70 per cent of cancer deaths occur in developing countries
Cancer strikes at a younger age in Pakistan than in the developed world

“Cancers are a significant problem in Pakistan and tend to affect patients at a younger age than what is seen in developed countries,” leading general surgeon Dr Inam Pal pointed out at a seminar organised by Aga Khan University (AKU). Dr Pal, Associate Professor, Department of Surgery, informed that approximately 70per cent of cancer deaths occur in developing countries. He asked for a paradigm shift in physicians' thinking by working towards managing tumors before they reach the incurable stage. “Early detection and access to a multidisciplinary treatment option are the best chances of cure,” he said.

A panel of expert consultant general surgeons addressed AKU's Continuing Medical Education (CME) seminar on “ Common Surgical Issues in Family Practice,”  to provide current, practical updates on the management of medical problems faced by primary care physicians and specialists.

Surgeon Dr Sadaf Khan said that rectal bleeding is a common problem reported by approximately 15 per cent of people. Almost 90 per cent of all episodes of rectal bleeding are caused by benign diseases. However, in the remaining 10 per cent, bleeding may be caused by a more sinister problem, such as colon and rectal cancer. Any new onset of bleeding, or a change in the pattern of bleeding or pattern of bowel movements requires further investigation. She recommended a high fibre diet that would help prevent straining and traumatic bowel movements. If symptoms persist, surgical intervention may be required.

Surgeon Dr Rizwan Khan, explained that gall stones are among the commonest reasons for hospitalisation due to gastroenterological problems. About 10-20 per cent of people have gallstones. The introduction of minimally invasive and laparoscopic surgery has refueled the discussion about the management of patients with silent stones. The current gold standard for management of patients with gallstones is laparoscopic cholecystectomy.

Discussing the future of minimally invasive surgery, surgeon Dr Tabish Chawla, explained the most modern technology called Natural Orifice Transluminal Endoscopic Surgery (NOTES) in which no incision is made and the organ is reached through the

body's natural orifices. Robotic surgery has made it possible to carry out a surgical procedure across continents as the surgeon controlling the mechanical robot sits at a distance on his console. He presented an overview of the different forms of minimally invasive surgery currently available but cautioned against the reckless use of laparoscopic surgery. “Laparoscopy should not be used as a screening tool. It is preferable in certain situations but a clinical examination must be done.”

Regarding the management of hernias, surgeon Dr Rehman Alvi said that hernia associated with intestinal obstruction is listed as one of the 10 leading causes of death in the developing world. He said that when performed by an experienced team, the laparoscopic approach has clear advantages for patients with recurrent or bilateral hernias.

Surgeon Dr Hasnain Zafar discussed the diabetic related complications. He advised physicians to look out for neuropathic lesions in the foot which require tropical cleansing and ample rest to heal. Poor diabetic control can lead to amputation of foot in diabetic patients, which is a life saving measure and prevents further complications and co morbidities for a long time.

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