India’s Contribution to Cancer Research

February 4th is known as World Cancer Day. India, very recently, lost her favourite oncologist/ humanitarian Dr V Shanta. Dr Shanta was the chairman of the Adyar Cancer Institute, Chennai and led the institute to its current glory for 60 plus years. Born in family of Nobel laureates, Dr Shanta pursued medicine. During her house surgency, her first posting was to the cancer ward. This was her first encounter with cancer. She joined the Adyar Institute in the 50’s and strived hard with Dr Muthulakshmi Reddy, another icon in the field of medicine and humanity, and Dr Krishnamurthy to bring about advancements in the institute and in the field of cancer.  What started off as a 12-bed cottage is now a large institute with many centres of excellence that include translational research laboratories. 

Dr Shanta’s period saw enormous enhancement and advancement in the biology, causation, evolution and natural history of cancer along with scientific research. The year 1970 was the dawn of chemotherapy era. Up until then only radiation therapy existed which patients were unwilling to take up. The era of high voltage to super voltage came about and under Dr Shanta, the institute was the first in the whole of Asia to install the cobalt 60 unit, that was willingly donated by the Baba Atomic Research Centre. When she began her career, the institute saw 100% morbidity with respect to paediatric cancers. Over the years 65% of paediatric cancers have been cured. 

Dr Shanta wanted to make cancer a notifiable disease in the country. She spoke at a WHO programme in 1980 and expressed her want to make cancer a notifiable disease. The government however said cancer has yet to become an epidemic status so it cannot be notifiable. Dr Shanta exclaimed at the thought of cancer becoming an epidemic in the country.

She also wanted to bring awareness to Oncology. Cancer is disease. Oncology is the science of cancer which went studied can lead to better approaches to therapeutics. She finally set up the first oncologic college in 1982 in Adyar. With that the Molecular diagnostics and genomics era came about. She wanted treatment to be given to the poorest of the poor without any economic and social divide. She made sure that as research went on, treatment was given accordingly. 

She set up the Tamil Nadu Cancer Registry in the 80’s and was able to understand and assess the type and cause of cancer in certain groups of people. Epidemiology of neck throat cancers was extensively studied. Uterine and cervical cancers. Awareness created to prevent the disease. In her opinion just as education is a human right, health is too and ‘state-of-art technology’ to improve health is a human right too. Lancet in 2005 called Adyar Cancer Institute a model institution for countries with limited resources. 

Her hope for the future of healthcare is Education, Research, Ethical and good clinical practices, and insurance for cancer. She stressed on how important it was for the physician and the patient to have a connection and that improves personalised care. 

Research in India when compared to developed countries is slow, however there is an acceleration in the research advancements. The Department of Biotechnology and The Indian Council for Medical Research collaborated with National Cancer Institute, USA to delve deeper into cancer research, prevention and control. The study provided insights into significant breakthroughs in the field of cancer research in India. Cancer research in India is of two types- pre-clinical and clinical. Pre-clinical occurs within research institutes and clinical is dealt by pharmaceutical companies. The most explored cancers in India are breast, colorectal, leukaemia, brain, lung, hepatocellular and cervical cancers. 

When we look back at the history and evolution of cancer, most literatures speak of Hippocrates and his humoral theory. This was established around 1900 years ago. He said that cancer is caused due an imbalance of the four fluids in the body. The theory was then overturned by the lymph theory in the 17th century. Following that, in the 18th century, the role of carcinogens came into light. Finally, in the 19th century, two German scientists postulated that cancer was the disease of the cells. With that, the drive to rule out cancer took momentum. 

However, if we go back 5000 years back, we can observe the real pioneers of cancer treatment were Indians. The Charaka and Sushrutha Samhita describe cancer as an inflammatory and non-inflammatory swelling. They divided the disease into two types- Granthi and Arbuda, meaning minor and major neoplasm respectively. Treatment of Ayurveda lies in balancing out the three Doshas. With respect to cancer, the same principle applies. When the cancer is benign, one or two doshas are in imbalance. When all the three are in imbalance, the cancer is malignant. 

Sushrutha even classified the pathology of tumour into 6 types- Sanchaya (early stages of the tumour), Prakopa (transformation of the tumour to metastatic tumours), Prasara (metastasis), Sthana samsraya (complete metastasis and secondary tumours), Vyakti (clinical symptoms expressed) and Bheda (differentiation of growth).

In the 7th century, Atreya and Dhanwantari used herbal medicines to treat early stages of cancer and surgery for the advanced stages. Vagbhata in the 8th century wrote two texts- Astanga Hrudaya and Astanga Sangraha where novel methods to treat cancer was introduced. Texts like Bhavaprakasha Samhita, Chakradatta, Rasatarangini, speak of many new remedies to treat neoplasms. 

Treatment involved either Sodhana Chikitsa where the imbalanced doshas are eliminated, or Somana Chikitsa where the doshas are pacified and the patient is gradually relieved of the disease. The latter is recommended only to weaker patients. Physicians used certain poisonous plants, mercury like metals and animal products which were first rendered weak by alchemy. Surgical procedures involved fomentation, cleansing by internal medication, internal contents of the tumour liquefied, evacuation of the tumour and cauterisation of the entire area to avoid recurrence followed by post-operative care. 

When medicinal herbs were used, they were administered in the form of decoctions that work o multiple biochemical pathways and enhance the organ systems to work simultaneously. Hence these herbs nourish the body and support the organ systems to work in balance. Commonly used herbs in anticancer treatment are Vitis vinifera (grape), Madhuca indica (mahua), Moringa oleifera (drumstick), Curcuma domestica (turmeric), Piper longum (pepper) and many more. 

Last year, TATA Cancer Center proposed clinical trials with Ayurveda herbs for cancer patients along with Yoga as part of the integrative approach to cancer treatment. India has had a highly advanced personalised anticancer treatment strategy centuries ago, which can be introduced along with modern medicine practices to enhance therapy, improve quality of life and bring about the best personalised care, which western medicine has been trying to work on for years.