Common Health and Medical Questions and Answers. This health blog contains the questions that I've been most often asked by the patient facing surgery, his immediate family or concerned relatives.
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What are Prostate Cancer Diagnosis and Test Methods?
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What are the symptoms of cancer of the prostate?
Symptoms which should not be ignored include a weak or interrupted flow of urine, inability to urinate or difficulty in starting urination, need to urinate frequently (especially at night), blood in the urine, urine flow that is not easily stopped, painful or burning urination, and continuing pain in the back, pelvis, or hips. These symptoms are often the same symptoms that indicate other prostatic problems such as BPH, but they are symptoms which should be checked by the doctor who can detect the difference between a cancerous and noncancerous enlargement of the prostate.
How does the doctor check the prostate?
The initial step is through a digital examination of the gland through the rectum. The doctor inserts a gloved finger into the rectum and feels the gland. It often can enlarge to the size of an orange. The doctor suspects a cancerous growth if the gland is stony and hard to the touch, rather than rubbery. If there is an enlargement of the prostate gland, the doctor will usually order urine and blood analyses and x-ray.
Do most prostate glands enlarge as a man gets older?
This happens to the majority of men, beginning in the 40s and increasing in each subsequent decade of life. The enlargement itself becomes a problem only if it produces serious side effects, obstructing the flow of urine, but it should be checked yearly by the doctor. Surgery is necessary only in those whose symptoms become acute or where cancer is present.
How is cancer of the prostate diagnosed?
The presence of cancer can be confirmed by the removal of a small piece of prostate tissue for microscopic examination. Often a needle biopsy is used. In other cases, biopsy can be obtained during surgical procedures required for dealing with complications caused by the enlargement of the prostate. Blood tests are also important in diagnosis, since prostatic cancer cells secrete a chemical substance known as prostatic acid phosphatase, which finds its way into the bloodstream. In a large percentage of patients with prostate cancer, the level of acid phosphatase rises above normal when the tumor tissue has spread outside the prostate. However, the acid phosphatase test alone is not a definitive test and must be used with other indicators to determine diagnosis. This is because the rise in acid phosphatase is sometimes seen in people who do not have cancer. And it is often not detectable in people who do have cancer of the prostate.
Diagnosis and treating prostate cancer
Are new tests being developed to routinely discover prostate cancer?
A major effort of the National Cancer Institute and the National Prostatic Cancer Project is to develop and refine sensitive chemical tests that will permit the use of prostatic acid phosphatase as a more precise tool. A new method is a simple test called immunoenzyme assay (IEA) which seems to be as reliable as the tests in use now and costs less. Two other tests under study are the solid phase fluorescent immunoassay (SPIF) and the counterimmunoelectrophoresis (CIEP). All of these tests are based on immune reactions of antibodies with a phosphatase enzyme. Scientists are continuing to isolate other biochemical changes, called markers, that are associated with cancer of the prostate.
Is ultrasound used to diagnose prostate cancer?
Some preliminary studies using ultrasound show some promise that this method of detection may improve the rate of finding prostate cancer early.
What is malignant melanoma?
Malignant melanoma is a less common form of skin cancer. When diagnosed early, it is easily cured. But if it is not found soon enough, it can be very difficult to treat. It is dangerous because, unlike the other skin cancers, it mestastasizes early and spreads quickly. It is one of the more uncontrollable cancers. The cell involved is the melanocyte, the cell which produces melanin, the dark protective pigment of the skin. What is the difference between an ordinary mole and melanoma?
An ordinary mole is evenly colored, and either brown, tan or black. It may be flat or raised. It is round or oval and its edges are sharply defined. An ordinary mole is usually less than 6 millimeters in diameter about the size of a pencil eraser. Ordinary moles may be present at birth. Sometimes several appear at the same time, usually on areas of the skin which have been exposed to the sun. Once the mole develops, it usually stays the same size, shape and color for many years.…
Yes. After prostatectomy, the ability to ejaculate through the penis is lost. What happens is that ejaculation occurs but it is directed backward into the bladder, rather than forward through the urethra. The semen remains in the bladder until urination, and is carried out via that route. The man who ejaculates in this manner has the very same sensations during sex that he had before except that there is no discharge through the penis. Can a total prostatectomy be done without impairing the ability to have an erection?
Dr. Patrick C. Walsh, a surgeon at Johns Hopkins University Hospital in Baltimore, Maryland, has developed a way of removing the prostate which preserves potency by bypassing the intricate nerve branches of the pelvic plexus. This technique is now being adopted by many surgeons for patients with early stage prostate cancer. Until the advent of this type of surgery, 90 percent of those having prostatectomies lost their sexual ability, and 2 to 5 percent became incontine…
Fractures of the AnkleHow do ankle fractures occur? Ankle fractures are caused by a forceful and excessive
twisting of the ankle, either in or out. The twist comes
from stumbling, catching the foot in a crevice, or falling,
in which the weight of the body is unevenly distributed.
Many skiers suffer fractured ankles, and some of the best
treatments have been evolved by surgeons practicing near
ski slopes. The stress and strain factors in the ankle are
so uniform that the pattern of the injury, dislocation and
deformity is specific. Many varieties of ankle fractures are
grouped together under the name of Pott's fracture.
What shall I do, Doctor? I'm at a gas station phone and
my wife just fell down and twisted her ankle.
If it is painful and she can't walk, it may be a fracture.
Don't manipulate it, don't pull it. Just wrap a towel or
pillow around it and take her to a hospital for an X ray.
It is best if she does not walk. You can carry her in a
chair. How does an an…
What is a bone marrow transplant?
