Pancreatic cancer is one of the severe cancers. It feasts quickly and is rarely detected in its early stages, a main reason that’s leading to the cause of cancer death. Signs and symptoms may not be noticed until the disease is quite progressive. By then, the cancer probable would have spread to other parts of the body and making surgical removal impossible.

For years, little was known about pancreatic cancer. But now researchers started to comprehend the genetic root of the disease — information that may ultimately helpful for new and better managements. Person can reduce risk of pancreatic cancer with some changes in lifestyle.

Signs and symptoms

Pancreatic cancer do not show any signs and symptoms until disease is advanced. When symptoms do appear, they may include:

• Upper abdominal pain that may radiate to your middle or upper back. Pain may be constant or intermittent and is often worse after eating or when lying down.
• Loss of appetite and unintentional weight loss. because cancerous (malignant) cells deprive healthy cells of nutrients.
• Yellowing of skin and the whites of eyes (jaundice). About half of people with pancreatic cancer develop jaundice, which occurs when bilirubin, a breakdown product of worn-out blood cells, accumulates in blood. Normally, bilirubin is eliminated in bile, a fluid produced in liver. But if a pancreatic tumor blocks the flow of bile, excess pigment from bilirubin may turn skin and the whites of eyes yellow. In addition, urine may be dark brown and stools white or clay-colored. Although jaundice is a common sign of pancreatic cancer, it’s more likely to result from other conditions, such as gallstones or hepatitis.
• Itching. In the later stages of pancreatic cancer, one may develop severe itching when high levels of bile acids, another component of bile, accumulate in skin.
• Nausea and vomiting. In advanced cases of pancreatic cancer, the tumor may block a portion of digestive tract, usually the upper portion of small intestine (duodenum), causing nausea and vomiting.
• Digestive problems. When cancer prevents pancreatic enzymes from being released into intestine, you’re likely to have a hard time digesting foods — especially those high in fat. Eventually, this may lead to significant weight loss and malnutrition.

Causes

Pancreas is about 6 inches long and looks something like a pear lying on its side. The wider end (head) is located near the centre of abdomen next to the upper part of small intestine (duodenum). The central part (body) of pancreas extends beyond abdomen, and narrow end (tail) is on left side, after spleen.

A part of digestive system, pancreas performs two vital roles.

It produces digestive juices and enzymes which is necessary for breaking down of carbohydrates, proteins and fats that food can be processed in small intestine.

It secretes the hormones insulin and glucagon that regulate the way body metabolizes sugar (glucose).

Pancreas has cells that manufacture digestive enzymes and juices. Pancreatic juices flow into the main pancreatic duct, which leads to small intestine (duodenum). The pancreatic duct links up with the tube connecting from gallbladder to form the common bile duct, which later drains into the small intestine. Pancreas also contains small “islands” of cells that secrete the hormones.

When to seek medical advice

See doctor if patient experience an unexplained weight loss, abdominal pain or jaundice. Many problems other than cancer may cause similar signs and symptoms, so doctor will check for these conditions as well as for pancreatic cancer.

Screening and diagnosis

Sensing pancreatic cancer in its initial stages is tough. Signs and symptoms generally don’t appear until the cancer is big or has feast (metastasized) to other tissues. Pancreas is quite unseen — pushed behind abdominal and inside a ring of small intestine — small tumors can’t be seen or touched through routine exams. It can be can be detected by a blood test. But when blood levels are sufficient to be measured, the cancer is no longer in its initial stages. Presently there is no effective screening trial for pancreatic cancer. If doctor doubts pancreatic cancer, patient may have to undergo one or more tests to detect the cancer: viz Ultrasound imaging. Computerized tomography (CT) scans Magnetic resonance imaging (MRI), Endoscopic retrograde cholangiopancreatiography (ERCP). Endoscopic ultrasound (EUS), Percutaneous transhepatic cholangiography (PTC), Biopsy and Laparoscopy.

Complications

Your pancreas produces a number of enzymes that break down food so your body can absorb the nutrients it contains. But pancreatic tumors frequently affect the fabrication of these enzymes. As an outcome, body can’t easily absorb nutrients, which may cause diarrhea or even severe weight loss.

Other complications of pancreatic cancer include:

Problems with glucose metabolism including diabetes.

Jaundice, sometimes with severe itching

Large pancreatic tumors may press on surrounding nerves, leading to back or abdominal pain that may sometimes be severe.

Pancreatic tumors are rarely discovered in the early stages, they often have time to spread to a number of vital organs, including your stomach, spleen, liver, lungs and intestine or to nearby lymph nodes.

Treatment

Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your age, overall health and personal preferences. Particularly when cancer is progressive, picking a treatment idea is a chief decision, and it’s vital to cautiously estimate choices.

Seeking a second opinion is the best option. This can provide extra facts to help to be more certain about the option you’re considering.

The primary goal of action is always to remove the cancer entirely. When that isn’t possible, the effort may be on stopping the tumor from developing or triggering more harm. In some cases, an approach called palliative care may be best. Palliative care states that treatment meant not at eliminating or slowing the disease but assisting to relieve symptoms and making as relaxed as possible.

Surgical options: The main route to eliminate pancreatic cancer is an operation to take out the tumor. Unfortunately, this is possible only in a small percent of people. Once the cancer has blowout beyond the pancreas to other organs, lymph nodes or blood vessels, surgery is customarily no longer a choice. Operations for pancreatic cancer are complex. The most effective results usually take place when these procedures are done in cancer centers by extremely skilled surgeons.

Radiation therapy: Radiation therapy uses high-energy X-rays to terminate cancer cells. Patient may get radiation treatments before or after cancer surgery, often with chemotherapy. Or, doctor may prescribe blend of radiation and chemotherapy treatments when cancer can’t be treated surgically.

Chemotherapy: Chemotherapy uses drugs to kill cancer cells. Vaccinated into a vein or taken verbally, these drugs travel through bloodstream.

Palliative procedures: If cancer has spread too far to be entirely removed by an operation, the prime goal will be to get rid of signs and symptoms. Treatments that focus on making you more comfortable include Surgical bypass, Stent insertion, Pain management, pancreatic enzyme tablets, and Insulin therapy.

New treatments: Researchers are studying a number of other approaches to treating pancreatic cancer, including Anti-angiogenesis factors, Farnesyl transferase inhibitors, Growth factor inhibitors.

Prevention

Although it’s not always possible to prevent pancreatic cancer, these lifestyle changes may help reduce risk:

• Quit smoking. Cigarette smoke contains carcinogens that can damage the DNA that regulates cell growth. Talk to doctor about the best ways to quit or contact the American Cancer Society or American Lung Association for more information.
• Maintain a healthy weight. Being overweight increases your risk of pancreatic cancer. For lose weight, slow and steady is the healthiest way to reach goals. Aim for no more than 1 to 2 pounds a week. Add 30 minutes or more of aerobic exercise — such as walking, jogging or biking — on most days, and can increase the amount of weight lost.
• Exercise regularly. Experts believe that getting even a moderate amount of exercise every week can cut risk of pancreatic cancer. For overall health, aim for 30 minutes of exercise on most days. If not used to exercising, start out slowly and work up to goal.
• Eat a healthy diet. A diet high in fruits and vegetables and low in animal fat can reduce risk of pancreatic cancer.

Dr. Chalapathy
Professor of General Surgery
Vydehi Hospital
Whitefield, Bangalore – 66
Ph: 080-28413381/2/3/4
www.vims.ac.in

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The parasite virus is also called ‘visha’ in Sanskrit.  This is due to the toxic nature of many viruses, which have a very simple structure: the outer coat of protein and lipids that encloses either the RNA or DNA genetic material.  RNA stands for ribose nucleic acid and viruses that contain this single stranded RNA are called RNA viruses (eg. SARS-CoV-2 that causes Covid-19).  DNA stands for deoxy ribose nucleic acid and viruses that contain the double stranded DNA are called DNA viruses (eg. adenovirus that causes common cold).

Viruses are obligate (compulsory) intracellular (they live inside host cell) parasites.  They enter host cell, hijack the nucleus, and control cellular machinery and makes copies of itself using the cell as a resource.  These copies of the virus then go on to infect other host cells – the new viruses enter new host cells and again makes viral copies.  This vicious cycle of entering the host cell, viral replication and entering other host cells – causes ever increasing viral load in the host body and thus severity of viral infection goes on increasing.  Either the natural immunity of the host body quells the viral infection or the host body succumbs to the viral infection.  Hence, the toxic nature of pathogenic or disease causing minute viruses can be distressing and at times fatal.

 Cancer is a frightening word

Cancer is a frightening word; this is a disease of the body in which body’s cells become enemy of the body.  When normal human cells turn abnormal due to genetic reasons or influence of certain chemicals or radiation – these cells start to multiply in an unrestricted way.  In cancer, there is uncontrollable growth of abnormal cells and this often leads to swelling, pain and bleeding as common signs and symptoms of cancer.  Carcinogens are established compounds or entities that are known to be cancer causing, they stimulate conversion of normal cells to abnormal cells and cancer is the result, as such, cancer can occur anywhere in the body.  Cancer can occur in the liquid component of the body (blood cancer) or in non-liquid part of the body too, in various organs.

Cancer can occur outside on the skin, lips and nose or in any of the internal organs like liver, pancreas, bone marrow and brain.  Well known carcinogens that cause cancer include tobacco smoke, benzene, radon, asbestos, various workplace chemicals, radiation, biological agents like viruses and even medications.  Getting afflicted with cancer implies severe loss in quality of life, many a time – death and a severe drain in finances.  The cancer patient’s social life and family life, plus the quality of life of caregivers’ in the family and friend circle is full of stress, anxiety, trauma and disruptions.

Viruses that cause cancer

If cancer is a dreaded disease causing much pain, anguish, trauma and death, just imagine how much suffering can be caused by a cancer causing virus, which is a toxic parasite.  Hence, from time immemorial holistic systems of healing like Ayurveda have emphasized detoxification to boost immunity or self-defense function.  If toxic overload is there in the body, metabolism and immunity are impaired and diseases like cancer occur in the individual.

Viruses that cause cancer are called oncoviruses.  Many of these oncoviruses are retrovirus, which means they can insert their RNA into the DNA of the host cell.  This RNA insertion into the host cell genetic makeup causes formation of cancerous tumours. Human tumour viruses are said to cause 12% to 20% of the global cancers.  These tumour viruses are known to cause persistent infection; they infect the host cell but do not kill them and cancer occurs years after infection. The oncoviruses are: Epstein – Barr Virus, Papillomaviruses 16 and 18, Herpes virus, Hepatitis B virus, Hepatitis C virus, HTLV-1, Merkel Cell Polyomavirus, and HIV.  

 An example of the oncovirus is the HTLV-1, which stands for human T-lymphotropic virus 1 and as the name indicates, this virus is having a strong affinity towards the T lymphocyte (a type of white blood cell).  HTLV-1 is a retro virus – this is a type of virus that inserts its RNA into the DNA of the host cell.  After this the HTLV-1 virus changes the normal pattern of DNA folding in the host cell.  The viral RNA acts on many sites of the human genome to cause this disruption of gene function by inducing abnormal human DNA folding inside the host cell.  This makes the T lymphocytes overactive immune cells and turns them into cancerous.  This rare type of cancer caused by HTLV-1 is called Adult T-cell leukemia (ATL).

As seen above oncoviruses cause persistent infection and the cancer may develop after several decades of the viral infection as in the case of ATL (due to HTLV-1).  There are an estimated 50 lakh to 1 crore carriers of this HTLV-1 virus in the world, in Japan alone it is estimated there are 10 lakh carriers.  The chronic activation of T lymphocytes by HTLV-1 is a phenomenon of research study and holds the key to anticancer drug development.

 Post Covid-19 scientific approach.

The other interesting facet of ongoing research is the carcinogenic potential of SARS-CoV-2 virus that causes Covid-19 pneumonia and multiorgan damage.  Even non retroviruses like coronavirus SARS-CoV-2 are known to cause persistent infection.  There are certain viral structural reasons for investigating carcinogenic potential of SARS-CoV-2.  Thus, besides long Covid complications – other long term complications are also being investigated.  Hence, good immune nutrition, hygiene practices and scientific detoxification practices to reduce oxidative stress – due to overproduction of toxic free radicals – and decreasing other toxin overload, is a post Covid-19 scientific approach.

