Cancer is one of the world's fastest-growing illnesses and the second-largest cause of death. Around one in six deaths worldwide is caused due to cancer, and according to reports, cancer accounted for more than 9.6 million deaths in 2018 itself. In the United States, 1662 people died due to cancer daily, while by comparison, according to the Indian Medical Research Council(ICMR), more than 1300 Indians die every day from cancer. Cancer treatment in India is making tremendous progress in diagnosis, treatment and palliative care, but is still a work in progress.
Yet interestingly, evidence shows that cancer is a man-made disease, and it developed largely because of inappropriate eating patterns, lifestyle and nutritional conditions. Reports from the WHO (World Health Organization) say that about one-third of cancer deaths are attributed to the five leading behavioural and dietary risks:
According to 2018 WHO fact sheet, the top cancers affecting the Indian population are lung, breast, cervical, head and neck and colorectal cancer.
A combination of environmental, genetic and lifestyle factors is the primary explanation behind this deadly disease in India. However, in India, the use of tobacco and tobacco products is another leading cause of cancer. Vaping, smoking, second-hand smoke, air pollution, chewing tobacco are significant factors in India which are responsible for lung and head and neck cancer. Breast cancer is the most commonly diagnosed form of cancer in Indian women and cervical cancer is the leading cause of death among women.
According to reports published on 4th February 2020 by the World Health Organization (WHO), one in ten Indians will grow cancer during their lifetime and one in fifteen will die from the disease. There are an estimated 1.16 million new cases of cancer reported in India each year, and about 7,84,800 people die each year from it.
According to the study, the most prevalent of 5.70 lakh new cases of cancer in men, is oral cancer, followed by cancer of lung, stomach, colorectal, and oesophageal account for 45 per cent of reported cases. Out of the 5.87-lakh cancer cases reported in females, the highest numbers are breast cancer, followed by cervical, ovarian, oral and colorectal cancer, attributing for 60 per cent of all cancer cases.
The WHO also reported that breast cancer, oral cancer, cervical cancer, lung cancer, stomach cancer and colorectal cancer were among the six main types of cancer recorded in India.
Breast cancer has seen 1,62,500 cases, and 57,000 colorectal cancer cases are registered annually. The six cancer forms constitute 49 per cent of all new cancer cases.
The incidence of cancer in India is substantially varying across geography. In India, for example, the incidence of cancer is highest for both sexes in the North East region. Aizawl district (located in Mizoram) recorded the highest cases in males while Papumpare district had the highest number in females in Arunachal Pradesh. Higher incidence of gallbladder cancer in northern India and the North-East region compared to other sections, higher incidence of stomach cancer in Chennai and Bengaluru, oesophagus cancer in Kashmir and the North-East may indicate various aetiological factors, such as environmental, diet, lifestyle, and genetic factors. Close to 50 per cent of male cancers and 15 per cent in females are related to the use of tobacco. These include cancers of head and neck, lung, oesophagus, pancreas, and renal and urinary bladder.
Most common cancers that affect the countryХs population include breast cancer, lung cancer, oral cancer, stomach cancer and cervical cancer.
Under the National Cancer Control Programme, there are 27 government-approved cancer centres. In 2010, the central government initiated a comprehensive National Program for Cancer, Diabetes, Cardiovascular Diseases & Stroke Prevention and Control (NPCDCS), which covers many districts across 21 county states.
The different forms of cancers have many similar characteristics. They leave the surrounding tissue to protect themselves against good blood supply and against the immune system. They also reach the lymph and blood systems to move to other parts of the body such as the lungs, liver and bones. Early detection of cancer could help save lives. Many cancer treatment options exist for various forms of the disease. A patientХs treatment plan depends on the type, level, and degree of cancer they encounter. It is not unusual for patients to go through different combinations of treatments.
When detected early, tumours appear to be smaller and are easier to remove surgically or more likely to shrink after chemotherapy or radiation therapy. For example, certain forms of lymphoma and leukaemia may be treated with chemotherapy and radiation, while other tumours, such as breast and colorectal cancers, may be cured with surgery and chemo-radiation.
Enlisted are the currently available cancer treatments in India:
With the rise in the number of cancer cases in India, the number of Tertiary Cancer Centres with excellent facilities and qualified oncologists is also growing in urban India. This is not the same for rural India, however. This is reflected in the fact that while cancer incidence in rural India is almost half that of urban India, mortality rates are double. This needs to change, particularly with 70 per cent of the Indian population being rural. For cancer therapy, patients from villages and smaller towns have to go to major cities. Because of financial restrictions and cultural differences, these patients present late to the Tertiary Cancer Centres (TCCs). Most TCCs are overcrowded, and treatment delays are further due to decreased workforce and limited infrastructure. Due to our male-dominated culture as well, few females are brought to the tertiary care centres, and this is reflected in the higher male: female ratios in most hospital-based registries. The parody of cancer care in India is that early (curable) cancers are made incurable by the improper treatment provided locally by non-oncologists without using oncology principles; at the same time, TCCs are referred to patients with advanced, metastatic incurable cancers patients who may require only palliative care. This leads to improper use of limited, valuable resources.
Nearly 70% of the population lives in rural areas, but about 95% of facilities for cancer treatment in India exists in the urban areas of the country. Therefore, even though the incidence of cancer in rural India is almost half of that of urban India, the mortality rates are double that of urban areas. There are few facilities in rural regions that disseminate information about cancer, screening and early diagnosis. Even the diagnostic process like biopsies or the blood investigations are sent to cities and the reports take weeks to come back. Until the time the patient could plan the arrangements to go to cities for care, this can cause more delays in diagnosis and disease progression. All this leads to the vicious cycle: Since these patients come with advanced illness, the results are low; and many rural patients are not willing to seek adequate care on time due to poor outcomes.
Cancer treatment in India is very expensive, and since much of the healthcare is self-funded, most patients make out-of-pocket cancer care payments. Getting cancer care alone is beyond the reach of most rural patients. Interestingly, none of the social assistance offered by trusts or non-governmental organizations — whether financial or logistical — is available to TCC patients in towns. Even government assistance such as the Health Ministers Fund, Rajiv Gandhi Arogya Yojna, etc., is mainly accepted for TCCs. Thus, patients are required to go for treatment to the cities. This flow can be stopped if all such assistance is also made available in rural centres.
Cancer is a group of over hundred diseases that evolve over time due to the uncontrolled division of cells within the body. Even though cancer can grow in practically any body tissue, and each form of cancer does have its own distinctive features, the fundamental processes producing cancer are very comparable in all types of cancer. Cancer can begin nearly anywhere in the human body, which consists of trillions of cells. Human cells usually expand and divide in order to create new cells, because the body requires them. They die as the cells grow old or get hurt, and new cells take their place. However, this orderly process breaks down as cancer grows. Sometimes, when cells become old or dysfunctional, they survive instead of dying, and in the meantime, new cells are being formed. These additional cells now divide without stopping and may form tumours. Many cancers form solid tumours that constitute tissue masses. Blood cancers, such as leukaemia, do not usually develop stable tumours.
Cancerous tumours are malignant, which means they can spread into surrounding tissues or invade them. As these tumours develop, some cancer cells may break off, migrate through the blood or lymph system to distant places in the body and form a new tumour far from the original one. Benign tumours do not grow into or invade surrounding tissues, as opposed to malignant tumours. However, benign tumours may often be relatively large. They usually do not grow back when removed, while sometimes, malignant tumours do. Benign brain tumours may be life-threatening as opposed to other benign tumours elsewhere in the body. A malignant tumour develops over time. This tumour develops because of four mutations but can vary in the number of mutations present in other types of the tumour. We do not know exactly how many mutations a normal cell takes to become a completely malignant cell, but the number is possibly less than ten.
Cancer is caused by certain gene changes, the basic physical units of inheritance. Genes are distributed in tightly packed, long strands of DNA called chromosomes. Cancer is a genetic abnormality — that is, it is affected by changes in genes that regulate how our cells work, especially how they grow and split. Genetic changes can be inherited from our parents can cause cancer. They can also occur during a person's lifetime because of errors that occur when cells divide or due to damage to DNA caused by other exposures to the environment. Cancer-causing threats to the atmosphere include pollutants such as cigarette smoke chemicals and radiation such as sun ultraviolet rays.
Cancer cells generally experience more genetic changes, such as DNA mutations, than healthy cells do. Any of those changes may have little to do with the cancer; rather than its origin, they may be the product of the cancer.
For various types of cancer, different types of staging schemes are used. Below is an example of one common form of staging:
The answer is “Yes.” All cancers are curable if diagnosed early enough. This is the rationale for diagnostic tests (such as mammograms, colonoscopies and Pap smear testing). If tumours are detected early, they appear to be smaller; in reaction to chemotherapy or radiation therapy, they are either easier to remove surgically or more likely to shrink. It can be eliminated by surgery when cancer is localized, but in most cases, it is almost impossible to detect cancer at such an early stage. Early detection is indeed the secret to surviving cancer of any kind.
In the last 50 years, cancer diagnosis and care have come a long way. Today we are able to treat and cure many forms of cancer; however, it is clear that these cancers need to be identified early. More than 7 out of 10 kids have cancer cured. With current therapies, testicular cancer, Hodgkin's lymphoma and other forms of leukaemia can all be treated in adults. Many of the skin tumours are surgically treated. In addition, radiotherapy treats several cases of thyroid cancer and laryngeal cancer. Many other cancers are also cured if found early enough-for example, 75% of breast cancers are found early. There is of course a long way to go before we can cure most cancers.
Some cancers have high levels of survival when diagnosed early. There are six highly treatable cancers breast, skin (nonmelanomas), colon, prostate, testes, and cervix cancers, among others. Most of the childhood malignancies (both hematolymphoid and solid) are curable. Breast cancer is the most common non-skin cancer among women as one out of every eight women in her lifetime will be identified. For women whose breast cancer is diagnosed when still in localized form have a 5-year survival rate of 98 per cent compared to a 72 per cent Stage III survival rate and just 22 per cent Stage IV survival rate. Skin cancer (basal cell carcinoma and squamous cell carcinoma) is the most common type of all human cancers, and if detected early, skin cancer can be treated at almost 100 per cent. Similarly, diagnosing cervical cancer when lesions are precancerous leads to a survival rate of approximately 100 per cent, but the rate decreases to only 32 per cent if diagnosed in stage III and 16 per cent if diagnosed in stage IV. Testicular cancer can be treated in 99 per cent of the time when found early, but and 73 per cent are cancer-free after 5 years if diagnosed in advanced stages. Similarly, when colon cancer is identified early, the 5-year survival rate is 90%, but only 39% of cases are diagnosed before cancer has begun to spread.
According to the Surveillance, Epidemiology and End Results Program, if prostate cancer is diagnosed at times where the disease is limited to the prostate gland (Stage I and II), it is 98 per cent survivable for 5 years or more. If diagnosed at Stage IV, the survival rate decreases to around 28 per cent.
There are many forms of cancer treatment in India. The types of therapy you get will depend on the type of cancer you have and how advanced it is. Many cancer patients can only have one treatment. Yet many people have a combination of treatments, like chemotherapy surgery and/or radiation therapy. You have a lot to read and think about when you decide to get cancer care. It is natural to feel overwhelmed and confused. However, talking to your doctor will make you feel more in control and learn about the types of care you should receive.
In theory, non-haematological cancers can be successfully treated if removed entirely by surgery, but this is not always possible. Complete surgical excision is usually impossible when the cancer has metastasised to other sites in the body.
the use of ionizing radiation to destroy cancer cells and shrink tumours is radiation therapy (also called radiation therapy, x-ray therapy or irradiation).
Chemotherapy uses medications to treat multiple tumours of different forms. This is most often delivered as a vein injection, or as tablets or capsules.
Cancer immunotherapy refers to a number of treatment approaches designed to induce the patient's own tumour-fighting immune system.
Targeted therapy is a type of cancer treatment, which targets changes in cancer cells that help them develop, divide and spread.
Hormone therapy is a type of cancer treatment in India, that reduces or prevents the growth of breast and prostate cancers using hormones.
Stem cell transplants are procedures that restore blood-forming stem cells in cancer patients who have had theirs destroyed by very high doses of chemotherapy or radiation therapy.
Precision medicine requires analysing tumour DNA to detect mutations or other genetic changes that cause their cancer. Doctors may then be able to choose a treatment for cancer of a specific patient that better suits, or targets, the tumour DNA mutations.
Stage 1 cancers need urgent diagnosis, radiation and sometimes surgery. Doctors generally do not recommend chemotherapy for the early stages of breast cancer. Hormone therapy is often an option, depending on the nature of the cancer cells and risk factors.
Stage 2 breast cancer is treated with surgery to protect the breast, or often with mastectomy. The distinction between breast cancer stage 2 A and stage 2 B is the size of the tumours and their distribution. Radiation is also required to destroy the remaining traces of cancer after the surgery. In case chemotherapy be needed, radiation will be delayed.
This cannot be cured but it can only be treated. These are often treated with neoadjuvant treatment that helps reduce the tumour before the main operation, which is breast reduction surgery in this case. Positive tumours, trastuzumab, are given a targeted drug along with pertuzumab for the human epidermal growth factor receptor 2 (HER2). Following surgery, doctors prescribe radiation therapy, and in some cases chemotherapy and/or hormone therapy are also given.
Stage 4 cancers have spread to other areas of the body outside the breast, including adjacent lymph nodes. Stage IV breast cancer treatment is usually a systemic (drug) procedure. Stage IV breast cancer is invasive, and may have spread to other body organs such as the lungs, distant lymph nodes, skin, bones, liver, or brain. As cancer has spread to other distant locations treatment such as surgery and radiation are not enough,. Doctors treat the symptoms with palliative treatment.
If breast cancer returns to surrounding lymph nodes (such as those under the arm or around the collarbone), it is treated, if possible, by removing such lymph nodes. This may be followed by radiation targeted at the area of infection. Systemic treatment (such as chemotherapy, targeted therapy, or hormone therapy) could also be considered after surgery.
Cost of Breast Cancer Treatment in India (Surgery): Approx. INR 2.9 to 3.5 Lakhs
When treated with surgery and/or radiation therapy, most patients with Stage 1 or 2 oral cavity and oropharyngeal cancer do well. Another alternative is chemotherapy (chemotherapy) given alongside radiation (called chemoradiation). Surgery is recommended for low, reversible, oral cancers. The first procedure can also be used for radiation alone. Surgery can be required later if the tumour is not adequately disposed of by radiation. If the tumour becomes thick, the risk of the cancer spreading to lymph nodes in the neck rises, so that the surgeon can cut them (called dissection of the lymph node) to test for cancer spread.
Sometimes these cancers are treated with chemoradiation, but in some cases, radiation and cetuximab can be used. Any cancer that persists after chemoradiation is surgically removed. If the cancer has spread to lymph nodes in the neck, they will also need to be removed after chemoradiation (a dissection of the lymph nodes). Another choice is to treat the cancer and lymph nodes at the neck with surgery first. Sometimes this is accompanied by chemotherapy or chemoradiation to reduce the risk of the cancer returning. Most doctors offer chemo, followed by chemoradiation, as the first operation, and then surgery if necessary. Yet not all physicians agree with this approach.
They are HPV-negative cancers that have spread into surrounding organs, structures and even lymph nodes already. Stage 4C cancers are spreading to other areas of the body, including the lungs. Usually those cancers are treated with chemo, cetuximab or both. Another choice could be immunotherapy, alone or with a chemotherapy. Alternative therapies, such as chemotherapy, can also be used to help alleviate cancer symptoms or to avoid new problems.
If the cancer occurs in the same region and radiation therapy was used as the first treatment, then surgery is often the next treatment if the cancer can be completely removed and the patient is adequately safe for surgery. If the cancer returns to the lymph nodes in the back, the nodes are frequently removed by surgery (dissection of the lymph nodes). Radiation can follow on from this.
Cost of Lip, Oral cavity Cancer in India (Surgery): Approx. INR 4.3 Lakhs
Surgery is the primary form of care for cervical cancer in Stage 1, but it depends on the patient's age, and whether they want to have a child. For women with stage 1A cervical cancer, doctors prescribe a cone biopsy; a cone-shaped tissue is removed from a woman's cervix in this operation. A hysterectomy eliminates the cervix and the uterus. It is typically prescribed for women with cervical cancer in stage 1. Removal of the surrounding lymph nodes, chemoradiation, or only radiation are options you may consider after consulting your healthcare team.
In stage 2 cervical cancer, the tumour has distributed out around the cervix into the other nearby parts of the body. Chemoradiation is the main method used to treat stage II cervical cancer. It is done at the same time as radiation therapy, for better outcomes. Chemoradiation can be performed after surgery. Cisplatin or cisplatin plus 5-fluorouracil are the effective chemo-drugs. Extreme hysterectomy, removal of pelvic and abdominal lymph nodes. Based on tumour size and delivery, radiation can be delivered in varying dosages.
Stage 3 cervical cancer spread to lower regions and the vaginal ligaments. Typically cisplatin or cisplatin, plus fluorouracil, is required. External beam radiation can then be used to undertake radiation therapy and brachytherapy.
Stage 4 of cervical cancer has metastasized too deeply. Its symptoms can be controlled. It has spread across the body to the pelvis and other distant areas. Treatment options are radiation therapy and chemotherapy designed to slow cervical cancer development. The normal chemotherapy treatment contains cisplatin or carboplatin and other medications such as paclitaxel, gemcitabine, or topotecan. The targeted therapy drug bevacizumab can be treated with pembrolizumab alone along with chemo or immunotherapy.
For recurrent cervical cancer, chemoradiation may be necessary. Usage can include 5-fluorouracil (Adrucil, 5-FU) plus cisplatin or mitomycin (Mutamycin) or other chemotherapy drugs. Radiation therapy is often combined alongside chemotherapy for recurrent cervical cancer, but in some cases it can be used alone as the primary treatment.
Cost of Cervical Cancer Treatment in India (Surgery): Approx. INR 1.9-3.2 Lakhs
If you have Non-small Cell Lung Cancer (NSCLC) Stage 1, surgery may be the only treatment you need. This can be accomplished either by removing the lung lobe that has the tumour (lobectomy), or by removing a smaller portion of the lung (resection of the arm, segmentectomy, or wedge). It would also remove at least some lymph nodes in the lung and in the area between the lungs and test for cancer. After surgery, the removed tissue is tested to see if the surgical specimen (called positive margins) has cancer cells at the edges. This could mean that some cancer was left behind, and a second operation will be performed to try to make sure all the cancer is removed. This might be followed by chemotherapy as well. Other choices might be to use radiation therapy after surgery.
People who have Stage 2 NSCLC and are well enough for surgery typically get cancer removed by lobectomy or resection of the arm. The entire lung (pneumonectomy) is often needed to be removed. It would also eliminate any lymph nodes known to have cancer in them. Chemotherapy (chemo) can follow on from this. Another alternative is to take radiation therapy.
Stage 3 NSCLC treatment may involve a combination of radiation therapy, chemotherapy (chemotherapy), and/or surgery. The preparation of stage IIIA NSCLC care also further requires guidance from a medical oncologist, radiation oncologist and a thoracic surgeon. Your treatment choices rely on the tumour size, where it is in your lung, whose lymph nodes it has spread to, your general health and how well you handle care. Where surgery, chemotherapy, or chemoradiation are not considered tolerable treatment choices, pembrolizumab (Keytruda) immunotherapy can be considered the first treatment.
The standard protocol for lung cancer treatment in India depends upon how far the cancer has spread, whether a certain gene or protein occurs in the cancer cells and on the general health of the patient. When you are otherwise in good health, therapies such as surgery, chemotherapy, laser therapy, immunotherapy, and radiation therapy will help you live longer and make you feel better by relieving your symptoms, even though they are unlikely to cure you.
Cost of Lung Cancer Treatment in India (Surgery): Approx. INR 2.9-3.5 Lakhs
People with Stage 1 cancer of the stomach typically get their cancer removed by total or subtotal gastrectomy. It also eliminates surrounding lymph nodes. Endoscopic resection of some small T1a cancers can rarely be an option. There is generally no need for further care after the surgery. Before surgery, chemotherapy (chemo) or chemoradiation (chemo plus radiation therapy) may be administered to try to shrink the cancer and make it easier to remove it.
Stage 2 stomach cancer is usually treated with surgery to remove all or part of the stomach, omentum, and surrounding lymph nodes. A number of patients are treated with chemo or chemoradiation before surgery to try to shrink the cancer and facilitate removal. Treatment can involve chemo alone or chemoradiation following surgery.
Surgery is the main cure for patients with this level of illness (unless they have other problems that make them too sick for it). Some patients may be cured by surgery along with other treatments, while for others the only surgery may be able to help control the cancer or help relieve symptoms. Many people can get pre- and post-operative chemo or chemoradiation.
Often, treatment can help keep the cancer under control and help relieve symptoms. This could include surgery, such as in some cases a gastric bypass or even a subtotal gastrectomy, to prevent blockage (obstruction) of the stomach and/or intestines or to control bleeding. In some cases, a laser beam that is directed through an endoscope (a long, flexible tube passed down the throat) can destroy most of the tumour without surgery and relieve obstructions. Nutrition is yet another concern for many stomach cancer patients. Help is available from nutritional counselling to placing a tube in the small intestine to help provide nutrition to those who are having trouble eating, if necessary.
Recurrent disease treatment options are usually the same as for stage IV cancers. Nevertheless, they also depend on where the cancer reappears, what treatments a patient has already had and the general health of the person.
Cost of Stomach Cancer Treatment in India (Surgery): Approx. INR 3.2-4.5 Lakhs
Stage 1 Oesophagus cancers that have not spread into the submucosa (T1a tumours) may be treated with Gastrointestinal endoscopic mucosal resection (EMR), often accompanied by another form of the endoscopic procedure, such as ablation, to remove any irregular residual areas in the lining of the oesophagus. Sometimes ablation alone is appropriate therapy. However, most healthy enough patients will have surgery (Oesophagectomy) to remove the portion of their oesophagus that contains the cancer. Chemotherapy and radiation therapy given simultaneously (chemoradiation) following surgery may be recommended.
Treatment for these cancers is most often chemoradiation followed by surgery for people who are healthy enough. Patients with adenocarcinoma are sometimes treated with chemo (without radiation) followed by surgery at the place where the stomach and oesophagus meet (the gastroesophageal junction). To some small tumours, surgery alone may be an option. If the first cure is surgery, then chemoradiation may be prescribed later, specifically if the cancer is an adenocarcinoma or if there are indications that any cancer might have been left over.
These cancers are sometimes hard to get rid of completely. Therefore, surgery is usually not a reasonable idea to try to cure the cancer. Treatment is primarily used to help keep the cancer under control for as long as possible and to alleviate any symptoms it may cause. Chemo (possibly combined with targeted drug therapy) can be offered to try to make patients feel better and live longer. Radiation therapy or other medications may be used to assist with pain or swallowing issues. Another choice might be treatment with the immunotherapy drug pembrolizumab (Keytruda) or the targeted drugs larotrectinib (Vitrakvi) or entrectinib (Rozlytrek).
Unless the cancer was originally treated endoscopically (such as endoscopic resection of the mucosa or photodynamic therapy), it most frequently returns to the oesophagus. This form of recurrence is frequently surgically treated to remove the oesophagus. If the patient is not too stable for surgery, the cancer may be treated with chemotherapy, radiation, or both. Radiation therapy can also be an option for relieving the symptoms.
Cost of Oesophagus Cancer Treatment in India (Surgery): Approx. INR 3.8-5.1 Lakhs
The tumour did not grow into the prostate during stage me of prostate cancer. If a prostate-specific antigen (PSA) test reads high, then the tumour is likely to be aggressive and recur. In the early stages of a tumour, active surveillance is needed to determine its existence and adjust care accordingly. Radiation therapy destroys cancer cells in the prostate and stops them from growing at an anomalous rate. It may be administered in-house or outside. Radical prostatectomy is another treatment choice, which surgically removes the prostate and associated tissues that have been damaged.
In stage 2, there are also the same treatment choices for prostate cancer as with stage 1-daily screening, radiation therapy, and radical prostatectomy. If the Gleason scores (an indicator that tests cancer aggressiveness) are high, then the radiation dose will be increased.
Stage 3 is when the cancer has spread beyond the prostate and associated organs such as the rectum, lymph nodes and bladder. Doctors recommend outside radiation plus hormone or brachytherapy. Extreme prostatectomy and reduction of pelvic lymph nodes are also combined.
In this stage, the tumour has spread to the bladder, rectum, lymph nodes, organs, or bones, however. Hormone therapy may be paired with surgery, radiation, or chemotherapy, external radiation, chemotherapy, and operation at this stage. Surgery relieves complications such as bleeding or clogging of the urine. Bisphosphonate drugs suppress cancer cell growth and help in the prevention of cancer cells.
Cost of Prostate Cancer Treatment in India (Surgery): Approx. INR 3.8-5.1 Lakhs
Thyroid cancer can be surgically treated through the removal of all or part of the thyroid. Total thyroidectomy is known by surgery to remove the whole thyroid. A lobectomy is called partial thyroid removal. Depending on the patient's age and size, the procedure is selected. Patients diagnosed for these two treatments tend to have comparable recovery periods, but differ on rates of surgical complications and varying chance of thyroid recurrence. Total thyroidectomy is a highly technical procedure and is best done by a trained surgeon who has previously performed this operation. The thyroid is close to the voice chamber, and there is a risk of nerve damage and therefore of a voice chamber function. Surgical complications are less frequent when an accomplished surgeon performs specialized procedures. In some patients, only a part of the thyroid can be removed. This approach is associated with a reduced risk of side effects, but with a higher risk of recurrence of the cancer in or near the thyroid.
The methods of cancer treatment in India for Stage 3 thyroid cancer is similar to Stages 1 and 2 , which includes surgery. Hormone therapy is subsequently given. After surgery, further radiation therapy with beam will be performed, in order to minimize the risk of recurrence in the neck if the tumour is severe. Research indicates that radioactive iodine treatment enhances the survival, particularly for those with cancers that spread to nearby lymph nodes or remote locations in the body, of patients with papillary or follicular thyroid cancer.
At this stage, treatment mostly consist of surgery, radioactive therapy, radiation, chemotherapy, or a combination of these methods of therapy. Combining two or more of these therapies has become an important way to increase the patient's chances of cure and survival. Treatment typically involves a range of medical methods such as cancer removal surgery and iodine therapy. Surgery typically involves removing the entire thyroid if it is not done previously.
If cancer returns to the neck, first an ultrasound-guided biopsy is performed to prove it is cancer. Often surgery is used when the tumour is resectable (removable). If the cancer appears on a radioiodine scan (meaning iodine is taken by the cells), radioactive iodine (RAI) therapy may be used either alone or under surgery. External radiation may be used if the cancer does not appear on the radioiodine scan but is found through other imaging tests (such as an MRI or PET scan).
Cost of Thyroid Cancer Treatment in India (Surgery): Approx. INR 2.1-5.3 Lakhs
Tumour reduction surgery is the primary treatment for Stage 1 ovarian cancer. The uterus, both Fallopian tubes, and both ovaries are most often removed (a bilateral salpingo-oophorectomy hysterectomy). After surgery, the treatment will depend on the cancer's sub-stage.
For cancers in Stage 2 (including 2A and 2B), treatment starts with staging and debulking surgery. This includes a bilateral salpingo-oophorectomy and a hysterectomy. The surgeon will try to get as much of the tumour as possible removed. Chemo is recommended for at least 6 cycles following the surgery. The carboplatin-paclitaxel combination is most often used. Instead of intravenous (IV) chemotherapy, some women with Stage 2 ovarian cancer are treated with intraperitoneal (IP) chemotherapy.
First, the cancer is surgically staged, and the tumour (like stage 2) is debulked. It removes both the fallopian tubes, uterus, ovaries, and omentum. The surgeon will also try to remove the maximum amount of tumour possible. The aim is to leave no visible tumour or tumour greater than 1 cm behind. Combination chemo is given after recuperation from surgery. The most widely used combination is carboplatin (or cisplatin) and a taxane, for example, paclitaxel (Taxol), issued IV (into a vein) for 6 cycles. The intended medication bevacizumab (Avastin) may also be prescribed along with chemo.
Treatment goals are to help patients feel better, and to live longer. Stage 4 may be treated as stage III, followed by chemo (and possibly the targeted drug bevacizumab [Avastin]) with surgery to remove the tumour and debulk the cancer. (If bevacizumab is administered, it is usually continued alone after chemo for up to a year.) Another option is, first, chemo treatment. Then, if the chemo allows the tumours to shrink, surgery can be performed, followed by more chemo. Most often, 3 cycles of chemo are administered before surgery, with at least three more following surgery. Another choice is to restrict therapies to those intended to improve comfort (palliative care).
More surgery is sometimes recommended. Targeted addiction treatment may be effective, too. Bevacizumab (Avastin), for example, can be combined with chemo. Another alternative may be a PARP inhibitor such as olaparib (Lynparza), rucaparib (Rubraca), or niraparib (Zejula). Some may also benefit from hormone therapy with such medications as anastrozole, letrozole, or tamoxifen. The same drugs that are used for newly diagnosed cancer − usually carboplatin and paclitaxel can be used to treat someone who did not initially receive chemo.
Cost of Ovarian Cancer Treatment in India (Surgery): Approx. INR 2.3-3.6 Lakhs
While the staging system of the American Joint Committee on Cancer (TNM) is often used to classify the progression of liver cancer accurately, physicians use a more realistic method to define treatment options. Hepatic cancers are classed as:
Potentially Transplantable Cancer Treatment When your cancer is at an early stage but the remainder of the liver is not stable, you could be treated with a transplant of the liver. Candidates for liver transplantation may have to wait a long time to have a liver available. While they wait, other treatments, such as ablation or embolization, are often given to keep the cancer under grasp.
Treatment options for the liver tumour(s) include ablation, embolization or both. Targeted treatment, immunotherapy, chemotherapy (either systemic or hepatic artery infusion), and/or radiation therapy can also be other options. In some cases, treatment may shrink the tumour(s) sufficiently to allow for surgery (partial hepatectomy or transplant). Such therapies are not going to cure cancer, but they may reduce symptoms, and may even help you live longer.
Such cancers are small enough and in the right position for surgery to remove, but the patient is not well enough for the operation. Treatment options for the liver tumour(s) include ablation, embolization or both. Targeted treatment, immunotherapy, chemotherapy (either systemic or hepatic artery infusion), and/or radiation therapy can also be other options.
Early hepatic cancer has spread to the lymph nodes or to other organs. Because these cancers are widespread, they are not surgically treatable. If the liver works well enough (Child-Pugh class A or B), the targeted therapy drugs sorafenib (Nexavar) or lenvatinib (Lenvima) may help regulate cancer growth for a while and may enable you to live longer. Other targeted drugs, such as regorafenib (Stivarga), cabozantinib (Cabometyx), or ramucirumab (Cyramza), are possible if these drugs no longer function. It may also be helpful for immunotherapy drugs such as pembrolizumab (Keytruda), nivolumab (Opdivo), or nivolumab with ipilimumab (Yervoy).
Treatment of liver cancer that occurs after initial therapy depends on several factors, including when it occurs, the type of initial therapy and how well the liver works. Patients with localized resectable disease that recur in the liver may be eligible for additional surgery or for local treatments such as ablation or embolism. Targeted therapy, immunotherapy, or chemotherapy drugs can be options when the cancer is widespread.
