Cancer: the name of the second death in Afghanistan

Khushhal Nabizadah

Cancer is not the only issue in the field of health, but the broad social, economic, promotional and human rights as well. Cancer causing a huge challenge to development and human progress around the world, especially in poor and developing countries. Cancer is the cause and consequence of poverty. In other words, cancer and poverty interact with each other so that cancer negatively affects the ability of families and society. Because of incapacity, according to the cancer patients who are not able to work efficiently and incomes are low in comparison with healthy people and on the other hand, they consume many possibilities for treatment.

Human understanding of cancers and proportional to the level of individuals and society is different. In progressive societies on one hand curious man with modern knowledge and the search of websites and scientific books from the latest scientific advances has awareness and on the other hand, sectors involved-do continuous useful in identifying cancer. The view of the cancer is deep & based on scientific facts. But in poor communities and deprived people have not reached its fullest use of technology and related sectors, there is not enough capacity, people’s views are based on anecdotal and unscientific. In short, people in developed countries, cancer is mostly is known as preventable and treatable disease, while people in poor countries including Afghanistan, named cancer as the second death.

In this article we have tried to introduce cancer, prevention and treatment and possible ways to detect it .In addition, we will talk about the situation of cancer and its treatment in Afghanistan.

Why Cancer / Crab?

Cancer is an Arabic word meaning crab. Its English equivalent is’ Cancer’ That the Latin word Crab And the concept leads to name it crab. Because people think that cancerous disease are like crabs that hold the body of a person, therefore, called it cancer or have crabs. Cancer continues to be one of the zodiac signs, because of the similarity between the shape and cancerous tumors, the disease is named Cancer.

How cancer develops?

Cancer is the result of changes in DNA Cells that is too much changes in DNA Resulting in a plurality of cells. Natural cells may be no apparent reason to become a cancer’s cell, but in most cases, become as a result of repeated exposure with cancer -causing effects similar to alcohol and tobacco. The behavior and appearance of cancer cells differ from normal cells. DNA Responsible for controlling the appearance and function rooms. When DNA cell has mutated, the cells with healthy cells along with their other differences and normal cells will not do function. The modified cells is isolated from neighboring cells and does not know when to stop growing. In other words, a modification of the command’s cell internal signals to other cells to which they are in control, and does not follow rather than behaves cooperatively with other cells. Under normal conditions, the body cells in terms of needs divides and make new cells as well as normal process when cells grows old die, & new cells replace them. But with changes in DNA Cells, this orderly process is disrupted, the new cells are produced when the body does not need them, and old cells at a time when they should not lose these extra cells often gets shape of the tissue mass which are called tumor or cancer .

What is different between the tumor & cancer?

As said when the order of production and cell death is disturbed, as a result of cancer cells resulting in an excessive number of cells in the tissue density, this growth or tumor cells that may be in the form of a cluster in which case, the tumor is usually not dangerous and common tumors can be removed surgically. Benign tumors are not cancerous. Tumors that are open and are dangerous form tumors called malignant. Malignant tumors are cancer. So all cancers can be tumors, but all the tumors are not cancer.

The difference between benign tumors and malignant

Benign tumors

These tumors are not cancerous and are not dangerous to patient’s life. But if the tumors near critical areas of the body, they can pose a risk, such as tumors of the brain. Other characteristics are as follows tumors:

Have very slow growth;

Often very close resemblance to the tissue from which they were derived,

Do not spread to neighboring tissues;

Usually do not cause serious problems;

An be surgically removed and their risk of recurrence is very low;

In most cases patients live longer and continue to live as normal;

Malignant tumors

These tumors are cancerous and often has the following properties:

Rapid growth;

Cells are different from tissue cells from which they originated;

Can spread to the adjacent organs and tissues. (Spread of cancer to other tissues and organs called metastasis);

Causing serious problems such as underweight, anorexia and anemia

Removing it by surgery is difficult, especially in advanced stages, it is likely to reoccur;

The risk of death is higher in patients.

Causes and risk factors of cancer

In most cases, there is no specific cause to get cancer, but some studies suggest several factors as risk factors for cancer. There are factors having property of carcinogenesis, carcinogenicity (Carcinogen). The other risk factors for cancer in people who are prone genetically, able to pass their carcinogenic effect. ⁽ ¹ ⁾ Risk factors may be chemical, physical, biological and nutrition that are associated to originating from inside body or from the outside to join in and contribute to the growth of cancer are all carcinogenic factors, including one of the four groups . ⁽ ³ ⁾ It is estimated that one third of cancers could be corrected, such as causes of preventing smoking and other tobacco use, which could include alcohol consumption, obesity, lack of physical activity, not consuming sufficient amount of fruits and vegetables, polluted air, indoors fumes, the fuels, used syringes are contaminated by germs. ⁽ ² ⁾

In general, the following are risk factors for cancer:

Aging;

Cigarette and tobacco consumption;

Alcohol consumption;

The sun;

Radioactive radiation;

Some viruses and Bacteria;

Some hormones;

Family history of cancer;

Poor diet which have more fat and less the amount of fruits and vegetables;

Physical inactivity;

Overweight and obesity;

Working in some specific jobs. Painters, miners, construction workers and workers in factories use of chemical materials, the greater the risk of developing cancer. Studies have shown that benzene, benzamine, cadmium, nickel and vinyl chloride could cause cancer.

Cancer Symptoms

First, in most cases there is no sign of cancer. This cancer forms in efforts to fight the problem, because if the cancer is detected and treated at an early stage, the chances of a full recovery and survival is too high. Signs and symptoms of cancer appear when one or more members are infected. Signs and symptoms of cancer are very high, but some symptoms are more common than others. In the event that one of these symptoms, especially if the life is more than 30 years, it is better to visit a doctor and must be consulted to help confirm or rule out cancer. :

A hard tumor or mass in the breast, testicle or in other parts of the body;

Development of a new mole in the part of the body or the emergence of changes in moles and other skin changes;

A change in activities or habits or indigestion;

Persistent cough or hoarse voice;

Difficulty in swallowing;

A sore that does not heal

Irregular menstruation or excessive;

Bloody cough;

Bloody stool;

Bloody urine;

Losing weight for no reason;

Tiredness and weakness;

Frequent fevers. ⁽¹⁾

Cancer Diagnosis

In addition to providing a detailed and accurate cancer diagnosis by the patient’s history and the life style, eating habits, alcohol consumption, smoking, absence of daily physical activity and family history of cancer, doctors usually perform a physical examination. In parts of the body that is visible to the eye, doctor should see and touch it to see changes that may indicate the cancer. But to confirm the diagnosis or detection of cancer in parts of the body that doctors cannot see without the means to access, examination like X-Ray, CT scan, MRI, ultrasound or ultrasound, laboratory tests in particular for the detection of blood cancers, cancer biopsy or biopsy of suspicious sites that are later analyzed in the laboratory and endoscopy for the diagnosis of cancers of the stomach and intestines are used.

Common cancers

Cancer can be caused to almost any organ, but the most common sites for cancer occurrence are as follows:

Lung cancers, can be in both genders, but are more in men;

Breast cancer or breast cancer occurred in both genders, but more in women;

Cervical cancer is that for women;

In Afghanistan, stomach cancer is higher among men;

Ovarian cancer that is in women;

Vaginal cancer in women;

Testicular cancer or cancer of the testicle occur in men;

Skin cancer in both genders;

Liver cancer in both genders;

Blood cancer in both genders;

Mouth cancer in both genders;

Anal cancer in both genders;

Bone cancer in both genders.

Staging and grading of cancer

To estimate the severity, selecting the type of treatment and understanding the consequences of cancers, it is very important to know staging and grading. The grade and stage of the cancer is different:

More changes in proportion to the cancerous cells entering into the normal cells is used to detect cancer stage. If the difference between cancer cells and normal cells is in the high number that cancer cells has no resemblance to normal cells and non-recognition , shows Fourth grade cancer. Tumors of grade one to grade four have been determined. As the tumor grade is high, where there treatment is low, the risk of spread to other areas and its consequences is dangerous.

