THE third Friday of October, breast cancer awareness month, was designated National Mammography Day. More women than men (100 to 1) are affected by breast cancer and hence all women from ages 45 to 55 are encouraged to do annual noninvasive screenings with a low dose of radiation. A mammogram shows calcification and or mass. Early detection, diagnosis and treatment if the mass is malignant will yield a better prognosis.

However, there is a plethora of cancers affecting both genders. The most lethal cancers are pancreatic, liver/intrahepatic, lung/bronchus, esophagus and stomach with a record ranging from six to 29 per cent survival in five years. A December 2020 PAHO/WHO publication showed that tracheal/lung/bronchus cancer was the sixth leading cause of death worldwide in 2019, with an increasing trend over previous years.

According to WHO, prostate cancer in men and cervical and breast cancers in women were among the leading causes of death in Guyana for 2018. But there were many other fatal cancers for the same period. In descending order of occurrence locally were uterine cancer, ovarian cancer, lung cancer, stomach cancer, liver cancer, pancreatic cancer and oral cancer. Some other types of prevalent cancers which may not be prominent here in Guyana are melanoma (skin), leukemia, non-Hodgkin lymphoma and colorectal cancer.

From observational studies in cancer prevalence, trends have been established with respect to gender, race and socioeconomics. Generally, more men die from cancer than women (189.5 versus 135.7 per 100,000). With respect to race, more African American than Asian (227.3 versus 85.6 per 100,000) have been affected. The incidents of cancers are greater in first world countries where there is a higher income, better educational opportunities, higher standard of living and increased life expectancy.

The good news is that in 2019 there were 16.9 million cancer survivors and there is a projected 22.2 million by 2030. Vaccines are in the pipeline at the clinical trial stage for some types of cancers. Additionally, new breakthrough treatments which are more tolerable and individualised with far fewer side effects are being tested. Ongoing game-changing research, especially in immunotherapy and gene therapy, may make the difference even in some advanced stage of cancer in the years to come.

Immunotherapy is empowering the body’s natural strength to fight back cancer cells by binding to the antigen hence marking the specific sites for attack and destruction. Soldiers in the army of immunity such as B cells, CD4+, CD8+ and helper T cells then attempt to kill or destroy harmful cells. Cytokines are released which communicates the coordinated combat followed with the dissolution by dendritic cells. The proteins of cancer cells, which are the life-giving nutrient of this monster, is rendered powerless by the macrophages of the immune system which scavenges and engulfs all invading antigens.

Currently in Guyana immunotherapy is not a trending option. The treatment choices available are surgery, radiation and chemotherapy (oral and intravenous) which is yoked with the burden of side effects along with the advancement of the disease itself.

Cancer is staged one to five depending on the disease progression. Staging is coded medical language. It directs treatment options based on the extent of the invasion signalling number and size of tumors and nodes and the location of metastasis in the body. Hence staging is important since it determines the prognosis by extrapolation of the characteristic response to radiation, chemotherapy or immunotherapy.

Some of the required pre-staging routines are physical examination, imaging tests (Xray, ultrasound, CT scan, MRI and PET scan), biopsy and sometimes endoscopy.

Early stage or stage 1 indicates a better survival rating and may only require surgery to remove the targeted mass. After surgical removal of the primary tumor and subsequently the repeated non detection of cancer cells, some persons refer to the status as “cancer-free”. These cells may no longer be detected via scans or in the case of leukemia in the blood. Cancers like leukemia present in the blood has already reached the entire body and cannot be staged unlike a tumor.

The lingo TNM staging where T refers to tumor, N refers to node and M refers to metastasis can be further simplified. The number following the letters T, N and M indicates the size of the tumor, nodes and organs or tissues to which it has metastasised where one is the smallest and four is the largest. Staging can be done at different points of the treatment to measure the success of the treatment outcomes.

There is another factor, the grading system, either low or high and coded G1 to G4. It differentiates the characteristic of the cancer with respect to the aggressive nature or speed of anticipated growth and spread. So a “well-differentiated” description in the lab report means that the cancer cells look normal, which is categorised as low grade with a slow rate of spread. The higher the grade, for example G4, will be described as high grade or “poorly-differentiated” which implies a more aggressive nature.

In end stage cancer palliative care makes the patient more comfortable by alleviating pain from the cancer disease and also side effects from the treatment. It entails appropriate medication and dosing intervals, nutritional changes, relaxation, emotional and spiritual support from family and friends. In Guyana there is a giant gap in palliative care and most times only family members are left to care and provide for such persons by which time all resources would have been exhausted on medical expenses. Faith based organisations can make a huge positive impact not only for the mental state of the patient but also for the caregivers.

In conclusion, you must hold onto to hope and faith, even though tiny as a “mustard seed” because it gives comfort to know that in your weakness lies His strength. As the 2021 World Cancer Day theme suggests, “I am and I will”.

For further advice consult the pharmacist at Medicine Express PHARMACY located at 223 Camp Street, between Lamaha and New Market Streets. If you have any queries, comments or further information on the above topic kindly forward them to medicine.express@gmail.com or send them to 223 Camp Street, N/burg. Tel #225-5142.