Oncology – Medical Radiation Nuclear
Welcome to the Oncology department of Sri Ramakrishna Hospital.
Our Oncology programme is dedicated to fighting cancer every single day, and has been doing it for a long time. We have treated more than 50,000 patients, screened more than 220,000 women for breast cancer and cervical cancer free of cost (under the DEEPAM project) and have been treating disadvantaged children with acute lymphatic leukaemia for free for more than a decade.
We’re proud to have among the finest Oncological Programmes in the country – one which is only getting better every single day. We have multi disciplinary teams comprising medical oncologists, surgical oncologists, radiation oncologists, physicians of nuclear medicine and a whole host of technicians working together to assess situations and diagnose patients before dispensing cutting edge treatment such as Radiation Therapy, Chemotherapy, Concurrent Chemoradiation, Stereotactic Radio Surgery and so on.
We all know that the human body (and basically any living body) is made up of a wide array of cells. These cells are the foundation of all life. Over time, they grow old, die and are replaced with new cells. Occasionally, cells may start to grow at an alarming, uncontrollable rate. They reproduce in large numbers and they form a mass. This mass is known as a tumour.
A tumour which will grow and spread is dangerous to the human body and is therefore termed malignant. One which grows but isn’t dangerous (and does not spread) is known as a benign tumour. Some cancers tend not to form masses but are simply large numbers of cells which spread through the body.
While there are many forms of cancer, the major types are four in number and they affect various parts of the body.
This has its beginnings in the skin covering the surface of glands and internal organs. They are the most common form of cancer and they typically form solid tumours. Breast, prostate, lung and colorectal cancers are all carcinomas.
Beginning in those tissues which support and connect the body, sarcomas may develop in fat, muscles, nerves, tendons, joints, blood or lymph vessels, cartilage and bone.
This is a cancer of the blood, due to which it doesn’t form a mass. It occurs when healthy blood cells metamorphosis and grow uncontrollably. Since they are in the bloodstream, they spread quickly. Four major kinds of leukaemia are acute lymphocytic leukaemia, chronic lymphatic leukaemia, acute myeloid leukaemia and chronic myeloid leukaemia.
A lymphoma, as the name implies, is a cancer in the lymphatic system which is a network of glands and vessels which help the body fight infection. The two major types of lymphomas are Hodgkins lymphoma and non-Hodgkins lymphoma. We can offer a wide variety of treatments for leukaemia including those such as radio immunotherapy.
We at Sri Ramakrishna Hospital can offer a wide variety of diagnostic options and treatments to patients. Our department of Oncology has leading experts in the field and we use state-of-the-art technology and cutting-edge treatments to bring relief and remission to patients suffering from cancer.
Treatments & Procedures
At Sri Ramakrishna Hospital we have extensive experience treating cancer through radiation therapy. It makes use of high-energy beams like x-rays and protons to kill the cells of a tumour.
Typically, radiation therapy is administered through the use of a machine outside the body in a process known as external beam radiation. External beam radiation therapy is the use of high energy beams like X-Rays and protons to kill cancer cells. External beam radiation can focus either specifically on a single part of the brain i.e. the location of the tumour. Or, it may be administered to the full brain, in its entirety. This is known as ‘whole-brain’ radiation.
This form of radiation therapy is mostly used to target cancer which may have spread from some other parts of the body to the brain. The types of external beam radiotherapy are:
- 3 Dimensional conformal radiation therapy [3DCRT]
- Intensity moderated radiation therapy [IMRT]
- Image guided radiation therapy [IGRT]
- Stereotactic Radio Surgery [SRS]
- Stereotactic Body Radiotherapy [SBRT]
In some rare instances, the radiation may be administered from within the body, close to a brain tumour. This is known as brachytherapy. There are three types of brachytherapy – intracavitary, insterstitial, and intraluminal.
Radiation therapy has side effects but their nature is dependent on the kind of radiation received and the dosage. Some of them include headaches, tiredness (fatigue) and irritation of the scalp.
At Sri Ramakrishna Hospital, we have extensive experience in SRS / SRT, SBRT, IGRT/IMRT and brachytherapy procedures.
Stereotactic Radio Surgery (SRS) is a type of external beam radiotherapy. It is a procedure wherein multiple beams of radiation are focused on a small, localized area of the brain. Where they meet, the unified, focused beam destroys cancerous cells. Using advanced computer planning, radiosurgery minimizes the amount of radiation received by normal brain tissues and focuses more effective radiation on the area to be treated. It is a minimally invasive procedure used to treat brain tumours, usually in patients who are unsuitable for conventional surgery for various reasons such as age, health problems or the presence of the tumour being in a highly sensitive location.
During the procedure, the patient does not have to be put under general anaesthetic as the treatment is completely pain free. He or she lies on a tray which is slid into the machine which delivers the radiation.
Depending on the kind of tumour, the treatment may use gamma knife technology (thereby giving it the well-known name of gamma knife surgery), linear accelerator machines (LINAC) or proton beams.
The treatment takes just 30 minutes to two hours for a session. Patients can often return home the very same day.
Image guided radiation therapy (IGRT), as the name suggests, utilises imaging technology to target radiation therapy more accurately. It greatly enhances precision of the delivery of treatment and is particularly useful in treating tumours in areas of the body which move, like the lungs.
Imaging technology allows doctors to ‘Image’ the tumour before and during the course of treatment. Prior to the session a ‘Simulation’ would have been run with the patient. The reference images taken during the simulation are then constantly compared to the images taken before and during the procedure. These allow the doctor to position the beams of radiation for maximum accuracy. To enhance the process, sometimes special markers, electromagnetic transponders or even tattoos of coloured ink on the skin are used to better target the radiation.
IGRT provides high resolution, three dimensional images to pinpoint tumour sites, adjust patient positioning when necessary and complete a treatment – all within the standard treatment time slot. This allows for precision treatment and the least possible side effects.
Patients suffering from inflammatory arthritis experience swelling and pain of the joints. Typically this is due to the excessive growth and inflammation of the synovium which is a membrane lining the joints. Ordinarily it is one or two cell layers thick and it produces build which aids in lubricating the joint.
However, when is grows in size, the overproduction of fluid can result in the deterioration of the cartilage on the surface of the joint. This is due to an abnormal immune response wherein the body attacks the cartilage as a foreign substance due to the excessive synovial fluid.
One non-invasive treatment for it is radiation synovectomy. In this, a radioactive isotope (P32) is injected into the joint. P32 halts the growth of the synovium and reduces the potential for arthritis. Radiationn synovectomy is done under topical anaesthetic and takes as little as five minutes for the whole treatment. Thus, it does not call for hospitalisation or a long recovery process.
In keeping with our efforts to offer the very best treatment to our patients the Department of Oncology at Sri Ramakrishna Hospital administers radio immunotherapy to cancer patients.
This is a combination of radiation therapy and immunotherapy. In the latter (immunotherapy), a molecule produced in a laboratory (called a monoclonal antibody) is designed to identify and bind itself to the surface of cancer cells. They mimic antibodies which are naturally produced by the immune system of the body which attack viruses and bacteria. The monoclonal antibody is then paired with a radiotracer which is a radioactive material. When the monoclonal antibody binds to the cancer cells, the radiotracer transfers a massive dose of radiation directly to the target (the tumour).
Typically, this form of treatment is used on patients suffering from non-Hodgkin B-cell lymphoma – those who already tried other treatments such as chemotherapy and those who have just been diagnosed. It is also used to treat some other sub-types of lymphoma.
Chemotherapy is the use of medicines to kill cancer cells. It is given orally or intravenously. Chemotherapy works throughout the whole body, thereby eradicating cancer cells that have spread to part of the body far away from the primary tumor.
