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.