A woman presents with a large breast mass, the skin has broken down and the wound is infected, she has large firm lymph nodes in her armpit – there is little to offer but a simple palliative mastectomy to remove the source of the putrid drainage. A young man presents with difficulty swallowing – a barium swallow shows inoperable esophageal cancer – there is no palliative care, the best course is to send him home to die. A child presents with a large abdominal tumor. Clinically it appears to be a Wilms tumor. Surgery is performed and the tumor resected but there is no chemotherapy available, hopefully the entire tumor was removed.
Three separate cases, all well advanced, all potentially curable. But the problem exists that these patients lacked the education to present early; the health system lacked the ability to provide appropriate screening; diagnostics were inadequate with pathology results sometimes taking 3 months to be returned. Chemotherapy and radiation therapy were non–existent and surgical care, when available, was simply palliative or even too late to help.
From Chapter 5: An overview of cancer in low and middle—income countries by Peter Kingham, MD and Olusegun Atatishe, MD in Operation Health: Surgical care in the developing world.
Operation Health: A series of books on surgery and global health from Johns Hopkins University Press 