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Category Archives: Cancer

No drop of Heart Attacks and Cancer even after Smoking banned in Public Places

By Vinod Kumar

While the ban of smoking in public places in the western countries has resulted to lesser heart attacks with the average drop being 20 %, leading  health experts in India feel that the ban has not resulted of any positive development in terms of the incidence of heart attacks, cancer and other diseases.

Dr. Purushottam Lal, Chairman of Metro Hospitals and Heart Institute said that the government should bring out stringent laws to stop the usage of all tobacco products among the masses. Apart from the policies undertaken by the government, it’s the will power of the smokers along with counseling and clinical intervention and more awareness that can bring the desired results. For a smoker the chance of dying from a heart attack is 2 to 3 times greater than that of a person who does not smoke. About 1 out of 4 heart attacks is believed to be directly related to smoking.

Quitting smoking is probably the most important step to be taken to decrease the chances of coronary artery disease (CAD) and a heart attack. Although all types of tobacco smoking increase the risk of developing CAD, smoking cigarettes increases this risk more than pipe smoking or cigar smoking. Up to 30% of all deaths related to CAD are attributed to cigarette smoking.

Dr. Lal said, “Smoking causes the platelets in the blood to clump together easily by making your blood cells more “sticky” and more likely to form clots. It can also cause spasms in the coronary arteries, which reduces the blood flow to the heart in a way similar to that of atherosclerosis.”

Apart from the above, smoking also triggers irregular heartbeats or (arrhythmias). It lowers “good” cholesterol (high-density lipoprotein, or HDL). It reduces the amount of oxygen that can be carried by red blood cells in the bloodstream.

World Health Organization (WHO) estimates that smoking-related deaths worldwide will surpass 9 million annually by 2020—with 7 million of those deaths occurring in developing nations. At present Around 5.4 million deaths a year are caused by tobacco, which means every 6.5 seconds a current or former smoker dies. Twenty-five years ago, nearly 70 percent of the lung cancer deaths worldwide occurred in high-income nations. Today, 50 percent of lung cancer deaths occur in low-income nations, and by 2030 that number is expected to increase to 70 percent. With around 9 lakh deaths occurring annually, cancer has become a major public health concern in India.

“There is a universal fear of cancer,” he said. “But, with the right frame of mind, and by taking appropriate action, some cancers can be averted or cured, ” said Dr. Lal.

According to Dr. Lal, apart from smoking, air pollution – mainly from vehicles, industry, and power plants – raises the chances of lung cancer and heart disease in people exposed to it long term. There’s an excess risk of both lung cancer and cardiopulmonary disease associated with increased exposure to fine particles [in air pollution],” said Dr. Lal.

More than 30 percent of all cancers can be prevented through simple measures such as avoiding smoking, eating a healthy diet and taking exercise, limiting alcohol consumption and protection against cancer-causing infections.

“Some cancers can be detected early, treated and cured. Certain cancers like those of the mouth, breast and cervix can be cured if detected early. One should be aware of its early signs and consult a health professional at the earliest.Easy accessibility of medical care and technology has made the disease curable, ,” said Dr. Lal.

Breast Cancer Comprises 10% of All Cancer Cases

Dr. Shilva

Cancer is strengthening its grip across India. Approximately 17.3 lakh new cancer cases are being estimated by the year 2020 in India. Breast cancer has a majority share of cancer cases and is the leading cause for deaths in women suffering with non-communicable disease. According to an Indian Council of Medical Research (ICMR) report, breast cancer shares 10% of all cases.

Approximately, 1.5 lakh breast cancer cases are being reported in the country every year and the incidence is showing an upward trend. One in eight women is known to develop breast cancer cases at some point of time in life. We suspect that the number might be higher. Due to lack of awareness amongst people and social stigma, a lot of women ignore symptoms and are wary of coming to doctors for diagnosis.

Diagnosis at early stage is important for any kind of cancer, for the treatment to be effective. However, it is more so for breast cancer because breast cancer do tend to show early signs by change in how breasts feel and look to an individual. An important sign is lump formation in breasts. Usually, cancerous lumps are hard mass with irregular edges, but they can also be soft, tender and rounded, and sometimes painful. However, any appearance of lump formation in breasts should not be ignored.

It is very important for women to know how their breasts feel and look because that increases the chance for a person to realize any new abnormality, which helps in diagnosing an early stage of cancer. Lump formation in breasts should not be ignored. Also, there should not be unnecessary panic. Eight out of ten breast lumps are nonmalignant or non-cancerous. However, it is only through a breast biopsy can cancer be detected or ruled out. One should not be satisfied with other forms of diagnosis or treatment options such as mammography.

Some of the other symptoms of breast cancer include breast swelling, skin irritation, pain in nipples or breasts, nipple turning inward or nipple retraction, and scaling, redness of nipple or skin of breasts.

Due to various societal and cultural factors, women find it hard to come out in open and discuss or get themselves diagnosed for breast cancer. Apart from anxiety and fear of being diagnosed as cancerous, changes of appearance and not feeling good about one’s body are also stressful factors. The treatment options like chemotherapy are in itself psychologically challenging because of their side-effects. Other than psychological and medical reasons, family and husband support are essential, and lack of such support or prejudice pertaining to the disease affects a potential patient psychologically preventing her to come go for check-ups. Cancer treatment options are sometimes expensive and that also acts as a limitation in going for timely treatment.

Breast cancer can be cured if it is timely diagnosed. To reduce the number of deaths due to the disease, myths surrounding the disease need to be busted and awareness about the disease and treatment options needs to be spread far and wide. Policies need to be framed to help the poor avail better treatment options. A combined nationwide effort is needed from all stakeholders to prevent this disease from becoming a national crisis.

Is a Consultant Obstetrics & Gynaecology, Paras Bliss Hospital.


Ensuring Access To Timely Treatment Of Cancer Patients

With very little percentage of cancer patients having access to comprehensive and timely treatment support, a need to face this issue has arisen. Take a look at the ways in which this issue can be resolved

Dr. Harit Chaturved

 It might seem like a contradiction – that in the field of oncology, we are doing much better than before, yet we have a long way to go. I often feel we have hardly covered any significant ground. Not more than 15 per cent of our population has access to timely and comprehensive treatment support. To add to this difficulty, we are expecting that cancer incidences will double within the next decade, because of demographic profile, life expectancy, growing economy, lifestyle, etc. Are we prepared to face this challenge?

Major issue

A major problem is that a big chunk of our resources are spent on advanced stages of cancer and that too in the last six months of treatment in a patient’s journey. If the same resources are spent on cancer prevention and early diagnosis, it would be extremely beneficial for the patients and society at large. It is heartening to realise that almost 60 per cent of cancer is preventable. Tobacco contributes to more than two-thirds of patients in this segment and the other preventable causes are related to diet, lifestyle, vaccine for cervical cancer, liver cancer, etc. Proper education using IT and mass communication tools, with focus from primary education level onwards, could change the scenario rapidly.

Establishment of diagnostic centres

In early stages, the treatment outcomes are very gratifying, less expensive and there is minimal treatment-related morbidity. The operational cost of such a setup would be less than 5 per cent of operational cost of a hospital. These centres could be attached to nearby larger treatment facilities. Probably lot of diagnostic load from hospitals would also shift. These centres should be well equipped with imaging, endoscopies and biopsy procedures. The SOPs should ensure that more than 80 per cent of the patients are adequately attended in less than 72 hours. No cancer facility is complete without a comprehensive palliative care setup as an integral part, and it’s high time we bring the palliative care program centre stage.

Need for infrastructure

In the last two decades, we have seen dramatic growth in trained manpower and number of comprehensive cancer centres. In fact, in the last fifteen years, these numbers would be more than the total work done in the hundred years before that. There is a need to understand our disease pattern and response to treatment. To execute this, we need the infrastructure for research.

Chairman – Max Institute of Cancer Care
Max Super Speciality Hospital, Saket, New Delhi




How is Cancer Diagnosed?

Dr. Navile Aditya Murli

There is no single, simple method to diagnose cancer. It may take several months or years for malignant cells to multiply to the point where they become a detectable cancer. The symptoms produced by a cancer depend on its location and unfortunately it is possible for cancer to become widespread before it starts to produce any symptoms at all.

Sometimes cancers may be discovered accidentally during routine tests or the investigation of non-specific symptoms.

