A Simple Guide to Pancreatic Cancer

A Simple Guide to Pancreatic Cancer
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What is Pancreatic Cancer?
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Pancreatic Cancer is a malignant disease of the exocrine pancreas. 90% are adenocarcinomas.

What are the causes of Pancreatic Cancer?
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1.Smoking. cigarettes smoke chemicals has been known to damage the pancreatic cells

2.Diets rich in red meat- high protein tends to stmulate more enzymes frm pancreas and cause dysfunction in the cells

3.Diabetes mellitus -damage to islets in pancreas may contribute to pancreatic cancer

4.Chronic pancreatitis has been found to have some causal effect

5.Helicobacter pylori infection -known to cause stomach cancer and also pancreatic cancer

6.Occupational exposure to certain chemicals including insecticides

7.Family history -there is a family history in 5-10% of pancreatic cancer patients

8.Obesity - the high fat diet may induce more disease of bile system with blockage of its tract

What are the symptoms and signs of Pancreatic Cancer?
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Symptoms - non-specific and varied.

1.pain in the upper abdomen that typically radiates to the back

2.pain relieved by leaning forward

3.painless jaundice related to bile duct obstruction (carcinoma of the head of the pancreas)

4.depression is sometimes associated with pancreatic cancer


Signs:

1.tenderness in upper abdomen

2.mass in the abdomen

3.Trousseau sign- Spontaneous blood clots in veins of extremities, or the superficial veins may indicate presence of pancreatic cancer.


How do you diagnose Pancreatic Cancer?
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Diagnosis can usually be made by :

History
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1.pain in upper abdomen radiating straight to the back, worse on eating

2.Weight loss severe with anorexia, early satiety, diarrhea, or steatorrhea.

3.Jaundice -initially painless, itchy with dark urine.
Painful jaundice occurs later

4.onset of atypical diabetes mellitus

5.unexplained recent thrombophlebitis

6.past history of pancreatitis

Location of cancer
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1.Tumors in the pancreatic body or tail usually present with pain and weight loss

2.Tumors in the head of the gland typically present with steatorrhea, weight loss, and jaundice.

Courvoisier sign
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presence of jaundice and a painlessly distended gallbladder is suggestive of pancreatic cancer

Liver function tests
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may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels).

CA19-9 (carbohydrate antigen 19.9)
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is a tumor marker that is frequently elevated in pancreatic cancer.

Ultrasound or abdominal CT
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may be used to identify tumors.

Endoscopic ultrasound (EUS) is another procedure that can help visualize the tumor and obtain tissue to establish the diagnosis.

What is the treatment of Pancreatic Cancer?
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Treatment of pancreatic cancer can be surgery or chemotherapy depending on the stage of the cancer.

Surgery
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1.Where the head of the pancreas is involved, the Whipple procedure is the most common surgical treatment for pancreatic cancers.
It is a major surgery involving the the resection of the head of pancreas and requres the patient to be fit for the surgery and the tumor to be localised without metastases. Only in small number of cases can the surgery be done.

2.Cancers of the tail of the pancreas can be removes by a technique called distal pancreatectomy

3.localized tumors of the pancreas have been surgically removed using laparoscopy.

4.Surgery may be performed for relief of symptoms especially if the cancer is invading or pressing on the duodenum or colon.

5.Bypass surgery may prevent the obstruction of the pancreatic ducts and improve quality of life.

Chemotherapy
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is used for patients not suitable for surgery. It can relieve symptoms and improve quality of life

Gemcitabine was approved by the US FDA after a clinical trial reported improvements in quality of life in patients with advanced pancreatic cancer

Gemcitabine may used after surgery to remove tumor tissue remaining in the body. As a result 5-year survival rates has improved.

Other drugs such as oxaliplatin and fluorouracil have also beneficial effect.

Radiation therapy
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The use of additional radiation therapy follwing surgery has been used in USA while rejected by most doctors in Europe.

What is the Prognosis of pancreatic cancer?
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The prognosis of pancreatic cancer is poor

1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.

