When to Suspect Cancer and How to Refer

A malignant wound anywhere needs to be confirmed on biopsy to establish the exact reason for it, and it should not be expected to heal on its own. It should be subjected to a biopsy to confirm the nature of the malignancy and the treatment options, with appropriate imaging to understand the underlying structures involved, and surgery offered if the wound is resectable.

Yes, definitely. An electrolarynx is an external prosthesis: once the device is attached to the skin it creates vibrations at high speed and the patient can vocalise using it.

Tumour markers can be used, but it is important to understand the patient's age, family history and smoking status first. At a basic level, a mammography for women, an ultrasound of the whole abdomen for endometrial or ovarian cancer, a serum PSA blood test for men with suspected prostate cancer, and a CT scan of the chest for smokers can be recommended. The frequency varies: colon cancer screening can be a colonoscopy every ten years, or a sigmoidoscopy with a faecal occult blood test.

This is a real issue even in India, where processing time for biopsies can be high in some regions. One workaround is relying more on FNAC, which is not the best strategy but can guide treatment decisions in select situations where a diagnosis is otherwise delayed. A second option is a frozen section facility, which gives some confirmation quickly but is resource-intensive and usually only available at high-volume cancer centres. Short of that, it is best to refer to an oncologist who can guide where a biopsy should be taken from for the best results.

The most important myth is patients' hesitancy to get a biopsy done, fearing it will cause the cancer to spread. A biopsy is one of the most crucial tests a cancer patient needs, and if planned and performed correctly it will not cause the cancer to spread. Another myth is that patients believe cancer is their own fault, from dietary habits or indulgences like tobacco or alcohol. More cases are now understood to happen because of environment or genetics rather than a patient's own fault, and it is important to destigmatise patients suffering from cancer, since stigma is what keeps them from seeking timely treatment.

A gradually increasing, usually painless lump or swelling; a persistent unexplained sore or worsening skin lesion; persistent hoarseness or a nagging cough, especially with blood-streaked sputum or a tobacco history; persistent bloating or abdominal symptoms, sometimes with jaundice; unscheduled or unexplained bleeding or discharge; a recent change in bowel, bladder or dietary habits or breathing difficulty; and any recent, otherwise unexplained pain, recurrent infection or functional decline.

He notes that prostate cancer in men and breast cancer in women are the cancers he sees most commonly among African patients, both of which can be identified early with a major impact on survival.