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كم‌خوني ناشي از فقر آهن

فقر آهن يكي از شايع‌ترين اختلالات تغذيه‌اي در كشورهاي در حال توسعه و مهم‌ترين علت كم‌خوني تغذيهاي در كودكان و زنان در سنين باروري است كه با ايجاد گلبول‌هاي قرمز كوچك و كاهش ميزان هموگلوبين مشخص مي‌شود كه اين بيماري سبب اتلاف منابع و مراقبت‌هاي بهداشتي، كاهش  بهره‌وري در اثر افزايش ميزان مرگ و مير ابتلا به بيماري در مادران و كودكان و بالاخره كاهش ظرفيت جسمي‌ و رواني در بخش بزرگي از جامعه مي‌شود.

دلايل فقر آهن

دلايل گوناگوني براي كمبود آهن وجود دارد كه از آن جمله مي‌توان به علل زير اشاره كرد

1 ـ دريافت ناكافي آهن به دليل رژيم غذايي مورد استفاده كه در آن آهن كمي ‌وجود دارد، مانند بعضي از رژيم‌هاي گياه خواري.

2 ـ جذب ناكافي آهن در اثر اسهال، كاهش ترشح اسيد معده، مشكلات گوارشي يا تداخلات دارويي و داروهايي مثل كلستيرامين، سايمتيدين، پانكراتين، رانيتيدين و تتراسايكلين).

3 ـ افزايش نياز به آهن براي افزايش حجم خون در دوران نوزادي، نوجواني،

از بارداري و شيردهي.

4 ـ خون‌ريزي زياد در دوران عادت ماهانه و يا در اثر جراحات يا ناشي از هموروييد (بواسير) يا بيماري‌هاي بدخيم و انگل‌ها. كمبود آهن در مردان بزرگسال معمولا در اثر دست دادن خون است.

 

علايم كم‌خوني ناشي از فقر آهن

بعضي از علايم كم‌خوني فقر آهن عبارتند از:

رنگ پريدگي پوست، زبان و مخاط داخل لب و پلك چشم‌ها، خستگي زودرس، سرگيجه و سردرد، خواب رفتن و سوزن سوزن شدن دست و پاها، حالت تهوع و در كم‌خوني شديد گود شدن روي ناخن(ناخن قاشقي).

منابع غذايي آهن دار

منابع غذايي آهن‌دار عبارتند از جگر، قلوه، گوشت قرمز، ماهي، زرده تخم‌مرغ، سبزي‌هاي داراي برگ سبز تيره مانند جعفري، اسفناج و حبوبات، مثل عدس و لوبيا همچنين ميوه‌هاي خشك (برگه‌ها) بخصوص برگه زردآلو و دانه‌هاي روغني.

درمان كم‌خوني ناشي از فقر آهن

براي درمان كم‌خوني از چند روش استفاده مي‌شود كه بهترين و كم‌خطرترين آن‌ها استفاده از مكمل‌هاي خوراكي است. درمان با نمك‌هاي ساده آهن مثل سولفات فروي خوراكي كاملا موثر بوده و به شكل قرص، كپسول يا مايع است و بايد مصرف آن‌ها تا چندين ماه ادامه يابد

 

+ نوشته شده در  دوشنبه سوم دی 1386ساعت 10:39  توسط maryam 

بیماریهای قابل پیشگیری با واکسن

 دیفتری

کزاز

سیاه سرفه

فلج اطفال

سرخک

مننژیت

هپاتیت B  

  دیفتری

ديفتري بيماري حاد باكتريال دستگاه تنفسي است كه بعلت كورينه باكتريوم ديفتريه ايجاد مي‌گردد. ديفتري بيماري شديد و بالقوه كشنده‌اي است كه ميزان مرگ و مير آن در كودكان خردسال و افراد مسن زيادتر مي‌باشد. استفاده از واكسن ديفتري در 50 سال گذشته باعث كاهش شيوع اين بيماري شده است مهمترين تظاهرات باليني ديفتري پيدايش غشائ التهابي قسمت فوقاني راههاي  تنفسي بخصوص در حلق و گاهي دربيني ، حنجره وناي مي باشد. توكسين توليد شده از ارگانيسم در بدن انتشار يافته و سبب آسيب به نسوج مختلفي من‌جمله ميوكارد ، اعصاب محيطي و كليه مي‌گردد.

