AIIMS June 2020 Surgery Questions

 

This PDF contains the Surgery Questions which were asked in the recent AIIMS June 2020 exam. The detailed video will soon be uploaded on my youtube channel.

AIIMS JUNE SURGERY RK

Breast Cancer Care During COVID19 outbreak

At present, almost half the world is in lock-down due to the corona virus outbreak and it is difficult to predict for how long this situation might remain the same. In India, it is almost certain that the lock-down due to COVID 19 will be extended till at least end of April. Even though we are in a state of lock-down but our body is still functioning and that means diseases like cancer might still be growing inside our system. So how does one deal with a problem like breast cancer/ breast lump during this period.

Tips for existing breast cancer patients

  1. Remain in touch with your treating breast cancer surgeon/ breast cancer oncologist. They will outline the treatment protocol during this period
  2. If you have an early stage breast cancer which is curable, you should not defer your treatment during this period, as it can lead to progression of the cancer.
  3. If you are suffering from cancer which has spread to the body (metastatic breast cancer), then discuss with your doctor if the chemotherapy frequency can be reduced or if you can be shifted to hormonal therapy/ oral treatment for the time being.
  4. Corona virus infection is usually severe in patients who are suffering from pre-existing conditions like cancer, diabetes, hypertension. So, please take all precautions to prevent infections
  • Eat a healthy/ balanced diet. Avoid outside food.
  • Make sure you take your daily dose of  vitamin C. This can either be in the form of a supplement or just a glass of lemonade
  • If you are undergoing chemotherapy (which can lead to reduced immunity and white blood count), please monitor the blood counts and if they are low, consult your breast cancer doctor immediately
  • Wear a mask whenever you are venturing out of your home, especially, when you are going to the hospital
  • Maintain strict hand hygiene. Wash your hands multiple times a day and use a hand sanitizer liberally

 

 

 

 

Recently detected a breast lump – what should you do during this period?

During the lock-down, lot of ladies are taking out time to carry out breast self examination and they are picking up new breast lumps. If you are one of them, I would advise that you consult a breast lump surgeon immediately. This consultation can either be an online consultation or a physical visit to the hospital. In an online consultation, if the doctor feels the need to carry out a physical examination, he/she would call you to the hospital.

A breast lump should not be ignored because if it is cancerous, it can increase in size during this period. A mammography or an ultrasound should be done after physical examination and if the lump is suspicious, a biopsy/ needle test should be done to confirm the diagnosis. If the breast lump turns out to be non cancerous (benign), then the treatment can be deferred till the time COVI19 situation improves. Your doctor can provide you medicines during this period to deal with the problem/ breast pain associated with the lump.

If the lump turns out to be breast cancer, as I have highlighted above, please consult your doctor and make a treatment plan which is suitable to you.

These are testing times for everyone, including patients. One has to be cautious about not getting infected by the virus as well as make sure that their breast cancer/ breast lump treatment doesn’t suffer. If you follow the tips which I have highlighted above, you can tide over this phase without compromising your health.

 

 

This information has been provided by

Dr. Rohan Khandelwal

Breast Cancer Surgeon

CK Birla Hospital, Gurgaon

To book an online consultation with Dr. Rohan Khandelwal, click here

 

What does BIRADS on your mammography/ ultrasound report mean?

Lot of times in my Breast Clinic at CK Birla Hospital, Gurgaon, I get patients who come and tell me that they are suffering from stage III breast cancer. When I ask them how do they know about that, the answer which I usually hear is that “my mammogram/ ultrasound report shows BIRADS III.” Not only patients but I have also seen some doctors getting confused with the BIRADS reporting.

BIRADS (Breast Imaging Reporting and Data Systems) is a standardized way of reporting breast radiology reports.  This helps radiologists categorize patients from a score of 0-6 and it helps breast cancer surgeons in taking decisions based on this score. Having a uniform reporting system is useful because patients might get their radiology and breast disease treatment done at different places.

The score doesn’t imply the stage of cancer and patients should be aware of this to avoid unnecessary anxiety after seeing the radiology report.

  • BIRADS 0 means an incomplete investigation – This usually occurs when a mammogram is done in a patient with a dense breast and it does not yield any meaningful information. In such a case, usually an ultrasound or MRI Breast is done

 

  • BIRADS 1 is a negative scan, which basically implies that there is no lesion in the breast and everything is normal. In these patients we advise them to follow up after 1 year

 

  • BIRADS 2 is suggestive of a benign lesion, which has essentially a 0% risk of cancer and these lumps don’t require a biopsy. They can be followed up in a year’s time. Simple cysts, most typical fibroadenomas fall under this category.

 

  • BIRADS 3 lesions are probably benign and these breast lesions/ lumps should be followed up every 6 months (short term follow-up). These lumps do not require a biopsy/ FNAC but if you have a family history of breast cancer, then the clinician might be inclined to do more tests/ biopsy at this stage rather than wait for 6 months.  Fibroadenomas, duct ectasias can fall under this category of lesions.

 

  • BIRADS 4 breast lumps/ lesions are suspicious lesions and they need to be biopsied to confirm the diagnosis. They are further sub-divided into 4a, 4b, 4c which implies low, medium and high risk for cancer. These patients should be counselled accordingly and a tru-cut/ core needle biopsy should be scheduled as soon as possible. Atypical fibroadenomas, suspicious microcalcifications, duct papillomas usually fall under this category of lesions

 

  • BIRADS 5 lesions are highly suggestive of malignancy and the risk of cancer in these breast lumps is more than 95%. All patients with these breast lumps should be subjected to the tru-cut biopsy, which is preferred over a FNAC (fine needle aspiration cytology)

 

  • BIARDS 6 lesions are when a radiological test is done after confirming the diagnosis of breast cancer.

 

The table below summarizes the BIRADS score and the action which needs to be taken in each category.

The Radiology Assistant : Bi-RADS for Mammography and Ultrasound 2013

 

So the next time you receive your mammography / breast ultrasound report, don’t be surprised to see the BIRADS score. Discuss the report with your radiologist and breast cancer surgeon and take action accordingly. Remember, that all breast lumps are not cancerous and all of them don’t even require a biopsy/ FNAC test.

 

This information has been provided by

Dr. Rohan Khandelwal

Principal Consultant,

The Breast Centre

CK Birla Hospital, Gurugram

Support the healthcare workers during COVID19 outbreak

Healthcare workers across the world are fighting an unprecedented battle against coronavirus. The least we can do is to support them and appreciate their efforts.

Imagine a soldier returning from battle – he would be welcomed with open arms and would be pampered by friends/ family members. Is that the same happening with doctors who are risking their lives daily and working in sup-optimal conditions for 24-48 hours at a stretch. No!! Not at all. Resident doctors and PG’s are being asked to vacate their hostel/ PG accommodations because the landlords are scared that they might bring infection into the house. Their rooms are not being cleaned, they are not being served proper food. Would we do the same thing with a soldier as well??

All healthcare workers appreciated the public display of support on Sunday but is a single time act of kindness enough to support these brave souls who are risking their lives everyday? As a doctor, it is my humble request to the general public to please support all healthcare workers on a regular basis during these tough times.

– Say a simple ‘thank you’ to these people. It will help in keeping their spirits high

– Don’t ask them to vacate their rooms. They are well aware of the risks and none of them would want to infect their friends/ family members

– Stop hoarding masks/ hand sanitizers/ essential medicines. You would be surprised to know that a lot of doctors don’t have access to proper PPE’s. They are having to do with cloth masks which offer little or no protection while treating patients. Hydrochloroquine has disappeared of shelves and it is unavailable to a lot of health care workers.

– Listen to the precautions they are highlighting on a regular basis. That is the only way to reduce the spread of this condition.

These are tough times for everyone. Least we can do is to support our #COVIDwarriors at this time.

Dr. Rohan Khandelwal

A doctor, teacher and a concerned citizen

World Cancer Day 2018

On the occasion of #worldcancerday, I would like to share the picture of the youngest #breastcancer patient I have treated till now.

She is a 25 year old, mother of a 2 year old who came to me with a small breast lump which she picked up after reading a Hindi article on breast cancer.

Few things which I would like to highlight through this case:

1. Age at diagnosis is reducing. This was my third patient in the 20’s over the last 3 months. Majority of my breast cancer patients are in their 30’s.

So, if anyone you know is suffering from a breast lump, please get it checked.

2. Awareness is increasing, which is an excellent thing. I am seeing a lot of patients with stage 1 and 2 disease, which leads to better survival.

To help create more awareness, each one reading this post should tell one more person about breast cancer and it’s symptoms (painless breast lump, recent change in shape of the breast, bloody discharge from the nipple)

3. Another heartening point is the change in the society’s attitude towards these patients. Friends and family members are becoming more accommodating towards the needs of cancer patients.

Please share this message to create more awareness.

This message has been shared in public interest by Dr Rohan Khandelwal, who is a Breast Cancer Surgeon at Gurgaon / Delhi NCR

Types of Breast Cancer – Invasive vs Non invasive

Breast cancer is the most common cancer amongst Indian women. Majority of these cancers arise from the 15-20 ducts present in the breast. These cancers can be of two types, invasive and non invasive. These terms are often mentioned in the pathology report after the breast cancer surgeon does the biopsy. This simple patient information video explains these terms and their practical implications.

If the patient is diagnosed with an invasive cancer, then the patient often requires chemotherapy, whereas, if the patient has non invasive cancer (ductal carcinoma in situ), chemotherapy can be avoided.

To diagnose the type of breast cancer, a breast biopsy is required (tru-cut or core needle biopsy). FNAC (fine needle aspiration cytology) is not useful in distinguishing between the two types of cancers.

This information has been provided by Dr. Rohan Khandelwal, Breast Cancer Surgeon at W Pratiksha Hospital, Gurgaon & Delhi NCR.

Don’t ignore a lump in the breast, it could be breast cancer!

 

Breast cancer is the most common cancer among Indian women now. The most common presentation of this condition is in the form of a painless lump in the breast. Early diagnosis of this dreaded condition can lead to complete cure. So, don’t ignore a lump in the breast as it could be cancer.

 

Scalp cooling device to reduce hair loss during chemotherapy

Hair loss during chemotherapy can be a huge psychological and physical blow to a lady. Today, we tried the Paxman scalp cooling device on two of our chemotherapy patients. This device leads to vasoconstriction of the scalp vessels and reduces hair loss during chemo.

Studies done using the device report a 70% reduction in hair loss with Paclitaxel based chemotherapy ( used for breast cancer, ovarian cancer) and a 30% reduction in hair loss with adriamycin (used for breast cancer) based chemotherapy.

 

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Breast Conservation Surgery for Early Breast Cancer

Breast Cancer Surgery has undergone a lot of change in the last few years. Earlier, mastectomy (full breast removal) was the norm for breast cancer management, but nowadays if the cancer is detected early, Breast Conservation Surgery (BCS) can be carried out.

In breast conservation surgery (BCS), only the cancerous lump and some portion of normal breast tissue around it is removed, preserving the rest of the breast, thereby leading to a better cosmetic outcome for the patient. BCS is also psychological and physically better for a patient suffering from breast cancer. The overall survival, whether the patient undergoes BCS or mastectomy for breast cancer treatment, remains the same.

 

Breast conservation surgery should be carried out by a trained breast cancer surgeon (breast onco-surgeon). A frozen section analysis should be done at the time of surgery to confirm that the tumor has been adequately removed.

 

 

 

Information provided by:

Dr. Rohan Khandelwal

W Pratiksha Hospital

Gurgaon

 

Free Breast Cancer OPD – Early detection is the best protection!!

 

 

Early detection is your Best Protection!!

 

breast cancer

 

 

Initiative by:

Dr. Rohan Khandelwal

Department of Breast Diseases & Cancer Care

W Pratiksha Hospital, Gurgaon