Category: Interview

When patients come to us with concerns, we strive to alleviate their fears by presenting the best-case scenarios. However, definitive diagnosis and treatment planning requires further investigation. The crucial message here is the importance of prompt action—hesitation can have severe consequences.

Oral health plays a pivotal role in maintaining overall physical, physiological, and emotional well-being. It significantly contributes to an individual’s personality, with oral hygiene accounting for approximately 90% of body odour, reflecting self-esteem and the robustness of the immune system. Remarkably, optimal oral health can prevent the onset of numerous non-communicable diseases, including 40% of cancers.

Enhancing the quality of life alone is a victory against a deadly illness like cancer. Instead of counting the days until their ultimate death, patients get to make the best use of their strengths, and that change in mindset alone makes a lot of difference.

Colorectal cancer is a commonly reported cancer worldwide. Though the incidence rate is low in India when compared to overseas, the number of cases has witnessed an increase over the past few decades. To learn about colorectal cancer, the CancerMitr team conversed with oncosurgeon Dr Chintamani Godbole.

In the following discussion, we will discuss more about colorectal cancer – from the challenges posed by the elusive early symptoms to the nuances of surgical interventions.

Home Surviving GI tract cancers: Dr. Kanchan stresses symptom awareness and regular screenings Gastrointestinal cancers (GI cancers) account for 26% of the global cancer incidence and 35% of all cancer-related deaths, according to a study published in the journal Gastroenterology. While India has historically experienced a lower incidence of gastrointestinal (GI) cancers compared to Western countries, a marked surge in cases over the last two decades, particularly concerning colorectal and pancreatic cancers, demands our attention. The intrigue of cancer lies in its ability to manipulate cellular division, coaxing cells meant to expire into a deathly process. The enigma deepens when it comes to GI tract cancers residing within the body, their telltale signs hidden from plain sight. Understanding the intricacies of GI cancer prognosis is crucial for effective management and treatment strategies. Picture this: an unusual lump forms, an accumulation of cells that might either be harmless bystanders (benign or non-cancerous tumours) or malicious infiltrators (malignant or cancerous tumours).  Ulcers, sores, and bleeding, the aftermath of these cellular conglomerates wreaking havoc. However, the real challenge arises with GI tract cancers, where the symptoms often emerge stealthily in advanced stages—when the tumour has grown substantially to colonize and affect the normal functioning of the neighbouring lymph nodes, organs, or distant territories through metastasis. As the tally of cases continues its worrisome ascent, we find ourselves grappling with a question. How do we confront this situation? In a candid tête-à-tête, the CancerMitr team engaged with the eminent GI tract oncosurgeon, Dr. Kanchan Sachanandani.Dr Sachanandani, with her profound insights and surgical prowess, navigates us through the labyrinth of GI cancers, unveiling strategies to unearth the disease in its latent stages. What is India’s current status regarding the prevalence of GI tract cancer? Which is the most reported GI tract cancer in India? The most reported GI tract cancer is colorectal cancer. It is a condition characterised by the presence of cancerous cells in the colon and rectum (the large intestine region). Now, here’s the eye-opener, the number of cases is scaling up, no sugarcoating that. We’re witnessing the formidable rise of colorectal cancer, followed by liver cancer. These are those diseases that are usually recorded amongst the elderly as the result of age-related complications. But alcohol abuse and a host of other enigmatic factors are pushing more youngsters into the spotlight. Based on your experience, at what stage do patients usually come to you with GI tract cancer? You see, cancer is complex and can be challenging to explain, but allow me to simplify it. We typically categorize cancers into four stages. Stages 1 and 2 are considered early stages, characterised by small, localized tumours. Then there are stages 3 and 4, where the tumour has spread to nearby lymph nodes and distant organs respectively. A significant number of colorectal cancer patients who seek my expertise are either in their first or second stage. This indicates that the tumour is still relatively small and contained. However, the treatment process remains arduous depending on the tumour’s specific characteristics and location. Picture the colon divided into two sections: the proximal region on the right side (ascending and transverse colons) and the distal colon on the left (descending and sigmoid colon). When the tumour appears in the distal colon, it triggers noticeable symptoms such as altered bowel habits (constipation or diarrhoea) and bleeding. In contrast, a tumour in the proximal colon can lead to indicators like anaemia or unexplained weight loss. These are apparent signals that prompt patients to seek medical attention promptly. We often succeed in catching the tumour early unless it’s a particularly aggressive variety, like a high-grade adenocarcinoma. Now, when it comes to the pancreatic cancer patients I have dealt with, the majority of them were in advanced stages, marked by metastasis—meaning the tumour has spread beyond its origin. It’s a sobering reality, highlighting the need for heightened awareness and proactive medical intervention. Why do GI tract cancers, especially pancreatic cancer, have such a low prognosis? Why is pancreatic cancer known as the silent killer? You see, many of these cancers operate in stealth mode, cunningly avoiding obvious signs and symptoms. It’s a tricky terrain where misdiagnoses can easily occur even with our vigilant tools, like ultrasounds and X-rays. Pancreatic cancer is the slickest of the lot. As we’re all aware, the pancreas serves as a key player in our body’s insulin-glucagon balance. Imagine it as a three-part ensemble with the head, body, and tail. Trouble brews when a malignant tumour shows up in any of these segments. What I’ve encountered in my professional journey is that a staggering 90% of reported cases focus on the body or tail regions, often discovered when cancer has already spread. Contrastingly, should this menacing growth show up in the head, a telltale sign emerges early on – jaundice – which is characterised by the yellowing of eyes and skin.  The melancholic truth is that the rest of the symptoms – the abdominal distress, the bloating, the curious stool or urine behaviours, the itchiness under the skin, and the anaemia – show up only in the later stages. Imagine this scenario: a patient in stage 1 or 2 notices abdominal pain, which is an ordinary occurrence for many. It’s easy to dismiss it. Meanwhile, the cancerous cells slowly and stealthily replace the normal workforce, those cells that should be maintaining the blood glucose levels.  Let’s not forget the nature of these pancreatic tumours, often referred to as adenocarcinomas. They’re relentless, aggressive tumours. It is often the final stop for those patients with stage 3 or stage 4 adenocarcinoma. Read: From palliative care to cancer recovery: Atul Thakkar shares his father’s cancer journey A recent research showed that “excess thirst” and “dark yellow urine” are initial signs of silent-killer pancreatic cancer. What is your professional opinion on that? Yes. Absolutely. Both these symptoms together might set off an alarm, but if you ask me, we can’t entirely depend on them as definitive indicators of pancreatic cancer. It’s a tricky situation.

