A Family Doctor's Tale - CANCER SCREENING 3

DOC DO I NEED TO GO CANCER SCREENING 3

Cancer Screening:

C. Breast cancer

Breast Cancer is the most common cancer in women.
Women who are at high risk are those with:
1.family history of breast cancer
A gene has been identified which indicates high incidence of breast cancer.


2.family history of other cancers such as ovary and colon


3.women of age 55 years and above

Cancer screening procedures includes:
1.monthly breast self examination(BSE) is recommended for all women from the age of 30 to detect breast lumps which may be early cancer


2.Mammography once every 2 years from the age of 50 years can help to detect breast cancer.


3.Ultrasound of the breasts together with mammogram  also helps in the detection of breast cancer.


4.Blood test-tumor markers such as CEA, CA 125 and CA 15.3 may be raised in cancer of the breast but are not significant in making a diagnosis.

D.Liver Cancer

Liver Cancer is the 4th most common cancer in men in Singapore.


Men are more often 4 times affected than women.


People who are at risk of developing liver cancer are:
1.Chronic hepatitis B carriers and infections


2.Hepatitis C liver cirrhosis and infection


3.Liver cirrhosis from other causes (eg alcohol)

Screening for hepatitis B is recommended for:
1.Healthcare workers because they are exposed to hepatitis patients


2.Pregnant women because the hepatitis infection can spread to her baby at birth


3.Dialysis patients because the fluid or plasma used in dialysis may contain the hepatitis B infection


4.Those people with a history of hepatitis B infection or liver cancer in the family


5.Those people with high risk behaviour having unprotected sex, multiple sex partners, drug addicts who share needles.

Cancer screening procedures includes:
1.Blood test-tumor marker alpha feto-protein level should be done every 3-6 months.


Patients with hepatitis and liver cancer has been found to have raised levels of serum alpha feto-protein.


However patients with germ cell cancers of the testes and ovary also have raised level of alpha feto-protein.

Pregnant women may also have raised alpha feto-protein at certain stage of their pregnancy.

2.Ultrasound of the liver including the gallbladder and bile ducts
should be done every 6 to 12 months.

E.Ovarian Cancer

Ovarian Cancer is the fifth commonest cancer in Singapore and can be potentially fatal if not detected early.

Early ovarian cancer may not have any symptoms and may be undetected unless screening is done.

Women who are at high risk are those with:
1.family history of ovarian cancer


2.abnormal menses

Cancer screening procedures includes:
1.Annual pelvic examination


2.pelvic ultrasound


3.Blood test-tumor markers CA125 and alpha feto-protein level should be done yearly for those with high risk of ovarian tumors

 

A Simple Guide to Down's Syndrome

A Simple Guide to Down's Syndrome
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What is Down's Syndrome?
------------------------------

Down syndrome is a genetic condition in which the affected person is born with mental disabilty and characteristic features.

These characteristic features have been called mongolism with:
1.obliquely set eyes
2.narrow palpebral fissures
3.epicanthyl folds
4.short stubby nose
5.flattened facies
6.short stature
7.generalized muscular hypotonia
8.dry skin
9.thin fine hair
10.underdeveloped genitalia

Most people with Down's Syndrome are not able to look after themselves because of their mental diability.

But many of them have gentle and endearing personalities.

There is no medical cure for this condition.

What causes Down's Syndrome?
-----------------------------------

Chromsomes are tiny structures in our body cells which can seen only with a special microscope.
They contains the genes which determines the characteristics of a person.

Anormal person has 23 pairs of matching chromosomes in each cell.
Each pair is different and given a number except for the sex chromosomes which are named XY in the male and XX in the female.

A person with Down's Syndrome has an extra chromosone no.21

What are the Types of Down Syndrome?
---------------------------------------

There are  three genetic variations that can cause Down syndrome:
1.Trisomy 21 is the commonest type in which all the cells have an extra chromosome 21.Here something goes wrong during egg formation in the mother so that the mother has an abnormal egg with extra chromosomes no.21. The child will then get an extra chromosone no.21. The cause of this abnomal egg formation is unknown but occurs more frequency with the mother's age.

2.Translocation Down syndrome happens when the extra chromosome 21  is attached to another chromosome. During cell division the embryo may get the attached chromosome and so have an extra chromosome no 21 and get Down's Syndrome.

3.Mosaic Down syndrome is a another form of Down's Syndrome in which only some cells have an extra chromosome 21.

What are the Risk factors of getting Down's Syndrome?
------------------------------------------------------

Risk factors include:

1.maternal age above 35 years. Most cases of Down's syndrome are born to women aged 35 and above. The risk of a woman above age 36 conceiving a child with Down syndrome is 1 in 350. The risk increases to 1 in 100 by the age of 40 and to 1 in 25 at the age of 45.
   
2.Mothers with one Down syndrome child have a 1 in 100 chance of having another child with Down syndrome.

3.Parents who are known to carry the translocated chromosome for Down syndrome can pass the abnormal gene to their offspring.

What are the Symptoms of Down's Syndrome?
------------------------------------------------
Mongolian features:
1.distinct flat facial profile
2.Upward slanting eyes
3.Flat nose
4.Protruding tongue
5.Flat back of the head
6.Small statue
7.Poor muscle tone
8.Broad, short hands with short fingers and a single crease in the palm
9.dry skin
10.thin fine hair

Mental retardation
1.mental disability
2.unable to look after themselves

Congenital defects:
1.congenital heart disease
2.other birth defects

Screening tests are done for all pregnant women above 35 years of age and include:

1.Triple test - is a blood test done for older pregnant mothers above 35 years which measures specific proteins in the mother’s blood. This may indicates the possibility of Down's Syndrome

2.Nuchal translucency test is an ultrasound scan of the embryo at 10-13 weeks of pregnancy. It measures the width of the spinal cord at the back of the baby’s neck.

If the screening tests suggest a possible high risk of Down syndrome, then the following diagnostic tests may be performed to determine or confirm whether the baby actually has Down syndrome:

1.Amniocentesis. A small amount of the amniotic fluid is obtained through a needle inserted into the mother's womb after 16 weeks of pregnancy. This fluid contains cells shed from the baby and can be examined to see if the chromosomes are normal.

2.Chorionic Villous Sampling (CVS) involves obtaining some cells from the mother's placenta to examine the baby’s chromosones.It is usually done around the 14th week of pregnancy.

3.Percutaneous umbilical blood sampling (PUBS) involves obtaining blood from a vein in the umbilical cord after 18 weeks of pregnancy. The blood cells are examined for chromosomal defects.

Complications of Down's Syndrome are:

1.Heart defects.
2.Leukemia 
3.Infectious diseases such as pneumonia
4.Dementia often appear before age 40
5.intestinal obstruction,
6.thyroid problems,
7.hearing loss
8.poor vision.

Treatment of Down's Syndrome:

There is no medical cure for Down syndrome.
However, children with Down syndrome do benefit from medical help and early interventions starting in infancy which improve the life expectancy and quality of life.

Prevention of Down's Syndrome:

Down syndrome cannot be prevented.
1.genetic counselling in high risk translocation genetic group before considering pregnancy.

2.Coping and support from a team of doctors, teachers and therapists who can  provide the resources and support to  take better care of your child.

3.Joining a Down Syndrome support group and families who are dealing with the same problem

Prognosis:
1.A better understanding of Down syndrome and early interventions have improved the quality of life of children and adults with Down syndrome.

2.If there is no major complications such as heart disease and leukemia, a person with Down Syndrome may have a slightly shortened life span than a normal person.

A Family Doctor's Tale - CANCER SCREENING 2

DOC DO I NEED TO GO FOR CANCER SCREENING 2

Cancer Screening tests:

A.Colorectal cancer

Colorectal cancer is the most common cancer in Singapore and can begin as behign growths (polyps)in the colon.

Early detection of these polyps means they can be removed to prevent colorectal cancer.

People who are at high risk are:

1. all men and women above the age of 50 years

2. those with a family history of colorectal cancer


Cancer screening procedures includes:

1.Faecal Occult Blood Test(FOBT)

This test detects tiny amounts of blood in the stools from bleeding in the colon and rectum.

Those who has a positive test should go for colonoscopy to exclude cancer.

This test should be done yearly.

2.Colonoscopy

A colonoscope has a light, camera and surgical instruments which can be used to examine the entire large intestine and removes polyps found during the procedure.

This test should done at 5 years interval especially for people above the age of 50 with a history of positive blood in the stools and a family history of colorectal cancer.

3.CT Colonography Special X ray equipment is used to create detailed images of the inside of the colon and rectum using computer tomograpghy. It can detect early polyps or cancer in the colon.

4.Blood test-tumor markers such as CEA may be raised in colorectal cancer but are not significant in making a diagnosis as they may be raised in other cancers as well.

CA 19.9 may also be raised in 64% of colorectal cancer.

B.Lung cancer

Lung cancer is the second most common cancer after colorectal cancer.

It is usually associated with smoking, air pollution, chemicals such as asbesto, gasoline.

People who are at high risk are:

1.People with a family history of lung cancer

2.smoking

3.exposure to inhalation of chemicals such as asbesto, gasolines,

They should be screened even at a early age of 25 years and above.

Cancer screening procedures includes:

1.CT scan of the lungs is the best way of determining the presence of cancer of the lungs.

2.Blood test -tumor marker such as CEA(carcinoembryonic antigen) is usually raised but can also be high in other cancers such as lung, stomach, breast, ovary abd cervix and also benign diseases such as inflammations of bowel, lung, pancreas and liver cirrhosis.

A Family Doctor's Tale - CANCER SCREENING

DOC DO I NEED CANCER SCREENING

Why do I need to go for cancer screening?

Cancer is the top killer in Singapore.
About one quarter of all deaths here are caused by cancer.

Our bodies are made up of billions of cells. Normal healthy cells grow and multiply in an orderly, controlled manner.

Cancer cells on the other hand multiply uncontrollably. They do not function normally and instead form a growth or tumour. These cancerous tumours can spread to nearby tissues and organs as well as to other parts of the body.


Cancer kills by:
1.Destroying important organs
2.Disturbing normal body functions
3.Blocking important blood vessels or air passages.

Not all cancers are the same


Cancer is really a group of diseases.

There are many types of cancer which can arise from the different types of cells in the body.

MOST COMMON TYPES OF CANCER IN SINGAPORE ARE:

Male
1.Lung
2.Colon & rectum
(large intestine)
3.Prostate
4.Liver
5.Stomach

Female
1.Breast
2.Colon & rectum
3.Lung
4.Ovary
5.Cervix
(neck of the womb)

Cancer can be prevented


Cancer is not contagious like the flu or chickenpox.


A person cannot catch cancer from someone who has it.


However some cancer can be inherited hence the need to prevent the cancer in people with a family history of cancer.

Many cancers develop because of lifestyle habits such as
1.smoking,


2.excessive drinking of alcohol


3.eating too much fat (especially animal fat).

4.sexual intercourse with multiple partners


Others are caused by factors in the environment such as
1.sunlight,


2.radiation


3.industrial chemicals.

4.bacterial infection like hylobacter pylori in stomach cancer

5.viral infections like hepatitis B and C, Epstein Barr virus in liver cancer and nasopharyngeal cancer


By leading a healthy lifestyle and avoiding certain risk factors, about one-third of all cancers can be prevented from occurring.

Cancer can be cured


Many people are afraid of cancer because they think it is incurable. In fact, about one-third of all cancers can be cured if they are detected and treated early enough.


Recognising the early warning signs and going for regular check-ups can save your life if cancer strikes.

What is cancer screening?

Cancer screening consists of various tests and procedures done at regular intervals:
1.once a year
2.once in 2 years
3.once in 5 years
4.when a person reach a certain age

Who should go for cancer screening?

Cancer screening helps to discover if a person is suffering from cancer even though the person has no symptoms.

In particular cancer screening should be done if there is a family history of cancer.

A Family Doctor's Tale - GOITER

DOC I HAVE GOITER

Goiter is the abnormal diffuse enlargement of the thyroid gland.

People who are at risk of Goiter are:
1.Goiter are more common in females than in male.

2.Goiter occurs in all edge groups but is more common in the 30- 60 age group.

3.Goiter may be endemic in areas of deficient iodine intake.

The causes of Goiter are:
1.Toxic goiter caused by hyperthyroidism usually diffuse with signs of hyperthyroidism

2.Autoimmune bacterial or viral thyroiditis(Hashimoto's disease) also presents with smooth diffuse goiter.

3.Benign tumors of the thyroid such as adenoma, cyst may presents more of nodular form of goiter.

4.Malignant tumors of the thyroid may be nodular or diffuse

5.Inherited disorders of thyroid gland metabolism may also manifest as goiter

6.Nontoxic or simple goiter is common in those people deficient in iodine intake.

7.Some goiters are caused by ingestion of goiter stimulating agents or medicines such as thyroxine

The symptoms and signs of Goiter are:
Symptoms:
1.Obvious swelling in the thyroid gland present for some time

2.Painful swelling are suggestive of bacterial or viral infection-

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:
1.Goiter or swelling of thyroid may be smooth, diffuse or nodular.
The swelling moves on swallowing.

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

3.Thyroid hormones may be normal, increased or decreased

4.Neck lymph nodes are enlarged

The diagnosis of Goiter is made using:

1.blood test for thyroid hormones(T$ and T3), TSH levels and thyroid stimulating immunoglobulins

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

3.ultrasound scans are done to differentiate between solid, diffuse 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 Goiter investigation except where there is suspected compression of teachea.

The Treatment of Goiter is:
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 medical treatment with carbimazole, radioactive iodine treatment or surgery.

Beta blockers are given in hyperthyroid cases where the heart beat is very fast.

Iodine deficient goiter patients may require iodine supplements.

Goiter due to Hashimoto disease or simple nontoxic goiter may become smaller with thyroxine treatment.

Prognosis of Goiter is good in all benign cases.

Malignant Goiter are slow growing and have good prognosis.

The prognosis of the more serious carcinoma will depend on any spread to other organs.

Hyperthyroid patients recovers after 2 years of anti-thyroid medications and 30 per cent remains in remission after withdrawal of anti-thyroid medications

A Family Doctor's Tale - EAR CANAL POLYPS

DOC I HAVE EAR CANAL POLYPS

Ear canal polyps or aural polyps are benign swellings that grow from the skin or glands of the external ear canal or from the lining of the ear drum.

Ear canal polyps occurs as a result of chronic irritation of the skin of the ear canal or eardrum usually from infections of the external ear canal.

The symptoms and signs of ear canal polyps are:
Symptoms:
1.pain in the ear


2.Itchiness


3.ear discharge


4.loss of hearing

Signs:
1.Presence of polyps in the ear canal


2.Infection in the ear canal

Diagnosis or ear canal polyps:
1.Otoscopy usually show the presence of pedunculated soft fleshy swellings in the ear canal

2.Infection may be present in ear canal with pus and debris

3.MRI or CAT SCAN may be done to exclude the presence of cholesteatoma (also a chronic infected ear cyst in the middle ear or inner ear) which can damage the bone in the inner ear and spread to the brain causing infection.

4.Ear canal polyp biopsy to exclude malignancy

The complications of ear canal polyps are:
1.Rarely Ear canal polyps may become malignant

2.In diabetes or immune deficient patients severe infections called malignant otitis externs  may spread to the mastoid and spread to the brain causing brain abscess, facial paralysis, deafness, meningitis, and osteomyelitis of the base of the
skull

Treatment of ear canal polyps is by:
1.Topical steroid cream and antibiotic ear drops

2.For chronic or repeat infections, steroid creams and white table vinegar (5% acetic acid) usually help to dissolve the polyps

3.Antifungal drops and creams are used for fungal infection.

4.Surgery of ear tubes may be necessay for ear canal Polyps developing from ear tubes if eardrop treatment is not effective.

5.Cholesteatoma-generated polyps may require drops and oral antibiotics

Some side effects of the medications used are:
1.allergic reaction


2.severe itching,


3.blistering,

4.redness,


5.thickening of the ear canal skin.

These medicines must be stopped if any of these symptoms develop.

Surgical removal of ear canal polyps may have pain and bleeding as side effects.

Prognosis of Ear canal polyp is:
In most cases, the infection and the ear canal polyp should resolve with treatment

Recurrence of the ear infection is common.
Reappearance of symptoms of ear discharge, hearing loss, bleeding, and itching may indicate the underlying infection has recurred.

In these cases, maintenance steroid drops, vinegar irrigations, or antifungal agents may be needed.

A Family Doctor's Tale -DEMENTIA

DOC I HAVE DEMENTIA

Dementia is  a disease in which brain tissue degenerates to the extent of loss of memory and other intellectual abilities serious enough to interfere with daily life.

In Dementia there is a severe and progressive decline in mental function.

It affects a person's ability to:
1.think,remember and reason

2.learn new information and skills

3.solve problems and make judgement

The causes of Dementia are :
There are several different factors which may contribute to its development.

They can be divided into:
1.Irreversible conditions
a.Aging is one important risk factor.
Alzeimer's Disease

b.Stroke

c.Parkinson's disease

2.Reversible conditions
a.Hypothyroidism

b.Vitamin B12 deficiency

c.Alcohol dependence diseases


Irreversible Dementia cannot be cured but it may be possible to slow down the progression of the disease.

It may be possible treat the cognitive symptoms.

Potentially reversible dementia may be curable.

The Symptoms of Dementia are:
1.Memory loss or Forgetfulness is often one of the earliest symptoms (Patients may forget dates, names of common objects and familiar people)

2.Confusion(Disorientation in time and place) ,

3.Trouble with organizing

4.Misplacing things,

5.Difficulty in expressing thoughts,

6.Difficulty performing familiar tasks

7.Difficulty understanding others

8.Poor or decreased judgment

9.Wandering and getting lost in familiar places

10.Changes in mood and behaviour (They may become easily agitated or depressed)

a.Changes in personality

b.paranoia

c.hallucinations

d.agitation

e.anxiety

f.sleep problems

Dementia should be assessed and investigated.

Diagnosis can be based on :
1.History of depression, anxiety, hallucination, paranoia, agitation or sleep problems

2.Various tests may be done to exclude other conditions that may be causing the same problems:
a.blood sugar, thyroid hormone, vitamin B12 level

b.CT Scan or MRI of the brain to exclude tumors or stroke

The family doctor can refer the patient to a psychiatrist for further assessment if dementia is suspected.

The Management of Dementia is by:
Dementia is quite common in old people.

Referral to a psychiatrist may then be necessary for assessement and advice on management.

Management of dementia usually involve :

1.Treatment of reversible causes and risk factors:
a.treatment of any reversible causes such as hypothyroidism(thyroxine tabs), Vitamin B12 deficiency(injections of Vitamin B12 or B12 oral tablets)

b.reduction of risk facors for stroke such as diabetes, hypertension, high cholesterol

c.Use of blood thinning medicines such aspirin, plavix, ticlid, warfarin to prevent stroke

2.At the present moment there is no cure for non reversible Dementia but there are many ways to reduce the behavioural and psychological symptoms.

These including having
a.a fixed routine daily,

b.making the home and surroundings safe and familiar

c.using memory aids like diaries and calendars.

d.social interactions and contacts with other patients

e.activity programs

3.There are now drugs available to help delay or prevent symptoms from becoming worse:
a.One group of drugs helps improve the ability to think, understand, and remember.(Donepezil, Rivastigmine, Galantamine, Memantine) .

There may be improvement of the symptoms but ultimately they do not prevent the disease from getting worse.

b.Another group of drugs is also to help with behavioural problems associated with Dementia, such as aggressiveness, agitation, depression, and anxiety.(Prozac, Seroxat, Zoloft)

4.Caring for a patient with dementia can be frustrating and stressful.

It gets worse as the disease progresses.

There are now support groups and organisations which can help caregivers providing:.
a.education on dementia and caretaker skills
b.individual and family couseling
c.caretaker support groups
d.dementia day care service

A Family Doctor's Tale - ROSEOLA INFANTUM

DOC I HAVE ROSEOLA INFANTUM

Roseola Infantum is usually a contagious childhood infection caused by the Roseola Infantum virus.

It is also known as "false measles" because of the appearance of its rashes which appear from the face and spread down to the legs and fever.


It is characterized by typical prodromal symptoms of fever, runny nose , cough, generalised rash and cervical lymphadenopathy

Any one at any age can contract Roseola Infantum but it usually occurs before the age of 2 years old because by that time most of the children has immunity to the virus.

Spread is usually by infected persons either from mucous discharges from their coughing and sneezing, or from contact with their skin rash,contaminated items and surfaces.

Usually a  person is contagious for about two days before symptoms appear, and up to five days after appearance of the rash.

There is a prodromal peroid of 5 to 7 days after contact with a infected person.


Early symptoms include:
1.high fever


2.coughing,


3.runny nose, stuffy nose,


4.tiredness,


5.red eyes, tearing. ,


6.Roseola Infantum rash usually occurs after the onset of fever.
The rash is typically red,maculopapular, and starts from behind the ears and face, then spreads downward to the neck, trunk, limbs, palms and soles.

The rash begins to fade in about four days .

There may be a brownish discoloration in areas of affected skin rahes but this is only temporary.


7. enlarged lymph glands may be felt in the neck and groins


8.inflammation of the eyes (conjunctivitis) with tearing may also occurs.


9. diarrhoea and vomiting may occurs in some patients.


Children who have had Roseola Infantum develop a natural immunity and cannot contract it again.

Complications are rare and include:

1.Ear infection (Otitis Media) is a common complication of Roseola Infantum.


2.pneumonia in very young children may be dangerous.


3.encephalitis (brain infection)may occur in rare cases

There is no cure for Roseola Infantum.

Treatment is therefore symptomatic.
1.Fever symptoms are treated with acetaminophen (Paracetamol).


Children should not be given aspirin due to the risk of Reye's Syndrome which affects the brain


2.Itch may be controlled by antihistamines which can also help to relieve the runny nose.


3.Antibiotics may be given if there is superimposed secondary bacterial infection such as otitis emdia and pneumonia..


4.Cough mixtures may be given to relieve the cough.


5.Plenty of bed rest is necessary.


6.Lots of fluids helps to prevent dehydration.


Most patients recover completely from Roseola Infantum.