CANCER TREATMENT PROGRAMS

BLOOD CANCER TREATMENT

Blood Cancer is essentially a set of malignancies that wrecks havoc with the patient’s
health and wellbeing, often leading to fatality. However, the good news is that blood
cancer treatment is readily available and evolving rapidly. As the treatment methods are
coming of age, the remission and survival rates are showing an upward curve. In the
recent medical breakthroughs, researchers have identified specific gene mutations that
can be targeted for safe and efficient recovery, provided the treatment is undertaken in
the initial phase.

From conventional modes like chemo and radiotherapy to stem cells and bone marrow
transplantations, we specialise in it all. Going a step ahead, we have taken the
prerogative to promote awareness about cancer among masses. After all, awareness is
the first line of defense against diseases. Accordingly, we have put up a concise guide to
blood cancer, covering all its key aspects, such as causes, types, symptoms and signs,
and stages. So, read on and stay informed.

TYPES OF BLOOD CANCER

A blood cancer patient experiences an anomaly in the reproduction of red blood cells or
cells of the bone marrow or the lymphatic system. This leads to the build-up of cancerous
cells in the bone marrow – the site of cell formation. So, we can categorise the medical
condition into three categories namely – Lymphoma, Leukaemia and Multiple Myeloma.

In a typical case of Leukaemia, the body is incapable of creating Red Blood Cells, which
are responsible for transporting Oxygen within the body. Lymphoma occurs when
cancerous cells impact the White Blood Cells that deter attacks from pathogens, while
Multiple myeloma has much to do with the plasma.

BLOOD CANCER SIGNS AND SYMPTOMS

As the malignant blood cells achieve a steady growth rate, signs of blood cancer become
visible, which may include heavy breathlessness, changes in skin color, fine rashes and
itching, along with swollen stomach, and continuous discomfort in the abdominal area.
The patient may also experience consistent pain in the bones, ribs, back and joints, in
addition to excessive bleeding from gums and cuts, and drastic weight loss.

Too much blood flows during menstruation and pain in urination tracts are also indicators
of blood cancer in women. The other prominent signs include frequent infections,
abnormal swelling of lymph glands, constant headache and visibility issues, and
unexpected bouts of chill. When any of these signs surface, the individual should seek
medical help at the earnest, as delays may aggravate the issue and lead to complications
in the blood cancer treatment.
BLOOD CANCER STAGES

Blood cancer is divided into four stages depending on the spread and impact of the
medical condition.

Stage 1: In the first stage, the lymph nodes gain size due to the sudden rise in the
number of lymphocytes. As the disease is yet to spread to other parts of the body, the
risk factor is low.

Stage 2: In this stage, the lymph nodes, spleen and liver show an excessive inflation in
size. The stage is also characterized by an uncontrolled growth of lymphocytes.

Stage 3: Herein, the cancer is spread to at least two of the organs involved – lymph
nodes, spleen and liver – and the risk factor surges higher.

Stage 4: The production of blood platelets dwindles rapidly, cancer spreads to other
organs, including lungs, and anemia becomes acute. The risk factor reaches criticality at
this stage.

BONE CANCER TREATMENT

Bone cancer is a malignant tumor resulting from the atypical growth of cells either in
the bones or any other body part. A significant number of bone cancer cases are
metastatic, wherein the tumor originates in remote parts and infects bones. While the
causes of bone cancer are yet to be uncovered, there are specific risk factors, such as
exposure to radiation and alkylating agents, specific gene mutation and so on. The
prominent symptom of the medical condition is a constant pain in the bones, which
may worsen with time. As the chances of recovery increase with the early
presentation, it makes sense to seek medical help on the onset of pain.

The Department of Oncology has the right combination of technology and workforce
to ensure world-class bone and soft tissue tumor treatments to domestic and offshore
patients. Adopting a multi-modality approach for your bone tumor treatment, we put
together a multispecialty team for complete cancer care. A typical bone tumor
management team will include orthopedic oncologists, radiologists, pathologists,
medical oncologists, reconstructive surgeons, surgical and radiation oncologists,
counselors, nurses and physiotherapists. As each aspect is catered with
professionalism and compassion, better patient outcomes are always anticipated.

We are well - equipped to manage all types of Orthopedic Oncological conditions.

Whether you are suffering from Primary Bone Cancers like Sarcomas or Metastatic
Bone Disease, we can take care of it all. We are also positioned to deliver treatments
for several other bone malignancies, such as Myeloma and Lymphoma, along with
Soft Tissue Sarcomas and Spine tumors. Benign tumors like Giant Cell Tumors,
Aneurysmal Bone Cyst and Chondroblastoma are also managed. Besides bone cancer
treatment, we can also support non-oncological orthopedic needs of patients
hospitalized for other medical conditions.
We have the technology and skills to carry out super specialized surgical procedures
for bone tumor treatment. We put our best foot forward to conduct limb salvage
surgery with endoprosthetic replacement, vascularised bone autografts and
extracorporeal radiotherapy. Our limb salvage surgery portfolio also includes re-
implantation of tumor bone and total femur and total humerus replacement. We also
perform specialized soft tissue sarcomas, internal hemipelvectomy, en bloc resections
of primary spinal tumors and extended curettage of benign aggressive bone tumors.

Though the nature and scope of surgeries differ vastly, we conduct each with a
common objective – to get rid of the malignant tumor while keeping the limb in the
best possible shape. Our bone cancer treatment relies on the evidence-based principles
supplemented by technology, research and personalized care. As a part of bone tumor
management, we also provide counseling services to aid the recovery process. A
dedicated desk is also available for overseas patients reaching out to us for advanced
cancer care. The desk is well-equipped to facilitate trouble-free, fast registration and
consultation. The foreign patients will be provided information on visa duration
through an International Patient Coordinator only upon ascertaining the exact medical
requirements.

BRAIN TUMOR SURGERY

Neuro Oncology is an important and developing field of Neuroscience , that

primarily deals with diagnosis and treatment of Spine tumors and complication
of systemic cancer. Other topics of interest and research are Molecular Genetics,
Paraneoplastic Diseases, Epilepsy and Neurotoxicity (both central and
peripheral).

The Neuro Oncology team at SRC & Super specialty seeks to offer patients and
their families a full spectrum of innovative, advanced treatments with a
coordinated, team-bases approach dedicated to maximizing quality of life. The
team focuses on spinal cord tumors, including glibolastoma and other gliomas,
primary central nervous system lymphoma and metastases. They are also expert
in managing the neurologic complication of cancer and its treatment. The team of
neurosurgeon, neurologist, radiation oncologist, nurses, social workers,
nutritionists, and others work to care patients, to achieve higher cure rates and
longer survival, and to chart the course of treatment for patients.

The Neuro Oncology medical staff specializes in using modern neuro imaging
techniques such as positron emission tomography (PET scanning), functional
magnetic resonance imaging (FMRI) and stereotaxy to ensure the most accurate
diagnostic biopsies and maximal resection of benign and malignant primary and
metastatic tumors of brain, spine, and peripheral nerves.

Pediatric brain tumors are treated by multidisciplinary group including pediatric

oncologist, radiation oncologist and neurosurgeon.
BREAST CANCER TREATMENT SERVICES
Over the last ten years Breast Cancer has been rising steadily and now it is the most
common cancer in women in India. Age adjusted rate is as high as 25.8 per 100,000
women and mortality 12.7 per 100,000 women. With the advent of effective screening
modalities it is now possible to detect breast cancer at an earlier stage. Five year survival
rate of breast cancer detected at the earliest stage is more than 90%.

We consider every woman and man diagnosed with breast cancer to be a unique
individual who deserves a carefully thought-out, personalized treatment plan offering
advanced care. With this objective each case is being discussed in detail in tumor board
for better outcomes. To provide the best treatment options to meet each patient’s goals,
our specialists work as a united team, carefully evaluating patient and the specifics of
breast cancer.

Our specialists are experts in breast cancer care and research, providing patients the
latest and the most effective treatments with the greatest chance of cure. Our center is
one of the few centers in the world providing latest cutting edge diagnostic technologies
and targeted treatments, minimal invasive surgery, molecular pathology and more-
effective chemotherapies, radiotherapy and prevention.

DIAGNOSTIC FACILITIES

DIAGNOSTIC FACILITIES listed below are all available under one roof. They range from:

 Digital Mammography
 Digital Tomosynthesis
 MR Mammography
 Scintimammography
 PET MRI.
INTERVENTIONAL advancements are used for establishing diagnosis wherever
indicated. They are as of:

 Stereotactic wire localization and guided biopsy

 MRI Guided biopsy
 Ultrasound Guided wire localization
 Sentinel node biopsy and
 Vacuum assisted biopsy – Scarless surgery of breast lump.
Our center excels in Mastectomy as well as lesser Invasive treatment options as of:

 Breast Conservative Surgery along with various forms of Breast Oncoplasty

 Volume Replacement and Displacements including Implants and free flaps.
Most effective chemotherapy and radiotherapy including Accelerated partial breast
irradiation are also available.

FACTS ABOUT BREAST CANCER

Breast Cancer is a malignant tumour specific to the human breast. It is the result of an
atypical growth of cells in the breast that can metastasize to other body parts, causing a
systematic breakdown of body processes and fatality. Lately, we have seen a surge in
breast cancer cases in India and worldwide. As per National Cancer Registry
Programme, 25% to 32% of all female cancers in the leading Indian urban centers are
related to breast cancer. Though females are the prime victim of breast cancer, males
can also develop the malignancy. The origin of breast cancer is shrouded in mystery.
However, there are certain risk factors specific to the condition, such as ageing, heredity,
genes, radiation exposure, obesity, delayed pregnancy and alcohol.

BREAST CANCER SIGNS AND SYMPTOMS

The prominent symptoms and signs of breast cancer may include, but not limited to:

 Formation of a thick piece of mass (lump) in the infected breast or just below the
armpit
 Constant pain in the infected region, ranging from mild to severe
 The breast skin developing pits and redness
 The infected nipple(s) carrying rashes
 Blood discharge from the nipple of the infected breast
 A deep-set or upturned nipple
 A drastic anomaly in the breast shape or size
 The skin of the nipple with effects like peeling, flaking or scaling
It is worth mentioning that the majority of lumps are benign. However, a regular check-up
is always advised, as the chances of successful breast cancer treatment amplify with an
early detection.

BREAST CANCER STAGES

Though a variety of staging methods are in use, generally breast cancer is spread out in
five stages, each of which is characterised by the size and outreach of the tumour. The
oncologist often determines the stages by subjecting the patient to a series of specialised
physical exams, X-rays, biopsies, bone scans and blood tests.

Initial stage: The primary stage of breast cancer is also medically referred to as Ductal
Carcinoma in Situ (DCIS). Here, the malignant cells are restricted within the duct and yet
to come in contact with the surrounding tissues.

Stage 1: This stage is characterised by the abnormal growth of malignant cells. The
tumour size is about 2 cm and the lymph nodes are not infected as yet.

Stage 2: Herein, the tumour gains size and outreach. The surrounding lymph nodes
come in contact with the infected cells.

Stage 3: In the onset of this stage, the tumour gains mass and may become as big as 5
cm across. The threat of infected lymph nodes is maximized.
Stage 4: The final stage is characterized by the metastasis of malignant tissues. Cancer
spreads to distant organs, among which the prime recipients are brain, liver, bones and
lungs.

BREAST CANCER TREATMENT

Surgery is the initial modality of treatment in early stages followed by chemotherapy /

Radiotherapy depending on the final histopathology report. In advanced cases initial
chemotherapy may be given to decrease the size of the tumor followed by surgery /
radiation. Patient may also require to take a tablet daily for minimum of 5 years based on
the final report.

Surgical options include modified radical mastectomy (complete removal of breast +

removing nodes from arm pit), Breast conservation surgery (BCS) {removal of tumor +
removing nodes from arm-pit}. Both surgeries have comparable cure rates and is decided
on the size of the tumor and patients personal choice. Sentinel lymph node biopsy can
be used in patients with no nodes in the arm -pit at diagnosis.

For patients who desire reconstruction of breast options are available like silicon
prosthesis, flaps which will help to restore the contour of breast.

CERVICAL CANCER TREATMENT

Cervical cancer is a medical condition exclusive to females. Typical of all cancers,
cervical cancer is also caused by excessive growth of cells either on the cervix camera or
in any remote organ. Though the rate of cervical cancer cases has steadily gone down
due to easy access to screening and vaccines, it still takes a significant toll on lives in
developing countries, including India. The majority of cervical cancers are caused when a
female comes in sexual contact or skin-to-skin contact with someone infected by Human
Papilloma Virus (HPV). The other risk factors include multiple sexual partners, prolonged
use of birth control pills and smoking.

We know over 100 types of HPVs but only selected types are associated with cancers
while the rest leads to the formation of non-malignant warts on the skin or genitals. In
addition to cervical cancer, the cancerous HPVs can also lead to cancers of the penis in
men, along with cancers of the anus, mouth and throat in both genders. The symptoms of
cervical cancer include unexplained vaginal bleeding, abnormal vaginal discharge and
prolonged bleeding in the post-menopause scenario, together with constant pain during
intercourse, excessive discharge and pain in the pelvic region. As cervical cancer
treatment gives better patient outcomes if detected early, you need medical help when
any of the symptoms persist for a prolonged period.

We continue to provide Gynae Oncology services with complete commitment and

compassion to anyone presenting with gynecological cancer or pre-cancer. We are well-
served by a team of seasoned and qualified Gynecologic Oncologists that puts the best
foot forward to manage cancers in proficient and scientifically proven ways. Our experts
stay at the top of the latest breakthroughs in Gynae oncology and implement the relevant
ones for better patient outcomes. We stand by the patient right through the journey,
providing consultations, screenings, clinical staging and treatments as per the disease
status.
We bring forth a range of OPD services for accurate diagnosis and treatment for cervical
cancer. Our frequently requested OPD services may include PAP smear, HPV testing,
including high-risk mRNA E6, E7, Colposcopy and directed biopsies and Endometrial
aspiration, along with Antiseptic dressings, catheter and stoma care. Cervical biopsies
and smears like vault smear and vulvar smear are also readily available. The disease is
clinically staged and triaged to determine the further course of action. Since we use
technology and human competence across all OPD services, patients can anticipate
accurate screening outcomes at all times.

We are up for minor and major incision based modalities when it comes to the treatment
for cervical cancer. Our Minor OT procedures include Biopsies like vulvar biopsy, cervical
biopsy and vaginal wall biopsy, resuturing and antiseptic dressing for all reconstructive
surgeries, along with Cryocautery and electrocautery for pre-invasive cervical lesions
(CIN I, CIN II) or persistent cervical erosions. Moreover, we have state of the art
operation suites for all major Gynae oncological surgeries, such as Open Surgeries,
Laparoscopic Surgeries and Robotic Surgeries.

HEAD AND NECK CANCER TREATMENT

SERVICES
Head and Neck Cancer treatment Services provide Comprehensive Cancer Care from
Prevention to Palliation. A team of Head & Neck Surgical Oncologists, Radiation
Oncologists, Medical Oncologists, Reconstructive Surgeons and other Medical
Specialties work together to treat each Head & Neck Cancer patient. They discuss
majority of the cases in Multi Specialty Clinic to decide the best course of action. We
discuss all options of treatment and investigations with patient and relatives. Head &
neck cancer treatment is promptly followed by a personalized rehabilitation plan to help
promote recovery and ensure an enhanced quality of life.

Modalities of Treatment Available for Head and Neck Cancer:

 Surgery
 Radiation
 Chemotherapy
 Rehabilitation
 Targeted Therapy
The treatment plan for an individual patient depends on a number of factors, including
the exact location of the tumor, the stage of the cancer, and the person’s age and
general health. The patient and the surgical oncologist should consider
treatment options carefully. They discuss each type of
treatment and how it might change the way the patient looks, talks, eats, or breathes.

Surgery
The surgeon may remove the cancer and some of the healthy tissue around it. Lymph
nodes in the neck may also be removed (lymph node dissection); if the Surgical
Oncologist suspects that the cancer has spread. Surgery may be followed by radiation
treatment.

Head & neck surgery often changes the patient’s ability to chew, swallow, or talk. The
patient may look different after surgery, and the face and neck may be swollen. The
swelling usually goes away within a few weeks. After surgery of neck and throat, patient
may feel numb because nerves have been cut. If lymph nodes in the neck were removed,
the shoulder and neck may be weak and stiff. Patients should report any side effects to
their Surgical Oncologist, and discuss what approach to take.

Radiation Therapy
Head & neck cancer in early cases may be treated with radical dose of radiation, but
patient may require radiation pre operation or post operation, with or without
chemotherapy. Different types of radiation may be planned for patients for example –
3DCRT, IMRT or IGRT.

