Interview with Oncologist Dr R Ranga Rao

Komorebi Post– Cancer, the term itself sends chills down the spine!! In India and according to India Cancer Organization, who estimated the current number of people living with the disease to be around 2.25 million.

The way it is spreading worldwide, is quite alarming! it is quite unfortunate that the more we are evolving as a sophisticated, tech-savvy, modern, polished and a gadget- friendly species, the more we are finding ourselves susceptible to fall prey to this deadly disease.

Even though it is one of the deadliest, highly perilous and fatal diseases, it is still completely curable, if checked and treated on time. Thus, awareness is crucial to increase the survival rates.  ‘Time matters’ and ‘Sooner, the better’ are highlighted in awareness campaigns that Dr Ranga Rao, conduct along with various Welfare Organizations. Dr Ranga Rao has served in the medical fraternity and Indian armed forces for almost 35 years. He is a prolific writer of papers and research-based articles, which keep publishing in various journals and publications. Komorebi Post, had the opportunity to present a candid conversation with Dr Ranga Rao about myths related to cancer:

Q. Why cancer is detected quite late?

Ans. It is discovered quite at the later stage when the patient has symptoms due to large size of the tumour. Unfortunately, when cancer tumour is small, it doesn’t produce any symptoms. Smallest tumour which can be detected by the patient or doctor is around 1 cm in size. By then, the tumour would have spent a considerable time, undergone 30 multiplications, and already small number of cells would have been spread to distant organs. It just needs another 10 to 12 multiplications to kill a person. Sometimes the symptoms are so vague that they are ignored.

Q. It is seen in most of the cases that patients report in advanced stages and cannot be cured. Sometimes they are under care of the doctors. And still it happens. Why does this happen?

Ans. Yes, most patients (almost 70-75%) report to the doctor in late stages 3 and 4, as compared to 20% to 30 % in the developed countries. This leads to less chances of cure, more expensive treatment and great deal of human suffering. This delay is due to several factors. Firstly, ignorance of the symptoms by the patient themselves due to many reasons including social causes. Secondly, the symptoms are so vague and mild that they are not recognized as symptoms of cancer. Thirdly, they can be mistaken as common diseases like TB or some other chronic medical problem.  For example, most lung cancers are mistaken for TB and are given few months of treatment for TB, before the final diagnosis is done. By that time, stage of cancer becomes advanced. Fourthly, the delay sometimes does occur after consultation with a doctor. The relevant tests are not done, or the test results are misleading or not recognized. In short, there is a lack of awareness amongst the public irrespective of their literacy, social status and amongst the doctors.

Moreover, may be due to some reasons, a few surgeons or doctors don’t refer a suspected cancer patient to an oncologist in time, which unfortunately may prove quite dangerous for the patient. Proper and timely referrals to oncologists can save lives. People also should be aware of waring symptoms of cancer and in case they do have them, they should immediately see an oncologist or get themselves referred to an oncologist.

Q. There is a myth or a belief that if a malignant or a cancerous tumour is operated upon, or is removed, the malignant cells start spreading. Is that true? Does the patient need some extra therapies or a cure to ensure that these cells don’t spread further?

Ans. No. Malignant cells do not spread after surgery, if the surgery is done properly by a trained and an experienced surgeon.  It is a false belief that cancer spreads after surgery. Sometimes, if the tumour is large, some tumour cells may have been left in visible or an invisible state, which can grow and spread in due course of time.  It is therefore essential that cancer operations are done by trained cancer surgeons and not those who are not experienced in these types of surgeries. Also, they require some further treatment after surgery with radiotherapy or chemotherapy or hormonal therapy or a combination to remove these cells. It is a false belief that cancer spreads after surgery, probably based on a few observations, where tumours operated improperly lead to a local or distant spread.

Q. Should Biopsy be done in all cases? Does it spread cancer?

Ans. Biopsy is a must in most cases. Firstly, with the biopsy, we get the correct diagnosis of cancer and secondly, the exact type of cancer. In addition, by performing special tests called immunohistochemistry (IHC), we get more information about the type and markers to decide the line of therapy. For example, in breast cancers we get the report of hormone receptors present, where we need to give the hormonal therapy. Similarly, lung cancers with a receptor called EGFR, need not be exposed to chemotherapy and can be offered some tablets of targeted therapy.

Q. Why so many people are having cancer today?

Ans. Cancer is a lifestyle disease, like diabetes, high blood pressure or heart attacks. The changes in lifestyles, in the long run lead to various changes in the cells, mutations and thus cancers. Lifestyles include dietary habits, consumption of alcohol, tobacco in any form-smoking, chewing; overweight, reproductive and sexual habits, lack of adequate exercise, exposure to radiation, immune suppression in transplants, infections like Hepatitis B, Human papilloma virus etc. Over the years the lifestyles have undergone so many changes and people have left good habits and adopted more easy, comforting and easy lifestyles.

Q. How come so many people are exposed to cancer causing things like tobacco, but only some have cancer?

Ans. Their strong immunity! It has come into a limelight that something is protecting them against such factors. There are good genes and there are bad genes. People with strong genes and good immunity are less susceptible to get affected by such factors in comparison to the ones with low immunity and bad genes. Science is beginning to understand them.   There is a beautiful balance of genes and immunity to protect the human body from cancers. When this balance is upset, the cancer-causing mutations are successful in leading to cancer.

Q. What is meant by ‘Bad gene’?

Ans. To make you understand, let me give you an example. A guy started smoking when he was 10 years old. Now the person is sixty years old and still fine. He smoked for fifty years and still fine because of his good genes. Whereas, another person who smoked for ten years get cancer because he has developed bad genes also called as cancer-causing genes or ‘oncogenes. These are changed good genes, changed by mutations. Also, we have cancer suppressing genes in our body. If they are changed (mutated) or lost, balance gets upset and the result is cancer.

Q. Are all the children of cancer patients susceptible to having cancer in future?

Ans. See, it’s true that they have ‘that’ in their genes. But there are only 5%-10% chances only. The genes can be acquired through environmental factors, diet, life style too. It takes years to form cancer. Cancer genes are inherited from the family in 5% of the patients.

See, there were very less cancer cases earlier. Environment used to protect us against cancer. Today, immunity too is affected by environment. We are losing this fight because now the environment is not protecting us, rather damaging our immunity levels. Because of our low immunity, poor life-style, we are getting more susceptible to the disease.

Q. Last, but indeed not the least, is the situation quite grim today? Aren’t cancers getting cured?

Ans. See, it too varies in case to case. If checked and treated on time, different cancers are curable in a majority, if properly handled by the patient’s family as well. But, I repeat, awareness among people matters a lot. It is necessary that whenever they suspect of cancer, they should go and see an oncologist. Awareness can bring down the number of cancer-related deaths.

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