Brain metastases from systemic cancer are the most common type of intracranial neoplasm in adults, being almost 10 times more common than primary malignant brain tumors, which cause a significant burden on the management of patients with advanced cancer (1). The lungs represent one of the most frequent sources of metastases to the brain, with a probability of (36 64%) (3). Symptoms suffered by the patients include headaches, epilepsy, focal weakness, numbness or changes in mental status. The prognosis of patients with brain metastases is not optimistic and the median survival time is  1 2 months if left untreated. The 1-year survival rate has been recorded as 10.4% (4,5). The treatment of metastatic brain tumors is complex; not only due to being able to provide local control and improve neurological function, but also due to factors such as age, performance and systemic disease status and the size, volume, location and number of metastases at presentation

CyberKnife is a robotic radiosurgery system with a linear particle accelerator (linac), which is coupled with real-time imaging to track and compensate for the patient s or target s motion. As a relatively non-invasive treatment modality, CyberKnife demonstrates certain benefits, including a more accurate target localization and improved dose delivery for the management of metastatic brain tumors that allows higher biologically effective dose delivery without increased incidence of toxicity.

In the present case, the results for the treatment of multiple brain metastases after CyberKnife surgery with a 7 8 Gy marginal dose was promising. CyberKnife for metastatic brain tumors is an effective and safe method for reducing the marginal dose prescribed for multiple brain metastases and for minimizing the radiation-related neurotoxicities. In conclusion, CyberKnife, a focused, highly-targeted radiosurgery and fractionated radiotherapy is particularly useful for multiple brain metastases. CyberKnife provides the advantage of the management of local recurrence and a tolerable complication rate. Although the treatment of brain metastases has been performed with CyberKnife, the clinical significance and optimal dose fractionation scheme require further investigation.

In case you have a concern or query you can always consult an expert & get answers to your questions!

CyberKnife Therapy Of 24 Multiple Brain Metastases From Lung Cancer!

Lung cancer is the cancer killer of both men and women in the world. When you think of risk factors for lung cancer, what comes to mind? Most of us think about the risk associated with smoking cigarettes, but did you know that air pollution can also cause lung cancer? Overwhelming evidence shows that particle pollution in the outdoor air we breathe like that coming from vehicle exhaust, coal-fired power plants and other industrial sources - can cause lung cancer. Particle pollution increases the risk of dying early, heart disease and asthma attacks, and it can also interfere with the growth and function of the lungs. 

What is Particle Pollution?

Particle pollution is a mix of tiny solid and liquid particles in the air and can be made up of a number of components, such as acids, organic chemicals, metals, soil and dust particles. It can be emitted directly from wood stoves, forest fires, vehicles and other sources, and it can also form from other types of pollution that come from sources like power plants. 

Why does particle pollution harm our bodies?

While breathing in larger sizes of particle pollution can be harmful to our health, smaller particles are more dangerous. Bigger particles can irritate your eyes, nose and throat, but our natural defenses help us to cough or sneeze them out of our bodies. Unfortunately, those defenses don't keep out smaller particles, which get trapped deep in the lungs and can even get into the bloodstream, causing damage to our health.



Who is most at risk?

As for who is at risk for health problems from breathing in particle pollution. Those who live where particle pollution levels are high is at risk. Some people face higher risk, including children, the elderly, people with lung and heart disease and diabetes, people with low incomes, and people who work or exercise outdoors.

How do we protect ourselves from particle pollution?

Check the air quality index forecast for the day and limit your activity if pollution levels are high. Avoid exercising along heavily traveled highways regardless of the overall forecast.

As individuals, we can play our part in reducing air pollution levels by trying to avoid creating more of it. Choosing  active travel  options where possible, like walking and cycling, can help reduce pollution levels from transport and is also a great way to be more active, which is linked to a reduced risk of cancer and other diseases. In case you have a concern or query you can always consult an expert & get answers to your questions!

The Connection Between Lung Cancer & Outdoor Air Pollution!

Cancer like most other diseases has the best rates of recovery with early detection and intervention. As there are no regular health screenings for blood cancer, only the awareness about the early warning signs can save your life. November is designated as the Lung Cancer Awareness Month, to ensure every individual is equipped to fight against lung cancer right from the start. Here are 4 vital facts you must know to win your fight against blood cancer.
Lung cancer is also known as pulmonary carcinoma or cancer of the lung. It occurs when DNA mutations develop in the cells/ tissues of the lungs leading up to uncontrolled growth in the tissues of the lung. By far, it is known to be the most common cancer in Asia.

1. Type: lung cancers can present as one of the following types: 

Non-Small Cell Lung Cancer (NSCLC): Most common type of lung cancer and constitutes nearly 85% of all lung cancers. The sub-types of NSCLC are as follows:
Large cell carcinoma
Squamous cell carcinoma (SqCC) (Epidermoid)
Adenocarcinoma   accounts for majority of the NSCLC.
Small Cell Lung Cancer (SCLC): It is also known as oat meal cancer and tends to spread (metastasize) quickly. This constitutes about 15% of the lung cancers.
Mesothelioma: It is a rare cancer that develops in the mesothelial cells of the pleural or peritoneal surfaces. It usually arises in the pleural membrane lining the lungs, known as pleural mesothelioma. One that arises from the peritoneum is called the peritoneal mesothelioma and the one that arises from the pericardium is known as pericardial mesothelioma. Lastly, it can also arise from the tunica vaginalis known as testicular mesothelioma. People working with or prior exposure to asbestos are mostly at risk of developing mesothelioma. The latency period between time of exposure and development of mesothelioma can be somewhere between 20 to 40 years. Maximum of the patients who develop mesothelioma are men.
2. Gender: It affects the male populace predominantly. It is more common in men than in women and in those of lower economic status. However, the incidence of lung cancer, in women too, is on the rise of late.

3. Etiology: Cigarette/ Tobacco smoking remains the most important cause of lung cancer accounting for 85   90% of the cases. Incidence/ risk is proportionate to the number of cigarettes smoked irrespective of the age. Also, environmental toxins including smoke from burning black tar, exhaust gases from automobiles etc. too contribute actively to various lung diseases including cancer. People working in asbestos manufacturing factories who are exposed to asbestos dust are also likely to get lung cancer. Tuberculosis too is an additive risk factor. Again, people who have received ionizing radiation especially to treat Hodgkin Lymphoma or other malignancies also run the risk of developing lung cancer. Above-mentioned causes apart, genetic factors may also play a role.

4. Features: Lung cancer clinically presents in the following ways mainly. Signs & symptoms of malignant mesothelioma are as enumerated below

Difficult/ labored breathing (Dyspnea)
Chest pain
Palpable chest wall mass
Discordant chest wall expansion
Weight loss (Cachexia)
Loss of appetite (Anorexia)
Night sweats
Signs & symptoms of non-small cell lung cancer (NSCLC) are as enumerated below. Majority of patients are symptomatic at diagnosis

Chronic cough
Difficult/ labored breathing (Dyspnea)
Chest pain
Blood stained sputum (Hemoptysis)
Hoarseness
Weight loss (Cachexia)
Loss of appetite (Anorexia)
Weakness
Bone pain
Pleural or pericardial effusion
Superior vena cava syndrome
Brachial plexopathy
Neurologic pain
Hypercalcemia of malignancy
Signs & symptoms of small cell lung cancer (SCLC) are as enumerated below

Symptoms as per the points 8   18 depicted above for NSCLC are applicable for SCLC as well. Additionally, patients suffering from SCLC may have:

Fever associated with chest infections like bronchitis/ pneumonia that refuse to go away or keep coming back
Horner syndrome
Paraneoplastic syndromes including encephalitis/ sub-acute sensory neuropathy, hyponatremia, acromegaly, cancer associated retinopathy, ectopic corticotropic syndrome etc all.
5. Screening: is generally recommended for asymptomatic/ symptomatic populations as surveillance for high-risk individuals   who are either current or former smokers (quit smoking within the last 15 years) have at least a 30 pack-year smoking history and those who do not have any prior history of lung cancer. The goal of screening, as usual, is to be able to detect & diagnose lung cancer at an early stage which is potentially curable. It is mostly radiologic with a low dose helical computed tomography (CT) scan being more effective in detecting early-stage lung cancer than a chest radiograph can.

