A fighting chance against cancer

At any given time, there are an estimated 40,000-50,000 cancer patients in Nepal. According to the World Health Organization, cancers of cervix, lung, breast, ovary and stomach are common among Nepali women, while, among Nepali men, lung, mouth and oropharynx, stomach, and blood cancers are more common.

Dr Murari Man Shrestha, a medical epidemiologist and the Head of Department of Preventive Oncology at Nepal Cancer Hospital and Research Center, Harisiddhi, says that at the outset there might be non-specific and generic symptoms like loss of appetite, decrease in immunity resulting in frequent infections, and indigestion. As the tumor grows, symptoms in affected areas are more common.

For women diagnosed early, the over-five year survival rate for breast cancer is up to 100 percent

“Diagnosing whether a disease is cancer is challenging,” says Dr Hari Dhakal, senior consultant pathologist and Head of Department of Pathology at the same hospital. “One approach is finding out if the disease has progressed up to the stage where symptoms show up. If a patient is asymptomatic, then there are screening tests for different parts of the body for most common types of cancers.”

More than nine out of 10 colorectal cancer patients live for over five years if they get early treatment. For women diagnosed at the earliest stage of breast cancer, the over-five year survival rate is up to 100 percent, whereas for women diagnosed at advanced stages, the same survival rate plummets to 22 percent.

“It is imperative to promote cancer screening,” says Dr Dhakal. “We need to make people aware that early detection of cancer is actually a good thing, as it is mostly curable.”

Video: Why you may want to get screened for cancer?

Dev Narayan Chaudhary, 53, of Udaypur in Province 1, was diagnosed with stage-three colorectal cancer over three years ago. Twelve cycles of chemotherapy and two surgeries later, he says that had he been diagnosed earlier, his treatment would have been much easier. “For long I took medicines for gastritis. I had no clue it was cancer.”

Cancer is not just one ailment, it is rather a cluster of diseases. Caused by uncontrollable division of cells that results in abnormal tissue growth and tumor-formation—with the exception of blood cancer—it can affect any part of the body other than hair and teeth. Not all cancers are malignant. The ones that are innocuous are called benign, and they do not require immediate medical attention.

One approach of diagnosis is finding out if the disease has progressed up to the stage where symptoms show up

There are over 100 known malignant tumors, each with its own symptoms, degree of severity and treatment options. But in the initial stage there are no observable symptoms.

 

Dr Murari Man Shrestha, a medical epidemiologist and the Head of Department of Preventive Oncology at Nepal Cancer Hospital and Research Center, Harisiddhi, says that at the outset there might be non-specific and generic symptoms like loss of appetite, decrease in immunity resulting in frequent infections, and indigestion. As the tumor grows, symptoms in affected areas are more common.

 

“Diagnosing whether a disease is cancer is challenging,” says Dr Hari Dhakal, senior consultant pathologist and Head of Department of Pathology at the same hospital. “One approach of diagnosis is finding out if the disease has progressed up to the stage where symptoms show up. If a patient is asymptomatic, then there are screening tests for different parts of the body for most common types of cancers.”

 

Worldwide, Asia accounts for nearly half of the new cancer cases and more than half the cancer-related deaths. In Nepal, as mentioned in the World Health Organization Cancer Country Profile, cancers of cervix, lung, breast, ovary and stomach are common among women, while, among Nepali men, lung, mouth and oropharynx, stomach, and blood cancers are more common. Dr Shrestha estimates that at any given time there are 40,000-50,000 cancer patients in Nepal.

 

According to WHO, screening refers to the use of tests in a healthy population to identify individuals who have disease but do not yet have symptoms. These are tests specific to parts of body affected by cancer. Examples include mammograms for breast cancers, the ‘pap test’ for cervical cancer, and low-dose computed tomography (CT) for lung cancer.

 

Dr Shrestha classifies cancer screening as a secondary prevention method. The primary method is to prevent cancer in cancer-free population, for instance through the promotion of a healthy lifestyle. Likewise, the tertiary method involves treatment of patients diagnosed with cancer. Detection of the disease when the tumor is not large and has not spread is vital as it vastly increases the chances of successful treatment.

 

More than nine out of 10 colorectal cancer patients live for over five years if they get early treatment. For women diagnosed at the earliest stage of breast cancer, the over-five year survival rate is up to 100 percent, whereas for women diagnosed at advanced stages, the same survival rate plummets to 22 percent. Early detection also implies less treatment and less recovery. “So it is imperative to promote cancer screening,” says Dr Dhakal. “We need to make people aware that early detection of cancer is actually a good thing, as it is mostly curable.”

 

You can choose to add cancer screening to your general examination. As the incidence of cancer is increasing even among the relatively young, Dr Shrestha advises that all those above 40 and those in high-risk groups undergo regular screening. About 10 percent malignant cancers are genetically inherited. Non-genetic risk factors include tobacco smoking, alcohol consumption, physical inactivity, obesity, and pollution.

 

The cost of screening depends on its type and quality, and not everyone may be able to afford one. “This is why it is imperative that the government make it accessible to everyone,” says Dr. Shrestha. 

 

This is also why WHO recommends that screening programs be undertaken “only when their effectiveness has been demonstrated, when resources (personnel, equipment, etc.) are sufficient to cover nearly all of the target group, when facilities exist for confirming diagnoses and for treatment and follow-up of those with abnormal results, and when prevalence of the disease is high enough to justify the effort and costs of screening.”

 

The bottom line? If you are in high-risk group and can afford screening, go get it done. “Some people are skeptical about the tests,” adds Dr Dhakal. “But it makes perfect sense if they think about it logically for a while.”

 

The cancer prevention triangle

While the media often reports on foods that “prevent cancer” and we would love to be told that eating one particular food will prevent cancer, it is unlikely that such a food exists. It is more likely that a combination of good foods may have a preventive effect. Studies over the years have looked at our diets and what foods, if any, will lead to a lower risk of cancer. Fruits and vegetables, whole grains and unprocessed foods have all been promoted as reducing cancer risk. Unfortunately, studies have not consistently proven this to be true. Expert panels state that a diet high in fruits and vegetables “probably” reduces cancer risk, but we just don't know for sure.

However, a healthy diet plays an important role in a sort of “triangle” of cancer prevention. A healthy diet, combined with regular physical activity and maintaining a healthy weight make up this triangle that has been shown to reduce cancer risk. This triangle is thought to be the second most important step, after not smoking, to preventing cancer. An estimated 20-30 percent of cancers could be prevented if people incorporated the triangle into their lifestyle!

But how much physical activity is enough? Experts feel that somewhere between 30 and 60 minutes per day of “moderate to vigorous” activity is needed to impact cancer risk. A moderate activity is the equivalent of a brisk walk, whereas vigorous activities increase heart and breathing rates.

Also, you may exercise a few times a week, but spend many hours sitting at a computer or watching TV. Your risk of many cancers may be higher because of this. Try taking a walk every hour, using a standing desk, taking the stairs to your lunch break, etc. Any way you can lessen the sedentary time and get some activity in is helpful.

Wonder how to get started with an exercise regimen? Make it fun and set reasonable goals. Find a friend to be a walking partner—you can motivate each other and make the walk more enjoyable.

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