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Adjuvant therapy for cancer

Adjuvant therapy for cancer



Adjuvant Therapy for Cancer ...

Adjuvant Therapy for Cancer
Prof. S. C. Varshney
Department of Shalya Tantra
Faculty of Ayurveda
Institute of Medical Sciences
Banaras Hindu University



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    Adjuvant therapy for cancer Adjuvant therapy for cancer Presentation Transcript

    • Adjuvant Therapy for CancerProf. S. C. VarshneyDepartment of Shalya TantraFaculty of AyurvedaInstitute of Medical SciencesBanaras Hindu UniversityVaranasi-221005
    • What is Cancer ?• Scientific terms used for Cancer- • Neoplasm • Tumor • Growth • Neoplasm-literally meaning “new growth” • Neoplasm is the uncontrolled proliferation of transformed cells.
    • Definition of CancerA mass of tissueresults of-– Uncoordinated– Abnormal– Excessive– Autonomous– Purposeless proliferation of cell.
    • Varieties of Neoplasm Cancer
    • Character of Cancer
    • Cancers arecaused by aseries ofmutations.Eachmutationalters thebehaviour ofthe cellsomewhat. 6
    • Epidemiology The 10 Leading Cancer Types for Men and Women by Incidence Men WomenProstate 33% Breast 31%Lung and bronchus 13% Lung and bronchus 12%Colon and rectum 10% Colon and rectum 11%Urinary bladder 6% Uterine corpus 6%Melanoma of the skin 5% Non-Hodgkins lymphoma 4%Non-Hodgkins lymphoma 4% Melanoma of the skin 4%Kidney and renal pelvis 3% Thyroid 3%Oral cavity and pharynx 3% Ovary 3%Leukemia 3% Urinary bladder 2%Pancreas 2% Pancreas 2%All other sites 18% All other sites 22%
    • The 10 Leading Cancer Types for Men and Women by Mortality Men WomenLung and Bronchus 31% Lung and bronchus 26%Colon and rectum 10% Breast 15%Prostate 9% Colon and rectum 10%Pancreas 6% Pancreas 6%Leukemia 4% Ovary 6%Liver and intrahepatic bile 4% Leukemia 4%ductEsophagus 4% Non-Hodgkins lymphoma 3%Non-Hodgkins lymphoma 3% Uterine corpus 3%Urinary bladder 3% Multiple myeloma 2%Kidney 3% Brain and other nervous 2% systemAll other sites 23% All other sites 23%
    • Etiology
    • Risk factors• Age- • Advance age• Sex- • Men > Women • Special organ related• Race- • Different cancer affect different races » Americans/ Europeans- lungs, breast & colon cancer » Black Africans- skin, penis, cervix & liver cancer » Japanese- gastric carcinoma• Family- • Positive family history – more risk of carcinoma
    • Tobacco-Induced Cancers Cancer Carcinogen Involvement TypeLung PAH, NNK (major) 1,3-butadiene, isoprene, ethylene oxide, ethyl carbamate, aldehydes, benzene, metalsLarynx PAHNasal NNK, NNN, other N-nitrosamines, aldehydesOral cavity PAH, NNK, NNNEsophagus NNN, other N-nitrosaminesLiver NNK, other N-nitrosamines, furanPancreas NNK, NNALCervix PAH, NNKBladder 4-aminobiphenyl, other aromatic aminesLeukemia benzenePAH, polycyclic aromatic hydrocarbons; NNK, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone;NNN, N-nitrosonornicotine; NNAL, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol.
    • Familial Cancer SyndromesSYNDROME GENES CANCER SITES AND ASSOCIATED TRAITSBreast/ovarian syndrome BRCA1 Cancer of the breast, ovary, colon, prostate BRCA2 Cancer of the breast, ovary, colon, prostate,Cowdens disease PTEN Cancer of the breast, endometrium, thyroidFamilial adenomatous polyposis APC Colorectal carcinoma, duodenal and gastric neoplasms,(FAP) medulloblastomas, osteomasFamilial melanoma P16,CDK4 Melanoma, pancreatic cancer, dysplastic nevi, atypical molesHereditary diffuse gastric cancer CDH1 Gastric cancerHereditary nonpolyposis colorectal hMLH1,2 Colorectal cancer, carcinomas of the stomach, small bowel,cancer pancreas, ovary hPMS1,2Hereditary papillary renal cell MET Renal cell cancercarcinomaPeutz-Jeghers syndrome STK11 Gastrointestinal carcinomas, breast cancer,Retinoblastoma RB Retinoblastoma, sarcomas, melanomavon Hippel-Lindau syndrome VHL Renal cell carcinoma, pheochromocytomaWilms tumor WT Wilms tumor
    • Hallmarks of hereditary cancer Hereditary cancer Sporadic cancerEarly age of onset Late age of onset Single individual affected withCancer in two or more close relatives cancerMultiple primary tumors (same or Solitary cancerdifferent types)
    • Oncogenes• Normal cellular genes that contribute to cancer when abnormal are called oncogenes.• More than 100 oncogenes have been identified.• Oncogenes may be – growth factors (e.g., platelet-derived growth factor), – growth factor receptors (e.g., HER2/neu), – intracellular signal transduction molecules (e.g., ras), – nuclear transcription factors (e.g., c-myc),• Protooncogenes can be activated by – Translocation (e.g., abl) – Promoter insertion (e.g., c-myc) – Mutations (e.g., ras) – Amplification (e.g., HER2/neu).
    • Retroviruses Containing Cellular OncogenesOncogene Virus Name Originabl Abelson murine leukemia virus Mousefes ST feline sarcoma virus Catfps Fujinami sarcoma virus Chickensrc Rous sarcoma virus Chickenmos Moloney murine sarcoma virus Mouseraf Murine sarcoma virus 3611 Mousesis Simian sarcoma virus MonkeyH-ras Harvey murine sarcoma virus RatK-ras Kirsten murine sarcoma virus RaterbA Avian erythroblastosis virus Chickenmyb Avian myeloblastosis virus Chickenmyc MC29 myelocytoma virus Chicken
    • CHEMICAL CARCINOGEN CHEMICAL CARCINOGEN PREDOMINANT TUMOR TYPEAflatoxins Hepatocellular carcinomaArsenic Skin cancerAsbestos Mesothelioma, lung cancerBenzene LeukemiaBenzidine Cancer of the urinary bladderBeryllium, Cadmium, Radon Lung cancerChromium compounds Lung cancerCoal tars Skin cancer, scrotal cancerEthylene oxide Leukemia, lymphomaNickel Lung cancer, nasal cancerTobacco smoke Lung cancer, oral cancer, pharyngeal cancer, laryngeal cancer, esophageal cancerVinyl chloride Hepatic angiosarcoma, hepatocellular carcinoma
    • PHARMACEUTICAL CARCINOGENS PHARMACEUTICAL PREDOMINANT TUMOR CARCINOGENS TYPEAzathioprine Non-Hodgkins lymphoma, squamous cell cancer of the skin, hepatocellular carcinoma, cholangiocarcinomaCyclophosphamide Cancer of the urinary bladder, leukemiaChlorambucil LeukemiaTamoxifen Endometrial cancerEstrogens (OCP, HRT) Cancer of the breast and endometrium
    • INFECTIOUS CARCINOGENS INFECTIOUS CARCINOGENS PREDOMINANT TUMOR TYPEEpstein-Barr virus (EBV) Burkitts lymphoma, Hodgkins disease, immuno- suppression-related lymphoma, nasopharyngeal carcinomaHepatitis B, Hepatitis C Hepatocellular carcinomaHuman immunodeficiency virus Kaposis sarcoma(HIV) type 1Human papillomavirus (HPV) Cervical cancer, anal cancertypes 16 and 18Human T-cell lymphotropic virus Adult T-cell leukemiatype I (HTLV-1)Helicobacter pylori Gastric adenocarcinomaOpisthorchis viverrini Cholangiocarcinoma, hepatocellular carcinomaSchistosoma haematobium Cancer of the urinary bladder
    • Chronic Inflammatory Conditions Pathologic Condition Associated Tumor(s)Sunburned skin, burn scar Basal cell carcinoma, SCC, melanomaSevere thermal injury Marjolins ulcer (SCC)Epidermolysis bullosa SCCGingivitis, lichen planus Oral SCCLichen sclerosus Vulvar SCCSialadenitis Salivary gland carcinomaSjogren syndrome, Hashimotos thryoiditis Mucosa-associated lymphoid tissue lymphomasAsbestosis, silicosis Mesothelioma, lung carcinomaBronchitis (nitrosamines, peroxides) Lung carcinomaReflux oesophagitis, Barretts oesophagus Oesophageal carcinomaHematochromatosis Liver carcinomaLiver cirrhosis Hepatocellular carcinomaChronic pancreatitis Pancreatic carcinomaInflammatory bowel disease, Crohns disease, Colorectal carcinoma, small intestinechronic ulcerative colitis carcinomaCystitis, bladder Bladder carcinoma
    • Physical Factors• UV rays• Ionizing rays • Gamma rays • X- rays• Asbestos fibers » Also included under chemical carcinogen
    • Dietary Factors• Energy Diet• Alcohol• Dietary Fat• Red Meat• Fruits and Vegetables• Fiber• Vitamin D• Folate• Carotenoids
    • Diagnosis of cancer
    • Clinical Presentation General feature
    • Clinical Presentation Digestive system
    • Clinical Presentation Respiratory System
    • Clinical Presentation Urinary System
    • Clinical Presentation
    • Cannon Ball DeformityMetastatic lesion of Ca Lungs
    • An invasive Colorectal Carcinoma (top center) in a2/2/2013 Colectomy specimen.
    • An invasive Ductal Carcinoma of the breast (pale area at the center) surrounded by spikes of whitish scar tissue in the surrounding yellow fatty tissue.2/2/2013 31
    • A Squamous CellCarcinoma (thewhitish tumor)near the Bronchi ina lung specimen. 32
    • A largeinvasiveDuctalCarcinoma in aMastectomyspecimen.
    • Biopsy• The definitive diagnosis of solid tumors is usually obtained with a biopsy of the lesion.• Biopsy determines – Tumor histology definitive – Grade therapeutic planning
    • BiopsyLesions that are easily palpable, such asthose of the skin, can either beobtained with a needle (FNAC) or withan open incisional or excisional biopsyor sampled by punch biopsy.
    • Biopsy• Biopsies of mucosal lesions usually are obtained endoscopically (e.g., via colonoscope, bronchoscope, or cystoscope).• Deep-seated lesions can be localized with CT scan or ultrasound guidance for biopsy.
    • TUMOR MARKERSTumor markers are indicators of cellular,biochemical, molecular, or geneticalterations.
    • TUMOR MARKERSThe information provided may be• Diagnostic and distinguish benign from malignant disease• Correlate with the amount of tumor present (so-called tumor burden)• Allow subtype classification to more accurately stage patients• Be prognostic, either by the presence or absence of the marker or by its concentration• Guide choice of therapy and predict response to therapy
    • TUMOR MARKERSThe ideal tumor marker has three definingcharacteristics: 1. The marker is expressed exclusively by the particular tumor 2. Collection of the specimen for the tumor marker assay is easy. 3. The assay itself is reproducible, rapid, and inexpensive
    • Tumor MarkersSensitivity and Specificity of Some Common Tumor Markers Marker Cancer Sensitivity SpecificityProstate-specific Prostate 57–93% 55–68%antigen (PSA) (4 g/L)Carcinoembryonic Colorectal 40–47% 90%antigen (CEA)CEA Breast 45% 81%CEA Recurrent disease 84% 100%Alpha-fetoprotein Hepatocellular 98% 65%Carbohydrate antigen Pancreatic 78–90% 95%CA 19.9CA 27.29 Breast 62% 83%CA 15.3 Breast 57% 87%
    • TNM Classification
    • Prevention• Risk Factors for Hereditary Cancer Syndromes – Early age of onset (e.g., <45 years for breast cancer; <50 years for colon cancer) – Multiple family members on the same side of the pedigree with the same cancer – Clustering of cancers in the family known to be caused by a single gene mutation (e.g., breast/ovarian/pancreatic, colon/uterine/ovarian)
    • Prevention……………. Risk Factors for Hereditary Cancer Syndromes – Multiple primary cancers in one individual (e.g., breast and ovarian cancer; multiple primary colon cancers) – Unusual presentation of cancer (e.g., breast cancer in a male) – Pathology (e.g., medullary breast cancer, triple negative breast cancer)