The cancers that are easiest to detect are those that are on the skin and which show, for example, as a change in a mole or wart. Others may start close to the surface and can be seen or felt as a lump or thickening. There are also some parts of the body that are relatively easy to examine for early signs of cancer such as the mouth and throat, the cervix and vagina or the rectum and anus.

What is Biopsy ?

Cancer is usually diagnosed by an expert who has looked at cell or tissue samples under a microscope. In some cases, tests done on the cells’ proteins, DNA, and RNA can help tell doctors if there’s cancer. These test results are very important when choosing the best treatment options.

Tests of cells and tissues can find many other kinds of diseases, too. For instance, if doctors are not sure a lump is cancer, they may take out a small piece of it and have it tested for cancer and for infections or other problems that can cause growths that may look like cancer.

The procedure that takes out a piece of the lump, or a sample for testing is called a biopsy. The tissue sample is called the biopsy specimen. The testing process is sometimes referred to as pathology.

How Biopsy is done ?

A biopsy is a procedure in which the doctor removes a sample of tissue. A pathologist  then looks at the tissue under a microscope to see if it is cancer. The sample may be removed in several ways:

  • With a needle: The doctor uses a needle to withdraw tissue or fluid.
  • With an endoscope: The doctor looks at areas inside the body using a thin, lighted tube called an endoscope. The scope is inserted through a natural opening, such as the mouth. Then, the doctor uses a special tool to remove tissue or cells through the tube.
  • With surgery: Surgery may be excisionalor incisional.
    • In an excisional biopsy, the surgeonremoves the entire tumor. Often some of the normal tissue around the tumor also is removed.
    • In an incisional biopsy, the surgeon removes just part of the tumor.

Lumps that could be cancer might be found by imaging tests or felt as lumps during a physical exam, but they still must be sampled and looked at under a microscope to find out what they really are. Not all lumps are cancer. In fact, most tumors are not cancer

 Is a CONSULANT MEDICAL ONCOLOGY at Oncoplus Cancer Care Centre, Defence Colony, New Delhi. He did His Senior Resident and fellowship for three years in Cancer Institute Adyar Chennai.

Robotic Surgery For Colorectal Cancers

Dr. Nitin Vashistha

Colorectal cancer is the third most common cancer in men and second most common cancer in women worldwide. In India colorectal cancers ranks in top 10 most common cancers.

What are the symptoms of colorectal cancers?

Colorectal cancer may not have any symptoms in the early phase but if present they may be:

  • Change in bowel habits (alternating diarrhea and constipation)
  • Decreased caliber of stools
  • Blood or mucus in stools
  • Sense of incomplete evacuation after passing stools
  • Generalized weakness
  • Unintentional loss of weight

What are the treatment options for colorectal cancers?

Depending on the stage of the colorectal cancer, there are several treatment options. These may be offered singly, sequentially or in combination based on the stage of cancer.

  • Chemotherapy
  • Radiotherapy
  • Surgery: open, laparoscopic or robot assisted

What are the advantages of robot assisted surgery for colorectal cancer?

Robotic system provides superior quality 3 dimensional view to the surgeon. It also provides a stable platform and eliminates the tremors. It helps surgeon to operate in closed, narrow spaces in the abdominal cavity such as the pelvis (cancer rectum) where it may be difficult to perform laparoscopic surgery. It also provides for ease in surgical suturing which helps in reconstruction.

For the patient this translates into less blood loss, less pain & lower requirement for analgesics and shorter hospital stay.

What are the specific advantages of robot assisted surgery for rectal cancer?

Robot assisted surgery helps in better nerve sparing rectal cancer surgery which translates into better functional outcomes.

Is robotic surgery safe?

Robotic surgery has been introduced in clinical practice nearly 2 decades ago and since then its safety is well documented in scores of publications on the subject. The technique has been approved by the US FDA.  In the Unites States of America robot assisted surgery is offered at over 1300 centers and increasing number of surgeries are being performed robotically all across the world including Europe, Japan, Korea and now India.

What is the current status of robotic colorectal cancer surgery?

Robot assisted surgeries are increasingly used for colorectal cancer patients because of its obvious advantages. In US an ever increasing number of patients now prefer robotic colon cancer surgery over other surgical options (1 out of 5 patients).

 Is a Consultant at Department Of Surgical Gastroenterology in Max Super Specialty Hospital, Saket, New Delhi.