Skin infections constitute some of the commonplace health conditions in Nigeria. According to a recent survey published in a health journal, poor personal hygiene practices, especially among children, are believed to be contributory to its prevalence. But what exactly are skin infections?

As an introduction, skin infection is an infection of the skin. Infection of the skin is distinguished from dermatitis, which is inflammation of the skin, but a skin infection can result in skin inflammation. Skin inflammation due to skin infection is called infective dermatitis. Examples of skin infections are described below:

Bacterial infections

• Impetigo is a highly contagious bacterial skin infection most common among pre-school children. It is primarily caused by Staphylococcus aureus, and sometimes by Streptococcus pyogenes.
• Erysipelas is an acute streptococcus bacterial infection of the deep epidermis with lymphatic spread.
• Cellulitis is a diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken – cracks in the skin, cuts, blisters, burns, insect bites, surgical wounds, intravenous drug injection or sites of intravenous catheter insertion. Skin on the face or lower legs is most commonly affected by this infection, though cellulitis can occur on any part of the body.

 Fungal infections

Fungal skin infections may present as either a superficial or deep infection of the skin, hair, and/or nails. They affect as of 2010 about one billion people globally.

 Parasitic infestations, stings, and bites

Parasitic infestations, stings, and bites in humans are caused by several groups of organisms belonging to the following phyla: Annelida, Arthropoda, Bryozoa, Chordata, Cnidaria, Cyanobacteria, Echinodermata, Nemathelminthes, Platyhelminthes, and Protozoa.

 Viral infections

Virus-related cutaneous conditions are caused by two main groups of viruses–DNA and RNA types–both of which are obligatory intracellular parasites.

 Athlete’s foot

Athlete’s foot is a very common infection. The fungus grows best in a warm, moist environment such as shoes, socks, swimming pools, locker rooms, and the floors of public showers. It is most common in the summer and in warm, humid climates. It occurs more often in people who wear tight shoes and who use community baths and pools.

 What causes athlete’s foot?

Athlete’s foot is caused by a microscopic fungus that lives on dead tissue of the hair, toenails, and outer skin layers. There are at least four kinds of fungus that can cause athlete’s foot. The most common of these fungi is trichophyton rubrum.

 What are the symptoms of athlete’s foot?

Signs and symptoms of athlete’s foot vary from person to person. However, common symptoms include:

• Peeling, cracking, and scaling of the feet
• Redness, blisters, or softening and breaking down of the skin
• Itching, burning, or both

 Types of athlete’s foot

• Interdigital: Also called toe web infection, this is the most common kind of athlete’s foot. It usually occurs between the two smallest toes. This form of athlete’s foot can cause itching, burning, and scaling and the infection can spread to the sole of the foot.
• Moccasin: A moccasin-type infection of athlete’s foot can begin with a minor irritation, dryness, itching, or scaly skin. As it develops, the skin may thicken and crack. This infection can involve the entire sole of the foot and extend onto the sides of the foot.
• Vesicular: This is the least common kind of athlete’s foot. The condition usually begins with a sudden outbreak of fluid-filled blisters under the skin. Most often, the blisters develop on the underside of the foot. However, they also can appear between the toes, on the heel, or on the top of the foot.

 How is athlete’s foot diagnosed?

Not all itchy, scaly feet have athlete’s foot. The best way to diagnose the infection is to have your doctor scrape the skin and examine the scales under a microscope for evidence of fungus.

 How is athlete’s foot treated?

Athlete’s foot is treated with topical antifungal medication (a drug placed directly on the skin) in most cases. Severe cases may require oral drugs (those taken by mouth). The feet must be kept clean and dry since the fungus thrives in moist environments.

 How is athlete’s foot prevented?

Steps to prevent athlete’s foot include wearing shower sandals in public showering areas, wearing shoes that allow the feet to breathe, and daily washing of the feet with soap and water. Drying the feet thoroughly and using a quality foot powder can also help prevent athlete’s foot.

Jock itch

Jock itch, also called tinea cruris, is a common skin infection that is caused by a type of fungus called tinea. The fungus thrives in warm, moist areas of the body and as a result, infection can affect the genitals, inner thighs, and buttocks. Infections occur more frequently in the summer or in warm, wet climates. Jock itch appears as a red, itchy rash that is often ring-shaped.

 Is jock itch contagious?

Jock itch is only mildly contagious. The condition can be spread from person to person through direct contact or indirectly from objects carrying the fungus.

 What are the symptoms of jock itch?

• Itching, chafing, or burning in the groin or thigh
• A circular, red, raised rash with elevated edges
• Redness in the groin or thigh
• Flaking, peeling, or cracking skin

How is jock itch diagnosed?

In most cases, jock itch can be diagnosed based on the appearance and location of the rash. If you are not certain that the condition is jock itch, contact your doctor. The doctor will ask about your symptoms and medical history, and will perform a physical exam. A microscopic exam of the scales of skin can confirm the diagnosis.

 How is jock itch treated?

In most cases, treatment of jock itch involves keeping the affected area clean and dry and applying topical antifungal medications. Jock itch usually responds to over-the-counter antifungal creams and sprays. However, prescription antifungal creams are sometimes necessary. During treatment of jock itch, be sure to:

• Wash and dry the affected area with a clean towel
• Apply the antifungal cream, powder, or spray as directed
• Change clothes – especially underwear – everyday

 Ringworm

Ringworm, also called tinea corporis, is not a worm, but a fungal infection of the skin. It can appear anywhere on the body and looks like a circular, red, flat sore. It is often accompanied by scaly skin. The outer part of the sore can be raised while the skin in the middle appears normal. Ringworm can be unsightly, but it is usually not a serious condition.

 Is ringworm contagious?

Ringworm can spread by direct contact with infected people or animals. It also may be spread on clothing or furniture. Heat and humidity may help to spread the infection.

 What are the symptoms of ringworm?

Ringworm appears as a red, circular, flat sore that is sometimes accompanied by scaly skin. There may be more than one patch of ringworm on the skin, and patches or red rings of rash may overlap. It is possible to have ringworm without having the common red ring of rash.

How is ringworm diagnosed?

A doctor can diagnose ringworm based on the appearance of the rash or reported symptoms. He or she will ask about possible exposure to people or animals with ringworm. The doctor may take skin scrapings or samples from the infected area and look at them under a microscope to confirm the diagnosis.

Boils

A boil is a skin infection that starts in a hair follicle or oil gland. At first, the skin turns red in the area of the infection, and a tender lump develops. After four to seven days, the lump starts turning white as pus collects under the skin.

The most common places for boils to appear are on the face, neck, armpits, shoulders, and buttocks. When one forms on the eyelid, it is called a sty. If several boils appear in a group, this is a more serious type of infection called a carbuncle.

Causes of boils

Most boils are caused by a germ (staphylococcal bacteria). This germ enters the body through tiny nicks or cuts in the skin or can travel down the hair to the follicle.

Symptoms of boils

A boil starts as a hard, red, painful lump usually about half an inch in size. Over the next few days, the lump becomes softer, larger, and more painful. Soon a pocket of pus forms on the top of the boil.

These are the signs of a severe infection:

• The skin around the boil becomes infected. It turns red, painful, warm, and swollen.
• More boils may appear around the original one.
• A fever may develop.
• Lymph nodes may become swollen.

