On a cold Thursday morning last month, *Fiona Oloo went under the knife determined to win her body and health back from cervical cancer.
Prior to this date, she had been enjoying her retirement in a suburb nestled in Nairobi when a regular visit to her doctor, after she started spotting, alarmed her gynaecologist enough to send the retiree now in her 70s for a Pap smear.
It had been three decades since her last menses, therefore, the spotting was a major red flag. The Pap smear test confirmed the cervical cancer. Luckily, it was at stage one and could be dealt with surgically.
Without delay, Dr Alfred Mokomba, her physician, recommended radical hysterectomy — a procedure to remove all parts of the uterus, fallopian tubes, ovaries and pelvic and aortic lymph nodes — before the malignant cells could spread further.
On the day of the surgery, the team of doctors and nurses at Kenyatta National Hospital (KNH) readied her for the operation in a spacious and well lit ward. And as the anaesthetist slowly put her into a deep sleep while talking to her reassuringly, the lead surgeon, Dr Mokomba, and his support team, already in full gear, scrubbed their hands clean as they exchanged pleasantries.
These conversations only served to show that this was one of the many procedures they had undertaken — and cancer had no chance.
Nothing left to chance
Two nurses in charge of the surgical tools carefully laid them out moments before the surgeon began the operation. In total, there were four nurses inside the operating room — equally shared between the two doctors; to help with the surgical tools and in monitoring the patient's breathing.
The operation began with a vertical incision on her lower abdomen, which cut through the patient’s seven centimetres of visceral fat- as the surgeon slowly made his way through to her uterus; the target organ.
Precision being key, no lymph node along the blood vessels was spared during the process. Dr Mokomba explained that the lymph nodes needed to be removed too to be sure that the surgical procedure had completely got rid of the cancer.
Studies show that during stage one of cervical cancer, “the cancer cells usually grow deeper into the tissues of the cervix, and possibly into the uterus and nearby lymph nodes.”
Dr Mokomba's hands worked through to her reproductive region, intermittently using a harmonic scalpel to cut and seal (cauterise) blood vessels and a suction to draw out excess bodily fluids.
After three hours of careful navigation; the surgeon finally got to the target organ and cut it out. The cancerous area (lesion) on the neck of the womb (cervix) was visible; and the wound appeared pink as if it was swollen; indicating the presence of a growth.
Ms Oloo was finally rid of the cancerous growth that was eating up her cervix.
Her initially apprehensive family was now happy the procedure had been successful and that they could take their mother home — but not until a week later after undergoing intensive care at the hospital. All in all, Ms Oloo emerged as among the lucky few who were able to arrest cancer in its early stages. She now remains under the doctor’s surveilllance to arrest recurrence of cancer - which may attack other organs.
As the family marked a happy ending at the hospital, on the flip side, tens of other women suffering the ravages of cervical cancer remained under palliative care at KNH’s 1D ward.
The ward also takes in patients suffering other forms of cancers of the reproductive system; but a majority remain cervical cancer patients. Most of the patients at the ward were middle-aged women who had sought doctor’s help when the cancer was already too advanced. So critical was the condition of some of the patients that they had to be helped to the washrooms. Others remained immobile, unable to walk due to the immense pain caused by the cancer.
“Most women come in when it is too late, and after they have been bleeding for months, even years. No one should die from cancer, it can be dealt with if detected early,” said Dr Mokomba.
“The dynamics are fast changing and we keep getting cases of very young women, no one is safe. And so every woman should go for early screening and for Pap smear, at least once every three years. Prevention is now possible by vaccination for girls above nine years.”
Pap smear enables doctors to detect lesions or abnormal cells in the cervix that can be treated before they turn cancerous. Kenya is yet to come up with screening guidelines but most countries recommend that women have their first cervical cancer test at the age of 21. Subsequent ones should take place every three years until the age of 70 years.
Dr Mokomba explained that stage two, three and four stages of cervical cancers can only be managed with the help of chemotherapy and radiotherapy.
Stage two means that it has spread beyond the cervix to nearby areas such as the vagina.
Stage three shows it has spread to the pelvic wall, may already occupy a third of the vagina, cause swelling of the kidney or stop it from working. Stage four is the most advanced stage where it has spread to the bladder, rectum and has affected the lymph nodes and over time spread to other parts of the body.
Symptoms of the disease include vaginal bleeding after intercourse, bleeding between periods or after menopause or a watery bloody vaginal discharge that may be heavy or accompanied by a foul smell. At times, those affected may experience pelvic pain or pain after intercourse. Additionally, women living with HIV have four to 10 times greater chance of developing cervical cancer when infected with human papillomavirus (HPV), than HIV-negative women.
Cancer of the cervix is the second most common kind in Kenya after breast cancer, according to recent statistics released by the International Agency for Research on Cancer last year. Cervical cancer is known to cause more deaths at 12 percent (of those diagnosed) than breast cancer (nine percent), said the agency.
The disease claims about eight women in Kenya every day, about 3,000 per year, according to statistics from the Ministry of Health.
Cost and access remain the greatest impediments towards early screening and treatment in Kenya to date. Screening costs at least Sh3,000.
Treatment too is costly with charges ranging from Sh172,000 ($1,720) to Sh759,000 ($7,590) to treat cervical cancer without surgery and Sh672,000 ($6,720) to Sh1.2 million ($12,500) if an operation is carried out, says the National Cancer Control Programme.