Dr. Ian Pinto
The word cancer often instills a sense of immense fear. Much of the fear is due to the perceived fatality and devastation associated with it. Cancer is ubiquitous, touching each one of us directly or indirectly, affecting close family members, friends or acquaintances. Modern advances have revolutionized both the experience during the treatment and the outcomes of patients with cancer.
Cancer occurs when our normal cells get damaged and mutate causing a loss of normal control on growth of a cell. Since the cells grows faster than the surrounding normal cells it manifests in a lump or a tumorous growth. Hence, the first warning sign is a lump, bump, abnormal change or growth in the body. If this happens one must immediately see a doctor. A biopsy of this lump would lead us to the diagnosis of cancer. Just as in battle before one starts cancer treatment one must know the origin and extent of spread of the cancer so a plan of attack can be formulated.
Can it be prevented?
Yes, it can. A healthy diet rich in fruits, vegetables, whole grains and low in saturated/trans fats can go a long way preventing it. Maintaining a healthy weight with a good diet and daily exercise is essential.
Tobacco and related products like gutkha lead to more than forty percent of all cancers and avoiding them decreases your risk. Previously the belief that a drink a day after forty years of age keeps the doctor away no longer applies.
New research reveals that even a drink a day can increase your risk of cancer and hence it is important to limit alcohol intake. Avoiding sun exposure and use of sunscreen prevents skin cancers. Prevention of infections such as Human Papilloma Virus (HPV) and Hepatitis B either through clean hygiene or vaccination can decrease your risk of cancer associated with these infections. In women breast feeding and childbearing decreases your risk for breast cancer.
Can cancer be detected early?
Yes, it can. If cancer is detected early, the five year survival is near 100 percent in comparison to 25-30 percent if detected late. In comparison to the developed world, most cases of cancer in India are detected in advanced stages and hence cancer survival as a whole is lower. Screening detects cancer early when the person is without any symptoms so that treatment will improve survival. Breast cancer is now the most common cause of cancer and cancer deaths in women in India. The only screening test for breast cancer is a mammogram. This should be done for women beginning at age forty and done every two years till age seventy-four. This test is associated with minimal radiation.
Cervical cancer used to be the number one cause of cancer in India and the U.S. but screening with pap smears has dropped this to third and seventh most common cause respectively. Pap smears should commence at age twenty and be done every three years if normal till 65 years of age. Pap smears are usually done by a gynecologist.
Colon cancer normally takes ten years to grow from a small mushroom like benign polyp into a cancer. A colonoscopy done after age fifty for men and women every ten years will screen for colon cancer. A simple blood test call the P.S.A. (Prostatic Specific Antigen) test done after age 50 every three years for males can screen for prostate cancer.
Is cancer genetic?
One of reasons people keep their cancer diagnoses secret is the stigma associated with it. As a result, patients do not reach out for support in their toughest time.
This is a misconception as genetics accounts for less than 5 percent. When cancer is present in first degree relatives (grandmother, mother and daughter) or when it presents earlier in life (i.e. less than forty years of age) or certain types of cancer like ovarian cancer there may be a genetic cause. For high familial risk breast cancer and all ovarian cancer patients, we check for the BRCA1 and BRCA-2 mutation and if positive we then check the children. This test can be done on a blood sample or cheek swab. Children both boys and girls need to be checked as males also can get breast cancer and are more strongly associated with genetic risk.
Can cancer be treated and controlled?
Yes, it can. Surgery forms an important pillar of cancer care but with the discovery of radiation, chemotherapy and immunotherapy we now have a multi-pronged attack plan. Good cancer surgery means removing the cancer with none left behind. This cannot be done if the tumour is large or has spread to other organs. Additionally, surgery may delay effective treatment from being initiated. Nowadays chemotherapy and targeted agents are used before surgery to shrink the tumor so that the surgeon can then cleanly remove the tumor. Even when the cancer has spread these medications shrink the tumor, giving relief from symptoms with improvement in the survival.
The word chemotherapy induces fear partly due to poor portrayal in films and partly because of old experiences of patients with chemotherapy. Nowadays we give medications prior to chemotherapy to alleviate most of the side effects from chemotherapy. Targeted therapies now attack only cancer cells with minimal collateral damage. These medications have better responses with lesser side effects.
Our immune cells normally fight against infections destroying them.
Cancer is smart and escapes our immune cells by binding to certain receptors on them. We now have immunotherapy drugs that open up these bonds and unleash our immune cells to destroy cancer cells.
So rather than depressing our immune system like some chemotherapy drugs, immunotherapy stimulates our immune system to fight these cancers. The inventors of this therapy recently received the Nobel prize for this discovery. These drugs have one of the highest number of US FDA approvals across many cancers and are now available for use in India.
In summary, cancer can be prevented with a smoke-free healthy lifestyle, detected early by screening and treated with new targeted therapies and immunotherapy.
