Advanced Treatment (non-invasive) for Bladder Cancer - Best Cancer Hospital in India

INITIAL BLADDER CANCER TREATMENT

The most common first treatment of non-muscle invasive bladder cancer is surgery to remove any abnormal appearing areas inside the bladder; this is called transurethral resection of bladder tumor (TURBT).

Transurethral resection of bladder tumor (TURBT) — Transurethral resection of bladder tumor (TURBT) is a procedure in which a physician uses a cystoscope to see inside the bladder and remove any abnormal-appearing areas. A cystoscope is a long thin tube that contains a light and a camera.

In most cases, this procedure is done in an operating room while the person is under anesthesia. After the procedure, you can usually go home, sometimes with a catheter for a few days.

In certain cases, usually in people with more aggressive microinvasive cancers, a second TURBT will be performed several weeks after the first to be sure that no tumor was missed during the original cystoscopy. If there are new areas that appear abnormal, they will be removed. If there are no new abnormal-appearing areas, you will begin adjuvant therapy.

BLUE LIGHT (FLUOROSCENT) CYSTOSCOPY

Enhanced visualization of tumors and improved removal can be accomplished with the advent of a cystoscopy procedure using ultraviolet (blue) light together with a dye that is injected into the bladder at least an hour beforehand. Usually performed while a patient is under anesthesia, this FDA-approved dye and procedure is gradually gaining increased acceptance in the United States, although it has been in use in Europe for over a decade. The main advantage appears to be about a 20 to 25 percent increased detection of tumors or carcinoma in situ (CIS) that is not seen under standard white light cystoscopy. This also helps define the margins of the bladder tumor for complete removal.

 Use of blue light cystoscopy results in a 10 to 15 percent absolute decrease in tumor recurrence at about two years. A similar technological advance does not require a dye at all but uses blue green filters to highlight areas of increased blood vessels often feeding the tumor. This technique is called narrow band imaging or NBI and can be done in the office with a flexible cystoscope. While not as rigorously studied as blue light cystoscopy, the results of clinical trials show a similar degree of increased tumor detection compared to standard white light cystoscopy.

ADJUVANT BLADDER CANCER THERAPY

Even in people who have their bladder tumor completely removed with TURBT, up to 50 percent of people will have a recurrence of their cancer within 12 months. Because of this high recurrence rate, adjuvant (additional) therapy is usually recommended. The type of adjuvant therapy recommended depends upon your risk of recurrence:

●Some people who are at low risk of recurrence will be advised to have a single dose of intravesical chemotherapy at the time of the initial TURBT. This is thought to help prevent floating tumor cells dislodged from the TURBT to seed and start new tumors.

"Intravesical" means that the treatment is put inside of the bladder, usually through a catheter (a flexible tube passed through the urethra, where urine exits). This allows a high concentration of the treatment to be applied directly to the areas where tumor cells could remain, potentially destroying these cells and preventing them from reemerging in the bladder and forming new tumors.

●Some people who are at intermediate risk of recurrence will be advised to have either a full six-week course of intravesical chemotherapy, most commonly mitomycin.

●People at high risk of recurrence or worsening will be advised to start intravesical BCG, usually within two to six weeks of the first treatment. This is most commonly followed by additional booster treatments (maintenance therapy) once a complete response is obtained. Occasionally, however, patients are advised to consider bladder removal (cystectomy) especially if the disease is extensive.

Intravesical chemotherapy — Chemotherapy refers to the use of medicines to stop or slow the growth of cancer cells. The most commonly used intravesical chemotherapy for bladder cancer is mitomycin. This is put inside the bladder in one of two ways:

●One regimen involves giving the mitomycin once, immediately after TURBT. The solution is left in the bladder for 30 to 60 minutes, then allowed to drain out through a catheter.

●Alternately, the mitomycin can be given on a weekly basis for six weeks. With this regimen, the bladder is filled with mitomycin with a catheter, the solution is left for one to two hours, then the person urinates. A maintenance treatment may be given once per month for up to one year.

Intravesical BCG — Bacillus Calmette-Guerin (BCG) is a live bacterium related to cow tuberculosis. It is a common treatment for non-muscle invasive bladder cancer, particularly for cancers that have a risk of worsening over time. BCG is believed to work by triggering the body's immune system to destroy any cancer cells that remain in the bladder after TURBT.

