 Good afternoon everyone and welcome to another edition of Let's Talk About It. We will be talking to Dr. Samuel, today's edition of Cancer with Dr. Denise Ajo. Welcome, thank you for joining us. About 10,000 cancer deaths were recorded in the recorded yearly across the world. About 10,000 are from Nigeria. So where are we now? There's an increase in the percentage of people with lung cancer who are living longer after the diagnosis, partly because more people are being diagnosed at an early stage. So I want to welcome you all to this particular edition with Dr. Denise Ajo as on Let's Cancer and in the house we've got a specialist. Dr. Samuel is a consultant, radiation and clinical oncologist. He is the chairman of the Nigeria Medical Association and the National Committee on Cancer. He's also a lecturer at the Federal University of Health Science Utupu Benwistit. Welcome to this conversation and thank you for taking your time out to join us. My pleasure, thank you. And to all our viewers, we're going to say, sit down, relax. Get your pens if you want to get information, but also at the end of it, we will be sharing how you can also participate and get more information going forward. So Dr. Samuel, I am now well and truly relaxed and trust me, I have a lot of questions for you. What is cancer and what is lung cancer? So there's cancer? Yeah. Precisely. Bam, thank you. Yeah, so there's actually two questions and it's better you ask it that way because it's easier to understand the second part when you get to understand the first part better. Cancer generally is a disease in which some cells in the body only defy the natural checks and balances that have been placed to control everything about them. Maybe I should explain that if you break down the human body into its smallest component, what you will get is called a cell. Now, the human body is made up of trillions upon trillions of cells, but every one of these cells seem to have a natural check and balance placed by nature that controls how large they grow, how fast they grow, how old they get to live before them, how many times they live. And as such it's so complicated that ordinarily if you take a cell from one part of the body, let's say you take a cell from the lungs and transfer them to the liver, the cells in the liver will only recognize the cell as, oh, this is a foreigner, it doesn't belong here, they gather together and they kill it. It's in the same body, but it's in a different part of the body. Now that's how complicated and how well regulated the cells are in the body, as many in trillions as they are. Now, for some inexplicable reason, some particular cells suddenly gain an ability to defy these checks and balances placed by nature. So they grow older that in fact they don't just grow old, they virtually become immortal. They gain an ability to grow and keep growing, they do not respect that control with regards to size. So they can grow bigger and bigger to the point where they get to compress other normal cells around them and kill them. Now, the most funny aspect of them is the fact that they even gain an ability to move from the part where they started to any other part of the body. That is what we call metastasis. So they have, they gain an ability to metastasis to a different part of the body. So somebody could have a cancer that starts from the tip of the toe and before you know it, they have metastasis to the brain or to the lungs or to the liver. And when they get their cells in this new environment, do not see them as foreign. Instead, they see them like the landlords in that place right now and assume they seem to bow to them and give them everything they need. So they become, they begin to torment the cells in this new environment. Now that is cancer. Any cell that's suddenly for an inexplicable reason develops an ability to outgrow its normal level of growth, to sustain itself in a totally new environment becomes a cancer cell. Now cancer can occur from any part of the body, head to toes. As long as it's made up of living cells, it can develop into a cancer cell. So when cancer cells develop from the lungs, we call that lung cancer. Just as if cancer cells develop from the breast, they will become breast cancer. They develop from the stomach, stomach cancer. So they are classified basically from the site in which they originate. So lung cancer is cancer cells that originate primarily from the lungs. Thank you for schooling us in the layman language. What Dr. Samuel has just explained is the first time I've heard the explanation of this whole cancer thing in that way because I always got it in a slightly different way, but maybe a bit more technical. So now you've answered it and brought it to ordinary man English because I always knew that there was, we all have cells because I always say to people everybody has cancer cells, but it's whether they wake up or not. See, I'm not a medical doctor. I'm getting very good. I'm getting very, very good. And you answered the first two questions that I had for you because you were then able to tell me the differences between how these cells work. So these normal cells and no normal cells. So thank you. You went there. So now the next question. What are the risk factors for lung cancer? Well, thank God you specified for lung cancer because usually the risk factors for cancers depend on the exact cancer we're talking about. So for lung cancer, the most common risk factor is smoking, cigarette smoking. Now, for cancers, we don't usually talk about costs. We talk about risk factors. That is because irrespective of how much you think a particular factor is responsible for a cancer, you are likely to still find an individual who has that cancer that is not exposed to that factor at all. So when you call that factor a cost of the disease, you would be also labeling that individual who has developed that disease without getting exposed to that factor as having been somebody. So if we say smoking is a cost