Surgery: Archives

Cancer May 4, 2021

Oral Cancer: Symptoms, Diagnosis And Treatment Options

Cancer is a disease in which cells divide and multiply uncontrollably, invading nearby tissues and organs. This happens when mutations are caused in the genes that control the growth of the cells. Cancer occurs when the cells grow uncontrollably, collectively forming a mass of tissue called a tumor. These tumors can either be cancerous or non-cancerous.

Oral cancer, also known as mouth cancer or oral cavity cancer, falls under a category of cancers called Head and Neck Cancers. Oral cancer occurs when there is a cancerous growth in the mouth or the oral cavity. Oral cancer usually occurs in the lips, tongues, cheeks, throat, hard and soft palate, the roof of the mouth, and on the floor of the mouth (under the tongue). People above the age of 40 are more susceptible to oral cancer.

Oral cancer usually begins in the squamous cells (flat, thin cells in the lining of the lips and inside the mouth). A majority of oral cancers are diagnosed to be Squamous Cell Carcinoma.

What are the Symptoms of Oral Cancer?

The diagnosis and treatment of oral cancer would be easier if one is aware of the symptoms and the signs of oral cancer. Some of the most common symptoms of oral cancer are:

A sore in the mouth or on the lip that doesn’t heal for a long time
Mass or lumpy growth anywhere in the mouth
A white or reddish patch inside the mouth
Unexplained bleeding
Loose teeth
Pain or difficulty in swallowing
Earache
Mouth ache
A lump in the neck
Numbness/tenderness in any area of the mouth, face, or neck
Sore throat
Stiffness or pain in the jaw
Drastic weight loss

Looking out for these symptoms and getting them checked immediately would help in effectively treating oral cancer. It is important to make an appointment with your doctor or dentist if you have one or more of these symptoms. Some of these symptoms may indicate another condition/disease/illness apart from oral cancer. Your doctor will look into the symptoms and rule out every other possibility before recommending tests for oral cancer.

How is Oral Cancer Diagnosed?

There are several procedures involved in diagnosing Oral Cancer. The first step is to gauge the reason behind the symptoms to rule out other underlying conditions and ensure that the symptoms are due to oral cancer. Once the patient has been diagnosed with oral cancer, the doctor might perform a further diagnosis to determine the type of cancer – invasive/non-invasive and the extent to which it has spread. Some of the tests and procedures used to diagnose oral cancer include:

Physical Exam: Your doctor will closely examine your lips and mouth to check for abnormalities, especially the roof and floor of your mouth, the back of your throat, your tongue, gums, cheeks, and the lymph nodes on the neck.

Biopsy: In case of a suspicious/infected area in the mouth, your doctor may take a sample of your tissue using a cutting tool or a needle for laboratory testing. This procedure is known as a biopsy.

Once the patient is diagnosed with oral cancer, the doctor will determine the extent (stage) of oral cancer, and how much it has spread. To determine this, the doctor may turn to one of these procedures:

Endoscopy: During this procedure, the doctor may insert a small camera with a light attached to a tube down your throat to determine how cancer has spread beyond the mouth.

X-Ray: The doctor might also suggest an x-ray to check if the cancerous cells have spread to the chest or lungs.

CT scan: The Computed Tomography (CT) scan is an imaging technique that uses a series of x-ray images to get detailed images of the body. The CT scan helps reveal any tumors in the mouth, throat, neck, and lungs.

PET scan: The Positron Emission Tomography (PET) scan is an imaging technique that uses a special dye that contains radioactive tracers. This is to determine if cancer has traveled to the lymph nodes or other organs.

MRI scan: Magnetic Resonance Imaging (MRI) uses a large magnet to generate images of the body using radio waves. This method also helps to determine the extent to which cancer has spread.

Once diagnosed, Oral cancer is determined in 4 stages.

Stage I: Where the tumor is 2cm or smaller and cancer hasn’t spread to the lymph nodes.

Stage II: Where the tumor is between 2-4cm, and cancer hasn’t spread to the lymph nodes.

Stage III: Where the tumor is larger than 4cm but hasn’t spread to the lymph nodes; or tumor is of any size but has spread to one lymph node.

Stage IV: Where the tumors are in any size and the cancerous cells have spread to the lymph nodes, nearby tissues, and other organs.

Oral Cancer Treatment

Depending on the location, stage, and nature of oral cancer, the treatment options will differ. Based on the analysis of your doctor, you may have to undergo one form of treatment or a combination of cancer treatments. Some of the most common and effective treatment options are:

Surgery: If the cancer is in an early stage, the surgeon may cut off the tumor and a margin of the healthy tissues that surround that area to ensure that all the cancerous cells have been removed. Minor surgery is required for small cancerous cells, but, larger tumors require an extensive procedure.

Radiation Therapy: This therapy uses high-energy radiation beams at the tumor. If the cancer is in an advanced stage, the doctor might use a combination of chemotherapy and radiation therapy.

Chemotherapy: This treatment uses chemicals/drugs to kills cancerous cells. The drug is usually administered through an Intravenous (IV) line or orally.

Targeted Therapy: This therapy treats mouth cancer by altering specific aspects of the cancerous cells that interfere with their growth.

Immunotherapy: This treatment uses your immune system to fight cancer cells. Cancerous cells produce proteins that bind the cells in the immune system. This therapy works by interfering with that process.

Though there are several treatment options to treat oral cancer, the best way to fight it would be by reducing the risk and following a healthy oral regimen. Early detection is the key to fight any disease. So be aware of the symptoms and check with your doctor as soon as you see any signs that may develop into oral cancer.

Cancer May 4, 2021

Lung cancer: Types and risk factors

The term cancer can be overwhelming for the majority of people. It can be physically as well as emotionally too much to take in for an individual along with people around them. Hence understanding cancer is very important because having the right information can lead to taking steps at the right time to cut down your risk of cancer. Cancer is a name given to a collection of diseases that are related. It causes body cells to divide rapidly and in some cases can also affect the surrounding tissues. The rapid creation of abnormal cells that grow beyond their boundaries is one of the most defining features of cancer, which can then invade other parts of the body; this process is referred to as Metastasis. The primary cause of death in cancer is Metastases.

Due to advanced technology and medicine, the treatments are constantly improving. With proper diagnosis and treatment, many cancers have a high cure rate. Between 30-50 % of cancer cases can be prevented by avoiding the risk factors and implementing existing prevention strategies.

Cancer is the leading cause of death in the world. After breast cancer, Lung cancer is the second most common type of cancer in the world. It is also one of the most common causes of cancer death in the year 2020. According to World Health organization Statistics, there were 2.21 million cases in 2020 worldwide in which there was 1.80 million death.

What is Lung cancer?

The two sponge-like organs in the chest are called lungs. The right lung has three sections called upper, middle, and lower lobes. The left lung has two lobes upper and lower lobes, left lung is smaller because the heart takes up more space on that side of the body. When we breathe, through the trachea (windpipe) the air inhaled goes into the lungs. The Trachea divides into tubes called Bronchi, which enters the lungs and is further divided into smaller Bronchi called Bronchioles. At the end of the Bronchioles, there are tiny sacs called alveoli. The main function of Alveoli is absorbing oxygen into the blood and removing carbon dioxide from the blood when you exhale.

Lung cancer can start in any part of the lungs or airways which includes the windpipe the main airway or the lungs themselves. When there is an uncontrolled growth of abnormal cells inside one or both lungs the cells grow to form a tumor.

The major risk factor for lung cancer is smoking though not everyone who develops lung cancer has a history of smoking. Lung cancer can be fatal but with proper diagnosis and treatment, the outlook to it could differ.

Types of Lung cancer

Cancer that starts growing in the lungs is called primary lung cancer. If cancer spreads from other parts of your body to the lungs is called Secondary lung cancer.

There are 2 types of Primary lung cancer:

Small cell lung cancer (SCLC)
Non-small cell lung cancer (NSCLC)

Small cell lung cancer

Small cell lung cancer is a fast-growing and more aggressive form of lung cancer. Cancer grows and spreads rapidly traveling to other parts of the body or metastasize more easily. Due to this, the condition is usually diagnosed after cancer has spread throughout the body, making recovery doubtful. But if it is detected in an early stage it may be treated effectively before cancer spreads.

Symptoms for Small cell lung cancer

SCLC is usually asymptomatic which means it doesn’t show symptoms. Once there are visible symptoms it often indicates that cancer has started growing and has infected other parts of the body.

Symptoms are:

Wheezing
Shortness of breath
Bloody mucus for the lungs
Fatigue
Weight loss
A persistent cough

If you notice any symptom connect to a doctor immediately.

Non-small cell lung cancer

It is the most common and less aggressive than Small cell lung cancer which means it doesn’t spread and grow rapidly.

NSCLC can be treated successfully with surgery, chemotherapy, and other treatments.

Smoking is the leading cause of NSCLC and other types of cancer.

Symptoms for Non-small cell lung cancer

Hoariness
Fatigue
Coughing up phlegm or mucus
Chest pain
Shortness of breath
Cough

You need to note that some of these symptoms may occur due to other reasons as well.

Risk factors for lung cancer

Anything that increases a person’s chance of getting cancer is classified as a risk factor. Some risk factors can be changed like smoking, but others like family history or a person’s age cannot be changed.

Some of the risk factors are:

Smoking- Smoking remains the number one reason for developing lung cancer. The longer you smoke greater the risk.
Passive smoking: If you are a non-smoker who hangs out with people who smoke, you are still at risk of developing lung cancer.
Air pollution: Air pollution raises the risk of lung cancer especially in cities.
Personal or family history: If you had relatives who suffered from lung cancer then the probability of you developing it increases.
Exposure to Radon: A naturally occurring radioactive gas that results from the breakdown of uranium in soil and rocks is Radon. Breathing it in can expose you to a small amount of radiation.

We should be careful and consider all these risk factors to reduce the chances of developing lung cancer.

Coping with a cancer diagnosis can be stressful and difficult. Learn about your condition and treatment by talking to your doctor about it. Online resources can also be useful to understand and gain a sense of control over the situation.

Lung cancer can be fatal but early diagnosis often have a good chance of survival. People who are at high risk of developing lung cancer should consider getting regular screenings. People who are concerned with the risk factor should talk to a healthcare professional.

Knee Replacement April 28, 2021

Robotic Knee Replacement: The Future of Knee Surgery

Knee Replacement Surgery is a surgical procedure to reverse knee damage caused by a disease or condition such as arthritis. Also known as arthroplasty or total knee replacement, this procedure involves cutting away the damaged bone and cartilage from the lower end of thighbone and an upper end of shinbone and replacing it with an artificial joint made of metal and plastic polymer.

Overview

For those who have severe knee trauma or knee joint conditions, your doctor might suggest a knee replacement surgery as an option to lead a pain-free life. This surgical procedure may be considered for someone with severe arthritis or knee trauma. The goal of knee replacement surgery is to repair the damage caused to the knee joint and relieve the pain when other forms of treatment such as medications do not work.

Knee replacement surgery is a common treatment for Osteoarthritis. When a patient is diagnosed with osteoarthritis, there is a breakdown of joint cartilage. If the cartilage suffers damage, movement becomes restricted and causes immense pain. People with osteoarthritis experience difficulties in performing day-to-day activities such as walking, climbing the stairs, or bending. These activities might strain the knee, causing it to swell or dislocate, as the knee joint is not stable. Another condition that may require knee replacement surgery is Rheumatoid Arthritis. Performed during an advanced stage, Total Knee Replacement has proven to be the most successful procedure that relieves the person from unremitting pain and deformity. With the advancement in science and technology, the medical fraternity has moved from traditional knee replacement surgery to robotic knee replacement surgery. Following is the detailed information on Robotic Knee Replacement Surgery.

What is Robotic Knee Replacement Surgery?

Severe joint conditions such as Arthritis may not have a complete cure yet. But the treatment methods are getting better and the long-term relief factor is improving as well. In traditional knee replacement surgery, the damaged part of the bone is removed and replaced with an artificial joint implant. Robotic knee replacement surgery is not carried out by a robot on its own (a common misconception due to its name). In this procedure, the same process of the traditional knee replacement surgery is carried out, but with the assistance of a robotic arm. This is the ideal treatment for patients suffering from severe knee pain, as the robotic knee replacement surgery offers long-lasting relief with maximum effectiveness.

When can you undergo robotic knee replacement surgery?

