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Insulin is a hormone that maintains homeostasis of blood glucose. It is released into circulation when
the levels of glucose rise. Glucose is the primary energy source in cell metabolism. Following its
absorption in the intestine, the blood glucose level rises. The result is an increase in insulin secretion,
which stimulates the body to either store or use the glucose effectively. Insulin secretion is altered in
direct response to the level of glucose present.

Insulin reduces high blood glucose levels by:

! acting and stimulating cellular glucose uptake and utilization by muscle and connective tissue
cells
! increasing conversion of glucose to glycogen (glucose stored for immediate release during times
of stress or low glucose), especially in the liver and skeletal muscles
! accelerating uptake of amino acids by cells, and the synthesis of protein
! promoting synthesis of fatty acids and storage of fat in adipose tissue

Sometimes, an insufficient amount of insulin is released. This may occur when the pancreas cannot
produce enough insulin, the insulin receptor sites have lost their sensitivity to insulin, or the person does
not have enough receptor sites to support his or her body size, as in obesity. This insufficiency of insulin
can cause a metabolic disorder known as Diabetes.
¦











Insulin replacement is used to treat diabetic conditions, such as type 2 diabetes mellitus in adults who
have no response to diet, exercise, and oral agents, and for type 1 diabetics who require insulin
replacement. Since it does not cross the placenta, it is used for managing diabetes during pregnancy.
Various preparations of insulin are available to provide short and long-term coverage. The peak, onset,
and duration of the different preparations vary with each type of insulin.

Originally, insulin was prepared from pork and beef pancreas. Today, all insulin is prepared by
recombinant DNA technology and is human insulin produced by genetically altered bacteria. This more
pure form of insulin is not associated with the sensitivity problems that many patients developed with
animal products. Animal insulin may still be obtained for patients who are most responsive to them, but
they are not generally used.

Frequently, more than one preparation of insulin is given to provide insulin coverage at different times
during the day. This may include a combination of regular and NPH insulin in the morning to cover the
glucose peak from breakfast (regular onset: 30-60 minutes), lunch and dinner. Another injection may be
required before bed. The types of insulin used are determined by the anticipated eating and exercise
activities of any particular individual.
Œ


 






Diabetes is a metabolic disturbance caused by a deficiency or absence of insulin or interference with
insulin activity. It may occur in either of two forms:
(1) Type 1/ Juvenile Onset/ Insulin-dependent- more severe, which typically affects the young
(2)Type 2/ Maturity Onset/ Non-insulin-dependent- has a slow, gradual development

Diabetes causes alterations in the body͛s ability to effectively deal with carbohydrate, protein and fat
metabolism. Thus, high blood glucose level results when there is insufficient insulin to deal with the
glucose in the body.

Reasons why blood glucose level remains high after meals in diabetics:
! glucose metabolism by body cells is defective
! conversion of glucose to glycogen in the liver and muscles is diminished
! there is an excessive synthesis of glucose (gluconeogenesis) from protein in response to the
deficient intracellular glucose

When diet and exercise no longer work to control glucose, oral agents are required. However, when
these are no longer effective, injection insulin may eventually be needed to replace the missing insulin.

High blood glucose levels are treated with insulin or oral agents. However, treatment can lower the
blood sugar too far, causing glucose blood sugar to drop (less than 40 mg/dL). It is important to monitor
one͛s blood glucose regularly.
‰







 hronic illness like diabetes requires management and control, especially compliance with prescribed
regimen. This is important since diabetes has serious effects and many of which are life-threatening.

Here are some tips to manage diabetes (regardless of type):

! `
   
  
- daily monitoring of blood glucose is necessary. This will allow
the person to achieve metabolic control and decrease the danger of low blood glucose
(hypoglycemia)
! ` 
 `
 - treatment depends on the type of diabetes. Regardless of type, strict
drug compliance is important in balancing food intake and to maintain as near normal blood
glucose levels as possible.
! 

  ` 
- management of diabetes requires a careful balance
between the intake of nutrients, the expenditure of energy, and the dose and timing of insulin
or oral antidiabetic agents. Although everyone has the same need for basic nutrition, the person
with diabetes must eat a more structured diet to prevent high blood glucose (hyperglycemia).
!   
- in people with diabetes, exercise increases the uptake of glucose by muscle
cells, potentially reducing the need for insulin.  onsult the doctor before beginning any exercise
program. The ability to maintain an exercise program is affected by many factors including
fatigue and glucose levels.
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People with diabetes are at high risk for amputation of a lower extremity. The high incidence of both
amputations and problems with the feet is the result of angiopathy, neuropathy, and infection.

Diabetic neuropathy of the foot produces multiple problems. Because the sense of touch and perception
of pain is absent, the person with diabetes may have some foot trauma without being aware of it. The
person thus is increased risk for trauma to tissues of the feet, leading to ulcer development. Infections
commonly occur in traumatized or ulcerated tissue.

