What is lung cancer?
Primary lung cancer is the uncontrolled proliferation of malignant cells in the airways and air sacs of the lungs. Lung cancer is an aggressive cancer that can spread to other parts of the body.
Lung cancer is of two basic types – non-small cell (NSCLC) and small cell lung cancer (SCLC). Of these the non small cell lung cancer accounts for a majority of cases of lung cancer. it grows and spreads more slowly than small cell cancer. The small cell lung cancer grows and spreads very rapidly to other parts of the body.
How is it caused?
The exact cause of lung cancer is not determined. But there are certain risk factors that predispose an individual to lung cancer. Some of them are:
The majority of lung cancers are caused due to excessive cigarette smoking. Research shows that in some cases, passive smoking is also harmful than.
In India, excessive exposure to pollution which may contain poisonous chemicals is the next most common risk factor.
Exposure to harmful radiation over a long period of time alters the natural make-up of cells causing cancer.
People working in areas related to asbestos manufacture are more at risk. Increased risk of lung cancer is an occupational hazard for people working in asbestos factories.
What are the symptoms?
Some symptoms of lung cancer are general and might not come to a person’s notice immediately. It is only when the symptoms either worsen, or occur simultaneously that they are noticed. Some common symptoms are:
Persistent cough
Spit or phlegm stained with blood
Chest pain sometimes associated with difficulty in breathing
Difficulty in swallowing
Persistent low grade fever with paleness of the skin. Sometimes the skin may become grey and dry.
Loss of weight
Loss of appetite
How is it diagnosed?
The doctor examines the chest area with a stethoscope in which a persistent wheezing sound acts as an alarm. Localized wheezing may be noticed, which is the low almost musical sound emitted when there is partial blockage in the air passages of the lungs. A chest X-ray is usually advised, which can show the cancerous lesions in the lungs. Sometimes, fluid may accumulated in the chest, and a sample of the fluid from the lungs may be taken for testing. A needle is inserted through the chest wall and some of the fluid is extracted. A sample of the sputum may also be taken to check for malignant cells.
Bronchoscopy is a procedure in which a thin lighted tube, called the bronchoscope, is passed through the mouth, via the wind pipe (trachea) into the lungs to examine the inside of the air passages. If a lesion is seen in chest X-ray or bronchoscopy, a small amount of the lung tissue is taken or biopsied for laboratory testing.
What is treatment?
Since lung cancer tends to spread throughout the body, chemotherapy is the most common form of treatment. Chemotherapy drugs include doxorubicin or adriamycin, vincristine,and etoposide. Radiation therapy may be used if the exact area of the origin of the tumour is located.
In some cases, surgery of the lungs may have to be carried out. The procedure involves the removal of only the tumour, a lobe of the lungs or the whole lung, depending on the location of the tumour and the extent of damage. Lung surgery is a major operation and the patient may need to be in hospital for several days following surgery. The patient must breathe deeply and frequently to expand the lung tissue which aids in recovery.
Are there any side effects?
Treatment for lung cancer may have side effects like:
Hair loss
Redness and swelling of the food pipe
Lowered blood counts and increased risk to infections
Injuries to the lungs
Nausea and vomiting.
Showing posts with label cancer. Show all posts
Showing posts with label cancer. Show all posts
Liver cancer
What is liver cancer?
Liver cancer is an abnormal, uncontrolled growth of cells in the liver.
The liver is the largest internal organ of the body. It helps to regulate and store blood glucose (sugar). It helps get rid of drugs and toxins and produces important proteins. The liver also produces bile, which helps the body process fats and get rid of waste products.
There are two types of liver cancer: primary and secondary.
Primary liver cancer starts from the cells of the liver. The two most common forms of primary liver cancer are:
Hepatoma, which is often associated with cirrhosis and hepatitis B or C infections
Cholangiocarcinoma, a rare tumour developing in bile ducts cells.
Secondary liver cancer occurs when a cancer starts someplace else and spreads to the liver. A secondary liver tumour may not be found until it causes symptoms.
What is the cause?
Although the exact cause of liver cancer is not known, the contributing factors include:
Heavy alcohol drinking
Hepatitis B and C infections, cirrhosis, and other chronic liver ailments
Chronic liver disease
Haemochromatosis
What are the symptoms?
Symptoms of liver cancer are:
Pain, especially in the abdominal area or around the right shoulder blade
Loss of weight
Loss of appetite
Pain or swelling in the abdomen
Jaundice (yellowing of the skin and whites of eyes)
How is the diagnosis made?
To diagnose liver cancer, the physician notes the symptoms, checks for weight loss, malnutrition, weakness, examines for enlargement of the liver and other signs. Certain tests required include:
Blood tests for anaemia and liver functions
Alpha-fetoprotein level (a protein that sometimes occurs in the blood when liver cancer is present)
Ultrasound exam of the liver
CT scan
Hepatic artery angiogram (a process in which a local anaesthetic is given and the person is injected with a dye-like substance; a series of x-ray pictures are then taken and examined for signs of any abnormal growths in the liver)
Biopsy (a procedure in which a local anaesthetic is given and then a small sample of tissue from the liver is obtained through the skin with a hollow needle)
What is the treatment?
The treatment depends on the stage of the disease and whether it is primary or secondary liver cancer.
The following may be recommended:
Surgery to remove all the tumour along with a part of the liver
Anti-cancer drugs (chemotherapy).
If a liver tumour (hepatoma) is detected at an early stage, surgery may result in a cure if there is no cirrhosis. However, surgery may not be a good option if the tumour is large or if the liver is not working well or if there is cirrhosis. Chemotherapy does not cure the cancer, but it may shrink the tumour. This helps prevent some symptoms, including pain. Another possible treatment is hyperthermia therapy, which uses heat to kill cancer cells.
The effects of liver cancer vary depending on the stage at which the tumour is detected and when treatment begins. Age and physical condition of the patient are also important because some treatments are not recommended for the elderly. They may get infections more easily because chemotherapy can lower the body's resistance. The more the cancer has spread before diagnosis, the less are the chances for cure. Survival after diagnosis is often only several months but may be longer.
How can it be prevented from spreading or recurring?
This can be achieved by following these guidelines:
Consult the doctor if a return of any previous symptoms is noticed
Avoid alcoholic drinks
Eat small, frequent, well-balanced meals throughout the day. Take vitamin and mineral supplements with iron, folic acid, and thiamine, if recommended by the doctor
Make sure that restaurants and grocery stores where you buy food, and areas where you prepare food, are safe and clean
Exercise according to your doctor's recommendation and observe good health practices
Do not use illegal drugs
What are the complications?
Gastrointestinal bleeding
Liver failure
Spread (metastasis) of the carcinoma
Liver cancer is an abnormal, uncontrolled growth of cells in the liver.
The liver is the largest internal organ of the body. It helps to regulate and store blood glucose (sugar). It helps get rid of drugs and toxins and produces important proteins. The liver also produces bile, which helps the body process fats and get rid of waste products.
There are two types of liver cancer: primary and secondary.
Primary liver cancer starts from the cells of the liver. The two most common forms of primary liver cancer are:
Hepatoma, which is often associated with cirrhosis and hepatitis B or C infections
Cholangiocarcinoma, a rare tumour developing in bile ducts cells.
Secondary liver cancer occurs when a cancer starts someplace else and spreads to the liver. A secondary liver tumour may not be found until it causes symptoms.
What is the cause?
Although the exact cause of liver cancer is not known, the contributing factors include:
Heavy alcohol drinking
Hepatitis B and C infections, cirrhosis, and other chronic liver ailments
Chronic liver disease
Haemochromatosis
What are the symptoms?
Symptoms of liver cancer are:
Pain, especially in the abdominal area or around the right shoulder blade
Loss of weight
Loss of appetite
Pain or swelling in the abdomen
Jaundice (yellowing of the skin and whites of eyes)
How is the diagnosis made?
To diagnose liver cancer, the physician notes the symptoms, checks for weight loss, malnutrition, weakness, examines for enlargement of the liver and other signs. Certain tests required include:
Blood tests for anaemia and liver functions
Alpha-fetoprotein level (a protein that sometimes occurs in the blood when liver cancer is present)
Ultrasound exam of the liver
CT scan
Hepatic artery angiogram (a process in which a local anaesthetic is given and the person is injected with a dye-like substance; a series of x-ray pictures are then taken and examined for signs of any abnormal growths in the liver)
Biopsy (a procedure in which a local anaesthetic is given and then a small sample of tissue from the liver is obtained through the skin with a hollow needle)
What is the treatment?
The treatment depends on the stage of the disease and whether it is primary or secondary liver cancer.
The following may be recommended:
Surgery to remove all the tumour along with a part of the liver
Anti-cancer drugs (chemotherapy).
If a liver tumour (hepatoma) is detected at an early stage, surgery may result in a cure if there is no cirrhosis. However, surgery may not be a good option if the tumour is large or if the liver is not working well or if there is cirrhosis. Chemotherapy does not cure the cancer, but it may shrink the tumour. This helps prevent some symptoms, including pain. Another possible treatment is hyperthermia therapy, which uses heat to kill cancer cells.
The effects of liver cancer vary depending on the stage at which the tumour is detected and when treatment begins. Age and physical condition of the patient are also important because some treatments are not recommended for the elderly. They may get infections more easily because chemotherapy can lower the body's resistance. The more the cancer has spread before diagnosis, the less are the chances for cure. Survival after diagnosis is often only several months but may be longer.
How can it be prevented from spreading or recurring?
This can be achieved by following these guidelines:
Consult the doctor if a return of any previous symptoms is noticed
Avoid alcoholic drinks
Eat small, frequent, well-balanced meals throughout the day. Take vitamin and mineral supplements with iron, folic acid, and thiamine, if recommended by the doctor
Make sure that restaurants and grocery stores where you buy food, and areas where you prepare food, are safe and clean
Exercise according to your doctor's recommendation and observe good health practices
Do not use illegal drugs
What are the complications?
Gastrointestinal bleeding
Liver failure
Spread (metastasis) of the carcinoma
Leukaemia
What is leukaemia?
Leukaemia is a type of cancer that affects the white blood cells called leukocytes. Blood contains three types of cells – red blood cells or RBC’s that carry oxygen, leukocytes or white blood cells, WBC’s that help to protect the body against infections and platelets cells that help in blood clotting. These blood cells are produced in the bone marrow that is present in the cavities in bones. The leukocytes are of different kinds and various types of leukaemia are named after the kind of leukocyte affected.
What are the different types of leukaemia?
Leukaemia may be acute or chronic. The former develops suddenly and with rapidly worsening symptoms, and the latter spreads slowly over a period of time. Examples of acute leukaemia are:
Acute myelocytic leukaemia (AML) – it occurs in adults and in children less than a year old. Caused by a rapid increase in immature WBC’s, AML is characterised by bleeding from the gums and nose, proneness to fatigue and joint pain. Due to decrease in the production of RBC’s by the marrow, anaemia may occur. Patients often have enlarged lymph nodes.
Acute lymphocytic leukaemia (ALL) – this is the most common form of leukaemia in children aged 3 to 7 years. It is a progressively harmful disease where the WBC’s do not mature fully and thus are unable to carry out their functions properly. These cells multiply and replace the normal cells till finally bone marrow failure occurs. The child is prone to infections due to lowered immunity and bleeds easily if injured due to the blood’s decreased capacity to clot. He may also get tired very easily hampering his normal routine.
Examples of chronic leukaemia are:
Chronic lymphocytic leukaemia (CLL) – this is the commonest variety of leukaemia and occurs mostly in people over the age of 50. The symptoms are not very sudden and are usually vague, so the person may not seek treatment till very late. It is usually detected in a routine blood test since the person may not show any symptoms. It is caused due to a slow but steady increase in the number of WBC’s in the blood.
Chronic myelogenous leukaemia (CML) – associated with a chromosomal abnormality, CML commonly occurs in people between the ages of 35 and 60 years and is characterised by a chronic phase which can turn acute suddenly. There is no known prevention at this time but chemotherapy is started as soon as the disease is identified.
How is leukaemia caused?
The causes of most types of leukaemia are not clearly known. Some of the possible causes may be:
Exposure to harmful radiation in large doses
Exposure to certain chemicals like benzene over a long period of time
Certain genetic defects
Exposure to certain viruses (called retroviruses) that may cause leukaemia.
What are the symptoms?
The symptoms in chronic forms of leukaemia may not appear for a long time and the person may be able to lead a normal life. However, acute leukaemia presents with symptoms like:
Fatigue associated with anaemia due to the lowered number of cells which carry oxygen
Paleness of the face
Continuous low grade fever
Bleeding from gums or nose due to decrease in the number of platelets
Vulnerability to infection due to lowered immunity
Appearance of small red marks or petechiae (blood clots in the skin)
Abnormal menstruation in women
Unexpected loss of weight with loss of appetite.
How is it diagnosed?
Chronic leukaemias are diagnosed mostly when the patient goes in for a routine blood test and the sample shows an abnormal amount of WBC’s. Subsequently, specialised tests may be done to determine the exact type of leukaemia. A bone marrow biopsy in which the bone marrow is sampled using a needle, confirms the presence of leukaemia.
In acute forms, the patient may seek medical help when he feels excessively tired and loses appetite. The above tests confirm the diagnosis.
What is the treatment?
The treatment of leukaemia usually involves intensive chemotherapy using drugs that kill the cancerous cells. The drugs are given as injections into the veins or by mouth; they are given at regular intervals over a period of time. They are very powerful and result in loss of hair and symptoms like nausea and loss of appetite.
In some cases of leukaemia, especially in children, bone marrow transplant may be done. This is an expensive procedure where a person’s diseased marrow is replaced by a healthy marrow from a matching donor. This matching is very important since the body rejects foreign marrow very easily.
What are the side effects of treatment?
Chemotherapy is a very powerful form of therapy and results in loss of hair. It also damages normal cells in the bone marrow thus making it weak and highly prone to infections. Sometimes these infections can be life threatening. The person may also bleed very easily due to the destruction of platelets. Other associated symptoms like nausea, tiredness and anaemia are also common.
After treatment, the patient may recover normal functioning depending on the severity of the disease. 50% of the patients lead a normal and disease free life after a bone marrow transplant. However, the disease can recur any time and thus regular monitoring is required. This monitoring will reduce in frequency as time passes and the patient ceases to show any symptoms of recurrence of the condition.
Leukaemia is a type of cancer that affects the white blood cells called leukocytes. Blood contains three types of cells – red blood cells or RBC’s that carry oxygen, leukocytes or white blood cells, WBC’s that help to protect the body against infections and platelets cells that help in blood clotting. These blood cells are produced in the bone marrow that is present in the cavities in bones. The leukocytes are of different kinds and various types of leukaemia are named after the kind of leukocyte affected.
What are the different types of leukaemia?
Leukaemia may be acute or chronic. The former develops suddenly and with rapidly worsening symptoms, and the latter spreads slowly over a period of time. Examples of acute leukaemia are:
Acute myelocytic leukaemia (AML) – it occurs in adults and in children less than a year old. Caused by a rapid increase in immature WBC’s, AML is characterised by bleeding from the gums and nose, proneness to fatigue and joint pain. Due to decrease in the production of RBC’s by the marrow, anaemia may occur. Patients often have enlarged lymph nodes.
Acute lymphocytic leukaemia (ALL) – this is the most common form of leukaemia in children aged 3 to 7 years. It is a progressively harmful disease where the WBC’s do not mature fully and thus are unable to carry out their functions properly. These cells multiply and replace the normal cells till finally bone marrow failure occurs. The child is prone to infections due to lowered immunity and bleeds easily if injured due to the blood’s decreased capacity to clot. He may also get tired very easily hampering his normal routine.
Examples of chronic leukaemia are:
Chronic lymphocytic leukaemia (CLL) – this is the commonest variety of leukaemia and occurs mostly in people over the age of 50. The symptoms are not very sudden and are usually vague, so the person may not seek treatment till very late. It is usually detected in a routine blood test since the person may not show any symptoms. It is caused due to a slow but steady increase in the number of WBC’s in the blood.
Chronic myelogenous leukaemia (CML) – associated with a chromosomal abnormality, CML commonly occurs in people between the ages of 35 and 60 years and is characterised by a chronic phase which can turn acute suddenly. There is no known prevention at this time but chemotherapy is started as soon as the disease is identified.
How is leukaemia caused?
The causes of most types of leukaemia are not clearly known. Some of the possible causes may be:
Exposure to harmful radiation in large doses
Exposure to certain chemicals like benzene over a long period of time
Certain genetic defects
Exposure to certain viruses (called retroviruses) that may cause leukaemia.
What are the symptoms?
The symptoms in chronic forms of leukaemia may not appear for a long time and the person may be able to lead a normal life. However, acute leukaemia presents with symptoms like:
Fatigue associated with anaemia due to the lowered number of cells which carry oxygen
Paleness of the face
Continuous low grade fever
Bleeding from gums or nose due to decrease in the number of platelets
Vulnerability to infection due to lowered immunity
Appearance of small red marks or petechiae (blood clots in the skin)
Abnormal menstruation in women
Unexpected loss of weight with loss of appetite.
How is it diagnosed?
Chronic leukaemias are diagnosed mostly when the patient goes in for a routine blood test and the sample shows an abnormal amount of WBC’s. Subsequently, specialised tests may be done to determine the exact type of leukaemia. A bone marrow biopsy in which the bone marrow is sampled using a needle, confirms the presence of leukaemia.
In acute forms, the patient may seek medical help when he feels excessively tired and loses appetite. The above tests confirm the diagnosis.
What is the treatment?
The treatment of leukaemia usually involves intensive chemotherapy using drugs that kill the cancerous cells. The drugs are given as injections into the veins or by mouth; they are given at regular intervals over a period of time. They are very powerful and result in loss of hair and symptoms like nausea and loss of appetite.
