With can­cer’

Daily Trust - - HOME FRONT - By Ruby Leo

Dr. Anil Ka­math is a sur­gi­cal on­col­o­gist from the Apollo Hos­pi­tal in In­dia. In this in­ter­view, he speaks on the rea­sons why more chil­dren are di­ag­nosed with can­cer and the latest treat­ment op­tions for the dis­ease.

Which types of can­cer do chil­dren ex­pe­ri­ence? Can­cer can af­fect any age. There are cer­tain types of can­cers which oc­cur ex­clu­sively in chil­dren. The com­mon child­hood can­cers are: Leukemia or blood can­cer, brain can­cer like medul­loblas­toma, can­cers aris­ing in the ab­domen near the kid­ney like tu­mour and neu­rob­las­toma, retinoblas­toma which is a type of can­cer af­fect­ing the eye and the bone.

The pre­sen­ta­tion of these can­cers is highly var­ied. Most of them present them­selves as ab­nor­mal swellings. For ex­am­ple, wilms tu­mour and neu­rob­las­toma most of­ten present them­selves as mass in the ab­domen. Leukemias may come as a fever, fa­tigue and bleed­ing. Brain tu­mours are pre­sented as headache, dou­ble vi­sion and vom­it­ing. In retinoblas­toma, the eye pupils usu­ally ap­pear white or pink. Di­ag­no­sis is usu­ally by biopsy and ra­di­o­logic imag­ing. Treat­ment is sim­i­lar to adult can­cers and is usu­ally a com­bi­na­tion of surgery, chemo­ther­apy and ra­di­a­tion. The chil­dren how­ever need spe­cial care dur­ing ad­min­is­tra­tion of the treat­ment. The good thing about child­hood can­cer is that the chances of cure are higher than for adults in most cases. With proper treat­ment, the child, in most cases, will be able to over­come the dis­ease and lead a nor­mal life.

Could can­cer be caused by ge­netic fac­tors, who are the fam­ily mem­bers likely to be at risk?

De­vel­op­ment of can­cer is linked to genes, habits and en­vi­ron­ment. Only a small frac­tion of can­cers run in fam­i­lies. The most well stud­ied ones are breast and colon can­cer. Just be­cause the mother de­vel­ops breast can­cer does not mean that the daugh­ter will also de­velop breast can­cer. How­ever, there are cer­tain fam­i­lies that have an ab­nor­mally high num­ber of breast, ovar­ian and other types of can­cer. These fam­i­lies need to be tested for the pres­ence of the breast can­cer or the BRCA gene.

Sim­i­larly, those fam­i­lies with ab­nor­mally high in­ci­dence of colon can­cer need to be tested for the colon can­cer gene.

Those mem­bers who har­bour the gene are at in­creased risk of de­vel­op­ing this type of can­cer. These mem­bers have to be un­der in­creased sur­veil­lance for de­vel­op­ment of these can­cers. In cer­tain se­lect cases, pro­phy­lac­tic surgery or medicines may also be ad­vised.

What is the latest tech­no­log­i­cal ad­vance­ment in man­ag­ing any type of can­cer dis­ease?

It is the sur­gi­cal on­col­ogy. The main at­tempt here is to pre­serve the or­gan and its func­tion. In the ear­lier days, can­cer surgery would be as rad­i­cal as pos­si­ble and it meant re­moval of the en­tire af­fected or­gan. Now, be it breast, rec­tum or any other or­gan, the at­tempt is to pre­serve the or­gan. There are new meth­ods of de­liv­er­ing ra­di­a­tion as pre­cisely to the af­fected por­tion as pos­si­ble. The True Beam STx is avail­able at Apollo Hos­pi­tal Ban­ga­lore. It’s a highly so­phis­ti­cated equip­ment. It helps in higher ac­cu­racy in treat­ing the tu­mours, faster treat­ment, re­duc­ing the time

and du­ra­tion, more com­fort to the pa­tient due to lesser side ef­fects and bet­ter clin­i­cal re­sults.

In med­i­cal on­col­ogy, a whole range of drugs are avail­able. The newer drugs, called tar­geted ther­apy, pre­cisely at­tack the can­cer cells and spare the nor­mal cells.

Tell us about prostate can­cer­can and its treat­ment op­tion?

This is one of the commo com­mon types of can­cer in males in Nige­ria. Th The treat­ment and prog­no­sis de­pends on the stage of the dis­ease. Treat­ment of prost pro­static can­cer will de­pend on var­i­ous fac­tors,fa like stage of the dis­ease, gen­era gen­eral con­di­tion of the pa­tient, co-mor­bidi­ties,co-m ag­gres­sive­ness of the can can­cer and the pa­tient’s wishes.

