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Nov2019: MGCHAPSA2019 – Lung Cancer Management

We have organized MGCHAPSA-2019 – a CME ON “Newer Paradigms in Management of Lung Cancers” in association with APSA – North Andhra Chapter on 17th Nov 2019 at Hotel Four Points by Sheraton, Visakhapatnam. Our specialists Dr. Murali Voonna , Dr. Raghava Kashyap, Dr. M P S Chandra Kalyan, Dr. P. Venkata Krishna Reddy, and Dr. Rakesh Reddy and Dr T. Balaraju of Gayatri Nursing home have addressed the large gathering of pulmonologists, thoracic surgeons, physicians and PG students shared knowledge on newer methods, techniques and equipment related managing Lung Cancers.

Topic: Introduction to the Program – Presentation Link
Speaker: Dr. Murali Krishna Voonna

Topic: Role of Nuclear Imaging in Chest Malignancies – Presentation Link
Speaker: Dr. Raghava Kashyap

Topic: Role of Intervention Pulmonology in Lung Cancer Management – Presentation Link
Speaker: Dr. T. Balaraju

Topic: Surgery in Early Stage Lung Cancer – Presentation Link
Speaker: Dr. M P S Chandra Kalyan

Topic: Newer Advances in Radio Therapy of Lung Cancer – Presentation Link
Speaker: Dr. P. Venkata Krishna Reddy

Topic: Personalized Medicine in Non small Cell Lungs Cancer – Presentation Link
Speaker: Dr. Rakesh Reddy Boya

Nov2019: BCMNASA2019 – Advances in Breast Cancer Management

Mahatma Gandhi Cancer Hospital successfully organized #BCMNASA2019, a Full Day Symposium to discuss 'Advances in Breast Cancer Management' by our in-house consultants on 10th November. Here are some of the best moments captured from the event.

 

Oct2019: MGBMTCON2019 – Conference On Hematopoietic Stem Cell Transplantation

Grand Inauguration of #MGBMTCON2019 – the Academic conference on “Introducing Hematopoietic Stem Cell Transplantation”. Our Managing Director Dr. Murali Voonna, Prof. Lalit Kumar from AIIMS, Dr. Vikram Mathews from CMC, Dr. Ch Lakshmana Rao from APMC, Dr. Rakesh Reddy and Dr. Chandrasekhar Bendi graced the occasion.

The academic conference #MGBMTCON2019 is kick-started by Prof. Lalit Kumar of AIIMS who took the audience through the ‘Journey of transplant scenario in the treatment landscape of blood disorders in Indian context’.

Prof. Vikram Mathews from CMC, enlightened the audience on ‘Curative option for non-cancerous blood disorders like Thalassemia, Aplastic Anemia’.

Dr. Anant Gokarn from TMC detailed the challenges unique to Allogeneic HSCT at #MGBMTCON2019 conference.

Dr. Rakesh Reddy discussed the intricacies of ‘Autologous HSCT’ and challenges related to this procedure in the forenoon of the day-long conference #MGBMTCON2019.

Dr. Sunil Bhat from Narayana Health spoke about the ‘Unique challenges in undertaking HSCT in children’ at #MGBMTCON2019 organized by Mahatma Gandhi Cancer Hospital in Visakhapatnam on 20-OCT-19.

Dr. Sharat Damodar from Narayana Health, Bengaluru, enlightened the audience on Various complications while doing HSCT, some obvious and some very unexpected with some real life example cases at the #MGBMTCON2019.

A panel of experts on HSCT Dr Madan Mohan of Vizag Hematology Center, Dr Chandrasekhar Bendi, Dr Pavan Kumar & Dr Varun Bafna were moderated by Dr Sunil Bhat in an extensive interactive discussion on Challenges in setting up and running a HSCT in resource-limited setting at #MGBMTCON2019 organised by Mahatma Gandhi Cancer Hospital on 20-OCT-2019 in Visakhapatnam.

The Co-founder of the DATRI foundation, that helps coordinate stem cell donation and registering, Mr. Raghu Rajagopal and spoke about the need, importance, and challenges in registering blood stem cell donors in the Indian context and various statistical facts related to blood stem cell donation in India. It also explained the scene of Blood Stem Cell Donation in India and the basic need of obtaining voluntary donors for the fatal blood disorders including Leukemia and Thalassemia.

Oct2019: Blood Stem Cell Donation – Awareness Program

Enthusiastic response to the public awareness program on ‘Blood Stem Cell Donation’ organised by Mahatma Gandhi Cancer Hospital & Research Institute today at VMRDA Children’s arena in association with YI, DATRI, Rohit Memorial and many other NGOs. More than 600 interested public and professionals alike have attended the program. 300+ individuals voluntarily pledged to donate Stem Cells and register themselves with DATRI Blood Stem Cell Donor Registry. Thanks to one and all who attended and spread the good message ‘Pledge to be a Stem Cell Donor and Save a Life and even more’.

Robotic Surgery – Facts and Myths

Dr.Karthik Chandra Vallam

Dr. Karthik Chandra Vallam, MBBS, M.Ch., DNB, Surgical Oncologist, Robotic and Laparoscopic Surgeon

Surgery has evolved from the era of invasive “open” model to the minimally invasive model especially when dealing with “cavity” surgery (abdominal/chest cavities).  The advantages of MIS are pretty obvious with smaller incisions, lesser pain, earlier return to normal activities, lesser wound-related complications. However, there are significant challenges with traditional laparoscopic surgery – counter-intuitive movements, rigid non-articulating instruments, limitation with 2D vision and ergonomic discomfort for the operating surgeon to name a few. Newer platforms like Robotic Surgery work to overcome these limitations and make it easier for the surgeons to do a better job and thereby improve outcomes for the patient.

How does the Robotic Surgery work?

The current Robotic Surgical System consists of four components: 1) a SURGEON CONSOLE where the surgeon sits, views the screen, and controls the robotic instruments and camera via finger graspers and foot pedals; 2) a ROBOTIC CART with four interactive arms that hold instruments through trocars attached to the patient; 3) a VISION CART WITH CAMERA that allows for a three-dimensional image of the surgical field using image synchronizers and illuminators; and 4) WRISTED INSTRUMENTS that translate the mechanical movements of the surgeon’s hands into computer algorithms that direct the instruments’ movements within the patient.

SRIRS logoDuring Robotic Surgery, small incisions are made on the patient’s abdomen/chest through which three to four trocars are introduced into the patient. Through these trocars, a few instruments and an endoscope (camera) are placed. These ports are “docked” (connected) to the robot which enables the surgeon to operate from the console which is connected to the robotic cart. The primary surgeon sits unscrubbed at the console in the operating room at some distance from the patient, using finger graspers and foot pedals to control the instruments (just like in a video game). The console provides 3D imaging with improved depth perception, and the surgeon has independent control of the camera and instruments. Finally, the robotic arm, with its wristed joint and six degrees of freedom, allows for greater dexterity than unassisted surgery and decreases normal hand tremors.

What are the advantages of Robotic Surgery?

MGCHRI-Live-Robotic-SurgeryRobotic surgery presents a spectrum of advantages over traditional laparoscopic techniques. Robotics allows the surgeon to see 3D images with 10x magnification, obtain better angles with the increased degrees of freedom provided by the EndoWrist instruments, and control three different instruments and the camera simultaneously. These advantages make it easier to execute complex laparoscopic procedures like identifying important neurovascular structures and intracorporeal suturing in deep and narrow places like the pelvis. Greater surgical precision and improved ability to spare healthy tissue not impacted by cancer are added benefits. The surgeon is able to operate from an ergonomically comfortable, seated position at a console, with eyes and hands in line with the instruments and is not dependent /minimally dependent on assistant surgeons. This is specifically advantageous for long-duration surgeries like certain cancer surgeries. With the robot, the surgeon does the job of 3 people simultaneously (camera assistant, operating surgeon, assistant surgeon) with ease.

Is the Robot “programmed” to do the surgery independently? / Is it safe?

Throughout the procedure, the surgeon controls every surgical maneuver. THE ROBOT CANNOT OPERATE INDEPENDENTLY. It is a master-slave system operated by a specially trained and highly skilled surgeon.

What are the surgeries which can be performed with the robot?

FDA has approved a long list of surgeries that can be safely performed with the da Vinci robotic surgical system. Surgeries, where robotic technology has a significant edge, are – prostatectomy, partial nephrectomy, colorectal cancer surgery, esophagectomy, radical hysterectomy (uterus removal for cancer) and certain (bariatric) weight reduction procedures.

Written by
Dr. Karthik Chandra Vallam,
Surgical Oncologist, Robotic and Laparoscopic Surgeon,
Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam

Cancer has an Answer…

Dr.P.S.Bhattacharya

Dr. Partha Sarathi Bhattacharyya, MD, Senior Radiation Oncologist

Cancer is the second leading cause of death in the world after cardiovascular diseases.  The word cancer came from the Greek words “Karkinos” to describe carcinoma tumors by Hippocrates (460-370 B.C). The world’s oldest case of breast cancer hails from ancient Egypt in 1500 BC.

The International Agency for Research on Cancer (IARC) estimates that one-in-five men and one-in-six women worldwide will develop cancer over the course of their lifetime, and those one-in-eight men and one-in-eleven women will die from their disease. Worldwide, the total number of people who are alive within 5 years of a cancer diagnosis, called the 5-year prevalence, is estimated to be 43.8 million. The increasing cancer burden is due to several factors, including population growth and ageing as well as the changing prevalence of certain causes of cancer linked to social and economic development.

Cancers of the lung, female breast, and colorectum are the top three cancer types in terms of incidence. Lung cancer is the most commonly diagnosed cancer in men (14.5% of the total cases in men and 8.4% in women) and the leading cause of cancer death in men (22.0%, i.e. about one in 5 of all cancer deaths). Breast cancer is the most commonly diagnosed cancer in women (24.2%, i.e. about one in 4 of all new cancer cases diagnosed in women worldwide are breast cancer).

Global patterns show that for men and women combined, nearly half of the new cases and more than half of the cancer deaths worldwide in 2018 are estimated to occur in Asia, in part because the region has nearly 60% of the global population.

As per the Indian Council of Medical Research (ICMR), the incidence of cancer cases in India was 14 lakhs in 2016.  Cancer of breast, cervix, oral cavity and lung constitutes 41% of the cases. Oral cavity cancer is the most common in men and third in women. “The age standardized rate is approximately 25.8 per one lakh women and is expected to rise to 35 per one lakh women in 2026,” the report stated.

A few months back my aunt was diagnosed with cancer. As soon it was diagnosed, I got a call from my uncle saying, “your aunt’s days are numbered now, please see what can be done.” Though they didn’t know the details of the diagnosis, I was surprised to hear such a depressing response to the diagnosis.

This is not the only reaction I get, but most of the families where someone is detected with cancer, this is a common response. Cancer has become synonymous with the end of life. Though the survival rate has increased due to early diagnosis and advances in treatment modalities, the cause of this fear is a lack of proper information and a lack of appropriate medical intervention at the right time.

Treatment of cancer involves a multidisciplinary holistic approach. The team of doctors for diagnosis, treatment, and care of cancer patients includes Surgical Oncologist, Medical Oncologist, Hematoncologist, Radiation Oncologist, Pathologist, Radiologist, Nuclear medicine specialist, Pain and Palliative care specialist, Dentist, etc., and also Medical physicist, Radiotherapy technologist/dosimetrist, Physiotherapist, Dietician and Oncology nurses. Each team member is important in this chain of cancer care to successfully treat a patient. The cancer care team at Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam, Andhrapradesh, with its gamut of services is fully equipped to manage a cancer patient holistically.

Cancer has always been known as a dreaded disease, and this unknown fear can be removed with timely intervention by the health care team specialized to manage such cases.

Written by
Dr. Partha Sarathi Bhattacharyya,
MD, Senior Radiation Oncologist
Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam

Sept2019: CII 20th National Award for Excellence in Energy Management 2019

We are happy to announce that Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam has been recognized as the Energy Efficient at the ‘CII 20th National Awards for Excellence in Energy Management – 2019’. In a glittering ceremony organized in Hyderabad between 16-18 September, we are presented this award for efficient management of energy in our organization in the healthcare sector of Andhra Pradesh, thereby helping to preserve the balance in environment.

Our organization is always at the forefront in implementing innovative solutions in the interest of patients, society, and nation in general. Managing director Dr. Murali Krishna Voonna congratulated the employees of the organization for the efforts in receiving this recognition.

Aug2019: The First Bone Marrow Transplant Treatment

Mahatma Gandhi Cancer Hospital proudly announces that the First Bone Marrow Transplant treatment (an Allogenic BMT) at our Andhra Pradesh’s FIRST EXCLUSIVE Bone Marrow Transplant Unit has been very successful. The procedure was performed on a 13-year old girl suffering from Aplastic Anemia. The girl has been discharged after a thorough examination and about a month-long treatment under very suitably controlled environment in the facility with class-10000 clean-room standard, HEPA filtration systems, and positive pressure ventilation and expert services of Hematologist & BMT Physician Dr. Chandrasekhar Bendi, Chief Medical Oncologist Dr. Rakesh Reddy and team. Managing Director Dr. Murali Voonna said ‘We feel proud and happy to bring this exclusive service to the people in the region (Andhra, Odisha & Chhattisgarh) benefiting patients suffering from blood cancers and conditions like Aplastic Anemia, Sickle Cell Anemia & Thalassemia too’.

The Long Battle of Childhood Cancer

Childhood CancerYoung Rajesh (name changed) was an exuberant child. Or so his mother describes him through tears and trepidation. Exuberant is not a word you would use to describe the child that lies shivering in front of my eyes on the couch. He was weak but he seemed to be using his last ounce of energy trying to repel me from examining him. As someone who had diagnosed and cared for such children for a while now, even a perfunctory examination was enough to suspect that I would be dealing with a case of acute leukemia in that 5-year-old. The multiple swellings in the neck, that irritability, the bleeding spots on his skin and the unmistakable pain in his bones were the telltale features. A small test called peripheral smear was done and the Pathologist calls up in a short while to confirm my fear. My fear is not to treat the disease really! It’s how to treat the family!

I believe no other cancer tests a doctor-family combine the way an acute lymphoblastic leukemia does. Shortly called ALL, it’s an acute affliction of the bone marrow where an over-proliferation of one cell line completely overtakes the rest of the cell lines. In plainer terms, this means that apart from a high white blood cell count, the patient would develop a very low hemoglobin and low platelets. Hence the symptoms of fever, fatigue, and bleeding. Without prompt diagnosis and immediate treatment, death is imminent and quick. Three months is what I tell the family!

Fortunately, advances in modern medicine have enabled cure in most of these patients (almost 80% of patients with a favorable risk profile of this disease gets cured). Unfortunately, the treatment is very long drawn. First, it would mean an admission for one month in the hospital hoping to bring the entire visible disease in the bone marrow to a zero. This is a crucial period where there would periods of prolonged low counts and the chances of complications are at the peak! Even if such control was achieved, there would be different phases of treatment which altogether last for two and a half years! A treatment of such a long duration is the only way to cure a disease which is notorious for its recurring nature. In fact, relapsed/recurrent ALL is the third most common childhood cancer, the first being a newly diagnosed ALL. Now imagine telling this to the parents of a child with this diagnosis. Imagine trying to make them understand, in their state of mind, the various aspects of care AND the duration of treatment. Add to it the uncertainty of cure – though high, there is always a chance of relapse in the first five years of treatment. Quite understandably, most of the families would be bewildered. There would be confusion, part denial, lot of uncertainty and the devil of them all – how to deal with the financial burden!

Rajesh’s parents sat through my initial counseling session. I have the final diagnosis by the way of flow cytometry, a diagnostic modality to confirm the disease. I could hardly tell if they were following me, so I do what I do. Repeat and pray. Slowly they start to breakdown. Father attempts to send the mother away, but she wants to stay. I try to make them see that this is a favorable risk profile and they cling on to it with all the greed in the world. That is enough to put me on the back foot as I’ve seen enough ‘favorable risk’ diseases relapsing! But even greater worry is how they would manage with the duration of treatment and the financial aspect of it!

Most of the families belong to low and lower-middle socio-economic strata and are dependent on a sole bread winner able to go to work on a daily basis. One can only imagine the financial implication if that person has to be curtailed in his/her attendance to job because of the child’s treatment. Fortunately, the Government of Andhra Pradesh has a public health scheme for the underprivileged, which could cover the treatment cost. Though a scheme which has its limitations, I found that it is workable for childhood ALL treatment. When I first joined Mahatma Gandhi Cancer Hospital and Research Institute, a preamble for treating such cases was not existent. In fact, that’s the case with the whole of City of Visakhapatnam unfortunately! The reasons were manifold, some serious, some manageable. Most of the patients of such illnesses used to be referred to hospitals in bigger cities like Hyderabad, Chennai, Mumbai, etc. Some families were able to take their children to such places. Most couldn’t, and all those children died! Even for those who were able to, the hardships of their families to manage such treatment can only be imagined!

I still remember the day I approached the managing director of our hospital, that such cases could be treated here. I’m sure Dr. Murali Krishna Voonna would’ve been skeptical, but he didn’t show it! He gave a reassuring nod of the head and I left the room. From then started a year of trials and tribulations. It’s a big teamwork and apart from me, most of my team is new to the delivery of this treatment! They learnt along the way, and I learnt along with them. Results followed. I daresay they were better than what I imagined. The team became bigger and better.

Rajesh’s treatment got initiated. Over the course of one month, he went through several doses of chemotherapy, multiple units of blood transfusions, episodes of severe infections. But I could see he was getting better. More than the tests, the activity of a child tells the course the disease was taking. He started to become active and I started to become hopeful. The day I did the test to see if his disease was indeed under control is a test for the month-long effort of the entire team. A lack of control would be a death knell. It wasn’t the case to be. Rajesh’s bone marrow at the end of one month was as good as new! His parents were overjoyed. I was happy too, but I know that it’s a job half done only!

The real test of anything in this world is a test of time. The test is for Rajesh’s parents now. I was fairly confident of the young child with the ‘now normal’ bone marrow able to pull it across the numerous other regimens of chemotherapy that he still had to undergo. But would his parents be able to bring him for treatment consistently at the defined intervals?

His mother stood up to the task. The kid was never late for any of his scheduled visits. He completed the whole course of treatment on time. Somewhere along the course, I realized that I’ve not seen his father for a while and I enquired about the same. I learnt that his father has to go away to earn for his family and his mother makes the travel of 200km to the hospital, each time it was needed, with the young kid in tow. She makes it a point to speak to families of other kids who were newly diagnosed. As I introspect, she’s not a lone example. Such is the case with many of the children who are getting treated at our center and most of them have a long duration of treatment. And more often than not, it’s their mothers who stand up to the task! I salute their undaunted spirit and strength!

Rajesh has reached the end of his treatment. I later realized that that day was his last admission for treatment. I was in a hurry that day and was doing a ‘curtailed round’, focusing on the sicker patients and waving byes to the fairly stable ones. Rajesh’s mother reached out to me and requested me to see his child once. I asked her if something was wrong. She shook her head and told me smiling that her son is so used to my smiling down on him and taking his wrist in my hand while enquiring his wellbeing, that he doesn’t want me to leave without doing that again to him! I was pleasantly amused. As I started towards his couch, I saw that the boy was neatly dressed and combed, like he usually is. Again, a bow to his mother! He was happily smiling and as I neared him further, he raised his arm for me to reach his wrist.

Over the last 3 years, the Medical Oncology team at Mahatma Gandhi Cancer Hospital and Research Institute has treated nearly 300 children with cancers. Close to 200 of them were cases of acute leukemias. We have lost a few, but we have saved the most. Along the way, we learned. Not just of the treatment, but also of the indomitable fight and human spirit. The journey has taken a new beginning in the form of establishment of a ‘Bone Marrow Transplant unit’, the first of its kind in the state of Andhra Pradesh. With this, we aim to be a place which will offer the complete gamut of services for blood cancer patients. A diagnosis of such a case need not mean uprooting the whole family anymore for people of this region!

Written by
Dr. B. Rakesh Reddy,
Chief Medical Oncologist &Hemato-oncologist,
Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam.

July2019: MGONCOCON2019 – Live Robotic Surgery Workshop

Formal Inauguration of #MGONCOCON2019 – Live Robotic Surgery Workshop with the wishes and blessings of mentors, seniors & teachers, Dr. T. Subramanyeshwar Rao, Dr. S.P. SomaShekhar & Dr. Ch. Subba Rao. On this occasion, Dr. Murali Voonna, Managing Director has offered surgeons of this region the opportunity to get trained & then use the Robotic Surgical System at our facility.

Following the Inauguration, a highly interactive & informative discussion on best practices in “Robotic Surgery in Urology” by best minds in Robotic Surgery and Urology over a live ‘Robotic Nephrectomy’ by Dr. Ananthakrishnan Sivaraman, Urologist & Robotic Surgeon of Chennai Urology & Robotics Institute.

Following the Live Surgery, detailed discussions & presentations on ‘Robotics In Urology’ by Dr. Gagan Prakash, ‘Targeted Therapy in Renal Cell Carcinoma’ by Dr. B. Rakesh Reddy & a video presentation on ‘Radical Prostatectomy’ by Dr.Ananthakrishnan Sivaraman on the Day-1 of #MGONCOCON2019 – Live Robotic Surgery Workshop.

After the interactive sessions, an in-depth interactive discussion on various surgical methods and options by experienced surgeons during a LIVE Robotic Surgery of ‘Robotic Esophagectomy’ by Robotic Surgeons & Surgical Oncologists, Dr. S.P. SomaShekhar and Dr. M.P.S. Chandra Kalyan (Matha Kalyan).

Dr. Karthik Chandra Vallam moderated a panel discussion with quite a few interesting questions on ‘Multi-Modality Management of Esophageal Cancers’ to the experienced Oncologists of all the modalities and the Gastroenterologist on a panel. At the end of the session, everyone in the audience felt better informed.

Towards the end of the first day interactive #MGONCOCON2019 workshop sessions, Dr. S.P. SomaShekhar & Dr. Prasanth Penumadu, discussed the incremental merits of ‘Robotic Surgery’ when compared to ‘Laparoscopic Surgery’ over video demonstrations of their surgical experiences.

The Day-2 of #MGONCOCON2019 workshop got initiated with a demonstration & LIVE Surgery of ‘Robotic Anterior Resection’ by senior Robotic Surgeon, Dr. S.P. SomaShekhar. Lively interaction between senior surgeons in the audience at the conference and the operating surgeon enriched the session for the whole audience.

Following the Live Surgery, Dr. Karthik Chandra Vallam discussed the importance of ‘CRS and HIPEC in GI Cancers’ during the 2nd day of Live Robotic Surgery Workshop, #MGONCOCON2019.

Dr. Praveen Kammar moderated a panel discussion on ‘Management of Colorectal Metastasis & Personalized Treatment of Colorectal Cancers’, in addition to many other important points.. The panel also discussed comparative merits/demerits of Ablation(RFA) and surgical options at the Live Robotic Surgery Workshop of #MGONCOCON2019.

Concluding the very highly interactive workshop and conference, Dr. Karthik Chandra Vallam shared the experience of the ‘First 100+ Robotic Surgeries’ at Mahatma Gandhi Cancer Hospital & Research Institute, experiences of being an early adopter and pioneer in the minimally invasive robotic surgery in this region.