.

علائم باليني

دوره كمون ديفتري  1 تا 5 روز و گاهي طولاني تر است . درجه حرارت در ديفتري 38.5 درجه است فعاليت بيمار اغلب كاهش يافته و گاهي تحريك پذيري پيدا مي كند در شروع بيماري مخاط حلق پرخون است در عرض 2 تا 3 روز غشايي با رنگ سفيد مايل به خاكستري ، ضخيم و چسبيده به نسج بوجود مي آيد . با جدا كردن غشاء خونريزي  ايجاد مي شود .غدد لنفاوي ناحيه قدامي گردن بطور مشخصي بزرگ و حساس مي گردند ديفتري بيني و پوست و ملتحمه گاهي ديده مي‌شود ولي نسبت به ديفتري حلق شيوع كمتري دارند.

تشخيص

امروزه تشخيص ديفتري بستگي به مهارت و آمادگي ذهني پزشك دارد ترشحات حلق و بيني بيماران مشكوك بر روي محيط مناسب كشت داده مي‌شود  بررسي گستره مستقيم ترشحات حلق قابل اطمينان نيست در صورت جدا سازي باسيل ديفتري از محيط  كشت لازم است سويه آن نيز تعيين گردد.

درمان

بيماري مي‌تواند بسرعت پيشرفت كرده و حيات بيمار را بخطر بياندازد. بدين جهت بلافاصله بعد از تشخيص باليني و حتي قبل از دريافت جواب آزمايش لازم است به بيمار آنتي‌توكسين (سرم اسبي) تزريق گردد. تجويز آنتي بيوتيك مناسب جهت از بين بردن باسيل لازم است ولي جايگزين آنتي توكسين نمي‌شود. براي قطع آنتي بيوتيك 3 كشت منفي از حلق و بيني بيمار لازم است .

پيشگيري

ايمن ساري غيرفعال :

براي درمان بيماران مبتلا به ديفتري و در موارد خاصي جهت پيشگيري از آنتي توكسين نوع اسبي استفاده مي‌شود.

ايمن سازي فعال :

امروزه توكسوئيد ديفتري بصورت استاندارد مورد استفاده قرار مي گيرد كسانيكه بطور كامل بر عليه ديفتري واكسينه شده باشند ميزان اثر واكسن بيش از 95 درصد مي باشد .

عوارض جانبي  واكسن

واكسن ديفتري يكي از واكسن‌هاي بسيار كم عارضه و در ضمن بسيار موثر مي‌باشد.www.eazphc.ir

+ نوشته شده در  دوشنبه سوم دی 1386ساعت 10:37  توسط maryam 
General Information About Small Intestine Cancer

Key Points for This Section


Small intestine cancer is a rare disease in which malignant (cancer) cells form in the tissues of the small intestine.

The small intestine is part of the body’s digestive system, which also includes the esophagus, stomach, and large intestine. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The small intestine is a long tube that connects the stomach to the large intestine. It folds many times to fit inside the abdomen.

Enlarge
Gastrointestinal (digestive) system anatomy; shows esophagus, liver, stomach, colon, small intestine, rectum, and anus
Anatomy of the lower digestive system, showing the colon and other organs.

There are five types of small intestine cancer.

The types of cancer found in the small intestine are adenocarcinoma, sarcoma, carcinoid tumors, gastrointestinal stromal tumor, and lymphoma. This summary discusses adenocarcinoma and leiomyosarcoma (a type of sarcoma).

Adenocarcinoma starts in glandular cells in the lining of the small intestine and is the most common type of small intestine cancer. Most of these tumors occur in the part of the small intestine near the stomach. They may grow and block the intestine.

Leiomyosarcoma starts in the smooth muscle cells of the small intestine. Most of these tumors occur in the part of the small intestine near the large intestine.

