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CERVICAL CANCER.

What is cervical cancer?

Cervical cancer is a malignancy that affects the cells lining the woman’s cervix, which connects the uterus and the vagina. The cervix plays an important role in the female reproductive system for conception, maintenance of pregnancy and timely delivery.
This cancer may affect the deeper tissues of the cervix and may spread often to the lungs, liver, bladder, vagina and rectum. This is described as metastasis. It is the second most common type of cancer which occurs when the cells in a woman’s cervix change from their normal characteristics as will be observed under a microscope by a pathologist.

According to WHO, in 2018, 511000 women were diagnosed with cervical cancer worldwide and 311000 women died from the disease. Kenya losses 9 women daily and this figure translates to 3285 annually!

Causes of cervical cancer.

In cases where one is immunosuppressed (low immunity), then one is likely to develop the cancer.

Cervical cancer has a low latency period and symptoms may begin showing after 20-30 years after infection on the assumption that the majority of youth engage in sexual practices from the ages of 18-24 years. Early sexual debut remains a huge challenge(Durowade et al., 2017). Timely HPV vaccination happens to be the appropriate course of action.

Once the cell is infected,the virus moves into the cell nucleus and integrates into the hosts DNA. This will result to mutation of the DNA and the cells formed will have abnormalities that results into cancer.

Some Human Papilloma Virus (HPV) types carry a higher risk of causing cervical cancer (HR-HPV). This includes type 16 and 17 that cause 70% of cervical cancer.

NB: HPV 16 may also cause oral cancer.

HPV- (HR-HPV) spread through unprotected sexual intercourse from male partner(s) who has/ have multiple sexual partners. It’s important to note that exposed men will always be asymptomatic for this particular virus because of the sexual anatomic differentiation from that of the females.

As HPV is a sexually transmitted virus, men are crucial in the prevention of cervical cancer(Kim et al., 2018). This provides an approach in prevention strategies.

Mutations in their DNA may occur or present uncontrollable growth of cells, which do not die as compared to normal cell growth that die eventually.

Symptoms may include;

Vaginal bleeding after and during intercourse
Vaginal bleeding between periods or after menopause
Watery heavy vaginal discharge that may be heavy and have a foul odor
Dyspareunia (pain during intercourse)

Testing.

As a diagnostic confirmation, testing is crucial for any type of cancer before care is initiated.

Testing may be done to confirm presence of HPV or the abnormal cellular structures and or extent of spread to other tissues.

The following are available tests.

Cobas® 4800 test which approved by FDA.

It’s more sensitive (>95%) than PAP smear (<60%).

It can be done to samples collected by self as well as one collected by your gynaecologist.

Quicker results and validated for women of 25years and above.

Pap test.

Pap smear is the gold standard, as this is done by a qualified gynecologist and examined by a qualified pathologist.

Its the most common test used to look for early changes in cells that can lead to cervical cancer. It involves use of special brush to scrape off cells from the cervix and upper vagina. It’s a painless procedure.

The collected cells will be sent to a laboratory where a pathologist will examine under a microscope for abnormal characteristics.

Ultrasound exam.

A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs in the pelvis and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.

MRI (Magnetic Resonance Imaging).

A procedure that uses a magnet and radio waves to make a series of detailed pictures of areas inside the body, such as the pelvis. The pictures are made by a computer. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Computerized Tomography (CT scan).

A procedure that makes a series of detailed pictures of areas inside the body, such as the pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. This procedure is also called computed tomography or computerized axial tomography.

Bone scan.

A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.

Cystoscopy.

A procedure that looks inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

Proctoscopy.

A procedure for looking inside the rectum and anus to check for abnormal areas, using a

proctoscope. A proctoscope is a thin, tube-like instrument with a light and a lens for viewing the inside of the rectum and anus. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

How to prepare for testing.

For accurate results;

It’s advisable that one does not have sexual intercourse for 2 to 3 days before the test
Avoid washing away abnormal cells
Avoid use of tampons, birth control foams, vaginal pessaries, douches, vaginal creams or powders at least 3 days before the test

What if I’m on my periods?

The best time to schedule your Pap test is at least 5 days after the end of your menstrual period. A Pap test can be done during your menstrual period, but it is better to schedule the test to another time.

Clinical staging.

This is a determination of extent of cancer in the body.

For cancer of the cervix,once the symptoms of unknown cause of bleeding, dyspareunia and discharge of thick yellow fluid with foul smell begin showing then this is an indication of progression of the malignancy.

Staging is important in determining the type clinical care that will be prescribed. May be clinical based on the observation of the physician or pathological based on the examination of biopsies in the laboratory.

Below is a guideline based on the International Federation of Gynacology and Obstetrics (FIGO).

