Dr. Vohra

The uterus is a very important organ within the human reproductive system as this is the chamber where an embryo grows into a baby. Due to a multitude of factors, the incidence of uterine cancer has been on the rise. Let's look at some of its symptoms.

Symptoms of uterine cancer
When cells within the uterus grow abnormally and turn malignant, it may be termed as uterine cancer. This may be in the form of a fibroid or tumor or be part of the uterine tissue itself. It may be caused due to a multitude of factors such as late menopause, radiation exposure, estrogen treatments and many others. Some of the common symptoms for uterine cancer could be:

a. Pain in the abdomen, lower back and especially the pelvic area.
b. Pain during urination,
c. Weight loss without any apparent reason
d. Vaginal bleeding with or without discharge
e. Pain during sex

Stages of uterine cancer:
Before we understand the stages of uterine cancer you need to know how doctors diagnose the various stages. This is done by the three following steps in the TNM method:

Tumor - Doctors try and search for tumors and locate them within the uterus, estimate its size and whether it is malignant or not.

Node - If the tumor is malignant, then doctors try to find out whether the tumor has reached the lymph nodes or not.

Metastasis - Doctors look for Metastasis which is whether the cancer has spread to other organs within the body and to what extent.

Stages of cancer - Cancer is primarily grouped in five stages from 0 to V according to the T, N and M stages mentioned below.

Stage 0 - This is a very early stage of cancer where the cells have malignant growth but are still small in number and haven't spread anywhere.

Stage I - If the cancer has developed a little but is restricted within the uterus, it is considered as stage one. This is also further divided into Stage 1A and 1B.

Stage II - When the cancer has started spreading but only to some parts of the cervix from the uterus, it is diagnosed as stage 2 uterine cancer.

Stage III - Categorized into Stage IIIA, Stage IIIB, Stage IIIC1 and Stage IIIC2, it is primarily where the cancer has spread to other organs but it is only limited to the pelvic area.

Stage IV A - When the cancer has gone beyond the pelvic area and also spread to the rectum and balder area.

Stage IV B - This is where the cancer has metastasized in the groin area or gone to other organs within the body as well.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Liver cancer is when the cells in the liver grow uncontrolled. As the liver filters blood from all parts of the body, one of the most common reasons for liver cancer is perhaps metastasis, which is spread from other parts. Through the blood, cancer cells from other parts reach the liver for filtration and can then make the organ cancerous.

In addition to this, there are other risk factors that can lead to liver cancer. For example, people suffering from obesity, alcohol and tobacco abuse, viral hepatitis (B or C), chronic liver disease (especially in men, who are more prone than women to develop cancer), cirrhosis and someone who has a history of a prolonged use of steroids can suffer from the disease. Also, while liver cancer is very rare in the Americas, it is very common in Africa and Southeast Asia as the prevalence of hepatitis is higher in these regions.

When it comes to the symptoms, it’s acceptable that liver cancer is insidious, and the exact point of origin cannot be identified. It continues to grow until symptoms become evident, which are also nonspecific. Before analyzing your health on your own, it’s always recommendable to seek an expert’s final word on it. Let’s take a look at the top signs that might point out towards liver cancer.

1. Abdominal pain: When you suffer a strong pain in the abdominal area, especially in the upper portion on the right side, it can signal a lump or a growing tumor in the liver. This can also be accompanied by middle or lower back pain.
2. Weight loss: Many a time, women who suffer from a sudden loss of weight can be going through a deadly disease like this one. In most cases, these weight loss cases show no attempts on the patient’s side, that is, the weight loss occurred for unknown reasons. A loss of appetite, without any reasons, is another indicator. These can result due to unexplained reasons and should be taken seriously.
3. White, chalky stools:This one is another tell-tale sign of liver cancer. Often, people tend to ignore stools in light, flaky colors. It is always better to consult a doctor, as you might be ignoring a sign of potential cancer.
4. Bloating: When you feel certain heaviness or bloating in the upper part of the abdomen due to fluid accumulation it indicates, which is one of the indicators for testing liver cancer.
5. Frequent body conditions: Apart from the above mentioned symptoms, one can also consider personal health history when facing any liver- related problems. Recurring severe nausea and vomiting and general signs of lethargy and weakness can also indicate liver cancer. Also, personal health history with claims the patient suffered from jaundice (due to the accumulation of bile pigments in the sclera and skin) can also be taken into consideration. If you wish to discuss about any specific problem, you can consult an Oncologist.

What is ECMO?
Like dialysis for unfunctional kidney, Ecmo for unfunctional lung.

Ecmo stands for extracorporeal membrane oxygenation. It is a method of giving oxygen for the body when icu pateint lungs and/or heart are not able to supply oxygen on their own. 

Why ICU pateint put on ECMO?

Doctors place ICU patients on ECMO when patients are not able to supply oxygen to the body.

ICU patients’ lungs fail for a number of reasons including pneumonia, lung cancer, pulmonary edema, pulmonary embolism and COPD.

 When a patient’s lungs fail, he/she first is intubated (breathing tube) and hooked up to a ventilator (breathing machine).
 However, sometimes lungs are so damaged that providing oxygen through intubation is not enough.

This is when doctors turn to v-v ecmo.
A heart can fail for many reasons including heart attack, pulmonary embolism, bad valve disease, or worsening heart failure. When a heart fails, doctors try to fix the underlying problem. They may also start medications (called ionotropes) to help improve the pump function of the heart. If medications are not enough, doctors will turn to v-a ecmo.

How long can someone stay on ecmo?

That is a complicated question. Due to the risks of ecmo discussed above, doctors try to keep patients on ecmo for as short a time as possible. Often patient will be on ecmo for several days up to 1-2 weeks. Every day, several blood and imaging tests are done to determine if a patient is ready to come off ecmo. As the technology of ecmo improves, hopefully side effects will decrease and patients can remain on ecmo for longer periods of time.

What is the difference between ecmo and a ventilator (breathing machine)?

Both ecmo and a ventilator aim to provide oxygen to the body when the patient’s own lungs and breathing are failing. The ventilator assists the patient’s own lungs by pushing oxygen with pressure into the lungs. Ecmo instead provides oxygen directly via a catheter placed in a patient’s vein or artery. We almost always try oxygenating a patient with a ventilator first. However, when a patient’s lungs are too sick for this, we turn to ecmo to assist in providing oxygen to the body. V-v ecmo provides oxygen through a vein. This blood then has to travel to the heart and be pumped around the rest of the body through arteries. Therefore, with v-v ecmo or with a ventilator, a patient must have a well-functioning heart to get the oxygen pumped throughout the body. V-a ecmo has the additional advantage of pumping blood directly to arteries. This “by-passes” the heart and is therefore the method of ecmo we use when a patient’s heart is failing.

Why and when to do liver cancer test?
The liver is a pyramid-shaped organ in our body that lies just below the right lung. It is the largest organ inside the human body. This vital organ is divided into right and left lobes and performs a number of functions. It makes bile necessary to digest fat, makes various proteins used by the body for a number of other purposes, breaks down toxic materials in the blood that are later removed by the body as waste, helps in blood clotting and stores certain nutrients absorbed from the intestine. Thus liver is primary to the healthy functioning of the human body. Liver cancer test in India when cancerous cells form in the liver, it is known as liver cancer. Primary liver cancer is cancer that starts in the liver tissue; whereas cancer that starts in some other site and spreads to the liver is classified as the secondary liver cancer. Varied methods & techniques are available to treat liver cancer.

Diagnosis: After examining your health and learning about family history, your doctor may tell you to go for one or more of the following tests for diagnosing liver cancer:

• Liver biopsy: Liver biopsy is done in order to remove a tissue sample from the suspected site in the liver. This tissue sample is analyzed under the microscope to confirm the presence of cancerous cells. Biopsy of liver laparoscopic biopsy, needle biopsy, and surgical biopsy are the different types of biopsies done.
• Blood tests: You may need to perform some blood tests like liver function tests (LFTs). Besides these, if a suspicion of liver cancer arises, doctors check the level of alphafetoprotein (AFP) in the blood. The level of AFP is usually found higher in people with primary level cancer; although there are cases of people with liver cancer having normal levels of AFP. Again the ratio of des-gamma-carboxy prothrombin is also checked.
• Ultrasound: Imaging tests are done to find suspicious sites that may be cancerous and also to know whether cancer has spread. Ultrasound uses sound waves to create an image on a video screen. This test can show tumors in the liver and these tumors are later tested for cancer if required.
• Computed tomography (scan): During a ct scan for diagnosing liver tumors, cross-sectional images of the abdomen are taken. Information regarding the shape, size, and location of the tumors in the liver or nearby blood vessels can be known which help the doctors plan certain treatments. Sometimes some contrast material may be used that aims to outline the intestine in order to avoid confusion regarding tumors. You may be given oral contrast or intravenous (iv) contrast.
• Magnetic resonance imaging (MRI): The difference between ct scan and MRI is that the latter uses radio waves and strong magnets instead of x-rays used by the former. Through waves and magnetic rays, certain images of the inside of the liver are taken. Your doctor can provide you contrast material if needed.
• Angiography: During an angiography, a contrast dye is injected into the bloodstream to know about the arteries supplying blood to a liver. This test is used for both surgical and non-surgical purposes.

Symptoms:
Liver cancer does not have any symptoms, of its own. However, the tumor causes some symptoms and these symptoms appear in the later stages of cancer. Sometimes these symptoms may show up in the early stages also. The common symptoms are mentioned below:

• Loss of appetite
• Vomiting
• Abdominal pain
• Unexplained weight loss
• Fever, yellowing of the skin and eyes (due to jaundice)
• Itching
• Feeling full while eating
• Wasting (cachexia)
• Increased swelling of the belly and feet
• Feeling of a mass under the ribs on the right side

Symptoms of liver cancer sometimes some tumors in the liver build hormones that influence other organs. These hormones may cause certain signs like low blood sugar levels, high cholesterols levels, enlarged breasts, high counts of red blood cells and high levels of calcium in the blood. If you have any of the symptoms at any stage of your life, you must consult your doctor right away to avoid unnecessary complications.

Stages:
The stages of liver cancer tell the doctor how far cancer has spread. Once the stage is determined, individualized treatment plans can be designed. There are different staging systems for this cancer, but all doctors across the globe do not follow the same system. The American joint committee on cancer (ajcc) is the commonly accepted method for staging liver cancer. According to this system, the stages can be evaluated on the basis of three main factors like:

• Tumor (t): It stands for the size and number of the original tumor.
• Lymph node (n): It describes if there is any cancer present in the nearby lymph nodes.
• Metastasis (m): It indicates whether cancer has spread to other parts of the body like lungs, bones etc.

Besides these, the letter x and a number (0-4) are also assigned to these factors. For instance, t1, t2, t3 and so on; a higher number refers to increasing severity. And the letter x indicates that no information could be gathered. Liver-cancer-stages-medifee

Usually, the size and number of the tumor (s) and whether cancer has spread to blood vessels or lymph nodes are the important criteria for staging liver cancer. Here a brief description of the 4 stages of liver cancer is described:

Stage 1: In stage 1, there is only one tumor and there is no growth of cancerous cells in the blood vessels, any other organs of the body or lymph nodes.

Stage 2: In this stage, there is a single tumor and it has started growing into the blood vessels. Again there may also be more than one tumor which is less than 5cm and have not grown into the blood vessels. In either of the case, cancer may be described to be in stage 2.

Stage 3: In this stage, 3 things can happen. Stage 3a refers to more than a single tumor and at least one of them is larger than 5 cm. But the cancerous cells have not grown in the lymph nodes or any other part of the body. Stage 3b refers to cancer that has grown either into the portal vein or hepatic vein. Again, there is no growth of cancerous cells in any part of the body or lymph nodes. Stage 3c describes the stage where cancer has spread into organs of the body that are close to the liver, like pancreas but not to lymph nodes or any distant organs.

Stage 4: Stage 4a refers to the phase where there can be more than one tumor of any size in the liver. Also, the cancerous cells may have spread to other organs around the liver and also blood vessels. Cancer has spread to lymph nodes but not to other body parts. Stage 4b is the phase when cancer has spread to another part of the body. The tumor is any size and may be more than one. It may have spread to the blood vessels and other organs around the liver. There may or may not be any presence of cancerous cells into the lymph nodes.

Doctors may follow any of the two staging criteria mentioned above or even go for some other staging processes.