Cancer Care Hospitals in Bangalore

Your Care

How is the program for your treatment decided?

  • In cancer usually, a combination of surgery, chemotherapy and radiotherapy is required to get the optimum results, most of the time. Occasionally it could be of one type, for example, lymphoma, blood cancer etc.
  • The decision about a particular type of treatment for you is the result of information accumulated over the decades of established treatment benefits of millions of patients treated earlier, all over the world. Oncologist's experience and recent technological discoveries complete the requirement of knowledge, skill and technology.
  • General principles: Although specific treatment varies from person to person and type of cancer, in general, art and science of cancer management are as follows.

Treatment of Cancer mass, as seen in the scans (CT/PETCT/MRI):

  • For the tumour arising from a particular site and that has not gone elsewhere, surgical removal is by far the first choice.
  • If surgery is not possible technically or not opted (e.g. elderly), then radiosurgery (biologically cutting off with focused radiation) or radiation therapy would be the next choice.
  • Sometimes, to facilitate surgical removal of the tumour, the size of cancer growth is decreased by chemotherapy alone, with/or radiation therapy, before surgery.
  • In some situations, instead of surgery, radiation along with chemotherapy is recommended.

Treatment of invisible cancer cells around cancer growth:

  • There are invisible cancerous cells present around visible cancer mass and lymph glands further away. Radiation can eliminate these cells.
  • In the modern-day approach, surgery removes visible disease with a rim of the surrounding region and radiation is given to the surrounding invisible cancer cells to save the organ or limb (organ preservation surgery). These organ saving procedures make the person appear and function normally or almost like before surgery. Also, this approach provides enormous psychological support and improves the quality of life.

Treatment of Cancer mass, when detected in other organs also (stage IV):

  • Chemotherapy/immunotherapy usually is the first and most important treatment in this situation.
  • If they are growths in less number of locations, then may add surgery or radiosurgery.
  • Also, even when the disease is in several locations initially, if the response to chemotherapy is good with only a few spots remaining, then also surgery or radiosurgery may be necessary.

Treatment of undetected disease elsewhere in the body (not detected on imaging):

  • Even with the best of the scans and tests available today, one cannot visualize some hidden cancer cells in lung, bone, liver, etc..
  • Its probability of being present is predicted based on the worldwide data accumulated from other patients treated so far. The likelihood of having such cancer cells anywhere in the body could be a) high, b) medium, c) low or d) rare. Literature shows the benefit of chemotherapy/immunotherapy when the probability of such an invisible disease in other parts of the body is high to low. A rare likelihood may not require chemotherapy/ immunotherapy, except in particular situations.
  • The very high probability may require relatively aggressive chemotherapy/immunotherapy.
  • Surgery or Radiation therapy or radiosurgery to selected sites in various organs may also be necessary when a limited number of spots appear, at a later date, if at all.
  • Other treatments such as hormone therapy, removal of mass with radiofrequency, radio- iodine therapy, isotope therapy, etc., are for specific situations.

The treatment process in brief:

  • If the treatment suggested for you is only surgery, the whole treatment gets concluded in a short period. This situation is usually occasional. On certain times, initially, only surgery would have been planned but may require additional therapies after the microscopic examination of the removed lump showing unexpected findings.
  • Radiation sessions along without or with chemotherapy (called concurrent chemo- radiation 4-6 doses) can require as much as 5-8 weeks. Here, chemotherapy, if given, is at a lower dose level. The strategy is to improve the effect of radiation.
  • Radiosurgery (as mentioned earlier, it's a way of giving highly focused radiation with sophisticated radiotherapy machine), when recommended, usually lasts 3-5 sittings and the entire treatment process may take 1-2 weeks.
  • Chemotherapy of 4-8 cycles can take as much as 3 - 6 months.
  • Usually, the total duration of surgery, radiotherapy and chemotherapy/immunotherapy, when combined, is 6-7 months.
  • Choice: If you want a safe treatment, received with the intention of no side effects at all, the control of cancer may not be up to the optimal level. All effective therapies will have some side effects. In the present day, probability & intensity of side effects has come down dramatically with sophisticated approaches and advanced technology.

Essentials of Follow-up and Self Improvement

Follow-up is the program of regular pre-arranged appointment with your primary oncologist at specified intervals, after the completion of prescribed treatment, even if you are feeling perfect. During every visit make it a point to reinforce your ideas of improving your feelings & general health (refer to blog on survivorship program for details).

First few follow-ups are to monitor the effects of treatment. It's essential to realize that even when the scans show no cancer, it's safer to presume that there is a hidden threat and take the following precautionary steps. This pragmatism relieves the nagging feeling whether cancer has disappeared or is going to come back. This mind-set also helps in coping with the psychological & physical after- effects of cancer and treatment. Again, this type of outlook in life, in turn, improves the probability of getting rid cancer.

Further, "Cancer free" report (if not, additional treatment is required) is the first requirement for the cure. Also, this is the most and maybe the only key opportunity for consolidating the position of advantage. The subsequent improvement in the possibility of remedy comes from improving the lifestyle and body immunity.

