Tata Memorial Hospital

The Tata Memorial Hospital is situated in Parel, Mumbai in India. It is a specialist cancer treatment and research centre, closely associated with the Advanced Centre for Treatment, Research and Education in Cancer (ACTREC).

One of the fields of specialisation of this hospital is in the treatment of acute lymphoblastic leukemia (A.L.L). The hospital clamis to treat and cure 99% of the A.L.L patients.

This hospital is also one of the few in India to have a P.E.T. scanner. The head of this hospital is Dr. Dinshaw while the head of the Bio-Imaging Unit is Dr. Venkatesh Rangarajan.

The Tata Memorial Centre is the national comprehensive cancer centre for the prevention, treatment, education and research in Cancer and is recognised as one of the leading cancer centres in this part of the world.

This achievement has been possible due to the far-sighted and total support of the Department of Atomic Energy, responsible for managing this Institution since 1962.

The Tata Memorial Hospital was initially commissioned by the Sir Dorabji Tata Trust on 28 February 1941 as a center with enduring value and a mission for concern for the Indian people.

In 1952 the Indian Cancer Research Centre was established as a pioneer research institute for basic research&mdash;later called the Cancer Research Institute (CRI). In 1957 the Ministry of Health took over the Tata Memorial Hospital. The transfer of the administrative control of the Tata Memorial Centre (Tata Memorial Hospital & Cancer Research Institute) to the Department of Atomic Energy in 1962 was the next major milestone. The Tata Memorial Hospital and Cancer Research Institute merged as the two arms of the Tata Memorial Centre (TMC) in 1966 as a classic example of private philanthropy augmented by Government support with a mandate for Service, Education & Research in Cancer.

Patient care
Every year nearly 30,000 new patients visit the clinics from all over India and neighbouring countries. Nearly 60% of these cancer patients receive primary care at the Hospital of which over 70% are treated almost free of any charges. Over 1000 patients attend the OPD daily for medical advice, comprehensive care or for follow-up treatment. During the year 2003, over 20000 new cases were registered in addition to over 13000 Referral Cards issued for only special investigations.

Nearly 8500 major operations are performed annually and 5000 patients treated with Radiotherapy and Chemotherapy annually in multi-disciplinary programmes delivering established treatments. At the TMH, Evidence Based Medicine is the keystone of our endeavour. Apart from the patient care and service, clinical research programmes and randomized trials contribute increasingly to improved delivery of care and highest standards of work ethics. Surgery remains the vital form of treatment along with radiation therapy and chemotherapy. The strategies for early diagnosis, treatment management, rehabilitation, pain relief and terminal care have been established in a comprehensive and multidisciplinary approach for a total cancer care programme.

Many advances have taken place in every speciality. In surgery, concepts have changed taking into account the biology of cancer. Radical surgeries have yielded place to more conservative surgery with the very important objective of quality of life, conserving function and organ without compromising overall survival outcomes. Radiation therapy has also made rapid advances with high technology, precision, computerisation and newer isotopes for therapy. Chemotherapy has played a very major role, with new drugs and clinical protocols investigated in clinical trials. The TMH was the first Centre in the country to initiate Bone Marrow Transplant in 1983. This has been possible due to better total supportive care using newer antibiotics, nutritional, blood transfusion support and nursing. Another important area of progress over the last few years has been radiological imaging techniques using ultrasound, CT scanners, MRI and more dynamic real-time nuclear medicine scanning and the PET Scan. A "first in India" PET CT scanner has been procured to make this cutting edge technology available for cancer management.

Pathology has progressed from basic histopathology to molecular pathology with emphasis on predictive assays for identifying the high risk prognostic factors. Groundwork and processing for NABL accreditation is underway.

Supportive care in the form of total rehabilitation, and counselling of patients is widely recognised to be very important aspects of therapy. Excellent work has been carried out in areas of rehabilitation, physiotherapy, occupational therapy, speech therapy, psychology and medical social work.

