Cancer is one of the most agonizing illnesses that affects the human body . Yet, despite the huge amount of funding poured into research globally, scientists have still to come up with a satisfactory explanation with regard to how it is caused. Compounding matters further, is the fact that there are different cancers located in different sites in the human body, each having its own unique symptoms making a general one shot treatment difficult.
While awareness about cancer today is much more than it was a decade ago, following education programs conducted by the National Cancer Prevention Program ( NCPP) and the Non Communicable Diseases Unit of the Health Ministry, not many patients take advantage of the services provided to them free of charge, to have themselves screened regularly, especially, if they fall into the high risk category.
The Sunday Observer spoke to Oncologist and Community Physician, National Cancer Prevention Program (NCCP) Dr Suraj Perera to give us more insights into this disease as Sri Lanka moves towards the UN goal of a cancer free world backed by President Maithrapala Sirisena and Health Minister Dr Rajitha Senaratne.
Excerpts…
Q. On February 4 ( World Cancer Awareness Day) the world came together to make its collective commitment to eradicate a disease that continues to remain elusive to cure, preventing any significant forward strides until scientists are able to resolve the root causes. As many persons including patients still do not understand what this complex disease is all about, explain what Cancer is, in laymen language .
A. Cancer is an un-controlled, purposeless growth of abnormal cells in the body, which can occur at any place in the body. These cells have the potential to invade adjacent tissues and migrate to a distant body site through blood or lymph vessels, and grow in new sites. This process is called ‘metastasis’
Q. Are there different types of Cancer? If so what are they?
A. ‘Cancer’ is a generic term for a large group of diseases that can affect any part of the body. Therefore, cancer is not a single disease. There are more than 200 types of cancers, and they can be grouped according to the type of cell they start. Cancers can be grouped to 5 main categories.
(i) Carcinoma- cancer that begins in the skin or in tissues that line or cover internal organs
(ii) Sarcoma- cancer that begins in the connective tissue or supportive tissues
(iii) Leukaemias – cancer that starts in blood forming tissues.
(iv) Lymphoma and myeloma – cancer that begins in the cells of immune system.
(v) Brain and spinal cord cancers – cancers that begins at the central nervous system
Q. Are tumours different from cancer? I understand there are different groups of tumours . Can having a tumour lead to cancer?
A. Tumour is a growth or lump in the body. It can be cancerous (malignant) or not (benign). Therefore all tumours are not malignant.
Q. How is cancer caused?
A. The smallest unit of the human body is a cell. Inside almost every cell there is a central structure called ‘nucleus’. In the nucleus, there are 23 pairs of chromosomes.
These chromosomes are made up of ‘genes.’ Most cancers start due to gene changes that happen over a person’s lifetime due to natural process or due to the effect of external factors such as tobacco smoke, radiation, chemical in the environment, etc. These changes of genes are called ‘mutations’. Rarely cancers start due to inherited faulty genes passed down in families.
Q. What are the first signs and symptoms of the onset of cancer? Are they specific to each type of cancer?
A. At the onset of cancer there may be no symptoms or signs. When cancer spreads the symptom may appear gradually. Symptoms and signs may vary according to the site of the cancer.
Q. Who are those most at risk of getting it – age wise ?
A. With advancing age, the risk of cancer increases. According to the data of 2014, the highest incidence of cancers are reported in the age group of 70-74 (crude incidence rate is 707/100,000 population).
Q. Yet today we see younger people being struck by the disease. Why?
A. Even though limited numbers of cancers are reported at younger age groups, there is little increase incidence of cancers over the years among younger age groups
Q. What are the tests needed to identify a malignant cancer ? Do they vary from cancer to cancer e.g breast cancer, cervical cancer?
