Max Institute of Cancer Care

Breast cancer, a common but complex disease, requires specialised and comprehensive care for effective treatment. At Max Hospitals, we recognize the intricacies of breast cancer and are dedicated to offering a holistic approach that blends advanced medical expertise with compassionate care. Our multidisciplinary team of oncologists, surgeons, and support staff collaborates to create personalised treatment plans tailored to each patient's unique needs. From state-of-the-art diagnostic tools to the latest in therapeutic options, Max Hospitals leads the way in breast cancer treatment, committed to achieving the best possible outcomes for our patients. What is Breast Cancer? Breast cancer is a type of cancer that originates in the cells of the breasts. It is one of the most common cancers diagnosed in women worldwide, but men can also develop it. Breast cancer occurs when abnormal cells in the breast begin to grow and divide uncontrollably, forming a tumour. These cancerous cells can invade surrounding tissues and spread (metastasize) to other parts of the body. Types of Breast Cancer Breast cancer can be classified into several types based on where it originates and its characteristics. The main types include: Invasive Carcinoma: This is the most common type, where cancer cells spread beyond the initial location in the breast tissue. Ductal Carcinoma In Situ (DCIS): This is an early-stage cancer where abnormal cells are present only within the milk ducts and haven't invaded surrounding tissues. Lobular Carcinoma In Situ (LCIS): Similar to DCIS, but the abnormal cells are found in the milk-producing lobules. While not cancerous itself, LCIS increases the risk of developing invasive breast cancer later. Less common types: Other less frequent types include inflammatory breast cancer, Paget's disease of the breast, and metastatic breast cancer (cancer that originated elsewhere and spread to the breast). Similarly, there are others such as Medullary, Mucinous, Tubular, Metaplastic, Papillary, and Apocrine. Breast Cancer Causes The exact cause of breast cancer remains unknown. However, several factors are believed to contribute to its development: Genetic mutations: Inherited changes in genes like BRCA1 and BRCA2 significantly increase breast cancer risk. Hormonal factors: Exposure to oestrogen over a longer period increases the risk. This includes factors like starting menstruation at a young age, having late menopause, or taking hormone replacement therapy (HRT) for an extended period. Lifestyle factors: Obesity, lack of physical activity, and excessive alcohol consumption can increase risk. Dense breast tissue: Breasts with more glandular tissue and less fatty tissue might be harder to screen for abnormalities and carry a slightly higher risk. Family history: Having a close relative (mother, sister, daughter) with breast cancer increases one’s risk. Breast Cancer Risk Factors Several risk factors can increase the likelihood of developing breast cancer. Some of these factors are modifiable, while others are not. Key risk factors include: Age: The risk of breast cancer increases as a woman gets older. Most breast cancers are diagnosed after age 50. Genetic Mutations: Inherited mutations in the BRCA1 and BRCA2 genes significantly increase the risk of breast and ovarian cancer. Family History: Having a first-degree relative (mother, sister, daughter) with breast cancer nearly doubles a woman’s risk. Reproductive History: Early menstruation (before age 12) and late menopause (after age 55) increase the risk due to prolonged exposure to hormones. Dense Breast Tissue: Women with dense breast tissue have a higher risk of breast cancer and may have more difficulty detecting it on mammograms. Previous Breast Conditions: Certain non-cancerous breast conditions, such as atypical hyperplasia or lobular carcinoma in situ (LCIS), are associated with an increased risk. Hormone Replacement Therapy: Long-term use of hormone replacement therapy (HRT) during menopause is linked to an increased risk of breast cancer. Radiation Exposure: Women who received radiation therapy to the chest for other cancers (such as Hodgkin's lymphoma) before age 30 have a higher risk of developing breast cancer later in life. Lifestyle Factors: Obesity, lack of physical activity, alcohol consumption, and poor diet are associated with an increased risk of breast cancer. Reproductive History: Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy can increase the risk of breast cancer. Understanding these risk factors can help in developing strategies for prevention, early detection, and treatment of breast cancer. Regular screenings, lifestyle modifications, and genetic counselling for those with a family history are essential components of breast cancer management. Breast Cancer Symptoms Breast cancer symptoms can vary from person to person, and some women might not experience any noticeable changes at all. However, it's important to be aware of potential signs and symptoms to facilitate early detection. Here's a list of breast cancer symptoms one must watch out for: Lump in the Breast or Underarm: The most common symptom is a new lump or mass in the breast or underarm (armpit). These lumps are often hard, irregular in shape, and painless, though some can be soft, round, and tender. Change in Breast Size or Shape: Any unexplained change in the size, shape, or appearance of the breast should be evaluated. This may include swelling of part or all of the breast, even if no distinct lump is felt. Skin Changes: Look for dimpling, puckering, or redness of the breast skin. Sometimes the skin may have a texture resembling an orange peel. Nipple Changes: This includes nipple discharge (other than breast milk), particularly if it is bloody, clear, or occurs without squeezing. Inversion (turning inward) or retraction of the nipple and any changes in the appearance of the nipple, such as scaling or thickening, are also concerning signs. Pain: Although most breast cancers do not cause pain, persistent breast pain or discomfort that does not correlate with the menstrual cycle or other benign conditions should be checked. Breast or Nipple Pain: Pain or tenderness in the breast or nipple area can be a symptom. However, it's important to note that breast pain alone is rarely a symptom of cancer. Swelling in the Armpit or Around the Collarbone: Swelling or lumps in these areas can indicate the spread of breast cancer to lymph nodes. Thickening of Breast Tissue: Any thickening in the breast that feels different from the other tissue may be a sign. Visible Veins: Sometimes, increased visibility of veins on the surface of the breast can indicate changes in the breast tissue. Breast Rash: A rash or redness around the nipple can sometimes be a sign of Paget's disease of the breast, a rare form of breast cancer. If an individual experiences any of the above symptoms, it is important to see a healthcare provider as soon as possible. While many breast changes are not cancerous, only a professional evaluation can determine the cause. Regular self-examinations and routine mammograms are crucial for early detection. Early-stage breast cancer often has a better prognosis and a wider range of treatment options, underscoring the importance of being vigilant about any changes in the breasts. Breast Cancer Diagnosis Diagnosing breast cancer typically involves a multi-step process. Here's a breakdown of what one can expect: Physical Examination A doctor examines the individual’s breasts and lymph nodes for lumps, changes in size or shape, or other abnormalities. Imaging Tests The imaging tests play a crucial role in detecting and characterising breast abnormalities. Common tests include: Mammography: X-ray images of the breast tissue to identify lumps, masses, or calcifications. Breast Ultrasound: Uses sound waves to create detailed images of the breast, helpful in differentiating between solid lumps and fluid-filled cysts. Breast MRI (Magnetic Resonance Imaging): Provides detailed 3D images, often used for high-risk individuals or for women with dense breast tissue where mammograms might be less effective. Biopsy If imaging tests reveal suspicious areas, a biopsy is necessary to confirm the presence of cancer cells. A small tissue sample is extracted using a needle or surgical procedure and examined under a microscope by a pathologist. Additional Tests (if cancer is diagnosed) Once cancer is confirmed, further tests might be needed to determine the stage and type of breast cancer, which helps guide treatment decisions. These may include: Hormone receptor testing: Determines if the cancer cells are sensitive to hormones like oestrogen and progesterone, which can influence treatment options. HER2 testing: Evaluates the presence of a protein called HER2 on the cancer cells. HER2-positive cancers often require targeted therapy drugs. Genetic testing: May be recommended in certain cases to assess the risk of hereditary breast cancer and guide future screening recommendations. Breast Cancer Treatment The course of treatment for breast cancer depends on various factors, including the stage and type of cancer, your overall health, and your preferences. Here's an overview of common treatment options: Surgery The most common treatment for breast cancer is surgery to remove the cancerous tissue. The type of surgery performed depends on the extent of the cancer: Lumpectomy: Removal of the tumour and a small margin of healthy tissue surrounding it. Often followed by radiation therapy. Mastectomy: Removal of the entire breast can be performed with or without reconstruction of the breast. Lymph node surgery: Removal of lymph nodes in the armpit to check for cancer spread. Radiation Therapy High-energy rays are used to destroy