Dr. Sucharita Jain

Uterine cancer, also known as endometrial cancer, occurs mostly to middle aged women. The uterus of a woman is a muscular organ. The cancer can affect any part of the uterus and is more common in women having obesity, diabetes and hypertension. In most cases, the cancer starts in the endometrium, hence called endometrial cancer. Uterine cancer can be cured using any of the following methods:

1. Surgical removal of the uterus along with ovaries, lymph nodes and fallopian tubes
2. Radiation therapy
3. Chemotherapy

Although uterine cancer is curable, it's always a better option to prevent it. You cannot control all the causes for uterine cancer like those related to heredity. But other than that, here are a few ways in which you can prevent suffering from uterine cancer:

1. Control body weight: Keep your body weight in control. Obesity can pose a huge risk of getting affected with uterine cancer. The fat in the body produces estrogen, which promotes the growth of uterine lining that is the Endometrium and may lead to Endometrium cancer.

2. Breast feed: If you are lactating, then the risk of the cancer decreases, as breast feeding decreases ovulation as well as estrogen activities.

3. Treat abnormal bleeding: If you are suffering from any type of abnormal bleeding, be that heavy periods, bleeding even after you reached menopause or if you start bleeding between two period cycles, consult your doctor immediately. Abnormal bleeding is the symptom of endometrial hyperplasia, which might eventually turn cancerous.

4. Exercise: As already said earlier, keep your weight under control to avoid uterine cancer. Exercise to avoid increase in weight leading to obesity. It also reduces the estrogen level in your body.

5. Healthy food: Healthy food is the key to avoid any disease, be that a common cold or uterine cancer. Eat a healthy and balanced diet everyday to be fit and bouncing. 

6. Birth control pills: It is believed that the intake of birth control pills helps to keep uterine cancer at bay.

So eat healthy, exercise and adopt healthy habits. Then nothing can stop you from enjoying life to the fullest. If you wish to discuss about any specific problem, you can consult a Gynaecologist.

Cancer of the kidneys is amongst the ten most common types of Cancer. There are many types of renal cancer with Renal cell carcinoma being the most common amongst them. Renal cancer is said to be triggered by a genetic mutation but the cause for this mutation is yet unknown. While kidney cancer appears suddenly in some cases, in others it is inherited from the parents. Here are 4 things you should know about cancer of the kidneys.

Risk Factors
Along with a mutation of the genes which is beyond our control, some lifestyle factors can also increase a person’s risk of suffering from renal cancer. Some of these factors are:

1. Smoking
2. Obesity
3. High blood pressure

Symptoms
An early diagnosis can make the treatment of renal cancer much easier than if it is left undiagnosed. Hence, it becomes important to recognise the symptoms of this disease. Common renal cancer symptoms include:

1. Blood in the urine
2. A lump on either side of the abdomen
3. Persistent pain on one side of the abdomen
4. Tiredness
5. Unexplained weight loss
6. Fever

These symptoms are common to a number of other diseases as well and hence if you experience them, it is best to get yourself checked out by a doctor. In order to confirm a diagnosis, your doctor is likely to ask for blood tests, urine tests, an ultrasound and a CT scan or an MRI. In most cases, your doctor will also schedule a biopsy to check for cancer cells in the kidney tissue.

Stages of kidney cancer
Once cancer has been diagnosed, your doctor will need to determine the extent of damage caused in order to find the best form of treatment for the disease. Stages of kidney cancer are determined by the size of the tumour and on how much it has spread from the original location. There are four stages of kidney cancer.
Stage I – When the cancer cells are restricted to the kidneys and the tumour is no bigger than 3” in diameter
Stage II – The tumour has grown bigger in size but is still restricted to the kidney
Stage III – The tumour may be big or small but has spread to at least one lymph node or has affected the blood vessels
Stage IV – The cancerous cells have spread to nearby lymph nodes or other organs or the tumour has grown through the fatty layer and outer fibrous layer of the kidney.

Treatment
Kidney cancer can be cured easily if detected in the early stages by removing the tumour and adjacent tissue or the entire kidney if need be. Removing one kidney is not fatal as a person can live a healthy life with a single kidney.

Renal cancer is also known as hypernephroma, renal cell carcinoma (RCC), kidney cancer or renal adenocarcinoma. The kidneys are organs in your body that dispose off waste, while additionally regulating fluid balance. There are small tubes in the kidneys called tubules. These filter the blood, help in discharging waste, and make urine. RCC happens when cancer cells start to grow out of control in the lining of the tubules of the kidney. Renal cancer is a progressive disease that spreads to the lungs and the organs around it.

Medical experts do not know the exact cause behind renal cancer. It is most commonly found in men between the ages of 50 and 70. There are some risk factors and signs that indicate one’s possibility of having renal cancer and these are as follows

1. Family history of renal cancer
2. Dialysis treatment
3. Hypertension or high blood pressure
4. Obesity
5. Smoking cigarettes
6. Polycystic kidney disease (a condition that causes cyst formation in the kidneys)

At a point when renal cancer is in its initial stages, patients might not see any symptoms. The symptoms are mainly seen in the later stages. Some of the most common symptoms are as follows:

1. Blood in urine: Blood in urine is called hematuria. As indicated by the Renal Cancer Association, hematuria is the most widely recognized indication of kidney cancer. In case you have blood in your urine, you may see pink, rust or even a red staining.
2. Lower back pain: The vast majority does not encounter pain until cancer is in later stages. Pain from renal cancer is felt on one side of the flank, the region over the pelvis, and beneath the ribs in the abdomen. This pain can go from a dull yearn to a sharp wound, frequently leaving the area blue. In case you have any sudden pain that continues for more than a couple of days, you need to see a specialist.
3. A mass or lump: A mass or protuberance in the abdomen can be an indication of renal cancer. Kidney knots might be hard to feel since they are somewhere down in the abdomen. Once a bump is found, your specialist may arrange symptomatic tests such as an ultrasound or a CT scan. These tests may diagnose what your knot might be.
4. Iron deficiency and fatigue: Weakness and a fall in your iron levels are the most common symptoms of any type of cancer. Cancer exhaustion is not quite the same as simply feeling tired.
5. Weight reduction, loss of appetite and fever: Another normal side effect of cancer is sudden and startling weight reduction. This happens quickly without any excessive workouts or dieting. A person diagnosed with cancer can also face a loss of appetite. In fact, even their most loved food items can get to be unappealing. Frequent fever is yet another common symptoms among most cancer patients.

In case your specialist suspects that you may have renal cancer, they will take some information about your and family’s medical history. They will then do a physical exam. Discoveries that can show renal cancer include swelling or irregularities in the stomach area. In case of men, augmented veins in the scrotal sac (varicocele) may be found. In case you have a concern or query you can always consult an expert & get answers to your questions!

Breast cancer begins when cells in the breast(s) start to grow out of control. It is understood as being the most common cancer, seen predominantly in females, globally. It is reasonably treatable and often curable.

1. Type: Adenocarcinomas constitute more than 95% of breast cancers with infiltrating ductal carcinoma (IDC) being the most common form of invasive breast cancer.

Frequently occurring breast cancers present as one of the following types mainly

1. Ductal Carcinoma In Situ (DCIS): Is the most common type of non-invasive breast cancer and is confined to the milk ducts of the breast. There is no invasion in the basement membrane. Pure DCIS metastasizes rarely. Non comedo cribrioform carcinoma is the most common DCIS found which, when compared to the comedo type, is mostly non-aggressive.

2. Infiltrating Ductal Carcinoma (IDC): Represents majority (about 3/4th) of the breast cancers, and is known to metastasize commonly to bones, lungs and liver.

3. Lobular Carcinoma In Situ (LCIS): Develops in multiple lobules of the breast (bilaterally). LCIS is less commonly seen, compared to DCIS.

4. Infiltrating Lobular Carcinoma (ILC): Represent about a tenth of all breast cancers and tends to metastasize to other regions of the body.

Less commonly occurring breast cancers such as

5. Inflammatory Breast Cancer: Is relatively uncommon and are caused probably owing to viral infections. The breast is warm, red and swollen.

6. Paget’s disease of the nipple: Is a rare form of breast cancer. It begins in the milk ducts and spreads to the nipple and areola.

7. Medullary Carcinoma

8. Mutinous Carcinoma

9. Tubular Carcinoma

10. Phylloides tumor etc all.

2. Gender: Affects the female populace predominantly. However, a small percentage of breast cancer is attributable to the male populace as well.

3. Etiology: No definite cause is known. However, diet, lifestyle, environment, hormonal/ reproductive factors, personal or family history of breast cancer especially in first degree relatives and also any benign breast disease history etc all are known to increase the risk of breast cancers. Specifically, excessive fatty diet, obesity, type 2 diabetes mellitus, benign breast disease, heredity/ inheritance of mutated breast cancer genes 1 (BRCA1) and 2 (BRCA2), smoking, alcohol intake, infertility, estrogen therapy/ hormone replacement therapy (long term) in post menopausal women, delayed age at first pregnancy, nulliparity (not having child), early menstruation, delayed onset of menopause, lactating mothers not breast feeding, exposure to ionizing radiation, sedentary lifestyle, depression, exposure to MMTV virus etc all can potentially increase the risk for breast cancer.

4. Features: Signs & symptoms, of breast cancer, manifest majorly in the following ways

1. Lump/ nodule in the breast that gets attached to the skin of the breast over time. The lump / nodule could be hard and painless with irregular edges or it could also be soft, rounded, tender and painful.

2. Enlarged lymph nodes in the axilla which are palpable.

3. Swelling of whole or a part of a breast. This is even if there is no distinct lump felt.

4. Retraction or thickening of the nipple(s).

5. Pain in the breast or nipple.

6. Discharge from nipple other than breast milk.

7. Irritation/ scaliness of skin over the breast.

8. Redness of nipples

9. Rarely, red, swollen and tender breast.

5. Screening: Is generally recommended for asymptomatic populations goal of which, as usual, is to be able to detect & diagnose breast cancer at an early stage which is potentially curable. It is mostly radiologic with mammography/ USG being instrumental in raising suspicions for further diagnostics (i.e. biopsy) that help detect breast cancer, if any, early.

6. Diagnosis: A self-examination/ clinical exam of the breast(s)/ axilla that reveals a palpable mass prompts the following diagnostics. Abnormal blood test results may be indicative of malignancy, but a follow up imaging/ biopsy is always the gold standard for accurate diagnosis.

1. Blood: ER/ PR/ HER2/neu, uPA, PAI-1, CA15-3, CA27.29 etc all tumor markers are helpful.
2. Imaging: Mammography/ USG Scan usually, as relevant. Again, CT Scan of abdomen & pelvis and chest, PET CT scan, bone scan etc all help detect metastasis, if any, for cancers in stage III & above.
3. Biopsy: either excisional, incisional, fine needle aspiration (FNA) or core biopsy technique, as contextually appropriate, is frequently employed and a histopathological examination (HPE) thereof clinches the diagnosis and the nature of the disease.

7. Treatment: Conventional treatment includes surgery, radiotherapy, hormone therapy/ chemotherapy as deems 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 is key for an effective therapeutic management & better prognosis. Like most other cancers, the chances of cure for an early stage breast cancer are more. The cure/ recovery chances are influenced by the type, grade, stage of cancer, recurrence and the patient’s general health & vitality etc all. Above-mentioned apart, age, menopause status, lymph node status, ER/ PR/ HER-2/ neu status, size & extent of breast cancer etc all also influence the treatment outlook in breast cancer. The five year survival rate is strongly correlated with the stage of breast cancer.

9. Prevention: Rightly said, prevention is always a better choice. Although genetic risks are difficult to modify, still an increased focus on protective factors and avoidance of the risk factors can be of help. An adherence to a Mediterranean diet, maintaining an ideal body weight and an active lifestyle with due emphasis on regular exercising (for at least 30 minutes daily), de-stressing and relaxation is highly recommended for reducing the risks of breast cancer. A healthy eating plate comprises essentially a low fat diet, fibre rich foods including whole grain cereals, green leafy vegetables cooked using healthy vegetable oils, fresh fruits of all colours as seasonally available and healthy proteins/ fats including fresh fish, poultry, beans, nuts etc all. It is advisable to limit milk/ dairy, preferably of low fat content, to 1 to 2 servings max daily. Although alcohol is optional and is not for everyone, the consumption of the same, if any, has to be strictly in moderation, and is best avoided. Smoking is to be avoided as well. Again, red meat, butter, refined grains, sweets, sugary drinks including carbonated beverages and other high calorie foods etc all, if any, are to be taken sparingly or are best avoided too. Limiting dosage/ duration of hormone therapy, if any, especially to counteract post menopausal symptoms and also avoiding exposure to radiation and environmental pollution can help reduce the risks of breast cancer. Apart from the above-mentioned, for high risk cases, a prophylactic oophorectomy, prophylactic radical mastectomy, long term hormone therapy etc all can help reduce the chances/ risks of developing breast cancer significantly. Breastfeeding is known to confer protection against breast cancer risk too.

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 

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

Outcome 

1. PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
2. 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.
3. PVP does augment height of VB but ideal would be kyphoplasty.
4. Patient is either off medicine or on reduced doses.
5. Patient feels so well that he almost forgets if he had VB

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