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Robotic Surgery – Facts and Myths

Dr.Karthik Chandra Vallam

Dr. Karthik Chandra Vallam, MBBS, M.Ch., DNB, Surgical Oncologist, Robotic and Laparoscopic Surgeon

Surgery has evolved from the era of invasive “open” model to the minimally invasive model especially when dealing with “cavity” surgery (abdominal/chest cavities).  The advantages of MIS are pretty obvious with smaller incisions, lesser pain, earlier return to normal activities, lesser wound-related complications. However, there are significant challenges with traditional laparoscopic surgery – counter-intuitive movements, rigid non-articulating instruments, limitation with 2D vision and ergonomic discomfort for the operating surgeon to name a few. Newer platforms like Robotic Surgery work to overcome these limitations and make it easier for the surgeons to do a better job and thereby improve outcomes for the patient.

How does the Robotic Surgery work?

The current Robotic Surgical System consists of four components: 1) a SURGEON CONSOLE where the surgeon sits, views the screen, and controls the robotic instruments and camera via finger graspers and foot pedals; 2) a ROBOTIC CART with four interactive arms that hold instruments through trocars attached to the patient; 3) a VISION CART WITH CAMERA that allows for a three-dimensional image of the surgical field using image synchronizers and illuminators; and 4) WRISTED INSTRUMENTS that translate the mechanical movements of the surgeon’s hands into computer algorithms that direct the instruments’ movements within the patient.

SRIRS logoDuring Robotic Surgery, small incisions are made on the patient’s abdomen/chest through which three to four trocars are introduced into the patient. Through these trocars, a few instruments and an endoscope (camera) are placed. These ports are “docked” (connected) to the robot which enables the surgeon to operate from the console which is connected to the robotic cart. The primary surgeon sits unscrubbed at the console in the operating room at some distance from the patient, using finger graspers and foot pedals to control the instruments (just like in a video game). The console provides 3D imaging with improved depth perception, and the surgeon has independent control of the camera and instruments. Finally, the robotic arm, with its wristed joint and six degrees of freedom, allows for greater dexterity than unassisted surgery and decreases normal hand tremors.

What are the advantages of Robotic Surgery?

MGCHRI-Live-Robotic-SurgeryRobotic surgery presents a spectrum of advantages over traditional laparoscopic techniques. Robotics allows the surgeon to see 3D images with 10x magnification, obtain better angles with the increased degrees of freedom provided by the EndoWrist instruments, and control three different instruments and the camera simultaneously. These advantages make it easier to execute complex laparoscopic procedures like identifying important neurovascular structures and intracorporeal suturing in deep and narrow places like the pelvis. Greater surgical precision and improved ability to spare healthy tissue not impacted by cancer are added benefits. The surgeon is able to operate from an ergonomically comfortable, seated position at a console, with eyes and hands in line with the instruments and is not dependent /minimally dependent on assistant surgeons. This is specifically advantageous for long-duration surgeries like certain cancer surgeries. With the robot, the surgeon does the job of 3 people simultaneously (camera assistant, operating surgeon, assistant surgeon) with ease.

Is the Robot “programmed” to do the surgery independently? / Is it safe?

Throughout the procedure, the surgeon controls every surgical maneuver. THE ROBOT CANNOT OPERATE INDEPENDENTLY. It is a master-slave system operated by a specially trained and highly skilled surgeon.

What are the surgeries which can be performed with the robot?

FDA has approved a long list of surgeries that can be safely performed with the da Vinci robotic surgical system. Surgeries, where robotic technology has a significant edge, are – prostatectomy, partial nephrectomy, colorectal cancer surgery, esophagectomy, radical hysterectomy (uterus removal for cancer) and certain (bariatric) weight reduction procedures.

Written by
Dr. Karthik Chandra Vallam,
Surgical Oncologist, Robotic and Laparoscopic Surgeon,
Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam

Cancer has an Answer…

Dr.P.S.Bhattacharya

Dr. Partha Sarathi Bhattacharyya, MD, Senior Radiation Oncologist

Cancer is the second leading cause of death in the world after cardiovascular diseases.  The word cancer came from the Greek words “Karkinos” to describe carcinoma tumors by Hippocrates (460-370 B.C). The world’s oldest case of breast cancer hails from ancient Egypt in 1500 BC.

The International Agency for Research on Cancer (IARC) estimates that one-in-five men and one-in-six women worldwide will develop cancer over the course of their lifetime, and those one-in-eight men and one-in-eleven women will die from their disease. Worldwide, the total number of people who are alive within 5 years of a cancer diagnosis, called the 5-year prevalence, is estimated to be 43.8 million. The increasing cancer burden is due to several factors, including population growth and ageing as well as the changing prevalence of certain causes of cancer linked to social and economic development.

