The division of thoracic oncology primarily treats patients with all thoracic malignancies such as tumours of the lung, esophagus, mediastinum and chest wall. It also serves patients with pulmonary metastases from other cancers. Most patients require multidisciplinary treatment. Based on the latest available evidence, the patient is offered surgery (including minimal invasive surgery to improve operative outcomes) or a combination of chemotherapy/radiation therapy and surgery. In the near future, patients will also be able to participate in clinical trials.
For cancer of the esophagus and cardia, surgery is the standard of care for medically fit patients. Patients with locally advanced disease are downstage with chemotherapy or a combination of chemo and radiation therapy and are then re-assessed for surgery. Patients with advanced cancer and poor general condition are palliated with a self-expanding stent. Esophageal surgery is one of the most complex procedures, best performed by a specialist in a well-equipped center. The surgeon in this division performs oesophagectomy using the minimally invasive surgical technique which has the potential to improve the operative outcomes.
Surgery provides the best chance of cure for early stage lung cancer. Surgical options include lobectomy, sleeve lobectomy and pneumonectomy. In patients with compromised lung function, segmentectomy or wedge resection is an option in selected cases. To improve the operative outcome, surgery can be performed using the video-assisted thoracoscopic technique in cases where indicated. Mediastinal adenopathy is not a contraindication for surgery as many of these patients can be downstaged by induction chemotherapy. Patients with locally advanced cancer, such as those with invasion of the chest wall, vascular structures and tracheo-bronchial tree, can be considered for aggressive surgical approaches. Patients with advanced stage disease are treated with a combination of chemotherapy, radiation, and pleurodesis and are provided supportive care, including management of cancer pain.
The division is capable of performing complex surgical procedures for lung pathology, including VATS. The centre can also treat small lung cancers with precise radical radiation in patients with compromised lung functions.
Tumours of the mediastinum are rare and require skilled radiologists and surgeons for proper diagnosis, staging and treatment. The centre has facilities for image-guided biopsy, mediastinoscopy, transbronchial biopsy and thoracoscopy for diagnosis and surgical management. Thoracoscopic thymectomy is a good approach for the treatment of myasthenia gravis when surgery is indicated. It does away with sternotomy and reduces hospital stay.
Chest Wall Tumours
Surgery is the treatment of choice for sarcoma and is also indicated in round cell tumours after chemotherapy. Resection of multiple ribs requires reconstruction with mesh and cement.
Patients with pulmonary metastases are candidates for surgery if the primary is controlled or controllable and is the only site of metastases. Patients with solitary metastases can be managed with VATS. Those with bilateral metastases can be managed with the clamp shell approach.
Tumors of the Airway (Trachea and Bronchus)
These tumours can be treated by surgery when indicated and many others can be managed endoscopically with laser or thermal excision-fulguration. Tumours which are advanced are treated with radiation (including intraluminal) therapy.
This is a relatively rare tumour. Most patients present with advanced stage disease and are treated with chemotherapy (pemetrexate/platinum). In patients who have limited or localised disease, pleuro-pneumonectomy is the preferred treatment.
Most people are aware that severe chest pain, especially after excretion may be a symptom of a heart attack or angina. Many who suffer this seek medical help. It is also widely known that heart attacks can be prevented by medication, angioplasty & stenting or by coronary artery bypass.
Majority of people are not aware that most paralytic strokes have a similar cause as a heart attack i.e. a blocked or narrowed artery! In fact the term Brain attack is an apt way of describing this. It is not common knowledge that strokes can, like heart attacks, be prevented by medication, surgery or sometimes angioplasty.
Many of us would have had a relative, acquaintance or friend who has unfortunately had a stroke and no treatment other than medicines and physiotherapy was offered!
Many of those who suffer a stroke usually would have suffered from a "mini stroke" (temporary loss of the use of an arm or leg or slurring of speech or temporary sudden blindness in one eye).This is a warning sign for an impending stroke and is equivalent to angina when comparing stroke to a heart attack.
If surgery to unblock the blocked artery is done at the time of the first warning sign many of these disabling or fatal strokes can be prevented.
India unfortunately has one of the worst records in the world for the prevention of stroke. This is because of a depressing lack of awareness among the public as well as the doctor community.
