Lesser Known Cancers

The most common cancers in India's breast, oral, lung and cervical cancer account for forty per cent of cancer burden. The other cancers are the lesser-known and are the subject of this article. These cancers are increasing in a number of cases and in some cases can be screened for or detected early if patients with symptoms get tested early. Most cancers if diagnosed in early stages have a near 100 per cent five-year survival rate which drops to less than 25 per cent if diagnosed in later stages where cancer has spread to other organs. Hence it is important to find cancer in the early stages.

1) Colon Cancer

Westernization of our diet and rural to city migration is leading to an increase. Colon cancer can present with a change in bowel habits, blood in the stool, abdominal pain, and iron deficiency anaemia (low haemoglobin). Screening for colon cancer consists of a colonoscopy at age 50. Faecal occult blood tests done yearly can also check for blood loss in stool.

2) Ovarian Cancer

This cancer is seen in women usually presenting in an advanced state as symptoms are subtle like abdominal bloating, distension, feeling full early in a meal, vague abdominal and low back pain. There is no screening test approved for ovarian cancers. Ovarian cancers can be associated with BRCA mutation that run-in families and patients with cancer must be tested for it. If tested positive it can affect both males and female children.

3) Prostate cancer

Seen normally in older men this cancer is increasing in India and presenting at an earlier age. Screening can be done by a PSA (Prostatic Specific Antigen) blood test at 50 years of age and repeated every couple of years if normal. Most patients are diagnosed in earlier stages without symptoms. Symptoms range from blood in urine or sperm, frequent urination, difficulty with urinary flow or urination. In more advanced stage bone pains and aches from spread to the bones.

4) Pancreatic Cancer

The two forms of pancreatic cancer are the more common exocrine tumours and less common neuroendocrine tumours (NET). They can present with fatigue, loss of appetite and weight, jaundice, abdominal pain, nausea, vomiting, diarrhoea or constipation. Pancreatic NETs can also have symptoms such as a spike or drop in blood sugar, excessive thirst or increased urination. There is no screening test currently for pancreatic cancer.

5) Stomach Cancer

This cancer was on the decline with better food refrigeration but now on the rise with obesity and changing lifestyle. It is seen in both men and women and now comes at a younger age. Persistent abdominal pain and weight loss are the most common symptoms. Difficulty swallowing solids, decreased appetite, a sense of fullness, dark black coloured stools and iron deficiency anaemia are other presentations. There is no screening test for stomach cancer. Proper storage of food and a healthy diet and lifestyle without tobacco and alcohol decreases your risk.

6) Liver Cancer

This cancer develops in the setting of long-lasting liver disease, in scarring (cirrhosis) left from fatty liver disease or Hepatitis B and C. Changing lifestyle with increasing obesity is leading to an increase in liver cancer. Advanced disease may present with upper abdominal pain, weight loss, feeling full early in a meal or a lump in the upper abdomen. One of the few cancers that can be diagnosed without a biopsy with the combination of blood and an abdominal imaging test. Vaccination for Hepatitis B has been mandated at birth in the developed world but the adoption in India is still lacking. Adults and children who do not have Hepatitis B can be vaccinated against it. Correction of diet, increasing activity and in some cases, medications can help prevent fatty liver progression.

7) Skin cancer

This cancer is mostly associated with skin damage from sun exposure. This can be easily prevented by using sunscreen and clothing that protects from the sun (e.g. Hats). Any skin lesion/mole especially those that change in shape, size, margins, texture, thickness or bleeds should be evaluated immediately by a skin specialist for additional workup.

Cancer can be treated using multiple modalities which include surgery, chemotherapy, radiation and Immunotherapy. Nowadays chemotherapy and targeted agents are used more often before surgery to shrink the tumour so that the surgeon can then cleanly remove the tumour. Even when cancer has spread these medications shrink the tumour, giving relief from the symptoms of cancer with improvement in the survival.

Targeted agents are now available that attack only cancer cells with minimal collateral damage to normal cells with better responses and lesser side effects. Our immune cells normally fight against infections destroying them. Cancer is smart and escapes our immune cells by binding to certain receptors on them. We now have immunotherapy drugs that open up these bonds and unleash our immune cells to destroy cancer cells. So rather than decreasing our immune system like chemotherapy drugs, immunotherapy stimulates our immune system to fight these cancers.

Tobacco and tobacco-related products like gutkha, pan masala are known to cause more than forty per cent of cancers. Cancer can be prevented with a smoke-free, healthy lifestyle, detected early by screening and treated with new targeted therapies and immunotherapy.

Dr Ian Pinto

Guest Author The author is Consultant Medical Oncology at Jaslok Hospital and Research Centre.