HT City

It’s high time to put out the smoke

- The author of this article is Dr Nitesh Rohatgi, MBBS, DNB, M.Med (UK), CCT (UK), MRCP (London)

It’s a tragedy when you expect things to go a certain way, but life has a series of unfortunat­e events planned for you. You could be 62 and have grand plans to catch up with your children and grandkids. However, those dreams could come crashing down thanks to lung cancer, and you’d be left wondering why you never quit smoking.

This is the tale of 70,000 men and women in India every year, which is more than 200 cases a day. Many of those diagnosed are not smokers, but victims of passive smoking-related lung cancers. There are many myths that surround the disease, one such being that low tar or light cigarettes are safer than regular ones — but they’re equally risky. Another is that pipes and cigars don’t cause cancer — in fact, they increase the likeliness of mouth, food pipe and lung cancer. Some even believe if one’s smoked for several years, it is too late to stop, which is not true. The risk of lung cancer keeps dropping over time.

No one is immune to the disease and some symptoms of lung cancer are hard to differenti­ate from those of common cold, so it is always better to visit your doctor and get tested. Common symptoms could include a new incessant cough — mostly dry but commonly relentless. Wheeziness or hoarseness of one’s voice is another symptom, especially if it leads to a change of the positions one usually sleeps in, which means something is blocking your airway. Increase in breathless­ness must not be ignored. Rare symptoms include loss of appetite, weight loss, chest pain and recurring chest infections, among others.

Smoking remains the culprit behind the majority of lung cancer cases. This includes current smokers, reformed smokers and passive smokers. A minority of the patients may have asbestos, radon or familial predisposi­tion as the implicatio­n of the cause of cancer.

Treatments related to lung cancer have become one of the fastest developmen­ts in the field of medicine. Today, we have already reached curability in early stage disease and crossed two years of survival in extensive stage disease. While the biggest changes were initially an impact of technology advancemen­ts in surgical, radiation and chemothera­py techniques, the recent big jumps have been made by the advent of molecular diagnosis and target therapies, including immunother­apy. The ability to understand the entire genome also made it possible to understand genomic abnormalit­ies in the DNA of the cancer cell. This, then made it possible to understand the most important defects that played a critical role in cancer formation and propagatio­n.

The next step was to make medicines that specifical­ly attacked these abnormalit­ies and hence, targeted therapy took birth. Its biggest advantage was that it did not attack normal cells as much. Hence, it achieved great effectiven­ess with minimal side effects. Many of the treatments were oral and achieved long-term control abilities. In recent times, the latest big jump that has aided the increase in survival of many cancer patients, especially lung cancer, has been immunother­apy.

This is also a form of targeted therapy where the medicine targets the barricade between lung cancer cells and the body’s immune cells, allowing for them to attack the cancer. This antagonise­s the mechanisms and the cancer cells develop to escape the eyes of the immune cells and once immunother­apy denudes the barricade between the cancer and immune cells, our body’s own immune system attacks the cancer cells and patients show marked responses with minimal toxicity.

Despite the treatments, it’s clear that the advancemen­ts do not promise cure and are expensive. Hence, it still makes sense to stop smoking and prevent the exposure of risk factors wherever possible.

 ?? PHOTOS: HTCS/ISTOCK ??
PHOTOS: HTCS/ISTOCK
 ??  ?? Many of those diagnosed are victims of passive smoking-related lung cancers
Many of those diagnosed are victims of passive smoking-related lung cancers
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