 NANASKARA Today, 4th February, we are observing world cancer day. You might have come across or read about cancer. But the intention of observing this world cancer day is to increase the awareness, take out the misunderstand misinformation, to reduce the skill gaps as well as to easy access to the healthcare. In the world, nearly 14 million, that means 1.4 crore people are diagnosed with cancer every year. 1 in 6 deaths are due to cancer. In a recent survey, nearly two-third of people either come across, suffered or come across with someone who is very close to them with cancer. So, it is our duty to know more about cancer, how we all getting together, uniting, we can beat this cancer, that is the reason we are here and observing World Cancer Day. Today, the cancer team of Kasturba Medical College KMC Hospital, Ambedkar Circle Mangalore are here to briefly talk about the different types of cancers, how we detect them, how can we prevent them and what are the principles of treatment. With us, Myself, I am Dr. Harshav Prasada, periodic hematologist and oncologist. On my left, I have Dr. Prashant, consultant hematologist and hematoconcologist. Dr. Sanyo Disoza, medical oncologist. Dr. Kartik, oncosurgeon. Dr. Harish, oncosurgeon are with us. So, to start, let me ask, in children, we see very rarely some children with cancer. Having said that, whereas in adults, it is much more common. I just want to know, I will ask Dr. Sanyo, what are the types of the cancers you come across in adults. So, commonly, we see in our daily practice, the common cancers, we can divide among most common cancers in males versus most common cancers in females. So, among the males, one of the common cancers is lung cancer and the oral cavity cancer. So, these two are the most common cancers, what we encounter in our place and for that matter in India. And then among ladies, we see one of the commonest cancers is breast cancer. And then there are genital cancers like cervical cancer and also this oral cancers and lung cancers are also one of the part. But commonly among ladies, breast and gynecological cancers are the common. So, that's how it is. Where do you place hematological cancers in a general population and how do they present? The hematological cancers are the blood cancers, we say. It's a group of cancers. When we tell about blood cancer, there are more than 150 subtypes of blood cancers that are described nowadays. They are fairly common. Depending on the type of the blood cancer that we talk about, the incidence varies. Like, you know, we are talking about cancer like multiple myeloma, which is extremely common in our country, especially in the rural areas. It's become very common. Whereas if we talk about some type of lymphomas, they are extremely rare. Sometimes there is something called here is leukemia. In our entire practice of 10 years, 15 years, we may come across one or two patients for that. So, it is difficult to exactly put a number that this many percentage of patients generally develop blood cancer. But rather than that, what I feel is that most important thing a person should do is get an early checkup. In my practice, what I see is there are two sets of people who generally come to us. One are the set of people who are overzealous of diagnosing and cancer. Doctor, I want to see whether there is a cancer in me. So, please do some tests. Now, whether it is blood cancer or any other type of cancer, a simple blood test immediately cannot detect, especially in a healthy person, who is otherwise completely normal. Then there is another set of people where they are really suffering from cancer. They have symptoms. They have swellings in their particular parts of the body. Or they are having some gum bleeding, swelling of the gums, swelling in the neck. They are having recurrent fever. But then they are not ready to get examined because they won't want to get tested. Because doctor may tell that I have a cancer. Then what I will do? This is unique to our country. That's what I feel. That the two extremes are very common here. So, most important, as we talk about progress, we will tell the symptoms of the cancer. Somebody who has a symptom, one thing I want to stress upfront. There is no specific symptom or sign for any cancer as such. Just because somebody has a cough, it doesn't become lung cancer. Somebody has bleeding gums, doesn't become a blood cancer. There is nothing that tells that upfront the moment we see a patient, okay, this is cancer. So, people should not feel that, okay, I have this symptom, okay, I have a cancer. But it may be anything. But if you have a symptom, always get it checked with a specialist. Then you will come to know. So, I think with that we will proceed with the symptoms of the cancer. Thank you doctor Prashant. So, bleeding gums, any swelling part of the body. Not a particular symptom. Don't get disheartened or worried immediately. But go and get checked by the specialist doctor and then take it from there. So, that's about some of the hematological cancers per se. Can I ask, Harish is being oncosurgeon. Many of those where you do therapy treatment as a surgery. What are the types of cancers where you see as a first port of call, in the sense they present to you with what symptoms they present to you? Would you please enumerate that? Sir, the common symptoms, signs and symptoms they present a cancer patient is, if you ask me, if a sore which is not healing, like a wound anywhere in the body which is not healing. So, ulcer in oral cavity or ulcer over the skin which is, since long time patient is having that even after taking treatment it is not reducing or bleeding anywhere in the body. Just say if a patient comes with hemoptysis like sputum, cough sputum is there along with that there is some blood. So, that is a worrisome symptom which is there since long time and bleeding per rectum. So, many of the patients, I am not saying as Dr. Prashant told, all bleeding per rectums are not cancerous. But we do see in our practice that many of the patients are treated as piles or something else, hemorrhoids and they have missed the cancerous thing in that. So, what happens? It is better to check anywhere bleeding first to consult the relevant doctor and rule out cancer. Cancer is a small part compared to the non-cancerous things but it is always good to diagnose cancer in early stage. So, other than that bleeding per urethra, so that is also that is while passing urine if the patient is passing blood or unexplained loss of weight. So, somebody who has lost more than 10 kgs in last 6 months without doing anything like he is not doing regular exercise, not on diet, something but still he has lost weight which is not explained by anything. So, they should be worried and something like a patient who is altered bowel habits, somebody who is having diarrhea and somebody who is having constipation for long time which is not matched to his regular habits. So, these altered bowel habits should be aware. So, these are some of the lump in the body like any swelling in the neck or any swelling in the breast. So, if you ask me as Dr. Sanyo told in female the common cancers are breast cancers and common cancers are gynecological cancers. So, a patient who is breast cancer patient who can present with lump in the breast. So, if it is a gynecological patient they present with bleeding per vagina which is may be post specially all these cancers what we see in elderly population or in adults are in elderly population like more than 40 years or 50 years later. So, that is the common cancer. I think you know pediatric cancers are little different from adult cancers. So, these patients specially if the patient present with lump in the breast if the patient presents in the early stage you are asking about surgical aspect. So, if the patient comes in the early stage we first try to diagnose the cancer. So, there are few tests which we have to do on this patient like a mammogram for a breast cancer and a biopsy. If at all it is in the early stage like we call it stage one or stage two as early cancers. If it is in the later stage we will not do surgery immediately. If it is in the early stage we diagnose the cancer and then we will take the patient for surgery. So, there are so many patients like this who present in early stage whom we directly do surgery and there are patients who present in little later stage we may have to give chemotherapy first that is called neo-argument chemotherapy and then do surgery. So, that is how this patient present to us. Dr. Harish has enumerated few symptoms which are very pathognomonic of the features of cancers and he mentioned one thing cancer is one diagnosis whereas there are many differential diagnosis for the symptoms. So, and he as well as Karthik routinely come across patients who have been neglecting these symptoms for a long time and he said when you present early then the treatment will be different and they could do especially if there are lumps or bleeding only small part of the body then they are able to take it out by doing surgery. Going to Dr. Karthik with similar to the presentation the common surgical oncosurgical problems or diagnosis you come across in day to day practice and how do they present which not been enumerated by the Harish. Most of the things have been covered by our doctors now like one of the most common attitude of people about cancer is they think that cancer is painful. So, they do not want to come to the doctor unless there is pain. So, unlike the popular thought where people think that cancer is painful it is not so in the early disease. Let us take it whether oral malignancy of stage one or two or breast cancer of stage one or two even more I can say most of the cancers even liquid cancer like leukemia or lymphoma they are not painful. So, people have this attitude of staying away from the doctor and that is the kind of attitude they have because they do not want to come to hospital. So, that attitude should go off. So, what they should understand is we have to diagnose more and more patients in stage one and two abroad like in European countries or American countries like all we know they are more focused on finding patients in stage one and two and so their prognosis is better the treatment cost is better the treatment duration is better and overall it is a happy attitude towards the disease. But here what is happening in India is people have very negative attitude about cancer and we find more and more patients presenting to us in stage three and stage four that is not good we have to find our ways to find more and more patients in early disease and early stages and we have to be able to treat the disease and one more important aspect or point what I want to put here is like about the nihilistic attitude of the people. They have a very negative attitude about cancer so they have that bad picture of cancer that it is very painful patients have to lose weight to have cancer and so many dark thoughts about cancer that should as a society we should alleviate those factors and we should encourage more and more people to come to us and so that we can treat the people better in stage one and two Thank you Dr. Karthik so once they present to you us with the symptoms what all the test you would do to diagnose this to have cancer so would you please enumerate Dr. Sanyam yeah so the tests which we conduct once we have a suspicion of a cancer in particular patient for whatever complaints they have come to us differs based on which site or organ is affected like for example if I start from above to below for example if someone comes with non-healing ulcer in mouth and there is a swelling or something like that or there is a swelling in the in our neck due to an ulcer inside the mouth then commonly what we do biopsy biopsy or FNA that is fine needle aspiration we call it so we either do a FNA or biopsy of that involved lesion or the abnormal area and then we do a CT scan or MRI scan to see has the disease spread beyond certain limits so that's how we stage that particular cancer for example if I go below still regarding the cancer of the lung so even there once we do a biopsy which is confirmatory of a particular cancer like I would like to say at this point that if someone comes with some X-ray finding of some abnormality in the lung that doesn't mean it is a cancer it may be many other things also so to confirm that it is a cancer we need to do something called as needle test just like what I said either biopsy or FNA to confirm that it is a cancer so once we confirm that it is a cancer for example in the lung and then we have to do something called as CT scan or full body scan is done called as PET scan sometimes in some cancers so these scans are done to know whether the disease has spread to some other parts of the body or whether disease has spread away from the main site of origin of the tumor so that we do the staging I mean stage 1 2 3 or 4 of that particular disease in the same way for example in our digestive system cancers like for example in the stomach or in the intestine cancers in those sites also if at all patient presents is some symptoms suggestive of cancer in either stomach or in the intestine then we do something called as endoscopy either passing a small tube through the mouth or passing a small tube through the anal side to see where is the location of the cancer and then once again like what I said just now to see whether the disease has spread to other parts we need to do a CT scan or a whole body PET scan to see whether the disease has spread to other parts of the body so basically speaking that cancer once we have a suspicion that someone is having a cancer we need to do 2 important things that one is the biopsy and one is the biopsy for the confirmation that it is a cancerous and scans whatever scans be as per the different sites to see whether it has spread to some distant parts of the body or away from the site of origin of the tube so that's how it is thank you Dr. Sanyo once we diagnose or suspect a cancer patients may feel that we are doing a battery of test but it's always important to have a right diagnosis and right staging because the treatment may differ so confirmation of the diagnosis and proper staging is must after diagnosing a cancer so once you break the news of a cancer to patients they will start to question us why did I get cancer did I do anything wrong should I have done anything differently so Dr. Prashant would you like to talk upon that yeah this is very interesting question every person who gets a disease he has a right to ask this question first number one everybody has a right to ask question and especially when a person is being diagnosed with a dreaded disease like cancer definitely he needs an answer why he developed it because if there is something that he can rectify you know to prevent future cancers either in him or in his family members near and dear ones then that becomes extremely crucial so if we see why the cancer comes there are answers for atleast 50 to 70% of the cancers we have an answer especially the modern lifestyle especially bad habits like smoking usage of drugs then alcohol excessive intake of alcohol excessive intake of carbohydrates fatty foods junk foods and especially the fast foods smoked foods you get these kebabs and this junk food where there is a suit on the surface of the food stuff now all these are getting highly carcinogenic chemicals in them and when we consume them just because I have gone and eaten one fish kebab I am not going to get any cancer there but then cancer is always a multifactorial one I am not doing regular exercises I am not doing any weight management I am putting on weight I am not following any healthy diet per se I am eating whatever comes in my way I have habit of smoking I may not be smoking but my friend who is always sitting next to me may be smoking and I am happily smoking whatever he is living that is also enough so the lifestyle everything matters over a period of time these carcinogens they go on attacking the body cells and body has threshold limit to which body can repair itself when the insults go beyond that threshold level body fails the immune system or the surveillance system in the body fails and the normal cells which were otherwise behaving normally turn into cancerous cells and then you know the entire process of cancer starts yes of course in around 20 to 30% of the cancer especially lot of this there is no exact reason it may be some underlying genetic problem which is not in the hands of either parents or in anybody's hands it is just by luck we can say or some of the blood cancer why do they get blood cancer nobody knows except for few of the cancers where pesticides are blamed for or smoking is blamed for otherwise we do not have a true answer for this so it is difficult to tell exactly particular patient you got this cancer because of this particular reason but then we can broadly guess what was the lifestyle of the patient which caused this cancer thank you Dr Prashant Dr Prashant just gave the details of why one would get a cancer especially in adult population during a periodic oncologist I do come across same question from every parents they themselves feel guilty did we do anything wrong for my son or child to get develop this cancer most of the times we do not have a answer as he said nearly one fourth of childhood cancers are known genetic problem but the question comes can we prevent this cancer in children there are various hypothesis why someone develops a cancer in a child but there are no hypothesis how can we prevent it there are quite significant differences between children and adult type of cancers as he mentioned the lifestyle related cancers we do not see in children children is mainly due to some to do the genetics the non-genetics only one fourth of them that when it diagnose cancer in children usually in advanced stage they would have spread by the time we diagnose whereas in adults you would if they come early they would diagnose in earlier stage in children the response to treatment is very good very intense treatment short treatment response is very good and overall survival is very good whereas in adults depending upon the types of cancers etc but overall the response is less than on the childhood cancers so with that note continuing from the lifestyle related issues now we will go to the basic principles of treatment in the early we will discuss about early detection screening and prevention so let me ask to Dr. Sanyu what are the principles of treatment in a diagnosed and confirmed cancer so once we diagnose the cancer and once we do the staging like what we discussed through the relevant scans once we diagnose the cancer at a particular stage then comes the treatment I will just give us overview of how the treatment is done in different cancers in general so there are three main treatments of cancer so one is surgery one is radiation therapy and one is chemotherapy so for any cancers at least one is definitely required we call it modalities of treatment surgery, radiation and chemotherapy so for any cancer at least one modality of the treatment is definitely required most of the cancers either two or three modalities are required like for example some cancers which originate from the blood like lymphomas blood cancers for that only chemotherapy is enough but most other tumors like common cancers like breast where all the three modalities may be required like surgery, chemotherapy and radiation therapy but this is I am saying is not in all the patients all treatments are required even in for example in breast cancer some patients we may need only surgery and chemotherapy some patients we may need only surgery so different cancers are managed in different ways by different combinations of surgery, chemotherapy radiation therapy but from last decade there has been something new modalities of treatment also with regard to systemic therapy we can say that is called targeted therapy and immunotherapy so this mostly is done for late stages of cancer especially stage 4 what happens is that the mutation in the cells is detected in two patients and we give treatment targeting to that particular mutation or change in the cell so that we call as targeted therapy so this is one new therapy which is a tablet treatment which is a new treatment which has come up in the last decade I would not say in all the cancers but in many cancers it has come up and one more new treatment which has come up in the last decade is immunotherapy which is it is an intravenous injection which is to be given over periodic intervals and these two is in the late stages stage 4 cancers we say what it does is it stimulates the immune system of your own body to act on the cancerous cells so that is how it acts and has been found to be beneficial in many tumor types so that is how we treat cancer and that is how we try to improve the survival of patients with cancer but one important thing during all these treatments is our aim is to give the patient a good quality of life during whatever treatments we choose because apart from increasing the life meaning to say apart from increasing the survival of the patient or one more aim is to improve the quality of life of the patient too because commonly there is a notion in general public that cancer treatments are painful and patient will his health condition will deteriorate his general condition will go down he will not be able to do day to day routines and all that I would like to differ and say that when cancer treatment is given in a proper way all these things do not occur of course sometimes some side effects of chemotherapy can occur but these are all for short duration immediately after surgery there may be some weakness but this is of short duration but overall the aim of first doctors is to give a good quality of life to the patient with whichever cancer treatments we plan for a particular patient