cancer cells and prevent them from recurring. Radiation therapy can be administered after surgery (to eliminate any remaining microscopic cancer cells) or before surgery (to shrink the tumour and make it easier to remove). Chemotherapy Medications are used to kill cancer cells throughout the body. Chemotherapy can be given before surgery (neoadjuvant) to shrink the tumour or after surgery (adjuvant) to reduce the risk of recurrence. Hormone Therapy For hormone receptor-positive cancers, medications can block the effects of oestrogen or progesterone on cancer cell growth. Hormone therapy can be taken as pills or injections for several years. Targeted Therapy Drugs These drugs target specific molecules or pathways involved in cancer cell growth and survival. They may be used in combination with other therapies for HER2-positive cancers or other specific subtypes. Immunotherapy A relatively new approach that helps the body's immune system recognize and attack cancer cells. Immunotherapy is still under development for breast cancer but may play a role in future treatment options. Reconstruction Breast reconstruction surgery can be performed after a mastectomy to restore the appearance of the breast. Reconstruction can be done at the time of mastectomy or in a separate procedure later. Regular follow-up care is crucial for monitoring the patient's recovery, managing any side effects, and checking for signs of recurrence. Follow-up typically includes physical exams, imaging tests, and laboratory tests to ensure that any changes are detected early and managed effectively. Breast Cancer Complications While breast cancer treatment aims for a cure or long-term control, there can be potential complications associated with the disease and its treatment. Here's a breakdown of some possible complications: Physical side effects of surgery: Depending on the type of surgery performed (lumpectomy or mastectomy), there can be pain, scarring, swelling, and lymphedema (fluid buildup in the arm). Side effects of radiation therapy: Radiation therapy can cause fatigue, skin irritation, and soreness in the treated area. In some cases, it can also lead to long-term effects like lung problems or heart issues. Side effects of chemotherapy: Chemotherapy drugs can cause various side effects, including nausea, vomiting,hair loss, fatigue, and mouth sores. The severity of these side effects depends on the specific drugs used and the dosage. Side effects of hormone therapy: Hormone therapy medications can cause hot flashes, vaginal dryness, joint pain,and an increased risk of blood clots. Lymphedema: This is a potential complication after surgery that involves lymph node removal. It can cause swelling in the arm, chest, or back due to fluid buildup. Breast cancer recurrence: There's always a risk that cancer may recur after treatment. Regular follow-up appointments with your doctor are crucial for monitoring and early detection of any recurrence. Emotional and psychological effects: A breast cancer diagnosis and treatment can be emotionally challenging. It's common to experience anxiety, depression, fear, and body image concerns. Breast Cancer Prevention While there is no guaranteed way to prevent breast cancer, certain lifestyle changes and preventive measures can reduce the risk. Key strategies for breast cancer prevention include: Maintain a Healthy Weight: Being overweight or obese, especially after menopause, increases the risk of breast cancer. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce this risk. Stay Physically Active: Engaging in regular physical activity helps maintain a healthy weight and can lower breast cancer risk. Aim for at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity each week. Limit Alcohol Consumption: Alcohol consumption is linked to an increased risk of breast cancer. Limiting alcohol intake to no more than one drink per day can help reduce this risk. Eat a Balanced Diet: A diet rich in fruits, vegetables, whole grains, and lean proteins can help maintain overall health and potentially reduce cancer risk. Limiting saturated fats and red meats is also beneficial. Breastfeed: Breastfeeding, especially for a year or more, has been shown to reduce the risk of breast cancer. It offers protective benefits for both mother and child. Avoid Hormone Replacement Therapy (HRT): Long-term use of combined oestrogen-progestin hormone therapy for menopause symptoms is associated with an increased risk of breast cancer. Discuss alternatives with a healthcare provider. Avoid Exposure to Radiation and Environmental Pollutants: Limiting exposure to radiation during medical imaging and avoiding environmental pollutants may help reduce the risk. Genetic Counseling and Testing: For those with a family history of breast cancer or known genetic mutations (e.g., BRCA1 or BRCA2), genetic counselling and testing can help assess risk and guide preventive measures, such as increased surveillance or preventive surgeries. Regular Screening: Regular mammograms and clinical breast exams can help detect breast cancer early when it is most treatable. Follow guidelines based on age, risk factors, and personal health history. Medications: In some high-risk women, preventive medications (chemoprevention) such as selective oestrogen receptor modulators (SERMs) or aromatase inhibitors can reduce the risk of developing breast cancer. Prophylactic Surgery: For women with a very high risk of breast cancer (e.g., those with BRCA mutations), prophylactic mastectomy or oophorectomy (removal of ovaries) can significantly reduce the risk of developing breast cancer. Adopting these preventive measures can help lower the risk of breast cancer and promote overall health and well-being. Frequently Asked Questions Can men get breast cancer? Yes, while breast cancer is much more common in women, men can also develop breast cancer. It is important for men to be aware of changes in their breast tissue and consult a healthcare provider if they notice any abnormalities. What lifestyle changes can help during and after breast cancer treatment? Maintaining a healthy diet, staying physically active, managing stress through mindfulness or therapy, and avoiding tobacco and excessive alcohol can help improve overall health and recovery during and after treatment. What are the side effects of breast cancer treatment? Side effects vary depending on the type of treatment and may include fatigue, nausea, hair loss, lymphedema, pain, cognitive changes, and emotional challenges. Discussing potential side effects with a healthcare provider can help in managing them effectively. How does breast cancer affect fertility and pregnancy? Some breast cancer treatments can affect fertility. It's important to discuss fertility preservation options with a healthcare provider before starting treatment. Breast cancer can be diagnosed during pregnancy, and treatment plans are carefully tailored to protect both the mother and the baby. What is the role of genetic testing in breast cancer? Genetic testing can identify mutations in genes like BRCA1 and BRCA2 that increase the risk of breast cancer. Knowing one's genetic risk can guide preventive measures and inform family members of their potential risk. Are there different stages of breast cancer, and what do they mean? Yes, breast cancer is staged from 0 to IV, indicating the extent of the cancer. Stage 0 is non-invasive, while stage IV indicates metastatic cancer that has spread to other parts of the body. Staging helps determine the best treatment approach. What are the latest advancements in breast cancer research and treatment? Recent advancements include targeted therapies, immunotherapy, personalised medicine based on genetic profiling, and improvements in surgical and radiation techniques. Staying informed about new research can provide options for cutting-edge treatments. Can diet and exercise impact breast cancer prognosis? Yes, a healthy diet and regular exercise can improve overall health and may positively impact prognosis by reducing the risk of recurrence and improving quality of life. How does one manage the emotional impact of a breast cancer diagnosis? Seeking support from friends, family, support groups, and mental health professionals can help manage the emotional impact. Mindfulness practices, stress reduction techniques, and maintaining a healthy lifestyle can also contribute to emotional well-being. Can breast cancer recur after treatment, and how is recurrence monitored? Yes, breast cancer can recur. Regular follow-up visits, imaging tests, and self-examinations are crucial for monitoring recurrence. Early detection of recurrence can lead to more effective management. What is the impact of breast cancer on long-term health and quality of life? Long-term health effects can include chronic pain, fatigue, and emotional challenges. Quality of life can be improved through comprehensive survivorship care plans, which address physical, emotional, and social aspects of recovery. Are there support groups or resources for breast cancer survivors? Yes, many local and national organisations offer support groups, counselling, educational resources, and survivorship programs for breast cancer survivors. Connecting with these resources can provide valuable support and information. How can I support a loved one who has been diagnosed with breast cancer? Providing emotional support, helping with daily tasks, accompanying them to appointments, and listening to their concerns are all valuable ways to support someone with breast cancer. Joining support groups and seeking professional counselling can also be beneficial. Review  Reviewed By Dr. Charu Garg, Senior Director - Cancer Care / Oncology, Gynecologic Oncology, Thoracic Oncology, Radiation Oncology, Breast Cancer on 19 Sep 2024.

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Gastrointestinal cancer is the second most common type of cancer present among individuals and represents a heterogeneous complex arrangement of several disorders and diseases. These are divided into rare inherited forms and more frequent sporadic forms. Amongst the cancers affecting the gastrointestinal tract, oesophageal cancer is the commonest followed by colorectal cancers (affecting the colon and rectum) and cancers of the stomach, and the small intestine. The elementary causes for different types of gastrointestinal cancers vary, but some of the key risk factors include smoking, excessive alcohol consumption, increasing age, viral and bacterial infections, chronic pancreatitis, and obesity. Hepato-pancreato-biliary (HPB) cancers include malignant or cancerous tumours originating in the cells of the liver, bile ducts, pancreas and gallbladder. Pancreatic cancer is cancer that takes place in the pancreas, which is a gland that produces digestive juices and hormones. Pancreatic cancer is more commonly seen in older people as compared to people under the age group of 40 years. Liver Cancer, which starts in the liver, depends on where it begins and the type of cell it involves. Bile duct cancer, also termed cholangiocarcinoma, is a very rare form of cancer and occurs when there is abnormal cell growth in a rampant way. Bile ducts are small tubes connecting the liver and gallbladder to the bowel. The bile ducts carry bile which helps in the breakdown of fats in food. GI Cancer Treatment Treatment options for GI cancer and HPB cancer rely on factors like cancer's location, stage as well as aggressiveness. The doctor also considers the general health and preferences while framing a plan of treatment. GI Cancer Surgery The main goal of surgery is to eradicate cancer and some of the healthy tissue around it. Operations used for GI cancer include: Curative surgery: Removing the tumours from the site of origin with a margin of healthy tissue Removing the regional lymph nodes Palliative surgery: Surgery to relieve signs and symptoms. Chemotherapy for GI Cancer Chemotherapy is a type of treatment that uses certain drugs to eliminate cancer cells. Chemotherapy drugs travel throughout the body and kill cancer cells that may have extended away from the site of origin. Chemotherapy sessions can be given before surgery to help constrict cancer so that it can be removed more easily. Chemotherapy is also used post-surgery to kill any cancer cells that might remain in the body. Chemotherapy is often combined with radiation therapy. Radiation Therapy for GI Cancer Radiation therapy involves high-power beams of energy to kill cancerous cells. The energy beams are emitted from a machine that moves around as a patient lie on a table. For advanced stomach cancer, which can't be eliminated with surgery, radiation therapy is used to reduce side effects as pain or bleeding occurs due to enlarged cancer. Targeted Drug Therapy for GI Cancer Targeted drug treatments concentrate on particular weaknesses lying within cancerous cells. Targeted drug treatments cause cancer cells to die by blocking these weaknesses. Immunotherapy for GI Cancer Immunotherapy is a form of drug treatment that helps the immune system to fight cancer. Immunotherapy is used either when the cancer is advanced, if it comes back or if it spreads to other parts of the body. Review Reviewed by Dr. Vivek Mangla, Director - Gastrointestinal and Hepatopancreatobiliary (GI & HPB) Surgical Oncology on 21-Mar-2022. FAQs What are the early symptoms of gastric cancer? Gastric cancer can manifest in various ways, including difficulty swallowing, feeling full after eating small amounts, heartburn, indigestion, nausea, stomach pain, unintentional weight loss, and vomiting. What defines the first stage of stomach cancer? According to the pathological staging system, stage 1 stomach cancer has spread to the inner, supporting, or muscle layer of the stomach. Is gastrointestinal cancer curable? When gastric cancer is detected at an early stage, there is a higher chance of recovery. However, gastric cancer is often diagnosed at an advanced stage, making it challenging to cure. Although it can be treated, the curability of gastric cancer in later stages is rare. What is the most effective treatment for gastric cancer? The most appropriate treatment for gastric cancer depends on several factors, including the stage, location, and overall health of the patient. A combination of surgery, chemotherapy, and/or radiation therapy can be effective. Early detection is crucial as it improves the prognosis of gastric cancer. How long does gastrointestinal surgery typically take? Gastrointestinal surgery can take anywhere from two to six hours. During the procedure, the affected area is removed, along with some nearby lymph nodes. In cases where the entire stomach is removed, the small intestine and oesophagus are connected. FAQs Review FAQs reviewed by Dr. Manish Jain, Principal Consultant, Cancer Care / Oncology, Surgical Oncology, Gastro Intestinal & Hepatopancreatobiliary Surgical Oncology.

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Max Institute of Cancer care (MICC) offers comprehensive state of the art services for early diagnosis, staging, treatment and hospital-based care of Disease management group (DMG) – Breast, Gynaecology, gastrointestinal cancers etc. An individualised treatment plan is made for each patient by a specialist multidisciplinary team of medical oncologists, radiation oncologists, surgeons, histopathologists, molecular pathologists, gastroenterologists, interventional radiologists, nuclear medicine, dieticians, physiotherapists and geneticist. There are a constant cross chat between the various specialities at the Respective DMG Tumour Board meeting, The main concept behind the DMGs at MICC is to make the best skills available to our patients. Site-specific oncology allows the clinicians involved in patients care to focus only on certain cancers at which they become world experts. Meetings are held once a week to discuss all patients diagnosed with DMG specific (Disease Management Group- Breast , Gynaecology , GI etc.) cancer and arrive at the best possible management for the patient. The Surgical Medical and Radiation specialists of the respective DMG along with the Pathologists, Radiologist and Molecular Oncologists attend these meetings. All patients seen between these meetings are, however, discussed in the common tumour Boards held once a week. Services available at the Gastrointestinal & Hepatobiliary Disease management group at MICC include: Diagnosis, tests and investigations: primary assessment and diagnosis Specialist review and second opinion Staging and investigation Cancer genetics Pre-operative counselling Site specific surgical oncology    Chemotherapy Immunotherapy Targeted therapy    Radiotherapy with newer techniques     Surgery, including sphincter-sparing surgery and trans-endoscopic microsurgery (TEMS) Critical care     Rehabilitation     Palliative and supportive care   Clinical trials     If you have been directed to the Gastrointestinal & Hepatobiliary DMG Service then you, or your relative, is suffering from either one of the following cancers or spread of another organ cancer to the following sites: Oesophagus Stomach Large intestine (colon), rectum and anus Pancreas Bile duct and Gallbladder Liver Small intestine Retroperitoneum (the deep part of the abdominal cavity) Neuroendocrine system What We Do Max Institute of Cancer Care (MICC) GI cancer multidisciplinary team includes group of experts in medical oncology, surgical oncology, radiation oncology, gastroenterologists, radiologist, pathologist, molecular oncologist, psychologist and physical therapists. They  collaborate and provide the  best comprehensive cancer care to all patients. The disease management group discussions and management options are discussed with patients to help them choose the best treatment for them. The molecular profiling of tumors for targeted therapy and genetic test to assess the risk in family members is an integral part of multidisciplinary treatment plan. Post operative specialized care in dedicated oncosurgery ICU and wards with help of experts intensivist, nurses and physical therapist helps in faster recovery. Surgical Oncology Unit The surgical unit of GI and Hepato-pancreato-biliary (HPB) DMG are specialized in all surgeries and minimal invasive procedures required for treatment of GI cancers. Radiation Oncology Unit What is Radiation Therapy and what does it do? Radiation Therapy  (RT) is use of high energy Ionization radiation (often X Rays ) to kill a cancer cell by damaging its DNA. Goal of Radiation Therapy (RT) is to use focused beams of radiation to kill cancer cell with as little risk as possible to normal cells. Radiation treatment, like surgery, is a local treatment. It affects the cancer cells only in a specific area of the body. Types of Radiation Therapy When the source of radiation is from a machine outside the body, it’s called as External Beam Radiation therapy (EBRT). When radioactive material is placed close to tumour or area harbouring cancer cells it’s called as Brach therapy. Timing of Radiation Therapy RT can be used before surgery to shrink a tumor, called as neoadjuvant/pre operative RT (Pre op RT). It may be used after surgery to stop growth of cancer cells that may remain called as adjuvant RT (Post op RT). At times radiation is used alone with curative intent which is called as Radical RT. It can also be used at the time of surgery known as Intra-operative Radiation (IORT). Medical Oncology Unit What is Medical oncology and what does it do? Medicines form an important part of the cancer treatment. These can be in the form of chemotherapy, hormone therapy, targeted therapy, biological therapy or immunotherapy. It's used primarily in the following scenarios  1)  Concurrent partner to radiotherapy to increase the efficacy  2)  Neoadjuvant chemotherapy – given before definitive therapy which could be chemoradiotherapy or surgery. This is also given to make inoperable tumours operable by reducing the size in some patients. 3) Adjuvant chemotherapy: this is given post surgery usually to decrease the risk of recurrence. 4) Palliative chemotherapy : to control advanced cancers ( cancer which has spread beyond the site of origin) or locally advanced tumour not amenable to surgery or radiotherapy.  What is EBRT? EBRT is usually given during outpatient visits (OPD Treatment) to a hospital. In this, a machine (also called as Linear Accelerator/LA) directs the high energy rays at the tumor bearing area within body. The type of machine used for radiation therapy is called as a Linear Accelerator and at Max Hospital it has several models like TrueBeam STx, Novalis or Clinax. Linear Accelerators have the capability of delivering RT by various techniques like IMRT (Intensity Modulated Radiation Therapy), IGRT (Image Guided Radiation Therapy), SRS (Stereotactic Radiation Therapy) and SBRT (Stereotactic Body Radiation Therapy). What is IMRT? Intensity-modulated radiation therapy (IMRT) refers to a technique of focusing radiation therapy at cancer bearing area using computer based optimization process to carefully create a gradient or a dose fall-off between the cancer/target tissues and the surrounding normal tissues. This fall of dose saves the surrounding normal organs effectively. Therefore, these techniques offer the prospect of increasing the cancer control probability while decreasing the side effects. What is IGRT? Image guided radiation therapy (IGRT) is classically defined as radiation therapy that is delivered only after verification of position of structures of interest by performing either an X-Ray or CT based image. The same are done by an imaging system mounted on the linear accelerator itself. IGRT technically includes IMRT and hence also called as IM- IGRT (Intensity-modulated Image guided radiation therapy) What is SBRT? Stereotactic body radiation therapy (SBRT) refers to use of principles of stereotaxy to identify and pin pointedly deliver precisely deliver intense doses of RT to only to cancer/tumour area. SBRT is essentially similar to Stereotactic Radiosurgery (SRS) brain except that term SBRT used when we are targeting areas outside brain.  Since SBRT involves delivery of higher intensity of radiation doses in shorter time, it also known as SABR (Stereotactic Ablative RT). SBRT is generally done by combining IMRT and IGRT together. SBRT generally has fewer sitting /fractions of radiation as compared to conventional IMRT or IGRT. Your Radiation Oncologist will discuss all these techniques and how they are relevant for your cancer and its treatment. What is more important for successful radiation therapy- Machine or team behind machine? Both machines and team behind machines are equally critical in successful delivery of RT. We are fortunate that at Max Institute of Cancer Care (MICC), we have this critical combination of the modern state of the art machines and a trained team available across all hubs of Max Hospitals. TrueBeam STX is an advanced radiotherapy system to deliver more powerful cancer treatments with pinpoint accuracy and precision. It uniquely integrates advanced imaging and motion management technologies within a sophisticated new architecture that makes it possible to deliver treatments more quickly while monitoring and compensating for tumor motion. While the technology always opens the door, it is always the skilful doctors who can get inside it. Supportive Services Stoma Care Nurse: stoma is an opening on the front of your abdomen which is made using surgery. It allows faeces or urine to be collected in a pouch (bag) on the outside of your body Sometimes, during surgery, it may be necessary for the surgeon to form an artificial opening on the wall of your abdomen called a 'stoma' to collect waste. The stoma may be temporary (to allow the bowel time to heal) or permanent. Onco-Psychology Dietitics and Nutrition Onco-Cardiology Cancer Prevention advise & services Cancer Genetics Molecular / Precision Oncology Tobacco cessation services FAQs What are the symptoms of gastrointestinal cancer? Early signs of gastrointestinal cancer include constant indigestion, frequent burping, trapped gas, heartburn, quick satiety, bloating, feeling unwell, pain in the breastbone or stomach, and difficulty swallowing (dysphagia). Can stomach cancer be detected with a CT scan? A CT scan uses X-rays to create detailed cross-sectional images of the body's soft tissues. It can provide a clear view of the stomach and often confirm the presence of cancer. Additionally, a CT scan can reveal if the liver, nearby lymph nodes, or other parts of the body have been affected by the spread of stomach cancer. Does gastric cancer spread to other organs? Stomach cancer commonly metastasises to the liver. It can also affect the peritoneum (the tissue lining the abdominal cavity), lungs, and lymph nodes. Is gastric cancer hereditary? Yes, gastric cancer can have a hereditary component, but it is not the sole cause. Other factors such as age and lifestyle habits also contribute to its development. Which foods are associated with stomach cancer? Consumption of foods preserved by salting, such as salted fish, meat, and pickled vegetables, can increase the risk of developing stomach cancer. Regular consumption of processed, grilled, or charcoaled meats is also associated with an increased risk of stomach cancer. FAQs Review FAQs reviewed by Dr. Manish Jain, Principal Consultant, Cancer Care / Oncology, Surgical Oncology, Gastro Intestinal & Hepatopancreatobiliary Surgical Oncology.

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Gynaecologic cancer is a type of cancer that starts in a woman's reproductive organs. While they are often discussed as a group, each gynaecologic cancer is unique. Each has different signs, symptoms, and risk factors.

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Head and Neck Cancer (H&N cancer) refers to a group of biologically similar cancers that arise in the head and neck region (comprises the lip, oral cavity (mouth), nasal cavity, sinuses, pharynx, larynx (voice box), salivary glands and the thyroid. H&N cancers together rank sixth amongst all cancers worldwide, comprising about 40% of all cancers in Southeast Asia, including India. Advances made in the last few decades in all the fields of Oncology (surgical, radiation and medical) have made H&N cancer a better-understood and better-managed subject today. We are dedicated to providing the highest standard of care for patients with head and neck cancer. Our team of highly skilled and experienced specialists are equipped with the latest technologies and techniques to provide the most effective treatment options. At Max Institute of Cancer Care, we provide the most advanced cancer treatments using cutting-edge technology based on International Standards. We firmly believe in delivering quality care, support and reassurance to our patients. Cancer care requires medical professionals from different specialities to execute an individualised patient care plan for the best results collectively. Accordingly, we have a Head and Neck DMG (Disease Management Group) led by a dedicated and expert team of doctors who deal with head and neck cancers. This team includes head and neck surgeons, radiation oncologists, medical oncologists, plastic and reconstructive surgeons, maxillofacial surgeons, radiologists, pathologists, nuclear medicine specialists, speech and swallowing therapists, occupational therapists, nutritionists, prosthodontics, dentists, rehabilitation specialists who provide targeted and personalised treatment for patients with head and neck cancer. The team sits together in a Head and Neck Tumor Board meeting and discusses each case in detail to ensure the best treatment is provided to the patient, keeping in mind the specific requirements of each patient. The team meets at regular intervals to analyse treatment and the patient's responses to the given treatment. Having experts from all these disciplines ensures that a patient's treatment plan is comprehensive and coordinated, not just in the treatment phase but even after the treatment is over, for better recovery and rehabilitation for a smooth life ahead. The treatment involves surgery, chemotherapy, radiation therapy, etc. Latest Technologies Used Tomotherapy: This advanced radiation therapy technique uses a specialised machine that delivers highly precise doses of radiation to the cancerous cells in the head and neck region. This method is particularly effective for tumours that are difficult to reach, and it helps to minimise damage to the surrounding healthy tissue. Robotic Surgery: Our team of experts are trained in the use of cutting-edge robotic surgical systems, which allow for minimally invasive procedures that provide quick and effective removal of cancerous tumours. This results in reduced pain and faster recovery times for our patients. True beam Linac: This state-of-the-art linear accelerator delivers high-energy radiation to the cancerous cells with extreme accuracy, reducing the risk of damage to the surrounding healthy tissue. This technology is particularly useful for treating tumours in the head and neck region, where the risk of complications is high. PET Scan: Our team of specialists uses advanced imaging technologies, including PET scans, to diagnose and monitor the progression of cancer in the head and neck region. It provides our patients with the most accurate and up-to-date information about their condition. Types of Head and Neck Cancer Treated at Max Hospitals: We treat a variety of head and neck cancers, including: Oral cancer Throat cancer Laryngeal cancer Pharyngeal cancer Thyroid cancer Parathyroid Tumors Parotid gland cancer Nasal Pharyngeal cancer Approach When a patient is suspected of Head and Neck Cancer, the examining clinician evaluates the medical history and performs a detailed physical examination. Other diagnostic tests are performed depending on the area of suspicion. A biopsy (study of a tissue sample from the suspected area under the microscope) / FNAC is mandatory to confirm the diagnosis of cancer. Also, depending on clinical evaluation and the doctor’s advice, radiological investigation to see the spread of the tumour and staging can be ascertained. The treatment plan varies from patient to patient depending on a number of factors like the stage of the tumour, location of the tumour, patient's age, general condition, occupation of the patient, etc. For early-stage cancer - the treatment is surgery or radiation; further therapy may be considered if other risk factors of cancer coming back are identified in the final histopathology report. For locally advanced cancers - the treatment is surgery and radiation with or without chemotherapy. Even in advanced cancer with good reconstruction, the patient has a good quality of life. For very advanced cancers where it has spread to vital structures or other parts of the body, treatment is not aimed at cure. Lifespan and quality of life can be improved with palliative therapy along with radiation therapy and chemotherapy or immunotherapy, depending on the general health of the patient. We understand that a cancer diagnosis can be a difficult and stressful experience, and we are here to provide the support and care you need during this time. Our team are dedicated to providing the best possible outcome for our patients. We will work closely with you to develop a personalised treatment plan that meets your individual needs and goals. We are committed to providing the highest standard of care for our patients with head and neck cancer. Contact us today to schedule an appointment with one of our head and neck cancer specialists.' Review Reviewed by Dr. Ranjit Kumar Padhiari, Associate Consultant - Surgical Oncology, Cancer Care / Oncology, Head & Neck Oncology.

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As its name suggests, this type of cancer affects the production and function of your blood cells. This type of cancer starts in bone marrow which is the integral source of blood production. Stem cells in your bone marrow mature and develop into three types of blood cells: red blood cells, white blood cells, or platelets. In case of cancer, the blood production process is interrupted due to the growth of an abnormal type of blood cell. The various types include Leukemia, Lymphoma and Myeloma.

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Musculoskeletal / Orthopaedic Oncology Disease Management Group (DMG) at Max Institute of Cancer Care comprises of a dedicated group of specialists whose focus is to provide a comprehensive management to all patients presenting with benign and malignant tumors of bones and soft tissues. It is now established beyond doubt that multidisciplinary involvement is essential for an optimal outcome of the management of these rare diseases, and we at Max Institute of Cancer Care (MICC) boast of a team of experienced doctors specialized in the care of patients with bone and soft tissue tumors. This team consists of orthopaedic, surgical, medical, and radiations oncologists, pathologists, radiologists, physiotherapists, onco-psychologists, nuclear medicine specialists, and molecular oncologists. Treatment of each musculoskeletal cancer patient needs to individualized planning and personalization. At Max Institute of Cancer Care, all such cases are taken up in a multidisciplinary Tumour board where specialists from the field of orthopaedic oncology, surgical oncology, radiation oncology, medical oncology, radiology and pathology discuss each case threadbare and come up with a treatment regimen that not only maximizes survival but also ensures good functional outcomes.

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Neuro Oncology is a branch of medicine that concerns cancers of the brain , spinal cord & peripheral nerves. Cancers of the nervous system are often severe conditions that eventually become life threatening. Cancers of the nervous system may occur as primary tumors or as secondary or metastatic tumors that arise due to cancer that has spread from another part of the body. Primary tumors can occur at any age but they often affect people while they are in their prime. Most primary cancers are more common among males than females, although meningiomas are more common among females. Secondary tumors can spread to the nervous system from another site of origin through metastasis, compression or direct invasion.

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Pediatric oncology deals with treating cancer found in children and adolescents. Even though most types of cancers are common in adults and children, children have different needs. They must be treated by someone who understands these needs thoroughly. With timely diagnosis and correct treatment, pediatric oncologists can cure more than 80% of children with malignant disease. But thanks to the ever-developing medical technology, for many cancers more than 90% of cancer patients who are kids can be treated entirely. Opting for a pediatric oncologist is vital since they are professionally trained to treat kids and young adults. Types The different types of cancer that can be found in children are as follows: Primary cancer: The place where cancer first starts is called primary cancer. Secondary cancer: When the cancer cells break down and spread through the other areas of the body, it is known as secondary cancer. Spinal cord and brain tumours: There are one of the most common kinds of cancer in children. They are primarily found in the brain and the the spinal cord. Symptoms for such types of cancers may include dizziness, double vision, vomiting, etc. Leukaemia: This type of cancer is found in the blood and bone marrow of children. It causes sudden weight loss, bleeding, and joint pain. Lymphoma: Cancer that originates in the lymph node of lymph tissue is known as lymphoma. They can be of two types, Hodgkin's lymphoma and non-Hodgkins lymphoma. Wilms tumour: This tumour mainly originates in the kidney and may cause lumps in the abdomen. Symptoms include nausea, vomiting, and weakness. Neuroblastoma: This type of cancer is usually found in infants. It commonly begins in the abdomen and may cause severe pain and high fever. Retinoblastoma is a common type of eye cancer in children that begins in the retina. It usually occurs when genetic mutations occur in the retina's nerve cells. It is a severe condition and must be treated immediately to extend the child's life expectancy. Sarcoma: It is a type of cancer that begins in the muscles and bones. It can be completely cured if it is diagnosed and treated in the early stages. Germ cell tumours: These tumours occur when the reproductive organs of an unborn baby don't develop correctly. Most of the children diagnosed with germ cell tumours are usually entirely cured. Symptoms may include constipation, difficulty holding urine, etc. Symptoms Children must be checked for cancer if they showcase the following symptoms: Sudden weight loss Extreme weakness Unexplained paleness Sudden change in vision Unusual swelling Fever that doesn't go away Constant Headaches with vomiting Bruising and bleeding easily These symptoms could be related to other infections, too. However, it's advised to check for cancer if the symptoms sustain for long periods of time. How to find a pediatric oncologist? You will be consulting a pediatric oncologist once your child is diagnosed with cancer. Your paediatrician will mostly refer you to a pediatric oncologist. Cancer in children is rarer than cancer in adults making it vital to research the doctors before choosing the right one for your child. Children are prone to contracting several infections, which could display the same symptoms as cancer. Only a pediatric oncologist will be able to diagnose it properly. Thus, relying simply on referrals won't be enough. To choose an excellent pediatric oncologist, you will have to: Find doctors’ names by researching the database of medical associations Compare the credentials of all the doctors Speak to the staff of the doctors Try to find out how many years of experience the doctor holds in the field Enquire about the number of patients the doctor has treated so far in his career Try to connect with a few past patients of the doctor Find online reviews, if any Ensure that the doctor is taking new patients Check if the doctor searches for clinical trials which are suitable for his patients Figure out if the pediatric oncologist is up to date with the latest advancements Book an appointment with the doctor you feel would be the right fit. Sometimes pediatric oncologists might ask to retake specific tests or get additional tests done just to be sure and be prepared for it. After the tests, if they confirm it to be cancer, the doctor will suggest treatments based on the nature of the tumour. Cancer can be overwhelming both for the patients and parents; an excellent pediatric oncologist is one who understands this and provides you with mental and emotional support by referring you to a few psychologists. How do pediatric oncologists diagnose cancer? Doctors conduct a number of tests to diagnose pediatric cancer. Some of them are: Biopsy: Here, a small part of the tissue is extracted and examined under a microscope to determine the type of tumour. The location of the tumour determines the type of biopsy to be performed. Blood tests: Blood tests are vital to diagnosing blood-related cancers like leukaemia. They help determine the amount of red and white blood cells in the body. If the presence of specific cells is too high or too low, it usually indicates cancer. Bone marrow aspiration: A small amount of the fluid is extracted using a needle and then sent to the lab to thoroughly examine and study the fluid. Lumbar puncture: Here, a sample of the cerebral spinal fluid is extracted using a needle and examined in the lab to detect cancer cells. Patients will be administered anaesthetics before the test to numb their lower back area. Ultrasound: It is an imaging test that uses sound waves to give the doctor a picture of the internal organs. CT and MRI scan: A CT scan uses X-rays to give the doctor a clear image of the internal organs of the body, whereas an MRI scan does the same using magnetic fields. PET scan: It is an imaging scan that makes use of radioactive substances to reveal a clear picture of the internal organs of one’s body. A safe amount of radioactive substance is injected inside the body, after which a scanner is used to detect the substance and create a picture of the body's internal organs. If the above-mentioned tests confirm the presence of cancer, the doctor will suggest treatments based on the nature of the cancer. These tests help categorise and describe the nature of cancer thoroughly so that no additional diagnostic tests would be required. However, your doctor may repeat them during treatment to determine their success rate. Last Update Reviewed by Dr. Ramandeep Singh Arora, Associate Director, Paediatric (Ped) Oncology on 30-Oct-2022. FAQs What impact does chemotherapy have on a child's growth and development? Chemotherapy can temporarily affect a child's growth and development, but most children can catch up on their growth after completing the treatment. Is radiation therapy safe for children? With careful planning and administration by experienced doctors and healthcare professionals, radiation therapy can be safe for children. What are the common types of childhood cancers? Leukaemia (blood cancer) is the most common type of cancer in children. Other common cancers include brain tumors, lymphoma, neuroblastoma, Wilms tumor, malignant bone tumor, retinoblastoma, and germ cell tumors. What are the side effects of chemotherapy in children? Chemotherapy kills rapidly dividing cancer cells. However, as a side effect, it also affects other rapidly dividing cells of the body. Thus, common side effects include hair fall, nail and skin discoloration which are all temporary and recover completely once treatment is over. Complications also depend on the type of cancer, treatment being given, and other factors. Most side effects are usually temporary and settle down once the treatment is over. The paediatric oncology team would guide you based on the child's specific diagnosis. Can childhood cancer recur after treatment? Most childhood cancers are curable. However, there is a risk of cancer coming back after treatment is completed, also known as relapse. What is the chance of a cure or complete recovery from cancer in children? Most cancers in children can be cured if diagnosed early and treated appropriately by doctors with expertise in treating children's cancers. These children will go on to complete their school, college and have family and professional life like other children.  Review Reviewed by Dr Prachi Jain, Senior Consultant -  Cancer Care / Oncology, Hematology Oncology, Paediatric (Ped) Oncology, Paediatric (Ped) Hematology, Medical Oncology, Musculoskeletal Oncology, Neuro Oncology on 22-Apr-2024.

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Lung cancer is an uncontrolled and abnormal growth of cells in lungs, this growth of abnormal cells do not carry out the functions of the normal lung cell and also do not help in developing healthy lung tissue. As these cells start growing in both the lungs; they divide swiftly and develop in the form of tumors, Lung cancer may spread to other parts of the body if not discovered and treated early. Mostly tumors that are in one place of the lung and not become noticeable to spread are called “benign tumors”. Tumor that spread to other parts of the body through the bloodstream or the lymphatic system is known as “malignant tumors”; usually the abnormal cells don’t develop in healthy lung tissues. Lung cancer is more difficult to treat when it spreads. One of the most common factors that can cause lung cancer are exposure to radon, air pollution, certain chemicals in the workplace; active passive smoking; or family history of lung cancer. Lung cancer is one of the leading causes of cancer deaths among both male and female, it claims more lives each year than do prostate, ovarian and breast cancers combined.

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Cancers of the organs covered by uro-oncologist inclube the kidneys, adrenal glands, ureters, urinary bladder, urethra and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate and penis). Kidney Cancer What is kidney cancer? Kidney cancer happens when normal cells in the kidney change into abnormal cells and grow out of control. People have 2 kidneys, 1 on each side of the mid-back. The kidneys' job is to filter the blood and remove waste and excess salt and water. Urine is made up of these ingredients. What are the symptoms of kidney cancer? — Smaller kidney tumors do not always cause symptoms. But larger tumors and tumors that have spread outside the kidney can cause symptoms, such as: Blood in the urine Pain on either side of your lower back, in your side, or in your stomach A lump in your belly or on the side of your back Weight loss that you cannot explain These symptoms can also be caused by conditions that are not cancer. But if you have these symptoms, you should be checked by a doctor or nurse. Is there a test for kidney cancer? — Yes. If you have symptoms of kidney cancer, your doctor or nurse might order a test to check your kidneys. These tests can show tumors or abnormal growths. They create images of your kidneys in different ways, and they include: CT scan (a type of X-ray) MRI (uses magnets to create images) Ultrasound (uses sound waves to create images) Most people find out they have kidney cancer after having an imaging test for an unrelated symptom. For example, people sometimes have a CT scan because they have belly pain and then find out they have a tumor in a kidney. What is kidney cancer staging? — Cancer staging is a way in which doctors find out how far a cancer has spread. The right treatment for you will depend a lot on the stage of your cancer. How is kidney cancer treated? People with kidney cancer often have one or both of the following treatments: Surgery – When cancer is confined to the kidney, it is usually treated with surgery with the goal of taking out the entire tumor. This can involve removing all or part of the affected kidney. The decision about how much to remove depends on different things, including how well the other kidney works and how big the tumor is. In some cases, surgery can help even if the cancer has already spread to other parts of the body. Medical treatment – Different medicines can also be used to treat kidney cancer, particularly if it cannot be removed or if there is evidence it has spread. This might include: Targeted therapy – This includes medicines that block certain blood vessels or proteins in your body that help the cancer grow. Immunotherapy – This is the term doctors use for medicines that work with the body's infection-fighting system (the "immune system") to stop cancer growth. What happens after treatment? After treatment, you will be checked every so often to see if the cancer comes back. Follow up tests can include exams, lab tests, and X-ray tests. What happens if the cancer comes back or spreads? If the cancer comes back or spreads, you might have more surgery or medical treatment. Prostate Cancer Overview of prostate cancer Prostate cancer is one of the most common types of cancer that is developed in the prostate gland of a male reproductive system. In most of the cases prostate cancers grow slowly; however, some grow relatively quick, it might be possible that cancer cells may spread from the prostate to other parts of the body, majorly in the bones and nodes. As it develops slowly so initially it may cause no symptoms for many years but later it may lead to difficulties such as problem while urinating. Mostly this type of cancer occurs in men older than age 65. The Prostate is a small gland that is located in a male’s lower abdomen; it is under the bladder that surrounds the urethra. This gland is regulated by the testosterone and produces seminal fluid, also known as semen. If prostate cancer is detected early and is still confined to the prostate gland has better chances of a successful procedure. Urinary Bladder Cancer What is bladder cancer? Bladder cancer happens when normal cells in the bladder change into abnormal cells, and grow out of control. What are the symptoms of bladder cancer? — Bladder cancer causes mild symptoms that can come and go. These include: Blood in the urine, which makes your urine look pink or red Pain on the sides of your back or above your pubic area Pain when urinating, urinating often, or leaking urine These symptoms can also be caused by conditions that are not bladder cancer. But if you have any of these symptoms, you should be checked by a doctor or nurse. Is there a test for bladder cancer? Yes. Doctors can use different types of tests to look for bladder cancer. These include: Urine tests - Urine tests can show what kind of cells are in the urine. X-rays, CT scans, or other imaging tests - These tests create images of the entire urinary tract, which includes the kidneys, ureters, and the bladder. They can show tumors or abnormal growths. Cystoscopy – Cystoscopy is a procedure that allows the doctor to look directly inside the bladder. To do a cystoscopy, the doctor inserts a small tube into the urethral opening, the opening through which urine leaves the body. Then he or she pushes the tube up into the bladder. The tube has a tiny camera that projects images of the bladder onto a screen. If the doctor sees anything unusual, he or she might take a sample of tissue (called a biopsy) to look at under the microscope How are bladder cancer treatment decisions made? — Once the diagnosis of bladder cancer is confirmed, the treatment depends on the cancer stage and grade. Cancer staging is a way in which doctors find out how far a cancer has spread. Grading refers to the way the cancer looks under the microscope. The right treatment for you will also depend on how old you are and whether you have any other medical problems. Surgery - Bladder cancer is usually treated with surgery. Depending on how large the cancer is and how far it has spread, doctors can do 1 of 3 things: . Take out the cancer and leave the bladder in place. In many cases this is done through cystoscopy. Usually this procedure has no impact on the ability to urinate. Take out the cancer and a part of the bladder. This option depends on how much of the bladder is involved, and is not done very often. After this procedure, people can often urinate normally. Take out the cancer, the bladder, and nearby internal organs. This option might be necessary for people with advanced bladder cancer. With this type of surgery, the surgeon also has to create a new way for urine to leave the body, because the bladder