For years, doctors have been looking for signs of cancer of the lymphatic system, lymphoma, just by checking for swellings under the skin.
Dr Andrew Odhiambo, a consultant oncologist says the disease mimics many common illnesses such as pneumonia or tuberculosis (TB). There is, therefore, a risk of missing it in its early stages if patients, caregivers, and clinicians are not aware of the ‘unique' symptoms.
“Some patients have no visible swellings but complain of unintentional weight loss, have a persistent cough, lose breath, have night sweats, swallowing difficulties, skin nodules, swollen breasts or testicles, or vaginal bleeding,” he says.
These patients are usually given antibiotics, TB medicines, or assumed to have cancers of the breast, testes, or cervix.
“When a patient’s symptoms are all over the place, not making sense, not responding to antibiotics by the second month, lymphoma or lupus should come to mind. Clinicians should refer these patients to specialists and do further tests immediately to save them from premature death,” he says.
The specialist who has studied the disease for many years now says other uncommon symptoms he has seen in the patients he treats include dark feaces, skin rash, seizures, and enlarged prostate.
“Others complain of intense hip and shoulder pain for over two months, discomfort in the upper abdomen, heart failure-like symptoms, the bladder doesn’t completely empty each time you urinate,” he says. “It can be hard to suspect cancer,” he adds.
Lymphoma can affect every body part; from breasts, anus, liver, genitals, bones, stomach, nose, paranasal sinuses, kidney, and pancreas.
The good news is even advanced lymphomas are highly treatable.
“Even Stage 4 lymphoma is curable, yet patients are dying even without a diagnosis,” Dr Odhiambo says, citing numerous patients with cancers that had burrowed deep into their bodies but are now okay after months of chemotherapy treatment.
Those with visible bizarre swellings on the face, testicles, breast, or mouth start seeing drastic changes after the second chemo treatment and eventually, the tumours disappear.
Some of the quick tests that can help rule out lymphoma include a CT scan, and blood tests to check kidney, liver function, and levels of uric acid.
“You have a small window to save these patients, send them for these tests” he says.
The availability of new cancer testing technologies such as PET scans at two hospitals in Nairobi has also hastened the diagnosis and treatment of the disease.
“I’m happy now PET scans are here, meaning that we can manage the disease better. The PET scan helps show see if the chemo drugs are working or not. If not, a patient can be switched immediately to second-line treatments {given if first-line drugs stop working},” he says.
Some lymphomas are slow-growing, while others are very fast-spreading. Patients whose disease is caught when it is still contained in one single organ or a single lymph node are said to have stage one cancer.
Those whose disease has moved to two or more lymph nodes on the same side of the diaphragm have stage 2 lymphoma. If the cancer is in two or more lymph nodes above and below the diaphragm, the patient has stage 3 lymphoma. If the cancer has spread to multiple body organs it is said to be stage 4.
In Kenya, lymphoma is the fifth most common cancer with over 2,300 new patients reported to have it every year, according to the World Health Organisation’s International Agency for Research on Cancer.
“Death rates in Kenya are unacceptably high because of late or non-diagnosis, yet the disease can be cured, irrespective of the stage,” says Dr Odhiambo, who also teaches oncology at the University of Nairobi.
