- 2 days ago
In this episode of Kauvery Podcast, our experts shed light on a critical question – Are women still ignoring cancer?
Dr. Haridas P Mani, Consultant – Medical Oncology, and Dr. Sathish Kumar Anandan, Senior Consultant – Surgical Oncology & Robotic Surgeon, Kauvery Hospital Vadapalani, as they discuss the importance of awareness, early detection, and timely treatment to fight cancer effectively.
Dr. Haridas P Mani, Consultant – Medical Oncology, and Dr. Sathish Kumar Anandan, Senior Consultant – Surgical Oncology & Robotic Surgeon, Kauvery Hospital Vadapalani, as they discuss the importance of awareness, early detection, and timely treatment to fight cancer effectively.
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00:00Cancer is a B. It's a term that everybody is getting afraid of.
00:05It's not a horror movie, it's a chemo.
00:08Sir, if you're doing a robot, what are you doing?
00:11If you're doing a robot, you're doing a P.P.A.
00:13So there's a lot of doubts.
00:15How do we choose?
00:16How do we choose?
00:17How do we do a breast cancer?
00:18How do we do a mastectomy?
00:20How do we choose?
00:22In India, most of the cancer patients present very late.
00:26Whenever we talk about these women cancers,
00:28we mostly concentrate on breast and cervical cancer.
00:31Other than these female genital system cancers,
00:34we also have colon cancer, gastric cancer, pancreatic cancer.
00:38So this is not all.
00:39There are other cancers.
00:41There are other cancers.
00:42Okay.
00:43Welcome.
00:44Welcome to Kaavari Podcast.
00:46Myself, Dr. Satish Kumar Anandhan.
00:48I'm a Senior Consultant in the Department of Surgical Oncology and Robotic Services at Kaavari Hospital, Vatapadani.
00:54So we have our dear medical oncologist with us, Dr. Hari.
01:09So we welcome you all for this wonderful conversation about women cancer care.
01:19Okay, Doctor.
01:20Shall we?
01:21Yes, Satish sir.
01:22Dr. Hari, like whenever we talk about this women cancers,
01:26so we mostly concentrate on breast and cervical cancer.
01:32But you know the spectrum is very much wider.
01:35So can you please highlight on those?
01:37Sure.
01:38Satish sir, first of all thank you for coming to this Kaavari Podcast.
01:43I'm Dr. Hari Das, medical oncologist working here in Kaavari Hospital, Vatapalani.
01:50And coming to Satish sir's question.
01:52So again, it's not only breast and ovarian cancer, but there is a huge spectrum.
01:57So if you're looking at the global cancer statistics, which is just been released in 2022,
02:02which is going to get released in 2026, we have breast cancer, ovarian cancer, cervical cancer,
02:09vaginal cancer, vulval cancer.
02:12And other than these female genital system cancers, we also have colon cancer, gastric cancer,
02:18pancreatic cancer.
02:19So it's not.
02:20It's not.
02:21I have a cancer.
02:22And there has to be a general awareness that in the cancer's realm.
02:29And so coming to my question to you.
02:32So you also know that cancer is a term that everybody is getting afraid of.
02:40So what is the reason in the lack of awareness?
02:44What is the reason for the general lack of awareness?
02:49And why do they come late for treatment, sir?
02:52What is the reason for the general lack of awareness is that women cancer is a huge spectrum.
03:02So in India, whenever we see, most of the cancer patients present very late.
03:09So according to the data, less than 10% of the breast cancer patients present at early stage.
03:1710% of the breast cancer patients present at early stage.
03:21If you look at cervical cancer, less than 30% of the breast cancer patients present at early stage.
03:2510% of the breast cancer patients present at early stage.
03:29And 70% of the breast cancer patients present at advanced stage or terminal stage.
03:34The main reason for this is lack of cancer discussions and awareness and associated social taboo with this.
03:43It is not as long as we speak about it.
03:47A type of problem is not that we can talk about it.
03:48How can we talk about it?
03:50We can talk about it.
03:52If we don't have to talk about it.
03:54And then, there is no discussion.
03:56When there is a lack of discussion,
03:58At a moment, we can't get cancer.
04:00We can't get cancer.
04:01So we can't get cancer.
04:02I can't get cancer.
04:03And so that is the reason for the late presentation.
04:06So that is the main reason for the late presentation.
04:10If they present early their overall survival as well as the treatment duration is very less that you exactly know so that will be my answer for this.
04:20Sir one more doubt sir so again when you are talking about lack of awareness how do we overcome it sir?
