4th February is celebrated as World Cancer Day with the underlying objective of creating awareness about this dreaded, yet treatable disease. Theme for 2022 is – Close The Care Gap. Worldwide, around 2 crore people are diagnosed with cancer each year, (India estimate – 12 lakhs) making it one of the commonest disease worldwide. Increased awareness about initial symptoms, when to seek medical help, diagnostic tests and various treatment modalities (both new/advanced and conventional) is crucial in making an early diagnosis. Cancer diagnosed at early stage is treated with curative intent. Lack of awareness results in delayed diagnosis and poor outcome.
On this day, we call upon all people to join hands in fighting cancer. Let us try to create awareness, bust myths and make efforts so that every cancer patient gets the adequate treatment he/she deserves. Despite availability of all the resources, technologies, expertise and infrastructure in our country, a lot of our patients cannot get access to cancer treatment. The reasons can be manifold including, financial, social, educational, logistics, beliefs, past experiences, etc. One such example wrong belief is that cancer spreads after biopsy. Biopsy is essential for diagnosis and treatment of cancer. It does not result in spread of cancer. Delaying biopsy cause increase in cancer stage, turning a curable disease into incurable one. The ultimate objective is to decrease death from cancer, which can only be achieved if we are able to recognize and close the care gap. Additionally, risk of developing cancer can be reduced by not using tobacco, maintaining body weight, eating a healthy diet, doing regular physical activity and not using alcohol.
Five TIPS to reduce our risk of developing CANCER
Many people believe that getting cancer is purely down to genes, fate or bad luck. But through scientific research, we know that our risk actually depends on a combination of our genes, our environment and things to do with our lifestyle, which we’re more able to control.
More than 4 in 10 cancer cases could be prevented, largely through lifestyle changes, such as not smoking, keeping a healthy bodyweight, eating a healthy, balanced diet, cutting back on alcohol enjoying the sun safely, keeping active, doing what you can to avoid certain infections(such as HIV, HPV or hepatitis).
Five TIPS to reduce our risk of developing CANCER include:
- Never start smoking/tobacco consumption or stop immediately if you do. This can significantly reduce the risk of several cancers including those of mouth, throat, esophagus, lungs, stomach, pancreas, urinary bladder, kidneys, uterine cervix, colon and rectum.
- Exercise regularly. Even moderate amount of physical activity can not only reduce the risk of developing cancer but also reduce the risk of developing recurrence after treatment of cancer. Regular exercise is associated with decreased risk of breast cancer, endometrial cancer and colon cancer.
- Avoid being overweight and obese. Obesity is associated with increased risk of cancer of esophagus, breast, uterus, pancreas and colon.
- Avoid excess alcohol consumption. Alcohol intake in excess of anything more than moderate amount is associated with increased risk of cancer of liver, mouth, throat, esophagus, breast and colon.
- Limit red meat and processed meat consumption and eat a healthy diet. Processed and red meat consumption is associated with increased risk of colon cancer. A high fibre diet is associated with decreased risk of colon cancer. Consume a diet rich in vegetables, fruits, whole grains and healthy proteins (pulses, beans, lentils, chicken and fish). Cut down intake of processed meat, sugary drinks and high calorie fast foods
Cervical Cancer Screening Decreases Deaths from Cervical Cancer
Cervical Cancer Screening
Cervical cancer is the second most common cancer among women in India with about one lakh twenty-five thousand new cases diagnosed each year. It is also one of the most common causes of cancer death among women in India with about sixty-five thousand women dying of it each year. Thus, it is one of the major public health problems of India.
What is the benefit of cervical cancer screening?
Screening for cervical cancer helps in detecting cervical cancer at an early stage or pre-cancerous stage (cervical intra-epithelial neoplasia). This pre-cancerous stage in cervical cancer persists for several years before progressing to invasive cancer. At this pre-cancerous stage and early invasive stage, the cancer can be cured with appropriate treatment and death from cancer can be prevented in nearly 100% cases. Overall, screening has resulted in upto 70% reduction in cervical cancer incidence.
What method is used for cervical cancer screening?
Cervical cancer screening is done by a test called Pap/Cervical smear test. The Pap test is used to find abnormal cells in the cervix that might develop into cancer over time. Pap test is a simple OPD procedure which involves gently scraping some cells from the surface of the cervix using a small spatula or a cytobrush and putting them on a slide. This procedure takes only a few minutes. The cells are then examined under a microscope in the laboratory to see if they are normal/abnormal.
What procedure is followed during a Pap test?
At a Pap test, your doctor will ask you to remove your clothing from the waist down and give you a drape to cover yourself. You will be asked to lie on the examining table with your legs placed in the stirrups and your bottom to the edge of the table. To perform the procedure, your primary care provider will insert an instrument called a speculum into your vagina for a clear view of your cervix. She or he will then gently collect a sample of cells from your cervix using a small spatula or a cytobrush. The test takes only a few minutes. Pap tests are safe.
What preparation is required before a Pap test?
The Pap test yields optimum results if scheduled between 10 to 20 days from the first day of menstrual period. The woman should not be menstruating at the time of test. Following should be avoided 48 hours before the test: Intercourse, douching of vagina, vaginal medications and vaginal contraceptives like creams/ jellies.
What are the screening recommendations for cervical cancer?
All women should start having Pap test at age 21 or 3 years after first sexual contact. Pap tests should be done once every 3 years up till the age of 65 years
Fight Cancer With Hope
What is Cancer?
Cancer starts when the cells of an organ or tissue in the body become abnormal. They grow and multiply out of control. Normal cells have a life cycle. They reproduce themselves throughout the body to replace worn out tissue, to heal wounds and to maintain healthy organs. When something happens and cells grow out of control they usually form a mass, called a tumour.
Some tumours grow only at the site where they begin (locally). These are called benign tumours. Other tumours grow locally but they might also invade and destroy the normal tissue around them or they might spread to distant parts of the body. These tumours are called malignant tumours or cancers.
What are the five most common cancers in males in Delhi?
Most common is lung cancer followed by tongue, prostate , mouth and larynx. However, taken together as a group, head and neck cancer is the commonest cancer in males in Delhi.
What are the five most common cancers in females in Delhi?
Most common is breast cancer followed by cervix, ovary, gall bladder and uterus.
How does cancer occur?
Most cancers occur by chance (randomly) as a result of damage to their genes. Genes play some role in all cancers. Many genes in the human body help to control how the cells divide and grow. When changes (called mutations) occur in those genes, they may lose that control over the cells. Because most cancers do not happen until a cell is affected by several gene mutations, most cancers are not seen until later in life. Gene mutations may be caused by aging, exposure to chemicals, radiation, hormones or other factors within the body and the environment. Over time, a number of gene mutations may occur in a cell, allowing it to divide and grow in a way that becomes a cancer.
What are risk factors for cancer?
It is usually not possible to know exactly why one person develops cancer and another doesn’t. But research has shown that certain risk factors may increase a person’s chances of developing cancer. Cancer risk factors include exposure to chemicals or other substances like tobacco, as well as certain behaviors like smoking. They also include things people cannot control, like age and family history. A family history of certain cancers can be a sign of a possible inherited cancer syndrome.
Risk factors are different for different cancers. Commonly implicated risk factors include elderly age, smoking, chewing tobacco, alcohol, industrial chemicals, chronic inflammation, diet rich in animal fats and red meat, immunosuppression, infectious agents (some viruses), obesity, radiation exposure, sunlight (skin cancer in fair skin people), etc.
Can cancer be prevented?
Over half of all cancers can be prevented. Don’t smoke, or quit smoking. Exercise and eat a healthy diet.
Can cancer be detected early?
Yes, screening for cancer can help detect cancer at an early stage. However, such screening strategies are found to be useful in few common cancers only, including breast cancer (screening by mammography), cervical cancer (screening by PAP smear) and colon cancer (screening by colonoscopy).
Is cancer a hereditary disease?
Most cancers are not caused by an inherited (hereditary) risk. Only 5-10% of all cancers are caused by an inherited gene mutation. While cancer is common, hereditary cancer is not.
Is cancer an infectious disease?
No, cancer is not infectious. It does not spread from one person to another by any mode of contact. However, some viral infections can predispose to development of cancer e.g. HPV infection predisposes to cervical cancer.
How are different cancers named?
