Onco- facts and fallacies

05/08/2025

I felt honoured to be invited to the State Level Workshop on Oncology Crossroads organised by Little Flower College of Nursing in association with Jubilee Memorial Hospital, Thiruvananthapuram on 26/7/2025. I had a talk on - Cancer Care Evolution : Trends, Treatment and Technology. Oncology service is a team work. Properly trained nursing staff is of utmost importance in an Oncology department. These workshops provide knowledge regarding preparation of cytotoxic drugs, safe handling, use of biosafety cabinets, precautions during administration and extravasation management.

14/07/2025

Good verbal and non verbal communication is essential for patient adherence. It was a refreshing experience attending the workshop on Communication skills in Oncology at IIT Hyderabad. The sessions were very structured and interactive which dealt with the communication issues that oncologists face in their day to day clinical practice. Faculty from JIPMER Puducherry and psycho- oncology team from IIT Hyderabad lead the workshop. Working as a team, addressing the psychosocial problems of cancer patients will definitely improve patient care and satisfaction.

Special thanks to Dr Biswajit Dubashi, Dr Prashanth Ganesan, Dr Veena P, Dr Gomathi Shankar,
Prof Mahati Chittem, Shraddha Namjoshi, Shweta Chawak

03/07/2025

How to reduce your cancer risk - Lifestyle and prevention strategies.

ഡയബറ്റിസ്, അമിത രക്തസമ്മർദ്ദം ഹൃദ്രോഗം എന്നീ അസുഖങ്ങളെപ്പോലെ ക്യാൻസറും ഇന്നൊരു ജീവിതശൈലി രോഗമായി കണക്കാക്കപ്പെട്ടിരിക്കുന്നു.

പുകവലി, മദ്യപാനം, മുറുക്ക് പോലുള്ള ലഹരികളും, റെഡ് മീറ്റ്, പ്രോസസ്ഡ് ഫുഡ്( ടിൻ ഫുഡ്സ്) എന്നിങ്ങനെയുള്ള ഭക്ഷണ ശീലങ്ങളും അർബുദം വരാനുള്ള സാധ്യത കൂട്ടുന്നതായി പഠനങ്ങൾ സൂചിപ്പിക്കുന്നു.

ലഹരിപദാർത്ഥങ്ങളിൽ നിന്നും, അനാരോഗ്യകരമായ ഭക്ഷണ ശീലങ്ങളിൽ നിന്നും മാറി നിൽക്കുന്നത് വഴി ഒരു പരിധി വരെ നമുക്ക് ക്യാൻസറിനെ അകറ്റിനിർത്താം.

പുകയില ഉപയോഗം ശ്വാസകോശ അർബുദത്തിനും, അമിതവണ്ണം, ശാരീരിക നിഷ്ക്രിയത്വം, അധിക കൊഴുപ്പ് എന്നിവ സ്തനം വൻകുടൽ ഗർഭാശയം എന്നിവയെ ബാധിക്കുന്ന അർബുദങ്ങൾക്കും കാരണമാകുന്നുവെന്ന് പഠനങ്ങൾ സൂചിപ്പിക്കുന്നു.

ടുബാക്കോയിൽ എഴുപതോളം കാർസിനോജനിക് ഘടകങ്ങൾ അടങ്ങിയിട്ടുണ്ട് എന്നാണ് കണക്കുകൾ. ഇത് വായ, അന്നനാളം, ആമാശയം പാൻക്രിയാസ്, വൃക്കകൾ, മൂത്രസഞ്ചി എന്നിവയെ ബാധിക്കുന്ന അർബുദങ്ങൾക്ക് കാരണമാകുന്നു. പുകയില ഉപയോഗം പോലെ തന്നെ അപകടകാരിയാണ് വെറ്റില മുറുക്ക് അല്ലെങ്കിൽ പാൻമസാല ഉപയോഗം. ഇതിൽ ഉപയോഗിക്കുന്ന അടക്ക വായിലെ അർബുദത്തിന് കാരണമാകുന്നു.

പുകവലിക്കുന്നതിന് പകരം പുകയില വായ്ക്കുള്ളിൽ വയ്ക്കുന്ന രീതി ഉത്തരേന്ത്യൻ സംസ്ഥാനങ്ങളിൽ വ്യാപകമാണ്. ഇത് ഖൈനി(khaini), ഗുഡ്‌ക(gudka), തമ്പാക്ക്(tambaku), സർദ (zarda) എന്നീ പേരുകളിൽ അറിയപ്പെടുന്നു. പൊതുവായി സ്മോക് ലെസ്സ് ടുബാക്കോ വിഭാഗത്തിലാണ് ഇതെല്ലാം വരുന്നത്.

മദ്യപാനം പ്രധാനമായി കരളിനെ ബാധിക്കുന്ന (ഹെപ്പറ്റോ സെല്ലുലർ കാർസിനോമ) ക്യാൻസറിനും, അന്നനാളം, ആമാശയം, പാൻക്രിയാസ്, സ്തനങ്ങൾ എന്നീ അവയവങ്ങളെ ബാധിക്കുന്ന ക്യാൻസറിനും കാരണമാകുന്നു.

അമിതവണ്ണം ഇൻസുലിൻ പ്രതിരോധത്തിലേക്കും (Insulin resistance) പിന്നീട് മെറ്റബോളിക് സിൻഡ്രം എന്ന അവസ്ഥയിലേക്ക് നയിക്കുകയും ചെയ്യുന്നു. അമിതവണ്ണം ഉള്ളവരിൽ ഗർഭാശയം, സ്തനങ്ങൾ, പാൻക്രിയാസ്, വൻകുടൽ എന്നിവയിലെ ക്യാൻസറുകൾ കൂടുതലായി കാണപ്പെടുന്നു.

അമിതമായി റെഡ്മീറ്റ്( ബീഫ്, മട്ടൻ, പോർക്ക്) കഴിക്കുന്നവരിൽ പ്രത്യേകിച്ച് ചെറുപ്പക്കാരിൽ പോലും വൻകുടൽ, മലാശയ ക്യാൻസറുകൾക്കുള്ള സാധ്യത കൂടുതലാണെന്ന് പഠനങ്ങൾ തെളിയിക്കുന്നു. പ്രോസസ്സ്ഡ് ഫുഡ് (Sausage, Hot dog, Bacon, Ham) വൻകുടലിലെ ക്യാൻസറിന് കാരണമാകുന്നു.

ചെറുപ്പക്കാരുടെ പ്രിയഭക്ഷണമായ ഗ്രിൽഡ് ചിക്കൻ, അല്ഫാം എന്നിവ നേരിട്ട് കനലിൽ വേവിച്ചെടുക്കുമ്പോൾ അതിലെ കൊഴുപ്പ് ഉരുകുകയും അതിൽ നിന്നും ഉണ്ടാകുന്ന പുക ഇറച്ചിയിൽ പറ്റിപ്പിടിക്കുകയും ചെയ്യുന്നു. ഇത് PAH ( Polycyclic aromatic hydrocarbons) എന്ന ക്യാൻസറിന് കാരണമാകുന്ന കാർസിനോജനിക് ഘടകങ്ങൾ ഉണ്ടാക്കുകയും ദീർഘകാലമുള്ള ഉപയോഗം മൂലം വൻകുടൽ ക്യാൻസറിന് കാരണമാവുകയും ചെയ്യുന്നു.

ഇത്തരം അർബുദ സാധ്യതകൾ ഇല്ലാതാക്കാൻ നമുക്ക് ജീവിതശൈലിയിൽ എന്തൊക്കെ മാറ്റങ്ങൾ വരുത്താൻ സാധിക്കുമെന്ന് പരിശോധിക്കാം.

പ്രധാനമായി നാരുകൾ അടങ്ങിയ ഭക്ഷണങ്ങളും, പഴങ്ങളും പച്ചക്കറികളും ശീലമാക്കുക. അരിയാഹാരങ്ങൾ ഉൾപ്പെടെ കാർബോഹൈഡ്രെറ്റ് അടങ്ങിയ ഭക്ഷണങ്ങൾ മിതമായ തോതിൽ കഴിക്കുക. ധാരാളം വെള്ളം കുടിക്കുക. ദിവസം അരമണിക്കൂർ എങ്കിലും വ്യായാമത്തിനായി മാറ്റിവയ്ക്കുക. അതിലൂടെ അമിതവണ്ണം ഒഴിവാക്കാനും, ഡയബറ്റിക്സ്, അമിത രക്തസമ്മർദ്ദം, ഹൃദ്രോഗം, ക്യാൻസർ എന്നിവ ഒരു പരിധിവരെ അകറ്റിനിർത്താനും നമുക്ക് കഴിയും. പുകവലി മദ്യപാനം മുറുക്ക് എന്നിവ പൂർണമായും ഒഴിവാക്കുക. മാംസാഹാരങ്ങൾ കഴിവതും കറിയായി വേവിച്ച്‌ മിതമായി ഉപയോഗിക്കാം.