of lung cancer, then how do we explain about the five to 10% of individuals who develop lung cancer without ever being exposed to primary or secondary smoking? But the majority of patients who develop lung cancer, over 90%, 80 to 90% of them are individuals who have smoked for a very long time or at least have been exposed to what we call secondary smoking. That is an individual who has stayed in a place where others are smoking. How many packs of cigarette do you smoke in a day? And then you extrapolate that to how many packs of cigarette do you smoke in a year? Now, when we say 20 pack years, it's like saying somebody has smoked at least a pack of cigarette every day for 20 years. Now, it will differ if somebody smokes two packs of cigarettes, it means that person could make 20 pack years within 10 years. If somebody smokes four packs of cigarettes in a day, that person could make 20 pack years within five years. If that person smokes half a pack of cigarette a day, it will take him 40 years there about to get 20 pack years. But if you do an extrapolation, you get an idea of what I'm talking about, that if an individual smokes on the average, one pack of cigarette a day for 20 years, the risk of lung cancer is quite significant. There are other factors, but these ones are now factors that we do not have control over some of them. For instance, if somebody has a relative, a first degree relative who has developed lung cancer, it means that person also has a very high chance of developing lung cancer in their lifetime. But that is something we do not have control over. Now, there are a few other things that we might have some control over because they are environmental factors. For instance, there is radon gas. Radon is a radioactive kind of gas that is generated in the environment from the soil, from the water, from rocks around us. But it is radioactive. It comes from the natural breakdown of certain chemicals within our environment. And it could pile up, especially within homes where we live or within offices where we work, radon gas could pile up. And it is radioactive and has the propensity to damage lungs and eventually lead to lung cancer. So there are different levels of radon based on the different environments in which we live. But if the level of radon within our environment is higher than acceptable, then our chances of developing lung cancer within that environment becomes much higher. Asbestos is one of those products that used to be commonly used for our roofing, you know, as a form of insulator, you know, under our roofs. But right now, most asbestos have been faced out because it was realized that too long exposure to asbestos could lead to lung cancer. So it has been faced out. So exposure to certain chemicals like asbestos like cadmium, either from a place of work or from where we live, that is one. Exposure to gases, dangerous radioactive gases like radon is another factor. Well, I've talked about first, first term, first degree relatives, but the most important factor which is actually within the control of most people is cigarette smoking. You just said something, they didn't smoke. And I would say that if you check a lot of people that have had lung cancer or diagnosed with lung cancer as a primary, they have actually felt very angry because they say, I didn't smoke. I don't smoke. But now with your explanation, it helps us to see why the challenges can be. Okay, so my next question will go. In light of that, how does lung cancer present in patients? Yeah, it happens in the lungs, basically. So the most common feature is likely to be related to the lungs. And that is cough. For most people, it is a cough that starts suddenly and refuses to go away. That is a very strong pointer. But for others, it progresses to things like not just the cough, but what we call hemoptysis, that is coughing and seeing blood in the sputum that is produced. Now, all of these are related to the lungs, cough, hemoptysis, difficulty in breathing. All of that is related directly to the lungs. But in so many other people, let me just even start by saying that lung cancer presents without any symptom at all in the early stages. So for many people, and this accounts for why it tends to present late, because one could have lung cancer in the early stages and never get to know, would not even have a cough, would not even have a discomfort whatsoever. And for some, what they will just have is what we call constitutional symptoms. They just feel some form of weakness that they do not understand. They get easily fatigued. They get, you know, they just have a sense of being unwell. All of that could be lung cancer. And in many people, that is how it comes. And they do not show any signs whatsoever. But when it becomes large enough, when it becomes advanced enough to begin to bring out symptoms, that's when we begin to talk about that's when we begin to talk about hemoptysis that's bringing out blood in the sputum. And then we begin to talk about some difficulty in breathing. The person begins to have some difficulty breathing. They just feel it has some pain when they breathe or they feel some, they just feel that the air is not going down there into the lungs the way it should. Now that is because of the lung cancer. But very importantly, it could also present as a feature for the first time of what I explained earlier in metastasis. So we could just have a patient who suddenly has a headache, because the disease has didn't even show any symptoms at all in the lungs, but has the brain could suddenly have a headache, will suddenly start advancing, will suddenly lose consciousness, will suddenly have what we call a pathological fracture. What should not ideally break a bone certainly leads to, you know, a fracture because the bone has been affected by a metastatic cancer and is weaker than usual. So a slight pain that shouldn't cause a fracture or some significant pain in a distant site of the body, maybe in a bone or somewhere, and