Dr Joyshree Panda

Let’s understand some difficult terms of a cancer report !!!!

Cancer is classified based on the type of tissue or cells from which it originates.

Here are some common terms used to describe different types of cancers:

1. Carcinoma :
- Origin: Epithelial cells, which line the inside and outside surfaces of the body.
- Common Sites: Skin, lungs, breasts, pancreas, colon, prostate.
- Examples:
- Adenocarcinoma - Cancer that starts in glandular tissues, such as the breast or colon.
- Squamous Cell Carcinoma - Cancer that begins in squamous cells, which are flat cells found in the skin and other organs.
- Basal Cell Carcinoma - A type of skin cancer that arises from the basal cells in the lower part of the epidermis.

2. Sarcoma :
- Origin: Connective tissues such as bone, cartilage, fat, muscle, and blood vessels.
- Common Sites: Bones, soft tissues.
- Examples:
- Osteosarcoma - Cancer that starts in the bones.
- Liposarcoma - Cancer that begins in fat cells.
- Leiomyosarcoma - Cancer that originates in smooth muscle tissue.

3. Lymphoma :
- Origin: Lymphocytes, a type of white blood cell involved in the immune system.
- Common Sites: Lymph nodes, spleen, thymus, bone marrow.
- Examples:
- Hodgkin Lymphoma- Characterized by the presence of Reed-Sternberg cells.
- Non-Hodgkin Lymphoma - A diverse group of lymphomas that do not contain Reed-Sternberg cells.

4. Leukemia -
- Origin: Blood-forming tissues, including the bone marrow and lymphatic system.
- Common Sites: Bone marrow and blood.
- Examples:
- Acute Lymphoblastic Leukemia (ALL) - A rapid-growing cancer of the immature lymphocytes.
- Chronic Myeloid Leukemia (CML) - A slow-growing cancer that affects the myeloid cells.

5. Melanoma :
- Origin: Melanocytes, the cells that produce pigment in the skin.
- Common Sites: Skin, but can also occur in the eyes or other organs like a**l ca**l , colon , nasal cavity and in many cases no pigment might be produced and in those cases they are called amelanotic melanoma
- Characterized by: Irregularly shaped, darkly pigmented lesions.

6. Glioma :
- Origin: Glial cells in the brain or spinal cord.
- Common Sites: Brain and spinal cord.
- Examples:
- Astrocytoma : Cancer originating from astrocytes, a type of glial cell.
- Glioblastoma : A highly aggressive form of glioma.

7. Myeloma :
- Origin: Plasma cells in the bone marrow.
- Common Sites: Bone marrow, bones.
- Example: Multiple Myeloma, which affects multiple areas in the body.

8. Neuroendocrine Tumors (NETs) :
- Origin: Neuroendocrine cells, which have traits of both nerve and hormone-producing cells.
- Common Sites: Gastrointestinal tract, lungs, pancreas.
- Example: Carcinoid Tumors often found in the gastrointestinal system and lungs
- Small cell carcinoma , large cell carcinoma , Neuroendocrine carcinoma also arises from Neuroendocrine cells but have high proliferation activity.

9. Germ Cell Tumors :
- Origin: Cells that produce eggs or s***m.
- Common Sites: Testicles, ovaries, sometimes in other areas of the body.
- Examples:
- Seminoma : A type of testicular cancer.
- Ovarian Germ Cell Tumors : Found in the ovaries.

These terms help in understanding the origin, behavior, and treatment strategies for different cancers.
Each type has unique characteristics, treatment options, and prognosis, depending on factors like stage, location, and cellular features.

**"Understanding Biopsies: When and Why They're Done"**

Biopsy is a medical procedure where a sample of tissue is taken from the body for examination. It's usually done to diagnose diseases, especially cancer, or to see how severe a condition is.

For example, if someone has a lump or abnormal growth, the doctor might do a biopsy to diagnose the underlying medical condition.

There are several types of biopsies, each suited for different situations and tissues.
Here are some common types:

1. Core Needle Biopsy : A larger needle is used to remove a core of tissue, providing more cells for a**lysis.

2. Excisional Biopsy : The entire lump or suspicious area is surgically removed for examination.

3. Incisional Biopsy : Only a portion of the abnormal tissue is removed for a**lysis.

4. Punch Biopsy : A special tool is used to remove a small, round piece of skin, often used for diagnosing skin conditions and oral cavity lesions .

5. Endoscopic Biopsy: An endoscope (a flexible tube with a camera and tools) is used to take tissue samples from inside the body, such as the digestive tract.

6. Bone Marrow Biopsy : A needle is used to remove a small sample of bone marrow, usually from the hip bone, to diagnose blood disorders or cancers.

7. Surgical Biopsy : Done during surgery, where a piece of tissue is removed from an organ or other area of concern.

8. Liquid Biopsy : A blood test that looks for cancer cells or pieces of tumor DNA circulating in the blood.

Each type of biopsy is chosen based on the location of the abnormality and the information needed for diagnosis.

Most of the procedures are done under anaesthesia and little discomfort is felt during the procedure. But diagnosis is very important for apt treatment.

Here are some images of various biopsy samples and biopsies under microscope.

Bone marrow aspiration and bone marrow biopsy are both procedures used to collect and examine bone marrow, the soft, spongy tissue inside bones where blood cells are produced.

Bone Marrow Aspiration
After making the area sceptic a needle is inserted into the bone, typically the hipbone or sternum, and a small amount of liquid bone marrow is withdrawn then smears are prepared stained with leisman and pap stain and examined under microscope.

Uses :
- To diagnose type of anemia and differentiate it from other disorders.
- To rule out or confirm leukaemia or multiple myeloma and many other hematologic malignancies.
- To diagnose infections like kala Azar or histoplasmosis and many others .
- Response to treatment can also be assessed.
- Usually from the collected marrow material flowcytometry is done for typing of cancers like AML and its sub classification or ALL and its subclassification and other hematological malignancies .

Bone Marrow Biopsy :
After making the area sceptic a slightly larger needle is used to remove a core of bone marrow tissue from the bone, usually from the hipbone.
-Uses
- Provides more comprehensive information than aspiration alone however it’s used in adjunct in most of the cases
- Biopsy is superior to aspiration in cases like lymphomas where biopsies help us to know what type of marrow infiltration has occurred and further immunohistochemistry can be done for confirmation or typing.
- It helps to know if marrow has metastasis or is involved by cancers.
- It helps in staging of certain cancers and also confirmation of myelodysplastic syndromes as it helps in evaluating bone marrow architecture and gives a better picture.
- It gives a better idea in cases of hypoplastic and aplastic anaemias as in them aspiration may result in dry tap ( that is nothing might have been aspirated) .

Is it done under anaesthesia ?
Yes it’s done under local anaesthesia where the skin and periosteum of bone is anaesthesised by using a small 22 gauge needle and left for 5 minutes and then the procedure is done and patient does not feel pain during procedure.

Does it pain ?
Well answer is during procedure minimal but after procedure it may pain after 3-4 hours and for that drugs are given and this pain goes in 3-4 days.

What are its side effects ?
Rare but yet some people may have bleeding or severe pain at the procedure site .

Bone marrow aspiration needles and bone marrow biopsy needles are shown in the pictures below.

A Rare and Intriguing Case: Castleman's Disease Mimicking Gastric Outlet Obstruction.

In the fascinating world of medical diagnostics, some cases challenge even the most experienced professionals. One such case involved a patient presenting with symptoms of gastric outlet obstruction, leading to a series of unexpected discoveries.

The patient initially exhibited symptoms consistent with an obstruction in both the pancreatic and common bile ducts, coupled with a stricture at the first part of the duodenum. Despite extensive testing, including multiple biopsies, no malignancy was detected. Given the severity of the obstruction, the medical team decided to proceed with Whipple's surgery (pancreaticoduodenectomy).

During the Grossing a firm, white fibrotic area was observed, but no distinct mass lesion was identified. This finding was peculiar, as it didn't align with typical presentations of malignancy or other common obstructions.

The real surprise came during the histopathological evaluation. Instead of cancer, the results revealed Castleman's disease, a rare and enigmatic condition. Castleman's disease, especially in such a presentation, is extraordinarily rare, with only a handful of cases reported worldwide.

This case underscores the importance of thorough diagnostic processes and the unpredictability of medical science. It serves as a reminder that even in the absence of malignancy, rare diseases like Castleman's can present with symptoms that mimic more common conditions, challenging both diagnosis and treatment approaches.

This patient's journey from suspected malignancy to a rare diagnosis highlights the critical role of histopathological evaluation and the intricate complexities of the human body. It’s a testament to the necessity of keeping an open mind and considering rare diseases in differential diagnoses, even when initial findings point towards more common conditions.

When and what symptoms of your body must never be neglected!!!!!

As in today’s world with increase in infectious diseases, chronic diseases and cancer our body gives us warning signals which must never be neglected . So here are a bunch of them and if you feel you have any you have Consult a Doctor!!!!

1. Unexplained Weight Loss:
Since we don’t weigh every day we can’t ourselves guess so we have to see if our clothes are becoming loose or if any friend or family member says you look weak or lean . This is a hidden bomb! Tuberculosis, cancer and many more diseases present in this way.
- Losing weight without any apparent reason can be a warning sign.

2. Persistent Fatigue:
- Ongoing fatigue that doesn’t improve with rest can be indicative of an underlying issue.

3. Pain:
- Persistent or unexplained pain, needs medical attention.

4. Changes in Skin:
- Noticeable changes in moles (anywhere) or skin patches, such as changes in color, size, or shape.
In hands, legs, soles and palms are often neglected and a treatable disease becomes a palliative one.

5. Unusual Bleeding or discharge:
- Post menopausal bleeding : Ladies tend to neglect this sign and here occurs delay in diagnosis.
- Bleeding during passing of stool: it’s not piles always.
You must meet the doctor for these signs and get a Pap smear or re**al examination or colonoscopy or endoscopy done depending on symptoms as early diagnosis is the key to vast treatment options.

6. Lumps or Swelling: All lumps are not bad. Some could be just swellings, some could be infections and some others could be benign tumours and lastly few could be cancerous growths so
- Any new lumps or swelling, anywhere in the body for example breasts, thyroid, testicles, lymph nodes, or soft tissues must be examined and FNAC has to be done from the swellings to confirm the nature! As I always say early diagnosis is the key.

7. Persistent Cough or Hoarseness:
- A cough that doesn’t go away, especially if it’s accompanied by blood has to be evaluated.
- Any change in voice has to be examined.

8. Changes in Bowel or Bladder Habits:
- Persistent constipation, diarrhea, changes in stool size, or blood in the stool must be evaluated.

9. Difficulty Swallowing:
- Persistent difficulty in swallowing or feeling of food being stuck in the throat or chest needs to be evaluated or examined by laryngoscopy .

10. Unexplained Fever or Night Sweats:
- A fast majority of diseases have this symptom of Persistent fever or night sweats or evening rise of temperature and must not be treated with over the counter drugs as you can suppress the symptom and not the disease.

11. A non healing ulcer: Be it in skin or tongue or mouth any non healing ulcer has to be examined and biopsied to know the cause.

Importance of Early Detection

Early detection of cancer or any disease significantly increases the chances of successful treatment and recovery.
Regular screenings, being aware of your body, and consulting a doctor at the first sign of trouble are key to early treatment.

Final Advice :
Talking to doctor and getting tests done may make you spend some 100 or 1000 rupees but in long run it saves 10000 and 1000000 and lots of physical and mental sufferings and could be life saving.

Preventing Cancer in Today’s World of Adulteration!!!!

Here are some practical measures to help you maintain a better and healthy life .

1. Eat a Healthy, Balanced Die.:
- Opt for Organic : Whenever possible, choose organic fruits and vegetables to reduce exposure to pesticides.
- Whole Foods : Focus on whole, unprocessed foods. Avoid Maida and refined oil. Avoid or I must say reduce to minimum the usage of packaged and processed items that may contain harmful additives.
-Antioxidant-Rich Foods: Include plenty of antioxidant-rich foods like berries, nuts, and leafy greens, citrus fruits which help combat oxidative stress.

2.Stay Hydrated:
- Drink plenty of clean, filtered water to help your body flush out toxins that is 1.5 to 2 litre for women and 2-2.5 litre for men . Avoid sugary drinks and limit alcohol consumption.( say no to aerated cold drinks)

3. Regular Exercise:
- Engage in regular physical activity to maintain a healthy weight, boost your immune system, and reduce inflammation.

4. Avoid To***co and Limit Alcohol:
- To***co use is a leading cause of cancer. Avoid smoking and exposure to secondhand smoke. Limit alcohol intake, as it can increase the risk of several types of cancer. This limit varies by age and gender yet many articles say up to 2 drinks allowed (120ml) for men and 60ml allowed for women.

5. Be Cautious with Chemicals:
- Minimize exposure to household and environmental chemicals. Use natural cleaning products and be mindful of the materials used in your home and workplace. Those who work in leather industries, coal industries, sugarcane industries, laboratories have to keep them selves updated about the chemicals they are smelling or touching and must use gloves and mask in those risky situations.

6. Regular Screenings:
- Early detection is key.
Participate in regular cancer screenings and health check-ups.
- You can ask your doctor for tests suitable as per your age and lifestyle.

7. Sun Protection:
- Protect your skin from harmful UV rays by using sunscreen, wearing protective clothing, and avoiding excessive sun exposure.

8. Stress reduction :
- Most important point to be discussed and which is neglected by all the youngsters and leading to lot of chronic diseases as well.
- Chronic stress can weaken your immune system.
Practice stress-reducing techniques like yoga, meditation, and deep breathing exercises.

Remember, small changes can make a big difference in the long run. Stay proactive, stay healthy!

Call now to connect with business.

What is FNAC and what is biopsy ???? How are they different and which is more definitive ?

Fine Needle Aspiration Cytology (FNAC) and biopsy are both diagnostic procedures used to collect tissue samples for examination, but they differ in their methods, uses, and the type of information they provide.

Fine Needle Aspiration Cytology (FNAC)

- FNAC involves using a thin, hollow needle to extract a small sample of cells from a lump or mass.
- The procedure is usually guided by palpation, ultrasound, or CT imaging to ensure accurate sampling.

**Use**:
- FNAC is commonly used for accessible and superficial lumps, such as those in the thyroid, lymph nodes, breast, and salivary glands.
- It is minimally invasive and can often be performed quickly and with minimal discomfort to the patient.

**Information Provided**:
- FNAC provides a cytological evaluation, meaning it examines individual cells or small clusters of cells.
- It is useful for identifying cell types and characteristics, such as malignancy, inflammation, or infection.
- FNAC is often used as a preliminary test to determine if further investigation or treatment is necessary.

**Advantages**:
- Quick and less invasive.
- Lower risk of complications, such as bleeding or infection.
- Typically requires no anesthesia or only local anesthesia.

**Limitations**:
- May not provide enough tissue architecture to make a definitive diagnosis.
- Sometimes inconclusive, requiring a follow-up biopsy.

# # # Biopsy

**Method**:
- A biopsy involves removing a larger tissue sample from the body, often using a larger needle (core biopsy) or through surgical excision.
- There are several types of biopsies, including core needle biopsy, incisional biopsy (removing part of the lump), and excisional biopsy (removing the entire lump).

**Use**:
- Biopsies are used for both superficial and deeper masses and organs.
- It is often performed when more comprehensive information is needed, such as the extent and precise type of a lesion or tumor.

