Abu Dhabi: For decades, cancer has evoked fear. The first mention of the disease can be paralysing for both patients and families, and overcoming the fear of mortality to fight it is often one of the hardest battles.
On the occasion of World Cancer Day, marked internationally on February 4, experts say that advances in the diagnosis and treatment of various cancers should help people take positive action when faced with the disease. This includes being proactive about screening, and seeking treatment even during a global pandemic, they say.
“Even today, many people in the Middle East avoid discussing cancer. But we need to talk much more about it, and make people more familiar with screening requirements.
"The best way to beat cancer, after all, is to live healthy and screen early,” Dr Humaid Al Shamsi, president of Emirates Oncology Society and director of oncology at Bujeel Cancer Institute, told Gulf News.
In the UAE, 4,500 new cancer cases are diagnosed each year, with cancers being the third leading cause of death after cardiovascular illnesses and injuries.
Dr Arun Karanwal, medical oncology specialist at Prime Hospital, reminded that beating cancer is about “focussing on the fight and not the fright”.
“In the last decade or so, there has been an overall improvement in five-year cancer survival rate from 50 per cent to 55 per cent. More importantly, when diagnosed in early stages, the five-year survival rate is more than 90 per cent for Hodgkins lymphoma, breast cancer, testicular cancer and prostate cancer,” Dr Karanwal said.
Tremendous headway in cancer therapy today even allows for some kinds of cancers to be ‘managed’.
“While cancer may still be a serious illness, more and more types of cancers are being managed as chronic diseases, like high blood pressure and diabetes. It still needs to be managed, and new methods of control are certainly needed, but the advances of the past 20 to 30 years have really allowed many people to live with their cancer,” said Dr Mustaqeem Siddiqui, haematologist and consultant at Department of Haematology and Oncology at Sheikh Shakhbout Medical City (SSMC).
Dr Siddiqui added that advances have been seen in the treatment of all kinds of cancers
“While it is true some cancers have had more advances than others, I am hopeful that we will come to a day where all cancers will see drastic improvements in survival rates. I believe what has enabled this improvement in survival is continued investment in understanding basic biology, understanding how cancer develops, understanding how a cancer cell behaves, and understanding how the cancer affects our body including the immune system,” he explained.
On World Cancer Day, the physician, who has long been involved in cancer research with the Mayo Clinic, also extended his gratitude to cancer patients who have participated in clinical studies.
“They are true trailblazers on the forefront of treating cancer and their experiences have informed how we treat cancer today. It is my hope that with continued support of research and clinical studies, one day cancer will be a footnote in history,” he added.
A number of survivors discussed their challenging journeys with Gulf News on the occasion. And while each involves its own trajectory, what shines through is the way all of them advocated for their own health.
Lung cancer: ‘I didn’t understand how my cancer could possibly be treatable’
The rest of the world was battling a pandemic, but Karen Johnson’s position was even more complicated.
Just before cities around the world had come to a halt, on January 19, 2020, Johnson was diagnosed with Stage IV lung cancer. Specifically ALK-positive non-small cell lung cancer, a type of cancer that is typically detected in its advanced stages.
“Usually, I’m the most positive person I know. I thrive on challenges and look for the good in everyone and everything. But being told I had cancer was a whole different kind of challenge. I was in new territory, and scared. I even lost my positive self for a short while,” the 49-year-old British sales and education executive told Gulf News.
She was therefore tremendously surprised when her oncologist said that her cancer, which had spread from her left lung to her abdomen, pelvis and bones, was both controllable and treatable with a regimen of just pills.
“My first question when I heard of my diagnosis was, ‘How long do I have?’ And then I was prescribed eight miracle tablets to take every day, and an injection once a month,” Johnson said.
Johnson had lost her younger sister to cervical cancer eight years ago, so the diagnosis was particularly scary. Added to that, the COVID-19 outbreak made the situation scarier. Not only did Johnson have to worry about her two children being unable to visit from miles away in the UK, she was worried that the cancer might make her more prone to contracting COVID-19.
“In a way, the hardest thing I’ve ever had to do as a mother was telling my children on a video call that I had cancer. I will never forget the look on their faces when I said those words – I have cancer. Right after, I had to quickly reassure them and tell them it was controllable, but they both looked so hurt and helpless,” Johnson said.
The children couldn’t visit right away but Johnson began the treatment, which included eight pills to be taken every day, along with an injection every month. She also needed a session of radiotherapy to treat a brain lesion.
The treatment has significantly reduced her cancer, and Johnson’s children – a 26-year-old son and 29-year-old daughter – were able to visit her during 2020.
She did face a setback when a particularly stubborn lesion required 15 sessions of radiotherapy, but Johnson believes that things will get better.
“I had tremendous support from my husband, children and friends. In fact, my husband has been like my cancer PA, and oftentimes, he has arranged everything so that all I have to do is just show up for my doctor’s appointments. I was worried about the toll on my family, especially since my mom and sisters haven’t been able to meet me for more than a year. But I decided I was going to keep an I-will-beat-this attitude, and trust the professionals treating me,” Johnson said.
She also credits her doctor – Dr Humaid Al Shamsi – with ‘bringing humour into cancer’, and helping her bear some of the mental toll of the illness.
With that being said, it was important for Johnson herself to find her own strength and positivity.
“As clichéd is it sounds, what helps is reminding myself that my diagnosis doesn’t define me, and that it is just part of my journey,” she added.
Colon cancer: ‘I had to remove 30 centimetres of my colon’
Ahmad Ayyash was convinced his low haemoglobin readings pointed to something, but his concerns were initially dismissed.
A general physician recommended he resolve the issue with simple iron tablets, but the 66-year-old senior management executive from Palestine persisted. In follow-up testing, another physician suggested he was losing blood, and recommended an endoscopy and colonoscopy to trace the source of the problem. That was when the cancer was discovered, affecting about five centimetres of his colon.
“The word cancer still strikes a sense of fear, and I cannot say I was immune to it. But after the initial diagnosis, I decided to put my faith in medicine, and in my doctors,” Ayyash told Gulf News.
He was first diagnosed in February 2017. A month or so later, Ayyash underwent surgery to remove 30 centimetres of his colon. The procedure was laparoscopic, and therefore only involved about four small cuts on his abdomen. But it left him in hospital for nine days, and relegated him to IV nutrition for eight or so days. Even beyond that, he was only able to stomach soft foods as his body recovered.
“The best thing to do when you have a procedure that involves your digestive system is not to eat, so it was obviously not easy. But beyond then, I have recovered well,” Ayyash said.
What also helped was that Ayyash’s cancer had few effects that were visible, the father-of-four said.
“My family would have been more worried had I been in visible pain, but thankfully, that was not the case with my cancer. I honestly feel like I discovered it by coincidence, and because I insisted that there was something that needed checking,” Ayyash said.
Despite the initial dismissal of his symptoms, Ayyash went on to find much support from his physicians as well.
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“My surgeon – Dr Sadir Alrawi, director of oncology at VPS Healthcare – put me very much at ease. He told me that if I had to choose a cancer, I’d rather choose this because it was treatable,” he said.
Because his cancer was in its early stages, Ayyash did not require any chemotherapy or radiation.
“In fact, the 30 centimetres of bowel that was resected included areas that looked cancer-free but may have been affected,” Ayyash said.
Since the surgery, the 66-year-old has continued to live a largely regular life, still working in senior management. He is regular with his follow-up blood tests, as well as with an annual colonoscopy and CT scan.
But he did learn some important lessons from the experience.
“Cancer should be viewed as a treatable disease as much as possible, and people should not be afraid to undergo screenings, or to insist when they believe something is wrong. After all, there really is a big difference in prognosis when a cancer is discovered at five months and when one is discovered at five years,” Ayyash said.
He also urged primary health professionals not to ignore sudden changes in parameters like haemoglobin level.
“In fact, I learnt to take any such changes seriously, and to pursue it till I am comfortable,” he said.
Lymphoma: 'I chose not to Google survival rates'
It was after a routine meal that 53-year-old business development manager Ajay Chaturvedi first felt that something was wrong.
Feeling nauseated and suffering from diarrhea, he had gone to an emergency unit for treatment, and was sent home with medicines to treat what appeared very much like gastroenteritis – a stomach bug.
Still, he sought out another physician, who discovered a swelling in his abdomen. Scans subsequently revealed that his spleen and liver were enlarged.
“I was shocked to see how my mesenteric arteries, which deliver blood from the heart to the gastrointestinal tract, were sandwiched in cancerous, enlarged lymph nodes,” Chaturvedi, an Indian expat, told Gulf News.
Further tests revealed that he was suffering from the initial stages of B-cell non-Hodgkins lymphoma – a cancer that affects the body’s lymphatic system, which manages immune response.
“I am a strong person, but along this journey, I sometimes found myself weak and broken. I needed support from friends and family, but eventually, I decided to concentrate on my work, and on beating this,” Chaturvedi said.
Diagnosed in 2015, the Dubai resident was prescribed six sessions of chemotherapy.
“I handled the first four sessions very well. But by the fifth one, I was anxious, stressed, weak. I remember distinctly how it was sometimes difficult to even get up once I had sat down in a chair. There was nausea and insomnia to counter, and after each session, I could barely walk for three to four days,” Chaturvedi said.
-Friends of Cancer Patients: 06-5065542
-Bosom Buddies: bosombuddiesad.org
-Brest Friends: 800-ALJALILA
-Breast Cancer Arabia
-Cancer Patient Care Society – Rahma: 80090
In addition to these, various community organisations also provide support, including financial means for patients.
Mustering all his strength, he continued with the chemotherapy sessions, scheduled about three weeks apart, even though he lost his hair and felt wretched.
Fortunately, his friends and family were very encouraging, and kept reminding Chaturvedi that survival rates were as high as 70 per cent when his specific type of lymphoma was discovered early.
“I would look up articles on the Internet, but I eventually chose not to read up about the cancer because it was easy to come across worrying figures and accounts,” Chaturvedi said.
He received the cancer all-clear in October 2017, and still keeps a close watch on his blood count with regular tests and doctor’s visits.
“I know I was scared, but eventually, I fought the fear and focused on conquering the illness. Having beat it, I would remind other people in the same position that there are today a multitude of targeted therapies and effective interventions,” Chaturvedi said.
In addition to keeping a watch on himself, Chaturvedi has also since undergone genetic testing to check if his children are at risk.
“I also derived a lot of strength from my family and friends, but I would urge anyone who feels alone to seek out the many cancer support groups in the UAE,” he added.
Breast cancer: ‘The UAE has very advanced cancer treatment options’
Following the discovery of a lump in 2014, Sofia Khalid had undergone a lumpectomy. Within two years however, the then-51-year-old economist from Pakistan was once again in pain.
Insisting on a battery of tests, including an MRI, her physicians discovered a lobular invasive carcinoma in its very early stages.
”My doctors told me that the cancer – a slow-growing variety – is rarely discovered in its first few stages, especially because it is not apparent through mammograms, physical exams or even ultrasound exams. I had however felt a lump in the same area, and even when everyone insisted it was just scar tissue, I insisted on further screenings,” Khalid told Gulf News.
The diagnosis, Khalid said, nevertheless felt like a death sentence.
“It felt like a bullet, especially since I had, for years, worried about a cancer. The first lump had turned out to be benign, but in 2016, I was convinced there was something more,” she said.
According to her physicians, Khalid’s cancer was rare for women under the age of 60 years, and was hard to detect because the cancer tissue looks very similar to breast tissue.
Still, Khalid took charge of her treatment, and opted for a full mastectomy with reconstruction. One of her daughters flew down from Canada, as well as an aunt from Pakistan, and Khalid said her workplace remained extremely supportive throughout the ordeal.
Since her cancer had not yet spread, there was no follow-up chemotherapy or radiotherapy. Instead, Khalid was prescribed hormone therapy in the form of a daily pill.
"When I consulted other experts, everyone told me I had been given some of the best medical treatment possible. The UAE does have very advanced cancer treatment available, and I was lucky to have access to it,” Khalid said.
Throughout a cancer journey, patients require various tests, assessments and treatments, which are performed by a range of caregivers at many different facilities. The Malaffi health information exchange in Abu Dhabi allows access to accurate, up-to-date health information and this helped Khalid and her care providers keep track of all the medical information from her appointments, and to go through all the follow-up checks. Khalid's medical teams could also see all the medications she was taking, and she didn’t need to worry that they might prescribe something that would cause a reaction.
Khalid was eventually able to both have her cancer tissue removed, and her breast reconstructed, during a single procedure.
But the ordeal had brought along its own trauma, and Khalid signed up for psychotherapy to resolve her feelings of depression.
“It’s taken me three years to work on my mental health, and I am glad I have chosen to do it. An atmosphere of doom and gloom helps nobody,” she said. The mother-of-four has also taken up regular exercise after her brush with cancer.
Following her experience, Khalid advised that women advocate for their own health.
“Had I not insisted on so many tests or discussed my concern repeatedly with my doctors, the cancer might not have been discovered so early. What I learnt was that if there are cancer symptoms, you may already be too late. So it is important to be proactive all the time,” she urged.
Lymphoma: 8 years on, I keep looking over my shoulder
Shyam A. Krishna, Senior Associate Editor
“It will be back,” the doctor said, referring to my lymphoma. That was eight years ago. The cancer hasn’t returned, but I’m still worried. I guess, the fear will always remain.
I do blood tests every six months, and a CT scan annually. So far, I’ve been cancer-free. But every time I have a sore throat (from acid reflux), I involuntarily check my lymph nodes in the neck. Whenever I get a shaft of pain anywhere in my abdomen, the alarm bells keep ringing.
Call it hypochondria or survival instinct, I make more visits to my gastroenterologist than necessary. That’s more for my GERD (Gastroesophageal Reflux Disease). He was the one who diagnosed my cancer even after the initial battery of tests turned up nothing. The pain in my lower abdomen kept recurring every week. As the final throw of dice, the doctor called for a CT-Scan that revealed a growth in a lymph node. Non-Hodgkins Lymphoma, that was the diagnosis. Immunotherapy and radiotherapy helped heal.
How was my cancer journey? What did I learn from it? Not much. Whatever little I learned, I forgot. Because life became normal. I’m reminded of my cancer only when the reminders for the tests pop on my phone. Yet, there are moments when I look back at the dark days with trepidation. And realise how lucky I was.
My doctor called it “the best cancer anyone can get”. It’s treatable, he added. Those words helped calm me. Later during my intense research on the internet, I found there are aggressive forms of lymphoma. And that it’s treatable but not curable. Which means there’s no 100% cure. So when the oncologist warned me that it might return I wasn’t surprised. By then, my initial shock had worn off. I was sure that I would survive.
I didn’t just survive, I live a full life. An active life. Cancer didn’t stop me, and I didn’t allow cancer to disrupt my life. It was a bump on the road. I’m cruising again. But the doctor’s words continue to reverberate in my ears. So I’m always looking over my shoulder.
Game changers in cancer therapy
Over the last decade, major advancements have been made towards turning cancers into more treatable, easily detectable conditions.
Dr Humaid Al Shamsi, president of Emirates Oncology Society, offered his take on the game changers that are available today, and those that are shaping up.
In the simplest of terms, a blood test is used to assess a patient’s DNA. The analysis of tumour fragments gives clues on specific mutations that can be targeted during therapy.
Essentially, mutations are like locks on cancer cells, and the targeted therapy, administered intravenously or in the form of pills, acts like keys to those locks. This means that two patients with the same cancer could receive different therapies to target their specific cancers. The targeted therapy acts to stop the growth of the specific cancer tissue. In fact, a treatment that targets a specific mutation or genetic feature could be used to target vastly different cancer types, and the United States Food and Drug Administration has already approved treatments that act on specific cancer biomarkers rather than the site where the cancer originates.
Why this is a game changer: Targeted therapies are more effective at fighting the cancer when a patient responds to them. There are also potentially fewer side effects, and less harm to normal cells.
This aims to activate the body’s immune response, which is often ‘put to sleep’ by cancer tissues.
Cancer cells grow by persuading the patient’s immune system that they are friendly, and eventually make this immune response dormant so that the cancer can grow. A PDL1 test, which looks for the PDL1 protein on cancer cells is usually carried out. This protein helps the immune system recognise non-harmful cells in the body, and cancers that have high amounts of PDL1 can therefore trick the human body and prevent the launch of an immune response.
A biopsy is required for the PDL1 test, and if the level of PDL1 is high enough, the patient may be started on immunotherapy.
Why this is a game changer: Once the immune system is cranked back into action, the patient is likely to suffer fewer side effects like thyroid dysfunction. In many cases, survival rates are also higher than with conventional cancer therapy.
Patients are often mistakenly afraid that a needle biopsy will cause cancer tissues to spread. In other cases, the cancer tissue is in a sensitive or hard-to-reach area, or a biopsy can cause much bleeding. A liquid biopsy is a simple blood test that is analysed for DNA to detect the presence of many types of cancers.
Their ease and versatility means that liquid biopsies, still under development for many cancer types, are likely to become the gold standard for cancer detection.
Why this is a game changer: A simple blood test can enable screening for multiple cancers, doing away with the need to perform multiple screenings to look for different types of cancers. In addition, they do away with the discomfort of needle and excisional biopsies.
Drawing on from liquid biopsies, blood-based tests will be capable of detecting multiple types of cancer from a single sample. They present an emerging approach to early cancer detection.
In fact, a single blood sample can be used to test for 50 or more types of cancer with 99 per cent accuracy, as shown in a study conducted on 100,000 people in the United Kingdom. The hurdle is that these blood tests and their analysis are extremely expensive right now, going up to Dh30,000 per test. However, with the regulatory approvals and widespread use, costs are bound to come down.
Although there are many single-cancer detection tests in development, multi-cancer screening tests have much greater potential to allow for widespread screening in the general population.
Why this is a game changer: Blood-based tests will allow authorities to conduct general population screenings much more efficiently, thereby allowing them to allocate effective diagnostic and treatment resources.
Robotic surgery with AI implementation:
Robotic surgery is often used in cancer treatment even now, and the next step involves surgeons operating remotely. This would give patients, especially those in rural or remote locations, access to better treatment. AI could also be used to identify critical organs and concerns, improving surgical accuracy.
While such procedures have been conducted in the United States and the United Kingdom, there are medico-legal considerations that have to be ironed out.
Why this is a game changer: Experts in a specific cancer or body part can operate on patients without either having to travel.