BCG is in a liquid solution that is put into the bladder with a catheter. The person then holds the solution in the bladder for two hours before they urinate. The treatment is usually given once per week for six weeks, starting approximately two to three weeks after the last TURBT. Further booster (maintenance) treatments can extend the benefit of BCG.

Benefits of intravesical BCG — Intravesical BCG, in combination with TURBT, is the most effective treatment for non-muscle invasive bladder cancer. BCG therapy has been shown to delay (although not necessarily prevent) tumor growth to a more advanced stage, decrease the need for surgical removal of the bladder at a later time, and improve overall survival .

Robotic laparoscopy prostatectomy offers several advantages - Prostate Treatment in India

Robotic laparoscopyprostatectomy offers several advantages. Although experts do not agree as to whether robotic or open surgery is best, the majority of prostate cancer surgeries  are being done with the laparoscopic/robotic approach, particularly at high volume medical centers that specialize in prostate cancer treatment. The post-operative goals for treating prostate cancer are the same regardless of whether the operation is done with an open or laparoscopic approach.

Less Scaring

The first advantage to robotic surgery is that it is an application of advance technology and is minimally invasive. Instead of having a 5 or 6” incision to the skin and abdominal fascia (See image below, left), patients have a series of small “band-aid” incisions. (On right) 

A Shorter Hospital Stay

With smaller incisions, the postoperative pain is significantly less, which means your length of hospitalization is shorter - as is the time to return to usual activity.

After the laparoscopic/robotic prostatectomy patients typically do not require an inpatient hospital stay over one night. Surgery is done in the morning and they typically go home after lunch on the first operative day.

Comparatively, after the open prostatectomy patients spend at least two nights in the hospital primarily for pain control, nausea and difficulty getting out of bed and getting back to an activity level that would be appropriate for them to be discharged home.

Less Drugs, More Blood

Patients' need for postoperative pain medicine and narcotics is also greatly reduced after the laparoscopic/robotic approach compared to open surgery.

Another advantage to robotic surgery is decreased intraoperative blood loss. During traditional open surgery, it is not at all uncommon for patients to lose between 600 cc and 1000 cc of blood intraoperatively given the intense vascularity of the prostate and its surrounding tissues. This entails some significant risk of intraoperative or postoperative transfusion (and secondarily the attendant risk of transfusion) among these patients.

During robotic/laparoscopic prostatectomy, blood loss is usually 200 cc or less, which is very minimal and has a negligible risk of needing a transfusion. This is likely a minor difference as the transfusions are quite safe. However, the small difference among treatment approaches may be quite important to some patients.

Postoperative Catheterization

The third advantage of robotic surgery over open surgery is a reduction in the required postoperative catheterization time. After open surgery, foley catheters are left to drain the urine for usually two or more weeks. After the robotic approach, the catheter typically remains in place 5 to 7 days. The reason for this difference is unclear but may be related to the increased precision and visibility the robotic approach offers and also maybe that a running anastamosis (bringing the bladder neck and urethral sphincter back together) may be done in a water-tight fashion compared to the open approach.

Erectile Function

The fourth advantage of robotic prostatectomy is the (at least theoretical) improved ability to preserve the erectile nerves. During an open prostatectomy through an incision on the anterior abdominal wall, the nerves that provide erection are hidden behind the prostate. The approach taken using the surgical robot, enters the abdomen and the robotic arms are positioned posterior to the prostate with the nerves directly in front of the robotic/laparoscopic camera. In this way, the nerves maybe preserved, primarily because the anatomy can be seen more clearly compared to open surgery.

In addition, the decreased blood loss of the robotic approach improves the intra-operative visibility. As you can imagine, attempting to preserve delicate nerve structures can be quite challenging in the pool of blood versus in a relatively dry surgical field that is expected with the laparoscopic/robotic approach.

Unbeatable Advantages of Robotic Prostate Surgery over the 
Conventional Prostate Cancer Surgery

Usually in conventional approach, surgeons make decisions using tactile and visual cues to identify a phenomenon, which is actually microscopic which is likely to damage nerves or to leave cancer behind. In the Advanced Robotic Technique (ART) surgeons uses a sophisticated mastr slave robot that incorporates 3-D high definition vision, scaling of movement and wristed instrumentation that gives him the ability to perform Prostate excision with minimal risk of leaving the cancer behind and also minimal bleeding and post operative risk of incontinence and impotence.

Neither clinical nor imaging tests are sensitive enough to capture a tumour at T3 stage where it has become locally advanced and a risk for spreading to other body parts. Sometimes it is difficult for surgeons to find a precise plane between the cancer and urinary sphincter or the nerves and err on the side of cancer safety leading to incontinence or Impotence Da vinci robot system minimizes side effects thereby greater control for the patient over urinary discharge i.e. continence and return to normal sexual function after the surgery.

What are the advantages of a laser prostatectomy? What are the alternatives to GreenLight PVP laser prostatectomy

Why have a laser prostatectomy?

The reasons are the same as for a TURP, which are:

• urinary symptoms due to an enlarged prostate (BPH) that are bothersome and are not adequately improved by medicines, changing one's lifestyle
• urinary symptoms due to BPH that are bothersome and cannot be treated by drugs or other minimally invasive techniques
• urinary symptoms due to BPH proven to be due to bladder outlet obstruction on urodynamics with a desire to remove obstruction in order to avoid long term problems of bladder outlet obstruction
• The inability to pass urine without a catheter ('urinary retention')
• kidneys that are not functioning properly because the prostate is blocking the bladder
• recurrent urine infections due to obstruction caused by the prostate
• bleeding from the prostate due its enlargement (BPH), which may not have improved with a 5-alpha reductase inhibitor like finasteride or dutasteride
• prostate cancer ('channel TURP'): this is to allow urine to flow and is not intended to be curative

In addition, the treatment can be performed in patients who have abnormal clotting or are on drug thinners (e.g. aspirin, warfarin etc) in certain cases.

What are the advantages of a laser prostatectomy?

Urinary symptoms are reduced as much as for traditional surgery and significantly more than with the use of medication. In addition, there is shorter stay in hospital, shorter period or no catheterisation and less blood loss. There is much less bleeding, which is why the procedure can be performed on men taking aspirin.

The instrumentation for a laser prostatectomy is smaller than that used for a TURP, so, in theory, there should be a reduced chance of a urethral stricture.

Saline is used during the procedure to irrigate the area, and this is safer than the irrigation used to a TURP that can cause a rare but dangerous problem known as TUR syndrome.

How well does a laser prostatectomy work?

The GreenLight PVP works as well as TURP for small or moderate sized prostates. Providing men have bladder outlet obstruction, 9 in 10 men should experience a significant improvement in urinary symptoms after laser prostatectomy. Patients who had a catheter in should be able to pass urine with little problem.

What are the alternatives to GreenLight PVP laser prostatectomy

There are several procedures of which the most common are listed below.

• Transurethral Needle Ablation (TUNA) of the prostate: this is a less invasive procedure than laser prostatectomy, can be performed in day surgery or as an outpatient, with fewer problems and maintains normal ejaculation. Symptoms are improved after TUNA, but not quite as much as after laser prostatectomy.
• TURP: This is the gold standard treatment for BPH by which other treatments are judged. Compared to laser prostatectomy, There is more blood loss and a greater chance of needing a blood transfusion, a longer hospital stay and more post operative complication. There is less discomfort felt in the bladder and penis after this compared to laser prostatectomy and usually there is no slough to pass.
• Open prostatectomy: For this, an incision is made in the lower abdomen under general anaesthetic or when the skin is made numb from the waist down, and the prostate removed. Urinary symptoms are improved possibly slightly better than laser prostatectomy. A prolonged hospital stay is required and bleeding can occur sometimes requiring a blood transfusion. This option is reserved for very large prostates that are usually too large to be treated by one of the other options.
• Prostate stent: This is usually reserved for patients who are unsuitable for any other form of therapy. It is performed in day surgery, involves local anaesthesia, but is less effective than the other options.
• Transurethral Microwave Thermotherapy (TUMT): this is another minimally invasive option that works well in selected patients but still results in retrograde ejaculation.
  
  
  
  

Low Cost Treatment for Colon and Rectal Cancer at World's Best Cancer Hospital in India

Causes and risk factors of colon and rectal cancer

Age : – About 90 percent of people diagnosed with colon cancer are older than 50. Colon cancer can occur in younger people, but it occurs much less frequently.

A personal history of colorectal cancer or polyps : – If you’ve already had colon cancer or adenomatous polyps, you have a greater risk of colon cancer in the future.

Inflammatory intestinal conditions : – Long-standing inflammatory diseases of the colon, such as ulcerative colitis and Crohn’s disease, can increase your risk of colon cancer.

Inherited disorders that affect the colon : – Genetic syndromes passed through generations of your family can increase your risk of colon cancer. These syndromes cause only about 5 percent of all colon cancers. One genetic syndrome called familial adenomatous polyposis (FAP) is a rare disorder that causes you to develop thousands of polyps in the lining of your colon and rectum.

Whento seek medical advice

If you notice any symptoms of colon cancer, such as blood in your stool or a persistent change in bowel habits, see your doctor as soon as possible. Keep in mind that colorectal cancer can occur in younger as well as older people. If you’re at high risk, don’t wait until symptoms appear. See your doctor for regular screenings.

Talk to your doctor about when you should begin screening for colon cancer. Guidelines generally recommend colon cancer screenings begin at age 50. Your doctor may recommend more frequent or earlier screening if you have other risk factors, such as a family history of the disease.

Testsand diagnosis

Screening

Most colon cancers develop from adenomatous polyps. Screening can detect polyps before they become cancerous. Screening may also detect colon cancer in its early stages when there is a good chance for cure.

You may be embarrassed by the screening procedures, worried about discomfort or afraid of the results. Discuss your screening options and your concerns with your doctor. Most procedures are only moderately uncomfortable, and working with a doctor you like and trust can help ease your embarrassment…

Diagnosis 

If your doctor suspects you may have colon cancer based on your signs and symptoms, he or she may recommend colonoscopy to look for colon cancer. Colonoscopy allows your doctor to look for polyps or unusual areas in your colon. Your doctor can also remove a sample of tissue from your colon to look for cancer cells. In some cases, barium enema or flexible sigmoidoscopy may be used to diagnose colon cancer.

Treatments 

The type of treatment your doctor recommends will depend largely on the stage of your cancer. The three primary treatment options are: surgery, chemotherapy and radiation.

• Surgery :Surgery is the mainstay of treatment and involves in block removal of diseased segment with adequate margins, surrounding tissue and lymph nodes. The names given to such resections are right hemicolectomy, transverse colectomy, left hemicolectomy, sigmoid colectomy, and subtotal colectomy:
• Polypectomy : If the cancer is found in a polyp (a small piece of bulging tissue), the polyp is often removed during a colonoscopy.
• Local excision : If the cancer is found on the inside surface of the rectum and has not spread into the wall of the rectum, the cancer and a small amount of surrounding healthy tissue is removed.
• Resection : If the cancer has spread into the wall of the rectum, the section of the rectum with cancer and nearby healthy tissue is removed. Sometimes the tissue between the rectum and the abdominal wall is also removed. The lymph nodes near the rectum are removed and checked under a microscope for signs of cancer.
• Pelvic exenteration : If the cancer has spread to other organs near the rectum, the lower colon, rectum, and bladder are removed.
  
  
  
  

What’s new in non-small cell lung cancer treatment in India ?

Prevention

Tobacco

Prevention offers the greatest opportunity to fight lung cancer. Although decades have passed since the link between smoking and lung cancers became clear, smoking is still responsible for at least 80% of lung cancer deaths. Research is continuing on:

• Ways to help people quit smoking and stay quit through counseling, nicotine replacement, and other medicines
• Ways to convince young people to never start smoking
• Inherited differences in genes that may make some people much more likely to get lung cancer if they smoke or are exposed to someone else’s smoke

Environmental causes

Researchers also continue to look into some of the other causes of lung cancer, such as exposure to radon anddiesel exhaust. Finding new ways to limit these exposures could potentially save many more lives.

Diet, nutrition, and medicines

Researchers are looking for ways to use vitamins or medicines to prevent lung cancer in people at high risk, but so far none have been shown to conclusively reduce risk.

Some studies have suggested that a diet high in fruits and vegetables may offer some protection, but more research is needed to confirm this. While any protective effect of fruits and vegetables on lung cancer risk is likely to be much less than the increased risk from smoking,

Early detection

As mentioned in the section “Can non-small cell lung cancer be found early?”, a large clinical trial called the National Lung Screening Trial (NLST) recently found that spiral CT scans in people at high risk of lung cancer (due to smoking history) lowers the risk of death from lung cancer, when compared to chest x-rays. This finding has led to the development of screening guidelines for lung cancer.

Another approach now being studied uses newer, more sensitive tests to look for cancer cells in sputum samples. Researchers have found several changes often seen in the DNA of lung cancer cells. Current studies are looking at new tests that can spot these DNA changes to see if this approach is useful in finding lung cancers at an earlier stage.

Diagnosis

Fluorescence bronchoscopy

Also known as autofluorescence bronchoscopy, this technique may help doctors find some lung cancers earlier, when they may be easier to treat. For this test, the doctor inserts a bronchoscope through the mouth or nose and into the lungs. The end of the bronchoscope has a special fluorescent light on it, instead of a normal (white) light.

The fluorescent light causes abnormal areas in the airways to show up in a different color than healthy parts of the airway. Some of these areas might not be visible under white light, so the color difference may help doctors find these areas sooner. Some cancer centers now use this technique to look for early lung cancers, especially if there are no obvious tumors seen with normal bronchoscopy.

Virtual bronchoscopy

This imaging test uses CT scans to create detailed 3-dimensional pictures of the airways in the lungs. The images can be viewed as if the doctor were actually using a bronchoscope.

Virtual bronchoscopy has some possible advantages over standard bronchoscopy. First, it is non-invasive and doesn’t require anesthesia. It also helps doctors view some airways that might not be seen with standard bronchoscopy, such as those being blocked by a tumor. But it has some drawbacks as well. For example, it doesn’t show color changes in the airways that might indicate a problem. It also doesn’t let a doctor take samples of suspicious areas like bronchoscopy does. Still, it can be a useful tool in some situations, such as in people who might be too sick to get a standard bronchoscopy.

This test will likely become more available as the technology improves.

Electromagnetic navigation bronchoscopy

Lung tumors near the center of the chest can be biopsied during bronchoscopy, but bronchoscopes have trouble reaching the outer parts of the lungs, so tumors in that part of the lung often need to have a needle biopsy. This test can be a way to use a bronchoscope to biopsy a tumor in the outer part of the lung.

First, CT scans are used to create a virtual bronchoscopy. The abnormal area is identified, and a computer helps guide a bronchoscope to the area so that it can be biopsied. The bronchoscope used has some special attachments that allow it to reach further than a regular bronchoscope.

What are the Treatments for Lung Cancer?

Non-small Cell Lung Cancer

Surgery

Most early-stage non-small cell lung cancers are treated with surgery, in which thoracic surgeons remove a lobe, or section, of the lung containing the tumor. Dr. Yendamuri uses video-assisted thoracoscopic surgery (VATS) when possible due to its minimally-invasive nature. In a VATS procedure, Dr. Yendamuri makes a small incision in the chest and inserts a tube called a thoracoscope. The thoracoscope has a light and a tiny camera connected to a video monitor on which Dr. Yendamuri vies the lung tissue to be removed. He then removes the cancerous lung tissue through the scope, eliminating the need to make a large incision in the chest or cut the rib.

Chemotherapy & Radiation

In cases of non-small cell lung cancer where surgical removal is possible, evidence suggests chemotherapy after surgery, also called adjuvant chemotherapy, may help prevent the cancer from returning. The stage of the cancer helps doctors guide whether or not use of chemotherapy might benefit a patient with non-small cell lung cancer.

In cases in which surgical removal is not possible, doctors typically recommend chemotherapy along with radiation therapy. In very advanced cases, doctors typically use only chemotherapy but may recommend radiation therapy for palliation of cancer symptoms.

Multimodal Therapy

In an aggressive tumor like lung cancer, the best possible outcomes can only be achieved by coordinated care between all three modes of therapy. The integrated clinics at AOI enable the patient to be seen by the medical oncologist, the radiation oncologist and the surgeon, often on the same day. This enables the development of an integrated treatment plan and coordinated care.

Small Cell Lung Cancer

Surgery

In patients with limited-stage small cell lung cancer and no lymph node tumors may benefit from surgery, which is typically paired with adjuvant chemotherapy.

Chemotherapy & Radiation

For patients with small cell lung cancer, chemotherapy is an essential part of treatment. Radiation treatment may be in conjunction with it, depending on the stage of cancer. About half the cases of small cell lung cancer spread to the brain, and in those cases, radiation is often used before or after chemotherapy for lung tumors.

Multimodal Therapy

In an aggressive tumor like lung cancer, the best possible outcomes can only be achieved by coordinated care between all three modes of therapy. The integrated clinics at AOI enable the patient to be seen by the medical oncologist, the radiation oncologist and the surgeon, often on the same day. This enables the development of an integrated treatment plan and coordinated care.

What are the Risk Factors for Kidney Cancer? and Warning Signs of Kidney Cancer ?

Risk Factors for Kidney Cancer

Some people's particular habits, activities, lifestyles, or genetics make them more susceptible to certain forms of cancer. Several risk factors, below, have been identified as increasing the risk of developing kidney cancer.

Smoking and Kidney Cancer:
Cigarette smoking has been shown to double the risk of kidney cancer and contributes to as many as one-third of the cases.

Obesity, Diet and Kidney Cancer:
Obesity and a high fat diet raises the risk of kidney cancer, according to some studies.

Workplace Exposure and Kidney Cancer:
Exposure in the workplace to chemicals including petroleum products, heavy metals, cadmium (in batteries, paints, or welding materials), or asbestos can increase the risk of kidney cancer.

Certain Genes and Kidney Cancer:
Changes in certain genes (either inherited or affected by environmental factors) can increase the risk of developing kidney tumors.

Certain Disorders and Kidney Cancer:
People with disorders such as von Hippel Lindau (VHL) syndrome caused by an inherited gene mutation; polycystic disorders affecting the kidneys, liver or pancreas; or those on long-term dialysis, are at an increased risk for developing kidney cancer.

Warning Signs of Kidney Cancer

Because routine imaging tests are now relatively common in the U.S., most people with kidney cancer never experience any symptoms and are diagnosed with the disease at an early stage. If symptoms do develop, the most common one is blood in the urine. Other symptoms include: lower back pain that does not go away; a lump in the abdomen; fatigue; loss of appetite and rapid weight loss for no apparent reason; fever unrelated to a cold, flu, or other infection; swollen ankles and legs; high blood pressure; low red blood cell counts (anemia).

It is important to report any of these symptoms to your physician since kidney cancer that is found and treated early can have a higher survival rate.

Diagnosis

Patients of kidney cancer need a complete staging work up to plan the line of management. Quite often it is a multidisciplinary approach which gives best results for an individual patient. It needs good physical examination along with complete blood tests like haemogram, blood chemistry, radiological imaging like ultrasound, CT scan, and MRI scan. Histological diagnosis is to be confirmed

by FNAC/trucut biopsy.

 In the early stage (localised kidney tumour, not spread to distant organs in the body), it is managed better with radical surgery, which is curative in majority of patients.

Radiation is one more modality of treatment that is advised in a very selective group of patients.

 Kidney cancer (RCC) is considered as one of the radio resistant and chemoresistant cancers with very poor response. For advanced stage RCC, biologic therapy/immunotherapy (like Interferon/ Interleukin-2) along with chemotherapy had been used for a long time with limited benefit.

Treatment

Surgery is the main treatment for kidney cancer that hasn’t spread outside the kidney (stages 1 and 2). If the tumour is small, the surgeon will usually only remove the part of the kidney containing the tumour. But in some cases, depending on the size of the cancer, the whole kidney may need to be removed (nephrectomy). This is sometimes done using keyhole surgery.

In some situations, treatments that destroy the cancer cells using heat (radiofrequency ablation) or extreme cold (cryotherapy) can be used to treat small kidney cancers instead of an operation. There is currently no standard treatment given to reduce the risk of kidney cancer coming back after surgery (called adjuvant treatment).

Advanced Cancer

Even when the cancer has spread outside the kidney, your surgeon may still advise you to have an operation to remove the kidney. This can help to slow down and control the cancer. You’ll usually have treatment with a targeted therapy drug as well.

When kidney cancer has spread outside the kidney and to other parts of the body the main treatment is targeted therapy. Occasionally radiotherapy, chemotherapy orhormonal therapy treatment is used.