A few years ago, a dear friend of mine succumbed to advanced Stomach cancer. It had spread quite far at the time of diagnosis although he had been symptomatic with stomach pain for just a week prior to that. After his death, a classmate who is a senior gynaecologist “ordered” her husband (another classmate) to undergo a Gastroscopy and Colonoscopy just to see if everything was OK, which he rightly refused to do! A diagnosis of Cancer or a death of a close relative from Cancer fills us with so much dread and we approach the topic (and even just the word) with so much anxiety and trepidation. Cancer screening (checking for cancer) must be done with a rational mind not swayed by emotion, denial or defiance!
Cancer is usually slow growing until or reached a certain size when they start to spread through the blood vessels and lymph vessels.
The diagram above gives a good depiction of how Cancer starts off. Mutations are changes in the DNA that happen frequently in dividing cells. Greater the cell growth, greater is the chance of more mutations. If the mutations code for faster cell growth, the mutated cell will start outgrowing the adjoining normal cells forming a “Lump”, initially a microscopic focus and then a visible lump. All cells have surface proteins that tell the immune system that they belong to the person himself. Mutated cells display different surface proteins which may help them escape detection by the immune cells thereby allowing them to continue growing.Once the basement membrane is invaded, the tumour starts spreading faster. Tumour cells invade the lymph vessels and the blood vessels and are distributed far away from their site of origin (Metastases). In each of these sites they grow uncontrollable until they steal all the energy from the normal cells and lead to weakening of the host body.
Chronic irritation of the body by alcohol and cigarette use, chronic infections such as Hepatitis B and C and HIV will increase the number of mutations. Malnourishment, old age, immunosuppressive infections, medications can impair the functioning of immune system and encourage the new growth. Genes may play a part by increasing cell turnover or impair immune function including those specific cells that kill cancerous cells.
The entire process may take upto 10 yrs or longer. It is therefore important to screen people to detect early stages of cancer i.e., premalignant conditions in order to implement early treatments to reduce cancer deaths. Therefore Cancer detection should be started earlier, continued at regular intervals until your doctor determines that your risk for whatever reason is now reduced and that you wouldn’t need further close screening. This would only be possible if you understand the need for and comply with periodic body check ups!
Who should be screened for cancer?
1. People who are older especially about the age of 60 are at a higher risk of cancer.
2. People with a strong family history of cancer in a first degree relative. Lets us look at my maternal grandmothers family history. She was from a big family with 7 siblings. The eldest sister had an Ovarian cancer, the next was her brother who had Diverticulosis with Cancer of the colon, the 3rd and the 4th brothers had prostatic cancer, the fifth had blood cancer, the 6th had uterine cancer and my grandmother had a Lymphoma twice and a breast cancer and her youngest (touch wood) is doing well. Cancer genes have varying penetrance i.e., their ability to go down the generations vary. Also the gene may get diluted with the inheritance from the other parent. Certain cancers like those of the Breast and Uterus can run in families.
3. People with bad Lifestyle – Smoking and tobacco in all its forms cause 14 different cancers from the mouth to the anus. Alcohol consumption, chronic chemical exposure and non vegetarian food intake can cause cancers. Others would include obesity, lack of physical exercise, inadequate fruits and vegetable intake and excessive saturated and trans fat intake.
4. People on immunosuppressive medication may be prone to some skin cancers.People who have received chemotherapy have a higher incidence of haematological cancers. Radiation therapy increases the chances of developing thyroid, breast, brain, skin and secondary sarcomas.
5. People who already have premalignant conditions that would require close monitoring or even treatment.
2. Oral submucosal fibrosis
3. Ductal or lobular carcinoma in situ breast
4. Lichen planus
5. Barrett’s oesophagus
6. Atrophic gastritis.
7. Ulcerative colitis and Crohn’s disease
8. Cervical intraepithelial neoplasia
9. Bladder carcinoma in situ
When should you start screening for cancer? It would be sensible to start screening for cancer between the ages of 40-50 or as advised by your doctor.
How should you go about screening yourself for Cancer?
Find yourself a good doctor who will make the time to talk to you patiently and answer all your questions. Not every lump or bump is a cancer. There are many lumps that are benign and will never turn cancerous like Lipomas. A good doctor will know when to reassure you , when to investigate and when to refer you on to the appropriate specialist.
An annual or biannual master health check up above the age of 40-50 yrs will be good to screen you and identify early lesions when you have no physical complaints with your body. For example thyroid lumps, breast lumps, lymph nodes, anaemia from intestinal blood loss may alert you to the possibility of a cancer.
Real life story:My friend’s 38 year old wife was given Iron supplements for anaemia by her gynaecologist. She came to me a month later with severe abdominal pain and fecal blood positive report. A colonoscopy was attempted but what they found was a tumour nearly fully occluding the rectum. She underwent a major surgery where they found that the tumour had spread all over the abdomen. She lived for just 6 months after that. It made me wonder if we could have changed the outcomes if we had tested her appropriately one month earlier.
Regular health check ups can pick up these issues earlier.
Know the worrying symptoms of cancer:
1. Unexplained weight loss >10% of body weight
2. Anorexia- absolute loss of appetite
3. Unexplained persistent fatigue.
4. High grade fever not due to any infection.
5. Altered bowel habits – alternating constipation and diarrhoea.
6. Blood in sputum, vomitus, stools and urine
7. Discovery of new lumps and bumps in the body especially those that are growing quickly.
8. Unexplained anaemia or low blood counts
9. Unexplained fracture of bone even without trauma.
Take home points:
1. Talk to your doctor and take his guidance. It is recommended that a PAP smear test is done every 3 yrs after the age of 20 and a mammogram every 2 yrs above the age of 50. For a man a sigmoidoscopy can be done every 5 yrs and a colonoscopy every 10 yrs.
2. Know what the worrying symptoms are and approach your doctor for advice.
3. Observe healthy lifestyles and avoid habits that put you at risk for cancer.