Further causes are varied and may include conditions that affect the ovaries, uterus, hypothalamus, or

pituitary gland. Hypothalamic amenorrhea is due to a disruption in the regulator hormones produced by
the hypothalamus in the brain. These hormones influence the pituitary gland, which in turn sends
signals to the ovaries to produce the characteristic cyclic hormones. A number of conditions can affect
the hypothalamus: extreme weight loss, emotional or physical stress, rigorous exercise, and severe
illness. Other types of medical conditions can cause secondary amenorrhea: tumors or other diseases of
the pituitary gland that lead to elevated levels of the hormone prolactin (which is involved in milk
production) also cause amenorrhea due to the elevated prolactin levels; hypothyroidism; elevated levels
of androgens (male hormones), either from outside sources or from disorders that cause the body to
produce too high levels of male hormones; ovarian failure (premature ovarian failure)
-----------
In some cases, ovarian cancer may cause early symptoms. The most common symptoms of ovarian
cancer include:4Frequent bloating.Pain in your belly or pelvis.Trouble eating, or feeling full
quickly.Urinary problems, such as an urgent need to urinate or urinating more often than usual. If you
have one or more of these symptoms, and it occurs almost daily for more than 2 or 3 weeks, talk with
your doctor. Recommended Related to Ovarian Cancer Understanding Ovarian Cancer
Symptoms
Ovarian cancer has some distinct symptoms. Often these symptoms can be diagnosed wrongly so if
these symptoms persist without any apparent relief, you should consult a doctor or a specialist.
Often, because the symptoms of ovarian cancer are so vague, by the time the cancer is diagnosed, the
cancer has inevitably spread to other parts of the body. The main symptoms include
Constant abdominal pressure
Persistent indigestion, gas or nausea
Change in bowel and bladder habits
A loss of appetite.
Physical pain or discomfort in the pelvic region
Increased abdominal girth
A persistent lack of energy and low back pain.
Vaginal bleeding and unexplained weight gain.
It is important to be able to spot the symptoms early and most of the early symptoms are just pain and
discomfort. You should remember that if it a persistent symptom, however vague, it is important to get
a complete check up. It can also help if you are aware of the causes that could lead to ovarian cancer.
What are the signs and symptoms of ovarian cancer?
Ovarian cancer often has no symptoms; however there are some signs that may indicate it.
They include:

term stomach pain or indigestion.







Back or leg pain.
--------------------
Ovarian cancer symptoms are often vague. Women and their doctors often blame the symptoms on
other, more common conditions. By the time the cancer is diagnosed, the tumor has often spread
beyond the ovaries.
See your doctor if you have the following symptoms on a daily basis for more than a few weeks:
Bloating or swollen belly area
Difficulty eating or feeling full quickly (early satiety)
Pelvic or lower abdominal pain; the area may feel "heavy" (pelvic heaviness)
Other symptoms are also possible with ovarian cancer. But these symptoms are also common in women
who do not have cancer:
Abnormal menstrual cycles
Digestive symptoms such as no appetite, indigestion, nausea and vomiting, constipation,
increased gas
Back pain for unknown reasons that worsens over time
Vaginal bleeding that occurs between periods
Weight gain or loss
Other symptoms that can occur:
Excessive hair growth that is coarse and dark
Sudden urge to urinate
Needing to urinate more often than usual (increased urinary frequency or urgency )


Ovarian cancer is a malignancy arising from the ovary. It is the leading cause of death from
gynaecological cancer in the UK. Early symptoms may be subtle and presentation is often late. The vast
majority of ovarian cancers are classified as epithelial, as they arise from the epithelial surface of the
ovary. Malignant ovarian tumours may be solid or cystic.
Classification
[
1
][
2
]

There are many different types of ovarian cancer, and the age group affected, management and
prognosis vary widely between them. Classification varies across the literature, but can be broadly
broken down as follows.
Epithelial ovarian tumours:
The most common type, accounting for 85-90% of all ovarian cancers.
Arise from the epithelial surface of the ovary.
Occur most commonly in women aged over 50 years.
There are a number of subtypes of epithelial tumours. These include:
Serous. The most common subtype, accounting for more than half of epithelial
tumours. Most occur in women between 40-60 years of age.
Endometrioid. 10-20% of epithelial tumours. Most common between ages 50-
70.
Clear cell tumours. 5-6% of epithelial tumours. Affect ages 40-80. Often
associated with endometriosis.
Mucinous tumours. 10% of epithelial tumours. Most commonly affect ages 30-
50.
Brenner (transitional cell) tumours. Rare.
Undifferentiated tumours. Do not fit into any of the above categories. 15% of
epithelial tumours.
Germ cell tumours:

Derived from primitive germ cells of embryonic gonad.
Account for 2-10% of all ovarian tumours.
Most common in younger women under the age of 35.
Often curable with high survival rates.
Usually present as a rapidly enlarging abdominal mass, which causes considerable pain.
They often rupture or undergo torsion.
Dysgerminoma is the most common type and has an excellent prognosis for Stage I
tumours.
Types of germ cell tumours are:

Dysgerminoma.
Endodermal sinus tumours.
Teratoma.
Embryonal carcinoma.
Choriocarcinoma.
Sarcomas.
Sex cord-stromal tumours:
Derive from connective tissue cells.
Less than 5% of all ovarian tumours.
Includes:

Fibroma.
Fibrosarcoma.
Sertoli-Leydig tumours.
Granulosa cell tumours.
Borderline tumours (tumours of low malignant potential):
[
3
]

These do not fit into the category of benign or malignant.
10-15% of ovarian tumours
Managed primarily by surgery and do not respond well to chemotherapy.
Types are:

Borderline serous - the most common.
Borderline mucinous.
Borderline endometrioid.
Metastatic tumours. Ovarian secondary tumours may arise from the breast, gastroentestinal
tract, haemopoietic system, uterus or cervix.
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Epidemiology
Ovarian cancer is the fifth most common cancer in women. It has a lifetime risk of around 2% for women
in England and Wales. It is the leading cause of death from gynaecological cancer.
[
4
]

Incidence rate in England in 2009 was 17.1 per 100,000 women. There were 5,861 cases in England in
2009, and 3,478 deaths.
[
5
]

In the UK as a whole, there were 7,011 new cases in 2010, and 4,295 deaths.
[
6
]

Age-specific Incidence rates rise with age, and the peak is in the 70s-80s; however, the number of cases
is highest in the 60-70 age range. Median age at diagnosis is 61 years, peaking at 75-79 years but it can
occur at any age. Elderly women are more likely than younger women to be in an advanced stage of
disease at initial diagnosis.
Risk factors
Increasing age.
Lifestyle. It has been estimated that 21% of ovarian cancer can be attributable to
lifestyle.
[
7
]
Factors which increase the risk include:
Smoking. It is estimated that 2% of cases may be caused by smoking.
[
8
]

Obesity. There is evidence of increased risk in postmenopausal women who are
overweight.
Lack of exercise. There is some evidence that regular physical exercise protects against
some forms of ovarian cancer.
Talcum powder use (pre-1975, after which regulation was introduced to prevent the
contamination of talcum powder with asbestos).
History of infertility and use of fertility drugs - eg, clomifene.
Nulliparous women are more likely to develop an ovarian malignancy than women who have
been pregnant three or more times.
Early menarche and late menopause.
Family history of ovarian cancer. Women with a first-degree relative with ovarian cancer have 3-
4 times the risk of developing the disease. However, only 10% of cases arise in women with a
positive family history.
[
9
]