In some cases of leukaemia, especially in children, bone marrow transplant may be done. This is an expensive procedure where a person’s diseased marrow is replaced by a healthy marrow from a matching donor. This matching is very important since the body rejects foreign marrow very easily.
What are the side effects of treatment?
Chemotherapy is a very powerful form of therapy and results in loss of hair. It also damages normal cells in the bone marrow thus making it weak and highly prone to infections. Sometimes these infections can be life threatening. The person may also bleed very easily due to the destruction of platelets. Other associated symptoms like nausea, tiredness and anaemia are also common.
After treatment, the patient may recover normal functioning depending on the severity of the disease. 50% of the patients lead a normal and disease free life after a bone marrow transplant. However, the disease can recur any time and thus regular monitoring is required. This monitoring will reduce in frequency as time passes and the patient ceases to show any symptoms of recurrence of the condition.
Leishmaniasis
What is it?
Leishmaniasis is a parasitic disease spread by a species of sandfly, the female phlebotomine sandfly. The disease has two main forms – the cutaneous form which affects the skin and the visceral form that affects the internal organs. Cutaneous leishmaniasis is seen when lesions form on the skin weeks to months after the possible insect bite. Visceral leishmaniasis causes swelling and enlargement of the spleen and liver in addition to anaemia.
Leishmaniasis is a disease that usually takes on epidemic proportions when it occurs. Kala-azar (visceral leishmaniasis) is the commonest form found in India and the last major epidemic occurred in 1977 when more than 100,000 cases were reported from Bihar. However, the states of both Bihar and West Bengal regularly report cases of Kala-azar.
What are the causes and risk conditions?
Leishmaniasis is a protozoal infection transmitted by the bite of the female phlebotomine sandfly. The sandfly needs the Leishmania parasites to obtain a protein necessary to develop her eggs. This parasite grows inside the fly and when it next bites a human being, the infection is transmitted. The incubation period i.e., the time lapse between the actual infection and the manifestation of symptoms, is usually 1-4 months but may range from 10 days to upto 2 years.
The disease occurs twice as many times in men as in women. It occurs most commonly among the lower socio-economic status and in migrant populations. People who work in open places in close proximity with animals are more prone to sandfly stings and thus the infection.
What are the symptoms?
Cutaneous leishmaniasis – this is the form of leishmaniasis that manifests itself in the form of lesions on the skin. These lesions may be open or closed and may sometimes be confused with leprotic lesions. The ulcers may be painful and may reduce an individual's ability to work. The main symptoms for this form are:
Painful ulceration of skin
The main ulcer surrounded by smaller lesions that may itch and pain
Discolouration of skin in some cases.
Visceral leishmaniasis (kala-azar) – this is the form that affects the internal organs like the liver and spleen causing a variety of symptoms like:
Swelling and enlargement of the spleen and liver
Persistent fever
Fatigue, weakness and loss of appetite
Persistent abdominal discomfort
Nausea and vomiting
Unexplained weight loss
Darkening of skin of face, hands, feet and abdomen (kala-azar = black illness).
How is it diagnosed?
The disease is diagnosed by a series of laboratory tests. Various skin tests may be done:
The Montenegro skin test – result based on skin reaction
Biopsy of the spleen
Lymph node biopsy
Bone marrow biopsy
Aldehyde test widely used in India for the diagnosis of Kala-azar
Serological tests – ELISA and IFAT (Indirect Fluorescent Antibody Test) are the commonly done diagnostic tests.
Other complementary tests are:
Complete blood count (CBC)
Haemoglobin check
Serum albumin
Serum protein
What is the treatment?
Once the disease is contracted, it can be treated with a tight vaccination schedule which involves a daily injection of sodium stibogluconate for 20 days for adults. To patients who do not respond to this form of therapy, a stronger and more toxic compound is administered under supervision. For cutaneous leishmaniasis, Amphotericin B, a potent antibiotic, is also used as a measure of treatment. However, since this drug is very toxic and has to be carefully administered, it is used only when the patient fails to respond to any other form of treatment.
However, the best method of treatment of the condition is prevention. Sandflies should be controlled with the help of insecticides, with DDT being sprayed at regular intervals. Insect repellents should be lit in the room at night. Popel who are more prone to insect stings can try rubbing insect repellant gels on the exposed parts of their body. Sanitation should be maintained in the neighbourhood with elimination of breeding places like garbage, rodent burrows, bricks or rubbish near houses and the like.
Animal reservoirs like dogs should be inoculated regularly. Health education becomes a necessary tool to be acquired to cope with the disease. Since once contracted, the disease has a high mortality rate, utmost care should be taken to avoid the breakout of Leishmaniasis.
Leishmaniasis is a parasitic disease spread by a species of sandfly, the female phlebotomine sandfly. The disease has two main forms – the cutaneous form which affects the skin and the visceral form that affects the internal organs. Cutaneous leishmaniasis is seen when lesions form on the skin weeks to months after the possible insect bite. Visceral leishmaniasis causes swelling and enlargement of the spleen and liver in addition to anaemia.
Leishmaniasis is a disease that usually takes on epidemic proportions when it occurs. Kala-azar (visceral leishmaniasis) is the commonest form found in India and the last major epidemic occurred in 1977 when more than 100,000 cases were reported from Bihar. However, the states of both Bihar and West Bengal regularly report cases of Kala-azar.
What are the causes and risk conditions?
Leishmaniasis is a protozoal infection transmitted by the bite of the female phlebotomine sandfly. The sandfly needs the Leishmania parasites to obtain a protein necessary to develop her eggs. This parasite grows inside the fly and when it next bites a human being, the infection is transmitted. The incubation period i.e., the time lapse between the actual infection and the manifestation of symptoms, is usually 1-4 months but may range from 10 days to upto 2 years.
The disease occurs twice as many times in men as in women. It occurs most commonly among the lower socio-economic status and in migrant populations. People who work in open places in close proximity with animals are more prone to sandfly stings and thus the infection.
What are the symptoms?
Cutaneous leishmaniasis – this is the form of leishmaniasis that manifests itself in the form of lesions on the skin. These lesions may be open or closed and may sometimes be confused with leprotic lesions. The ulcers may be painful and may reduce an individual's ability to work. The main symptoms for this form are:
Painful ulceration of skin
The main ulcer surrounded by smaller lesions that may itch and pain
Discolouration of skin in some cases.
Visceral leishmaniasis (kala-azar) – this is the form that affects the internal organs like the liver and spleen causing a variety of symptoms like:
Swelling and enlargement of the spleen and liver
Persistent fever
Fatigue, weakness and loss of appetite
Persistent abdominal discomfort
Nausea and vomiting
Unexplained weight loss
Darkening of skin of face, hands, feet and abdomen (kala-azar = black illness).
How is it diagnosed?
The disease is diagnosed by a series of laboratory tests. Various skin tests may be done:
The Montenegro skin test – result based on skin reaction
Biopsy of the spleen
Lymph node biopsy
Bone marrow biopsy
Aldehyde test widely used in India for the diagnosis of Kala-azar
Serological tests – ELISA and IFAT (Indirect Fluorescent Antibody Test) are the commonly done diagnostic tests.
Other complementary tests are:
Complete blood count (CBC)
Haemoglobin check
Serum albumin
Serum protein
What is the treatment?
Once the disease is contracted, it can be treated with a tight vaccination schedule which involves a daily injection of sodium stibogluconate for 20 days for adults. To patients who do not respond to this form of therapy, a stronger and more toxic compound is administered under supervision. For cutaneous leishmaniasis, Amphotericin B, a potent antibiotic, is also used as a measure of treatment. However, since this drug is very toxic and has to be carefully administered, it is used only when the patient fails to respond to any other form of treatment.
However, the best method of treatment of the condition is prevention. Sandflies should be controlled with the help of insecticides, with DDT being sprayed at regular intervals. Insect repellents should be lit in the room at night. Popel who are more prone to insect stings can try rubbing insect repellant gels on the exposed parts of their body. Sanitation should be maintained in the neighbourhood with elimination of breeding places like garbage, rodent burrows, bricks or rubbish near houses and the like.
Animal reservoirs like dogs should be inoculated regularly. Health education becomes a necessary tool to be acquired to cope with the disease. Since once contracted, the disease has a high mortality rate, utmost care should be taken to avoid the breakout of Leishmaniasis.
Kidney failure
What is kidney failure?
The main function of the kidneys is to eliminate excess fluid and waste material from the blood. When the kidneys lose this filtering ability, dangerous levels of fluid and waste accumulate in the body leading to a condition known as kidney or renal failure. This may be due to various factors including infections, autoimmune diseases, and other endocrine disorders, cancer, and toxic chemicals. Kidney failure usually occurs in the late stages of the disease processes. Once kidney failure occurs, it requires immediate management and even then prognosis is often not satisfactory unless kidney transplantation is done.
What is the cause?
There are two main types of kidney failure:
Acute renal failure (ARF)
This is characterised by a sudden impairment of renal function marked by rapid, and steadily increasing accumulation of toxic products in the blood, normally excreted by the kidneys. The causes of acute kidney failure include:
factors that interfere with renal blood flow (for example: fluid and electrolyte depletion, haemorrhage, severe infections, cardiac or liver failure, heat stroke, fluid depletion due to burns).
factors that cause obstruction (for example enlarged prostate and kidney stones can also lead to acute kidney failure).
other causes are factors that impair the renal function directly (for example acute tubular injury or acute glomerulonephritis, which is an inflammatory disorder of the kidney).
Chronic renal failure (CRF)
This is characterised by a slow and irreversible impairment of the excretory and regulatory functions of the kidneys. The causes of CRF include:
Chronic disease of the kidneys like glomerulonephritis
Chronic infection like tuberculosis
Anomalies of the kidneys that are present since birth
Vascular disease like hypertension
Endocrine disease like diabetes
Obstructive processes in the kidneys such as kidney stones
Nephrotoxins (toxic chemicals that affect the kidneys)
What are the symptoms?
The symptoms and signs of kidney failure depend upon the type of failure. In acute kidney failure, the patient may have oliguria (reduced urine output) along with generalised swelling (oedema) of the body together with high blood pressure. Sometimes there may be blood in the urine. In the early stages of chronic kidney failure, the patient may merely have increasing fatigue and tiredness and symptoms like nocturia (increased frequency of urination at night). Vomiting, oedema and high blood pressure eventually develop. There is also loss of appetite. Other symptoms depend upon the cause of the failure. For example, if there are kidney stones, then there may be excruciating groin pain or if there is severe haemorrhage or diarrhoea there may be signs of shock. Complications in renal failure include pulmonary oedema (presence of fluid in the lungs), severe sustained increase in blood pressure, acidosis, hyperkalaemia (increased level of potassium in the blood), and infection. If untreated, the last stage of kidney failure is almost invariably fatal.
How is the diagnosis made?
Urine examination is done to determine the presence of protein, sugar, casts and crystals, pH and specific gravity and the quantity of sodium. This gives an idea as to the cause of the failure. Blood tests include tests of renal function like
Blood urea nitrogen
Serum creatinine
Serum electrolytes.
Creatinine clearance is also an important index of renal function.
Blood counts and the haemoglobin levels are also useful. An ultrasound of the abdomen or a CT-scan needs to be taken to assess kidney size with grossly shrunken kidneys indicating a more advanced disease. End-stage renal disease is diagnosed when blood tests consistently show very high levels of urea and creatinine, a sign that kidney function has been severely and permanently damaged.
What is the treatment?
In acute kidney failure, general treatment measures include avoiding drugs that require renal excretion, balancing fluid intake with output, high carbohydrate and low-protein diet, essential amino acid replacement and at least 100gms of glucose per day, decreased intake of salt and potassium, vitamin supplements, prevention of injury or infection, weight management, electrolytes monitoring, and monitoring of vital signs, cardiac status, and mental status. Peritoneal or haemodialysis is the treatment of choice when other measures fail. Drugs are used to reduce the blood pressure; diuretics (drugs that increase urine output) are used in some cases to increase blood flow unless oliguria is present. Antibiotics may be needed to treat associated infections (predominantly only antibiotics excreted by the liver are used if there is no liver disease).
In chronic kidney failure, general treatment measures include a diet low in sodium, potassium, and phosphate, but high in calories and supplemented with essential amino acids. Other measures include balanced fluid intake, and monitoring weight changes, vital signs, electrolyte balance, cardiac and mental status.
Drug therapy: This includes antihypertensives for hypertension, diuretics for oedema and hypertension, phosphate binders for hyperphosphataemia (increased phosphate levels in the body), antibiotics, anticonvulsants for seizures, antiemetics (drugs that prevent vomiting) for nausea, laxatives for constipation, calcium, iron, and vitamin supplements.
Dialysis: Peritoneal dialysis or haemodialysis is often required for end-stage disease.
Surgery: Kidney transplantation is the solution for several patients as dialysis is often a measure that cannot be done indefinitely. The results of transplantation are now extremely good with substantial five-year survival rates.
What is the prevention?
Prevention of the causative factors, wherever possible, may help in preventing the development of the disease. Control of blood sugar in diabetics is of great importance. After the disease has developed, drug therapy may help and dialysis and kidney transplantation are increasingly being performed with excellent results. Control of blood pressure and avoiding smoking, alcohol, and drug abuse are also necessary. Proper diet and exercise also help in delaying the progress of the disease.
The main function of the kidneys is to eliminate excess fluid and waste material from the blood. When the kidneys lose this filtering ability, dangerous levels of fluid and waste accumulate in the body leading to a condition known as kidney or renal failure. This may be due to various factors including infections, autoimmune diseases, and other endocrine disorders, cancer, and toxic chemicals. Kidney failure usually occurs in the late stages of the disease processes. Once kidney failure occurs, it requires immediate management and even then prognosis is often not satisfactory unless kidney transplantation is done.
What is the cause?
There are two main types of kidney failure:
Acute renal failure (ARF)
This is characterised by a sudden impairment of renal function marked by rapid, and steadily increasing accumulation of toxic products in the blood, normally excreted by the kidneys. The causes of acute kidney failure include:
factors that interfere with renal blood flow (for example: fluid and electrolyte depletion, haemorrhage, severe infections, cardiac or liver failure, heat stroke, fluid depletion due to burns).
factors that cause obstruction (for example enlarged prostate and kidney stones can also lead to acute kidney failure).
other causes are factors that impair the renal function directly (for example acute tubular injury or acute glomerulonephritis, which is an inflammatory disorder of the kidney).
Chronic renal failure (CRF)
This is characterised by a slow and irreversible impairment of the excretory and regulatory functions of the kidneys. The causes of CRF include:
Chronic disease of the kidneys like glomerulonephritis
Chronic infection like tuberculosis
Anomalies of the kidneys that are present since birth
Vascular disease like hypertension
Endocrine disease like diabetes
Obstructive processes in the kidneys such as kidney stones
Nephrotoxins (toxic chemicals that affect the kidneys)
What are the symptoms?
The symptoms and signs of kidney failure depend upon the type of failure. In acute kidney failure, the patient may have oliguria (reduced urine output) along with generalised swelling (oedema) of the body together with high blood pressure. Sometimes there may be blood in the urine. In the early stages of chronic kidney failure, the patient may merely have increasing fatigue and tiredness and symptoms like nocturia (increased frequency of urination at night). Vomiting, oedema and high blood pressure eventually develop. There is also loss of appetite. Other symptoms depend upon the cause of the failure. For example, if there are kidney stones, then there may be excruciating groin pain or if there is severe haemorrhage or diarrhoea there may be signs of shock. Complications in renal failure include pulmonary oedema (presence of fluid in the lungs), severe sustained increase in blood pressure, acidosis, hyperkalaemia (increased level of potassium in the blood), and infection. If untreated, the last stage of kidney failure is almost invariably fatal.
How is the diagnosis made?
Urine examination is done to determine the presence of protein, sugar, casts and crystals, pH and specific gravity and the quantity of sodium. This gives an idea as to the cause of the failure. Blood tests include tests of renal function like
Blood urea nitrogen
Serum creatinine
Serum electrolytes.
Creatinine clearance is also an important index of renal function.
Blood counts and the haemoglobin levels are also useful. An ultrasound of the abdomen or a CT-scan needs to be taken to assess kidney size with grossly shrunken kidneys indicating a more advanced disease. End-stage renal disease is diagnosed when blood tests consistently show very high levels of urea and creatinine, a sign that kidney function has been severely and permanently damaged.
What is the treatment?
In acute kidney failure, general treatment measures include avoiding drugs that require renal excretion, balancing fluid intake with output, high carbohydrate and low-protein diet, essential amino acid replacement and at least 100gms of glucose per day, decreased intake of salt and potassium, vitamin supplements, prevention of injury or infection, weight management, electrolytes monitoring, and monitoring of vital signs, cardiac status, and mental status. Peritoneal or haemodialysis is the treatment of choice when other measures fail. Drugs are used to reduce the blood pressure; diuretics (drugs that increase urine output) are used in some cases to increase blood flow unless oliguria is present. Antibiotics may be needed to treat associated infections (predominantly only antibiotics excreted by the liver are used if there is no liver disease).
In chronic kidney failure, general treatment measures include a diet low in sodium, potassium, and phosphate, but high in calories and supplemented with essential amino acids. Other measures include balanced fluid intake, and monitoring weight changes, vital signs, electrolyte balance, cardiac and mental status.
Drug therapy: This includes antihypertensives for hypertension, diuretics for oedema and hypertension, phosphate binders for hyperphosphataemia (increased phosphate levels in the body), antibiotics, anticonvulsants for seizures, antiemetics (drugs that prevent vomiting) for nausea, laxatives for constipation, calcium, iron, and vitamin supplements.
Dialysis: Peritoneal dialysis or haemodialysis is often required for end-stage disease.
Surgery: Kidney transplantation is the solution for several patients as dialysis is often a measure that cannot be done indefinitely. The results of transplantation are now extremely good with substantial five-year survival rates.
What is the prevention?
Prevention of the causative factors, wherever possible, may help in preventing the development of the disease. Control of blood sugar in diabetics is of great importance. After the disease has developed, drug therapy may help and dialysis and kidney transplantation are increasingly being performed with excellent results. Control of blood pressure and avoiding smoking, alcohol, and drug abuse are also necessary. Proper diet and exercise also help in delaying the progress of the disease.
Haemoptysis
What is haemoptysis?
Haemoptysis is defined as coughing out of blood originating in the lower respiratory tracts that is trachea, bronchi and lungs. It includes coughing out of blood and blood streaked sputum. It is a symptom of a disease and not a disease. If the coughed up blood is more than 600-800 ml in 24 hours, urgent medical treatment may be needed.
What are the common causes?
The common causes for haemoptysis include infections of the lungs like tuberculosis, bronchitis, pneumonia, bronchiectasis or an abscess in the lungs. Cancer of the bronchi or lungs may also be present with haemoptysis. Other causes may be injury to the chest causing lung contusions. Irritation of the throat with violent coughing may also result in haemoptysis.
How is the condition diagnosed?
Detailed clinical history and physical examination of the chest and lungs is done to diagnose the underlying condition. The doctor may ask for diagnostic tests including X-ray of the chest, complete blood count, sputum culture, bronchoscopy, lung scan and lung biopsy. In bronchoscopy, a lighted tube is passed into the air passages that allows visualisation of the lining of the airways. Through this a biopsy of any suspicious area can also be taken.
What is the treatment?
Treatment may depend on the cause. Cough suppressants may be used in case of irritation of the throat from violent coughing but it is best to avoid them as they have the effect of allowing blood clot to accumulate in the bronchi. Haemoptysis usually stops spontaneously and nothing but reassurance is necessary. A sedative may be given to allay anxiety. If the underlying cause is infective, antibiotics may need to be given, sometimes even intravenously.
In case of severe blood loss, blood transfusion may be necessary. Control of bleeding by surgical measures is occasionally required. In this a portion of the lung or the whole diseased lung may have to be removed.
Haemoptysis is defined as coughing out of blood originating in the lower respiratory tracts that is trachea, bronchi and lungs. It includes coughing out of blood and blood streaked sputum. It is a symptom of a disease and not a disease. If the coughed up blood is more than 600-800 ml in 24 hours, urgent medical treatment may be needed.
What are the common causes?
The common causes for haemoptysis include infections of the lungs like tuberculosis, bronchitis, pneumonia, bronchiectasis or an abscess in the lungs. Cancer of the bronchi or lungs may also be present with haemoptysis. Other causes may be injury to the chest causing lung contusions. Irritation of the throat with violent coughing may also result in haemoptysis.
How is the condition diagnosed?
Detailed clinical history and physical examination of the chest and lungs is done to diagnose the underlying condition. The doctor may ask for diagnostic tests including X-ray of the chest, complete blood count, sputum culture, bronchoscopy, lung scan and lung biopsy. In bronchoscopy, a lighted tube is passed into the air passages that allows visualisation of the lining of the airways. Through this a biopsy of any suspicious area can also be taken.
What is the treatment?
Treatment may depend on the cause. Cough suppressants may be used in case of irritation of the throat from violent coughing but it is best to avoid them as they have the effect of allowing blood clot to accumulate in the bronchi. Haemoptysis usually stops spontaneously and nothing but reassurance is necessary. A sedative may be given to allay anxiety. If the underlying cause is infective, antibiotics may need to be given, sometimes even intravenously.
In case of severe blood loss, blood transfusion may be necessary. Control of bleeding by surgical measures is occasionally required. In this a portion of the lung or the whole diseased lung may have to be removed.
Gall bladder cancer
What is gall bladder cancer?
Gallbladder is a small, pear-shaped organ on the right side of the abdomen, just beneath the liver. Its main function is to store bile; a fluid that helps digest fats and carries cholesterol and toxins from the body. Cancers of the gallbladder and bile duct (the gallbladder and bile duct together are called the biliary tract) seldom produce symptoms in the early stages. In fact, early gallbladder cancer is often discovered only when the gallbladder is removed as a treatment for gallstones. Otherwise, biliary tract cancers are often quite advanced by the time they are diagnosed.
What are the symptoms?
Gallbladder cancer rarely produces signs and symptoms in the early stages. When symptoms do appear, they often resemble those of other, more common, gallbladder problems, such as gallstones or infection.
The signs and symptoms include:
Abdominal pain
Nausea and vomiting
Jaundice results from high blood levels of bilirubin. Normally, bilirubin is metabolised in the liver and eliminated through the bile ducts. But a blocked bile duct can cause bilirubin to accumulate in the blood.
Loss of appetite or weight
Jaundice is the most common initial sign of bile duct cancer (cholangiocarcinoma). Other signs and symptoms include:
Enlarged gallbladder
Intense itching (pruritus)
Brown coloured urine
Loss of appetite and weight
White or clay-coloured stools
Fever
How is the diagnosis made?
Many gallbladder cancers are discovered when a pathologist examines a gallbladder that has been removed for symptoms of gallstones. But many gallbladder and most bile duct cancers are found only after related signs and symptoms appear. The doctor conducts a physical exam and the following tests:
Blood tests: This is to check for elevated levels of bilirubin or the enzyme alkaline phosphatase.
Ultrasound: Ultrasound is usually one of the first tests done in the evaluation of patients with jaundice and is especially good at diagnosing the presence of gallstones and obstructed bile ducts. It can also show the presence and extent of tumours.
CT scan: This helps determine if cancerous cells have spread to the common bile duct, lymph nodes or the liver.
MRI: This test uses a powerful magnetic field and radio waves to create images and can help determine whether the flow of bile is blocked or a tumour has invaded the liver.
Endoscopic retrograde cholangiopancreatiography (ERCP): This test is most sensitive for detecting an obstruction of the bile ducts and its cause, and can also be used in preparation for surgery. ERCP can also allow a biopsy to be performed, confirming a diagnosis.
Laparoscopy: This is often used to confirm how far the cancer has spread.
Biopsy: In this procedure, a small sample of tissue is removed and examined for cancerous cells under a microscope. It is the only way to make a definitive diagnosis of cancer.
What is the treatment?
Treatment for biliary tract cancers depends on the type and stage of cancer as well as on the patient’s age and overall health. The goal of treatment is to completely eliminate the cancer. Unfortunately, this is often not possible and the focus may need to be changed to treating the signs and symptoms the cancer is causing or preventing the tumour from causing more harm.
For gallbladder cancer: Surgical removal of the gallbladder usually offers the best hope for people with gallbladder cancer. If the tumour is very small and has not spread to the deeper layers of the gallbladder tissue, the surgeon may perform a simple cholecystectomy, which removes only the gallbladder. If the cancer is more advanced, some liver tissue and nearby lymph nodes are removed along with the gallbladder.
For bile duct cancer: Surgery usually offers the best chance for people with bile duct cancer. But the type of surgery varies depending on the location of the cancer and how extensive it is. For example, removing the affected part of the liver treats tumours that are within the liver. Tumours that develop where the hepatic duct leaves the liver (perihilar tumours) are usually treated by surgically removing a portion of the bile duct, the gallbladder, and parts of the liver, pancreas and the small intestine.
What are the complications?
A tumour that blocks the bile duct can cause pain, jaundice, nausea and vomiting. Tumours located where the pancreatic duct enters the small intestine may block the small intestine, preventing normal passage of food. Tumours may make it difficult to digest and absorb nutrients from the food by blocking the flow of the pancreatic enzymes. The most serious complication of biliary tract cancer is metastasis. Since biliary tract cancers are rarely discovered in the early stages, they often tend to spread to the other organs around the gall bladder, including liver, stomach, pancreas and intestines or to the nearby lymph nodes.
Gallbladder is a small, pear-shaped organ on the right side of the abdomen, just beneath the liver. Its main function is to store bile; a fluid that helps digest fats and carries cholesterol and toxins from the body. Cancers of the gallbladder and bile duct (the gallbladder and bile duct together are called the biliary tract) seldom produce symptoms in the early stages. In fact, early gallbladder cancer is often discovered only when the gallbladder is removed as a treatment for gallstones. Otherwise, biliary tract cancers are often quite advanced by the time they are diagnosed.
What are the symptoms?
Gallbladder cancer rarely produces signs and symptoms in the early stages. When symptoms do appear, they often resemble those of other, more common, gallbladder problems, such as gallstones or infection.
The signs and symptoms include:
Abdominal pain
Nausea and vomiting
Jaundice results from high blood levels of bilirubin. Normally, bilirubin is metabolised in the liver and eliminated through the bile ducts. But a blocked bile duct can cause bilirubin to accumulate in the blood.
Loss of appetite or weight
Jaundice is the most common initial sign of bile duct cancer (cholangiocarcinoma). Other signs and symptoms include:
Enlarged gallbladder
Intense itching (pruritus)
Brown coloured urine
Loss of appetite and weight
White or clay-coloured stools
Fever
How is the diagnosis made?
Many gallbladder cancers are discovered when a pathologist examines a gallbladder that has been removed for symptoms of gallstones. But many gallbladder and most bile duct cancers are found only after related signs and symptoms appear. The doctor conducts a physical exam and the following tests:
Blood tests: This is to check for elevated levels of bilirubin or the enzyme alkaline phosphatase.
Ultrasound: Ultrasound is usually one of the first tests done in the evaluation of patients with jaundice and is especially good at diagnosing the presence of gallstones and obstructed bile ducts. It can also show the presence and extent of tumours.
CT scan: This helps determine if cancerous cells have spread to the common bile duct, lymph nodes or the liver.
MRI: This test uses a powerful magnetic field and radio waves to create images and can help determine whether the flow of bile is blocked or a tumour has invaded the liver.
Endoscopic retrograde cholangiopancreatiography (ERCP): This test is most sensitive for detecting an obstruction of the bile ducts and its cause, and can also be used in preparation for surgery. ERCP can also allow a biopsy to be performed, confirming a diagnosis.
Laparoscopy: This is often used to confirm how far the cancer has spread.
Biopsy: In this procedure, a small sample of tissue is removed and examined for cancerous cells under a microscope. It is the only way to make a definitive diagnosis of cancer.
What is the treatment?
Treatment for biliary tract cancers depends on the type and stage of cancer as well as on the patient’s age and overall health. The goal of treatment is to completely eliminate the cancer. Unfortunately, this is often not possible and the focus may need to be changed to treating the signs and symptoms the cancer is causing or preventing the tumour from causing more harm.
For gallbladder cancer: Surgical removal of the gallbladder usually offers the best hope for people with gallbladder cancer. If the tumour is very small and has not spread to the deeper layers of the gallbladder tissue, the surgeon may perform a simple cholecystectomy, which removes only the gallbladder. If the cancer is more advanced, some liver tissue and nearby lymph nodes are removed along with the gallbladder.
For bile duct cancer: Surgery usually offers the best chance for people with bile duct cancer. But the type of surgery varies depending on the location of the cancer and how extensive it is. For example, removing the affected part of the liver treats tumours that are within the liver. Tumours that develop where the hepatic duct leaves the liver (perihilar tumours) are usually treated by surgically removing a portion of the bile duct, the gallbladder, and parts of the liver, pancreas and the small intestine.
What are the complications?
A tumour that blocks the bile duct can cause pain, jaundice, nausea and vomiting. Tumours located where the pancreatic duct enters the small intestine may block the small intestine, preventing normal passage of food. Tumours may make it difficult to digest and absorb nutrients from the food by blocking the flow of the pancreatic enzymes. The most serious complication of biliary tract cancer is metastasis. Since biliary tract cancers are rarely discovered in the early stages, they often tend to spread to the other organs around the gall bladder, including liver, stomach, pancreas and intestines or to the nearby lymph nodes.
Colorectal cancer
What is it?
The colon and the rectum are parts of the large intestine. The intestine is an organ that helps in digestion and excretion. Digestion is mainly carried out by the small intestine, while excretion is the major function of the large intestine. A malignant growth of cells in the large intestine is called colorectal cancer. Separately, the cancer may be of the colon (colon cancer) or the rectum (rectal cancer).
What are the causes?
Like most cancers, the exact cause of colorectal cancer is not known. However, there are certain risk factors that predispose an individual to it. These are:
Age – risk increases with age.
A diet high in fat but low in fibre.
The presence of some kinds of polyps, which are benign growths in the intestine. These growths present on the wall of the intestine are not harmful by themselves, but if present in large numbers may be a leading cause of colorectal cancer.
As with all cancers, a family history of colorectal cancer.
A condition affecting the colon called ulcerative colitis, in which the colon becomes red and inflamed.
What are the symptoms?
Colorectal cancers may produce no symptoms till the disease is advanced. However, the most frequently noted symptoms that may be indicative of the disease are:
Passage of bright red or dark coloured blood in the stools
Change in bowel habits with frequent diarrhoea or constipation
Change in the appearance of stools
Constant feeling of fullness or gas in the stomach
Persistent feeling that the bowel is not being cleared fully
Unexplained loss of weight sometimes accompanied by anaemia
Fatigue and tiredness.
How is it diagnosed?
A thorough examination of the patient’s medical history is done in addition to a physical check-up. The doctor may also prescribe certain tests for confirmation. An X-ray of the intestine, called a barium enema, helps the doctor to detect the presence of any abnormal growths or cysts.
Colonoscopy or sigmoidoscopy may be done which allow the doctor to see inside the colon and the rectum for detection of polyps or cysts. A thin, flexible tube-like telescope is inserted through the rectum into the intestine. A small sample of the area may be taken for biopsy with the helps of forceps attached to the instrument. In some cases, any polyps that are detected may also be removed simultaneously by burning them.
What is the treatment?
Surgery to remove the tumour is the most common form of treatment. If the tumour has not spread to other parts of the organ, it can be easily removed. Mostly some healthy parts of the intestine are also removed to reduce the risk of recurrence. Sometimes, a surgical procedure called colostomy is performed. This is done if the surgeon, after removing parts of the colon is unable to join it back with the rectum. In this, the colon opens in the skin of the abdomen, to allow faecal matter to drain and be collected in a bag. This procedure may be temporary or permanent.
In some cases with wide-spread disease, chemotherapy is given to destroy the cancer cells. Radiation therapy may also be done in some cases if the tumour is localized.
Treatment may have side effects like pain in the area after partial removal of the colon. The usual side effects of chemotherapy like hair loss, nausea and vomiting may also be present. There may also be loss of appetite and loss of weight after the treatment procedures.
The colon and the rectum are parts of the large intestine. The intestine is an organ that helps in digestion and excretion. Digestion is mainly carried out by the small intestine, while excretion is the major function of the large intestine. A malignant growth of cells in the large intestine is called colorectal cancer. Separately, the cancer may be of the colon (colon cancer) or the rectum (rectal cancer).
What are the causes?
Like most cancers, the exact cause of colorectal cancer is not known. However, there are certain risk factors that predispose an individual to it. These are:
Age – risk increases with age.
A diet high in fat but low in fibre.
The presence of some kinds of polyps, which are benign growths in the intestine. These growths present on the wall of the intestine are not harmful by themselves, but if present in large numbers may be a leading cause of colorectal cancer.
As with all cancers, a family history of colorectal cancer.
A condition affecting the colon called ulcerative colitis, in which the colon becomes red and inflamed.
What are the symptoms?
Colorectal cancers may produce no symptoms till the disease is advanced. However, the most frequently noted symptoms that may be indicative of the disease are:
Passage of bright red or dark coloured blood in the stools
Change in bowel habits with frequent diarrhoea or constipation
Change in the appearance of stools
Constant feeling of fullness or gas in the stomach
Persistent feeling that the bowel is not being cleared fully
Unexplained loss of weight sometimes accompanied by anaemia
Fatigue and tiredness.
How is it diagnosed?
A thorough examination of the patient’s medical history is done in addition to a physical check-up. The doctor may also prescribe certain tests for confirmation. An X-ray of the intestine, called a barium enema, helps the doctor to detect the presence of any abnormal growths or cysts.
Colonoscopy or sigmoidoscopy may be done which allow the doctor to see inside the colon and the rectum for detection of polyps or cysts. A thin, flexible tube-like telescope is inserted through the rectum into the intestine. A small sample of the area may be taken for biopsy with the helps of forceps attached to the instrument. In some cases, any polyps that are detected may also be removed simultaneously by burning them.
What is the treatment?
Surgery to remove the tumour is the most common form of treatment. If the tumour has not spread to other parts of the organ, it can be easily removed. Mostly some healthy parts of the intestine are also removed to reduce the risk of recurrence. Sometimes, a surgical procedure called colostomy is performed. This is done if the surgeon, after removing parts of the colon is unable to join it back with the rectum. In this, the colon opens in the skin of the abdomen, to allow faecal matter to drain and be collected in a bag. This procedure may be temporary or permanent.
In some cases with wide-spread disease, chemotherapy is given to destroy the cancer cells. Radiation therapy may also be done in some cases if the tumour is localized.
Treatment may have side effects like pain in the area after partial removal of the colon. The usual side effects of chemotherapy like hair loss, nausea and vomiting may also be present. There may also be loss of appetite and loss of weight after the treatment procedures.
Cervical cancer
What is cervical cancer?
Cervical cancer is a disease caused by the abnormal growth and division of cells that make up the cervix (the portion of the uterus attached to the top of the vagina). Ninety percent of the cervical cancers arise from the flattened or squamous cells covering the cervix. Most of the remaining 10% arise from the glandular, mucous-secreting cells of the cervical canal leading into the uterus.
What are the causes?
The development of cervical cancer is gradual and begins as a pre-cancerous condition called dysplasia. In this form it is 100% treatable, usually without the need for a hysterectomy (surgical removal of the uterus). Dysplasia, depending on its severity, can resolve without treatment, particularly in young women. However, it often progresses to actual cancer called ‘carcinoma in situ’ (CIS) if it has not spread, or ‘microinvasive’ if it has spread only a few millimeters into the surrounding tissue but not into the lymph channels or blood vessels.
