The recent death of a well known film critic brought to my memory a quote from the book “The Emperor of all Maladies – “Now it is cancer’s turn to be the disease that doesn’t knock before it enters”.

Cancer, more so breast cancer has entered India without knocking. Over 100,000 women develop breast cancer in India every year. One in 26 women is at a lifetime risk of developing breast cancer. The incidence is more in urban areas and in a decade younger (40-50 years age group) than in western countries, thus affecting women in their prime of life. The loss of the organ is associated with significant personal, social and sexual overtones.

In the context of these facts, we have made various improvisations in the surgical treatment.

1). Modified Radical Mastectomy: The size of the scar has reduced from a traditional 10-12 inches to 6-7 inches. The orientation of the incision makes it cosmetically acceptable. Skin and nipple sparing mastectomy are performed in selected patients, who are potential candidates for breast reconstruction. Complications like flap necrosis and infection are less than 3%.

2). Axillary dissection: Refinement in techniques has reduced the morbidity of axillary dissection Lymphedema (swelling of the arm) is uncommon though seroma (fluid accumulation in the armpit) is not. Patients with non palpable axillary lymphnodes undergo SENTINEL LYMPHNODE BIOPSY (Use of a radioactive and / or blue dye to accurately stage the axilla), thus avoiding a conventional axillary dissection.

3). Breast conservation surgery: Long term results of numerous randomized trials have demonstrated that Breast Conservation Surgery (Wide Excision and Axillary Dissection) is as effective as Modified Radical Mastectomy in loco-regional control. In patients with appropriate tumor to breast ratio and in the absence of other contraindications this surgery promises excellent cancer control and cosmesis.

4). Breast Reconstruction: All patients undergoing a unilateral or bilateral breast surgery should be seen by a reconstructive plastic surgeon to discuss options for breast reconstruction. Selection of reconstructive method depends on
a. Patient expectations: No reconstruction Perfect Breast

b. Physical appearance: Breast size / shape, weight, scars, skin quality.

c. Cancer treatment: Chemotherapy, Radiotherapy, Unilateral Vs Bilateral

Options for breast reconstruction

Implant Based Reconstruction

Saline – filled implant
Silicon – filled implant

Autologous Tissue Reconstruction

Latissimus Dorsi Myocutaneous Flap with or without implant

Abdominal wall flaps:
Pedicled TRAM (Trans Rectus Abdominus Myocutaneous Flap)
Free TRAM Flap
Muscle-sparing free TRAM Flap
DIEP (Deep Inferior Epigastric Perforator) Flap
SIEA (Superficial Inferior Epigastric Artery) Flap

SGAP (Superior Gluteal Artery Perforator) Flap
ALT (Anterolateral Thigh) Flap
Gracilis Myocutaneous Flap

Even the nipple areola complex can be reconstructed.

Thus the traditional mutilating potentially devastating Halstedian surgery has been replaced by refined and cosmetically more acceptable surgery.

:HealthCare Global Enterprises Ltd, The Specialist in Cancer Care, today organized a press conference today in Mangalore on the New Trends in Ortho Oncology.

Dr. Pramod Chinder S, Consultant, Ortho Oncologist, HCG, said, “There have been great advancements in the treatment for bone cancers. Where at one time, treatment was limb amputation, with a high mortality rate, but today in 90% of the cases, bone cancers can be treated with limb saving surgery followed by reconstruction. In the treatment, first when cancerous tumor is identified, the aim is to save the life of the patient and the limb, preserving its functionality. The limb saving surgeries improves the quality of life for the patients, where they can perform their basic activities on their own. The overall survival rate in patients diagnosed with bone cancers is 60% to 70% with the medical advancements. Each patient presents with a unique problem and multi disciplinary team approach is important. When amputation is advised for patients, it’s always better to seek a second opinion from the specialists, as there are lots of cases where amputation was advised and we have successfully preserved his or her limb.”

HCG, is the only hospital in Karnataka, who perform advanced Biological Reconstruction Surgeries and was the first hospital in India, to perform Biological Reconstruction for Ewing’s Sarcoma, using a massive donor bone.

About HCG:
Health Care Global Enterprises Ltd, (HCG), The Specialist in Cancer Care, headquartered in Bangalore with over 23 cancer centers is South Asia’s largest cancer care network. HCG has defined the future of cancer care in India by designing, building and managing cancer care centres with a committed vision. HCG focuses on cancer care treatment, imaging and laboratory services, clinical trials and research services. The vision of HCG is to make high quality cancer care accessible by adopting global innovations to all segments of the society.

HealthCare Global Enterprises Ltd, The Specialist in Cancer Care, today organized a press conference at Hyderabad, on Robotic Radiosurgery for Urological Conditions.

