National guidelines for cancer management drafted

EHM News Bureau - Mumbai

To rule out the discrepancies in diagnosis and treatment of cancer, the Indian Comprehensive Cancer Network (ICCN) has drafted national guidelines for standardising diagnosis and treatment of the malignant disease. The guidelines were drafted at the second meet of the ICCN at the Asian Institute of Oncology on April 12-13, 2003.

Oncologists brain-storming to draft guidelines at the Asian Insitute of Oncology

The steering committee of ICCN, which comprises 40-odd oncologists across the country, has drafted the minimum and optimal tests required for diagnosis and the line of treatment that is required for various stages of the disease. The guidelines have been laid for cancers of head and neck, lungs and oesophagus, breast and cervix.

The guidelines would be presented to the Ministry of Health and Family Welfare (MoHFW), Indian Council of Medical Research (ICMR) and the Director General of Health Services (DGHS) so that it can be practiced in all the 18 regional cancer centres, hospitals and teaching medical college across the country.

Said Dr P Jagannath, secretary, ICCN, “In November 2001, members of ICCM met in Jaipur and agreed to formulate the guidelines. The objective of the guidelines is to make cancer diagnosis cost-effective and efficacious. It also increases the quality of cure.” The guidelines have made high-tech tests like CT, MRI and PET which are routinely done by oncologists as optional.

Said Vinay Dhir, professor and head of department of digestive diseases and endoscopy, Asian Institute of Oncology, “An oncologist may order a battery of expensive tests which may not be affordable to the patients. Tests like physical examination, gives 70 per cent confirmation of cancer. For these high-tech tests patients are being unnecessarily sent to metropolis. Why should anybody spend several thousands more on CT, MRI and PET.”

The guidelines are based on the National Comprehensive Cancer Treatment (US) which in 2000 had standardised diagnosis and treatment of 98 types of cancer. “The modifications were necessary to address the socio-economic diversity in India,’’ he added. According to Padmashree-winner Dr S H Advani, chairman, ICCN, and chief of medical oncology at the Asian Institute of Oncology, “The reason for disparity in diagnosis and treatment could be due to lack of or uneven distribution of resources between different cancer centres, or availability or the lack of technology at different cancer centres.”

The diagnosis and treatment module is based on scientific evidence, and would be reviewed from time to time. The ICCN would hold another meeting two months from hence, before the draft is finally submitted to the ICMR and DGHS.

The guidelines

Breast Cancer

• Modified Radical Mastectomy (removal of whole breast) is a standard treatment for operable breast cancer. In selected patients breast conservation is an equally good option if all the facilities for radiotherapy are available.
• Mammography is an option if a breast cancer is diagnosed in a palpable lump.
• Routine mammography is not necessary unless specific high risk factors are present.
• Chemotherapy using Adriamycin is recommended to a majority of women with breast cancer as it improves the survival. The type of chemotherapy has to be individualized.

Cervical Cancer

• Biopsy confirmation and staging essential before planning treatment.
• Expensive investigations like MRI are only optional and ultrasonography and clinical examination are adequate for staging
• Surgery and Radiotherapy give equivalent results in stage I disease and choice depends on availability of expertise. Combining chemotherapy with radiotherapy in stage II, III would improve the response.

Head and Neck Cancer

• In stage I and II cancers of mouth, tongue - surgery or radiation are equally effective
• In stage III, IV - surgery is preferred if feasible
• Quality of life and function preservation like voice preservation for throat cancer are now feasible and should be offered.

Lung and Oesophagus Cancer

• As tuberculosis and lung cancer mimic each other, any shadow in the lung should be investigated by biopsy if there is no response to anti-tuberculosis treatment for six weeks.
• Surgery is preferred if the lung cancer is localized and if pulmonary functions are not adequate radiation can be offered. There is no advantage of giving chemotherapy before surgery for oesophageal cancer.