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Category Archives: Oncology

Combining CRS and HIPEC Techniques – A Game Changer For Oncologists

Dr Kapil Kumar

A 65-year-old hypertensive lady with Carcinoma Ovary post three cycles of chemotherapy was admitted to BLK Cancer Centre. Carcinoma is a type of cancer in the epithelial cells of the abdominal cavity.  Cancer in each of the abdominal organs can spread to abdominal surfaces and the peritoneum. This kind of spread is called peritoneal carcinomatosis and traditionally, considered an incurable disease with a life expectancy of not more than few months. Despite undergoing chemotherapy, her disease was present with nearly two liters of ascites(abnormal accumulation of fluids in the abdomen) and thickened omentum and peritoneum which are the fatty lining covering stomach, large intestines and other abdominal organs containing lymph nodes.

A specialized oncological team took up the task which was led by Dr Kapil Kumar, Director & HOD, Surgical Oncology. On complete and detailed investigation it was observed that the carcinoma involving the peritoneum, included metastasis (spread) of cancer of the appendix, cancer of the colon and rectum, cancer of the ovaries, and cancer of the stomach. After going through the complete history of the patient, the team came to a conclusion of performing multiple surgeries, using the innovative technique known as Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

 What is a CRS?

Because heated chemotherapy can penetrate only at a very limited distance in the tumor tissue, it is imperative to remove all visible and palpable tumor deposits before HIPEC is delivered. Surgery for removal of tumor deposits in the abdomen is known as cytoreductive surgery. Cytoreductive surgery is a complex surgical procedure, during which some organs are resected (removed). This includes various surgeries as in the case of this patient. She underwent the following: –

1. Total Abdominal Hysterectomy(TAH) – It is a surgical procedure done for the removal of uterus along with cervix. It is done in extreme cases like cancer when non-surgical treatments fail.

2. Bilateral Saplingo Oopherectomy(BSO) – This surgical procedure is done for removal of both ovaries and the fallopian tube. It is usually performed along with TAH when the cancer cells have spread completely and a more casual term is used ‘Ovariohysterectomy(TAH-BSO)

3. Lymphadenectomy – lymph node dissection is the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer. This patient also underwent pelvic and para aortic lymph node dissection.

4. Omentectomy – Surgery to remove part or all of the omentum, an large apron of fatty tissue containing veins, arteries, lymphatics. The omentum attaches to and nourishes the stomach and the entire colon.

5. Peritonectomy is the most common surgical procedure for peritoneal mesothelioma patients. The goal of the surgery is to remove the cancerous part of the lining of the abdominal cavity.

6. Extended Right Hemicolectomy – Open right hemicolectomy is a procedure that involves removing the cecum, the ascending colon, the hepatic flexure (where the ascending colon joins the transverse colon), the first one-third of the transverse colon, and part of the terminal ileum, along with fat and lymph nodes.

With more than 11 hours of complex surgical performance the patient was now ready for HIPEC. This type of complex surgery requires special equipments and high surgical skills. CRS is aggressive removal of all or most visible tumours in the abdomen and preventing growth of microscopic cells which are left behind. After completion of the resection of all tumor tissue, the HIPEC procedure was performed.

How is the HIPEC Procedure conducted? 

Hyperthermic Intraperitoneal Chemotherpy (HIPEC) is instilled via a machine which circulates Chemotherapy solution in the peritoneal cavity at 42 degree Celsius for 60-90 minutes. During the HIPEC procedure, a machine will continuously circulate a heated sterile solution containing a chemotherapeutic agent throughout the peritoneal cavity of the patient, for one to one and half hours and killed the remaining cancer cells. The HIPEC procedure also improves drug absorption and effect with minimal exposure to the rest of the body. In this way, the normal side effects of chemotherapy can be avoided. It is being performed in selected centres across India including BLK Cancer Centre and abroad.

She made steady post-operative progress, and was discharged after two weeks. She is now undergoing her remaining chemotherapy procedure. Her quality of life has improved and chances of her survival are very much on the cards.

Most commonly treated diseases are pseudomyxoma peritonei, mesothelioma, colon and rectal cancer, appendiceal cancer, gastric cancer, ovarian cancer, and primary peritoneal cancer.

Another 43 years old African patient was diagnosed with carcinoma ovary with incomplete staging surgery done in Kenya came to BLK. Where similar procedure was followed with three cycles of chemotherapy and CRS was done. The team drained out 19 liters of ascites. She is making steady progress now and has hope of improved survival despite stage IV Ovarian Cancer.

The HIPEC procedure, when combined with CRS, has proven to be an effective therapy that has improved survival outcomes. BLK Cancer centre has now treated many peritoneal cancer patients in the recent times with this innovative technology.

 Dr Kapil Kumar, & HOD, Surgical Oncology, BLK Cancer Centre, New Delhi

Breast Cancer Comprises 10% of All Cancer Cases

Dr. Shilva

Cancer is strengthening its grip across India. Approximately 17.3 lakh new cancer cases are being estimated by the year 2020 in India. Breast cancer has a majority share of cancer cases and is the leading cause for deaths in women suffering with non-communicable disease. According to an Indian Council of Medical Research (ICMR) report, breast cancer shares 10% of all cases.

Approximately, 1.5 lakh breast cancer cases are being reported in the country every year and the incidence is showing an upward trend. One in eight women is known to develop breast cancer cases at some point of time in life. We suspect that the number might be higher. Due to lack of awareness amongst people and social stigma, a lot of women ignore symptoms and are wary of coming to doctors for diagnosis.

Diagnosis at early stage is important for any kind of cancer, for the treatment to be effective. However, it is more so for breast cancer because breast cancer do tend to show early signs by change in how breasts feel and look to an individual. An important sign is lump formation in breasts. Usually, cancerous lumps are hard mass with irregular edges, but they can also be soft, tender and rounded, and sometimes painful. However, any appearance of lump formation in breasts should not be ignored.

It is very important for women to know how their breasts feel and look because that increases the chance for a person to realize any new abnormality, which helps in diagnosing an early stage of cancer. Lump formation in breasts should not be ignored. Also, there should not be unnecessary panic. Eight out of ten breast lumps are nonmalignant or non-cancerous. However, it is only through a breast biopsy can cancer be detected or ruled out. One should not be satisfied with other forms of diagnosis or treatment options such as mammography.

Some of the other symptoms of breast cancer include breast swelling, skin irritation, pain in nipples or breasts, nipple turning inward or nipple retraction, and scaling, redness of nipple or skin of breasts.

Due to various societal and cultural factors, women find it hard to come out in open and discuss or get themselves diagnosed for breast cancer. Apart from anxiety and fear of being diagnosed as cancerous, changes of appearance and not feeling good about one’s body are also stressful factors. The treatment options like chemotherapy are in itself psychologically challenging because of their side-effects. Other than psychological and medical reasons, family and husband support are essential, and lack of such support or prejudice pertaining to the disease affects a potential patient psychologically preventing her to come go for check-ups. Cancer treatment options are sometimes expensive and that also acts as a limitation in going for timely treatment.

Breast cancer can be cured if it is timely diagnosed. To reduce the number of deaths due to the disease, myths surrounding the disease need to be busted and awareness about the disease and treatment options needs to be spread far and wide. Policies need to be framed to help the poor avail better treatment options. A combined nationwide effort is needed from all stakeholders to prevent this disease from becoming a national crisis.

Is a Consultant Obstetrics & Gynaecology, Paras Bliss Hospital.

 

What is Cancer & What are its general Signs & Symptoms?

    Dr. Navile Aditya Murli

Cancer is the uncontrolled growth of abnormal cells in the body. Cancer develops when the body’s normal control mechanism stops working. There are over 100 different types of cancer, and each is classified by the type of cell that is initially affected. Old cells do not die and instead grow out of control, forming new, abnormal cells. These extra cells may form a mass of tissue, called a tumor. Some cancers, such as leukemia, do not form tumors.

Tumors can grow and interfere with the digestive, nervous, and circulatory systems, and they can release hormones that alter body function. Tumors that stay in one spot and demonstrate limited growth are generally considered to be benign. When a tumor successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a serious condition that is very difficult to treat.

Cancer may occur anywhere in the body. In women, breast cancer is one of the most common. In men, it’s prostate cancer. Lung cancer and colorectal cancer affect both men and women in high numbers.

There are five main categories of cancer:

 Carcinomas begin in the skin or tissues that line the internal organs.

 Sarcomas develop in the bone, cartilage, fat, muscle or other connective tissues.

 Leukemia begins in the blood and bone marrow.

 Lymphomas start in the immune system.

 Central nervous system cancers develop in the brain and spinal cord.

Signs and symptoms of Cancer

 Cancer is a group of diseases that can cause almost any sign or symptom. The signs and symptoms will depend on where the cancer is, how big it is, and how much it affects the organs or tissues. If a cancer has spread (metastasized), signs or symptoms may appear in different parts of the body.

 As a cancer grows, it can begin to push on nearby organs, blood vessels, and nerves. This pressure causes some of the signs and symptoms of cancer. If the cancer is in a critical area, such as certain parts of the brain, even the smallest tumor can cause symptoms.

 But sometimes cancer starts in places where it won’t cause any signs or symptoms until it has grown quite large. Cancers of the pancreas, for example, usually don’t cause symptoms until they grow large enough to press on nearby nerves or organs (this causes back or belly pain). Others may grow around the bile duct and block the flow of bile. This causes the eyes and skin to look yellow (jaundice). By the time a pancreatic cancer causes signs or symptoms like these, it’s usually in an advanced stage. This means it has grown and spread beyond the place it started – the pancreas.

 A cancer may also cause symptoms like fever, extreme tiredness (fatigue), or weight loss. This may be because cancer cells use up much of the body’s energy supply, or they may release substances that change the way the body makes energy from food. Cancer can also cause the immune system to react in ways that produce these signs and symptoms.

 Sometimes, cancer cells release substances into the bloodstream that cause symptoms that are not usually linked to cancer. For example, some cancers of the pancreas can release substances that cause blood clots in veins of the legs. Some lung cancers make hormone-like substances that raise blood calcium levels. This affects nerves and muscles, making the person feel weak and dizzy.

General signs and symptoms of cancer

You should know some of the general signs and symptoms of cancer. But remember, having any of these does not mean that you have cancer – many other things cause these signs and symptoms, too. If you have any of these symptoms and they last for a long time or get worse, please see a doctor to find out what’s going on.

Unexplained weight loss

Most people with cancer will lose weight at some point. When you lose weight for no known reason, it’s called an unexplained weight loss. An unexplained weight loss of 10 pounds or more may be the first sign of cancer. This happens most often with cancers of the pancreas, stomach, esophagus (swallowing tube), or lung.

Fever

Fever is very common with cancer, but it more often happens after cancer has spread from where it started. Almost all people with cancer will have fever at some time, especially if the cancer or its treatment affects the immune system. (This can make it harder for the body to fight infection.) Less often, fever may be an early sign of cancer, such as blood cancers like leukemia or lymphoma.

Fatigue

Fatigue is extreme tiredness that doesn’t get better with rest. It may be an important symptom as cancer grows. But it may happen early in some cancers, like leukemia. Some colon or stomach cancers can cause blood loss that’s not obvious. This is another way cancer can cause fatigue.

Pain

Pain may be an early symptom with some cancers like bone cancers or testicular cancer. A headache that does not go away or get better with treatment may be a symptom of a brain tumor. Back pain can be a symptom of cancer of the colon, rectum, or ovary. Most often, pain due to cancer means it has already spread (metastasized) from where it started.

Skin changes

Along with skin cancers, some other cancers can cause skin changes that can be seen. These signs and symptoms include:

Darker looking skin (hyperpigmentation)

Yellowish skin and eyes (jaundice)

Reddened skin (erythema)

Itching (pruritis)

Excessive hair growth

 

Signs and symptoms of certain cancers

Along with the general symptoms, you should watch for certain other common signs and symptoms that could suggest cancer. Again, there may be other causes for each of these, but it’s important to see a doctor about them as soon as possible – especially if there’s no other cause you can identify, the problem lasts a long time, or it gets worse over time.

Change in bowel habits or bladder function

Long-term constipation, diarrhea, or a change in the size of the stool may be a sign of colon cancer. Pain when passing urine, blood in the urine, or a change in bladder function (such as needing to pass urine more or less often than usual) could be related to bladder or prostate cancer. Report any changes in bladder or bowel function to a doctor.

Sores that do not heal

Skin cancers may bleed and look like sores that don’t heal. A long-lasting sore in the mouth could be an oral cancer. This should be dealt with right away, especially in people who smoke, chew tobacco, or often drink alcohol. Sores on the penis or vagina may either be signs of infection or an early cancer, and should be seen by a health professional.

White patches inside the mouth or white spots on the tongue

White patches inside the mouth and white spots on the tongue may be leukoplakia. Leukoplakia is a pre-cancerous area that’s caused by frequent irritation. It’s often caused by smoking or other tobacco use. People who smoke pipes or use oral or spit tobacco are at high risk for leukoplakia. If it’s not treated, leukoplakia can become mouth cancer. Any long-lasting mouth changes should be checked by a doctor or dentist right away.

Unusual bleeding or discharge

Unusual bleeding can happen in early or advanced cancer. Coughing up blood may be a sign of lung cancer. Blood in the stool (which can look like very dark or black stool) could be a sign of colon or rectal cancer. Cancer of the cervix or the endometrium (lining of the uterus) can cause abnormal vaginal bleeding. Blood in the urine may be a sign of bladder or kidney cancer. A bloody discharge from the nipple may be a sign of breast cancer.

Thickening or lump in the breast or other parts of the body

Many cancers can be felt through the skin. These cancers occur mostly in the breast, testicle, lymph nodes (glands), and the soft tissues of the body. A lump or thickening may be an early or late sign of cancer and should be reported to a doctor, especially if you’ve just found it or notice it has grown in size. Keep in mind that some breast cancers show up as red or thickened skin rather than a lump.

Indigestion or trouble swallowing

Indigestion or swallowing problems that don’t go away may be signs of cancer of the esophagus (the swallowing tube that goes to the stomach), stomach, or pharynx (throat). But like most symptoms on this list, they are most often caused by something other than cancer.

Recent change in a wart or mole or any new skin change

Any wart, mole, or freckle that changes color, size, or shape, or that loses its sharp border should be seen by a doctor right away. Any other skin changes should be reported, too. A skin change may be a melanoma which, if found early, can be treated successfully. See pictures of skin cancers and other skin conditions in our Skin Cancer Image Gallery.

Nagging cough or hoarseness

A cough that does not go away may be a sign of lung cancer. Hoarseness can be a sign of cancer of the larynx ( voice box) or thyroid gland.

Is a Consulant of Medical Oncology at Oncoplus Cancer Care Centre, New Delhi. Dr. Murli passed his DM oncology in the August 2016 from the prestigious cancer institute (WIA), He did his Senior Resident and fellowship for three years in Cancer Institute Adyar Chennai.

 

Breast Cancer – Giving Up Is Not An Option

Dr. Kanchan Kaur

Being diagnosed with breast cancer is a life-changing experience. It can be hard to handle the news at first, and even harder to know how to proceed.

Breast cancer is a type of cancer that appears in the cells of the breast. The cells present in the breast increases uncontrollably with time and may take the shape of a tumor. The disease has recorded 1.5 lakh new cases in the year 2016. In India, most of the breast cancer cases are reported at a later stage, like stage IV because of the lack of awareness about the symptoms. Here are some of the symptoms

  1. Painless lump in the breast

This is one of the commonest symptoms that the patients see in their body.  A painless hard lump develops in the breast or sometimes under the arm. There can be more than one lump at times too.

  1. Inverted nipple

Nipple pulled inside is another threatening signal of breast cancer. Here, the nipple changes its direction and moves deep inwards into the breast. It is normal for the nipple to be in the outward direction. Also, beware if the nipple looks and feels sore.

  1. Discharge from the nipple

Did you find blood on the tip of the nipple even without any activity? This can be a sign of breast cancer looming just under your skin. While not all discharge is cancerous is nature, you should immediately see your doctor when you notice blood.

  1. Dimpling of the breast

If you have breast cancer, the skin over your breast will change notably. Dimpling or puckering of the breast should not be avoided.

  1. Redness

A red tint around or all over your breast is an indication of inflammatory breast cancer that is rare in nature and termed as an advanced stage of breast cancer. This also includes thickening and flaking where the breast skin looks similar to that of the skin of an orange. Redness in mostly seen in the younger patients whereas the older patients witness scabbing of the nipple.

6. Changes in a breast

The breasts might go through a lot of changes in case you have cancer in your breast cells. There can be a transformation in the breast size, shape, skin texture as well as color. You should be careful if you notice swelling which might take place on just one side.

So, have you off late noticed any of the symptoms? If yes, then you should hurry up and meet your doctor. But not all these symptoms primarily mean that you are suffering from breast cancer. Though this should not stop you from visiting a doctor because it can be some other issue altogether. Many a time mammograms catch breast cancers even before any sign of the symptoms, so a routine check-up can help you invade cancer early.

There are few risk factors that take you closer to breast cancer. Some of them are incurred while others are natural.  Like Alcohol, Drinking too much alcohol has been directly linked with the increased risks of breast cancer. It is found that as compared to non-drinkers, those who have 1-5 glasses of alcoholic drink a day are more at risk. Not just breast cancer, it escalates the chances of other cancers too. Other factors may include Obesity  the period after menopause is vital. If you gain weight post-menopause, you are at higher risk. The ovaries and fat tissue makes estrogen in women’s body. Once you reach menopause, the ovaries stop doing this activity but the fat tissue continues. This raises the estrogen level after menopause, hence taking you closer to breast cancer. Fat accumulation around the waist area and as well as weight gain during adulthood in women are the other factors. Some other factors include Birth control pills, Gender, Menstrual history, Aging, etc.

Like other types of cancer, breast cancer has its stages too which defines the severity of a patient’s condition. It has 5 stages in total which start with 0 to IV. These are decided based on the size of the tumor (T), its spread to the surrounding lymph nodes (N) or to other parts in the body (M). In these stages there stand few subcategories as well. Traditionally, the size of the tumor helps to stage the breast cancer patients. While Stage 0 indicates an early stage, the seriousness increases with the growing stages. Knowing the stages clearly might help you understand your breast cancer better.

With breast cancer being on the rise in India, doctors at the breast cancer department at Medanta say they are witnessing higher number of cases of women with breast cancer.

Once a woman has been diagnosed with breast cancer, the doctor will suggest appropriate treatment options according the stage of the disease. These options include

Surgery

Surgery is the standard treatment for breast cancer. This depends upon factors like the size of the cancer in your breast and also the affected area. The surgery is done in two procedures.

Breast-conservation surgery: Best suited for initial breast cancer Stages like I and II, this surgery tries saving the as many as healthy breast tissue. This procedure includes Lumpectomy, Partial mastectomy and breast reconstruction.

Other side effects are possibilities of infection, pain and bleeding which are considered part of any operation.

Radiation Therapy

Radiation therapy is the usage of a large machine which targets the patient’s body with external energy beams. The X-rays and protons present in the powerful energy beams kills the cancer cells. The other way through which radiation can be delivered to the patient is by putting radioactive material internally.

Radiation therapy leaves the skin red and rashes appear on the targeted area. Swollen breast tissues and nausea are the other side effects.

Chemotherapy

This is the process of using powerful drugs to kill the fast growing and dividing cancer cells in the body. Chemotherapy lessens the chances of cancer recurrence. The drugs either taken orally or infused through the veins, is advised by the doctor when there is a high risk of the cancer spreading to the other parts of the body. The level of the after-effects of chemotherapy depends on the kind of drugs that you are put on. Generally, nausea (very low currently), hair loss, infection, fatigue, fever, anemia, loss of appetite, lower sex drive, pain and constipation are some of the demerits of chemotherapy.

Hormone Therapy

Hormone therapy blocks or reduces the growth of the hormones in the body which encourages the advancement of some breast cancers. This therapy also narrows and controls the cancer that in this case uses hormones in the blood to grow. Fatigue, nausea, hot flashes, pain in the joint and muscle, vaginal discharge and vaginal dryness or irritation are some of the common risks involved.

Targeted Therapy

Targeted therapy uses drugs and other substances to locate and target cancer cells more accurately in the cancer treatment. This a new type of therapy which only targets the cancer cells in the body unlike chemotherapy which damages the cancer cells as well as the healthy cells. This therapy usually affects the skin. Dry skin, itching, photosensitivity, redness and hand-foot syndrome (pain, swelling, and redness on the palms and soles of the feet) are those included. High blood pressure, blood clotting, heart damage are other risks that the patient might experience.

Can Any of These Treatments Single-Handedly Cure Breast Cancer?

