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At Max Cancer Centre, we are committed to recuperating our patients as soon as possible. Our dedicated team of leading Oncologists provides the most advanced cancer treatments using cutting edge technology, based on supreme International Standards. Cancer Care requires medical professionals from different specialties to collectively execute an individualized customer care plan for best results. We firmly believe in delivering quality care, support and re-assurance to our patients.
We believe that each patient and his/her disease is unique, hence our team of Oncology experts customize a 'personalized treatment plan' based on the discussions in tumor board conferences. We constantly review and improve our protocols and encourage the participation of our patients as well as care givers to understand the disease and its treatment process.
"Back to Life" is how we like to define the intent behind our services at Max Cancer Centre and we prefer to call our program "Max Cancer Care" because we strongly believe that caring for the needs of the patients and caregivers is more important that the medical services they avail.
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Warm regards,
Dr. Harit K. Chaturvedi
Chief Consultant & Director Surgical Oncology
Dr. A.K. Anand
Chief Consultant & Director Radiation Oncology
Dr. Bhawana Sirohi
Chief Consultant & Director Medical Oncology
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Surgery is an integral part of oncology and provides a real chance of cure in solid tumours. With advancements and refinement in other fields of medicine, surgical techniques have also evolved from extra radical to radical and now to the more conservative approaches. A conservative approach does not mean doing less or sub-optimal surgery but it means giving maximum function and less morbidity without compromising the oncologic principles of surgery. Besides conservative surgery, minimally invasive methods are coming to be largely used in cancer surgery. It is now possible to achieve what open surgery can achieve, through key hole surgery in select situations. This has made the post-operative recovery smoother in a large number of patients.
The Surgical Oncology Department at Max Cancer Centre is equipped to provide the entire range of surgeries for all solid cancers. Our commitment to comprehensive cancer care sees us utilizing to the hilt the skills of experts in the various fields of Surgical Oncology. They are able to carry out complicated surgeries successfully after optimizing patients in collaboration with anaesthetists, physicians, chest physicians, cardiologists, physiotherapists and dieticians. This is to ensure that the patient's safety is not compromised intra operatively and post operatively. Post operative care in major surgeries is ably taken care of by the surgical team in close collaboration with the intensivists.
The intent of surgery may vary from person to person depending on the stage of disease. About 60% cancer patients undergo surgery, either alone or in combination with other treatments.
Diagnostic Surgery
This surgery is performed to obtain tissue for pathologic diagnosis of cancer. |
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Trucut biopsy - When fine needle aspiration cytology (FNAC) does not give requisite information on the nature of cancer, then it is necessary to resort to Trucut biopsy (core-needle biopsy) to obtain cores of tissue for a diagnosis. |
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Incisional or excisional biopsy - performed under local anaesthesia to remove a small piece of a tumour (Incisional) or the entire mass (excisional) to arrive at a pathologic diagnosis or to characterize the tumour better. If the tumour is within the chest or the abdomen then thoracoscopic biopsy (chest) or a laparascopic biopsy (abdomen) may be resorted to under general anaesthesia. |
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Curative Surgery
This involves removing the tumour with margins. This may entail removal of part of an organ or a whole organ or sometimes adjacent organs as well. The lymphatic basin to which the tumour drains is also addressed in curative surgery. A curative surgery may be stand alone but is usually followed by adjuvant treatment in the form of chemotherapy or radiotherapy.
Reconstructive Surgery
It now co-exists with surgical oncology and is also given the term "Oncoplastic Surgery". In areas like head and neck cancers where large defects may be created as a part of removing the tumour with adequate margins, the role of the reconstructive surgeon is paramount. Restoration of near normal appearance to the face can be conferred upon patients with head and neck cancers using myocutaneous flaps, free flaps etc. Similarly, a patient undergoing mastectomy can undergo immediate breast reconstruction in the same sitting. For patients undergoing breast conservation surgery, breast contour can be restored to near normal with plastic surgery.
Prophylactic Surgery
It is a tool to reduce the risk of cancer in patients with a high risk of getting the same. This applies to patients with precancerous polyps in the colon where prophylactic colectomies may be required. In those with a strong family history of breast or ovarian cancer or BRCA I or II carriers, bilateral prophylactic mastectomies and oophorectomies are offered to these patients as a risk reduction measure.
Supportive Surgery
It is performed to ease the administration of other therapies. A port insertion (device connected to central venous system) or Hickmann catheter aids in the ease of chemotherapy administration especially when prolonged treatment is required.
Palliative Surgery
It is performed to ease symptoms associated with advanced cancer. The idea is to aid the nutrition of the patient, keep him/her pain free and improve overall quality of life in the terminal stages of illness.
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BREAST CANCER
BREAST CANCER
Fighting Breast Cancer
Breast cancer does not spell doom anymore what with modalities to pick up the disease early. Do not however, disregard any lump in the breast that you come across. Every woman has some chance of developing breast cancer during her lifetime. The earlier the disease is picked up better are the treatment options and better is the outcome. |
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| MYTHS |
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Do not feel guilty. You have done nothing wrong. |
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You cannot catch breast cancer. It is not infectious. |
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Stress/injury to the breast does not cause breast cancer. |
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70-80% of women who develop breast cancer do not have any known risk factors or family history. |
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| Risk Factors |
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Age |
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Family history |
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Obesity |
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Hormonal profile |
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Diet |
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Oral Contraceptives |
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HRT |
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Presentation
Breast cancer commonly presents as: |
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A lump in the breast |
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Nipple discharge |
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Nipple retraction |
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Dimpling of skin |
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| Diagnosis |
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Multi prong Assessment is mandatory and complementary for an accurate diagnosis. |
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Clinical Examination -Your doctor will assess the size, location and spread of the tumor. |
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Radiological assessment-Mammography-low dose X-ray of the breast useful in evaluating palpable as well as non palpable masses. |
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Ultrasound |
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Pathological Assessment - FNAC. Trucut biopsy if FNAC is negative in a background of high index of suspicion. |
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FNAC is mandatory for all breast lumps irrespective of age of the patient. |
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Stereotactic Biopsy - For lesions picked up on mammography. |
HEAD & NECK CANCERS
HEAD & NECK CANCERS
Head & Neck cancer refers to a group of biologically similar malignancies cancer that arise in the head and neck region [comprises the lip, oral cavity (mouth), nasal cavity, sinuses, pharynx, larynx (voce box), salivary glands and the thyroid].
Head & Neck Cancer (HNC) ranks sixth amongst all cancer worldwide and it comprises about 40%of all cancer in South East Asia including India.
Advances made in the last few decades in all the fields of oncology (surgical, radiation and medical) has made HNC a better understood and better managed subject. The overall prognosis of HNC is better in comparison to cancer of other sites, if detected early.
List of services
All surgeries related to HNC (viz. mandibulectomy, Laryngectomy, Microlaryngoscopy and laser surgey, Parotidectomy, Thyroidectomy) with greater emphasis in organ preservation and reconstruction.
Medical Programmes
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Cancer screening programmes |
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Cancer awareness/ education programmes |
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Cancer rehabilitation programmes (speech therapy, swallowing therapy) |
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Pain & palliative care programmes for the terminally ill. |
LUNG CANCERS
LUNG CANCERS
Our emphasis is on improving both the survival and quality of life of patients with lung cancer.
Our team of experts in medical and radiation oncology, surgery, pathology and pulmonary medicine, diagnose and treat patients with all types of lung cancer.
The recent advances in Radiation therapy like 4d Gating device and IGRT are specially suited to treat lung tumors which move with respiration.
The behavioral sciences and smoking cessation programs of Max Healthcare are an effort towards cancer prevention in the population and promoting healthy lifestyles.
GI CANCERS
GI CANCERS
Entire gamut of Gastrointestinal cancers ranging from esophageal cancers to colorectal cancers, are treated by a comprehensive team of surgeons, radiation oncologists, medical oncologists, gastroenterologists, radiologists and pathologists.
IMRT is used to target tumor and treat with pinpoint accuracy while sparing sensitive organs like liver, kidneys and spinal cord.
GENITOURINARY CANCERS
GENITOURINARY CANCERS
Carcinomas of the bladder and prostate are managed by a team of urologists and radiation therapy specialists, dedicated to providing the highest quality screening, treatment and care based on a complete picture of the patient.
Latest techniques of IMRT and IGRT provide a technological edge with documented improved survival and side effect profile.
GYNECOLOGIC CANCERS
GYNECOLOGIC CANCERS
The Max Cancer Centre has a multi-disciplinary team approach to provide counseling, screening and treatment for cervical, uterine and ovarian cancers.
The HPV Vaccine is a part of the prevention programme. Brachytherapy and External radiation therapy are two modes of radiation therapy for cervical cancers.
Radical Hysterectomy is performed for cervical cancers in early stages.
SARCOMA AND CONNECTIVE TISSUE CANCERS
SARCOMA AND CONNECTIVE TISSUE CANCERS
Sarcomas of the bone and soft tissue are treated by combination of surgery, radiation and chemotherapy.
Limb salvage surgeries are performed by experienced surgical oncologists, orthopaedic surgeons and radiation oncology.
Physical rehabilitation therapy is an integral part of Limb Salvage programme.
Radiation therapy is the use of high energy X Rays (called ionizing radiation) to destroy cancer cells and shrink tumors. About half of all people with cancer are treated with radiation therapy, either alone or in combination with other types of cancer treatment.
The department of radiation oncology is equipped with the latest state- of- art equipment to deliver highly precise radiation therapy to achieve better tumor control and also to reduce radiation dose to surrounding normal organs. It helps to reduce some of the side effects associated with radiation therapy.
At Max Cancer Centre, we have acquired one of the most sophisticated Radiation therapy equipment, - the NOVALIS TX with ROBOTIC ON-BOARD IMAGER and CLINAC Ix to achieve desired dose to the tumor with minimum side effects. |
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| The three-Dimensional Conformal Radiation Therapy (3DCRT) is an advanced form of external beam radiation therapy that uses computers to create a three-dimensional (3D) picture of the tumor using high definition software. |
IMRT incorporates two distinct features over 3DCRT; 1) inverse treatment planning i.e. where we feed the dosage to be delivered to a particular area and let the computer plan the treatment, and 2) computer-controlled intensity modulation of the radiation beam. It has distinct advantages in treating irregular shaped tumors especially if the tumor is located near critical organs. |
Tumors can move between treatment sessions. The change in the position of tumor can be tracked with a CT image (called Cone Beam CT), just before the treatment delivery and the appropriate corrections are made online. The imaging information from the "planned CT" scan done earlier is overlapped on this Cone Beam CT. This is called IGRT (Image Guided RadioTherapy). IGRT further helps to improve the delivery of radiation. In some cases, tiny gold markers are implanted in or near the tumor to pinpoint it for IGRT. |
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The department of radiation oncology is supported by highly skilled medical physicists and radiotherapy technologists to plan and execute complex radiation plans. |
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NOVALIS TX with EXACT-TRAC & ROBOTIC ON-BOARD IMAGER
NOVALIS TX with EXACT-TRAC & ROBOTIC ON-BOARD IMAGER
| It is used for tracking tumors online to enable highly accurate treatments for moving tumors like lung, liver, prostate etc. |
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| Benefits of Novalis TX Radio surgery: |
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Offers ultra fine beam-shaping capabilities to match the exact contour of the tumor thus ensuring that the maximum prescribed dose is delivered to the entire tumor. |
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Non-invasive, outpatient procedure, which reduces likelihood of tumor movements thus ensuring the highest possible level of treatment accuracy. |
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Employs a wide range of treatment modalities, ensuring patients receive the best possible individualized treatments. |
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Frameless radiosurgery offers a more patient friendly alternative to other radiosurgery devices that require immobilization with a head ring attached to the skull. |
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INTEGRATED MRI-BRAIN SUITE AND NOVALIS TX WITH EXACT-TRAC
INTEGRATED MRI-BRAIN SUITE AND NOVALIS TX WITH EXACT-TRAC
| It is the only facility of its kind in India which provides comprehensive treatments for Brain and Spinal Tumors. |
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MRI guided Neurosurgical suite-where neurosurgery is directly under the guidance of MRI in the Operation Theater. |
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Novalis TX Exact-Trac for frame based and frameless |
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Stereotactic RadioSurgery (SRS) and Stereotactic RadioTherapy (SRT). |
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RAPID ARC
RAPID ARC
TREATMENT OF MOVING TUMORS WITH 4D GATING DEVICE
TREATMENT OF MOVING TUMORS WITH 4D GATING DEVICE
| It helps in avoiding unnecessary radiation to the normal organs which move with the breathing motion while treating the tumor accurately e.g. Carcinoma lung |
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PET-CT GUIDED RADIATION PLANNING
PET-CT GUIDED RADIATION PLANNING
| PET scan is able to differentiate between active and inactive tumor and PET guided Radiation planning helps in treating only the active (viable) tumor with high accuracy. It helps in reducing side effects of Radiotherapy substantially. |
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COMPREHENSIVE BRACHYTHERAPY FACILITY
COMPREHENSIVE BRACHYTHERAPY FACILITY
| It is with high dose rate remote afterloading equipment (MicroSelectron HDR) including facility for Intraoperative Brachytherapy. |
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To provide the best care to cancer patients by correct alignment of laboratory and clinical approaches. To maintain the highest quality integrated programs in patient care and training of medical professionals and in cancer screening.
