Cancer: A preventable and curable disease

Dr Th Tomcha Singh *

Introduction: The technological advances in recent past have drastically curtained the number one killer in the past "Infection related diseases" but the opposite is true in respect of cancer. The present day increase in life span coupled with modern life style and environmental pollution culminated in a spurt of this dreaded disease.

In fact, the incidence of cancer is gradually yet consistently on the rise world over. Once considered a western disease, cancer now is spreading its tentacles in the underdeveloped as well as the developing world. Presently approximately 70% of deaths from cancer occurs in these low and middle-income countries.

Fortunately, the dreaded disease of cancer is preventable by majority by taking precautionary measures. Even if it could not be prevented, early detection is quite possible by screening programs. When detected early, the disease is quite curable, contrary to what people commonly believe.

What is cancer: Cancer is formed when our body cells develop some abnormalities whereby there is increase in cell proliferation or decrease in cell apoptosis (programmed cell death) or both. It is a multistep carcinogenetic process that involves initiation, promotion, conversion and progressithereby; a normal cell is completely transformed into a malignant (cancer) cell.

The very process entails abnormal DNA repair mechanisms, variable expression of oncogenes (cancer producing genes) and loss of tumour suppressor genes. The unique quality of a cancerous growth is its ability for infiltration into its neighborhood and distant spread.

Cancer cells do grow very fast as they have high metabolic turnover and all these are happening at the expense of its host. About 10% of cancers are hereditary and the rest acquired during one's lifetime due to age related cellular degeneration and exposure to harmful chemical / physical / biologic carcinogens.

Magnitude of cancer: The cancer incidence and menace is increasing at an alarming rate all over the globe. The global cancer burden is reported to be about 18 millions and annual mortality of about 9 millions. Every year about 14 million new cancer cases are added to the cancer burden. According to World Health Organization, it is predicted that newly detected cancer incidence will be increased 70% by 2 decades from now on.

Cancer is the second killer only next to cardiovascular disease. In India also, Indian Council of Medical Research estimates the cancer incidence to be 125-135 per one lakh population and there are about 12 lakhs new cases per year. The odds of suffering from cancer in India are roughly 1 in every 10 individuals against 1 in 4 in USA. Even if we are lucky to escape from its clutches, each of us is destined to be involved either as a relative or a friend.

Not only the same trend prevails in the North-east India but also certain types of cancers are relatively very high in the region compared to national figures. The incidence of stomach cancer is very high in Mizoram and Arunachal Pradesh and is comparable to that of Japan, the highest in the world.

In contrast to national scenario, nasopharyngeal cancer is the commonest in Nagaland, lung cancer in Manipur and oesophageal and hypopharyngeal cancers in Assam. Liver cancer is also very common in Arunachal Pradesh.

More than 50% of the cancers are in the exposed parts viz. oral cavity, cervix uteri and breast. Luckily these cancers can be detected by the patient themselves in very early stage and when treated early, they can be cured.

Prevention of cancer: Like any other disease, prevention is better than cure. It is amazing to note that at least 50% of cancers are preventable as it is closely related to life-style. The following are some of the avenues for prevention of cancer.

Smoking: The carcinogenic effects of smoking are well known. It is staggering to note that tobacco is related to 3.5 million deaths every year globally, 1 million of which are in developing countries and 8 lakhs in India alone. 30% of all American cancer deaths are related to smoking.

A person who smokes 20 sticks or more a day, his or her chance of developing lung cancer is more than 10 times as compared to a non-smoker. Bidi smoking, a cheaper version of smoking is more injurious than cigarette smoking. One of the paradoxes of our modern electronic era is that computers require smoke-free environments because of impaired machine function resulting from even small particles of smoke in the atmosphere, and yet people are not similarly protected.

It has been further documented that passive smokers particularly children living or working with smokers may perhaps have higher incidence of lung cancer. Tobacco is responsible for over 25 diseases including the dreaded cancer disease. Tobacco smoke contains about 4000 chemicals, of which more than 20 are carcinogenic (Cancer causing).

Smoking increases the chances of developing cancer all over the body particularly of lung, larynx, oral cavity, throat, bladder, kidney, pancreas, uterus and breast. Smoking accounts for almost 96% of all male lung cancers. It is estimated that giving up of smoking will eliminate about a third (30%) of all cancers.

Food Habit: A proper food habit can prevent about 20% of cancers. An ideal cancer preventive food is a well balanced diet with plenty of vegetables and raw fruits and it should contain enough of anticancer vitamins – A, C, D & E and minerals like Selenium, chromium, calcium, molybdenum, etc. Meat should be allowed only in moderation.

Excess meat consumption, particularly red meat, increases chances of developing colonic cancers and breast cancer – very common in Western countries and amongst the hill people of North-east. Salt preserved food, smoked food, canned food, etc. should be avoided / minimized.

Regular consumption of salted fish has strong affinity for Nasopharyngeal carcinoma, a common cancer in our region. Consumption of smoked food (prevalent in Manipur) is also highly carcinogenic. It has been estimated that the quantity of carcinogenic polycyclic aromatic benzopyrene consumed by eating one well-cooked charcoal broiled steak is equivalent to that inhaled by smoking 600 cigarettes.

Alcohol: Excess consumption of alcohol is associated with many health hazards including cancer and its avoidance can achieve 7% reduction of cancers. Alcohol is associated with cancers of floor of mouth, pharynx, larynx, oesophagus, stomach, liver, pancreas and breast.

Hygiene: Improving personal hygiene including the potentially dirty areas of oral cavity and private parts (Both husband and wife) can reduce quite a good number of cancers of oral cavity, cervix and penis. Good hygiene along with avoidance of early marriage, multiparity and sexual promiscuity can prevent at least half of the incidence of cancer cervix, the commonest female malignancy in rural India.

Hazardous occupations: People working in hazardous occupations such as those handling with carcinogenic chemicals in industries/factories should use all possible protective and preventive measures such as masks, gloves, aprons, goggles and boots. Strong chemicals must not be handled by bare hands nor directly inhaled.

Infections: Some microbial infections are associated with cancer. The incidence is as high as 25% in low -income and middle-income countries. Hepatitis B virus infection may lead to the development of liver cancer, EB virus is associated with nasopharyngeal cancer and Hodgkin's disease, Human papilloma virus can cause cervical cancer and Schistosomiasis infestation bladder malignancy. By maintaining a clean environment, observance of antiseptic and aseptic precautions and vaccination, many of such infection related cancers can be eliminated.

Sunlight: Ultra violet rays contained in the sun's rays can cause cancers of the skin. People particularly fair complexioned should avoid long exposures to sunlight. For people who works in open sunshine must wear full-sleeved shirts, hats, sun protection cream etc.

Exercise and ideal body weight: Recent understanding has strongly implicated lack of activity/exercise and obesity for the cause of many types of cancers particularly those of colon, breast, uterus and prostate.

"Siting is new smoking" meaning thereby that inactivity in most of the times is as injurious as smoking. It is advocated that everybody must have at least half an hour vigorous exercise per day, at least 5 days per week. A standard body weight for one's height must also be maintained.

Prevention of common cancers:

Preventive measures of Oral Cancer:

1. Stop tobacco in any form;
2. Improve oral hygiene;
3. Avoid heavy alcohol drinking;
4. Have food rich in green leafy vegetables and colourful fruits;
5. Brush teeth after every meal, at least twice a day;
6. Practise self-mouth exam (Using mirror) at least once a month and
7. Get an examination of your mouth done by a doctor at least once a year, whether you have problems or not.

Preventive measures of breast cancer:

1. Avoid late marriage (After 30);
2. Encourage breast-feeding;
3. Avoid high fatty food, particularly animal fat;
4. Avoid excessive meat (particularly red meat), tobacco and alcohol;
5. Have regular exercise;
6. Control body weight;
7. Practise regular Breast Self Examination (BSE) once monthly;
8. Undergo physical exam by doctor;
9. Undergo mammography and
10. Antioxidants, Isoflavones in soya and omega-3 fatty acid in fish are protective.

Preventive measures of Womb Cancer:

1. Avoid early marriage (Before 18 yrs, particularly before 16);
2. Control family size;
3. Improve personal hygiene – Both husband and wife;
4. Avoid sexual promiscuity;
5. Take balanced diet and
6. Have regular Pap Swear.

Preventive measures of Lung Cancer:

1. Stop smoking;
2. Avoid smoke-filled/polluted environment;
3. Proper ventilation of houses and
4. Take proper diet.

Early detection of cancer: The earlier the stage at which a cancer is detected, the better is the chance of cure with treatment. 50% of cancers detected in early stages (stage I & II) can be cured. Thus early detection and prompt treatment is the second best thing only next to prevention. Early detection may be before symptoms or with symptoms.

Detection before symptoms: The mystery of cancer is that it does not produce any symptom in the very initial stage. Detection in thus stage is the most curable. To enable detection in this stage, the habit of regular medical checkup, at least once in a year, preferably every six months must be practiced especially for those above 40 years of age.

This check up must be irrespective of whether somebody is sick or not. This practice is embraced in western countries and hence cancers are detected in early stage in 80%. Unfortunately the same is not a priority for developing and underdeveloped countries and hence when cancer disease is diagnosed, 80% will be detected late. When detected late, chances of cure are very remote.

Detection with symptoms: Early detection is also possible in most of the instances if people are aware of the warning signals of cancer and if they report immediately to the concerned doctors to confirm / rule out cancer. Everybody must be thoroughly familiar with the 7-warning signals of cancer, which covers all types of cancers that can affect human body.

Seven warning signals of cancer:
Change in bowel or bladder habits;
A sore that does not heal;
Unusual bleeding or discharge;
Thickening or lump in breast or elsewhere;
Indigestion or difficulty in swallowing;
Obvious change in wart or mole and
Nagging cough or hoarseness.

If anyone has any or more of the symptoms given above, he/she must consult the concerned doctors to confirm or rule out cancer.

Warning signals of Oral Cancer:
1. Swelling / lump inside the oral cavity;
2. Non-healing ulcer;
3. White, red or black patches;
4. Inability to open mouth;
5. Difficulty in swallowing;
6. Hoarseness of voice and
7. Sudden weight loss.

Warning signals of Breast Cancer:
1. Lump in breast;
2. Deformity of breast;
3. Puckering of skin over breast;
4. Skin ulceration;
5. Discharge from nipple;
6. Lump in armpit and
7. Sudden and unexplained weight loss.

Warning signals of Womb Cancer:
1. Post coital bleeding – earliest symptom;
2. Discharge per vagina;
3. Bleeding per vagina;
4. Pain lower abdomen or low back, may be referred to buttocks and thighs;
5. Constipation and
6. Sudden weight loss.

Warning signals of Lung Cancer:
1. Cough;
2. Haemoptysis (Blood in sputum);
3. Respiratory difficulty;
4. Chest pain;
5. Hoarseness and
6. Sudden weight loss.

Some facts about cancer:
Cancer is not communicable;
All cancers are not hereditary;
Cancer in early stage may be symptomless;
Cancer is curable in early stages;
The earlier the stage of detection, the better is the chances of cure;
Majority of cancers are preventable;
Even in late stages, Oncologists (Cancer specialists) have a role to play and
Running away/shying away from the realities of the disease leads to advancement of stage and worsen prognosis

Conclusion:

It is a fact that cancer incidence is on the increase world over. As the disease is related to old age, modern life style and environmental factors, predictions are that the disease incidence will continue to rise in coming future. Luckily, majority of the disease are preventable by taking proper precautionary measures.

Moreover, the disease is quite curable if detected early. Public must try to acquaint the preventive measures and also cherish the habit of regular medical check-up at least once in a year, irrespective of whether one has symptom or not or on the earliest event of having any of the warning signals of cancer.

The advice from the doctors must also be sincere, friendly, prompt, sympathetic and judicious. His advice to the patient must be such that the patient is none other than he himself only.