Despite the elimination of cancer, either through chemotherapy, surgical excision, or radiation, cancer cells have an inner engineering mechanism aimed at regeneration, thanks to their genetic roots. Knowingly and unknowingly, this fact induces the fear of cancer recurrence among patients although they may not know the science behind it. Talking of early-stage cancers, as many as 10 to 20 percent of cancers can recur, while in advanced stage cancers, as many as 30 to 60 percent can strike again, based on the sites and subsites. There is also an element of time in the recurrence phenomenon as many cancers are known to recur within two years based on the higher recurrence propensity of the cancer cells during this span.

The moot point is why and how do these cancer cells reappear if they have been removed completely. As mentioned earlier, cancer is a genetic disease, which is not to be confused with hereditary disease. Consequently, cancer cells, at a genetic code level, often tend to find a way to communicate and reengineer other cells to follow their path, which cause the tumours to recur. So, despite the excision at the particular site, the tumour learns to rearrange itself,given that the manufacturing unit is prone to damage. The question before science is: Can we rectify this manufacturing flaw through a surgery at the genetic level? Possibly, in the time to come, we may see surgeons repairing the genes at the base root itself. However, at this juncture, it is only an aspiration which we hope to achieve sooner or later with an aggressive cancer moon-shot initiative.

Talking of the fear of recurrence, an analogy can be given of a man crossing a road with a dull, lurking sense pervading his mind that an accident waiting to happen. But that fear does not stop the man from crossing the road. He doesn't go about looking for a vehicle to come and hit him. If he does that, the vehicle will also come looking for him in a two-way communication. Same is the case with the fear of cancer recurrence. If a patient continues to be fixated on the fear of its recurrence, the focal attention might supress the immune system in a way that ends up inviting a recurrence. So, cancer recurrence is as much a function of genetic mechanism, as also the psychological fear of the recurrence manifesting in chronic anxiety.

Even in a cancer patient at stage IV where the tumour has metastasized, we may have a situation where cancer cells are 30%, but 70% are still normal immune cells. In the focal attention to the 30%, the 70% is largely unacknowledged. Similarly, in early-stage cancer, the whole attention is on the 5%, leaving 95%of it undervalued. This 95 percent is the epigenome that influences the genome through factors of mind, food, water, air, breath, and the environment around us. So, we need to strengthen the epigenome which in turn would impact the genome.Simply put, we need to consciously choose a holistically therapeutic path - of a nutritious low-sugar diet, deep breathing, physical exercise. and positive thinking. This is the path of healing the cancer, as against merely fighting it.It is crucial that the patient takes good care of his or her health, steer clear of tobacco, avoid or limit alcohol consumption, ensure intake of proteins, whole grains, vegetables and fresh fruits, and exercise for a minimum of 30 minutes per day.

Needless to say, regular follow-ups are most important to monitor and manage treatment-induced side effects, as also to improve the sustainability of outcomes and quality of life. The follow-up care plan will have all the details like the frequency of hospital visits, type of examinations, and medical tests. After discharge, the patient should not make his or her own conclusions and never miss scheduled follow-up visits. The patient should never ignore symptoms like pain at the prior cancer site, any lumps or swelling, persistent fever and cough, unexplained fatigue, sudden weight gain or loss,severe depression, or any other symptom that creates anxiety in the patient's mind about the possibility of cancer recurrence.

- Dr. B S Ajaikumar, Executive Chairman, HealthCare Global Enterprises Limited