Archive for February, 2020

Causes, Risk Factors & Symptoms of Cervical Cancer

Thursday, February 27th, 2020
What causes Cancer Cervix?

The causative factor for cervical cancer is a virus called Human Papilloma Virus (HPV), which causes over 99% cases of cervical cancer. This virus is transmitted through sexual contact. There are over 90 types of HPV viruses which have been identified. These are categorized into Low risk /high risk depending on there ability to cause cervical cancer. Women with persistent infection with High risk types are likely to develop cervical cancer

What are risk factors for developing cervical cancer?

Sexual intercourse at an early age, multiple sexual partners, multiple childbirth, smoking and weakened immune system are known risk factors associated with the development of cervical cancer.

Is it preventable?

Cervical cancer is definitely preventable, as there is an effective screening test available to detect precancerous changes which can be treated and progression to cancer can be stopped.

What is screening?

Screening is looking for cancer before you have symptoms. It is a test which helps us to diagnose the precancerous changes or cancer early and hence the disease can be treated more effectively.

What are the screening tests available for cervical cancer?

Worldwide cervical cytology (Pap smear) is used as a screening test for cervical cancer.

Current evidence also points effectiveness of HPV- DNA testing as a screening test for cervical cancer.

What is a Pap smear test?

It is a simple outpatient procedure in which cells will be collected from the cervical surface by scrapping and will then be evaluated by Pathologist to see if abnormal cells are present. Depending on the result further evaluation is planned.

When should I get myself tested?

As per international recommendations, one should start getting regular Pap tests at age 21, or within three years of the first time you have sex, which ever happens first. The Pap test is one of the most reliable and effective cancer screening tests available.

It is vital for women over 30 yrs to be part of the screening programme. The screening initially is done at yearly interval and after three negative smears the interval can be increased. It is also important to follow-up results of the test, after you have done a Pap smear

What are the signs and symptoms of cervical cancer?

Following are some of the symptoms of cervical cancer: –

  • Abnormal bleeding-.
  • Unusual heavy discharge-
  • Pelvic pain
  • Pain during urination-
  • Bleeding between regular menstrual periods, after sexual intercourse or douching.

Preserving Fertility After a Cervical Cancer Operation Is Possible

Thursday, February 27th, 2020

An anxious 29 yrs old lady walked in my clinic with her husband and family members. She was recently diagnosed with cervical cancer and was advised surgery, which would essentially render her infertile (As conventional surgery for cervical cancer requires complete removal of uterus). As she was childless was very keen to know if, any surgical option is available, which can preserve her fertility. Fertility preservation surgery (Radical Trachelectomy) is an accepted treatment for cervical cancer, but there are strict criteria to identify eligible patients.

After counseling and examination, we started evaluating this patient to identify, if she was a suitable candidate for fertility preserving surgery, which included MRI to note the extent of size and spread. After completion of all necessary tests, she was identified as a suitable patient for radical trachelectomy.

Radical trachelectomy is a surgery in which only the diseased cervix along with lymph nodes are removed, leaving behind the upper part of the uterus which is then sutured with vagina. Also whenever possible this should be done by a minimally invasive (Keyhole) approach, so the handling of tissues during surgery is less and hence problems for future conception are avoided. The Robotic assisted surgery works best in this situation as the suturing of the uterus with vagina can be extremely difficult and the endowrist instruments with magnified 3D vision makes this part of the procedure as well as the dissection extremely safe and effective. At Kokilaben Dhirubhai Ambani Hospital,

We discussed and counseled the patient and her husband about the surgery and the advantages of using Robotic platform. She underwent Robotic Radical trachelectomy with bilateral pelvic lymph node dissection at Kokilaben Dhirubhai Ambani Hospital and Research center .. Her postoperative recovery was uneventful and was discharged from the hospital on 5th Postoperative day. She will be closely observed for a period of 1 year and then if things are fine she can attempt pregnancy.

Cervical cancer is the most common Genital tract cancer seen in Indian women with an incidence on 22.9/100000 women. Every year over 122000 new cases are diagnosed in India and almost 67000 women die every year because of this disease. Radical trachelectomy is an established surgery for early stage cervical cancer for women who desire future fertility.

Unfortunately in India, women do not present early hence there are not many patients who can undergo this operation. This was second such case operated at our hospital. The first case was a 4-year-old girl diagnosed with cervical cancer. Robotic assisted surgical platform is of great help in performing these surgeries as, the technology allows you to overcome some of the problems you face when you do these complex surgeries and also help patient recover fast postoperatively.

In the end it was great to see smile back on her face, not only relieved of all the stress and anxiety regarding her cancer treatment, but also being able to preserve her ability of being a mother.

Dr Yogesh Kulkarni,
Consultant, Gyn Oncology & Robotic Surgeon
Kokilaben Dhirubhai Ambani Hospital. Mumbai
M: 93215427311


Pain Management

Monday, February 24th, 2020

Are you always in pain?

Does pain rule your life?

Does it limit your personal and professional life?

Pain can be debilitating and frustrating. It may interfere with sleep, work, activities and quality time with friends and family. Globally, it is estimated that about one in five, or about 1.5 billion people, suffer from chronic pain. Pain management provides relief so you can lead a normal life. But pain management can be complex and needs specialists for correct diagnosis and safety monitoring.

Types of Pain

The occurrence of pain rises as people get older, and women are more likely to experience pain than men.

There are two main types of pain.

  • Acute Pain – a normal response to an injury. It starts suddenly and is usually short-lived.
  • Chronic Pain – continues beyond the time expected for healing. It generally lasts for longer than three months.

Pain may be anything from a dull ache to a sharp stab and can range from mild to extreme. You may feel pain in one part of your body or it may be widespread. Studies suggest that a person’s emotional wellbeing can impact the experience of pain. Understanding the cause and learning effective ways to cope with your pain can help improve your quality of life.

Pain Management Specialist

A pain management specialist is a physician with special training in the evaluation, diagnosis, and treatment of all different types of pain. Pain is a wide spectrum of disorders including acute pain, chronic pain, and cancer pain and sometimes a combination of these. As the field of medicine learns more about the complexities of pain, it has become more important to have physicians with specialized knowledge and skills to treat these conditions. An in-depth knowledge of the physiology of pain, the ability to evaluate patients with complicated pain problems, understanding of specialized tests for diagnosing painful conditions, appropriate prescribing of medications to varying pain problems, and skills to perform procedures (such as nerve blocks, spinal injections and other interventional techniques) are all part of what a pain management specialist uses to treat pain.

Causes of Pain

Here are the most common conditions when pain management is needed:

  • Cancer pain.
  • Post-operative pain.
  • Low back pain.
  • Neck pain.
  • Headache / Migraine.
  • Knee pain and joint pains.
  • Muscle pain.
  • Sports injury pains.
  • Post-stroke pains.
  • Any pain with more than 1-3 months duration, not relieved by medicines or exercises.
How is Pain Treatment Guided?

The treatment of pain is guided by the history of the pain, its intensity, duration, aggravating and relieving conditions, and structures involved in causing the pain. Pain management has a role in identifying the precise source of the problem and isolating the optimal treatment.

Pain Management Techniques

Pain management can be simple or complex, depending on the cause of the pain. Sometimes it requires a variety of skills and techniques to treat the pain. Key pain management strategies include:

  • Pain-relieving medicines.
  • Physical therapies such as heat or cold packs, massage or hydrotherapy.
  • Psychological therapies such as cognitive behavioural therapy.
  • Occupational therapy.
  • Interventional procedures.
  • Physical therapy or chiropractic therapy.
  • Psychological counselling and support.
  • Acupuncture and other alternative therapies.
Pain Medicines

Many people will use pain medicine (analgesic) at some time in their lives. This may be paracetamol, non-steroidal anti-inflammatory drugs, local anaesthetics or some antidepressants.

