3C Cancer Care Centre, part of Nadkarni’s 21st Century Hospitals, Vapi, finished 2 successful year of its existence and services in south Gujarat. It was shocking to see the increasing trend of cancer in this part of India. Few salient features noted during this first year:
• Head Neck cancers and Lung cancers the most common in men breast cancer commonest in the women
• Total lack of awareness among the people regarding symptoms of cancer
• 64% cases registered at the centre-diagnosed at stage 3/ stage 4
• Patients spending long time diagnosing, changing doctors and taking alternative medications for cancer which have no proven efficacy (other systems of medicine) before getting the right treatment
• Superstitions regarding cancer treatment
• Lack of protocols among doctors, regarding diagnosing and treating cancer cases
In view of the above situation in south Gujarat, NADKARNI MEDICAL FOUNDATION, and the 3C Cancer Centre has decided to publish a 6 monthly issue regarding cancer update for doctors and family physicians, called the 3C Cancer Connect.
This issue shall be providing you a summary of the work, the foundation and the cancer centre has done, along with 3-4 case discussions and topics regarding cancer update and management, with the only intention of spreading awareness and unity among doctors, regarding Cancer management.
The cancer centre wants doctors to be on the panel, hold meetings and get together for cancer awareness and update among people and doctors, in order to form protocols and detect and manage cancer at an early stage and increase general awareness about SCREENING.
The doctor can register at the 3 Cancer centre, if interested, for being on panel, to help the cause. The registered doctors interested for spreading cancer awareness, once a team, can refer cases, share experiences, hold meetings, get together, CMEs and updates along with cancer screening camps at their localities, in order to help the cause, with the help of the 3C cancer centre.
I hope, you will get inspired and get registered to the centre- for increasing cancer awareness. REGISTRATION IS FREE (for registering see below)
We have also developed cancer software and registry for reporting cancer causes which we are already supplying to the government. Shortly, developing an online website for connectivity among doctors for interaction- 3ccancerconnect.com
This current issue shall give you a summary of activities that the 3C cancer team has done and also highlight four case reports.

Dr. Akshay Nadkarni

[(MS. General Surgery)Ex.Tata Memorial Hospital,Dip.Lap.Surgery (Germany)Cancer & Lap. Surgeon]

3C CANCER CARE CENTER

21st CENTURY HOSPITALS PVT LTD, VAPI

Mobile No:+91 9879507743

E-mail: drakshaynadkarni@yahoo.co.in

The Nadkarni medical foundation was started in 2011 by Dr. Kishore and Dr. Purnima Nadkarni, for doing social work in the field of infertility. In 2012, Dr. Akshay added the cancer awareness initiative through this foundation. The foundation is giving subsidized treatment to poor patients for infertility, since last two years.

Since March 2012, the foundation has started its activities for cancer patients and for cancer awareness.

The whole motive and objective of making the foundation was to have a platform to serve the needy poor getting cancer/infertility.

We have been doing following activities in last 1 year: (CANCER AWARENESS ACTIVITIES FOR EARLY DETECTION)

Holding camps- free checkups and screening and cancer detection tests at <50% standard rates. Already 5 major camps conducted:

  • FEB 3RD world cancer day 2012- saw 65 patients and given 4 patients free treatment and surgery.
  • 1st week after opening 7 DAY FREE CAMP MARCH 25TH -30TH-2012. It screened 180 patients and the department did ten cancer surgeries at subsidized rates. Newly diagnosed cases due to screening in the camp—5
  • WORLD ANTI TOBACCO DAY 31ST MAY-LAUNCH OF ANTI TOBACCO CAMPAIGN
  • Screened 140 patients and detected 5 new cases of cancer, apart from treating 8 already diagnosed cancer patients as subsidised rates(surgery and chemotherapy)
  1. MORE THAN 40 INDUSTRIES VISITED 3C CANCER TEAM (VAPI/DAMAN/SILVASA/ATUL) GIVING FREE LECTURES ON LCD PROJECTORS WITH INNOVATIVE SPEECHES, PRESENTATIONS, PLAYSAND INTERACTIVE DE ADDICATION SESSIONS.
  2.  DE ADDICTION CENTRE STARTED AT 3C CANCER CENTRE- FREE COUNSULTATION AND COUNSELLING WITH ROUND THE CLOCK FREE PRESENTATION AND PAMPLETS BEING DISTURBED TO PATIENTS.
  • WOMAN CANCER AWARENESS WEEK 17TH TO 22ND JUNE 2012
  1.  Meetings with social woman organizations like Vapi Maharashtra mahila mandal, Bori samaj, Lioness Club Vapi Silvassa, shri Krishna cancer aid foundation, and many others for holding presentations and lectures- FREE OF COST- for exclusive women, for encouraging SCREENING for BREAST AND CERVICAL CANCERS.
  2. FREE COUPON DISTRIBUTION AT THE END OF LECTURES FOR MAMMOGRAPHIES AND PAPS SMEAR DONE AT 30% RATES.
  • FREEDOM FROM CANCER INITIATIVE 1sTH AUGUST 2012
  1. 1 day FREE CAMP where all the cancer patients operated at the centre, were invited with their family and had a get to gether and live press conference where the patients and relatives highlighted their experience about going through cancer treatment and the effects of tobacco on their family. They encouraged others to stop tobacco and proved that cancer, if detected early, can be cured.
  2. 55 patients checked and 3 detected of cancer.
  • DIWALI SPECIAL WEEK OFFER - CELEBRATED 2012 DIWALI WITH- cancer screening packages whole body checkups, males, females,, separate packages where FREE CONSULTATION followed by <50o/o rate packages for cancer screening and early detection.
  •  Apart from all the above activities, the cancer centre is publishing data and awareness news and pamphlets to rural and urban patients of valsad district every month, as handbills in news papers, awareness articles in Newspapers, interviews on news channels and is persistently Encouraging people and organizations for holding Lectures/presentations for spreading the awareness of cancer symptoms/prevention modalities and concept of screening, with a whole and sole motive for EARLY CANCER DETECTION.
  • Many peripheral rural camps in association with other organizations like LIONS Club, Silvassa, Krishna Cancer Aid, Lions Club Bhilad, etc for organizing FREE CHECK UP CAMPS in rural areas, free blood  investigations, paps smears and checkups.
  • ALSO, any poor patient who comes to the cancer centre, who cannot afford the standard rates of the centre, is being offered many options:
  • 50% discount in whatever treatment charges if pt is BPL or is Poor (even without BPL card) - expenses paid by Nadkarni Medical Foundation.
  • Antibiotics and analgesics, which form a major portion of the extra expenses for a patient getting operated for cancer, is being provided free for all cancer patients in the general ward of 3C cancer care centre. These drugs are purchased and stock kept for such patients ( by Nadkarni medical Foundation)
  • Any patient for palliative care ( terminally ill cancer patient) is getting 10% discount of the final bill - all patients irrespective of affordability
  • All patients needing adjuvant treatment in the form of chemotherapy are given chemotherapy injections at minimal rates/FREE, (case to case basis)
  • Free chemotherapy to general ward patients. ( NMF)

Case 1:

A 30 old male patient presented with ulcer on the right lateral border tongue x 3 months.

On examination: 3x3 cm ulcer right lateral border tongue with induration and abutting the gingivolabial sulcus, neck showed enlarged left submandibular lymphnodes level 1B

CECT: Lesion in tongue with infiltration into right mandibular cortex with nodes in neck

Plan: Biopsy 1ST – Sqamous cell carcinoma, well differentiated

Treatment: right adequate (hemi glossectomy) with right henimadibulectomy with right modified radical neck dissection level 1-5 and right pectoralis myocutaneous flap

Post Op Recovery: RT feeds for 1 week, orally from day 8, neck drain and stitches out on POD 12

HPR: 4x3 cm lesion T2N1Mx with all margins clear, well differentiated with 2/12 lymphnodes positive

Post Op Management: Adjuvant CT + RT for 5 weeks, completed treatment

Pet scan 6 months: Negative for any metabolically active disease in body

Follow up 1 year: Patient working normally and no evidence of recurrence

Discussion:Since the patient has come late, stage 3, the case needed massive operation. If, it was a small lesion T1, CT/RT or a small non-morbid surgery would be enough. So, it is important to diagnose cases, early.

Case 2:

55 year old male with hoarseness of voice x 1.5 years, diagnosed case of Ca larynx, biopsy proven well differentiated squamous cell carcinoma, taken many doctors treatment(ayurvedic) for 6 months , had 3 CT scan reports every 3 months done by patient. Every scan showed increase in the lesion over 1 year

Recent CT on examination had 4x2 cm mass lesion in right vocal codes with extension to left cord with anterior commissure involvement with thyroid cartilage involvement, post cricoids normal and had bilateral multiple lymphnodes. The mass was extending to parapharyngeal spaces and reaching to tonsillar bed.

Management: After a direct laryngoscopy under GA and clinical examination, the patient appeared to have a locally advanced disease as he had come very late to us.

A modified method of management was planned for him. We gave him 3 cycles of Neo-adjuvant chemotherapy with paclitaxel, Cisplatin and 5 Fu every 21 days and respected Ct, Found > 70% response, reduction of tumour size to 3 cms and reduction in lymphnodal mets, later staged total radical laryngectomy with bilateral neck dissection with permanent Tracheostomy with voice prosthesis and patch pmmc (Pectoral muscle flap to reconstruct the anterior wall of upper Esophagus) was done.

Post op management – recovered in 15 days, small anastomotic leak, healed with conservative management, taken adjuvant CT RT after surgery within 2 months, completed treatment in 3 months of surgery. Follow up 8 months, PET negative and patient today is vocalising normally and is working in bhilad.

Case 3:

A 26 year old female patient with left maxillary mass for last 6 months. Slowly growing tumour in a tobacco chewer.

O/E- Oral cavity showed left upper hard palate ulcer proliferative lesion not crossing midline. Biopsy- sqamous cell carcinoma.

CECT: Showed a huge mass infiltering the medical and lateral walls of maxilla extending to zygomaand mandible, not involving the infratemnporal fossa.

Plan: Radical left mexilectomy with left hemimandibulectomy with neck dissection with pmmc flap.

POST OPERATIVELY- adjuvant RT taken, follow up 4 months, patient is normally taking orals and working.

Case 4:

A 26 year old male patient has a left adrenal mass on routine health check up USG finding. Worker in a factory in vapi.

CECT reported in vapi as 8x10 cm large cystic lesion with solid component in left adrenal gland with infiltration into left kidney, spleen and tail of pancreas. malignant adrenal mass.

The catch in this case- normal asymptomatic young patient, incidentaloma under evaluation.

Now adrenal masses can be secretory or non secretory, so its important to do some blood tests to rule out pheochromocytoma, or cortisol secreting tumours, all tests like urinary VMA, 24 hrs samples, 4,8 am cortisol levels, etc all levels were normal.

2nd catch- the CT report showing inoperability.

The ability of the surgeon to read a CT image is a very important. Myself, I felt the CT was wrongly reported. On the scans, with whatever minimal experience I have, I thought the mass was a well circumscribed cystic lesion and I thought it is benign. I did not do a pre operative FNAC as it would lead to loss of planes intra op. Also my gut feeling said, this is operable and this young patient has to be given a good chance of survival. Seeing the CT report, Ahmedabad surgeons had doomed him for palliative care already.

On table- huge vascular lesion, multiple blood vessels direct branches from aorta and IVC. Using a multiclip applicator and stand by 3 bottles blood with 2 anaesthetists around, dared to open the case. To my surprise it was a 8x10x9 cms mass cystic well circumscribed with lots of vessels around, abutting the spleen or kidney or pancreas.

The patient is cured of the disease and reported HPR is NON FUNCTIONALADENOMA.

LIST OF SOME CANCER SURGERIES THAT CAN BE DONE AT YOUR CENTRE (with OT set up)

 

  •  All head neck cancers can be done including major Commandos at your premises with minimal post operative tensions. (Good anesthesia set up sos tracheotomy set up needed) rest all Instruments can be managed by 3c cancer team
  •  All Plastic Reconstructions (PEDICLED FLAPS – Pectoralis Major and Deltopectoral, DONE BY ME) NO REQUIREMENT OF ADD ON PLASTIC SURGEON TEAM.
  • Ca Breast - Modified radical Mastectomies and Brest Conservation Surgeries.
  • All Gastro-Intestinal and Gynec Cancer Surgeries (Ca stomach, Ca colon. Ca Gall Bladder, Ca Ovary, Endometrial Ca. Ca Cervix).
  • Thyroid surgeries
  • Soft tissue sarcomas
  • Ca penis with groin Node dissection
  • Ca Lip with Reconstruction.

Surgeries other than these like Ca Lung, Ca esophagus, Ca pancreas Shall require close post operative watch and should ideally be referred to the centre.

Along with exclusive onocsurgeries, I have developed Laparoscopy at our centre in Vapi, as eventually I plan to practice laparoscopic Oncology.

The following procedures are routinely done at 21 " century hospitals Vapi:

  • LAP. HYSTERECTOMY
  • LAP. ENDOMETRIOSIS
  • LAP MYOMECTOMY
  • INFERTILITY ENHANCING GYNEC SURGERIES/ hysterosoopies
  • LAP CHOLECYSTECTOMY
  • LAP APPENDISECTOMY
  • LAP CBD EXPLORATION
  • LAP HERNIA
  • DIAGNOSTIC,LAP. AND OTHER ROUTINE LAP PROCEDURES
  • STARTED DOING LAP COLORECTAL, LAP FUNDOPLICATION, ETC

 LAST ONE YEAR. WE HAVE DONE ABOUT ‘I95 LAPAROBCOPIC CASES.I shall be happy to get your referrals for ONCO or Laparoscopy cues or even be more than happy to come to your centre for doing such cases.

CANCER INCIDENCE AND PROBLEM STATEMENT

WORLD

  • There were an estimated 12.7 million cancer cases around the world in 2008, of these 6.6 million cases were in men, 6.0 million in women.
  • This number is expected to increase to 21 million by 2030.

INDIA

  • According to a study by the world health organization, one in 12 women in urban India will develop cancer in their lifetime.
  • Approximately 40% of new cases of cancer in India afflict women.
  • In the past decade, breast cancer has overtaken cervical cancer as the most common cancer among women in Indian cities such as Mumbai and Delhi.
  • Also, India has the highest rate of cervical cancer in the world. One in every 10 cancer deaths worldwide is in urban India.
  • What’s more alarming, 75-80% of patients are in advanced stages of the disease at the time of diagnosis.

GUJARAT

  • 1 crore Guajarati’s (every 2nd man and every 5th women in Gujarat) use Tobacco every day.
  • Of the 12 to 15 lakh oral cancer patients in the country, Gujarat now has 2,75,000 lakh oral cancer patients which is next only to Utter Pradesh (approx 20% cases).
  • Moreover, 85% of total oral, head and neck cancers are linked to tobacco use and due to widely prevalent practice of chewing tobacco oral.
  • Head and neck cancer are the most common type of cancers in India as 40% of the total cancer cases in India are of this type.
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