Cancers are usually named after the part of the body where the cancer first began. The name does not change even if the cancer spreads to another part of the body. For example, if breast cancer spreads (metastasizes) to the lung, it is called breast cancer with lung metastases. If chemotherapy is indicated as the best treatment, breast cancer drugs would be used to treat the lung metastases. Other cancers such as leukemia (a cancer involving the blood) may not mention a tumour site in the name.
What are common symptoms of cancer?
Different types of cancer vary in their signs and symptoms. Symptoms also depend on how fast cancer grow, how it spread and to what organs it spreads. Common symptoms include a swelling or lump in a body part e.g. breast cancer, long standing oral ulcer (mouth cancer), difficulty in swallowing (oesophagus cancer), change in bowel habits (colon cancer), prolonged cough with or without hemoptysis (lung cancer), obvious changes in a mole (skin cancer).
How cancer spreads?
Sometimes malignant cells break loose from the original (primary) tumour, get carried to other parts of the body and start growing in the new site as an independent secondary cancer. A tumour that has spread in this way has ‘metastasized’ and the secondary tumour (or tumours) is called a metastasis (or metastases).
When one type of cancer spreads to another part of the body, it doesn’t become another type of cancer. For example, if a person with colon cancer develops a metastasis in the lung, then the tumour growing in the lung has the same features as the colon cancer. It is the same cancer in a new place. This is why it is very important for the doctors treating a patient to be able to find the primary site where the cancer started.
Metastasis takes place in many ways: through the lymphatic system, through the blood or by spreading through body spaces such as the abdominal cavity. Cancers can spread by more than one route.
Lymphatic system
The most common way for cancer to spread is through the lymphatic system. The lymph system has its own channels that circulate throughout the body, similar to the veins and arteries of the bloodstream. These channels are very small and carry fluid called lymph throughout the body.
Often when a solid tumour is removed by surgery, the surgeon will remove not only the tumour but the neighboring lymph glands, even though there is no visible sign of cancer in those glands. This is done as a precautionary measure, because if even one cell has broken away from the tumour and lodged in the lymphatic system, the cancer could continue growing and metastasizing.
Circulatory system
Cancer can metastasize through the blood. All cells (healthy and cancer) must have a blood supply in order to live, so all cancer cells have access to the bloodstream. Malignant cells can break off from the tumour and travel through the bloodstream until they find a suitable place to start growing a new tumour. Tumours that spread by blood almost always metastasize through the veins rather than through the arteries. Sarcomas spread through the bloodstream, as do certain types of carcinomas, like carcinoma of the kidneys, testicular carcinoma, and Wilms’ tumour, a type of kidney cancer seen in young children.
Local invasion
Cancers can spread by local invasion — by growing into the healthy tissue that surrounds the tumour. Some cancers that spread this way do not travel very far from the original site. An example of this kind of cancer is basal cell carcinoma of the skin. When this kind of cancer is removed by surgeon, a wide area of healthy tissue surrounding it is also removed and it is usually “cured” immediately. Unless some cells have been left behind, it is very unlikely that it will recur. However, it is possible that a second cancer of the same kind may start to grow at a later time at a completely different site — the new growth would not be connected with the first.
Cancers do not spread in a completely random fashion. Some parts of the body accept metastases more easily than others. For example, cancers rarely metastasize to the skin, but they often metastasize to the liver and lungs. Each type of cancer has its own pattern for metastases. See the individual cancer pages for more information.
What are the treatment options?
Treatment options include surgery, cancer drugs (chemotherapy, targeted therapy, hormonal therapy, immunotherapy) and radiation therapy. These are used singly or in combination (MULTI-MODALITY TREATMENT) depending on cancer type and stage of disease. These treatment modalities have shown to cure cancer (in early stage disease) and extend life along with improvement in quality of life (in advanced stage disease).
The type of treatment or the order of treatment will be different for individual patients, depending on the location/type of the tumour, the stage of the disease at diagnosis and patient/physician preferences. For example, surgery is generally considered the first treatment option in early stage disease. However, sometimes radiation therapy or cancer drugs are used to shrink the tumour before surgery, or chemotherapy may be the best first option. Cancer drugs are often given in combinations called chemotherapy protocols.
Is cancer curable?
Yes, a lot of cancers in early and localized stage are curable with the use of current surgical techniques, systemic chemotherapy/targeted therapy and advancements in radiation techniques.
Ovarian Cancer
What is Ovarian cancer?
Ovaries are two almond-shaped glands in the female reproductive system. These produce the eggs needed for reproduction and also produce female hormones, estrogen and progesterone. They are located on either side of uterus/womb in the pelvis. Development and proliferation of abnormal cells in the ovaries leads to ovarian cancer.
What are risk factors for ovarian cancer?
Risk factors include:
- Family history of ovarian and breast cancer
- Women with BRCA 1 and BRCA 2 gene mutations
- Women who have early menstruation (before age 12) and late menopause (after age 50) have a higher risk
- Women who never carried a pregnancy or carried first pregnancy after 35 years of age have a higher risk
- Increasing age (>50 years)
- Obesity (Body mass index>30)
What are the symptoms of ovarian cancer?
Most common symptoms include:
- Bloating sensation in abdomen
- Feeling full quickly after meals
- Pain in lower abdomen
- Urinary urgency or frequency
What are available treatment options for ovarian cancer?
Treatment options for ovarian cancer include surgery and chemotherapy. Majority of patients require a combination of these two treatment modalities.
Can ovarian cancer be cured with treatment?
If diagnosed in early stage and treated properly, ovarian cancer can be cured. However, most patients with ovarian cancer are diagnosed in advanced stages where the disease can only be controlled using systemic chemotherapy and surgery.
Cervical Cancer
What is cervical cancer?
Cervix is the lowermost part of the uterus or womb which opens in the vagina. Development and proliferation of abnormal cells in this region leads to cervical cancer. Persistent infection with Human Papilloma Virus (HPV) plays the central role in the development of cervical cancer.
How common is cervical cancer?
Cervical cancer is the second most common cancer among women in India. Each year about 1.4 lakh women develop cervical cancer in India.
What are the risk factors for developing cervical cancer?
Risk factors for cervical cancer include:
- Multiple sexual partners
- Early onset of sexual activity
- Multiple child births
- History of sexually transmitted disease
- Immuno-compromised state like HIV infection
- Smoking
What are the common symptoms of cervical cancer?
- Foul smelling or blood stained vaginal discharge.
- Abnormal vaginal bleeding, bleeding after sexual activity, post menopausal bleeding.
How is cervical cancer diagnosed?
When a lady present with symptoms suspicious of cervical cancer, first a clinical examination is done. If any abnormal cervical growth is detected, a biopsy is performed. If biopsy is confirmatory of cancer, subsequently staging scan is done which includes MRI of pelvis.
What are the available treatment options for cervical cancer?
Treatment of cervical cancer depends on stage of disease.
- In early stage disease / stage I – Patients are treated with surgery with or without radiation therapy.
- In locally advanced stage / stage II & III – Patients are treated with a combination of radiation therapy and chemotherapy.
- In widespread / stage IV – Patients are treated with chemotherapy with or without targeted therapy.
Can cervical cancer be cured with treatment?
If treated properly, majority of patients who are diagnosed with stage I, II & III disease are completely cured. However, patients presenting with stage IV disease have poor outcome.
Endometrial Cancer
What is endometrial cancer?
Excessive proliferation of abnormal endometrial cells, which form the inner lining of the uterus or womb leads to endometrial cancer.
What are the symptoms of endometrial cancer?
Most common symptom of endometrial cancer is abnormal vaginal bleeding in a post menopausal lady.
How is endometrial cancer diagnosed?
When a lady present with symptoms suspicious of endometrial cancer, first a clinical examination is done. This is followed by endometrial biopsy or dilatation & curettage. If biopsy is confirmatory of cancer, subsequently staging scan is done which includes CT of abdomen and pelvis.
What are the available treatment options for endometrial cancer?
Treatment of endometrial cancer depends on stage and grade of disease.
- In stage I with no high risk features – Patients are treated with surgery alone.
- In stage I with high risk features & stage II – Patients are treated with surgery followed by radiation therapy.
- In stage III – Patients are treated with surgery followed by chemotherapy and radiation therapy.
- In widespread / stage IV – Patients are treated with chemotherapy.
Can endometrial cancer be cured with treatment?
If treated properly, majority of patients who are diagnosed with stage I, II & III disease are completely cured. However, patients presenting with stage IV disease have poor outcome.
Dr. Alok Gupta 