Primary tumor staging represents the size of the tumor within an organ, spread to nearby organs and lymph nodes or metastasis farther to the areas. Tumor staging will take from zero to four. There is no tumor at the stage zero of the tumor, the stage one a small tumor at its only organ is presented, in phase two, the tumor has spread to adjacent organs, in stage three lymph nodes are affected and in stage four has spread to distant organs. As the tumor stage is high, the treatment is lower and causes more serious consequences. ⁽ ¹ ⁾

Treatment methods

Choice and method of treatment depends on the stage, location and type of cancer and the patient’s decision about the selection of the treatment method. The patient’s age and general health are also considered in the choice of treatment. The goal of cancer treatment is the first step toward a full recovery if full recovery is not possible, disease control, limiting spread and reduce the problems caused by the cancer to other organs. Treatment methods may stop disease progression over time due to changes.

Current methods of treatment include surgery, radiation therapy or radial / radiotherapy, Chemotherapy or treated by specific anti-cancer drugs, the treatment is palliative and sometimes hormonal therapy. Bone marrow transplantation in the treatment of some cancer. In keeping with the grade and stage of the cancer, approximately 50 to 65 percent of cancer patients during treatment need radiation therapy, either alone or together with one of the other methods, ⁽ ⁴ ⁾

Cancer patients are usually treated by specialists from several disciplines and will be done jointly. Sometimes only a method of treatment is used while in some other patients the treatment method is chosen jointly.

Because most drugs used to treat cancer are very toxic and can cause serious side effects, therefore, in the treatment of cancers in addition to their cancer treatment, control or treating side effects of drugs is extremely important and vital. ⁽ ² ⁾

Cancer patients in addition to ongoing treatment need psychotherapy and psychosocial rehabilitation. Studies have shown that the psychological effects of cancer. Causing mental harm to a person’s cancer diagnosis, he is entourage and his confidence gets down. Apart from the consequences of cancer, the psychological effects of cancer affects the patient more. For example, a patient with pancreas cancer consequences is similar to the consequences of a patient with heart Wall thickening who is newly diagnosed (average survival in both is approximately 8 months). Heart valve patient lives normal life with confidence, while Pancreas cancer patients entirely loses their confidence and perspectives to family, colleagues and other people who know him, he gets quite upset about it .

Prevention and detection of cancer

Recent advances has provided great role in the diagnosis of cancer and how they exist prior to detection and prevention of cancers that commonly refers to cancer control,. With prior detection and selection of appropriate treatment, two-thirds of cancer patients are cured. ⁽ ² ⁾ The development of cancer in a real-time event but rather part of a transformation of cells and tissues and their transformation into cancer occurs in a continuous and ongoing process. Cancer prevention involves identifying and modifying risk factors, biological, environmental and genetic factors. Below we present the possible ways to prevent cancer:

Raise awareness and promote healthy life styles among people

Raising people’s awareness of the risk factors to prevent cancer and encourage health and hygiene habits helps in the prevention and control of cancer. Doctors play a key role in conveying the message. Providing information about side effects of smoking and other tobacco products, the benefits of healthy living practices, testing methods are available to get and evaluate cancers and avoiding sunlight exposure can provide a good chance to prevent cancer, .

Smoking is one of the factors of tobacco use and other preventable diseases like pulmonary, cardiac and cancer. Smoking kills one out of every three persons, one of them due to lung cancer and heart disease and early death related to Smoking. Lung cancer and cancers of the larynx, esophagus, stomach, kidney, and bladder pancreas have smoking relationship. Quitting smoking than any other factor can save the lives of the people. The effects of tobacco smoking is not limited to those who smoke but can spread in the community for a secondary and also the effect children.

Increase physical activity to reduce the risk of cancer of the large intestines (colon) and breast cancer.

International studies have shown that high-fat diet is the risk of breast cancer, colon cancer, prostate cancer, and cancer of the uterus wall. In observational studies, reducing the risk of colon polyps and colon cancer with consumption of large amounts of dietary fiber (non-digestible parts of foods) has been assessed. As evidence by eating plenty of fruits and vegetables a reduced risk of cancer has been shown.

The risk of colon cancer, breast cancer, uterine cancer, kidney cancer and esophageal cancer is more body fat in overweight people. Research has shown that the risk of colon cancer in obese men is1. 5 to 2 and in obese women 1. 2 and 1. 5 times more than the general population. Obese women after 30 have 50% more chances of developing breast cancer.

The relationship between skin cancers and exposure to sun radiation has been proven. Sun burn in childhood can increase the risk of developing skin cancer in adulthood. ⁽ ² ⁾

Medicinal prevention of Cancer

Medicines prevent certain cancers, including natural or synthetic chemical substances, inhibit or prevent the formation and process of the development and spread of cancer. For example, studies have shown that calcium-rich foods reduces the risk of colon cancer . ⁽²⁾

Cancer Prevention

Some people whose organs are prone to developing cancer, by surgically removing the organs can be taken as one of the preventive measures. The women who run the necessary tests, which detects cells in her womb cervical cancer cells can remove the partial or complete removal of the uterus is sometimes recommended. Practical removing part of the intestine, large (colon) in people who have certain pests (hereditary polyposis or ulcerative colitis. Preventive bilateral removal of the breasts in women who have genetic risk of breast cancer is useful. Sometimes in women at high risk of developing ovarian cancer or breast cancer are preventive removal of the ovaries is performed. ⁽ ² ⁾

Global Status of Cancer

In many developed countries, cancer is the second cause of death after heart disease. ⁽ ⁵ ⁾ No country in the world is free of cancer disease. ⁽ ⁴ ⁾ According to World Health Organization, annually about 11 million people worldwide gets cancer, of which approximately 8 million lose their lives, of which about 70% of deaths and about 5. 5 million people are in poor countries and the developing world. If the situation continues this way and preventive measures are not taken, it is estimated that the incidence of cancer will increase in 2030 to 26 million in the world and the deaths of the 17 million, of which approximately 9 million deaths will occur in poor and developing countries. ⁽ ⁴ ⁾ Global distribution of cancer deaths shows that, 45% in Asia, 26% in Europe, 14 . 5% in North America, 7. 1% in Central and South America, 6% in Africa and 1% in Australia and New Zealand has happened. ⁽ ² ⁾

Considering the type of cancer, lung cancer is the most common type of cancer causing death in the world. In most cases breast cancer is after lung cancer at the global level while the mortality rate of breast cancer is fifth after lung, stomach, liver, intestine and large (colon and Rectum). Of the eight common cancers, lung cancer (twice), breast cancer (3 times), prostate cancer ( 2 . 5 times) and colon cancer and Rectum ( 3 -fold) is more in developed countries while liver cancer ( 2 fold), cancer of the cervix ( 2 times) and esophageal cancer ( 2 to 3 -fold) is in the least in developed countries in the world. Stomach cancer in developed countries and the poor have the same amount of cases but its occurrence is higher in Asia than in North America and Africa. Cancer of the cervix, breast, and liver most cases are more in Africa. ⁽ ² ⁾

Cancer situation in Afghanistan

According to the International Agency for Research on Cancer (IARC) In the year 2008 the rate of cancer cases in Afghanistan is about 14,000, and the deaths about 11,000. It is estimated that the number of deaths from cancer in the country is about 80 percent. The department of cancer cases, in the year 2012 had estimated about 16,000. According to the latest report, quoting the Ministry of Public Health of Afghanistan in the year 2015 the number of cases of cancer in the country was 20 thousand and the mortality from it was 16 thousand, it is shows an estimation of 80 percent of deaths ⁽ ⁶ ⁾ By comparing the number of cases in the year 2008 to the number of cases in the year 2015 , during the seven years cancer increased by about 25percent in Afghanistan. Given strain of cancerous growth from year 2008 to year 2015, if the country is not very effective in the prevention and control of cancer the likelihood of cancer cases may increases by the year 2030 to more than 30 thousand.

