Welcome, Guest    Sign in to Windows Live ID | Register  

  Industry Medical Portal |  Student Centre |  Sitemap |  Help 
FAQAbout Us |  Disclaimer & Legal |  Contact Us 
Expert Speak

Cancer Concerns

The Cancer Institute (WIA) at Chennai is a landmark institution in Cancer Care in South Asia. It serves as a tumour registry for the Madras Metropolitan area. Dr R Ravi Kannan is a distinguished surgical oncologist belonging to the Cancer Institute’s committed team of specialists. Here he discusses various issues related to cancer in the Indian context.

Epidemiological Trends
Cancer Risk
Screening Methods
Minimally Invasive Theraphy
New Treatment Modalities
Alternative Theraphy
Cancer : Chronic / Treatable
Affordability of Treatment

The Cancer Institute WIA also serves as a registry covering a large area in the South.What are the epidemiological trends observed in the last 5 years?

The Cancer Institute maintains two registries. Madras Metropolitan Tumour Registry is a population based registry being collated here with data from all the hospitals and nursing homes in Chennai and around on all cancer cases.

The Hospital registry captures and maintains information on all patients who visit our Institute.

We have been observing a marked decrease in incidence of cervical cancers, while there has been a rising incidence of breast and lung cancers.

Trends in incidence of cancers as reflected in data available are as follows:

Lung cancer in men (AAR – Age adjusted rate per 100 thousand)

1984-88 AAR 8.6
1989-93 AAR 10.9
1994-98 AAR 11.7

Cervix and breast cancer in women

1984-88 AAR Cx 44.0 Bt. 20.1
1989-93 AAR Cx 34.1 Bt 21.2
1994-98 AAR Cx 29.6 Bt 24.7

The Cancer Institute has taken great efforts to spread the message that some cancers are preventable. How far has this message reached?

The incidence of cervical has come down with our much focused effort: the publicity on the need for proper genital hygiene, ill effects of promiscuity, etc. seem to have made a difference.

On the other hand, despite the awareness programs on tobacco, there is an increasing trend observed on incidence of lung cancer.

Is cancer incidence in India due more to wrong personal habits or due to environmental/ genetic/unknown causes?

Cancer occurrence in India is not particularly high in terms of endemic cancer. Though the numbers may be high due to the size of population itself, it is not as high per 100,000 in comparison to other countries.

Your institution deals with more number of patients than most other Indian hospitals with reference to cancer. Have there been any improvements in the screening methods and their reach among the masses?

Easy screening methods for oral, breast and cervical cancers are available. The group dealing with preventive cancer in our Institute is very active and conducts camps in various locations periodically apart from training village health nurses to handle screening.

Prevention and early detection of cancer is extremely critical in a country like India, where in case of late detection cost of treatment is very high. Advanced stages of cancer call for expensive modalities of treatment.

What has been the one factor that has had the most impact with reference to treatment of Cancer in India in the last five years?

The awareness being created will have an impact, though it may not be apparent in the short term but will certainly be seen in ten to fifteen years time.

Specialists in the field of oncology are also concentrated in the major cities across the country limiting the reach of care. In order to increase the impact, the spread of specialists into towns and closer to the rural populations is necessary.

What about some new thinking on surgical options such as:

  • Lumpectomy vs mastectomy
  • limb salvage vs amputation

Are we also moving towards minimally invasive therapies?

Organ conservation is the “in” thing with minimally invasive techniques being adopted. Due to socio-economic circumstances, many patients may not opt for conservation therapy especially in private hospitals. (More than one surgery may be required over a period of time, regular monitoring etc becomes more essential in minimally invasive techniques.)

Treatment modalities that came into discussion in Annual Meeting of Clinical Oncologists in 2002 were:

  • Use of Gleevac in CML (Chronic Myeloid Leukemia)
  • Harmone therapy for breast cancer
  • Bisphosphonates in bone cancer
  • Vaccine therapy after the first course of treatment in cancers

  • Use of gleevac in CML

    Gleevac is a selective tyrosine kinase inhibitor. It was declared the molecule of the year a few years ago. Haematological responses are seen in 90% of patients, major cytological response in 70 - 80 % of patients, complete cytological response in 60% of patients. Discontinuation due to toxicity occurs in less than 1% of patients and progression under treatment in about 2% of patients.

