WCD 2026: Treatment of Cancer, Symptoms and Control in Nigeria, By Honesty Victor

Cancer is a large group of diseases with one thing in common: They happen when normal cells become cancerous cells that multiply and spread. Your genes send instructions to your cells — like when to start and stop growing, for example. Normal cells follow these instructions, but cancer cells ignore them.

Cancer is the second most common cause of death in the U.S. But fewer people are dying of cancer now than 20 years ago. Early detection and innovative treatments are curing cancer and helping people with cancer live longer.

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Cancer encompasses over 100 distinct types, with a significant global impact. Understanding cancer statistics, both within Nigeria and globally, holds paramount importance. These statistics furnish crucial data on diagnosis, fatalities, and survivors, aiding policymakers and the public in comprehending the issue, formulating effective strategies, and evaluating policy success.

The World Health Organization (WHO) cites cancer as the second leading global cause of death, contributing to 1 in 6 fatalities worldwide. Approximately 70% of cancer-related deaths occur in low- and middle-income nations, including Nigeria.

In Nigeria, the National Cancer Control Plan (2018–2022) indicates a staggering 72,000 annual cancer-related deaths and an estimated 102,000 new cases yearly. The country’s cancer mortality ratio is alarmingly high compared to other nations. For instance, while the US reports a 19% breast cancer fatality rate, Nigeria experiences a disconcerting 51% mortality rate.

Breast cancer dominates among women, while prostate cancer prevails among men in Nigeria. The Global Cancer Observatory 2018 (Globocan) reports 115,950 total cancer cases in Nigeria, with breast cancer accounting for 22.7%, cervical cancer for 12.9%, prostate cancer for 11.3%, colorectal cancer for 5.8%, Non-Hodgkin lymphoma for 4.6%, and other types for 42.7%.

Evidently, breast and cervical cancers stand out as the most prevalent cases overall, translating to a higher incidence among women. The 2018 Globocan data reveals 71,022 cases in women and 44,928 cases in men.

Types of cancer

There are over 100 types of cancer. Healthcare providers categorize them according to where they start in your body and the type of tissue they affect. There are three broad cancer classifications:

• Solid cancers: This is the most common type of cancer, making up about 80% to 90% of all cases. This includes carcinoma that forms in epithelial tissue (like your skin, breast, colon and lungs) and sarcoma that forms in bone and connective tissues.
• Blood cancers: These are cancers that start in your blood cells or lymphatic system. Examples include leukemia, lymphoma and multiple myeloma.
• Mixed: Cancers that involve two classifications or subtypes. Examples include carcinosarcoma and adenosquamous carcinoma.

Common Types of Cancer in Nigeria

There are several cancers which are most prevalent in Nigeria, and they occur in both men and women which are;

1. Breast Cancer

Breast cancer is the most common cancer among Nigerian women and the leading cause of cancer death among them. While it also affects men (though much less commonly), awareness campaigns target women.

Symptoms of Breast Cancer:

It is noteworthy that the most primitive breast cancer may not present any overt signs. Yet, as the cancer progresses, various signs and symptoms may arise:

• A new underarm or breast lump or thickening: The most common symptom. Lumps vary in size and consistency and are tender or nontender.
• Alteration in breast size or shape: One breast may become noticeably larger or exhibit a noticeable different outline from the other.
•      Alterations in the nipple: These may include inversion (inward turning), retraction (drawing back), or changes in position.
• Nipple discharge: Any discharge other than breast milk, especially if bloody or if spontaneous (without squeezing), requires examination.
• Dimpling (like the skin of an orange), puckering, redness, scaling, or thickening of the skin over the breast.
•   Pain in the breast or nipple: While never a cancer indicator, new pain or persistent pain in the breast is something that should be examined by a doctor.
•     Warming, reddening, darkening, swelling of the breast: These may be associated with inflammatory breast cancer, which is a less common but more rapidly growing type of cancer.

