Lung Cancer Part-8

Lung Cancer Part-8

What is the prognosis (outcome) of lung cancer?

The prognosis of lung cancer refers to the chance for cure or prolongation of life (survival) and is dependent upon where the cancer is located, the size of the cancer, the presence of symptoms, the type of lung cancer, and the overall health status of the patient.
SCLC has the most aggressive growth of all lung cancers, with a median survival time of only 2 to 4 months after diagnosis when untreated. (That is, by 2 to 4 months, half of all patients have died.) However, SCLC is also the type of lung cancer most responsive to radiation therapy and chemotherapy. Because SCLC spreads rapidly and is usually disseminated at the time of diagnosis, methods such as surgical removal or localized radiation therapy are less effective in treating this type of lung cancer. When chemotherapy is used alone or in combination with other methods, survival time can be prolonged four- to fivefold; however, of all patients with SCLC, only 5% to 10% are still alive 5 years after diagnosis. Most of those who survive have limited-stage SCLC.
In non-small cell lung cancer (NSCLC), the most important prognostic factor is the stage (extent of spread) of the tumor at the time of diagnosis. Results of standard treatment are generally poor in all but the smallest of cancers that can be surgically removed. However, in stage I cancers that can be completely removed surgically, 5-year survival approaches 75%. Radiation therapy can produce a cure in a small minority of patients with NSCLC and leads to relief of symptoms in most patients. In advanced-stage disease, chemotherapy offers modest improvements in survival although rates of overall survival are poor.

The overall prognosis for lung cancer is poor when compared with some other cancers. Survival rates for lung cancer are generally lower than those for most cancers, with an overall 5-year survival rate for lung cancer of about 17% compared to 67% for colon cancer, 90% for breast cancer, 81% for bladder cancer, and over 99% for prostate cancer.

Lung Cancer Part-7

Lung Cancer Part-7

What is staging of lung cancer?

The stage of a cancer is a measure of the extent to which a cancer has spread in the body. Staging involves evaluation of a cancer's size and its penetration into surrounding tissue as well as the presence or absence of metastases in the lymph nodes or other organs. Staging is important for determining how a particular cancer should be treated, since lung-cancer therapies are geared toward specific stages. Staging of a cancer also is critical in estimating the prognosis of a given patient, with higher-stage cancers generally having a worse prognosis than lower-stage cancers.
Doctors may use several tests to accurately stage a lung cancer, including laboratory (blood chemistry) tests, X-rays, CT scans, bone scans, MRI scans, and PET scans. Abnormal blood chemistry tests may signal the presence of metastases in bone or liver, and radiological procedures can document the size of a cancer as well as its spread.
NSCLC are assigned a stage from I to IV in order of severity:

• In stage I, the cancer is confined to the lung.
• In stages II and III, the cancer is confined to the chest (with larger and more invasive tumors classified as stage III).
• Stage IV cancer has spread from the chest to other parts of the body.

SCLC are staged using a two-tiered system:

• Limited-stage (LS) SCLC refers to cancer that is confined to its area of origin in the chest.
• In extensive-stage (ES) SCLC, the cancer has spread beyond the chest to other parts of the body.

What is the treatment for lung cancer?

Treatment for lung cancer can involve surgical removal of the cancer, chemotherapy, or radiation therapy, as well as combinations of these treatments. The decision about which treatments will be appropriate for a given individual must take into account the location and extent of the tumor as well as the overall health status of the patient.
As with other cancers, therapy may be prescribed that is intended to be curative (removal or eradication of a cancer) or palliative (measures that are unable to cure a cancer but can reduce pain and suffering). More than one type of therapy may be prescribed. In such cases, the therapy that is added to enhance the effects of the primary therapy is referred to as adjuvant therapy. An example of adjuvant therapy is chemotherapy or radiotherapy administered after surgical removal of a tumor in an attempt to kill any tumor cells that remain following surgery.

Surgery: Surgical removal of the tumor is generally performed for limited-stage (stage I or sometimes stage II) NSCLC and is the treatment of choice for cancer that has not spread beyond the lung. About 10% to 35% of lung cancers can be removed surgically, but removal does not always result in a cure, since the tumors may already have spread and can recur at a later time. Among people who have an isolated, slow-growing lung cancer removed, 25% to 40% are still alive 5 years after diagnosis. It is important to note that although a tumor may be anatomically suitable for resection, surgery may not be possible if the person has other serious conditions (such as severe heart or lung disease) that would limit their ability to survive an operation. Surgery is less often performed with SCLC than with NSCLC because these tumors are less likely to be localized to one area that can be removed.

Lung Cancer Part-6

Lung Cancer Part-6

How is lung cancer diagnosed?

Doctors use a wide range of diagnostic procedures and tests to diagnose lung cancer. These include the following:

• The history and physical examination may reveal the presence of symptoms or signs that are suspicious for lung cancer. In addition to asking about symptoms and risk factors for cancer development such as smoking, doctors may detect signs of breathing difficulties, airway obstruction, or infections in the lungs. Cyanosis, a bluish color of the skin and the mucous membranes due to insufficient oxygen in the blood, suggests compromised function due to chronic disease of the lung. Likewise, changes in the tissue of the nail beds, known as clubbing, also may indicate chronic lung disease.
• The chest X-ray is the most common first diagnostic step when any new symptoms of lung cancer are present. The chest X-ray procedure often involves a view from the back to the front of the chest as well as a view from the side. Like any X-ray procedure, chest X-rays expose the patient briefly to a small amount of radiation. Chest X-rays may reveal suspicious areas in the lungs but are unable to determine if these areas are cancerous. In particular, calcified nodules in the lungs or benign tumors called hamartomas may be identified on a chest X-ray and mimic lung cancer.
• CT (computerized tomography, computerized axial tomography, or CAT) scans may be performed on the chest, abdomen, and/or brain to examine for both metastatic and lung tumors. A CT scan of the chest may be ordered when X-rays do not show an abnormality or do not yield sufficient information about the extent or location of a tumor. CT scans are X-ray procedures that combine multiple images with the aid of a computer to generate cross-sectional views of the body. The images are taken by a large donut-shaped X-ray machine at different angles around the body. One advantage of CT scans is that they are more sensitive than standard chest X-rays in the detection of lung nodules, that is, they will demonstrate more nodules. Sometimes intravenous contrast material is given prior to the scan to help delineate the organs and their positions. A CT scan exposes the patient to a minimal amount of radiation. The most common side effect is an adverse reaction to intravenous contrast material that may have been given prior to the procedure. This may result in itching, a rash, or hives that generally disappear rather quickly. Severe anaphylactic reactions (life-threatening allergic reactions with breathing difficulties) to contrast material are rare. CT scans of the abdomen may identify metastatic cancer in the liver or adrenal glands, and CT scans of the head may be ordered to reveal the presence and extent of metastatic cancer in the brain.
• A technique called a low-dose helical CT scan (or spiral CT scan) is sometimes used in screening for lung cancers. This procedure requires a special type of CT scanner and has been shown to be an effective tool for the identification of small lung cancers in smokers and former smokers. However, it has not yet been proven whether the use of this technique actually saves lives or lowers the risk of death from lung cancer. The heightened sensitivity of this method is actually one of the sources of its drawbacks, since lung nodules requiring further evaluation will be seen in approximately 20% of people with this technique. Of the nodules identified by low-dose helical screening CTs, 90% are not cancerous but require up to 2 years of costly and often uncomfortable follow-up and testing. Trials are underway to further determine the utility of spiral CT scans in screening for lung cancer.

Lung Cancer Part-5

Lung Cancer Part-5

What are lung cancer symptoms and signs?

Symptoms of lung cancer are varied depending upon where and how widespread the tumor is. Warning signs of lung cancer are not always present or easy to identify. Lung cancer may not cause pain or even any symptoms at all in some cases. A person with lung cancer may have the following kinds of symptoms:

• No symptoms: In up to 25% of people who get lung cancer, the cancer is first discovered on a routine chest X-ray or CT scan as a solitary small mass sometimes called a coin lesion, since on a two-dimensional X-ray or CT scan, the round tumor looks like a coin. These patients with small, single masses often report no symptoms at the time the cancer is discovered.
• Symptoms related to the cancer: The growth of the cancer and invasion of lung tissues and surrounding tissue may interfere with breathing, leading to symptoms such as cough, shortness of breath, wheezing, chest pain, and coughing up blood (hemoptysis). If the cancer has invaded nerves, for example, it may cause shoulder pain that travels down the outside of the arm (called Pancoast syndrome) or paralysis of the vocal cords leading to hoarseness. Invasion of the esophagus may lead to difficulty swallowing (dysphagia). If a large airway is obstructed, collapse of a portion of the lung may occur and cause infections (abscesses, pneumonia) in the obstructed area.
• Symptoms related to metastasis: Lung cancer that has spread to the bones may produce excruciating pain at the sites of bone involvement. Cancer that has spread to the brain may cause a number of neurologic symptoms that may include blurred vision, headaches, seizures, or symptoms of stroke such as weakness or loss of sensation in parts of the body.
• Paraneoplastic symptoms: Lung cancers frequently are accompanied by symptoms that result from production of hormone-like substances by the tumor cells. These paraneoplastic syndromes occur most commonly with SCLC but may be seen with any tumor type. A common paraneoplastic syndrome associated with SCLC is the production of a hormone called adrenocorticotrophic hormone (ACTH) by the cancer cells, leading to oversecretion of the hormone cortisol by the adrenal glands (Cushing's syndrome). The most frequent paraneoplastic syndrome seen with NSCLC is the production of a substance similar to parathyroid hormone, resulting in elevated levels of calcium in the bloodstream.
• Nonspecific symptoms: Nonspecific symptoms seen with many cancers, including lung cancers, include weight loss, weakness, and fatigue. Psychological symptoms such as depression and mood changes are also common.

Lung Cancer Part-3

Lung Cancer Part-3

What are the types of lung cancer?

Lung cancers, also known as bronchogenic carcinomas, are broadly classified into two types: small cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC). This classification is based upon the microscopic appearance of the tumor cells themselves. These two types of cancers grow and spread in different ways and may have different treatment options, so a distinction between these two types is important.
SCLC comprise about 20% of lung cancers and are the most aggressive and rapidly growing of all lung cancers. SCLC are strongly related to cigarette smoking, with only 1% of these tumors occurring in nonsmokers. SCLC metastasize rapidly to many sites within the body and are most often discovered after they have spread extensively. Referring to a specific cell appearance often seen when examining samples of SCLC under the microscope, these cancers are sometimes called oat cell carcinomas.
NSCLC are the most common lung cancers, accounting for about 80% of all lung cancers. NSCLC can be divided into three main types that are named based upon the type of cells found in the tumor:

• Adenocarcinomas are the most commonly seen type of NSCLC in the U.S. and comprise up to 50% of NSCLC. While adenocarcinomas are associated with smoking, like other lung cancers, this type is observed as well in nonsmokers who develop lung cancer. Most adenocarcinomas arise in the outer, or peripheral, areas of the lungs.
• Bronchioloalveolar carcinoma is a subtype of adenocarcinoma that frequently develops at multiple sites in the lungs and spreads along the preexisting alveolar walls.
• Squamous cell carcinomas were formerly more common than adenocarcinomas; at present, they account for about 30% of NSCLC. Also known as epidermoid carcinomas, squamous cell cancers arise most frequently in the central chest area in the bronchi.
• Large cell carcinomas, sometimes referred to as undifferentiated carcinomas, are the least common type of NSCLC.
• Mixtures of different types of NSCLC are also seen.

Other types of cancers can arise in the lung; these types are much less common than NSCLC and SCLC and together comprise only 5% to 10% of lung cancers:

• Bronchial carcinoids account for up to 5% of lung cancers. These tumors are generally small (3 cm to 4 cm or less) when diagnosed and occur most commonly in people under 40 years of age. Unrelated to cigarette smoking, carcinoid tumors can metastasize, and a small proportion of these tumors secrete hormone-like substances that may cause specific symptoms related to the hormone being produced. Carcinoids generally grow and spread more slowly than bronchogenic cancers, and many are detected early enough to be amenable to surgical resection.
• Cancers of supporting lung tissue such as smooth muscle, blood vessels, or cells involved in the immune response can rarely occur in the lung.

As discussed previously, metastatic cancers from other primary tumors in the body are often found in the lung. Tumors from anywhere in the body may spread to the lungs either through the bloodstream, through the lymphatic system, or directly from nearby organs. Metastatic tumors are most often multiple, scattered throughout the lung, and concentrated in the peripheral rather than central areas of the lung.

Lung Cancer Part-2

Lung Cancer Part-2

How common is lung cancer?

Lung cancer is the most common cause of death due to cancer in both men and women throughout the world. Statistics from the American Cancer Society estimated that about 228,000 new cases of lung cancer in the U.S. will be diagnosed and about 159,000 deaths due to lung cancer would occur in 2013. According to the U.S. National Cancer Institute, approximately one out of every 14 men and women in the U.S. will be diagnosed with cancer of the lung at some point in their lifetime.
Lung cancer is predominantly a disease of the elderly; almost 70% of people diagnosed with lung cancer are over 65 years of age, while less than 3% of lung cancers occur in people under 45 years of age.
Lung cancer was not common prior to the 1930s but increased dramatically over the following decades as tobacco smoking increased. In many developing countries, the incidence of lung cancer is beginning to fall following public education about the dangers of cigarette smoking and the introduction of effective smoking-cessation programs. Nevertheless, lung cancer remains among the most common types of cancers in both men and women worldwide. In the U.S., lung cancer has surpassed breast cancer as the most common cause of cancer-related deaths in women.

What causes lung cancer?

Smoking

The incidence of lung cancer is strongly correlated with cigarette smoking, with about 90% of lung cancers arising as a result of tobacco use. The risk of lung cancer increases with the number of cigarettes smoked and the time over which smoking has occurred; doctors refer to this risk in terms of pack-years of smoking history (the number of packs of cigarettes smoked per day multiplied by the number of years smoked). For example, a person who has smoked two packs of cigarettes per day for 10 years has a 20 pack-year smoking history. While the risk of lung cancer is increased with even a 10-pack-year smoking history, those with 30-pack-year histories or more are considered to have the greatest risk for the development of lung cancer. Among those who smoke two or more packs of cigarettes per day, one in seven will die of lung cancer.
Pipe and cigar smoking also can cause lung cancer, although the risk is not as high as with cigarette smoking. Thus, while someone who smokes one pack of cigarettes per day has a risk for the development of lung cancer that is 25 times higher than a nonsmoker, pipe and cigar smokers have a risk of lung cancer that is about five times that of a nonsmoker.
Tobacco smoke contains over 4,000 chemical compounds, many of which have been shown to be cancer-causing or carcinogenic. The two primary carcinogens in tobacco smoke are chemicals known as nitrosamines and polycyclic aromatic hydrocarbons. The risk of developing lung cancer decreases each year following smoking cessation as normal cells grow and replace damaged cells in the lung. In former smokers, the risk of developing lung cancer begins to approach that of a nonsmoker about 15 years after cessation of smoking.

Passive smoking

Passive smoking or the inhalation of tobacco smoke by nonsmokers who share living or working quarters with smokers, also is an established risk factor for the development of lung cancer. Research has shown that nonsmokers who reside with a smoker have a 24% increase in risk for developing lung cancer when compared with nonsmokers who do not reside with a smoker. The risk appears to increase with the degree of exposure (number of years exposed and number of cigarettes smoked by the household partner). An estimated 3,000 lung cancer deaths that occur each year in the U.S. are attributable to passive smoking.

Lung Cancer Part-4

Lung Cancer Part-4

What are lung cancer symptoms and signs?

Symptoms of lung cancer are varied depending upon where and how widespread the tumor is. Warning signs of lung cancer are not always present or easy to identify. Lung cancer may not cause pain or even any symptoms at all in some cases. A person with lung cancer may have the following kinds of symptoms:

• No symptoms: In up to 25% of people who get lung cancer, the cancer is first discovered on a routine chest X-ray or CT scan as a solitary small mass sometimes called a coin lesion, since on a two-dimensional X-ray or CT scan, the round tumor looks like a coin. These patients with small, single masses often report no symptoms at the time the cancer is discovered.
• Symptoms related to the cancer: The growth of the cancer and invasion of lung tissues and surrounding tissue may interfere with breathing, leading to symptoms such as cough, shortness of breath, wheezing, chest pain, and coughing up blood (hemoptysis). If the cancer has invaded nerves, for example, it may cause shoulder pain that travels down the outside of the arm (called Pancoast syndrome) or paralysis of the vocal cords leading to hoarseness. Invasion of the esophagus may lead to difficulty swallowing (dysphagia). If a large airway is obstructed, collapse of a portion of the lung may occur and cause infections (abscesses, pneumonia) in the obstructed area.
• Symptoms related to metastasis: Lung cancer that has spread to the bones may produce excruciating pain at the sites of bone involvement. Cancer that has spread to the brain may cause a number of neurologic symptoms that may include blurred vision, headaches, seizures, or symptoms of stroke such as weakness or loss of sensation in parts of the body.
• Paraneoplastic symptoms: Lung cancers frequently are accompanied by symptoms that result from production of hormone-like substances by the tumor cells. These paraneoplastic syndromes occur most commonly with SCLC but may be seen with any tumor type. A common paraneoplastic syndrome associated with SCLC is the production of a hormone called adrenocorticotrophic hormone (ACTH) by the cancer cells, leading to oversecretion of the hormone cortisol by the adrenal glands (Cushing's syndrome). The most frequent paraneoplastic syndrome seen with NSCLC is the production of a substance similar to parathyroid hormone, resulting in elevated levels of calcium in the bloodstream.
• Nonspecific symptoms: Nonspecific symptoms seen with many cancers, including lung cancers, include weight loss, weakness, and fatigue. Psychological symptoms such as depression and mood changes are also common.

When should one consult a doctor?

One should consult a health care professional if he or she develops the symptoms associated with lung cancer, in particular, if they have

• a new persistent cough or worsening of an existing chronic cough
• blood in the sputum
• persistent bronchitis or repeated respiratory infections
• chest pain
• unexplained weight loss and/or fatigue
• breathing difficulties such as shortness of breath or wheezing

Lung Cancer Part-1

Lung Cancer Part-1

Lung Cancer Symptoms and Signs

Lung cancer is the most common cancer in men and the fifth most common in women, even causing more cancer-related deaths in women than breast cancer. The incidence of lung cancer is strongly correlated with cigarette smoking, with about 90% of lung cancers arising as a result of tobacco use.

Lung cancer facts

• Lung cancer is the number one cause of cancer deaths in both men and women in the U.S. and worldwide.
• Cigarette smoking is the principal risk factor for development of lung cancer.
• Passive exposure to tobacco smoke also can cause lung cancer.
• The two types of lung cancer, which grow and spread differently, are the small cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC).
• The stage of lung cancer refers to the extent to which the cancer has spread in the body.
• Treatment of lung cancer can involve a combination of surgery, chemotherapy, and radiation therapy as well as newer experimental methods.
• The general prognosis of lung cancer is poor, with overall survival rates of about 16% at 5 years.
• Smoking cessation is the most important measure that can prevent the development of lung cancer.

What is lung cancer?

Cancer of the lung, like all cancers, results from an abnormality in the body's basic unit of life, the cell. Normally, the body maintains a system of checks and balances on cell growth so that cells divide to produce new cells only when new cells are needed. Disruption of this system of checks and balances on cell growth results in an uncontrolled division and proliferation of cells that eventually forms a mass known as a tumor.
Tumors can be benign or malignant; when we speak of "cancer," we are referring to those tumors that are malignant. Benign tumors usually can be removed and do not spread to other parts of the body. Malignant tumors, on the other hand, grow aggressively and invade other tissues of the body, allowing entry of tumor cells into the bloodstream or lymphatic system and then to other sites in the body. This process of spread is termed metastasis; the areas of tumor growth at these distant sites are called metastases. Since lung cancer tends to spread or metastasize very early after it forms, it is a very life-threatening cancer and one of the most difficult cancers to treat. While lung cancer can spread to any organ in the body, certain locations -- particularly the adrenal glands, liver, brain, and bones -- are the most common sites for lung cancer metastasis.
The lung also is a very common site for metastasis from tumors in other parts of the body. Tumor metastases are made up of the same type of cells as the original (primary) tumor. For example, if prostate cancer spreads via the bloodstream to the lungs, it is metastatic prostate cancer in the lung and is not lung cancer.

The principal function of the lungs is to exchange gases between the air we breathe and the blood. Through the lung, carbon dioxide is removed from the bloodstream and oxygen from inspired air enters the bloodstream. The right lung has three lobes, while the left lung is divided into two lobes and a small structure called the lingula that is the equivalent of the middle lobe on the right. The major airways entering the lungs are the bronchi, which arise from the trachea. The bronchi branch into progressively smaller airways called bronchioles that end in tiny sacs known as alveoli where gas exchange occurs. The lungs and chest wall are covered with a thin layer of tissue called the pleura.

Arsenic Poisoning Part-5

Arsenic Poisoning Part-5

How is arsenic poisoning treated?

Acute toxic inorganic arsenic exposure and arsine gas exposure can rapidly result in death, and there are only a few ways to possibly save the patient's life. Hemodialysis can remove arsenic from the bloodstream, but only before it binds to the tissues so there is only a short time window for this treatment to work. Similarly, arsine binds to and causes rapid destruction of red blood cells, so blood transfusions and exchange transfusions may help the patient. In addition, if the arsenic was ingested, stomach or bowel irrigation may be attempted, but there is no good data to indicate these will be successful. Consultation with a nephrologist and a toxicologist as soon as possible is recommended; other consultants may need to be called (hematologist, psychiatrist, or others).
Chelation therapy (the use of drugs that selectively bind and effectively inactivate substances) is usually begun quickly through an intravenous line. The drug and the bound arsenic is then excreted through the urine. The chelation drug of choice is Dimercaprol (also termed BAL in oil); Succimer (DMSA) has also been used successfully, and Dimerval (DMPS) may also work as a chelator, but it is not readily available in the US.

What is the prognosis (outcome) of arsenic poisoning?

If the patient survives an acute toxic exposure, most will develop some degree of nerve damage to the peripheral nerves (sensory and motor disturbances); many survivors may have cardiac, liver, renal, and skin problems; the prognosis is fair to poor. Chronic poisoning and organic arsenic exposure have better outcomes with fewer and less severe problems.

