Principal Director, Medical Oncology & Hemato-Oncology, Fortis Hospital, Bannerghatta Road, Bengaluru, India
Series overview · 12 articles
Diagnosing Common Cancers and Blood Disorders
August 28, 2026
More than half of all cancers are curable, and every cancer can receive treatment that either extends life, controls symptoms, or improves quality of life. The variable that decides which outcome a patient gets is rarely the treatment itself. It is how early the diagnosis is made. Dr. Niti Raizada, Principal Director of Medical Oncology and Hemato-Oncology at Fortis Hospital, Bannerghatta Road, Bengaluru, built her Jivo Healthcare masterclass around eight real patients to show referring physicians exactly where that diagnostic window opens and closes.
Dr. Raizada runs her practice through a comprehensive cancer centre model: every patient is reviewed by a multidisciplinary tumour board of medical, surgical and radiation oncologists, an onco-pathologist and an onco-radiologist before a treatment sequence is agreed. The eight cases she walked through, breast, lung, colon, ovarian, cervical, liver and oral cancers, plus one haematological emergency, were chosen because each one hides behind a presentation a general practitioner sees every week: a lump, a cough, fatigue, bloating, bleeding, jaundice, a mouth ulcer, easy bruising.
Why this guide is organised around red flags, not organs
The masterclass was not built as an organ-by-organ tour of oncology. It was built around the specific clinical details that separate a routine complaint from one that needs urgent referral: a hard irregular breast mass in a 35-year-old with a strong family history, a lung lesion that fails to respond to anti-tubercular therapy, anaemia in a young man rather than a young woman, ascites and a CA-125 of 745, a cervix that bleeds on touch, a liver nodule on the background of chronic hepatitis B, a tongue ulcer that will not heal, and a 32-year-old with bruising, gum bleeding and a coagulation profile in freefall.
Each of the articles in this series takes one of these cases and works through it the way Dr. Raizada did live on the call: history, examination, the specific investigation sequence, the result, and the screening or prevention guideline that would have caught the disease even earlier. Read together, they form a working reference for any GP, internal medicine physician or general surgeon who wants to know when a common symptom deserves an oncology referral rather than reassurance.
The eight cases in this series
Breast cancer in a 35-year-old with triple-negative disease and a strong family history of breast and ovarian cancer. Lung cancer misdiagnosed as tuberculosis in a 52-year-old smoker who did not respond to a full course of anti-tubercular therapy. Colon cancer and Lynch syndrome in a 37-year-old man whose only early sign was unexplained anaemia. Ovarian cancer in a 63-year-old with abdominal distension and a markedly elevated CA-125. Cervical cancer in a 52-year-old with irregular postmenopausal bleeding. Hepatocellular carcinoma in a 60-year-old with chronic hepatitis B and cirrhosis. Oral cancer in a 55-year-old tobacco chewer with a non-healing tongue ulcer. And acute promyelocytic leukaemia, a medical emergency, in a 32-year-old schoolteacher who first noticed easy bruising.
How to use this series
Every article ends with the specific screening or referral guideline Dr. Raizada gave for that cancer: the age to start self-examination, the interval for a stool occult blood test, who qualifies for a low-dose CT of the chest, and what endometrial thickness on ultrasound should trigger a biopsy. A final article in the series distils her most consistent piece of advice across all eight cases: when a GP is unsure, a basic panel of a complete blood count, liver function tests and kidney function tests will usually tell them whether to worry, long before any scan is needed.
As Dr. Raizada put it in closing the session, the numbers reported across Africa and much of the Global South almost certainly understate the true burden of cancer: what gets recorded is only the fraction of patients who reach medical attention and complete treatment. Closing that gap starts with recognising the red flags in this series before a patient's disease has moved past the point where cure is still on the table.
This guide is based on a live Jivo Masterclass — Dr. Niti Raizada taught doctors across Africa on February 1, 2026.
Watch the full recording, or read the guide above.
FROM THE LIVE Q&A
Host (Varun, Jivo Healthcare)
Can a general practitioner also perform a clinical breast examination, or does it need to be a specialist?
Dr. Niti Raizada
Self-examination should be done by the woman herself, using the opposite hand on the opposite breast with three fingers held flat, including the axilla and neck. Clinical breast examination should be done by anyone properly trained, which can include nurse practitioners, physician assistants, internal medicine doctors, general surgeons, gynaecologists and oncologists. Training, not job title, is what matters, since missing lesions is common when the examiner has not been trained. GPs and internal medicine doctors should learn the technique and offer it to every woman who comes to the clinic.
Frequently Asked Questions
What further investigations are needed to assess disease extension before starting management of this cervical cancer case?▼
Once the diagnosis is confirmed by biopsy, a staging scan, often a PET scan, establishes the exact stage, including whether the bladder, rectum, parametrium or lymph nodes are involved. Fitness for treatment is then assessed with kidney function testing (GFR) and audiometry, since some chemotherapy agents can affect hearing. Weekly chemotherapy is then given alongside radiation, with the potential radiation side effects explained to the patient beforehand.
