SURGICAL EMERGENGIES IN ONCOLOGY
There are a large number of emergencies seen in the practice of surgical oncology, and up to ten percent of patients with cancer may develop or present with surgical emergencies. Many of these patients need urgent intervention and good nursing care
Gastrointestinal emergencies
There a large number of gastrointestinal emergencies seen in oncological practice
Most of these are due to obstruction in the passage of intestines, due to recurrent or metastatic disease, lymph node or as a part of complication of surgeries or radiotherapy Patients may primarily present too, with intestinal obstruction or jaundice
Intestinal obstruction
Investigation Routine haemogram, s electrolytes, blood sugar, LFT, urea and creatinine, radiographs of chest and abdomen and ECG
A CECT scan can be done if facilities are available
Conservative management
Nil orally, I V Fluids, Ryles tube aspiration, monitoring of vitals, urinary output and abdominal girth
Many of these patients will be in a poor nutritional status and may need TPN
The same to continue for sub acute obstruction ,but surgical intervention may be needed for acute obstruction, specially if patient has some life expectancy, These patients should be taken up for emergency surgery
Gastric outlet obstruction gastrojejunostomy or feeding jejunostomy
Small bowel obstruction resection and anastamosis of small gut
Right Large gut obstruction ileocolic anastamosis, right hemicolectomy if possible
Or Ileostomy
Left Large gut obstruction Transverse colostomy, left hemicolectomy or
Caecostomy
Rectal obstruction sigmoid colostomy or Hartman’s procedure
Dysphagia
Dysphagia may be due to growth larynx, hypopharynx or carcinoma esophagus and proximal stomach
These patients are managed with endoscopic placement of Ryles tube, or with gastrostomy or feeding jejunostomy
Surgical obstructive jaundice
This may be due to carcinoma gall bladder, cholangiocarcinoma, carcinoma stomach, and carcinoma head of pancrease, hepato cellular carcinoma or due to metastatic lymph nodes in the porta hepatis
These patients are in a critical state and need active care
Besides the routine workup these patients should undergo a coagulation profile, and preferably a MRCP and ERCP (endoscopic retrograde cholangio pancreaticogram)
They should be given injection Vit K and 10%glocuse
These patients should be monitored very carefully for urinary output, specially in post operative period and may need Inj Lasix or Mannitol
These patients can be offered definitive surgery, palliative surgery or non-operative palliation
Definitive surgery
Patients with periampulary ca,ca head of pancrease and lower cholangiocarcinoma can be offered Whipples procedure which entails pancreaticoduedenectomy with choledochojejunostomy,gastrojejunostomy and pancreaticojejunostomy
Patients with cholangiocarcinoma are offered resection and those with early ca gall bladder are managed with radical cholecystectomy
Palliative surgery
If the above cases are not amenable to definitive surgery, due to extensive disease or moribund state, they are offered palliative surgery
The palliative procedures can be, cholecystostomy. Cholecystojejunostomy, choledochojejunostomy, hepaticojejunostomy or segment three bypass
If these patients have gastric outlet obstruction along with obstructive jaundice then a double or triple bypass should be done, which includes any of the above procedure with gastro jejunostomy
Non operative palliation
Patients who are in a very moribund state should be offered non-surgical means to relieve obstructive jaundice
This can be done by a endoscopic placement of nasogastric tube or a biliary stent
Ascitis
Ascitis may be seen in ovarian malignancies, haematological malignancies or G I malignancies
They are managed with salt restriction, and use of lasix and aldectone and repeated peritoneal tapping .
Massive ascitis may need permanent internal shunts
Respiratory system
Airway obstruction
May be due to growth larynx, or hypo pharynx, and need emergency tracheostomy
Pleural effusion
The may be seen in pulmonary metastasis, carcinoma lung, or mesotheliomas
Managed with pleural tapping, inercostal drainage, placement of pigtail catheter and in cases of recurrent massive pleural effusion, internal shunts may be used
Malignant pleural effusion may be hemorrhagic too
Urinary system
Lower urinary tract obstruction may be seen in Ca prostate, Ca neck of bladder and in few cases of ca penis
These patients need suprapubic cystostomy
Obstruction of the ureteric orifices may occur due to ca urinary bladder or locally advanced malignancies of the pelvic organs. these cases or cases with uretiric obstruction may develop hydro ureteronephrosis
These patients need nephrostomy
Head and neck
Besides pain, dysphagia, difuculty in talking or airway obstruction, patients of the head and neck malignancy may develop severe bleeding due to erosion of major vessels, like lingual artery in ca tongue or a carotid blowout in massive malignant cervical lymphadenitis
These patients may need emergency ligation of the internal carotid artery
Limbs
Large fungating masses over the limb in soft tissue or bone tumors or skin malignancies may need urgent intervention due to pain, bleeding and infection
These patients or those with non-viable limbs due to involvement of neurovascular bundle may need emergency operation
Paraplegia
Compression of the cord may be seen in involvement of the vertebra due to bony mestasis, commonly in ca prostate, thyroid or breast
Emergency laminectomy or decompression is needed in these patients
Saturday, January 16, 2010
Saturday, December 19, 2009
OTHER TREATMENTS OF CANCER
OTHER TREATMENTS OF CANCER
In the previous issues we discussed the three major modalities of treatment of cancer, Surgery, Chemotherapy and Radiotherapy. There are other modalities and newer therapies being used today for cancer care:-
Hormonal therapy
Some cancers like Breast, prostate and of uterus are hormone dependant. Hormonal therapy is used here for treatment, in prevention of recurrence and second cancers and also to prevent cancers. Tab tamoxifen is the most common of these, which is an anti estrogen and used for five years in cases of breast cancer.Aromatase inhibitors like Anestrazole and Letrazole are being used too.
Laser Therapy
Lasers are being extensively used these days to excise skin tumors and small cancers of head and neck. They are also used to control bleeding for inoperable cancers.
Thalidomide
Thalidomide is a drug that is used in slow growing recurrent, advanced or residual cancers, it is an antiangiogenesis agent, which stops the blood flow to the cancer cells causing their death and preventing growth.
Radioactive Frequency ablation
Radioactive frequency ablation is a technique where cancer cells, especially in the liver are killed by exposing them to radio frequency waves. This can be done by directing the waves through a needle under ultrasound guidance or during open surgery.
Photodynamic Therapy
This is a technique by which special light waves are used to kill cancer cells. Special photosensitive agents are injected in the tumor. when this is exposed to special light waves, the reagent gets activated and releases energy to kill the cancer cells. This is very helpful in lesions of the skin.
Radioactive ablation
Radioactive ablation is a method where radioactive reagents specially targeted to specific organs are used to kill cancer cells. Most commonly used here is radioactive Iodine ablation for cancer of Thyroid Cancers.
Intra-arterial chemotherapy
For better results chemotherapy can be delivered directly to the cancer cells, especially in the liver by placing a delivery port in the artery supplying blood to the involved organ.
TACE (Trance arterial chemo embolization )
The artery supplying the involved organ can be blocked by interventional radiology techniques andchemotherapy injected to ensure direct and permanent action of the chemotherapeutic agent on localized cancer areas.
Embolisation
The blood supply to the involved organ can be stopped by embolising (blocking ) the blood vessels supplying the involved organ. This can be done under interventional radiology and various materials like gel foam and lipadiol are used to block the blood vessels.
Intracavitary chemotherapy
Chemotherapy can be instilled inside the body cavities, especially that of the abdomen, lungs and brain to treat disseminated (widespread) cancers.
Intra Operative Radiotherapy
Radiotherapy is often given directly to the involved organ directly while surgery, specially if a part or total of it cannot be removed.
IMRT ( Intensity Modulated Radio therapy )
This is a technique where radiotherapy is directly precisely to a localized area under computerized control and image monitoring. This is very helpful for cancers of prostate, brain and head and neck region.
Argon Beam
A special cautary machine delivers argon beam. The argon beam is helpful in destroying superficial cancer cells on surface of body or organs and more useful in controlling bleeding from the cancerous region.
Stem cell and Bone marrow transplant
This technique is used in patients of blood cancers or in metastasis cases of cancers of solid tumors.
Here the Stem cells and bone marrow ( which produce blood cells )are removed. Patient is then given high dose chemotherapy to kill all cancer cells and then the removed stem cells or bone marrow cells are reinfused.
Gene therapy
Research in gene therapy has come a long way and will soon be used in treatment and prevention of cancer. Gene Therapy changes the altered genes that cause cancer. It will be used to remove, repair and replace defected genes in patients at high risk of cancer or whose with familial history of cancer.
In the previous issues we discussed the three major modalities of treatment of cancer, Surgery, Chemotherapy and Radiotherapy. There are other modalities and newer therapies being used today for cancer care:-
Hormonal therapy
Some cancers like Breast, prostate and of uterus are hormone dependant. Hormonal therapy is used here for treatment, in prevention of recurrence and second cancers and also to prevent cancers. Tab tamoxifen is the most common of these, which is an anti estrogen and used for five years in cases of breast cancer.Aromatase inhibitors like Anestrazole and Letrazole are being used too.
Laser Therapy
Lasers are being extensively used these days to excise skin tumors and small cancers of head and neck. They are also used to control bleeding for inoperable cancers.
Thalidomide
Thalidomide is a drug that is used in slow growing recurrent, advanced or residual cancers, it is an antiangiogenesis agent, which stops the blood flow to the cancer cells causing their death and preventing growth.
Radioactive Frequency ablation
Radioactive frequency ablation is a technique where cancer cells, especially in the liver are killed by exposing them to radio frequency waves. This can be done by directing the waves through a needle under ultrasound guidance or during open surgery.
Photodynamic Therapy
This is a technique by which special light waves are used to kill cancer cells. Special photosensitive agents are injected in the tumor. when this is exposed to special light waves, the reagent gets activated and releases energy to kill the cancer cells. This is very helpful in lesions of the skin.
Radioactive ablation
Radioactive ablation is a method where radioactive reagents specially targeted to specific organs are used to kill cancer cells. Most commonly used here is radioactive Iodine ablation for cancer of Thyroid Cancers.
Intra-arterial chemotherapy
For better results chemotherapy can be delivered directly to the cancer cells, especially in the liver by placing a delivery port in the artery supplying blood to the involved organ.
TACE (Trance arterial chemo embolization )
The artery supplying the involved organ can be blocked by interventional radiology techniques andchemotherapy injected to ensure direct and permanent action of the chemotherapeutic agent on localized cancer areas.
Embolisation
The blood supply to the involved organ can be stopped by embolising (blocking ) the blood vessels supplying the involved organ. This can be done under interventional radiology and various materials like gel foam and lipadiol are used to block the blood vessels.
Intracavitary chemotherapy
Chemotherapy can be instilled inside the body cavities, especially that of the abdomen, lungs and brain to treat disseminated (widespread) cancers.
Intra Operative Radiotherapy
Radiotherapy is often given directly to the involved organ directly while surgery, specially if a part or total of it cannot be removed.
IMRT ( Intensity Modulated Radio therapy )
This is a technique where radiotherapy is directly precisely to a localized area under computerized control and image monitoring. This is very helpful for cancers of prostate, brain and head and neck region.
Argon Beam
A special cautary machine delivers argon beam. The argon beam is helpful in destroying superficial cancer cells on surface of body or organs and more useful in controlling bleeding from the cancerous region.
Stem cell and Bone marrow transplant
This technique is used in patients of blood cancers or in metastasis cases of cancers of solid tumors.
Here the Stem cells and bone marrow ( which produce blood cells )are removed. Patient is then given high dose chemotherapy to kill all cancer cells and then the removed stem cells or bone marrow cells are reinfused.
Gene therapy
Research in gene therapy has come a long way and will soon be used in treatment and prevention of cancer. Gene Therapy changes the altered genes that cause cancer. It will be used to remove, repair and replace defected genes in patients at high risk of cancer or whose with familial history of cancer.
COMMON QUERIES ABOUT CANCER
Common Queries about Cancer
Since when do I have the disease?
Though it is usually not possible to state the exact duration, but generally a cancer has been growing for a few months or years before it is detected
Could this have been caused by an old injury?
Old injuries don’t cause cancer, though in few cases it may occur in very old scars
How long will I live?
This is generally a presumptive estimate made depending on the type of cancer, stage of cancer, general condition of the patient and response to treatment
Will treatment help?
Treatment cures several, prolongs life in few and decreases the pain and other problems in all
What should I eat?
Except during chemotherapy when raw fruits and vegetables are to be avoided, a cancer patient should eat a normal diet that they can tolerate
What should I eat to prevent cancer?
Green vegetables and fresh fruits like carrot and apple and Vit A C and E prevent cancer
What should be my lifestyle?
Every cancer patient should live a normal life with all the daily personal and official duties that he or she can perform without getting tired
Can I spread cancer to others in the house?
Staying in the same house, by contact or by even eating food together, does not spread Cancer
Should I get married?
Yes a cancer patient can get married, but it is advisable that the patient should get married at least after two years of completion of treatment. Most recurrence of cancer occurs within two years of completion of treatment. The patient and the family members should inform the partner regarding the patient’s medical history of cancer. Off lately there are several marriages being arranged amongst cancer survivors
Can I have sex with my partner?
Yes cancer patients can have sex with their partners. However patients with cancers of the genital organs like the cervix or penis should avoid sex for at least one year and preferably two years after completion of treatment
Can I have Children?
Yes patients who are desirous of having children can have children after one or two years of treatment
Will I pass down the cancer to my child?
Though a few cancers are transmitted genetically, most cancer patients can have children without passing the cancer to them. However cancer patients planning to have children should consult a medical counselor before having a child
Does treatment affect childbearing?
Surgical removal of testis or ovaries, chemotherapy and radiotherapy to the testis or ovaries will adversely affect childbearing. Patients who have not completed their families and are to undergo these treatment and want a child later, should preserve their sperm or ovum before the treatment is started, to be used at a later stage
If my one child has cancer then will my other child have cancer too?
Some cancers have strong horizontal genetic familial presentation and may be seen in several siblings. Hence before planning a second child consultation with a counselor is a must
Does personality or stress cause cancer?
There are no scientific studies to prove that cancer is caused by stress or personality has any impact on its causation
Are there any Societies or Groups providing help for cancer patients?
There are a large number of Social Welfare Groups like V Care, Cancer Sahyog, Cancer Care, Prerna etc which provide, social, moral, psychological, medical and even financial support to cancer patients and their relatives
What are the other facilities available for cancer patients?
Cancer patients and one attendant gets 75 % concession in rail travel and 50 % concession in air travel throughout life to travel from home town to the city of treatment, for treatment or review. They are also entitles tax exemption on money spent on cancer treatment. Certain cancer institutes provide cancer care and medicines to poor patients at subsidized rates and even free. Financial aid for it can also be availed from Chief Ministers Funds
Since when do I have the disease?
Though it is usually not possible to state the exact duration, but generally a cancer has been growing for a few months or years before it is detected
Could this have been caused by an old injury?
Old injuries don’t cause cancer, though in few cases it may occur in very old scars
How long will I live?
This is generally a presumptive estimate made depending on the type of cancer, stage of cancer, general condition of the patient and response to treatment
Will treatment help?
Treatment cures several, prolongs life in few and decreases the pain and other problems in all
What should I eat?
Except during chemotherapy when raw fruits and vegetables are to be avoided, a cancer patient should eat a normal diet that they can tolerate
What should I eat to prevent cancer?
Green vegetables and fresh fruits like carrot and apple and Vit A C and E prevent cancer
What should be my lifestyle?
Every cancer patient should live a normal life with all the daily personal and official duties that he or she can perform without getting tired
Can I spread cancer to others in the house?
Staying in the same house, by contact or by even eating food together, does not spread Cancer
Should I get married?
Yes a cancer patient can get married, but it is advisable that the patient should get married at least after two years of completion of treatment. Most recurrence of cancer occurs within two years of completion of treatment. The patient and the family members should inform the partner regarding the patient’s medical history of cancer. Off lately there are several marriages being arranged amongst cancer survivors
Can I have sex with my partner?
Yes cancer patients can have sex with their partners. However patients with cancers of the genital organs like the cervix or penis should avoid sex for at least one year and preferably two years after completion of treatment
Can I have Children?
Yes patients who are desirous of having children can have children after one or two years of treatment
Will I pass down the cancer to my child?
Though a few cancers are transmitted genetically, most cancer patients can have children without passing the cancer to them. However cancer patients planning to have children should consult a medical counselor before having a child
Does treatment affect childbearing?
Surgical removal of testis or ovaries, chemotherapy and radiotherapy to the testis or ovaries will adversely affect childbearing. Patients who have not completed their families and are to undergo these treatment and want a child later, should preserve their sperm or ovum before the treatment is started, to be used at a later stage
If my one child has cancer then will my other child have cancer too?
Some cancers have strong horizontal genetic familial presentation and may be seen in several siblings. Hence before planning a second child consultation with a counselor is a must
Does personality or stress cause cancer?
There are no scientific studies to prove that cancer is caused by stress or personality has any impact on its causation
Are there any Societies or Groups providing help for cancer patients?
There are a large number of Social Welfare Groups like V Care, Cancer Sahyog, Cancer Care, Prerna etc which provide, social, moral, psychological, medical and even financial support to cancer patients and their relatives
What are the other facilities available for cancer patients?
Cancer patients and one attendant gets 75 % concession in rail travel and 50 % concession in air travel throughout life to travel from home town to the city of treatment, for treatment or review. They are also entitles tax exemption on money spent on cancer treatment. Certain cancer institutes provide cancer care and medicines to poor patients at subsidized rates and even free. Financial aid for it can also be availed from Chief Ministers Funds
RADIOTHERAPY
RADIOTHERAPY
What is Radiotherapy ?
Radiotherapy is use of high energy radiation like X-Ray to kill cancer Cell. In common language it is called heat treatment. Radiotherapy works by damaging the cancer cells, due to which they are unable to multiply.
It is given for a few minutes only, five days a week for an average of five to six weeks .Radiotherapy may damage some healthy cells too and hence cause side effects.
Types of Radiotherapy
Tele Therapy here radiotherapy is given from a distance. This is the most common form of radiotherapy.
Brachy Therapy here the source of radiotherapy is in contact of the body, as used in cancer of the cervix.
Intraluminal Therapy here the source is put inside the narrow hollow organs of the body like the windpipe or the foodpipe.
Interstitial Therapy here the radiotherapy is passed through very fine tubes placed in the body, as in cancer of the muscles and breast.
Cobalt Therapy is the conventional method of radiotherapy. Here the source of rays is Cobalt.
Linear Accelerator is the modern radiotherapy machine which is more effective, is faster and has less side effects.
Indications of Radiotherapy
Adjuvant used postoperatively to prevent local spread.
Primary used as the main modality of treatment as in cancer of cervix, and few cases of head and neck cancers and in some advanced inoperable cancers.
Pre Operative to shrink the tumor to make it operable and to decrease the extent of surgery.
Palliative given to bones and spine in cases of metastasis to the bone, for severe pain and to prevent fractures. It can also be used to stop generalized bleeding from cancers.
Side effects of Radiotherapy
Radiotherapy may cause nausea, vomiting, dryness of mouth, ulcers in mouth and skin, and diarrhea. These are generally temporary effects. it may however cause severe damage to the lungs, heart, nerves and brain if these organs are not protected well.
DOs and DONTs
• See the doctor at least once while on treatment
• No shaving if getting radiotherapy on face Avoid scrubbing or rubbing the area
• Avoid crowds and meeting people as they could give infection
• Report to the doctor immediately even in case of mild fever or bleeding
• Ensure you do not rub off the markings made on the skin to pinpoint the exact place where the radiotherapy is to be directed
Nutrition
Drink lots of fluids
Eat small frequent meals at room temperature
Eat well-cooked soft food
Avoid hot and spicy food
Eat a good nutritious diet rich in calories and proteins
Avoid tea, coffee, alcohol, and tobacco
Drink juices, soups, coconut water fresh lime etc
General Care
Exercise for a few minutes every day
Rest as much as you can
Do not over exert
Wear loose fitting clothes preferably of soft cotton material
Do not use perfumes, scented soaps etc
Sponge the radiated area lightly with lukewarm water and pat it dry.
What is Radiotherapy ?
Radiotherapy is use of high energy radiation like X-Ray to kill cancer Cell. In common language it is called heat treatment. Radiotherapy works by damaging the cancer cells, due to which they are unable to multiply.
It is given for a few minutes only, five days a week for an average of five to six weeks .Radiotherapy may damage some healthy cells too and hence cause side effects.
Types of Radiotherapy
Tele Therapy here radiotherapy is given from a distance. This is the most common form of radiotherapy.
Brachy Therapy here the source of radiotherapy is in contact of the body, as used in cancer of the cervix.
Intraluminal Therapy here the source is put inside the narrow hollow organs of the body like the windpipe or the foodpipe.
Interstitial Therapy here the radiotherapy is passed through very fine tubes placed in the body, as in cancer of the muscles and breast.
Cobalt Therapy is the conventional method of radiotherapy. Here the source of rays is Cobalt.
Linear Accelerator is the modern radiotherapy machine which is more effective, is faster and has less side effects.
Indications of Radiotherapy
Adjuvant used postoperatively to prevent local spread.
Primary used as the main modality of treatment as in cancer of cervix, and few cases of head and neck cancers and in some advanced inoperable cancers.
Pre Operative to shrink the tumor to make it operable and to decrease the extent of surgery.
Palliative given to bones and spine in cases of metastasis to the bone, for severe pain and to prevent fractures. It can also be used to stop generalized bleeding from cancers.
Side effects of Radiotherapy
Radiotherapy may cause nausea, vomiting, dryness of mouth, ulcers in mouth and skin, and diarrhea. These are generally temporary effects. it may however cause severe damage to the lungs, heart, nerves and brain if these organs are not protected well.
DOs and DONTs
• See the doctor at least once while on treatment
• No shaving if getting radiotherapy on face Avoid scrubbing or rubbing the area
• Avoid crowds and meeting people as they could give infection
• Report to the doctor immediately even in case of mild fever or bleeding
• Ensure you do not rub off the markings made on the skin to pinpoint the exact place where the radiotherapy is to be directed
Nutrition
Drink lots of fluids
Eat small frequent meals at room temperature
Eat well-cooked soft food
Avoid hot and spicy food
Eat a good nutritious diet rich in calories and proteins
Avoid tea, coffee, alcohol, and tobacco
Drink juices, soups, coconut water fresh lime etc
General Care
Exercise for a few minutes every day
Rest as much as you can
Do not over exert
Wear loose fitting clothes preferably of soft cotton material
Do not use perfumes, scented soaps etc
Sponge the radiated area lightly with lukewarm water and pat it dry.
CHEMOTHERAPY
CHEMOTHERAPY IN CANCER
What is Chemotherapy ?
Chemotherapy is the use of drugs in cancer treatment. Besides surgery and radiotherapy, chemotherapy is one of the three main modalities of treatment in cancer. In the multimodality treatment of cancer, chemotherapy is used in more than three fourths of the patients at some stage or the other. The medical branch dealing with chemotherapy is called Medical Oncology and the oncologist giving chemotherapy is known as Medical Oncologist.
Chemotherapy Drugs
There are about 100 chemotherapy drugs belonging to various groups. The common ones are adriamycin, taxol, cyclophosphamide, cisplatinum, methotrexate, 5 flurouracil. Mitomycin, bleomycin, etoposide etc. They are usually given as intravenous injections in the veins but few drugs can be given orally too.
Indications of chemotherapy
Chemotherapy is used in various settings; it can be used as the following:-
• Primary Chemotherapy - where chemotherapy is used as the main mode of treatment as in leukemia, lymphoma and cases which are inoperable or patient is unwilling for surgery
• Preoperative Chemotherapy – here chemotherapy is used before surgery to make the cancer operable or to decrease the extent of surgery and to preserve the affected organ
• Post operative- here chemotherapy is used after surgery to prevent local and distant recurrence
• Salvage – here chemotherapy is used for recurrence
• Palliative- chemotherapy may also be used to decrease pain and other symptoms in advanced cancers
• Chemoprevention- chemotherapy is also used in certain cases to prevent cancer in high risk patients or to prevent second cancer in cancer patients
Duration of Chemotherapy
There are various schedules of chemotherapy. It is usually given in cycles repeated every 3 weeks. Normally a patient receives six cycles. Some drugs are given over few hours while others may be given continuously for two to five day. Some regimes have a weekly schedule of chemotherapy and few drugs specially those being taken orally are given daily.
Actions of chemotherapy
Chemotherapy prevents cell division and leads to cell death. Maximum effect is on the cancer cells, however normal cells are affected too. The most commonly affected normal cells are of the bone marrow, blood and the intestines.
Preparation For Chemotherapy
Before chemotherapy the following blood tests should be done, hemoglobin, blood count, platelet, electrolyte, liver and kidney function tests. If the blood counts are high or low, then chemotherapy should be postponed. Patient should drink a lot of water and have light meals before chemotherapy.
Side Effects of chemotherapy
• Vomiting and nausea
• Loose motions
• Fever
• Low blood counts
• Loss of hair
• Bone marrow suppression
• Stopping of periods
• Blackening of skin and nails
Precautions during chemotherapy
• To drink adequate fluids
• To avoid heavy meals
• To avoid eating raw vegetables or fruits
• To avoid infections
• To avoid going in crowded areas soon after chemotherapy
Ports and catheters
In patients who need chemotherapy for long durations and frequently or in those where veins are not found easily, chemotherapy can be given through special catheters or ports which are placed in a central big vein .The drugs are injected directly into the catheter which are outside the body or the port which are placed under the skin. These prevent frequent injection of drugs in the veins.
Chemotherapy is being used extensively these days in the treatment of cancer patients with good results.
Sunday, October 4, 2009
TREATMENT OF CANCER
TREATMENT OF CANCER
The treatment of cancer today is a multimodality treatment where more than one modality of treatment is used. Almost all cancers are treated with at least two modes of cancer therapy while a fairly large number of patients receive three or even more forms of treatment to fight cancer. Treatment of cancer needs a close consultation between the surgical, radiation and medical oncologists, who are the specialists of surgical oncology (cancer surgery), chemotherapy and radiotherapy respectively and the ontological pathologist. Hence all patients should be seen by a team of oncologists consisting of all these specialists to plan the treatment, before starting the therapy.
The various modality of treatment of cancer are as follows
· Surgery
· Chemotherapy
· Radiotherapy
· Hormonal therapy
· miscellaneous therapies
· Recent Advances
SURGERY
Surgery is the main mode of therapy in most of the cancers, especially those affecting the solid organs of the body. Surgery is the mainstay of treatment in the following organs
· Head and neck tumors
· Breast cancer
· Brain tumors
· Lung cancer
· Cancers of intestines
· Endocrine gland tumors
· Cancers of muscles and bones
· Genitourinary tract tumors
It can be used in the following settings
· Curative -where the complete disease is removed with an intent to cure cancer
· Debulking- here as much of the cancer is removed as possible, to reduce tumor burden
· Biopsy –surgery may be performed for biopsy and to reach a diagnosis
· Palliative-here surgery is done to combat the complications caused by cancer or the treatment, like in obstruction, severe infection or bleeding
Principles of Surgery
· To remove the complete cancerous part
· To remove a clear margin around it
· To remove the local lymph nodes along with the organ or part of the organ being removed
· To ensure minimum handling of the tumor
· To reconstruct the organ or limb operated to maintain continuity or function
· To ensure cosmesis with minimum functional disability without compromise in the extent of clearance of cancer
Contraindications for Surgery
Definitive major surgery should not be performed in the following circumstances
· Distant spread of disease
· Poor general condition of the patient
· Extensive local spread
· Disease which cannot be reconstructed after excision
· Where there would be extensive functional or cosmetic defect
· Where the survival of the patient is expected to be very short
Organ Preserving Surgery
With advancement of surgical skill and the use of chemotherapy and radiotherapy, extensive surgery is now a days being replaced by procedures where the organ is being preserved. This is especially being practiced in cancers of breast, voice box (larynx),limbs and the urinary bladder. Amputation as the treatment of cancers of muscles and bones has been replaced in most cases by limb preserving surgery where the affected part including the joint is excised and replaced by metallic prosthesis.
Minimal Access Surgery
Incision less or minimally invasive surgery is being practiced for cancer treatment also these days. Commonly called laproscopy, this is used in cancers of the intestine and other abdominal organs, lung and esophagus ( thoracoscopy and mediastenoscopy) .Here telescopes mounted with fibre-optic lights are used to enter the body cavity while surgery is performed under video monitoring. Here the incisions are very small so the postoperative recovery is faster.
Reconstructive (plastic )Surgery
Plastic surgery is often used in surgery of cancer. Common sites of its use are head and neck tumors, and in cancers of breast, larynx and muscles and bone. Common procedures performed are to provide skin cover, loss of inner lining, bone or muscles. Breast reconstruction is most commonly used besides transfer of muscles in limb saving surgery and head and neck cancers
The treatment of cancer today is a multimodality treatment where more than one modality of treatment is used. Almost all cancers are treated with at least two modes of cancer therapy while a fairly large number of patients receive three or even more forms of treatment to fight cancer. Treatment of cancer needs a close consultation between the surgical, radiation and medical oncologists, who are the specialists of surgical oncology (cancer surgery), chemotherapy and radiotherapy respectively and the ontological pathologist. Hence all patients should be seen by a team of oncologists consisting of all these specialists to plan the treatment, before starting the therapy.
The various modality of treatment of cancer are as follows
· Surgery
· Chemotherapy
· Radiotherapy
· Hormonal therapy
· miscellaneous therapies
· Recent Advances
SURGERY
Surgery is the main mode of therapy in most of the cancers, especially those affecting the solid organs of the body. Surgery is the mainstay of treatment in the following organs
· Head and neck tumors
· Breast cancer
· Brain tumors
· Lung cancer
· Cancers of intestines
· Endocrine gland tumors
· Cancers of muscles and bones
· Genitourinary tract tumors
It can be used in the following settings
· Curative -where the complete disease is removed with an intent to cure cancer
· Debulking- here as much of the cancer is removed as possible, to reduce tumor burden
· Biopsy –surgery may be performed for biopsy and to reach a diagnosis
· Palliative-here surgery is done to combat the complications caused by cancer or the treatment, like in obstruction, severe infection or bleeding
Principles of Surgery
· To remove the complete cancerous part
· To remove a clear margin around it
· To remove the local lymph nodes along with the organ or part of the organ being removed
· To ensure minimum handling of the tumor
· To reconstruct the organ or limb operated to maintain continuity or function
· To ensure cosmesis with minimum functional disability without compromise in the extent of clearance of cancer
Contraindications for Surgery
Definitive major surgery should not be performed in the following circumstances
· Distant spread of disease
· Poor general condition of the patient
· Extensive local spread
· Disease which cannot be reconstructed after excision
· Where there would be extensive functional or cosmetic defect
· Where the survival of the patient is expected to be very short
Organ Preserving Surgery
With advancement of surgical skill and the use of chemotherapy and radiotherapy, extensive surgery is now a days being replaced by procedures where the organ is being preserved. This is especially being practiced in cancers of breast, voice box (larynx),limbs and the urinary bladder. Amputation as the treatment of cancers of muscles and bones has been replaced in most cases by limb preserving surgery where the affected part including the joint is excised and replaced by metallic prosthesis.
Minimal Access Surgery
Incision less or minimally invasive surgery is being practiced for cancer treatment also these days. Commonly called laproscopy, this is used in cancers of the intestine and other abdominal organs, lung and esophagus ( thoracoscopy and mediastenoscopy) .Here telescopes mounted with fibre-optic lights are used to enter the body cavity while surgery is performed under video monitoring. Here the incisions are very small so the postoperative recovery is faster.
Reconstructive (plastic )Surgery
Plastic surgery is often used in surgery of cancer. Common sites of its use are head and neck tumors, and in cancers of breast, larynx and muscles and bone. Common procedures performed are to provide skin cover, loss of inner lining, bone or muscles. Breast reconstruction is most commonly used besides transfer of muscles in limb saving surgery and head and neck cancers
Sunday, August 9, 2009
DIAGNOSIS OF CANCER
DIAGNOSIS OF CANCER
Diagnosis of Cancer
The Diagnosis of Cancer involves three sets of investigations
Confirmation of Diagnosis, by biopsy which we discussed in the last issue
Staging workup, to see the extent of disease locally, its spread and the operability
General Investigations, to assess the general fitness of the patient to undertake the treatment
The routine investigations to asses the general fitness of the patient include blood tests for hemoglobin, white cell count, sugar, liver function tests, kidney function tests, proteins and electrolyte(to detect nutritional deficiencies) and blood grouping
X Rays
X-ray chest to see the state of the lungs and any spread to the lungs
X-rays of the limbs, head, spine are done when cancers of the bone are suspected, or in cancers of muscles, to see the involvement of bones
Ultrasound
Ultrasound of the Abdomen -This is a simple OPD procedure, which is cheap, painless, fast and very informative. Besides giving details of the cancers of the abdominal organs (digestive system, kidneys, liver, gall bladder and female organs like uterus, ovary etc) it is helpful in showing the spread to the liver and the nodes.
Ultrasound of the neck is done to see the nodes in the neck and for glands like the thyroid
Ultrasound of the breast and other swellings on the limbs are done too to see if the swelling contains water or is solid
Scopy
Scopy is an investigation where the inside of a hollow organ is seen by an instrument which has fiber optic light. It not only shows the cancer or the disease but also can be used to take a biopsy, stop bleeding, and put stents to bypass blocks and perform other procedures
Usually done without anesthesia
Upper Gastrointestinal Scopy
This is for the stomach and the upper intestines. This is done through the mouth and can also be used to see the pancreatic duct and the bile duct. ERCP(Endoscopic Retrograde Cholangio Pancreatico graphy) is done by this too
Broncoscopy is done through the nose to see the air passage and the lungs
Nasopharyngoscopy is done to see the inside of the nose, through the nose
Laryngoscopy is done to see the Larynx (Voice Box) through the nose
Colonoscopy is done through the rectum to see the large intestines
Doppler
Doppler is done over blood vessels (artery and veins) to see the blood flow in them, and to find the involvement of the vessels or any compression on them by the tumor. This is like the ultrasound and done externally
Computerized Axial Tomography
Commonly called CAT scan or CT scan, this is a very common investigation done to see the extent of the cancer. It gives a very good picture of the cancer, the organs involved, and the local and distant spread. It is however a little expensive and not available in all the hospitals in our country. It is very helpful in cancers of the chest, abdomen and brain and is a great help in deciding the extent of surgery and the treatment for the patient
MRI (Magnetic Resonance Imaging)
Like Tuscan, MRI is a very helpful investigation to see the internal organs, specially the bones, spine, limbs and the head
Radioactive Scans
These are done by injecting radioactive dyes specific for particular organ and subsequently picking up the radio sensitivity by special cameras. They help to see the involvement of various organs and the functioning. Commonly done scans are for bone, liver, kidney and thyroid gland
Tumor Markers
These are tests done on blood. Tumor Markers are substances which are normally not found in the blood or found in very small quantities. The presence or rise of these in the blood is an indicator of cancer. It is very good investigation to see the response to treatment in which situation it will fall to normal and for follow-up of cancer patients, where rise in the levels after treatment indicates relapse. Following are some common tumor markers
CA-125 for cancer of ovary
PSA (Prostates Specific Antigen) for cancer prostate
CEA (Carcinoma Embryonic Antigen) for cancer of large intestines and rectum
AFP (Alpha Fetor Protein) for cancer of testis and liver
BHCG (Beta Human Chronic Gonadotropin) for cancer of testis and ovary
Calcitonin for Medullary carcinoma of thyroid
Thyroglobulin for cancer of thyroid
Diagnosis of Cancer
The Diagnosis of Cancer involves three sets of investigations
Confirmation of Diagnosis, by biopsy which we discussed in the last issue
Staging workup, to see the extent of disease locally, its spread and the operability
General Investigations, to assess the general fitness of the patient to undertake the treatment
The routine investigations to asses the general fitness of the patient include blood tests for hemoglobin, white cell count, sugar, liver function tests, kidney function tests, proteins and electrolyte(to detect nutritional deficiencies) and blood grouping
X Rays
X-ray chest to see the state of the lungs and any spread to the lungs
X-rays of the limbs, head, spine are done when cancers of the bone are suspected, or in cancers of muscles, to see the involvement of bones
Ultrasound
Ultrasound of the Abdomen -This is a simple OPD procedure, which is cheap, painless, fast and very informative. Besides giving details of the cancers of the abdominal organs (digestive system, kidneys, liver, gall bladder and female organs like uterus, ovary etc) it is helpful in showing the spread to the liver and the nodes.
Ultrasound of the neck is done to see the nodes in the neck and for glands like the thyroid
Ultrasound of the breast and other swellings on the limbs are done too to see if the swelling contains water or is solid
Scopy
Scopy is an investigation where the inside of a hollow organ is seen by an instrument which has fiber optic light. It not only shows the cancer or the disease but also can be used to take a biopsy, stop bleeding, and put stents to bypass blocks and perform other procedures
Usually done without anesthesia
Upper Gastrointestinal Scopy
This is for the stomach and the upper intestines. This is done through the mouth and can also be used to see the pancreatic duct and the bile duct. ERCP(Endoscopic Retrograde Cholangio Pancreatico graphy) is done by this too
Broncoscopy is done through the nose to see the air passage and the lungs
Nasopharyngoscopy is done to see the inside of the nose, through the nose
Laryngoscopy is done to see the Larynx (Voice Box) through the nose
Colonoscopy is done through the rectum to see the large intestines
Doppler
Doppler is done over blood vessels (artery and veins) to see the blood flow in them, and to find the involvement of the vessels or any compression on them by the tumor. This is like the ultrasound and done externally
Computerized Axial Tomography
Commonly called CAT scan or CT scan, this is a very common investigation done to see the extent of the cancer. It gives a very good picture of the cancer, the organs involved, and the local and distant spread. It is however a little expensive and not available in all the hospitals in our country. It is very helpful in cancers of the chest, abdomen and brain and is a great help in deciding the extent of surgery and the treatment for the patient
MRI (Magnetic Resonance Imaging)
Like Tuscan, MRI is a very helpful investigation to see the internal organs, specially the bones, spine, limbs and the head
Radioactive Scans
These are done by injecting radioactive dyes specific for particular organ and subsequently picking up the radio sensitivity by special cameras. They help to see the involvement of various organs and the functioning. Commonly done scans are for bone, liver, kidney and thyroid gland
Tumor Markers
These are tests done on blood. Tumor Markers are substances which are normally not found in the blood or found in very small quantities. The presence or rise of these in the blood is an indicator of cancer. It is very good investigation to see the response to treatment in which situation it will fall to normal and for follow-up of cancer patients, where rise in the levels after treatment indicates relapse. Following are some common tumor markers
CA-125 for cancer of ovary
PSA (Prostates Specific Antigen) for cancer prostate
CEA (Carcinoma Embryonic Antigen) for cancer of large intestines and rectum
AFP (Alpha Fetor Protein) for cancer of testis and liver
BHCG (Beta Human Chronic Gonadotropin) for cancer of testis and ovary
Calcitonin for Medullary carcinoma of thyroid
Thyroglobulin for cancer of thyroid
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