Cancers of the lung, female breast, and colorectum are the top three cancer types in terms of incidence. Lung cancer is the most commonly diagnosed cancer in men (14.5% of the total cases in men and 8.4% in women) and the leading cause of cancer death in men (22.0%, i.e. about one in 5 of all cancer deaths). Breast cancer is the most commonly diagnosed cancer in women (24.2%, i.e. about one in 4 of all new cancer cases diagnosed in women worldwide are breast cancer).

Global patterns show that for men and women combined, nearly half of the new cases and more than half of the cancer deaths worldwide in 2018 are estimated to occur in Asia, in part because the region has nearly 60% of the global population.

As per the Indian Council of Medical Research (ICMR), the incidence of cancer cases in India was 14 lakhs in 2016.  Cancer of breast, cervix, oral cavity and lung constitutes 41% of the cases. Oral cavity cancer is the most common in men and third in women. “The age standardized rate is approximately 25.8 per one lakh women and is expected to rise to 35 per one lakh women in 2026,” the report stated.

A few months back my aunt was diagnosed with cancer. As soon it was diagnosed, I got a call from my uncle saying, “your aunt’s days are numbered now, please see what can be done.” Though they didn’t know the details of the diagnosis, I was surprised to hear such a depressing response to the diagnosis.

This is not the only reaction I get, but most of the families where someone is detected with cancer, this is a common response. Cancer has become synonymous with the end of life. Though the survival rate has increased due to early diagnosis and advances in treatment modalities, the cause of this fear is a lack of proper information and a lack of appropriate medical intervention at the right time.

Treatment of cancer involves a multidisciplinary holistic approach. The team of doctors for diagnosis, treatment, and care of cancer patients includes Surgical Oncologist, Medical Oncologist, Hematoncologist, Radiation Oncologist, Pathologist, Radiologist, Nuclear medicine specialist, Pain and Palliative care specialist, Dentist, etc., and also Medical physicist, Radiotherapy technologist/dosimetrist, Physiotherapist, Dietician and Oncology nurses. Each team member is important in this chain of cancer care to successfully treat a patient. The cancer care team at Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam, Andhrapradesh, with its gamut of services is fully equipped to manage a cancer patient holistically.

Cancer has always been known as a dreaded disease, and this unknown fear can be removed with timely intervention by the health care team specialized to manage such cases.

Written by
Dr. Partha Sarathi Bhattacharyya,
MD, Senior Radiation Oncologist
Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam

The Long Battle of Childhood Cancer

Childhood CancerYoung Rajesh (name changed) was an exuberant child. Or so his mother describes him through tears and trepidation. Exuberant is not a word you would use to describe the child that lies shivering in front of my eyes on the couch. He was weak but he seemed to be using his last ounce of energy trying to repel me from examining him. As someone who had diagnosed and cared for such children for a while now, even a perfunctory examination was enough to suspect that I would be dealing with a case of acute leukemia in that 5-year-old. The multiple swellings in the neck, that irritability, the bleeding spots on his skin and the unmistakable pain in his bones were the telltale features. A small test called peripheral smear was done and the Pathologist calls up in a short while to confirm my fear. My fear is not to treat the disease really! It’s how to treat the family!

I believe no other cancer tests a doctor-family combine the way an acute lymphoblastic leukemia does. Shortly called ALL, it’s an acute affliction of the bone marrow where an over-proliferation of one cell line completely overtakes the rest of the cell lines. In plainer terms, this means that apart from a high white blood cell count, the patient would develop a very low hemoglobin and low platelets. Hence the symptoms of fever, fatigue, and bleeding. Without prompt diagnosis and immediate treatment, death is imminent and quick. Three months is what I tell the family!

Fortunately, advances in modern medicine have enabled cure in most of these patients (almost 80% of patients with a favorable risk profile of this disease gets cured). Unfortunately, the treatment is very long drawn. First, it would mean an admission for one month in the hospital hoping to bring the entire visible disease in the bone marrow to a zero. This is a crucial period where there would periods of prolonged low counts and the chances of complications are at the peak! Even if such control was achieved, there would be different phases of treatment which altogether last for two and a half years! A treatment of such a long duration is the only way to cure a disease which is notorious for its recurring nature. In fact, relapsed/recurrent ALL is the third most common childhood cancer, the first being a newly diagnosed ALL. Now imagine telling this to the parents of a child with this diagnosis. Imagine trying to make them understand, in their state of mind, the various aspects of care AND the duration of treatment. Add to it the uncertainty of cure – though high, there is always a chance of relapse in the first five years of treatment. Quite understandably, most of the families would be bewildered. There would be confusion, part denial, lot of uncertainty and the devil of them all – how to deal with the financial burden!

