Preserving Fertility After a Cervical Cancer Operation Is Possible

An anxious 29 yrs old lady walked in my clinic with her husband and family members. She was recently diagnosed with cervical cancer and was advised surgery, which would essentially render her infertile (As conventional surgery for cervical cancer requires complete removal of uterus). As she was childless was very keen to know if, any surgical option is available, which can preserve her fertility. Fertility preservation surgery (Radical Trachelectomy) is an accepted treatment for cervical cancer, but there are strict criteria to identify eligible patients.

After counseling and examination, we started evaluating this patient to identify, if she was a suitable candidate for fertility preserving surgery, which included MRI to note the extent of size and spread. After completion of all necessary tests, she was identified as a suitable patient for radical trachelectomy.

Radical trachelectomy is a surgery in which only the diseased cervix along with lymph nodes are removed, leaving behind the upper part of the uterus which is then sutured with vagina. Also whenever possible this should be done by a minimally invasive (Keyhole) approach, so the handling of tissues during surgery is less and hence problems for future conception are avoided. The Robotic assisted surgery works best in this situation as the suturing of the uterus with vagina can be extremely difficult and the endowrist instruments with magnified 3D vision makes this part of the procedure as well as the dissection extremely safe and effective. At Kokilaben Dhirubhai Ambani Hospital,

We discussed and counseled the patient and her husband about the surgery and the advantages of using Robotic platform. She underwent Robotic Radical trachelectomy with bilateral pelvic lymph node dissection at Kokilaben Dhirubhai Ambani Hospital and Research center .. Her postoperative recovery was uneventful and was discharged from the hospital on 5th Postoperative day. She will be closely observed for a period of 1 year and then if things are fine she can attempt pregnancy.

Cervical cancer is the most common Genital tract cancer seen in Indian women with an incidence on 22.9/100000 women. Every year over 122000 new cases are diagnosed in India and almost 67000 women die every year because of this disease. Radical trachelectomy is an established surgery for early stage cervical cancer for women who desire future fertility.

Unfortunately in India, women do not present early hence there are not many patients who can undergo this operation. This was second such case operated at our hospital. The first case was a 4-year-old girl diagnosed with cervical cancer. Robotic assisted surgical platform is of great help in performing these surgeries as, the technology allows you to overcome some of the problems you face when you do these complex surgeries and also help patient recover fast postoperatively.

In the end it was great to see smile back on her face, not only relieved of all the stress and anxiety regarding her cancer treatment, but also being able to preserve her ability of being a mother.

Dr Yogesh Kulkarni,
Consultant, Gyn Oncology & Robotic Surgeon
Kokilaben Dhirubhai Ambani Hospital. Mumbai
M: 93215427311

Mail. Yogesh.v.kulkarni@relianceada.com

What is Cancer?

Cancer is a broad term. It describes the disease that results when cellular changes cause the uncontrolled growth and division of cells. Some types of cancer cause rapid cell growth, while others cause cells to grow and divide at a slower rate. Certain forms of cancer result in visible growths called tumours, while others, such as leukaemia, do not.

Cancer statistics in India

• One woman dies of cervical cancer every 8 minutes in India.
• For every 2 women newly diagnosed with breast cancer, one woman dies of it in India.
• Mortality due to tobacco use in India is estimated above 3500 persons every day.
• Tobacco (smoked and smokeless) use accounted for 3,17,928 deaths (approx) in men and women in 2018.
• Cancer took 7 lakh lives in India in 2018.
• India has around 22.5 lakh people living with cancer.
• Every year, more than 11 lakh new cancer patients are registered in India.

Cancer Symptoms

Signs and symptoms caused by cancer will vary depending on what part of the body is affected. Some general signs and symptoms associated with, but not specific to, cancer, include:

• Lump or area of thickening that can be felt under the skin.
• Weight changes, including unintended loss or gain.
• Skin changes, such as darkening or redness of the skin, sores that won’t heal, or changes to existing moles.
• Difficulty swallowing.
• Persistent indigestion or discomfort after eating.
• Persistent, unexplained muscle or joint pain.
• Unexplained bleeding or bruising.

What causes cancer

Cancer is caused by changes (mutations) to the DNA within cells. The DNA inside a cell is packaged into a large number of individual genes, each of which contains a set of instructions telling the cell what functions to perform, as well as how to grow and divide. Errors in the instructions can cause the cell to stop its normal function and may allow a cell to become cancerous.

What do gene mutations do?

A gene mutation can instruct a healthy cell to:

• Allow rapid growth. A gene mutation can tell a cell to grow and divide more rapidly. This creates many new cells that all have that same mutation.
• Fail to stop uncontrolled cell growth. Normal cells know when to stop growing so that you have just the right number of each type of cell. Cancer cells lose the controls (tumor suppressor genes) that tell them when to stop growing. A mutation in a tumor suppressor gene allows cancer cells to continue growing and accumulating.
• Make mistakes when repairing DNA errors. DNA repair genes look for errors in a cell’s DNA and make corrections. A mutation in a DNA repair gene may mean that other errors aren’t corrected, leading cells to become cancerous.

These mutations are the most common ones found in cancer. But many other gene mutations can contribute to causing cancer. 5 to 10% gene mutations are due to genetic reasons. Others are caused due to smoking, radiation, viruses, cancer-causing chemicals (carcinogens), obesity, hormones, chronic inflammation and a lack of exercise.

Prevent Cancer

Here are a few steps to take in daily life to prevent cancer.

1. Say No to Tobacco – The use of tobacco products has been linked to many types of cancer, including lung, colorectal, breast, throat, cervical, bladder, mouth and oesophageal. It’s never too late to quit.

2. Protect your skin from sun – Skin cancer is the most preventable form of cancer. Exposure to the sun’s ultraviolet radiation causes most skin cancer. Be sure to use adequate sun protection year-round.

3. Eat a healthy diet – Eat lots of fruits, vegetables, beans and whole grains. Limit red meat and cut out processed meats. It is also important to limit alcohol consumption because alcohol can increase your risk for liver, colorectal and breast cancers.

4. Maintain a healthy weight and be physically active – Getting at least 30 minutes of physical activity each day can make a big difference in your general health and well-being. Inactivity and obesity have been linked to breast and colorectal cancer.

5. Practise safe sex – Many strains of the human papillomavirus, also known as HPV, are spread through skin to skin contact during vaginal, anal and oral sex. High-risk strains of HPV have increasingly been found to cause many types of cancer.

6. Get immunized – Certain viruses have been linked to cancer, but are preventable through vaccination. Talk to your doctor about preventive cancer care.

7. Be regular with cancer screenings – Talk to your family doctor to know more cancer screening tests. Early detection highly increases your chances of recovery.

Cancer treatment

Below are examples of approaches to cancer treatment:

• Chemotherapy aims to kill cancerous cells with medications that target rapidly dividing cells. The drugs can also help shrink tumors, but the side effects can be severe.
• Hormone therapy involves taking medications that change how certain hormones work or interfere with the body’s ability to produce them.
• Immunotherapy uses medications and other treatments to boost the immune system and encourage them to fight cancerous cells.
• Radiation therapy uses high-dose radiation to kill cancerous cells. Also, a doctor may recommend using radiation to shrink a tumor before surgery or reduce tumor-related symptoms.
• Stem cell transplant can be especially beneficial for people with blood-related cancers, such as leukemia or lymphoma. It involves removing cells, such as red or white blood cells, that chemotherapy or radiation has destroyed. Lab technicians then strengthen the cells and put them back into the body.
• Surgery is often a part of a treatment plan when a person has a cancerous tumor. Also, a surgeon may remove lymph nodes to reduce or prevent the disease’s spread.
• Targeted therapies perform functions within cancerous cells to prevent them from multiplying. They can also boost the immune system. Two examples of these therapies are small-molecule drugs and monoclonal antibodies.

Doctors will often employ more than one type of treatment to maximize effectiveness.

Cancer care at Kokilaben Dhirubhai Ambani Hospital:

Our Centre for Cancer is equipped with high-end technologies like:

• EDGE Radiosurgery system, Asia’s first equipment which enables precise, non-invasive treatments helping patients heal faster with less discomfort.
• We are the first hospital in India to have Novalis TX machine, which performs high precision surgeries to remove deep-seated tumours.
• We have the first Trilogy (linear accelerator) in India, which is capable of performing on-board CT scan, KV and MV imaging with respiratory gating systems.

Cancer Care in rural Maharashtra:

• Our team has started Cancer care centres across Maharashtra under Reliance Hospitals. We plan to establish 18 cancer care centres across Maharashtra. The centres will be managed and operated by Kokilaben Dhirubhai Ambani Hospital. The new cancer centres will be equipped with advanced TrueBeam® medical linear accelerators to equip them with the latest technology. The Akola, Gondia and Solapur Reliance Cancer centres are now open and the rest will follow in a few years. We aim to make world-class cancer care accessible to all Indians.

Please find below link of our Cancer care facilities in Mumbai, Navi Mumbai and in rural Maharashtra:

https://www.kokilabenhospital.com/departments/centresofexcellence/technology/centrefor_cancer.html

https://www.reliancehospitals.com/

Cancer refers to any one of a large number of diseases characterized by the development of abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal body tissue. Cancer often has the ability to spread throughout your body.

Cancer is the second-leading cause of death in the world. But survival rates are improving for many types of cancer, due to improvements in cancer screening and cancer treatment.

Cancer Symptoms:

Cancer can cause many different symptoms. These are some of them: 

• Skin changes, such as: 
• A new mole or a change in an existing mole.
• A sore that does not heal.
• Breast changes, such as: 
• Change in size or shape of the breast or nipple.
• Change in the texture of breast skin.
• A thickening or lump on or under the skin.
• Hoarseness or a cough that does not go away.
• Changes in bowel habits.
• Difficult or painful urination.
• Problems with eating, such as: 
• Discomfort after eating, a hard time swallowing, changes in appetite
• Weight gain or loss with no known reason.
• Abdominal pain.
• Unexplained night sweats.
• Unusual bleeding or discharge, including: 
• Blood in the urine, vaginal bleeding, blood in the stool
• Feeling weak or very tired

What causes Cancer?

Cancer is caused by changes (mutations) to the DNA within cells. The DNA inside a cell is packaged into a large number of individual genes, each of which contains a set of instructions telling the cell what functions to perform, as well as how to grow and divide. Errors in the instructions can cause the cell to stop its normal function and may allow a cell to become cancerous.

Risk factors:

Here is a list some common risk factor which highly increases your chance of getting cancer:

• Smoking – Cigarette smoke contains hundreds of toxic chemicals. Of those chemicals, about 70 can cause cancer. Smoking as well as being exposed to second-hand smoke increases your risk of cancer.
• Obesity – Extra fat tissue produces excess amounts of estrogen and other hormones that may stimulate cell growth and proliferation (the more often cells divide, the more opportunities cancer has to develop). Obesity may also cause chronic inflammation, which over time can damage DNA and is one of the things that cause cancer.
• Age – One-quarter of new cancer cases are diagnosed in people between age 65 and 74, according to the National Cancer Institute. Getting old highly increases your chance of getting cancer.
• Sedentary lifestyle – Spending more time sitting for work or leisure highly increases your chance of getting cancer as compared to others who lead active lives.
• Alcohol – Limit your alcohol intake. One unit for women, two for men: that’s the recommended daily limit if you choose to drink alcohol. The more alcohol you consume, the higher your risk of developing certain cancers: specifically that of the head and neck, oesophagus, liver, and breast.
• Hereditary – If your mother, father, or siblings were diagnosed with any form of cancer than it’s a sign that it may be caused by an abnormal gene that you may have inherited. Overall, inherited mutations result in only about 5 to 10 per cent of all cancers.

Prevent Cancer:

Here are a few ways how changing your lifestyle and eating habits can help prevent cancer:

• Be as lean as possible without becoming underweight.
• Be physically active for at least 30 minutes every day.
• Avoid sugary drinks, and limit consumption of high-calorie foods, especially those low in fiber and rich in fat or added sugar.
• Eat more of a variety of vegetables, fruits, whole grains, and legumes (such as beans).
• Limit consumption of red meats (including beef, pork, and lamb) and avoid processed meats.
• If you drink alcohol, limit your daily intake to two drinks for men and one drink for women.
• Limit consumption of salty foods and food processed with salt (sodium).
• It’s best for mothers to exclusively breastfeed their babies for up to six months and then add other liquids and foods.
• After treatment, cancer survivors should follow the recommendations for cancer prevention.