then we suddenly do some further work and realize that, oh, this is a secondary disease. Where is the primary? Where did it start? Oh, we see something in the lungs and realize that that is where it started from. So it will start from primary, secondary, any of those parts. You highlighted a lot of things because one of the first things I was going to say was about the, there's a statement I always say, I say, cancer is an everyday illness. And a lot of people always ask, what do you mean? I say, you can just have a cough and before you know it, that can be cancer. And so anything that's persistent can be cancer. So just make sure you have any everyday persistence. Then you then highlight it and I know you don't know me personally. So it didn't make sense when you came up to the metastasis and you put the brain because actually I'm going to now state, I am, I live with cancer, as I said, but I have breast cancer metastasizing in the brain and all the tumors are in the brain. They are not in the breast. In the primary site, yes. Yes, they're not in the primary site. So now you see how you just explained something and I know you didn't know that. So it's very interesting. Okay. So now let's take this and let's take a break at this point and we'll come back to this very interesting conversation everyone. So let's just take a break and we'll come back again. Thank you. Welcome back everyone. Thank you for joining us on this cancer with Dr. Denise Ejo. Gosh, we're having a fantastic discussion on lung cancer and it's quite interesting because even for someone like me who live with disease, I am actually having to learn a lot that I knew but I didn't know the meaning. So Dr. Samwell, we're really having a fantastic time. Yeah, can you talk us through the cancer treatment and its options? Okay. Well, maybe I would just say that there are about five, six treatments for cancer generally. The first and the easiest to think about is surgery. Now, surgery entails like most people are now going in and using a knife in the theater to cut up the disease. It's the oldest form of cancer treatment available and ideally it's supposed to be the treatment that offers the patients the highest chance of getting a cure. Now, apart from surgery, there is what we call radotherapy. Now with radotherapy, what we try to do is to use ionizing radiation. This is radiation that has an ability to alter and kill cells, focus this ionizing radiation on the cancer cells and kill them. I'm trying to be as simple as possible. Now, so we've talked about surgery, we've talked about radotherapy. Now there is chemotherapy. I mentioned the basic characteristic of cancer cells being their ability to grow more rapidly than the normal cells. Now, because they come from within the individual, it's difficult to get something about them to target and kill. And one of the things that is noticed about them that is very vital to them is their growth. So as they grow and reproduce, there are certain chemicals they produce a lot. So when we give chemotherapy, what we do is to target those chemicals that they produce. So we are targeting their growth, we are trying to halt their growth. I am mentioning this because I will just digress for 10 seconds and say that is why chemotherapy seems to have a lot of side effects and those side effects seem to affect more of other cells that by nature are also rapidly growing. Because when you are targeting the cancer cells because they are growing rapidly, you will also realize that there are other cells like cells in the bone marrow, like cells in the gut that are also by nature rapidly growing on a daily basis. So they are like cancer cells, but they are within the normal confines of nature. So when you are attacking the cancer cells growth, the chemotherapy also attacks these cells significantly and that way chemotherapy seems to have a lot of side effects like vomiting, like diarrhea, like you know the blood keeps going down because the chemotherapy affects all of these rapidly growing cells. So I have mentioned surgery, I have mentioned radiotherapy, I have mentioned chemotherapy. Now there is also what is called targeted therapy. Now this is a little bit more recent and that is because science has gone a little bit further to investigate a little bit more about the cancer cells themselves and try to find out something about them that makes them unique compared to every other cell within the body. Now whenever any such thing is found, it becomes what is called a target and that target becomes what a drug or a chemical, a molecule is developed to specifically link onto and kill the cancer cells. Now that way targeted therapy has significantly less side effect because it is targeted to the cancer cell itself. Now maybe a little bit technically I will talk about what we call stereotactic body irradiation. Now it is a form of radiotherapy just like I mentioned earlier, but in this case it happens with lung cancer cells that are very, very small. So instead of just irradiating the whole of the body or irradiating a large part of the lungs, lots of radiation sources are targeted all around that little tiny cancer cell and as such you have various radiation sources flashing radiation on a small point of the body at the same time you are able to get a very high dose of radiation to a very limited area of the lungs and that way kill we normally jokingly call it frying. It's like frying or totally eradicating the cancer cell but that is because the cancer cell is very small and for some reason the patient is probably not fit to undergo surgery. So stereotactic body irradiation could be used. Maybe the final modality I mentioned is what we call immunotherapy. Now I mentioned that cancer cells just seem to have a way of surviving within the body such that they could even move from one part of the body to the other. How they do this is by by evading finding ways of evading the body's normal immune response system. So what science