We have more than 200 bones in our body and each of them is susceptible to bone cancer. However, long bones in the arms and legs are most susceptible to this condition. Bone cancer can be primary or secondary. Primary bone cancer involves uncontrolled and abnormal cell division within the bones while secondary bone cancer refers to cancer that originated somewhere else in the body and later spread to the bones. While children and adults are equally at risk for primary bone cancer, adults and elderly people are more susceptible to secondary bone cancer. If diagnosed early enough, bone cancer can be treated and even cured with surgery, chemotherapy or radiation. 

Hence it is essential to recognize the signs and symptoms of bone cancer. Here s what you should look out for.

Pain in Bones: Pain is one the primary symptoms of bone cancer. As the tumour grows larger, this pain can become more intense. In its early stages, the pain may be experienced as a dull ache inside the bone or the affected part of the body. It may also increase or decrease according to your activity level or may be experienced only at night. However, not all bone pains signify  cancer  as this is also a symptom associated with osteoporosis.
Swelling: In some cases, the abnormal growth of bone cells can result in the formation of a lump of mass that may be felt through the skin. In other cases, the affected area may also show signs of swelling.
Breaking of the Bone: Cancer can weaken the bones and make them more brittle. This may make the bones more susceptible to fractures. A bone breaking in an area that has been painful or sore for a long period of time may be a sign of cancer. This is known as a pathologic fracture.
Reduced Flexibility: If the tumour is located near a joint, it may affect the range of movements possible and make simple actions uncomfortable. For example, a tumour around the knee may make walking and climbing stairs a painful exercise.
Other symptoms to look out for are sudden and drastic weight loss, tiredness, excessive sweating at night, fever and difficulty breathing in case cancer has spread to other organs. Since many of these symptoms are common to other medical disorders, you should conduct a doctor immediately if you notice any of them. A physical examination and a couple of tests along with a biopsy will be required to confirm a diagnosis of bone cancer.

Bone Cancer - 4 Signs You are Suffering from it!

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. It occurs in both women and men, although breast cancer in men is rare.

Risk factors:

Lack of physical activity
Alcohol consumption
Advancing age
No childbirth or no breastfeeding
Family history of breast cancer
Early menarche (< 12 years of age) or late menopause ( > 55 years of age)
History of ovarian cancer or endometrial cancer
History of benign breast conditions (e.g. atypical hyperplasia) or lobular carcinoma in situ
Receiving hormonal replacement therapy (HRT)
History of receiving radiation therapy to the chest before age of 30
More importantly, you can lower your risk of having breast cancer by the following measures:

 Have regular physical activities, do at least 150 minutes of moderate-intensity aerobic physical activities per week (e.g. climbing stairs or brisk walking)
Avoid alcohol drinking;
Maintain a healthy body weight and waist circumference - aim for a body mass index (BMI) between 18.5 and 22.9, and a waist circumference of not more than 80cm for women; and
Have childbirth at an earlier age and breastfeed each child for longer duration factors include:
What are the common symptoms of breast cancer?

The symptoms of breast cancer may not be easily noticed at an early stage. Any of the following changes in the breast can be a symptom of breast cancer:

  Breast lump;

  A change in the size or shape of the breast;

  A change in skin texture of the breast or nipple (e.g. red, scaly, thickened or  orange-skin  appearance);

  Rash around the nipple;

  In-drawing of the nipple;

  Discharge from one or both nipples;

  New and persistent discomfort or pain in the breast or armpit; and

  A new lump or thickening in the armpit

What is breast cancer screening? Should I screen for breast cancer if I do not have any symptom?

Screening means examining people without symptoms in order to detect disease or fi nd people at increased risk of disease. It is often the fi rst step in making a defi nitive diagnosis. For breast cancer screening, its purpose is to fi nd women who have breast cancer, before they have any symptom, in order to offer them earlier treatment.

Mammography is widely used as a screening tool. It is an X-ray examination of the breasts. During mammography, the breast is pressed between 2 plates to flatten and spread the breast tissue, in order to obtain a clear image. Some women may find it uncomfortable or painful but the discomfort is usually short lasting. Mammography screening is safe in general and only a very small dose of radiation is used in the procedure. One in 5 female breast cancer patients may be missed by mammography.

Prevention and Screening for Breast Cancer: Information for women and their families

Breast cancer is a form of cancer which develops from the breast tissue. Breast cancer is indicated by signs such as a lump in the breast, changes in breast shape, fluid flowing from the nipple, dimpling of skin, or the development of red scaly patches. Breast cancer is a fatal form of cancer in women and immediate diagnosis is required on observing the symptoms.

Diagnosis of breast cancer
Other than the regular breast screening, the diagnosis of breast cancer involves the following steps and methods:

Seeing your general practitioner (GP): It is very important to visit your GP soon after noticing the symptoms of breast cancer. Your GP will examine you properly and in case your symptoms need more assessment, he/she will refer you to a breast cancer clinic.
Mammogram and breast ultrasound: You will be required to have a mammogram, as recommended by a specialist breast unit. This is an X-ray of the breasts. An ultrasound scan may also be required. Breast ultrasound should be undertaken only if you are less than 35 years of age. This is because, young women have denser breasts and a mammogram is not as effective as ultrasound in the diagnosis of breast cancer. In ultrasound, high frequency sound waves are used for obtaining an image of your breasts. It is observed to notice any abnormality or lumps. A breast ultrasound is also important for determining whether a lump is solid or contains liquid.
Biopsy: In this diagnosis process, a sample of the tissue cells is taken from the breasts and tested under a microscope to find out if it is cancerous. A scan and needle test for the lymph nodes present in your armpit is also done to check whether they have also been affected. A biopsy is undertaken in several ways, depending upon the condition and severity. A needle aspiration biopsy is used for testing a sample of your breast cells without the removal of the tissues. This is the most common form of biopsy and it is also used for draining a small fluid-filled lump or benign cyst. During the process, you will be given a local anesthetic. Usually, a needle biopsy is carried out guided by an X-ray, ultrasound and an MRI scan as well. This helps in distinguishing it from non-invasive changes such as ductal carcinoma in situ.
Another form of biopsy used for the diagnosis of breast cancer is called vacuum assisted biopsy or mammotome biopsy. In this process, a needle gets attached to a suction tube, which helps in obtaining the sample and for clearing the bleeding.

How Is Breast Cancer Diagnosed?

Breast cancer is a type of cancer, which occurs due to the development of cancerous cells in breasts. Women are usually affected by breast cancer and breast cancer is one of the most common forms of cancer after skin cancer. Usually fatal if not diagnosed in its early stage, breast cancer is a very serious medical ailment. Read on more to find all about the different symptoms, causes, preventive measures and treatment of breast cancer.

Symptoms
Breast cancer has few distinct characteristics and if you have a few or all the following symptoms you could be more likely to suffer from breast cancer. 
a) The formation of a lump in your breast, which is different from the surrounding tissue and usually more thickened.
b) The discharge of bloody fluid  material from the nipples.
c)  Sudden change of the size, shape and appearance of the breast.
d) Certain distinct changes to the skin over the breast for example an indentation in the skin similar to that of a dimple.
e) Appearance of an extra nipple which is inverted.
f)  If the darkened area around the nipples known as the areola is flaking or peeling off.
 
Causes
Studies and researches remain inconclusive on what causes breast cancer. Breast cancer occurs due to abnormal division of the cells located in the breast, which over time accumulate and form lumps. They
might spread to other parts of the body. Breast cancer is caused mainly due to a complex interaction of personal genetics, environment and lifestyle choices. Breast cancer can also be caused due to genetics as about 5% to 10% of cases are due to gene mutations which pass onto generations.

Risk factors
There are certain factors, which increase the probability of contracting breast cancer. Increasing age, personal and family history of breast cancer, obesity, radiation exposure, pregnancy at an older age, postmenopausal hormone therapy are some of the factors that increase the chances of breast cancer.

Treatment
Several forms of surgical methods exist to treat breast cancer. Depending on the condition and spread of the disease a suitable surgery is performed. These include mastectomy, lumpectomy, axillary lymph node dissection and removal of both breasts. Other forms of treatment include chemotherapy or the use of high doses of drugs to destroy cancerous cells. Radiation therapy where X-rays are used to destroy the cancer cells is also effective.

All About Breast Cancer

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!

Q1. What exactly is Laparoscopy?
Laparoscopy is an alternative to 'Open' surgery wherein the abdomen is opened by tiny 'key hole' incisions and surgery is done. 'Scopy' means the use of an endoscope or telescope to see inside the abdomen. This is attached to a camera and a light source and the inside of the abdomen is projected on to a monitor. The surgeon performs surgery looking at this screen. The surgeon makes a total of 2-4 small cuts on the abdomen ranging from half to 1 cm through which the telescope and other thin surgical instruments are passed into the abdomen. When the uterus is removed , known as hysterectomy, there is also a cut at the top of the vagina where the uterus is attached.
Q2. What kind of gynaecological surgeries can be performed by Laparoscopy?
Most surgeries done in gynaecology can now be performed by Laparoscopy and do not require the large incision as for open surgery. Laparoscopy can be done sometimes only for diagnosis and is called Diagnostic Laparoscopy, as in checking whether the tubes are open or not and to look for any causes of infertility or pain outside the uterus. In women who are unable to conceive, Diagnostic Laparoscopy is often combined with Hysteroscopy (endoscope inside the uterus, inserted from below, via the vagina). When laparoscopy is done to perform some surgical procedure inside the abdomen it is called Operative Laparoscopy. This may be for simple procedures like sterilization, minor adhesions, drilling ovaries; or for intermediate or major reasons like fibroids, endometriosis, removal of ovaries or tubes or both or removal of uterus, for staging of cancers or radical surgeries for cancer. However, about 5% of all surgeries including those for cancer or very large tumours may benefit from open surgery.
Q3. Why does an expert surgeon recommend Laparoscopy over Open Surgery?
Laparoscopic surgery has many advantages above open surgery: the incisions are much smaller (open surgery incisions are 8-10 cms long), therefore pain is much less; requirement for pain killers (which can have side-effects like sleepiness, impaired judgement) is lesser; hospital stay is shorter; complications fewer; requirement for blood transfusions infrequent; recovery in terms of physical, emotional and mental state is much better and quicker; return to work is faster with consequent lesser loss of working and earning days. Surgery with laparoscope is more precise because it is magnified view. Further vision is much better because it's like having your eye behind the structure because you can see with the telescope at places where the surgeon's eye cannot reach.
Q4. If the cuts on the abdomen are so small in Laparoscopic surgery, how do you remove the uterus or a large tumour from inside the abdomen?
Quite often if the tumour is not malignant and contains fluid, it is punctured to collapse it into a smaller size. If it is solid, it can be cut into smaller pieces inside the abdomen using a special instrument. The collapsed or cut structures can be removed gently through the 1 cm cut on the abdomen which may be increased a bit if required. After hysterectomy, the uterus can be removed easily from below, through the vagina.
Q5. Will there be much pain or discomfort after Laparoscopic Surgery?
There may be some pain and discomfort in lower abdomen for one day to few days after Laparoscopic surgery but this is much less as compared to open surgery because the incisions on the abdomen are much smaller and there is much less tissue handling inside the abdomen by fine instruments instead of rough, big, gloved hands which can cause tissue injury in open surgery. There may be some pain in the shoulder following laparoscopy. This is not serious and is due to the gas used in the surgery to make space for instruments.
Q6. When can I be discharged from hospital?
Following Diagnostic Laparoscopy or with simple Operative Laparoscopy you can expect to be discharged from hospital latest by the morning after surgery. In most other cases of intermediate or even major surgery, discharge is generally 1-2 days following the surgery unless there is some health issues prior to the surgery or any complication during the surgery. The complication rates for Laparoscopic surgery are not more than for open surgery and depend upon patient factors like anaemia, diabetes, obesity and skill of the surgeon.
Q7. When can I perform routine household activities or return to work after Laparoscopic Surgery?
Recovery after surgery depends upon many factors: presence of health problems before surgery; why the surgery is required; what surgery is being done; problems or complications of surgery, anaesthesia or blood transfusions. If all is well, one can perform routine household activities by 1 week, provided one doesn't feel tired. Although there may not be any harm, it may be unwise to be normally active within 48 hours of procedure. Following Diagnostic Laparoscopy or Operative Laparoscopy for simple procedures, one can return to work in 1 week. For other procedures, a 2-3 week off from work is reasonable. It depends on the type of work you are returning to. Avoid too rapid return to work if it is manually hard or requires standing for long durations of time. Sometimes a surgical procedure brings on a well needed rest and break from a lifetime of work. Mostly, when you return to work depends upon your own body and its signals of tiredness. You need to listen to those signals.


Know All About Gynae Laparoscopy Surgery

Don't wait any longer, manage your Pediatric Radiologist online with a Lybrate doctor today

Consult for Pediatric Radiologist - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES