Cancer

Cancer is a large group of diseases defined by abnormal cells growing uncontrollably, moving beyond their usual boundaries to invade adjoining parts of the body and potentially spread to other organs; this process is called metastasis. Widespread metastases are the primary cause of death from cancer. Globally, cancer is the second leading cause of death. It accounted for nearly 10 million deaths in 2022, representing approximately one in six deaths worldwide. Cancer affects people of all ages; each year, an estimated 400 000 children and adolescents aged 0–19 years develop cancer globally. The most common types of childhood cancer include leukemias, brain and spinal cord tumours, lymphomas, neuroblastomas and Wilms tumours.

Cancer is one of the top four leading causes of death in the WHO Eastern Mediterranean Region. The Region faces a substantial health challenge, with nearly 500 000 people dying from cancer annually. The most frequent cancers identified in the Region are breast and colorectal cancers in females, and lung and prostate cancers in males. The rising burden of cancer is attributable to factors such as population ageing, improved detection and registration, and increased exposure to risk factors, including tobacco consumption, unhealthy diet, physical inactivity, pollution, and industrial and agricultural carcinogens. Chronic infections like HIV, Epstein-Barr virus, and malaria are risk factors for childhood cancer particularly relevant in low- and middle-income countries.

Between 30% and 50% of cancer deaths could be prevented by modifying or avoiding key risk factors and implementing existing evidence-based prevention strategies. The cancer burden can also be reduced through early detection of cancer and management of patients who develop cancer. Prevention also offers the most cost-effective long-term strategy for the control of cancer.

Modifying or avoiding the following key risk factors can help prevent cancer:

• avoid tobacco use, including cigarettes, nicotine products, and smokeless tobacco;
• maintain a healthy weight;
• eat a healthy diet with plenty of fruit and vegetables;
• exercise regularly;
• limit alcohol use;
• practice safe sex;
• get vaccinated against hepatitis B and human papillomavirus (HPV);
• reduce exposure to ultraviolet radiation;
• prevent unnecessary ionizing radiation exposure (e.g. minimize occupational exposure, ensure safe and appropriate medical use of radiation in diagnosis and treatment);
• avoid urban air pollution and indoor smoke from household use of solid fuels;
• get regular medical care, as some chronic infections are also risk factors for cancer. People in low- and middle-income countries are more likely to develop cancer through chronic infections.

Early detection

Cancer is more likely to respond to effective treatment when identified early, resulting in a greater probability of surviving as well as less morbidity and less expensive treatment.

There are two distinct strategies that promote early detection:

1. Early diagnosis identifies symptomatic cancer cases at the earliest possible stage.
2. Screening aims to identify individuals with abnormalities suggestive of a specific cancer or pre-cancer who have not developed any symptoms and refer them promptly for diagnosis and treatment.

Treatment options include surgery, cancer medicines and/or radiotherapy, administered alone or in combination. A multidisciplinary team of cancer professionals recommends the best possible treatment plan based on tumour type, cancer stage, clinical and other factors. The choice of treatment should be informed by patients' preferences and consider the capacity of the health system.

Palliative care

Palliative care, which focuses on improving the quality of life of patients and their families, is an essential component of cancer care. Survivorship care includes a detailed plan for monitoring cancer recurrence and detection of new cancers, assessing and managing long-term effects associated with cancer and/or its treatment, and services to ensure that cancer survivor needs are met.

Palliative care in most of the Eastern Mediterranean Region remains at an early stage of development, with insufficient strategic planning by governments for palliative care services. The situation is further compounded by complicated political situations and weak health care systems coupled with conflicts affecting some countries in the Region, weakening health services and further increasing the demand for palliative care services.