If you are eligible to undergo a traditional knee replacement surgery, then you are also eligible for a robotic knee replacement surgery. But, before you go in for the robotic knee replacement surgery, take the opinion of your doctor. For conditions like osteoarthritis and rheumatoid arthritis, your doctor might prescribe other forms of treatment before suggesting the surgery. Depending upon the severity of your condition and pain, they may recommend less invasive methods such as:

Anti-inflammatory medications
Pain killers
Limiting strenuous physical activities
Weight loss
Healthy diet
Physical therapy
Cortisone injections
Devices to assist walking (cane/walker)
Viscosupplementation injection (to make joint movements less painful)

If you do not get relief through these treatments, your doctor will suggest a knee replacement surgery.

How does the robotic knee replacement procedure take place?

As mentioned above, the procedure is assisted by a robotic arm, while the orthopedic surgeon controls it. The traditional method involves the surgeon manually removing the damaged bone and cartilage, replacing it with an artificial joint. However, the robotic arm in this method helps the surgeon in performing knee replacement surgery with utmost precision.

Before the surgery, a CT is taken, through which a 3D model of the patient’s knee is created. This allows the surgeon to be more accurate while planning for the surgery and thus executing it further inside OT. As per the plan approved by surgeon, the robotic arm performs a series of tasks such as bone registration, bone resection, intra-operative monitoring followed by implant positioning. During the surgery, the robotic arm works in a predefined space by the surgeon during 3D pre-planning, ensuring maximum bone cutting precision and safety as the surrounding tissues are not damaged.

What are the benefits of Robotic Knee Replacement Surgery?

Since this technique is quite new, the long-term benefits of robotic knee replacement surgery are yet to be determined. But, the short-term benefits of robotic knee replacement surgery are plenty and quite promising.

Reduced recovery time: In a traditional knee replacement surgery, an average patient won’t be able to resume physical activities such as walking, driving, or any strenuous activity until 4 – 6 weeks. But with robotic knee replacement surgery, this time is reduced by half. This is due to the comparatively lesser invasive nature of this procedure, involving smaller incisions and great precision, which ensures that there is lesser bone trauma and the nearby tissues aren’t damaged.

Fewer complications: Patients who undergo robotic knee replacement surgery tend to have fewer complications as compared to those who undergo traditional knee replacement surgery. The minimally invasive nature of this surgery ensures lower chances of infection, so that the patient does not have to take another trip to the hospital.

Lower joint awareness: After the completion of the knee replacement surgery and the associated resting period, you should be able to go about your daily tasks without any hindrance. But, for many patients, these day-to-day tasks might be difficult as they may trigger Joint awareness in the form of stiffness, numbness, or pain. Improved accuracy of the robotic knee replacement surgery, reduces the possibility of joint awareness and relieves pain.

Even though robotic knee replacement surgery is a relatively new procedure to treat arthritis and knee trauma, it has been proven to give better results as compared to the traditional procedure. According to studies, robotic knee replacement surgery offers more accuracy, and its less invasive nature prevents damage to the surrounding areas resulting in lesser blood loss and faster recovery. But before you zero down on your final treatment option, consult with your doctor/healthcare provider and analyze the pros and cons of this treatment method to see if it is ideal for your condition.

Cancer April 23, 2021

Breast Cancer: Types And Its Diagnosis

Cancer is usually caused due to the mutations that take place in the genes that regulate cell growth, leading the cells to divide and multiply uncontrollably. Breast cancer, as the name itself suggests, develops in the breast cells. As per reports, the number of cases of breast cancer in India is on the rise. More than 50% of Indian women suffer from stage 3 or stage 4 breast cancer. Thus, survival becomes difficult at later stages. But the good news is that we can come together and make people aware of the symptoms and help them take precautions about the same. But first, let us understand what breast cancer is.

In breast cancer, usually, the tumors are formed in the ducts or the lobules of the breast. These cancerous cells invade the other healthy tissues and travel to the lymph nodes, leading to the spread of tumors to the other parts of the body.

