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medical-oncology

Blood cancers and many solid cancers have already spread to the entire body even at the time of their detection. Even when a tumor like breast cancer is detected in an apparently localised early stage, many a times, the disease comes back if surgery alone is performed for its treatment. It is assumed that even in some of the earliest tumors, some cancer cells might have spread to distant sites where they remain dormantly for an indefinite time period before eventually relapsing. That is why we need to treat the disease with medicines that can reach each and every site in our system- this forms the basis of systemic treatment for cancers.

Over the last 50 years, tremendous advances have happened in our understanding of many cancers. Many paediatric solid tumors and leukemias are now eminently curable with chemotherapy. Systemic chemotherapy has also been established as important components of treatment of cancers like testicular cancer, breast cancer, ovarian cancer and colonic cancers.
The biggest challenge about systemic chemotherapy lies in its nonselective nature. That is, the drug cannot distinguish between cancer cells and many normal rapidly dividing cells..

Most of the dreaded complications of chemotherapy like hairloss, decreased blood cell counts and life threatening infections are due to this nonselective effects on normal cells. But with recent advances in drug delivery and the introduction of the whole new gamut of more selective targeted agents, chemotherapy has evolved into a much more tolerable treatment

Autologous and allogenic bone marrow transplants have also extended the limits of modern day medical oncology in the management of blood diseases like leukemias and myeloma.

bnr-radiation

High energy Xrays are used to induce genetic damage in cancer cells, resulting in their eventual elimination by body defense mechanisms.

This forms the basis of radiotherapy, which is the most important method of nonsurgical treatment of localised cancers. Old generation Cobalt machines were effective, but resulted in significant toxicity and morbidity to the patient. Nowadays they have more or less been replaced by new generation Linear Accelerators that allow more precise treatment delivery with fewer side effects. This makes radiation a still more attractive option in patients who are not willing for; or due to medical reasons, unfit for surgery.

Other refinements that have revolutionised radiation treatment is three dimensional planning, dose painting and image guided radiotherapy have resulted in lesser toxicity and more efficacy by sparing of critical structures, and by correcting issues related to patient movement, respiration or tumor shrinkage during treatment.

Yet another advancement is in the field of brachytherapy where radioactive materials may be placed within the tumor to deliver continuous radiation with least amount of side effects to normal tissues. Precision techniques and image guidance has also allowed the focussed use of radiation beams as gamma knife to treat tumors within critical and surgically inaccesible locations.

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Traditionally, surgery had been regarded as one of the most important weapons in the fight against cancer, and it’s status is still unchanged. But rather than trying to remove more and more to push for a possible cure, conserving functioning tissue with out compromising cure has become the key to successful cancer surgery.

The power of conservatism has slowly spread across the fields of surgery in breast cancer, bone and soft tissue cancer, cancer of the kidney and urinary bladder, laryngeal cancer and rectal cancer now. Surgical steps have become more or less standardised, and due care is exercised to harvest enough number of lymph nodes to ensure oncological adequacy. The evolution of surgeons who exclusively perform cancer surgeries is a step towards the right direction, so is the recognition that results of treatment and better with high volume centres.Rightly done surgery is now recognised as an important prognostic factor in many cancers. The surgeon’s role has become even more critical as an active member of multidisciplinary team in present day cancer management.`

preventive-oncology

Cancer incidence is on an alarming rise. Many environmental factors are held responsible for this increase. Unfortunately, many of these factors, like pollutants in atmosphere, soil and water and background radiation are beyond our power to avoid altogether. Adopting healthy life style practices like complete abstinence from the use of tobacco and alcohol, avoidance of excess meat, processed foods and animal fat containing diet, inclusion of more of fruits and vegetables and regular exercises are all important steps in the direction of a cancer free living. Some cancer causing viruses may be kept away by vaccination.

Certain individuals may be recognised to have high risk of some cancers, based on strong family history and genetic testings. These individuals may go for frequent screening tests, and in extreme situations, even removal of a normal organ at risk of developing future cancer, as Angelina Jolie did by removing her normal breasts.

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One in eight women will be diagnosed with breast cancer during her lifetime. It accounts for more than 30 percent of all cancers found in women. Breast cancer is not selective. The majority of women diagnosed with breast cancer have no family history of the disease and while it occurs more often in women who are over the age of 50, younger women are at risk too. KCC Breast Cancer Center is solely dedicated to the prevention, early diagnosis and treatment of the cancer.

Our Breast Cancer Center will provide screening for early diagnosis using the mammogram and ultrasound and will conduct programmes for both medical personnel as well as public awareness.  The Gynecological Oncology will focus on pap smears for prevention and early diagnosis of cervical cancer as well as combined modality approach for the treatment of cancer in the cervix, uterus and ovary.

  • KCC offers the entire range of hemato-oncology services including the diagnosis and management of the entire spectrum of acute and chronic leukemia, lymphomas and myelomas.
  • Complete range of hematology, biochemistry, histopathology services, all type of open and minimally invasive biopsies
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  • KCC Nuero-oncology Offers evaluation and treatment of primary and secondary tumors of the brain, spinal cord, and the membranes that surround the brain and spinal cord (meninges).
  • Surgical Treatments for Brain Tumours (Glioma, Meningoma, pituitary adenoma, Vestibular schwannoma, Intraventricular tumours, Craniopharyngioma and Metastases),Craniotomies and Resection. Skull base approaches and Awake Craniotomy
  • Spine Tumors (Vertebral tumors, Intradural extramedullary tumours and intramedullary tumours) resection with and without instrumentation.
  • Well equipped operation theaters with modern microscopes, high speed drill systems, Neuroendoscopes and Ultrasonic surgical aspirators.
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  • Gynecologic oncology is a specialized field of medicine that focuses on cancers of the female reproductive System.
  • KCC Offers the diagnosis and treatment of Ovarian cancer, uterine cancer,Vaginal cancer,Cervical cancer, Vulvar cancer etc.
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  • The hospital has dedicated paediatric oncology division with specialist team to manage all childhood cancers.
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Bone marrow is the soft tissue inside bones, which produces the red and white blood cells and platelets, which are vital for the body’s immune functions. When certain diseases of the blood, like leukaemia, occurs, the high dose of chemotherapy used to destroy the cancer cells can also damage the normal blood cells, requiring a BMT.

One way of transplanting bone marrow is to take it from a donor’s hip bone, separate the stem cells and then infuse it into the patient’s veins. This will be naturally carried to the bone cavities, where it will generate fresh marrow. But this is a painful procedure and is done under anaesthesia. But now after discovering that a good yield of stem cells can be harvested directly from blood, we use the method called Peripheral Blood Stem Cell Transplant (PBSCT) for drawing stem cells, which are then transplanted on the patient. Stem cells are taken from the peripheral blood using an apheresis machine.

There are 2 types of bone marrow transplant called autologous and allogenic transplants. Autologous transplant involves isolation of healthy marrow or stem cells from the patient’s own blood before he undergoes high-dose chemotherapy. This is cryo preserved and re-infused to the patient’s body after completion of the chemo treatment.

Allogenic transplant involves a donor, usually a sibling, whose tissue exactly matches the patient’s. Stem cells harvested from the donor are then put into the patient’s veins after giving high dose chemotherapy.

Diseases which require autologous transplant are Multiple myeloma, Lymphoma and few cancers in children like neuroblastoma. It is mandatory to have a reasonable disease control before doing a transplant. Diseases which require allogenic transplant are usually high risk blood cancers.

This is a very complicated procedure as despite a perfect tissue match there is always the possibility of graft rejection.

The post-transplant period is highly critical because the patient’s immune system will not be functioning properly and he/she will be at serious risk of developing infections. The recovery period could be anywhere from three to six weeks.

The decision as to which of these procedures can be opted for a patient depends on the type of the disease and how far it has damaged the bone marrow. If the marrow has undergone extensive damage, an autologous transplant may not be possible. In the case of leukaemia, allogenic transplant is required.

A bone marrow transplant is not a procedure for every one and is adopted for those who fail the standard treatment or whose cancer has been coming back.

It requires machinery for stem cells separation and cryo preservation also a specialised unit with highly sterile environment for post transplant recovery.

KIMS Cancer center has acquired a modern bone marrow transplant (BMT) unit, which will help the institute offer both autologous and allogeneic bone marrow transplants to those suffering from myelomas, lymphomas and acute leukemias at very affordable cost.

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  • Nuclear medicine is a medical specialty involving the application of radioactive substances in the diagnosis and treatment of disease. Nuclear medicine, in a sense, is “radiology done inside out” or “endoradiology” because it records radiation emitting from within the body rather than radiation that is generated by external sources like X-rays. In addition, nuclear medicine scans differ from radiology as the emphasis is not on imaging anatomy but the function and for such reason, it is called a physiological imaging modality./li>
  • Single Photon Emission Computed Tomography or SPECT and Positron Emission Tomography or PET scans are the two most common imaging modalities in nuclear medicine<

Immunotherapy is treatment that uses certain parts of a person’s immune system to fight diseases such as cancer. This can be done in a couple of ways:

  • Stimulating your own immune system to work harder or smarter to attack cancer cells
  • Giving you immune system components, such as man-made immune system proteins

Some types of immunotherapy are also sometimes called biologic therapy or biotherapy.

In the last few decades immunotherapy has become an important part of treating some types of cancer. Newer types of immune treatments are now being studied, and they’ll impact how we treat cancer in the future.

Immunotherapy works better for some types of cancer than for others. It’s used by itself for some of these cancers, but for others, it seems to work better when used with other types of treatment.

Your immune system is a collection of organs, special cells, and substances that help protect you from infections and some other diseases. Immune cells and the substances they make travel through your body to protect it from germs that cause infections. They also help protect you from cancer in some ways.

The immune system keeps track of all of the substances normally found in the body. Any new substance that the immune system doesn’t recognize raises an alarm, causing the immune system to attack it. For example, germs contain substances such as certain proteins that are not normally found in the human body. The immune system sees these as “foreign” and attacks them. The immune response can destroy anything containing the foreign substance, such as germs or cancer cells.

The immune system has a tougher time targeting cancer cells, though. This is because cancer starts when cells become altered and start to grow out of control. The immune system doesn’t always recognize cancer cells as foreign.

Clearly, there are limits on the immune system’s ability to fight cancer on its own, because many people with healthy immune systems still develop cancer. Sometimes the immune system doesn’t see the cancer cells as foreign because the cells aren’t different enough from normal cells. Sometimes the immune system recognizes the cancer cells, but the response might not be strong enough to destroy cancer. Cancer cells themselves can also give off substances that keep the immune system in check.

To overcome this, researchers have found ways to help the immune system recognize cancer cells and strengthen its response so that it will destroy them.

The main types of immunotherapy now being used to treat cancer include:

  • Monoclonal antibodies: These are man-made versions of immune system proteins. Antibodies can be very useful in treating cancer because they can be designed to attack a very specific part of a cancer cell.
  • Immune checkpoint inhibitors: These drugs basically take the ‘brakes’ off the immune system, which helps it recognize and attack cancer cells.
  • Cancer vaccines: Vaccines are substances put into the body to start an immune response against certain diseases. We usually think of them as being given to healthy people to help prevent infections. But some vaccines can help prevent or treat cancer.
  • Other, non-specific immunotherapies: These treatments boost the immune system in a general way, but this can still help the immune system attack cancer cells.

At KCC we have specially trained doctors in immunotherapy and we are one of the hospitals which started this type of treatment successfully in Kerela. At present this treatment is mainly used for lung cancer, renal cell carcinoma, melanoma and lymphoma.