Multidisciplinary Cancer Care: Tumour Boards, Robotic Surgery and Patient Outcomes

As a tumour breaks down, its cells release DNA that circulates in the blood. Finding this DNA in a blood sample can be used as a screening test, prompting further investigation like colonoscopy, CT scan or mammography to locate the source. Measured before and after treatment, for example after three months of chemotherapy, a drop to absent or minimal levels indicates a good response. Checked every six months for years after treatment, a previously absent reading reappearing can signal recurrence. It is not yet fully specific and is still being researched, but is expected to be used more heavily in screening, diagnosis, prognosis, monitoring and recurrence detection.

CAR-T cell therapy, and immunotherapy generally, works on a simple concept: our own immune cells are competent enough to fight infection and cancer, but whenever cancer is present, immunity goes down. Immunotherapy retrains the remaining immune cells to fight again, rather than killing the tumour directly. The drugs make our own immunity more competent, cells that were lying idle are retrained and made to recognise the cancer as the enemy, and then they go and fight it.

The exact mechanism is still not fully known. But one clear factor is genetic aberrations that occur over time because of environmental exposure: if a patient achieves a cure but resumes alcohol or smoking, the damage caused by tobacco or other carcinogens affects the DNA again and dormant cells can get reactivated. That is one reason recurrence happens, though most of the time the actual mechanism is not known.

For bone metastasis, use a nuclear bone scan; if that is unavailable, do a skeletal survey, plain X-rays of the spine, ribs, pelvis and limbs. For liver metastasis, a CT abdomen substitutes for PET, and an ultrasound is a fair investigation if CT is also unavailable. For the lungs, a CT chest is the alternative, and a plain chest X-ray is fair enough if CT is not available. Also check the uterus and ovaries with a pelvis ultrasound in every breast cancer patient, to rule out Krukenberg tumours. Ultrasound and X-rays are available almost everywhere in the world, and while less precise than PET-CT, this combination is enough to establish metastatic staging.

Diagnosing cancer early, at stage 1 or 2, translates into cure; stage 4 offers very minimal chances of cure for any cancer. Where facilities and education are limited, the solution has three parts: awareness, awareness, and awareness, among doctors, the public and government. Over almost 30 years of practice, running thousands of community cancer-awareness camps across India, Nepal, Bhutan and Bangladesh with NGO partners has produced a real shift: around 1997, 75-80% of patients presented in stage 3 or 4; today in metropolitan India, around 60% present at an early stage.

It can shorten recovery from around ten days with open surgery to three or four days, with less pain and lower rates of bleeding and infection, while the cure rate remains comparable.

For complex cases with no standard guideline, a tumour board brings a pathologist, radiologist, surgical oncologist, medical oncologist, radiation oncologist and social worker together to reach a joint decision, rather than each specialist independently pushing their own preferred treatment.