(Author: Dr Amit Kumar Gupta, MBBS, MD, MBA)
Cancer is a serious and life-threatening health condition worldwide. Of late, it is emerging as a major public health problem in India also (here it has become one of the ten leading causes of death). Cancers of mouth, lungs, breasts and cervix make the largest proportion of this disease. The irony is that many cancers manifest late in an advanced stage when the disease has already spread from its primary site (organ of origin) to other organs (metastasis) thereby increasing the risk of further complications (including death). However, appropriate changes in lifestyle and other identified measures can help in prevention, early diagnosis and prompt treatment of many of such cases.
To raise awareness on cancer and encourage people for its prevention, detection, and treatment, we observe World Cancer Day on February 4 every year. Let’s know about cancer and how we can prevent and manage it.
Causes and risk factors
Although multiple factors may play roles and contribute, most cancers (90-95% of cases) are linked to environmental factors and only a small proportion (5-10%) occurs due to genetic factors.
Smoking and tobacco chewing: They form the single most important modifiable risk factor for cancer. In addition to the cancers of mouth, lungs, voice box, throat and food pipe, they can also lead to cancers of pancreas and kidneys. Passive smoking (second hand smoking) also results in increased risk of cancers among non-smokers exposed to tobacco smoke.
Alcohol: Alcohol intake is associated with cancers of liver, mouth, throat, voice box and food pipe. Alcohol and smoking habits together can further increase the cancer risk significantly.
Sexual and reproductive factors: These are associated with breast and cervical cancers. Sexual behaviour factors (like young age at first sexual activity, multiple sexual partners and poor sexual hygiene) and infection with the human papillomavirus (HPV) have been linked to cervical cancer. Late age at marriage, not having any kid and late menopause increase the risk of breast cancer.
Dietary factors: Diets high in fresh vegetables and fruits tend to reduce the risk for cancer whereas diets rich in animal fats (especially red meats) increase the risk. Other specific dietary factors linked to certain cancers include smoked fish, lack of dietary fibre, high fat diet and certain food additives & food contaminants.
Occupational exposures: They include exposures to benzene, arsenic, cadmium, chromium, vinyl chloride, asbestos, polycyclic hydrocarbons etc. The risk of developing cancer is higher among certain industry workers such as rubber tyres makers, textile workers, ship & dockyard workers, wood workers and those working in chemical & pharmaceutical plants. The risk increases further in smokers.
Certain viral infections: They include chronic infections with hepatitis B and C viruses (liver cancer), HIV (Kaposi’s sarcoma, non-Hodgkin’s lymphoma), HPV (cervical cancer), certain other viruses.
Genetic factors: Primarily, they are inherited genetic defects (mutations). Carriers of such mutations are at increased risk of developing cancers. More common ones among such cancers are breast cancer, ovarian cancer, certain blood cancers (leukemias) and certain gut cancers. A person having a family member with such a cancer is also at an increased risk of developing that cancer.
Other factors: These include certain parasitic infections, exposure to radiation, certain pesticides etc.
Most cancers do not cause any symptom in their initial stages. Some cancers have a pre-cancerous stage (in which the affected body tissue becomes borderline abnormal but yet not fully cancerous). When manifest, the symptoms may appear slowly (such as a lump that increases in size slowly, causing discomfort, pain or other local symptoms depending upon the type and location of the cancer). In advanced stages, the cancer may spread to other body organs, which can lead to further symptoms due to it. In addition, there can also be certain nonspecific or general symptoms common to most cancers.
Pre-cancerous conditions and features: They may include:
A white or reddish patch on the inner side of cheek (esp. in smokers/tobacco chewers)
An ulcer-like skin lesion or a slowly growing lump on or under the skin
A lump within the belly or in an organ (such as breast) that a person can feel.
Local features: These generally occur due to the cancerous mass or its ulceration. For example:
General (systemic) features: The following non-specific features may occur in many cancers:
Features upon metastasis: As a cancer spreads to other body organs, following feature may appear:
Enlarged lymph nodes (glands in neck, armpits, groin etc)
These may be spelled out with the pneumonic “CAUTION” :
All people should be aware of these warning signals. Merely the presence of any of these features does not mean a definitive diagnosis of cancer, however, any such sign not responding to appropriate treatment warrants immediate medical attention and prompt management.
Periodic health check-up and screening are very important in early diagnosis of cancers. When a patient visits a doctor for one problem, the doctor can also utilize that opportunity to screens him/her for another specified condition (for example, screening for a reddish patch in mouth). During medical evaluation, doctors pay special attention to early warning signals and those with suspected cancer are investigated with various medical tests. A definitive diagnosis generally requires confirmation through histopathological examination (such as biopsy and liquid cytology). Further tests may be required for determining the disease extent, deciding the treatment options available and evaluating the patient during follow-up.
As a preventive measure, certain screening tests can be done to detect potential pre-cancerous and cancerous conditions, esp. in those who do not yet have clinical manifestations. They help in early detection, timely treatment at an early stage, and reduction of further risks & complications.
Pap test: This test screens women for pre-cancerous and cancerous conditions of cervix. In this test, the gynaecologist scrapes and collects cells from the surface of the cervix, which are then examined for any abnormal cells (including pre-cancerous and cancerous cells). Pap test can also be combined with the human papillomavirus test (called as the Pap-HPV co-testing) which can be done in single sitting and is considered better than an isolated Pap test.
Self-breast examination: This is an important screening method used for detecting early breast cancer in women, in which the woman herself looks at her breasts in the mirror and feels each breast for possible lumps, distortions or swelling, and then seeks professional help if indicated
Mammography: This test uses low-energy X-rays to examine the breasts for screening and early detection of breast cancer.
Tumour markers: Some cancers release specific biochemical substances which can be measured in the blood and are useful in the detection and diagnosis of those cancers. Such tumour markers include:
Histopathological tests: These include tissue biopsy and liquid cytology (such as on blood, bone marrow and other body fluids). They not only confirm the diagnosis and differentiate between cancerous and non-cancerous lesions but also provide further details about the cancer’s nature (like type, stage, grade etc).
Other tests: They may include blood tests (such as liver and kidney function tests to know functions of these organs), X-rays, ultrasonography, CT scan, MRI scan, radio-nuclear scan, and endoscopic tests.
More than 30% of cancer deaths are preventable and we can reduce the cancer risk by choosing a healthy lifestyle and maintaining good personal habits. Many of the cancer-related environmental risk factors are also controllable through such simple measures as give below:
Quit smoking and tobacco chewing: If needed, talk to your doctor and life coach who can provide help and guide you through various programmes on smoking cessation and tobacco de-addiction. Avoid passive smoking (second hand smoking) including spending too much time in polluted air (such as during heavy traffic on roads).
Stop alcohol: Controlling alcohol consumption is no more a difficult task. Meet your doctor and life coach today.
Take healthy, balanced diet: Include fresh vegetables, fruits and fibre in your diet. Avoid junk foods and food items that are rich in fats (esp. animal fats/red meats).
Do regular exercise and control weight: Regular physical activity and exercise are good for both patients as well as healthy persons. You can take up any exercise of your choice and capacity (such as jogging, morning walk, outdoor games, yoga etc) to control your weight and keep you fit and freshened.
Maintain good personal, sexual and reproductive health: Keep good physical & sexual hygiene. Avoid high-risk sexual behaviours (like starting sexual activity at a young age, having multiple sexual partners, and having casual sex with unknown or risky persons). Talk to your doctor for further advice.
Be aware: Health education focused on various cancer-related risk factors & risk behaviours and on their preventive measures can help reduce the risk. Talk to your doctor; read health articles, participate in relevant group sessions; and take necessary steps actively. HCL Healthcare and Benefit Box periodically release newsletters and organize group sessions on these topics.
Get health checks done: Take advantage of cashless health checks available for you and your family members. Your doctor will evaluate including screening against common cancers & pre-cancerous conditions. Appropriate clinical examination and necessary investigations (such as Pap test in women and PSA in men) help detect problems at an early stage so that they can be handled promptly and further risks reduced.
Do self-breast examination regularly: This examination in done in different postures and every woman should know how to do it. When needed, no woman should hesitate and should seek help from her doctor or gynaecologist immediately.
Get your vaccination: The risk of certain cancers can be reduced through vaccination (such as HPV vaccine for cervical cancer and HBV vaccine for Hepatitis B). Talk to your doctor for further information and advice.
Avoid unwarranted drugs and radiation: Do not indulge in self-medication and getting unnecessary radiation (like x-rays, CT scans etc). Always follow your doctor’s advice in this regard.
Protect against occupational exposures: In case your workplace has risk of harmful occupational exposure (such as carcinogenic chemicals in certain industries), the risk can be reduced by such measures as use of appropriate personal protective equipment (PPE), frequent rotation of the workers, mechanized handling of such chemicals etc. Talk to your work manager and doctor for further information and advice.
(The author Dr Amit Kumar Gupta is a medical specialist cum public health expert working as Senior Consultant – Medical Services & Quality at HCL Healthcare. He can be reached out at Amit_Gupta@hcl.com)