**Information Provided**:
- Biopsy provides a histological evaluation, meaning it examines the architecture of the tissue, including cell arrangement and the relationship between different cell types.
- It is crucial for making a definitive diagnosis and determining the nature of a lesion, such as benign vs. malignant, and the grade of a tumor.

**Advantages**:
- Provides detailed information about tissue architecture.
- Can yield a definitive diagnosis and guide treatment planning.

**Limitations**:
- More invasive than FNAC.
- Higher risk of complications, such as bleeding, infection, and pain.
- May require local or general anesthesia.

Summary :

In summary, FNAC and biopsy are both essential tools in the diagnostic process, but they serve different purposes.
FNAC is less invasive and provides a quick, preliminary cytological assessment, while a biopsy is more invasive and provides a comprehensive histological evaluation necessary for a definitive diagnosis.
The choice between FNAC and biopsy depends on the clinical context, the nature of the lesion, and the information needed to guide patient management.

Are all alcoholic beverages harmful ??

Alcohol, or ethanol, is a psychoactive substance. Upon ingestion, it is rapidly absorbed into the bloodstream and metabolized primarily in the liver by enzymes such as alcohol dehydrogenase and acetaldehyde dehydrogenase. These metabolic processes convert ethanol into acetaldehyde, a toxic compound, and subsequently into acetate, which is harmless.

Wine: A Special Case!!!!!

Wine, particularly red wine, is often highlighted for its potential health benefits.
This is largely attributed to its rich content of polyphenols, including resveratrol. Polyphenols are known for their antioxidant properties, which help combat oxidative stress and inflammation in the body. Resveratrol, in particular has potential to activate sirtuins, specifically SIRT1, a protein associated with longevity and metabolic regulation.

What are Sirtuins ?

Sirtuins are a family of NAD+-dependent deacetylases and ADP-ribosyltransferases that play a crucial role in cellular homeostasis. There are seven known sirtuins (SIRT1-7) in mammals, each with distinct functions:

- **SIRT1**: Regulates metabolism, inflammation, and aging processes.
- **SIRT2**: Involved in cell cycle regulation and stress response.
- **SIRT3**: Promotes mitochondrial function and energy production.
- **SIRT4**: Participates in mitochondrial metabolism and insulin secretion.
- **SIRT5**: Regulates ammonia detoxification and urea cycle.
- **SIRT6**: Implicated in DNA repair and glucose metabolism.
- **SIRT7**: Associated with ribosomal RNA synthesis and cellular stress.

Research suggests that moderate consumption of red wine may activate sirtuins, particularly SIRT1, through compounds like resveratrol. This activation is thought to mimic the effects of caloric restriction, a well-known intervention that extends lifespan in various organisms. SIRT1 activation enhances mitochondrial function, reduces oxidative stress, and improves metabolic efficiency, all of which contribute to improved health and longevity.

However, it is crucial to emphasize moderation. Excessive alcohol consumption has detrimental effects on health, including liver disease, cardiovascular problems, and increased cancer risk. The key is finding a balance where the benefits of moderate wine consumption can be enjoyed without tipping into harmful territory.

Practical Recommendation !!!!

1. **Moderation is Key**: Limit alcohol intake to moderate levels. For women, this means up to one drink per day, and for men, up to two drinks per day.
2. **Choose Red Wine**: If you choose to drink, red wine may offer additional health benefits due to its polyphenol content.
3. **Lifestyle Integration**: Combine moderate wine consumption with a healthy diet, regular exercise, and other positive lifestyle choices.
4. **Consult Healthcare Providers**: Always discuss alcohol consumption with your healthcare provider, especially if you have underlying health conditions or are taking medications.

Eastern zone hematology quiz winners 2016!!!

Receiving fellowship certificate from Padhashree Dr Mammen Chandy sir .

How ANA looks in fluorescent microscope !!!

Senior residency days !

Guess the specimen !!!! Grossing of bone tumour !!!!

Posters and presentations

Conference and presentations

When I happened to get an opportunity to visit my school AECS Jadugoda for an ‘Aluminium meet’ and share my experiences and journey.

Fellowship days !!!!!