Rajesh’s parents sat through my initial counseling session. I have the final diagnosis by the way of flow cytometry, a diagnostic modality to confirm the disease. I could hardly tell if they were following me, so I do what I do. Repeat and pray. Slowly they start to breakdown. Father attempts to send the mother away, but she wants to stay. I try to make them see that this is a favorable risk profile and they cling on to it with all the greed in the world. That is enough to put me on the back foot as I’ve seen enough ‘favorable risk’ diseases relapsing! But even greater worry is how they would manage with the duration of treatment and the financial aspect of it!

Most of the families belong to low and lower-middle socio-economic strata and are dependent on a sole bread winner able to go to work on a daily basis. One can only imagine the financial implication if that person has to be curtailed in his/her attendance to job because of the child’s treatment. Fortunately, the Government of Andhra Pradesh has a public health scheme for the underprivileged, which could cover the treatment cost. Though a scheme which has its limitations, I found that it is workable for childhood ALL treatment. When I first joined Mahatma Gandhi Cancer Hospital and Research Institute, a preamble for treating such cases was not existent. In fact, that’s the case with the whole of City of Visakhapatnam unfortunately! The reasons were manifold, some serious, some manageable. Most of the patients of such illnesses used to be referred to hospitals in bigger cities like Hyderabad, Chennai, Mumbai, etc. Some families were able to take their children to such places. Most couldn’t, and all those children died! Even for those who were able to, the hardships of their families to manage such treatment can only be imagined!

I still remember the day I approached the managing director of our hospital, that such cases could be treated here. I’m sure Dr. Murali Krishna Voonna would’ve been skeptical, but he didn’t show it! He gave a reassuring nod of the head and I left the room. From then started a year of trials and tribulations. It’s a big teamwork and apart from me, most of my team is new to the delivery of this treatment! They learnt along the way, and I learnt along with them. Results followed. I daresay they were better than what I imagined. The team became bigger and better.

Rajesh’s treatment got initiated. Over the course of one month, he went through several doses of chemotherapy, multiple units of blood transfusions, episodes of severe infections. But I could see he was getting better. More than the tests, the activity of a child tells the course the disease was taking. He started to become active and I started to become hopeful. The day I did the test to see if his disease was indeed under control is a test for the month-long effort of the entire team. A lack of control would be a death knell. It wasn’t the case to be. Rajesh’s bone marrow at the end of one month was as good as new! His parents were overjoyed. I was happy too, but I know that it’s a job half done only!

The real test of anything in this world is a test of time. The test is for Rajesh’s parents now. I was fairly confident of the young child with the ‘now normal’ bone marrow able to pull it across the numerous other regimens of chemotherapy that he still had to undergo. But would his parents be able to bring him for treatment consistently at the defined intervals?

His mother stood up to the task. The kid was never late for any of his scheduled visits. He completed the whole course of treatment on time. Somewhere along the course, I realized that I’ve not seen his father for a while and I enquired about the same. I learnt that his father has to go away to earn for his family and his mother makes the travel of 200km to the hospital, each time it was needed, with the young kid in tow. She makes it a point to speak to families of other kids who were newly diagnosed. As I introspect, she’s not a lone example. Such is the case with many of the children who are getting treated at our center and most of them have a long duration of treatment. And more often than not, it’s their mothers who stand up to the task! I salute their undaunted spirit and strength!

Rajesh has reached the end of his treatment. I later realized that that day was his last admission for treatment. I was in a hurry that day and was doing a ‘curtailed round’, focusing on the sicker patients and waving byes to the fairly stable ones. Rajesh’s mother reached out to me and requested me to see his child once. I asked her if something was wrong. She shook her head and told me smiling that her son is so used to my smiling down on him and taking his wrist in my hand while enquiring his wellbeing, that he doesn’t want me to leave without doing that again to him! I was pleasantly amused. As I started towards his couch, I saw that the boy was neatly dressed and combed, like he usually is. Again, a bow to his mother! He was happily smiling and as I neared him further, he raised his arm for me to reach his wrist.

Over the last 3 years, the Medical Oncology team at Mahatma Gandhi Cancer Hospital and Research Institute has treated nearly 300 children with cancers. Close to 200 of them were cases of acute leukemias. We have lost a few, but we have saved the most. Along the way, we learned. Not just of the treatment, but also of the indomitable fight and human spirit. The journey has taken a new beginning in the form of establishment of a ‘Bone Marrow Transplant unit’, the first of its kind in the state of Andhra Pradesh. With this, we aim to be a place which will offer the complete gamut of services for blood cancer patients. A diagnosis of such a case need not mean uprooting the whole family anymore for people of this region!

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

All Cancers Are Not The Same!