FIGO Stage		Stage Description.
I		The cancer cells have grown from the surface of the cervix into deeper tissues of the cervix. Cancer has not spread to nearby lymph nodes. Cancer has not spread to distant sites.
	IA	There is a very small amount of cancer, and it can be seen only under a microscope. It has not spread to nearby lymph nodes. It has not spread to distant sites.
	IA1	The area of cancer can only be seen with a microscope and is less than 3 mm (about 1/8-inch) deep. It has not spread to nearby lymph nodes. It has not spread to distant sites.
	IA2	The area of cancer can only be seen with a microscope and is between 3 mm and 5 mm (about 1/5-inch) deep. It not has not spread to nearby lymph nodes. It has not spread to distant sites.
	IB	This includes stage I cancer that has spread deeper than 5 mm (about 1/5 inch) but is still limited to the cervix. It has not spread to nearby lymph nodes. It has not spread to distant sites.
	IB1	The cancer is deeper than 5 mm (about 1/5-inch) but not more than 2 cm (about 4/5-inch) in size. It has not spread to nearby lymph nodes. It has not spread to distant sites.
	IB2	The cancer is at least 2 cm in size but not larger than 4 cm. It has not spread to nearby lymph nodes. It has not spread to distant sites.
	IB3	The cancer is at least 4 cm in size and limited to the cervix. It has not spread to nearby lymph nodes. It has not spread to distant sites.
II		The cancer has grown beyond the cervix and uterus, but hasn’t spread to the walls of the pelvis or the lower part of the vagina. It has not spread to nearby lymph nodes. It has not spread to distant sites.
	IIA	The cancer has grown beyond the cervix and uterus but has not spread into the tissues next to the cervix (called the parametria). It has not spread to nearby lymph nodes. It has not spread to distant sites.
	IIA1	The cancer is not larger than 4 cm (about 1 3/5 inches). It not has not spread to nearby lymph nodes. It has not spread to distant sites.
	IIA2	The cancer is 4 cm or larger. It has not spread to nearby lymph nodes. It has not spread to distant sites.
	IIB	The cancer has grown beyond the cervix and uterus and has spread into the tissues next to the cervix (the parametria). It has not spread to nearby lymph nodes. It has not spread to distant sites.
III		The cancer has spread to the lower part of the vagina or the walls of the pelvis. The cancer may be blocking the ureters (tubes that carry urine from the kidneys to the bladder). It might or might not have not spread to nearby lymph nodes. It has not spread to distant sites.
	IIIA	The cancer has spread to the lower part of the vagina but not the walls of the pelvis. It has not spread to nearby lymph nodes. It has not spread to distant sites.
	IIIB	The cancer has grown into the walls of the pelvis and/or is blocking one or both ureters causing kidney problems (called hydronephrosis). It has not spread to nearby lymph nodes. It has not spread to distant sites.
	IIIC	The cancer can be any size. Imaging tests or a biopsy show the cancer has spread to nearby pelvic lymph nodes (IIIC1) or para-aortic lymph nodes (IIIC2). It has not spread to distant sites.
IV		The cancer has grown into the bladder or rectum or to far away organs like the lungs or bones.
	IVA	The cancer has spread to the bladder or rectum or it is growing out of the pelvis.
	IVB	The cancer has spread to distant organs outside the pelvic area, such as distant lymph nodes, lungs or bones. Metastasis is greatest.

How is cervical cancer prevented?

Gardasil 9 vaccine helps prevent infection from HPV-16,HPV-18, and 5 other types of HPV linked to cancer. It can also prevent the 2 low-risk types of HPV known to cause 90% of genital warts(Finocchario-Kessler et al., 2016)(Heard et al., 2017).

The U.S. Food and Drug Administration (FDA) approved Gardasil 9 for everyone between the ages of 9 and 45. The U.S. Centers for Disease Control (CDC) recommends HPV vaccination for everyone through the age of 26 if not already vaccinated. Vaccination is not recommended for everyone older than age 26.

Some adults between the ages of 27 and 45 who have not already been vaccinated may decide to get it after reviewing their risks for infection and benefits of the vaccine with their doctor. Teenagers (both genders) should get the vaccination before they become sexually active. If you are already having sex, you should still talk with your health care team about getting the vaccine. Even if you have 1 type of HPV, the vaccine may protect you from the types of HPV you do not have. Vaccinating the boys is crucial in cutting the cycle for spread and recurrent infection with HPV.

Early detection and treatment of precancerous lesions is another form prevention of cervical cancer. This achieved by screening(Sankaranarayanan, 2014).
Responsible sexual practices can help reduce your risk of HPV. Limiting your number of sex partners is another way to reduce risk. Using a condom cannot fully protect you from HPV during sex as its transmission is more of contact of body with fluids from someone with HPV infection. Sharing of paraphernalia should be discouraged.

Is the HPV vaccine safe and effective?

Studies show that the HPV vaccine is safe and prevents lasting infections. They also show that the vaccine reduces precancerous lesions. Recent research suggests that reducing precancerous lesions results in less cancer.