Presence of BRCA1 and 2 genes increases susceptibility. Women with a prior history of ovarian
cancer or breast cancer have an increased risk of ovarian cancer. BRCA1 gene confers familial
susceptibility for the breast-ovarian cancer syndrome.
History of endometriosis confers a significant increased risk.
[
10
]
Studies suggest a link between
ovarian endometriosis and clear-cell ovarian cancer, possibly linked to mutation of the ARID1A
gene.
[
11
]

Asbestos exposure.
Hormone replacement therapy (HRT):
[
12
][
13
]

Further studies are needed to ascertain the exact risk. There does appear to be a small
increased risk of ovarian cancer associated with the use of HRT for more than five years.
This is present for both oestrogen-only and combined HRT. Risk of serous and
endometrioid tumours is increased, although risks of some other types may be reduced.
Past users of HRT are not at an increased risk of developing or dying from ovarian
cancer.
Protective factors
Any factor which prevents or inhibits ovulation appears to protect against ovarian cancer.
[
5
]
Protective
factors therefore include:
Childbearing
Breast-feeding
Early menopause
The oral contraceptive pill
Any condition described by the word "syndrome" can sound alarming. Syndrome simply refers to a
collection of experiences and changes that often occur together. But premenopausal syndrome is
nothing to fear; it's a perfectly normal phase of a woman's life signifying the beginning of menopause .
The syndrome can cause hot flashes, night sweats, and inconsistent menstruation. Premenopausal
syndrome may begin a few years before menopause actually occurs.

"There are much better things to call it than a syndrome," says Ann M. Voda, RN, PhD, the past
president of the North American Menopause Society. "Women get confused when they hear that,
because they think it's something that needs to be cured. It's not. It's all part of the transition in a
woman as she gets older."

Changes: Physical and Emotional
Menopause itself is defined as the cessation of the menstrual cycle for 12 months, and it usually occurs
around age 50. Perimenopause brings with it a host of well-known effects, including irregular periods,
hot flashes, vaginal dryness, sleep interruption, and irritability.

In addition, women going through the menopausal years are at risk for conditions such as osteoporosis
and various forms of heart disease .
Definition
By Mayo Clinic Staff
Painful intercourse can occur for a variety of reasons ranging from structural problems to
psychological concerns. Many women experience painful intercourse at some point in their lives.
The medical term for painful intercourse is dyspareunia (dis-puh-ROO-ne-uh) which is defined as
persistent or recurrent genital pain that occurs just before, during or after intercourse. Talk to your
doctor if you're experiencing painful intercourse. Treatments focus on the underlying cause, and can
help eliminate or reduce this common problem.
Entry pain
Pain during penetration may be associated with a range of factors, including:
Insufficient lubrication. This is often the result of not enough foreplay. Insufficient lubrication is
also commonly caused by a drop in estrogen levels after menopause, after childbirth or during
breast-feeding. In addition, certain medications are known to inhibit desire or arousal, which
can decrease lubrication and make sex painful. These include antidepressants, high blood
pressure medications, sedatives, antihistamines and certain birth control pills.
Injury, trauma or irritation. This includes injury or irritation from an accident, pelvic surgery,
female circumcision, episiotomy or a congenital abnormality.
Inflammation, infection or skin disorder. An infection in your genital area or urinary tract can
cause painful intercourse. Eczema or other skin problems in your genital area also can be the
problem.
Vaginismus. Involuntary spasms of the muscles of the vaginal wall (vaginismus) can make
attempts at penetration very painful.
Deep pain
Deep pain usually occurs with deep penetration and may be more pronounced with certain positions.
Causes include:
Certain illnesses and conditions. The list includes endometriosis, pelvic inflammatory disease,
uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome,
hemorrhoids and ovarian cysts.
Surgeries or medical treatments. Scarring from surgeries that involve your pelvic area, including
hysterectomy, can sometimes cause painful intercourse. In addition, medical treatments for
cancer, such as radiation and chemotherapy, can cause changes that make sex painful.
The most common signs and symptoms
of ovarian cancer are:

Bloating- clothes may no longer fit, this is beyond monthly water retention
Feeling full after eating a small amount of food
Fatigue and tiredness- a general feeling of malaise
Low back pain
Pelvic or abdominal pain or discomfort
Vague, but persistent gastrointestinal upsets such as gas, nausea and indigestion
Frequency and/or urgency of urination without having an urinary tract infection
Unexplained changes in bowel habits;
Unexplained weight gain or weight loss, particularly weight gain in the abdominal region
Pelvic and/or abdominal swelling, bloating, and/or feeling of fullness
Pain during intercourse
Abnormal postmenopausal bleeding (this symptom is rare).
"There is a burning need for an effective screening test" for ovarian cancer, explained Dr. Beth Karlan,
director of gynecologic oncology at Cedar Sinai Medical Center, Los Angeles, California. She suggests
that ultrasound may be that test.
Unfortunately, there is still no reliable and quick screening test for ovarian cancer like the Pap smear for
cervical cancer or the mammogram for breast cancer. In addition, its symptoms - such as abdominal
discomfort or bloating, cramps, unaccountable weight gain or loss, abnormal bleeding -- can often be
mistaken for signs of less serious conditions. Consequently, raising awareness of risk factors for ovarian
cancer is a crucial weapon in our effort to save lives. While every woman has the potential to develop
ovarian cancer, the risk is higher for those who have never given birth; who are over the age of 50; or
who have a family history of ovarian, breast, or colon cancer.
Cancer Related Wasting Syndrome
Cancer cells produce biochemicals, called cachexins, which circulate in your blood and cause fatigue,
loss of appetite(anorexia) and general wasting of muscle. Technically up to half of all cancer patients
die of malnutrition, not catastrophic complications from the cancer. This is an even bigger problem in
ovarian cancer because the intestine itself is attacked by tumor implants which mechanically interferes
with nutritional support. Avoiding protein-calorie malnutrition is critical to immune function, which is
also compromised in cancer patients.
increase in abdominal girth is the more common symptom of OVCA. This is usually due to ascites that
build up in the abdomen
Ovarian cancer is uncontrolled cell growth that causes tumors in the ovaries, the female reproductive
organs that make the female hormones and produce eggs. All women have some risk of developing
ovarian cancer, but according to the Centers for Disease Control and Prevention, approximately 90
percent of women who get ovarian cancer are over the age of 40. MayoClinic.com notes that recent
studies have shown that women with ovarian cancer are more likely than are other women to
consistently experience abdominal pressure, fullness, swelling or bloating.
Ovary Pain and Ovarian Cancer: Is There a Connection?
It is true that women with ovarian cancer do experience abdominal pain, pressure, or discomfort.
Experts recommend that women who experience pelvic pain daily for at least two to three weeks should
consult their physician for further evaluation.
According to UpToDate (an electronic resource used by many patients and their doctors looking for in-
depth medical information), there are many variables in ovarian cancer detection:
"During the early stages of ovarian cancer, symptoms are often vague and ill-defined. Symptoms may
include pelvic or abdominal discomfort, bloating, difficulty eating or feeling full, increased abdominal
size, or urinary symptoms (urgency and frequency).
"In some women, ovarian cancer is initially suspected when a mass or lump is felt during a routine pelvic
examination. However, a mass is not always detectable in the early stages of ovarian cancer. Even when
a mass is detected, it does not necessarily mean that the woman has ovarian cancer. A number of other
non-cancerous conditions can cause masses."
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You can see that while ovarian/pelvic pain can be a symptom of ovarian cancer, it can also be the
symptom of several other, less serious conditions. This is why it is so important to see a doctor if you are
experiencing persistent pain -- only a physician can determine the cause and appropriate course of
action.
Causes of Ovary Pain
Many times "ovarian" pain isn't caused by anything related to the ovaries. Harmless conditions like
constipation or gas can cause pain that only feels like it's coming from the ovaries. Other conditions
related to ovarian pain include, but aren't limited to:
ovarian cysts
polycystic ovarian syndrome (PCOS)
endometriosis
pelvic inflammatory disease (PID)
Diseases such as diabetes can cause problems with the nervous system. Diabetes can also cause damage
to the vagus nerve that regulates stomach movement. When the vagus nerve is injured, peristalsis can
slow or stop, causing the stomach to empty very slowly.

Gastroparesis is the most common cause of early satiety. People with gastroparesis have early satiety
because food stays in their stomachs longer than it should. The cause of many cases of gastroparesis is
unknown. However, according to the National Institutes of Health (NIH), diabetes is the most common
known cause of gastroparesis (NIH, 2012). Parkinsons disease, MS, and intestinal surgery can also cause
gastroparesis.
Ovarian cancer may not cause any specific symptoms, particularly in its early stages. When it does cause
symptoms, these may be nonspecific and vague. Symptoms can include abdominal enlargement
or swelling, abdominal fullness, early satiety (feeling full early), changes in bowel or bladder habits, or
clothes not fitting well. Other signs and symptoms can include shortness of breath, leg swelling,
and pain in the abdomen or pelvis.Fatigue may be present, but it is considered another nonspecific
symptom.
Because the symptoms of ovarian cancer can be very subtle or vague, affected women may not be
diagnosed immediately because the condition is not suspected at first. When ovarian cancers are very
large, they are more likely to cause symptoms related to obstruction or pressure on other organs.
For the Consumer
Applies to metformin: oral solution, oral tablet, oral tablet extended release
In addition to its needed effects, some unwanted effects may be caused by metformin. In the event that
any of these side effects do occur, they may require medical attention.
You should check with your doctor immediately if any of these side effects occur when taking
metformin:
More common
Abdominal or stomach discomfort
cough or hoarseness
decreased appetite
diarrhea
fast or shallow breathing
fever or chills
general feeling of discomfort
lower back or side pain
muscle pain or cramping
painful or difficult urination
sleepiness
Less common
Anxiety
blurred vision
chest discomfort
cold sweats
coma
confusion
cool, pale skin
depression
difficult or labored breathing
dizziness
fast, irregular, pounding, or racing heartbeat or pulse
feeling of warmth
headache
increased hunger
increased sweating
nausea
nervousness
nightmares
redness of the face, neck, arms, and occasionally, upper chest
seizures
shakiness
shortness of breath
slurred speech
tightness in the chest
unusual tiredness or weakness
wheezing
Rare
Behavior change similar to being drunk
difficulty with concentrating
drowsiness
lack or loss of strength
restless sleep
unusual sleepiness
Other causes of chronic nausea in these patients include the following:[12]

Raised intracranial pressure (from metastatic brain disease or primary brain tumors).
Metabolic abnormalities such as hypercalcemia, hyponatremia, and uremia.
Dehydration.
Malignant bowel obstruction.
Gastroduodenal ulcers.
Infections of the mouth, pharynx, or esophagus.
Nausea, like many other symptoms, may have psychological undercurrents that either exacerbate or
induce chronic nausea.
Fluid on the lungs or abdomen
It is quite common for fluid to collect when cancer affects the outer covering of the lungs. Two sheets of
tissue called the pleura or pleural membranes cover the lungs. The fluid collects between them and is
called a pleural effusion. When you breathe in, the lungs expand. When you have a pleural effusion,
they can't expand as far because the fluid is taking up space that the lung would otherwise expand into.
This will make you short of breath.

Cancer can also make fluid build up in the abdomen. This fluid is called ascites. Ascites is quite common
in women with cancer of the ovary. Cancer cells attach themselves to the lining of the abdomen and
irritate it. This makes the abdominal lining make fluid, which collects in the abdomen. People with
secondary liver cancer may also get ascites because of congestion in the liver making pressure build up
in the circulation. The pressure makes fluid leak out from the bloodstream and lymphatic system and
collect in the abdomen.
If there is a lot of fluid, your abdomen can become quite swollen. So it pushes upwards, against your
stomach and the sheet of muscle that separates your abdomen from your chest (the diaphragm). The
increased pressure on your diaphragm makes it harder for your lungs to expand when you breathe in.
This can make you breathless.
If you have pleural effusion or ascites, doctors can drain the fluid to make your breathing easier. But this
does not usually cure the problem for good because the fluid is likely to build up again.
If your doctors talk about fluid on the lung they may mean pleural effusion. Or they may mean you have
fluid actually collecting inside the lung. This is called pulmonary oedema. Unfortunately, it isnt possible
to have this type of fluid collection drained. Pulmonary oedema is most often due to heart problems so
you need treatment for your heart to stop the fluid collecting.
Fatigue
Cancer-related fatigue is defined by the National Comprehensive Cancer Network (NCCN) as "a
distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion
related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual
functioning." In cancer patients, fatigue is often severe; has a marked anticipatory component; and
results in lack of energy, malaise, lethargy, and diminished mental functioning that profoundly impairs
quality of life. It may be present early in the course of the illness, may be exacerbated by treatments,
and is present in almost all patients with advanced cancer.
Fatigue is sometimes referred to as asthenia, tiredness, lack of energy, weakness, and exhaustion. Not
all of these terms have the same meaning to all patient populations. Moreover, different studies of
fatigue and asthenia have looked at different outcomes, ranging from physical performance to the
purely subjective sensation.
Mechanism
The mechanisms of cancer-related fatigue are not well understood. Substances produced by the tumor
are postulated to induce fatigue. When injected into a rested subject, blood from a fatigued subject has
produced manifestations of fatigue. The host production of cytokines in response to the tumor can also
have a direct fatigue-inducing effect. Muscular or neuromuscular junction abnormalities are a possible
cause of chemotherapy- or radiotherapy-induced fatigue. In summary, fatigue is the result of many
syndromesnot just one. Multiple mechanisms are involved in causing fatigue in most patients with
advanced cancer.
Clinical Features
The causes of fatigue in an individual patient are often multiple, with many interrelated factors. Figure
1 summarizes the main contributors to fatigue in cancer patients.
FIGURE 1 Contributors to fatigue in cancer patients.
Cachexia
Cancer cachexia results from a complex interaction of host and tumor products. Host cytokines such as
tumor necrosis factor, interleukin-1 (IL-1), and IL-6 are capable of causing decreased food intake, loss of
body weight, a decrease in synthesis of both lipids and proteins, and increased lipolysis. The metabolic
abnormalities involved in the production of cachexia and the loss of muscle mass resulting from
progressive cachexia may cause profound weakness and fatigue. However, many abnormalities
described in Figure 1 are capable of causing profound fatigue in the absence of significant weight loss.
Immobility
Decreased physical activity has been shown to cause deconditioning and decreased endurance to both
exercise and normal activities of daily living. On the other hand, overexertion is a frequent cause of
fatigue in noncancer patients. It should also be considered in younger cancer patients who are
undergoing aggressive antineoplastic treatments such as radiation therapy and chemotherapy and who
are nevertheless trying to maintain their social and professional activities.
Psychological distress
In patients without cancer who present with fatigue, the final diagnosis is psychological (eg, depression,
anxiety, and other psychological disorders) in almost 75% of patients. The frequency of major psychiatric
disorders in cancer patients is low. However, symptoms of psychological distress or adjustment
disorders with depressive or anxious moods are much more frequent. Patients with an adjustment
disorder or a major depressive disorder can have fatigue as their most prevalent symptom.
Anemia
Low red blood cell count related to advanced cancer or chemotherapy has been associated with fatigue,
and its treatment results in improvement of fatigue and quality of life in these patients. In terminally ill
patients with advanced cancer, treatment of anemia may not resolve fatigue adequately due to the
multifactorial nature of its etiology. Fatigue may be the result of the more intense nature of the other
contributory factors.
Autonomic failure
Autonomic insufficiency is a frequent complication of advanced cancer. Autonomic failure has also been
documented in patients with severe chronic fatigue syndrome. Although the association between
fatigue and autonomic dysfunction has not been established in cancer patients, it should be suspected
in patients with severe postural hypotension or other signs of autonomic failure.
Hypogonadism
Both intrathecal and systemic opioid therapies, as well as cachexia and some antineoplastic therapies,
can result in hypogonadotropic hypogonadism. This condition can lead to fatigue, depression, and
reduced libido.
Chemotherapy/radiotherapy
Chemotherapy and radiotherapy are common causes of fatigue in cancer patients. The pattern of
fatigue reported by patients with cancer who receive myelosuppressive chemotherapy is cyclical. It
begins within the first few days after therapy is started, peaks around the time of the white blood cell
nadir, and diminishes in the week thereafter, only to recur again with the next cycle of chemotherapy.
Fatigue tends to worsen with subsequent cycles of chemotherapy, which suggests a cumulative dose-
related toxic effect. Compared with women who have no history of cancer, former patients with breast
cancer who had received adjuvant chemotherapy reported more fatigue and worse quality of life due to
this symptom. Similar results have been noted in breast cancer patients who have been treated with
high-dose chemotherapy and autologous stem-cell support and in patients treated for lymphoma.
Radiation therapy tends to cause a different pattern of fatigue. It is often described as a "wave" that
starts abruptly within a few hours after treatment and subsides shortly thereafter. Fatigue has been
noted to decrease in the first 2 weeks after localized treatment for breast cancer but then to increase as
radiation therapy persists into week 4. It then decreases again 3 weeks after radiation therapy ceases.
The mechanism for fatigue in these situations is not well understood.
Administration of chemotherapy and radiotherapy for malignancy causes a specific fatigue syndrome.
Combined therapy with the two modalities appears to cause worse fatigue than does either modality
given alone.
Surgery
Surgery is another common cause of fatigue in patients with cancer. In addition, commonly used
medications such as opioids and hypnotics may cause sedation and fatigue.
Other
Comorbid conditions not necessarily related to cancer, such as renal failure or congestive heart failure,
may coexist and contribute to the problem. Other conditions include the chronic stress response
(possibly mediated through the hypothalamic-pituitary axis), disrupted sleep or circadian rhythms, and
hormonal changes (eg, premature menopause and androgen blockade secondary to cancer treatment).
Most people associate cigarette smoking with breathing problems and lung cancer. But people who
smoke are more also likely to develop hypertension and heart disease.
About 30% of all deaths from heart disease in the U.S. are directly related to cigarette smoking. That's
because smoking is a major cause ofcoronary artery disease, especially in younger people.
Recommended Related to Hypertension
High Blood Pressure in Children
Most people think of high blood pressure, also known as hypertension, as a condition that affects older
people. This may have been true in the past, but these days, high blood pressure affects people of all
ages -- including young children. Why is high blood pressure in children a growing problem? What can
you do to protect your child from this threat? The first step is to learn all you can about high blood
pressure in children, its causes, consequences, and treatment.
Read the High Blood Pressure in Children article > >
A person's risk of heart attack greatly increases with the number of cigarettes he or she smokes and the
longer a person smokes, the greater their risk of heart attack. People who smoke a pack of cigarettes a
day have more than twice the risk of heart attack than non-smokers. Women who smoke and also take
birth control pills increase several times their risk of heart attack, stroke, and peripheral vascular
disease.
How Does Smoking Increase Heart Disease Risk?
The nicotine present in tobacco products causes:
Decreased oxygen to the heart
Increased blood pressure and heart rate
Increase in blood clotting
Damage to cells that line coronary arteries and other blood vessels
tactile fremitus,
a tremulous vibration of the chest wall during speaking that is palpable on physical examination. Tactile
fremitus may be decreased or absent when vibrations from the larynx to the chest surface are impeded
by chronic obstructive pulmonary disease, obstruction, pleural effusion, or pneumothorax. It is
increased in pneumonia.
Anemia
Symptoms may include tiredness, palpitation , sometimes chest pain , light headed.
Hemoglobin inside the cells make the cell that transport oxigen look red and then transmit that red color
through the nail bed and conjunctiva, when there is not enough hemoglobin in the case of anemia this
red color does not transmit much, thus making you look pale

