The world of medical science has gone through a sea of change over the last few decades, thus increasing life expectancy and the recovery rate of certain diseases. One of the areas which have benefited immensely through medical advancement is cancer and its treatment.

While even the subject of cancer is difficult to face, the progress in the field of cancer treatment is a ray of sunshine. Medical professionals around the world are dedicated to improving life expectancy after the detection of cancer and helping patients live with the disease and survive.

One of the aspects that can influence the effectiveness of cancer treatment is the stage at which cancer is detected. Early detection can improve life expectancy to a great extent. For example, in Malaysia, patients suffering from breast cancer have a 5-year survival rate of 87.5% when cancer is detected in Stage I, compared to 23.3% when cancer is detected in Stage IV. Similarly, the 5-year survival rate is 37.1% for Stage I lung cancer as compared to 6.3% for Stage IV lung cancer.

Relative survival by stage of diagnosis and cancer types in Malaysia (2007 – 2016)

Source: https://www.moh.gov.my/moh/resources/Penerbitan/Laporan/Umum/Malaysian_Study_on_Cancer_Survival_MySCan_2018.pdf

The importance of detecting cancer at an early stage cannot be emphasised enough. Let’s take an in-depth look at the early detection of cancer and its effects on cancer treatment.

What is early detection of cancer?

As is evident from the name, early detection of cancer is detecting cancerous cells in a person at an early stage. According to the World Health Organisation, “Early diagnosis of cancer focuses on detecting symptomatic patients as early as possible so they have the best chance for successful treatment.”

What are the different stages of cancer?

The process of detecting the stage of cancer is known as Cancer Staging. Cancer staging is done in two ways:

1. The TNM staging system
2. The number staging system

Carcinoma in situ

Apart from the above two, another commonly used term for cancer staging is Carcinoma In Situ. Carcinoma in situ means that a group of abnormal cells have been found in the body which may develop into cancer cells in the future.

Carcinoma in situ is often known as non-invasive cancer. In many cases, they do not develop into cancer at all. The cells are too small in number to form a tumour, hence in the case of internal organs, they may not show up in a scan as well. However, they can be detected through a cancer screening programme.

Cancer staging is extremely important as it helps the medical team to understand what kind of treatments the patient needs. If the cancer is localised and not spread into other organs, doctors might suggest local treatment such as surgery or radiotherapy. Only one area of the body is treated through local treatment.

However, if the cancer has spread to other parts of the body, then the patient might need other systematic treatments such as chemotherapy, immunotherapy, hormone therapy and targeted cancer drugs.

When should you seek medical support?

So, let us come to the most important aspect – when should you seek medical support?

You should contact a medical practitioner immediately if you face any of the following:

• Lump in any part of your body
• Loss of blood or other kinds of abnormal discharge in your body
• Prolonged fever
• Extreme tiredness and fatigue
• Abnormality or change in your defecation or urination patterns
• Chronic wound
• Chronic coughing or hoarseness in the voice
• Loss of appetite, weight or difficulty in swallowing. Changes in wart moles or unusual growth in a birthmark
• Unusual pain in any part of the body
• Unusual skin changes such as excessive hair growth, itching, redness of the skin, and hyperpigmentation.

The above list is not exhaustive. One may experience other symptoms as well. Also please note that one or more of the above symptoms does not mean you have cancer. A medical practitioner is more equipped to guide you about the same.

What is cancer screening?

Cancer screening is the use of a few tests among healthy individuals who do not have symptoms. It is a sort of health checkup, but specifically for cancer detection. Screening can be very useful in detecting cancer at an earlier stage.

One of the most effective methods to detect cancer at an early stage is cancer screening. Effective screening can reduce the symptoms and increase the chances of survival. At present screening tests are done for the following types of cancer:

• Breast cancer
• Prostate cancer
• Skin cancer
• Cervical cancer
• Head and neck cancer
• Lung cancer
• Prostate cancer

Often, doctors may suggest that you get a screening done. But that does not necessarily mean that you have cancer. Remember, cancer screening is done on patients who do not have any symptoms.

It is also important to note that cancer screening entails certain risks as well. There can be false-positive and false-negative results. Hence, following your medical team’s instructions is suggested.

Common types of cancer screening tests

Different kinds of screening tests are done for different kinds of cancer:

Breast cancer:

The most common way to diagnose breast cancer early is mammograms. Breast self-examination, clinical breast examination and magnetic resonance images (MRI) are also effective.

