Interview with Dr Ravindrasinh Raj (Surgical Oncologist)

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Dr Ravindrasinh Raj, surgical oncologist, talks about the various aspects of cancer treatment in India and breast cancer, GI cancer, head & neck cancer and more.

About Dr Ravindrasinh Raj

Dr Ravindrasinh Raj is a Surgical Oncologist specialized in throat cancer and breast cancer treatment with sub-specialties like Minimal Access Oncosurgery and Upper GI Oncosurgery. He was nominated for the Guinness Book of World Records for 101 hour non-stop cancer surgeries under one roof. He also has two Limca Book of Records under his name. Dr Raj is a strong promoter of function preserving Oncosurgery, giving maximum importance not only towards the success of surgery but also caring for the best possible quality of life after the cancer treatment.

Breast Cancer and Treatment Procedures

Breast cancer is hormone-dependent cancer that is usually seen in middle-aged and old aged women. The lumps can be formed in both the breasts as well as in the armpits. Though the percentage is very low, breast cancer occurs in men too.

In the majority of cases, breast cancer treatment follows a multi-modality therapy that includes surgery, chemotherapy and radiation therapy or a combination of any two of these. In stage 1 and stage 2 cases, surgery is the main treatment procedure, where we try breast reconstruction surgery after removing the lump.

Mammoplasty

The term Mammoplasty stands for the procedure where we do a surgery to reinstate the shape or size of the breasts. In breast cancer cases, we do Oncoplasty, where there will be a larger breast volume lost due to the lump's removal, and we will be trying to reconstruct the breast. The main difference is that Mammoplasty is used for cosmetic purposes where the volume of breasts is increased or reduced as per the need. There are several modern surgery options to suit the several kinds of breast cancer patients that need reconstruction.

Head and Neck Cancer

Head and Neck cancers are a broad area since there are several organs in the head and neck area. The major cause for all types of Head and Neck cancers is the habit of chewing tobacco. All over the Indian subcontinent, this habit is the major reason for the high number of head and neck cancer cases, compared to the rest of the world, where smoking is the main method of tobacco intake, leading to a higher number of respiratory cancer diseases such as lung cancer and cancer of the pharynx.

Mandibular reconstruction and Artificial Tongue reconstruction for Oral cancer

In Oral cancer cases, the primary treatment method is surgery, and we lose the normal tissues. And in cases where more than one-third of the tongue tissue is removed, we have to reconstruct it. We use autologous transfer, where we use the tissue from the patients' own body( from the forearm) so that the rejection rates are lower.

In the case of the mandible, it is a bone loss. In cases where we have jaw tumors, we may have to remove the mandible. In those cases, the patient's appearance, chewing and other functions will be disturbed, due to which we will have to reconstruct it. In these cases, we take a part from the fibula in the leg, muscle blood and skin, and reconstruct it.

Endoscopic Neck Dissection

So what happens is, in oral cancer cases where the tumor is not large, only the inner part of the cheek is removed. Lymph node dissection is always needed, and it always leaves a scar. So we try for a minimally invasive surgery, where we put small holes below the collar line so that the patient won't have any visible scars after the treatment. And let me proudly add that this procedure is now known as Dr Ravi Raj neck dissection technique.

Upper GI Cancer and its Surgery

Upper Gastro-Intestinal Cancer is mainly divided into three groups: the first is colorectal cancer that includes the large intestine and rectum. The second is the HPB with the biliary tract, liver and pancreas, and the third is Esophageal Gastric cancers. The normal symptoms in Esophageal Gastric cancers are the inability to swallow, along with acidity and pain, and in rare cases, blood in vomit or stool.

Usually, either minimally invasive surgery or open surgery is preferred. The type of advanced surgery used depends on the technologies available and the patients' affordability as the cost of the procedure also increases with the rise in technologies used.

When to opt for surgery?

In Esophageal Gastric cancer cases, surgery is the primary treatment method. In most cases, surgery is the only mode of treatment and chemo or radiation therapy is not needed. In other countries such as Japan, if stomach cancer is diagnosed in the first stage, surgery is the only treatment modality. Even in stage two or three cancers, surgery is the primary modality, and the remaining methods are used to reduce the risks of reoccurrence or relapse.

Alternative and Conventional medicines to help advanced cancer patients

Depending on the type of cancer and the patients' vitals, if curative treatment is not possible, we go for palliative care, where we try to improve their quality of life. We cannot give chemotherapy to very weak patients, as it may do more harm than cure as chemotherapy in itself is a toxic method of treatment. Sometimes, we may need to give pain killers to make the patient's life pain-free. We mainly try to address two things; to improve the quality of life and to ensure the prolonging of the patients' lives.

Gastro-Intestinal Cancers

As I said earlier, there are three different types of Gastro-Intestinal cancers. The Hepatobiliary (HPV) cancer includes the liver, the biliary tract, gall bladder and the pancreas. Cancer of this type is more aggressive and hard to cure if not properly diagnosed at the right time.

Surgery is the primary treatment for all Gastro-Intestinal cancers, and in advanced cases, chemotherapy and other methods are also used.

Usually, Gastro-Intestinal cancers are silent cancers with very minimal symptoms. The symptoms depend on the location of the tumor and differ according to different cancer types. Basically, if any difficulty persists for longer than 15 days, you should immediately go for an endoscopy or any other test if there are no improvements. This is what I call the Rule of 15.

Importance of early detection

We Indians are fortunate in the sense that most aggressive cancers like the HPB are not so common in our country. As for the cancers that are very common in our country, we have screening procedures available for almost all of them. Most of these common cancer types, such as breast cancer, have many symptoms that are comparatively easier to notice. As in the case of breast cancer, screening tests such as mammograms are advised for women above the age of 40. Similarly, screening tests are available for all common cancer types such as cervical cancer, oral cancer and lung cancer.

My advice for everybody is to go for regular screening procedures once you reach the stipulated age.

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