OVERVIEW

Oncological surgery is among the most demanding disciplines in medicine. The Department of Surgical Oncology is dedicated to fighting cancer through surgical treatment. For a number of patients, tumours can be excised surgically during the course of an operation. Here, at Sri Ramakrishna Hospital, we have performed thousands of oncological surgeries to excise tumours of the head and neck, breast, liver, pancreas, colon, ovaries, kidneys, lungs and skin. Depending on the kind of cancer and a host of factors, the surgery is accompanied with other treatments such as chemotherapy, radiation or hormone therapy. A whole host of physicians, technicians, nutritionists, rehabilitation experts and so on, work in close collaboration with surgeons to ensure the patient has the best chance of recovery. Sri Ramakrishna Hospital is among the first institutions in the country to have performed stem cell transplantation and limb salvage procedures for cancer patients. We operate at the forefront of medicine, giving hope to innumerable cancer patients. Browse this section to find out about some of the more complex procedures we perform.


MEDICAL CONDITIONS

As the name indicates, head and neck cancers are a wide-ranging group of cancers that are found in the upper aero-digestive tract. There are an array of treatments based on the their location, nature and the stage of development. In addition to radiation and chemotherapy, they usually require surgery in some form or to some extent.

The road to recovery usually requires a team of rehabilitation specialists for swallowing and speech therapy, physiotherapy, counselling regarding cosmesis and so on. Some of the types of head and neck cancer are as follows.

  • Lip cancer
  • Mouth cancer
  • Cancer of the floor of the mouth
  • Cancer of palate
  • Cancer of maxilla
  • Tonsil cancer
  • Nasal cavity cancer
  • Esthesioneuroblastoma
  • Salivary gland cancer
  • Thyroid cancer
  • Parathyroid cancer
 

Being the most common cancer (along with skin cancer), breast cancer forms in the cells of the breast. Though it is most common in women, it may also occur in men. With huge publicity thanks to awareness campaigns and popular Hollywood stars’ involvement, breast cancer is among the most well-funded areas of cancer research and this has helped improve ways to diagnose and treat it. Survival rates have improved and mortality from it has reduced. Though the incidence appears to be increasing amongst the younger population, advanced diagnostic methods like streotatic biopsy, newer chemotherapeutic drugs have increased the survival rates. Reconstructive procedure fill in for cosmetic deformity.

This begins in the cells of the liver. The liver is located in the upper right section of the abdomen. It is where chemicals are detoxified and drugs are metabolised. Bile is secreted from the liver and sent back to the intestines which helps in absorption of fats, proteins, vitamins and so on. There are a number of kinds of cancer which affect the liver of which hepatocellular carcinoma is the most common. Some less common types are hepatoblastoma and intraheptic cholangiocarcinoma. The liver also is affected by cancers which originate in other parts of the body and metastasise (spread) to it. These are actually more common than the cancers originating in the liver.

The pancreas is a tiny organ which secretes enzymes that aid in digestion and hormones to regulate sugar metabolism. Cancer of the pancreas (pacreatic cancer) is one of the leading causes of fatalities from cancer. This is because it is hard to detect early, the cancer spreads rapidly and complete excision of the pancreas is not possible. In patients of good general health, a tumour that can be removed completely is best treated through surgery. However, there are advanced surgical options which we at Sri Ramakrishna Hospital can explore with the patient.

The large intestine is known as the colon and it is the lower section of the digestive tract. The last section (several inches) of the colon is known as the rectum. Cancer to this section of the body is collectively known as colorectal cancer (colon cancer and rectal cancer) Cancer in this region may begin as small clumps of cells which are non cancerous. They are known as adenomatous polyps. Eventually with time some of these polyps may become colon cancer. Colorectal screening tests may be useful to detect cancer in its early stages or even before it begins. Hence, regular screening in individuals with family history of cancer or persistent symptoms is recommended. Polyps or cancerous cells may be surgically removed before or after chemotherapy and radiation therapy may also be prescribed.

The ovaries are comprised of three major types of cells and each kind of cell can develop into different types of cancer.

Epithelial Tumours: These are tumours which originate in the cells which cover the outer surface. They form the majority of ovarian tumours.

Germ Cell Tumours: The cells which produce the ova are called germ cells. Tumours which begin from here are named after them.

Stromal Tumours: There are structural tissue cells which hold the ovary together. These are responsible for producing the female hormones known as oestrogen and progesterone. Stromal tumours originate here.

The majority of ovarian tumours are non-cancerous (benign). They do not spread beyond the ovary. They are treated through surgical removal of the cancerous cells. Malignant tumours can spread with in the abdomen commonly and must be treated with initial course of chemotherapy. Surgeons at Sri Ramakrishna Hospital will advise patients on the most prudent course of action.

This is cancer which may originate in the kidneys. Located behind the abdominal organs, there is one kidney on either side of the spine. They filter the blood passing through the body, removing wastes, controlling the balance of fluid in the body and regulating electrolytes. They create urine as they filter blood. The kidneys are comprised of units called nephrons. Each of these is a microscopic blood filter. Even with as much as 90% loss of one kidney, it is possible that symptoms or trouble will not be visible. The most widespread kind of kidney cancer in adults is renal cell carcinoma while children may develop a type known as Wilms’ tumour. While kidney cancer in general might appear to be on the rise, it is possible that new imaging techniques such as CT scans are actually identifying more of them than before.

The lungs absorb oxygen during inhalation and release carbon dioxide during exhalation. Uncontrolled growth of tumorous cells may begin in one or both lungs. Typically it happens in the cells which line the air passages. As they grow, they begin to inhibit the lungs’ ability to oxygenate the bloodstream. They may metastasise and spread to other parts of the body through the bloodstream.

There are three major kinds of lung cancer:

Non-Small Cell Lung Cancer:

The most common form of lung cancer, it comprises about 85% of all cases. Subtypes of non-small cell lung cancer may be squamous cell carcinoma, adenocarcinoma and large cell carcinoma.

Small Cell Lung Cancer:

This is also known as oat cell cancer and it spreads very rapidly. Between 10% to 15% of all forms of lung cancer fall into this.

Lung Carcinoid Tumour:

Lung carcinoid tumours form less than 5% of lung cancer cases. They very rarely spread and the advance slowly.

Smoking greatly increases the risk of lung cancer. The risk is proportionate to the amount smoked and the length of time a person has been been smoking. Quitting greatly reduces the risk, even if the person has been a habitual smoker for years.

There are two major categories of skin cancer - melanoma and non-melanoma. Melanoma is the most serious and common type of skin cancer. It affects the cells which produce the pigment which colours the skin (melanin), known as melanocytes. Melanoma may also form in other parts of the body such as the eyes and, more rarely, internal organs such as the rectum. The exact cause of melanomas has not been determined but it has been linked to ultraviolet radiation (UV) from direct sunlight, tanning beds and so on. This is why sun screen lotion is usually recommended for people who spend long hours in direct sunlight.

Non melanoma skin cancer is, as the name suggests, includes all forms of cancer of the skin other than melanoma. There are many which fall under this category such as basal cell carcinoma and squamous cell carcinoma.

Typical treatment for skin cancer involves surgery to remove the tumours. At Sri Ramakrishna Hospital, surgeons will advise you on the best course of action, based on your individual symptoms and history.


TREATMENTS & PROCEDURES

Surgeons at Sri Ramakrishna Hospital carry out a host of procedures for the treatment of cancer of the head and neck area. These are some of the procedures.

  • Composite Resection with Pedicle Flap or Microvascular Reconstruction for Oral Cancer:

    After the removal of a tumour, a part of the throat, neck or mouth may have to be reconstructed. In these cases a skin graft can be used. A slice of skin (flap) which is removed from the thigh is re-attached in the affected area which needs repair. Sometimes if the defect is larger, muscle may also be used. Microvascular surgery is the attaching of blood vessels through the help of a microscope. This new surgical technique allows such procedures to be carried out

  • Laryngectomy / Laryngopharynegectomy with free jejunal flap / voice reconstruction:

    Occasionally, in order to remove a tumour of the oropharynx, hypopharynx or the larynx (voice box) may have to be fully or partially removed. There are a number of procedures which can then help the patient 'recover' his or her voice

  • Laryngopharyngoesophagectomy with gastro or coloplasty
  • Total Thyroidectomy with central neck dissection or functional neck dissection
  • Parotidectomy: This is the removal of the salivary glands due to a tumour of the region. The tumour may be benign or malignant
  • Radical maxillectomy with reconstruction: This is the complete or partial removal of the maxilla bone for tumours of the hard palate, maxillary sinus, nose or other maxilla tumours. The defect can be reconstructed with a prosthesis

Breast cancer is unfortunately growing in numbers but, it has also received tremendous attention and funding for research. This has allowed the field to progress rapidly and we at Sri Ramakrishna Hospital have stayed at the forefront of the treatment wave. We offer patients sophisticated surgical solutions to treat breast cancer with excellent outcomes.

  • Modified radical mastectomy with or without lattisimus dorsi reconstruction:

    Modified radical mastectomy is a procedure wherein the whole breast is removed in order to treat breast cancer. This includes the skin, areola, nipple and most of the axillary lymph nodes. The lattisimus dorsi is a muscle located below the shoulder and at the back of the armpit. It is what facilitates twisting movements such as swinging a cricket bat. An oval flap of this, including skin, fat, muscle and blood vessels may be used to reconstruct the breast.

  • Breast Conserving Surgery: 

    Also known as lumpectomy, quadrantectomy or partial mastectomy, breast conserving surgery aims to remove the cancer and some tissue without removing the entire breast. This usually requires radiation therapy after the surgery in order to ensure that any remaining cancer cells are killed.

