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Cancer: High prevalence of Hodgkin’s Lymphoma worrisome – Expert

The increasing number of Nigerians suffering from Hodgkin’s Lymphoma has become a source of concern, Ima-Obong A. Ekanem, a Professor of Pathology/Chief Consultant Pathologist at…

The increasing number of Nigerians suffering from Hodgkin’s Lymphoma has become a source of concern, Ima-Obong A. Ekanem, a Professor of Pathology/Chief Consultant Pathologist at the faculty of medicine, College of Medical Sciences in the University of Calabar Teaching Hospital, has said.

She said the prevalence in Calabar was higher than what is obtainable elsewhere in the country.

Ekanem, who is also the Director of Calabar Cancer Registry, in an exclusive interview with Daily Trust, explained that Hodgkin Lymphomas are a group of cancers derived from the immune lymphoid white cells called lymphocytes.  There are two major types of Hodgkins and non-Hodgkins lymphomas.

Prof Ekanem said: “Hodgkin lymphomas (HL) have five sub-classes all of which are characterized by an abnormal proliferation of a particular type of B-lymphocytes and a diagnostic giant cell, the Reed Sternberg cell in a background of inflammatory cells.”

According to Ekanem who is also a former national president of the  Cancer Society of Nigeria Hodgkin lymphomas affect mainly young adult males and in some rare cases, elderly males and females.

She said that they do not yet understand the reason for the very high prevalence but that further investigations need be carried out.

She also disclosed that there is a relatively high incidence of prostate cancer and Kaposi sarcoma in men and cervical cancer in women,  adding that breast cancer in women is now of note.

Quoting a recent study conducted by the registry between 2009 and 2013 on Cancer Incidence in Calabar, she said HIV-associated cancer such as cervical cancer, Kaposi’s sarcoma and lymphoma are among the most common cancers in Calabar.

The study disclosed that breast cancer is the leading cause of cancers in women just as it is the most frequently diagnosed cancer in women worldwide where 1.7m new cases were diagnosed a few years ago.

It said that men in their forties are mostly affected by  prostate cancer.  “The age-specific incidence of prostate cancer which is the leading cancer among men in Calabar rises sharply from age 40-44 years.  This possibly may be due to an increased number of urologists in the teaching hospital during the period thus the study leading to more cases being diagnosed.”

She explained that cancer data from the Calabar Cancer Registry, regarded by experts around the world as foremost African cancer registry, indicate that Hodgkin lymphoma is the second commonest cancer in males after the prostate while in females it is the third commonest after cancers of the breast and the uterine cervix.

“The development of Hodgkin lymphoma is closely related to a suppressed immunity of an individual.  This may be due to an infection by certain cancer-causing viruses such as the Epstein Barr Virus (EBV) which also causes Burkitt’s Lymphoma in children and the Human immune deficiency virus (HIV) which causes the Immune Acquired Deficiency Syndrome (AIDS).

“The rising sero-prevalence of HIV infection in less developed countries including Nigeria is strongly related to the rising incidence of HIV-associated cancers observed in Calabar among which are the lymphomas.”

She said that most patients with Hodgkin lymphoma often present with progressive painless enlargement of the lymph nodes in the neck axillary (armpit) region as well as enlargement of lymph nodes in the chest cavity and later of abdominal organs.

She added that as the disease progresses, other symptoms such as fever, night sweats, generalized weakness and weight loss occur.

Ekanem said this ailment may not readily kill but that if there is delay by the patients the danger becomes unavoidable and death becomes inevitable.

But if there is proper treatment using a combination of “chemotherapeutic drugs and/or radiotherapy, the response is quite good. However, palliative care is also helpful in advance cases for pain relief and improved quality of life.”

The expert said “Cancer prevention involves adhering to multiple healthy, behavioural and sociocultural practices which could begin with primary prevention such as vaccination against the causative viruses or protecting self against acquiring the viral infection.

“In the case of Hodgkin lymphoma, HIV infection can be prevented by avoiding a risky sexual lifestyle such as having multiple sexual partners.  Avoiding the use of contaminated needles and syringes especially among drug addicts and of unsterilised surgical blades for traditional procedures like circumcisions, female genital mutilations, uvulectomies and tribal scarifications is important.  Sharing of barbing clippers, needles or using unsterilised instruments by manicurists, pedicurists, hairdressers and barbers could be quite risky and must be avoided.

“If there is no exposure to environmental radioactive pollutants and transfusion of unscreened blood products, the risk of developing Hodgkin lymphoma, is considerably reduced.

“Consumption of a healthy balanced diet is a very important dietary habit for cancer prevention generally.  This must be rich in fruits and green vegetables which provide the body with the essential protective antioxidants capable of neutralizing the oxygen-free radicals that can cause cancer,” she said.

Ekanem said individuals that are sexually active should go for voluntary HIV screening to determine their serological status and avoid transmission to uninfected clients including the unborn babies in the case of pregnant women.

According to Ekanem, over a third of all cancers are preventable by reducing exposure to risk factors. She recommends that early detection of cancers including the use of screening programmes, better awareness and service availability can lead to early diagnosis.

“However, such screening is not affordable by the majority of the women.  For these detection programmes to be effective a strong health care system must be in  place to produce equity of access to diagnosis, treatment and palliative care of all cancer patients.”

She stressed that people should not patronize unorthodox medical practitioners, who carry out life-threatening and hazardous surgical procedures and should ensure the environment at home, workplace and recreational/public facilities were clean and pollution-free.  She added that the annual medical examination is made a  routine.

The cancer expert also advised that people should remember to report any unexplained symptoms like sudden weight loss, generalized weakness and swelling in any part of the body to the doctor.

Ekanem stressed that knowledge of one’s HIV status is important and that the ARV be sustained if sero-positive, maintaining that there should be no breastfeeding of newborn babies by infected mothers.

“To remain healthy and cancer-free, avoid tobacco and harmful use of alcohol.  Do not be overweight or obese by avoiding a sedentary lifestyle.  Regular physical exercise, low intake of sugar, salt, preservatives and saturated fats/calories will enhance good health, prolong life and reduce the chances of dying from cancer and other chronic non-communicable diseases too.

“Finally, keep yourself free from cancer by heeding the early warning signs.  Go for screening, early diagnosis and prompt treatment if cancer is detected.  Remember that cancer is a chronic disease and is curable if detected early.”

Supporting the cancer expert, wife of Cross River State Governor and President of Mediatrix Development Foundation, Dr. Linda Ayade said cancer kills quickly, admonishing women especially those who are sexually active and exposed, to go for regular check-up to avoid cervical cancer, which is a killer disease that is claiming the lives of many women in the society.


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