Cost of Liver Cancer Treatment in India (Surgery): Approx. INR 3.2-5.7 Lakhs
Stage 1 includes cancers, which were part of a polyp. If the polyp is completely removed during the colonoscopy, without cancer cells at the edges (margins) of the removed piece, no further treatment may be required. If the cancer in the polyp is of high quality, or cancer cells are at the polyp edges, further surgery may be required. In cancers that are not in a polyp, partial colectomy is the preferred procedure in removing the colon portion that has cancer and surrounding lymph nodes. You will not typically need any more treatment.
The only treatment needed could be surgery to remove the segment of the colon that contains the cancer (partial colectomy) along with nearby lymph nodes. However, if your cancer has a higher risk of returning (recurring), your doctor may recommend adjuvant chemotherapy (chemotherapy after surgery). If chemo is used, 5-FU and leucovorin, oxaliplatin, or capecitabine are the main options but other combinations may also be used.
The primary treatment for this stage is surgery for removing the section of the colon with the cancer. This is called partial colectomy along with surrounding lymph nodes, accompanied by chemo. Either the FOLFOX (5-FU, leucovorin, and oxaliplatin) or CapeOx (capecitabine and oxaliplatin) regimens are more commonly used for chemo, although certain patients get 5-FU either with leucovorin or with capecitabine depending on their age and health needs. For people who are not healthy enough for surgery, radiation therapy and/or chemotherapy may be options.
In most cases, surgery is not an effective cure to stage IV colon cancers. However, if there are just a few small areas of cancer (metastasis) in the liver or lungs, they can be removed along with colon cancer. Surgery will help you live longer in these cases. If the cancer has spread too widely to attempt surgically to cure it, the main therapy is chemo. If the cancer blocks the colon, or is likely to do so, surgery may still be required. Such surgery can often be prevented by inserting a stent (a hollow metal or plastic tube) inside the colon during a colonoscopy to hold it open. Otherwise, operations such as a colectomy or colostomy diverter (cutting the colon above the cancer stage and connecting the end to an opening in the skin on the belly to accommodate waste) may be required.
If the cancer returns locally, often surgery (often accompanied by chemo) can help, you live longer, and can even cure you. If the cancer is not surgically removed, chemo may be attempted first. If the tumour is shrinking enough, surgery may be an option. More chemo will move on from this again. Another alternative may be immunotherapy treatment for people whose cancers are found to have certain characteristics on laboratory tests.
Cost of Colon Cancer Treatment in India (Surgery): Approx. INR 3.5-4.8 Lakhs
Stage 1 melanoma is treated with wide excision most often. Doctors are suggesting a sentinel lymph node biopsy (SLNB) for cancer detection in nearby lymph nodes. If the lymph nodes are not cancerous, follow-up is still advised. If the tumour is detected, further treatment with an immune checkpoint inhibitor or targeted therapy drugs is suggested.
Wide excision is the standard treatment for stage II melanomas, which depends on the thickness and position of the melanoma. The results of SLNB rely on whether follow-ups or immune-checkpoint inhibitors are necessary, and targeted therapy drugs must be used for adjuvant therapy.
Stage 3 melanomas are those which reached the lymph nodes when they were diagnosed. After surgery, adjuvant therapy (therapy given after initial care to minimize the risk of returning cancer) is considered either with an immune checkpoint inhibitor or with targeted therapy drugs.
By Stage 4, Melanomas will have spread to the lymph nodes and other locations in the body. These skin tumours or swollen lymph nodes cause symptoms. A combination of surgery, radiation therapy, and palliative treatment helps relieve these effects but never cures the tumour itself. Immunotherapy drugs such as pembrolizumab (Keytruda) or nivolumab (Opdivo) are used as inhibitors of checkpoints, especially in people who have no mutations in their B-Raf genes (a protein-coding gene). These medications continue to compress tumours for longer periods. However, there are gene changes in BRAF in about half of the recorded cases of melanoma. New targeted therapies incorporate the use of a BRAF inhibitor and a MEK inhibitor.25.
Cost of Melanoma Cancer Treatment in India (Surgery): Approx. INR 2-4.2 Lakhs
Doctors usually recommend chemotherapy (two to four times), accompanied by radiation to the original site of the disorder. ISRT or site radiation treatment involved is a procedure for most patients. Chemotherapy (usually 4 to 6 cycles) alone in chosen patients is another choice. After a few physical procedures, doctors order a PET / CT scan to see how well the treatment works and how much (if necessary) additional treatment is required. Radiation therapy, by itself, may be the alternative if a person is not able to have chemotherapy due to certain health problems.
Chemotherapy with different medicines or high-dose chemotherapy (and possibly radiation) with stem cell transplant may be recommended for those not responding to treatment. Monoclonal Brentuximab Vedotin Antibody Treatment may be an alternative. Treatment with an immune control point inhibitor may be helpful if this is not helpful.
Physicians usually use more complex regimens than in prior phases to treat these stages of lymphoma. The regimen of ABVD is often used (for a minimum of 6 cycles) but some doctors are more advantageous for 3 cycles or up to 8 cycles in the regimen with Stanford V if several adverse predictive factors are observed. PET / CT scans can be used to determine how much further care is required before or after chemo. More chemo may be administered depending on the results of the scans. After chemotherapy, particularly if there were large areas of the tumour, radiation therapy could be provided.
Chemical medications or high dose (and possibly radiation) chemotherapy followed by stem cell transplant may be recommended for those whose HL does not respond to therapy. Monoclonal Brentuximab Vedotin Antibody Therapy could be another alternative. An immunotherapy medication, such as nivolumab or pembrolizumab, may be useful.
