consultancy corner: Degree of optimism in cancer diagnosis & treatment

The year 2016 took us several steps ahead in our understanding of cancer and I believe the next year will be no different. We are living in the era of precision oncology. Instead of ‘carpet bombing’ a tumour and losing a lot of normal healthy tissue as ‘collateral damage’, we have the skill and know-how to precisely image and treat many cancers. Minimally invasive surgery, image-guided radio therapy, designer drugs and gene therapy—all of this has meant that a cancer diagnosis today can be met with a degree of optimism and hope that we did not have a few decades ago. 

Today, we can sequence the DNA of tumour cells to look for patterns in the genes that will predict the tumour’s behaviour and identify what line of treatment will work best for the patient. This is especially true for breast, lung and colon cancer. 

The growing importance of early   screening will find a central place in managing cancer treatment successfully. Better screening and detection of cancer have already been linked to better survival rates in certain parts of the world. This must also extend to better detection of recurrent cancer, which is when a cancer that was previously treated comes back after some time. Molecular and improved conventional imaging techniques have made this a not-so-distant dream for us. Helping patients to be alert to the possible signs or symptoms, and encouraging them to go for their regular check-ups and follow-ups will be integral to this. 

Greater awareness of the link between cancer and diet: We know that processed meats (curing, fermentation, salting and/or smoking of meats), alcohol, areca nut and betel quid (often found in paan) are clearly linked to certain cancers, while a diet that is rich in whole grains, fruits and vegetables may help to lower a person’s cancer risk. As we gain a deeper understanding of the food that can predispose us to a higher or lower risk of cancer, we will be in a better position to both prevent and manage the disease. 

“Radiation genomics” the next frontier in treatment: As we continue to uncover how specific DNA variations in a tumour can affect its sensitivity to radiation, I predict that radiation genomics will become a part of our everyday vocabulary in cancer care. For an oncologist, this would become a powerful tool to predict whether a cancer will respond to radiation and plan a patient’s treatment with greater precision. 

Genetic studies specific to India in India: It is my conviction that cancer research in the country must have an India focus, when it comes to genetic studies. While international studies with people of other nationalities are no doubt useful, it is crucial to recognize that different populations often have specific differences in their DNA (for e.g. people in Iceland have green or blue eyes, while most of us in the country have black or brown eyes). India is made up of over 4000 communities and it is possible that there are links between diseases such as cancer and DNA changes specific to Indians, which could impact our approach towards cancer management. The Indian Genome Variation Consortium (IGVC) project is a step in the right direction but we need to fine-tune our focus. 

 We want patients to be able to “live with cancer”. Of course we cannot do this for all cancers just yet, but we will continue our efforts to make this a reality.