Overview of Cancer in Egypt and North Africa -Interview with Dr. Micheal Maher (Cairo, Egypt)
Written by Mark Wahba
The rates of cancer are increasing around the world. Therefore, it's important that we understand how different regions around the world make a diagnosis and provide treatment for such a complex disease. Today, I have the privilege of talking to Dr. Micheal Maher, as he talks about the state of diagnosis, treatment, and care in Egypt and North Africa.
Mark: Dr. Maher, thank you for taking the time to speak with me about this topic. I want to start with the basic question we tend to look for an answer to. How is cancer usually diagnosed in Egypt?
Dr. Micheal Maher: Diagnosis of cancer generally starts with the presentation of symptoms and signs by patients, which would also depend on the type of cancer. For example, there are some common warning signs like unintended weight loss or cachexia that could raise suspicion for an underlying malignancy. It is, therefore, very critical that the patient watch this symptom for early presentation to the doctor.
Mark: Ok then what are the steps taken for such a diagnosis?
Dr. Micheal Maher: We conduct appropriate medical history and physical examination once a patient enters the hospital. From these findings, based on history and physical examination, we often recommend laboratory studies which often include a CBC, ESR, and specific tumor markers depending on the type of cancer that may be anticipated. Testing like this can help narrow down what could be wrong.
Many times, further imaging studies such as PET scans are ordered to detail exactly the location of the tumor and evaluate for metastatic spread. I would like to emphasize that a diagnosis of metastatic cancer is not the end of the world; although it certainly complicates treatment, options do exist to manage the disease.
Mark: What are some of the treatment modalities that are available to cancer patients, particularly those that are metastatic?
Dr. Micheal Maher: Treatment plans may include chemotherapy and radiotherapy. Such therapies are sometimes neither curative nor aimed at the tumor itself but rather at symptom alleviation and enhancement of quality of life. In those cases that are assessed as being incurable, we consider providing hospice care to ensure that patients receive the needed compassionate support through their terminal stages.
Mark: Those sound a lot like the kinds of treatment plans that are happening in North America almost as though metastatic cancers have some kind of general approach to treatment across the board. What gives you hope with those treatment plans?
Dr. Micheal Maher: What really gives me hope, though, is the high cure rates we see in patients diagnosed at an early stage. For example, I had a patient with a laryngeal tumor who was successfully treated back to health with chemotherapy and radiotherapy alone, with no need for surgical intervention. This case illustrates the kind of successful outcomes that can be achieved when cancers are caught early.
As far as treatment is concerned, Egypt follows generally internationally accepted protocols, and we do have access to a great many advanced therapies. For early-stage cancer, we use surgery, chemotherapy, and radiation therapy. The treatment for metastatic cases becomes more complex, usually just symptomatic, symptom-oriented, to make the quality of life better rather than curative.
Mark: It is nice to know in any case that something is being done for the better. What do you think are the most serious problems faced by cancer patients nowadays in Egypt?
Dr. Micheal Maher: The biggest challenge a cancer patient faces in Egypt, especially in metastatic cases, is access: access to early diagnosis, especially in rural areas. The financial aspect also plays a huge role. Though we have public health services, they are usually overburdened, and private care is beyond the reach of many.
Mark: I can tell there is at least a bit of work still going on when it comes to the Egyptians having access to health in the rural areas; hopefully, that gets taken care of soon. How about now, the pathway to being an oncologist, and hopefully filling whatever gaps within those rural areas?
Dr. Micheal Maher: We need more trained professionals—oncologists, radiologists, and specialists in the field of palliative care. Though we have many skilled doctors, more additions to the list of doctors would make all the difference in the outcome for patients across the board. In Egypt, the road to being an oncologist usually starts with graduation from medical school, followed by an application to enter the residency program in oncology. It's a tiresome journey, yet important, to ensure our patients get nothing but the highest standards of care.
Mark: That is great to hear Dr. Maher, I hope that cancer continues to be well taken care of worldwide and I again would like to appreciate you sharing your insights on metastatic cancer in Egypt. The more we learn about similar topics from around the world, the greater we can find collaborative solutions.
