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  • 0 The Thyroid - Function and Pathologies

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    What is the Thyroid? The thyroid gland is the biggest gland in the neck. It is situated in the anterior (front) neck below the skin and muscle layers. The thyroid gland takes the shape of a butterfly with the two wings being represented by the left and right thyroid lobes which wrap around the trachea. The sole function of the thyroid is to make thyroid hormone. This hormone has an effect on nearly all tissues of the body where it increases cellular activity.  The thyroid produces hormones that help your body to function properly. The thyroid gland absorbs iodine from the diet, which is found in fish, seafood and dairy products. It also produces two hormones; thyroxine (T4) and triiodothyronine (T3) which help keep the body functioning normally. Ultrasounds is the first imaging modality being used to identify any thyroid abnormalities. The thyroid scan is one of our most popular investigations amongst the private ultrasounds we offer in our clinic in London. Common Thyroid Problems The thyroid gland is prone to several very distinct problems, some of which are extremely common. These problems can be broken down into [1] those concerning the production of a hormone (too much, or too little), [2] those due to increased growth of the thyroid causing compression of important neck structures or simply appearing as a mass in the neck, [3] the formation of nodules or lumps within the thyroid which are worrisome for the presence of thyroid cancer, and [4] those which are cancerous.  The information in this article is arranged to give you more detailed and complex information as you read further. —      Goiters ~ A thyroid goitre is a dramatic enlargement of the thyroid gland. Goitres are often removed because of cosmetic reasons or, more commonly because they compress other vital structures of the neck including the trachea and the oesophagus making breathing and swallowing difficult. Sometimes goitres will actually grow into the chest where they can cause trouble as well. Several nice x-rays will help explain all types of thyroid goitre problems. —      Thyroid Cancer ~ Thyroid cancer is a fairly common malignancy, however, the vast majority have excellent long term survival.  —      Solitary Thyroid Nodules ~ There are several characteristics of solitary nodules of the thyroid which make them suspicious for malignancy. Although as many as 50% of the population will have a nodule somewhere in their thyroid, the overwhelming majority of these are benign. Occasionally, thyroid nodules can take on characteristics of malignancy and require either a needle biopsy or surgical excision.  —      Hyperthyroidism ~ Hyperthyroidism means too much thyroid hormone. Current methods used for treating a hyperthyroid patient are radioactive iodine, anti-thyroid drugs, or surgery. Each method has advantages and disadvantages and is selected for individual patients. Many times the situation will suggest that all three methods are appropriate, while other circumstances will dictate a single best therapeutic option. Surgery is the least common treatment selected for hyperthyroidism. The different causes of hyperthyroidism are covered in detail. —      Hypothyroidism ~ Hypothyroidism means too little thyroid hormone and is a common problem. In fact, hypothyroidism is often present for a number of years before it is recognized and treated. There are several common causes, each of which are covered in detail. Hypothyroidism can even be associated with pregnancy. Treatment for all types of hypothyroidism is usually straightforward. —      Thyroiditis ~ Thyroiditis is an inflammatory process ongoing within the thyroid gland. Thyroiditis can present with a number of symptoms such as fever and pain, but it can also present as subtle findings of hypo or hyperthyroidism. There are a number of causes, some more common than others. Each is covered on this site.   Thyroid Cancer In the UK, approximately 3000 people are diagnosed with thyroid cancer each year according to Cancer Research. It is a fairly rare type of cancer that develops slowly and is usually more common in middle-aged and older people. However, there is one type, known as papillary thyroid cancer, which often affects younger people. Overall, more women get thyroid cancer than men. It rarely affects children. The four main types of thyroid cancer are: Papillary Thyroid Cancer - Papillary cancer develops in the follicular cells and grows slowly. It is usually found in one lobe; only 10% to 20% of papillary cancers appear in both lobes. Follicular Thyroid Cancer - Follicular cancer also develops in the follicular cells and grows slowly, yet is less common. When detected early, it can be treated successfully. Papillary and follicular cancers makeup 80% to 90% of thyroid cancers, and are grouped under the term differentiated thyroid cancer. When detected early, especially in people below the age of 45-50 years, it can be treated successfully. Medullary Thyroid Cancer - Medullary cancer develops in the C cells. It can be controlled if it is found and treated before it spreads to other parts of the body. Medullary cancer accounts for 5% to 10% of thyroid cancers. Anaplastic Thyroid Cancer - This is a very rare and aggressive form of thyroid cancer that takes its origin from differentiated thyroid cancer or other benign tumours of the gland, and in its giant cell variety is often rapidly fatal. The outlook for most types of thyroid cancer is usually very good, and many people are completely cured of the disease, even if it has spread beyond the thyroid. As we well know, there are many kinds of cancer; unfortunately, they all come about because of the out-of-control growth of abnormal cells. Healthy Cells vs. Cancer Cells Healthy cells are like a cat.  They need structure to determine the size of bones and shape of the body, tail and whiskers. The DNA in genes and chromosomes determine this. They need the energy to play and prowl and sustain life. This is derived from chemicals in food. Cats need a system to deliver chemicals (food nutrients like amino acids, carbohydrates, fats, vitamins and minerals) to all parts of their body. These are the blood vessels. Growth factors take a kitten into a lazy old cat, all the while helping it to function normally. The body and its cells are mostly made up of protein. The building blocks of proteins are substances called amino acids that in the form of enzymes and hormones literally control every chemical reaction within the cells. When these are modified, different messages are sent to a complex control system that can alter their function. There are twenty different kinds of amino acids that are essential to life. Twelve of these can be synthesized within the body however; eight must be supplied by the daily diet.   Signs and Symptoms of  Thyroid Cancer   The most common symptom of thyroid cancer is a lump or nodule, that can be felt in the thyroid gland or neck. Other symptoms are rare. Pain is seldom an early warning sign of thyroid cancer. You may have a tight or full feeling in the neck, difficulty breathing or swallowing, hoarseness or swollen lymph nodes.   Thyroid Ultrasound The thyroid ultrasound scan will identify any lumps on the thyroid and will also check the overall appearance of the thyroid for evidence of thyroiditis.  International ultrasound services offer ultrasound scanning services in a central London location.  