In addition to its desired effect on cancer cells, radiation therapy often causes unwanted
effects. Patients who receive radiation to the head and neck may experience redness,
irritation, and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing;
changes in taste; or nausea. Other problems that may occur during treatment are loss of
taste, which may decrease appetite and affect nutrition, and earaches (caused by
hardening of the ear wax). Patients may also notice some swelling or drooping of the skin
under the chin and changes in the texture of the skin. The jaw may feel stiff and patients
may not be able to open their mouth as wide as before treatment. Patients should report
any side effects to their Oncologist and ask how to manage these effects.

Chemotherapy
Chemotherapy may be given along with radiation or alone in selected situations. The side
effects of chemotherapy depend on the drugs that are given. In general, anticancer drugs
affect rapidly growing cells, including blood cells that fight infection, cells that line the
mouth and the digestive tract, and cells in hair follicles. As a result, patients may have
side effects such as lower resistance to infection, sores in the mouth and on the lips, loss
of appetite, nausea, vomiting and diarrhea. They may also feel unusually tired and
experience skin rash and itching, joint pain, loss of balance, and swelling of the feet or
lower legs. Patients should talk with their medical oncologist about the side effects they
are experiencing, and how to handle them.

Targeted Therapy
Targeted therapies are different than chemo therapies. They are like smart bombs vs
cluster bombs of chemotherapy. These are oral form of drugs which selectively kill
cancer cells. They have limited applications in head and neck cancer.

LIVER CANCER TREATMENT

Liver cancer is a growing cause of casualties in India and the world. Like all cancers, liver cancer can
also be attributed to the uncharacteristic rise in cell reproduction. When more cells are produced than
needed, tumours, which can be either benign or malignant, are formed. The benign tumours are
relatively harmless, as they can be eliminated from the system. On the other hand, malignant tumours
are hard to deal with and escalate into cancer. These tumours multiply at a rapid pace and spread to
distant body parts via blood and lymph nodes.

TYPES OF LIVER CANCER

Liver is vulnerable to several types of cancers, such as Hepatocellular Carcinoma, Intrahepatic
Cholangiocarcinoma and Hepatoblastoma. Hepatocellular Carcinoma is the most prevalent form of
liver cancer that originates from Hepatocyte, the primary cells found in liver. Individuals with chronic
liver issues like cirrhosis are more prone to this dreaded condition. Atypical Hepatocellular Carcinoma
screening involves blood tests, standard imaging tests and liver biopsy. Advanced imaging tests,
including Magnetic Resonance Elastography may also be used.

SIGNS AND SYMPTOMS OF LIVER CANCER

The general prognosis of liver cancer is awful. The symptoms remain dormant in the early stages and
when they surface, the disease becomes virtually uncontrollable. The standard signs and symptoms of
liver cancer may include, but not limited to, liver overgrowth, white-collared stools and skin turning
yellow. Other non-specific symptoms include sudden and drastic weight loss, appetite loss, nausea,
vomiting, constant fatigue and atypical swelling. These symptoms are called nonspecific, as other
chronic disorders may trigger similar effects.

LIVER CANCER STAGES

As per the TNM system for staging, liver cancer is categorized into four stages and several sub-stages.

Stage 1: At the onset of liver cancer, a tumour develops within the liver. However, effects of the
tumour are localized, as it is yet to come in contact with any blood vessels.

Stage 2: The tumour grows in dimension reaching a size up to 5 cm across. The possibility of
developing several small tumours is also there. Though the tumour has grown into blood vessels, the
spread is still localised.

Stage 3A: This stage is also characterised by outgrowth of the tumour(s). The average size of the
tumour is 5 cm across, and surrounding lymph nodes still remain immune to the cancer.

Stage 3 B: One or more tumours intrude into the portal or hepatic vein of the liver. Here the nearby
lymph nodes and distant body organs are yet to get in contact with the malignancy.

Stage 3C: The tumour has either engulfed the outer surface of the liver or penetrated into nearby
organs. Distant sites are still not affected by the cancer.

Stage 4A: The size and number of tumours in the liver grow phenomenally. This stage also marks the
spread of tumours into lymph nodes, blood vessels or surrounding organs. The distant sites are still
unaffected.

Stage 4B: The entire body is infected by the malignant cells.

TREATMENT OPTIONS AVAILABLE

Liver Cancer treatment available at hospital for Hepatocellular Carcinoma, may include surgery, liver
transplants, ablation procedures, chemotherapy, radiation therapy and targeted drug therapy. A
combination of two or more therapies is a common practice.