There are several types of breast cancer but are mainly classified into two categories; “invasive” and “non-invasive”. Invasive breast cancer spreads from the breast cells to other glands and parts of the body, while non-invasive breast cancer does not spread. The different types of breast cancer are as follows:

Ductal Carcinoma in Situ (DCIS): This type of breast cancer is non-invasive. In this condition, the cancerous cells are confined to the ducts in the breasts and have not spread to the nearby cells and tissues.
Lobular Carcinoma in Situ (LCIS): This cancer grows in the lobules of the breast. Lobules are the milk-producing glands in the breast. This condition is also non-invasive and does not spread to the nearby tissues
Invasive Ductal Carcinoma (IDC): This the most common type of breast cancer found in people. It develops in the ducts (tube-like structures that carry milk to the nipples) and invades the nearby tissues.
Invasive Lobular Carcinoma (ILC): Like IDC, this type of breast cancer is also invasive. It develops in the lobules of the breast and spreads to the nearby tissues.

The Symptoms of Breast Cancer may not be visible at an early stage. Because, at an early stage, a tumor might be too small to be felt. Different types of breast cancer have different symptoms, but the most common symptoms of breast cancer are:

A lump or thickening in the breast
Pain in the breast
Red, pitted skin over the breast
Peeling or crusting of the pigmented skin around the nipple area
A fluid discharge from the nipple apart from breast milk
Discharge of blood from the nipple
A sudden change in the shape or size of the breast
Inverted nipple

How can one detect breast cancer at an early stage?

Certain symptoms can either be caused by breast cancer or a benign breast condition. To determine if it is breast cancer, you may have to undergo diagnostic tests along with a physical examination of the breast. Some tests that can help diagnose breast cancer are:

Breast Examination: This doctor will physically examine your breast and the lymph nodes in your armpits to detect any signs of breast cancer.

Mammography: This is the most common test that is used to diagnose breast cancer. A mammogram refers to the x-ray of the breast. It is advisable for women of age 40 and above to have an annual mammography screening.

Breast Ultrasound: An ultrasound uses sound waves to create an image of the tissues located deep in the breast. An ultrasound can also help distinguish between a tumor and a benign cyst.

Breast Biopsy: A biopsy is one of the most definitive ways to diagnose breast cancer. A sample of your breast tissues will be removed for testing.

What are the immediate measures one can take after being diagnosed with breast cancer?

Knowing that you’ve been diagnosed with breast cancer can be extremely overwhelming. Your next question might probably be “What now?” Here are a few immediate measures that you can take after you’ve been diagnosed with breast cancer.

Understand your diagnosis: While the term Breast Cancer is easy enough to understand, there different types that require different treatment. Talk to your doctor and understand the type of tumor, the cancer stage, and how much it has spread. This will help you in further research and also in making an informed decision.

Decide how much you want to know: Though most cancer patients would like to know everything about their condition and the exact chances of survival, some don’t. If you do not prefer to know all the details, you can let your doctor know. You can also seek the help of a trusted family member or a friend to come along with you to the consultation for support.

Explore your treatment options: Depending on the type and stage of cancer, there are various treatment options for you to consider. You can do your research and make your own decisions on the treatment or you can leave it to your doctor to suggest the right treatment for you.

Analyze the risks and benefits involved in the treatment: After understanding your treatment options, it is very important to weigh the pros and cons of each treatment option before you finalize one. You must consider parameters such as side effects and financial costs. You must also consider how treatment might affect your everyday life and take the necessary steps.

Although the cases of breast cancer have been increasing in women, there is always a way to prevent it. Keeping your eyes open for minor symptoms, sharing all the credible knowledge with your loved ones, and building a strong immune system are some of the measures that can be taken into consideration. Last but not the least, having a positive outlook can do wonders!

Aortic Stenosis/TAVR/TAVI April 19, 2021

Transcatheter Aortic Valve Replacement (TAVR)- Who qualifies for the procedure?

As we move ahead in life, it’s not just our lifestyles that change – the amount of pressure we put on our hearts increases as well. The increased strain at times gives way to various heart diseases, one of the most common ones among them being Aortic Valve Stenosis.

Aortic Valve Stenosis is a condition of the heart where one of the four valves i.e. the aortic valve is narrowed and fails to open properly. This causes various cardiovascular diseases due to inadequate blood supply and pressure on the aortic valve. To treat the said condition, a procedure called Transcatheter Aortic Valve Replacement (TAVR) is performed.

What is a TAVR Procedure?

TAVR is a minimally invasive medical procedure that is used to treat Aortic Stenosis (AS). Before TAVR, Surgical Aortic Valve Replacement (SAVR) or open-heart surgery was the only way to cure aortic stenosis, but the procedure also led to several other complications among patients. But TAVR has made this procedure Less painful, less scarring with a faster recovery.

As this approach avoids surgically opening the chest or making an incision on the heart, TAVR is a safer option for high-risk patients. Before deciding on undergoing TAVR, you must consult your cardiac surgeon and specialists to determine if the procedure is beneficial for you.

Why does Aortic Valve Stenosis need to be treated?

A few of the complications that arise with Aortic Stenosis are chest pain, extreme fatigue, fainting, gasping, and swelling on the leg. It may also lead to cardiac arrest and heart failure. Hence, it must be treated immediately.

What has involved in the Transcatheter Aortic Valve Replacement (TAVR) procedure?

A catheter, which is a small, flexible tube is used to place a new valve in the heart. The doctor will make a small incision in a blood vessel in your leg or the chest wall. Once done, the doctor uses advanced imaging techniques to guide the catheter to your heart and into the aortic valve and position it properly.

What are the different types of TAVR Procedures?

While TAVR is essentially the placing of a valve via a catheter, the procedure varies from case to case. These include –

Transfemoral TAVR: A small opening is made to access an artery in the groin area at the top of the leg.

Transapical TAVR: An incision is made in the chest wall, between the left ribs, through which the catheter is inserted.

Transaortic TAVR: A small opening is made on top of the breast bone, through which the catheter is directly inserted into the aorta.

Transcaval TAVR: An incision is made in a large vein in the groin area, through which the catheter can be inserted, from which it goes through the vena cava to the abdominal aorta, and into the aortic valve.

Why can’t all Patients with Aortic Valve Disease opt for a Transcatheter Aortic Valve Replacement (TAVR) procedure?

One can opt for TAVR if they have Aortic Stenosis that leads to other symptoms and complications. They can usually opt for TAVR if they are at a higher risk of experiencing complications from open-heart surgery. Open-heart surgery is also risky if one has a kidney or lung disease. Though TAVR might be preferred due to its minimally invasive nature, one must be thoroughly evaluated before undergoing a TAVR. Patients with extremely high risk to moderate risk conditions are usually the ideal candidates for TAVR. Similarly, patients with active endocarditis infection or a similar aneurysm also cannot opt for a TAVR. Bicuspid patients who don’t prefer an open-heart surgery can seek a thorough evaluation with the TAVR team to discuss the risk factors and benefits and to also seek other treatment options. Also, patients in their 50s and 60s are refrained from opting for TAVR due to limited data present for the durability of bioprosthetic heart valves.

Are there any risks involved in a TAVR procedure?

Every medical procedure comes with some risks and the same applies to TAVR too. Hence it is important to have an expert opinion before undergoing any surgery for Aortic Valve diseases. Some of the major risks involved in TAVR are as follows:

Bleeding: Though the procedure is minimally invasive, it involves inserting a catheter in your leg, which may lead to internal bleeding.

Complications in the blood vessels: Injuries are caused due to vascular access which in turn, can lead to tissue malperfusion. Passing catheters through the arteries can also damage them.

Replacement valve: It might also lead to problems with the replacement valve such as blood leaks around the new valve or the valve slipping out of place.

Arrhythmia: It might lead to irregular heart rhythms, which would require pacemaker implantation.

Stroke: A small percentage of patients undergoing TAVR have complained of stroke, either during the procedure or after it.

Damage to the kidney: The dye that is used for imaging can affect the kidneys, leading to kidney damage. But this complication is usually reversible.

Heart Attack: A minimal percentage of patients have also had heart attacks during the procedure.

Infection: Passing catheters through the arteries can also lead to infections, but they are usually treatable.

Death: While TAVR is usually effective, there is a very low possibility that the patient cannot survive the procedure.

When it comes to heart health, it is important to weigh the pros and cons properly to avoid health issues in the future. As technology advances, the risks associated with it grows. But proper medical care and procedure surely avert all the risks and helps people to lead a normal life after TAVR or any surgery. All you need to do is take proper precautions and follow the advice of your doctor in the pre and post phases of the surgery to keep your heart healthy in the long run.