As India strides into the 21st century, the spectrum of disease has changed from mainly infectious diseases to more chronic disease (such as heart disease & diabetes), while cancer has assumed epidemic-like proportions. This is due partly to lack of awareness of health promotion & disease prevention as well as lack of amenities for early diagnosis and treatment.
Cancer & its types
Cancer refers to an abnormal & unregulated growth of tissue, which may invade surrounding normal structures as well as spread to sites distant from that of origin. Cancers are broadly of 3 types:
- (1) Carcinomas (70%) : arise in membranes (coverings) and glands/ ducts of glands; commonest type of cancer; usually spreads to neighbouring sites, then to distant sites; important sites include head-neck, lung , prostate, breast, oesophagus, colorectum & anus
- (2) Sarcomas (10-20%): arise from bone/muscle/nerve; less common; spreads to distant sites early
- (3) Blood cancers: Leukemia , Lymphoma & Myeloma
The commonest cancers worldwide in men are Lung Cancer & Prostate Cancer, and in women, are Breast Cancer and Lung Cancer. However, in India, the commonest cancers in men are Head-Neck cancers (especially Oral cancers in the Eastern part of the country), while in women, the commonest cancer is Uterine Cervical Cancer.
Ironically, both of these are preventable diseases, since head-neck cancers are almost always related with use of tobacco, while cervical cancer arises from chronic infection by Human Papilloma Virus.
- (1)Avoiding smoking and other tobacco products (khaini, etc) can prevent many cancers (head-neck, lung, urinary bladder, etc) as well as chronic heart & lung diseases
- (2) Lower consumption of red meat & processed meat
- (3) Increased consumption of green, leafy vegetables
- (4) Vaccination against Human Papilloma Virus (prevents cervical cancer) & Hepatitis B virus (prevents chronic liver disease & liver cancer)
Many diseases can be diagnosed at a very early stage, even before they produce symptoms, and when treatment will have a much greater benefit. Such diseases can be actively searched for in the general population by a process called “screening”.
Successful screening is possible for: –
a. Cervical cancer (all women in reproductive age group should have a Pap smear done annually)b. Prostate cancer (all men beyond age 50 years should have an annual blood test called PSA) c. Breast cancer (all women beyond age 40 should have an annual X-ray of the breasts, called Mammography).
Cancer symptoms vary according to site of disease. However, any abnormal lump/ sore anywhere in the body, along with any abnormal bleeding or discharge needs to be reported to the nearest community physician, who can then arrange for further investigations & hospital consultations. Cancer often requires a battery of tests, including blood tests, X-ray, endoscopies, CT scan/MRI scan. Cancer diagnosis almost always involves getting a tissue/ cell sample from the suspicious growth, called a biopsy.
Various treatment modalities are required in treatment of common cancers. These include surgery, radiotherapy & chemotherapy/ targeted therapy.
Surgery involves operative removal of the tumor with a margin of healthy tissue and most centres have specialized surgeons for each organ system of the body. Radiotherapy refers to treatment of cancers by X-rays & Gamma rays, from outside the body (teletherapy) or inside (brachytherapy). Chemotherapy & targeted therapy are systemic treatments acting on the entire body, usually to prevent or tackle disseminated disease.
Treatment modality varies according to site & stage of disease. Many common cancers in stage I or II can be treated by single modality, either surgery or radiotherapy. More advanced disease usually will also require systemic therapy (chemotherapy/targeted therapy), while metastatic disease & blood cancers are almost solely treated by such systemic therapy.
Challenges in cancer control in India
Till now, the focus has been on treating cancer, less on prevention and even on diagnosis. This is wrong because some cancers can be prevented and many cancers can be treated more effectively if diagnosed early. We need to evolve a more organized network of primary care providers, who can be involved with a particular community on a continuous basis. This demands proper funding and education of the primary care providers and a systematic division of the population according to catchment area, amongst them.
Even in the treatment of cancers, India is running far behind in the number of institutes, doctors, other staff and equipment necessary to deal with the hordes of patients. The situation cries out for increased funding on cancer care, setting up of new institutes and training of more staff than available at present. Cancer care is an expensive business and too often the patient’s ablity to take and comply with treatment is undermined by their inability to pay. Subsidized government institutes alone cannot cope with the demand…resources must be pooled. There needs to be a supervising authority in cancer care in every state, to guide the patients so that they can get the right treatment at the right time.
Dr Jyotirup Goswami
Consultant Radiation Oncologist, Narayana Health Cancer Institute,
Narayana Superspeciality Hospital, Howrah, West Bengal