Cancer specialists throughout the world including Sri Lanka, observed yet another World Cancer Day on February 4. The focus this year was on “Closing the care gap” in cancer diagnosis and treatment. It is also noted that equal distribution of cancer care, and raising awareness with the support of the public, patients and community in general is of utmost importance.
The Sunday Observer spoke to Medical Officer, National Cancer Control Programme (NCCP) Dr. Kalmuni Leelaratne to get more insights into what is cancer and risk factors, its rise globally and in Sri Lanka and how those vulnerable to it can reduce their risks by following some simple rules.
Excerpts
Dr. Kalmuni Leelaratne
Q. World Cancer specialists across the world gathered together on February 4 this year to discuss a subject that is now causing increasing concern: namely the sharp rise in cancer figures in the past decade. Since many people are still unaware of what exactly cancer is, could you please define it? Is it due to an abnormal cell?
A. Every living cell (except mature nerve cells) in our body divides naturally in a well-planned, controlled manner. This cell division is necessary for the body to grow, develop and repair. However, these normal cells in the body sometimes divide in an unplanned, uncontrolled manner resulting in abnormal cells. This abnormal cell growth is called a tumour. This could be either benign (non-cancerous) or malignant (cancerous).
Q. Can a new tumour start to grow in the same area of the body, or does it spread to another part of the body?
A. A benign tumour is restricted to the area of the body where it initially started. A malignant tumour could be seen in the body where it started/ can spread to any other parts of the body through blood circulation/ lymphatics. This process is known as metastasis.
Q. Which part/parts of the body are they most commonly found?
A. Cancers most commonly spread to Lungs, liver, lymph nodes, bones and brain.
Q. According to Australia data where cancer is one of the leading causes for morbidity and mortality, it is said that prostate cancer, breast cancer, bowel cancer, endometrial cancer, melanoma, lung cancer and skin cancers are some of the commonest cancers. Is it the same in Sri Lanka?
A. According to the Sri Lankan national cancer incidence and mortality data 2021; the five most common cancers in males are; Oral (tongue/lip and mouth) cancers, Lung cancers, Colorectal cancers, Oesophageal cancer and prostate cancers. In females Breast cancer, Thyroid cancer, Colorectal cancers, ovarian cancers and cervical cancers. There are variations between countries.
Breast cancer is the most common cancer among females while oral cancer is the most common among males. Melanomas and skin cancers are common in Caucasians but not in Sri Lankans as melanin pigment in our skin protects us from UV radiation.
Q. How does Sri Lanka compare with world figures on cancer?
A. In the world, cancer is considered as a global epidemic with a rising trend. According to GLOBOCAN 2020, 19.3 million new cancer cases had been detected globally and around 10 million people had died from cancer worldwide. The incidence of cancer is projected to increase over 28.5million during the next twenty years.
According to the National Cancer Registry Sri Lanka, 37,753 new cancer cases (103 per day) were reported in the year 2021. This amounts to 17,582 males and 20,171 females. In Sri Lanka, cancer is the 3rd leading cause of hospital deaths (Annual Health Bulletin, 2020).
Q. Can males get breast cancer?
A. Yes. According to the National Cancer Registry 2021, 124 new male breast cancer cases were reported. However, the risk for a male to develop breast cancer is around 100 times less than the risk for a female.
Q. What are the symptoms and early warning signs to watch out for?
A. Most of the time, cancer in its early stages does not show symptoms or signs.
Common late-stage symptoms are; anaemia, fatigue, loss of appetite, loss of weight, back pain, bone pain, epilepsy..
For the most common cancers following symptoms are more specific:
· Breast cancer – Lumps, changes in the skin, size/ shape of breasts, breast pain, unusual nipple discharge, underarm lumps
· Oral cancer – Non-removable red/white or mixed red and white patches. Restricted mouth opening and tongue protrusion, unusual burning sensation in the mouth, non-healing ulcer>2 weeks.
· Cervical cancer – Inter-menstrual bleeding, bleeding after menopause, bleeding after sexual intercourse, foul smelling vaginal discharge.
· Colorectal cancer – Recent change in bowel habits (constipation followed by loose stools, thinned out stools, feeling of incomplete evacuation), Passing blood (black, brown/red colour) with stools
· Esophageal cancer – Difficulty in swallowing, vomiting after eating, recent onset voice change, palpable abdominal mass/ lump
· Lung cancer – Long standing cough, chest pain, difficulty in breathing, coughing up blood with sputum.
· Thyroid cancer – Gradually and rapidly enlarging neck lump/lumps, recent onset voice change, difficulty in swallowing, difficulty in breathing and coughing when lying down.
· Prostate cancer – Poor urine flow, difficulty in initiating urination, straining to urinate, feeling of incomplete emptying of bladder, frequent urination, burning sensation, passing blood with urine.
However, having any of these symptoms does not necessarily mean that you are having cancer. If you have any of these symptoms, it is highly recommended to seek immediate medical advice.
Q. What are the risk factors that cause genetic changes leading to cancer? Is tobacco smoking one of them? Why?
A. Risk factors can be divided into two main groups.
1. Non-modifiable risk factors – Old age (above 50), Sex, Genetic factors (Gene mutations like BRCA 1 & 2, for breast cancer)
2. Modifiable risk factors – exposure to carcinogens (food related, environmental, occupational), bad habits, obesity and impaired immunity
Tobacco (chewing or smoking) is a confirmed human carcinogen by the IARC (International Agency for research on Cancer). It contains many carcinogens that are absorbed through the oral mucosa causing oral cancer. Tobacco smoke contains many carcinogens that enter the lung and damages its cells leading to lung cancer. Hence, smoking is equally bad for the active smoker and for others around him.
Q. What about harmful substances in the environment due to the rapid surge in vehicular traffic and chemicals being dumped into lakes, and other waterways by factories?
A. Most common confirmed human carcinogens in the environment include; diesel engine exhaust, fumes from outdoor burning of polythene, plastics and rubber, asbestos, some bacteria and viruses.
Bus, lorry, van and other heavy vehicle drivers, traffic police, toll booth workers and also people who regularly get stuck in traffic are exposed to diesel engine exhaust. This causes lung cancer.
Arsenic is a carcinogen that is exposed via contaminated water. Waste water from industries may contaminate water sources if not cleaned before disposal.
Throwing out and burying electronic waste without proper disposal mechanisms cause contamination of soil and water by cadmium and beryllium compounds which are also carcinogens.
Q. Can a healthy diet minimise cancer risks? If so, give us some guidelines.
A. Yes a healthy diet can minimise cancer risk. Common confirmed human carcinogens we ingest are; alcohol, smoking or smokeless tobacco, betel nut and betel nut products (Pani Puwak/ Mawa/ Babul), Aflatoxin (fungi infested food), Processed meat (Sausages/ Ham/ Bacon/ Salami/ Salted and cured meat). Stopping or minimising intake of these can reduce cancer risk.
Also washing hands before meals and proper preparation of food will minimise exposure to Helicobacter pylori infections which is also a carcinogenic bacterial infection. Consuming more fresh vegetables, fruits, grains, fish, meat and milk reduces risk of colo-rectal cancers. Eating healthy and avoiding fast food will also reduce obesity which is also a risk factor for cancer.
Q. Vitamins?
A. Vitamins are not considered as carcinogens at the moment.
Q. What about lifestyle changes?
A. Lifestyle changes like quitting smoking, betel nut, tobacco chewing and alcohol will reduce cancer risk. Also incorporating daily exercise, refraining from binge eating and eating fast food to avoid overweight and obesity are some lifestyle changes that can reduce the cancer risk.
Q. Exercise? What sort of exercise do you recommend for 1) those without symptoms and 2) those already undergoing treatment.
A. 1) For healthy individuals, regular daily exercise like brisk walking or jogging for 30 minutes a day for 5 days per week is sufficient to reduce cancer risk by 18 percent.
2) For those undergoing treatment for cancer, low intensity or moderate intensity exercises and practising mindfulness are recommended 1-3 times per week for about 1hour. (For example Yoga)
However, specific instructions may change according to the patient.
Q. Treatment wise if a patient walks into a clinic with a suspicious lump what is the diagnosis procedure? What are the tests he/she will have to undergo?
A. After taking a patient’s history and examining the lump, confirmatory tests, imaging, biopsies will be done accordingly.
Q. Who gives the final diagnosis? A medical officer or a specialist?
A. A specialist onco-surgeon after a proper clinical assessment and conducting relevant investigations.
Q. Does testing or screening of patients need hospital settings?
A. A hospital clinic setting or at least a mobile health unit setting is needed as for testing and screening for cancer needs special equipment and trained staff.
Q. I understand that this year’s World Cancer Day’s theme is, “Close the Care Gap”. What is its significance globally and for Lankan cancer patients in particular?
A. The theme urges to reduce the time gap between diagnosing cancer and obtaining treatment. This is important because early diagnosis of cancer with prompt and proper management can save a life in the early stages (1st and 2nd stages) of a cancer.
Q. With an aging population how do you see the future of Cancer patients in Sri Lanka and abroad given the new hi technology we now have?
A. A With aging, the incidence of cancer increases around the world. New Hi Technology helps early detection of cancer.
E.g.: Mammography can identify breast cancer in early stages. In the USA and Australia, by screening mammography, 90 – 96 breast cancer cases per 100,000 population are diagnosed annually and only about 12 of them die. In Sri Lanka, screening mammography facilities are not available. Therefore, while 24 breast cancer cases per 100,000 population are diagnosed annually, 12 of them die in Sri Lanka. This shows the importance of early diagnosis and the diagnostic gap between developed countries and our country.
Q. I’m told that delay on the part of patients to undergo screening is one of the biggest problems. Do you agree?
A. Yes, it is a big problem as delay in presenting to the hospitals result in late diagnosis and poor cure rate.
Q. Where can a person get himself screened in Sri Lanka with no payment?
A. Cancer screening is done at government Cancer Early Detection Centers (Narahenpita, Matara, Ratnapura, Jaffna). Breast clinics are established in general, district general hospitals in Sri Lanka for breast screening. Well women clinics in MOHs screen for breast and cervical cancer in women at the age of 35 and 55 years. There are Healthy Lifestyle clinics, Dental clinics to screen oral cancers, surgical clinics, etc. in hospitals. All these services are free of charge.
Q. Have you a message for all Lankans out there on how to protect themselves from cancer and how to reduce symptoms of those who already have the disease? What are the do’s and don’ts?
· Do not be afraid of cancer.
· Be aware of the carcinogenic factors and avoid/ reduce the exposure to them.
· For females, conduct regular self-breast examinations for early detection of breast cancers and mouth examination for oral cancer detection.
· Please seek advice from a properly qualified medical professional and not from people around you.
· Adhere to the given treatment.
· If your cancer is untreatable do not let the cancer define you and consume you. Palliative care services are there to help you live your life to the fullest.