The follow-up also helps in early detection and treatment of side effects (if at all when it happens).

Generally, the first follow up is at six weeks after the day of completion of the last dose of chemotherapy or radiation. Subsequently, it is every three months during the first year, every six months during the next 2- 3 years and every year afterwards. It is required to adhere to this schedule, routinely.

To repeat, again and again, it's safer to assume that risk of getting back maybe there despite the positive findings of the examinations. This assumption may support the mind to get rid of the inner fear– the ever-persisting voice deep in mind will it come back? In other words, now may be the right time to take steps to initiate the reversal process that created the "cancer". This advice comes from the "soil and seed theory" of cancer; where cancer - the "the seed" grows, when the human body or organ - "the soil" becomes weak.

Invoke resilience of mind and beyond: Short-term stress increases immune- protection involved in wound healing, vaccination, and response to anti- infectious and anti-cancer agents etc. On the other hand, chronic stress suppresses these beneficial immune reactions. It is possible to convert chronic stress to advantage by cognitive behavioural therapy (CBT) techniques (refer below). Not only one should gain the original confidence, but also strive to be better than before getting cancer.

Key point to remember: Can one ever be sure that cancer will never come back?

There is never a guarantee that even if the disease disappears entirely after the treatment that cancer will never be back. Your oncologist will give information about the probability of cure or control. This data is not of much help for the individual. Always the human tendency is to worry about the percentage of failure figures and not of feeling confident over the success rate.

You likely to hear the words: "no evidence of any cancer", "it is gone" or "removed all cancer" etc. Even so, there's a chance that some microscopic cancer cells may be surviving. Worrying about this would be unnecessary if all the cells are gone. Also, over time, the remaining few cells can get wiped out by the immune cells continually scanning our body, finally resulting in cure (assisted by the survivorship program that you follow).

Survivorship program will be of use one more way. Sometimes another cancer unrelated to the first one, which can start after 10 to 15 years. Having cured of one cancer is not a protection against a second or even a third altogether different cancer. Therefore, consider initial cancer as angels signal, and the dedicated survivorship program will help in the prevention of second cancer that can come after decades. Survivorship program, since self-driven, is an inexpensive investment, sometimes leading to a better life than before cancer.

Your Choices & Options:

It is usual to worry about cancer coming back. However, for some people, these feelings become a "fear" that gets in the way of daily life and getting free of cancer. Only "YOU" can help yourself in overcoming this.

How to deal with these persistent undesirable thoughts?

  • Self-help is the best by Positive Modification of Thought (PMT) with Cognitive Behavioural Therapy (CBT): Maybe turn out to be the most suitable method for you. It is all about self-practice, improving every passing day. Here, in practical yet straightforward terms, consciously set up an auto-biofeedback- cycle of giving steady input to the mind with "thoughts or images what one likes most". This feedback thought replaces the "undesirable/fearful disturbing thoughts". Never ask yourself "What might happen?" – There are always thousands of disagreeable possibilities. Regularly replace and send the message to the mind, thousands of time with "what should happen (what you desire)". To think positive things always may not be possible or necessary. However, Positive Modification Thought (PMT), with strong pleasant mind images, replacing anxious thoughts, is the very much feasible and the best bet. PMT is the fundamental principle of Cognitive Behavioural Therapy (CBT). PMT strengthens the constant internal emotional support, moving away from the non-dependable external emotional support. One can also replace the fearful thoughts with spiritual images, as well.
  • Avoid distraction by concentrating on what's most important for "today."
  • Invoke a clear purpose for the future.
  • Others take measures such as joining a friend support group or
  • Seek the assistance of mental wellness professional (highly recommended).
  • Reports have shown that regular brisk physical activity helps the brain to secrete feel-good factor, lessen anxiety and or depression (equal to mild to moderate anti-depressive drugs). Brisk walking for 25 to 45 minutes boosts self-esteem & coolness, along with the decrease in symptoms of tiredness, nausea/uneasiness, tolerance to pain etc. These benefits happen through moderate brisk physical activity on most days of the workweek. This physical activity forms the foundation for the survivorship program since it is the basis of motivation for other healthy lifestyle practices.
  • Some or all of the above

You have a vital role in deciding on the choice of treatment. Most of the time oncologist will able to give you different options and recommend the one that is most applicable to you. Next step is to accept the same, or if you decide from other alternatives (which are acceptable as per the guidelines), then you need to choose the same without any worries (cannot revisit that particular decision at a later date). Later, if the situation changes, one can review the options afresh.

The final word is, whatever decisions you take, even with delivery of best and most expensive of the treatments, your doctor cannot give you any guarantee of cure or control or prognosis. The doctor cannot assure what he cannot know, and the doctor (or anybody) does not see the future. Each patient is different in responding to the prescribed treatment, despite the similar disease. We should avoid thinking about what don't know, and what we cannot change. Acceptance of this unconditionally in mind does improve adherence to treatment, control/cure rate and your quality of life immensely.