WHO recommends screening every 5 years from 26-30 years of age.

Treatment.

At early stages,cancer is treatable while as it progresses to later stages only palliative care can be given. Its best to initiate early diagnosis for better outcomes.

Treatment options are;

Surgery.

May include hysterectomy which is removal of uterus.

Radiation.

Use of radiation energy to kill cancer cells.

Chemotherapy.

Administration of anticancer drugs either by oral or injections. There are programs such as clinical trials in a research study in which one or more human subjects are prospectively assigned to one or more interventions (which may include placebo or other control) to evaluate the effects of those interventions on health-related biomedical or behavioral outcomes.

Immunotherapy(Gupta et al., 2020)(296 Proc. Roy. Soc. Med. Volume 67 April 1974 Patient’s, 1980). Use of immune stimulants and booster to enable the immune system to fight cancer.

Palliative care.

Done as clinical symptomatic management with main goal of treatment being to reduce and or manage pain.

TAKE HOME.

Early cancer screening is key in the diagnosis and fight against cancer.
Vaccination of all teenage genders is encouraged to prevent. Note even the boys must be vaccinated.
Its important for the men to look out after women’s health just as much as they do theirs.

References.

296 Proc. roy. Soc. Med. Volume 67 April 1974 patient’s. (1980). 67(April 1974), 1980.

Durowade, K. A., Babatunde, O. A., Omokanye, L. O., Elegbede, O. E., Ayodele, L. M., Adewoye, K. R., Adetokunbo, S., Olomofe, C. O., Fawole, A. A., Adebola, O. E., & Olaniyan, T. O. (2017). Early sexual debut : prevalence and risk factors among secondary school students. Afri Health Sci., 17(3), 614–622.

Finocchario-Kessler, S., Wexler, C., Maloba, M., Mabachi, N., Ndikum-Moffor, F., & Bukusi, E. (2016). Cervical cancer prevention and treatment research in Africa: A systematic review from a public health perspective. BMC Women’s Health, 16(1). https://doi.org/10.1186/s12905-016-0306-6

Gupta, S., Gupta, S. C., Hunter, K. D., & Pant, A. B. (2020). Immunotherapy: A New Hope for Cancer Patients. Journal of Oncology, 2020. https://doi.org/10.1155/2020/3548603

Heard, I., Tondeur, L., Arowas, L., Demazoin, M., Falguières, M., & Du Chatelet, I. P. (2017). Effectiveness of human papillomavirus vaccination on prevalence of vaccine genotypes in young sexually active women in France. Journal of Infectious Diseases, 215(5), 757–763. https://doi.org/10.1093/infdis/jiw639

Kim, H. W., Kim, D. H., & Kim, Y. (2018). Men’s awareness of cervical cancer: A qualitative study 11 Medical and Health Sciences 1117 Public Health and Health Services. BMC Women’s Health, 18(1), 1–10. https://doi.org/10.1186/s12905-018-0650-9

Sankaranarayanan, R. (2014). Screening for cancer in low- and middle-income countries. Annals of Global Health, 80(5), 412–417. https://doi.org/10.1016/j.aogh.2014.09.014

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PROTECTIVE FACE MASK IN THE COVID-19 ERA.

Its day 11, third month of the lock down, 6 Am, my usual day for work. I am considered essential, so its business as usual with much enthusiasm for me and some of my mates, except for those few in dentistry.

I am literally in a matatu enjoying the solemn, quiet, chilly misty drive to work, a whole two-seater seat for skinny me! Of course, this was not accidental! GoK has made sure that safety in public transport during this pandemic be a priority, http://www.xinhuanet.com/english/2020-04/06/c_138949862.htm, many thanks to W.H.O global campaigns across the globe on the needful and benefits of sanitizing with alcohol-based hand sanitizers, proper use of face mask and keeping a social but a “friendly” distance.

This was the first pandemic where I had a chance to participate professionally to offer my little expertise in the disease control and management of any possible outcomes. The use of protective facemasks was the only sure way that we’re going to triumph this virus, CORONAVIRUS! Or, ‘CoVid-Virus’ as my 5-year-old angel calls it. She’s probably right, with the much information she could gather in this span.

In Nairobi city, I saw the price of facemask and its demand conversely rise to several folds than expected. Everyone values life, this statement depends on the amount of dollar one spends a day, as one may see it from a different perspective. They, masks, came in rousing designs branded with favourite portraits of nature, celebrities and even country flags (symbolizing patriotism and solidarity). For the political class, BBI inscriptions did not miss! Some customized for the youth and young adults, had favourite money heist- https://www.imdb.com/title/tt6468322/ – cast on them! All these, to motivate us to put them on appropriately, as recommended by the ministry of health.

