BY LUCY ANAYA 

A FEW days before meeting his death, we had agreed on meeting, to discuss on ways and means we were going to use to carry out advocacy. A campaign to sentisitize the public on the dangers of tobacco use as well as popularize the tobacco control act 2007.

Our agenda was to reduce tobacco intake in Kenya through dissemination of accurate information.

Ours was to lobby for pictorial health warnings on cigarettes and engaging the public in active protest, making anti-tobacco issue the national mainstream debate.

The man was an ex-smoker and anti-tobacco advocate on International platform; I therefore banked on his experiences, intellectual prowess coupled with his journalistic skills. He was articulate and organized in his ideas, perhaps it’s a move that endeared him to lovers of journalism who accorded him the honor of being the first African to be awarded the Erick Eich Bert scholarship, to study his masters in journalism at the University of Nairobi, way back in 80’s
 
Remember we were communicating through short messages (sms) and we would ex change upto 10 in a day. Reason, he had lost his voice!

Something cropped up in the midst of our arrangement. He had to undergo his second operation to reconstruct his voice box. Therefore he was in upbeat jovial mood. At least he was going to regain his voice. The sms read, “My dear, I’m undergoing my second operation, please pray for me.” 
Just few days to the D-day, he took a brief stroll, came back to the house breathing heavily and slept. Never to wake up !

This is a tribute to an editor of repute, who worked in all mainstream print media houses in this country. He used the power of a pen to educate, entertain and inform his audience. “Nick” as fondly referred to by his friends, died recently from throat cancer.

What is throat cancer

According to Prof. Herbert O. Oburra, Consultant: Otolaryngologist  Ear nose and throat (ENT), Head and Neck Surgeon , Chairman department of surgery, University of Nairobi, the neck is a big place which starts  from the back of the tongue, tonsils, behind the nose, esophagus, behind the voice box and the voice  box itself.
It is used for breathing, talking and swallowing food.

Throat Cancer is the disease of cancer of the lining of the throat or tonsils or vocal cords, or malignant tumors of the esophagus- gullet and throat. It is a complication related to tobacco smoking or excessive consumption of alcohol.
The professor explains that it can also be associated with an infection of the Human papillomavirus (the same virus that causes cervical cancer) though he insist that cigarette smoking is the main culprit of this disease. He adds humor, “Cigarette smoking is the main culprit that keeps many of us in the business.”
Alcohol alone he notes has been found to cause this type of cancer especially African brew which has lots of impurities.

Various symptoms are associated with throat cancer. For instance difficulty or pain with swallowing, persistent throat pain or ear pain, new or persistent hoarseness in a smoker, coughing up blood, neck nodule/ swollen lymph node, emoptysis, unexplained weight loss, especially in patients who moderately drink alcohol or smoke tobacco.

Cancer of the voice box

Prof. Oburra explains that vocal voice abuse can cause cancer of the voice box.  The cancer of the area around the voice box can invade the voice box itself. Some of the people vulnerable to this include preachers, broadcasters, and football fans, drunkards who shout on top of their voices while on a drinking spree or clubbing.

“Sometimes when the voice is hoarse, a pimple appears making the vocal box not to vibrate in a synchronized manner. This pimple turns to be cancerous,” he discloses and goes a head to explain that difficulties in digesting food in the stomach, making the contents come up causing belching and regular production of the acid also contribute to cancer of the throat.

If detected earlier, the cancer is removed and the voice box reconstructed. The patient therefore gains his voice. Alternatively, a patient undergoes a definitive surgery whereby a permanent whole is inserted in his throat to help in breathing. This surgery is difficult and expensive because a patient requires gargets and need to maintain high standards of hygiene. Blocking of the gargets by mucus, saliva, or other components lead to death.

At times he notes, one can develop cancer at the back of the tongue without knowing hence assume he is well so long as he can swallow and breath.
“Other patients develop some swelling on one side of the neck, be very careful especially if it is not painful, sometimes if a swelling gland is cut, it could be cancerous hence sent its daughter cells to the rest of the body,” warns the professor.

He goes a head, “The disease can only be diagnosed by biopsy-surgical removal of the tissue of the affected area for scrutiny in the laboratory,” he adds
Lose of the voice permanently, difficulty in swallowing and breathing he insist is dangerous and if noticed a patient should seek medical help.
“Brain can sometimes fail to differentiate pain in the throat or ear. That’s why we examine a patient’s mouth, throat and ear. We use telescope to get a bit of the flesh take it to laboratory for testing,” he adds. Research has established that throat Cancer usually occurs in people after the age of 40.
This type of Cancer is not common and only accounts for 3% of cancers diagnosed in adults, about 13,000 cases say in each year.

The don explains that locally cases are common especially in Meru region of Eastern and Kikuyu of Central province. This could be attributed to heavy smoking and genetic disposition. “We all have different genes that is why we look different if one happens to have genes infected with virus causing cancer, then it is bad luck,” he adds

Medical practitioners advise that the risk may be decreased by eating fruits and vegetables.
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Treatment for such an ailment includes surgical resection of the cancer, chemotherapy and a possibility of radiation treatment to burn possible residual cancer.

A study conducted recently and was reported in a section of the media, revealed that this type of cancer is prevalent in men in Western Kenya. It was reported that Patients who suffer from esophageal cancer in Western Kenya have an age of 59.

  Earlier on, the study had indicated that Rift Valley had a low prevalence for this type of cancer.
Responding to this he says, most people in western region take a lot of smoked fish which helps cancer to develop. Local brew such as changaa’ and busaa is also the main contributor of this type of cancer in Western region. The disease is rare in North Eastern and Coast Provinces.
China is the leading country with high cases of throat cancer which is found in particular areas within the country.

Researchers at the Moi Teaching and Referral Hospital (MTRH), found out that it is the 3rd most common cancer in Women.
 According to doctors, it is easy to believe the report since the hospital has clear documentation. All reports of esophageal cancers are separated and analyzed according to gender, age among other things. Therefore makes it easy to monitor the trend of such a disease.
 At the moment, the country has no National Cancer registry. However, documents from Kenyatta National Hospital indicates that approximately 65 cases of cancer of the neck are recorded in a year. If included other tumors and malignant cancers and those treated in private hospitals, the number rises to over a hundred.

Prof. Oburra reveals that it is a difficult operation that takes eight hours or even more. Approximately six surgeons operate on one patient for instance, a dentry surgeon to repair the dental formula, maxillofacial surgeon to repair the face, a speech therapist who teach patient without a voice box how to speak again. This surgery has to ensure  reconstruction of the throat to enable the patient breath again, talk and swallow failure to deter all the mentioned.
                                 
Training

 “The training takes along time and the rewards are low. Many doctors fear or are not interested in this kind of operation because patients come late, it is difficult and takes long, and the patients can be horrible! A lot of mucus, saliva, generally it is dirty.”
He also discloses that there is no cure for cancer at an advanced stage therefore many patients become depressed and die and that is demoralizing for a doctor.

“Majority of the cases are advanced or incurable. Doctors in peripheral centers do not recognize this type of cancers or refer patients to us majority who don’t turn up because of the distance,” he says.
Initially, the government provided transport for patients from poor backgrounds to access treatment in main referrals. This is a phenomenal that has changed. Majority of patients with such cancers are from poor backgrounds therefore die.

The don explains that the nursing care for such patients is difficult. “The nature of secretions from the lining makes the patient discouraged before cured, hence become depressed.” He says

Prof. Oburra’s words
The country has 50 ENT surgeons and six head and Neck surgeons, two are women.
Majority who are trained in neck and head surgery are not interested in practicing.
The number is low compared to US which has more women surgeons compared to men. In Kenya, there is still stereotype that women can not perform most sophisticated surgery. The new phenomena is the academic performance of women at the University level is higher than men’s.
KNH is the best equipped hospital in Sub Saharan Africa for this type of surgery.
The University of Nairobi intends to introduce a new curriculum in Head and Neck Surgery this year. Initially most students trained in South Africa and elsewhere in the world.
Two hospitals KNH and Nairobi have a cobalt 60 machine used for radio therapy. Chemotherapy he explains can be given in any hospital by a physician.

Cancer of Esophagus and Cancer of the throat are different

According to Prof. Peter A. Odhiambo, thoracic and cardiovascular surgery specialist, cancer of the throat is different from cancer of esophagus.

“People call loosely cancer of the gullet (esophagus) as cancer of the throat because there is a problem of swallowing. These are two different complications,” he says. He adds that this type of cancer is common in Kenya compared to Uganda and Tanzania.

He goes a head to explain that in major referral hospital for instance, out of the 30 cancer patients admitted, at least 10 are likely to have cancer of the gullet.  The disease affects more men than women.
In 1975-1976, a research was conducted all over the country which suggested that cattle could have the same disease. This disease was rare in Rift Valley but common on the lake shores.
Tobacco remains the top on the list, as the major cause of this cancer. This is caused as a result of direct smoking or indirect smoking otherwise known as (second hand smoking)
Elsewhere in the world United States (US ) and Australia, bar maids have sued tobacco companies for exposing them to risks of such cancers caused by second hand smoking.