Cancer / Onco Surgery

PATIENTS SPEAK

View Doctors

No image found
Dr. Shamsuddin J. Virani
Consultant - Onco Surgeon
Cardiology & Cardiothoracic Surgery

Cancers are a group of diseases associated with abnormal growth of cells. Without any check, the disease may keep on progressing ultimately leading to pre-mature death. They can arise anywhere in the body and can affect people from all age groups, socio-economic strata and race. Cancer is the leading cause of morbidity and mortality in the world. According to data by International Agency for Research on Cancer, there were 141 lakh new cancer cases, 82 lakh cancer deaths and 326 lakh people living with cancer in 2012 worldwide. In our own country, about 4.7 lakh new cases of cancer are detected annually. Cancer is responsible for death of about 3.5 lakh people annually in India itself.

There are several major types of cancers: carcinomas form in the cells that cover the skin or line the mouth, throat, lungs and organs; sarcomas are found in the bones, muscles, fibrous tissues and some organs; leukemia is found in the blood, the bone marrow, and the spleen; and lymphomas are found in the lymphatic system.

Oral Cancer Surgery
  • Oral cancer or mouth cancer, a type of head and neck cancer, is any cancerous tissue growth located in the oral cavity.
  • There are several types of oral cancers, but around 90% are squamous cell carcinomas, originating in the tissues that line the mouth and lips.
  • Oral or mouth cancer most commonly involves the tongue. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), lips, or palate (roof of the mouth).

Signs and symptoms

  • Skin lesion, lump, or ulcer that do not resolve in 14 days located:
  • On the tongue, lip, or other mouth areas
  • Usually small
  • Most often pale colored, may be dark or discolored
  • Early sign may be a white patch (leukoplakia) or a red patch (erythroplakia) on the soft tissues of the mouth
  • Usually painless initially
  • May develop a burning sensation or pain when the tumor is advanced
  • Additional symptoms that may be associated with this disease:
  • Tongue problems (moving it)
  • Swallowing difficulty
  • Pain and paraesthesia are late symptoms.

Premalignant lesions

  • A premalignant (or precancerous) lesion is defined as "a benign, morphologically altered tissue that has a greater than normal risk of malignant transformation." There are several different types of premalignant lesion that occur in the mouth. Some oral cancers begin as white patches (leukoplakia), red patches (erythroplakia) or mixed red and white patches (erythroleukoplakia or "speckled leukoplakia"). Other common premalignant lesions include oral lichen planus (particularly the erosive type), oral submucous fibrosis and actinic cheilitis. In the Indian subcontinent oral submucous fibrosis is very common. This condition is characterized by limited opening of mouth and burning sensation on eating of spicy food. This is a progressive lesion in which the opening of the mouth becomes progressively limited, and later on even normal eating becomes difficult. It occurs almost exclusively in India and Indian communities living abroad.

Causes

  • Tobacco
    Smoking and other tobacco use are associated with about 75 percent of oral cancer cases, caused by irritation of the mucous membranes of the mouth from smoke and heat of cigarettes, cigars, and pipes. Tobacco contains over 60 known carcinogens, and the combustion of it, and by-products from this process, is the primary mode of involvement. Use of chewing tobacco or snuff causes irritation from direct contact with the mucous membranes.
  • Alcohol
    Human papillomavirus

Diagnosis

  • An examination of the mouth by the health care provider or dentist shows a visible and/or palpable (can be felt) lesion of the lip, tongue, or other mouth area. The lateral/ventral sides of the tongue are the most common sites for intraoral SCC.
  • A tissue biopsy, whether of the tongue or other oral tissues and microscopic examination of the lesion confirm the diagnosis of oral cancer or precancer.
  • A tissue biopsy, whether of the tongue or other oral tissues and microscopic examination of the lesion confirm the diagnosis of oral cancer or precancer.

Management

  • Surgical excision (removal) of the tumor is usually recommended if the tumor is small enough, and if surgery is likely to result in a functionally satisfactory result. Radiation therapywith or without chemotherapy is often used in conjunction with surgery, or as the definitive radical treatment, especially if the tumour is inoperable. Surgeries for oral cancers include
  • • Maxillectomy (can be done with or without orbital exenteration)
    • Mandibulectomy (removal of the mandible or lower jaw or part of it)
    • Glossectomy (tongue removal, can be total, hemi or partial)
    • Radical neck dissection including various types
    • Combinational e.g. glossectomy and laryngectomy done together.
    • Feeding tube to sustain nutrition.
  • Owing to the vital nature of the structures in the head and neck area, surgery for larger cancers is technically demanding. Reconstructive surgery may be required to give an acceptable cosmetic and functional result. Pedicle or free surgical flaps such as the radial forearm flap, Anterolateral thigh flap, free fibular flap are used to help rebuild the structures removed during excision of the cancer. An oral prosthesis may also be required. Most oral cancer patients depend on a feeding tube for their hydration and nutrition. Some will also get a port for the chemo to be delivered.
  • Many oral cancer patients are disfigured and suffer from many long term after effects. The after effects often include fatigue, speech problems, trouble maintaining weight, thyroid issues, swallowing difficulties, inability to swallow, memory loss, weakness, dizziness, high frequency hearing loss and sinus damage.
  • Survival rates for oral cancer depend on the precise site, and the stage of the cancer at diagnosis.Survival rates for stage 1 cancers are approximately 90%, hence the emphasis on early detection to increase survival outcome for patients.
Laryngeal Surgery
  • The larynx (voice box) is located at the top of the trachea (the windpipe).
  • The larynx contains the vocal cords. Vocal cords vibrate and allow us talk and sing.
  • With cancer of the larynx (laryngeal cancer), malignant cells grow in the tissue of the larynx. Most laryngeal cancers form in squamous cells, the flat cells that line the inside of the larynx.

Cancer Staging

  • Staging the cancer helps doctors decide the prognosis and the best treatments to prescribe. Cancer stages are determined by the size and the exact location of the tumor.
  • Radiation therapy stops cancer cells from dividing. The growth of the tumor is slowed. Radiation also destroys cancer cells and can shrink or eliminate tumors.
  • People who are diagnosed with an early stage laryngeal cancer can often be cured with radiotherapy only. This treatment preserves the voice.
  • Radiation alone (without surgery) is successful in treating 80% to 90% of people with stage I laryngeal cancer, and 70% to 80% with stage II cancer.
  • Stage III and IV usually require a combination of radiation and chemotherapy.
  • Radiotherapy may also be given as an additional therapy (adjuvant therapy). Adjuvant therapy is used after surgery:
  • • If some cancer cells might still remain in the body
    • If the tumor was difficult to remove completely
    • When the tumor has penetrated the wall of the larynx
    • If the pathologist finds cancer cells in the lymph nodes
  • If the tumor is pressing against the windpipe it can cause pain and difficultly breathing or swallowing. Radiotherapy can relieve the symptoms by shrinking the size of the tumor. Only a short course of treatments is needed to control symptoms (palliation).
  • If the radiotherapy is not able to destroy all the cancer, surgery might be needed to remove the cancer that remains (called salvage surgery).
  • Medical oncologists administer chemotherapy if the cancer has spread to lymph nodes or other organs. The medicine circulates in the blood and disrupts the growth of the cancer cells. Chemotherapy medications are taken by mouth or given through a vein for several months.
  • Chemotherapy alone cannot cure this type of cancer.
  • Chemotherapy is prescribed for different reasons:
  • • Together with radiotherapy as an alternative to surgery (called chemoradiation)
    • After surgery to decrease the risk of the cancer returning
    • To slow the growth of a tumor and control symptoms when the cancer cannot be cured (palliative treatment).

