Technological updating and innovation have made cancer treatment accessible and accessible

Last June, Aarti Dhowtall, 23, lost her sixty-year-old mother, Preeti, to stage 4 lung cancer. The engineering student and her father, Ashok, were taken by surprise. For Preeti had no symptoms until she started spitting up blood. By that time, it was too late. “We tried everything; nothing worked,” remembers Aarti. “She got worse and because of her low immunity, she got infections in the hospital, which… led to more complications.”

It is in cases like these that the importance of early detection and diagnosis through screening becomes even more evident. The only way to beat cancer is to catch it early and nip it in the bud. As researchers learn more about the nature of the deadly disease, new diagnostic tools are being developed and existing ones are being refined. And this push for innovation in early cancer detection has picked up pace especially in the post-Covid phase.

“The need for early detection has always been acute and extreme, because that’s the only way to prevent cancer deaths,” said Dr. Somashekhar S.P., global director of the Aster International Institute of Oncology. “What’s happened in the last year or so is that some of the more expensive technology has become affordable because of the need to fight Covid, and in turn, it’s helped a lot in oncology.”

Somashekhar cited the example of polymerase chain reaction (PCR) sequencing, which has always been used to genetically detect and diagnose cancer. In pre-Covid times, very few hospitals used it due to its high cost. However, during the pandemic, the cost was reduced and customs fees were significantly reduced to allow all hospitals to perform PCR sequencing to detect Covid-19. Now, PCR has become the ideal method for amplifying specific DNA (and sometimes RNA) sequences to detect cancer in its early stages.

“The issue is that we are now moving beyond the traditional/morphological forms of cancer screening, which included mammography (breast cancer), Pap smears (cervical cancer), CT scans (lung and colorectal cancers) and trying to identify the most common cancers. at a molecular and genetic level, that is, by detecting the presence of tumor cells circulating in the blood,” said Somashekhar. “This involves the clinical application of another revolutionary cancer screening tool, namely liquid biopsy, which is rapidly moving from research stages to application in hospitals.”

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Aster Hospitals provide liquid biopsies for breast cancer, early colorectal cancer and cervical cancer. Liquid biopsies are different from standard tissue biopsies, which often involve invasive procedures to detect a tumor. Saving time and efficiency, liquid biopsies detect circulating tumor cells and circulating tumor DNA through a simple blood test.

In March of this year, Rituparna Badgamia (name changed), 43, was diagnosed with stage 1 breast cancer after noticing “a painful lump in her breast”. She underwent a liquid biopsy which revealed the presence of cancer cells. The diagnosis was later confirmed by ultrasonography, followed by mammography. Until recently, liquid biopsies were only available for advanced cancers.

Genomics, said Dr. Amrit Kaur Kaler, consultant in molecular pathology at Kokilaben Dhirubhai Ambani Hospital in Mumbai, is playing an important role in understanding cancer, helping to identify the mutations responsible for a particular type of cancer and narrowing down treatment modalities. “The latest technique is next-generation sequencing, which has been around for a decade but is now being routinely used more than before, primarily due to low cost, easy accessibility, and year-to-year sophistication,” said Kaler, an expert in genomics. of cancer.

The Doctor. Sharat Damodar, President of Oncology Services at Narayana Health, Bengaluru, highlighted how the “lab work” associated with cancer detection and diagnosis has become increasingly digitalised. Previously, a sample had to arrive at the lab and the pathologist had to examine it inside the lab. Now you can simply capture images and transfer them digitally to the pathologist, who may be working from home. This is huge in the area of cancer screening, which requires cutting-edge precision. “All this made the processes more structured, refined and fine-tuned”, said Damodar. “With every city now having a genetic testing laboratory, the field of cancer diagnosis itself has gone up several notches and become super sophisticated. Our diagnostic and prognostic ability has therefore improved.”

In the case of cervical cancer, which is reportedly the fourth most prevalent cancer among women, a new native vaccine based on mRNA technology, which doctors hail as the next era in cancer prevention, has been launched by the Serum Institute of India . Until then, we worked with DNA technology or deactivated vaccines. It was only after Covid-19 that it was thought to use mRNA technology in cancer prevention. The vaccine was made available at a reasonable rate, becoming a game-changer in curbing cases of cervical cancer.

Everything that happened in the last year and a half in the field of cancer detection would have taken ten times as much money and another ten years to get where we are today,” said Somashekhar. “A lot of technology has been developed that we never thought would be possible and all at half the cost.”

Breast cancer, in which early detection significantly improves prognosis and reduces long-term mortality, has seen much innovation and breakthrough research. Mammography, which is the most advanced technique for detecting a tumor in the breast tissues, underwent digitalization to offer physicians better image quality in a shorter period of time. It also avoids unnecessary radiation exposure as it is specific and much more focused. There is also 3D tomosynthesis or mammography, which uses low-dose X-rays and computerized reconstruction to create 3D images of the breasts, thus helping oncologists to locate the exact location of the tumor. There is also the two-dimensional Finite Differences in Time Domain (2D FDTD) technique that uses electromagnetic rays to detect tumors as small as 2 mm in size, which would otherwise be lost among healthy breast tissues.

And there’s more. For example, respiratory biopsy allows for the non-invasive collection and analysis of body compounds in exhaled breath, said Dr. Aneeta Bajaj, Consultant Radiologist, Apollo Hospitals, Navi Mumbai. “We also have what’s called an ultrasound magnetic resonance elastography, which tells us how stiff the breast tissue is,” she said. “Malignant nodules are more rigid than benign ones. So we immediately know the type of tumor.” But there’s no denying that biopsy remains the gold standard, she added, and that mammography is still needed.

In June, Apollo Cancer Centers with Datar Cancer Genetics introduced a blood test that can detect breast cancer at an early stage in asymptomatic individuals. EasyCheck Breast helps detect breast cancer even before the first stage and is available at all Apollo centers across the country. “In India, we detect cancers at advanced stages, stage 3 or 4, whereas in the west, it’s much earlier due to their robust screening programs,” said Dr. Prathap Reddy, Founder and President of Apollo Hospitals at a press conference. “So it is our responsibility to detect it at an early stage. When detected early, mortality is much lower. The EasyCheck breast test is a simple, non-invasive blood test that does not involve radiation.” But Bajaj said the test might not be entirely conclusive and is at best indicative.

But there is no such innovation for early detection of ovarian cancer. What makes it even more difficult is that there are no specific symptoms. “It can start with indigestion, weight loss, bloating, bleeding, loss of appetite…. These are symptoms of gastrointestinal disease,” said Dr. Kanika Gupta, Senior Director of Surgical Oncology (Gynecological and Robotic Surgery), Max Healthcare, New Delhi. “In 10 to 15 percent of cases, genetics is the cause. While the Pap smear test is available, there is nothing in the way of early diagnosis. In fact, over three quarters of my patients discover their cancer through accidental diagnosis, and that too at stage 3. We desperately need something in this area because 80% of the time it is diagnosed at stages 3 and 4 and with very high grade tumors. high”.

But there is hope — a new study from the Wilmot Cancer Institute has revealed technology that can detect missed ovarian cancer cells through a blood test and predict cancer in people with a lesion or cyst in the pelvic area. Artificial intelligence is also helping oncologists in the UK detect ovarian cancer in patients much earlier than previously possible, according to TPP CEO Frank Hester, which provides health-related software for doctors and nurses. While nothing conclusive has emerged yet, he hopes we’ll get something that’s indigenous very soon.

Infertility in young women

After the pandemic, we have seen an unusual increase in infertility issues among women, especially related to polycystic ovary syndrome, and this is true for women in their late 20s and early 30s compared to women in their 40s. I have a large number of patients with severe vitamin D deficiency; they complain of sharp back pain. Obesity due to sedentary lifestyle resulting in menstrual irregularities is also observed.

I strongly advise women to prioritize their health. Daily exercise for at least 45 minutes is extremely crucial and this should include at least 10 minutes of back exercises alone. Calcium and vitamin D supplements for those who are acutely deficient are important. It is important that the person has dinner in a controlled manner if he has skipped the first two meals of the day, because otherwise the sugar levels can rise uncontrollably. Regular annual exams are mandatory. Mammography should be done at least once a year by women over 40 years old, so as not to miss any lumps in the breasts. Pap smears should be done to detect cervical cancer. Ultrasound should be done regularly to check for fibroids or polyps in ovarian cells.

―Dr. Surabhi Siddhartha, Obstetrician and Gynecologist Consultant, Motherhood Hospital, Navi Mumbai

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