Methods of treatment for breast cancer are local or systemic. Local treatments are used to remove, destroy, or control the cancer cells in a specific area. Surgery and radiation therapy are local treatments. Systemic treatments are used to destroy or control cancer cells throughout the body. Chemotherapy and hormonal therapy are systemic treatments. A patient may have just one form of treatment or a combination. Different forms of treatment may be given at the same time or one after another.
Surgery is the most common treatment for breast cancer. Several types of surgery may be used. The doctor can explain each of them in detail, discuss and compare the benefits and risks of each type, and describe how each will affect the patient's appearance. An operation to remove the breast (or as much of the breast as possible) is a mastectomy. Breast reconstruction is often an option at the same time as the mastectomy, or later on. An operation to remove the cancer but not the breast is called breast-sparing surgery or breast-conserving surgery. Lumpectomy and segmental mastectomy (also called partial mastectomy) are types of breast-sparing surgery. They usually are followed by radiation therapy to destroy any cancer cells that may remain in the area. In most cases, the surgeon also removes lymph nodes under the arm to help determine whether cancer cells have entered the lymphatic system.
In lumpectomy, the surgeon removes the breast cancer and some normal tissue around it. Often, some of the lymph nodes under the arm are removed.
In segmental mastectomy, the surgeon removes the cancer and a larger area of normal breast tissue around it. Occasionally, some of the lining over the chest muscles below the tumor is removed as well. Some of the lymph nodes under the arm may also be removed.
In total (simple) mastectomy, the surgeon removes the whole breast. Some of the lymph nodes under the arm may also be removed.
In modified radical mastectomy, the surgeon removes the whole breast, most of the lymph nodes under the arm, and often the lining over the chest muscles. The smaller of the two chest muscles is also taken out to help in removing the lymph nodes.
In radical mastectomy (also called Halsted radical mastectomy), the surgeon removes the breast, the chest muscles, all of the lymph nodes under the arm, and some additional fat and skin. For many years, this operation was considered the standard one for women with breast cancer, but it is very rarely used today and only in cases of advanced cancer in which the cancer has spread to the chest muscles.
Tuesday, June 23, 2009
Monday, June 15, 2009
Alcohol Syndrome
Why do even the most effective, well-run programs have treatment failures with motivated patients? One reason may be due to a problem that is sometimes difficult to see: organic brain damage. People with central nervous system (CNS) dysfunction have difficulty processing information, which can have a significant impact on how they respond to treatment. Such individuals may appear normal during routine assessment, but once they begin participating in treatment, difficulties soon become apparent that set them apart from other patients. In particular, there may be problems linking cause with effect, memory deficits, or inability to think in abstract terms -- all of which are important for treatment efficacy. If a program's resources are to appropriately address the issues of such patients, CNS dysfunction must be addressed at intake, and services must be tailored to meet special needs.
One cause of CNS dysfunction is prenatal exposure to alcohol, estimated to affect approximately one to three per 1000 people in the United States.
(FAS) manifests in three primary symptom categories:
* Growth deficiency of prenatal onset (height or weight);
* Central nervous system (CNS) dysfunction, including microcephaly, delayed development, hyperactivity, attention deficits, learning disabilities and intellectual deficits; and
* A specific pattern of facial characteristics, including short palpebral fissures, thin upper lip and smooth and/or long philtrum. Individuals who are exposed to alcohol in utero and who display some, but not all, of these characteristics are often described ashaving possible fetal alcohol effects (FAE). The CNS dysfunction associated with FAS/FAE frequently causes attention problems, memory problems, affective problems and maladaptive behaviors such as poor impulse control.
Unless an individual exhibits the specific facial features and growth problems associated with prenatal alcohol exposure, it is often difficult to diagnose the disorder. Quite often, by adulthood, the normal maturation process has attenuated the characteristic facial features and growth anomalies. Consequently, only the cognitive and behavioral manifestations of FAS/FAE are left to serve as markers for the disorder. This situation not only makes diagnosis difficult, it seriously complicates treatment for impaired clients. Assessment procedures often address intellectual capacity, which can be determined by means of IQ testing. But assessing behavior is more complicated and more time consuming. However, if patients with FAS/FAE go unrecognized, treatment failure is almost certainly guaranteed. Such patients cannot deal easily with the concepts and abstractions that typically comprise most programs and often have difficulty following through on basic rules (e.g., abstinence) that are far more concrete.
One cause of CNS dysfunction is prenatal exposure to alcohol, estimated to affect approximately one to three per 1000 people in the United States.
(FAS) manifests in three primary symptom categories:
* Growth deficiency of prenatal onset (height or weight);
* Central nervous system (CNS) dysfunction, including microcephaly, delayed development, hyperactivity, attention deficits, learning disabilities and intellectual deficits; and
* A specific pattern of facial characteristics, including short palpebral fissures, thin upper lip and smooth and/or long philtrum. Individuals who are exposed to alcohol in utero and who display some, but not all, of these characteristics are often described ashaving possible fetal alcohol effects (FAE). The CNS dysfunction associated with FAS/FAE frequently causes attention problems, memory problems, affective problems and maladaptive behaviors such as poor impulse control.
Unless an individual exhibits the specific facial features and growth problems associated with prenatal alcohol exposure, it is often difficult to diagnose the disorder. Quite often, by adulthood, the normal maturation process has attenuated the characteristic facial features and growth anomalies. Consequently, only the cognitive and behavioral manifestations of FAS/FAE are left to serve as markers for the disorder. This situation not only makes diagnosis difficult, it seriously complicates treatment for impaired clients. Assessment procedures often address intellectual capacity, which can be determined by means of IQ testing. But assessing behavior is more complicated and more time consuming. However, if patients with FAS/FAE go unrecognized, treatment failure is almost certainly guaranteed. Such patients cannot deal easily with the concepts and abstractions that typically comprise most programs and often have difficulty following through on basic rules (e.g., abstinence) that are far more concrete.
Possible Side Effects of Erythromycin
Side effects of erythromycin can include gastrointestinal problems and allergies. Liver problems can occur, especially in patients with preexisting liver disorders. Some cases of dangerous heart irregularities have also been reported. Erythromycin should not be taken with terfenadine, astemisole or cisapride, as these combinations can greatly increase the possibility of heart irregularities. Nausea, vomiting, gastric pain, and abdominal cramps are also known side effects.
Pregnant Women
All pregnant smokers should be strongly encouraged to stop smoking throughout the entire length of their pregnancy. Cutting down the amount smoked is NOT sufficient. All pregnant smokers should be offered, at the very least, a minimal intervention (See below). Whenever possible, intensive counseling is recommended. It's never too late to quit smoking during pregnancy. Health benefits, for both the mother and fetus, can be obtained throughout the entire 9 months.
The same behavioral interventions that have been shown to be effective with all smokers should be applied to the pregnant smoker. Remember the Five A's:
1. Ask every pregnant women about smoking -- some pregnant women may try to hide their smoking status or try to minimize their use.
2. Advise every pregnant women to quit early since this benefits the mother and fetus most. Quitting anytime (even late in pregnancy) will benefit both the mother and fetus.
3. Assess the willingness of the women to make a quit attempt.
4. Assist every pregnant woman by providing motivational messages, such as:
"This is the most important gift you, as a new mother, can give to your baby. It will be important to stay quit after your baby is born. Remaining smoke-free will keep your baby healthy. I would like to help you stop smoking today".
5. Arrange for follow-up to assess progress. Congratulate successes -- remind the woman that she is truly helping herself and her baby. Incorporate relapse prevention strategies since postpartum relapse rates are high even if a women maintains abstinence during pregnancy.
To date, nicotine replacement, as a form of treatment, has not been systematically evaluated among pregnant smokers. According to the 1996 AHCPR [now Agency for Healthcare Research and Quality (AHRQ)] Smoking Cessation Clinical Practice Guideline, nicotine replacement should be used during pregnancy only if the increased likelihood of smoking cessation, with its potential benefits, outweighs the risk of nicotine replacement and potential concomitant smoking.
The same behavioral interventions that have been shown to be effective with all smokers should be applied to the pregnant smoker. Remember the Five A's:
1. Ask every pregnant women about smoking -- some pregnant women may try to hide their smoking status or try to minimize their use.
2. Advise every pregnant women to quit early since this benefits the mother and fetus most. Quitting anytime (even late in pregnancy) will benefit both the mother and fetus.
3. Assess the willingness of the women to make a quit attempt.
4. Assist every pregnant woman by providing motivational messages, such as:
"This is the most important gift you, as a new mother, can give to your baby. It will be important to stay quit after your baby is born. Remaining smoke-free will keep your baby healthy. I would like to help you stop smoking today".
5. Arrange for follow-up to assess progress. Congratulate successes -- remind the woman that she is truly helping herself and her baby. Incorporate relapse prevention strategies since postpartum relapse rates are high even if a women maintains abstinence during pregnancy.
To date, nicotine replacement, as a form of treatment, has not been systematically evaluated among pregnant smokers. According to the 1996 AHCPR [now Agency for Healthcare Research and Quality (AHRQ)] Smoking Cessation Clinical Practice Guideline, nicotine replacement should be used during pregnancy only if the increased likelihood of smoking cessation, with its potential benefits, outweighs the risk of nicotine replacement and potential concomitant smoking.
Fertility Treatment
Fertility Treatment in Kerala is a specialized treatment offered at a large number of hospitals and clinics in Kerala. Assisted reproduction programs offer parents who are unable to conceive, the hope of having biological children with the assistance of modern technology.
Assisted Reproductive Technology (ART) is provided at specialized hospitals that offer Fertility Treatment in Kerala. The treatment program includes medical checkups of the couple, to determine the physiological causes of infertility. After the cause is determined the appropriate assisted reproductive technique is prescribed.
Advanced techniques such as GIFT (Gamete Intra Fallopian Transfer) and ZIFT (Zygote Intra Fallopian Transfer) are offered at well-equipped Fertility centers in Kerala. With fully-equipped laboratories, ultrasound equipment and experienced doctors and support staff, fertility treatment in Kerala is economically priced and has been a sought-after treatment option by many Indian residents of the Middle East Countries.
The positive results of fertility treatment in Kerala has led to more couples making the trip to Kerala to take advantage of the medical expertise on offer. Some of the hospitals and clinics that offer fertility treatment in Kerala are:
* Amritha Institute of Medical Science & Research Centre, Ernakulam
* Sree Chitra Tirunal Institute of Medical Science, Trivandrum
* Atingal Multispeciality Hospital, Trivandrum
* Specialist's Hospital, Ernakulam
* Asha Maternity & General Hospital, Kollam
Assisted Reproductive Technology (ART) is provided at specialized hospitals that offer Fertility Treatment in Kerala. The treatment program includes medical checkups of the couple, to determine the physiological causes of infertility. After the cause is determined the appropriate assisted reproductive technique is prescribed.
Advanced techniques such as GIFT (Gamete Intra Fallopian Transfer) and ZIFT (Zygote Intra Fallopian Transfer) are offered at well-equipped Fertility centers in Kerala. With fully-equipped laboratories, ultrasound equipment and experienced doctors and support staff, fertility treatment in Kerala is economically priced and has been a sought-after treatment option by many Indian residents of the Middle East Countries.
The positive results of fertility treatment in Kerala has led to more couples making the trip to Kerala to take advantage of the medical expertise on offer. Some of the hospitals and clinics that offer fertility treatment in Kerala are:
* Amritha Institute of Medical Science & Research Centre, Ernakulam
* Sree Chitra Tirunal Institute of Medical Science, Trivandrum
* Atingal Multispeciality Hospital, Trivandrum
* Specialist's Hospital, Ernakulam
* Asha Maternity & General Hospital, Kollam
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