Pancreatic tumour fastest-growing cause of Kenya’s cancer deaths

Pancreatic cancer may be rare but its toll is shocking.

Statistics show it is the fastest- rising killer cancer in Kenya and East Africa as a whole — a trend doctors link to difficulty in detection and diagnosis.

Although it accounted for only one per cent of cancer incidence in Kenya, its fatality rates are high — killing 667 patients in 2017 alone compared to 188 in 1990, figures by Our World in Data, a research team based at the University of Oxford shows.

The trend replicates in the entire East African region where the disease has claimed 36,000 lives over the past 27 years between 1990 and 2017.

“Any cancer that arises in the pancreas is hard to detect at an early stage because it presents with non-specific symptoms.

“However, if it is on the head of the pancreas, a patient presents with yellow eyes (jaundice) so one can catch it in its earlier stages (stage I or II),” says Fredrick Chite, a medical oncologist and haematologist and director, International Cancer Institute.

Statistics reveal that in 2017, pancreatic cancer caused the death of 419 people in Uganda compared to 125 in 1990.

In Tanzania, 774 people died of pancreatic cancer in 2017 compared to 299 in 1990. Rwanda and Burundi recorded 170 and 98 deaths in 2017 respectively.

“Pancreatic cancer is difficult to detect and diagnose early because often there aren’t any noticeable signs or symptoms in the early stages.

“Sometimes the signs and symptoms, when present, are like those of many other illnesses. Moreover, the pancreas is hidden behind other organs such as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts. So when there are stomach pains, one can end up being treated for a condition in any of those organs,’’ said Dr Chite.

More disturbing is that the incidence of pancreatic cancer continues to rise in the region — raising fears of further rises in deaths.

A total of 511 new incidents were reported in Kenya as in 2017, about 310 in Uganda, 564 in Tanzania and 124 in Rwanda. Burundi had the lowest incidence of 74.

Stomach ache, indigestion, unexplained weight loss and faeces that float rather than sink in the lavatory can be warning signs of the potentially deadly disease, according to the Pancreatic Cancer UK.

Early signs

Pancreatic cancer comes in two types — pancreatic adenocarcinoma, which is the most common (85 percent of cases) arising in exocrine glands of the pancreas, and pancreatic neuroendocrine tumour, which is less common (less than five percent) and occurs in the endocrine tissue of the pancreas.

“Sometimes pancreatic cancer may not cause early signs or symptoms.

It is, therefore, important to check with your doctor if you have any of the following: Jaundice — yellowing of the skin and whites of the eyes, light-coloured stools, dark urine, pain in the upper or middle abdomen and back, weight loss for no known reason, loss of appetite and feeling very tired, Dr Chite advises.

The doctor explains that some risk factors of pancreatic cancer include smoking, obesity, having a personal or family history of diabetes or chronic pancreatitis. Some people also inherit gene changes from their parents that raise their risk of pancreatic cancer.

Sometimes these gene changes are part of syndromes that include increased risks of other health problems as well, according the American Cancer Society.

The diagnosis of pancreas cancer includes physical examination and history, blood chemistry studies, tumour marker test, CT-scan and abdominal and endoscopic ultrasound.

“ Diagnosis is made on tissue biopsy. A biopsy involves the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.

“There are several ways to do a biopsy for pancreatic cancer. A fine needle or a core needle may be inserted into the pancreas during an X-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy or surgery,” Dr Chite says.

Statistics from the National Cancer Institute for the period 2014-2018, suggest that 10 per cent of people diagnosed with pancreatic cancer at the local stage had a five-year survival rate of 32 per cent. If the cancer is at stage III, the five-year survival rate is 12 percent.

By stage IV the five-year survival rate falls to below three per cent.

The five-year survival rate is the percentage of people who live at least five years after being diagnosed with cancer.

“Chance of recovery depends on whether or not the tumour can be removed by surgery, the stage of the cancer (the size of the tumour and whether cancer has spread outside the pancreas to nearby tissues or lymph nodes or other places in the body, whether cancer has just been diagnosed or has recurred and the patients general health”, says the oncologist.

Pancreatic cancer can be controlled only if it is found before it has spread when it can be completely removed by surgery. If cancer has spread, palliative treatment can improve the patient’s quality of life by controlling the symptoms and complications of this disease.