However, before the year 1969 in the Department of Pathology medical university, at the time of registration the number of 895 tumors were recorded. ⁽ ⁴ ⁾

Cancer situation in Afghanistan, in proportion to neighboring countries, the region and the world is dreadful. In the United States of America throughout the year 1. 5 million new cancer cases are registered, of which about 500 thousand lose their lives ⁽ ² ⁾ The number of deaths from cancer are only about 33 percent of every three people with cancer or in other words, only one person die & two people are treated while in Afghanistan the death is about 80 percent, from every 5 persons four of them lose their lives. ⁽ ⁴ ⁾ According to reports to the International Agency for Research on Cancer the annual number of cancer cases in India is 1 . 1 million and its mortality rate is 635 thousand, about 57 percent, it is still a low level of mortality is the proportion to Afghanistan. In India cancer constitutes 8 per cent of all deaths ⁽ ⁴ ⁾ While in Afghanistan, despite the high rate of deaths from wars and infectious diseases, cancer is responsible for about 13percent of deaths. ⁽ ⁷ ⁾ In Iran, the number of cancer cases annually is about 80 thousand reported of which 30 thousand people have lost their lives that is about 37 percent of deaths, show that the ratio is very low compared to Afghanistan. ⁽ ⁴ ⁾

In terms of actual numbers and the deaths from six types of cancer among men in Afghanistan the most cases are of gastric cancer, esophageal cancer, lung cancer, bladder cancer, cancer of the large intestine (colon and Rectum) and leukemia and six types of cancer among women which have the highest incidence and mortality are breast cancer, gastric cancer, esophageal cancer, large bowel cancer (colon and Rectum), cervix cancer and leukemia. If both genders are considered together, a total of six cancers that have the highest incidence and mortality rates are breast cancer, gastric cancer, esophageal cancer, lung cancer, large bowel cancer (colon and rectum) and cancer of the cervix. ⁽ ⁴ ⁾

According to the World Health Organization and the Department Statistics in Afghanistan, the number of women older than 15 years are 6. 25 millions. Estimates show that total annual of about 486 women are diagnosed with cervix cancer, including 319 of them lose their lives. ⁽ ⁴ ⁾

Cancer treatment in most countries in a comprehensive program that includes diagnosis, treatment, and is prevention takes place but in Afghanistan that we do not have such program. There have been few advances in the diagnosis of cancer diseases, while there is no treatment centers in the country which is very disappointing. In order to prevent cancer and early detection and timely measures are not taken. From the above mentioned treatment protocols only surgery is performed in Afghanistan, where as radiotherapy which the core treatment for cancer, it is not available to patients which is required for proper cure. Hence, patients in order to get the treatment they travel to other countries. According to officials in order to detect, assess and treat cancers people have to Pakistan, Iran, India, Turkey and a few of them travel to Western countries. According to the Afghan Ministry of Public Health estimates the annual cost of cancer treatment outside of Afghanistan for Afghans is about 300 million US dollars. ⁽ ⁶ ⁾

The low level of awareness, the more recent stage cancer patients have cancer, see a doctor. The big challenge is facing increased cancerous cases in the country’s health system. If the situation continues this way, the number of cases and deaths from cancer will double by the year 2030. ⁽ ⁴ ⁾

In the year 2008 a non-governmental organization the Indian National Cancer Society, established two camps in Kabul. A total of 350 patients received examination and treatment, and information was gathered about them. Most tumor that was found in this study were tumors of the esophagus and stomach. Most cases of lung cancer were secondary. Cases of head and neck tumors were uncommon. The highest incidence rate were of breast cancer among women. It is also clear that the incidence of cancers of the digestive system in Afghanistan is incredibly high. The study also identified several risk factors for cancer in Afghanistan, including smoking cigarette and tobacco, air pollution, chronic diseases of stomach, H. pylori bacteria in the stomach, unhygienic foods, hot foods, foods high in fat, obesity, chronic intestinal diseases and sustainable use of stomach medicines (such as Omeprazole). ⁽ ⁴ ⁾ Since the population of Kabul is increasing, thus the incidence of cancer will increase too. For this reason there is need for establishing proper cancer centers to provide services of chemotherapy and radiotherapy.

