Dr. R V Raghunandan, Senior Consultant - Radiation Oncology, HCG MNR Cancer Hospital, Ongole

Colorectal cancer, also known as bowel cancer, is one of the most common types of cancer worldwide, affecting millions of people each year. In India, it is estimated that over 50,000 new cases of colorectal cancer are diagnosed annually. While these statistics may seem alarming, the good news is that colorectal cancer is one of the most preventable types of cancer. By incorporating healthy habits into our daily lives, we can significantly reduce our risk of developing this disease.

Maintaining a Healthy Diet

A well-balanced diet plays a crucial role in preventing colorectal cancer. Foods that are high in fiber, such as whole grains, fruits, and vegetables, can help to keep the digestive system healthy and reduce the risk of cancer. It is recommended to consume at least 25-30 grams of fiber per day. A high-fiber diet can help to promote regular bowel movements, prevent constipation, and support the growth of beneficial gut bacteria. In addition to fiber, other essential nutrients that can help to prevent colorectal cancer include omega-3 fatty acids, antioxidants, and vitamin D. It is also essential to limit the intake of red and processed meat, which have been linked to an increased risk of colorectal cancer. The American Cancer Society recommends limiting red meat consumption to no more than 18 ounces per week.

Staying Physically Active

Regular physical activity is another important aspect of preventing colorectal cancer. Exercise can help to improve digestion, boost the immune system, and reduce inflammation in the body. Aim to engage in at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week. Moderate-intensity exercise includes activities such as brisk walking, swimming, cycling, and dancing. Vigorous-intensity exercise includes activities such as running, jumping rope, boxing or kickboxing, and high-intensity interval training (HIIT). In addition to regular exercise, incorporating physical activity into daily routines can also be beneficial. This can include taking the stairs instead of the elevator, walking to work or school, or doing household chores.

Managing Stress and Getting Enough Sleep

Chronic stress and lack of sleep can weaken the immune system and increase the risk of colorectal cancer. Practicing stress-reducing techniques, such as meditation or yoga, and aiming for 7-8 hours of sleep per night can help to mitigate this risk. Effective stress-reducing techniques also include deep breathing exercises, progressive muscle relaxation, and mindfulness meditation. In addition to stress reduction, getting enough sleep is also essential for overall health and wellbeing. Tips for improving sleep quality include establishing a consistent sleep schedule, creating a relaxing bedtime routine, avoiding caffeine and electronics before bedtime, and creating a dark, quiet sleep environment.

Getting Screened Regularly

Regular screening is essential for detecting colorectal cancer in its early stages, when it is most treatable. The American Cancer Society recommends that adults aged 45 and older undergo regular colorectal cancer screening. Common screening tests for colorectal cancer include fecal occult blood test (FOBT), fecal immunochemical test (FIT), colonoscopy, and computed tomography (CT) colonography. By incorporating healthy habits, such as a balanced diet, regular physical activity, stress management, and regular screening, into our daily lives, we can significantly reduce our risk of developing colorectal cancer.

While colorectal cancer is a serious disease, it is also highly preventable. By taking proactive steps towards a healthier lifestyle, we can reduce our risk of developing this disease. Let us prioritize our health and well-being, and take the necessary steps 

This article highlights the factors behind rising lung cancer incidence in non-smoking women. It is the need of the hour for women to prevent lung cancer by avoiding secondhand smoke, and pollutants, getting screened regularly, and eating a nutritious diet. Read on to learn more about this article. 

Lung cancer is causing higher morbidity and mortality rates not only in India but across the world. This deadly cancer is commonly associated with smoking in men. However, a large number of women who are nonsmokers are now getting diagnosed with lung cancer which is taking a toll on their overall well-being. So, not only in those having a history of tobacco but even lung cancer rates are increasing in nonsmokers. According to reports, even though smoking rates are going down, lung cancer cases are rising at an alarming rate in women too.

Factors causing lung cancer in non-smoking women:  One of the major factors leading to lung cancer is secondhand smoking which involves toxic chemicals such as arsenic ammonia, benzene, and formaldehyde. Estrogen levels among menopausal women with lung cancer are usually higher than those in women without lung cancer. Hence, this also can be the cause of lung cancer. Genetic mutations and hepatitis B and C, human papillomavirus or HPV, and Epstein-Barr virus are also known to cause lung cancer in women.

The warning signs of lung cancer are constant coughing, chest pain, asthma, fatigue, breathlessness, poor appetite, chest pain, and recurrent respiratory infections that women shouldn’t notice and seek accurate diagnosis and treatment without any delay.

The treatment: Of lung cancer is based on the stage and location of the tumor. It will be essential for women to follow the guidelines given by the expert for successful outcomes. The treatment involves a tailor-made approach consisting of surgery, radiation therapy, and chemotherapy. Apart from this, one may also be advised targeted and immunotherapy for cancer management. Just like smokers, nonsmoking women will also have to be proactive when it comes to their lung health.  If you don’t smoke, that doesn’t mean you will not suffer from lung cancer.  Taking preventive measures goes beyond just avoiding smoking. Regular check-ups with experts can lead to earlier detection of potential issues. Women should eat a balanced diet rich in antioxidants, and ensure good indoor air quality through proper ventilation and air purification systems. Women need to stay vigilant regarding their health.

By:- Dr  Shahid Patel, Consultant Pulmonologist, Medicover Hospitals, Kharghar, Navi Mumbai

One of the most critical health issues in our country requires urgent attention to be applied and solved -  addiction to substances. Known for afflicting millions of people, substance abuse has emerged as a grave public health issue. Though tobacco and alcohol often grab headlines, we are globally increasingly facing the problem of drug abuse, which urgently needs attention.

Today, drug addiction in India has crossed alarming levels. As per the National Survey on Magnitude of Substance Use in India (2019), approximately 2.6 crore people (2.1% of the population) use heroin. Additionally, over 8.5 lakh people are estimated to be injecting drug users, with serious health risks including the transmission of HIV and Hepatitis C. These figures depict a worrisome trend, wherein drug use in the erstwhile rural hubs is significantly on the rise but now even more so in the districts. The most vulnerable victims are the youth, exposed to synthetic drugs and opioids that are equally potent and deadly. The social, economic, and health-related effects of drug addiction are severe, calling for intervention in both preventive as well as treatment measures. 

Dr. Swapnil Agrawal, Psychiatrist, Mind Clinic, Napier Town Jabalpur says, “Drug addiction is recognized as a chronic, relapsing disease that alters brain chemistry, making it difficult for individuals to break free from substance dependence. Opioids, in particular, bind to receptors in the brain, creating feelings of euphoria but also leading to tolerance, dependence, and eventually addiction. Heroin, one of the most commonly abused opioids in India, poses a significant risk of overdose and death.”

With addiction being a biological condition, treatment should be based on medical and behavioral interventions rather than morality or punishing the individual. In the recent past, immense advances have been in the treatment of drug addiction through medical therapies. Medications used in the treatment of opioid substitution therapy help people manage withdrawal symptoms and curb cravings without the euphoric effects associated with harmful drugs like heroin. Another critical treatment is through life-saving drugs that reverse opioid overdose, given by first responders and caregivers in time of need. This kind of treatment, accompanied by behavioral support, forms the foundation of advanced, evidence-based treatments of addiction and holds promise for millions fighting against substance dependence in India.

While advanced therapies are essential for those already in battle with addiction, prevention is the bedrock upon which a society free of drug dependency will be erected. The Indian government has made great strides under initiatives such as the National Action Plan on Drug Demand Reduction that serves not only to prevent drug abuse but also offers treatment to those in dire need of it. However, the scale of prevention has to be increased with more public awareness, education, and community outreach investment.

Public awareness campaigns, stricter implementation of existing regulations, and inclusion of addiction education programs are headed to reduce the burden of addiction. Such investments in prevention have been proven to greatly cut through the high healthcare costs and infrastructures that treat addiction and those accompanying health conditions, including cancer, heart disease, and liver cirrhosis. Education should also be directed toward schools, workplaces, and communities to prevent drugs, talk about the hazards of substance abuse, and present healthier alternatives. Furthermore, the stigma surrounding addiction should be lowered and help brought forward when the person who is suffering can be treated effectively, without fear, at an early stage.

Let us recapture the commitment to a drug-free India. By providing support to preventive efforts as well as to evidence-based treatments, we shall take giant leaps forward to eliminate the menace of drug addiction from our society.
 

As we celebrate the remarkable milestone of Southeast Asia’s 11 member states achieving a decade of being polio-free, it is with great pride and optimism that I extend my heartfelt congratulations to Bangladesh, Bhutan, Democratic People’s Republic of Korea, Indonesia, Maldives, Nepal, Sri Lanka, Thailand, Timor-Leste, Myanmar, and India. This achievement stands as a testimony to the power of collaboration, determination, and commitment to public health. The success stories of these nations serve as an inspiration, demonstrating that with the right strategies, the goal of polio eradication is attainable.

While five of six WHO Regions have successfully eliminated wild polio, Afghanistan and Pakistan are the two countries where wild polio periodically surges threatening the health of children and communities. With 12 cases of wild poliovirus (WPV) reported in the two remaining endemic countries in 2023 (six cases in Pakistan and six cases in Afghanistan), and 34 cases to date in 2024 (16 in Pakistan and 18 in Afghanistan), we have a renewed opportunity to stop wild poliovirus transmission epidemiologically.

