by DR HITENDRA PATIL

Consultant Surgical oncologist & Director, Suyog cancer clinics, Thane

Exercises after the surgery

Exercises are required for following reasons:

• Avoid deep vein thrombosis
• Improves circulation to muscles
• Light exercises improve healing and prevent hernias.
• Exercises to pelvic floor
• Deep breathing exercises helps in lung expansion, better oxygenation and early recovery
• Ambulation and exercises makes early return to intestinal motility

Recovery time after the abdominal surgery is approximately one month.

During this time you have to avoid lifting and carrying heavy loads (maximum 1-2kg).

The following measures may be taken:

• Sit upright. It may help to sit at the edge of the bed with your feet hanging over the side. If you cannot sit like this, raise the head of your bed as high as you can.
• If your surgical cut (incision) is on your chest or belly, you may need to hold a pillow tightly over your incision. This helps with some of the discomfort.
• Take a few normal breaths, then take a slow, deep breath in.
• Hold your breath for about 2 to 5 seconds.
• Gently and slowly breathe out through your mouth. Make an “O” shape with your lips as you blow out, like blowing out birthday candles.
• Repeat 10 to 15 times,

Circulation exercises

 These help to maintain the blood circulation in your legs whilst you are not so active. This reduces the risk of getting a blood clot (DVT). 

• 

• Keep your legs and ankles uncrossed at all times

 • With your legs stretched out, briskly circle your feet and bend them up and down.

 Do these every hour while you are awake. You can do these when lying down or sitting in a chair

Basic exercises

 Start with exercises sat in a chair: 

• March your knees alternately for 30 seconds.

• Bend and straighten your knees. Hold your knee straight for 10 seconds, keeping your toes pulled up. Repeat 5 times with each leg as you are able.

After 2 weeks post surgery:

you can start exercises for the internal abdominal muscles. The purpose of this exercise is to regain the function of abdominal muscles and to prevent wound hernia. You should do this exercise 5 – 6 days a week.

After 6 weeks of surgery you can start exercises for the external abdominal muscles. The purpose of this exercise is to strengthen your abdominal muscles.

Core Stability Exercises

 Having major abdominal surgery will affect your abdominal muscles and hence your core stability. To improve your core stability, please do the exercises outlined in the following pages. The best position to do these exercises is lying on the floor. However, if you are unable to do so, you could do them lying on a bed. Aim to do them three times a day.

1. Deep Abdominals

• Lie on your back, knees bent, at hip width apart, feet flat

 • Put one pillow under your head

 • Breathe in, gently letting your tummy rise

 • As you breathe out, gently draw your tummy button towards your spine

• Hold for a few seconds, then relax

 • Rest for a few seconds

 • Repeat 3-5 times

2. Pelvic Tilting

 Lie in the same position as shown.

 • As you breathe out and draw your tummy in, gently tilt your pelvis and flatten the small of your back into the bed. 

• Hold for a few seconds, and then relax

• Repeat 3-5 times and gradually build up to 10 times

3. Knee Rolling

Walking & Yoga:

Aim to walk every day gradually increasing the distance. You should aim to be able to walk 30 minutes daily by one to two months after your operation. Start walking on level ground and gradually build up to inclines and uneven ground such as cobble paths. Walking on uneven surfaces requires small changes of direction which can cause some discomfort in the healing abdominal muscles. After two to three months you could consider moderate exercise like swimming or cycling. To progress your core stability exercises you could attend a Yoga or Pilates group. However, seek advice from the group’s instructor about an appropriate level of exercise. If you wish to return to a specific sporting activity please discuss this with your consultant.

You can return to your previous activities after 1 – 2 months.

Exercise summary

Exercises before your operation:

• General exercise

• Deep breathing exercise

• Core stability exercises

Exercises after your operation:

• Getting in and out of bed and walking

• Deep breathing exercises

• Exercises for clearing secretions

• Circulation exercises

• Core stability exercises

Exercises after you have returned home:

• Core stability exercises

• Exercises sat in a chair

• Once comfortable, exercises in standing

• General exercise

Cancer is a disease due to change in our genetic material. Hence such cells are characterized by unrestricted growth of cells that is independent of need, body signals and lack the cell mortality unlike normal cells. so such ever proliferation immortal sort of cells produce a big toll on our body as they consume lots of nourishment instead of other normal vital tissues. Hence cancer is a dangerous disease.

Cancer incidence in our country is on tremendous rise and soon it will be No1 disease as far as total number of affected population and the death toll too. Thus a lot of efforts need to be put in control and more importantly prevention of such disease. Following are the simple measures that can significantly reduce cancer risk.

AVOID TOBACCO:

Tobacco in any form is dangerous and can cause cancers in multiple organs. It is the single largest and preventable cause for cancer. It accounts for almost 40 % of total cancer burden in India. Despite the media publicity and warning signs on cigarette packs and tobacco pouches, the consumption of these products hasn’t yet ceased. Hence a stringent public awareness and deaddiction programs are a must and be made available at multiple accessible places.

HEALTHY DIET:

Diet has a great role in normal growth of an individual. However with the changing trends in food, food habits, food storages, fast food, pesticides, genetically modified animals and plants used in food have greatly increased the risk of cancers.

one need to consume 1/4 portion of diet as raw fruits and vegetables. They provide good antioxidants and vitamins apart from the loads of fiber contents. The vitamins and antioxidants aid in neutralizing the cancer causing agents and fibers in diet reduce the contact period with gut and aids in excretion of harmful substances.

NO ALCOHOL:

Alcohol has become a status symbol for many and habit or addiction for the rest consumers. However both the subset of people do not understand the gravity of issues like cancer which are invited with each peg of liquor. Alcohol is itself harmful for oral cavity, esophagus, stomach, gut, liver and pancreas.

It also increases the solubility of other cancer causing agents and help in their absorption in blood. So its role is not additive but multiplicative in cancer causation. Alcohol habit can only be prevented by public awareness and deaddiction facilities.

EXERCISE:

Daily moderate exercise helps in maintain circulation, muscle activity, good lung and heart compliances. It as well utilizes the stored excess fats and sugars in body and thus keeps the weight under control. Obesity contributes to 15% of cancer load. Exercise is an effective method to keep it under control.

BREAST FEEDING:

The risk of breast cancer is less in the ladies who have breast fed the kids at least for first 6 months. It is a protective factor hence need to be advocated among the young mothers.

VACCINES:

Human papilloma virus causes cervical, anal or perianal cancers, oral and pharyngeal cancers. Thus vaccine against HPV is postulated to prevent these cancers. the two dosages are to be administered to young teens ie 9-12 years ideally and maximum up to 26 years, more importantly to the ladies not exposed to sexual intercourse.

Hepatitis B is also a preventable cause for liver cancer. The vaccine against HBV is effective and time tested.

CANCER SCREENINGHK:

Screening is evaluation of apparently asymptomatic population to find out disease under evaluation. the effective screening detects many early cancers that are curable. Screening may detect pre cancerous conditions or high risk individuals that can be treated in time to prevent cancers completely.

AVOID TOO MUCH SUNLIGHT:

though sunlight is essential source of vit D, excess of it may expose one to the harmful U V rays. UV rays are known to produce skin cancers like Basal cell carcinoma etc. Use of sunscreens and avoiding long exposure to sun may prevent skin cancers

The magnitude of problem globally:

Cancer is a leading cause of death worldwide, accounting for an estimated 9.6 million deaths in 2018.

The most common cancers are:

• Lung (2.09 million cases)
• Breast (2.09 million cases)
• Colorectal (1.80 million cases)
• Prostate (1.28 million cases)
• Skin cancer (non-melanoma) (1.04 million cases)

• Stomach (1.03 million cases)

Cancer is the second leading cause of death globally, and is responsible for an estimated 9.6 million deaths in 2018. Globally, about 1 in 6 deaths is due to cancer.

Approximately 70% of deaths from cancer occur in low- and middle-income countries like India.

The most common causes of cancer death are cancers of:

• Lung (1.76 million deaths)
• Colorectal (862 000 deaths)
• Stomach (783 000 deaths)
• Liver (782 000 deaths)
• Breast (627 000 deaths)

What causes cancer?

Cancer arises from the transformation of normal cells into tumour cells in a multistage process that generally progresses from a pre-cancerous lesion to a malignant tumour. These changes are the result of the interaction between a person’s genetic factors and 3 categories of external agents, including:

• Physical carcinogens, such as ultraviolet and ionizing radiation;
• Chemical carcinogens, such as asbestos, components of tobacco smoke, aflatoxin (a food contaminant), and arsenic (a drinking water contaminant); and
• Biological carcinogens, such as infections from certain viruses, bacteria, or parasites.