  • 0 Symptoms of Thyroid Cancer

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    Thyroid Cancer Symptoms, Signs   It is very common to identify thyroid nodules during a thyroid ultrasound in our private ultrasound clinic. Some of these nodules look benign but some others have been proven by FNA to be malignant. You should be aware of the thyroid cancer signs and seek medical advice when necessary.    What are the symptoms of thyroid cancer? Lump in the neck (or lump in throat): painless, enlarged nodule; But not always, sometimes there is pain. Thyroid cancer involves the adjacent tissues (e.g. throat), causing a difficulty swallowing, hoarseness. One or multiple firms or hard, fixed thyroid nodules. Swollen lymph nodes in the neck. Thyroid cancer symptoms are often not accompanied by high thyroid symptoms and low thyroid symptoms. Early symptoms of thyroid cancer At the beginning of the disease, thyroid cancer symptoms almost do not emerge. Therefore, the patients do not notice it. Only with an increase in the size of the thyroid cancer, the patient will feel discomfort and have thyroid cancer symptoms. Most of the thyroid cancers do not lead to changes in thyroid function, so the patients have "thyroid cancer symptoms" but no high thyroid (hyperthyroidism symptoms), as well as no low thyroid (hypothyroidism symptoms). Advanced thyroid cancer symptoms In the early stage, the thyroid cancer symptoms often can not be perceived by victims. However, with further growth of the tumour, the thyroid cancer increases in size and therefore causes thyroid cancer symptoms: Sufferers palpate a lump in the thyroid, that is larger with time and characterized by one or multiple firm, hard and fixed thyroid nodules. The large thyroid cancer has the ability to invade and squeeze the adjacent organs and tissues. For this reason, the patients may experience some "thyroid cancer symptoms", such as difficulty in breathing and swallowing by pressure on the trachea or throat. ①When the growing thyroid cancer involves nerves, other "thyroid cancer symptoms" may occur. If the so-called "recurrent laryngeal nerve" affected, the voice may sound hoarse due to a paralysis of the vocal folds. The hoarseness is very common and can occur in the throat cancer, oesophagal cancer, other benign or malignant tumours of the neck.   Thyroid cancer symptoms may also occur due to an invasion to the so-called "cervical sympathetic plexus". If the thyroid cancer involves the nerves in the neck, it will develop a "Horner's syndrome": It is characterized that the pupil is constricted, the eyeball is sunk back into the orbit (eye socket) and the upper eyelid droops on the affected side. Horner's syndrome can also be caused by "Pancoast tumour", that is lung cancer in the apex of the lung.  If the "cervical plexus nerves" of the neck are affected, the patients may feel pain in ear, shoulder or the back part of the skull.The above three types of thyroid cancer symptoms are all caused by thyroid cancer, that invades and compresses the nerves of the neck. In end-stage, the above thyroid cancer symptoms get worse, and the weight loss looks very prominent. Thyroid cancer metastasis Can thyroid cancer spread? There are large differences in the degree of malignancy among the different types of thyroid cancer. In some cases, the thyroid cancer spread to lymph nodes starts in the stage 1 thyroid cancer; Some thyroid cancers begin with stage 2; Some thyroid cancer does not spread via the lymphatic circulation, until stage 3 or 4. Lymph node metastasis to the neck is not always proportional to the prognosis for recovery. For lymph node metastasis, the thyroid cancer symptoms are manifested with some rough and swollen lymph nodes in the neck, poorly moved in the neck's tissue. Does thyroid cancer spread to distant organs? Thyroid cancer cells can spread to the lungs, liver, bone, brain, and that patients thus lose the chance of surgery, but not always. Thyroid function In general, thyroid cancer does not affect the thyroid function, and therefore, thyroid cancer symptoms do not include abnormal thyroid function. One of the exceptions is that the follicular thyroid cancer (20% of thyroid cancer) will cause high thyroid symptoms: such as tremor, loss of weight, sweating, heat intolerance, heart palpitations, restlessness, irritability. The other is low thyroid, which can be caused due to the normal thyroid tissue and cells damage by thyroid cancer. Therefore, thyroid hormone production is not enough. The low thyroid symptoms: inactivity, cold intolerance, muscle pain, increased need to sleep, constipation, dizziness, tingling sensations in hands, hair loss, and rougher voice. Weight gain? It seems unlikely because the end-stage thyroid cancer symptoms are cachexia and emaciation. When to seek medical advice for thyroid cancer? If you have the above-mentioned symptoms, you'd better make an appointment with your doctor. Lump in the neck, enlarged thyroid, thyroid nodules is all the words used to describe the diseases associated with the thyroid. They are very common, and the vast majority of lump and nodules are benign, due to goitre, hyperthyroidism, as well as thyroiditis and thyroid adenoma. Less than 5 per cent are thyroid cancer. In recent years, there are about 50,000 people a year who are diagnosed with thyroid cancer in the United States. Thyroid cancer typically presents as a thyroid lump or one or more thyroid nodules. Compared with benign, they all look almost the same. How to clarify the causes and diagnose thyroid cancer, is the doctor's responsibility and expertise. It is recommended if you have an enlarged thyroid, thyroid nodules or lump in the front of your neck/throat, you should see your GP and request an ultrasound scan asap.    

  • 0 Testicular Cancer

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    Testicular Cancer   Testicular cancer is a disease in which malignant (cancer) cells form in the tissues of one or both testicles.   The Testicles The testicles are 2 egg-shaped glands located inside the scrotum (a sac of loose skin that lies directly below the penis). The testicles are held within the scrotum by the spermatic cord, which also contains the vas deferens and vessels and nerves of the testicles. The testicles are the male sex glands and produce testosterone and sperm. Germ cells within the testicles produce immature sperm that travel through a network of tubules (tiny tubes) and larger tubes into the epididymis (a long coiled tube next to the testicles) where the sperm mature and are stored. Almost all testicular cancers start in the germ cells. The two main types of testicular germ cell tumours are seminomas and nonseminomas. These 2 types grow and spread differently and are treated differently. Nonseminomas tend to grow and spread more quickly than seminomas. Seminomas are more sensitive to radiation. A testicular tumour that contains both seminoma and nonseminoma cells is treated as a nonseminoma. Testicular cancer is the most common cancer in men 30 to 34 years old. There are 2400 testicular cases every year which is almost 6 every day.   Risk Factors of Testicular cancer   Anything that increases the chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for testicular cancer include: Having had an undescended testicle. Having had abnormal development of the testicles. Having a personal or family history of testicular cancer. Being white.   Signs of testicular cancer. Signs of testicular cancer include swelling or discomfort in the scrotum. These and other symptoms may be caused by testicular cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur: A painless lump or swelling in either testicle. A change in how the testicle feels. A dull ache in the lower abdomen or the groin. A sudden build-up of fluid in the scrotum. Pain or discomfort in a testicle or in the scrotum.   Diagnostic Tests   Tests that examine the testicles and blood are used to detect and diagnose testicular cancer. The following tests and procedures may be used: Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. The testicles will be examined to check for lumps, swelling, or pain. A history of the patient’s health habits and past illnesses and treatments will also be taken. Testicular Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. International Ultrasound Services provides testicular ultrasound scans and other private ultrasound tests helping to obtain a quick diagnosis and speed up any treatment. You can also combine your private scan with other ultrasound scans for men to evaluate your overall health. Serum tumour marker test: A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumour cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumour markers. The following 3 tumour markers are used to detect testicular cancer: Alpha-fetoprotein (AFP). Beta-human chorionic gonadotropin (β-hCG). Lactate dehydrogenase (LDH). Tumour marker levels are measured before radical inguinal orchiectomy and biopsy, to help diagnose testicular cancer. Radical inguinal orchiectomy and biopsy: A procedure to remove the entire testicle through an incision in the groin. A tissue sample from the testicle is then viewed under a microscope to check for cancer cells. (The surgeon does not cut through the scrotum into the testicle to remove a sample of tissue for biopsy, because if cancer is present, this procedure could cause it to spread into the scrotum and lymph nodes.) If cancer is found, the cell type (seminoma or nonseminoma) is determined in order to help plan treatment. Prognosis The prognosis (chance of recovery) and treatment options depend on the following: Stage of cancer (whether it is in or near the testicle or has spread to other places in the body, and blood levels of AFP, β-hCG, and LDH). Type of cancer. Size of the tumour. Number and size of retroperitoneal lymph nodes. Testicular cancer is often curable. Treatment for testicular cancer can cause infertility. Certain treatments for testicular cancer can cause infertility that may be permanent. Patients who may wish to have children should consider sperm banking before having treatment. Sperm banking is the process of freezing sperm and storing it for later use.   Stages of Testicular Cancer   After testicular cancer has been diagnosed, tests are done to find out if cancer cells have spread within the testicles or to other parts of the body. The process used to find out if cancer has spread within the testicles or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:•Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.•CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.•Lymphangiography: A procedure used to x-ray the lymph system. A dye is injected into the lymph vessels in the feet. The dye travels upward through the lymph nodes and lymph vessels, and x-rays are taken to see if there are any blockages. This test helps find out whether cancer has spread to the lymph nodes.•Abdominal lymph node dissection: A procedure to examine lymph nodes in the abdomen. Lymph nodes are removed and a pathologist checks them for cancer cells. For patients with nonseminoma, removing the lymph nodes may help stop the spread of disease. Cancer cells in the lymph nodes of seminoma patients can be treated with radiation therapy.•Radical inguinal orchiectomy and biopsy: A procedure to remove the entire testicle through an incision in the groin. A tissue sample from the testicle is then viewed under a microscope to check for cancer cells. (The surgeon does not cut through the scrotum into the testicle to remove a sample of tissue for biopsy, because if cancer is present, this procedure could cause it to spread into the scrotum and lymph nodes.)•Serum tumour marker test: A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumour cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. The following 3 tumour markers are used in staging testicular cancer:◦Alpha-fetoprotein (AFP)◦Beta-human chorionic gonadotropin (β-hCG).◦Lactate dehydrogenase (LDH). Tumour marker levels are measured again, after radical inguinal orchiectomy and biopsy, in order to determine the stage of cancer. This helps to show if all of cancer has been removed or if more treatment is needed. Tumour marker levels are also measured during follow-up as a way of checking if cancer has come back. There are three ways that cancer spreads in the body. The three ways that cancer spreads in the body are:•Through tissue. Cancer invades the surrounding normal tissue.•Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.•Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body. When cancer cells break away from the primary (original) tumour and travel through the lymph or blood to other places in the body, another (secondary) tumour may form. This process is called metastasis. The secondary (metastatic) tumour is the same type of cancer as the primary tumour. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer. The following stages are used for testicular cancer: Stage 0 (Carcinoma in Situ) In stage 0, abnormal cells are found in the tiny tubules where the sperm cells begin to develop. These abnormal cells may become cancer and spread into nearby normal tissue. All tumour marker levels are normal. Stage 0 is also called carcinoma in situ. Stage I In stage I, cancer has formed. Stage I is divided into stage IA, stage IB, and stage IS and is determined after a radical inguinal orchiectomy is done.•In stage IA, cancer is in the testicle and epididymis and may have spread to the inner layer of the membrane surrounding the testicle. All tumour marker levels are normal.•In stage IB, cancer:◦is in the testicle and the epididymis and has spread to the blood or lymph vessels in the testicle; or◦has spread to the outer layer of the membrane surrounding the testicle, or◦is in the spermatic cord or the scrotum and may be in the blood or lymph vessels of the testicle. All tumour marker levels are normal. •In stage IS, cancer is found anywhere within the testicle, spermatic cord, or the scrotum and either:◦all tumour marker levels are slightly above normal; or◦one or more tumour marker levels are moderately above normal or high.   Stage II Stage II is divided into stage IIA, stage IIB, and stage IIC and is determined after a radical inguinal orchiectomy is done.•In stage IIA, cancer:◦is anywhere within the testicle, spermatic cord, or scrotum; and◦has spread to up to 5 lymph nodes in the abdomen, none larger than 2 centimetres. All tumour marker levels are normal or slightly above normal. •In stage IIB, cancer is anywhere within the testicle, spermatic cord, or scrotum; and either:◦has spread to up to 5 lymph nodes in the abdomen; at least one of the lymph nodes is larger than 2 centimetres, but none are larger than 5 centimetres; or◦has spread to more than 5 lymph nodes; the lymph nodes are not larger than 5 centimetres. All tumour markers levels are normal or slightly above normal. •In stage IIC, cancer:◦is anywhere within the testicle, spermatic cord, or scrotum; and◦has spread to a lymph node in the abdomen that is larger than 5 centimetres. All tumour marker levels are normal or slightly above normal. Stage III Stage III is divided into stage IIIA, stage IIIB, and stage IIIC and is determined after a radical inguinal orchiectomy is done.•In stage IIIA, cancer:◦is anywhere within the testicle, spermatic cord, or scrotum; and◦may have spread to one or more lymph nodes in the abdomen; and◦has spread to distant lymph nodes or to the lungs. The level of one or more tumour markers may range from normal to slightly above normal. •In stage IIIB, cancer:◦is anywhere within the testicle, spermatic cord, or scrotum; and◦may have spread to one or more nearby or distant lymph nodes or to the lungs. The level of one or more tumour markers may range from normal to high. •In stage IIIC, cancer:◦is anywhere within the testicle, spermatic cord, or scrotum; and◦may have spread to one or more nearby or distant lymph nodes or to the lungs or anywhere else in the body. The level of one or more tumour markers may range from normal to very high.   Testicular Cancer Prognosis   For nonseminoma, all of the following must be true:•The tumour is found only in the testicle or in the retroperitoneum (area outside or behind the abdominal wall); and•The tumour has not spread to organs other than the lungs; and•The levels of all the tumour markers are slightly above normal. For seminoma, all of the following must be true:•The tumour has not spread to organs other than the lungs; and•The level of alpha-fetoprotein (AFP) is normal. Beta-human chorionic gonadotropin (β-hCG) and lactate dehydrogenase (LDH) may be at any level. Intermediate Prognosis For nonseminoma, all of the following must be true:•The tumour is found in one testicle only or in the retroperitoneum (area outside or behind the abdominal wall); and•The tumour has not spread to organs other than the lungs; and•The level of any one of the tumour markers is more than slightly above normal. For seminoma, all of the following must be true:•The tumour has spread to organs other than the lungs; and•The level of AFP is normal. β-hCG and LDH may be at any level. Poor Prognosis For nonseminoma, at least one of the following must be true:•The tumor is in the centre of the chest between the lungs; or•The tumor has spread to organs other than the lungs; or•The level of any one of the tumor markers is high. There is no poor prognosis grouping for seminoma testicular tumours.   Testicular Cancer Questions and Answers  •Nearly all testicular cancers are one of two general types: seminoma or nonseminoma. Other types are rare (see Question 1).•This disease occurs most often in men between the ages of 20 and 39. It accounts for only 1 per cent of all cancers in men (see Question 1).•Risk factors include having an undescended testicle, previous testicular cancer, and a family history of testicular cancer (see Question 2).•Symptoms include a lump, swelling, or enlargement in the testicle; pain or discomfort in a testicle or in the scrotum; and/or an ache in the lower abdomen, back, or groin (see Question 3).•Diagnosis generally involves blood tests, ultrasound, and biopsy (see Question 4).•Treatment can often cure testicular cancer (see Question 5), but regular follow-up exams are extremely important (see Question 6).  