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The month of November is observed as the Men's health awareness month. As the pandemic continues wreaking havoc in the country, healthcare disruptions caused have played a significant role in delaying potentially life-saving conversations for those suffering from cancer, and men have been no exception. In India, an increasing number of deaths amongst males is registered due to cancer every year. According to a report published by the Indian Council of Medical Research, males account for a higher proportion of all cancer cases (3,19,098 - 52.4 %) than females (2,90,986 - 47.3%). As per data presented by the National Cancer Registry Programme (NCRP) from 2012 to 2019, more than one-third of these patients were diagnosed with cancers of the tongue, larynx, thyroid, corpus uteri, kidney, and bladder, and about another third were diagnosed with lung, prostate, bladder, and thyroid cancer.
In keeping with this, the cause "Movember" is actively used worldwide to spread awareness on men's health issues, men's mental health, and growing cancer concerns in men. A timely diagnosis in most such cancers cases coupled with timely, efficient, and advanced treatment approaches can be proven life-saving for cancer patients and improve these statistics in India. This Movember, we encourage men across the country to focus on their mental and physical health while raising much-needed awareness for cancers that affect this population, empowering them to live happier, healthier, and longer lives.Here are a few doctors who share insights on the prevalent cancer types amongst Indian men.
Dr. Surendar Kumar Dabas, Senior Director & HOD, Surgical Oncology, BLK-Max Super Speciality Hospital, Delhi, calls out the most preventable cancer in men Tobacco-related cancers. "Tobacco use remains one of the leading causes of cancer and death in men. The common misconception is that it only causes lung cancer. Tobacco use, including cigarettes, cigars, pipes, and chewing tobacco, is a significant risk factor for oral cancers."
Oral cancer, also known as mouth cancer, is a disease that largely presents itself among the male population and can occur in any part of the mouth, including the lips, roof or floor of the mouth, tongue, inner cheek lining, and gums. The more a person uses tobacco and the longer they use it, the greater the risk of developing cancer. A person who smokes a pack of cigarettes or more per day has at least twice the risk of being diagnosed with these cancers as a nonsmoker, and the risk does not go away when tobacco use is discontinued. This disease also has a significant impact on quality of life. It is critical to see a doctor in case one experiences symptoms such as a lip or mouth sore, a growing mass anywhere in your mouth, difficulty swallowing, bleeding gums, loose teeth, persistent earache, numbness in the face, neck, or mouth, lump in the neck, or sudden and unexplained weight loss, to name a few.
It is usually diagnosed when cancer has spread to the lymph nodes of the throat, and it is imperative that it be diagnosed at an early stage in order to avert more complex problems. A regular dental checkup can aid in the early detection of oral cancer.
"Tumors at the base of the tongue, throat, and tonsils can be difficult to access and are generally removed by operations that require a significant neck incision and bottom jaw cutting. Long hospital stays, prolonged rehabilitation, and difficulties swallowing and speaking are all common side effects of these procedures. Surgical removal of the tumor, cancerous lymph nodes, or cancer cells in the throat and neck is one of the choices for removing the tumor, cancerous lymph nodes, or cancer cells.
Robotic technology and minimally invasive approaches have made it possible to reach these tumors through the mouth, thanks to advances in surgical equipment. Another option is radiation therapy, which includes focusing a beam of X-rays on the cancer cells and administering them to patients once or twice a day for approximately 2 to 8 weeks. Chemotherapy is another approach for treating malignant cells with medications that can be administered orally or via an intravenous line. They are effective in destroying cancer cells. However, in advanced cancer stages, patients receive all three modalities of treatment and do well in the postoperative period. After the treatment for esophageal cancer, such patients require certain lifestyle modifications," mentioned Dr. Dabbas.
Dr. Gautam Ram Choudhary, Associate professor, Department of Urology, AIIMS, Jodhpur, talks about Prostate cancer - second-highest Cancer in Indian men after tobacco-related cancers. Prostate enlargement is a fairly common ailment that occurs as people become older. It is a benign condition that has no adverse effects on one's health. However, the prostate gland can sometimes expand too quickly, causing it to pressurize and invade the surrounding tissues. The term "prostate cancer" refers to this condition.
Many prostate cancers grow slowly and are therefore difficult to detect till the patient shows symptoms such as painful or frequent urination, erectile dysfunction, persistent pain in the lower back, and reduced semen, to name a few. Some forms of prostate cancer are slow-growing and require little or no therapy; however, others are aggressive and spread quickly, making it a deadly disease. Prostate cancer, when detected early, has the best chance for successful treatment. The diagnosis includes rectal examination followed by a Prostate-specific antigen (PSA) test.
In a recent case treated by Dr. Choudhary, a 58-year-old teacher with a history of two bladder stone removal surgeries in the past, presented with urinary problems due to two additional bladder stones to the hospital. Further tests like the PSA test followed by tissue biopsy showed prostate cancer. The patient opted for robot-assisted prostate cancer surgery and bladder stone surgery. Post-procedure, the patient recovery was very fast. On Day 12, the per-urethral catheter was removed, and there was no urine leakage which was a fantastic outcome that affected the patient's quality of life greatly. In robotic surgery, blood loss during prostate cancer surgery is also very less, and precision is high, so the chance of saving urine control mechanism is high. Post the RAS procedure, the patient was able to go back to his regular diet, walk around as before, and was allowed to be discharged from the hospital.
Dr. Jagdish Kothari, GI & HPB Cancer Surgeon, Director HCG Cancer Centre, Ahmedabad, wanted to bring the attention of men to the cancer of the food pipe (Esophageal Cancer), as it is one of the most ignored aggressive Cancer in India. It's found to be more common in men in comparison to women. The largest incidence of esophageal cancer is seen in southern and eastern India primarily due to dietary habits apart from the larger incidence of tobacco and alcohol usage. In India, around 47,000-50,000 new cases of esophageal cancer are identified yearly.
Commenting on the symptoms, diagnosis, and treatment of such cancers, Dr. Kothari said, "In advanced stages, symptoms such as difficulty in swallowing solid food may present itself which is usually taken lightly by many a patient and would need to be addressed on priority. This also causes drastic weight loss of approx. 2 4 kgs/ per month and is a typical symptom of Esophageal Cancer. In keeping with this, the diagnosis is usually done using endoscopy followed by tissue biopsy in case a patient is suspected of the disease. Today, these tests are widely available across the country and are a simple outpatient procedure. After a thorough investigation followed by a PET CT scan, the stage of the cancer is determined.
The treatment procedures, depending on the stage of cancer and the area affected, would largely be surgery to remove the tumor, or a portion of the food pipe and/ or upper part of the stomach in case cancer has spread aggressively. Additionally, In most cases, the patient is likely suggested chemotherapy and radiation therapy prior to surgery. Surgery is the only curative treatment for such cancers.
Minimally invasive esophagectomy or keyhole surgery is the current standard of care. Robotic-assisted esophagectomy using the da Vinci surgical system is the most advanced form of minimally-invasive approach available today, given the complexity of the surgery, which has resulted in a significant reduction of morbidity. Furthermore, as seen by many a surgeon, the mortality rate in most advanced cases is less than 2%, having done the esophagectomy procedure. Post the removal of the affected portion of the esophagus, a new food pipe is reconstructed from the patient's own stomach. In my experience, this process has resulted in significant improvement in clinical outcomes and reduction in recurrence of cancer in more than 70% of the case, including cases of stage three esophageal cancer."
Dr. Santoshi Nagaonkar, Consultant Urologist Surgeon, P.D.Hinduja Hospital & Medical Research Centre, shares kidney cancer is estimated to affect roughly 2/100,000 males in India. Kidney cancer is a condition when select cells in the kidney start to grow uncontrollably. This largely affects males in comparison to females. The problem with this is that it rarely causes any symptoms in the early stages and can easily be ignored, resulting in late-stage identification and associated detrimental effects on the quality of life. Blood in the urine, low back pain on one side (not caused by injury), a mass (lump) on the side or lower back, chronic exhaustion, loss of appetite, and weight loss not caused by dieting are some of the signs and symptoms of kidney cancer. Preventive methods include regular health checkups followed by urine and blood analysis.
In case the doctor makes a diagnosis of kidney cancer, other tests may be required to confirm if cancer has spread within the kidney, to the other kidney, or other parts of the body. Depending on the cancer's stage and location, the surgeon may recommend a partial nephrectomy (in which solely the cancerous portion of the kidney is removed), allowing the patient to keep the healthy portion of the affected kidney. Today with the advances of surgical techniques such as Robotic-Assisted Surgery, RAS, (commercially available as da Vinci surgical system), advanced surgical procedures can be carried out with much better precision resulting in added advantage for the patient.
Dr. Ajit Pai, Chennai, Senior Consultant & Lead GI Surgical Oncology, Apollo Proton Cancer Centre, mentions that colorectal cancer has rapidly increasing incidence in Indian males and affects the large intestine, colon, or rectal region, depending on where the cancer cells are present.
"The only way to diagnose the disease early is through regular screening and monitoring aspects such as changes in bowel habits, blood in the stool, pain in passing motion; it can also present very innocuously as anemia in blood examination. The disease largely presents itself in men above the age of 50 and can be diagnosed by examination of the stool for blood and possible colonoscopy to determine the source of bleeding. The treatment in such cases includes multimodality approaches such as surgery and chemotherapy for colon cancer and surgery, radiotherapy, and chemotherapy for rectal cancer. In the case of surgery, depending on the complexity of the case, stage of cancer, and comorbidities, minimally invasive surgical procedures using robotic technology can often be recommended to patients."
Dr. Abhay Kumar, Uro-Oncologist, Narayan Superspeciality Hospital, Howrah, Kolkata, wanted to call out the effect of bladder cancer that affects twice as many males in India compared to women. "This is cancer that begins in the inner lining of the urinary bladder and presents itself with the presence of blood in the urine. Thus, giving people a chance to recognize the disease and providing the patient with a high probability of identifying cancer early on and successfully treating it. Diagnosis of such cancers involves urine tests, followed by cystoscopy and bladder biopsy using an endoscopic method.
The treatment options include an endoscopic surgery called TURBT, radiation therapy, Radical surgery followed by chemotherapy. However, all this depends on the stage and location of the cancer. Other modern methods of therapy can also be considered based on the need," mentioned Dr.Kumar.
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