Early Detection of Breast Cancer:

Early detection significantly improves chances of successful treatment and survival for breast cancer. The primary ways of early detection are:

• Breasts Self-Examination (BSE): Monthly breast self-examination is a simple but effective measure. Women should familiarize themselves with the normal appearance and feel of their breasts in order to identify any deviation. BSE must be done every month on the same date of each month (e.g., a few days after the end of the menstruation cycle in menstruating women).
• Clinical Breast Examination (CBE): It is the physical check-up of the breasts conducted by a health care provider (medical doctor or nurse). CBE is promoted as a component of regular health screening.
• Mammography: This is an X-ray of the breast that can detect lumps or abnormalities even if they are not yet palpable. Mammography screening is usually recommended for women aged 40 and above, and earlier for those at increased risk.
• Ultrasound and Breast MRI: These may be used under specific conditions, i.e., to assess the result of a mammogram, in women with dense breasts or at high risk of breast cancer.

2. Cervical Cancer

Cervical cancer is also a significant health problem among women in Nigeria. It is found in the cervix cells, the lower part of the uterus that opens into the vagina. The primary cause of cervical cancer is persistent infection with high-risk types of human papillomavirus (HPV).

Symptoms of Cervical Cancer:

Early cervical cancer can cause no signs or symptoms. The cancer only develops signs and symptoms once it becomes a larger tumor and has grown beyond the cervix. They could be:

• Abnormal vaginal bleeding: During or between periods, after sex, or after menopause.
• Pelvic pain: Abdominal or pelvic pain.
• Pain during sex: Also referred to as dyspareunia.
• Unusual vaginal discharge: Malodorous, watery, or bloody discharge
• Prolonged or heavier than normal menstrual periods.

Cervical cancer can be highly prevented and treated once detected early through screening:

• Pap Smear (Papanicolaou test): The test is performed by scraping cells from the outside surface of the cervix and viewing them under a microscope for any cancerous or precancerous changes.
• HPV Test: It is utilized to screen for the presence of high-risk types of HPV that can lead to cervical cancer. It can be taken separately or in combination with a Pap smear.
• Visual Inspection with Acetic Acid (VIA): An inexpensive screening method in which dilute acetic acid (vinegar) is put on the cervix. Precancerous lesions whiten and can be seen by the naked eye. VIA is particularly well-suited for use in low-resource settings.

3. Prostate Cancer

Prostate cancer is the most common cancer among men in Nigeria. It is cancer of the prostate gland, a small walnut-sized gland that produces seminal fluid.

Symptoms of Prostate Cancer:

Early prostate cancer does not show any symptoms. Symptoms develop as the cancer grows and may include:

• Frequent urination, especially at night.
• Difficulty starting or stopping urination.
• Weak or interrupted stream of urine.
• Painful or burning urination.
• Blood in urine or semen.
• Erectile dysfunction.
• Pain in hips, back (spine), chest (ribs), or other areas of the body if the cancer has spread to bones.
• Weakness or numbness in the legs or feet, or loss of bladder or bowel control if the cancer presses on the spinal cord.

Early Detection of Prostate Cancer:

Screening tests can detect prostate cancer early, although the benefits and harms of mass screening are still in dispute. The most widespread screening tests are:

• Prostate-Specific Antigen (PSA) Test: PSA is a protein produced by the prostate gland, and the blood test measures its level. Elevated levels of PSA may be an indication of prostate cancer, but also could be caused by other conditions like benign prostatic hyperplasia (BPH) or prostatitis.
• Digital Rectal Examination (DRE): A doctor inserts a gloved, lubricated finger into the rectum to feel the prostate gland for lumps or abnormalities.

4. Colorectal Cancer

Colorectal cancer refers to the disease of the colon (large bowel) or rectum. The incidence of colo-rectal cancer in Nigeria is increasing, perhaps due to modification of diet and lifestyles.

