This World Cancer Day, 4th February 2022, we wanted to explore the prognosis of cancer with an expert, to truly understand the likely course and outcome of the disease. A cancer diagnosis strikes instant fear in a patient and their family members. And while it continues to take the lives of many, the advanced treatment options and early detection tools have improved the chances of complete recovery from certain types of cancers.
SL Raheja Hospital’s Senior Consultant Surgical Oncologist Dr Kirti Bhushan eases the fear surrounding cancer.
Why Cancer Is Among The Leading Diseases Of Concern
Characterised by the development of abnormal cells that divide uncontrollably, infiltrate and destroy normal body tissue, cancer is the leading cause of death in the world. According to WHO, around one-third of cancer deaths have a background of high tobacco and alcohol use, high Body Mass Index (BMI), a diet with low fruit and vegetable intake, and lack of physical activity. In India, which has a population of 1.39 billion people, cancer incidence is 70-90 per 100,000 population, with over 800,000 new cases and 5,50,000 deaths occurring each year.
According to Indian Council of Medical Research (ICMR) data, the most common are cancers of the oral cavity, oesophagus, stomach and lung in males. In contrast, the common cancers in females are the cervix, breast, oral cavity, and oesophagus. More than 70% of the cancer cases present in the advanced stage and account for poor survival and high mortality. But survival rates are improving for many types of cancer, thanks to improvements in cancer screening, treatment and prevention.
6 Cancer Facts To Ease Your Mind
1. Success rates of cancer treatments are now higher than before
People are diverse, and so are cancers. Two types of cancer that might occur in the same organ may not necessarily behave or react to treatment in the same way. Genetic makeup can further complicate detection, diagnosis, and treatment. However, cancer treatment has come a long way, and today researchers are making commendable progress in the prevention, detection, treatment, and survivorship of the disease.
Treating cancer has changed dramatically. With refined surgical techniques, newer chemotherapeutic drugs and regimens, modified radiation techniques, along with targeted therapies and immunotherapy has marked a massive breakthrough in cancer care. The outcome has fairly improved after treating Cancer with all these modalities, especially for early-stage cancers where survival rates are almost more than 90%. Even in advanced cancers, we are able to halt the progression and increase disease-free survival. Cancers with aggressive biology, even in early stages, are posing problems with a tendency to recur and spread even after multimodality treatment. Though huge progress has been made to understand the biology of cancer, plus the advances in treatment modalities, still, a lot needs to be explored to make treatment more friendly and impactful to improve survival.
2. Lifestyle changes can prevent cancer
In recent times, there has been an increase in cancer incidence in India as nearly two people are diagnosed every minute with cancer. This is mainly attributed to urbanisation, industrialisation, lifestyle changes, population growth and increase in lifespan. The predominant risk factors associated with cancers are genetic, environmental and lifestyle factors. Non-modifiable factors like age, sex and genetic factors contribute to only 10-15% of adult cancers.
Modifiable factors like tobacco & alcohol, excess weight, and obesity, infections (HIV, HBsAg, HCV, HPV) and an imbalanced diet contribute to 85%-90% of cancer causes. Other significant causes include a sedentary lifestyle, weakened immunity, stress, diabetes, sunlight, pollution and chronic inflammations. This means that dietary and lifestyle modifications can help prevent future occurrences of cancer.
3. Early detection can save lives & a watch list of symptoms is available
Early diagnosis of cancer is essential to have the best possible chance for successful treatment. When cancer care is delayed or inaccessible, there is a lower chance of survival with more significant problems associated with treatment and higher care costs. Any sign or symptom that is unusual, unexplained and persists for more than three weeks irrespective of treating conservatively, needs medical attention as they may represent early cancer symptoms and signs. These include the following
- Persistent headache
- Non-healing ulcer anywhere in the body
- Painless swelling anywhere on the body
- Blood from mouth, urine or stool
- Loss of weight and appetite
- Indigestion or difficulty in swallowing
- Hoarseness of voice
For early detection in asymptomatic individuals, routine screening yearly or two-yearly can be done with the following recommendation:
- Clinical examination by an oncologist
- Blood tests like CBC, LFT, RFT, Lipid profile, vitamin D, Ca levels
- Routine chest x-ray
- Ultrasound abdomen and pelvis
- Mammography, CA125, PAP smear in women
- PSA in males
Cancer doesn’t occur overnight, and it’s a process, and it takes many years for a normal cell to get and ultimately present itself as a cancer case. This means that through certain dietary and lifestyle modifications, the manifestation and progression of cancer can be halted. Remember the LMNOP formula at all times.
L – low fat, high protein diet
M – more of fruits and vegetables, vitamins, minerals, antioxidants
N – no to smoking, alcohol, tobacco, processed meat
O – organise oneself, meditation, timely food, work, and sleep
P – physical activity with at least 45-min brisk walk five days a week
As a good metric, it is recommended that Body Mass Index (BMI) should be restricted to 27kg/m2 in males and 25kg/m2 in females. It is also essential that people get immunised and practice safe sex.
4. Advanced cancer diagnosis and screening tools are available
Once cancer is suspected in a patient, the next aim of the physician is to confirm the disease by doing a biopsy of the representative lesion (tru-cut, excision or image-guided). The physician will also need to see the extent of the disease by imaging (CT scan or MRI scan or/and PET scan) to plan the treatment accordingly. The focus is to neither over nor under investigate. Any investigations that don’t change the line of treatment are not required. If confused or dissatisfied, patients have every right to seek a second opinion as qualitative and affordable treatment is their right. Proper clinical staging and a treatment plan are done once the reports are ready.
5. Doctors now include patients in their treatment plan
There is a lot of ethical drama associated with delivering bad news of cancer to patients and families. The healthcare team must disclose the cancer prognosis to the patient straightforwardly to avoid adverse reactions. Not revealing the information correctly, telling family members and not the patients, using other terminologies like growth for cancer or particular medicine for chemotherapy is a good idea. It is essential to understand that the patient will eventually know the truth, and non-disclosure may negatively impact the outcome in treatable cancers. Physicians now involve patients in the treatment plan and discuss with them more freely.
When physicians are open about the diagnosis and prognosis, patients can think more realistically about their condition and participate actively in the treatment planning. Most individuals can adjust to the diagnosis over time. Most healthcare professionals address the family’s fears about sharing the news and offer suggestions for assisting the patient.
The following are guidelines for disclosing bad news of cancer:
- Provide privacy, support, and adequate time to share the information
- Ask the patient how much they want to know
- Encourage the patient to bring a family member to the meeting
- Consider taping the meeting or providing a written summary of the information
- Monitor for signs of emotional distress and respond as needed
- Give the information gradually rather than starting with the diagnosis
- Listen to the patient’s and family’s concerns
- Assess their understanding of what has been shared throughout the process
- Develop an alliance with the patient about the treatment plan
- If needed, ensure that professional interpreters are available
- If the prognosis is inferior, avoid giving a definite time frame
- Reinforce information given on subsequent visits and when the patient and family see other healthcare professionals
- Provide resources for follow-up support
6. There are multiple treatment plans with better success rates than before
Once cancer is diagnosed and the patient and their family are adequately counselled, the next step is understanding the course of the treatment. Currently, three main cancer treatments include surgery, chemotherapy, and radiation (either single therapy or multimodality). There have been many advances in cancer treatment, and with technological advances, the principles of surgical management have been revolutionised considerably. The mutilating surgeries of the bygone era have been replaced with organ-preserving surgeries with better results, decreased relapses and improved survival. Reconstructive surgeries improve the cosmetic, functional and aesthetics of patients.
Additionally, systemic chemotherapy helps in advanced cancers by either down-staging the disease and making them amenable to surgeries, or are given in metastatic settings. A variety of chemotherapy drugs are available and offered in different combinations to increase success in treatments. With recent advances in the field that include targeted therapies and immunotherapies, cancer survival chances are pretty high, especially in cases of early detection.
An old proverb says: “To defeat an enemy, one needs to understand the enemy well’. Though tremendous progress has been made to understand the biology of cancer and advances in treatment modalities, there is still quite some way to go before defeating cancer in a broader sense. And while significant discoveries in cancer tend to grab a lot of attention, small incremental advances happen all the time. Add several incremental advances together, and you’ve got a significant shift in cancer care.
In conclusion, to make cancer prognosis less stressful and painful, patients must not ignore the early signs and symptoms of cancer and consult an oncologist at the earliest. Also, proper diet and lifestyle modifications make it possible to prevent cancer. Remember, cancer is preventable, treatable, and beatable if detected and treated early.