    • Cancer-related check-upEvery men and women, age 20+ ,On the occasion of aperiodic health examination, the cancer-relatedcheck-up should include examination of the *Thyroid * Testicles * Ovaries * Lymph nodes *Oral cavity * Skin * Breast * Prostate Health counseling about *Tobacco *Sun exposure *Diet and nutrition *Risk factors *Sexual practices *Environmental and occupational exposures
    • Cancer ScreeningCancer Site Population Test or ProcedureBreast Women, age 20+ Breast self-examination Clinical breast examination MammographyColorectal Men and women, Fecal occult blood test (FOBT) age 50+ Flexible sigmoidoscopy Fecal occult blood test and flexible sigmoidoscopy Double-contrast barium enema (DCBE) ColonoscopyProstate Men, age 50+ Digital rectal examination (DRE) and prostate-specific antigen test (PSA)Cervix Women Pap test
    • Dietary Recommendations• Engage in regular physical activity• Avoid overweight and weight gain in adulthood• Limit alcohol consumption• Consume lots of fruits and vegetables• Consume whole grains and avoid refined carbohydrates and sugars• Replace red meat and dairy products with fish, nuts, and legumes
    • Cancer Therapy
    • Cancer Therapy• Multidisciplinary Approach to Cancer- to improve patient survival rates – Surgery is the most effective therapy for most solid tumors – Systemic chemotherapy – Radiation therapy – Recent Trends
    • Surgical Approaches to Cancer Therapy• Roles for Surgery – Diagnosis of Cancer – Prevention of Cancer – Surgical Management of Primary Tumors – Surgical Management of the Regional Lymph Node Basin – Surgical Management of Distant Metastases – Palliation
    • Chemotherapy• In patients with documented distant metastatic disease, chemotherapy is usually the primary modality of therapy.• The goal of therapy – To decrease the tumor burden, thus prolonging survival. – To eradication of micrometastatic disease
    • Anticancer Agents Alkylating agents Antitumor Antimetabolites Plant Alkaloids Miscellaneous Antibiotics AgentsBusulfan Bleomycin Methotrexate Vinca alkaloids AsparaginaseChlorambucil Dactinomycin Azathioprine Vinblastine Estramustine (actinomycin D)Cyclophosphamide Daunorubicin Mercaptopurine Vincristine Milotane Melphalan Doxorubicin Thioguanine Vindesine Mitomycin C Idarubicin Cladribine Vinorelbine Carmustine Plicamycin Fludarabine Etoposide (BCNU) (mithramycinLomustine (CCNU) Pentostatin Paclitaxel Carboplatin Cytarabine Docetaxel Cisplatin FloxuridineDacarbazine (DTIC) Gemcitabine
    • Hormonal Therapy Pharmacologic Category and Clinical Applications Products AvailableTestosterone propionate- Fluoxymesterone Breast cancerAntiandrogens - Flutamide, Finasteride Prostate cancerAntiestrogens - Tamoxifen Breast cancerEstrogens - Diethylstilbestrol Prostate cancerEstrogens - Ethinyl estradiol Breast cancerGlucocorticoids -Hydrocortisone Leukemia, lymphomaGlucocorticoids - Prednisone Breast cancerGlucocorticoids - Dexamethasone Multiple myelomaGonadotropin inhibitors - Leuprolide Prostate cancerProgestins - Medroxyprogesterone Breast cancerAromatase inhibitors - Aminoglutethimide Prostate cancer, Breast cancerSomatostatin analogues - Octreotide acetate Neuroendocrine tumor of the gut, carcinoid vipoma, APUD tumors
    • Radiation Therapy• Radiation deposition results in DNA damage manifested by single- and double-strand breaks in the sugar phosphate backbone of the DNA molecule.• Electromagnetic radiation is indirectly ionizing through short-lived hydroxyl radicals produced primarily by the ionization of cellular hydrogen peroxide (H2O2).• Radiation damage is manifested primarily by the loss of cellular reproductive integrity.
    • Local Effects of RadiationOrgan Acute Changes Chronic ChangesSkin Erythema, wet or dry Telangiectasia, subcutaneous desquamation, epilation fibrosis, ulcerationGastro- Nausea, diarrhea, edema, Stricture, ulceration, perforation,intestinal tract ulceration, hepatitis hematocheziaKidney Nephropathy, renal insufficiencyBladder Dysuria Hematuria, ulceration, perforationGonads Sterility Atrophy, ovarian failureHematopoietic Lymphopenia, neutropenia, Pancytopeniatissue thrombocytopeniaBone Epiphyseal growth arrest NecrosisLung Pneumonitis Pulmonary fibrosisHeart Pericarditis, vascular damageEye Conjunctivitis Cataract, keratitis, optic nerve atrophyNervous system Cerebral edema Necrosis, myelitis
    • Recent Trends inCancer Management
    • Biologic Therapy• The basic principle of molecular therapeutics is to exploit the molecular differences between normal cells and cancer cells to develop targeted therapies.• Biologic therapies include – Inhibitors of growth factor receptors – Inhibitors of intracellular signal transduction – Cell-cycle inhibitors, apoptosis-based therapies – Antiangiogenic compounds
    • Immunotherapy • The aim of immunotherapy is to induce or potentiate inherent antitumor immunity that can destroy cancer cells.Categories and Examples of Tumor-Associated Antigens Recognized by Human T CellsCategory Tumor Antigens Cancers Expressing the AntigenCancer testis antigens MAGE-1MAGE-2,MAGE- Melanoma, breast, head and neck, 3MAGE-12,BAGE,GAGE bladder, gastric, and lung cancersDifferentiation antigens TyrosinaseTRP-1 Melanomaa TRP-2gp 100Tumor-specific antigens Immunoglobulin B-cell NHL, MM idiotype, CDK4Overexpressed self Proteinase 3 CMLantigen CEA Colon, breast, pancreatic cancers Normal p53 Breast, colon, and other cancers PSA Prostate cancer -fetoprotein Liver cancerViral antigens HPV E6/E7 Cervical and penile cancers HCV Liver cancer
    • Gene Therapy• The field of cancer gene therapy utilizes a variety of strategies – replacement of mutated or deleted tumor suppressor genes to enhancement of immune responses to cancer cells – to modifying the genetic program of cancer cells
    • Concept of Cancer in Ayurveda
    • Cancer in Ayurveda• It may be • Arbuda- Denotes both Benign and Malignant Growth – Vataja, Pittaja, Kaphaja & Medaja may be Benign growth » Symptoms resemble to respective Granthi. » All are curable – Raktaja & Mamsaja resemble as Malignant growth • Dusta Vrana- – Specific symptoms resemble to malignant growth – They are- iÉjÉÉÊiɺÉÆ´ÉÞiÉÉä%ÊiÉÊ´É´ÉÞiÉÉä%ÊiÉEúÊ`üxÉÉä%ÊiɨÉÞnÖü¯þiºÉzÉÉä%-------- EÞú¹hÉ®Hú{ÉÒiɶÉÖKúÉnüÒxÉÉÆ ´ÉhÉÉÇxÉɨÉxªÉiɨɴÉhÉÉæ ¦Éè®´É: {ÉÚÊiÉ---------------------- ÖÇiºÉƒû¬¨ÉxÉÉäYÉnü¶ÉÇxÉMÉxvÉÉä%iªÉlÉÈ --------nÖüŸüµÉhÉÊ™üƒûÉÊxÉ**22/7**
    • Definition of ArbudaMÉÉjÉ|Énäü¶Éä FúÊSÉnäü´É nüÉä¹ÉÉ: ºÉƨÉÚÐSUüiÉÉ ¨ÉÉƺɨÉʦÉ|ÉnÚü¹ªÉ **´ÉÞkÉÆ ÎºlÉ®Æ ¨Éxnü¯þVÉÆ ¨É½ýÉxiɨÉxɱ{ɨÉÚ™Æü ÊSÉ®´ÉÞrü¬{ÉÉEú¨É **13**EÖú´ÉÇÎxiÉ ¨ÉÉƺÉÉä{ÉSɪÉÆ iÉÖ ¶ÉÉä¡Æú iɨɤÉÖÇnÆü ¶ÉÉÛÉÊ´ÉnüÉä ´ÉnüÎxiÉ **
    • Etiological factors• Trauma• Excessive Non- vegetarian diet• ¨ÉÖÊŸü|ɽýÉ®ÉÊnüʦɮÌnüiÉä%ƒäû ¨ÉÉƺÉÆ |ÉnÖüŸÆü |ÉEú®ÉäÊiÉ ¶ÉÉä¡ú¨É **17** +jÉänüxÉÆ Ê×ÉMvɨÉxÉxªÉ´ÉhÉǨÉ{ÉÉEú¨É¶¨ÉÉä{ɨɨÉ|ÉSÉɱªÉ¨É ** |ÉnÖüŸü¨ÉÉƺɺªÉ xÉ®ºªÉ ¤ÉÉf¨ÉäiÉ‘ü´Éäx¨ÉÉƺÉ{ɮɪÉhɺªÉ **18**
    • Pathogenesis of Arbuda• Dosa- Vata, Pitta, Kapha MÉÉjÉ|Énäü¶Éä FúÊSÉnäü´É nüÉä¹ÉÉ: ºÉƨÉÚÐSUüiÉÉ ¨ÉÉƺɨÉʦÉ|ÉnÚü¹ªÉ **13** ...EÖú´ÉÇÎxiÉ ¨ÉÉƺÉÉä{ÉSɪÉÆ iÉÖ ¶ÉÉä¡Æú iɨɤÉÖÇnÆü ¶ÉÉÛÉÊ´ÉnüÉä ´ÉnüÎxiÉ **• Dushya- Rakta, Mamsa, Meda ¶ÉÉäÊhÉiÉɶÉÉæ%¤ÉÖÇnüɃû¨ÉnüÉǺÉÞMnü®®HúÊ{ÉkÉ|ɦÉÞiɪÉÉä ®HúnüÉä¹ÉVÉÉ: MÉÖnü¨ÉÖJɨÉäfÅ{ÉÉEúÉõÉ, +ÊvɨÉÉƺÉɤÉÖÇnüɶÉÉæ%ÊvÉÊVÉâÉä{ÉÊVÉâÉä{ÉEÖú¶É ---------¢|ÉEúÉä{ÉMÉ™üMÉhbü¨ÉÉ™üÉ|ɦÉÞiɪÉÉä ¨ÉÉƺÉnüÉä¹ÉVÉÉ:, ...¶OÉÎxlÉ´ÉÞÊrüMÉ™üMÉhbüɤÉÖÇnü¨ÉänüÉäVÉÉè¢|ÉEúÉä{ɨÉvÉÖ¨Éä½ýÉÊiɺlÉÉ豪ÉÉÊiÉ- º´Éänü|ɦÉÞiɪÉÉä ¨ÉänüÉänüÉä¹ÉVÉÉ:,
    • No Paka (Suppuration) in Arbuda xÉ {ÉÉEú¨ÉɪÉÉÎxiÉ Eú¡úÉÊvÉEúi´ÉÉx¨ÉänüÉä¤É½Öýi´ÉÉcÉ Ê´É¶Éä¹ÉiɺiÉÖ ** nüÉä¹ÉκlÉ®i´ÉÉnÂüOÉlÉxÉÉcÉ iÉä¹ÉÉÆ ºÉ´ÉÉǤÉÖÇnüÉxªÉä´É ÊxɺÉMÉÇiɺiÉÖ **21**• Due to- • Kapha and Meda dominated disease. • Stability of involve Dosa. • Intermingled Dosa and Dushya
    • Clinical Features• General Clinical Feature ´ÉÞkÉÆ ÎºlÉ®Æ ¨Éxnü¯þVÉÆ ¨É½ýÉxiɨÉxɱ{ɨÉÚ™Æü ÊSÉ®´ÉÞrü¬{ÉÉEú¨É **13** EÖú´ÉÇÎxiÉ ¨ÉÉƺÉÉä{ÉSɪÉÆ iÉÖ ¶ÉÉä¡Æú iɨɤÉÖÇnÆü ¶ÉÉÛÉÊ´ÉnüÉä ´ÉnüÎxiÉ **• Arbuda is kind of Shopha begins with Mamsopchaya, characterized by • Vrittam- Spherical Shape(May be Benign) • Sthiram- fixity(Characteristic of Malignant Growth) • Mandrujam- Less pain or painless (Characteristic of Malignant Growth) • Mahantam- Larger in size (Characteristic of Malignant Growth) • Analpmoolam- Broader Base S/O Invasive nature of Growth • Chirvriddhi- Slow growing (Characteristic of Benign Growth) • Apakam- No suppuration
    • Clinical Features• Vataja, Pittaja, Kaphaja, Medaja- Manifests as respective Granthi ´ÉÉiÉäxÉ Ê{ÉkÉäxÉ Eú¡äúxÉ SÉÉÊ{É ®HäúxÉ ¨ÉÉƺÉäxÉ SÉ ¨ÉänüºÉÉ SÉ **14** iÉWÉɪÉiÉä iɺªÉ SÉ ™üIÉhÉÉÊxÉ OÉxlÉä: ºÉ¨ÉÉxÉÉÊxÉ ºÉnüÉ ¦É´ÉÎxiÉ **
    • Raktarbuda nüÉä¹É: |ÉnÖüŸüÉä ¯þÊvÉ®Æ ÊºÉ®ÉºiÉÖ ºÉÆ{ÉÒbü¬ ºÉØûÉäSªÉ MÉiɺi´É{ÉÉEú¨É **15** ºÉÉ»ÉɴɨÉÖzÉÁÊiÉ ¨ÉÉƺÉÊ{ÉhbÆü ¨ÉÉƺÉÉØÙû®è®ÉÊSÉiɨÉɶÉÖ´ÉÞÊrü¨É ** »É´ÉiªÉVÉ»ÉÆ ¯þÊvÉ®Æ |ÉnÖüŸü¨ÉºÉÉvªÉ¨ÉäiÉpÖüÊvÉ®Éi¨ÉEÆú ºªÉÉiÉ **16** ®HúIɪÉÉä{Épü´É{ÉÒÊbüiÉi´ÉÉiÉ {ÉÉhbÖü¦ÉÇ´ÉäiÉ ºÉÉä%¤ÉÖÇnü{ÉÒÊbüiɺiÉÖ **• Mamsapindam unnahyati- Elliveted tissue• Mamsankura- Granulation with Angiogenesis• Ashuvriddhi- Fast spreading(Malignancy)• Sravet Rudhiram- Bleed on Touch• Pandu- Anaemia• Raktakshaya Upadrava- Blood loss related complications
    • Mamsarbuda ¨ÉÖÊŸü|ɽýÉ®ÉÊnüʦɮÌnüiÉä%ƒäû ¨ÉÉƺÉÆ |ÉnÖüŸÆü |ÉEú®ÉäÊiÉ ¶ÉÉä¡ú¨É **17** +jÉänüxÉÆ Ê×ÉMvɨÉxÉxªÉ´ÉhÉǨÉ{ÉÉEú¨É¶¨ÉÉä{ɨɨÉ|ÉSÉɱªÉ¨É ** |ÉnÖüŸü¨ÉÉƺɺªÉ xÉ®ºªÉ ¤ÉÉf¨ÉäiÉ‘ü´Éäx¨ÉÉƺÉ{ɮɪÉhɺªÉ **18** ¨ÉÉƺÉɤÉÖÇnÆü i´ÉäiÉnüºÉÉvªÉ¨ÉÖHÆú ºÉÉvªÉä¹´É{ÉÒ¨ÉÉÊxÉ Ê´É´ÉVÉǪÉäkÉÖ ** ºÉÆ|É»ÉÖiÉÆ ¨É¨ÉÇÊhÉ ªÉcÉ VÉÉiÉÆ »ÉÉäiÉ:ºÉÖ ´ÉÉ ªÉcÉ ¦É´ÉänüSÉɱªÉ¨É **19**• Avedanam- Painless• Snigdham- Soft in Touch• Ananyavarnam- Skin Colored• Apakam- No suppuration• Ashmopama- Stony hard• Aprachalyam- Fixed• Mamsaparayana- specially in non- vegetarian
    • Dvi-Arbuda, Adhi-Arbuda ªÉWÉɪÉiÉä%xªÉiÉ JÉ™Öü {ÉÚ´ÉÇVÉÉiÉä YÉäªÉÆ iÉnüvªÉ¤ÉÖÇnü¨É¤ÉÖÇnüYÉè: ** ªÉnÂüuüxuüVÉÉiÉÆ ªÉÖMÉ{ÉiÉ Gú¨ÉÉuüÉ Êuü®¤ÉÖÇnÆü iÉcÉ ¦É´ÉänüºÉÉvªÉ¨É **20**• Dvi-Arbuda- A growth appeared on preexisted growth S/O Recurrence of Malignancy.• Adhi-Arbuda- A growth appeared nearby growth or appeared one by one or together S/O Invasion or metastasis of Malignancy. • Both are incurable S/O Malignancy
    • Prognosis •»É´ÉiªÉVÉ»ÉÆ ¯þÊvÉ®Æ |ÉnÖüŸü¨ÉºÉÉvªÉ¨ÉäiÉpÖüÊvÉ®Éi¨ÉEÆú ºªÉÉiÉ **16** •¨ÉÉƺÉɤÉÖÇnÆü i´ÉäiÉnüºÉÉvªÉ¨ÉÖHÆú ºÉÉvªÉä¹´É{ÉÒ¨ÉÉÊxÉ Ê´É´ÉVÉǪÉäkÉÖ **19 •--------------------------------- iÉnüvªÉ¤ÉÖÇnü¨É¤ÉÖÇnüYÉè: ** ªÉnÂüuüxuüVÉÉiÉÆ ªÉÖMÉ{ÉiÉ Gú¨ÉÉuüÉ Êuü®¤ÉÖÇnÆü iÉcÉ ¦É´ÉänüºÉÉvªÉ¨É **20**• Sadhya (Curable)- *Vataja, *pittaja, *Kaphaja & *Medaja• Ashadhya (Incurable)- * Raktarbuda, * Mamsarbuda * Adhi-Arbuda, * Dvi-Arbuda
    • Prognosis • --------------------------- ºÉÉvªÉä¹´É{ÉÒ¨ÉÉÊxÉ Ê´É´ÉVÉǪÉäkÉÖ ** ºÉÆ|É»ÉÖiÉÆ ¨É¨ÉÇÊhÉ ªÉcÉ VÉÉiÉÆ »ÉÉäiÉ:ºÉÖ ´ÉÉ ªÉcÉ ¦É´ÉänüSÉɱªÉ¨É **19**• Symptoms showing incurability- – Samprasuti- Continuous Discharge from Saddhya Arbuda – Marmani- Situated on Marma (vital organ) – Srotasu- Situated in Srotasa (Body opening) – Achalyam- Fix in nature
    • Management of Arbuda
    • Management of ArbudaSamsamana Shalya Pancha Karma Karma•Alepa •Chedana •Vamana •Vidarana•Upnaha •Lekhana •Virechana•Swedana •Kshar Karma •Visravana•Sneha •Agni karma •Kshar SutraPana •Krimichikitsa
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    • Sneha Pana• ´ÉÉiÉɤÉÖÇnÆü -------------------------- ®HÆú ¤É½Öý¶ÉÉä ½ý®äcÉ ** ´ÉÉiÉPÉîÊxɪÉÚǽý{ɪÉÉ䨙ü¦ÉÉMÉè: ʺÉrÆü ¶ÉiÉÉJªÉÆ ÊjÉ´ÉÞiÉÆ Ê{ɤÉäuüÉ **31**• ¶ªÉɨÉÉÊMÉÊ®âɉÉxÉEúÒ®ºÉä¹ÉÖ püÉIÉÉ®ºÉä ºÉ”ÉÊ™üEúÉ®ºÉä SÉ ** PÉÞiÉÆ Ê{ɤÉäiÉ KúÒiÉEúºÉÆ|ÉʺÉrÆü Ê{ÉkÉɤÉÖÇnüÒ iÉWÉ`ü®Ò SÉ VÉxiÉÖ: **34**
    • Shalya Karma • Chedana • Vidarana • Lekhana • Kshar Karma • Agni karma • Kshar Sutra • Krimichikitsa
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    • Total eradication is must- otherwise Recurrence is sure•ºÉ¶Éä¹ÉnüÉä¹ÉÉÊhÉ Ê½ý ªÉÉä%¤ÉÖÇnüÉÊxÉ Eú®ÉäÊiÉ iɺªÉɶÉÖ {ÉÖxɦÉÇ´ÉÎxiÉ **42** iɺ¨ÉÉnü¶Éä¹ÉÉÊhÉ ºÉ¨ÉÖrü®äkÉÖ ½ýxªÉÖ: ºÉ¶Éä¹ÉÉÊhÉ ªÉlÉÉ Ê½ý ´ÉÊá: **
    • Panchakarma• Vamana• Virechana• Visravana
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    • Virechana•º´ÉänüÉä{ÉxÉɽýÉ ¨ÉÞnü´ÉºiÉÖ EúɪÉÉÇ: Ê{ÉkÉɤÉÖÇnäü EúɪÉÊ´É®äSÉxÉÆ SÉ **Ê´ÉPÉÞ¹ªÉ SÉÉänÖü¨¤É®¶ÉÉEúMÉÉäVÉÒ{ÉjÉè¦ÉÞǶÉÆ IÉÉèpüªÉÖiÉè: |ÉÊ™ü¨{ÉäiÉ **32**• ¶ÉÖrüºªÉ VÉxiÉÉä: Eú¡úVÉä%¤ÉÖÇnäü iÉÖ ®Häú%´ÉʺÉHäú iÉÖ iÉiÉÉä%¤ÉÖÇnÆü iÉiÉ **pü´ªÉÉÊhÉ ªÉÉxªÉÚv´ÉǨÉvÉõÉ nüÉä¹ÉÉxÉ ½ý®ÎxiÉ iÉè: Eú±EúEÞúiÉè: |ÉÊnüÁÉiÉ **35**
    • Visravana• »ÉÉ´ªÉÉ Ê´ÉpüvɪÉ: {ÉˆÉ ¦É´ÉäªÉÖ: ºÉ´ÉÇVÉÉoüiÉä **12** EÖú¢ÉÊxÉ ´ÉɪÉÖ: ºÉ¯þVÉ:-------------- **+¤ÉÖÇnüÉÊxÉ Ê´ÉºÉ{ÉÉÇõÉ OÉxlɪÉõÉÉÊnüiÉõÉ iÉä **• ´ÉÉiÉɤÉÖÇnÆü ---------- º´ÉänÆü Ê´ÉnüvªÉÉiÉ EÖú¶É™üºiÉÖ xÉÉbü¬É ¶ÉÞƒäûhÉ ®HÆú ¤É½Öý¶ÉÉä ½ý®äcÉ **• -------- -----------------------Ê{ÉkÉɤÉÖÇnäü EúɪÉÊ´É®äSÉxÉÆ SÉ ** Ê´É»ÉÉ´ªÉ SÉÉ®M´ÉvÉMÉÉäÊVɺÉÉä¨ÉÉ: ¶ªÉɨÉÉ SÉ ªÉÉäVªÉÉ EÖú¶É™äüxÉ ™äü{Éä **33**• ¶ÉÖrüºªÉ VÉxiÉÉä: Eú¡úVÉä%¤ÉÖÇnäü iÉÖ ®Häú%´ÉʺÉHäú iÉÖ iÉiÉÉä%¤ÉÖÇnÆü iÉiÉ **
    • Personal experiences OfBreast Cancer Patients
    • Name : Mrs. Usha A. DeshmukhAge : 32 yrs Sex : femaleDate : 12/2/02
    • C/O : lump in Lt brest since ½ yr increasing in size & shapegradually pain off & on
    • # FNAC report showedEpithelial MalignancyClinical Diagnosis : ? Ca Ltbreast
    • Histopath : Epithelial Carcinoma
    • Name : Mrs. Nalini S.Wasnik Age: 40yrs
    • C/O : 1. lump in Lt breast since 8 months 2. swelling gradually increase in size & shape 3. swelling rapidly increase in size since 15 days 4. mild pain in Lt arm
    • Nature of Specimen: C/O lump in Ltbreast, nipple retracted, ? Carcinoma.Mastectomy done with excision ofaxillary lymph nodes.Gross feature : 1. Mastectomy specimenwith large skin flap of about 6.0” indimensions & with inverted nipple &areola with underlying fat. No pectoralismuscle seen . C/S shows subareolarmass, grey white, firm with areas ofhaemorrhage& necrosis. Three sectionstaken from nipple/areola & underlying mass, from mass & peripheral fat.2. Specimen of lymph nodes – two innumber, enlarged with peripheral fat,sizes about 2.5*2.5*2.0 cms &1.5*1.0*1.0 cms. Cut surface grey white& necrotic.
    • Impression : InfiltratingDuct Carcinoma ( NOStype ) of Breast.
    • Specimen
    • Specimen
    • Post - Operative
    • Name : Shevantabai Sule Age: 65yrsSex: female Date: 10/4/97 C/O : 1. Lump in Rt breast since 10 months 2. Mild pain 3. growth rapidly increase in size & shape sine 2 months
    • Clinical Diagnosis : Ca Rt Breast Nature of specimen : Rt Breast with lymphnodes.Impression : Infiltrating Duct Carcinoma ofBreast.
    • Name : Sushilabai L. Dhandekar Age: 45 yrs Sex : female Date:23/3/01C/O : Lump in Lt Brest since 1 yr
    • L/N : Lt axillary L/Nenlarged
    • Diagnosis : Ca Lt breast.
    • Specimen
    • Name : Mrs. Usha A. DeshmukhAge : 32 yrs Sex : femaleDate : 12/2/02
    • C/O : lump in Lt brest since ½ yr increasing in size & shape gradually pain off & on
    • # FNAC report showedEpithelial MalignancyClinical Diagnosis : ? Ca Ltbreast
    • Histopath : Epithelial Carcinoma