OSTEOSARCOMA - most common type of bone cancer in childrens and adult !!!

                Osteosarcoma is the most common bone cancer in children and adolescents, and the third most common cancer in adolescence.
                Osteosarcoma is most common between the ages of 10 and 25 when the bones are rapidly growing

Risk factors :
        - Exact cause is unknown associated with random genetic mutations of osteoblasts
        - Transmission of diseases including retinoblastoma, Li Fraumeni syndrome, Rothmund-Thomson syndrome,- Paget's disease, and Werner's syndrome from parents to offspring
        - Only known environmental risk factor is exposure to radiation

Symptoms include :
       - Bone fracture (may occur after what seems like a routine movement)
       - Bone pain
       - Limitation of motion
       - Limping (if the tumor is in the leg)
       - Pain when lifting (if the tumor is in the arm)
       - Tenderness, swelling, or redness at the site of the tumor

Investigations :
       - Biopsy (at time of surgery for diagnosis)
       - Blood tests
       - Bone scan to see if the cancer has spread to other bones
       - CT scan of the chest to see if the cancer has spread to the lungs
       - CT scan and MRI scan
       - PET scan
       - X-ray

Diagnosis :
       - Chemotherapy is the first line of treatment, drugs include
Carboplatin (Paraplatin), Cisplatin, Cyclophosphamide (Cytoxan), Doxorubicin (Adriamycin), Epirubicin, Etoposide, Ifosfamide (Ifex), Methotrexate (high dose) with leucovorin
       - Surgery is used after chemotherapy to remove any remaining tumor. In most cases, surgery can remove the tumor while saving the affected limb (this is called limb-salvage surgery)

Prognosis :
If the tumor has not spread to the lungs (pulmonary metastasis), long-term survival rates are better

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CHRONIC PYELONEPHRITIS - why 1 out of 7,000 people develop pyelonephritis each year in the US

Introduction :
             One of the most common renal diseases, acute pyelonephritis is a sudden inflammation caused by bacteria.It is characterized by renal inflammation and fibrosis induced by recurrent or persistent renal infection, vesicoureteral reflux, or other causes of urinary tract obstruction.
Occurs almost exclusively in patients with major anatomic anomalies, most commonly in young children with vesicoureteral reflux (VUR)
               Non-obstructive secondary to obstruction or vesiculourethral reflux with recurrent infection (reflex nephropathy, most common). Vesiculourethral reflux due to an incompetent ureterovesical junction is most common in children (males < 1 year, females > 1 year). Obstruction may be due to renal stones, prostatic hyperplasia, or tumors. Hydronephrosis eventually results, with entry of infected urine into the renal medula.

Definition :
            Pyelonephritis is a serious bacterial infection of the kidney that can be acute or chronic

Clinical features :
         - high grade fever with chills
         - flank pain
         - confusion
         - headache
         - renal colic pain
         - other symptoms include hypertension, anemia and renal insufficiency

Investigations :
        - urine analysis
        - urine culture
        - ultrasound study of kidneys

Treatment :
       - broad-spectrum antibiotic therapy
       - hospitalization in severe cases

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CARCINOMA OF BREAST (pathology)

Types :
        - ductal carcinoma
        - lobular carcinoma

Causes :
        - age :- women more than 50 years
        - sex :- women are 100 times more prone than males
        - family history of breast cancer and genetic influence
        - hormonal replacement therapy, alcohol use
        - menstrual cycle :- early menarche and late menapause
        - radiation

Clinical features :
       - lump in breast
       - change in size, shape or feel of breast and nipple
       - abnormal fluid coming from breast
       - In advanced cancer :- bone pain, breast pain, skin ulcer, swelling in one arm, weight loss

Investigations :
       - MRI, ultrasound of breast
       - biopsy
       - mammography
       - PET scan
       - sentinel lymph node biopsy

Treatment :
        - chemotheraphy
        - radiotherapy
        - surgery includes
                                  lumpectomy :- removal of breast lump
                                  mastectomy :- removal of all or part of breast and nearby structures
        - hormonal therapy ex :- tamoxifen

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ACUTE GLOMERULONEPHRITIS (pathology)

Definition :
        - disease of kidney characterized by inflammation of glomeruli

Causes :
        - post streptococcal glomerulonephritis
        - tuberculosis, syphilis
        - injecting illegal drugs
        - bacterial endocarditis
        - hepatitis B and C, HIV
        - lupus
        - Good pasture's syndrome , IgA nephropathy
        - polyartheritis, wegener's granulomatosis

clinical features :
       - an elevated body temp (100.4)
       - breathing difficulties
       - edema
       - nausea, vomiting, loss of appetite
       - pallor, vision problems

Investigations :
       - urine test
       - blood test
       - throat swab
       - renal function test
       - kidney biopsy
       - imaging tests (x-ray,  USG, CT)

Treatment :
      - diet and fluid intake
      - treatment for hypertension
      - antibiotic for bacterial infections
      - corticosteroids for lupus and vasculitis
      - kidney dialysis

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CARCINOMA STOMACH (pathology)

    
Risk factors :
        -  helicobactor pylori infection
        - stomach lymphoma
        - age after 50 years
        - more common in males
        - more common in Japan, China, Southern and Eastern Europe, and South and Central America
        - large amounts of smoked foods, salted fish and meat, and pickled vegetables. Nitrates and nitrites are substances commonly found in cured meats
       - tobacco use, obesity, previous stomach surgery
       - type A blood, family history of stomach cancer
       - EBV infection
       - immune deficiency

Clinical symptoms :
        - weight loss
        - persistent abdominal pain
        - dysphagia
        - occasional nausea and intestinal obstruction

Investigations :
        - Check FBC (possible anemia)
        - Rapid-access flexible endoscopy
        - Chromoendoscopy (use of dyes to highlight various aspects of the gastric mucosa), narrow band imaging and auto-fluorescence
        - biopsy

Management :
       - Surgery is the treatment of choice for gastric cancer
       - Distal (antral) tumours should be treated by subtotal gastrectomy and proximal tumors by total gastrectomy
       - Limited gastric resections should presently only be used for palliation or in the very elderly.

      

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