Dr. G. Kilara, Senior Consultant, Radiation Oncologist, HCG, said, “The incidence of the prostate cancer is on the rise. Lifestyle factors have also contributed to this increase. Prostate cancer constitutes to 6% of all cancers in men. With the advancement in technology, we are now able to target the disease with larger doses of radiation, with sub-millimeter accuracy. Because of the organ motion, traditional methods of radiation had to treat a larger volume of tissue to achieve this and this meant increased dose to some of the normal surrounding structures. For Ex: Bladder, Rectum and Intestine. Robotic Whole Body Stereo Tactic Radio Surgery, tracks the organ motion in real time and directs radiation with sub millimeter precision at the tumor tissue. This is typically applicable in prostate cancer, where we effectively cure the disease, but spare the bladder and the rectum.”

He further adds, “Because of the high doses of radiation per sitting (Hypo Fractionation), the entire process of treatment can be completed in 8 to 10 days as opposed to 7 to 8 weeks with conventional treatments.”

CyberKnife:

It is the world’s first non-invasive whole body robotic radiosurgery. CyberKnife offers patients new hope for the treatment of tumours and lesions, including ones that previously have been diagnosed as inoperable or untreatable with the existing technology. CyberKnife uses state-of-the-art real-time image guidance, similar to cruise missile technology, to precisely target tumours anywhere in the body with pinpoint accuracy and delivers high doses of radiation.

Advantages of CyberKnife:

 Non-invasive and pain-less
 Treats inoperable tumors
 Pin-point accuracy
 Significantly reduces treatment time
 Automatic movement tracking
 No need for invasive body or head frame
 Higher radiation dose possible
 Minimises side effects

About HCG:
Health Care Global Enterprises Ltd, (HCG), The Specialist in Cancer Care, headquartered in Bangalore with over 23 cancer centers is South Asia’s largest cancer care network. HCG has defined the future of cancer care in India by designing, building and managing cancer care centres with a committed vision. HCG focuses on cancer care treatment, imaging and laboratory services, clinical trials and research services. The vision of HCG is to make high quality cancer care accessible by adopting global innovations to all segments of the society.

One in every 10,000 children in India is affected by cancer. According to statistics, 1.6 to 4.8 of all cancer cases reported in the country is among children below 15 years of age. On the occasion of International Childhood Cancer Day, on February 15, experts from the city speak about childhood cancer and treatments available.

In India the reported incidences of childhood cancer have increased over the last 25 years.

“The cause for many cancers is unknown, though theories point to genetic and environmental factors. There is an increased awareness about cancer in children in the society, leading to early diagnosis. Better availability of advanced treatments has led to better outcomes. Today, we can cure 70 per cent of all cancers in children. The survival of cancer-affected children is improving in the country and we are catching up with developed nations in this regard,” said Dr CP Raghuram, consultant, pediatric oncologist, Healthcare Global (HCG).

He further adds, “Also, in case of pediatric cancer, sperm banking is advised before starting chemotherapy for boys above 12 years of age, as there is a risk of infertility in later life due the treatment. However, preservation of eggs in case of cancer-affected girls is yet to take off in the city, said Dr Raghuram.

BANGALORE: Isak Ibraham from Tanzania was one among the unlucky 1,00,000 children across the globe suffering from retinoblastoma or cancer of the eye. It was a double whammy for the two-year-old as he was diagnosed with cancer in both eyes.

A study says it’s the most common eye cancer in children and constitutes 3% of all cancers in kids. The incidence is about 1 in 1,00,000 under 5 years but 80% of the cases are seen in children below 4 years.

SECOND OPINION HELPED

Isak was diagnosed in Tanzania in early 2011, and his left eye was surgically removed. But he faced the danger of losing his other eye. His mother then came to HCG Cancer Hospital in Bangalore for a second opinion and saved his right eye.

Dr CP Raghuram, consultant , paediatric oncologist, HCG Cancer Hospital, said: “We wanted to treat the cancer while trying to save the other eye and his vision. We first gave him chemotherapy to shrink the tumor. We also preserved his eye by reducing the size of the tumor and making it amenable for local treatment by the ophthalmologist.”

Dr Raghuram said organ and vision preservation is the main concern in children with retinoblastoma. Abnormality in the eye with squint is its usual symptom. “If untreated, children will lose their vision and could be life threatening,” he said. Isak also received laser and thermotherapy in an eye hospital. He is completely cured now and has left for Tanzania , said the doctor.

Says Geeta, “I was told that to live, I would have to lose my breast. But now as I live and realize that breast removal was not necessary to cure me or my breast could have been immediately reconstructed, I feel miserable, humiliated, half woman with one breast. It’s terrible. I wear clothes that will not show my missing breast, wear padded bras and do all things possible to undermine this humiliation. Sometimes I wish I had the guts to choose to die rather than live with one breast.”

Breast conservation became standard practice globally since the last three decades as a result of path breaking research. Unfortunately myths and substandard practices rule the roost in our country and hence patients like Geeta, suffer the consequences of these mutilating surgeries.

In India about 1,00,000 women suffer from breast cancer every year and the incidence is increasing rapidly especially in the Metropolitan cities. It affects younger women in India (around 40 to 50 yrs) as compared to the Caucasian race, thus making it even more relevant that we do not disfigure women at this age.

Oncoplastic surgery a recent advancement not only saves lives but also ensures excellent cosmesis. Women globally prefer to have their breasts lifted, reshaped and contoured to make them look younger, aesthetic and shapely. Oncoplastic surgery that combines these principles of plastic surgery with those of cancer surgery helps women look younger, more shapely after treatment for breast cancer adding a new dimension to their quality of life.

Mastectomy or breast removal becomes absolutely mandatory in about a quarter to a third of breast cancer patients due to certain compelling reasons such as large tumors, multiple tumors in a breast etc. Various techniques of immediate breast reconstruction by either using safe breast silicone prosthesis or using borrowed muscle and skin from the back or abdomen have evolved where women can feel complete immediately after their surgery where the reconstructed breast mimics a natural breast accurately. The silicone prosthesis available today are compact, cohesive and safe. There is no credence to the fact that use of the prosthesis can induce cancer. The incidence of rupture of the prosthesis and other complications are negligible.

Thus, Breast surgery has evolved from being simple but mutilating (Radical extirpation of the breast, muscle, skin and lymph nodes from the axilla) to advanced, complex, refined and comprehensive, aimed at providing better quality life. Today breast saving surgery, mastectomy ( breast removal) or skin saving mastectomy both with immediate reconstruction and removal of only one node from the armpit(sentinel node) have replaced radical surgery. These techniques ensure that women feel normal, enhanced younger and have markedly less side effects.
Breast saving treatment and breast reconstruction options address maintains the feminity, body image, sexuality and the sense of being complete, prevent depression and sense of loss in women. They address issues related to the partners psyche and reduce marital problems. Conventional mastectomy causes physical problems as well such as shoulder stiffness, massive swelling of the arm and postural problems

To conclude , oncoplastic breast units address the issues of breast treatment globally and provide an option of leaving or creating an intact perfect breast post treatment. Such a comprehensive oncoplastic breast unit would eventually offer cosmetic surgery options to women seeking solutions for the ageing breast that droops or the young breast that needs to be enhanced.

By focusing on molecular and cellular changes that are specific to cancer, targeted cancer therapy may prove to be effective against the disease.

Cancer, the dreaded C-word, is most often related to pain and inevitable death. But modern medicine is far advanced and new treatments have enabled doctors to treat it, reduce side effects and thus improve the quality of life of a patient. Target therapy is opted as the first line of treatment for most cancer diseases and has yielded positive results.

What is targeted cancer therapy?

Targeted cancer therapy uses drugs that block the growth and spread of cancer.

They interfere with specific molecules involved in carcinogenesis (the process by which normal cells become cancer cells) and tumour growth. As scientists prefer to call these molecules molecular targets, this form of therapy is called molecularly-targeted therapy. By focusing on molecular and cellular changes that are specific to cancer, targeted cancer therapy may be more effective than current treatments and less harmful to normal cells.

Most targeted cancer therapies are in preclinical testing (research with animals), but some are in clinical trials (research studies) or have been approved by the US Food and Drug Administration (FDA). Targeted cancer therapies are being studied for use alone, in combination with each other, and in combination with other cancer treatments, such as chemotherapy.

What are the cellular changes that lead to cancer?

Normally, cells grow and divide to form new cells as and when the body needs them.

When cells grow old, they die, and new cells take their place. Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumour. The cells in malignant (cancerous) tumours are abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumour and spread to other parts of the body.

Normal cell growth and division are largely under the control of a network of chemical and molecular signals that give instructions to cells. Genetic alterations (changes) can disrupt the signaling process so that cells no longer grow and divide normally, or no longer die when they should. Alterations in two types of genes can contribute to the cancer process. Proto-oncogenes are normal genes that are involved in cell growth and division. Changes in these genes lead to the development of oncogenes, which can promote or allow excessive and continuous cell growth and division.

Tumour suppressor genes are normal genes that slow down cell growth and division. When a tumour suppressor gene does not work properly, cells may be unable to stop growing and dividing, which leads to tumour growth.

To use the metaphor of a car, the presence of an oncogene is like having a gas pedal that is stuck to the floorboard, causing cells to continually grow and divide.

Tumour suppressor genes act like a brake pedal. The loss of a functioning tumor suppressor gene is like having a brake pedal that does not work properly, allowing cells to continually grow and divide.

Genetic changes that are not corrected by the cell can lead to the production of abnormal proteins. Normally, proteins interact with each other as a kind of relay team to carry out the work within a cell. For example, when molecules called growth factors (GFs) attach to their corresponding growth factor receptors (GFRs) on the surface of the cell, a process, carried out by proteins, signals the cell to divide.

Damaged proteins may not respond to normal signals, and may over-respond to normal signals, or otherwise fail to carry out their functions. Cancer develops when abnormal proteins inside a cell causes it to reproduce excessively and allow that cell to live longer than normal cells.

How does the targeted therapy work?

Targeted cancer therapy interferes with cancer cell growth and division in different ways and at various points during the development, growth, and spread of cancer.

Many of these therapies focus on proteins that are involved in the signaling process.

By blocking the signals that tell cancer cells to grow and divide uncontrollably, targeted cancer therapy can help to stop the growth and division of cancer cells.

What impact will targeted therapy have on cancer treatment?

Targeted cancer therapy will give doctors a better way to treat cancer. Eventually, treatments may be individualised based on the unique set of molecular targets produced by the patient’s tumour. Targeted cancer therapy also holds the promise of being more selective, thus harming fewer normal cells, reducing side effects, and improving the quality of life.

HCG and Art of Living Foundation join hands to create awareness on cancer

February, 4th, 2012, Bangalore: HealthCare Global Enterprises Ltd, The Specialist in Cancer Care, in association with The Art of Living, on World Cancer Day organized a walkathon to create awareness on cancer. Today, cancer has become a lifestyle disease. Lifestyle changes can prevent nearly 60% of new cancers diagnosed every year.

The aim of this walkathon is to create awareness of the fact that people can make changes today that can reduce the risk of developing cancer.

The walkathon was flagged of by Dr. K S Gopinath, Surgical Oncologist, HCG & Mr. Ravindra Prasad, faculty, the Art of Living, which saw hundreds of participants. Doctors, cancer survivors, cancer support groups, corporates, students and public at large participated in the event.

Speaking on this occasion Dr. K S Gopinath, Surgical Oncologist, HCG, said, “Awareness is the key and the first step in fighting cancer. Activities such as these go in a long way in creating awareness and help in the fight against cancer. I’m glad to see so many people coming to lend their support.”

Mr. Ravindra Prasad, said, “We are pleased to join hands with HCG in the fight against cancer. Cancer being a lifestyle disease has found a direct correlation with smoking. Art of Living quite smoking program has been very effective in helping people abstain from smoking and strengthening the resolve to fight cancer.”

Vandana Ramnane, Cancer Survivor, said, “Awareness is the key, once you know the cause you can make changes. Hospitals creating awareness about the disease help people by imparting knowledge. I was diagnosed with breast cancer, it could be detected early only because I was aware of the symptoms of breast cancer and met the specialist at the right time.”

The cancer communication exhibition and awareness talk is organized at The Art of Living campus in the evening where more than 1000 people are expected to participate.
The theme for World Cancer Day 2012 – “Together it is possible” as stated by Union for International Cancer Control

About HCG:
Health Care Global Enterprises Ltd, (HCG), The Specialist in Cancer Care, headquartered in Bangalore with over 23 cancer centers is South Asia’s largest cancer care network. HCG has defined the future of cancer care in India by designing, building and managing cancer care centres with a committed vision. HCG focuses on cancer care treatment, imaging and laboratory services, clinical trials and research services. The vision of HCG is to make high quality cancer care accessible to all segments of the society by adopting global innovations

About Art of Living: Founded in 1981 by Sri Sri Ravi Shankar, The Art of Living Foundation is a not-for-profit, educational and humanitarian NGO (Non-Governmental Organisation) engaged in stress-management and service initiatives. The organisation operates globally in 151 countries.
The organisation as guided by the founder conducts programs which focus on making an individual stress free and healthy life at every level of its existence starting from physical, mental, emotional and societal. Sudarshan Kriya, a rhythmic breathing technique taught during the program helps in detoxifying the body and relaxing the mind leading to a healthier life.

The Art of Living has conducted Stop Smoking, Start Living” workshop to help people quit smoking. The program has also reached out to 400 people in Bangalore. Programs have also been conducted for cancer patients in various hospitals of the country.