Understanding Precision Medicine for Cancer.

We often hear of Precision Medicine for Cancer, but what is Precision Medicine, how is it different from standard treatment protocols and what can be the benefits for choosing Precision Medication over standard protocols?

The diagnosis and treatment of cancer at a cellular or molecular level is known as Precision Medicine.

Cancer
Precision medicine : Tailored medication for cancer based on specific patients, genetic profile .

Cancer is a heterogenous disease, with different genetic profile not only between patients with different cancers but also differences in genetic , molecular and cellular profile even within the same type of cancer.

All cancers are genetic by nature and with cellular profile changing over time even in the same patient, till now no single drug is known to cure even a single type of cancer let alone different types of cancer’s.

Standard chemotherapy protocols focus of administering standard chemotherapy drugs ( one size fits all) without taking into account cellular or genetic profile of the patient.

Precision medicine on the other hand focuses on accurate and effective treatment to each patient based on the genetic profile, the proteins feeding the tumours or the cancers.

There are sufficient number of detractors even amongst the best doctors but precision medicine or administering drugs based not a specific tailored patient profile not being the best option is a pre mature conclusion.

This week being Breast Cancer week, let’s shed some light on Precision medicine for breast cancer.

Breast cancer treatment in India beyond surgical options of lumpectomy, mastectomy involves administering chemotherapy and radiotherapy, with chemotherapy being the first line of treatment.

Difference in outcomes depends upon whether the patient has been tested for HER2(human epidermal growth factor receptor 2), ER, PR or not.

For patients testing positive for HER 2, addition of trastuzumab to chemotherapy slows down disease progression. Lapatinib plus chemotherapy (i.e., capecitabine) achieved a longer median time to disease progression compared with chemotherapy alone.

A combination of pertuzumab, trastuzumab, and chemotherapy further improved the median overall survival time to a median of almost 5 years compared with a combination of only trastuzumab and chemotherapy for a median of 3 and half years.

Similarly treatment with ado-trastuzumab emtansine, a conjugate of a HER2 monoclonal antibody and a cytotoxic drug, significantly improved the length of progression-free survival and overall survival with lower adverse effects when compared with lapatinib and chemotherapy

The above examples clearly show how genetic profiling, identification of key mutations like the Bcr-Ablfusion or HER2 can benefit a large number of breast cancer patients.

Genetic profiling also enables identification of molecular targets for intervention.Cell death is caused by a combination of deficiencies in the expression of two or more genes, whereas deficiency in only one of these genes can increase viability or enhance multiplication of mutant cells. For example, BRCA (mutant gene responsible for particularly aggressive breast cancers( and poly ADP ribose polymerase (PARP) genes were found to have a synthetic lethal relationship.

For example, by using olaparib, a PARP inhibitor, to treat BRCA-mutant ovarian cancer patients, the progression-free survival of BRCA-mutant ovarian cancer patients was significantly prolonged by olaparib compared with standard chemotherapy protocols.

This methodology focusses on identifying cancer vulnerabilities and subsequent tailored treatment based on patient profile.

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Good Friday and A Happy Easter!

Good Friday and A Happy Easter!Easter Eggs Benefits:

Easter eggs are lovely but do we know that eggs are incredibly nutritious and a great addition to diet too.

Great for fertility, healthy heart, weight loss along with many other health benefits, here are a few reasons to crack one daily

An egg a day can fulfill the following daily vitamin and mineral requirements

Vitamin A: 6% of the RDA.

Folate: 5% of the RDA.

Vitamin B5: 7% of the RDA.

Vitamin B12: 9% of the RDA.

Vitamin B2: 15% of the RDA.

Phosphorus: 9% of the RDA.

Selenium: 22% of the RDA.

Eggs also contain vital vitamins such as  of Vitamin D, Vitamin E, Vitamin K, Vitamin B6, Calcium and Zinc.

Protein Intake

One egg gives about 6.5 g of protein. The protein component is largely found in the egg white.

Daily protein reqt  is approximately 50 gms so 3 egg whites alone can make up for roughly half of daily protein recommended intake.

One egg has as much protein as 30g cooked meat, fish or poultry.

Breast Cancer

Research shows that Choline can reduce the risk of breast cancer by 24 percent. An egg yolk contains 125.5 milligrams of choline, about 1/4th of the recommended daily intake, so just two boiled eggs can work wonders.

Women who eat 6 eggs a week have a 44% reduced risk of developing  breast cancer.

Preggers – Eggs are the best for foetus development

Choline found in the eggs helps in foetal brain development and l memory enhancement.  Choline is of extreme importance during pregnancy and lactation when the reserves may get depleted.  Going in for an IVF(In Vitro Fertilization), don’t forget your daily intake of 2 eggs a day.

Weight Loss

One Egg contains roughly 70-86 calories. Eating eggs for breakfast keeps us full at a low calorie count and leads to less snacking and subsequent weight loss when on a diet.

Many dieticians recommend atleast 6 egg whites in a week during weight loss programs

Prevents Cataract

An egg  a day may reduce your cataract risk by 20%. It may also reduce age-related lens and retinal degeneration, the leading cause of blindness in the elderly (up to a 40% decrease).

Eggs are a good source of the antioxidants lutein and zeaxanthine, which play an important role in keeping the eyes healthy.  Getting enough lutein and zeaxanthine is therefore very important from childhood onwards throughout life.

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Why do we discover cancers at a late stage and often without symptoms for long ?

Most cancers do not cause symptoms until  late due to the phenomenal resilience and immunity that our bodies have.

Which is why, regular checkups which lead to early detection of cancer are a must.

Most stomach cancers do not have any symptoms except  loss of appetite, acid reflux, stomach pain , feeling of  fullness  which many of us  may relate to a bout of indigestion or a stomach infection.
Kidney cancer never have symptoms at an early stage.
Early stage liver cancer symptoms are often pain on the right side of the abdomen, loss of appetite.
Pancreatic Cancers are rarely found operable unless they invade the bile duct.
Thyroid Cancer often the earliest symptom is hoarseness in the voice.
Being non specific , the symptoms are often overlooked in a patient with an early stage cancer leading to discovery at a much later stage, when the cancer is  metastatic.
With newer treatment options and newer drugs , it is possible to treat , extend and improve quality of life even at a later stage.
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World Cancer Day

Best cancer hospital in India,cancer treatment cost in India

Diagnostic tests such PET Scan and in case of unavailability of a PET CT,  MRI or CT scan, Bone scans give a clear picture of spread and subsequent treatment options.

Some of the Best Cancer Hospitals in India offer cancer treatments like chemotherapy, radio therapy, IGRT, IMRT.

Many even offer more specialised treatment such as  PRRT, SBRT, Brachytherapy.
Preventive Diagnostics such as genetic testing for Breast Cancer, ( BRCA 1 , 2) play an important role in subsequent prevention.

Cost of Cancer Treatment varies from a US$ 5000-7000 to US$ 36000 if an allogenic bone marrow transplant is required for Leukemia.

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Check your boobs !

Breast Cancer Treatment in India

Treatment of breast cancer in india

Breast Cancer if detected early is completely curable.
Breast cancer treatment in india is offered at most of the good hospitals, however it is good to check on the medical and surgical oncology doctors and evaluate before commencing treatment.
Breast cancer treatment cost may vary from depending upon stage and whether surgical intervention is required or not.
Chemotherapy is often the first line of treatment along with lumpectomy or mastectomy with or without reconstruction for early stage breast cancer.
For late stage breast cancer, surgery is often carried out with a palliative intent and cost is often the cost of chemotherapy drugs and often radiation depending upon metastasis
Since prevention is better than cure most cancers, it is imperative to get BRCA 1 and 2 tests done for other female members in the family too.
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Breast Cancer Treatment, Procedures, Cost in India

Breast Cancer Treatment, Procedures, Cost in India

Breast Cancer Treatment

When diagnosed with breast cancer, this can be an overwhelming experience. Treatment options depend upon the stage of cancer.

For early stages we have lumpectomy, mastectomy with and without reconstruction along with chemotherapy, hormone therapy and radiation. . There may be a great concern of which surgical options are best to treat the type of cancer diagnosed.