2.Median survival from diagnosis is around 3-4 months;

3.5-year survival is lower than 5%.

4.Pancreatic cancer has the highest mortality of all the cancers.

5.Pancreatic cancer may sometimes cause diabetes.

How to prevent Pancreatic Cancer?
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1.a healthy lifesyle

2.increase consumption of fruits, vegetables

3.reduce red meat intake

4.Vitamin D can reduce the risk of pancreatic cancer

5.B vitamins such as B12, B6, and folate in food but not in tablets may reduce the risk of pancreatic cancer

6.Avoid smoking and drinking of alcohol

A Simple Guide to Hepatitis C

A Simple Guide to Hepatitis C
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What is Hepatitis C?
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Hepatitis C is a serious inflammatory liver disease caused by a virus which is called hepatitis C virus (HCV).

Who is at risk of Hepatitis C?
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Hepatitis C virus infection is one of the most common chronic bloodborne infection.
Persons at risk for infection are:

1. injection-drug users

2. blood transfusions or solid organ transplant recipients before July 1992

3. on long-term dialysis

4. sexual exposure to infected HCV carriers(rare)

What are the symptoms of Hepatitis C?
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Persons who has been newly infected with HCV usually are asymptomatic or have a mild clinical illness:

1.mild fever and bodyaches

2.slight jaundice

3.nausea

4.enlarged liver

How do you diagnose Hepatitis C?
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A person exposed to Hepatitis C infection can detect HCV RNA in blood within 1-3 weeks.
The time from exposure to antibody to HCV seroconversion(or Anti-HCV) is 8-9 weeks.
Therefore diagnosis can usually be confirmed by :

1.the presence of Anti-HCV in 98% of infected persons within 6 months of exposure.

2.Reverse transcriptase polymerase chain reaction to detect HCV RNA

Chronic HCV infection occurs in 70% of HCV-infected persons.

Two thirds of these have evidence of active liver disease but may not be aware of their infection because they are not clinically ill.

Infected HCV carriers can transmit the illness to others and develop chronic liver diseases for years after infection.

What is the treatment of Hepatitis C?
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There is no cure for HCV infections.
Persons found to be anti-HCV positive should be evaluated for presence of
1.active infection,

2.presence or development of Chronic Liver Disease,

3.for possible treatment of HCV.

Combination therapy with interferon and ribavirin may help in treatment of patients with chronic hepatitis C.

What is the Prevention for Hepatitis C?
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No vaccine for hepatitis C is available.

Immune globulin is not effective in preventing HCV infection after exposure.

Primary prevention is to reduce or eliminate HCV transmission.

Secondary prevention activities is to reduce liver and other chronic diseases in HCV-infected persons by identifying them and providing appropriate medical management and antiviral therapy.

Persons who test positive for anti-HCV should be provided information regarding

1) how to protect their liver from further harm by avoiding alcohol and taking any new medicines (including OTC and herbals)

2) how to prevent transmission to others
a) not donate blood, body organs, other tissue, or semen;

b) not share any personal items that might have blood on them (e.g., toothbrushes and razors);

c) cover cuts and sores on the skin to keep from spreading infectious blood or secretions

3) the need for medical evaluation including assessment of liver function tests, assessment for severity of liver disease and possible treatment, and determination of the need for hepatitis A and B.

HCV-positive women do not need to avoid pregnancy or breastfeeding.

Regardless of test results, persons who use or inject illegal drugs should be counseled to
1.stop using and injecting drugs;

2.enter a program to eradicate complete substance abuse treatment, including relapse prevention;

3.take the following steps to reduce personal and public health risks, if they continue to inject drugs:

4.never reuse or share syringes, water, or drug preparation equipment;

5. use only syringes obtained from a reliable source (e.g., pharmacies);

6.use a new, sterile syringe to prepare and inject drugs;

7.get vaccinated for hepatitis A and B.

A Simple Guide to Hepatitis A

A Simple Guide to Hepatitis A
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What is Hepatitis A?
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Hepatitis A is a acute inflammatory infection of the liver which is caused by the hepatitis A virus(HAV).

How is Hepatitis A virus spread?
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The virus is excreted in faeces and transmitted through contaminated food and water. Eating shellfish, cockle shells, prawns or crabs taken from sewage-contaminated water is a common means of contracting hepatitis A.
It can also be acquired by close contact with individuals infected with the virus.
HAV causes the liver to become enlarged, inflamed and tender resulting in all the symptoms of hepatitis.
There is no chronic (long-term) infection.

What are the Symptoms of Hepatitis A?
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A person is infectious for 2-3 weeks before he or she experiences symptoms:
1.fever and joint pains

2.jaundice

3.fatigue

4.loss of appetite

5.nausea and vomiting

6.abdominal pain

7.pale coloured stools and dark urine

8.itchy skin due to irritation by the bilirubin.

During the first week of the illness he feels very sick and weak.
As the condition improves, the patient generally feels better after the first week but may requires to rest at home for 6 weeks to avoid damage to the liver.

How is the diagnosis of Hepatitis A made?
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A blood test is the best way to diagnose hepatitis A.
His hepatitis antigens are raised at the early stage but as his condition improves the antibodies become positive.

His liver function tests are also done to assess the damage to the liver.
Usually the serum bilirubin is high, liver enzymes or tramsaminase, alkaline phosphatase are raised in the acute stage of illness.
As the condition improves, these tests gradually returned to normal.

What is the Treatment of Hepatitis A?
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There are no medicines for treatment of Hepatitis A except for symptomatic treatment of symptoms.
1.Rest in bed

2.multivitamins especially vitamin B to improve the function of the liver

3.Lots of fluids

4.carbohydrate diet

5.Anti-itch creams and lotions to stop itch

Recovery is usual with very rare cases going on to cirrhosis of the liver.

What is the Prevention of Hepatitis A?
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Hepatitis A vaccination is the best protection.
It is usually given in 2 doses within 1 year.

Immune globulin can be given for short-term protection.
It is given before and within 2 weeks after coming in contact with hepatitis A virus.

The vaccine is recommended for travellers travelling to developing countries and people with chronic liver disease.

Always practice good food hygiene.
Avoid food like seafood which may be contaminated by unhygienic water.

Always wash your hands with soap and water after using the toilet, before preparing and eating food.

Recovery is usual within 6 weeks.

What is the difference between Hepatitis A and Hepatitis B?
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Hepatitis A is spread through eating food contaminated with the HAV virus.
Examples include partially cooked shellfish (oysters, clams) or in situations where there is poor hygiene (food/drink/utensils contaminated with an infected person's faeces).
Most people suffer an acute episode and upon recovery have immunity to Hepatitis A.

Hepatitis B is spread by contact with blood or body/fluids of an infected person (including a carrier) or from a carrier mother to her newborn during childbirth.
Hepatitis B infection can lead to hepatitis carrier stage or chronic hepatitis which can results in liver cirrhosis or cancer.

A Simple Guide to Hepatitis B

A Simple Guide to Hepatitis B
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What is Hepatitis B?-
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Hepatitis B is a serious chronic inflammatory liver disease caused by a virus which is called hepatitis B virus (HBV).

What are the Symptoms of Hepatitis B?
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Most of the time a person with HBV infection has no symptoms at all.
Older people are more likely to have symptoms.

If you have symptoms, they might include :
1.jaundice (yellowing of the skin and white of eye)

2.dark coloured urine

3.pale stools

4.prolonged tiredness

5.nausea and vomiting.

6.loss of appetite

7.abdominal pain

8.fever and joint pains

How is the diagnosis of Hepatitis made?
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A blood test is the only way to diagnose hepatitis B.
You may be infected with HBV and may even spread it to others without knowing it.

HBV can be spread from an infected mother to her infant during birth.
To prevent spread of HBV from infected mothers to their infants, every woman should have her blood tested for hepatitis B surface antigen (HBsAg) during each pregnancy.

