The problem of cancer is universal. To the uninitiated, cancer means painful and slow death. But the scenario is changing rapidly. Most of the patients with early diagnosis of cancer live for many years with proper treatment. In a number of cases, the cancer is cured. In the majority, the cancer is controlled for some time. In India, there is also an active interest among physicians to develop both domiciliary and hospital-based palliative care centers. There is optimism among the physicians, the surgeons, the radiotherapists and the chemotherapists who treat these cases. This book is meant to give hope and show the positive side of cancer therapy. It is meant to instill confidence in the physicians and health workers that slowly but surely, we shall conquer cancer as we have conquered other infectious diseases or control it as we control hypertension or rheumatoid arthritis. This book is meant to create an awareness in medical students, physicians and health workers who may pass on this optimistic information to the Indian millions through their personal approach, by word of mouth and electronic media. The people in different parts of India, both in villages and towns, should know that if they approach a doctor early, that is, in the early stage of the disease, it could be cured. The problem must be approached with a sense of objectivity tempered with modern scientific outlook.

The etiological factors are many. Recent research has shed light on the role of genes in the origin of cancers. We are not unfamiliar with the familial cancers developing in certain families, particularly in the gastrointestinal tract, the breast and the ovary.

8The role of environment on initiating cancer by smoking, chewing tobacco and imbibing spurious alcohol is also well documented.

Environmental causes have become a serious problem in the 21st century. There are many carcinogens in the industrial waste. The automobile exhaust fumes, pesticides and other chemicals are incriminated in the initiation of cancer. Our rivers, lakes, paddy and wheat fields, cities and towns have become polluted with chemicals and industrial waste. Radiation too has become a serious etiological problem. The story of Hiroshima and Nagasaki still haunts the minds of research workers. Frequent deaths in these cities by non-leukemic cancer still occur, 55 years after atomic bombing. The Chernobyl disaster too has cast a pall of gloom among the scientists involved in the role of nuclear fission in the production of energy. The problem of disposal of nuclear waste is still not solved. The health officials in many developed countries have still not found an answer to the growing hazards of radiation in the major cities in the West.

The task of writing a book on this subject is a strenuous one. Consider merely the vast amount of material available as research papers being published from different centers in the world. The Internet will provide a large number of publications but to choose the necessary information therefrom is a laborious task.

This book is divided into three sections with 56 chapters. The first one deals with general discussion about cancer like its etiology, molecular basis of cancer, investigations, the cancer metastases, enigma of unknown primary, etc. The second section deals with system or organ specific cancer like that of the breast and the alimentary system, tumors of male and female genital tracts, leukemia, lymphoma, etc. The third and final section deals with the treatment of cancer such as radiation, chemotherapy and palliative care. Even though the book is on oncology, which includes both benign and malignant tumors, throughout the book, the authors have given more stress on the diagnosis and treatment of malignant neoplasms.

The adult cancer patients go through the following 5 phases once a competent physician diagnoses cancer:

In the case of children, the first 3 phases are not present. They accept the diagnosis without any emotion, they are not angry towards anyone; nor do they bargain with others or God. They accept the diagnosis, they all want to live but hardly challenge fate and succumb to death quietly. One boy of 17 told a few minutes before his death, “Doctor, I am all right.” and became deeply unconscious.

Lastly a chapter has been included in which the care of the terminally ill patient is discussed. This chapter on the care of the terminally ill patients is to 9 help those who have dedicated themselves to the service of these unfortunate men and women in our country. We intend to tell doctors and nurses that death, after all, is not a painful experience but the final and true freedom. All the aspects of palliative care, the drugs used and the counseling for the terminally ill patients shall be discussed in this chapter. The readers are advised to read books on these subjects by Kubler-Ross, Dame Cicely Saunders, Ms Satyavathy Sirsat and Fr Louis Pereira.

It is our attempt to keep the discussions as simple as possible. A book like this, with multidisciplinary approach on cancer edited by international editors, is not available in India. Many biochemists and oncologists are spending their whole lives in different parts of the world to find answers to many vexing problems. Oncology is one of the fast advancing fields in medicine and things are changing almost everyday. A few questions are answered but the challenge lingers on.

They have come forward with great enthusiasm, as this is one of the few books in India on cancer edited by international authors. Their names appear on page VII in the list of contributors. We know that most of them are busy with their clinical work, teaching and research, and yet they found time to write excellent chapters. To each of them, we are deeply grateful.

Some others too, seeing our enthusiasm, helped us in many ways—some of them reading the manuscript as well as giving valuable suggestions and others checking the language errors.

They principally include:

Dr M Krishnan Nair, MD, Director, The Regional Cancer Center, Trivandrum, Kerala, India.

Dr J Jacob, FRCP, Formerly Director, Christian Medical College, Ludhiana, India.

Dr Aleyamma Mathew, MD, FRCP (Path), Cheshire, UK.

Dr Rejoo Daniel, MS, FRCS, Department of Paediatric Surgery, Hull Royal Infirmary, Hull, UK.

Dr Sunil Mathai, MD,DM (Gastroenterology), Medical Trust Hospital, Cochin, Kerala, India.

We are grateful to the staff of the Department of Radiology and Pathology of Christian Medical College, Vellore, India for providing the CT scan pictures and histological pictures respectively which appear in the chapter on cancers of female genital organs.

Mr MT Thomas, Professor, Department of English, Bharata Mata College, Thrikkakara, Cochin, Kerala, India has always been rendering his services as an efficient orthographer and language consultant. To him we are ever so grateful for the careful shepherding of the manuscript.

To Mrs Aley Jacob, MA and Ellen Samuel, we offer our sincere gratitude for reading through a few sections of the manuscript.

Mr MG Rajan of Chaithanya Computer Center, Cochin, India was responsible for the typing and page layout. To him we are deeply indebted.

To Mr M Antony who designed the cover pages, we offer our sincere thanks.

To Ms Shali Joseph, the secretary, we remain indebted for the preliminary job of typing the manuscript.