Tumor or Neoplasm occurs when abnormal cells form a mass (swelling) with in a tissue or within an organ. There are two main types of tumor: Malignant (cancerous) tumor and benign tumor. Cancer is the name given to malignant or cancerous tumor. Cancerous tumor has the capacity to grow rapidly and to metastasize or spread to other tissues. Some tumors like leukemia grow as cell suspensions but most grow as solid masses of tissue.

Cancer is not a singular, specific disease but a group of variable tissue responses that result in uncontrolled cell growth (Figue 5.1). Healthy tissues are composed of cells. Healthy cells have a specific size, structure, function and growth rate that best serves the needs of the tissues they compose. Cancer cells differ from normal cells in size, structure, function, and growth rate. These malignant cells lack the normal controls of growth seen in healthy cells, and grow uncontrollably. This uncontrolled growth allows the cancer cells to invade adjacent structures and then destroy surrounding tissues and organs.


Figure 5.1: (a) Cells in the body are usually well organized into tissues and do not grow beyond their normal boundaries. (b) Cancer cells grow uncontrollably, forming a mass with undefined boundaries. (Source: Level IV Health extension Non-Communicable diseases training module, part one, page 31.

Malignant cells may also metastasize to other areas of the body through the cardiovascular or lymphatic systems. This uncontrolled growth and spread of cancer cells can eventually interfere with one or more of a person's vital organs or functions and possibly lead to death.

There are many types of cancer, and they are named by the body part involved or the type of body cells involved; for example, cervical cancer, breast cancer, brain tumor, lung cancer, colon cancer, prostate cancer, skin cancer and lymphoma. The symptoms of cancer vary depending on the parts of the body involved. In Ethiopia there are no official data on cancer rates, but hospital reports suggest that cancer of the female cervix may be the leading type, followed by breast cancer.

How is cancer diagnosed at the health extension level?

The earlier cancer is diagnosed and treated, the better the chance of its being cured. Despite the limitations of diagnosing cancers from their symptoms because of the extreme diversity of the symptoms and signs, Some types of cancer such as those of the skin, breast, mouth, testicles, prostate, and rectum may be detected by routine self-exam or other screening measures before the symptoms become serious. Most cases of cancer are detected and diagnosed after a tumor can be felt or when other symptoms develop. In a few cases, cancer is diagnosed incidentally as a result of evaluating or treating other medical conditions. Cancer diagnosis begins with a thorough physical exam and a complete medical history.

A health extension worker has to refer any suspected cases of cancer she detected to the next referral level. At higher level the suspected tumor will be further investigated by imaging tests such as X-rays, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and fiber-optic endoscopy examinations. These tests help doctors to determine the cancer's location and size. To confirm the diagnosis of most cancers, a biopsy needs to be performed in which a tissue sample is removed from the suspected tumor and studied under a microscope to check for cancer cells.

Problems in diagnosing cancers from their symptoms

The symptoms and signs of cancer are extremely diverse, depending on where in the body the tumors are growing. There are no characteristic signs and symptoms that are only due to cancers, because their effects resemble many other diseases.

Some symptoms are local, affecting only the tissue or organ containing the original tumor; for example, a persistent cough may be a symptom of cancer in the lungs. Some cancers may have widespread effects all over the body because of their systemic effect; for example, cancer in the pancreas can alter the production of insulin and glucagon, causing disruption to the patient's energy supply from glucose in the diet, affecting all body functions.

Even though there is no official data on cancer rates in Ethiopia, hospital reports suggest that cancer of the cervix may be the leading type, followed by breast cancer. As types of cancer are many, we will discuss on two common types of cancers.

Cervical Cancer

Cervical cancer occurs when the cancer cells grow in the tissues of the cervix (the muscular organ connecting the uterus and the vagina). Infection with Human Papilloma virus, HPV2 (a sexually transmitted infection causing venereal wart) is the comments cause (risk factor) for cervical cancer. In low- and middle-income countries, cervical cancer is the most common female cancer and one of the leading causes of death amongst women. In Ethiopia, it is believed from hospital reports that cervical cancer is the most common of all cancers. It is usually a slow-growing cancer that may not produce symptoms in its early stages. If the cancer is advanced, it may produce symptoms including an offensive discharge and bleeding from the vagina, and pain during sexual intercourse.

As a health extension worker, you should encourage any woman with these symptoms to seek urgent medical attention. Cervical cancer can be prevented by educating your community to encourage women above the age of 21 years to undertake PAP smear test every 3 years by going to a health facilities where the service is delivered. Educating your community on risk reduction from sexually transmitted infection is also one of the strategies you can employ during your home visit service or community education sessions to prevent cervical cancer.

Breast Cancer

According to the reports from hospitals, it has been suggested that in Ethiopia breast cancer is the second leading types of cancer, preceding cervical cancer. Breast cancer is mainly a problem of women because they are 150 times more likely to develop it compared to men (the proportion of female to male ratio is about 150: 1). Women who are obese and/or eat a high fat diet, or drink a lot of alcohol are more at risk. Women should be strongly encouraged to examine their breasts monthly

Screening for breast cancer

Screening refers to any method of examining an apparently healthy person to see if they have the early signs of a particular disease, which would benefit from having early treatment. Screening for breast cancer is easily carried out by women themselves. You should advise women in your community to examine their breasts once every week or monthly, using the method of breast self-assessment.

The best time to do a self-breast exam is about 3 - 5 days after the menstruation period starts because breasts are not as tender or lumpy at this time. For women who have gone through menopause, do the breast exam any time on the same day every month.

Steps in breast self-examination:

a. View the breasts with arms down at your sides. One breast is normally a little larger than the other, but do they appear about the same size and shape? Is the outline of each breast rounded and smooth, or are there any creases or dimples?.
b. Look at your breasts for the same signs as in (a), but this time with your arms raised and your hands holding each other behind your head.
c. Repeat the visual inspection with your hands on your hips.
d. Raise your right hand above your head; with all four fingertips of your left hand, gently press the whole of your right breast, moving your fingers to the next area and using small circular movements. Feel for any lumps or thickened tissue. Repeat with the left breast and right hand.
e. Hold your right nipple between the thumb and first finger of your left hand; gently roll the nipple, feeling for any lumps or tenderness. Repeat with the left breast.
f. Lie down and stretch your left arm upwards and behind your head. Use small circular pressures with the finger tips of your right hand to examine the whole breast. Repeat with the right breast and left hand.

The following diagrams indicate the steps of breast self-examination. Steps (a) to (c) are done facing a mirror. Step (f) is done lying down.


Figure 5.2: The steps of breast self-examination.


Any mass / lump / in the breast does not mean breast cancer, because benign harmless lumps in the breast are very common. So you need to reassure women in your community that every change and every lump found in the breasts does not mean breast cancer. But you should not forget that, any women with breast lump / mass/ of two or more weeks duration should be advised to get medical checkup by health professional, they should not go to the traditional healers.

Normally, the breasts are changing every month with the phases of the menstrual cycle, due to changes in the levels of the female reproductive hormones (oestrogen and progesterone), and sometimes these changes result in temporary lumps in the breast. Some women develop small painless lumps just before their menstrual period, which disappear after a few days. Sometimes a small tender cyst develops (a collection of fluid in the breast), which also disappears after a few days.

Risk factors for cancer

Risk factor refers to any condition, behaviour or factor that increase the occurrence of a health problem. The followings are among the factors increase risk of acquiring cancer:

  • Age - being old.
  • Cigarette smoking and chewing tobacco or khat.
  • Genetic factors.
  • Environmental risk factors, such as radiation and certain viruses.
  • Exposure to some industrial chemicals (e.g. insecticides).
  • Sedentary life - lack of exercise.
  • Poor dietary habits - Fatty diet leading to obesity.
  • Excessive alcohol consumption.
Last modified: Saturday, 12 November 2016, 2:28 PM