A glimpse of KNH One-Stop Breast Clinic

By Cynthia Cherono

Receiving state-of-the-art care at one of Kenya’s best surgical treatment centers is reassuring for those facing the many uncertainties of various breast diseases.

The One-Stop Breast Clinic is committed to helping women and men address all issues concerning the breast.

Located within the Kenyatta National Hospital, the Breast Care and management surgical clinic (24) offers a full spectrum of services to improve breast health.

The services include screening and diagnostics, breast cancer treatment for both benign and malignant breast disease, breast abscess/Mastitis Cancer, and other breast problems, all delivered with the expertise, compassion, and individualized service expected from East Africa’s largest National Teaching and referral hospital-KNH.

KNH was the first in the region to be granted full accreditation by the National Accreditation Program for Breast Centers.

The Hospital is also an accredited Breast Imaging Center of Excellence through the KNH Radiology department (Radiology, Nuclear Medicine, Breast Imaging, Cardiothoracic Imaging). The clinic has a navigation cancer treatment team through collaboration with an NGO and the KNH multidisciplinary team.

The breast clinic receives referred patients and KNH staff only and operates on an appointment basis where patients are given an appointment date for minor problems, and in the case of cancer patients, they are booked within a week or attended to immediately.

Treatment and diagnosis: The clinic comprises expert specialists at breast treatment; most of whom are well-trained nurses, physicians, registrars, and specialized doctors. The consultants and students from UON work collaboratively to identify the most effective treatment options for each breast-diagnosed condition for the respective patients.

Diagnosis and management This entail all aspects of breast and skin problems, benign breast lumps, breast pain, nipple discharge, family history, breast cancer treatment, oncoplastic surgery, immediate and delayed reconstruction, breast implant exchange, augmentation, reductions, and lipo modeling- for correction of breast deformities and or breast asymmetry for patients having undergone breast cancer surgery in the past.

KNH radiology department works together with the surgical clinic for Breast Imaging, incorporating mammography, ultrasound, MRI, and image-guided biopsy.

What to Expect at the One-Stop Clinic:

At the clinic, one is seen by the Breast Consultant and a nurse, where they ask if you have had any breast problems before and whether you have a family history of cancer.

The specialist examines the breasts and under the armpits. They then explain the tests needed.

These may include:

Mammogram – uses low-energy X-rays to identify abnormalities in the breast. This is the most important breast screening tool as it identifies early signs of breast cancer, micro-calcifications, and small lesions. Regular mammograms are the most effective tests for detecting breast cancer early, sometimes up to 3 years before it can be felt as a lump.

Breast ultrasound – uses highfrequency sound waves to assess the size and shape of breast lumps and determine whether they could be tumorous growths or fluid-filled cysts and ultrasound of the lymph nodes in the armpit.

Biopsy – uses an image-guided method to obtain a breast tissue sample via a needle so that it can be evaluated by a laboratory.

Breast MRI- uses an advancedimagine technology that helps detect and diagnose breast cancer and can be an additional safeguard for women at increased risk.

KNH breast clinic has developed a multidisciplinary care program every Tuesday to streamline breast treatment and diagnosis, followup of the patients. In addition, the surgical oncologists and plastic surgeons work in collaboration to plan and perform breast reconstructions.

Personalized breast treatment plans - In most cases, the patient meets with multiple physicians in a single day and leaves with a treatment plan in place.

Clinical trials and basic research- By combining laboratory and clinical research, the patients receive the latest advances in breast diagnosis and treatment, including sentinel lymph-node mapping, breast-conserving surgery, immediate breast reconstruction, and radiation therapy implants for cases of a cancer patient and they are given proper follow –up by the Multidisciplinary team.

Support Services:

Cancer treatment is a complex journey for patients and families. Before the diagnosis of breast diseases, life has its challenges and with the ailment, they may seem insurmountable. The anxieties about health, keeping up with daily activities, and maintaining important critical relationships are common concerns for all cancer patients and their families.

KNH patient and family support services are established to help patients so that they know that they have experienced specialists to count on. KNH breast clinic makes a difference not only in the patient’s clinical outcome but in the journey to full recovery.

Sharp, shooting, sickening and drowning pain: Endometriosis Awareness Month

By Verah Mugambi

March is Endometriosis Awareness Month. Endometriosis is a disorder in which small pieces of tissue that normally line the uterus grow outside the uterus.