Symptoms of Colorectal Cancer:

Symptoms of colorectal cancer vary depending on the tumor’s size and place. They include:

• Recurrent change in bowel habits: This can be diarrhea, constipation, or a change in the character of stool.
• Bleeding from the rectum or in stool: Typically found as bright red, dark red, or black stools.
• Recurrent abdominal pain: It can include cramping, gas, or pain.
• Sensation that the bowel does not empty completely.
• Involuntary weight loss.
• Weakness or fatigue.

Early Detection of Colorectal Cancer:

Several screening tests can help detect colorectal cancer early or identify precancerous polyps that can be removed:

• Colonoscopy: A flexible tube with a camera at the tip is inserted through the rectum to view the entire colon. Polyps can be taken out during the procedure.
• Sigmoidoscopy: Same as colonoscopy but only the rectum and sigmoid colon are examined.
• Fecal Occult Blood Test (FOBT) and Fecal Immunochemical Test (FIT): These tests identify occult blood in the stool, which can be a sign of cancer or polyps.
• Stool DNA Test: This test looks at stool samples for DNA changes that might be indications of cancer or precancerous polyps.

5. Liver Cancer

Liver cancer, particularly hepatocellular carcinoma (HCC), is another significant cancer in Nigeria, commonly associated with chronic hepatitis B and C viral infections.

Symptoms of Liver Cancer:

The symptoms of liver cancer do not appear until late and can include:

• Pain or tenderness over the upper right abdomen.
• A palpable firm mass under the ribs on the right side.
• Swelling of the abdomen.
• Jaundice (yellowing of the skin and whites of the eyes).
• Unexplained weight loss.
• Weakness or fatigue.
• Nausea and vomiting.

Early Detection of Liver Cancer:

The disease is difficult to diagnose early because symptoms only appear late. Screening is recommended in those at high risk, such as those with chronic hepatitis C or B and cirrhosis:

• Alpha-fetoprotein (AFP) blood test: AFP is a protein produced by the liver. Elevated levels sometimes indicate liver cancer.
• Liver Ultrasound: Imaging of the liver is able to detect tumors.
• CT Scan or MRI: These newer imaging methods can give more precise images of the liver.

In continuation, Cancer is the second most common cause of death worldwide. Researchers estimate that in 2024, over 2 million people living in the U.S. will receive a cancer diagnosis, and over 611,000 people will die from the disease.

About 1 in 4 people will develop cancer at some point during their lifetime.

What actually causes cancer?

Cancer is a genetic disorder. But that doesn’t necessarily mean it’s inherited. It happens when genes that manage cell activity mutate (change). They create abnormal cells that divide and multiply, eventually disrupting how your body works.

These cells create cancer clusters, or tumors. Cancerous cells may break away from tumors and travel to other areas of your body through your lymphatic system or bloodstream. (Healthcare providers call this metastasis.)

For example, a tumor in your breast may spread to your lungs, making it hard for you to breathe. In some types of blood cancer, your bone marrow makes abnormal blood cells that multiply uncontrollably. Eventually, the abnormal cells crowd out normal blood cells.

According to medical researchers, inherited genetic mutations (changes you can’t control) cause about 5% to 10% of all cancers. More often, cancer occurs as an acquired genetic mutation (change). That means it happens over the course of your life. Medical researchers have identified several risk factors that increase your chance of developing cancer.

How Medical professionals diagnosed Cancer

Healthcare providers begin a cancer diagnosis by doing a complete physical examination. They’ll ask you to describe your symptoms and your family medical history. They may also need to do:

• Blood tests for cancer, which may include complete blood count (CBC), blood protein tests and tumor marker tests.
• Imaging tests like CT scans, MRI, ultrasound or iodine metaiodobenzylguanidine (MIGB).
• Biopsies, which could be surgical (with an incision) or nonsurgical (with a needle).
• Genetic testing for cancer to diagnose and plan treatment for inherited forms of cancer.

How can cancer be treated?

Healthcare providers may use several different treatments, sometimes combining treatments based on your situation. Common cancer treatments include:

• Surgery: Can remove cancerous tumors that haven’t spread.
• Chemotherapy: Destroys cancer cells with powerful drugs in pill form or intravenously (through a needle into a vein).
• Radiation therapy: Kills cancer cells with high dosages of radiation.
• Immunotherapy: Engages your immune system to fight the disease.
• Targeted therapy: Targets the genetic mutations (changes) that turn healthy cells into cancer cells.
• Hormone therapy: Blocks cancer-causing hormones. For example, people who have prostate cancer might receive hormones to lower testosterone, which can contribute to prostate cancer.
• Bone marrow transplant: Replaces damaged blood stem cells with healthy ones.

Cancer treatments can cause several side effects. These side effects vary depending on which treatment you have and how your body tolerates it. If you develop side effects during your cancer treatment, let your healthcare provider know. They may be able to give you recommendations or medications that can help.

Challenges in Cancer treatment and Diagnosis in Nigeria

Nigeria has a population of 300 million people and an annual cancer death figure of about 72,000, faces many issues in its cancer diagnosis Though the likes of the Federal Ministry of Health’s (FMoH), 2006 National Cancer Control Plan (NCC) were put in place to ease these challenges, the inconsistent show of its effectiveness has made sustained efforts to improve cancer diagnosis across the country a necessity. A study highlighted decades of 72.81% late presentation of cancer cases in the country amidst all efforts; hence, one of the challenges of cancer diagnosis is Nigerians’ habit of waiting for symptoms to worsen before seeking medical attention often negatively impacts the chances of cancer curative treatment.

Another is that the 2024 Federal Healthcare Budget of ₦1.48 trillion by headcount would equal ₦6400/person, so it is not surprising that data showed almost 90% of Nigerian healthcare expenditure is paid through out‐of‐pocket sources. The problem, however, is that only about 5%–32% of Nigerians can afford the cost of cancer diagnosis and/or care out‐of‐pocket without experiencing catastrophic healthcare expenditure (CHE). Also, the unavailability of key screening and diagnostic equipment is a challenge. Both governmental and nongovernmental organizations have intermittently introduced breast and cervical cancer screening programs, primarily in urban areas. For instance, 1336 healthcare facilities provide breast ultrasound (US), with 47.8% (639 of 1336) being public facilities. However, only 218 facilities offer mammography, of which 45.4% (99 of 218) are public. Furthermore, just 2.5% (33 of 1336) of the facilities that provide breast US also offer US‐guided breast biopsy, a crucial diagnostic procedure for confirming cancer. However, with 50% of Nigerians residing in rural regions, the vast majority of people in the region are symptomatic when they present with sickness owing to the unavailability of screening tools in the rural area.

Also, a survey reported that there are 58 magnetic resonance imaging (MRI) machines for use in Nigeria, which is small, but worse is that all of them are located in urban areas. This is a major concern as rural communities are left to suffer, resulting in a greater distribution of late diagnoses and untreated cancer cases.

Nigeria’s government has made a significant contribution to cancer diagnosis following the establishment of the National Institute for Cancer Research and Treatment (NICRAT) in 2023 and the setting up of a National Strategic Cancer Control Plan (NSCCP) 2023–2027. Nigeria is currently running NSCCP Phase I, and goal 2 of 8 is “to improve access to quality, cost‐effective, and equitable diagnostic and treatment services for cancer care“. February 2024 has seen the National Health Insurance Authority (NHIA) make moves to imbibe universal health coverage and ultimately more cancer services under its insurance policy through the NHIA Act of 2022. This would increase access to cancer screening and early detection, reducing the burden of late diagnosis.

With a significant N37.4 billion grant from the Federal Government, FMOH Oncology is committed to improving access to oncology care and support services nationwide. To ensure fair access to cancer care in Nigeria, the FMOH has identified the underlisted teaching hospitals in various geopolitical zones to be outfitted with modern medical infrastructure. The proposed medical infrastructure for these teaching hospitals includes linear accelerators, iridium brachytherapy machines, computed tomography (CT) simulators, positron emission tomography (PET) scanners, and cyclotrons. This comprehensive strategy ensures that all participating hospitals have the necessary tools to accurately diagnose and manage cancer cases. NSIA has been tasked with carrying out the FMH&SW’s Oncology Initiative. Building on the success of three key projects—the NSIA‐LUTH Cancer Centre (NLCC), NSIA‐Umuahia Diagnostic Centre (NUDC), and NSIA‐Kano Diagnostic Centre (NKDC)—the NSIA is expanding its healthcare program. This expansion aims to establish 4 oncology centers, 23 advanced diagnostic centers, and 7 catheterization centers across Nigeria’s 6 geopolitical zones.

Cancer Treatments and Risk Reduction

In Nigeria, Surgery remains one of the main methods of treatment for many solid tumors, including breast, cervical, and prostate cancers in Nigeria. Tertiary institutions across the nation, such as teaching hospitals and Federal medical centers, often situated in cities, offer surgical oncology services, often as the first line of treatment, especially in cases that were diagnosed early. This often goes hand in hand with chemotherapy, another widely used method in Nigeria. Hence, most tertiary hospitals and designated cancer treatment centers have chemotherapy units where cancer patients receive care. Each chemotherapy session costs between 600,000 naira and 1.5 million naira each.

Radiation therapy is a cancer treatment option available in a few specialized centers across Nigeria. As of recent estimates, fewer than 10 functional radiotherapy centers are serving a population of over 200 million. Each radiation therapy machine, which ordinarily should treat appropriately 500 people/annum, has to carry the burden of 124,000 yearly cancer patients; hence, patients often have to deal with expensive waiting times and accessibility issues for rural populations.

Nigeria incorporated the human papillomavirus (HPV) vaccine into its regular immunization program on October 24, 2023, to immunize 7.7 million females—the greatest number of girls in Africa to receive HPV vaccinations in a single round—against the virus that is responsible for almost all cases of cervical cancer. With assistance from Gavi, the Vaccine Alliance, the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), and other partners, the Federal Ministry of Health is offering the vaccine for free through the National Primary Health Care Development Agency. To date, over 35,000 health workers have received training in advance of the campaign and the subsequent vaccination delivery in all healthcare facilities. To guarantee that no eligible female is left behind, vaccination facilities have been set up in all 4163 wards throughout the 16 states covered in the phase one rollout. To guarantee that isolated areas can receive the vaccine, mobile immunization units have also been established. Cervical cancer is one of the few diseases that may be completely prevented with a vaccine; thus, now is a critical time for Nigeria’s attempts to reduce the incidence of the disease.

The Nigerian government has received ~15 million HPV vaccinations from UNICEF. In addition, the children’s agency has created educational resources to refute myths and false information, such as radio and TV jingles in several local languages. UNICEF provided two rounds of readiness evaluations to academic institutions and researchers to better understand the public’s attitudes toward HPV and vaccination as part of their outreach efforts. Furthermore, UNICEF has provided cold chain supplies for vaccine preservation and coordinated logistical support for immunization campaigns. In < 2 years, Nigeria has vaccinated over 12 million girls nationwide against the HPV, reaching a 71% national coverage rate for females aged 9–14.

What should we do?

Cancer diagnosis in Nigeria is inadequate, most especially in the screening for breast, prostate, and cervical cancer, which are the most common types of cancer in the country. There is an urgent need for the establishment of an organized screening program for the predominant cancers in the country and the prioritization of cancer research that addresses key policies. Due to the increasing rate of cancer patients in the country, government agencies should create more comprehensive functional cancer care centers with adequate and advanced medical devices for diagnosis and treatment, such as MRI machines, CT scanners, operating rooms equipped for cancer surgeries, a pathology laboratory for tissue analysis, molecular diagnostics equipment, a palliative care unit, and a clinical trials unit.