Fight against cancer is a world-encompassing task. Scientists and practical doctors are in constant search of new surgical techniques, equipment for irradiation and pharmacotherapeutic remedies. Leading world’s oncological centers gladly provide help to the international patients, contributing to more favorable survival rates in people with different types of cancer all over the globe. In addition to such traditional leaders in cancer treatment as Germany and Israel, India becomes more and more popular destination among the medical travelers. Due to cultural, scientific and financial peculiarities, this country can surprise us and offer patients from European, Arabic and Asian countries significant benefits.
Peculiarities of cancer treatment in India
According to the World Health Organization (WHO), 800 000 of new cancer cases are registered annually in India. In combination with significant heterogeneity of population in terms of access to the medical help, paying capacity and education level, this leads to the certain specific features of providing help to the cancer patients.
1. Availability of world’ approved state-of-art treatment methods and elaborating additional options on their basis. Leading Indian hospitals actively use latest achievements in the sphere of oncology, like neuronavigation during interventions on the brain, PET CT scans and immunotherapy. Nevertheless, Indian scientists never stop at this point. They improve surgical techniques and develop new drug molecules.
2. Active participation in clinical trials. During the last decade, over 5900 clinical trials were registered in the Clinical trial registry, India (CTRI). Which is remarkable, more than 700 of these were cancer trials. India is one of the most favorable countries for this purpose due to:
- Large number of cancer cases
- Substantial unmet need in medical help and pool of naïve patients
- Presence of well-equipped clinical trial sites
- Presence of educated and skilful investigators
- Availability of comprehensive and updated cancer registries
- Availability of corresponding regulatory bodies
Results of clinical trials are actively implemented in the clinical practice for the benefit of patients.
3. Making costs reasonable and affordable. All options of cancer treatment, including complex neurosurgical interventions, are 500% to 700% cheaper, when compared to European countries and the USA. This is connected with excluding overpricing even in the private sector of medicine.
4. Genetic testing for the certain types of tumors. Revealing risk factors and early detection of cancer are essential conditions of the effective treatment. Investigating person’s genome (the whole number of chromosomes with genetic material) gives chance to find harmful genes in advance and start prophylactic surveillance.
5. Paying additional attention to the most widespread types of cancer in India – prostate cancer, brain neoplasms, and colorectal cancer. Naturally, the greatest effort is made to help people in overcoming these illnesses and vast experience is gained in the corresponding sphere. Further we will take a closer look at treatment options of particular cancer types in leading Indian hospitals.
Brain tumors – precise interventions and effective irradiation
In India, incidence of central nervous system neoplasms ranges from 5 to 10 per 100,000 population and demonstrates an increasing trend during last decades. Fortunately, up-to-date therapeutical options give such patients another chance – 2-year survival rates in patients with glioblastoma multiforme and anaplastic astrocytoma (the most unfavorable histological types of cerebral neoplasms) already exceed 10%. This is possible due to the following medical advancements.
1. Stereotactic radiosurgery. Gamma Knife and CyberKnife are technical devices that successfully substitute conventional scalpel and wide skin / skull incisions. Precisely focused beams destroy the primary malignant neoplasm and metastases. Gamma Knife has the accuracy of 0.3 mm – this means that healthy brain tissue 0.3 mm away from the pathological locus will remain safe. CyberKnife intervention is less precise (up to 1.0 mm), but totally non-invasive and requires no anesthesia.
2. Diverse modalities of radiation therapy. Proton therapy is irradiation with heavy nuclear particles. It helps patients with recurrent cerebral tumors or those who require postoperative radiation therapy. Another option, 3D conformal radiation therapy, takes into consideration volume and shape of the tumor. Adjustment of irradiation to the certain shape lowers neighboring healthy tissues radiation exposure.
3. Systemic and local chemotherapy. In addition to the systemic chemotherapy, when the drug is given by mouth or injected intravenously, local chemotherapy is possible in patients with brain cancer. Local chemotherapy includes introduction of drugs directly into the cerebral tissue right after the surgery. Another option is repeated introduction of the necessary medications via the spinal shunt. Local, targeted chemotherapy is more effective and has less undesired side effects.
Nevertheless, sometimes conventional surgical interventions via invasive approaches are 100% effective. In February 2018 CNN has told the whole world about the story of Sanlal Pal. Sanlal Pal is a 31-year-old male, who lives in Uttar Pradesh. He has appealed to a hospital in Mumbai for medical aid with complaints of head deformity and blurred vision. After the examination, a 4.1-pound tumor was removed from his brain. Luckily, surgery was the only necessary treatment option.
Prostate cancer – robotic surgeries and biological treatment
According to the population-based Indian cancer registries, prostate cancer is the disease of large cities. Men in Delhi, Mumbai and Kolkata are 4-5 times more likely to develop the prostate cancer than men in small towns. In general, age adjusted rate ranges from 5.4 to 11.1 per 100,000 population, which is quite high.
Depending on the stage of the disease and general state of patient, different medical tactics can be chosen. Fortunately, the whole spectrum of treatment options is available in leading Indian hospitals.
1. Watchful waiting. This approach is used in patients with small, presumably benign, tumors and suspicious changes in the prostate tissue. More aggressive therapy may have more risks than benefits, so patients just stay under the doctor’s surveillance and monitor PSA levels.
2. Radical prostatectomy is the most simple and effective way to get rid of the prostate cancer. All cancer cells are removed during one surgery and a patient is considered to be totally cured. Radical prostatectomy is performed in absence of metastases – this should be obligatory confirmed by PET CT scan. If the total volume of prostate gland is not too big, then the robotic surgery can be used. This is an extremely precise and nerve-sparing keyhole surgery. Viable nerves ensure normal urination and sexual function in the future.
3. Brachytherapy implies placement of radioactive devices (also called radioactive “seeds”) into the prostate gland, in close proximity to cancer cells. Radiation gradually destroys undesirable cells leading to the disease remission.
4. Conformal radiotherapy takes into consideration exact localization, shape and volume of the neoplasm. Thus, irradiation is more accurate and fewer side effects arise.
5. Intensity modulated radiotherapy (IMRT) is even more advanced form of the conformal radiotherapy. IMRT uses radiation beams of different intensity and length in order to target oncological tissue and preserve the healthy ones. This intervention requires obligatory computer control.
6. Radioactive injections. Injections of Radium-233 into the prostate gland kill cancer cells. The therapeutic radionuclide doesn’t enter systemic circulation and cause no harm to the rest of body.
7. Drug therapy includes chemotherapeutic drugs, estrogen patches for patients with hormone-sensitive neoplasms and administration of Xtandi. Xtandi, or enzalutamide, is the anti-androgen medicine that blocks testosterone receptors and slows down growth and spread of prostate cancer.
Such variety of basically different medical possibilities gives doctors real chance to reach complete remission of the disease with minimal side effects. After getting cured, men preserve normal urination and sexual function.
Immunotherapy – enhancing own immunity against cancer
While surgery, chemo- and radiation therapy aim at destroying a malignant tumor by external means, immunotherapy modifies patient’s own immune system. Under normal conditions cancer cells are invisible for the immune system due to the specific structure of superficial antigens. Such invisibility allows them to multiply uncontrollably and invade distant organs. Reinforced immune cells become able to see cancer cells and kill them.
Immunotherapy has various forms and mechanisms of action. Nowadays this is the most promising anti-cancer therapy, new sides of which are yet to be discovered. Indian specialists actively use such forms of biological therapy in their clinical practice:
- Monoclonal antibodies. Usual antibodies are produced by B-cells (a part of the human’s immune system) and target specific molecules on the surface of pathogenic cells. Monoclonal antibodies are able to recognize and attack cancer cells.
- Antiangiogenic drugs. This is a kind of monoclonal antibodies that suppresses grows of tumor’s blood vessels. Deprived of blood supply and nutrients, a neoplasm shrinks and dies.
- Checkpoint inhibitors destroy masking ability of cancer cells, making them visible to the person’s immunity. Even more, drugs of this group additionally activate T-cells – direct killers of abnormal and foreign for the organism cells.
- General immune modulating agents. Over-activation of the immune system by non-specific vaccines increases the chance of simultaneous attacking cancer cells.
One more key feature of the immunotherapy in India is reasonable price of medications. Indian healthcare specialists follow the “principle of 2A” – the treatment should be available and affordable. Other way, all the scientific advances are useless for people and practical medicine. By the word, in 2018 immunotherapy with modified T-cells received the Nobel Prize in Medicine.
Best Indian doctors, specialized in cancer treatment
Oncology is usually a secondary medical specialty. Doctors start their education and career in the field of therapy or surgery, shifting to the cancer treatment later on. Practical experience in other spheres of medicine is a significant advantage when it comes to the comprehensive cancer treatment. Further we will talk about the most prominent Indian oncologists.
