Our Team
Cancersahay is a non government based organisation dedicated to cancer. Since it’s inception in the year 2014, Cancersahay has come up a long way in it’s endeavour against this deadly disease.is a non government based organisation dedicated to cancer.
Get In Touch With Us
Cancer is becoming an epidemic. Very soon one member of every family will be inflicted with this lethal disease. Cancers are usually detected late due to very late manifestations. Some potential carcinogens that have been identified are tobacco, environmental toxins and chemicals, viruses, inappropriate radiation exposure, poor lifestyle changes and diet. Hereditary factors play a minor role in cancer occurrence. Out of these many are reversible. Cancer is preventable and curable if detected at an early stage. Innovations in the field of Medical science has brought new diagnostic and treatment options. The barriers to early detection are - lack of awareness, lack of effective screening methods for all type of cancers, lack of education, lack of infrastructure and lack of guidance. 4th Feb has been declared " World Cancer Day" to overcome these obstacles. It's time that we all unite in all aspects of life to fight this deadly disease.
Cancer surgery is very specialised. It is not only about removing the affected organ. It is about ensuring that the margins of the resected part are clear of all signs of disease. It is also about removing all the surrounding lymph nodes to which the disease has chances of spreading.
Cancer surgery is not about how you do it. It is about what you do. So it doesn't matter whether the surgery is done by conventional methods, laparoscopy ( minimally invasive surgery) or by robotic techniques. The bottomline is that the aim should be R-0 resection, that is, leaving no residual disease and to remove all the draining lymph nodes.
This is not an easy surgery. The surgeon should have proper training in such detailed and extensive surgeries and should also possess thorough knowledge of the disease and its character.
Chemotherapy is the treatment of cancer with one or more cytotoxic agents. These agents kill cancer cells and prevent progression of this lethal disease. Chemotherapy may be given with a curative intent or it may aim to prolong life or to palliate symptoms. It is often used in conjunction with other cancer treatments, such as radiation therapy and surgery. Chemotherapy can be given before primary therapy (neoadjuvant chemotherapy), or after the primary therapy (adjuvant). Infact in advanced cancer patients chemotherapy becomes the most important modality of treatment.
Traditional chemotherapeutic agents act by killing cells that divide rapidly, one of the main properties of most cancer cells. This means that chemotherapy also harms cells that divide rapidly under normal circumstances: cells in the bone marrow, digestive tract, and hair follicles. This results in the most common side-effects of chemotherapy: myelosuppression(decreased production of blood cells, hence also immunosuppression), mucositis (inflammation of the lining of the digestive tract), and alopecia(hair loss).
Some newer anticancer drugs (for example, various monoclonal antibodies) are not indiscriminately cytotoxic, but rather target proteins that are abnormally expressed in cancer cells and that are essential for their growth. Such treatments are often referred to as targeted therapy (as distinct from classic chemotherapy) and are often used alongside traditional chemotherapeutic agents in antineoplastic treatment regimens. Targeted therapy maybe expensive but strives to cure cancer at the molecular level.
Chemotherapy may use one drug at a time (single-agent chemotherapy) or several drugs at once (combination chemotherapy or polychemotherapy). The agents are repeated in weekly or biweekly or 3 weekly most of the times. It is not always necessary that a patient needs to be admitted for chemotherapy. He can take it from the daycare facility and get discharged by afternoon.
Common side effects of chemotherapy though scary are nowadays better managed with advances in medical science. Anemia or fall in white blood cells can be stimulated by growth factors. Mucositis can be prevented using special gargle formulas. Nausea and vomiting, one of the most distressing symptoms of chemotherapy can be prevented with newer drug formulations.
Finally chemotherapy can cure certain cancers like some lymphomas, choriocarcinoma, germ cell tumours.
Bone marrow transplantation (BMT) was first used experimentally to treat people exposed to radiation following a nuclear accident. Transplanted bone marrow effectively replaced marrow that had been destroyed by radiation. This same procedure was found to be effective in treating certain malignant and nonmalignant diseases that cause the marrow to produce either abnormal blood cells or very low numbers of normal cells. Drugs and radiation are used to destroy both abnormal and normal cells, and BMT replaces the diseased or damaged marrow with healthy marrow. BMT is not a surgical procedure, but a painless infusion, similar to a blood transfusion, that is done in the hospital room
The BMT procedure is based on the simple principle.
The potentially lethal disease of the patient should be such that it can be eradicated by high dose chemotherapy/radiotherapy.
Such treatment is highly toxic and will lead to permanent destruction of blood forming cells (hematopoietic stem cells). The bone marrow previously harvested from the patient/donor is used as a rescue measure to re-establish the hematopoiesis (formation of blood).
Depending upon the source of these stem cells, the BMT is classified as:
Indications for BMT
Malignant Diseases
Leukemia
Lymphoma
Non-Malignant Diseases:
Goal of BMT
Whether the diagnosis is a malignant or nonmalignant disease, the goal of BMT is a cure. Cure rates are still low, but are steadily increasing. Even if there is no cure, most transplants result in a period of remission. But one should be aware that there are no guarantees. BMT is an intensive procedure with many risks, and some patients will die despite BMT, from complications of transplant or from relapse of the original disease. The success of BMT will be influenced by a number of factors, including age, general physical condition, diagnosis, and disease stage, procedural complication etc.
The High Cost of BMT: The cost of the therapy will be discussed before undergoing the treatment with patient & family.
Cost varies according to type of transplant (allogenic / autologous) and complications occuring during the stay in BMT unit.
(Approximate cost for AutologousBMT is 3-6 lakhs and for Allogenic BMT 5-15 lakhs)
Patient’s selection:
When considering transplantation, the physician will carefully evaluate a patient’s history to be sure this procedure is the most appropriate treatment option and weigh the benefits against the risks involved from the procedure.
Donor’s selection:
For allogenic bone marrow transplant along with routine test and checkup donor has to under go a specific blood test called Human Leukocyte Antigen test ( HLA test ) to select a suitable donor.
Pre-Admission Testing & consent
Few weeks before transplant, patient will visit the transplant center to undergo heart, lung and kidney tests and other tests that may be needed to evaluate general health. The physician will recommend treatment plans, and explain the potential risks and benefits of various treatments. Once the patient understands the treatment plan, he or she (and in case of minor, one of the parent) will be asked to sign consent forms.
Bone Marrow Harvest and collection of stem cells:
Collection of the stem cells can be done by two methods.
Bone marrow harvest – Bone marrow for transplantation is collected, or harvested, in the operating room while the patient or donor is under general anesthesia. Marrow is removed from the hip bone. Multiple aspirates are required for the collection. The amount of marrow removed will depend on the amount required for transplant. ( 10-20 ml/ kg of donor or recipient who ever is smaller)
Donors usually remain in the hospital overnight, but may resume normal activities upon returning home. There will be some discomfort in the areas where marrow has been withdrawn; usually this can be controlled with a mild painkiller.
Peripheral blood stem cell (PBSC) collection – Stem cells required for transplant can be collected from the peripheral blood. Small numbers of stem cells are also found in the circulation, however the number of the stem cells in the blood can be drastically increased after mobilization with hematopoietic growth factor and / or chemotherapy.(mobilization protocol on attached paper). Collection of the stem cells is automated by connecting the donor to an apheresis machine and performing a modified leukopheresis procedure. Although variety of machines are available for this purpose, they all function on the same principle. The blood is drawn from the donor, anticoagulated and pumped into the spinning chamber, here the blood separates into its component elements on the basis of their density and cell size, forming the distinct bands within the vessel. The leukocyte rich layer is harvested into a collection vessel and the remaining elements return to the donor. This is the painless procedure and done without anaesthesia.
After harvest, autologous bone marrow /peripheral stem cells may be treated to reduce the risk of certain complications. The marrow may be transplanted immediately after processing, or frozen and stored (Cryopreserved) for later use.
Cryopreservation is done after adding cryoprotectant – DMSO to prevent intracellular crystallization.
Dump freezing at -80 degree C for 3-6 months
Control rate freezing at -140 C in mechanical freezer or at -196 C in liquid nitrogen for long term storage ( more than 9 years)
Most of the autologous and few of the allogenic transplants are done with PBSC.
Central Venous Line
An important part of therapy is the placement of a central venous (CV) line, sometimes called by the trade name Hickman or Broviac. This is a flexible tube that is inserted into chest so that blood can be drawn and medications given without the need for additional needle sticks. The CV line will be placed before any pre-transplant therapy is begun, and will remain in place at least throughout the hospital stay, and maybe longer. The bone marrow will be given through the CV line, which will be used for intravenous nutrition and to infuse blood and platelets as well.
Protective Isolation
In preparation for transplant, patient’s immune system will be suppressed, greatly increasing the risk of infection. To help reduce this risk, some form of protective isolation will be practiced.
It requires visitors and staff to wear sterilized cloths and surgical cap & masks when inside the room. Staff and visitors will be required to wash their hands frequently and always when entering the room. Hand washing is an important part of protective isolation, and proper hand washing is the single most effective way to prevent the spread of infection.
No fresh fruits, vegetables, flowers, or plants will be permitted in the room. Persons with colds, flu diarrhea or other infectious diseases will be asked to stay away until they recover.
Hospitalization
From admission until after engraftment patient will remain admitted in BMT unit. The stay may prolong if any associated complication.
It takes few weeks for stem cells to regrow (engraft) in the bone marrow space and eventually produce new blood cells. During this period patient is susceptible to several complications. In case of allogenic bone marrow transplantation, patient is vulnerable to GVHD (Graft Versus Host Disease). During this period patient will require close monitoring and intensive supportive care with clean environment and in isolation.
Conditioning with Chemotherapy with or without Radiation
Before transplantation, patient will receive a conditioning treatment. This includes the use of high dose chemotherapy with or without radiation to destroy any remaining cancer cells. That may be used to suppress the immune system and prevent rejection of an allogeneic transplant.
(*Conditioning regimen on the attached paper)
Transplantation:
The bone marrow transplant will take place in BMT room, where the marrow will be given through the central venous line. The procedure is similar to a blood transfusion, and does not hurt. While the marrow is being infused, the patient will be checked frequently for fever, chills, chest pain, or other signs of any adverse reactions.
PBSCs infusion
Cryopreserved stem cells are thawed in a water bath at 37 C over period of 1-2 minutes and infused in small aliquots over a period of few minutes. During infusion patient may experience unique smell and taste (some described as garlic like taste – due to added DMSO). Some patient may develop nausea and vomiting, coughing, abdominal cramp etc. Medications are given to prevent and treat these symptoms. Patient may be passing out red coloured urine for about a day after the transplantation. This is because some of the red blood cells, which have been damaged, are removed by the kidneys and are passed out in the urine.
After infusion, the marrow travels through the bloodstream into the bone marrow spaces, where the basic stem cells grow, divide, and begin to produce new red blood cells, white blood cells, and platelets
Side Effects of conditioning treatment
Chemotherapy and radiation may have Unpredictable short-term and long-term side effects, which are sometimes life-threatening
Short-term side effects may include nausea, vomiting, diarrhea, fluid buildup, bloody urine, dry mouth, mouth sores, sore throat, loss of appetite, taste changes, skin rashes, VOD of liver, GVHD in case of allo BMT, bone marrow suppression. Temporary hair loss occurs in all patients. TBI may also cause temporary skin darkening similar to sunburn, salivary gland swelling, or loss of taste.
Long-term side effects of chemotherapy and radiation include sterility, cataracts, and decreased growth, chronic GVHD in allo BMT patients, Damage to the vital organs -- liver, lungs, kidneys, or heart -- may be life-threatening.