Not just one disease, but group of diseases . There are more than 100 different types of cancer.

It depends from where the cancer has originated, if it is from blood- leukemia .Some are sarcoma if originated from mesenchymal cells and others are carcinomas.

A tumour is a growth of tissue made up from abnormal cells. These are of two types: Benign and Malignant.

Benign tumour does not invade into nearby tissues and they grow slowly.

The tumors which can spread into or invade nearby structures, are called malignant or cancerous tumors.

Cancer can start almost anywhere in the human body.

There occurs changes in DNA also called mutation. This leads uncontrolled growth of cells which is named as cancer.

Symptoms of cancer depends upon the site from which it has originated.

• Non healing ulcer
• Hard lump in breast or anywhere else
• Difficulty during swallowing
• Unusal bleeding etc

Any problem which persists more than three weeks should be consulted with qualified doctor.

Chemical carcinogens-

• Any form of Tobacco
• Excess of alcohol
• Workplace chemicals- asbestos, benzene, farmeldehyde Age

Lifestyle factors-

• Lack of regular exercise,
• Obesity
• drinking too much alcohol
• eating a lot of red meat

Radiation

Infection- Hepatitis B, Hepatitis C infection

Immune system suppression

Don’t ignore the symptoms and get regulay check up done.

In most cases, biopsy is the only way to be sure whether cancer is present. Fine needle aspiration cytology(FNAC)/ biopsy do not spread cancer.

Surgery, chemotherapy and radiation are the main three types of cancer treatment.

Chemotherapy are the drugs , used for treatment of cancer. It can be either in the form of oral or intravenous forms.

Radiotherapy uses radiation, such as x-rays, gamma rays, electron beams or protons, to kill cancer cells or damage them so they cannot grow or multiply.

Every year more than 10 lacs new cancer patients are diagnosed in India. Earlier cancer cervix followed by cancer breast were the most common cancers amongst females. Now situation has been reversed.

Breast cancer is the most common cancer in India and in most cities, and 2nd most common in the rural areas. Breast cancer accounts for 27% and cervix cancer for 15% of all female cancers in Delhi.

Radiation therapy has an important role in treating all stages of breast cancer.

• After breast-conserving surgery (BCS), to help lower the chance that the cancer will come back in the breast or nearby lymph nodes
• After a mastectomy, if the disease is locally advanced
• If disease has spread to other parts of the body, such as the bones or brain

In India, now more and more numbers of patients being diagnosed with breast cancer to be in the younger age groups (in their thirties and forties).People are also becoming aware about the disease. At early stage and younger age group breast conservation surgeries with oncoplastic surgeries are becoming quite often. Radiotherapy to breast is part and parcel of this conservation surgery.

With the newer techniques of radiotherapy (intensity modulated radiotherapy IMRT, image guided radiotherapy IGRT), skin changes and fibrosis has become less common hence cosmesis is good. High dose to normal structures such as lung , heart has also been minimized.

With addition of radiotherapy after breast conservation surgery local failure has been reduced from 40% to 12%.(NSABPB-06). After mastectomy radiation decrease 16% chances of recurrence.(Lancet 2014)

3D Radiotherapy in breast

Image guided radiotherapy in breast

Radiation dose after breast conservation surgery by IGRT

The primary treatment of early stage cervical cancer is either surgery or radiotherapy (stage IA, IB1 and selected IIA1). Radiation along with chemotherapy is generally the primary treatment of choice for Stage I B2 to IVA.

Some patients may need postop radiotherapy depending upon risk factors (large size, positive margin, positive node, deep stromal invasion etc).

With older techniques of radiation side effects related to bladder , rectum and intestine were quite common. With newer modalities (IMRT, IGRT, SBRT) these side effects has been decreased because of less radiation exposure of normal tissues.

Stage 1 has 80% chances of cure while sage II has 60% chances. This cure rate is same for both modalities surgery or radiotherapy. Post op radiotherapy decreases 30% chances of recurrence.(AJCC2010)

Endometrial cancer

Radiotherapy is used as postop treatment to decrease the chances of disease to return even in stage I. It depends upon many risk factors such as age, myometrial invasion, grade, nodal involvement etc.

In some cases when disease is inoperable due to co morbidities, radiation can be used.

In stage I depending upon grade, there is 10-14% chances of disease recurrence at vagina and 30% chances at pelvic nodal region.(Lancet 2000)

External Beam Radiotherapy

Conventional radiotherapy to cervix and nodes

Image guided radiotherapy to post op bed and nodes

Brachytherapy

Brachytherapy in an important part of gynecological treatment. In this technique some instruments are palced inside the body throughwhich radiation is given. This is a OPD basis procedure

Conclusion

Currently radiotherapy occupies a major role in the treatment of cancer.The previous two decades have brought great technological innovations in the field of radiation oncology with improved ability of targeting radiation dose to the tumor.

What is cancer…… As brick is the smallest unit of any building, cell is the smallest unit of our body. DNA is the genetic material of cell. There are various environmental conditions that cause damage in genetic material of cell. This damage can either be repaired or remains unchanged. These damaged cells grow endless. This endless growth of damaged cells is called as CANCER.

Cancer is of several types. Infact every part of body can be affected by cancer. Every part of body is different. Each of us does not resemble, we all are different. Hence every cancer is different and has its own profile . We can not say this happened to that very man or woman , the same will be true for every one.