Dr Harit Chaturvedi, the surgical oncologist from New Delhi, works in Max Super Speciality Hospital. Dr Harit Chaturvedi has dedicated more than 25 years of his life to surgical treatment of malignant tumors, with special attention to cancer of gastrointestinal tract and breast cancer. He has over 50 publications and conference reports on the local and international levels. Dr Chaturvedi is a member of Association of Surgeons of India, Association of Breast Surgeons of India, Indian Association of Surgical Oncology, and India Society of Oncology.
Dr. Kapil Kumar is also the surgical oncologist from New Delhi. He works in BLK Super Speciality Hospital, combining practical work in the operating rooms with the administrative position of the medical director. With 25 years of work in the relevant field, Dr. Kumar specializes in treatment of breast, lung and esophagus cancer, as well as in oncoplastic surgeries. He is an active member of Delhi Medical Association and Indian Society of Oncology.
Dr. Subodh Chandra Pande has another specialty, he is the radiation oncologist. Dr. Subodh Chandra Pande works in Gurgaon, in Artemis Hospital, and occupies a position of Head Physician of the Radiation Oncology Department. According to his specialty, doctor is an expert in all kinds of brachytherapy, image guided radiation therapy (IGRT) and PET scan based techniques. Dr. Subodh Chandra Pande actively participates in work of Association of Radiation Oncologists of India, Indian Society of Oncology, and International Society of Pediatric Oncology.
Best Indian hospitals, specialized in cancer treatment
Most super specialty hospitals have oncology departments, but only certain of them demonstrate outstanding successes and impressive survival rates. Accreditation of Joint Commission International (JCI), National Accreditation Board for Hospitals and Healthcare (NABH) and National Accreditation Board for Testing and Calibration Laboratories (NABL) is a must for leading oncological hospitals.
Fortis Memorial Research Institute (FMRI), Gurgaon, is a comprehensive institute, also called “Mecca of Healthcare” for Asia Pacific region. During last 3 years hospital has provided help to more than 4000 oncological patients, including the international ones. FMRI takes leading positions in pediatric onco-hematology, constantly participating in corresponding clinical trials. Another hospital’s special offer is robotic operations in the neck and chest region (namely, in patients with thyroid gland cancer and esophageal cancer).
BLK Super Speciality Hospital, New Delhi, possibly has the best-equipped oncological department. It was Asia’s first hospital that started using CyberKnife in patients with brain cancer and applied HIPEC (hyperthermic intraperitoneal chemotherapy) in patients with colorectal cancer. In addition, hospital offers patients with breast cancer such innovative techniques, as 3D conformal breast irradiation and single dose intra-operative radiation therapy.
Apollo Hospital, Chennai has few areas of special interest – complex surgical interventions and proton therapy. Surgical oncologists annually perform hundreds of successful liver and lung resections, limb preserving surgeries in patients with bone tumors and laparoscopic surgeries in patients with colorectal cancer. Complicated cases are discussed in the tumor board, which includes specialists in therapeutic, surgical and radiation oncology.
How to apply for cancer treatment in India?
As it was mentioned before, Indian hospitals are ready to provide help to the foreign patients. Large population of the country, high demand in the specialized oncological help and excellent quality/cost ratio of the medical services create significant waiting lists. That is why you should plan treatment in advance or register in the reduced waiting list as an international patient.
Applying for the treatment as an international patient has a number of peculiarities. In order to prepare necessary documents and successfully meet all the requirements, it is better to ask for assistance of the authorized partner of TOP Indian cancer centers – company Booking Health. Booking Health is the medical tourism operator that annually helps thousands of people to fight cancer.
In accordance with the international quality control ISO certificate ISO 9001:2015 in the field of medical tourism, Booking Health offers help in such important aspects:
- Choosing the right clinic based on the annual qualification profile
- Establishing communication directly with your doctor
- Preparing medical program in advance, without repeating previous examinations
- Providing favorable costs, without overpricing and additional coefficients for foreign patients (saving up to 50%)
- Booking the appointment on the necessary date
- Monitoring medical program at all stages
- Help in buying and forwarding of medicines
- Communication with the clinic after treatment completion
- Control of invoices and return of unspent funds
- Organization of additional examinations
- Offering service of the highest level: booking hotels and plane tickets, transfer organization
To start planning treatment you should leave the request on the web-site of Booking Health. Our patient case manager or medical advisor will contact you the same day to discuss all the details of your condition. Aim of our work is to help you in improving and maintaining your health. We will carefully guide you through the whole process of treatment in India and lead to the best possible results.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova
Photo: (c) depositphotos