The most dreaded words coming from your doctor's mouth are, "You have Cancer!" Pre-Covid, the worst diagnosis was stage 4 cancer, which means that cancer has metastasized and spread to distant organs away from its primary source. The yardstick for measuring the severity of the disease is still the 5-year survival statistics.
I've worked in cancer for the past 25 years, not as a physician or an oncologist, but from an R&D researcher in drug discovery to commercial consulting for the top-pharma companies on their most complex challenges. Over the years, I've interviewed oncologists and HCPs to seek information on various cancer types and identify pain points for my stakeholders and physicians.
I want to share a few insights that I've gathered over the years:
Early Detection and Prevention
The incidence of cancer keeps rising, and more so as humans have gained more control over heart disease and stroke. People live longer, and cancer is typically an older people's disease; the exception is pediatric cancer.
1) Early detection - especially in breast cancer, is a must, as it saves lives. Postponing mammograms can result in a death warrant for some. Similarly, a colonoscopy can lead to early detection, especially in the Western hemisphere, where CRC (Colorectal Cancer ) is more prevalent.
2) Cancer prevention is a lot better than cure.
a) Don't smoke; if you do, follow steps to give up gradually.
b) Chewing tobacco is a significant risk factor for oral cancers.
c) Stay away from unwanted x-rays.
d) Practice hygiene, HPV (Human Papilloma Virus) is a significant factor in cervical cancer. Get your child immunized towards HPV ( three doses). The HPV vaccine can be taken till age 26 and up to age 45 for a few.
e) Avoid red meat, or restrict its intake—mainly processed foods such as pepperoni and salamis.
f) Genetically modified organism usage (Genetically engineered foods) is linked to various cancers.
g) Healthy weight is critical towards cancer prevention.
h) Fairer skin people should use sunscreen and avoid direct sunlight for extended periods.
h) If you have a close family member (1st-degree relatives with cancer), your cancer risk rises; getting tested to detect specific gene mutations such as BRCA mutations (often called biomarkers).
Like the treatment for heart disease and diabetes, cancer treatment too has evolved over the years. Even though the new treatment paradigms offer hope, it just means an incremental survival benefit for many.
Cancer is a highly personalized disease, and the latest treatments work differently with every patient. Surgery and Chemotherapy often play a vital role in the initial stages of cancer. However, once cancer has metastasized or recurred, newer forms of therapy are utilized. The two broad groups of treatments, post-chemotherapy, are; 1) Targeted therapies 2) Immunotherapies.
The cancer treatment settings in solid tumors are 1) Adjuvant, 2) Neoadjuvant 3) Metastatic.
Adjuvant: Stages I - IIIc - Cancer is limited to the organ and not yet spread distally; there may be locally advanced disease. Called adjuvant as the treatment in initial stages is given post-surgery or when surgery is not an option.
Neoadjuvant: Therapy given before surgery to reduce the size of the tumor for easier excision.
Metastatic: Stage IV - The therapy given once the disease has spread to distal organs. Such as Lung cancer spreading to the brain or liver. Prostate Cancer spreading to the bone.
In hematological malignancies, such as leukemia, lymphoma, and multiple myeloma, the treatment settings are:
1) Induction 2) Consolidation and 3) Maintenance
There's also the stem-cell transplant option considered.
Treatment by classifications:
1) Surgery - The best option in earlier stages is to eliminate the malignant tissue that could potentially spread or grow.
2) Chemotherapy - Utilize medications, mostly IV in the form of a bolus or a drip, and are given in cycles of 3 weeks to 4 weeks. Typically a cocktail of drugs is given. Chemo carries side effects of bone marrow aplasia and may require additional hematopoietic agents to assist recovery.
3) Radiation therapy - Similar to chemo, often given in the early stages of the disease
4) Targeted therapy - Targets specific cancer-promoting protein, causing cancer cells to die a natural death called "apoptosis." It works well in some individuals but not in others.
5) Immunotherapy - Latest trend, making use of the patient's immune system to combat cancer. Significantly, the checkpoint inhibitors which target the PD-1 receptor or the PD-L1.
6) Palliative therapy - Typically given towards the end of life, the objective is to lower the patient's pain and improve the last remaining days of life.
None of the therapy from 2 - 5 above is devoid of side effects, and an oncologist decides if the benefit of a particular treatment paradigm outweighs the risks involved.
Cancer support programs, such as patient support groups or caregivers support system is critical to battle cancer. The costs of cancer treatment can be humongous, often draining the fiscal resources of families, with only a few months' gain in survival. Cancer patients don't suffer alone, so do their family members.
Cancer is the only disease with no guarantee of a cure due to its diverse grip on human anatomy and physiology. Nevertheless, we have conquered HIV, Heart Disease, Diabetes, Stroke, and Hepatitis C. Heart Disease and Diabetes are now reversible, with proper diet, exercise, and medications.
I'm confident that we will achieve significant strides in our quest to conquer this dreadful disease over the next decade.