1. What is testicular cancer? Testicular cancer is a disease in which cells become malignant (cancerous) in one or both testicles. The testicles (also called testes or gonads) are a pair of male sex glands. They produce and store sperm and are the main source of testosterone (male hormones) in men. These hormones control the development of the reproductive organs and other male physical characteristics. The testicles are located under the penis in a sac-like pouch called the scrotum. Based on the characteristics of the cells in the tumor, testicular cancers are classified as seminomas or nonseminomas. Other types of cancer that arise in the testicles are rare and are not described here. Seminomas may be one of three types: classic, anaplastic, or spermatocytic. Types of nonseminomas include choriocarcinoma, embryonal carcinoma, teratoma, and yolk sac tumors. Testicular tumors may contain both seminoma and nonseminoma cells. Testicular cancer accounts for only 1 percent of all cancers in men in the United States. About 8,000 men are diagnosed with testicular cancer, and about 390 men die of this disease each year (1). Testicular cancer occurs most often in men between the ages of 20 and 39, and is the most common form of cancer in men between the ages of 15 and 34. It is most common in white men, especially those of Scandinavian descent. The testicular cancer rate has more than doubled among white men in the past 40 years, but has only recently begun to increase among black men. The reason for the racial differences in incidence is not known.  1.What are the risk factors for testicular cancer?•Undescended testicle (cryptorchidism): Normally, the testicles descend from inside the abdomen into the scrotum before birth. The risk of testicular cancer is increased in males with a testicle that does not move down into the scrotum. This risk does not change even after surgery to move the testicle into the scrotum. The increased risk applies to both testicles.•Congenital abnormalities: Men born with abnormalities of the testicles, penis, or kidneys, as well as those with inguinal hernia (hernia in the groin area, where the thigh meets the abdomen), may be at increased risk.•History of testicular cancer: Men who have had testicular cancer are at increased risk of developing cancer in the other testicle.•Family history of testicular cancer: The risk for testicular cancer is greater in men whose brother or father has had the disease. The exact causes of testicular cancer are not known. However, studies have shown that several factors increase a man’s chance of developing this disease.  1.How is testicular cancer detected? What are symptoms of testicular cancer?•a painless lump or swelling in a testicle•pain or discomfort in a testicle or in the scrotum•any enlargement of a testicle or change in the way it feels•a feeling of heaviness in the scrotum•a dull ache in the lower abdomen, back, or groin•a sudden collection of fluid in the scrotum Most testicular cancers are found by men themselves. Also, doctors generally examine the testicles during routine physical exams. Between regular checkups, if a man notices anything unusual about his testicles, he should talk with his doctor. Men should see a doctor if they notice any of the following symptoms: These symptoms can be caused by cancer or by other conditions. It is important to see a doctor to determine the cause of any of these symptoms.  1.How is testicular cancer diagnosed? •Blood tests that measure the levels of tumor markers. Tumor markers are substances often found in higher-than-normal amounts when cancer is present. Tumor markers such as alpha-fetoprotein (AFP), Beta-human chorionic gonadotropin (ßHCG), and lactate dehydrogenase (LDH) may suggest the presence of a testicular tumor, even if it is too small to be detected by physical exams or imaging tests.•Ultrasound, a test in which high-frequency sound waves are bounced off internal organs and tissues. Their echoes produce a picture called a sonogram. Ultrasound of the scrotum can show the presence and size of a mass in the testicle. It is also helpful in ruling out other conditions, such as swelling due to infection or a collection of fluid unrelated to cancer.•Biopsy (microscopic examination of testicular tissue by a pathologist) to determine whether cancer is present. In nearly all cases of suspected cancer, the entire affected testicle is removed through an incision in the groin. This procedure is called radical inguinal orchiectomy. In rare cases (for example, when a man has only one testicle), the surgeon performs an inguinal biopsy, removing a sample of tissue from the testicle through an incision in the groin and proceeding with orchiectomy only if the pathologist finds cancer cells. (The surgeon does not cut through the scrotum to remove tissue. If the problem is cancer, this procedure could cause the disease to spread.) To help find the cause of symptoms, the doctor evaluates a man’s general health. The doctor also performs a physical exam and may order laboratory and diagnostic tests. These tests include: If testicular cancer is found, more tests are needed to find out if the cancer has spread from the testicle to other parts of the body. Determining the stage (extent) of the disease helps the doctor to plan appropriate treatment.  1.How is testicular cancer treated? What are the side effects of treatment?•Surgery to remove the testicle through an incision in the groin is called a radical inguinal orchiectomy. Men may be concerned that losing a testicle will affect their ability to have sexual intercourse or make them sterile (unable to produce children). However, a man with one healthy testicle can still have a normal erection and produce sperm. Therefore, an operation to remove one testicle does not make a man impotent (unable to have an erection) and seldom interferes with fertility (the ability to produce children). For cosmetic purposes, men can have a prosthesis (an artificial testicle) placed in the scrotum at the time of their orchiectomy or at any time afterward. Some of the lymph nodes located deep in the abdomen may also be removed (lymph node dissection). This type of surgery does not usually change a man’s ability to have an erection or an orgasm, but it can cause problems with fertility if it interferes with ejaculation.  

