Sunday, July 19, 2015

Is Cancer Curable? An Answer By An Oncologist in Kolkata

Is Cancer Curable? An Oncologist Speaks
"Is cancer curable?" This is one of the oldest questions perturbing everyone- from a cancer patient to a five-year old kid who has just heard the 'deadly' word-cancer. I too harbored the same question as a child, especially after seeing two of my first-degree relatives dying of this 'fatal' disease.
Today, as a resident oncologist treating hundreds of patients in Calcutta Medical College- Asia's oldest cancer department, I do have an answer.
Before getting into the answer, it's necessary to inform you one thing: Cancer is not a single disease as spoken about in popular media. Lung cancer and prostate cancer are not just one disease cancer affecting two different  organs, lung and prostate. They are two different disease entities having different prognosis and treatment modalities. Again, lung cancer is not a single disease. Small cell carcinoma of lung and adenocarcinoma lung are two different histological varieties of lung cancer having different aetiologies, different behaviour and different response to chemotherapy. So it's essential to know the exact histological feature of your cancer, as written in the biopsy or cytology report before answering whether your cancer is curable or not.
Is cancer curable?
Yes. The answer is a resounding YES, provided your cancer is detected early, managed properly in a time-bound manner as per latest treatment guidelines.
Here is what I mean. Arati and Rani are two women in their early 50s. Arati noticed per vaginal bleeding on two occasions within the last two weeks and consulted a gynaecologist. A Pap smear was done and it revealed cancer of her cervix. She consulted an oncologist, who diagnosed her as Stage IIB cancer cervix and treated her with concomitant chemo-radiation over the next 9 weeks. After the completion of her treatment, further investigations were done and she was declared cancer-free. Today she is leading a normal life, touring Europe with her son who has recently got a job. On the other hand, we see Rani who is as old as Arati but who had been ignoring those abnormal bleedings since the last six months. Today she is brought to the emergency- unconscious. A CT scan of her brain reveals a large metastatic deposit of her cervical cancer up in her brain. Now Rani's death is pathetic, as today treatment of cervical cancer is a treatable disease and Rani was not supposed to die, provided she had not ignored her vaginal bleeding and consulted a doctor six months back. In that case, Rani would likely have been declared cancer-free by now and leading a normal life and certainly not battling for her life in the emergency room
Never ignore your symptoms. 99% chance it's not cancer. But what about the 1%? You never know you are not this unlucky chap who falls within this 1%. Consult with a learned doctor in case you notice any abnormality in your health. Even a simple cough lasting for a week or more maybe an indicator of lung cancer. A cancer has the best chance of cure in its early stages. The chance of your cure falls with every passing day.
Another thing that is not really in the hands of the patient is vital for curability of your cancer. You consult your family physician and he refers you to a specialist where you need not be referred. This we encounter quite frequently in clinical practice. Now, cancer warrants multimodality treatment involving either surgery or chemotherapy or radiotherapy or any two of these or all three. An example, ovarian cancer in early stages warrants surgical excision. But this is not the case with all cancers. An example is Stage IIIB cervical cancer which responds to concurrent chemoradiation and does not merit surgery. Now, if that patient is treated with a radical surgery, it raises her morbidity without reducing chance of her mortality. The onus of proper referral rests with his or her family physician. It's always wise to double check whether your treatment is being done as per latest treatment protocols.
Most importantly, proper decision-making and updated knowledge on part of the oncologist treating the disease is one of the most important prognostic factor determining the cure of the cancer you or your near one is suffering from. Oncology is the fastest developing field in modern medicine and needs regular updating of knowledge and skill on part of the oncologist. Adequate dose calculation, proper selection of chemotherapy regimen and radiation planning are important determinants of successful treatment of your cancer.
N.B.: Even if your cancer is detected late, it does not always mean you are bound to die. Palliative chemotherapy and radiotherapy are still options there to enable you fight cancer. Many cancers have indolent course and often respond to chemotherapy or radiotherapy even in the last stages. And that's why I repeat emphatically- CANCER IS CURABLE.