The risk factors for cervical cancer are:
Infection with the virus that causes genital warts (human papilloma virus or HPV) may increase the risk of developing dysplasia and subsequent cancer. Fortunately, not all women who have had HPV infection or genital warts develop cervical cancer. Other factors, such as smoking, may increase the risk of developing cervical cancer in those who have had HPV
Early age at first sexual intercourse
Multiple sexual partners or partners who have multiple partners
There is a small increased risk of abnormal Pap smears among women who take birth control pills. It is because such women are more sexually active, are less likely to use condoms, and have more frequent Pap smears in order to be prescribed the birth control pill
Women whose immune systems are weakened - such as those with HIV infection or women who have received organ transplants and are taking drugs to suppress the immune system - may be at a higher risk
Infections with genital herpes or chronic chlamydia infections, both sexually transmitted diseases, may increase risk
What are the symptoms?
Most often, cervical cancer in its earliest and most treatable stages does not cause any symptoms. When there are symptoms, the most common are:
Persistent vaginal discharge, which may be pale, watery, pink, brown, blood streaked, or dark and foul-smelling
Abnormal vaginal bleeding, especially between menstrual periods, after intercourse or douching, and after menopause, which gradually becomes heavier and longer
Symptoms of advanced cervical cancer may include:
Loss of appetite, weight loss, fatigue
Pelvic, back, or leg pain
Leaking of urine or faeces from the vagina
Bone fracture
How is the diagnosis made?
Invasive cervical cancer often appears as an irregular fleshy growth, often firm or hard, that tends to bleed easily. But even on pelvic examination by a doctor, pre-cancers and even early cancers of the cervix are often not visible to the naked eye. Special tests are necessary to diagnose cervical pre-cancers and cancers:
Pap smears screen for cervical pre-cancers and cancers. The Pap smear test consists of cells wiped or brushed off the cervix and placed on a microscope slide. This is usually done at the time of a pelvic examination, though not every pelvic exam includes a Pap smear.
Colposcopy is an examination of the cervix under magnification in order to locate an abnormality of the cervix
Biopsy, colposcopy, or sometimes the use of LASER (a loop electrode) or other instrument allows a diagnosis to be made
When cervical cancer is found, additional tests - such as X-rays, using an instrument to look into the bladder (cystoscopy), and rectum and colon (colonoscopy) - are used to determine how far the cancer has spread and what stage the disease is in
What is the treatment?
Treatment of cervical cancer depends on the type of cancer, the stage, the size and shape of the tumour, the age and general health of the woman, and her desire for future childbearing.
In its earliest stages, the disease is curable by removing or destroying the pre-cancerous or cancerous tissue. This can often be done in various ways without removing the uterus or damaging the cervix so that a woman is still capable of having children.
In other cases, a removal of the uterus (hysterectomy) is performed, with or without removal of the ovaries. In more advanced disease, a radical hysterectomy may be performed which removes the uterus and much of the surrounding tissues, including internal lymph nodes. In the most extreme surgery, called a pelvic exenteration, all of the organs of the pelvis, including the urinary bladder and rectum, are removed.
Radiation or chemotherapy may be used to treat cancer that has spread beyond the pelvis, or has recurred. A variety of chemotherapeutic drugs, or combinations of them, are used. Sometimes radiation and chemotherapy are used before or after surgery.
What is the prevention?
There are two ways to prevent cervical cancer - the first is to prevent infections with HPV, the second is to get regular Pap smears that will detect pre-cancerous conditions and HPV. Both of these can be treated and the progression to cervical cancer be arrested.
Precancers are completely curable when followed up properly. To reduce the chances of cervical cancer, girls less than 18 years of age should avoid sexual activity or always use condoms. HPV infection causes genital warts. These may be barely visible or several inches across. If a woman sees warts on her partner's genitals, she should avoid intercourse. To further reduce the risk of cervical cancer, women should limit the number of their sexual partners, avoid sexually promiscuous partners, and discontinue any tobacco use. Condoms may help prevent the transmission of HPV.
Annual pelvic examinations, including a pap smear, should begin when a woman becomes sexually active, or by the age of 20 in a non-sexually active woman. All abnormal findings should be followed up with colposcopy and biopsy.
Cervical cancer is a disease caused by the abnormal growth and division of cells that make up the cervix (the portion of the uterus attached to the top of the vagina). Ninety percent of the cervical cancers arise from the flattened or squamous cells covering the cervix. Most of the remaining 10% arise from the glandular, mucous-secreting cells of the cervical canal leading into the uterus.
What are the causes?
The development of cervical cancer is gradual and begins as a pre-cancerous condition called dysplasia. In this form it is 100% treatable, usually without the need for a hysterectomy (surgical removal of the uterus). Dysplasia, depending on its severity, can resolve without treatment, particularly in young women. However, it often progresses to actual cancer called ‘carcinoma in situ’ (CIS) if it has not spread, or ‘microinvasive’ if it has spread only a few millimeters into the surrounding tissue but not into the lymph channels or blood vessels.
The risk factors for cervical cancer are:
Infection with the virus that causes genital warts (human papilloma virus or HPV) may increase the risk of developing dysplasia and subsequent cancer. Fortunately, not all women who have had HPV infection or genital warts develop cervical cancer. Other factors, such as smoking, may increase the risk of developing cervical cancer in those who have had HPV
Early age at first sexual intercourse
Multiple sexual partners or partners who have multiple partners
There is a small increased risk of abnormal Pap smears among women who take birth control pills. It is because such women are more sexually active, are less likely to use condoms, and have more frequent Pap smears in order to be prescribed the birth control pill
Women whose immune systems are weakened - such as those with HIV infection or women who have received organ transplants and are taking drugs to suppress the immune system - may be at a higher risk
Infections with genital herpes or chronic chlamydia infections, both sexually transmitted diseases, may increase risk
What are the symptoms?
Most often, cervical cancer in its earliest and most treatable stages does not cause any symptoms. When there are symptoms, the most common are:
Persistent vaginal discharge, which may be pale, watery, pink, brown, blood streaked, or dark and foul-smelling
Abnormal vaginal bleeding, especially between menstrual periods, after intercourse or douching, and after menopause, which gradually becomes heavier and longer
Symptoms of advanced cervical cancer may include:
Loss of appetite, weight loss, fatigue
Pelvic, back, or leg pain
Leaking of urine or faeces from the vagina
Bone fracture
How is the diagnosis made?
Invasive cervical cancer often appears as an irregular fleshy growth, often firm or hard, that tends to bleed easily. But even on pelvic examination by a doctor, pre-cancers and even early cancers of the cervix are often not visible to the naked eye. Special tests are necessary to diagnose cervical pre-cancers and cancers:
Pap smears screen for cervical pre-cancers and cancers. The Pap smear test consists of cells wiped or brushed off the cervix and placed on a microscope slide. This is usually done at the time of a pelvic examination, though not every pelvic exam includes a Pap smear.
Colposcopy is an examination of the cervix under magnification in order to locate an abnormality of the cervix
Biopsy, colposcopy, or sometimes the use of LASER (a loop electrode) or other instrument allows a diagnosis to be made
When cervical cancer is found, additional tests - such as X-rays, using an instrument to look into the bladder (cystoscopy), and rectum and colon (colonoscopy) - are used to determine how far the cancer has spread and what stage the disease is in
What is the treatment?
Treatment of cervical cancer depends on the type of cancer, the stage, the size and shape of the tumour, the age and general health of the woman, and her desire for future childbearing.
In its earliest stages, the disease is curable by removing or destroying the pre-cancerous or cancerous tissue. This can often be done in various ways without removing the uterus or damaging the cervix so that a woman is still capable of having children.
In other cases, a removal of the uterus (hysterectomy) is performed, with or without removal of the ovaries. In more advanced disease, a radical hysterectomy may be performed which removes the uterus and much of the surrounding tissues, including internal lymph nodes. In the most extreme surgery, called a pelvic exenteration, all of the organs of the pelvis, including the urinary bladder and rectum, are removed.
Radiation or chemotherapy may be used to treat cancer that has spread beyond the pelvis, or has recurred. A variety of chemotherapeutic drugs, or combinations of them, are used. Sometimes radiation and chemotherapy are used before or after surgery.
What is the prevention?
There are two ways to prevent cervical cancer - the first is to prevent infections with HPV, the second is to get regular Pap smears that will detect pre-cancerous conditions and HPV. Both of these can be treated and the progression to cervical cancer be arrested.
Precancers are completely curable when followed up properly. To reduce the chances of cervical cancer, girls less than 18 years of age should avoid sexual activity or always use condoms. HPV infection causes genital warts. These may be barely visible or several inches across. If a woman sees warts on her partner's genitals, she should avoid intercourse. To further reduce the risk of cervical cancer, women should limit the number of their sexual partners, avoid sexually promiscuous partners, and discontinue any tobacco use. Condoms may help prevent the transmission of HPV.
Annual pelvic examinations, including a pap smear, should begin when a woman becomes sexually active, or by the age of 20 in a non-sexually active woman. All abnormal findings should be followed up with colposcopy and biopsy.
Cancer pain
Two thirds of patients with cancer have pain that is severe enough to prevent them from doing their activities of daily living. Poor appreciation of this problem and the inability to assess pain was the reason why pain was poorly relieved in these patients.
The aim of cancer pain management are to:
Minimize pain and suffering
Improve quality of life
Provide psychological support for patients and their families
What are the common misconceptions about cancer pain?
Cancer causes intolerable pain that cannot be relieved - in fact some patients with cancer pain never have pain. For those who do, cancer pain can be relieved.
Pain means that cancer is getting worse - Pain can be due to cancer or the effects of cancer treatment, Sometimes the pain is unrelated to cancer.
“Shots” or injections will be needed to control cancer pain - at least 90% of cancer pain can be effectively relieved by simple medications that are taken by mouth. “Shots” are almost never necessary.
Patients who use narcotics will become addicted - patients who take narcotics for pain rarely, if ever, become addicted.
If strong narcotics like morphine are used too early in the treatment, they will not work later if the pain gets worse - strong medications like morphine stay effective as long as they are needed. If pain increases, the medication dose can be increased.
What causes cancer pain?
Not all people with cancer have pain, and those who do, do not necessarily have it all the time, nor is it always severe. Pain associated with cancer usually comes from one of three sources. The cancer itself may be the cause of the pain if it pushes against bones, nerves, or organs in the body. Sometimes, pain can be caused by cancer therapy. In addition, pain may be unrelated to the cancer but is aggravated by it.
How is cancer pain relieved?
Although the doctor will help ease the pain, there are some things the patients can do to make things a little better. Changing some habits in the lifestyle may help.
Coffee intake must be reduced. Caffeine in coffee increases adrenaline levels that increase the sensitivity to pain. Similarly, cigarettes also stimulate adrenalin. Toning the body by regular exercises strengthen the muscles so that the bouts of pain can be better handled. While the exercise may not feel good at first, in the long run, it helps. A healthy diet, avoiding unhealthy junk foods keeps the body supplied with essential nutrients. Laughing is good physically; and it helps to increases the amount of oxygen in the blood. It also helps to relax the muscles. It provides some relief from the stress and anxiety that often accompany illness.
One of the most important ways doctors work to control pain is to raise the threshold of an individual to pain. This is the level at which pain is felt. The idea is to build up a resistance to pain so that one doesn't feel it so much when it occurs. Patients may learn methods of resisting pain such as by hypnosis. Hypnosis is effective because it trains the mind to attack pain stimuli automatically without having to think about it. Hypnosis can be made convenient for most patients under the supervision of a professional and by using hypnotic tapes that can be played at home. Although not everyone will respond to hypnosis, anyone who has pain can help to control it by reducing stress in his or her life. Stress makes pain hurt more, and reducing stress automatically raises the pain threshold. The family can be a strong source of support if the patient is experiencing the discomfort associated with cancer.
The use of analgesics or pain relieving medicines and pain management is not synonymous. Not only is pain a complex experience, but also all pain does not respond equally to narcotic analgesic. Use of analgesics is regarded as a part of multimodal approach to treatment. They should not be reserved for terminal care as they are safe, well tolerated and effective at all stages of the disease.
In some cases helper drugs may be required. These may include:
Anti-depressants for neuropathic pain, concurrent depression, and pain related sleep disturbances
Anti-convulsants for neuropathic pain
Anti-emetics to control morphine related nausea and vomiting
Anti-anxiety drugs for sleep deprivation
Local anaesthetic to block the nerves
The aim of cancer pain management are to:
Minimize pain and suffering
Improve quality of life
Provide psychological support for patients and their families
What are the common misconceptions about cancer pain?
Cancer causes intolerable pain that cannot be relieved - in fact some patients with cancer pain never have pain. For those who do, cancer pain can be relieved.
Pain means that cancer is getting worse - Pain can be due to cancer or the effects of cancer treatment, Sometimes the pain is unrelated to cancer.
“Shots” or injections will be needed to control cancer pain - at least 90% of cancer pain can be effectively relieved by simple medications that are taken by mouth. “Shots” are almost never necessary.
Patients who use narcotics will become addicted - patients who take narcotics for pain rarely, if ever, become addicted.
If strong narcotics like morphine are used too early in the treatment, they will not work later if the pain gets worse - strong medications like morphine stay effective as long as they are needed. If pain increases, the medication dose can be increased.
What causes cancer pain?
Not all people with cancer have pain, and those who do, do not necessarily have it all the time, nor is it always severe. Pain associated with cancer usually comes from one of three sources. The cancer itself may be the cause of the pain if it pushes against bones, nerves, or organs in the body. Sometimes, pain can be caused by cancer therapy. In addition, pain may be unrelated to the cancer but is aggravated by it.
How is cancer pain relieved?
Although the doctor will help ease the pain, there are some things the patients can do to make things a little better. Changing some habits in the lifestyle may help.
Coffee intake must be reduced. Caffeine in coffee increases adrenaline levels that increase the sensitivity to pain. Similarly, cigarettes also stimulate adrenalin. Toning the body by regular exercises strengthen the muscles so that the bouts of pain can be better handled. While the exercise may not feel good at first, in the long run, it helps. A healthy diet, avoiding unhealthy junk foods keeps the body supplied with essential nutrients. Laughing is good physically; and it helps to increases the amount of oxygen in the blood. It also helps to relax the muscles. It provides some relief from the stress and anxiety that often accompany illness.
One of the most important ways doctors work to control pain is to raise the threshold of an individual to pain. This is the level at which pain is felt. The idea is to build up a resistance to pain so that one doesn't feel it so much when it occurs. Patients may learn methods of resisting pain such as by hypnosis. Hypnosis is effective because it trains the mind to attack pain stimuli automatically without having to think about it. Hypnosis can be made convenient for most patients under the supervision of a professional and by using hypnotic tapes that can be played at home. Although not everyone will respond to hypnosis, anyone who has pain can help to control it by reducing stress in his or her life. Stress makes pain hurt more, and reducing stress automatically raises the pain threshold. The family can be a strong source of support if the patient is experiencing the discomfort associated with cancer.
The use of analgesics or pain relieving medicines and pain management is not synonymous. Not only is pain a complex experience, but also all pain does not respond equally to narcotic analgesic. Use of analgesics is regarded as a part of multimodal approach to treatment. They should not be reserved for terminal care as they are safe, well tolerated and effective at all stages of the disease.
In some cases helper drugs may be required. These may include:
Anti-depressants for neuropathic pain, concurrent depression, and pain related sleep disturbances
Anti-convulsants for neuropathic pain
Anti-emetics to control morphine related nausea and vomiting
Anti-anxiety drugs for sleep deprivation
Local anaesthetic to block the nerves
Cancer Chemotherapy
What is chemotherapy?
Chemotherapy is the use of medications to treat cancer. It has played a major role in cancer treatment for half a century. Years of testing and research have proved chemotherapy to be an effective cancer treatment. It may be the only treatment, or it may be used in combination with other treatments, such as surgery and radiation therapy.
Chemotherapy works by killing rapidly dividing cells. These cells include cancer cells, which continuously divide to form more cells, and healthy cells that divide quickly, such as those in the bone marrow, gastrointestinal tract, reproductive system and hair follicles. Healthy cells usually recover shortly after chemotherapy is complete.
What is chemotherapy used for?
The main advantages of chemotherapy are that unlike radiation, which treats only the area of the body exposed to the radiation, chemotherapy treats the entire body. As a result, any cells that may have escaped from the original cancer are treated.
Depending on what type of cancer a person has, the doctor may use chemotherapy to:
Eliminate all cancer cells in the body, even when cancer is widespread
Prolong the life by controlling cancer growth and spread
Relieve symptoms and enhance the quality of life
In some cases, chemotherapy may be the only treatment. But more often, it is used in conjunction with other treatments, such as surgery, radiation or a bone marrow transplant, to improve results. For example:
Neoadjuvant therapy: The goal of neoadjuvant therapy is to reduce the size of a tumour before surgery or radiation therapy.
Adjuvant therapy: This is given after surgery or radiation. The goal of adjuvant therapy is to eliminate any cancer cells that might linger in the body after earlier treatments.
What are the types of chemotherapy?
Chemotherapy may not be limited to a single drug. Most chemotherapy is given as a combination of drugs that work together to kill cancer cells. Combining drugs that have different actions at the cellular level may help destroy a greater number of cancer cells and might reduce the risk of cancer developing resistance to one particular drug. The doctor will recommend drug combinations that have been tested in people with similar conditions and have been shown to have some effect against the particular type of cancer.
What chemical the doctor recommends is generally based on the type, stage and grade of the cancer, as well as the person's age, general health and willingness to tolerate certain temporary side effects.
Some types of chemotherapy medications commonly used to treat cancer include:
Alkylating agents: These medications interfere with the growth of cancer cells by blocking the replication of DNA. Example: Mechlorethamine
Antimetabolites: These drugs block the enzymes needed by cancer cells to live and grow. Example: Methotrexate.
Anti-tumour antibiotics: These antibiotics are different from those used to treat bacterial infections and interfere with DNA, blocking certain enzymes and cell division and changing cell membranes. Example: Doxorubicin
Mitotic inhibitors: These drugs inhibit cell division or hinder certain enzymes necessary in the cell reproduction process. Example: Etoposide and Vinorelbine
Nitrosoureas: These medications impede enzymes that repair DNA. Example: Cisplatin and Cisplatinum.
How is chemotherapy given?
One usually receives chemotherapy in cycles, depending on the condition and the type of drugs used. Cycles may include taking the drugs daily, weekly or monthly for a few months or several months, with a recovery period after each treatment. Recovery period allows the body to rest and produce new, healthy cells.
Chemotherapy drugs can be taken in a number of forms. The treating doctor determines what form(s) to use primarily based on what type of cancer a person has and what drug(s) will best treat the cancer. Chemotherapy is given through the following methods:
Intravenous (IV): Chemotherapy is injected into a vein, using a needle inserted through the skin. This allows rapid distribution of the chemotherapy throughout the body.
Oral: The patient swallows this kind of chemotherapy as a pill.
Topical: This type of drug is applied to the skin to treat localised skin cancers.
Injection: The doctor injects the drug directly into the muscle using a needle on the skin or into a cancerous area on the skin.
Chemotherapy medications, regardless of how they're given, generally travel in the bloodstream and throughout the body. The intravenous route is the most common, allowing chemotherapy drugs to spread quickly through the system. In cases where the doctor wants to direct chemotherapy to a more confined area, for example, to ensure a tumour is exposed to more of the drug, he may insert a catheter directly into that area or into a blood vessel supplying the tumour.
What are the various side effects of chemotherapy?
Since chemotherapy drugs can affect healthy cells, one of their disadvantages is that the person may experience side effects, some temporary and some long term. Not every drug will cause every side effect. The treating doctor can tell what to expect from the drugs.
Temporary side effects might include:
Hair loss
Dry mouth
Mouth sores (stomatitis)
Difficult or painful swallowing (oesophagitis)
Nausea
Vomiting
Diarrhoea
Constipation
Fatigue
Bleeding
Susceptibility to infection
Infertility
Loss of appetite
Changes in the way food tastes
Cognitive impairment, sometimes referred to as chemo brain
Liver damage
How long these temporary side effects last, depends on what drug(s) are being taken and for how long. Most side effects subside shortly after the chemotherapy treatment is stopped. Most short-term side effects can be minimised with medication. For example, the doctor can give medications to help relieve nausea or build up the blood counts. One must always tell the doctor if one is uncomfortable with a side effect. If the side effects are more than one is willing to endure, one can change treatments.
As people with cancer are living longer after treatment, doctors have discovered that some treatments cause long-lasting side effects or side effects that become apparent long after treatment ends. These long-term side effects are rare. Before one begins treatment, one must discuss with the doctor about the long-term effects. Some chemotherapy drugs can cause:
Organ damage, including problems with heart, lungs and kidneys
Nerve damage
Blood in urine (haemorrhagic cystitis)
Another cancer, including Hodgkin's disease and non-Hodgkin's lymphoma, leukaemia and some tumours
Infertility
The doctor can explain about the signs and symptoms to watch for after the treatment. Knowing what long-term side effects to watch for can help one stay healthy after treatment.
While beginning chemotherapy can be frightening, one must know that new medications are helping reduce unpleasant side effects. But chemotherapy will always cause some significant side effects. One must keep in mind that many people with cancer are living longer than ever — thanks partly to chemotherapy.
Chemotherapy is the use of medications to treat cancer. It has played a major role in cancer treatment for half a century. Years of testing and research have proved chemotherapy to be an effective cancer treatment. It may be the only treatment, or it may be used in combination with other treatments, such as surgery and radiation therapy.
Chemotherapy works by killing rapidly dividing cells. These cells include cancer cells, which continuously divide to form more cells, and healthy cells that divide quickly, such as those in the bone marrow, gastrointestinal tract, reproductive system and hair follicles. Healthy cells usually recover shortly after chemotherapy is complete.
What is chemotherapy used for?
The main advantages of chemotherapy are that unlike radiation, which treats only the area of the body exposed to the radiation, chemotherapy treats the entire body. As a result, any cells that may have escaped from the original cancer are treated.
Depending on what type of cancer a person has, the doctor may use chemotherapy to:
Eliminate all cancer cells in the body, even when cancer is widespread
Prolong the life by controlling cancer growth and spread
Relieve symptoms and enhance the quality of life
In some cases, chemotherapy may be the only treatment. But more often, it is used in conjunction with other treatments, such as surgery, radiation or a bone marrow transplant, to improve results. For example:
Neoadjuvant therapy: The goal of neoadjuvant therapy is to reduce the size of a tumour before surgery or radiation therapy.
Adjuvant therapy: This is given after surgery or radiation. The goal of adjuvant therapy is to eliminate any cancer cells that might linger in the body after earlier treatments.
What are the types of chemotherapy?
Chemotherapy may not be limited to a single drug. Most chemotherapy is given as a combination of drugs that work together to kill cancer cells. Combining drugs that have different actions at the cellular level may help destroy a greater number of cancer cells and might reduce the risk of cancer developing resistance to one particular drug. The doctor will recommend drug combinations that have been tested in people with similar conditions and have been shown to have some effect against the particular type of cancer.
What chemical the doctor recommends is generally based on the type, stage and grade of the cancer, as well as the person's age, general health and willingness to tolerate certain temporary side effects.
Some types of chemotherapy medications commonly used to treat cancer include:
Alkylating agents: These medications interfere with the growth of cancer cells by blocking the replication of DNA. Example: Mechlorethamine
Antimetabolites: These drugs block the enzymes needed by cancer cells to live and grow. Example: Methotrexate.
Anti-tumour antibiotics: These antibiotics are different from those used to treat bacterial infections and interfere with DNA, blocking certain enzymes and cell division and changing cell membranes. Example: Doxorubicin
Mitotic inhibitors: These drugs inhibit cell division or hinder certain enzymes necessary in the cell reproduction process. Example: Etoposide and Vinorelbine
Nitrosoureas: These medications impede enzymes that repair DNA. Example: Cisplatin and Cisplatinum.
How is chemotherapy given?
One usually receives chemotherapy in cycles, depending on the condition and the type of drugs used. Cycles may include taking the drugs daily, weekly or monthly for a few months or several months, with a recovery period after each treatment. Recovery period allows the body to rest and produce new, healthy cells.
Chemotherapy drugs can be taken in a number of forms. The treating doctor determines what form(s) to use primarily based on what type of cancer a person has and what drug(s) will best treat the cancer. Chemotherapy is given through the following methods:
Intravenous (IV): Chemotherapy is injected into a vein, using a needle inserted through the skin. This allows rapid distribution of the chemotherapy throughout the body.
Oral: The patient swallows this kind of chemotherapy as a pill.
Topical: This type of drug is applied to the skin to treat localised skin cancers.
Injection: The doctor injects the drug directly into the muscle using a needle on the skin or into a cancerous area on the skin.
Chemotherapy medications, regardless of how they're given, generally travel in the bloodstream and throughout the body. The intravenous route is the most common, allowing chemotherapy drugs to spread quickly through the system. In cases where the doctor wants to direct chemotherapy to a more confined area, for example, to ensure a tumour is exposed to more of the drug, he may insert a catheter directly into that area or into a blood vessel supplying the tumour.
What are the various side effects of chemotherapy?
Since chemotherapy drugs can affect healthy cells, one of their disadvantages is that the person may experience side effects, some temporary and some long term. Not every drug will cause every side effect. The treating doctor can tell what to expect from the drugs.
Temporary side effects might include:
Hair loss
Dry mouth
Mouth sores (stomatitis)
Difficult or painful swallowing (oesophagitis)
Nausea
Vomiting
Diarrhoea
Constipation
Fatigue
Bleeding
Susceptibility to infection
Infertility
Loss of appetite
Changes in the way food tastes
Cognitive impairment, sometimes referred to as chemo brain
Liver damage
How long these temporary side effects last, depends on what drug(s) are being taken and for how long. Most side effects subside shortly after the chemotherapy treatment is stopped. Most short-term side effects can be minimised with medication. For example, the doctor can give medications to help relieve nausea or build up the blood counts. One must always tell the doctor if one is uncomfortable with a side effect. If the side effects are more than one is willing to endure, one can change treatments.
As people with cancer are living longer after treatment, doctors have discovered that some treatments cause long-lasting side effects or side effects that become apparent long after treatment ends. These long-term side effects are rare. Before one begins treatment, one must discuss with the doctor about the long-term effects. Some chemotherapy drugs can cause:
Organ damage, including problems with heart, lungs and kidneys
Nerve damage
Blood in urine (haemorrhagic cystitis)
Another cancer, including Hodgkin's disease and non-Hodgkin's lymphoma, leukaemia and some tumours
Infertility
The doctor can explain about the signs and symptoms to watch for after the treatment. Knowing what long-term side effects to watch for can help one stay healthy after treatment.
While beginning chemotherapy can be frightening, one must know that new medications are helping reduce unpleasant side effects. But chemotherapy will always cause some significant side effects. One must keep in mind that many people with cancer are living longer than ever — thanks partly to chemotherapy.
Cancer
What is cancer?
Cancer is the generic term used to describe a group of disorders caused by an uncontrolled multiplication of cells, which usually resulting in the destruction of neighbouring tissues. Gradually, these tissues and organs stop functioning and death may occur.
The reasons for cells to start multiplying is unknown in most cases. They may have some inbuilt abnormality or may be affected by external influences.
What are the common terms associated with cancer?
Since cancer is a group of disorders, there are some terms commonly used in the description of the disease.
Oncology – ‘onco’ meaning ‘cancer’, oncology is the study of various types of cancers.
Tumour – a lump resulting from an uncontrolled growth of cells which may be malignant or benign.
Malignant – a growth of cells that destroys the surrounding tissue and spreads to other parts of the body.
Benign – a growth of cells that is not cancerous.
Both benign and malignant growths are unwanted multiplications of cells, but whereas a benign growth does not generally leave the place of its origin, a malignant growth usually destroys not only the tissue of its origin but also the surrounding ones. This is why cancers are caused due to malignant growths which spread to all areas of the body.
Carcinoma – a term synonymously used with cancer. But carcinomas are specifically malignant tumours mostly forming on the outlines (epithelium) of the affected organ. It is the most frequently occurring form of cancer.
Sarcoma – another form of cancer where specifically the connective tissue (that which supports the various parts of the body), is affected. It is a malignant form and cancers of the blood, lymphatic system, bone and the like, fall under this category.
What are the symptoms?
Cancers appear in many different ways. Most often they are noticed as a lump or growth in some part of the body. This is the case with tumours that form on the outlines of organs. When the cancerous growth is not physically identifiable, there may be other revealing symptoms depending on the form of cancer and the affected organ.
Cancer in the brain may have symptoms like headache, vomiting, difficulty in walking, paralysis and memory problems. Tumours of the intestine can present problems in bowel movements and pain in the stomach. Lung cancers may be manifested by difficulty in breathing and cough. Cancers of the breast are detected as a painless lump. There may also be some deformity of one or both breasts in some cases.
Some malignant tumours are manifested by abnormal bleeding from the affected organ. For example, cancer of the intestine may result in loss of blood in stools. Similarly, lung cancer may be detected when the patient passes blood in the sputum. Pain, as popularly believed, is not a common symptom of cancer. It only occurs in some cases where a nerve is pressed due to rapid enlargement of a tumour.
Other symptoms that may be common to all forms of cancer are a lack of appetite, unexplained loss of weight, general feeling of weakness and fatigue and increased proneness to infections.
How is it diagnosed?
In case blood is passed in stools or cough, the patient should see a doctor. For confirmation, a biopsy of the affected organ is done. In this procedure, a small part of the tissue is taken for laboratory testing to detect the presence of cancerous cells.
In case of cancer of the lungs, liver, stomach or intestine, an X-ray or ultrasound of the area may be taken. CT scans of the organs may also be done for diagnosis. The diagnosis is always made keeping in mind the patient’s previous medical history.
What is the treatment?
Treatment is most effective if the cancer is detected early. Chemotherapy is the most common method of treatment for cancer that has spread to other parts of the body. In this procedure, the malignant cells are destroyed with the help of powerful chemicals like methotrexate and vincristine which are given intra-venously i.e. directly injected into the veins. This procedure requires a hospital stay for the duration of therapy. It is also associated with various side effects like loss of hair, nausea, vomiting, loss of appetite and weakness for some days.
For a tumour that has not spread, radiotherapy or radiation, or surgery may be done. In the former, the cells are destroyed with the help of strong radio active waves. The exact position of the tumour is marked and the area is exposed to radiation under strictly controlled conditions. This treatment is given in breaks and in pre-determined doses.
Tumours that develop in organs under hormonal control like the breast, thyroid or prostate, may also be treated with endocrine therapy. In this treatment, either the source of the hormone is removed or anti-hormone drugs are given. This treatment scores over chemotherapy because it usually has less severe side effects. But the doctor decides the best course of treatment depending on the diagnosis of the form of cancer.
Cancer is the generic term used to describe a group of disorders caused by an uncontrolled multiplication of cells, which usually resulting in the destruction of neighbouring tissues. Gradually, these tissues and organs stop functioning and death may occur.
The reasons for cells to start multiplying is unknown in most cases. They may have some inbuilt abnormality or may be affected by external influences.
What are the common terms associated with cancer?
Since cancer is a group of disorders, there are some terms commonly used in the description of the disease.
Oncology – ‘onco’ meaning ‘cancer’, oncology is the study of various types of cancers.
Tumour – a lump resulting from an uncontrolled growth of cells which may be malignant or benign.
Malignant – a growth of cells that destroys the surrounding tissue and spreads to other parts of the body.
Benign – a growth of cells that is not cancerous.
Both benign and malignant growths are unwanted multiplications of cells, but whereas a benign growth does not generally leave the place of its origin, a malignant growth usually destroys not only the tissue of its origin but also the surrounding ones. This is why cancers are caused due to malignant growths which spread to all areas of the body.
Carcinoma – a term synonymously used with cancer. But carcinomas are specifically malignant tumours mostly forming on the outlines (epithelium) of the affected organ. It is the most frequently occurring form of cancer.
Sarcoma – another form of cancer where specifically the connective tissue (that which supports the various parts of the body), is affected. It is a malignant form and cancers of the blood, lymphatic system, bone and the like, fall under this category.
What are the symptoms?
Cancers appear in many different ways. Most often they are noticed as a lump or growth in some part of the body. This is the case with tumours that form on the outlines of organs. When the cancerous growth is not physically identifiable, there may be other revealing symptoms depending on the form of cancer and the affected organ.
Cancer in the brain may have symptoms like headache, vomiting, difficulty in walking, paralysis and memory problems. Tumours of the intestine can present problems in bowel movements and pain in the stomach. Lung cancers may be manifested by difficulty in breathing and cough. Cancers of the breast are detected as a painless lump. There may also be some deformity of one or both breasts in some cases.
Some malignant tumours are manifested by abnormal bleeding from the affected organ. For example, cancer of the intestine may result in loss of blood in stools. Similarly, lung cancer may be detected when the patient passes blood in the sputum. Pain, as popularly believed, is not a common symptom of cancer. It only occurs in some cases where a nerve is pressed due to rapid enlargement of a tumour.
Other symptoms that may be common to all forms of cancer are a lack of appetite, unexplained loss of weight, general feeling of weakness and fatigue and increased proneness to infections.
How is it diagnosed?
In case blood is passed in stools or cough, the patient should see a doctor. For confirmation, a biopsy of the affected organ is done. In this procedure, a small part of the tissue is taken for laboratory testing to detect the presence of cancerous cells.
In case of cancer of the lungs, liver, stomach or intestine, an X-ray or ultrasound of the area may be taken. CT scans of the organs may also be done for diagnosis. The diagnosis is always made keeping in mind the patient’s previous medical history.
What is the treatment?
Treatment is most effective if the cancer is detected early. Chemotherapy is the most common method of treatment for cancer that has spread to other parts of the body. In this procedure, the malignant cells are destroyed with the help of powerful chemicals like methotrexate and vincristine which are given intra-venously i.e. directly injected into the veins. This procedure requires a hospital stay for the duration of therapy. It is also associated with various side effects like loss of hair, nausea, vomiting, loss of appetite and weakness for some days.
For a tumour that has not spread, radiotherapy or radiation, or surgery may be done. In the former, the cells are destroyed with the help of strong radio active waves. The exact position of the tumour is marked and the area is exposed to radiation under strictly controlled conditions. This treatment is given in breaks and in pre-determined doses.
Tumours that develop in organs under hormonal control like the breast, thyroid or prostate, may also be treated with endocrine therapy. In this treatment, either the source of the hormone is removed or anti-hormone drugs are given. This treatment scores over chemotherapy because it usually has less severe side effects. But the doctor decides the best course of treatment depending on the diagnosis of the form of cancer.
Breast cancer
What is breast cancer?
Breast cancer is the uncontrolled malignant growth of cells in the breast tissue. There are many types of breast cancers, those that form in the milk glands, in the ducts that carry milk, in the fatty area or in the connective tissue of the breast.
Cancer of the milk ducts is the most commonly occurring form of breast cancer. Usually only one breast is affected. There is a rare type of breast cancer in which the breast becomes red and swollen and resembles infection of the breast.
How is it caused?
The exact reason for the cancerous growth of cells is not known. There are certain factors that do not cause cancers by themselves, but make a person more at risk for the development of cancer. These risk factors may be genetic or environmental in nature:
Cancer tends to run in families. The risk for cancer increases for a person if one or more of his family members suffer from the disease.
Genetic predisposition that is, a person may carry genes that make certain normal cells cancerous.
Women who begin menstruating before the age of 12 years or stop after 55 years are more at risk for developing breast cancer.
Women who have not borne children or have had children late in their life (usually after the age of 30) are also more at risk.
Obesity or overweight is a condition that is associated with an increased risk of breast cancer.
Other factors like excessive drinking of alcohol and lack of exercise are also risk factors for breast cancer.
Environmental factors like exposure to harmful radiation, cigarette smoke over a long period of time and pesticides also increases the risk.
In some cases, women who undergo hormone replacement therapy have an increased risk of cancer of the breast.
What are the symptoms?
The most common symptom of cancer of the breast is the presence of a lump in the breast. The lump is often detected by the patient herself either accidentally or during a routine self examination. The lump is usually painless and hard. Sometimes, there may be changes in the shape and size of the breast and the nipple.
A dimple in the skin overlying the breast accompanied with dryness and scaling should be a cause for concern. There may be discharge of blood stained fluid from the nipple along with dryness and cracking of the skin of the nipple.
How is it diagnosed?
A breast lump is usually first detected by a woman on self examination. This procedure should be regularly done by all women over the age of 40 years. In this procedure, the woman lies down, raises the arm on the side of the breast and feels the breast with the other hand. Any difference from in the normal feel of the breast is noted. The woman may then look at herself in the mirror and note any changes in the shape and size of her breasts. Any change should be brought to the doctor’s notice.
The doctor may palpate or feel the breast for any unusual lumps or any other signs. In case a lump is detected by the doctor, mammography may be done. This is a special X-ray of the breast. It can detect early breast cancers and gives a fairly accurate picture of any changes in the breast. Any spots that show up in the mammogram are then further analysed by a biopsy. In this procedure, a small part of the lump tissue is taken for laboratory testing. The biopsy can also be done in many ways. In some cases, a small needle may be inserted into the lump and a small portion of the fluid may be taken.
In another form of biopsy, a small cut may be made on the breast to get to the lump, a piece of which is then taken for testing. In some cases, the entire lump may be removed. The procedure followed is decided by the doctor keeping in mind the patient’s history.
In case cancer of the breast is confirmed, other tests may be done to look for spread of the disease. These include blood tests, X-rays and ultrasound scan of the abdomen. In some cases a bone scan may be done.
What is the treatment?
Since the breast is not an organ that is necessary for survival, it is generally removed by a surgical procedure called mastectomy. In some cases only the lump is removed, in others the whole breast is removed.
Later, the patient may be given radiotherapy. This procedure helps to destroy the cancerous cells without harming the neighbouring tissue. If the cancer has spread to other parts of the body as well, chemotherapy using drugs like vincritine, adriamycin and cyclophosphamide is done. In some cases, hormonal treatment using tamoxifen is advised. Usually a combination of all of these procedures is followed for complete treatment. In most cases, if the cancer is detected early and treated appropriately, breast cancer patients can usually lead a cancer free life.
Breast cancer is the uncontrolled malignant growth of cells in the breast tissue. There are many types of breast cancers, those that form in the milk glands, in the ducts that carry milk, in the fatty area or in the connective tissue of the breast.
Cancer of the milk ducts is the most commonly occurring form of breast cancer. Usually only one breast is affected. There is a rare type of breast cancer in which the breast becomes red and swollen and resembles infection of the breast.
How is it caused?
The exact reason for the cancerous growth of cells is not known. There are certain factors that do not cause cancers by themselves, but make a person more at risk for the development of cancer. These risk factors may be genetic or environmental in nature:
Cancer tends to run in families. The risk for cancer increases for a person if one or more of his family members suffer from the disease.
Genetic predisposition that is, a person may carry genes that make certain normal cells cancerous.
Women who begin menstruating before the age of 12 years or stop after 55 years are more at risk for developing breast cancer.
Women who have not borne children or have had children late in their life (usually after the age of 30) are also more at risk.
Obesity or overweight is a condition that is associated with an increased risk of breast cancer.
Other factors like excessive drinking of alcohol and lack of exercise are also risk factors for breast cancer.
Environmental factors like exposure to harmful radiation, cigarette smoke over a long period of time and pesticides also increases the risk.
In some cases, women who undergo hormone replacement therapy have an increased risk of cancer of the breast.
What are the symptoms?
The most common symptom of cancer of the breast is the presence of a lump in the breast. The lump is often detected by the patient herself either accidentally or during a routine self examination. The lump is usually painless and hard. Sometimes, there may be changes in the shape and size of the breast and the nipple.
A dimple in the skin overlying the breast accompanied with dryness and scaling should be a cause for concern. There may be discharge of blood stained fluid from the nipple along with dryness and cracking of the skin of the nipple.
How is it diagnosed?
A breast lump is usually first detected by a woman on self examination. This procedure should be regularly done by all women over the age of 40 years. In this procedure, the woman lies down, raises the arm on the side of the breast and feels the breast with the other hand. Any difference from in the normal feel of the breast is noted. The woman may then look at herself in the mirror and note any changes in the shape and size of her breasts. Any change should be brought to the doctor’s notice.
The doctor may palpate or feel the breast for any unusual lumps or any other signs. In case a lump is detected by the doctor, mammography may be done. This is a special X-ray of the breast. It can detect early breast cancers and gives a fairly accurate picture of any changes in the breast. Any spots that show up in the mammogram are then further analysed by a biopsy. In this procedure, a small part of the lump tissue is taken for laboratory testing. The biopsy can also be done in many ways. In some cases, a small needle may be inserted into the lump and a small portion of the fluid may be taken.
In another form of biopsy, a small cut may be made on the breast to get to the lump, a piece of which is then taken for testing. In some cases, the entire lump may be removed. The procedure followed is decided by the doctor keeping in mind the patient’s history.
In case cancer of the breast is confirmed, other tests may be done to look for spread of the disease. These include blood tests, X-rays and ultrasound scan of the abdomen. In some cases a bone scan may be done.
What is the treatment?
Since the breast is not an organ that is necessary for survival, it is generally removed by a surgical procedure called mastectomy. In some cases only the lump is removed, in others the whole breast is removed.
Later, the patient may be given radiotherapy. This procedure helps to destroy the cancerous cells without harming the neighbouring tissue. If the cancer has spread to other parts of the body as well, chemotherapy using drugs like vincritine, adriamycin and cyclophosphamide is done. In some cases, hormonal treatment using tamoxifen is advised. Usually a combination of all of these procedures is followed for complete treatment. In most cases, if the cancer is detected early and treated appropriately, breast cancer patients can usually lead a cancer free life.
Brain tumour
What is brain tumour?
A brain tumour, like a tumour anywhere else in the body, is a result of an abnormal proliferation of cells in the brain. A primary brain tumour is one where the tumour originates from the brain cells. Secondary brain tumours are cancers originating elsewhere in the body and spreading to the brain through the blood stream. It may be mentioned that some chronic infections like tuberculosis and fungal infections often produce a tumour like moss in the brain which may mimic a cancerous lesion. A brain tumour may directly destroy brain cells or it may cause brain dysfunction by various other means.
The skull is a hard bony structure and thus provides only limited space to the structures within. Since the brain does not have any space to expand, a space-occupying tumour may be especially dangerous. Brain tumours can cause indirect damage by compressing brain tissue, inflammation of the brain (cerebral oedema) and increasing the pressure within the brain (intracranial pressure) by interfering with the circulation of brain fluid (cerebrospinal fluid or CSF).
Though most tumours are classified as 'malignant' or 'benign', brain tumours are usually classified as "high grade" or rapidly growing and "low grade" or slow growing. This is because even non-cancerous brain tumours may be life threatening since they do not have space to grow and thus endanger other parts of the brain.
What are the various kinds of tumours?
Brain tumours are basically of two kinds – those that originate from the layers covering the brain (meninges) and those that originate from the brain cells. The former are called meningiomas. They are almost always non-cancerous and are easy to remove surgically. The tumours arising from the supportive tissues of the brain are called gliomas. They are more common in adults and are more dangerous, since they are usually malignant and can often not be completely removed.
The most commonly occurring tumours in adults are gliomas, while in children, tumours usually arise near the brain stem (medulloblastoma).
What are the causes?
The exact cause of tumours is not known. However, there is a higher risk of tumours in:
Children and elderly
People with certain rare congenital abnormalities like Li-Fraumeni syndrome, tuberous sclerosis etc.
People with disorders of the immune system or auto-immune disorders like AIDS
People who are exposed to X-rays of the head
People who work in certain industries like oil refining, drug and rubber manufacturing.
What are the symptoms of tumours?
Symptoms of brain tumours are usually non-specific in the beginning. They also depend on the size and location of the tumour in the brain. The symptoms of a brain tumour may be varied since they may affect different functioning capacities of the brain. For example, a tumour that causes swelling of the brain may exhibit different symptoms than that which compresses the tissues of the brain.
Some of the common symptoms indicating a tumour in the brain are:
Frequent headaches that vary in intensity and time of the day. These headaches are usually intense in the mornings and ease out during the day.
Nausea or vomiting
Epileptic seizures or convulsions
Visual disturbances due to compression of the optic nerve or oedema of the optic disc (papilloedema)
Changes in memory functions
Changes in speech
Drowsiness and bouts of incoherence
Partial or local paralysis. Neurological deficits like weakness or paralysis of some parts of the body, loss of sensation, unsteadiness of gait (ataxia), etc.
How is it diagnosed?
The doctor first conducts a thorough physical examination of the patient and takes his medical and family history. The physical examination includes a detailed neurological examination. The latter consists of examinations for alertness, muscle strength, coordination, reflexes and response to pain. Any swelling of the eyes and visual disturbances is also ascertained.
The doctor may ask for tests like CT or MRI scan to study the tissues of the brain. These procedures help to identify any changes in the brain tissues, and outline any abnormal growth. Other tests that may be requested by the doctor are EEG, angiogram and a skull X-ray.
When should the doctor be consulted urgently?
Persistent or increasing frequency of headache specially if it is associated with vomiting, blurring or double vision, weakness of any part of the body, epileptic fits, difficulty in speaking, instability of gait. Change of behaviour, memory impairment with or without the above symptoms should also prompt expert consultation.
What is the treatment?
Depending on the type of tumour, its location, and the extent of its spread, the treatment may be surgery, chemotherapy and/or radiation therapy. These procedures may be used exclusively or in combination. Before treatment begins, patients are usually given steroid treatment to reduce brain swelling. They may also be given medication to keep the seizures (epileptic fits) under control.
Surgery - The most common form of treatment of brain tumours is removal of the cancerous mass. The neurosurgeon makes a hole in the skull and reaches the site of the tumour through that. The procedure is called craniotomy. As far as possible, the entire tumour is removed. This is usually possible to achieve in case of benign tumours like meningiomas, neuro fibromas, etc. Gliomas on the other hand, cannot be excised completely as they do not have clearly defined limits. However, the doctor is careful not to damage any vital tissues of the brain, and thus in cases where the whole tumour cannot be removed, partial removal is done. This helps to relieve the pressure within the skull and leaves a smaller portion of the tumour to be treated through radiation and/or chemotherapy.
Chemotherapy – it is the destruction of cancerous cells with the help of powerful drugs. Drugs are usually given orally or as injections into the vein.
Radiation therapy – in this high power rays are used to kill cancerous cells and prevent them from proliferating. Radiotherapy is given for a short period of time followed by a break. The period of therapy depends on the age of the patient, the site of the tumour and its size. The radiation is given with pin point accuracy, so that the surrounding healthy brain tissue is protected.
What are the side effects of treatment?
Brain tumour treatment may leave many side effects which may become less with time. Since craniotomy is a major procedure, there may be side effects like coordination difficulties, problems in comprehension and memory and personality changes. This is caused due to some damage to normal tissues surrounding the tumour.
Post surgery complications include cerebral oedema and seizures. Other side effects depend upon the location and extent of the tumour. In case there is no neurological deficit before operation, post-operatively also there should be no defect. In a large majority of cases even pre-operative deficit improves. However if tumour removed is delayed or the deficit is already severe this may not recover fully.
Side effects of radiation and chemotherapy include nausea, vomiting, weight loss, loss of hair and allergic reactions of the skin. Children who have had radiation therapy for brain tumours may have learning difficulties and visual problems. There may also be growth deficiencies in some children due to hormonal imbalance.
Some anticancer drugs may cause infertility. Women on anticancer drugs may experience menopausal symptoms like hot flashes and vaginal dryness. Some drugs may also cause kidney damage. A common condition is the formation of blood clots, usually in the leg, after the drug treatment.
What are the long term effects?
Early treatment of the tumour is necessary for better chances of recovery. The prognosis is grim for patients in whom the tumour is not completely removed. Although the inevitable is delayed with medication, survival chances are very low. The average life expectancy is about 6 months in case of a malignant tumour. In cases of benign tumours, and those which are completely removed, the prognosis is good and the patient can gain full recovery. The side effects of treatment lessen with time and the patient can resume his normal routine. Physiotherapy and rehabilitative therapy may be given to minimise the residual effects. There are various support groups that are working in the area of rehabilitation of cancer patients and they may provide the much needed support.
A brain tumour, like a tumour anywhere else in the body, is a result of an abnormal proliferation of cells in the brain. A primary brain tumour is one where the tumour originates from the brain cells. Secondary brain tumours are cancers originating elsewhere in the body and spreading to the brain through the blood stream. It may be mentioned that some chronic infections like tuberculosis and fungal infections often produce a tumour like moss in the brain which may mimic a cancerous lesion. A brain tumour may directly destroy brain cells or it may cause brain dysfunction by various other means.
The skull is a hard bony structure and thus provides only limited space to the structures within. Since the brain does not have any space to expand, a space-occupying tumour may be especially dangerous. Brain tumours can cause indirect damage by compressing brain tissue, inflammation of the brain (cerebral oedema) and increasing the pressure within the brain (intracranial pressure) by interfering with the circulation of brain fluid (cerebrospinal fluid or CSF).
Though most tumours are classified as 'malignant' or 'benign', brain tumours are usually classified as "high grade" or rapidly growing and "low grade" or slow growing. This is because even non-cancerous brain tumours may be life threatening since they do not have space to grow and thus endanger other parts of the brain.
What are the various kinds of tumours?
Brain tumours are basically of two kinds – those that originate from the layers covering the brain (meninges) and those that originate from the brain cells. The former are called meningiomas. They are almost always non-cancerous and are easy to remove surgically. The tumours arising from the supportive tissues of the brain are called gliomas. They are more common in adults and are more dangerous, since they are usually malignant and can often not be completely removed.
The most commonly occurring tumours in adults are gliomas, while in children, tumours usually arise near the brain stem (medulloblastoma).
What are the causes?
The exact cause of tumours is not known. However, there is a higher risk of tumours in:
Children and elderly
People with certain rare congenital abnormalities like Li-Fraumeni syndrome, tuberous sclerosis etc.
People with disorders of the immune system or auto-immune disorders like AIDS
People who are exposed to X-rays of the head
People who work in certain industries like oil refining, drug and rubber manufacturing.
What are the symptoms of tumours?
Symptoms of brain tumours are usually non-specific in the beginning. They also depend on the size and location of the tumour in the brain. The symptoms of a brain tumour may be varied since they may affect different functioning capacities of the brain. For example, a tumour that causes swelling of the brain may exhibit different symptoms than that which compresses the tissues of the brain.
Some of the common symptoms indicating a tumour in the brain are:
Frequent headaches that vary in intensity and time of the day. These headaches are usually intense in the mornings and ease out during the day.
Nausea or vomiting
Epileptic seizures or convulsions
Visual disturbances due to compression of the optic nerve or oedema of the optic disc (papilloedema)
Changes in memory functions
Changes in speech
Drowsiness and bouts of incoherence
Partial or local paralysis. Neurological deficits like weakness or paralysis of some parts of the body, loss of sensation, unsteadiness of gait (ataxia), etc.
How is it diagnosed?
The doctor first conducts a thorough physical examination of the patient and takes his medical and family history. The physical examination includes a detailed neurological examination. The latter consists of examinations for alertness, muscle strength, coordination, reflexes and response to pain. Any swelling of the eyes and visual disturbances is also ascertained.
The doctor may ask for tests like CT or MRI scan to study the tissues of the brain. These procedures help to identify any changes in the brain tissues, and outline any abnormal growth. Other tests that may be requested by the doctor are EEG, angiogram and a skull X-ray.
When should the doctor be consulted urgently?
Persistent or increasing frequency of headache specially if it is associated with vomiting, blurring or double vision, weakness of any part of the body, epileptic fits, difficulty in speaking, instability of gait. Change of behaviour, memory impairment with or without the above symptoms should also prompt expert consultation.
What is the treatment?
Depending on the type of tumour, its location, and the extent of its spread, the treatment may be surgery, chemotherapy and/or radiation therapy. These procedures may be used exclusively or in combination. Before treatment begins, patients are usually given steroid treatment to reduce brain swelling. They may also be given medication to keep the seizures (epileptic fits) under control.
Surgery - The most common form of treatment of brain tumours is removal of the cancerous mass. The neurosurgeon makes a hole in the skull and reaches the site of the tumour through that. The procedure is called craniotomy. As far as possible, the entire tumour is removed. This is usually possible to achieve in case of benign tumours like meningiomas, neuro fibromas, etc. Gliomas on the other hand, cannot be excised completely as they do not have clearly defined limits. However, the doctor is careful not to damage any vital tissues of the brain, and thus in cases where the whole tumour cannot be removed, partial removal is done. This helps to relieve the pressure within the skull and leaves a smaller portion of the tumour to be treated through radiation and/or chemotherapy.
Chemotherapy – it is the destruction of cancerous cells with the help of powerful drugs. Drugs are usually given orally or as injections into the vein.
Radiation therapy – in this high power rays are used to kill cancerous cells and prevent them from proliferating. Radiotherapy is given for a short period of time followed by a break. The period of therapy depends on the age of the patient, the site of the tumour and its size. The radiation is given with pin point accuracy, so that the surrounding healthy brain tissue is protected.
What are the side effects of treatment?
Brain tumour treatment may leave many side effects which may become less with time. Since craniotomy is a major procedure, there may be side effects like coordination difficulties, problems in comprehension and memory and personality changes. This is caused due to some damage to normal tissues surrounding the tumour.
Post surgery complications include cerebral oedema and seizures. Other side effects depend upon the location and extent of the tumour. In case there is no neurological deficit before operation, post-operatively also there should be no defect. In a large majority of cases even pre-operative deficit improves. However if tumour removed is delayed or the deficit is already severe this may not recover fully.
Side effects of radiation and chemotherapy include nausea, vomiting, weight loss, loss of hair and allergic reactions of the skin. Children who have had radiation therapy for brain tumours may have learning difficulties and visual problems. There may also be growth deficiencies in some children due to hormonal imbalance.
Some anticancer drugs may cause infertility. Women on anticancer drugs may experience menopausal symptoms like hot flashes and vaginal dryness. Some drugs may also cause kidney damage. A common condition is the formation of blood clots, usually in the leg, after the drug treatment.
What are the long term effects?
Early treatment of the tumour is necessary for better chances of recovery. The prognosis is grim for patients in whom the tumour is not completely removed. Although the inevitable is delayed with medication, survival chances are very low. The average life expectancy is about 6 months in case of a malignant tumour. In cases of benign tumours, and those which are completely removed, the prognosis is good and the patient can gain full recovery. The side effects of treatment lessen with time and the patient can resume his normal routine. Physiotherapy and rehabilitative therapy may be given to minimise the residual effects. There are various support groups that are working in the area of rehabilitation of cancer patients and they may provide the much needed support.
Bone marrow transplant
What is bone marrow transplant?
Bone marrow transplant is a procedure in which healthy bone marrow is transplanted into a patient whose bone marrow is not functioning properly. Problems in bone marrow are often caused by chemotherapy or radiation treatment for cancer. This procedure can also be done to correct hereditary blood diseases. The healthy bone marrow may be taken from the patient prior to chemotherapy or radiation treatment (autograft), or it may be taken from a donor (allograft).
What is bone marrow?
Bone marrow is the soft, sponge-like material found inside bones. It contains immature cells called stem cells that produce blood cells. There are three types of blood cells: white blood cells, which fight infection; red blood cells, which carry oxygen to and from organs and tissues; and platelets, which enable the blood to clot.
Why is it done?
If a patient develops a disease of the blood cells, especially cancers such as leukaemia, he may require high doses of chemotherapy to destroy the cancer. However, this also destroys normal blood cells.
Alternatively, hereditary or acquired disorders may cause abnormal blood cell production. In these cases, transplantation of healthy bone marrow may save a patient's life. Transplanted bone marrow will restore production of white blood cells, red blood cells, and platelets.
What is the procedure?
Bone marrow transplant patients are usually treated in specialised centres and the patient stays in a special nursing unit (a bone marrow transplant unit) to limit exposure to infections. The hospitalisation period is from 4 to 6 weeks, during which time the patient is isolated and under strict monitoring because of the increased risk of infection and/or bleeding.
Donated bone marrow must match the patient's tissue type. It can be taken from the patient, a living relative (usually a brother or a sister), or from an unrelated donor. Donors are matched through special blood tests called HLA tissue typing.
Bone marrow is taken from the donor in the operating room while one is unconscious and pain-free (under general anaesthesia). Some of the donor's bone marrow is removed from the top of the hip bone. The bone marrow is filtered, treated, and transplanted immediately or frozen and stored for later use. Then, transplant material is transfused into the patient through a vein and is naturally transported back into the bone cavities where it grows to replace the old bone marrow.
Alternatively, blood cell precursors, called stem cells, can be induced to move from the bone marrow to the blood stream using special medications. These stem cells can then be taken from the bloodstream through a procedure called leukapheresis.
The patient is prepared for transplantation by administering high doses of chemotherapy or radiation (conditioning). This serves two purposes. First, it destroys the patient's abnormal blood cells or cancer. Second, it inhibits the patient's immune response against the donor bone marrow (graft rejection).
Following conditioning, the patient is ready for bone marrow infusion. After infusion, it takes 10 to 20 days for the bone marrow to establish itself. During this time, the patient requires support with blood cell transfusions.
What are the indications?
Bone marrow transplant may be recommended for:
Bone marrow deficiency disease caused by:
abnormal red blood cell production, such as thalassaemia or sickle cell disease
aggressive cancer treatments (chemotherapy, radiation therapy), especially for leukaemia or lymphoma
lack of normal blood cell production (aplastic anaemia)
Immune system disorders (immunodeficiency) such as:
congenital neutropenia
severe combined immunodeficiency syndrome
Bone marrow transplant is not recommended for:
patients with heart, kidney, lungs, or liver disorders
patients with other diseases that may limit survival
What are the risks?
The risks for any anaesthesia are:
reactions to medications
problems breathing
Chemotherapy given prior to bone marrow transplant (conditioning) can cause significant toxicity, such as mouth sores, diarrhoea, liver damage, or lung damage. While waiting for bone marrow to grow, the patient is at high risk for infection as also bleeding.
The major problem with bone marrow transplants (when the marrow comes from a donor, not the patient) is graft-versus-host disease. The transplanted healthy bone marrow cells may attack the patient's cells as though they were foreign organisms. In this case, drugs to suppress the immune system must be taken, but this also decreases the body's ability to fight infections.
Other significant problems with a bone marrow transplant are those of all major organ transplants - finding a donor and the cost. The donor is usually a sibling with compatible tissue. The more siblings the patient has, the more chances there are of finding a compatible donor.
What is the prognosis?
Bone marrow transplant prolongs the life of a patient who would otherwise die. Relatively normal activities can be resumed as soon as the patient feels well enough and after consulting with the doctor.
The patient will require attentive follow-up care for 2 to 3 months after discharge from the hospital. It may take 6 months to a year for the immune system to fully recover from this procedure.
Bone marrow transplant is a procedure in which healthy bone marrow is transplanted into a patient whose bone marrow is not functioning properly. Problems in bone marrow are often caused by chemotherapy or radiation treatment for cancer. This procedure can also be done to correct hereditary blood diseases. The healthy bone marrow may be taken from the patient prior to chemotherapy or radiation treatment (autograft), or it may be taken from a donor (allograft).
What is bone marrow?
Bone marrow is the soft, sponge-like material found inside bones. It contains immature cells called stem cells that produce blood cells. There are three types of blood cells: white blood cells, which fight infection; red blood cells, which carry oxygen to and from organs and tissues; and platelets, which enable the blood to clot.
Why is it done?
If a patient develops a disease of the blood cells, especially cancers such as leukaemia, he may require high doses of chemotherapy to destroy the cancer. However, this also destroys normal blood cells.
Alternatively, hereditary or acquired disorders may cause abnormal blood cell production. In these cases, transplantation of healthy bone marrow may save a patient's life. Transplanted bone marrow will restore production of white blood cells, red blood cells, and platelets.
What is the procedure?
Bone marrow transplant patients are usually treated in specialised centres and the patient stays in a special nursing unit (a bone marrow transplant unit) to limit exposure to infections. The hospitalisation period is from 4 to 6 weeks, during which time the patient is isolated and under strict monitoring because of the increased risk of infection and/or bleeding.
Donated bone marrow must match the patient's tissue type. It can be taken from the patient, a living relative (usually a brother or a sister), or from an unrelated donor. Donors are matched through special blood tests called HLA tissue typing.
Bone marrow is taken from the donor in the operating room while one is unconscious and pain-free (under general anaesthesia). Some of the donor's bone marrow is removed from the top of the hip bone. The bone marrow is filtered, treated, and transplanted immediately or frozen and stored for later use. Then, transplant material is transfused into the patient through a vein and is naturally transported back into the bone cavities where it grows to replace the old bone marrow.
Alternatively, blood cell precursors, called stem cells, can be induced to move from the bone marrow to the blood stream using special medications. These stem cells can then be taken from the bloodstream through a procedure called leukapheresis.
The patient is prepared for transplantation by administering high doses of chemotherapy or radiation (conditioning). This serves two purposes. First, it destroys the patient's abnormal blood cells or cancer. Second, it inhibits the patient's immune response against the donor bone marrow (graft rejection).
Following conditioning, the patient is ready for bone marrow infusion. After infusion, it takes 10 to 20 days for the bone marrow to establish itself. During this time, the patient requires support with blood cell transfusions.
What are the indications?
Bone marrow transplant may be recommended for:
Bone marrow deficiency disease caused by:
abnormal red blood cell production, such as thalassaemia or sickle cell disease
aggressive cancer treatments (chemotherapy, radiation therapy), especially for leukaemia or lymphoma
lack of normal blood cell production (aplastic anaemia)
Immune system disorders (immunodeficiency) such as:
congenital neutropenia
severe combined immunodeficiency syndrome
Bone marrow transplant is not recommended for:
patients with heart, kidney, lungs, or liver disorders
patients with other diseases that may limit survival
What are the risks?
The risks for any anaesthesia are:
reactions to medications
problems breathing
Chemotherapy given prior to bone marrow transplant (conditioning) can cause significant toxicity, such as mouth sores, diarrhoea, liver damage, or lung damage. While waiting for bone marrow to grow, the patient is at high risk for infection as also bleeding.
The major problem with bone marrow transplants (when the marrow comes from a donor, not the patient) is graft-versus-host disease. The transplanted healthy bone marrow cells may attack the patient's cells as though they were foreign organisms. In this case, drugs to suppress the immune system must be taken, but this also decreases the body's ability to fight infections.
Other significant problems with a bone marrow transplant are those of all major organ transplants - finding a donor and the cost. The donor is usually a sibling with compatible tissue. The more siblings the patient has, the more chances there are of finding a compatible donor.
What is the prognosis?
Bone marrow transplant prolongs the life of a patient who would otherwise die. Relatively normal activities can be resumed as soon as the patient feels well enough and after consulting with the doctor.
The patient will require attentive follow-up care for 2 to 3 months after discharge from the hospital. It may take 6 months to a year for the immune system to fully recover from this procedure.
Birth control pills (Oral Contraceptives)
What are birth control pills?
Birth control pills (oral contraceptives) are a method of birth control that uses hormones to prevent pregnancy. The man-made female hormones in the pills change a woman's natural hormone levels and prevent her ovaries from releasing an egg each month. If a woman does not ovulate she cannot get pregnant because there is no egg to be fertilized. The cervix also produces less and thicker mucous so that sperm cannot easily enter the uterus. In addition, the lining of the uterus becomes thinner, so it would be more difficult for a fertilized egg to stay in the uterus.
What are the types?
The most commonly used pills are "combined" pills. They contain man-made forms of 2 hormones: oestrogen and progesterone. There is also a progesterone-only pill (the mini-pill), but it is not as effective and causes a lot of blood spotting between menstrual periods.
How are the pills used?
The combined pills usually come in a package of 28 pills. They are also available in 21-pill packs. The doctor decides which type of package is best suited for a person. She will probably advise one to start taking the pills on the Sunday after the period has started or on the first day of the next period, depending on one’s preference.
If one is using the 21-pill pack, it is necessary to take 1 pill every day for 3 weeks. One should stop taking the pills for 7 days and then start a new pack.
If one is using the 28-day package, it is necessary to take 1 pill every day for 4 weeks and then start a new package the next day. The last 7 pills contain no medication for birth control; they just keep one in the habit of taking a pill every day. It is important to try to take the pills at approximately the same time every day. The period will usually occur soon after the last hormone-containing pill is taken.
Some antibiotics can affect the way birth control pills work in one’s body. If one is taking antibiotics, it is necessary to tell the doctor. One may need to use an additional form of birth control while one is taking antibiotics.
What if one forgets to take a pill?
If one forgets to take some of the pills, one will have menstrual bleeding at unpredictable times and one may get pregnant.
If one forgets to take a pill, it is necessary to take it as soon as one remembers and take the next pill at the usual time. If one misses 2 consecutive pills, one should take 2 pills each day for 2 days and then go back to the regular schedule.
If one misses 3 or more pills, stop taking the pills and use a different birth control method until the next menstrual cycle starts. If the menstrual cycle does not start on schedule, it is necessary to get in touch with a doctor.
If one has forgotten to take 2 or more pills and have missed a period, one might be pregnant. One should stop taking the pills and use other forms of birth control until pregnancy is ruled out. One should not stop taking the pills if one has taken them correctly.
When to start taking the pills after having a baby?
If one is breast feeding the baby, one should not take oral contraceptives until one has a good milk supply. This will take about 4 to 6 weeks after the birth. Then, a low-dose pill or progesterone-only pill may possibly be used. It is necessary to talk to the doctor about when one can start the pills again. Also, one should remember that breast feeding is not a sure protection against pregnancy, so one should use another form of birth control before one starts taking birth control pills again.
If one is not breast feeding the baby, one may be able to start taking birth control pills 1 to 2 weeks after the birth or when one begin menstruating again. It is necessary to check with a doctor before one starts taking birth control pills again.
What are the benefits?
The main benefit of birth control pills is that they are effective in preventing pregnancy but do not interrupt sexual intercourse. The pills also may decrease the risk of uterine and ovarian cancer, ovarian cysts, rheumatoid arthritis, and ectopic (tubal) pregnancy. Also, when one uses birth control pills, the periods become regular, lighter, and less painful. There is also a lower incidence of pelvic inflammatory disease (PID), fibrocystic changes in the breasts, and fibroadenoma (benign tumours) of the breast.
Generally, women who have no gynaecologic problems before they start taking oral contraceptives have no trouble becoming pregnant after they stop taking birth control pills, regardless of how long they have been taking them. There is no advantage to "taking a break" from birth control pills unless one has problems specifically related to the pills. When one wishes to get pregnant, it is recommended that one waits until one has had at least 2 normal menstrual periods after stopping the pills.
What are the disadvantages?
One disadvantage of birth control pills is that one must remember to take a pill every day.
Problems one may have while taking birth control pills include:
irregular bleeding for the first few months
nausea and vomiting
weight gain
breast swelling and tenderness
increased appetite
depression
headaches
scant or missed periods
high blood pressure
dizziness
Women who take birth control pills and smoke, especially those over 35 years old, have an increased risk of severe problems such as heart disease and blood clots. The heart disease could cause a heart attack. The blood clots may cause leg pain or swelling, chest pain, stroke, or death.
It is necessary to monitor one’s blood pressure after one has taken the pills for 3 months. Birth control pills do not protect one from sexually transmitted diseases such as AIDS. Latex condoms are the only safe way to protect against AIDS.
It is necessary to consult a doctor if one experiences:
leg pain or swelling
loss of vision or double vision
bleeding irregularities
more headaches than usual
numbness of arms, legs, or any other part of your body.
Birth control pills (oral contraceptives) are a method of birth control that uses hormones to prevent pregnancy. The man-made female hormones in the pills change a woman's natural hormone levels and prevent her ovaries from releasing an egg each month. If a woman does not ovulate she cannot get pregnant because there is no egg to be fertilized. The cervix also produces less and thicker mucous so that sperm cannot easily enter the uterus. In addition, the lining of the uterus becomes thinner, so it would be more difficult for a fertilized egg to stay in the uterus.
What are the types?
The most commonly used pills are "combined" pills. They contain man-made forms of 2 hormones: oestrogen and progesterone. There is also a progesterone-only pill (the mini-pill), but it is not as effective and causes a lot of blood spotting between menstrual periods.
How are the pills used?
The combined pills usually come in a package of 28 pills. They are also available in 21-pill packs. The doctor decides which type of package is best suited for a person. She will probably advise one to start taking the pills on the Sunday after the period has started or on the first day of the next period, depending on one’s preference.
If one is using the 21-pill pack, it is necessary to take 1 pill every day for 3 weeks. One should stop taking the pills for 7 days and then start a new pack.
If one is using the 28-day package, it is necessary to take 1 pill every day for 4 weeks and then start a new package the next day. The last 7 pills contain no medication for birth control; they just keep one in the habit of taking a pill every day. It is important to try to take the pills at approximately the same time every day. The period will usually occur soon after the last hormone-containing pill is taken.
Some antibiotics can affect the way birth control pills work in one’s body. If one is taking antibiotics, it is necessary to tell the doctor. One may need to use an additional form of birth control while one is taking antibiotics.
What if one forgets to take a pill?
If one forgets to take some of the pills, one will have menstrual bleeding at unpredictable times and one may get pregnant.
If one forgets to take a pill, it is necessary to take it as soon as one remembers and take the next pill at the usual time. If one misses 2 consecutive pills, one should take 2 pills each day for 2 days and then go back to the regular schedule.
If one misses 3 or more pills, stop taking the pills and use a different birth control method until the next menstrual cycle starts. If the menstrual cycle does not start on schedule, it is necessary to get in touch with a doctor.
If one has forgotten to take 2 or more pills and have missed a period, one might be pregnant. One should stop taking the pills and use other forms of birth control until pregnancy is ruled out. One should not stop taking the pills if one has taken them correctly.
When to start taking the pills after having a baby?
If one is breast feeding the baby, one should not take oral contraceptives until one has a good milk supply. This will take about 4 to 6 weeks after the birth. Then, a low-dose pill or progesterone-only pill may possibly be used. It is necessary to talk to the doctor about when one can start the pills again. Also, one should remember that breast feeding is not a sure protection against pregnancy, so one should use another form of birth control before one starts taking birth control pills again.
If one is not breast feeding the baby, one may be able to start taking birth control pills 1 to 2 weeks after the birth or when one begin menstruating again. It is necessary to check with a doctor before one starts taking birth control pills again.
What are the benefits?
The main benefit of birth control pills is that they are effective in preventing pregnancy but do not interrupt sexual intercourse. The pills also may decrease the risk of uterine and ovarian cancer, ovarian cysts, rheumatoid arthritis, and ectopic (tubal) pregnancy. Also, when one uses birth control pills, the periods become regular, lighter, and less painful. There is also a lower incidence of pelvic inflammatory disease (PID), fibrocystic changes in the breasts, and fibroadenoma (benign tumours) of the breast.
Generally, women who have no gynaecologic problems before they start taking oral contraceptives have no trouble becoming pregnant after they stop taking birth control pills, regardless of how long they have been taking them. There is no advantage to "taking a break" from birth control pills unless one has problems specifically related to the pills. When one wishes to get pregnant, it is recommended that one waits until one has had at least 2 normal menstrual periods after stopping the pills.
What are the disadvantages?
One disadvantage of birth control pills is that one must remember to take a pill every day.
Problems one may have while taking birth control pills include:
irregular bleeding for the first few months
nausea and vomiting
weight gain
breast swelling and tenderness
increased appetite
depression
headaches
scant or missed periods
high blood pressure
dizziness
Women who take birth control pills and smoke, especially those over 35 years old, have an increased risk of severe problems such as heart disease and blood clots. The heart disease could cause a heart attack. The blood clots may cause leg pain or swelling, chest pain, stroke, or death.
It is necessary to monitor one’s blood pressure after one has taken the pills for 3 months. Birth control pills do not protect one from sexually transmitted diseases such as AIDS. Latex condoms are the only safe way to protect against AIDS.
It is necessary to consult a doctor if one experiences:
leg pain or swelling
loss of vision or double vision
bleeding irregularities
more headaches than usual
numbness of arms, legs, or any other part of your body.
Antioxidants
What are antioxidants?
Antioxidants are substances that may protect cells from the damage caused by unstable molecules known as free radicals. Damage due to free radicals damage may lead to cancer. Antioxidants interact with and stabilise free radicals and may prevent some of the damage free radicals otherwise might cause. Examples of antioxidants include beta-carotene, lycopene, vitamins C, E, and A, and other substances.
Which foods are rich in antioxidants?
Fruits and vegetables provide a range of antioxidants, vitamins A, C and E, carotenoids and flavonoids. Fruits and vegetables that have comparatively high levels of antioxidants include apples, grapefruit, green grapes, oranges, peach, red plums, strawberries, beetroot, sprouts cauliflower, green cabbage, lettuce, onion, spinach and tomatoes. Antioxidants are abundant in other foods including nuts, grains and some meats, poultry and fish.
Beta-carotene is found in many foods that are orange in colour, including sweet potatoes, carrots, apricots, pumpkin, and mangoes. Some green leafy vegetables including spinach, are also rich in beta-carotene
Lutein, best known for its association with healthy eyes, is abundant in green, leafy vegetable, spinach etc.
Lycopene is a potent antioxidant found in tomatoes, watermelon, guava, papaya, apricots, pink grapefruit, oranges, and other foods
Selenium is a mineral, not an antioxidant nutrient. However, it is a component of antioxidant enzymes. The amount of selenium in soil, which varies by region, determines the amount of selenium in the foods grown in that soil. Animals that eat grains or plants grown in selenium-rich soil have higher levels of selenium in their muscle
Vitamin A is found in three main forms: retinol (Vitamin A1), 3,4-didehydroretinol (Vitamin A2), and 3-hydroxy-retinol (Vitamin A3). Foods rich in vitamin A include liver, sweet potatoes, carrots, milk, egg yolks and mozzarella cheese
Vitamin C is also called ascorbic acid, and can be found in high abundance in many fruits and vegetables and is also found in cereals, beef, poultry and fish
Vitamin E, also known as alpha-tocopherol, is found in almonds, in many oils including wheat germ, safflower, corn and soybean oils, and also found in mangoes, nuts, broccoli and other foods
What are the uses?
Antioxidants help to reduce the risk of cancer, heart attack and stroke.
Protection against heart disease:
Deficiencies in Vitamins A, C, E and beta carotene have been linked to heart disease. All of these nutrients have antioxidant effects and other properties that may benefit the heart.
Vitamin E: eating foods rich in natural vitamin E may be protective. Vitamin E may prevent blood clots and the formation of fatty plaques and cell proliferation on the walls of the arteries
Vitamin C: Vitamin C appears to maintain blood vessel flexibility and to improve circulation in the arteries
Folate, Vitamin B6, and Vitamin B12. Several important studies have demonstrated a link between deficiencies in the B vitamins folate, B6, and B12 and elevated blood levels of homocysteine, an amino acid believed to be a risk factor for atherosclerosis. Both B12 and folate reduce homocysteine levels, and evidence is increasing that this effect may protect the heart.
Vitamin B3. Niacin (vitamin B3) is used for lowering unhealthy cholesterol levels
Carotenoids and heart protection: a high intake of fruits and vegetables containing beta carotene, lycopene, and other carotenoids may reduce the risk of heart attack
Phytochemicals and heart protection: Flavonoids, particularly those found in both black and green tea, onions, red wine or red grape juice, and apples, may protect against damage done by cholesterol and help prevent blood clots
Protection against stroke:
Vitamin C. There is a lower risk for stroke in subjects with the highest blood levels of vitamin C. Studies have found protection in foods rich in vitamin C, although supplements do not appear to offer any advantage.
B Vitamins: Vitamins B6, B12, and folate are important for the production of neurotransmitters, the chemical messengers in the brain that regulate mood and concentration. Deficiencies in these vitamins have been observed in people with depression and dementia. People who have higher blood levels of folic acid have a lower than average risk for stroke
Carotenoids and stroke protection: Studies have reported a lower risk of stroke from carotenoids, including beta carotene and lycopene.
Protection against cancer:
Many fresh fruits and vegetables contain chemicals that may fight many cancers, including lung, breast, colon, and prostate cancers. Examples of important cancer-fighting foods include the following:
Cruciferous vegetables (e.g., cabbage, sprouts, broccoli)
Tomatoes (which contain lycopene)
Carrots (which contain alpha and beta carotene)
There is some evidence that antioxidants may enhance the anticancer effects of chemotherapy. Antioxidant nutrients that may have properties that may help reduce the side effects of chemotherapy include vitamins E and C, beta carotene, isoflavones found in soy, and quercetin (found in red wine and purple grape juice).
Vitamins and cancer protection.
Although supplements of vitamins A, C, and E appear to have no advantages, studies have reported an association between low blood levels of these antioxidant vitamins and a higher risk for cancer.
Vitamin D. Some studies have suggested that certain vitamin D compounds may inhibit certain cancer cells, specifically prostate cancer, from proliferating.
Folate and B12. These B vitamins helps prevent cells from becoming malignant. Folic acid supplements may provide some protection against cervical and colon cancer and may reduce the risk for breast cancer among women who regularly drink alcohol
Carotenoids and cancer protection. A number of studies have reported that fruits and vegetables rich in carotenoids are associated with protection against many cancers. Lycopene, found in tomatoes, may have particular value in protection against prostate, colon, lung, and bladder cancer.
Protection against other diseases include: Alzheimer's Disease, asthma, eye disorders, skin disorders, wrinkles, osteoporosis, gall stones and menstrual disorders.
Antioxidants are substances that may protect cells from the damage caused by unstable molecules known as free radicals. Damage due to free radicals damage may lead to cancer. Antioxidants interact with and stabilise free radicals and may prevent some of the damage free radicals otherwise might cause. Examples of antioxidants include beta-carotene, lycopene, vitamins C, E, and A, and other substances.
Which foods are rich in antioxidants?
Fruits and vegetables provide a range of antioxidants, vitamins A, C and E, carotenoids and flavonoids. Fruits and vegetables that have comparatively high levels of antioxidants include apples, grapefruit, green grapes, oranges, peach, red plums, strawberries, beetroot, sprouts cauliflower, green cabbage, lettuce, onion, spinach and tomatoes. Antioxidants are abundant in other foods including nuts, grains and some meats, poultry and fish.
Beta-carotene is found in many foods that are orange in colour, including sweet potatoes, carrots, apricots, pumpkin, and mangoes. Some green leafy vegetables including spinach, are also rich in beta-carotene
Lutein, best known for its association with healthy eyes, is abundant in green, leafy vegetable, spinach etc.
Lycopene is a potent antioxidant found in tomatoes, watermelon, guava, papaya, apricots, pink grapefruit, oranges, and other foods
Selenium is a mineral, not an antioxidant nutrient. However, it is a component of antioxidant enzymes. The amount of selenium in soil, which varies by region, determines the amount of selenium in the foods grown in that soil. Animals that eat grains or plants grown in selenium-rich soil have higher levels of selenium in their muscle
Vitamin A is found in three main forms: retinol (Vitamin A1), 3,4-didehydroretinol (Vitamin A2), and 3-hydroxy-retinol (Vitamin A3). Foods rich in vitamin A include liver, sweet potatoes, carrots, milk, egg yolks and mozzarella cheese
Vitamin C is also called ascorbic acid, and can be found in high abundance in many fruits and vegetables and is also found in cereals, beef, poultry and fish
Vitamin E, also known as alpha-tocopherol, is found in almonds, in many oils including wheat germ, safflower, corn and soybean oils, and also found in mangoes, nuts, broccoli and other foods
What are the uses?
Antioxidants help to reduce the risk of cancer, heart attack and stroke.
Protection against heart disease:
Deficiencies in Vitamins A, C, E and beta carotene have been linked to heart disease. All of these nutrients have antioxidant effects and other properties that may benefit the heart.
Vitamin E: eating foods rich in natural vitamin E may be protective. Vitamin E may prevent blood clots and the formation of fatty plaques and cell proliferation on the walls of the arteries
Vitamin C: Vitamin C appears to maintain blood vessel flexibility and to improve circulation in the arteries
Folate, Vitamin B6, and Vitamin B12. Several important studies have demonstrated a link between deficiencies in the B vitamins folate, B6, and B12 and elevated blood levels of homocysteine, an amino acid believed to be a risk factor for atherosclerosis. Both B12 and folate reduce homocysteine levels, and evidence is increasing that this effect may protect the heart.
Vitamin B3. Niacin (vitamin B3) is used for lowering unhealthy cholesterol levels
Carotenoids and heart protection: a high intake of fruits and vegetables containing beta carotene, lycopene, and other carotenoids may reduce the risk of heart attack
Phytochemicals and heart protection: Flavonoids, particularly those found in both black and green tea, onions, red wine or red grape juice, and apples, may protect against damage done by cholesterol and help prevent blood clots
Protection against stroke:
Vitamin C. There is a lower risk for stroke in subjects with the highest blood levels of vitamin C. Studies have found protection in foods rich in vitamin C, although supplements do not appear to offer any advantage.
B Vitamins: Vitamins B6, B12, and folate are important for the production of neurotransmitters, the chemical messengers in the brain that regulate mood and concentration. Deficiencies in these vitamins have been observed in people with depression and dementia. People who have higher blood levels of folic acid have a lower than average risk for stroke
Carotenoids and stroke protection: Studies have reported a lower risk of stroke from carotenoids, including beta carotene and lycopene.
Protection against cancer:
Many fresh fruits and vegetables contain chemicals that may fight many cancers, including lung, breast, colon, and prostate cancers. Examples of important cancer-fighting foods include the following:
Cruciferous vegetables (e.g., cabbage, sprouts, broccoli)
Tomatoes (which contain lycopene)
Carrots (which contain alpha and beta carotene)
There is some evidence that antioxidants may enhance the anticancer effects of chemotherapy. Antioxidant nutrients that may have properties that may help reduce the side effects of chemotherapy include vitamins E and C, beta carotene, isoflavones found in soy, and quercetin (found in red wine and purple grape juice).
Vitamins and cancer protection.
Although supplements of vitamins A, C, and E appear to have no advantages, studies have reported an association between low blood levels of these antioxidant vitamins and a higher risk for cancer.
Vitamin D. Some studies have suggested that certain vitamin D compounds may inhibit certain cancer cells, specifically prostate cancer, from proliferating.
Folate and B12. These B vitamins helps prevent cells from becoming malignant. Folic acid supplements may provide some protection against cervical and colon cancer and may reduce the risk for breast cancer among women who regularly drink alcohol
Carotenoids and cancer protection. A number of studies have reported that fruits and vegetables rich in carotenoids are associated with protection against many cancers. Lycopene, found in tomatoes, may have particular value in protection against prostate, colon, lung, and bladder cancer.
Protection against other diseases include: Alzheimer's Disease, asthma, eye disorders, skin disorders, wrinkles, osteoporosis, gall stones and menstrual disorders.
Acid phosphatase
What is acid phosphatase?
Acid phosphatase is an enzyme present in the cells throughout the body. It is present in especially high concentrations in the prostate and semen in men. Prostatic diseases result in its release in the blood. A blood test can measure the enzyme acid phosphatase. Drugs and substances that can interfere with the test include fluorides, oxalates, clofibrate, and alcohol.
Why is the test done?
This test is usually done to check an abnormality of the prostate gland, prostate cancer, or to monitor the response of cancer to treatment. This is a good blood test to test for prostate cancer (accurate in half to three fourths of cases), but a physical examination is much more reliable.
How is the test done?
Blood is drawn from a vein, usually from the inside of the elbow. No special preparation is required for the test.
What are the normal values?
Normal values range from 0 to 0.8 U/L (units per litre)
What do the abnormal results (high levels) lead to?
Prostatitis (swelling or infection in the prostate)
Prostate cancer with spread to bones
Paget's disease of bones (thicker and softer bones)
Hyperparathyroidism
Stimulation of the prostate during colonoscopy, enemas or prostate examination
Multiple myeloma
Acid phosphatase is an enzyme present in the cells throughout the body. It is present in especially high concentrations in the prostate and semen in men. Prostatic diseases result in its release in the blood. A blood test can measure the enzyme acid phosphatase. Drugs and substances that can interfere with the test include fluorides, oxalates, clofibrate, and alcohol.
Why is the test done?
This test is usually done to check an abnormality of the prostate gland, prostate cancer, or to monitor the response of cancer to treatment. This is a good blood test to test for prostate cancer (accurate in half to three fourths of cases), but a physical examination is much more reliable.
How is the test done?
Blood is drawn from a vein, usually from the inside of the elbow. No special preparation is required for the test.
What are the normal values?
Normal values range from 0 to 0.8 U/L (units per litre)
What do the abnormal results (high levels) lead to?
Prostatitis (swelling or infection in the prostate)
Prostate cancer with spread to bones
Paget's disease of bones (thicker and softer bones)
Hyperparathyroidism
Stimulation of the prostate during colonoscopy, enemas or prostate examination
Multiple myeloma
AIDS-associated tumours
What are AIDS-associated tumours?
AIDS (acquired immunodeficiency syndrome) caused by HIV (Human immunodeficiency virus) attacks the body's immune system. In AIDS, the body can no longer fight off disease successfully. As a result, certain cancers, infections, diseases of the nervous system and muscles occur more easily in individuals infected with HIV compared to healthy people. Cancers seen more frequently in AIDS include Kaposi's sarcoma, lymphomas, cancers of the cervix and the anus. Kapsoi's sarcoma often manifests itself as raised purplish-red bumps on the skin. These bumps can vary greatly in size. Lymph nodes, the intestines and the lungs can also be affected. In fact, any part of the body can be affected by this tumour. Several kinds of lymphomas can occur including those which involve the brain exclusively.
What are the symptoms?
The symptoms of AIDS-associated cancers relate to the affected organs like the skin, internal organs of the body, or the lymphatic system.
How are they diagnosed?
The diagnosis of a cancer can be suspected on the symptoms and the results of the physical examination. Kaposi's sarcoma is diagnosed by a biopsy of any purple patch or sore on the skin or mucous membrane. Lymphoma and the other cancers require a biopsy of the affected lymph nodes.
What is the treatment?
Treatment for AIDS-associated cancers include:
Chemotherapy: This uses drugs that kill the tumour cells.
Radiotherapy: is also used to destroy cancerous growths and slow
their spread.
Combination therapy: Treatment includes a combination of surgery,
chemotherapy and radiotherapy.
How can AIDS be prevented?
Avoid sexual contact with HIV infected individuals or use a condom during sex.
Ensure the barber doesn't reuse blades.
Intravenous drug users shouldn't share needles.
HIV infected individuals should not donate blood, semen, or body
parts.
Breast feeding should be avoided because the virus can be
transmitted to the infant.
AIDS (acquired immunodeficiency syndrome) caused by HIV (Human immunodeficiency virus) attacks the body's immune system. In AIDS, the body can no longer fight off disease successfully. As a result, certain cancers, infections, diseases of the nervous system and muscles occur more easily in individuals infected with HIV compared to healthy people. Cancers seen more frequently in AIDS include Kaposi's sarcoma, lymphomas, cancers of the cervix and the anus. Kapsoi's sarcoma often manifests itself as raised purplish-red bumps on the skin. These bumps can vary greatly in size. Lymph nodes, the intestines and the lungs can also be affected. In fact, any part of the body can be affected by this tumour. Several kinds of lymphomas can occur including those which involve the brain exclusively.
What are the symptoms?
The symptoms of AIDS-associated cancers relate to the affected organs like the skin, internal organs of the body, or the lymphatic system.
How are they diagnosed?
The diagnosis of a cancer can be suspected on the symptoms and the results of the physical examination. Kaposi's sarcoma is diagnosed by a biopsy of any purple patch or sore on the skin or mucous membrane. Lymphoma and the other cancers require a biopsy of the affected lymph nodes.
What is the treatment?
Treatment for AIDS-associated cancers include:
Chemotherapy: This uses drugs that kill the tumour cells.
Radiotherapy: is also used to destroy cancerous growths and slow
their spread.
Combination therapy: Treatment includes a combination of surgery,
chemotherapy and radiotherapy.
How can AIDS be prevented?
Avoid sexual contact with HIV infected individuals or use a condom during sex.
Ensure the barber doesn't reuse blades.
Intravenous drug users shouldn't share needles.
HIV infected individuals should not donate blood, semen, or body
parts.
Breast feeding should be avoided because the virus can be
transmitted to the infant.
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