Ageing is another fundamental factor for the development of cancer. The incidence of cancer rises dramatically with age, most likely due to a build-up of risks for specific cancers that increase with age. The overall risk accumulation is combined with the tendency for cellular repair mechanisms to be less effective as a person grows older.

Risk factors for cancers

Tobacco use, alcohol use, unhealthy diet, and physical inactivity are major cancer risk factors worldwide and are also the 4 shared risk factors for other non-communicable diseases.

Some chronic infections are risk factors for cancer and have major relevance in low- and middle-income countries. Approximately 15% of cancers diagnosed in 2012 were attributed to carcinogenic infections, including Helicobacter pylori, Human papillomavirus (HPV), Hepatitis B virus, Hepatitis C virus, and Epstein-Barr virus.

Hepatitis B and C virus and some types of HPV increase the risk for liver and cervical cancer, respectively. Infection with HIV substantially increases the risk of cancers such as cervical cancer.

Reducing the cancer burden

Between 30–50% of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies. The cancer burden can also be reduced through early detection of cancer and management of patients who develop cancer. Many cancers have a high chance of cure if diagnosed early and treated adequately.

Modify and avoid risk factors

Modifying or avoiding key risk factors can significantly reduce the burden of cancer. These risk factors include:

• tobacco use including cigarettes and smokeless tobacco
• being overweight or obese
• unhealthy diet with low fruit and vegetable intake
• lack of physical activity
• alcohol use
• sexually transmitted HPV-infection
• infection by hepatitis or other carcinogenic infections
• ionizing and ultraviolet radiation
• urban air pollution
• indoor smoke from household use of solid fuels.

Tobacco use is the single most important risk factor for cancer and is responsible for approximately 22% of cancer-related deaths globally.

Late-stage presentation and inaccessible diagnosis and treatment are common. In 2017, only 26% of low-income countries reported having pathology services generally available in the public sector. More than 90% of high-income countries reported treatment services are available compared to less than 30% of low-income countries.

Only 1 in 5 low- and middle-income countries have the necessary data to drive cancer policy

Dr Hitendra Patil                                                  

Consultant Surgical Oncologist                     

 Website: www.drhitendra.com

Director, Suyog Cancer Clinics.                                    

www.suyogcancerclinics.com   

As we all know the most common cancers affecting males and females are concerned with the diet. The diet brings in the carcinogens in loads inside the human body. Food is though mainly the need but largely a fad too, when we look at the urbanization of diet in our Indian cultures. As do the lifestyle and food, our cancer statistics too are aping the west.

Below is the brief insight into the commonly encountered food items that are strongly related to cancers. Top 10 Cancer Causing Foods: need to know them to cut Cancer Risk significantly:

 1. Genetically Modified Foods (GMOs): 

The rapidly growing industry of genetically modified crops are infiltrating our food supply at an alarming rate. More than 90% of our grains, fruits and vegetables are now genetically modified. This fairly new practice is the source of many debates. Experts agree that adequate testing was not done before GMO foods were added to the ingredient listing of thousands of products. In other words, no one – including the growers and manufacturers of GMO foods – knows the long-term effect they will have on human health. Look for GMO-free labels whenever possible or buy organic (which always means a product is not genetically modified).

 2. Microwave Popcorn: 

From the chemically-lined bag to the actual contents, microwave popcorn is at the centre of lung cancer debates around the world. Not only are the kernels and oil likely GMO (which the manufacturer does not have to disclose) unless organic, the fumes released from artificial butter flavouring contain diacetyl, which is toxic to humans. Make your own organic popcorn the old-fashioned way – it tastes better, doesn’t release toxic fumes, and is a healthier choice for you.

3. Canned Goods:  

Most cans are lined with a product called bisphenol-A (BPA), which has been shown to genetically alter the brain cells of rats. Many plastic goods, thermal paper, water lines, and many dental composites also contain BPA. Help protect your DNA by sticking to fresh or frozen vegetables that have no added ingredients for your family’s table! These are better for you and available year-round.

4. Grilled Red Meat: 

While grilled food can taste delicious, scientists have discovered that preparing meats in this way – especially processed meats like hot dogs – releases a carcinogen called heterocyclic aromatic amines. When you grill red meat to the point of well-done, it changes the chemical and molecular structure of the meat. You’re better off baking, broiling, or preparing meat in a skillet than on the grill.

5. Refined Sugar: 

The biggest cancer-causing food (by far) is high-fructose corn syrup (HFCS) and other refined sugars. Even brown sugar is highly refined white sugar with some of the removed molasses added back in for flavour and colour. Refined sugars (and foods made with them) are the source of major insulin spikes and feed the growth of cancer cells. Since the majority of the sugar supply in the U.S. is made using genetically modified (GMO) sugar beets, a healthier option is organic honey, coconut sugar, or maple sugar.

6. Salted, Pickled, and Smoked Foods:

These products typically contain preservatives, such as nitrates, which are intended to prolong shelf life. The additives used in processed foods can accumulate in your body over time. Eventually, such toxins cause damage at the cellular level and lead to diseases like cancer. When smoked foods are cooked at high temperatures, the nitrates are converted to the much more dangerous nitrites. (Note: By pickled foods we don’t mean the fermented foods you make at home.)

7. Soda and Carbonated Beverages: 

Sodas have been at the centre of the health debate for two decades as a major cancer-causing food. Filled with high-fructose corn syrup (HFCS), dyes, and a host of other chemicals, they are very bad for every aspect of your health. They provide zero nutritional value and rob your body of the nutrients you get from other foods. Adding “diet” to the label means you’re also likely consuming aspartame – which is no better than rat poison to human cells.

8. White Flour:

When flour is refined, all nutritional value is removed. Then it’s bleached with chlorine gas to make it more appealing to consumers. The glycaemic index for white flour is very high – meaning it spikes your insulin levels without providing nutritional fuel. Carbohydrates are converted to sugars by your body, so excessive products that contain white flour can lead to increased insulin resistance. Simple sugars (like refined carbohydrates) are the preferred fuel source for cancer.

9. Farmed Fish: 

Commercial fish farming involves raising an incredible number of fish (such as salmon), in a crowded environment. More than 60% of the salmon comes from a farming operation where they are treated with antibiotics, pesticides, and other carcinogenic chemicals to try and control the bacterial, viral, and parasitic outbreaks that result from cramming so many fish in a small space. Farmed fish also don’t have as much omega-3 as wild salmon.

10. Hydrogenated Oils:

Vegetable oils are chemically extracted from their source, chemically treated, and more chemicals are added to change the smell and taste. They’re packed with unhealthy omega-6 fats (that Americans already consume way too much of) and have been proven to alter the structure of our cell membranes.

 4 Steps to Help Prevent Cancer:

In addition to the 10 foods listed above, also be sure to avoid any food labelled as “diet” “light” or “fat-free.” In order to remove fat or natural calories, they are replaced with chemicals that are dangerous to your body. Instead of consuming food products that manufacturers claim is “good for you” –

Follow these four anti-cancer diet tips to prevent cancer the easy way:

1. Eat organic whenever possible. 

2. Choose raw or clean food items in diet

3. Fill half your plate each meal with non-starchy vegetables. If you eat animal products, make sure they’re pastured and grass-fed meats and dairy goods (including eggs). Use only high-quality oils such as coconut oil, olive oil, ghee, or grass-fed butter.

4.  Cut back drastically on grains and sugars.

Not only will eliminating these foods lower your cancer risk, you’re going to feel (and look) better from the inside out. Now that you know what the top cancer-causing foods are, what are you going to do about their presence in your kitchen and your daily eating plan?

Medicine is the field of health and healing. It includes nurses, doctors, and various specialists. It covers diagnosis, treatment, and prevention of disease, medical research, and many other aspects of health. Medicine aims to promote and maintain health and wellbeing.

A pharmaceutical drug, also called a medication or medicine, is a chemical substance used to treat, cure, prevent, or diagnose a disease or to promote well-being. Traditionally drugs were obtained through extraction from medicinal plants, but more recently also by organic synthesis.

•Cancer treatment involves the medical part and the after care. After care not only means follow up but in addition means re-establishing approximately to pre-treatment normalcy state. As cancer surgeries, chemotherapy and radiation can make a patient physically, vocationally or functionally debilitated, rehabilitation is of utmost important.

•Definition: •Rehabilitation is defined as action of restoring someone to health or normal life through training, therapy or intervention after illness or definitive treatment. •This term was originally used for addicted or imprisoned individuals.