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10 Cancer Awareness Facts and Celebrating National Cancer Awareness Day, 2020

Sunday - November 8, 2020 1:08 pm , Category : WTN SPECIAL

Views Expressed by -
Dr Dodul Mondal
Cancer Specialist, Indraprastha Apollo Hospitals, Delhi

WTN- 7th November is celebrated as National Cancer Awareness Day in India since 2014. Every year many activities happen surrounding this day, but this year is bit different due to COVID-19 pandemic. I do not believe in any particular “day” for increasing cancer awareness as I believe that awareness has to be increased every day, every moment. Of course, importance of one day should also not be ignored. So, the first question which comes to mind is, why 7th November? Let me start from awareness about “7th November” and its importance in cancer care.

In 1867, Marie Sklodowska Curie, popularly known as Marie Curie, was born in Poland on 7th November. She invented radioactivity in 1898. Within few years she discovered Radium and Polonium, two radioactive elements and won Nobel prize twice for her revolutionary work. These inventions changed cancer care landscape throughout the world within few years only. Needless to say, modern Radiation Oncology, which cures millions throughout the world, would not have seen the daylight of this world without her. Can any other date be better than this to celebrate National Cancer Awareness Day? How many of us are aware about this!
Whenever I talk about cancer awareness, I see people discussing screening, vaccine and healthy lifestyle only as if awareness should be limited to these three things and nothing else! There are many more things about cancer to be aware about. Let me show this from a different perspective. I believe, awareness means a holistic awareness about cancer starting from how does it happen to remaining aware about ways to reduce its treatment related complications!

Cancer Awareness Fact 1:
Why Cancer happens? No one knows the answer completely! Only few reasons are known so far. Few factorshave significant association with cancer like smoking is related to lung cancer, tobacco is related to oral cancer, Human Papilloma Virus (HPV) is related to cervical cancer and few oropharynx cancers, hepatitis virus is associated with some liver cancers, few chemical agents and heavy metals are associated with skin cancer, bladder cancers etc. Some gene mutations are associated with some types of hereditary and familial cancers,

Cancer Awareness Fact 2:
How can it be prevented? There is no single answer to this question. I have mentioned about few possible causes of cancer in the above paragraph. There is no magic wand which can prevent all causes by one simple solution. It’s a myth! However, it is always advisable to follow a good, healthy and fit lifestyle, avoiding chemicals in food, cessation of smoking, alcohol, tobacco use etc. Many countries have adopted vaccination against cervical cancer, and it is postulated that it can reduce cervical cancer to a great extent when the vaccine is given to a girl early in the life before sexual exposure. Vaccination after sexual exposure reduces its effectiveness. Similarly, vaccination against hepatitis B virus is also helpful in preventing some liver cancers. There are many more things which can prevent occurrence of cancers, but beyond scope of discussion here.

Cancer Awareness Fact 3:
How can it be detected early? By increasing awareness. Mostly people talk about Mammography or sonomammography (combination of ultrasonography and mammography) for early detection of breast cancer. But there are many more cancers which can’t be detected by mammography! And breast cancer is not the only cancer which can be detected and cured at an early stage. A simple test can detect cervical cancer at a very early stage (sometimes even before formation of a full-fledged cancer); cervical cancer is one of the leading killer cancers in developing and underdeveloped countries. A simple visual examination of mouth can detect oral cancer on many occasions by an experienced cancer specialist. Again, in a suitable population, very low dose chest CT scan can detect lung cancer at very early stage, colonoscopy can detect cancer of rectum, colon, some blood tests can detect prostate cancer at early stage etc. It is important to remain aware about your body, remain awareabout any unusual symptoms and remain cautious to visit a cancer specialist whenever a cancer is suspected. Discuss with your doctor if those symptoms can be due to cancer or not! 

Cancer Awareness Fact 4:
What are the new diagnostic tools and how costly they are? Whereas newer diagnostic tools are mostly costly, it is not always necessary to undergo costly tests to detect a cancer inside body. Most of the screening tests for early detection of cancers are usually cheaper and many times done almost at a negligible cost in government hospitals. Mammography, sonography, PAP smear (for cervical cancer), few blood tests, oral examination etc. are not hugely expensive and in fact the cost is actually cheaper than few packets of cigarettes! Once cancer is detected, it becomes necessary to know its exact nature and stage. It can require endoscopy or endoscopic ultrasound, CT scan, PET scan,  PET-CT Scan (Combination of PET scan and CT scan), MRI, PET-MRI (Combination of PET scan and MRI), biopsy, Immunohistochemistry, mutation analysis etc. Sometimes, it becomes necessary to advise costly tests or investigations to properly understand and treat the cancer. In our country, on multiple occasions, adequate investigations are not done considering financial implication on the patients. Become aware that, sometimes costly investigations are required. I forgot to mention, X-ray is not obsolete, but mostly are not used nowadays in cancer care in good well equipped centers.

Cancer Awareness Fact 5:
How can it be treated? Broadly, treatments are divided into surgery or operation, radiation or radiotherapy, chemotherapy, targeted therapy, immunotherapy etc. Rarely, only one type of treatment modality is required but most of the times, multiple treatment types are combined together to maximize the response and control the tumor. While most people understand what is operation (as it is obvious), people do not understand much about radiation, chemotherapy, targeted therapy or immunotherapy. If required, it is always better to visit a cancer specialist to discuss these things. 

Cancer Awareness Fact 6:
What are the new things about radiation treatment? Few days back I was writing an article on Radiation Oncology and how important is it in curing cancer. In last two decades, extraordinary developments have taken place in radiation machines. With currently available cutting edge machines, it is possible to pinpoint radiation to the tumor and make sure it is being delivered at the right place. Some machines have a precision of targeting the tumor with variation of less than 1 millimeter! Again, there are machines of proton beam therapy which can literally reduce radiation dose to zero around the tumor or target. Another newer machine, known as Tomotherapy can treat the tumor in a slice by slice manner! Radiation machines (most of them are linear accelerators which use very high energy X-ray) are now equipped with integrated scanning facility (either with CT scan or MRI) to accurately position and treat the patients. Although less known and discussed, few machines are now based on robotic principles as well making them extremely sophisticated. All these have made it sure that radiation is delivered at the desired area and the dose to normal organs is reduced to a large extent. It increases the chance of cure and reduce toxicity. When seeking treatment, patients and care givers should remain aware about these technologies and discuss with their radiation oncologists to understand what can be the best cost-effective treatment for their patents. 

Cancer Awareness Facts 7:
What is “Brachytherapy”? I am sure not many people are aware about this treatment technique. It is the oldest form of radiation technology which is a gift of invention of Marie Curie as I told at the beginning.  Brachytherapy is considered as an extremely precise form of radiation in experienced hand which is available only in selected centers and can be performed safely by highly skilled and experienced specialists only. Indeed, brachytherapy requires lot of background training and skill. In this technique, the radiation source is placed almost in direct contact of the tumor inside the body. Sometimes, the radiation source is actually placed inside tumor making it possible to burn the tumor with very high dose and giving negligible dose of radiation to surrounding normal organs.

Cancer Awareness Facts 8:
What is chemotherapy/targeted therapy/immunotherapy? Popularly they are known as anti-cancer medicines. These are available in different forms, commonest being in the form of injection which is diluted in saline mostly and then introduced in the body via veins. Some newer medicines are available in tablet or capsule form also and they are known as oral anticancer drugs. However, it is necessary to understand that chemotherapy is not equivalent to targeted therapy or immunotherapy. Chemotherapy most of the time has its effect on the entire body while targeted therapy or immunotherapy most of the time attacks the tumor cells selectively. That is why side effects from targeted therapy or immunotherapy are less compared to chemotherapy but this may not be true all the times. 

Cancer Awareness Facts 9:
How to reduce side effects of treatment? Reducing side effects of radiation require a concerted effort by the treating physician, nurse, technologists, supporting care givers, social support and of course, the patients. A positive attitude towards accepting the disease (once cancer is detected, it has to be accepted) and treatment helps the patient tolerating the side effects in a much better way. Using newer technologies and medicines wherever appropriate, using anticancer agents with lesser side effects and equal or better efficacy and some newer treatments to reduce long term side effects can help the patient reduce the burden of side effects of cancer treatment.

Cancer Awareness Facts 10:
Is it safe to treat cancer patients during COVID pandemic? Most of the time yes, but essentially needs lot of understanding by the treating physician or the team of doctors. Balance between benefits of treating cancer and risk of acquiring COVID infection versus potential harm due to lack of timely anticancer treatment (radiation, surgery, chemotherapy) is most crucial. Some patients during their cancer treatment can also develop COVID infection and it is a common confusion what is right at that time-to treat or not to treat and wait till the patient becomes COVID negative! The confidence of the doctor, his understanding about the entire complex scenario, experience and preparedness of the treating team, the hospital and the understanding of the patient- all are important to decide this. Not all hospitals are able to treat in such situation due to multiple complex factors. It is important on the part of the patient and caregivers to understand and discuss these issues with the treating physician before starting the treatment. COVID needs special attention.
So, at the end, keeping cancer awareness in mind, I would rather say that the idea of cancer awareness does not end only with the knowledge of cancer prevention or saying “eat healthy, live healthy, do exercise” etc. At present everyone has to be more aware about what is happening around cancer. A holistic awareness about how to prevent cancer, how to detect and diagnose cancer, how to treat cancer and how to minimize treatment related complications of cancer will make it a success. 

(Author was previously Asst. Professor at National Cancer Institute of AIIMS Delhi and Fellow, Proton Beam Therapy and Precision Radiation Oncology at Cancer Institute of New Jersey, USA),
(Views are personal and information provided are true to the best possible knowledge of the author. Any error is unintentional. It is important to see a qualified cancer specialist to discuss and decide whenever required. Author is not responsible for any error in treatment or whatsoever arising out of this community knowledge sharing).
Author can be contacted at : -
Email: dodulmondal@gmail.com
Mob: 91-8860-102-093
Website- www.drdodulmondal.com