How­ever, many peo­plepe with prostate can­cer do not die of the dis­ease. In many cases, the can­cer may be just an in­no­cent by­stander un­likely to trou­ble the pa­tient.pat So in el­derly pa­tients with less ag­gres­sive can­cer, not do­ing anyth any­thing till it trou­bles him is also an op­tion.op­tio Another op­tion is the rad­i­cal prosta­te­c­tomy.prostate This is con­sid­ered a good op­tion forf younger pa­tients with early stage can­cer.c The surgery ef­fec­tively clears t the dis­ease and can also pre­serve the po­ten­cy­pot of the pa­tient in most cases. The o op­er­a­tion is done macro­scop­i­cally and by usingu ro­botic arms in higher cen­tres. Ra­diat Ra­di­a­tion ther­apy is usu­ally given by two meth­od­smethod -ex­ter­nal beam ra­di­a­tion and brachyther­apy.brachyt In brachyther­apy, wires are pla placed within the prostate so that high doses of ra­di­a­tion can be given to that area. Ra­di­a­tionRa has con­trol rates sim­i­lar to surgery­surge but has higher chances of caus­ing im­po­tence. We also have treat­ment op­tions for metastatic prostate c can­cer, this is one can­cer wh which can be ef­fec­tively tre treated even

in ad­vanced stage. The main treat­ment here would be what we call hor­mone ther­apy. The de­vel­op­ment and spread of prostate can­cer is highly de­pen­dent on the male hor­mone an­dro­gens. If an­dro­gens are blocked au­to­mat­i­cally the growth of the tu­mour re­duces. The main source of an­dro­gens in males is the testes. Re­mov­ing both the tes­ti­cles ef­fec­tively con­trols pro­static can­cer. The an­dro­gens can also be con­trolled by in­jec­tions which sup­press the testes from pro­duc­ing an­dro­gens. These are called lutein­is­ing hor­mone, re­leas­ing hor­mone ag­o­nists in those pa­tients with the dis­ease pro­gress­ing, de­spite hor­mone block­age. Prostate can­cer is cur­able in a good num­ber of cases. In those that can­not be cured, it can be con­trolled for long pe­riod of time. Those pa­tients who have early prostate can­cer and are treated with surgery or ra­di­a­tion have a good chance of pre­serv­ing their fer­til­ity.

Is there any hope for women with cer­vi­cal can­cer?

The symp­toms of cer­vi­cal can­cer are bleed­ing out­side men­strual pe­ri­ods, bleed­ing af­ter sex­ual in­ter­course, per­sis­tent white dis­charge, chronic pelvic pain, while oth­ers can be asymp­to­matic. De­vel­op­ment of cer­vi­cal can­cer is closely linked to a virus known as Hu­man Pa­pil­loma Virus (HPV). The main mode of trans­mis­sion of HPV is through sex­ual con­tact. The chances of de­vel­op­ing HPV in­fec­tion are higher when a lady has mul­ti­ple sex­ual part­ners, poor gen­i­tal hy­giene and re­peated gen­i­tal in­fec­tions. While most HPV in­fec­tions re­solve spon­ta­neously, in some cases they are per­sis­tent. The per­sis­tent in­fec­tions are what lead onto pre­can­cer­ous changes and, in some cases, can­cer. The chances of de­vel­op­ing can­cer are much higher when the im­mu­nity of the per­son re­duces in con­di­tions like HIV in­fec­tion.

We can how­ever test for cer­vi­cal can­cer through Pap smear, which is a test com­monly per­formed to screen ladies for cer­vi­cal can­cer. The test is rec­om­mended to all ladies af­ter be­gin­ning sex­ual in­ter­course and is usu­ally a part of the an­nual health check. Even ladies with nor­mal Pap smear are rec­om­mended re­peat checks once in 3-5 years. Since the cervix is easily felt, what is usu­ally done in a Pap smear is that scrap­ings are taken with a spat­ula from the cervix and sent to the pathol­o­gist for ex­am­i­na­tion un­der a mi­cro­scope. The pathol­o­gist ex­am­ines the smears and cat­e­gorises the smears into mild, mod­er­ate or se­vere changes. In a few cases, there may ac­tu­ally be pres­ence of cer­vi­cal can­cer which may be de­tected. Af­ter con­fir­ma­tion of cer­vi­cal can­cer, based on clin­i­cal and ra­di­o­logic ex­am­i­na­tion, the stage of the can­cer is de­ter­mined. Cer­vi­cal can­cer is staged from I-IV, depend­ing on the ex­tent of spread. Surgery is pre­ferred in early cases of cer­vi­cal can­cer. The pro­ce­dure is known as rad­i­cal hys­terec­tomy in which the uterus, ovaries and lymph nodes around the uterus are re­moved. In the more ad­vanced cases, the treat­ment is usu­ally a com­bi­na­tion of chemo­ther­apy and ra­di­a­tion. Surgery is re­served for those cases which have not re­sponded to chemo­ther­apy and ra­di­a­tion. Chemo­ther­apy alone is given in ad­vanced cases of cer­vi­cal can­cer as a pal­lia­tive mea­sure. There are vac­cines avail­able which can help pre­vent fe­males from HPV in­fec­tion. Though there is still a great deal of con­tro­versy sur­round­ing the vac­cine, the Amer­i­can Can­cer So­ci­ety does rec­om­mend giv­ing the vac­cine to all girls be­tween the ages of 11-13. 3 doses of the vac­cine are given over a 6 months pe­riod.

Dr. Anil Ka­math

Newspapers in English

Newspapers from Nigeria

© PressReader. All rights reserved.