Cancer treatment as a whole evolves from surgical oncology to radiation oncology to medical oncology. Now is the era of biological oncology. The future oncologist may not be a surgeon or a specialist who manipulates the cells in the laboratory and then does the extension of the treatment. This is how systems work. I am very happy to see that Ayurveda has plans to establish medical oncology. Allopathy, Ayurveda and Homeo systems of medicine are not competitors, however, those who can do what is best for a patient, should be able to execute whatever specialty it is.

Here are some areas that we have completely failed to manage, such as hepatocellular carcinomas, pancreatic tumors, etc. I believe that these are the areas where all the incoming medicine branches should be pushed. In the central part of Kerala, hepatocellular carcinoma, pancreatic tumor, etc. They are very common. Allopathic medicine cannot offer them much relief so they are sent to hospice clinics. These are the areas where other drug systems should be able to come up and try to do something. But all experiments must be on a scientific basis.

I start with some examples (case reports). A girl with acute lymphoblastic leukemia was treated in 1991-92, after treatment; she got married and is now well established in Dubai. Unlike many other chronic diseases, cancer patients can return to their normal lives after treatment. Another case, a woman with acute myeloid leukemia after treatment returned to normal life. There is another story of a mother, who had acute lymphoblastic leukemia, when she was pregnant. The patient was not willing to abort and take the medications. The pregnancy continued and only chemotherapy was done. The child was born on the RCC oncology ward and was named ‘Medimon’ (because the child was born on the medical oncology ward). The mother and child are now well. This is the example of the advancement of oncology where we can select the drugs that are less toxic.

You need to know what cancer is or what actually happens in the body.

Basically, in cancer the cells are reasonably immortal. If the cells of the body become immortal, the cancer state occurs in two ways

1. Uncontrolled multiplication of cells or
2. The cells once reached maturity, but were not killed.

The natural mechanism of programmed cell death is called apoptosis. If apoptosis does not occur, cells continue to multiply without interruption. There will be an uncontrolled multiplication of cells, which is the basic problem in a malignant neoplasm.

The essential

Consider the skin as a model. If an injury occurs, there will be a recovery phenomenon. After the repair of the injury, there will be negative feedback and there will be no further repair work that needs to be done in a well-balanced state. In malignancy, cells migrate and go in search of uncontrollable proliferation.

The increased number of cells is called hyperplasia, not malignant. But when there is a little change in nature (the cells don’t look alike or the arrangement is different), they are called dysplastic cells. Again, they are not malignant but can progress to malignancy; but the hyperplasia will never progress to malignancy.

Next we can consider carcinoma in situ. The cells show characteristics of malignancy, still remain within the basement membrane. When the cells are outside the basement membrane and break off, then it’s invasive cancer, invasive carcinoma.
Dysplasia can also revert to a normal state. Once they progress to carcinoma in situ, they can never be reversed. They’re going for invasive carcinoma.

The problem is not only on the local site. The cells remain in the state for a while, then multiply, and then begin to migrate.

Migration forms:

1. Invasion of blood or lymphatic vessels – migration
2. Spread by other routes such as CSF, implantation and transcoelomic spread.

Terminology:

Cancer is not a single disease. With many etiologies and characters there is cancer. That’s the problem with identifying the cancer action plan. Cancers can occur anywhere in the body, including hair follicles. No area, sex, age is excluded. Depending on the type of tumor, the terminology varies. (Lymphoma in the lymph nodes, sarcoma in the connective tissues, etc.) Epithelial tumors are called carcinoma; Connective tissue tumors are called sarcomas.

Cancer detection and diagnosis:

No patient should be viewed or treated as cancer based on histopathologic diagnosis alone.
The basic diagnostic criteria must be present, including fine-needle aspiration, biopsy, surgical specimen on which we are doing histopathological study, etc. But the pathologists must give black and white and say that it is a malignancy before starting treatment. This must be done in all cases except brain tumor, where the tumor is in a very vulnerable site. In those cases, it is justified to treat without biopsy, but we should have evidence in radiology to say that there is a tumor that is malignant. There are many non-malignant tumors that can mimic malignancy and must be excluded before treating as malignancy.

Characteristics of malignancy.

Normal cells, if they exhibit any variation in size and shape, can be described in two ways.

1. Benign tumors are described as having a “turned-girl appearance” and white or blue and white cells.
2. 2nd type – malignant cells (‘College Girl Appearance’ No Uniformity) Totally messy arrangement.

