Prostate Cancer - Alternative Cancer Treatments in India

The prostate is a walnut-sized gland in the male reproductive system that helps in formation and storage of seminal fluid. The prostate gland in a male body is located in pelvis under the urinary bladder  and in front of the rectum. In simple words we can define and understand Prostate cancer as one which is mainly associated with urinary dysfunction

Prostate cancer tends to develop in men over the age of fifty and very uncommon in men younger than 45 but becomes often common with the men of advancing age. As of 2011, prostate cancer is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males worldwide.

 Signs and Symptoms:-

 Early prostate cancer usually causes no symptoms because most of the prostate cancers are slow growing however, there are cases of aggressive prostate cancers with following symptoms:-

·         Frequent urination,

·         Nocturia (increased urination at night)

·         Hematuria (blood in the urine)

·         Dysuria (painful urination)

·         Difficulty in starting and maintaining a steady stream of urine

·         Loss of weight and appetite, fatigue, nausea, or vomiting

·         Weakness or paralysis in the lower limbs

   

Diagnosis:-

• Prostate-Specific Antigen (PSA) Test : A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that's naturally produced by your prostate gland. It's normal for a small amount of PSA to be in your bloodstream but if the value increases, the cause must be located.
• Ultrasound : If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. This gives a clear picture of the prostate gland.
• Bone Scans and X-rays : It may reveal whether the cancer has invaded the bones. To perform a bone scan, doctors inject low doses of a radioactive substance into the patient's vein, which accumulates in bones that have been damaged by cancer.
• Digital Rectal Exam (DRE): During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. It helps to detect any structural anomalies in the prostate.
• Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Scans : They can further pinpoint the location of cancer that has spread beyond the prostate.
• Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist. The pathologist will check the biopsy sample to see if there are cancer cells and find out the Gleason score.

    Treatment for Prostate Cancer :-

·         Active surveillance:- It refers to the process of observation and regular monitoring and it               can be used effectively when prostate cancer is suspected in its early stage. It includes PSA blood tests and prostate biopsies.   

·         Surgery:- prostatectomy i.e Surgical removal of the prostate. It is most common mode of treatment either for early stage prostate cancer or for aggressive prostate cancer cases. It involves the two major kinds of radical prostatectomy those are radical perineal prostatectomy, and radical retropubic prostatectomy.       

·         Cryosurgery:- It is yet another method of the  treatment of prostate  cancer in which the prostate gland is exposed to freezing temperatures.

·         Radiation therapy:- It is also known as radiotherapy which is used  in the treatment of all  stages of  prostate cancer patients. There are two different kinds of radiation therapy used: external beam radiation therapy and brachytherapy . Brachytherapy involves the surgical placement of radioactive seeds or implants directly into the cancerous portions of the prostate where the radiation kills the available cancerous cells.

·   Advanced Robotic Prostate Surgery  is now preferred choice for Prostate Cancer patients due to following unmatched advantages:-

•  Minimal Bleeding
• Much quicker recovery
• Reduced hospital stay
• Lesser pain killer requirements
• Improved preservation of physical appearance
• Three (3) D vision enables surgeon to perform Prostate excision with Cancer
• Control without risk of Post Surgery Continence (control over urinary and fecal discharge) and causing Impotency

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Blood Cancer Treatment‎ : Bone marrow transplant procedure in India

How the Bone Marrow Functions

Bone marrow is the soft, spongy center of your bone where blood is produced. Marrow is filled with blood-producing cells, called stem cells, which develop into mature white blood cells, red blood cells or platelets. White blood cells of various kinds make up part of your immune system for fighting infections.Red blood cells are responsible for carrying oxygen throughout your body.Platelets clot your blood to prevent bleeding. Stem cells are constantly being produced by your bone marrow, and will develop into the types of cells your body needs.

Types of Bone Marrow Transplants

Most people who need to undergo a bone marrow transplant have cancer, such as leukemia or lymphoma. There are different types of bone marrow transplants. The type and severity of your disease determine what type of bone marrow transplant you will need.

Allogeneic Bone Marrow Transplants

An allogeneic bone marrow transplant involves receiving donor bone marrow or peripheral stem cells. This bone marrow transplant donor is genetically matched and can be related or unrelated to you. An autologous transplant involves receiving your own bone marrow or peripheral stem cells. A syngeneic bone marrow transplant involves receiving your identical twin's bone marrow or peripheral stem cells.

Allogeneic Transplants

An allogeneic bone marrow transplant involves receiving very high-doses of chemotherapy and/or radiation therapy, followed by the infusion of your donor's bone marrow or peripheral stem cells. The high-dose cancer fighting treatments are given to eliminate the cancer in your body. The infusion of the new marrow or peripheral stem cells during an allogeneic bone marrow transplant replaces the bone marrow destroyed by the chemotherapy and/or radiation therapy.

You may be a potential candidate for an allogeneic bone marrow transplant if you have leukemia, aplastic anemia, myelodysplasia, myelofibrosis, high-grade lymphoma or other types of cancers.

A non-myeloablative (“mini”) allogeneic bone marrow transplant involves receiving low-doses of chemotherapy and radiation therapy followed by the infusion of your donor's bone marrow or peripheral stem cells. The objective of the bone marrow transplant is to suppress your own bone marrow by receiving just enough chemotherapy and radiation therapy to allow your donor cells to engraft and grow within you. The hope is these donor cells will mount an immunologic attack against your underlying cancer, generating a response called the "graft-versus-leukemia" effect or “graftversus- cancer” effect.

You may be a potential candidate for a mini allogeneic transplant if you have a slow growing, indolent disorder, such as chronic leukemia, multiple myeloma, myelodysplasia, low-grade lymphoma, and in some cases, renal cell carcinoma. The mini allogeneic transplant is not appropriate, for example, if you have fast-growing acute leukemia.

Autologous Bone Marrow Transplants

An autologous bone marrow transplant involves receiving very high-dose chemotherapy followed by the infusion of your previously-collected peripheral stem cells or bone marrow.

The high-dose chemotherapy treatments are given to eliminate the cancer in your body. The infusion of your new marrow through a bone marrow transplant or peripheral stem cells replaces the bone marrow destroyed by the chemotherapy and/or radiation therapy.You may be a potential candidate for an autologous bone marrow transplant if you have lymphoma, multiple myeloma, Hodgkin's disease, germ cell cancer, breast cancer or certain types of leukemia.

Bone marrow transplant procedure in India

Bone marrow transplant procedure in India comprises two major activities: the harvesting of the stem cells and the transplantation of the stem cells.

The procedure for harvesting stem cells is the same for both autologous and allogenic bone marrow transplants in India. Under general anaesthesia, bone marrow is extracted from major bone structure is such as the hip and the spine. There are no surgical incisions, just skin punctures to insert the needles. The harvested stem cells may need to be processed to make them fit for transplantation.

 In the second phase, the actual transplantation procedure is performed. All hospitals that perform bone marrow transplant procedure in India have a special and segregated bone marrow transplant unit which is highly sterile. This is because bone marrow transplant patients are susceptible to infections on account of lower levels of immunity.

Prior to the procedure, catheters are inserted to allow administration of drugs, nutrition etc. Patients would receive medications such as antibiotics and antivirus to prevent as well as to treat infections of any kind. Patients scheduled for allogenic transplant will also receive special medications to prevent rejection of the donor cells by the patients immune system.

Healthy stem cells are introduced into the body through the bloodstream, and no surgery is normally necessary. The stem cells upon reaching the bone marrow, engraft there and after a couple of weeks commence production of normal blood cells.

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India's leading Cancer hospitals now have some of the world's moset advanced radiation equipment : Pancreatic Cancer

Pancreatic Cancer

The pancreas is in the upper abdomen and lies behind the stomach and intestines (guts). The shape of the pancreas is like a tadpole, and so the pancreas has a 'head', a 'body' and a 'tail'. The head section is nearest to the duodenum (the part of the gut just after the stomach). The pancreas makes a fluid that contains enzymes (chemicals) that are needed to digest food. The enzymes are made in the pancreatic cells and are passed into tiny ducts (tubes). These ducts join together like branches of a tree to form the main pancreatic duct. This drains the enzyme-rich fluid into the duodenum. The enzymes are in an inactive form in the pancreas (otherwise they would digest the pancreas). They are 'activated' in the duodenum to digest food.

Symptoms of Pancreatic Cancer 

In most of the cases the tumour first develops in the head of the pancreas and it tends to block the bile duct. This stops the flow of bile into the duodenum which leads to :

• Jaundice (yellow skin caused by bile seeping into the bloodstream due to the blockage).
• Dark urine - caused by the jaundiced blood being filtered by the kidneys.
• Pale faeces - as the faeces contain no bile which causes their normal brown colour.
• Pain is often not a feature at first. Therefore a 'painless jaundice' that becomes worse is often the first sign of pancreatic cancer. Nausea and vomiting are also fairly common symptoms..
• Pain in the upper abdomen. Pain can also pass through to the back.

Diagnosis Of Pancreatic Cancer 

The initial tests revolve around the symptoms of Jaundice to confirm if its because of blocked gallstone or hepatitis (liver inflammation) or if the cause of jaundice is a blockage from the head of the pancreas..

• CT scan (computerised tomography) is a commonly used test to assess pancreatic cancer. It is a specialised X-ray test that can give quite clear pictures of the inside of your body.

• MRI scan is sometimes done. MRI stands for magnetic resonance imaging. An MRI scan uses a strong magnetic field and radio waves to create pictures on a computer of tissues, organs and other structures inside your body.

• Endoscopic ultrasound (EUS). An endoscope (gastroscope) is a thin, flexible, telescope. It is passed through the mouth, into the oesophagus and stomach and on into the duodenum. The endoscope contains fibre optic channels which allows light to shine down so the doctor or nurse can see inside. Some endoscopes are fitted with a tiny ultrasound scanner at their tip which can obtain pictures of structures behind the gut such as the pancreas.
• Endoscopic retrograde Cholangiopancreatography (ERCP): a test that uses a flexible scope inserted through the nose, stomach, and into the pancreas and may be used to introduce a dye for X-rays or to place a stent (a metal or plastic tube that can help keep a duct open and functioning)

• Magnetic resonance cholangiopancreatography (MRCP): a type of MRI that is used to see the pancreas, its ducts, and the bile ducts more clearly, often used before or instead of ERCP.

                                             

Treatment of Pancreatic Cancer 

Surgery - One of the following types of surgery may be used to take out the tumor:

Whipple procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Care is taken to preserve pancreas to produce digestive juices and insulin.

Total Pancreatectomy: This surgery removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen and nearby lymph nodes.

Distal Pancreatectomy: The body and the tail of the pancreas and usually the spleen are removed. If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms:

Surgical Biliary Bypass: If cancer is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area.

Endoscopic Stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.

Gastric Bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body

Radiation therapy

India's leading Cancer hospitals now have some of the world's moset advanced radiation equipment like Linac, Novelis, Gamma Knife and Cyberknife for treating Pancreatic Cancers. High technology radiation is used to kill cancer cells without affecting the healthy tissues

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Stomach Cancer Treatment at Best Cancer Hospitals in India

Stomach cancer

Stomach cancer is sometimes called gastric cancer. Worldwide it is one of the most common cancers. Stomach cancer is more common in men than in women and ten/ds to occur mainly in older people. Most people who develop stomach cancer are over the age of 55.

In most cases, stomach cancer begins from a cell which is on the inside lining of the stomach (the mucosa). This type of stomach cancer is called adenocarcinoma of the stomach. As the cancer cells multiply :

• The tumour may invade deeper into the wall of the stomach. In time, it may pass through the wall of the stomach and invade nearby organs such as the pancreas or liver.
• The tumour may spread up or down the stomach into the oesophagus (gullet) or small intestine.
• Some cells may break off into the lymph channels or bloodstream. The cancer may then spread to nearby lymph nodes or spread to other areas of the body (metastasise).

Types of Stomach Cancer

• Adenocarcinoma : is the most common type of stomach cancer. More than 95 out of every 100 stomach cancers (95%) diagnosed are adenocarcinomas. The cancer starts in the gland cells in the stomach lining. The gland cells produce mucus and stomach juices.
• Squamous : cells are the skin like cells that lie between gland cells to make the stomach lining. These cancers are treated in the same way as adenocarcinomas.
• Lymphoma : is another type of cancer altogether. It is very rare. There is a whole section on non Hodgkin's lymphoma, which will be more relevant to you if you have been diagnosed with lymphoma of the stomach.
• Gastrointestinal Stromal Tumour GISTs : can be cancerous or non cancerous (benign). These rare tumours develop from the cells of the connective tissue that support the organs of the digestive (gastrointestinal) tract. Most are found in the stomach.
• Neuroendocrine tumours (NETs) : can be cancerous or non cancerous. They grow in hormone producing tissues, usually in the digestive system. They are rare, but the most common is carcinoid tumour.

