Globally each year on 4 February, researchers and key leaders in the Cancer care community unite and celebrate World Cancer Day by raising awareness & education about cancer, its prevention, detection, and treatment. With several moonshot missions undertaken by researchers around the world, prevention and cure for every cancer remain cryptic yet achievable. We understand that it is incredibly difficult for patients to find and fight cancer. Information about cancer on the internet is too scientific and not actionable for all.

In an effort to bridge this gap I will be briefing the latest updates on cancer, its prevention, detection, and cure.

What is cancer and why does it grow?

We call it cancer when the cells multiply and spiral way beyond control, mostly spurred by a mutation (defect) in the genes. It can be inherited or triggered by physical factors (hormones or inflammation, for example), or even environmental influences such as harmful chemicals. More often than not, the interplay between our lifestyle choices and environmental factors determines our risk for cancer.

Early diagnosis generally increases the chances of successful treatment by focusing on detecting symptoms as early as possible. Some of the early visible signs of cancer include sores that fail to heal, persistent indigestion, chronic hoarseness, abnormal bleeding, and lumps. The late-stage presentation is noticed commonly in people from lower resources and vulnerable populations. As a result, they are more prone to a poor likelihood of survival, higher costs, which causes avoidable deaths and disability from cancer. Early detection and treatment are more relevant for cancers of the breast, cervix, mouth, larynx, colon and rectum, and skin.

“Being well-informed about the whys and wherefores of cancer & staying attuned to your body can help you in preventing cancer. Early diagnosis generally increases the chances of successful treatment by focusing on detecting symptoms as early as possible.“

What is cancer screening?

The process of identifying cancer before a person develops any symptoms is called cancer screening. Early detection of cancer or any abnormal tissue can help in early treatment before cancer may grow and spread. However, one must remember that merely getting a screening test doesn’t always mean that a person is suspected to have cancer. Cancer screening gives a heads-up to receive best-in-class care in preventing and treating cancer.

There are different methods to screen cancers, some of which include:

• Person’s family and medical history: A person’s personal history including habits like smoking tobacco, alcohol consumption, etc, and family history of the presence of any type of cancer is taken.
• Physical examination: Examination of the body to identify general signs of health and the presence of any abnormalities like lumps.
• Laboratory tests: Investigations in which tests are performed on samples of body tissue, blood, urine, or other fluids of the body.
• Imaging tests: Investigations like X-ray, MRI, etc of areas inside the body to identify any abnormalities.
• Genetic tests: Medical tests to identify the presence of any mutations/abnormal genes that may be linked to some types of cancer.

MOUTH CANCER

Early detection of oral cancer is important in countries like India, Sri Lanka, Pakistan & Bangladesh. Tobacco (both chewed and smoked), betel nut (paan masala) & alcohol along with poor dental hygiene are the top risk factors for this aggressive cancer.

Look out for difficulty and pain in swallowing, pain in the mouth, or pain/lump in the neck. Since there is no effective screening program to catch it early, watch out for tell-tale signs like a mouth-ulcer that doesn’t heal in over three weeks or a white/red patch inside the mouth or lips, especially if you use tobacco or drink heavily.

Diagnosis: No single oral exam or oral cancer screening test is proven to reduce the risk of dying of oral cancer. Still, you and your dentist may decide that an oral exam or a special test is right for you based on your risk factors.

Rx: Surgery is the primary treatment modality. Radiation therapy and chemotherapy are adjuncts. Modern oncoplastic and reconstructive surgery can restore the smile.

COLORECTAL CANCER

Colorectal cancer is the third most commonly diagnosed cancer. Both men and women have an average risk of 4.5% and it increases in their 40s & 50s. About 71% of cases arise in the colon and 29% in the rectum.

Look out for persistent abdominal discomfort, rectal bleeding, weakness or fatigue, and a change in bowel habits such as diarrhea, change in nature of stools.

Diagnosis: Colonoscopy and sigmoidoscopy are helpful in colorectal cancer screening. Fecal Immunochemical Test (FIT), Fecal Occult Blood Test (FOBT) are other tests that show reduced deaths due to colorectal cancer from biennial screening.

Rx: Treatment of colorectal cancer is multidisciplinary and includes surgery, chemotherapy, and HIPEC. Other treatment options include immuno-oncology, biological therapy, liver-directed therapy, & radiation therapy.

BREAST CANCER

The incidence of breast cancer is on the rise and is the most common cancer in women. However, it is one of the curable cancers if detected early. When detected and treated in Stage I, 9 in 10 women survive breast cancer and live a cancer-free life.

Breast cancer is categorized depending on the tumor size, grade (how fast the tumor is likely to grow), and stage (how far the tumor has spread). You can screen for breast cancer yourself by doing a breast self-examination (BSE) regularly after age 20. Mammography is advised for screening after ages 40 or 50, depending on risk factors.

Look out for any changes such as redness, discharge, and feel for lumps. Follow BSE with an evaluation by an oncologist every few years up to age 50. If you have a family history of breast cancer, you may need more frequent monitoring.

Diagnosis: Doctor-performed physical examination to look for any abnormality, followed by ultrasound, mammography, and FNAC (fine-needle aspiration cytology, a diagnostic procedure) is used to confirm malignancy. All breast cancers are not the same. There are about 20 different types, each of which behaves differently. So receptor tests (such as estrogen receptor assay test, progesterone receptor assay test, HER2 assay test) are also done as part of the diagnostic process to ascertain the type of cancer and choose the most effective medication.

Rx: “Based on the results, surgery and/or radiation therapy is used in combination with chemotherapy, hormone therapy, and/or targeted therapy.

Good to Know: Breast conservative surgery and breast reconstruction increase self-confidence in the patient.

CERVICAL CANCER

Cervical cancer is caused by persistent infection with high-risk types of the human papillomavirus (HPV), which can be transmitted during sex and is compounded by other factors such as poor genital hygiene. Known risk factors include first sexual encounter at a young age (<18 years); multiple pregnancies; having multiple sexual partners; smoking (it can damage cervical cells, making them vulnerable); HIV infection and sexually transmitted infections.

Look out for pain or bleeding during or after intercourse, unusual and persistent vaginal discharge, unexpected spotting, or bleeding. There may be no obvious symptoms in its earliest stages.

Diagnosis: Screening is recommended for all women at risk of cervical cancer to detect precancerous changes which can be treated before it progresses to cancer. “Pap smear or a liquid-based Pap test can catch pre-cancerous lesions.

Other screening tests include HPV DNA tests and VIA. Confirmation is done through colposcopy and biopsy.

Rx: Precancerous lesions can be treated by simple OPD procedures like cryotherapy, cold coagulation, and Loop Electrosurgical Excision Procedure (LEEP). Cancer in the early stages is treated using surgery or radiation. In advanced stages, radiation with or without chemotherapy or advanced chemotherapy is used.

Good to Know: The Pap smear (cytology) has been shown to reduce the incidence of cervical cancer and related deaths. The pre-cancerous stage of cervical cancer could last up to 15 or even 20 years, thus these simple tests can save lives. Ideally, screening should start at the age of 21 (depending upon the sexual activity). An HPV test is recommended in combination with a Pap test from the age of 30 years. Screening should be repeated every one to two years. However, if three consecutive smears are negative, the interval between the screenings can be increased to five years.

The HPV vaccine protects against HPV types 16 and 18, responsible for over 80 percent of cervical cancer cases in India.

It is recommended for young girls (aged 10 to 14 years, especially before initiation of sexual activity). At this age, two doses at 0 and 6 months are sufficient. Don’t skip your Pap smear even if you have taken the vaccine as it doesn’t protect against all strains of HPV.

OVARIAN CANCER

The ovaries are small organs tucked deep inside the pelvis and inaccessible to physical inspection. This is one reason why ovarian cancer is detected at an advanced stage when chances of survival are poor.

Look out for abdominal distension and pain, urinary frequency, postmenopausal bleeding, loss of appetite, non-specific gastrointestinal symptoms like frequent bouts of indigestion.

Diagnosis: Pelvic examination, transvaginal sonography, and a blood test for CA-125 level for women with a strong family history.