Refer to the following PDQ summaries for more information on small intestine cancer:

Diet and health history can affect the risk of developing small intestine cancer.

Risk factors include the following:

Possible signs of small intestine cancer include abdominal pain and unexplained weight loss.

These and other symptoms may be caused by small intestine cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

  • Pain or cramps in the middle of the abdomen.
  • Weight loss with no known reason.
  • A lump in the abdomen.
  • Blood in the stool.

Tests that examine the small intestine are used to detect (find), diagnose, and stage small intestine cancer.

Procedures that create pictures of the small intestine and the area around it help diagnose small intestine cancer and show how far the cancer has spread. The process used to find out if cancer cells have spread within and around the small intestine is called staging.

In order to plan treatment, it is important to know the type of small intestine cancer and whether the tumor can be removed by surgery. Tests and procedures to detect, diagnose, and stage small intestine cancer are usually done at the same time. The following tests and procedures may be used:

  • Physical exam and history. An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.

  • Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver disease that may be caused by small intestine cancer.

  • Abdominal x-ray: An x-ray of the organs in the abdomen. An x-ray is a type of energy beam that can go through the body onto film, making a picture of areas inside the body.

  • Barium enema: A series of x-rays of the lower gastrointestinal (GI) tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.

    Enlarge
    Barium enema procedure; shows barium liquid being put into the rectum and flowing through the colon. Inset shows person on table having a barium enema.
    Barium enema procedure. The patient lies on an x-ray table. Barium liquid is put into the rectum and flows through the colon. X-rays are taken to look for abnormal areas.



  • Fecal occult blood test: A test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.

    Fecal Occult Blood Test (FOBT) kit; shows card, applicator, and return envelope.
    Fecal Occult Blood Test (FOBT) kit to check for blood in stool.



  • Upper endoscopy: A procedure to look at the inside of the esophagus, stomach, and duodenum (first part of the small intestine, near the stomach). An endoscope (a thin, lighted tube) is inserted through the mouth and into the esophagus, stomach, and duodenum. Tissue samples may be taken for biopsy.

  • Upper GI series with small bowel follow-through: A series of x-rays of the esophagus, stomach, and small bowel. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus, stomach, and small bowel. X-rays are taken at different times as the barium travels through the upper GI tract and small bowel.

  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. This may be done during the endoscopy. The sample is checked by a pathologist to see if it contains cancer cells.

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

  • Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.

  • Laparotomy: A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken for biopsy.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The type of small intestine cancer.
  • Whether the cancer has spread to other places in the body.
  • Whether the cancer can be completely removed by surgery.
  • Whether the cancer is newly diagnosed or has recurred
+ نوشته شده در  دوشنبه سوم دی 1386ساعت 10:33  توسط maryam 

Also called: Bellyache

Your abdomen extends from below your chest to your groin. Some people call it the stomach, but your abdomen contains many other important organs. Pain in the abdomen can come from any one of them. The pain may start somewhere else, such as your chest. Severe pain doesn't always mean a serious problem. Nor does mild pain mean a problem is not serious.

Call your healthcare provider if mild pain lasts a week or more or if you have pain with other symptoms. Get medical help immediately if

  • You have abdominal pain that is sudden and sharp
  • You also have pain in your chest, neck or shoulder
  • You're vomiting blood or have blood in your stool
  • Your abdomen is stiff, hard and tender to touch
  • You can't move your bowels, especially if you're also vomiting

Start Here

+ نوشته شده در  دوشنبه سوم دی 1386ساعت 10:19  توسط maryam 
  • When to Contact a Medical Professional
  • What to Expect at Your Office Visit
  • References

    • Illustrations

    Intestinal gas
    Intestinal gas
    Abdominal ultrasound
    Abdominal ultrasound

    Alternative Names    Return to top

    Flatulence (flatus)

    Definition    Return to top

    Gas, also called flatus or flatulence, is air in the intestine that is passed through the rectum. Air that is passed from the digestive tract through the mouth is called belching.

    Considerations    Return to top

    Gas is formed in the intestines as food is being digested. Gas can make you feel bloated, which may cause crampy or colicky abdominal pain.

    Causes    Return to top

    Gas can be caused by any of the following:

    • Swallowing air while eating.
    • Eating foods that are difficult to digest, such as fiber. If you recently introduced fiber into your diet, having gas may be temporary. Give it a little time. Your body may adjust and stop producing gas.
    • Eating foods that you cannot tolerate -- for example, if you have lactose intolerance and eat dairy products.
    • Irritable bowel syndrome -- a chronic form of stomach upset that gets worse from stress.
    • Malabsorption (when your body cannot absorb or digest a particular nutrient properly, often accompanied by diarrhea).
    • Antibiotics.

    Home Care    Return to top

    • Eat more slowly.
    • Chew your food thoroughly.
    • Avoid gum chewing.
    • Relax while you eat.
    • Avoid beans, cabbage, and carbonated beverages.
    • Try Beano, a product sold over-the-counter at most drugstores, if you eat a lot of beans, fruits, vegetables, and other high-fiber foods.
    • Walk for 10 to 15 minutes after eating.
    • Drink peppermint or chamomile tea after a meal.

    When to Contact a Medical Professional    Return to top

    Call your doctor if:

    • Your have other symptoms in addition to gas, like abdominal or rectal pain, heartburn, nausea, vomiting, diarrhea, constipation, or weight loss.
    • You have oily, foul-smelling, or bloody stools.

    What to Expect at Your Office Visit    Return to top

    Your doctor will perform a physical examination with special attention to your abdomen, and ask questions about your symptoms, such as:

    • What is your diet like?
    • Has it recently changed?
    • What foods do you eat commonly?
    • What foods have you eaten recently?
    • Have you increased the fiber in your diet?
    • How fast do you eat, chew, and swallow?
    • Would you say that your gas is mild or severe?
    • Does your gas seem to be related to eating milk products or other specific foods?
    • What seems to make your gas better?
    • What medications do you take?
    • Do you have other symptoms like abdominal pain, diarrhea, early satiety (premature fullness after meals), bloating, or weight loss?

    Diagnostic tests that may be performed include:

    References    Return to top

    Birrer RB. Irritable bowel syndrome. Dis Mon. 2002; 48(2): 105-143.

    Lovelace HY. Diagnosis, symptoms, and calcium intakes of individuals with self-reported lactose intolerance. J Am Coll Nutr. 2005; 24(1): 51-57.

    Andrès E. Food-cobalamin malabsorption in the elderly. Am J Med. 2002; 113(4): 351-352.

    + نوشته شده در  دوشنبه سوم دی 1386ساعت 10:11  توسط maryam  | 

    Also called: Circumscribed scleroderma, Dermatosclerosis, Morphea, Systemic sclerosis

    Scleroderma means hard skin. It is a group of diseases that causes abnormal growth of connective tissue, the proteins that support your skin and organs. There are two main types. Localized scleroderma affects only your skin. Systemic scleroderma affects your blood vessels and internal organs, as well as your skin.

    Symptoms of scleroderma include

    • Calcium deposits in connective tissues
    • Raynaud's phenomenon, narrowing of blood vessels in the hands or feet
    • Swelling of the esophagus, the tube between your throat and stomach
    • Thick, tight skin on your fingers
    • Red spots on your hands and face

    No one knows what causes scleroderma. It is more common in women. It can be mild or severe. There is no cure, but various treatments can relieve symptoms.

    National Institute of Arthritis and Musculoskeletal and Skin Diseases

    Start Here
    Basics Learn More Multimedia & Cool Tools
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    Research Reference Shelf For You

    + نوشته شده در  دوشنبه سوم دی 1386ساعت 10:4  توسط maryam 

    About psoriasis
    Statistics

    The following statistics show that psoriasis and psoriatic arthritis are common, life-altering and often debilitating conditions.

    Worldwide

    • Psoriasis affects an estimated 2-3 percent of the world's population.

    • 125 million people worldwide have psoriasis, according to the World Psoriasis Day consortium.

