From Detection to Recovery

Cancer care has moved a long way from the era when a diagnosis of stage four disease meant survival measured in months. Dr. Nithin S.G., a medical oncologist at Fortis Hospital, Vasant Kunj, walked doctors across Africa through the full arc of that shift: what to look for before a patient ever reaches an oncologist, how a suspected cancer is actually confirmed, and how precision oncology, targeted therapy and immunotherapy have changed what recovery looks like for patients who once had no real options. This guide introduces a complete series covering the detection, diagnosis and modern treatment of cancer.

Recognising Cancer Early

Most cancers announce themselves through symptoms that are easy to dismiss individually but form a recognisable pattern together: a change in bowel or bladder habits, a sore that will not heal, unusual bleeding or discharge, a thickening or lump, indigestion or difficulty swallowing, an obvious change in a wart or mole, and a nagging cough. Beyond these organ-specific warnings, unexplained weight loss of more than 10 kilograms in six months and persistent fatigue, even without any other symptom, are consistent enough across cancer types to justify testing on their own.

Confirming the Diagnosis

A blood test, imaging and tissue diagnosis each play a distinct role. Anaemia, an abnormal white cell or platelet count, deranged liver or kidney function and an elevated LDH can all point toward cancer before imaging is even ordered. Contrast-enhanced CT remains the workhorse scan for most cancers, MRI is reserved for suspected brain, uterine, rectal, bladder or prostate involvement, and a PET-CT adds whole-body staging, though it can light up infections such as tuberculosis just as readily as cancer. The tissue diagnosis itself should come from a core needle or excisional biopsy rather than FNAC, which yields too few cells to run the hormone receptor and genetic tests that now guide treatment. A small number of cancers, including confirmed liver masses in a cirrhotic patient, retinoblastoma in children, and swellings of the kidney or testis, are deliberately not biopsied at all, because the biopsy itself risks rupturing the tumour capsule and spreading the disease.

Staging Before Treatment

Once a diagnosis is confirmed, staging from one to four determines everything that follows. Stage one to three disease, confined to the organ of origin and nearby lymph nodes, is usually curable with a combination of surgery, chemotherapy and radiation. Stage four disease, where the cancer has spread to distant organs, is harder to control, and is where the newer forms of treatment covered in this series have made the most visible difference.

From Chemotherapy to Precision Oncology

Conventional chemotherapy works by attacking rapidly dividing cells, which is why it also damages bone marrow, hair follicles and the lining of the mouth and gut alongside the tumour. Two newer approaches now sit alongside it. Targeted therapy uses genetic testing, typically next generation sequencing, to identify the specific mutation driving an individual patient's cancer and match it to an oral drug that acts only on cells carrying that mutation, sparing healthy tissue and its side effects. Immunotherapy takes a different route, retraining the patient's own immune system to recognise and attack cancer cells it had previously been evading. Both approaches were illustrated by real cases from Dr. Nithin's own practice: a 55-year-old lung cancer patient with six to eight brain metastases who is alive and well three years after starting an EGFR-targeted tablet, and a 22-year-old sarcoma patient with metastases in her lung, liver and pelvis who has had no detectable disease for years on immunotherapy alone.

In This Series

The articles below cover the symptom checklist for common cancers, the blood tests and imaging used to confirm a diagnosis, why biopsy is preferred over FNAC, what tumour markers can and cannot tell you, cancer staging, precision oncology and genetic testing, immunotherapy, breast cancer subtypes and treatment, targeted therapy for patients in poor health, working up testicular and prostate cancer, liquid biopsy, and why uterine fibroids fall outside precision oncology altogether.

When to Suspect Cancer: A Symptom Checklist by Cancer Type | From Suspicion to Diagnosis: Blood Tests and Imaging Explained | Why Biopsy Beats FNAC in Cancer Diagnosis | Tumour Markers: What They Can and Cannot Tell You | Cancer Staging and Why It Decides the Treatment Plan | Precision Oncology: How Genetic Testing Is Changing Cancer Treatment | Immunotherapy: Retraining the Immune System to Fight Cancer | Breast Cancer: Subtypes, Diagnosis and Newer Targeted Treatments | Targeted Therapy for Advanced Cancer Patients with Poor Performance Status | Testicular Cancer, Prostate Cancer and PSA: Working Up Common Urologic Presentations | Liquid Biopsy: A Newer, Less Invasive Way to Detect and Monitor Cancer | Uterine Fibroids Are Not Cancer: Why Targeted Therapy Doesn't Apply

This article is based on a Jivo Masterclass session conducted by Dr. Nithin S.G., Consultant, Medical Oncology, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording