Dil Bechara (2020): Two Cancers, One Story

Kizie Basu is twenty-one and lives in Jamshedpur. She has thyroid cancer. Her days are tethered to an oxygen cylinder and to her parents' worry.

Then she meets Manny, a loud, Rajinikanth-obsessed twenty-three-year-old. His osteosarcoma, a cancer that starts in bone, cost him part of a leg, and it is now in remission. He is shooting an amateur film with his friend JP, and he casts Kizie in it. They fall in love over a shared fixation: an unfinished song by a reclusive lyricist, Abhimanyu Veer.

They plan a trip to Paris to find him. It nearly collapses when Kizie gets worse and is admitted to hospital. The meeting itself is a disappointment; the artist is evasive and unkind.

Soon after, Manny tells her his cancer has come back and is now terminal. Kizie pushes him and JP to finish the film. Manny stages a mock funeral so he can hear his own eulogies. Then he dies, leaving her a letter and a finished version of the song.

This is Mukesh Chhabra's adaptation of John Green's novel The Fault in Our Stars. It was released on 24 July 2020, a month after the death of its lead actor, Sushant Singh Rajput.

The ending is discussed below.

The adaptation keeps the sharpest thing in its source. Young people with cancer are not saints, and they resent being turned into inspiration.

The logistics are treated as logistics rather than tragedy props. Kizie's oxygen line. Her limited stamina. The sudden admission that nearly cancels the trip. Manny's amputation and his prosthesis. None of it is shot as a lesson.

The film is good on parents too. It shows a mother who cannot let go, and the constant negotiation between protecting a dying child and letting her have a life.

Manny's mock funeral is the film's best idea and its truest. Wanting some say over your own ending is a real and common wish, and it is one people rarely feel allowed to voice.

It is also right that recurrence lands differently from the first diagnosis. The first time, there is a plan. The second time, the plan already failed once.

Manny's cancer comes back and becomes terminal within what feels like weeks. That is the film's largest shortcut.

In life, a suspected recurrence starts a sequence. Imaging to confirm it and find out where. Sometimes a biopsy. Then a conversation about second-line treatment, what it could realistically achieve, and what it would cost in side effects and time. Some of those options are worth taking and some are not, and working out which is slow.

Treatment is essentially invisible in this film. There are no chemotherapy cycles, no scans, no side effects, and pain is badly under-shown. Both leads stay well-groomed and energetic for people with advanced disease.

The travel is a stretch too. Long-haul flying with severe oxygen-dependent lung involvement needs medical clearance, an airline-approved oxygen supply and planning weeks ahead. It is not impossible. It is not a spontaneous decision either.

Thyroid cancer usually shows up as a painless lump or swelling at the front of the neck. NCI says it may cause no early symptoms at all, and is sometimes found during a routine examination.

The signs it lists are:

• A lump, or nodule, in the neck.
• Trouble swallowing.
• Pain when swallowing.
• Trouble breathing.
• Hoarseness.

Almost all of these are found because someone noticed a lump, not by any screening programme.

The US Preventive Services Task Force recommends against screening for thyroid cancer in adults who have no symptoms. That is a grade D. Its conclusion is that screening asymptomatic people causes harms that outweigh the benefits.

The mechanism is overdiagnosis. Feeling the neck, or scanning it with ultrasound, turns up small thyroid cancers that would never have caused any trouble in a person's lifetime. Once found, they get treated, and thyroid surgery carries real risks. So people are harmed by treatment for a disease that was never going to harm them.

That said, Kizie's illness is not the usual picture. Most thyroid cancer is slow and has a good outlook. A young woman on continuous oxygen is at the far end of the range, and a case like that is being managed for disease that has spread, not for a lump in the neck.

Osteosarcoma is a rare cancer that starts in bone. It mostly affects teenagers and young adults during the growth spurt.

NCI lists these symptoms:

• Swelling over a bone or a bony part of the body.
• Pain in a bone or joint.
• Pain in the arm when lifting.
• Stiffness in a joint.
• A limp or difficulty walking.
• A bone that breaks for no known reason.

There is no screening test for osteosarcoma either. So the only route to an earlier diagnosis is someone taking persistent bone pain seriously.

The features worth acting on are simple. Pain that has lasted more than two or three weeks. Pain that wakes a young person at night. Pain with a swelling over the bone, particularly around the knee or shoulder. Any of those deserves an X-ray rather than more rest.

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Dil Bechara is a romance that happens to have two cancers in it, and it is far better on how young patients feel than on what they go through.

Two things in it are worth carrying. Recurrence is a different event from diagnosis, and it deserves its own conversation about what treatment can and cannot do. And a young person may want some control over how their ending goes, which is a request to be taken seriously rather than talked out of.

If a teenager you know has bone pain that has not shifted in a few weeks, ask for imaging. If you have a neck lump or a hoarse voice that will not settle, ask to be examined. See possible warning signs and screening.

This page discusses Dil Bechara for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email corrections@cancerexplained.org.