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Modalities are combined to create a treatment program that is appropriate for the patient and is based on patient and tumor characteristics as well as patient preferences.
Treatment of cancer can involve any of several modalities:

Radiation Therapy

Radiation treatment or radiotherapy is the use of precisely calculated doses of high energy X-rays to treat parts of the body where there is cancer. It is generally a pain-free treatment and external radiation therapy does not cause you to be radioactive.

Chemotherapy

Chemotherapy is the use of drugs to destroy rapidly growing cancer cells. Some kinds of chemotherapy may slow the growth of cancer cells, and keep them from spreading to other parts of the body. It may be used with radiation to help shrink the tumor before surgery. It may also be used after surgery or radiation to destroy remnant cancer cells. At the centre, chemotherapy is given as an outpatient procedure at our specialized treatment areas, managed by a team of oncology trained nurses who provide close monitoring.

Surgery

Surgery plays a pivotal role in the management of most solid cancer. While surgery alone is adequate for early cancers, most advanced tumors require multi modality treatment.

A brain tumor is a cancerous/non-cancerous mass or growth of abnormal cells in the brain. Two of the most common forms of brain cancer are Metastatic Brain Tumors (secondary spread from other parts) and Glioma (primarily from brain).

Warning sins

  • Headaches (usually worse in the morning)
  • Vomiting
  • Muscle jerking or twitching (seizures or convulsions)
  • Vision problem
  • Speech & Hearing difficulty
  • Weakness in the arms & legs
  • Changes in mood, personality or ability to concentrate
  • Numbness or tingling in the arms or legs
  • Memory loss

Risk factors

  • Radiation exposure
  • Family history
  • Immune system disorders
  • Environmental factors such as exposure to vinyl chloride (a chemical used to manufacture plastics), petroleum products, etc

Progression

Malignant primary brain tumors are cancers that originate in the brain, typically grow faster than benign tumors, and aggressively invade surrounding tissue. Although brain cancer rarely spreads to other organs, it will spread to other parts of the brain and the central nervous system.

Diagnosis

Primary diagnosis: Physical exam and personal/family health history
Advanced diagnosis: Neurologic exam, MRI, CT Scan, Angiogram and Biopsy
The mainstay of diagnosis is currently MRI scan followed by surgery for histological examination by a pathologist

Treatment in a nutshell:

The standard treatment for brain tumors includes surgery, radiation therapy, and/or chemotherapy. In general, radiation and chemotherapy treatments are used as secondary or adjuvant treatments for malignant tumors. However, radiation and chemotherapy may be used without surgery if the tumor is inoperable.

The Oesophagus is a tube that starts in the neck, traverses through the chest and joins the stomach in the upper abdomen. It transports food from mouth into the stomach. In cancer of the oesophagus (food pipe), malignant (cancerous) tumor arises in the innermost lining of the tube. It then progresses outwards, lengthwise and circumferentially to cause progressively increasing difficulty in swallowing. Two most common form of cancer oesophagus are squamous cell carcinoma and adenocarcinoma; latter generally involved lower part of the oesophagus near stomach.

Tobacco and heavy alcohol use are known to increase the risk of developing cancer of the oesophagus. People with long standing reflux disease and anemia (women in particular) also have increased risk of developing cancer of the oesophagus.

Warning signs

  • Difficulty in swallowing/ painful swallowing
  • Weight loss
  • Pain behind the breastbone
  • Hoarseness and cough
  • Indigestion and heartburn
  • Black stools or blood in vomit
  • Long standing reflux (acidity)

Risk factors

  • Tobacco, alcohol and tambul (betel nut)
  • Gastroesophageal reflux disease (GERD)
  • Obesity
  • Exposure to chemical fumes
  • Injury to oesophagus

Progression

  • Stage 0: Cancer is confined to the lining of the oesophagus
  • Stage 1: Cancer has spread deeper into the tissues of the oesophagus
  • Stage 2: Cancer may now affect lymph nodes near the oesophagus
  • Stage 3: Cancer has progressed to surrounding tissues
  • Stage 4: Cancer has metastasized, or spread, to other parts of the body

Diagnosis

  • Primary diagnosis: Physical examination
  • Secondary diagnosis: Barium swallow, Oesophago-Gastro-Duodenoscopy, CT Scan with contrast, PET CT scan whole body

The following tests and procedures are necessary for confirming the diagnosis:

  • Barium Swallow: A series of x – rays of the esophagus and stomach. The patients drinks a liquid that contains barium (a silver white metallic compound). The liquid coats the esophagus and x ray is taken
  • Oesophago-Gastro-Duodenoscopy: This involves introducing a flexible telescope through the mouth to visualize esophagus and stomach. A biopsy may be done at the same time if tumor is seen at endoscopy
  • CT Scan with Contrast: This is computerized imaging of chest and abdomen done after intravenous and oral contrast. This gives information about the location, extent and spread of spread disease and hence helps in planning treatment
  • PET CT Scan Whole Body: This is combination of CT scan entire body and PET. It involves giving a special dye before scanning. The dye (FDG) helps in identifying the spread of disease and thus is more accurate for staging of disease and planning of treatment. The treatment depends on the stage of cancer. Cancer of the esophagus is staged from I to IV; stage I is early, localized cancer and stage IV is when cancer has spread to other organ such as lung, liver bone, etc., or neighboring structures, such as tracheo-bronchial tree, nerves or aorta.

For most people, a tummy ache is just that. A simple tummy ache is something we tend to take very casually. But, on occasion, a stomach ache can be indicative of a far more serious problem – digestive track complications, colitis and even cancer. Tackling these conditions at an early stage ensures you a better chance of survival. In cases involving colonic cancer and colitis, timely intervention can save the lives of 70-80% of patients. So, make it a point to visit your doctor regularly for check-ups.

Colorectal cancer starts in the colon or the rectum. These cancers can also be named colon cancer or rectal cancer, depending on where they start.

Warning signs

  • Persistent constipation or diarrhea
  • An urgency to move the bowels
  • Rectal cramping, or rectal bleeding
  • Dark patches of blood in or on stool; or long, thin, “pencil stools”
  • Abdominal discomfort or bloating
  • Unexplained fatigue, loss of appetite, and/or weight loss
  • Pelvic pain, which occurs at later stages of the disease

Risk factors

  • Older age (after 50)
  • Inflammatory bowel disease, Crohn’s disease, or ulcerative colitis
  • A personal or family history of colorectal cancer or colorectal polyps
  • Lack of regular physical activity
  • Low fruit and vegetable intake
  • A low-fibre and high-fat diet
  • Overweight and obesity
  • Alcohol consumption
  • Tobacco use

Progression:

Stage I: Cancer has grown through the mucosa and has invaded the muscular layer of the colon or rectum.

Stage II: Cancer has grown through the wall of the colon or rectum

Stage III: Cancer has grown through the inner lining or into the muscle layers of the intestine and spread to one to three lymph nodes

Stage IV: Cancer has spread to different organ like lungs, bones, liver, lymph nodes, brain or spinal cord.

Diagnosis

Primary diagnosis : Physical examination, blood tests
Advanced diagnosis : Colonoscopy (using a scope to examine the inside of your colon)

According to World Health Organization (WHO), deaths from cancer worldwide are projected to continue rising, with an estimated 12 million deaths in 2030. Breast cancer is the most common cancer affecting urban Indian women. The last three decades have seen the numbers of breast cancer patients grow steadily. It is estimated that by 2015-2020, India will be among the world leaders in new breast cancer cases detected every year. Sedentary lifestyle (lack of exercise), increased consumption of fat products, postmenopausal obesity, late marriages, delayed child bearing and lesser number of children being conceived, reduced duration of breastfeeding (less than one year per child) are all believed to be reasons for increased risk of breast cancer.

Cancers if neglected or left untreated will progress to an advanced stage and threaten the life of the patient in the long run. Therefore, it is important to spread awareness on the disease as well as ways and means to prevent the disease or detect it early so that cure rates are maximized. With the latest technological advancements in the medical sector, today there are higher chances of getting diagnosed early leading to better management of the disease. A Comprehensive Breast Care Unit is well-equipped and has highly qualified specialists who guide a patient towards right treatment plan for any breast related disease.

Breast cancer starts in the cells of the breast. Although both men and women can get breast cancer, over 99 per cent of cases occur in women. Breast cancer is the most common invasive cancer in females worldwide. It accounts for 16 per cent of all female cancers and 22.9 per cent of invasive cancers in women. In fact, 18.2 per cent of all cancer deaths worldwide, including men and women, are from breast cancer.

What are the signs and symptoms of breast cancer?

Breast cancer is not always visible to the naked eye. Its early signs are often hidden within the breast tissues. In early stages, breast cancer usually has no symptoms. However, as the tumor progresses, you may note the following signs:

A lump in the breast, is often the first apparent symptom of breast cancer, breast lumps are usually painless, although some may cause a prickly sensation. Lumps are usually visible on a mammogram long before they can be seen or felt.
A noticeable flattening or indentation on the breast which may indicate a tumor that cannot be seen or felt
Any change in the contour, texture or temperature of the breast, reddish, pitted surface like the skin of an orange (called Peau d’orange) is symptomatic of advanced breast cancer
A change in the nipple, such as an indrawn or dimpled look, itching or burning sensation or ulceration, scaling of the nipple is symptomatic of Paget’s disease, a localized cancer
Unusual discharge from the nipple that may be clear, bloody or of another color, is usually caused by benign conditions but possibly could be due to cancer as well
Swelling in the armpit can suggest presence of breast cancer as this lymph node swelling probably could be felt due to the presence of a primary lump, which may be deep seated and impalpable
If you notice a lump, or are experiencing anything unusual, you must report the symptoms to your doctor as soon as possible.

Most gall bladder cancers start in the glandular cells in the gall bladder. The gallbladder is a small, pear-shaped organ under the liver. The gallbladder concentrates and stores bile, a fluid made in the liver.

Warning signs

  • Nausea & Vomiting
  • Lump in abdomen
  • Abdominal bloating
  • Upper abdominal pain
  • Fever
  • Weight loss
  • Jaundice

Risk factors

  • Gallstones
  • Porcelain gallbladder (incidence higher in females of Northern India)
  • Obesity
  • Older age
  • Choledochal cysts
  • Gallbladder polyps
  • Primary sclerosing cholangitis
  • Industrial and environmental chemicals
  • Typhoid and family history

Progression

Tumor which is present as small gallbladder mass may spread to liver, bile duct, vessels or adjacent organ and can present as mass in abdomen, jaundice, fluid in tummy, vomiting, cachexia.

Diagnosis

Tests such as Biopsy, X-ray, Percutaneous cholangiography, Blood tests, Computed tomography (CT or CAT) scan, Magnetic resonance imaging (MRI). Clinical symptoms along with biochemical tests and tumor markers (CA 19-9, CEA) are used for diagnosis. Biopsy is carried out only for inoperable cases (for palliative therapy).

Gynecologic Oncology is a subspecialty of Obstetrics and Gynecology that focuses on diagnosing and treating women with cancers of the reproductive system. Cancers can occur in any part of the female reproductive system—the vulva, vagina, cervix, uterus, fallopian tubes, or ovaries. These cancers are called gynecologic cancers. Each woman with gynecological cancer has unique medical and emotional needs. To meet these needs, AIMS hospital has highly qualified experts who are specialized in different modalities of cancer care and work as a team, backed by cutting-edge technology.

Aim of Gynecologic Oncology services at AIMS Hospital

  • To provide high quality, evidence based comprehensive and personalized care to patients with a suspected or diagnosed Gynecological cancer
  • To coordinate with social organizations in order to increase awareness of general public about Gynecological cancer screening, prevention and early detection
  • To participate in national and international research in the field of Gynecological Oncology that will reduce the incidence of gynecologic cancer and improve the survival and quality of life of patients with gynecologic cancer
  • To offer services with the help of multidisciplinary team from prevention to palliation

 

Spectrum of diseases treated by Gynecological Oncology unit

  • Premalignant Diseases of Vulva and Vagina
  • Premalignant Diseases of Cervix
  • Cervical Cancer
  • Endometrial Cancer
  • Ovarian Cancer
  • Vulval Cancer
  • Vaginal Cancer
  • Cancer of Fallopian Tube
  • Gestational Trophoblsatic Neoplasia

 

Services provided by Gynecological Oncology unit

The Gynecological Oncology services provide a full-range of women’s health care, including Diagnostic, Consultative and Treatment services. Following services are offered by our Gynecological Oncology unit.

  • Screening for Cervical Cancer: Pap Smear/Liquid based cytology/ HPV testing
  • Colposcopy Clinic
  • Excision Procedures for Premalignant Lesions of Cervix: (Loop Electro-surgical Excision/ Cone Biopsy)
  • Evaluation/consultation and Counseling for high-risk individuals due to strong family history of Ovarian/Breast Cancers
  • Surgical procedures for diagnosed cases of Gynecological Cancers –
  • Surgery for early Ovarian Cancer (Staging Laprotomy)
  • Surgery for advanced Ovarian Cancer (Debulking Surgery)
  • Radical Hysterectomy (Wertheim’s Operation )
  • Surgery for Endometrial Cancer
  • Total Pelvic Exentration
  • Anterior/Posterior Pelvic Exentration
  • Pelvic/Paraortic (Retroperitoneal) Lymph Node Dissection
  • Radical Vulvectomy + Groin Node Dissection
  • Radical Vulvectomy + Reconstruction

Head and neck cancers are cancers that start in the tissues and organs of the head and neck. They include cancers of the larynx (voice box), throat, lips, mouth, nose, and salivary glands. Most types of head and neck cancer begin in squamous cells that line the moist surfaces inside the head and neck (for example, the mouth, nose, and throat).

Cancer of the head and neck are the most common cancers in India (30% of all cancers). Gone are the days when a stand-alone surgeon could treat a patient of head and neck cancer. Treatment of head and neck cancer now requires a multi-disciplinary approach with a team comprising of a head and neck cancer surgeon, a reconstructive surgeon, an onco-anaesthetist, a radiation oncologist, a medical oncologist, an onco-pathologist, a speech and swallowing therapist, a physiotherapist, a dental surgeon, an occupational therapist and a medical counselor.

In the past, the treatment of head and neck cancer was only aimed at cancer-free survival. Issues like cosmoses, speech, swallowing, pain relief etc. were considered secondary. Over the last few years, the goals of such treatments have changed. Now, in addition to improved survival, we also aim to improve the quality of life of our patients with better cosmoses, better functional outcomes like normal speech, swallowing, taste, smell etc. Each member of the multi-disciplinary team works towards the goal of improving the quality of life of head and neck cancer patients. And, a good team can deliver excellent service with the support of advanced infrastructure.

Warning signs

  • Persistent sore throat
  • Foul breath
  • Hoarseness voice changes
  • Swelling of throat
  • Lump, bump or mass without pain
  • White or red patch, non-healthy oral ulcer
  • Persistent nasal obstructions or congestions

Risk factors

Three substances greatly increase the risk of developing head and neck cancers :

  • Tobacco :Tobacco in all forms like cigarettes, cigars or pipes, chewing tobacco and using snuff is harmful. Topical application in the form of masheri. Single largest factor (85 per cent) of head and neck cancers are linked to tobacco use.
  • Alcohol :Frequent and heavy alcohol consumption raises the risk of developing cancers in the mouth, pharynx, larynx and oesophagus.
  • Human papilloma virus, Epstein barr virus

Progression

A head and neck cancer can progress from primary site to the draining lymph nodes. Hematogenous (through blood stream) is much less common in head & neck cancers.

Diagnosis

  • Primary diagnosis :Patient’s medical history, physical examination
  • Secondary diagnosis :Diagnostic tests like endoscopy, lab tests, radiographs, CT scan, MRI, PET scan. Examination of the ample of tissue under the microscope (mandatory to confirm a diagnosis)
  • Advanced diagnosis :Once cancer is confirmed, stage needs to be known for which examination under anaesthesia (in the operating room), X-rays and other imaging procedures like CT scan, MRI etc. can be carried out

Treatment in a nutshell

The treatment requires a multidisciplinary approach with the team of Head and neck cancer surgeon, reconstructive surgeon, an onco-anaesthetist, radiation oncologist, a medical oncologist, an onco-pathologist, a speech and swallowing therapist, a physiotherapist, a dental surgeon, occupational therapist and a medical counselor. In the past the treatment was only aimed at cancer free survival. Issues like cosmesis, speech, swallowing, and pain relief were considered secondary. Over the last few years priority is given to improve the quality of life to our patients with better cosmesis and functional outcomes like speech, swallowing. Each member of the team works towards this goal, which is not possible without the required infrastructure.

Surgery : During surgery, the aim is to remove the diseased tissue and get healthy margins around it to be safe. The tissue removed is sent for a Pathological evaluation which takes approximately 8 – 10 days.

Radiation/Chemotherapy : After the report is reviewed, a call may be taken for further treatment like Radiation with or without chemotherapy. You may need further consultation with a Radiation and/or a Medical Oncologist for the same.

Additional treatment usually begins 4 – 6 weeks after your surgery.

This is cancer that starts in the kidney. The most common type of kidney cancer is called Renal Cell Carcinoma (RCC). About 90 percent of all kidney cancers are renal cell carcinomas. The other 10 percent are made up of transitional cell carcinomas, Wilm’s tumors (found in children), and other rare tumors.

There are about 190,000 new cases of kidney cancer each year around the world, which means it accounts for about one in fifty cancers. In the UK and USA, it is about the tenth most common type of cancer. Estimated new cases and deaths from kidney (renal cell and renal pelvis) cancer in the United States in 2012: New cases: 64,770, Deaths: 13,570. Reports say even in India the incidence is increasing.

Why one needs to be aware?

Knowing the facts could save your life or the life of someone you love. Kidney Cancer is a rare cancer which does not respond to traditional chemotherapies or radiation. It is NOT something doctors typical check for. If found due to symptoms, it’s usually in the late stages. If found early, it’s usually found due to an scan/ultrasound/MRI being performed for another reason. There is always hope and the most important thing is find a doctor who specializes in renal cell carcinoma.

Do you fall in the high risk group?

  • Renal cell carcinoma is the most common type of kidney cancer in adults. It occurs most often in men ages 50 – 70.
  • Genetics :Genetic changes which predispose individual to probability of increased cancer risk
  • Smoking :Cigarette Smokers are twice as likely as nonsmokers to develop kidney cancer. Chewing Tobacco also may increase the risk of this disease.
  • Obesity
  • High Blood Pressure
  • Long-Term Dialysis
  • Von Hippel-Lindau (VHL) Syndrome: An abnormal VHL gene increases the risk of kidney cancer. It also can cause cysts or tumors in the eyes, brain, and other parts of the body
  • Occupation : Coke oven workers in the iron and steel industry are at risk. Workers exposed to asbestos or cadmium also may be at risk

However, many people with kidney cancer have no known risk factors. On the other hand, people who have one or more known risk factors may never get the disease

What are the common signs and symptoms?

In the early stages, kidney cancer often causes no symptoms. It is usually detected by imaging like ultrasonography and CT scan of abdomen done as health check up or for vague symptoms. As the cancer grows, symptoms may develop. These are the most common symptoms in people with kidney cancer:

Warning signs

  • Blood in the urine
  • Side or back pain
  • A mass or lump in the side or lower back
  • Fatigue, which is a chronic, unexplained tiredness
  • Rapid weight loss without making an effort to lose weight
  • Other symptoms, such as fever with no known cause, leg or ankle swelling, and high blood pressure

Risk factors

  • Age more than 40
  • Smoking
  • Risk is more in men than women
  • Obesity
  • Long-term pain medication (over-the-counter drugs and prescription drugs
  • Genetic conditions like von Hippel-Lindau (VHL) disease or inherited papillary renal cell carcinoma
  • Family history of kidney cancer
  • Exposure to chemicals like asbestos, cadmium, benzene, organic solvents, or certain herbicides
  • High blood pressure
  • Risk in blacks is slightly higher than in whites.

For an unknown reason, there is an increased risk of kidney cancer in patients with lymphoma.

Leukemia is a type of cancer that affects the blood and bone marrow. Normally all blood cells are produced by the bone marrow (the spongy area in the middle of bones) in a controlled fashion. All leukemia have in common property that the leukemia cells are abnormal and do not respond to normal control mechanisms. Large numbers of leukemia cells build up as they multiply or because they live much longer than normal cells, or both. With many leukemia cells in the bone marrow, they spill out into the bloodstream.

If you develop leukemia it is important to know exactly what type it is. This is because the outlook (prognosis) and treatments vary for the different types.

What are common types of Leukemia?

The four most common types of leukemia are:

  • Acute Myeloid Leukemia (AML)
  • Acute Lymphoblastic Leukemia (ALL)
  • Chronic Myeloid Leukemia (CML)
  • Chronic Lymphocytic Leukemia (CLL)

Each main type of leukemia is named according to the type of cell that is affected (a myeloid cell or a lymphoid cell) and whether the disease begins in mature or immature cells. People can get leukemia at any age. It is most common in people over age 60. The most common types in adults are AML and CLL. ALL is the most common form of leukemia in children.

What causes Leukemia?

In most cases of leukemia, the reason why a cell becomes abnormal is not known. There are certain risk factors which increase the chance that certain leukemia will develop, but these only account for a small number of cases. Risk factors for some types of leukemia include:

  • Radiation:Previous radiotherapy for another condition. Many of the survivors of the atom bomb used in World War II developed leukemia due to the fall out of radiation
  • Past treatment with chemotherapy or other drugs that weaken the immune system
  • Certain genetic disorders e.g. Down’s syndrome
  • Exposure to certain chemicals, such as benzene

What are the signs & symptoms of Leukemia?

As large numbers of abnormal blood cells are made, much of the bone marrow fills with these abnormal cells. Because of this, it is difficult for normal cells in the bone marrow to survive and produce enough normal mature blood cells. Also, the abnormal cells spill out into the bloodstream.

Therefore, the main problems which can develop include:

  • Tiredness or no energy
  • Shortness of breath during physical activity
  • Pale skin
  • Mild fever or night sweats
  • Slow healing of cuts and excess bleeding
  • Black-and-blue marks (bruises) for no clear reason
  • Pinhead-size red spots under the skin
  • Aches in bones or joints (for example, knees, hips or shoulders)
  • Low white cell counts, especially monocytes or neutrophils

Also, there are a reduced number of normal white blood cells which usually combat infection. Therefore, serious infections are more likely to develop. Depending on the type and site of infection which develops, the symptoms can vary greatly.

The time taken to develop these symptoms after the disease starts varies. Typically, it is within weeks for ALL or AML. It may take months or years for symptoms to develop with CLL or CML as these leukemia progresses slowly.

Warning signs

  • Pain in the bones or joints
  • Swollen lymph nodes
  • Fevers or night sweats
  • Feeling weak or tired
  • Bleeding and bruising easily
  • Frequent infections
  • Discomfort or swelling in the abdomen
  • Weight loss/loss of appetite

Risk factors

Most cases arise without a known cause. However, some known risk factors are:

  • Exposure to certain chemicals, such as benzene
  • Smoking
  • Certain genetic disorders, such as Down syndrome
  • Certain types of previous cancer treatments like chemotherapy or radiation therapy (this happens rarely)

Family history of blood cancer

The liver continuously filters blood that circulates through the body, converting nutrients and drugs absorbed from the digestive tract into ready-to-use chemicals. The liver can be affected by primary liver cancer, which arises in the liver, or by cancer which forms in other parts of the body and then spreads to the liver.

Warning signs

  • Nausea & Vomiting
  • Abdominal bloating
  • Loss of appetite
  • Weakness & fatigue

Some other symptoms are swelling of abdomen (fluid in abdomen), upper abdominal pain, itching, passing white colored stools, etc.

Risk factors

  • Men are more likely to get hepato-cellular carcinoma than women
  • Obesity can increase the risk for hepato-cellular carcinoma
  • Studies have suggested a link between diabetes and liver cancer. This is likely due to the link between diabetes and fatty liver disease
  • Diseases that disrupt the normal metabolism of the body have been shown to increase your risk of liver cancer
  • Long-term alcohol use has been linked to an increased risk of liver cancer. Regular, heavy alcohol use can damage the liver, leading to inflammation. This, in turn, might raise the risk of liver cancer
  • Studies have found a link between liver cancer and some rare diseases like alpha -1-antitrypsin deficiency, tyrosinemia, and Wilson’s disease, haemochromatosis
  • Patients with known cirrhosis, chronic liver disease (Hepatitis B/C, ETOH related), chronic infection HBV,HCV Exposure to Aflatoxins

Progression

Primary liver tumor:
May develop new symptoms like jaundice and mass or fluid tummy from solitary to multiple, from one side to another side, or diffuse involvement of entire liver. It spreads to lungs, bones, blood vessels and lymph nodes.

 

Secondary (Metastatic) tumor
Generally Stage IV tumors can involve the liver. Site of origin could be GI tract or other organ (lung, thyroid, breast, biliary tract, and pancreas). Patient with chronic liver disease should undergo screening to detect tumor at an early stage.

Lung cancer, also known as lung carcinoma, is the uncontrolled growth of abnormal cells in one or both lungs. It most often occurs in people who smoke. As lung cancer grows, abnormal cells can form tumors and interfere with the functioning of the lung, which provides oxygen to the body via blood.

Warning signs

Lung cancer is generally diagnosed on a chest X-ray, which is done for other reasons or as part of a health check-up. The associated symptoms of lung cancer include:

  • Persistent cough
  • Blood in sputum (spit or phlegm)
  • Shortness of breath—either on exertion or at rest
  • Chest pain
  • Change in voice

Risk factors

  • Tobacco smoking (causes 60-65 per cent of lung cancers)
  • Exposure to second-hand or passive smoking
  • Exposure to radon gas, asbestos and other carcinogens
  • Family history of lung cancer

Progression

  • Stage I:Cancer is confined to lung
  • Stage II/III:Cancer is confined to chest
  • Stage IV:Cancer spreads to other organs (lymph nodes, brain, liver, adrenal glands)

Diagnosis

Over 80 per cent of lung cancers have a chance to be cured if detected early. Lung cancer is diagnosed in the following ways:

Primary diagnosis
Chest X-ray or a CT scan

Secondary diagnosis
Bronchoscopy, EBUS (Endobronchial Ultrasound) or CT-guided biopsy for obtaining tissue from the tumor

Advanced diagnosis
PET CT whole body, MRI, Mediastinoscopy and other surgical procedures

A lymphoma is a cancer of lymphatic cells in the lymphatic system. About 54 percent of the blood cancers that occur each year are types of lymphoma. Lymphomas are divided into two types – Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. There are various types of non-Hodgkin’s lymphoma which are divided into high-grade (fast growing) and low-grade (slow growing).It is important to know exactly what type you have. This is because the treatments and outlook (prognosis) can vary for different types of lymphoma. Majority of lymphoma can be cured with treatment.

What is the lymphatic system?
The lymphatic system consists of lymph nodes (glands), a network of thin lymphatic channels (like thin blood vessels), and organs, such as the spleen and thymus.

The lymphatic system also forms a major part of the immune system. Lymph and lymph nodes contain white blood cells called lymphocytes and antibodies which defend the body against infection. The lymphocytes are made in the bone marrow. When they are mature they are released into the bloodstream and migrate into the lymphatic system.

There are three types of mature lymphocytes :

  • B lymphocytes which make antibodies that attack infecting bacteria, viruses, etc.
  • T lymphocytes (which finish off their maturing in the thymus gland) have various functions, including helping the B lymphocytes to make antibodies.
  • Natural killer lymphocytes which also help to protect against infection.

What causes a Lymphoma and how does it develop?

The exact cause is not known. If your immune system is down (for example, if you have AIDS) your risk of developing a lymphoma is increased. A previous infection with a virus called the Epstein-Barr virus, HTLV may increase the risk slightly. However, many people have an infection with the Epstein-Barr virus, and the vast majorities do not develop Hodgkin’s lymphoma. However, this only accounts for a small number of cases and the cause is unknown for most people. It is not an inherited condition and does not run in families.

Origin of a cancer (such as a lymphoma) starts from one abnormal cell. Exactly why the cell becomes cancerous is unclear. It is believed to be something that damages or alters certain genes in the cell making the cell abnormal. These cells multiply and produce many more abnormal cells. The cancerous lymphocytes tend to collect in lymph nodes. The lymph nodes become bigger and form cancerous tumors. Some abnormal cells may travel to other parts of the lymphatic system, such as the spleen. So you may develop lots of large cancerous lymph nodes and an enlarged spleen. Cancerous lymphocytes can also form lymphoma tumors in places in the body outside of the lymphatic system. This is because lymphocytes can also travel in the bloodstream.

Who gets non-Hodgkin’s Lymphoma?
Anyone can be affected. Most cases occur in people over the age of 60. Men are more commonly affected than women.

Who gets Hodgkin’s Lymphoma?
Anyone can be affected, including children. However, most cases occur between the ages of 20 and 25 years, or after the age of 70. It is one of the few cancers where there is a peak of incidence in young adults.

What are the signs & symptoms of Lymphoma?

Enlarged Lymph Nodes: The most common early symptom is to develop one or more swollen lymph nodes in one area of the body – most commonly the side of the neck, an armpit or the groin. The swollen lymph nodes tend to be painless and gradually get bigger. If the affected lymph nodes are in the chest or abdomen, you will not be aware of them swelling in the early stages of the disease.

However, the most common cause of swollen lymph nodes is infection. A lymphoma may be suspected if lymph nodes remain swollen, or if there is no infection to cause the swelling.

Various other general symptoms may also develop, e.g.:

  • Recurrent fevers (greater than 38˚C)
  • Night sweats (drenching)
  • Weight loss (greater than 10% in less than six months)
  • Fatigue (severe and persistent)

As a lymphoma develops you may feel generally unwell. If the lymphoma tumors become large and press on nearby parts of the body, various other symptoms can develop. For example, you may develop a cough or breathing problems if the tumor enlarges in the lymph nodes inside the chest, stomach pain if the lymphoma develops in the stomach.

How is Lymphoma diagnosed?
Lymphoma is generally diagnosed on biopsy of enlarged lymph nodes. A biopsy is when a small sample of tissue is removed from a part of these nodes. Sometimes an entire lymph node is removed. The sample is then viewed under a microscope to look for abnormal cells, patterns and grade of lymphoma. In Hodgkin’s lymphoma, a cell called the Reed-Sternberg cell is seen under microscope.

The additional test like immunohistochemistry (IHC) is performed for identifying subtypes of lymphoma. Some cases this sample may be processed for cytogenetics or immunophenotype.

What are different types of non-Hodgkin’s Lymphoma?
Non-Hodgkin’s lymphoma is also divided as High-Grade (fast-growing) or Low-Grade (slow-growing) depending on grade and B cell or T cell depending upon cell of origin. The common types of non-Hodgkin’s lymphomas include: diffuse large B-cell lymphoma, lymphoblastic lymphoma, follicular lymphoma, anaplastic large-cell lymphoma, lymphoplasmacytic lymphoma and mantle cell lymphoma – but there are various other types. Different types of lymphoma are treated differently and different outlook.

What are different types of Hodgkin’s Lymphoma?
There are various sub-types of Hodgkin’s lymphoma. It is divided in classical Hodgkin’s lymphoma and lymphocyte predominant Hodgkin’s lymphoma as treatment of these two types different.

How is Lymphoma staging done?

The aim of staging is to find out how much the lymphoma has grown locally, and whether it has spread to other lymph nodes or to other parts of the body. For determining stage of lymphoma CT scan, blood tests, a bone marrow biopsy or other tests are performed. Nowadays PET/CT scans are considered superior to CT scans and preferred. All staging investigations are repeated at end of treatment for documenting complete clearance of lymphoma. PET scan can be done in interim after 2-3 cycles of chemotherapy for assessing initial response to chemotherapy.

Ann Arbor staging of Lymphoma

  • Stage 1 :The lymphoma is confined to one group of lymph nodes only.
  • Stage 2 :The lymphoma affects two or more groups of lymph nodes. However, they are all on the same side of the diaphragm. (The diaphragm is the large muscle that separates the chest from the abdomen and helps us to breathe. So, for stage 2, all the affected nodes will either be above or below the diaphragm.)
  • Stage 3 :The lymphoma affects nodes on both sides of the diaphragm.
  • Stage 4 :The lymphoma affects parts of the body outside of the lymphatic system.

Each stage is also divided into A or B. ‘A’ means that you do not have symptoms of night sweats fevers or weight loss. ‘B’ means that you do have one or more of these symptoms.

Malignant melanoma is a type of skin cancer which begins in cells called as melanocytes (these cells give pigment to the skin). It is more commonly seen in the white population and is related to the skin damage caused by ultraviolet rays of sun.

Warning signs

  • Change in size, shape, colour of any pre-existing mole
  • Bleeding or ulceration of any pre-existing mole
  • Any new spots/moles – brown, black or red
  • New pigmentation at the base of the nails

Risk factors

  • Previous sun exposure (UV light)
  • Family history of melanoma
  • Family history of multiple nevus syndrome
  • Race—common in white population

Progression

  • Stage I:Melanoma is confined to skin
  • Stage II:Melanoma has grown thicker but is confined to skin
  • Stage III:Melanoma has spread in lymph nodes near the primary tumor
  • Stage IV:Melanoma has spread to distant areas like the draining lymph nodes, visceral organs like lungs, liver, bone etc.

Diagnosis

Early melanomas can be differentiated from the benign nevus by the popular mnemonic ABCDE

  • Asymmetrical lesion
  • Border is usually irregular
  • Colour is variable
  • Diameter is >6mm
  • Enlarging lesion

Diagnosis

  • Medical history and physical examination
  • Excisional biopsy or Incisional biopsy

Sentinel lymph node biopsy (for evaluation of draining lymph nodes, required for lesions >1mm deep) and Cross sectional imaging

Medical Oncology is one of the three pillars of cancer treatment along with surgery and radiotherapy. It deals with treatment of cancer using drugs which kill cancer cells. Aims of the treatment include cure, prolongation of life, relief of symptoms and providing good quality of life, depending on the extent of disease at presentation. Recent years have seen the advent of several new chemotherapy drugs and also targeted therapy to help achieve the above-mentioned aims.

Medical Oncology involves treating cancer using the following drugs:

  • Chemotherapy:These are drugs which kill cancer cells or stop their growth. However, they also act on normal body cells, thus leading to side effects.
  • Targeted Therapy:These drugs target cancer cells specifically, sparing normal cells, thus limiting side effects.
  • Hormonal Therapy:This involves use of hormonal agents for prevention and treatment of certain cancers such as breast cancer and prostate cancer.

Chemotherapy Day Care Unit

We have a dedicated day care unit for patients receiving outpatient chemotherapy. This is manned by our chemotherapy specialist nurses. Apart from giving chemotherapy and targeted therapy, we also administer supportive treatment like blood transfusion, platelet transfusion, growth factor support and intravenous fluids in the day care unit. It has a procedure room for performing routine medical procedures such as lumbar puncture, pleural fluid drainage, ascitic fluid drainage, bone marrow aspiration and biopsy. There is a separate pharmacy room for proper handling and preparation of chemotherapy drugs. The day care unit is equipped with cable television facility for entertainment during chemotherapy administration.

Why AIMS

The department has been set-up with an aim to provide state-of-the-art, safe and effective treatment in a clean environment. We plan to target all aspects of the patient illness with a multi-disciplinary approach involving a team of medical oncologist, surgical oncologist, radiation oncologist and support services like preventive oncology, palliative care clinic, counseling and rehabilitation. Chemotherapy and targeted therapy is provided, both, as inpatient and outpatient facilities.

Facilities

  • 30 bedded chemotherapy day care unit located on the 7th floor in the Centre for Cancer.
  • Chemotherapy specialist nurses trained in the administration and monitoring of chemotherapy.
  • Counselor to deal with the psychosocial aspects of cancer.
  • Specialists in giving supportive care to terminally ill cancer patients.

Pediatric (childhood) cancers are different from adult cancers as there are no clear causative factors as to why a child gets cancer. The most common childhood cancers are leukemia, lymphoma and brain cancer.

Cancer in children is certainly distressing but here is a reason to smile-pediatric cancers tend to respond better to treatment, compared to adults. Children can usually be cured for life. It is essential to be patient and trust your doctor.

Warning signs

  • Unexplained weight loss
  • Headaches, often with early morning vomiting
  • Pain/swelling in bones, joints, back or legs
  • Lump or mass in the abdomen, neck, chest, pelvis or armpits
  • Excessive bruising, bleeding or rash
  • Constant infections
  • A whitish color behind the pupil
  • Persisting nausea
  • Constant tiredness or noticeable paleness
  • Eye or vision changes that occur suddenly and persist
  • Recurrent fevers of unknown origin

Risk factors

  • Longer life expectancy in children allows a longer time for cancer processes to manifest, increasing the risk of developing some cancer types later in life.
  • Genetic and familial factors are identified in 5-15 per cent of pediatric cancer cases.
  • Environmental exposure such as prenatal exposure to tobacco, X-rays or certain medications are identified in <5 per cent of cases.
  • For the remaining 95 per cent of cases, however, individual causes remain unknown

Progression

Different types of cancers in children spread to different organs of the child’s body. Leukemia may affect the brain and spinal cord, testicles, rarely ovaries, kidneys and other organs. Lymphoma may spread to the liver, bone marrow or spleen. Brain tumors may spread to spinal cord tissue. Rhabdomyosarcoma, when it spreads, creates new lesions in the lymph nodes, bone, bone marrow or lung.

Diagnosis

  • Primary diagnosis:Physical examination, blood tests

Advanced diagnosis: Biopsy, bone marrow aspiration and biopsy, lumbar puncture, ultrasound, computed tomography scan (CT or CAT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scan may be performed.

The pancreas is a gland about 6 inches long, shaped like a thin pear. It lies between the stomach and the spine. It has two main jobs in the body—to make juices that help digest (break down) food and to make hormones, such as insulin and glucagon, that helps control blood sugar levels. Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas.

Warning signs

  • Jaundice (yellowing of the skin and whites of the eyes)
  • Light-colored stools
  • Dark urine
  • Pain in the upper or middle abdomen and back
  • Weight loss for no known reason
  • Loss of appetite
  • Feeling very tired
  • Some other symptoms are abdominal pain, back pain, fever with chills and vomiting.

Risk factors

  • Smoking
  • Being overweight
  • Old Age
  • Having a personal history of diabetes or chronic pancreatitis
  • Having a family history of pancreatic cancer or pancreatitis
  • Having certain hereditary conditions, such as multiple endocrine neoplasia type 1 (MEN1) syndrome, hereditary non-polyposis colon cancer, hereditary breast and ovarian cancer syndrome, familial atypical multiple mole melanoma (FAMMM) syndrome

Progression

Stage I
The tumor is in the pancreas, has not spread to lymph nodes or other parts of the body

Stage II
The tumor extends beyond the pancreas, but has not spread to nearby arteries, veins, lymph nodes or other parts of the body

Stage III
The tumor has spread to nearby arteries, veins, and/or lymph nodes but has not spread to other parts of the body

Stage IV
Tumor has spread to other parts of the body (liver, peritoneum, lungs)

It can spread to adjuvant organ like small bowel, vessels, liver, lungs and give rise to jaundice and mass abdomen, back pain and vomiting.

Diagnosis

Primary diagnosis
Physical exam and history, blood chemistry studies, tumor marker tests

Advanced diagnosis
MRI, CT scan, and PET scan, abdominal ultrasound, endoscopic ultrasound, laparoscopy and biopsy (not mandatory)

Prostate Cancer is a disease which only affects men. Cancer begins to grow in the prostate, a gland in the male reproductive system.

Prostate cancer is now the most commonly diagnosed male cancer in many Western countries and records show that its incidence is increasing in India. The number of recorded cases has increased a lot in recent years. This is partly due to the increased use of the Prostate-Specific Antigen (PSA) test, which has resulted in more cases being detected, and partly due to the fact that men are living longer. Like most cancers, prostate cancer is more common in those over 60. In 2013, more than 242,000 men will be diagnosed with prostate cancer, and more than 28,000 men will die from the disease. One new case occurs every 2.1 minutes and a man dies from prostate cancer every 18.6 minutes.

Particularly in Asia we face a future major increase in the rates of prostate cancer. Collaborative action now is a high priority to allow the preparations necessary for effective control of prostate cancer.

What is Prostate Cancer?

Prostate cancer is caused when cells in the prostate multiply and grow out of control to form a mass or tumor. Being a very variable disease, some tumors remain small and grow so slowly that they cause no problems for the rest of a man’s life; others are aggressive (which may eventually spread to bone), grow quickly and become life- threatening.

Why one needs to be aware?

If prostate cancer is diagnosed early (before it has spread outside the prostate gland) it can be treated very successfully. Treatment provides long term cure for at least 9/10 cases. However, when the cancer is advanced, it becomes very difficult to cure. If the cancer has spread outside the gland, the prospects are worse. Even a small amount of spread reduces the chance of a cure. More distant spread makes a cure very unlikely. Treatment can give these patients extra years of life and stop the pain of the disease, but is only able to cure a minority of them. Overall, only about one in three of patients with cancer spread outside the prostate survive for five or more years after the diagnosis. All men over 50 should be aware of the warning signs and check with their doctor at regular intervals.

What are the common signs and symptoms?

Early stage prostate cancer does not cause any symptoms. So men who are above 50 years of age are advised to undergo voluntarily testing for prostate cancer.

Warning signs

  • Frequent urination, more often at night
  • Difficulty in urinating
  • Blood in the urine / painful urination
  • Ejaculation may be painful (less common)
  • Achieving or maintaining an erection may be difficult (less common).
  • Inability to urinate
  • Passing urine often (particularly at night)
  • Weak or interrupted urine flow
  • Pain when urinating
  • Pain in the lower back, hips and upper thighs

However, all of these symptoms can also be caused by other conditions, such as benign prostate enlargement. Men with any of these symptoms should consult their doctor.

INFINITY WITH AGILITY – LINEAR ACCELERATOR

We have consistently brought cutting edge technology to our patients, Elekta Infinity with Agility™ first in India .

The Infinity with Agility- linear accelerator enables extremely accurate, image guided adaptive radiotherapy to be delivered safely and in a short period of time. This makes it possible to irradiate any site in the body with great precision. Agility, a multi leaf facilitates faster and more accurate delivery of radiotherapy. Agility offers high resolution beam shaping capabilities including inter digitation across the 40×40 cm field size.

Volumetric Modulated Arc Therapy (VMAT/Rotational IMRT)

VMAT is a novel radiation technique, which can achieve highly conformal dose distributions with improved target volume coverage and sparing of normal tissues compared with conventional radiotherapy techniques. VMAT also has the potential to offer additional advantages, such as reduced treatment delivery time compared with conventional static field intensity modulated radiotherapy (IMRT).

