Trends in oncology: Transforming therapeutic approach

March 2010

The oncology segment of medical science has witnessed remarkable technological advances over the last few years. This has resulted in not only detecting the disease in its nascent stage but also controlling it by adopting an effective treatment approach for the same. Saloni Vora provides an insight into the new emerging diagnostic trends, treatment modalities and likely future developments in this field.

Cancer, also referred to as neoplasm, is fast becoming widespread in the modern world. According to medical experts, the ailment is considered to be one of the most feared diseases among the masses today. Also, in recent times the number of deaths caused due to cancer is more than the deaths caused by AIDS, tuberculosis and malaria combined.

Avers Dr Prem Prakash Singh, Medical Superintendent & Head-Quality, Rajiv Gandhi Cancer Institute & Research Centre, “Every year, nearly 10 million new cancer cases are diagnosed worldwide, of which approximately 4.7 million are observed in the more developed countries while nearly 5.5 million in the less developed nations. Cancer is also one of the fastest growing non-communicable diseases in India. Its prevalence in the country is estimated to be around 2.5 million, with over 8,00,000 new diagnosed cases and 5,50,000 deaths each year.”

Dr Prem Prakash Singh

Factors like increasing proportion of an aging population; high consumption of tobacco, alcohol & unhealthy diets; shift in lifestyle patterns; over exposure to different electromagnetic radiations are the different factors that have been recognised to fuel the high incidence rates of cancer in the Indian subcontinent today. Reveals Dr Ajai Kumar, Chairman, HealthCare Global Enterprises Ltd (HCG), “Breast, colon, rectal, prostate and stomach cancers are more frequently observed in urban India whereas head& neck and cervix cancer are more prominent in rural India.” In addition, cancers of the oral cavity, lungs, oesophagus and stomach have been found to be more widespread among males whereas cervix and breast cancer among females.

Diagnostic trends

In recent times, even cancers of the breast and uterine cervix can be diagnosed during their initial stages with the introduction of sophisticated screening tests. “Periodic examination by pap smear and mammography are the accepted standards for early detection of cervix and breast cancers in the developed countries,” says Dr Singh.

Besides these screening tests, cancer biomarkers  constitute one of the most rapidly advancing fields in clinical diagnostics. Adds Dr Singh, “Cancer biomarkers help in screening asymptomatic individuals in the general population and thereby assist early as well as specific diagnosis in suspect cases. Also, the introduction of advanced sophisticated technologies like microarray, mass spectrometry and automated DNA sequencing has opened new avenues in the field of biomarkers. Further, oncology imaging has also undergone remarkable advances.”

In addition, the development of techniques like C-banding, used for labelling the chromosome has enabled scientists to pinpoint the precise location of genes in various chromosomes. Moreover, this technique also helps in discovering new cancer-causing genes.

Dr Ajai Kumar

Says Dr Shripad Banavali, Professor & Head – Department of Medical Oncology, Tata Memorial Centre, “Automated complete blood count (CBC) machines, flow cytometry equipment, molecular studies like RT PCR, RQ PCR, DNA micro assays, various ELISA tests and immunohistochemistry studies go a long way in diagnosing the disease in a better manner.”

Treatment advances & surgery

Significant improvements have taken place in the conventional modalities used to treat the disease like surgery, radiotherapy and chemotherapy.

Surgery

Recent trends in surgery include the organ preservation using concomitant chemoradiotherapy. This approach eliminates the need for an extensive surgical process and improves the outcome of the procedure. Says Dr Kumar, “In earlier days, we used to opt for surgery, but today, we limit the same, as the cosmetic result means a better quality of life for the patient. For example, we do not opt for mastectomy of the breast while treating breast cancer. Instead, we prefer neoadjuvant chemotherapy to initially reduce the size of the tumour, which is then followed by performing limited surgery for tumour removal. Similarly, in larynx cancer, one can preserve the voice of the patient by adopting the same approach.”

Radiotherapy

Dr Shripad Banavali

Significant progress has taken place in radiological oncology. Today, oncologists can deliver more accurate treatments to treat tumours that experience motion when the patient performs involuntary functions like breathing, neck movement, etc. Opines Dr Singh, “The introduction of intensity-modulated radiation therapy (IMRT) enhances the capacity of focussing radiation on cancer affected areas. However, sometimes, the tumours may experience movement.”

Another breakthrough equipment launched in this field is the CyberKnife, which can deliver radiation treatment in various angles with less side effects.

Chemotherapy

Chemotherapy, widely used to treat malignant tumours using cytotoxic drugs, has undergone tremendous evolution with time. Says Dr Singh, “These include gene therapy, immune system boosters, vaccines, etc to stimulate the body’s defence mechanism against cancer.”

Palliative care

The objective of palliative care is helping patients to control pain and other symptoms that may be psychological or social in nature and thereby helping them to lead a normal life in their last days. Avers Dr Kumar, “This approach is something similar to diabetes and blood pressure, where the disorders are not completely cured but managed in an appropriate manner.” Further, the awareness regarding centres imparting palliative care in India is low. According to Dr Banavali, more awareness needs to be created on the same and more number of community based palliative care centers need to be established in the country.

Challenges

Although significant progress has been made in India with the introduction of better diagnostic modalities and treatments, the country still faces multiple challenges that it needs to overcome. Further, the cost involved in diagnosing and treating the disease has spiraled with the availability of expensive equipment and chemotherapeutic drugs & therapies. Hence, according to Dr Banavali, development of affordable therapies is one of the most important challenges in the field of oncology.

Future trends

Research is already underway for developing new drugs and therapies that can treat cancer more specifically & selectively. Opines Dr Kumar, “There will be an increased focus on use of gene therapy, targeted therapy, phasing of systemic therapy, advancement of CyberKnife and associated therapies, which will help bring better control of the disease with few side-effects. Also, stem cell therapy will make a big difference in this approach.”

According to Dr Banavali, the new drugs will revolutionise the treatment of cancers like multiple myleoma. Also, oral preparations of anti-cancer drugs utilising the concept of ‘metronomic therapies’, which includes provision of low doses of chemotherapy on a continuous basis every day rather than providing high doses once a month will also help. “New therapies would aim towards controlling the disease rather than cure, considering many adult cancers are not curable,” he concludes.

(mmedit@infomedia18.in)