6. Diagnosis: Abnormal blood test results may be indicative of malignancy, but a follow-up imaging/ biopsy is always the gold standard for an accurate diagnosis. Following are the diagnostics employed mainly:

Blood: Hb may be low, TLC, ESR and polymorphs increased. Adenocarcinomas are likely to express thyroid transcription factor 1 (TTF-1) or carcinoembryonic antigen (CEA). On the other hand, mesotheliomas are likely to express Wilms Tumor -1 (WT-1) protein and Calretinin.
Imaging: Thoracoscopy, Bronchoscopy, X-Ray, CT Scan etc all. Positron Emission Tomography (PET) / CT scan and Magnetic Resonance Imaging (MRI) scan help detect metastasis if any.
Biopsy: It clinches the histologic diagnosis and the nature of the disease.
7. Treatment: Conventional treatment includes surgery, chemotherapy and radiotherapy as contextually appropriate. Simultaneously, an adjunctive or integrative naturopathic treatment with suitable complementary & alternative medicines (CAM) too can help improve clinical outcomes and facilitate recovery as would be feasible contextually.

8. Prognosis: Preventive measures, earlier diagnosis and right early treatment are key for effective therapeutic management & better prognosis. Like most other cancers, the chances of cure for early-stage lung cancer are more. The cure/ recovery chances are influenced by the grade, stage of cancer, recurrence and the patient s general health & vitality etc all. The primary determinant of prognosis in NSCLC is the stage at which the cancer is diagnosed. For non-metastatic cancers, however, it is the nodal status that determines the stage and hence the prognosis.

9. Prevention: Rightly said, prevention is always a better choice. Cigarette smoking is to be avoided by all means as it is the single major cause of lung cancer. Even exposure to cigarette smoke (passive or secondhand) is also an established cause of lung cancer and is known to increase the risk of lung cancer in non-smokers as well. Preventing exposure to secondhand smoke can be helpful in decreasing the incidence and mortality of primary lung cancers. Above-mentioned apart, other important risk factors such as exposure to ionizing radiation, environmental carcinogens like smoke from burning black tar, exhaust gases from automobiles, outdoor air pollution, and occupational exposure to asbestos, arsenic, beryllium, nickel, cadmium, chromium etc all too are known to increase the risk for lung cancer and mortality thereof. In fact, cigarette smoking is known to potentiate the effect and hence the lung cancer risk of many of the above-mentioned carcinogens, multi-fold, in smokers. Thus, either eliminating or reducing the exposure to the above-mentioned carcinogens can lead to a decrease in the risk of lung cancer and incidences thereof. Furthermore, randomized clinical trials indicate that high-intensity smokers (only) who take supplementation of beta-carotene have an increased risk/ incidence of lung cancer. Vitamin E supplementation, on the other hand, does not affect the risk of lung cancer as indicated by the trials. 

In case you have a concern or query you can always consult an expert & get answers to your questions!

Lung Cancer Awareness Month - Lung Cancer In Nutshell!

International Childhood Cancer Day is celebrated annually on 15 February to raise awareness and to express support for children and adolescents with cancer, survivors and their families.

Why is Cancer the biggest Threat to the YOUNG in India?

There are fewer Indians who have successfully battled Cancer and have emerged successful. Yuvraj Singh, the legendary cricketer, who was diagnosed with a rare cancer at 29, survived due to an early detection. Cancer cases in India are not as many as they are in the developed world. However, due to late detection the survival rate in the country is far worse. Particularly, we are losing our youth to Cancer. Most tobacco (pan masala) related cancers and child cancers go undetected until very late.

Few cancers like cervical cancer and breast cancer which affect women of any age, are curable, however, due to lack of awareness and timely screening, many Indian women succumb to these cancers. The most common sites for cancer among men are lung, prostate, colon, rectum, stomach and liver while that among women are breast, colon, rectum, lung, cervix and stomach.

In proportion to our population, we lack the right infrastructure nationwide. esp in the northern and north eastern region, there is a dearth of good cancer facilities, where radiation, care or treatment can be given. Not even one third of cancer patients are alive beyond 5 years after their diagnosis in India, and about 71% of cancer deaths occur in patients in their prime productive years   between the ages of 30 to 69 years.

 Most Indians believe that cancer is generally incurable and that it should be kept secret from neighbors and family.  -  Dr Paul Goss, MD, Harvard University.

All these factors have contributed to a very high mortality rate. No wonder Cancer is dreaded in the country. Investment, infrastructure, lifestyles as well as mindsets need to change if we were to contain the Cancer mortality rate. While you need to watch out for early signs of cancer, here are the lifestyle changes every individual esp. all youth must adopt to avoid cancer.

Avoid Tobacco - both smoking and chewing.

Reduce alcohol intake - Save your organs from deteriorating.

Limit UV ray exposure from the sun - Keeps your skin safe.

Maintain a healthy diet - Include foods rich in Vitamins, minerals and fiber which nourish your body and build immunity.