31/05/2025

May 31st- World No To***co day!!

To***co use can cause cancer, respiratory and cardiovascular diseases. Lets pledge not to use or promote to***co products and let us help others quit to***co use.

🚭 World No To***co Day – May 31, 2025 🩺Let’s unite for a healthier, to***co-free future! 🌍❤️Dr. Sherry S AbrahamConsultant – Medical OncologyAnanthapuri H...

16/05/2025

Skin cancer awareness month…

Basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma are the common skin cancers.
Exposure to UV rays is an important risk factor for melanoma and BCC.

Avoid midday sun exposure, wear proper clothing and use of sunscreens can decrease the risk of melanoma
Regular skin examinations help in early detection of skin cancers…

10/05/2025

Cancer immunotherapy - Common queries and answers!!!

Immmunotherapy is considered as a groundbreaking discovery in the field of cancer therapeutics. This is different from the traditional cancer treatment modality which is chemotherapy. Chemotherapy acts mainly on the rapidly dividing cancer cells but affects normal cells also causing chemo related side effects.

What is immunotherapy?

We have an immune system in our body which fights against bacteria, virus, fungi and other foreign bodies. It has an innate component and a cell mediated component. T cells and B cells constitute the cell mediated immunity. T cells are the main defense mechanism against cancer cells. Unfortunately due to various reasons, T cells are not able to effectively mount an immune response against cancer cells or in other words the T cells are suppressed.

The strategy of immunotherapy is to reactivate the immune system to specifically target cancer cells. Cancer immunotherapy is a broad term which includes many treatment modalities like ICI (immune check point inhibitors), targeted antibodies, CART cell therapy, cancer vaccines, adoptive T cell therapy. In the discussion that follow I am referring to immune check point inhibitors, commonly known as “Immunotherapy” in cancer.

1. What are ICI (Immune check point inhibitors)?

These are a group of drugs which when administered bind with cell surface receptors (PD1 and PDL1) in T cells and cancer cells, reactivate T cells to specifically act against cancer cells. Unlike chemotherapy they dont have a direct action on normal cells but indeed have side effects which will be discussed later. Drugs under this category include Pembrolizumab, Nivolumab, Atezolizumab, Durvalumab, Tremelimumab.

2. How is ICI administered and are they effective in all cancers?

It is administered either intravenously (through veins) or subcutaneously(injected beneath the skin) and can be given on outpatient basis.
Although it is approved in a variety of cancers, its not effective in all cancers. There are certain biomarkers in tumour tissue (TMB, CPS score) which determine the efficacy of these agents.

3. Are they effective in all stages

They are effective both in early and advanced stages and are used as per the guidelines for the approved indications.

4. Can they be used along with chemotherapy?

Yes. Immunotherapy can be used along with chemotherapy known as chemoimmunotherapy.

5. Are they costly?

Yes these are costly drugs. Cost ranges from 2 to 7 lakhs for an injection. Private insurances may cover only a part of the cost or may even be an exclusion. For advanced stages, the treatment need to be continued as long as the disease is in control which can pose significant financial burden for the patients. This should be discussed before starting treatment.

6. Are there any side effects?

It does have its side effect profile which is different from chemotherapy known as immune related side effects. This can occur in any organ. It is usually seen after 8 to 10 weeks of treatment. The severity of the side effects decides whether it should be continued or stopped permanently. All patients may not develop side effects.

08/05/2025

Ovarian cancer ……the silent killer

It is considered as a dreadful gynaecologic malignancy due to its silent presentation, rapid intrapelvic and intraabdominal spread and high chance for recurrence.

Although common after fifties, younger age group may also be affected by a subtype of ovarian cancer called ovarian germ cell tumours which is having a good outcome. These tumours are highly sensitive to chemotherapy and are curable even in the advanced stages.

Ovarian germ cell tumours in adolescents present with sudden onset of abdominal pain due to ovarian torsion or bleeding into the tumour. I recently saw a 26 old girl in op who had acute abdominal pain, found to have an ovarian mass, underwent surgery which turned out to be a germ cell tumour.

The more common epithelial ovarian cancer is seen in elderly population. They usually have non specific symptoms like early satiety and abdominal fullness and they go unevaluated for a long time. Only when they develop gross ascites and peritoneal spread, the disease is diagnosed. Advanced ovarian cancer has recurrence rates reaching 70 to 90% after curative treatment. Once recurred, its almost incurable and patients succumb to it within few months.