A. According to the site of cancer , the investigations may vary. See table 1
Q. Are these tests available in all State hospitals with cancer clinics in Sri Lanka? Where ?
A. Mammograpy machines – National Hospital, Teaching Hospitals – Kandy, Peradeniya, Karapitiya, Anuradhapura, Batticaloa, Ratnapura, Jaffna, Apeksha Hospital Provincial General Hospital – Badulla, Kurunegala District General Hospital – Polonnaruwa Colposcopy facilities - Castle Street Hospital for women, Apeksha Hospital, TH Kandy, TH Mahamodara, TH Hospital Ratnapura, DGH Kegalle, Base Hospital Telippalai, TH Batticaloa, TH Jaffna
Q. Where are these facilities available in Sri Lanka?
A. Cervical cancer – screening program is for all married /sexually active females from the age of 35 . Services are available in more than 1,000 Well Woman Clinics island wide. It is also available daily at the Cancer Early Detection Centre, Narahenpitiya, and De Soysa Maternity Hospital . Some of the gynaecological units and the private sector also offer this service.
Oral cancer – Early detection of oral potentially malignant disorders ( OPMD) through screening of persons with high risk behaviours (consuming betal quids /alcohol/smoking/tobacco or arecanut related products. Clinical oral examination for oral cancer /OPMD is conducted at all government dental surgical clinics.
Q. Can treatment cure certain cancers? If so what are they?
A. Yes. If a person with suspicious symptom or sign comes to a health institution as early as possible, medical teams can direct them to necessary investigations to confirm or exclude having a cancer.
If cancer is confirmed, with timely initiation and completion of treatment some cancers can be cured successfully, (Eg. breast cancer, thyroid cancer, childhood leukaemia etc)
Q. Cancer places a heavy economic burden on the family and carers and state aid is often not enough for the underprivileged. What has the National Cancer Control Program (NCCP) done to help these persons?
A. Patients are encouraged to obtain financial support through the Social Services Officers attached to Divisional Secretariat Offices.
Additionally several non governmental organizations work with cancer centres to provide financial and material support for cancer patients. Also, the National Cancer Control Program gives necessary guidance to NGOs and religious organizations to help needy families with cancer. Even community based organizations may be able to assist cancer patients.
Q. From where can patients get details of such services?
A. Cancer patients can always ask medical and nursing staff at cancer centres about it and they will direct them.
Q. Treatment wise what is the first line of treatment for someone who comes to your clinic with a suspected lump of some sign of cancer?
A. Those who are presented with suspected lesions may need to undergo diagnostic tests to confirm or exclude cancer.
bSee table 2
Q.Is this procedure followed in all state hospitals?
A. Yes these services are available at Base Hospitals, District General Hospitals, Provincial General Hospitals and Teaching Hospitals
Q. Is radiation and chemotherapy the standard treatments? Is it given to children and adults as well?
A. Yes. Surgery, chemotherapy and radio therapy are the standard treatment for most of the cancers.
Q I understand the Health Ministry has introduced some in-service training programs and diploma courses for new medical students and nurses. Tell us more about them.
A. The first batch of medical officers now follow the Post Graduate Diploma in Palliative Medicine . In addition, a curriculum is being prepared for Post Basic Diploma in Palliative Nursing.
Q. The NCCP is the focal point of cancer services. What are the services you offer at Narahenpitiya? I understand you have walking mobile services?
A. Consultants, medical officers, dental surgeons, public health nursing sisters and nursing officers work together as a team providing interventions for primary prevention of cancers, early detection services (cervical cancer screening through pap smear test and HPV test, and clinical breast examination. The centre is open from 8 a.m. to 4p.m.
Q. The World Campaign theme for this year “I am” and ”I will,” marks the launch of a three year call to action ending in 2021 to empower cancer patients and raise awareness. What are the programs that the NCCP will be conducting to this end during this period?
A. Through this theme, every person is empowered to continue to practise healthy habits and ensure a safe environment for primary prevention of cancers, encourage every person to be vigilant for early warning symptoms of cancers and promote participation in healthy lifestyle centres and Well Women Clinics at recommended age groups.
Also those diagnosed with cancers need to be empowered to continue their specific treatment.
Q. Cancer patients are still constrained by prejudices and myths. Some prefer to go to kattadiyas and do home treatments like drinking papaw juice and katu atha before seeing a Western qualified doctor. Your comments?
A. These practices need to be discouraged. The public need to be educated to seek evidence based treatment options.
Q. Your message to the public?
A. One third of cancers can be prevented through healthy lifestyles and safe environments. Another one third can be cured successfully through early detection and prompt treatment.
The balance one third can be managed through treatment, survivorship care and palliative care and ensure the quality of life.