When a doctor asked Esther Gichumbi if she wanted to fight cervical cancer that had struck back the second time and burrowed deep into her lungs, she took a few seconds to answer.
“I felt like he was asking me, ‘do you want to let go and die or do you want to try living? I didn’t like what he said. He told me it was stage 4 cancer. When I heard stage 4, death came to mind,” she says laughing.
At 26, no woman would ever think she would be fighting against cancer that has spread from the cervix to the right lung, aggressively stalling the dreams of becoming a nurse.
For Ms Gichumbi, it is a nightmare that came too early in life, and that she hopes will end soon.
Two years ago, she started having abdominal pains.
“I couldn’t really tell whether the pain was in the lower abdomen or the stomach. I went from one hospital to another, different doctors, different diagnosis. I was treated for amoeba and even given deworming drugs,” she says.
Unlike most women with cervical cancer who seek treatment after bleeding heavily for months, Ms Gichumbi’s menses had not lasted long. At one time, she bled for 10 days, unlike the normal five to seven days.
“I used to have heavy periods when I was younger, so I thought it was normal. But when I started bleeding a week after the menses, I went to see a gynaecologist. After waiting for him from 8am to 1am, he said he couldn’t examine me because I was bleeding. He told me to come back after a month,” she says.
After one month, she went back to the gynaecologist but “he was too busy to see private patients”.
“I went to another gynaecologist and he tried to take a Pap smear sample but he could not because there was a big tumour blocking the cervix. He asked me to do a biopsy instead,” she says. The tests took five days and during this period, even though she was a nurse, cancer never crossed her mind.
“Worst case I thought it would be an STI [sexually transmitted infection]. I picked the results and being a trained nurse, I tore the envelope and my eyes went straight to the conclusions. I saw keratinised squamous cell carcinoma, words that broke my heart into pieces. I threw the envelope. My mother asked what I had read and I told her, ‘They say I have carcinoma’. I knew she did not know what carcinoma meant,” she says.
Cervical cancer, caused by human papillomavirus (HPV), carries a lot of stigma and self-shame. Since HPV usually causes no symptoms, most men can pass it on without realising it. A majority of women blame themselves for the disease yet there are others who have a rare type. They may have an inherited condition that makes them less able to fight off HPV infection than others.
“I spent the whole weekend blaming myself, but now I don’t. I didn’t pray. I thought that I had predisposed myself to cancer. I hated myself, cursed myself. I hoped that it was an early disease that would be surgically removed without chemo,” she says.
The first doctor suggested a hysterectomy (removal of the uterus) and then chemotherapy and radiotherapy treatment.
“I am too young, I don’t have a baby. If I did a hysterectomy, I will never ever have my own baby. I also feared going into early menopause,’’ she says.
The second doctor suggested chemotherapy, radiotherapy and brachytherapy. That time the cancer was at stage 2b.
After four months of treatment, Ms Gichumbi counted herself lucky. The cancer was in remission, the doctor said, although there was some fluid in her lungs that was no cause for worry.
“It was a clean slate in January 2018. I gave my body time to recover and started looking for work in March,’’ she says.
She got a part-time job. Then one day she started having chest pains radiating to the back. “I was taken to a clinic nearby and they assumed it was pneumonia. Without even doing an X-ray, I was given intravenous antibiotics for three days. A few weeks later the pain started again. This time I did an X-ray. My chest was clear,’’ she says. She was given anti-histamine drugs and painkillers but the pain never subsided. She went to another doctor who treated her for “paranoia and acidity.” The fourth doctor asked her to do a CT scan.
“It showed I had one large mass on the right lung, three nodules and fluid. He told me to do a biopsy to see if it was TB or cancer. I was so sure it was TB but it wasn’t,” says Ms Gichumbi.
When cancer recurs, it drags along misery, unexplainable pain and higher costs of treatment.
“When the doctor told me to go home and think about the new treatment which would be harsher and costlier, I told him ‘No, we start right now’. And after the first chemo, my hair fell off,” she says. After nine weeks, she did another test to see if the new chemo drugs were working.
“All I was praying for was that the tumours had reduced and not spread. The results came back and the chemo was not working. The tumours had actually grown bigger. I cried and thanked God they hadn’t spread,” she says.
She was put on a new treatment regime, bevacizumab, a drug that improves survival with advanced cervical cancer. But it is expensive. A dose costs Sh120,000 and she may take it for one or two years. This drug works differently than chemotherapy and helps starve tumours and prevent them from growing.
So far, the tumours in her lungs have shrunk by 10 percent.
“By 26, everyone has big dreams. I had pictured myself in my own house, with a job, financially helping my parents. Most of my age-mates are married. Others have children even though they have no husbands. If God allowed it to happen the second time, then I stand with Psalm 118:17,” she says.