Preventive oncology
Preventive Oncology has a very major and important role to play for early diagnosis, screening and down staging of cancer. Department of Preventive Oncology was commissioned in the year 1993, which give special focus on education in cancer prevention and early detection, cancer screening.

Of the 2 to 2.5 million cases of cancer in the country over 70% of cases are detected late and report for treatment in very advanced stages. The emphasis on early detection would go a long way to dealing with the large numbers as well as to mitigate avoidable suffering and a financial burden. With this aim, TMC established its first Rural Outreach Cancer Centre at Barshi, Sholapur Dist. for early diagnosis and treatment in 1983. In 2003, the second Rural Outreach Cancer Centre was set up at Dervan, Chiplun, Ratnagiri District.

Clinical research
A Scientific Review Committee critically reviews the proposed research programmes and projects in detail and ensures that the research effort is at the cutting edge of an international effort. The Hospital Ethics Committee consisting of Doctors and Scientific Officers of the Centre and external expert members in the field of medicine, law and social science critically evaluate the research and medical practices followed in the Hospital. A separate Data Monitoring and Safety Committee, in addition, evaluates and monitors all officially sanctioned intramural research programmes.

Education
The Tata Memorial Centre is a recognised training centre for cancer education and research by national and international organisations such as WHO, IAEA and UICC. Tata Memorial Hospital is a post-graduate teaching centre and is affiliated to the University of Mumbai, National Board of Examinations and Maharashtra University of Health Sciences. Every year about 80 post-graduate students register with the Centre for doing their Master's or Doctorate courses. There are about 400 students undergoing training every year in medical and non-medical fields in long and short term courses.

Tata Clinic
A 12-storey block "The Tata Clinic and Faculty Block" is being planned on the premises vacated by the CRI. This facility will house site speciality clinics, 50 additional beds, Minor theatre coplex, day care beds, academic offices, post graduate education, seminar rooms and a Telemedicine Centre.

ACTREC
The Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) is a new state-of-the-art R&D satellite of the Tata Memorial Centre (TMC). It has the mandate to function as a national centre for treatment, education and research in cancer.

TMC is an autonomous grant-in-aid institution of the Department of Atomic Energy (DAE), Government of India. It is registered under the Societies Registration Act (1860) and the Bombay Public Trust Act (1950). It is governed by a Governing Council chaired by the Chairman, Atomic Energy Commission, Government of India.

ACTREC comprises 2 arms&mdash;a basic research arm constituted by the erstwhile Cancer Research Institute (CRI) which has shifted from the Parel Campus to the new location in August 2002, and a Clinical Research Centre (CRC) which will begin functioning by the end of 2003. The latter comprises a 50 bed research hospital which is fully equipped with state-of-the-art diagnostic and therapeutic facilities.

Research investigations at CRI currently focus on molecular mechanisms responsible for causation of major human cancers relevant to India. It is envisaged that in the future, ACTREC will play a greater role in drug development and emerging therapies for treatment and prevention of cancer.

Cancer Research Institute (CRI)
In its 50th year, the Cancer Research Institute at Parel, Mumbai moved to Navi Mumbai to become the basic research wing of the Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), and started functioning from its new premises at Kharghar from 19 August 2002. ACTREC, which comprises the basic and clinical research wings and an educational complex, will carry out mission-oriented research and development on cancers prevalent in the Indian subcontinent, and where there are internationally competitive opportunities, will use state-of-the-art technology in partnership with the Tata Memorial Hospital. During the year, in spite of the disruption of work due to its move from Parel to Kharghar, the Institute has managed to continue with its activities. Research investigations have focused on molecular mechanisms responsible for the causation of the major human cancers in parallel with studies in animal models and cells in tissue culture.

