Early Detection Of Cancer & Treatment

The majority of Cancers (upto 70%) in our country are detected in the late stages, where a cure is not likely. Hence eventually half of these cases will die, due to recurrence or spread of the cancer to other vital parts of the body, such as the Brain, lungs, liver, bones/ marrow.

The chief causes of the detection in late stages and consequently decreased survival from cancer in India is due to a combination of: -

1. Ignorance (on the part of the patient, as well as the first treating physician, especially a GP/ in a remote area), about the early warning signs and symptoms of cancer. Also a perception that Cancer may be contagious leads many patients to hide their disease till late stages.
2. Social factors, including the perceived stigma associated with cancer especially when the cancer affects the parts of the body normally hidden by clothes, precludes early detection.
3. Poverty, due to which the patient may not be able to buy a train ticket from the remote village to a city, or sustain him/ herself and the attendant in the city during the period of investigations and treatment (leading to them sleeping on the footpaths) and then the actual cost of cancer treatment which forces many families into debt (even those who are not BPL).
4. Poverty, coupled with a lack of Insurance cover, also leads the patient detected in early stages to turn to the freely available, cheaper, alternate systems of medicine which the patient may try first, on the hope of a cure. However, after a year or two, when these hopes are often belied, the same patient invariably returns to a proper cancer centre, with the same cancer now in an advanced stage, where one can only offer symptomatic and supportive care.
5. Lack of quality cancer care, especially in the underserved parts of the country, leads to many non-trained general surgeons or physicians trying their hand on the patient, with results detrimental to the patient in the long run. Hence it is important that we have proper cancer centres in the underserved parts of the country and that the patient reports to those centres from the beginning, or is referred to one.

     In my last article, I had emphasised about the importance of creating an awareness in the populace about the “Preventable causes of cancer”. If prevention is not successful, the next important step is to create which can help detect cancer in its early stages (when it is potentially curable) is to create awareness about: -

SCREENING

This means investigating apparently normal people, especially in a high-risk population (particular age group, or in a country or region with a high incidence of a particular type of cancer), to find out if they are harbouring an asymptomatic (i.e. no complaints) cancer. So the UICC (the International body for cancer control) or the AJCC (the American Cancer association) have published guidelines of when, how and on whom these screening tests are to be carried out. However, these guidelines are useful in detecting cancers in the pre-clinical stage (i.e. before they are visible to the naked eye or on examination of the patient) in a population with a high incidence of cancer and cannot be recommended as a Public health program when the incidence of a particular cancer is low (for example the incidence of our commonest cancer amongst women in India is 30/1,00,000 populations, whereas in the west its 130/1,00,000 women). So while in the west it is recommended that all women above 40 years undergo a mammogram every 2 years and annually after age 50 years, for a country like India it is more cost effective to advise that all women over the age of 20 years examine their own breasts (breast self-exam or BSE) every month, a week after completing their periods and undergo a clinical breast exam (CBE) by a trained doctor ever 2-3 years for next 50 years. 

Similarly, all women (especially sexually active ones), should have an annual Gynaecological exam, every year from the   age of 21 years onwards, to rule out cervical cancer and women over the age of forty, especially those at risk, should also undergo an Ultrasound of the abdomen and Pelvis to rule out Ovarian Cancer.

In those Indians, who are at high risk for developing Oral cancers esp. tobacco users (smokers/ chewing tobacco/ gutka/ betel nut), it is advisable that they undergo an annual oral examination, to rule out pre-cancerous lesions (white/ or white on red patches) in the mucosa of lips/cheek/ tongue etc., or a frank cancer.

EARLY WARNING SIGNS OF CANCER

Some of the common symptoms (complaints), or signs, which should be a cause for concern (and medical check-up to rule out cancer unless proved otherwise) are: -

1. Any lump, especially painless and progressively growing (since cancer is usually painless till it stretches the capsule of the solid organ in which it has developed or presses on adjoining nerves) appearing anywhere in the body (for example in the breasts, armpits, neck, groin, soft tissue or bone, abdomen etc.), should be viewed with suspicion and investigated for cancer, unless proved otherwise. 
2. Any sore (ulcer), which does not heal, in any part of the body, chiefly in the oral cavity and the skin
3. A mole which suddenly starts growing rapidly, or ulcerates, or develops satellite nodules around it, or other similar lesions develop elsewhere in the body.
4. Unexplained, significant weight loss (say 10 kg in 2-3 months).
5. Unexplained weakness and anaemia should be investigated.
6. Bleeding or discharge from any orifice, whether from the nose (epistaxis), mouth (can be coughed out blood also), urethra (passing blood in the urine), vagina or anus.
7. Change in voice (hoarseness), recent onset of cough, breathlessness.
8. Change in bowel habits (constipation, especially if alternating with diarrhoea)

Once examined and it is found that there is a possibility of cancer, the patient will require further investigations and then treatment, which will be the subject of my next article.