CANCER THERAPY – A LIFELONG JOURNEY
In previous issues, we discussed how we can prevent cancer, as well as take certain screening tests for early detection of the disease. In this issue, we shall discuss further about treatment of cancer.
What is cancer? It is an uncontrolled mutation of cells in certain parts of the body that results in formation of a tumor in that location. Moreover, these cells can spread to other parts of the body and cause problems in those organs also. Dysfunctions resulting from cancer are bleeding, blockage, malfunction and compression. These changes cause a variety of symptoms, weakness and deterioration of the body, eventually resulting in death.
Not all cancers are same. Some are fast growing; some slow. Some cause symptoms early on while others are silent until advanced. Some are nearly curable while others are lethal. Some are preventable to a good measure, while others occur for no reason. Some are genetically linked, while others are related to lifestyle.
Treatment of the disease is done in steps. First step is to diagnose the cancer: whether it is truly cancer or not, because certain conditions can mimic a cancer. Next step is to find out how advanced it is or what stage is it in. Third step is to start treatment based on several factors. Not all cancers are treated the same way. Even then multiple recommendations on sequences of therapy and related interventions are taken into consideration. Last step is continued follow-up and rehabilitation to ensure that the disease is not coming back and to achieve full return to normal life. Unfortunately, some individuals may be looking at end-of-life issues, and palliative or hospice care.
How do we make the diagnosis of the disease? On most occasions, one would obtain a tissue sample for microscopic analysis. This procedure is called biopsy. A small sliver of tissue or cells from the abnormal-looking area is taken out, often with a needle or by surgery. Doing a biopsy can be minimally invasive with use of special equipment and devices or in certain situations it may need a minor surgery procedure. In addition to confirming the diagnosis, this piece of tissue is further analyzed to know the grade or aggressiveness of the cancer, sensitivity of the tumor cells to different types of treatment and the prognosis. In certain parts of the body such as the brain, it may be difficult to get a biopsy, and one may have to depend upon other tests such as a CAT or MRI scan.
After the confirmation of diagnosis, doctors move on to next phase of staging the disease. Usually, they are staged from one to four, stage one being very early and stage four most advanced. Variety of tests are conducted. Some tests are non-invasive – ultrasound, CAT, MRI, PET and bone scans, and regular X-rays. Some other tests could be invasive involving GI endoscopies, bronchoscopy, mediastinoscopy, biopsy of lymph nodes or biopsy of metastatic nodules. At times, staging and curative surgery may be concurrent, as in treatment of early breast cancers, where a wide excision lumpectomy and a sentinel lymph node biopsy of axillary nodes are part of staging and treatment.
Now comes the treatment. In the past, it used to be a simple choice between surgery, chemotherapy and radiation therapy in combination or alone. Now, it is more complex with other modalities such as molecular biology agents, monoclonal antibodies, gene therapy, hormonal therapy, cryotherapy, infra-red knife, invasive radiology techniques, minimally invasive procedures and vaccinations, being used as adjuvants. Some of the time-honored treatment protocols have changed and continue to evolve with research and studies. Every patient is evaluated and assessed on an individual basis and treated with custom-made plans. The same cancer may be treated differently between different individuals based on a variety of risk factors and analytical projections. To make it more confusing, different physicians may have different opinions on choices, sequences, medications and protocols. The goal is to get rid of the disease one way or other, with best possible outcome with least possible inconvenience to the patient.
Earlier the cancer is detected, better is the chance for cure. Nearly half can be prevented by lifestyle measures, according to American Cancer Society. Cure rate for treatment has significantly improved. There has been over 30 percent increased survival of all patients compared to just 20 years ago. Cervical cancer has been nearly eradicated with routine pap smear and HPV vaccinations. Radical disfiguring and disabling surgery have given way to less aggressive procedures with other adjuvant modalities. With advancements in gene therapy and artificial intelligence in medicine, further improvements can be anticipated.
Continued follow-up care and surveillance are equally important. Once a cancer, always beware of it. Many people go into remission and can get a recurrence. One may have undertaken the most curative treatment with excellent results, only to see relapse a few years later, or a different type of cancer pop up elsewhere. Some need help on rehabilitation via prosthesis, plastic surgery procedures, ostomy care, wound care, nutritional management and emotional support. Recovery is a lifelong journey and no two people are similar.
Finally, a few unfortunate ones will face end of life issues with terminal cancer. These are patients who have done everything imaginable under the sun to treat and control their medical problems, but the destiny is unfavorable. There comes a point in their lives to make wise choices, whether to suffer being bedridden for a few more days of longevity or to go with peace and comfort. There is help available in the form of hospice and palliative care to enable comfort measures with less pain, better sleep and empathy.
Cancer is a dreaded diagnosis. But there is a lot of hope. Many people live their expected normal lifespan despite the dreaded disease. Many individuals can be cured or nearly cured, if diagnosed and treated appropriately. Things are getting better all the time, thanks to better diagnostic and therapeutic modalities.
