Cancer is as old as mankind. It was found in the mummy of Egypt from 5000 years back. Unfortunately, even now, people are unaware about its nature, its cause, its prevention and most importantly there are several misconcepts which make the problem even more complicated.
What is Cancer?
Body has the inherent capacity of repairing a dead or damaged tissue by multiplication of cells and there is a control system for this. When there is lack of control, the cells multiply excessively and form a lump. This is called tumour. This can be benign- where the lump is slow growing, does not cause damage to the neighbouring structure and do not spread to other organs and are usually not fatal. The other type of tumour is obviously malignant (cancer), where the lump grows very rapidly, involves the neighbouring and distant organs and can be fatal if not treated early.
What are the common types of Cancer?
In male, where tobacco addiction is a common problem, the common cancers are that of oral cavity, lung and prostate. In females, in rural population the common cancer is that of uterine cervix, whereas that of urban women is breast cancer.
What are the causes
Unfortunately, the causes in 2/3 of all cancers are still not clear, and several researches are going on worldwide to determine this. In 1/3, the causes are proved beyond doubt- of which the most important is tobacco in any form- smoking (Bidi, cigarette, hukka etc.) and smokeless (paan, paan masala, ghutka, khaini, jarda etc.). The other less common causative agents are diet (adulterated food, high fat and less of fruits, vegetables and vitamins, more intake of junk, fast, stored and charred food), sunlight (causes skin cancer especially in the white race), western lifestyle (lack of or delayed pregnancy and less breast feeding can cause breast cancer). For uterine cervical cancer the common causes are early and multiple children, multiple partners, low personal hygiene, infection by a virus (Human Papilloma Virus). In some cases (less than 5%), a genetic abnormality is found which can predispose to cancers in many members of the same family (mainly of breast, ovaries and bowel).
What are the symptoms of cancer?
Loss of appetite and body weight, an ulcer which is not healing, lump which is rapidly increasing, persistent change of voice, bleeding with cough, vomitus, stool or urine, intermenstrual bleeding, difficulty in swallowing etc.
Cancer means death- Most cancers if detected early can be cured completely.
Cancer is contagious
– it is not
Biopsy can cause cancer or spread of cancer- Biopsy or any surgery does not cause a benign tumour to turn cancerous. Taking a small sample of tissue (mostly done by Fine/ Wide bore Needle or a small punch forceps) do not cause any spread. The doctors can guide you regarding the best way of doing it. Biopsy is important before embarking on a major surgery, radiotherapy or chemotherapy as the tumour may actually be not malignant at all. Even if malignant, the treatment strategy is completely different in different kinds of cancer, so it is important to plan beforehand by knowing the nature of it.
Surgery in cancer causes spread of cancer- it is the reverse. The main treatment for most cancers in early stage is to remove the tumour along with some good healthy tissue margins and the neighbouring glands which may be involved. Removing a tumour partially is always bad and is never advisable. If the tumour is big and when complete surgical excision is not possible, chemotherapy (anti-cancer drugs) or radiotherapy is used to reduce the size and make it operable.
Cancer is hereditary- in 95% cases they are not. So there is no need to panic if only one member in the family had cancer, as it may be just accidental. However, if there are 2 or more members who are affected, it will definitely be advisable to see an Oncologist who can assess the risks and order relevant tests.
Chemotherapy is painful and causes severe vomiting and permanent hair-loss-
Although some strong chemotherapies which are administered in advanced diseases may cause vomiting, diarrhoea, low White Cell count and hence low Immunity etc., these can be counteracted by some preventive medications. Hair-loss is only temporary and does not occur with most of the chemotherapies.
Cancer can cause a very painful death- fortunately with different medicines which are now available and also with radiotherapy in some cases; pain can be very well controlled in advanced diseases where the patient cannot be cured. A new modality is Interventional pain therapy where the nerves conducting pain to the brain can be blocked by injection at specific sites.
There is no diagnostic or treatment facility in Eastern India- this is about time people of Eastern India realizes that there is no need to travel to far south or west or outside India for management of cancer. It is not only expensive to travel long distances, but causes unnecessary mental stress on the patient, when they prefer to stay in their locality and get maximum support from all the near and dear ones. There are enough facilities available in Eastern India for all classes of people. You may take help of different help lines, media and internet to find out which one suits you most.
Take home messages:
Cancer is preventable by avoiding the risk factors, and can be detected early if people come forward to the doctors with symptoms mentioned above without ignoring them. There is no need to think that one should not do tests as that may cause cancer or expose the fact that he or she is harbouring cancer. On the contrary, it is prudent to detect a cancer or a pre-cancerous area which can then be completely cured. The more it is neglected the worse is the result and more aggressive and expensive will be the treatment. Many organs like breast, limbs, larynx (voice-box) etc. can be preserved in early stages with the new modalities of treatment. It is not contagious, and hence it is important that the families give maximum support to the victims rather than staying away in fear.
Biopsies are advisable before embarking on a treatment and surgery is the treatment in most of the cancers in the early stage. There is no need to panic about radiotherapy and chemotherapy- in expert hands the side-effects are minimum and can improve the results significantly. Even in advanced stages symptom control can be well achieved with the Palliative care team and different Support groups. Together we must fight to remove all the misconceptions and try and prevent this potentially preventable and curable disease.
(The writer is Immediate Past President of IASO, Medical Director & Prof in Dept of Surgical Oncology, Saroj Gupta Cancer Centre & Research Institute, Thakurpukur, Kolkata)