HEROPHILIUSS ELIXIR

Study Guide

HSS-Fusion 2015

Module Director Hafi Wadgama

This guide was exclusively written for HSS-Fusion 2015 by our very own Managing
Director- Mr. Hafi Qadir Wadgama. He was assisted in writing this work by the
STEM coordinator-Sualeh Asif and HSS alumni- Areeba Abid Ali.

The guide was edited and compiled by The Executive Council members- Sualeh

Asif and Muhammad Zain Viqar (President and Vice-President

respectively).)

Our Advice
The reviews here in are not at all exhaustive. They are written to facilitate
students and thus are not meant to be rote-learnt. 3 participants from each
delegation are expected to go through the guide understanding the diseasestheir symptoms and effects to be able to diagnose patients and produce
relevant treatments. The module director specially recommends you to go
through the history taking section, since it is the most important part of the
event.
WE WILL REWARD THE BEST DIAGNOTITIAN FROM YOU!

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PSYCHIATRIC DISORDERS
ALZHEIMERS DISEASE
INTRODUCTION
Alzheimers disease is an irreversible, progressive brain disorder that slowly
destroys memory and thinking skills, and eventually the ability to carry out the
simplest tasks. Alzheimer's is the most common form of dementia, a general term
for memory loss and other intellectual abilities serious enough to interfere with
daily life. Alzheimers accounts for most of dementia cases.

CAUSES
It is not known exactly what causes this process to begin, although people with
Alzheimer's disease have been found to have abnormal amounts of protein, fibers
and a chemical called acetylcholine in the brain.
These reduce the effectiveness of healthy neurons (nerve cells that carry
messages to and from the brain), gradually destroying them.

SYMPTOMS
Symptoms in Alzheimers appear in three different stages - the early, the middle
and the late symptoms
In the early stages, the main symptom of Alzheimer's disease is memory lapses.
For example, someone with early Alzheimer's disease may:
forget about recent conversations or events
forget the names of places and objects
repeat themselves regularly, such as asking the same question several

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times
show poor judgment or find it harder to make decisions
become unwilling to try out new things or adapt to change
There may also be some early signs of mood changes, such as increasing anxiety
or agitation, or periods of confusion.
As Alzheimer's disease develops, memory problems will get worse and someone
with the condition may find it increasingly difficult to remember the names of
people they know and may struggle to recognize their family and friends.
Other symptoms may also develop, such as:
increasing confusion and disorientation for example not knowing where
they are and walking off and getting lost
obsessive, repetitive or impulsive behavior
delusions (believing things that are untrue)
problems with speech or language (aphasia)
disturbed sleep
changes in mood, such as frequent mood swings, depression and feeling
increasingly anxious, frustrated or agitated
difficulty performing spatial tasks, such as judging distances
problems with eyesight, such as poor vision or hallucinations(seeing
things that are not there)

By this stage, someone with Alzheimer's disease will usually need support to help
them with their everyday living. For example, they may need help eating, washing,
getting dressed and using the toilet.

In the later stages of Alzheimer's disease, the symptoms become increasingly

severe and distressing for the person with the condition, as well as their careers,
friends and family.
Hallucinations and delusions will often become worse and the person with the
condition may start to become violent, demanding and suspicious of those around
them.
A number of other symptoms may also develop as Alzheimer's disease progresses,

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such as:
difficulty eating and swallowing (Dysphagia)
difficulty changing position or moving around without assistance
considerable weight loss (although some people eat too much and put
on weight)
unintentional passing of urine (urinary incontinence) or stools (bowel
incontinence)
gradual loss of speech
significant problems with short and long-term memory
During the severe stage of Alzheimer's disease, people often start to neglect their
personal hygiene. It is at this stage that most people with the condition will need
to have full-time care because they will be able to do very little on their own.

TREATMENT
There is currently no cure for Alzheimer's disease, although medication is available
that can temporarily reduce some symptoms or slow down the progression of the
condition in some people.
Cholinesterase inhibitors are drugs that work by boosting levels of a cell-to-cell
communication chemical depleted in the brain by Alzheimer's disease. Most
people can expect to keep their current symptoms at bay for a time.
Less than half of those taking these drugs can expect to have any improvement.
Memantine (Namenda). This drug works in another brain cell communication
network and slows the progression of symptoms with moderate to severe
Alzheimer's disease. It's sometimes used in combination with a cholinesterase
inhibitor.

PROGNOSIS
Although Alzheimers disease gets worse over time, the course of the
disease is varies from person to person. Some might lose the ability to

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perform daily activities early on in the disease, whereas others will be

able to perform quite well until the late stage of the disease.
The disease tends to get worse gradually. It usually starts with mild
memory loss. It progresses to severe mental and functional problems
and eventual death.
Its hard to predict as to how long the three phases of Alzheimers- early,
middle and late will last.
The average amount of time a person lives after developing symptoms
of Alzheimer's disease is 8 to 10 years.

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BIPOLAR DISORDER
INTRODUCTION
Bipolar disorder is a mental illness that brings severe high and low moods and
changes in sleep, energy, thinking, and behavior.
People who have bipolar disorder can have periods in which they feel overly
happy and energized and other periods of feeling very sad, hopeless, and sluggish.
In between those periods, they usually feel normal. You can think of the highs and
the lows as two "poles" or phases of mood, which is why it's called "bipolar"
disorder. Mood shifts may occur only a few times a year or as often as several
times a week.

CAUSES
The cause of bipolar disorder is not entirely known. The current thinking is that
this is a predominantly biological disorder that occurs in a specific part of the brain
and is due to a malfunction of the neurotransmitters (chemical messengers in the
brain). As a biological disorder, it may lie dormant and be activated spontaneously
or it may be triggered by stressors in life.
Although, no one is quite sure about the exact causes of bipolar disorder,
researchers have found these important clues:
MRI study found that the brain's prefrontal cortex in adults with bipolar
disorder tends to be smaller and function less well compared to adults who
don't have bipolar disorder. (The prefrontal cortex is a brain structure
involved in "executive" functions such as solving problems and making
decisions.)
Bipolar disorder tends to be familial, meaning that it runs in families.
About half the people with bipolar disorder have a family member with a
mood disorder, such as depression.
A person who has one parent with bipolar disorder has a 15 to 25 percent
chance of having the condition.
A person who has a non-identical twin with the illness has a 25 percent

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chance of illness, the same risk as if both parents have bipolar disorder.
A person who has an identical twin (having exactly the same genetic
material) with bipolar disorder has an even greater risk of developing the
illness about an eightfold greater risk than a non-identical twin.

SYMPTOMS
As bipolar disorder has two opposite phases- hypomania and depression, the
symptoms vary for both phases
1) Symptoms of hypomania are the following:

2)

Euphoria or irritability
Increased energy and activity
Excessive talk; racing thoughts
Inflated self-esteem
Unusual energy; less need for sleep
Impulsiveness, a reckless pursuit of gratification (shopping
sprees, impetuous travel, more and sometimes promiscuous sex,
high-risk business investments, fast driving)

Symptoms of depression are the following:

Depressed mood and low self-esteem
Low energy levels and apathy
Sadness, loneliness, helplessness, guilt
Slow speech, fatigue, and poor coordination
Insomnia (inability to sleep) or oversleeping
Suicidal thoughts and feelings
Poor concentration
Lack of interest or pleasure in usual activities

DIAGNOSIS
When doctors suspect someone has bipolar disorder, they typically do a number
of tests and exams. These can help rule out other problems, pinpoint a diagnosis
and also check for any related complications. These may include:

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 Physical exam. A physical exam and lab tests may be done to help identify
any medical problems that could be causing your symptoms.
Psychological evaluation. Your doctor or mental health provider will talk the
one suspected about his thoughts, feelings and behavior patterns. He may
also have fill out a psychological self-assessment or questionnaire.
With his permission, his family members or close friends may be asked to provide
information about his symptoms and possible episodes of mania or depression.
Mood charting. To identify exactly what's going on, the doctor may have
the suspect keep a daily record of his moods, sleep patterns or other
factors that could help with diagnosis and finding the right treatment.
Signs and symptoms. The doctor or mental health professional typically will
compare the symptoms with the criteria for bipolar and related disorders in
order to determine a diagnosis.

TREATMENT
Treatment for bipolar disorder aims to reduce the number and severity of the
episodes of depression and mania that characterize the condition. In doing so, a
person can live as normal a life as possible.
Medications may include:
Mood stabilizers: When one has bipolar disorder, he will typically need
mood-stabilizing medication to control manic or hypomanic episodes.
Examples of mood stabilizers include lithium and valproic acid
Antipsychotics: If symptoms of depression or mania persist in spite of
treatment with other medications, adding an antipsychotic medication such
as olanzapine, risperidone may help. The doctor may prescribe some of
these medications alone or along with a mood stabilizer.

Antidepressants: The doctor may add an antidepressant to help manage

depression. Because an antidepressant can sometimes trigger a manic

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episode, it's usually prescribed along with a mood stabilizer or

antipsychotic.
Anti-anxiety medications: Benzodiazepines may help with anxiety and
improve sleep. Benzodiazepines are generally used for relieving anxiety
only on a short-term basis.
Most people with bipolar disorder can receive most of their treatment without
having to stay in hospital.
However, hospital treatment may be needed in case the symptoms are severe.

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AUTISM SPECTRUM DISORDER

INTRODUCTION
Autism is a brain disorder that often makes it hard to communicate with and relate
to others. With autism, the different areas of the brain fail to work together. The
main features of ASD typically start to develop in childhood, although the impact
of these may not be apparent until there is a significant change in the persons life,
such as a change of school.

CAUSES
There is no known single cause for autism spectrum disorder, but it is generally
accepted that it is caused by abnormalities in brain structure or function. Brain
scans show differences in the shape and structure of the brain in children with
autism compared to in neurotypical children. However, the exact cause of autism
is not yet known.

SYMPTOMS
Features of ASD that can develop in older children and teenagers are explained
below.
Spoken Language
preferring to avoid using spoken language
speech that sounds very monotonous or flat
speaking in pre-learned phrases, rather than putting together individual
words to form new sentences
seeming to talk at people, rather than sharing a two-way conversation
Responding to others
taking peoples speech literally and being unable to understand sarcasm,
metaphors or figures of speech

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 reacting unusually negatively when asked to do something by someone else

Interacting with others

not being aware of other peoples personal space, or being unusually
intolerant of people entering their own personal space
little interest in interacting with other people, including children of a similar
age, or having few close friends despite attempts to form friendships
not understanding how people normally interact socially, such as greeting
people or wishing them farewell
being unable to adapt the tone and content of their speech to different
social situations, for example speaking very formally at a party and then
speaking to total strangers in a familiar way
not enjoying situations and activities that most children their age like
rarely using gestures or facial expressions when communicating
avoiding eye contact
Behavior
having repetitive movements such as flapping their fingers, rocking back
and forth or flicking their fingers
playing in a repetitive and unimaginative way, often preferring to play with
objects rather than people
developing a highly specific interest in a particular subject or activity
preferring to have a familiar routine, and getting extremely upset if there
are changes to their normal routine
Having a strong like or dislike of certain foods, based on the texture or color of the
food as much as taste.

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DIAGNOSIS/TESTS
Presently, we dont have a medical test that can diagnose autism. Instead,
specially trained physicians and psychologists administer the symptoms of autism
In most cases, parents notice the symptoms of autism spectrum disorder (ASD)
when their child is around two or three years old.
In some instances, mild cases may not be detected until adulthood.
There are no individual tests to confirm a diagnosis of ASD, a diagnosis is instead
based on the range of features the child is showing.
The type of assessment carried out often depends on things such as access to
additional information (for example nursery or school records) Moreover existing
information about the child's development, health and behavior may be sought.
Focused observation may also help to diagnose autism. Focused observation looks
at language, behavior, the pattern of your child's thinking (known as their
cognitive ability) and how they interact with others.

TREATMENT
There is no cure for ASDs. Therapies and behavioral interventions are designed to
remedy specific symptoms and can bring about substantial improvement. The
ideal treatment plan coordinates therapies and interventions that meet the
specific needs of individual children. Most health care professionals agree that
the earlier the intervention, the better.
Educational/behavioral interventions: Therapists use highly structured and
intensive skill-oriented training sessions to help children develop social and
language skills, such as Applied Behavioral Analysis. Family counseling for the
parents and siblings of children with an ASD often helps families cope with the
particular challenges of living with a child with an ASD.
Medications: Doctors may prescribe medications for treatment of specific autismrelated symptoms, such as anxiety, depression, or obsessive-compulsive disorder.
Antipsychotic medications are used to treat severe behavioral problems. Seizures
can be treated with one or more anticonvulsant drugs. Medication used to treat
people with attention deficit disorder can be used effectively to help decrease
impulsivity and hyperactivity.

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Other therapies: There are a number of controversial therapies or interventions

available, but few, if any, are supported by scientific studies. Parents should use
caution before adopting any unproven treatments. Although dietary
interventions have been helpful in some children, parents should be careful that
their childs nutritional status is carefully followed.

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ATTENTION DEFICIT HYPERACTIVITY DISORDER

INTRODUCTION
Attention deficit hyperactivity disorder (ADHD) is a chronic condition that affects
millions of children and often persists into adulthood. ADHD includes a group of
behavioral symptoms that include inattentiveness, hyperactivity and
impulsiveness. These symptoms can cause problems at home, school, work, or in
relationships.

CAUSES
ADHD runs in families. If a parent has ADHD, a child has more than a 50% chance of
having it. If an older sibling has it, a child has more than a 30% chance.
Children born with a low birth weight, born premature, or whose mothers had
difficult pregnancies have a higher risk of having ADHD. The same is true for
children with head injuries to the frontal lobe of the brain, the area that controls
impulses and emotions. However, only a small percentage of children with ADHD
a have suffered a traumatic brain injury. Studies show that pregnant women who
smoke or drink alcohol may have a higher risk of having a child with ADHD.
Exposure to lead or pesticides may also have a role - preschoolers who are
exposed to high levels of lead, which can sometimes be found in plumbing
fixtures or paint in old buildings, have a higher risk of developing ADHD.

SYMPTOMS
1) Inattention:
You might not notice it until a child goes to school. In adults, it may be easier to
notice at work or in social situations.
The person might procrastinate, not complete tasks like homework or chores, or
frequently move from one uncompleted activity to another.
They might also:

Be disorganized
Lack focus

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Have a hard time paying attention to details and a tendency to make

careless mistakes. Their work might be messy and seem careless.
Have trouble staying on topic while talking, not listening to others, and not
following social rules
Be forgetful about daily activities (for example, missing appointments,
forgetting to bring lunch)
Be easily distracted by things like trivial noises or events that are usually
ignored by others.

2) Hyperactivity
It may vary with age. You might be able to notice it in preschoolers. ADHD
symptoms nearly always show up before middle school.
Kids with hyperactivity may:

Fidget and squirm when seated.

Get up frequently to walk or run around.
Run or climb a lot when it's not appropriate. (In teens this may seem like
restlessness.)
Have trouble playing quietly or doing quiet hobbies
Always be "on the go"
Talking excessively
Toddlers and preschoolers with ADHD tend to be constantly in motion,
jumping on furniture and having trouble participating in group activities
that call for them to sit still.
School-age children have similar habits, but one may notice those less
often. They are unable to stay seated, squirm a lot, fidget, or talk a lot.

Hyperactivity can show up as feelings of restlessness in teens and adults. They

may also have a hard time doing quiet activities where you sit still.

3) Impulsivity
Symptoms of this include:

Impatience
Having a hard time waiting to talk or react

There is no single test that can be used to diagnose attention deficit hyperactivity
disorder in children and adults. ADHD is diagnosed after a person has shown some
or all of the symptoms of ADHD on a regular basis for more than six months. In

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addition, symptoms must be present in more than one setting. Depending on the
number and type of symptoms, the diagnosis may be done.

TREATEMENT
There is no cure for attention deficit hyperactivity disorder (ADHD), but treatment
can help relieve the symptoms and make the condition much less of a problem in
day-to-day life.
ADHD can be treated using medication or therapy, but a combination of both is
often the best way to treat it.
Treatment will usually be arranged by a specialist, such as a pediatrician or
psychiatrist.

Medication
There are four types of medication licensed for the treatment of ADHD:
1. Methylphenidate
2. Dexamphetamine
3. Iisdexamfetamine
4. Atomoxetine

These medications are not a permanent cure for ADHD, but they can help
someone with the condition concentrate better, be less impulsive, feel calmer,
and learn and practice new skills.
Some medications need to be taken every day, but some can be taken just on
school days. Treatment breaks are occasionally recommended, to assess whether
the medication is still needed.
If you or your child is prescribed one of these medications, you will probably be
given small doses at first, which may then be gradually increased. You or your
child will need to see your GP for regular check-ups, to ensure the treatment is
working effectively and to check for signs of any side effects or problems.
Your specialist will discuss how long you should take your treatment but, in many
cases, treatment is continued for as long as it is helping.

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Some of the therapies that may be used to treat ADHD are outlined below.
PSYCHOEDUCATION means you or your child will be encouraged to discuss ADHD
and how it affects you. It can help children, teenagers and adults make sense of
being diagnosed with ADHD, and can help you to cope and live with the condition.
BEHAVIOUR THERAPY provides support for careers of children with ADHD, and
may involve teachers as well as parents. Behavior therapy usually involves
behavior management, which uses a system of rewards to encourage your child to
try to control their ADHD.
If your child has ADHD, you can identify types of behavior you want to encourage,
such as sitting at the table to eat. Your child is then given some sort of small
reward for good behavior, and removal of a privilege for poor behavior. For
teachers, behavior management involves learning how to plan and structure
activities, and to praise and encourage children for even very small amounts of
progress.
These programmes are usually arranged in groups and can last several weeks.
SOCIAL SKILLS TRAINING involves your child taking part in role play situations, and
aims to teach them how to behave in social situations by learning how their
behavior affects others.
COGNITIVE BEHAVIOURAL THERAPY (CBT) is a talking therapy that can help you
manage your problems by changing the way you think and behave. A CBT
therapist would try and change how your child feels about a situation, which
would in turn potentially change their behavior.

Diet:
People with ADHD should eat a healthy, balanced diet. Do not cut out foods
without medical advice.

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NARCISSISTIC PERSONALITY DISORDER

INTRODUCTION
Narcissistic personality disorder is a mental disorder in which people have an
inflated sense of their own importance, a deep need for admiration and a lack of
empathy for others. People with this disorder often believe they are of primary
importance in everybodys life or to anyone they meet. But behind this mask of
ultra-confidence lies a fragile self-esteem that's vulnerable to the slightest
criticism. However one should know that theres a difference between being selfabsorbed, often called a narcissist, and having narcissistic personality disorder,
which is a mental illness.

CAUSES
The exact cause is not known, but there are several theories. Parents who put
their children on a pedestal and shower them with endless praise can plant a seed
of narcissism, a recent study found. Theres a line between being nurturing and
supportive and inflating an ego. Moreover narcissistic personality disorder may
also be linked to genetics or psychobiology the connection between the brain
and behavior and thinking

SYMPTOMS
In order for a person to be diagnosed with narcissistic personality disorder (NPD)
they must meet five or more of the following symptoms:
Has a grandiose sense of self-importance (e.g., exaggerates achievements
and talents, expects to be recognized as superior without commensurate
achievements)
Is preoccupied with fantasies of unlimited success, power, brilliance,
beauty, or ideal love
Believes that he or she is special and unique and can only be understood
by, or should associate with, other special or high-status people (or
institutions)
Requires excessive admiration

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 Has a very strong sense of entitlement, e.g., unreasonable expectations of

especially favorable treatment or automatic compliance with his or her
expectations
Is exploitative of others, e.g., takes advantage of others to achieve his or
her own ends
Lacks empathy, e.g., is unwilling to recognize or identify with the feelings
and needs of others
Is often envious of others or believes that others are envious of him or her
Regularly shows arrogant, haughty behaviors or attitudes

DIAGNOSIS
Narcissistic personality disorder is typically diagnosed by a trained mental health
professional, such as a psychologist or psychiatrist. Family physicians and general
practitioners are generally not trained or well-equipped to make this type of
psychological diagnosis. There are no laboratory, blood or genetic tests that are
used to diagnose personality disorder.
Many people with narcissistic personality disorder dont seek out treatment.
People with personality disorders, in general, do not often seek out treatment
until the disorder starts to significantly interfere or otherwise impact a persons
life.

TREATEMENT
Clinical treatment is rare because most narcissists avoid therapy. However,
narcissists can learn to be more caring about others, and narcissism can be
reduced when these individuals are included in social groups.
Psychotherapy may be useful in getting the individual with narcissistic personality
disorder to relate to others in a less maladaptive manner.
There are no medications specifically used to treat narcissistic personality
disorder. However, if you have symptoms of depression, anxiety or other
conditions, medications such as antidepressants or anti-anxiety drugs may be
helpful.

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GASTROINTESTINAL DISORDERS
CROHN'S DISEASE
INTRODUCTION
Crohn's disease is a long-term condition that causes inflammation of the lining of
the digestive system. It is one of the types of IBD (Inflammatory Bowel Disease)
and is an autoimmune disease.
Inflammation can affect any part of the digestive system, from the mouth to the
back passage, but most commonly occurs in the last section of the small intestine
(ileum) or the large intestine (colon).

CAUSES
The exact cause of Crohn's disease remains unknown. Previously, diet and stress
were suspected, but now doctors know that these factors may aggravate but
don't cause Crohn's disease. A number of factors, such as heredity and a
malfunctioning immune system, likely play a role in its development.
Immune system. It's possible that a virus or bacterium may trigger Crohn's
disease. When the immune system tries to fight off the invading
microorganism, an abnormal immune response causes the immune system to
attack the cells in the digestive tract, too.
Heredity. Crohn's is more common in people who have family members with
the disease, so genes may play a role in making people more susceptible. In
fact about 20% of people with Crohn's disease may have a close relative with
either Crohn's or ulcerative colitis. However, most people with Crohn's disease
don't have a family history of the disease.

Moreover smoking also has an impact on Crohns disease- the symptoms of

smokers with Crohns disease are more severe than those of nonsmokers.

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SYMPTOMS
People with Crohn's disease can experience periods of severe symptoms followed
by periods of remission that can last for weeks or years. The symptoms of Crohn's
disease depend on where the disease occurs in the bowel and its severity. In
general, symptoms can include:

Chronic diarrhea, often bloody and containing mucus or pus

Weight loss
Fever
Abdominal pain and tenderness
Feeling of a mass or fullness in the abdomen
Rectal bleeding
People suffering from Crohns often experience loss of appetite and may
lose weight as a result. A feeling of low energy and fatigue is also common.
Among younger children, Crohn's may delay growth and development.

DIAGNOSIS
There isn't any one test that can tell you whether or not one has Crohn's disease.
And Crohn's disease has many possible symptoms that are the same as symptoms
for other health problems.
Through history taking the doctor will be able the following information:

Diarrhea, which may be bloody

Family history of Crohn's disease
Fever
Pain and tenderness in the abdomen

These would indicate the need for further tests for example Barium X-rays, CT
scans, colonoscopy, etc.
After the exams and lab tests the doctor will discuss the findings with the patient.
If the doctor believes that the patient is suffering from Crohn's disease, he will
work with the patient to develop a treatment program.

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TREATMENT
There's currently no cure for Crohn's disease, so the aim of treatment is to stop
the inflammatory process, relieve symptoms (induce and maintain remission) and
avoid surgery wherever possible.
The first treatment offered to reduce symptoms is usually steroid medication
(corticosteroids). If this doesn't help, medication to suppress the immune system
(immunosuppressant) and medication to reduce inflammation may be used.
In some cases, surgery may be needed to remove the inflamed section of
intestine.
Once the symptoms are under control (in remission), further medication may be
needed to help maintain this.

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CANCERS
BRAIN CANCER
INTRODUCTION
Brain tumors are abnormal growths of cells in the brain. Although such growths
are popularly called brain tumors, not all brain tumors are cancer. Cancer is a term
reserved for malignant tumors.
Malignant tumors can grow and spread aggressively, overpowering healthy cells
by taking their space, blood, and nutrients. They can also spread to distant parts
of the body. Like all cells of the body, tumor cells need blood and nutrients to
survive.
Tumors that do not invade nearby tissue or spread to distant areas are called
benign. In general, a benign tumor is less serious than a malignant tumor. But a
benign tumor can still cause many problems in the brain by pressing on nearby
tissue.

PRIMARY BRAIN CANCERS

The brain is made up of many different types of cells.
Some brain cancers occur when one type of cell transforms from its normal
characteristics. Once transformed, the cells grow and multiply in abnormal ways.
As these abnormal cells grow, they become a mass, or tumor.
The brain tumors that result are called primary brain tumors because they
originate in the brain. The most common primary brain tumors are gliomas,
meningiomas, pituitary adenomas, vestibular schwannomas, and primitive
neuroectodermal tumors (medulloblastomas).
Most of these are named after the part of the brain or the type of brain cell from
which they arise.

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CAUSES
As with tumors elsewhere in the body, the exact cause of most brain cancer is
unknown. Genetic factors, various environmental toxins, radiation to the head,
HIV infection, and cigarette smoking have all been linked to cancers of the brain.
In most cases, no clear cause can be shown.

SYMPTOMS
Not all brain tumors cause symptoms, and some (such as tumors of the pituitary
gland) are often not found until after death. The symptoms of brain cancer are
numerous and not specific to brain tumors, meaning they can be caused by many
other illnesses as well. The only way to know for sure what is causing the
symptoms is to undergo diagnostic testing. Symptoms can be caused by:

A tumor pressing on or encroaching on other parts of the brain and keeping

them from functioning normally.
Swelling in the brain caused by the tumor or surrounding inflammation.

The symptoms of primary and metastatic brain cancers are similar. The following
symptoms are most common:

Headache
Weakness
Clumsiness
Difficulty walking
Seizures

Other nonspecific symptoms and signs include the following:

Altered mental status -- changes in concentration, memory, attention, or

alertness
Nausea, vomiting
Abnormalities in vision
Difficulty with speech
Gradual changes in intellectual or emotional capacity

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In many people, the onset of these symptoms is very gradual and may be missed
by both the person with the brain tumor and the family. Occasionally, however,
these symptoms appear more rapidly. In some instances, the person acts as if he
or she is having a stroke.

DIAGNOSIS/TESTS
Findings of a medical interview and physical exam suggests to health care
providers that one has problem with the brain or brain stem.
In most cases, a CT scan of the brain is done. This test is like an X-ray, but shows
more detail in three dimensions. Usually, a harmless dye is injected into the
bloodstream to highlight abnormalities on the scan. More often, the MRI scan is
being used instead of a CT scan for suspected brain tumors. This is because MRI
has a higher sensitivity for detecting the presence of, or changes within, a tumor.
Currently, however, most institutions still use the CT scan as the first diagnostic
test.
People with brain cancer often have other medical problems; therefore, routine
lab tests may be performed. These include analysis of blood, electrolytes, liver
function tests, and a blood coagulation profile.
If the mental status has been the major change in a person, blood or urine tests
may be done to detect drug use.
If scans indicate the presence of a brain tumor, the patient is referred to a cancer
specialist, called an oncologist.
The next step in diagnosis is confirmation that cancer exists, usually by taking and
testing a sample of the tumor. This is called a biopsy:
The most widely used technique for obtaining a biopsy is surgery. The skull is
opened, usually with the intention of removing the whole tumor, if possible. A
biopsy is then taken from the tumor.
If the surgeon is unable to remove the entire tumor, a small piece of the tumor is
removed.
In some cases, it is possible to collect a biopsy without opening the skull. The

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exact location of the tumor in the brain is determined by using a CT or MRI scan
while the head is held still in a frame. A small hole is then made in the skull and a
needle guided through the hole to the tumor. The needle collects the biopsy and
is removed. This technique is called stereotaxis, or stereotactic biopsy.
The biopsy is examined under a microscope by a pathologist (a doctor who
specializes in diagnosing diseases by looking at cells and tissues).

TREATMENT/PROGNOSIS
Treatment of brain cancer is usually complex. Most treatment plans involve
several consulting doctors.
The team of doctors includes neurosurgeons (specialists in the brain and
nervous system), oncologists, radiation oncologists (doctors who practice
radiation therapy), and, of course, the primary health care provider. The
team may also include a dietitian, a social worker, a physical therapist, and,
possibly, other specialists.
The treatment protocols vary widely according to the location of the tumor,
its size and type, your age, and any additional medical problems that you
may have.

The most widely used treatments are surgery, radiation therapy, and
chemotherapy. In most cases, more than one of these is used,

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COLON CANCER
INTRODUCTION
Colon cancer is cancer of the large intestine (colon) which is the lower part of your
digestive system. Rectal cancer is cancer of the last several inches of the colon.
Together, they're often referred to as colorectal cancer.

CAUSES
In most cases, it's not clear what causes colon cancer. Doctors know that colon
cancer occurs when healthy cells in the colon become altered.
Healthy cells grow and divide in an orderly way to keep your body functioning
normally. But when a cell is damaged and becomes cancerous, cells continue to
divide even when new cells aren't needed. These cancer cells can invade and
destroy normal tissue nearby. Cancerous cells can also travel to other parts of the
body.
Colon cancer most often begins as clumps of precancerous cells (polyps) on the
inside lining of the colon. Removing polyps before they become cancerous can
prevent colon cancer.
Inherited gene mutations that increase the risk of colon cancer can be passed
through families, but these inherited genes are linked to only a small percentage
of colon cancers. They can increase an individual's risk of cancer significantly.

SYMPTOMS
In its early stage, colorectal cancer usually produces no symptoms. Even when
symptoms appear, they'll likely vary, depending on the cancer's size and location
in your large intestine. Signs and symptoms of colon cancer include:
A change in your bowel habits, including diarrhea or constipation or a
change in the consistency of your stool
Rectal bleeding or blood in your stool
Persistent abdominal discomfort, such as cramps, gas or pain
A feeling that your bowel doesn't empty completely
Weakness or fatigue
Unexplained weight loss

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DIAGNOSIS
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. A history of the patients health habits and past
illnesses and treatments will also be taken.
Digital rectal exam: An exam of the rectum. The doctor or nurse inserts a
lubricated, gloved finger into the rectum to feel for lumps or anything else
that seems unusual.
Barium enema: A series of x-rays of the lower gastrointestinal tract. A liquid
that contains barium (a silver-white metallic compound) is put into the
rectum. The barium coats the lower gastrointestinal tract and x-rays are
taken. This procedure is also called a lower GI series.
Sigmoidoscopy: A procedure to look inside the rectum and sigmoid (lower)
colon for polyps (small areas of bulging tissue), other abnormal areas, or
cancer. A sigmoidoscope is inserted through the rectum into the sigmoid
colon. A sigmoidoscope is a thin, tube-like instrument with a light and a lens
for viewing.
Colonoscopy: A procedure to look inside the rectum and colon for polyps,
abnormal areas, or cancer. A colonoscope is inserted through the rectum
into the colon. A colonoscope is a thin, tube-like instrument with a light and
a lens for viewing. It may also have a tool to remove polyps or tissue
samples, which are checked under a microscope for signs of cancer.
Virtual Colonoscopy: A procedure that uses a series of x-rays called
computed tomography to make a series of pictures of the colon. A
computer puts the pictures together to create detailed images that may
show polyps and anything else that seems unusual on the inside surface of
the colon. This test is also called colonography or CT colonography.
Biopsy: The removal of cells or tissues so they can be viewed under a
microscope by a pathologist to check for signs of cancer.

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TREATEMENT
Treatment depends partly on the stage of the cancer. In general, treatments may
include:

Surgery (most often a colectomy) to remove cancer cells

Chemotherapy to kill cancer cells
Radiation therapy to destroy cancerous tissue

SURGERY
Stage 0 colon cancer may be treated by removing the cancer cells, often during a
colonoscopy. For stages I, II, and III cancer, more extensive surgery is needed to
remove the part of the colon that is cancerous.
There is some debate as to whether patients with stage II colon cancer should
receive chemotherapy after surgery. This should be discussed with the oncologist.
CHEMOTHERAPHY
Almost all patients with stage III colon cancer should receive chemotherapy after
surgery for approximately 6 - 8 months. The chemotherapy drug 5-fluorouracil has
been shown to increase the chance of a cure in certain patients.
Chemotherapy is also used to improve symptoms and prolong survival in patients
with stage IV colon cancer.
One may receive just one type, or a combination of drugs as a part of treatment
too.
RADIATION
Although radiation therapy is occasionally used in patients with colon cancer, it is
usually used in combination with chemotherapy for patients with stage III rectal
cancer.
For patients with stage IV disease that has spread to the liver, various treatments
directed specifically at the liver can be used. This may include:

Burning the cancer (ablation)

Delivering chemotherapy or radiation directly into the liver
Freezing the cancer (cryotherapy)
Surgery

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LEUKEMIA
INTRODUCTION
Leukemia is cancer of the blood cells. Most blood cells form in the bone marrow.
In leukemia, cancerous blood cells form and crowd out the healthy blood cells in
the bone marrow.
The type of leukemia depends on the type of blood cell that has become
cancerous. For example, acute lymphoblastic leukemia is a cancer of the
lymphoblasts (white blood cells that
fight infection). White blood cells are
the most common type of blood cell to
become cancer. But red blood cells
(cells that carry oxygen from the lungs
to the rest of the body) and platelets
(cells that clot the blood) may also
become cancer.
Leukemia occurs most often in adults
older than 55 years, and it is the most
common cancer in children younger
than 15 years.
Leukemia is either acute or chronic. Acute leukemia is a fast-growing cancer that
usually gets worse quickly. Chronic leukemia is a slower-growing cancer that gets
worse slowly over time. The treatment and prognosis for leukemia depend on the
type of blood cell affected and whether the leukemia is acute or chronic.
Chemotherapy is often used to treat leukemia.

CAUSES
There is no single known cause for any of the different types of leukemia.
Leukemia, like other cancers, results from mutations in the DNA. Certain
mutations can trigger leukemia by activating oncogenes or deactivating tumor
suppressor genes, and thereby disrupting the regulation of cell death,
differentiation or division. These mutations may occur spontaneously or as a result
of exposure to radiation or carcinogenic substances.
Exposure to radiation is known to increase the risk of developing AML, CML, or

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ALL. Increases in leukemia were observed in people surviving atomic bombs.

Radiation therapy for cancer can also increase the risk of leukemia. Exposure to
benzene, used commonly in the chemical industry, increases the risk of leukemia.
Cigarette smoking is known to increase the risk of developing AML.

Down syndrome, Li-Fraumeni syndrome, and other medical conditions can

increase the risk of developing leukemia.
Viruses have also been linked to some forms of leukemia. For example, human Tlymphotropic virus (HTLV-1) causes adult T-cell leukemia.

Some people have a genetic predisposition towards developing leukemia. This

predisposition is demonstrated by family histories and twin studies. The affected
people may have a single gene or multiple genes in common. In some cases,
families tend to develop the same kinds of leukemia as other members; in other
families, affected people may develop different forms of leukemia or related
blood cancers.

SYMPTOMS
Symptoms of acute leukemia depend on how much the cancer has grown. They
may include:
A new lump or swollen gland in your neck, under your arm, or in your groin.
Frequent nosebleeds, bleeding from the gums or rectum, more frequent
bruising, or very heavy menstrual bleeding.
Frequent fevers.
Night sweats.
Bone pain.
Unexplained appetite loss or recent weight loss.
Feeling tired a lot without a known reason.
Swelling and pain on the left side of the belly.
The chronic forms of leukemia often cause no symptoms until much later in the
disease. And when symptoms appear, they usually appear gradually. If leukemia
cells have infiltrated the brain, symptoms such as headaches, seizures, confusion,
loss of muscle control, and vomiting can occur.

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DIAGNOSIS
If your doctor suspects leukemia, he or she may:
Ask about your medical history.
Check for enlarged lymph nodes camera.gif in your neck, underarm, or
groin.
Check for an enlarged liver or spleen camera.gif.
Do a complete blood count (CBC) and a blood chemistry. These tests let
your doctor look into symptoms such as fatigue, weakness, fever, bruising,
or weight loss.
Do a bone marrow aspiration and biopsy. This is the key to diagnosing most
leukemias and helps determine the type.
If your blood work points to possible leukemia, your doctor will want to find out
what kind you might have. Your treatment plan will depend on the specific kind of
leukemia that you have. The doctor may also order for several other X-Rays and
CT-Scans to check if the cancer has metastasized.

TREATMENT
There are a number of different medical approaches to the treatment of leukemia.
Treatment will typically depend upon the type of leukemia, the patient's age and
health status, as well as whether or not the leukemia cells have spread to the
cerebrospinal fluid. The genetic changes or specific characteristics of the leukemia
cells as determined in the laboratory can also determine the type of treatment
that may be most appropriate.

Treatments for leukemia include:

chemotherapy (major treatment modality for leukemia)

radiation therapy
biological therapy
targeted therapy
Stem cell transplant.

Combinations of these treatments may be used. Surgical removal of the spleen

can be a part of treatment if the spleen is enlarged.
Acute leukemia needs to be treated when it is diagnosed, with the goal of
inducing a remission (absence of leukemia cells in the body). After remission is
achieved, therapy may be given to prevent a relapse of the leukemia. This is called

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consolidation or maintenance therapy. Acute leukemias can often be cured with

treatment.
Chronic leukemias are unlikely to be cured with treatment, but treatments are
often able to control the cancer and manage symptoms. Some people with
chronic leukemia may be candidates for stem cell transplantation, which does
offer a chance for cure.

Supportive treatments
Because many of the treatments for leukemia deplete normal blood cells,
increasing the risk for bleeding and infection, supportive treatments may be
needed to help prevent these complications of treatment. Supportive treatments
may also be needed to help minimize and manage unpleasant side effects of
medical or radiation therapy.
Types of supportive and preventive treatments that can be used for patients
undergoing treatment for leukemia include the following:

Vaccines against the flu or pneumonia

Blood or platelet transfusions
Anti-nausea medications
Antibiotics or antiviral medications to treat or prevent infections
White blood cell growth factors to stimulate white blood cell production
Red cell growth factors to stimulate red blood cell production (darbepoetin
alfa [Aranesp] or epoetin alfa [Procrit])
Intravenous injections of immunoglobulin to help fight infection

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LUNG CANCER
INTRODUCTION
Lung cancer is a type of cancer that begins in the lungs. Lung cancer is the
uncontrolled growth of abnormal cells that start off in one or both lungs; usually
in the cells that line the air passages. The abnormal cells do not develop into
healthy lung tissue, they divide rapidly and form tumors. As tumors become larger
and more numerous, they undermine the lungs ability to provide the bloodstream
with oxygen.
This growth may lead to metastasis, which is the invasion of adjacent tissue and
infiltration beyond the lungs. The vast majority of primary lung cancers are
carcinomas of the lung, derived from epithelial cells. Lung cancer, the most
common cause of cancer-related death in men and women, is responsible for 1.3
million deaths worldwide annually, as of 2004.
The main types of lung cancer are small cell lung carcinoma and non-small cell lung
carcinoma. This distinction is important, because the treatment varies; non-small
cell lung carcinoma (NSCLC) is sometimes treated with surgery, while small cell
lung carcinoma (SCLC) usually responds better to chemotherapy and radiation.

CAUSES
Most cases of lung cancer are caused by smoking, although people who have
never smoked can also develop the condition.

1) Smoking
Smoking cigarettes is the single biggest risk factor for lung cancer. It is responsible
for about 90% of all cases.
Tobacco smoke contains more than 60 different toxic substances, which can lead
to the development of cancer. These substances are known to be carcinogenic
(cancer-producing).
If you smoke more than 25 cigarettes a day, you are 25 times more likely to get
lung cancer than a non-smoker.
Smoking is measured in pack-years. (No. of packets smoked in a day X No. of
years) So the higher the pack years the greater the risk of Cancer.
While smoking cigarettes is the biggest risk factor, using other types of tobacco
products can also increase your risk of developing lung cancer and other types of

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cancer, such as Oesophageal Cancer and Mouth Cancer.

These products include:

cigars
pipe tobacco
snuff (a powdered form of tobacco)
chewing tobacco

Smoking cannabis has also been linked to an increased risk of lung cancer. Most
cannabis smokers mix their cannabis with tobacco. While they tend to smoke less
than tobacco smokers, they usually inhale more deeply and hold the smoke in
their lungs for longer.

2) Passive smoking
If you do not smoke, frequent exposure to other peoples tobacco smoke (passive
smoking) can increase your risk of developing lung cancer.
For example, research has found that non-smoking women who share their house
with a smoking partner are 25% more likely to develop lung cancer than nonsmoking women who live with a non-smoking partner.

3) Radon
Radon is a naturally occurring radioactive gas that comes from tiny amounts of
uranium present in all rocks and soils. It can sometimes build up in buildings. If
radon is breathed in, it can damage your lungs, particularly if you are a smoker.

4) Occupational exposure and pollution

Exposure to certain chemicals and substances that are used in several occupations
and industries has been linked to a slightly higher risk of developing lung cancer.
These chemicals and substances include arsenic, asbestos, beryllium, cadmium,
coal and coke fumes, silica and nickel.
Research also suggests that being exposed to large amounts of diesel fumes for
many years may increase your risk of developing lung cancer by up to 50%. One
study has shown that your risk of developing lung cancer increases by about a
third if you live in an area with high levels of nitrogen oxide gases (mostly
produced by cars and other vehicles).
5) Asbestos fibers
Asbestos fibers are silicate fibers that can persist for a lifetime in lung tissue
following exposure to asbestos. The workplace is a common source of exposure
to asbestos fibers, as asbestos was widely used in the past for both thermal and
acoustic insulation materials. Today, asbestos use is limited or banned in many
countries including the Unites States. Both lung cancer and mesothelioma (a type

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of cancer of the pleura or of the lining of the abdominal cavity called the
peritoneum) are associated with exposure to asbestos. Cigarette smoking
drastically increases the chance of developing an asbestos-related lung cancer in
exposed workers. Asbestos workers who do not smoke have a fivefold greater
risk of developing lung cancer than non-smokers, and those asbestos workers
who smoke have a risk that is 50 to 90 times greater than non-smokers.

SYMPTOMS
There are usually no signs or symptoms in the early stages of lung cancer.
However, symptoms develop as the condition progresses.
The main symptoms of lung cancer are listed below:
Persistent or intense coughing
Pain in the chest shoulder, or back from coughing (Pancoasts Syndrome)
Changes in color of the mucus that is coughed up from the lower airways
(sputum)
Difficulty breathing and swallowing
Hoarseness of the voice
Chronic bronchitis or pneumonia
If the lung cancer spreads, or metastasizes, additional symptoms can present
themselves in the newly affected area. Swollen or enlarged lymph nodes are
common and likely to be present early. If cancer spreads to the brain, patients
may experience vertigo, headaches, or seizures.
In addition, the liver may become enlarged and cause jaundice and bones can
become painful, brittle, and broken. It is also possible for the cancer to infect the
adrenal glands resulting in hormone level changes.
Lung cancers frequently are accompanied by paraneoplastic symptoms that result
from production of hormone-like substances by the tumor cells. These
paraneoplastic syndromes occur most commonly with SCLC but may be seen with
any tumor type. A common paraneoplastic syndrome associated with SCLC is the
production of a hormone called adrenocorticotrophic hormone (ACTH) by the
cancer cells, leading to over secretion of the hormone cortisol by the adrenal
glands (Cushings syndrome). The most frequent paraneoplastic syndrome seen
with NSCLC is the production of a substance similar to parathyroid hormone,
resulting in elevated levels of calcium in the bloodstream.
As lung cancer cells spread and use more of the body's energy, it is possible to

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present symptoms that may also be associated with many other ailments.
These include:

Fever
Fatigue
Unexplained weight loss
Pain in joints or bones
Problems with brain function and memory
Swelling in the neck or face
General weakness
Bleeding and blood clots

DIAGNOSIS
Physicians use information revealed by symptoms as well as several other
procedures in order to diagnose lung cancer. Common imaging techniques include
chest X-rays, bronchoscopy (a thin tube with a camera on one end), CT scans, MRI
scans, and PET scans.
Physicians will also conduct a physical examination, a chest examination, and an
analysis of blood in the sputum. All of these procedures are designed to detect
where the tumor is located and what additional organs may be affected by it.
Although the above diagnostic techniques provided important information,
extracting cancer cells and looking at them under a microscope is the only
absolute way to diagnose lung cancer. This procedure is called a biopsy. If the
biopsy confirms lung cancer, a pathologist will determine whether it is non-small
cell lung cancer or small cell lung cancer.
After a diagnosis is made, an oncologist will determine the stage of the cancer by
finding out how far the cancer has spread. The stage determines which choices
will be available for treatment and informs prognosis.
For non-small cell lung cancer, TNM descriptions lead to a simpler categorization
of stages. These stages are labeled from I to IV, where lower numbers indicate
earlier stages where the cancer has spread less.
More specifically:
Stage I is when the tumor is found only in one lung and in no lymph nodes.
Stage II is when the cancer has spread to the lymph nodes surrounding the
infected lung.
Stage III-a is when the cancer has spread to lymph nodes around the
trachea, chest wall, and diaphragm, on the same side as the infected lung.

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 Stage III-b is when the cancer has spread to lymph nodes on the other lung
or in the neck.
Stage IV is when the cancer has spread throughout the rest of the body and
other parts of the lungs.
Small cell lung cancer has two stages: limited or extensive. In the limited stage,
the tumor exists in one lung and in nearby lymph nodes. In the extensive stage,
the tumor has infected the other lung as well as other organs in the body.

TREATMENT
Lung cancer treatments depend on the type of cancer, the stage of the cancer
(how much it has spread), age, health status, and additional personal
characteristics. As there is usually no single treatment for cancer, patients often
receive a combination of therapies and palliative care.
The main lung cancer treatments are surgery, chemotherapy, and/or radiation.
However, there also have been recent developments in the fields of
immunotherapy, hormone therapy, and gene therapy.

1) Surgery
Surgery is the oldest known treatment for cancer. If a cancer is in stage I or II and
has not metastasized, it is possible to completely cure a patient by surgically
removing the tumor and the nearby lymph nodes. After the disease has spread,
however, it is nearly impossible to remove all of the cancer cells.
Lung cancer surgery is performed by a specially trained thoracic surgeon.
Surgery carries side effects - most notably pain and infection. Lung cancer surgery
is an invasive procedure that can cause harm to the surrounding body parts.
Doctors will usually provide several options for alleviating any pain from surgery.
Antibiotics are commonly used to prevent infections that may occur at the site of
the wound or elsewhere inside the body.

2) RADIATION
Radiation treatment, also known as radiotherapy, destroys or shrinks lung cancer
tumors by focusing high-energy rays on the cancer cells. This causes damage to
the molecules that make up the cancer cells and leads them to commit suicide.
Radiotherapy utilizes high-energy gamma-rays that are emitted from metals such
as radium or high-energy x-rays that are created in a special machine. Radiation
can be used as the main treatment for lung cancer, to kill remaining cells after
surgery, or to kill cancer cells that have metastasized.
Common side effects of radiation therapy may include fatigue, nausea, loss of
appetite, hair loss, and skin affectations that cause skin to become dry, irritated,

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and sensitive.

3) Chemotherapy
Chemotherapy utilizes strong chemicals that interfere with the cell division
process - damaging proteins or DNA - so that cancer cells will commit suicide.
These treatments target any rapidly dividing cells (not just cancer cells), but
normal cells usually can recover from any chemical-induced damage while cancer
cells cannot. Chemotherapy is considered systemic because its medicines travel
throughout the entire body, killing the original tumor cells as well as cancer cells
that have spread throughout the body.
A medical oncologist will usually prescribe chemotherapy drugs for lung cancer to
be taken intravenously, but there are also drugs available in tablet, capsule, and
liquid form. Chemotherapy treatment occurs in cycles so the body has time to heal
between doses, and dosages are determined by the type of lung cancer, the type
of drug, and how the person responds to treatment. Medicines may be
administered daily, weekly, or monthly, and can continue for months or even
years.
Chemotherapy carries several common side effects, but they depend on the type
of chemotherapy and the health of the patient. These include nausea and
vomiting, appetite loss, diarrhea, hair loss, fatigue from anemia, infections,
bleeding, and mouth sores. Many of these side effects are only temporarily felt
during treatment, and several drugs exist to help patients cope with the
symptoms.

Complications:
Lung cancer can cause complications, such as:
Shortness of breath. People with lung cancer can experience shortness of
breath if cancer grows to block the major airways. Lung cancer can also cause
fluid to accumulate around the lungs, making it harder for the affected lung to
expand fully when you inhale.
Coughing up blood. Lung cancer can cause bleeding in the airway, which can
cause you to cough up blood (hemoptysis). Sometimes bleeding can become
severe. Treatments are available to control bleeding.
Pain. Advanced lung cancer that spreads to the lining of a lung or to another
area of the body, such as a bone, can cause pain. Tell your doctor if you
experience pain. Pain may initially be mild and intermittent, but can become
constant. Medications, radiation therapy and other treatments may help make
you more comfortable.

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 Fluid in the chest (pleural effusion). Lung cancer can cause fluid to accumulate
in the space that surrounds the affected lung in the chest cavity (pleural space).
Pleural effusion can result from cancer spreading outside the lungs or in reaction
to lung cancer inside the lungs. Fluid accumulating in the chest can cause
shortness of breath. Treatments are available to drain the fluid from your chest
and reduce the risk that pleural effusion will occur again.
Cancer that spreads to other parts of the body (metastasis). Lung cancer often
spreads (metastasizes) to other parts of the body most commonly the brain,
bones, liver and adrenal glands. Cancer that spreads can cause pain, nausea,
headaches, or other signs and symptoms depending on what organ is affected. In
some cases, treatments are available for isolated metastasis, but in most cases,
the goal of treatment for metastasis is only to relieve signs and symptoms.
Death. Unfortunately, survival rates for people diagnosed with lung cancer are
very low. In most cases, the disease is fatal. People diagnosed at the earliest
stages have the greatest chances for a cure. Your doctor can discuss your chances
for survival with you.

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DIABETES MELLITUS
INTRODUCTION
Diabetes Mellitus is a widespread disease commonly referred to as Diabetes.
The Blood from the Intestines enters the Liver via the Hepatic Portal Artery
containing a high concentration of Glucose. The Liver and the Pancreas then
secrete a Hormone called Insulin into the bloodstream which helps maintain a
constant glucose concentration in the blood by converting excess glucose into
Glycogen (then stored in the Liver for later use). However, any disfunctioning of
these organs may result in a lack of Insulin produced to convert the glucose giving
a rise to the glucose concentration in the blood. This may further lead to the
egestion of the excess glucose in the bloodstream by the Kidneys as urine,
resulting in a deficiency of Glucose in the body, a condition known as "Diabetes
Mellitus".