  • 0 PELVIC INFECTIONS: CAUSES AND PREVENTION

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    Pelvic Infections or Pelvic Inflammatory Disease (PID), is a term used for infection of Pelvic organs i.e the Uterus, Fallopian tubes & Ovaries in a woman. These are commonly transmitted sexually but may, sometimes, be attributed to other causes. According to WHO, about 448 million new cases of Sexually Transmitted Infections (STI) are diagnosed annually and it is among the top 5 disease categories for which an individual seeks medical care. Signs and Symptoms – Many women having PID may not have any obvious symptoms, but usually an episode of PID or Pelvic infections may present with the following symptoms:   Lower abdominal pain Pain during intercourse Bleeding after intercourse Irregular/ abnormal periods or spotting in between two periods. Excessive or foul-smelling vaginal discharge Vaginal or Perineal itching Frequent or painful/burning urination Occasionally, in advanced cases, there may be fever, vomiting, severe pain or even fainting episodes. Pelvic ultrasound is the first line of investigation for suspected pelvic inflammatory disease. You can find more about the investigation at our pelvic ultrasound page.   Complications – Pelvic infections and PID can be a cause of significant morbidity and may have long-lasting outcomes including: It is the leading cause of infertility, about 1 in 8 women having a history of PID can have difficulty in getting pregnant. It may lead to chronic pelvic pain in about 25% of women. They may have pain related to menstrual cycles or may have persistent lower abdominal pain. PID leads to the formation of adhesions i.e scar tissue in or around fallopian tubes which significantly increases the chances of Ectopic pregnancy ( pregnancy implanted outside the cavity of the uterus that can lead to serious life-threatening complications) In the long-term, recurrent pelvic infection, especially with HPV, can be a precursor of cervical cancer. Causes and Risk factors – PID is generally considered to be a polymicrobial infection, i.e it is caused by multiple micro-organisms. These generally include bacterial pathogens like Chlamydia and Neisseria along with a number of other pathogens like Gardnerella, Mycoplasma, Trichomonas, Herpes Simplex Virus-2 and various anaerobic bacteria that may be transmitted by sexual contact and are found in the vagina. Hence, it comes as no surprise that PID results primarily from unprotected sexual intercourse in most cases. However, there may be other causes for the development of the infection and the following factors may increase the risk of a woman suffering from PID: Unprotected sexual activity i.e intercourse without using a condom. Having multiple sexual partners or having intercourse with a person who has multiple sexual partners. The onset of sexual activity before the age of 25 years. A history of the prior sexually transmitted disease which has been incompletely treated in the woman or the sexual partner. A history of sexual abuse Any history of Gynaecological interventional procedure for eg. Endometrial biopsy, IUCD insertion, Hysteroscopy etc. Vaginal douching has been paradoxically associated with the development of a vaginal infection as it alters the normal vaginal balance of useful versus harmful bacteria. However, some studies have failed to demonstrate a clear association between the two. Apart from these, certain genetic factors have been studied which are found to predispose to pelvic infection. Any decrease in generalized body immunity may also cause a flare-up of an underlying infection for eg – in prolonged illness, HIV infection or any immune-compromised state such as pregnancy. Pelvic Infection Treatment and Prevention – PID or Pelvic Infection treatment is usually by an antibiotic course along with other medications lasting for about 2 weeks. Depending upon your symptoms, this may be either an oral medication or sometimes, in severe cases, a woman may need to be hospitalised for injectable medications or surgical intervention as required. It is important for the sexual partner to be treated simultaneously to prevent re-infection. However, PID and sexually transmitted infections are better prevented than treated. Hence, anyone who is at risk of pelvic infections should take the following precautions: Practice safe sex i.e always use a condom at the time of intercourse ( unless of course, you are actually trying for pregnancy) Avoid indulging in indiscriminate sexual activity with multiple partners or with a partner who is in a sexual relationship with multiple persons. Avoid indulging in sexual activity at a very young age. Consult a doctor at the first sign of infection & take proper treatment. Practice good perineal hygiene and avoid vaginal douching. It helps to wipe from the front backwards after passing urine/stools rather than wiping from back to front. Consume a variety of fruits, probiotics and a healthy, well-balanced diet to boost your immunity.    

