Sir Ganga Ram Hospital, New Delhi, India

Medical Oncology

Introduction

The department of Medical Oncology at Sir Ganga Ram Hospital was started in 1997 & is today one of the pioneering centre of bone marrow transplant (BMT) & clinical research in medical oncology in India. It has made a unique name for itself in a short span of time. The department is involved in management of haematological malignancies & solid tumours. The department treats approximately, 4000-5000 patients every year (with 2000 patients in day care). Emergency services are available round the clock. We are one of the centres of excellence in performing bone marrow transplants (BMT) for which patients come from abroad and allover India. The department is one of the first to conduct autologous as well as allogenic bone marrow transplantation.

The department provides chemotherapy, targeted therapy & immunotherapy. It is also involved in teaching DNB students of various disciplines. The department also participates in medical grand rounds & journal club meetings with the department of medicine. The department regularly conducts Annual Oncology updates & conferences. The department organises free cancer detection & cancer awareness programmes on breast cancer, multiple myeloma, etc. 

The department works to provide quality care to our cancer patients. Medical Oncology today is a dynamic branch where each patient's needs are catered uniquely & where constant monitoring & care is mandatory. The department of Medical Oncology provides following services to cancer patients: - 

1) Chemotherapy of Solid Cancers & Haematological Malignancies: Various solid cancers are managed with adjuvant & palliative chemotherapy regimen. Colorectal Cancer is treated with FOLFOX regimen (Oxaliplatin, Leucovorin, 5 FU) FOLFIRI Regimen (Oxaliplatin, Leucovorin, 5 FU, irinotecan), Capecitabine & new targeted drugs. Cancer of upper GI (Carcinoma Stomach, oesophagus), earlier had very poor prognosis, but the advent of new chemotherapeutic drugs has markedly increased the life span of patients. The commonly used chemotherapeutic drugs are Cisplatin, Leucovorin, 5 FU, Paclitaxel, docetaxel, Oxaliplatin, 

Capecitabine. Carcinoma Breast which is today the commonest cancer in females, is being treated effectively with numerous new drugs, both in adjuvant & metastatic setting. The drugs in use are - Cyclophosphamide, Epirubicin, 5FU, Paclitaxel, Docetaxel, Vinorelbine, Anastrazole, and Letrozole & new Targeted Drugs. Carcinoma Lung, Unknown primary cancer, Primary peritoneal cancer are being treated with Carboplatin & Paclitaxel. Carcinoma lung is now treated with new drugs like - Gemcitabine, Vinrelbine, Alimta & targeted drugs. 

Carcinoma Bladder is treated with Gemcitabine, Carboplatin. Pancreatic cancer & hepatobiliary cancer are treated with Gemcitabine & targeted drugs. Germ cell tumours are treated with Bleomycin, Etoposide & Platinum. Gynecological cancers like - carcinoma endometrium, choriocarcinoma, carcinoma cervix, carcinoma ovary are also treated with new chemotherapeutics drugs. Haematological malignancies treated include non - hodgkin's lymphoma (treated with Rituximab, Cyclophosphamide, Adriamycin, Vincristine, Prednisolone), Hodgkin's lymphoma (treated with Adriamycin, Vinblastine, Bleomycin, DTIC), acute myeloid leukemia (treated with Cytarabine, Daunorubicin, FLAG-Regimen) and acute lymphoid leukemia (treated with Vincristine, L -Asperiginase, Adriamycin, Prednisolone). 

2) Targeted Therapy & Immunotherapy: The Armamentarium of drugs available to Medical Oncologist has been enhanced with availability of targeted therapy in form of Rituximab, Imatinib, Geftinib, Bortezemib, Trastuzumab. These drugs are tumour cell specific, hence are less toxic to chemotherapy and give better quality of life to patients. Rituximab is used in management of non - Hodgkin's lymphoma; Imatinib is magic bullet for CML, and Gefitinib is wonder drug for Lung and Pancreatic Cancer. Bortezemib is being used in Myeloma & Trastuzumab in Breast Cancer, Erbitux (Cetuximab) & Avastin in Colorectal Cancer. Nexavar (Sorafinib) in HCC & Renal Cell Carcinoma. Sutent (Sunitinib) in GIST, RCC. Immunotherapy is being used for R.C.C in the form of interleukin 1-2, Interferon.

3) Stem Cell Transplant - Autologous P.B.S.C.T. Allogenic P.B.S.C.T: We have a bone marrow transplant unit, which was inaugurated in April 2007. Autologous & allogenic peripheral blood stem cell transplants are being performed by the department. Stem cell harvesting is done and high dose chemotherapy given. Patient stays in the hospital till the count is stabilised under the supervision of the oncologist. Twenty-five successfully bone marrow transplants have been performed by the department till date. 

4) Research - Clinical trials on new drugs in cancers & study of molecular biology in blood cancers & solid cancers: Clinical trials are being conducted by the department in various frills Global Sponsors & C.R.O. in Renal Carcinoma, Colon Cancer, Breast Cancer, R.C.C. Cancer-related Anaemia fungal infections, Lung cancer, Neuro Endocrine Cancer. The response, efficacy and safety of new chemotherapeutic and targeted drugs in various solid cancers are studied. Molecular biology in blood cancers & solid cancers - There are many in ~ house/pilot projects in CML, Lung Cancer, Colorectal, and Pancreatic Cancer. Research papers are actively published by department.

5) Teaching- Teaching of DNB students: The department conducts its academic meetings every second Friday of the month at 11 :30AM to discuss important and interesting cases. The faculty conducts grand round meeting every 6 months and conducts lecture classes (Wednesday 3-4 p.m. for DNB students). Clinical demonstration concerning medical oncology and annual updates are conducted to inform about latest development in medical oncology for all specialites. The curriculum of department of medical oncology aims to make trainee independent clinicians with basic training & knowledge of medical oncology. 

6) Patient awareness programmes & community outreach programmes: The department conducts patients free awareness programmes for general public & patients on various cancers like Myeloma, Breast Cancer etc. 

7) Annual Updates on Cancers: The departments is engaged in updating the knowledge on various cancers and their management among patients and doctors. Conferences are actively organised on regular basis. The nineth update in oncology on breast cancer was conducted was 2 December 2007 at the Shangrila Hotel in which Ms. Jennnie Mulford, wife of US Ambassador was chief guest. 

8) Free cancer detection camps: These camps are conducted in different parts of the country, even in remote areas. These help in detecting cancer at an early stage and hence reduce mortality. 

9) Future plans- include expanding research in molecular biology, introducing DNB and PhD.