thank you right treatment in right way you may get side effects for a short duration and for which you have got medicines for those side effects and as a doctor as a team led by the medical oncologist and surgical oncologist all putting together we all try to give a good quality of life to the patients Dr. Harish would you please tell me what can we screen or detect early detection of cancer in general public early detection is something where we detect cancer in a patient who is having symptom see somebody who is having already some ulcer or lump in the breast or somebody who is having bleeding or rectum or something so where you can present in different stages like stage one so we can treat better so that is how we can detect the patient in early stage depending on whether the patient is having symptom or not so that is called early detection that is done when the patient visits the hospital early or we can also do general population programs so that time we can detect the lesion and do a biopsy or imaging what we have already mentioned that is called early detection another thing called screening screening is something we do in general population like we are doing programs and in a population where they don't have any symptom they don't know there is something in their body but we are trying to detect it it may be cancer so that is how that is what is called screening so we can't screen all the cancers so there are so many cancers but that is because whatever we screen we have to detect early and we have to treat otherwise there is no point detecting something and without giving proper treatment for that so only some cancers are there like breast cancer where we can do a mammogram for screening so oral cavity cancers where we do screening there may be lesions like white lesions or reddish lesions like called leukoplechia erythroplechia or there may be an ulcer during our screening programs so we can take biopsy of those lesions which may be precancerous or under early stage of cancer and lung cancer that low dose CT scan that's what we say it is not practiced in many countries few countries and few areas it's been practiced where detection rate is also high we use low dose CT scan not an x-ray there other than that cervical cancer which is a very important cancer most of the cervical cancer is because of it's PV infection so human papilloma virus is more than 90% of the cause for this cervical cancer so in this situation we can do a simple test called pap smear so which can detect the cancer in the general population and with that we can actually treat the cancer better so all these cancers where a proper test is available to detect a cancer we can detect the cancers in general population and treat them better because of this we know that compared to the previous decade the cervical cancer incidence has come down with proper hygiene and also screening programs many of the centers in India are also doing so that's how we can detect about screenings thank you doctor Karthik would you please tell us what are the risk reduction things one has to do if he is well but he is worried about he may get cancer in the future what he can do to prevent the cancer and second question is what is the role of vaccines this is a very important question because this is also one of the gist of the world cancer day so to understand about how to prevent so prevention is even before the pathology has started doctor Prashant already told that the factor causing cancer is environmental and host factor so environmental factor is like pollution dust whatever the hazards of the present day life which requires the whole society to act and control which is little difficult because you need governance to control at that level to our level what we can do so that is on the host factor so host factor what is responsible from the host to cause cancer so one is these addictions tobacco or alcohol among the most common addictions then the whatever reduces the immunity of a body to fight the early cancer cells so this has to be improved to control cancer so about let me speak briefly about tobacco and alcohol so alcohol potentiates tobacco most commonly and that is how alcohol acts that is why we always tell to prevent alcohol but we always tell to stop smoking so that word we have to understand and after the decades of negligence or decades of denial towards tobacco then in the early 90s America started with the tobacco prevention act from there actually took 3 decades and now America US has reduced the tobacco causing malignancies by 50% so we are in the early phases of this and we have to take it as an individualistic attitude to stop smoking so that is one aspect and then about that aspect of the addictions then about improving the host immunity regular exercises to reduce to maintain a healthy BMI and to improve improve the quality of food items take more and more food which has more of antioxidants and avoid carcinogenic food like charred meat products or salted meat products so the basics of what then the most important aspect is like the second question what you mentioned is about vaccine preventable disease in malignancy also we have some vaccine preventable importantly what we already know and what is very popular is hepatitis B vaccine so hepatitis B is responsible for chronic cirrhosis which in turn causes malignancy of the liver in 2 or 3 decades of span so hepatitis B vaccine prevents malignancy of the liver and we should actively participate in the hepatitis B vaccination and now what we speak recently is like human papillomavirus we have already discussed papillomavirus causing carcinoma cervix and also nowadays oral malignancy is caused by human papillomavirus so popularly we have 2 kinds of vaccine they are quadrivalent or bivalent that is Gardasil or cervix which is the brand which costs around 3000 rupees per shot and when it has to be taken it has to be taken in early teens in 11 to 13 years of age 2 shots has to be taken so that is a good preventive modality in vaccine prevention so when it comes to cancer we have 2 broad vaccine preventable disease that is malignancy of the liver and malignancy caused by human papillomavirus so this is about prevention so we have to be aware we have to be aware and we should come out of the denial mode and get into get into a positive mode and treat the cancer effectively thank you doctor Karthik world cancer day is unique in the sense though it has been observed for the past 20 years since the year 2000 we have in the middle of pandemic you all know this pandemic made almost all citizens aware of their help and about the cleanness, infection control practices and everyone is worried about covid especially so those who are receiving treatment for cancer are their relatives so I just want to ask doctor Prashan how covid has affected the cancer care and what are the problems extra they will face because of the covid so it is very important nowadays because whatever we are seeing covid does not seem to be like disappearing very soon it is going to be with us for quite some time since last one year now we have a large body of data what happens for a cancer patient when he develops covid infection now we clearly know just like any other infection a cancer patient has a defective immunity that is why on the first place he has developed a cancer so with that defective immunity any infection will increase the chance of increased morbidity that is more sickness and also the chance of dying because of the infection same way covid also the data is around cancer patients are the risk is almost 2 to 2.5 times more in cancer patients the covid death rate rather than normal population now the other important aspect is you know because of this covid pandemic we were forced to modify all our chemotherapy you know lot of the patients received those reductions in the chemotherapy thereby there may be certain you know compromise on the overall survival of the patient because of the cancer but then you know if you had given the full dose there was a chance that patient would have died because of covid there was an immediate death so to prevent the immediate death there has been certain measures that are taken which may be troublesome for the long term the next thing that we are now in the future we are looking at is invariably just like any other normal population the patients who have been you know recovered of the covid just like patients who have otherwise you know recovered of malaria or typhoid or dengue fever over a period of time they can develop cancer not that covid is causing cancer invariably they would have even without developed cancer now the patient who had covid infection comes with the cancer now what happens is that with the covid they would have had end organ damages to the lungs to the liver or kidneys now it is going to be a big challenge for us to you know formulate the right treatment for these patients because we know that all our drugs we have some amount of side effects so there is a chance that this end organ damages may trouble the patient so that is why it is extremely crucial for any point of view we are not talking just about cancer prevention per se whether it is heart disease or lung disease or whatever disease that we talk of it is extremely important to prevent covid infection so whatever government is telling we just have to sincerely follow because the politicians are not telling it it is the scientific body analyzing the situation and giving guidelines to the government and government is a mouthpiece for the scientific body so we have to follow that other common question that is asked by lot of our patients is that you know can we receive a covid shot you know vaccine you know patients who have been treated of cancer earlier or those who are having active cancer also you know if they get an opportunity to get covid vaccine they should get it because there is no risk in taking covid vaccine because it is a killed vaccine it is not a live virus vaccine so there is no harm in the patient only thing is that effectiveness of the covid vaccine may be slightly on the lower side in patients who are having active cancer or those who have been treated for cancer but if given a chance everybody should get a covid vaccine that is what I would talk about covid thank you doctor prashant every year on the world cancer day the union of international cancer association they come up with a theme for the past 3 years the theme is I am I will the very purpose of today's discussions answering the questions is to make all of us united in fighting against a cancer remove all the miss and misinformation easy to get access and make it affordable as well today we touched upon the basics of common presentation of cancer early diagnosis detail of the basic of principles prevention screening and also on covid and cancer with that note I would like to conclude today's discussion thanks doctor prashant doctor sanjo disoja doctor harish doctor karthik thank you