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Liver Cancer Awareness Programme

Do you Know
Obesity & Diabetes can cause Liver Cancer
Obesity and Diabetes are the major causes of Fatty Liver; Fatty Liver can cause chronic liver disease which is a risk factor for Liver cancer also known as HCC or hepatocellular carcinoma
Which vaccination can prevent Liver Cancer
Hepatitis B Vaccine is available; Hepatitis B infection can cause chronic Liver disease; This vaccine prevents Hepatitis B infection
Preventive steps of Liver Cancer
Stop Alcohol & Smoking/ Hepatitis B Vaccination / Weight control/ Diabetes and Hyperlipidemia Control/ Safe sex/ Do not use contaminated needles & Blood products
Who are at risk of developing Liver Cancer
Alcohol/Obesity/Diabetes/Hyperlipidemia/Hepatitis B & C Infection
Early Symptoms & Signs of Liver cancer
Weight loss & Anorexia are common in Cancer; Patient with chronic Liver disease present with features of decompression like ascites/jaundice/hepatic encephalopathy
Early detection is possible in high risk patients
Yes early detection is possible, there is a screening programme for high risk patients in which regular tests are done
Is Liver Cancer caused by alcohol intake different
In 80% of cases liver cancer occur in the background of chronic liver disease; Alcohol and other risk factors causes chronic liver disease and cancer at this stage in these patients behave similarly
Recent Advances in the management of Liver Cancer
Early detection in high-risk patients/ Liver resection techniques/ Minimal approach through RFA and cryoablation

Pancreas Disease Caused By Alcohol Intake

1. Which Pancreatic Disease is not related to Alcohol intake

Alcohol intake damage many organs of our body and pancreas is one of them, Pancreas is one of the vital organ of our body which has got two main functions, one is secretion of digestive enzymes and other is regulation of blood sugar level Short term alcohol intake can cause acute pancreatitis which is acute inflammatory condition of the pancreas, Most of the cases are mild pancreatitis and resolve; But severe pancreatitis can be life threatening; Stopping alcohol intake prevent further episodes of pancreatitis Long term alcohol intake and repeated episodes of acute pancreatitis can cause chronic pancreatitis which is an irreversible condition and patient suffer from frequent and severe pain abdomen, Loss of functional pancreatic tissue can give rise to diabetes and digestive enzymes deficiency; Chronic pancreatitis is a risk factor for pancreatic cancer.

Complications of Gall-bladder Stone

2. Which type of Gallbladder Cancer is Caused by Gallstone
Gall-bladder stone disease is common; Ultrasound abdomen is the commonest investigation for any abdomen complaint and the result being the incidence of asymptomatic gallstones are also increasing
It is said that in 90% of patients the first complaint of gallbladder stone is right upper abdomen pain and after the first episode the frequency of pain abdomen increases and so the complication rate
In 10% of patients, the first presentation can be one of the complications of gallbladder stone; The complications of gallbladder stones include jaundice/cholangitis/pancreatitis/cancer gallbladder/fistulous communication to nearby organs
When the stone in the gallbladder pass to common bile duct through cystic duct patient can have just jaundice if it simply obstruct the CBD lumen and prevent passage of bile from CBD to duodenum; This obstruction when leads to infection patient will have fever and it is called as cholangitis which is a serious condition and patient may develop septic shock and require urgent biliary drainage; Biliary pancreatitis is another life threatening complication, it is said that passage of stone lower down causes temporary blockage of pancreatic secretions and can cause pancreatitis
Long-standing inflammation anywhere in the body predispose to cancer so in case of gallbladder stone; Gallbladder stone is known risk factor for cancer gallbladder

The Pear-Shaped Gallbladder Sits Below The Liver In The Upper Right Hand Corner Of The Abdomen. It Is Connected To The Liver And To The Small Intestine By Several Tubes Called Bile Ducts. Its Purpose Is To Store Bile Liquid Which Is Produced By The Liver That Helps Us Digest Fat. Illustration Complications Of Gallstones Pancreas

