Comprehensive Cancer Care Department
How To Reach
Nearest Commercial Airport: Chhatrapati Shivaji Maharaj International Airport, Mumbai, 250kms, Pune International Airport, Pune – 255 kms.
Travelling time required
- 7 Hr’s by road from Mumbai to Sawarde
- 6 Hr’s by road from Pune to Sawarde
Nearest Major Railway Station : Chiplun, Distance in Km -25 kms, Travrling Time:30 Minutes
Nearest Major City is : Ratnagiri, distance in Km 75kms, Traveling Time
Free Medical Oncology Treatment under Mahatma Jyotirao Phule Jan Arogya Yojana for economically backward patients
| Breast | Terminally Ill |
| Multiple Myeloma | Vulval Cancer |
| Wilm’S Tumor | Rectal Cancer Stage 2 And 3 |
| Hepatoblastoma -Operable | Febrile Neutropenia Fn High Risk 2 |
| Cervix | Vaginal Cancer |
| Childhood B-Cell Lymphomas | Ovary |
| Neuroblastoma Stage I –Iii | Small Cell Lung Cancer |
| Retinoblastoma | Ovary Germ Cell Tumour |
| Histocytosis | Gestational Trophoblast Ds. Low Risk |
| Rhabdomyosarcoma | Testis |
| Ewing’S Sarcoma | Prostate |
| Urinary Bladder | Oncologyoesophagus |
| Acute Myeloid Leukemia | Stomach |
| Acute Lymphatic Leukemia | Colon Rectum |
| Unlisted Regimen | Bone Tumors/Osteosarcoma |
| Lymphoma Nhl | Lymphoma, Hodgkin’S |
| Cyclophosphamide / Methotraxate / 5flurouracil | 2nd Line Iv Antibiotics And Other Supportive Therapy(Carbapenems, Fourth Generation Cephalosporins, Piperacillin, Anti-Fungal . Azoles Etc.,) |
| Tamoxifen Tabs – Per month | 1st Line Iv Antibiotics And Other Supportive Therapy ( Third Generation Cephalosporin, Aminoglycoside Etc.,) |
| Adriamycin/Cyclophosphamide (Ac) | Cisplastin/5-FU |
| 5- Flurouracil A-C (FAC) | Carboplastin/ Paclitaxel |
| AC (AC Then T) | Cisplastin/Etoposide (IIIB) |
| Paclitaxel/Docitaxel | Bleomycin-Etoposide-Cisplastin (BEP) |
| Hormonal Treatment – Per month (Letrozole/Tamoxifen) | Actinomycin |
| Bortezomib+Lenoladom ide+Dexamethasone/Cyclophosphamide+Bortezomib+Dexamethasone | Weekly Methotrexate |
| Vincristin, Adriamycin,Dexamethasone (VAD) | Etoposide – Methotrexate – Actinomycin / Cyclophosphamide Avincristine (EMA-CO) |
| Thalidomide+Dexamethasone(Oral) | Bleomycin-Etoposide-Cisplastin (BEP) |
| Melphalan+Thalidomide+Prednisone Oral | Hormonal Therapy – Per month |
| Zoledronic Acid/Pamindronic acid Along With any chemotherapy regime | Cisplastin- 5FU |
| SIOP/NWTS Regimen (Stages I III) – Per month | 5-Fu Leucovorin (MCDONALD Regimen) |
| Cisplastin Adriamycin | 5- Flurouracil-Oxaliplastin Leucovorin (Folfox) (Stage III Only) |
| Cervical Cancer Weekly Cisplastin | Monthly 5-FU/Capacitabine |
| Variable Regimen Inv – Hematology – Payable maximum upto | Cisplatin/Adriamycin/Ifosfamide |
| Variable Regimen Inv – X-Ray/CT Scan – Payable maximum upto/Per month | Adriamycin Bleomycin Vinblastin Dacarbazine (ABVD) |
| Carbo/Etoposide/Vincristin | “Cyclophosphamide Adriamycin Vincristin Prdnisone (CHOP)+Rituximab/Bendamustine+Rituximab/R-CVPChlorambicil+Rituximab/Fludarabine+Rituximab” |
| Variable Regimen Inv – CT, Biopsy – Payable maximum upto | Gemcitabine + cisplatin |
| Vincristin-Actinomycin- Cyclophosphamide (VACTC) Based Chemo – Per month | Brain GBM(Temozolomide) (per month) |
| Variable Regimen Inv – Hematology, Biopsy – Payable maximum upto | Radioiodine ablation therapy for cancer thyroid |
| Bladder Cancer Weekly Cisplastin | Induction 1st And 2 nd Months – Payable maximum upto |
| Methotraxate Vinblastin Adriamycin Cyclophosphamide | Induction 3rd, 4th, 5th months – Payable maximum upto |
| Induction Phase – Payable maximum upto | Palliative Chemotherapy -Unlisted Regimen – Payable maximum upto per cycle |
| Consolidation Phase – Payable maximum upto | Palliative And Supportive Therapy – Per month |
| Maintenance Phase – Per month | Cisplastin/5-FU |
| Maintenance Phase – Per month | Xelox Along With Adjuvant Chemotherapy Of AS-I |
Free Surgical Oncology Treatment under Mahatma Jyotirao Phule Jan Arogya Yojana for economically backward patients
| Hemiglossectomy | Internal Hemipelvectomy |
| Maxillectomy Any Type | Curettage & Bone Cement |
| Neck Dissection Any Type | Forequarter Amputation |
| Laryngectomy Any Type | Hemipelvectomy |
| Laryngo Pharyngo Oesophagectomy | Sacral Resection |
| Thyroidectomy Any Type | Bone Resection |
| Parotidectomy Any Type | Shoulder Girdle Resection |
| Composite Resection & Reconstruction | Limb Salvage Surgery With Modular Prosthesis |
| Hemimandibulectomy | Emasculation |
| Small Bowel Resection | Radical Cystectomy |
| Abdomino Perineal Resection (Apr) + Sacrectomy | Nephroureterectomy For Transitional Cell Carcinima Of Renal Pelvis |
| Closure Of Ileostomy | Radical Nephrectomy |
| Closure Of Colostomy | Partial Penectomy |
| Total Exenterating | Inguinal Block Dissection One Side |
| Whipples Any Type | Other Cystectomies |
| Tripple Bypass | Total Penectomy |
| Anterior Resection | Partial Nephrectomy |
| Abdominoperineal Resection | Bilateral Orchidectomy |
| Other Bypasses-Pancreas | Radical Prostatectomy |
| Gastrectomy Any Type | High Orchidectomy |
| Colectomy Any Type | Retro Peritoneal Lymph Node Dissection(RPLND) (For Residual Disease) |
| Oesophagectomy Any Type | Retro Peritoneal Lymph Node Dissection Rplnd As Part Of Staging |
| Radical Cholecystectomy | Adrenalectomy |
| Splenectomy | Urinary Diversion |
| Resection Of Retroperitoneal Tumours | Anterior/Posterior Exenterating |
| Abdominal Wall Tumour Resection | Total Exenterating |
| Resection With Reconstruction of Abdominal Wall Tumour | Bilateral Pelvic Lymph Node Dissection(BPLND) for CA Urinary Bladder |
| Bilateral Pelvic Lymph Node Dissection(BPLND) | Mediastinal Tumour Resection |
| Radical Vaginectomy + Reconstruction | Lung Metastatectomy. Multiple |
| Total Pelvic Exenterating | Oesophagectomy With Two Field Lymphadenectomy |
| Total Abdominal Hysterectomy(TAH) + Bilateral Salpingo Ophorectomy (BSO) + Bilateral Pelvic Lymph Node Dissection (BPLND) + Omentectomy | Oesophagectomy With |
| Three Field Lymphadenectomy | |
| Maxillectomy + Orbital Exenteration | Tracheostomy |
| Maxillectomy + Infratemporal Fossa Clearance | Ileotransverse Colostomy |
| Orbital Exenteration | Jejunostomy |
| Cranio Facial Resection | Ileostomy |
| Chest Wall Resection | Gastrostomy |
| Chest Wall Resection + Reconstruction | Intercostal Drainage(ICD) |
| Limb Salvage Surgery Without Prosthesis | Gastro Jejunostomy |
| Limb Salvage Surgery With Custom Made Prosthesis | Colostomy |
| Myocutaneous / Cutaneous Flap | Resection Of Nasopharyngeal Tumour |
| Surgery For Ca Ovary Advance Stage | Micro Vascular Reconstruction |
| Vulvectomy | Skin Tumours Wide Excision + Reconstruction |
| Salpino Oophorectomy | Skin Tumours Amputation |
| Mastectomy Any Type | Skin Tumours Wide Excision |
| Axillary Dissection | Wide Excision for tumour |
| Wide Excision of Breast for Tumour | Wide Excision soft tissue/Bone Tumours |
| Chest Wall Resection | Wide Excision + Reconstruction soft tissue/Bone Tumours |
| Lumpectomy Breast | Amputation for soft tissue/Bone Tumours |
| Breast Reconstruction | Marginal Mandibulectomy |
| Oesophageal stenting including stent cost | Segmental Mandibulectomy |
| Submandibular Gland Excision | Total Glossectomy + Reconstruction |
| Tracheal Resection | Full Thickness Buccal Mucosal Resection & Reconstruction |
| Tracheal Resection | Sleeve Resection |
| Parathyroidectomy |
Free Radiation Oncology Treatment under Mahatma Jyotirao Phule Jan Arogya Yojana for economically backward patients
| Palliative Treatment |
| Radical Treatment |
| Adjuvant Treatment |
| Radical Treatment With Photons |
| Adjuvant Treatment With Photons/Electrons |
| Palliative Treatment With Photons |
| A) Intra-cavitary I. LDR Per Application |
| A) Intra-cavitary II. HDR Per Application |
| B) Interstitial II. HDR One Application And Multiple Dose Fractions |
| B) Interstitial I. LDR Per Application |
| IMRT-Up To 40 Fractions In 8 Weeks |
| 3DCRT-Up To 30 Fractions In 6 Weeks |
| SRS/SRT upto 5 fractions |
| VMAT Therapy-Up To 40 Fractions In 8 Weeks |
| IMRT+IGRT-Up To 40 Fractions In 8 Weeks |
| Tomo therapy(Radical/Adjuvant/Neo-adjuvant) |
Details of Cancer Screening Program in collaboration with Tata Memorial Centre
PREVENTIVE ONCOLOGY SERVICES
1. TMCROP (Tata Memorial Centre Rural Outreach Program)
B.K.L.Walawalkar hospital is an outreach centre for TMH since 2003 and has under taken TMCROP Cancer Screening Program in Ratnagiri & Sindhudurg districts during 2003 – 2012
- Mandate of TMH to extend its Cancer Control & Prevention services to the rural areas for the benefit of the underserved population.
- TMH has devoted considerable time and resources towards development of simple cost effective technologies for the early detection of common cancers.
- Thus the aim was to develop a model service programme in the form of a “District Cancer Control Programme” to demonstrate a successful workable model which can be translated in other parts of the country as well as can be integrated in the general Health Care Infrastructure of the country.
- Konkan belt (Ratnagiri & Sindhudurg ) was chosen as it was the most under served in terms of cancer care and prevention facilities. Also more approachable for regular monitoring and surveillance activities.
- Currently cancer screening activity is going on on regular basis
2. Cancer Registry (Ratnagiri + Sindhudurg) collaboration with TMC
Tata Memorial Outreach Programme was started in the Ratnagiri district with the collaboration of BKL Walawalkar Hospital, Dervan in August 2003. The screening program was primarily to screen for detection of head and neck, breast and cervix cancers. Since this screening was an ongoing service oriented activity, it was necessary to follow-up the cases. Thus under these circumstances, it was proposed and initiated to set up the population based cancer registry in the Ratnagiri district. Also, due to the fact that there was no cancer statistics available from the Ratnagiri district. Therefore, establishing a cancer registry was essential. Registry started functioning formally in Feb. 2009.
Project Objective
- Generating reliable data on the magnitude and patterns of cancer – this would be based on Morbidity and Mortality information according to age, sex and residence of the patient, anatomical site of cancer etc.
- Undertaking epidemiologic research, such as case control or cohort studies based on observations of registry data.
- Providing database for developing appropriate strategies to aid in District Cancer Control Programme this would be in the form of planning, monitoring and evaluation of activities under this programme.
- Developing human resource in Cancer registration and Epidemiology.
The project has an excellent potential for community based epidemiological study to identify the risk factors. the registry’s outcome can be improved from time-to-time. The land terrains of Ratnagiri (Konkan area) are difficult to approach and the registry staff have been trained adequately and instructed to maximize the visit to these areas through proper planning prior to the visit.
There was no major cancer hospital in Ratnagiri district. BKL Walawalkar hospital, a General hospital in Dervan, Chiplun taluka has developed into a comprehensive cancer center with the help of Tata Memorial Hospital (TMH), Mumbai, in patient care, service, research and education in cancer.
Registry Methodology
- Follow up – For mortality data – By Household visit, By phone calls
- Quality Control Checks – Duplicate Checks Duplicates checks are done by comparing various fields like name, address, sex, age and site. There are two methods to find out the duplicates – Manual method by using the index card and Electronic method through the software.
- Residence Confirmation – Residence confirmation is done by house visits on given address or through the telephone numbers if available.
- Re-checking – 5 % of the cases are re-approached for collection of information which includes visits to the labs, hospitals, house etc. and the data which is already collected is checked again. This will ensure the correctness of the information.
- HBCR – Hospital Based Cancer Registry was Started on 18th February 2023 and it was inaugurated by Dr. Shripad Banavali & Dr. Mahendra Gulati.
3. Chest Project (cancer of Hypo pharynx Esophagus Screening Trial)-with TMC
Effect of screening with visual examination on oral cancer mortality in Ratnagiri district, Maharashtra – A cluster randomized controlled trial.
Project objective
- To assess the effect of screening using visual examination by trained health workers on oral cancer-related mortality.
- To assess improvement in survival after a diagnosis of oral cancer.
- To identify possible etiological factors in a high risk rural population in Ratnagiri district of Maharashtra.
COMPREHENSIVE CANCER CARE UNIT
MEDICAL ONCOLOGY
The department caters the medical needs of cancer patients and is accompanied by trained residential doctors and full time medical oncologist from Tata Hospital is posted at B.K.L.Walawalkar Hospital to offer chemotherapy facility. The sophisticated medical intensive care unit (MICU) is well equipped with all facilities. This institute has got separate wards for cancer patients where Chemotherapy is administered as per standard as well as locally developed protocols. Chemotherapy is the administration of cytotoxic drugs and more recently biological to destroy the cancer cells. It is one of the multi- disciplinary approaches for the treatment of cancers and has become the mainstay of treatment for almost all malignancies especially in Leukaemia’s (Blood Cancer), Lymphomas, Germ cell tumour and Choriocarcinoma, Cancer Breast and Ovary to name a few. The department on a regular basis gives high dose chemotherapy as per the requirements. Oral Metronomic Chemotherapy is also available.
The following services are offered by the department:
Emergencies are attended round the clock
- Outpatient department
- Day care chemotherapy
- In patient chemotherapy
In Patient Services:
- Nutritional assessment and supplementation to the patients.
- Planning the diets and counselling the patients according to their individual needs, medical conditions and treatment.
- Taking care of the food services by planning different menus for the various diets like liquids, normal diet, diabetic diet etc.., and supervision of the food services and quality check of the food prepared.
Supportive Facilities:
| Radiology services | Laboratory | Inpatient Facilities |
|---|---|---|
| CT Scanner – 2 | Biochemistry | Number of major OT-10 |
| MRI | Haematology & Clinical Pathology | Number of minor OT-8 |
| X-ray unit (digital) -5 | Blood Components & transfusion services | Central Sterilization Services Department (CSSD) |
| X-ray unit (non-digital)-4 | Microbiology &virology | |
| Mammography | Histopathology & Cytology | Pharmacy |
| ECG/EEG | Immunology | In house Pharmacy Services |
| 2D Echo | Genomic analysis | 24*7 pharmacy |
| Ultrasound (non-Doppler) -4 | Immunohistochemistry tumor markers | |
| Color Doppler ultrasound–3 |
VARIOUS SCHEMES FOR CANCER PATIENTS
- Mahatma Jyotibha Phule Jan Aaroya Yojana (cashless treatment for all types of cancers) for orange and yellow ration card holders.
- Indian Cancer Society (cashless treatment for all types of cancers – Annual Income up to 4 lakhs)
- Arun-Kurkure Initiation & Treatment Fund (AKITF) (Initial investigations, diagnosis and primary treatment of cancer – annual income up to 4 lakhs) for curable cancer with good survival
- Rotary Club of Bombay Queen’s Necklace Charitable Trust-(Initial investigations, diagnosis and primary treatment of cancer – annual income up to 4 lakhs)
- Caner Care Fund for investigations and follow ups
- Cancer Nutrition Program free Nutritional Ladoo Distribution by BKLW Hospital
- Walawalkar Health Scheme for patients in below poverty.
- Ila Madan funds (Initial investigations, diagnosis and primary treatment of cancer – annual income up to 4 lakhs)
- Free food program for cancer patients
SURGICAL ONCOLOGY
The Department of Surgical Oncology has expertise to deal with head & neck, thoracic, breast, soft tissue, and gastrointestinal, urologic and gynecologic malignancies. The Surgical Oncology department has a team of qualified and very well trained surgical oncologists who are well accomplished to carry out the complex surgeries on all types of cancers of the body as per the latest approved international standards and protocols. They are ably complemented by the state of the art operation theatres, modern and scientifically updated instruments and machineries. The surgical team is backed by a team of highly trained & competent anesthetists and by a well-equipped post -operative intensive (ICU) & Surgical Intensive Care Units (SICU), monitored round the clock by the trained team of doctors. The department forms the backbone of the comprehensive cancer care of the patient that the hospital offers in a structured coordinated multidisciplinary approach – for the treatment of patients suffering from cancer with the aim of patient care, complete cure, and rehabilitation.
RADIATION ONCOLOGY
Hospital has one of the largest radiation oncology departments in Konkan region. Padma Vibhushan Dr. Anil Kakodkar, Chairman Department of Atomic Energy inaugurated Radiotherapy unit “BHABHATRON-2” on 7th February 2009.
Radiation oncologists from B.K.L.Walawalakar hospital in collaboration with technical support from Tata Hospital carry out radiation on all types of cancer. Following equipment is available in the department.
List of Equipment in Radiation Oncology Department
| MACHINE | MODEL – COMPANY | TECHNIQUE |
|---|---|---|
| LINAC | Halcyon-Varian |
|
| TALE COBALT | Bhabhatron II-Pancecia |
|
| HDR BRACHYTHERAPY | Microselectron Nucletrone |
|
| CT SIMULATIOR | Siemens |
|
| MOULD ROOM |
|
PALLIATIVE CARE
Palliative care is care meant to improve the quality of life of patients who have a serious or life-threatening disease, such as cancer. It can be given with or without curative care. Palliative care is an approach to care that addresses the person as a whole, not just their disease
Palliative care may be provided at any point during cancer care, from diagnosis to the end of life. When a person receives palliative care, they may continue to receive cancer treatment.
DORMITORY FACILITY
Dormitory is available for poor patients free of cost. The majority of patients coming to Hospital for surgery or post-surgical treatment (radiotherapy, chemotherapy, etc.) need a place to stay while undergoing treatment. Anyone who has had to look for accommodation in this rural area knows what an impossible task it can be. And these people are poor, often illiterate, and ill. BKLW Hospital attempts to fill each family’s needs.
B.K.L. Walawalkar Hospital – A Legacy of Oncology Care
It all started with a need to address the growing menace of cancer cases in Konkan region of Maharashtra. Konkan per say is an extremely challenging area for implementation of any public health program. This is more true for oncology care as it involves many a dimensions ranging from preventive, curative, rehabilitative and palliative care.
The difficult geographical terrain of Konkan, low awareness levels regarding cancer in general population, belief in alternative medicine and traditional healers like mantrics, poor socio-economic levels, less priority being accorded to health, seasonal variations in diseases and health care utilization all came together in Konkan and made the prevention, detection and cure of cancer even more complex.
This called for a super-specialty set-up for oncology care in Konkan region which would cater to all dimensions of this health challenge and address the felt need of rural population of Konkan region on an urgent basis. This need was recognized by the power that be and also by Dr. Shripad Banavali, a well known oncologist from Tata Memorial Centre who was coming on a regular basis to B.K.L Walawalkar Hospital since the time of its inception. This need to do something for Cancer patients of Konkan was then recognized by Tata Memorial Centre, which is the largest oncology centre in the whole of South – East Asia.
An appropriate partner was found by Tata Memorial Centre in the form of B.K.L Walawalkar Hospital Diagnostic and Research Centre. B.K.L Walawalkar Hospital had all the necessary background, infrastructure, human resources, social commitment and support of trustees, which made the institution eligible for a strategic partnership with Tata Memorial Centre for Oncology Care.
The Strong Foundation of Oncology Services at B.K.L Walawalkar Hospital
- International standards quality care in collaboration with Tata Memorial Centre: Tata Memorial Centre Team of Oncologist, Onco-surgeons, Radiation oncologist, Pathologist, Statisticians and Administrators regularly visiting Walawalkar Hospital to ensure highest Quality Oncology care. The hospital itself is an ISO certified institution.
- Oncology services made accessible to rural population of Konkan region thus leading to early detection of cancers, raised awareness levels and reduced cancer mortality and morbidity over a period of time.
- Affordability as oncology services are provided free of cost to the needy patient. Thus the project is able to ensure equitable distribution of health care services irrespective of the ability to pay.
- A series of innovations are involved in the project with on-going research in the field of metronomic by Dr. Banavali. Metronomic Chemotherapy substantially decreases the cost, side-effects and in turn increases the compliance of chemotherapy. This metronomic project was born at Walawalkar Hospital and is now implemented at Tata Memorial Centre. Research is going on in the field of Immune Modulating Radiation too.
- Local staff appointed and trained to high levels of proficiency in oncology care. Many nursing staff is taken up from B.K.L Walawalkar Hospital by Tata Memorial Centre due to their high degree of technical skills and quality.
The Oncology Services have a very favorable cost-benefit ratio and high social impact value. - The Oncology services at B.K.L Walawalkar Hospital are viewed upon as Model Cancer Services and many a foreign visitors from Rosalind Franklin University, National University of Singapore, B.B.C team and delegates from other foreign countries pay visit to learn about this unique cancer project. The National Cancer Control Program has also taken a note of this Oncology Model. Many famous personalities in the related field like Dr. Anil Kakodkar Ex Chairmen A.E.R.B, Dr. S.K. Jain – Chairmen N.P.C.L, Dr. K.S Nair
- National Cancer Control Program have paid their visit and provided their expert guidance to Oncology Services at B.K.L Walawalkar Hospital.
Over the year community participation has substantially increased with many village Gram Panchayats, Self-help groups, social activist approaching Walawalkar Hospital on their own for arranging oncology services for their villagers. Many trusts like Thakur Trust have come forward with funding proposals. - The oncology services have helped in Advocacy, Communication, and Social Mobilization efforts in the field of Oncology and achieved the dream of providing high quality affordable and accessible oncology care for the rural population of Konkan region of Maharashtra.
LINAC (Linear Accelerator)
A linear accelerator (LINAC) is the device most commonly used for external beam radiation treatments for patients with cancer. The linear accelerator is used to treat all parts/organs of the body. It delivers high-energy x-rays or electrons to the region of the patient’s tumor. These treatments can be designed in such a way that they destroy the cancer cells while sparing the surrounding normal tissue. The LINAC is used to treat all body sites, using conventional techniques, Intensity-Modulated Radiation Therapy (IMRT), Volumetric Modulated Arc Therapy (VMAT), Image Guided Radiation Therapy (IGRT), Stereotactic Radiosurgery (SRS) and Stereotactic Body Radio Therapy (SBRT).
