Cancer: A Changed Concept
The word "cancer" sends shivers down one's spine, but cancerous disease is not always synonymous with death. The newer concepts of cancer prevention and early detection using imaging techniques and other immunological methods, and the most recent "targeted" treatment (which targets only the cancerous cells while sparing the normal ones—the innocent bystanders) has changed the scenario by increasing the survival rate and life-span of the patients. The mode of targeted treatment is gaining acceptability. For example, the only option of treating chronic myeloid leukemia (a form of blood cancer) was bone-marrow transplant with all its side-effects, costs, and procedure related mortality. Now we target the abnormal gene "BCR-ABL" with tyrosine kinase and the patient becomes disease free.
Similarly, non-Hodgkin lymphoma (a cancer of the lymphatic system) is targeted with CD2O antibodies, and lung cancer is targeted by tyrosine kinase inhibitors (in tablet form). These targeting agents are devoid of the harmful (and even counter productive) effects of chemotherapy. Similarly, immunotherapy and vaccines against certain cancers have revolutionized cancer management. A number of patients are now increasingly being declared as "cured."
The earlier a cancer is detected, the more likely it is to be cured. Mortality is mainly due to spread of the cancer from its original site to another part of the body. Some cancers have a good prognosis: if cancers of breast, prostate, testicles, skin, and blood are detected and treated early, the survival rate is good. Even though it is difficult to always detect cancer in its early stage, there are certain signs and symptoms which should alert a person. These symptoms might not necessarily indicate cancer, but they are ominous and should not be ignored. These symptoms include: unexplained weight loss of more than 4 kgs over a period of one month, feeling of fatigue, loss of appetite, excessive sweating, bony pains, unexplained fever, change in bowel habits, blood in stools, a feeling of not having fully emptied the bowels after going to the toilet, a lump or a swelling in the breast or other parts of the body, a change in the size or color of a wart or mole in the skin, white patches in the mouth or the tongue, difficulty in swallowing food, blood in urine, abnormal bleeding between menstrual cycles, bleeding after menopause, persistent headache with vomiting, progressive diminishing of eyesight, convulsions seen for the first time in an elderly person, increased size of a swelling with accompanying pain, a cough that lasts for more than three weeks, blood in the sputum and breathlessness (this could be anything from an infection to a malignancy), a nagging cough or hoarseness of voice (this can be a sign of throat cancer), and so on and so forth. It is important to be aware of any unexplained change in your body so that timely steps are taken. An early intervention is necessary.
Cancer can now be diagnosed more easily than before. Pap-smear test and mammography exam are used to detect cervical and breast cancers in women, respectively. There are well defined protocols of colonoscopy to exclude or confirm cancer of intestines. Certain blood tests can detect tumor markers. For example, PSA estimation is done to look for prostate cancers. Similarly, CA-125 is done to detect ovarian cancers. Imaging techniques like CT scans, MRI screening, PET scans, ultrasonography, etc. make it easy to detect cancer. TRUS biopsies are done to confirm or exclude prostate cancers. CT guided biopsies are done to remove tissue from otherwise inaccessible parts of the body.
Cancer is basically because of genetic damage. How this damage is really caused is not sufficiently understood. However, there are some risk factors which predispose a person to cancer. Non-avoidable risk factors are not under our control, but we can take care of other risk factors and ensure our safety. Cigarette smoking increases the risk of cancers of lungs, oral cavity and food-pipe. Infections like hepatitis-B and hepatitis-C can lead to liver cancers. H pylori infection is implicated in stomach cancers. Human papiloma virus (HPV) can cause cervical, vaginal, and oral cancers. We can protect ourselves against these viral and bacterial diseases. Drugs and vaccines are available to treat and prevent some of these infectious agents that have been linked with cancer. HIV infection is also a well known risk factor. Excessive use of x-rays and CT-scans increases exposure to radiation. This may lead to leukemia (blood cancer) and can also induce thyroid and breast cancers. Prolonged exposure to ultraviolet rays in sunlight can cause non-melanoma skin cancers. Obesity is also a risk factor. Obese patients are prone to get post-menopausal breast cancers, and colorectal, pancreatic and gall bladder cancers. We should strive to achieve an ideal body weight. Physical activity protects against breast and uterine cancers in post-menopausal women. It is also helpful to fight obesity. Diet needs to be high in fiber and low in fat and protein. It has been seen that red meat is a risk factor in colorectal cancers. Fruit and non-starchy vegetables are protective.
There is no evidence that vitamin supplements prevent cancer. Selenuim in multi-vitamin tablets is claimed to reduce cancer risk but its excessive intake may increase the risk of prostate cancer. Supplemental vitamin-E and foliate have not been found to be associated with a decreased risk of lung cancer, rather supplemental vitamin-E has been found to be associated with a small increase in risk. Beta-carotene in multivitamin tablets may increase lung cancer risk in smokers. Instead of vitamin supplements one should get vitamins from a balanced diet, vegetables, fruits, and other natural sources.
Salty foods have been linked with stomach and esophageal cancers. In Kashmir we consume salt tea and cancer of food-pipe and stomach is very common. Mouldy foods contain aflatoxins, which cause liver cancer. Alcohol leads to liver, mouth, food-pipe, and breast cancers. Intake of coffee and tea (whether green or black) have neither been documented to cause cancers nor is there any proof that consuming green tea reduces the risk of cancer. A diet rich in calcium has been seen to be protective against colon cancers but increased intake may enhance the risk.
Air pollution, fumes in kitchen, and car exhaust fumes may cause lung and skin cancers. Water pollution due to discharge of industrial waste products into rivers and streams can lead to bladder cancer and it is a matter of great concern. Some food additives may be carcinogenic. Potasium bromate used in bakery products has been documented to cause cancers. Irradiated food does not pose any risk. All these risk factors should be taken into consideration and avoided. Cancer does not necessarily mean death. As mentioned, early diagnosis and recognizing the warning symptoms mentioned above are necessary. We can cure a varied number of cancers, and in a great number of patients we can increase the chances of survival or improve the quality of life. Let us change our lifestyle and be hopeful. Last but not least, the emotional well-being of the patient is very important. The patient should not lose hope and the treating doctor should infuse faith and confidence. The patient should remain socially interactive and active as far as possible. That will ensure the psychological well-being of the patient.
I dedicate this article to the memory of my late brother, Ajaz Banday, who died of cancer on Nov 17, 2013.