Diagnosis:

If you have symptoms that could be caused by bone cancer, your doctor will take your medical history and perform a physical examination. Bone cancer can be difficult to diagnose, and it is likely that you will have some of the following tests:
• x-rays – can reveal bone damage or the creation of new bone
• blood tests – help check your overall health
• CT or MRI scans – a special computer is used to create pictures to highlight any bone abnormality
• PET scan – you will be injected with a small amount of radioactive glucose solution to highlight any cancerous areas on the scan
• bone biopsy – removes some cells and tissues from the outer part of the affected bone for examination under a microscope. The biopsy may be done in one of two ways. In a core biopsy, a local anaesthetic is used to numb the area, then a thin needle is inserted into the bone under CT guidance to take a sample. In an open or surgical biopsy, the surgeon will cut through the skin under general anaesthesia to remove a piece of bone.
If Ewing’s sarcoma is suspected, you will have a procedure to examine cells from the inner part of the affected bone. A thin needle is used to remove a sample of fluid (aspirate) from the bone marrow.
Treatment The treatment of bone cancers is complex and requires specialist care. Treatment will depend on:
• the type of primary bone cancer
• the location and size of the tumour
• whether or not the cancer has spread (its stage)
• your age, fitness, general health and preferences.
Treatment for primary bone cancer usually includes surgery, chemotherapy and radiation therapy, or a combination of these treatments. The aim is to control the cancer and maintain the use of the affected area of the body. Many people who are treated for bone cancer go into remission (when the symptoms of bone cancer decrease or disappear).
Understanding your treatment options and possible side effects can help you weigh up the pros and cons of different treatments. You may want to get a second opinion from another specialist to confirm or clarify your first doctor’s recommendations.

Surgery:

There are different types of operations depending on the location of the cancer.
Limb-sparing surgery
Surgery to remove the cancer but keep (spare) the limb is done in about nine out of 10 people. You will have a general anaesthetic, and the surgeon will remove the affected part of the bone. The surgeon will also take out some surrounding normal-looking bone and muscle to remove as much of the cancer as possible, and to reduce the chance of the cancer coming back. This is called a wide local excision. A pathologist will check the tissue to see whether the edges are clear of cancer cells.
The bone that is removed is replaced with a metal implant (prosthesis) or a bone graft. A graft uses a piece of healthy bone from another part of your body or from a “bone bank”. A bone bank is a facility that collects tissue for research and surgery. In some cases, it may be possible to treat the removed bone with radiation therapy to destroy the cancer cells, then use the treated bone to reconstruct the limb.
The risks of surgery will be explained to you. After surgery, you will be given medicine to manage any pain and reduce the chance of getting an infection in the bone or prosthesis. There will be some changes in the way the limb looks, feels or works.
A physiotherapist can plan an exercise program to help you regain strength and function in your limb.

Surgery to remove the limb (amputation):

In some cases when it is not possible to remove all of the cancer without affecting the arm or leg too much, the limb is removed (amputation). For about one in 10 people, this is the only effective treatment. This procedure has become less common as limb-sparing surgery has improved.
After surgery, you will be given medicine to manage the pain and taught how to care for the part that remains (residual limb). After the area has healed, you may be fitted for an artificial limb (prosthesis).
If you have a leg removed (amputated) and receive a prosthesis, a physiotherapist will teach you exercises and techniques to improve walking and other movement. Some people find using a prosthetic leg too difficult and prefer to use a wheelchair.
If you have an arm removed, an occupational therapist will teach you how to eat and dress yourself using one arm. If you receive a prosthetic arm, the occupational therapist will teach you exercises and techniques to better control and use the prosthesis.

Surgery in other parts of the body:

• Pelvis – When possible, the cancer is removed along with some healthy tissue around it (wide local excision). Some people may need to have bone grafts to rebuild the bone.
• Jaw or cheek bone (mandible or maxilla) – The surgeon will remove the affected bone. Once healed, bones from other parts of the body may be used to replace the affected bone. As the face is a delicate area, it can be difficult to remove the cancer with surgery and some people may need to have other treatments.
• Spine or skull – If surgery isn’t possible, a combination of treatments may be used. This may include radiation therapy, chemotherapy, cryotherapy (freezing method) or curettage (scooping out the cancer). If you need one of these specialised types of treatment, your doctor will discuss the details with you.

• He has been instrumental in introducing Intensity Modulated Radiation Therapy (IMRT) and later Image Guided radiation Therapy (IGRT) in India.
• He is on the International Advisory Board of International Journal of Radiation Oncology Biology & Physics (Red Journal) published by the American Society for Radiation Oncology (ASTRO) and is also an on the panel of International Experts appointed by International Atomic Energy Agency (IAEA) Vienna.
• He is a well-known member of the American Society for Radiation (ASTRO), European Society for Radiotherapy and Oncology (ESTRO) .
• Dr Hukku special interest lies in Image-Guided Radiotherapy (IGRT), Head and Neck Cancer, Brain Tumours and Breast Cancer. the Association of Radiation Oncologists in India (AROI).

• Dr. Vivek has publications in several international as well as national medical journals.

• Awarded Gold Medal for Best MD Thesis Presentation
• Awarded 2nd Prize for Paper presentation in Diabetes and CAD
• Member of various renowned organizations such as Indian Society of Hematology and Blood Transfusion (ISHTM), Delhi Medical Association (DMA) and Indian Society for Atherosclerosis Research (ISAR)

• His special interest lies in TransOral Robotic Surgeries (TORS), minimally invasive thoracic surgery using uniportal thoracoscopy/Video-Assisted Thoracoscopic Surgeries  (VATS) and Robotic Assisted Thoracoscopic Surgeries for gastrointestinal and gynecological malignancies.
• He is an active member of the Association of Surgeons of India (ASI), Indian Association of Surgical Oncologists (IASO), Society of Endoscopic and Laparoscopic Surgeons of India (SELSI).

• Experienced in the radiosurgery treatment of AVM’s, acoustic neuroma, pituitary adenoma, craniopharyngioma, brain metastasis and similar clinical conditions.
• Recipient of the 3rd 4th S Takahashi Memorial International Fellowship twice for her exemplary work in cancer cervix which was presented at Nagoya, Japan in 2001 & 2004.
• Holds keen interest in clinical research and has published more than 20 research papers in peer reviewed international journals .
• Member of Association of Radiation Oncologists of India.

• He has participated in various conferences and made Poster and Oral presentations.
• He has a keen interest in research and has several publications to his credit in reputed medical journals.
  

• After completing MBBS from prestigious medical college, he completed MS and DNB in Surgical Oncology.