Bangalore ROH MAR 18WEB
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March, 2018 Bangalore MANAGEMENT OF HEAD AND NECK CANCER TREATMENTS PRESERVATION OF TONGUE IS POSSIBLE IN CANCER Greetings from HCG! As oncologists our focus has been and will always continue to be on our patients. We have maintained world-class standards in onco-care and we believe in restoring the quality of life for our patients being treated at HCG. To achieve the goals on quality, patient care, safety and better outcomes, we have been supported by fellow clinicians, employees and staff. On this month of International Women’s Day, I salute the spirit of these women who work round the clock and juggle between work and life to ensure patient care and satisfaction. On the occasion of International Women’s Day, HCG foundation had organised a mobile clinic for free breast cancer screening. The mobile unit was parked at the venue for complimentary mammography to women coming for the check-ups and the initiative was well appreciated by women who undertook the screening. They were urged to undergo periodic cancer screening. In this issue of ROH from our Bangalore Centre, we have highlighted two case studies. The first article is a series of case studies on the management of head and neck cancer treatments. The second case study talks about how preservation of tongue is possible in cancer. Today cancer care is moving from evidence-based medicine to personalised care, and because of that, there has been a significant improvement in treatment modalities leading to better outcomes. New cancer treatments focus on the vulnerabilities in cancer cells and how to use these vulnerabilities to inhibit tumour growth. We are proud to say that we are not only present in the big cities, but have also successfully penetrated across tier 2/3 cities. In the past, we have taken complex situations and simplified it, and we will continue to do so in the future. That not only goes for cancer care, but for our other areas of interests like multi-specialty hospitals and our fertility clinics. We have also launched the SelfV - Survivor Stories - a campaign pioneered to celebrate the spirit of cancer survivors. Cancer is considered as a stigma in the society and it is important to spread the message in the right way, which gives the cancer survivors courage to come up and share their stories of inspiration. The aim of this initiative is to make efforts, which over a period of time, our society starts to accept cancer as a chronic disease and not fear it, as one can live a regular life even with a chronic disease. To capture the story of their struggles and conquests over cancer, SelfV is a perfect platform for all survivors to share their stories of hope to others and thereby give them strength. I wish you good health and hope you enjoy reading this! Dr. BS Ajaikumar Chairman & CEO HCG Enterprises Ltd. 1 MANAGEMENT OF HEAD AND NECK CANCER TREATMENTS Dr. Vishal Rao Consultant - Head and Neck Surgery Case Study 1: multi-disciplinary approach by a team of The Patient was suffering from chronic ulcer of oncosurgeons, plastic surgeons, medical the upper jaw and was diagnosed with oncologists and radiation oncologists. He was Mucoepidermoid Carcinoma of the maxillary advised to undergo a repeat surgery with alveolus. He eventually underwent surgery plastic surgical reconstruction (replacement) of (partial maxillectomy) elsewhere though. The the diseased area. The patient was also post-surgery histopathology report revealed undergoing emotional stress with recurrence that the cut margin was positive for cancer. and re-treatment. He finally underwent the Hence, he underwent radiotherapy repeat surgery (total maxillectomy and free immediately. But his ulcer reappeared again in fibula graft). He received chemotherapy and 6 months, which was confirmed by a biopsy radiation after the surgery to complete his that revealed his cancer had come back. treatment. He is disease-free until now and Following this report, he was treated by using a undergoes regular follow-up. Pre-surgery picture Pre-surgery PET-CT scan Surgical removal of the tumor The removed maxilla 4 weeks after the surgery (upper jaw replaced by leg bone) 2 Case Study 2: the thyroid was extending below the collar bone A 40-year-old female patient was referred to us into her upper chest as well (intrathoracic with a midline neck swelling, which she noticed extension). for the last 2 months. She had initially consulted The goitre was excised by the combined team an ENT surgeon for chronic throat pain and was of head & neck surgeons and cardio-thoracic suspected to be having a thyroid disease. surgeons. Exploration of the tumour revealed it When we examined her neck, prominent veins to be extending up to the major blood vessels