Oncoviruses gain entry and infect humans through infected bodily fluids like semen, blood, and breast milk.  Thus, unprotected sex, injecting drug use, tissue transplantation, and blood or blood product transfusion can be a source of HTLV-1 transmission (and other oncoviruses).  Human immunity can be made strong only through optimal immune nutrition, and reducing entry of pathogenic microbes like viruses & bacteria, and infectious proteins like prion proteins.  Hence, staying safe through precautionary methods is good sense!

Sunil S Chiplunkar

M Pharm (Pharmacology) MBA (Marketing) PGDHRM (PhD)

VP – Business Development

Group Pharmaceuticals, Bangalore

E mail: 1969sunilchiplunkar@gmail.com

Mob: 63645 78669

Further reading:

• https://www.who.int/news-room/fact-sheets/detail/human-t-lymphotropic-virus-type-1
• https://www.imperial.ac.uk/news/232637/how-virus-transforms-immune-cells-into/
• Further reading: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2267909/
• https://www.mdanderson.org/publications/focused-on-health/7-viruses-that-cause-cancer.h17-1592202.html
• https://www.imperial.ac.uk/news/186970/cancer-causing-virus-htlv-1-changes-dna-loops/
• https://www.sciencedirect.com/science/article/pii/S0306987720311531

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The global burden of colorectal cancer (CRC) is expected to increase by 60% to more than 2.2 million new cases and 1.1 million deaths by 2030.  On one hand, COVID-19 has been unfolding in its changing gestures for past one year, grabbing full attention of healthcare systems, on the other hand, the treatment of most of the fatal diseases has been compromised – and cancer is one of them. Cancer is the second leading cause of death globally and is responsible for an estimated 9.6 million deaths in 2018. Out of 9.6 million cancer deaths, colorectal cancer – the most common cancer contributed to 1.80 million deaths.

The fatality of Colorectal Cancer (CRC) 

Colorectal Cancer (CRC) is cancer that starts in the colon (large intestine) or rectum. Both of these organs are in the lower portion of your digestive system. The rectum is at the end of the colon. Usually CRC attacks older adults when they are in their seventies of above. However, it can happen at any age. This is the third most common cancer and the fourth most common cause of cancer death worldwide. Predictions of the future burden of the disease inform health planners and raise awareness of the need for cancer control action.

Colorectal cancer may not present with any symptoms, especially in the early stages. However, if you do experience during the early stages, the symptoms may include – constipation, diarrhoea, changes in stool colour, blood in the stool, bleeding from the rectum, excessive gas, abdominal cramps and abdominal pain. There are so many factors of cancer to develop. It may be caused by genetic mutations, either inherited or acquired. These mutations don’t guarantee that it will cause the development of colorectal cancer, but they do increase the chances.

Some mutations may cause abnormal cells to accumulate in the lining of the colon, forming polyps. There’s an array of risk factors that act alone or in combination to increase a person’s chances of developing colorectal cancer. Lifestyle-related risk factor such as dietary factor wherein Red meats (such as beef, pork, lamb, or liver) increases the risk. Likewise, cooking meats at very high temperatures (frying, boiling, or grilling) creates chemicals that increase risk. However, diets high in vegetables, fruits, and whole grains along with increased physical activity have been linked with a decreased risk.

Diagnosis & Treatment

The intensity of diagnosis followed by treatments determines the degree of cure to any disease. Thus in such conditions, early is better; the delay is fatal. Likewise, an early diagnosis of colorectal cancer gives the best chance of curing it. Usually, the diagnostic methods such as Colonoscopy & Biopsy — the most accurate, CT/MRI/PET scan, Stool for occult blood and tumour marker (CEA) are employed. Similarly, the popular screening methodologies employed are Colonoscopy/Sigmoidoscopy, and FOBT (Fecal occult blood testing).

As far as the treatment of colorectal cancer is concerned, it depends on a variety of factors. The state of your overall health and the stage of your colorectal cancer will help your doctor create a treatment plan. In the earliest stages of colorectal cancer, it might be possible for your surgeon to remove cancerous polyps through surgery. If the polyp hasn’t attached to the wall of the bowels, you’ll likely have an excellent outlook. Besides, Radiation therapy and Chemotherapy therapy are also used for its treatment.

In addition to the conventional treatment modality of colorectal cancer, newer technologies such as Liquid Biopsy, Minimal Invasive (Keyhole), Robotic, Personalised Chemotherapy, Targeted chemotherapy and Gene editing have been in use widely.