Between MRI and CT scan, which is the better imaging modality for staging this cervical cancer case?▼
MRI of the pelvis is excellent for local pelvic structures, but the upper abdomen and chest still need to be assessed, which is better done on CT. The recommendation is CT of the thorax combined with CT of the abdomen and pelvis with contrast, or alternatively MRI of the abdomen and pelvis with contrast combined with a CT of the chest. The chest is generally better seen on CT, and the pelvis is generally better seen on MRI.
I am seeing a Stage III breast cancer patient currently on filgrastim 300 micrograms for 3 days. What further treatment plan would you initiate for this patient?▼
Treatment depends on the patient's oestrogen receptor, progesterone receptor and HER2 status, and on whether she is receiving neoadjuvant chemotherapy followed by surgery, or surgery followed by adjuvant chemotherapy. Filgrastim is supportive care only, a white blood cell growth factor given to prevent a drop in counts after chemotherapy; it is not the primary cancer treatment. Its use depends on which chemotherapy protocol is being followed, but the treatment plan for the cancer itself is a separate, biology-driven decision.
Can the HPV vaccine still be given to a patient who has already tested positive for HPV?▼
Yes. If a nine-valent vaccine is given and the patient is positive for one strain of HPV, the vaccine still confers protection against the remaining eight strains it covers.
Are there any specific concerns in monitoring chronic liver disease, for example the frequency of ultrasound and the skill set of the radiographer?▼
Ultrasound should be done once every 6 months for a chronic liver disease patient, along with alpha-fetoprotein testing every 6 months. The skill of the radiographer matters because ultrasound is a subjective, operator-dependent test. If there is any doubt on ultrasound, a triple-phase CT scan or a multiphasic MRI should be done immediately.
What is a multidisciplinary tumour board and why does it matter for cancer diagnosis?▼
A multidisciplinary tumour board is a review process in which every patient's case is discussed by a full team, including medical, surgical, and radiation oncologists together with an onco-pathologist and an onco-radiologist, before a treatment sequence is agreed. This structure ensures that surgery, chemotherapy, and radiation are sequenced correctly rather than decided by a single specialist in isolation, which reduces the risk of a treatment plan missing a critical step.
Why does this series organise cases by red flag symptom instead of by cancer type?▼
The masterclass was built around the everyday complaints a general practitioner already sees, a lump, a cough, fatigue, bloating, bleeding, jaundice, a mouth ulcer, or easy bruising, rather than as an organ by organ tour of oncology. Organising by symptom mirrors how a GP actually encounters these cases and highlights the specific clinical details that separate a routine complaint from one that needs urgent referral.
Which eight cases does this masterclass series cover?▼
The series works through breast cancer in a 35 year old with a strong family history, lung cancer initially mistaken for tuberculosis in a 52 year old smoker, colon cancer and Lynch syndrome in a 37 year old man, ovarian cancer in a 63 year old with a markedly elevated CA-125, cervical cancer in a 52 year old with postmenopausal bleeding, hepatocellular carcinoma in a 60 year old with chronic hepatitis B, oral cancer in a 55 year old tobacco chewer, and acute promyelocytic leukaemia in a 32 year old schoolteacher.
What single step does Dr. Raizada recommend when a GP is unsure whether a case needs referral?▼
Her most consistent advice is to start with a basic panel, a complete blood count, liver function tests, and kidney function tests, before ordering a scan. This panel is inexpensive and fast, and in most cases it tells a clinician whether there is cause for concern long before imaging is needed.
Why might official cancer statistics understate the true burden of disease in a region?▼
Reported numbers only capture the patients who reach medical attention and complete treatment. Many cases go undiagnosed or untreated and are never recorded, which means the true incidence and mortality in a region can be substantially higher than official figures suggest.
In This Series: Diagnosing Common Cancers & Blood Disorders
- 1.Diagnosing Common Cancers and Blood Disorders
- 2.Breast Cancer in Young Women: Reading the Red Flags Beyond Age
- 3.Breast Cancer Screening: What to Do at 18, 30 and 40
- 4.When a Persistent Cough Isn't Tuberculosis: Diagnosing Lung Cancer
- 5.Colon Cancer, Lynch Syndrome and the Case for Cascade Testing
- 6.Ovarian Cancer: The Silent Killer and Its Diagnostic Trail
- 7.Cervical Cancer: From Diagnosis to Concurrent Chemoradiation
- 8.HPV Vaccination: Who Needs It and What It Prevents
- 9.Hepatocellular Carcinoma: Diagnosing Liver Cancer in Chronic Liver Disease
- 10.Oral Cancer: Recognizing a Non-Healing Ulcer Early
- 11.Acute Promyelocytic Leukaemia: A Bleeding Emergency Hiding in Plain Sight
- 12.The Basic Blood Panel: A GP's First Line of Defence Against Missed Cancers