Cost of Bone Marrow Transplant in India: Approx. INR 12.2 Lakhs
Surgery is typically the principal treatment. Some early Stage 1 cancers can be removed via the anus, using trans anal resection or trans anal endoscopic microsurgery (TEM), without cutting the abdomen (belly). A low anterior resection (LAR), proctectomy with colo-anal anastomosis, or an abdominoperineal resection (APR) can be performed for other cancers, depending on exactly where the cancer is located within the rectum.
Most people with Stage 2 rectal cancer should be treated with chemotherapy, radiation therapy, and surgery, although some people can consider the sequence of those treatments different. Many people are given chemotherapy as well as radiation therapy (called chemoradiation) as their first treatment. The radiation administered chemo is typically either 5-FU or capecitabine (Xeloda). Typically, this is accompanied by surgery, such as low anterior resection (LAR), colo-anal anastomosis proctectomy, or abdominoperineal resection (APR), depending on where the cancer is in the rectum.
Chemotherapy, radiation therapy, and surgery can treat most people with Stage 3 rectal cancer, but the order of these treatments can vary. Chemo is most commonly offered first alongside radiation therapy (called chemoradiation). This will shrink the cancer, also making removing larger tumours easier. It also reduces the risk of the cancer arising in the pelvic. Giving radiation before surgery often appears to cause fewer complications than following surgery. Surgery is accompanied by chemoradiation to kill the rectal tumour and adjacent lymph nodes.
To some extent, treatment options for stage IV illness depend on how common the cancer is. If it is possible to eliminate all cancer (for example, there are just a few tumours in the liver or lungs), the most popular treatment choices are:
Cost of Rectal Cancer Treatment in India (Surgery): Approx. INR 2.5-5 Lakhs
The first therapy for CLL can be used in several different medications and combinations of medicines. The choices include monoclonal antibodies, other specific drugs, chemotherapy, and several of these combinations. Some of the most commonly used therapies include:
Where the only concern in one part of the body is an enlarged spleen or swollen lymph nodes, localized treatment with low-dose radiation therapy can be used. Splenectomy (a spleen reduction surgery) is another alternative if the enlarged spleen causes symptoms.
Very high numbers of CLL cells in the blood often cause problems with normal circulation. The word leukostasis is used here. Chemo does not decrease the number of cells until a few days after the first dose, and some of the cells will need to be extracted from the blood with a process called leukapheresis before administering the chemo. This procedure immediately reduces blood counts. The impact only lasts for a short time, but can help before the chemo has an opportunity to function. Leukapheresis is often used to avoid tumour lysis syndrome before chemo if there are very large numbers of leukaemia cells (even though they are not causing problems).
Some people with a high-risk disease (based on prognostic factors) may be referred for possible stem cell transplantation (SCT) early in the treatment.
If the original treatment no longer works, or the disease returns, another form of treatment is always beneficial. If the initial treatment response lasted a long time (usually at least a few years), then the same treatment may be used again. Unless the original response was not long, lasting it is not as likely to be beneficial to use the same procedure. The options would depend on what was the first-line treatment and how well it performed, and the overall health of the individual. Many of the above-mentioned medications and combinations (as well as others) can also be options as second line therapies. Targeted therapy and antibody-monoclonal drugs are widely used, isolated or in combination. In certain cases, stem cell transplant could be an option if the leukaemia reacts.
Many people may get a good response to first-line treatment (such as fludarabine), but there may still be many evidence for a small number of leukaemia cells in the blood, bone marrow, or lymph nodes. This is called reduced residual disease. CLL cannot be cured, and physicians are not sure whether further therapy would be effective right away. Some limited studies have shown that alemtuzumab can often help get rid of these residual cells, but whether this improves survival is still not clear.
One of CLL's most severe complications is a shift (transformation) of the leukaemia into a high-grade or aggressive type of non-Hodgkin lymphoma (NHL) called a diffuse large B-cell lymphoma (DLBCL) or Hodgkin lymphoma. This occurs in 2 to 10 per cent of CLL cases, and is known as the transformation of Richter. Treatment is often the same as it would be for lymphoma and can require transplantation of stem cells; as such cases are more difficult to handle. CLL can progress less frequently toward prolymphocytic leukaemia. Some studies have indicated that certain drugs like cladribine (2-CdA) and alemtuzumab can be of benefit. Leukaemia turns into acute lymphocytic leukaemia (ALL) in rare CLL cases. If this occurs, the procedure will generally be identical to that used in other cases.
Another unusual complication in patients who have undergone CLL treatment is acute myeloid leukaemia (AML). Drugs like chlorambucil and cyclophosphamide can damage blood-forming cell DNA. These damaged cells will continue to grow into cancer, leading to AML, which is very aggressive and sometimes difficult to treat.
Cost of Leukemia Surgery (Approx.): INR 4-7 Lakhs
The cost of chemotherapy in India differs due to several factors such as the chemo drug used, the hospital/ infusion center, and the method of chemo administration. Generally, the average cost per chemotherapy at a Budget hospital is around INR 15,000 per cycle, while the same at a Premium hospital comes to around INR 30,000 per cycle. But the cost for the same at a Chemo Infusion Center comes down to around INR 7,000-10,000 per cycle since they only charge for the chemo drug and infusion charge, unlike the hospitals, which take extra charging for nursing, admin, and hospitality.