Dr. Venkit S. Iyer, MD, FACS, is a retired general and vascular surgeon. He has authored six books: “Decision making in clinical surgery” first and second editions; “Aging well and reaching beyond,” “The Clinic,” “Geriatrics Handbook” and “Iyer’s story book for children.” They are available through Amazon or from the author. His website venkitiyer.com has necessary links and contact information.
EYE CARE
October: A Crucial Month for Eye Care Awareness
By Dr. ARUN GULANI
October holds special significance in the field of eye care, with numerous global and national initiatives designed to bring attention to the importance of eye health and safety. From raising awareness about preventable blindness to promoting eye injury prevention, the month serves as a reminder for individuals to prioritize their vision. This article explores the various eye care initiatives associated with October and why it is important for both eye professionals and the public to focus on ocular health.
World Sight Day: A Global Initiative
One of the most prominent events is World Sight Day, which falls on the second Thursday of the month. The day is promoted by the International Agency for the Prevention of Blindness (IAPB) in collaboration with the World Health Organization (WHO). Its primary goal is to raise awareness about the global issue of blindness and visual impairment, particularly in low- and middle-income countries where access to eye care services is limited.
Each year, World Sight Day focuses on a specific theme related to eye health, such as universal eye care, access to vision correction, or the need for regular eye exams. The theme serves as a call to action for individuals, communities and governments to recognize the significance of eye health and take proactive steps to prevent avoidable vision loss.
The Burden of Visual Impairment
Globally, about 2.2 billion people suffer from visual impairments, with at least one billion of those cases being preventable or correctable. The leading causes of vision impairment include uncorrected refractive errors, cataracts, glaucoma, and diabetic retinopathy. Many of these conditions can be treated or managed with early intervention, yet millions of people continue to suffer from vision loss due to lack of access to eye care.
World Sight Day shines a spotlight on the disparities in eye care services and encourages eye health professionals and policymakers to work together to improve access to vision care. It emphasizes the importance of routine eye exams, which can detect early signs of eye conditions, and highlights the role of education in preventing vision problems.
National Eye Injury Prevention Month
In the United States, October is recognized as National Eye Injury Prevention Month, an initiative aimed at reducing the number of eye injuries that occur each year. According to the American Academy of Ophthalmology (AAO), thousands of eye injuries happen daily, many of which are preventable. Eye injuries can occur in various settings, including at home, in the workplace, and during recreational activities, with sports-related eye injuries being especially common.
National Eye Injury Prevention Month focuses on educating the public about the importance of using protective eyewear, whether at work, during sports, or when performing tasks around the house that could pose a risk to eye safety. For instance, using goggles when handling chemicals or debris, wearing protective eyewear while playing contact sports, and using safety glasses during home improvement projects can significantly reduce the risk of eye injuries.
The campaign also highlights the importance of workplace safety, especially in industries like construction and manufacturing, where workers are frequently exposed to potential hazards such as flying debris, chemicals, and ultraviolet (UV) radiation. By implementing proper safety protocols and using protective equipment, many workplace eye injuries can be avoided.
Halloween Eye Safety
October’s association with Halloween brings another important eye care issue to the forefront: the risks of costume contact lenses and makeup. Decorative contact lenses, which are often used to create spooky or dramatic looks, can pose serious health risks if not purchased through a licensed eye care professional. Non-prescription lenses are often sold without proper fitting or instructions for safe use, leading to complications such as infections, corneal abrasions and even vision loss.
Many people are unaware that all contact lenses, whether for vision correction or cosmetic purposes, are considered medical devices and require a prescription. Wearing contact lenses that are not properly fitted to the eye can cause serious damage, including corneal ulcers, which may result in permanent vision impairment if left untreated. In addition to the risks of improper contact lens use, Halloween makeup products can cause allergic reactions or eye irritation if applied too close to the eyes or not removed properly.
Eye care professionals use October as an opportunity to educate the public about these risks, encouraging individuals to seek professional guidance when using contact lenses and to practice proper hygiene when applying makeup around the eyes.
Please be Proactive
The focus on eye health in October serves as a reminder for everyone to take proactive steps in maintaining their vision. Routine eye exams are a critical part of preventive care, as many eye conditions develop without noticeable symptoms. Early detection through comprehensive eye exams can prevent or reduce the severity of conditions like glaucoma, cataracts and macular degeneration.
Children and adults alike should have regular eye check-ups to ensure their vision is healthy. For children, undiagnosed vision problems can affect learning and development, while for adults, especially those over 40, eye exams are essential in detecting age-related changes in vision and other eye health issues.
In addition to regular check-ups, maintaining a healthy lifestyle can also contribute to better eye health. A balanced diet rich in fruits, vegetables and Omega-3 fatty acids can help protect the eyes from conditions like cataracts and macular degeneration. Wearing sunglasses that block UV rays and taking breaks from digital screens to reduce eye strain are also simple but effective practices.
The message of October is clear: protecting eyes today can preserve your sight for the future. Through increased awareness and proactive eye care, individuals and communities can work together to reduce the global burden of vision impairment and ensure that everyone has access to the care they need.