Partner Profile

Cancer Institute (WIA), Chennai, India

by Dr. V. Shanta Executive Chairman, WIA

The Cancer Institute in Chennai, India, provides the finest in diagnostic and therapeutic oncology to the poorest of India.

The Cancer Institute (WIA) was established in 1954 by the Women's Indian Association Cancer Relief Fund under the dynamic leadership of the late Dr. Muthulakshmi Reddy, India's first female medical graduate and a pioneer social reformer. It was at that time the first and only cancer facility in the South Indian peninsula and only the second in the country. From its inception, its guiding principle has been the multi-disciplinary care of patients, irrespective of social standing or economic status. It has grown from a few straggling huts and menacing financial insecurity to a comprehensive regional cancer centre of national importance and international interest.

In 1969, the World Health Organization, in conjunction with the Cancer Institute, established the first International Cancer Control Programme in the developing world at Kanchipuram, near Madras.

The Cancer Institute today comprises a 428-bed hospital, a research centre, a centre of preventive oncology and the Muthulakshmi College of Oncologic Sciences. Annually, 70,000 cancer patients from all over India pass through the Institute. Two-thirds of them are indigent, with fewer than one percent covered by health insurance.

The division of radiation oncology is the largest in the country with a great tradition. It has an array of four linear accelerators, two cobalt-60 units and three remote after-loading brachytherapy units and supporting ancillary facilities such as a treatment planning system, interfaced CT scanner, simulator etc. One of the brachy-therapy units is a product of the Institute's engineering and physics department. It was the first indigenous remote after-loading unit in India, built at a tenth of the cost of an imported one. A high dose rate interstitial brachytherapy unit is under development. The Institute pioneered a number of programmes on radiosensitisation of oral and cervical cancers and has collaborated in global international trials with the Medical Research Council of U.K., the IAEA, Vienna and others. It also introduced multi-modality treatment in the management of advanced oral and breast cancers as early as 1958, an evolution born of necessity and which today is the accepted state-of-the-art the world over.

Surgical oncology, still the solid foundation on which the cure of many cancers depends, includes teams for head and neck, gastrointestinal, thoracic, breast and gynaecology, genito-urinary and reconstructive (including micro-vascular) surgery.

Medical oncology, introduced as a distinct specialty in 1970, is the most expensive division to maintain because of the ever-widening areas of its application, the spiraling cost of new drugs, the increasing use of colony stimulating factors and wider use of peripheral blood stem cell infusions and marrow transplantation.

These three main clinical divisions are supported by state-of-the-art imaging services, haematology (including blood component therapy) pathology, cytology, cytogenetics, a prosthetic laboratory and a rehabilitation and counseling service.

The focus of research has been on the common cancers in South India, viz., cancers of cervix, breast, oral cavity and pediatric leukemias. We are involved in identification of molecular aberrations (other than HPV) needed for converting a normal cervical epithelium to a malignant one, including those of the cell cycle regulatory molecules and cytokines. We are using differential display in an attempt to identify genes involved in radio-responsiveness in cervical cancer, and study molecular markers such as Cripto, amphiregulin and C-ErbB4 in cervical, oral and breast cancer in studies of their prognostic value. We are also attempting to develop targeting treatment approaches using monoclonal antibodies raised against Epithelial Growth Factor Receptor in head and neck tumors. Minimum residual disease in T-ALL is being studied using Tal-1 & TCR gene rearrangement as markers. A randomised trial to evaluate the role of hyperthermia in the treatment of cervical cancers is ongoing (IAEA, Vienna & DAE, India).

The Dr Muthulakshmi College of Oncologic Sciences was established in March 1984, the first such college in the country to offer specialty training in surgical and medical oncology. Its alumni are heading various new oncology centres and oncology wings of medical colleges all over the country. The college also runs the master's training courses for medical physicians and registers students for doctoral and post-doctoral research.

The centre for preventive oncology is a network of programmes rather than a physical entity. It consists of two main components—cancer prevention and early detection, and demographic and hospital registries.

The preventive program is essentially educational at both the public and professional levels. Rural-based educational programmes include the training of village health nurses (VHN) and multi-purpose workers in the detection of an abnormal cervix, and abnormal changes in the mouth and the female breast. Over 750 VHNs and 250 rural medical practitioners have been trained in early detection, including taking Pap smears. Rural training centres and cytology laboratories for screening have been established.

The fully computerized hospital and demographic registries at the Institute are rated highly. The hospital registry has good documentation and the follow-up division has over 80% lifetime followup of patients treated.

The demographic registry has provided the lead for cancer control activity in our area. The rising trend in lung cancer incidence in men and breast cancer incidence in women is ominous.

The registry is collaborating in a number of epidemiologic studies with Japan. A major tobacco survey and the impact of tobacco on mortality is ongoing with support provided by the World Bank, Clinical Trial Service Unit of Oxford, and the World Health Organization.