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At any given time, there are an estimated 40,000-50,000 cancer patients in Nepal. According to the World Health Organization, cancers of cervix, lung, breast, ovary and stomach are common among Nepali women, while, among Nepali men, lung, mouth and oropharynx, stomach, and blood cancers are more common.

Dr Murari Man Shrestha, a medical epidemiologist and the Head of Department of Preventive Oncology at Nepal Cancer Hospital and Research Center, Harisiddhi, says that at the outset there might be non-specific and generic symptoms like loss of appetite, decrease in immunity resulting in frequent infections, and indigestion. As the tumor grows, symptoms in affected areas are more common.

For women diagnosed early, the over-five year survival rate for breast cancer is up to 100 percent

“Diagnosing whether a disease is cancer is challenging,” says Dr Hari Dhakal, senior consultant pathologist and Head of Department of Pathology at the same hospital. “One approach is finding out if the disease has progressed up to the stage where symptoms show up. If a patient is asymptomatic, then there are screening tests for different parts of the body for most common types of cancers.”

More than nine out of 10 colorectal cancer patients live for over five years if they get early treatment. For women diagnosed at the earliest stage of breast cancer, the over-five year survival rate is up to 100 percent, whereas for women diagnosed at advanced stages, the same survival rate plummets to 22 percent.

“It is imperative to promote cancer screening,” says Dr Dhakal. “We need to make people aware that early detection of cancer is actually a good thing, as it is mostly curable.”

Video: Why you may want to get screened for cancer?

Dev Narayan Chaudhary, 53, of Udaypur in Province 1, was diagnosed with stage-three colorectal cancer over three years ago. Twelve cycles of chemotherapy and two surgeries later, he says that had he been diagnosed earlier, his treatment would have been much easier. “For long I took medicines for gastritis. I had no clue it was cancer.”

Cancer is not just one ailment, it is rather a cluster of diseases. Caused by uncontrollable division of cells that results in abnormal tissue growth and tumor-formation—with the exception of blood cancer—it can affect any part of the body other than hair and teeth. Not all cancers are malignant. The ones that are innocuous are called benign, and they do not require immediate medical attention.

One approach of diagnosis is finding out if the disease has progressed up to the stage where symptoms show up

There are over 100 known malignant tumors, each with its own symptoms, degree of severity and treatment options. But in the initial stage there are no observable symptoms.

Dr Murari Man Shrestha, a medical epidemiologist and the Head of Department of Preventive Oncology at Nepal Cancer Hospital and Research Center, Harisiddhi, says that at the outset there might be non-specific and generic symptoms like loss of appetite, decrease in immunity resulting in frequent infections, and indigestion. As the tumor grows, symptoms in affected areas are more common.

“Diagnosing whether a disease is cancer is challenging,” says Dr Hari Dhakal, senior consultant pathologist and Head of Department of Pathology at the same hospital. “One approach of diagnosis is finding out if the disease has progressed up to the stage where symptoms show up. If a patient is asymptomatic, then there are screening tests for different parts of the body for most common types of cancers.”

Worldwide, Asia accounts for nearly half of the new cancer cases and more than half the cancer-related deaths. In Nepal, as mentioned in the World Health Organization Cancer Country Profile, cancers of cervix, lung, breast, ovary and stomach are common among women, while, among Nepali men, lung, mouth and oropharynx, stomach, and blood cancers are more common. Dr Shrestha estimates that at any given time there are 40,000-50,000 cancer patients in Nepal.

According to WHO, screening refers to the use of tests in a healthy population to identify individuals who have disease but do not yet have symptoms. These are tests specific to parts of body affected by cancer. Examples include mammograms for breast cancers, the ‘pap test’ for cervical cancer, and low-dose computed tomography (CT) for lung cancer.

Dr Shrestha classifies cancer screening as a secondary prevention method. The primary method is to prevent cancer in cancer-free population, for instance through the promotion of a healthy lifestyle. Likewise, the tertiary method involves treatment of patients diagnosed with cancer. Detection of the disease when the tumor is not large and has not spread is vital as it vastly increases the chances of successful treatment.

More than nine out of 10 colorectal cancer patients live for over five years if they get early treatment. For women diagnosed at the earliest stage of breast cancer, the over-five year survival rate is up to 100 percent, whereas for women diagnosed at advanced stages, the same survival rate plummets to 22 percent. Early detection also implies less treatment and less recovery. “So it is imperative to promote cancer screening,” says Dr Dhakal. “We need to make people aware that early detection of cancer is actually a good thing, as it is mostly curable.”

You can choose to add cancer screening to your general examination. As the incidence of cancer is increasing even among the relatively young, Dr Shrestha advises that all those above 40 and those in high-risk groups undergo regular screening. About 10 percent malignant cancers are genetically inherited. Non-genetic risk factors include tobacco smoking, alcohol consumption, physical inactivity, obesity, and pollution.

The cost of screening depends on its type and quality, and not everyone may be able to afford one. “This is why it is imperative that the government make it accessible to everyone,” says Dr. Shrestha. 

This is also why WHO recommends that screening programs be undertaken “only when their effectiveness has been demonstrated, when resources (personnel, equipment, etc.) are sufficient to cover nearly all of the target group, when facilities exist for confirming diagnoses and for treatment and follow-up of those with abnormal results, and when prevalence of the disease is high enough to justify the effort and costs of screening.”

The bottom line? If you are in high-risk group and can afford screening, go get it done. “Some people are skeptical about the tests,” adds Dr Dhakal. “But it makes perfect sense if they think about it logically for a while.”

The cancer prevention triangle

While the media often reports on foods that “prevent cancer” and we would love to be told that eating one particular food will prevent cancer, it is unlikely that such a food exists. It is more likely that a combination of good foods may have a preventive effect. Studies over the years have looked at our diets and what foods, if any, will lead to a lower risk of cancer. Fruits and vegetables, whole grains and unprocessed foods have all been promoted as reducing cancer risk. Unfortunately, studies have not consistently proven this to be true. Expert panels state that a diet high in fruits and vegetables “probably” reduces cancer risk, but we just don't know for sure.

However, a healthy diet plays an important role in a sort of “triangle” of cancer prevention. A healthy diet, combined with regular physical activity and maintaining a healthy weight make up this triangle that has been shown to reduce cancer risk. This triangle is thought to be the second most important step, after not smoking, to preventing cancer. An estimated 20-30 percent of cancers could be prevented if people incorporated the triangle into their lifestyle!

But how much physical activity is enough? Experts feel that somewhere between 30 and 60 minutes per day of “moderate to vigorous” activity is needed to impact cancer risk. A moderate activity is the equivalent of a brisk walk, whereas vigorous activities increase heart and breathing rates.

Also, you may exercise a few times a week, but spend many hours sitting at a computer or watching TV. Your risk of many cancers may be higher because of this. Try taking a walk every hour, using a standing desk, taking the stairs to your lunch break, etc. Any way you can lessen the sedentary time and get some activity in is helpful.

Wonder how to get started with an exercise regimen? Make it fun and set reasonable goals. Find a friend to be a walking partner—you can motivate each other and make the walk more enjoyable.

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Nepal has an abundance of fabulous festivals and here is one more for the celebration calendar. And even if you are not celebrating Christmas, Christmas markets act as a one-stop-shop for gift-hunters!  Not only a big shopping opportunity, these markets are great social events to mingle with people from all walks of life. The markets mentioned here are not the only ones in town so check out venues near you!

The GIZ Christmas Bazaar offers an opportunity to purchase goods from fair trade vendors

 The Kathmandu Chorale host their annual Holiday Concert on Dec 8, Saturday

Awon Christmas Bazaar

This is among the pioneers of Christmas markets in Kathmandu. AWON, or Active Women of Nepal, is a non-profit organisation that aims to make a difference in the lives of disadvantaged women and children.  This year sees the Awon Christmas Bazaar head to a new venue. Over the years, as new markets joined the Christmas calendar, the AWON Bazaar lost some of its sparkle. So let’s see whether the new location can bring life back into this long-established event.

What to expect: Goods on display include a range of items mainly from not-for-profit vendors. Food stalls have been a feature in the past.

The details: Saturday Dec 1, 10am to 5pm, Soaltee Crown Plaza. Rs100 for adults, Rs50 for children.

GIZ Fair Trade Christmas Bazaar

GIZ is a German INGO which has been working in Nepal since 1974 in more than 60 districts. The GIZ Fair Trade Christmas Bazaar offers an opportunity to purchase goods from fair trade vendors—from Christmas decorations to items for children and the home. 

What to expect: Artisans will be on hand with live demonstrations to inform and entertain the whole family. Children will have the opportunity to block print their own Christmas cards. The International Club offers room for children to run around and food, including Gluhwein (hot, spiced wine) and German delicacies, will be available.

The details: Saturday Dec 1, 11am to 5pm, at the International Club, Sanepa. Entrance free.

Summit Hotel Christmas Bazaar

This is another pioneer of the Christmas market scene in Kathmandu. And perhaps it offers the most in terms of Christmas ambiance. Again, the vast majority of goods on sale are from non-profit vendors but there is a wide range of other goods such as silver jewellery, face and body products, pashminas etc as well. 

What to expect: Come in daylight hours when it’s warmer or come after dark when the twinkling lights and the sound of the Kathmandu Choral singing fills the air. There are dozens of stalls selling everything one could want to make Christmas special, including authentic Christmas cake. Plenty of food and drink is available in the garden, or take advantage of the hotel’s warm bar and restaurant.

The details:  Sunday Dec 9, noon to 8pm at the Summit Hotel, Sanepa. Free entrance.

Ecole Française International de Katmandou (the French School)

This is the first time the French School will be hosting a Christmas market, so here is an opportunity for those of us who have not been there to take a look around their green environment! As the school is focused on French education in Nepal, they have brought a French theme to Christmas with a host of French vendors, shops, artists, and restaurants.

What to expect: French and local produce, including gifts, children’s toys, jewellery, leather craft, etc.  To keep the children occupied there will be face painting, bouncy castle, and other activities and games. Food and drink will have a French theme and includes a barbeque and French Himalayan cheeses, including Raclette (hot melted cheese).

The details: Saturday Dec 1, 10am to 4pm at the school premises, Lazimpat.  Free entrance.

Le Sherpa

While not a Christmas market as such, Le Sherpa will add additional Christmas themed gift stalls to their usual Saturday market.

What to expect: In addition to fresh produce, there will be Christmas themed stalls and goodies. Plenty of space for children to run around in and if it all becomes too much, parents can always escape to Le Sherpa restaurant for brunch.

The details: Saturday Dec 1, 8 and 15, 8.30am till 12.30pm, Le Sherpa premises, Panipokhari. Free entrance.

The Local Project

Bringing together local artisans The Local Project is hosting three Christmas Markets at different locations.

What to expect: Beautifully crafted and unique gifts all made in Nepal.

The details: Friday Nov 30, 6 to 10pm, at Evoke; Saturday Dec 8, 2 to 6pm at Moksh; Saturday Dec 15, 4 to 8pm at Basecamp.  Free entrance.

Festivals also Need Music!

Where and When: The Kathmandu Chorale will be hosting their annual Holiday Concert on Saturday Dec 8, at the British School at 3pm and 6pm. Free admission, charity donations welcome. 

Christmas Treats!

What’s a festival without some yummy treats? Check out the Annapurna Hotel, Shangri-la Hotel and the Radisson Hotel cake shops for Christmas inspired cookies and cakes. Lakuri Bakery (Soma Café, Baluwatar) will once again be making their Christmas cupcakes, chocolate Yule logs and iced Christmas cookies. Meanwhile, Hermans Bakery (Sanepa) will be baking Christmas inspired goodies; as will bakeries in your neighbourhood!

Merry Christmas!

 “Barud Mathi Udda”, a literary work of Captain Rameshwor Thapa being published by Bookhill Publi­cation, will hit the bookstands in the first week of December.

The book is based on the pilot and entrepreneur’s extensive fly­ing career, including during the 10 years of the Maoist insurgency. Thapa had as a pilot back then saved the lives of numerous army personnel. According to him, the book offers vivid portrayals of the battlefields and describes his experience of flying during those tumultuous times.

Former AIG Rajendra Bahadur Singh offers insight into Thapa’s role during the Maoist rebellion. “The pilots in the army were not able to supply arms and ammunition to the contingent that was defending the village of Khara from the Maoist forces. Notwithstanding the chal­lenge presented by the chaotic bat­tle, Captain Thapa was able to safely land the aircraft, ensuring that the army had enough supplies and that the injured got essential medical care. Were it not for him, the battle at Khara would have taken a heavy toll on Nepal Army.”

Singh isn’t the only one to appre­ciate Thapa’s flying prowess. Nepal Police DSP Yogeshwor Rom Thami says in the book, “Captain Thapa’s audacity and skillful maneuvers helped us survive Maoist sieges many times.”

The book provides descriptions of Thapa’s flying experiences throughout Nepal. It revisits Tha­pa’s rescue and supply missions in various corners of the then war-torn Nepal such as Khara, Rukum; Bhi­mad, Sindhuli; Bethan, Ramechhap; and Nomu, Dailekh.

It is also a rich story that explains Thapa’s life-altering experiences and frustrations that characterize his journey

But the book is more than just a compendium of Thapa’s experiences during the Maoist insurgency. It is also a rich story that explains Thapa’s life-altering experiences and frustrations that characterize his journey from a kid born into an ordinary farming family to the renowned entrepreneur that he is today. The book has been edited by Rajaram Gautam, former editor of the Annapurna Post.

The aptly named Butterfly Effect, whereby even the smallest of chang­es today can alter or even revolu­tionize the future, is helping raise awareness about gender-based vio­lence, sexuality, and human rights through music.

The Butterfly Effect is bringing together female- headed bands in a celebratory concert, part of its three-phase event that also involves key personnel and celebrities pledg­ing their support through hashtags and photographs over social media. Donations raised through the Cel­ebration Phrase of live concert will be utilized in awareness programs in urban and rural areas of the country. Videos of the concert will appear on TV and social media to further spread the word.

Organized by Sangeet Pathsha­la, in association with Dristi Nepal, a non-profit working for women affected by drugs, HIV and AIDs, the concert will feature Nattu with 11.11 OST, Samriddhi Rai, Mental Radio, Somiya Baraily, Space, Didi Bahini, Faithom, and Superfuzz. The Anna­purna Express is the media partner for the event.