Based on the scientific evidence published in major medical journals on the safety of the appropriate use of facemask in the prevention of respiratory infections with specific interest to those due to pathogenic nature, I chose adhering to the guidelines to the later. Even when I am going out for an afternoon walk along the riverbank of The Nairobi River in my in the hood in Kiambu County. I saw a huge problem in the larger population that is cognizant of the catastrophe the globe faces today, but choose to live lackadaisically. They have been living normally, the way our health CS has been quoted on the media, as if everything is perfectly well! Consequently, the results have overwhelmingly expected with a rocketing number of new cases of infections and deaths as observed in Italy. In Kenya today we are 3,215! https://www.worldometers.info/coronavirus/country/kenya/ Majority of the cases in Kenya are from Nairobi and Mombasa counties. Cities are centers of excellence in a particular country. In Kenya, Residents of Nairobi and Mombasa have highest literacy levels but incapable of sane reasoning! Citizens have to policed to wear masks! ‘Sell me one mask I don’t want to be arrested.’ A Nairobi resident at a pharmacy in Hurlingham. It is no wonder our numbers are rising sharply and steadily! These acts have turned our quarantine facilities into a 14-21day cell. Indeed ignorance is no defence!

Fellow practitioners, some of them, unfortunately, fail us in this war by not following the guidelines they encourage the public to adhere. It is my prayer that we all practice what we preach and endeavour to learn. Its only after learning that we shall live to learn even more.

I have made it a personal choice to practice the ritual not as show off but,

In respect and in solidarity with my frontline colleagues who depend on PPE for their safety and that of their families.
When I am out and about, in my small village I consider myself as an agent of change and as a role model of good behaviour to my angel.
Lastly, like those who have come before my time, I believe in the precautionary principle when it comes to this strange and frightening virus.

Impact of Parallel Drug Imports on Kenyan Healthcare.

The parallel importation of pharmaceuticals in Kenya—legally enabled under Section 58(2) of the Industrial Property Act (2001) and regulated by the Pharmacy and Poisons (Parallel Imported Medicinal Substances) Rules (2019)—offers a bold opportunity to bring genuine, patented drugs from lower-price markets without needing the rights holder’s consent. This initiative, designed to enhance affordability and access to life-saving medicines, also unleashes significant risks, especially in a nation where over 70% of our pharmaceuticals are imported. I am compelled to illuminate the critical downsides of this practice, with a passionate focus on the pressing concerns about efficacy that we must not overlook.

1. Risks to Drug Efficacy, Safety, and Quality.

Parallel imports often bypass the manufacturer’s authorised supply chain, leading to potential degradation or alterations that compromise a drug’s therapeutic performance. Efficacy refers to a drug’s ability to produce the intended clinical effect, which can be undermined by improper handling, storage, or sourcing. Key issues include:

Storage and Transportation Challenges: Pharmaceuticals are at risk of exposure to compromised conditions, such as extreme heat, humidity, or extended transit durations, particularly during rerouting from their original markets. For example, temperature-sensitive items like vaccines or biologics may experience a loss of potency if they are not maintained within appropriate cold chain protocols, consequently leading to diminished efficacy. In the context of Kenya’s tropical climate, this issue is exacerbated, as intermediaries may repackage pharmaceuticals without adhering to Good Distribution Practices (GDP).
Sourcing from Unregulated or Low-Price Markets: Imports frequently originate from countries with laxer regulatory oversight (e.g., India or China, which supply ~46% of Kenya’s drugs). These may include “grey market” products not intended for Kenyan use, potentially with formulations optimised for different climates or populations. Labels in non-English languages (e.g., Arabic, Turkish, or German) can confuse users, leading to misuse and diminished efficacy.
Batch Variability and Lack of Localized Testing: Parallel drugs must meet Kenyan registration standards, but efficacy testing is often based on the originator’s data rather than local bioequivalence studies. If sourced from dubious labs, as seen in some generic ARVs delisted by WHO in 2004, therapeutic results may not be achieved, exacerbating conditions like HIV/AIDS treatment failure.
Increased Counterfeit Infiltration: Weak enforcement at ports enables the entry of substandard or falsified (SF) drugs through parallel channels, which mimic genuine products but lack active ingredients. The Pharmacy and Poisons Board (PPB) reports SF drugs account for up to 10-30% of the market, directly eroding public trust and health outcomes.

These factors lead to treatment failures, antibiotic resistance, or adverse events, straining Kenya’s healthcare system. The PPB can suspend imports if efficacy is lacking, but post-market surveillance remains under-resourced.

2. Economic and Market Disruptions

Harm to Local Manufacturing: Kenya’s pharmaceutical sector, which produces ~28-30% of the drugs consumed, faces unfair competition from cheaper imports. This discourages investment in local production, as seen in the East African Community’s goal to reduce non-regional imports to 50% by 2027. Declining sales and efficiency potentially lead to job losses in a sector employing thousands.
Undermining Authorised Distribution: Parallel trade erodes exclusive agreements, forcing price reductions that squeeze margins for legitimate distributors. This can result in supply shortages if originators limit exports to Kenya to avoid arbitrage.

Illustration depicting the classic circular flow of goods alongside the parallel import process in pharmaceuticals, highlighting steps from original manufacturers to customers.

3. Regulatory and Enforcement Challenges

Overburdened Oversight: The PPB must verify each parallel import license for quality, but limited capacity leads to delays and gaps. Importers bear recall responsibilities, but fragmented supply chains complicate traceability.
Public Health Vulnerabilities: In a market where 50% of sales are anti-infectives, efficacy lapses from parallel drugs heighten risks like antimicrobial resistance. Broader fragmentation—driven by ~1,274 importers—fuels illegal trade, with quack outlets dispensing unverified products-double tragedy if you ask me.

4. Social and Ethical Concerns

Erosion of Trust: Patients are increasingly fed ineffective treatments, breeding a toxic skepticism towards healthcare. The most vulnerable—those battling chronic illnesses—are left to face the consequences, as the divide continues to widen.
Dependency on Imports: We are shackled by an overreliance on foreign suppliers, crippling our self-sufficiency ambitions. Kenya’s Vision 2030 and the Africa CDC’s vaccine manufacturing aspirations are nothing but lofty dreams if we don’t break free from this dependency.

In summary, while parallel importation supports affordability, its downsides—especially efficacy risks from supply chain disruptions—pose significant threats to patient safety in Kenya. Strengthening PPB enforcement, mandating local efficacy testing, and incentivizing local production (e.g., via tax exemptions for essential medicines) could mitigate these.

Teleconsultation- a pharmacist perspective.

Teleconsultation has revolutionized healthcare, offering convenience and accessibility to patients. However, for pharmacists, this shift comes with significant challenges, particularly when patients choose to purchase their medications from other outlets after a consultation. To be very honest I find this inconveniencing in some way. This practice not only undermines the pharmacist’s intellectual efforts but also impacts the overall effectiveness of teleconsultation services. Imagine now, the same patient comes to you, wanting you to address a specific ADR – ofcourse the dont want to pay for this consultation!

Intellectual Effort and Expertise

Pharmacists invest considerable time and expertise in teleconsultations, providing personalized advice and ensuring that patients understand their medications. When patients opt to buy their medications elsewhere, it feels like a waste of the pharmacist’s intellectual capabilities. The detailed consultations, which include medication management, potential side effects, and interactions, are rendered less effective if the patient does not follow through with the recommended pharmacy.

Continuity of Care

One of the key benefits of teleconsultation is the continuity of care. When patients purchase their medications from the consulting pharmacist, it ensures that the pharmacist can monitor the patient’s progress and make necessary adjustments. This continuity is disrupted when patients buy from other sources, potentially leading to gaps in care and less optimal health outcomes.

Economic Impact

From an economic perspective, teleconsultation should ideally lead to increased sales for the consulting pharmacy. However, when patients choose other outlets, the financial benefits are lost. This can be particularly detrimental for smaller, independent pharmacies that rely on these sales to sustain their operations.

Pharmacist go

Pharmacist go out of their way in many ways to give their patient value.

Education: Informing patients through tik-tok videos etc about the importance of continuity of care, better therapies, skin care etc and the benefits of purchasing from the consulting pharmacy.
Convenience: Offering delivery services or easy pick-up options to make it more convenient for patients to buy from the consulting pharmacy.
Incentives: Providing discounts or loyalty programs to encourage patients to return to the consulting pharmacy.

Teleconsultation has the potential to enhance healthcare delivery significantly. However, for pharmacists to fully realize its benefits, it is essential to address the issue of patients purchasing medications from other outlets. By fostering a stronger connection between teleconsultation and medication purchase, we can ensure that pharmacists’ intellectual efforts are not wasted and that patients receive the best possible care.

what would you do if you were a pharmacist in this position?

Cancer Clinical trials – Yes or No for a child.

Introduction:

Clinical trials are research studies that test the safety and effectiveness of new medical treatments or drugs in humans. They are an essential part of advancing medical knowledge and provide the basis for developing new cancer treatments. In pediatric oncology, clinical trials have been instrumental in improving the survival rates of children with cancer. This blog post will discuss the benefits of involving children with cancer in clinical trials, as well as ethical considerations surrounding their participation in such studies.

Benefits of Involving Children with Cancer in Clinical Trials:

Access to Latest Treatments:

Children with cancer who participate in clinical trials have access to the latest cancer treatments and drugs, which may not yet be available to the general public. Being part of a clinical trial gives patients priority in receiving innovative treatments that could potentially be the breakthrough that they need.

Improved Survival Rates:

Clinical trials have led to significant improvements in the survival rates of children with cancer. Treatments that are proven effective in clinical trials can be approved by regulatory agencies for routine use in pediatric cancers, thus improving the overall outlook for children with cancer.

