This medical term were found from 4 different sources | Health Encyclopedia
n. the spread of a malignant tumour from its site of origin. This occurs by three main routes: (1) through the bloodstream (haematogenous); (2) through the lymphatic system; (3) across body cavities, e.g. through the peritoneum (see transcoelomic spread). Highly malignant tumours have a greater potential for metastasis. Individual tumours may spread by one or all of the above routes, although *carcinoma is said classically to metastasize via the lymphatics and *sarcoma via the bloodstream. —metastatic adj.
The spread of cancer cells through the blood, lymphatics or directly and establishment of these newgroups of cells at locations distant from the original cancer.
Metastasis, and metastatic, are terms applied to the process by which malignant disease spreads to distant parts of the body, and also to the secondary tumours resulting from this process. For example, a cancer of the breast may produce metastatic growths in the glands of the armpit; cancer of the stomach may be followed by metastases in the liver. Metastases are colloquially known as secondaries and their spread occurs through the bloodstream, lymphatic system and across the body cavities. Highly malignant tumours – for example, melanomas – are especially prone to spread far and fast. (See CANCER.)
A secondary cancerous tumour (one that has spread from a primary cancer to another part of the body). The term also applies to the process by which such spread occurs. Metastases can spread through the lymphatic system, in the bloodstream, or across a body cavity.
– the hormone which provokes the adrenal cortex into action.
Symptoms The clinical symptoms appear slowly and depend upon the severity of the underlying disease process. The patient usually complains of appetite and weight loss, nausea, weakness and fatigue. The skin becomes pigmented due to the increased production of ACTH. Faintness, especially on standing, is due to postural HYPOTENSION secondary to aldosterone de?ciency. Women lose their axillary hair and both sexes are liable to develop mental symptoms such as DEPRESSION. Acute episodes – Addisonian crises – may occur, brought on by infection, injury or other stressful events; they are caused by a fall in aldosterone levels, leading to abnormal loss of sodium and water via the kidneys, dehydration, low blood pressure and confusion. Patients may develop increased tanning of the skin from extra pigmentation, with black or blue discoloration of the skin, lips, mouth, rectum and vagina occurring. ANOREXIA, nausea and vomiting are common and the sufferer may feel cold.
Diagnosis This depends on demonstrating impaired serum levels of cortisol and inability of these levels to rise after an injection of ACTH.
Treatment consists in replacement of the de?cient hormones. HYDROCORTISONE tablets are commonly used; some patients also require the salt-retaining hormone, ?udrocortisone. Treatment enables them to lead a completely normal life and to enjoy a normal life expectancy. Before surgery, or if the patient is pregnant and unable to take tablets, injectable hydrocortisone may be needed. Rarely, treated patients may have a crisis, perhaps because they have not been taking their medication or have been vomiting it. Emergency resuscitation is needed with ?uids, salt and sugar. Because of this, all patients should carry a card detailing their condition and necessary management. Treatment of any complicating infections such as tuberculosis is essential. Sometimes DIABETES MELLITUS coexists with Addison’s disease and must be treated.
Secondary adrenal insu?ciency may occur in panhypopituitarism (see PITUITARY GLAND), in patients treated with CORTICOSTEROIDS or after such patients have stopped treatment.... Medical Dictionary
Course of the disease is unpredictable, cases surviving for many years on primary or supportive herbal treatment. Suspected malignancy should be referred to modern hospital treatment immediately. Early detection is vital.
Common signs calling attention are: (1) Unusual bleeding or discharge. (2) Tired feeling all the time. (3) Thickening or lump in breast or elsewhere. (4) Sudden change in hair texture and colour. (5) Irritable cough or hoarseness. (6) Extreme mental depression. (7) Obvious change in a mole or wart. (8) Muscle weakness and cramps. (9) A sore that does not heal. (10) Change in bowel or bladder habit. (11) Sudden weakness of the eyes. (12) Difficulties in swallowing; indigestion. (13) Excess wind in stomach or bowel.
Tumour-killing effect of chemotherapy may be intensified and side-effects minimised (loss of weight, and of white blood cells) when certain neoplastic herbs are prescribed. Cytotoxic drugs inhibit the ability of Vitamin C to stimulate the body’s defences. Herbs enhance the body’s self-healing ability to eliminate. An inoperable cancer would appear to be good grounds for herbal medication which often relieves pain and preserves a man’s dignity in his hour of extremity.
A series of medical trials in Finland revealed that terminal cases had 12 per cent lower mean serum selenium concentration than controls. Other similar trials point to the need for selenium supplements. Those with both low selenium and low Vitamin E levels are especially at risk.
See: GERSON CANCER THERAPY.
Exercise. High levels of fitness are associated with lower death rates. (American study)
Plants with a special reference to cancer include: Blue Flag, Burdock, Clivers, Condurango, Echinacea, Guaiacum, Houseleek, Poke root. There are many more referred to in medical literature.
Poke Root. John Bartram reported in the late 18th century that from his experience among the Mohawk Indians, Poke root (Phytolacca decandra) was a “cure” for cancer. (American Indian Medicine, Virgil J. Vogel)
Blood Root. For internal or external bleeding of cancer.
Calendula (Marigold). For the same purpose.
Mistletoe. Dr Alfred Vogel advises an extract of the plant (Loranthus europaeus) as grown on the Oak tree: dose: 10-15 drops.
Almonds. Edgar Cayce, Virginia Beach, USA, with some successes to his credit, advised eating three almonds a day to counter any tendency towards the disease.
Laetrile. From Apricot kernels that contain cyanogenic glucosides. Though competent physicians have reported positive results in some terminal cases without prior surgery or radiation, the remedy has been withdrawn from general practice because of possible toxicity.
Much needless suffering may be incurred because of out-moded resistance of doctors and governments against prescribing morphine early in cancer patients. It is estimated that 50-80 per cent of patients do not receive satisfactory pain-relief because doctors fear tolerance of the drug would increase, necessitating a higher dosage. From the beginning of time the Opium Poppy has been the most effective analgesic for the terminal condition. Morphine is a respiratory depressant and some authorities believe it should be given before the final stages in continuous doses for adequate pain control. Risks must be balanced with benefits. Dangerous in asthmatics.
Way of Life. Herbal medication of malignant disease involves the patient with his treatment. Here is something he or she can do to regain some control over their life. It can give them the satisfaction of knowing that in some way they are ‘fighting back’ thus influencing the quality of life and a sense of well- being.
If improvement in cancer is not possible maybe the condition can be stabilised and the patient helped to cope with the very unpleasant side-effects of chemotherapy and radiation. Thus, may be restored the body’s natural balance and a possible extension of lifespan.
For this, patients and practitioners may need information and support. That is why suggestions for malignant disease are included in this book. Moreover, well-meaning friends and relatives may exert pressure on the patient ‘to leave no stone unturned’ in search of a cure. Thus every possible secondary treatment should be considered since any one may prove to contribute towards recovery. It is hoped that this book will invite a therapeutic alliance with members of the medical profession as well as with other practitioners.
Macmillan nurses help alleviate physical pain and the psychological distress that can accompany this illness. They are trained to help people with cancer and their families fight cancer with more than medicine.
All forms of cancer should be treated by or in liaison with a qualified medical practitioner or an oncologist. ... Bartrams Encyclopedia of Herbal Medicine
Causes of cancer include environmental factors such as sunlight, smoking, pollutants, alcohol consumption, and dietary factors. These factors may provoke critical changes in body cells in susceptible people. Susceptibility to certain cancers may be inherited.
Many cancers are now curable, usually by combinations of surgery, radiotherapy, and anticancer drugs. For information on particular cancers, refer to the organ in question (for example lung cancer; stomach cancer).... BMA Medical Dictionary
There are many causative factors, some of which are known; for example, cigarette smoking is associated with lung cancer, radiation with some sarcomas and leukaemia, and several viruses are implicated (see oncogenic). A genetic element is implicated in the development of many cancers. In many cancers a gene called *p53 is deleted or impaired: its normal function is to prevent the uncontrolled division of cells (see tumour necrosis factor). Whatever the initiating cause, cancer always results ultimately from DNA mutations.
Treatment of cancer depends on the type of tumour, the site of the primary tumour, and the extent of spread. *Truth-telling will be important for most cancer patients but is still hard for some clinicians.... Oxford | Concise Colour Medical Dictionary
By the blood and lymph cancer may be transferred (metastasised) to the lymph nodes under the arm, liver, brain or lungs. An association has been shown between a low intake of Vitamin A and lung cancer. Causes: occupational hazards, environmental pollution, radiation, keeping of pet birds. Cigarette smoking is a strong risk factor. Studies show that a high Vitamin A/carotene intake is protective against the disease in men. Among women, evidence of a similar protective effect has not been found. Vitamin C reduces cancer risk. The increased prevalence of smoking among women results in more female lung cancer. All smokers should drink freely carrot juice (Vitamin A).
Symptoms. Chronic irritative cough, difficult breathing, pain in the chest, recurrent spitting of blood, clubbing of fingers, weight loss.
Alternatives. Only transient benefit is obtainable, yet it may be sufficient to achieve a measure of relief from distressing symptoms. See: CANCER: GENERAL REMARKS. Mullein tea has its supporters. Bugleweed strengthens lung tissue and supports the action of the heart. Blood root is known to arrest bleeding (haemoptysis).
Tea. Equal parts: Red Clover, Gota Kola, Mullein. 2 teaspoons to each cup boiling water; infuse 5-15 minutes. 1 cup three or more times daily.
Formula No 1. Equal parts: Elecampane, Violet, Red Clover, Echinacea. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Thrice daily and, if necessary, at bedtime for relief.
Formula No 2. Tincture Blood root 10 drops; Liquid extract Dogwood 20 drops; Liquid extract Elecampane 200 drops (14ml); Liquid extract Bugleweed (Lycopus europ) 30 drops. Flavour with Liquorice if necessary. Dose: 1-2 teaspoons in water 3 or more times daily. (W. Burns-Lingard MNIMH)
Where accompanied by active inflammation, anti-inflammatories are indicated: Mistletoe, Wild Yam, etc.
Diet. A substance in fish oil has been shown to experimentally prevent cancer of the lung. Mackerel, herring and sardines are among fish with the ingredient. See: DIET – CANCER.
Chinese Herbalism. See: CANCER – CHINESE PRESCRIPTION.
Treatment by a general medical practitioner or hospital oncologist. ... Bartrams Encyclopedia of Herbal Medicine
Computed tomography can distinguish soft tissues from cysts or fat, but in general soft-tissue masses have similar appearances, so that distinguishing an in?ammatory mass from a malignant process may be impossible. The technique is particularly useful in patients with suspected malignancy; it can also de?ne the extent of the cancer by detecting enlarged lymph nodes, indicating lymphatic spread. The main indications for computed tomography of the body are: mediastinal masses, suspected pulmonary metastases, adrenal disease, pancreatic masses, retroperitoneal lymph nodes, intra-abdominal abscesses, orbital tumours and the staging of cancer as a guide to e?ective treatment.... Medical Dictionary
The metal is claimed to have a beneficial effect on asthma, high blood pressure, Raynaud’s disease, heart and circulatory disorders. Believed to be a challenge to cancer cells and metastasis.
Source plants: Aloe Vera, Comfrey (Symphytum pereginum), Chlorella, Bandai udo (Aralia cordata) and Bandai Moss; Pearl Barley.
Ginseng becomes defenceless against viruses and bacteria where there exists a deficiency of Germanium in the soil. (Dr Kazuhike Asai, Tokyo, Japan)
Garlic is rich in this trace element. (Dr Uta Sandra Goodman) ... Bartrams Encyclopedia of Herbal Medicine
Basically, the therapy consists of a vegetarian diet with meals of vegetables, fruits and whole grains, fresh or freshly prepared. Drinking water is replaced by hourly, fresh, raw juices of vegetables and fruits. Refined, altered, denatured or enhanced foodstuffs are forbidden. The diet is sodium, chloride, fat and protein restricted. Supplemental potassium, iodine, thyroid and crude liver extract comprise the medical armamentarium. A repeatable choleretic, enemas of a solution of boiled coffee, is administered to lower serum toxin levels. Coffee is a potent enhancer of the carcinogen detoxifying enzyme system, glutathione S-translerase (Wattenburg). The Gerson cancer therapy reduces accumulated tissue sodium and chloride, promoting diuresis. Gerson Therapy Center: Hospital de Baja California, at La Gloria, Mexico
Diet. Lunch and dinner contain ample cooked food, mainly to act as a ‘blotter’ to the daily intake of 5.25 pints fresh raw fruit juices that are the backbone of the therapy. Ingredients of the juices include 41bs raw organic carrots a day, with no harm to the liver. (JAM, May 1991, p5. Beata Bishop on her recovery from metastasised malignant melanoma)
The Gerson therapy is based on the ‘holistic’ philosophy which states that cancer represents a clinical manifestation of an underlying toxic condition. Such condition should receive primary treatment that is lifestyle orientated. The theme is: detoxification through internal cleansing. The diet and supplements are re-inforced by ‘positive thinking’ and supported by meditation and emotional balance. ... Bartrams Encyclopedia of Herbal Medicine
The later stages of the disease are marked by jaundice and ascites (excess fluid in the abdomen).
Tumours are often detected by ultrasound scanning, and diagnosis may be confirmed by liver biopsy.
A hepatoma can sometimes be cured by complete removal.
In other cases, anticancer drugs can help to slow the progress of the disease.
It is usually not possible to cure secondary liver cancer, but anticancer drugs or, in some cases, removal of a solitary metastasis may be advised.... BMA Medical Dictionary
Treatment. Maintain adequate fluid intake.
Tea. Formula. Angelica 2; Centuary 1; Marigold 1. 2 teaspoons to each cup boiling water; infuse 15 minutes. Add pinch Cayenne. Quarter-1 cup every 2 hours, according to age. Where recovery is tardy, add 3-4 drops Spearmint oil.
With nervousness: add 1 part skullcap.
With swollen testicles or ovarian involvement: Agnus Castus.
Absence of urine: Yarrow.
Alternative formula:– Echinacea 2; Poke root 1; Yarrow 2. Dose: Liquid Extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Children: 1 drop for each year to age of 5; 2 drops thereafter to age of 10. Thrice daily.
Tablets/capsules. Poke root. Echinacea.
Malecite Indians: Cramp bark. Echinacea. Decoction.
European traditional. Balm tea, internally, half-1 cup freely. Externally to bathe face and genitals. Tinctures: Formula. Equal parts: Pulsatilla, Ginkgo, Vinca major. Adults: 1-2 teaspoons in water thrice daily. Children: 1 drop for each year to 5 years; thereafter 2 drops each year to 12.
Metastasis. Equal parts, Liquid Extracts. Pulsatilla (testes and mammae); Skullcap (Brain); Vinca major (pancreas). Dosage as Liquid Extract.
Gargle. 5-10 drops Tincture Myrrh in glass of water freely.
Hot compress. St John’s Wort oil to neck or face (Dr A. Vogel).
Poultice to reduce swelling: fresh Mullein leaves.
Vitamins. A. B-complex, C. D. E.
Minerals. Calcium. Iodum. Zinc. Dolomite.
To be treated by or in liaison with a qualified medical practitioner. ... Bartrams Encyclopedia of Herbal Medicine
Surgery may be most common, and is often the only treatment, for some gastrointestinal tumours, soft-tissue tumours, gynaecological tumours and advanced cancers of the head and neck.
Radiotherapy uses ionising radiation to kill tumour cells. Radiation is by naturally occurring isotopes (see ISOTOPE) or arti?cially produced X-RAYS. Germ-cell tumours (see SEMINOMA; TERATOMA) and malignant lymphomas (see LYMPHOMA) appear to be particularly sensitive to irradiation, and many head and neck tumours, gynaecological cancers, and localised cancers of the PROSTATE GLAND and URINARY BLADDER are curable with radiotherapy. It is also a valuable means of reducing pain from bone metastases (see METASTASIS). Unpleasant side-effects are common: chie?y lethargy, loss of appetite and dry, itchy skin symptoms.
Chemotherapy is also an important treatment in germ-cell tumours (see above); in some forms of LEUKAEMIA and lymphoma; in ovarian cancer (following surgery – see OVARIES, DISEASES OF); and in small-cell lung cancer (although most patients die within 18 months – see LUNGS, DISEASES OF). It is also used in some breast cancers (see BREASTS, DISEASES OF); advanced myeloma (see MYELOMATOSIS); sarcomas (see under CANCER); and some childhood cancers (such as WILMS’ TUMOUR).
More than 20 substances are in common use, the major classes being ALKYLATING AGENTS (e.g. cyclophosphamide, chlorambucil, busul fan); ANTIMETABOLITES (e.g. methotrexate); VINCA ALKALOIDS (e.g. vincristine, vinblastine); and antitumour ANTIBIOTICS (e.g. actinomycin D). Choice of agent and the appropriate regimen requires expert guidance. Common side-effects include nausea and vomiting, bone-marrow suppression and ALOPECIA, with each substance having its own spectrum of unwanted effects.
Good doctor-patient communication, with the sharing of information and bringing the patient into the decision-making process, is vital even if time-consuming and exhausting.
Equally imortant treatment is PALLIATIVE, for example to ensure e?ective pain or nausea control. Common sources of pain in cancer may involve bone, nerve compression, soft tissue, visceral, myofascial, constipation, muscle spasm, low-back pain, joint pain (e.g. capsulitis) and chronic post-operative pain. Patients may be suffering from more than one pain, all of which should be identi?ed. The aim should be to eliminate pain.
There are three rungs of the analgesic ladder; if one rung fails, the next one should be tried:
(1) non-opioid drugs – for example, aspirin, PARACETAMOL, NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS); (2) weak opioids – for example, CODEINE, DIHYDROCODEINE, dextropropoxyphene; (3) strong opioids
– for example, MORPHINE, DIAMORPHINE, buprenorphine. Oral treatment is always preferable, unless prevented by severe vomiting. (See also CANCER; ONCOLOGIST; PAIN; PALLIATIVE CARE.)... Dictionary of Tropical Medicine
Beams of radiation may be directed at the tumour from a distance, or radioactive material
– in the form of needles, wires or pellets – may be implanted in the body. Sometimes germ-cell tumours (see SEMINOMA; TERATOMA) and lymphomas (see LYMPHOMA) are particularly sensitive to irradiation which therefore forms a major part of management, particularly for localised disease. Many head and neck tumours, gynaecological cancers, and localised prostate and bladder cancers are curable with radiotherapy. Radiotherapy is also valuable in PALLIATIVE CARE, chie?y the reduction of pain from bone metastases (see METASTASIS). Side-effects are potentially hazardous and these have to be balanced against the substantial potential bene?ts. Depending upon the type of therapy and doses used, generalised effects include lethargy and loss of appetite, while localised effects – depending on the area treated – include dry, itchy skin; oral infection (e.g. thrush – see CANDIDA); bowel problems; and DYSURIA.... Dictionary of Tropical Medicine
Others appear under their appropriate alphabetical headings: ACNE; ALBINISM; ALOPECIA; ALOPECIA AREATA; APHTHOUS ULCER; BASAL CELL CARCINOMA; BOILS (FURUNCULOSIS); BOWEN’S DISEASE; CALLOSITIES; CANDIDA; CHEILOSIS; CHEIRAPOMPHOLYX; DANDRUFF; DERMATOFIBROMA; DERMATOMYOSITIS; DERMATOPHYTES; DERMOGRAPHISM; ECTHYMA; ERYSIPELAS; ERYTHEMA; ERYTHRASMA; ERYTHRODERMA; ESCHAR; EXANTHEM; FUNGAL AND YEAST INFECTIONS; HAND, FOOT AND MOUTH DISEASE; HERPES GENITALIS; HERPES SIMPLEX; HERPES ZOSTER; IMPETIGO; INTERTRIGO; KELOID; KERATOSIS; LARVA MIGRANS; LICHEN; LUPUS; MADURA FOOT; MELANOMA; MILIARIA; MOLLUSCUM CONTAGIOSUM; MOLE; MYCOSIS FUNGOIDES; NAEVUS; ORF; PEDICULOSIS; PEMPHIGUS; PHOTOCHEMOTHERAPY; PHOTODERMATOSES; PITYRIASIS; PORPHYRIAS; PRURITUS; PSORIASIS; RINGWORM; ROSACEA; SARCOIDOSIS; SCABIES; SCLERODERMA; URTICARIA; VITILIGO; WARTS; XANTHOMATA.
Skin cancer Primary cancer is common and chronic exposure to ultraviolet light is the most important cause. BASAL CELL CARCINOMA is the most common form; squamous cell carcinoma is less common and presents as a growing, usually painless nodule which may ulcerate. Squamous cancer may spread to regional lymph glands and metastasise, unlike basal cell cancer. Occupational exposure to chemical carcinogens may cause squamous carcinoma – for example, cancer from pitch warts or the scrotal carcinoma of chimney sweeps exposed to coal dust in earlier centuries. Squamous carcinoma of the lip is associated with clay-pipe smoking.
Cancer may arise from the population of melanocytes of the skin (see MELANOCYTE; MELANOMA).
Apart from these three most frequent forms of skin cancer, various forms of cancer can arise from cells of the dermis, of which LYMPHOMA is the most important (see also MYCOSIS FUNGOIDES).
Lastly, secondary deposits from internal cancer, particularly from the breast, may metastasise to the skin.
Dermatitis and eczema These are broadly synonymous, and the terms are frequently interchangeable. Eczema is a pattern of in?ammation with many potential causes. Dermatitis is commonly used to suggest an eczema caused by external factors; it is a common pattern of in?ammation of the skin characterised by redness and swelling, vesiculation (see VESICLE), and scaling with intense itching and often exudation (weeping). Fissuring, thickening (licheni?cation – see LICHEN) and secondary bacterial infection may follow. Dermatitis can affect any part of the body. It may be genetically detemined or due to other ‘internal’ factors, such as venous HYPERTENSION in a leg, or stress. Often it is ‘external’ in origin – due to strong irritants or chemical allergens. (See also ALLERGY; ALLERGEN.) ATOPIC DERMATITIS is genetic in origin and usually begins in infancy. It may persist for years, and ASTHMA, allergic RHINITIS and conjunctivitis (see under EYE, DISORDERS OF) – ‘hay fever’ – may be associated. Atopic children tend to have multiple allergies, especially to inhaled allergens such as house-dust mite, cat and dog dander and pollens. Allergy to foods is less common but potentially more dangerous, especially if to nuts, when it can cause acute URTICARIA or even ANAPHYLAXIS. Atopic subjects are particularly prone to persistent and multiple verrucae (see WARTS) and mollusca (see MOLLUSCUM CONTAGIOSUM) and to severe HERPES SIMPLEX infections. (See also ATOPY.)
EXFOLIATE DERMATITIS (PITYRIASIS RUBRA)
Generalised exfoliation and scaling of the skin, commonly with ERYTHEMA. Drugs may cause it, or the disorder may be linked with other skin diseases such as benign dermatoses and lupus erythematosus (see under LUPUS). SUMMER POMPHOLYX is an acute vesicular eczema of the palms and soles recurring every summer. Inhaled allergens are a frequent cause. VENOUS (STASIS) DERMATITIS begins on a lower calf, often in association with PURPURA, swelling and sometimes ulceration. Chronic venous hypertension in the leg, consequent on valvular incompetence in the deep leg veins owing to previous deep vein thrombosis (see VEINS, DISEASES OF), is the usual cause. NEURODERMATITIS A pattern of well-de?ned plaques of licheni?ed eczema particularly seen on the neck, ulnar forearms or sides of the calves in subjects under emotional stress. IRRITANT CONTACT DERMATITIS Most often seen in an industrial setting (occupational dermatitis), it is due to damage by strong chemicals such as cutting oils, cement, detergents and solvents. In almost all cases the hands are most severely affected. ALLERGIC CONTACT DERMATITIS, in contrast, can affect any part of the body depending on the cause – for example, the face (cosmetics), hands (plants, occupational allergens) or soles (rubber boots). Particularly common allergens include metals (nickel and chromate), rubber addititives, and adhesives (epoxy resins).
Treatment Avoidance of irritants and contact allergens, liberal use of EMOLLIENTS, and topical application of corticosteroid creams and ointments (see CORTICOSTEROIDS) are central.... Medical Dictionary
Acute gastritis is an in?ammatory reaction of the gastric mucosa to various precipitating factors, ranging from physical and chemical injury to infections. Acute gastritis (especially of the antral mucosas) may well represent a reaction to infection by a bacterium called Helicobacter pylori. The in?ammatory changes usually go after appropriate antibiotic treatment for the H. pylori infection. Acute and chronic in?ammation occurs in response to chemical damage of the gastric mucosa. For example, REFLUX of duodenal contents may predispose to in?ammatory acute and chronic gastritis. Similarly, multiple small erosions or single or multiple ulcers have resulted from consumption of chemicals, especialy aspirin and antirheumatic NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS).
Acute gastritis may cause anorexia, nausea, upper abdominal pain and, if erosive, haemorrhage. Treatment involves removal of the o?ending cause.
Chronic gastritis Accumulation of cells called round cells in the gastric mucosal characterises chronic gastritis. Most patients with chronic gastritis have no symptoms, and treatment of H. pylori infection usually cures the condition.
Atrophic gastritis A few patients with chronic gastritis may develop atrophic gastritis. With or without in?ammatory change, this disorder is common in western countries. The incidence increases with age, and more than 50 per cent of people over 50 may have it. A more complete and uniform type of ATROPHY, called ‘gastric atrophy’, characterises a familial disease called PERNICIOUS ANAEMIA. The cause of the latter disease is not known but it may be an autoimmune disorder.
Since atrophy of the corpus mucosa results in loss of acid- and pepsin-secreting cells, gastric secretion is reduced or absent. Patients with pernicious anaemia or severe atrophic gastritis of the corpus mucosa may secrete too little intrinsic factor for absorption of vitamin B12 and so can develop severe neurological disease (subacute combined degeneration of the spinal cord).
Patients with atrophic gastritis often have bacterial colonisation of the upper alimentary tract, with increased concentration of nitrite and carcinogenic N-nitroso compounds. These, coupled with excess growth of mucosal cells, may be linked to cancer. In chronic corpus gastritis, the risk of gastric cancer is about 3–4 times that of the general population.
Postgastrectomy mucosa The mucosa of the gastric remnant after surgical removal of the distal part of the stomach is usually in?amed and atrophic, and is also premalignant, with the risk of gastric cancer being very much greater than for patients with duodenal ulcer who have not had surgery.
Stress gastritis Acute stress gastritis develops, sometimes within hours, in individuals who have undergone severe physical trauma, BURNS (Curling ulcers), severe SEPSIS or major diseases such as heart attacks, strokes, intracranial trauma or operations (Cushing’s ulcers). The disorder presents with multiple super?cial erosions or ulcers of the gastric mucosa, with HAEMATEMESIS and MELAENA and sometimes with perforation when the acute ulcers erode through the stomach wall. Treatment involves inhibition of gastric secretion with intravenous infusion of an H2-receptorantagonist drug such as RANITIDINE or FAMOTIDINE, so that the gastric contents remain at a near neutral pH. Despite treatment, a few patients continue to bleed and may then require radical gastric surgery.
Gastric ulcer Gastric ulcers were common in young women during the 19th century, markedly fell in frequency in many western countries during the ?rst half of the 20th century, but remained common in coastal northern Norway, Japan, in young Australian women, and in some Andean populations. During the latter half of this century, gastric ulcers have again become more frequent in the West, with a peak incidence between 55 and 65 years.
The cause is not known. The two factors most strongly associated with the development of duodenal ulcers – gastric-acid production and gastric infection with H. pylori bacteria – are not nearly as strongly associated with gastric ulcers. The latter occur with increased frequency in individuals who take aspirin or NSAIDs. In healthy individuals who take NSAIDs, as many as 6 per cent develop a gastric ulcer during the ?rst week of treatment, while in patients with rheumatoid arthritis who are being treated long term with drugs, gastric ulcers occur in 20–40 per cent. The cause is inhibition of the enzyme cyclo-oxygenase, which in turn inhibits the production of repair-promoting PROSTAGLANDINS.
Gastric ulcers occur especially on the lesser curve of the stomach. The ulcers may erode through the whole thickness of the gastric wall, perforating into the peritoneal cavity or penetrating into liver, pancreas or colon.
Gastric ulcers usually present with a history of epigastric pain of less than one year. The pain tends to be associated with anorexia and may be aggravated by food, although patients with ‘prepyloric’ ulcers may obtain relief from eating or taking antacid preparations. Patients with gastric ulcers also complain of nausea and vomiting, and lose weight.
The principal complications of gastric ulcer are haemorrhage from arterial erosion, or perforation into the peritoneal cavity resulting in PERITONITIS, abscess or ?stula.
Aproximately one in two gastric ulcers heal ‘spontaneously’ in 2–3 months; however, up to 80 per cent of the patients relapse within 12 months. Repeated recurrence and rehealing results in scar tissue around the ulcer; this may cause a circumferential narrowing – a condition called ‘hour-glass stomach’.
The diagnosis of gastric ulcer is con?rmed by ENDOSCOPY. All patients with gastric ulcers should have multiple biopsies (see BIOPSY) to exclude the presence of malignant cells. Even after healing, gastric ulcers should be endoscopically monitored for a year.
Treatment of gastric ulcers is relatively simple: a course of one of the H2 RECEPTOR ANTAGONISTS heals gastric ulcers in 3 months. In patients who relapse, long-term inde?nite treatment with an H2 receptor antagonist such as ranitidine may be necessary since the ulcers tend to recur. Recently it has been claimed that gastric ulcers can be healed with a combination of a bismuth salt or a gastric secretory inhibitor
for example, one of the PROTON PUMP INHIBITORS such as omeprazole or lansoprazole
together with two antibiotics such as AMOXYCILLIN and METRONIDAZOLE. The long-term outcome of such treatment is not known. Partial gastrectomy, which used to be a regular treatment for gastric ulcers, is now much more rarely done unless the ulcer(s) contain precancerous cells.
Cancer of the stomach Cancer of the stomach is common and dangerous and, worldwide, accounts for approximately one in six of all deaths from cancer. There are marked geographical di?erences in frequency, with a very high incidence in Japan and low incidence in the USA. In the United Kingdom around 33 cases per 100,000 population are diagnosed annually. Studies have shown that environmental factors, rather than hereditary ones, are mainly responsible for the development of gastric cancer. Diet, including highly salted, pickled and smoked foods, and high concentrations of nitrate in food and drinking water, may well be responsible for the environmental effects.
Most gastric ulcers arise in abnormal gastric mucosa. The three mucosal disorders which especially predispose to gastric cancer include pernicious anaemia, postgastrectomy mucosa, and atrophic gastritis (see above). Around 90 per cent of gastric cancers have the microscopic appearance of abnormal mucosal cells (and are called ‘adenocarcinomas’). Most of the remainder look like endocrine cells of lymphoid tissue, although tumours with mixed microscopic appearance are common.
Early gastric cancer may be symptomless and, in countries like Japan with a high frequency of the disease, is often diagnosed during routine screening of the population. In more advanced cancers, upper abdominal pain, loss of appetite and loss of weight occur. Many present with obstructive symptoms, such as vomiting (when the pylorus is obstructed) or di?culty with swallowing. METASTASIS is obvious in up to two-thirds of patients and its presence contraindicates surgical cure. The diagnosis is made by endoscopic examination of the stomach and biopsy of abnormal-looking areas of mucosa. Treatment is surgical, often with additional chemotherapy and radiotherapy.... Medical Dictionary
Tamoxifen is also used to treat INFERTILITY, being taken on certain days of the menstrual cycle (see MENSTRUATION).... Medical Dictionary
Varieties Some are of an infective nature, as already stated; some arise as the result of injury, and several contributing factors are mentioned under the heading of CANCER.
Traditionally tumours have been divided into benign (simple) and malignant. Even benign tumours can be harmful, because their size or position may distort or damage nerves, blood vessels or organs. Usually, however, they are easily removed by surgery. Malignant tumours or cancers are harmful and potentially lethal, not just because they erode tissues locally but because many of them spread, either by direct growth or by ‘seeding’ to other parts – ‘metastasising’. Malignant tumours arise because of an uncontrolled growth of previously normal cells. Heredity, environmental factors and lifestyle all play a part in malignancy (see also ONCOGENES). Symptoms are caused by local spread and as a result of metastases. These cause serious local damage, for example, in the brain or lungs, as well as disturbing the body’s metabolism. Unless treated with CHEMOTHERAPY, RADIOTHERAPY or surgery or a combination of these, malignant tumours are ultimately fatal. Many, however, can now be cured. The original site and type of a malignant tumour usually determine the rate and extent of spread.
The type of cell and organ site determine the characteristics of a malignant tumour. The prognosis (outlook) for a patient with a malignant tumour depends largely upon how soon it is diagnosed. Staging criteria have been developed to assess the local and metastatic spread of a tumour, its size and also likely sensitivity to the types of available treatment. The ability to locate a tumour and its metastases accurately has vastly improved with the introduction of radionuclide and ULTRASOUND scanning, CT scanning and magnetic resonance imaging (MRI). Screening for cancers such as those in the breast, cervix, colorectal region and prostate help early diagnosis and usually improve treatment outcomes.
Tumours are now classed according to the tissues of which they are built, somewhat as follows:
simple tumours of normal tissue. hollow tumours or cysts, generally of simple nature.
malignant tumours: (a) of cellular structure, resembling the cells of skin, mucous membrane, or secreting glands; (b) of connective tissue.... Dictionary of Tropical Medicine
Ultrasound is replacing ISOTOPE scanning in many situations, and also RADIOGRAPHY. Ultrasound of the liver can separate medical from surgical JAUNDICE in approximately 97 per cent of patients; it is very accurate in detecting and de?ning cystic lesions of the liver, but is less accurate with solid lesions – and yet will detect 85 per cent of secondary deposits (this is less than COMPUTED TOMOGRAPHY [CT] scanning). It is very accurate in detecting gall-stones (see GALL-BLADDER, DISEASES OF) and more accurate than the oral cholecystogram. It is useful as a screening test for pancreatic disease and can di?erentiate carcinoma of the pancreas from chronic pancreatitis with 85 per cent accuracy.
Ultrasound is the ?rst investigation indicated in patients presenting with renal failure, as it can quickly determine the size and shape of the kidney and whether there is any obstruction to the URETER. It is very sensitive to the presence of dilatation of the renal tract and will detect space-occupying lesions, di?erentiating cysts and tumours. It can detect also obstruction of the ureter due to renal stones by showing dilatations of the collecting system and the presence of the calculus. Adrenal (see ADRENAL GLANDS) tumours can be demonstrated by ultrasound, although it is less accurate than CT scanning.
The procedure is now the ?rst test for suspected aortic ANEURYSM and it can also show the presence of clot and delineate the true and false lumen. It is good at demonstrating subphrenic and subhepatic abscesses (see ABSCESS) and will show most intra-abdominal abscesses; CT scanning is however better for the retroperitoneal region. It has a major application in thyroid nodules as it can di?erentiate cystic from solid lesions and show the multiple lesions characteristic of the nodular GOITRE (see also THYROID GLAND, DISEASES OF). It cannot differentiate between a follicular adenoma and a carcinoma, as both these tumours are solid; nor can it demonstrate normal parathyroid glands. However, it can identify adenomas provided that they are more than 6 mm in diameter. Finally, ultrasound can di?erentiate masses in the SCROTUM into testicular and appendicular, and it can demonstrate impalpable testicular tumours. This is important as 15 per cent of testicular tumours metastasise whilst they are still impalpable.
Ultrasonic waves are one of the constituents in the shock treatment of certain types of gallstones and CALCULI in the urinary tract (see LITHOTRIPSY). They are also being used in the treatment of MENIÈRE’S DISEASE and of bruises and strains. In this ?eld of physiotherapy, ultrasonic therapy is proving of particular value in the treatment of acute injuries of soft tissue. If in such cases it is used immediately after the injury, or as soon as possible thereafter, prompt recovery is facilitated. For this reason it is being widely used in the treatment of sports injuries (see also SPORTS MEDICINE). The sound waves stimulate the healing process in damaged tissue.
Doppler ultrasound is a technique which shows the presence of vascular disease in the carotid and peripheral vessels, as it can detect the reduced blood ?ow through narrowed vessels.
Ultrasound in obstetrics Ultrasound has particular applications in obstetrics. A fetus can be seen with ultrasound from the seventh week of pregnancy, and the fetal heart can be demonstrated at this stage. Multiple pregnancy can also be diagnosed at this time by the demonstration of more than one gestation sac containing a viable fetus. A routine obstetric scan is usually performed between the 16th and 18th week of pregnancy when the fetus is easily demonstrated and most photogenic. The fetus can be measured to assess the gestational age, and the anatomy can also be checked. Intra-uterine growth retardation is much more reliably diagnosed by ultrasound than by clinical assessment. The site of the placenta can also be recorded and multiple pregnancies will be diagnosed at this stage. Fetal movements and even the heartbeat can be seen. A second scan is often done between the 32nd and 34th weeks to assess the position, size and growth rate of the baby. The resolution of equipment now available enables pre-natal diagnosis of a wide range of structural abnormalities to be diagnosed. SPINA BIFIDA, HYDROCEPHALUS and ANENCEPHALY are probably the most important, but other anomalies such as multicystic kidney, achondroplasia and certain congenital cardiac anomalies can also be identi?ed. Fetal gender can be determined from 20 weeks of gestation. Ultrasound is also useful as guidance for AMNIOCENTESIS.
In gynaecology, POLYCYSTIC OVARY SYNDROME can readily be detected as well as FIBROID and ovarian cysts. Ultrasound can monitor follicular growth when patients are being treated with infertility drugs. It is also useful in detecting ECTOPIC PREGNANCY. (See also PREGNANCY AND LABOUR.)... Medical Dictionary