On World Cancer Day 2017, we speak to Dr. Donald John of p53 Cancer Clinic about Organ Preservation Surgery.
Cancer is a disease that patients live with even after it is cured. The removal of tumors, benign or malignant, often requires amputation. As such, while the disease may be defeated, it leaves behind wounds that last a lifetime. There is hope, however, in the form of Organ Preservation Surgery. Dr. Donald John of p53 Cancer Clinic tells YBT’s Afshan Shaikh why Organ Preservation Surgery is the need of the hour when it comes to cancer treatment in India.
Afshan: What exactly is Organ Preservation Surgery? How is it different from other cancer surgeries?
Dr. Donald: The common cancer surgery in India, or radical surgery as it is known, relies on the removal of a part of or sometimes even the entire infected organ in order to remove the cancer itself. Organ Preservation Surgery seeks to, as the name suggests, preserve or save the organ and NOT remove it. For example, in the case of breast cancer – radical surgery would suggest that the entire breast be removed to get rid of the cancer. However, in Organ Preservation Surgery, we would aim to conserve the breast. We would remove only the lymph node which is affected, then use chemo-therapy to treat the area. If a major part of the breast still has to be removed, plastic surgery to reform the breast is part of the Organ Preservation Therapy procedure. So, we are talking about the typical breast cancer treatment where the patient has to live with a lifelong, very visible, reminder of the surgery. On the other hand, Organ Preservation Surgery goes the extra length to make sure than not only is the organ naturally preserved, but any deformity is reformed in the best possible manner, thereby ensuring a better quality of life for the patient once they have beaten the cancer.
Afshan: That sounds very promising! Why is Organ Preservation Surgery not adopted widely enough then? Is the procedure fairly new?
Dr. Donald: Actually, Organ Preservation Surgery has been around for decades and is a standard of treating cancer in Western countries. In India though, doctors have adhered to radical surgery. The logic was, the bigger the chunk of the organ you remove, the higher the chances of cure. Now, this perception was based entirely on the personal experience and opinion of surgeons. This had been in practice for about a 100 years! There is no proof of the efficacy of organ removal to treat cancer. Since the doctors were either apprehensive about the method or did not know how to perform Organ Preservation Surgeries, patients were simply recommended radical surgery instead.
In the last 25 to 30 years though, there has been an influx of evidence based medicine. Evidence based medicine relies on the findings of clinical trials, where about 20,000 patients undergo trials with their consent. They could be testing medicines, new chemo-therapy techniques, or a new method of surgery. As such, medicine and surgery that is based on the findings of these trials and have themselves been tested, obviously, have proved efficacy. We know they work – for a fact.
Organ Preservation Surgery has been proven to be better than radical surgery. It is oncologically safe and aesthetically appealing. Most importantly, it does not leave the patient feeling handicapped and greatly reduces the psychological trauma caused due to amputation in radical surgery. Evidence of this has been present in the medical circles since the 1970s but the awareness has simply not been allowed to spread here. Organ Preservation Surgery should be a norm in cancer treatment in India too.
Afshan: Can Organ Preservation Surgery be applied to all cancer patients? What kind of cancers can be treated through this method?
Dr. Donald: No, not all cancer patients can benefit from Organ Preservation Therapy. Sometimes the cancer is just to advanced, or maybe the patient is too old and cannot cope with the reformation procedures. However, studies have shown that breast cancer affects more young people in India than the west. And if you think about it, young ladies being forced to have their breasts surgically removed is almost criminal. Especially in India, there is so much stigma that such patients cannot imagine stepping out and having normal social interactions without being stared at or being treated as a ‘lesser’ person.
Similarly, kidney preservation allows the kidney to be saved. A patient who has had one kidney removed has increased chances of developing other ailments such chronic renal failure and coronary diseases at a later stage in life. The overall quality of life is also greatly reduced. Then there is the option of sphincter preservation in the case of rectal cancer. Radical surgery would require the entire rectum to be removed, the stoma being removed permanently, leaving the patient with a severe deformity. However, Organ Preservation Surgery would first shrink the tumor before the surgery, only temporarily remove the stoma, and then simply replace it once the treatment is done. Finally, cancer of the jaw is very common among Indian men and radical surgery would mean the entire, or at least a part of, the jaw being removed, including teeth. Organ Preservation Surgery saves the patient from going through this ordeal.
Afshan: How does Organ Preservation Surgery compare with radical cancer surgery in terms of effectiveness? What are the chances of a person going into a relapse if they undergo Organ Preservation Surgery instead of radical surgery?
Dr. Donald: In any cancer surgery, there is always a chance of relapse. One may remove the entire organ or opt for Organ Preservation Surgery, but there are always exceptions – some people may not respond as well as others. Studies have proven that the success rate as well as relapse rate of cancer remains the same whether your opt for radical surgery or Organ Preservation Surgery.
Afshan: Why do patients still choose radical surgery when there is a much better option available?
Dr. Donald: First of all, it is a matter of awareness. People simply do not know that they can have cancer surgery without amputation. When people are informed about organ Preservation Surgery, they know that, not only will it increase their lifespan, but will also ensure a higher quality of life. Patient, however, depend on their doctor to inform them of the possibilities of organ preservation. As, I had mentioned earlier, doctors tend to withhold this information because they either do not know how to perform Organ Preservation Surgery and do not wish to lose a client, or they simply believe that radical surgery is better as the doctors themselves are not well informed.
Then there is the issue of cost. Organ Preservation Surgery and the plastic surgery that goes with it, obviously costs more than radical surgery. Unlike the US where people have health insurance, Indian cancer patients mostly have to bear the entire treatment expense. They might simply not be able to afford it. Finally, there is the aspect of fear. Even if a doctor does tell the patient that Organ Preservation Surgery is as effective as radical surgery, and even when the patient can afford it – they might still opt for the radical method as they firmly believe that getting rid of the affected organ is the only way to ensure there will not be a relapse. That’s a mistake – that is not how cancer works.
Afshan: Is there a way to boost the chances of success of a cancer surgery?
Dr. Donald: Cancer detected in early stages is much easier to treat and has a lower chance of relapse as compared to late stage cancer. The West has a better screening process, and so cancers are detected early and more preservation is possible. Most of the cases of cancer we get in India are already in the advanced stages. However, we can still reduce the tumor or cancer by chemo and then conduct organ preservation surgery.
Afshan: Thank you so much for helping us understand Organ Preservation Surgery better! Would you like to send a message to our readers?
Dr. Donald: I would appeal to doctors to recommend or at least inform their patients about Organ Preservation Surgeries as an option to treat cancer. Patients listen to their suggestions and so the onus of raising awareness about Organ Preservation Surgeries is on the doctors. These surgeries have been conducted around the world for over 20 years and are very common in the West. And to the patients, or those who know someone suffering from cancer – you do not have to have your organs removed or amputated. There is a much better way to treat cancer and lead a perfectly normal and fulfilling life after treatment – it is called Organ Preservation Surgery – and you should find out everything you can about it!