04:29What are the steps we can go for it?
04:32So that's a beautiful question mainly it happens at the root level
04:37Number one making more and more cancer awareness programs like outreach camps in a very rural areas
04:44So another way camps can take care of awareness to the public that is the first thing
04:50Second thing among the healthcare professionals if you ask me cancer specialists are called as oncologists
04:58Either they can be a surgical oncologist, medical oncologist, radiation oncologist or nuclear physicians
05:02But they can't be available everywhere in India
05:05So it is the need of the heart to train each and every department people
05:09Especially the general physicians who are the first point of contact for other people
05:13So if they are doing cancer awareness
05:17Whenever they see any patients who is suspected of any kind of cancer
05:23They should be properly referred to the tertiary care center or cancer care center
05:30So if they are creating awareness
05:32Early referral and early cancer care provide
05:35So these are the two main root level interventions which I feel is the need of the heart
05:40So if I ask you Dr. Hari
05:46We discussed about the basics of this women cancer
05:49But there is a doubt about that
05:52Sir, what is the first step we do and how do we plan our treatment?
05:57We have to consider them as family members
06:08So we have to be empathetic
06:11We have to care and it is not like a hit and run
06:16Be with the patient, be with the attenders
06:21We have to consider them as a cancer
06:23We have to consider them as a holistic view
06:27Treatment, diagnosis, evaluation, nutrition, sleep, education
06:35The treatment process is a long duration treatment process
06:38It is a very chronic disease
06:39So how do we treat treatment duration?
06:41So first and foremost
06:42Biopsy, we will get to know what type of cancer is
06:47What type of cancer is
06:49Now what type of cancer is
06:51What stage is spread?
06:52Stage 1, 2, 3, 4 stages
06:54So in the cancer stage
06:56First we will go for the evaluation status
07:00Where is the issue?
07:02Where is the issue?
07:04Where is the comorbid?
07:05Sugar, pressure, fits
07:08What is the issue of the treatment?
07:10That is financial logistics
07:12We have to consider them as a patient
07:15Surgery
07:16Chemo
07:17Radiation
07:18You have to check this
07:19In case there is CSR Schemes
07:22We have this corporate social response schemes
07:25So we have the option of giving them the treatment from our side
07:32And we have done it to a certain level of success
07:35And with all these 3 modalities in play
07:40they have a good outcome. And it is this outcome that is shown in the patient's care.
07:47So in the patient's care, we are going to move on.
07:50Wonderful listening Dr. Hari, like one take home here is go and meet your oncologist first.
07:58So the doctor will be in a better position to tell you what exactly next thing is going to happen.
08:05So now Dr. Hari, a scan, a biopsy, these are the two main steps in any kind of cancer management.
08:14If you have any stage, any treatment options, you will be clear to me.
08:20So do remember this.
08:22In the past, we were very afraid.
08:25We were afraid of cancer.
08:30Now, where is it now, sir?
08:32Where is it now in the 21st century?
08:36What is your thought process?
08:38I don't know where it is now.
08:40That's right.
08:41If you want to be advanced,
08:43if you want to do surgery for cancer,
08:45if you want to take care of cancer,
08:47that's the question.
08:49In our clinical practice, I can see two sub-sets of patients.
08:52One of the first patients is that they do surgery in advanced stage four.
09:00Do you do something?
09:01If you want to do the first subset,
09:03if you want to take care of cancer at the early age,
09:05then you will have to take care of cancer.
09:07So those two sub-sets would always be done.
09:09So, the common question in that subset is,
09:13In the case of the surgery, if we are working on the surgery,
09:17there are only 10 or 15 years of surgery.
09:21In the case of the cancer surgery, patients say,
09:24what do they do?
09:26They are working on facial features,
09:28they are working on facial features,
09:30they are working on facial features,
09:32they are working on facial features.
09:34But now, with the latest advancement of robotic surgery
09:37and other advancement in surgical oncology,
09:39the cancer surgery became more and more precise
09:42and more and more with good quality.
09:44Now, we are discussing about this breast cancer.
09:47In the case of the breast cancer,
09:49what we have done previously,
09:51for females and women,
09:53they have three things.
09:55They call it mastectomy.
09:57So, that is a huge social trauma for other women.
10:00So, now we are trying to preserve the breast
10:03and we do something called as breast conservation surgery.
10:07If they have three things,
10:09they will be able to achieve the cancer.
10:11So, this is a modality.
10:13Not only providing cancer surgery or cancer cure for the patient,
10:17we provide quality of life for the patient as well.
10:21Same thing for other cancers like ovary cancer, uterus cancer.
10:25We do something called as robotic surgery.
10:28Which is very very precise and with minimal tissue damage,
10:31with less scars.
10:34But, it provides a beautiful outcome for the patient.
10:37After robotic surgery,
10:38if you have a patient,
10:39if you have a patient,
10:40the surgeon will be able to achieve it.
10:41They will be able to achieve it.
10:42They will be able to achieve it.
10:44Right now, we are concentrating more on the quality of care,
10:48along with complete cancer cure.
10:50So, I think that sums up the surgical fear and stress.
10:56So, I have a doubt, Dr. Hari sir.
10:59Like, if there is a group of patients who are afraid of surgery,
11:03they will be afraid of chemo.
11:06Correct, sir.
11:07So, what are you going to say about that?
11:09Are there any other better options with chemotherapy,
11:13or some other newer modality?
11:15Can you tell us about that?
11:16Correct, sir.
11:17So, again,
11:18if you are talking about chemo,
11:19there is no fear.
11:20If you are talking about a horror movie,
11:22if you are talking about chemo,
11:23there is no side effects.
11:26But,
11:27believe me,
11:28there is no side effects.
11:30There is no side effects.
11:31There is no side effects.
11:32There is no side effects.
11:33That means,
11:34in our body,
11:35there is no side effects.
11:36Right.
11:37And,
11:38so,
11:39when you are talking about chemotherapy,
11:41it is basically,
11:42we are killing the cancer cells.
11:44Cancer cells are not OD,
11:46and the cancer cells are not OD,
11:47and the cancer cells are not OD,
11:48and the cancer cells are not OD.
11:49So,
11:50there is no side effects.
11:51So,
11:52when you are talking about other treatment modalities,
11:54now,
11:55targeted therapy,
11:56it will kill.
11:57Targeted therapy,
11:58for operation sindhuur,
11:59drone strike.
12:00Particularly,
12:01the cancer,
12:02it will kill.
12:04That means,
12:05the side effects are not OD.
12:07Okay.
12:08Next,
12:09we have what we call immunotherapy.
12:11So,
12:12our body immunity,
12:13there is no other state in cancer patients.
12:15So,
12:16when we are giving immunotherapy,
12:17we are activating our immune system.
12:19So,
12:20when we activate our immune system,
12:22and the immune cells,
12:23will cover that particular cancer cells,
12:26and cause an effect.
12:27which is also HIV,
12:28to prevent prevent treatment and disease.
12:29If we are adding blood cancers,
12:32lymphoma,
12:33which is refractory to treatment,
12:34which is all card cell medical treatment.
12:38That is a car cell therapy,
12:39and it is costly,
12:41but very effective,
12:42highly effective.
12:44We have to add many vaccines,
12:48in fact,
12:49to be honest,
12:50paper or clippings,
12:51After all, to be honest, it is just paper reports, paper clippings, phase 3 trial, we can stimulate or emulate it into the normal people.
13:05For cancer vaccines, it is just paper clippings.
13:10So, there is also a fad or concept. First of all, Chemo, Targeted, Immunotherapy and Cartesian Therapy.
13:21Wonderful, Dr. Harry.
13:23There is an important topic regarding these vaccines.
13:29As you can see in the news, there is a Russian vaccine.
13:32They are released in Russia.
13:37So, as the doctor said, these vaccines are in the very primitive stage right now.
13:43And the vaccines are in the colon cancer.
13:46Only the animal studies are completed.
13:48And the phase 1, the human phase is starting.
13:51So, there is a huge time lag and the timeline is there.
13:55Now, if you have cancer patients, it is time-tested therapy.
14:00So, whatever doctor told all, time-tested treatments.
14:03So, it is better to follow your ontology advice rather than going for some unknown angels.
14:09Correct.
14:10And Sati sir, you are well-versed in robotic surgery, right?
14:14So, my doubt is, how is it different if there is a recovery rate?
14:19How fast are they recovering from a robotic surgery?
14:28It is the future.
14:31The future is here, the future is now.
14:33Sati sir is here with us.
14:35How do we go on about these differences, sir?
14:38When we talk about robotic surgery, before going to the recovery part,
14:42everyone has a myth.
14:44Sir, we are going to do a robotic surgery.
14:46What are you doing with the doctor?
14:47So, if we do a robotic surgery, we will pay you.
14:50So, there is a doubt about this.
14:52So, robotic surgery is a surgery done by your surgeon.
14:56You are going to do a cancer surgeon with the help of robotic instruments.
15:01Now, if you look at my legs, it is a normal human hand.
15:05But, for robotic hands, it is very very small.
15:07It is very small.
15:09It is a small size.
15:10If you look at the small legs,
15:12you are going to do a robotic surgery.
15:15So, what is the advantage?
15:17What is the advantage of the cancer patients?
15:20What is the advantage of the cancer patients?
15:21Faster recovery.
15:22In the sense of recovery,
15:24their blood loss,
15:25their surgery is a little bit less.
15:27When the operation is done,
15:29when the patient is done,
15:31when you have to do an operation,
15:33it is usually three to four days.
15:35So, for robotic surgery,
15:36they will be able to order the first day or second day.
15:39Second, early recovery to work.
15:41If you do a normal open surgery,
15:43if you do a normal surgery,
15:44you will have to take care of the body.
15:45At least 4-5 years or twice.
15:46If you have to take care of the body,
15:47you will have to take care of the body.
15:49But, if you look at robotic surgery,
15:50the patient can comfortably walk on the
15:52first day after surgery.
15:53The surgery is a good problem.
15:55It is a good problem.
15:56It is a good problem.
15:57It will be a social and emotional boost to the patient.
16:01Why don't they say that they will be very weak.
16:05If they are a wife and kids, they will be dependent and they will feel.
16:11So, without that, after surgery, they can't get immediately,
16:15they can't eat, they can't eat, they can't get a scar.
16:20So, these are the three advantages of robotic surgery.
16:23So, because of this, the patient can go to their work in a much faster rate,
16:29rather than having bed rest for a couple of weeks.
16:31So, if they are open surgery, they will be able to take care of them,
16:35they will be able to take care of them, they will be able to take care of them,
16:37they will be able to take care of them, they will be able to take care of them.
16:41So, that's a very big advantage for our cancer patients in a robotic field.
16:45So, again, Sathiswar Sunamadri, post-op bed rest.
16:49At the bed rest, if you are not doing much of physiotherapy rehabilitation,
16:53there is a chance for deep pain, thrombosis and other issues.
16:57But, we are negating those with the help of robotic surgery.
17:01Again, under complications, we are able to get the patient recovering in a faster state.
17:07Correct.
17:08Now, we have the highest robotic surgery in the surgical aspect.
17:12In the medical field, in the medical oncology aspect, there is something called liquid biopsy.
17:17So, the liquid biopsy is the only thing that we have to say about cancer care.
17:22So, this is a newer form of biopsy sir, liquid biopsy.
17:26So, this is a newer form of biopsy sir, liquid biopsy.
17:30So, now, we have a single test.
17:33We will test all the tests.
17:35We will know if there is cancer.
17:38Now, there is a volume of the disease.
17:42There is no volume of the disease.
17:44There is no disease.
17:45There is no disease.
17:46Now, we have blood, for example, lung cancer patients, prostate cancer patients, breast cancer patients, colon cancer patients.
17:54So, this is time tested and proven.
17:57Liquid biopsy is very effective.
17:58Now, for example, we have lung cancer.
18:01In the lung cancer, our liquid biopsy, our blood test tube will be sent to sampling.
18:07Sampling.
18:087-14 days, we will report.
18:11What is the cancer?
18:13What is the armature?
18:15What is the genetic mutation?
18:17What is the genetic mutation?
18:18Now, lung cancer is genetically driven.
18:23Genetically driven.
18:24There is a driver mutation.
18:27To almost 50-60% of the population.
18:30In the population, there is a genetic-driven mutation.
18:34In the population, there is a targeted therapy.
18:38So, let's check that.
18:40Driver mutations.
18:41For lung cancer.
18:42Colon cancer.
18:43Colon cancer.
18:44Circulating tumor DNA.
18:47A new concept.
18:49Circulating tumor DNA, we can know.
18:52If there is a patient in the chemo,
18:54the next circulating tumor DNA is the same.
18:57For example, before treatment,
19:00there is a number of 35 levels.
19:06If there is a type of cancer,
19:07there is a type of cancer,
19:08there is a type of cancer.
19:09There is a type of cancer.
19:10There is a type of cancer.
19:11So, if you check the cancer,
19:12there is a type of cancer.
19:13The tumor DNA in the blood is completely gone.
19:17Completely disappeared.
19:18At that level,
19:20circulating tumor DNA has helped us in finding measurable residual disease.
19:25Suppose patient is on observation.
19:30Observation,
19:32if we check the circulating tumor DNA,
19:34it will rise.
19:36It will rise.
19:37We are able to find out that there is an onset of cancer.
19:44In the genetic test,
19:45how are we able to differentiate your surgical portfolio based on the genetic tests?
19:57What are the genetic tests?
19:58What are the genetic tests?
19:59What are the genetic tests?
20:00What are you saying about it?
20:01It is a huge problem.
20:03Our cancer is a genetic test.
20:06If it comes to our genes,
20:07it is not that we may be able to do it.
20:09It is genetic testing.
20:11So, now we ask,
20:13we ask a question of a problem.
20:15We ask,
20:16I've got a father,
20:17I'm going to have cancer.
20:18My mother is going to have cancer.
20:20I'm going to have cancer.
20:21When we ask,
20:2280-70% usually is not genetic.
20:27We have cancer.
20:29But 10-15% this cancer occurs because of the hereditary genes.
20:34Our father has a cancer gene.
20:37So, why are we doing this?
20:39That is genetic testing.
20:40What do we do in this test?
20:42If we look at the cancer, we will test the cancer.
20:47If we look at the cancer, we will test it.
20:50What is the advantage of this?
20:52What do we do in this test?
20:54There are two advantages.
20:56One is the patient.
20:58If we look at the genes,
21:00if there is breast cancer,
21:04if we look at the BRCA gene,
21:06if we look at the other genes,
21:08they will have cancer in the same way.
21:10For example, ovarian cancer, endometrial cancer,
21:12they will have cancer in the same way.
21:14So, if we look at the genes,
21:16if we look at the cancer,
21:18if we look at the cancer,
21:20if we look at the cancer,
21:21we call it as prophylactic surgery,
21:23or risk reduction surgery.
21:25If we look at this,
21:26in the future,
21:27the cancer in the future,
21:28will be very low.
21:29There will be 0%.
21:30This is the benefit of the patient.
21:32This is the benefit of the patient.
21:33This is the benefit of the family members.
21:35This is the benefit of the genes of the cancer.
21:37It has high penetrance.
21:39So, there are the benefits of the cancer.
21:41If we look at the cancer patient,
21:43we will take care of the cancer patients,
21:45and we will do counseling with the family members.
21:47This is the benefit of the genes.
21:49If you have the genes,
21:50it will be the benefit of the family.
21:52So,
21:53you will have better to get the blood of your cancer.
21:56So,
21:57you can be kept under some kind of surveillance,
22:00or some kind of treatment.
22:02So that you can prevent cancer from the cancer.
22:04So,
22:05in this case,
22:06even with the patient,
22:07even with the family,
22:08genetic testing,
22:09it is helpful.
22:11Now,
22:12you can't do any of the patients.
22:13That is not.
22:14What the patient is doing,
22:16what the cancer is doing,
22:17what the cancer is doing.
22:19That is,
22:20the oncologist is a better person to tell,
22:22based on the risk profile.
22:23So,
22:24before jumping into this genetic testing,
22:26consult your oncologist,
22:27whether it is needed for your patient,
22:29for your family or not.
22:30So,
22:31that is a take out for you.
22:32Again,
22:33an added statement.
22:34Now,
22:35there are five types of breast cancer.
22:38Now,
22:39one breast cancer patient,
22:40one breast cancer patient,
22:41one breast cancer patient,
22:42they will have some conflict of interest.
22:44What is it?
22:45One breast cancer patient,
22:46sometimes,
22:47can't do chemo.
22:48So,
22:49they will be at crossroads.
22:51So,
22:52again,
22:53they will be at crossroads.
22:54Why do they have chemo?
22:55Why do they have chemo?
22:56Why do they have chemo?
22:57They have some confusing items.
22:58So,
22:59the reason is,
23:00breast cancer,
23:01there are genetic factors.
23:02So,
23:03there are genetic mutations,
23:05HER2,
23:06hormone positive breast cancers,
23:08HER2 positive breast cancers,
23:09triple negative breast cancers,
23:11there are variants of breast cancers.
23:13One variant is one type of treatment.
23:16Sometimes,
23:17hormone positive breast cancers,
23:20with a very low and aggressive rate,
23:24straight away surgery.
23:25But,
23:26hormone positive,
23:27HER2 positive breast cancers,
23:29triple negative breast cancers,
23:31we give chemotherapy first,
23:33followed by surgery.
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