A surgical drain is a small flexible tube placed inside the body at the end of an operation. The other end sits in a bulb outside the skin. Its job? Pull out fluid, blood and lymph that collect after surgery before it builds up under the skin. Most drains stay in for 3 to 10 days. They come out when daily output drops below 30 ml for two days running. Quick to remove. Almost always uncomfortable rather than painful.

According to Prof. Dr. Sandeep Nayak, Surgical Oncologist in India, “Drains aren’t there to make recovery harder. They prevent fluid pockets called seromas that delay healing or get infected. Once the daily output falls under 30 ml and the wound looks settled, the drain comes out, usually in clinic, in about ten seconds.”

Surgery leaves an empty space inside. That space fills up with fluid unless drained.

• Prevents seroma: Surgical sites collect blood and lymph in the days after. Without a drain, this pools into a seroma. A drain stops that fluid before it ever accumulates.
• Lowers infection: Stagnant fluid is the perfect food for bacteria. Drain the fluid out continuously and the chance of a wound infection drops sharply.
• Eases pressure: Fluid trapped under the skin causes swelling, pain and pulls at the stitches. The drain keeps tension off the healing wound.
• Helps wound healing: Tissues knit back together better when they’re held in close contact. Drains pull the layers closer and keep them there.

For patients whose surgery uses keyhole precision through small incisions, robotic cancer surgery often needs smaller or fewer drains thanks to less tissue disruption.

Output decides it, not the calendar. Removal itself is quick.

• Output drops: The drain comes out when daily fluid is under 30 ml for two days in a row. Some breast and head and neck cases need a bit more, some abdominal cases less.
• Wound check: The surgeon looks at the wound first. No infection, no leakage, healing looking on track? The drain comes out.
• Removal moment: A snip of the holding stitch. A quick pull. Done in seconds. Most patients feel a tugging sensation, not real pain. No anaesthesia needed.
• After removal: A small dressing over the site. A tiny bit of clear fluid for a day or two is normal. Shower allowed once the site is dry.

For everything else about recovery after surgery including diet, dressings and when to resume normal activity, our guide on post surgery care walks through the full recovery.

Dr. Sandeep Nayak has spent 24 years in surgical oncology. He holds DNB qualifications in Surgical Oncology and General Surgery and a fellowship in Laparoscopic and Robotic Onco Surgery. He places drains only when surgery genuinely needs them, removes them as soon as output drops to safe levels, and uses minimally invasive techniques that often reduce or eliminate drain need entirely.

That careful judgement on when drains are needed and when they’re not is what separates a thoughtful surgical plan from a routine one. Every case at MACS Clinic goes through tumour board review, where the surgical plan is set together. Call +91 8104310753 to book your consultation.

Disclaimer: This blog is for informational purposes only and is not a substitute for professional medical advice.

Ascites is a build up of fluid inside the abdominal cavity. When it’s linked to cancer, it’s called malignant ascites. It happens most often in ovarian, liver, colorectal, stomach, pancreatic and breast cancer, usually when the disease has spread to the abdominal lining. The fluid builds up because the tumour irritates the peritoneum, blocks lymphatic drainage or damages the liver’s protein balance. Treatment focuses on draining the fluid, controlling the underlying cancer and managing symptoms.

According to Prof. Dr. Sandeep Nayak, Surgical Oncologist in India, “Ascites is one of the clearest signs that cancer has reached the peritoneal cavity, and it changes how we think about treatment. Draining the fluid relieves symptoms quickly, but the real focus has to be on treating the cancer driving it, otherwise the fluid keeps coming back.”

Several mechanisms can trigger it, and most are tied to cancer behaviour.

• Peritoneal spread: When cancer cells reach the abdominal lining, they cause inflammation and leaky blood vessels. Fluid and protein pour into the cavity instead of staying in circulation.
• Liver involvement: Cancer in or around the liver pushes up portal pressure. The liver also makes less albumin, which is what normally holds fluid in the bloodstream.
• Lymph blockage: Tumours can block lymphatic drainage channels in the abdomen. Without proper drainage, fluid that would normally be reabsorbed builds up instead.
• Tumour signals: Some tumours release chemicals that increase blood vessel leakiness. The result is more fluid escaping into the peritoneal space.

For patients whose cancer can be surgically controlled, robotic cancer surgery brings precise tumour removal that often reduces the fluid burden meaningfully.

Diagnosis is straightforward. Treatment is layered, depending on cause and stage.

• Paracentesis: A small needle drains fluid from the abdomen. It relieves symptoms in around 90 percent of patients. The fluid is also tested for cancer cells under cytology.
• Diuretics added: Tablets like spironolactone or furosemide help the kidneys clear extra fluid. Works better when liver involvement is part of the cause.
• Cancer directed: Chemotherapy, targeted therapy or HIPEC can shrink the underlying cancer. When the cancer responds, ascites often slows or stops returning.
• Long term drains: When fluid keeps coming back quickly, a tunnelled catheter lets the family drain at home. Reduces hospital visits significantly.

For patients whose peritoneal cancer is being managed with cytoreductive surgery, our blog on HIPEC surgery walks through outcomes and what survival actually depends on.

Dr. Sandeep Nayak has spent 24 years in surgical oncology. He holds DNB qualifications in Surgical Oncology and General Surgery and trained further with a fellowship in Laparoscopic and Robotic Onco Surgery. He approaches ascites as a sign that needs both immediate relief and root cause treatment, combining paracentesis, diuretics and cancer directed therapy including HIPEC and PIPAC where appropriate.

That dual focus on comfort and underlying disease is what separates real ascites management from symptomatic drainage alone. Every case at MACS Clinic goes through tumour board review, where the treatment plan is set together. Call +91 8104310753 to book your consultation.

Disclaimer: This blog is for informational purposes only and is not a substitute for professional medical advice.

Node positive cancer means that cancer cells have spread from the original tumour into one or more nearby lymph nodes. It usually puts the cancer at stage 2 or 3, not stage 4, which would require spread to distant organs. The number of involved nodes, where they sit and how the tumour behaves all shape the treatment plan. Node positive cancers remain very treatable, and in many cases, curable with the right combination of surgery and follow up therapy.

According to Prof. Dr. Sandeep Nayak, Surgical Oncologist in India, “Node positive isn’t a verdict, it’s information. It tells the team how far the cancer has travelled inside its own neighbourhood, which then shapes whether we need to add radiation, chemo or both alongside surgery. Many node positive cancers still have excellent outcomes when the full plan is properly executed.”

The finding gives the team essential information about how the cancer is behaving.

• Spread starting: Cancer cells have escaped the original tumour and reached the closest filter system, the lymph nodes. It hasn’t reached distant organs.
• Stage shifts: Node involvement typically moves the staging from 1 to 2 or 3. Stage 4 needs distant organ involvement, which node positive alone doesn’t mean.
• Number matters: One small involved node carries far less weight than five large involved nodes. The count and size strongly shape treatment intensity.
• Behaviour clue: Node positivity hints at how active and aggressive the tumour is. This information feeds directly into chemotherapy and radiation planning.

For patients whose plan includes surgical removal of the tumour and involved nodes, robotic cancer surgery brings precise dissection in tight anatomical areas.

Treatment becomes more layered, but stays focused and effective.

• Surgery first: The tumour and involved nodes usually come out together. Clean margins on both the primary tumour and the affected nodes are the goal.
• Chemo added: Most node positive cases get chemotherapy alongside surgery. It deals with any microscopic cells that may have escaped further than the imaging picked up.
• Radiation often: Radiation to the lymph node area is common, particularly in breast cancer with multiple involved nodes. It prevents local recurrence.
• Targeted therapy: For specific cancers like HER2 positive breast or BRAF mutant melanoma, targeted drugs add another precise layer of treatment beyond chemo.

For breast cancer patients wanting to understand exactly how involved lymph nodes are managed surgically, our blog on lymph node surgery in breast cancer walks through the decisions.

Dr. Sandeep Nayak has spent 24 years in surgical oncology. He holds DNB qualifications in Surgical Oncology and General Surgery and trained further with a fellowship in Laparoscopic and Robotic Onco Surgery. He treats node positive cancers with the same calm, structured approach used in major centres worldwide, surgery first where indicated, followed by carefully sequenced chemo, radiation and targeted therapy as the case requires.

That structured, multi modal approach is what gives node positive patients their best chance at long term outcomes. Every case at MACS Clinic goes through full tumour board review, where the treatment plan is set together. Call +91 8104310753 to book your consultation.

Disclaimer: This blog is for informational purposes only and is not a substitute for professional medical advice.

A PET scan can miss cancer. Not often, but it happens. The test works by detecting cells that consume sugar at high rates, which most cancers do, but not all. Very small tumours under a centimetre, slow growing cancers, prostate cancer, lobular breast cancer and low grade lymphomas can all stay invisible on PET despite being there. A negative scan is reassuring, but not definitive on its own, especially when symptoms persist.

According to Prof. Dr. Sandeep Nayak, Surgical Oncologist in India, “A clean PET scan is reassuring but it isn’t the final word. Certain cancers simply don’t light up the way the test expects, and small tumours fall below detection threshold. When clinical signs persist after a negative scan, that’s when biopsy or alternative imaging matters, not after another month of waiting.”

The technology has clear limits. Knowing them helps you understand the result.

• Tumour too small: PET scans struggle with anything under one centimetre. The signal is just not strong enough to stand out from background activity.
• Low sugar uptake: Some cancers don’t use much glucose. Prostate cancer, certain neuroendocrine tumours and lobular breast cancer fall into this group.
• Slow growing: Indolent lymphomas and low grade tumours grow slowly and metabolise slowly too. The scan reads them as normal tissue, not disease.
• Technical limits: Patient movement, recent infection, high blood sugar or inflammation can all reduce signal accuracy. Even the best scanner has these blind spots.

For patients whose treatment plan involves surgery after diagnosis, robotic cancer surgery brings precise removal of tumours that imaging alone can’t fully define.

A negative scan plus persistent symptoms shouldn’t end the conversation.

• Trust symptoms: Unexplained weight loss, persistent pain, ongoing fatigue or a stable lump deserves serious follow up, even if imaging looks clean.
• Get specific tests: MRI, ultrasound, endoscopy and tumour markers can pick up cancers that PET misses. Different cancers need different tools.
• Push for biopsy: When everything else is inconclusive and clinical suspicion is high, a tissue biopsy gives the answer no scan can match.
• Second opinion: A specialist looking at the same scan and same symptoms fresh sometimes catches what the original team missed. Worth asking for if the answer doesn’t feel right.

For patients facing inconclusive scans where the next step is tissue diagnosis, our blog on cancer biopsy explains how the procedure works.

Dr. Sandeep Nayak has spent 24 years in surgical oncology. He holds DNB qualifications in Surgical Oncology and General Surgery and trained further with a fellowship in Laparoscopic and Robotic Onco Surgery. He reads PET scans alongside symptoms, never in isolation, and orders biopsy or alternative imaging when clinical suspicion stays high despite a clean scan.

That refusal to rely on a single imaging result is what catches the cancers others miss. Every case at MACS Clinic goes through full tumour board review, where the diagnostic plan is set together. Call +91 8104310753 to book your consultation.

Disclaimer: This blog is for informational purposes only and is not a substitute for professional medical advice.

Cachexia is a wasting syndrome that causes severe loss of muscle and fat, even when the patient is eating normally. It affects up to 80 percent of people with advanced cancer. The cause is inflammation, insulin resistance and hormone changes triggered by the tumour, not simple under nutrition. Early stages respond to nutrition, medication and exercise. Late refractory cachexia is largely irreversible, which is why catching it early matters so much.

According to Prof. Dr. Sandeep Nayak, Surgical Oncologist in India, “Cachexia is one of the most underdiagnosed complications in advanced cancer, despite being among the most consequential. It’s not just weight loss, it’s a fundamental change in how the body uses energy, and catching it at the pre cachexia stage is when intervention actually works.”

It’s not simple malnutrition. The biology behind it is much more layered.

• Inflammation drives it: The tumour releases inflammatory chemicals that disrupt how muscle and fat cells use energy. This is the main reason eating more doesn’t fix the problem.
• Insulin resistance: Cancer pushes the body into insulin resistance. Glucose can’t reach the cells properly, so muscle breaks down for fuel instead.
• Hormone shifts: Catabolic hormones, which break tissue down, become more active than anabolic ones, which build it up. The balance tips toward wasting.
• Specific cancers: Cachexia is most common in pancreatic, lung, head and neck, oesophageal and stomach cancers. Breast and prostate cancers cause it less often.

For patients whose treatment includes surgical removal of the tumour driving cachexia, robotic cancer surgery brings precise tumour control with faster recovery from surgical stress.

Diagnosis is staged. Treatment is multi pronged.

• Three stages: Pre cachexia is mild weight loss, less than 5 percent. Cachexia is over 5 percent loss with muscle wasting. Refractory cachexia is severe loss, often in late stage disease.
• Early signs: Unintended weight loss, fatigue, weakness, loss of appetite, frequent infections. These flag the syndrome before it gets serious.
• Nutrition support: Protein rich diet, small frequent meals, oncology dietitian input. Helps mainly in early stages, less so once refractory.
• Medication options: Anamorelin, megestrol, low dose steroids and newer trial drugs like ponsegromab help appetite, weight and muscle. Always alongside cancer treatment.

For patients dealing with cachexia commonly seen in pancreatic cancer, our blog walks through survival expectations and management.

Dr. Sandeep Nayak has spent 24 years in surgical oncology. He holds DNB qualifications in Surgical Oncology and General Surgery and trained further with a fellowship in Laparoscopic and Robotic Onco Surgery. He flags cachexia at the pre cachexia stage where intervention works, coordinates nutrition, medication and supportive care alongside cancer treatment, and never treats severe weight loss in cancer patients as simply a side effect.

That early identification and active management is what separates good cancer care from passive observation. Every case at MACS Clinic goes through tumour board review, where the treatment plan is set together. Call +91 8104310753 to book your consultation.

Disclaimer: This blog is for informational purposes only and is not a substitute for professional medical advice.