For most Kenyans, cancer treatment means surgery, chemotherapy and radiotherapy. However, there is another treatment method called brachytherapy, which involves inserting radioactive materials directly on a tumour.
Dr Peter Rotich, the chief radiologist at HCG CCK Cancer Centre says brachytherapy, which is used to accurately treat cancers of the cervix, prostate, oesophagus, endometrium (lining of the uterus), tongue and others affecting the head and neck.
The hospital, which was previously Cancer Care, launched brachytherapy in July and has so far treated 40 patients, most of them suffering from cancer of the cervix, a common disease in Kenyan women.
Not many Kenyans undergo brachytherapy due to low number of treatment centers and some doctors are not familiar with it. Also, most cancer patients seek treatment when the disease has spread to distant organs, making it hard for it to work effectively.
However, Mr Rotich says brachytherapy, given after chemotherapy and 25 sessions of radiotherapy kills remaining tumours and stops them from re-growing.
Does it eliminate cancer cells?
Brachytherapy works best in curing cervical cancer. In developed countries, it has gained popularity because cancer patients can afford to be treated on outpatient basis and it spares the rectum, pelvis and bladder from getting affected from high doses of radiation. It helps shrink cervical cancer tumours in about 70 to 80 per cent of women.
In women with cancer of the endometrium which cannot be surgically removed, brachytherapy can be used for as the first treatment.
How long is the treatment?
It takes about two hours, says Isaac Kamau, a radiation therapist at HSK. For cervical cancer, a patient is first taken into a room where an applicator (a cylindrical kind of device) is inserted through the vagina into the cervix.
The length of the applicator used varies. The depth also depends of whether the disease has spread and if the patient has had the uterus surgically removed or not. After that, the patient is taken to another room for a CT scan. This ensures the applicator is placed appropriately and then the scans are sent to a medical physicist who checks for accuracy so as not to miss the tumour.
The physicist also checks the amount of radiation spilling to surrounding organs, for instance rectum and bladder to avoid late side-effects. The scan is then sent to the brachytherapy room where treatment is done and radioactive material is precisely released to the diseased body part.
How many sessions does a patient require?
Two to three sessions that cost Sh40,000 per session. The National Health Insurance Fund pays for brachytherapy.
Is it an alternative treatment to chemotherapy or radiotherapy?
It is a complementary treatment, Dr Rotich says. However, in men with early prostate cancer which is confined to the prostate alone, brachytherapy can be used alone instead of surgery due to its low risks.
When is surgery advised for women with cervical cancer?
When the cancer is stage one, the uterus and parts of the cervix may be removed . However, most Kenyan women see doctors when the disease has advanced.
‘’Most of the ones we treat have stage 2 to stage 4,’’said Dr Rotich.
For these patients, chemotherapy, 25 sessions of radiotherapy and two to three sessions of brachytherapy work best.
Does one lose sexual function after brachytherapy?
Some women may experience vaginal dryness, bladder incontinence and infertility. Brachytherapy does not affect erection in men and quality of sperm. However, some men may see blood is semen or urine.
For men, there are two types of brachytherapy treatments. A patient may opt for the first method where a therapist inserts radioactive seed-like pellets which stay in the body permanently. This method which costs about Sh800,000 has some risks. The radiactive pellet may fall off, affecting other organs.
Also, it may be cumbersome because through it beeps in airport security checkpoints . The second method is temporary brachytherapy where a radioactive material is placed inside the body for a certain amount of time and then withdrawn. This treatment costs Sh100,000 per session. Patients can do three to five sessions.
Can patients have sex during treatment?
Yes. Mr Kamau says it is advisable to have moderate sex during radiotherapy.
Radiotherapy causes the vagina to lose its elasticity, makes it shorter and it may become narrow. Continued sex may help to ensure it is less stiff and remains a bit stretchy over time. Use lubricants.
What are some of the misconceptions about radiation?
Mr Kamau says most patients think it is painful. ‘’People call radiotherapy kuchomwa (to get burnt). This has made patients fear yet it is a painless process with only the machines humming in the background,’’ he says.
He adds that Kenyans also shy away from seeking treatment. ''Men don’t talk about any abnormalites of the prostate because they think it is a weakness. Most religious women fear male doctors treating them especially for breast and cervix diseases.
How has brachytherapy changed?
Brachytherapy has gradually evolved over the past century. Initially, it was performed by inserting the radioactive sources directly into the tumour (“hot” loading), which exposed hospital staff to high doses of radiation, and hence, brachytherapy did not gain much popularity.