When to seek medical care:

• You start running a fever.
• You have swollen lymph nodes.
• The skin around the boil turns red or red streaks appear.
• The pain becomes severe.
• The boil does not drain.
• A second boil appears.
• You have a heart murmur, diabetes, any problem with your immune system, or use immune suppressing drugs (for example, corticosteroids or chemotherapy) and you develop a boil.

Boils usually do not need immediate emergency attention. If you are in poor health and you develop high fever and chills along with the infection, a trip to a hospital’s emergency room is needed.

 Exams and tests

Your doctor can make the diagnosis with a physical exam. Many parts of the body may be affected by this skin infection; so some of the questions or exam may be about other parts of your body.

Boils treatment – home remedies

• Apply warm compresses and soak the boil in warm water. This will decrease the pain and help draw the pus to the surface. Once the boil comes to a head, it will burst with repeated soakings. This usually occurs within 10 days of its appearance. You can make a warm compress by soaking a wash cloth in warm water and squeezing out the excess moisture.
• When the boil starts draining, wash it with an antibacterial soap until all the pus is gone. Apply a medicated ointment and a bandage. Continue to wash the infected area two to three times a day and to use warm compresses until the wound heals.
• Do not pop the boil with a needle. This could make the infection worse.

Leprosy

Leprosy is an infectious disease that causes severe, disfiguring skin sores and nerve damage in the arms and legs. The disease has been around since the beginning of time, often surrounded by terrifying, negative stigma and tales of leprosy patients being shunned as outcasts. At one time or another, outbreaks of leprosy have affected, and panicked, people on every continent. The oldest civilisations of China, Egypt, and India feared leprosy was an incurable, mutilating, and contagious disease.

However, leprosy is actually not highly contagious. You can catch it only if you come into close and repeated contact with nose and mouth droplets from someone with untreated, severe leprosy. Children are more likely to get leprosy than adults.

Today, more than 200,000 people worldwide are infected with leprosy, according to the World Health Organisation, most of them in Africa and Asia. About 100 people are diagnosed with leprosy in the U.S. every year, mostly in the South, California, Hawaii, and some U.S. territories.

What causes leprosy?

Leprosy is caused by a slow-growing type of bacteria called Mycobacteriumleprae (M. leprae). Leprosy is also known as Hansen’s disease, after the scientist who discovered M. leprae in 1873.

What are the symptoms of leprosy?

Leprosy primarily affects the skin and the nerves outside the brain and spinal cord, called the peripheral nerves. It may also strike the eyes and the thin tissue lining the inside of the nose.

The main symptom of leprosy is disfiguring skin sores, lumps, or bumps that do not go away after several weeks or months. The skin sores are pale-coloured. Nerve damage can lead to:

• Loss of feeling in the arms and legs
• Muscle weakness

It takes a very long time for symptoms to appear after coming into contact with the leprosy-causing bacteria. Some people do not develop symptoms until 20 or more years later. The time between contact with the bacteria and the appearance of symptoms is called the incubation period. Leprosy’s long incubation period makes it very difficult for doctors to determine when and where a person with leprosy originally got sick.

 Forms of leprosy

Leprosy is characterised according to the number and type of skin sores you have. Specific symptoms and your treatment depend on the type of leprosy you have. The types are:

• Tuberculoid: A mild, less severe form of leprosy. People with this type have only one or a few patches of flat, pale-coloured skin (paucibacillary leprosy). The affected area of skin may feel numb because of nerve damage underneath. Tuberculoid leprosy is less contagious than other forms.
• Lepromatous: A more severe form of the disease. It involves widespread skin bumps and rashes (multibacillary leprosy), numbness, and muscle weakness. The nose, kidneys, and male reproductive organs may also be affected. It is more contagious than tuberculoid leprosy.
• Borderline: People with this type of leprosy have symptoms of both the tuberculoid and lepromatous forms.

How is leprosy diagnosed?

If you have a suspicious skin sore, your doctor will remove a small sample of the abnormal skin and send it to a lab to be examined. This is called a skin biopsy. A skin smear test may also be done. With paucibacillary leprosy, no bacteria will be detected. In contrast, bacteria are expected to be found on a skin smear test from a person with multibacillary leprosy.

 How Is leprosy treated?

Leprosy can be cured. In the last two decades, more than 14 million people with leprosy have been cured. The World Health Organisation provides free treatment for all people with leprosy.

Treatment depends on the type of leprosy that you have. Antibiotics are used to treat the infection. Long-term treatment with two or more antibiotics is recommended, usually from six months to a year. People with severe leprosy may need to take antibiotics longer. However, antibiotics cannot reverse nerve damage.

Anti-inflammatory drugs are used to control swelling related to leprosy. This may include steroids, such as prednisone. Patients with leprosy may also be given thalidomide, a potent medication that suppresses the body’s immune system. It helps treat leprosy skin nodules. Thalidomide is known to cause severe, life-threatening birth defects and should never be taken by pregnant women.

 Leprosy complications

Without treatment, leprosy can permanently damage your skin, nerves, arms, legs, feet, and eyes.

Complications of leprosy can include:

• Blindness or glaucoma.
• Disfiguration of the face (including permanent swelling, bumps, and lumps).
• Erectile dysfunction and infertility in men.
• Kidney failure.
• Muscle weakness that leads to claw-like hands or an inability to flex the feet.
• Permanent damage to the inside of the nose, which can lead to nosebleeds and a chronic, stuffy nose.
• Permanent damage to the peripheral nerves, the nerves outside the brain and spinal cord, including those in your arms, legs, and feet.

Nerve damage can lead to a dangerous loss of feeling. A person with leprosy-related nerve damage may not feel pain when the hands, legs, or feet are cut, burned, or otherwise injured. Approximately 1 to 2 million people worldwide are permanently disabled because of leprosy.

 Carbuncles

A carbuncle is a red, swollen, and painful cluster of boils that are connected to each other under the skin. A boil (or furuncle) is an infection of a hair follicle that has a small collection of pus (called an abscess) under the skin. Usually single, a carbuncle is most likely to occur on a hairy area of the body such as the back or nape of the neck. But a carbuncle also can develop in other areas of the body such as the buttocks, thighs, groin, and armpits.

 Cause

Most carbuncles are caused by Staphylococcus aureus bacteria, which inhabit the skin surface, throat, and nasal passages. These bacteria can cause infection by entering the skin through a hair follicle, small scrape, or puncture, although sometimes there is no obvious point of entry.

Filled with pus – a mixture of old and white blood cells, bacteria, and dead skin cells — carbuncles must drain before they’re able to heal. Carbuncles are more likely than boils to leave scars.

An active boil or carbuncle is contagious: the infection can spread to other parts of the person’s body or to other people through skin-to-skin contact or the sharing of personal items. So it’s important to practice appropriate self-care measures, like keeping the area clean and covered, until the carbuncle drains and heals.

Carbuncles require medical treatment to prevent or manage complications, promote healing, and minimise scarring. Contact your doctor if you have a boil or boils that have persisted for more than a few days.

 Risk factors for carbuncles

Older age, obesity, poor hygiene, and poor overall health are associated with carbuncles. Other risk factors for carbuncles include:

• Chronic skin conditions, which damage the skin’s protective barrier
• Diabetes
• Kidney disease
• Liver disease
• Any condition or treatment that weakens the immune system

Carbuncles also can occur in otherwise healthy, fit, younger people, especially those who live together in group settings such as college dorms and share items such as bed linens, towels, or clothing. In addition, people of any age can develop carbuncles from irritations or abrasions to the skin surface caused by tight clothing, shaving, or insect bites, especially in body areas with heavy perspiration.

 Symptoms of carbuncles

The boils that collect to form carbuncles usually start as red, painful bumps. The carbuncle fills with pus and develops white or yellow tips that weep, ooze, or crust. Over a period of several days, many untreated carbuncles rupture, discharging a creamy white or pink fluid.

Superficial carbuncles – which have multiple openings on the skin’s surface – are less likely to leave a deep scar. Deep carbuncles are more likely to cause significant scarring. Other carbuncle symptoms include fever, fatigue, and a feeling of general sickness. Swelling may occur in nearby tissue and lymph nodes, especially lymph nodes in the neck, armpit, or groin.

 Complications of carbuncles

Sometimes, carbuncles are caused by methicillin-resistant Staphylococcus aureus (MRSA) bacteria, and require treatment with potent prescription antibiotics if the lesions are not drained properly.

In rare cases, bacteria from a carbuncle can escape into the bloodstream and cause serious complications, including sepsis and infections in other parts of the body such as the lung, bones, joints, heart, blood, and central nervous system.

Sepsis is an overwhelming infection of the body that is a medical emergency and can be fatal if left untreated. Symptoms include chills, a spiking fever, rapid heart rate, and a feeling of being extremely ill.

Home treatment for carbuncles

The cardinal rule is to avoid squeezing or irritating a carbuncle, which increases the risk of complications and severe scarring.

Warm compresses may promote the drainage and healing of carbuncles. Gently soak the carbuncle in warm water, or apply a clean, warm, moist washcloth for 20 minutes several times per day. Similar strategies include covering the carbuncle with a clean, dry cloth and gently applying a heating pad or hot water bottle for 20 minutes several times per day. After each use, washcloths or cloths should be washed in hot water and dried at a high temperature.

Washing the carbuncle and covering the area with a sterile bandage also may promote drainage and healing and help prevent the infection from spreading. Over-the-counter medications such as acetaminophen or ibuprofen can help relieve the pain of an inflamed carbuncle.

It is important to thoroughly wash your hands after touching a carbuncle. Launder any clothing, bedding, and towels that have touched a carbuncle and avoid sharing bedding, clothing, or other personal items.

Medical treatments for carbuncles

See your doctor if a boil or boils do not drain and heal after a few days of home treatment; or if you suspect you have a carbuncle. Also, seek medical evaluation for a carbuncle that develops on your face, near your eyes or nose, or on your spine. Also see a doctor for a carbuncle that becomes very large or painful.

Your doctor may cut and drain the carbuncle, and ensure that all the pus has been removed by washing the area with a sterile solution. Some of the pus can be collected and sent to a lab to identify the bacteria causing the infection and check for susceptibility to antibiotics.

If the carbuncle is completely drained, antibiotics are usually unnecessary. But treatment with antibiotics may be necessary in cases such as:

• When MRSA is involved and drainage is incomplete
• There is surrounding soft-tissue infection (cellulitis)
• A person has a weakened immune system
• An infection has spread to other parts of the body

Depending on severity, most carbuncles heal within two to three weeks after medical treatment.

Impetigo

Impetigo is a highly contagious bacterial skin infection. It can appear anywhere on the body but usually attacks exposed areas. Children tend to get it on the face, especially around the nose and mouth, and sometimes on the arms or legs. The infected areas appear in plaques, ranging from dime to quarter size, starting as tiny blisters that break and expose moist, red skin. After a few days the infected area is covered with a grainy, golden crust that gradually spreads at the edges.

In extreme cases, the infection invades a deeper layer of skin and develops into ecthyma, a deeper form of the disease. Ecthyma forms small, pus-filled bumps with a crust much darker and thicker than that of ordinary impetigo. Ecthyma can be very itchy, and scratching the irritated area spreads the infection quickly. Left untreated, the sores may cause permanent scars and pigment changes.

The gravest potential complication of impetigo is post-streptococcal glomerulonephritis, a severe kidney disease that occurs following a strep infection in less than 1 per cent of cases, mainly in children. The most common cause of impetigo is Staphylococcus aureus. However, another bacteria source is group A streptococcus. These bacteria lurk everywhere.

It is easier for a child with an open wound or fresh scratch to contract impetigo. Other skin-related problems, such as eczema, body lice, insect bites, fungal infections, and various other forms of dermatitis can make a person susceptible to impetigo.

Most people get this highly infectious disease through physical contact with someone who has it, or from sharing the same clothes, bedding, towels, or other objects. The very nature of childhood, which includes lots of physical contact and large-group activities, makes children the primary victims and carriers of impetigo.

Pilonidal cyst

A pilonidal cyst occurs at the bottom of the tailbone (coccyx) and can become infected and filled with pus. Once infected, the technical term is pilonidal abscess. Pilonidal abscesses look like a large pimple at the bottom of the tailbone, just above the crack of the buttocks. It is more common in men than in women. It usually happens in young people up into the fourth decade of life.

 Causes

Most doctors think that ingrown hairs cause pilonidal cysts. Pilonidal means “nest of hair.” It is common to find hair follicles inside the cyst. Another theory is that pilonidal cysts appear after trauma to that region of the body. During World War II, more than 80,000 soldiers developed pilonidal cysts that required a hospital stay. People thought the cysts were due to irritation from riding in bumpy Jeeps. For a while, the condition was actually called “Jeep disease.”

 Symptoms

The symptoms of a pilonidal cyst include:

• Pain at the bottom of the spine
• Swelling at the bottom of the spine
• Redness at the bottom of the spine
• Draining pus
• Fever

 When to seek medical care for a pilonidal cyst

A pilonidal cyst is an abscess or boil that needs to be drained or lanced, to improve. Like other boils, it does not improve with antibiotics. If any of the above symptoms occur, consult a doctor.

Exams and tests

A doctor can diagnose a pilonidal cyst by taking a history (asking about the patient’s history and symptoms regarding the cyst) and performing a physical exam. The doctor may find the following conditions:

• Tenderness, redness, and swelling between the cheeks of the buttocks just above the anus
• Fever
• Increased white blood cells on a blood sample (not always taken)
• Inflammation of the surrounding skin

 Home remedies

Early in an infection of a pilonidal cyst, the redness, swelling, and pain may be minimal. Sitting in a warm tub may decrease the pain and may decrease the chance that the cyst will develop to the point of requiring incision and drainage.

 Medical treatment for a pilonidal cyst

Antibiotics do not heal a pilonidal cyst. Doctors have any of a number of procedures available, including the following treatments.

• The preferred technique for a first pilonidal cyst is incision and drainage of the cyst, removing the hair follicles and packing the cavity with gauze.

Advantage – Simple procedure done under local anaesthesia

Disadvantage – Frequent changing of gauze packing until the cyst heals, sometimes up to three weeks

• Marsupialisation – This procedure involves incision and draining, removal of pus and hair, and sewing of the edges of the fibrous tract to the wound edges to make a pouch.

Advantages – Outpatient surgery under local anaesthesia, minimises the size and depth of the wound without the need to pack gauze in the wound

Disadvantages – Requires about six weeks to heal, needs a doctor trained in the technique

• Another option is incision and drainage with immediate closing of the wound.

Advantages – Wound completely closed immediately following surgery without need for gauze

Disadvantages – High rate of recurrence (it is hard to remove the entire cyst, which might come back). Typically performed in an operating room, it requires a specially trained surgeon.

Skin and molluscum contagiosum

Molluscum contagiosum is a viral skin infection that causes either single or multiple raised, pearl-like bumps (papules) on the skin. It is a chronic infection and lesions may persist from a few months to a few years. However, most cases resolve in six to nine months.

 Causes

Molluscum contagiosum is caused by a virus (the molluscum contagiosum virus) that is part of the pox virus family. The virus is contagious through direct contact and is more common in children. However, the virus also can be spread by sexual contact and can occur in people with compromised immune systems. Molluscum contagiosum can spread on a single individual through scratching and rubbing.

 Symptoms

Common locations for the molluscum contagiosum papules are on the face, trunk, and limbs of children and on the genitals, abdomens, and inner thighs of adults. The condition usually results in papules that:

• Are generally painless, but can itch
• Are small (2 to 5 millimetre diameter)
• Have a dimple in the centre
• Are initially firm, dome-shaped, and flesh-coloured
• Become softer with time
• May turn red and drain over time
• Have a central core of white, waxy material

Molluscum contagiosum usually disappears spontaneously over a period of months to years in people who have normal immune systems. In people who have AIDS or other conditions that affect the immune system, the lesions associated with molluscum contagiosum can be extensive and especially chronic.

 Diagnosis

Diagnosis of molluscum contagiosum is based on the distinctive appearance of the lesion. If the diagnosis is in question, a doctor can confirm the diagnosis with a skin biopsy — the removal of a portion of skin for closer examination. If there is any concern about related health problems, a doctor can check for underlying disorders.

Treatment

Molluscum contagiosum is usually self-limited, so treatment is not always necessary. However, individual lesions may be removed by scraping or freezing. Topical medications, such as those used to remove warts, may also be helpful in lesion removal.

Note: The surgical removal of individual lesions may result in scarring.

 Prevention

To prevent molluscum contagiosum, follow these tips:

• Avoid direct contact with anyone who may have the condition.
• Treat underlying eczema in children.
• Remain sexually abstinent or have a monogamous sexual relationship with an uninfected individual. (Male and female condoms cannot offer full protection as the virus can be found on areas not covered by the condom.)

Shingles

Shingles (herpes zoster) results from a reactivation of the virus that also causes chickenpox. With shingles, the first thing you may notice is a tingling sensation or pain on one side of your body or face. Painful skin blisters then erupt on only one side of your face or body along the distribution of nerves on the skin. Typically, this occurs along your chest, abdomen, back, or face, but it may also affect your neck, limbs, or lower back. The area can be very painful, itchy, and tender. After one to two weeks, the blisters heal and form scabs, although the pain often continues.

The deep pain that follows after the infection has run its course is known as postherpetic neuralgia. It can continue for months or even years, especially in older people. The incidence of shingles and of postherpetic neuralgia rises with increasing age. More than 50 per cent of cases occur in people over 60. Shingles usually occurs only once, although it has been known to recur in some people.

 What causes shingles?

Shingles arises from varicella-zoster, the same virus that causes chickenpox. Following a bout of chickenpox, the virus lies dormant in the spinal nerve cells. But it can be reactivated years later when the immune system is suppressed by:

• Physical or emotional trauma
• A serious illness
• Certain medications

Medical science doesn’t understand why the virus becomes reactivated in some people and not in others.

Chicken Pox

Chickenpox (varicella), a viral illness characterised by a very itchy red rash, is one of the most common infectious diseases of childhood. It is usually mild in children, but adults run the risk of serious complications, such as bacterial pneumonia.

People who have had chickenpox almost always develop lifetime immunity (meaning you can’t get it again). However, the virus remains dormant in the body, and it can reactivate later in life and cause shingles.

Because the chickenpox virus can pass from a pregnant woman to her unborn child, possibly causing birth defects, doctors often advise women considering pregnancy to confirm their immunity with a blood test.

 What causes chickenpox?

Chickenpox is caused by the herpes zoster virus, also known as the varicella zoster virus. It is spread by droplets from a sneeze or cough, or by contact with the clothing, bed linens, or oozing blisters of an infected person. The onset of symptoms is seven to 21 days after exposure. The disease is most contagious a day before the rash appears and up to seven days after, or until the rash is completely dry and scabbed.

Reports compiled by Adebayo Folorunsho-Francis with addition information from webmd.com/skin-problems-and-treatments and wikipedia.org/wiki/Skin_infection

Poised to reduce the global burden of cancer, which kills about thrice the number of people who die of tuberculosis, HIV and malaria combined, the Union for International Cancer Control (UICC), established the World Cancer Day (WCD), on 4 February, 2008, to raise awareness and generate support for people living with the disease. From then on, WCD has been commemorated annually. However, the impact of the celebration seems quite limited, as the prevalence of the terminal disease continues to rise from year to year, and from border to border, claiming multitudes of lives all along.

One major issue that has been generally identified as a setback in the fight against cancer, especially in Nigeria, is inadequate medical facilities for the screening and treatment of the condition, as well as late presentation of patients to care centres.

This is why the theme for this year’s edition of WCD – “We can. I can” – is centred on deliberate actions by the government, corporate bodies and individuals, in reducing the disease burden in the country. The theme, which will last through 2018, implies that everyone can do something to inspire action, take action, prevent cancer, challenge perceptions, create healthy environments, improve access to cancer care, build a quality cancer workforce, mobilise networks to drive progress, shape policy change, make the case for investing in cancer control, and work together for increased impact.

This deliberate concerted effort is imperative because, according to the World Health Organisation (WHO), more than 70 per cent of cancer deaths occur in low- and middle-income countries. Although the risk of developing or dying from it is still higher in the developed world, early detection and prompt medical attention are key in its management.

According to the Medical Director, Pfizer Pharmaceutical Company, Dr Kodjo Soroh, cancer is on the rise, not only in Nigeria, but worldwide. As a result, doctors are still researching into its cure.

“The unfortunate aspect of cancer situation in Nigeria is not that doctors cannot treat it, but the cost of treatment and availability of medical equipment is grossly inadequate. Nigeria is not prepared for the Tsunami that is about to break in cancer. I did a little survey in the northwest of the country some two years ago. It was recorded in a teaching hospital that 30 new cases are reported every day. Cancer is killing Nigerians every day. The rate at which cancer is killing Nigerians is alarming. It is more than cases of deaths caused by malaria AIDS and Tuberculosis.

“The best way to get an idea on the prevalence is to go by the WHO statistics on cancer situation in Nigeria. The statistics is alarming. It says that per hour 30 Nigerians are dying of cancer. I say Nigeria is not prepared because, if you look at our National Health Insurance Scheme (NHIS) cancer is not covered. So, if you develop cancer now, you are on your own. How many radiotherapy units do you have in Nigeria and the specialists, how many oncologists? Early detection and diagnosis are important. Once these are delayed, it spreads and causes more damage. If you have money to go out, then the cost is on your head.”

He continued: “The best option anybody has is to prevent it. Government should invest more on the infrastructure and health personnel. Early screening and detection are important in cancer management or its prevention. Let us create more awareness by telling our women to do self breast examination, screen for cervical cancer that is even preventable by getting vaccinated.

“Let people disabuse their minds on a misconception that if they get female teenagers immunised against cervical cancer – that they are indirectly being prepared for promiscuity. Nigerians should move on. Get our women vaccinated against cervical cancer. There are some women who have been known to keep only a man and still come down with cervical cancer because pappiloma virus is the cause of that type of cancer. The statistics even have it that more married women may have cervical cancer than the unmarried.”

