There are many known substances or agents that play an important role in cancer formation these agents are called carcinogenesis which may be either viral carcinogens, physical carcinogens, genetic carcinogens and chemical carcinogens

How cancer formed or what is cancer 

The body is the basic unite of the life, so question how normal cells become cancer cells as we know the body contains millions of cells these normal cells undergo the process of growth ,division  in controlled manner to produce more cells as they need to keep the body healthy when these normal cells become old or damaged they die which called programmed cell death and are replaced by new normal cells but sometimes this normal orderly process goes wrong as we know also all normal cells in the body have a central nucleus which contains genes made from DNA, this gene control the function of the cell  when this genetic material DNA of the cell become changed or damaged by carcinogenic agents this lead to mutations that affect the normal cell growth and division ,when this occur the cells do not die when they should and new cells form when the body does not need them these abnormal cells not die but continuous to growth in abnormal manner without any control untill form mass called tumor then the cancer can spread or metastasis to other organs

the cancer is a complex process which arise from single cell 

There are many different types of cells in the body ,and many different types of cancer which arise from many different types of cells

What are the causes of cancer

Cancer causes can be divided into main four categories as follow

Viral causes

Physical causes

Genetic causes

Chemical causes

Viral causes of cancer

  There are several human viruses are known to have oncogenic properties, oncogens means  is a gene that has the potential to causes cancer and several have been causally linked to human cancers it is estimated that 15% of all human tumors worldwide are caused by viruses
Viruses may cause or increase the risk of malignancy through several mechanisms Including direct transformation, expression of oncogenes that interfere with cell-cycle check points or DNA re­pair, expression of cytokines or other growth factors, and alter­ation of the immune system
Oncogenic viruses may be RNA or DNA viruses, Oncogenic RNA viruses are retroviruses and con­tain a reverse transcriptaseAfter the viral infection, the single­ stranded RNA viral genome is transcribed into a double-stranded DNA copy which is then integrated into the chromosomal DNA of the cell Retroviral infection of the cell is permanent, thus integrated DNA sequences remain in the host chromosome Oncogenic trans­forming retroviruses carry oncogenes derived from cellular genes
These cellular genes, referred to as proto oncogenes, usually are involved in mitogenic signaling and growth control, and include pro­tein kinase, G proteins, growth factors, and transcription factors
Integration of the provirus upstream of a protooncogene may produce chimeric virus-cell transcripts and recombination during the next round of replication that could lead to incorporation of the cellular gene into the viral genome
Unlike the oncogenes of the RNA viruses, those of the DNA tumor viruses are viral, not cellular in origin
These genes are required for viral replication utilizing the host cell machinery

In permissive hosts, infection with an oncogenic DNA virus may result in a pro­ductive lytic infection, leading to cell death and the release of newly formed viruses
In non permissive cells, the viral DNA can be inte­grated into the cellular chromosomal DNA, and some of the early viral genes can be synthesized persistently,leading to transformation of cells to neoplastic state
Uno-compromised individuals are at elevated risk most patient,s infected with oncogenic viruses do not develop cancer when cancer does developIt usually occurs several years after the viral infection It is estimated, for example, that the risk of the hepatocellular carcinoma among hepatitis C virus-infected individuals is 1 to 3 % after 30 years
  There may be synergy between various environmental factors and viruses in carcinogenesisFactors that predispose to hepatocellular carcinoma
 Among hepatitis C virus-infected include heavy alcohol intake. hepatitis B co-infection and possibly diabetes

some examples for selected viral carcinogens

 Epstein Bar Virus
Related to Burkitts lymphoma ,Hodgkins disease, Immunosuppression related lymphoma, Nasopharyngeal carcinoma

Hepatitis B
 Related to Hepatocellular carcinomaHepatitis C

  Related to Hepatocellular carcinoma

  Human immunodeficiency virus or AIDSRelated to Kaposi,s sarcoma and non hodgkin,s lymphoma

Human papilloma virus type 16 and 18
Related to Cervical and  Anal cancers

 Human T -cell lymphotropic virus
  related to Adult T - cell leukemia and lymphoma

Physical causes of cancer

Physical carcinogenesis can occur through induction of inflamma­tion and cell proliferation over a period of time or through exposure to physical agents that induce DNA damage
Foreign bodies can cause chronic irritation that can expose cells to carcinogenesis by alter environmental agents

In humans it is associated with chronic irritation and inflammation such as
Chronic non healing wounds

  Burns
 Inflam­matory bowel syndrome have all been associated with an increased risk of cancer Helicobacter pylori is associated with gastritis and gastric cancer, and thus its carcinogenicity may be considered phys­ical carcinogenesis
The liver fluke Opisthorchis viverrini similarly leads to local inflammation and cholangiocarcinoma
The induction of lung and mesothelial cancers from asbestos fibers and non fibrous particles such as silica are other examples
If foreign-body-induced physical carcinogenesis asbestos and other fibrous minerals are the key determinants of their carcinogenicityShort fibers can be inactivated by phagocyto­sis while long fibers (> 10 um) are cleared less effectively and are encompassed by proliferating epithelial cells
The long fibere support cell proliferation and have been shown   to preferentially induce tumors
 Asbestos-associated biologic effects also may be mediated through reactive oxygen and nitrogen speciesFurther ­ more, an interaction occurs between asbestos and silica and compo­nents of cigarette smoke Polycyclic aromatic hydrocarbons (PAH) in cigarette smoke are metabolized by epithelial cells and form DNA adducts
 If PAH is coated on asbestos, PAH uptake is increased. Both PAH and asbestos impair lung clearance, potentially increasing
uptake further, Therefore, physical carcinogens may be synergistic with chemical carcinogens.

Radiation

 Is the best known agent of physical carcinogenesis and is classified as

 Ionizing radiation (x-rays, gamma rays, and alpha and beta particles) or

Non ionizing radiation (UV) The carcinogenic potential of ionizing radiation was recognized soon after Roentgen,s
, a large number­ of radiation-related skin cancers were reported
Long-term follow-up of survivors of the Hiroshima and Nagasaki atom bombs revealed that virtually all tissues exposed to radiation are at risk for cancer.

Radiation can induce a spectrum of DNA lesions that includes

damage to the nucleotide bases, cross-linking, and DNA single- and double-strand breaks (DSBS) Mis repaired DSBs are the principal lesions of importance in the induction of chromosomal abnormal­ities and gene mutations

DSBs in irradiated cells are repaired primarily by a non homologous end-joining process, which is error prone, thus DSBs facilitate the production of chromosomal rear­rangements and other large-scale changes such as chromosomal deletions
It is thought that radiation may initiate cancer by inacti­vating tumor suppressor genes
Activation of oncogenes appears to play a lesser role in radiation carcinogenesis
Although it has been assumed that the initial genetic events induced by radiation are direct mutagenesis from radiation, other indi­rect effects may contribute to carcinogenesis For example, radiation induces genomic instability in cells that persists for at least 30 generations after irradiation
 Therefore, even if cells do not acquire mutations at initial irradiation, they remain at risk for developing new mutations for several generations
Moreover, even cells that have not been directly irradiated appear to be at risk, a phenomenon referred to as the bystander effect irradiated cells may secrete cytokines or other factors that increase production of reactive oxy­gen species in bystander cells, or alternatively, the bystander effect may involve cell-cell communication via gap junctions

Non ionizing UV radiation

Is a potent DNA damaging agent and is known to induce skin cancer
Most non­ melanoma human skin cancers are thought to be induced by re­peated exposure to sunlight leading to a series of mutations that allow the cells to escape normal growth control
For example, mu­tations in the res oncogene and in the tumor suppressors p53 and PTCH have been identified in human skin cancers In most cases, the mutations induced by the UVB spectrum have been localized to pyrimidine-rich sequences, which indicate that these sites are probably the targets for UV-induced DNA damage and subsequent mutation and transformation
 Patients with inherited xeroderma pigmentosum lack one or more DNA-repair pathways, conferring susceptibility to UV-induced cancers, especially on sun-exposed body parts. Patients with ataxia telangiectasia mutated syndrome also have a radiation-sensitive phenotype

  Genetic causes of cancer

One widely held opinion is that cancer is a genetic disease that arises from an accumulation of mutations that leads to the selection of cells with increasingly aggressive behavior
These mutations may lead ei­ther to a gain of function by oncogenes or to a loss of function by tumor suppressor genes
Most mutations in cancer are somatic and are found only in the cancer cells
Most of our information on human cancer genes has been gained from hereditary cancers
 In the case of hereditary cancers, the individual carries a particular germline mutation in every cell
 In the past decade, more than 30 genes for autosomal dominant hereditary cancers have been identified a few of these hereditary cancer genes are oncogenes, but most are tumor suppressor genes,
Though hereditary cancer syndromes are rare, somatic mutations that occur in sporadic cancer have been found to disrupt the cellular pathways altered in heredi­tary cancer syndromes. suggesting that these pathways are critical to normal cell growth, cell cycle and proliferation

What are the criteria may suggest the presence of a hereditary cancer
. Tumor development at a much younger age than usual
. Presence of bilateral disease
. Presence of multiple primary mutiguancies
. Presentation of a cancer in the less affected sex (e.g.,male breast cancer
 Clustering of the same cancer type in relatives

. Cancer associated with other conditions such as mental retardation or pathognomic skin lesions
It is crucial that all surgeons taking care of cancer patients be aware of hereditary cancer syndromes, since a patient's genetic background has significant implications for patient counseling , planing of surgical therapy
Some examples of the more common hereditary cancer syndromes like as
 rb1 Gene and Hereditary Retinoblastoma
   P53 and U-Fraumeni Syndrome
hCHK2 li-fraumeni Syndrome. and Hereditary Breast cancer
BRCA1, BRCA2, and Hereditary Breast-Ovarian
Cancer Syndrome
   APC Gene and Familial Adenomatous Polyposis
   Mismatch Repair Genes and Hereditary Non polyposis Colorectal Cancer
   P16 and Hereditary Malignant Melanoma
  E- Cadherin and Hereditary Diffuse Gastric Cancer

Chemical Causes of cancer
the report that cancer could be caused by environmental factors it found that 60­ to 90% of cancers all! thought to be due to environmental factors
chemicals carcinogens are classified into three groups based on how they contribute to tumour formation

the first group of chemical agents the genotoxins which can initiate carcinogenesis by causing a mutations

the second group the co-carcinogens by themselves can not causes cancer but potentiate carcinogenesis by

enhancing the potency of the genotoxins

the third group tumour promoters enhance tumour formation when given after exposure to genotoxins

some important examples for chemical agents or carcinogens and it is relation to cancer causing

   Aflatoxins related to liver cancer

  Aresnic related to skin cancer

 Benzene related to leukemia

 Benzidine related to bladder cancer
   Berylium related to lung cancer

   Diethylstilbestrol  related to vaginal and cervical clear cell adenocarcinoma

   Estrogen replacement therapy related to endometrial and breast cancers

   tobacco products smokeless related to oral cancer

  Tobacco smoke related to lung cancer oral cancer pharyngeal laryngeal esophageal cancers pancreatic liver renal bladder cervical cancers and leukemia

Coal tar related to skin and scrotal cancers

tags:cancer,carcinogenesis,aflatoxins,asbestos

How we can diagnosed the cancer

How we can diagnosed the cancer

Cancer diagnosis can be done by the following methods such as laboratory diagnosis and clinical diagnosis such as the features or pictures of the cancers such as it is symptoms which means what the patient complaining and by it is signs which means what the doctor see or notice in the patient by the general and local examination of the whole body of the patient
 
what are the symptoms and signs of malignancy

Malignancy or cancer it is a neoplasm or tumor which can be represented by the following criteria

 Local features of the tumours
 Distant clinical features
 Systemic or general clinical features

Local features of the neoplasm or tumours
This cancer can be present either in the form of mass the patient complaining from abnormal something in his body like mass he felt it by his hand or the patient may complaining from pain which it is very rare in case of malignancy in the site of the tumor or the patient may complaining from change in the function of the organ which have the malignancy such as cancer intestine the patient may come with obstructive manifestations such as inability to pass stool ,abdominal distension,bleeding from rectum and may be vomiting

So that the local features of the cancer can be divided as follow
mass, pain ,changes in organ function obstruction in a hollow viscus ,bleeding or infarction
 
Mass

• Mass may be palpable

• Mass may be a primary tumour or lymph nodes enlarged or secondary lymphadenopathy

• Mass may be painful or more commonly, painless (eg breast lump, testicular lump cancer most commonly come without pain and very rare to become painful such as in some certain conditions
• May cause a mass effect
 Compression of surrounding structures such as cancer thyroid may compress on the trachea and esophagus o Raised ICP in intracranial lesions

Pain
What are the causes of pain in cancer
The pain in case of cancer may be a feature of

• Local mass compression on other structures or nerves

• Capsular stretch eg hepatic, renal carcinoma  may stretch the capsule overlying these organs producing pain
• Infiltration of regional nerves by the tumou or cancer cells which produce neurological pain

• Obstruction of a hollow lumen any structures have a lumen such as intestine ,colon,rectum,esophagus,larynx and pharynx the cancer can causes obstruction of the lumen of these structures because the tumor occupying the lumen by itself may causes pain  

• Metastasis cancer spread to other organs such as the bone can produce bone pain which may be severe boring pain and may not respond to usual analgesia and may need for narcotic to relieve it

Changes in organ function
The cancer can produce changes in the function of that organ have a cancer such as when cancer spread or metastasis to the liver produce jaundice which mean yellowish discolouration of the sclera of the eye and skin of the patient and ascitis which mean accumluation of the fluid inside the abdominal cavity and the patient may complaining from abdominal distension or the cancer spread to the lungs and the patient complaining from shortening of breathing and pleural effusion which mean accumulation of malignant fluid in the pleural cavity or the cancer spread to the brain and the patient may complaining from headache blurring of vision and neurological deficits or to the bone and the patient may complaining from bone pain as above or from repeated bone fractures or pathological fractures

Obstruction in a hollow viscus

• The cancer may arising from inside the lumen of the structures( intraluminally) (eg embolism of tumour invading large vessel

• The cancer may arising from the vessel or lumen wall (eg annular circumferential rectal tumour

• The cancer may arising extraluminally (eg peritoneal deposits obstructing ureters

Bleeding
The cancer may causes bleeding which may be due to
May be effect of local tumour ulceration eg rectal carcinoma
May be result of erosion into large vessel eg gastric cancer
Acute bleed into tumour mass may provoke pain eg hepatoma
Infarction torsion and infarction of ovarian masses

GENERAL CLINICAL FEATURES OF NEOPLASMS

General features of neoplasms include
Anaemia

Metabolic effects

Exudates

Paraneoplastic syndromes

Cancer cachexia

Ectopic hormone secretion

Distant clinical features of the tumours

Anaemia

• Occult or overt bleeding

Poor nutritional state

• Low erythropoietin production

Metabolic effects

Weight loss
Anorexia
Pyrexia
Altered sensation eg taste

Specific effects of metastasis
.Exudates eg ascites pleural effusion
Bone metastasis and pathological fractures

Discussions of paraneoplastic syndrome
Paraneoplastic syndromes refer to non-metastatic systemic symptom complexes accompany malignant disease. Symptoms may affect any system of the body and occur
remotely from the site of the primary tumour of secondary deposits. They may be due to
the release of cytokines or autoimmunity generated by cross-reactivity against antibodies
produced against the tumour

Types of paraneoplastic syndrome

Approximately 10% of patients with advanced malignancies have paraneoplastic syndromes. These syndromes are divided into the following categories: miscellaneous(non-specific), rheumatological, renal, gastrointestinal, haematological, cutaneous endocrine, and neuromuscular.

Paraneoplastic syndromes

Rheumatological

Arthropathies, Scleroderma

SLE

. Amyloidosis

Renal

Tumours that can produce ACTH, antidiuretic hormone (ADH), and gut hormones. may cause hypokalaemia, hyponatraemia or hypernatraemia, hyperphosphoramia and alkalosis/acidosis

Nephrotic syndrome

Gastrointestinal

Malabsorption (especially with tumours that produce prostaglandins eg medullary thyroid
Diarrhoea

Haematological Anaemia Thrombocytosis

Disseminated intravascular coagulation (DIC) Migrating vascular thrombosis (Trousseau syndrom
Cutaneous
Itching  Herpes zoster Alopecia Hypertrichosis   Acanthosis migricans (blackish pigmentation of the skin occurring in patients with
metastatic melanomas or pancreatic tumours
Endocrine Cushing syndrome (excessive ACTH or ACTH-like peptides

- Hypercalcaemia (osteolysis or calcaemic humoral substances

Neuromuscular

.Neuromyopathic syndromes such as myasthenia gravis

;management of paraneoplastic syndromes
 respond to resection of the primary tumour. In some cases, where there are clearly identifiable autoantibodies, immunosuppression is considered

Cancer cachexia

 Cachexia is a wasting syndrome with progressive loss of body fat and severe weakness. is unclear but it may be related to the secretion of cytokines by the tumour or response to the tumour. It does not occur in proportion to tumour size (eg can occur dramatically in small oesophageal tumours
Ectopic hormone secretion and neoplasia

 Many tumors that arise from endocrine tissue continue to secrete functional hormones. some tumors that have no basis in endocrine tissue also secrete peptide molecules that are very similar in structure to active hormones or hormone fragments and these molecules acts as analogues
 mostly commonly these peptides mimic the CRF-ACTH axis and result in Cushing syndrome
sometimes ADH may be released and the syndrome of inappropriate ADH is produced

 Laboratory diagnosis

The definitive diagnosis of solid tumors is usually obtained with a biopsy of the lesion Biopsy determines the tumor histology and grade and thus assists in definitive therapeutic planning
When a biopsy has been obtained at an outside institution, the slides should be reviewed to confirm the outside diagnosis
Biopsies of mucosal lesions usually are obtained endoscopically e.g., via colonoscope in case of cancer colon or rectum bronchoscope in case of cancer bronchus, or cystoscope in case of cancer urinary bladder

Lesions that are easily palpable, such as those of the skin, can either be excised or sampled by punch biopsy

 Deep-seated lesions can be localized
with CT scan or ultrasound guidance for biopsy

A sample of a lesion can be obtained with

•  Fine-needle aspiration
•    Open incisional biopsy
•  core-needle biopsy
• excisional biopsy 

 Fine-needle aspiration is easy and relatively safe, but has
the disadvantage of not giving information on tissue architecture
. For example, fine-needle aspiration biopsy of a breast mass can make the diagnosis of malignancy, but cannot differentiate between an invasive and non invasive tumor

  Core-needle biopsy is more advantageous when the histology will affect the recommended therapy

Core biopsy like fine-needle as­piration, is relatively safe and  can be performed either by direct palpation (e.g a breast mass or a soft-tissue mass) or can be guided by an imaging stady (e.g., stereotactic core biopsy of the breast

 Core biopsies, like fine-needle aspirations, have the disadvantage of introducing sampling error

For example, some patients with a diagnosis of atypical ductal hyperplasia on core biopsy of a mam­mographic abnormality are found to have carcinoma upon excision of the lesion it is crucial to ensure that the histologic findings are
consistent with the clinical scenario, and to know the appropriate interpretation of each histologic finding 
, Open biopsies have the advantage of providing more tissue for
histologic evaluation and the disadvantage of being an operative procedure

lncisional biopsies are reserved for very large lesions in which a definitive diagnosis cannot be made with needle biopsy

 Ex­cisional biopsies are performed for lesions in which core biopsy is either not possible or is non diagnostic

Excisional biopsies should be performed with curative intent, that is, by obtaining adequate tissue around the lesion to ensure negative surgical margins

 Orien­tation of the margins by sutures or clips by the surgeon and inking of the specimen margins by the pathologist will allow for determi­nation of the surgical margins and will guide surgical re-excision
If one or more of the margins are positive for microscopic tumor or close

The biopsy incision should be oriented to allow for excision­ of the biopsy scar if repeat operation is necessary

The biopsy incision should directly overlie the area to be removed rather than tunneling from another site, which runs the risk of con­taminating a larger field

Finally, meticulous hemostasis during a biopsy is essential since a hematoma can lead to contamination of the tissue planes and can make subsequent follow-up with physical examinations much more challenging

What are the techniques of tumours cytology 

These including the following cytology techniques

Bruchings eg oesophagus and cervix

FNAC , Fluids either physiological eg cells in urine or sputum or pathological eg cells in ascites or pleural effusion

 The cytological features of malignancy are

• loss of cellular cohesiveness: nuclei oriented in different directions and are irregularly­
  spaced
• Cells become detached from one another
•   Pleomorphism: variation in size, shape and number of nucleoli
•  moulding of nuclei: nuclei appear pushed into one another or stacked together like a vertebral column
•  Nuclear to cytoplasmic ratio increased
•  Chromatin shows irregular clumping and hyperchromasia nuclear membrane is irregular with angular bites
• Abnormal mitoses may be present

what are the difference between cytology and histology in the diagnosis of malignancy

• Fine nuclear detail may be lost in formalin fixed histology

•  Cohesiveness of cells is more easily evaluated on cytologic material
• Histologic sections provide added information on tissue architecture and relation­ ship of cancer cells to normal structures depth of invasion, presence of vascular invasion, etc

What are the histological features or architectural of malignant tumours 
invasion of the underlying or surrounding tissue: extension of tumour beyond the basement membrane for carcinomas and an irregular front penetrating the surrounding tissue
for mesenchymal tumour

stromal changes: the change that occurs in the stroma as tumour invades is called desmoplasia it is a response to invasion of tissue by malignant tumour cells

Loss of normal structure: as tumours become less and less differentiated, they resemble the tissue of origin less and less­

new structures: some tumours will create structures such as glandular structures colon, endometrium cancers or papillary structures thyroid, bladder cancers

Necrosis: may indicate areas of tumour that have insufficient blood supply Angiogenesis and neovasculature

 Inflammation: tumours often cause inflammation and the inflammatory infiltrate is visible immunostaining: an antibody is raised against a protein of particular prognostic significance­
the distribution and concentration of which can then be identified

It can be used for

 
• Identifying poorly differentiated tumours

• Sub-typing tumours

• Identifying an unknown primary from a metastatic deposit

• Assessing tumour microvessel density and angiogenesis

tags:cancer,diagnosis,biopsy,neoplasm

Tumor markers for cancer detection

Tumor markers for cancer detection

Definition:Tumour markers are substances that can be detected in higher than normal amounts in the blood or serum ,urine, nipple ,aspirate fluid or stool and tissues of patients with certain types of cancer

How tumor markers produced

Tumors markers are produced either by the cancer cells themselves or by the body as a response to the cancer which can be detect by immunohistochemistery
 These tumor markers can be present also in some benign diseases

What are the aim of tumour markers
tumour markers are useful in diagnosis, staging ,treatment and detection of recurrence of cancers
Over the past decade, there has been an especially large interest
in identifying tissue tumor markers that can be used as prognostic or predictive markers. Although the terms prognostic marker and predictive marker are sometimes used interchangeably, the term prognostic marker usually is used to describe molecular markers that predict disease-free survival, disease-specific survival. and overall survival, while the term predictive marker is often used in the context of predicting response to certain therapies

The goal is to identify prognostic markers that can give informa­tion on prognosis independent of other clinical characteristics, and therefore can provide information in addition to what can be pro­jected on the basis of clinical presentation

This could allow us to further classify patients as being at higher or lower risk within clin­ical subgroups and to identify patients who may benefit most from adjuvant therapy. Ideally, prognostic tumor markers would be able to help determine which group of patients with node-negative breast cancer is at higher risk of relapse and thus provide adjuvant systemic therapy only to that group. regarding potential prognostic tumor markers for breast cancer
What are the predictive markers

Predictive tumor markers 
 Are markers that can prospectively identify patients who will benefit from a certain therapy. Some of the best predictive markers are estrogen receptor and HER2|neu. which can identify patients who can benefit from antiestrogen therapies (e.g. tamoxifen) and anti-HER|neu therapies (e.g. trastuzumab), respectively

 There is increasing interest in identifying predictive markers for chemotherapy so that patients can be given the reg­imens they are most likely to benefit from, while those who are most likely to benefit from existing conventional therapies can be spared the toxicity of the therapy and be offered investigational therapies

Examples for serum tumour markers as follow

PSA prostate specific antigen

• A prostatic epithelial protein

• Elevated if> 4 ng/dl, in general

• Used in conjunction with digital rectal examination, transrectal sonography needle biopsy for screening diagnosis and monitoring of treatment of prostatic cancer

• It is also elevated in benign prostatic hyperplasia, prostatitis, prostatic urinary retention, instrumentation and even ejaculation

• Thought not to rise significantly following rectal examination

• PSA velocity measures rate of change of PSA with time (> 0.7ng|dl suggessts malignancy

• PSA density compares PSA value with volume of prostate (> 0.15 suggests malignancy

• Age-related PSA (older patients have a higher normal cut-off

• Free-total PSA ratio 25% suggests malignancy

PSA is normally present in low concentrations in the blood of all adult males

CEA carcinoembryonic antigen

Is a glycoprotien found in the embryonic endodermal epithelium

 
An oncofetal antigen, normal, expressed in ermbryonic gut, liver, pancreas

Elevated in colorecral carcinoma In 60-90% of cases

may also be elevated in ovarian and breast carcinoma

also occasionally elevated In cirrhosis,alcoholic hepatitis.  inflammatory bowel disease,pancreatitis

Not specific or sensitive enough to be used as a screening tool

 Used to monitor efficacy of therapy and detection of recurrence

Alpha fetoprotein alpha-FP

Is glycoprotein normally produced by a developing fetus

AFP level decrease soon after birth to around 10 ng|ml in healthy adults

An embryonic antigen

Elevated in carcinoma of liver (also in cirrhosis, chronic hepatitis, normal pregnancy, fetal neural tube defects

Also elevated in non-seminomatous germ cell tumours of the testes NSGCT

AFP  is considered to be sensitive and specific enough to be used for screening for hepatocellular carcinoma

in higher risk populations 

 

Can be used for screening healthy hepatitis B  virus with annual or semi annual AFP levels and to screen

carriers with cirrhosis or chronic hepatitis and patient with cirrhosis of any etiology with twice yearly AFP

and liver ultrasound

Human chorionic gonadotrophin beta-hCG

A hormone

Elevated in pregnancy
Elevated in choriocarcinoma, non-small cell germ cell tumour (NSGCT) and in 7%
of seminomas where syncytiotrophoblastic elements are present

CAantigens CA-125 for non-mucinous ovarian cancers. A high concentration is more likely to associated

with malignancy. Can be used to monitor therapy. Can be raised in other conditions (eg pancreatitis

endometriosis, breast and pancreatic carcinomas

 CA-15-3 a glycoprotein, occasionally elevated in breast carcinoma

  CA-19-9 a glycoprotein sometimes elevated in pancreatic and advanced colorectal carcinoma

Thyroglobulin elevated in some thyroid carcinoma
 

Calcitonin elevated in medullary thyroid carcinoma
 
 ACTH and ADH are elevated in some lung carcinomas

lactate dehydrogenase cancer type germ cell tumours

Immunogobulins cancer type multiple myeloma and

waldenstrom macroglobulinema can be present in blood and

urine(Bence Jones protein) in urine

Fibrin and fibrinogen cancer type bladder cancer present in urine
HE4  ovarian cancer
HER2|NEU cancer types are breast gastric oesophageal cancer
Estrogen receptor (ER) Progestrone receptor (PR) in breast
 
Cancer tissue analyzed the tumour itself

CD20  non hodgkin lymphoma

tags:markers,tumor,cancer,immunohistochemistery

Internal fixation for treatment bone fractures

Internal fixation for treatment bone fractures

Fixation of bone fractures can be divided into external and internal fixations

Internal fix­ation

Definition
Are implants that are fitted directly on to or put down the inside of the bone and are then covered with soft tissues and skin ,Internal fixation can allow accurate reduction of fractures, and allows strong and stable fixation, so that the patient can rapidly return to everyday activities, with the minimum of inconvenience
Internal fixation is best performed under a tourniquet, if possible in order to obtain a blood-free view
Internal fixation requires careful preplanning and the best surgery is performed if the fractures are drawn out on stencils first, and the problems of reduction and obtaining mechanical stability planned in advance

Soft-tissue dissection should be kept to a minimum but must be adequate to obtain a clear view and access

 

External fixation
 Are those where the mechanical strength of the construct is outside the skin or fixation of fracture outside the skin

There are two main ways in which a fracture can be held which make a profound difference to the way in which the fracture heals

  

Rigid fixation blocks the normal callus formation of bone healing.The bone appears to be unaware that there is a frac­ture if there is no movement at the fracture site

As the bone undergoes normal physiological remodelling. the fracture cleft is gradually obliterated by new bone

This takes about a year During that time the fixation must share the loads normally taken by the bone

Most implants fatigue under the repetitive load imposed by the human body and will soon fail if the bone does not heal and take over its original function

Fracture healing is therefore a race against time: the bone must unite before the implant fails or the construct will col­lapse

• Non-rigid means of fixing (such as plaster of Paris) allow limited movement and loading of the fracture site

 The aim is to allow movement and load to stimulate callus formation without allowing the fracture to redisplace

This delicate bal­ancing act depends on the quality of the fixation the type of fracture and the compliance of the patient

Rigid versus non-rigid fixation

• Rigid fixation allows immediate loading but does not stimulate callous formation
• Non rigid fixation risks loss of reduction but stimulates rapid callus formation

Semi-rigid fixation

If the fixation of the fracture is not completely rigid then some callus will form rapidly. but the patient may be able to resume near-normal function because the fracture is held stable if not immobile by the fixation

 This partial rigidity therefore offers the best of both worlds with rapid biological healing combined with the benefits of early mobilisation of the patient

Types of Internal fixation

Screws

  

 Can be used to hold plates on to bone or can he used in their own right to hold bone fragments together

In orthopaedics, screws have been standardised to an agreed set of diameters

The threads of the screws also come in two standard forms. one for cortical and the other for cancellous bone

The size of these thread, and their pitch (the distance between each thread) are specifically designed to give the best possible grip in healthy human bone

The drills which create the holes for these screws are also standerdised allow as snug a fit of the screws as possi­ble without putting under load on the bone Taps are also sup­plied which cut the grooves in the bone to take the threads of the screws tables are available in every orthopaedic theatre to show which drill should be used for which screw

Plates and screws

• Sizes of screw and plates are now standardised

• Maximum grip is obtained without risking crocking the bone

• Nevertheless, plates must be plated on the tension side of the bone

Lagging

 
If a screw is to be used to compress two bone fragments together it is important that the thread of the screw should grip only the distal fragment in which the tip of the screw is embedded. as the screw is tightened the shoulder of the screw (the part that tapers in under the head) presses down on the proximal fragment and compresses the two fragments together. If the thread of the screw engages with the proximal fragment the screw can actually hold the fragment apart

There are techniques used to ensure that the fragments are drawn together as the screw is tightened

First a screw can be used which has no proximal thread. just a smooth shaft this known as lag screw

An alternative strategy is to use a fully threaded screw but to drill the hole in the proximal fragment to a slightly larger size so that the screw threads cannot engage with the wall of the hole

This is called lagging the drill hole and serves the same purpose as using a lag screw

Lagging

• Ensures that bone fragments are drown together as the screw is tightened

Plates

Plate, come in several sizes. each designed to be used with a stan­dard set of screws

 They are designed to fit on to the curved sur­face of bone and to be held there by screws

 The plates can be used in several ways and there are specific plate designed for each function

Use of plates

 
• They can butress,compress or neutralise plates

• In all cases their strength is in tension

• They are not good at resisting bending

Buttress plates: Buttress plates prevent one fragment of bone slip­ ping on another

They are especially useful in oblique fractures in load bearing bones, when they will stabilise what is a very unstable­ fracture configuration

Dynamic compression plates :(DCP) Dynamic compression plates have oval screw holes in them with tapered walls

If the screw holes are drilled into the bone at one end of these holes (there are drill guides to assist in doing this) then the plate slides along the bone as the screw is tightened home

If the plate has already been firmly fixed to the other fragment then the slip can be used to compress the fragments of bone tightly together

This has the ben­efit of stabilising the construct by increasing the area of contact. it also appears to stimulate healing by putting the bone edges in close apposition

Neutralisation plates :Neutralisation plates are used to prevent bone ends from being distracted

They can be used to resist angular forces by being placed on the side of a bone that goes into tension when load is applied the side that opens when the fracture bends

Plates with screws are excellent at resisting tension

 and this is how they are used in neutralisation

Plates have very little resistance to bending and so should never be put on the side of the bone that is in compression and which will go into concave angulation when load is applied

Wires

Wires are much less traumatic than plates and screws

 They can be used temporarily to hold fragments reduced while plates and screws are applied

They can also be used to resist shear where loads are not great. They are especially useful m children's frac­tures, when plates and screws could damage the epiphyseal plate

Wires can cross the growth plate without causing long-term effects and if left protruding from the skin can be removed when the fracture is secure without the need for a further surgery

The value of wires

• Can be introduced and removed percutaneously

• Safe to cross an epiphyseal plate

• Can be used as a guide for cannulated screws
Kapanji wires These are a technique which can be used in fractures in which Impaction may have left a defect that leaves the fracture unstable when reduced

After the fracture has been dis­impacted and reduced, wires are introduced into the fracture cleft on the side of the defect

 As soon as the tip of the wire is in the medulla the wire is tilted so that its tip travels proximally and embeds on the Inside of the far cortex

 One or more wires placed in this way substitute for the missing cortex and work with the intact periosteum on the other side to create a stable reduction

Figure-of-eight wiring This allows a strong wire suture to be woven over the cortex of bone which is held in tension
The device is not prominent and so fits well subcutaneously and is commonly used on the olecranon and on the patella 

Intramedullary nails

Implants driven down the medulla of a long bone sutter from a significant mechanical disadvantage because they must be narrower than the bone into which they are introduced, The resistance of an implant to bending and twisting proportional to the square of its diameter, Nevertheless, the medulla can provide a natural guide for the implant, and introducing the nail into one end of the bone (under image intensifier control) minimizes the risk of infection from opening the fracture, .and preserves the periosteal blood supply

 Nails are now available for the humerus and tibia as well as the femur

 In recent years the scope of intramedullary nails has been increased by the introduction of the locking nail
 
This system has hole through the nail at each end. using jigs or an image intensifier screw can be passed through the bone, the hole in the nail and out through the opposite cortex of the bone. This produces a construction that holds the bone rigidly,and is especially resistant to twisting it follow an intramedullary nail to be used for a far greater range of long bone fractures including those in the metaphysis some of the newer nails can now be passed down the medulla without requiring any reaming in advance the unreamed nails this makes the operation quicker and reduces the trauma to the patient

Advantages of intramedullary nails

• Now available for all major long bones

• Can be put in closed and unreamed

• Locking screws gives great stability

• Periosteal blood supply is preserved

• Patient can be mobilised early

Disadvantages and complications of internal fixation

The disadvantages of internal fixation are those of damage to soft tissues, especially blood supply

The rigidity of fixation slows the natural healing process, even though it allows earlier mobilisation of the patient

Internal fixation is technically demanding, requires a large range of implants and instruments, and is best performed in ultra clean theatres as infection is a disaster
 
This includes size and type of plates and position of screws. Only in this way can the operation be performed quickly and cleanly (minimising the risk of tissue damage and infection) so that the strongest fixation is obtained.
 There are complications inherent in using a tourniquet such as cuff damage to nerves as a result of inflation to an excessive pressure and problems of reper­fusion injury if the cuff is left inflated for too long.

Exposure of the fracture may damage the soft-tissue attachments to the bone and produce avascular fragments, which will delay or even prevent fracture union

The risk of infection can be minimised by cleaning out open
fractures and leaving them open with the fractures stabilised until it is certain that all dead and contaminated tissue has been removed

Only when they are clean should they be closed delayed primary closure

When internal fixation is used, infection is min­imised by performing quick, tidy and well-planned surgery, and by adhering to strict theatre discipline on theatre sterility
. Surgery should be covered by three doses of a broad-spectrum antibiotic which has good activity against Staphylococcus (the most common infective organism) and Streptococcus (the second most common

Internal fixation can also leave unsightly scars, and should be planned to minimise cosmetic deformity without compromising­ access

Drills and screws can damage nerves and vessels

 Drill guards should always be used to prevent soft tissues being inadvertently dragged into a spinning drill

When the drill is cutting into the far cortex, the hand that the surgeon is using to hold the drill should have a straight finger resting on the limb through which the drill is passing

Only light pressure should be applied to the drill so that when the drill then comes out through the far cortex it will not suddenly penetrate deep in the soft tissues on the far side of the bone where it might perforate a nerve or vessel .

Complications of Internal fixation

• Damage to soft tissues and blood supply

• Risk of introducing infection

•Callus formation is inhibited

Indications for removal of internal fixation

Implants for internal fixation are made of surgical-grade stainless steel and should not corrode

Nevertheless, the alloys con­tain transitional metal such as chromium and vanadium, whose salts are allergenic toxic and may even be carcinogenic

Despite this, there is little evidence that metalware left in patients for long periods causes any chemical or even allergic problems

Children should have metalware removed if it is likely to compromise growth

It should be removed as early as possible because periosteal bone grows rapidly over the plates and makes their removal difficult

 Internal fixation also shields the bone around it from load and so may cause local osteoporosis

The load passing down the bone may then peak at the end of a plate (a stress raiser) and cause a fracture

 Internal fix­ation of a fracture next to an old plate already embedded in the bone is very difficult to manage

Despite this, it is now normal practice to leave plates and even intramedullary nails in the patient unless they are causing pain or there is another specific reason for the patient to receive another general anaesthetic for another procedure
in which case plates can be removed at the same time

Reasons for removing metalwork

• Plates may load shield, producing osteoporosis

• Salts of stainless steel may be toxic in long term


tags:fixation,internal,bone,fractures,plate

Pig or swine influenza causes types diagnosis and treatment

Pig or swine influenza causes types diagnosis and treatment

Introduction

Pig or swine influenza it is a viral infection which affect human and can produce mild to severe disease and the disease is transmitted from people to other people

Transmission of virus from pigs to human is not common and rare to causes human flu

Pig or swine influenza also known as 2009 virus which caused by influenza A serotype  H1N1

HA means haemagglutinin and NA means neuraminidase which they are the viral proteins that determine the subtype of influenza virus for example A|H1N1 and H3N2 v
The HA and NA are important in the immune response against virus antibodies the NA protein is the target of the antiviral drugs such as relenza and tamiflu

The pig or swine virus are more common and more dangerous in those with low immunity from any causes such as extreme of age eg infants, child and old age also in pregnant woman ,immune-compermized patient such as AIDS,diabetic patient ,cancer or patient with malignancy or on chemotherapy ,patient with chronic pulmonary air way diseases and cardiovascular diseases or blood diseases such as leukemia, renal and hepatic diseases and neurological diseases
What are the classification of virus influenza
There are three known types of virus influenza type A,B and C that can causes human flu but in pigs there is two types influenza A which is common and influenza C which is rare

Influenza A
Pig or swine influenza is known to be caused by influenza type A subtypes H1N1,H1N2,H2N3,H3N1,and H3N2 in 2012 the center for disease control and prevention CDC confirmed the presence H3N2 v
What are the methods of transmission in human
People in direct contact or exposure to poultry and swine are more liable for infection with influenza virus endemic in these animals such as farm worker
In human influenza spread between humans when infected people cough and sneeze ,then other people breathe in the virus or touch something with the virus on it such as tables or glasses and then people touch their own face such as eye ,nose and mouth

What are the symptoms and signs in human

• The patient may complaining from symptoms similar to those of usual influenza 
• The patient may complaining from high grade body temperature fever
• The patient may complaining from sore throat 
• The patient may complaining from cough and increased nasal secretion
• The patient may complaining from body ache or generalized skeletal pain
• The patient may complaining from severe headache
• The patient may complaining from lethargy and fatigue and loss of appetite
• The patient may complaining from diarrhea and vomiting which important
• The patient may complaining from chills and shivering
• These are symptoms not specific to swine flu so that the CDC advise the doctors to consider swine influenza infection in the differential diagnosis of patients with acute febrile  respiratory illness who have either  been in contact with person with confirmed swine flu
• To confirm the diagnosis that need for laboratory testing by taken simple swab from the nose and throat
• Best method of diagnosis recommended by CDC it is real time polymerase chain reaction( PCR )as the method of choice to diagnosis H1N1
• The patient may complaining from the virus complications such as respiratory failure and pneumonia

What are the complications of swine virus

There are some complications which can be associated with swine virus which may be the causes of death such as respiratory failure ,pneumonia ,renal failure,  dehydration and electrolytes imbalance due to excessive vomiting and diarrhea ,high fever can affect the brain and lead to neurological manifestations

 

What are the methods of human transmission prevention

There are two methods that can prevent transmission of the virus as follow

Prevention OF transmission from pigs to human

• The transmission of swine virus to human occur mainly in swine farms because they are in direct contact with living pigs ,although strains of swine influenza are usually not able to causes human infections so to prevent this transmission the farm workers and veterinarians or other people with direct contact with infected pigs should be use face masks when they deal with these animals
• There are risk factors which can increased transmission of the disease from swine to human such as smoking and people not wear gloves in his hands when working with these infected pigs so these leads to increased risk of  hand to eye,hand to nose or hand to mouth transmission
• Vaccination against swine virus to prevent their infection is consider a major method to limit swine to human transmission

Prevention OF transmission from human to human

• There are recommendation to prevent spread of infection between human such as
• Frequent washing of the hand with soap and water or with alcohol based hand sanitizers especially after being out in public also washing the face
• Using disinfecting materials such as diluted chlorine bleach solution for household surface more effective to decreased incidence of transmission
• Avoid touching your own eye ,nose and mouth by your hand
• As influenza can spread in cough and sneezes so small droplets of containing the virus can linger on tabletops telephones and other surface which transferred by the fingers to the eye ,nose and mouth but using alcohol based gel or foam hand sanitizers reduce the risk of transmission
• Any person with flu like symptoms such as sudden fever, muscle pain and cough should be stay away from work or public transportation and should contact a doctor for advise
• Social distancing is staying away from other people who might be infected and can include avoiding large gatherings,spreading out a little at work or may be stay in the home and lying low if an infection is spreading in community
• The patient should use a tissue to cover his mouth and nose when he get cough or sneeze and put them in a waste basket
• Follow your doctors instructions

What are the vaccination against swine virus

The Food and Drug Administration FDA approved that the new swine flu vaccine for use in United State on 2009  ,studies by the national institutes of health show a single dose  of the vaccine can created enough antibodies to protect against the virus within about 10 days

What are the treatment of pig or swine virus in human

Treatment can be including the following items

Antiviral drugs

  These drugs make the disease mild and make the patient feel better faster

These drugs also can reduce or prevent  the risk of the complications

These drugs give better result when they start early within first two days of the symptoms

The U.S.Centers for disease Control and Prevention recommends the use of oseltamivir (Tamiflu) or zanamivir (Relenza) for the treatment and or prevention of infection with swine influenza virus

It is important to know that most of people infected with virus make a full recovery without requiring medical attention or antiviral drugs

It was found that the virus isolated in the 2009 outbreak have been found resistant to other antiviral drugs such as amantadine and rimantadine

Beside antiviral drugs the patient need supportive care either at home or better at hospital for controlling of their symptoms such as fever and to relieve pain and maintaining fluid balance also for treatment any associated complications or other medical problems

Don not take aspirin because it may lead to reyes syndrome

tags:pig,influenza,swine,H1N1,tamiflu

Carcinoma of thyroid gland types causes diagnosis and treatment

Carcinoma of thyroid gland types causes diagnosis and treatment

Introduction

Thyroid gland is that gland which present in front of the neck which has two lobes one on each side connected together by an isthmus taken butter fly appearance

Thyroid gland is responsible for release of thyroid hormones such as tri-iodothyronine T3 tetra-iodiothyronine T4 and thyroid stimulating hormones TSH ,these hormones are responsible for the process of metabolism in the body if there is any disorders affect the release of these hormones are associated with diseases either in the form of increased secretion of thyroid hormones causing hyperthyroidism or decreased secretion of thyroid hormones causing hypothyroidism 

 

Thyroid cancer is a malignant tumor or neoplasm which arise from either follicular or parafollicular cells of the thyroid gland it is uncommon cancer which affect women more than men ,there are several types of thyroid cancer and different methods of treatment

 

What are the causes of cancer thyroid 

 There are certain factors which may associated with cancer thyroid such as

• Exposure to irradiation head and neck exposure to irradiation such as X rays during childhood for treated other diseases such as tuberculosis or TB of the lymph nodes which was done in the past these patients are more liable for development of cancer thyroid
• Endemic cancer such as the incidence of follicular carcinoma  is high in endemic areas possibly due to TSH stimulation
• Presence of benign thyroid lesions which may transformed to malignancy such as adenoma of the thyroid gland especially in male ,nodular goitre and Hashimotos thyroiditis
• Cancer thyroid may occur alone without previous causes DE Novo such as anaplastic carcinoma
• Hereditary causes may be found

What are the types of  thyroid cancer

 

There are several types of thyroid cancer as follow

• Papillary:it is the most common type of thyroid cancer account for more than 60% which can occur in young age begins in the follicular cells characterized by localized slowly growing nodule,can spread through lymphatic vessels to lymph nodes which is the main route of spread  it is hormonal dependency tumor and if diagnosed early and treated give good result and best prognosis
• Follicular : it is the second most common causes account for about 17% which also begins in the follicular cell of the thyroid gland can occur in young and old age characterized by slow rate of growth but more than papillary type ,can spread to through the blood to the lung and bones which is the main route of spread it is Iodine uptake tumor and if diagnosed early and treated can give better result but less than papillary type
• Anaplastic :it is least common type account for about 13% of thyroid cancer common in old age patient above 60 years ,begins also in follicular cells of thyroid gland , characterized by large rapid growing highly infiltrating mass ,can spread either by direct spread to surrounding organs which is the main route of spread or to the lymph nodes through lymphatic spread or to the lung bones liver and brain through blood spread,give temporary response to external irradiation has poor prognosis
• Medullary :less common type of thyroid cancer which arise from parafollicular cells called C- cells of thyroid gland which secreted calcitonin characterized by some tumors are familial runs in family and form part on multiple endocrine syndrome type II MEN type II or Sipples syndrome which has two forms MEN type IIa which consists of medullary carcinoma pheochromocytoma and hyerparathyyroidism ,MEN type IIb when the familial form is associated with prominent mucosal neuromas involving lips , tongue and eyelids can spread through lymphatic to the lymph nodes or through the blood to the lungs bone brain and liver which is the main route of spread the disease common associated with diarrhea due to 5 -hydroxy traptophan 5HT or prostaglandins produced by the tumor cells,calcitonin is a biomarker  it is non hormonal dependent can give good result after treatment without blood spread or metastases

What are the symptoms and signs of thyroid cancer

• The patient may complaining from mass or swelling in front of the neck
• The patient may not complaining and the thyroid mass or swelling is discovered incidentally by the physician during routine examination
• The patient may complaining from thyroid swelling of recent onset with rapid increased in size 
• The patient may complaining from pain either in front of the neck or in the ear earache due to Arnolds nerve infiltration by cancer cells this nerve is the auricular branch of the vagus nerve
• The patient may complaining from difficulty in swallowing dysphagia due to swelling compression on the esophagus
• The patient may complaining from change in his voice in the form hoarseness of voice due to recurrent laryngeal nerve infiltration by cancer cells
• The patient may complaining from shortening or difficulty in breathing dypsnea and cough either due to swelling compression effect or due to spread of cancer cells to the lungs
•    The doctor may showing by examination thyroid swelling which it is hard ,tender,irregular and fixed
• The doctor may show enlarged lymph nodes which hard and  mobile then become fixed
• The doctor may showing other signs of distant metastases or cancer spread such as loos of weight and jaundice in case of liver affection

When we can suspected thyroid cancer

 

Thyroid cancer can be suspected to be malignant in the following cases

• When there is thyroid swelling or goitre with previous history of head and neck exposure to irradiation
• When thyroid swelling present either in young or very old ages
• When thyroid swelling become increased in size and rapid growth
• When thyroid swelling associated with pain 
• When thyroid swelling become hard ,irregular and fixed or with limitation of it is mobility
• When there is blood or lymphatic metastases 

What are the investigations of cancer thyroid

 

Laboratory

 

Complete blood count

For anemia and fitness

   Liver function test

For elevation of liver enzymes in case of liver metasteses

Tumor markers

For detection of of thyrogobulin for differentiated carcinoma or calcitonin for medullary carcinoma

Tumor markers definition types and its aims

Thyroid function test

For T3,T4,TSH hormones of thyroid gland either elevated or decreased

Other according to the case

 

Radiological

 

Thyroid ultrasound

 

To differentiated between cystic from solid swelling

 

Thyroid scanning

 

By radioactive iodine to show the thyroid nodule which appear as

 

Cold nodule (inactive nodule)  a cold nodule it is the nodule which takes up no isotope such as in case of cancer  thyroid or common in cystic nodule

 

  Hot nodule or overactive nodule which takes up isotope while the surrounding thyroid tissue is inactive because the nodule is producing such high levels of thyroid hormones that TSH secretion is suppressed such as in case of hyperthyroidism

 

 Warm nodule or active nodule in which the warm nodule take isotope like normal thyroid tissue

 

X rays

For the neck ,chest,skull,spine and pelvis for detection cancer metastases

 

Laryngoscopy and bronchoscopy

For detection of recurrent laryngeal nerve or tracheal invasion by cancer cells

 

CT scanning of the head neck and chest and brain

MRI scanning of the head neck chest and brain

 

Whole body scanning

 

By using radioactive iodine which go through circulation to different body organs to detect cancer metastases

Other according to the case

 

Thyroid biopsy

 

Biopsy of thyroid gland it is essential for diagnosis of thyroid cancer which may be done by an open operation by surgical removal of the swelling or by needle fine needle aspiration cytology FNAC or by true cut needle biopsy which taken for histological examination under microscope for detection of cancer cells

If an enlarged lymph node is present it may be removed through a small incision directly over it and taken for microscopic examination for detection of cancer cells

 

What are the treatment of thyroid cancer

Treatment of thyroid cancer depend on many factors such as the type of the cancer the size of the cancer ,the age of the patient , there is distant metastases to other organs such as to the liver lungs bone brain lymph nodes or no the patient fit for operation or no

Treatment of thyroid cancer can be done by the following methods

Surgical

 

Surgical removal of thyroid gland by an operation called thyroidectomy

 

Radiotherapy

External irradiation indicated in case of some thyroid cancer which can not be treated by surgery or for recurrent cancer after it is removal or as palliative treatment to relieve pain or ulceration can be used in anaplastic cancer

 radiotherapy how it is work types and its complications

 

Hormonal therapy

 

    Some thyroid cancers are hormonal dependent and can respond to thyroid hormones like L-thyroxine such as papillary and follicular carcinoma

  Hormonal therapy how it is work types and its complications

Chemotherapy

 

Can be used in some thyroid cancer such as medullary carcinoma and analpastic cancer can be used also to relieve pain

Chemotherapy how it is work types and its complications

 

Radioactive iodine

 

Can be used in some thyroid cancer which its can uptake iodine such as follicular carcinoma by using sodium Iodide 131 which given by oral route then absorbed into the body and reach thyroid gland which trapped inside it which causes irradiation to the thyroid tissue and causing its damage so reduced secretion of thyroid hormones from thyroid gland  the half life of sodium Iodide 131 is eight days and can be retained in the body for several week and the excess Sodium Iodide are eliminated from the body through the kidney passing to the urine

tags:thyroid,cancer,malignancy,papillary,madullary