Critical gaps in the proportion of children vaccinated against polio remain in both countries. In Afghanistan, this is largely the result of years of insecurity and a complex humanitarian crisis. In Pakistan, the main drivers are insecurity, community boycotts of vaccination activities, inconsistent access to populations on the move, and pockets of vaccine refusals. Cross-border transmission is also an ongoing challenge, and neither country will be protected from polio so long as it continues to circulate in the other. For example, in 2023, 96% of the environmental samples detected in Pakistan were linked to the cluster of poliovirus circulating in Afghanistan.

In Pakistan, the fight against polio has been ongoing for decades, with a dedicated team of frontline workers and community support, Pakistan remains committed to reaching every child with the polio vaccine.

Rotary’s PolioPlus program has been at the forefront of providing vital support to polio eradication efforts in Pakistan. Through initiatives such as the establishment of resource centers, team support centers, and Permanent Transit Points (PTPs), Rotary has helped create essential infrastructure to effectively target missed children and transient populations. This includes strengthening cold chain management and routine immunization by providing ice-lined refrigerators, vaccine carriers, and Permanent Immunization Centers (PICs). Most importantly, Rotary Clubs across the country have played an important role in engaging

Rotary members and clubs have also engaged communities by distributing fliers, Fatwa booklets, children’s books, vaccination information booklets, and advocacy items (tee shirts, hats, stickers, pencils, and more) to schools, advocacy seminars, ulema workshops, community centers in villages and remote regions. The premise of these activities is the understanding that as communities are engaged, interest in and support for polio immunization will increase, and the number of children who miss polio immunizations will be reduced.

In retrospect, one of the key learnings from this fight has been the Southeast Asia region's emphasis on data-driven decision-making. Regular monitoring and evaluation helped us identify gaps and challenges, allowing for adjustments to be made to vaccination campaigns and other interventions.

As we continue our efforts, it is important to acknowledge the invaluable support of organizations and individuals like Dr. Hamid Jafari, who led the WHO team that helped eradicate polio in India. Now leading polio eradication in the Eastern Mediterranean Region of WHO, Dr. Jafari appreciates the strong progress toward the eradication of polio in Pakistan. Similar to India, Dr. Hamid Jafari continues to count on the critical support that Rotary members in Pakistan provide, backed by the steadfast commitment of Rotary International to help end polio, not just in Pakistan but across the world.

To end polio in the face of today’s unique challenges, the GPEI is fine-tuning its tactics to reach every child, in every community, with polio vaccines and other life-saving interventions. The GPEI’s Polio Oversight Board (POB) has recently approved an extension to the timeline for eradication from 2026 to 2029. While the program has continually adapted its approaches to address new challenges and implement new tools, the extended timeline will allow it to build on this track record, adjust appropriately, and ensure that no child is paralyzed by polio again. To achieve this, the program will build on time-tested strategies in the endemics, to reach persistently missed children, through strong cross-border coordination, the delivery of broader health interventions alongside polio vaccines, and the investment in women as vaccinators, planners, and supervisors.

This is a powerful reminder that, with will and commitment, we can make the seemingly impossible task a reality. Pakistan hopes to soon join the world in celebrating its polio-free status. The last mile is always the hardest to cover, but if the whole world can eliminate a disease using vaccines, Pakistan can do the same. We must all play our part in increasing awareness and educating ourselves and others. I convey my best wishes to all the members for their continued efforts to ensure the region remains polio-free until polio is eradicated globally. Together, let us continue to strive for a world where every child can live free from the threat of polio.

An 80-year-old man who was recovering from a recent stroke and a complex medical history presented to us with a recent history of shortness of breath and wheezing for two days. He had undergone a tracheostomy during his stroke treatment due to prolonged ventilation, and it was initially suspected that he had a post-tracheostomy stenosis. He underwent evaluation by pulmonology and a scan revealed a mass in the mid-posterior tracheal wall, roughly 3 cm in length and obstructing the lumen by >80% with focal invasion of the cricoid ring, which forms the cartilaginous base of the voice box on which the vocal cords sit. Endoscopy showed that the tumor was obstructing the airway with each expired breath. It was suspected to be cancerous. After evaluation by the head and neck surgery and anesthesia teams, multiple plans were discussed to completely remove the tumor and re-establish the airway.

Complete resection of the upper trachea and the cricoid ring (the cartilaginous base of the voice box framework) would likely be too high-risk a surgery for the patient to withstand, and the previous tracheostomy scar would increase the likelihood of failure. A pure bronchoscopy approach where the tumor could be completely removed using an endoscope also would not be feasible since there was a risk of bleeding and airway obstruction, and the location of the tumor made complete removal unlikely. After extensive discussion, a hybrid approach was planned. Under local anesthesia, the previous tracheal scar was freed, an anterior tracheal opening was created, and the patient was administered general anesthesia. After that bronchoscopy debulking was performed to remove most of the tumor from the lumen. A carbon dioxide fiber laser was then used to completely excise the tumor from within the trachea up to the cricoid ring. The opening in the trachea was then carefully closed. The patient was safely extubated and was completely relieved of his airway obstruction, discharged home on day 5. This was a novel approach, not having been described before for the treatment of these tumors, which allowed adequate access and complete removal, with minimal side-effects of surgery and quick recovery.

