Friday, December 14, 2012
On Sunday, 23rd of September, 2012, a National Seminar on "Management of Cancer" was held at THE TAJ VIVANTA HOTEL, Yeshwanthpur, in our very garden Bangalore. I was invited to attend the seminar by the organizer of the event, Mr. J.S. Pant. The event changed my perspective towards cancer treatment to a great extent. It was a great learning experience for me, therefore I am sharing it on my blog to spread the word about new frontiers being conquered on the cancer front.
The informative event was organized by Indian Society of Health Administrators, known commonly to public by its acronym ISHA. ISHA was founded by late Dr Ashok Sahni in 1979, with the goal of providing manpower training, improving health system development, and life style and effective management of resources available in to the health management professionals. It has been effectively trying to narrow the gaping gap between the available and desirable health services in Karnataka and other parts of India. http://canmanwin.org is the seminar website.
The seminar organizing committee was
Dr Sita Bhateja
Gynecologist And President ISHA
Advocate and Consultant in Health Laws
Dr P.N. Halagi
Retd. Director, Health & Family Welfare Vice President ISHA
Retd. Director General of Medical Services (Indian Navy)
Dr. S.M. Manjula
Ayurvedic Consultant & Holistic Medicine Practitioner
Director, HCG MSR Curie Centre of Oncology
Dr. Ashok Patil
Physician and Cardio Vascular Fitness Consultan
Dr. Kamni Sahni
The seminar began with the registration of delegates from 9.00 a m onwards. The entry fee for of Rs.500 was drawn in favor of ISHA for the following delegates
· Physicians/ Family Doctors
· Oncologists/Cancer Specialists
· Holistic Medicine Practitioners
· Cancer Care Personnel
The entry fee was exempted for candidates who came under the category of
· PG Oncology Students
· NGO's Working for Cancer
· Cancer Affected
· ISHA Life Members
The message given out by the Seminar was strong and clear - Cancer is treatable, controllable and manageable like a chronic disease, it need not be feared or dreaded. The one day seminar was tightly packed with presentations by experts and outstanding professionals in the field of Oncology where they explained in simple terms which everyone could follow about managing cancer and living a healthy life through conventional medical treatment, modern technologically improved treatment, in addition to alternative therapies and yoga.
The seminar began with an inspiring speech given by Dr V.S.Dixit. He introduced the gathered delegates to the great personality called Dr.Ashok Saini who is the founder of the ISHA. Dr. Ashok Saini a professor and honorary resource person had also worked as a consultant to the UNO and WHO. By founding ISHA, Dr. Saini aimed at training the health management professionals in Health and Family Welfare fields, Medical institutions, programmes conducted for health management and in education of Community Health Development. ISHA also brings out updates regarding revolutionary methods coming up in health industry.
According to Mr. Dixit the first point of contact for the patients were the health professionals and it was utmost important to prepare them to give proper guidance to the patients who approached them. Though there has been leaping progress in medical science, cancer now seems to be more possessive than ever before. It continues strike terror in the heart of people as though it is all consuming demon. But the truth is that cancer is controllable and curable with proper mode of treatment. Though the cancer survivors are shattered they need not give up on hope. Often the life of the survivor goes through a roller coaster ride of fear and hope. He gave out a message that cancer can be handled well and there is no need for those diagnosed to despair as cancer patients can lead a fruitful life.
The next speaker was the eminent personality who had to her credit many achievements including her contribution to St. Martha’s for 34 years, where laid foundation for the Dept. of Obstetrics and Gynecology, which has now developed into a top-notch department. Dr. Sita Bhateja was the first lady to be inducted into the Rotary Club of Bangalore. She is also a world renowned philatelist with the greatest collection of Indian stamps. She has given back to the society in hundred folds than what she has received from it.
Dr. Sita Bhateja spoke with high respect about Dr. Saini, his ideals and her association with him. She stressed on the awareness program for cancer which would lead to early detection. She stressed on the part where a large section of our population approaches medical facilities for diagnosis of cancer only when it has reached an advanced stage. The hospitals in our country lack facilities that would enable early diagnosis. She was of the opinion that the Indian Govt. should open cancer diagnosis cells in hospitals which would be accessible 24/7. When patients with minor symptoms get treatment, it saves them from financial burden that comes along with late treatment. She gave out some guidelines in management of cancer including healthy diet, yoga and other simple changes in life-style through which they could achieve a good life. Dr Bhateja mentioned that to deal successfully with the psychological effect of depression, there was a need to have support groups for cancer patients. She is also quoted as to have brought up the idea of establishing a cancer detection cell in every hospital so that cancer can be detected in the early stages and that she would put forward an appeal to the State government to establish such cells across the State.
The next inspiring words came from the chief guest N. Prabhu Dev, Vice-Chancellor, Bangalore University. Mr Dev, who is a also a medical doctor, mentioned how cancer evokes fear not only in patients but also medical personnel. He called upon everyone to join the War on Cancer declared by U.S. President Richard Nixon when signing of the National Cancer Act of 1971. Since then a lot of effort has been put into finding a cure, understanding the cause of and prevention of cancer, the biology and genetics of cancer cells and moreover a more effective treatment of cancer patients. Mr. Dev called upon the medical professionals to join the war against cancer so that it will cease to be a major cause of death among the human population. He also elaborated on stem cell technology in cancer treatment including its use in treating Leukemia. A stem cell transplant infuses healthy stem cells into the body to stimulate new bone marrow growth, which will suppress the disease, and reduce the possibility of a relapse.
There are certain cancer stem cells which are the tiny powerhouses that generate and maintain tumor growth in many types of cancers, have developed resistance to chemotherapy and ionizing radiation often used as therapy for these conditions.
Mr. Dev called upon everyone to join hands in providing better treatment of the malignant diseases. He stressed on the point where the health professionals were treating only cancer and not the cause of cancer. He termed the medical institutions as money making system which lacked competence. He advised everyone to follow proper diet and healthy lifestyle to prevent cancer.
Mr. Dev had tons of information regarding the cancer cells, the toxins that dying cancer cells leave behind, about the need of cancer markers and many other revolutionary and innovative methods for conquering cancer. He believed that the Non-traditional method of treating cancer will soon be the standard form of treatment. He shared the information regarding the advanced treatment which used the immune based drug in combating cancer. This method used human immune system as a potentially powerful weapon to wage on cancer. The process was simple where the body’s antibodies and immune cells were allowed to seek and destroy cancer in the same way they destroyed bacteria and viruses.
He also elaborated on Immunohistochemistry, which is a method where antigens or proteins in tissue are localized into sections by the use of labeled antibodies as specific reagents through antigen-antibody interactions that are visualized by a marker such as fluorescent dye, enzyme, or colloidal gold. This particular method helps in finding the source of the malady. Immunohistochemistry is often used nowadays to assess the tumors that are likely to respond to a specific therapy, by detecting the presence or elevated levels of the molecular target. This is bringing Targeted Chemotherapy into the picture, which will go a long way in saving all those healthy cells which are destroyed in standard Chemotherapy treatment. He also talked about the image guided radiotherapy, through which the damage to normal cells can be minimized by improving the precision and accuracy of the deliverance of treatment. Image guided radiotherapy quips the physician with ability to image the tumor either before or during the process of radiation itself using specialized computer software. In case of deviation, adjustments are made to the patient’s position or radiation beams, so that the radiation will target only the tumor while avoiding the healthy tissue that surrounds it.
Even with the progress shown by medical science an estimated 106 million people died of cancer in the year 2011. It was now time for the doctors to buck up and sharpen their weapons to precisely fight the cancer, minimizing collateral damage.
The message given out by the eminent Dr. Dev carries a lot of weight and should be taken seriously by every medical practitioner. Cancer takes away so much from people, there is no need to take more of their healthy tissues by rendering them vulnerable to more diseases.
The opening session had everyone listening with utter attention; because the presentation, though of high medical advancement, was rendered in a manner which could be understood by anyone who had just basic knowledge of oncology and cancer.
The message and advice given out by Mr. Dixit, Dr. Sita Bhateja and Dr. N. Prabhu Dev would change the life of people going through cancer to a great extent, if they were taken note of by the masses, medical professionals and government.
The inaugural session ended with a vote of thanks presented by Dr. S.M. Manjula who heartily thanked the speakers and everyone present for their contribution to the success of the Seminar.
Sequel to the National Seminar on "Management of Cancer" held on Wednesday the 7th Nov. 2012 at the Seminar Hall of Indian Society of Health Administrators, Banashankari, Bangalore.
There were some eminent speakers who could not attend the first National Seminar on "Management of Cancer which was held On Sunday, 23rd of September, 2012, at THE TAJ VIVANTA HOTEL, Yeshwanthpur, in our very garden city of Bangalore. The sequel was organized to cover all the fields of cancer management by bringing in the missed out topic and presentations.
Cancer is a broad term used for identifying a large number of diseases. Perhaps the only common feature of these diseases is the ability of uncontrolled or abnormal proliferation of cells that cannot be checked by the homeostatic mechanism. A normal cell suddenly turns into a rogue cell and starts dividing continuously without check, leading to development of tumors or an unusual rise in the number of cells. Occurrence of cancer can be in any part of the body, and in any organ or tissue. Cancer originates in our own cells, but several factors, both internal and external to the body, which influence our daily life can add to the life time cancer risk. The intrinsic factors include the age and hormonal status of the individual, family history and genetic disposition, whereas the extraneous factors include food or diet and life style, stress, individual habits like smoking and alcohol consumption, exposure to environmental pollutants, toxic chemicals and radiation.
HOW TO MANAGE CANCER
With the advances in medical sciences and technology, it has been possible to slowdown, contain and even control the proliferation of cells and metastatic manifestations. Chemotherapy, radiation therapy and surgery either alone or in combination have brought about remission in cancer patients to a considerable extent. Chemotherapy alone has been the mainstay in the effective treatment of most cancers. In the cancer management, alternative approaches and complementary procedures constituting holistic medicine such as ayurveda, herbal medicine and homoeopathy have gained acceptance, partly because of affordability and faith in these systems, besides their having hardly any side effects. However, more scientific studies and evidential research in these systems of medicine would have to be carried out if they have to become widely acceptable. Yoga and Nutrition are known to contribute to improving the quality of life of cancer patients, and in the prevention and management of cancer. It is said that beyond modern and alternative therapies, the body and mind of cancer patients alone have to manage cancer eventually. In this context, the role of naturopathy, meditation and prayer have become significant. Then, it is the constant personalized counseling, encouragement and infusion of confidence in the cancer patients by the attending oncologists and health professionals that would make a difference, and bring about the required determination and positive outlook in them to fight against, and conquer the disease.
The seminar kicked off at 11.15 a.m. with the introduction by Mr. J.S. Pant, Hony. Director of ISHA, who was short and crisp with his introduction. Dr. Sita Bhateja spoke about how the first seminar had made a great impact on whole of the nation, which had woken up to look at the question why we are failing in management of cancer. Questions raised at the seminar had thrown light on formerly unknown areas of cancer management and why they were not being taken advantage of. Most of the cancer patients are diagnosed at very late stage in our country, one of the reasons why the success rate of treatment is very low. Early detection and right treatment will help in treating cancer more successfully. As the first step towards early detection, it is important to make every medical professional, even in the remote village of India, efficient in diagnosing the early symptoms of cancer. Only then will early detection of cancer will be possible.
Topics Covered in the Seminar
Thursday, December 13, 2012
Mr. J.C. Pant then went ahead to explain the importance of Ayurveda and how it can contribute in wellness and management of cancer before Dr.Mangali, Joint Director of Ayush took on the stage.
He mentioned how happy he was to be associated with the program in management of cancer. Mr. Shivakumar, a cancer battle winner was bothering him to come up with an alternative ayurvedic solution to management of cancer.
Ayurveda is an old science, which has been practiced in India for more than 5000 years. Though there is no mention of cancer in ayurveda, there has been mention about the symptoms that indicate cancer in the books of ayurveda. Cancer is not a disease or illness but an uncontrollable growth of cells that do not comply with the rules of life. The symptom of Kshataja Khaza is very similar to the symptoms of lung cancer we see today. Many of such diseases mentioned in the ayurvedic books of past show similar symptoms to cancer. Therefore cancer is not a new dreaded disease to ayurveda.
The word ‘cancer’ may be new but ancient Ayurvedic classics are aware of the clinical features, resembling cancer, with the names such as Apachi, Gulma, Granthi, and Arbuda. Following are names of some of the conditions mentioned in Ayurvedic classics that have relevance to cancer manifestations in modern medicine. Charmakeel has symptoms similar to Keloid, Pandu looks like Leukaemia, Apachi is nothing but older version of Hodgkin's Disease, Stanarbuda/Agantuja Stanaroga is now called Breast Cancer, Raktagulma has become Tumors of Uterus / Ovary in modern terminology, Swarabhangahas all symptoms of tumors of Larynx and Raktapitta, Pandu has all symptoms indicating Various Type of Leukemia.
A special cell for treatment of cancer has been opened up by Ayush for management of cancer in patients who are in 4th stage of cancer, those who were neglected by the mainstream treatment, those who do not want to go through chemotherapy and those patients who refuse to undergo the standard treatment for cancer at any cost. No one is refused treatment at this cell.
Where as in many hospitals after going through the significant side effects involved in standard treatment of cancer, which include hair loss, skin rashes, body pain, loss of body weight, weakness and debility, loss of appetite, diarrhea, bleeding, impotence, etc. the patient may be considered terminal in case the cancer is not controlled. Often the patients in the final or terminal stage are not treated anymore but rather sent home where they then die a slow, miserable and painful death.
This is where Ayurveda can step in to ease the experience of a dying cancer patient which can be ameliorated by making use of Ayurvedic principles. Ayurveda can be helpful in the management of cancer in many ways such as—prophylactic, palliative, curative and supportive. Ayurvedic medicines help to improve the quality of life of the patients. Ayurvedic preparations can act as an adjuvant or a co-therapy along with chemotherapy or radiotherapy and not as an alternative treatment to cancer. It is also helpful in post-surgery care where the Ayurvedic medicines can be used to minimize the side effects of these therapies.
Pain management is one of the main aspects that are stressed upon by the doctors over there. Even a simple enema therapy can be effective in management of various illnesses, which was proved by the Dr. in Pune.
Ayurveda does not want to venture into the area where standard medicine can help a patient. This point was made very clear by Dr. Mangali. He stressed that Ayurveda came to the aid of those people who could not benefit by standard medical treatment. Their goal was to start cancer detection units in their hospitals. He also spoke about the contribution of Dr. Ibrahim Nagnoor of Kidwai in bringing about the revolutionary change in the different aspects in management of cancer.
The next speaker was Dr. Ajai Kumar, an oncologist who single handed had revolutionized cancer care, cancer management and cancer treatment in our country. With an astounding experience of 35 years in the field of oncology, there was no other better person to give his views on management of cancer.
He spoke about the way cancer is addressed in our society which has added fuel to already burning fear about cancer. Any negative happening or bad incidences are referred to as cancer, for e.g. corruption is referred to as cancer of society, which creates an image of cancer to be something to be dreaded in the mind of the people. Such term should be avoided by the media, so that the word cancer stops sending fear among the masses. It is important to redefine the terminology used in regard to cancer.
Treating cancer the right way, the first time, is a philosophy that can change the face of cancer care in India according to Dr. Ajai Kumar.
He narrated an incident that had taken place in Chicago in way back 1975 when he was an enthusiastic young doctor. His first patient, a woman with breast cancer named Phyllis, was scared and shocked with her diagnosis which said she was terminally ill. Though hesitant initially, the Doctor initiated talks and slowly she started opening up to him. She asked the question finally, “I am terminal?” There is no definite meaning for the word terminal, as it defined by how a person lives his/her life rather than by how long they live.
The patient wanted to do many things in her life before she died. The doctor encouraged her to get treatment and then go ahead and do whatever she wanted to do. The treatment began in 1978 and she went on to live for eight more years. She did every physical activity and other things on her bucket list before she finally succumbed to illness. Dr. Ajai Kumar recalled the days in sentimental tone, “in 1986 I came to India on a short visit. When I returned it was on a Sunday. She was waiting for my return, so I went to meet her. The cancer had taken its toll on her body and she was weak. She thanked me for the 8 years of life, in which she had done all she wanted. She died the same night,”
No matter how much of philosophy a person reads, dealing with survivor is the true lesson of life that no philosophy can teach them. He also spoke about the Cobalt units which are used in treatment of cancer. He spoke about the advantages of Linear Accelerator over the cobalt therapy. With development of Linear Accelerators the Cobalt treatment has been phased out in most part of the world. Cobalt does not focus on the tumor or cancerous tissue, but will possibly cause damage to healthy tissue around the cancer growth. In Linear Accelerator, more focus can be obtained and the radiation that can spill over on the normal tissues is to the minimum bearable extent.
Though he stressed on early detection, he said it was easier said than done. How are we going to screen 1.2 billion people for cancer, to detect it early? He stressed upon the early detection of recurrence of cancer too, which has been one of the highest killer.
He again stressed on the wrong terminology used even by doctors when referring to people going through cancer treatment. Words like survivors, palliative care, terminally ill, advanced stage etc tells the patient that their days are numbered. Even at the stage 4, there are different levels in the progression of cancer. All cannot be grouped into single unit. For people who are dealing with heart disease, diabetes, asthma etc, which does not have a cure, yet no one refers to as survivors, under palliative care of terminal kind of terminology. When no one says a victim of diabetes or asthma, why say ‘cancer victim’ was the question asked by Dr. Ajai Kumar. Redefining cancer in terms and make it a chronic disease was the goal to be perceived and achieved by all the medical practitioners.
Cancer is no more a deadly disease. Nearly 80% of Breast Cancer survivors are living for more than 6 years. The amazing feat has been achieved by right treatment the first time. This also proves less financial burden on the patient in the long run.
Patients nowadays have access to internet where they can search for guidance and treatment options. Unlike most of the doctors who are for organ removal, Dr. Ajai Kumar stands out with his views where he considers removal of an organ is unethical. In fact he goes on to explain that conservation of breast in breast cancer cases is easier, when compared to going for total radical mastectomy. The fear of organ removal makes many people hesitate to approach the doctors for treatment. Breast is an important part of women and her sensuality. Does anyone bother how her life, especially her married and sexual life is affected after removal of breast? The concern for such a sensitive topic coming from an experienced oncologist was very touching.
Pain management is easy to achieve, quality of life is not that easy. The need of the hour is to concentrate on providing a good quality of life to patients after they have been through cancer. Many people associate cancer with pain and fear the pain. Pain is not a big issue, as it can always be controlled with pain killers, quality of life cannot be corrected with a pill. Dr. Ajai Kumar stressed that we cannot take away the good quality of life a person has every right to enjoy just because he/she has cancer.