Personalized Treatment:

Clinical trials usually involve personalized treatment for children with cancer. These treatments are often based on the child’s unique needs, the stage of the cancer, and other factors, allowing both for customization of effective treatments and sparing unnecessary.

Childhood Cancers.

Introduction:

Childhood cancers are rare but they can be devastating for families. They are characterised by the abnormal growth and division of cells, which can occur in different parts of the body. In this blog post, we will explore the origins of childhood cancers and discuss their signs and symptoms, clinical visits, the stigma and neglect surrounding these conditions, management, managing side effects of treatment, counselling and the outlook for patients.

Origin:

Childhood cancers are usually genetic and arise from mutations that occur during development, viral infections like Epstein-barr virus and Radiations. Studies suggest that inherited mutations may only play a role in 5% of childhood cancer cases, while most childhood cancers are caused by random gene mutations that occur during cell division. These mutations can occur before birth, during childhood, or even later in life. They include; Leukamias, Lymphoma and Tumours of central nervous system, CNS.

Signs and Symptoms:

The signs and symptoms of childhood cancers are often non-specific, and can be similar to more common illnesses like the flu. Some common symptoms include fatigue, unexplained weight loss, fever, bone pain, and swelling or lumps. The sooner a child with cancer symptoms is diagnosed and treated, the better their chances of recovery.

Clinic Visits:

If you are concerned about any symptoms in your child, it is important to bring them to a healthcare professional for proper evaluation. Healthcare professionals can enlist specific tests to find out if the child has any underlying medical issues.

Stigma and Neglect:

Childhood cancers often suffer from social stigma which can lead to neglect and marginalisation. Countries with limited resource availability, treatment and management of these cancers become difficult which results in the patient’s untimely death.

Management:

The management of childhood cancers usually involves a multi-disciplinary team, with doctors from different fields collaborating to come up with the best treatment plan. The treatment will depend on the specific type and stage of cancer, and may include surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy.

Managing Side Effects of Treatment:

The treatments used to manage childhood cancers can have side effects such as nausea, vomiting, hair loss, fatigue, and gastrointestinal distress. Healthcare professionals can use some of the available symptom-relieving drugs and pain relievers to help the patient manage these symptoms and provide them with the necessary care and support they need.

Counselling:

Patients, and families of patients suffering from childhood cancers often experience emotional and psychological burdens that need attention. The support of a psychologist can help patients and their families manage the mental and emotional tolls of cancer.

Conclusion:

Childhood cancers are devastating diseases that require early recognition and prompt management. Healthcare professionals must work together with patients and their families to determine the best treatment plan based on the specific type of cancer and the stage of illness at the time of diagnosis. Children diagnosed with cancer undergo a lot of emotional and psychological trauma, hence the need of a support system that involves professional care and counselling cannot be overemphasized. Using effective treatments to manage side effects can improve the overall quality of life of patients and help them achieve better outcomes. As we continually raise awareness about childhood cancers and the stigma surrounding them, we can help ensure that all children with these diseases receive the support and care they need to achieve a healthy future.

DR. JOHN KANYI

1.Name: Dr. John Kanyi

2. Nationality: Kenyan 🇰🇪

3. Age: 34 Years

4. Would you walk us through your academic journey. – Hehe. I attended Ng’elesha Primary School in Ng’arua, Laikipia, then Ndururumo Highschool in Nyahururu. I joined the University of Nairobi in October 2006 and graduated with a Bachelors degree in Pharmacy (BPharm) in Dec 2010. I hold a post graduate diploma in clinical pharmacy from the MTRH College of health sciences. I am currently pursuing an MPharm (Radiopharmacy) at Sefako Makgatho University of Health Sciences, South Africa.

5. Do you love being a pharmacist? Yes!

6. Which places have you worked so far? – I did my internship at Laborex, then Lifecare Pharmaceuticals and then MTRH for my hospital rotation. After internship, I was posted to Masalani District Hospital, Garissa County, where I immediately became the district pharmacist. I didn’t work there for long-but looking…

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IMMUNOTHERAPY AND CANCER VACCINE.

Among the many researched current cancer treatment options, IMMUNOTHERAPY and CANCER VACCINES tops the list. One in the field of medical sciences my be deemed as an old-fashioned practitioner if s/he doesn’t know what immunotherapy is all about. Such fellows may not exist in Kenya with the availability of worldwide web – WWW- we’re all on the grid of information.

IMMUNOTHERAPY

So, what is immunotherapy?

Immunotherapy, also called biologic therapy, According to the American Society of Clinical Oncology, ASCO, it is described as a type of cancer treatment that boosts the body’s natural defences to fight cancer. It uses substances made by the body or in a laboratory to improve or restore immune system function.

The science of immunology has been in existence from as early as 5^th century BC. Today many amazing applications have saved the world from extinction through human and animal health science. Names like Robert

Koch, Louis Pasteur (Father of Immunology) cannot leave our heads. Edward Jenner eradicated smallpox through the development of vaccines in 1976. Today the world is safer an indication that VACCINES WORK!

Types of immunotherapy.

There are several types of immunotherapy, including:

Monoclonal antibodies and tumour-agnostic therapies
Non-specific immunotherapies
Oncolytic virus therapy
T-cell therapy
Cancer vaccines

How does immunotherapy work?

Stopping or slowing the growth of cancer cells
Stopping cancer from spreading to other parts of the body.
Helping the immune system work better at destroying cancer cells.

One form of immunotherapy is called an immune checkpoint inhibitor. It takes the brakes off immune cells, unlocking their ability to detect altered proteins on cancer cells in order to attack and kill these cells. These drugs include programmed death (PD-1)-inhibitors and PD-L1-inhibitors (such as pembrolizumab, atezolizumab, nivolumab), and cytotoxic T-lymphocyte antigen (CTLA)-4 inhibitors (ipilimumab).

Side effects of immunotherapy.

All drugs have side effects, including the immunotherapy drugs discussed here. Understanding the information below can help if you or a loved one does experience side effects.

These side effects are common but may not occur in all people or with all types of immunotherapies.

Feeling tired (fatigue)
Diarrhoea.
Fever.
Shortness of breath.
Rash and/or blisters, covering less than 10% of the body.
Nausea.
Vomiting.
Itching.

How are the side effects of immunotherapy managed?

Severe side effects are controlled by stopping the immunotherapy and starting corticosteroids (such as prednisone), which are tapered slowly over a period of weeks. If you’ve had immunotherapy at any time in the past,

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report any new symptom to your treating oncologist before self-medicating with drugs purchased over the counter. For example, if you have diarrhoea, taking loperamide (Imodium) may arrest the symptom. But it won’t address the root cause, which is inflammation of the large intestine. Uncontrolled inflammation of the intestine may lead to rupture of the intestinal wall, which can be life-threatening. Similarly, if you have a cough, consuming cough suppressants (caution for products containing codeine needs monitoring I pediatric use if it is a must,) allows lung inflammation to continue and become potentially life-threatening. Medical advice is sought to better manage the symptoms.

Antibiotics and immunotherapy.

As we begin to understand the immune system better, an important nugget of emerging information is that antibiotics may reduce the ability of immunotherapy to kill cancer by killing harmless bacteria that live in the gut. People taking immune checkpoint inhibitors who receive antibiotics are less likely to benefit from immunotherapy than those who do not. Hence, it appears important to avoid unnecessary antibiotics for minor infections, which may be prescribed for patients visiting the ER for fever, cough, or other symptoms suggestive of infections. Check with your cancer team about this.

Challenges and future trends.

Unpredictable efficacy.
Drug resistance.
Cost of immunotherapy drugs re high.
Tumour heterogenicity impedes efficacy.
Need for more predictive biomarkers.

During recent decades, our understanding of cancer immunology has advanced dramatically. Many obstacles still impede the success of cancer immunotherapies in a wider variety of malignancies and patients. However, the rapid progress that has led to the present era of cancer immunotherapy is expected to continue vastly. Current obstacles will likely be surmounted through the implementation of available and potential solutions, including the development of more targeted cancer immunotherapies; personalized treatment with cancer immunotherapy drug combinations; cancer immunoprevention strategies; and additional important innovations.

Success of immunotherapy.

Although immunoprevention for viral-induced cancers has been successful in the setting of hepatitis B and human papillomavirus vaccination, notably, primary prevention of non-viral-induced cancers is in its conception.

CANCER VACCINES.

A vaccine is a biological preparation that provides active acquired immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins.

A cancer vaccine is a product used to help the body fight disease. A vaccine exposes the immune system to an antigen. This triggers the immune system to recognize and destroy that antigen or related materials. There are two (2) types of cancer vaccines.

Prevention vaccines.

The administration of preventive vaccines at pre-malignant stages of the disease holds promise, as they function before tumour-associated immune suppression is established. Accordingly, immunological and clinical studies are yielding impressive results.

Certain human cancers, notably prostate adenocarcinoma and cervical cancer, can currently be detected at very early stages of carcinogenesis. Earlier detection of these cancers, combined with existing vaccines directed against them, will soon make them targets for therapeutic vaccination in the preventive setting

This ability to detect cancer in the pre-malignant setting and being able to immunize patients at the very earliest stages of carcinogenesis, when they have fully competent immune systems, has the potential to cause a fundamental change in how therapeutic cancer vaccines are tested and used clinically.

2. Therapeutic vaccines.

Therapeutic cancer vaccines have been extensively tested in patients with advanced cancer but have had little clinical success, which has been attributed to the immunosuppressive tumour microenvironment.

Limitations of vaccines in cancer.

Autoimmunity seems to be a major setback in this treatment option.
The stage of cancer at which the vaccine is administered also matters a lot. At end-stage very less may be expected as the prognosis is poor.
Underlying diseases like immunosuppressed syndromes my hinder expected outcomes of vaccines
Prior treatments may also have an effect on vaccinations if immunity was compromised example chemotherapy.

Do vaccines work?

This question has brought a lot of controversies both in the political, medical-science and religious arena.

A story is told of Mithridates VI. He was paranoid about being poisoned and so he would take a little portion of poison throughout his life to develop immunity against It. When he was finally captured by the Romans, he attempted suicide by ingesting poison so that he could die but he could not, he was immune. SIMPLE. He was captured, of course alive.

You have your answer.

The government of Kenya supports this ideology, there’s a division of vaccines and immunizations, DVI, in the ministry of health with vision of increasing access and reducing morbidity of vaccine preventable deaths. Today in Kenya all new-born to the age of 5yrs get

immunized free of charge as a government initiative to promote immunization.

So, get out there and vaccinate your daughter against human papilloma virus, HPV, don’t let her become vulnerable, for facts will remain facts even if they’re ignored.

Anti-vaccine crusaders alive today should be thankful for those shots they got; they’d otherwise all be dead. EVIDENCE THAT VACCINES WORK!

References.

www.reseachgate.com

cancer.net.org

onclive.com

practiceupdate.com

National Cancer Institute

cdc.org

clinical care options http://www.nhs.uk/news/2009/09September/Pages/Cervical-cancer vaccine-QA.aspx

Cryotherapy. The wonder of oncology.

Cryotherapy is a treatment that uses extreme cold to destroy cancer cells. Cryotherapy can be used to treat a number of different types of cancer and precancerous conditions.

Cryotherapy and cancer.

Cryotherapy uses extreme cold to destroy cancer cells locally. It’s also called cryosurgery or cryoablation. During cryotherapy treatment the doctor freezes the cancer cells to kill them. It doesn’t treat any cancer cells in other parts of the body. After the treatment the body’s immune system gets rid of the dead tissue over a few weeks.

Why you might have this treatment for prostate cancer.

For men with localized advanced prostate cancer this is the best option. Cryotherapy is an effective treatment and minimally invasive with low surgical risk, low morbidity with good results in the long term follow up in terms of survival, biochemical recurrence, cancer-specific survival and overall survival. It is valid technique for organ confined tumors and preferably in low- and intermediate risk groups. Its safe alternative for patients with high surgical risk or contraindication for radiotherapy with low rate of complications it can be repeated in case of biochemical relapse after histological confirmation of local recurrence.

The low rate of complications with the exception of erectile dysfunction, is good basis for the future for the election of cryosurgery s the techniques of choice for the development of prostatic focal therapy. In fact, although on n experimental basis, it is considered in clinical guidelines.

But information about the long-term outlook to find out if it is as good as other treatments at stopping the cancer coming back is still ongoing. Some cancers need to be frozen and thawed a number of times. Depending on the treatment area, it can take from a few minutes to a couple of hours. To help the doctor position the cryoprobe you may have either an ultrasound scan or CT scan. The position of the cancer in the body affects how the doctor puts the cryoprobe into the area. You may have cryotherapy through the skin (percutaneously) or cryotherapy through a scope. You might also have cryotherapy as part of a clinical trial and this may benefit patients with socio-economic strain.

Cryotherapy for changes on the cervix.

To treat precancerous changes on the cervix the doctor or nurse specialist puts a speculum into the vagina so they can see the cervix. They put special instruments called cryo-probes into the vagina so that they firmly cover the abnormal areas of cervical tissue.

The liquid nitrogen in the cryoprobes then freezes the cells. This process might be repeated a couple of times. The treatment usually takes less than half an hour.

You might have period pain during and for a short time afterwards. And you may have some light vaginal bleeding which can last for up to 4 weeks.

Cryotherapy for skin cancer.

Your doctor sprays liquid nitrogen on to the area of cancer. Or they put it directly on to the area with a cotton swab. The liquid freezes the area. After treatment the liquid nitrogen dissolves and the area thaws.

A scab forms in the area. Over the next month or so the scab falls off along with any dead cancer cells.

Side effects include:

pain
swelling and redness
blistering
infection, although this is uncommon

Rare and longer-term side effects might include scarring, numbness in the area and changes in skin colour, it may become either lighter or darker.

Having cryotherapy for cancer inside the body.

For cancers inside the body, a small probe is inserted next to or inside the tumor. This probe is called a cryoprobe. The cryoprobe is attached to a supply of liquid nitrogen controlled by the doctor. Your doctor or specialist nurse will talk to you beforehand about how you will have treatment and exactly what is involved.

There is a HOPE that there is LIGHT despite all of the darkness.