Despite the many potential sources of foot trauma in the person with diabetes, the most common are
cracks and fissures caused by dry skin or infections such as athlete͛s foot, blisters caused by improperly
fitting shoes, pressure from stockings or shoes, ingrown toenails, and direct trauma (cuts, bruises, or
burns).

Foot lesions usually begin as a superficial skin ulcer. If the injury goes unattended, the ulcer extends
deeper into muscles and bone and gangrene can develop.

 are of the feet should be included as an essential part of care in a person with diabetes. This includes
checking the feet daily for cut areas or cracks, including between the toes and washing the feet daily
with lukewarm water and mild soap.
º



 



Because the sense of touch and perception of pain is altered, people with diabetes are at increased risk
for foot trauma. Foot care is important. This includes choosing the type of shoes. Improperly fitting
shoes creates pressure, causing blisters.

In buying and wearing shoes, a person with diabetes should note on the following:
! Shoes that allow ½ to ¾ inch of toe room are best; there should be room for toes to spread out
and wiggle. The lining and inside stitching should be smooth and the insole soft. The sole should
be flexible and cushion the foot. The heel should fit snugly, and the arch support should give
good support.
! Do not wear open-toed shoes, sandals, high heels, or thongs; they increase the risk of trauma.
! Buy shoes late in the afternoon, when feet are at the largest; always buy shoes that feel
comfortable and do not need to be ͞broken in͟.
! Shoes made of natural fibers (leather or canvas) allow perspiration to escape.
!  heck the shoes before each wearing for foreign objects, wrinkled insoles and cracks that might
cause lesions.
! Wear insulated boots during winter.

It is also important to be sure, that if the person is unable to inspect or do foot care daily, someone else
does.
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 "




Adenoid cystic carcinoma (A  ) is a relatively rare form of cancer that most commonly develops in the
salivary glands or other regions of the head and neck. In some cases, A   may arise in other primary
sites, such as the skin, breast, and neck of the uterus (cervix) in females and prostate gland in males, or
other areas.

A   tumors are characterized by a distinctive pattern in which abnormal "nests" or cords of certain cells
(epithelial cells) surround and/or infiltrate ducts or glandular structures within the affected organ. These
structures are typically filled with a mucous-like material or contain abnormal fibrous membranes
(hyaline membranes). Such characteristics are apparent during microscopic evaluation of the tumor
cells. A   is considered a low-grade malignancy that has a history of slow growth, but tends to be
aggressively invasive and to infiltrate nearby lymph nodes as well as the "sheaths" or coatings
surrounding nerve fibers (perineural spaces). This form of cancer may have a tendency to recur later at
the site where it first developed (local recurrence) and to spread to distant bodily sites, particularly the
lungs, potentially resulting in life-threatening complications.

Recommended standard therapy is often based upon primary tumor site, size, location and its ability to
metastasize, and other factors. These may include postoperative radiation to help treat known or
possible residual disease. If initial surgery is not an option due to the specific location and progression of
the malignancy, therapy may include radiation alone. Radiation therapy preferentially destroys or
injures rapidly dividing cells, primarily cancerous cells.




















































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Adrenal glands are small glands resting above the kidney. They produce the hormones collectively
known as corticosteroids. These hormones enable us to better cope with the changing environment.
Important homeostatic adaptations mediated by the adrenal hormones include the maintenance of
sodium and potassium levels (mineralocorticoids) and regulation of blood glucose level (glucocorticoids),
as well as various cardiovascular responses.

A tumor is an abnormal mass of tissue growing on or in the body. Tumors in the adrenal gland involve
the adrenal cortex and adrenal medulla. These tumors may be benign (not cancerous) or malignant
(cancerous). Malignant adrenal gland tumors metastasize extensively and so, has a poor prognosis.

Tumors in the adrenal cortex produce the hypersecretion of glucocorticoids. The hypersecretion of
glucocorticoids may later on develop  ushing͛s syndrome .People who suffer with this condition are
often obese and with a typical pattern of fat deposition in the face (responsible for the puffiness in the
eyelids), the base of the neck and in the abdomen. It is characterized by florid (red) skin and facial
roundness or ͞moon face͟.

Rare tumors arise in the adrenal medulla. One, pheochromocytoma, is usually benign, and the other,
neuroblastoma, is malignant. These tumors arise due to excessive catecholamine secretion. The nature
and severity of symptoms of functioning tumors of the adrenal medulla depend on the relative
proportions of epinephrine and norepinephrine secretion. The typical triad of symptoms is headache,
diaphoresis (profuse sweating), and palpitations in the patient with hypertension. However,
approximately 8% of those affected are completely asymptomatic.

Ë


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Amyloidosis is an increase or accumulation of amyloid beta protein. This type of protein substance is
directly toxic and is involved in triggering and supporting generalized inflammation response.