The answer is no. None of the treatments have that powerful impact when used alone for treating breast cancer. These treatments are always done in combination to cure the cancer in a better way. Your doctor is going to customize your treatment according to the intensity of your condition. It is often-

  1. Surgery+ Radiation+ Chemotherapy
  2. Surgery+ Chemotherapy
  • Surgery+ Hormone Therapy
  1. Surgery+ Chemotherapy+ Hormone Therapy+ Targeted Therapy
  2. Surgery+ Chemotherapy+ Targeted Therapy
  3. There are certain patients who need all five of the treatments. That makes it- Surgery+ Chemotherapy+ Hormone Therapy+ Targeted Therapy+ Radiation

When treatments are combined, you can always expect better results. Your oncologist and surgeon at Medanta Hospital are the best persons to combine the mentioned treatments according to your condition.

 

Ensuring Access To Timely Treatment Of Cancer Patients

With very little percentage of cancer patients having access to comprehensive and timely treatment support, a need to face this issue has arisen. Take a look at the ways in which this issue can be resolved

Dr. Harit Chaturved

 It might seem like a contradiction – that in the field of oncology, we are doing much better than before, yet we have a long way to go. I often feel we have hardly covered any significant ground. Not more than 15 per cent of our population has access to timely and comprehensive treatment support. To add to this difficulty, we are expecting that cancer incidences will double within the next decade, because of demographic profile, life expectancy, growing economy, lifestyle, etc. Are we prepared to face this challenge?

Major issue

A major problem is that a big chunk of our resources are spent on advanced stages of cancer and that too in the last six months of treatment in a patient’s journey. If the same resources are spent on cancer prevention and early diagnosis, it would be extremely beneficial for the patients and society at large. It is heartening to realise that almost 60 per cent of cancer is preventable. Tobacco contributes to more than two-thirds of patients in this segment and the other preventable causes are related to diet, lifestyle, vaccine for cervical cancer, liver cancer, etc. Proper education using IT and mass communication tools, with focus from primary education level onwards, could change the scenario rapidly.

Establishment of diagnostic centres

In early stages, the treatment outcomes are very gratifying, less expensive and there is minimal treatment-related morbidity. The operational cost of such a setup would be less than 5 per cent of operational cost of a hospital. These centres could be attached to nearby larger treatment facilities. Probably lot of diagnostic load from hospitals would also shift. These centres should be well equipped with imaging, endoscopies and biopsy procedures. The SOPs should ensure that more than 80 per cent of the patients are adequately attended in less than 72 hours. No cancer facility is complete without a comprehensive palliative care setup as an integral part, and it’s high time we bring the palliative care program centre stage.

Need for infrastructure

In the last two decades, we have seen dramatic growth in trained manpower and number of comprehensive cancer centres. In fact, in the last fifteen years, these numbers would be more than the total work done in the hundred years before that. There is a need to understand our disease pattern and response to treatment. To execute this, we need the infrastructure for research.

Chairman – Max Institute of Cancer Care
Max Super Speciality Hospital, Saket, New Delhi

 

 

 

How is Cancer Diagnosed?

Dr. Navile Aditya Murli

There is no single, simple method to diagnose cancer. It may take several months or years for malignant cells to multiply to the point where they become a detectable cancer. The symptoms produced by a cancer depend on its location and unfortunately it is possible for cancer to become widespread before it starts to produce any symptoms at all.

Sometimes cancers may be discovered accidentally during routine tests or the investigation of non-specific symptoms.

The cancers that are easiest to detect are those that are on the skin and which show, for example, as a change in a mole or wart. Others may start close to the surface and can be seen or felt as a lump or thickening. There are also some parts of the body that are relatively easy to examine for early signs of cancer such as the mouth and throat, the cervix and vagina or the rectum and anus.

What is Biopsy ?

Cancer is usually diagnosed by an expert who has looked at cell or tissue samples under a microscope. In some cases, tests done on the cells’ proteins, DNA, and RNA can help tell doctors if there’s cancer. These test results are very important when choosing the best treatment options.

Tests of cells and tissues can find many other kinds of diseases, too. For instance, if doctors are not sure a lump is cancer, they may take out a small piece of it and have it tested for cancer and for infections or other problems that can cause growths that may look like cancer.

The procedure that takes out a piece of the lump, or a sample for testing is called a biopsy. The tissue sample is called the biopsy specimen. The testing process is sometimes referred to as pathology.

How Biopsy is done ?

A biopsy is a procedure in which the doctor removes a sample of tissue. A pathologist  then looks at the tissue under a microscope to see if it is cancer. The sample may be removed in several ways:

  • With a needle: The doctor uses a needle to withdraw tissue or fluid.
  • With an endoscope: The doctor looks at areas inside the body using a thin, lighted tube called an endoscope. The scope is inserted through a natural opening, such as the mouth. Then, the doctor uses a special tool to remove tissue or cells through the tube.
  • With surgery: Surgery may be excisionalor incisional.
    • In an excisional biopsy, the surgeonremoves the entire tumor. Often some of the normal tissue around the tumor also is removed.
    • In an incisional biopsy, the surgeon removes just part of the tumor.

Lumps that could be cancer might be found by imaging tests or felt as lumps during a physical exam, but they still must be sampled and looked at under a microscope to find out what they really are. Not all lumps are cancer. In fact, most tumors are not cancer

 Is a CONSULANT MEDICAL ONCOLOGY at Oncoplus Cancer Care Centre, Defence Colony, New Delhi. He did His Senior Resident and fellowship for three years in Cancer Institute Adyar Chennai.

Cervical cancer

Dr. Shruti Bhatia

Every year in India, approximately 123000 new cases of cervical cancer are diagnosed and 68000 women die from this deadly disease. Maximum numbers of cases occur in rural areas as compared to urban areas because of lack of awareness, knowledge and facilities to diagnose. Fortunately the incidence is decreasing but unfortunately it is still one of the most common cancer in Indian women, along with breast cancer.

Cervical cancer is a cancer arising from the lower narrow part of the uterus which is the entrance to the womb. It commonly presents as abnormal bleeding, which may be inter-menstrual or post-coital or post-menopausal .Seldom it does not cause any significant symptoms.

The cells lining the cervix undergo certain changes which may or may not proceed to full blown cancer. There is a strong correlation of HPV infection (human papilloma virus infection) with progression to cancer cervix. Almost all cases of cancer cervix are associated with prior HPV infection. The age group most prone is 35-55. It is rarely seen below 20 years. Although 20% cases are above 65 years of age.

HPV infections are of two types- low risk and high risk. There are nearly about 120 types of HPV of which many are “low risk” types. Low risk infections usually do not progress to cancers. They can, however, cause genital warts or very minor cell changes in the cervix. There are more than a dozen types of “high-risk” HPV that can cause abnormal cells to form on the cervix. Types 16 and 18 are the most dangerous, since they cause about 80-90 percent of cervical cancers of total. In one study, the National Cancer Institute found that about 10 percent of women with HPV type 16 or 18 developed advanced, pre-cancerous cervical disease within three years, and 20 percent did so in 10 years.

High risk infections can be detected on routine screening like PAP smear, HPV DNA testing and by colposcopy. They often present as lesions on the cervix like cervical erosions which can be treated by cryocautery, electrocautery or LEEP. For prevention of HPV infection, two vaccines are available- injections Gardasil and injection Cervarix. Both vaccines target HPV 16 and 18 which are the high risk HPV strains. All girls and women between ages 13 to 45 are advised to meet their gynecologist and go in for the vaccination.

Lower age of sexual exposure and multiple sexual partners are definitely responsible for HPV infections and progression to cervical cancer. Lower age at first pregnancy and long term use of oral contraceptives also contribute to risk factors. Low socio- economic status, low education, smoking, exposure to DES in the mother’s womb are also linked to cancer cervix. A person affected with HIV infection is 5 fold more at risk of cancer cervix.

Detection of cancer cells can be done by conventional PAPs screening/ Liquid cytology + HPV testing. This is usually done by an experienced gynecologist. Once the cancer cells are detected the next step is the staging of cancer. This depends on the size of tumor, depth of spread and spread to lymph nodes. Also spread to distant and neighboring organs is looked into. Treatments offered are surgery + radiotherapy + Chemotherapy. In advanced cases we offer targeted therapy where treatment is customized to make the rest of the patient’s life comfortable.

Case Study:-

A 32 year old lady had come to us with complaints of persistent discharge and post coital bleeding. She had large cervical erosion for which she was advised hysterectomy by gynecologists. We examined the patient, did PAP smear, HPV testing and Colposcopy directed biopsy of cervix. She was diagnosed to have cervical intra-epithelial neoplasia I( CIN I) with high risk HPV infection. After antibiotics course, Cryo therapy was done to cure her erosion. Patient was kept under observation and repeated PAP smears and HPV testing were done. She is now symptom free and her PAP smears and HPV testing are normal.

Consultant, Gynae Oncology Action Cancer Hospital,

New Delhi