Posts Tagged ‘Surgery’

What are different treatment options available for treating liver cancer?

These are some of the treatments available:
- Surgery,
- Immunotherapy,
- Photodynamic Therapy,
- Hyperthermia,
- Radiation Therapy
- Radiosurgery
The best option for curing liver cancer is surgery.

Other techniques used to treat liver cancer are:
- Including inserting needles into the tumor.
- Destroying the tumor (ablation).
- Injecting a substance into the tumor to deprive it of the blood supply it needs (embolization).
- Chemotherapy
- Radiation therapy

The best treatment for the liver cancer is based on:
- Age, overall health, and medical history.
- Extent of the disease.
- Stage of the cancer.
- Your tolerance of specific medicines, procedures, or therapies.
- Expectations for the course of the disease.
- Your opinion or preference.

Surgery
- Surgery is the only way to cure liver cancer.
- The most common type of surgery for liver cancer is resection (removal of the cancer).
- The presence of cirrhosis of the liver makes surgical resection less successful.
- It may require the entire liver to be removed and replaced with a donated liver (liver transplant).
- Surgery depends on whether the part of your liver that is not affected by the cancer is healthy.
- When part of your liver is removed, enough healthy liver tissue left is to be taken care of, to carry out all of the critical jobs of the liver.

Ablation
- Ablation destroys the tumor without removing it.
- It is a good option for patients with small liver tumors.
- This process uses high-energy radio waves, alcohol injections and very cold metal probes to destroy the tumor.

Embolization
- Tumors need the oxygen supplied by blood to grow.
- Embolization stops blood from flowing to the tumor.
- Embolization can be done by injecting substances that plug the artery.
- This is sometimes combined with chemotherapy (chemoembolization) or radiation therapy (radioembolization).

Chemotherapy
- Chemotherapy drugs kill cancerous cells.
- It works by stopping cancer cells from growing or reproducing, which kills the cells.
- Chemotherapy may be taken by mouth in pill form or injected into a vein or muscle.
- Sometimes it is injected into a hepatic artery through a thin tube (catheter).
- This process is known as chemoembolization.

Radiation Therapy
- Radiation therapy uses high-energy radiation to kill cancer cells and shrink tumors.
- Radiation therapy for liver cancer is usually delivered internally.
- It is done by inserting a radioactive substance into the body.

Targeted Therapy
- Targeted therapy blocks the steps involved in the growth and proliferation of cancer cells.
- Targeted therapy drug may be taken by mouth or in a pill form.
- The main targeted therapy for liver cancer is a drug called Nexavar (sorafenib tosylate).

Hepatocellular Carcinoma
- Partial hepatectomy to resect the entire tumor.
- Liver transplantation.
- Cryoablation.
- Chemoembolization.
- Radiotherapy.
- Sorafenib.
- Radiofrequency ablation.
- Radiofrequency ablation combined with local chemotherapy.

Cholangiocarcinoma
- Photodynamic therapy.
- Brachytherapy.
- Radiotherapy.
- Liver transplantation.

Hepatoblastoma
- Chemotherapy, including vincristine, cyclophosphamide, and doxorubicin.
- Radiotherapy.
- Liver transplantation.
- Surgical resection.

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What is meant by Hemicorporectomy?

In medicine (surgery), hemicorporectomy can also be called as translumbar amputation and “halfectomy”.

- It is a radical surgery in which the body below the waist is amputated that transects the lumbar spine.
- Hemi is generally used to refer to one of two sides like e.g., hemiplegia, which affects the arm and leg on one side of the body.
- The first hemicorporectomy was attempted by Charles S. Kennedy in 1960.

This includes the removal of:
- legs,
- the genitalia (internal and external),
- urinary system,
- pelvic bones,
- anus,
- rectum.

What kind of patients is recommended to undergo this procedure?
- It is a severely mutilating procedure recommended only as a last resort for patients.
- It is suggested to the patients with severe and potentially fatal illnesses like osteomyelitis, tumors, severe traumas and intractable decubiti in, or around, the pelvis.
- Cancer patients who need:
1. Extended radical mastectomy.
2. Radical gastrectomy.
3. Pancreatectomy.
4. Pelvic exenteration.
5. The ‘Commando Operation’ (tongue, jaw and neck dissection).
6. Bilateral back dissection.
7. Hemipelvectomy.
8. Hemicorporectomy or translumbar amputation.

Indications
- The operation is most often performed to treat spreading cancers related to that of the spinal cord and pelvic bones.
- Trauma affecting the pelvic girdle (“open-book fracture”).
- Uncontrollable abscess or ulcers of the pelvic region (causing sepsis).
- Other locally uncontainable conditions.

The Surgical Procedure
- It is often done in two stages.
- It is also possible to conduct the surgery in one stage.
- The first stage is the discontinuation of the waste functions in colostomy (rectum) and ileal conduit (bladder).
- The second stage is the amputation.

What are the points to be considered when undergoing this procedure?
- With the removal of almost half of the circulatory system, cardiac function needs to be closely monitored.
- A new blood pressure set-point develops.
- Removal of large parts of the colon can lead to loss of electrolytes.
- A calculated measurements of renal function (such as the Cockroft-Gault formula) are unlikely to reflect actual activity of the kidney.

Post Treatment
- Extensive physiotherapy and occupational therapy are necessary.
- The design and construction of bucket prosthesis.

Prosthetic
- Following a hemicorporectomy, patients are fitted with a socket-type prosthetic often referred to as a bucket.
- Early bucket designs often presented significant pressure problems for patients.
- New devices have incorporated with an inflatable rubber lining composed of air pockets.
- These evenly distribute pressure based on the patient’s motions.
- Two openings at the front of the bucket create space for the colostomy bag and the ileal conduit.

Postoperative management requires
- Particular attention to fluid replacement,
- Temperature control,
- Pulmonary care.

Long-term management issues involve:
- Hypertension,
- Weight gain,
- Temperature control,
- Stoma management,
- Skin care

How to treat Bone cancer by Cryosurgery?

Bone Cancer is the cancer that begins in the bone. Primary bone cancer is relatively uncommon with secondary or metastatic cancer. This is cancer that occurs initially in another organ and then spreads to bone tissue.

The most common types of bone cancer includes:
- Osteosarcoma,
- Ewing’s sarcoma,
- Chondrosarcoma,
- Malignant fibrous histiocytoma,
- Fibrosarcoma,
- Chordoma

Diagnosis of bone cancer:
- Check for a complete medical history.
- A description of your symptoms can help.
- A complete physical examination can help find the cause of your symptoms.
- Testing your muscle strength.
- Sensation to touch
- Reflexes
- Certain blood tests
- Plain X-rays
Benign tumors are more likely to have a smooth border while malignant tumors have a ragged border on X-ray images.

- A CT scan
- An MRI (magnetic resonance imaging).
- Positron emission tomography (PET) scan.
- An angiogram, which is an x-ray of blood vessels.
- A bone scan.
- Obtain a biopsy sample of the tumor.
- Get examined in the laboratory by a pathologist.
- Determine what kind of tumor it is.

What is the treatment for bone cancer?
The best treatment is based on:
- the type of bone cancer,
- the location of the cancer,
- how aggressive the cancer is,
- whether or not the cancer has invaded surrounding or distant tissues (metastasized).

The main types of treatment for bone cancer:
- Surgery,
- Chemotherapy,
- Radiation therapy
- Cryosurgery
These can be used either individually or combined with each other.

Process of Cryosurgery
- This method is the use of liquid nitrogen to freeze and kill cancer cells.
- This technique can sometimes be used instead of conventional surgery to destroy the tumor.
- The application of liquid nitrogen as a local adjuvant to curettage in the treatment of bone tumors was first introduced three decades ago.
- Cryosurgery was shown to achieve excellent local control.
- It is used for a variety of benign-aggressive and malignant bone tumors.
- Cryosurgery can cause significant morbidity if performed inappropriately.

An effective and safe procedure must follow these consecutive steps:
- Adequate exposure of the tumor cavity.
- Meticulous curettage and burr drilling.
- Soft-tissue mobilization and protection.
- Introduction of LN to the tumor cavity.
- Internal fixation of the cavity after cryotherapy.
- Protection of the operated bone throughout the healing period.

Side effects
- The exposure of normal bone and soft tissues (skin, muscles, nerves, and blood vessels) to the freezing effect of LN can result in significant morbidity.
- Early studies of the use of cryosurgery in the treatment of bone high complication rates, mostly pathological fractures and infections.