Onco- facts and fallacies

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

10/03/2025

March is Colorectal cancer (CRC) awareness month. It is the third most common malignancy after lung and breast cancer and the second most common cause of cancer death. It usually affects elderly but recently there has been a rise in incidence of CRC among younger population (less than 50 years). This is probably attributed to the unhealthy lifestyle habits like excessive consumption of red meat, processed meat, alcohol and obesity in this population. We need to be aware of this fact because it is one of the modifiable risk factor.

Often elderly people come to the opd with severe fatigue and their hemoglobin levels will be very low. They tend to neglect other symptoms. On evaluation, stool occult blood will be positive and colonoscopy will reveal an ulcer or growth which is causing blood loss. Anemia in elderly population is overlooked quite often. Only when they end up with very low hemoglobin levels, they are evaluated.

There are screening guidelines for early detection of CRC from 45 years which involves colonoscopy, sigmoidoscopy, and stool based tests. Screening is underutilised in our community due to lack of awareness and reluctance to undergo colonoscopy. There are stool based tests available which needs only a stool sample and can be done as a preliminary screening test. Let us spread awareness and encourage our younger generation to lead a healthy lifestyle.

https://www.facebook.com/share/p/1AAsoGPfn6/?mibextid=wwXIfr

08/03/2025

Today we are celebrating International Women’s day. In this occasion its our duty to uplift them in all sectors and to strengthen them to face the uncertainties. Maintaining good health is of utmost importance in building a successful career. Awareness regarding the prevalent health issues, early detection and preventive strategies is what we should focus on from the health care perspective. Breast cancer and cervical cancer are the two most common malignancies in women. We have effective screening strategies for both which can decrease the mortality. Let us spread cancer awareness in our society and make this day a meaningful one.






https://www.facebook.com/share/v/18csFN9jKR/?mibextid=wwXIfr

https://youtu.be/a-_-Wl6Vmao?si=HeM6QryK2aewto8a

04/03/2025

This was the last session of the National Cancer Awareness month. Thanks to Dr Mintu and Bobben sir for the invitation to Trivandrum Oncology club meeting for a session on Role of immunotherapy in brain metastasis from carcinoma lung at Taj Vivanta. More than an academic discussion, it was a great opportunity to interact with TK Padmanabhan sir and Babu Mathew sir. Meetings like these help in a great way to socialise with others which i feel is lacking in our community.

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