Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably. The cancerous cells can invade and destroy surrounding healthy tissue, including organs.
The earlier cancer is diagnosed and treated, the better the chance of curing it.
However, in Malawi cancer care is in a dire state as narrated on Facebook by anatomical pathologist and epidemiologist Dr Tamiwe Tomoka in her open letter to President Lazarus Chakwera in August.
Effective diagnosis and treatment of cancer requires a collaborative approach whereby nurses, clinicians, pathologists, medical laboratory scientists, oncologists and radiologists work closely together as a team.
Diagnosis begins with a thorough physical exam and a complete medical history performed by clinicians. Laboratory tests are usually requested on blood, urine or stool, and are carried out by trained medical laboratory scientists.
Detection of abnormalities in these samples may indicate cancer. For example, the concentration of a particular protein, alpha-fetoprotein (AFP), is raised in most patients with cancer of the liver, some patients with cancer of testis and occasionally in other cancers.
When a tumour is suspected, imaging test such as X-ray, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound and fibre-optic endoscopy examinations help clinicians determine the cancer’s location and size. Imaging tests are just another essential part of diagnosis and treating cancer.
Dr Tomoka said, in her letter, that there is no MRI scanner at Kamuzu Central Hospital (KCH) and thre CT scanner is not functioning.
To confirm the diagnosis of most cancers, a small tissue sample is removed from the suspected tumour and examined under a microscope by a pathologist to check for cancer cells, either from their appearance or by testing for specific cancer markers.
However, as Dr Tomoka observed, there are only two pathologists and five technicians working at the KCH pathology laboratory.
Some types of cancer—such as those of the skin, breast, mouth, testicles, prostate and rectum—can sometimes be detected by routine self-examination or other screening measures before the symptoms become serious.
Most cases of cancer are detected and diagnosed after a tumour can be felt or when other symptoms develop. In a few cases, cancer is diagnosed incidentally as a result of evaluating or treating other medical conditions.
Investment in pathology, laboratory medicine and radiology services has been compromised by a focus on medicinal drugs rather than clinical diagnosis.
Professor Admson Muula of College of Medicine, a constituent of the University of Malawi, in his 2019 article, suggested that government should consider a higher budgetary allocation to clinical diagnosis.
As government is implementing comprehensive but priority-driven healthcare reforms that focus on all health system functions, we all have a role to play.
Journalists, editors and translators with extensive experience in medical writing should write articles highlighting the challenges pathology, laboratory medicine and radiology are experiencing.
Regulatory bodies, including the Nurses Council of Malawi and the Medical Council of Malawi, should protect patients and the public from harm and guide the regulation of their professions.
The diagnostic process is a complex, collaborative activity that involves clinical reasoning and high-quality diagnostic testing to determine the cause of a patient’s health problem.
Research conducted at Queen Elizabeth Central Hospital Oncology Unit has also shown that a previous incorrect diagnosis and treatment of tuberculosis can delay the diagnosis of cancer, and so create an important clinical problem in Malawi.
Depending on the type and stage of cancer, treatment to eradicate the tumour or slow its growth may include some combination of surgery, radiation therapy, chemotherapy, hormone therapy or immunotherapy. The quicker a specific diagnosis is made; the quicker treatment can commence and the better the clinical outcome will be.
There is an urgent need for patients, healthcare staff and policymakers to collaborate in setting measurable targets and indicators for acceptable quality in cancer diagnosis and treatment. Examples of such targets are available from other countries