Pain Block

A pain block is a treatment by injection around the specific nerve responsible for your pain. These injections are done under local anaesthesia, usually in an operation theatre. There is almost 100% accuracy because the exact point of injection is confirmed using either X-ray, Ultrasound or CT scan guidance.

Meet specialists at our Department of Pain Management and Palliative Care. They are equipped with advanced pain blocks like Radiofrequency Ablation, Nucleoplasty, Spinal Cord Stimulators, Intrathecal Pumps, etc., which help treat specialised pain conditions like Post Back Surgery Pain Syndrome, Trigeminal Neuralgia and Advanced Cancer Pain.

Epilepsy Awareness

Monday, February 10th, 2020

Epilepsy is a chronic non-communicable disease of the brain that affects around 50 million people worldwide. It is characterized by recurrent seizures, which are brief episodes of involuntary movement that may involve a part of the body (partial) or the entire body (generalized). Seizure episodes are a result of excessive electrical discharges in a group of brain cells. Different parts of the brain can be the site of such discharges. Seizures can vary from the briefest lapses of attention or muscle jerks to severe and prolonged convulsions. Seizures can also vary in frequency, from less than 1 per year to several per day. It is estimated that there are more than 10 million persons with epilepsy (PWE) in India.

Epilepsy Symptoms

The main symptom of epilepsy is recurrent seizures. However, if a person experiences one or more of the following symptoms, they should seek medical attention, as it may indicate epilepsy:

  • a convulsion with no fever.
  • short blackouts or confused memory.
  • sudden stiffness for no apparent reason.
  • sudden falling for no apparent reason.
  • intermittent fainting spells, during which they lose bowel or bladder control, frequently followed by extreme tiredness.
  • temporary unresponsiveness to instructions or questions.
  • peculiar changes in senses, such as smell, touch, and sound.
  • jerking arms, legs, or body, which will appear as a cluster of rapid jerking movements in babies.
Causes of Epilepsy

Epilepsy has no identifiable cause in about half the people with the condition. In the other half, the condition may be a result of:

  • Hereditary factors.
  • Head trauma.
  • Prenatal injury.
  • Developmental disorders.
  • Brain damage like stroke or brain tumours.
  • Infectious diseases like meningitis or AIDS.
Key facts about Epilepsy
  • Epilepsy is a chronic non-communicable disease of the brain that affects people of all ages.
  • Nearly 80% of people with epilepsy live in low- and middle-income countries.
  • It is estimated that up to 70% of people living with epilepsy could live seizure-free if properly diagnosed and treated.
  • The risk of premature death in people with epilepsy is up to three times higher than for the general population.
  • In many parts of the world, patients with epilepsy suffer from stigma and discrimination.
Epilepsy Diagnosis

A doctor will review an individual’s medical history and the symptoms they have experienced, including a description and timeline of past seizures, to diagnose epilepsy. Several types of imaging test, as well as neurological tests are used to diagnose epilepsy and find the type of it.

Epilepsy Medication

Most people with epilepsy can become seizure-free by taking one anti-seizure medication, which is also called anti-epileptic medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications.

Epilepsy Surgery

When medications fail to provide adequate control over seizures, surgery may be an option. With epilepsy surgery, a surgeon removes the area of your brain that’s causing seizures. Doctors usually perform surgery in the below scenarios:

  • Your seizures originate in a small, well-defined area of your brain.
  • The area in your brain to be operated on doesn’t interfere with vital functions such as speech, language, motor function, vision or hearing.
Epilepsy Myths and Facts

Myth 1: If you’ve had a seizure, you have epilepsy.

Fact: A person is diagnosed with epilepsy when he or she has two or more unprovoked seizures, that occur more than 24 hours apart. But when something provokes a seizure, such as a binge drinking or sleep deprivation these are not related to epilepsy.

Myth 2: People with epilepsy are mentally ill or emotionally unstable.

Fact: Epilepsy is an umbrella term covering many types of seizures and epileptic disorders. It is a functional, physical problem, not a mental one, and it has many unidentifiable causes.

Myth 3: It’s easy to tell when a seizure is about to happen.

Fact: One cannot predict when seizures are beginning. However, once patients are aware of the seizure triggers they can avoid such situations.

Myth 4: Seizures hurt.

Fact: A person is unconscious and not in any pain during most seizures. However if the person falls down or has bit their tongue, they may experience discomfort.

Myth 5: Epilepsy is most common in children.

Fact: Epilepsy is most common in both the very young and the elderly. However, this disease can develop at any age.

Myth 6: You should force something into the mouth of someone having a seizure.

Fact: That is not true. Never put anything into a person’s mouth if they are having a seizure. This could injure them. Roll the person on one side, keep him or her a safe distance from any nearby objects, and let the seizure run its course.

Are you or a loved one suffering from Epilepsy? Seek expert help from our neurologists at our Centre for Neurosciences. Please find the below link for more details:

World Cancer Day

Tuesday, February 4th, 2020
What is Cancer?

Cancer is a broad term. It describes the disease that results when cellular changes cause the uncontrolled growth and division of cells. Some types of cancer cause rapid cell growth, while others cause cells to grow and divide at a slower rate. Certain forms of cancer result in visible growths called tumours, while others, such as leukaemia, do not.

Cancer statistics in India
  • One woman dies of cervical cancer every 8 minutes in India.
  • For every 2 women newly diagnosed with breast cancer, one woman dies of it in India.
  • Mortality due to tobacco use in India is estimated above 3500 persons every day.
  • Tobacco (smoked and smokeless) use accounted for 3,17,928 deaths (approx) in men and women in 2018.
  • Cancer took 7 lakh lives in India in 2018.
  • India has around 22.5 lakh people living with cancer.
  • Every year, more than 11 lakh new cancer patients are registered in India.
Cancer Symptoms

Signs and symptoms caused by cancer will vary depending on what part of the body is affected. Some general signs and symptoms associated with, but not specific to, cancer, include:

  • Lump or area of thickening that can be felt under the skin.
  • Weight changes, including unintended loss or gain.
  • Skin changes, such as darkening or redness of the skin, sores that won’t heal, or changes to existing moles.
  • Difficulty swallowing.
  • Persistent indigestion or discomfort after eating.
  • Persistent, unexplained muscle or joint pain.
  • Unexplained bleeding or bruising.
What causes cancer

Cancer is caused by changes (mutations) to the DNA within cells. The DNA inside a cell is packaged into a large number of individual genes, each of which contains a set of instructions telling the cell what functions to perform, as well as how to grow and divide. Errors in the instructions can cause the cell to stop its normal function and may allow a cell to become cancerous.

What do gene mutations do?

A gene mutation can instruct a healthy cell to:

  • Allow rapid growth. A gene mutation can tell a cell to grow and divide more rapidly. This creates many new cells that all have that same mutation.
  • Fail to stop uncontrolled cell growth. Normal cells know when to stop growing so that you have just the right number of each type of cell. Cancer cells lose the controls (tumor suppressor genes) that tell them when to stop growing. A mutation in a tumor suppressor gene allows cancer cells to continue growing and accumulating.
  • Make mistakes when repairing DNA errors. DNA repair genes look for errors in a cell’s DNA and make corrections. A mutation in a DNA repair gene may mean that other errors aren’t corrected, leading cells to become cancerous.

These mutations are the most common ones found in cancer. But many other gene mutations can contribute to causing cancer. 5 to 10% gene mutations are due to genetic reasons. Others are caused due to smoking, radiation, viruses, cancer-causing chemicals (carcinogens), obesity, hormones, chronic inflammation and a lack of exercise.