Explaining the development of cancer, the Medical Director, Triumph Medical Centre, Dr Deji Morenikeji, said cancer is the abnormal growth of body tissues in the cells and can affect any part of the body. “When a person is said to have developed cancer, it simply means the cells that are normal are fast growing into abnormal cells and distorting them. There is increase of awareness on cancer now. Government is actually playing a major role in cancer detection. It has a unit in the Ministry of Health dedicated to that.

“Unfortunately, in this part of the world people go late to the hospital. The treatment is not encouraging. If cancer is detected early, depending on the type of cancer, there is a five-year survival rate, and the rate is higher and impressive. Cancer drugs and treatments are expensive worldwide. Government is trying its best to contain the development of the disease, all things being equal, including not having its hereditary trait, and then its prevention, that is, its development is more individualistic.

On prevention, he said: “People should be mindful of their lifestyle. They should watch what they eat as what they consume plays important role on their well-being. They should exercise more and do away with sedentary lifestyle. They should do more health assessments, routine medical examinations.”

Statistics show that there are six most common cancers in Nigeria. They include:

• — Breast cancer
• — Cervix cancer
• — Prostate cancer
• — colorectal cancer
• — liver cancer and
• — NHL

 Breast cancer

Breast cancer is the commonest female cancer and studies have indicated increase in the relative frequency ratio; moving from number two or three to the number one cancer in both sexes..This increase has been attributed to increase awareness and presentation for screening. Majority of breast cancers occur in pre-menopausal women with the peak age in the 5th decade…

About 80-85 per cent still present in advance stage III with attendant poor outcome. In Nigerian studies, only 25-50 per cent of the tumours are reported to be oestrogen/progesterone receptor positive, which is the basis for hormonal treatment.

 Causes of breast cancer

When you’re told that you have breast cancer, it’s natural to wonder what may have caused the disease. But no one knows the exact causes of breast cancer. Doctors seldom know why one woman develops breast cancer and another doesn’t, and most women who have breast cancer will never be able to pinpoint an exact cause. What we do know is that breast cancer is always caused by damage to a cell’s DNA.

Risk factors for breast cancer

• — Female gender
• — increasing age
• — Maternal relative with breast cancer
• — Abnormal genes (BRCA 1, BRCA2 genes)
• — Nulliparity
• — Late age at first pregnancy and longer reproductive span (early menarche<12yrs, late menopause>50yrs).

Others are

• obesity
• — Increased dietary fat & alcohol intake
• — Cigarette smoking
• — Previous breast lesion with atypical changes
• — Previous breast cancer.

Male breast cancer

In Nigeria, this represents 3.7-8.6 per cent of all breast cancers. This is higher than the 1 per cent recorded from other parts of the world. The higher figures in Nigeria may be due to small sample size, since the data are mainly-hospital based. The peak age incidence is 40-49 years, similar to that of female cancer. Majority are invasive ductal carcinoma. It is characterised by late presentation at advanced stage with attendant poor prognosis.

Diagnosis of breast cancer

Breast cancer is sometimes found after symptoms appear, but many women with early breast cancer have no symptoms. This is why getting the recommended screening tests before any symptoms develop is so important.

If you think you have any signs or symptoms that might mean breast cancer, be sure to see your doctor as soon as possible. Your doctor will ask you questions about your symptoms, any other health problems, and possible risk factors for benign breast conditions or breast cancer.

If breast symptoms and/or the results of your physical exam suggest breast cancer might be present, more tests will probably be done. These might include imaging tests, looking at samples of nipple discharge, or doing biopsies of suspicious areas.

 Mammograms

A mammogram is an x-ray of the breast. Screening mammograms are used to look for breast disease in women who have no signs or symptoms of a breast problem. Screening mammograms usually take 2 views (x-ray pictures taken from different angles) of each breast.

For a mammogram, the breast is pressed between two plates to flatten and spread the tissue. This may be uncomfortable for a moment, but it is necessary to produce a good, readable mammogram. The compression only lasts a few seconds. If your diagnostic mammogram shows that the abnormal area is more suspicious for cancer, a biopsy will be needed to tell if it is cancer.

Even if the mammograms show no tumour, if you or your doctor can feel a lump, a biopsy is usually needed to make sure it isn’t cancer. One exception would be if an ultrasound exam finds that the lump is a simple cyst (a fluid-filled sac), which is very unlikely to be cancerous.

Magnetic resonance imaging (MRI)

MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image. For breast MRI to look for cancer, a contrast liquid called gadolinium is injected into a vein before or during the scan to show details better.

MRI scans can take a long time “ often up to an hour. For a breast MRI, you have to lie inside a narrow tube, face down on a platform specially designed for the procedure. The platform has openings for each breast that allow them to be imaged without compression. The platform contains the sensors needed to capture the MRI image. It is important to remain very still throughout the exam.

 Prevention of breast cancer

The following tips are essential in preventing breast cancer

• Regular breast examination
• Changing lifestyle or eating habits.
• Avoiding things known to cause cancer.
• Taking medicine to treat a precancerous condition or to keep cancer from starting.

 Cervical cancer

Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be successfully treated when it’s found early. It is usually found at a very early stage through a Pap test.

Cervical cancer is the second most common cancer in Nigerian women and the most common female genital cancer constituting a major cause of mortality among Nigerian females in their most productive years. It was the commonest cancer reported from Ibadan, Eruwa, Zaria, Jos, Benin and Calabar and in the early years, second to breast in Enugu and Ife-Ijesha , as indicated by a study conducted by Professor Fatimah Abdulkareem of the College of Medicine, University of Lagos.

Recent data shows that it has however been overtaken by breast cancer – except in Kano where it was reported as the most common cancer in both sexes. In Jos, it is the most common female cancer.

Human papillomavirus (HPV) is a necessary cause of cervical cancer being present in 99.9 per cent of cases. In a study of 233 cases of cervical cancer from Lagos, HPV 16 and 18 were present in 65.2 per cent.. This supports data that effective vaccination against these two types will reduce the cervical burden in Nigeria.

You can get HPV by having sexual contact with someone who has it. There are many types of the HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms.

 Symptoms of cervical cancer may include:

• Bleeding from the vagina that is not normal, such as bleeding between menstrual periods, after sex, or after menopause.
• Pain in the lower belly or pelvis.
• Pain during sex.
• Vaginal discharge that isn’t normal.

The treatment for most stages of cervical cancer includes:

• Surgery, such as a hysterectomy and removal of pelvic lymph nodes with or without removal of both ovaries and fallopian tubes.
• Chemotherapy.
• Radiation therapy.

 Prevention of cervical cancer

The Pap test is the best way to find cervical cell changes that can lead to cervical cancer. Regular Pap tests almost always show these cell changes before they turn into cancer. It’s important to follow up with your doctor after any abnormal Pap test result so you can treat abnormal cell changes. This may help prevent cervical cancer.

If you are age 26 or younger, you can get the HPV vaccine, which protects against two types of HPV that cause most cases of cervical cancer.