Dr.Karthik Chandra Vallam

Dr.Karthik Chandra Vallam, MBBS, M.Ch., DNB, Surgical Oncologist

Contrary to widespread belief, Cancer is not the same in every patient. Just as there are so many parts in the human body, there are thousands of cancer variants a person can get affected with.

The two key determinants of outcomes of cancer therapy are the BODY ORGAN which is involved and the STAGE at which it is detected in the patient.

Cancers are basically divided into solid organ cancers and hematological (blood and lymphatic system) cancers. The survival of a patient differs where it affects, thyroid/brain/lung/kidney/gallbladder/intestine/bones/blood etc.. Most of the solid organ cancers which have not metastasized (spread to other parts of the body) are treated with surgery, sometimes with radiation and many times with a combination of surgery, radiation, and chemotherapy. Meanwhile, chemotherapy is the mainstay of treatment in hematological cancers, occasionally supplemented by radiotherapy and very rarely with surgery.

Cancers are usually categorized into four stages with stage one being the earliest and stage four being the last stage where patients are not expected to live long and usually have a tumultuous few months to live. In well-developed nations, due to better education, awareness, and access to good healthcare facilities, cancers are detected in an early stage whereas, in underdeveloped countries and underprivileged socioeconomic groups, cancers are usually detected in late stages leading to poor outcomes.

It is difficult to predict the outcome of treatment for cancer. For example, a variant of thyroid cancer called papillary cancer has very good treatment outcome and most of these patients live a normal and uncomplicated life. The same is the case with early stage breast cancer. Whereas, lung cancers are usually detected in a late stage and most patients succumb to it within a few months of diagnosis. The treatment of blood cancers is usually prolonged and requires multiple cycles of chemotherapy, complicated bone marrow, and stem cell transplants, immuno-suppression related complications, high cost, etc., which makes treating these patients a challenge. Cancer specialists gain experience over time and are able to predict and treat better.

Cancer patients need to be evaluated with multiple tests initially to accurately diagnose and predict the stage of cancer which often takes a few days to a couple of weeks during which period the patients and their relatives experience a lot of anxiety. The exact identification of site, variant, and the stage is key to chalk out the appropriate treatment plan. This is best achieved in experienced cancer centers with trained and experienced group of oncologists who hold tumor-board discussions before finalizing treatment plans.

So, it is important NOT to generalize all cancers and to treat each patient as unique and advise as per that specific patient’s condition.

CORE POINT: Cancer is an imminently curable condition when detected at an early stage and treated by good oncologists at an established cancer center like Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam.

Written by 
Dr. Karthik Chandra Vallam,
MS, M.Ch., DNB, Surgical Oncologist, Robotic and Laparoscopic Surgeon,
Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam.

Pathology At The Forefront Of Advances In Oncology

Dr.G.Veniprasanna

Dr. G. VeniPrasanna, M.D., Pathologist

The practice of pathology and its role in cancer care has changed significantly in the past decade. In the olden days, it was limited to a microscope and a few special stains. Immunohistochemistry (IHC) arrived after that to advance diagnosis and treatment capabilities.

The current treatment landscape is ever so changing – the era of chemotherapy changed to an era of precision medicine / personalized medicine. “One size fits all” (the approach of chemotherapy) is no longer valid. Each tumor is unique in its own genetic/molecular subtypes. Identifying driver mutation which drives the growth of cancer predominantly and thus also becomes a target for treatment is the present focus of cancer research. The best example is lung cancer. In the past, the major types of lung cancer (on basis of microscopy and IHC) used to be adenocarcinoma, squamous cell carcinoma, and small cell carcinoma. Presently, it’s important to subtype lung Adenocarcinoma into EGFR/ ALK/ ROS1 driven. Specific drugs are available to target these mutations and they have proven to be superior to chemotherapy in controlling cancer. These mutations can be detected in tumor biopsy samples by specialized tests like PCR (Polymerase chain reaction), FISH (Fluorescence in-situ hybridization), etc. Detecting such biomarkers has revolutionized the treatment outcomes in advanced lung cancer. In few cases where a biopsy cannot be done (which is the case with few patients), these mutations can be detected in tumor cells that are shed into blood (called circulating tumor DNA / circulating tumor cells) by an advanced test called Liquid biopsy.

Advances happened in the diagnostic realm of hematologic malignancy also. Subtyping of Acute and chronic leukemias is important for accurate treatment. This is possible with a technique called FACS/ Flow cytometry. This has now become a standard test that should be done before embarking on treatment. Further risk stratification of these leukemias and lymphomas are sometimes important and this is achieved with FISH/PCR/ Karyotyping.

These advances in pathology have made it possible to accurately subtype the major types of cancer and have heralded the era of personalized medicine in oncology. Pathology has truly become the Final Diagnosis.

Written by 
Dr. G VeniPrasanna, 
MD., Pathologist, 
Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam.

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.