Ongoing investigations on oral cancer have changed focus from alterations in oncogenes and tumor suppressor genes to global analysis of gains and losses of chromosomal regions, gene and protein expression, alteration in genes regulating DNA repair and xenobiotic metabolizing enzymes, role of intermediate filament proteins in epithelial cell transformation, presence of novel HPV, preparation of gene therapy reagents against oral cancer, understanding the molecular mechanisms in immune surveillance and development of single chain antibodies against antigens from oral tumor cells.

With respect to breast cancer, studies have investigated the importance of HLA in breast cancer predisposition in specific ethnic groups such as the Parsis and Maharashtrians and their relation to age of onset of the disease. Epigenetic mechanisms regulating genes involved in cell proliferation have also received attention.

In-depth studies are on to understand the molecular mechanisms of hepatitis B virus infection leading to hepatocellular carcinoma. The utility of the viral mRNA for HBx gene, and circulating antibodies towards the HBx protein are being assessed as markers for viral infection.

Analysis of cytokine profiles and the role of antibodies to the viral proteins E6 and E7 in cervical cancer, cytokine imbalance in lung cancer patients, and the role of urinary cytokines in intravesical BCG therapy in superficial bladder cancer are ongoing. The significance of the T-cell repertoire in T-ALL, presence of HPV in esophageal cancer and HHV6 in lymphoproliferative disorders are also receiving attention. The biology of HIV-2, the virus which has spread only in India and Africa is being studied in-depth. Having an Indian isolate of HIV-2 has also provided the impetus to develop an indigenous retroviral vector for gene transfer.

Studies in cultured cells address questions related to chromatin structure, specific signal transduction pathways, molecules and intermolecular interactions mediating cell proliferation, cell death and functional differentiation, many of which are altered during cellular transformation in response to DNA damaging agents and environmental chemical carcinogens.

Studies on tobacco mediated carcinogenesis have encompassed chemical analysis, examination of the bioactivity of various tobacco products, transplacental carcinogenesis and biomonitoring of habitués. Sizeable effort has been directed towards delineation of the mechanisms of chemopreventive action of agents from Indian foods, such as turmeric, tea and grapes, and development of mechanism-based biomarkers of exposure.

The first transgenic mouse in the country, which was made at the Institute, hosts a gene for a growth modulator. This mouse is being developed as a model for squamous cell carcinoma. In parallel, newer cell lines useful for cancer research and an expression system for the E6 protein of HPV are being developed.

During 2002, scientists at the Institute have obtained extra mural support from different funding bodies to the tune of Rs. 100,000,000. Work from the Institute has led to 19 publications in peer reviewed journals. Eleven students have obtained Ph.D. in different disciplines of life sciences from the University of Mumbai.

The Institute initiated the celebrations of its Golden Jubilee Year with the Foundation Day Lecture by Nobel Laureate, Sir Paul Nurse in January 2002. As its first major scientific activity after the move to ACTREC, it organized the XXVI All India Cell Biology Conference and Symposium where over 250 scientists from India and abroad participated and exchanged views on recent trends in Cell Biology. The Golden Jubilee Year culminated at the celebrations held at Kharghar on 31 December 2002 in the august presence of Dr. Anil Kakodkar, Chairman, AEC.

Clinical Research Centre
The Clinical Research Centre comprises a 50 bed hospital which is devoted to clinical research in the field of Cancer. In the first phase, the focus will be on Pediatric Oncology and emerging therapies, including gene therapy. Besides full support of the Tata Memorial Hospital at Parel, the hospital at ACTREC is also fully equipped with all required diagnostic and therapeutic facilities. This includes a 7 bed BMT unit, 2 operation theatres, 1 endoscopy theatre, 6 ICU beds and fully equipped radiology, pathology, microbiology, transfusion medicine and anesthesia services.

The radiotherapy at ACTREC is equipped with state of the art dual-energy linear accelerator, IMRT, stereotactic therapy and HDU-brachytherapy units. The Centre is committed to carry out clinical trails under GCP conditions, including Phase I/II trials for investigational new drugs. In addition, the Centre would specialize in cancer genetics including counselling and genetic testing and molecular pathology.