What is Cancer?
To simply understand different Cancer treatment in India for various cancer types, let us know what is Cancer. Cancer is a group of over 100 diseases that evolve over time and require 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 several 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.
Causes of Cancer
Cancer is one of the world’s fastest-growing illnesses and the second-largest cause of death. According to reports, in 2018 cancer accounted for 9.6 million deaths while in the United States an additional 606,880 people died. Around one in six deaths worldwide is caused due to cancer. By comparison, according to the Indian Medical Research Council (ICMR), more than 1300 Indians die every day from cancer.
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:
- High body mass index
- Low fruit and vegetable intake
- Lack of physical activity
- Tobacco use
- Alcohol use
According to the 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 that 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 of 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 of females are related to the use of tobacco. These include cancers of the head and neck, lung, oesophagus, pancreas, and renal and urinary bladder.
How Cancer Arises
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 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 ultraviolet rays from the sun.
Cancer cells generally experience more genetic changes, such as DNA mutations, than healthy cells do. Some of those changes may have little to do with cancer; rather than its origin, they may be the product of cancer.
Stages of Cancer:
For various types of cancer different types of staging, schemes are used. Below is an example of one common form of staging:
Stage 0– indicates where cancer originated (in situ) and did not spread
Stage I– the size of the cancer is small and it has not spread out
Stage II– cancer has grown, but has not spread
Stage III– cancer is larger and may have spread to adjacent tissues and/or lymph nodes
Stage IV– cancer has spread to at least one other organ from where it originated; also called “secondary” or “metastatic” cancer
Stages of Cancer Development:
- When a cell experiences a mutation, the tumour begins to develop which makes the cell more likely to divide than it normally would.
- Very often the altered cell and its descendants increase and fragment, a disorder called hyperplasia.
- The descendants of this cell divide excessively and look abnormal, a disorder called dysplasia.
- If the tumour that has grown from these cells is still present within its original tissue, it is called cancer in situ.
- The tumour is considered malignant if certain cells undergo additional mutations that cause the tumour to invade neighbouring tissues and shed cells into the blood or lymph. The escaped cells will produce new tumours (metastases) on other locations in the body.
Cancer Treatment in India
Is Cancer Curable?
Is Cancer Curable? 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 an 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 percent compared to a 72 percent Stage III survival rate and just 22 percent 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 percent. Similarly, diagnosing cervical cancer when lesions are precancerous leads to a survival rate of approximately 100 percent, but the rate decreases to only 32 percent if diagnosed in stage III and 16 percent if diagnosed in stage IV. Testicular cancer can be treated in 99 percent of the time when found early, and 73 percent 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 has a 98 per cent survivable rate for 5 years or more. If diagnosed at Stage IV, the survival rate decreases to around 28 per cent.
The most common cancers that affect the country’s 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 patient’s 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.
Cancer Treatment in Rural 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, fewer 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.
There are few facilities in rural regions that disseminate information about cancer, screening and early diagnosis. Even the diagnostic process like biopsies or 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. 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 is becoming expensive every day, and in India, where 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, most 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 in the cities. This flow can be stopped if all such assistance is also made available in rural centres.
Types of Cancer Treatment
There are many forms of treatment for cancer. 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 treatment that reduces or prevents the growth of breast and prostate cancers using hormones to grow.
Stem Cell Transplant:
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, tumour DNA mutations.
Cancer Treatment Types and Stages in India
Breast Cancer Treatment by Stages in India
Stage I Breast Cancer Treatment
Stage I breast cancer need an 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 II Breast Cancer Treatment
Stage II breast cancer is treated with surgery to protect the breast, or often with mastectomy. The distinction between breast cancer stage II A and stage II 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 is needed, radiation will be delayed.
Stage III Breast Cancer Treatment
These are often treated with neoadjuvant treatment that helps reduce the tumour before the main operation, which is breast reduction surgery in this case. Trastuzumab, is given as 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 IV Breast Cancer Treatment Options
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.
Recurrent Breast cancer
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.
Lip, Oral cavity Cancer Treatment in India
Stage I and II Oral Cancer Treatment
When treated with surgery and/or radiation therapy, most patients with stage I or II 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. Surgery can be required later if the tumour is not adequately disposed of by radiation. If the tumour becomes thick, the risk of 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. 15
Stage III and IVA Oral Cancer Treatment
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.
Stage IVB and IVC
They are HPV-negative cancers that have spread into surrounding organs, structures and even lymph nodes already. Stage IVC 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.
Recurrent oral cavity or oropharyngeal cancer
If cases where 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.
