Digital technology improves early diagnosis of digestive system cancers

At the Gastroenterology Department in Kenyatta National Hospital (KNH), doctors were crowded in an operating room as they keenly observed events unfolding before them on digital screens.

Specialists from different parts of the world were offering training on the use of advanced medical equipment in the diagnosis and treatment of numerous diseases affecting the digestive (gastroenterological) system.

The hi-tech equipment in question was a device known as the endoscopic ultrasound (EUS). It comprises a tube with a video camera and small ultrasound probe at the end.

Once inserted into the body through natural openings (like the mouth or anus), it relays clear video images of various internal body organs — such as the stomach, liver, gall bladder or pancreas – to digital television monitors installed in the room.

This approach allows doctors to assess the status of targeted body organs whilst determining if a patient has cancer and how far the disease has spread.

The endoscopic ultrasound used on that day was availed at no cost by Olympus – Japanese medical equipment company – with an aim of training selected doctors from various counties and East African countries on their usage.

After the three day training workshop – organised by the Gastroenterology Society of Kenya and KNH - the specialists went back to their respective countries, and so did the technologies they had come with, which benefited about 60 patients treated at no cost during that period.

The trainee doctors were lucky to have had an opportunity to learn locally, as the few local gastroenterologists that are highly skilled in such advanced medical procedures mainly got their training abroad — in Europe, America and South Africa.

But most of their skills are lying idle, as the government is yet to invest in such sophisticated technologies. “And the country is in dire need of them, to address the looming cancer crisis,” said Dr Miriti Kiraitu, Consultant Surgeon and Gastrointestinal Specialist at KNH.

Traditional ultrasounds – such as the ones being distributed to the counties through the government’s medical equipment leasing deal – are used externally.

Doctors usually place the probes on the surface of the skin, say around the abdomen area, to get images of body organs they are interested in like the pancreas or gall bladder.

Though useful, Dr Kiraitu stated that these external ultrasounds are inappropriate for the diagnosis of digestive system cancers as they usually catch them at advanced stages thus compromising treatment success rates.

He notes that computed tomography (CT) scans or Magnetic resonance imaging (MRI) – currently relied on to diagnose these cancers - are much better.

But they are still not effective in catching the cancers early enough (at stage one) when they can easily be cured. The accuracy levels of a CT scan for instance, said Dr Kiraitu, is about 70 per cent with regards to the diagnosis of digestive system cancers.

So sometimes doctors may think a patient’s cancer is localised only to find that it has spread to other body organs when it is already too late.

Cancers affecting the digestive sytem — such as oesophageal, stomach, pancreatic, liver, colon and intestinal – are rapidly rising in Kenya and claiming may lives due to late diagnosis.

Dr Kiraitu therefore noted that it is high time the government invested in endoscopic ultrasounds that can effectively catch the cancers at Stage One. When it is inserted into the body, it is able to offer clear images of the inner lining of organs and subsequent organ muscles.

At stage 1, the cancer will be contained in the inner lining of the stomach for instance and the muscle.

But once the malignant cell go past the muscles, the disease is considered advanced as the cancer cells move to affect other organs like the liver, kidney, pancreas or gall bladder.

In the latter scenario, the patient will need surgery coupled with longer sessions of chemotherapy and radiotherapy which most people cannot afford.

The KNH which has the only radiotherapy machine in the country charges a fee of Sh500 per session and some patients end up dying while waiting for their turn in the long treating queue spanning close to two years.

The private sector offers alternatives but radiotherapy sessions are priced higher – at a cost of between Sh5000 to Sh10, 000 per session.

“As most Kenyans cannot afford the treatment costs, it makes sense for us to prevent cancer and also invest in technologies that can catch the digestive system cancers early enough,” Dr Kiraitu said.

Currently, the endoscopic ultrasound is only available at Nairobi Hospital, making it inaccessible to most Kenyans.

It retails at Sh36 million compared to the less than Sh10 million charged for conventional external ultrasound machines.

“But it is worth the investments to our health sector. And public hospitals really need it as they handle a majority of cancer patients.”

As endoscopic ultrasounds go inside the body, they are in close proximity to gastrointestinal organs and will therefore offer high quality, accurate and detailed images compared to external ultrasounds, MRIs or CT scans.

In addition, the new technology does not expose patients to radiation.

At the time when the endoscopic ultrasound is being performed on a patient, doctors can perform treatment interventions such as scrapping off cancerous cells if the disease is detected in its very early stages. They can also take samples of cells (biopsy) for further tests. The patient is then able to go home the same day.

Of the approximately 41,000 Kenyans diagnosed with cancer annually, about 28,000 end up dead based on the World Health Organisation Global Cancer statistics (GLOBOCAN).

Early symptoms of digestive system cancers such as heart burn, stomach acidity, bloating and blood stained stool usually resemble other stomach complications. So sometimes patients may be misdiagnosed.

“Doctors should be on the lookout and subject patients to further investigation if their stomach symptoms keep recurring even after treatment. You may be treating heart burn yet someone has cancer.”

The Ministry of Health notes that these cancers are on the rise due to factors such as physical inactivity, tobacco use, excessive alcohol intake, over consumption of high calorie diets and reduced intake of fruits and vegetables.