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Throat Cancer - Types, Symptoms, Prevention and Treatment

Throat cancer refers to malignant tumors that develop in the throat (pharynx), voice box (larynx), or tonsils. It is a broad term that encompasses various types of cancers, including those affecting different parts of the throat.

Types of Throat Cancer
  1. Pharyngeal Cancer:
    • Nasopharyngeal Cancer:
      • Location: Occurs in the upper part of the throat behind the nose (nasopharynx).
    • Oropharyngeal Cancer:
      • Location: Affects the middle part of the throat, including the back of the tongue, tonsils, and the soft palate.
    • Hypopharyngeal Cancer:
      • Location: Found in the lower part of the throat above the esophagus and trachea (hypopharynx).
  1. Laryngeal Cancer:
    • Location: Develops in the larynx (voice box), which is involved in breathing, speaking, and protecting the trachea against food aspiration.
  2. Tonsillar Cancer:
    • Location: A type of oropharyngeal cancer that begins in the tonsils, part of the lymphatic system at the back of the throat.
Risk Factors and Causes
  1. Tobacco Use:
    • Primary Risk Factor: Smoking cigarettes, cigars, or pipes, as well as chewing tobacco, significantly increases the risk of throat cancer.
  2. Alcohol Consumption:
    • High-Risk Behavior: Heavy alcohol use is strongly associated with an increased risk, particularly when combined with tobacco use.
  3. Human Papillomavirus (HPV) Infection:
    • Increasing Cause: Certain strains of HPV, especially HPV-16, are linked to the development of oropharyngeal cancers.
  4. Age and Gender:
    • Demographics: Most common in people over 50 and more prevalent in men than in women.
  5. Diet and Nutrition:
    • Nutritional Deficiencies: Poor diet, particularly low intake of fruits and vegetables, can elevate risk.
  6. Gastroesophageal Reflux Disease (GERD):
    • Chronic Irritation: Acid reflux may contribute to cancer in the throat and voice box.
  7. Occupational Hazards:
    • Exposure Risks: Jobs involving exposure to asbestos, chemicals, or wood dust can increase the risk.
  8. Genetics and Family History:
    • Inherited Factors: A family history of throat or related cancers can play a role in increased risk.
Symptoms of Throat Cancer
  1. Persistent Sore Throat:
    • Duration: A sore throat that doesn’t go away, even after treatment, can be a symptom.
  2. Voice Changes:
    • Hoarseness or Weak Voice: Changes in voice quality, persistent hoarseness, or voice loss.
  3. Difficulty Swallowing:
    • Dysphagia: A feeling that food is stuck in the throat or trouble swallowing.
  4. Ear Pain:
    • Referred Pain: Pain in the ear that doesn’t originate from an ear infection.
  5. Lump in the Throat or Neck:
    • Visible or Palpable Mass: A noticeable mass that doesn’t subside.
  6. Unexplained Weight Loss:
    • Cancer Indicator: Significant and unintended weight loss can be a sign.
  7. Chronic Cough:
    • Persistent Cough: A cough that lingers and doesn’t respond to usual treatments.
  8. Breathing Difficulties:

Stridor or Dyspnea: Noisy breathing or shortness of breath.

Diagnosis of Throat Cancer
  1. Physical Examination:
    • Initial Assessment: Thorough examination of the throat, neck, and lymph nodes by a healthcare provider.
  2. Endoscopy:
    • Direct Visualisation: Use of a flexible scope to inspect the throat and larynx, and to take tissue samples if necessary.
    • Types: Laryngoscopy for the larynx and nasopharyngoscopy for the nasopharynx.
  3. Imaging Tests:
    • CT Scan: Provides detailed cross-sectional images of the head and neck.
    • MRI: Offers high-resolution images to differentiate between normal and abnormal tissues.
    • PET Scan: Detects cancer cells based on their increased glucose metabolism.
  4. Biopsy:
    • Definitive Diagnosis: Removal of a tissue sample for microscopic examination to confirm the presence of cancer cells.
  5. Fine Needle Aspiration (FNA):
    • Lymph Node Analysis: Uses a thin needle to extract cells from a lump in the neck for analysis.
  6. HPV Testing:
    • Viral Association: Tests to determine the presence of high-risk HPV strains, particularly for oropharyngeal cancers.
Staging of Throat Cancer

Throat cancer is staged based on the size of the tumor, lymph node involvement, and whether cancer has spread (metastasis). The TNM system is commonly used:

  • T (Tumor): Size and extent of the primary tumor.
  • N (Nodes): Degree of spread to regional lymph nodes.
  • M (Metastasis): Presence or absence of distant metastasis.
Treatment of Throat Cancer
  1. Surgery:
    • Tumor Resection: Removal of the tumor and some surrounding healthy tissue.
    • Laryngectomy: Partial or total removal of the larynx, which may be necessary for advanced laryngeal cancer.
    • Neck Dissection: Removal of lymph nodes in the neck to prevent the spread of cancer.
  2. Radiation Therapy:
    • External Beam Radiation: Targets the cancer with high-energy beams from outside the body.
    • Brachytherapy: Places radioactive seeds close to or inside the tumor for internal radiation.
  3. Chemotherapy:
    • Systemic Treatment: Uses drugs to kill cancer cells or stop their growth; often combined with radiation (chemoradiation).
    • Neoadjuvant and Adjuvant Therapy: Administered before surgery to shrink tumors or after to eliminate remaining cancer cells.
  4. Targeted Therapy:
    • Precision Medicine: Drugs like cetuximab target specific aspects of cancer cells, such as the epidermal growth factor receptor (EGFR).
  5. Immunotherapy:
    • Immune Activation: Drugs such as pembrolizumab (Keytruda) or nivolumab (Opdivo) help the immune system recognize and attack cancer cells, particularly in cases of advanced or recurrent throat cancer.
Prevention and Risk Reduction
  1. Avoid Tobacco and Alcohol:
    • Primary Prevention: Eliminating or reducing the use of tobacco and alcohol significantly lowers the risk.
  2. HPV Vaccination:
    • Preventive Measure: Vaccination against HPV can reduce the risk of HPV-related throat cancers.
  3. Healthy Diet and Lifestyle:
    • Nutrition and Exercise: A diet rich in fruits and vegetables and regular physical activity can help lower the risk of throat cancer.
  4. Protective Measures at Work:
    • Occupational Safety: Using protective equipment and following safety protocols to minimise exposure to harmful substances.
  5. Regular Medical Check-Ups:
    • Early Detection: Routine check-ups and prompt attention to persistent symptoms can facilitate early diagnosis and treatment.
Innovations and Future Directions
  1. Advanced Imaging Techniques:
    • Enhanced Detection: Techniques like PET/CT and MRI provide detailed visualisation and help in precise tumor mapping.
  2. Minimally Invasive Surgery:
    • Robotic Surgery: Robotic-assisted procedures offer precision with smaller incisions and quicker recovery times.
    • Endoscopic Surgery: Minimally invasive approaches for tumor removal with less impact on function and appearance.
  3. Personalized Medicine:
    • Genetic Profiling: Tailoring treatment based on genetic and molecular characteristics of the tumor to improve outcomes.
  4. Combination Therapies:
    • Multimodal Approaches: Combining different therapies (surgery, radiation, chemotherapy, and immunotherapy) for more effective treatment strategies.
  5. Immunotherapy Advances:
    • New Treatments: Ongoing research into checkpoint inhibitors and other immune-modulating drugs offers hope for more effective treatment of advanced throat cancers.

Throat cancer is a complex condition with varied causes and symptoms. Early detection and prompt treatment are crucial for improving outcomes. Advances in diagnosis and treatment, along with preventive measures, are vital in reducing the burden of throat cancer. Awareness and lifestyle modifications play a significant role in prevention, while innovations in medical science continue to enhance the effectiveness of treatments.

Thyroid Disorders: Types, Symptoms, Prevention and Treatment

The thyroid gland is a butterfly-shaped organ located at the base of the neck, responsible for producing hormones that regulate metabolism, growth, and development. Thyroid disorders can significantly impact overall health and well-being.

Types of Thyroid Disorders

  1. Hypothyroidism:
    • Definition: A condition where the thyroid gland produces insufficient thyroid hormones.
    • Common Causes: Hashimoto’s thyroiditis, iodine deficiency, or treatment for hyperthyroidism.
  2. Hyperthyroidism:
    • Definition: A condition characterised by excessive production of thyroid hormones.
    • Common Causes: Graves’ disease, toxic nodular goiter, or thyroiditis.
  3. Thyroid Nodules:
    • Definition: Lumps or abnormal growths in the thyroid gland.
    • Types: Can be benign (non-cancerous) or malignant (cancerous).
  4. Goiter:
    • Definition: Enlargement of the thyroid gland, which can occur with both hypo- and hyperthyroidism.
    • Common Causes: Iodine deficiency, Graves’ disease, or Hashimoto’s thyroiditis.
  5. Thyroid Cancer:
    • Definition: Malignant tumors that originate in the thyroid gland.
    • Types: Includes papillary, follicular, medullary, and anaplastic thyroid cancers.
  6. Thyroiditis:
    • Definition: Inflammation of the thyroid gland, which can cause either temporary hyperthyroidism or hypothyroidism.
    • Types: Includes Hashimoto’s thyroiditis, subacute thyroiditis, and postpartum thyroiditis.
Hypothyroidism

Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormones, leading to a slow metabolism.

Causes

  1. Hashimoto’s Thyroiditis:
    • Autoimmune Disease: The most common cause in developed countries; the immune system attacks the thyroid gland.
  2. Iodine Deficiency:
    • Nutritional Cause: Lack of iodine in the diet, more prevalent in developing countries.
  3. Thyroid Surgery or Radiation Therapy:
    • Post-Treatment Effect: Surgical removal or radiation treatment for thyroid problems can reduce hormone production.
  4. Medications:
    • Side Effects: Certain drugs, such as lithium or amiodarone, can impair thyroid function.
  5. Congenital Hypothyroidism:
    • Birth Defect: Babies can be born with a defective thyroid gland or no thyroid gland at all.

Symptoms

  • Fatigue and Weakness: Persistent tiredness and lack of energy.
  • Weight Gain: Unexplained weight gain despite normal diet and exercise.
  • Cold Intolerance: Increased sensitivity to cold temperatures.
  • Dry Skin and Hair: Coarse, dry skin and brittle hair.
  • Constipation: Slowed digestion leading to constipation.
  • Depression: Mood swings and depressive symptoms.
  • Memory Problems: Difficulty with concentration and memory.
  • Bradycardia: Slowed heart rate.

Diagnosis

  1. Blood Tests:
    • TSH (Thyroid-Stimulating Hormone): Elevated levels indicate hypothyroidism.
    • Free T4 (Thyroxine): Low levels confirm the diagnosis.
  2. Antibody Tests:
    • Thyroid Peroxidase (TPO) Antibodies: Elevated in autoimmune thyroid disease (Hashimoto’s).
  3. Imaging:
    • Ultrasound: Used if a goiter or nodules are present to assess gland structure.

Treatment

  1. Thyroid Hormone Replacement:
    • Levothyroxine: A synthetic form of thyroxine (T4) taken daily to normalize hormone levels.
  2. Regular Monitoring:
    • TSH Levels: Regular blood tests to adjust medication dosage.
  3. Dietary Adjustments:

Adequate Iodine Intake: Ensuring sufficient iodine in the diet through iodized salt or supplements

Hyperthyroidism

Hyperthyroidism results from excessive production of thyroid hormones, accelerating the body’s metabolism.

Causes

  1. Graves’ Disease:
    • Autoimmune Disorder: The most common cause, where antibodies stimulate the thyroid to produce too much hormone.
  2. Toxic Nodular Goiter:
    • Overactive Nodules: One or more nodules in the thyroid become overactive.
  3. Thyroiditis:
    • Inflammation: Temporary overproduction of thyroid hormone due to thyroid inflammation.
  4. Excess Iodine:
    • Diet or Medications: High intake of iodine can cause hyperthyroidism in susceptible individuals.

Symptoms

  • Weight Loss: Unintentional weight loss despite normal or increased appetite.
  • Heat Intolerance: Increased sensitivity to heat.
  • Tremors: Shaking hands or fingers.
  • Palpitations: Rapid or irregular heartbeats.
  • Nervousness and Irritability: Anxiety, nervousness, and mood swings.
  • Increased Sweating: Excessive perspiration.
  • Muscle Weakness: Especially in the upper arms and thighs.
  • Frequent Bowel Movements: More frequent or loose stools.

Diagnosis

  1. Blood Tests:
    • TSH Levels: Low or undetectable levels.
    • Free T4 and T3: Elevated levels.
  2. Radioactive Iodine Uptake Test:
    • Gland Activity: Measures how much iodine the thyroid gland absorbs.
  3. Thyroid Scan:
    • Nodules Assessment: Helps determine the cause of hyperthyroidism.

Treatment

  1. Anti-Thyroid Medications:
    • Methimazole and Propylthiouracil (PTU): Reduce thyroid hormone production.
  2. Radioactive Iodine Therapy:
    • Gland Shrinkage: Destroys overactive thyroid cells.
  3. Beta-Blockers:
    • Symptom Control: Used to manage symptoms like rapid heart rate and tremors.
  4. Surgery:
    • Thyroidectomy: Partial or total removal of the thyroid gland in severe cases or when other treatments fail.
Thyroid Nodules

Thyroid nodules are lumps that can form within the thyroid gland. Most are benign, but some can be cancerous.

Causes

  1. Iodine Deficiency:
    • Nutritional Factor: Can lead to the development of nodules.
  2. Thyroiditis:
    • Inflammation: Chronic inflammation can cause nodules.
  3. Thyroid Adenomas:
    • Benign Growths: Non-cancerous tumors that may produce thyroid hormones.
  4. Cancer:
    • Malignant Nodules: A small percentage of nodules can be thyroid cancer.

Symptoms

  • Visible Lump: A noticeable lump or swelling in the neck.
  • Difficulty Swallowing: A feeling of a lump in the throat.
  • Voice Changes: Hoarseness or changes in the voice.
  • Pain: Discomfort in the neck or throat.
  • Hyperthyroid Symptoms: If the nodule is overactive, symptoms of hyperthyroidism may be present.

Diagnosis

  1. Physical Examination:
    • Palpation: Doctor feels the neck for lumps or irregularities.
  2. Ultrasound:
    • Imaging: Determines the size, shape, and characteristics of nodules.
  3. Fine-Needle Aspiration (FNA) Biopsy:
    • Cell Analysis: A sample of cells is taken from the nodule to check for cancer.
  4. Thyroid Function Tests:
    • Hormone Levels: Blood tests to assess thyroid function.

Treatment

  1. Observation:
    • Monitoring: Regular follow-up and ultrasound if the nodule is benign and not causing symptoms.
  2. Surgery:
    • Nodule Removal: If the nodule is large, symptomatic, or suspicious for cancer.
  3. Radioactive Iodine Therapy:
    • Treatment: Used for overactive nodules.
Goiter

A goiter is an enlargement of the thyroid gland, which can occur with normal, high, or low thyroid hormone levels.

Causes

  1. Iodine Deficiency:
    • Primary Cause: Most common cause globally, where iodine intake is insufficient.
  2. Graves’ Disease:
    • Autoimmune Factor: Stimulates thyroid enlargement.
  3. Hashimoto’s Thyroiditis:
    • Inflammation: Chronic inflammation leading to gland enlargement.
  4. Thyroid Nodules:
    • Growths: Can cause localised or diffuse enlargement of the gland.

Symptoms

  • Visible Swelling: Swelling at the base of the neck.
  • Tightness: Feeling of tightness in the throat.
  • Coughing: Frequent coughing or a sense of choking.
  • Breathing Difficulty: Trouble breathing, especially when lying down.
  • Swallowing Difficulty: Dysphagia or difficulty swallowing.

Diagnosis

  1. Physical Examination:
    • Observation and Palpation: Doctor examines the neck and feels for swelling.
  2. Ultrasound:
    • Imaging: Assess the size and structure of the thyroid.
  3. Thyroid Function Tests:
    • Hormone Levels: Blood tests to determine thyroid function.
  4. Radioactive Iodine Uptake:
    • Functional Assessment: Measures iodine uptake by the thyroid to evaluate function.

Treatment

  1. Iodine Supplementation:
    • Deficiency Treatment: Iodine supplements if goiter is due to iodine deficiency.
  2. Medications:
    • Thyroid Hormone Therapy: To shrink the goiter and normalise thyroid hormone levels.
  3. Radioactive Iodine:
    • Size Reduction: To reduce the size of the gland.
  4. Surgery:
    • Thyroidectomy: Removal of part or all of the thyroid in severe cases or if cancer is suspected.
Thyroid Cancer

Thyroid cancer originates in the thyroid gland and can vary widely in aggressiveness and treatment response.

Types

  1. Papillary Thyroid Cancer:
    • Most Common: Generally slow-growing and spreads to lymph nodes.
  2. Follicular Thyroid Cancer:
    • Moderate Aggression: Can spread to distant organs like the lungs and bones.
  3. Medullary Thyroid Cancer:
    • Rare and Genetic: Associated with multiple endocrine neoplasia type 2 (MEN2) syndrome.
  4. Anaplastic Thyroid Cancer:
    • Highly Aggressive: Rapidly growing and often difficult to treat.

Symptoms

  • Lump in the Neck: A palpable mass or swelling in the neck.
  • Hoarseness: Changes in the voice due to nerve involvement.
  • Swallowing and Breathing Difficulties: Compression of the esophagus or trachea.
  • Persistent Cough: Not related to a cold or other respiratory illness.
  • Neck Pain: Persistent pain that can radiate to the ears.

Diagnosis

  1. Physical Examination:
    • Neck Check: Doctor examines the neck for lumps and nodules.
  2. Ultrasound:
    • Imaging: Detailed visualization of the thyroid and surrounding tissues.
  3. Fine-Needle Aspiration (FNA) Biopsy:
    • Cell Sampling: Collects cells from the nodule for microscopic examination.
  4. Thyroid Function Tests:
    • Hormone Levels: Blood tests to evaluate thyroid hormone levels.
  5. Imaging Tests:
    • CT, MRI, PET Scans: Used to determine the extent of cancer spread.

Treatment

  1. Surgery:
    • Thyroidectomy: Partial or total removal of the thyroid gland.
    • Lymph Node Dissection: Removal of affected lymph nodes.
  2. Radioactive Iodine Therapy:
    • Ablation: Destroys remaining thyroid tissue or metastatic cancer cells after surgery.
  3. External Beam Radiation Therapy:
    • Local Control: Targets residual cancer cells in advanced cases.
  4. Thyroid Hormone Therapy:
    • Suppression: Replaces normal hormone levels and suppresses TSH to prevent cancer growth.
  5. Targeted Therapy:
    • Precision Drugs: Such as tyrosine kinase inhibitors for certain advanced thyroid cancers.
  6. Chemotherapy:
    • Systemic Treatment: Used in aggressive or metastatic cases where other treatments are not effective.
Thyroiditis

Thyroiditis is an inflammation of the thyroid gland that can result in temporary hyperthyroidism followed by hypothyroidism.

Types

  1. Hashimoto’s Thyroiditis:
    • Autoimmune Disease: Chronic inflammation leading to hypothyroidism.
  2. Subacute Thyroiditis:
    • De Quervain’s Thyroiditis: Painful inflammation usually following a viral infection.
  3. Postpartum Thyroiditis:
    • Post-Pregnancy: Inflammation that can occur after childbirth.
  4. Silent Thyroiditis:
    • Painless: Mild inflammation that can lead to transient hyperthyroidism.

Symptoms

  • Pain and Tenderness: Especially in subacute thyroiditis.
  • Thyroid Dysfunction: Symptoms of hyperthyroidism or hypothyroidism depending on the stage.
  • Swelling: Enlarged, tender thyroid gland.

Diagnosis

  1. Blood Tests:
    • TSH, Free T4, and T3 Levels: To determine thyroid function.
    • Thyroid Antibodies: To check for autoimmune thyroiditis.
  2. Erythrocyte Sedimentation Rate (ESR):
    • Inflammation Marker: Elevated in subacute thyroiditis.
  3. Radioactive Iodine Uptake:
    • Thyroid Activity: Low uptake in subacute thyroiditis due to damaged thyroid cells.

Treatment

  1. Pain Management:
    • NSAIDs: Nonsteroidal anti-inflammatory drugs to reduce pain and inflammation.
    • Corticosteroids: For severe pain in subacute thyroiditis.
  2. Thyroid Hormone Replacement:
    • Hypothyroidism Management: Levothyroxine for persistent hypothyroidism.
  3. Beta-Blockers:
    • Symptom Relief: To manage symptoms of hyperthyroidism.
Innovations and Future Directions in Thyroid Disease Management
  1. Genetic and Molecular Testing:
    • Personalised Medicine: Tailoring treatments based on genetic and molecular profiles of thyroid tumors.
  2. Minimally Invasive Procedures:
    • Robotic and Endoscopic Surgery: Less invasive techniques for thyroid surgery with quicker recovery.
  3. Advanced Imaging Techniques:
    • Enhanced Detection: Improved imaging technologies for accurate diagnosis and monitoring.
  4. Targeted and Immunotherapy:
    • Precision Treatments: New drugs targeting specific cancer pathways or enhancing immune response against thyroid cancer.
  5. Artificial Intelligence (AI) in Diagnosis:
    • AI Tools: Use of AI for improved analysis of thyroid scans and biopsy results.

Thyroid disorders encompass a range of conditions affecting the gland’s function and structure, from underactivity and overactivity to nodules and cancer. Early diagnosis and tailored treatment are essential for effective management. With advancements in medical technology and personalised approaches, outcomes for thyroid disease patients continue to improve.

Frequently Asked Questions

1. What are the common signs and symptoms of throat cancer?
Throat cancer symptoms often include a persistent sore throat, difficulty swallowing, a lump in the neck, voice changes, unexplained weight loss, ear pain, and coughing up blood.

2. How can one identify the early signs of throat cancer?
Early signs of throat cancer may include a persistent sore throat, hoarseness, difficulty swallowing, a lump in the neck, and unexplained weight loss.

3. What are the symptoms of thyroid gland cancer?
Symptoms of thyroid gland cancer can include a lump in the neck, trouble swallowing, neck pain, hoarseness, swollen lymph nodes, and difficulty breathing.

4. What is thyroiditis and how is it related to cancer?
Thyroiditis is inflammation of the thyroid gland, which can sometimes lead to the development of thyroid tumors or thyroid cancer. Persistent thyroiditis should be evaluated by a doctor.

5. What are the symptoms of a thyroid tumor?
Symptoms of a thyroid tumor may include a noticeable lump in the neck, difficulty swallowing, hoarseness, swollen lymph nodes, neck pain, and trouble breathing.

6. How is early-stage throat cancer detected?
Early-stage throat cancer is often detected through symptoms such as persistent sore throat, hoarseness, and difficulty swallowing, and confirmed by medical examinations like endoscopy, biopsy, and imaging tests.

7. What are the common types of thyroid tumors?
Common types of thyroid tumors include benign nodules, papillary thyroid carcinoma, follicular thyroid carcinoma, medullary thyroid carcinoma, and anaplastic thyroid carcinoma.

8. What are the throat tumor symptoms one should look out for?
Symptoms of throat tumors include a persistent sore throat, hoarseness, difficulty swallowing, a lump in the neck, ear pain, and unexplained weight loss.

9. Is throat cancer curable?
Throat cancer can be curable, especially if detected early. Treatment options such as surgery, radiation therapy, and chemotherapy can be effective, depending on the stage and location of the cancer.

10. What kinds of therapies are available for throat cancer?
Therapies for throat cancer include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy, depending on the cancer’s stage and location.

11. What types of papillary thyroid cancer exist?
Papillary thyroid cancer can be classified into several types, including classic, follicular variant, tall cell variant, and diffuse sclerosing variant, each with different prognoses and treatment approaches.

12. How does thyroid cancer present differently in men and women?
Thyroid cancer symptoms in men and women are generally similar, but women are more likely to develop thyroid cancer. Symptoms include neck lumps, difficulty swallowing, and hoarseness.

13. What are the early signs of thyroid cancer in the throat?
Early signs of thyroid cancer in the throat can include a noticeable lump, difficulty swallowing, hoarseness, neck pain, and swollen lymph nodes.

14. What types of thyroid tumors are most common?
The most common types of thyroid tumors are benign nodules, papillary thyroid carcinoma, follicular thyroid carcinoma, medullary thyroid carcinoma, and anaplastic thyroid carcinoma.

15. What are the symptoms of throat cancer in women?
Symptoms of throat cancer in women include persistent sore throat, hoarseness, difficulty swallowing, a lump in the neck, ear pain, unexplained weight loss, and coughing up blood.

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      4.7

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      • Best health services from different health service providers offered under one umbrella.

      • Big savings on your healthcare cost

      • Choice & convenience to your employees to avail health services at any of our network centers

      • Customized Health Packages