Cases

Right colonic mass can present with only anemia

Persistent anemia, Stool OB positive, no bowel complaints. Colonoscopy: Right colon mass + Adenocarcinoma. PET CT No metastatic. Right hemicolectomy done. Moral: Right colonic mass can present with only anemia.

Early referral to specialist – amenable to VATS decortication. Faster recovery.

LRTI due to chicken pox in December 2021. Lung abscess right lower lobe. Managed elsewhere. Presented with severe dry cough and chronic empyema + CT scan: Thickened peel with collapse right lung. Decortication done, complete lung expansion + Moral: Early referral to specialist – amenable to VATS decortication. Faster recovery.

Carcinoma buccal mucosa.

40/M

Carcinoma buccal mucosa. Deemed palliative in view of N3b. Given RT followed by Palliative CT. Presented with fungating nodal mass with no palpable/ visible primary. Re staging showed complete metabolic response to primary with N3 disease. Underwent radical neck dissection with PMMC. N3 : not a contraindication to a attempt at cure and no reason to live with a fungating mass definitely. Team Heal Onco Care

26/M

NON SMOKER, NON TOBACCO CHEWER,

right tongue cancer due to “sharp tooth”. Yes it does happen.

Tobacco causes 90% of cancers of tongue. Rest 10% are because of various reasons like – sharp tooth, ill fitting dentures, spicy or very hot oral intake, HPV and more. Laser wide local excision done with frozen section With right modified radical neck dissection. Final Histopath is T3N0(0/55nodes). Will need radiation.

Lesson : don’t ignore any ulcer on your tongue if persistent.

Team Heal Onco Care

66/F/Operated in past for hysterectomy with left oopherectomy for benign cause.

Had a lap rectopexy and vesicopexy repair done 7 years ago.
Currently increasing abdominal distension. Investigated: large multiseptated cystic lesion. Tumour markers negative. Underwent exploratory laparotomy.entire abdominal cavity replaced with large right ovarian cyst. Excision of right ovary with entire cyst done in toto. Weight 4.5 kgs. Final Histopath: benign mucinuous cystadenoma of ovary. Saved a possible pseudomyxoma peritonei.
Moral: whenever possible get lumps / cysts etc out in toto during surgery!
Team heal Onco Care: Dr Prriya Eshpuniyani and Dr Ketul shah

46/M/ no comorbidities/ history of Gall stone pancreatitis 6 months ago. conserved. Asymptomatic now. On routine USG Gall bladder fundal mass. Ca 19-9 : 120. PET CT : fundal mass with high SUV max 11.3. underwent radical cholecystectomy with wedge of liver with cystic duct margin ( frozen negative) with clearance of hepatoduodenal ligament nodes. Final HPE: xanthomatous granulomatous cholecystitis.

Rare diagnosis that can be mistaken as malignancy radiologically. Patient discharged well on POD5

68/F diagnosed case of squamous cell carcinoma mid third esophagus. Underwent NACRT. Had complete metabolic response.

Then patient “defaulted” and decided not to do anything else In view of complete metabolic response and full response in symptoms.

Within 6 months patient had recurrence in primary as well as nodal recurrence encasing the celiac trunk. Trial dissection done after chemotherapy but found to be inoperable !

Moral of story: if anyone gets NACT or NACRT please ensure that the patient completes the treatment ! Doesn’t leave it midway !!! Sad end to a great response to initial therapy !

41/M Operated for bowel Obstruction at village December 2021. Carcinoma rectosigmoid. Distal margin positive. Struggled for 4 months to get surgery done. I did a Revision resection of rectum, small bowel was involved now so did a right quarter colectomy, and diversion ileostomy. Patient home on POD6 uneventfully.

Most common risk factors for colon cancer ! Easy to remember and cross check in any pt. Lets be aware and spread awareness. Colorectal cancer awareness month

69/F/ old history of carcinoma breast. Had history of neck swelling since last 1 year. history of palpitations. Got full cardiac evaluation done including dobutamine stress test. Started on medications

Came to us for routine annual follow up for carcinoma breast. I got a basic thyroid profile done . Diagnosed to be hyperthyroid and a large thyroid extending retrosternally. Team approach with physician taken. Stabilised with 3 weeks of neomercazole. Palpitations disappeared. Taking all precautions after 3 weeks operated via neck incision subtotal thyroidectomy done. Postop uneventful.

Window thoracostomy

Window thoracostomy – useful as an option in empyemas with trapped lung and patient either unfit or failure of surgery. Many a times in post pneumonectomy empyema with BPF also.

In this particular case, patient is a case of metastatic Ca lung – stage 4. Well controlled with oral targeted therapy. But he had an empyema, unexpanded lung and persistent subtle sepsis..

Window thoracostomy in him – takes care of the pain of the tube, makes it easier for the pus to drain, better care of cavity and he can return back to work.

A major surgery for him wont be to possible due to the disease extent. Lets do the next best for him !

46/Female/ non smoker/ no comorbidities. C/o backache. Incidental diagnosis of left lingular lung cyst. Investigated. Planned for VATS excision in view of the size. 2 port VATS excision done in toto. With silver of lingular lobe. Final HPE: cystic lymphangiectasis. Rare. Pt’s ICD removed in 2days and patient discharged on POD3. One 10mm and one 25mm incision. Patient comfortable and cured. Dr. Prriya Eshpuniyani, Consultant Thoracic Surgeon. Heal Onco Care

Some surgeries are intensely satisfying. 17 year old boy who lost his father to TB just 9 months ago. Himself suffering from TB and empyema. Timely decortication, removal of entire empyema cavity , expanding the lung completely at end of surgery. Gratifying procedure.

BLOOD CANCER AWARENESS

CHILDHOOD CANCER AWARENESS

UROLOGICAL CANCER AWARENESS

THYROID CANCER AWARENESS

GYNECOLOGIC CANCER AWARENESS

BLOOD CANCER AWARENESS

History: 35 year old lady, respiratory complaints. Bronchoscopy with debulking of right Lower lobar bronchus tumour done in August. Proven to be G1 typical carcinoid.

DotA scan: tumour in right lower lobe.rest clear

Underwent right bilobectomy. Intraop FOB: tumour just beyond secondary carina with small middle lobe. Decision taken to do bilobectomy

Postop uneventful. Discharged on POD5.

Final histopath carcinoid. IHC awaited