The practice of pathology and its role in cancer care has changed significantly in the past decade. In the olden days, it was limited to a microscope and a few special stains. Immunohistochemistry (IHC) arrived after that to advance diagnosis and treatment capabilities.

The current treatment landscape is ever so changing – the era of chemotherapy changed to an era of precision medicine / personalized medicine. “One size fits all” (the approach of chemotherapy) is no longer valid. Each tumor is unique in its own genetic/molecular subtypes. Identifying driver mutation which drives the growth of cancer predominantly and thus also becomes a target for treatment is the present focus of cancer research. The best example is lung cancer.

Cancer is the second leading cause of death in the world after cardiovascular diseases. The word cancer came from the Greek words “Karkinos” to describe carcinoma tumors by Hippocrates (460-370 B.C). The world’s oldest case of breast cancer hails from ancient Egypt in 1500 BC.

The International Agency for Research on Cancer (IARC) estimates that one-in-five men and one-in-six women worldwide will develop cancer over the course of their lifetime, and those one-in-eight men and one-in-eleven women will die from their disease. Worldwide, the total number of people who are alive within 5 years of a cancer diagnosis, called the 5-year prevalence, is estimated to be 43.8 million. The increasing cancer burden is due to several factors, including population growth and ageing as well as the changing prevalence of certain causes of cancer linked to social and economic development.

Cancers of the lung, female breast, and colorectum are the top three cancer types in terms of incidence. Lung cancer is the most commonly diagnosed cancer in men (14.5% of the total cases in men and 8.4% in women) and the leading cause of cancer death in men (22.0%, i.e. about one in 5 of all cancer deaths). Breast cancer is the most commonly diagnosed cancer in women (24.2%, i.e. about one in 4 of all new cancer cases diagnosed in women worldwide are breast cancer).

Global patterns show that for men and women combined, nearly half of the new cases and more than half of the cancer deaths worldwide in 2018 are estimated to occur in Asia, in part because the region has nearly 60% of the global population.

As per the Indian Council of Medical Research (ICMR), the incidence of cancer cases in India was 14 lakhs in 2016. Cancer of breast, cervix, oral cavity and lung constitutes 41% of the cases. Oral cavity cancer is the most common in men and third in women. “The age standardized rate is approximately 25.8 per one lakh women and is expected to rise to 35 per one lakh women in 2026,” the report stated.

You can prevent CRC by being physically active, eating plenty of fruits and vegetables, and limiting the intake of alcohol.

In colorectal cancer (CRC), there is a malignant growth in the large intestine. In the advanced stages, cancer spreads from the intestine to the liver. Rarely does it spread to the lungs or bones, but when it does, it is known as metastatic CRC.

Globally, CRC is the 3rd most common cancer and the 4th most common cause of death. It is more common in developed countries, but its incidence has also been rising in developing countries. In India, it is the seventh most common form of cancer.

The symptoms are blood in stools, altered bowel habits, anaemia, or unexplained weight loss. The risk factors are advancing age, a family history of colon cancer, a diet high in fat and red meat but low in fibre, smoking, alcohol consumption, obesity, and sedentary lifestyle.

Detection in the early stages maximizes the chances of cure. The screening tests for CRC are fecal occult blood test (FOBT) and colonoscopy.

In the early stages (1 & 2), surgery is the form of treatment, and it is curative in more than 90% of cases. For stage 3 colon cancers, chemotherapy is given for 3-6 months after surgery. For rectal cancers, radiotherapy is also used.

For stage 4 (metastatic) CRC, the primary mode of treatment is chemotherapy. Additionally, targeted therapy significantly helps in improving the life spans of patients. The use of certain ‘biomarkers’ has enabled oncologists to select the appropriate form of targeted therapy. This is referred to as ‘personalization of treatment’.

With the advances in treatment and the advent of immunotherapy, the life span of a stage 4 CRC patient has gone up by 3 years.

You can prevent CRC by being physically active, eating plenty of fruits and vegetables, limiting the intake of fast food and alcohol, and exercising regularly.

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