Treatment of complex airway problems pose a major challenge to even experienced teams. Limited working space and complex anatomy make approaches difficult and working in the airway while allowing the patient to breathe pose numerous challenges. Hybrid approaches allows the best of both worlds – bronchoscopy approaches allow minimal access and quick recovery, while surgery allow definitive access and completeness of treatment. Newer technologies like laser and cryotherapy allow precise treatment with very little collateral damage to the surrounding normal tissue. Dr Vivek Gundappa, Consultant Pomologist notes, “Tracheal masses are rare; they present with severe respiratory distress whether cancerous or not, and a multi-disciplinary approach is essential to mitigate them”.

Coordinated approaches between airway surgeons, interventional pulmonologists, and anesthetists allow low complication rates and quick return to function. In addition to cancer, other problems include post-tracheostomy scarring and fibrosis, post-acid-ingestion injuries, and benign tumors. Dr Narayana Subramaniam, Senior Consultant and Director of Head and Neck Surgery and Oncology and Director of Clinical Innovation commented, “This gentleman had a complex tumor and a previous surgery in the same site which made treatment difficult. Additionally, he had a complex medical history that required a tailor-made approach that reduced the risk of extensive surgery while being effective. We were happy to offer him a good result with excellent coordination and planning between surgeons, pulmonologists, and anesthetists. The Sparsh Yelahanka Complex Airway Clinic offers multi-disciplinary care to patients with airway problems. With significant expertise in interventional pulmonology, surgery, anesthesiology, radiology, and pathology, as well as the best technology, we can offer the best quality care for people with these difficult groups of disorders.

By: Dr Narayana Subramaniam, Senior Consultant and Director Head and Neck Surgery and Oncology and Director of Clinical Innovation, Sparsh Hospital

In today's fast-paced world, maintaining a healthy lifestyle is crucial for overall well-being. We focus on healthy eating, regular exercise, and mental well-being, but often overlook a critical aspect of cancer prevention: understanding our genetic heritage. Knowing your family history can help identify genetic cancer risks, empowering you to take proactive steps toward prevention.

The Importance of Family History

Family history plays a significant role in assessing cancer risk. If multiple relatives have been diagnosed with cancer, especially at a young age, it may indicate a genetic predisposition. Certain genetic mutations can increase the risk of developing specific types of cancer.

Types of Genetic Cancer Risks

BRCA1 and BRCA2 Mutations

Mutations in the BRCA1 and BRCA2 genes significantly increase the risk of breast and ovarian cancers. These genes normally produce proteins that help repair damaged DNA, but when mutated, can lead to uncontrolled cell growth and cancer. Women with BRCA1 or BRCA2 mutations have a 45-72% lifetime risk of developing breast cancer and a 20-40% risk of ovarian cancer.

Lynch Syndrome

Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), increases the risk of various cancers, including colorectal, endometrial, ovarian, stomach, small intestine, and other cancers. This condition is caused by mutations in DNA mismatch repair genes, such as MLH1, MSH2, MSH6, and PMS2.

Familial Adenomatous Polyposis (FAP)

Familial adenomatous polyposis (FAP) is a genetic condition that increases the risk of colorectal cancer. Caused by mutations in the APC gene, FAP leads to the development of hundreds to thousands of polyps in the colon and rectum, which can become cancerous if left untreated.

Li-Fraumeni Syndrome

Li-Fraumeni syndrome is a rare genetic disorder that increases the risk of multiple cancers, including breast, brain, osteosarcoma (bone cancer), soft tissue sarcoma, and adrenocortical cancer. This condition is caused by mutations in the TP53 tumor suppressor gene.

Other Genetic Cancer Risks

Other genetic mutations associated with increased cancer risk include:

●      Cowden syndrome: Increases risk of breast, thyroid, and endometrial cancers.

●      Peutz-Jeghers syndrome: Increases risk of colorectal, breast, and ovarian cancers.

●      Multiple endocrine neoplasia (MEN): Increases risk of thyroid, parathyroid, and adrenal gland cancers.

●      Hereditary breast and ovarian cancer (HBOC): Increases risk of breast and ovarian cancers.

Knowing your family history is crucial in understanding genetic cancer risks. By acknowledging and addressing these risks, you can take proactive steps toward cancer prevention. Embrace the power of knowledge and break the family cycle of cancer.

By:- Dr. R Shrikanth, Consultant-Medical oncology, HCG NMR Cancer Centre, Hubli