CAUSES
There are two main types of diabetes which can be classified as Type 1 diabetes
and Type 2 diabetes.
In type 1 diabetes, the body's immune system malfunctions and attacks the tissues
making them unable to produce sufficient insulin. With the lack of insulin
produced, a rise in the blood glucose level may be experienced.
Type 1 diabetes is an auto-immune condition. Your immune system (the body's
natural defense against infection and illness) mistakes the cells in your pancreas as
harmful and attacks them, destroying them completely or damaging them enough
to stop them producing insulin.
It's not known exactly what triggers the immune system to do this, but some
researchers have suggested that it may be due to a viral infection.
Type 1 diabetes is often inherited by the gene (runs in families), so the autoimmune reaction may also be genetic
Type 2 diabetes is where the body doesn't produce enough insulin, or the body's
cells don't react to insulin. This is known as insulin resistance. At first, the pancreas
makes extra insulin to make up for it. But, over time it isn't able to keep up and

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can't make enough insulin to keep your blood glucose at normal levels. Type 2
diabetes is the most common form of diabetes

TREATMENT
In Type 1 Diabetes insufficient insulin is produced, therefore those with this type
have to inject insulin in their bodies for the rest of their lives.

As for the Type 2 Diabetes, there is seldom a need to inject insulin on daily basis.
However, the body requires other things in order to bring it under control.
A combination of exercises aerobic exercises, such as walking or dancing on
most days, combined with resistance training, such as weightlifting or yoga twice
a week will help to control blood sugar level.
There is no specific diet prescribed for diabetes, however the meal should be
made up of foods that are rich in fibre but low in fat for example vegetables, fruits
and whole grain.

PROGNOSIS
Diabetes is a leading cause of death in all industrialized nations.

Type 1 diabetes
About 15% of people with type 1 diabetes die before age 40 year
In Type 1, prognosis can be improved with good blood sugar control. Maintaining
tight blood sugar control has been proven to prevent, slow the progression of,
and even improve established complications of type 1 diabetes.

Type 2 diabetes
Excellent glycemic control, tight blood pressure control, and keeping the "bad"
cholesterol (LDL) level at the recommended level of <100 mg/dL (or lower,
particularly if other risk factors for cardiovascular disease are present) and the
"good" (HDL) cholesterol as high as possible. Use of aspirin when indicated can
prevent, slow the progression of, and improve established complications in
diabetes

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APPENDICITIS
INTRODUCTION
Appendicitis is a painful swelling of the appendix, a finger-like pouch connected to
the large intestine.
Appendicitis typically starts with a pain in the middle of your abdomen (tummy)
that may come and go. Within hours the pain travels to the lower right-hand side,
where the appendix usually lies, and becomes constant and severe.

CAUSES
Appendicitis occurs when the appendix becomes blocked, often by stool, a
foreign body, or cancer. Blockage may also occur from infection, since the
appendix swells in response to any infection in the body.

SYMPTOMS
Dull pain near the navel or the upper abdomen that becomes sharp as it
moves to the lower right abdomen. This is usually the first sign.
Loss of appetite
Nausea and/or vomiting soon after abdominal pain begins
Abdominal swelling
Fever of 99-102 degrees Fahrenheit
Inability to pass gas

DIAGNOSIS/TESTS
Tests and procedures used to diagnose appendicitis include:

Physical exam to assess the pain. The doctor may apply gentle pressure
on the painful area. When the pressure is suddenly released,
appendicitis pain will often feel worse, signaling that the adjacent
peritoneum is inflamed.
Blood test to see if the body is fighting the infection
Urine test to rule out a urinary tract infection
Rectal exam
Imaging tests

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 CT scans and/or ultrasound

TREATMENT
Surgery to remove the appendix, which is called an appendectomy, is the standard
treatment for appendicitis.
Generally, if appendicitis is suspected, doctors tend to err on the side of safety
and quickly remove the appendix to avoid its rupture. If the appendix has formed
an abscess, you may have two procedures: one to drain the abscess of pus and
fluid, and a later one to remove the appendix. However, there is some research
showing that treatment of acute appendicitis with antibiotics may eliminate the
need for surgery.

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NAEGLERIA FOWLERI - PRIMARY AMEBIC

MENINGOENCEPHALITIS (PAM)
INTRODUCTION
Naegleria fowleri (commonly referred to as the "brain-eating amoeba" or "braineating ameba"), is a free-living microscopic ameba, (single-celled living organism).
It can cause a rare and devastating infection of the brain called primary amebic
meningoencephalitis (PAM) The amoeba is commonly found in warm freshwater
(for example, lakes, rivers, and hot springs) and soil.

CAUSES
Naegleria Fowleri is acquired by people when infected water is forcibly aspirated
into the nose. This infected water can be bodies of warm freshwater, such as lakes
and rivers, inadequately chlorinated swimming pool water or heated tap water
(greater than 47 degree). When such infected water enters the nose (This can
occur through recreational swimming, diving, or during sports like water skiing).
The amoeba then migrates through the olfactory nerves and enters the brain
where it destroys the brain tissue causing brain swelling and death. However one
cannot be infected by naegleria by drinking contaminated water. Moreover,
naegleria is not found in salt water like the ocean.

SYMPTOMS
Naegleria infection causes a disease called primary amebic meningoencephalitis.
This disease causes brain inflammation and destruction of brain tissue.
Generally beginning within two to 15 days of exposure to the amoeba, signs and
symptoms of naegleria infection may include:

A change in the sense of smell or taste

Fever
Sudden headache
Stiff neck
Sensitivity to light

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Nausea and vomiting

Confusion
Loss of balance
Sleepiness
Seizures
Hallucinations
These signs and symptoms can progress rapidly. They typically lead to
death within a week.

DIAGNOSIS
Because of the rarity of the infection and difficulty in initial detection, about 75% of
diagnoses of PAM are made after the death of the patient.

PAM and Naegleria fowleri infection can be diagnosed in the laboratory by

detecting:
Naegleria Fowleri organisms in cerebrospinal fluid (CSF), biopsy, or tissue
specimens, or
Naegleria Fowleri nucleic acid in CSF, biopsy, or tissue specimens, or
Naegleria Fowleri antigen in CSF, biopsy, or tissue specimens.

TREATMENT
Miltefosine is a drug, which when tested in the lab against Naegleria Fowleri killed
it. However, when the drug is transferred in the human infection scenario, a lot of
factors come into play. The drug was effective against Kali Hardig (though many
other treatments were used on her) one of the three survivors of Naegleria in the
United States. It was also used once three years ago in a boy who had contracted
the parasite, but the boy didn't survive.

PROGNOSIS
The fatality rate is over 97%. Only 3 people out of 133 known infected individuals in
the United States from 1962 to 2014 have survived

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HISTORY TAKING
Taking a patients history is the most important skill in medicine; it is the keystone
of clinical diagnosis and the foundation for the doctorpatient relationship. The
history will help you to formulate a differential diagnosis and focus your physical
examination.
As important, it will also help you in getting to know patients, winning their
confidence and understanding the social context of their illness. The consultation
is best viewed as a meeting of two experts: the patient, an expert on the
experience of illness and the unique context in which it has occurred, and the
clinician, an expert on the diagnosis and management of illness.

The aims of history taking are threefold:

To identify the relevant organ system(s) responsible for symptoms
To clarify the nature of the pathological processes at play
To characterize the social context of patients illness, their concerns, their
interpretation of symptoms, beliefs and attributions and any limitations of daily
activities consequent upon their illness.

Diagnostic information
The key to reaching an accurate diagnosis is obtaining a detailed description of the
patients symptoms. Every individual symptom suggests a differential diagnosis
which may initially be wide ranging but can be brought into sharper focus by
obtaining as much detail as possible about the symptomatology.

Approach to the patient. You will feel intimidated in your first attempts at history
taking. Most patients, however, are keen to put the apprehensive student at ease.
Aim to develop a professional but friendly manner. View the consultation as a
meeting of two experts and you will quickly gain an effective rapport with the
patient. Try to be caring and compassionate but remember that you are not
directly responsible for your patients medical care. Show tolerance, particularly
with the elderly and the deaf. Seek first to understand and not judge the patient
so that you dont react to patients with criticism, anger or dismissal.
Introduce yourself with a friendly greeting, giving your name and status.
Explain the purpose of your visit, ask for and remember the patients name and

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request permission to interview and examine the patient. Some patients rapidly
tire of being questioned or examined, and others may be depressed because they
are ill or apprehensive in a strange environment. If there are difficulties in
establishing a rapport, try to determine the reason; if in doubt, consult the
medical or nursing staff.