At present there are not any centers for treating cancer. Some surgical procedures can be done at Aliabad teaching hospital, [and Republic hospital] while some private hospitals also offer services without cancer drug treatment. Indira Gandhi Child Health Republican hospitals and give medicine and offer blood treatment services for cancer patients. This is despite the fact that more than 95percent of patients, according to lack of resources, do not receive any services from the hospital. We Afghanistan seriously have lack of capacity in prevention, public awareness, assessment and diagnosis and treatment of cancer. Some patients have the financial ability to travel abroad, while very few patients are sent abroad for treatment by the government. If traveling out of the country 30 thousand US dollars payment is estimated for treatment that is difficult for the government and the family. ⁽ ⁴ ⁾

About 40 years ago, Afghanistan had a cancer treatment center with limited services at the Aliabad hospital, but after the Civil War in 1992, like other infrastructure, equipment and materials the center was also destroyed. Radial treatment center Aliabad hospital was inaugurated in 1967 by the Hungarian President and Chairman of Energy Commission. Project was supported by the atomic world organization, providing needed radioactive materials. Also in 1991 a package of radioactive materials which is used in the treatment of cancers of obstetric gynecology unit was imported from India.

So we said radial treatment/ radiation therapy is vital to treat cancer cells. In most cases (50 to 65 percent) in addition to other forms of treatment, radiation therapy is required during treatment. During the 40 years the world’s nuclear agency, the health sector in poor and developing countries is setting up diagnostic radiography, nuclear and radiation treatment has provided technical assistance. International Organization for Nuclear technical assistance required is a series of preconditions, including the cooperation of the Government on the necessary assessments, planning, education, economic analysis, implementation and finally the development of infrastructure for bearing protection, safety and security that many of these preconditions are weak in Afghanistan.

Lack of services and cancer treatment centers in Afghanistan, the need for access to facilities and related services for cancer patients is increasing, especially medicines and diagnostic services. Providing the right to equal access to cancer treatment centers for all those in need and providing treatment and diagnostic services required and relevant professionals to treat them at home, so that in the strategic plan of the Ministry of Public Health for the years 2011 to 2015 they are also priorities of the Afghan government.

Given the above, the Ministry of Higher Education in charge of Kabul Medical University, teaching hospital, Aliabad and a number of teaching and other treatment centers in coordination with the Ministry of Public Health is working on planning a center equipped to treat cancer in the hospital, Aliabad district. In this project Commission for Atomic Afghanistan and world atomic organizations are co-workers. The work of the project which started in the year 2013 will probably continue to seven years. However, due to facing security problems the project will be one of the major challenges, such as radioactive material that is used in the center due to its harmful effects, can be exploited. If stability does not improve, probably the world Atomic Energy Organization avoid to provide radioactive materials to Aliabad Hospital.

Diagnostic imaging and cancer diagnosis due to lack of necessary equipment is one of the most challenging issues in Afghanistan. Accurate diagnosis and appropriate treatment planning of cancer requires the existence of a parallel diagnostic center equipped with a good radiotherapy center.

After meeting the commitment of UN member states in September 2011 to prevent cancer, prevention and treatment of cancer it is not only the government but that international organizations such as WHO, the International Atomic Energy Agency, International Federation for Cancer Control (UICC) is required.

So the Afghan government, along with the atomic world to create at least a small center of radiation therapy / treatment, radial / radiotherapy that must take its course before it legal channels. By the year 2008 all legal and practical responsibilities will be on the Ministry of Public Health while after the decree of President of Afghanistan to create the Atomic Energy Commission, has been delegated all responsibility to the Commission. Ministry of Public Health Treatment only in some aspects, such as determining the radius and quality control services in the country will be involved. In coordination with the Ministry of Justice provided the need for nuclear energy the law was passed in the year 2012 by Parliament.

