A Glance into Advanced Clinical Oncology with Dr. Anil Thakwani from Sharda Hospital, Gurgaon

Cancer has plagued humanity for centuries and still continues to be a significant global health challenge. With advancements in medical technology and research, however, the landscape of cancer treatment has undergone a remarkable transformation. 

To gain insights into the latest developments in clinical oncology, Vaidam had the opportunity to speak with Dr. Anil Thakwani, a renowned oncologist from Sharda Hospital, Noida.

Major Highlights of the Session

The incidence of cancer has been steadily rising worldwide, with a significant portion of the burden falling on developing countries like India. In 2019, around nine lakh death cases were registered due to cancer.

The correlation between early detection and improved survival rates in cancer underscores the necessity of timely screening and, thus, the overall treatment. Some of the major screening and cancer detection measures are listed below.

Radiological Findings

These detect the abnormalities with the help of medical imaging tests like PET-CT scans, MRIs, and ultrasounds. These abnormalities can suggest the possibility of cancer and give an idea about shape and size of the tumour however it does require further confirmation.

Considering the example of breast cancer, any sort of breast tissue abnormalities detected by mammograms, MRI, or ultrasound is an indicator of cancer. The results are measured on the Breast Imaging Reporting and Data System (BI-RADS) scale. It comprises the categories, which range from Category 1, indicating that there is no cancer, to Category 6, indicating that there is a high likelihood of cancer. We have a category 0, which indicates that more tests are needed. 

Biopsies 

In biopsies, a small sample of tissue is removed for microscopic examination. Based on the histopathological analysis, presence of cancer cells is confirmed Often referred to as a gold standard, biopsies are the most definitive way to diagnose cancer.

In the case of breast cancer, for example, a biopsy is performed in the BI-RADS category of 4 and 5 to confirm the presence of cancer.

Tumour Markers

Tumour markers are usually proteins that are produced by cancer cells. Their presence in the blood, urine, or other bodily fluids, indicate the possibility of specific type of cancer. 

Some of the common types of tumour markers are:

• Alpha-fetoprotein (AFP) markers: These are associated with liver and testicular cancers.
• Carcinoembryonic antigen (CEA) markers: These are associated with colorectal, lung, breast, and pancreatic cancers.
• CA-125: These markers are indicative of ovarian cancer.
• PSA (prostate-specific antigen): These markers are indicative of prostate cancer.

Dr. Thakwani also discussed that in some cancer cases, screening tests don’t bring any significant change in the treatment plan and survival rate.

It can be defined in terms of the lead time, which refers to the time interval between when a cancer is diagnosed through screening or early detection methods and the time it would have been diagnosed symptomatically.

For example, in the case of small cell lung cancer, the disease can progress silently, which often remains undetected until it reaches an advanced stage.

Once the presence of tumour cells is established, the focus now shifts to developing a personalised treatment strategy for the treatment of cancer.

Meanwhile, Dr. Thakwani also reflected upon the importance of collaboration of multidisciplinary teams (MDTs) which include surgical, medical and radiation oncologists. With their comprehensive perspective on informed decision making, they ultimately aim to reduce the potential risks and achieve high patient outcomes.

Management and Treatment of Cancer

Once the cancer has been detected, radiation oncologists coordinate with medical oncologists, surgeons and other cancer doctors to create a tailored plan and perform the treatment. Dr. Anil Thakwani discussed the following therapeutic approach, which has revolutionised cancer treatment.

Stereotactic Body Radiation Therapy (SBRT)

SBRT is a specialised form of radiation therapy that delivers very high doses of radiation to small, well-defined tumours in fewer treatment sessions (typically 1-5 sessions). It uses precise imaging and positioning techniques to focus the radiation on the tumour, sparing nearby healthy tissues. This is often considered a standard cancer therapy. In the case of breast cancer, SBRT usually takes 5-8 weeks.

However, with the hypofractionation technique employed in SBRT, the number of doses per fraction is increased while the number of doses remains the same. This makes the therapy more effective and the patient stay for treatment in India can be significantly reduced.

Intensity-Modulated Radiation Therapy (IMRT)

Considered as an advanced form of external beam radiation therapy, IMRT utilises computer-controlled linear accelerators to deliver precise radiation doses to treat tumours. If the tumour size is irregular, for example, the radiation field would be of the same shape by modulating the intensity of the radiation beams. Thus, it allows for higher precision in targeting cancerous tissue, without affecting the healthy cells.

Image-Guided Radiation Therapy (IGRT)

It is an image-assisted advanced form of radiation therapy, where the tumour’s location is tracked during radiation treatment in real-time, after which it can be treated with radiation.

Before each therapy session, the patient undergoes imaging such as MRI, the radiation oncologist compares these images with those taken during the treatment plan. Then, they adjust the patient’s position or radiation beams as per the requirement. 

Warning Signs of Cancer and Prevention

When we talk about a disease as deadly as cancer, we must understand some symptoms which might be indicative of cancer. Let’s discuss some common warning signs below.

• Unexplained weight loss
• Persistent fatigue
• Sudden appearance of Lumps or bumps which change colour or become harder with time
• Sudden bleeding from unusual places

Dr. Thakwani then emphasised the importance of some mandatory screening tests, such as mammography for women who have crossed the age of 30 and a pap smear for early detection of cervical cancers to ensure that treatment is not delayed and more lives can be saved. 

Routine screening tests of oral cancer in regular tobacco consumers when any sort of ulcer appears also highlight the importance of early recognition of symptoms and immediate medical intervention.

Summing up

Cancer remains a formidable challenge in healthcare, but advancements in clinical oncology offer hope for patients and their families. 

By staying informed about the latest developments and seeking expert care, individuals can improve their chances of overcoming this challenging disease. Dr. Anil Thakwani’s insights provide valuable guidance and reassurance for those affected by cancer.