Nulliparity, hormone replacement therapy (oestrogen - only), obesity, strong family history of ovarian or breast cancer increase the risk of ovarian cancer whereas use of OCP decrease the risk.

Unlike breast or cervical cancer, there are no effective screening modalities for an early diagnosis. Serum tumour markers like Ca 125 lack sensitivity and specificity.

Another interesting fact is the association of breast and ovarian cancer with BRCA mutation carriers. Patients harbouring these mutations have a life time risk of upto 50% for developing ovarian cancer at 30 to 40 yrs. Risk reduction surgeries are advocated for this group at an early age soon after child bearing.

Surgery and chemotherapy are the main treatment modalities. Optimal cytoreductive surgery either following chemotherapy or upfront is the goal. Surgery includes removal of uterus, both ovaries, omentum and any suspicious sites of disease. Fertility preservation surgeries are recommended for germ cell tumours since these affect younger population. Recent developments in the treatment such as HIPEC (Hyperthermic intraperitoneal chemotherapy) and PARP inhibitors have improved the treatment outcomes still the recurrence rates have not come down significantly.

Let us spread awareness regarding ovarian cancer for early detection and betterment of our society.

May 8 is World Ovarian Cancer day.
NO WOMAN LEFT BEHIND!!!!

World Ovarian Cancer Day, observed on May 8, highlights this deadly cancer affecting women globally. Often difficult to detect due to subtle symptoms

23/04/2025

Early symptoms of cancer - What to watch out for…

Generally, the symptoms of cancer depends upon the site which is affected. For example breast cancer usually presents as a painless lump in breast or someone with lung cancer can have persistent cough, blood in sputum, recent change in voice. Having said that quite often patients have non specific symptoms. Following are the red flag
symptoms of cancer which you need to look out for and should never be ignored:

1. Weight loss of more than 10 kg in the past 6 month.

2. Unexplained fatigue which is not relieved by rest.

3. Unexplained fever - Fever can be due to infection but persistent on and off fever even after treatment for infections need to be evaluated.

4. Drenching night sweats - Excessive night sweats during sleep that soaks the clothing and bedding can be symptom of lymphoma.

5. Persistent pain in any part of body which is not relieved by medications.

6. Post menopausal bleeding- This is the first symptom of uterine cancer.

7. Bleeding per re**um - Blood mixed with stools or bleeding while straining for stools can be a symptom of colorectal cancer.

8. Altered bowel habits - Recent alteration in bowel habits like constipation or diarrhoea are also seen in colorectal cancer patients.

9. Skin changes - blackish discolouration of skin, non healing and enlarging ulcer. These are worrisome signs of skin cancers (melanoma, basal cell ca and squamous cell ca).

Ignorance and lack of awareness lead to delay in diagnosis. Early detection can significantly decrease the mortality from a vast majority of cancers. Although the above discussed symptoms is not exclusively seen in cancer, a doctor consultation is mandatory to rule out an underlying malignancy.

We are living in a country which is one of the largest contributor of newly diagnosed cancer patients. There is nothing much we can do for the ever increasing incidence of cancer but we can make a difference through screening and early detection which will save lives….

https://www.ucsfhealth.org/covid/17-cancer-symptoms-you-shouldnt-ignore

https://www.hopkinsmedicine.org/health/wellness-and-prevention/early-cancer-warning-signs-5-symptoms-you-shouldnt-ignore

10/04/2025

As per the Globocan 2022 data, oral cavity is the most common site of cancer in males in India and India has the highest incidence of oral cancer globally. The developing countries of South and Southeast Asia are the major contributors to the global oral cancer burden.

Oral cavity includes lip, tongue, buccal mucosa, palate and floor of mouth.

Risk factors:
Smoking, alcohol use, pan chewing, human papilloma virus (HPV) infection, poor oral hygiene.

The use of ‘Smokeless to***co’ is widespread in Northern states and refer to the use of to***co other than for smoking like chewing and sniffing. These are known in different names (khaini, gutka, zarda) in different parts of the country.

Another notable risk factor for oral cancer is a sharp tooth which causes constant irritation and injury to the tongue or cheek (buccal mucosa) which can later evolve into cancer. This can be prevented by dental procedures like smoothening the sharp tooth in order to prevent injury. This is quite often seen in those who do not have any unhealthy habits.

Betel nut chewing is common in many parts of our country. It is a mixture of betel leaf, areca nut and lime. Areca nut contain arecoline which is a carcinogen. Prolonged use can cause oral cancer.

Premalignant lesions:
Leukoplakia, erythroplakia and oral submucous fibrosis constitute the premalignant lesions of oral cavity. These are seen as whitish, reddish patches and band like thickening in the oral mucosa respectively. Patients having these lesions needs close monitoring to rule out development of oral cancer.

Clinical presentation:
1. Persistent non healing ulcer
2. Persistent pain
3. Difficulty in swallowing or chewing
4. Bleeding from mouth
5. Loosening of teeth
6. Neck swellings

Diagnosis and treatment:
Biopsy is needed for diagnosis. Treatment depends on the stage and site of the tumour. Surgery alone is needed for early stage tumours. Surgery and radiation (+/- chemotherapy) is recommended for locally advanced tumours

Oral cancer screening:
Oral cancer screening involves examination of mouth with the help of physician or dentist for signs of cancer or precancerous conditions with the aim of early detection. Apart from oral examination, there are screening tools like VELscope, Orascoptic DK which help in identifying and sampling abnormal areas.

Oral cavity cancers are closely associated with smoking, alcoholism and betel nut chewing. Quitting these habits and maintaining good oral hygiene can decrease the incidence and mortality from this cancer.

April is Head and neck cancer awareness month!!!!

15/03/2025

Multiple myeloma is a hematological malignancy which develop due to uncontrolled proliferation of plasma cells in bone marrow. Plasma cells play a role in immune system by producing antibodies to help fight infections. In multiple myeloma, these cells become abnormal and multiply uncontrollably leading to the production of large amounts of abnormal antibodies (monoclonal proteins or M proteins) which cause damage to various organs primarily kidneys, bone and bone marrow. This can lead to anemia, bone pain and deranged kidney function.

There are three stages for multiple myeloma, stage 1 having the longest survival. Multiple myeloma usually affects elderly population. Younger patients have more aggressive disease.

Causes:
Exact etiology is unknown. Certain risk factors like age (> 65 years), family history, exposure to certain chemicals and radiation can increase the likelihood of developing multiple myeloma.

Symptoms:
Common symptoms include bone pain ( back, hips, ribs) fatigue, frequent infections, weight loss.

Diagnosis:
Diagnosis involves blood tests, urine tests, bone marrow studies(to see the presence of abnormal plasma cells), Xray, CT or MRI

Treatment:
The mainstay of treatment is chemotherapy. Usually a 3 drug regime is used which includes oral and intravenous drugs given as weekly injections. Radiation therapy is used for treatment of bone pain and spinal cord compression. Other treatment modalities include autologous stem cell transplantation, immunotherapy and CAR T cell therapy. CAR T cell therapy is a recent advancement which is used for those who have failed multiple treatment lines.

Even though this disease is not curable, patients live for several years (5- 10 years or more) with the latest treatment options. Patients are often given drug free intervals after several years of treatment.

Mortality in these group of patients is commonly due to recurrent infections or coexisting cardiovascular disease and not due to myeloma per se. Multiple myeloma is a rare ‘blood cancer’ and is not a life threatening disease like the more common blood cancer, acute leukemia. Patients have long survival with the novel treatment strategies.

https://www.mayoclinic.org/diseases-conditions/multiple-myeloma/symptoms-causes/syc-20353378

https://amp.cancer.org/cancer/types/multiple-myeloma/treating/car-t-cell-therapy.html

24/02/2025

I was honoured to be invited for a talk on Preventive strategies, early detection and cancer awareness at KELTRON, Vellayambalam. It was my first visit to the tech hub of our State Government. I was fascinated to see the premises of the old palace being maintained without much renovation. Almost all the staff attended the session. Thanks to Usha madam and HR department for the warm hospitality.

15/02/2025

I got the opportunity to interact with a young crowd at Genrobotics, Technopark campus, a group of vibrant techies who gave innovative solutions for manhole cleaning and gait training as part of rehabilitation.

I emphasized the importance of lifestyle modification and cancer screening and its role in prevention and early detection. I feel that the awareness regarding these aspects should be spread targeting the younger population since those are the vulnerable group in our society and they are actively involved in spreading the information through strong communication. I thank the organizers at Genrobotics for conducting this meeting.

https://www.instagram.com/reel/DGDC7ssycVI/?igsh=czhrcjA4cmNuZzhz

https://ananthapurihospitals.com/news