Diagnosis and Treatment for Bone tumours - Best Cancer Hospital India

Bone tumours comprise of benign (non-cancer) and malignant tumours. They afflict people in the prime of their life, and since they usually involve the limbs, they are a source of morbidity, loss of livelihood and social ostracisation.

Great strides have been made in the early diagnosis and management of bone sarcomas especially in the field of limb preservation, so much so, that malignant bone tumours are no longer the dreaded cancers that they once were.

Signs and symptoms

* Pain in the bones

* Swelling

* Restriction of joint movement

* Erythema (redness and raised temperature over swelling)

Evaluation

A preliminary work up by way of a clinical examination and X-ray of the local part reveals it to be a bony lesion. Thereafter, taking into consideration the age of the patient and radiological characteristics of the tumour, the lesion can be characterized as benign or malignant with greater than 90 per cent accuracy. Suspected malignant lesions require further evaluation to know the histology and stage of the tumour. Bone biopsy by a bone needle done as a day-care procedure is the preferred method. It produces minimal trauma and soft tissue contamination by tumour as compared to an open biopsy, which should be used only as a last resort.

CT scan and MRI scan identify local spread of the disease and neurovascular (blood vessels and nerves) involvement.

Staging

Bone scan and PET scan identify metastatic disease i.e. spread of disease to other parts.

Management

Benign bone tumours, which are asymptomatic, can be observed whereas the larger lesions and symptomatic (bone pain etc.) require surgery:

* Bone curettage with bone cementing or grafting

* Wide local excision with bone cementing and bone grafting

Malignant bone tumours

The principles of treatment are local control of the disease and prevention of metastases. The chemo sensitive bone sarcomas like osteosarcoma and Ewing's tumour undergo two to three cycles of neoadjuvant chemotherapy (i .e. drugs that kill cancer cells given by way of intravenous infusion) to downstage and downsize the tumour. The next stage of the treatment is surgery.

Surgery for malignant bone tumour:

Prior to the 1990s, nearly all extremity sarcomas were treated by amputation of the affected limb which still did not lead to high cure rates. In the last decade, with better understanding of the biology of the disease, and achievement of specialised expertise procedures like limb salvage surgery, today limb conservation is possible in more than 70 per cent of patients. Limb salvage surgery is a complex two stage limb preservation procedure.

* Stage I - Meticulous neurovascular dissection is done to separate nerves and vessels from the tumour  bearing bone. The entire liability and functionality of the limb is dependent on this step.

* Stage 11- Prosthetic (Titanium) implantation in the gap produced by removal of the bone enzymes preserves integrity of the limb. Thus at the end of the procedure the diseased portion of the limb has been removed with preservation of a functional limb.

Children and adults no longer have to face ostracisation and pity due to amputation, and with the help of limb salvage surgery can continue to lead productive lives on their own feet. Early detection of bone sarcomas and appropriate treatment leads to high cure rates. 

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Bone Marrow Transplant In India For Leukaemia, Lymphoma, Multiple Myeloma, Sickle Celled Anaemia, Thalassemia and Aplastic Anaemia

Bone Marrow Transplant

 

A bone marrow transplant is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow stem cells. Bone marrow is the soft, fatty tissue inside your bones. Stem cells are immature cells in the bone marrow that give rise to all of your blood cells.

Hematopoietic stem cell transplantation (HSCT) is the transplantation of multipotent hematopoietic stem cell or blood, usually derived from bone marrow, peripheral blood stem cells, or umbilical cord blood. Stem cell transplantation is a medical procedure in the fields of hematology and oncology, most often performed for people with diseases of the blood, bone marrow, or certain cancers.

Hematopoietic stem cell transplantation remains a risky procedure with many possible complications; it has traditionally been reserved for patients with life-threatening diseases. While occasionally used experimentally in nonmalignant and nonhematologic indications such as severe disabling auto-immune disease and cardiovascular disease, the risk of fatal complications appears too high to gain wider acceptance.

Why is a bone marrow transplant needed?

In patients with leukemia, aplastic anemia, and some immune deficiency diseases, the stem cells in the bone marrow malfunction, producing an excessive number of defective or immature blood cells (in the case of leukemia) or low blood cell counts (in the case of aplastic anemia). The immature or defective blood cells interfere with the production of normal blood cells, accumulate in the bloodstream and may invade other tissues.