Pathology – Description

1. Morphology: the pattern of the cells, what they look like, etc.
2. Peoulioe- markings characteristic of certain cells. For example: – leukemia, where the cytoplasm in the nucleus can be stained using some special stains. Therefore, they can be easily diagnosed.
3. Immunized chemistry. The cells expel antigens, which can be identified with the use of immune chemistry. Once the cells are identified, we can label them.
4. Cytogenetics: there are certain cytogenetic abnormalities, which are specific to some tumors. This way we can identify the type of tumors.

Combining these tests helps the doctor reach a correct diagnosis.
The pathology, after diagnosing the type of tumors, should predict the possibilities of progress of the tumors. The doctor must understand the chances of survival.
The chances of survival depend on

1. General condition of the patient
2. Site of tumors.
3. Grade of the tumors (grade 1 tumors: the cells have characteristics almost like normal cells

Grade 2 tumors: between G1 and G2xG3.

Grade 3 and 4 tumors: very poorly differentiated.

They do not have the characteristic of primary cells).

Generally speaking, poorly differentiated tumors or rapidly growing tumors have a high probability of metastasis and will respond well to chemotherapy and radiotherapy. But the relapse will also be there. While well-differentiated and slow-growing tumors have little chance of metastasis. Their response to chemotherapy and radiotherapy is not very effective.

tumors

You should do investigations to understand whether metastasis has occurred or not. If metastasis has occurred, the prognosis is poor. Before doing all the investigations, you need to take the natural history of the diseases, and then decide on the staging. Natural history is the basic study of oncology. Tumors have affinity with certain areas. In each tumor, there is a specific federation of metastases to a specific area. Doctors should know that.

Stage I, Stage II, Stage III, Stage IV ® Stages
Stage I – well localized
Stage II: regional lymph nodes are involved
Stage III – Many more lymph nodes are involved
Stage IV – Distorted Metastasis

The TNM classification is the fundamental classification. The idea of ​​cancer screening is to identify cancer at the earliest stage.

Blood tests to diagnose malignancy:-
Tumor markers are certain biochemicals available in the blood that are secreted by tumors that, when identified, aid in diagnosis. There is some specificity, for example, if there is prostate cancer, the PSA (prostate specific antigen) will be high in the blood. That does not mean that all patients with PSA will have prostate cancer. But there is a tumor marker, by which we can be sure of the diagnosis in the serum. Beta SEG is detected clinically in gestational trophoblastic tumors. You can go to treatment without doing the histological test.
What causes cancer:-

Unknown Applications

1. Inheritance
2. Radiation to some extent
3. Chemicals
4. Infections

Concept: – cancers do not develop overnight; it is a process that progresses slowly, which can be reversed at different stages of progression, through intervention. But it can progress if you don’t intervene. Each part has to contribute to the formation of cancer.
Molecular aspects:-

Normal Cell Gene regulates cell growth.

When genes mutate (in a cancer cell), there is excessive activity of genes (oncogenes). These genes affect cell growth. Growth is accelerated. The excessive acceleration of oncogenes is one of the causes.

Certain genes can prevent cancers (Anti oncogenes). The balance between oncogenes and anti-oncogenes maintains proper cell growth. Failure of anti oncogenes to function leads to excessive growth of cells.

What happens at the cellular level:-

You have receptors on the cells. The growth factor goes and binds to the receptors. Signal, called transudation signals message to molecules. By activating the genes, the count of results from the genes keeps the cycle going. As a result, the cell multiplies and uncontrolled proliferation occurs.

Duplication Process:-

The time it takes for a cell to duplicate is the doubling time. The doubling time will be short for rapidly growing tumors. If the doubling time remains normal, the curve (combustion growth curve) will be linear. But this does not happen. The initial part, the multiplication will be a slow process; but in the end the multiplication will be a fast process. Up to a certain point, that is, 109 no cells are available in the body; it is subclinical and cannot detect developed cancers with any available research. At the time, 109 to 1010 no cell multiplication, the patient will no longer exist.

Importance of early detection in malignancy.

Cancer Prevention:-

1. Cells that are displaced early may have a chance to return to normal and we can try to prevent the multiplication process.
2. National Cancer Conversion Program (NCKP) In which the focus is on tobacco, which is a well-established and well-identified cancer-causing agent. Even a passive tobacco smoker has a 15% higher incidence of developing lung cancer. Smoking in public places must be totally prohibited.
3. Diet Breast Cancers Diet (diet-related) Women who are high in fat and fat are the most likely candidates for developing breast cancer.

Control measure – Avoid high fat diets, burn fat by exercising. Vegetables (preferably green leafy vegetables) have antioxidant properties that can reverse the malignant property of cells. Many vegetables must be taken as part of the diet.