The long term survival rate of someone diagnosed with breast cancer is based on the spread of the disease. Such characteristics will include the size of the tumor, whether there are hormonal receptors found on the tumor itself and the different types of tumor grades.

 

Factors such as age may also play an important part on which treatment a patient should undergo.

For example, patients over seventy years old may not usually undertake the more aggressive treatments.

Chemotherapy is a common treatment used by many patients to prolong their life expectancy and survival rate, which is usually done before or after surgery depending upon stage and spread. Many patients will have to avail a combination of treatment options.

Types of Surgical Procedures:

Lumpectomy is a surgical procedure where a part of the breast is removed. The medical term of lumpectomy is called partial lumpectomy. This procedure may or may not be accompanied by radiation therapy. When radiation therapy is used, this will help to kill the cancer cells surrounding the lump.

Mastectomy is a procedure that removes all of the soft tissue from a woman’s breast. This type of procedure can impact a woman’s emotional state higher than if she underwent a lumpectomy procedure as the patient is left with a flat chest. Patients who inherit abnormal genes or have a family history with a high occurrence cancer rate will be better off undergoing this type of surgery.

Breast Reconstruction is done to try to restore the normal appearance of a woman’s breast after undergoing a lumpectomy or mastectomy procedure.

There are two types of reconstruction procedures. Both procedures involve a number of pros and cons.

A reconstruction implant is a procedure where a doctor implants a foreign object in a patient’s breast. This type of surgery has a shorter recovery time than when using your own soft tissue to reconstruct your breast. The downside is that the implant used is a foreign object and is not part of your own tissue.

Also, there is risk of infection and bacteria and possible leakage. The implant placed can build up to form a bundle of scar tissue, which can become thick and harden which will eventually change the shape of the women’s breast.
Reconstruction done from your own tissue also has its benefits and side effects. When using your own soft tissue, there is less concern about leakage as no foreign object has been implanted. There is less chance of infection and your body will not form much scar tissue around the area.

The downside is that you will have scars and open wounds which may take time to heal and the duration of the operation is much longer.

India is a country which offers great medical care by highly trained physicians as well as cheaper surgical rates, which will be a great benefit for the patient.

Cost of Breast Cancer in India:

  • Lumpectomy – $ 4500- $ 5000
  • Mastectomy- $ 6,000-7,000
  • Reconstruction may cost US$ 7500- 9000, depending on the type of reconstruction

Recourse for women testing positive for BRCA

Risk Reducing(Prophylactic) Mastectomy with simultaneous or successive removal of ovaries whenever a woman feels comfortable is an option. It is a very important and difficult decision to remove one’s normal breasts, but with advances in reconstruction techniques a woman is able to get her breasts back, thus minimally affecting the routine life. . Angelina Jolie is a living example of it. Therefore, BRCA testing if timely done and with appropriate interventions, the risk of Breast cancer can be reduced by 90%.

Breast Cancer can be prevented with certain lifestyle changes in all women and properly informed genetic analysis in select women. Certain methods like Screening and Risk reducing surgery are really effective in saving life.

What is to be done for those who test positive for BRCA?

There are two courses of action which are done to prevent  Breast cancer related death. First, is to intensify screening, by starting it at an early age of around 25 to 30 years. MRI is included along with Ultrasound and Mammogram, usually MRI and Mammogram are done every 6 monthly in alternate fashion.

BRCA Testing, Breast Cancer Awareness

These are just recommendations from the West for Breast Cancer Screening. The Afro asian guidelines are yet to be formulated. The BRCA testing is never to be done as over the counter test. It has to be prescribed by a Breast Oncologist and should only be done after a genetic counselling session.

Who should undergo BRCA testing ?

US Preventive Service Task Force suggests the following to undergo BRCA testing; Women having cancer or with strong family history :

  1. Cancer at < 50 years
  2. Multiple cancer recurrences or cancer in both the breasts
  3. Both breast and ovarian cancers in the same woman
  4. Male having Breast Cancer
  5. Ashkenazi Jew Ethnicity