Meenakshi Pain Management Centre

With the dawn of modern technology, the sight of robots performing a surgery is fast turning into a reality. Robotic surgery is one of the latest and greatest advancements in surgical cancer care. It is mostly sought for its unmatched levels of precision and control.

The da Vinci Robot, which is a widely used robotic surgery, employs the use of 3D modelling, touch screen controls, ultra-modern surgical attachments and other robotic tools. This surgical method is one of the greatest inventions in modern surgery that aims to provide greater control to the surgeon at all times. For patients, this means quicker recovery times, minimal scarring, lower complications and higher satisfaction.

Robotic cancer surgery can be performed under the following conditions:

1. Prostate cancer
2. Bladder cancer
3. Gynaecologic cancer
4. Endocrine cancer
5. Lung cancer
6. Gastrointestinal cancer

Benefits of robotic cancer surgery:

1. Less scarring: The minimally invasive approach of robotic surgery contributes to minimal scarring. Instead of having a deeper incision of up to 5 or 6” on the skin, patients can have a series of small incisions or one relatively smaller incision, based on the nature of the surgery.
2. Shorter hospitalization: With minimal incisions, postoperative care is speeded and pain is lessened. This surgery will not require the patients to stay for a prolonged period of time in the hospital. At the most, they tend to spend up to two nights in the hospital, if the situation demands so. As a result of this, within no time, you can get back to your normal life.
3. Less drugs: With traditional surgery, typically a patient is administered a lot of painkillers to alleviate pain. However, with robotic surgeries, thanks to decreased postoperative pain after surgery, the patient will not need excessive painkillers to help them deal with pain.
4. No blood loss: During traditional open surgery, patients tend to typically lose between 600cc to 1000cc of blood, depending on the area of treatment. As a result, postoperative transfusion of blood becomes a necessity. However, during robotic surgery, blood loss is usually 200cc or less and so there is no need for transfusions.
5. Accuracy and precision: The 3D modelling techniques and other advanced tools employed by robotic surgery allows for better planning and accuracy, which is greatly needed in cancer surgeries. Especially in the case of prostate cancer, if the tumour is in a critical location, then a robotic surgery is handy to carry out the procedure, without damaging the important nerves of erections.

How to do Self-Breast Examination?

The best time to do your Breast self-examination is while having a shower. Soap your hands and body, then use the flat of your fingers and move them over the breasts step by step as indicated below:-

Step 1: Look at your breasts in the mirror with your shoulders straight and your arms on your hips. Observe the size, shape and colour of the breasts. Look for any deviation from normal – any visible distortion or swelling should be immediately brought to the doctor’s attention. Also, look for the following changes:-

• Dimpling or small depression on the breast
• Change in nipple position or inversion of nipple (nipple being inward instead of sticking out)
• Redness, soreness, rash, or swelling

Step 2: Raise your arms and look for the same changes. Sometimes, the changes in size and shape are more evident in this position.

Step 3: Look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, a yellow or bloody discharge). Gently squeeze the nipples to check for discharge and observe the colour of the discharge.

Step 4: Lie down and feel your breasts using your right hand to feel your left breast and then your left hand to feel your right breast.

• Use a firm, smooth touch with the finger pads of your hand (ring finger, middle finger and index finger), keeping the fingers flat and together.
• Use circular motion (each motion measuring about the size of a coin) to palpate* the breasts.
• Cover the entire breast from top to bottom, side to side – from your collarbone to the top of your abdomen, and from your armpit to your cleavage.
• Follow a pattern (either horizontal – side to side or vertical – up and down) to be sure that you cover the whole breast.
• Squeeze the nipples and observe if there is any discharge.

Step 5: Repeat step 4 in standing and sitting position.

Fact- A woman who detects a lump on Self Breast Examination should undergo a mammogram [(if above 40 years of age) or an ultrasound (if she is below 40 years of age)].

