Sir H. N. Reliance Foundation Hospital and Research Centre (On Call)

Good morning everyone, my name is Dr Ninad Katdare I am a cancer surgeon and I specialise in gastrointestinal cancers and gynaec cancer and something called as peritonial cancers. So today I will be telling you about ovarian cancer so basically I am a surgical oncologist I work at 5 different hospitals in Mumbai first is Global Hospital second is Raheja hospital at Mahim third is H.N. Reliance hospital at Charni Road and BSES MG hospital in Andheri and SCG hospital at Borivali. So let's start our lecture on ovarian cancer, basic early ovarian cancer is one of the most common cancers in women and you must know about it and it is the most deadliest of the cancers the maximum number of women would die from gynaecological cancer are due to ovarian cancer. So I will speak mainly on the various aspects the staging and the treatment protocols, so to begin with ovarian cancer can be in four stages. There are stages by something called as the Figo staging which you will see in next slide. So the Figo Staging stages the cancer according to where it is localised to the ovary or whether it has spread to the pelvis or out side of the pelvis into the rest of the abdomen and the last stage 4 stage is when it spread beyond the abdomen. So in the first three stages you can potentially cure the patient. So there are very vague signs and symptoms to ovarian cancer they can be persistent distinction of abdomen, wake pain in the abdomen, constipation for a pro long duration of time, vague, aches and pain in the abdomen. So if you have any of this problem you should get it evaluated by a gynecologist or surgical oncologist. The first most commonest test which we do is a tumor marker called as CA 125 and sonography of the abdomen if there are any suspicious finding then the second investigation which is commonly done whether it is CT scan or an MRI. So based on these two test and on the clinical examination you are able to stage the disease, if there are some doubtful findings where the ovarian masses can be secondary to cancer in other organs of the body like the stomach or a colorectal cancer then the endoscopy of the stomach or the colonoscopy of the colon will required. So once the diagnosis of ovarian cancers confirmed for stage 1 stage 2 and stage 3 the first step is always surgery, contrary to the routine treatment protocol which are done in India especially for stage 3, we always prefer a surgery this surgery is called as cytoreduction. Basically, even if there is water in the abdomen which is called as ascitis, but if the diseases is of table which is evaluated by the MRI and by the laparoscopy. So even in statge 3, the chemotherapy should not be given first because if you do the surgery first and we are able to remove all the disease the survival of the patient is much higher. Though cytoreduction is a not possible in each and every patient but in selected patients if you can remove the whole disease the survival live in the stage 3 ovarian cancer is almost more than 50%. So basically what we do in the cytoreduction, is we open the entire of abdomen and remove all the diseases not only the ovaries we remove the uterus and also something called as a omentum we remove the appendix and if required we remove the inner lining of the abdomen called as peritonium and any other diseases which is present in whole the abdominal cavity is removed through very supra major surgery called as cytoreduction which may last for anywhere between 6 to 10 hours. But if you are able to remove each and every part of the disease visible to the naked eye then the cure its even a stage 3 ovarian cancer are very high and once the surgery is done and the patient recovers from that you can give chemotherapy. Even in stage 4 cancer we have new technologies available where in we can try for a cure, this therapy is called as a Hipec therapy. What is Hipec stands for, it stands for Heated Intraperitoneal Chemotherapy. In this basically the cytoreduction which I mentioned previously is done and once the procedure is over you have to use this technology and circulate the heated chemotherapy in the abdominal cavity and once this is circulated for anywhere between 60 to 90 minutes and then the abdominal cavity is washed and close like in a normal surgery. So with this Hypec and one more new technology called as Pipec, you can even get better cure its in stage 3 and in somewhere cases of stage 4 cancer. So these technologies are all done by me in various hospitals where ever. So this is how even with the advanced ovarian cancers nowadays we can get good success rates, thank you. If you want any more information you can contact me through lybrate.com.

Good Morning everyone, my name is Dr Ninad Katdare I am a cancer surgeon and I specialise in gastrointestinal cancers and gynae cancer and peritoneal cancers. I am available at H.N. Hospital, Charni Road, Global Hospital, Parel, Raheja hospital, Mahim, BSES Hospital, Andheri and HCG Oncologist Hospital at Borivali. Today we will be speaking about Colorectal Cancer, this is one of the fastest growing cancer in India and more and more younger patients we are seeing with colorectal cancers. So I will take you through a short video showing the various treatment options and the various stages of colorectal cancers. So basically colorectal cancer is stage using something called as AJCC system which you can see in the next slide and I won’t go to the detail of it, you can just go through the details for it, this gives us just an idea ki on which stage is the cancer. So based on the stage of the cancer there very good treatment modalities available which does not sometimes necessitate even surgery and sometimes whenever we need surgery. It can be in the form of minimally invasive surgery. So I will go through all the aspects of that, so stage one cancer, these are not very common these are usually seen when you have gone through a health check or sometimes on routine screening colonoscopy you have found a colorectal cancer. In this stage one cancer’s almost 80 to 90% of the cancers can be removed by what is called as endoscopy resection. In this you don't need to undergo any surgery through the endoscope which is put through rectum and through special instrument pass through the score you can do the surgery and the tumour can be removed from inside the intestine itself and the patient is up and above and can be discharge in a day also so with this kind of treatment you don't need any surgery at all but this is limited only for stage one and those also early stage one cancers anything which is late stage 1 or beyond you cannot do the this procedure for these procedures which is a late stage 1, stage 2 and stage 3. Nowadays an open surgery is very rarely done. It has been shown that laparoscopic surgery can remove whole of your cancer without causing any increases of cancer. At the same time using laparoscopic surgery you have very small 1 cm cuts on your abdomen so that your recovery from the surgery is very fast so these are some photos showing how the laparoscopic surgery is done and laparoscopic colostomy and laparoscopy rectal surgeries now routinely available at our hospitals. In addition for stage 3 most of the time chemotherapy will be required to the patient, even first stage two and three another new technologies is available which is called as robotic surgery. In certain cases where the patient is very obese or if the cancer is very deep down into the pelvis these are the cases where robotic surgery has the best advantage and the recovery is very fast from the surgery. With robotic surgery here you can see that there is a robot which is why the patient side and there is one console, on which the surgeon sits and does the surgery. Usually after robotic surgery and laparoscopic surgery the patient can be sins sitting and on his bed in 6 hours and by next day he is walking around in the hospital. The recovery is very fast with these two procedures. One more thing which stage 2 and stage 3 cancers, especially in rectal Cancers, if they are very down in the rectum very close to what is called sprinters. Initially we used to do something called as a abdominal perineal resection, where in, for your whole life you use to requires a colostomy on the abdominal wall that means the stool use to pass from your abdominal wall now with the advent of new technology called as Pinto Preserving surgery, we are able to save with the sprinkles. So even if for a very low rectal cancer we are able to save the sprinkles and the colostomy is not required. In this image you can see the various technologies where we can do the springto preserving surgery. For stage 4 cancer also, in Colorectal Cancer specially there are many new technologies available so initially what we used to fear that this is a last stage of Cancer is not true anymore in colorectal Cancer. So for cancers which has spread to the liver and the lungs, we can do surgery with or without something called as ablation therapy which you can see on the right side and for something the peritoneal metastasis of colorectal Cancer we can do what is called the Hipec which you can see on the left side also along with all this treatment modality obviously chemotherapy is required at stage 4. But this should be noted that even for stage 4 cancer good selected patients you can get survival for even more than 5 years which was not possible 5 years back. So for colorectal cancer from stage 1 to stage for various technologies are available these are available at all the hospital where I work and for all this stage is the success rate are very good. Thank you, for any further questions you can contact me through lybrate.Com, thank you.

Good Morning, everyone, my name is Dr Ninad Katdare I am a cancer surgeon and I specialise in gastrointestinal cancers and gynae cancer and peritoneal cancers. I practise at H.N. Reliance Hospital, Charni Road, Global Hospital, Parel, Raheja Hospital, Mahim, BSES Hospital, Andheri and HCG Cancer Centre at Borivali. Today we will be speaking about peritoneal cancer peritoneal cancers is one of the least understood cancer and as such many of these patients don't receive good form of treatment, so I will be taking you through a short presentation about what is peritoneal cancer and what are the new modalities which can be actually curative in certain cases of peritoneal cancers. So the presentation is titled peritoneal cancers which are no more a death sentence which was the situation just 5 years ago. So basically what are peritoneal cancer so those can be one, the last stage of Cancer such as colorectal cancer, stomach cancer, appendix cancer, gallbladder cancer and pancreas cancer. In all of these the fourth stage is presents with peritoneal disease and what is known as peritoneal metastasis. It can also be a third stage cancer in ovarian cancer when the disease spread out of the ovary and through the pelvis into the rest of the abdominal cavity it present with peritoneal cancer. It can also present as a primary peritoneal cancer which is called as primary peritoneal adenocarcinoma and a rare case of cancer called as mesothelioma, and there is one specific NDT called as Pseudomyxoma pertonei, all these diseases basically are club together because the routine chemotherapy which is the IV chemotherapy given through your veins is very less effective in this type of cancers. Hence newer technologies which are called as HIPEC and PIPAC which I will come to it shortly are used and this can have curative effects on this type of cancer. So why does chemotherapy fail because usually this peritoneum receive only 1% of cardiac volume that is the amount of blood which your heart pumps, that is 5 litre per minute only 1% of that is received by your peritoneum and there is something called as a peritoneum plasma barrier so whatever chemotherapy which is given through your saline, very less quantity reaches to the peritoneum and as such the routine chemotherapy does not work on this peritoneal cancers. Hence, to combat that we have interesting new technologies the first is called as Cytoreductive surgery and HIPEC so CR stands for Cytoreductive surgery and HIPEC stands for Heated Intraperitoneal Chemotherapy.

In Cytoreductive surgery what we aim is to remove all the visible disease from your abdominal cavity and once that has been clear we circulate a chemotherapy solution which is heated to around 43 degrees and is kept circulating in the abdominal cavity for 90 minutes. Using a combination of Cytoreductive surgery and HIPEC, in many of these peritoneal cancers you can have a cure, it exceeding 5 years and which is a standard patient with the standard chemotherapy with the patient would like for more than 6 months. So in such cases from 6 months, the survival goes to beyond 5 years. Certain cases which are not suitable for this CRS and HIPEC we have a revolutionary technology known as PIPAC. So what is PIPAC stand for is Pressurized Intraperitoneal Aerosol Chemotherapy, in this basically the chemotherapy which is in the liquid form is converted into a gas form and through small keyholes surgery that is called as Laparoscopy we introduce this gaseous chemotherapy into your abdominal cavity. It has been found that patients who have stopped responding to routine chemotherapy also a response to this gaseous chemotherapy. So with the help of this HIPEC and PIPEC many of the peritoneal carcinomatosis are almost 30% can be cured and another 30% can be controlled with this kind of therapy and these patients normally would have died in 6 months, some of them alive for even after 2 years and even 30% of them are alive even 5 years after the diagnosis of their disease. So these therapies can really make a difference in your treatment, thank you. For any further questions, you can contact me on lybrate.com.