, there is self-breast cancer examination, as well as mammograms. We can do screening with other cancers as well, because these cancers have other specific causes. So, once a patient has something that will dispose them off, they have to start going in for regular checkups to detect this possible development of the cancer. The patients who have virus hepatitis they are usually tested for a mark called Alpha-Feto-Protein (AFP), because this protein gives the measure, it’s one of the predictive markers that helps us to detect that cancer cells have started growing in the liver or not. Another one is an enzyme called the gamma transference enzyme (GGT). It detects by reacting in case there is an abnormal growth in the liver and actually in a modern clinical practice this one is becoming more accurate than even AFP because with even a single lesion, the enzyme will start going up, it’s very reactive to abnormal growth in the liver, though some cancers can be hard to detect because some malignant tumours manifest in a tricky manner. Chemotherapy and radiotherapy are strong medications that kill or inhibit actions of cancerous cells. But they also kill vital cells in the body. How can cancer patients and medics try to limit such damage and what are the remedies if any? We always have medications that accompany chemotherapy and radiotherapy to minimize their toxicity. They all have toxicity, so before we give patients these drugs, there is another drug that is injected to prevent the occurrence of any effects. With breast cancer, would mastectomy necessarily stop the disease? And does it mean the whole breast is removed, as in the chest going flabby? Yes, it involves the whole breast being removed. A patient could have a disease just in the breast but has not invaded deeper structures of the veins and other components. So if the tumour is only in the breast, the only option we have is to remove the breast so that the patient can survive. Only if the cancer is in a small lobe of the breast can we remove that particular part of the breast. However, mastectomy doesn’t necessarily stop the disease. But we can apply radiotherapy so as to stop the cells from coming back. Many times when people talk about cancer treatment, it is as if only radiotherapy and chemotherapy work. Are there no drugs that can effectively cure some cancers? Surely, they are not there. There are no drugs that can manage to suppress cancer cells. Cancer treatment has a unique action that is why its approach is aggressive. The only drug that works well with cancer cells is prednisolone, but still it works with a command for chemotherapy. Therefore, chemotherapy and radiotherapy are the most important treatment s for cancer and another being surgery. What is the relationship between nitric oxide and cancers? Some people think it’s the gas that makes you laugh at the dentist’s office. Some think it’s the fuel racecar drivers use to speed up their cars. But it’s neither. Nitric oxide is a molecule that our body produces to help its 50 trillion cells communicate with each other by transmitting signals throughout the entire body. Nitric oxide has been shown to be important in assist the immune system at fighting off bacteria and defending against tumours, regulate blood pressure by dilating arteries, improve sleep quality, help the memory and behavior by transmitting information between nerve cells in the brain, and others. HIV reduces the immune ability of the white blood cells, but why is that most people with HIV nowadays die of cancer? Should people with cancer worry about their HIV status then? Automatically yes. If you have cancer and you’re having HIV, as far as the immune system is concerned they are all immune depressants. So the cancer cells feed on body cells to survive, the HIV virus feed on body nutrients and they cause a deficit. And by this, they make other body cells die. Through this, the body loses its defense mechanism, automatically if you have two things that are reducing your immune cells, you stand low chances of surviving. In one of your columns in Healthy Times, you discussed how dynamism of medical practices is impacting health service delivery. What is the symbiotic relationship between allopathic and holistic approaches as you mentioned and how are the two applicable in cancer care and treatment? With allopathic approach, it’s a modern practice which involves working in an expertise manner. It entails analysing and investigating deeper about a complaint of an illness. A holistic approach would go for empirical symptomatic treatment and then looking at a faster stabilisation. When you relate them, the allopathic method is the conventional measure that is used in the modern setting, meaning with it you need advanced mechanism of investigation and deeper understanding of the disease before you treat, while with holistic, you take from superficial measures and understanding of the disease. Both are important in cancer treatment, though with allopathic one gets a better understanding of the cancer situation. Click here for a related story