Prostate cancer

The prostate is a gland that is a part of the male reproductive system that wraps around the male urethra at its exit from the bladder. Common problems are BPH (Benign Prostatic Hyperplasia), acute and chronic bacterial prostatitis and chronic prostatitis (non-bacterial)

Prostate cancer is common in men over 50, especially those who eat fatty food and/or have a father or brother with prostate cancer. It is the most common cancer in Nigerian males, having overtaken liver cancer. It accounts for 6.1-19.5 per cent of all cancers and the incidence is increasing.. Current data from most parts of the country show it to be the 3rd most common cancer, except in Calabar where a very high figure was recorded for prostate cancer as the most common in both sexes accounting for 34.7 per cent of all cancers.

Compared to African-American men, Nigerian men are 10 times more likely to have prostate cancer and 3.5 times more likely to die from it. Environmental and most importantly, genetic factors have been incriminated as the reason for the geographic differences in incidence.

Risk factors for prostate cancer include:

• — race
• — age above 40years
• — positive family history
• — high fat diet and
• — high serum androgens levels; the latter being most consistent.

 Symptoms of prostate cancer

Symptoms of prostate problems (and prostate cancer) include urinary problems (little or no urine output, difficulty starting (straining) or stopping the urine stream, frequent urination, dribbling, pain or burning during urination), erectile dysfunction, painful ejaculation, blood in urine or semen and/or deep back, hip, pelvic or abdominal pain. Other symptoms may include weight loss, bone pain and lower extremity swelling.

Prostate cancer is definitively diagnosed by tissue biopsy. Initial studies may include a rectal exam, ultrasound and PSA (prostate-specific antigen) levels.

Treatments for prostate cancer may include surveillance, surgery, radiation therapy, and hormone therapy. PSA testing is considered to be yearly PSA tests; not all agree this should be done.

Identifying prostate problems early is a way to reduce future prostate problems.

 Diagnosis of prostate cancer

The diagnosis of prostate cancer mostly involves a combination of three tests:

• Digital rectal examination: As part of a physical examination, your doctor inserts a gloved and lubricated finger into your rectum and feels toward the front of your body. The prostate gland is a walnut or larger-sized gland immediately in front of the rectum, and beneath your bladder. The back portion of prostate gland can be felt in this manner. Findings on this exam are compared to notes about the patient’s prior digital rectal examinations.

The exam is usually brief, and most find it uncomfortable due to the pressure used to adequately examine the prostate gland. Findings such as abnormal size, lumps, or nodules, may indicate prostate cancer.

This examination should be part of an annual physical in all men over 50 years of age to note changes in the prostate. In men with a family history of prostate cancer, or in African American men exams should begin at 40 years of age.

• Prostate specific antigen (PSA) blood test: The PSA blood test measures the level of a protein found in the blood that is produced by the prostate gland and helps keep semen in liquid form. The PSA test can indicate an increased likelihood of prostate cancer if the PSA is at an increased or elevated level, but it does not provide a definitive diagnosis. Prostate cancer can be found in patients with a low PSA level but this occurs less than 20 per cent of the time.

If the PSA level is elevated (levels can depend upon your age, on the size of your prostate gland on examination, certain medications you may be taking, or recent sexual activity), further testing may be needed to rule out prostate cancer. PSA measurements are often tracked over time to look for evidence of a change. The amount of time it takes for the PSA level to increase is referred to as PSA velocity. A PSA doubling time can be also tracked in this fashion. PSA velocity and PSA doubling time can help your doctor determine whether prostate cancer may be present.

The presence of an abnormal result on digital rectal examination, or a new or progressive abnormality in a PSA test may lead to a referral to a surgeon who specialises in diseases of the urinary system (a urologist) who may perform further testing, such as a biopsy of the prostate gland.

• Prostate biopsy: A biopsy refers to a procedure which involves taking of a sample from a tissue in the body. Prostate cancer is only definitively diagnosed by finding cancer cells on a biopsy sample taken from the prostate gland. The urologist may have you stop medications such as blood thinners before the biopsy.

On the day of the biopsy, the doctor will apply a local anaesthetic by injection or topically as a gel inside the rectum over the area of the prostate gland. An ultrasound probe is then placed in the rectum. This device uses sound waves to take a picture of the prostate gland and helps guide the biopsy device. The device used is a spring-loaded needle that allows the urologist to extract cores from the prostate gland. Usually 12 cores are obtained, six from each side. Two cores are taken from the upper, middle, and lower portions of the prostate gland. The cores are submitted for analysis to a pathologist (a doctor who specializes in examining tissues to make a diagnosis). Results may take several days.

A biopsy procedure is usually uncomplicated, with just some numbness, pain, or tenderness in the area for a short time afterwards. Occasionally, a patient has some bleeding in the urine after the procedure. Rarely, the patient may develop an infection after a biopsy procedure, or be unable to urinate. The patient will be advised to call and consult a doctor if such problems occur.

 Prostate cancer biopsy results

The result of the pathologist’s analysis of the biopsy cores under the microscope is the only way to diagnose prostate cancer.

Treatment of prostate cancer

Treatment options for prostate cancer are many, and while this is an advantage in that prostate cancer is such a common disease in men, it can also be a cause of great confusion. The following overview presents some information about these options, but it is not a complete explanation of any of these.

 Surgery

The removal of the entire prostate gland and the attached seminal vesicles is referred to as a radical prostatectomy. This is usually done through an incision or incisions made over the front of the lower abdominal wall, with the procedure taking place behind the pubic bones at the front of the pelvis (a retropubic approach). Today the main choice is between a standard open radical prostatectomy and the use of a robotic system for performance of the procedure through smaller incisions. The former allows the surgeon to feel the tissues and make the cuts themselves. The latter uses an operating system robot, which the surgeon guides. The former takes longer to recover from, and has more risk of blood loss associated with it. The latter results in a more rapid recovery and less blood loss generally.

Intact pelvic nerve bundles on either side of the prostate in the pelvis are essential for a man to be able to have an erection. Impotence – or the inability to have and sustain an erection of a quality sufficient for successful intercourse – can occur after this operation. The likelihood of impotence is primarily dependent on whether or not the necessary nerves can be preserved during surgery, AND the patient’s true preoperative ability to still have an erection. Nerve-sparing surgical technique is desirable and the surgeon should plan to do this, if possible. These important pelvic nerve bundles may need to be sacrificed if they are too close to or are involved with the cancer. The objective of the surgery is to cure the patient of the prostate cancer with the least number of problems afterward as possible, but the performance of a potentially curative procedure must remain the primary objective of the surgeon.

The radical prostatectomy involves the removal of a portion of the urethra. The urethra is the tube that runs from the bladder to the outside through the penis. It runs through the prostate gland. The procedure can disrupt the sphincter or valve, which controls urine flow from the bladder. The surgeon reconnects the urethra to the bladder after the prostate is out. The more careful and experienced the surgeon, the less the risk of long-term inability to control the flow of urine (incontinence).

The risks of an operation lasting several hours also remains substantial and include heart problems, blood loss, as well as a risk of infection, blood clots, and rarely, death. Such operations are appropriate for patients whose cancer appears to be confined to the prostate gland.

 Radiation therapy

Radiation therapy involves potentially curative treatment using machines that generate and administer controlled, invisible beams of energy known as radiation. This is called external beam radiation therapy (EBRT). It also can be done using radioactive sources, or seeds, implanted permanently, or higher energy sources placed temporarily into the body. This technique is called brachytherapy.

An X-ray machine uses a low energy radiation beam to take a picture of a portion of the body. Radiation therapy machines put out high energy beams that can be focused very precisely to deliver treatment to a site. The radiation does not “burn out” the cancer, but damages the cells’ DNA, which causes the cancer cells to die. This process can take some time to occur after the radiation treatments have been given.

