Radio Therapy or Radiation Therapy: Refers to the treatment of cancer through Ionizing Radiation to kill or contain the malignant cancer cells. It is generally useful in containing the growth of malignant cells and may also be used as curative treatment of Cancer. The Hospitals are equipped with latest machines and equipments to impart radiation therapy. The equipments such as Linear Accelerators and various kinds of CT and MRI machines are used to impart Radiation
Chemotherapy: It is a kind of Cancer treatment, which by injecting certain Antineoplastic drugs in the body, can kill cancer cells. An Oncologist would decide the kind of drug to be used for Chemotherapy and its duration. It is a useful treatment and is used in treating various kinds of Cancers. The conventional Chemotherapy has known side effects and now there are newer drugs, which directly act against the abnormal proteins in the cancer cells. This is called Targeted Chemotherapy Treatment.
Bone Marrow Transplants: Is a form of intensive treatment used to treat certain cancers like leukemia, lymphomas and some non-cancerous diseases like thalassaemia. Bone marrow is found inside our bones, and is the 'factory' that makes blood. It is responsible for producing white blood cells (to protect against infection), red blood cells (to carry oxygen around the body) and platelets (to prevent bleeding). Stem cells are blood cells at their earliest stage of development in the bone marrow, before they have become committed to developing into white cells, red cells or platelets. It is these 'mother' cells, which are the key factors in transplantation. There are two main types of transplants - Autologous and Allogenic.
- Autologous Transplants: This means that the bone marrow or stem cells used for the transplant are one's own. A little bit of the patient's bone marrow or stem cells is taken and stored before high dose treatment. When the treatment is over, the bone marrow or stem cells are given back through a vein.
- Allogeneic Transplants: In this type of transplant, bone marrow donated by someone else is used. It is essential that the donor's tissue match. The most suitable donor is usually a close relative, most commonly a brother or sister. It is possible to get a good match from an unrelated donor, but this facility does not exist in India.
Breast Cancer: Breast cancer is the most leading and life threatening cancer originating in breast tissue that affects most women worldwide. It is the principle cause of mortality in the women across the world. Breast cancer in its early stage is very difficult to diagnose as it does not cause any symptoms and usually the pain and discomfort in breast is absent. Any of the following changes in the breast may indicate the risk of presence of breast cancer;Changes in the skin over the breast or skin dimpling,Change in size and shape of the breast,Lump in the breast or axilla,Nipple abnormalities like nipple inversion and skin changes,Blood stained single duct discharge. Breast cancer like other cancers can spread and invade in the adjacent breast and it also has a tendency to spread and grow in other different parts of the body through metastasis. Breast cancer is considered as the second leading cause of death in women in their 30s and 50s.
Stages of breast cancer-
- Stage 0: disease is localised to milk ducts
- Stage 1: cancer is less than 2 inches in size and is not spread anywhere with no involvement of lymph nodes
- Stage 2: cancer is-Less than 2 cm and spread to the axillary lymph nodes,Between 2-5 cm with or without spreading to lymph node,Larger than 5 cm and has not spread to axillary lymph nodes.
- Stage 3: cancer at this stage is called as locally advanced breast cancer. Tumour is of any size and has spread to lymph nodes (stage 3A), spread to skin, chest wall or internal mammary lymph nodes that are located beneath the breast (stage 3B).
- Stage 4: cancer is defined as tumour irrespective of size that has spread to other areas away from breast like bones, liver, lungs or brain.
The treatment for breast cancer is usually recommended after analysing some key factors like the size and site of tumour, the extent to which it is spread, lab investigation results, stage of the breast cancer and the generalised health and age of the patient.Treatment options for breast cancer includes-
- Surgical Intervention: Breast cancer can be treated by surgery using two approaches depending on the extent and stage of cancer.
- Breast conserving surgery: The main goal of breast conserving surgery is to save as much breast tissue as possible by removing only the part of the tissue containing cancer. Women might need radiation therapy or chemotherapy after this surgery. This surgery includes-
- Partial mastectomy
- Lumpectomy/ quadrantectomy
- Breast removal surgery: Breast removal surgery aims at removing the entire breast, and is medically called as mastectomy. Breast removal is often followed by the reconstruction surgery to restore the normal appearance of the breast. However, reconstruction surgery is subjective. Mastectomy can be performed using following methods-
- Simple mastectomy: entire breast is removed sparing the axillary lymph nodes and tissue/ muscle underneath the breast. It is the most common type of surgery used to treat breast cancer.
- Skin sparing mastectomy: skin sparing mastectomy is done in females who choose to get reconstruction surgery after mastectomy. In this procedure, the breast tissue is removed keeping the skin over the breast and the nipples intact.
- Radical mastectomy: this is an extensive procedure characterised by removal of entire breast with the axillary lymph nodes and pectoral muscle of the chest present under the breast.
- Modified radical mastectomy: this is less extensive commonly performed surgery in which the breast is removed along with the axillary lymph nodes. Lymph nodes are removed using-
- Axillary lymph node dissection (ALND) in which around 10-20 lymph nodes are removed from the axilla and are checked for cancer spread.
- Sentinel lymph node biopsy (SLNB) only removes the first few lymph nodes up to which the cancer is most likely spread.
- Radiation Therapy: It is often needed after the breast conservation surgery like partial mastectomy and lumpectomy in which radiations are used to destroy the cancerous cell in the breast and occasionally in the axilla and chest wall under the breast.
- Chemotherapy: Unlike radiation therapy, in this the medication given by injections are used to kill the cancer cells. This therapy has the side effect like hair loss, nausea, vomiting and sometimes infection as along with the cancer cells this can affect the normal healthy cells too. Medication therapy: This includes-Hormone therapy: Mostly used for postmenopausal women in which cancer cells which have oestrogen receptors are targeted and their growth is stopped using the oestrogen blocking medication like tamoxifen. It is usually done to enhance the chances of recovery and to allow the surgery to take place with success
- Biological therapy: This is given by injections which inhibits the growth of cancer cells and assist to kill those cell.
Blood Cancer: Blood cancer, also known as the haematological cancer is the cancer of the blood cells and the organs that form blood.There are 3 major kinds of blood cancers-Leukaemia,lymphoma,Multiple myeloma. All these cancers develop either in the bone marrow or the lymphatic tissue in the body and affect the blood cell production and the immune response from the disease to great extent.
Treatment Option-There are various treatment options for Blood cancer. The treating doctor would suggest the best treatment for the patient or a combination of these depending upon the medical condition of the patient:
- Chemotherapy: This is considered as the main treatment for blood cancer.
- Radiation therapy: This is done to shrink the tumour mass which is compressing the important structure of the body. This is mainly employed in cases of localized disease.
- Biological therapy: In this, body uses its own immune system to destroy cancer cell. Biological agents like interferon, interleukins, tumour necrosis factors, monoclonal antibodies and colony stimulating factors are used as special immune system cells to stimulate the body's immune system so as to destroy and kill the cancerous cells.
- Bone marrow transplants: also known as the stem cell transplant is most frequently performed procedure for the treatment of leukaemia and lymphomas. In this the damaged bone marrow is replaced with the new and healthy one from either a donor or from your body. Bone marrow transplant can be performed in 3 ways -
- Autologous BMT: During Autologous bone marrow transplant, stem cells are removed from your body before undergoing the chemotherapy or radiation therapy and are preserved. After the chemo/radiation they are put back in the body to produce normal blood cells.
- Allogenic BMT: During Allogenic Bone marrow transplant, stem cells are taken from the donor whose genes are partly matching yours like your brother or sister can be the best match for you.
- Umbilical cord blood transplant: During umbilical cord blood transplant, stem cells are taken from the umbilical cord (which were preserved when the patient was born) and there is no need for matching. Bone Marrow Transplant- is a complex and major procedure. There are risks and complications associated with the procedure and the procedure is thus recommended to select few patients when other treatments have failed.Bone Marrow Transplant is recommended if other treatments are not working and there is higher risk of the condition returning without the transplant. If the physician feels that the benefits of the transplant outweigh the risks associated with the procedure, bone marrow transplant is advised. The best candidates for bone marrow transplant are those in otherwise good health and have stem cells available from a sibling, or another family member, with the same tissue type.
Prostate Cancer: The prostate cancer typically advances slowly and primarily remains restrained to the prostate gland and thus requires minimal treatment. However some prostate cancers may need quick attention and aggressive treatment for complete cure. Early detected prostate cancer that is confined to the glad itself has good chances of complete cure. Prostate cancer may not show any signs and symptoms when it is at its early stage but more advanced cancer may cause symptoms like Blood stained semen, discomfort and pain in pelvic region, difficulty in micturition, bone pain, erectile dysfunction etc.
The stages of prostate cancer are -
- Stage I: Cancer is confined to small area of prostate gland and cells are not at all aggressive
- Stage II: Cancer is small but the cancer cells may reflect as aggressive or the cancer is large may have grown enough that is involving prostate glands of both the sides
- Stage III: Cancer has advanced outside the prostate and affecting seminal vesicles and adjacent tissues
- Stage IV: Cancer has advanced to plague nearby organs including urinary bladder, bones, lymph nodes, lungs or other tissues and organs.
Treatment Option-The prostate cancer can be treated with following options which depend on the size and site of the cancer, stage of the cancer and extent to which the disease has spread.
- Radiation Therapy: It comprises of high intensity energy to destroy the cancerous cells and is delivered in 2 ways-
- External beam radiation therapy: Radiation from outside the body is focused on prostate gland using high powered energy beams like protons or X-ray.
- Brachytherapy: Radiation is delivered from inside the body. It involves placement of radioactive seeds which are rice-sized that emit the low dose of radiation for long period. The seeds are implanted in the prostate using ultrasound guided needle.
- Hormone therapy: The cancer cells of prostate are dependent on the male hormone testosterone for their growth. Thus, hormone therapy aims at inhibiting the production of testosterone that may stop the growth of the cells or may cause them to die. This therapy includes-
- LH-RH (luteinizing hormone-releasing hormone) agonists to stop the production of testosterone. The medicines include goserelin, leuprolide, histrelin and triptorelin
- Anti-androgens to block the testosterone to reach the cancer cells. These includes flutamide, bicalutamide and nilutamide.
- Chemotherapy: It is used to destroy the fast growing cells by using injectable drugs. It is the treatment of choice for the men whose cancer has advanced to other areas of the body or for the men who have not responded well to the hormone therapy.
- Biological therapy: Also known as immunotherapy in which your own body's immune system is made to fight the cancer. In this some of your immune cells are taken and genetically modified in the lab and are injected back in your body to fight the cancer cells.
- Surgery: The surgery to treat prostate cancer is to remove the prostate gland and is known as Radical prostatectomy. Radical prostatectomy is the surgery done to remove the entire prostate and any nearby tissues i.e seminal vesicles and some nearby lymph nodes that may contain cancer. It is the surgery of choice in men whose cancer is limited to prostate. Following are the different approaches of the prostatectomy -
- Laparoscopic prostatectomy: This is minimally invasive method in which prostate is removed through small incisions in the abdomen with the help of laparoscope.
- Robot assisted laparoscopic prostatectomy: The surgical instruments are attached to the robot (mechanical device),and the surgeon uses the controls to direct the device to move the instruments. This surgery is gaining immense popularity as it more precise, less traumatic and minimally invasive procedure. The most popular robotic prostatectomy includes the da Vinci surgical systems which aids to provide dexterity, precision and advanced visualization compared to open and laparoscopic surgery. Using da vinci robotic prostatectomy the surgery can be done through small incision of 1-2 cm.
- Nerve sparing prostatectomy: It is performed when the cancer is entwined with the nerves to maintain the normal function and structure of the nerve.
- Radical prostatectomy with retro pubic approach: Traditional open surgery to remove the prostate gland. The prostate is removed through an incision on lower abdomen.
- Radical prostatectomy with perineal approach: Prostate is reached through an incision between the anus and scrotum.
Lung Cancer Treatment:Cancer happens when the cells in a part of the body grow abnormally faster and in uncontrolled manner due to mutation in the DNA of the cells. Similarly cancer in the lungs happens when the cancer cells invades the lungs and destroy the healthy cells of the lungs thereby hindering the normal functions of the lung. Cancer in lungs may take several years to develop. The lungs cancer often go unnoticed in early stages as it hardly produces any symptoms. The advanced cancer may show up symptoms like blood in the cough, persistent cough, chest pain, hoarseness in the voice, recurrent chest infection etc. There are two main types of lungs cancer -
- Small cell lung cancer (SCLC): Small cell lung cancer starts in the air tubes that advances to the bronchi and affect the lung tissue. It produces large tumours that can spread faster to other parts. This is usually seen in chronic and life time smokers. It has two sub-types -
- Small cell carcinoma (oat cell carcinoma) is most common.
- Combined cell carcinoma.
- Non-small cell lung cancer (NSCLC): Makes up 85% of all the lung cancer which are slow growing and larger and has following types -
- Squamous cell carcinoma
- Large cell carcinoma
Treatment Option-To regulate the survival rates, it is essential to know the stage of the disease. The treatment for the lung cancer can either be curative in which the interventions are done to control the growth of the cancer, or it can be palliative, which aims to improve the quality of life by managing pain and associated symptoms.
- Surgery: Surgery to treat lung cancer is considered as the gold standard which is performed to excise the cancerous tumour and the surrounding lung tissue in order to cure the patients when the disease is particularly localized. Initially, only traditional open surgeries were performed for resection of the tumour. The recent advances in the surgical procedure has made minimally invasive surgery the primary option for surgical resection of lung cancer. The following procedures are now being performed by the surgeons using VATS that is video assisted thoracic surgery and robotic surgery as well.
- Wedge resection or segmental resection: done to remove only the small part of the diseased lung
- Lobectomy: most commonly performed to remove the lobe of your lung if the cancer in extensive.
- Pneumonectomy: to remove the entire lung if the cancer has invaded all the lobes. These procedures are done using minimally invasive VATS technology that involves insertion of thin tube that is attached to the thorascope (camera) and the specialized small surgical instruments to carry out the required surgery. The thorascope provides images on the monitor using which the surgeon removes the tissue with more ease and precision.
- Chemotherapy: It comprises of specialized drugs that destroy the growing cancer cells. The drug may be injected intravenously or can be taken orally in the form of pills.
- Radiation therapy: This uses high powered energy beams like X-ray or protons to kill the cancerous cells. It can either be use as a sole treatment or can be combined with the chemotherapy with or without the surgery. Following radiation therapy most of the patients are relieved from the pain, obstruction in the airways, shortness of breath etc. It can be done using External radiation or Brachytherapy (internal radiation)
- Radiosurgery: The new innovation in radiation therapy is radiosurgery, which is used in very limited patients where tumours are small but undergoing surgery may prove harmful. In such cases, surgery is done using radiosurgery, in which high doses of radiation that are focused precisely on targeted cells in the lungs to kill the cancer cells without harming the nearby tissues.
Liver Cancer Treatment: Liver is one of the most important organs in the human body located in the right upper part of the abdomen just beneath the diaphragm. Liver performs wide spectrum of functions which include maintaining and regulating the storage of glycogen, production of hormones, plasma proteins, RBC decomposition, detoxification and production of bile that helps in digestion. There are mainly two types of Liver cancer -
- Primary Liver Cancer: Cancer that originates in the liver cells itself is called Primary liver cancer, There are two types of primary liver cancer
- Hepatocellular Carcinoma (HCC) - HCC is the most common type of liver cancer and starts from the main cells of the liver. People affected with cirrhosis are most prone to have HCC.
- Other types of Primary liver cancer are Cholangiocarcinoma, cancer that starts in the cells lining the bile duct and Angiosarcoma, which is a rare liver cancer starting in the blood vessels.
- Secondary Liver Cancer: It is the cancer that has originated in the other parts of the body but has spread to liver (known as metastasis)
- Surgery: Liver surgery is the most commonly performed procedure for liver cancer. There are mainly two types of surgical procedures:
- Partial hepatectomy: This surgery is indicated only in cases of small tumours and when the liver functions are good. During the procedure, only the tumour and the small portion of the healthy tissue around the tumour is excised as the liver has the tendency to re grow.
- Liver transplant surgery: Liver transplant is the procedure to remove the diseased liver and replacing it by a healthy and normally functioning liver from the donor.
- Non surgical procedures:
- Cryoablation: This entails killing the cancerous cells using an instrument called cryoprobe that delivers nitrogen which freezes and kills the cells.
- Radio Frequency ablation: This procedure includes insertion of the needles to reach tumour through small incision in the abdomen and then heating the needle at very high temperature with an electric current to destroy the targeted cancerous cells.
- Chemotherapy: Strong anti- cancer drugs are injected in the hepatic artery which is then blocked so as to cut the blood supply to the cancer cells which makes them shrink and ultimately die. This procedure is often called as chemoembolization
- Radiation therapy: By using the high powered energy beams, the cancer cells are targeted to shrink and die. The new advance technique called as stereotactic radiotherapy can be used to treat liver cancer.
- Targeted drug therapy: The drugs that interfere with the tumour function and inhibit the advancing spread of carcinoma are used to control the cancer. Sorafenib is one such drug.
Pancreatic cancer Treatment: Pancreatic cancer is the cancer of the pancreatic tissue and is of major concern as it grows and spreads very rapidly and has poor prognosis even if it is detected early. It rarely produces any symptoms in its early stage. The signs and symptoms always appears when the cancer is in the advanced stage and the symptoms may include pain in the upper abdomen that often radiates to back, loss of weight and appetite, yellowish discolouration of the skin and eyes, blood clots and associated depression.
Treatment Option-The treatment for pancreatic cancer aims to primarily eliminate the cancer if possible but the choice of treatment is highly dependent on the stage of the cancer and the age, overall health and fitness of the patient. If complete cure is not possible, focus on the preventing further growth of the cancer becomes necessary. However, in more advanced cancer, when it is more likely that the treatment will not benefit the patient, reliving the symptoms of the patient is the focus.
- Surgery: It is indicated when the cancer is confined to the pancreas. This includes surgery of either the head or tail of the pancreas depending on where the tumour is present. Different types of surgery are:
- Pancreatoduodenectomy: commonly known as Whipple procedure, it is done when the cancer is located in the head of the pancreas. This procedure includes excision of the head of the pancreas with small portion of the duodenum (part of small intestine), gall bladder and some part of biliary duct. The residual parts are then reconnected to allow proper digestion of food.
- Distal pancreatectomy: this is performed to remove the tail of the pancreas along with small portion of the body of pancreas. Spleen may or may not be removed depending on the extent of disease. These procedures can be done either through traditional method in which the single incision is made to perform the surgery or the minimally invasive (laparoscopic) approach is used to lessen the risk and complication which are common in traditional approach.
- Radiation Therapy: Involves the use of high powered energy beam to kill cancerous cells. Patient may need radiation therapy either before or after the surgery or in combination with the chemotherapy. The radiation can be delivered using -
- External beam radiation therapy: the machine that emits radiation beam moves around the patient targeting the specific area of body
- Intraoperative radiation: the radiation therapy is used as a part of surgery or given during the surgery.
- Chemotherapy: Involves using one or combination of drugs that may be injected or taken orally that helps in killing the cancer cells. If the cancer is not confined to the pancreas and has spread to nearby organs, then chemotherapy is combined with the radiation therapy often called as chemoradiation is used to treat the cancer.
- Targeted Drug Therapy: Involves the use of drugs that restrict the substances that provoke the cancer cell to divide and grow. Erlotinib is the one such drug if combined with the chemotherapy, can be used to treat more advanced cases of pancreatic cancer.
- Immunotherapy: Also known as biological therapy. It entails using the patient's own body's immune system to fight the cancer. Some of the patient's own immune cells are taken and genetically modified in the lab and are injected back in the body to fight the cancer cells. Biological agents like monoclonal antibodies, therapeutic vaccines, checkpoint inhibitors, immune modulators, adoptive T cell and cytokinesare used as the special immune system cells to stimulate the body's immune system so as to destroy and kill the cancerous cells.
Colon Cancer Treatment:Cancer that begins in the colon or rectum is termed as colon cancer, rectal cancer or colorectal cancer. Mostly colon cancers are adenocarcinomas which start when mutation takes place in the lining of the wall of the colon or rectum. The cancer usually begins with the formation of polyps often called as adenoma in the intestine. Polyps are the abnormal growth of tissue that become precancerous initially and then become cancerous. The colon cancer can be staged as-
- Stage I: Cancer has begun but confined to the inner wall lining of the colon
- Stage II: Cancer has spread to the organs adjacent to the colon or rectum but has not invaded the lymph nodes
- Stage III: Cancer has invaded the lymph nodes but has not spread to distant organs of the body,
- Stage IV: Cancer has spread to lymph nodes and is carried to the distant organs through the lymphatic system. Lungs and liver are the common organs to get affected first.
Treatment Option-Surgery-Surgery aims at removing the colon or rectum or a part of it affected by the cancer, with or without the adjacent lymph nodes using one of following approaches. The type of surgery depends on the type, size, location and the extent of the cancer spread.
- Polypectomy: Polypectomy involves removal of the polyps which are small adenomatous growth that are present in the inner lining of the wall of colon. They are removed using colonoscopy.
- Colectomy: Colectomy involves removing the part or whole of the colon with the cancer and some of the surrounding tissue. This can be done in two ways:
- Traditional open colectomy: involves removal of the part or whole of the colon through single large incision in the abdomen
- Laparoscopic colectomy: most commonly used procedure in which colectomy is done through multiple small incisions of about 5-10mm size using laparoscope and specialized laparoscopic surgical instruments.
- Chemotherapy: involves giving medicines either intravenously or orally to attack and kill the cancerous cells. This therapy can be used before the surgery in order to shrink the size of the tumour or after the surgery to eliminate the cancer cells, if left any. Chemotherapy is also given to slow down the advancing cancer and to relieve the symptoms in case of extensive cancer.
- Radiation therapy: Involves delivery of high powered energy beam like protons or X-rays to specifically target cancer cells without or minimally affecting the normal healthy cells of the body. It can be used in combination with chemotherapy either before or after the surgery, or may be used for relieving the symptoms associated with cancer if the cancer is extensive and cure is not possible.
Cyberknife Treatment:CYBERKNIFE, the world's first non-invasive radio surgery technology, offers new hope to the patient exploring a non-surgical option to treat complex and inoperable tumors. It is a cutting edge innovation in the treatment of both cancerous and non-cancerous tumors in any part of the body including the brain, spine, liver, pancreas, kidney and prostate with state-of-the-art and real time guidance to deliver powerful dose of radiation on the targeted tumour with pinpoint accuracy, without affecting the surrounding tissues. Cyberknife Radio surgery in India is a robotic surgical procedure that enables the radiation oncologist to deliver high energy beams of radiation in such a precise way that the radiation can be harmonized with the contour of even small complex tumors stationed near vital organs. The added benefit of cyberknife in India is highly affordable cost. Cost of cyberknife treatment in India is a fraction of what you would need to pay for the same in any Western country. Cyberknife surgery is effective in delivering favourable outcomes to the cancer patient thus building confidence in our efficient team of highly qualified surgeons and specialists in India to tackle even the most complicated benign and malignant tumors with sub millimetre accuracy.
Works of Cyber Knife-Cyberknife incorporates the highly innovative technologies that sets it far ahead of other parallel cancer treatments. Advantages of Cyberknife-
- The High resolution imaging system traces and ascertains the shape, size and location of the tumour and enables the automatic compensation in an event of any movement of patient during treatment. It thus excludes the need of invasive head frames which allows the patient to be comfortable and breathe normal during delivery of treatment.
- The digital data image traced by the imaging software is conveyed to the cyberknife system which is analysed by the surgeon to plan the treatment in order to precisely match the required dose of radiation for the tumour.
- A multi-joint computer regulated robotic arm with six degrees of movement freedom moves around and emits high energy radiation beams mounted on the robotic arm to precisely target the tumour from more than 1200 angles with pinpoint accuracy without harming the surrounding healthy tissues.
- These focused radiation beams converge at the point where tumour is sited so as to maximize the accuracy in delivering the required high dose of radiation that destroys the tumour cells sparing adjacent tissues.