Support of Persons with Cancer-an NGO Response & Tertiary Prevention of Cancer

Cancer is a global medical issue. In The Bahamas, families are being affected by cancer in some shape or form almost daily. Fortunately, thanks to the National Cancer Society of The Bahamas which is a Non-Profit Organization, patients who live on the family islands especially, now have a place to stay when they have to undergo treatment or testing in Nassau called the Cancer Caring Center.

The Center can accommodate up to ten persons at a time plus one family member or personal nurse. It is ran by volunteers and is tucked away in an ideal location as it is literally less than 5 minutes away from either hospital and about 10 minutes away from the private cancer treatment center.

Our day was spent visiting the Cancer Caring Center as well as the private medical pavilion which houses various medical specialties as well as the Radiation Therapy Facility. At the Cancer Caring Center we received a tour of the facility and the photos are attached.

All of the rooms are furnished and have two twin sized beds; there is a bathroom attached to each room and a balcony overlooking the grounds. The center also has comfortable seating areas for guests to congregate as well as a functional kitchen and conference rooms.

Time for a selfie

Corridor leading to the kitchen and dining area

Gathering area for guests at the Cancer Care Center

Library at the Cancer Care Center

Conference Room at the Cancer Care Center

Conference Room

A little bit of local design; Androsia print table cloth

Small group picture before we leave

After touring The Cancer Caring Center, our last stop for the day was a visit to the Medical Pavilion. Here we met with Dr. Girgis- Medical Oncologist who provided a brief orientation to what is done at the Pavilion. On the island of New Providence, The Bahamas, there is only one radiation machine available and it is housed at the Medical Pavilion. 

As such, both insured and non-insured persons on the islands who are in need of radiation therapy are treated at the Pavilion. For persons who are needing medical oncology consultations, they can receive assistance either through the private sector at the Pavilion or the oncologist of their choice or publicly at the Princess Margaret Hospital's Oncology Center. 

Proof of Accreditation 

The future

Dr. Girgis at the Centerville Medical Pavilion

In general, if a simple survey were to be conducted of any population, most persons if asked, would be able to give their understanding of what cancer is. It is interesting to note though that, despite some general knowledge of what cancer is, the background of where the term 'cancer' came from and the first documented case of cancer is a bit more vague.

The term 'cancer' was used by Hippocrates (the Father of Medicine) who was a Greek Physician who noticed tumors which he called carcinos.  In Greek, the word cancer means crab which is a reflection of the true character of these tumors since it sticks to surfaces or parts of the body stubbornly like a crab. The first discovery of cancer was by the Egyptians apparently who documented this on the papyrus and their tombs; they were also able to differentiate between benign and malignant but of course at that time cauterization or palliative treatment were the treatment options.

To understand cancer, we must first understand the normal function of a cell. Cells are the smallest functional unit of our existence containing a cytoplasm and a nucleus, with the nucleus being the masterpiece of the cell (home of the DNA and RNA). Each cell in general is responsible for metabolism, reproduction and day-to-day functions. Cells also grow, replicate and assist in repair of the organs and the genetic material (DNA and RNA) and the immune system also aid in this process.

Now in the event one of the cells are damaged, the normal process is for the cell to undergo what is called apoptosis or programmed cell death. Cancer is the term used to describe a large group of diseases characterized by a singular malfunction. As previously mentioned, the normal cells are programmed to know what to do and when to do it in the event a cell is damaged; cancer cells on the other hand, do not have this programming and therefore grow and replicate out-of-control and despite them being larger in number due to their rapid replication, they serve no physiological function.

Generally, cancer cannot be diagnosed before a biopsy is done. A biopsy allow differentiation of normal cells and abnormal cells microscopically by a Pathologist.  Some of the features of cancer cells are they are largely shaped dividing cells; the nucleus of the cell compared to the cell's size is also examined and in cancerous cells, the nucleus is usually large and variably shaped compared to a normal cell's smooth, round nucleus. The cytoplasmic volume is another feature that is examined; in cancerous cells the cytoplasmic volume is smaller. Clinically benign tumors can be defined as slow growing, expansive masses often with a pushing margin, often enclosed with a fibrous capsule; malignant tumors are cancer and are rapidly growing masses that invades the neighboring tissues and spreads or metastasizes to other sites. Common sites of metastasis are the brain, bone, lungs and the liver.

In The Bahamas, Cancer screening is available and can be done free of charge. While visiting San Salvador, we spoke with the President of the chapter of the Cancer Society of The Bahamas on the island, who mentioned that annually their chapter organizes a trip to Nassau, where women on the island are taken to be screened for cancer and others are taken for treatment. Screening is a term used to describe the process of looking for the presence of a disease in a normal population. Screening is vital as it allows for early detection and treatment of disease. Once a patient has been screened, in the event there is a positive finding, the cancer will be staged and the prognosis will also be given as well as treatment options.

A look at radiation therapy treatment planning for a hypothetical patient

At the Pavilion, when patients are referred for radiation therapy treatment, imaging studies are done for their own treatment process planning by the Medical Physicist.  The main reason why a treatment plan is done is because radiation treatment uses high energy as well as high doses of radiation. So if the doses are not precise and the treatment is not accurate complications can arise.

Patients first have a simulation CT scan done at the Pavilion, this allows them to see where radiation will be targeted and to obtain precise measurements of the area of interest. They utilize various immobilization tools during this process and the administration of the radiation therapy.

The images that are acquired from the CT scan are exported to the treatment planning system. High energy radiation is used to treat cancers and can also be used to treat benign tumors as well. The treatment planning system will receive the images in various views and in a 3D format. Since the system is not designed to identify all of the organs in the body, the treatment designer must first "tell the system" or input this information into the program before any doses can be calculated. After the organs are inputed, they will also identify the organ which will be receiving the targeted dose of radiation and all of the other organs will be contoured-as each organ is able to tolerate a certain amount of radiation, the system will ensure the tolerated amount is not exceeded.

Tour of the area where Radiation is administered

The radiation can be delivered one of two ways, either from an external source or internally using bracket therapy. Bracket therapy allows the radiation source to be placed next to the tumor so that it delivers the radiation from inside, outwards.

External beam therapy uses linear accelerators. The treatment planning process is very intricate and specific to the patient. The radiation can be delivered anteriorly or posteriorly and is monitored by the dose volume histogram. Planning can take as long as two days but the actual administration of treatment can last as long as 7 minutes inclusive of changing the arm of the machine. Some patients may have to have treatments for as long as 7 weeks.

The treatment is offered between Monday-Friday; the patients are allowed to rest over the weekend.
Radiation Machine- Linear Accelerator

Radiation Therapist demonstrating set up 

Some of the gang at The Cancer Caring Center
Exposure to both the public and private sectors that provide treatment for patients with cancers is an important component of medical education as it provides students and future Physician with the knowledge of what is available locally for patients who are affected by cancer.


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