During the early days of my training as a medical oncologist at AIIMS, New Delhi, I was alarmed to see patients as young as 20 years being diagnosed with advanced stages of oral cavity cancers and dying within one year of diagnosis despite treatment. Tobacco chewing is the single most important cause of these cancers and in certain parts of the country, it is so prevalent that it has become the most common cause of cancer.
Research points out that Tobacco abuse is the most common cause of cancer. It is responsible for 10 different types of cancers and collectively they are referred to as ‘Tobacco-related cancers’. They are head and neck cancers (mostly related to tobacco chewing), Lung cancer (primarily due to tobacco smoking), esophageal (food pipe) cancer, stomach cancer, pancreatic cancer, kidney cancer, bladder cancer, liver cancer, cervix cancer and acute myeloid leukemia (a type of blood cancer). Together, these account for almost 40% of the cancer burden worldwide, making tobacco the single most common cause of cancer.
Tobacco smoke has at least 70 chemicals that cause cancer, called as carcinogens. Tobacco chewing causes irritation of mucosa in the oral cavity which on long term exposure turns into cancer. An indirect exposure to tobacco smoke from people who smoke around you can place you at a higher risk of getting cancer. This is called ‘passive smoking’ and is especially important to pregnant women as it is shown to be one of the causes of childhood cancers.
If the current trend in smoking and population growth continue, the number of current smokers is expected to reach 2 billion worldwide by 2030. The WHO (World Health Organization) estimates that one out of two young people who start smoking and continue smoking throughout their lives will develop ‘Tobacco-Related Cancer’ (TRC). The numbers are alarming. According to the latest GLOBOCAN data (2018) for India, there were 1.1 million new cases of cancers occurring in a year and 2.2 million people living with cancer. Of these, at least 40% are tobacco-related. Even these reports are likely to be an under-representation due to lack of a good cancer registry covering an adequate population.
What these numbers would suggest is that cancer incidence is growing at an alarming rate and unfortunately a very significant proportion of it is due to a preventable cause, tobacco abuse. The need of the hour is a strong effort from Government and regulatory authorities to curb tobacco. Effective policies, public education through popular media and partnership of all stakeholders across multiple sectors are some of the ways. Every year on 31st May, the WHO and its global partners celebrate World No Tobacco Day (WNTD). The annual campaign is an opportunity to raise awareness on the harmful and deadly effects of tobacco use and second-hand smoke exposure, and to discourage the use of tobacco in any form.
The focus of World No Tobacco Day 2019 is on “tobacco and lung health.” The campaign aims to increase awareness on the negative impact of tobacco on people’s lung health, from cancer to chronic respiratory disease.
The focus is not just on Government and such campaigns but on the public as well to understand the risks. Peers to peers, parents to children should talk about the negative impact of tobacco. Its time to ‘kick the butt’!
Dr. B. Rakesh Reddy,
Consultant Medical Oncologist & Hemato-oncologist,
Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam.
Grand inauguration of ‘Centre for Advanced Hematology & Hemato-oncology (Bone Marrow Transplant) Unit’ by Mahatma Gandhi Cancer Hospital on 16th May 2019 evening by Senior specialists & well wishers of Visakhapatnam city Dr K.Radha Krishna, Dr K.Vishnu Prasad & Dr R.Madan Mohan in Health City. All guests appreciated and congratulated the efforts of Dr Murali Voonna and Mahatma Gandhi Cancer Hospital for bringing such unique treatment facility closer home.
‘Let the Discussions Begin!’. The National Conference on Stereotaxy by Mahatma Gandhi Cancer Hospital & Research Institute has begun with enthusiastic participation of specialists from across the nation. These sessions add points to ‘SOP guidelines in Radiotherapy’.
During ‘The National Conference on Stereotaxy‘, there are more talks and discussions on Stereotactic Radiotherapy on Acoustic-Neuroma, Post-op Brain-Metastasis, Meningioma and Cavity Radiotherapy and some more.
Towards the end of the first day of National Conference on #Stereotaxy, an e-document with a compilation of ‘SOP Guidelines in #Stereotactic #Radiotherapy’ has been released formally by Dr. Rakesh Vyas, Director of Vedant Cancer Hospital, Raipur. This is first of its kind document on this subject in the country, arguably among the first in the world, which would go in a long way in spreading commonly accepted practices in Stereotactic Radiotherapy. Prof. Dr. Sujatha N of KGH, Visakhapatnam, Dr. Sarbani Laskar of TMC-Mumbai also graced the occasion along with our own managing director Dr. Murali Voonna and Dr. Kanhu Charan Patro as editors-in-chief of the book. All the contributors to this book of guidelines have been felicitated too.
All the speakers, delegates and organizers of the ‘National Conference on #Stereotactic #Radiotherapy’, congregate for a group-photograph; This souvenir enhances the memorable discussions in the conference and makes the event memorable!
More speeches & more discussions on AVM, Spine-SABR, Lung-SBRT, Prostate-SBRT, Cardiac-SBRT, Head-N-Neck SBRT Simulation and also on Motion-management and Stereotaxy in Skull Base tumors as part of the ‘National Conference on Stereotaxy’ by Mahatma Gandhi Cancer Hospital.
A parallel session on ‘Principles of #Radiosurgery for Nuero-Surgeons and Neuro-Physicians’ was presented by Dr. Shankar Vangipuram. The discussions on SBRT continued with focus on Lungs, Liver, Pancreases, and PVT in the morning session of the second day of ‘National Conference on #Stereotaxy’.
Of the 10 lakh cases of cancer detected in India every year, around 2 lakh are cancers of the ‘head and neck’ category.
‘Head and Neck’ cancers are tumors in and around the throat, larynx, nose, sinuses, or mouth. These develop when healthy cells in these regions change and grow out of control forming a mass called tumor. They are mostly squamous cell carcinomas, which originate from flat squamous cells that form the surface area of tissue inside head and neck. In India, oral squamous cell carcinoma is the most common cancer in men and the fourth most common cancer in women. Cancers of the lip and oral cavity are the second most common cancer in India.
Head and neck cancer is caused by tobacco use, use of both smoke & smokeless tobacco, and over-consumption of alcohol. Other risk factors include infection with human papilloma virus (HPV) and overexposure to sun-rays.
The symptoms of head and neck cancer include red or white patches on the gums, breathing difficulties, pain while swallowing, lump or sore that doesn’t heal, unexplained change-invoice, fatigue, unexplained weight-loss or pain in the face. Tests such as biopsy, endoscopy, X-ray, CT-scan, Ultrasound, and PET-CT scan are recommended to diagnose head-and-neck cancer.
The treatment options include surgery, radiotherapy, chemotherapy and a combination of these and depend on the tumor location, cancer stage, person’s age, and general health condition.
Patients with localized(Stage I and II) head and neck carcinomas are generally managed with either surgery or radiation therapy alone. However, a combined modality treatment may be required in cases with high-risk features. In more advanced stages (III, IV A & IV B), the disease is typically managed with both radiotherapy and chemotherapy. Palliative systemic therapy is appropriate for most patients with locally recurrent and metastatic disease.
Newer therapies like Immunotherapy and targeted therapy can be employed that may use body’s own mechanisms to fight cancer. Immunotherapy or targeted therapy is different from traditional chemotherapy in the sense that it works by targeting the cancer-specific genes, proteins, or tissues limiting damage to the healthy cells. It works if the tumor has the necessary target proteins to attack. Immunotherapy boosts the body’s natural defences to fight cancer.
In general, family members and friends often play an important role in taking care of a person with ‘head and neck’ cancer.
Dr. Praveena Voonna,
Consultant Medical Oncologist,
Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam.
You can prevent CRC by being physically active, eating plenty of fruits and vegetables, and limiting the intake of alcohol.
In colorectal cancer (CRC), there is a malignant growth in the large intestine. In the advanced stages, cancer spreads from the intestine to the liver. Rarely does it spread to the lungs or bones, but when it does, it is known as metastatic CRC.
Globally, CRC is the 3rd most common cancer and the 4th most common cause of death. It is more common in developed countries, but its incidence has also been rising in developing countries. In India, it is the seventh most common form of cancer.
The symptoms are blood in stools, altered bowel habits, anaemia, or unexplained weight loss. The risk factors are advancing age, a family history of colon cancer, a diet high in fat and red meat but low in fibre, smoking, alcohol consumption, obesity, and sedentary lifestyle.
Detection in the early stages maximizes the chances of cure. The screening tests for CRC are fecal occult blood test (FOBT) and colonoscopy.
In the early stages (1 & 2), surgery is the form of treatment, and it is curative in more than 90% of cases. For stage 3 colon cancers, chemotherapy is given for 3-6 months after surgery. For rectal cancers, radiotherapy is also used.
For stage 4 (metastatic) CRC, the primary mode of treatment is chemotherapy. Additionally, targeted therapy significantly helps in improving the life spans of patients. The use of certain ‘biomarkers’ has enabled oncologists to select the appropriate form of targeted therapy. This is referred to as ‘personalization of treatment’.
With the advances in treatment and the advent of immunotherapy, the life span of a stage 4 CRC patient has gone up by 3 years.
You can prevent CRC by being physically active, eating plenty of fruits and vegetables, limiting the intake of fast food and alcohol, and exercising regularly.
Dr. B. Rakesh Reddy,
Consultant Medical Oncologist & Hemato-oncologist,
Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam.
Awareness talk at Gurajada Public School, Vizianagaram:
Early Detection of Cancer is the only way to avoid Cancer-fatalities. Awareness should begin even earlier. Hence Mahatma Gandhi Cancer Hospital, in association with rural medical practitioners of Vizianagaram, has organized a cancer awareness talk at Gurajada Public School, Dr. Venkata Krishna Reddy addressed the school-kids encouraging them to discuss with their parents and spread cancer awareness.
