Cancer – what we all need to know

Question: Is Cancer Curable?

Answer: Yes, cancer is curable, if detected early and treated promptly by cancer experts as per standard treatment guidelines, preferably at NABH accredited cancer hospitals. Thirty percent cancers prevalent in India cannot be detected at an early stage and therefore are not curable. Therefore, our focus should always be to concentrate on 70% cancers which can be detected early by self examination and annual cancer check ups, which should be mandatory for all of us.

Question: Why do people call Cancer Incurable?

Answer: Unfortunately maximum number of patients report to hospitals very late due to following reasons:-

• Lack of awareness leading to delayed diagnosis.
• Delay in starting treatment due to misperceptions and misguidance.
• Incomplete treatment which can be due to inadequate surgery without lymph node clearance or positive margins of the specimen removed during surgery.
• Non-compliance of prescribed treatment e.g. if radiation or chemo is advised. patients/families do not start treatment on time leading to progress of the disease.
• Lack of regular follow ups to detect recurrence at an early stages.

Because of the above mentioned factors about 60-70% patients become incurable when they come for treatment. This large percentage of patients and their families therefore start spreading the message that cancer is incurable.

Question: Is it advisable to treat advanced disease or patients should be left alone?

Answer: There is no straight answer to this question. Stage III and stage IV patients, who have advanced disease, are reviewed by a panel of cancer experts i.e. Medical Oncologists, Radiation Oncologists, Surgical Oncologists, Gynae Oncologists, Paediatric Oncologists, Onco-pathologists, Radiologists and Imaging experts in the tumour board. Depending on the Physical condition of the Patient and performance status final decision is taken about starting palliative therapy.

Question: What is Palliative Therapy?

Answer: Palliative Therapy is given to relieve symptoms and make the patients comfortable. The mean objective of Palliative therapy is to relieve pain and improve the performance status of the patient.

Types of Palliative Therapies:

1. Palliative surgery: – If the patient is not able to swallow food or water. A tube is inserted directly into the stomach so that patient can be given food and water through the tube. This is called Gastronomy and is a Palliative Surgery.

2. Palliative Radiation: – If the tumour is pressing on the spinal cord patient develops severe pain in the back along with weakness of the lower limbs. If the pressure is not relieved in time, patient can become paralytic. Similarly Palliative radiation is given to the brain when brain tumour is causing weakness of the limbs to prevent paralysis.

3. Palliative Chemotherapy: – Palliative Chemotherapy is given in most of the cancer patients in advanced stages to decrease the progression of the disease shrink the tumour to prevent pain, pressure symptoms and Paralysis.

To relieve symptoms- For examine when patients with Cancer of the food pipe are not able to swallow food. Palliative Chemotherapy reduces the size of the tumour and patient is able to swallow solid and liquid food. Similarly in Cancer of the lung, patients become breathless. By giving Chemotherapy patients breathing improve considerably.

Palliative treatment has a vital role and can lead to a good quality of life for several years. Therefore Palliative treatment should be started to add quality to life.

Question: What is performance status?

Answer: Performance scoring is done as per the following criteria:

• Patient has good performance and can look after Self, Job and the family.
• Patient can manage to look after himself/herself but is unable to do any other work.
• Needs help to eat, drink, bath, dress etc. but is mobile.
• Has no control on the bladder/bowel

Question: Who is the best person to detect Cancer at an early stage?

Answer:

You yourself 10%

You family doctor and Gynecologist 60%

Cancer experts 30%

Question : Where should one go for cancer treatment?

Answer : Cancer treatment should be taken at dedicated cancer hospitals with NABH accreditation because of the following reasons :

Dedicated cancer centres have facilities for cancer prevention, early detection, staging work up, radiation, chemotherapies, Surgery, supportive care, palliative treatment and services of all other allied specialists to treat any other existing diseases in cancer patients. This ensures that patients are treated promptly without loosing precious time.

NABH accreditation ensures that hospital has the desired facilities, technology, manpower, quality and safety standards to ensure best treatment outcomes.

Question : What are the advantages of getting treatment at NABH accredited cancer hospital?

Answer : The advantages of getting treatment at NABH Accredited cancer hospital are as follows :

• Will to achieve the organization’s objective of winning cancer by improving cure rates and adding quality to life.
• Organization’s policies of working towards continuous quality improvement.
• Commitment to fight cancer by prevention, early detection and prompt treatment.
• Conducting teaching, training and research to achieve the above objectives.
• Continuous monitoring of systems and processes; internal and external assessments and audits of NABH standards and integrated ISO systems for quality, environment and safety as per ISO 9001:2000 and ISO 14001:2004 to ensure implementation of quality and safety standards.

Question : What is NABH Accreditation ?

Answer : NABH Standards for National Accreditation Board for Hospitals and Healthcare providers, which has been constituted by Quality Council of India. NABH has formulated a set of very stringent standards about care and quality of patients, management of medication, patient safety, infrastructure (building, technology, equipment, manpower standard), Medical audits, to evaluate the quality of care, documentation, medical errors etc. Accreditation assessment relies on establishing technical competence of healthcare organization in terms of accreditation standards in delivering services with respect to its scope. It goes beyond compliance. It calls for excellence on continued basis. Accreditation is also one of the established mechanism world over, and a means to promote acceptance of conformity assessment results, nationally as well as internationally. These standards are at par with International standards for hospital’s accreditation.

Question : Who should perform cancer surgeries ?

Answer : Cancer surgeries are highly complex surgeries and are best performed by surgeons who are trained as surgical oncologists and have done their M.Ch. Surgical Oncology or a higher organ specific surgeries. For best results, there are teams of Surgical Oncologists, Gynaecologists Urologists, Gastroenterologists, Plastic Surgeons, Maxillofacial Surgeons, Neuro Surgeons, Orthopaedic Surgeons and Laparoscopic Surgeons.

Question : Who should give chemotherapy?

Answer : Medical Oncologists are the best people to give chemotherapies for the following reasons : –

Medical oncologists are physicians who after completing their MD / DNB enroll themselves for a full time three years post doctorate programme DM / DNB medical oncology in prestigious cancer centres.

Their training and experience enables them to manage routine, serious and high risk patients requiring medical management of cancer and other associated problems.