Lymphoma: The ignored killer

By Miriam Mukama

Cases might be lower than those of lung or breast cancer but this cancer is growing at a quicker rate

Annet Nakawesa, 30, woke up on a hot day, eight months ago feeling fatigued. She realised she had swollen bumps around her neck.

Thinking it was a slight body upset because she was not feeling pain, she ignored the bumps.

Within two months, the swelling had bulged but when she visited doctors, they thought it was just an infection or goiter. They discharged her with pain killers and other drugs.

However, one fateful Saturday morning, she woke up and suddenly realised she could not turn her neck. She was rushed to a hospital near her home in Kyengera in Wakiso district near Kampala.

Unknown to her, the mother of two had been playing with the deadly lymphoma.

“If I had ignored it, I would be dead by now because the pain was unbearable,” she says.

She is not alone.

Although there are numerous strains of cancers, cancer specialists say that lymphoma, which has over 70 different strains classified in at least four categories by the World Health Organisation, is one of the most dangerous. This is because it attacks the immune system that is supposed to protect the body against diseases.  It is also the reason the cancer is associated with people infected with HIV/AIDS.

Lymphoma is the leading type of cancer among children, fourth among men and fifth among women in Uganda, says Dr Jackson Oryem, the Director of Mulago Cancer Institute, a senior consultant and oncologist. We spoke a day before World Cancer Day Feb. 4, on the sidelines of a National Civil Society Consultative dialogue on cancer awareness at the Uganda Cancer Institute (UCI).

The UCI was, in fact, started in 1967 as the Lymphoma Treatment Centre to treat predominantly childhood lymphomas, especially Burkitt’s Lymphoma which is endemic to the tropics.

Oryem says the government plans to expand the institute by erecting a six-story block to house two cancer theatres, wards for the patients, Intensive Care Units and facilities to store tissue for research and future reference.

Today, however, the institute is a small neat sky-blue corrugated iron-roofed bungalow with white-washed walls where anxious-looking patients are squashed together on uncomfortable-looking metal beds, waiting for either treatment or death. The patients have swollen faces, eyes, lips, cheeks, lymph nodes and tumors. Others have masks on their faces.  Their caretakers, perhaps unable to deal with the pain inside, lurk around the tinny compound outside with the same fearful look as the patients.

Lymphoma patients live with varied degrees of pain and discomfort because it attacks the lymphatic structure—a network of vessels and nodes scattered all over the body. Throughout this network of vessels are lymph nodes, where white blood cells are made and stored in all parts of the body. The vessels also carry watery fluid called lymph that contains the infection-fighting white blood cells

So when Lymphoma strikes, the white blood cells known as lymphocytes become abnormal and start dividing without control. Specialists say that lymphoma begins when normal cells change and grow uncontrollably, forming a mass called a tumor. And because lymphatic tissue is present in many parts of the body, lymphoma can start almost anywhere. Groups of lymph nodes are found in the underarms, groin, pelvis, neck, chest, and abdomen. Lymphoma occurs when these infected parts of patient malfunction because the cells have been killed.

Like other cancers, lymphoma symptoms also include non -specific symptoms such as fever, chills, unexplained weight loss, night sweats, and itching.

In its initial changes, symptoms of the ailment may only be the presence of swollen lymph nodes (neck, armpits, and groin), fever, fatigue, weight loss, abdominal swelling or pain, loss of appetite, feeling of weakness, itchy skin, breathlessness along with the swelling of the face and neck.

To Oryem, the main problem about lymphoma cancer, like all other cancers, is that patients lack knowledge of the disease hence making them prone to many other infections.This makes it very difficult to amount an effective measure to treat it if not discovered early.

Out of all new cancer cases diagnosed per year the majority of cases are reported too late.

This is why on Feb.3 his institution kicked off the campaign by launching the cancer awareness magazine. He says that with everybody’s input, cancer can be reined in.

Dr. Christine Ondoa, the Minister of Health, on the World Cancer Day also reminded the public that there are free cancer treatment drugs and other services at UCI Mulago that are accessible free of charge to all Ugandans.

Lymphoma diagnosis includes; several blood tests, biopsy, imaging and bone marrow examinations – depending on what is favorable for the patient.

Treatment for lymphoma also depends on the type and stage. Factors such as age, overall health, and whether one has already been treated for lymphoma cancer before influence the treatment decision-making process.

The most extensively used therapies are combinations of chemotherapy and radiation therapy. Biological therapy that takes advantage of the body’s innate cancer- fighting abilityis used in some cases.

The goal of medical therapy in lymphoma is complete reduction. This means that all signs of the disease have disappeared after treatment.

The numbers of such lymphoma cases might be lower than a third of those of lung or breast cancer currently especially in Uganda but this cancer is growing at a quicker rate and is projected to become the second largest cancer by 2025.