Prostate cancer:

Mainly two tests are done for prostate cancer screening:

• Digital rectal exam (DRE) – where the doctor inserts a gloved lubricated finger into the patient’s rectum to feel the surface for prostate or any other irregularities.
• Prostate-specific antigen (PSA) test – a blood test that measures the level of PSA in the patient’s blood sample. Patients with prostate cancer usually have higher than normal levels of PSA. However, high PSA levels can be due to other reasons that are not cancerous.

Skin cancer:

Skin cancer screening usually includes three kinds of tests:

• Skin self-examination – where the patient can examine their own body for signs of abnormality.
• Full body skin exam – where a Dermatologist examines the skin of the entire body for signs of cancer.
• Dermoscopy – where the Dermatologist uses an instrument called a dermatoscope to evaluate the shape, size and pigmentation of skin lesions. Dermoscopy is effective for early detection of melanoma (a serious type of skin cancer).

Colorectal cancer:

Colorectal cancer can include any of the following tests:

• Colonoscopy – the doctor inserts an illuminated flexible tube called a colonoscope into the rectum to check for polyps or cancer.
• Sigmoidoscopy – the doctor inserts a lighted flexible tube called a sigmoidoscope into the rectum to check for cancer or polyps. This test cannot be done on the upper part of the colon.
• Double-contrast barium enema – this is an x-ray of the colon or rectum which can check the outline of the colon or rectum for abnormalities. This test is done on people who cannot have a colonoscopy.
• Fecal occult blood test (FOBT) – small amounts of blood detected in the stool or faeces can be a sign of cancer. FOBT tests this blood to detect the disease.
• Stool DNA test – the DNA of a person’s stool sample is taken during this test to look for cancer.

Cervical cancer

Cervical cancer screening usually includes:

• Human papillomavirus (HPV) test – cells from the outside of the cervix are scraped and tested for specific strains of HPV. Some strains of HPV are more strongly linked to cervical cancer. This test can be done as a stand-alone or jointly with a pap test.
• Pap test – cells from outside the cervix are also used in this test for identifying cancerous cells. This test is sometimes called a pap smear test.

Head and neck cancer

Head and neck cancer screening is usually not a part of general screening. Doctors check the nose, mouth and throat for abnormalities. They also check the neck for lumps. Head and neck cancer can also be detected during regular dental check-ups. The dentist can also check your tongue, cheek, lips and throat for signs of oral cancer.

Lung cancer

Lung cancer screening is done by using a low-dose helical or spiral computed tomography, commonly known as a CT scan or CAT scan. During this scan, x-rays are taken of the inside of the body from different angles. The images are then combined by the computer for detecting abnormalities or tumours.

Is cancer hereditary?

It is a common notion that cancer is hereditary. Well, it is not true but yet true. It is important to understand the nuances of it.

Cancer or genetic changes in tumour cells cannot be specifically passed down from parents to children. However, if a genetic change, which increases the risk of cancer, is present in the parent’s egg or sperm, then it can be inherited.

This is why it seems that cancer runs in families. Almost 10% of all cancers are caused by inherited genetic changes. What is important is to remember that inheriting cancer genetic change does not mean that you will definitely have cancer. It only means that you have an increased risk of cancer.

Certain genetic tests can reveal that you have inherited this kind of genetic change. Such kinds of tests are usually done using a small sample of blood, saliva, skin cells or cells from inside the cheek. Genetic tests can be especially helpful if there is a family history of breast or ovarian cancer.

So, should you get genetically tested for cancer?

Not everyone needs to go through genetic testing. It is better to consult your doctor to decide if you need to get tested. By understanding your family history, they will be in a better position to advise you on whether such tests are required.

Sources:

1. https://www.who.int/activities/promoting-cancer-early-diagnosis
2. https://www.moh.gov.my/moh/resources/Penerbitan/Laporan (PDF)
3. https://www.cancerresearchuk.org/about-cancer/cancer-symptoms/why-is-early-diagnosis-important
4. https://www.moh.gov.my/moh/resources/ (PDF)
5. https://www.cancerresearchuk.org/about-cancer/what-is-cancer/stages-of-cancer
6. https://www.who.int/europe/news-room/fact-sheets/item/cancer-screening-and-early-detection-of-cancer
7. https://www.wattanosothcancerhospital.com/en/all-about-cancer/the-importance-of-early-detection-of-cancer
8. https://www.cancer.net/navigating-cancer-care/prevention-and-healthy-living/cancer-screening