Fibroids affect 1 out of every 4 women, atleast once in their lifetime. Usually affecting women in the age group pf 30-50, fibroids can be as small as a pea or as big as a melon.
Fibroids increase or decrease in size and can even go away. Fibroids are sensitive to oestrogen levels and tend to swell when the level of oestrogen is high for example in heavier women typically weighing over 70 kgs or more.
On the other hand, fibroids can shrink when the level of oestrogen goes down and hence tend to shrink on weight loss or post menopause.
Fibroids are also called Uterine Myomas, Fibromyomas or Leiomyomas. Most Fibroids grow within the muscle tissue of the womb.
What are the common problems associated with fibroids ?
Heavy, Painful Periods: Bleeding is often heavier with fibroids and is often accompanied with pain. Besides affecting quality of life, heavy periods may lead to anaemia.
Bloating, Swelling: Large fibroids, may lead to swelling in the lower abdomen and discomfort in the lower abdomen and lower back.
Painful Intercourse: Fibroids growing near the vagina or the cervix may lead to pain during intercourse.
Bladder Problems: If a fibroid presses on the bladder which is in front of the womb, it may cause frequent urination.
Bowel Problems: Though extremely rare, if a fibroid presses on the bowel, which lies behind the womb, it may cause constipation.
Infertility: If the fibroids grow into the cavity of the womb, they can sometimes block fallopian tubes which can hamper conception and cause Infertility. In such cases an IVF often helps, post fibroid treatment.
Miscarriages: Though rare, sometimes fibroids may cause repeat miscarriages.
Early labour and possibility of a C-section: Sometimes fibroids, may result in an early labour and even a C -section instead of a normal delivery.
There are several ways to treat fibroids, which includes medical management and also surgical options.
Surgical options for treatment of fibroids are:
Hysterectomy: is removal of the womb when fibroids are causing symptoms and pain. If fibroid are small in size, the womb can be removed via the vagina and if the fibroids are large, then the womb may need to be removed via an incision in the lower abdomen.
Uterine Artery Embolisation: can also help with treatment of fibroids.
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Nicknamed magic bullet therapy, now targeted alpha therapy offers hope for even metastasized, castration resistant prostate cancer( mCRPC and has changed the way metastatic prostate cancer can now be treated.
How does Magic Bullet Therapy work for Prostate Cancer ?
Prostate-specific membrane antigen radiology ( PSMA-RLT) with 177 Lu, holds great potential as the Prostate Specific Member antigen peptide binds itself specifically to prostate cancer cells but not to normal healthy cells. With a range of 0.1mm, this method allows selective irradiation, killing cancerous cells with minimal damage to healthy tissue.
The Alpha emitters work by inducing clusters of DNA damage such as double- stranded breaks and cellular cell modifications which leads to destruction of cancerous cells due to cell cycle arrest.
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The PET CT Scan is one of the sought after diagnostic tests. Lets find out more on what is a PET CT and why is it preferred over other diagnostic tests, such as an MRI, CT Scan or an ultrasound.
What is a PET Scan ?
A PET Scan is a nuclear medicine technique which produces images of the human body at a molecular level.
A PET CT, uses radioactive tracers in conjugation with isotopes such as oxygen, nitrogen, carbon etc. These radio isotopes act at a molecular level and work as probes which seek out disease, cancer in the body while giving out radio signals which are captures to produce an image.
This can help in diagnosis of even the tiniest lesions, thus increasing the accuracy of investigation, subsequent diagnosis and hence cancer treatment.
A PET CT Scan, therefore reveals a lot more about the body than standard diagnostic tests such as MRI, CT Scan or an ultrasound.
What happens during a PET Scan ?
A PET CT Scan, is always on a price appointment basis as the radio isotopes, having a a very short half life need to be brought in just before the scan.
A PET CT, is usually carried out empty stomach on overnight or ateast 6 hrs fasting.
The creatinine levels, need to checked prior to conducting the PET CT by a simple blood tests called KFT or Kidney function test
If the creatinine levels are in order, the patient is tested for blood sugar and if found in order , the patient is given an injection of glucose with a radioactive tracer.
After the injection, the patient is made to rest for about 90 mins and then taken for the actual scan which takes about 30 mins to 45 mins depending upon the imaging required.
During the scan, the patient is made to lie on a comfortable table that moves slowly through the ring like PET scanner.
After the scan, the patient can leave immediately. However close contact with others especially children and pregnant women is best avoided for the next 4-6 hrs.
It is also good to drink a lot of water, to flush out the radio active tracer from the body.
The imaging can be seen by the doctors and the nuclear medicine specialists almost immediately for evaluation, though a formal written report takes a day to be handed over to the patient.
Are there any side effects or discomfort due to the scan ?
There are no sid effects or discomfort due to the PET CT Scan, except the minor prick while injecting the tracer.
The PET CT scanner, also does not make any sounds while the scan is going on unlike a few other diagnostics tests.
What are the diseases for which a PET CT Scan can be used ?
The most common use case for a PET CT Scan is for detecting and treating cancer. However other applications, include diagnosing cardiac or heart problems and also neurology.
During the initial stages of the disease, a PET CT helps distinguish between benign and malignant disease and also cancer staging, that is knowing and determining the stage of the disease and also its characteristics, which further helps oncologists decide the best treatment option for the patient.
During course of treatment, it helps determine response to therapy or cancer treatment and if the metabolic activity decreases on the PET CT Scan, the oncologists know that the drugs being administered are working.
On the other hand, if the metabolic activity on the scan increases, it indicates that the treatment option is losing its efficacy or is not working and helps oncologists change the line of treatment to benefit the patient.
Cardiac Care: Post a heart attack, a PET CT Scan can be used to determine myopathy , need for CABG or open heart surgery and if there would be any benefit from CABG or would a heart transplant or an LVAD be a better treatment option.
Neurology: Alzeheimer’s at an early stage can be diagnosed using a PET Scan leading to early intervention.
A PET CT Scan helps locate tumours, distinguish between benign and malignant tumours and also scar tissue for brain surgery.
A PET CT is also useful for treatment of epileptic seizures. It can help locate the origin and focus of seizures and assess sites for intervention if any is required.
What is the difference between a PET CT and an MRI or a CT ?
A CT or an MRI works on the physical level and can give the size and location of the tumour with accuracy.
However since both tests donot work on the molecular level, they cannot indicate metabolic activity of the tumour which only a PET CT Scan can indicate, thereby making a PET CT, a diagnostic test of choice for oncologists, cardiologists, cardiac or heart surgeons and interventional neurologists.
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Infertility is defined as inability to conceive or carry a pregnancy to full term.
Infertility affects millions of women worldwide. IVF or assisted In vitro fertilisation is the answer to infertility problems for millions of women, unable to conceive naturally or carry a pregnancy full term.
Q.When do I explore, IVF as an option for conception ?
Ans. If you are not able to conceive for an 1 year after unprotected intercourse is when IVF should be explored.
Q.How long does IVF treatment last ?
Ans. A successful IVF may need one cycle or a couple more cycles. Each IVF cycle takes 4-6 weeks to complete.
Q.What if I am ok but my husband is found sterile or has a very low sperm count?
Ans. In such a case donor sperms may be used. Please write to us for more information on firstname.lastname@example.org or click here to send us a query.
Q.What will happen if the quality of my own eggs is poor ?
Ans. If the quality of eggs is really poor, IVF can be carried out using donor eggs also, incase there is no other viable alternative.
Q.What I have fibroids ? Do they interfere with conception ?
Ans. Fibroids interfere with conception and are usually removed by laparoscopic fibroid surgery or myomectomy for better results.
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Q. What if I have endometriosis ?
Ans. If you have an endometriotic cyst, it can be removed with laparoscopic surgery before you ahead with IVF treatment.
Q. What if I have had failed cycles of IVF already ?
Ans. ICSI, laser hatching, Embryoscope and IMSI are some of the options which give better results.
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Childhood cancers or Paediatric cancers are biologically different from adult cancers.
They grow faster than most adult cancers.
Factors which trigger cancer or cause childhood cancers are different from those causing adult cancers for example smoking a leading cause of adult lung cancer is not a cause for childhood lung cancer.
Most Paediatric cancers are non hereditary and happen due genetic mutations of growing up cells, though pollution, exposure to radiation, chemicals are also contributory factors in a few cases.
Common cancers in children:
The most common childhood cancer is Leukemia or Blood Cancer. Of all types of blood cancers, ALL is the most common one. It affects children in the age group of 2-6 years.
Other common paediatric cancers are tumours of the brain, retinoblastoma, neuroblastoma, lymphoma, tumours of the kidney, tumours of the adrenal gland, sarcomas , bone tumours etc.
Symptoms of Childhood Cancers:
- Unusually High Fever
- Bruise marks or blue marks on the body
- Prolonged fever with no established cause
- Unusual weight loss
- Nose bleed, gum bleed
- Swelling in the abdomen
- Joint pains
- Pale palor, accompanied with fever, body ache
- Swelling in the neck or axilla.
- Increase in size of lymph nodes, along with cough, fever, weight loss
- Persistent headache
- Unusual Redness in the eye
- Early morning vomiting, loss of appetite
If you notice any of these, it may be a good idea to plan a visit to the doctor.
Are Childhood cancers curable ?
As childhood cancers grow faster than adult cancers, they are also more responsive to chemotherapy and other forms of treatment.
Depending on the stage of cancer and the spread of cancer, a combination of surgery, chemotherapy and radiation may be advised.
With advances in medical treatment, it is now possible to save limbs in bone cancers, eyes in retinoblastoma depending upon stage of cancer and response to treatment options.
Most blood cancers in children respond extremely well to chemotherapy and get cured.
Over 70% of childhood cancers get cured. 5 year survival rates for brain tumour are more than 90%, for Hodgkins lymphoma are over 90% and for ALL or acute lymphoblastic leukaemia survival rates are over 80%.
Even after complete cure, regular followups with paediatric oncologists are required for the next couple of years.
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On World Stroke Day, let’s create awareness on how to recognise symptoms of a stroke, risk factors and treatment options.
Strokes are leading causes of death and permanent disability worldwide.
In a stroke, a part of the brain doesn’t receive sufficient blood or oxygen and as result functioning of the corresponding body part gets affected.
Strokes are of 3 types, Transient Ischemic attack, Hemorrhagic Stroke and Ischemic Stroke.
In a Transient ischemic stroke, a blood clot temporarily stops the blood flow from reaching the brain,
In an Ischemic stroke, a blood clot stops blood flow to the brain. This can be due to a clot travelling from another part of the body to the brain.
In a hemorrhagic stroke, a blood vessel spills or ruptures, causing a leak.
Symptoms of a stroke are usually all neurological, affecting speech, movement and balance.
Usual Stroke symptoms are :
- Slurry Speech, inability to speak coherent words and sentences
- Droopy face, with a droop towards one side
- Inability to lift one arm or sudden weakness in one limb
- Sudden, severe headache
- Loss of balance
- Loss of consciousness
- Dizziness, Vertigo, with or without nausea
- Confusion, inability in understanding speech are often symptoms too.
Are there any factors, which increase risk of stroke ?
- Several life style factors contribute to increasing risk of stroke
- Obesity or excess weight
- Hypertension or High Blood pressure
- History of Heart Disease
- Sleep Apnea
- Sedentary lifestyle, lack of exercise and adequate physical activity
What to do when you spot a stroke victim ?
A Stroke can be completely reversible if treated well in time. The time window for treatment is usually not more than a couple of hours from onset of symptoms.
Time is of essence for a stroke victim as many as 32000 cells die every minute of delay, leading to irrepairable damage with every minute of delay.
A CT scan or an MRI are first diagnostic tests and based on whether it is a clot that can be surgically removed or needs to be dissolved, or a leak or rupture of blood vessels, a neurologist or a neurosurgeon take over.
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World Obesity day is observed on 11 th Oct globally, to create awareness and find solutions to check the epidemic called “ Obesity”
Obesity is sometimes genetic but normally builds up over a period of time due to sedentary life style and excessive intake of calories, more than what are being burned by daily activities and exercise.
Obesity is usually defined as excess of body weight, atleast 20% higher than normal which has an adverse affect on the body.
It is normally calculated using a ratio of height to weight called as Body Mass Index ( BMI)
A person having a BMI( Body Mass Index) of over 30, is classified as “Obese”. A BMI between 25 and 30, classifies as “overweight”.
What causes Obesity ?
Obesity builds up largely due to a combination of factors, such as excessive intake of foods, lack of physical activity, intake of sterioids, certain types of medication, endocrine disorders, medication for mental illnesses and sometimes even genetic susceptibility. A genetic mutation in the FTO gene, significantly increases risk of obesity.
Other medical conditions, which lead to obesity are as follows:
- Hypothyroidism caused by under activity of thyroid gland slows metabolism causes weight gain.
- PCOD, or polycystic ovarian disease also leads to obesity. Vice versa, women who are over weight or obese often have PCOD.
- Over production of hormone cortisol by adrenal glands also known as Cushing’s syndrome, leads to weight gain and full in the upper body, face and neck.
- Prader-Willi syndrome, a rare condition which leads to constant eating also leads to obesity.
What are the medical complications associated with Obesity?
A few medical conditions associated with Obesity are coronary heart disease, needing angioplasty or even an open heart surgery, diabetes, gallstones which require gallbladder removal , hypertension or high blood pressure, wearing out of knees due to excess weight and subsequently osteoarthritis which may require knee replacement, sleep apnea, several type of cancers and infertility whuch may require an IVF.
The list of cancers due to obesity is fairly long with 25% of cancers being attributed to an increased risk due to obesity.
These include breast cancer, multiple myelomas a type of blood cancer, cancer of the gall bladder, oesophageal cancer or cancer of the food pipe, thyroid cancer, prostate cancer, ovarian cancer, liver cancer, colorectal cancers, kidney cancer and even some of the brain tumours.
The important question here is “ How to treat obesity?”
Regular exercise, diet modification, eating small healthy meals, avoiding junk , high carbohydrate and fat rich food has benefits and helps lose weight.
Maintaining a journal or a food dairy, to record what’s being consumed helps and so does keeping a record of exercise being done everyday.
Using fitness wearable’s is a good idea too.
A weight loss surgery may be considered only when the BMI exceeds 35 or if there is a serious medical condition associated with obesity.
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As we continue our conversation on Precision Medicine for cancer, a popular therapy used to treat NET tumours or Neuro Endocrine Tumours is PRRT or Peptide Receptor Radionuclide therapy.
Neuroendocrine tumours are a rare form of cancer and originate from Neuro endocrine cells in the body and hence the name.They are different from adenocarcinoma’s and often do not do not respond well to chemotherapy, the 1st line of treatment for most cancers.
By administering radioactive protein lutetium octreotate, it is possible to treat NET tumours or neuro endocrine carcinoma with precision and offset progression of disease.
In PRRT a peptide or a cell targeting protein is combined with a small amount of radio active nuclide creating what is called as a radio peptide. The radio peptide when injected into the patients blood stream travels and binds to a neuro endocrine tumour, delivering a high dose of radiation to the tumours. This also limits damage to the nearby healthy tissue and hence lesser and milder side effects than chemotherapy.
What kind of cancers can be treated by PRRT?
Along with Neuroendocrine tumours, carcinoids, islet cell carcinoma of the pancreas, small cell carcinoma of the lung a form of lung cancer, pheochromocytoma (a rare tumor that forms in the adrenal glands), gastro-enteropancreatic (stomach cancer , intestine cancer and pancreas) neuroendocrine tumors, and rare thyroid cancers that are unresponsive to treatment with radio iodine are often treated with PRRT.
Role of PRRT is also being explored for treatment of prostate cancer.
When is a patient a candidate for PRRT ?
Patients with following conditions are often proposed for PRRT
- When neuro endocrine tumours are not responsive to other lines of cancer treatment
- When surgical removal of tumours is not possible at current stage, PRRT may be used to reduce size of the tumours.
- PRRT is also a treatment option for last stage inoperable cancers when metastasis has set in.
The main aim of PRRT is then to slow down progression of disease, offer relief and prolong life.
However, not all neuroendocrine tumours respond to PRRT. First an OctreoScan is done. If the patient is found to have a positive OctreoScan and meets other requirements, PRRT is proposed.
What happens during PRRT ?
For patients having a positive octreoscan, to start with an amino acid solution is delivered to protect the kidneys.
As most net tumours have a lot of a specific type of surface receptor, a protein called somatostatin. Octreotide, is a lab version of somastostatin. During PRRT, a dose of radio nuclides such as Lutetium, Yttrium are often combined with octreotide and injected into the blood stream.
Molecular imaging and scans follow to see whether the radio peptide has latched on of the tumour sites correctly.
The entire session usually lasts for about 4 hrs and is often done as an out patient procedure.
The main goals of PRRT hence are to provide symptom relief, to stop or slow tumor progression and to improve overall survival.
Advantages of PRRT ?
PRRT along with other molecular therapies or targeted therapies offer excellent results as they are tailor made keeping in mind molecular properties of the tumour and also biologic characteristics of the patient.
PRRT is offered in Germany , USA, UK and other developed countries at a significant cost, In India, a single session of PRRT costs approx USD 6300.
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We often hear of Precision Medicine for Cancer, but what is Precision Medicine, how is it different from standard treatment protocols and what can be the benefits for choosing Precision Medication over standard protocols?
The diagnosis and treatment of cancer at a cellular or molecular level is known as Precision Medicine.
Cancer is a heterogenous disease, with different genetic profile not only between patients with different cancers but also differences in genetic , molecular and cellular profile even within the same type of cancer.
All cancers are genetic by nature and with cellular profile changing over time even in the same patient, till now no single drug is known to cure even a single type of cancer let alone different types of cancer’s.
Standard chemotherapy protocols focus of administering standard chemotherapy drugs ( one size fits all) without taking into account cellular or genetic profile of the patient.
Precision medicine on the other hand focuses on accurate and effective treatment to each patient based on the genetic profile, the proteins feeding the tumours or the cancers.
There are sufficient number of detractors even amongst the best doctors but precision medicine or administering drugs based not a specific tailored patient profile not being the best option is a pre mature conclusion.
Difference in outcomes depends upon whether the patient has been tested for HER2(human epidermal growth factor receptor 2), ER, PR or not.
For patients testing positive for HER 2, addition of trastuzumab to chemotherapy slows down disease progression. Lapatinib plus chemotherapy (i.e., capecitabine) achieved a longer median time to disease progression compared with chemotherapy alone.
A combination of pertuzumab, trastuzumab, and chemotherapy further improved the median overall survival time to a median of almost 5 years compared with a combination of only trastuzumab and chemotherapy for a median of 3 and half years.
Similarly treatment with ado-trastuzumab emtansine, a conjugate of a HER2 monoclonal antibody and a cytotoxic drug, significantly improved the length of progression-free survival and overall survival with lower adverse effects when compared with lapatinib and chemotherapy
The above examples clearly show how genetic profiling, identification of key mutations like the Bcr-Ablfusion or HER2 can benefit a large number of breast cancer patients.
Genetic profiling also enables identification of molecular targets for intervention.Cell death is caused by a combination of deficiencies in the expression of two or more genes, whereas deficiency in only one of these genes can increase viability or enhance multiplication of mutant cells. For example, BRCA (mutant gene responsible for particularly aggressive breast cancers( and poly ADP ribose polymerase (PARP) genes were found to have a synthetic lethal relationship.
For example, by using olaparib, a PARP inhibitor, to treat BRCA-mutant ovarian cancer patients, the progression-free survival of BRCA-mutant ovarian cancer patients was significantly prolonged by olaparib compared with standard chemotherapy protocols.
This methodology focusses on identifying cancer vulnerabilities and subsequent tailored treatment based on patient profile.
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We often get queries on CyberKnife and what is CyberKnife used for ?
CyberKnife is an excellent treatment option for treating cancer’s such as prostate cancer, gliomas ,brain cancer, kidney cancer, lung cancer, spine cancer, cancer of the pancreas, head and neck cancer, liver cancer, early stage -localised breast cancer and several types of malignant tumours, benign tumours and several other medical conditions.
CyberKnife delivers stereostatic radiation( SBRT) with extreme precision and a tissue margin of 1-5mm
Cyber knife is totally non invasive and offers hope for inoperable localised cancers such as small cell lung cancer,for inoperable lesions where there is no other alternative for the patient to be treated.
CyberKnife can spot the exact size, shape and location of the tumor and delivers highly concentrated beams of radiation with precision ranging from 1 to 5 mm and this leads to minimal damage and bleeding.
Since CyberKnife treatment is totally non invasive, it is used for treatment of inoperable cancers as an alternate to surgery or as an alternative to surgery to minimise trauma, avoid complications and reduce risk.
Most patients can be treated several times with the CyberKnife and even treated again or retreated with minimal side effects leading to a better quality of life.For example for prostate cancer, even for a repeat surgery, CyberKnife can be used very successfully.
CyberKnife treatment is FDA approved and can spot patient movement even while breathing. The radiation beams can be aimed from several directions, thereby never losing the precision which is hall mark of a CyberKnife treatment.
CyberKnife treatment usually gets completed in 3 to 5 sessions spread over a week. Most patients can lead normal lives post CyberKnife treatment Most CyberKnife treatments are covered by insurance providers all over the world.
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Since the treatment involves a high degree of expertise, CyberKnife treatment is not offered by most hospitals.
The stage, location and size of the tumour or the cancer plays an important role, hence multiple teams of doctors and oncologists need to be involved before a decision on use of CyberKnife as treatment option can be arrived.
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