One systemic effect of inflammation is the rapid increase of this protein. It acts on inflammatory
response by binding directly to the surface of pathogens, particularly bacteria. However, during the
destruction of microorganisms, the DNA that is exposed is bound by these proteins, making it easier to
clear the other debris of inflammation. This takes inflammation longer.

In chronic inflammation, the prolonged presence of these proteins leads to deposition or accumulation.
Accumulated amyloid proteins interfere with the function of the organ within which it is deposited, thus,
facilitating more increase in the inflammatory response. This condition will further complicate the
person͛s existing problem and worst, can be fatal.

It is important to limit inflammation. Despite its beneficial role in dealing with the agents that produce
tissue damage, problems are associated with excessive or inappropriate inflammation, like Amyloidosis.
For this reason, anti-inflammatory therapy may be necessary. However, the challenge is in applying the
therapy in such a way as to limit inflammation, while allowing a sufficient response to deal effectively
with the problem.

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The major function of the rectum is to store feces until evacuation. When feces enter the rectum,
peristalsis occurs. Many disorders in the rectal area result from constipation or failure to empty the
rectum when peristalsis occurs.

The mucous membrane at the mucocutaneous border of the anal canal changes to skin that has
cutaneous somatic nerve endings. Because of this anatomic structure, lesions of the external anal canal
are very painful. The two most common manifestations are bleeding and pain. However, blood on the
stool usually indicates a perianal disease, a polyp or carcinoma of the left colon or rectum, inflammatory
bowel disease or carcinoma of the proximal colon or hemorrhoidal bleeding.

 arcinoma and melanoma can occur at the anus but are rare, constituting fewer than 5% of anorectal
cancers. They spread by local extension into the perineal spaces and then to the inguinal nodes.  ancer
of the anal canal or lower rectum can coexist with other rectal conditions, and the client may falsely
attribute bleeding to haemorrhoid instead of carcinoma.

Anal cancers are more common in African Americans, in clients who have had human papilloma virus
(HIV), and in clients with pre-existing anal and perianal problems, such as fistulas. Bleeding, local pain
and itching, and tenesmus (ineffective and painful straining during bowel elimination) are characteristic
manifestations. A person is usually aware of a lump near the anus that has bled and that gradually
becomes more and more painful, particularly during or just after a bowel movement.

Many anal cancers are not diagnosed until they are large, and by then the prognosis is poor. Some
tumors are treated with radiation and chemotherapy, whereas others may require surgical excision.
Surgical intervention involves excision of the anus with an abdominoperineal resection.












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The lumen of appendix is very small and there is little scope for swelling when it becomes inflamed.
The initial cause of inflammation is not always clear. Microbial infection is commonly superimposed on
obstruction by hard faecal matter (fecoliths), kinking and a foreign body. Inflammatory exudates with
fibrin and phagocytes cause swelling and ulceration of mucous membrane lining. In mild cases the
inflammation subsides and healing takes place. In more severe cases, microbial growth processes leads
to suppuration, abscess formation and further congestion. The rising pressure inside the appendix
occludes first the veins, then the arteries and ischemia (restriction in blood supply) develops, followed
by gangrene and rupture.

With the diagnosis of appendicitis, surgical removal of the appendix is the only treatment. However, in
rare cases, cancer of the appendix is diagnosed after appendectomy. The common causes of appendix
cancer include carcinoid (slow- growing neuroendocrine) tumors, mucinous cystadenocarcinoma
(malignant form of glandular epithelium) tumors, adenocarcinoma (cancer of glandular epithelium) and
paraganglioma (are neuroendocrine tumor). This is often diagnosed after a biopsy, following an
appendectomy. Risk factors also play a role in the contribution of this type of disease like smoking,
stress and poor diet.

As in any type of cancer, its prognosis depends on early diagnosis and treatment. Treatment therefore,
also depends with the tumor size and location. This may include chemotherapy, radiation and
medications to control symptoms.

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The vermiform appendix is a potential site of inflammation. This 8-10 cm long structure is a slender
extension of the cecum (pouch, connecting the ileum with the ascending colon of the large intestine)
containing nodules of lymphoid tissue in its submucosa. Acute inflammation of the appendix can occur
at any age, but the highest incidence is in the range of ages 10-20. It is the most common cause of
abdominal surgery in children.

Although appendix cancer is very rare, 40% of its cases are diagnosed after an appendectomy. There are
various types of cancer tumors causing appendix cancer. These includes cancer include carcinoid (slow-
growing neuroendocrine) tumors, mucinous cystadenocarcinoma (malignant form of glandular
epithelium) tumors, adenocarcinoma (cancer of glandular epithelium) and paraganglioma (are
neuroendocrine tumor).

More often, signs and symptoms are attributed to appendicitis and a varying change in bowel function is
usually present. Protrusion of the abdomen and bloating are also very common. Prognosis depends on
early diagnosis and treatment of the disease. High incidence of survival is also associated when appendix
cancer is still small.

Treatment includes surgery, radiation, chemotherapy and drug therapy to control symptoms. Metastasis
often depends on the aggressiveness of the type of tumor causing it.






















































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Brain tumors are expanding lesions within the skull. Approximately 20% of the malignant tumors that
occur in children are brain tumors. One of the main types of brain tumors that appear in children are
 erebellar astrocytoma.

 erebellar astrocytoma is a slow-growing, often cystic type of tumor of the cerebellum that accounts
10% to 20% of all pediatric brain tumors. This tumor produces slowly increasing intracranial pressure. It
is classified according to its malignancy, from grade I (least malignant) to grade IV (most malignant).

 erebellar astrocytoma has insidious onset and slow course.  ommon manifestations show evidence of
increased intracranial pressure- especially headache, visual disturbances, papilledema (optic disc
swelling), and personality changes;  erebellar signs- ataxia (loss of muscle coordination), dysmetria
(inability to control the range of muscular movement), nystagmus (involuntary eye movement);
behavioural changes; seizures

 omputed tomography ( T) scan, magnetic resonance (MRI), myelogram, positron emission tomography
(PET) are the common procedures used to diagnose and determine the type of tumor that is suspected,
localize and determine its extent.

Treatment includes surgery, radiation therapy, chemotherapy, ventriculoperitoneal shunting and the
use of immunotherapy or gene transfer therapy. Prognosis is improved in cases that involve early
diagnosis and adequate therapy. Five-year survivors are increasing, especially in children with low-grade
astrocytomas.
















































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T-cell and B-cell immune deficiencies comprise a heterogeneous group of disorders, all characterized by
profound impairment in the development or function of the cellular, the humoral, or both parts of the
immune system. A variety of inherited (autosomal recessive and X-linked) conditions fit this description.
These conditions are typified by disruption of the normal communication system of B-cells and T-cells
and impairment of the immune response, and they appear early in life.

Ataxia-telangiectasia is an autosomal recessive neurodegenerative disorder that arises because of a

defect on chromosome 11; the ataxia-telangiectasia mutation that affects both T- and B-cell immunity.
In 40% of patients with this disease, a selective IgA deficiency exists. IgA and IgG subclass deficiencies,
along with IgE deficiencies, have been identified. Variable degrees of T-cell deficiencies are observed
and become more severe with advancing age.

The disease is associated with neurologic, vascular, endocrine, hepatic, and cutaneous abnormalities. It
is accompanied by progressive cerebellar ataxia (loss of muscle coordination), telangiectasias (vascular
lesions caused by dilated blood vessels), recurrent bacterial infection of the sinuses and lungs, and an
increase incidence of cancer.

Treatment of ataxia-telangiectasia includes early management of infections with antimicrobial therapy,

management of chronic lung disease with postural drainage and physical therapy, and management of
other presenting symptoms.

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More than 95% of colorectal cancers develop from adenomatous polyps (adenomas). The three types of
adenomas are tubular, tubulovillous, and villous. The last type has the highest risk of becoming
cancerous. The polyps grow slowly, and most take 5 to 10 years or longer to become malignant. As a
polyp becomes malignant, it increases in size within the lumen and begins to invade the bowel wall.
Tumors in the right intestine tend to be bulky and to cause necrosis and ulceration. Tumors in the left
intestine start as small, button-like masses that cause ulceration of the blood supply.

Attenuated familial adenomatous polyposis (AFAP) is a subtype of familial adenomatous polyposis (FAP).
It is often attributed genetically. It is associated with the presence of an inherited gene adenomatous
polyposis coli (AP ). A person with familial adenomatous polyposis (AFAP) develop hundreds of
thousands of polyps in their colons at an early age and have an almost 100% chance of developing
cancer by the age of 40. As a result, some elect to have prophylactic colectomy (surgical resection of any
extent of the large intestine) as a preventive measure and genetic counselling for couples might be
necessary. However, little is still known about this type and further studies are still being made.

Malignant tumors commonly spread by direct invasion to a nearby organ, such as the stomach from the
transverse colon, lymphatic and hematogenous channels, usually to the liver and seeding or implanting
of cells into peritoneal cavity. Blood-borne metastasis extends most commonly to the liver but may also
involve the lungs, kidneys and bones.






















































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Beckwith-Wiedemann syndrome is a congenital (present from birth) condition and growth disorder that
causes large body size and large organs. The cause is not yet clear. However, it is often attributed
genetically and is often associated with a defect in chromosome 11. Genetic counseling may necessary
to couples planning to have children. A higher incidence of tumor development is also associated with
this condition. Adrenal carcinoma and Wilm's tumor are the most common tumors to exist.

The most common signs and symptoms include large protruding tongue, enlarged kidneys, liver, and
spleen, large and prominent eyes , creases in ear lobes ,low blood sugar (hypoglycemia), a ridge in the
forehead caused by premature closure of the bones (metopic ridge), abdominal wall defects like
umbilical hernia or omphalocele, enlarged fontanelle (soft spot), and large newborn size.

Swelling of the tongue can cause problems with feeding and sleeping, thus, the child may need
assistance to prevent aspiration. Low blood sugar may be treated with intravenous fluid. Defects in the
abdominal wall may need to be repaired and the child must be watched closely for the development of
tumors.

 hildren with Beckwith-Wiedemann syndrome who survive infancy are likely to do well. However,
normal to a slight decreased in mental development is common.

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The liver supports metastatic growth and the vast majority of hepatic tumors are secondary growths,
usually, originating in the colon, breast, stomach, or lung. Multiple tumor emboli (detached
intravascular mass carried by the circulation) typically establish several metastatic foci in the liver, with
their location reflecting the path taken through hepatic vessels. In advanced stages, secondary tumors
may produce pronounced liver enlargement. Approximately one-third of all malignant tumors growing
in the liver are secondary.

Primary hepatic tumors are rare. If benign, such as bile duct adenoma (benign tumor of glandular origin)
or liver cell adenoma, they are well tolerated and seldom produce liver enlargement. The incidence of
bile duct adenoma is low but seems linked to the use of birth control pills. The hormones in these pills
seem, in some way, to favour the development of growth of bile duct adenomas. When growing near
the liver͛s surface, these tumors can break through it to produce serious haemorrhage into the
abdominal cavity.

Malignant tumors arise from two different hepatic cell types. The most common (80%) is the
hepatocarcinoma or hepatoma, which derives from the hepatocyte.

However, of primary hepatic malignancies, 20% originate in bile duct epithelium, forming a scirrhous
(hard, slow-growing) tumor termed as cholangiocarcinoma, also called bile duct cancer.






















































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Birt-Hogg-Dubé syndrome (BHDS) is a rare autosomal dominant disorder characterized by a triad of
benign tumors of the hair follicle, spontaneous pneumothorax (collection of air or gas in the pleural
cavity) and kidney tumors. The BHD gene (OMIM 135150) codes for the protein folliculin, which is
expressed in multiple tissues including kidney, lung, and skin. This tumor-suppressor gene, results in the
cutaneous hamartomas associated with internal neoplasia (abnormal proliferation of cells).  utaneous
tumors are fibrofolliculomas, trichodiscomas and acrochordons. Fibrofolliculomas and trichodiscomas
tend to appear in the third or fourth decade of life as small white or skin-colored multiple papules on
the face, neck and upper trunk.

Affected individuals have a high chance of developing cysts in the lungs and spontaneous
pneumothorax. Although almost all patients who have BHDS have lung blebs (90%), only one fifth will
have spontaneous pneumothorax. The strong association of spontaneous pneumothorax with BHDS
suggests that the presence of this in a member of a BHDS family could be used as a criterion for its
diagnosis.

However, no specific medical treatment exists for the cutaneous lesions of BHDS. Surgical removal has
provided definitive treatment of solitary perifollicular fibromas and electrodesiccation may be helpful in
removal of multiple lesions, but these can recur. Prognosis of this condition depends on age and the
number and type of tumors.

cË





 ancer of the bladder is more common in people between the ages of 50 and 70 years. It affects more
men than women. Bladder cancer is the fourth leading cause of cancer in men and has a high worldwide
incidence.

 ancers arising from the prostate, colon, and rectum in males and from the gynaecologic tract in
females may metastasize to the bladder. Tobacco is the leading risk factor of bladder cancer. People
who smoke get bladder cancer twice as often as those who do not smoke.

Bladder tumors usually arise at the base of the bladder and involve the ureteral orifices and bladder
neck. Visible, painless hematuria (presence of blood cells in the urine) is the most common symptom of
bladder cancer. Infection of the urinary tract is a common complication, producing frequency, urgency,
and dysuria (painful urination). However, any alternation in voiding or change in urine may indicate
cancer of bladder. Pelvic or back pain may occur with metastasis.

Treatment of bladder cancer depends on the grade of the tumor (the degree of cellular differentiation),
the stage of tumor growth (the degree of local invasion and the presence or absence of metastasis), and
the multicentricity (having many centers) of the tumor. The patient͛s age and physical, mental, and
emotional status are considered when determining treatment modalities.
























































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Bone provides a supportive environment for metastases and so is a very common site of secondary
tumor growth. Its usual primary tumor most often arise from the prostate, breast, thyroid, lung or
kidney. Access to bone is by way of blood, rather than lymph, and the sites most often involved are the
bones of the axial bone (bones in the head and trunk) (except the skull) and the proximal femur and
humerus.


Once established, a secondary tumor may grow and invade locally, disrupting the organization of the
osseous tissue by inducing bone breakdown (osteolysis) of new bone formation. These effects are due
to the release by the metastatic cells of substances that activate local osteoclasts, osteoblasts, or both.
The result is a mix of growing tumor, resorbing bone, and new bone formation at secondary site.

In bone cancer, primary tumors are much less common than secondary tumors, but can have
devastating effects in that they arise most often in the young. Actively growing bone is much more likely
to undergo a neoplastic transformation, and pain is an early indication of the tumor͛s expansion within
the densely organized bone tissue. Like secondary tumors, primary bone tumors induce osteolysis, so
that weakening of the bone, which produces a tendency for a fracture. In addition, normal bone
adjacent to the tumor may respond to tumor pressure by altering its pattern of remodelling. This
response produces an altered and expanded contour of the bone͛s surface.

The danger in malignancies is, of course, metastasis, and in bone cancer, it typically involves the lung. In
many tragic cases, amputation is necessary to cope with primary tumor when therapy is too little or too
late.

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Brain tumors are expanding lesions within the skull. Approximately 20% of the malignant tumors that
occur in children are brain tumors. One of the main types of brain tumors that appear in children are
brain stem glioma.

Brain stem glioma is a tumor of the brain stem that accounts for approximately 15% of brain tumors in
children. Through its growth, brain stem glioma interferes early with the function of cranial nerve nuclei,
pyramidal tracts, and cerebellar pathways.

 ommon manifestations in brainstem glioma includes cranial nerve palsies- strabismus (cross-eyed),
weakness, atrophy (partial or complete wasting of a part of the body), fasciculations of the tongue,
swallowing difficulties; hemiparesis (weakness on one side of the body); cerebral ataxia (loss of muscle
coordination); signs of intracranial pressure (advanced disease)

Lumbar puncture with  SF cytologic evaluation, computed tomography ( T) scan, magnetic resonance
(MRI), myelogram, positron emission tomography (PET) and angiograhy are the common procedures
used to diagnose and determine the type of tumor that is suspected, localize and determine its extent.

Treatment includes surgery, radiation therapy, chemotherapy, ventriculoperitoneal shunting (for

children who develop hydrocephalus) and the use of immunotherapy or gene transfer therapy. Brain
stem herniation is the possible complication of brain stem glioma.




















































¦¦




" 



Tumors of the central nervous system constitute about 3-5% of over one million cases of cancer
diagnosed in adults yearly. In children, this type of cancer is much less common.

Since tumors can arise only in tissues capable of mitosis, brain tumors exclude arising from neurons or
primitive precursor cells. These cells, capable of tumorigenesis, include astrocytes.  ells producing blood
vessels also give rise to tumors (e.g., arteriovenous malformations).

Outside the brain, the danger posed by tumor is largely a function of its malignancy. In the cranial vault,
malignancy is only one factor that may affect morbidity and mortality. If it is located in or near strategic
sites, for example, adjacent to the cerebral aqueduct or in the brain stem, even a small, slowly benign
tumor can have devastating effects.

Tumor excision is usually the treatment. However, brain tumors can be physically inaccessible, may have
infiltrated diffusely and require the resection of too much tissue, or may be small but located in vital
brain centers. The blood-brain barrier (restricts the diffusion of microorganisms and large molecules into
 SF) makes chemotherapy ineffective for most brain tumors, and this fact, combined with the foregoing,
often makes radiation the chief acceptable therapy. The limited capacity of the cranial vault is an
additional variable that blurs the distinction between malignant and benign. Even though malignant
brain tumor will probably increase in mass faster, the ultimate impact of compression, herniation, and
increased intracranial pressure from benign but inoperable tumor will probably be the same.




















































¦Œ








 urrently over 10% of North American women can be expected to develop breast cancer. Most cases
are diagnosed in menopausal and post-menopausal women, with much lower incidence prior to the
mid-20͛s. There are numerous factors that predispose to greater risk.

Genetic factors are involved in breast cancer. These are involved in genetic transmission of a
predisposition to cancer. Dependence in estrogen is also a growth stimulus for this type of cancer. In
such cases, over a woman͛s life, high exposure to the estrogen peaks that are associated with normal
ovarian cycling seem to enhance breast cancer development. Since estrogen peaking is reduced during
pregnancy, factors that prolong normal cycling, like an early menarche (first menstrual cycle), a delayed
first pregnancy, having no children at all (nulliparity), and an extended reproductive life span, are all
associated with increased breast cancer incidence. Ultimately, breast cancer appears to result from a
complex interplay between genetic predisposition and environmental agents interacting in a supportive
hormonal milieu.

