OncoWin Clinic

What can we do to prevent cancer??? This is one of the commonest questions asked to us by many people and especially relatives of cancer patients. The answer to this question is – Yes!! We can definitely reduce the risk of cancer by following few simple tips.

About 30- 50 % cancers are preventable since they are closely related to our lifestyle. The common cancers which can be prevented include-  
Breast Cancer ,Cervical Cancer,Colon Cancer,Liver cancer,Oral Cancer,skin Cancer

Let us see few simple tips which will help you to reduce your risk of cancer development:

1)     Avoid Tobacco- Consumption of tobacco in any form either smoking or smokeless is the single most important cause of many cancers in India. Smoking has been linked to various types of cancer — including cancer of the lung, mouth, throat, larynx, pancreas, bladder, cervix and kidney. Chewing tobacco has been linked to cancer of the oral cavity and pancreas. Even if you don't use tobacco, exposure to secondhand smoke might increase your risk of lung cancer. Quitting tobacco is the most important step towards cancer prevention. If you need help quitting tobacco, ask your doctor about stop-smoking products and other strategies for quitting.

2)     Eat Healthy diet- a healthy diet can not only keep you fit but also help you to reduce risk of cancers like colon cancers and stomach cancers.

a)     Eat more fruits and vegetables- Fresh fruits are rich in antioxidants and vegetables and fiber rich food helps to reduce risk of cancers.

b)    Limit processed meat- High consumption of processed meat has been shown to increase risk of certain cancers.

c)    Limit /avoid alcohol- Alcohol inself has been shown to be responsible for increasing risk of certain cancers like Liver cancer,

3)     Maintain Healthy weight and physical activity- Apart from protecting your heart, a modest amount of exercise can help you to prevent obesity which is shown to be indirectly associated with increased risk of Breast Cancer, endometrial cancer, Colon Cancer, Ovarian cancer. A simple brisk walking for 30 minutes a day is what is recommended. Maintaining ideal body weight will definitely help in long run to reduce risk of many other diseases as well!! 

4)     Get Vaccinated- Some cancers are associated with infections. Getting vaccinated against these infections can indirectly prevent these cancers. 

For eg-
a)     One of the most common cause of Hepatocellular carcinoma is Hepatitis B infection. Hepatitis B vaccine is available and can protect you from acquiring Hepatitis B and thus reduce the risk of HCC.
b)    Human Papilloma Virus (HPV) is associated with development of cervical cancer in females as well as head and neck cancers. HPV vaccine is now available for both girls and boys. Please contact your gynaecologist or oncologist for suitable age for vaccination. 

5)     Avoid unnecessary sun exposure- Unnecessary and prolonged exposure to strong sunlight for years is an important risk factor for development of skin cancer. Hence as far as possible avoid unnecessary exposure to strong sunlight and skin tanning. Appropriate use of sunscreens with SPF more than 30 may also help.

6)     Avoid High risk behaviours- Risky and unsafe behaviours like unsafe sexual practices can increase risk of infections like Hepatitis B,HIV, HPV which in long run can increase your risk of cancer. Also sharing needles and unsafe blood transfusions increases risk of transmission of infections. Please stay away from risky behaviours and protect you and your family as well!

7)     Know about your family history- Some cancers like Breast cancer, Ovarian Cancer, Colon Cancer can be sometimes hereditary i.e they can be passed on to next generations or close relatives. It is worthwhile that you are aware of any history of multiple cancers in family or close relatives. In such cases you can discuss with oncologist about possible hereditary cancers and if indicated can get genetic counseling and testing done. In certain hereditary cancers, certain prophylactic medicines or surgeries can prevent development of cancers in future.

8)     Follow cancer screening guidelines- Simple cancer screening tests like self breast examination, mammography, PAP smear can help to diagnose breast and cervical cancers even in precancerous stages and appropriate treatment at earliest stages can prevent development into actual cancers.

Best treatment of cancer is to prevent it !!
Lets spread this awareness and stay away from cancer!!!