As all the modalities have their respective significance, Laparoscopic/Robotic surgery has certain advantages. This modality decreases pain, help return of bowel function, reduces the length of stay, reduces wound-related problems, renders less disability and finally gives a better cosmetic result.

Dr Deep Goel
Senior Director, Consultant Robotic surgeon
Department of Surgical Gastroenterology
Bariatric & Minimal Access Surgery
BLK Super Specialty Hospital, New Delhi

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Bangalore:  In order to spread awareness about breast cancer and salute the spirit of breast cancer survivors, the medical staff at Aster CMI Hospital donned pink masks, formed a pink-ribbon human chain, and educated the patients on early detection of breast cancer at the hospital by holding pink placards. Due to the COVID-19 pandemic, many patients started avoiding regular physical check-ups, including essential health screenings, like mammograms. This has put a huge burden on the medical and preventive care progress of breast cancer patients.

As per a recent WHO report, there has been a sharp rise in the incidences of cancer in the country due to the increase in sedentary lifestyles. The report further highlights that one in 10 Indians will develop cancer in their lifetime. With the cases of breast cancer rising each year, the age group of cancer patients also seems to be getting younger, with many women now being diagnosed in their 30s. This has made preventive measures like regular mammograms all the more essential. Therefore, by undertaking this initiative, the medical staff at Aster CMI Hospital has aimed at encouraging more women to get screened for cancer as early detection can increase survival chances and can aid in better managing the disease.

Speaking on the initiative undertaken by the hospital, Dr. Vijay Agarwal, Lead & Sr. Consultant – Medical Oncology & Haematology, Aster CMI Hospital, said: “Breast Cancer is currently very prevalent among the women of the age group 40-55. Due to the lifestyle changes, this disease has now started creeping up among younger women also. Even though many of us are aware of this disease, however, we still fail to undertake the necessary precautions and measures. A simple measure such as Breast Self-Examination can play a vital role in the early detection of the disease and can aid the doctors in successfully diagnosing it. Therefore, the sole motive of our hospital behind undertaking this initiative is to spread awareness about breast cancer. Even while managing between work and life, women should take out some time to take care of themselves and should be proactive to visit a doctor if they spot any unusual signs and symptoms of breast cancer like a lump in the breast and nipple retraction. This can help in reducing the incidences of breast cancer in the country and provide early diagnosis of the disease to the women.”

Sharing his views, Dr. G Girish, Consultant, Surgical Oncology, Aster CMI Hospital, said: “Currently there are a lot of myths surrounding breast cancer. Due to which many women often feel anxious while undergoing breast cancer screening tests and many more choose to avoid these tests due to the fear of cancer diagnosis. One must understand the early detection can save lives. Hence, with this initiative, we not only want to break the several myths surrounding breast cancer but also want to make women feel more confident while undergoing these tests and help them lead a happy life.”

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A 38-year-old patient visited hospital with complaints of pain in left side chest and double vision. During the process of understanding his case history, the patient revealed that he is a chain smoker and has been feeling bouts of chest pain since few months. Initially, he had consulted a doctor elsewhere for chest pain & was asked to undergo ECG and ECHO and had ruled out cardiac problems.

He was treated for gastric issues. Post his treatment, after 8 months, the patient complained about repeated chest pain and double vision. To understand and evaluate his condition better, he was asked him to undergo MRI brain scan. The scan results revealed a tumor in his brain and further tests showed lung cancer. Since lung cancer was not treated at the right time, it had spread to his brain. As an immediate action, radiotherapy and other treatment was done which helped in the control of the growth of tumor.

Continuous smoking habit led to lung cancer:

In this case his continuous smoking habit led to lung cancer and the delay in diagnosis had resulted in spreading of the tumor to other parts of the body. Lung cancer spreads very fast and it is difficult to understand the symptoms of the same. When upper lung tumors compress nerves and arteries, the patient can present with pain or weakness in the arm or change in voice. When it  involves covering of lung (pleura), they present with chest pain. Left side chest pain is not always related to heart or gastritis. It is important for people to take necessary steps when they get these symptoms as it could lead to severe health issues.

