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Tobacco – The Most Common Preventable Cause Of Cancer

Dr. B Rakesh Reddy

Dr. B Rakesh Reddy

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’!

#It’sNeverTooLate

Written by
Dr. B. Rakesh Reddy, 
Consultant Medical Oncologist & Hemato-oncologist,
Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam.

All about ‘Head and Neck’ Cancers !

Dr. Praveena Voona

Dr. Praveena Voona

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.

Written by
Dr. Praveena Voonna,
Consultant Medical Oncologist,
Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam.

Lower your risk for colorectal cancer

Dr. B Rakesh Reddy

Dr. B Rakesh Reddy

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.

#It’sNeverTooLate

Written by
Dr. B. Rakesh Reddy, 
Consultant Medical Oncologist & Hemato-oncologist,
Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam.