Just like chemotherapy, immunotherapy is also administered as IV infusions.

Immunotherapy is not as toxic as chemotherapy. In fact, it has less severe toxicities compared to chemotherapy, and the frequency of toxicities is lower. However, the side effect profile of immunotherapy is different, and one needs to be extremely vigilant to identify and manage these side effects effectively.

Side effects of immunotherapy are due to its mechanism of action, i.e., boosting your immune system. Your immune system may act against your body, manifesting as side effects. Common side effects include skin rash, hypothyroidism, diarrhea, and hepatitis. Less common side effects include interstitial lung disease, kidney injury, and adrenocortical insufficiency.

Among all patients treated with immunotherapy, nearly 10 to 20% of cases are cured, with the disease not recurring for more than 5 years or sometimes never in a lifetime. It has significantly changed the lives of many individuals, curing them of their cancer.

There is no definitive answer to this question. Ideally, it should be continued indefinitely. However, there is evidence that 2 years of immunotherapy may suffice for durable and sustainable responses.

Precision medicine, also known as “personalized medicine,” uses specific information about a person’s tumor, taking into account factors such as genetic make-up and tumor proteins, to help in diagnosis and tailoring cancer treatment. It also helps assess the prognosis and effect of the treatment on specific cancer types.

Depending on the genetic make-up and protein expression of the cancer, diagnosis and treatment plans are made. For example, in breast cancer, depending on the expression of estrogen (ER), progesterone (PR) receptors, and HER2 protein on the cancer cells, the treatment of the cancer subtype is adjusted. If the cancer is ER/PR positive, hormonal therapy is used along with chemotherapy. If it is HER2 overexpressed, targeted therapy like Trastuzumab is used.

Precision medicine is being developed and explored in almost all cancers. To name a few, it is available in breast, lung, stomach, colon, pancreatic, ovarian, prostate cancers, etc.

Since treatment is planned based on specific cancer markers, therapeutic agents act specifically on the cancer cells. This type of treatment is also known as targeted therapy. Therefore, the efficacy of the treatment is increased with fewer side effects, as the treatment targets only cancer cells.

Side effects associated with precision medicine depend on the targeted therapy used. As these therapies act specifically on cancer cells, side effects are expected to be lower than those from systemic chemotherapy and can be managed easily. For example, Trastuzumab does not have the chemotherapeutic side effects like nausea, vomiting, hair loss, or cytopenias, but it may have class-specific side effects that can affect the heart in rare cases.

CAR-T Chimeric Antigen Receptor T Cell Therapy is a type of immunotherapy. "Chimera" refers to a fusion. In simple terms, T cells are initially collected from the patient's blood when the cancer is in remission. These T cells are then genetically modified by viruses that do not cause disease. The modified T cells produce specialized receptors on their surface called Chimeric Antigen Receptors (CARs). These T cells are cultured to produce millions of CAR-T cells. The final product, CAR-T cells, are infused into the patient, where they bind to specific antigens on the cancer cells and kill them.

CAR-T cells are being extensively investigated in both hematological and solid malignancies. However, they are currently approved for Acute Lymphoblastic Leukemia (ALL), Lymphomas, and Multiple Myeloma. It is important to note that CAR-T cells are not yet approved for first-line management of these malignancies. They are used for patients who are relapsed and refractory, who have exhausted other therapeutic options, including bone marrow transplantation.

CAR-T cells, being genetically modified, come with side effects. Commonly expected side effects include cytokine release syndrome, neutropenia, infections, and, rarely, neurologic sequelae. These side effects can be managed with timely intervention.

Evidence suggests that CAR-T cells are very effective in eradicating cancer in many patients, with benefits potentially lasting for many years, even after multiple lines of treatment. In the future, CAR-T cell therapy might become more curative when used earlier in treatment.

In Bone Marrow Transplantation (BMT), stem cells are collected from the patient's blood or a relative's blood and infused into the patient after high-dose chemotherapy. Chemotherapy helps kill cancer, and BMT aids in the recovery of blood cells. In contrast, CAR-T cell therapy involves collecting T cells from the patient when their disease is in remission, genetically modifying these T cells to target cancer cell antigens, and then infusing them back into the patient to kill cancer cells.

A liquid biopsy is a non-invasive laboratory test that examines blood, urine, and other body fluid samples for the detection of cancer. As the cancer grows, it sheds off cancer cells, DNA, RNA, and other molecules into the blood, urine, and other body fluids. Liquid biopsy helps in identifying these.

In a traditional biopsy, a tissue from a specific organ is needed for the diagnosis of cancer. It requires an invasive method to get this tissue, which is a painful procedure. It takes time to arrange for a biopsy and needs further time for pathological evaluation. The total turnaround time for complete diagnosis takes around 2 weeks. With liquid biopsy, it can be decreased to nearly a week.

Liquid biopsy is intended to help in diagnosing and planning cancer treatment. It can also help in identifying treatment resistance mechanisms. As of now, liquid biopsy isn’t always reliable for diagnosing cancer; traditional biopsy is still required.

To date, only 5 different types of liquid biopsies are approved by the US FDA. These biopsies are either used in diagnosis, planning treatment, and monitoring resistance mechanisms in cancers. The most important and significant test among these is the mutation testing and resistance mechanism testing of EGFR in lung cancer.

Yes, liquid biopsy can help in monitoring treatment responses in cancers. However, it’s in the preliminary stages of research for clinical use. A lot of research is being done on this, and it may become available for clinical use in the near future.

Research is being done to screen for cancers using liquid biopsy, but so far none of the tests are approved for cancer screening.

Cancer survivorship begins at the time of diagnosis and continues throughout and after treatment and living beyond cancer. It encompasses the physical, psychological, social, financial aspects, surveillance for recurrences, cancer prevention, and coping with short-term and long-term side effects of cancer treatment. It also involves support from healthcare providers, caregivers, family, friends, and support groups to help survivors navigate life after cancer treatment.

Diagnosing cancer is a big blow and shock to the majority of patients due to the stigma associated with it, often assuming there is no cure or treatment. Cancer patients face challenges including physical, psychological, social, financial issues, and short-term and long-term side effects of the treatment. These challenges need to be addressed with the help of healthcare providers, caregivers, family, and friends.

Survivorship care plans outline the specific details of the cancer survivor’s treatment history, as well as recommendations for follow-up care and strategies for maintaining overall health and well-being. The importance of survivorship care plans lies in several key areas: a) continuity of care b) education and empowerment c) addressing survivorship issues (as discussed above) and promoting health and wellness.

Not all the cancers caused are hereditary in nature. Hereditary cancers are the ones which run in families and these include a spectrum of cancers. For example, breast cancers and ovarian cancers run together and this syndrome is called hereditary breast ovarian cancer syndrome (HBOC). There is a high risk of hereditary cancers when the cancers occur in individuals at a young age. Therefore, it is important to know about the detailed family history of cancers and any other medical illness on both paternal and maternal family members as hereditary cancers can be from both parents.

Simple and direct answer to this question is NO. Genetic testing is not done in all cancers. There are specific indications for genetic testing in cancer. Before going into further details, one should know that genetic testing is basically of two types in cancers. First is the somatic testing and second is the germline testing. Somatic genetic testing is done on the cancer tissue specimen and will let us know about the mutations that occurred in that specific cancer; these mutations can be either inherited or acquired. The second type is germline genetic testing, which tests whether there are any inherited genetic mutations in the cancer. These are the mutations which can run in families.

Somatic testing or germline genetic testing is done based on the age, type of cancer, detailed family history, and therapeutic implications of the cancer type. As already discussed, there is no need for genetic testing in all cancers.

Depending on the somatic and germline mutations identified, genetic testing can help in cancer treatment and screening. For example, if an ovarian cancer patient with a family history of breast cancer has a BRCA1 germline mutation, she is eligible for treatment with PARP inhibitors (targeted therapy), which has a high impact on disease progression and survival. Family members of the patient are also eligible for genetic testing and should be screened for specific cancers for early detection and management, which could be worse if not detected early.

Palliative medicine is a specialized medical treatment that focuses on relief of pain and other symptoms of serious illness. It helps you cope with the side effects of medical treatment. Goals of palliative care are to: Maximize the quality of life, provide relief from pain and other medical symptoms, provide psychosocial and spiritual care, and provide support to the family during the patient’s illness and in their subsequent bereavement.

Palliative care addresses physical, psychological, social, and spiritual needs of the patients and their family members. It starts from the start of the cancer diagnosis, throughout the treatment and later too. Palliative care is provided whether the patient is receiving curative treatment or palliative treatment.

Many people assume Palliative care and End of life care are the same. As discussed above, palliative care begins from the start of diagnosis and continues throughout the treatment and follow-up, whereas end of life care, also known as hospice care, focuses on the quality of life, care, and comfort of the patients who are approaching the end of their lives.

Cancer screening is the method by which cancer can be detected in the early stage when the patient does not have any symptoms. Therefore, it helps in the curative treatment of cancer and thus prolongs life.

Increase in age is one of the risk factors for some cancers like breast, colon, cervical, and prostate cancer. So, the general population and individuals with certain risk factors should be screened for cancers as recommended by regulatory authorities, thus cancer can be detected early and managed accordingly.

Generally, cancer screening methods are non-invasive. These can be either blood tests, radiological imaging, or endoscopy procedures. Methods depend on the cancer you are screened for. For example, breast cancer is screened by mammography, colon cancer by colonoscopy, cervical cancer by pap smear, etc.

No, all cancers cannot be screened. For a cancer to be screened, it should be detected in the early stages, have a long latency period to develop into a full-blown cancer, and have treatments available for the diagnosed cancer. Therefore, cancers with these properties are screened, including breast cancer, cervical cancer, and colon cancer. Others include ovarian cancer, prostate cancer, oral cancers, and lung cancers.

Discussing screening guidelines is very extensive. But for general information: breast cancer screening should start at 40 years of age, colon cancer screening should start at 50 years of age, and cervical cancer screening from the age of 21 years. Other cancers like oral cancers, lung cancers, and prostate cancers are screened depending on the risk factors.

As discussed, screening methods are generally non-invasive blood tests, radiological imaging, and endoscopy procedures. Side effects with these methods are either none or minimal. So any individual interested in screening for cancer can go for the method with confidence after discussing with a physician regarding the specific method of testing.

Diet plays a major role in the causation and prevention of cancer. Nearly 30% of cancers are estimated to be due to the western diet (standard American diet), sedentary lifestyle habits, and their consequences. Due to increased adoption of this diet in our lifestyle from the western world, which has high concentrations of sugars, processed foods with less fiber, and a sedentary lifestyle, there might be an increased incidence of cancers in the Indian subcontinent in recent years. Increased intake of foods with highly concentrated sugars, processed foods, and less fiber impairs glucose metabolism, subsequently leading to obesity and cancer.

Yes, there is ample evidence that cancer can be prevented with a balanced diet. A diet with complex carbohydrates, unprocessed foods, high fiber, whole grains, green leafy vegetables, vitamins, and minerals through natural foods helps in the prevention of multiple cancers.

Once cancer is diagnosed, some patients tend to consume less food than required. Growing evidence suggests that there is no need for a restricted diet during cancer treatment. One should eat according to their body's needs and not starve. The important consideration is to consume home-cooked food to avoid contaminated and unhygienic outside food.

A neutropenic diet is advised during the period of neutropenia, particularly in blood cancer patients. During neutropenia, there is an increased risk of infections compared to normal. Therefore, this diet was formulated to limit individuals' exposure to harmful bacteria in foods and drinks. This diet avoids raw vegetables, undercooked food, and outside food. However, recent literature suggests that if proper hygienic measures are maintained, there is no need for a stricter neutropenic diet.

Many family members assume that cancer spreads from one individual to another and start isolating them from the family and even feeding them separately. Contrary to this assumption, cancer is a non-communicable disease, and family members can share space and food with cancer-affected individuals. It is crucial for cancer patients to receive support from their family more than ever and be motivated to maintain a positive attitude.

For a cancer drug or for that matter any drug to use in general clinical practice, it is first evaluated for safety and efficacy in animals (pre-clinical studies) and when it is found to be safe and efficacious for treatment it is then evaluated in humans (clinical studies). Studies which are done in humans for further safety and efficacy for a treatment are called clinical trials.

To use any new drug for a particular disease when there is no treatment or when there is existing treatment, it is important to prove that the new drug is better than either no treatment or the existing treatment in terms of its efficacy and side effects. If the new drug has good efficacy in treating the disease and has fewer side effects, it will then be approved by regulatory authorities to use in regular clinical practices. So, to prove the safety and efficacy of a drug, it is important to do clinical trials.

No, there is no need to enrol all the cancer patients in clinical trials. There are established standard treatments in the majority of cancers. In such instances, there is no need for enrolment into a clinical trial. However, when there are multiple recurrences and therapeutic options are exhausted, it is prudent to know about the ongoing clinical trials and enrol if possible so that cancer patients can get the benefit of trial drugs.

When you meet your oncologist, you can discuss all the available treatment options and clinical trials. Depending on the disease stage, recurrence, and inclusion and exclusion criteria, you can enrol in the trial.