Why chemotherapy for cancer
Dr S.M. Bose

Chemotherapy (CT ) or treatment of cancer by using chemical agents is being used more frequently today. The beneficial effect of this form of therapy was demonstrated way back in 1865, but the way it is used now started is the early 1940s. It has revolutionised cancer treatment.

The principle behind the use of CT depends upon the fact that the chemical agents are more toxic to sensitive cancer cells than normal cells of the patient. These agents may induce cell death ( cytotoxicity ) or may suppress cancer cells for variable periods without inducing cell death ( cytostatic effects ).

CT and surgery

It has now been realised that surgery provides only local control of the cancer whereas the advanced stage of the disease requires systemic control also. It has been proved beyond doubt that multi-modality treatment, consisting of surgery, chemotherapy, radiotherapy, immunotherapy and others may be required for adequate management of the cancer of different kinds.

CT drugs are usually used along with surgery. It is mostly used after an operation (adjuvant therapy) to take care of the circulating cancer cells or for any residual tumour at the primary site or at distant metastasis. The disease where CT is being commonly used along with surgery is the cancer of the breast, the cervix, ovaries, colon, rectum, urinary bladder, prostate, Wilms tumour of kidney, tumours of childhood, etc.

CT is also used before the operation in the advanced stage of certain types of cancer (Neoadjuvant therapy).

However, CT agents do not lead to only the beneficial results in cancer patients. They also give rise to a number of toxic sideeffects. This toxic reaction is the limiting factor for the use of CT. Nausea, vomiting, weakness, lethargy, loss of appetitive and hair-fall are the common complications associated with CT.

Patients are counselled against conceiving children during active CT because congenital malformations may result, especially with a few drugs administered during the first trimester of pregnancy.

It should be clearly understood that CT drugs are not foolproof in any type of cancer. These may not produce any benefit and, therefore, at times their use in the advanced stage of the disease may not only be useless but may also be hazardous.

Administration of CT

CT drugs may be administered by diverse routes to get the maximum drug availability at the tumour target site. It may be given orally, intravenously, intramuscularly, intra-arterially or it may be directly used over the skin or instilled into the urinary bladder, chest, abdominal cavity or cerebrospinal fluid.

Liver and kidneys are the most common routes of excretion for CT drugs. Their function may be critical to the success of the therapy and great care is needed for the use of drugs when either of these organs is functioning abnormally. It may require dosage reductions.

In a nutshell, CT has emerged as a boon for cancer patients, but its proper use and administration are mandatory to achieve the desired results.

The writer is a former Head of the Department of Surgery, PGI, Chandigarh. 

eYESIGHT
Eye: cosmetic rehabilitation 
Dr Mahipal S. Sachdev

The eye is a vital organ not only in terms of vision but also as an important component of facial expression. There can be various reasons why a person may have to lose the eye — trauma, infections, post-surgery complications, tumours, etc.

There are some situations where a non-functioning eye needs to be removed surgically. There are other instances where a blind eye is not removed, but it shrinks in size on its own accord as per the natural course of the disease affecting it, reaching ultimately a stage which is clinically known as “Phthisis or Atrophic Bulbi”.

The loss of an eye or a disfigured eye has a far-reaching impact on an individual’s personality. It also affects one’s social and professional life.

There are various options available today for cosmetic rehabilitation of such people ranging from cosmetic contact lenses to customised ocular prosthesis.

Coloured cosmetic lenses, which are available in a range of different colours, are useful if the central transparent part of the eye — the cornea — turns opaque or white while the rest of the eye is not much disfigured.

But in situations where the overall shape of the eye gets distorted due to either chronicity of the disease process or lack of care, a custom prosthetic device (artificial eye) is a better alternative which may be used with or without the removal of underlying non-functioning eye.

Sources vary on when and where artificial eye manufacturing originated, but there is evidence that the craft can be traced to the late renaissance when Venetian glass-makers started creating glass eyes. The art flourished primarily in France and Germany, where carefully guarded fabricating secrets were handed down from one generation to the next. Ocularistry, the science of making ocular prosthesis, has undergone phenomenal growth since then.

Typically known as glass eyes, the ocular prosthesis roughly takes the shape of a convex shell. Since World War II plastic has become the preferred material for the artificial eye because of its durability and longevity. The plastic used in eye making is a high optical quality acrylic (methacrylate resin), similar to the material used to make dentures.

Customised prosthetic eyes offer several advantages over the glass eyes or traditional plastic stock eyes. They can be impression-fit, matching the exact contours of the socket. After the original fabrication by moulding, they can be enlarged or otherwise modified as necessary. They can also be attached by titanium pegs to the newer integrated motility implants available today.

These prosthesis can also be polished and cleaned repeatedly when needed and are practically unbreakable. Besides better motility, there is also a lesser incidence of complications like irritation, discharge and discomfort which used to be quite common with the use of older readymade stock eyes. It has to be very clear to the patient that an ocular prosthetic device does not provide vision and is only meant for improving the overall facial appearance.

The task of giving a cosmetically acceptable appearance to such patients needs a joint effort by a team of an oculoplastic surgeon and a proficient ocularist. Thus, this is a realm where science and art truly meet.

With all the advances happening in the area of cosmetic rehabilitation of the blind eye, people can now have a better facial appearance and, in turn, greater confidence.

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. Email: drmahipal@gmail.com

The cases that doctors can't explain
Roger Dobson

Doctors call them heart-sink cases: the one in four patients whose symptoms have no known cause. So are they really ill?

Most patients expect a quick diagnosis and cure from their doctor. But what if nothing can be found? What if there is no medical explanation for the symptoms, let alone a cure? More than one in four patients visiting their GP have unexplained pain or symptoms, according to a new report. Other research suggests that up to 50 per cent of primary-care users have symptoms that cannot be tracked down.

And it is not just chronic aches and pains. Sensory loss, walking problems, hallucinations, non-cardiac chest pain, paralysis and seizures are all there, with no apparent cause. Some patients have a history of eight or more unexplained complaints in different parts of their body. According to a new British Medical Journal report, these "heart-sink patients" – a name based on the doctor's reaction to seeing them in the surgery – are a considerable problem. "More than a quarter of primary-care patients in England have unexplained chronic pain, irritable bowel syndrome or chronic fatigue," it says.

Medically unexplained symptoms (MUS) are those that cannot be explained by specific illness or injury. Common conditions associated with MUS include irritable bowel syndrome, non-epileptic attack disorder, chronic fatigue syndrome, multiple chemical sensitivity, hyperventilation syndrome and Gulf War Syndrome. For the patient, the symptoms are as disabling as those for which a cause is found. Some patients can suffer for years with chronic pain, while others are bed-ridden. — The Independent