is trying to do is to find ways of upregulating the body's immune system. So they give what we call immunomodulators. These immunomodulators tend to modulate the body's immune system upwards and make it easier for the body itself to fight against the cancer. I'm going to say something again that is going to surprise you. I've been through every single step you mentioned. The current chemo I take is for life so I take it every day for life. And apparently one of them is an immunotherapy. So you see I still have a bit of knowledge. So to those of you, you are looking all right. So you better don't give up. You better just know that you will continue to find this. You are in a miracle. Honestly, I am in a miracle. We thank God. So let's go on now. So the next question I'm going to ask you. So then just give me two ways, no three ways you can just confirm straight away that you guys, somebody has cancer. Well, I think I will just give you one. That one is primary. That one is primary to every other. You see no matter how it looks like a dog or looks like a dog, it doesn't necessarily have to be a dog. No matter how much the features look like lung cancer, the only real confirmation we could have that this is a lung cancer is when we get a tissue from the cancer itself and get to examine it under the microscope. Now whether we do that by biopsy, by cutting open the lungs, whether we do that by immediate stimulus to me, whatever thing we do, if we're able to access a part of the cancer tissue and then examine it under the microscope and see cancer cells with our eyes under the microscope and describe them with precision, that becomes the only time a lung cancer is actually confirmed. It could be as easy as getting some of the sputum the patient produces. If this sputum contains cancer cells, if you examine it under the microscope, you would see the cancer cells. Now because the diagnosis of cancer is one that can be so life changing, we have to be as much as possible precise so that when you're telling a patient he has a cancer or she has a cancer, you should not have to come back tomorrow and say oh sorry that was a mistake, it actually wasn't. So the only way you can be very sure you are talking about the cancer is when you get to see it, see the cells and describe the cells with your eyes. So the most precise diagnosis for cancer is almost always a biopsy so that we can do a histological confirmation in the lab. Okay now so please can you just tell us please because this is one word that as non-medics we all hear prognosis. Prognosis to a layman means um you are telling us what the disease what we have the sickness. Prognosis is actually saying what do you expect as an as a possible outcome of the disease that is prognosis so with prognosis we are actually saying with this disease how long does this patient have to live? What do we expect? Do we expect this patient to get cured? Do we expect this disease to be with this patient until the patient is no longer with us? Now that's prognosis you are trying to get an idea of the possible future outcome of the disease that sits in front of you and that's one of the reasons why we stage cancers all types of cancers are staged either stage 0 to stage 4 or sometimes stage 5 because the stage at which the patient presents to the oncologist determines the prognosis determines the possible outcome so am I hoping that this disease can get cured so let me be a little bit more radical in what I go about it going all out against it because I know I can get it get rid this patient of the disease or has the disease gone so advanced that I am not I know for certain that there is nothing I can do to really totally eradicate this disease this patient will have to live with the disease now those are decisions that the oncologist makes in the course of managing the patient and that precisely is what we refer to as prognosis. I have now gotten to understand the staging of cancer and I want the public to really understand that the earlier you get a diagnosis the better it is for you to to have good outcomes and the outcomes are variable so if we wait because like I said I have lost two people in the very short space of time and both of them somewhere in the story there was lung cancer mentioned and it's a shame because it's to do with metastasis and this word metastasis is another conversation for another day and I think I'm going to bring it up again because metastasis is some understanding what metastasis means to a lot of people and how it helps so as we draw to the end of this year because I want to thank you for watching this program with us Dr. Samuel I want to really appreciate you for everything you've done for me today because honestly it's me and you that know how we've gone this journey but I want to really appreciate you and I look forward to having you back on to really talk about this cancer from a different perspective and as we go on I'd like to share with everyone you can follow us on Komod Cancer Foundation we have a website which is dot org not dot Komod is dot org we've got a youtube page which is also Komod Cancer Foundation NG and these videos are there there are over 50 videos that create awareness on different types of cancers and I would suggest people to look out and find that find information because the more you know the better you the better chances you have of you have of getting the help you need at the right time from the right source understanding that there are less than a hundred oncologists in Nigeria means always find that oncologist not just a doctor an oncologist is who you need we are doing through the cancer journey and finally to everyone any questions you have you can go on to our instagram page our facebook page write questions send us share us your views and we will take you from there thank you for joining us and thank you plus tv for giving us these segments and thank you dr. Samuel for this thank you very much have a lovely day thank you very much