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A Roadmap for Better Cancer Care
Technology has revolutionised the way cancer is diagnosed
and treated
Dr CS Pramesh |
The diagnosis and treatment of cancer has seen tremendous
progress in the last two decades. Advances in surgical techniques have been
paralleled and boosted to a great extent by rapid progress in medical and paramedical
technology. The overall outcome has improved due to better understanding of
disease processes, innovative methods to treat disease without gross disfigurement
and increasing awareness about the importance of overall quality of life.
Breast Cancer
Conservatism in cancer surgery is one aspect which has overturned many a dogma
on its head. Cancer surgery is in the midst of a gradual but relentless change
from heroic, often futile 'mega' surgery to a more conservative surgery today,
with preservation of form and function gaining importance. There has been no
better example of this than breast cancer wherein the traditional surgical treatment
of complete removal of the breast (radical mastectomy) gave way to a more gentle,
humane 'breast conservation therapy' which meant removal of the lump along with
the glands in the armpit, with post-operative radiation. The cosmetic and psychological
impact of breast conservation can hardly be over emphasised. Today, more than
two-thirds of early breast cancer patients can be offered breast conservation
therapy. Other examples of conservative surgery in cancer include voice preserving
surgery for larynx (throat) cancer and sphincter preserving surgery for rectal
cancer.
Bone Tumor
 Bone
and soft tissue tumors, in addition to the disease impact, have an additional
burden in that they commonly affect children, adolescents and young adults.
As late as the 70s and 80s, the commonest surgery performed for these tumors
was amputation. With improved understanding of the biology of these tumors,
better and effective chemotherapy, limb salvage is now possible in a large majority
of patients with relatively early stage tumors.
Improved technology with better and modular prosthesis has helped the orthopaedic
oncologist to replace and reconstruct the operated part of the limb. Amputations
are now reserved only for very advanced tumors or for those that do not respond
to chemotherapy.
Keyhole Approach to Cancer
Keyhole surgery or Minimally-invasive surgery (MIS) was initially performed
for non-cancerous diseases like gallstones, hernia and appendicitis, but was
rapidly embraced by cancer surgeons worldwide. Keyhole surgery is now performed
regularly for various cancers in the chest, abdomen, and pelvis without compromising
the radicality or completeness of the surgery. It is expected that this might
result in reduced postoperative pain, faster recovery, and faster return to
normal activity. The added advantage for surgeons would be the magnification
afforded by these sophisticated equipment which helps identify important structures
better. Robotic surgery is an even newer advance, and has already shown promise
in various fields of cancer surgery including prostate and lung surgery.
In this battle against the modern scourge of disease, the
surgeon has been supported hugely by improved diagnostic techniques. Improved
imaging technology has helped diagnose and stage disease more accurately than
ever before. The advent of computed tomography (CT) scans with rapidly advancing
technology, endoscopic ultrasonography, magnetic resonance imaging (MRI) scans,
positron emission tomography (PET) scans and the PET-CT fusion scans have laid
a roadmap for the surgeon wherein operative surprises and shocks have now become
few and far between. Advanced interventional radiology techniques have also
played a big role in managing many diagnostic and therapeutic dilemmas.
| All these advances in cancer surgery notwithstanding,
probably the single most important advancement has been in improving the
safety of major cancer surgeries. Surgeries for cancer of the esophagus,
lung, pancreas and liver, which had prohibitively high mortality rates in
the recent past, are now routinely performed in most specialised cancer
centers with negligible mortality. This improvement has resulted from increasingly
specialised surgical teams focused on specific surgical procedures, improved
intensive and critical care facilities and expertise, support staff including
dedicated nurses, physiotherapists, occupational therapists and dieticians. |
Future Lies in the Genes
Cancer surgeons worldwide are now increasingly involved in clinical and basic
research, and have lead several path breaking studies not only in surgical oncology,
but in medical and radiation oncology, immunology, molecular biology and gene
therapy. These breakthroughs have contributed immensely towards improved outcomes
in cancer treatment. The surgical oncologist today is no longer a mere technician
who cuts and chops on demand, but he is also a strategist, continuously planning
and plotting with fellow researchers to achieve small but significant breakthroughs
in cancer care.
The writer is Associate Professor and Assistant Surgeon
Tata Memorial Hospital Mumbai
E-mail: cspramesh@vsnl.net
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