Small lump, big threat: Doctors warn of bone cancer danger

Prof Jessie Githang’a, Dr Joyfrida Chepchumba and Dr Doreen Karimi-Mutua discuss findings from a study on healthcare-seeking behaviour among caregivers of children with cancer in Kenya at PrideInn Azure Hotel, Nairobi. [James Wanzala, Standard]

What begins as a small, seemingly harmless swelling on your limbs can sometimes be the first visible sign of a disease that has already begun taking root.

Orthopaedic cancer specialists are now urging Kenyans not to ignore swellings that continue to grow, particularly those that reach the size of an egg, warning that delayed investigation could allow bone cancers to advance to stages where treatment becomes far more difficult.

For doctors, however, the challenge is to detect the warning signs early, investigate them properly and refer patients before the disease advances to a life-threatening stage.

“Any swelling which is the size of an egg is a red flag. Every centimetre of cancerous growth decreases the chances of cure,” says Oxford-based orthopaedic consultant Dr Duncan Whitwell during a conference at St Luke’s Orthopaedic and Trauma Hospital in Eldoret.

His warning captures a growing concern among specialists dealing with cancers of the musculoskeletal system; diseases that can affect bones, muscles, joints, connective tissues and other structures supporting the body.

For many patients, the first signs can be deceptively ordinary: a swelling, persistent pain or what appears to be an injury.

But by the time the patient reaches a specialist, the tumour may have grown substantially.

“Late presentation remains the real threat to successful cancer treatment,” Dr Whitwell says.

He said bone cancers were complex and required several specialists to work together, including orthopaedic surgeons, oncologists, radiologists and pathologists.

“It is a team approach to treatment. Doctors are being targeted for training to diagnose and treat bone cancer better,” he added.

The warning comes against the backdrop of Kenya's wider cancer burden. The World Health Organisation estimates that Kenya records about 44,700 new cancer cases and 27,000 cancer-related deaths annually. Screening and early diagnosis remain major challenges, particularly because specialised cancer services are concentrated in major urban centres.

But specialists at the Eldoret meeting said the number of patients arriving with advanced disease was alarming.

St Luke’s Orthopaedic and Trauma Hospital director Dr Lectary Kibor Lelei said the country had the capacity to identify bone and other cancers earlier if health workers were adequately trained and facilities equipped to investigate suspicious cases.

Dr Lelei said there were no reliable national figures showing the precise burden of primary bone cancers, making it difficult to establish the true scale of the problem.

“It is possible for doctors to detect bone and other cancers at initial stages. Bone cancer is a major problem in Kenya because of late diagnosis,” Dr Lelei said.

He urged patients not to wait for a swelling to become painful or debilitating before seeking medical attention.

“Any swelling in your body that is the size of an egg could likely be a cancer and should attract investigations immediately after presentation,” he said.

The emphasis, specialists said, should not be on frightening patients but on changing a culture in which persistent swellings are often dismissed as injuries, infections or harmless growths.

Among children, the problem can be particularly difficult to diagnose at early stages.

Dr Lelei said bone cancers in children were sometimes mistaken for injuries sustained while playing.

This, he says, is worsened by delayed referral and specialised investigations.

Dr Nashat Noor, director of cancer prevention and control at the National Cancer Institute of Kenya, said patients sometimes go through treatment for injuries or infections before discovering that they had cancer.

“People usually assume that they are battling injuries and infections only to realise later that they had cancer of the bones,” Dr Noor said.

She said musculoskeletal cancers were common among children and that restoring hope and dignity to patients must remain central as the cancer burden grows.

“With the expertise that we have, we can deal with misdiagnosis of orthopaedic cancers,” she said.

Technology

Specialists say technology is increasingly becoming an important weapon against late diagnosis.

A simple X-ray remains an important first-line examination for suspected bone tumours, but modern diagnosis can require more sophisticated imaging.

MRI provides detailed images of the tumour and surrounding soft tissues, while CT scans offer detailed cross-sectional images and are particularly important when assessing whether a cancer has spread to the lungs.

For confirmed osteosarcoma, one of the main primary bone cancers, international guidelines recommend MRI of the affected bone, CT where MRI is unavailable and, where appropriate, PET-CT or PET-MRI to assess the spread of disease. A biopsy is ultimately required to establish whether a tumour is cancerous.

PET-CT can be particularly useful in staging because it combines metabolic information from PET with anatomical images from CT. The National Cancer Institute notes that PET-CT has shown greater sensitivity than bone scanning in detecting bone metastases in osteosarcoma.

Kenya, however, still faces a major equipment gap.

The Ministry of Health's 2023 Health Facility Census found that only 15 per cent of surveyed facilities had CT scanners, four per cent had MRI machines and three per cent had PET scanners.

Dr Lelei said expanding access to diagnostic equipment was therefore critical.

“Apart from normal X-rays, we should be able as a country to access CT scans and MRI. If we have enough technology, we can diagnose cancers early,” he said.

He said the high cost of equipment remained one of the barriers to access.

“Diagnostic equipment is expensive and that limits availability. If this equipment is subsidised, the problem of access will have been solved,” he said.

He added that Kenya did not necessarily need the most sophisticated equipment in every facility.

“We don’t need very sophisticated equipment at the moment, but the available ones can serve so long as they are available.”

There are signs of movement in that direction.

In January this year, the Ministry of Health inaugurated a 160-slice CT scan centre at Longisa County Referral Hospital, expanding access to advanced imaging for oncology, trauma and other conditions. In April, a 128-slice CT scanner was unveiled at Bungoma County Referral Hospital.

The government has also been rolling out equipment through the National Equipment Service Programme. By April 2026, the Ministry said 213 facilities across 43 counties had been equipped with modern medical equipment under the programme.

At The Nairobi Hospital, the Ministry commissioned a 256-slice CT scanner in 2025, described by the government as East Africa's first of its kind, with applications including oncology and orthopaedics.

But technology alone will not solve the problem.

Doctors at the Eldoret conference stressed that equipment must be matched with trained personnel, pathology services, referral systems and public awareness.

“The challenge has been access to care and getting the right data,” Dr Noor said.

She said technological innovations were already improving cancer management and care, but adoption needed to be the next phase.

A disease that often arrives quietly

Unlike some cancers where recognised risk factors help doctors identify people at high risk, many primary bone cancers have no clear cause.

“A majority of bone cancers unfortunately have no cause; they just strike,” Dr Whitwell said.

That unpredictability makes vigilance even more important.

Specialists further say that unexplained bone pain, or symptoms that do not improve as expected, should prompt medical assessment rather than prolonged self-treatment.