This is the continuum of organs comprising the oesophagus, stomach, small intestine (bowel) and colon. Beginning at the mouth and ending at the anus, it transports food through the body while absorbing the nutrients. There are a host of cancers which affect this system. We offer a host of surgical treatments to fight them.

  • Oesophagus - Transhiatal Oesophagectomy: The oesophagus is the tube through which food moves from throat to stomach. Oesophagectomy is a surgery that aims to remove the oesophagus partially or completely. After removal, the oesophagus is rebuilt using part of the stomach or the large intestine. The transhiatal approach involves the surgeon working through the neck and the abdomen at the same time.
  • Stomach –Radical gastrectomy with D2 dissection.
  • Pancreas–Whipple’s Procedure (Pancreaticoduodenectomy): This is the most common approach for removal of tumours in the pancreas. During a Whipple procedure, the head of the pancreas, part of the duodenum, the gallbladder, a tiny portion of the stomach (the pylorus) and lymph nodes in the region are removed. What remains of the pancreas and the digestive organs is them reconnected. Thus, pancreatic digestive enzymes, stomach contents and bile will flow into the small intestine. The surgery may take 5 to 8 hours.
  • Pancreas -Distal pancreaticosplenectomy is a surgical procedure done in order to treat pancreatic disease of the body and tail. It is also called spleen-preserving pancreatectomy.
  • Liver-Major hepatic resections.
  • Large Intestine-Colectomy:  The colon is susceptible to a number of diseases. In these cases a colectomy is performed. It is the surgical removal of either part of or the complete colon. This may be done through open surgery or laparoscopically.
  • Rectum- We perform a host of surgical procedures on the rectal region from trans anal procedures to anterior resections to abdomino perineal resection.
  • Pelvic Exenteration- This is a surgical treatment which is classified as radical. It involves removal of all the organs from the pelvic cavity of the patient. The rectum, urinary bladder, urethra and anus are removed. In women the vagina, cervix fallopian tubes, uterus, ovaries and (sometimes) vulva may be removed. The prostate in men is removed. The person will have to have a ‘urinary diversion’ and colostomy permanently.

This is a highly specialised field which focuses on the treatment of cancers of the female reproductive system such as uterine cancer, ovarian cancer, vaginal cancer, cervical cancer and vulvar cancer. The department of Surgical Oncology at Sri Ramakrishna Hospital can provide a host of surgical treatment options for gynaecological cancers including the following.

  • Staging laparotomy with peritonectomy for the treatment of ovarian or endometrial carcinoma.
  • Laparoscopic hysterectomy with lymph adenectomy is done for endometrial cancer.
  • Radical hysterectomy through both open and laparoscopic approaches, for the treatment of cervical cancer.
  • Vulval excisions with ilioinguinal block dissection.
 

This is the system of reproductive organs and the urinary system. There are a number of organs which fall under this and a host of cancers which affect it. The following are some of the surgical procedures we perform to treat certain types of genitourinary cancer.

Kidneys - Nephrectomy: A nephrectomy is surgical removal of the kidney. Partial nephrectomy is the removal of only cancerous tissue within a kidney. As much healthy tissue that can be spared is left behind. Radical nephrectomy is the removal of the entire kidney with surrounding fat and lymph node tissue. The procedure may be done laparoscopically or through open surgery.

Bladder - Cystectomy: This the removal of all or part of the bladder, in order to treat bladder cancer. A partial cystectomy is the removal of part of the bladder while radical cystectomy is the removal of the entire bladder. For women, the uterus, fallopian tubes, ovaries, cervix and part of the vagina may be removed. For men, the seminal vesicles, prostate and a portion of the vas deferens is removed. Surgeons at Sri Ramakrishna Hospital are also expert at neobladder reconstruction. This involves the creation of a new bladder using a part of the small intestines. It is then placed in the same place as the bladder and connected to the urinary tract. In time, it will function as the old bladder did.

Testicles Retroperitoneal Lymph Node Dissection: Testicular cancer spreads in a predictable pattern. The lymph nodes of the retroperitoneum are one of the key landing areas during the spread. An incision is created from sternum to a few inches below the navel and the abdominal lymph nodes are removed. Penectomy: This is the surgical removal of part of, or the complete penis for cancer of the region with of without ilio inguinal block dissection.

There are a host of surgical procedures which are used to treat muscle, bone and skin cancer. Sri Ramakrishna Hospital can offer patients a number of treatment options such as the following.

  • Major wide local excision of soft tissue with all types of flap reconstruction
  • Limb salvage surgery for bone tumours
  • Ablative surgeries with sentinel node biopsy for melanoma

Lung cancer is treated by a variety of means, including surgery.

We offer a host of treatment options including:

  • Lung resections with nodal dissection
  • Chest wall resection
Chemoport:A port is exactly what it sounds like - a little disc which gives access to a large vein.Usually constructed from plastic or metal, it is installed under the skin and allows doctors to administer chemotherapy through a special needle which fits into the port. Blood may also be drawn from it. It is a key facilitator in the fight against cancer.