Awareness talk at Airport, Visakhapatnam:
We have participated in a Cancer-Awareness-event organized at Vizag-Airport in association with ‘India Turns Pink’ Organisation by Dr. Karthik Chandra addressed the Airport employees and Kendriya-Vidyalaya students on the occasion of World Cancer Day.
Awareness talk at Railway Hospital, Visakhapatnam:
Dr. Madhuri Palla, Radiation Oncologist, has addressed a gathering of patient-attendants of railway-hospital and Railway-Employees @ railway-hospital premises in Visakhapatnam today on the occasion of World Cancer Day to raise awareness on the importance of early detection.
Awareness talk at MKCG Medical College, Berhampur, Odisha:
Dr. Kanhu Charan Patro, Chief Radiation Oncologist of our hospital, has addressed the gathering of Doctors and Nurses of MKCG Medical College, Berhampur on the occasion of World Cancer Day and threw light on the cancer scenario in the country at present and the ways to tackle the menace to reduce cancer fatalities. A few of Cancer Survivors also attended the session.
We have organized interactive stalls at most populated public places in the city of Visakhapatnam, to raise awareness of CANCER on the occasion of World Cancer Day and received a massive public response. The places include Visakhapatnam Railway Station, RTC Complex, Vizag Airport, CMR-Central, Andhra University, KGH, Railway Hospital and major junctions across the city. Kudos to all the staff who spread all over the city and are spreading the cancer awareness message far and wide.
To support the World Cancer Day, our team has taken the oath, showed our support for the fight against cancer by spreading awareness. On the eve of World Cancer Day, Honorable Minister Shri Ganta Srinivasa Rao garu flagged off the massive awareness walk at RK Beach on 03-Feb, Sunday. Over 1000 enthusiastic volunteers from all walks of life participated in the awareness walk. We thank the honorable minister for gracing the occasion and also volunteers from IDA, CII-Vizag, YI, CII-IWN, social service organization and students who participated and supported this endeavor.
Celebrated 70th Republic Day of India at the hospital premises with enthusiasm with the unfurling of the flag by Medical Director Dr. Sitarama Swamy Voonna and saluting the flag with patriotic fervor. Speaking on the occasion, managing director Dr. Murali Voonna reminded all the sacrifices made by our freedom fighters and the effort and foresight demonstrated by our nation builders while writing the largest and most comprehensive constitution in the world that keeps the largest democratic country vibrant and dynamic all the time, becoming the symbol, to the world, of ‘Unity in Diversity‘!
A diagnosis of cancer could hit one hard. That is why it is important to learn the facts about the condition and the best available options for treatment before choosing the way ahead.
The surgical treatment of cancers has traditionally been by open techniques. Open surgery is associated with a large wound and delayed recovery and return to normal activities. Laparoscopic surgery has been established as a feasible, safe and sound option for certain cancers including colon, endometrial, cervical and esophageal cancer but has limitations imposed by the 2-dimensional image, instruments with limited range of motion and dependence on a trained assistant for holding the camera.
Robotic surgery with the da Vinci System, on the other hand, bestows very high definition and magnified 3-dimensional vision with the camera controlled by the surgeon. The instruments with extreme degrees of freedom (Endo-wristed), enable the surgeon to use instruments in narrow confined spaces, to access difficult to reach cancers, and at angles that are impossible with open or laparoscopic instruments. Motion scaling which allows the surgeon to reduce the degree of instrument movement as a proportion of movement of the surgeon’s fingers enables a greater degree of precision. All these provide the ultimate flexibility and precision for exceptional surgical techniques in cancer surgery.
In cancer surgery, robotic techniques enable a radical operation to be performed with preservation of nerves and other critical structures, due to better visualization. This is particularly important in rectal, gynaecologic and prostate cancer surgeries. For example, in robotic prostate cancer surgery, every effort is made to spare the nerves. As the nerves and vessels are all magnified and it is much easier to save them and help retain potency.
Patient benefits include:
Practically all cancers are amenable to this approach with the exception of locally advanced tumors. Specific cancers where robotic surgery is able to provide excellent outcomes include:
Transoral Robotic Surgery (TORS): This is another type of minimally invasive surgery, specifically designed for patients with head and neck cancer. Here, the surgeon controls the robotic instruments that have been inserted through the mouth. No incisions are needed. In contrast, traditional open surgery requires long incisions through the throat and jaw, which often leave patients with visible scars, difficulty breathing or swallowing, and a lengthy recovery.
Trans Oral Robotic Surgery may be used to treat:
Undoubtedly, robotic surgical techniques have revolutionized cancer surgery and improved survival and quality of life in cancer patients, giving them real hope that cancer is conquerable.