Prevent Cancer

Here are a few steps to take in daily life to prevent cancer.

1. Say No to Tobacco – The use of tobacco products has been linked to many types of cancer, including lung, colorectal, breast, throat, cervical, bladder, mouth and oesophageal. It’s never too late to quit.

2. Protect your skin from sun – Skin cancer is the most preventable form of cancer. Exposure to the sun’s ultraviolet radiation causes most skin cancer. Be sure to use adequate sun protection year-round.

3. Eat a healthy diet – Eat lots of fruits, vegetables, beans and whole grains. Limit red meat and cut out processed meats. It is also important to limit alcohol consumption because alcohol can increase your risk for liver, colorectal and breast cancers.

4. Maintain a healthy weight and be physically active – Getting at least 30 minutes of physical activity each day can make a big difference in your general health and well-being. Inactivity and obesity have been linked to breast and colorectal cancer.

5. Practise safe sex – Many strains of the human papillomavirus, also known as HPV, are spread through skin to skin contact during vaginal, anal and oral sex. High-risk strains of HPV have increasingly been found to cause many types of cancer.

6. Get immunized – Certain viruses have been linked to cancer, but are preventable through vaccination. Talk to your doctor about preventive cancer care.

7. Be regular with cancer screenings – Talk to your family doctor to know more cancer screening tests. Early detection highly increases your chances of recovery.

Cancer treatment

Below are examples of approaches to cancer treatment:

  • Chemotherapy aims to kill cancerous cells with medications that target rapidly dividing cells. The drugs can also help shrink tumors, but the side effects can be severe.
  • Hormone therapy involves taking medications that change how certain hormones work or interfere with the body’s ability to produce them.
  • Immunotherapy uses medications and other treatments to boost the immune system and encourage them to fight cancerous cells.
  • Radiation therapy uses high-dose radiation to kill cancerous cells. Also, a doctor may recommend using radiation to shrink a tumor before surgery or reduce tumor-related symptoms.
  • Stem cell transplant can be especially beneficial for people with blood-related cancers, such as leukemia or lymphoma. It involves removing cells, such as red or white blood cells, that chemotherapy or radiation has destroyed. Lab technicians then strengthen the cells and put them back into the body.
  • Surgery is often a part of a treatment plan when a person has a cancerous tumor. Also, a surgeon may remove lymph nodes to reduce or prevent the disease’s spread.
  • Targeted therapies perform functions within cancerous cells to prevent them from multiplying. They can also boost the immune system. Two examples of these therapies are small-molecule drugs and monoclonal antibodies.

Doctors will often employ more than one type of treatment to maximize effectiveness.

Cancer care at Kokilaben Dhirubhai Ambani Hospital:

Our Centre for Cancer is equipped with high-end technologies like:

  • EDGE Radiosurgery system, Asia’s first equipment which enables precise, non-invasive treatments helping patients heal faster with less discomfort.
  • We are the first hospital in India to have Novalis TX machine, which performs high precision surgeries to remove deep-seated tumours.
  • We have the first Trilogy (linear accelerator) in India, which is capable of performing on-board CT scan, KV and MV imaging with respiratory gating systems.
Cancer Care in rural Maharashtra:
  • Our team has started Cancer care centres across Maharashtra under Reliance Hospitals. We plan to establish 18 cancer care centres across Maharashtra. The centres will be managed and operated by Kokilaben Dhirubhai Ambani Hospital. The new cancer centres will be equipped with advanced TrueBeam® medical linear accelerators to equip them with the latest technology. The Akola, Gondia and Solapur Reliance Cancer centres are now open and the rest will follow in a few years. We aim to make world-class cancer care accessible to all Indians.

Please find below link of our Cancer care facilities in Mumbai, Navi Mumbai and in rural Maharashtra: