Dr P L Kariholu, dean and professor of surgery, School of Medical Sciences and Research, Sharda University
Cancer is not only an important health problem in developed countries, but in a developing country like ours it is also a major health problem. It is going to be a bigger problem since it is predicted that there is going to be fivefold increase in the number of cancer patients in India by 2025. This is because of a change in our dietary habits, lifestyle, environmental pollution, and increasing life span. Surgery, Radiation, and Hormonal therapy are old but effective anticancer therapies.
Surgery which involves removal of primary tumor and associated regional lymph nodes cures more patients than any other individual form of cancer therapy because it works on zero order kinetics in which 100% excised cancer cells die. After the introduction of radiation oncology in1920 and anticancer chemotherapy in1940 shift has taken place from radical surgery to less radical/conservative surgery.
Radiotherapy and chemotherapy are capable of destroying only a fraction of cancer cells with each treatment and are thus complementary to each other. Considerable improvement in operative and anesthesia techniques has increased the 5-year survival rates in colorectal liver metastases. Radiotherapy is used in various cancers involving rectum, esophagus, breast etc., alone or in combination with surgery pre or post-operatively and or with chemotherapy. Chemotherapy may be used before, during or after radiation therapy. Hormones are being used with good response in breast and prostate cancer. Two-thirds of cancer patients have been able to defeat their disease by the use of these combined modalities of treatment mentioned above. With the advent of robotic surgery and gamma knife the results are improving further.
Immunotherapy: Cell based immunotherapy is used for prostate carcinoma, antibody-based as targeted therapy for colorectal cancer, cytokine-based Interleukin2 and Interleukin alpha in renal cell carcinoma and malignant melanoma.
Vaccination for prevention of cervix cancer by using HPV vaccination in girls between ages of 9-12 years is in practice in our country. Therapeutic vaccination against carcinoma prostate and melanoma is already approved by FDA.