  • Hormone therapy for breast cancer

Hormone therapy for breast cancer -- Usually in four settings:

1) Chemo-prevention: for reduction in odds of breast cancer in the opposite side for a patient with cancer on one side by about 49%. Individuals who develop a cancer in the contralateral breast while on hormonal therapy will have receptor negative aggressive cancers. For reduction in odds for development of breast cancer in high-risk patients - those with a strong family history of breast cancer especially in the younger ages.

2) Adjuvant setting: In all estrogen receptor positive patients, hormonal therapy is indicated and the results are comparable to those of combination chemotherapy. Tamoxifen an anti oestrogen, is the first line drug. It's side effects include a 4% incidence of thromboembolic events and a 0.4% incidence of endometrial cancer. These are usually low-grade, low stage cancers and surveillance is not necessary. Investigations on abnormal vaginal bleeding are adequate. The newer aromatase inhibitors can be used as first line hormone manipulation if the risk of thromboembolism needs to be reduced. These include the third generation Anistrezole and Letrazole, which are selective for the specific step of conversion of androstenedione to estrone and estiol but are reversible. These can however be used only in the castrate patient or the postmenopausal patient. Exemustine, which is an irreversible aromatase inhibitor, may be used instead.

3) Metastatic breast cancer: The aromatase inhibitors are the first line for hormone manipulation in the metastatic setting. They have however been shown to be of lesser value with reference to bone metastases when compared to tamoxifen

4) Neoadjuvant setting: An area of current interest in older patients to avoid surgery

  • Bisphosphonates in bone cancer

    Biphosphonates in bone cancer reduce bone events including pain, cord compression, fractures that require fixation and hypercalcemia. They are Important in the management of hypercalcaemia. Provides for exciting possibilities in their role in the possible prevention of bone metastases. Can also be used in osteoporosis due to aging, castration. First, second and third generation drugs are available, the last having greater potency, reduced infusion time and a reduced incidence of renal toxicity.

  • Vaccine therapy after the first course of treatment in cancers

As yet in an investigational stage for colorectal cancer, gastric cancer, malignant melanoma, renal cell cancer, CML and myeloma

Are some of these relevant to the Indian Context?

All of them are relevant in the Indian context.

Allopathy is only one stream of medicine in India. Even in the west alternative therapies is being touted for Cancer. What is the advise you would give to those who turn to alternative therapies?

To our knowledge, alternative therapies do not cure cancer. These therapies are chosen as options when there is no hope in the allopathy treatment available.

Is Cancer being seen as a chronic ailment rather than a fatal one?

Cancer should be seen as a treatable ailment. Some forms of cancers, even if they are detected in the advanced stages, allow patients to have a meaningful extension of life. Many cancers are treatable.

In India is cancer treatment affordable for the lower middle class patient? Can it be made affordable?

Treatment of advanced cancer is expensive and most of the lower middle class patients would find it hard to meet the expenses of such treatment.

Wider availability of health insurance to a larger section of the public, increased government input in cancer care ( at present health expenditure is a very small fraction of which expenditure for cancer care is a small fraction), a modified approach on the part of treating physicians could make a difference. We need more cancer centres in the districts, more radiation units and more qualified personnel.

Dr R Ravi Kannan, MS, M Ch. is the Professor & Head, Surgical Oncology at the Cancer Institute (W.I.A.), Adayar, Chennai 600 020. His areas of specialisation are Head and Neck Oncology and Bone and Soft tissue Sarcoma. His area of special interest is Skull Base Surgery.

Advertisement
Tell us what you think about Web Health Centre - Send us your feedback
Copyright © 2015 WebHealthCentre. All rights reserved. Brought to you by