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Thursday, February 04, 2010


Today is the world cancer day .
More than 12 million people are diagnosed every year with cancer and more than 7.6 million succumb to it .
It is estimated that more than 84 million people would die of it between 2005 and 2015 without intervention .

Cancer is the uncontrolled growth and spread of cells. It can affect almost any part of the body. The growths often invade surrounding tissue and can metastasize to distant sites.

Many cancers can be prevented by avoiding exposure to common risk factors, such as tobacco smoke.
In addition, a significant proportion of cancers can be cured, by surgery, radiotherapy or chemotherapy, especially if they are detected early.

Good news is around 40% of cancers are potentially preventable.
Hence the importance of avoiding trigger factors , and also in screening to detect early cancers .
Stop tobacco use and avoid exposure to second-hand smoke .
Limit alcohol consumption .
Avoid excessive sun exposure .
Maintain a healthy weight, through eating healthily and exercising regularly .
Protect against cancer-causing infections .
Screening is accepted today only for three types of cancers
Colon : routine colonoscopy after 50 yrs once in 10 years 
or for those with family history at 40 every 5 years 
or FOBT or fecal occult blood test every year and if positive for colonoscopy 
Breast : mammogram for all women at 40 and earlier for those with family history,clinical breast examination from 20 to 30 years every 3 years and for those above 40 years every year 
Cervix : pap smear at 20 to 29  years for all women once in 3 years after 30 once in 5 years upto 65 years 
prostate specific antigen for prostate cancers can be done for those with a family history after informing the patient of false negative results 
for those with a very strong smoking history spiral cT scans are attempted as an early screenign these days but is not confrmed 

Detection of cancers by routine medical examination ,blood tests and imaging :
Health check ups could at times catch cancers in an early stage .

Never ignore symptoms like change in bowel habits ,bleeding in stools or black coloured motion ,loss of weight ,unexplained cough ,blood in sputum ,anemia fatigue ,bleeding from nose ,gums ,or any swelling anywhere growing in size .
In any malignancy the prognosis depends not only on its type ,its aggressiveness but also mainly on its stage and spread .
The earlier one catches it and treats it the better the prognosis .( predictable future  )

Diagnosis with cancer is one of the most devastating news for any person ,
Having worked in oncology for many years I have faced many reactions .
It requires great communication skills ,scientific reason ,and empathy for a practitioner to break the news for he needs to do a tight rope walking between truth and hope .

Cancer treatment is by a team which involves many specialties and the family of the patient too .
I have noticed that patients with a positive attitude always fare  better .

The good news is on the paradigm changes that have taken in the treatment of this scourge over the years
when just about 10 % could have expected to live beyond five years
( five year survival often is the gold standard used here ) in the sixties today it is well beyond 60 to 70 % of course with the right treatment .
The advent of molecular science and research in pathology has made more finer classification and consequent prognostic and management results .
The entry of monoclonal antibodies and other targeted therapies which like missiles target only the concerned malignant cell producing greater kill with lesser toxicity has dramatically changed the out come of several cancers ( Vascular endothelial growth factor receptor antagonizing and Epithelial growth factor receptor antagonizing agents are examples )

The finding of the cause for certain types of cancers at molecular levels and fine tuning their targeting like the Tyrosine kinase inhibitor Imatinib Mesylate and their later derivatives of Dasatnib and Nilotinib  have made diseases like chronic Myeloid leukamia almost curable .
More refined chemotherapy drugs which are coated and protected in protein covers called lypholysed versions have decreased toxicity to a large extent ,better anti emetics which decrease vomiting ,drugs which cause lesser alopecia ( baldness ) and better wigs in the market .

Growth factors that stimulate the marrow affected by myelosupression due to chemotherapy or disease have been landmark discoveries which changed the face of oncological management .
Blood component transfusions ,higher end antibiotics which would combat virulent infections in the immunocompromised , infectious disease specialty care have made enormous differences in mortality and morbidity in oncology of today .
Autologus and Allogenic bone marrow transplants whose centers are increasing all over the world provide hope for cure for many .
Finer surgical techniques are producing cleaner exisons with less chances of recurrences and at the same time have turned less mutilating and more flesh sparing .
Endoscopic and laporoscopic advances with stenting and other capabilities ,orthopedic manoevures of sophistication and neurosurgical advances have all helped in oncology treatment today .
It is truly a multispeciality field where everybody have pitched in .
Radiotherapy too has made enormous strides with linear accelarators . electron therapies ,better simulators ,Intensity modulated radiotherapy ,sophisticated cT guided planning equipments ,the dose to normal tissues while targetting the tumours .

