Ovarian cancer is the second most common type of gynaecologic cancer. The ovaries are composed of three distinct cell types: epithelial cells, germ cells, and stromal cells. Each of these cell types can give rise to different kinds of tumours. 9 out of 10 ovarian tumours originate in the epithelial cells. Epithelial ovarian cancer is the most common, originating in the epithelial cells that cover the surface of the ovaries.

A family history of ovarian cancer is the strongest risk factor for this disease. Women with mutations in the BRCA genes have a particularly increased risk. Some factors – such as having surgery to remove the ovaries, the use of oral contraceptives, and tubal ligation — have been shown to help prevent ovarian cancer.
SYMPTOMS

The four symptoms much more likely to occur in women with ovarian cancer than women in the general population are bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary symptoms.
DIAGNOSIS & TREATMENT

The two methods currently available to reduce the risk of ovarian cancer from ever occurring are using oral contraceptives or undergoing risk-reducing (prophylactic) surgery to remove the ovary and fallopian tubes.
DIAGNOSIS

Ovarian cancer is usually diagnosed with a pelvic examination and transvaginal ultrasound. A surgical biopsy of the tissue is used to confirm the diagnosis; additional imaging tests may be performed to determine if the disease has spread.
TREATMENT

The primary treatments for epithelial ovarian cancer are surgery, chemotherapy, and radiation therapy, delivered alone or in combination with another therapy.

The standard treatment for ovarian cancer is surgery — for diagnosis, staging (determining the extent of cancer), and tumour debulking, or cytoreduction — followed by chemotherapy.

For cancers that appear to be confined to the ovary, the use of less invasive techniques to remove the tumour(s) is adopted. These laparoscopic procedures, performed through small incisions made into the abdomen, can be used to biopsy and stage, and also to determine the extent of a cancer.

Depending on the size and location of the tumour, laparoscopy also can be used to remove cancerous tissue, meaning that a more extensive open surgery can be avoided. Such surgical approaches result in shorter hospital stays, a quicker recovery, and lower costs, and are as effective as conventional surgery. For selected younger patients, fertility preservation (retaining a normal ovary and the uterus) can be considered.

Early-stage ovarian cancer with minimally invasive surgery is equally effective and accurate as staging during open surgery. Our surgeons use the robotic da Vinci® Surgical System.
Chemotherapy

To destroy any tumour cells that remain after surgery, chemotherapy is recommended for the majority of women with ovarian cancer. This usually includes a combination of systemic and regional chemotherapy.
Radiation Therapy

Radiation therapy may be given over a period of several weeks. It is rarely used as a primary treatment for ovarian cancer, but is sometimes considered after the removal of a recurrent tumour or in the treatment of a recurrence.

Article By

Apollo Hospitals

Pediatric Malignancies:

Every year, 150 out of every million children in India get diagnosed with cancer. Leukaemia and lymphoma represent the most frequent Pediatric malignancies followed by brain tumours. Bone tumours, neuroblastoma, nephroblastoma are less frequent. Brain tumours are the most common type of solid tumour in children.

Pediatric Leukaemia is the most common form of childhood cancer, and accounts for about 30% of all cancers that affect children and young adults. The number of boys presenting to cancer centres in India are far more than girls and this represents our social bias rather than a true male preponderance.

In the last three decades, treatment for childhood cancers has improved in leaps and strides with an overall survival rate of above 80%. This progress is mostly due to advances in diagnostics, supportive care, multimodal chemotherapy treatment protocols, surgical clearance with precision and high technology radiotherapy delivery.
SYMPTOMS

Leukaemias result from the uncontrolled proliferation of white cells that may be lymphoid or myeloid cell groups. Depending on the type of cell groups involved they are called Acute Lymphoblastic Leukaemia (ALL) the most common type present in 85% of children and Acute Myeloid Leukaemia (AML) that accounts for approximately 15% of childhood leukaemia.

Children may present with fever, bone pain and reddish skin spots or bleeding from nose and mouth. On examination, most of them have an enlarged liver, spleen or lymph nodes. Bone pain could be indicated by a young child limping or refusing to walk. Signs of bleeding include easy bruising or small spots of blood called petechiae under the skin. Prolonged fever with no apparent cause can also be a presenting symptom. Persistent headache, vomiting, inability to walk or visual symptoms could be features of a brain tumour. A painless bony swelling that has come to light after a trivial injury is the most common presenting feature of a bone tumour. A white eye reflex is an early sign of an eye cancer called retinoblastoma.
TREATMENT

Apollo Hospitals is a pioneer in cancer treatment and has dedicated Pediatric Oncology units with clinical expertise to manage all types of childhood cancers. Treatment in the form of chemotherapy, surgery, radiotherapy or in various combinations is used depending upon the cancer type for maximum benefit after discussion in a multidisciplinary team meeting.

