Partner Profile

The National Cancer Institute in Cairo

by Dr Hussein M. Khaled
Vice Dean, NCI

Cairo's National Cancer Institute, first established in 1969, is the largest cancer center in the Middle East.

History

The development of modern oncology in Egypt is credited to two great surgeons—Professor Aboul-Nassr and Professor El Sebai. The idea of establishing a National Cancer Institute arose in the 1950s and it was eventually implemented through the determined efforts of Professor Ahmed Lotffi Aboul-Nassr. With the same enthusiasm, Professor Ismail EL-Sebai introduced radical surgery for cancer and trained a large group of Egyptian surgeons. Thanks to their efforts, Cairo University recognised oncology as a separate specialty in 1959.

The National Cancer Institute, including its hospital of 270 beds, opened in 1969.

The Problem

In Egypt today, the number of new cancer patients per year is estimated to be 65,000. Accumulated patients represent about three times the number of new cases. This patient load will expand in the future as the population continues to grow and age, and as the prevalence of known etiological factors increases. Egyptian patients with cancer usually present at a relatively advanced stage in their disease, which has a negative impact on treatment results. The three most common cancers encountered are urinary bladder (30%), breast (14%), and lymphomas and leukemias (12%).

Patients with cancer require repeated hospital visits and hospitalizations, sometimes over the course of several years. A child with acute leukemia requires about 132 hospital visits over ten years while a woman with breast cancer may require more than 20 visits over ten years. Since NCI is the largest comprehensive cancer center in the country, it is overloaded by patient referrals from all over Egypt, although in recent years eight small cancer centers have opened throughout the country. In addition to these cancer centers, six university-based clinical oncology departments operate in various parts of Egypt.

Patient population

The NCI registry, over a 23-year period (1970-1993), included a total of 1,057,733 patient services, comprising 122,099 new cancer patients, 50,399 admitted patients, and 935,634 outpatient visits. About 38% of patients came from the Cairo metropolitan area, 40% from Lower Egypt, and 22% from Upper Egypt. About 65% of patients are treated free of charge and private patients generally have health insurance which covers their costs.

Facilities

The present hospital of 500 beds is the largest cancer center in the Middle East, and developed in stages. In 1989, the old NCI hospital was renovated at a cost of 6.6 million Egyptian pounds L.E., and in 1993, a new 230-bed hospital was opened, permitting more patients to be served. The total cost of the new hospital was 83.5 million L.E. (44.5 million L.E from the Egyptian government, 25 million L.E. from foreign grants and 14 million L.E. from public donations). This project received valuable support from the USAID program of the American government, the European Union, and the United Nations Development Program (UNDP). With these successive enlargements, the number of new patients rapidly doubled, while the number of outpatient visits increased approximately ten-fold. In 1999, just ten years later, 20,000 new patients were seen at the NCI, and the number of outpatient visits totalled approximately 140,000 visits.

At the present time, the hospital includes a broad array of medical services. There are 14 operating theatres, an intensive care and recovery unit (36 beds), adult and pediatric medical oncology units, a pain control clinic, and a bone marrow transplantation unit. Radiotherapy facilities include three linear accelerators, three cobalt machines, two simulators, one deep X-ray therapy machine, and interstitial therapy after-loading capabilities. There is a nuclear medicine unit and a radiodiagnosis department equipped with standard x-ray facilities, mammography, computerized tomographic scanning, ultrasonography, and magnetic resonance imaging. There is a diagnostic endoscopy unit, several clinical pharmacy units, clinical pathology laboratories, a blood bank, a laboratory of surgical pathology, a laboratory of cytopathology, a cancer registration and epidemiology unit, a department of cancer biology, an electron microscopy unit, and an experimental surgery unit associated with an animal house.

Academic Program and Research

NCI offers academic degrees in various oncology specialties, including a master's degree in pain control, and doctoral degrees in surgical oncology, adult and pediatric medical oncology, radiotherapy, pathology, clinical pathology, and cancer biology. A total number of 58 master's degrees and 185 doctoral degrees have been awarded.

The NCI is the nation's first to receive international research grants to study cancer problems of particular importance to Egypt. During the past two decades, seven NCI staff members have received the National Research Award.

Community Outreach

NCI recognises its role in community health and maintains a positive attitude toward all cancer-related problems. It has active programs in cancer prevention and early detection through public education. It also plays an important role in educating doctors throughout Egypt who serve in various health care sectors via its visiting residency programs, continuing education programs, and staff visits to satellite clinics.

International Collaboration

The institute has an active program of scientific collaboration with a number of international cancer centers which at various times have included the National Cancer Institute, Bethesda, USA; Institute Gustave Roussy and Lyon Hospital, France; the National Cancer Institute, Holland; Guy's Hospital, London; Karolinska Hospital, Stockholm, Sweden; and Health Care International, Scotland. Currently the NCI is an active member of the European Organization for Research and Treatment of Cancer (EORTC) in Brussels, Belgium, and participates in treatment protocols for cancers of the breast, GIT, and lung as well as lymphomas. The NCI has been recognized by the World Health Organization as a collaborating center in bladder cancer and head and neck cancer.

Pioneer Achievement

• NCI is the world's first in bladder surgery (16,000 cases).
• Egypt's first to perform bone marrow transplantations (1988).
• Egypt's largest hospital computer network and integrated Hospital Information System (1992).
• Egypt's first to use computers in radiotherapy dosimetry (1992).
• Egypt's first Cytology Laboratory (1973).
• The nation's first Medical Oncology Department (1970).
• Egypt's first to use Iridium implants (1973).
• Egypt's first Tumor Markers Laboratory (1982).
• Egypt's first to screen anti-cancer activities of Egyptian plants in experimental animals