Chemotherapy has been the remedy for cancer since the late 90s. But in today s world the medical field has been improved so much that new methods have been invented. One of them is Hormonal therapy. It is used to cure some types of breast cancer that are affected by hormones. Receptor proteins in the breast cancer cells attach to estrogen and help the cells grow. This therapy stops the receptors attaching to estrogen in various ways.

When it is used?
Hormonal breast cancer therapy is performed after surgery to prevent the cancer from coming back. It is also applied to treat the cancer that has come back or to prevent the cancer from spreading to other parts of the body. Sometimes, if needed, it starts before the surgery. It takes five years, generally.

How it works?
Hormonal therapy mainly stops estrogen from acting on the cancer cells or lowers the estrogen level. There are different ways to do that.

Blocking Estrogen Receptors: These drugs stop estrogen from helping breast cancer cells.
Tamoxifen: It acts as anti-estrogen in the breast cells, but acts like estrogen in other cells. It lowers the risk of breast cancer and also stops cancer from coming back.
Toremifene: It works in a similar way, but it is only used in metastatic breast cancer. It also decreases the pain and swelling in the muscles and bones.
Fulvestrant: It blocks and damages estrogen receptors. It is given by injections after other drugs stop working.
Lowering Estrogen Levels: These drugs slow the growth of cancer by lowering estrogen levels.
Aromatase Inhibitors: These drugs stop estrogen production in women whose ovaries are not working due to menopause or other treatments. There are three types of this drug- Letrozole, Anastrozole and Exemestane.
Ovarian Suppression: In this method, ovaries are removed or shut down to turn pre-menopausal women to post-menopausal. There are several ways to do this, and they are- Oophorectomy or surgery, LHRH analogs and applying chemotherapy drugs.
There are some other types of hormone therapy that are less common. They were used more in the past. They are:

Megestrol acetate
Androgens
High doses of estrogen
Side Effects:
Unfortunately, Hormonal breast cancer therapy has lots of side effects. They are-

Hot flashes
Mood swings
Vagina discharge or dryness
Developing uterine cancer
Blood clots
Stroke
Night sweat
Headache
Mild nausea
Bone pain
Injection site pain
Muscle pain and joint stiffness and pain
Bone thinning
Menopause
Although hormonal therapy has lots of side effects, they are limited to different kinds of hormonal therapies and it is not necessary that they will surely happen. But it is best to undergo any kind of treatment with a doctor s advice. So patients should consult the doctor first.

Breast Cancer - New Advancements That Can Help!

Cancer that originates in the bones of a human body is referred to as bone cancer. Any bone could come under the threat of this disease, but generally the longer bones of your body, so to say the bones of your limbs, are at a greater risk. 

A few factors that might push you an inch closer to bone cancer are:

 Genes could jinx your health: a few typical genetic syndromes could increase a person's chances of contracting bone cancer. These syndromes could have been active in any person belonging to your lineage. One such syndrome is li-fraumeni.
 Treatment for one kind of cancer can make you prone to some other kind: radiation affects your bones adversely. A patient of breast cancer might be undergoing radiation therapy that further increases his or her risk of contracting bone cancer in future. 
 Paget's disease can have unfavorable implications: paget's disease is a disease that affects elderly people. This condition, if left untreated, can turn into bone cancer at a later stage. 

Several symptoms of bone cancer can be found below:

 Sudden loss of weight: if you lose a considerable amount of weight in a few weeks time without having made any effort at all, you should probably be worried about the health of your bones. Bone cancer can result in sudden and unintentional weight loss. 
 Unexpected bone fracture or breakage: cancer of the bones is known to gnaw at the strength of your bones. Weakened and diseased bones can break or get fractured very easily. An unexpected fracture should not be overlooked so as to prevent chances of anything more harmful.
 Long spans of unyielding exhaustion: constant fatigue and sleepiness might be hinting at a more serious underlying problem. The bones in your body hold you together; cancerous bone cells can make you feel exhausted without much exertion as your bones lose their inherent potency.
 Persistent pain in the bones: excruciating cramps or pangs of stinging pain in a person's bones either continuously or at odd hours, could be indicative of bone cancer. Such instances require the advice and guidance of an experienced oncologist.
 Bone swelling: the area affected by bone cancer can grow big and tender or the bone itself can swell up.

All About Bone Cancer

The treatment options for bone cancer depends on the type of cancer one is suffering from, the general health of the patient, the stage of cancer and the general preference of the patient. Different treatment options are designed for different types of cancer, based on the diagnosis. Each treatment responds in a different way. An oncologist decides the treatment options considering all the factors mentioned above. For instance, some cancer is best suited to surgery, while some cancer needs radiotherapy or chemotherapy to curb them. In many cases, all three modes of treatment might be required to tackle the growth of the cancer cells.

Surgery:
The goal of surgery is to eradicate the cancer cells in totality along with some surrounding healthy tissues. This involves special techniques to remove a tumor in one piece. Following are the types of surgeries that are available:

Removing the cancer cells sparing the limb: At the very first sight, the surgeon tries to understand whether it is possible to separate cancer cells from the tissues and the nerves. If the same is possible, the surgeon tries to save the limb while getting rid of the cancer cells. For the sake of safety and to ensure that the surgery is effective, the surgeon removes some of the healthy bone from the body and may replace the same with tissue from other parts of the body. To achieve this, a doctor might seek the help from of a bone bank or use a special metal prosthesis.
Surgery that does not involve the limbs: If the bone cancer does not involve the legs and the arm, surgeons can remove the affected bone along with some healthy bone from the surrounding areas. Cancer of the ribs and the spine are good examples of this type.
Surgery that affects the limb: Bone cancer that has spread to a significant extent and is strategically located in such areas that it is very difficult to remove, requires amputation. While this form of treatment is being increasingly discouraged by the wider medical community, it still does exist. In such cases, patients are fitted with artificial limbs and trained to do their job without the use of natural limbs.
Chemotherapy:
This is a form of drug treatment that uses powerful chemicals to kill cancer cells throughout the body. This medication is mostly given through an IV and the medication kills whatever cancer cells it comes across. 

Radiation therapy:
Radiation therapy involves the usage of special X-ray beams that have high power and can kill cancer cells. The patients are required to lie on a table, while a machine moves around the affected area and treats it with high energy X-rays, thereby killing the cancer cells. Radiation therapy is often used in conjunction with chemotherapy to reduce the size of a tumor before operating on it.


Bone Cancer - Know The Treatment Options!

Liver transplantation or hepatic transplantation is the second most carried out transplant procedure in the world. It is a potentially difficult surgery that is performed by a team of two to four surgeons along with the help of anesthesiologists and nurses. It takes around 10 to 12 hours to complete the procedure as there are many anastomoses, sutures, reconnections, and disconnections, which are to be performed under the liver bed which is necessary for the transplant to be a success.

Tests required before a transplant is planned

Computed tomography, or CT scan which employs X-rays and a computer to create pictures of the liver, showing its size and shape. CTs and chest X-rays are also recorded to evaluate your heart and lungs.
Laser Doppler flowmetry: to check if the blood vessels to and from the liver are normal.
Echocardiogram to check the status of heart function.
Pulmonary function test or lung capacity test to study and determine the lungs' ability to exchange oxygen and carbon dioxide.
Blood tests are performed to determine the patient's blood type, clotting ability, and biochemical status of blood, and to determine liver function.
The liver transplant procedure

After an admission at the hospital, an Intravenous line is started in the patient's arm or hand. Other tubes (catheters) are put in their neck and wrist, or their collarbone or the area between the belly and the thigh (the groin). These are used to check heart and blood pressure, and to get blood samples.
The patient is placed on the back, over the operating table.
If there is too much hair at the surgical site, it may be shaved.
A catheter is placed into the bladder to drain urine.
After the patient is sedated, the anesthesiologist will insert a tube into the lungs. This is done so that the breathing can be helped with a ventilator. The anesthesiologist will keep checking the heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
The skin at the surgical site will be cleaned with a sterile (antiseptic) solution.
The doctor will make a cut (incision) just under the ribs on both sides of the belly.
The doctor will carefully separate the diseased or the injured liver from the nearby organs and structures.
The attached arteries and veins are then clamped to stop the blood flow into the diseased liver.
The diseased liver will be cut off from the blood vessels and then removed.
The surgeon will check the donor liver before implanting it into the body.
The donor's liver is placed in the patient's body.
The incision will then be closed with sutures or surgical staples.
In case you have a concern or query you can always consult an expert & get answers to your questions!

Liver Transplant Surgery - Understanding The Procedure!

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

Minimally invasive spinal surgery is a quicker and safer alternative to open surgery. The spinal discs, vertebrae and nerves are present deep inside the body. A small incision is made and the surgical instruments and a camera is inserted which push aside the muscles and reach the problem area.

Which medical conditions can be addressed with minimally invasive spine surgery?

1. Degenerative Disc Disease (osteoarthritis of the spine)
2. Herniated Disc (the disc protrudes from its right place)
3. Spinal Tumours
4. Vertebral compression fractures (collapse of the vertebra)
5. Lumbar spinal stenosis (narrowing of the space near the spinal cord)
6. Scoliosis (the spine curves sideways)
7. Spinal infections
8. Spinal instability

What are the goals of minimally invasive spine surgery?

1. Decompression: this procedure eases the pressure being exerted on the spinal cord or the nerve roots. This pressure can be the cause of pinched nerves.
2. Stabilization: sometimes, a segment of the spinal cord that has come loose can be the source of pain. A stabilizations surgery fuses the segment to the rest of the structure.



The three most common methods of minimally invasive spine surgery are-

1. Tubular: it is also called  muscle splitting  surgery. A tubular retractor passes through the muscles of the back and reaches the spine.
2. Mini-open: it is a lot like open surgery but with fewer risks and blood loss. The possibility of post-operation infection goes down significantly.
3. Endoscopic: it is also called a keyhole surgery. A small camera is introduced through a small incision and guided to the spine. The camera gives an internal view of the spine to the doctors.

The three types of Minimally Invasive Spinal Surgery are-

1. Microdiscectomy: involves the removal of the intervertebral disc that is putting pressure on the spinal cord.
2. Foraminotomy: spinal conditions can lead to narrowed foramen (the area where the spinal nerve exits the spine). The aim of the surgery is to expand the foramen.
3. Microlaminectomy: this is yet another type of decompression surgery. The aim is to relieve pain caused pinched nerves or a segment of the bone pressing down on the nerves.

What are the benefits of minimally invasive spine surgery?

  Speedy and pain-free recovery after surgery
  A patient is discharged the same day
  Very little loss of blood
  Reduced chances of infection
  Less scarring because the operation is done through small incisions
  Less muscle damage

Are there any risks attached to minimally invasive spine surgery?

No surgery is free of risks or side effects. Some common problems in the aftermath of minimally invasive spine surgery are-

  Allergies
  Reaction to anaesthesia
  Blood clots
  Infections
  In rare cases stroke and paralysis.

Minimally invasive spinal surgery incorporates the latest advances in the world of technology. It is the relatively hassle-free procedure and convenient for both doctors and patients.

Minimally Invasive Spinal Surgery - A Safer Alternative To Open Surgery!

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