has been removed (figure 2) Medical therapy – Medicines are an important part of treatment for people with bladder cancer. Doctors use different medicines depending on the extent of the cancer. For people with very early bladder cancer that has not spread into the bladder muscle (called "superficial bladder cancer"), medicine is given directly into the bladder. For people with cancer that invades the bladder muscle, chemotherapy should be given before surgery. Chemotherapy is the medical term for medicines that kill cancer cells or stop them from growing. This can shrink the cancer and make it easier to remove. For people with invasive bladder cancer who did not go through chemotherapy before surgery, chemotherapy can be given once they are healed from surgery. Radiation therapy – Radiation kills cancer cells. Radiation therapy might be an option for some people instead of surgery. It is often given along with chemotherapy. What happens after treatment? — After treatment, you will be checked every so often to see if the cancer comes back. Follow up tests can include urine tests, cystoscopy, and X-rays. Tell your doctor or nurse if you have any of the symptoms listed above. Having those symptoms could mean the cancer has come back. What happens if the cancer comes back or spreads? — If the cancer comes back or spreads, you might have more surgery, or get chemotherapy or radiation. Penile Cancer Penile cancer is a rare type of cancer that occurs on the skin of the penis or within the penis. It most commonly affects men over the age of 50. Testicular Cancer Testicular Cancer is a rare type of Cancer that occurs in the male organs that make male hormones and sperm (testicles). Treatments include surgery, radiation and chemotherapy. What We Do Cancers we treat The management of urologic cancers have transformed over the years with technical innovations in surgery and radiation, advancements in targeted therapy, hormonal therapy, chemotherapy and immunotherapy. The team aims to deliver state-of-the-art disease management by integrating the latest medical technologies, minimally invasive therapies and research. The diseases treated include malignancies of Prostate, adrenal, kidney, upper urinary tracts, Urinary bladder, Testis, Penile and urethral cancers In early stage cancer different surgical modalities are employed to treat these cancers, often in a multi-disciplinary team approach with the integration of expertise by medical oncology and/or radiation oncology. In advanced/metastatic stage urological cancers, systemic therapy approach comprising chemotherapy, hormonal therapy, targeted therapy and immunotherapy, alone or in combinations is employed to achieve maximum patient benefit. Surgical Uro-Oncology & Robotics We regularly perform Robotic/laparoscopic and open partial nephrectomy, Robotic/Laparoscopic/Open radical nephrectomy, Robotic/Open radical nephrectomy with inferior vena cava thrombectomy for advanced kidney cancer, Robotic radical prostatectomy and Robotic/Open radical cystectomy with intracorporeal/open urinary diversions amongst others. Endourological procedures and other less-invasive treatment alternatives (where appropriate) for urologic cancers such as active surveillance are offered for select candidates. Our team have been at the forefront of pioneering complex surgeries in a minimal invasive manner such as Robotic radical nephrectomy with IVC thrombectomy and Robotic radical cystectomy with intracorporeal neobladder/ileal conduit formation. These procedures are currently being performed in only a handful of centres around the world. The complication rates are no more than that of at best centers around the world. The average length of stay after surgery for all robotic cases (except radical cystectomy) has been less than 48-72 hours keeping in sync with our motto of eager to get you home!! The clinical activities of the Center are supported by world-class clinical experts in pathology, radiology, and anesthesia team. Intraop – IVC and renal vein dissection during robotic radical nephrectomy with IVC thrombectomy Radiation Oncology Radiation Oncology for urogenital tumors takes pride of treating about 16% patients with rare or special tumors like pediatric RMS, Small cell carcinomas and double Cancer that requires a dedicated-integrated Multi-specialty Team for best outcome. Radiation Oncology department at Max Hospital, is equipped with ‘State of Art’ facility of IMRT (Intensity Modulated Radiation Therapy), IGRT (Image Guided Radiation Therapy) SBRT (Stereotactic Body Radiation Therapy) which allow very focused precise treatment. We are amongst leading institution that regularly does short course radiation therapy for prostate cancer. Whole treatment is done in 5 weeks instead of 8 weeks that leads to better compliance, as mostly these patients are elderly. We pay equal importance to cure as well as quality of life and offer ‘Organ Conservative Radiation Therapy’ in suitable patients with Urinary bladder Cancer. Uro-Medical oncology Uro-Medical oncology takes care of judicious use of chemotherapy, targeted therapy, hormonal therapy and immunotherapy in the treatment of Urological Cancers. The intent of treatment is cure in cases where the disease is localized. In those cases where disease is widespread and cure is not possible, we aim to control the disease, improve of maintain quality of life, prevent/delay cancer complications and increase the survival. Uro-Medical Oncology is one of the most dynamic and rapidly developing fields in Oncology. Over last decade more than 20 new targeted therapies, hormonal agents and immunotherapy agents have shown improvement in survival outcomes of patients with urological cancers. During treatment, updated standard practice guidelines are followed strictly. The new concept of chemo-hormonal therapy in metastatic prostate cancer is routinely practiced and the survival data is remarkable. Metastatic kidney cancer is a unique entity in which there is little role of chemotherapy. Such cancers are successfully treated with oral targeted therapy. How is Urologic Cancer Diagnosed? Thorough evaluation is done in a systematic manner for making a particular diagnosis. Patient’s symptoms, personal and family medical history, physical exam and screening tests can help identify a patient’s urologic cancer type. Urologic cancer symptoms vary depending on the specific cancer type, and may include: Abdominal pain Blood in urine Elevated hormone levels Enlarged prostate The diagnostic tests recommended will depend on specific symptoms and may include: Biopsy Blood tests to evaluate hormone levels Bone scan CT scan (computed tomography) Digital rectal exam Liver function test MRI scan (magnetic resonance imaging) PET CT scan Pelvic exam Renal arteriography Ultrasound Urine test Urologic oncology care at Max Institute of Cancer Care is a multidisciplinary team approach that includes the Uro-Oncologist, medical oncologist, radiation oncologist and many cancer care associates. It is holistic at its core – healing the body, mind and spirit -- so that patients are back doing the activities they love. Patient health and well-being are top priorities and every effort is made to compassionately guide our patients and their families through the treatment process—from the first hospital visit to the postoperative appointment. Taking Patient Care to the Next Level Our team collaborates on each patient’s case, tailoring a precise treatment plan that is best suited to the patient’s physical, mental and emotional needs. Every case is discussed in tumor board and a wide array of treatment options are offered ranging from conventional care to leading-edge alternatives. Patients facing a urological cancer diagnosis can be confident that they will receive the most advanced and effective disease treatment.

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