The 3 main goals of chemotherapy are:
This treatment utilises drugs in order to kill the cells of a tumour. The drugs are either taken orally (as a tablet) or intravenously (injected into a vein). There are many types of drugs prescribed based on the nature of the cancer affecting the patient. One such example is temozolomide (Temodar) which is ingested in the form of a tablet. It is typically used in the treatment of brain tumours. The choice of drugs depends on the site and stage of disease and the side effects vary based on the kind of cancer, the drugs used and the dosage. Some of them are hair loss, vomiting and nausea.
Targeted cancer therapies are drugs or other substances that can focus on certain abnormalities which exist within the cells of the cancer. They block the abnormalities, by interfering with specific molecules involved in the growth, progression and spread of cancer, causing the cancer cells to die. In general the drugs work to:
- Block or turn off chemical signals for cancer cell growth
- Change processes within the cancer cells
- Stop making new blood vessels to feed the cancer cells
- Trigger the immune system to kill cancer cells
One such targeted drug therapy is bevacizumab (Avastin). It is used to treat a kind f brain cancer called a glioblastoma. Administered intravenously, it prevents the formation of new blood cells, cuts off the supply of blood to the tumour, resulting in the death of the tumour cells. Another such targeted drug is called everolimus (Afinitor). It is used to treat a kind of benign brain tumour affecting people with tuberous sclerosis. It blocks one of the body’s enzymes which ordinarily aids the growth of cancer cells.
During the past 20 years, the advent of neoadjuvant, adjuvant and primary chemoradiotherapy has improved cancer care dramatically. Significant contributions have been made by technological improvements in radiotherapy, as well as by the introduction of novel chemotherapy agents and dosing schedules.
Concurrent chemoradiotherapy is a treatment where they are used concurrently to treat a patient. This is the result of both advanced research and technology and great skill and expertise, both of which we at Sri Ramakrishna Hospital have in good measure. Drugs used in chemotherapy increase the sensitivity of cancer cells to radiotherapy, thereby aiding in their destruction. It is usually administered a short while before radiotherapy.
Typically, chemoradioitherapy may be prescribed with the following rationale :
- organ-preserving intent
- where chemotherapy acts as a radiation sensitizer
- local treatment combined with systemic treatment to eradicate distant micro metastases.
An MRI is a well-known diagnostic tool used to navigate through the affected part of the brain. During the course of surgery however, MRIs lose their accuracy. This is because cerebrospinal build might have drained and the tumour may have been removed along with some tissue. Thus, the landscape of the brain has changed. Intraoperative magnetic resonance imaging (IMRI) allows the brain to be images in real time. This allows surgeons to understand changes that have taken place at all times and for the operation to be completed in safety.
Nuclear Medicine: FDG whole body PET, Brain PET, Cardiac PET and Bone PET
Nuclear medicine is the field of medicine where patients are given tiny amounts of radioactive medication. This is known as a radiopharmaceutical and, in effect, it makes the body a little radioactive for a short period of time. A specialised camera for nuclear medicine, which can detect radiation emissions from the body, can then take ‘pictures’ of it (the radiation). This is essentially a picture of the inside of the body as it works. Depending on the organs under investigation, it gives specialists a window into the functioning of the affected part. Different types of medications are used for different organs and they are administered in different ways – orally, by injection in the tissue, by injection into a shunt, injection into a joint or inhalation.
While it is more commonly a diagnostic tool, nuclear medicine can also be used to treat certain types of tumours. What separates nuclear medicine from conventional testing methods is that normal scans such as CTs or MRIs show the anatomy of the affected area while nuclear medicine tests can show its physiological function. Which means that you can not only view its shape, but how it is performing.
A key component of nuclear medicine is positron emission tomography or a PET scan as it is usually known. In it, a tracer (made of a radioactive substance) is injected into the body. The tracer moves through the body as collects in regions where there are increased levels of chemical activity. These are usually areas with disease. During the scan, they are highlighted as bright spots. Here at Sri Ramakrishna Medical hospital we are well-equipped to do a number of PET scans such as whole-body FDG, brain, heart and bone.