Large doses of chemotherapy and/or radiation are required to destroy the abnormal stem cells and abnormal blood cells. These therapies, however, not only kill the abnormal cells but can destroy normal cells found in the bone marrow as well. Similarly, aggressive chemotherapy used to treat some lymphomas and other cancers can destroy healthy bone marrow. A bone marrow transplant enables physicians to treat these diseases with aggressive chemotherapy and/or radiation by allowing replacement of the diseased or damaged bone marrow after the chemotherapy/radiation treatment.

Different types of Bone Marrow Transplant

There are three kinds of bone marrow transplants:          Autologous bone marrow transplant: "Auto" means "self." Immature marrow cells (stem cells) are removed from the patient himself before he receives high-dose chemotherapy or radiation treatment. After these treatments are done, the stems cells are put back in the body. This is called a "rescue" transplant. Allogeneic bone marrow transplant: In this procedure stem cells are taken either by bone marrow harvest or apheresis from a genetically-matched donor, generally a brother or sister or parent. It can also be a unrelated bone marrow transplant when the donor is not a relative of the patient but his cells are matching genetically with the patient. Umbilical cord blood transplant: In this type of transplant stem cells are taken from an umbilical cord immediately after delivery of an infant. These stem cells are than tested, typed, counted, and frozen until they are ready to be transplanted.

Bone Marrow Transplant Procedure

These are four stages involved in BMT.

Stage 1: Evaluate the patients for BMT (WORK-UP) usually 14-30 days before

One will undergo complete medical check-up to evaluate one’s suitability to go through the BMT procedure. This involves the following:

• Blood Tests
• Chest X- ray and CT Scans
• Tests to assess the condition of heart and lungs
• Bone Marrow Tests

Patients will be counselled in detail about the procedure, the complications, the chances of success, the cost and the possible length of stay in the hospital. Patient will be encouraged to go through the educational material/booklet and discuss any queries or doubts that he / She might have.

Stage2: Prepare the patient for BMT (CONDITIONING) usually 2-10 days

High dose of chemotherapy or radiotherapy is given to destroy the diseased marrow or destroy the cancer elsewhere and the bone marrow gets damaged as a result. This is needed to create space for new blood stem cell and also to suppress the patient’s own immune system (in case of allogeneic transplant), so that the blood stem cells are not rejected.

The actual process of transplantation

The transplant procedure is actually fairly simple, the stem cells or bone marrow cells to be transplanted are given through the Central Venous line (CVL). The procedure is just like getting a blood transfusion, except the following precautions which has to be taken care of :

• Just before the infusion of the new bone marrow, the patient may be given medication to help avoid any allergic reactions.
• A monitor is used to check breathing, heart rate and blood pressure during the procedure. The nurse monitors closely throughout the infusion of stem cells or bone marrow.
• A doctor is available in the unit and will check the patient periodically. Medications may be given to deal with problems that may arise, such as high blood pressure or a fast heart rate.

Stage 3: Pre-engraftment (before the transplanted blood stem cells start working): (Usually 2-3 weeks)

After high dose chemo-radiotherapy the blood stem cells are destroyed and normal blood cells are not produced. The patients need to be kept in a clean room within the BMT unit in strict isolation during this time. They also need a lot of blood and platelet transfusion. Most patients get serious infections during this period and need treatment with antibiotics.

Stage 4: Post-engraftment (after the transplanted blood stem cells start working)

Early phase (first 3 months)

There are two types of white blood cells: neutrophils and lymphocytes. Neutrophils save us from acute infections and lymphocytes prevent repeated or chronic infections. Once the neutrophil count is above the critical value of 500 cells per microlitre, the patient can come out of critical isolation. This is called engraftment or the first sign that the transplanted blood stem cells are functioning. Soon after the neutrophil increase to normal or near-normal levels and if there is no other complication, the patient can be discharged home. However, regular check-up and blood tests (2-3 times a week) are required. There is also a risk of graft-versus-host disease (GVHD) at this stage.

Late Phase (3 months-12 months)

The immunity against viruses takes a very long time to recover. Even though some of the immunity is restored, the patient is still at risk of infections with viruses and fungus. This is more so if they are being treated for GVHD, which can become chronic and lingering. If the patient is well, the frequency of check-ups and blood tests reduce over several months.

After the Procedure

A bone marrow transplant is usually done in a hospital or medical center that specializes in such treatment. Most of the time, you will stay in a special bone marrow transplant unit in the center to limit your chance of getting an infection. All or part of an autologous or allogeneic transplant can be done on an outpatient basis. This means you do not have to stay in the hospital or medical center.

How long you stay in the hospital depends on how much chemotherapy or radiation you received, the type of transplant, and your medical center's procedures. While you are in the hospital, you will be isolated because of the increased risk of infection. The health care team will closely monitor your blood count and vital signs.

While you are in the hospital you may:

• Receive medications to prevent or treat infections, including antibiotics, antifungals, and antiviral drugs.
• Need many blood transfusions
• Be fed through a vein (IV) until you can eat by mouth and stomach side effects and mouth sores have gone away
• Be given medication to prevent graft-versus-host disease

Recovery

The new bone marrow normally takes almost a year in order to function normally. During this period the patient is to be monitored closely to identify any infections or complications that may develop. The recovery process continues for several months or longer after discharging from the hospital, during which time the patient cannot return to work or many previously enjoyed activities.

New Advancements in Bone Marrow Transplantation at Hospitals in India 

Haploidentical Allogeneic BMT for patients without donors

Haploidentical Allogeneic peripheral blood stem cell transplant offers an innovative option for patients who cannot be suitably matched with a family member, or who do not have an unrelated donor readily available for transplant. This technique makes it possible to use partially matched family members as donors. 

In this new procedure, peripheral blood stem cells are collected from the donor, and depleted of T cell lymphocytes known to cause graft-versus-host disease. The first treatment phase for the patient includes chemotherapy, immunosuppressive drugs, and radiation. Transplant specialists can then infuse the prepared cells from the donor into the patient's body. This transplant method allows physicians to select a partially matched donor from the patient's family whose white blood cells will act as natural killer cells against the leukemic cells of the patient. 

  FAQ - Organ Transplant Surgery in India

      Q. Which is the Best Hospital for Organ Transplantation in India?

India has a number of world-class hospitals performing successful Organ transplantations. Send us your medical report and we will choose the best hospital after consulting medical experts.

·      Q. Can I resume normal activities after the transplant?

Yes. In fact, Organ patients feel more energized and capable of performing daily functions. You should however strictly follow the guidelines of the doctor.

·      Q. Who are the Best Organ Transplant Surgeons in India?

There are many renowned Organ Transplant surgeons in India. Mail us your medical report and we will find the surgeon most suitable for your medical condition.

·      Q.Is Organ Transplant in India safe?

 
India is evolving as a hot destination for organ transplants. Most of our surgeons doctors have international experience and hospitals are equipped with the latest infrastructure. The high quality and low cost treatments make India the top spot for Organ Transplant.

·   Q. Can u tell me Comparison of total Expense of Organ Transplant in India and in Foreign Countries?

Send us your medical report and query, and after consulting the medical experts, we will inform you about the expenses involved and cost comparison.

Get a free of cost second opinion from renowned surgeons within 24 hours.

For further information or free consultation, we request you to fill in inquiry form on the website and send medical reports to free@mymedopinion.com. MyMedOpinion assures you that all arrangements for examinations, surgeries, and post-operative recuperation will be ably taken care of you

Get the MyMedOpinion Advantage

MyMedOpinion help by its expertise and speed and quality of response. From arranging opinion from India's best cancer hospitals, hospital appointment bookings, travel and hotel accommodation, we manage our patient’s needs efficiently.

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·         World class results for  treatment

·         Cancer specialists with great qualifications and experience

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Bone Marrow Transplantation - Stem cell transplantation in India

Having a bone marrow transplant is a complicated five stage process.

The five stages are:

• a physical examination of your body to assess your general level of health
• obtaining the stem cells that will be used in the transplant (known as harvesting)
• preparing your body for the transplant (known as conditioning)
• transplanting the stem cells
• the recovery period, during which you will be monitored for any complications or side effects

The five stages are described in more detail below.

Physical examination

You will have a thorough physical examination before having a stem cell transplant. Your overall level of health before the transplant will play a big part in how well you recover after the procedure. As part of the examination, you may have some scans to check the condition of internal organs, such as your liver, heart and lungs.

Some medicines used in the conditioning and recovery process can occasionally cause problems with your organs, so it is important to know how well they are functioning beforehand. After the transplant, your risk of developing an infection will be increased, so it is vital to ensure you do not have any current underlying infections. If you have a cancer-related condition, you may need to have a biopsy. This involves removing a small sample of cancerous cells so they can be checked in a laboratory. The results of a biopsy can show whether your cancer is in remission (under control) and whether there is a high risk of it returning after your transplant.

Obtaining stem cells

When you've had a physical examination, the stem cells will need to be harvested. The usual method involves removing blood from the body, separating the stem cells from the other cells in the blood and then returning the blood to the body. Alternatively, the bone marrow itself can be collected by removing stem cells from the hip bone using a special needle and syringe. This may be recommended for certain conditions that require a transplant, or if the donor is a child.

Autologous transplantation

If they are suitable, it may be possible to use your own stem cells. This is known as an autologous transplantation. They can be harvested using either method described above. Your stem cells may need to be treated with radiation or chemotherapy to ensure that there are no cancerous cells left. If your bone marrow is being extracted, a needle will be used to remove about a litre of bone marrow. It will usually be removed from your hip bone while you are under general anaesthetic. The procedure is low risk but the area where the needle is inserted may be painful afterwards. The procedure may need to be carried out several times before enough bone marrow is harvested.

Allogeneic transplantation

If your own stem cells are not suitable, stem cells will be harvested from a healthy donor. This is known as allogeneic transplantation. There is a particular shortage of donors from African, African-Caribbean, Asian, Jewish, eastern European and Mediterranean communities.

The process of harvesting cells from a healthy donor is similar to the one used for an autologous transplant. For four days before the transplant, the donor will be given medication to stimulate the production of stem cells in their blood. On the fifth day, they will have a blood test to check they have enough circulating stem cells. They will then be connected to a cell-separator machine. A general anaesthetic is not needed, which means the harvesting can be done as an outpatient procedure. Blood is removed through a vein in one arm and passed through a filtering machine to separate the stem cells from other blood cells. It is then returned to the body through a vein in the other arm.

Preparing your body

As part of your conditioning, you will need to be given a range of medicines, so a tube will be inserted into a large vein near your heart. This is known as a central line and will avoid the need for you to have many painful injections.
The conditioning process involves using high doses of chemotherapy and possibly radiation. It is done for three reasons:

• to destroy the existing bone marrow and make room for the transplanted tissue
• to destroy any existing cancer cells
• to stop your immune system working in order to reduce the chance of the transplant being rejected 

The conditioning process usually takes four to seven days. You will probably need to stay in hospital throughout the procedure. Side effects from chemotherapy are common and include:

• nausea (feeling sick)
• vomiting
• loss of appetite
• mouth ulcers 
• tiredness

The transplant

It is usually possible to carry out the transplant one to two days after conditioning has finished. The donated stem cells will be passed into your body through the central line. The process can take from half an hour to several hours to complete, depending on the type of blood cells being used. The transplant is not painful and you will be awake throughout the procedure.

Recovery

You may feel weak after the transplant, and you may experience vomiting, diarrhoea and have a loss of appetite. To prevent malnutrition (a lack of essential nutrients), you will need to have nutritional support, with high-protein fluids taken by mouth or through a tube running through your nose to your stomach. The first stage of the recovery process involves waiting for the stem cells to reach your bone marrow and start producing new blood cells. This is known as engraftment and it usually occurs 15-30 days after the transplant takes place.
During this period, you will need to have regular blood transfusions because you will have a low number of red blood cells.You will also be at increased risk of developing an infection because you will have a low number of white blood cells. This means that you will need to stay in hospital in a germ-free environment.

MyMedOpinion Affiliated Hospitals in India the Leading Destination for Organ Transplant Surgery

A large number of foreign patients now come to India for Live Related Organ Transplant Surgery like Kidney Transplants, Liver Transplants and Bone Marrow Transplants. Organ Transplantation is a very complex surgical specialty and requires very high degree of Clinical skills and Medical Technology and Infrastructure. India has now become the most preferred destination for organ transplant procedures. These include Liver, Kidney and Bone marrow transplant surgeries. .Not only the cost is low; the success rate of organ transplant in India is at par with the world's best success rate for organ transplant.

Since Organ Transplantation is a very complex surgical specialty and requires very high degree of Clinical skills and Medical Technology, and Indian surgeons and healthcare has proven its competence, there has been a great surge in the number of medical tourists coming to India for various organ transplants. The Infrastructure and technology used at these best organ transplant hospitals in India is the most sophisticated technology available in the world, which results in better patient recovery, higher success rate, low cost and convenience to the patient.

There are two main types of organ transplantation surgeries:

• Deceased Donor Organ Transplants: In deceased donor transplants, the donor organ isused from a personwhen he/she dies and his or her family donates the organ. Patients who need a deceased donor organ should get her/his name registered in the transplant registry of India, which maintains the database of all patients waiting for a deceased donor organ. In India the waiting time for a deceased donor transplant surgery is very long since there are many patients in India who are looking for a suitable deceased donor.
• Living DonorOrganTransplants: In a living donor organ transplantation surgery, the transplantsurgeons remove a portion or complete organfrom a healthy living person (donor) for transplantation into the patient (recipient). In India, the living donor has to be afirst degree relative of the recipient or the patient who is compatible and willing to make the organ donation. Before accepting a candidate as a donor, the transplant committee thoroughly evaluates the donor. It is mandatory to obtain approval of the authorization committee, appointed by the government to undergo transplant surgery. The transplant team determines the suitability of the donor for the donation after studying the various aspects and performing a series of medical tests.
  Liver Transplant
  Liver failure has many causes, like liver cirrhosis, biliary duct atresia, cystic fibrosis, early-stage liver cancer, hemochromatosis, primary sclerosing cholangitis, primary biliary cirrhosis and Wilson's disease. Your liver can fail to perform its functions rapidly in a matter of weeks orit can also occur slowly over months or years. A liver transplant surgery is the last resort for patients suffering from liver failure. Liver transplant surgery is a meant for those patients who have end-stage liver failure and that cannot be controlled or treated using other any other treatment option. A liver transplant surgery is a procedure to remove the diseased liver of the patient and replace it with a portion of a healthy liver from a donor. Since only a portion of liver is removed from the donor body and the liver has the ability to grow, living-donor liver transplantation is possible.
  Kidney Transplant
  
  Your kidneys filter and remove excess fluid and waste from the blood. This function is very important to your body. When the kidneys lose their ability to perform this function then dangerous levels of fluid and waste get accumulated in your body. This condition is known as kidney failure and over a period of time this becomes a life threatening condition. There are many causes for kidney failure. Over a period of time you may need either dialysis or a kidney transplant to stay alive.A kidney transplantation surgery is often the best treatment for kidney failure when medication and other conservative treatment options fail. In a kidney transplantation surgery your non- functioning kidney is replaced with a healthy kidney from your donor. Since only one donated kidney is needed to replace two failed kidneys, living-donor kidney transplantation is possible.
  Bone Marrow Transplant

  

  Bone marrow is a special soft, flexible, spongy, fatty tissue that houses stem cells and it is found inside a few large bones. The development and storage of 95% of the body's blood cells occurs in the bone marrow. Bone marrow transplant (BMT) is done to treat various diseases and cancer. A bone marrow transplant procedure may also be required when a person's bone marrow has been damaged or destroyed due to a disease or intense treatments of radiation or chemotherapy for cancer. Bone marrow transplant may be used in the treatment of diseases or conditions like Leukemia, Aplastic Anemia, Sickle Cell Anemia, Hurler's syndrome, Adrenoleukodystrophy etc. Bone marrow transplantation (BMT) involves taking out stem cells that are normally found in the bone marrow, filter those cells, and give them back either to the patient or to another person. The goal of BMT is to transfuse healthy bone marrow cells into a person after their unhealthy bone marrow has been removed. There are different types of bone marrow transplants depending on who the donor is. In India there are some very advanced and world-class centres for bone marrow transplantation. A bone marrow transplant is an expensive procedure and requires a longer stay in India.
  
  

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