Lung cancer in India is high-mortality cancer due to late stage diagnosis. This has resulted in treating and curing only 15 percent of cases of lung cancer at the time of diagnosis. Lung Cancer also can strike you at young age. 80% of lung cancer typically present late in stage 3 or 4 as there are often no warning symptoms shown.

Hence, those who smoke are always at a higher risk of developing these cancers and sometimes the first presentation is itself a lung cancer. Recently, we are seeing many young people also presenting with lung cancer which is increasing at an alarming rate.

Also Read: WHY HIGHER CANCER CASES ARE REPORTED IN INDIA?

Dr. Rajashekhar C Jaka
Surgical Oncologist
BR Life SSNMC Hospital
Rajarajeshwari Nagar
Bengaluru

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Mumbai 3rd February 2020: Metropolis Healthcare Ltd,the leading pan-India ‘pathology specialist, tested 57,052 samples for cancer in 2019 in Mumbai. The data of given samples indicates that about 9% (5151) of these samples were diagnosed with cancer. Out of these 9% (5151), 3.84% (2191) were tested positive male cases whereas 5.17% (2952) were positive female cases.

1. Amongst females, breast cancer (1008 females) was reported maximum number of times followed by cancer of the cervix (302 females), GI Tract (342 females) and hematolymphoid cancer (296 females).

2. Amongst males, Cancer of the GI tract (399 males) was reported maximum number of times followed by Head & Neck (366 males) and Hematolymphoid (489 males).

3. Prostate Cancer also contributed to a considerable percentage amongst males (293 males).

An age-group wise segregation revealed that a bulk of the positive cases were reported positive amongst the 51-60 and 61-70 age group followed by 41-50 age group.

Commenting on the data, Dr. Kirti Chaddha, Sr. Vice President – GRL Operations & Medical Affairs and Sr. Consultant Oncopathologist, MD, PDCC (Oncopath & Oncohemat), Metropolis Healthcare Ltd said, “In Maharashtra, we have seen the age-groups of 51-60 and 61-70 are more prone to cancer than others. In females, the incidences of breast cancer are rising. The exact cause of rising breast cancer is not known. However, there are benefits for women who exercise regularly, maintain a healthy weight, do not smoke and have a low intake of alcohol.”

She added, “Breast cancer cannot be prevented, but if it is diagnosed early then it becomes easier to treat. Under doctor’s supervision, or through home-screening, the regular breast screening from the age of 30 onwards would be beneficial.”

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“People diagnosed with cancer need more than just treatment – they need to come to terms with their disease and requisite emotional and physical support. This is known as palliative care. When given in a timely manner, it can help in improving the patient’s quality of life and of their families” says  Dr Vishal Sehgal, Medical Director, Portea.

Palliative care in some cancer patients, when used as a supportive form of therapy in early stages along with other treatments such as chemotherapy or radiation, is also known to prolong life. A diagnosis of cancer is accompanied with associated problems such as depression, anxiety, and fear.

In palliative care, experts counsel and support patients and make referrals to mental health professionals. There are also other things that a patient’s family may need to address including financial and legal issues, or insurance. This is also an area where palliative care specialists assist and help in coordinating with relevant professionals. Last but not the least, through palliative care, cancer patients are guided to come to terms with their condition and are able to make better sense of their thoughts and fears.

The World Health Organization (WHO) today spells out the need to step up cancer services in low and middle-income countries. WHO warns that, if current trends continue, the world will see a 60% increase in cancer cases over the next two decades. The greatest increase (an estimated 81%) in new cases will occur in low – and middle – income countries, where survival rates are currently lowest.

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Why higher cancer cases are reported in India? Poor lifestyle habits main cause of higher cancer cases among Indians. particularly, higher incidences of cancer cases reported in women than men.

Poor lifestyle habits have aided the prevalence of cancer among Indians and higher incidences of cancer cases reported in women than men. Increasing awareness can make India cancer-free.A lifestyle which involves excessive smoking and drinking, lack of physical exercise (leading to obesity and hormone imbalance) and a poor diet is the culprit for the rising number of cancer cases. World Health Organization’s (WHO) International Agency for Research on cancer stated that cancer will claim 9.6 million lives in the world this year. India will account for 8.17 per cent of the same. Another report by the Lancet reinforced the same saying cancer is India’s second biggest killer after heart disease.

