Question 1

Why order a genetic test for a patient who already has cancer? Will it help the prognosis?

Dr. Mohit Agarwal · Accepted Answer

It helps in three ways: it may reveal specific therapies available only for that patient, it tells you whether other family members are at risk, and it tells you whether that individual has a tendency to develop cancer in another part of the body.

Question 2

Can testing for tumour markers be used as a screening test for cancer in a general patient checkup?

Dr. Mohit Agarwal · Accepted Answer

No. Tumour markers are not specific to cancer and can be raised in non-cancerous situations too, so they should not be used as a screening tool. In a patient already diagnosed with cancer, however, they are useful for monitoring the disease.

Question 3

What is the current management strategy for colorectal cancer?

Dr. Mohit Agarwal · Accepted Answer

First, a biopsy to understand what type of cancer it is. Second, a PET-CT scan to determine whether it is stage one, two, three or four. If it is stage one to three, the patient may go for surgery with further treatment based on the report; stage four starts with medical management first.

Question 4

How can we bring cancer diagnostics down to the local level?

Dr. Mohit Agarwal · Accepted Answer

Only through education and awareness. If patients know the seven warning signs of cancer, they will talk to their doctor and undertake screening, which brings cancer diagnosis down to the local level and enables earlier treatment.

Question 5

To prevent cancer death and increase early treatment, what can be done to detect and diagnose cancer?

Dr. Mohit Agarwal · Accepted Answer

The same principle applies: go for screening, be aware of the warning signs, and maintain a healthy lifestyle, meaning regular exercise, no tobacco, minimal alcohol and a balanced diet. Doing these things means you will either not develop cancer or you will catch it early.

Question 6

What are the risks of working in a close environment to chemotherapy?

Dr. Mohit Agarwal · Accepted Answer

Chemotherapy, if not handled properly, can be toxic to people nearby. It has to be prepared in a specific mixing unit with proper precautions, and only staff trained in handling and administering chemotherapy should give it.

Question 7

What are the best treatment options for already metastasised malignant disease?

Dr. Mohit Agarwal · Accepted Answer

It is not a one-size-fits-all approach. It depends on the individual patient, which cancer is present in the body, and which site it has metastasised to. Treatment can be chemotherapy, immunotherapy or targeted therapy depending on exactly what is being treated.

Question 8

Why do brain tumours relapse so much compared with other tumours?

Dr. Mohit Agarwal · Accepted Answer

Brain tumours relapse mainly when they are high-grade tumours or at an advanced stage. The primary modality for brain tumours is surgery, but complete surgical removal of an infiltrating tumour in the brain is nearly impossible, so high-grade tumours are likely to recur. Low-grade tumours that can be completely removed are cured.

Question 9

A male patient has a cystic mass with solid components draining blood-stained, chocolate-coloured, thick fluid from the left breast, and histology is not yet available. What type of breast cancer is this likely to be, and what is the likely prognosis?

Dr. Mohit Agarwal · Accepted Answer

Any discharge from a male breast is not normal. It can be an infection, a malignancy, or something arising from the chest wall. The key next step is imaging and a histopathological diagnosis; this could turn out to be breast cancer, which would need immediate treatment.

Question 10

What are the prognostic factors for breast cancer?

Dr. Mohit Agarwal · Accepted Answer

The major prognostic factors are the patient, the stage of the disease, and the biology of the disease, meaning which receptors are present on the tumour for targeted or hormonal therapy.

Question 11

If a patient responds to chemotherapy, is there any further need for radiotherapy?

Dr. Mohit Agarwal · Accepted Answer

For early breast cancer with lymph node involvement in the armpit, radiotherapy is typically given after chemotherapy to sterilise the local area. Whether radiotherapy is needed depends on the individual patient's stage and disease.

Question 12

Can chemotherapy and hormonal therapy be combined for the treatment of breast cancer?

Dr. Mohit Agarwal · Accepted Answer

They are not usually given together, because they have been seen to oppose each other. Hormonal therapy can be combined with targeted therapy and immunotherapy, but it is usually not given along with chemotherapy; if both are needed, hormonal therapy is given after the chemotherapy is completed.

Question 13

In case of relapse after successful chemotherapy, what other modality of treatment can be adopted?

Dr. Mohit Agarwal · Accepted Answer

If the relapse is localised to one or two sites after a good amount of time, the patient might be given re-surgery or radiation to that area, along with some medical management depending on the biology of the disease. If the relapse is not local, it is medical management: chemotherapy, targeted therapy or immunotherapy, depending on the receptors present.

Question 14

What is the best therapy for a patient above 60 years old with advanced breast cancer?

Dr. Mohit Agarwal · Accepted Answer

It depends again on the patient's receptor status. It could be chemotherapy with some form of maintenance, targeted therapy if HER2-positive, hormonal therapy if the hormone receptors are positive, or immunotherapy if the patient fits those categories.

Question 15

You said tumour markers have no role in screening for ovarian cancer. If a patient has ovarian cancer of the smallest size, do tumour markers have a role in diagnosis?

Dr. Mohit Agarwal · Accepted Answer

A tumour marker is a red flag in a patient suspected of having the disease, but it does not clinch the diagnosis. Diagnosis is confirmed only on the basis of a biopsy or complete resection histopathology. Even if a patient has ovarian cancer with some metastasis and a raised CA-125, I cannot directly start treatment: I have to perform a biopsy to confirm the histopathology first.

Question 16

I have a stage-four leiomyosarcoma patient at the end stage where nutritional approaches aren't working. How can nutrition care be incorporated into cancer management, and should it be at a policy level or a treatment level?

Dr. Mohit Agarwal · Accepted Answer

The amount and quality of food consumed matters broadly for cancer prevention: a balanced diet appropriate to the individual's age, height and weight, an ideal body weight and regular exercise support immunity against cancer and other diseases alike. For an advanced case like this, remember that cancer is a catabolic state, meaning the body breaks down more than it builds up, so the patient needs support to keep the muscles maintained: a good protein diet, calcium and vitamin D if deficient, vitamin B1 and folate if deficient, regular meals at regular intervals, less sugar, and complete avoidance of alcohol and tobacco, with protein supplements if the patient is underweight. Nutrition is a core part of every cancer management plan, and a nutritionist is a must in every cancer care team, assessing and treating each patient individually.

Live Discussion with Dr. Mohit Agarwal