Pediatric surgeons can offer minimally invasive surgery that reduces pain after the procedure, shortens the child’s stay in the hospital and speeds recovery so the child can return to his or her usual daily activities as early as possible. Radiotherapy is delivered with precision and is planned carefully by a team of physicists and radiation oncologists. Small children are sedated by senior anaesthetists to help deliver care with minimum psychological trauma to a child.

At Apollo, our Pediatric neurosurgical team has tremendous amount of clinical experience and endeavours to achieve complete surgical removal of the tumour without major secondary neurologic side effects.

Our pathologists collaborate with the clinical teams and analyse tumour tissues using the latest technology available including flow cytometry and PCR based molecular assays. This approach ensures that children and young adults who do not need high doses of chemotherapy or radiation are spared the side effects of treatment whilst also making sure that patients with more aggressive cancers receive the most effective form of therapy available. Blood bank standards are of international quality and all patients receive filtered blood that has been tested using nucleic acid methods to avoid blood borne viral infections.

Our team of compassionate and competent nurses and paramedical staff ensure that the child and family receive safe and holistic care. Our patient support group is actively involved in counselling families to help them through periods of emotional crisis. Long-term follow up is part of the care to ensure that there are no late side effects of therapy in growing children.

Article By
Apollo Hospitals

The thyroid gland is a butterfly-shaped gland that lies over trachea (the tube that carries air to lungs). It produces thyroxin which helps to regulate body’s metabolism.

Thyroid nodules are very common in women of the reproductive age group (15-45 years). Palpable nodules are present in 4-7% of females. On ultrasonography 50-60% of women will have nodules in the thyroid gland. Most of these are benign. Treatment of these nodules is needed when they are malignant, are cosmetically deforming, cause compressive symptoms (airway obstruction, facial oedema), or cause functional symptoms (hyperthyroidism).
SYMPTOMS

Malignancy should be suspected when there is a

Prior history of radiation
Rapid growth of the nodules
Extremes of age (less than 15 yrs or more than 45 yrs)
Family history of medullary cancer
Associated with difficulty in swallowing and change in voice

Thyroid cancer usually presents with solitary nodules and neck node metastasis (swelling on side of neck). It may also present with compressive symptoms (airway obstruction, facial oedema, etc) and bone pain (mainly flat bones). Diffuse enlargement of the thyroid gland occurs in benign conditions (hypo or hyperthyroidism). It is managed medically and will not need surgery.

Ultrasound done by an expert sonologist is the investigation of choice. It helps to characterise the nodule (benign or malignant). It can be used to target a biopsy (FNAC). Ultrasound is used in the follow–up of benign nodules. FNAC (fine needle aspiration cytology) from the nodule is done as an outpatient procedure. A tissue sample is aspirated using a small bore needle and sent for pathological examination. It helps in reaching a diagnosis and planning treatment.

Thyroid cancers are various types. These are papillary, follicular, medullary and anaplastic carcinomas of the thyroid. Papillary cancer is the most common form of thyroid cancer (80-85%). It usually spreads to lymph nodes in the neck. 95% of the patients are usually cured of this cancer.
TREATMENT

The main stay of treatment is surgery. Any tumour more than 1.5 cm will need total thyroidectomy with central compartment nodal clearance. Neck dissection needs to done if lateral neck nodes are present. Tumours invading trachea, will need either wedge resection or resection and end to end anastomosis. Tumours invading vascular structures (IJV), will need removal of the vein or the vein can be opened and thrombus can be delivered.
Radioactive Iodine Therapy (RAI)

This causes the destruction of the thyroid remnant and it is also used to treat metastatic cancer.

Medullary thyroid cancer accounts for about 5% of thyroid cancers. They are usually treated by total thyroidectomy and neck dissection. Calcitonin (tumour marker) is used to follow up medullary carcinoma patients. Anaplastic cancer is a relatively rare cancer, and is the most aggressive form of thyroid cancer.

Article by
Apollo Hospitals

Breast Cancer:

Breast Cancer is the commonest cancer in women in most of India’s metros. Each year, more than 80,000 women in this country develop breast cancer. Breast cancer is the uncontrolled growth of breast cells. Cancer occurs as a result of mutations, or abnormal changes in the genes responsible for regulating the growth. Normally, the cells replace themselves through an orderly process of cell growth, healthy new cells take over as old ones die out. But over time mutations can ‘turn on’ certain genes and ‘turn off ‘ others in a cell. The changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumour. A tumour can be benign (not dangerous to health) or malignant (has the potential to be dangerous). Benign tumours are not considered cancerous: their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumours are cancerous. Left unchecked, malignant cells eventually can spread beyond the original tumour to other parts of the body. Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include fatty and fibrous connective tissues of the breast. Over time, cancer cells can invade nearby healthy breast tissue and spread to the underarm lymph nodes and to ther parts of the body.

Breast cancer is always caused by a genetic abnormality. However, only 5-10% of cancers are due to an abnormality inherited from mother or father. About 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process of life in general.
DIAGNOSIS

When a woman finds an abnormal mass on examination or an abnormal area is detected by screening mammogram, a careful history and physical examination should be carried out. A thorough physical examination of the breast should be done by a doctor. The specialists at Apollo who treat breast cancer include surgical oncologists, medical oncologists and radiation oncologists.
TREATMENT

Breast cancer is considered to be a systemic disease to start with, in majority of the cases. This does not mean that there is an obvious cancer at different sites. It only means that while the primary disease in the breast is obvious, there is the possibility of microscopic disease elsewhere, which is not detectable, but all the same needs treatment. Hence treatment is required for local area and distant sites. Local treatment is removal or destruction of the local tumour by either surgery or radiation. The treatment of distant sites is either by chemotherapy or hormonal treatment. Patients may need one form of treatment or require four forms of treatment either simultaneously or in sequence.
SURGERY

Surgery is the most common treatment for cancer, where the breast or part of it is removed. Reconstructive surgery can be by an artificial implant between the skin and chest wall or by the woman’s own tissues. The tissues can be taken either from the abdomen or from the back. Other procedures include sentinel lymph node biopsy (SLNB) where the sentinel lymph node is identified, removed, and examined to determine whether cancer cells are present.
RADIATION THERAPY

In common terms it is called ‘heat’ therapy where a high-energy x-ray beam is used to damage cancer cells. Radiation is also of two types:

External radiotherapy and
Implantation radiotherapy (also called Brachy therapy)

When external radiotherapy to the breast or chest wall is given post operatively the treatments are usually given for 5 days a week for 5 or 6 weeks. At the end of this an extra boost is usually given at the site of the breast tumour removal. The boost may be external or by using an implant.
CHEMOTHERAPY

Drugs are used to kill cancer cells. In the current setting drugs by themselves will not cure breast cancer. Usually more than two drugs are used. Usually these drugs are given by injections. The injections can be given in outpatient sitting day care or after short admission to the hospital depending on which drugs are used. General condition of the patient also dictates a short stay in the hospital. When chemotherapy is given after surgery and is called adjuvant chemotherapy and in this setting it is used to take care of microscopic disease elsewhere. When it is given before surgery is called Neoadjuvant chemotherapy and in this setting the purpose is to reduce the size of a large tumour, and make it surgically removable. Whether it is adjuvant or Neo-adjuvant – it is administered several times over a period of months with breaks between treatments.
HORMONAL THERAPY

Hormonal therapy is used as oral tablets such as Tamoxifen, Raloxifen or Letrazole which block the cancer cell from taking up oestrogen from the blood. Oestrogen promotes the growth of breast cancer. This is usually given to those patients in whom cancer cells are hormone receptor positive (oestrogen and or progesterone receptor positive). Sometimes the same effect is obtained by removing the source of oestrogen (overies). Like chemotherapy, hormonal therapy is also given to control systemic disease elsewhere.

Article By

Apollo Hospitals

Cordocentesis:

Cordocentesis — also known as percutaneous umbilical blood sampling — is a highly specialized prenatal test in which a sample of the baby’s blood is removed from the umbilical cord for testing.

Cordocentesis can be used to detect certain blood conditions and infections. Cordocentesis can also be used to deliver blood transfusions and medication to a baby through the umbilical cord.

Use of cordocentesis is decreasing, however, since newer forms of technology can sometimes provide the same information from tests that pose a smaller risk of miscarriage — such as amniocentesis or chorionic villus sampling.

Cordocentesis might be offered when:

The desired information can’t be obtained any other way
Results from other prenatal tests are unclear
Test results might have a significant impact on the immediate management of the pregnancy

Cordocentesis is used primarily to detect and treat blood conditions, such as fetal anemia — a lack of healthy red blood cells in a developing baby.

If you have an infection, cordocentesis might be used to determine whether the baby has the infection, too.

If necessary, cordocentesis can be used to deliver blood transfusions and medication to the baby through the umbilical cord.

Article By
Fortis Hospitals

What is Fetal Surgery

We offer the full spectrum of feral therapies except FETO or open fetal surgery at present.

Fetal surgery is a highly complex surgical intervention to repair birth defects in the womb that requires the most expert care for both mother and unborn baby.

Its estimated that there would be about 487,000 babies born with birth defects in India, out of these 7200 per year are in Delhi. Maternal-fetal specialists have long known that some birth defects could be successfully treated after birth. But as technology, fetal imaging and prenatal testing have improved in the past few decades, so too has our knowledge of fetal development.

Expanded diagnostic tools have allowed us to identify more precisely when conditions worsen during fetal development. This knowledge has helped us develop new ways to help babies sooner. Today, fetal therapy is recognized as one of the most promising fields in fetal medicine, and prenatal surgery is becoming an option for a growing number of babies with birth defects.

We follow the principles laid down in 1982 when fetal surgery was first contemplated.
Pre-requisite for considering fetal surgery*
Fetal conditions which warrant in utero therapy are usually simple structural defects that interfere with normal fetal development but if corrected will allow normal development to proceed
Accurate prenatal diagnosis
Exclusion of associated structural and genetic abnormalities
Normal fetal karyotype
An understanding of the natural history of the disease with established prognosis – fetal intervention is justified only if there is a reasonable probability of benefit from it
Serial evaluation of the fetus to differentiate those with mild disease who may not need intervention from those with severe disease who will not survive without intervention
Therapy proven to be useful at least in animal models
Informed consent after detailed discussion with the family regarding risks and benefits including long term outcomes
Multidisciplinary team comprising obstetrician with interest in high risk pregnancy, fetal medicine specialist, neonatologist, paediatric surgeon and psychologist
Centre equipped with the logistics, instruments, expertise and intensive care nursery to deal with these uncommon procedures

Article by
Apollo Hospitals

Rhinoplasty:

Rhinoplasty is a surgical procedure to improve the function or the Appearance of a human nose.

In rhinoplasty one or more of the following are done

* Elevation of a depressed nose by adding cartilage
* Bone or silicone implant
* Removal of a hump
* Reduction of the bulk of the tip
* Narrowing of the nasal bones elevation of the tip of the nose
* Reduction of the size of the nostrils
* Narrowing of the base of the nose

Article By
Apollo Hospitals

Single Incision Laparoscopic Surgery:

One of the latest additions to Bariatric surgery is the new technique of port entry called the Single Incision laparoscopic Surgery. SILS is the next generation of laparoscopy, where the access is only through a single port instead of multiple ports. This utilizes new specialized port and roticulator instruments thus making the procedure literally scarless as it will be buried inside the belly button. This procedure though consumes more time, gives early post operative recovery with less pain than in conventional laparoscopy thus making it a treatment of choice for patients.

Article by

Apollo Hospitals

What is Bone Marrow Transplantation?

Bone Marrow Transplantation is a form of intensive treatment used to treat certain cancers like leukaemias, 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.
What are the different types of bone marrow or stem cell transplantation?

There are two main types of transplants – Autologous and Allogeneic.

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 matches. 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.

What is the basic process?

There are three main steps in the transplantation process

The first step is the collection of the bone marrow or stem cells (the harvest) from the donor. We now know that the umbilical cord blood is also a rich source of stem cells.

The second step is to completely destroy the existing bone marrow and thereby help the patient receive the new stem cells.

The third step is to infuse the bone marrow or the stem cells through the intravenous route, like a blood transfusion. There may be no signs of a new bone marrow growing for two to three weeks, and occasionally it may be a few months before the new bone marrow produces all the components of the blood adequately.
How does one prepare for transplantation?

Having a transplant can be very demanding, physically and emotionally, and the family and friends too, may find this very stressful. It may help if patients can talk about their fears and concerns.

It is important to understand why one is having the transplant and what the actual processes will be, so that the patient can make practical arrangements and also prepare himself or herself mentally. It is a good idea to discuss the entire process with the doctors and nurses involved, before the patient goes into hospital.

Here are some questions one may like to ask:

What are the benefits of the treatment?
What are the risks of the treatment?
How will the transplant affect the way I live?
Will I be able to have children after a transplant?
How long will it be before I can start leading a normal life again?
What are the other treatments available to me?
Can one predict how the disease will progress?
Who can visit me?
Will my treatment make me feel too unwell to see people?
Is there a television in the room?
Is there a telephone link in the room?
Can I bring in my own clothes?
What do you suggest that I bring to the hospital to make my stay more comfortable?
Where can the attenders stay?

Being fully informed and prepared will help to make the transplant process easier for the patient and the family.
Who can be a donor for an Allogeneic transplant?

Matching bone marrow is done by blood tests alone. It is not necessary to test the donors bone marrow at this stage.

It is usual to start by testing the brothers and sisters, as they are likely to provide the best match; parents are not usually good matches.

The donor should be in good health. He or she will be given a thorough medical checkup to make sure that there will be no risk to his or her own health from the procedure.
Collecting bone marrow

About a week or two before the bone marrow harvest is done, the patient (or the donor, for an Allogeneic transplantation) may have 1 to 2 units of blood withdrawn. This will be given back during the bone marrow harvest.

The harvest itself is carried out under general anaesthesia, so one will feel nothing. It involves the removal of some marrow from inside the bones at the back and front of the pelvis (the hip bones).

The patient or donor will have to stay in hospital overnight to recover fully from the general anaesthesia. Usually it feels sore for a few days and mild painkillers may be required. These will be administered by the nurses or doctors.
How are the stem cells collected?

Stem cell harvesting is done following a course of daily injections of a growth factor. This procedure takes about 3 hours. The patient will be made to lie down on a couch and a transfusion will be put into the vein of each arm. Blood will be collected from one arm, into a machine called a centrifuge, which spins it to separate out the stem cells. These are collected, and the remaining blood is returned through the IV in the other arm. The stem cells can even be frozen.
What is Umbilical Cord Blood Transplantation?

Many children and young adults with serious blood diseases, such as leukaemia, need a bone marrow transplantation to give them a chance to live. Unfortunately a marrow donor cannot always be found. Sometimes searching for a donor takes so long that the patient dies before a compatible donor is available.

However, now a new source of blood forming stem cells has been found – Umbilical Cord Blood.

This is the blood that is left behind in the placenta and the umbilical cord after the delivery of a baby. Cord blood is rich in stem cells and can be used instead of bone marrow for transplantation.

The stem cell in the cord blood is of high quality and very potent in producing blood cells. Cord blood transplants appear to cause less serious immunological side effects. The ‘matching’ between donor and recipient appears to be less critical. This means that the chance of finding suitable cord blood for transplantation is much greater than that of bone marrow.
Article by
Apollo Hospitals

Treatments for Kidney Disease
Dialysis

Dialysis is the process of removing wastes and impurities from the blood and is done when a person’s kidney doesn’t function properly, due to kidney failure, severe diabetes, a congenital kidney disease, hypertension or other health problems.

Dialysis is a form of renal replacement therapy. Dialysis can be done for a short period, in case the patient is waiting for a kidney transplant. If the patient doesn’t qualify for the transplant, life-long dialysis will be needed.

There are two types of dialysis:
Hemodialysis

In hemodialysis, a machine called a dialyser is used to filter the blood. A catheter is placed in a vein in the arm, and a needle inserted into this catheter is connected to a tube that carries blood into the dialyser. In the dialyser, a semi-permeable membrane separates the blood from a dialysis fluid. The wastes in the blood pass through the membrane into the fluid, and the clean blood is sent into the body.
Peritoneal Dialysis

In peritoneal dialysis, the abdomen is filled with a glucose-based liquid through a small hole created in the peritoneal membrane (lining of the abdominal cavity). This solution cleans the blood of wastes.

Peritoneal dialysis can be done when the patient is performing regular activities. Such dialysis is called Continuous Ambulatory Peritoneal Dialysis. The patient will be trained to infuse and drain out the fluid a few times every day. Peritoneal dialysis can also be done with the help of a machine, at night, when the patient is sleeping.

Plasma exchange may be done along with dialysis, to filter clotting factors and unwanted proteins. Charcoal hemofiltration in which a charcoal layer is used to remove wastes from blood, a process similar to dialysis, may sometimes be used.

Article By
Apollo Hospitals