Most Advanced Whipple surgery for Pancreatic Cancer

Whipple surgery ?

The Whipple procedure is an operation to remove a pancreatic tumour and a lot of the tissue around it. After a large cut is made in your belly, the surgeon will look at the pancreas and other organs in the area, including lymph nodes, to see if the cancer has spread. Tissue samples will be taken for a biopsy.

When the surgeon is satisfied that the tumour has not spread and can be removed entirely, he or she takes out the part of the pancreas containing the tumour. The surgeon will also take out the first part of the small intestine, the bile duct, the gallbladder, and nearby lymph nodes. Sometimes the lower part of the stomach is also removed. The goal of surgery is to remove the tumour and some of the normal tissue around it. The normal tissue is examined under a microscope to see if it is free of cancer cells. This is known as getting "clear margins." Having clear margins improves the chances—but doesn't guarantee—that all cancer cells have been removed.

The second part of the surgery involves sewing your digestive tract back together. Sometimes this operation can be done with laparoscopic surgery, using several small incisions instead of one large one.

Categorization of Wipple Procedures

Standard Whipple Procedure

In a standard Whipple procedure, the surgeon removes the head of the pancreas, the gallbladder, part of the duodenum which is the uppermost portion of the small intestine, a small portion of the stomach called the pylorus, and the lymph nodes near the head of the pancreas. The surgeon then reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the small intestine during digestion.

Pylorus preserving Whipple Procedure

In another type of Whipple procedure known as pylorus preserving Whipple, the bottom portion of the stomach, or pylorus, is not removed. Taking out the head of the pancreas is called pylorus preserving pancreaticoduodenectomy (PPPD).

Laparoscopic Wipple Procedures

A laparoscopic Whipple procedure may be offered to select individuals. The laparoscopic Whipple procedure is performed through small incisions in the abdominal wall. A laparoscope, a long thin tube with a lighted camera at its tip, is inserted through one incision. The surgeon operates using specially designed surgical instruments placed through the remaining incisions, guided by the laparoscope images shown on a monitor in the operating room. Conventional surgeries require a longer incision and wider opening of the abdomen. With laparoscopic procedures, surgeons are generally able to reduce blood loss and risk infection for the patient.

Complications and Outcomes

The most common post-surgical complication of pancreatoduodenectomy is leaking of pancreatic juices from the incision. If this occurs, a drain may be inserted through the skin to allow drainage for several weeks after surgery. Weight loss is another frequent complication of the Whipple procedure. Diabetes is a potentially serious concern for some people (a minority) after surgery. In general, although many people do very well after the Whipple procedure, some develop immediate complications that affect their quality of life.

Colon Cancer | Rectal cancer Treatment at World Top Hospitals in India

What is Colon Cancer?

Colon Cancer also known as Colorectal Cancer or Large Bowel Cancer includes cancerous growths in the colon, rectum and appendix. Screening for Colon cancer should begin at the age of 40 in healthy adults. 70 to 80 percent of colorectal cancer cases occur in adults without specific risk factors. Colon cancer may affect any racial or ethnic group; however, some studies suggest that Americans of northern European heritage have a higher-than-average risk of colon cancer.

What are Types of Colon Cancer?

The Types of Colon Cancer are as under:

•  Adenocarcinomas: These are the most common type of Colon Cancer and originate in glands. They account for about 90-95 percent of all colorectal Cancers and have two subtypes, Mucinous and signet ring cell. The Mucinous subtype comprises about 10-15 percent of Adenocarcinomas while the signet ring cell subtype comprises less than 0.1 percent of Adenocarcinomas.

•  Leiomyosarcomas: This type of Colon Cancer occurs in the smooth muscle of the Colon. Leiomyosarcomas account for less than two percent of colorectal Cancers and have a fairly high chance of metastasizing.

•  Lymphomas: These are the rare and are more likely to start in the rectum than in the Colon. However, lymphomas that start somewhere else in the body are more likely to spread to the Colon than to the rectum.

•  Melanomas: This type of Colon cancer is rare. Usually, it results from a melanoma that started somewhere else and then spread to the Colon or rectum. Melanomas account for less than 2% of colorectal Cancers.

•  Neuroendocrine Tumors: This tumor is divided into two main categories: aggressive and indolent.

Colorectal cancer, also called colon cancer or large bowel cancer, includes cancerous growths in the colon, rectum and appendix. Colorectal cancers arise from adenomatous polyps in the colon. These mushroom-shaped growths are usually benign, but some develop into cancer over time. Localized colon cancer is usually diagnosed through colonoscopy.

Symptoms of Colon Cancer

• Leaking of bowel contents into the pelvis can cause inflammation and infection.
• Change in frequency or character of stool.
• Small-caliber or ribbon-like stools.
• Sensation of incomplete evacuation after a bowel movement.
• Rectal bleeding may be hidden and chronic and may show up as an iron deficiency anemia.

Causes of Colon Cancer

• A family history of colorectal cancer and polyps.
• The presence of polyps in the large intestine.
• Chronic ulcerative colitis.

How is for Colon Cancer diagnosed?

• Colonoscopy: An endoscope is inserted into the rectum and advanced through the colon, through this the doctor can examine the entire colon.

• Diagnosis is confirmed with a colon biopsy - Stage of disease is confirmed by pathologists and imaging tests, such as computerized tomography (CT or CAT) scans.

• Endoscopic ultrasound and magnetic resonance imaging (MRI) may also be used to stage rectal cancer

• Sigmoidoscopy: In this an endoscope is interested in the rectum and moved through the left side of the colon. It cannot be used to view the middle and right sides of the colon.

• Fecal occult blood test (FOBT) along with Complete blood count (CBC to check for anemia and CT, MRI or PET scans of the abdomen, pelvic area.

Stages of Colon Cancer

The staging of colon cancer helps doctors determine a course of treatment. Staging is done on a scale from 0 to 4, with the higher stages indicating a cancer than has spread more throughout the body.

•  Stage 0: In this stage, the cancer hasn’t grown beyond the inner layer of the colon or rectum.

• Stage I: The cancer has spread through the colon’s inner lining, but hasn’t spread beyond the colon wall or rectum.

• Stage II: The cancer has grown through the colon or rectal wall, but hasn’t spread to nearby lymph nodes.

• Stage III: The cancer has invaded nearby lymph nodes but isn’t affecting other parts of the body.

• Stage IV: The cancer has metastasized throughout the body to sites such as the liver, lung, ovaries or the lining of the abdominal cavity.

Colon Cancer Treatment and Surgery in India

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. In women, the cervix, vagina, ovaries, and nearby lymph nodes may be removed. In men, the prostate may be removed. Artificial openings (stoma) are made for urine and stool to flow from the body to a collection bag.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy beams or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses linear accelerators outside the body to send radiation toward the cancer. Internal radiation therapy (Brachytherapy) uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells 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 (systemic chemotherapy). When chemotherapy is placed directly in the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Other Types of Treatment Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy is a type of targeted therapy being studied in the treatment of rectal cancer.

Monoclonal antibody therapy uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Most Advanced Minimally Invasive or Laparoscopic Colon Cancer Surgery in India

Advantages of Minimally Invasive Laparoscopic Colon Cancer Surgery

• Less surgical trauma, shorter hospitalization, Improved cosmetic results.

•  Reduced post operative pain, faster recovery and return to daily activities and normal diet.

• Less postoperative pain killer requirement

Ovarian Cancer Treatment in India | Best Cancer Hospitals for Most Advanced Ovarian Cancer Treatment in India

Ovarian cancer is a type of cancer that begins in the ovaries. Women have two ovaries, one on each side of the uterus. The ovaries - each about the size of an almond - produce eggs (ova) as well as the hormones estrogen, progesterone. Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. Ovarian cancer is a type of cancer that begins in the ovaries. Women have two ovaries, one on each side of the uterus. The ovaries — each about the size of an almond — produce eggs (ova) as well as the hormones estrogen, progesterone and testosterone. Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is difficult to treat and is often fatal.

Symptoms of ovarian cancer are not specific to the disease, and they often mimic those of many other more-common conditions, including digestive and bladder problems. When ovarian cancer symptoms are present, they tend to be persistent and worsen with time.

Symptoms of Ovarian Cancer

There are no specific symptoms of the ovarian cancer. They are very similar to other diseases like digestive or bladder problems. However, they worsen with time.

It is very important that an early diagnosis of Ovarian Cancer is made for complete treatment of the patient and better quality of life.

Few of the symptoms of Ovarian Cancer may include:

• Abdominal pressure, fullness, swelling or bloating
• Pelvic discomfort or pain
• Persistent indigestion, gas or nausea
• Changes in bowel habits, such as constipation
• Changes in bladder habits, including a frequent need to urinate
• Loss of appetite or quickly feeling full
• Increased abdominal girth or clothes fitting tighter around your waist
• A persistent lack of energy
• Low back pain

What are various Stages of Ovarian Cancer?

There are four stages of ovarian cancer. Your doctor will determine your stage of ovarian cancer. Ovarian cancer is treated differently depending on which stage you are diagnosed with.

Stage I

The cancer is completely contained within the ovary or ovaries:

•  Stage IA- One ovary involved

•  Stage IB- Both ovaries involved

•  Stage IC- One or both ovaries involved, but with cancer on the surface of an ovary, rupture of an ovarian cyst malignant ascites or positive abdominal washings.

Stage II

The cancer is in one or both of the ovaries and has spread to additional organs located in the pelvis such as the bladder, colon, rectum or uterus.

• Stage IIA - Spread to uterus or fallopian tubes

• Stage IIB - Spread to pelvic peritoneum

• Stage IIC - Confined to the pelvis, but with malignant ascites or positive abdominal washings

Stage III

The cancer is in one or both ovaries and has spread to one or both of the following: the lining of the abdomen or the lymph nodes.

• Stage IIIA - Microscopic spread to the upper abdomen

• Stage IIIB - Cancer nodules less than 2 cm in the abdomen

• Stage IIIC - Nodules more than 2 cm, or positive pelvic or aortic lymph nodes

Stage IV

The most advanced stage of cancer. The cancer has spread from one or both ovaries to additional organs such as the liver or lungs, or there may be cancer cells in the fluid surrounding the lungs.

Diagnosis of Ovarian Cancer

A pelvic exam is performed for examining rectum, vagina and lower abdomen for growths or masses. If the growths are visible on ovaries then certain other tests are also performed for producing detailed images of the ovaries. Some of the tests include –

• Exploratory Surgery : This surgery is performed for confirming the diagnosis of ovarian cancer.

• Ultrasound : High-frequency sound waves are produced in order to get precise images of the structures inside the body.

• Blood Tests: CA 125 blood test is performed for those women who are suspected of having ovarian cancer or previously had ovarian cancer. This blood test helps in detecting a protein antigen that can be found at abnormally high levels in the blood serum of those women who have ovarian cancer.

• Positron Emission Tomographic Scan (PET) : This test helps in defining those areas that altered blood supply and also helps in identifying cancer.

• Upper G.I. and Lower G.I. Scopy: It helps in ruling out the primary cancer present in G.I. tract.

• CT scan: This helps in generating two dimensional images of the body that may show whether the cancer has spread.

• Mammography: Metastatic tumors can be ruled out with this test.

• Magnetic Resonance Imaging (MRI): Magnetic energy is used for generating highly detailed images of the anatomy such as tumors.

Most Advanced Ovarian Cancer Treatment in India

Surgery

Three types of surgeries are involved in treating ovarian cancer such as:

• Laparoscopy : Gynaeoncologist perform laparotomy through a large abdominal incision, most often removing your ovaries, uterus, fallopian tubes, nearby lymph glands, a fold of fatty tissue called the omentum and as much of the tumor as possible.

• Frozen Section Tissue Analysis : The rapid analysis of the tissue is done under a microscope. The nature of the tumor is determined as whether it is cancerous or non-cancerous that also helps surgeons to perform a suitable procedure during the first surgery.

• Laparotomy : This procedure is used by making a large abdominal incision. This incision is done for removing uterus, ovaries, Fallopian tubes surrounding lymph glands, omentum (a fold of fatty tissue) and tumor. Cytoreductive or debulking surgery is another name for this surgery.

Chemotherapy

After surgery, you'll most likely be treated with chemotherapy - drugs designed to kill any remaining cancer cells. Chemotherapy may also be used as the initial treatment in some women with advanced ovarian cancer. Chemotherapy drugs can be administered in a vein (intravenously) or injected directly into the abdominal cavity, or both methods of administering the drugs can be used. Chemotherapy drugs can be given alone or in combination.

Radiation therapy

Radiation therapy uses high-energy beams to kill cancer cells. The use of radiation therapy to treat ovarian cancer has declined in recent years, but Gyneconcologist use it in certain cases, such as when patient have a recurrence of cancer at the original site or if she can't tolerate chemotherapy. Gyneconcologist may use whole abdominal radiation to treat ovarian cancer that remains or recurs in the abdomen.

Latest and Advanced Minimally Invasive Surgery for Ovarian Cancer in India

Indian Hospitals gives women with ovarian cancer access to the latest in cancer treatment. For example, Indian surgeons use fertility-sparing surgery, minimally and robotic surgery in select cases, when app minimally invasive surgery — also called laparoscopic surgery — for several conditions. In minimally invasive procedures, your doctor makes one or more incisions, each about a half-inch long, to insert a tube. The number of incisions depends on the type of surgery. The tube or tubes let the doctor slip in tiny video cameras and specially designed surgical instruments to perform the procedure.

When you have minimally invasive surgery, you're likely to lose less blood and have less postoperative pain, fewer and smaller scars, and a faster recovery than you would after open surgery. Depending on your condition, you may need only a short hospital stay. For some conditions, your doctor may recommend robotic surgery. That technology gives your doctor great precision, flexibility and control by providing a magnified, 3-D view of the surgical site.