Surgery

  • Endoscopic laser surgery on the larynx is very effective. In stages I and II, surgery has better or equal cure rates when compared to radiation therapy.
  • Endoscopic Resection
    Endoscopic resection can remove very early cancers of the larynx. General anesthesia is used. The surgeon inserts an endoscope (a tube with a camera and a light on the inside of the tube) into the throat to locate the cancer. Then the surgeon uses a scalpel or a laser to remove the cancerous tissue. A laser is a thin hot beam of light. It cuts tissue and controls bleeding at the same time.
    Surgery is often the best and only option for large cancers, or cancer that does not respond to radiation treatments.
  • Partial Laryngectomy
    Partial laryngectomy is used to treat small laryngeal cancer, or for cancer that has returned after radiation (recurrent cancer). During partial laryngectomy, only part of the larynx is removed. At least one part of one vocal cord is not removed. After a partial laryngectomy patients can still speak, but the voice might be hoarse or weak. There are different types of partial laryngectomies.
    Your doctor might use these names:
    • A cordectomy is the removal of one vocal cord.
    • A frontolateral laryngectomy is the removal of the front of both vocal cords and most of the cancerous cord.
    • An anterior frontal laryngectomy is the removal of the front of both vocal cords.
    • A hemilaryngectomy is the removal of one side of the voice box.
    During the procedure, the surgeon will make an opening in the neck to the windpipe. This will create a temporary tracheostomy (a hole in the neck for breathing). The tracheostomy allows the larynx to heal after surgery. After healing, the patients usually speak and eat differently.
  • Supraglottic Laryngectomy
    A supraglottic laryngectomy is used when the tumor is only in the area above the vocal cords. The surgeon will use either the laser or the open technique to remove the voice box structures above the vocal cords (the false vocal cords and the epiglottis).
    During the procedure, the surgeon will make an opening in the neck to the windpipe. This will create a temporary tracheostomy (a hole in the neck for breathing). The tracheostomy allows the larynx to heal after surgery. After healing, patients usually speak and eat effectively.

What is Breast Cancer?

  • It is characterized by uncontolled growth in breast tissues which may arise from lobules which secrte milk or ducts (most common) in which milk flaws.
  • When “controls” in breast cells are not working properly and allows continuous growth then cancer forms. There it forms hard lump or swelling and over the time it increases in size called as localized disease-stage I or II.
  • Over time, cancer cells can invade nearby healthy breast tissue and make their way into the underarm lymph nodes called locoregional disease-stage III.
  • And finally goes to another parts of body via blood like bones,liver,lungs,brain etc, called distant disease-stage IV.

Breast Cancer Risk Factors

  • Staging the cancer helps doctors decide the prognosis and the best treatments to prescribe. Cancer stages are determined by the size and the exact location of the tumor.
  • Be sure to talk with your doctor about all of your possible risk factors for breast cancer. There may be steps you can take to lower your risk of breast cancer, and your doctor can help you come up with a plan. Your doctor also needs to be aware of any other risk factors beyond your control, so that he or she has an accurate understanding of your level of breast cancer risk. This can influence recommendations about breast cancer screening — what tests to have and when to start having them.

Screening & Symptoms of Breast Cancer

  • It is characterized by uncontolled growth in breast tissues which may arise from lobules which secrte milk or ducts (most common) in which milk flaws.
  • When “controls” in breast cells are not working properly and allows continuous growth then cancer forms. There it forms hard lump or swelling and over the time it increases in size called as localized disease-stage I or II.
  • Over time, cancer cells can invade nearby healthy breast tissue and make their way into the underarm lymph nodes called locoregional disease-stage III.
  • And finally goes to another parts of body via blood like bones,liver,lungs,brain etc, called distant disease-stage IV.
  • • swelling of all or part of the breast
    • skin irritation or dimpling
    • breast pain
    • nipple pain or the nipple turning inward
    • redness, scaliness, or thickening of the nipple or breast skin
    • a nipple discharge other than breast milk
    • a lump in the underarm area
  • These changes also can be signs of less serious conditions in around 90% of cases such as an infection or a cyst.However, it’s important to get any breast changes checked out promptly by a doctor.

GYNAE ONCOLOGY

  • Cancer Patients wiil continually do so, to provid an evidence-based high quality & focased approach to cancer care. With Radiation Therapy centre right on the corner at navsari, we are upgrading our services as a complete set up for diagnosis & treatment.We are responsive to the needs of patients & their families, & as a part of an ongoing modernization program, we are continally upgrading our services & equipments.
  • Cancer Patients wiil continually do so, to provid an evidence-based high quality & focased approach to cancer care. With Radiation Therapy centre right on the corner at navsari, we are upgrading our services as a complete set up for diagnosis & treatment.We are responsive to the needs of patients & their families, & as a part of an ongoing modernization program, we are continally upgrading our services & equipments.
Know Your Cancer Risk
,  
           
Share Your Cancer Story
Maximum Limit 2MB, Upload Image (jpg, jpeg, png)
Maximum Limit 2MB, Upload Image (jpg, jpeg, png)