GASTROINTESTINAL CANCER SURGERY
GI & HPB ONCOLOGY
Dr Muralidhar Nambada is one of the high volume surgeons in Visakhapatnam and north costal Andhra Pradesh to perform open esophageal surgeries and a few Minimally invasive surgeries with a total of 65 esophagectomies (Trans Hiatal, Transthoracic and Laparoscopic).
Dr Muralidhar Nambada, worked exclusively in GI & HPB Oncology for three years at Mahatma Gandhi Cancer Hospital Visakhapatnam, after he sub specialized in Surgical Gastroenterology from Nizam’s Institute of Medical Sciences, Hyderabad.
GI & HPB Oncology deals with the management of cancers of the Esophagus, Stomach, Colon, Rectum, Liver, Pancreas and Gall Bladder.
Dealing with these cancers involve performance of procedures like Esophagectomies (Minimally Invasive), Radical Gastrectomies (Laparoscopic/Open), Radical Hemicolectomies (Laparoscopic), Radical resections of rectal cancers (Laparoscopic Anterior Resections and Laparoscopic Abdomino Perineal Resections). Surgery for HPB cancers (Liver, Pancreas & Gall Bladder) is a unique speciality of a surgical gastroenterologist. Surgeries like Hepatectomies (Liver resections), Whipples Procedure (Surgery for pancreas cancer), radical cholecystectomy ( Surgery for Gall Bladder Cancer) are well performed by a surgical gastroenterologist who is well trained in this specific area
Dr Muralidhar Nambada has vast experience in performing such major procedures in this part of the state. He has performed one of the highest numbers of liver cancer surgeries (Hepatectomies), pancreatic surgeries (Whipple’s Procedure, Central Pancreatectomy, Distal Pancreatectomy) and Gall bladder cancer surgery (Radical Cholecystectomy) in this part of the state since 2013.
Whoelse can deal with Cancers related to the Gastro Intestinal system way better than a Surgical Gastroenterologist who is trained exclusively on the Gastro Intestinal , Liver, Pancreas and Biliary system.
What is Stomach/Gastric Cancer?
Stomach is that portion of the intestine, next to the esophagus (food pipe), which is sac like, where the first process of digestion starts. Cancer arising in stomach is called GASTRIC CANCER.
What are the Symptoms of Gastric Cancer?
Stomach cancer in its initial stages usually do not cause any symptoms and usually detected during a screening/routine endoscopy
Symptoms of Gastric Cancer include, loss of appetite, loss of weight, dark stool (also known as malena), rarely in cases of obstruction to the stomach outlet can cause vomiting, upper abdominal swelling and pain. In advanced stages, these patients may have distension of the entire abdomen due to ascites (fluid accumulation in the stomach).
How is Stomach Cancer Diagnosed?
Stomach cancer is diagnosed by means of an upper gastrointestinal endoscopy, which can visualize the tumor in the stomach and take a biopsy for pathological confirmation. Sometimes, it is difficult toestablish a diagnosis during the first biopsy and few patients may need repeat/multiple biopsies
Once stomach cancer is confirmed, then tests are done to find out in which clinical stage the cancer is. These tests include an ultrasound scan of the abdomen, followed by a CT scan of abdomen and chest if required. PET scan is also recommended if the cancer appears to be an advanced one on CT scan
What is the treatment of Gastric Cancer?
Treatment of gastric cancer depends on which stage the cancer is in.
For early stage cancers where the tumor is confined to the superficial lining layers of the stomach lumen, an endoscopic removal of the tumor if expertise is available to do third space endoscopy is available. Otherwise surgery remains a good alternative
For tumors that have involved the muscle layer of the stomach wall, and with no deeper penetration or distant spread, initial surgical approach is recommended and the procedure for this is known as RADICAL GASTRECTOMY, which can be done either through an open approach or laparoscopically.
For tumors that have involved the lymphnodes around the stomach with no distant spread to liver or other organs, the initial approach will be chemotherapy followed by reassessment of response after three cycles and then proceed with a radical gastrectomy
For tumors that have spread to the liver or other organs or for tumors that have caused fluid accumulation in the abdominal cavity, there is no treatment with a curative intent and these patients are kept on few cycles of palliative chemotherapy depending on their general condition. The life span is a few months and best supportive care is what is offered in these patients
For patients who have vomiting due to the stomach outlet obstruction, surgery is indicated if the tumor is in a resectable stage or if the tumor is advanced and stage IV, the treatment options in such cases are either an endoscopic placement of a metal stent or a GastroJejunal Bypass surgery
Post operative chemotherapy is indicated in patients after surgery if the final pathology report shows advanced stage
Liver cancer also known as Hepatocellular carcinoma is the most common primary liver cancer which is the fifth most common cause of cancer related deaths across the world.
Unfortunately, due to non specific or absent symptoms in the initial stages of liver cancer, these cancers are usually detected at a very late stage and the outcomes are very bad.
What are the symptoms of liver cancer?
As discussed above, liver cancer may not show any symptoms and can be diagnosed during a health check or during periodic screening in significant number of patients. However, in patients who develop symptoms they can have any of the following symptoms
Fatigue/ Sever Generalized Weakness
Loss of Appetite
Loss of weight
Abdominal swelling (due to fluid filled abdominal cavity) in late stages
Jaundice in late stages
Dark coloured stool (also known as malena)
Blood in vomiting – especially in patients who have portal hypertension due to advanced liver cirrhosis