EXPERTS INTRODUCE EARLY SCREENING FOR GASTROINTESTINAL CANCERS IN NIGERIA
Health minister, Prof Chukwu
Gastrointestinal (GI) cancers affecting the oesophagus (gullet), stomach, colon and the rectum collectively are the leading causes of cancer related death worldwide. Though, there are regional varieties that need to be taken into consideration.
There are well recognized pre-cancerous conditions that if detected (via endoscopy or colonoscopy) and treated can alter the natural history and prevent progression to cancer (malignancy). For example Banet's oesophagus and oesophageal cancer, H Pylori infection, atrophic gastritis and gastric cancer, coloration polyp disease and colorectal cancer.
In the developed world, advances in fibre-optic endoscopy, wider availability of endoscopy facilities and public awareness has resulted in the earlier detection and in larger number of cases prevention of cancer development through open access endoscopy (walk-in centers), patient education and formal screening programmes.
In Nigeria, Direct and Therapeutic Endoscopy Centre, D & Tec, is the first of its kind, purpose designed to offer gastro-intestinal assessment and diagnosis to international standards. 'Our team of highly skilled and trained consultants has a combined knowledge and experience level equivalent to well over 60 years,' according to a source at D & Tec.
'The aims of our campaign are firstly to inform and enlighten the community as to the risks of GI cancers as well as highlight some of the early warning symptoms, secondly to offer patients private, confidential and high quality assessments and treatment when indicated,' Dr Austin Obichere, Consultant General Laparascopic Colorectal Surgeon at University College London Hospital said.
Upper GI endoscopy or OGD examines the oesophagus, stomach and duodenum. This is used to determine the cause of the following symptoms; abdominal pain, nausea, vomiting, swallowing difficulties, anaemia gastro-oesophagea reflux, unexplained weight loss, bleeding in the upper GI tract.
'This procedure can also be used to remove objects lodged in the oesophagus and the threat conditions such as bleeding ulcers. It can also be used to biopsy tissue in the upper GI tract. During a biopsy, a small piece of tissue is removed for further examination,' says Dr Abuchi Okaro, Consultant General, Laparoscopic, Upper GI surgeon at the Kent Oncology Centre, Maidstone.
Lower GI endoscopy or Colonscopy is used to visualize the colon and rectum, in order to investigate the cause of blood in the stool, deudominal pain, diarrhoea, a change in bowel habit, or an abnormality found on computerized tomography (CT) scan.
Individuals with previous history of polyps or colon cancers or colonic problems that may be associated with colon cancer (such as ulcerative colitis and colonic polyps) may be advised to have periodic colonscopies because their risks are greater for polyps or colon cancer. How often one should undergo colonscopy depends on the degree of the risks and the abnormalities found at previous colonscopies. More recently, it has been recommended that even healthy people at normal risk for colon cancer should undergo colonscopy at age 50 and every 10 years thereafter, for the purpose of removing colonic polyps before they become cancerous.
Sometimes, a colonscopy is used to confirm the results of other tests, faced occult blood (FOB) test, which is used in routine screening and looks for hidden blood in your stool.
'During the procedure, we may also remove any polyps (small growth of tissue) found on your bowel wall. Polyps are usually benign (not cancerous), but can become cancerous over a number of years. Most bowel cancers are thought to develop from a pre-existing polyp. The assessment of the GI tract is usually performed either under local anesthetic spray or conscious sedation as a day case,' Dr Ayo Oshowo, who trained in laparascopic and colorectal surgery in Oxford and London, United Kingdom said. Continuing, Dr Obichere pointed out that out problem here in Nigeria has always been on the diagnostic side. 'Accurate diagnosis is what we should try to achieve in Nigeria. All symptoms are not for malaria. We need to sort out our diagnosis, we need to have endoscopy services side by side other services in Nigeria.
'We need the technology, the infrastructure and the equipment to do endoscopy investigations in Nigeria and they are not available in Nigeria. We are pioneering this development in Nigeria. Nigerians don't need to go abroad for endoscopic investigation,' he said.
Dr Okaro added, 'any gastrointestinal symptoms that has been on from 4-6 weeks should be investigated. For oesophagus cancer, if you have difficulty in swallowing, you should have it investigated.'
The crack medical team of Dr Obichere, Dr Okaro and Dr Ashawo held a 2-day workshop on endoscopy for Nigeria doctors recently in Lagos. The workshop which was tagged: Castrointestinal Endoscopy Master Class' among other things provided expert instruction on diagnostic and therapeutic endoscopy based on the United Kingdom Joint Advisory Group (JAG) on endoscopy curriculum.
There was a hands-on skill practice, observation of live diagnostic and therapeutic gastrointestinal endoscopy (gastroscopy and colonoscopy), set-up and maintenance of the basic endoscopy start system for doctors, nurses and endoscopy technicians.
Also live cases took place at the Diagnostic and Therapeutic Endoscopy Centre (D & Tec) in Ikeja, Lagos.