Increase your level of fitness - Maintain a good bodyweight. Additional flab invites a host of troubles, that includes variety of cancers.

Seeking regular medical checkup or screening - This is the only way to prevent and get detected early on.

International Childhood Cancer Day - Why Cancer Is A Threat For Young?

Without our lungs, it would be impossible to breathe. People suffering from chronic lung diseases have compromised lung functioning. This leads to shortness of breath, fatigue and weakness. In turn, this can make the person avoid anything that exerts the lungs such as exercise. While this may seem like a good idea, it is actually detrimental. Not exercising can further weaken the lungs and muscles and make this a vicious cycle. This is where physiotherapy can help with lung rehabilitation or pulmonary rehabilitation.

Physiotherapy is a branch of medicine that treats diseases and health conditions with exercise and manual therapy. Physiotherapists may also use radiation, sound waves, electric therapy, prosthesis and assistive devices. The aim here is not to cure the disease but to improve lung functioning and the patient s quality of life. Pulmonary rehabilitation can help in a number of ways.

It reduces breathlessness: As the lung muscles weaken, their ability to pump oxygen and transport it to the other parts of the body reduces. This can make a person feel breathless even with the slightest exertion. Lung rehabilitation works on strengthening the lung muscles to reduce this breathlessness.
It increases muscle strength in the arms and legs: When oxygen does not reach the limbs, they, in turn, get weaker. By strengthening the lungs, lung rehabilitation increases the muscle strength in the patient s arms and legs.
It increases stamina and endurance: Stamina is directly linked to lung functioning. By helping the patient breathe more comfortably, lung rehabilitation increases the patient s stamina and helps him or her endure more physical exercise.
It helps patients understand your condition: Physiotherapy is part exercise and part education. By helping patients get an insight into their condition, physiotherapy helps them come to terms with their limitations and motivates them to work harder towards overcoming them.
It increases self-confidence: Feeling breathless and tired all the time can make people feel frustrated. This is especially so because these things cannot be controlled without help. Physiotherapy teaches patients how to deal with these issues and thus increases their confidence in dealing with their medical issues.
It makes patients more independent: A lack of energy can make people dependent on others. Even simple tasks like getting a bottle of water from the fridge can seem like a tiring task. Physiotherapy improves lung functioning and hence makes the person feel less tired doing everyday tasks. This makes the person more independent and improves their quality of life.

Lung Rehabilitation With Physiotherapy!

Lungs are the most important organ of our body that has the responsibility of taking in the oxygen and releasing out carbon dioxide. When cancer develops in it, the entire body gets imbalanced. Lung cancer leads to more death than any other type of cancer, which is why identifying the symptoms and knowing the causes are instrumental in obtaining a timely diagnosis as well as in prevention of lung cancer.

Symptoms of Lung Cancer

In the early stages:

Persistent coughing

Chest pain

Bleeding

Fatigue

Loss of appetite

Sudden weight loss

Headaches

Coughing up blood

In the later stages:

Bone pain

Joint pain

Facial paralysis

Neck swelling

Blood clotting

Weakness

Sever chest pain

Causes of Lung Cancer:

Smoking: People who smoke are more prone to lung cancer. With the increase in the number of cigarettes you smoke, your chances of getting lung cancer increase too. People who don't smoke but are surrounded by the smokers also have high chances of being affected by this form of cancer.
Exposure to Asbestos: Asbestos is a group of mineral, which is present naturally in the environment. Lung cancer can occur due to the inhalation and ingestion of asbestos fibers.
Exposure to Ranon Gas: Ranon is a radioactive gas, which is formed naturally on decaying of radioactive elements. It is found in low levels in the air that we breathe and the water that we drink. Consumption of air and water having this gas leads to lung cancer.
High Levels of Air Pollution: Presence of high levels of dust particles and pollutants in the air that we breathe can cause lung cancer. 1-2% of lung cancer is caused because of it.
High Levels of Arsenic in Drinking Water: Consuming water with arsenic content is harmful as it directly affects the lungs and when the arsenic content is too high, it may lead to lung cancer.
Exposure to Chemicals: Exposure to certain chemicals like uranium, coal products, gasoline, diesel exhaust and mustard gas can also cause lung cancer.
Family History of Lung Cancer: Chances of getting lung cancer increase if your parents, child or siblings are already prone to lung cancer. In case you have a concern or query you can always consult an expert & get answers to your questions!

Lung Cancer - Symptoms & Causes! 

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