Fifty five year-old Hassan Iddi has been a long distance driver for 35 years and is married with four children. When I spoke to him on the phone, his voice sounded low and unclear. I kept asking him to repeat his words because I could not hear what he was saying. I had to listen carefully in order to get his correct address.
When I finally meet Hassan, I have to get very close to him in order to hear what he is saying. His breath is laboured, with a wheezing sound coming out of his chest. When he speaks, his voice is shaky and low, like a whisper. He keeps clearing his throat while speaking and he is unable to speak without taking an interlude to cough.
Iddi has a scarf wrapped around his neck and on the left side; there is a swelling with a white tip full of pus. In an interview at the cancer ward at Mulago hospital, Hassan narrates his experience of dealing with a cancerous tumour in his voice box.
“I have been an active smoker for a long time as I drove to those long distance destinations. I would smoke a packet of whatever brand of cigarettes I came across. Last year, I developed a deep uncomfortable cough but even when I came to Mulago for treatment, it did not clear. The cough also affected my voice so I could not speak loudly anymore.
I went back to the hospital where they did several tests and the doctor told me I have a problem with my voice box. He told me there was a growth on it that had to be treated.
Six months later, after I had started on the cough treatment, I developed a swelling on my neck but it was painless. However, as the tumour gets bigger, my voice gets worse. The doctor suggested that I must go for surgery after the biopsy tests two months ago so I came here for the operation.”
Head and neck cancers – a leading cause of death
A ccording to Dr Nicholas Asiimwe, a medical officer at Mulago hospital, the persistent cough is called the smokers’ cough caused due to long-term smoking. The smoke usually damages and destroys the protective cilia of the respiratory tract. The outer tumour on the neck is caused by the swelling of the lymph nodes caused by the cancer.
Dr Asiimwe says Hassan has a tumour in the vocal cord and, therefore, cancer of the neck. “This neck cancer was diagnosed at a very late stage. All we can do is give palliative care but we cannot rule out that it can cure.”
He adds, “We shall do a surgery on his voice box and he will go for chemotherapy and radiotherapy like any other cancer patients. This will help him regain his voice but the tumours will be recurrent because of the late diagnosis.”
About the cancers
The head and neck cancers are a leading cause of death and disability in many parts of the world. They affect the breathing, speech, feeding, sight and smell of a person. They usually spread faster to the lymph nodes of the neck causing them to swell.
According to Dr Jeffrey Otiti, an ENT consultant at Uganda Cancer Institute in Mulago hospital, head and neck cancer can cause disfiguring and significant morbidities among patients including loss of sight.
“These cancers are not known by so many people so most of the patients come here when the cancer is in the late stages and all we can do is give palliative care. These cancers spread so fast up to the lymph nodes and usually cause deformities on the head and neck,” Dr Otiti says.
Globally, an estimated 650,000 cases of head and neck cancers are documented every year and two thirds of these are found in developing countries. The cancers claim about 300,000 lives globally with a survival rate of 40 per cent in five years in developed countries but the percentage is much lower in developing countries as only a third of the patients survive due to poor health-seeking behaviour and inadequate treatment.
At the cancer institute, “There are 15 new cases of the head and neck cancers weekly but this is just a tip of the iceberg because so many cases are not documented. People do not come for treatment and die of the cancers of the head and the neck,” says Dr Otiti.
There is inadequate functioning equipment especially with the one radiation machine that serves cancer patients from almost all east African countries.
The institute also has shortage of space to cater for the increasing number of patients that go for treatment as there are only 80 beds for the patients yet the institute receives 80 adult patients daily for chemotherapy only.
Dr Otiti says, “Since most of the tests are done out of the hospital and at high expense, there is always a delay in the initiation of treatment of the cancers as clients do not have the money to do the
Risk factors and treatment of head and neck cancers
According to Dr Jeffrey Otiti, an ENT consultant, head and neck surgeon at Uganda Cancer Institute in Mulago hospital, head and neck cancers usually affect people in their 30s and 40s but can be much earlier depending on the risk factors.
Tobacco: Tobacco use (including chewed tobacco) depending on the duration and frequency of the smoking increases the risk by 25 per cent compared to the non-smokers.
Alcohol intake: Heavy alcohol consumption also pre-disposes one to the risk of catching the cancers. For instance, if someone takes five drinks and a pack of tobacco every day for 10 years, their risk of getting the cancers is 40 times greater.
Human Papilloma Virus: “The head and neck cancers have always been present but the recent trend shows there is a relationship between the Human Papilloma Virus and the cancers,” says Dr Otiti.
Ninety three per cent of the cancers found in the oral cavity are caused by the HP virus while other viruses such as the EBV that cause nasal carcinomas are associated with multiple sex partners and oral-anal contact.”
Dietary deficiencies: The cancers may also develop due to dietary problems such as Vitamin A and iron deficiency that cause changes in the alignment of the throat.
There are also occupational exposure risks to chemicals such as chromium, nickel, radium, asbestos, products from leather and saw dust.
What should be done?
According to Dr Otiti, early diagnosis is the simplest cure for any type of cancer. People should go for examination in case of changes in their speech, breathing or swallowing or see any Ear Nose and Throat (ENT) specialist in case of any abnormal growths in the neck.
The cancers are known to affect the tongue, voice box, pharynx, nasal cavity and throat. Treatment for the cancer includes surgery to remove the cancer tumour, radiation for five days a week for six weeks and chemotherapy depending on how intense the tumour was.
Signs and symptoms of cancer
People with head and neck cancer often experience the following symptoms or signs. Sometimes, people with head and neck cancer do not show any of these symptoms. Or, the symptoms may be caused by a medical condition that is not cancer.
Swelling or sore that does not heal; this is the most common
Red or white patch in the mouth
Lump, bump, or mass in the head or neck area, with or without pain
Persistent sore throat
Foul mouth odor not explained by hygiene
Hoarseness or change in voice
Nasal obstruction or persistent nasal congestion
Frequent nose bleeds and/or unusual nasal discharge
Numbness or weakness of a body part in the head and neck region
Pain or difficulty chewing, swallowing, or moving the jaw or tongue
Ear and/or jaw pain
Blood in the saliva or phlegm, which is mucus discharged in mouth from respiratory passages
Loosening of teeth
Dentures that no longer fit
Unexplained weight loss