Pale from stress
Most common cause of pallor is high adrenaline levels, not actually anemia.
Adrenaline constricts small blood vessels, making less blood in capillaries and therefore less redness, i.e.,
pallor. Stress causes high adrenaline, and sleep loss is terribly stressful.
The conjunctivae (the mucous membranes that line the inner surface of the eyelid and the exposed
surface of the eyeball) are normally a healthy red colour. In anaemia (haemaglobin < 90g/L), these
tissues become unnaturally pale. Pallor of the conjunctivae is therefore a sign of anaemia used in clinical
examination.
What is anicteric sclerae.
Just means
You do not have signs of high bilirubin ie the whites of your eyes are not yellow.
Sclera is defined as the white hard covering of the eye. It is what makes the actual eye ball. Anicteric
means without jaundice. So, anicteric sclera would mean that whites of the eyes are actually white and
not yellow as if there was a problem with the liver. When someone is jaundiced, their skin and the
whites of their eyes can take on a yellow tint. This is common with newborns as their body is learning
how to release the toxins.
In medicine, bulging flanks are a sign of ascites. If the sides of the abdomen are seen to bulge outward
in an unusual fashion on a patient (most easily observed from the patient's foot end), they are likely to
have fluid in the abdomen. This occurs if a significant amount of free fluid is present. The fluid collects
around the flanks due to gravity, causing them to bulge somewhat like a water balloon.
In medicine, the fluid wave test or fluid thrill test is a test for ascites (free fluid in the abdominal cavity).
It is performed by having the patient (or a colleague) push their hands down on the midline of the
abdomen. The examiner then taps one flank, while feeling on the other flank for the tap. The pressure
on the midline prevents vibrations through the abdominal wall while the fluid allows the tap to be felt
on the other side. The result is considered positive if tap can be felt on the other side. However, even
with the midline pressure, transmission through the skin must be excluded. A positive fluid wave test
indicates that there is a free fluid (ascites) in the abdomen. When one side of the abdomen is pressed,
the other side may also be painful due to the transfer of the fluid in it.
Hemidiaphragm: Half of the diaphragm, the muscle that separates thechest cavity from
the abdomen and that serves as the main muscle ofrespiration. Both hemidiaphragms are visible on X-
ray studies from the front or back.
The right hemidiaphragm is protected by the liver and is stronger than the left. The left hemidiaphragm
is more often subject to rupture and herniathan the right. This may also reflect weaknesses at the points
of embryologic fusion of the left hemidiaphragm.
Elevated hemidiaphragm: Elevation of half of the diaphragm, the muscle that separates the chest cavity
from the abdomen and that serves as the main muscle of respiration. The elevation of a hemidiaphragm
is a significant sign of a problem.
That problem may lie below, within or above the diaphragm:
Below the diaphragm -- In the abdomen there may be a cyst, an infection or abscess (filled with
pus), hematoma (collection of blood), atumor, or abdominal surgery.
In the diaphragm -- The hemidiaphragm may be paralyzed or lax because of damage to the
phrenic nerve (that controls the diaphragm) or infiltration of the diaphragm by lung cancer or
another tumor.
Above the chest -- In the chest there may be atelectasis (lung collapse), lung fibrosis,
painful pleurisy, pulmonary embolus, or a ribfracture.
An elevated hemidiaphragm may be suspected on the physical examination and confirmed on an X-ray
or CT of the chest or upper abdomen. It is also called a raised hemidiaphragm.