Understanding cancer

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According to the International Agency for Research on Cancer, in many countries, cancer will affect one in two men and one in three women during their lifetime. The World Health Organization estimates that the disease is responsible for nearly one in six deaths worldwide.

Those are daunting statistics. Yet most of us known little about this malady that can suddenly affect any of our lives.

To mark World Cancer Day, we spoke to renowned consultant oncologist and haematologist Dr. Muhammad Arif – the owner of the Razia Sultana Memorial Cancer and Blood Associates clinic in Lahore – and asked him about the disease, what triggers it, and how to prevent it.

Us: What is cancer?

Dr. Muhammad Arif: Cancer is a disease which involves the abnormal, uncontrolled growth of cells. It eventually becomes visible with testing or even to the naked eye. Cancer can start anywhere in the body and spread to other organs. It can be fatal if not caught and treated early.

Us: What causes cancer?

Dr. Arif: There are a number of theories regarding what causes cancer to develop.

The most widely accepted one nowadays is that the number one reason for cancer is likely to be lifestyle, which includes factors like diet, nutrition, exercise, weight, and stress. It is believed that about 60 to 70 percent of the cancer cases in the world are because of unhealthy lifestyle.

There are also some cancers that are triggered by a gene you get from your parents, but only about three to five percent of cancers in general are inherited. The rest of the cancers are incidental and sporadic.

Cancer starts when a cell changes its behaviour. Usually it starts with a mutation. But first mutation never causes cancer; the mutations accumulate over time.

These mutations are either acquired or inherited.

For instance, in our Pakistani context, we see a lot of hepatitis in the general population, which leads to a very high risk of liver cancer in those patients. In Western countries, it happens because of lifestyle; a condition known as fatty liver leads to a high risk of liver cancer.

Us: What are the most common types of cancer?

Dr. Arif: In women, breast cancer is considered the most common type of cancer. In men, it’s generally lung cancer.

Overall, the most common cancer is skin cancer – like squamous cell carcinoma or basal cell cancer – but most of the time, these are not deadly cancers; they are very easily treatable, so that’s why we don’t hear too much about them. The other skin cancer, melanoma … that’s rare, especially in Pakistan, but that’s actually a very deadly cancer.

In Pakistan, the most common cancers after breast and lung cancer are lymphomas. Then we have a lot of people with blood cancers, like myeloma. In some areas, we have a lot of cancers of the head and neck area – like tongue or mouth – especially in people who chew tobacco or smoke.

Other cancers aren’t uncommon either. We see a lot of stomach, pancreatic, and colon cancer, and liver cancer is among the most common ones in Pakistan because of hepatitis. 

Us: What are the main risk factors for cancer? You mentioned lifestyle…

Dr. Arif: Yes, the number one factor is lifestyle, which includes diet, exercise, weight, and stress.

Eating healthy and getting proper nutrition is essential. The second most important thing is probably exercise and weight management. Exercise leads to a lot of benefits – 30 to 45 minutes of brisk walk or light exercise every day, four to five days minimum per week, can reduce cancer risk by about 20 to 30 percent. So that’s recommended. Exercise also helps to maintain weight.

Third would be stress. Healthy stress, like exam stress or a little bit of competition stress, is ok. But unnecessary stresses – which have a lot of impact on your overall health – should be avoided.

Sleep is another important thing, especially in teenagers and youngsters. People who get a good night’s sleep are generally overall very healthy.

Other risk factors include – particularly since hepatitis is very common here – needle sharing. We should make sure there is no reuse of syringes and ensure that hygiene is maintained during medical procedures.

Us: What are the signs and symptoms of cancer?

Dr. Arif: Most cancers are initially silent, but when the cancer gets to a point where it starts to show symptoms, the most common symptom is a gradual decline in overall health. People might feel fatigue, tiredness; they might start to lose weight or lose appetite; they might notice a change in the colour of their eyes (which could become yellow if somebody has jaundice) or urine; they may become pale; or they might start to feel shortness of breath when they walk.
In practical terms, any symptom – from pain to a lump – which is new and persistent – more than a week or so – should be evaluated. 