Stereotactic Body Radiotherapy (SBRT)SBRT

SBRT is also called stereotactic ablative radiotherapy (SABR), is a type of radiation therapy in which a few very high doses of radiation are delivered to small, well-defined tumors. The goal is to deliver a radiation dose that is high enough to kill the cancer while minimizing exposure to surrounding healthy organs. A stereotactic radiation treatment for the body means that a specially designed coordinate-system is used for the exact localization of the tumors in the body in order to treat it with limited but highly precise treatment fields. SBRT involves the delivery of a single high dose radiation treatment or a few fractionated radiation treatments

Image Guided Radiotherapy (IGRT )

IGRT is a step forward of IMRT in which various biological and anatomical imaging techniques are integrated into the radiation therapy process. The overall goal of IGRT is to target tumors more accurately while better sparing the normal tissues .Our machine has on board CT scanner with KV imaging facility capable of online and offline matching of planned image with treatment image accurately

Intensity Modulated Radiotherapy (IMRT)IMRT

This is a specialised form of 3 D conformal radiotherapy . As the name implies, intensity-modulated radiation allows us to modulate the intensity of each radiation beam which is divided into thousands of beamlets , so each field may have one or many areas of high intensity radiation and any number of lower intensity areas within the same field, thus allowing for greater control of the dose distribution with the target. This achieves maximum dose envelop to the tumour sparing the surrounding normal structures.

Stereotactic Radiotherapy (SRT)/(SRS)

SRT is specialized type of external beam radiation therapy uses focused radiation beams targeting a well-defined tumor, relying on detailed imaging, computerized three-dimensional treatment planning and precise treatment set-up to deliver the radiation dose with extreme accuracy.

Three-dimensional Conformal Radiation Therapy(3D CRT)

3D CRT is a technique where the beams of radiation used in treatment are shaped to match the tumor. Conformal radiation therapy uses the targeting information to focus precisely on the tumor, while avoiding the healthy surrounding tissue.

CT SimulatorCT Simulator

CT simulation transmits X-rays through tissue to create a graphic display of the tumor and surrounding normal tissues. Simulator allows for precise treatment planning by demonstrating the relationship between the target tumor and healthy tissues while the patient is in treatment position.

Especially designed for the specific needs of radiation therapy planning for advanced treatment methods such as conformal, IMRT or stereotactic radiotherapy. The large bore of 80cm, moving lasers and the accurate table alignment allow for high precise patient positioning.
Using Siemens’ z-Sharp technology the SOMATOM Definition AS can provide the fastest sub millimeter volume coverage at industry’s highest spatial resolution, preparing optimally for advanced treatment techniques such as SRS and SBRT
Additionally, its large bore of 80 cm and a table load capacity of up to 307 kg opens this CT to all patients, meaning that virtually no patient is excluded and even clinically challenging cases like in the ED or bariatric patients can be imaged rapidly from head to toe without difficulty.

 

Treatment planning system TPS

MONACO is presently the only planning system that uses super accurate and complex Monte Carlo Dose engine. This is considered the “gold standard’’ in planning. MONACO also allows biological modeling, which ensures that doses reaching normal structures are kept well below their tolerance limits. We also do have ONCENTRA for planning, contouring and image fusion.

 

Oncology management system

MOSAIQ is an electronic medical records (image enabled) system that streamlines the entire radiotherapy process.

Imaging

A choice of high quality KV & MV  X-ray imaging, or KV CT scan is available on the linear accelerator to ensure the tumor, as well as the normal surrounding structures, are actually visualized before radiation is delivered.

Integrity safety

The system has 3 tiers of safety built into every treatment. This ensures that even the smallest of errors in any of the multiple, complex steps of radiation delivery is detected and treatment is discontinued till the errors are corrected.

Primary bone cancer (Bone Sarcomas), which begins in the bone is a rare cancer. Bone cancer can begin in any bone in the body, but it most commonly affects the long bones in the arms and legs.

More commonly we encounter metastatic bone cancer, which is a cancer of other organs that has spread to the bone.

Warning signs

  • Bone pain
  • Swelling and tenderness near the joint
  • Difficulty in normal movements
  • Broken bone
  • Fatigue
  • Unintended weight loss

Risk factors

Most of the patients who develop bone cancer do not have any risk factor. However, certain factors are associated with an increased risk, including:

  • Inherited genetic syndromes like Li-Fraumeni syndrome and Hereditary Retinoblastoma
  • Paget’s disease of bone that occurs mostly in older adults
  • Exposure to large doses of radiation, such as those given during radiation therapy for cancer, increases the risk of bone cancer in the future

Progression

  • Stage I:The tumor is low grade, has not spread to any lymph nodes or to other parts of the body.
  • Stage II:The tumor is high grade but has not spread to any lymph nodes or to other parts of the body.
  • Stage III:Multiple tumors in the primary bone site, but they have not spread to any lymph nodes or to other parts of the body.
  • Stage IV:Tumors have spread to the lung(s) and/or other organs besides lungs

Diagnosis

Primary diagnosis
Medical history, Physical examination

Secondary diagnosis
Imaging tests like radiographs, MRI and/or CT scan, Biopsy (sample of tissue from the tumor)

Advanced diagnosis
Bone scan, PET scan, CT scan of chest etc.

Squamous cell Carcinoma (SCC) is a type of skin cancer which usually presents as non healing ulcers but can grow below the skin and spread to draining nodes or distant organs.

Warning signs

  • Sore or wound that doesn’t heal
  • Flat or little raised red/ brown patch that can have bleeding, itching, pain

Risk factors

  • Previous sun exposure (UV light)
  • Previous skin damage such as burns or a major scar
  • Non healing wounds and draining sinuses in persistent infection
  • Actinic keratosis, a precancerous skin condition

Progression

Squamous Cell Carcinoma can spread to the draining lymph nodes or distant organs.

Diagnosis

Primary diagnosis: Medical history, Physical examination
Advanced diagnosis: Incisional biopsy (a small area of tumor is sampled for histo-pathological examination)

Soft tissue sarcoma is a cancer that can start anywhere in the body, typically muscles, blood vessels, nerves, fat, joints and tissues. Soft tissue sarcomas comprise 2 per cent of all cancers. More than 30 different types of sarcomas have been identified and are usually named according to the type of tissue they start in, like liposarcomas for fat tumors, rhabdomyosarcomas for muscle tumors, angiosarcomas for blood vessel tumors, etc.

Warning signs

  • New lump or increase in size of a pre-existing lump
  • Difficulty in normal movements
  • Pain in lump
  • Fatigue
  • Unintended weight loss

Risk factors

Most of the patients who develop soft tissue sarcomas so not have any risk factor. However, certain factors are associated with an increased risk, including:

  • Inherited genetic syndromes like neurofibromatosis, Li-Fraumeni syndrome and Gardner syndrome
  • Exposure to large doses of radiation, such as those given during radiation therapy for other cancers
  • Exposure to certain chemicals like vinyl chloride, herbicides and dioxin.

Progression

  • Stage I – The tumor is of low grade and has not spread to any lymph nodes or to other parts of the body.
  • Stage II – The tumor is intermediate to high grade but has not spread
  • Stage III – The tumor has spread to the draining lymph nodes but not to other organs
  • Stage IV – The tumor has spread to other organs like lungs, liver, bone etc.

Diagnosis

Primary diagnosis
Imaging tests including radiographs, MRI and/or CT scan

Secondary diagnosis
Biopsy (a procedure to remove a sample of tissue from the tumor for laboratory testing).