    National health concern

    • According to the National Institutes of Health (NIH), between 5.8 and 7.5 million Americans have psoriasis.

    • Studies have shown that between 10 percent and 30 percent of people with psoriasis also develop psoriatic arthritis.

    National Psoriasis Foundation Benchmark Survey

    In 2001, the National Psoriasis Foundation commissioned the Benchmark Survey on Psoriasis and Psoriatic Arthritis. The results provided prevalence information, increased our understanding of the impact of psoriasis and psoriatic arthritis, and demonstrated that psoriasis and psoriatic arthritis carry a substantial burden. This Psoriasis Forum article provides more information about the survey and the published papers it generated. The statistics below come from the Benchmark Survey.

      Prevalence

      • 2.2 percent of American adults have been diagnosed with psoriasis, confirming that psoriasis is a common disease.1

      • 11 percent of those diagnosed with psoriasis have also been diagnosed with psoriatic arthritis. This is a prevalence of 0.25 percent of American adults in the general population.2

      • Psoriasis prevalence in African Americans was 1.3 percent compared to 2.5 percent of Caucasians.3

      Quality of life

      • Psoriasis is not a cosmetic problem. Nearly 60 percent reported their disease to be a large problem in their everyday life.1

      • Nearly 40 percent with psoriatic arthritis reported their disease to be a large problem in everyday life.2

      • Patients with psoriasis covering more of their body (more extensive skin disease) experienced a greater negative impact on their quality of life.4

      • Psoriasis had a greater impact on quality of life in women and younger patients.4

      Treatment satisfaction

      • Less than 40 percent of respondents indicated they were very satisfied with any of the four therapies assessed in the study (acitretin [brand name Soriatane], cyclosporine, methotrexate or PUVA [psoralen plus ultraviolet light A]).5

      • Nearly 80 percent of persons who were very dissatisfied with their treatment did not have severe disease (less than 10 palms of coverage or <10 percent BSA).1

      • Members of the National Psoriasis Foundation reported their disease to be significantly less of a burden and were more satisfied with treatment.6

    Age of onset

    • Psoriasis often appears between the ages of 15 and 25, but can develop at any age.

    • Psoriatic arthritis usually develops between the ages of 30 and 50, but it can develop at any time.

    Severity of psoriasis

    • The National Psoriasis Foundation defines mild psoriasis as affecting less than three percent of the body; 3 percent to 10 percent is considered moderate; more than ten percent is considered severe. The palm of the hand equals 1 percent of the skin. However, the severity of psoriasis is also measured by how psoriasis affects a person's quality of life. Psoriasis can have a serious impact even if it involves a small area, such as the palms of the hands or soles of the feet.

    • The majority of people with psoriasis have mild disease.

    • Nearly one-quarter of people with psoriasis have cases that are considered moderate to severe.

    Cost of psoriasis

    • Overall costs of treating psoriasis may exceed $3 billion annually. A 1993 study estimated that between $2 and $3 billion was spent annually on psoriasis treatments.7

    Genetic aspects of psoriasis

    • About one out of three people with psoriasis report that a relative had psoriasis.

    • If one parent has psoriasis, a child has about a 10 percent chance of having psoriasis. If both parents have psoriasis, a child has approximately a 50 percent chance of developing the disease.

    Survey panels

    The National Psoriasis Foundation conducts survey panels twice each year to understand the experiences and opinions of people with psoriasis and psoriatic arthritis and document the burden of these diseases.

    Cited studies

    1. Stern RS, Nijsten T, Feldman SR, Margolis DJ, Rolstad T. Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction. J Investig Dermatol Symp Proc. 2004 Mar;9(2):136-9.

    2. Gelfand JM, Gladman DD, Mease PJ, Smith N, Margolis DJ, Nijsten T, Stern RS, Feldman SR, Rolstad T. Epidemiology of psoriatic arthritis in the population of the United States. J Am Acad Dermatol. 2005 Oct;53(4):573.

    3. Gelfand JM, Stern RS, Nijsten T, Feldman SR, Thomas J, Kist J, Rolstad T, Margolis DJ. the prevalence of psoriasis in African Americans: results from a population-based study. J Am Acad Dermatol. 2005 Jan;52(1):23-6.

    4. Gelfand JM, Feldman SR, Stern RS, Thomas J, Rolstad T, Margolis DJ. Determinants of quality of life in patients with psoriasis: a study from the U.S. population. J Am Acad Dermatol. 2004 Nov;51(5):704-8.

    5. Nijsten T, Margolis DJ, Feldman SR, Rolstad T, Stern RS. Traditional systemic treatments have not fully met the needs of psoriasis patients: results from a national survey. J Am Acad Dermatol. 2005 Mar;52(3 Pt 1):434-44.

    6. Nijsten T, Rolstad T, Feldman SR, Stern RS. Members of the National Psoriasis Foundation: more extensive disease and better informed about treatment options. Arch Dermatol. 2005 Jan;141(1):19-26.

    7. Sander HM, Morris LF, Phillips CM, Harrison PE, Menter A. The annual cost of psoriasis. J Am Acad Dermatol. 1993; 28; 422-9.

    + نوشته شده در  دوشنبه سوم دی 1386ساعت 9:46  توسط maryam 

    Stomach cancer

    From Wikipedia, the free encyclopedia

    Jump to: navigation, search
    Stomach cancer
    Classification & external resources
    A suspicious stomach ulcer that was diagnosed as cancer on biopsy and resected. Surgical specimen.
    ICD-10 C16.
    ICD-9 151
    OMIM 137215
    DiseasesDB 12445
    eMedicine med/845 
    MeSH D013274

    Stomach cancer (also called gastric cancer) can develop in any part of the stomach and may spread throughout the stomach and to other organs; particularly the esophagus and the small intestine. Stomach cancer causes nearly one million deaths worldwide per year.[1]

    Contents

    [hide]

    [edit] Epidemiology

    Stomach cancer represents roughly 2% (25,500 cases) of all new cancer cases yearly in the United States, but it is much more common in Korea, Japan, Great Britain, South America, and Iceland. It is associated with high salt in the diet, smoking, and low intake of fruits and vegetables. Infection with the bacterium H. pylori is the main risk factor in about 80% or more of gastric cancers. It is more common in men.

    Gastric or stomach cancer has very high incidence in Korea and Japan. Gastric cancer is the leading cancer type in Korea with 20.8% of malignant neoplasms, the second leading cause of cancer deaths. It is suspected several risk factors are involved including diet, gastritis, intestinal metaplasia and Helicobacter pylori infection. A Korean diet, high in salted, stewed and broiled foods, is thought to be a contributing factor. Ten percent of cases show a genetic component.[2] In Japan and other countries bracken consumption and spores are correlated to stomach cancer incidence.[3] Epidemiologists have yet to fully account for the high rates of gastric cancer as compared to other countries. Gastric cancer shows a male predominance in its incidence as up to 3 males are affected for every female. Estrogen may protect women against the development of this cancer form.[4]

    A very small percentage of diffuse-type gastric cancers (see Histopathology below) are thought to be genetic. Hereditary Diffuse Gastric Cancer (HDGC) has recently been identified and research is ongoing. However, genetic testing and treatment options are already available for families at risk.[5]

    Metastasis occurs in 80-90% of individuals with stomach cancer, with a five year survival rate of 75% in those diagnosed in early stages and less than 30% of those diagnosed in late stages. The death rate is 12,400 a year in the United States.

    [edit] Symptoms

    Endoscopic image of linitis plastica, a type of stomach cancer where the entire stomach is invaded, leading to a leather bottle-like appearance with blood coming out of it.
    Endoscopic image of linitis plastica, a type of stomach cancer where the entire stomach is invaded, leading to a leather bottle-like appearance with blood coming out of it.

    Stomach cancer is often asymptomatic or causes only nonspecific symptoms in its early stages. By the time symptoms occur, the cancer has generally metastasized to other parts of the body, one of the main reasons for its poor prognosis. Stomach cancer can cause the following signs and symptoms:

    Early

    Late

    These can be symptoms of other problems such as a stomach virus, gastric ulcer or tropical sprue and diagnosis should be done by a gastroenterologist or an oncologist.

    [edit] Diagnosis

    To find the cause of symptoms, the doctor asks about the patient's medical history, does a physical exam, and may order laboratory studies. The patient may also have one or all of the following exams:

    • Gastroscopic exam is the diagnostic method of choice
    • Upper GI series (may be called barium roentgenogram)
    • Fecal occult blood test is obsolete except possibly as a screening test; a negative test proves nothing and a positive result may result from a large number of other conditions beside gastric carcinoma.

    Abnormal tissue seen in a gastroscope examination will be biopsied by the surgeon or gastroenterologist. This tissue is then sent to a pathologist for histological examination under a microscope to check for the presence of cancerous cells. A biopsy, with subsequent histological analysis, is the only sure way to confirm the presence of cancer cells.

    A condition of darkened hyperplasia of the skin, frequently of the axilla and groin, known as acanthosis nigricans, commonly prompts a study into gastric carcinoma. It should be noted that this hyperplasia can be found in obese individuals with no underlying cancer.

    [edit] Histopathology

    Poor to moderately differentiated adenocarcinoma of the stomach. H&E stain.
    Poor to moderately differentiated adenocarcinoma of the stomach. H&E stain.
    Gastric signet ring cell carcinoma. H&E stain.
    Gastric signet ring cell carcinoma. H&E stain.
    • Gastric adenocarcinoma is a malignant epithelial tumor, originating from glandular epithelium of the gastric mucosa. It invades the gastric wall, infiltrating the muscularis mucosae, the submucosa and thence the muscularis propria. Histologically, there are two major types of gastric cancer (Lauren classification): intestinal type and diffuse type.
    • Intestinal type adenocarcinoma: tumor cells describe irregular tubular structures, harboring pluristratification, multiple lumens, reduced stroma ("back to back" aspect). Often, it associates intestinal metaplasia in neighboring mucosa. Depending on glandular architecture, cellular pleomorphism and mucosecretion, adenocarcinoma may present 3 degrees of differentiation: well, moderate and poorly differentiate.
    • Diffuse type adenocarcinoma (mucinous, colloid): Tumor cells are discohesive and secrete mucus which is delivered in the interstitium producing large pools of mucus/colloid (optically "empty" spaces). It is poorly differentiated. If the mucus remains inside the tumor cell, it pushes the nucleus at the periphery - "signet-ring cell".

    [edit] Staging

    If cancer cells are found in the tissue sample, the next step is to stage, or find out the extent of the disease. Various tests determine whether the cancer has spread and, if so, what parts of the body are affected. Because stomach cancer can spread to the liver, the pancreas, and other organs near the stomach as well as to the lungs, the doctor may order a CT scan, an ultrasound exam, or other tests to check these areas. Blood tests for tumor markers, such as carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) may be ordered, as their levels correlate to extent of metastasis, especially to the liver, and the cure rate.

    Staging may not be complete until after surgery. The surgeon removes nearby lymph nodes and possibly samples of tissue from other areas in the abdomen for examination by a pathologist.

    TNM staging is used

    [edit] Treatment

    Like any cancer, treatment is adapted to fit each person's individual needs and depends on the size, location, and extent of the tumor, the stage of the disease, and general health. Cancer of the stomach is difficult to cure unless it is found in an early stage (before it has begun to spread). Unfortunately, because early stomach cancer causes few symptoms, the disease is usually advanced when the diagnosis is made. Treatment for stomach cancer may include surgery, chemotherapy, and/or radiation therapy. New treatment approaches such as biological therapy and improved ways of using current methods are being studied in clinical trials.

    [edit] Surgery

    Surgery is the most common treatment for stomach cancer. The surgeon removes part (subtotal or partial gastrectomy) or all (total gastrectomy) of the stomach, as well as some of the tissue around the stomach, with the basic goal of removing all cancer and a margin of normal tissue. Depending on the extent of invasion and the location of the tumor, surgery may also include removal of part of the esophagus, spleen, ovaries, intestine or pancreas . Tumors in the lower parts of the stomach may call for a Billroth I or Billroth II procedure. Endoscopic mucosal resection is a treatment for early gastric cancer that has been pioneered in Japan, but is available in the United States at some centers. In this procedure, the tumor is removed from the wall of the stomach using an endoscope, with the advantage in that it is a smaller operation than removing the stomach. Surgical interventions are currently curative in less than 40% of cases, and, in cases of metastasis, may only be palliative.

    [edit] Chemotherapy

    Chemotherapy is the use of systemic drugs to fight the stomach cancer. Unfortunately, gastric cancer has not been especially sensitive to these drugs until recently, and historically served to palliatively reduce the size of the tumor and increase survival time. Some drugs used in stomach cancer treatment include: 5-FU (fluorouracil), BCNU (carmustine), methyl-CCNU (Semustine), and doxorubicin (Adriamycin), as well as Mitomycin C, and more recently cisplatin and taxotere in various combinations. Scientists are exploring the benefits of giving chemotherapy before surgery to shrink the tumor, or as adjuvant therapy after surgery to destroy remaining cancer cells. Combination treatment with chemotherapy and radiation therapy is also under study. Doctors are testing a treatment in which anticancer drugs are put directly into the abdomen (intraperitoneal hyperthermic chemoperfusion). Chemotherapy also is being studied as a treatment for cancer that has spread, and as a way to relieve symptoms of the disease. The side effects of chemotherapy depend mainly on the drugs the patient receives.

    [edit] Radiation therapy

    Radiation therapy (also called radiotherapy) is the use of high-energy rays to damage cancer cells and stop them from growing. When used, it is generally in combination with surgery and chemotherapy, or used only with chemotherapy in cases where the individual is unable to undergo surgery. Radiation therapy may be used to relieve pain or blockage by shrinking the tumor for palliation of incurable disease

    [edit] Multimodality therapy

    While previous studies of multimodality therapy (combinations of surgery, chemotherapy and radiation therapy) gave mixed results, the Intergroup 0116 (SWOG 9008) study[6] showed a survival benefit to the combination of chemotherapy and radiation therapy in patients with nonmetastatic, completely resected gastric cancer. Patients were randomized after surgery to the standard group of observation alone, or the study arm of combination chemotherapy and radiation therapy. Those in the study arm receiving chemotherapy and radiation therapy survived on average 36 months, compared to 27 months with observation. .

    [edit] Biological therapy

    Biologic therapy is still in the testing stages for stomach cancer. The side effects of biological therapy vary with the type of treatment. Some cause flu-like symptoms, such as chills, fever, weakness, nausea, vomiting, and diarrhea. Patients sometimes get a rash, and they may bruise or bleed easily. These problems may be severe, and patients may need to stay in the hospital during treatment.

    [edit] External links

    [edit] References

    1. ^ Cancer. World Health Organization (Feb 2006). Retrieved on 2007-05-24.
    2. ^ AHyuk-Joon Lee, Han-Kwang Yang, Yoon-Ok Ahn, Gastric cancer in Korea Gastric Cancer, Volume 5, Number 3 / September, 2002. DOI:10.1007/s101200200031]
    3. ^ Alonso-Amelot ME, Avendano M., Human Carcinogenesis and Bracken Fern: A Review of the Evidence, Curr Med Chem. 2002 Mar;9(6):675-86
    4. ^ Estrogen in the development of esophageal and gastric adenocarcinoma (Thesis) http://diss.kib.ki.se/2007/978-91-7357-370-2/
    5. ^ Brooks-Wilson AR, Kaurah P, Suriano G, et al (2004). "Germline E-cadherin mutations in hereditary diffuse gastric cancer: assessment of 42 new families and review of genetic screening criteria". J. Med. Genet. 41 (7): 508–17. PMID 15235021. 
    6. ^ Macdonald JS, Smalley SR, Benedetti J, et al (2001). "Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction". N. Engl. J. Med. 345 (10): 725–30. PMID 11547741. 
    Retrieved from "http://en.wikipedia.org/wiki/Stomach_cancer"
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