Cancer is not a stigma or dangerous monster which attacks to kill, but just a lifestyle disease. It should be treated as such, without using excessive terminology like victims and survivors. The fear of cancer should be overcome. People hide the fact that they have cancer fearing their daughter will not get married.
Sometimes it should be considered whether it is really worth taking the treatment, because cancer treatment itself can be harsh on the patient. Sometimes the Cancer centers are nothing more than waiting for death centers where people just wait for their turn to die. Many doctors consider cobalt to sufficient in treating cancer, when better treatment cannot be afforded in a poor country like India.
He pointed out that despite advancements in radiation oncology, Cobalt therapy still remains the mode of treatment for the poor people in India. Its wider use in developing countries like India, among the poor patients warrants for its production, though it is phased out in the developed world. “It’s unfair to deny such facilities for the poor. But certainly we need effective treatment models. For instance, Linear Accelerator may not be a new thing. Old models are in use. What we have done is to create an independent treatment centre and allow everyone to access it,” said Dr. Ajai Kumar very passionately.
Dr Ajai Kumar talked about the decision of bringing in Linear Accelerator to BIO and bringing in the mode of treatment models that enabled everyone to go for a sophisticated treatment.
With advancement of treatment, it has been possible treat more tumor and less normal tissue. The target of therapies is only cancer cells. The right treatment with right technology is controlling cancer without many side effects. While Cobalt therapy can still be used in palliative care, he feels advanced therapy is imperative in cases of definitive cure.
Financial burden of cancer treatment is another topic, which usually doctors do not like to discuss, but Dr. Ajai Kumar even ventured into that area. So how are the hospitals going to treat everyone, even the ones who do have any enough money to afford the treatment? He brought a good solution for the complicated in the form of capacity utilization. The screening like PET would be made available at lesser cost or free at late hours. Those who can afford it can approach the hospitals at the convenient time like 11 a.m. whereas those who cannot afford it can approach the hospital at 11 p.m.
In this regard, Dr. Ajai Kumar has taken steps at the HCG to treat all patients that approach the hospital for treatment, without sending back anyone disappointed neither is the patient deprived of the quality of treatment due to financial constraints. Various methods have been adopted by the hospital like giving concessions on ward, nursing charges to make the treatment affordable and within the reach of every person.
With tie ups with pharmaceutical companies, the hospital has been able to provide free medicines to the patients. Also relief comes in form of EMI payments, for those who cannot afford to pay at one go.
All the achievements have been done without any grant or support from the government. That is something that needs a big applause.
Though people complain about financial burden of treating cancer, the doctor pointed out that India has the cheapest treatment option available to people. Even in Africa the expense is almost 3 times higher than in India.
The failure of the government is what that has let the medical professionals down in our country. Countries like S.A and Vietnam have changed their policies of health care and shown great improvement.
Cancer care should be available to everyone. If the cancer hospitals are located only in few cities, how will the people in the rural area afford treatment? As the standard treatment may last for more than 6 months, the poor farmers may have to sell farms to get treated at places far away from their homes. Even when they survive and go back home, poverty and burden of earning livelihood itself can kill them. Providing cancer care hospitals near to their homes can help them continue with their work and life when they are being treated. The target goal should be to provide accessible, affordable and high quality treatment to every person of the country.
Treatment of cancer cannot be standardized. There are different types of patients who will require treatments according to their diagnosis, personal health condition and other conditions. 5 patients who were diagnosed with Breast Cancer were given different treatments as they had different needs. Individual, tailor made models of treatment for every patient is what proves to be effective in the long run.
Gone are the days of mastectomy, colostomy and amputations, as doctors now resort to remove only what they have to, not the whole organ. Dr. Ajai Kumar again stressed on the fact that it is easy to remove only the cancerous tumor, than removal of whole breast. He showed the audience details about the limp salvage surgery performed on a young patient through the replacement of fibula. With proper intervention, it was possible to give the young patient a good quality of life.
Decision about the treating patients cannot be made in haste. There is no way a doctor can decide what the patient needs in 5 minutes. The doctor has to look at the reports, the pathology test results, general health of the patient before deciding what can be done to manage cancer in the best possible way. No cancer is going to grow overnight, and he stressed that there is no need to hurry up with the treatment without thinking over it properly. There is no hurry to remove the stomach, as was mentioned to one of the patients who approached him from Chennai, nor is there any emergency to remove the breast assured the doctor who had such vast experience on the subject. The proper plan of treatment to be executed can make a world of difference to the quality of life of the patient.
A doctor himself, he went on to question why the doctors discriminate between the patients and their family members. Will a doctor recommend the same treatment to his wife or sister that he had recommended to his patient? This was something very perplexing and bothering as it questioned the ethics and principles of the medical profession itself. The patient trusts the doctor totally, when they do not guide them properly, than it is the biggest disservice they are doing to their profession.
There is no cure for cancer, but every patient can live with the disease symptom free. Cancer can be treated like any other chronic disease.
He also talked about the efficiency of the Indian doctors. The finance minister of Tanzania had once visited India for treatment. When asked why he had chosen India over all the developed nations, he said when he visited the developed nations, all the efficient doctors working in those hospitals were from India, so he decided why not go to their homeland itself for treatment and came over here.
He also explained in detail about the advantages of Digital Mammography, laser capture micro-dissection (LCM), PET Scan, CT scan, FDG procedure where fludeoxyglucose is injected into a patient to aquire images of the distribution of FDG around the body. The images are later assessed by a nuclear medicine physician or radiologist to provide diagnoses cancer. He also went ahead to explain the advantages doctors have now with MRI,PET and other advanced types of screening procedures which assist them in treatment.
Technologically it is now possible to predict occurrence of cancer through the BRCA1 and BRCA2 genes.BRCA1 and BRCA2 are human genes that belong to a class of genes known as tumor suppressors the mutation of which has been linked to hereditary breast and ovarian cancer.
Prevention is better than cure. It is good to eat healthy food and follow a healthy lifestyle to prevent cancer as much as possible. People who eat out cannot have healthy diet. He even joked about the waiter who told him he will put only pure butter on the dosa when asked not to use too much of oil. Unfortunately, tasty food is not always healthy food. The incidences of Breast Cancer being less among the rural women indicate that it is a lifestyle disease that can be controlled.
Prevention should be the primary goal in cancer management, where as screening and treatment can take secondary place. Smoking contributes to high incidences of cancer. Dividing the types of cancer and categorizing them on demographics will help in prevention of cancer to a great extent.
Pesticides have been contributing to incidences of cancer. He narrated a incidence when he had visited farmers growing cauliflowers, who had dipped the vegetables in the pesticides to get rid of the worms. There has been nearly 40 % increase in cases of cancer due to herbicide and pesticide used by the agriculturists. Carbonated drinks another promoters of illness and cancer.
People who carry on their lives with positive attitude usually remain healthy. Even if illness cannot be cured by will power it will help in overcoming any kind of disease to a great extent. Chronic stress promotes tumor growth and Angiogenesis in the mouse models which were experimented upon. He also explained how yoga and alternative treatments can help in success of cancer management in a better way by increasing the tolerance of the body to the medicines.
The most amazing part of the presentation came when he spoke about the how mind can master the body. For the first time I was listening to a medical professional who talking about alternative therapies in treatment. Everyone says be positive, but for the person going through cancer being positive is not easy. Understanding the psychology of cancer was very important. If was not important to just add years to life but important to add life to years. With all the advancement in medical technology, we have not even touched the surface of cancer care. There are other fields to be explored and brought together to create a perfect solution to management of cancer.
The presentation of Dr. Ajai Kumar ended with a big applause given to an oncologist who was unbiased in his speech, going ahead to even promote other therapies and process in treating cancer.
The Technical Session started with the introduction of Dr.G.K. Kallur, Director PET-CET, HCG Cancer Care Network, Bangalore by Dr V.S.Dixit, Retd. Director General of Medical Services (Indian Navy)
Topic :- Early Detection Of Cancer – Symptomatic Manifestations and Clinical Diagnosis.
Dr. Kallur has twelve years of experience in the field on Nuclear Medicine who had established Nuclear Medicine Department at HCG. Serving as the Director of Nuclear Medicine since Aug 1996m he has received advanced training in PET imaging, Nuclear Cardiology, and SPECT at Rush Presbyterian St. Luke’s Medical College and University, Illinois, USA.
His areas of interest are – Cardiovascular Imaging, Pulmonary Imaging, Hematologic Imaging, Endocrine system, Central Nervous system, Cerebrospinal fluid dynamics, Bone Imaging, Liver and spleen, Hepatobilliary, Gallium Imaging, Genitourinary Imaging and Therapeutic Nuclear Medicine. He played a significant role in establishing India’s first FDA compliant Cyclotron and PET Radiopharmaceutical unit.
Dr. Kallur began his presentation with applauding Dr. Ajai Kumar for covering up almost every topic in management of cancer.
Prevention and early detection of cancer was necessary for prevention of cancer deaths. The cases that come to him were already in very advanced staged said Dr. Kallur regretfully. It is difficult to draw a line and send the patients to hospice telling them there is nothing much a doctor can do for them.
Usually the patient who are going through cancer, first approach the local physicians who keep treating them for the symptoms. When the symptoms do not subside, they often keep changing doctors and medicine. Finally when they come to the realization that they are suffering from cancer, often it is too late for a cure.
Cancer is preventable as 80 – 90 percent of cancer is caused due to bad habits and unhealthy lifestyle. Cancer may start on one site, but will go on involving and spreading to other parts of the body.
70-80% of cancer is detected quite late in our country, which makes it impossible to control the cancer growth. Early detection may not actually cure all cancers, but it can cure some cancers. There are only a few types of cancer that can be prevented or diagnosed early enough to make treatment more successful. These include breast cancer in women, cervical cancer, lung cancer, melanoma, colorectal cancer, and prostate cancer.
Whether we like it or not, we want it or not, cancer affects each one of us directly or indirectly at some point in our lives. Preventing cancer is easier than you may think. Through simple lifestyle changes, we can reduce our risk of developing many types of cancer. The points to keep in mind to prevent occurrence of cancer are as following:
1. Avoid smoking, whether it is actual smoking or secondhand passive smoke. Though people know and keep hearing how bad cigarettes are for health, and increase the risk of lung cancer they do not stop smoking. Smoking is the most significant risk factors for cancers that we can reduce. Smoking not only increases the risk of lung cancer but will also increase the risk for many other cancers including esophagus, larynx (voice box), mouth, throat, kidney, bladder, pancreas, stomach and cervix. About 70% of the lung cancer can be ascribed to smoking alone. Second-hand smoke (SHS), also known as environmental tobacco smoke, has been proven to cause lung cancer in non-smoking people. Smokeless tobacco which is consumed various causes oral, esophageal and pancreatic cancer. Consumption of tobacco in any other forms like Gutka or Zarda is one of the main reasons for increase in oral cancer cases. Dr. Kallur mentioned that betel nut contains carcinogens also and therefore chewing them should be avoided.
2. Including fruits and vegetables which are rich in antioxidants in the daily diet will help repair the damaged cells. Green vegetables, orange and yellow fruits are foods that will help in prevention of cancer. Diet has been proven one of the risk factors for cancer though there has been no substantial proof of it. Some studies show that fruits and non-starchy vegetables may protect against cancers of the mouth, esophagus, and stomach. Fruits are known to protect against lung cancer. Diet which is high in fat and low in fiber, fruits and vegetables increases the risk of colorectal cancer. Watch the meats you eat, especially smoked or cured foods. Research suggests that a diet high in animal fat can lead to the development of certain cancers. A diet high in smoked foods, salted fish and meat, and pickled vegetables increases the risk factor for cancer.
3. Air pollution and exposure to chemicals and other harmful substances in the environment is linked some types of cancer especially air pollution. Air pollution can be in form of second hand tobacco smoke, outdoor air pollution due to vehicles, industries and asbestos. Contamination of water due to arsenic has increased risk of skin, bladder and lung cancers. Also the pesticides used on food products are carcinogenic. Exposure to Sunlight is another risk factor for skin cancer. It is better to avoid direct exposure to sunlight, especially when the sun is high in the sky.
4. Drinking excessive amounts of alcohol regularly increases your risk factor for cancer. People who drink and smoke get double dose of risk factor for cancer of oral cavity, pharynx, larynx and esophagus. Studies suggest that men who consume 2 alcoholic drinks per day and women who have 1 alcoholic drink per day significantly increase their risk factors for certain types of cancer. High intake of coffee and tea is also considered to increase the risk factors of cancer.
