The number of cancer patients getting treated at PGIMER Chandigarh’s across the region has almost doubled, with hospital statistics and data reporting revealing that from 3,000 to 4,000 new cases annually (from 2000 to 2010), the institute is seeing 5,000 to 7,000 new cases on a yearly basis (from 2011 to 2015). And a bulk of these cases are coming from Punjab.
“At the PGIMER, the maximum share of cancer patients is from Punjab, with 65 per cent of patients, followed by Haryana (20 to 25 per cent), and Himachal Pradesh (10 to 15 per cent). Patients from Uttarakhand, Jammu and Kashmir, and Himachal form about 5 per cent of cancer patients at the PGIMER,” says Dr Rakesh Kapoor, Head, Department of Radiation Oncology, PGIMER.
He adds that on an average, PGI has about 40,0000 cancer patients annually (both new and follow-up patients), with as much as 65 to 70 per cent being in stage three and four, and stresses that 30 to 25 per cent of patients can be cured if the disease is detected at an early stage.
As to the cause why so many patients are from Punjab, Kapoor says that a study by Tata, PGIMER and Punjab Agricultural University found arsenic levels high in Punjab, but there is no consensus on the direct link between pesticide use and cancer.
“We are in a dilemma on this. Ignorance of symptoms and a delay in treatment are the major issues that need to be addressed, for few cancers, like gall bladder don’t have a lag time. We are seeing a decrease in cervical cancer because of menstrual hygiene and in our OPDs, we have started doing family, symptomatic and secondary screening. The rise in cancer cases cannot be attributed to one factor, and genetic and etiological factors also needs to be considered,” the radiation oncology specialist adds.
He adds that in women, earlier cervical cancer was most common, but now it is breast cancer. A population-based cancer registry, which is being maintained by Memorial Centre, Homi Bhabha National Institute, Mumbai, in collaboration with PGIMER has found breast cancer to be the most prevalent form (33 per cent) of the disease in Chandigarh. “In males, the incidence of head and neck cancers is very high, as are cancers of the esophagus and gallbladder,” Kapoor says.
Dr Sushmita Ghoshal, Head, Department of Radiotherapy, PGIMER, claims early detection and appropriate treatment can cure approximately one-third of all cancers. Cancer, she says, can be detected early by actively looking for the disease even before it has become obvious – and that process is called screening.
Cancers of the mouth or uterine cervix are known to develop over many years through a continuous process of changes in the tissue. These changes are pre-malignant in the beginning and following constant exposure to the risk factor(s) may convert into full-blown cancer, according to Ghosal.
“By observing the tissue, it may be possible to detect the changes quite early and appropriate action may be taken to prevent further progression of the disease process. Similarly, small nodules in the breast can be diagnosed by methodical physical examination or seen with the aid of X-rays or ultrasound. When detected in the pre-malignant or early stage, cancer treatment is very effective with lesser side effects and disfigurement,” Ghosal explains.
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Dr Pankaj Malhotra, Head, Department of Clinical Haematology and Medical Oncology, PGIMER says cancer cells were once considered ‘immortal’, but not anymore. The 2000s, he adds, marked the emergence of targeted therapies, drugs that kill cancer cells by sensing specific molecular changes in these cells. Over the past decade, immunotherapy, therapies that give strength to a patient’s immune system to attack tumours have yielded excellent results.
“We are proud to offer all these treatments here at PGIMER and the department is equipped to treat all types of cancer. Another form of immunotherapy, CAR T-cell therapy, has been shown to eradicate advanced leukemias and lymphomas, giving new hope to oncologists. Cancer may take two to three years to develop and with new tests, we may have a chance to identify and prevent many cancers, including hereditary ones, and this could reduce disease burden and suffering.
The future of treatment is bringing artificial intelligence, which can offer personalised therapy, be it showing different mutations in a cancer patient, the combination of medicines that would work for the best response rate, etc,” concludes Malhotra.