Bone marrow transplantation is an approach used over the past 10 years for the treatment of acute leukemia and lymphoma. It is a complex procedure and should be undertaken only by physicians with the experience and resources needed to get the best results. When is a bone marrow transplant used?
It may be used in some cases of several types of diseases aplastic anemia (when patients do not have enough red cells to carry oxygen, enough white cells to fight bacteria, or enough platelets to help clotting), in some types of acute and chronic leukemia, for some lymphomas, for severe combined immunodeficiency syndrome, and for certain inherited blood disorders such as thalassemia. A bone marrow transplant replaces a patient's abnormal or diseased marrow with healthy marrow from a donor. Can any leukemia patient undergo a bone marrow transplantation?
No. When patients and doctors consider the possibility of treatment with a bone marrow transplant, they m…
Head Injuries
The brain is man's most vital possession. Recent
details about organ transplants have centered on the
definition of death. These discussions have emphasized
that, even though the heart may continue to beat, the
individual is considered dead if there is no brain activity.
Nature provides a thick scalp and skull to protect the
brain and further encloses it in envelopes called the
meninges. Some injuries to the head may be trivial, others
may be fatal.
The surgeon who is called upon to evaluate the patient
with a head injury tackles the problem from within out.
Damage to the brain and its envelope is most important;
injury to the skull is of concern in only some instances.
Bleeding from the scalp is the most apparent manifestation
of injury but is the least important. Survival and
the late effects of a head injury depend on the extent of
the injury to the brain and not to its coverings. The
best possible supportive medical crre is provided to
those who will recover spon…
Would the doctor prescribe estrogen if my ovaries were removed because of cancer?
No. If there is any sign of a cancerous condition, estrogen would probably not be prescribed. What is the estrogen controversy?
Estrogen is a female hormone produced by the ovaries. Scientists have also developed chemical estrogen. Both regulate the development of female sexual characteristics. For a number of years, estrogens have been prescribed for women during and after menopause to make up for the decline in this hormone normally produced by the ovaries. Estrogen has been found helpful in relieving symptoms associated with menopause, such as hot flashes, in overcoming drying of vaginal tissues and in retarding osteoporosis (thinning of bones). However, the use of estrogen during and after menopause has been linked to an increase in endometrial cancer (cancer of the lining of the uterus), and it may be linked to other cancers as well. At this time,scientists do not agree about whether the risks of …
Chest Injuries
The chest consists of the bony thorax and the organs
that lie within it. The thorax comprises twelve ribs on
each side of the chest, each of which attaches to the bony
spine in the back and to the chest bone (sternum) in
front. Each chest cavity has a smooth delicate lining
(pleura) within which the lung rhythmically expands and
deflates.
The diaphragm is the dome shaped muscle that seals
off the lower end of the chest from the abdomen. Its upand down motion provides the bellows action for the
expansion of the lungs that fills them with air. The function
of the lungs is to provide ventilation. Air is moved
in to provide oxygen, and carbon dioxide is moved out
as a waste product.
The heart is in its own envelope in the center of the
chest, behind the breastbone. The heart functions solely
as a pump. It circulates the blood into the lung for oxygenation and delivers oxygenated blood to the entire
body. The chest also harbors the large blood vessels and
the breathing and s…
Hodgkin's Disease and Non-Hodgkin's LymphomaWhat are lymphomas?
Lymphomas are cancers that affect the white blood cells of the immune system. They are characterized by the abnormal growth of lymphocytes, the infection fighting cells in the lymph nodes, spleen, and thymus. The tonsils, stomach, small intestine, and skin may also be affected. Lymphomas are usually classified as Hodgkin's disease, the most common form, or non-Hodgkin's lymphoma. There are also other rare forms of the disease, such as mycosis fungoides, a primary skin lymphoma. Burkitt's lymphoma, rare in most of the world, is the most common childhood cancer in central Africa and is one of the fastest growing human cancers. What is the role of the lymph system in the body?
The lymph system is made up of nodes and thin walled tubelike veins along which the nodes lie. Its job is to help fight diseases and infection, and it serves as part of the body's drainage system. Lymph nodes are usually very sm…
Hand Injuries
Most of us earn our living with our hands. The goal
of the treatment of hand injuries is maximum preservation
of function. In terms of possible permanent disability,
there is no minor surgery in this area. The magnitude of
the problem is apparent in the frequency with which it appears in the statistics of the Workmen's Compensation
Board and insurance companies.
The best treatment is prevention. One must be constantly
alert to the possibility of punctures, door slams,
burns, pressure injuries, and the perverse potential of
certain mechanical tools. Failing this, early treatment to
prevent infection is best. There are relatively clearly defined
methods of managing various types of injury. The
patient can describe the site of the injury by indicating
its relation to the various creases in the palm or to the
knuckles and nails on the back of the hand. Physicians can
treat all hand and finger injuries under some form of
nerve blocking anesthesia, so the patient feels abs…
In the radical mastectomy (also known as the Halsted mastectomy) the doctor removes the breast tissue, the lymph nodes under the armpit, and the muscle under the breast. The modified radical, which most surgeons are now using, removes the breast tissue and the lymph nodes, but the muscle is left intact. The advantage of the modified radical is that it is cosmetically more attractive and does not handicap the motion of the arm. Studies indicate that the survival rate for the two operations is the same. Is the choice of what surgical procedure I will have up to me or up to the doctor?
Of course your doctor is responsible for the surgery. But he cannot perform any operation unless you give your signed consent to have it done. You should have your doctor give you his complete explanation of what he recommends as his bestjudgment and ask him all the questions that concern you about the operation. Do not sign anything until you are certain you understand what you are signing. It is your righ…
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