The radiation passes directly through the tissues in EBRT. Radiation treatment used today delivers very little energy to normal tissues. It just passes through. Most of the energy is able to be focused and delivered directly to the area of the prostate gland containing cancer. This process minimises damage to healthy tissue.

Radiation therapy to the prostate gland by external beam technique may cause fatigue and bladder and/or rectal irritation. These effects are usually temporary but may recur or persist long after treatments are finished. Radiation damage to adjacent tissues can cause skin irritation, and local hair loss. Delayed onset of impotence can occur after radiation therapy due to its effect on normal tissues including nerves adjacent to the prostate. Radiation therapy may be given alone or in combination with hormonal therapy which can also shrink up the prostate gland thereby reducing the size of the radiation area or field that needs to be treated.

A recently popular technique of EBRT is called proton beam radiation, which can theoretically more closely focus on the area being treated. Proton beam radiation therapy is more expensive. Its side effects presently appear similar to those discussed for standard radiation therapy. Studies comparing the effectiveness and overall results of conventional radiation therapy versus proton beam therapy have not been completed yet.

EBRT is appropriate for men who are candidates for radical prostatectomy but do not wish to undergo the surgery. It is also used to shrink tumours and reduce pain in areas where metastatic prostate cancer is damaging bone, or is pressing on important structures including the spinal cord.

Note that radiation therapy can be performed after radical prostatectomy if prostate cancer recurs in the region where the prostate was, and can potentially cure a locally recurrent prostate cancer if it has not spread beyond the area, after radiation therapy has been given. If radiation fails to control the cancer, surgery is difficult – if not impossible – to perform due to scar tissue which develops in the area.

Colorectal cancer

Most colorectal cancers arise from adenomatous polyps. Such polyps are comprised of excess numbers of both normal and abnormal appearing cells in the glands covering the inner wall of the colon. Over time, these abnormal growths enlarge and ultimately degenerate to become adenocarcinomas.

People with certain genetic abnormalities develop what are known as familial adenomatous polyposis syndromes. Such people have a greater-than-normal risk of colorectal cancer. In these conditions, numerous adenomatous polyps develop in the colon, ultimately leading to colon cancer.

Colorectal carcinoma is the commonest malignancy of the gastrointestinal tract worldwide. Previous studies had shown it to be a rare disease in Nigeria representing 3-6 per cent of all malignant tumours in most studies. .It accounts for 10-50 per cd of all GIT malignancies in Nigeria. Peak incidence is 60-70 years; mean age in Lagos is 50.7yrs..When it occurs in the young, associated with polyposis syndrome or ulcerative colitis should be suspected.

Contrary to previous report which showed it to be rare, recent report shows the incidence to be increasing. An 81 per cent increase over a period of two decades was reported from Ibadan. .A recent study from Lagos & Sagamu showed similar trend with an increase in annual frequency of this cancer from 14 cases per annum to 32.3 cases per annum. .The low incidence in Nigerians was attributed to fibre rich diet which is common practice and rarity of the familial polyposis syndrome and IBD.

Recent urbanisation/civilisation has resulted in upsurge of confectionary food outlets in major cities resulting in many Nigerians changing their dietary habit from a fibre rich diet, which was common practice to a highly refined carbohydrate and fat diet.

 Colon cancer symptoms

Cancer of the colon and rectum can exhibit itself in several ways. If you have any of these symptoms, seek immediate medical help. You may notice bleeding from your rectum or blood mixed with your stool.

• People commonly attribute all rectal bleeding to haemorrhoids, thus preventing early diagnosis owing to lack of concern over “bleeding haemorrhoids.” New onset of bright red blood in the stool always deserves an evaluation. Blood in the stool may be less evident, and is sometimes invisible, or causes a black or tarry stool.
• Rectal bleeding may be hidden and chronic and may only show up as an iron deficiency.
• It may be associated with fatigue and pale skin due to the anaemia.
• It usually, but not always, can be detected through a fecal occult (hidden) blood test, in which samples of stool are submitted to a lab for detection of blood.
• If the tumour gets large enough, it may completely or partially block your colon. You may notice the following symptoms of bowel obstruction:
• Abdominal distension: Your belly sticks out more than it did before without weight gain.
• Abdominal pain: This is rare in colon cancer. One cause is tearing (perforation) of the bowel. Leaking of bowel contents into the pelvis can cause inflammation (peritonitis) and infection.
• Unexplained, persistent nausea or vomiting
• Unexplained weight loss
• Change in frequency or character of stool (bowel movements)
• Small-calibre (narrow) or ribbon-like stools
• Sensation of incomplete evacuation after a bowel movement
• Rectal pain: Pain rarely occurs with colon cancer and usually indicates a bulky tumour in the rectum that may invade surrounding tissue.

Other factors that may affect your risk of developing a colon cancer:

• Diet: Whether diet plays a role in developing colon cancer remains under debate. The belief that a high-fibre, low-fat diet could help prevent colon cancer has been questioned. Studies do indicate that exercise and a diet rich in fruits and vegetables can help prevent colon cancer.
• Obesity: Obesity has been identified as a risk factor for colon cancer.
• Smoking: Cigarette smoking has been definitely linked to a higher risk for colon cancer.
• Drug effects: Recent studies have suggested postmenopausal hormone, oestrogen replacement therapy may reduce colorectal cancer risk by one third. Patients with a certain gene which codes for high levels of a hormone called 15-PGDH may have their risk of colorectal cancer reduced by one half with the use of aspirin

Also at high risk for developing colon cancers are people with any of the following:

• Ulcerative colitis or Crohn’s colitis (Crohn’s disease)
• Breast, uterine, or ovarian cancer now or in the past
• A family history of colon cancer

The risk of colon cancer increases two to three times for people with a first-degree relative (parent or sibling) with colon cancer. The risk increases further if you have more than one affected family member, especially if the cancer was diagnosed at a young age.

Exams and tests

You may have a test called a colonoscopy. This is a test that allows a specialist in digestive diseases (a gastroenterologist) to look at the inside of your colon. This test looks for polyps, tumours, or other abnormalities.

Colonoscopy is an endoscopic test. This means that a thin, flexible plastic tube with a tiny camera on the end will be inserted into your colon via your anus. As the tube is advanced further into your colon, the camera sends images of the inside of your colon to a video monitor.

Colonoscopy is usually done with sedation and is not an uncomfortable test for most people. You will first be given a laxative solution to drink that will clear most of the faecal matter from your bowel. You will be allowed nothing to eat for a short period before the test and a liquid diet only for a day before the test.

Flexible sigmoidoscopy is similar to colonoscopy but does not go as far into the colon. It uses a shorter endoscope to examine the rectum, sigmoid (lower) colon, and most of the left colon.

CT colonography is another way to examine the colon. Again, the stool must be cleared from the colon before the examination. Colonoscopy allows sample to be taken (biopsies) if an abnormality is found. Colonography does not allow that, as there is no direct visualisation of the interior of the colon.

This test highlights tumours and certain other abnormalities in the colon and rectum.

Other types of contrast enemas are available.

Air-contrast barium enema frequently detects malignant tumours, but it is not as effective in detecting small tumours or those far up in your colon.

If a tumour is identified in the colon or rectum by a biopsy performed during a sigmoid or colonoscopy, you will

Medical treatment

The primary treatment of colon cancer is to surgically remove part of your colon. Suggestive polyps, if few in number, may be removed during colonoscopy. Chemotherapy after surgery can improve your likelihood of being cured if your colon cancer has spread to nearby lymph nodes.

