FM AUGUST 2018 ISSUE1 - digital edition

“We need to be honest with the
patient and relatives about the
morbidity rates and what quality
of life they can expect”
Dr. Rajendra Toprani
Cancer Surgeon, HCG Ahmedabad
debilitated was no cure at all.
He also said there was no ‘head-tohead
comparison’ that showed that
the technique reduced recurrences,
and removing an entire compartment
to cure cancer was like ‘destroying the
whole forest’ to make a road through it.
“These surgeries are not without a bad
morbidity,” Toprani said. “We need to
be honest with the patient and relatives
about the morbidity rates and what
quality of life they can expect.”
Toprani’s stand was opposed by
practitioners such as Dr. Moni Kuriakose
of Cochin Cancer Research Center — one
of India’s top cancer surgeons — who
pointed out that if a person’s life can
be saved, it should be saved, without
worrying about quality of life.
“We must not give up on a patient,” he
said, adding that he too was advocating
the procedure only for stage 3 and stage
4 cases. “We can only talk about quality of
life for a live person. A dead person does
not have quality of life.”
“We can only talk about quality
of life for a live person. A dead
person does not have quality
of life”
Dr. Moni Kuriakose
Cochin Cancer Research Center., Kochi
Dr. Anil D Cruz, director at Tata Memorial
Hospital acknowledged that the
industry was divided about the use of
the procedure.
He said nobody disputes the need for
surgery “in 99% of the cases”.
“There is a big fight about the extent
of resection. Youngsters want to push
the boundary more and more. People
who are more mellow, want to be
more circumspect,” he said, adding that
sometimes, removing a tumour doesn’t
always result in a better outcome for
the patient.
For doctors like Krishnakumar Thankappan
of Amrita Institute of Medical Sciences at
Kochi, the discussions provided valuable
insights into the technique.
“It’s a new concept that’s coming in how
to clear the disease,” he said.
“The attendees brought an insight into the
usefulness of the procedure and how that
will improve the outcomes.”
India’s HNC
burden
C
arcinoma of the head and
neck constitute nearly
one-third of all cancers in India.
Whereas, it is only 4–5% in the
developed world. Even though the
cancer burden is significantly high,
there is no specific guidelines to
manage head and neck carcinoma
(HNC) in India. Currently, the
management of HNC is dictated by
guidelines from the west since there
are only a few seminal publications
from India.
The western world could
successfully bring down the
incidence of HNC by decreasing
use of tobacco over the last few
decades. The government of India
has initiated some attempts to cut
tobacco use. It is yet to make the
desired impact, considering the
magnitude of the problem.
In India, majority of cancers present
as locally advanced Stage III/
IV disease. Most efforts usually
focus on therapy and outcomes in
India. Emphasis is still needed for
early detection.
A randomized controlled trial
conducted in the southern
Indian state of Kerala showed a
reduction in mortality from oral
cancers in high-risk individuals
subjected to screening by trained
health workers. Measures such as
opportunistic screening among
high-risk individuals or mouth
self-examination are considered
cost-effective alternatives.
Courtesy: South Asian Journal
of Cancer
AUGUST 2018/ FUTURE MEDICINE / 33