Cancer has been rightly named as the ‘Emperor of all Maladies’. As per reports published in India Today, Cancer burden in India has more than doubled over the last 26 years, the highest increase among all therapy areas. As per the Indian Council of Medical Research (ICMR) data, India had 14 lakh cancer patients in 2016 and this number is expected to increase. “The age standardized rate is approximately 25.8 per one lakh women and is expected to rise to 35 per one lakh women in 2026,” the report stated.
It is usually not possible to know exactly why one person develops cancer and another doesn’t. However, research has shown that certain risk factors may increase a person’s chances of developing cancer. These include things people cannot control, like age and family history. Lifestyle choices that increase your chances of cancer are the usual suspects such as smoking, obesity, lack of exercise and poor diet.
Cancer is one of the leading cause of fatalities all around the globe. Cancer cells are known to adapt and survive any attack; ever-evolving disease with capacity to invade different parts of the body and overcome many conventional treatments.
Cancer treatment is broadly categorized into two types of treatment: Local treatment and Systemic Therapy. Local treatments are treatments that would address the tumour locally at the site focussed, while systemic treatment also addresses the tumour cells not only locally but also in other parts of the body.
The two different forms of Local Treatment are Surgery and Radiation Therapy. The earliest evidence of tumours found has been as early as 3000 years BC and there has been some mention at that time also that most solid tumours were addresses by surgery as local therapy. Thereafter radiation also developed as a local therapy for cancer treatment. Conventional therapies can help combat the disease to some extent. However, in many cases the disease has the ability to overwhelm the normal defense processes and spread.
The major change that has happened in the management of cancer is realization of the fact that cancer is a systemic disease. So most cancers, even when they appear localized to the eye, have micro-metastasis which are there in the different parts of the body.
Another development that has happened is the development of newer Systemic Therapies. The various types of systemic therapies are Chemotherapies, Targeted therapy, Immunotherapy, etc.
Chemotherapy: Chemotherapy (also called chemo) is a type of cancer treatment that uses medicines to combat cancer cells. Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. The types of treatment that you need depends on the type of cancer you have, if it has spread and where, and if you have other health problems. Chemotherapy may be given in many ways. Some common ways include:
- Oral
- Intravenous (IV)
- Injection
- Intrathecal
- Intraperitoneal (IP)
- Intra-arterial (IA)
- Topical
Targeted therapy: Targeted therapy is also a cancer treatment that uses drugs, but it is different from traditional chemotherapy. Targeted therapy works by targeting the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. These genes and proteins are found in cancer cells or in cells related to cancer growth, like blood vessel cells. Targeted therapy is often used along with chemotherapy and other treatments.
There are several types of targeted therapy:
- Monoclonal antibodies. Drugs called “monoclonal antibodies” block a specific target on the outside of cancer cells and/or the target might be in the area around the cancer.
- Small-molecule drugs. Drugs called “small-molecule drugs” can block the process that helps cancer cells multiply and spread. These drugs are usually taken as pills. Angiogenesis inhibitors are an example of this type of targeted therapy. .
Immunotherapy: Immunotherapy is another arm into the armoury to fight against cancer which is also known as biologic therapy. As it goes by its name, Immunotherapy is a type of cancer treatment which boosts the body’s natural defenses to fight the cancer.
The immune system helps your body fight infections and other diseases. Immunotherapy helps in following ways:
- Stopping or slowing the growth of cancer cells
- Stopping cancer from spreading to other parts of the body
- Helping the immune system work better at destroying cancer cells
There are several types of immunotherapy e.g. monoclonal antibodies, Non-specific immunotherapy’s, Oncolytic virus therapy, T-cell therapy, Cancer vaccines.
Immunotherapy delivers survival benefits for patients with many types of solid tumors. Immunotherapy lifts the survival curve, with anywhere between 5% and 30% of patients under the curve who survive and continue to live with their disease, even if immunotherapy is introduced late in their disease, at an advanced or metastatic stage. Biological agents block the immune checkpoint proteins and increase the body immune level to kill cancer cells. Ipilimumab was the first such drug to get approval for the treatment of melanoma 3rd July 2013. It blocks the activity of a checkpoint protein known as CTLA4. Two other FDA-approved checkpoint inhibitors, nivolumab and pembrolizumab work in a similar way, but they target a different checkpoint protein on activated T cells known as PD-1.
Immunotherapy is giving a new dimension to the cancer therapy by improving the outcomes in terms of survival and reducing the treatment related toxicities.
Immunotherapy is not yet as widely used as surgery, chemotherapy, and radiation therapy. However, it was opened door to a whole new world of tremendous possibilities in treatment of a deadly disease like cancer.
With the advent of these new treatment options a revolutionary change is expected with better treatment outcomes and far less toxicities and hospital admissions.
About the Author:
Dr Meenu Walia is a renowned Medical Oncologist (Cancer Specialist) with over 27 years of experience. She is India’s first DNB, Medical Oncologist and spearheads the Department of Medical Oncology & Hematology at Max Super Specialty Hospital (Patparganj, Vaishali and Noida). She has been decorated with various awards namely Bharat Jyoti Award and Medical Excellence by IMA multiple times. She is a keen cancer researcher and is actively involved with several NGOs working towards the welfare of cancer patients. She is the author of a hugely popular book among cancer patients and caregivers, “Tips for Happiness in The Shadow of Cancer”.
Dr Meenu Walia being felicitated by Shri Ram Nath Kovind, Hon’ble President of India