Diagnostics have made great strides with sopisticated CT ,MRI ,ultrasound,mammograms and PET scans accurately giving the picture for diagnosis and reevalaution .

Anxillary and supportive departments like physiotherapy ,oncological psychiatry ,palliative care and pain management ,other medical and surgical specialities ,social support services have all contributed thier mite .

The future is bright with nanotechnology delivery of drugs and so many other exiting research going on
with all this there are still clouds dotting the horizon .
Education and awareness is still not enough
people do get tempted by quackery and waste thier time and come late for diagnosis and treatment
Myths abound and this is exploited by charltans who produce food substitutes and drugs which empty the patient of his health and his pockets .
Research in oncology involves huge sums of money and pharmaceuticals who discover a drug would be expected to make thier profits but cancer treatment today has become inordiantely expensive and Governments should bring out insurance shcmes to help people who can never afford such money .
Practioners should never deviate from thier ethics too .

Working in Lakeshore hospital Kochi initially  later at Tawam hospital , Al Ain ,U.A.E ( managed by Johns hopkins ,U.S.A ) and now in the Brunei cancer center Brunei Darussalam  has been an opportunity to me to interact with the best in the field and to consider oncology as my mission .

Let us look forwards to the day where cancer is no more !
not its victims


anas_conversationkiller said...

its a very informative article, thnk u doctor..............
may god save us n all others from cancer.............!!

Dr.Thomas Antony said...

Good one, Hari. You have put the data interesting. I realize how little I knew about medical oncology..

Why not start a blog on upadation of medical oncology? Passing through your pen, it should be interesting!

Beena Narayanan said...

Hi Hari, thanks for the detailed write up. It is very informative and hope readers will readily agree, cancer can be prevented. I had the great opportunity to be invited for Dr V P G's function on World Cancer day at Lakeshore auditorium and the was fortunate to see his presentation on " Cancer can be prevented too ". Very informative and he presented it with a sense of humour. enjoyed every sec being there.
Thanks for sharing this .

Ujwal Unni said...

Very useful and informative article. Thanks for posting it.

harimohan said...

tks anas and ujju
beena i really missed sirs speech

bipin's views. said...

Hi Hari,

Done a nice thing. Making aware all about cancer.

Bipin,s views

harimohan said...

tks bipin

Anonymous said...

very informative article uncle. many matters which noone is aware. thanks a lot.sandhya

CYRIL said...

Hi Dr hari Mohan
I am a GP Doctor Practising in Brisbane, Australia. I am from Ernakulam, Keraka. Very interesting Blog and details regarding cancer prevention and awareness, very relevant to present-day Life-style and World Cancer day. My e mail ID is
DR: cyril Fernandez

CYRIL said...

Hi Dr hari Mohan
I am a GP Doctor Practising in Brisbane, Australia. I am from Ernakulam, Keraka. Very interesting Blog and details regarding cancer prevention and awareness, very relevant to present-day Life-style and World Cancer day. My e mail ID is
DR: cyril Fernandez

CYRIL said...

Good and relevent Blog to presen day life-style and relevent to World Cancer day. The preventive aspects of cancer and its awareness is nicely emphasised . Good work
DR: Cyril Fernandez
General Practitioner
Brisbane , Australia
Born in : Ernakulam, Kochi, Kerala
E mail

Dr.Thomas Antony said...

Hi Hari,

This was a good blog and I had posted a comment, don't know what happened to it. My net conxn has been having some problems. I had forewarded the link to many of my contacts. Happy to find one has posted his comments already :-)

And my sister's (USA) reply was one line - " Very informative and easy to read and understand..."

I myself feel you can start a blog for updation in oncology for the lay (that includes doctors in other specialties;-)

harimohan said...

tks TA
will definitely do
have snet this to I express and gulf news

ajai perti said...

Good one Sir shows your commitment and passion forward treating this dreadful condition. .an excellent writeup. .looking forward to reading many many more. .best wishes always

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