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Wednesday, 15 August 2012

Presentation On Cancer

Cancer is the uncontrolled growth of abnormal cells in the body. Cancerous cells are also called malignant cells. Cells are the building blocks of living things.
Cancer grows out of normal cells in the body. Normal cells multiply when the body needs them, and die when the body doesn't need them. Cancer appears to occur when the growth of cells in the body is out of control and cells divide too quickly. It can also occur when cells forget how to die.
There are many different kinds of cancers. Cancer can develop in almost any organ or tissue, such as the lung, colon, breast, skin, bones, or nerve tissue.

There are many causes of cancers, including:
  • Benzene and other chemicals
  • Drinking excess alcohol
  • Environmental toxins, such as certain poisonous mushrooms and a type of poison that can grow on peanut plants (aflatoxins)
  • Excessive sunlight exposure
  • Genetic problems
  • Obesity
  • Radiation
  • Viruses
However, the cause of many cancers remains unknown.
The most common cause of cancer-related death is lung cancer.
The three most common cancers in men in the United States are:
  • Prostate cancer
  • Lung cancer
  • Colon cancer
  • In women in the United States, the three most common cancers are:
  • Breast cancer
  • Colon cancer
  • Lung cancer
  • Some cancers are more common in certain parts of the world. For example, in Japan, there are many cases of stomach cancer, but in the United States, this type of cancer is pretty rare. Differences in diet may play a role.
Some other types of cancers include:
  • Brain cancer
  • Cervical cancer
  • Hodgkin's lymphoma
  • Kidney cancer
  • Leukemia
  • Liver cancer
  • Non-Hodgkin's lymphoma
  • Ovarian cancer
  • Skin cancer
  • Testicular cancer
  • Thyroid cancer
  • Uterine cancer
Symptoms of Cancer
Symptoms of cancer depend on the type and location of the cancer. For example, lung cancer can cause coughing, shortness of breath, or chest pain. Colon cancer often causes diarrhea, constipation, and blood in the stool.
Some cancers may not have any symptoms at all. In certain cancers, such as pancreatic cancer, symptoms often do not start until the disease has reached an advanced stage.
The following symptoms can occur with most cancers:
  1. Chills
  2. Fatigue
  3. Fever
  4. Loss of appetite
  5. Malaise
  6. Night sweats
  7. Weight loss
Signs and tests
Like symptoms, the signs of cancer vary based on the type and location of the tumor. Common tests include the following:
  1. Biopsy of the tumor
  2. Blood tests (which look for chemicals such as tumor markers)
  3. Bone marrow biopsy (for lymphoma or leukemia)
  4. Chest x-ray
  5. Complete blood count (CBC)
  6. CT scan
  7. MRI scan
Most cancers are diagnosed by biopsy. Depending on the location of the tumor, the biopsy may be a simple procedure or a serious operation. Most patients with cancer have CT scans to determine the exact location and size of the tumor or tumors.
A cancer diagnosis is difficult to cope with. It is important, however, that you discuss the type, size, and location of the cancer with your doctor when you are diagnosed. You also will want to ask about treatment options, along with their benefits and risks.
It's a good idea to have someone with you at the doctor's office to help you get through the diagnosis. If you have trouble asking questions after hearing about your diagnosis, the person you bring with you can ask them for you.

Treatment for Cancer
Treatment varies based on the type of cancer and its stage. The stage of a cancer refers to how much it has grown and whether the tumor has spread from its original location.
If the cancer is confined to one location and has not spread, the most common treatment approach is surgery to cure the cancer. This is often the case with skin cancers, as well as cancers of the lung, breast, and colon.
If the tumor has spread to local lymph nodes only, sometimes these can be removed.
If surgery cannot remove all of the cancer, the options for treatment include radiation, chemotherapy, or both. Some cancers require a combination of surgery, radiation, and chemotherapy.
Lymphoma, or cancer of the lymph glands, is rarely treated with surgery. Chemotherapy and radiation therapy are most often used to treat lymphoma.
Although treatment for cancer can be difficult, there are many ways to keep up your strength.
If you have radiation treatment, know that:
Radiation treatment is painless.
Treatment is usually scheduled every weekday.
You should allow 30 minutes for each treatment session, although the treatment itself usually takes only a few minutes.
You should get plenty of rest and eat a well-balanced diet during the course of your radiation therapy.
Skin in the treated area may become sensitive and easily irritated.
Side effects of radiation treatment are usually temporary. They vary depending on the area of the body that is being treated.
If you are going through chemotherapy, you should eat right. Chemotherapy causes your immune system to weaken, so you should avoid people with colds or the flu. You should also get plenty of rest, and don't feel as though you have to accomplish tasks all at once.
It will help you to talk with family, friends, or a support group about your feelings. Work with your health care providers throughout your treatment. Helping yourself can make you feel more in control.
Support Groups
The diagnosis and treatment of cancer often causes a lot of anxiety and can affect a person's entire life. There are many resources for cancer patients.

Expectations (prognosis)
The outlook depends on the type of cancer. Even among people with one type of cancer, the outcome varies depending on the stage of the tumor when they are diagnosed.
Some cancers can be cured. Other cancers that are not curable can still be treated well. Some patients can live for many years with their cancer. Other tumors are quickly life-threatening.

Complications
One complication is that the cancer may spread. Other complications vary with the type and stage of the tumor.
Calling your health care provider
Contact your health care provider if you develop symptoms of cancer.

Prevention
You can reduce the risk of getting a cancerous (malignant) tumor by:
  1. Eating a healthy diet
  2. Exercising regularly
  3. Limiting alcohol
  4. Maintaining a healthy weight
  5. Minimizing your exposure to radiation and toxic chemicals
  6. Not smoking or chewing tobacco
  7. Reducing sun exposure, especially if you burn easily



  8. Cancer screenings, such as mammography and breast examination for breast cancer and colonoscopy for colon cancer, may help catch these cancers at their early stages when they are most treatable. Some people at high risk for developing certain cancers can take medication to reduce their risk.

SOURCE: U.S. National Library of Medicine - The World's Largest Medical Library


READ MORE ON CANCER HERE:

Understanding What Cancer Is and How Cancer Develops

Questions to Ask Your Doctor After a Cancer Diagnosis


American Cancer Society achives





Information on Candidiasis

Candidiasis or thrush is a fungal infection (mycosis) of any of the Candida species (all yeasts), of which Candida albicans is the most common. Also commonly referred to as a yeast infection, candidiasis is also technically known as candidosis, moniliasis, and oidiomycosis.

Candidiasis encompasses infections that range from superficial, such as oral thrush and vaginitis, to systemic and potentially life-threatening diseases. Candida infections of the latter category are also referred to as candidemia and are usually confined to severely immunocompromised persons, such as cancer, transplant, and AIDS patients, as well as nontrauma emergency surgery patients.

Superficial infections of skin and mucosal membranes by Candida causing local inflammation and discomfort are common in many human populations. While clearly attributable to the presence of the opportunistic pathogens of the genus Candida, candidiasis describes a number of different disease syndromes that often differ in their causes and outcomes.







Classification of Candidiasis

Candidiasis may be divided into the following types:
Angular cheilitis (perlèche)
Antibiotic candidiasis (iatrogenic candidiasis)
Candidal intertrigo
Candidal paronychia
Candidal vulvovaginitis (vaginal yeast infection)
Candidid
Chronic mucocutaneous candidiasis
Antibiotic candidiasis (iatrogenic candidiasis)
Candidal intertrigo
Candidal paronychia
Candidal vulvovaginitis (vaginal yeast infection)
Candidid
Chronic mucocutaneous candidiasis
Congenital cutaneous candidiasis
Diaper candidiasis
Erosio interdigitalis blastomycetica
Oral candidiasis (thrush)
Perianal candidiasis
Systemic candidiasis
Signs and symptoms

Skin candidiasis

Nail candidiasis (onychomycosis)












View Pictures of manifestation of CANDIDIASIS here https://www.google.com.gh/search?q=candidiasis&hl=en&client=opera&hs=cRt&rls=en&channel=suggest&prmd=imvns&source=lnms&tbm=isch&sa=X&ei=O0grUJL4M6eW0QXY5YHQCw&ved=0CAoQ_AUoAQ&biw=1920&bih=957

Symptoms of candidiasis vary depending on the area affected. Most candidial infections result in minimal complications such as redness, itching and discomfort, though complications may be severe or fatal if left untreated in certain populations. In immunocompetent persons, candidiasis is usually a very localized infection of the skin or mucosal membranes, including the oral cavity (thrush), the pharynx or esophagus, the gastrointestinal tract, the urinary bladder, or the genitalia (vagina, penis).

Candidiasis is a very common cause of vaginal irritation, or vaginitis, and can also occur on the male genitals. In immunocompromised patients, Candida infections can affect the esophagus with the potential of becoming systemic, causing a much more serious condition, a fungemia called candidemia.

Thrush is commonly seen in infants. It is not considered abnormal in infants unless it lasts longer than a few weeks.

Infection of the vagina or vulva may cause severe itching, burning, soreness, irritation, and a whitish or whitish-gray cottage cheese-like discharge, often with a curd-like appearance. These symptoms are also present in the more common bacterial vaginosis. In a 2002 study published in the Journal of Obstetrics and Gynecology, only 33% of women who were self-treating for a yeast infection actually had a yeast infection, while most had either bacterial vaginosis or a mixed-type infection. Symptoms of infection of the male genitalia include red, patchy sores near the head of the penis or on the foreskin, severe itching, or a burning sensation. Candidiasis of the penis can also have a white discharge, although uncommon.


Candida yeasts are commonly present in humans, and their growth is normally limited by the human immune system and by other microorganisms, such as bacteria occupying the same locations in the human body.

C. albicans was isolated from the vaginas of 19% of apparently healthy women, i.e., those who experienced few or no symptoms of infection. External use of detergents or douches or internal disturbances (hormonal or physiological) can perturb the normal vaginal flora, consisting of lactic acid bacteria, such as lactobacilli, and result in an overgrowth of Candida cells, causing symptoms of infection, such as local inflammation. Pregnancy and the use of oral contraceptives have been reported as risk factors. Diabetes mellitus and the use of antibacterial antibiotics are also linked to an increased incidence of yeast infections. Diets high in simple carbohydrates have been found to affect rates of oral candidiases, and hormone replacement therapy and infertility treatments may also be predisposing factors. Wearing wet swimwear for long periods of time is also believed to be a risk factor.

A weakened or undeveloped immune system or metabolic illnesses such as diabetes are significant predisposing factors of candidiasis. Diseases or conditions linked to candidiasis include HIV/AIDS, mononucleosis, cancer treatments, steroids, stress, and nutrient deficiency. Almost 15% of people with weakened immune systems develop a systemic illness caused by Candida species. In extreme cases, these superficial infections of the skin or mucous membranes may enter into the bloodstream and cause systemic Candida infections.

In penile candidiasis, the causes include sexual intercourse with an infected individual, low immunity, antibiotics, and diabetes. Male genital yeast infections are less common, and incidences of infection are only a fraction of those in women; however, yeast infection on the penis from direct contact via sexual intercourse with an infected partner is not uncommon.

Candida species are frequently part of the human body's normal oral and intestinal flora. Treatment with antibiotics can lead to eliminating the yeast's natural competitors for resources, and increase the severity of the condition.[citation needed] Higher prevalence of colonization of C. albicans was reported in young individuals with tongue piercing, in comparison to unpierced matched individuals. In the Western Hemisphere, about 75% of females are affected at some time in their lives.
Diagnosis



Diagnosis of a yeast infection is done either via microscopic examination or culturing.

For identification by light microscopy, a scraping or swab of the affected area is placed on a microscope slide. A single drop of 10% potassium hydroxide (KOH) solution is then added to the specimen. The KOH dissolves the skin cells, but leaves the Candida cells intact, permitting visualization of pseudohyphae and budding yeast cells typical of many Candida species.

For the culturing method, a sterile swab is rubbed on the infected skin surface. The swab is then streaked on a culture medium. The culture is incubated at 37°C for several days, to allow development of yeast or bacterial colonies. The characteristics (such as morphology and colour) of the colonies may allow initial diagnosis of the organism causing disease symptoms.
Treatment

In clinical settings, candidiasis is commonly treated with antimycotics; the antifungal drugs commonly used to treat candidiasis are topical clotrimazole, topical nystatin, fluconazole, and topical ketoconazole.

For example, a one-time dose of fluconazole (150-mg tablet taken orally) has been reported as being 90% effective in treating a vaginal yeast infection. This dose is only effective for vaginal yeast infections, and other types of yeast infections may require different dosing. In severe infections, amphotericin B, caspofungin, or voriconazole may be used. Local treatment may include vaginal suppositories or medicated douches. Gentian violet can be used for thrush in breastfeeding babies, but when used in large quantities, it can cause mouth and throat ulcerations, and has been linked to mouth cancer in humans and to cancer in the digestive tract of other animals.

Chlorhexidine gluconate oral rinse is not recommended to treat candidiasis, but is effective as prophylaxis; chlorine dioxide rinse was found to have similar in vitro effectiveness against Candida.

C. albicans can develop resistance to antimycotic drugs. Recurring infections may be treatable with other antifungal drugs, but resistance to these alternative agents may also develop.

What is candidiasis?

Candidiasis, commonly called a yeast infection, is an infection caused by a fungal microorganism, most often the fungus Candida albicans. Candidiasis is also known as candida and thrush. It can cause yeast infections in many areas of the body including:
 

The fungus that causes most cases of candidiasis, Candida albicans, normally lives in the mouth, vagina, and other places in the body. It exists in a certain balance with other microorganisms, including bacteria. However, some factors or conditions may cause an overgrowth of Candida albicans resulting in candidiasis. Candidiasis can also be passed from a pregnant woman to her child during pregnancy or breastfeeding.

Candidiasis is treatable in generally healthy people. However, candidiasis is more likely to occur and can be more difficult to treat in people with weakened immune systems due to such conditions as HIV/AIDS, diabetes, or taking steroid medications or chemotherapy. In these cases, complications of candidiasis may become life threatening.

Recurring candidiasis infections can also be a symptom of a serious, undiagnosed underlying disease, such as HIV/AIDS or diabetes. Seek prompt medical care for recurring candidiasis infections including vaginal yeast infections or oral thrush.

SYMPTOMS
What are the symptoms of candidiasis?

Symptoms of candidiasis differ depending on the severity of the infection and the area of the body affected.... Read more about candidiasis information symptoms
CAUSES
What causes candidiasis?

Candidiasis most often occurs when there is an overgrowth of Candida albicans in places in the body where it normally lives, such as the mouth and vagina. When Candida albicans grows unchecked, it throws off the normal balance of other microorganisms that normally live in the body.... Read more about candidiasis information causes
TREATMENTS
How is candidiasis treated?

Treatment of candidiasis begins with seeking regular medical care throughout your life. This allows your health care professional to assess your risks of developing candidiasis and promptly order diagnostic testing for candidiasis and underlying conditions as needed. These measures greatly increase the chances of diagnosing and treating underlying causes of candidiasis in their earliest stages.... Read more about candidiasis information treatments

Source: http://www.localhealth.com/article/candidiasis-information


MORE READING ABOUT CANDIDIASIS

http://www.emedicinehealth.com/candidiasis_yeast_infection/article_em.htm

http://www.webmd.com/skin-problems-and-treatments/candidiasis-yeast-infection

http://emedicine.medscape.com/article/213853-clinical


Tuesday, 14 August 2012

Introduction to Hypertension

Hypertension- Causes and Symptoms of Hypertension  

Hypertension, also called High Blood Pressure, is a condition in which the blood pressure in either arteries or veins is abnormally high. Hypertension is one the major causes of death and disability in the world. Hypertension is known as "Silent Killer" because it may be present for years with no perceptible symptoms.

All about Hypertension - Causes and Symptoms of Hypertension

High blood pressure is not only a serious condition by itself, but it is also the leading cause of heart attacks, strokes and kidney failure. Severe and immediately life-threatening hypertension is called Malignant hypertension and usually requires hospitalization and acute medical care.
The measurement of blood pressure is written as two numbers. The normal blood pressure reading is systolic 120 over diastolic 80 represented as 120/80 mm of Hg. Blood pressure above this range is considered to be high and should be viewed seriously. The best way to prevent hypertension is to undergo regular blood pressure checks and take treatments in case the pressure level is high.

What causes hypertension or high blood pressure?

Hypertension can be classified as essential hypertension and secondary hypertension.
Essential hypertension or idiopathic hypertension is the most common form of hypertension, which occurs in almost 90 percent of cases. The causes of essential hyper tension is unknown, however, medical studies and research have identified some factors which cause hypertension. Some of these factors are unhealthy dietary habits, tension, stress, insufficient rest, smoking, excessive consumption of liquors, obesity, metabolic disorders, excessive consumption of tea and coffee etc...
Secondary hypertension is the result of a specific disease, disorder, or other condition. A hypertension within the renal arteries causes renal hypertension and it affects the entire circulatory system.
Another cause of secondary hypertension is Cushing's syndrome or aldosteronism, a metabolic disorder caused by overproduction of corticosteroid hormones by the adrenal cortex and often resulting in obesity and high blood pressure.
Other causes of secondary hypertension are excess hormone secretion resulting from pheochromocytoma, excess secretion of hormones by pituitary tumors, coarctation (congenital narrowing of a short section of the aorta), pregnancy, use of oral contraceptives etc. Treating the underlying condition or cause relieves secondary hypertension.
In general the major causes of hypertension are the following:
  • Hectic and stress filled life style
  • Unhealthy food habits
  • Obesity
  • Excessive consumption of liquors
  • Smoking
  • Over consumption of tea/coffee
  • Insufficient rest and sleep
  • Metabolic disorders
  • Hardening of the arteries
  • Excessive use of pain killers and other strong medicines
  • Genetic disorders
  • Over consumption of oily food and fast food
  • High salt intake
  • Emotional and Physical stress
  • Family history of hypertension

Symptoms of Hypertension

As mentioned earlier, hypertension is not a disease, but it is a symptom in itself. In most cases, hypertension produces no symptoms until dangerous complications occur.
However there are some known symptoms of hypertension, which a person with hypertension may experience now and then.
  • Headaches - Headaches may be experienced due to elevation in blood pressure. Sometimes morning headaches can also be due to hypertension.
  • Dizziness - Dizziness is often experience by people with high blood pressure. However dizziness cannot always be treated as a symptom of hypertension. If dizziness is experienced it is always wise to consult a medical practitioner.
  • Heart pain
  • Palpitations
  • Nosebleeds - Nosebleeds without particular reason might be a symptom of high blood pressure. It is better to check the blood pressure in such cases.
  • Difficulty in breathing
  • Tinnitus (ringing or buzzing in the ears)
  • Blurred Vision
  • Frequent urination
Source: http://www.prokerala.com/health/hypertension.htm


Signs and tests
Your health care provider will check your blood pressure several times before diagnosing you with high blood pressure. It is normal for your blood pressure to be different depending on the time of day.
Blood pressure readings taken at home may be a better measure of your current blood pressure than those taken at your doctor's office. Make sure you get a good quality, well-fitting home device. It should have the proper sized cuff and a digital readout.
Practice with your health care provider or nurse to make sure you are taking your blood pressure correctly. See also: Blood pressure monitors for home
Your doctor will perform a physical exam to look for signs of heart disease, damage to the eyes, and other changes in your body.
Tests may be done to look for:
High cholesterol levels
Heart disease, such as an echocardiogram or electrocardiogram
Kidney disease, such as a basic metabolic panel and urinalysis or ultrasound of the kidneys

Treatment
The goal of treatment is to reduce blood pressure so that you have a lower risk of complications. You and your health care provider should set a blood pressure goal for you.
If you have pre-hypertension, your health care provider will recommend lifestyle changes to bring your blood pressure down to a normal range. Medicines are rarely used for pre-hypertension.
You can do many things to help control your blood pressure, including:
Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water. See: High blood pressure and diet
Exercise regularly -- at least 30 minutes of aerobic exercise a day.
If you smoke, quit -- find a program that will help you stop.
Limit how much alcohol you drink -- one drink a day for women, two a day for men.
Limit the amount of sodium (salt) you eat -- aim for less than 1,500 mg per day.
Reduce stress -- try to avoid things that cause you stress. You can also try meditation or yoga.
Stay at a healthy body weight -- find a weight-loss program to help you, if you need it.
Your health care provider can help you find programs for losing weight, stopping smoking, and exercising. You can also get a referral from your doctor to a dietitian, who can help you plan a diet that is healthy for you.
There are many different medicines that can be used to treat high blood pressure. See: High blood pressure medicines
Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two or more drugs. It is very important that you take the medications prescribed to you. If you have side effects, your health care provider can substitute a different medication.
Expectations (prognosis)
Most of the time, high blood pressure can be controlled with medicine and lifestyle changes.

Complications
When blood pressure is not well controlled, you are at risk for:
Bleeding from the aorta, the large blood vessel that supplies blood to the abdomen, pelvis, and legs
Chronic kidney disease
Heart attack and heart failure
Poor blood supply to the legs
Stroke
Problems with your vision
Calling your health care provider
If you have high blood pressure, you will have regular appointments with your doctor.
Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked during your yearly check-up, especially if someone in your family has or had high blood pressure.
Call your health care provider right away if home monitoring shows that your blood pressure is still high.
Prevention
Adults over 18 should have their blood pressure checked regularly.
Lifestyle changes may help control your blood pressure.
Follow your health care provider's recommendations to modify, treat, or control possible causes of high blood pressure.
Source

What is Breast Cancer?

Breast cancer is an uncontrolled growth of breast cells. To better understand breast cancer, it helps to understand how any cancer can develop.
Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy. The genes are in each cell’s nucleus, which acts as the “control room” of each cell. Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out. But over time, mutations can “turn on” certain genes and “turn off” others in a cell. That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.
A tumor can be benign (not dangerous to health) or malignant (has the potential to be dangerous). Benign tumors are not considered cancerous: their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumors are cancerous. Left unchecked, malignant cells eventually can spread beyond the original tumor to other parts of the body.
The term “breast cancer” refers to a malignant tumor that has developed from cells in the breast. Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast.
Breast AnatomyBreast Anatomy
Over time, cancer cells can invade nearby healthy breast tissue and make their way into the underarm lymph nodes, small organs that filter out foreign substances in the body. If cancer cells get into the lymph nodes, they then have a pathway into other parts of the body. The breast cancer’s stage refers to how far the cancer cells have spread beyond the original tumor (see Stages of Breast Cancer table for more information).
Breast cancer is always caused by a genetic abnormality (a “mistake” in the genetic material). However, only 5-10% of cancers are due to an abnormality inherited from your mother or father. About 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and the “wear and tear” of life in general.
There are steps every person can take to help the body stay as healthy as possible and lower risk of breast cancer or a breast cancer recurrence (such as maintaining a healthy weight, not smoking, limiting alcohol, and exercising regularly). Learn what you can do to manage breast cancer risk factors. Always remember, breast cancer is never anyone's fault. Feeling guilty, or telling yourself that breast cancer happened because of something you or anyone else did, is not productive.

Stages of Breast Cancer

StageDefinition
Stage 0Cancer cells remain inside the breast duct, without invasion into normal adjacent breast tissue.
Stage IAThe tumor measures up to 2 cm
AND
the cancer has not spread outside the breast; no lymph nodes are involved
Stage IBThere is no tumor in the breast; instead, small groups of cancer cells -- larger than 0.2 millimeter but not larger than 2 millimeters – are found in the lymph nodes
OR
there is a tumor in the breast that is no larger than 2 centimeters, and there are small groups of cancer cells – larger than 0.2 millimeter but not larger than 2 millimeters – in the lymph nodes.
Stage IIANo tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm)
OR
the tumor measures 2 centimeters or smaller and has spread to the axillary lymph nodes
OR
the tumor is larger than 2 but no larger than 5 centimeters and has not spread to the axillary lymph nodes.
Stage IIBThe tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes
OR
the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.
Stage IIIANo tumor is found in the breast. Cancer is found in axillary lymph nodes that are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone
OR
the tumor is any size. Cancer has spread to the axillary lymph nodes, which are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone.
Stage IIIBThe tumor may be any size and has spread to the chest wall and/or skin of the breast
AND
may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone.

Inflammatory breast cancer is considered at least stage IIIB.
Stage IIICThere may either be no sign of cancer in the breast or a tumor may be any size and may have spread to the chest wall and/or the skin of the breast
AND
the cancer has spread to lymph nodes either above or below the collarbone
AND
the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone.
Stage IVThe cancer has spread — or metastasized — to other parts of the body.



WHAT WIKIPEDIA SAYS ABOUT BREAST CANCER

Breast cancer is a type of cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk.[1] Cancers originating from ducts are known as ductal carcinomas, while those originating from lobules are known as lobular carcinomas. Breast cancer occurs in humans and other mammals. While the overwhelming majority of human cases occur in women, male breast cancer can also occur.[2]
The size, stage, rate of growth, and other characteristics of a breast cancer determine the kinds of treatment. Treatment may include surgery, drugs (hormonal therapy and chemotherapy), radiation and/or immunotherapy.[3] Surgical removal of the tumor provides the single largest benefit, with surgery alone curing many cases. To increase the likelihood of cure, several chemotherapy regimens are commonly given in addition to surgery. Radiation is used after breast-conserving surgery and substantially improves local relapse rates and in many circumstances also overall survival.[4] Some breast cancers are sensitive to hormones such as estrogen and/or progesterone, which makes it possible to treat them by blocking the effects of these hormones.
Worldwide, breast cancer comprises 22.9% of all cancers (excluding non-melanoma skin cancers) in women.[5] In 2008, breast cancer caused 458,503 deaths worldwide (13.7% of cancer deaths in women).[5] Breast cancer is more than 100 times more common in women than in men, although men tend to have poorer outcomes due to delays in diagnosis.[6][7]
Prognosis and survival rates for breast cancer vary greatly depending on the cancer type, stage, treatment, and geographical location of the patient. Survival rates in the Western world are high;[6] for example, more than 8 out of 10 women (84%) in England diagnosed with breast cancer survive for at least 5 years.[8] In developing countries, however, survival rates are much poorer.

Signs and symptoms
Early signs of breast cancer
Breast cancer showing an inverted nipple, lump and skin dimpling.
The first noticeable symptom of breast cancer is typically a lump that feels different from the rest of the breast tissue. More than 80% of breast cancer cases are discovered when the woman feels a lump.[9] The earliest breast cancers are detected by a mammogram.[10] Lumps found in lymph nodes located in the armpits[9] can also indicate breast cancer.
Indications of breast cancer other than a lump may include thickening different from the other breast tissue, one breast becoming larger or lower, a nipple changing position or shape or becoming inverted, skin puckering or dimpling, a rash on or around a nipple, discharge from nipple/s, constant pain in part of the breast or armpit, and swelling beneath the armpit or around the collarbone.[11] Pain ("mastodynia") is an unreliable tool in determining the presence or absence of breast cancer, but may be indicative of other breast health issues.[9][10][12]
Inflammatory breast cancer is a particular type of breast cancer which can pose a substantial diagnostic challenge. Symptoms may resemble a breast inflammation and may include itching, pain, swelling, nipple inversion, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d'orange;[9] the absence of a discernible lump delays detection dangerously.
Another reported symptom complex of breast cancer is Paget's disease of the breast. This syndrome presents as eczematoid skin changes such as redness and mild flaking of the nipple skin. As Paget's advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget's also have a lump in the breast.[13]
In rare cases, what initially appears as a fibroadenoma (hard movable lump) could in fact be a phyllodes tumor. Phyllodes tumors are formed within the stroma (connective tissue) of the breast and contain glandular as well as stromal tissue. Phyllodes tumors are not staged in the usual sense; they are classified on the basis of their appearance under the microscope as benign, borderline, or malignant.[14]
Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain.[15] Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are called non-specific, meaning they could be manifestations of many other illnesses.[16]
Most symptoms of breast disorders, including most lumps, do not turn out to represent underlying breast cancer. Less than 20% of lumps for example are cancer[17] and benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. Nevertheless, the appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age.[18]

Risk factors

The primary risk factors for breast cancer are female sex and older age.[19] Other potential risk factors include: lack of childbearing or breastfeeding,[20] higher hormone levels,[21][22] diet and obesity.

Lifestyle

Smoking tobacco appears to increase the risk of breast cancer with the greater the amount of smoked and the earlier in life smoking began the higher the risk.[23] In those who are long term smokers the risk is increased 35% to 50%.[23] A lack of physical activity has been linked to ~10% of cases.[24]
The association between breast feeding and breast cancer has not been clearly determined with some studies finding support for an association and others not.[25] In the 1980s the abortion–breast cancer hypothesis posited that induced abortion increased the risk of developing breast cancer.[26] This hypothesis has been the subject of extensive scientific inquiry which has concluded that neither miscarriages nor abortions are associated.[27] There may be an association between oral contraceptives and the development of premenopausal breast cancer.[28] Whether or not this association is causal is debated and if there is indeed a link the absolute effect is small.[29][30] In those with BRCA1 or BRCA2 mutations or a family history modern OCPs do not appear to affect the subsequent risk of breast cancer.[31][32]
There is a relationship between diet and breast cancer including an increased risk with a high fat diet,[33] alcohol intake,[34] and obesity.[35] Dietary iodine deficiency may also play a role.[36]
Other risk factors include radiation,[37] and shift-work.[38] A number of chemicals have also been linked including: polychlorinated biphenyls, polycyclic aromatic hydrocarbons, and organic solvents.[39] Although the radiation from mammography is a low dose, it is estimated that yearly screening from 40 to 80 years of age will cause ~225 cases of fatal breast cancer per million women screened.[40]

[edit] Genetics

Some genetic susceptibility probably plays a role in most cases.[41] Overall however genetics is believed to be the cause of 5-10% of all cases.[42] In those with zero, one or two affected relatives the risk of breast cancer before the age of 80 is 7.8%, 13.3%, and 21.1% with a subsequent mortality from the disease of 2.3%, 4.2%, and 7.6% respectively.[43] In those with a first degree relative with the disease the risk of breast cancer between the age of 40 and 50 is double that of the general population.[44]
In less than 5% of cases genetics plays a more significant role.[41] This include those who carry the BRCA1 and BRCA2 gene mutation.[41] These mutations account for up to 90% of the total genetic influence with a risk of breast cancer of 60-80% in those affected.[42] Other significant mutations include: p53 (Li-Fraumeni syndrome), PTEN (Cowden syndrome), and STK11 (Peutz–Jeghers syndrome), CHEK2, ATM, BRIP1, and PALB2.[42]

[edit] Medical conditions

Certain breast changes: atypical hyperplasia and lobular carcinoma in situ found in benign breast conditions such as fibrocystic breast changes are correlated with an increased breast cancer risk.[citation needed]

[edit] Pathophysiology

Overview of signal transduction pathways involved in apoptosis. Mutations leading to loss of apoptosis can lead to tumorigenesis.
Breast cancer, like other cancers, occurs because of an interaction between the environment and a defective gene. Normal cells divide as many times as needed and stop. They attach to other cells and stay in place in tissues. Cells become cancerous when mutations destroy their ability to stop dividing, to attach to other cells and to stay where they belong.
Normal cells will commit cell suicide (apoptosis) when they are no longer needed. Until then, they are protected from cell suicide by several protein clusters and pathways. One of the protective pathways is the PI3K/AKT pathway; another is the RAS/MEK/ERK pathway. Sometimes the genes along these protective pathways are mutated in a way that turns them permanently "on", rendering the cell incapable of committing suicide when it is no longer needed. This is one of the steps that causes cancer in combination with other mutations. Normally, the PTEN protein turns off the PI3K/AKT pathway when the cell is ready for cell suicide. In some breast cancers, the gene for the PTEN protein is mutated, so the PI3K/AKT pathway is stuck in the "on" position, and the cancer cell does not commit suicide.[45]
Mutations that can lead to breast cancer have been experimentally linked to estrogen exposure.[46]
Failure of immune surveillance, the removal of malignant cells throughout one's life by the immune system.[47] Abnormal growth factor signaling in the interaction between stromal cells and epithelial cells can facilitate malignant cell growth.[48][49] In breast adipose tissue, overexpression of leptin leads to increased cell proliferation and cancer.[50]
In the United States, 10 to 20 percent of patients with breast cancer and patients with ovarian cancer have a first- or second-degree relative with one of these diseases. The familial tendency to develop these cancers is called hereditary breast—ovarian cancer syndrome. The best known of these, the BRCA mutations, confer a lifetime risk of breast cancer of between 60 and 85 percent and a lifetime risk of ovarian cancer of between 15 and 40 percent. Some mutations associated with cancer, such as p53, BRCA1 and BRCA2, occur in mechanisms to correct errors in DNA. These mutations are either inherited or acquired after birth. Presumably, they allow further mutations, which allow uncontrolled division, lack of attachment, and metastasis to distant organs.[37][51]However there is strong evidence of residual risk variation that goes well beyond hereditary BRCA gene mutations between carrier families. This is caused by unobserved risk factors.[52] This implicates environmental and other causes as triggers for breast cancers. The inherited mutation in BRCA1 or BRCA2 genes can interfere with repair of DNA cross links and DNA double strand breaks (known functions of the encoded protein)[53] These carcinogens cause DNA damage such as DNA cross links and double strand breaks that often require repairs by pathways containing BRCA1 and BRCA2.[54][55] However, mutations in BRCA genes account for only 2 to 3 percent of all breast cancers.[56] About half of hereditary breast–ovarian cancer syndromes involve unknown genes.

[edit] Diagnosis

Most types of breast cancer are easy to diagnose by microscopic analysis of the biopsy. There are however, rarer types of breast cancer that require specialized lab exams.
While screening techniques are useful in determining the possibility of cancer, a further testing is necessary to confirm whether a lump detected on screening is cancer, as opposed to a benign alternative such as a simple cyst.
Very often the results of noninvasive examination, mammography and additional tests that are performed in special circumstances such as ultrasound or MR imaging are sufficient to warrant excisional biopsy as the definitive diagnostic and curative method.
Both mammography and clinical breast exam, also used for screening, can indicate an approximate likelihood that a lump is cancer, and may also detect some other lesions.[57] When the tests are inconclusive Fine Needle Aspiration and Cytology (FNAC) may be used. FNAC may be done in a GP's office using local anaesthetic if required, involves attempting to extract a small portion of fluid from the lump. Clear fluid makes the lump highly unlikely to be cancerous, but bloody fluid may be sent off for inspection under a microscope for cancerous cells. Together, these three tools can be used to diagnose breast cancer with a good degree of accuracy.
Other options for biopsy include core biopsy, where a section of the breast lump is removed, and an excisional biopsy, where the entire lump is removed.
In addition vacuum-assisted breast biopsy (VAB) may help diagnose breast cancer among patients with a mammographically detected breast in women.[58]

[edit] Classification

Breast cancers are classified by several grading systems. Each of these influences the prognosis and can affect treatment response. Description of a breast cancer optimally includes all of these factors.
  • Histopathology. Breast cancer is usually classified primarily by its histological appearance. Most breast cancers are derived from the epithelium lining the ducts or lobules, and these cancers are classified as ductal or lobular carcinoma. Carcinoma in situ is growth of low grade cancerous or precancerous cells within a particular tissue compartment such as the mammary duct without invasion of the surrounding tissue. In contrast, invasive carcinoma does not confine itself to the initial tissue compartment.[59]
  • Grade. Grading compares the appearance of the breast cancer cells to the appearance of normal breast tissue. Normal cells in an organ like the breast become differentiated, meaning that they take on specific shapes and forms that reflect their function as part of that organ. Cancerous cells lose that differentiation. In cancer, the cells that would normally line up in an orderly way to make up the milk ducts become disorganized. Cell division becomes uncontrolled. Cell nuclei become less uniform. Pathologists describe cells as well differentiated (low grade), moderately differentiated (intermediate grade), and poorly differentiated (high grade) as the cells progressively lose the features seen in normal breast cells. Poorly differentiated cancers have a worse prognosis.
  • Stage. Breast cancer staging using the TNM system is based on the size of thetumor (T), whether or not the tumor has spread to the lymph nodes (N) in the armpits, and whether the tumor has metastasized (M) (i.e. spread to a more distant part of the body). Larger size, nodal spread, and metastasis have a larger stage number and a worse prognosis.
    The main stages are:
  • Receptor status. Breast cancer cells have receptors on their surface and in their cytoplasm and nucleus. Chemical messengers such as hormones bind to receptors, and this causes changes in the cell. Breast cancer cells may or may not have three important receptors: estrogen receptor (ER), progesterone receptor (PR), and HER2.
    ER+ cancer cells depend on estrogen for their growth, so they can be treated with drugs to block estrogen effects (e.g. tamoxifen), and generally have a better prognosis. HER2+ breast cancer had a worse prognosis,[60] but HER2+ cancer cells respond to drugs such as the monoclonal antibody trastuzumab (in combination with conventional chemotherapy), and this has improved the prognosis significantly.[61] Cells with none of these receptors are called triple negative although they frequently express receptors for other hormones such as androgen receptor and prolactin receptor.
  • DNA assays. DNA testing of various types including DNA microarrays have compared normal cells to breast cancer cells. The specific changes in a particular breast cancer can be used to classify the cancer in several ways, and may assist in choosing the most effective treatment for that DNA type.

[edit] Prevention

The World Cancer Research Fund indicated that women can reduce their risk of breast cancer by maintaining a healthy weight, drinking less alcohol, being physically active and breastfeeding their children.[62] These modifications might prevent 38% of breast cancers in the US, 42% in the UK, 28% in Brazil and 20% in China.[62] The benefits with moderate exercise such as brisk walking are seen at all age groups including postmenopausal women.[62][63]
Prophylactic bilateral mastectomy may be considered in people with BRCA1 and BRCA2 mutations.[64][65] Some carcinogens are known to take advantage of deficiencies in processes that depend on normal BRCA1 and BRCA2 function.

[edit] Screening

Breast cancer screening refers to testing otherwise-healthy women for breast cancer in an attempt to achieve an earlier diagnosis. The assumption is that early detection will improve outcomes. A number of screening test have been employed including: clinical and self breast exams, mammography, genetic screening, ultrasound, and magnetic resonance imaging.
A clinical or self breast exam involves feeling the breast for lumps or other abnormalities. Research evidence does not support the effectiveness of either type of breast exam, because by the time a lump is large enough to be found it is likely to have been growing for several years and will soon be large enough to be found without an exam.[66] Mammographic screening for breast cancer uses x-rays to examine the breast for any uncharacteristic masses or lumps.
For the average woman, the U.S. Preventive Services Task Force recommends (2009) mammography every two years in women between the ages of 50 and 74.[67] The European Cancer Observatory (2011) recommends mammography every 2 - 3 years between 50 and 69.[68] These task force reports point out that in addition to unnecessary surgery and anxiety, the risks of more frequent mammograms include a small but significant increase in breast cancer induced by radiation.[69] More recently, the Cochrane Collaboration (2011) concluded that mammograms reduce mortality from breast cancer by 15% or .05% absolute, but also result in unnecessary surgery and anxiety, resulting in their view that it is not clear whether mammography screening does more good or harm.[70] The US Cochrane Collaboration now refer readers to The Nordic Cochrane Collection (2012), which reviews updated research to state that advances in diagnosis and treatment make mammography screening less effective today. They state screening is “no longer effective.” They conclude that “it therefore no longer seems reasonable to attend” for breast cancer screening at any age, and warn of misleading information on the internet.[71]
Molecular breast imaging is currently under study and may also be an alternative.[72]

[edit] Management

Breast cancer is usually treated with surgery and then possibly with chemotherapy or radiation, or both. A multidisciplinary approach is preferable.[73] Hormone positive cancers are treated with long term hormone blocking therapy. Treatments are given with increasing aggressiveness according to the prognosis and risk of recurrence. The NPI Nottingham Prognostic Index is a useful tool in assessing the prognosis
  • Stage 1 cancers (and DCIS) have an excellent prognosis and are generally treated with lumpectomy and sometimes radiation.[74] HER2+ cancers should be treated with the trastuzumab (Herceptin) regime.[75] Chemotherapy is uncommon for other types of stage 1 cancers.
  • Stage 2 and 3 cancers with a progressively poorer prognosis and greater risk of recurrence are generally treated with surgery (lumpectomy or mastectomy with or without lymph node removal), chemotherapy (plus trastuzumab for HER2+ cancers) and sometimes radiation (particularly following large cancers, multiple positive nodes or lumpectomy).
  • Stage 4, metastatic cancer, (i.e. spread to distant sites) has poor prognosis and is managed by various combination of all treatments from surgery, radiation, chemotherapy and targeted therapies. 10 year survival rate is 5% without treatment and 10% with optimal treatment.[76]

[edit] Surgery

Chest after right breast mastectomy
Surgery involves the physical removal of the tumor, typically along with some of the surrounding tissue and frequently sentinel node biopsy.
Standard surgeries include:
If the patient desires, then breast reconstruction surgery, a type of cosmetic surgery, may be performed to create an aesthetic appearance. In other cases, women use breast prostheses to simulate a breast under clothing, or choose a flat chest.

[edit] Medication

Drugs used after and in addition to surgery are called adjuvant therapy. Chemotherapy or other types of therapy prior to surgery are called neoadjuvant therapy.
There are currently three main groups of medications used for adjuvant breast cancer treatment: hormone blocking therapy, chemotherapy, and monoclonal antibodies.
Hormone blocking therapy
Some breast cancers require estrogen to continue growing. They can be identified by the presence of estrogen receptors (ER+) and progesterone receptors (PR+) on their surface (sometimes referred to together as hormone receptors). These ER+ cancers can be treated with drugs that either block the receptors, e.g. tamoxifen (Nolvadex), or alternatively block the production of estrogen with an aromatase inhibitor, e.g. anastrozole (Arimidex)[77] or letrozole (Femara). Aromatase inhibitors, however, are only suitable for post-menopausal patients. This is because the active aromatase in postmenopausal women is different from the prevalent form in premenopausal women, and therefore these agents are ineffective in inhibiting the predominant aromatase of premenopausal women.[78]
Chemotherapy
Predominately used for stage 2–4 disease, being particularly beneficial in estrogen receptor-negative (ER-) disease. They are given in combinations, usually for 3–6 months. One of the most common treatments is cyclophosphamide plus doxorubicin (Adriamycin), known as AC. Most chemotherapy medications work by destroying fast-growing and/or fast-replicating cancer cells either by causing DNA damage upon replication or other mechanisms; these drugs also damage fast-growing normal cells where they cause serious side effects. Damage to the heart muscle is the most dangerous complication of doxorubicin. Sometimes a taxane drug, such as docetaxel, is added, and the regime is then known as CAT; taxane attacks the microtubules in cancer cells. Another common treatment, which produces equivalent results, is cyclophosphamide, methotrexate, and fluorouracil (CMF). (Chemotherapy can literally refer to any drug, but it is usually used to refer to traditional non-hormone treatments for cancer.)[citation needed]
Monoclonal antibodies
Trastuzumab (Herceptin), a monoclonal antibody to HER2, has improved the 5 year disease free survival of stage 1–3 HER2+ breast cancers to about 87% (overall survival 95%).[79] Trastuzumab, however, is expensive, and approximately 2% of patients suffer significant heart damage.[80] Other monoclonal antibodies are also undergoing clinical trials. Trastuzumab is only effective in patients with the HER2 mutation.
Between 25 and thirty percent of breast cancers have an amplification of the HER2 gene or overexpression of its protein product.[81] This receptor is normally stimulated by a growth factor which causes the cell to divide; in the absence of the growth factor, the cell will normally stop growing. Overexpression of this receptor in breast cancer is associated with increased disease recurrence and worse prognosis.
Aspirin may reduce mortality from breast cancer.[82]

Source: http://en.wikipedia.org/wiki/Breast_cancer




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