Also Read: Story of Throat Cancer Survivor
Cervical Cancer Treatment in India
Stage I cervical cancers treatment
Surgery is the primary form of care for cervical cancer in stage I, but it depends on the patient’s age, and whether they want to have a child. For women with stage IA1 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 I. Removal of the surrounding lymph nodes, chemoradiation, or only radiation are options you may consider after consulting your healthcare team.
Stage II Cervical Cancers Treatment
In stage II 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.
Total hysterectomy, removal of pelvic and abdominal lymph nodes. Based on tumour size and delivery, radiation can be delivered in varying dosages.
Stage III Cervical Cancers Treatment
Stage III 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 IV Cervical Cancers Treatment
Stage IV 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 used with pembrolizumab alone along with chemo or immunotherapy.
Recurrent Cervical Cancer Treatment
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.
Lung Cancer (Non-small Cell Lung Cancer) Treatment in India
Stage I Lung Cancer Treatment
If you have NSCLC stage I, 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. Another choice might be to use radiation therapy after surgery.
Stage II Lung Cancer Treatment
People who have stage II 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 III Lung Cancer Treatment
Step III 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 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.
Stage IV Lung Cancer Treatment
Treatment choices depend on where and how far cancer has spread, whether a certain gene or protein occurs in the cancer cells, and general health.
When you are otherwise in good health, therapies such as surgery, chemotherapy (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.17
Stomach Cancer Treatment in India
Stage I Stomach Cancer Treatment
People with stage I 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 cancer and make it easier to remove it.
Stage II Stomach Cancer Treatment
Stage II 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 cancer and facilitate removal. Treatment can involve chemo alone or chemoradiation following surgery.
Stage III Stomach Cancer Treatment
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 cancer or help relieve symptoms. Many people can get pre-and post-operative chemo or chemoradiation.
Stage IV Stomach Cancer Treatment
Often, treatment can help keep 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 tumours 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 Stomach Cancer Treatment
Recurrent disease treatment options are usually the same as for stage IV cancers. Nevertheless, they also depend on where cancer reappears, what treatments a patient has already had and the general health of the person.
Oesophagus Cancer Treatment in India
Stage I Oesophagus Cancer Treatment
Some very early stage I cancers that are only in a limited area of the mucosa and 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 residual irregular 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 cancer. Chemotherapy and radiation therapy given simultaneously (chemoradiation) following surgery may be recommended
Stage II & III Oesophagus Cancer Treatment
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.
Stage IV Oesophagus Cancer Treatment
These cancers are sometimes hard to get rid of completely. Therefore, surgery is usually not a reasonable idea to try to cure cancer. Treatment is primarily used to help keep 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 treated with the immunotherapy drug pembrolizumab (Keytruda) or the targeted drugs larotrectinib (Vitrakvi) or entrectinib (Rozlytrek).
Recurrent Oesophagus Cancer Treatment
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, cancer may be treated with chemotherapy, radiation, or both. Radiation therapy can also be an option for relieving the symptoms.
Prostate Cancer Treatment
Stage I Prostate Cancer Treatment
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.
Stage II Prostate Cancer Treatment
In stage II, there are also the same treatment choices for prostate cancer as with stage I-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 III Prostate Cancer Treatment
Stage III is when cancer has spread beyond the prostate and associated organs such as the rectum, lymph nodes and bladder. Doctors recommend external radiation plus hormone or brachytherapy. Total prostatectomy and reduction of pelvic lymph nodes are also combined.
Stage IV Prostate Cancer Treatment
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.20
Thyroid Cancer Treatment
Stage I and II Thyroid Cancer Treatment
Thyroid cancer can be surgically treated through the removal of all or part of the thyroid. Total thyroidectomy is used by surgery to remove the whole thyroid. A lobectomy is used for 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 differing rates of surgical complications and varying chances 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 cancer in or near the thyroid.
Stage III Thyroid Cancer Treatment
Treatment is similar to stage I and stage II, which includes surgery. Hormone therapy is subsequently given. After surgery, further radiation therapy with a 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.
Stage IV Thyroid Cancer Treatment
At this stage, treatment mostly consists of surgery, radioactive therapy, radiation, chemotherapy, or a combination of these methods. 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.
Recurrent Thyroid Cancer Treatment
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 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 cancer does not appear on the radioiodine scan but is found through other imaging tests (such as an MRI or PET scan).
Stage I Ovarian Cancer Treatment
Tumour reduction surgery is the primary treatment for stage I 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 cancer’s sub-stage.
Stage II Ovarian Cancer Treatment
For cancers in stage II (including IIA and IIB), 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 II ovarian cancer are treated with intraperitoneal (IP) chemotherapy.