of were noticeable over a thyroid swelling. FNAC the heart. After the surgery her voice was revealed the swelling to be a multinodular normal. She was able to go home six days after goitre. Pre-operative MRI imaging showed that the surgery. Operative picture of the extensive goitre MRI image of the thyroid 3 Case Study - 3 breathing pipe (trachea) for him to breathe A 50-year-old man from Tumkur district in comfortably. But during this process he had lost Karnataka noticed a change in his voice and his voice already. He was then referred to HCG was diagnosed with malignancy of the voice and was evaluated by the multi-disciplinary box. He was staged as an early disease (Stage team. The diseased had progressed to the I) and was adviced to undergo radiotherapy in extent where surgery was a better option for city cancer centre. After completing his him. He underwent complete removal of the radiotherapy, the post procedure imaging diseased voice box and reconstruction of the showed that his disease had progressed. food pipe. At the same time, a small valve was Shortly after this, his breathlessness increased inserted in the remaining trachea for him to and he had to undergo a procedure called speak in future. He was referred to the speech tracheostomy, where a tube was inserted in his and swallow therapist for rehabilitation. Removed diseased voice box Pre-surgery scan The speaking valve being inserted The speaking valve in place 4 Case Study 4: He underwent an extensive counselling by the A young man in his twenties was referred to us plastic surgeon and the psycho-oncology team with an ulcer in his left cheek. He was a regular since he was concerned about his work, social tobacco chewer for only one year but noticed a acceptance after the surgery. He underwent small ulcer in his cheek for the last 3 or 4 complete resection of the diseased upper and months. He was eventually diagnosed with lower jaw on left side along with the cheek ulcer. squamous cell carcinoma of the cheek and Post-surgery, he was able to go home by the received chemotherapy at another centre. But tenth day. The speech and swallow therapist, as his disease did not respond to the a part of the rehabilitation team helped him get chemotherapy and he was given the option of better at speech. He is undergoing regular surgery after discussion in a multi-disciplinary follow-up and has access to the multimodality meeting. team at any point of time. Pre-surgery picture of the through and through cheek ulcer Scan showing the pre-treatment areas Post-operative image of the patient 5 PRESERVATION OF TONGUE IS POSSIBLE IN CANCER Dr. Vijay Agarwal Consultant - Medical Oncology An elderly retired gentleman, about seventy-two chemotherapy was suggested as an initial years from Bangalore, had noticed the presence treatment plan. The modality named of a persistent ulcer on the right half of his neo-adjuvant chemotherapy was suggested to tongue since January, 2015. He visited HCG him, where if found responsive, he had a high with the complaints of shooting pain at the probability of preserving his tongue with the tongue ulcer whenever he had a spicy meal. He adjunct of radiotherapy. had never been a smoker or a tobacco chewer. He received the chemotherapy for one and half A biopsy of the ulcer was done and it revealed months with regular monitoring and care to that it was a type of cancer (moderately minimise the side-effects. After completion he differentiated squamous cell carcinoma). was re-evaluated. The cancer in his tongue had He was advised to undergo a whole body responded to the treatment very well and was PET-CT scan, a newer modality of cancer found to be substantially reduced in size. diagnosis which helps to detect the precise Hence, he continued to receive local radiation location of cancer and its spread elsewhere in therapy (brachytherapy) along with another the body. It was found that the cancer had chemotherapy agent. During his treatment he spread to his neck glands as well. Hence, he had the support of the speech and swallow was diagnosed to have an advanced cancer of therapy team to keep his tongue functions near tongue in stage III. Incidentally, he was also normal. found to have a cardiac problem, which made The psycho-oncology team boosted his morale him a questionable candidate for surgery. to go through the procedure. After the The multi-disciplinary team of doctors in HCG completion of his treatment of around 3 months, hospitals, comprising surgical oncologists, he was evaluated with PET-CT scan and there medical oncologists, radiation oncologists, was a complete response to the treatment. The speech and swallow therapist and tongue ulcer had completely disappeared and psycho-oncologists had a detailed discussion his tongue function was near normal.