Cancer facts in India:

• There are more than 100 types of cancers; almost any part of the body can be affected.
• The five most frequent cancers (ranking defined by the total number of cases) in India between men and women are breast, cervical, oral cavity, lung, and colorectal. These top five account for 47.2 per cent of all cancers
• Cancer is the second most common cause of death in India (after cardiovascular disease).
• Use of tobacco products (eg smoking cigarettes) is the single most preventable cause of death worldwide. As many as 2,500 persons die every day due to tobacco-related diseases in India.
• One woman dies every 8 minutes in India from cervical cancer, which is more than any country. Rural women have more risk than their urban counterparts.
• Breast cancer is the most common cancer in women in India and accounts for about a quarter of all cancers in women in Indian cities.
• The WHO data says India will have 1.16 million new cancer cases in 2018.

Our Cancer centre is equipped with high-end technologies like:

• EDGE Radiosurgery system, Asia’s first equipment which enables precise, non-invasive treatments helping patients heal faster with less discomfort.
• We are the first hospital in India to have Novalis TX machine, which performs high precision surgeries to remove deep-seated tumours.
• We have the first Trilogy (linear accelerator) in India, which is capable of performing on-board CT scan, KV and MV imaging with respiratory gating systems.

Consult our highly experienced and expert oncologists for any cancer diagnosis or treatment. Please find below link for more details:

https://www.kokilabenhospital.com/departments/centresofexcellence/centrefor_cancer.html

It is no surprise that the sooner breast cancer is detected, the better the chances there are of curing it. Initially, though, breast cancer doesn’t show evident symptoms. If the lump is too small for you to feel, you may not even notice it. However, over time, if you begin to experience a sharp pain in your breast along with some tenderness, you ought to get it checked.

When it comes to cancer, detection is key. If you detect the disease in its early stages, you have a better chance at survival. If you recognize any of these symptoms, book an appointment with your doctor today!

1. Changes in shape or texture If one of your breast has the lump, chances are that there will be significant changes in the shape or size of the affected breast. For instance, one breast might droop or become larger than the other. If there is puckering of the skin or your breast starts to look red and inflamed, you ought to get it checked.

2. Thickening of the nipple If you are in the habit of checking your breasts regularly, you’ll be able to spot changes quickly. Is one of your nipple or both of them feeling thicker than usual? If yes, you might want to get it investigated. What’s more? Dimpling and itching of the skin shouldn’t be ignored as they are warning signals your body is giving you.

3. Nipple discharge It is true that nipple discharge happens for a variety of reasons and most of the time it is nothing to worry about. However, if the discharge occurs without squeezing the nipple or it happens in one breast and not the other, you need to visit your doctor. If the discharge has blood in it, it’s advisable to seek medical help.

4. Lump in the armpit More often than not, women look for lumps in their breasts. While that is necessary, you should not ignore swelling in or around your collarbone or armpit. Sometimes, these lumps are spotted even before you feel a lump in your breast. It’s worth seeking medical advice as soon as you notice this symptom.

5. Bloating Women tend to bloat easily. And while it is easy to overlook this symptom, if it occurs with weight loss or bleeding, it is a cause of worry. Constant bloating is a definite sign of cancer. Visit your doctor to know the cause of the problem.

Once you’ve successfully detected these symptoms, your doctor will advise you to get a mammogram done. Women of all ages are encouraged to examine their breasts regularly.

What does Cancer…the dreaded disease actually mean?

Cancer, also called malignancy refers to any one of a large number of diseases characterized by the development of abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal body tissue. Cancer often has the ability to spread throughout the body.

There are more than 100 types of cancer, including breast cancer, skin cancer, lung cancer, colon cancer, prostate cancer, and lymphoma. The symptoms vary depending on the type. Cancer treatment may include chemotherapy, radiation, and/or surgery.

Cancer Symptoms

Signs and symptoms caused by cancer will vary depending on what part of the body is affected. Some of them are listed below:

1. Fatigue
2. Lump or area of thickening that can be felt under the skin
3. Weight changes, including unintended loss or gain
4. Skin changes, such as yellowing, darkening or redness of the skin, sores that won’t heal, or changes to existing moles
5. Changes in bowel or bladder habits or indigestion
6. Persistent cough or trouble breathing
7. Difficulty swallowing, hoarseness in voice
8. Persistent, unexplained muscle or joint pain
9. Persistent, unexplained fevers or night sweats
10. Unexplained bleeding or bruising

Causes

Cancer is caused by changes (mutations) to the DNA within cells. The DNA inside a cell is packaged into a large number of individual genes, each of which contains a set of instructions telling the cell what functions to perform, as well as how to grow and divide. Errors in the instructions can cause the cell to stop its normal function and may allow a cell to become cancerous.

Risk factors

Factors known to increase your risk of cancer include:

1. Your age – Cancer can take decades to develop. That’s why most people diagnosed with cancer are 65 or older. While it’s more common in older adults, cancer isn’t exclusively an adult disease — cancer can be diagnosed at any age.
2. Your habits – Certain lifestyle choices are known to increase your risk of cancer. Smoking, drinking more than one alcoholic drink a day, excessive exposure to the sun, being obese, and having unsafe sex can contribute to cancer.
3. Your family history – Only a small portion of cancers are due to an inherited condition. If cancer is common in your family, it’s possible that mutations are being passed from one generation to the next.
4. Your environment – The environment around you may contain harmful chemicals that can increase your risk of cancer. Second hand smoke, chemicals in your home or workplace, such as asbestos and benzene, also are associated with an increased risk of cancer.

Prevention

There’s no certain way to prevent cancer. But you can reduce your risk of getting cancer by taking the below steps:

1. Stop smoking. If you smoke, quit. If you don’t smoke, don’t start. Smoking is linked to several types of cancer — not just lung cancer. Stopping now will reduce your risk of cancer in the future.
2. Avoid excessive sun exposure. Harmful ultraviolet (UV) rays from the sun can increase your risk of skin cancer. Limit your sun exposure by staying in the shade, wearing protective clothing or applying sunscreen.
3. Eat a healthy diet. Choose a diet rich in fruits and vegetables. Select whole grains and lean proteins.
4. Exercise most days of the week. Regular exercise is linked to a lower risk of cancer. Aim for at least 30 minutes of exercise most days of the week.
5. Maintain a healthy weight. Being overweight or obese may increase your risk of cancer. Work to achieve and maintain a healthy weight through a combination of a healthy diet and regular exercise.
6. Drink alcohol in moderation, if you choose to drink. Do not start drinking if you don’t. If you choose to drink alcohol, limit yourself to one drink a day if you’re a woman of any age or a man older than age 65, or two drinks a day if you’re a man 65 years old or younger.
7. Schedule cancer screening exams. Talk to your doctor about what types of cancer screening exams are best for you based on your risk factors.

Some crucial facts about Cancer:

1. Cancer is the #2 killer in developed countries and #1 in underdeveloped countries.
2. Scientific experts worldwide agree that at least half of all cancers and cancer-related deaths are preventable.
3. A single cigarette contains 69 known cancer-causing carcinogens and over 4,000 chemicals.
4. Cancer is the #1 disease killer of children.
5. Globally, one in every eight deaths is caused by cancer. Approximately 70% of cancer deaths occur to those of low and middle incomes.
6. One may experience no symptoms of ovarian cancer, lung cancer, or colon cancer until the cancer cells spread to other areas of your body. Early screening is imperative to catching these cancers in time.
7. What you eat matters. Green tea, berries, turmeric, avocados, garlic, kale, and even dark chocolate can naturally trigger cancer cells to self destruct via apoptosis.
8. If anyone among your family or friends is showing any cancer related symptoms, waste no time. Meet our team of specialists at the Centre for Cancer at Kokilaben Dhirubhai Ambani Hospital. Please see below link for more details:

https://www.kokilabenhospital.com/departments/centresofexcellence/centrefor_cancer.html