Speedy action saved me from colon cancer

John Anunda was determined to take good care of himself. He lived an active, healthy life and, unlike many ordinary Kenyans, he went for regular check-ups. That is why when the father of six woke up with what seemed like a bad case of constipation on April 16 this year, he was not unduly worried.

“I had difficulty in passing stool, so I took Eno,” recalls the 61 year-old.

Hours later, the situation had not improved, and worse still, he had developed back pain.

By April 21, the pain in his back had become so bad that he could not get out of bed. Concerned, his family rushed him to the Nairobi Hospital, where he underwent a series of tests and a number of x-rays of his back were taken.

They revealed that fourth and fifth discs of his spine were damaged as a result of a tumour that had developed in his colon. He was diagnosed with colon cancer stage three. He and his family were devastated.

“I was told I needed to undergo surgery immediately to remove the tumour, but when I sought a second opinion, the doctor suggested that I wait,” he says.

Meanwhile, Mr Anunda had to undergo chemotherapy. He says that, given that his cancer was at a pretty advanced stage, he had to have a chemo port placed in his chest to help administer the treatment since administering the drugs directly would have adverse side effects.

“That was the most awful experience I have ever undergone. The chemo port was put on my left side after it was discovered that that the veins on the right were not properly developed.

I was extremely scared because the heart is on the left side of the body. After two sessions of chemotherapy, I felt relief and started passing stool again. I was discharged but no sooner had I reached home than my hands got so swollen that they were bigger than my feet,” he recalls.

When he was rushed back to the hospital, he was told that what had happened was a result of negligence; the chemo port had not been flushed with a saline solution as it should be, making it hard for blood to pass from the lungs to the heart, leading to blood clots in his hands.

This meant he had to have an operation to have the chemo port removed, so he would now have the chemotherapy treatment administered directly, despite its negative side effects.

“After four sessions of chemo, I went home on a Sunday but the very next morning I was taken back to hospital because passing stool had become a problem again. After being examined, I was taken to theatre, where a colostomy was done,” he says. (Colostomy involves drawing the healthy end of the large intestine through the abdominal wall through which stool is passed and collected in a bag.)

By then he had undergone six sessions of chemotherapy, and an MRI had established that the tumour had moved to a fold in his colon, making it easier to remove. The operation lasted about 12 hours and eight days later, he could pass stool fairly normally.

On October 5, Mr Anunda received the news that he had been desperately hoping for: “I was told I was cured. Although I am still undergoing chemotherapy to destroy any cancer cells that might still be left, by the grace of God I have defeated colon cancer. Battling cancer is not easy but with prayers and love and care my family showed, I was determined to fight the disease. After all, if we, patients, give up, what hope will our families have?”

But although he is now well, his six-month battle with the disease took a huge toll on his body: he underwent four surgeries, his weight dropped from 178 to 78 kilogrammes and his waistline shrank from 45 to 35 inches.

DIFFERENT TREATMENT

Patients with colon cancer undergo different treatment, depending on a variety of factors. Among these are the stage the cancer has reached, the likelihood that it will recur, and the overall state of the patient’s health.

It is important to note that before a treatment regimen is chosen for a patient, they must be told what to expect and their views sought.

The treatment options are chemotherapy, radiotherapy and surgery. Surgery is the first course of treatment for colon cancer if the disease is diagnosed in good time. During the surgery, the cancerous tumours and nearby lymph nodes are removed. In the case of chemotherapy, a chemical is administered to the patient to destroy the cancer cells. Chemotherapy is sometimes used to shrink the tumour before the patient undergoes surgery, as was done in Mr Anunda’s case.

IN NUMBERS

4
The number of surgeries colon cancer patient John Anunda underwent

100
The number of kilos he lost in weight

10

The number of inches he lost from his waistline

But cancer treatment does not come cheap. For instance, for just one session of chemotherapy Mr Anunda had to pay Sh500,000. He was lucky because every time he was admitted, his National Hospital Insurance Fund medical cover gave Sh150,000, and he was able to raise the rest with the help of family and friends. He says the least he has paid for a chemo session was sh383, 000. Yet it is sometimes necessary for a patient to undergo 12 sessions, with one session after two weeks.

FYI
A chemo port is a small disc made of plastic or metal that is surgically placed under the patient’s skin, usually on the chest, under local anaesthesia. It is connected to a large vein via a catheter. The chemotherapy medicines are given through a special needle that fits into the port.

Prof Abinya cautions that colon cancer is lethal irrespective of the stage at which it is diagnosed, adding that the earlier it is diagnosed, the better. He advises the primary caregivers of those with advanced cancer to consider hospice care.

“A hospice is a place that offers quality care to patients with critical illnesses. There, it is about receiving the best care from trained personnel, which is better than having the patients admitted to hospitals, thereby incurring huge hospital bills related to caregiving. In Kenya, there are also hospice centres like the Nairobi Hospice. They tend to be more affordable than hospital. Besides, it is not only about the patient, but also the caregiver, who is counselled on how to cope and what to do to ease the patient’s pain,” he explains.

He says the government should resolve the current stalemate between the Ministry of Health and nurses, who have been on strike for several months. He says that as a result of the strike, many patients’ cancer patients have relapsed, with some even having died, while others’ conditions have stagnated or worsened because they cannot get attention thanks to the nurses’ strike.

“As much as there are efforts to create cancer awareness, there is a great need to create awareness of colon cancer. Also, support groups for caregivers should be set up just like support groups for other cancer patients to help those taking care of the patients understand more regarding what to do and how to cope,” says Prof Abinya.

Even though Kenyans are becoming aware of cancer in general thanks to initiatives by individuals or through various government initiatives like cancer walks, experts concur that there is a dire need to create awareness about colon cancer, and that the government should look into subsidising the medication as well as buying better equipment for treatment.

What causes colon cancer and measures to take to reduce risks of developing the disease

According to data from the World Health Organisation, colon cancer is the third most common cancer worldwide in both men and women. However, little is known about it compared with cancers that affect other organs such as the lungs, breasts, and ovary and prostrate.

Prof Nicholas Abinya, an oncologist at the Nairobi Hospital, says colon cancer develops when a cancerous tumour starts growing in the inner walls of the large intestines. The disease is treatable if diagnosed in its early stages. However, if it is diagnosed late, it can cause death.

"Both hereditary and environmental factors can lead to one developing this disease. Most colon cancer cases are considered to be sporadic, that is, occurring predominantly under the influence of environmental factors,” he says. “However, there are distinct genetic syndromes that might predispose a person to colon cancer. Still, only a small percentage of colon cancer cases are believed to be hereditary.”
Dr Abinya says colon cancer affects men slightly more than it does women. The risk of colon cancer increases with age, with most cases recorded occurring in people above the age of 60.

A notable factor is that, in people under the age of 20, the incidence of colon cancer is much higher among Blacks than Whites. The opposite is true in the case of adults.

“Generally, the common risk factors for colon cancer are: high alcohol consumption, diets with high concentration of animal protein, fats and calories; being overweight or obese; consumption of diets with very low dietary fibre; being physically inactive; and smoking,” he says, adding, “Smoking is significantly linked to increased risk of colon cancer and death.”

Prof Abinya says the fact that cancer mimics other diseases makes it very hard to detect in the early stages. Consequently, he adds, if you notices any of the following symptoms you should seek medical attention immediately: blood in the stool, a feeling that the bowel doesn’t empty properly after bowel movement, bloating and stomach pain, inexplicable weight loss, a feeling of fullness in the abdomen even when one has not eaten, unexplained iron deficiency in men or in women after menopause, vomiting and persistent fatigue. The persistence of these symptoms might be a sign that one has colon cancer.

Prof Abinya says that there is a lot one can do to lower their chances of developing this disease.

“Make sure that your diet has plenty of fibre, fruits, vegetables and quality carbohydrates. Reduce consumption of red and processed meat or cut them off completely if you can,” he asserts, adding, “switch to good quality fats like avocado, olive, fish and fats from nuts. Also, exercise regularly to keep your body weight healthy.”

He adds that the secret to beating it is going for regular check-ups, especially if one is a first degree relative (parent, sibling or child) of a patient with the disease. This is because chances of having the particular gene defect and cancer are high.