Gastric (Stomach) Cancer: Symptoms, Investigations & Treatment

The incidence of stomach cancer is increasing, Dietary factors predispose to gastric cancer, Patient can present in different ways, There can be just mild epigastric pain or feeling of lump left upper abdomen, if the tumor obstruct the passage of food patient can have vomitting and if the tumor bleed patient can have black colored stools and symptoms of anemia such as weakness; Anorexia and weight loss are common

Ultrasound is the first investigation in any abdominal complaints, which may show a mass in the stomach; Upper GI endoscopy show the mass in the stomach and biopsy can be taken, once the diagnosis is confirmed CECT abdomen is done for staging and if the tumor is resectable surgery is the treatment of choice

Intra-op staging laparoscopy is the first step and if there is no metastases definitive surgical procedure is performed, depending on the location of tumor either radical distal/sub-total/complete gastrectomy is performed

Obesity, killing more people then Underweight

Obesity is a silent killer, root cause of a number of diseases such as diabetes, hypertension, sleep apnoea, fatty liver, cancer, osteoarthritis, infertility and so; As the incidence of obesity is increasing so the incidence of all these diseases; Most of these diseases do not cause immediate harm but silently take our body to end stage of life; thats why it is a silent killer
Prevention is always better than cure, Obesity is preventable if we take care of our diet and do regular exercise but may be the side effect of today life-style its incidence is increasing; Again it can be treated if we follow the same but again we got failed
Today we have the option of Bariatric Surgery to control weight and prevent ourself from all these silent killer diseases

Gastro-Esophageal Reflux Disease

GERD is reflux of gastric contents into the esophagus, It occur when the lower esophageal sphincter which normally prevents reflux of gastric contents into the esophagus is weak
Patient complain of heartburn, reflux of food content into the esophagus; patient can have extra-esophageal symptoms such as cough; Upper GI Endoscopy is the first step which will show features of esophagitis
Proton pump inhibitors such as pantaprazole which inhibit acid formation will give relieve to the symptom of heartburn but it does not prevent reflux and patient is predisposed to cancer due to reflux so endoscopy is advised to these patients who are on long term on proton pump inhibitors
Surgery is advised to those patients who on investigation are confirmed to have reflux disease and have extra-esophageal symptoms, young age, defective lower esophageal sphincter; Surgery performed is Laparoscopic Fundoplication


Pregnancy after Bariatric Surgery

The incidence of obesity is increasing, Lifestyle and dietary changes has made young population vulnerable to this disease and result being more and more young population with high BMI are being referred for Bariatric Surgery
Young females with high BMI being referred for Bariatric Surgery have a doubt whether this surgery have an effect on there married life and what about course of Pregnancy after Bariatric Surgery
Marriage after Bariatric Surgery has never been an issue; Infact Infertility associated with obesity improve after weight loss from Bariatric Surgery; There is high incidence of abortions, diabetes, hypertension, fetal growth malformation and cesareans in high BMI pregnant female patinets; Now we have ample data which suggest that incidence of diabetes and hypertension during pregnancy and low birth weight are reduced after this surgery
Most of the weight loss after Bariatric Surgery occur in the first 12 months thats why it is recommended to weight atleast 12 months after this surgery for conception; This is based on the fact that pregnancy during a period of malnutrition can lead to low birth weight or malformations

Pancreas Cancer: Risk Factors, Symptoms & Treatment Options

Pancreas is vital organ of our body which has got two major functions, Firstly it releases certain enzymes which help in digestion and Second it releases hormones which maintain blood glucose level

Pancreatic cancer is known for its poor prognosis; Nearly more than 25,000 new pancreatic cancer patients are diagnosed every year in India, It is 13th most common cancer but 5th most common cause of death due to cancer in India; Without treatment not more than 15% patient survive more than a year and with best treatment possible still less than 15% patient survive more than 5 years

Smoking is most common risk factor, Nearly 75% patients are chronic smokers and risk equalize to non-smoker after 10 year of quitting it; Alcohol causes chronic inflammatory condition of the pancreas called chronic pancreatitis which is a risk factor for pancreatic cancer; Recent studies show long term diabetes is also a risk factor, Pancreatic cancer in itself can cause diabetes; Obesity leading to diabetes is also one of the risk factor; It runs in about 5% of families

During the early stage patient is asymptomatic, Pain is constant feature which is mild to moderate in intensity and localized to upper abdomen which may radiate to back; Anorexia and weight loss are common, Cancer located in the head of pancreas can cause distal CBD obstruction leading to jaundice and Duodenal obstruction leading to vomitting, Tumor located at body and tail region of pancreas can grow to large size without any symptom and may present as lump andomen

Ultrasound is the first investigation in patients presenting with any abdominal complaint, When it suggest a mass lesion in the pancreas, CECT abdomen is done to further delineate the mass, its relation with surrounding structures and any distant lesions; Once it suggests tumor is resectable surgery is the treatment of choice, in case of locally advanced tumor pre-operative chemoradiothearpy is given; The standard surgical procedure done in case of tumor located in head of pancreas is whipple procedure (pancreatico-duodenectomy), if it is located in the distal part distal pancreatcetomy with splenectomy is done

Patient with head tumor can have jaundice, Pre-operative biliary stenting is done if the bilirubin level is very high, patient have fever and poor general condition with poor nutrition

Liver Cancer Prevention, Symptoms, Early Diagnosis and Treatment Options

Prevention is always better than cure; Known major risk factors for liver cancer are Alcohol, Smoking, Hepatitis B and C Infection, Fatty liver disease; If we quit alcohol and smoking not only liver cancer risk but we can reduce the risk for so many other cancer also; Hepatitis B & C infection spread from one infected person to other through sexual contact, using infected needles and syringes and through blood and blood products, so by taking precautions these infections can also be prevented, Hepatitis B Vaccine is also available; Fatty liver disease in now emerging as the major cause of liver damage and as liver cancer risk factor, Major cause of fatty liver disease is obesity and diabetes, Weight control by means of healthy life style and good diabetic control can reverse it

The symptoms of Liver cancer are right upper abdomen pain, anorexia and weight loss; Sometime patient present with symptoms of chronic liver disease such as hematemesis (blood in vomitus), black colored stools, Abdomen distension due to ascites, jaundice and during investigation they are found to have chronic liver disease along with Liver cancer

Cancer patients survival rate is is good if detected and treated at early stage, In patients of chronic liver disease routine USG and a blood test for alpha feto protein level is done every 6 month; These tests can detect cancer at early stage when the tumor size is small

Once Ultrasound suggest a mass lesion in the liver, triple phase CT abdomen is done to further delineate the lesion and for any other lesion not picked by USG, CECT chest is also done for staging purpose

Treatment options for liver cancer patients are Surgery, Local ablative procedures and chemotherapy; Surgery is the preferred one, There are two options in surgery one is liver transplantation and other is liver resection, Liver transplantation is preferred in those patients who have liver cancer on background of chronic liver disease, as the chances of recurrence after liver resection is high in these patients, In 20% patients liver cancer develop on background of normal liver, liver resection is the treatment of choice in these patients; Local ablative procedures are done when patient is not fit for surgery and as a bridge to liver transplant but the results are inferior to surgery; Chemotherapy is used in advanced cancer


Pregnancy after Bariatric Surgery WHEN ?

As the no of bariatric surgery is increasing and the majority of patients being female and of reproductive age, it is important to know its effect on future pregnancy

As the majority of weight loss after bariatric surgery occur in first 12 months it is advised to wait at least for 12 months prior to conception because pregnancy occurring during this period of malnutrition can lead to low birth weight and malformations.