The Department of Medical Oncology recognizes the heavy burden that cancer places on the patient and the community. Our endeavor would be to provide the foremost leadership in the care of patients with malignancies and contribute to solving the cancer problem.
The department of Medical Oncology offers diagnosis and treatment for the entire gamut of solid tumors (breast, lung, colon, ovary etc.) and hematological malignancies (lymphomas, leukemias, multiple myelomas etc.) affecting both adults and children.
The different treatments offered are -
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Neoadjuvant and Adjuvant Chemotherapy |
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Immunotherapy |
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Palliative chemotherapy |
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Autologous and allogeneic bone marrow/peripheral blood stem cell transplants |
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A significant proportion of patients receive combined modality treatment with radiotherapy and chemotherapy often concurrently. Patients' needs extend far beyond treatment administrations to take care of complex medical, psychosocial and supportive care needs. Medical oncology works closely with a range of supportive care departments, including psychology, social work, nutrition, occupational therapy, palliative care and physiotherapy.
We work in multidisciplinary teams and are committed to evidence-based practice and clinical research. The Department is also committed to ensuring that patients receive optimal supportive care (including psychosocial care). Many patients receive chemotherapy (and other treatments) in the day care chemotherapy units.
We are dedicated to quality patient care and bringing into cancer care an innovative approach keeping in mind the latest developments in the world of oncology including molecular techniques and immunotherapies where indicated. |
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PAEDIATRIC ONCOLOGY
PAEDIATRIC ONCOLOGY
Childhood cancer accounts for 1-3% of all cancers. About 35-40 thousand children develop cancer every year in India.
Early diagnosis and appropriate treatment is essential to improve the survival. There is a dramatic improvement in the treatment of childhood cancer in the last 30 years. The 5-year survival rate in children with cancer is nearly 79% (1996-2003).
Combined modality treatment, including chemotherapy, surgery and radiation therapy are required to treat most childhood cancers with good supportive care. |
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| Childhood cancer differs from adult cancers |
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Childhood cancer is mostly related to inherited susceptibility whereas adult cancer is mostly related to exogenous exposure. |
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Response to treatment is better in childhood cancer than adult cancer. |
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Few risk factors are known for childhood cancer therefore less opportunity for primary prevention |
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| List of few common childhood cancers: |
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| Leukemia |
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Leukemia (blood cancer) is a type of cancer where there is abnormal increase in the number of white blood cells. |
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It is the most common childhood cancer. |
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Three types of leukemia are seen in children - acute lymphoblastic leukemia (ALL), the most common type and acute myeloid leukemia (AML) and chronic myeloid leukemia (CML). |
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Common signs & symptoms - long duration fever, bruising, bleeding from gums, joint pain, neck swelling and enlarged liver and spleen. |
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Diagnosis - it is diagnosed by blood and bone marrow examination |
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Treatment - A newly diagnosed ALL is treated with combination chemotherapy. |
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With the present available treatment the survival rate is almost 70-80%. |
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For AML, treatment options are chemotherapy followed by stem cell (bone marrow) transplantation. |
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| Brain Tumours |
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Most common solid tumour in children accounts for almost 20% of all paediatric cancers. |
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Common signs & symptoms - headache, vomiting, abnormal gait, increase in size of head, vision problems etc. |
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Diagnosis - is by MRI brain or CT scan brain and biopsy. |
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Treatment - children with brain tumours are treated with combined modality treatment including surgery, radiation therapy and chemotherapy depending on the type and site of tumour. |
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| Lymphomas |
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Childhood lymphomas are type of cancers which arise in lymph system |
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There are two types of lymphomas - non-Hodgkin's lymphoma and Hodgkin's lymphoma |
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Signs & symptoms - neck or axillary or groin swellings, abdominal mass, fever, weight loss etc |
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Diagnosis - is confirmed by a biopsy from the involved gland. |
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Other investigations like CT scan, PET scan and bone marrow biopsy are necessary for staging the disease. |
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Treatment - combination chemotherapy is the mainstay of treatment +/- radiation therapy. |
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| Other childhood solid tumors are |
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Neuroblastoma, Wilms' tumor, Hepatoblastoma |
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Soft tissue sarcomas |
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Bone tumours |
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Retinoblastomas |
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Germ cell tumours |
HAEMATO-ONCOLOGY
HAEMATO-ONCOLOGY
At Max Cancer Centre a specialized team comprising of haemato-oncologists & radiation oncologists provide state-of-the art treatment for a variety of cancers like lymphomas, leukemia and multiple myelomas.
Bone Marrow Transplant programme would provide high end care to the patients needing this facility.
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