Arsenic Poisoning Part-4

Arsenic Poisoning Part-4

How is arsenic poisoning diagnosed?

The history of the patient is very important as exposures are most often from industrial accidents so other people (coworkers, rescue personnel) may be exposed and not realize they may have some risk also. People exposed to toxic levels of arsenic may have breath and urine that smells like garlic as a clue to their diagnosis. Most doctors that suspect arsenic (or other metal or metalloid poisonings) will request lab studies such as blood cell counts and serum electrolytes such as calcium and magnesium; if there is evidence of hemolysis (blood cell destruction), a type and screening for a potential blood transfusion is done.

 There are rapid urine "spot" tests available to diagnose elevated levels of arsenic, but they usually don't distinguish between organic and inorganic arsenic. The patient's blood and urine will be sent for analysis for arsenic; a result of > 50 micrograms/L is considered elevated, but acute toxic exposures may result in levels 5 to 100 times or more than those which are considered "elevated." A speciation test (determines levels of inorganic versus organic arsenic) is required in all cases in which total urine arsenic is elevated since inorganic arsenic is so toxic. Electrocardiograms (ECG, EKG) and nerve conduction tests are often done in any type of suspected arsenic exposure. Tests for other toxins or toxic overdoses (for example, Tylenol ingestion) may also be done.

Arsenic Poisoning Part-3

Arsenic Poisoning Part-3

What is organic arsenic?

Organic arsenic is any compound that is made from a chemical combination of the element arsenic with any organic compound (compounds containing a large amount of carbon). These are often termed arsenical organic compounds. Most frequently organic arsenic is a component used in making insecticides and weed killers and other compounds. Organic arsenic usually is not poisonous to humans but may be poisonous to humans in high concentrations. In general, organic arsenic is usually far less poisonous than inorganic arsenic.

What are the symptoms of arsenic poisoning?

People can be exposed to arsenic by inhaling it, by consuming contaminated foods, water, or beverages, or by skin contact. We are normally exposed to trace amounts of arsenic in the air and water, and in foods. People may be exposed to higher levels if they live near industrial areas that currently or formerly contained arsenic compounds. Areas with known high concentrations of arsenic in the drinking water are also associated with greater exposure.
Acute or immediate symptoms of a toxic level of exposure to arsenic may include the following:

• Vomiting
• Abdominal pain
• Diarrhea
• Dark urine (termed black water urine)
• Dehydration
• Cardiac problems
• Hemolysis (destruction of red blood cells)
• Vertigo
• Delirium
• Shock
• Death

Long-term exposures to aresenic lower than toxic levels can lead to skin changes (darkening or discoloration, redness, swelling and hyperkeratosis (skin bumps that resemble corns or warts). Whitish lines (Mees' lines) may appear in the fingernails. Both sensory and motor nerve defects can develop. Additionally, liver and kidney function may be affected.

Arsenic exposure over the long-term has also been associated with the development of certain cancers, and arsenic has been classified as a carcinogen by the Environmental Protection Agency (EPA). Studies of people in parts of Southeast Asia and South America where there has been a high level of arsenic in the drinking water have reported an increased risk of developing cancers of the bladder, kidney, lung, and skin. Organic arsenic compounds are not as toxic as inorganic compounds and are not believed to be linked to cancer.

Arsenic Poisoning Part-2

Arsenic Poisoning Part-2

Arsenic is a grey-appearing chemical element (atomic number 33, symbol As in the periodic table) also termed a metalloid. Arsenic can exist in a metallic state in three forms (yellow, black, and gray; with gray predominating) and in ionic forms. Arsenic is considered to be a heavy metal, and arsenic toxicity shares some features with poisonings by other heavy metals. Historically, arsenic has been used as a medicinal agent, a pigment, a pesticide, and an agent with intent to harm (use with criminal intent). Up until 2003, arsenic (in the form of chromated copper arsenate) was used in the US as a treatment to prevent insect infestation of wood used in building. In 2003 the use of this compound was banned by the US Environmental Protection Agency.
Arsenic is mixed with copper or lead to strengthen alloys containing these materials. Arsenic and some of its compounds react with proteins, mainly the thiol portions, and uncouples the process of oxidative phosphorylation, thus inactivating most cellular functions. Consequently, arsenic and some of the substances it combines with are deadly poisons to most biologic systems, except for a few bacterial species. Arsenic is used in making insecticides and weed killers. Arsenic is also thought to be carcinogenic, meaning that it has the potential to cause cancer.
Arsenic can be found as a contaminant in food and water sources. Shellfish and other seafood, as well as fruits, vegetables, and rice; are the foods most commonly contaminated. Arsenic poisoning typically occurs as a result of industrial exposure, from contaminated wine or illegally distilled spirits, or in cases of malicious intent.

What is inorganic arsenic?

Inorganic arsenic is metallic or metalloid element that forms a number of poisonous compounds. In industry, it can be found in a gaseous form termed arsine gas that is very toxic when inhaled. Inorganic arsenic is found in nature at low levels mostly compounded with oxygen, chlorine, and sulfur. These are called inorganic arsenic compounds. Inorganic arsenic compounds are much more poisonous to most biologic systems (animals, plants, humans) than organic arsenic (see below). Inorganic arsenic occurs in nature in the soil, copper and lead ore deposits, and water, but usually in low concentrations. However, it can become more concentrated when industrial processes use it to make wood preservatives, metal compounds, or organic arsenic-containing compounds such as insecticides, weed killers, and other compounds. If such compounds are burned, inorganic arsenic can be released into the air and later settle on the ground or in water and either remain in the inorganic form or combine with organic material.

Arsenic Poisoning Part-1

Arsenic facts

• Arsenic is an element (metalloid) that can combine with organic and inorganic substances.
• Inorganic arsenic is arsenic alone or combined with inorganic substances that are very toxic to most biologic systems, including humans.
• Organic arsenic is arsenic combined with organic substances and may be non-toxic or far less toxic to many biologic systems than inorganic arsenic.
• Symptoms of arsenic poisoning vary with the type and concentration of the poison; inorganic arsenic may cause abdominal pains, destruction of red blood cells (hemolysis ), shock, and death quickly, while lower concentrations and occasionally organic arsenic cause far less severe symptoms.
• Diagnosis of arsenic poisoning is made by determining inorganic and organic levels of arsenic in the blood and urine.
• Treatment of arsenic poisoning in acute toxic poisonings needs to begin quickly; treatment involves removal of arsenic by dialysis, chelating agents, replacement of red blood cells, and if ingested, bowel cleansing.
• Acute toxic inorganic arsenic poisoning has only a fair to poor outcome; chronic poisoning has a better outcome.
• Arsenic is found in groundwater, many chemicals, and foods. If arsenic is in the organic form, it is likely nontoxic or weakly toxic to humans, but inorganic arsenic can also be found in similar locations and materials and in high concentrations in industrial processes. In 2013, the FDA made recommendations that less than 10 parts per billion of arsenic was acceptable for levels in apple juice. Levels for arsenic have yet to be FDA approved for rice (still under study), although groundwater levels that provide arsenic to rice are FDA set at less than 10 parts per billion.

Chemotherapy Part-6

Chemotherapy Part-6

What are clinical trials and are they an option for me?

Cancer clinical trials (also called cancer treatment studies or research studies) test new treatments for people with cancer. These can be studies of new types of chemotherapy, other types of treatment, or new ways to combine treatments. The goal of all these clinical trials is to find better ways to help people with cancer.
Your doctor or nurse may suggest you take part in a clinical trial. You can also suggest the idea. Before you agree to be in a clinical trial, learn about:

• Benefits. All clinical trials offer quality cancer care. Ask how this clinical trial could help you or others. For instance, you may be one of the first people to get a new treatment or drug.
• Risks. New treatments are not always better or even as good as standard treatments. And even if this new treatment is good, it may not work well for you.
• Payment. Your insurance company may or may not pay for treatment that is part of a clinical trial. Before you agree to be in a trial, check with your insurance company to make sure it will pay for this treatment.

Tips for Meeting With Your Doctor or Nurse

• Make a list of your questions before each appointment. Some people keep a "running list" and write down new questions as they think of them. Make sure to have space on this list to write down the answers from your doctor or nurse.
• Bring a family member or trusted friend to your medical visits. This person can help you understand what the doctor or nurse says and talk with you about it after the visit is over.
• Ask all your questions. There is no such thing as a stupid question. If you do not understand an answer, keep asking until you do.
• Take notes. You can write them down or use a tape recorder. Later, you can review your notes and remember what was said.
• Ask for printed information about your type of cancer and chemotherapy.
• Let your doctor or nurse know how much information you want to know, when you want to learn it, and when you have learned enough. Some people want to learn everything they can about cancer and its treatment. Others only want a little information. The choice is yours.
• Find out how to contact your doctor or nurse in an emergency. This includes who to call and where to go.

Chemotherapy Part-5

Chemotherapy Part-5

How will I know if my chemotherapy is working?

Your doctor will give you physical exams and medical tests (such as blood tests and x-rays). He or she will also ask you how you feel.
You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well. Or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.

How much does chemotherapy cost?

It is hard to say how much chemotherapy will cost. It depends on:

• The types and doses of chemotherapy used
• How long and how often chemotherapy is given
• Whether you get chemotherapy at home, in a clinic or office, or during a hospital stay
• The part of the country where you live

Does my health insurance pay for chemotherapy?
Talk with your health insurance plan about what costs it will pay for. Questions to ask include:

• What will my insurance pay for?
• Do I or does the doctor's office need to call my insurance company before each treatment for it to be paid for?
• What do I have to pay for?
• Can I see any doctor I want or do I need to choose from a list of preferred providers?
• Do I need a written referral to see a specialist?
• Is there a co-pay (money I have to pay) each time I have an appointment?
• Is there a deductible (certain amount I need to pay) before my insurance pays?
• Where should I get my prescription drugs?
• Does my insurance pay for all my tests and treatments, whether I am an inpatient or outpatient?

How can I best work with my insurance plan?

• Read your insurance policy before treatment starts to find out what your plan will and will not pay for.
• Keep records of all your treatment costs and insurance claims.
• Send your insurance company all the paperwork it asks for. This may include receipts from doctors' visits, prescriptions, and lab work. Be sure to also keep copies for your own records.
• As needed, ask for help with the insurance paperwork. You can ask a friend, family member, social worker, or local group such as a senior center.
• If your insurance does not pay for something you think it should, find out why the plan refused to pay. Then talk with your doctor or nurse about what to do next. He or she may suggest ways to appeal the decision or other actions to take.

Chemotherapy Part-4

Chemotherapy Part-4

How will I feel during chemotherapy?

Chemotherapy affects people in different ways. How you feel depends on how healthy you are before treatment, your type of cancer, how advanced it is, the kind of chemotherapy you are getting, and the dose. Doctors and nurses cannot know for certain how you will feel during chemotherapy.
Some people do not feel well right after chemotherapy. The most common side effect is fatigue, feeling exhausted and worn out. You can prepare for fatigue by:

• Asking someone to drive you to and from chemotherapy
• Planning time to rest on the day of and day after chemotherapy
• Getting help with meals and childcare the day of and at least 1 day after chemotherapy

There are many ways you can help manage chemotherapy side effects.

Can I work during chemotherapy?

Many people can work during chemotherapy, as long as they match their schedule to how they feel. Whether or not you can work may depend on what kind of work you do. If your job allows, you may want to see if you can work part-time or work from home on days you do not feel well.
Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during chemotherapy. You can learn more about these laws by talking with a social worker.


One way to let your doctor or nurse know about these drugs is by bringing in all your pill bottles. Your doctor or nurse needs to know:

• The name of each drug
• The reason you take it
• How much you take
• How often you take it

Talk to your doctor or nurse before you take any over-the-counter or prescription drugs, vitamins, minerals, dietary supplements, or herbs.

Can I take vitamins, minerals, dietary supplements, or herbs while I get chemotherapy?

ChemotherapyPart-3

 

Chemotherapy Part-3

How is chemotherapy given?

Chemotherapy may be given in many ways.

• Injection. The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip or right under the skin in the fatty part of your arm, leg, or belly.
• Intra-arterial (IA). The chemotherapy goes directly into the artery that is feeding the cancer.
• Intraperitoneal (IP). The chemotherapy goes directly into the peritoneal cavity (the area that contains organs such as your intestines, stomach, liver, and ovaries).
• Intravenous (IV). The chemotherapy goes directly into a vein.
• Topically. The chemotherapy comes in a cream that you rub onto your skin.
• Orally. The chemotherapy comes in pills, capsules, or liquids that you swallow.

Things to know about getting chemotherapy through an IV
Chemotherapy is often given through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. Let your doctor or nurse know right away if you feel pain or burning while you are getting IV chemotherapy.
IV chemotherapy is often given through catheters or ports, sometimes with the help of a pump.

• Catheters. A catheter is a soft, thin tube. A surgeon places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until all your chemotherapy treatments are done. Catheters can also be used for drugs other than chemotherapy and to draw blood. Be sure to watch for signs of infection around your catheter.
• Ports. A port is a small, round disc made of plastic or metal that is placed under your skin. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for more than 1 day. Be sure to watch for signs of infection around your port.
• Pumps. Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port. Pumps can be internal or external. External pumps remain outside your body. Most people can carry these pumps with them. Internal pumps are placed under your skin during surgery.

Complete Blood Count-Part-2

 

 Complete Blood Count-Part-2

What are values for a complete blood count (CBC)?

The values generally included are the following:

• White blood cell count (WBC) is the number of white blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4,300 and 10,800 cells per cubic millimeter (cmm). This can also be referred to as the leukocyte count and can be expressed in international units as 4.3 to 10.8 x 109 cells per liter.

A machine generated percentage of the different types of white blood cells is called the automated WBC differential. These components can also be counted under the microscope on a glass slide by a trained laboratory technician or a doctor and referred to as the manual WBC differential.

• Red cell count (RBC) signifies the number of red blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4.2 to 5.9 million cells/cmm. This can also be referred to as the erythrocyte count and can be expressed in international units as 4.2 to 5.9 x 1012 cells per liter.

Red blood cells are the most common cell type in blood and people have millions of them in their blood circulation. They are smaller than white blood cells, but larger than platelets.

• Hemoglobin (Hb). This is the amount of hemoglobin in a volume of blood. Hemoglobin is the protein molecule within red blood cells that carries oxygen and gives blood its red color. Normal range for hemoglobin is different between the sexes and is approximately 13 to 18 grams per deciliter for men and 12 to 16 for women (international units 8.1 to 11.2 millimoles/liter for men, 7.4 to 9.9 for women).
• Hematocrit (Hct). This is the ratio of the volume of red cells to the volume of whole blood. Normal range for hematocrit is different between the sexes and is approximately 45% to 52% for men and 37% to 48% for women. This is usually measured by spinning down a sample of blood in a test tube, which causes the red blood cells to pack at the bottom of the tube.
• Mean corpuscular volume (MCV) is the average volume of a red blood cell. This is a calculated value derived from the hematocrit and red cell count. Normal range may fall between 80 to 100 femtoliters (a fraction of one millionth of a liter).
• Mean Corpuscular Hemoglobin (MCH) is the average amount of hemoglobin in the average red cell. This is a calculated value derived from the measurement of hemoglobin and the red cell count. Normal range is 27 to 32 picograms.
• Mean Corpuscular Hemoglobin Concentration (MCHC) is the average concentration of hemoglobin in a given volume of red cells. This is a calculated volume derived from the hemoglobin measurement and the hematocrit. Normal range is 32% to 36%.
• Red Cell Distribution Width (RDW) is a measurement of the variability of red cell size and shape. Higher numbers indicate greater variation in size. Normal range is 11 to 15.
• Platelet count. The number of platelets in a specified volume of blood. Platelets are not complete cells, but actually fragments of cytoplasm (part of a cell without its nucleus or the body of a cell) from a cell found in the bone marrow called a megakaryocyte. Platelets play a vital role in blood clotting. Normal range varies slightly between laboratories but is in the range of 150,000 to 400,000/ cmm (150 to 400 x 109/liter).
• Mean Platelet Volume (MPV). The average size of platelets in a volume of blood.

Complete Blood Count (CBC) Part-1

 

Complete Blood Count (CBC)

What is the complete blood count test (CBC)?

The complete blood count (CBC) is one of the most commonly ordered blood tests. The complete blood count is the calculation of the cellular (formed elements) of blood. These calculations are generally determined by special machines that analyze the different components of blood in less than a minute.
A major portion of the complete blood count is the measure of the concentration of white blood cells, red blood cells, and platelets in the blood.

How is the complete blood count test (CBC) done?

The complete blood count (CBC) test is performed by obtaining a few milliliters (one to two teaspoons) of blood sample directly form the patient. It can be done in many settings including the doctor's office,  laboratories, and hospitals. The skin is wiped clean with an alcohol pad, and then a needle is inserted through the area of cleansed skin into to patient's vein (one that can be visualized from the skin.) The blood is then pulled from the needle by a syringe or by a connection to a special vacuumed vial where it is collected. This sample is then taken to the laboratory for analysis.

Chemotherapy Part-2

 

 

Chemotherapy Part-2

How does my doctor decide which chemotherapy drugs to use?

This choice depends on:

• The type of cancer you have. Some types of chemotherapy drugs are used for many types of cancer. Other drugs are used for just one or two types of cancer.
• Whether you have had chemotherapy before
• Whether you have other health problems, such as diabetes or heart disease

Where do I go for chemotherapy?

You may receive chemotherapy during a hospital stay, at home, or in a doctor's office, clinic, or outpatient unit in a hospital (which means you do not have to stay overnight). No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and make any needed drug changes.

How often will I receive chemotherapy?

Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:

• Your type of cancer and how advanced it is
• The goals of treatment (whether chemotherapy is used to cure your cancer, control its growth, or ease the symptoms)
• The type of chemotherapy
• How your body reacts to chemotherapy

You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive 1 week of chemotherapy followed by 3 weeks of rest. These 4 weeks make up one cycle. The rest period gives your body a chance to build new healthy cells.

Can I miss a dose of chemotherapy?

It is not good to skip a chemotherapy treatment. But sometimes your doctor or nurse may change your chemotherapy schedule. This can be due to side effects you are having. If this happens, your doctor or nurse will explain what to do and when to start treatment again.

Chemotherapy Part-1

 

 Chemotherapy

What is chemotherapy?

Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to destroy cancer cells.

How does chemotherapy work?

Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. But it can also harm healthy cells that divide quickly, such as those that line your mouth and intestines or cause your hair to grow. Damage to healthy cells may cause side effects. Often, side effects get better or go away after chemotherapy is over.

What does chemotherapy do?

Depending on your type of cancer and how advanced it is, chemotherapy can:

• Cure cancer - when chemotherapy destroys cancer cells to the point that your doctor can no longer detect them in your body and they will not grow back.
• Control cancer - when chemotherapy keeps cancer from spreading, slows its growth, or destroys cancer cells that have spread to other parts of your body.
• Ease cancer symptoms (also called palliative care) - when chemotherapy shrinks tumors that are causing pain or pressure.

How is chemotherapy used?

Sometimes, chemotherapy is used as the only cancer treatment. But more often, you will get chemotherapy along with surgery, radiation therapy, or biological therapy. Chemotherapy can:

• Make a tumor smaller before surgery or radiation therapy. This is called neo-adjuvant chemotherapy.
• Destroy cancer cells that may remain after surgery or radiation therapy. This is called adjuvant chemotherapy.
• Help radiation therapy and biological therapy work better.
• Destroy cancer cells that have come back (recurrent cancer) or spread to other parts of your body (metastatic cancer).

Anemia Part-7

How is blood collected for a CBC?

Blood is collected by venipuncture (using a needle to draw blood from a vein) in a lab, hospital, or physician's office. Typically, blood is collected in a special sterile tube from an arm vein. The tube has some preservatives to prevent clotting of the blood. Results may be available in an hour or longer depending on the setting.
In some instances, a quick in office test called hemoglobin rapid test may be performed using a few drops of blood from a finger prick. The advantage of this quick test is that results may be obtained in a few minutes and only a few drops of blood may be required.

What is the red blood cell (RBC) count?

The red blood cells (RBCs or erythrocytes) are the most common type of cells in the blood. We each have millions and millions of these little disc-shaped cells. The RBC count is done to determine if the number of red blood cells is low (anemia) or high (polycythemia).
In an RBC count, the number and size of the RBCs are determined. This is usually reported as number of RBCs per a specified volume, typically in millions of RBCs in microliters (one one-thousandth of an ml) of whole blood. The shape of the RBCs is also evaluated under a microscope. All of this information, the number, size and shape of the RBCs, is useful in the diagnosis of anemia. Further, the specific type of anemia may be determined by this information.

What is hemoglobin?

Hemoglobin is a red pigment that imparts the familiar red color to red blood cells and to blood. Functionally, hemoglobin is the key chemical compound that combines with oxygen from the lungs and carries the oxygen from the lungs to cells throughout the body. Oxygen is essential for all cells in the body to produce energy.
The blood also transports carbon dioxide, which is the waste product of this energy production process, back to the lungs from which it is exhaled into the air. The transport of the carbon dioxide back to the lung is also achieved by hemoglobin. The carbon dioxide bound to hemoglobin is unloaded in the lungs in exchange for oxygen to be transported to the tissues of the body.

Anemia Part-8

What are the complications of anemia?

As mentioned earlier, hemoglobin has the important role of delivering oxygen to all parts of the body for consumption and carries back carbon dioxide back to the lung to exhale it out of the body. If the hemoglobin level is too low, this process may be impaired, resulting in low levels of oxygen in the body (hypoxia).

What is the outlook (prognosis) for anemia?

Anemia generally has a very good prognosis and it may be curable in many instances. The overall prognosis depends on the underlying cause of anemia, its severity, and the overall health of the patient.

Anemia Part-6

What does a low hemoglobin level mean?

Low hemoglobin is called anemia. When there is a low hemoglobin level, there is often a low red blood cell count and a low hematocrit, too. Reference ranges are slightly different from one source to another, but typically hemoglobin of less than 13.5 gram/100 ml is abnormal in men and less than 12.0 gram/100 ml in women.

What is the hematocrit?

The hematocrit is specifically a measure of how much of the blood is made of red cells. The hematocrit is a very convenient way to determine whether the red blood cell count is too high, too low, or normal. The hematocrit is a measure of the proportion of blood that is composed of the red blood cells.

How is hematocrit determined?

The red blood cells in the sample of blood are packed down by spinning the tube in a centrifuge under prescribed conditions. The proportion of the tube that consists of red blood cells is then measured. Let's say that it is 45%. The hematocrit is 45%.

How is anemia treated?

The treatment of the anemia varies greatly. First, the underlying cause of the anemia should be identified and corrected. For example, anemia as a result of blood loss from a stomach ulcer should begin with medications to heal the ulcer. Likewise, surgery is often necessary to remove a colon cancer that is causing chronic blood loss and anemia.
Sometimes iron supplements will also be needed to correct iron deficiency. In severe anemia, blood transfusions may be necessary. Vitamin B12 injections will be necessary for patients suffering from pernicious anemia or other causes of B12 deficiency.
In certain patients with bone marrow disease (or bone marrow damage from chemotherapy) or patients with kidney failure, epoetin alfa (Procrit, Epogen) may be used to stimulate bone marrow red blood cell production.
If a medication is thought to be the culprit, then it should be discontinued under the direction of the prescribing doctor.

Anemia Part-5

How is anemia diagnosed?

Anemia is usually detected, or at least confirmed, by a complete blood cell (CBC) count. A CBC test may be ordered by a physician as a part of routine general checkup and screening or based on clinical signs and symptoms that may suggest anemia or other blood abnormalities.

What is a complete blood cell (CBC) count?

Traditionally, CBC analysis was performed by a physician or a laboratory technician by viewing a glass slide prepared from a blood sample under a microscope. Today, much of this work is often automated and done by machines. Six component measurements make up a CBC test:

1. Red blood cell (RBC) count
2. Hematocrit
3. Hemoglobin
4. White blood cell (WBC) count
5. Differential blood count (the "diff")
6. Platelet count

Only the first three of these tests -- the red blood cell (RBC) count, the hematocrit, and the hemoglobin -- are relevant to the diagnosis of anemia.
Additionally, mean corpuscular volume (MCV) is also often reported in a CBC, which basically measures the average volume of red blood cells in a blood sample. This is important in distinguishing the causes of anemia. Units of MCV are reported in femtoliters, a fraction of one millionth of a liter.
Other useful clues to causes of anemia that are reported in a CBC are the size, shape, and color of red blood cells.

Anemia Part-4

Yes, anemia may be genetic. Hereditary disorders can shorten the life span of the red blood cell and lead to anemia (for example, sickle cell anemia). Hereditary disorders can also cause anemia by impairing the production of hemoglobin (for example, alpha thalassemia and beta thalassemia).
Depending on the degree of the genetic abnormality, hereditary anemias may cause mild, moderate, or severe anemia. In fact, some may be too severe to be compatible with life and may result in death of the fetus (unborn infant). On the other hand, some of these anemias are so mild that they are not noticeable and are incidentally revealed during a routine blood work.

What are the symptoms of anemia?

Some patients with anemia have no symptoms. Others with anemia may feel:

• Tired
• Fatigue easily
• Appear pale
• Develop palpitations (feeling of heart racing)
• Become short of breath

Additional symptoms may include:

• Hair loss
• Malaise (general sense of feeling unwell)
• Worsening of heart problems

It is worth noting that if anemia is longstanding (chronic anemia), the body may adjust to low oxygen levels and the individual may not feel different unless the anemia becomes severe. On the other hand, if the anemia occurs rapidly (acute anemia), the patient may experience significant symptoms relatively quickly.

Anemia Part-3

What are other causes of anemia?

Some of the most common causes include:

• Vitamin B12 deficiency may cause pernicious anemia. This type of anemia could happen in people who are unable to absorb vitamin B12 from their intestines due to a number of reasons.
• Strict vegetarians are at risk if they do not take adequate vitamin supplements.
• Long-term alcoholics.
• People who have abnormal structure or function of the stomach or intestines leading to impaired B12 absorption despite adequate intake.

This typically causes macrocytic (large blood cell volume) anemia. Vitamin B12, along with folate, is involved in making the heme molecule that is an integral part of hemoglobin. Folate deficiency can be the culprit of anemia as well. This may also be caused by inadequate absorption, under-consumption of green, leafy vegetables, and also long-term heavy alcohol use.

• There can be rupture or destruction of red blood cells (hemolytic anemia) due to antibodies clinging to the surface of the red cells. Examples of hemolytic anemia include hemolytic disease of the newborn, medication induced hemolytic anemia, transfusion related hemolysis, and autoimmune hemolytic anemia.
• A wide assortment of bone marrow diseases can cause anemia.
• For example, cancers that spread (metastasize) to the bone marrow, or cancers of the bone marrow (such as leukemia or multiple myeloma) can cause the bone marrow to inadequately produce red blood cells, resulting in anemia.
• Certain chemotherapy for cancers can also cause damage to the bone marrow and decrease red blood cell production, resulting in anemia.
• Certain infections may involve the bone marrow and result in bone marrow impairment and anemia.
• Finally, patients with kidney failure may lack the hormone necessary to stimulate normal red blood cell production by the bone marrow.
• Chronic alcohol consumption may lead to anemia via different pathways and thus, anemia is commonly seen in alcoholics.
• Another common cause of anemia is called anemia of chronic disease. This could typically occur in individuals with longstanding chronic diseases.

Anemia Part-2

Can inadequate iron cause anemia?

Absolutely! As a matter of fact, iron deficiency is a very common cause of anemia. This is because iron is major component of hemoglobin and essential for its proper function. Chronic blood loss due to any reason is the main cause of low iron level in the body as it depletes the body's iron stores to compensate for the ongoing loss of iron. Anemia that is due to low iron levels is called iron deficiency anemia.
Young women are likely to have low grade iron deficiency anemia because of the loss of blood each month through normal menstruation. This is generally without any major symptoms as the blood loss is relatively small and temporary.
Another common reason for iron deficiency anemia can be due to recurring or small ongoing bleeding, for instance from colon cancer or from stomach ulcers. Stomach ulcer bleeding may be induced by medications, even very common over-the-counter drugs such as aspirin and ibuprofen (Advil, Motrin). Slow and chronic oozing from these ulcers can lead to loss of iron. Gradually, this could result in anemia. In infants and young children, iron deficiency anemia is most often due to a diet lacking iron.
Interpretation of CBC may lead to clues to suggest this type of anemia. For instance, iron deficiency anemia usually presents with low mean corpuscular volume (microcytic anemia) in addition to low hemoglobin.

What about acute (sudden) blood loss as a cause of anemia?

Acute blood loss from internal bleeding (as from a bleeding ulcer) or external bleeding (as from trauma) can produce anemia in an amazingly short span of time. This type of anemia could result in severe symptoms and consequences if not addressed promptly. Dizziness, lightheadedness, fatigue, confusion, shortness of breath, and even loss of consciousness can occur with severe, sudden blood loss anemia.

Anemia Part-1

Anemia facts*

*Anemia facts medical author: William C. Shiel Jr., MD, FACP, FACR

• Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal.
• For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml.
• Anemia is caused by either a decrease in production of red blood cells or hemoglobin, or an increase in loss or destruction of red blood cells.
• Some patients with anemia have no symptoms. Others may feel tired, easily fatigued, appear pale, a feeling of heart racing, short of breath, and/or worsening of heart problems.
• Anemia can be detected by a simple blood test called a complete blood cell count (CBC).
• The treatment of the anemia varies greatly and very much depends on the particular cause.

What is anemia?

Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal. The normal level of hemoglobin is generally different in males and females. For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml. These definitions may vary slightly depending on the source and the laboratory reference used.

What causes anemia?

Any process that can disrupt the normal life span of a red blood cell may cause anemia. Normal life span of a red blood cell is typically around 120 days. Red blood cells are made in the bone marrow.
Anemia is caused essentially through two basic pathways. Anemia is caused by either:

1. a decrease in production of red blood cells or hemoglobin, or
2. an increase in loss or destruction of red blood cells.

A more common classification of anemia (low hemoglobin) is based on the Mean Corposcular Volume (MCV) which signifies the average volume of individual red blood cells.

1. If the MCV is low (less than 80), the anemia is categorized as microcytic anemia (low cell volume).
2. If the MCV is in the normal range (80-100), it is called a normocytic anemia (normal cell volume).
3. If the MCV is high, then it is called a macrocytic anemia (large cell volume).

Looking at each of the components of a complete blood count (CBC), especially the MCV, a physician can gather clues as to what could be the most common reason for anemia in each patient.

Picture of Red Blood Cells

Reviewed by William C. Shiel Jr., MD, FACP, FACR on 3/26/2012

GastritisPart-3

 

GastritisPart-3

What are the treatment medications and home remedies for gastritis?

Treating the underlying cause of gastritis is the most effective way to reduce or resolve gastritis. For example, if the cause of gastritis is Helicobacter pylori, then treatment with appropriate antibiotics (usually a combination of amoxicillin and clarithromycin [Biaxin, Biaxin XL] plus bismuth subsalicylate [Pepto-Bismol]) should be effective.
If NSAIDs are the cause, then stopping the drug should be effective. However, other treatments are often used in addition to those that treat the specific cause. These treatments may reduce or stop symptoms of gastritis and allow gastric mucosal healing to begin regardless of the underlying cause. These medications include antacids (Maalox , Rolaids, and Alka-Seltzer), histamine (H2) blockers (famotidine [Pepcid AC], ranitidine [Zantac 75]) and PPI's or proton pump inhibitors (omeprazole [Prilosec], pantoprazole [Protonix], esomeprazole [Nexium]). They all function by different mechanisms to reduce acid in the stomach but usually do not treat the underlying cause of gastritis.

Gastritis Part-4

Gastritis Part-4

 

What are the complications of gastritis?

The complications of gastritis may occur over time, especially if gastritis becomes chronic and the underlying causes are not treated. Complications may include peptic ulcer, bleeding ulcers, anemia, gastric cancers, MALT lymphoma, gastric scarring, and strictures with outlet obstruction, dehydration, renal problems, and even death.

What is the prognosis of gastritis?

Most people that get gastritis have few or short-term symptoms and recover completely. Those people with underlying causes that are appropriately treated often recover completely. The prognosis of individuals with chronic disease and those who develop serious complications like bleeding ulcers, obstruction and cancer is more guarded.

How is gastritis prevented?

If the underlying cause of gastritis is preventable, then gastritis can be prevented. For example, if alcohol consumption or NSAIDs cause an individual's gastritis, prevention is accomplished by stopping the consumption of these agents. Avoidance may be preventive in situations where chemicals, radiation or some toxin ingestion could occur. It may be more difficult to prevent some infectious causes, but proper hygiene, hand washing, and eating and drinking only adequately cleaned or treated foods and fluids are healthy ways to decrease your risk of getting gastritis from infectious agents.

Gastritis

 

Gastritis

What is gastritis?

Gastritis is inflammation of the lining of the stomach. Unfortunately, the term "gastritis" has been misused to include many different upper abdominal problems, but true gastritis refers to the stomach lining (gastric mucosa) that is inflamed. All or part of the gastric mucosa may be involved. Gastritis may be classified as acute or chronic. Acute gastritis maybe characterized as erosive (damaged areas where mucosal cells are disrupted or missing) and nonerosive. Chronic gastritis is determined by histopathology (appearance of the gastric mucosa). This article will focus on true gastritis. Gastritis has many causes, but most causes result in similar symptoms. This has leads to some confusion and is the reason why many health care professionals now consider the term "gastritis" as a non-specific description of a cluster of symptoms.

What causes gastritis?

A major cause of both acute and chronic gastritis is infection of the stomach mucosa by a bacterial species named Helicobacter pylori. Usually, this bacterium first infects the stomach antrum (stomach mucosa without acid-producing cells) acutely and may progress to infect most or all of the stomach's mucosa over time (chronic gastritis) and remain there for years. This infection generates an initial strong inflammatory response and eventually, a long-term chronic inflammation with intestinal cell changes may develop. Another major cause of acute and chronic gastritis is the use (and overuse) of nonsteroidal anti-inflammatory drugs (NSAIDs).
However, there are many other causes of gastritis; the following is a list of common causes of both acute and chronic gastritis; chronic gastritis may occur with repeated or continual presence of most of these causes:

• Bacterial, viral and parasitic infections
• Certain drugs (cocaine)
• Alcohol
• Bile reflux
• Fungal infections
• Allergic reactions
• Stress reaction
• Radiation
• Certain food poisonings (infectious and chemical)
• Trauma

In general, infectious agents, especially Helicobacter pylori, and NSAIDs are responsible for the majority of gastritis patients.


 

Gastritis Part-2

Gastritis Part-2

 

What are the symptoms of gastritis?

Surprisingly in many people, gastritis often produces no symptoms and is diagnosed only when samples of the stomach mucosa are examined for other suspected diseases. However, when gastritis symptoms occur, the most common symptoms include abdominal pain (intermittent or constant burning, gripping or gnawing pain), often accompanied by nausea and vomiting and occasionally, diarrhea. Other symptoms such as loss of appetite, bloating, and burping or belching may occur. These latter symptoms come and go over time especially with chronic gastritis. Indigestion (dyspepsia) is another term that encompasses this cluster of symptoms.

How is gastritis diagnosed?

Gastritis is presumptively diagnosed by the patient's symptoms and history of a previous diagnosis and treatment of gastritis, alcohol consumption, and use of NSAIDs. Definitive diagnosis is made by identifying the underlying cause of the gastric mucosal inflammation and/or by tissue (gastric) biopsy. For example, the major infective cause of gastritis is Helicobacter pylori (H. pylori). This bacterium can be detected by breath, blood, stool, immunological and biopsy tests. Although the bacterium can be cultured from the patient, this is seldom attempted. Other pathogens can be identified using culture, stool and immunological tests.
Biopsy of the stomach mucosa, done during endoscopy examinations, is often used in patients to identify the causes of chronic gastritis and may allow visualization of mucosal erosions and other stomach mucosal changes. Abdominal X-rays or barium studies (upper or lower) may demonstrate the presence of thickened mucosa and folds that are signs of inflammation in the stomach.
Your doctor can help determine which tests should be done, including ancillary tests that may help identify other causes of the non-specific symptoms commonly found with gastritis.

Heart Disease Part-7

Heart Disease Part-7

Angioplasty and stenting

If the coronary angiogram (coronary=heart + angio=artery + gram=record) shows significant blockage in an artery, the cardiologist may attempt an angioplasty, in which a balloon is placed via a catheter (as with angiography) at the area of narrowing and when quickly inflated, compresses the offending plaque into the wall of the artery. Often a stent, or a metal cage, is placed at the site of angioplasty to keep the blood vessel from narrowing again. Should a stent be placed, patients are usually started on antiplatelet medication to prevent clot formation. Clopidogrel (Plavix) and prasugrel (Effient) are the two most common medications prescribed.

Surgery

For those patients with multiple coronary artery blockages, coronary artery bypass grafting may be a consideration.