Diagnosis of Stomach Cancer

If you have symptoms that suggest stomach cancer, your doctor will check to see whether they are due to cancer or to some other cause. Your doctor may refer you to a gastroenterologist, a doctor whose specialty is diagnosing and treating digestive problems. Your doctor will ask about your personal and family health history. You may have blood or other lab tests. You also may have :

• Physical exam : oncologist feels the abdomen of the patient for fluid, swelling, or other changes. They also will check for swollen lymph nodes.
• Endoscopy : Surgical Oncologist uses a thin, lighted tube (endoscope) to look into the stomach after numbing the throat with an anesthetic spray. Patient may be given medicine to help him relax. The tube is passed through the mouth and esophagus (food pipe) to the stomach.
• Biopsy : An endoscope has a tool for removing tissues. Surgical Oncologist uses the endoscope to remove tissue from the stomach. A pathologist checks the tissue under a microscope for cancer cells. A biopsy is the only sure way to know if cancer cells are present.

Stages of Stomach Cancer

• Stage 0 (Carcinoma in situ): In this stage, cancer is present in the inner lining of the mucosal layer of the wall of the stomach.
• Stage I : This stage is categorized into two stages- IA and IB that also depends on the spread of the cancer.
  • Stage IA : Here in this stage, the cancer has spread completely from the mucosal layer of the wall of the stomach.
  • Stage IB : Cancer has spread to the muscularis layer of the stomach wall or has completely spread from the mucosal layer of the stomach wall that can be found in almost 6 lymph nodes surrounding the tumor.
• Stage II : In this stage, the cancer has spread –
  • To the serosal layer of the wall of the stomach but not to other organs or to lymph nodes
  • To the middle layer of the stomach wall and can be found in almost 6 lymph nodes surrounding the tumor, or
  • From the innermost layer of the wall of the stomach and can be found in 7-15 lymph nodes surrounding the tumor
• Stage III : This stage is categorized into IIIA and IIIB that depend on the spread of the cancer. In stage IIIA, cancer has spread to –
  • Organs just next to the stomach that has not spread to other body parts or to lymph nodes
  • The middle layer of the wall of the stomach and can be found in 7-15 lymph nodes surrounding the tumor, or
  • The outermost layer (serosal) of the wall of the stomach and can be found in 1-6lymph nodes surrounding the tumor
• Stage IV : Here in this stage, the cancer has spread to –
  • Different body parts
  • Organs just next to the stomach and to at least 1 lymph node, or
  • More than 15 lymph nodes

Most Advanced Stomach Cancer Surgery and Treatment in India

Surgery

The goal of surgery is to remove all of the stomach cancer and a margin of healthy tissue, when possible. Options include :

• Removing a Portion of the Stomach (Subtotal Gastrectomy). During subtotal Gastrectomy, the surgeon removes only the portion of the stomach affected by cancer. Subtotal gastrectomy can be of two types :
  • Distal subtotal gastrectomy is performed if the tumor cells are present in the lower part of the stomach near to the stomach duodenum junction.
  • Proximal subtotal gastrectomy is done when the tumor is situated in the upper part of the stomach and also involves the esophagus.
• Removing the Entire Stomach (Total Gastrectomy). Total Gastrectomy involves removing the entire stomach and some surrounding tissue. The esophagus is then connected directly to the small intestine to allow food to move through your digestive system.
• Removing Lymph nodes to look for Cancer. The surgeon examines and removes lymph nodes in your abdomen to look for cancer cells.

MedWorld India Affiliated Hospitals in India the Leading Destination for Bone Marrow Transplant

Bone Marrow Transplant at World Best Hospitals in India

A large number of foreign patients now come to India for Live Related Organ Transplant Surgery like Kidney Transplants, Liver Transplants and Bone Marrow Transplants. Organ Transplantation is a very complex surgical specialty and requires very high degree of Clinical skills and Medical Technology and Infrastructure. India has now become the most preferred destination for organ transplant procedures. These include Liver, Kidney and Bone marrow transplant surgeries. .Not only the cost is low; the success rate of organ transplant in India is at par with the world's best success rate for organ transplant.

Since Organ Transplantation is a very complex surgical specialty and requires very high degree of Clinical skills and Medical Technology, and Indian surgeons and healthcare has proven its competence, there has been a great surge in the number of medical tourists coming to India for various organ transplants. The Infrastructure and technology used at these best organ transplant hospitals in India is the most sophisticated technology available in the world, which results in better patient recovery, higher success rate, low cost and convenience to the patient.

Bone Marrow Transplant

Stem cells produce red blood cells, white blood cells, and platelets. In some cases, stem cells in your bone marrow may not be functioning well or need to be destroyed to help treat a disease. If this happens, you will need new stem cells.
During this procedure, healthy stem cells are taken from a donor's:

·         Bone marrow (bone marrow transplant or BMT)

·         Blood (peripheral blood stem cell or PBSC)

The stem cells will be injected into your vein. The new cells travel through the bloodstream to your bone cavities. It may take about a month for the donor stem cells in the bone marrow to begin to function fully. If the transplant is successful, new bone marrow cells will produce healthy red blood cells, white blood cells, and platelets.

Stem cell transplantation may be done using:

·         Stem cells that were taken from your own bone marrow or blood and stored

·         Stem cells from a donor

How Bone Marrow Transplant would be done... 

Prior to procedure the donor will be carefully tested to check for diseases. Both you and the donor will be tested to ensure that your tissues are compatible. In order for the transplant to be successful, certain markers, called HLS types, on the blood cells and bone marrow cells must match.

As the recipient, you will be given medicines to suppress your immune system. This is to prevent your body from rejecting the donor stem cells. In the weeks prior to the transplant, you may have to have:

·         Chemotherapy

·         Radiation therapy

This process is called "conditioning." It will rid the body of diseased cells and clear the bone marrow cavities for the new bone marrow.

If the stem cells will be from the donor's bone marrow (BMT), the       doctor will clean an area of the donor's hip. A hollow needle and     syringe will be used to remove the bone marrow.The doctor will make several small punctures. This is to harvest enough bone marrow for the transplant (1-2 quarts). Lastly, the wounds will be covered with bandages.
If the stem cells will be from the donor's blood (PBSC), the doctor will stick a needle in the donor's large vein or veins in the arms. A machine will receive blood from the vein. This machine will spin the blood so that the stem cells are concentrated. The rest of the blood will be given back to the donor. The doctor will cover the puncture wounds with bandages. This procedure may require more than one blood donation. The donor may also be required to take pills that cause more stem cells from the bone marrow to go into the blood.

The donated stem cells will be filtered. Next, the doctor will administer the cells through a small, flexible tube, called a catheter, into one of your large veins.

Immediately after procedure the donor will recover quickly. You, the recipient, will be placed in isolation. This is to avoid infection until the new stem cells in the bone marrow begin to produce infection-fighting cells.

Recovery

The new bone marrow normally takes almost a year in order to function normally. During this period the patient is to be monitored closely to identify any infections or complications that may develop. The recovery process continues for several months or longer after discharging from the hospital, during which time the patient cannot return to work or many previously enjoyed activities.

MedWorld India Affiliated Hospitals in India the Leading Destination for Organ Transplant Surgery

·         Indian doctors are known all over the world for their skill and knowledge and have the experience of studying and working at the best hospitals in the world.

·         India's leading liver transplant centre conducts perhaps the world's highest number of liver transplants (16 to 18 every month).

·         The hospital has a special centre for liver diseases amongst children and liver transplants for children . Highly skilled surgical teams with vast experience and excellent track record of doing largest numbers of Live related donor kidney and liver transplants with survival rates comparable to world's best centers.

·         Most advanced Technology Infrastructure - Blood Bank with 24 hour apharesis facility, advanced laboratory and microbiology (infection control) support, advanced cardiology, DSA and interventionalradiology, portable and colour ultra-sonology, Liver Fibro-scan, 64 slice CT scanner, 3 T MRI, PET-CT and nephrology (including 24 hour dialysis and CVVHD) facilities. Organ Transplant Hospitals in India are now equipped with the latest and high end technology.

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