Advanced diagnosis
PET scan, CT scan of chest and ultrasonography of draining glands, etc

It is recommended that your biopsy be done at the cancer centre where you will receive treatment. Evaluation at a cancer centre that treats a large number of sarcoma patients and has a specialised sarcoma management team improves chances of correct diagnosis and treatment and reduces the risks of relapse. A wrong biopsy may cause cancer to spread.

Nearly everyone has had a stomachache at some point due to different reasons. It generally isn’t taken seriously because it’s quite common. But, on certain occasions, a stomach ache can be indicative of a far more serious problem – digestive track complications, colitis and even cancer. Tackling these conditions at an early stage ensures you a better chance of survival. In cases involving colonic cancer and colitis, timely intervention can save the lives of 70-80per cent of patients. So, make it a point to visit your doctor regularly for check-ups.

Warning signs

  • Poor appetite
  • Weight loss (without trying)
  • Abdominal (belly) pain, discomfort
  • A sense of fullness in the upper abdomen after eating a small meal
  • Heartburn or indigestion
  • Nausea
  • Vomiting, with or without blood
  • Swelling or fluid build-up in the abdomen
  • Low red blood cell count (anemia)

Risk factors

  • A diet high in salty and smoked foods
  • A diet low in fruits and vegetables
  • Smoking
  • Eating foods contaminated with aflatoxin fungus
  • Family history of stomach cancer
  • Infection with Helicobacter pylori (a type of bacteria)
  • Long-term stomach inflammation
  • Pernicious anemia
  • Stomach polyps

Progression

  • Stage I: Cancer has grown into the inner layer of the wall of the stomach
  • Stage II: Cancer has grown into the outer muscular layers of the wall of the stomach
  • Stage III: Cancer has grown through all of the layers of the muscle into the connective tissue outside the stomach and has grown to nearby organs or structures
  • Stage IV: Cancer has spread to the liver and to the inside of the abdomen. Less commonly, it can also spread to the lungs.

Diagnosis

Primary diagnosis
Physical examination

Advanced diagnosis
Biopsy, endoscopy, endoscopic ultrasound, X-ray, barium swallow, computed tomography (CT or CAT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, laparoscopy

The Department of thoracic oncology primarily treats patients with all thoracic malignancies such as tumors of the lung, oesophagus, mediastinum and chest wall. It also serves patients with pulmonary metastases from other cancers. Most patients require multidisciplinary treatment. Based on the latest available evidence, the patient is offered surgery (including minimal invasive surgery to improve operative outcomes) or a combination of chemotherapy/radiation therapy and surgery. In the near future, patients will also be able to participate in clinical trials.

Oesophageal Cancer

For cancer of the oesophagus and heart, surgery is the standard of care for medically fit patients. Patients with locally advanced disease are down staged with chemotherapy or a combination of chemo and radiation therapy and are then re-assessed for surgery. Patients with advanced cancer and poor general condition are palliated with a self-expanding stent.

Oesophageal surgery is one of the most complex procedures, best performed by a specialist in a well-equipped centre. The surgeon in this division performs oesophagectomy using the minimally invasive surgical technique which has the potential to improve the operative outcomes.

Lung Cancer

Surgery provides the best chance of cure for early stage lung cancer. Surgical options include lobectomy, sleeve lobectomy and pneumonectomy. In patients with compromised lung function, segmentectomy or wedge resection is an option in selected cases. To improve the operative outcome, surgery can be performed using the video-assisted thoracoscopic technique in cases where indicated. Mediastinaladenopathy is not a contraindication for surgery as many of these patients can be downstaged by induction chemotherapy. Patients with locally advanced cancer, such as those with invasion of the chest wall, vascular structures and tracheo-bronchial tree, can be considered for aggressive surgical approaches. Patients with advanced stage disease are treated with a combination of chemotherapy, radiation, pleurodesis and are provided supportive care, including management of cancer pain.

The division is capable of performing complex surgical procedures for lung pathology, including VATS. The centre can also treat small lung cancers with precise radical radiation in patients with compromised lung functions.

MediastinalTumors

Tumors of the mediastinum are rare and require skilled radiologists and surgeons for proper diagnosis, staging and treatment. The centre has facilities for image-guided biopsy, mediastinoscopy, transbronchial biopsy and thoracoscopy for diagnosis and surgical management. Thoracoscopicthymectomy is a good approach for the treatment of myasthenia gravis when surgery is indicated. It does away with sternotomy and reduces hospital stay.

Chest Wall Tumors

Surgery is the treatment of choice for sarcoma and is also indicated in round cell tumors after chemotherapy. Resection of multiple ribs requires reconstruction with mesh and cement.

Pulmonary Metastases

Patients with pulmonary metastases are candidates for surgery if the primary is controlled or controllable and is the only site of metastases. Patients with solitary metastases can be managed with VATS. Those with bilateral metastases can be managed with the clamp shell approach.

Tumors of the Airway (Trachea And Bronchus)

These tumors can be treated by surgery when indicated and many others can be managed endoscopically with laser or thermal excision-fulguration. Tumors which are advanced are treated with radiation (including intraluminal) therapy.

Malignant Mesothelioma

This is a relatively rare tumor. Most patients present with advanced stage disease and are treated with chemotherapy (pemetrexate/platinum). In patients who have limited or localised disease, pleuro-pneumonectomy is the preferred treatment.

Urinary Bladder Cancer begins when cells in the urinary bladder start to grow uncontrollably.

The bladder is a hollow organ in the lower abdomen (pelvis), which collects and stores urine produced by the kidneys. It is estimated that there are 383,000 cases of bladder cancer worldwide out of which they are most commonly found in industrialized countries. Bladder cancer occurs mostly among older individuals although it has been noted to appear among the younger age groups as well. The average age of diagnosis is in the 60s. The cancer has a high rate of recurrence.

What is cancer of bladder?

Bladder cancer is a type of malignancy arising from the epithelial lining (i.e., the urothelium) of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder. The most common type of bladder cancer recapitulates the normal histology of the urothelium and is known as transitional cell carcinoma or more properly urothelial cell carcinoma.

What are the common signs and symptoms?

Early stage tumor may not give any symptoms. Common symptoms of bladder cancer include:

Blood in the urine
Pain or burning during urination
Feeling as if you need to go right away, even when the bladder is not full
Having trouble urinating or having a weak urine stream
Frequent urination or feeling the need to urinate without results
These symptoms are not sure signs of bladder cancer. Infections, benign tumors, bladder stones or other problems also can cause these symptoms. Anyone with these symptoms should see a doctor so that the doctor can diagnose and treat any problem as early as possible. If there is blood in the urine, then one should be careful and should not neglect it.

dr-swapnil-kapote

DR. SWAPNIL KAPOTE

M.S. (Oncosurgery)
ONCO SURGEON
PROFILE APPOINTMENT
IMG-20170609-WA0005-1

DR. SANJAY AGARWAL

M.B.B.S, M.D., Fellowship in Haemato-Oncology
HEMATO MEDICAL ONCOLOGIST
PROFILE APPOINTMENT
dr-sagar-gaikwad

DR. SAGAR GAYAKWAD

M.B.B.S., M.D., D.N.B.
RADIATION ONCOLOGIST
PROFILE APPOINTMENT