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.