Cancer is one of the leading causes of death in the world, perhaps one of the top 5. For Indians, with exposure to contaminated water, polluted environments, and genetic factors, the risk is even higher. It is a national epidemic, and governments, institutions of research and hospitals gearing up and developing processes to handle the disease burden.
Only recently has the knowledge, that cancer is not one disease, but a group of diseases with some common features, been realised by the general public. To doctors though, especially medical oncologists such as Dr. Sankar Srinivasan at Apollo Hospitals, this has been a guiding force in diagnosing and treating cancer.
A further evolution in this thought is that the cancer - its origins, drive and growth - are further characterised by the organ or site in which it appears in the patient, and that cancers of two different organs may be very different from each other, and therefore require very different methods for curing it.
The major sites, or organs, thus seen are: Brain cancer, Head & Neck Cancer, Breast Cancer, Oral cancer, Lung cancer, Liver cancer, Leukemia or Blood Cancer, Cervical, Pelvis, Prostrate cancers, Kidney, and so on.
Organ Specific Cancer Care, and Disease management
Medical Oncologists today, such as Dr. Sankar Srinivasan, have seen the field of oncology, and the system of cancer treatment, grow and expand in many ways in India. From a total of 5 qualified Medical Oncologist in Chennai in 1995, to over 300 specialists, several speciality hospitals and institutions for cancer treatment available now, the magnitude of growth is heartening.
However, despite the growth in number of doctors, there is still a severe shortage of qualified experts, and a lack of advanced centres of care. This means that today, all oncologists continue to see all patients, and handle all kinds of malignancies.
However, this will change, believes Dr. Sankar. He sees a near future in which oncologists specialise in organ-specific or site-specific cancer treatment. “The major advantage of cancer-specific, or site-specific care, is you can develop a system,” says Dr. Sankar. With a system of care in place, and with practice and volume, chances of errors are reduced, the scope of care is more detailed and more patient friendly, and ultimately translates to good news for all concerned.
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Protocols can be developed for each organ, and each cancer type. This allows doctors to also keep up with more specific research and development in their chosen specialised field. With more and more research published regularly, and with new sciences, and methods of treatment, it will become close to impossible for one oncologist to keep up with all information on all cancers. Specialisation reduces the volume of information one must know, but sharpens the focus. For instance, Dr. Sankar Srinivasan says he would like to concentrate on breast cancer, cervical and prostate cancers. Specialising in three organs allows Dr. Sankar to gain a more in-depth knowledge of these cancers, and ways to cure them. Dr. Sankar will also then be able to see patterns and similarities, across a large number of patients, thereby developing a “gut instinct” to treat individual patients.
“Eventually it will be in the interest of the patients for the oncologist to restrict themselves to few oncology, and to a minimum number of sites.”
Newer Methods of Treatment
Site-specific cancer care also allows Dr. Sankar, and other medical oncologists to follow medical trials and suggest specific, newly developed courses of treatment for their patients. “This will certainly improve the outcome,” he says. Specialisation in certain organ-specific cancer helps an oncologist create specific protocols within their hospitals so that nothing is left to chance, and no patient receives less than perfect treatment.
So far, radiation and chemotherapy have been the generally accepted methods of treating cancer, but they act in a very general way, targeting not just cancer cells, but also the healthy cells that may be close to it.
But with newer research - especially into the genetics and protenomics (study of protein in cells) of the cancer cell, and the growing use of immunotherapy methods for cancer care, is allowing oncologists to easily target and kill the cancer cells, without damaging other tissues. Immunotherapy and genetics are also allowing for greater long term results and better quality of life for patients overall.
Diagnosis and treatment - especially targeted therapies for certain cancers - is better when a doctor specialises, and survival post cancer is higher for patients.
This article has been produced by TNM Marquee in association with Apollo Hospitals.