Breathing with the tumor , Advances in cancer care
Mrs. Sharma, aged 77 years presented with few months back developed severe headache, intermittent
fever, pain all over the body and dry cough. Investigations led to the diagnosis of malaria which was a great
relief for her. But during the investigations in addition to certain benign findings in addition to the changes in
the brain indicative of blood supply problems (ischaemia) a small mass in the left lung. The size of the mass
was less than 2cms. A CT guided Biopsy was done revealed cancer of the lung. In medical terminology it
was very early stage of lung cancer, in this situation diagnosed accidentally when investigating for other
problem. Is it a blessing in disguise?
Just a few years back it would not have been a blessing. The only choice for this stage at that time was only
surgery and many times surgery was not possible in this situation because of relatively advanced age &
associated diseases like that of heart. There goes up in smoke the slogan “cancer is curable if detected
early”. Additionally, in such an age, surgery did carry a risk of mortality. A few years back a new technique of
radiotherapy was designed. That is stereotactic body radiotherapy, in short SBRT. Stereotaxy means ability
to locate a point in the body in three-dimensional space. If that is attained, then one could deliver relatively
high dose of radiation to the tumour avoiding the normal tissue attaining the same result that of surgery.
Theoretical foundation was laid, later came the implementation.
The first problem was tackling the movement of tumor in the lung. It was realized early that the tumor moves
as much as 4 cms during the breathing, not only up and down but in all directions. The way out was to treat
the volume encompassing all the positions of the tumour. This was done by including 1 to 2 cms of normal
lung tissues around the tumor and dose of radiation was kept a level that could be tolerated by normal