--Dr.Rahul S.Kulkarni

As an oncologist, I come across lot of elderly patients who are diagnosed with cancers. Some are lucky enough to be diagnosed at early stages while some unfortunately get diagnosed at advanced stages. In some patients cure is possible if we treat as per the standard cancer treatment plan, whereas for some patients cure is not possible but still they can be offered treatment which can control the cancer and improve their quality of life. However, many people are skeptical while starting cancer treatment particularly only because of old age and the most important question which is asked is “Can he/she sustain cancer treatment at this age???”. Many a times only because of this mindset some patients miss out the chance of cure since they choose to opt out from desired cancer treatment. In this article we will see how we as oncologist approach while we deal with elderly cancer patients and how we can personalize treatment to derive the best care plan for them and this will help you in making treatment decisions for your near and dear ones.

Almost 60 % of cancers occur above 65 years of age. However treatment of cancer in elderly becomes challenging as older adults are more likely to have chronic illnesses like diabetes, blood pressure, heart diseases, lung disorders, joint problems or they may be frail due to age. These factors may increase the risk of complications during surgery, chemotherapy or radiotherapy. But age should not be the only factor which guides the decision; as we don’t just look at chronological age but biological age is more important in treatment decisions. In geriatric medicine or in particular geriatric oncology, we consider a constellation of factors while making treatment decisions in elderly cancer patients. We discuss following points with patients and relatives.

1) What type of cancer it is and how far it has spread?
Certain cancer types have favourable response to treatment, example- lymphomas, myeloma, breast cancer , lung cancer, prostate cancer can respond very well to simple and less toxic treatments which can give dramatic results to treatment even in advanced stages 

 2) What is going to be the treatment goal?

a) Cure- whether being cancer free is possible and if so what modalities are required to achieve the goal. In such cases we need to be bit aggressive as it’s a question of life and death but at the same time balance the risks and benefits.
b) Control- Sometimes, even if cure is not possible, we can control cancer very well by simple treatment options. Patients can live longer even with cancer with simple and effective medications.
c) Palliation- in some cases which are very advanced and aggressive cancers, goal can be to just alleviate the symptoms and to make patient comfortable.

3) What are the treatment options and risks and benefits of each one?

Cancers can be treated using any of the following method
a) Surgery
b) Radiotherapy
c) Chemotherapy- oral/IV
d) Targeted therapy
e) Immunotherapy 

 4) How do we decide while choosing the treatment option?

While dealing with elderly patients, we do a overall evaluation of patient which is called “Comprehensive Geriatric Assessment”.It is a multidisciplinary diagnostic and treatment process that identifies medical, psychological and functional limitations of elderly patients in order to develop a coordinated plan to maximize the cancer treatment outcome.

The questionnaire includes evaluation of following points:

a) Age
b) Medical comorbidities - Heart problems, Kidney /liver dysfunction
c) Ability to perform functional tasks and need for assistance in doing activities of daily living- whether patient can perform their activities on their own/limited/bedridden and whether the current status was prior to diagnosis of cancer or due to the cancer itself.
d) Fall history
e) Mental health
f) Social and financial support.

Various assessment scales can help us to stratify vulnerable elderly patients for whom we can choose to offer milder yet effective treatment options and reduce the chances of toxicities.

• Reduce the dose intensity- We generally start with a lower than desired doses of chemotherapy so that we can judge the effects as well as reduce the chances of sideeffects. Based on the tolerance we can either increase or decrease the doses in next cycle
• Modify the dose frequency- We can give small doses of chemotherapy more frequently eg weekly instead of usual 3 weekly chemotherapies. By doing this we can judge the patient periodically and modify treatment as per responses and side effects. This can also help in building confidence in patient as well as relatives and acceptance of treatment can increase.
• Choosing alternative modes of administration- We can sometimes choose oral chemotherapy drugs over Intravenous which avoids need for hospitalization if patient is not fit because of disease, but at the same time patients condition can improve slowly on oral chemotherapy and later the treatment can be intensified as per the improvement in general condition.
• Choosing more selective treatment- with great advances in oncology, now a days we have many targeted therapies which act selectively on cancer cells without much side effects but at the same time it can give wonderful results
  
  
  So there are multiple ways to modify the treatment and make it most effective as per the condition of patient.
  

The most important message which needs to go out in the society is that, age is not the sole determinant for cancer treatment planning.
 Age is just a number!! Don’t deprive your near and dear elders from cancer treatment which they deserve just on the basis of age.

Together We Can make their life better!!


Dr.Rahul Kulkarni
MD,DM(MedicalOncology)
Diploma in Geriatric Medicine
European Certification in Medical Oncology