5. Obesity is another risk factor for cancer. An overweight person has highly increased chances of developing cancer, therefore keeping weight under control and regular exercise is a good defense against cancer. According to the report published by WHO, regular physical activity and the maintenance of a healthy body weight, along with a healthy diet, will considerably reduce risk of cancer.
6. Development of industries has contributed to development of cancer to a great extent. Moreover some of the environment in industries creates occupational carcinogens that increase the risk factor of cancer of the lung, bladder, larynx and skin, leukemia and nasopharyngeal cancer. Mesothelioma (cancer of the outer lining of the lung or chest cavity) is to a large extent caused by work-related exposure to asbestos. Dumping chemical wastes of industries into water has not only increased the risks of cancer, but has led to many other health hazards as well. Workers who are exposed to Gasoline, diesel exhaust, arsenic, beryllium. vinyl chloride, nickel chromates, coal products, mustard gas, and chloromethyl ethers run the higher risk of developing cancer as all these products are carcinogens.
7. The atom bomb that was dropped on Japan had given birth to various cancers, which is being suffered by generations even after decades of exposure. Exposure of the fetus to X-rays has led to lots of childhood cancers. It is best to avoid exposure of pregnant women to any kind of radiation. According to the report published by WHO “Ionizing radiation is carcinogenic to humans. Knowledge on radiation risk has been mainly acquired from epidemiological studies of the Japanese A-bomb survivors as well as from studies of medical and occupational radiation exposure cohorts. Ionizing radiation can induce leukaemia and a number of solid tumours, with higher risks at young age at exposure. Residential exposure to radon gas from soil and building materials is estimated to cause between 3% and 14% of all lung cancers, making it the second cause of lung cancer after tobacco smoke. Radon levels in homes can be reduced by improving the ventilation and sealing floors and walls. Ionizing radiation is an essential diagnostic and therapeutic tool. To guarantee that benefits exceed potential radiation risks radiological medical procedures should be appropriately prescribed and properly performed, to reduce unnecessary radiation doses, particularly in children.
Ultraviolet (UV) radiation, and in particular solar radiation, is carcinogenic to humans, causing all major types of skin cancer, such as basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. Globally in 2000, over 200 000 cases of melanoma were diagnosed and there were 65 000 melanoma-associated deaths. Avoiding excessive exposure, use of sunscreen and protective clothing are effective preventive measures. UV-emitting tanning devices are now also classified as carcinogenic to humans based on their association with skin and ocular melanoma cancers”.
8. Certain viruses, notably human papillomavirus (HPV), cytomegalovirus (CMV), herpes simplex virus (HSV) and Epstein-Barr virus (EBV), are known to produce tumors in animals and cell transformation in vitro and they have been implicated in the pathogenesis of human cancers. All these viruses are also known to infect the esophagus. It is important to talk get immunized against infections to reduce not only the risk of cancer, but the infection itself. Hepatitis B can increase the risk of developing liver cancer. The hepatitis B vaccine which is routinely given to infants can also be administered to certain high-risk adults — such as adults who are sexually active but not in a mutually monogamous relationship, men who have sex with men, and health care or public safety workers who might be exposed to infected blood or body fluids. Human papillomavirus (HPV) is a sexually transmitted virus that can lead to cervical cancer HPV, in addition it may also increase the risk of cancer of the anus, penis, throat, vulva and vagina. The HPV vaccine is available to both men and women age 26 or younger who didn't have the vaccine as adolescents. Avoid risky behaviors that can lead to infections that, in turn, may increase the risk of cancer. Having sex with multiple partners without a condom increases the chances of contracting sexually transmitted infection — such as HIV or HPV. People who have HIV or AIDS have a higher risk of cancer of the anus, cervix, lung and immune system. Sharing needles should be avoided as it can lead to HIV, as well as hepatitis B and hepatitis C — which can increase the risk of liver cancer.
9. Though not all, some of cancers can be genetic. Therefore it is important to know the family history of cancer which helps a person to take better measures towards prevention. It can also aid in genetic testing and counseling, to assist the individual in finding out if the presence of a mutated gene that increases risk factor for cancer.
10. Regular screening tests like the Pap smear and mammogram for are a woman, and a DRE (digital rectal exam) if for a man are very important for early detection of cancer. The Pap and DRE can detect cellular changes before they become cancerous, and the mammogram may be able to detect breast cancer early. A rectal exam should be part of a woman's yearly gynecology exam.
Cancer in the early stages may not show up any symptoms, by the time the symptoms surface, the cancer will be in advanced stage. Cancer silently develops inside the body, only when it grows enough to press on nerves does it produce pain. At times cancer penetrates blood vessels and cause bleeding or may disrupt normal functions of organs.
In its early stages, cancer may have no symptoms, but eventually a malignant tumor will grow large enough to be detected.
As it continues to grow, it may press on nerves and produce pain, penetrate blood vessels and cause bleeding, or interfere with the function of a body organ or system.
In early stages the doctors will be able to provide better treatment to patients, where as in advanced stages it may not be possible. Also the financial and psychological burden increases with the advancement of cancer.
Dr.Kallur also mentioned the 7 danger signs that helps and medical practitioner or person going through it to detect cancer.
C - Change in bowel or bathroom routine and habits
A – A sore that does not heal with medications
U - Unusual bleeding or discharge
T - Thickening or lump in the breast, testicles, or elsewhere
I – Indigestion or difficulty swallowing
O – Obvious change in the size, color, shape, or thickness of a wart, mole, or mouth sore
N – Nagging cough or hoarseness
In addition to the above, other danger signals which warn about the presence of cancer are
· Sudden weight loss
· Loss of appetite
· Chronic pain that does not heal with time
· Nausea and vomiting
· Fever that persists
· Repeated infections
Seizures, sleepiness, confusion, and behavioral changes can be symptoms of brain tumor; fortunately not all brain tumors are cancerous. Persistent hoarseness, soreness in the neck, difficulty in swallowing can be indications of esophagus cancer.
Usually in cases breast cancer there are no symptoms initially, but as the cancer progresses there could be appearance of a breast lump, Nipple discharge or redness Breast or pain in nipple, swelling of part of the breast or dimpling. Breast cancer stages range from early, curable breast cancer to metastatic breast cancer, with a variety of breast cancer treatments.
Ovarian cancer in early stages may not cause obvious symptoms but as the cancer grows, symptoms like pressure or pain in the abdomen, pelvis, back, or legs, swollen or bloated abdomen, nausea, indigestion, gas, constipation, or diarrhea, fatigue may surface. In addition the patient may have shortness of breath, heavy periods, or bleeding after menopause and frequent urination. These symptoms are sure signs of cancer, and only an oncologist or efficient doctor will be able to assure absence of cancer.
Risk factors for ovarian cancer are family history of cancer, personal history of cancer, age over 55, women who have not been through pregnancy and menopausal hormone therapy.
The risk factors of breast cancer are age, family history, personal history, benign breast conditions, early menarche, late menopause, dense breast tissue, race, exposure to radiations, having no children, not breast feeding, obesity, oral contraceptives, hormone therapy, alcohol consumption and lethargic lifestyle.
The symptoms of cervical cancer may include abnormal vaginal bleeding, discharge that may have mucus and be tinged with blood, significant change in menstrual cycle, bleeding or pain during sex.
As the cervical cancer progresses the symptoms may include anemia, pelvic, leg, or back pain, difficulty in urinating due to blockage of a kidney or ureter, leakage of urine or stool into the vagina due to abnormal opening (fistula) between the vagina and the bladder or rectum, and weight loss.
Risk factors for cervical cancer include, an ongoing infection of human papillomavirus (HPV), high-risk sexual behaviors, having an impaired immune system, exposure to diethylstilbestrol (DES) before birth smoking, and secondhand smoke.
Most of the cases of Anal cancer are mistaken for piles and fistula by people which prevents them from approaching oncologists until the cancer advances to untreatable stage. Symptoms of Anal cancer include
· Appearance of tumor near anal opening
· Bleeding from the anus or rectum
· Feeling of pain or pressure in the area around the anus
· Itching or discharge from the anus
· Change in routine of bowel movements
The risk factors for anal cancer is age over 50 years, infection of HPV, multiple sexual partners, receptive anal sex, inflammation around the anus, fistulas and sore that have been ignored and smoking cigarettes.
The tests can be conducted either by digital rectal examination (DRE), Anoscopy, Proctoscopy, Endo-anal or endorectal ultrasound and Biopsy to rule out cancer.
The barium exam was the only choice in earlier days, before the introduction of endoscopy. The barium swallow is still being used for some purposes, one of which is the study of strictures in the oesophagus as an adjunct to other techniques.
Colon cancer is related to high consumption of red meat among people. The type of cancer which was seen mostly in developed countries has been on rise in India in recent times. Studies show that the increasing consumption of western style food with less fiber may be one key contributing factor for the change which is affecting mostly the young generation of India.
Presence of polyps as small, non-cancerous (benign) clumps of cells) in the colon can be cancerous in later stages. Changes in lifestyle like consumption of diet rich in fat and starch without fiber, not much physical activity, smoking, alcohol consumption, family history of colon polyps and history of inflammatory bowel disease (two diseases Ulcerative Colitis & Crohn’s disease are known risk factors of colon cancer.
The signs and symptoms for colon cancer are also common in other diseases; therefore without proper tests the presence of cancer cannot be determined.
Persisting diarrhea, or change in consistency of stool, bleeding from rectum, blood in stools, pain and discomfort in abdomen, pain during bowel movement, feeling of fullness even after passing of stools and weight loss are the symptoms that may indicate colon cancer.
Thickening of the skin of breast or symptoms like redness, swelling, and warmth in the breast, often without a distinct lump in the breast could be indication of inflammatory breast cancer. The redness and warmth are caused by cancer cells blocking the lymph vessels in the skin. The skin of the breast may also appear pink, reddish purple, or bruised with ridges that are pitted, like the skin of an orange (called peau d’orange), which is caused by a buildup of fluid and edema (swelling) in the breast. Symptoms like heaviness, burning, aching, increase in breast size, tenderness, or a nipple that is inverted (facing inward) are also indication IBC.
Dr. Kallur went to explain how to check for the changes in wart or mole, appearance of skin and watching out for other signs that may indicate cancer.
He also talked about the new treatment options like immunotherapy, gene therapy and other options that are being seriously considered now in management of cancer.
After the lunch session was dedicated to holistic medicines. The first topic covered was Ayurvedic Identification and Conceptual Analysis of Cancer by Dr. B.V. Kumaraswamy, Retd. Professor and Head : Indian Medicine Kidwai Memorial Institute of Oncology.
After the lunch session was dedicated to holistic medicines. The first topic covered was Ayurvedic Identification and Conceptual Analysis of Cancer by Dr. B.V. Kumaraswamy, Retd. Professor and Head : Indian Medicine Kidwai Memorial Institute of Oncology.
Dr. Kumaraswamy went to explain the role of Ayurvedic treatment strategies for cancer management and its relevance in modern oncology.
He attributed the cause of cancer to technology and modern development taking place in the society which has brought in along with it carcinogens. Studies conducted so far have shown that cancer has risen dramatically since the Industrial Revolution, particular childhood cancer – proving that the rise is not simply due to people living longer.
Taking example from the quotes of Bhagavad Gita, Dr. Kumaraswamy explained the importance of mind power and the influence it can have on our lives. He also quoted Charaka who had mentioned the qualities required by a person to become a physician.
Charaka says the person who can become a physician should have excellent medical knowledge, should posses experience, should have dexterity and should be pure.
There are numerous cases of cardiovascular disease in our times. In the past we never heard young people dying of heart diseases, but now the age of people affected by heart problems is coming down. Though cancer and many maladies are afflicting humans now, the Acharyas of the past spoke about them. It is amazing to note that they had extensive knowledge of the problems that were not prevalent in their times.
He spoke about the scientists who had been awarded noble prize for their research. The research was already present in the book written by Shushruta.
Few years ago the hazards of led in petrol was discovered. The use of lead additives in gasoline has been one of the main contributors to the exposure of urban populations to lead. Children in developing countries may be particularly vulnerable to exposure because they spend a significant part of their time on the streets, and often lack proper nutrition that increases their susceptibility to lead poisoning. With the phasing out of led everyone were happy, but unfortunately Dr. Kumaraswamy says the replacement of led has more carcinogenic substance in them.
Ayurveda describes cancer as inflammatory or non-inflammatory swelling and mention them as either Granthi (minor neoplasm) or Arbuda (major neoplasm). Ayurveda defines three body-control systems, the nervous system (Vata or air), the venous system, (Pitta or fire), and the arterial system (Kapha or water) which mutually coordinate to perform the normal function of the body.
Malignant tumours (Tridosaja) are very harmful because all the three major bodily systems lose mutual coordination and thus cannot prevent tissue damage, resulting in a deadly morbid condition.
He spoke extensively about Dosha, Dhatu and Ojus which are the three main constituents of our body. When there is proper balance among these constituents, the body will be in equilibrium and healthy. Imbalance in them will lead to disease and death.
There are in all seven dhatus in the living body, namely, Rasa, Rakta, Mansa, Meda, Asthi, Majja and Shukra. Dhatus are the main physical constituents of the body and are responsible for the maintenance of physical state of the body.
Dosha controls the physiological activities of the body and is responsible for pathology. It is one of three bodily humors that make up one's constitution. Ayurveda states that good health exists when there is a balance between three fundamental bodily humours or doshas called Vata, Pitta and Kapha.
Ojas is the cream present in every cell of the human body which is the essence that gives the tissues strength and endurance, the force that keeps the tissues healthy. Composed primarily of earth and water and produced from the essence of Shukra, Ojus is known as the force of stability which provides the body with the ability to fight against disease. When the Ojus is strong, there is absence of illness as no disease can affect the body. Ojus is also known to stabilize the mind and keep it in peace. Ojas is the sap of one's life energy which, when sufficient, is equated with immunity and, when indeficient, results in weakness, fatigue and ultimately disease. Medical science is yet to identify the correlate of ojas.
Ojas is diminished by under eating, overeating, eating when previous food has not yet been digested, consumption of poor quality food that results in the blocking of the channels, consumption of stale foods, canned foods, fermented foods like cheese, meat, irregular diet, excessive exercise, fasting, negative emotional stressors such as anxiety, anger, sadness, grief, hatred, jealousy, long held resentment, fear, grief, consumption of alcohol, smoking, lack of sleep, excessive discharge of mucus, blood, semen and other excreta, with age and injury by other organisms, undue exposure to wind and sun, excessive sexual activity.
Endogenous and exogenous toxins causes severe damage to Ojas according the Ayurvedic etiology. When the Ojas is damaged the Vish bypasses Doshas and attacks Dhatus thus causing illness and diseases. The latest trend where people are served fruit salads and ice-cream is very wrong method as creates imbalance in digestive system. Frozen food is not good for health.
Earlier in Samudra Manthan first there appeared Halahala a poison and then amruta, but nowadays we have only vish no amruta anywhere with our spoilt lifestyles. Visha damages Ojas and Raksha. Virudda Ahara and Vishama ahara are the wrong diets that lead to illness. Ayurveda has classified food into five type of wrong diets.
1. Quantitative dietary deficiency - This includes under-nutrition due to insufficient food, and even starvation
2. Qualitative dietary deficiency- This includes wrong food combination which results in malnutrition, toxic condition and lack of essential nutrients.
3. Qualitative and quantitative over- nutrition - This includes emotional overeating which can result in obesity and/or high cholesterol which can lead to hypertension, heart attacks or paralysis.
4. Toxins in food - Certain foods and food combinations lead to toxemia and to certain digestive disorders.
5. Foods not suitable to one's constitution may affect natural resistance and cause disease.
The pathogenesis of cancer has 5 phases
Induction phase – 15 -30 years
In Situ Phase – 5-10years
Invasion phase – 1-5 years
Dissemination Phase – 1-5 years
Sushruta has proposed six stages in the pathogenesis of all diseases, but his concept suits more to the pathology of the tumor than the pathogenesis itself.
Sanchaya : Early stages of localized neo plastic changes
Prakopa: Transformation of primary growths into metastatic tumors
Sthana samsraya: Complete metastasis and secondary growth
Vyakti: Clinical signs and symptoms are expressed
Bheda: The stage where differentiation of growth occurs on the basis of histopathology
Treatment Strategies followed in Ayurveda for cancer
· First it aims at elimination of Doshas
· Removal of toxins and purification
· Restoring balance among doshas and dhatus
· Reorganize dosha dhatu and mala.
In short we can say that Ayurveda overhauls all the pathways of all systems.
Therapy Strategies of Ayurveda include
· Poorna Karma
· Pradhana karma
· RT and Rasayana
· CT and Rasayana
· Agni Karma or Radiation
Ayurveda advocates a specific procedure called Shodhana which is a purification process to remove toxins.
All rasayana remedies described in Ayurveda are considered as promoters of ojas. There can be varying degrees of specificity of the effects of Ayurvedic rasayanas even on nutritional dynamics. There are rasayanas which may have specific beneficial effects on specific organs and tissues such as the brain, heart, skin, eyes, hair etc. These are classically called medhya rasayana, hrdya rasayana, tvacya rasayana, caksusya rasayana and kesya rasayana. They may be specific medicinal nutrients for the respective tissues and hence, promote their health.
With the help of proper ayurvedic treatment studies have shown that 50% need of radiation comes down. Dr. Kumaraswamy explained how ayurveda can help in control and treatment of hematological malignancies also.
The rejuvenator group of herbal medicines in Ayurveda is termed as 'Rasayanas'. The micronutrients, which are one of the key ingredients of Rasayanas, are beneficial to the body, because they improve health, immunity, vigor, vitality and longevity of life. The branch of rasayana or rejuvenation is one of the eight specialized branches of Ayurveda that primarily deals with the maintenance of health. Rasayana is defined as any herb, food, or activity which confers youthfulness and cures diseases. If taken in a proper way, the rasayana prevents early aging and keeps you young and active both physically and mentally.
Meditation and music goes a long way in helping the person to heal.
Dr. Kumaraswamy explained the important of using spices while cooking food, as most of them had specific medical properties. Chilli, which is harmful spice, is not origin of Indian culinary diet. He also elaborately explained the importance of the morning rituals which also had medical healing powers. He also explained the importance of pachamurta and tamboola.
Significance of the ingredients of Panchamrut/Panchamrit/Charnamrit
Milk is for the blessing of purity and piousness.
Yogurt is for prosperity and progeny.
Honey is for sweet speech.
Ghee is for victory.
Sugar is for happiness.
Water is for purity.Overall it was a very good holistic view of Indian ways and Indian medicine which can help people