Stage III Ovarian Cancer Treatment
First, the cancer is surgically staged, and the tumour (like stage II) is debulked. It removes both the fallopian tubes, uterus, ovaries, and omentum. The surgeon will also try to remove the maximum amount of tumours 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.
Stage IV Ovarian Cancer Treatment
Treatment goals are to help patients feel better and to live longer. Stage IV may be treated as stage III, followed by chemo (and possibly the targeted drug bevacizumab [Avastin]) with surgery to remove the tumour and debulk 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).
Recurrent Ovarian Cancer Treatment
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.
Liver Cancer Treatment:
While the staging system American Joint Committee on Cancer (TNM) is often used to accurately classify the progression of liver cancer, physicians use a more realistic method to define treatment options. Hepatic cancers are classed as:
- Potentially resectable or transplantable
- Inoperable with only local disease
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 cancer under grasp.
Unresectable liver cancers
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.
Inoperable liver cancers with only local disease
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.
Advanced or metastatic liver cancers
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).
Recurrent liver cancer Treatment
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.
Colon Cancer Treatment in India
Stage I Colon Cancer Treatment
Stage I includes cancers, which were part of a polyp. If the polyp is completely removed during colonoscopy, without cancer cells at the edges (margins) of the removed piece, no further treatment may be required. If 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.
Stage II Colon Cancer Treatment
The only treatment needed could be surgery to remove the segment of the colon that contains 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.
Stage III Colon Cancer Treatment
The primary treatment for this stage is surgery for removing the section of the colon with 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.
Stage IV Colon Cancer Treatment
Surgery is not an effective cure for such cancers, in most cases. However, if there are just a few small areas of the spread of cancer (metastasis) in the liver or lungs, and they can be removed along with colon cancer, surgery will help you live longer.
If cancer has spread too widely to attempt surgically to cure it, the main therapy is chemo. If 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.
Recurrent Colon Cancer Treatment
If 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.
Melanoma Cancer Treatment in India
Stage I Melanomas Treatment
Stage I 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.
Stage II Melanomas Treatment
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 III Melanomas Treatment
Stage III 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.
Stage IV Melanomas Treatment
At Stage IV melanomas entered the lymph nodes while in the body, or other remote locations. 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.
Treatment for Lymphomas
Stages I & II A Lymphomas Treatment
Doctors usually recommend chemotherapy (two to four times), accompanied by radiation to the original site of the disorder. ISRT or site radiation treatment 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.
Stages III or IV Lymphomas Treatment
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 supportive 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 cancer 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.
Rectal Cancer Treatment in India
Stage I Rectal Cancer Treatment
Surgery is typically the principal treatment. Some early stage I 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.
Stage II Rectal Cancer Treatment
Most people with stage II 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.
Stage III Rectal Cancer Treatment
Chemotherapy, radiation therapy, and surgery can treat most people with stage III rectal cancer, but the order of these treatments can vary. Chemo is most commonly offered first alongside radiation therapy (called chemoradiation). This will shrink cancer, also making removing larger tumours easier. It also reduces the risk of cancer arising in the pelvic. Giving radiation before surgery often appears to cause fewer complications than the following surgery. Surgery is accompanied by chemoradiation to kill the rectal tumour and adjacent lymph nodes.
Stage IV Rectal Cancer Treatment
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:
- Surgery (and/or radiation therapy, in some cases) to suppress the rectal tumour and distant tumours;
- Chemotherapy, followed by surgeries to correct the rectal tumour and remote tumours, usually followed by chemoradiation
- Chemotherapy, followed by chemoradiation, then surgery to remove the rectal tumour and remote tumours.
- Chemoradiation, then surgeries to correct the rectal tumour and remote tumours. Chemotherapy can follow on from this.
Chronic Lymphocytic Leukaemia (CLL)
Initial treatment of Chronic Lymphocytic Leukaemia (CLL)
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:
- Ibrutinib (Imbruvica), alone or with rituximab (Rituxan)
- Acalabrutinib (Calquence), alone or with obinutuzumab (Gazyva)
- Venetoclax (Venclexta) and obinutuzumab
- Venetoclax alone, or with rituximab
- Bendamustine and rituximab (or another monoclonal antibody)
- High-dose prednisone and rituximab
- FCR: fludarabine, cyclophosphamide, and rituximab
- PCR: pentostatin, cyclophosphamide, and rituximab
- Chlorambucil and rituximab (or another monoclonal antibody)
- Ibrutinib and obinutuzumab
- Alemtuzumab (Campath), alone or with rituximab
- Other drugs or combinations of drugs may also be used
Radiation or surgery
Where the only concern in 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).
Stem cell transplant
Some people with a high-risk disease (based on prognostic factors) may be referred for possible stem cell transplantation (SCT) early in the treatment.
Second-line treatment of CLL
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 much 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.
Treating complications of CLL
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.
Complementary and Alternative Medicine (CAM) for Cancer in India
What is complementary medicine?
Complementary medicine is a group of diagnostic and therapeutic disciplines used in combination with traditional medicine. Aromatherapy is an example of a supportive treatment to help relieve the pain of a patient following surgery.
In medical schools or hospitals, complementary medicine is typically not taught or used. Complementary medicine comprises a significant number of healthcare procedures and programs that have not been accepted by traditional Western medicine for a variety of cultural, social, economic, or scientific reasons. Nowadays there are specialised CAM according to cancer types like CAM for breast cancer or CAM for rectal cancer
Complementary medical products vary from traditional medicine. Though complementary medicine is used in combination with traditional medicine, alternative medicine is used instead of conventional medicine. An example of alternative treatment is to use a particular diet to treat cancer, rather than having surgery, radiation, or chemotherapy prescribed by a doctor.
Types of Complementary and alternative medicine (CAM):
Ayurveda (ayurvedic medicine)
What is alternative medicine?
Alternative medicine practices are used instead of routine medical treatments. Alternative medicine is distinct from complementary medicine and is meant to supplement traditional medical procedures rather than replacing them. The medical profession usually does not accept complimentary treatment treatments as traditional or mainstream medical methods.
Alternative treatment covers dietary supplements, mega doses of vitamins, herbal treatments, special teas, massage therapy, magnet therapy and spiritual cure.
What are complementary and alternative medicine (CAM) therapies?
Complementary and alternative medicine therapies are of five major types:
Alternative Medical Systems
Alternative medical systems are based on the philosophy and reality of full systems. Such methods have also grown separately from and faster than the traditional approach to medicine used in the US. Homoeopathic medicine and naturopathic medicine are examples of traditional treatment systems that have developed in Western societies. Examples of structures that have developed in non-Western societies include traditional Chinese and Ayurvedic medicine.
Mind-body medicine uses a range of methods intended to enhance the capacity of the mind to affect bodily function and symptoms. Some strategies historically considered CAM has become popular (e.g., patient support groups, and cognitive-behavioural therapy). Many mind-body methods, including meditation, prayer, emotional healing and interventions that use artistic tools such as painting, music, or dance, are also called CAMs.
Biologically Based Therapies
CAM dependent biological therapies use substances present in nature, such as plants, meats, and vitamins. Some instances involve nutritional supplements, herbal supplements, and other natural therapies (e.g., cancer treatment using shark cartilage).
Manipulative and Body-Based Methods
Manipulative and body-based methods in CAM are based upon one or more parts of the body being controlled and/or moved. Some examples include, and acupuncture, chiropractic or osteopathic manipulation.
Energy therapies involve the use of energy fields. They are of two types:
- Biofield treatments are meant to impact fields of energy theoretically surrounding and entering the human body. These areas have still not been scientifically proved to exist. By applying pressure and/or controlling the body by putting the hands in or around these areas, some types of energy biofields are created. Types include Qi Gong, Reiki, and Contact Therapeutics.
- Bioelectromagnetic therapeutic approaches involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields or alternating current or direct current fields.
Side effects & symptoms of Cancer Treatment
Cancer treatments cause various side effects. Side effects are complications that develop when healthy tissues or organs are damaged by medication. Speak up about any problems you may have. Your health care provider will monitor and/or explore ways to mitigate these side effects, so you feel good.
Integrative oncology is an effective choice for coping with cancer treatment side effects. These therapies work in conjunction with the standard methods of treatment (surgery, chemotherapy, radiation) for the body. Integrative oncology with the best Oncologists in India can improve the condition with the objectives of treatment, treatment of side effects, distress relief, and may help with treatment outcomes and commitment.
Integrative Oncology uses Mind-body methods – mindfulness, biofeedback, cognitive-behavioural therapy, mediation, relaxation, yoga, music therapy, creative therapies, and spirituality. It also focuses on onco-nutrition like vitamins, herbs, foods, special diets.
Thorough Integrative Oncology, you can have access to onco-psychologist, onco-nutritionist and fitness experts who are able to manage the below-mentioned side effects:
Bleeding and Bruising (Thrombocytopenia)
Fertility Issues in Women and Men
Hair Loss (Alopecia)
Infection and Neutropenia
Nerve Problems (Peripheral Neuropathy)
Immunotherapy and Organ-Related Inflammation
Sexual Health Issues in Women and Men
Skin and Nail Changes
Sleep Problems and Insomnia
Urinary and Bladder Problems