With Endometriosis, the tissues can be found on the ovaries, fallopian tubes, or intestines.

It is not just a bad period, it’s not just a bad time of the month, it is a chronic illness causing emotional and mental stress with physical pains, agonizing pelvic cramps and ovulation, painful bowel movements, and urination.

According to World Health Organization (WHO), Endometriosis is one of the most painful health conditions which affect more than 1 in 10 women around the world.

There is a lack of awareness of this chronic condition. It wreaks havoc in women’s lives and relationships, it comes with pain and stress.

In an interview, Dr. Wanja Njiru, KNH Senior Registrar Obstetrics & Gynecology said that Endometriosis is a dangerous illness which if not treated, the symptoms will remain and in some cases, they may get worse. “With endometriosis, the endometrial-like tissue acts as endometrial tissue would, it thickens, breaks down, and bleeds with each menstrual cycle. Since this tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form,” explained Dr. Wanja.

Newsline: What causes endometriosis?

Dr. Wanja: The cause of endometriosis is still unknown, however, there are some possible explanations/theories. Some of the major ones include:

Retrograde menstrual flow; is the most likely cause of endometriosis. Some of the tissue sheds during the period flow and goes through the fallopian tube into other areas of the body, such as the pelvis.

Genetics: It is more common to be affected by endometriosis if a female member of your family (especially a parent or sibling) has endometriosis. It can occur in women of all ethnicities.

Immune system: It may be that some women’s immune system is not able to get rid of the tissue, therefore women with low immune systems may be more at risk of endometriosis.

“In addition to pelvic pain, infertility is another common complication of endometriosis. About half of all women with endometriosis have problems getting pregnant. Patients with endometriosis have a higher risk of developing ovarian cancer. Any woman with severe pelvic pains should consider visiting their Gynaecologist for proper diagnosis and treatment,” Dr. Wanja told Newsline.

Newsline: Is endometriosis curable?

Dr. Wanja: For many women, endometriosis goes away at menopause, when their periods stop. Until menopause, medicine and surgery may be able to help with symptoms of endometriosis.

Tests to check for physical clues of endometriosis include:

Pelvic exam- during a pelvic exam, your doctor manually feels (palpates) areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus.

Ultrasound- This test uses highfrequency sound waves to create images of the inside of your body. To capture the images, a device called a transducer is either pressed against your abdomen or inserted into your vagina (transvaginal ultrasound). A standard ultrasound imaging test will identify cysts associated with endometriosis (endometriomas).

Magnetic Resonance Imaging (MRI)- MRI is an exam that uses a magnetic field and radio waves to create detailed images of the organs and tissues within the body. For some, an MRI helps with surgical planning, giving the surgeon detailed information about the location and size of endometrial implants.

Laparoscopy- a laparoscopy test provides information about the location, extent, and size of the endometrial implants. The surgeon may take a tissue sample (biopsy) for further testing. Often, with proper surgical planning, the surgeon can fully treat endometriosis during the laparoscopy so that one needs only one surgery.

Symptoms of endometriosis

Symptoms may vary with some women having none or severe pain. The most common symptoms are pain and menstrual irregularities. Others include pain in the lower abdomen, pelvis, or lower back around ovulation time, but also throughout the cycle, ongoing pelvic pain lasting six months or longer, pain during or after sex, difficulty getting pregnant, painful bowel movements, and emptying of the bladder.

Treatment for endometriosis involves medication or surgery. According to Dr. Wanja, the approach is dependent on how severe one’s signs and symptoms are and whether one plans to get pregnant.

“Typically, it recommends to try conservative treatment approaches first and opting for surgery if initial treatment fails. Some overthe-counter pain relievers e.g non-steroidal anti-inflammatory drugs (NSAIDs) are used to help ease painful menstrual cramps. Doctors may also recommend Hormone therapy like; Hormonal contraceptives, Gonadotropinreleasing hormone (Gn-RH) agonists and antagonists and Aromatase inhibitors.” Dr. Wanja concluded.

Endometriosis is still shrouded in stigma as many reproductive health problems are in our society. Patients suffering from the disease are mostly in unbearable pain and discomfort but given the stigma, they rarely share their suffering with others.

Dr. Wanja Njiru, KNH Senior Registrar Obstetrics & Gynecology

PHOTO | COURTESY