India is on par with developed nations in terms of treatment and diagnosis of cancers such as cervical and breast cancer. A culture of screening is gradually developing with government support. Doctors follow the international guidelines in cancer treatment and efforts are made across the country to follow a uniform treatment protocol across in the form of national cancer grid (NCG).
NCG with the support of Tata Trusts announced a major initiative a few months back of facilitating a high bandwidth, secure and private network through which cancer hospitals in the country can interact directly with other centres, thus enabling inter-centre knowledge sharing and providing access to cancer care facilities like Virtual Tumor Board (VTB).
VTB provides the hospitals free expert opinion and bilateral discussions from leading cancer specialists to plan treatment of cancer patients in an effective and timely manner. The NCG at present comprises 108 centres, which account for about 60% of the cancer load of the country.
Awareness on screening cancer
A key to successful screening program in breast cancers is clinical breast examination. Women, from the age of 50 onwards, may get a screening mammography done every 2 years. However, even then, regular self- breast examination with yearly interval examination by a physician or trained health worker is of extreme help for picking up early cancers across all ages.
Similarly, for cervical cancers, maintaining good genital hygiene and safe sexual practices decreases the incidence of cervical cancers. Regular examinations by Pap smear / VIA test from 25 to 65 years of age is recommended for early detection of cancer.
Standardization cancer medicine practice
Standardization of cancer medicine practice can be accomplished by initiatives like NCG which can help cancer hospitals across the country to follow a standard treatment protocol and make cancer treatment accessible for which Tata Memorial Hospital (TMH) has a virtual tumor board (VTB) to provide therapies around cancer.
TNM stands for Tumor, Node and Metastasis, and is a system for staging cancers, which will eventually determine the management and treatment. It is based on the findings seen on clinical examination, imaging and pathological findings.
The TNM classification is a unified standard and is a prerequisite for ensuring the quality of care in all resource-settings. It goes beyond clinician practice and constitutes vital information for policy-makers developing or implementing cancer control and prevention plans and it is therefore important to include the TNM classification as part of cancer registration.
Staging is based on commonly understood knowledge about the way cancer develops and spreads. In most cases, the stage is based on four main factors like location of the primary (original) tumor, tumor size and extent of tumors, lymph node involvement (whether or not the cancer has spread to the nearby lymph nodes) and presence or absence of distant metastasis (whether or not the cancer has spread to distant areas of the body).
Cancer diagnosis through mobile app
Doctors at Tata Memorial Hospital (TMH) in Mumbai developed a free, offline, mobile app, “TNM” to make the cancer diagnosis and treatment easier. Such kind of app will also help bring about standardization of cancer medicine practice across the country.
Resident doctors refer a TNM handbook to correctly identify the stage of cancer in the patient they are treating. It is not possible for the doctors to remember various permutations and combinations among 65 types of cancers, particularly in their early years of profession, and for those who do not only see cancer cases in their routine practice.
The need to carry the textbook has been eliminated as most people carry smartphones and can download the app which is free. The app, once downloaded, can be accessed offline. It is an interactive app where the doctor can feed the required information and within 30 seconds can get the stage of cancer.
TNM classification for cancer staging
The American Joint Committee on Cancer (AJCC) has developed and compiled cancer staging references. The Union for International Cancer Control (UICC) has also published the UICC TNM classification of malignant tumours for over 50 years.
Stage is an increasingly important component of cancer surveillance and cancer control and an endpoint for the evaluation of the population-based screening and early detection efforts.
The UICC TNM Classification is an anatomically based system that records the primary and regional nodal extent of the tumor and the absence or presence of metastases. Each individual aspect of TNM is termed as a category. T category describes the primary tumor site, N category describes the regional lymph node involvement, M category describes the presence or otherwise of distant metastatic spread
Objectives of the TNM classification are to aid treatment planning, provide an indication of prognosis, assist in the evaluation of treatment results, facilitate the exchange of information between treatment centres, contribute to continuing investigations of human malignancies, support cancer control activities, including through cancer registries.
So, having an App globally available free of cost, increases the utility, accuracy and frequency of use of this system for better staging. There are more than 20,000 users of this App across the globe. Being offline and interactive, it makes an easy and readily available access even in poor network areas.
About the Expert:
Dr Palak Popat
Consultant radiologist at Tata Memorial Hospital with special interest in Breast, Gynaecological and Urological malignancies.