Adopting good lifestyle practices to prevent non-communicable diseases, particularly cancer is the need of the hour. It is necessary to ensure and have a balanced diet and engage in regular physical activity.  Most diets are marred with preservatives and added flavours. A lot of hidden carcinogens are entering human bodies. Tobacco consumption, alcohol intake and substance abuse has increased, leaving the body weak and the immune system vulnerable. Lung cancer is also occurring in people who have never smoked as well. Statistics reveal that 15% of patients diagnosed with lung cancer have no history of tobacco use. This could be because of exposure to second hand smoke, asbestos exposure, air pollution (outdoor and indoor), and exposure to radon gas, diesel exhaust fumes or a genetic predisposition.

There are two prominent trends that have been observed in the last year. Firstly, breast cancer incidence has gone up by 39.1% over the last decade, making it the most prevalent type of cancer. The second trend indicates a high rate of re – occurrence or dual occurrence of cancer. A survivor’s risk of getting a new cancer diagnosis is 14% greater than someone who never had cancer. This is a worrying fact but to counter it, we need to create awareness about regular check-ups and counselling even after one is completely cured.

In India, majority of cancers are diagnosed once they have advanced to stage three or stage four. This is because periodic screenings and early detection are not practiced stringently. In addition to this many hospitals are not properly equipped to provide adequate treatment to cancer patients. Therefore efforts are focused on ensuring palliative care and therapy as these ultimately lead to the most favourable outcomes.

There is no increase of incidence from 2018-2019. However population explosion and pollution increase, exposure to carcinogens may increase the number and incidence of the diseases. Early detection can also contribute. In males oral cancer, lung cancer, prostate and Gastro-Intestinal (GI) cancers can be seen as early as the age of 25 years. In females breast cancer, cervix cancer, ovarian and uterine cancer and oral cancers are common from age 35 onwards. Lifestyle factor contributions are tobacco and alcohol, junk food, stress and lack of exercise. India accounts for high number of oral cancer amongst young due to tobacco, alcohol. 30-35% cases are in this group. Similarly lung cancer incidence is high due to smoking habits. It is diagnosed late due to use of antibiotics and anti-tubercular treatment for chest symptoms. Northern India has incidence of gallbladder cancer due to proximity of sub Himalaya Ganges. Gall stones are also contributory. Pollutants in water is one of causes.

Lung and breast cancer are leading worldwide with approximately 2.1 million diagnoses estimated in 2018. Colorectal cancer (1.8 million cases, 10.2% of the total) is the third most commonly diagnosed cancer, prostate cancer is the fourth (1.3 million cases, 7.1%). Cancer is a generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasms. The defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries. Between 30–50% of cancers can currently be prevented. This can be accomplished by avoiding risk factors and implementing existing evidence-based prevention strategies.

Dr Kapil Kumar
MBBS, MS, FICS
Director and HOD, Surgical Oncology
Fortis Hospital, Shalimar Bagh
New Delhi -110088
Ph: 011 4530 2222

Dr Mandeep S Malhotra
MBBS, MS Head- Breast
Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj

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Suffering from a rare form of blood cancer called Acute Pro-Myelocytic Leukaemia, 19-year-old Roopa (name changed) was able to beat all the odds and tackle life with a zest after receiving complete remission at Aster CMI Hospital. Acute Pro-Myelocytic Leukaemia is a disease which is usually seen in middle-aged people of the age group 40-50 years and is very rarely found among individuals below the age of 20. The disease is quite fatal early on and during the initial few weeks of diagnosis the risk of internal bleeding is quite high.

She presented with heavy menstrual and gum bleeding when she came to the hospital.  Further investigations revealed that Roopa had abnormal blood counts and derangement of the clotting mechanism in her body. Being a young lady and having the rest of her life ahead of her, the doctors were required to think of an immediate term of curing her cancer. Doctors then decided to give the patient a personalized treatment which not only cures her cancer but also enables her to manage her academics efficiently. She was then planned to undergo a chemotherapy – free regimen where only targeted medications were used to bring her cancer under control.

After 6 weeks of intensive monitoring, the patient’s bone marrow test was repeated showing the cancer to be in complete remission. Roopa needed 4 more months of consolidation therapy, however, this did not deter her from resuming her academic career. Today she attends college 5 days a week and comes to the hospital in the evening to continue her treatment.