Factors in establishing rapport

Introduce yourself in a warm, friendly manner.
Maintain good eye contact.
Listen attentively.
Facilitate verbally and non-verbally.
Touch patients appropriately.
Discuss patients personal concerns.

METHODS OF HISTORY TAKING

Eliciting accurate, detailed and unbiased information from a patient is a skilled
task and not simply a matter of recording the patients responses to a checklist of
questions. Adopt a personal, conversational style rather than an interrogative
approach and dont confuse patients with medical jargon. Avoid interrupting
patients, particularly as they begin to tell you the story of the presenting features
of the illness.
Given the opportunity, most patients will provide relevant information about their
illness and often need to talk about their troubles. Recognizing the patients need
to talk without interruption and being a good listener will greatly help you to
establish a good relationship quickly. Try to limit your intervention at this stage to
encouraging the flow of information with simple verbal and nonverbal cues but, if
necessary, steer the talkative individual from less relevant facts. Clarify any details
about which you remain uncertain such as the precise meaning of ambiguous
terms, e.g. indigestion. When asking specific questions relating to symptoms,
avoid leading questions which might compromise the quality of information
obtained. If asking about the aggravating and relieving factors of pain, ask as
follows:
Tell me everything you noticed about the pain.
Did you notice whether anything made the pain better or worse?

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 Did moving around make the pain better, worse or have no effect?
(NB: Try to avoid suggesting a particular answer to the patient, such as by asking
Was the pain worse when you moved? Once you are satisfied that you have all
the necessary information, it is important to summarize the story, as you
understand it, so that the patient can check its accuracy and alter or add to it if
required. Some patients may be unable to give a history because they are too ill,
confused, demented or unconscious.)

It is then vital to obtain further information from relatives, friends and the
patients general practitioner.

Give the patient your undivided attention

Keep your note-taking to a minimum when the patient is talking
Use language which the patient can understand
Let patients tell their own story in their own way
Steer patients towards the relevant
Use open questions initially and specific (closed) questions later
Summarize (reflect back) the story for the patient to check
Utilize all available sources of information

There is no single, correct way to take a history; with time you will develop your
own style; however, one effective and commonly used sequence comprises:
1.
2.
3.
4.
5.
6.
7.
8.
9.

Introduction
Presenting complaint
History of current illness
Systemic enquiry
Past medical history
Drugs and allergies
Family history
Social and personal history
Patients ideas, concerns and expectations.

Patients account
As described earlier, you should begin by inviting patients to provide an account
of recent events in their own words. Learn to listen without interruption and
encourage the patient to continue the story right up to the time of interview.

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 When did you last feel fit and well?

When did you first notice a change in your usual state of health?
What was the first symptom you noticed?
When was that and what has happened since?
What else have you noticed about your health?
What has happened to you since you came into hospital?
How do you feel at the moment?

Interrogation
When the patient has completed the story, clarify the description by specific
questioning to obtain a detailed chronological account of the development of the
illness from the first symptom to the time of the interview. Do not be misled by
accepting the patients interpretations uncritically; for example flu may really be
a trivial cold or a serious systemic illness. Identify what investigations and
treatment have been undertaken so far and what the patient has been told about
the illness. Obtain a detailed description of every symptom reported by the
patient.

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HISTORY TAKING: SYSTEMIC ENQUIRY

Fatigue Dysuria
Anorexia Frequency/nocturia
Weight change
Change in color/smell of urine
Itch Prostatic symptoms
Rashes Urethral/vaginal discharge
Low mood Incontinence
Fevers/night sweats
Menstrual difficulties
Heat/cold intolerance
Postmenstrual bleeding
Change in appearance Sexual difficulties
Cardiorespiratory Central nervous system
Chest pain Headaches
Breathlessness Fits/faints/funny turns
Orthopnoea Weakness
Paroxysmal nocturnal dyspnoea Sensory symptoms
Palpitation Changes in taste/smell
Cough Hearing disturbance
Sputum Visual disturbance
Wheeze Speech disturbance
Haemoptysis Dizziness
Gastrointestinal Locomotor
Swallowing difficulty Pain
Nausea and vomiting Stiffness
Haematemesis Immobility
Heartburn Swelling
Indigestion Loss of joint function
Abdominal pain
Change in bowel habit
Change in colour/consistency of motions
General Genitourinary

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Use a variety of questions to jog the patients memory. Patients may have
forgotten about previous health problems or believe them to be irrelevant or too
embarrassing. Ask about the outcome of any previous medical or radiological
examinations including those tests performed for employment or insurance
purposes. Check the patients immunization status, e.g. tetanus, rubella and

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tuberculosis. Ask about any travel or residence abroad, especially if infection is

suspected and the cause is not immediately obvious, e.g. falciparum malaria.
Accurately record the patients drug therapy including over-the-counter
remedies. Adverse drug effects are a common cause of ill health and may explain
any worsening of existing symptoms, particularly if drug therapy has changed
recently.

Checklist 1

Have you had any similar episodes in the past?

What investigations have you had in the past? X-rays? Scans?
What were the results of your previous tests?
Have you had any other medical problems or conditions?
Have you had any serious illness in the past?
Have you been in hospital before?
Have you had any operations?
Have you ever had a blood transfusion?
What injuries or accidents have you had in the past?
When and where have you travelled abroad?
Have you ever had any of the following conditions: asthma/chronic
obstructive pulmonary disease (COPD)/angina/heart attack/stroke
/diabetes/epilepsy/rheumatic fever/blood clot in the leg or lung/tuberculosis
(TB)/jaundice/high blood pressure/high blood cholesterol?

Checklist 2

What medications do you actually take?

What over-the-counter drugs or herbal remedies do you use?
Do you take low-dose aspirin? Vitamin pills?
Do you take the oral contraceptive pill? HRT (hormone replacement
therapy)?
Have your medications changed at all recently?
How often do you forget to take your tablets?
Have any medicines ever upset you? If so, how?
What exactly happens when you take that medication?
Are you allergic to anything? Hay fever? Asthma? Eczema?

In addition to providing information on any predisposition to disease, the family

history may help uncover the patients underlying and, often unspoken, anxieties.
When relevant, draw a family tree to map the inheritance pattern of particular
diseases Use symbols in a pedigree chart beginning with the affected person first
found to have the trait (propositus if male, proposita if female); include all the

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relevant information regarding siblings and all maternal and paternal relatives.

Has any family member suffered from a similar problem?

Do you know of any illnesses that run in your family?
Has any member of your family died before the age of 60?
Abortion or stillbirth
Affected male
Affected female Propositus

An individuals health and well-being are affected by occupational, social and

personal factors. Knowledge of the patients background is useful not only for
diagnosis but also for management. How patients think, live and behave influence
how they cope with illness. The details of patients personal lives, events and
difficulties serve both to inform you and reaffirm your interest in the patient as an
individual. Get to know your patients and their concerns; seek to understand the
impact of illness on their personal, working and family lives. Ask about their
employment, housing, personal and sexual relationships (or lack of them), leisure
interests, physical exercise and the use of drugs including tobacco, alcohol and
other recreational drugs, e.g. cannabis. Quantify cigarette consumption in pack
years (20/day/year), and alcohol consumption as average number of units per
week.

Checklist 3

What jobs have you done since starting work?

What did these jobs involve?
How do you spend your time when you are not at work?
Where do you live? What is your house like?
Are you able to do all the activities that you need to be able to do?
Who lives with you at home? Partner? Single?
Have you had children? Any worries or illness with them?
How many sexual partners have you had? Male? Female?
Have you ever smoked? Ever been a heavy drinker?

1 Alcohol unit (8 g) 12 pint beer 1 small glass wine 1 single spirit.

CAGE Questionnaire
C Have you felt the need to cut down your alcohol intake?

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A Have you felt annoyed that folk think you drink too much?
G Have you felt guilty about your use of alcohol?
E Have you needed an eye-opener in the morning to feel better?
(Scores of two or more positive answers indicate a significant alcohol problem.)

The commonest cause of patient dissatisfaction from consultations is a failure of

communication. Consultations are significantly more likely to be ranked by
patients as good consultations when a doctor asks about the personal aspects of
a patients life, compared with consultations in which this does not occur. If the
personal and social history is overlooked, unfounded assumptions may be made
regarding patients understanding of their illnesses, leading to either unnecessary
anxiety or unrealistic optimism.

This guide may not be used, or

copied without the permission of
the HSS Fusion 2015 Medical Unit.

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