Broadly, there are two classes of breast cancer: carcinoma in situ ( IS) is non-invasive, with its growth
confined within the basement membrane of the duct or gland in which it arises. The other class is
invasive carcinoma, where tumor cells infiltrate adjacent tissues, gain access to lymphatics and
metastasize.

Treatment involves appropriate combinations of surgery, usually mastectomy (removal of the tumor
mass or the entire breast), radiation, and chemical agents.

As in any type of cancer, intervention in early stages is related to better prognosis. However, it is widely
accepted that by the time of diagnosis, 50% of breast cancers have already metastasized.
¦‰



' "" 




The increase use of mammography as a screening tool has contributed to the dramatic increase in the
diagnosis of breast cancer. An estimated 62,000 new cases are diagnosed annually. The most common
are non-invasive form of breast cancer. It is characterized by the proliferation of malignant cells inside
the milk ducts without invasion into the surrounding tissues. However, if left untreated, there is an
increased likelihood that it will progress to invasive type of cancer.

One type of invasive breast cancer is inflammatory breast cancer. It is a rare (1 % to 2%) and aggressive
type of breast cancer that has unique symptoms. This type is characterized by diffuse edema (abnormal
accumulation of fluid) and brawny erythema (redness) of the skin often referred to as peau d͛ orange
(resembling an orange peel). This is due to malignant cells blocking the lymph channels in the skin. An
associated mass may or may not be present; if there is, it is often a large area of indiscrete thickening.

Inflammatory breast cancer can be confused with an infection because of its presentation. The disease
can spread to other parts of the body rapidly.  hemotherapy often plays an initial role in controlling the
disease progression, but radiation and surgery may also be useful.

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Although men have much less breast tissue than women, they do have breast cells that can undergo
cancerous changes. Breast cancer in men accounts for approximately 1% of all breast cancers. Although
this is not very common, in most case, it is not known what triggers cancer cells to grow to men.
However, it is often attributed genetically. This means that men who have parents or first degree
relatives with defective breast cancer genes are at risk in developing breast cancer. However, most
genetic abnormalities related to breast cancer are not inherited but develop during a person͛s lifetime.
These genetic abnormalities may occur as a result of exposure to radiation, chemotherapy,
environmental toxins, viruses and other still unknown factors.

Other factor that might predispose men from having breast cancer is estrogen. Although estrogen is
predominantly female hormone, men͛s bodies also produce estrogen, but in very small amounts. When
estrogen levels rise above normal, men͛s breast tissues are stimulated and enlarged. Exposure to high
levels of estrogen increases the risk of breast cancer development.

 ertain illnesses may also increase the levels of estrogen produced by the body, or prolong exposure to
estrogen. One condition is Klinefelter͛s syndrome. In males, this chromosomal abnormality results in
production of more of the female estrogen. When a man has liver cirrhosis, the liver is unable to
degrade estrogen and the body produces less of the proteins that bind and inhibit estrogen. This results
increased estrogen activity. Obesity is also a risk factor for breast cancer in men, because of the
increased number of fat cells that are able to convert the male hormone androgen to estrogen.

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Breast cancer or carcinoma is the leading cause of cancer among American women. One of eight women
develops breast cancer. Most breast cancer begins in the lining of the milk ducts, sometimes in the
lobule. Eventually it grows through the wall of the duct and into the fatty tissue. Family history accounts
approximately 7% of breast cancers. However, carcinogens are not associated to have an important role
in its development. Hormones such as estrogen are not thought to produce this type of cancer;
however, they may influence its growth.

Metaplastic breast cancer is a rare type of invasive breast cancer. As the name implies, this type of
cancer cells are metaplastic or can withstand a new environment. They change into another type more
suited to the new environment to survive. However, its symptoms are the same with the other types.

Invasive tumors may produce various changes at the breast͛s surface due to contraction of the tumor͛s
fibrous stoma. Dimpling of the surface may result, or nipple may be drawn inward. When the invading
tumor cells reach the overlying dermis, they may infiltrate and obstruct its lymphatics. The result is a
local reddening and hardening of the skin that is termed peau d͛ orange, since it has some resemblance
to an orange peel.

Metastasis of most breast cancers is via lymphatic drainage to the regional nodes of the axilla, but
blood-borne spread also occurs. The tumor emboli disseminate widely to grow at multiple sites, most
often the lung, liver, adrenal glands, brain, skin and bone.

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 arcinoid tumors of the gastrointestinal tract are rare and slow growing. Most tumors occur in the small
intestines, followed by the rectum and stomach. Non functioning tumors cause symptoms of
intermittent intestinal entrapment secondary to mesenteric fibrosis. Functional tumors secrete notably
serotonin, leading to the manifestations of carcinoid syndrome, characterized by diarrhea,
bronchoconstriction and palpitations. Excess serotonin contributes to carcinoid heart disease
(endomyocardial fibrosis, tricuspid insufficiency and pulmonary valvular disease). Liver metastasis and a
large tumour burden contribute to the severity of the carcinoid syndrome.

Diagnostic imaging includes 111Indium-Pentetreotide Scintigraphy (Octreotide scan) is highly sensitive

and specific for both functioning and non-functioning carcinoid tumours which express somatostatin
receptors. It can show early evidence of lesions not revealed by other procedures. It should be done at
baseline, after curative surgery and annually thereafter.  T scan, MRI and ultrasound may also be
helpful in evaluating the extent of disease. The main goals of carcinoid tumour management include
symptom, biochemical and objective tumor control, and quality of life improvement.

External radiation therapy is recommended for bone and brain metastasis. Tumor targeted treatment
with radioactive octreotide derivatives are associated with tumor shrinkage in up to 25% and
biochemical response in up to 50%. However, the exact role of this treatment is not yet defined, but it is
an accepted alternative in the therapy of these neoplasms.

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 arney complex ( N ) is a rare autosomal dominant inherited trait expressed as pigmented skin lesions,
cardiac, cutaneous, mucosal myxomas (usually non-cancerous primary tumor of the heart), neural and
functioning endocrine tumors causing endocrine overactivity. Although most cases are familial, sporadic
cases may occur.

A gene implicated in  arney complex, a rare disorder of the adrenal glands, appears to function as a
molecular switch to limit cell growth and division. The normal process by which cells in the adrenal gland
grow old and die is put on hold when the gene, known as Prkar1a, is deactivated. The Prkar1a gene is
known to be involved in how the cell regulates its activities.

Individuals with  arney complex typically develop  ushing͛s syndrome, a combination of weight gain,
high blood pressure, diabetes, and other symptoms stemming from the overproduction of the hormone
cortisol, which is produced by the adrenal glands. People with  arney complex are also predisposed to
developing benign tumors of the heart and connective tissue, as well as benign and cancerous tumors of
the adrenal and other glands. Previous studies have shown that people with  arney complex are likely
to have a mutation in the Prkar1a gene. Appropriate referrals to cardiology, endocrinology, gynecology,
and urology should be made.

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The nervous system continues to mature through the first 12 years of life. It actually consists of two
separate systems: the central nervous system ( NS) and the peripheral nervous system (PNS).

The  NS consists of the brain, the spinal cord, and the surrounding membranes or meninges that protect
the delicate tissues from normal trauma. These tissues are also protected by the skull, the vertebral
column, the cerebrospinal fluid ( SF), the fluid in the subarachnoid space, which serves as a cushion.

 NS tumor can be either benign (growth is limited) or malignant (cancerous). Even when tumor is
benign, however, it may not be completely harmless. It can cause damage by pressing adjacent tissues.
Brain tumors in children, for example, are often benign, but they can cause extensive respiratory center
depression from increasing pressure.

The exact origin of tumor growth is unknown, and any growth may actually involve more than one
cause. In children, tumors frequently occur in organs unexposed to the environment (brain, bloodstream
and kidney). A common theory on why these tumors grow is cell mutation. This suggests that
carcinogenic agents and hereditary susceptibility combine to alter the nature of cells, leading to its
abnormal growth.

One common neurologic sign that may occur with these space-occupying lesions or tumors is an
increased intracranial pressure. This can cause local injury and severe pressure elevation that compress
the brain stem and lead to cardiac and respiratory failure. It is therefore important, that  NS tumors are
identified and removed as quickly as possible to prevent further injury when possible.
















































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The cervix (neck) forms the lower third of the uterus. In the young adult, the exocervix (portion of the
cervix that projects into the proximal vagina), consists of layer of columnar cells resting on a bed of
reserve cells. These cells are the source of new cells needed to replace those normally sloughed from
the surface. With maturity, the exocervix is exposed to various vaginal irritants, as well as pH and
estrogen changes, and to the trauma of coitus and childbirth. These induce an adaptive thickening and
strengthening of the exocervix.


Over a period of years, the continuing growth of new tissue from the site, leads to the development of
tumor. Unless there is intervention to interrupt its progression, tumor cells break through the basement
membrane to invade locally. With more extensive invasion, adjacent organs are affected and access to
lymphatics is achieved, followed by metastasis to regional lymph nodes.

Previously more common, cervical cancer has been declining because of the ease with which a sample of
cervical epithelium can be obtained via a Pap smear. Early detection is strongly related to the
therapeutic success in cervical cancer. When the diagnosis is made while the tumor confined in the
epithelium, it is relatively simple to remove or destroy the lesion. At later stages, the treatment may
include hysterectomy (surgical removal of the uterus), excision of invading tumor, and radiation therapy.

Previous studies about this type of cancer shows sexual transmission of a viral agent. Incidence of the
tumor is high when sexual activity starts early and involves multiple partners.