What is the treatment of Hepatitis B?
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There are no medications available for recently acquired (acute) HBV infection. There are antiviral drugs eg interferon which may be able to treat chronic HBV infection.

Who is at risk of getting Hepatitis B?
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For those who has never been immunised or do not have antibodies from having a previous Hepatitis B infection, you are at risk of Hepatitis B infection.

The Hepatitis B virus is is not spread through food or water, sharing eating utensils, breastfeeding, hugging, coughing, sneezing, or skin contact.

HBV is spread by exposure to infected blood from skin puncture or contact with mucous membranes.

It is spread by:
1.sexual contact with an infected person

2.an infected mother to her newborn during childbirth

3.a Hepatitis B infected person's blood during blood transfusion

4.sharing of injection needles among drug abusers

5.accidental cuts to the skin by a nail clipper, shaving blade or other instruments that are contaminated with a Hepatitis B infected person's blood

6.contact with an infected person's saliva or blood through cuts or sores in the mouth or skin. Kissing by itself do not spread HBV unless there is a cut in the lips.

7.during acupuncture, body or ear piercing and tattooing if the needles used are contaminated with Hepatitis B infected person's blood

8.have a job that involves contact with human blood or body fluids

What is the best prevention for Hepatitis B?
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Hepatitis B vaccine is the best prevention against hepatitis B.
If you do not have antibodies from a previous infection and if you are not a Hepatitis B carrier, you can get vaccinated against Hepatitis B and protect yourself from its complications.
Hepatitis B vaccine is recommended for all infants, for children and adolescents who were not vaccinated as infants, and for all unvaccinated adults who are at risk for HBV infection as well as any adult who wants to be protected against HBV infection.
The vaccine is safe.
It is also extremely effective provided you complete all 3 doses:
1st dose - at the appointed date
2nd dose - 1 month after the 1st dose
3rd dose - 5 months after the 2nd dose
A booster vaccination may be necessary after 5 years if the blood test showed a drop in immunity.

Infants born to infected mothers need to get hepatitis B vaccine and another shot call HBIG (hepatitis B immune globulin) soon after birth to prevent infection.

Besides vaccination, other ways to prevent transmission of HBV are:
1.avoid multiple sexual partners; keep to one sexual partner

2.Latex condoms, when used consistently and correctly, may reduce the risk of sexually transmitted HBV transmission.

3.Do not inject illegal drugs. Never share needles, syringes or drugs.

4.Do not share personal items like razors, toothbrushes or any other instruments that may cause tears to the skin and hence spread of any blood borne infection.

5.seek reliable operators for ear or body piercing, tattooing or acupuncture.

What happens if I am a Hepatitis B carrier?
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A simple blood test can tell if you are a carrier, are immune or need immunisation.
If you are found to be a carrier, then:
1.you will need to see your doctor every 6 months to a year for tests to check your liver function and blood alpha-foetoprotein which is a cancer marker for liver cancer

2.your immediate family members should go for blood tests.
They should get immunised if they are not immune.
If they are carriers too, they should go for regular follow up with the doctor.

3.you should take precautions to prevent the spread of hepatitis B to your family and loved ones

4.you should avoid smoking and drinking alcohol as they may further increase the risk of damage to your liver

5.inform your doctor and dentist that you are a carrier

6.do not donate blood, organs or sperm

7.know the symptoms and signs of the various complications and see your doctor at once if you experience any of them.

What are the Complications of Hepatitis B ?
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Hepatitis B can lead to complications like:
1.acute hepatitis (episode of liver inflammation)

2.chronic hepatitis (permanent liver inflammation)

3.liver cirrhosis (permanent scarring and hardening of the liver)

4.liver failure (liver is unable to function,
resulting in toxins accumulating in body)

5.liver cancer

Those who recover completely from Hepatitis B infection become immune to the disease.
1 in 10 people who get infected with the virus become carriers who then carries the Hepatitis B virus permanently in his body.

Hepatitis B carriers seldom show any symptoms but they can:

1.spread the disease to others
2.develop serious liver complications such as those mentioned above.

About 15%-25% of people with chronic HBV infection die prematurely from these complications.

A Simple Guide to Liver Cancer

A Simple Guide to Liver Cancer
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What is Liver Cancer?
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Liver Cancer develops when the liver cells undergo abnormal changes to form cancer cells.
Most Primary cancer of the liver begins as mutated hepatocytes(liver cells).
Secondary cancer of the liver is due to spread from the stomach, colon, breast, lungs, ovaries etc

What is the incidence of Liver Cancer?
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Liver cancer is one of the most common cancer.
It occurs in men more than women.
It is more common in the 40s and 50s age groups.

What are the Risk Factors of Liver Cancer?
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The main risk factor for liver cancer is
1.Hepatitis B infection.

Other important risk factors include
2.Hepatitis C infection

3.alcoholic liver disease (disease of the liver caused by heavy alcohol consumption).

4.family history of liver cancer

5.Chemicals exposures such as nitrites,solvents, hydrocarbons,viny chloride

6.poisons (e.g. aflatoxin present in some spoilt or mouldy peanuts).

7.inherited liver diseases (alpha-1 anti-trypsin deficiency)

8.Drug abuse eg heroin


What are the Signs and Symptoms of Liver Cancer?
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During the early stages, most people with liver cancer do not show any signs or symptoms.
Signs and symptoms, when they do appear, include:

1.loss of appetite and weight

2.discomfort or swelling in the upper part of the abdomen on the right side

3.weakness and fatigue

4.nausea and vomiting

5.jaundice - yellowness of the skin and eyes

6.dark color urine

7.Persistent or swinging fever

How is the Diagnosis of Liver Cancer confirmed?
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1. full medical history especially history of Hepatitis B and alcohol

2. full examination especially of the liver

3.an ultrasound scan of the liver and gallbladder, if possible the whole abdomen.
4.CT scan or MRI of the liver and surrounding tissues


5.blood tests (a protein present in blood called the alpha- fetoprotein or AFP may be found to be raised in liver cancer)

6.needle liver biopsy into the liver swelling as detected by ultrasound or MRI (to confirm the liver cancer).

With the diagnosis confirmed, the doctor will proceed with further tests to find out how advanced the liver cancer is. This will help the doctor to plan the treatment.

What is the Treatment of Liver Cancer?
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As in all cancers, treatment includes surgery, radiation therapy, chemotherapy.

In Liver cancer percutaneous ethanol (alcohol) injection is injected directly into the tumour, by means of a small needle, to kill the cancerous cells.

Liver transplant can also be carried out in selected cases where the size of the cancer is not too massive but surgery is not feasible due to the patient's limited liver reserve(provided a suitable liver donor can be found).

Treatment depends on the the stage of the cancer as well as health of the affected person.

The goal of treatment is complete cure.

However, where this is not possible, treatment is aimed at
preventing the tumour from spreading or growing.
Helping to eliminate uncomfortable symptoms is also an important aspect of liver cancer treatment.

How to Protect yourself from Liver Cancer?
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Prevention from getting liver cancer is by taking steps to reduce your risk factors.

1. Reduce your risk of Hepatitis B by getting vaccinated. The Hepatitis B vaccine is safe and effective.
Both Hepatitis B and C are spread through infected blood or sexual fluids as well as intravenous drug abuse. It is therefore important to avoid activities that put you at risk:

2.Avoid multiple sex partners and having sex with commercial sex workers, strangers or anyone with multiple sex partners.

3.Do not abuse drugs or share injection needles.

4.Never share personal items like razors, toothbrushes or other items that may cause breaks in the skin.

5.Visit only reliable operators for ear/body piercing, tattooing or acupuncture.

6.It is also important that you limit your consumption of alcohol as excessive drinking can give rise to liver disease and increase your risk of liver cancer.

The liver is one of the largest and most important organs in your body. It performs many essential functions including:
making and storing of essential nutrients
making important hormones and enzymes
breaking down harmful substances.

Do not abuse Your LIVER by excessive drinking or taking drugs!