ORAL CANCER

Oral cancer includes caner affecting lips, tongue, floor of the mouth, palate, gingiva, alveolar mucosa, buccal mucosa, and oropharynx.

Cause and statistics :

Oral cancer in India is different compared to the western countries as most common cause us tobacco (70%) and found in 3^rd or 4^th stage associated with higher risk. Incidences are chiefly seen in males and 5 years survival rate in 1^st stage is 80% and 5^th stage is 15%.

Treatment :

The treatment options considered for these locally advanced Buccal Mucosa tumors are:

• Two types of standard treatment are used:
  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Hyper fractionated radiation therapy ( divided dose radiation)
  • Hyperthermia therapy (Increasing body temperature).

Complication :

May be side effects of the disease or treatment or they may have other causes are :

• Dry mouth
• Change in taste
• Inflammation and ulcers of the mucous membranes
• Easy bleeding in the mouth
• Tooth decay and gum disease
• Nerve damage
• Salivary gland damage partially or completely
• Fibrosis (growth of fibrous tissue) in the mucous membrane in the mouth
• Oromandibular dystonia: Characterised by forceful contractions of face, jaw, tongue leading to dehydration and malnutrition
• Fungal and viral infections.

Ayurveda in preventing oral cancer :

Procedures and herbs indicated in daily regimes in Ayurveda like Danta Dhavana (Dental hygiene and gum strengthening), Kavala, Gandusha, Dhoomapana and Nasya are highly beneficial in preventing oral cancer.

Ayurveda in treating as well as subsiding oral cancer complications :

• Kavala is highly effective in reducing inflammation, facilitate healing of mucous ulcer, controls gum bleeding, stimulate salivary glands, reduces dryness of mouth thus enhance taste perception.
• Gandush is highly recommended in stimulating salivary glands, increase oral circulation facilitate healing and regeneration, reduces fibrosis and dystonia of face, jaw and tongue, beneficial in improving quality of speech, chewing and swallowing food.
• Karnapoorna reduce temper mandibular joint dry and stiffness.
• Nasya helps to upkeep moisture of facial sinuses, strengthen maxilla bones which includes upper jaw and hard palate, reduce chances of getting infection and improve nerve conduction.

Reference :

• https://www.cancer.gov

OESOPHAGEAL CANCER

Oesophagus is a muscular tube connects Throat and Stomach, through with the food and water reaches stomach after swallowing. Men are more prone to oesophageal cancer mostly between the are group of 55-85 years.

According to ICMR (Indian Council of Medical Research)

• 8th common cancer in the world
• Very high incidence has been reported in North-East region of India
• Survival ranges from 5 to 30% in five years
• The lower oesophageal cancers the most common site of malihnancy.

Most common caused for oesophageal Cancer :

• Smoking
• Alcohol
• Habit of drinking hot or too cold liquid
• Acid reflex (heart burn)
• Obesity
• Oral leukoplakia
• Achalasia
• Baret’s oesophagus

First signs normally is difficulty in swallowing food or liquid which make the person to eat less leading to weight loss. Chest pain or burning/pressure.

Treatments :

• Surgery
• Radiation Therapy
• Chemo Therapy
• Laser Therapy
• Electrocoagulation
• Targeted Therapy

Ayurveda in preventing oesophageal cancer :

There are effective treatment and diet regimens to treat repeated irritation caused in oesophagus. Being obese will be a platform for multiple systemic diseases which need to be regulated only through proper lifestyle, Ayurveda is the pioneer in techniques of healthy lifestyle.

Ayurveda in treating oesophageal cancer :

• Pachakarama : If patient is suitable. This helps to remove Bahu Dosha (Toxin) and try to restore physiology which further helps for better and quicker therapeutic results.
• Very early stage of oesophageal cancer is responds well to Ayurveda treatment.
• Ayurveda External treatments and internal medications are helpful to reduce the complication as well as to improve the endurance in persons who are undergoing Chemo or radiation therapy.

Recurrence : Avoiding or treating triggering factors with lifestyle changes, Ayurveda medications as per the requirement.

Palliative care with the combinations of medicines as well as various food preparations explained in Ayurveda are highly recommended in situations like patient has difficulty in swallowing.

STOMACH CANCER

Stomach is a part of digestive system, it is J-shaped hollow organ present in the upper abdomen between Oesophagus and Small Intestine. Stomach is not merely a transitory storage of food before digestion but also secretes acid and enzymes that helps to digest food. The stomach muscles contract periodically, churning food to enhance digestion.

Most Stomach Cancers are a type called Adenocarcinoma (Cancer started in the glandular tissue that lines the inside of the stomach).

Cause and Statistics : It is the 4th leading cancer in the world and the 2nd most common cause of death due to malignancy. According to a study conducted in Karnataka, Gastric Cancer ranks amongst the 5th most common cancers. The 5-year survival rate, 0 – 1st stage 68%, 2 – 3rd stage 31% and 4th stage 5%.

Risk Factors :

• Age : > 50 years.
• Gender : Men and Women at 2:1 ratio.
• Incidence rates are the highest in the north-eastern Indian region.
• Food and Habits :
  • Eating a diet high in salt : High intake of pickle, smoked, salty or preserved foods and a low intake of fruits and vegetables.
  • Tobacco use and drinking a lot of alcohol.
• Obesity : Excess body weight increases a man’s risk of developing Stomach Cancer. It is not clear whether obesity increases a woman’s risk of Stomach Cancer.
• Predisposing conditions :
  • People who have had Stomach surgery.
  • Mainly Bacteria – Helicobacter pylori (H. pylori) causing stomach inflammation and ulcers.
  • Pernicious Anemia.
  • Achlorhydria (lack of hydrochloric acid in the gastric juices).

Treatment : Often a combination of treatment is used for Stomach Cancer includes Surgery, Radiation therapy, Chemotherapy, Targeted therapy or Immuno-therapy.

Ayurveda in preventing Stomach / Gastric Cancer :

Considering the risk factors a healthy stomach can prevent it from being victim of cancer. Healthy ways and means of eating considering individual body type, age, season, nature of food, time of day and night are key factors behind healthy stomach. A primary consultation with an Ayurveda doctor is necessary for to get proper guidance regarding all these factor influencing the state of stomach.

Ayurveda in treating as well as subsiding Stomach / Gastric complications :

Most of the time it is difficult to cure Stomach Cancer because it is often not found until it is at an advanced stage.

• Avoids recurrence : As 60 – 70% recurrence in post-surgery cases within 2 years or maximum of 5 years, this risk period can be altered / avoided with Panchakarma procedures.
• Supportive care / Palliative Care :
  • Post-surgery; Amount of stomach removed will affect how much you need to change the way you eat ie. storage will be issue, vitamin deficiencies as stomach is not fully functional. Ayurveda techniques are highly beneficial guiding the food which is suitable to that individual type and need.
  • Medication for supporting body either during or post conventional therapies.
  • Metastatic stomach cancer only Palliative treatments including medication, nutritional changes, relaxation techniques, emotional and spiritual support and other therapies

References :

https://www.cancer.net

https://Cancer.org

Consensus document for management of gastric cancer by ICMR

SUBCUTANEOUS PANNICULITIS – LIKE T – CELL LYMPHOMA (SPTCL)

A very rare form of skin lymphoma that is localized primarily to the subcutaneous adipose tissue/ subcutaneous tissue without palpable involvement of the lymph nodes. Category of peripheral T-cell lymphoma in the World Health Organization classification.

• Characterized by infiltration of the subcutaneous tissue by neoplastic cytotoxic T cells mimicking panniculitis.

• Diagnosis
  • SPTCL is a challenge, especially during its early phases when symptoms mimic other, more common conditions, such as benign panniculitis, eczema, dermatitis, psoriasis and cellulitis.
  • Clinical and systemic features are nonspecific and can include fever, chills, and weight loss. Further complicating diagnosis is the high number of false negatives provided by biopsy.

• Age group : The average age of presentation is mid to late thirty with a female predominance (male: female=0.5).

• Treatment : No standardized therapy for SPTL currently exists.

• Local radiotherapy for indolent local disease has been found successful.
• For indolent disease with a more generalized distribution, immunosuppressive agents as well as low dose chemotherapy may be used.
• For aggressive presentations, combination chemotherapy, anthracycline-based regimens, fludarabine-based regimens, and rarely high-dose chemotherapy followed by hematopoietic stem cell transplant (SCT) with moderate success.

• Ayurveda in Preventing and Treating :
  • Among Panchakarma, Vamana will be highly beneficialindetoxing Rasa (plasma / body fluids), improve micro circulation, helps in avoiding fluid accumulation and stasis, improve immunity, reduce fat accumulations / cholesterol and maintain specific gravity of body fluids.
  • Udwarthana : Dry or medicated power massage helps to reduce accumulation of fluid beneath skin by improving lymphatic circulation and improve skin tonicity.
  • Lepa : If the skin is sensitive for udwarthana, lepa helps in inducing similar benefits, can be sued till sensitivity come down then switch on to
  • Kashayadhara : Rhythmical method of pouring warm medicated water on the body improves cutaneous circulation and acts like flush therapy to displace accumulation in and beneath skin.
  • Internal medication according to condition specific need to be selected to target Rasa, Raktha, Kapha

References;

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5242123/

https://www.longdom.org/open-access/subcutaneous-panniculitislike-tcell-lymphoma-review-of-therapies-2165-8048-1000198.pdf

PROSTATE CANCER

Prostate is a small walnut size and shaped glad in men that produces seminal fluid for nourishing and sperm transport. Cancer of Prostate is the most common type of cancer in elderly men. Prostate cancer tends to grow slowly compared with most other cancers. Cell changes may begin 10, 20, or even 30 years before a tumour gets big enough to cause symptoms. Eventually, cancer cells may spread (metastasize) throughout the body. By the time symptoms appear, the cancer might be advanced.

Risk factor :

• There is no exact cause
• The most common riskfactor is age above 50 years of age
• Person with family history have 2 to 3 times higher risk
• Risk is slightly higher in men from families with history of breast cancer
• Person eating high-fat diet may be at risk

Symptoms can be similar to the symptoms of BPH (Benign prostatic hyperplasia) :

• Trouble passing urine
• Frequent urge to pass urine, especially at night
• Weak or interrupted urine stream
• Pain or burning when passing urine
• Blood in the urine or semen
• Painful ejaculation
• Nagging pain in the back, hips, or pelvis

5-year relative survival rates :

• Localized : There is no sign that the cancer has spread outside the prostate is nearly 100%
• Regional : The cancer has spread outside the prostate to nearby structures or lymph nodes is neatly 100%
• Distant : The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones is 31%
• Overall 5-year survival rate for prostate cancer in Indiais 64%

Tests for diagnosis :

• Digital rectal examination to feel the texture of prostate gland
• Prostate-specific antigen (PSA) test
• Trans-rectal ultrasound (TRUS)
• Prostate biopsy
• PET CT scan

Treatment : Depending on stage of prostate cancer following methods are adopted ;

• Observation or active surveillance
• Surgery
• Radiation therapy
• Cryotherapy
• Hormone therapy
• Chemotherapy
• Immunotherapy
• Treating prostate cancer spread to bones

Ayurveda in preventing :

• Food and life style
• Doing Panchakarma like Virechan or Basti once in year or two depend on individual after the age of 40 years
• Urinating in
• Pelvic floor exercise

Ayurveda in treating :

• Surgery advised wherever required
• Aiming to strengthen bone tissues to prevent metastasis progression to reduce pain and reduce cancer progression.
• Aim to reduce PSA so that the intensity of active prostate cancer can be reduced
• Shrinking tumour and relieve the symptoms of prostate enlargement helps in reducing Trouble passing urine, Frequent urge to pass urine, Weak or interrupted urine stream

Pain or burning when passing urine, Blood in the urine or semen, Painful ejaculation, Nagging pain in the back, hips, or pelvis

Medications can be used during other conventional therapies like chemo, radio, immune etc.

References:

1. https://www.cancer.gov/publications/patient-education/understanding-prostate-changes (assessed on 18^th March 2020)
2. https://www.cancer.org/cancer/prostate-cancer/treating.html(assessed on 18^th March 2020)

BREAST CANCER

Breast Cancer now become the most common female cancer in urban India, varies from as low as 5 per 1 lakh female population per year in rural areas to 30 per 1 lakh female population per year in urban areas. With the exception of 5-10% Breast Cancers where the main risk factor is genetic predisposition, in the remaining 90% of sporadic Breast Cancers.

Risk Factors :

1. Being Female
2. Increasing age
3. Family history & Genetic factor
4. Early menarche
5. Late menopause
6. Poor diet, Obesity, Alcohol consumption
7. Lack of physical activity
8. History of hormone therapy
9. Late first pregnancy (<30years) and never been pregnant (nulliparous)

Symptoms :

1. Change in size
2. Lump in breast
3. Nipple discharge
4. Change in skin colour
5. Nipple retraction
6. Peaud’ Orange
7. Ulcerative mass
8. Swelling in armpit
9. Dimpling

5 years survival rate:

For Indian women with operable Breast Cancer who received standard multimodal treatment in the control arm of a recently published large randomized clinical trial from Tata Memorial Hospital (TMH), the 5 years disease free survival (DFS) rate of 70% and overall survival rate of 78% was reported.

Male Breast Cancer :

1. Male Breast Cancer (MBC) is an uncommon malignancy.
2. MBC comprised of 1.03% of total Breast Cancer cases.
3. Median age of presentation was 60 years ranging from 42 years to 70 years.
4. Most of the patients presented to us in advanced stage.

Modalities for early detection :

1. Self and clinical Breast examination.
2. Mammograpy, Ultrasonography, CT or MRI.
3. Confirmative test by Biopsy.

General types of Breast Cancer :

1. In Situ Breast Cancers that have not spread or on-invasive or pre-invasive Breast Cancer.
2. Invasive or Infiltrating Cancers have spread (Invaded) into the surrounding Breast tissue.

Conventional Treatment :

1. Surgery
2. Radiation / Chemo / Both Therapy
3. Hormone Therapy
4. Targeted Therapy

Preventions :

1. Food and life style which can avoid early menarche and obesity.
2. Breast feeding for an year.
3. Most physically active women had a 12 – 21% lower risk of Breast Cancer than those who were least physically active.
4. Periodically doing self-Breast massage with oil (Coconut / Sesame Oil).
5. Avoiding tight bra.

Ayurveda Treatment :

1. Ayurveda drugs significantly reduce side effects in Breast Cancer patients during Chemo or Radiation Therapy and helps in faster recovery.
2. If the person and stage are suitable for surgery that will be best to avoid further spread.
3. Suitable Panchakarma is advised before and after surgery.
4. Herbs having specific action on Rasa and Stanyavaha Srotas are the key too.
5. In metastatic conditions, the line of treatment formulated according to metastatic sights.

BLADDER CANCER

Bladder is a hollow muscular (flexible) sac situated in lower abdomen dose the function of temporary reservoir of urine received through ureters filtered by kidneys. Most commonly cancer is found in urothelial cells (bladder lining) tend to go out control in their growth leading to tumor, which can be benign or cancerous. Since urothelial cells are also present in renal pelvis and ureters, cancer of these parts is also considered a type of bladder cancer and it generally called as upper tract bladder cancer.

Risk factor :

• Tobacco smokers are 4 to 7 times more susceptible in both genders.
• Chemical exposures in Aroma, Rubber, Leather, Textile, Paint, Printing industries and Truck drivers (diesel fumes exposure) and drinking water contaminated with arsenic.
• Age > 65.
• More common in men than in women but women are more likely die for bladder caner.
• Iatrogenic cause :
  • Cyclophosphamide used in chemotherapy
  • Pioglitazine used for diabetes more than 1 years
• Previous history :
  • Repeated urinary infections, untreated bladder stones
  • Bladder cancer once
  • Family history in siblings
• Schistosomiasis; Inherited condition lynch sylndrome

Screening is essential in for early detection in,

• People who had cancer before
• People with birth defects in bladder
• People who has more exposure to chemicals

Signs and symptoms :

Though the early symptoms mimic UTI, Renal calculi and diabetic but commonly the haematuria or microscopic haematuria will be diagnostic

• Blood in urine
• Pain or burning sensation while urination
• Frequent urination or unable to pass even feeling urge
• Low back pain in one side of body
• Pelvic pain

Diagnostic tools :

• Urine test : Random urine sample for routine and micro (cytology test) to see the presence of tumor cells.
• Urine test of tumor markers :
  • UroVysin : to see chromosome changes which normally found in baladder cancer cells
  • To see the presence of bladder tumor- association antigen (BTA)
  • ImmunoCYt; to look for mucin and carcinoembryonic angtigent (CEA)
  • NMP33 Bladder check

 

• Cystoscopy :
  • It is the key diagnostic, eases to see inside bladder for any abnormality of growths etc. and to decide to go for biopsy or surgery
  • Biopsy if required for check signs of cancer
  • It can be therapeutic to remove the entire tumour during biopsy procedure if appropriate
• Imaging techniques : Any of the suitable
  • USG; if cystoscopy not possible or for routine check
  • For diagnosis CT or MRI with or without contrast
  • PET CT is frequently used to confirm metastasis

Survival rate : About 77 % in 5 year depending on stage

• Localized : There is no sign that the cancer has spread outside of the bladder.
• Regional : The cancer has spread from the bladder to nearby structures or lymph nodes.
• Distant : The cancer has spread to distant parts of the body such as the lungs, liver or bones.

 

Treatment depending on the stage :

• Surgery, though there are known risk and side effects but inevitable :

• Transurethral resection of bladder tumor : to take out cancer cell and surrounding tissues till the muscle layer of the bladder wall of bladder wall
• Cysteomy :
  • Partial cysteomy : If cancer is invaded the muscle layer of bladder but localised
  • Radical cystectomy : If cancer is not localised, removal of complete bladder and nearby lymph nodes needed. In male patients along with complete bladder prostate and seminal vesicles are also removed. Similarly in women ovaries, fallopian tube, uterus, cervix and small part of vagina are also removed.

 

• Intravesical therapy where medicines are put in to the bladder to stay for 2 hours so that drug interaction will be more targeted and localised, more over drug effects on other parts of body will be less. They are of 2 type immunotherapy and chemotherapy
• Chemotherapy : Might be intavesial chemotherapy or systemic (will pills or injections either IV or IM)

 

• Radiation therapy :
• • Helpful in early stage as therapeutic
  • To avoid relapse where surgery where bladder is removed partially
  • To prevent further spread in advanced/ metastatic conditions

Ayurveda view in preventions :

1. Since Basti (bladder) is Sadhya praanhara marma (vital part/ organ if injured lead to death) and Snayu marma ( Ligament and fibres tissue ) injury or disease related to bladder will not be easy to treat hence prevention is best.
2. Vulnerable group can start adopting food and life style as per their body type will reduce more chances of being the victim.
3. If required periodical intervention of Panchakarma specially Virechana, Basti and Uttrabasti.
4. Drink only required quantity of liquid according to the nature of job individual does and with respect to season.
5. Avoid with holding urge of urination, forcing and interfering urine flow during urination.
6. Keep regular bowel movements.
7. Avoid nap.

Ayurveda treatment :

1. Ayurveda drugs significantly reduce side effects in bladder cancer patients during chemo or radiation therapy and helps in faster recovery.
2. If the person and stage are suitable for surgery that will be best to avoid further spread.
3. Suitable Panchakaram is advised before and after surgery to help early recovery avoid further complication.
4. Herbs having specific action on Apana vata, Mutravaha srotas and Marma ghata treatments will be beneficial.
5. In metastatic conditions, the line of treatment formulated according to metastatic sights.

Reference

https://www.cancer.org

https://seer.cancer.gov/statfacts/html/urinb.html

BONE CANCER

Bone cancer are mostly secondary or metastatic cancer of breast, prostate, lung etc., similarly multiple myeloma is most common cancer that start from bone marrow but cause tumour in bone. Bone cancers are primary only that starts from bone itself is called Sarcomas. Sarcomas starts in bone, muscle, fibrous tissues, blood vessels, fat tissue and some other tissues.

Cancer and Sarcoma:

1. Carcinomas are cancers that develop in epithelial cells, which cover the internal organs and outer surfaces of your body.
2. Sarcomas are cancers that develop in mesenchymal cells, which make up both your bones and soft tissues, such as muscles, tendons, and blood vessels.

Primary Bone sarcoma constitute as the 3^rd most common cause of mortality in adolescents and most commonly affects the long bones. 5years over all survival rate is 65-70% in adolescent’s age group, if metastasis to other parts will reduce survival rate. Benign tumours of bone are not life threating as they often cured with surgery.

Types of primary bone cancers are:

• Osteosarcoma: Osteogenic sarcoma is most common type which stats from bone cells. Effects age group between 10-30 years and 10% in 60 to 70 years. It is more common in males and most commonly seen in long bones.
• Chondrosacroma: It is 2^nd most common and it starts in cartilage cells (some time from trachea, larynx, scapula, ribs and skull). Rare in < 20 years age and risk group is 20-75 years. Most common in females. It can start in cartilage tissue but commonly seen in hip, leg and arm bones. Benign tumour are common in cartilage origin.
• Ewing Tumor: 3^rd common and 2^nd most common in children, teens and young adults. Most common site it pelvis, chest wall and long bones.
• Malignant fibrous histiocytoma: Most often starts in soft tissue like ligament, tendon, fat and muscle and rare in bones. Commonly seen in elderly and middle age in legs or arms. Most of time it is localized but some time metastatic in nature to lungs.
• Fibrosarcoma: More likely occur in soft tissue effecting middle age and elderly, Long bones and jaw are most often affected.
• Giant cell bone tumor: It is of both benign and malignant types, Benign affects knee or arms of young and middle aged adults. They recur in the same place after operation.
• Chordoma: Usually occur in base of skull and spine.

Risk factors:

• Unknown
• Very less number are linked to hereditary factors
• Exposure to larger doses of radiation

Signs and Symptoms:

• Swelling and tenderness near affected area
• Bone pain
• Week bone and pathological fracture
• Weight loss

Diagnosis:

• Biopsy either by core needle or open
• Radiological investigations simple x- ray to PET CT
• Bone scan

Treatment:

• Surgery if localized
• Chemotherapy
• Radiation therapy
• Targeted therapy
• Immunotherapy

Ayurveda approach:

• As disease involving or originates in deeper Dhatu (tissues) like Meda( ~adipose), Asthi (~Bone) , Majja (~Bone marrow) and Surka ( ~reproductive fluids) are maintenance as difficult to treat.
• If patient Bala (Strength) is good then we can go for Panchakaram, Vanama or virechan or both depending on need.
• Basti ( ~medicated enema).
  • Will be choice of therapy as it is applicable from birth to elderly.
  • Vata and Asthi (~bone) are indirectly proportional i.e., if Vata increase will reduce the Asthi.
  • It is the best treatment to treat Vata and use of tikata rasa ksheerabasti directly nourishing the bone and found effective most of done degenerative diseases.
• Herbal and herb mineral combination to strengthen Majjadhatu ( ~bone marrow) so that bone change are should not influence Majja if happen so the bone cancer or denegation will get accelerated.
• Most of bone cancer are supportive and palliative treatments but treatment stated in very initial stages will be highly beneficial.

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991135/
2. https://www.cancer.org
3. https://www.cancer.net

MULTIPLE MYELOMA

It is a type of blood cancer of unknown cause. Plasma cells, part of white blood cells which has an important role in our immune system and are present in bone marrow. When they starts multiply uncontrollably leads to myeloma. Plasma cells let too much protein (immunoglobulin) into bone and blood results in bone destruction and damage immune system, kidneys as well as reduce blood cells count.

Signs and Symptoms might be :

• Reduces Blood count : Anaemia, low platelets count (thrombocytopenia) and reduces WBC count (leukopenia).
• Bleeding : Low platelets count (thrombocytopenia).
• Frequent infection : Reduces WBC count( (leukopenia).
• Reduced Bone density : Myeloma cells make a substance that accelerate dissolving the bone without new bone cells replacement, making the bones weak and easy to break.
• Raised blood calcium level : Accelerated bone cells destruction can also raise calcium levels in the blood.
• Antibodies produced by myeloma cells will impair kidney function and leading to kidney failure.

Risk factor : Obesity, radiation exposure, family history, certain chemicals used in rubber manufacturing, wood working or fire fighting or in herbicides.

Preventions : As there is no clear or strong risk factor hence currently no known ways to prevent it. Although the mutations that cause myeloma are acquired and not inherited, family history is a known risk factor for multiple myeloma.

Overall survival rate : 54%

Conventional Treatment :

• Chemotherapy
• Radiation therapy
• Corticosteroids
• Bone marrow (Stem-cell) transplant
• Blood transfusion
• Bone care

Ayurveda treatment for multiple myeloma :

• Looking at pathology, signs, symptoms and it’s secondary complication at its later stage, involves majorly 4 Dhatu (tissues) of rasa (~ Plasma), Raktha (~ Blood), Asthi (~ Bone) and Majja (~ Bone marrow)
• Ayurveda medications : Herbo and herbo-mineral combinations are prescribed as per the patient requirement to :
  • Enhance blood quality
  • Prevent reduction in bone density to avoid pathological fracture
  • Regulate or to rectify bone marrow and liver functions
  • Prevent kidneys diseases
  • To increase immunity and avoid bleeding

• Panchakarma :
  • Among Pancha karam Basti is the line of treatments indicated in Asthi and Majja disease helps in
• Restore normal function of Asthi and Majja Dhatu
  • Best in avoiding secondary complications like bone destruction and kidney problems
• Virechana and Vamana if required before the Basti

 

PHYLLODES / PHYLLOIDES TUMOUR OF BREAST

The word Phyllodes is from Greek term which means “leaf like” appearance of growth. This is uncommon but mostly seen in adult women (> 40- 50 Yrs.).It is grows in connective tissues of breast called stroma (tissues, ligaments, milk duct, blood vessels and lymph vessels).

Risk factor : Though there is no specific riskfacator specified butinjury or increased levels of estrogen hormone are noted in several cases

Signs and symptoms :

• Breast lump with tendency to grow quickly with-in a week to month
• It is often difficult to distinguish benign from malignant phyllodes tumors from other benign entities such as fibroadenomas.
• Fibroadenomas grow up to 2-3 cm then stop growing whereas phyllodes tumors fast-growing and can increase in size in just few weeks (Sometime grow up to 40 cm)
• Less than 1% are of malignant;
  • all forms of phyllodes tumor are regarded as having malignant potential
  • that has an aggressive growth pattern, often leading to a markedly large palpable mass with resultant skin thickening and tenseness of the breast
  • Malignant phyllodes tumours behave like sarcomas an develop blood-borne metastases
  • the commonest sites for distant metastases are the lung, bone, and abdominal viscera
• Open sore is seen if the tumor breaks through skin though it might be malignant

Diagnostic tools : Hard to diagnose as they look very similar to fibroadenomas

• USG of breast
• Mammogram
• MRI
• Biopsy; Core needle but some time excisionalwill be confirmative

Survival rate : Various research shown 5 years survival rate in benign 91% and malignantis 82%

Treatment:

• Conventional : Surgical resection remains the gold standard of treatment, whereas radiation therapy and chemotherapy have a more undefined role. Most studies recommend a more than 1- to 2-cm excision margin based on the evidence that local recurrence occurs more frequently in patients with narrow surgical margins less than 1-2 cm
• Ayurveda treatment :
  • Since the nature of the phyllodes tumor is fast growing and tendency to beso surgery will be mandatory
  • Once the post-surgical would get heeled and suitable for Panchakaram is advised for detoxification before stating internal medications to nullify the nature of rapid growth (Regression)
  • Herbs having specific action on Rasa and stanyavaha srotas are the key
  • In metastatic conditions, the line of treatment formulated according to metastatic sights

References :

1. https://pubmed.ncbi.nlm.nih.gov/22816226/#:~:text=They%20arise%20from%20intralobular%20fibrous,are%20to%2040%20cm%20big.
2. https://en.wikipedia.org/wiki/Phyllodes_tumor#:~:text=Phyllodes%20tumors%20(from%20Greek%3A%20phullon,1%25%20of%20all%20breast%20neoplasms.
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823393/

Colorectal Cancer

Colorectal cancers or bowel cancers are often conversed together because of their common features but termed either colon or rectal cancer depending on site of origin. Structurally colon is a hallow muscular tube about 1.5 meters long having 4 parts i.e., Ascending colon which starts form the end of small intestine, transverse colon, descending colon and sigmoid colon which is ’S’ shaped continues as rectum and connects anus.

Though Polyps (growth on inner lining of colon or rectum) are commonly seen during initial stage or alarming sings but not always, which depends on size and type of polyp confirmed by biopsy.

Types; may be benign or malignant. Commonly seen colorectal cancer are adenocarcinomas. Though less common tumours which can start from colon or rectum are Carcinoid, Gastrointestinal stromal tumours (GISTs), Lymphoma and Sarcoma.

Risk factors :

• Obese or over weight
• Less physical activity
• Non-veg
  • More of meat (Beef, pork, lamb or liver)or processed food (hot dog etc.)
  • Eating, meat cooked at very high temperature (deep fry, grilling) creates chemical that might raise cancer risk.
• Low serum Vitamin D levels.
• Smoking &
• Elderly (above 50yrs).
• Person with history of IBS, colorectal polyps, ulcerative colitis.

Symptoms :

• Bowel habits changes.
• Diarrhoea or constipation.
• A feeling that the bowel does not empty properly after a bowel movement.
• Blood in stools that makes stools look black.
• Bright red blood coming from the rectum.
• Pain and bloating in the abdomen.
• Feeling of fullness in the abdomen, even after not eating for a while.
• Fatigue or tiredness.
• Unexplained weight loss, vomiting .
• Unexplained iron deficiency in men, or in women after menopause.

If any of few symptoms persist for 4 weeks or more will be suspect of colorectal cancer

Statistics :

• 8% of every new cancer detected patients.
• More common in male than females.
• 5 years survival rate is 64%.

Prevention :

* Screening once a year is the best way in

– In case of family history.

– Above the age of 45 years with anorectal symptoms .

– Fecal occult blood test (FOBT)/ fecal immunochemical test (FIT).

– Colonoscopy – once in 10 years OR Sigmoidoscopy OR Virtual colonoscopy ( atypie of CT3-D image ) – once in 5 year.

• Maintain weight and physically active
• Avoid smoking and alcohol
• Limit red meat and processed meat
• Timely treating bowel diseases

Treatment :

Depends on several factors like location, size, cancer stage, whether recurrent if so overall state of health of individual patient.

 

1. Surgery; Ranging from cryosurgery to colectomy etc
2. Chemo therapy
3. Radiation therapy

Recovery

1. If metastasis to other parts of the body if left untreated
2. The chances of a complete cure depend enormously on how early the cancer is diagnosed and treated.
3. A patient’s recovery depends on the following factors:

• The stage when diagnosis was made
• Whether the cancer created a hole in intestine

Our approach:

• Surgery will be initial line of treatment if appropriate to patient.
• As per the cancer stage and endurance of patient either supportive, detoxing therapies are adopted to provide better quality life support to extend the span of life.
• Among tridoshapredominately Vatadosha resides in colon and that is the one which regulates the movement of Pitt and Kapha so the treatments are:
  • Aimed for regulating vatadosha for regression of tumour.
  • To reduce further growth or advance stage tridosha needs attentions.
• Treatments are also aimed to support or manage adverse reaction other therapies like chemo/ radiation etc.

LIVER CANCER

 

Liver is the largest internal organ, major chemical factory of our body situated in Right-upper part of abdomen. Prime function of it is filtering, breaking down and stores many of nutrients from the blood received from the digestive system prior to circulate in body as well as responsible for neutralizing or eliminating chemicals and drug metabolism etc. Bile secretion from liver is essential for digestion and absorption of fat and fat soluble vitamins in the small intestine.

Cancer pertaining to liver can either be a primary cancer which begins from it or secondary to any other cancer where liver has metastatic lesions.

Risk Factors :

• Gender :
  • Male : Hepatocellular is common.
  • Female : Fibro lamellar sub type of HCC is common.
• Chronic viral hepatitis is most common risk factor.
• Cirrhosis of liver : Most common cause seen where liver cells are damages and replaced with scar tissue.
  • Non-alcoholic fatty liver : Commonly seen in obese.
  • Primary billary cirrhosis : Autoimmune disease that affect liver.
  • Inherted metabolic disease : Like people with hereditary hemochromatosis absorb too much iron from their blood.
  • Alcohol : Heavy indulge
• Tobacco consumption specially smoking history or current smoker.
• Type 2 diabetes with other risk factors like alcohol, chronic viral hepatitis, overweight and obese.
• Anabolic steroids used for long period.

Signs and symptoms : Some are commonly seen but might be not specific.

• Sudden weight loss
• Enlarged liver or spleen (felt as fullness under the ribs)
• Pain near Right shoulder blade.
• Swelling or fluid in abdomen
• Itching
• Yellowing of skin and eyes (Jaundice)
• In case of liver tumour
  • High blood calcium
  • Breast enlargement / Gynecomastia or shrinkage of testicles
  • High RBC count
  • High Cholesterol levels.

Test for Liver Cancer:

• Imaging test like USG, CT, MRI, Angiography Bone scan are helpful.
• Biopsy : Biopsy helps to re confirmation, though imaging test can confirm the diagnosis.
• Lab test : Changes in liver functions tests like AFP, Viral hepatitis, blood clotting, Kidney function test, Complete blood count.

5-year survival rate :

• Early stage will be ~33%
• If spread to surrounding tissues and lymph nodes will be ~11%
• If spread to distant part of body will be ~2%

Liver cancer types are,

1. Malignant type :
   • Primary :
     • Hepatocellular carcinoma (HCC) : Most common type on adults.
     • Intrahepatic cholangiocarcinoma (Bile duct cancer) : About 10 to 20% primary liver cancer.
     • Angiosarcoma and hemangiosarcoma : Rare cancers of begin in liver blood vessels.
     • Hepatoblastoma : Exceedingly rare that develop in children < 4years.
   • Secondary (Metastatic) : This type is more common than the primary and it might be metastatic from Pancreas, Colon, Stomach, Breast and Lung.
2. Benign type : Some time grow large enough but do not spread.
   • Hemangioma : Most common that starts in blood vessels withoutsymptoms.Some might bleed.
   • Hepatic adenoma : Tumor starts from hepatocytes (liver cells), might be without symptoms or might cause pain or lump in abdomen or blood loss. Eventually it can turn to liver cancer. Seen in women taking birth control pills and men using anabolic steroids.
   • Focal nodular hyperplasia (FNH) : Tumor like growth made up of several cell types like hepatocytes, bile duct, connective tissue cells. Hard to differentiate form liver cancer.

Treatment depending on the stage :

1. Surgery :
   • Partial hepatectomy where part of liver removed, suggested in person with single tumor not grown into blood vessels, good liver function and no other systemic complication.
   • Liver transplant
2. Ablation : Suggested in tumors≤ than 3 cm and various methods like Radiofrequency, MicrowavsCryo and Ethanol are used as per the need.
3. Embolization : Used to block or reduce the blood flow to tumor by injecting substance in to particular artery of liver in patients
   • Where the tumors that cannot be operated
   • Tumor larger than 5 cm across

Methods used are Trans-arterial embolization (TAE), Trans arterial chemoembolization (TACE), Drug-eluting bead chemo embolization (DEB-TACE) and Radioembolization (RE)

1. Radiation
2. Chemotherapy / Targeted drug therapy
3. Immunotherapy

https://www.cancer.org

https://www.cancer.net

GALLBLADDER CANCER

The gallbladder is a small, pear – shaped hollow organ of 7 to 10cm long and 3 cm broad at its widest part and 30 to 50ml capacity. It sits just beneath the Right lobe of liver behind right lower ribs. Gall bladder is a reservoir of bile before it is released into duodenum.

Gallbladder uncommon and when discovered at its earliest stages the chance for a cure is very good. But most gallbladder cancers are discovered at a late stage, because it often causes no specific signs or symptoms. Also, the relatively hidden nature of the gallbladder makes it easier for gallbladder cancer to grow without being detected. When the prognosis is often very poor.

Risk factor :

• Being Female
• Increases as the age
• Obesity
• Person with history of gallstone, polyps, inflammation and infection
• Genetic predisposition
• Heavy metals
• Oral contraceptive
• Extensive calcium encrustation of Gall bladder

Signs and symptoms may include :

• Abdominal pain, particularly in the upper right portion of the abdomen
• Abdominal bloating
• Losing weight without trying
• Yellowing of the skin and whites of the eyes (Jaundice)
• Lump in abdomen
• Fever

Diagnosing

• Physical examination, Liver function test, Blood chemistry (Ca 19-9), CT or USG or MRI, ERCP, Laparoscopy and biospy

Statistics :

• If the cancer is diagnosed and treated before it has spread outside the gallbladder, the 5-year survival rate is 65%.
• If the cancer has spread to surrounding tissues or organs and / or the regional lymph nodes, the 5-year survival rate is 28%.
• If the cancer has spread to a distant part of the body, the 5-year survival rate is 2%.

Treatment depending on stage : Surgery, Radiation Therapy, Chemotherapy, Targeted Therapy Drugs, Immunotherapy and Palliative are chosen

Our approach :

• Prevention :
  • Lifestyle modification
  • Treating gall bladder diseases at their initial stage so that they wont turn to cancer i.e., 95% of GBC are with gallstone are probable cause
• Treatment :
  • Surgery will be initial line of treatment if appropriate to patient.
  • As per the cancer stage and endurance of patient either supportive, detoxing therapies are adopted to provide better quality life support to extend the span of life.
  • Among tridosha predominately Pitta dosha resides in liver and that is the one which regulates transformation hence therapies focused on Pitta and enhancing liver functions.
  • Treatments are also aimed to support or manage adverse reaction other therapies like chemo / radiaton etc

• https://www.cancer.net