How is oncoplastic surgery performed?

Depending on the size & location, the primary tumor is removed either by a lumpectomy – surgical removal the tumor along with a rim of normal tissue around it or mastectomy – Removal of the entire breast This is combined with removal of the lymph nodes in the axilla either by a sentinel lymph node biopsy of axillary dissection.

Oncoplastic Reconstruction

Depending on the nature of the disease, the health and body of the patient and their desired outcome, there are many different oncoplastic techniques.

• Local Advancement Flap
• Bilateral Breast Reduction
• Bilateral Breast Lift (Mastopexy)
• Skin-Sparing Mastectomy (surgery to remove all breast tissue from a breast as a way to treat or prevent breast cancer.)with immediate reconstruction with patients own tissues or a silicone implant

Advantages of Oncoplastic surgery at the time of lumpectomy

• Enables the removal of a larger amount of tissue, while preserving the breast, which is helpful in situations where the tumor is bigger or where there is doubt about the ability to obtain negative margins.
• If a larger amount of tissue has to be removed, improved balance is given by conducting a similar procedure on the other breast. This requires only one surgery.
• As the surgery is done before radiation, risks of wound healing that may occur in case of post radiation surgery can be avoided
• Better body image
• Patients feel psychologically better as the breast is preserved

Head & Neck cancers may further be classified by the area of head & neck in which they appear. Some of these include:

• Oral Cavity Cancer - Originates in the mouth
• Oropharyngeal Cancer - Begins in the back of the throat or mouth
• Nasopharyngeal Cancer - Starts in the upper part of the throat behind the nose
• Laryngeal Cancer -Starts in the voice box
• Hypopharyngeal cancer -starts in the lower part of the throat behind the voice box
• Paranasal Sinus Cancer - Starts in the openings around or near the nose called sinuses
• Thyroid cancer
• Parathyroid – Usually benign tumors. But cause symptoms due to its hormone hypersecretion

What are the Risk Factors?

Alcohol & Tobacco use are the two most common factors that result in head & neck cancers, especially cancers of the oral cavity, oropharynx, hypopharynx & larynx. Research indicates that almost 75% of Head & Neck Cancers are due to use of Tobacco & alcohol.

Surgical for Head & Neck Cancer

Surgery forms the main stay of treatment for early cancers. Locally advanced cancers are usually treated with a combination of surgery & radiotherapy

Surgery usually involves removal of tumor along with a margin of normal tissue. This would lead to wide defects with both cosmetic & functional deformity. These defects require reconstruction with a local muscle or myocutaneous flaps or a microvascular free flap. Further surgery for laryngeal cancer might lead to a loss of voice which needs voice restoration with a voice prosthesis.

Common surgeries performed are :

• + - Composite resection for oral cancer
• + - Total and partial laryngectomy with voice restoration using latest voice prosthesis
• + - Surgery of the thyroid
• + - Minimal access Parathyroid surgery using intra-op PTH estimation
• + - Parotid and other salivary gland surgery
• + - Skull base surgery for sinus and other advanced cancers and parapharyngeal tumors
• + - Reconstructive surgery of the Head & Neck including micro-vascular free flap technique
• + - Surgery and reconstruction for skin cancers

Each gynecologic cancer is unique with different signs & symptoms and different treatment approaches. Most of the cancers in early stages are treated with surgery. Advanced stages may be treated with Radiotherapy or chemotherapy, with surgery forming a part of treatment.

Cervical Cancer

Early stage cancers are treated with surgery. Surgery is usually in the form of Radical hysterectomy i.e., Removal of the uterus with its surrounding tissues along with a pelvic lymphadenectomy i.e., removal of lymph nodes which drain the uterus. This surgery can be done by a conventional open surgery or by a laparoscopic (key hole) surgery.

Symptoms of Cervical Cancer

• Abnormal Bleeding
• Bleeding after menopause
• Bleeding during intercourse
• Longer than normal menstrual bleeding

Symptoms of Ovarian Cancer

• Abdominal Bloating
• Loss of Appetite
• Indigestion & Nausea
• Frequent urination

Endometrial Cancer

Surgery forms the main stay of treatment for endometrial cancers. Surgery would include a Hysterectomy with removal of both ovaries, pelvic and para-aortic lymph nodes and Omental biopsy.Laparoscopic surgery is the gold standard for endometrial cancer

Symptoms of Endometrial Cancer

• Postmenopausal bleeding
• Pain or mass in the pelvic region
• Difficulty urinating
• Abnormal bleeding

Ovarian Cancer

Early stage cancers are treated with primary surgery.But majority of the patients usually present with spread to the lymph nodes or to the peritoneum (lining of the abdomen). These patients are usually treated with a combination of chemotherapy and surgery.
Patients with recurrent ovarian cancers with disease in the peritoneum can be treated with Cytoreductive surgery(CRS) + HIPEC

How to prevent Gynecologic Cancers?

• Pap Tests
• Healthy Eating & Lifestyle
• Genetic Testing
• HPV Vaccine

Benefits of Laparoscopic Surgery

With the advancement in technology, laparoscopic surgery is now being used in diagnosing and treating several cancers

• Less discomfort
• Shorter Hospital Stay
• Less visible scarring

Cancers that can be treated using Laparoscopic Surgery include

• Stomach cancer
• Colon Cancer
• Rectal Cancer
• Cancers of Cervix
• Endometrial cancer
• Prostate Cancer

Cancers that can be treated using Thoracoscopic Surgery (VATS) include

• Esophagus cancer
• Lung cancer

When do we need a Chemoport in cancer treatment?

A chemo-port is used when a person needs intravenous (IV) access to receive fluids or drugs over a long period of time and the small veins in the body are thrombosed and can no longer be used.

Benefits of Chemoport

• The most important benefit of chemoport is that it reduces the number of needle sticks.
• Can stay in the vein for a long period of time
• Reduces discomfort because IV therapy can be given more easily
• Does not require a dressing once the skin has healed
• Prevents the “burning” sensation sometimes felt when getting drugs by other IV methods
• Does not restrict activity – You can bathe, exercise, swim and play once the incision heals and the needle is not in place. It requires no care at home

When can we start using a chemoport?

A chemo port may be used, often the same day or the next morning. The skin may be tender around the incisions for 1–2 days after the port is placed. The insertion site usually heals in next 5-7 days. The sutures at insertion site are absorbable within 12-15 days.

Call the doctor if

• There is any redness, tenderness, bruising or drainage at or near the port injection site
• The person has a fever, aches or flu-like symptoms
• The port moves or there is swelling, tingling or pain at or near the port injection site.