Home Cancer is a devastating condition that takes a toll on an entire family, leaving a lasting mark on their lives. Characterized by the body’s own cells turning against it through abnormal cell division, this disease disrupts the harmonious functioning of vital tissues and organs. Its unpredictability is truly unsettling, as it strikes even those who lead healthy lifestyles. In the face of such uncertainty, how do we confront a condition notorious for its enigmatic nature? In the realm of battling cancer, the words “early detection saves lives” resonate powerfully. This mantra, vehemently embraced and endorsed by medical experts worldwide, holds the key to transformative outcomes. The question that keeps coming up is how can we ensure early detection of cancer, thus gaining the upper hand in this relentless battle? In pursuit of this knowledge, we turn to the expertise of Dr. Ravi Shankar – a surgical oncologist whose passion for combating cancer shines brightly. Dr. Shankar’s invaluable insights are generously shared with the CancerMitr team, illuminating a path of hope for everyone. Why is early detection important? Which all stages are usually referred to as the early cancer stage? Cancer is a condition characterized by abnormal cell division, which can penetrate various tissues and organs. Depending on the tumour’s size and location, cancer is classified into four stages. Stages 1 and 2 are often referred to as the early stages, offering a glimmer of hope and the possibility of effective intervention. During these initial phases, the tumour is localized. It has not invaded the nearby tissues, lymph nodes, blood vessels, or organs. This is the time when targeted measures can be taken to either destroy the tumour outright or surgically remove the affected portion, mitigating the risk of further spreading. As the journey progresses into later stages, the tumour assumes a more significant presence, potentially affecting nearby structures or spreading distant sites (process known as metastasis). Navigating this phase demands an expensive, time-consuming, and comprehensive approach as treatment frequency increases. At the same time, the patient faces more complexities and damages caused by the tumour. Amidst the challenges posed by cancer, understanding the stages empowers individuals and families to make informed decisions. By fostering awareness and knowledge, people can support one another in the face of both uncertainty and adversity. What is the current prevalence of cancer in India? Is the number low or high when compared to earlier? In my expertise, oral cancer is the most prevalent, along with lung, breast and colorectal cancers. However, it’s important to note that these numbers can vary depending on the region. Currently, India is grappling with a substantial burden of Head and Neck cancer. Undoubtedly, we are witnessing a rise in cancer cases compared to earlier times, but let’s explore the two crucial aspects contributing to this trend: incidence and diagnosis. When it comes to the incidence, several factors play a role, including lifestyle habits like smoking, tobacco chewing, and more, along with environmental factors like air pollution. Acknowledging and addressing these contributors is paramount in our efforts to combat the disease. On a positive note, the increase in the number of cancer diagnoses indicates an encouraging shift. More people are becoming aware of the importance of early detection and willingly seeking tests for the disease. This proactive approach significantly impacts prognosis, as early identification paves the way for better outcomes. We should embrace the power of awareness and knowledge. By understanding the causes, fostering healthy habits, and prioritizing regular screenings, we can collectively shape a brighter future in the fight against cancer. In your experience, at what stage do patients usually come to you? Do you come across more patients who experience initial symptoms but don’t talk about it until the cancer worsens? Unfortunately, 60-70% of the patients who come to me are in their advanced stage of cancer. Many of these individuals have experienced symptoms such as persistent ulcers, sore throats, or unusual pain, which often go unnoticed or are mistakenly treated for something else, due to a lack of awareness. Regrettably, even misdiagnoses can occur, prolonging the time it takes to initiate proper investigations, ultimately leading to later-stage diagnoses. The importance of awareness cannot be overstated, as it empowers patients to recognize potential warning signs and seek timely medical attention. In that way, the patient will know where to go for timely intervention. On a more positive note, there are patients who demonstrate admirable awareness about their health. They recognize that certain symptoms might indicate something abnormal and warrant immediate investigation. Their proactive approach to seeking appropriate care can lead to earlier detection and better treatment outcomes. We are trying to instil the mantra “early detection saves lives” into people’s minds by highlighting it’s importance. So, based on your expertise, how do you compare the prognosis of stage I and stage 4 cancer patients? When it comes to cancer stages, understanding the risk of recurrence is vital. The focus of treatment revolves around preventing recurrence. By using a combination of therapies, post-surgery chemotherapy or radiation, doctors aim to target any remaining cancerous cells in the bloodstream. When it comes to stage I patients – 80 out of 100 individuals do not experience a relapse. It is because early-stage tumours are localized and haven’t spread. However, the scenario changes for stage III or IV patients. Here, 80-90% of individuals may experience a relapse, as the initial treatment didn’t completely eliminate all cancerous cells. If even a small number of cancerous cells, 100 out of 1 lakh, for example, survive treatment, they can trigger a resurgence of the disease. One thing almost all of my patients ask me is if I can guarantee that the cancer won’t come back after treatment. My honest answer is no; such guarantees are beyond my reach. Each patient’s journey is unique, and predicting individual outcomes is not possible. What I can assure them, though, is my unwavering commitment to providing the finest treatment and tailored protocols customized to their abilities and convenience. The

Home Breast cancer is an epidemic that is affecting people around the world, including India. Cancer can be described metaphorically as a condition in which a person’s body turns against them. It is characterised by the proliferation of abnormal tumour cells that divide, spread, and invade other tissues and organs, interfering with their normal function. Breast cancer is where abnormal tumour cells grow in the breast nipples, lobules (the gland that produces milk), ducts (which carry milk to the lobules), and connective tissue. According to a recent report by the National Cancer Registry Programme and ICMR (Indian Council of Medical Research), breast cancer is the most reported cancer in India. It is also one of the leading causes of mortality amongst the female population. ICMR also reports a 12% rise in cancer rates in the next five years. CancerMitr team conversed with gynaecologist Dr Shwetha Shah to learn more about the reasons behind the high numbers and how aware women are of this ailment. Dr Shwetha Shah recently collaborated with CancerMitr for a women’s health awareness session at Nexus Malls. On the occasion of International Women’s Day week, Nexus Malls focussed on their women employees’ health, including their vulnerability to breast cancer. Dr Shwetha Shah conducted an awareness session for all women employees of Nexus Malls, especially blue-collar workers. She shares her experiences with CancerMitr. How did your collaboration with CancerMitr start? I share my expertise actively on my Instagram page. After seeing my work on social media, the CancerMitr team got in touch with me. We have previously worked together on significant projects, most notably an awareness session at KMCT. Then, we worked on a breast and oral cancer awareness session in Nexus Malls. What was your experience at Nexus like? It was a memorable experience. We conducted sessions in both Nexus Seawoods and Nexus’s head office in Mumbai, both locations had a very enthusiastic and curious audience. The management working at Nexus was also very supportive and provided the right setting and atmosphere. Working with CancerMitr has always been fruitful, and I look forward to more. How did the female employees at Nexus respond to information related to cancer? I have noticed how differently the audience responded to the information we provided. Blue-collar workers didn’t interact much because they were given a lot of new information. But the employees working at the head office were very interactive because they were more educated. I had a fruitful one-to-one interaction with the Nexus Malls’ head office employees. They were curious and had a lot of knowledge about cancer and women’s health.  It also shows how education broadens a person’s mind and brings them out of the social barriers that stop them from talking about their health and well-being. Our work with blue-collar workers marks the beginning of our long journey in spreading awareness. Do you see a lot of breast cancer patients in your practice? Yes absolutely. My colleagues frequently refer patients with specific gynaecological symptoms to me. In my experience and interactions, I’ve noticed a higher prevalence of breast cancer among young women than older women. Most breast cancers are found in women who are older than 50 years of age. But I have worked with patients who are as young as 30-35 years of age. A study published in PubMed central mentioned that breast cancer is the most reported cancer in India. What reason is behind such a high number, especially amongst younger women? There are a lot of reasons behind the prevalence of breast cancer among younger women. Lifestyle and habits like prolonged sitting have led to obesity and health issues among women. Obesity and hypertension are linked to cancer. In addition, unhealthy habits like smoking and excessive alcohol consumption affect your body and increase cancer risk. But these are all universally known facts. But, one factor that plays a critical role in the prevalence of breast cancer is family history. Most breast cancer patients I interact with have someone in their family with breast cancer. Certain gene mutations, notably the BRCA1 and BRCA2, increase breast cancer risk.  However, it is important to know that cancer is an unpredictable disease, but it is not inevitable. People should be aware, but they shouldn’t fear for the rest of their lives. Several studies, including a report by National Cancer Registry Programme, mentioned how mortality due to breast cancer is higher in India compared to the U.S. What is the reason behind low survival rates? Women typically disregard their health and put everyone else around them first. That is what we have seen for years. At the same time, a lot of stigma and shame are associated with women’s healthcare. Women are often shamed for visiting a gynaecologist. Many parents also don’t take their daughters to the doctor because they fear uncomfortable conversations with people in their family and friends circle. Because of that, they ignore the initial signs and symptoms of breast, oral, cervical, or uterine cancer. As a result, it is often too late for an effective treatment when they get diagnosed. Thankfully, it is changing a lot now due to better education and more awareness.  Women are seeking more information on how to care for themselves and put themselves first. Communities are stronger if their women are strong and healthy. While working as a gynaecologist, do you recommend patients undergo screening for cancer? Yes, of course. I recommend various tests to patients exhibiting symptoms that suggest diseases or abnormalities, including possible breast, uterine or cervical cancer. What is your general opinion about early screening and testing for breast cancer? It is very important. In fact, early screening is what saves lives because we can detect cancer in its initial stages, which makes it easy to treat. So, I encourage my patients to undergo early screening if symptoms suggest possible cancer. As I mentioned, now there is better awareness, and women are well-educated. Women sit down with me for one-to-one discussions on not just cancer but various topics related

Home Hormones are the chemical messengers of the human body that affect various processes, such as growth and development, metabolism, sexual function, reproduction, and mood. It is secreted by a particular organ called the endocrine glands. Women possess a pair of endocrine glands named ovaries which produce the female hormones progesterone and estrogen. Estrogen and progesterone play a pivotal role in the reproduction and sexual function of women. Estrogen consists of estrone, estradiol, and estriol. Like any other hormone, an excess of estrogen is a double-edged sword that puts the body at risk of several health issues, including cancer. As per cancers that develop due to estrogen, known as estrogen-dependant, include breast, ovarian and uterine cancer. CancerMitr spoke to Dr Sandip Bipte regarding estrogen dependant cancer, its prevalence and how to handle it. Dr Sandip Bipte specialises in oncoplastic breast surgery and has over 17 years of experience as a specialist. He shared his expertise with the CancerMitr team about the prevalence of cancer, notably breast cancer, due to the hormone estrogen. What role does estrogen play in the development of cancer? Estrogen is a hormone secreted by ovaries, adrenal glands and special fat tissues. Cancer is basically the abnormal lumps of tissue known as neoplasm or tumour that is malignant in nature – which means it grows, spreads and invades other body parts. Like normal body cells, cancer cells also have special proteins called receptors. If the cancer cells are estrogen receptor-positive (ER-positive), they bind to estrogen. Estrogen fuels the growth and spread of cancer cells. Estrogen-dependant cancer includes breast cancer, ovarian cancer, and uterine cancer. 60% of breast cancer cells are ER-positive, in my experience. Does estrogen trigger the growth of the cancers mentioned above? Yes. Excess estrogen levels trigger the cells, especially breast cancer cells. It can start with a small tumour or mutation; if it is ER-positive, the tumour size increases over time. So, is it safe to call estrogen a carcinogen? ​ No. Of course not. Although it can trigger cancer cell proliferation, it is not right to call estrogen carcinogenic. Estrogen is essential for various functions in the human body, associated with sexual and reproductive health. It improves the conditions of the ovaries, vagina, and secondary sexual characteristics. It is the excess estrogen levels that cause health concerns, and cancer is one of them. Excess estrogen levels cause other health-related challenges like mood swings, blood clots, irregular periods, etc. In fact, all hormones are harmful in excess. For example, Androgen (male hormone) is linked with prostate cancer. A perfect hormonal balance is crucial. This is because the human body relies on these chemical messengers, and if excessive hormone secretion is causing physical or mental health problems, it must be treated. How do you find out if a particular cancer is estrogen dependent? The cancer cells are taken out during the biopsy and checked under laboratory conditions. If it has estrogen receptors, then it is called ER-positive. If it has progesterone receptors, then it is called PR-positive. If it does not have either of these receptors, then it is called ER-PR negative. Women with ER-positive cancers are given treatment for estrogen imbalance, like surgical removal of ovaries (which secretes estrogen) or medication. If excess estrogen does cause cancer in both women and men, wouldn’t it be a concern for those to undergo HRT? It is important to note the incidence of breast cancer in men is low compared to women. Women are vulnerable to breast cancer, ovarian cancer, and uterine cancer. Yes, HRT or hormone replacement therapy is a concern. HRT is a treatment involving estrogen and progesterone to treat health issues due to their deficiency. However, a medical expert always ensures that the HRT process is done systematically and healthily. Even then, there are cases where women undergo HRT without proper medical supervision and risk health issues due to excess estrogen and progesterone, including cancer. Are you suffering form breast cancer? Looking for a suitable treatment? Dr. Sandip Bipte is the best breast cancer surgeon & you can book an appoinment Now! Book Now There is a study in PubMed Central that mentioned the association of estrogen-dependant cancer with PCOD. Does the condition of PCOD increase cancer risk? Yes. It is because PCOD as a condition is associated with estrogen dominance or high levels of estrogen. Therefore, treatment of PCOD involves medications that control hormone levels, including that testosterone. According to research, estrogen treatment people take to treat conditions like prostate cancer leaves them vulnerable to breast cancer. At the same time, medications used to treat breast cancer, like Tamoxifen, are linked to uterine cancer risk. So how can one avoid dangers while taking medications?​ Simple, consult a doctor. Elevated levels of estrogen and low levels of estrogen are linked to cancer. Low estrogen level increases the risk of obesity, osteoporosis and cardiovascular issues  Obesity is linked to cancer. A doctor prescribes medications by taking both sides of the treatment into account. Also, Tamoxifen is an excellent option for breast cancer treatment. The incidence of uterine cancer due to this medication is only 1 out of 10,000. Tamoxifen is prescribed in a well-calculated manner, and patients should not hesitate before taking these medications.  One thing I would highlight is the importance of doctor consultation. For example, people have the tendency to take oral contraceptives or birth control medications without proper guidance. It leads to hormone imbalance, including elevated estrogen levels How is estrogen dependant cancer linked to the absence of pregnancy and breastfeeding? Pregnancy and breastfeeding lead to a change in estrogen and progesterone levels. Estrogen levels decrease during the breastfeeding period. Now, imagine being exposed to high estrogen levels for a long time between menarche (first period) and menopause (last period). Prolonged exposure to estrogen increases the breast cancer risk. Several studies linked both breast and ovarian cancer to high estrogen levels as a result of no pregnancy and subsequent breastfeeding process. What about women who choose not to have children? How can they avoid estrogen-dependant cancer