The surgery done to prevent a major stroke can, unlike a cardiac bypass, be done under a local anaesthetic and the patient is usually fully fit for discharge in a day or two. The cost implications for this surgery is also low, compared to a cardiac bypass, and when compared to looking after somebody with paralysis!
How do I know if somebody is having a stroke or mini stroke?
It is very easy to make out is somebody is developing a stroke or mini stroke.
Just remember FAST.
F : Has their face fallen to one side? Can they smile?
A : Arms, can they raise both arm and keep them there?
S : Speech, is their speech slurred?
T : Time to seek urgent medical help
Sometimes sudden blindness in one eye that recovers soon can also be a sign of a mini stroke.
FATTY LIVER - Facts at a Glance
- A fatty liver is caused by the build-up of excess fat in the cells of the liver.
- If fat accounts for more than 5-10% of your liver's weight, then you have a fatty liver.
- People tend to develop a fatty liver if they have certain other conditions, such as obesity, diabetes or high triglyceride levels.
- About 10-20% of Indians suffer from fatty liver disease.
- If your liver is inflamed, over time it can develop into liver cirrhosis and eventually lead to liver failure.
- People can have an inflamed or fatty liver for many years without experiencing any symptoms.
- The liver, which is one of the largest organs in the body, is very complex and performs many important functions. These include:
- Breaking down food (to be stored as energy)
- Storing vitamins, iron and other minerals
- Making proteins, including blood clotting factors, to keep the body healthy and to help it grow
- About 10-20% of Indians suffer from fatty liver disease.
- Making bile, which is needed for food digestion
- Metabolizing or breaking down medication and alcohol
- The liver works very hard to keep the body healthy and, most often, it does not give any warning signs to let you know that it is damaged. Certain conditions that develop, such as fatty liver disease and steatohepatitis, may be signs of liver injury and can lead to permanent liver damage, which must be taken seriously.
What is Fatty Liver disease?
- As the name suggests, fatty liver disease occurs when there is a build-up of excess fat in the cells of the liver. It is normal for your liver to contain some fat. But, if fat accounts for more than 5-10% of your liver's weight, then you have a fatty liver. This can lead to more serious complications.
- What are the causes of Fatty Liver disease?
- Fatty liver disease may cause no damage, but sometimes the presence of excess fat leads to the inflammation of the liver. This condition, which is called non-alcoholic steatohepatitis or NASH, causes liver damage. An inflamed liver may become scarred and hardened over time. This condition, which is called cirrhosis, is serious and often leads to liver failure.NASH is one of the top three leading causes of cirrhosis.
- About 10-20% of Indians have fatty liver disease about 2-5% have nash
What are the symptoms of Fatty Liver disease?
- A fatty liver produces no symptoms on its own. So, people often learn that they have a fatty liver when they go for medical tests for other reasons. NASH can damage your liver over years or even decades without causing any symptoms. If the disease gets worse, you may experience weakness, weight loss, fatigue, swelling of the abdomen or edema feet, vomiting (blood),or even confusion. People can have NASH for many years without symptoms, even though liver damage may still be occurring.
How is Fatty Liver disease diagnosed?
- Your hepatologist (liver specialist) may see something unusual in your blood test or notice that your liver is slightly enlarged during a routine check-up. These could be signs of a fatty liver.
- To make sure you don't have any other liver disease, your hepatologist (liver specialist) may ask for more blood tests, an ultrasound, a CT scan or even an MRI.
- If other diseases are ruled out, you may be diagnosed with NASH. The only way to know for sure is to get a liver biopsy done. During a liver biopsy, the hepatologist (liver specialist) takes a sample of the liver tissue with a needle and examines it under a microscope. Liver biopsies are performed only when absolutely necessary.
How is Fatty Liver disease treated?
- If you have fatty liver disease or NASH, you should:
- Lose weight
- Lower your triglyceride levels by controlling diet, medication or both
- Avoid consuming alcohol.
- Keep a control on diabetes (if you have it).
- Maintain a balanced, healthy diet.
- Increase your level of physical activity.
- Go for a health check-up on a regular basis.
- Get a hepatologist to guide you with your dietary and medical treatment