Radiation treatment after surgery does not improve cure rates in people with colon cancer, but it is important for people with rectal cancer. Given before surgery, radiation may reduce tumour size. This can improve the chances that the tumour will be removed successfully. Radiation before surgery also appears to reduce the risk of the cancer coming back after treatment.

Radiation plus chemotherapy before or after surgery for rectal cancer can improve the likelihood that the treatment will be curative

Liver cancer

Primary liver cancer is a condition that happens when normal cells in the liver become abnormal in appearance and behaviour. The cancer cells can then become destructive to adjacent normal tissues, and can spread both to other areas of the liver and to organs outside the liver.

Malignant or cancerous cells that develop in the normal cells of the liver (hepatocytes) are called hepatocellular carcinoma. A cancer that arises in the ducts of the liver is called cholangiocarcinoma.

What is metastatic liver cancer?

Metastatic cancer is cancer that has spread from the place where it first started (the primary site) to another place in the body (secondary site). Metastatic cancer in the liver is a condition in which cancer from other organs has spread through the bloodstream to the liver. Here the liver cells are not what have become cancerous. The liver has become the site to which the cancer that started elsewhere has spread.

Metastatic cancer has the same name and same type of cancer cells as the original cancer. The most common cancers that spread to the liver are breast, colon, bladder, kidney, ovary, pancreas, stomach, uterus, breast, and lungs.

Metastatic liver cancer is a rare condition that occurs when cancer originates in the liver (primary) and spreads to other organs (secondary) in the body.

Some people with metastatic tumours do not have symptoms. Their metastases are found by x-rays or other tests. Enlargement of the liver or jaundice (yellowing of the skin) can indicate cancer has spread to the liver.

Liver cancer is the most common cause of cancer death in Nigeria and the most common liver malignancy in Nigeria is hepatocellular carcinoma (HCC). Data from various parts of Nigeria show that it accounts for between 1.6 per cent – 7.2 per cent of all cancers in both sexes and represent the 2nd or 3rd most common cancer in males.

HCC was earlier reported to be the most common male cancer until recently when it was overtaken by prostate cancer.   It is the most common cause of liver disease in Nigeria accounting for between 29.3 per cent – 64 per cent of all liver biopsies in several studies. The peak age incidence has been found to be a decade earlier than for liver cirrhosis and hepatitis. A significant number of cases occur in association with liver cirrhosis.

Most people who get liver cancer get it in the setting of chronic liver disease (long-term liver damage called cirrhosis), which scars the liver and increases the risk for liver cancer. Conditions that cause cirrhosis are alcohol use/abuse, hepatitis B, and hepatitis C.

The causes of liver cancer may be linked to environmental, dietary, or lifestyle factors. For example, in November 2014, researchers at the University of California, San Diego School of Medicine, found that long-term exposure to triclosan, a common ingredient in soaps and detergents, causes liver fibrosis and cancer in laboratory mice. Although triclosan has not been proven to cause human liver cancer, it is currently under scrutiny by the FDA to determine whether it has negative health impacts.

According to the American Cancer Society, “The stage of cancer is a description of how widespread it is. The stage of a liver cancer is one of the most important factors in considering treatment options. A staging system is a standard way for the cancer care team to sum up information about how far a cancer has spread. Doctors use staging systems to get an idea about a patient’s prognosis (outlook) and to help determine the most appropriate treatment. There are several staging systems for liver cancer, and not all doctors use the same system.”

Liver biopsy as well as imaging studies help in classifying liver cancer stages as per the American Joint Committee on Cancer (AJCC) TNM system, the Barcelona Clinic Liver Cancer (BCLC) staging system, the Cancer of the Liver Italian Programme (CLIP) system, or the Okuda system.

Treatment of liver cancer

The treatment chosen depends upon how much the cancer has spread and the general health of the liver. For example, the extent of cirrhosis (scarring) of the liver can determine the treatment options for the cancer. Similarly, the spread and extent of spread of cancer beyond the liver tissue plays an important part in the types of treatment options that may be most effective.

• Surgery: Liver cancer can be treated sometimes with surgery to remove the part of liver with cancer. Surgical options are reserved for smaller sizes of cancer tumors. Complications from surgery may include bleeding (which can be severe), infection, pneumonia, or side effects of anaesthesia.

• Liver transplant: The doctor replaces the cancerous liver with a healthy liver from another person. It is usually used in very small unresectable (not able to be removed) liver tumours in patients with advanced cirrhosis. Liver transplant surgery may have the same complications as noted above for surgery. Also, complications from medications related to a liver transplant may include possible rejection of the liver transplant, infection due to suppression of the immune system, high blood pressure, high cholesterol, diabetes, weakening of the kidneys and bones, and an increase in body hair.

• Ablation therapy: This is a procedure that can kill cancer cells in the liver without any surgery. The doctor can kill cancer cells using heat, laser, or by injecting a special alcohol or acid directly into the cancer. This technique may be used in palliative care when the cancer is unresectable.

• Embolisation: Blocking the blood supply to the cancer can be done using a procedure called embolisation. This technique uses a catheter to inject particles or beads that can block blood vessels that feed the cancer. Starving the cancer of the blood supply prevents the growth of the cancer. This technique is usually used on patients with large liver cancer for palliation. Complications of embolisation include fever, abdominal pain, nausea, and vomiting.

• Radiation therapy: Radiation uses high-energy rays directed to the cancer to kill cancer cells. Normal liver cells are also very sensitive to radiation. Complications of radiation therapy include skin irritation near the treatment site, fatigue, nausea, and vomiting.

• Chemotherapy: Chemotherapy uses a medicine that kills cancer cells. The medicine can be given by mouth or by injecting it into a vein or artery feeding the liver. People can have a variety of side effects from chemotherapy, depending on the medications used and the patient’s individual response. Complications of chemotherapy include fatigue, easy bruising, hair loss, nausea and vomiting, swollen legs, diarrhoea, and mouth sores. These side effects are usually temporary.

 Prognosis of liver cancer

The prognosis for liver cancer depends on multiple factors such as the size of the cancer, the number of lesions, the presence of spread beyond the liver, the health of the surrounding liver tissue, and the general health of the patient. Life expectancy depends on many factors that determines whether a cancer is curable.

The American Cancer Society states that the overall 5-year survival rate for all stages of liver cancer is 15 per cent. One of the reasons for this low survival rate is that many people with liver cancer also have other underlying medical conditions such as cirrhosis. However, the 5-year survival rate can vary, depending on how much the liver cancer has spread.

If the cancer is localised (confined to the liver), the 5-year survival rate is 28 per cent; if it is regional (has grown into nearby organs), the 5-year survival rate is 7 per cent. Once the cancer is distant (spread to distant organs or tissues), the survival time is as low as 2 years.

Survival rate can also be affected by the available treatments. Liver cancers that can be surgically removed have an improved 5-year survival rate of over 50 per cent. If caught in the earliest stages, and the liver is transplanted, the 5-year survival rate can be as high as 70 per cent.

 References:

Report compiled by Temitope Obayendo, with additional information from Professor’s Fatimah Abdulkareem’s work on: “Epidemiology & Incidence of Common Cancers in Nigeria”; American Cancer Society; WHO; National cancer institute; thenationonlineng; and emedicinehealth