Never Get Cancer

Cancer is caused when cells multiply and spiral way beyond control, spurred by a mutation (defect) in the genes. It can be inherited or triggered by physical factors (hormones or inflammation, for example), or even environmental influences such as harmful chemicals. However, experts say that only a small percentage of cancer is inherited. More often than not, the interplay between our lifestyle choices and environmental factors determine our risk of cancer.

Being well-informed and attuned to your body and the whys and wherefores of cancer can help you prevent it summarily. We have here critical information and insights about top cancers in Indian metros. Update yourself and build a defence plan with life-saving advice from experts.

Lung Cancer

Stub the butt already! "Smoking tobacco, in any form, is a major risk factor for lung cancer. Passive smokers are also at risk," says Dr Raj K. Shrimali, consultant radiation oncologist, Tata Medical Center, Kolkata. Avoiding tobacco smoke at any age significantly lowers the risk. "Other risk factors include diesel exhaust-even radon and asbestos (if working in an associated industry)," adds Shrimali.

LOOK OUT FOR persistent cough, hoarseness or wheezing, shortness of breath, sputum streaked with blood, weight loss and chest pain.

Diagnosis: X-ray, followed by a CT scan and a biopsy.

Rx: "Once diagnosed, it is classified into non-small cell and small cell lung cancer. The former is more common-surgery is suggested for early stages (I & II); radiation therapy and chemotherapy may be used after surgery to kill micrometastatic cells. These are also typically the first-line treatments, for advanced tumours when surgery isn't feasible," says Dr Ullas Batra, a consultant medical oncologist at Delhi's Rajiv Gandhi Cancer Institute and Research Centre.Targeted therapy with drugs such as erlotinib and crizotinib (for EGFR mutation) and geftinib (for ALK+ mutation), usually used in stage IV, can work remarkably well in some patients. "Small cell lung cancer spreads rapidly. Chemotherapy is the mainstay of treatment. However, in patients with limited stage disease, radiation therapy must be added to chemotherapy early for better control (most cases) or cure (14 per cent cases)," adds Shrimali.

Good to Know: The symptoms of lung cancer and TB being similar, a large number of patients are put on antitubercular treatment for six to nine months, by which time the cancer has usually advanced, says Shrimali. Do get a second opinion, especially if you smoke.

Mouth Cancer

"Tobacco (both chewed and smoked), betel nut (paan masala) and alcohol are the top risk factors for this aggressive, but avoidable, cancer. Tobacco and alcohol are synergistic and potentiate each other's actions," says Dr Deepak Sarin, head and neck onco surgeon at Medanta-The Medicity, Gurgaon. Some mouth cancers, however, have no identified causes.

LOOK OUT FOR difficulty and pain in swallowing, pain in the mouth or pain/lump in the neck. "Since there is no effective screening programme to catch it early, watch out for tell-tale signs like a mouth-ulcer that doesn't heal in over three weeks or a white/red patch inside the mouth or lips, especially if you use tobacco or drink heavily," says Dr Moni Abraham Kuriakose, professor and director, surgical oncology, Mazumdar Shaw Cancer Centre, Narayana Health City, Bengaluru. 

Diagnosis: Outpatient biopsy

Rx: "Surgery is the primary treatment modality. Radiation therapy and chemotherapy are adjuncts," adds Kuriakose.

Good to Know: Swallowing and speech therapy along with psychological counselling may be needed to help overcome post-surgery challenges, says Sarin.

Prostate Cancer

It develops in the prostate, a gland of the male reproductive system. Experts attribute the steady rise in cases of prostate cancer in the past decade to the availability and awareness about the PSA (prostate-specific antigen) test. Risk increases with age, typically striking after age 60, as does family history, according to Dr Sudhir Rawal, medical director and chief of surgical gynae uro-oncology at Rajiv Gandhi Cancer Institute and Research Centre.

LOOK OUT FOR low urinary tract symptoms (LUTS). "In early stages patients may not show symptoms. But as the cancer progresses, patients may display LUTS: increased frequency, urgency, pain, poor stream, terminal dribbling and incomplete voiding. In very advanced stages, it can cause back pain and weakness in the lower limbs," says Dr Abhay Kumar, consultant urologist and uro-oncologist at Narayana Superspeciality Hospital, Kolkata.

Diagnosis: Clinical examination via the PSA test, an MRI and biopsy. "Once diagnosed, patients are classified into high-, intermediate- and low-risk groups. Treatment is chosen based on age and risk category," says Rawal.

Rx: An 80-year-old low-risk patient may not be advised follow-ups with the doctor, as his chance of dying from prostate cancer is negligible. Typically, surgery (removal of the prostate) or radiation therapy with hormone treatment is used for low- and intermediate-risk scenarios. A combination of surgery, radiation and hormone therapy is used for metastatic and high-risk disease; hormone therapy and/or chemotherapy is used according to primary burden and response/resistance to the hormone therapy.

Good to Know: When it comes to family history, the closeness of the relation (father, brother), the age at which the relative was diagnosed with prostate cancer and the number of family members diagnosed together determine the risk, explains Rawal.

Breast Cancer

The incidence of breast cancer is on the rise. However, it is one of the curable cancers if detected early. Detected and treated in Stage I, the survival rate is over 90 per cent. The cancer is categorized depending on the tumour size, grade (how fast the tumour is likely to grow) and stage (how far the tumour has spread). You can screen for breast cancer yourself by doing a breast self-examination (BSE) regularly after age 20. Mammography is advised for screening after ages 40 or 50, depending on risk factors. 

LOOK OUT FOR any changes such as redness, discharge and feel for lumps. Follow BSE with an evaluation by a gynae every few years up to age 50. If you have a family history of breast cancer, you may need frequent monitoring.

Diagnosis: Doctor-performed physical examination to look for any abnormality, followed by ultrasound, mammography and/or MRI. FNAC (fine-needle aspiration cytology, a diagnostic procedure) is used to confirm malignancy."All breast cancers are not the same. There are about 20 different types, each of which behaves differently. So receptor tests (such as oestrogen receptor assay test, progesterone receptor assay test, HER2 assay test) are also done as part of the diagnostic process to ascertain the type of cancer and choose the most effective medication," explains Rosina Ahmed, senior consultant, breast onco surgery at Tata Medical Center, Kolkata.

Rx: "Based on the results, surgery and/or radiation therapy is used in combination with chemotherapy, hormone therapy and/or targeted therapy," says Dr Ramesh Sarin, senior consultant, surgical oncology, Indraprastha Apollo Hospital, New Delhi.

Good to Know: "The earliest symptom of breast cancer is most commonly a painless lump, not breast pain," cautions Ahmed. "The latter is almost always physiological and innocuous."

Cervical Cancer

It is caused by persistent infection with high-risk types of the human papillomavirus (HPV), which can be transmitted during sex and is compounded by other factors such as poor genital hygiene (among both women and their spouses). Known risk factors include first sexual encounter at a young age (<18 years); multiple pregnancies; having multiple sexual partners; smoking (it can damage cervical cells, making them vulnerable); the HIV infection and sexually transmitted infections. 

LOOK OUT FOR pain or bleeding during or after intercourse, unusual and persistent vaginal discharge, unexpected spotting or bleeding. There may be no obvious symptoms in its earliest stages.

Diagnosis: Screening tests include Pap smear, HPV DNA test and VIA. Confirmation is done through colposcopy and biopsy. 

Rx: Precancerous lesions can be treated by simple OPD procedures like cryotherapy, cold coagulation and LEEP. Cancer in the early stages is treated using surgery or radiation. In advanced stages, radiation with or without chemotherapy or advanced chemotherapy is used.

Good to Know: "Pap smear or a liquid-based Pap test can catch pre-cancerous lesions. Since pre-cancerous stage of cervical cancer could last up to 15 or even 20 years, these simple tests can save lives. Ideally, screening should start at the age of 21 (depending upon sexual acti-vity). An HPV test is recommended in combination with a Pap test from the age of 30 years. Screening should be repeated every one to two years. However, if three consecutive smears are negative, the interval between the screenings can be increased to five years," says Dr Rupinder Sekhon, senior consultant, gynae-oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi. "HPV vaccine protects against HPV types 16 and 18, responsible for over 80 per cent cervical cancer cases in India," says Dr Neerja Bhatla, professor, department of obstetrics and gynaecology, AIIMS, New Delhi, and chairperson, committee for gynaecologic oncology, International Federation of Gynecology and Obstetrics (FIGO). It is recommended for young girls (aged 10 to 14 years, especially before initiation of sexual activity). At this age, two doses at 0 and six months are sufficient. "Don't skip your Pap smear even if you have taken the vaccine as it doesn't protect against all strains of the virus," she adds.

Ovarian Cancer

The ovaries are small organs tucked deep inside the pelvis and inaccessible to physical inspection. This is one reason why ovarian cancer is detected at an advanced stage when chances of survival are poor.

LOOK OUT FOR abdominal distension and pain, urinary frequency, post-menopausal bleeding, loss of appetite, non-specific gastrointestinal symptoms like frequent bouts of indigestion.

Diagnosis: Pelvic examination, transvaginal sonography and a blood test for CA-125 level for women with a strong family history.

"This translates to two or more ovarian cancers in first-degree relatives; 1 ovarian and 1 breast cancer (at age <50) in first-degree relatives; 1 ovarian and 2 breast cancers (at age <60) in first-degree relatives; 1 ovarian and 3 colorectal cancers (at least 1 at age <50) in first-degree relatives; documented mutation of a BRCA1 or BRCA2 gene. Women of this profile have at least a 10 per cent lifetime risk of developing ovarian cancer," says Dr Rajendra Kerkar, professor and head, department of gynaecological oncology, Tata Memorial Hospital, Mumbai.

Rx: Treatment of ovarian cancer is multidisciplinary and includes both surgery and chemotherapy. Radiotherapy is generally not used in the majority of cases and is reserved only for a few highly selected cases.

Good to Know: "In about 10 per cent of ovarian cancer cases a genetic mutation called BRCA1 and BRCA2 is responsible," says Dr Shalini Rajaram, director and professor at UCMS and GTB Hospital, Delhi.Genetic tests are recommended in appropriate cases as they provide information useful for the further management of the patient and also for assessment of cancer risk in family members like children and siblings. Other risk factors include age (being above 60 or younger in the case of some Indian women), early onset of periods, late menopause, not having children or having been treated for infertility.

Your Defence Plan

Recent research led by a team at Stony Brook University, US, and published in the journal Nature found that environmental factors and behaviour account for 70-90 per cent of cancer cases. Here are healthy habits that can keep you safe.

Ban tobacco in all forms.According to the WHO, it is the single greatest avoidable risk factor for cancer mortality worldwide. Say no to tobacco in all forms including e-cigarettes. "While the data to establish the link between e-cigarettes and smoking is insufficient, studies show that toxic and carcinogenic components are just about half the level below conventional smoking, based on duration and intensity of vaping," says Dr Manu Raj Mathur, associate professor and senior research scientist at Public Health Foundation of India, New Delhi. Passive smoking is dangerous too. "Non-smokers who live with a smoker and inhale second-hand smoke increase their risk of lung cancer by 20-30 per cent," Mathur adds.

Drink moderately; choose red wine over others. Alcohol contains nitrosamine-a carcinogen that ups the risk of cancers of the oropharynx, oesophagus, stomach, colorectum, liver and urinary bladder, says Dr S. H. Advani, senior consultant, medical oncology, Fortis Hospitals, Mumbai.

Load up on fresh fruits and vegetables. "Fruits and vegetables are rich in cancer-fighting antioxidants. They are also loaded with fibre, which helps to pass toxins out of your system through your stool," says Advani. In fact, a diet low in fruits and vegetables is linked with a higher incidence of colon cancer. Get five servings a day to stop cancer. Switch to organic produce to dodge harmful chemicals and pesticides.

Stay physically active. Regular exercise has a positive effect on hormones. Balanced hormone levels help protect against cancer. Besides, staying physically active will help you lose weight. Being overweight is a big risk factor for several cancers. The American Cancer Society recommends at least 30 minutes a day of dedicated exercise above and beyond the usual activities of daily life five or more days a week to reduce cancer risk. Aim to keep your BMI between 18.5 to 25 kg/m2.

Breastfeed for safety. Breastfeeding can provide some protection against uterine, cervical, ovarian and breast cancer. In fact, a 2015 study published in the US-based Journal of the National Cancer Institute stated that women who breastfed their babies had a 30 per cent lower risk of recurrence and those who breastfed for at least six months or more conferred a slightly larger reduction in risk. "Having children before the age of 30 can also reduce your risk of getting breast cancer," adds Dr Ramesh Sarin.

Don't forget water. Drinking plenty of water may reduce the risk of bladder cancer by diluting the concentration of cancer-causing toxins in urine and helping to flush them out quickly. Drink at least eight cups (about two litres) of liquid a day, suggests the American Cancer Society.                                         

Breakthroughs to Defeat Cancer

Cancer research made more progress in the last year. Here, some of the big ones to watch out for.

Ocean-floor cure 

Scientists at the Weizmann Institute of Science in Israel, in collaboration with Steba Biotech, have developed a new treatment, 'vascular-targeted photo-dynamic therapy' (VTP) using a light-sensitive drug WST11, derived from the ocean bacteria. Men with low-risk prostate cancer (early and localized) could benefit from this drug. When injected into the bloodstream and activated with laser, it destroys tumour tissue, while leaving the healthy tissue unharmed. Research published in The Lancet Oncology found that two years after the treatment, 49 per cent of 413 patients with low-risk prostate cancer went into complete remission compared with 13.5 per cent in the control group who were given no treatment. Lifesaving DNA testsDNA tests (treatment based on targeted gene sequencing or using the patient's whole genetic profile) can shrink tumours at six times the rates of conventional medicine. This is the first major study that examined the advantages from treatments based on genetic profiling. Experts think that treatment on the basis of DNA tests could become the norm in the next five years.

Just a blood test

Last year, Australian and French scientists got closer than ever before to creating a blood test for breast cancer detection. They discovered that the presence of isotopes carbon-13 and nitrogen-15 in certain proportions in a tissue sample can reveal whether the tissue is cancerous or not. It may still be several years away from being used in hospitals, but the test can help with ongoing monitoring as well as detect breast cancer.

To join the fight against cancer, you can make a donation at www.cansupport.org or volunteer your time. You can also join the Reader's Digest team on 5 February 2017 at Rajpath for the 10th Walk For Life event to show your support and spread awareness about cancer. Register online at www.walkforlifeindia.org