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Treatment for breast cancer depends on the type of cancer, hormone sensitivity, size, grade and stage of cancer. A doctor considers the overall health of the patient and the patient’s individual preference before recommending a treatment plan. While there are many treatments options available for breast cancer, surgery is by far the most popular option for most patients. Along with surgery, some other treatments that a patient undergoes include radiation, chemotherapy and hormonal therapy.
- Lumpectomy: This is a procedure wherein the surgeon cuts the tumour and removes some of the surrounding healthy tissue in order to ensure that cancer does not spread to the healthy cells after the surgery. This procedure is applicable for small tumours.
- Mastectomy: This is a procedure in which all tissues of the breast are removed. This includes lobules, fatty tissue, ducts, areola, and nipple. In a skin-sparing mastectomy, all of the breast skin, except the nipple and the areola, is preserved, which makes the reconstruction process easier.
- Sentinel node biopsy: Since the sentinel lymph nodes are the first place that cancer is likely to spread, a doctor might suggest a sentinel node biopsy if cancer has spread to the lymph nodes. If no trace of a cancer cell is found in the nodes, it is unlikely that any more nodes need to be removed.
- Removal of breasts: Many women who have cancer in one breast often choose to remove both the breasts in order to avoid the risk of cancer spreading. While a family history of breast cancer can greatly increase the chance of breast cancer in a woman, statistics show that most women who have cancer in one breast do not develop cancer in the other one.
- Radiation: This is a process where a high-powered beam of energy is directed at the cancer cells to kill them. This method is often used after a lumpectomy. Radiations are of two types—external beam and brachytherapy. Some side effects of this treatment include fatigue, hair fall, loss of appetite and rashes.
- Chemotherapy: Chemotherapy is the treatment of cancer by cytotoxic and other drugs. This is often recommended by doctors when there is a good chance of the cancer cells spreading to other locations of the body. This form of treatment is often recommended before the surgery to shrink a tumour or restrict the growth of cells.
- Hormone therapy: Hormonal therapy is used to treat cancers that have hormonal sensitivity. They can be used before or after the surgery in order to ensure that cancer does not reoccur. Some of the treatment methods in this section include medication that restricts hormones from getting attached to the cancer cells, medications that restrict the body to produce oestrogen post-menopause and a medication that destroys cancer receptors.
I have slip discs problem since 4 month and serious pain in left leg. Now can not able to walk 500 mtr. Please suggest me what can I do?
1. What are the symptoms of liver disease? When to see a doctor?
Most of the liver diseases present with similar symptoms with some variations. Some of the common symptoms can be loss of appetite, nausea and vomiting, vomiting of blood, jaundice(yellowish discoloration of the eye), abdominal pain, itching, distension of abdomen( accumulation of fluid- ascites), swelling of lower limbs, weight loss, altered sensorium, confusion, and in a late stage- coma.
2. Can liver disease be prevented?
Liver is a crucial body organ which is responsible for processing essential nutrients from the food you eat, synthesizing bile and most importantly removing harmful toxins from the system. To ensure that your liver keeps performing its functions, you need to follow a healthy lifestyle.
Some of the liver diseases are metabolic and hence inherent at the time of birth and manifest later. However, some of the more common liver diseases are preventable like alcohol induced liver disease, fatty liver induced liver disease (NAFLD), Hepatitis A, B and C.
3. What is liver transplantation? What is the average cost of liver transplantation?
Liver transplantation is the treatment for end stage liver disease in both adults and children. In this operation, the diseased liver is removed and replaced by a healthy one. The success rate for the operation is high and terminally ill patient can return to normal lives.
The average cost of liver transplantation is Rs 18 to 20 Lakhs at Sahyadri specialty hospital, Pune Maharashtra. The cost of investigations of the donor and recipient is Rs 90,000. When patients are too sick and require prolonged stay following liver transplantation, the cost of treatment can escalate; hence it is advisable to patients to have the liver transplantation before they develop complications secondary to the liver disease (Cirrhosis).
Most of the patients seek help at a very late stage or referred late to a Surgeon. It is advisable for patients to seek the opinion of a Surgeon at a very early stage of the disease. The patient needs to take medicines for the rest of his life to prevent rejection of the new liver. The cost of medicines and the investigations in the first year is approximately Rs 10-15000/-. The number of medicines and the frequency of blood investigations are much less after the first year of liver transplantation.
The cost of liver transplantation in India is one-twentieth when compared to USA, UK and other European Countries.
4. When should a liver transplant be performed?
When a person’s liver is severely damaged and cannot function properly or complications may develop and liver transplantation should be considered. Conditions like hepatic coma, massive upper gastrointestinal bleeding, and liver cancer is the best treated by complete removal of the liver (cirrhotic liver).
In general, when a patient needs a new liver, the earlier the operation, the higher the success rate is.
Urgent liver transplantation is recommended in patients who have acute liver failure and this could be due to many reasons. The common conditions are Hepatitis B, Hepatitis A, Hepatitis E and drug induced. In such patients, liver transplantation is urgently needed in order to save the life of the individual.
5. What are the advantages/benefits to the recipient of getting a living donation vs cadaver?
A new liver can come from either of the two sources: A living donor or a brain-dead deceased donor.
Living donor transplantation:
It is technically feasible to remove part of the liver from a living person and transplant it to a patient who needs a new liver. The operation has now been done since 1989. Depending on the size matching of the donor and recipient, either the left side (about 35-40%) or the right side (60-65%) of the liver will have to be removed. The liver remnant in the donor will grow to its original size in 6-8 weeks time.
This process helps in an earlier transplantation before the recipients’ conditions deteriorates. It is a planned procedure whilst cadaver liver transplantation is an emergency procedure. It avoids the risk of death while waiting for a deceased donor liver graft(40% overall and 75% for patients in Intensive care units). The survival rate of a living donor transplant is over 90%.
There are risks like complications of the investigations and surgical procedures but the possibility of donor death rate is of 0.2-0.5%. Seventeen donor deaths have been reported in Brazil, France, Germany, Egypt, Hong Kong, Japan, USA and India.
This is well established in the Europe and USA. Unfortunately, the availability of deceased donor liver is not very often in India. Depending on your blood group, you may have to wait for 0 to 6 months before you get a new liver.
During this waiting period, you may develop complications like spontaneous bacterial peritonitis (infection of the fluid in the abdomen) which, if repetitive may produce severe adhesions in your abdomen rendering liver transplantation difficult if not impossible.
It is important for everyone to register for organ donation, so that when we die, this noble act will help many people to lead normal lives. In the Western world the organ donation rate is between 15-18/million population where as in Indi it is less than 1/million.
6. Who can be a suitable living donor?
The most important criteria is that the donation of portion of the liver is done voluntarily. The donor has to be less than 50 years of age, body mass index of less than 25 and is a near relative of the recipient. Both the donor and the patient should have the same Blood group or O Blood group.
Besides, the potential donor should understand clearly that
- The donor operation carries complication rate of 10-15%.
- The recipient is successful in 90-95%, which means that there is 5-10% chance of dying.
- The donation is done out of his/her own wish and without any coercion.
- There is no financial gain related to the act of donation.
- The donor has the right to withdraw at any time without the need of giving any reasons to do so.
7. Which patients are excluded from liver transplantation procedure?
Patients who have cancer in another part of the body, active alcohol or illegal drug abuse, active or severe infection in any part of the body, serious heart, lung or neurological conditions or those who are unable to follow doctors’ instructions are excluded generally.
8. What are the risks to the recipient from the surgery?
The overall success rate of liver transplant is over 94% and the majority of recipients can return to normal activities and achieve 95% of their quality of life which they had prior to liver disease. Since the recipients’ body may reject the new liver, it is essential for them to take immunosuppressive medications and continue follow up at the liver transplant clinic. They will need to continue these medications for life, at a reducing dosage.
The risk for the recipient is the return of the original problem that necessitated the liver transplant in the first place, e.g. hepatitis C, recidivism (return to alcoholism), noncompliance of medications. The other complications that can arise are thrombosis of blood vessels going into or out of the liver, primary or delayed graft non-function, bile duct complications, renal failure and other infections.
9. What are the side effects of having a liver transplant?
After a successful liver transplantation (95% of patients) – the patient is advised to take care of infections and to take anti-rejection medicines for life. The patient can return to normal quality of life and can return back to work in three months time. The patient has to regularly follow up with the surgeon in the first year and later at regular intervals as advised by his doctor. He will require blood tests to determine that his liver functions and to adjust his medications in the beginning and later the tests are infrequent. The patient is advised not to take any herbal or alternative drug treatment.
The transplant patient is assessed regularly for various complications like rejection, infection, narrowing of blood vessels etc., and appropriate treatment is initiated. Post transplantation, he is under the guidance of his doctor throughout his life. Any health problems that do come up have to be investigated and treated, though they are infrequent.
In case you have a concern or query you can always consult an expert & get answers to your questions!
It is perfectly normal for women to experience the periodic monthly bleeding cycle. However, if a woman experiences uterine bleeding which is abnormal and dysfunctional, it could be a symptom of infection. Other causes of abnormal uterine bleeding include hormonal imbalance, infection in cervix and cancer of the uterus. Many women can also experience abnormal uterine bleeding during first trimester of pregnancy.
The following are considered to be abnormal or dysfunctional uterine bleeding:
- A menstrual cycles occurs between 21 to 35 days, anything shorter or longer than this is abnormal
- No period for 3–6 months (amenorrhea) is abnormal
- Spotting or bleeding between periods
- Spotting or bleeding after intercourse
- Bleeding that is heavier or lasts longer than usual
- Spotting or bleeding after menopause
What can cause such a situation?
Some of the common causes leading to abnormal bleeding are as follows:
- Ectopic pregnancy
- Cervical or uterine infections
- Hormonal imbalances
- Problems with blood clotting
- Polycystic ovarian
- Endometrial hyperplasia
- Cancer of the reproductive tract
How to Diagnose it?
Most women tend to ignore abnormal bleeding, taking it as something to do with age or hormones. A detailed physical examination and history is done to understand menstrual cycle patterns and family history. In addition, the following would be used.
- Ultrasound: The pelvic organs are examined through sound waves to locate the problem area
- Hysteroscopy: Through a thin device that is inserted into the vagina, the doctor takes a look at the inside of the organs and identify the cause for the bleeding
- Endometrial biopsy: The uterine lining tissue is removed and examined under microscope to look for tissue changes that could be causing the bleeding
How Best to Treat It?
This would depend on the reason for the abnormal bleeding. However, in most cases, combinations of the following are useful in treatment.
- Hormone replacement can be done depending on the age and gynecological history, the type and the dose of the hormone would be decided upon. These could be in the form of tablets, vaginal creams, injections, or through an intrauterine device
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are useful in reducing bleeding and controlling cramps during excessive menstrual bleeding.
- Antibiotics may be useful if there is infection of the pelvic organs.
- Polyps, cysts, cancers, and other growths can be removed via hysteroscopy and sent for biopsy to confirm they are not cancerous.
- Endometrial ablation where the endometrial tissue is treated with heat can be used to control bleeding permanently.
- Hysterectomy would be done if other forms of treatment have failed. This could depend on their gynecologic history and other considerations as she cannot get pregnant after this.
Do not ignore if you see a change in the pattern of your uterine bleeding. It definitely calls for medical attention and if identified early, can be managed in much simpler ways. If you wish to discuss any specific problem, you can consult a gynaecologist.
Disk l4 l5 mildly bulged diffusely and posture bilaterally mildly narrowing lateral recesses. I have phasing problem from last 2 months now I got MRI so I got above impression .Is it major and what is the solution and I am getting pain back to but.
I am 33 years old, I have backache from last 1 year, x ray indicate there is borderline slip disk, what kind of precaution can I take for future?
I am 29 years old. I am from bangladesh. I have a problem with my backbone. I have slipped disc. I have been suffering from this since 2011. I consulted with some local doctors. They prescribed me with some exercise but no improvement till now. I feel that a bone or two is/are displaced somewhere my waist. I need expert suggestion.
How and why of breast cancer?
Breasts have milk producing glands as well as connective tissue including fat, fibrous tissue, nerves, blood vessels, etc. Milk produced in the glands reaches the exterior through a network of ducts. Most cancers develop in milk producing glands and ducts and later continue to grow and spread to lymph nodes in armpit as well as distant organs.
Warning signs and symptoms:
Given the high incidence of breast cancer, knowing the symptoms helps in early identification. Read on to know more. Pay extra attention if there is a family history.
- Appearance of a lump in the breasts or the armpits
- Any change in the size, shape, or contour of the breasts
- Presence of a watery or bloody discharge from the nipple
- The breast or the nipple turning red
- Sudden thickening of breast tissue or skin that continues for a while
- Change in the feel or look of the skin (dimpling, puckering, scaliness, reddishness, warmth, etc.)
- Hardening of the tissue under the breast skin
- Difference in appearance or feel of one area in comparison with other areas
The presence of any of these or a combination of these symptoms should be an indication for a detailed check-up. As mentioned, early diagnosis helps in improving outcome. Treatment is also easier with early stage of disease. It is also good to know risk factors, which also indicate if you need to watch for symptoms.
- Family history: Breast cancer can run in families, and if you have close relative(s) with breast cancer, watch out for symptoms. Family member or self have a positive test for BRCA1 and BRCA2 Family history of other cancers Age Women over the age of 40 years are at an increased risk of developing breast cancer.
- Hormones: Increased use of estrogen increases the chances of developing breast cancer. Therefore, women who have used birth control pills for long time or are on hormone replacement therapy are at greater risk.
- Abnormal gynaecologic milestones: Women who have abnormal menstrual milestones are more predisposed to developing breast cancer. For instance, girls who have start of menstrual cycles before age of 12, get pregnant after 30, and reach menopause after 55. Women with menstrual irregularities including cycles earlier than 26 days and later than 29 days are also likely to have hormonal issues and are, therefore, at higher risk of breast cancer.
- Other factors: Smoking, alcohol consumption, and obesity also increase the chances of a woman developing breast cancer."
The pain which a person experiences as a result of having a herniated disc can be quite debilitating, to tell you the truth. However, taking into due account the fact that all a person in such a situation would want would be to be up and running as soon as possible.
In order for this to happen, as would be expected, he or she would need to go through the options which are available for treatment of a herniated disc. There are various types of herniated disc treatments which are available though it can be said that conservative treatments are preferred as these treatments do not require surgery to be carried out on the person who is suffering from the issue.
The course of this sort of treatment lasts somewhere between one month to one and a half months. The aim of conservative treatment is to reduce or minimise the pain that is automatically associated with a herniated disc. There is a strategy to help a person improve by which he or she is provided with medicine for the purpose of pain relief while physiotherapy is made use of to make the underlying condition better.
Surgical treatment may be required, if the case is such that the person has lost a great degree of function and is in pain that seems to be pretty much unbearable. `If the person has a lumbar herniated disc, then the conservative treatment for this sort of case would require him or her to apply ice and heat from a warm source to provide relief to the area. If the pain is very bad yet the person is determined not to undergo surgery then the answer would be to consume some oral steroids or narcotic pain medications. One should surely keep in mind that this is only to carried out as per the prescription of a doctor who is trained and experienced to a sufficient degree.
If surgery is required for this sort of herniated disc, then it is likely to be a lumbar decompression surgery which aims to allow for the growth of the spine back to health as a result of removing the herniated disc. When it comes to cervical herniated disc treatment, conservative solutions include using drugs like ibuprofen and physical therapy; similar to solving lumbar herniated discs. However, surgical treatment for cervical herniated discs warrants anterior cervical decompression; where the disc is removed from the front of the neck. If you wish to discuss about any specific problem, you can consult a Physiotherapist.