Rx: Treatment for ovarian cancer is multidisciplinary and includes both surgery and chemotherapy.

Good to Know: Modern HIPEC therapy and targeted therapy can further increase the survival of advanced ovarian cancer patients.

PROSTATE CANCER

It develops in the prostate, a gland of the male reproductive system. Experts attribute the early diagnosis of prostate cancer in the past decade to the availability and awareness about the PSA (prostate-specific antigen) test. Risk increases with age, typically striking after age 60, as does family history.

Look out for In early stages patients may not show symptoms. But as cancer progresses, patients may display lower urinary tract symptoms (LUTS): increased frequency, urgency, pain, poor stream, terminal dribbling, and incomplete voiding. In very advanced stages, it can cause back pain and weakness in the lower limbs.

Rx: An 80-year-old low-risk patient may not be advised follow-ups with the doctor, as his chance of dying from prostate cancer is negligible. Typically, surgery (removal of the prostate) or radiation therapy with hormone treatment is used for low- and intermediate-risk scenarios. A combination of surgery, radiation, and hormone therapy is used for metastatic and high-risk diseases; hormone therapy and/or chemotherapy is used according to primary burden and response/resistance to the hormone therapy.

Robotic Surgery plays important role in early prostate cancer surgery

LUNG CANCER

Lung cancer is estimated for around 1 in 5 cancer deaths globally. Smoking tobacco, in any form, is a major risk factor for lung cancer. Passive smokers are also at risk. Avoiding tobacco smoke at any age significantly lowers the risk. Other risk factors include air pollution and asbestos (if working in an associated industry).

Look out for persistent cough, hoarseness or wheezing, shortness of breath, sputum streaked with blood, weight loss, and chest pain.

Rx: Once diagnosed, it is classified into non-small cell and small cell lung cancer, the former is more common. Surgery is suggested for early stages (I & II); radiation therapy and chemotherapy may be used after surgery to kill micrometastatic cells. For advanced stage III & IV tumors when surgery isn’t feasible. Targeted therapy with drugs such as erlotinib, gefitinib, and crizotinib (for EGFR and for ALK+ mutation), usually used in stage IV, can work remarkably well in some patients. Conventional chemotherapy is the mainstay treatment for lung cancer.

YOUR DEFENCE PLAN

Recent research led by a team at Stony Brook University, US, published in the journal Nature found that environmental factors and behavior account for 70-90 percent of cancer cases. Here are healthy habits that can keep you safe.

• Ban tobacco in all forms. According to the WHO, it is the single greatest avoidable risk factor for cancer mortality worldwide. Say no to tobacco in all forms including e-cigarettes. Passive smoking is dangerous too, inhaling second-hand smoke increases their risk of lung cancer by 20-30 percent.
• Drink moderately; choose red wine over others. Alcohol contains nitrosamine, a carcinogen that ups the risk of cancers of the oropharynx, esophagus, stomach, colorectum, liver, and urinary bladder.
• Load up on fresh fruits and vegetables. Fruits and vegetables are rich in cancer-fighting antioxidants. In fact, a diet high in fiber is linked with a lower incidence of colon cancer. Switch to organic produce to dodge harmful chemicals and pesticides.
• Stay physically active. 30 minutes of regular exercise has a positive effect on hormones. Balanced hormone levels help protect against cancer. Besides, staying physically active will help you lose weight. Being overweight is a big risk factor for several cancers. Aim to keep your BMI between 18.5 to 25 kg/m2.
• Breastfeed for safety. Breastfeeding can provide some protection against uterine, cervical, ovarian, and breast cancer. Having children before the age of 30 can also reduce your risk of getting breast cancer.
• Don’t forget water. Drink at least eight cups (about two liters) of liquid a day. It reduces the risk of intestinal & bladder cancer by diluting the concentration of cancer-causing toxins.
• Live a stress-free life-Yoga, Meditation, digital de-addiction, happy relationships are the most important key elements for a healthy life.
• Regular screening for major cancers and general health check-ups.

About the author-Dr. Sachin Marda, Senior Surgical Oncologist, Yashoda Hospitals, Hyderabad.