Us: But many of these symptoms could suggest a different disease…
Dr. Arif: Yes, definitely. You shouldn’t be scared if you have some lump. It may be something else, like an infection or something benign. Similarly, if you have weight loss, it doesn’t necessarily mean that you have cancer; some people who have thyroid disease start to lose weight. But if the symptom persists, it should be investigated to make sure it doesn’t have a serious underlying cause.

Us: How important is early detection?
Dr. Arif: Early detection is definitely the only way, at present, to cure a cancer. Cancer can be detected early through screening. When the disease has started in the body but you don’t have any symptom and cannot detect it with your eye or by examination, you do these tests, like mammogram, Pap smear, and coloscopy. If the disease is detected early – Stage I and II – and surgery is performed, a majority of the cases are curable.
Take the example of colon cancer. If you diagnose it by screening through colonoscopy that finds a small polyp in the colon and you take it out – that’s all you need, surgery – then you’re cured. About 95 percent people are cured in Stage I colon cancer. In Stage II, it drops by about 20 to 30 points. In Stage III, there’s an about 40 percent cure rate; in the rest of the cases, the disease comes back at some point. Stage IV is not curable. Very, very rarely, if somebody has very limited stage IV and it has not advanced too much, then it might be possible to control with surgery. 

Us: But screening can be expensive…
Dr. Arif: There is cost analysis on that, and if you look at the value of the test, there is a positive correlation – it is very, very cost effective instead of having the disease diagnosed at an advanced, late stage.
Treatments – medicines, surgery – are so expensive. When it’s diagnosed in early stage, most people won’t need very extensive treatments, like chemotherapies and targeted therapies; they might need just a small surgery. Compared to early disease, advanced disease will cost a lot, plus it’s not curable. If you add up these things, it’s very cost effective to do screening tests.
In women, yearly mammograms are recommended after the age of around 40 or 45. Coloscopy is recommended for both men and women who are 50 and above. In men, prostate cancer can be detected early. Similarly, cervical cancer and uterine cancer can be detected by Pap smear which is recommended for women who are married.

Us: Are there any other ways to prevent cancer, like vaccines?
Dr. Arif: Yes. There is, for instance, a hepatitis vaccine which provides almost 80 to 90 percent protection against the disease, so even if someone is exposed to the virus, it won’t cause problems like cancer and liver diseases.
In Western cultures, they recommend cervical and oral cancer prevention with a vaccine that they give to youngsters which has been shown to reduce the risk of cervical cancer.

Us: What are the treatment options available for cancer?
Dr. Arif: The classic three ways of cancer treatment are surgery (if possible), radiation, and medicines called chemotherapy.
Nowadays, there are many new advances, especially immunotherapy and targeted therapies. They are very effective in some people.
For example, five to seven years ago, people with Stage IV lung cancer survived only a year or so; now about 20 to 25 percent people survive over five years. Similarly, the survival rate for myeloma was two years on average a few years ago; now it is about eight to 10 years. 

Us: Why is there no actual cure for this disease?
Dr. Arif: By its very nature, in cancer, there are some cells that mutate all the time. Once that process starts, you treat one type of cell, it changes into a different type of cell and becomes resistant to the treatment you are using. So it continues to progress over time. Although you may be able to control it for a long time, eventually it is not possible [to stop it].
Still, there are, say, on average about 30 percent people who are cured of their cancer. It’s getting better – from zero percent to 30 percent – but there’s obviously still a long way to go.
We are hoping that cancer eventually becomes a chronic disease, like other incurable conditions such as diabetes and heart disease; people get long-term treatment for it, but it is no longer an automatic death sentence. That will be a great success, I think.

Us: Do you have any recommendations for the readers?
Dr. Arif: I would say that prevention is probably the best strategy. Be proactive about your health – think about your well-being, make sure what you put in your body is not harmful, do not abuse your body, exercise, sleeping well, avoid unnecessary stresses. Don’t get exposed to risk factors which you can avoid, like hepatitis, unnecessary radiation exposures, unnecessary medications.
The next best strategy is that when you are in the appropriate age range, get screening done so that even if you develop cancer, it is caught early, treated promptly, and you hopefully get rid of the disease for good.

- By Sameen Amer

Us Magazine, The News - 2nd February 2024 *