Cancer is a term that is associated with death and incurability, unless it is detected early and the disease is localized enough to be resected completely. Despite major advances in surgical techniques, the affected organ whether it is a kidney or the breast have to removed entirely from the body in most cases followed by local radiation therapy and treatment with anti-cancer drugs aimed at preventing its recurrence or spread. Once the cancer has spread beyond the geographical limits of its organ or has escaped into the bloodstream to invade distant organs (like a breast cancer going to the bones or the brain) it is called metastasis and is deemed incurable.
Compare this to the development of blood cancers (named under three broad categories-Leukemia, Lymphoma and Myeloma)! They are blood cells originating from the bone marrow which have gone rogue and are exploding or seeding different lymph nodes and organs through the entire length and breadth of the body. Yet, blood cancers remain the most curable cancer, not only in children but also in adults. The primary reason for this is three-fold. First, the cancer cells are flowing in the bloodstream and are accessible to the drugs we want to expose them to. Secondly, we know that they originate from the blood stem cells or their immediate progenies and they can be replaced with a normal healthy blood stem cells. Finally, cancer of any sort arises from deficiency in surveillance of our immune system. By changing the soldiers of the immune system who are exhausted and cannot fight the cancer anymore with fresh ones, we can cure blood cancers which are not responsive to drugs. The latter two goals are achieved with a process called blood and marrow transplantation (BMT).
BMT is not a process in isolation but a culminating treatment for blood cancers where the initial steps are orchestrated and entwined to lead to the crescendo of the final harmony ie BMT. Thus, doctors who specialize in treating blood cancers and who are competent in performing the procedure of BMT are best suited to treat blood cancers. Whilst this segregation of treatment of blood cancers and BMT is established in the western world, the concept is still nascent and embryonic in India. There was a time when surgeons administered chemotherapy and later the radiotherapists also joined forces as the drugs available to treat cancers were limited and blood cancers were left in the hands of destiny. Subsequently, surgery and radiation therapy have attained greater precision and numerous drugs have been added to the anti-cancer armamentarium. Despite the explosive increase in anti-cancer drugs, newer drugs have increased the survival of patients with advanced solid organ cancers by an average of 3 months. On the other hand, majority of the blood cancers irrespective of their type or nature are potentially curable in younger patients (less than 65 years) with a BMT done at the right time in the right way. Lack of awareness often leaves a patient suffering from blood cancer languishing under assaults of repeated chemotherapy and radiotherapy without being offered a curative option such as BMT. For example, 80% of adults with acute myeloid leukemia require a BMT once the disease is under control (called first complete remission) and have a good 80% chance of being cured. This reduces to less than 10% once the disease returns with vengeance. Unfortunately, less than 10% of the patients in the former category ever receive a BMT depriving them of a potentially curative option.
Finally, a word of caution about BMT as well. Being the most intricate process of modern medicine, this requires the greatest degree of expertise. This story is best left for another time.
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