What is Ovarian Cancer?

Ovarian cancer refers to malignant growth arising from different parts of the ovaries. (Diagram of anatomy). The ovaries are part of a woman’s reproductive system, where the eggs are developed. Most ovarian cancers are classified as "epithelial" and arise from the surface (epithelium) of the ovary. Other types arise from the egg cells (germ cell tumor) or supporting cells (sex cord/stromal).

How common is Ovarian Cancer?

Ovarian cancer is the 5th commonest cancer in Singapore. There are 280 cases diagnosed yearly based on the Singapore Cancer Registry 2005-2009. It is the second most common female genital tract cancer.

Age of Onset

Epithelial ovarian cancer usually affects older women although it can also happen to younger women. Germ cell cancers of the ovary occur more frequently in younger women.

Causes and Risks

Risk factors associated with ovarian cancer include:-

• late pregnancy
• early onset of menstruation
• late menopause
• never had children-history of breast cancer
• genetic predisposition
• endometriosis

Ovarian cancer is known to run in some families where family members may have increased risk of getting ovarian, breast and endometrial cancer(eg BRCA gene abnormalities) or increased risk of getting endometrial cancer, colorectal cancer in addition to ovarian cancer (Lynch syndrome). In women who have a sister or mother with this disease, the risk of developing ovarian cancer is increased twenty-fold. Ovarian cancer also runs in certain families with a history of breast and colon cancers. There is now evidence to suggest that certain genes are involved in causing these diseases.

Symptoms

Among female genital tract cancers, epithelial ovarian cancers are the most difficult to prevent or cure because they rarely have early symptoms or signs. Symptoms tend to develop only when the cancer is advanced. These symptoms include abdominal swelling and discomfort, bloating or wind, pain, change in bowel habits.

Diagnosis

Although a marker in the blood, called CA-125, is raised in about 80% of patients with epithelial ovarian cancers, it is not always accurate and not adequate for diagnosis of ovarian cancer. It is also raised in non-cancerous conditions, such as endometriosis and appendicitis. The result of elevated CA-125 must therefore be interpreted in the light of other clinical findings. Pelvic ultrasound can help to detect abnormal ovarian cysts. CT scans of the abdomen and pelvis and chest x-rays are also useful in detecting whether are areas of the body is affected. Ultimately an operation or biopsy is required to prove that the cells affected are cancerous and originated from the ovaries.

Treatment of Ovarian Cancer

To determine the actual extent of the cancer, surgical exploration or staging is required. During the procedure, the doctor will examine the peritoneum, which is the inner lining of the abdomen. Fluid within the abdomen is sent for assessment which involves analysis under a microscope. Besides determining the stage of the cancer, the aim of surgery is to remove as much of the cancer as possible. Often this includes removing ovaries, the uterus and its surrounding lymphatics.

Additional treatment following surgery will be determined by the stage of the disease, the grade of the disease (aggressiveness) and the type of cancer.

For very early stage disease and non-aggressive types, further treatment may not be required. For the more advanced and aggressive types of cancers, chemotherapy is the treatment of choice.

Prognosis of Ovarian Cancer

Ovarian cancer in the early stage can potentially be cured while those in the late stage of the cancer, permanent cure maybe difficult.

Frequently Asked Questions

Is there a screening test for ovarian cancer?

There is currently no widely accepted and effective screening test for ovarian cancer. However, if there is a strong family of history of breast or ovarian cancer, it may be appropriate for that woman to go for genetic counseling and testing.

This article was originally published in nccs.com.sg

Tuberculosis

Tuberculosis (TB) is an infectious disease caused by a germ known as mycobacterium tuberculosis. Up until about 50 years ago, there were no drugs to cure TB. Now, we have adequate facilities and means to diagnose, prevent and treat TB. Yet, we are still facing a worldwide epidemic of TB. Worse, we are seeing an emergence of a TB germ that is resistant to the drugs we use to treat the disease.

TB infections are spread by breathing in droplets containing the TB germs. When people who are infected cough or sneeze, they spray TB germs into the air. Other people get infected when they inhale these TB germs.

Not everybody who gets infected with the germ develops the disease. The body's immune system 'walls off' the TB germ, which can lie dormant in the body for years. TB disease develops in about 10% of those infected. If your immune system is weakened e.g. by AIDS or drugs the chance of getting TB will be higher.

Causes & risk factors

TB is an air-borne disease transmitted through respiratory droplets from a person with the disease.
The risk of developing active TB disease is higher in:

• Persons with prolonged close contacts with someone known to have untreated TB
• Persons with underlying medical conditions such as HIV disease and diabetes
• Persons who have a weakened immune system e.g. due to drugs or sickness
• Persons who have poor nutritional status
• Drug addicts

Signs & symptoms

The following features raise the suspicion of TB:

• Cough lasting longer than 3 weeks
• Coughing out blood
• Feeling tired all the time
• Fever and night sweats
• Loss of weight
• Chest pain

Complications

Infection with TB can cause permanent lung damage if not treated early. It can also spread to other parts of the body such as the bone, intestine, brain and central nervous system where it can lead to life-threatening complications. The most serious complication, however, is when TB infection recurs and the strains causing the disease are resistant to multiple anti-TB medications.

Screening & diagnosis

If you have a cough that persists longer than 3 weeks or any of the other symptoms, see your doctor right away. If you know of someone who has the same symptoms, encourage the person to go as well. Your doctor will ask you to go for a chest X-ray. Some of you may be referred to a specialist for further investigations.

Treatment

TB disease can be cured with anti-TB drugs. To be effective, the drugs must be taken exactly as prescribed. Treatment usually involves a combination of several different drugs. Because TB germs die very slowly, anti-TB drugs must be taken for 6 to 9 months. You must continue to take your medicine until all the germs are killed, even if the symptoms of disease go away and you start to feel better.

Incomplete TB treatment means that the TB germs in the body that survive continue to grow and multiply. But this time, the germs may develop resistance to the usual TB drugs. In such situations, a different set of drugs with more side effects must be taken for a longer period. The chance of cure is also considerably reduced. What's more, the next person e.g. a family member, who gets infected, will have the same drug-resistant germs.

The World Health Organisation has advocated DOT as the standard of care for TB patients. DOT stands for Directly Observed Treatment. It means having your TB treatment supervised, usually at the polyclinics. Trained nurses will observe you taking the correct dosage and combination of TB medications. The best way to cure TB and curb its spread is to receive your treatment under the Ministry of Health's DOT programme.

Prevention

TB is a preventable disease. People with TB should be treated before they develop active disease. Also, one of the ways to control the infection is to take careful precautions with people hospitalised with TB.

There are also measures you can take on your own to help protect yourself and others:

• Complete the full course of your TB medications.

TB bacteria have a chance to become resistant to most TB drugs if full course of TB treatment is stopped. The mutant TB strains become more deadly and difficult to treat.

• Go for regular testing.

Skin testing is advised annually for those people whose immune system is weakened due to HIV or for those who have a substantially increased risk of exposure to the disease such as healthcare workers.

• Lead a healthy lifestyle.

Keep your immune system healthy by adopting healthy eating habits, exercising regularly and having enough sleep

If you have active TB, you can help keep your family and friends from getting sick by:

• Staying at home all the time especially the first two to three weeks of treatment.
• Covering your mouth with a tissue when you cough or sneeze and wear a mask in the presence of other people during the first few weeks of treatment.
• Disposing properly the dirty tissue by sealing it in a bag and throwing it away.

This article was originally published in http://www.hpb.gov.sg

Knees and Arthritis

"I couldn't even sleep at night because of the pain in my knees," said Sally, sharing about her osteoarthritis of the knees at AAOS.org. As a hostess in a restaurant and an active person who loved biking, tennis, walking, gardening and traveling, Sally found that her osteoarthritis had a negative impact on her life.

Sally's condition affected both knees, making it impossible for her to walk, especially up and down the stairs. The constant pain left her hunched over and limping. No longer able to exercise, she gained weight and her overall health began to deteriorate.

Osteoarthritis (OA) is a degenerative joint disease often found in the hands, knees, hips, feet and spine, according to the AAOS article. It is one of the most common forms of arthritis and occurs when the cartilage that cushions the ends of the bones breaks down, resulting in a bone-on-bone contact and significant pain, loss of movement and deformity. Besides physical limitations, OA can also cause financial strain to the sufferer as treatments can be expensive, and for some patients with this condition, they may no longer be able to work.

Symptoms

Common symptoms of OA according to an article at Pain-Research.org:

• Joint pain and swelling
• Early morning stiffness
• Warmth around a joint
• Redness of the skin around a joint
• Reduced ability to move the joint
• Unexplained weight loss, fever, or weakness that occurs with joint pain

Diagnosis

Diagnosing arthritis according to the Pain Research article includes:

A physical examination may show fluid being collected around the joint known as effusion, and the affected joints may indicate limited range of motion, being painful or difficult to move in some directions. In certain forms of arthritis, for example rheumatoid arthritis, the joints may become deformed if the disease continues for too long without treatment.

Diagnostic tests vary depending on the suspected cause, and may include blood or urine tests, as well as joint X-rays. In septic arthritis or inflammation of a joint due to a bacterial or fungal infection, fluid may be removed from the joint with a needle and examined for the presence of infection.

Medication and Treatment

Many over-the-counter medications include common anti-inflammatory drugs like:

• Aspirin
• Ibuprofen
• Naproxen

Such drugs may be used to effectively control pain and inflammation in arthritis, as described in another article at Pain-Research.org. However, these drugs need to be used with care as they have possible side effects of causing damage to the stomach lining and the kidneys.

Glucosamine and chondroitin which are known to provide naturally-occurring nutrient for forming the building blocks of cartilage may be recommended. These are available at health food stores or supermarkets without a prescription. Early studies indicate that these compounds are quite safe and may improve symptoms relating to arthritis.

Injections of liquid cortisone directly into the joint may temporarily help to relieve pain and swelling. However, it should be noted that repeated frequent injections into the same joint can damage the joint and have undesirable side effects.

If nonsurgical treatment fails to give relief, a surgery for arthritis by an orthopedist may be considered. This is the advice given in an article on arthritis treatments at Pain-Research.org. The orthopedist and patient will choose the type of surgery by taking into account the type of arthritis, its severity, and the patient's physical condition.

Surgical procedures include:

• Removal of the diseased or damaged joint lining
• Realignment of the joints
• Total joint replacement
• Fusion of the bone ends of a joint to prevent joint motion and relieve joint pain

For professional help with osteoarthritis and joint degeneration, please consult a doctor or an orthopedic specialist.

What Causes Joint to Wear Out?

by Singapore Health

Knee Osteoarthritis and Physiotherapy Management

by Singapore Health

When to Seek Medical Care for a Nosebleed

When to call the doctor about nosebleeds: 

• If you have repeated episodes of nosebleeds 
• If you have additional bleeding from places other than the nose, such as in the urine or stool 
• If you bruise easily 
• If you are on any blood-thinning drugs, including aspirin or warfarin (Coumadin) 
• If you have any underlying disease that may affect your blood clotting, such as liver disease, kidney disease, or hemophilia (inability of blood to clot) 
• If you recently had chemotherapy 

Go to the hospital for nosebleeds if:

• You are still bleeding after pinching the nose for 10 minutes. 
• You are having repeated episodes of nosebleeds over a short time. 
• You feel dizzy or light-headed or like you are going to pass out. 
• You have a rapid heartbeat or trouble breathing. 
• You are coughing up or vomiting blood. 
• You have a rash or temperature greater than than 101.4°F (38.5°C). 
• Your doctor instructs you to go to a hospital's emergency department. 

Nosebleed Exams and Tests

• To examine the nose, the doctor places medications into the nostrils, usually with a cotton ball, that numb the inside of the nose as well as constrict the blood vessels in that area. This will also reduce swelling and allow the doctor to see inside the nose better 
• The diagnosis of a posterior nosebleed is usually made when attempts to control the bleeding when the measures used for an anterior nosebleed have failed. Seeing the source of a posterior nosebleed is nearly impossible. 
• Lab tests may be done to evaluate blood loss or the effects of blood thinning drugs. 

Home Treatment for Nosebleeds

• A small amount of bleeding from a nosebleed requires little intervention. A common scenario is when a person with a cold or a sinus infection blows his or her nose vigorously and notices some blood in the tissue. 
• Avoiding any more vigorous nose blowing, sneezing, or nose picking is usually enough to keep the bleeding from getting worse. 

To stop a nosebleed:

• Remain calm. 
• Sit up straight. 
• Lean your head forward. Tilting your head back will only cause you to swallow the blood. 
• Pinch the nostrils together with your thumb and index finger for 10 minutes. Have someone time you to make sure you do not release the nostrils any earlier. 
• Spit out any blood in your mouth. Swallowing it may make you vomit. 
• After the bleeding has stopped: 
• Try to prevent any irritation to the nose, such as sneezing or nose blowing, for 24 hours. 
• Ice packs do not help. 
• Exposure to dry air, such as in a heated home in the winter, can contribute to the problem. Adding moisture to the air with a humidifier or vaporizer will help keep the nose from drying out and triggering more bleeding. Another option is to place a pan filled with water near a heat source, such as a radiator, which allows the water to evaporate and adds moisture to the air.