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WHAT IS COLON CANCER?
Colon cancer, rectal cancer, or colorectal cancer is the malignancy of the large
intestine. Malignancy is the overproduction of cells in an unchecked and
uncontrolled fashion. Often it is due to growth of colon or rectal polyp or
unregulated inflammatory bowel disease (Crohns disease or Ulcerative Colitis).

RISK FACTORS FOR COLON CANCER AND REASON TO CONSULT
WITH A LOS ANGELES COLORECTAL ROBOTIC SURGEON.
 The following are predisposing factors related to colon cancer;
 Previous family history of the disease
 Pre-existing rectal polyps
 An underlying inflammatory bowel disease
 Excessive intake of fat, sugars, red meat, and processed meat
 Alcoholism
 Sedentary lifestyle

SIGNS & SYMPTOMS
It mainly depends on the involved area of the large intestine and the extent of disease. A majority of the cases of colon cancers don’t show any symptoms at all. Symptoms, if any, that may appear are;
 Blood in stool
 Changed bowel habits
 Weight loss

 Nausea, vomiting
 Constipation
 Rectal bleeding

DIAGNOSIS & TREATMENT
A complete history and physical examination will lead your doctor to suspicion of
colon cancer.

Your doctor may advise sigmoidoscopy or colonoscopy.

These two procedures allow the doctor to inspect different parts of the colon and may also be used to take the specimen of the suspected area.

Sigmoidoscopy, however, has some limitations in all parts of the colon.
Colonoscopy in turns allows for examination of the entire colon.
Once the biopsy result establishes the diagnosis of colon cancer, a treatment plan is devised for each case differently depending upon the depth and extent of disease. Treatment of the colon cancer focuses mainly on surgical removal of the diseased with or without adjuvant chemotherapy.

Three possible surgical procedures can achieve the goal but each with more
advantages than the previous one.

Conventional open surgery requires a big incision. A surgeon directly operates on the diseased part, cuts it and reunites the both ends of the colon. The wound is closed with a conventional suturing technique. 

Drawbacks of the open surgery outweigh its advantages. 

Delayed wound healing, prolonged hospital stays, incease in pain, late return to normal routine life, and greater chances of infection and future hernias make this approach the least surgery of choice in most of the cases. 
This approach may be necessary in extremely challenging surgeries on patients with extensive abdominal scar tissues and multiple prior surgeries.

Laparoscopy is a moderately advanced surgical option for colon cancer. 

3 to 6 small (keyhole) incisions make this surgery possible. 
 
Tube carrying instruments and camera are inserted via these keyholes. 

A surgeon holds the other end of the tube and operates watching on the screen. 

The goal of the treatment remains the same that is to cut the diseased part, and re-
attach both ends of the colon. 

This procedure is performed by trained laparoscopic surgeons and comprises
several advantages over conventional one e.g., early wound healing, less hospital
stay, early return to routine life, and lesser infections.

Robotic Surgery is the state of the art and super-advanced surgical options
available to a few fortunate in the developed world. 

It uses small keyhole incisions. 

Tubes for the camera are inserted in almost the same manner as in laparoscopy but the difference is that these are attached to robotic arms instead of the surgeon’s hands. The surgeon indirectly operates sitting on console, viewing in 3D, controlling the robotic arms with master controllers. 

This procedure has the following advantages;
 Amplification of a surgeon’s skill
 3D view
 Elimination of tremors
 Full range of motion
 Small keyhole incisions
 Least chances of infection
 Least time of hospital stay
 Earliest return to normal life
 Comfortable Surgeon Position

The following table shows the comparison of these three surgical options.
Attributes Open Surgery Laparoscopic Surgery Robotic Surgery
1.Incision size Big Incision Small keyhole
incisions

Small keyhole
incisions
2.Wound Healing Delayed Early Earliest

3.Return to routine life Delayed Early Earliest

4.Chances of Infection

Higher Lower Lowest

5.Blood loss Highest Lower Lowest
6.Range of motion Limited (Human arm) Limited (Human arm) Full range (Robotic arm)
7.View Direct 2D 3D
8.Hand tremors Present Eliminated
9.Level of advancement Classical Treatment

Moderately Advanced State of the Art, latest

10.Level of expertise Required by surgeon

Normal Higher Highest

CHOOSING THE RIGHT SURGEON
Surgery Group LA (Los Angeles) is a team of highly skilled board-certified
surgeons with vast experience in robotic surgeries, conventional laparoscopic, and open colorectal surgeries. Resection of the diseased part along with the safe cancer-free margins is the goal
of surgery in colon cancer. Achieving this goal via robotic surgery minimizes the associated complications of open surgery. It all adds up to early and better recovery of the patient.

Schedule an appointment with us for the evaluation and recommendations for you or your loved one’s condition so you can make an informed decision.

Pilonidal Cyst; Overview, Cause, and Treatment

Pilonidal cyst, also known as tailbone cyst, occurs at intergluteal cleft (area between two buttock cheeks).

The term pilonidal means nest of hair.

At times, an infection may arise in the cyst resulting in the formation of abscess know as pilonidal abscess.

Cause of the Pilonidal Cyst

Many embryologists consider it as congenital remnants. It is present as a defect at birth in the sacrococcygeal region of the body.

Other argues it to be acquired.  The acquired theory proposes that it arises due to prolonged pressure leading to ingrown hair and debris accumulation.

Excessive sweating increases the moisture in the area that promotes the growth of anaerobic bacteria.

It also explains the reason for its high recurrence and development of this disease in the hands of the barber, sheep shearer, and dog groomers.

Risk Factors of the Pilonidal Cyst

• Male > Female
• Young adults
• Excessive hair in the area
• Occupations
• Drivers (own hair)
• Barber (Customer hair)
• Dog groomer, Sheep shearer (Animal hair)
• Obesity
• Poor hygiene
• Narrow intergluteal cleft
• Family history

Signs & Symptoms

It commonly reports as painful swelling and occasional purulent drainage in tailbone area

Other symptoms are

• An unpleasant smell
• Blood discharge
• Tenderness
• A previous history of  pilonidal cyst
• History of trauma
• Fever
• Excessive moisture in the affected area

Diagnosis & Treatment

A complete history and physical examination mainly establishes the diagnosis rarely requiring advanced investigations.

Treatment of the pilonidal cyst varies with the severity of the disease.

Patients with relatively minor symptoms require a more conservative approach. Strict hygiene with hair removal usually resolves the issue.

An acute infection of the cyst resulting in purulent drainage needs extra attention. Rest, hygiene modification, antibiotic coverage, and local antiseptic dressings are the key measures.

In some cases, it is necessary to perform an incision and drainage of the cyst removing the debris and granulation tissue under general or local anesthesia.

The chronic form of the disease demands a more aggressive management. A surgeon resects the sinus with the cystic lining under general anesthesia.

Choosing the Right Surgeon

Surgery Group LA (Los Angeles) is a team of board-certified surgeons with a vast experience in pilonidal cysts.

Schedule an appointment with us for the evaluation and recommendations for you or your loved one’s condition so you can make an informed decision.

Hernias in the Covid Era

Not all abdominal hernias require surgery and this is particularly true during the Covid lockdown. However, hernias causing pain or intestinal upset can and should be surgically repaired even during the Covid lockdown. During times like these, necessary, urgent, or emergent surgery CAN be performed safely. It is important to avoid delays in medical and surgical treatment. Delays in surgical treatment can result in a worsening of medical and surgical conditions.

An overview of hernia can enhance one’s understanding of it helping in making a decision when to see a doctor and when to go for elective or emergency surgery.

Hernia: Etiology, Diagnosis & Treatment

A hernia is a protrusion of an organ through the wall of the cavity containing it. 

It can appear as a bulge in the abdomen or groin region. 

A defect in the muscular wall holding abdominal contents in place results in an opening or a weak spot in the wall allowing displacement of abdominal fat or intestine.

Etiology

A hernia may develop due to congenital abnormalities or anatomical variations. Physiological conditions and diseases that increase intra-abdominal pressure can further aggravate the underlying problem. These include:

• Persistent cough
• Smoking
• Obesity
• Straining while urinating or defecating, e.g., in constipation
• Heavy weight lifting
• Enlarged prostate
• Abdominal fluid

Types of Hernia & Associated Risk Factors

The following table summarizes types of hernia along with their location, features, and risk factors.

Type of Hernia	Location	Features &Risk Factors
1.Inguinal hernia (Most common)	Groin	MaleOlder adultsSmokersConstipation  patientsPrevious history of hernia
2.Umbilical hernia	At the navel	Babies with premature birth or low birth weights
3.Femoral hernia	Just below the groin	Female>MaleCauses strangulations
4.Hiatal hernia	Upperpart of stomach	Over weightAge over 50
5.Incisional hernia	At the site of a previous surgical incision	Recent  surgeryWeight gain after surgery

Sign & Symptoms

Hernia often presents as a palpable lump under the skin that may or may not be associated with pain.

Sign & symptoms vary with each type of hernia.

A reducible hernia is a hernia that can be pushed back into the abdomen. It can become more prominent with any activity increasing the intra-abdominal pressure, e.g., standing, heavy weight lifting or straining.

However, a non-reducible hernia doesn’t show any variation in size. It is a more chronic form which can lead to strangulation of blood vessels and kinking of the intestine. Nausea, vomiting, and other abdominal symptoms may appear as a result of obstruction.

Treatment

An asymptomatic hernia requires a more conservative approach.

 It includes dietary modifications, changes in lifestyle, exercise, quitting smoking, and some medications. Your doctor may recommend watchful waiting.

A truss is sometimes advised especially for inguinal hernia. It is a belt-like device that aids in the reduction of protruded content.

Surgical treatment for hernia depends on the type of hernia & circumstances and done mainly to prevent complications.

Open surgery repairs the hernia using a big incision pushing herniated tissue back and securing to its original positions often using a mesh to prevent recurrence. 

 This procedure can be performed under local andspinal anesthesia thus avoiding general anesthesia. So it is particularlyadvised to medically compromised patients.

Laparoscopic surgery, is a minimally invasive surgical technique. It uses smaller (keyhole) incisions that allow entry to thin camera and surgical instruments. This technique demands special surgical skills. There are higher chances of recurrence of hernia if an inexperienced laparoscopic surgeon performs the repair.

Laparoscopic surgery has several advantages over open surgery.

It includes;

• Reduced time of hospital stay
• Less chances of infection
• Aesthetics
• Quick recovery
• Fewer complications
• Less chances of bleeding

Robotic Laparoscopic Surgery is the most contemporary technique used for hernia repair. It utilizes keyhole incisions and insertion instruments similar to conventional laparoscopic techniques. Robotic arms are attached to instruments. A surgeon, sitting on the operating console, directly controls the robotic arms. The operating console is equipped with various tools but mainly master controllers and stereo vision.

This state of the art technology further adds the following advantages to laparoscopy.

• Comfortable sitting posture of the surgeon-less likely to be tired
• Full range of motion of robotic arms-a limitation of a human arm
• Elimination of physiological tremors
• Superior cross infection control protocol-less chances of infection

Why Choose Us?

Surgery Group LA (Los Angeles) is a team of highly skilled board-certified surgeons with vast experience in robotic laparoscopic, conventional laparoscopic and open hernia repair surgeries.

 Conservative management and avoidance of surgery is the desired treatment in these patients. This exactly matches our mission statement.

Schedule an appointment with us for the evaluation and recommendations for you or your loved one’scondition so you can make an informed decision.

Melanoma- The Notorious Skin Cancer
Melanoma also known as malignant melanoma is a type of skin cancers. In the US 9500 cases of skin cancers are diagnosed each day. Melanoma represents only 5% of the total number of skin cancers but accounts for the vast majority of skin cancer
deaths in the US. Each year the US spends approximately $ 8.1 billion on skin malignancies out of which $ 3.3 billion is spent on melanoma.

How does Melanoma develop?
Melanoma results from uncontrolled and defective growth of a type of skin cell called a melanocyte. Melanocytes account for the color of skin through the production of a dark pigment called “melanin”. More melanin in skin means more dark color. These cells are also responsible for the development of moles. Exposure to prolonged and high doses of ultraviolet (UV) radiation leads to DNA damage in melanocytes. Most cases of melanoma are related to UV damage by the sun. UV damaged cells start reproducing in an unchecked way leading to malignancy. Genetic mutations running in families can also contribute to the development of melanoma. A previous history of melanoma in the family increases the chances of developing the disease many fold.

Who Is At Risk?
Followings are the risk factors associated with melanoma;
 Fair Skin Color
 Increased exposure to the sun- Risk doubles for those with more than 5
sunburns

 Living in Australia, North America, and Europe
 Age approaching the 70s
 Family history of melanoma
 Presence of moles
 Male gender

Prevention?
Avoiding the avoidable- This is the key practice to prevent melanoma. One can’t change one’s genetic makeup but observe the following;
 Regular checkups 
 Reducing exposure to UV light
 Avoid tanning procedures
 Wear sunscreen of SPF at least 30
 Avoid the sun between 10 am to 4 pm

When to See a Doctor? 
Early signs of melanoma may include a newly developing mole near an existing
mole, or anywhere else in the body. A change in the color of a mole is suspicious too. Unlike the non-lethal benign mole, melanomas have irregular borders and different levels of pigmentation. They grow slowly over time and are somewhat funny looking spots as compared to symmetrical round mole. Favorite sites for melanoma in males are head, neck, and trunk region while in females they tend to develop on arms and legs.

Diagnosis & Treatment
If your doctor suspects a melanoma based on history and clinical examination, a biopsy will be advised.  A biopsy is a procedure in which a small part of a lesion is removed by a physician for examination under a microscope by a pathologist.
Melanoma cells have a typical appearance that can be recognized by an
experienced pathologist. 

A biopsy for a suspected melanoma will either result in a diagnosis of a benign mole, an atypical mole or a malignant melanoma. Benign moles require no further treatment. Atypical moles, otherwise known as atypical melanocytic nevi need to be surgically removed completely. The treatment of malignant melanoma depends on characteristics including the depth of the melanoma. Thin melanomas are generally treated with wide excision of the melanoma with some surrounding normal skin. Thicker melanomas may require removal of some lymph nodes in the area of the melanoma in a procedure known as a sentinel lymph node biopsy. Once a diagnosis of melanoma is made, it will be important to be evaluated by a surgeon with expertise in the management of malignant melanoma. Some patients with more advanced melanoma may need to be seen by a medical oncologist and treated with immunotherapy following surgery.

Prognosis of the Disease
Early detection and treatment of melanoma is the single most important factor in limiting the course of the disease. Timely diagnosed and managed patients have a survival rate of 99% after 5 years. The survival rate drops with an increase in the depth of the lesion and delays in treatment.

Eating kale can decrease your risk of cancer!

That’s thanks to sulforaphane, a substance in kale that has been shown to help fight the formation of cancer at the molecular level.

Eat garlic to prevent cancer!

Sulfur-rich foods, like garlic and cruciferous veggies, can help protect against diseases like diabetes and cancer. Sulfur helps metabolize food and protects your body from inflammation and oxidative stress.

Lower your risk of cancer by eating grapefruit!

Lycopene is an antioxidant in grapefruit that combats the body’s cell aging triggered by harmful free radicals. For the most lycopene, reach for a ruby red.

Click here for more health tips.

Reduce your risk of cancer with broccoli! 

The cruciferous vegetable contains a compound called sulforaphane, which has shown to have anti-cancer properties in multiple studies. 

Eat coriander to get more cancer-fighting antioxidants. 

Compounds in the herb have been shown to lower inflammation as well as slow the growth of cancer cells in the lungs, prostate, breast, and colon. 

Click here to learn more health benefits of this fantastic herb.

Eating flaxseeds could help prevent breast cancer. 

Flaxseeds contain phytoestrogens, which may prevent cancer in the first place – as well as can prevent recurrences. 

Permanent hair dyes could increase the risks of breast cancer.

New research published in the International Journal of Cancer found that women who use permanent hair dye and/or chemical straighteners have a 7% higher chance of getting cancer than those who do not. Surgery Group of LA’s Elizabeth Arena M.D. was asked to comment on it. Dr. Arena said, “Like anything else, this is something that would need to be looked into.”

Click here to learn more about this new finding.

Menopausal night sweats may cause brain fog in women who’ve had breast cancer. 

Research presented at The North American Menopause Society found sleeping longer increases vasomotor symptoms like hot flashes and night sweats, which can increase cognitive decline. 

Hormone replacement therapy (AKA HRT) has been linked with breast cancer.

A new study done at the University of Oxford cautions that doing five years of menopausal hormone therapy increases the incidence of breast cancer in women.

Common household items might contribute to an aggressive form of breast cancer.

Research presented at the Society for Endocrinology conference said that detergents, antiseptics, and some prescribed medications could be the culprits. 

Click here to read more. 

The average age of male breast cancer diagnosis is 56.

In a study published in the ACS Journal Cancer, researchers have found a few differences in how male breast cancer and female breast cancer development.

For instance, male breast cancer tends to occur later in life, and it more commonly moves into lymph nodes, making it harder to treat.

A blood test could soon be used to detect early breast cancer.

Researchers at the University of Nottingham have found that a panel of tumor-associated antigens could be used to do the test – which would be less expensive and easier than mammography! Until then, we suggest getting screened.