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Frequently Asked Questions

Cancer is the name given to a group of diseases that have the common feature of uncontrolled cell division, which does not fulfill any useful purpose. This uncontrolled growth produces a mass called as a 'tumour'.
Cancer is broadly divided into solid organ cancers [e.g. cancers of the breast, stomach, intestines] and Haemato - lymphoid cancers [which involve the lymph glands, bone marrow and blood forming elements, commonly called as lymphomas and leukemias or 'blood cancers']
Cancer presents when the tumour interferes with the function of the organ from which it arises. For instance, cancer of the rectum, the last part of the intestine presents with bleeding and constipation. That arising from the food pipe causes difficulty in swallowing food etc. Apart from these specific symptoms, weakness, fatigue, loss of appetite and unexplained weight loss are symptoms common to all cancers.
Cancer is caused by multiple environmental factors and their interaction with a person's genes and while it cannot be completely prevented, the risk of getting a cancer can be reduced by taking certain precautions, including: Avoiding tobacco in all forms, reducing or avoiding alcohol consumption, reducing consumption of processed food, increasing the intake of fruits and vegetables and maintaining an ideal body weight by regular exercise.
  • Cancer is caused by a change in a person's genes called a mutation. This leads to loss of the body's control over the cell, leading to uncontrolled growth. This may be a hereditary process, implying that the mutation is present in the parents and passed onto the children or it can arise due to interaction of the person's cells with environmental toxins.
  • The common agents causing cancer include: Ultraviolet radiation [Present in Sunlight], Alcohol [liver and rectal cancer], smoking [responsible for 40 - 50% of all cancers including those of the mouth, throat, stomach, kidney, pancreas and bladder], Viral infections [Hepatitis viruses causing liver cancer], chemicals and industrial dyes [bladder cancer]. Obesity is a risk factor for colon, uterine and breast cancer.
Screening refers to the application of simple tests so as to detect cancer at an early stage, before it produces symptoms. The treatment of cancers so detected should lead to a reduction in the death rate due to the cancer.

    The tests which are part of screening and which can detect cancers at an early stage include:

  • Mammography: Breast cancer
  • Serum PSA test: Prostate cancer
  • Colonoscopy: Colon and Rectal [large intestine] cancers
  • Pap Smear: Cervix cancer in women
The treatment of cancer is complex and involves surgery, radiotherapy and chemotherapy either alone or in different combinations to produce the best outcome for the patient. Often treatment is tailored - meaning that the dosage of drugs and type of treatment vary between patients having the same cancer, depending on the patient's nutritional status, general condition, other illnesses like heart disease all of which will influence the ability to tolerate the treatments offered.
Surgery is a major part in the treatment of solid organ cancers. In most cancers surgical removal either at the beginning or after shrinkage by chemotherapy and or radiation is necessary for cure. Surgery is also required to remove cancers that recur after treatment with radiation and chemotherapy, for e.g. cervix cancer after radiotherapy. Surgery is often needed for diagnosis of many cancers, to obtain a biopsy of the tumour and to treat complications such as intestinal obstruction, tumour bleeding or to establish a route to feed the patient.
Chemotherapy is a form of treatment using drugs called chemotherapeutic agents, which target the tumour cells, and destroy them, while sparing normal body cells. It is a very strong treatment modality and though it acts selectively on cancer cells, some effect on the normal body tissues do occur, leading to side effects. Common effects are: hair loss, nausea and vomiting, loose motions, weakness and mouth ulcers. Many of these are preventable or minimized using modern medicines given as a pre-medication before the chemotherapy.
Radiotherapy is a treatment modality that uses ionizing radiation [similar to X-Rays] to destroy cancer cells. The particles in the radiation beam act on cells to produce free radicals, which then destroy the cancerous tissue. Some 'bystander effect' is also seen on normal tissue around the tumour; this is however minimized using modern radiotherapy machines and techniques such as 'Cyberknife', Intensity Modulated Radiotherapy [IMRT] and Three - dimensional conformal radiotherapy [3D CRT]. Radiotherapy may be used as a curative modality by itself for e.g. for early stage cancers of the cheek and tongue or in combination with chemotherapy as Chemoradiotherapy. The treatment may be curative in itself or given to shrink the tumour for surgery - neoadjuvant approach; as is done in rectal cancers. Radiotherapy is also used to relieve symptoms due to a tumour, when it cannot be cured to stop bleeding from a tumour or to relieve pain or relieve a block in the food pipe or intestine or voice box.
Cancer treatment today is very sophisticated and is moving towards increased precision while at the same time maintaining a good quality of life for the patient and minimizing the sequelae of cancer.

    Surgery :

    The two important advances are:

    1. Organ preservation strategies, where in the entire organ affected by the cancer need not be removed, rather chemotherapy and or radiation is used to shrink the cancer and then a surgery to remove only the affected area is undertaken. This preserves the form and function of the organ and is now standard treatment for breast cancer - the entire breast need not be removed, only a small portion of the breast and the lymph glands in the armpit need be removed to ensure cure.

    2. Minimally invasive or 'keyhole surgery' where the radical cancer operation is undertaken through tiny incisions using special long instruments, with vision provided using a high definition camera on a device called the endoscope. This may take one of 2 forms - conventional laparoscopic surgery or robotic surgery. Robotic surgery is an advanced form of laparoscopy using a computer interface to improve the precision of the surgeon's movements to perform a radical operation, which is as radical as open surgery but more delicate and associated with a faster recovery for the patient.

    Chemotherapy :

    1. Modern chemotherapy is safe, effective and well tolerated. Recent advances include the use of special formulations which reduce the toxicity while retaining or enhancing the efficacy of these drugs, for example, by using nanoparticle coated formulations. The use of intra - arterial chemotherapy to directly inject the drugs at high concentration into a tumour [e.g. in liver cancers] or instillation into the abdominal cavity using a pump which heats and distributes the drugs within the cavity, destroying cancer cells, as can be performed for Ovarian cancer [HIPEC-Hyperthermic Intra PEritoneal Chemotherapy] are cutting edge developments we use in practice.

    2. Biologic agents are a new class of drugs which target tumours at the molecular level, acting selectively on tumour cells carrying specific receptors. These drugs bind to these target receptors and selectively block the growth of the cancer or in some cases prevent the growth of blood vessels, which are essential for tumours to grow and spread. They are generally well tolerated and safer than conventional chemotherapy, but more expensive.

    Radiotherapy

Contrary to popular perception, a large proportion of cancers in the early stages can be cured. When the cancer shows no signs of having come back in the 5 years which have passed since treatment, we take it that the person is cured. While life long checkups are needed, most cancers do not come back after 5 years from the time of treatment. Cancers, which present late can also be cured, but the success rate drops sharply, the more advanced the cancer.
  • Only about 5% of cancers are genetic, meaning that that there is a change in the genes [a mutation] of a person with cancer, which can be passed on to the offspring [children]. Many cancers run in families, though there may not be a defined or detectable change in the genes. These are called familial cancers. The vast majority [over 85%] of cancers are sporadic - which means that there is a change in the genes of the person with cancer, but they do not pass it on to their children.
  • Features which suggest a genetic basis include - cancers developing in multiple members of a family at a young age, multiple cancers in the same person - such as breast and ovarian cancer.
  • As such, there is no magic test or single test, which can detect all cancers. Screening [see above] detects certain cancers at an early stage and this results in a high cure rate for these cancers.
  • One can however be aware of the common symptoms and signs of cancer, and report to the doctor immediately if these are present. Also certain environmental agents e.g. cigarette smoking and tobacco use are known causative agents for a variety of cancers, and one should avoid these agents [see below].
  • Be sure to ask your doctor about the risk you have of developing cancer when you accompany your family member who is undergoing treatment.

Cancer is not communicable - meaning that one does not get cancer by taking care of a person affected by the disease. Cancer patients are at an increased risk of developing infections especially when they are on chemotherapy.

During this period contact with people should be minimized, especially those who have cough/cold or respiratory infections. They should drink boiled water and eat only cooked food - bland and easily digestible such as rice, potato, bread, yoghurt [avoid raw food/salads]. They should peel fruits before eating. They should avoid dust and crowded places such as markets and places of worship.

  • Avoid tobacco in all forms - smoked, chewed and inhaled [as snuff].
  • Avoid or moderate alcohol consumption.
  • Reduce intake of processed foods - pickles, marinated foods, and barbecued foods [tandoori items].
  • Avoid consuming reheated food on a regular basis.
  • Eat plenty of fresh fruits and vegetables (colour based - yellow [capsicum, papaya], purple [cabbage, beetroot, onions], red [capsicum] and green [leafy vegetables, spinach].
  • Maintain ideal body weight by combination of diet and exercise. Especially reduce intake of refined flour [Maida], polished rice, sugar saturated fats and red meat.
  • www.cancer.org [American Cancer Society]
  • www.cancer.gov [National Cancer Institute USA]
  • www.indiancancersociety.org [Indian Cancer Society Webpage]