Leukaemia is a group of cancers that originate in the bone marrow, producing abnormal white blood cells. These cells form in the bone marrow — the soft, spongy inner portion of certain bones. Acute myelogenous leukaemia (AML) and chronic lymphocytic leukaemia (CLL) are the most common types in adults. Chronic myelogenous leukaemia (CML) and acute lymphoblastic leukaemia (ALL) are less common. Although uncommonly diagnosed in adults, ALL represents about 85% of all childhood leukaemias, while about 15% of pediatric leukaemias are AML.

Normal blood-cell development begins in the marrow from the hematopoietic stem cells. These primitive cells are capable of developing into full range of blood cells — red and white blood cells and platelets — each of which makes important contributions to how the body functions. Normal, healthy white blood cells, or leukocytes, have a very short life span — sometimes only a few hours long — and are continuously replenished in the bone marrow. They proceed through their life cycles in an orderly way, and when they die they are replaced by new cells.

Leukaemia develops when the genetic material, or DNA, of a white blood cell is altered giving growth advantage to that leukocyte. The diseased cells cannot mature beyond an early stage in their life cycles, so they never develop into functional cells. Because they do not mature, they become immortal and live indefinitely. The diseased cells — called blasts — eventually take over the bone marrow and do not allow normal RBC, WBC and platelet development.As the numbers of normal cells decline, patients may develop anaemia, a low level of oxygen-carrying red blood cells; infections caused by low counts of micro-organism fighting white blood cells; and bruising and bleeding, resulting from low levels of platelets, the blood component crucial to blood clotting and wound healing. Leukaemic cells may also invade the liver, spleen, lymph nodes, and other organs.
TYPES OF LEUKAEMIA

Blood cells can become malignant at any stage in their development. The leukaemia cells that result carry many characteristics of the cell from which they originate. Most leukaemias develop from one of two types of white blood cells, lymphocytes or myelocytes, and are classified as lymphocytic leukaemia or myeloid leukaemia, respectively.

Lymphocytic Leukaemia
Myeloid Leukaemia
Acute or Chronic Leukaemia

TREATMENT

Apollo Cancer Centres provides multi disciplinary care in treating leukaemia. An expert team of medical oncologists, radiation oncologists, and bone marrow transplant specialists work in coordination to provide treatment. A well equipped blood bank along with Apheresis equipment helps in stem cell collection and in providing blood components to the critically sick patients with low counts. Latest advances in chemotherapy, radiation leukaemia therapy, and bone marrow and/or stem cell transplantation combined with the expertise and skills of doctors from across many medical disciplines offer comprehensive treatment options along with compassionate care.

A collaborative approach is very important when caring for people with leukaemia because many patients require more than one form of treatment. Having a team of specialists working together from the very beginning optimises patient care.

Members of the team meet regularly to review and discuss each patient’s treatment plan. Other specialists, including those who provide psychosocial support, help the team meet the nonmedical needs of both patients and their caregivers. These healthcare professionals work together to provide a full spectrum of supportive and holistic care.

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Apollo Hospitals

Lung transplant:

A lung transplant is a surgical procedure to replace a diseased or failing lung with a healthy lung, usually from a deceased donor. Depending on your medical condition, a lung transplant may involve replacing one of your lungs or both of them. In some situations, the lungs may be transplanted along with a donor heart.

Unhealthy or damaged lungs can make it difficult for your body to get the oxygen it needs to survive. A variety of diseases and conditions can damage your lungs and hinder their ability to function effectively, including:

Chronic obstructive pulmonary disease (COPD), including emphysema
Scarring of the lungs (pulmonary fibrosis)
Cystic fibrosis
Sarcoidosis with advanced fibrosis
Pulmonary hypertension

Lung damage can often be treated with medication or with special breathing devices. But when these measures no longer help or your lung function becomes life-threatening, your doctor might suggest a lung transplant.

HOW to Prepare:
A lung transplant is a surgical procedure to replace a diseased or failing lung with a healthy lung, usually from a deceased donor. Depending on your medical condition, a lung transplant may involve replacing one of your lungs or both of them. In some situations, the lungs may be transplanted along with a donor heart.

The number of people needing lung transplants far exceeds the number of donated lungs available. When a donor organ becomes available, the donor-recipient matching system administered by the United Network for Organ Sharing (UNOS) finds an appropriate match based on specific criteria, including:

Blood type
Size of organ compared with chest cavity
Geographic distance between donor organ and transplant recipient
Severity of the recipient’s lung disease
Recipient’s overall health
Likelihood that the transplant will be successful

While you wait

It may take months or even years before a suitable donor becomes available, but you must be prepared to act quickly when one does. Make sure the transplant team knows how to reach you at all times.

Keep your packed hospital bag handy — including an extra 24-hour supply of your medications — and arrange transportation to the transplant center in advance. You may be expected to arrive at the hospital within just a few hours.
At the hospital

Once you arrive at the hospital, you will undergo tests to make sure the lung is a good match and that you are healthy enough to have the surgery. The donor lung also must be healthy or it will be declined by the transplant team. The transplant will be canceled if it doesn’t appear that the surgery will be a success.

Risks:
Complications associated with a lung transplant can sometimes be fatal. The two major risks are rejection and infection.
Risk of rejection

Your immune system defends your body against foreign substances. Even with the best possible match between you and the donor, your immune system will try to attack and reject your new lung or lungs.

Your drug regimen after transplant will include medications to suppress your immune system in an effort to prevent organ rejection. You’ll likely take these anti-rejection drugs for the rest of your life.
Side effects of anti-rejection drugs

Anti-rejection drugs may cause noticeable side effects, including:

Weight gain
A rounder face
Acne
Facial hair
Stomach problems

Some anti-rejection medications can also increase your risk of developing new or aggravating existing conditions, such as:

Diabetes
Kidney damage
Osteoporosis
Cancer
Hypertension

Risk of infection

The anti-rejection drugs suppress your immune system, making your body more vulnerable to infections, particularly in your lungs. To help prevent infections, you should:

Wash your hands often
Take care of your teeth and gums
Protect your skin from scratches and sores
Avoid crowds and people who are ill
Receive appropriate vaccinations

Results:
A lung transplant can substantially improve your quality of life. The first year after the transplant — when surgical complications, rejection and infection pose the greatest threats — is the most critical period. Although some people have lived 10 years or more after a lung transplant, only about half the people who undergo the procedure are still alive after five years.

Article By

Fortis Hospitals

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