Because to control Cancer Control Center in Afghanistan for cancer radiation therapy (Radiation Oncology Department) Kabul Medical University will be in charge, so the atomic agency, Afghanistan Kabul Medical University and the Atomic Energy Commission in coordination with the Ministry of Public Health since 2013 have begun work on a plan to create a radiotherapy center. ⁽ ⁴ ⁾

Challenges

In short, major challenges ahead of cancer control and care in Afghanistan can be summarized as follows:

The lack of preventive measures to change people’s way of life to prevent cancer in general;

The lack of detailed information and documents about cancer;

The lack of diagnostic centers in the country, leading a large number of cancer patients to travel to receive care abroad;

The lack of health centers in the country that can respond to treatment with medicines and radiotherapy;

The lack of qualified staff and trained in the area of health care that can help to prevent cancer diseases, diagnosis and patient treatment;

The lack of a comprehensive plan for the care, control, prevention and treatment of cancer patient;

Lack of coordination among different health organizations to control cancerous disease;

Lack of coordination between the health sector in general with other sectors that can contribute to cancer control, such as the Environmental Protection Agency, municipalities, ministries of energy and water, industry, economy, finance, and other organizations.

The conclusions and recommendations

Cancer is a global problem and no country in the world that can be free of cancer and Afghanistan is no exception. Cancer does not mean death; there are easy and inexpensive ways to prevent it. More than40 percent of cancers are preventable and treatable. More than three-quarters of them are as successful. So providing the right to equal access to cancer treatment centers and providing treatment for all those in need and to provide needed medical technologies and related experts for treatment in their own countries, the priorities to the poor and developing countries [including Afghanistan] . ⁽⁴ ⁾

Cancerous disease control infrastructure in Afghanistan is extremely weak. Socio – Economic decades has led to the development of standards for cancer care and control not to be priority in Afghanistan. Lack of information and documents, lack of trained human resources and most importantly the lack of policies and strategies in this case is very clear. The main priorities of cancer control and care in Afghanistan was discussed in detail above. Here is a summary of specific proposals to control cancer in the country:

Prevention: policy makers in health system need to develop “cancer control program,” which contains four elements: prevention, early detection, treatment and palliative care. Improve health forming the foundation step of cancer control, while encouraged to quit smoking, improve nutrition and promote physical activity and exercise, healthy living and cancer prevention is key steps. At the same time, public awareness campaigns about cancer are considered priority.

Data collection and arrange documents: The first step in fulfilling this issue is to create a “cancer centers” in the country. If the existence of the registry of cancer cases is present in each health facility, accurate and timely data can be collected. If the creation of such centers in all health facilities are scarce, it should first begin from Kabul hospitals and regional hospitals in some regions.

Establishing equipped diagnostic centers: equipped diagnostic centers must be established with the help of doctors who have experience and knowledge.

Establish a treatment center bearing / radiation therapy: In this regard, Aliabad Hospital can be renovated and equipped.

Establish a treatment center (Chemotherapy): The first step in direction in the treatment of cancer include medicines, that are on the list of essential medicines in Afghanistan and measures must be taken to legalize and promote them.

Capacity building for medical staff: doctors must be trained and qualified employees inside or outside the country about the prevention, diagnosis, treatment and palliative care for cancer can lead us to that goal. ⁽ ⁴⁾

Reference:

KUMAR, ABBAS, FAUSTO, MITCHELL, 2007. Rubbins Basic Pathology, 8^th Edition, Philadelphia: Saunders, an imprint of Elsevier Inc.

LONGO, FAUCI, KASPER, HAUSER, JAMESON, LOSCALZO, 2012. Harrison’s Principles of Internal medicine, 18th Editions, New Yark: McGraw Hill.

MOHAN H. 2005. Text Book of Pathology, New Delhi: Jaypee Brothers Press.

SILBERMANN, FAQEERZAI, SALJUQI, SAMIEI, 2016, Cancer Care in Countries and Societies in Transition, 1^stEdition, Switzerland: Springer International Publishing.

MAHA JAN, GUPTA, 2013. Text book of Preventive and Social Medicine, New Delhi: Jaypee Brothers Press.

BBC site

Ministry of Public Health, Afghan Public Health Institute, 2011. Afghan Mortality Survey, Kabul Afghanistan.