It was not only a battle of life, but a battle for good quality of life as well. This youngster had the bravery to strike a balance between her will to excel in her academics and treatment sessions. Eventually, she came out victorious, being able to do both, a unique achievement.  With advances in diagnosis and with a personalized approach it is possible to treat even selected blood cancers with targeted treatment and enable a good quality of life.

“Patient developed bleeding in the eyes during the initial days of treatment requiring constant support with blood transfusions. After a couple of weeks, she also developed fluid accumulation in the lungs, requiring a heavy dose of steroids. On completion of the initial phase of treatment, she was encouraged to get back to college. Since she required daily injections for alternate months, we worked out a schedule for her where she could come to the hospital in the morning, give her blood sample for testing, go to college and come late afternoon and by which time the reports were ready and she could receive the day’s treatment as per protocol. The use of targeted agents helped minimize the side effects and ensured that day to day life did not get affected,” said Dr. N Aditya Murali, Consultant, Medical and Haemato Oncology, Aster CMI Hospital.

“Even today there is a lot of fear around cancer but the disease is no longer the threat that it once used to be. Many cancers are now curable despite being in advanced stage and people can live a long and healthy life post treatment. This has been made possible by medical advancement in chemotherapy, targeted therapy, Radiotherapy, surgery and supportive care treatment. In fact cancer should no longer be a taboo as cancer survivors are now everywhere and a testament to what the right treatment first time around can do – cure people. Cancer must be looked at as any other disease and patients must approach the treatment with a positive attitude,” said Dr. Vijay Agarwal, Lead & Sr. Consultant Medical Oncology & Hematology, Aster CMI Hospital.

Narrating her battle through cancer, Roopa says: “I was shocked when the doctors told me that I had blood cancer and lost hope on continuing my academics. Amidst all the feeling of depression and helplessness in my mind and spirit, I was still determined to not end my fight with cancer. The robust support provided by friends, family and counselling from psychologists made all the difference. I would also like to thank the doctors for constantly motivating me to attend college and giving me a ray of hope. Initially, coming to terms with the disease, the long term implications and the treatment process was very hard for me. However, the personalized treatment provided by them assisted me balancing my academics and social life. Today, I attend classes in the morning and go for treatment to the hospital late afternoons.”

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Breast Cancer is the biggest killer among women in India today. While in western countries the survival rates in Breast Cancer over the years has become progressively very high, sadly in India it is still woefully low. This is primarily due to lack of awareness and periodic screening as a result of which majority of the cases get detected in stage 3 or stage 4.

To create an awareness on Breast Cancer with a mission “Early Detection. Saves Lives”, Rotary Bangalore Palmville in association with Sakra World Hospital has initiated the Pink Express. The Pink Express, a mobile breast cancer screening centre equipped with breast cancer screening equipment.  The Pink Express will be used for conducting awareness and screening camps for the underprivileged free of cost. While the Rotary is funding all the medical equipment for the Pink Express, Sakra Hospital is providing the doctors and medical technicians to conduct these camps.

Mr Ritesh Goel (President – Rotary Palmville) said “we are very happy to launch this initiative as a part of Rotary International’s global focus on Healthcare.  The technology being used in the Pink Express for screening is based on Thermal Imaging. This is a “No Touch No Pain” process encouraging more women to undergo this test and hence create a bigger social impact”

Mr Takashi Maki (MD of Sakra World Hospital) says “This initiative is in line with our philosophy of community services. We are very pleased to partner with Rotary who are committed to projects for a social cause. This initiative is hence focused on Awareness Building and Early Detection leading to higher survival rates”

 The Pink Express will travel to parts of Rural Bangalore, Karnataka and Tamil Nadu to do the camps. It is equipped with the Thermal Imaging equipment and an Ultrasonogram. The unique thing about the screening is the use of a new technology which is based on Thermal Imaging where heat maps of the breast are captured and subsequently interpreted by the system automatically aided by AI based Machine Learning software. The solution- Thermalytix is from Niramai, a Bangalore based company. Besides other benefits like a pain free process and no radiation hazards, this technology can detect abnormalities even below the age group of 40 years which is very relevant as India has a growing incidence rate of Breast Cancer in the younger population.

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