Oral cancer is the name given to cancer that develops in the tissues of the mouth or oral cavity. If you interact with a specialist, you will know that oral cancers belong to a larger group of cancers called head and neck cancers. And more importantly, oral cancers are one of the most preventable cancers. You may already be aware that cancers develop when cells begin to divide indiscriminately forming malignant tumors. In oral cancers, the dividing cells are the ‘squamous’ cells found in the lining of your mouth, tongue, and lips.

India is the oral cancer capital of the world and almost half of the total nber of oral cancers in the world happen in our country. Also, oral cancers have a high local failure rate and are therefore beat treated by surgery and radiotherapy in most cases.

An implausible fact about oral cancers is that these are most often discovered after they have spread to the lymph nodes of the neck- which means at the stages III and IV. All cancers including oral cancers become more difficult to cure at these later stages. This is why early detection is key to surviving oral cancer.

Types of oral cancers

1. Oral cancers, to be precise, including cancers of the:
2. Lips
3. Tongue
4. Gums
5. Cheek
6. Floor of the mouth
7. Roof of the mouth, including hard and soft palate

Usually, it’s your dentist who is the first to notice the first signs of oral cancer.

Risk factors
Tobacco use is the biggest risk factor for oral cancer. Tobacco includes smoking cigarettes, cigars, hookahs, and pipes, as well as chewing tobacco. Alcohol is another big risk factor. So, if you are one of those heavy drinkers, be aware of the scourge of oral cancer and get yourself tested periodically to rule out this killer. The risk for oral cancer also increases exponentially when both alcohol and tobacco are used together.

Other important risk factors are:

1. HPV infection i.e. human papillomavirus is a sexually transmitted virus that spreads through unprotected vaginal as well oral sex
2. Chronic sun exposure on the face, especially the lips
3. Family history of oral or other types of cancer
4. Men are more susceptible to oral cancers
5. Being older than 45
6. Radiation exposure
7. Having any other form of head and neck cancer

Symptoms of oral cancer

1. Sore lip or mouth that is not healing
2. Any growth inside your mouth
3. Bleeding from the mouth, including jaws
4. Loose teeth
5. Difficulty or pain while swallowing
6. Major trouble wearing dentures
7. A lump in neck or cheek
8. Chronic earache
9. Serious weight loss
10. Numbness in lower lip, face, neck, or chin
11. Any colored patch in the mouth or lips

Diagnosis of oral cancer

1. Diagnosis starts with a physical exam of your mouth. The physician will examine the roof and floor of your mouth, the back of your throat, tongue, and cheeks, and the lymph nodes in your neck.
2. If your doctor finds any tumor, growth, or suspicious lesions in your mouth, she/he will perform a biopsy to collect cells from a tumor. This tissue is then examined for cancerous cells.
3. Other tests include X-rays to see if cancer cells have spread to your jaw, chest, or lungs; a CT scan to check for and reveal any tumors in your mouth; PET scan to see whether the cancer has traveled to the lymph nodes or other organs like the lungs.

Prevention

1. An excess of sun exposure on your face and lips increases the risk of oral cancer so you can start reducing the danger of getting this cancer by using a lip balm or cream with SPF regularly.
2. Another way to reduce risk is alcohol and tobacco cessation.
3. Eating a balanced diet containing fruits and vegetables
4. Removing your dentures at night and using them the next day only after cleaning them
5. Visiting your dentist on a regular basis so that she/he can warn you about any alarming change in your mouth.

Treatment 

Oral cavity cancers are these days treated with Image-guided intensity modulated radiation therapy (IGRT with IMRT). In this form of radiation therapy, the dose of radiation is focused only to organs at risk with sparing of critical swallowing neural and speaking structures. It also saves important organs like salivary glands and eyes etc. This has a huge impact on quality of life outcomes of patients. At the very least it decreases immediate problems that occur during radiation therapy and leads to better long-term outcomes such as it decreases the risk of mouth and closure non - healing ulcers, etc.

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