A Simple Guide to Thyroid Nodules

A Simple Guide to Thyroid Nodules
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What are Thyroid Nodules ?
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Thyroid nodules are abnormal swellings in the thyroid gland which occurs when the thyroid tissues starts to proliferate in one part of the thyroid gland.


Who are at risk of thyroid nodule?
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1.Thyroid nodules are more common in females than in male.

2.However the thyroid nodule in males are more prone to malignancy than in females

3.Thyroid nodules occurs more in the 30- 60 age group.


What are the different types of Thyroid Nodules?
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1.solid - solid thyroid nodules which may or not feel hard

2.cystic - the nodules is filled with fluid.

3.benign - non malignant

4.malignant - cancerous


What are the symptoms and signs of Thyroid Nodules?
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In mild cases there is usually no obvious symptoms.

In moderate or severe cases of thyroid nodules:

Symptoms:
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1.Obvious swelling in the thyroid gland

2.Neck swelling -suuggest presence of spread to the lymph node

3.Hoarseness of voice may occur if there is pressure on the vocal cord or recurrent nerve to vocal cord

4.Dyspnea or breathlessness if there is pressure on the trachea

5.Dysphagia or difficuly in swallowing due to pressure on the oesophagus


Signs:
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1.Thyroid nodules are felt only if they are more than 1.5 to 2cm in diameter.

2.Cystic nodules may feel hard while solid nodules may be soft to firm.

3. The vocal cords should always be examined to exclude lesions in the vocal cords causing hoarseness.

4.Malignant thyroid nodules present similarly to benign nodules but can spread to other parts of the body.


How are diagnosis of Thyroid Nodules made?
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1.blood test for thyroxine and TSH levels

2.fine needle aspiration biopsy is a simple way to determine if a nodule is benign or malignant.

The biopsied material is then sent to the lab for tests to look for any malignant cells.

3.ultrasound scans are done to differentiate between solid and cystic nodules,

4.thyroid scans which help to show if a nodule is producing excessive thyroid hormone(hot) or not.

5.CT Scan or MRI are not routine to thyroid nodules investigation except where there is suspected compression of teachea.


What is the Treatment of Thyroid Nodules?
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Benign lumps can be monitored by doctors at regular intervals.

If there are symptoms of compressing a neighbouring organ or the nodule is cancerous, surgery is required.

Patients who has symptoms of hyperthyroidism are advised to go for radioactive iodine treatment or surgery.


What is the Prognosis of Thyroid Nodules?
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Prognosis is good in all benign cases.

Malignant thyroid nodules will depend on any spread to other organs.

A Simple Guide to Liver Cancer

A Simple Guide to Liver Cancer
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What is Liver Cancer?
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Liver Cancer develops when the liver cells undergo abnormal changes to form cancer cells.
Most Primary cancer of the liver begins as mutated hepatocytes(liver cells).
Secondary cancer of the liver is due to spread from the stomach, colon, breast, lungs, ovaries etc

What is the incidence of Liver Cancer?
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Liver cancer is one of the most common cancer.
It occurs in men more than women.
It is more common in the 40s and 50s age groups.

What are the Risk Factors of Liver Cancer?
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The main risk factor for liver cancer is
1.Hepatitis B infection.

Other important risk factors include
2.Hepatitis C infection

3.alcoholic liver disease (disease of the liver caused by heavy alcohol consumption).

4.family history of liver cancer

5.Chemicals exposures such as nitrites,solvents, hydrocarbons,viny chloride

6.poisons (e.g. aflatoxin present in some spoilt or mouldy peanuts).

7.inherited liver diseases (alpha-1 anti-trypsin deficiency)

8.Drug abuse eg heroin


What are the Signs and Symptoms of Liver Cancer?
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During the early stages, most people with liver cancer do not show any signs or symptoms.
Signs and symptoms, when they do appear, include:

1.loss of appetite and weight

2.discomfort or swelling in the upper part of the abdomen on the right side

3.weakness and fatigue

4.nausea and vomiting

5.jaundice - yellowness of the skin and eyes

6.dark color urine

7.Persistent or swinging fever

How is the Diagnosis of Liver Cancer confirmed?
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1. full medical history especially history of Hepatitis B and alcohol

2. full examination especially of the liver

3.an ultrasound scan of the liver and gallbladder, if possible the whole abdomen.
4.CT scan or MRI of the liver and surrounding tissues


5.blood tests (a protein present in blood called the alpha- fetoprotein or AFP may be found to be raised in liver cancer)

6.needle liver biopsy into the liver swelling as detected by ultrasound or MRI (to confirm the liver cancer).

With the diagnosis confirmed, the doctor will proceed with further tests to find out how advanced the liver cancer is. This will help the doctor to plan the treatment.

What is the Treatment of Liver Cancer?
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As in all cancers, treatment includes surgery, radiation therapy, chemotherapy.

In Liver cancer percutaneous ethanol (alcohol) injection is injected directly into the tumour, by means of a small needle, to kill the cancerous cells.

Liver transplant can also be carried out in selected cases where the size of the cancer is not too massive but surgery is not feasible due to the patient's limited liver reserve(provided a suitable liver donor can be found).

Treatment depends on the the stage of the cancer as well as health of the affected person.

The goal of treatment is complete cure.

However, where this is not possible, treatment is aimed at
preventing the tumour from spreading or growing.
Helping to eliminate uncomfortable symptoms is also an important aspect of liver cancer treatment.

How to Protect yourself from Liver Cancer?
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Prevention from getting liver cancer is by taking steps to reduce your risk factors.

1. Reduce your risk of Hepatitis B by getting vaccinated. The Hepatitis B vaccine is safe and effective.
Both Hepatitis B and C are spread through infected blood or sexual fluids as well as intravenous drug abuse. It is therefore important to avoid activities that put you at risk:

2.Avoid multiple sex partners and having sex with commercial sex workers, strangers or anyone with multiple sex partners.

3.Do not abuse drugs or share injection needles.

4.Never share personal items like razors, toothbrushes or other items that may cause breaks in the skin.

5.Visit only reliable operators for ear/body piercing, tattooing or acupuncture.

6.It is also important that you limit your consumption of alcohol as excessive drinking can give rise to liver disease and increase your risk of liver cancer.

The liver is one of the largest and most important organs in your body. It performs many essential functions including:
making and storing of essential nutrients
making important hormones and enzymes
breaking down harmful substances.

Do not abuse Your LIVER by excessive drinking or taking drugs!

A Simple Guide to Ovarian Cancer

A Simple Guide to Ovarian Cancer
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What is Ovarian Cancer?
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Ovarian Cancer is a disease which cause abnormal cells in the ovary to proliferate and spread to the rest of the ovary or outside the ovary.

What are the different types of Ovarian Cancer?
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Most experts group ovarian cancers within three major categories, according to the kind of cells from which they were formed:

1.epithelial tumors arise from cells that line or cover the ovaries;

2.germ cell tumors originate from cells that are destined to form eggs within the ovaries; and

3.sex cord-stromal cell tumors begin in the connective cells that hold the ovaries together and produce female hormones.

The most common type, the epithelial carcinoma, that begins from the surface of the ovary is discussed here.

Who is at risk of Ovarian Cancer?
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The cause of cancer of the ovary is unknown.
However, studies show that certain factors may increase the chance of developing this disease. 1.family history of ovarian cancer.

2.history of cancer of the breast or colon.

3.age over 60 years.

4. Infertility or not having children. The more children you have, the lesser your risk is.

5.Early menstruation before the age of 12

6.late menopause

7.high fat diet

8.Use of fertility drugs, or Hormone Replacement Therapy (HRT).

Attempts are being made to detect early stages of ovarian cancer, especially among women who have an increased risk. A blood test is done to check for a substance called CA 125.
If the sample contains raised amounts of CA 125, an ultrasound scan may be done to see if your ovaries appear abnormal in any way.

What are the Symptoms of Ovarian Cancer?
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Ovarian cancer is the most dangerous of gynaecological cancers because it is often silent and difficult to detect.There is no early detection method, so you must be vigilant and take note of persistent warning signs seriously.

If you are having some of the following symptoms persisting for more than a week or so, see your doctor.
1.Vague gastrointestinal symptoms such as gas, indigestion, nausea and a bloated feeling

2.Swelling in the abdomen, unexplained weight gain

3.Pelvic or abdominal pain or discomfort, and/or feeling of fullness

4.Urinary symptoms e.g. frequency and/or urgency of urination in the absence of an infection

5.Unexplained or changes in bowel habits

6.Loss of appetite/loss of weight

7.backache or pain inthe legs

8.Abnormal vaginal bleeding, although this is rare

If you do have any of the above symptoms you must have them checked by your doctor. Remember, they are non specific and most women with these symptoms will not have cancer.

How do you make the diagnosis of Ovarian Cancer?
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If you are at risk of ovarian cancer, see your gynaecologist regularly.

The following may be done:
recto-vaginal bimanual pelvic exam,

Pap smear,

blood test for CA-125

transvaginal ultrasound

What are the treatment of Ovarian Cancer?
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Treatment depends on a number of factors, including the stage of the disease (the extent of spread of the disease) and the general health of the patient.
Surgery, chemotherapy and various types of radiotherapy may be used alone, or in combination to treat ovarian cancer.

Surgery
Surgery is normally the first choice of treatment for ovarian cancer, and may sometimes also be needed to make the diagnosis. If detected is in the early stages, surgery is all the treatment that may be required. The ovaries, fallopian tubes, uterus and cervix are usually removed. The omentum and lymph nodes in the abdomen are often removed too.

If the surgeon feels the cancer may be difficult to remove, a few cycles of chemotherapy may be applied first and surgery carried out thereafter, in the hope that the tumour would have been reduced.

Chemotherapy
Chemotherapy may be given to destroy any cancerous cells that may remain in the body after surgery, to control cancer growth or to relieve symptoms of the disease. Sometimes a few cycles of chemotherapy may have to be applied before surgery is carried out.

Radiotherapy
Radiotherapy is less commonly used in this cancer but may sometimes be used to treat individual areas of cancer which have recurred after surgery and chemotherapy.

Hormone Therapy

There have been many reports of the potential benefits of hormone treatments in patients with ovarian cancer that does not respond to conventional therapy.

Some patients with treatment-resistant (refractory) epithelial cancers have been treated with:
1.progestins - crude forms of the female sex hormone progesterone;

2.estrogens - for example, diethylstilbestrol
3.combination estrogen/progestin therapy;
4.antiestrogens - tamoxifen;
5.androgens - male sex hormones for example, Halotestin
6.gonadotropin-releasing hormone (GnRH) - a hormone of the hypothalamus that stimulates the release of ovary-related hormones from the pituitary gland.

Gene Therapy

Gene therapy eventually may provide some control over cancer susceptibility and its treatment. Ovarian cancer, like all cancers, is believed to result from a build-up of genetic defects within the cells.Genetic engineers hope to correct such damage by transplanting copies of normal genes into cells with genetic defects. However at the moment gene therapy is still experimental.

A Simple Guide to Breast Cancer

A Simple Guide to Breast Cancer
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What is Breast Cancer?
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Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. It is the most common type of cancer among women.

How does Breast Cancer Presents?

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Breast Cancer occurs as uncontrolled growth of mutated (abnormal) cells from the breast tissues.

It occurs as in 2 main forms:
1.preinvasive cancer:

Preinvasive breast cancer is confined to the breast ducts or lobules and the cancer cells do not have the abilty to spread. It is classified as Stage 0 Breast Cancer (carcinoma-in-situ).

2.invasive cancer:

Invasive Breast Cancer occurs when the cancer cells spread to the surrounding tissues of the breasts and then to the lymph nodes under the armpits.
These cancer cells can also spread to other parts of the body like the lungs, liver and bones.
Invasive breast cancer is classified into 4 stages from Stage 1 to 4 according to severity, stage 4 being the most severe.

What are the Risk factors in Breast Cancer?
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All women are at risk of breast cancer and the risk increases with age.
Main risk factors are:
1.family history of breast cancer,

2 past medical history of breast cancer and ovarian cancer,

3.Menstruating at an early age.

4.late menopause or

5.having your first child after age 30 or never having given birth.

6.Taking hormones such as estrogen and progesterone.

What are the signs of Breast Cancer?
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Signs, which may indicate Breast Cancer, are:
1.a painless lump in the breast or armpit

2.abnormal discharge from the nipple

3.changes in the skin over the breast or nipple

4.new retraction (pulling in) of the nipple

5.persistant rash around the nipple

How do you diagnose Breast Cancer?
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1.Breast Self Examination (BSE)
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It is very important for every woman above aged 30 years old to learn, and practise BSE regularly once a month, about a week after each menstrual period. Women who no longer have periods should practise BSE on a fixed date each month.

2.Mammography
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1.Women aged 40 - 49 years are encouraged to go for regular mammography every year 2.Women 50 years and above should go every two years.
3.Women who are at higher risk of developing breast cancer should see a doctor for advice. You may need to go for screening earlier and more frequently.
Mammography is a low-dose X-ray of the breast using specially designed X-ray machine.
It is the most effective method to detect very small lumps in the breast even before they can be felt by the hand.

3.Ultrasound of the Breasts
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Ultrasound of the Breasts is used together with mammography in cases where the diagnosis of possible cancer of the breast is not confirmed.
The ultrasound may be able to detect small lumps, which are not detected by mammogram.

4.MRI (magnetic resonance imaging) of the Breasts
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MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas in the body. With advancement of technology, a MRI of the breasts can detect even more clearly any abnormal lumps or tissues in the breasts.

5.Estrogen and progesterone receptor test:
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A test to measure the amount of estrogen and progesterone (female hormones) receptors in cancer tissue. The test results show whether hormone therapy may stop the cancer from growing.

6.Biopsy:
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The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, the doctor may need to cut out a small piece of the lump.
Four types of biopsies are as follows:
Excisional biopsy: The removal of an entire lump or suspicious tissue.
Incisional biopsy: The removal of part of a lump or suspicious tissue.
Core biopsy: The removal of part of a lump or suspicious tissue using a wide needle.
Needle biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle.

What is the Treatment of Breast Cancer?
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There are different types of treatment for patients with breast cancer.
Four types of standard treatment are used:
1.Surgery
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Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.
Lumpectomy: Breast-conserving surgery to remove a tumor (lump) and a small amount of normal tissue around it.
Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it. This procedure is also called a segmental mastectomy.
Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.
Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
Radical mastectomy: Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy, chemotherapy, or hormone therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.
If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast's shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at a future time.
2.Radiation therapy
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Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.
External radiation therapy uses a machine outside the body to send radiation toward the cancer.
Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
3.Chemotherapy
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Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
4.Hormone therapy
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Hormone therapy is a cancer treatment that removes female hormones or blocks their action and stops cancer cells from growing.
Examples are tamoxifen and aromaase inhibitors.

Other newer methods are:
Sentinel lymph node biopsy followed by surgery
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Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. After that biopsy, the surgeon removes the tumor (breast-conserving surgery or mastectomy).
Monoclonal antibodies as adjuvant therapy
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Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. The antibodies attach to the cancer cells, block their growth, or keep them from spreading.
Examples are Trastuzumab (Herceptin) which blocks the effects of the growth factor protein HER2, Tyrosine kinase inhibitors which block signals needed for tumors to grow, Lapatinib which blocks the effects of the HER2 protein and other proteins inside tumor cells.

Treatment of Preinvasive Breast Cancer
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Surgery is the main form of treatment for this stage of Cancer.
Either a lumpectomy or a mastectomy can be done.
Women who choose lumpectomy usually have to undergo radiation treatment or radiotherapy.

The type of surgical treatment depends on
1. The size and extent of cancer within the breast
2.the patient's suitability or desire to undergo radiotherapy.

Chemotherapy is not required for cancer detected at such an early stage.

Treatment of Invasive Breast Cancer
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Surgery is the main treatment as well in this case.
It involves the removal of the cancer with or without preserving the breast.
In the late stages where the cancer has spread to the other parts of the body, surgical removal of the cancer may be done to reduce the pain.

Chemotherapy is given to treat the cancer that has spread beyond the breast and armpit. It can be given orally or by injection.
The decision to use chemotherapy depends on:
1. The stage of the cancer
2. Type of cancer cells
3. Whether the woman has reached menopause
Chemotherapy may be used before surgery in large cancers to reduce cancer recurrence or to increase the chance of safe breast preservation surgery.

Hormonal therapy is used for hormone responsive cancers to deprive the cancer cells of oestrogen, which is required for such cancers to grow.
It is given in place of chemotherapy or following it.

Radiotherapy uses high-energy rays to kill cancer cells or stop them from growing further. It may be given for a peroid of time after a lumpectomy or after a mastectomy.
It is also given for inoperable cancers.

How is Breast Cancer Recurrence detected?
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After cancer treatment, patients are required to follow up with their doctors at regular intervals especially in the first 5 years after treatment when the risk of recurrence is highest.
This include:
Physical examination of the breasts, underarm, neck.
Peroidic mammograms
Blood tests
Chest x-rays and
Bone scan.
Any complaints of change in surgical areas or other parts of the breasts, swollen lymph glands or bone pains may suggest a recurrence.

What is the Prognosis of Breast Cancer?
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The prognosis (chance of recovery) and treatment options depend on the following:
1.stage of the cancer (whether it is in the breast only or has spread to lymph nodes or other places in the body).
2. type of breast cancer.
3.Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
4.woman's age, general health, and menopausal status (whether a woman is still having menstrual periods).
5.Whether the cancer has just been diagnosed or has recurred.

Finally please note that Breast Cancer can also occur in Men!