Dr Kamal Kishor Lakhera - Cancer Surgeon in Jaipur

27/03/2019

Patients with chronic hepatitis B (CHB) who take daily aspirin may lower their risk for developing hepatocellular carcinoma (HCC), according to a study published online March 18 in JAMA Internal Medicine.

"Although [nucleos(t)ide a**logue (NA)] therapy remains the mainstay for the prevention of [hepatitis B virus (HBV)]-related HCC, most HBV carriers do not receive NA therapy], " write Teng-Yu Lee, MD, MBA, PhD, Taichung Veterans General Hospital, Taichung, Taiwan, and colleagues. Therefore, "daily aspirin therapy may be of help to further improve the chemoprevention of hepatitis B virus-related [HCC]."
Lee and colleagues evaluated claim data from a Tawainese nationwide database, identifying 204, 507 patients with CHB from 1997 and 2012. Patients who received daily aspirin therapy for 90 or more days were included in the aspirin-treated cohort (n = 2123). Approximately 98% of patients in the aspirin group received ≤ 100 mg of aspirin/day.
Treated patients were matched 1:4 with patients who did not receive aspirin therapy (untreated cohort, n = 8492). Patients with other viral hepatitis, HIV, or alcoholic liver disease were excluded. Patients were followed for 180 days or until HCC diagnosis.
Overall, the study authors noted that aspirin therapy was associated with a 29% reduction in the risk for HCC after adjusting for age, male s*x, liver cirrhosis, diabetes, hyperlipidemia, hypertension, statin use, metformin use, and NA use (hazard ratio [HR], 0.71; 95% CI, 0.58 - 0.86;P < .001).
However, liver cirrhosis was still found to be associated with a higher risk for HCC (HR, 2.89; 95% CI, 2.45 - 3.40; P < .001) and NA use was associated with a lower risk for HCC (HR, 0.54; 95% CI, 0.41 - 0.71; P < .001).
With respect to the adverse event of developing a peptic ulcer (PUB) secondary to aspirin therapy, the authors found the 5-year cumulative incidence among those receiving aspirin was not significantly higher
"Our findings may be of help in future efforts to further improve the chemoprevention of HBV-related HCC, and a proof-of-concept study is thus warranted, "

"In the meantime, physicians can individually counsel patients who have an indication for aspirin about the potential for HCC risk reduction, especially if they are not candidates for NA therapy, " the editorialists conclude.

Patients with chronic hepatitis B (CHB) who take daily aspirin may lower their risk for developing hepatocellular carcinoma (HCC), according to a study published online March 18 in JAMA Internal Medicine.

20/03/2019

Hybrid minimally invasive versus open Ivor Lewis esophagectomy

Ivor Lewis esophagectomy is traditionally an open procedure. In a randomized trial of >200 patients with cancer in the middle or lower third of the esophagus, a hybrid approach of laparoscopic gastric mobilization combined with open right thoracotomy resulted in fewer major intraoperative and postoperative complications (especially pulmonary complications) and similar three-year survival compared with open surgery . This is a reasonable surgical option where appropriate surgical expertise is available.

Hybrid minimally invasive versus open Ivor Lewis esophagectomyIvor Lewis esophagectomy is traditionally an open procedure. In a randomized trial of >200 patients with cancer in the middle or lower third of the esophagus, a hybrid approach of laparoscopic gastric mobilization combined with open right...

18/03/2019

Nonoperative management of clinical complete responders after neoadjuvant therapy for re**al cancer

Nonoperative treatment is increasingly being offered to patients who have a complete clinical response (cCR) to neoadjuvant therapy for re**al cancer, using clinical, endoscopic, and radiographic evaluation. However, there are no randomized trials addressing the safety of this approach. In a retrospective series of 250 patients treated with neoadjuvant therapy, those who achieved a cCR and were observed without surgery experienced an inferior disease-specific survival compared with those who underwent mesore**al excision and were found to have a pathological complete response. Moreover, over a third of the patients who had local regrowth in the observation group developed distant metastases, despite local salvage therapy. We continue to offer surgical resection after neoadjuvant chemoradiotherapy, even in those who have a cCR, unless they are poor candidates for surgery.

17/03/2019

The effect of parity on breast cancer risk

The relationship between parity and breast cancer risk is complex. An observational cohort study of almost 900, 000 women suggested that a woman's risk of breast cancer is increased for several years after childbirth relative to nulliparous women, and that the protective effect of parity occurs decades later. Other data suggest that women who become pregnant later in life actually have an increased risk of breast cancer compared with nulliparous women. We counsel women to engage in age-appropriate breast cancer screening, according to their familial and other personal risk factors, irrespective of their childbirth history.

17/03/2019

Body fat and breast cancer risk in postmenopausal women

Among postmenopausal women, a higher body mass index (BMI) has been associated consistently with an increased risk of breast cancer, assumed to be related to peripheral conversion of estrogen precursors to estrogen in the excess adipose tissue. This mechanism is supported by a secondary a**lysis of the Women's Health Initiative trial evaluating postmenopausal women with normal BMIs; those in the highest quartile for body fat had an increased risk for breast cancer compared with those in the lowest quartile (hazard ratio 1.9) These observations suggest that a normal BMI may be an inadequate representation of breast cancer risk in postmenopausal women.

18/11/2018

Minimally invasive approaches to radical hysterectomy for cervical cancer associated with decreased survival

Minimally invasive surgical approaches (MIS; laparoscopy and robotic surgery) have been utilized for radical hysterectomy in women with cervical cancer, with the goal of reducing operative morbidity. However, two new studies found worse oncologic outcomes with MIS procedures. In a randomized trial of women with cervical cancer who underwent radical hysterectomy, MIS compared with laparotomy resulted in a higher rate of death from cervical cancer at 3 years (4.4 versus 0.6 percent) and a lower rate of disease-free survival at 4.5 years (86.0 versus 96.5 percent). Similarly, a cohort study found that MIS radical hysterectomy was associated with a higher four-year mortality rate (9.1 versus 5.3 percent).
Both studies were underpowered to detect a difference in outcomes for tumors

Minimally invasive approaches to radical hysterectomy for cervical cancer associated with decreased survivalMinimally invasive surgical approaches (MIS; laparoscopy and robotic surgery) have been utilized for radical hysterectomy in women with cervical cancer, with the goal of reducing operative mor...

02/11/2018

Cancer is the leading cause of death across the globe
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The World Health Organization (WHO) note that, worldwide, nearly 1 in 6 deaths are down to cancer. In the United States alone, the National Cancer Institute (NCI) estimated 1, 688, 780 new cancer cases and 600, 920 cancer-related deaths in 2018. Currently, the most common types of cancer treatment are chemotherapy, radiotherapy, tumor surgery, and — in the case prostate cancer and breast cancer — hormonal therapy.
However, other types of treatment are beginning to pick up steam: therapies that — on their own or in combination with other treatments — are meant to help defeat cancer more efficiently and, ideally, have fewer side effects.
Innovations in cancer treatment aim to address a set of issues that will typically face healthcare providers and patients, including aggressive treatment accompanied by unwanted side effects, tumor recurrence after treatment, surgery, or both, and aggressive cancers that are resilient to widely utilized treatments.

Reference: MEDICAL NEWS TODAY

Cancer is the leading cause of death across the globe+++++++++++++++++++++++++++++++++++++++++++++++++++The World Health Organization (WHO) note that, worldwide, nearly 1 in 6 deaths are down to cancer. In the United States alone, the National Cancer Institute (NCI) estimated 1, 688, 780 new cancer....

19/09/2018

Undescended testicles could lead to testicular cancer and infertility in adult males

An undescended te**is (cryptorchidism) is a condition in which one or both of the te**es have not descended into the right position in the sc***um at birth and either stay at the abdomen or descend partly into the sc***um.

Usually, the undescended te**is moves into its right position into the sc***um by itself within a few months after birth, but if that did not happen children must undergo surgery ‘orchidopexy’ to relocate the testicle into the sc***um.

Medical guidelines are recommending this surgery before 18 months of age to decrease the risk of any complications to undescended te**is as testicular cancer and adult male infertility. Researchers at the University of Sydney published a new study that confirms the need to comply with these guidelines.

The study that was published in The Lancet Child & Adolescent Health is considered the first population-based cohort study to evaluate testicular cancer and infertility risk after the correction surgery. It is a study of 350, 835 boys born in Western Australia between 1970 and 1999 and followed them up until 2016 via data linked to different resources as hospital admissions.

They discovered that the risk for adult testicular cancer increased 2.4 times for boys suffering from undescended te**es compared to healthy boys. Also, the risk of testicular cancer was higher by 6% with each 6-month increase in age at the time of surgery.

As for the risk of infertility, it increased by 20% for the affected boys compared with the healthy ones, and they had twice the chance of using assisted reproductive technology for infertility as adults.

“In addition to an increased risk of testicular cancer, we found that boys with undescended te**es had decreased paternity and increased use of assisted reproductive technologies for infertility in later life, ” said the University of Sydney’s Professor Natasha Nassar, the study’s senior author.

“Before this study, there was no evidence-based information on the impact of early surgery on the future risk of testicular cancer and infertility in adult males, ” said study leader, Dr. Francisco Schneuer of the University of Sydney.

As Testicular cancer is the second most common cancer in young males and although it is rare, its occurrence has increased by 50% in the last 30 years, and male infertility affects 5-10% of men worldwide. Therefore, parents should be more aware of early diagnosing undescended te**es and comply with the guidelines to undergo surgery as early as possible if it is required to lower the risk of any complications.

17/09/2018

Cancer Incidence Continues to Rise: 1 in 5 Men, 1 in 6 Women

In 2018, an estimated 18.1 million new cases cancer will be diagnosed globally, and 9.6 million will die from the disease, according to the latest report from the International Agency for Research on Cancer (IARC).

One in 5 men and one in 6 women worldwide will develop cancer during their lifetime, and one in 8 men and one in 11 women will die from cancer.

09/09/2018

Green Dye Beats Blue for Node Mapping in Uterine Cancer

A green fluorescent dye beat the standard blue dye for mapping lymph nodes when the two were compared directly in women with uterine or cervical cancers. The finding comes from a phase 3 noninferiority trial, known as Fluorescence Imaging for Lymphatic Mapping (FILM).

The results showed not only that indocyanine green fluorescent dye was noninferior to isosulfan blue dye when used in conjunction with near-infrared imaging but also that it was significantly better than the standard-issue blue dye in identifying more sentinel nodes and more lymph nodes with metastases in women with uterine cancers.

The study was published online August 21 in the Lancet Oncology.

"Accurate identification of sentinel lymph nodes in patients with cancer improves detection of metastatic disease and decreases surgical morbidity, " Michael Frumovitz, MD, University of Texas MD Anderson Cancer Center, Houston, and colleagues write.

"If [indocyanine green fluorescent dye] is approved for on-label use, it will hopefully become the new standard of care for lymphatic mapping and sentinel lymph node biopsy for women with cervical and uterine cancers, " they suggest.

"Through its user-friendliness and effectiveness, indocyanine green is enabling surgeons to transition from systematic lymphadenectomy to sentinel lymph node biopsy, " the editorialists suggest.

The findings from this study "confirm both the non-inferiority and superiority of indocyanine green compared with isosulfan blue dye as a new standard in sentinel lymph node mapping,

02/09/2018

Testicular cancer symptoms: What you should know

Knowing your body and recognizing symptoms can help you detect testicular cancer early, when it’s easiest to treat.

Who’s at risk for testicular cancer?

Testicular cancer can affect men at any age. But the average age of patients affected is between 15 and 35. Common risk factors include:

An undescended testicle

Family history of testicular cancer

A personal history testicular cancer

What are testicular cancer symptoms?

The most common testicular cancer symptom is painless swelling or a lump. Other symptoms include:

Change in consistency of the testicles

Feeling of heaviness in the sc***um

Dull ache in the lower abdomen or the groin

Sudden collection of fluid in the sc***um

Pain or discomfort in a testicle or in the sc***um

Breast growth or loss of s*xual desire

Growth of facial and body hair at an abnormally young age

Lower back pain if cancer spreads

Sudden severe shortness of breath or a bloody cough

Unexplained fevers, weight loss or night sweats

What are some ways to detect testicular cancer?

It’s important to understand your body. You want to be able to recognize any changes. If you do notice changes, talk to your doctor right away.

Starting around age 15, boys should learn how to do a self-exam. The easiest way to look for unusual lumps, bumps or other symptoms is after a shower.

Building an open relationship with your doctor helps, too. Make sure your doctor is someone you feel comfortable talking to, even about subjects that may be awkward or uncomfortable.

Testicular cancer symptoms can be awkward to talk about. What advice do have for parents trying to teach their sons to look for testicular cancer symptoms?

Teach your children to be aware of their own bodies so they can recognize any abnormalities or changes. Not only will this help them recognize testicular cancer symptoms, but symptoms of other cancers or other diseases.

This is also true for special-needs children. We are seeing an increase in late-stage diagnosis of testicular cancer in men with autism or developmental differences, and we suspect it’s because they’re less likely to talk to someone about these changes.

Teach your children the importance of getting regular exams or physicals and encourage them to form an open relationship with their doctors. This will help them report any changes or abnormalities.

Why is early detection important?

Testicular cancer treatment success rates are high. About 95% of cases can be cured. But men with testicular cancer diagnosed in later, more advanced stages have worse outcomes. Recognizing and acting on cancer symptoms can keep you from having to undergo more extensive testicular cancer treatment.

Surgery, chemotherapy and radiation have all come a long way and have less side-effects than they used to, but our goal is to limit the long-term side-effects of these treatments if possible.

16/08/2018

7 viruses that cause cancer

You may not associate viruses with cancer, but there are several oncoviruses that increase your risk for the disease. Learn what they are and how you can protect yourself.

Researchers know that there are several viruses that can lead to cancer. For example, the human papillomavirus (HPV) can cause cervical and several other cancers. And hepatitis C can lead to liver cancerand non-Hodgkin’s lymphoma.

Studying viruses and cancer is helping researchers develop vaccines and other ways to reduce cancer risk.

How do viruses cause cancer?

Viruses are very small organisms. They are made up of genes – DNA or RNA – surrounded by a protein coating. There are several oncoviruses, or viruses that causes cancer:

Epstein-Barr virus (EBV) is a herpes virus that’s spread through saliva. EBV infection increases the risk of Burkitt lymphoma, some types of Hodgkin’s and non-Hodgkin’s lymphoma and stomach cancer. There is currently no vaccine for Epstein-Barr virus.

Hepatitis B virus (HBV) is spread through infected blood, semen and other body fluids. Hepatitis B is a leading cause of liver cancer. The hepatitis B vaccine is recommended for all children and adults. If you are not sure if you’ve been vaccinated, talk to your doctor.

Hepatitis C virus (HCV) is spread through infected blood. Hepatitis C is a leading cause of liver cancer, and can cause non-Hodgkin’s lymphoma. There is no vaccine against hepatitis C, but it is highly treatable.

Human immunodeficiency virus (HIV) is spread through infected semen, vaginal fluids, blood and breast milk. While it does not cause cancer directly, researchers believe it increases the risk of cancer by damaging the immune system, which reduces the body’s defenses against other oncoviruses. It can enable other oncoviruses to cause cancer. HIV-associated cancers include Kaposi sarcoma, non-Hodgkin’s and Hodgkin’s lymphoma, cervical cancer, and cancers of the a**s, liver, mouth and throat and lung. There is no vaccine against HIV.

Human herpes virus 8 (HHV-8) is related to Kaposi sarcoma in people who have a weakened immune system. That includes patients with HIV.

Human papillomavirus (HPV) has at least 12 strains that can cause cancer in men and women, including a**l, cervical, pe**le, throat, vaginal and vulvar cancer. Boys and girls age 11-12 should get the HPV vaccine. It’s available for patient from age 9-26.

Human T-cell leukemia virus type, also called human T-lymphotrophic virus (HTLV-1) is linked to adult T-cell leukemia/lymphoma. It is spread through infected semen, vaginal fluids, blood and breast milk. The infection is rarely found in the United States.

The effects of these viruses on cancer development is highly complicated. Experts don’t fully understand how most known oncoviruses cause cancer. What is known is that viruses highjack cells and insert their own DNA or RNA into the host cell. This can cause the host cells to become cancerous.

What can people do to avoid getting these cancer-causing viruses?

You can take steps to reduce your risk of getting oncoviruses.

Get vaccinated. The HPV vaccine can help reduce risk of HPV-related cancer. The hepatitis B vaccine can help reduce your liver cancer risk.

Get screened. Screening is available for some cancer-related viruses, like HPV, HIV and hepatitis B and C. If you’re at risk, get screened. Screening is one of the best ways to catch cancer early, when it’s easiest to treat.

Practice safe s*x. Viruses like HPV, HIV, hepatitis B and C are s*xually transmitted.

Don’t use illegal drugs, share syringes, needles or other infected equipment or personal items that might have blood on them.

If you think you may have or be at risk for an oncovirus, talk to your doctor about reducing your cancer risk.