  • 0 Uterine Fibroids

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    What are fibroids Fibroids are benign (Non-cancerous) growths that develop from the muscle tissue of the uterus. Although their cause is unknown, they are known to be hormone-dependent tumours & estrogen stimulates their growth. They may be present inside the cavity of the uterus, within its wall, on its outer surface or attached to it by a stem-like structure.   Who is most likely to have fibroids? They are more common in women aged between 30-40 yrs but may actually occur at any age.  Commonly associated with familial predisposition & early onset of periods, these tumours are found more frequently in African- American women & Caucasians.   How does a woman suspect she may have fibroids? Most of the fibroids may not cause any symptoms at all and diagnose on a routine pelvic ultrasound scan during a gynaecological check-up.  When symptomatic, the Fibroids may cause the following symptoms : Changes in menstruation- Longer, more frequent or heavy menstrual periods.   Painful periods or vaginal bleeding at times other than menstruation. Pain- Often dull, heavy & aching pain in the lower back or abdomen Pressure symptoms-  Difficulty in urination or frequent urination; constipation/ rectal pain or difficult bowel movements A large lump in the abdomen Infertility or miscarriages and commonly diagnosed during early pregnancy scans and follicular tracking scans   How are fibroids diagnosed? The fibroids may present with the above symptoms or be detected on routine pelvic ultrasound examination. Once clinically suspected, the diagnosis may be confirmed by: Ultrasonography- Uses sound waves to create a picture of uterus & other pelvic organs Hysteroscopy- Uses a camera mounted on slender long device to see the inside of the uterus Hysterosalpingography-  Special X-ray test used to detect changes in the shape & size of Uterine cavity and fallopian tubes. Laparoscopy- Uses a camera on a slender long device to see the inside of the abdominal cavity MRI- Uses magnetic waves to produce exact images of body tissues   Do all fibroids need to be treated? No, fibroids that do not cause symptoms, are small or occur in a woman nearing menopause often may not require treatment. However, certain signs & symptoms  may signal the need for treatment: Heavy or painful periods Bleeding in-between periods A rapid increase in size Infertility Pressure symptoms, Difficulty in urination or defaecation Pelvic pain or lump abdomen   Can medications be used to treat fibroids? Medications can be used to decrease the heavy bleeding or pelvic pain caused due to fibroids, but they do not prevent the growth of the fibroids nor do they make the fibroids disappear. Some medications that can be used are the painkillers eg. Paracetamol &  Brufen, Oral contraceptive pills,  Progesterone pills or IUCD  & Gn RH agonists.   What surgeries may be used to treat fibroids? Myomectomy is the surgical removal of fibroids while leaving the uterus intact. It may be done by laparoscopy/ hysteroscopy or by giving a cut on the abdomen in a conventional manner. Hysterectomy is the surgical removal of the uterus with the fibroids. The ovaries may or may not be removed. This also may be done by Laparoscopy or abdominally or vaginally. Hysterectomy is done when other treatments have failed or the fibroids are too large & childbearing function of the uterus has been completed. Other treatments modalities include Uterine artery embolisation or HIFU (High intensity focused Ultrasound ).   Pelvic ultrasound Scan   The pelvic ultrasound scan is the first line of investigation when fibroids or other gynaecological problems are suspected.  Your doctor will probably refer you to your local hospital to have a transvaginal ultrasound scan but as the ultrasound NHS waiting times are along you can opt to have a private ultrasound instead. You can find more about the transabdominal and transvaginal scans we offer at the exam page information.  

  • 0 Abdominal Ultrasound Scan. Gallstones: Risk Factors and Causes

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        The private abdominal scan is one of our most popular examinations. Upper abdominal pains that can be caused by calculi within the gallbladder are very common. Cholelithiasis is the medical term for Gallstone disease. Cholelithiasis is one of the most common and costly of all digestive system diseases. This post outlines some of the associated risk factors and the more common causes of gallstone formation with some additional details about their classification. According to the NHS, gallstones are thought to be caused by an imbalance in the chemical makeup of the bile within the gallbladder. These chemical imbalances cause tiny crystals to form within the bile that can gradually increase in size from tiny grains of sand to the size of a pebble over a period of time.   Risk Factors The risk factors identified by Wang and Afdhal (2016) for gallstones in the gallbladder (cholelithiasis) include:- diet, age, gender, oestrogen therapy, obesity, fasting, diabetes, family history, rapid weight loss, some medications including those that reduce cholesterol or Lipids or an antibiotic called Cerfriaxone, disease of the ilium or it’s resection and spinal cord injuries. Stockley (2001) states that gallstones are not exclusive to fair, fat, flatulent, fertile over 40 years old females as was previously thought but are also found in young and old alike and have even been detected on fetal ultrasound scanning in the womb. According to Nathanson (2014) it has been estimated from autopsy studies that 12% of men and 24% of women of all ages have gallstone disease present and that 10-30% of them become symptomatic. There are over 40,000 operations to remove the gallbladder and its gallstones (cholecystectomy) performed annually in the UK. Stockley (2001) states that gallstones are formed in several ways: Cholesterol stones which are hard are formed due to an increase in the concentration of cholesterol in the blood (hypercholesterolaemia). An increase in bilirubin in the blood (hyperbilirubinaemia) found in patients with haemolytic anaemia which form irregularly shaped soft, small brown pigment gallstones. Biliary stasis caused by a faulty, malformed, non-emptying gallbladder or obstructed cystic duct leading to stagnant bile. This creates high concentrations of cholesterol and bile pigments following excessive water absorption. This leads to the formation of mixed cholesterol and bile pigment stones, the most common type of gallstone.    Gallstone Classification There are different methods used for gallstone classification, namely their chemical composition location Wang and Afdhal (2016) classify gallstones into 3 types based on their chemical composition and macroscopic appearance: cholesterol, pigment and rare stones. 75% of gallstones in the Western world are cholesterol stones consisting mainly of cholesterol monohydrate crystals and precipitates of amorphous calcium bilirubinate. These stones are further sub-classified as either pure cholesterol or mixed stones that contain at least 50% of cholesterol by weight. The remainder of gallstones are classified as pigmented stones that contain mostly calcium hydrogen bilirubinate and they can be further sub-classified into two groups: black pigment (20%) and brown pigment stones (4.5%). Rare gallstones account for 0.5% and include calcium carbonate stones and fatty acid-calcium stones.   Wang and Afdhal (2016) classify gallstones by their location as Intrahepatic stones which are predominantly brown pigment stones Gallbladder stones which are mainly cholesterol stones with a small group of black pigment stones. Bile duct stones (choledocholithiasis) which are composed mostly of mixed cholesterol stones.   Gallstone Diagnosis The abdominal ultrasound scan is the first line of investigation in the diagnosis of gallstones. This ultrasound scan is performed on a fasted patient.  The reason for fasting is that the gallbladder is like a balloon. When we eat something fatty, the gallbladder will excrete the bile into the gut to break down the fat and therefore the gallbladder collapses and it is not possible therefore to see if there are any stones within the lumen.  International Ultrasound Services offers private ultrasound scans to evaluate your gallbladder for any signs of gallstones, thickening of the gallbladder wall and the existence of any pericholecystic fluid. We will also check your liver, your pancreas, your kidneys and the spleen at the same time. You can book an ultrasound scan in London by visiting our ultrasound scan appointments booking page. You can find more information about the upper abdominal scan here.     References: NHS Choices (2016) Gallstones causes. Available at: http://www.nhs.uk/Conditions/gallstones/Pages/causes.aspx [Accessed 17/10/2016] Wang, D., Afdhal, N. (2016). Gallstone Disease In: Feldman, M., Friedman, L., Brandt,L.(eds) Sleisanger and Fordtran’s Gastrointestinal and Liver Disease Pathophysiology / Diagnosis / Management. Volume 1. 10th Edition. Philadelphia, Saunders Elsevier. pp -1100 - 1108 Stockley, M (2001) Abdominal Ultrasound. 1st edition. Greenwich Medical Media Nathanson, L. (2014) Gallstones, In: Garden, O., Parks, R. (eds.) Hepatobilary and Pancreatic Surgery. A Companion to Specialist Surgical Practice. 5th edition. Edinburgh. Saunders Elsevier. p 174. Bibiliograph: http://www.webmd.com/digestive-disorders/gallstones#1What Are Gallstones? [Accessed 17/10/2016] http://www.livescience.com/34726-gallstones-symptoms-treatment.html. [Accessed 18/10/2016] Mayo Clinic (2013) Gallstones causes. Available at: http://www.mayoclinic.org/diseases-conditions/gallstones/basics/causes/con-20020461. [Accessed 18/10/2016]      

 

 

 

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