shaukat khanum
TRANSCRIPT
THE HOSPITAL
Over the past decade, Shaukat Khanum Memorial Cancer Hospital & Research Centre has established itself as a centre of excellence providing comprehensive care free of cost to thousands of indigent cancer patients. This pioneering, state-of-the-art hospital located in the heart of the Punjab was founded by Imran Khan, one of Pakistan's most illustrious cricketers. As a charitable institute, it is funded predominantly from the donations of friends and well-wishers from around the country and across the world.
FAST FACTS
Inagurated December 29, 1994
Founder Imran Khan (Chairman Board of Governors)
Annual budget Rs. 3.3 billion
Financially supported patients
75% (since 1994)
Philanthropic spending Rs. 6.97 billion
Area/Location 20 acres, Lahore (Pakistan)
Beds 115
New registrations 7,981 (Year 2009)
Outpatient visits 124,372 (Year 2009)
Chemotherapy 26,448 (Year 2009)
Radiation treatments 43,307 (Year 2009)
Admissions 6,545 (Year 2009)
Surgical procedures 4,487 (Year 2009)
Pathology tests 2,494,616 (Year 2009)
Imaging studies 132,578 (Year 2009)
Pharmacy Dispensing 792,795 (Year 2009)
Staff 1393 (41 Consultants, Physicians & Surgeons)
HISTORY
Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) is a state-of-the-art cancer centre located in Lahore, Pakistan. It is a project of the Shaukat Khanum Memorial Trust, which is a charitable organization established under the Societies Registration Act XXI of 1860 of Pakistan. The institution is the brainchild of Pakistani cricket superstar, Imran Khan. The inspiration came after the death of his mother, Mrs. Shaukat Khanum, from cancer
Fundraising
Imran Khan made a nation-wide appeal for the collection of funds from a match between Pakistan and India on November 10, 1989 at Gaddafi Stadium, Lahore which raised Rs. 2,902,600. This was followed by a series of more than 50 successful fund raisers held throughout the world. Pakistan's win under Imran's captaincy in the 1992 cricket world cup in Melbourne helped fundraising efforts. He was able to collect one and a half million pounds in just six weeks after the World Cup when the same amount had taken 2 years to collect earlier. He donated his entire prize money of 85,000 pounds for the project. In 1994 when the project required more financing for the ongoing construction, Imran Khan launched a mass contact campaign in which he toured 27 cities in the country and collected Rs. 120 million. During the entire campaign for the construction of the hospital, over a million individual donors from ordinary citizens to the rich and famous pitched in. Everything from cash to jewelry and valuables was donated.
SOURCES OF FUNDS - PHASE I
Donations 67%
Credit and Loans 33%
EXPENSES - PHASE I
Expenses Pak Rupees US$
Land and Building 231,000,000
Medical Equipment 314,000,000
Ancillary Equipment 132,000,000
Total 677,000,000 22,200,000
Making Of The Hospital
Designing and execution of the master plan was overseen by Dr. Nausherwan K Burki MB, PhD, FRCP, FCPS, FCCP, of the University of Kentucky Medical Center, Lexington, Kentucky, USA in collaboration with an international team of cancer physicians and research workers. Designing and architectural services were provided by Arrasmith, Judd & Rapp, Architects in Health Planning of Louiseville, Kentucky, USA. Architectural details were handled by Messrs. Nayyar Ali Dada & Associates of Lahore. Local engineering was performed by Messrs. Progressive Consultants, Lahore. Ground was broken in April 1991 and the hospital opened its doors on December 29, 1994.
A WORD FROM IMRAN KHAN
Over the years, my faith in the goodness of mankind has increased greatly. Shaukat Khanum Memorial Cancer Hospital & Research Centre is a living tribute to your kindness and generosity. I am personally thankful to all those men, women, children, old and young who have made a contribution to launch SKMCH & RC and who have continued to support us in alleviating the sufferings of the victims of cancer.
We needed your support then and we need your support ever more now. More than Rs. 3.3 billion are required annually to run the Hospital. Almost 50% of our revenue is collected from selling Hospital services. The rest comes from Zakat and generous donations from well-wishers all over the world.
We were able to launch SKMCH & RC because we had your support. I sincerely hope that I can look forward to your continued support to help keep the Hospital running and providing
hope to those victims of cancer who have no other hope for treatment.
Yours faithfully,
Imran Khan
MISSION STATEMENT
To act as a model institution to alleviate the suffering of patients with cancer through the application of modern methods of curative and palliative therapy irrespective of their ability to pay, the education of health care professionals and the public and perform research into the causes and treatment of cancer.
PROJECTS OF SKMT
Being the only cancer centre in the entire region with all the specialized cancer diagnostic and therapeutic facilities the Shaukat Khanum Trust realizes the its colossal responsibilities in its fight against cancer. It has established a number of centres all over Pakistan that help in the awareness, diagnosis and treatment of cancer in Pakistan.
Hospitals:
Shaukat Khanum Memorial Cancer Hospital & Research Centre (Lahore, Pakistan) Shaukat Khanum Memorial Cancer Hospital & Research Centre (Karachi, Pakistan) Land
Purchased, Planning in progress Shaukat Khanum Memorial Cancer Hospital & Research Centre (Peshawar, Pakistan) Planning
in progress
Outreach Cancer Screening Clinics:
Shaukat Khanum Karachi Clinic ( Karachi , Pakistan ) Shaukat Khanum Peshawar Clinic ( Peshawar , Pakistan ) Community screening service ( Lahore , Pakistan )
Diagnostic Centres:
Shaukat Khanum Diagnostic Centre ( Lahore , Pakistan ) Shaukat Khanum Diagnostic Centre ( Karachi , Pakistan )
Pathology Collection Centres:
56 Shaukat Khanum Pathology Collection Centres (all over Pakistan )
BOARD OF GOVERNORS
The Board of Governors of the Shaukat Khanum Memorial Trust comprises of bankers, researchers, businessmen and physicians.
Mr. Imran Khan (Chairman) Dr. Nausherwan Khan Burki Mrs. Aleema Khanum Dr. Uzma Ahad Mr. Ashiq Hussain Qureshi Mr. Sarfaraz Ahmed Rehman Mr. Zain ul Hassan Shabbir Mr. Mujahid Hamid Mr. Mansoor A. Javed Dr. Tauseef Ahmed
Professor Jeffery Lucas Mr. Saifuddin Zoomkawala Mian Arshad Alam Mr. Ali Habib Mrs. Marriana Karim Mian Muhammad Abdullah Mr. S. M. Muneer Mr. Liaquat H. Merchant Mr. Munir Kamal Mr. Irfan Mustafa
MANAGEMENT
Dr. Faisal Sultan, Chief Executive Officer Dr. M. Aasim Yusuf, Medical Director Mr. Tariq Azam, Director Marketing & Resource Development Mr. Muhammad Fareedullah Qureshi, Chief Financial Officer Mrs. Virginia A. Gumley, Director Nursing
FINANCIAL STATISTICS
Revenue (Rs. In Millions)1994- 2009
YearHospitalServices
Zakat DonationsOther
IncomeTotal
Revenue
Dec 2009 * 1,281 865 602 40 2,788
Dec 2008 1,125 646 460 37 2,268
Dec 2007 954 535 486 33 2,008
Dec 2006 750 438 273 34 1,495
Dec 2005 573 265 320 29 1,186
Dec 2004 424 397 368 33 1,222
2003-2004 374 287 238 14 913
2002-2003 261 244 178 15 698
2001-2002 234 152 174 17 577
2000-2001 211 131 190 15 547
1999-2000 139 117 152 17 425
1998-1999 113 100 129 11 353
1997-1998 90 99 103 11 303
1996-1997 62 117 105 7 291
1995-1996 35 109 87 18 249
1994-1995 5 46 85 5 141
Financial year changed from June 30 to Dec 31 in December 2004. Therefore, December 2004represents 12 months results - 06 Months from Financial year ended June 30, 2004 and six months ended December 31, 2004.
* Draft figures
(Click here for exchange rates)
Operating Expenses (Rs. In Millions) * For The Year 2009
Category Amount Percentage
Salaries and benefits - medical staff 584 24%
Salaries and benefits -admin staff 222 9%
Medicines 476 20%
Pathology, Nursing & Other Supplies 537 22%
Utilities 62 3%
Fundraising expenses 43 2%
Finance costs 60 3%
Repairs and maintenance 136 6%
Other Operating Expenses 267 11%
Operating expense 2,389 100%
* Operating Expenses for the year ended December 31, 2009.* These are draft figures and subject to audit.
PATIENT STATISTICS
YearPatients
RegisteredOutpatient
VisitsAdmissions
Chemotherapy Treatments
Surgical Operations
Radiation Therapy
Imaging Studies
Pathology Tests
*1994 - 1999
25,862 125,009 9,092 57,400 6,778 79,373 92,916 1,408,358
2000 3,014 40,325 2,599 9,600 1,531 17,033 26,703 392,120
2001 3,656 49,511 3,102 9,322 1,847 22,170 31,462 565,717
2002 3,093 49,270 3,309 11,690 1,828 25,059 36,138 664,763
2003 3,486 54,190 3,668 12,839 2,268 26,149 45,025 878,330
2004 4,219 69,023 4,177 15,377 2,750 32,318 62,657 1,148,224
2005 6,570 76,736 4,910 15,868 3,795 36,326 80,455 1,411,930
2006 7,696 87,534 5,134 18,206 4,080 39,545 95,646 1,762,116
2007 9,125 112,714 6,023 23,719 4,398 41,463 117,924 2,176,649
2008 9,529 119,037 6,079 23,709 4,514 43,143 128,636 2,368,844
2009 7,981 124,372 6,545 26,448 4,487 43,307 132,578 2,494,616
Total 84,231 907,721 54,638 224,178 38,276 405,886 850,140 15,271,667
* Dec. 1994 - Dec. 1999
Note: 75% of the patients receive financial support.
CLINICAL SERVICES
Anesthesiology Clinical Radiology Medical Oncology
Internal Medicine Nuclear Medicine Pathology Pediatric Oncology Pharmacy Radiation Oncology Surgical Oncology
ANESTHESIOLOGY & PAIN MEDICINE
Medical StaffFull Time Consultants:Dr. Muhammad Zafar Khan MBBS, FCARCSI Head of the DepartmentDr. Mian Muhammad Yaqub MBBS, FFARCSI
Visiting Consultants:Dr. Syed Zia Haider MBBS, FCPSDr. Ahmad Khan MBBS, FCPS
Facilities & ServicesAnesthesia Department at Shaukat Khanum Memorial Cancer Hospital & Research Centre provides anesthesia to a wide variety of surgical patients inside the four operating rooms.Anesthesia is also provided in MRI suit, where a state of the art MRI compatible anesthesia machine and monitoring is used for safe conduct of the diagnostic test. Sedation and anesthesia is provided in Endoscopy unit for either Gastro-esophageal or pulmonary interventions. Sedation and anesthesia is also provided for vascular coiling and for neuro-interventional radiology. Other areas for activity are sedation for Radiation simulations in children in the dept. of Radiation Oncology.
Our practice is as wide based as are the demands for anesthesia requirements in different specialties and varied locations through out the hospital. The dept. is well equipped with the latest tools to safely conduct anesthesia and sedation. Operating rooms are equipped with most modern anesthesia machines with availabity of invasive monitoring, We are in the process to updating all the older equipment in the operating rooms and the PACU ( post anesthesia care unit) to the most modern equipment available.
Wide variety of interventional pain procedures including Radiofrequency Nerve and Joint Ablations as well as permanent neurolysis for cancer pain are routinely performed. Interventional Pain Service with dedicated pain nurse provides a wide variety of solutions to patients in sever pain
TrainingThe dept. has 10 Resident Doctors positions, Training is provided as per collage of physicians and Surgeons Pakistan curriculum. Departmental academic activity includes daily patient rounds, weekly presentations, weekly interactive problem based anesthesiology meeting, weekly Journal Club meeting and fortnightly M& M meetings
Trainees get training for Invasive monitoring, Fibro-optic intubations in a wide case mix of clinical scenarios, both inside as well as out of operating rooms.
Research
1. Comparison of Quality of Pain control in patients having Total Knee Replacement with epidural infusion consisting of morphine with preservative compared to epidural infusion consisting of preservative free morphine.
2. Comparison of degree of pain relief with continuous epidural infusions containing 0.125% Bupivacaine with epidural infusions containing 0.125% Bupivacaine and Morphine.
3. Quality and duration of analgesia after Pulsed Radiofrequency ablation of the Glossopharyngeal nerve in patients with Oral cancer and Glossopharyngeal Neuralgia.
4. Comparison of recovery and quality of analgesia between inhalational anesthesias compared to total intravenous anesthesia in patients having Brachytherapy.
Awards, Certifications & AffiliationsThe Department of anesthesiology is recognized for full four year training programme for FCPS (Anesthesiology) and MCPS (Anesthesiology) degrees by the College of Physicians and Surgeons of Pakistan
INTERNAL MEDICINE
Medical Staff
The Internal Medicine Department currently has 11 consultants (6 full time and 5 part times) from different specialties.
Cardiology Dr. Faiz Ur RehmanEndocrinology Dr. Syed Abbas RazaGastroenterology Dr. M. Aasim Yusuf Dr. M. Qayyum KhanHospital Medicine Dr. Ahsan AzharDr. Haroon HafeezInfectious Diseases Dr. Faisal Sultan Dr. Hammad NazirNeurologyDr. Ahmad FawadNephrology Dr. Nauman Tarif Pulmonology Dr. Faheem Mahmood ButtPalliative CareDr. Haroon Hafeez MRCP/FCPS Trainees There are twenty four Part II positions.
Facilities & ServicesCancer Screening ClinicsExecutive Health Clinics
Consultation and Inpatient Services in the areas of :
General Medicine
Infectious Diseaseso Febrile neutropaenia serviceo HIV infectiono The Infectious Diseases service is in the process of obtaining recognition as a
training site leading to the FCPS in Infectious Diseases.
Cardiovascular Diseaseso Echocardiography Exerciseo Treadmill Testing
Pulmonary Medicine o Bronchoscopy with lavage and biopsyo Transbronchial biopsyo Laryngoscopyo Pleuroscopyo Foreign body removal
Critical Care Service o Modern ICU with facilities for mechanical ventilation and invasive monitoringo Staffed by fully qualified respiratory technicians and ICU nurseso Supervision by a full time Intensive Care Specialist
Gastroenterology The department runs daily Consultant run clinics for GI disorders.
o Liver DiseasesThe hospital is a referral center for cirrhosis and its complications. Consultants are well-versed in innovative and comprehensive therapies for liver disease including complications of cirrhosis. The Hospital is a tertiary referral center for primary liver cancer or hepatocellular carcinoma.
o Medical, surgical, and radiological specialists cooperate closely to diagnose and treat all types of liver disease and disorders including liver masses. Staff have extensive experience with relatively uncommon hepatobiliary procedures including resection of biliary tract cancer, resection of liver cancer, ablation of liver cancers using a radio frequency probe and chemoembolization of liver tumors.
o Endoscopy ServicesShaukat Khanum Memorial Cancer Hospital & Research Center provides state of the art diagnostic and therapeutic endoscopic facilities. The purpose-built, endoscopy Unit provides facilities for all endoscopic procedures and is fully equipped with the latest videoscopes and recording systems. A computerized reporting system ensures a permanent record is maintained of all the procedures performed. International standards of cleansing and sterilization of equipment are followed to ensure patient safety.
o Upper GI Endoscopy (oesophago-gastroduodenoscopy) Diagnostic and therapeutic OGD including dilatation, polypectomy, banding, metallic stent placement, argon plasma coagulation (APC) therapy, metallic stent and percutaneous endoscopic gastrostomy (PEG) placement
o Lower GI endoscopy (Colonoscopy) Diagnostic and therapeutic colonoscopy including polypectomy, dilatation, argon plasma coagulation (APC) and metallic stent placement.
o Endoscopic retrograde Cholangiopancreatography (ERCP) Diagnostic and therapeutic ERCP including biliary / pancreatic stone removal and /
or stent placement, both plastic as well as metallic. o Endoscopic Ultrasound (EUS)
Diagnosis and staging of esophageal cancer Diagnosis and staging of pancreatic cancer EUS guided FNA of mediastinal masses/lymph nodes EUS guided pancreatic mass FNA EUS-guided aspiration of cystic lesions Coeliac axis neurolysis for pain control Diagnosis, imaging and treatment of pancreatic pseudocysts
o Other Tests / ProceduresSmall bowel enteroscopy Liver biopsy PEG tube change
Endocrinology Nephrology Neurology
TrainingThe department is recognized for both FCPS and MRCP training in Medicine.The department offers a one year diploma in Respiratory Therapy.ACLS courses.MRCP PACES courses.
ResearchThe department provides an infrastructure, superior teamwork and an excellent environment for the house staff and faculty to be involved in Clinical Research independently and in collaboration with other institutions.
Selective publications from House staff and faculty.
Awards, Certifications & AffiliationsThe Department of Medicine is working towards JCIA recognition.
NUCLEAR MEDICINE
Medical StaffThe Department has full time Consultant Nuclear Physician, Fellow, Resident Doctors, Medical Physicists, Cyclotron Engineers, Radio Pharmacists, NM nursing staffs, Transcriptionist, Technologists and Unit Coordinator.
Facilities & ServicesDepartment of Nuclear Medicine has two Dual Head Gamma Cameras, Nuclear Medicine Hot Lab for Gamma Imaging Radiopharmaceuticals, Cyclotron, PET Hot Lab, Philips Gemini ToF16 slice PET-CT Scanner and Heli-Probe for Diagnostic purposes.
Around 7000 procedures are performed per annum. The annual turnover of Thyroid Cancer Outpatient Clinic is 850patients/year. Radioablative Iodine Therapy is offered as an inpatient service to about 60 patients per year. More than 100 patients are given Radioactive Iodine Therapy for Hyperthyroidism yearly. The Nuclear Medicines Studies available are:
CardiologyMyocardial Perfusion Studies (MIBI Stress & MIBI Rest)MUGA for Ventricular Function
Urinary SystemDynamic Renal Studies (DTPA & MAG3)DMSA Renal Scan
Hepatobiliary SystemCholescintigraphy (HIDA)RBC labeled Liver Scintigraphy (Hemangioma)Liver-Spleen ScanSpleen Scintigraphy
Gastrointestinal SystemUrea Breath TestGastrointestinal Bleeding ScanMeckel’s DiverticulumEsophageal & Gastric Motility Studies Salivary Scan
Central Nervous SystemCerebral Perfusion Imaging
Endocrinology
Thyroid Scans (Tc0499m & I-131 post therapy scan)Parathyroid ScanAdrenal Scan
Infection and InflammationGallium Scan (Sarcoidosis & Infection)Labeled White Cell ScanThree Phase Bone Scan
Pulmonary SystemLung Perfusion ScanVentilation ScintigramQuantitative Lung Scan
Molecular ImagingMIBG Scan Octreotide Scan (Neuroendocrine tumors) F18-FDG PET-CT Scan*
OncologyGallium 67 Whole Body ScanBone ScanI-131 Whole body ScanScintimammographyMIBI for Non-Specific Tumor Imaging Lymphatic SystemSentinel Lymph Node Scintigraphy for Breast CancerLymphoscintigraphy
TherapiesRadioactive Iodine Therapy for Hyperthyroidism and Thyroid Cancer.Strontium-89 Palliative Pain Therapy
(* F18-FDG PET-CT Scanner will be functional shortly)
Training
The department of Nuclear Medicine offers full four years of FCPS II training for resident doctors, post FCPS one year fellowship in Nuclear Oncology/ Nuclear Medicine, training and research facilities to M.Sc. (Nuclear Medicine and Medical Physics) fellows from the Pakistan Institute of Engineering and Applied Sciences (PIEAS University) and to M.Sc. (Physics) students from the University of Punjab (PU), Lahore. Department is also actively involved in teaching and training of BSc in Medical Imaging from Bradford University. Department also offers 4 or 8 weeks elective rotation for Medical College students. Students from College of
Pharmacy PU come to the department for observing and attending lecture on radiopharmaceuticals preparation and handling. Clinical rotation of nursing for Diploma in Oncology/Cancer Nursing is also entertained.
Research
Three research projects of trainees are underway apart from the other miscellaneous research activities. Every year abstracts are sent for poster and oral presentations to renowned nuclear medicine societies and research work is presented internationally.
Published Papers“Pleomorphic Liposarcoma Metastatic to the Thyroid Gland”Clin Nucl Med 2002; 27:9-10.
“Differentiated thyroid carcinoma in a juvenile patient” Clin Nucl Med 2008; 33:319-20.
“Abdominal Tuberculosis Diagnosed on Gallium Scintigraphy in a child with Pyrexia of Unknown Origin” Ann King Edward Med Col 2005; 11: 575-6.
Poster and Oral Presentations“Managing Juvenile differentiated thyroid carcinoma: Our Experience from 1994-2008”Accepted at the 56th SNM Annual meeting to be held from 13th to 17th June 2009 in Toronto, Canada.
“Oncological Imaging with Ga-68 PET: The story so far…”Accepted at the 56th SNM Annual meeting to be held from 13th to 17th June 2009 in Toronto, Canada.
“Recombinant TSH (rhTSH) use in pediatric differentiated thyroid carcinoma (DTC) patients” 37th Annual Scientific meeting of the BNMS to be held in Manchester, April 2009.
“Preoperative cardiac risk stratification with Gated myocardial perfusion scintigraphy (G-MPS) for non-cardiac surgery in cancer patients”37th Annual Scientific meeting of the BNMS to be held in Manchester, April 2009.
“Clinical utility of I-131 MIBG in patients with neuroblastoma: 8 years experience” 39th Annual Scientific Meeting of ANZSNM to be held in April 2009, Sydney Australia.
“Judicious Use of Recombinant TSH in Management of Differentiated Thyroid Carcinoma in a Developing Country and Charity-based Hospital Setting” 8th INCTR meeting held at Anatalya, Turkey from March 22nd to 24th 2009.
“Sentinel lymph node biopsy in the treatment of early breast cancer: Experience in 300 cases”
J Pak Med Assoc 2008; 58 No: 12S: S25.
“Correlation between serum thyroglobulin levels done prior to baseline I-131 whole body pre-therapy scan and frequency of radioactive iodine therapy in juvenile differentiated thyroid carcinoma”J Pak Med Assoc 2008; 58 No: 12S: S23
“Low dose Gallium Scintigraphy in the diagnosis of Sarcoidosis” 94th Scientific Assembly and Annual Meeting of RSNA 2008.
“Recombinant TSH in management of differentiated thyroid carcinoma: Five year experience 2003-2008” 9th Asia Oceania Congress of Nuclear Medicine & Biology, at New Delhi, India held from 31st October to 4th November 2008.
“Sentinel lymph node detection in bilateral early breast cancer patients” 9th Asia Oceania Congress of Nuclear Medicine & Biology, at New Delhi, India held from 31st October to 4th November 2008.
Clinical usefulness of low dose Gallium scintigraphy in the diagnosis of Sarcoidosis. 9th Asia Oceania Congress of Nuclear Medicine & Biology, at New Delhi, India held from 31st October to 4th November 2008.
“Correlation between serum Thyroglobulin levels prior to baseline I-131 whole body pre-therapy scan and frequency of radioactive iodine therapy in juvenile differentiated thyroid carcinoma” Joint International Conference of the CPSP and Bangladesh College of Physicians held at Dhaka, Bangladesh from 21st October to 23rd October 2008.
“Sentinel lymph node detection in early breast carcinoma patients: A single center preliminary experience” Eur J Nucl Med Mol Imaging 2008; 35 (Suppl 2): S289
“Clinical significance of Somatostatin Receptor Scintigraphy in follow up of Medullary carcinoma thyroid patients with hypercalcitoninaemia”Eur J Nucl Med Mol Imaging 2008; 35 (Suppl 2): S265
“Clinical usefulness of rhTSH aided Radioactive Iodine (RAI) treatment of patients with differentiated thyroid carcinoma” Eur J Nucl Med Mol Imaging 2007
“Assessment of pulse rate as initial predictor of final outcome of Radioactive Iodine (RAI) therapy in patients with hyperthyroidism”Eur J Nucl Med Mol Imaging 2007
“High dose radioactive iodine I-131 therapy for treatment of hyperthyroidism in Pakistani patients: A single center experience” Proceeding of 9th World Congress of Nuclear Medicine & Biology, Seoul, Korea 2006.
“Differentiated Thyroid Cancer (DTC: A Single Center Experience in Pakistan)” Eur J Nucl Med Mol Imaging 2004; 31: ppS436.
“Recombinant human thyrotropin for Iodine-131 therapy in management of differentiated thyroid carcinoma: A single center case series from Pakistan” Eur J Nucl Med Mol Imaging 2005; 32: ppS197.
“Patients with Differentiated Thyroid Carcinoma: A 10-year experience from Pakistan” Eur J Nucl Med Mol Imaging 2005; 32: ppS222.
“Attenuation of Ionizing Radiation by Water and its Impact on Image” Pakistan Journal of Science 2003; 55: 4-9.
“Verification of Thyroid Uptake Calculations and Calculation of Radiation Absorbed Dose to the Thyroid Gland from Tc-99m thyroid uptake scans” Pakistan Journal of Scientific Research 2002; 54: 3-4.
“Impact of Pixel Size on Resolution of Gamma Camera” Pakistan Journal of Scientific Research 2003; 55: 1-4.
“Correlative Study of Gallium-67 Uptake in Histological Variants of Non Hodgkin’s Lymphoma”Eur J Nucl Med and Mol Imaging 2007.
Awards, Certifications & Affiliations
The department of Nuclear Medicine is recognized by the College of Physicians and Surgeons of Pakistan for the full four years of FCPS II training. FCPS-II final examination (April 2009) was held at SKMCH & RC. Trainees are encouraged during their due course for research awards and fellowship grants.
INCTR Poster Award, Abstract selected for 3rd Scientific Writing Workshop of INCTR to be held in fall 2009. CYP-APPNA & YPPRC Award for poster presentations December 2008.ARCCNM Award for oral and poster presentations The 9th Asia Oceania Congress of Nuclear Medicine & Biology, at New Delhi, India held from 31st October to 4th November 2008.PET-CT training fellowship with EANM Marie-Curie Training Grant at Clinical PET Center, St. Thomas’ Hospital, London, United Kingdom, 2007.ARCCNM Award for oral presentation at the 9th World Congress of Nuclear Medicine and Biology, Seoul, Korea 2006.
UICC ICRETT Fellowship Award in Nuclear Oncology at Royal Free Hospital London, United Kingdom for project “Radioimmunotherapy in Non-Hodgkin’s Lymphoma” 2006
PATHOLOGY
Medical StaffThe department is staffed by highly trained pathologists, certified by the American Board of Pathology and Royal College of Pathologists with sub-specialization in areas of oncologic pathology, cytopathology and hematopathology.
All the lab staff works under the close supervision of these pathologists, residents and the laboratory manager to ensure reliability, accuracy and promptness of lab test results.
Facilities & ServicesThe department comprises Anatomical Pathology, Clinical Pathology and the Blood Bank
The department consists of fully functional Anatomic and Clinical Pathology sections. Anatomic Pathology includes surgical pathology including frozen section diagnosis facility and cytopathology which includes FNA procurement and analysis.
One of the specialized areas of anatomic pathology is Immunohistochemistry, which is offered by only a few centers in Pakistan. Clinical pathology includes hematology, immunology, transfusion medicine, clinical chemistry, microbiology, coagulation, and molecular pathology. The hematology service provides prompt and accurate diagnosis through microscopic bone marrow and peripheral blood analyses and flowcytometry.
The laboratory facilities are modern with up-to-date, state of the art automated equipment and procedures.
Fully active programs in clinical specialties and sub-specialties provide material for approximately 39000 surgical specimens, 9000 cytological cases, 2500 bone marrows and 2300000 clinical tests annually.(Based on 2008 figures).
The Shaukat Khanum Cancer Hospital laboratory provides a very high quality, prompt and reliable diagnostic service for both cancer and non-cancer diseases the lab facilities are also available to the general public through a nationwide network of collection centres.
The departments engages in Quality Assurance Systems including a Quality Control Program, Quality Control Protocols, Equipment and test kit validation, Peer review and the laboratory information system, which are integral parts of the laboratory function.
Range of services include:
Hematological studies and coagulation profiles Bone marrow evaluations and Flow Cytometry Full range of clinical chemistry Hormonal studies Drug levels Tumor markers Serologic tests Microbiology - using standard and automated culture detection methods PCR for HBV, HIV, HCV Genotype for HCV Histopathology including Immunohistochemistry Frozen sections Cytopathology Electrophoresis Separation of blood components including Packed Red Blood Cells, Fresh Frozen Plasma and
Platelets Platelet and granulocyte aphaeresis Screening of all donated products for HIV, malaria, syphilis, Hepatitis B and C
The Department of Pathology operates a STAT lab at Karachi, for Routine Chemistry, Hematology and Routine Microbiology.
TrainingThe Department of Pathology conducts a one year Post Graduate Diploma Program in Medical Laboratory Technology in Clinical Pathology.
The Faculty comprises Pathologists, MolecurBiologists, Microbiologist and Senior Medical Technologists.
ResearchAll areas in anatomic and clinical pathology engage in developmental and research activities. Shaukat Khanum Cancer Hospital laboratory has been acting as the “Central lab” of the region for multinational clinical trials.
The Department of Pathology works in close collaboration with the Basic Sciences Department of the Research Wing of SKMCH&RC
Awards, Certifications & Affiliations
The Department of Pathology at SKMCH&RC is recognized by the College of Physicians and Surgeons of Pakistan for FCPS-II training in Anatomic Pathology.
The Department of Pathology is ISO 9001-2000 (QMS) certified and is registered with the College of American Pathologists in their External Survey Program for proficiency testing.
PAEDIATRIC ONCOLOGY
Medical Staff
Paediatric Oncology is staffed by three full time Consultant Paediatric Oncologists, one Paediatric Hospitalist (part time), Six Fellows and Nine Medical Officers
Facilities & Services
The SKMCH&RC Pediatric Oncology department takes approximately 300 new cancer patients every year. These patients are then given the most up-to-date treatment for the large majority of childhood cancers following international protocols. Around 7,000 outpatient appointments are made every year to evaluate those undergoing treatment and to follow-up others who have completed theirs. The department participates in local and international trials and has an active teaching program for its doctors and nurses.
A child with cancer needs very special attention: good medical care and constant nurturing in addition to unconditional support for his or her family as well. At Shaukat Khanum Memorial Cancer Hospital, our team of doctors, nurses and supportive services strive to provide the best possible care for children with cancer. The aim is not only to provide cancer treatment but also to improve the lives of those who receive it. Department sub-sections:
Inpatients The Pediatric Oncology department shares a 31-bed Inpatient Ward with the Adult Oncology Department with an average of 20-25 children admitted at any time. Intensive care unit (ICU) facility is also available for children requiring such care.
Chemotherapy Bay The department has a 10-bed day unit where outpatient chemotherapy is provided to 35-40 patients every day.
Clinics Outpatient clinics for cancer patients are held on a daily basis. There is a formal long term follow up clinic where children, who are long term survivors of cancers are followed up with a view not only to oversee the late toxicities of cancer treatment, but also to help these individuals’ integration into society. There is also a General Clinic for non-cancer children (mainly for employees’ children) as well as a Pediatric Surgery clinic.
Training
The department runs a three year fellowship programme for paediatrcians wishing to undertake specialist training in Paediatric Oncology. Training format is fashioned in line with the Paediatric Oncology specialist training in the UK. During the three year period, fellows are provided specialist training by direct teaching, work experience in various disciplines of Oncology ( Paediatric Oncology, Radiation Oncology, Lab Haematology). At the end of the three year programme, a fellowship certificate is awarded which is widely respected nationally and internationally.
DION: Paediatric oncology is an integral part of the diploma in oncology nursing. Consultant physicians actively participate in teaching/training the nursing students enrolled in the diploma programme
Research
The department actively carries out clinical and basic research; both in-house and in collaboration with international bodies such as INCTR.
Two such studies are:
1. Understanding the problems faced by parents of children with Retinoblastoma prior to treatment (INCTR trial)
2. Transcriptional profiling of Hodgkin’s Lymphoma; Relationship to EBV status, histological subtype and geographical locale
Awards, Certifications & AffiliationsAffiliation to INCTR CCLG UK
PHARMACY
Medical StaffThe Pharmacy Department is staffed with a full-time Manager Pharmacy, two Senior Pharmacists, Nine full-time staff Pharmacists, Pharmacy Technicians and Pharmacy Support Officers.
Facilities & ServicesThe Pharmacy Department is a full service centralized inpatient hospital pharmacy. Services are provided for all inpatients as well as those patients served by our outpatient service departments and clinics.
A restricted Hospital Formulary approved by the Pharmacy & Therapeutics Committee and the Medical Staff is used within the hospital. The Pharmacy Department maintains a complete and comprehensive computerized patient drug profile on all patients. A unit dose drug distribution system is used throughout the hospital with computerized dispensing cabinets to reduce the potential for medication errors. Clinical consultations are provided for patients and physicians as requested. Although drugs are commodities which have significant implications for cost, the effectiveness and safety of their use in all patients is one of the most important components of health care. As such, the appropriate, safe, and cost-effective use of drugs is the primary concern of the pharmacy. Specifically, the department of pharmacy is responsible for:
The specifications of quality for procurement of all drugs The preparation and distribution of all drugs. The control and management of drug costs. The monitoring and assurance of quality of drug use. The evaluation of drug literature and the communication of drug and disease related
information. The application of professional and scientific principles in the selection, use,
administration and monitoring of drug effectiveness for all patients.
The Department of Pharmacy provides pharmaceutical care to both inpatients and outpatients. Clinical pharmacists function as integral members of health care teams at SKMCH&RC, working with physicians to achieve desired therapeutic outcomes, prevent or minimize drug-related problems, and improve medication use. Currently, 2 clinical pharmacists, including 2 new positions added in a year 2009 (in all areas of SKMCH&RC), practice full time providing direct patient care services, work collaboratively with other health care professionals and direct the control of medication administration and drug distribution in the ward. In addition, an online clinical pharmacy practice module implemented at SKMCH&RC. This module expands the role of the clinical pharmacist beyond pharmacy operations, enabling them to participate in direct patient care activities.
Pharmacists actively participate in the development, implementation and enforcement of drug use guidelines, policies and procedures, help to ensure appropriate use of high-risk medications, and serve on quality improvement committees throughout the institution. Specific departmental programs help assure cost-effective and appropriate use of high-risk or high-cost medications.
Another feature, which distinguishes our Pharmacy department from the rest, is the ability to provide Total Parental Nutrition to those patients who are not on natural diet. The SKMCH&RC Pharmacy also provides this service to other hospitals, which don’t have this facility. The pharmacy department provides comprehensive leadership within the hospital for any and all matters relating to drugs or drug therapy. It is the mission of the pharmacy to excel in the provision of pharmaceutical care to our community and hospital.
TrainingDepartment of Pharmacy takes keen interest in providing training and educational services that can be gauged from the periodical Pharmacy News Letter and the compiled Hospital Formulary. We have a comprehensive Internship program for fresh pharmacy graduate from various Universities of the country as well as foreign Pharmacists.
ResearchPharmacy is actively involved and participated in all clinical research studies conducted at SKMCH&RC. Pharmacy is responsible to manage the drug storage, preparation, dispensing and drug accountability.
Department of Pharmacy also conducted in-house research including medication errors, drug utilization review; clinical efficacy of new drug added in the formulary and also headed patient care related research in collaboration with local universities scholars.
Awards, Certifications & AffiliationsThe Department of Pharmacy is ISO certified and working towards Joint Commission International Accreditation (JCIA)
RADIATION ONCOLOGY
Medical StaffThe Department is staffed with five radiation oncologists with site specialization , each treating a specified cancer.The Department of physics is staffed with six medical physicists one radiation dosimeterest and fourteen radiation technologists.There are three radiation nurses and three nursing assistants.
Facilities And ServicesThe department is equipped with two Linear Accelerators with dual energies both photons and electrons (photons from 6mv to 15 mv and electrons from 4 mev to 15 mev).One of the linear accelerator is capable of delivering IMRT (intensity modulated radiation therapy, and both machines has the capability of treating patients with precise conformal radiation treatment planning techniques.
We have Cobalt 60 unit ideal for treating advanced head and neck cancers and palliative radiotherapy for boney metastasis.
Facility for treating patients with gynecological cancers with Brach therapy is also available.We have a CT simulator and conventional simulator.
The department is equipped with state of the art three dimensional radiation treatment planning system.
Facility of a mould room for mould fabrication with Cerroband blocks is available were manual blocking is required during radiation treatment.
TrainingThe department of radiation oncology is recognized for fellowship training programme in radiation therapy by College of Physicians and Surgeons Pakistan. We have nine posts for resident doctors who are trained to sit in FCPS II examination at the end of their training period.Training of students for B.Sc. in medical imaging affiliated with Bradford University is also done.
Awards, Certifications & Affiliations
The Department of Radiation Oncology at SKMCH&RC is recognized by the CPSP for FCPS II training.
SURGICAL ONCOLOGY
Medical StaffFull TimeDr. Aamer Ali Syed - Golorectal, Hepatobiliary, Gynaecologic and Upper GI SurgeryDr. Amina Iqbal Khan - Breast SurgeryDr. Raza Hussain - Maxillofacial SurgeryDr. Ahsan Shamim - Orthopedic SurgeryDr. Irfan Ahmed - Urological Surgery
VisitingDr. Muhammad Usman Khan - Urological SurgeryDr. Zia ul Meraj - Pediatric SurgeryDr. Abdul Hameed - Plastic and Reconstructive SurgeryDr. Raja Pervaiz Akhtar - Thoracic SurgeryDr. Ali Raza Khan - Thoracic and Vascular SurgeryDr. Kamran Hussain - NeurosurgeryDr. Saleem Malik - Gynecologic SurgeryDr. Zahid Kamal - Ophthalmic Surgery
Facilities & ServicesShaukat Khanum offers four modern theatre suites with excellent CSSD facilities. The operation theatres are well equipped to allow a wide range of surgical procedures in all available specialties.
TrainingThe Department currently offers a one year fellowship in Breast Surgery
ResearchResearch projects are currently underway in the treatment of breast, colorectal, gastrointestinal, maxillofacial and musculoskeletal tumors.
ABOUT CANCER
What Is Cancer?
Cancer refers to any one of a large number of diseases characterized by the development of abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal body tissue. Cancer can spread throughout your body.
Cancer refers to any malignant tumor. There are many types of cancers which can occur in nearly every organ. The pattern of growth of cancer cells often resembles a twisted and distorted version of the tissue that is arising. Before we proceed, there are a few basic terms which must be defined.
A tumor means a swelling or mass. A tumor can be benign or malignant.
Benign to a tumor which does not have the potential to spread beyond the organ it arises.
Malignant refers to a tumor which has the ability to spread or metastasize beyond the organ from which it arises.
Broadly speaking, cancers can be divided into four major categories:
1. A carcinoma is a cancer which is derived from the lining cells, or epithelium, of an organ. There are 4 major types of epithelium in the body (Glandular, squamous, transitional, and pseudostratified). Some types are only found in a few select organs such as the lung (pseudostratified) or urinary bladder (transitional). Carcinomas can arise from any of these epithelial types. For example, breast carcinoma is most commonly derived from the lining cells of the milk producing glands. A carcinoma with a glandular growth pattern is an adenocarcinoma. Common adenocarcinomas include prostate, colon, and breast. A carcinoma with a growth pattern resembling the squamous lining cells is termed a squamous cell carcinoma. Common squamous cell carcinomas are found in the esophagus and skin. However, any of these organs may have either type of carcinoma arising from it, although these latter diagnoses are exceedingly rare.
2. A sarcoma a cancer derived from the soft tissues of the body. Soft tissues include the fat, muscle, nerves, and connective tissue support. Although not usually soft, it also includes bone and cartilage.
3. A lymphoma a cancer derived from the white blood cells that are present in the lymphoid tissues of the body. These sites most commonly include the lymph nodes and spleen. However, lymhomas may arise from any organ and body site.
4. A melanoma a cancer derived from melanocytes. These are the pigment producing cells present in the skin. A mole is a benign growth of melanocytes.
Being diagnosed with cancer can be frightening. But understanding what's going on inside your body can help you feel more in control of your disease.
Who Gets Cancer?
Cancer doesn't discriminate when it comes to race, sex or age — anyone can get cancer. The ACS estimates that half the men and one-third of the women in the United States will develop cancer in their lifetimes. The ACS estimates that about 1.4 million new cases of cancer are expected in 2007, and about 560,000 people will die of the disease.
What Causes Cancer?
Cancer begins with damage (mutations) in your DNA. Your DNA is like a set of instructions for your cells, telling them how to grow and divide. Normal cells often develop mutations in their DNA, but they have the ability to repair most of these mutations. Or, if they can't make the repairs, the cells often die. However, certain mutations aren't repaired, causing the cells to grow and become cancerous. Mutations also cause cancer cells to live beyond a normal cell life span. This causes the cancerous cells to accumulate.
The initial genetic mutation is just the beginning of the process by which cancer develops. Scientists believe you need a number of changes within your cells in order to develop cancer, including:
An initiator to cause a genetic mutation. Sometimes you're born with this initial genetic mutation. Other times a genetic mutation is caused by forces within your body, such as hormones, viruses and chronic inflammation. Genetic mutations can also be caused by forces outside of your body, such as ultraviolet (UV) light from the sun or cancer-causing chemicals (carcinogens) in your environment.
A promoter to cause rapid cell growth. take advantage of genetic mutations created by initiators. Promotors cause cells to divide rapidly. This could lead to a tumor. Promoters could be inherited, could come from inside your body or could come from outside your body.
A progressor to cause cancer to become aggressive and spread. Without a progressor a tumor may remain benign and localized. Progressors make cancers more aggressive and more likely to spread. Like initiators and promoters, progressors could be inherited or they could come from environmental sources.
Your genetic makeup, forces within your body, your lifestyle choices and your environment can all set the stage for cancer or help complete the process once it's started. For instance, if you've inherited a genetic mutation that predisposes you to cancer, you may be more likely than other people to develop cancer when exposed to a certain cancer-causing substance. The genetic mutation begins the cancer process, and the cancer-causing substance could play a role in further cancer development. Likewise, smokers who work with asbestos are more likely to develop lung cancer than smokers who don't work with asbestos because the two carcinogens both play roles in cancer development.
What Increases Your Risk of Cancer?
While doctors have an idea of what can put you at risk of cancer, the majority of cancers occur in people who don't have any known risk factors. Factors known to increase your risk of cancer include:
Your habits Certain lifestyle choices are known to increase your risk of cancer. Smoking, drinking more than one drink a day (for women) or two drinks a day (for men), excessive exposure to the sun or frequent blistering sunburns, and having unsafe sex can contribute to cancer. You can break these habits to lower your risk of cancer — though some habits are easier to break than others.
Your family history About 10 percent of cancers are due to an inherited condition. If cancer is common in your family, it's possible that mutations are being passed from one generation to the next. You might be a candidate for genetic screening to see whether you have inherited mutations that might increase your risk of cancer. Keep in mind that having an inherited genetic mutation doesn't necessarily mean you'll get cancer.
Your health conditions Some chronic health conditions, such as ulcerative colitis, can markedly increase your risk of developing certain cancers. Talk to your doctor about your risk.
Your health conditions Some chronic health conditions, such as ulcerative colitis, can markedly increase your risk of developing certain cancers. Talk to your doctor about your risk.
Warning Symptoms And Signs of Cancers
1. A sore or ulcer that does not heal, increases in size, bleeds or becomes painful2. Change in bowel or bladder frequency, change in color of stool, diarrhea or
constipation; blood in urine or stools.3. Unusual bleeding or discharge in urine or stools; discharge (particularly if blood
stained) from any part of the body, e.g., nipples, urethra or vagina; bleeding after sexual intercourse, bleeding in between menstrual cycles.
4. Thickening or lump in breast, scrotum or elsewhere in the body5. Indigestion or difficulty in swallowing or feeling full after eating only a small amount
of food.6. Obvious change in a wart or mole7. A cough that persists; hoarseness or change in the voice; a cough that does not go
away; blood in the sputum8. A white or red patch in the mouth, lasting more than four weeks.
Reference: http://www.inctr.org/publications/2007_v07_n04_w01.shtml
How Does Cancer Grow?
Normal, healthy cells in your body grow in a very orderly and well-controlled way, living for a set period of time and then dying on schedule. When a normal cell dies, your body replaces it with another normal cell. Cancer cells grow in an uncontrolled manner. They forget to die and
therefore the diseased cells accumulate. One malignant cell becomes two, two become four, four become eight, and so on, until a mass of cells (a tumor) is created. Tumors remain small until they're able to attract their own blood supply, which allows them to obtain the oxygen and nutrients they need to grow larger.
Not all tumors are cancerous, and not all cancers form tumors. For example, leukemia is a cancer that involves blood, bone marrow, the lymphatic system and the spleen, but doesn't form a single mass or tumor.
Cancer can also spread (metastasize) and invade healthy tissue in other areas of your body.
Cancer can take decades to develop. By the time a cancerous mass is detected, it's likely that 100 million to 1 billion cancer cells are present, and the original cancer may have been dividing for five years or more.
How To Diagnose
The only way to diagnose cancer is to examine the cells under a microscope. Some imaging tests, such as computerized tomography (CT) or mammography, can indicate the possible presence of cancer by showing an abnormal mass, but cancer can be definitively diagnosed only by looking closely at the cancer cells under a microscope.
Your doctor uses a surgical process called a biopsy to get a sample of suspect tissue.
Under the microscope, normal cells look uniform, with similar sizes and orderly organization. Cancer cells look less orderly, with varying sizes and without apparent organization.
Find out more. Please click on the following links for more information on symptoms, research, treatment and other aspects of cancer:
American Institute For Cancer Research National Cancer Institute Fred Hutchinson Cancer Research Center Abramson Cancer Center, University of Pennsylvania AMC Cancer Research Centre
How To Live A Healthy Life
Eat Less:
In animal studies, reducing calories increased life expectancy and delayed age-related disease.
While this hasn't been proven in humans, we do know that modest reductions in total fat, saturated fat and cholesterol help maintain a healthy weight... and reduce the risks for diabetes, cardiovascular disease and stroke -- three leading causes of premature death.
Helpful:
Eat several small meals during the day instead of three large ones... or eat from a smaller plate so that it appears you have more food.
Put your fork down after every bite. This encourages you to eat more slowly, giving your stomach time to signal your brain that you are full.
Boost Your Consumption of Fruits and Vegetables:
A diet rich in produce halves your risk of developing certain cancers.
But that doesn't mean you're restricted to broccoli and apples. Every week, try to buy at least one fruit or vegetable that you've never tried before and integrate it into your regular meals.
Examples: Mango salsa with fish or chicken... tomatillos in salad... or red, yellow and orange peppers mixed with cilantro and a bit of vinegar for an interesting salad.
Consume Less Fat:
Limit your total fat intake to 30% of the calories you get each day. Limit saturated fat -- from animal products, such as butter, eggs, meat and regular milk -- to 10%.
Quit Smoking And Drink Only Moderately:
One recent study of Kentucky centenarians found that none currently smoked, and only one had done so in the past. None of them used alcohol excessively.
Take a Daily Nutritional Supplement:
This is especially important for older people to ensure an adequate intake of calcium and vitamins B-6, B-12, D and E.
Take a Daily Aspirin Tablet:
One children's aspirin (81 mg) per day reduces your risk for heart attack and stroke.
Walk in the Sun:
Older people especially need regular sun exposure to get enough vitamin D. This vitamin is essential for strong bones and to regulate the sleep-wake cycle. Avoid the sun from 11 a.m. to 3 p.m. and wear sunscreen.
Get Regular Exercise:
It's critical not only for weight control and cardiovascular health, but also for building strong
bones. Each year, about 250,000 older Americans suffer hip fractures. Forty percent of these patients die within one year of sustaining the injury.
Biggest Culprits:
Weak thighs, legs and ankles, which lead to falls. To avoid this.
Track Your Steps:
Wear an electronic pedometer to measure how many steps you take every day. You can purchase a pedometer at a sporting-goods store. Aim for 10,000 steps a day.
Use the bathroom on another floor, walk down the hall to talk to a coworker instead of E-mailing... and park your car in the farthest parking place at the mall.
Get Out The Weights:
Without resistance training, muscle mass decreases by 40% between ages 30 and 70. Consult a personal trainer for a customized weight-training routine.
Regularly using hand weights reduces flab and fragility and increases life expectancy. Ankle weights can help build up your thigh muscles.
Stand on One Foot:
Better yet, learn how to catch a ball while standing on one foot. It improves your balance, which reduces your risk of falling.
Get More Sleep:
Natures own fountain of youth -- human growth hormone -- is produced during sleep. We make less of it as we age, so get as much sleep as you can.
Relax:
Today's world is faster and more complex than ever. Excessive stimulation wreaks havoc on the immune system, setting the stage for such age-related diseases as cancer and hypertension.
Try Eastern relaxation methods -- yoga, tai chi or meditation.
Stay Connected:
People who live with someone else live longer. It may be because there's someone there to care for you if you get sick, to pick up prescriptions and call a doctor. But it also may be that the emotional connection strengthens your own resolution to survive.
Find A Purpose:
People who have goals for which they actively strive live longer and enjoy a better quality of life.
Exercise Your Brain:
Crossword puzzles, computer games, returning to school and writing your autobiography are all good ways to make sure that the most important "muscle" in your body gets exercised.
PATIENT INFORMATION BROCHURES
Cancero Breast Cancer
Breast Cancer Breast Awareness
o Child Cancer o Liver Cancer o Lung Cancer
Diagnostic Test
o Ultrasound Scan o CT Scan o MRI o Mammography
Cancer Treatment
o Having an Operation o Chemotherapy o Radiotherapy
Radiotherapy (Abdomen) Radiotherapy (Chest) Radiotherapy (Head & Neck)
Others
o Post-Mastectomy Exercises o Lymphoedema o After Someone Dies (A leaflet about death, bereavement and grief)
o Clean Food o Clean Hands - Save Lives (Help to prevent the spread of infection)
o Clean Water o Cover Your Cough
CANCER REGISTRY AND CLINICAL DATA MANAGEMENT
Introduction
The computerized Cancer Registry at SKMCH & RC is a data system designed for collection, management, and analysis of detailed data on patients registered at the Hospital. The Cancer Registry at the Hospital has been functioning since the inauguration of the Hospital in December 1994. Every year the Registry generates cancer statistics according to sex, age, demographic area, topography, morphology, stage, grade etc. From December 1994 till December 2003, the International Classification of Diseases, Ninth Revision, Clinical Modification, was used to code the diseases. On January 2004, the Registry implemented the International Classification of Disease for Oncology, Third Edition (ICD-O-3) to code the cancer cases.
Results
During the last fifteen years, a total of 43,908 neoplasms were registered at SKMCH & RC (of which 1,745 were benign and 42,163 malignant). The distributions seen amongst males and females were (49.08% and 50.92%, respectively). About 88.66% tumors were found in adults whereas 11.34% were diagnosed in children. The top three malignancies in all age group and both sexes combined were breast cancer, leukemia, and non-Hodgkin’s lymphoma (NHL). The top three malignancies amongst adult females were: cancers of the breast, ovary & uterine adnexa, and lip & oral cavity, whereas, in adult males, they were lip & oral cavity, liver & intrahepatic bile ducts and non-Hodgkin’s lymphoma.
In adults, regardless of gender, malignant neoplasm of the breast, lip & oral cavity, and non-Hodgkin’s lymphoma, were established as the leading malignancies, whereas, in children, the commonest malignancies were categorized as acute lymphoblastic leukemia (ALL), Hodgkin’s disease, and non-Hodgkin’s lymphoma (NHL).
In the year 2009, a total of 3,836 malignancies were added to the Registry database. Of a total of 3,836 malignant cases, 3,288 (90.98%) were analytical cases, whereas 326 (9.02%) were non analytical cases (Class of case 0 to 2 and 3 to 9 are considered analytical cases and non-analytical cases respectively according to the Facility Oncology Revised Data Standards (FORDS) Revised for 2004). The top three malignancies in all age groups and both sexes combined were breast cancer, lip & oral cavity and liver & intrahepatic bile ducts cancer. In adult males, liver & intrahepatic bile ducts, prostate and lip & oral cavity were the top malignancies whereas in adult females, breast, lip & oral cavity and cervix uteri were the leading malignancies. In children, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma and ALL were the commonest malignancies.
The Registry uses the American Joint Committee on Cancer (AJCC) staging manual for staging all available cancer sites. TNM categorizes cancers in stages 0, 1, 2, 3, 4, and also as unstageable. Amongst 3,288 analytical cases (Class of case 0, 1, 2) , 0.94% cases were staged into stage 0, 13.72% in stage I, 25.15% in stage II, 22.38% in stage III, and 17.97% in stage IV. In 9.15% of the patients, no AJCC stage was defined and 10.68% of the cases were unstageable. In histological grading, 8.00% presented in Grade I, 24.60 % in Grade II, 22.58% in Grade III, 1.13% in Grade IV, and in 43.69% Grade was not determined.