If you're the victim of a traditional swindle, most people know what to do: File a police report with the proper jurisdiction if it's a criminal matter, or hire a lawyer. But Internet fraud and e-mail scams happen in the nether world of Cyberspace, where it's not always easy to find a cop on the electronic street corner. What's a victim to do?
There are definite steps you can take for reporting e-mail scams and Internet fraud. Several federal agencies, responding to the growing volume of scams, have set up divisions to take reports and investigate such incidents. Reporting e-mail scams helps everyone on the Internet.
fbi e-mail scam alert
Image courtesy of FBI
The FBI monitors e-mail scams and sends out alerts.
The FBI, together with the National White Collar Crime Center, run a Web site dedicated to Internet crime, called the Internet Crime Complaint Center. Visitors can learn more about Internet crime, review a "Frequently Asked Questions" gallery and view e-mail fraud and Internet scam examples. The site contains a large number of tips for avoiding specific scams. It also has a link for filing a complaint against a third party whom you believe has defrauded or attempted to defraud you.
The U.S. Department of Justice also hosts Web sites that allow you to report Internet fraud and e-mail scams. The site contains links to documents on how to report such crimes broken down by the specific type of fraud. It points out, for instance, that the U.S. Secret Service, U.S. Postal Service, Bureau of Alcohol Tobacco and Firearms and U.S. Immigration and Customs Enforcement all play a role in investigating and prosecuting e-mail scams and Internet fraud, depending on its nature.
There are also many private Web sites that contain information and tips about what to do if you suspect an Internet or email scam. Site such as Scamdex and Hoax-Slayer are two examples.
If the past is any indication, e-mail scam artists and Internet fraud perpetrators will continue to evolve with technology, constantly probing security systems for weaknesses and searching for victims to dupe. Like expert marketers, a recent trend has e-mail scams shying away from the "mass mailing" approach they once used in favor of targeted, more personalized appeals. Internet users should always use caution when receiving e-mails from unknown sources and should avoid following links they provide. Use the delete key, experts advise. If you think you've been a victim, report it to the online authorities.
Kamis, 22 Mei 2008
Avoiding E-mail Scams
E-mail scams are constantly evolving, driven by the nature of the crooks who invent them. In many cases, avoiding e-mail scams or Internet fraud can be achieved by being aware of the different methods that scam artists use. Here are some prime examples of e-mail scams along with tips on how to avoid becoming a victim:
* Phishing: This scam involves thieves trolling the Internet with fake e-mails, Web sites, chat rooms and other devices while illegally using the names of trusted financial brands in an attempt to convince victims to divulge personal financial information such as credit card or social security numbers.
* Money handling: This scam involves recruiting a third-party to receive funds stolen through another e-mail scam into an account before then transferring the money overseas, minus a commission. One such e-mail that recruits money handlers, or "mules," often has a subject line like, "I need your assistance," and a message that describe the sender as an overseas government official who is trying to move his countries' assets to a new secure location.
* Advance fee fraud: In this arrangement, a person is approached by someone posing as Nigerian official about an opportunity to make a huge commission by helping the crooked "official" hide a massive overpayment on a government contract. In the end, the victim is persuaded to provide a large up-front fee to keep the transaction moving forward.
* Lottery scams: Potential victims are notified via e-mail that they have won a large prize in a foreign lottery. In most cases, the victim is asked to provide either an up-front fee, or bank account or social security numbers so that the lottery can transfer the money.
* Internet auction scams: In this case, scam artists pick victims from those using sites such as eBay or Craigslist. They contact those bidding by e-mail asking to work with them outside the auction to make a deal. As usual, the perpetrator asks for payment up front, often in cash.
The best way to avoid e-mail scams and Internet fraud is by using common sense, experts agree. If it sounds too good to be true, it probably is. If you receive an e-mail from an unknown source, practice extreme caution. Keep in mind that the latest wave of e-mail fraud relies on targeting e-mails to specific individuals whom the crooks have picked through various means. Because of this, such an e-mail may contain information designed to peak your interest. Don't be fooled.
Phishing sample
Image courtesy of AntiPhishing.org
E-mail scams such as phishing involve sending fake e-mails.
Also, never click on a link provided in such an e-mail, as it may take you to a site where malicious software will attempt to invade your computer. If someone is offering you something for free, such as software downloads, be suspicious.
Above all, NEVER give out personal, sensitive information, such as social security, bank account or credit card numbers in response to such e-mails.
Vincent Weafer, an Internet security expert for Symantec, advises computer users to make sure they take advantage of patches offered by browser providers, which can plug holes in security systems discovered after the software's release, CNN reported.
Money Magazine asked several identity theft experts how they protect themselves. The experts said the most important steps include:
* getting free credit reports three times a year
* keeping an eye on online banking and brokerage accounts
* using cash or credit cards (not debit cards, which are associated with your bank account) when practical
* telling banks and other institutions not to share your financial info with another party.
Consumers should guard their social security number closely and ignore e-mail and other solicitations asking for sensitive information. On the next page, we'll talk about how to report e-mail scams.
* Phishing: This scam involves thieves trolling the Internet with fake e-mails, Web sites, chat rooms and other devices while illegally using the names of trusted financial brands in an attempt to convince victims to divulge personal financial information such as credit card or social security numbers.
* Money handling: This scam involves recruiting a third-party to receive funds stolen through another e-mail scam into an account before then transferring the money overseas, minus a commission. One such e-mail that recruits money handlers, or "mules," often has a subject line like, "I need your assistance," and a message that describe the sender as an overseas government official who is trying to move his countries' assets to a new secure location.
* Advance fee fraud: In this arrangement, a person is approached by someone posing as Nigerian official about an opportunity to make a huge commission by helping the crooked "official" hide a massive overpayment on a government contract. In the end, the victim is persuaded to provide a large up-front fee to keep the transaction moving forward.
* Lottery scams: Potential victims are notified via e-mail that they have won a large prize in a foreign lottery. In most cases, the victim is asked to provide either an up-front fee, or bank account or social security numbers so that the lottery can transfer the money.
* Internet auction scams: In this case, scam artists pick victims from those using sites such as eBay or Craigslist. They contact those bidding by e-mail asking to work with them outside the auction to make a deal. As usual, the perpetrator asks for payment up front, often in cash.
The best way to avoid e-mail scams and Internet fraud is by using common sense, experts agree. If it sounds too good to be true, it probably is. If you receive an e-mail from an unknown source, practice extreme caution. Keep in mind that the latest wave of e-mail fraud relies on targeting e-mails to specific individuals whom the crooks have picked through various means. Because of this, such an e-mail may contain information designed to peak your interest. Don't be fooled.
Phishing sample
Image courtesy of AntiPhishing.org
E-mail scams such as phishing involve sending fake e-mails.
Also, never click on a link provided in such an e-mail, as it may take you to a site where malicious software will attempt to invade your computer. If someone is offering you something for free, such as software downloads, be suspicious.
Above all, NEVER give out personal, sensitive information, such as social security, bank account or credit card numbers in response to such e-mails.
Vincent Weafer, an Internet security expert for Symantec, advises computer users to make sure they take advantage of patches offered by browser providers, which can plug holes in security systems discovered after the software's release, CNN reported.
Money Magazine asked several identity theft experts how they protect themselves. The experts said the most important steps include:
* getting free credit reports three times a year
* keeping an eye on online banking and brokerage accounts
* using cash or credit cards (not debit cards, which are associated with your bank account) when practical
* telling banks and other institutions not to share your financial info with another party.
Consumers should guard their social security number closely and ignore e-mail and other solicitations asking for sensitive information. On the next page, we'll talk about how to report e-mail scams.
How E-mail Scams Work
Almost everyone who has e-mail has been greeted with a message that offers an amazing financial opportunity. From pleas from African government officials to notices that you've won a lottery (that you don't remember entering), the e-mail messages appear too good to be true. And they are.
E-mail scams and Internet fraud are two of the most common complaints of computer users today. Often well disguised and including just enough true information to be enticing, e-mail fraud can be potentially dangerous to the recipient's finances and credit rating. These thieves may seek to steal your money directly, using bank account or credit card numbers you provide. Or they may seek to steal your identity, running up charges in your name. Money Magazine reports that more than 93 million personal data records have been lost or stolen since February 2005.
online shopping
© Photographer: Tyler Olson | Agency: Dreamstime
Shopping online requires careful monitoring to avoid potential e-mail scams.
No one is safe. The FBI issued a warning in July 2007 about an increasing number of e-mail scams where the perpetrators impersonated the FBI to intimidate victims into giving up personal data. A similar e-mail scam was sent to taxpayers seemingly from the Internal Revenue Service, telling the taxpayers that they had an unclaimed refund.
E-mail scammers also act quickly. In November 2007, CNN reported that scammers were e-mailing people and asking them to donate to victims of the California wildfires.Such scams also appeared after 2005's Hurricane Katrina.
A recent report from Symantec, a supplier of Internet security software, said Web pirates are moving away from viruses and other damaging software and instead are focusing on financial gain through fraud. Government and private citizens in the United States provide more than half of the Internet activity that might lead to identity theft, the report stated.
E-mail scams and Internet fraud are widespread and costly. The FBI estimates computer-related crimes, including virus attacks, identity theft and other fraud, has cost $400 billion in the United States. The Internet Crime Complaint Center, a joint venture between the FBI and the National White Collar Crime Center, logged its 1 millionth complaint in the summer of 2007.
In this article we'll discuss e-mail scams and Internet fraud -- how to recognize it and how to protect yourself
E-mail scams and Internet fraud are two of the most common complaints of computer users today. Often well disguised and including just enough true information to be enticing, e-mail fraud can be potentially dangerous to the recipient's finances and credit rating. These thieves may seek to steal your money directly, using bank account or credit card numbers you provide. Or they may seek to steal your identity, running up charges in your name. Money Magazine reports that more than 93 million personal data records have been lost or stolen since February 2005.
online shopping
© Photographer: Tyler Olson | Agency: Dreamstime
Shopping online requires careful monitoring to avoid potential e-mail scams.
No one is safe. The FBI issued a warning in July 2007 about an increasing number of e-mail scams where the perpetrators impersonated the FBI to intimidate victims into giving up personal data. A similar e-mail scam was sent to taxpayers seemingly from the Internal Revenue Service, telling the taxpayers that they had an unclaimed refund.
E-mail scammers also act quickly. In November 2007, CNN reported that scammers were e-mailing people and asking them to donate to victims of the California wildfires.Such scams also appeared after 2005's Hurricane Katrina.
A recent report from Symantec, a supplier of Internet security software, said Web pirates are moving away from viruses and other damaging software and instead are focusing on financial gain through fraud. Government and private citizens in the United States provide more than half of the Internet activity that might lead to identity theft, the report stated.
E-mail scams and Internet fraud are widespread and costly. The FBI estimates computer-related crimes, including virus attacks, identity theft and other fraud, has cost $400 billion in the United States. The Internet Crime Complaint Center, a joint venture between the FBI and the National White Collar Crime Center, logged its 1 millionth complaint in the summer of 2007.
In this article we'll discuss e-mail scams and Internet fraud -- how to recognize it and how to protect yourself
Appetite Increase
Definition
Hunger is a normal desire for food. Hyperphagia and polyphagia refer to being focused only on eating (gluttony), or eating excessively before feeling full. These can be symptoms of various disorders.
Images:
Lower digestive anatomy
Lower digestive anatomy
Alternative Names
Hyperphagia; Increased appetite; Hunger; Excessive hunger; Polyphagia
Considerations
Both psychological and endocrine gland disorders can cause polyphagia, which is fairly common.
Polyphagia can be intermittent (come and go), or persistent, depending on the cause. It does not always result in weight gain.
Common Causes
* Anxiety
* Premenstrual syndrome
* Bulimia (most common in women between ages 18 and 30 years old)
* Diabetes mellitus (including Gestational diabetes)
* Graves' disease
* Hyperthyroidism
* Hypoglycemia
* Drugs -- such as corticosteroids, cyproheptadine, and tricyclic antidepressants
Home Care
Emotional support, and in some cases psychological counseling, are recommended.
For drugs that cause increased appetite and weight gain, ask your health care provider if you can decrease the dosage or discontinue the medication. CONSULT WITH YOUR HEALTH CARE PROVIDER BEFORE CHANGING MEDICATIONS.
Call your health care provider if
* There is an unexplained, persistent increase in appetite.
* Other unexplained symptoms accompany the problem.
What to expect at your health care provider's office
A history will be obtained (with emphasis on eating habits) and a physical examination performed. Once determined, the underlying cause will be treated.
Medical history questions may include:
* Eating habits
o Have you changed your eating habits?
o Have you begun dieting?
o Do you have concerns about your weight?
o What do you eat in a typical day?
o How much do you eat?
* Medication
o What medications are you taking?
o Are you taking any new medications, or have you changed the dose of your medications?
o Do you use any illicit drugs? If so, what?
* Time pattern
o Does the hunger occur during the sleep period?
o Does the hunger seem to occur in a pattern related to your menstrual cycle?
* Other
o What other symptoms are occurring at the same time?
o Have you noticed an increase in anxiety?
o Do you have frequent urination?
o Is there increased heart rate?
o Do you have palpitations?
o Is there an increase in thirst?
o Have you had an unintentional weight gain?
o Is there intentional or unintentional vomiting?
The physical examination will probably include a measurement of the body weight. Psychological evaluation may also be performed in some cases.
Diagnostic tests that may be performed are:
* Blood tests, including a chemistry profile
* Tests for suspected physical causes (such as thyroid function tests)
After seeing your health care provider:
You may want to add a diagnosis related to increased appetite to your personal medical record.
Hunger is a normal desire for food. Hyperphagia and polyphagia refer to being focused only on eating (gluttony), or eating excessively before feeling full. These can be symptoms of various disorders.
Images:
Lower digestive anatomy
Lower digestive anatomy
Alternative Names
Hyperphagia; Increased appetite; Hunger; Excessive hunger; Polyphagia
Considerations
Both psychological and endocrine gland disorders can cause polyphagia, which is fairly common.
Polyphagia can be intermittent (come and go), or persistent, depending on the cause. It does not always result in weight gain.
Common Causes
* Anxiety
* Premenstrual syndrome
* Bulimia (most common in women between ages 18 and 30 years old)
* Diabetes mellitus (including Gestational diabetes)
* Graves' disease
* Hyperthyroidism
* Hypoglycemia
* Drugs -- such as corticosteroids, cyproheptadine, and tricyclic antidepressants
Home Care
Emotional support, and in some cases psychological counseling, are recommended.
For drugs that cause increased appetite and weight gain, ask your health care provider if you can decrease the dosage or discontinue the medication. CONSULT WITH YOUR HEALTH CARE PROVIDER BEFORE CHANGING MEDICATIONS.
Call your health care provider if
* There is an unexplained, persistent increase in appetite.
* Other unexplained symptoms accompany the problem.
What to expect at your health care provider's office
A history will be obtained (with emphasis on eating habits) and a physical examination performed. Once determined, the underlying cause will be treated.
Medical history questions may include:
* Eating habits
o Have you changed your eating habits?
o Have you begun dieting?
o Do you have concerns about your weight?
o What do you eat in a typical day?
o How much do you eat?
* Medication
o What medications are you taking?
o Are you taking any new medications, or have you changed the dose of your medications?
o Do you use any illicit drugs? If so, what?
* Time pattern
o Does the hunger occur during the sleep period?
o Does the hunger seem to occur in a pattern related to your menstrual cycle?
* Other
o What other symptoms are occurring at the same time?
o Have you noticed an increase in anxiety?
o Do you have frequent urination?
o Is there increased heart rate?
o Do you have palpitations?
o Is there an increase in thirst?
o Have you had an unintentional weight gain?
o Is there intentional or unintentional vomiting?
The physical examination will probably include a measurement of the body weight. Psychological evaluation may also be performed in some cases.
Diagnostic tests that may be performed are:
* Blood tests, including a chemistry profile
* Tests for suspected physical causes (such as thyroid function tests)
After seeing your health care provider:
You may want to add a diagnosis related to increased appetite to your personal medical record.
Excessive Urination at Night
Definition
Waking up several times a night to urinate is called nocturia.
Images:
Female urinary tract
Female urinary tractMale urinary tract
Male urinary tract
Alternative Names
Nocturia
Considerations
Normally, urine decreases in amount and become more concentrated at night. That means, most people can sleep 6 to 8 hours without having to urinate.
But, persons with nocturia get up more than once during the night to urinate. Because of this, those who have excessive urination at night often have disrupted sleep cycles.
Common Causes
* Drinking too much fluid before bedtime -- particularly coffee, caffeinated beverages, or alcohol
* Benign prostatic hyperplasia
* Diabetes
* Chronic or recurrent urinary tract infection
* Chronic renal failure
* Congestive heart failure
* Cystitis (acute urinary tract infection)
* Drugs such as diuretics, cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D
* Obstructive sleep apnea
Home Care
Keep a diary of how much fluid you drink, how often you urinate, and urine output. Record your body weight at the same times and on the same scale daily.
Call your health care provider if
* Excessive nighttime urination continues over several days, and is not explained by medications or increase of fluids before bedtime.
* You are bothered by the number of times you must urinate during the night.
What to expect at your health care provider's office
Your health care provider will perform a physical examination and ask questions about your nighttime urination, such as:
* When did it start?
* How many times does this occur each night?
* Has there been a change in the volume of urine produced?
* Do you ever have "accidents" or bed wetting?
* How much urine is voided each time?
* What makes the problem worse? Better?
* How much fluid do you drink before bedtime? Have you tried restricting fluids before bedtime?
* What other symptoms are also present? Do you have increased thirst, pain or burning on urination, fever, abdominal pain, or back pain?
* What medications are being taken?
* How much caffeine do you consume each day?
* Have you had any bladder infections in the past?
* Is there a family history of diabetes?
* Does nighttime urination interfere with adequate sleep and rest?
* Do you drink alcoholic beverages and, if so, how much each day?
* Have you changed your diet recently?
Electrolytes and fluids will be monitored over a period of time.
Diagnostic tests that may be performed include:
* Blood urea nitrogen
* Serum creatinine or creatinine clearance
* Fluid deprivation
* Osmolality
* Serum electrolytes
* Urinalysis
* Urine concentration
* Urine culture
Treatment depends on the cause. If excessive nighttime urination is due to diuretic medications, you may be told to take your medication earlier in the day.
Waking up several times a night to urinate is called nocturia.
Images:
Female urinary tract
Female urinary tractMale urinary tract
Male urinary tract
Alternative Names
Nocturia
Considerations
Normally, urine decreases in amount and become more concentrated at night. That means, most people can sleep 6 to 8 hours without having to urinate.
But, persons with nocturia get up more than once during the night to urinate. Because of this, those who have excessive urination at night often have disrupted sleep cycles.
Common Causes
* Drinking too much fluid before bedtime -- particularly coffee, caffeinated beverages, or alcohol
* Benign prostatic hyperplasia
* Diabetes
* Chronic or recurrent urinary tract infection
* Chronic renal failure
* Congestive heart failure
* Cystitis (acute urinary tract infection)
* Drugs such as diuretics, cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D
* Obstructive sleep apnea
Home Care
Keep a diary of how much fluid you drink, how often you urinate, and urine output. Record your body weight at the same times and on the same scale daily.
Call your health care provider if
* Excessive nighttime urination continues over several days, and is not explained by medications or increase of fluids before bedtime.
* You are bothered by the number of times you must urinate during the night.
What to expect at your health care provider's office
Your health care provider will perform a physical examination and ask questions about your nighttime urination, such as:
* When did it start?
* How many times does this occur each night?
* Has there been a change in the volume of urine produced?
* Do you ever have "accidents" or bed wetting?
* How much urine is voided each time?
* What makes the problem worse? Better?
* How much fluid do you drink before bedtime? Have you tried restricting fluids before bedtime?
* What other symptoms are also present? Do you have increased thirst, pain or burning on urination, fever, abdominal pain, or back pain?
* What medications are being taken?
* How much caffeine do you consume each day?
* Have you had any bladder infections in the past?
* Is there a family history of diabetes?
* Does nighttime urination interfere with adequate sleep and rest?
* Do you drink alcoholic beverages and, if so, how much each day?
* Have you changed your diet recently?
Electrolytes and fluids will be monitored over a period of time.
Diagnostic tests that may be performed include:
* Blood urea nitrogen
* Serum creatinine or creatinine clearance
* Fluid deprivation
* Osmolality
* Serum electrolytes
* Urinalysis
* Urine concentration
* Urine culture
Treatment depends on the cause. If excessive nighttime urination is due to diuretic medications, you may be told to take your medication earlier in the day.
Frequent Or Urgent Urination
Definition
Frequent urination means needing to urinate more often than usual. Urgent urination is a sudden, compelling urge to urinate, along with discomfort in your bladder.
A frequent need to urinate at night is called nocturia. Most people can sleep for 6 to 8 hours without having to urinate. Middle aged and older men often wake to urinate once in the early morning hours.
Images:
Female urinary tract
Female urinary tractMale urinary tract
Male urinary tract
Alternative Names
Urgent urination; Urinary frequency or urgency
Common Causes
Together, frequent and urgent urination are classic signs of a urinary tract infection. Since inflammation reduces the bladder's capacity to hold urine, even small amounts of urine cause discomfort.
Diabetes, pregnancy, and prostate problems are other common causes of these symptoms.
Other causes include:
* Interstitial cystitis (an ongoing inflammation of the bladder that is much more common in women than men; often difficult to diagnose and treat)
* Diuretics and many other medications
And, less commonly:
* Radiation therapy
* Bladder dysfunction
* Bladder cancer
Common causes of nighttime urination:
* Drinking too much before bedtime, especially caffeine or alcohol
* Enlarged prostate
Home Care
Follow the therapy recommended by your doctor to treat the underlying cause of your urinary frequency or urgency. It may help to keep a diary of times and amounts of urine voided to bring with you to the doctor.
In some cases, you may experience some urinary incontinence for a period of time. You may need to take steps to protect your clothing and bedding.
Call your health care provider if
Call your doctor right away if:
* You have fever, back or side pain, vomiting, or shaking chills.
* You have increased thirst or appetite, fatigue, or sudden weight loss.
Also call your doctor if:
* You have urinary frequency or urgency, but you are not pregnant and you are not drinking excessive amounts of fluid.
* You have incontinence or have altered your lifestyle because of your symptoms.
* You have bloody or cloudy urine.
* There is a discharge from the penis or vagina.
What to expect at your health care provider's office
Your health care provider will take a medical history and perform a physical examination. Medical history questions may include:
* When did the increased urinary frequency start?
* How many times each day are you urinating?
* Is there more frequent urination during the day or at night?
* Do you have an increased amount of urine?
* Has there been a change in the color of your urine? Does it appear lighter, darker, or more cloudy than usual? Have you noticed any blood?
* Do you have pain when urinating, or a burning sensation?
* Do you have other symptoms? Increased thirst? Pain in your abdomen? Pain in your back? Fever?
* Do you have difficulty starting the flow of urine?
* Are you drinking more fluids than usual?
* Have you had a recent bladder infection?
* Are you pregnant?
* What medications are you taking?
* Have you had any previous urinary problems?
* Have you recently changed your diet?
* Do you drink beverages containing alcohol or caffeine?
Diagnostic tests that may be performed include:
* Urinalysis
* Urine culture and sensitivity tests
* Cystometry (a measurement of the pressure within the bladder)
* Cystoscopy
* Neurological tests (for some urgency problems)
* Ultrasonography (such as an abdominal ultrasound or a pelvic ultrasound)
Treatment is determined by the cause of the urgency and frequency. Antibiotics and medicine may be prescribed to lessen the discomfort, if needed.
Prevention
For nighttime urination, avoid excessive fluid before going to bed, particularly coffee, other caffeinated beverages, and alcohol.
Frequent urination means needing to urinate more often than usual. Urgent urination is a sudden, compelling urge to urinate, along with discomfort in your bladder.
A frequent need to urinate at night is called nocturia. Most people can sleep for 6 to 8 hours without having to urinate. Middle aged and older men often wake to urinate once in the early morning hours.
Images:
Female urinary tract
Female urinary tractMale urinary tract
Male urinary tract
Alternative Names
Urgent urination; Urinary frequency or urgency
Common Causes
Together, frequent and urgent urination are classic signs of a urinary tract infection. Since inflammation reduces the bladder's capacity to hold urine, even small amounts of urine cause discomfort.
Diabetes, pregnancy, and prostate problems are other common causes of these symptoms.
Other causes include:
* Interstitial cystitis (an ongoing inflammation of the bladder that is much more common in women than men; often difficult to diagnose and treat)
* Diuretics and many other medications
And, less commonly:
* Radiation therapy
* Bladder dysfunction
* Bladder cancer
Common causes of nighttime urination:
* Drinking too much before bedtime, especially caffeine or alcohol
* Enlarged prostate
Home Care
Follow the therapy recommended by your doctor to treat the underlying cause of your urinary frequency or urgency. It may help to keep a diary of times and amounts of urine voided to bring with you to the doctor.
In some cases, you may experience some urinary incontinence for a period of time. You may need to take steps to protect your clothing and bedding.
Call your health care provider if
Call your doctor right away if:
* You have fever, back or side pain, vomiting, or shaking chills.
* You have increased thirst or appetite, fatigue, or sudden weight loss.
Also call your doctor if:
* You have urinary frequency or urgency, but you are not pregnant and you are not drinking excessive amounts of fluid.
* You have incontinence or have altered your lifestyle because of your symptoms.
* You have bloody or cloudy urine.
* There is a discharge from the penis or vagina.
What to expect at your health care provider's office
Your health care provider will take a medical history and perform a physical examination. Medical history questions may include:
* When did the increased urinary frequency start?
* How many times each day are you urinating?
* Is there more frequent urination during the day or at night?
* Do you have an increased amount of urine?
* Has there been a change in the color of your urine? Does it appear lighter, darker, or more cloudy than usual? Have you noticed any blood?
* Do you have pain when urinating, or a burning sensation?
* Do you have other symptoms? Increased thirst? Pain in your abdomen? Pain in your back? Fever?
* Do you have difficulty starting the flow of urine?
* Are you drinking more fluids than usual?
* Have you had a recent bladder infection?
* Are you pregnant?
* What medications are you taking?
* Have you had any previous urinary problems?
* Have you recently changed your diet?
* Do you drink beverages containing alcohol or caffeine?
Diagnostic tests that may be performed include:
* Urinalysis
* Urine culture and sensitivity tests
* Cystometry (a measurement of the pressure within the bladder)
* Cystoscopy
* Neurological tests (for some urgency problems)
* Ultrasonography (such as an abdominal ultrasound or a pelvic ultrasound)
Treatment is determined by the cause of the urgency and frequency. Antibiotics and medicine may be prescribed to lessen the discomfort, if needed.
Prevention
For nighttime urination, avoid excessive fluid before going to bed, particularly coffee, other caffeinated beverages, and alcohol.
Excessive Thirst
Definition
Excessive thirst is an abnormal feeling of always needing to drink fluids.
Images:
Insulin production and diabetes
Insulin production and diabetes
Alternative Names
Increased thirst; Polydipsia; Excessive thirst
Considerations
Drinking lots of water is usually healthy. However, the urge to drink too much beyond a certain limit may be the result of an underlying disease, either physical or emotional. Excessive thirst may be a symptom of high blood sugar (hyperglycemia), and can be an important clue in detecting diabetes.
Excessive thirst is a fairly common symptom. It is often the reaction to fluid loss during exercise, or to eating salty foods.
Common Causes
* A recent salty or spicy meal
* Bleeding enough to cause a significant decrease in blood volume
* Diabetes
* Diabetes insipidus
* Drugs such as anticholinergics, demeclocycline, diuretics, phenothiazines
* Excessive loss of water and salt (possibly due to not drinking enough water, profuse sweating, diarrhea, or vomiting)
* Loss of body fluids from the bloodstream into the tissues due to:
o Conditions such as severe infections (sepsis) or burns
o Heart, liver, or kidney failure
* Psychogenic polydipsia, the result of a mental disorder, is a condition causes a person to drink too much
Home Care
Because thirst is usually the body's signal to replace water loss, it is usually appropriate to drink plenty of liquids.
A very strong, constant urge to drink may be a sign of a psychological problem, which may mean psychological help is needed.
For thirst caused by diabetes, follow the prescribed treatment to properly control blood sugar levels.
Call your health care provider if
* Excessive thirst is persistent and unexplained
* Thirst is accompanied by other unexplained symptoms, such as blurry vision and fatigue
* You are passing more than 5 quarts of urine per day
What to expect at your health care provider's office
The health care provider will get your medical history and perform a physical examination.
Medical history questions may include the following:
* How long have you been aware of having increased thirst?
* Is it consistent during the day?
* Is it worse during the day?
* Did it develop suddenly or slowly?
* Are you eating more salty or spicy foods?
* How much salt do you have each day?
* Did you change your diet?
* Have you noticed an increased appetite?
* Have you noticed an unintentional weight gain?
* Have you noticed an unintentional weight loss?
* Has your activity level recently increased?
* What other symptoms are happening at the same time?
* Have you recently suffered a burn or other injury?
* Are you urinating more or less frequently than usual?
* Are you producing more or less urine than usual?
* Have you noticed any bleeding?
* Are you sweating more than usual?
* Is there any swelling in your body?
* Do you have a fever?
A psychological evaluation may be recommended if compulsive thirst of psychological origin is suspected. Fluid intake and output will be closely watched.
Diagnostic tests that may be performed include the following:
* Urinalysis
* CBC and blood differential
* Serum calcium
* Blood glucose level
* Urine osmolality
* Serum osmolality
* Serum sodium
Excessive thirst is an abnormal feeling of always needing to drink fluids.
Images:
Insulin production and diabetes
Insulin production and diabetes
Alternative Names
Increased thirst; Polydipsia; Excessive thirst
Considerations
Drinking lots of water is usually healthy. However, the urge to drink too much beyond a certain limit may be the result of an underlying disease, either physical or emotional. Excessive thirst may be a symptom of high blood sugar (hyperglycemia), and can be an important clue in detecting diabetes.
Excessive thirst is a fairly common symptom. It is often the reaction to fluid loss during exercise, or to eating salty foods.
Common Causes
* A recent salty or spicy meal
* Bleeding enough to cause a significant decrease in blood volume
* Diabetes
* Diabetes insipidus
* Drugs such as anticholinergics, demeclocycline, diuretics, phenothiazines
* Excessive loss of water and salt (possibly due to not drinking enough water, profuse sweating, diarrhea, or vomiting)
* Loss of body fluids from the bloodstream into the tissues due to:
o Conditions such as severe infections (sepsis) or burns
o Heart, liver, or kidney failure
* Psychogenic polydipsia, the result of a mental disorder, is a condition causes a person to drink too much
Home Care
Because thirst is usually the body's signal to replace water loss, it is usually appropriate to drink plenty of liquids.
A very strong, constant urge to drink may be a sign of a psychological problem, which may mean psychological help is needed.
For thirst caused by diabetes, follow the prescribed treatment to properly control blood sugar levels.
Call your health care provider if
* Excessive thirst is persistent and unexplained
* Thirst is accompanied by other unexplained symptoms, such as blurry vision and fatigue
* You are passing more than 5 quarts of urine per day
What to expect at your health care provider's office
The health care provider will get your medical history and perform a physical examination.
Medical history questions may include the following:
* How long have you been aware of having increased thirst?
* Is it consistent during the day?
* Is it worse during the day?
* Did it develop suddenly or slowly?
* Are you eating more salty or spicy foods?
* How much salt do you have each day?
* Did you change your diet?
* Have you noticed an increased appetite?
* Have you noticed an unintentional weight gain?
* Have you noticed an unintentional weight loss?
* Has your activity level recently increased?
* What other symptoms are happening at the same time?
* Have you recently suffered a burn or other injury?
* Are you urinating more or less frequently than usual?
* Are you producing more or less urine than usual?
* Have you noticed any bleeding?
* Are you sweating more than usual?
* Is there any swelling in your body?
* Do you have a fever?
A psychological evaluation may be recommended if compulsive thirst of psychological origin is suspected. Fluid intake and output will be closely watched.
Diagnostic tests that may be performed include the following:
* Urinalysis
* CBC and blood differential
* Serum calcium
* Blood glucose level
* Urine osmolality
* Serum osmolality
* Serum sodium
Type 2 Diabetes
Definition
Type 2 diabetes is a life-long disease marked by high levels of sugar in the blood. It occurs when the body does not respond correctly to insulin, a hormone released by the pancreas. Type 2 diabetes is the most common form of diabetes.
See also:
* Diabetes
* Type 1 diabetes
* Gestational diabetes
Images:
Diabetes and exercise
Diabetes and exerciseDiabetic emergency supplies
Diabetic emergency suppliesLow blood sugar symptoms
Low blood sugar symptoms15/15 rule
15/15 ruleStarchy foods
Starchy foodsGlucose in blood
Glucose in bloodAlpha-glucosidase inhibitors
Alpha-glucosidase inhibitorsBiguanides
BiguanidesSulfonylureas drug
Sulfonylureas drugThiazolidinediones
ThiazolidinedionesFood and insulin release
Food and insulin releaseMonitor blood glucose - series
Monitor blood glucose - series
Alternative Names
Noninsulin-dependent diabetes; Diabetes - type 2
Causes, incidence, and risk factors
Diabetes is caused by a problem in the way your body makes or uses insulin. Insulin is needed to move glucose (blood sugar) into cells, where it is used for energy.
If glucose does not get into the cells, the body cannot use it for energy. Too much glucose will then remain in the blood, causing the symptoms of diabetes.
There are several types of diabetes. This article focuses on type 2, which is usually accompanied by obesity and insulin resistance.
Insulin resistance means that insulin produced by your pancreas cannot get inside fat and muscle cells to produce energy. Since the cells are not getting the insulin they need, the pancreas produces more and more. Over time, abnormally high levels of sugar build up in the blood. This is called hyperglycemia. Many people with insulin resistance have hyperglycemia and high blood insulin levels at the same time. People who are overweight have a higher risk of insulin resistance, because fat interferes with the body's ability to use insulin.
Type 2 diabetes usually occurs gradually. Most people with the disease are overweight at the time of diagnosis. However, type 2 diabetes can also develop in those who are thin, especially the elderly.
Family history and genetics play a large role in type 2 diabetes. Low activity level, poor diet, and excess body weight (especially around the waist) significantly increase your risk for type 2 diabetes.
Other risk factors include:
* Race/ethnicity (African-Americans, Hispanic-Americans, and Native Americans all have high rates of diabetes)
* Age greater than 45 years
* Previously identified impaired glucose tolerance by your doctor
* High blood pressure
* HDL cholesterol of less than 35 mg/dL or triglyceride level of greater than 250 mg/dL
* History of gestational diabetes
Symptoms
Often, people with type 2 diabetes have no symptoms at all. If you do have symptoms, they may include:
* Increased thirst
* Increased urination
* Increased appetite
* Fatigue
* Blurred vision
* Frequent or slow-healing infections
* Erectile dysfunction
Signs and tests
Type 2 diabetes is diagnosed with the following blood tests:
* Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on 2 occasions.
* Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic symptoms of increased thirst, urination, and fatigue (this test must be confirmed with a fasting blood glucose test).
* Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours.
Treatment
The first goals are to eliminate the symptoms and stabilize your blood glucose levels. The ongoing goals are to prevent long-term complications and prolong your life. The primary treatment for type 2 diabetes is exercise and diet.
LEARN THESE SKILLS
You should learn basic diabetes management skills. They will help prevent complications and the need for medical care. These skills include:
* How to test and record your blood glucose (see blood glucose monitoring)
* What to eat and when
* How to take medications, if indicated
* How to recognize and treat low and high blood sugar
* How to handle sick days
* Where to buy diabetes supplies and how to store them
It may take several months to learn the basic skills. Always continue to educate yourself about the disease and its complications, as well as how to control and live with diabetes. Over time, stay current on new research and treatment.
SELF-TESTING
Regular self-testing of your blood sugar tells you how well your combination of diet, exercise, and medication are working. Tests are usually done before meals and at bedtime. More frequent testing may be needed when you are sick or under stress.
A device called a glucometer can provide an exact blood sugar reading. There are different types of devices. Usually, you prick your finger with a small needle called a lancet, which gives you a tiny drop of blood. You place the blood on a test strip, and put the strip into the device. Results are available within 30 to 45 seconds.
A health care provider or diabetes educator will help set up an appropriate testing schedule for you. You will also be taught how to respond to different ranges of glucose values obtained when you self-test.
The results of the test can be used to adjust meals, activity, or medications to keep blood sugar levels in an appropriate range. Testing provides valuable information for the health care provider and identifies high and low blood sugar levels before serious problems develop.
Accurate record keeping of test results will help you and your health care provide plan how to best control your diabetes.
DIET AND WEIGHT CONTROL
Meal planning includes choosing healthy foods, eating the right amount of food, and eating meals at the right time. You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. Your specific meal plans need to be tailored to your food habits and preferences.
Managing your weight and eating a well-balanced diet are important. Some people with type 2 diabetes can stop medications after intentional weight loss, although the diabetes is still present. A registered dietitian can be helpful in determining your specific, individual dietary needs. (See diabetes diet.)
REGULAR PHYSICAL ACTIVITY
Regular exercise is important for everyone, but especially if you have diabetes. Regular exercise helps control the amount of glucose in the blood. It also helps burn excess calories and fat so you can manage your weight.
Exercise improves overall health by improving blood flow and blood pressure. It decreases insulin resistance even without weight loss. Exercise also increases the body's energy level, lowers tension, and improves your ability to handle stress.
The following should be considered when starting an exercise routine:
* Check with your health care provider before starting an exercise program.
* Choose an enjoyable physical activity that is appropriate for the current fitness level.
* Exercise every day, and at the same time of day, if possible.
* Monitor blood glucose levels at home before and after exercise.
* Carry food that contains a fast-acting carbohydrate in case blood glucose levels get too low during or after exercise.
* Wear a diabetes identification bracelet and carry change or a cell phone for a phone call in case of emergency.
* Drink extra fluids that do not contain sugar before, during, and after exercise.
* Changes in exercise intensity or duration may require modification of your diet or medication to keep blood glucose levels in an appropriate range.
MEDICATION
When diet and exercise do not help maintain normal or near-normal blood glucose levels, your doctor may prescribe medication. Some of the most common types are listed below. They are taken by mouth.
* Oral sulfonylureas (like glimepiride, glyburide, and tolazamide) trigger the pancreas to make more insulin.
* Biguanides (Metformin) tell the liver to decrease its production of glucose, which increases glucose levels in the blood stream.
* Alpha-glucosidase inhibitors (such as acarbose) decrease the absorption of carbohydrates from the digestive tract, thereby lowering the after-meal glucose levels.
* Thiazolidinediones (such as rosiglitazone) help insulin work better at the cell site. In essence, they increase the cell's sensitivity (responsiveness) to insulin.
* Meglitinides (including repaglinide and nateglinide) trigger the pancreas to make more insulin in response to how much glucose is in the blood.
If you continue to have poor blood glucose control despite lifestyle changes and taking medicines by mouth, your doctor will prescribe insulin. Insulin may also be prescribed if you have had a bad reaction to other medicines. Insulin must be injected under the skin using a syringe and cannot be taken by mouth.
Insulin preparations differ in how fast they start to work and how long they work. Your healthcare provider will determine the appropriate type of insulin to use and will tell you what time of day to use it.
More than one type may be mixed together in an injection to achieve the best control of blood glucose. Usually injections are needed one to four times a day. Your doctor or diabetes educator will show you how to give yourself an injection.
FOOT CARE
People with diabetes are prone to foot problems. Diabetes can cause damage to nerves, which means you may not feel an injury to the foot until a large sore or infection develops. Diabetes can also damage blood vessels, which makes it harder for the body to fight infection.
To prevent injury to the feet, a person with diabetes should adopt a daily routine of checking and caring for the feet as follows:
* Check your feet every day, and report sores or changes and signs of infection.
* Wash feet every day with lukewarm water and mild soap, and dry them thoroughly.
* Soften dry skin with lotion or petroleum jelly.
* Protect feet with comfortable, well-fitting shoes.
* Exercise daily to promote good circulation.
* See a podiatrist for foot problems, or to have corns or calluses removed.
* Remove shoes and socks during a visit to the health care provider to remind them to examine your feet.
* Stop smoking because it worsens blood flow to the feet.
CONTINUING CARE
A person with type 2 diabetes should have a visit with a diabetes care provider every 3 months. A complete examination includes:
* Glycosylated hemoglobin (HbA1c) is a 3-month average of your blood glucose level. This test measures how much glucose has been sticking to red blood cells and other cells. A high HbA1c is an indicator of risk for long-term complications. Currently, the ADA recommends an HbA1c of less than 7% to protect oneself from complications.
* Blood pressure check
* Foot and skin examination
* Ophthalmoscopy examination
* Neurological examination
The following evaluations should be done at least once a year:
* Random microalbumin (urine test for protein)
* BUN and serum creatinine
* Serum cholesterol, HDL, and triglycerides
* ECG
* Dilated retinal exam
Support Groups
For additional information, see diabetes resources.
Expectations (prognosis)
The risk of long-term complications from diabetes can be reduced. If you control your blood glucose and blood pressure, you can reduce your risk of death, stroke, heart failure, and other complications. Reduction of HbA1c by even 1% can decrease your risk for complications by 25%.
Complications
Emergency complications include diabetic coma.
Long-term complications include:
* Diabetic retinopathy (eye disease)
* Diabetic nephropathy (kidney disease)
* Diabetic neuropathy (nerve damage)
* Peripheral vascular disease (damage to blood vessels/circulation)
* High cholesterol, high blood pressure, atherosclerosis, and coronary artery disease
Calling your health care provider
Call your health care provider immediately if you have:
* Trembling
* Weakness
* Drowsiness
* Headache
* Confusion
* Dizziness
* Double vision
* Lack of coordination
These symptoms can rapidly progress to emergency conditions (such as convulsions, unconsciousness, or hypoglycemic coma).
Prevention
Everyone over 45 should have blood glucose checked at least every 3 years. Regular testing of random blood glucose should begin at a younger age and be performed more often if you are at particular risk for diabetes.
Maintain a healthy body weight and keep an active lifestyle to help prevent the onset of type 2 diabetes.
References
Rao G. Insulin resistance syndrome. Am Fam Physician. 2001 Mar 15;63(6):1159-63, 1165-6.
Watson S, Miller K. Encyclopedia of the Human Body: The Endocrine System. Westport, CT: Greenwood Publishing, 2004.
Larson PR, Kronenberg HM, Melmed S, et al. Williams Textbook of Endocrinology. 10th ed. St. Louis, MO: WB Saunders; 2003.
Type 2 diabetes is a life-long disease marked by high levels of sugar in the blood. It occurs when the body does not respond correctly to insulin, a hormone released by the pancreas. Type 2 diabetes is the most common form of diabetes.
See also:
* Diabetes
* Type 1 diabetes
* Gestational diabetes
Images:
Diabetes and exercise
Diabetes and exerciseDiabetic emergency supplies
Diabetic emergency suppliesLow blood sugar symptoms
Low blood sugar symptoms15/15 rule
15/15 ruleStarchy foods
Starchy foodsGlucose in blood
Glucose in bloodAlpha-glucosidase inhibitors
Alpha-glucosidase inhibitorsBiguanides
BiguanidesSulfonylureas drug
Sulfonylureas drugThiazolidinediones
ThiazolidinedionesFood and insulin release
Food and insulin releaseMonitor blood glucose - series
Monitor blood glucose - series
Alternative Names
Noninsulin-dependent diabetes; Diabetes - type 2
Causes, incidence, and risk factors
Diabetes is caused by a problem in the way your body makes or uses insulin. Insulin is needed to move glucose (blood sugar) into cells, where it is used for energy.
If glucose does not get into the cells, the body cannot use it for energy. Too much glucose will then remain in the blood, causing the symptoms of diabetes.
There are several types of diabetes. This article focuses on type 2, which is usually accompanied by obesity and insulin resistance.
Insulin resistance means that insulin produced by your pancreas cannot get inside fat and muscle cells to produce energy. Since the cells are not getting the insulin they need, the pancreas produces more and more. Over time, abnormally high levels of sugar build up in the blood. This is called hyperglycemia. Many people with insulin resistance have hyperglycemia and high blood insulin levels at the same time. People who are overweight have a higher risk of insulin resistance, because fat interferes with the body's ability to use insulin.
Type 2 diabetes usually occurs gradually. Most people with the disease are overweight at the time of diagnosis. However, type 2 diabetes can also develop in those who are thin, especially the elderly.
Family history and genetics play a large role in type 2 diabetes. Low activity level, poor diet, and excess body weight (especially around the waist) significantly increase your risk for type 2 diabetes.
Other risk factors include:
* Race/ethnicity (African-Americans, Hispanic-Americans, and Native Americans all have high rates of diabetes)
* Age greater than 45 years
* Previously identified impaired glucose tolerance by your doctor
* High blood pressure
* HDL cholesterol of less than 35 mg/dL or triglyceride level of greater than 250 mg/dL
* History of gestational diabetes
Symptoms
Often, people with type 2 diabetes have no symptoms at all. If you do have symptoms, they may include:
* Increased thirst
* Increased urination
* Increased appetite
* Fatigue
* Blurred vision
* Frequent or slow-healing infections
* Erectile dysfunction
Signs and tests
Type 2 diabetes is diagnosed with the following blood tests:
* Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on 2 occasions.
* Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic symptoms of increased thirst, urination, and fatigue (this test must be confirmed with a fasting blood glucose test).
* Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours.
Treatment
The first goals are to eliminate the symptoms and stabilize your blood glucose levels. The ongoing goals are to prevent long-term complications and prolong your life. The primary treatment for type 2 diabetes is exercise and diet.
LEARN THESE SKILLS
You should learn basic diabetes management skills. They will help prevent complications and the need for medical care. These skills include:
* How to test and record your blood glucose (see blood glucose monitoring)
* What to eat and when
* How to take medications, if indicated
* How to recognize and treat low and high blood sugar
* How to handle sick days
* Where to buy diabetes supplies and how to store them
It may take several months to learn the basic skills. Always continue to educate yourself about the disease and its complications, as well as how to control and live with diabetes. Over time, stay current on new research and treatment.
SELF-TESTING
Regular self-testing of your blood sugar tells you how well your combination of diet, exercise, and medication are working. Tests are usually done before meals and at bedtime. More frequent testing may be needed when you are sick or under stress.
A device called a glucometer can provide an exact blood sugar reading. There are different types of devices. Usually, you prick your finger with a small needle called a lancet, which gives you a tiny drop of blood. You place the blood on a test strip, and put the strip into the device. Results are available within 30 to 45 seconds.
A health care provider or diabetes educator will help set up an appropriate testing schedule for you. You will also be taught how to respond to different ranges of glucose values obtained when you self-test.
The results of the test can be used to adjust meals, activity, or medications to keep blood sugar levels in an appropriate range. Testing provides valuable information for the health care provider and identifies high and low blood sugar levels before serious problems develop.
Accurate record keeping of test results will help you and your health care provide plan how to best control your diabetes.
DIET AND WEIGHT CONTROL
Meal planning includes choosing healthy foods, eating the right amount of food, and eating meals at the right time. You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. Your specific meal plans need to be tailored to your food habits and preferences.
Managing your weight and eating a well-balanced diet are important. Some people with type 2 diabetes can stop medications after intentional weight loss, although the diabetes is still present. A registered dietitian can be helpful in determining your specific, individual dietary needs. (See diabetes diet.)
REGULAR PHYSICAL ACTIVITY
Regular exercise is important for everyone, but especially if you have diabetes. Regular exercise helps control the amount of glucose in the blood. It also helps burn excess calories and fat so you can manage your weight.
Exercise improves overall health by improving blood flow and blood pressure. It decreases insulin resistance even without weight loss. Exercise also increases the body's energy level, lowers tension, and improves your ability to handle stress.
The following should be considered when starting an exercise routine:
* Check with your health care provider before starting an exercise program.
* Choose an enjoyable physical activity that is appropriate for the current fitness level.
* Exercise every day, and at the same time of day, if possible.
* Monitor blood glucose levels at home before and after exercise.
* Carry food that contains a fast-acting carbohydrate in case blood glucose levels get too low during or after exercise.
* Wear a diabetes identification bracelet and carry change or a cell phone for a phone call in case of emergency.
* Drink extra fluids that do not contain sugar before, during, and after exercise.
* Changes in exercise intensity or duration may require modification of your diet or medication to keep blood glucose levels in an appropriate range.
MEDICATION
When diet and exercise do not help maintain normal or near-normal blood glucose levels, your doctor may prescribe medication. Some of the most common types are listed below. They are taken by mouth.
* Oral sulfonylureas (like glimepiride, glyburide, and tolazamide) trigger the pancreas to make more insulin.
* Biguanides (Metformin) tell the liver to decrease its production of glucose, which increases glucose levels in the blood stream.
* Alpha-glucosidase inhibitors (such as acarbose) decrease the absorption of carbohydrates from the digestive tract, thereby lowering the after-meal glucose levels.
* Thiazolidinediones (such as rosiglitazone) help insulin work better at the cell site. In essence, they increase the cell's sensitivity (responsiveness) to insulin.
* Meglitinides (including repaglinide and nateglinide) trigger the pancreas to make more insulin in response to how much glucose is in the blood.
If you continue to have poor blood glucose control despite lifestyle changes and taking medicines by mouth, your doctor will prescribe insulin. Insulin may also be prescribed if you have had a bad reaction to other medicines. Insulin must be injected under the skin using a syringe and cannot be taken by mouth.
Insulin preparations differ in how fast they start to work and how long they work. Your healthcare provider will determine the appropriate type of insulin to use and will tell you what time of day to use it.
More than one type may be mixed together in an injection to achieve the best control of blood glucose. Usually injections are needed one to four times a day. Your doctor or diabetes educator will show you how to give yourself an injection.
FOOT CARE
People with diabetes are prone to foot problems. Diabetes can cause damage to nerves, which means you may not feel an injury to the foot until a large sore or infection develops. Diabetes can also damage blood vessels, which makes it harder for the body to fight infection.
To prevent injury to the feet, a person with diabetes should adopt a daily routine of checking and caring for the feet as follows:
* Check your feet every day, and report sores or changes and signs of infection.
* Wash feet every day with lukewarm water and mild soap, and dry them thoroughly.
* Soften dry skin with lotion or petroleum jelly.
* Protect feet with comfortable, well-fitting shoes.
* Exercise daily to promote good circulation.
* See a podiatrist for foot problems, or to have corns or calluses removed.
* Remove shoes and socks during a visit to the health care provider to remind them to examine your feet.
* Stop smoking because it worsens blood flow to the feet.
CONTINUING CARE
A person with type 2 diabetes should have a visit with a diabetes care provider every 3 months. A complete examination includes:
* Glycosylated hemoglobin (HbA1c) is a 3-month average of your blood glucose level. This test measures how much glucose has been sticking to red blood cells and other cells. A high HbA1c is an indicator of risk for long-term complications. Currently, the ADA recommends an HbA1c of less than 7% to protect oneself from complications.
* Blood pressure check
* Foot and skin examination
* Ophthalmoscopy examination
* Neurological examination
The following evaluations should be done at least once a year:
* Random microalbumin (urine test for protein)
* BUN and serum creatinine
* Serum cholesterol, HDL, and triglycerides
* ECG
* Dilated retinal exam
Support Groups
For additional information, see diabetes resources.
Expectations (prognosis)
The risk of long-term complications from diabetes can be reduced. If you control your blood glucose and blood pressure, you can reduce your risk of death, stroke, heart failure, and other complications. Reduction of HbA1c by even 1% can decrease your risk for complications by 25%.
Complications
Emergency complications include diabetic coma.
Long-term complications include:
* Diabetic retinopathy (eye disease)
* Diabetic nephropathy (kidney disease)
* Diabetic neuropathy (nerve damage)
* Peripheral vascular disease (damage to blood vessels/circulation)
* High cholesterol, high blood pressure, atherosclerosis, and coronary artery disease
Calling your health care provider
Call your health care provider immediately if you have:
* Trembling
* Weakness
* Drowsiness
* Headache
* Confusion
* Dizziness
* Double vision
* Lack of coordination
These symptoms can rapidly progress to emergency conditions (such as convulsions, unconsciousness, or hypoglycemic coma).
Prevention
Everyone over 45 should have blood glucose checked at least every 3 years. Regular testing of random blood glucose should begin at a younger age and be performed more often if you are at particular risk for diabetes.
Maintain a healthy body weight and keep an active lifestyle to help prevent the onset of type 2 diabetes.
References
Rao G. Insulin resistance syndrome. Am Fam Physician. 2001 Mar 15;63(6):1159-63, 1165-6.
Watson S, Miller K. Encyclopedia of the Human Body: The Endocrine System. Westport, CT: Greenwood Publishing, 2004.
Larson PR, Kronenberg HM, Melmed S, et al. Williams Textbook of Endocrinology. 10th ed. St. Louis, MO: WB Saunders; 2003.
Type 1 Diabetes
Definition
Type 1 diabetes is a chronic (lifelong) disease that occurs when the pancreas does not produce enough insulin to properly control blood sugar levels.
See also:
* Diabetes
* Gestational diabetes
* Type 2 diabetes
Images:
Endocrine glands
Endocrine glandsInsulin pump
Insulin pumpGlucose test
Glucose testInsulin pump
Insulin pumpType I diabetes
Type I diabetesMonitor blood glucose - series
Monitor blood glucose - series
Alternative Names
Insulin-dependent diabetes; Juvenile onset diabetes; Diabetes - type 1
Causes, incidence, and risk factors
Diabetes is a lifelong disease for which there is not yet a cure. There are several forms of diabetes. Type 1 diabetes is often called juvenile or insulin-dependent diabetes. In this type of diabetes, cells of the pancreas produce little or no insulin, the hormone that allows glucose to enter body cells.
Without enough insulin, glucose builds up in the bloodstream instead of going into the cells. The body is unable to use this glucose for energy despite high levels in the bloodstream. This leads to increased hunger.
In addition, the high levels of glucose in the blood cause the patient to urinate more, which in turn causes excessive thirst. Within 5 to 10 years, the insulin-producing beta cells of the pancreas are completely destroyed and the body can not longer produce insulin.
Type 1 diabetes can occur at any age, but it usually starts in people younger than 30. Symptoms are usually severe and occur rapidly.
The exact cause is unknown.
Symptoms
* Increased thirst
* Increased urination
* Weight loss despite increased appetite
* Nausea
* Vomiting
* Abdominal pain
* Fatigue
* Absence of menstruation
Signs and tests
The following tests can be used to diagnose diabetes:
* Urinalysis shows glucose and ketone bodies in the urine, but a blood test is required for diagnosis
* Fasting blood glucose is 126 mg/dL or higher
* Random (nonfasting) blood glucose exceeds 200 mg/dL (this must be confirmed with a fasting test)
* Insulin test (low or undetectable level of insulin)
* C-peptide test (low or undetectable level of the protein C-peptide, a by-product of insulin production)
Treatment
At diagnosis, the immediate goals of treatment are to treat diabetic ketoacidosis (also called DKA) and high blood glucose levels. Because of the sudden onset and severity of symptoms in type 1 diabetes, treatment for newly diagnosed people may involve hospitalization.
The long-term goals of treatment are to prolong life, reduce symptoms, and prevent diabetes-related complications such as blindness, kidney failure, and amputation of limbs.
These goals are accomplished through education, insulin use, meal planning and weight control, exercise, foot care, and careful self-testing of blood glucose levels.
INSULIN
Insulin lowers blood sugar by allowing it to leave the blood stream and enter cells. Everyone needs insulin. People with type 1 diabetes can't make their own insulin, and they must take insulin every day.
Insulin is injected under the skin or inhaled. In some cases, a pump delivers the insulin continuously. Insulin does not come in pill form.
Insulin preparations differ in how fast they start to work and how long they last. The health care professional reviews blood glucose levels to determine the appropriate type of insulin the person should use. More than one type of insulin may be mixed together in an injection to achieve the best control of blood glucose.
The injections are needed, in general, from 1 to 4 times a day. People are taught how to give insulin injections by their health care provider or a diabetes nurse educator. Initially, a child's injections may be given by a parent or other adult. By age 14, most children can be expected (but should not be required) to give their own injections.
DIET
Meal planning for type 1 diabetes requires consistency to allow food and insulin to work together to regulate blood glucose levels. If meals and insulin are out of balance, extreme variations in blood glucose can occur.
The American Diabetes Association and the American Dietetic Association has information for planning healthy, balanced meals. A consultation with a registered dietitian or nutrition counselor can be helpful.
PHYSICAL ACTIVITY
Regular exercise helps control the amount of sugar in the blood and helps burn excess calories and fat to achieve optimal weight.
Ask your health care provider before starting any exercise program. Those with Type 1 diabetes must take special precautions before, during, and after intense physical activity or exercise.
SELF-TESTING
Blood glucose monitoring is done by checking the glucose content of a small drop of blood. The testing is done on a regular basis and will inform the person with diabetes how well diet, medication, and exercise are working together to control diabetes.
The results can be used to adjust meals, activity, or medications to keep blood sugar levels within an appropriate range. It will provide valuable information for the health care provider to suggest changes to improve care and treatment. Testing will identify high and low blood sugar levels before serious problems develop.
FOOT CARE
Diabetes causes damage to the blood vessels and nerves, which can result in a decreased ability to feel injury to or pressure on the foot. A foot injury could go unnoticed until severe infection develops.
Additionally, diabetes affects the body's immune system, decreasing the body's ability to fight infection. Small infections can rapidly progress to death of the skin and other tissues. Amputation may be needed.
See: Daily foot care routine
TREATING LOW BLOOD SUGAR
Low blood sugar, known as hypoglycemia, can occur from too much insulin, too much exercise, or too little food. Hypoglycemia can develop quickly in people with diabetes. Symptoms typically appear when the blood sugar level falls below 70. Watch for weakness, shaking, sweating, headache, nervousness, and hunger.
If these symptoms occur and you have a blood sugar test kit available, do a blood sugar check. If the level is low, the person with diabetes should eat something with sugar: fruit juice, several teaspoons of sugar, a cup of skim milk, or regular soda. If you don't have a test kit handy, sugar should be eaten anyway - it can't hurt. Symptoms should go away within 15 minutes. If the symptoms don't go away, more sugar should be eaten and the sugar level tested again.
AFTER the symptoms go away, more substantial food can be eaten. Eat simple sugar first to get the situation under control. Even if you or your child is hungry, "real" food should not be eaten until the sugar level comes up - real food won't produce enough sugar and takes too long to digest.
If you are a parent, relative, or friend of someone experiencing these symptoms, monitor the person closely. If symptoms become worse -- confusion, seizures, or unconsciousness -- give the person a shot of glucagon. If you don't have glucagon, call 911 immediately.
You should have some glucagon stored for emergencies. Make sure everyone in your home, as well as babysitters and caregivers, knows how to use it. Periodically remind everyone how to use it, and check the expiration date.
Don't panic. Glucagon works very fast -- usually within 15 minutes. Lay the person on the side to prevent choking. If the person is not better in 15 minutes, call 911.
TREATING HIGH KETONES
When there is not enough insulin to move glucose into cells, glucose can build up in the blood. The body then looks for other forms of energy and uses fat as a fuel source. As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis.
You can check for ketones using a simple urine test available at pharmacies. This test should be done every 4-6 hours anytime a person with diabetes has a blood sugar above 240 or if they are sick, unusually thirsty, has a dry mouth, frequent urination, or vomiting.
The warning signs that ketoacidosis is getting serious might include flushed face, dry skin and mouth, nausea or vomiting, stomach pain, deep, rapid breathing, or fruity breath odor.
If these symptoms occur, call the doctor or go to the emergency room right away. If left untreated, this condition will lead to coma and even death.
MONITORING
Visit your health care provider or diabetes educator at least four times a year. Have your glycosylated hemoglobin (HbA1c) regularly checked. Cholesterol and triglyceride levels should be checked yearly, along with kidney function.
Visit your ophthalmologist (preferably one that specializes in diabetic retinopathy) at least once a year, or more frequently if signs of diabetic retinopathy develop.
See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.
Check your feet every day for early signs of injury or infection. Make sure your health care provider inspects your feet at each visit.
Stay up-to-date with all of your vaccinations and get a flu shot every year in the fall.
EDUCATION
You are the most important person in managing your diabetes. Diabetes education involves learning how to live with your diabetes and helps prevent complications. You should know the basic steps to diabetes management:
* How to recognize and treat low blood sugar (hypoglycemia)
* How to recognize and treat high blood sugar (hyperglycemia)
* Diabetes meal planning
* How to give insulin
* How to monitor blood glucose and urine ketones
* How to adjust insulin and food intake during exercise
* How to handle sick days
* Where to buy diabetes supplies and how to store them
Expectations (prognosis)
The outcome for people with diabetes varies. Studies show that tight control of blood glucose can prevent or delay complications to the eyes, kidneys, and nervous system. However, complications may occur even in those with good diabetes control.
Complications
Emergency complications include:
* Ketoacidosis
* Hypoglycemia
Long-term complications include:
* Vascular disease, including blocked arteries and heart attacks -- risk can be reduced by treating high cholesterol and blood pressure, exercising regularly, and avoiding or quitting tobacco products
* Eye problems, including diabetic retinopathy , retinal detachment, glaucoma, and cataracts
* Kidney disease (diabetic nephropathy)
* Nerve damage (diabetic neuropathy)
* Foot problems, including skin changes, arterial insufficiency, neuropathy, and specific foot deformities (hallux valgus, bunion, hammertoe, and calluses)
* Infections of the skin, female genital tract, and urinary tract
Calling your health care provider
If you are newly diagnosed with type 1 diabetes, you should probably have medical follow-up weekly until you have good control of blood glucose. Your health care provider will review results of home glucose monitoring and urine testing, and a diary of meals, snacks, and insulin injections.
As the disease becomes more stable, follow-up visits will be less frequent. Periodic visits to your health care provider is very important for monitoring potential long-term complications associated with diabetes.
Call your health care provider or go to the emergency room if you have symptoms ketoacidosis:
* Increased thirst and urination
* Nausea
* Deep and rapid breathing
* Abdominal pain
* Sweet-smelling breath
* Loss of consciousness (This may occur in insulin dependent diabetics who miss a dose of insulin, or if they are sick or have an infection.)
Go to the emergency room or call 911 if you have symptoms of severe hypoglycemia or insulin reaction:
* Trembling
* Weakness
* Drowsiness
* Headache
* Confusion
* Dizziness
* Double vision
* Lack of coordination
* Convulsions or unconsciousness
You can treat early signs of hypoglycemia at home by eating sugar or candy or taking glucose tablets. If your signs of hypoglycemia are still not relieved or if your blood glucose levels remain below 60 mg/dL, go to the emergency room.
References
Standards of medical care in diabetes--2007. Diabetes Care. Jan 2007;30 Suppl 1:S4-S41.
Larsen PR, Kronberg HM, Schlomo M, et al. Williams Textbook of Endocrinology. 10th ed. St. Louis, Mo: WB Saunders; 2003:1427-1468, 1485-1504.
Armstrong C. ADA Releases Standards of Medical Care for Patients with Diabetes. Am Fam Physician. Sept 2006; 74(5); 871-874.
Type 1 diabetes is a chronic (lifelong) disease that occurs when the pancreas does not produce enough insulin to properly control blood sugar levels.
See also:
* Diabetes
* Gestational diabetes
* Type 2 diabetes
Images:
Endocrine glands
Endocrine glandsInsulin pump
Insulin pumpGlucose test
Glucose testInsulin pump
Insulin pumpType I diabetes
Type I diabetesMonitor blood glucose - series
Monitor blood glucose - series
Alternative Names
Insulin-dependent diabetes; Juvenile onset diabetes; Diabetes - type 1
Causes, incidence, and risk factors
Diabetes is a lifelong disease for which there is not yet a cure. There are several forms of diabetes. Type 1 diabetes is often called juvenile or insulin-dependent diabetes. In this type of diabetes, cells of the pancreas produce little or no insulin, the hormone that allows glucose to enter body cells.
Without enough insulin, glucose builds up in the bloodstream instead of going into the cells. The body is unable to use this glucose for energy despite high levels in the bloodstream. This leads to increased hunger.
In addition, the high levels of glucose in the blood cause the patient to urinate more, which in turn causes excessive thirst. Within 5 to 10 years, the insulin-producing beta cells of the pancreas are completely destroyed and the body can not longer produce insulin.
Type 1 diabetes can occur at any age, but it usually starts in people younger than 30. Symptoms are usually severe and occur rapidly.
The exact cause is unknown.
Symptoms
* Increased thirst
* Increased urination
* Weight loss despite increased appetite
* Nausea
* Vomiting
* Abdominal pain
* Fatigue
* Absence of menstruation
Signs and tests
The following tests can be used to diagnose diabetes:
* Urinalysis shows glucose and ketone bodies in the urine, but a blood test is required for diagnosis
* Fasting blood glucose is 126 mg/dL or higher
* Random (nonfasting) blood glucose exceeds 200 mg/dL (this must be confirmed with a fasting test)
* Insulin test (low or undetectable level of insulin)
* C-peptide test (low or undetectable level of the protein C-peptide, a by-product of insulin production)
Treatment
At diagnosis, the immediate goals of treatment are to treat diabetic ketoacidosis (also called DKA) and high blood glucose levels. Because of the sudden onset and severity of symptoms in type 1 diabetes, treatment for newly diagnosed people may involve hospitalization.
The long-term goals of treatment are to prolong life, reduce symptoms, and prevent diabetes-related complications such as blindness, kidney failure, and amputation of limbs.
These goals are accomplished through education, insulin use, meal planning and weight control, exercise, foot care, and careful self-testing of blood glucose levels.
INSULIN
Insulin lowers blood sugar by allowing it to leave the blood stream and enter cells. Everyone needs insulin. People with type 1 diabetes can't make their own insulin, and they must take insulin every day.
Insulin is injected under the skin or inhaled. In some cases, a pump delivers the insulin continuously. Insulin does not come in pill form.
Insulin preparations differ in how fast they start to work and how long they last. The health care professional reviews blood glucose levels to determine the appropriate type of insulin the person should use. More than one type of insulin may be mixed together in an injection to achieve the best control of blood glucose.
The injections are needed, in general, from 1 to 4 times a day. People are taught how to give insulin injections by their health care provider or a diabetes nurse educator. Initially, a child's injections may be given by a parent or other adult. By age 14, most children can be expected (but should not be required) to give their own injections.
DIET
Meal planning for type 1 diabetes requires consistency to allow food and insulin to work together to regulate blood glucose levels. If meals and insulin are out of balance, extreme variations in blood glucose can occur.
The American Diabetes Association and the American Dietetic Association has information for planning healthy, balanced meals. A consultation with a registered dietitian or nutrition counselor can be helpful.
PHYSICAL ACTIVITY
Regular exercise helps control the amount of sugar in the blood and helps burn excess calories and fat to achieve optimal weight.
Ask your health care provider before starting any exercise program. Those with Type 1 diabetes must take special precautions before, during, and after intense physical activity or exercise.
SELF-TESTING
Blood glucose monitoring is done by checking the glucose content of a small drop of blood. The testing is done on a regular basis and will inform the person with diabetes how well diet, medication, and exercise are working together to control diabetes.
The results can be used to adjust meals, activity, or medications to keep blood sugar levels within an appropriate range. It will provide valuable information for the health care provider to suggest changes to improve care and treatment. Testing will identify high and low blood sugar levels before serious problems develop.
FOOT CARE
Diabetes causes damage to the blood vessels and nerves, which can result in a decreased ability to feel injury to or pressure on the foot. A foot injury could go unnoticed until severe infection develops.
Additionally, diabetes affects the body's immune system, decreasing the body's ability to fight infection. Small infections can rapidly progress to death of the skin and other tissues. Amputation may be needed.
See: Daily foot care routine
TREATING LOW BLOOD SUGAR
Low blood sugar, known as hypoglycemia, can occur from too much insulin, too much exercise, or too little food. Hypoglycemia can develop quickly in people with diabetes. Symptoms typically appear when the blood sugar level falls below 70. Watch for weakness, shaking, sweating, headache, nervousness, and hunger.
If these symptoms occur and you have a blood sugar test kit available, do a blood sugar check. If the level is low, the person with diabetes should eat something with sugar: fruit juice, several teaspoons of sugar, a cup of skim milk, or regular soda. If you don't have a test kit handy, sugar should be eaten anyway - it can't hurt. Symptoms should go away within 15 minutes. If the symptoms don't go away, more sugar should be eaten and the sugar level tested again.
AFTER the symptoms go away, more substantial food can be eaten. Eat simple sugar first to get the situation under control. Even if you or your child is hungry, "real" food should not be eaten until the sugar level comes up - real food won't produce enough sugar and takes too long to digest.
If you are a parent, relative, or friend of someone experiencing these symptoms, monitor the person closely. If symptoms become worse -- confusion, seizures, or unconsciousness -- give the person a shot of glucagon. If you don't have glucagon, call 911 immediately.
You should have some glucagon stored for emergencies. Make sure everyone in your home, as well as babysitters and caregivers, knows how to use it. Periodically remind everyone how to use it, and check the expiration date.
Don't panic. Glucagon works very fast -- usually within 15 minutes. Lay the person on the side to prevent choking. If the person is not better in 15 minutes, call 911.
TREATING HIGH KETONES
When there is not enough insulin to move glucose into cells, glucose can build up in the blood. The body then looks for other forms of energy and uses fat as a fuel source. As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis.
You can check for ketones using a simple urine test available at pharmacies. This test should be done every 4-6 hours anytime a person with diabetes has a blood sugar above 240 or if they are sick, unusually thirsty, has a dry mouth, frequent urination, or vomiting.
The warning signs that ketoacidosis is getting serious might include flushed face, dry skin and mouth, nausea or vomiting, stomach pain, deep, rapid breathing, or fruity breath odor.
If these symptoms occur, call the doctor or go to the emergency room right away. If left untreated, this condition will lead to coma and even death.
MONITORING
Visit your health care provider or diabetes educator at least four times a year. Have your glycosylated hemoglobin (HbA1c) regularly checked. Cholesterol and triglyceride levels should be checked yearly, along with kidney function.
Visit your ophthalmologist (preferably one that specializes in diabetic retinopathy) at least once a year, or more frequently if signs of diabetic retinopathy develop.
See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.
Check your feet every day for early signs of injury or infection. Make sure your health care provider inspects your feet at each visit.
Stay up-to-date with all of your vaccinations and get a flu shot every year in the fall.
EDUCATION
You are the most important person in managing your diabetes. Diabetes education involves learning how to live with your diabetes and helps prevent complications. You should know the basic steps to diabetes management:
* How to recognize and treat low blood sugar (hypoglycemia)
* How to recognize and treat high blood sugar (hyperglycemia)
* Diabetes meal planning
* How to give insulin
* How to monitor blood glucose and urine ketones
* How to adjust insulin and food intake during exercise
* How to handle sick days
* Where to buy diabetes supplies and how to store them
Expectations (prognosis)
The outcome for people with diabetes varies. Studies show that tight control of blood glucose can prevent or delay complications to the eyes, kidneys, and nervous system. However, complications may occur even in those with good diabetes control.
Complications
Emergency complications include:
* Ketoacidosis
* Hypoglycemia
Long-term complications include:
* Vascular disease, including blocked arteries and heart attacks -- risk can be reduced by treating high cholesterol and blood pressure, exercising regularly, and avoiding or quitting tobacco products
* Eye problems, including diabetic retinopathy , retinal detachment, glaucoma, and cataracts
* Kidney disease (diabetic nephropathy)
* Nerve damage (diabetic neuropathy)
* Foot problems, including skin changes, arterial insufficiency, neuropathy, and specific foot deformities (hallux valgus, bunion, hammertoe, and calluses)
* Infections of the skin, female genital tract, and urinary tract
Calling your health care provider
If you are newly diagnosed with type 1 diabetes, you should probably have medical follow-up weekly until you have good control of blood glucose. Your health care provider will review results of home glucose monitoring and urine testing, and a diary of meals, snacks, and insulin injections.
As the disease becomes more stable, follow-up visits will be less frequent. Periodic visits to your health care provider is very important for monitoring potential long-term complications associated with diabetes.
Call your health care provider or go to the emergency room if you have symptoms ketoacidosis:
* Increased thirst and urination
* Nausea
* Deep and rapid breathing
* Abdominal pain
* Sweet-smelling breath
* Loss of consciousness (This may occur in insulin dependent diabetics who miss a dose of insulin, or if they are sick or have an infection.)
Go to the emergency room or call 911 if you have symptoms of severe hypoglycemia or insulin reaction:
* Trembling
* Weakness
* Drowsiness
* Headache
* Confusion
* Dizziness
* Double vision
* Lack of coordination
* Convulsions or unconsciousness
You can treat early signs of hypoglycemia at home by eating sugar or candy or taking glucose tablets. If your signs of hypoglycemia are still not relieved or if your blood glucose levels remain below 60 mg/dL, go to the emergency room.
References
Standards of medical care in diabetes--2007. Diabetes Care. Jan 2007;30 Suppl 1:S4-S41.
Larsen PR, Kronberg HM, Schlomo M, et al. Williams Textbook of Endocrinology. 10th ed. St. Louis, Mo: WB Saunders; 2003:1427-1468, 1485-1504.
Armstrong C. ADA Releases Standards of Medical Care for Patients with Diabetes. Am Fam Physician. Sept 2006; 74(5); 871-874.
Diabetes
Definition
Diabetes is a life-long disease marked by high levels of sugar in the blood.
Images:
Endocrine glands
Endocrine glandsDiabetic retinopathy
Diabetic retinopathyIslets of Langerhans
Islets of LangerhansBlood test
Blood testPancreas
PancreasInsulin pump
Insulin pumpGlucose test
Glucose testInsulin pump
Insulin pumpType I diabetes
Type I diabetesDiabetic blood circulation in foot
Diabetic blood circulation in footFood and insulin release
Food and insulin releaseInsulin production and diabetes
Insulin production and diabetesMonitor blood glucose - series
Monitor blood glucose - series
Causes, incidence, and risk factors
Diabetes can be caused by too little insulin (a hormone produced by the pancreas to control blood sugar), resistance to insulin, or both.
To understand diabetes, it is important to first understand the normal process of food metabolism. Several things happen when food is digested:
* A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
* An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.
People with diabetes have high blood sugar. This is because their pancreas does not make enough insulin or their muscle, fat, and liver cells do not respond to insulin normally, or both.
There are three major types of diabetes:
* Type 1 diabetes is usually diagnosed in childhood. The body makes little or no insulin, and daily injections of insulin are needed to sustain life.
* Type 2 diabetes is far more common than type 1 and makes up most of all cases of diabetes. It usually occurs in adulthood. The pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to the insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to the growing number of older Americans, increasing obesity, and failure to exercise.
* Gestational diabetes is high blood glucose that develops at any time during pregnancy in a woman who does not have diabetes.
Diabetes affects more than 20 million Americans. About 54 million Americans have prediabetes. There are many risk factors for diabetes, including:
* A parent, brother, or sister with diabetes
* Obesity
* Age greater than 45 years
* Some ethnic groups (particularly African Americans, Native Americans, Asians, Pacific Islanders, and Hispanic Americans)
* Gestational diabetes or delivering a baby weighing more than 9 pounds
* High blood pressure
* High blood levels of triglycerides (a type of fat molecule)
* High blood cholesterol level
* Not getting enough exercise
The American Diabetes Association recommends that all adults over age 45 be screened for diabetes at least every 3 years. A person at high risk should be screened more often.
Symptoms
High blood levels of glucose can cause several problems, including frequent urination, excessive thirst, hunger, fatigue, weight loss, and blurry vision. However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.
Symptoms of type 1 diabetes:
* Increased thirst
* Increased urination
* Weight loss in spite of increased appetite
* Fatigue
* Nausea
* Vomiting
Patients with type 1 diabetes usually develop symptoms over a short period of time, and the condition is often diagnosed in an emergency setting.
Symptoms of type 2 diabetes:
* Increased thirst
* Increased urination
* Increased appetite
* Fatigue
* Blurred vision
* Slow-healing infections
* Impotence in men
Signs and tests
A urine analysis may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose diabetes. The following blood glucose tests are used to diagnose diabetes:
* Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on two occasions. Levels between 100 and 126 mg/dl are referred to as impaired fasting glucose or pre-diabetes. These levels are considered to be risk factors for type 2 diabetes and its complications.
* Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)
* Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours (This test is used more for type 2 diabetes.)
You should also ask your doctor how often to you need your hemoglobin A1c (HbA1c) level checked. The HbA1c is a measure of average blood glucose during the previous 2 to 3 months. It is a very helpful way to determine how well treatment is working.
Ketone testing is another test that is used in type 1 diabetes. Ketones are produced by the breakdown of fat and muscle, and they are harmful at high levels. The ketone test is done using a urine sample. High levels of blood ketones may result in a serious condition called ketoacidosis. Ketone testing is usually done at the following times:
* When the blood sugar is higher than 240 mg/dL
* During acute illness (for example, pneumonia, heart attack, or stroke)
* When nausea or vomiting occur
* During pregnancy
Treatment
There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms and complications.
LEARN THESE SKILLS
Basic diabetes management skills will help prevent the need for emergency care. These skills include:
* How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)
* What to eat and when
* How to take insulin or oral medication
* How to test and record blood glucose
* How to test urine for ketones (type 1 diabetes only)
* How to adjust insulin or food intake when changing exercise and eating habits
* How to handle sick days
* Where to buy diabetes supplies and how to store them
After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems. People with diabetes need to review and update their knowledge, because new research and improved ways to treat diabetes are constantly being developed.
SELF-TESTING
If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a number of devices available, and they use only a drop of blood. Self-monitoring tells you how well diet, medication, and exercise are working together to control your diabetes and can help your doctor prevent complications.
The American Diabetes Association recommends that premeal blood sugar levels fall in the range of 80 to 120 mg/dL and bedtime blood levels fall in the range of 100 to 140 mg/dL. Your doctor may adjust this depending on your circumstances.
WHAT TO EAT
You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. A registered dietician can be very helpful in planning dietary needs.
People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugars from becoming extremely high or low.
Persons with type 2 diabetes should follow a well-balanced and low-fat diet.
HOW TO TAKE MEDICATION
Medications to treat diabetes include insulin and glucose-lowering pills called oral hypoglycemic drugs.
Persons with type 1 diabetes cannot make their own insulin, so daily insulin injections are needed. Insulin does not come in pill form. Injections that are generally needed one to four times per day. Some people use an insulin pump, which is worn at all times and delivers a steady flow of insulin throughout the day. Other people may use a new type of inhaled insulin.
Insulin preparations differ in how quickly they start to work and how long they remain active. Sometimes different types of insulin are mixed together in a single injection. The types of insulin to use, the doses needed, and the number of daily injections are chosen by a health care professional trained to provide diabetes care.
People who need insulin are taught to give themselves injections by their health care providers or diabetes educators.
Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth. There are several types of medicines used to lower blood glucose in type 2 diabetes. They fall into one of three groups:
1. Medications that increase insulin production by the pancreas. They include glimepiride, glipizide, glyburide, repaglinide, nateglinide, and sitaglyptin.
2. Medications that increase sensitivity to insulin. These include metformin, rosiglitazone, and pioglitazone.
3. Medications that delay absorption of glucose from the gut. These include acarbose and miglitol.
There are some injectable medicines used to lower blood sugar. They include exenatide and pramlintide.
Most persons with type 2 diabetes will need more than one medication for good blood sugar control within 3 years of starting their first medication. Different groups of medications may be combined or used with insulin.
Some people with type 2 diabetes find they no longer need medication if they lose weight and increase activity, because when their ideal weight is reached, their own insulin and a careful diet can control their blood glucose levels.
It is unknown if hypoglycemic medicines taken by mouth are safe for use in pregnancy. Women who have type 2 diabetes and take these medications may be switched to insulin during pregnancy and while breastfeeding.
Gestational diabetes is treated with insulin and changes in diet.
EXERCISE
Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than diabetics who do not exercise regularly. You should be evaluated by your physician before starting an exercise program.
Here are some exercise considerations:
* Choose an enjoyable physical activity that is appropriate for your current fitness level.
* Exercise every day, and at the same time of day, if possible.
* Monitor blood glucose levels before and after exercise.
* Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise.
* Carry a diabetes identification card and a mobile phone or change for a payphone in case of emergency.
* Drink extra fluids that do not contain sugar before, during, and after exercise.
Changes in exercise intensity or duration may need changes in diet or medication dose to keep blood sugar levels from going too high or low.
FOOT CARE
People with diabetes are prone to foot problems because of the likelihood of damage to blood vessels and nerves and a decreased ability to fight infection. Problems with blood flow and damage to nerves may cause an injury to the foot to go unnoticed until infection develops. Death of skin and other tissue can occur.
If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations.
To prevent injury to the feet, people with diabetes should adopt a daily routine of checking and caring for the feet as follows:
* Check your feet every day, and report sores or changes and signs of infection.
* Wash your feet every day with lukewarm water and mild soap, and dry them thoroughly.
* Soften dry skin with lotion or petroleum jelly.
* Protect feet with comfortable, well-fitting shoes.
* Exercise daily to promote good circulation.
* See a podiatrist for foot problems or to have corns or calluses removed.
* Remove shoes and socks during a visit to your health care provider and remind him or her to examine your feet.
* Stop smoking, which hinders blood flow to the feet.
Support Groups
For additional information, see diabetes resources.
Expectations (prognosis)
With good blood glucose and blood pressure control, many of the complications of diabetes can be prevented.
Studies have shown that strict control of blood sugar and blood pressure levels in persons with diabetes helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.
Complications
Emergency complications include diabetic hyperglycemic hyperosmolar coma.
Long-term complications include:
* Diabetic retinopathy
* Diabetic nephropathy
* Diabetic neuropathy
* Peripheral vascular disease
* Hyperlipidemia, hypertension, atherosclerosis, and coronary artery disease
Calling your health care provider
Go to the emergency room or call the local emergency number (such as 911) if symptoms of ketoacidosis occur:
* Increased thirst and urination
* Nausea
* Deep and rapid breathing
* Abdominal pain
* Sweet-smelling breath
* Loss of consciousness
Go to the emergency room or call the local emergency number if symptoms of extremely low blood sugar (hypoglycemic coma or severe insulin reaction) occur:
* Weakness
* Drowsiness
* Headache
* Confusion
* Dizziness
* Double vision
* Lack of coordination
* Convulsions or unconsciousness
Prevention
Maintaining an ideal body weight and an active lifestyle may prevent the onset of type 2 diabetes. Currently there is no way to prevent type 1 diabetes.
References
Standards of medical care in diabetes--2007. Diabetes Care. Jan 2007;30 Suppl 1:S4-S41.
Larsen PR, Kronberg HM, Schlomo M, et al. Williams Textbook of Endocrinology. 10th ed. St. Louis, Mo: WB Saunders; 2003:1427-1468, 1485-1504.
Armstrong C. ADA Releases Standards of Medical Care for Patients with Diabetes. Am Fam Physician. Sept 2006; 74(5); 871-874.
Caballero E. Prediabetes. J Clin Endocrinol Metab. Jan 2007; 92(1); 15A-16A.
Diabetes is a life-long disease marked by high levels of sugar in the blood.
Images:
Endocrine glands
Endocrine glandsDiabetic retinopathy
Diabetic retinopathyIslets of Langerhans
Islets of LangerhansBlood test
Blood testPancreas
PancreasInsulin pump
Insulin pumpGlucose test
Glucose testInsulin pump
Insulin pumpType I diabetes
Type I diabetesDiabetic blood circulation in foot
Diabetic blood circulation in footFood and insulin release
Food and insulin releaseInsulin production and diabetes
Insulin production and diabetesMonitor blood glucose - series
Monitor blood glucose - series
Causes, incidence, and risk factors
Diabetes can be caused by too little insulin (a hormone produced by the pancreas to control blood sugar), resistance to insulin, or both.
To understand diabetes, it is important to first understand the normal process of food metabolism. Several things happen when food is digested:
* A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
* An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.
People with diabetes have high blood sugar. This is because their pancreas does not make enough insulin or their muscle, fat, and liver cells do not respond to insulin normally, or both.
There are three major types of diabetes:
* Type 1 diabetes is usually diagnosed in childhood. The body makes little or no insulin, and daily injections of insulin are needed to sustain life.
* Type 2 diabetes is far more common than type 1 and makes up most of all cases of diabetes. It usually occurs in adulthood. The pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to the insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to the growing number of older Americans, increasing obesity, and failure to exercise.
* Gestational diabetes is high blood glucose that develops at any time during pregnancy in a woman who does not have diabetes.
Diabetes affects more than 20 million Americans. About 54 million Americans have prediabetes. There are many risk factors for diabetes, including:
* A parent, brother, or sister with diabetes
* Obesity
* Age greater than 45 years
* Some ethnic groups (particularly African Americans, Native Americans, Asians, Pacific Islanders, and Hispanic Americans)
* Gestational diabetes or delivering a baby weighing more than 9 pounds
* High blood pressure
* High blood levels of triglycerides (a type of fat molecule)
* High blood cholesterol level
* Not getting enough exercise
The American Diabetes Association recommends that all adults over age 45 be screened for diabetes at least every 3 years. A person at high risk should be screened more often.
Symptoms
High blood levels of glucose can cause several problems, including frequent urination, excessive thirst, hunger, fatigue, weight loss, and blurry vision. However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.
Symptoms of type 1 diabetes:
* Increased thirst
* Increased urination
* Weight loss in spite of increased appetite
* Fatigue
* Nausea
* Vomiting
Patients with type 1 diabetes usually develop symptoms over a short period of time, and the condition is often diagnosed in an emergency setting.
Symptoms of type 2 diabetes:
* Increased thirst
* Increased urination
* Increased appetite
* Fatigue
* Blurred vision
* Slow-healing infections
* Impotence in men
Signs and tests
A urine analysis may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose diabetes. The following blood glucose tests are used to diagnose diabetes:
* Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on two occasions. Levels between 100 and 126 mg/dl are referred to as impaired fasting glucose or pre-diabetes. These levels are considered to be risk factors for type 2 diabetes and its complications.
* Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)
* Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours (This test is used more for type 2 diabetes.)
You should also ask your doctor how often to you need your hemoglobin A1c (HbA1c) level checked. The HbA1c is a measure of average blood glucose during the previous 2 to 3 months. It is a very helpful way to determine how well treatment is working.
Ketone testing is another test that is used in type 1 diabetes. Ketones are produced by the breakdown of fat and muscle, and they are harmful at high levels. The ketone test is done using a urine sample. High levels of blood ketones may result in a serious condition called ketoacidosis. Ketone testing is usually done at the following times:
* When the blood sugar is higher than 240 mg/dL
* During acute illness (for example, pneumonia, heart attack, or stroke)
* When nausea or vomiting occur
* During pregnancy
Treatment
There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms and complications.
LEARN THESE SKILLS
Basic diabetes management skills will help prevent the need for emergency care. These skills include:
* How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)
* What to eat and when
* How to take insulin or oral medication
* How to test and record blood glucose
* How to test urine for ketones (type 1 diabetes only)
* How to adjust insulin or food intake when changing exercise and eating habits
* How to handle sick days
* Where to buy diabetes supplies and how to store them
After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems. People with diabetes need to review and update their knowledge, because new research and improved ways to treat diabetes are constantly being developed.
SELF-TESTING
If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a number of devices available, and they use only a drop of blood. Self-monitoring tells you how well diet, medication, and exercise are working together to control your diabetes and can help your doctor prevent complications.
The American Diabetes Association recommends that premeal blood sugar levels fall in the range of 80 to 120 mg/dL and bedtime blood levels fall in the range of 100 to 140 mg/dL. Your doctor may adjust this depending on your circumstances.
WHAT TO EAT
You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. A registered dietician can be very helpful in planning dietary needs.
People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugars from becoming extremely high or low.
Persons with type 2 diabetes should follow a well-balanced and low-fat diet.
HOW TO TAKE MEDICATION
Medications to treat diabetes include insulin and glucose-lowering pills called oral hypoglycemic drugs.
Persons with type 1 diabetes cannot make their own insulin, so daily insulin injections are needed. Insulin does not come in pill form. Injections that are generally needed one to four times per day. Some people use an insulin pump, which is worn at all times and delivers a steady flow of insulin throughout the day. Other people may use a new type of inhaled insulin.
Insulin preparations differ in how quickly they start to work and how long they remain active. Sometimes different types of insulin are mixed together in a single injection. The types of insulin to use, the doses needed, and the number of daily injections are chosen by a health care professional trained to provide diabetes care.
People who need insulin are taught to give themselves injections by their health care providers or diabetes educators.
Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth. There are several types of medicines used to lower blood glucose in type 2 diabetes. They fall into one of three groups:
1. Medications that increase insulin production by the pancreas. They include glimepiride, glipizide, glyburide, repaglinide, nateglinide, and sitaglyptin.
2. Medications that increase sensitivity to insulin. These include metformin, rosiglitazone, and pioglitazone.
3. Medications that delay absorption of glucose from the gut. These include acarbose and miglitol.
There are some injectable medicines used to lower blood sugar. They include exenatide and pramlintide.
Most persons with type 2 diabetes will need more than one medication for good blood sugar control within 3 years of starting their first medication. Different groups of medications may be combined or used with insulin.
Some people with type 2 diabetes find they no longer need medication if they lose weight and increase activity, because when their ideal weight is reached, their own insulin and a careful diet can control their blood glucose levels.
It is unknown if hypoglycemic medicines taken by mouth are safe for use in pregnancy. Women who have type 2 diabetes and take these medications may be switched to insulin during pregnancy and while breastfeeding.
Gestational diabetes is treated with insulin and changes in diet.
EXERCISE
Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than diabetics who do not exercise regularly. You should be evaluated by your physician before starting an exercise program.
Here are some exercise considerations:
* Choose an enjoyable physical activity that is appropriate for your current fitness level.
* Exercise every day, and at the same time of day, if possible.
* Monitor blood glucose levels before and after exercise.
* Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise.
* Carry a diabetes identification card and a mobile phone or change for a payphone in case of emergency.
* Drink extra fluids that do not contain sugar before, during, and after exercise.
Changes in exercise intensity or duration may need changes in diet or medication dose to keep blood sugar levels from going too high or low.
FOOT CARE
People with diabetes are prone to foot problems because of the likelihood of damage to blood vessels and nerves and a decreased ability to fight infection. Problems with blood flow and damage to nerves may cause an injury to the foot to go unnoticed until infection develops. Death of skin and other tissue can occur.
If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations.
To prevent injury to the feet, people with diabetes should adopt a daily routine of checking and caring for the feet as follows:
* Check your feet every day, and report sores or changes and signs of infection.
* Wash your feet every day with lukewarm water and mild soap, and dry them thoroughly.
* Soften dry skin with lotion or petroleum jelly.
* Protect feet with comfortable, well-fitting shoes.
* Exercise daily to promote good circulation.
* See a podiatrist for foot problems or to have corns or calluses removed.
* Remove shoes and socks during a visit to your health care provider and remind him or her to examine your feet.
* Stop smoking, which hinders blood flow to the feet.
Support Groups
For additional information, see diabetes resources.
Expectations (prognosis)
With good blood glucose and blood pressure control, many of the complications of diabetes can be prevented.
Studies have shown that strict control of blood sugar and blood pressure levels in persons with diabetes helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.
Complications
Emergency complications include diabetic hyperglycemic hyperosmolar coma.
Long-term complications include:
* Diabetic retinopathy
* Diabetic nephropathy
* Diabetic neuropathy
* Peripheral vascular disease
* Hyperlipidemia, hypertension, atherosclerosis, and coronary artery disease
Calling your health care provider
Go to the emergency room or call the local emergency number (such as 911) if symptoms of ketoacidosis occur:
* Increased thirst and urination
* Nausea
* Deep and rapid breathing
* Abdominal pain
* Sweet-smelling breath
* Loss of consciousness
Go to the emergency room or call the local emergency number if symptoms of extremely low blood sugar (hypoglycemic coma or severe insulin reaction) occur:
* Weakness
* Drowsiness
* Headache
* Confusion
* Dizziness
* Double vision
* Lack of coordination
* Convulsions or unconsciousness
Prevention
Maintaining an ideal body weight and an active lifestyle may prevent the onset of type 2 diabetes. Currently there is no way to prevent type 1 diabetes.
References
Standards of medical care in diabetes--2007. Diabetes Care. Jan 2007;30 Suppl 1:S4-S41.
Larsen PR, Kronberg HM, Schlomo M, et al. Williams Textbook of Endocrinology. 10th ed. St. Louis, Mo: WB Saunders; 2003:1427-1468, 1485-1504.
Armstrong C. ADA Releases Standards of Medical Care for Patients with Diabetes. Am Fam Physician. Sept 2006; 74(5); 871-874.
Caballero E. Prediabetes. J Clin Endocrinol Metab. Jan 2007; 92(1); 15A-16A.
Lung Cancer - Non-small Cell
Definition
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. It usually grows and spreads more slowly than small cell lung cancer.
There are three forms of NSCLC:
* Adenocarcinomas are often found in an outer area of the lung.
* Squamous cell carcinomas are usually found in the center of the lung by an air tube (bronchus).
* Large cell carcinomas can occur in any part of the lung. They tend to grow and spread faster than the other two types.
Images:
Lungs
LungsVitamin B3 source
Vitamin B3 sourceVitamin B6 benefit
Vitamin B6 benefitVitamin C benefit
Vitamin C benefitSecondhand Smoke and Lung Cancer
Secondhand Smoke and Lung Cancer
Alternative Names
Cancer - lung - non-small cell; Non-small cell lung cancer; NSCLC
Causes, incidence, and risk factors
Smoking causes most cases of lung cancer. Being around the smoke from others (secondhand smoke) also raises your risk for lung cancer. However, people who do not smoke and have never smoked have become sick with lung cancer.
A review of decades of research has recently shown that smoking marijuana may help cancer cells grow, but there is no direct link between the drug and lung cancer.
High levels of air pollution, working with or near cancer-causing chemicals or materials (such as asbestos), and drinking water containing high levels of arsenic can increase your risk for lung cancer. Radiation therapy to the lungs can also increase the risk.
Symptoms
Early lung cancer may not cause any symptoms. Symptoms you should watch for include:
* Cough that doesn't go away
* Coughing up blood
* Shortness of breath
* Wheezing
* Chest pain
* Loss of appetite
* Losing weight without trying
* Fatigue
Other symptoms that may be due to NSCLC:
* Weakness
* Swallowing difficulty
* Nail problems
* Joint pain
* Hoarseness or changing voice
* Swelling of the face
* Facial paralysis
* Eyelid drooping
* Bone pain or tenderness
Note: These symptoms can be due to other, less serious conditions. It is important to talk to your health care provider.
Signs and tests
The health care provider will perform a physical exam and ask questions about your medical history. You will be asked if you smoke, and if so, how long you have smoked.
When listening to the chest with a stethoscope, the health care provider can sometimes hear fluid around the lungs, which could (but doesn't always) suggest cancer.
Tests that may be performed include:
* Chest x-ray
* CBC
* Sputum test
* Bone scan
* CT scan
* MRI
* Positron emission tomography (PET) scan
* Thoracentesis
In some cases, the health care provider may need to remove a piece of tissue from your lungs for examination under a microscope. This is called a biopsy. There are several ways to do this:
* Bronchoscopy combined with biopsy
* Pleural biopsy
* CT scan directed needle biopsy
* Mediastinoscopy with biopsy
* Open lung biopsy
* Endoscopic esophageal ultrasound (EUS) with biopsy
If the biopsy reveals you do have lung cancer, more imaging tests will be done to determine the stage of the cancer. Stage means how big the tumor is and how far it's spread. Non-small cell lung cancer is divided into five stages:
* Stage 0 - the cancer has not spread beyond the inner lining of the lung
* Stage I - the cancer is small and hasn't spread to the lymph nodes
* Stage II - the cancer has spread to some lymph nodes near the original tumor
* Stage III - the cancer has spread to nearby tissue or spread to far away lymph nodes
* Stage IV - the cancer has spread to other organs of the body such as the other lung, brain, or liver
Treatment
There are many different types of treatment for non-small cell lung cancer:
* Surgery - part or all of the lung is removed
* Radiation therapy - uses powerful x-rays or other radiation to kill cancer cells
* Chemotherapy - uses drugs to kill cancer cells and stop new ones from growing
* Laser therapy - a small beam of light burns and kills cancer cells
* Photodynamic therapy - uses a light to activate a drug in the body, which kills cancer cells
* Watchful waiting - in rare cases, the person may only be monitored until symptoms change
Treatment depends upon the stage of the cancer. A combination of treatments may be needed. Research has suggested that chemotherapy or a combination of chemotherapy and radiation therapy prior to surgery might be the best treatment for some patients.
Surgery is the often the first line of treatment for most patients with stage I and II non-small cell lung cancer, and some patients with stage III tumors. Surgery can cure the disease.
Chemotherapy alone is often used when the cancer has spread (stage IV). Chemotherapy has been shown to prolong the life and improve the quality of life in some stage IV patients.
Support Groups
For additional information and resources, see cancer support group.
Expectations (prognosis)
Cure rates are related to the stage of disease and whether you are able to have surgery.
* Stage I and II cancer can be cured with surgery, sometimes in more than 50% of cases.
* Stage III tumors can be cured in some cases, but cure rates are much lower than earlier stage NSCLC
* Patients with stage IV disease are almost never cured, and the goals of therapy are to extend and improve the quality of their life.
Complications
* Spread of disease beyond the lung
* Side effects of surgery, chemotherapy, or radiation therapy
Prevention
If you smoke, stop smoking. It's never too early to quit. Try to avoid secondhand smoke.
Eat a diet rich in fruits and vegetables.
Routine screening for lung cancer is not recommended. Many studies have been done to look at the idea, but scientists have concluded that, at this time, screening would not find help improve a person’s chance for a cure.
References
Mehra R, Moore BA, Crothers K, Tetrault J, Fiellin DA. The association between marijuana smoking and lung cancer: a systematic review. Arch Intern Med. 2006 Jul 10;166(13):1359-67.
American Cancer Society. Cancer Facts and Figures 2006. Atlanta, Ga: American Cancer Society; 2006.
U.S. Preventive Services Task Force. Lung cancer screening. Ann Int Med. 2004;140:738-739.
Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004:1690-1
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. It usually grows and spreads more slowly than small cell lung cancer.
There are three forms of NSCLC:
* Adenocarcinomas are often found in an outer area of the lung.
* Squamous cell carcinomas are usually found in the center of the lung by an air tube (bronchus).
* Large cell carcinomas can occur in any part of the lung. They tend to grow and spread faster than the other two types.
Images:
Lungs
LungsVitamin B3 source
Vitamin B3 sourceVitamin B6 benefit
Vitamin B6 benefitVitamin C benefit
Vitamin C benefitSecondhand Smoke and Lung Cancer
Secondhand Smoke and Lung Cancer
Alternative Names
Cancer - lung - non-small cell; Non-small cell lung cancer; NSCLC
Causes, incidence, and risk factors
Smoking causes most cases of lung cancer. Being around the smoke from others (secondhand smoke) also raises your risk for lung cancer. However, people who do not smoke and have never smoked have become sick with lung cancer.
A review of decades of research has recently shown that smoking marijuana may help cancer cells grow, but there is no direct link between the drug and lung cancer.
High levels of air pollution, working with or near cancer-causing chemicals or materials (such as asbestos), and drinking water containing high levels of arsenic can increase your risk for lung cancer. Radiation therapy to the lungs can also increase the risk.
Symptoms
Early lung cancer may not cause any symptoms. Symptoms you should watch for include:
* Cough that doesn't go away
* Coughing up blood
* Shortness of breath
* Wheezing
* Chest pain
* Loss of appetite
* Losing weight without trying
* Fatigue
Other symptoms that may be due to NSCLC:
* Weakness
* Swallowing difficulty
* Nail problems
* Joint pain
* Hoarseness or changing voice
* Swelling of the face
* Facial paralysis
* Eyelid drooping
* Bone pain or tenderness
Note: These symptoms can be due to other, less serious conditions. It is important to talk to your health care provider.
Signs and tests
The health care provider will perform a physical exam and ask questions about your medical history. You will be asked if you smoke, and if so, how long you have smoked.
When listening to the chest with a stethoscope, the health care provider can sometimes hear fluid around the lungs, which could (but doesn't always) suggest cancer.
Tests that may be performed include:
* Chest x-ray
* CBC
* Sputum test
* Bone scan
* CT scan
* MRI
* Positron emission tomography (PET) scan
* Thoracentesis
In some cases, the health care provider may need to remove a piece of tissue from your lungs for examination under a microscope. This is called a biopsy. There are several ways to do this:
* Bronchoscopy combined with biopsy
* Pleural biopsy
* CT scan directed needle biopsy
* Mediastinoscopy with biopsy
* Open lung biopsy
* Endoscopic esophageal ultrasound (EUS) with biopsy
If the biopsy reveals you do have lung cancer, more imaging tests will be done to determine the stage of the cancer. Stage means how big the tumor is and how far it's spread. Non-small cell lung cancer is divided into five stages:
* Stage 0 - the cancer has not spread beyond the inner lining of the lung
* Stage I - the cancer is small and hasn't spread to the lymph nodes
* Stage II - the cancer has spread to some lymph nodes near the original tumor
* Stage III - the cancer has spread to nearby tissue or spread to far away lymph nodes
* Stage IV - the cancer has spread to other organs of the body such as the other lung, brain, or liver
Treatment
There are many different types of treatment for non-small cell lung cancer:
* Surgery - part or all of the lung is removed
* Radiation therapy - uses powerful x-rays or other radiation to kill cancer cells
* Chemotherapy - uses drugs to kill cancer cells and stop new ones from growing
* Laser therapy - a small beam of light burns and kills cancer cells
* Photodynamic therapy - uses a light to activate a drug in the body, which kills cancer cells
* Watchful waiting - in rare cases, the person may only be monitored until symptoms change
Treatment depends upon the stage of the cancer. A combination of treatments may be needed. Research has suggested that chemotherapy or a combination of chemotherapy and radiation therapy prior to surgery might be the best treatment for some patients.
Surgery is the often the first line of treatment for most patients with stage I and II non-small cell lung cancer, and some patients with stage III tumors. Surgery can cure the disease.
Chemotherapy alone is often used when the cancer has spread (stage IV). Chemotherapy has been shown to prolong the life and improve the quality of life in some stage IV patients.
Support Groups
For additional information and resources, see cancer support group.
Expectations (prognosis)
Cure rates are related to the stage of disease and whether you are able to have surgery.
* Stage I and II cancer can be cured with surgery, sometimes in more than 50% of cases.
* Stage III tumors can be cured in some cases, but cure rates are much lower than earlier stage NSCLC
* Patients with stage IV disease are almost never cured, and the goals of therapy are to extend and improve the quality of their life.
Complications
* Spread of disease beyond the lung
* Side effects of surgery, chemotherapy, or radiation therapy
Prevention
If you smoke, stop smoking. It's never too early to quit. Try to avoid secondhand smoke.
Eat a diet rich in fruits and vegetables.
Routine screening for lung cancer is not recommended. Many studies have been done to look at the idea, but scientists have concluded that, at this time, screening would not find help improve a person’s chance for a cure.
References
Mehra R, Moore BA, Crothers K, Tetrault J, Fiellin DA. The association between marijuana smoking and lung cancer: a systematic review. Arch Intern Med. 2006 Jul 10;166(13):1359-67.
American Cancer Society. Cancer Facts and Figures 2006. Atlanta, Ga: American Cancer Society; 2006.
U.S. Preventive Services Task Force. Lung cancer screening. Ann Int Med. 2004;140:738-739.
Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004:1690-1
Breast Cancer
Definition
Breast cancer is a cancer that starts in the tissues of the breast.
There are two main types of breast cancer:
* Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type.
* Lobular carcinoma starts in parts of the breast, called lobules, that produce milk.
In rare cases, breast cancer can start in other areas of the breast.
Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast cancer tumor to grow. Such cancer is called estrogen receptor positive cancer or ER positive cancer.
Some women have what's called HER2-positive breast cancer. HER2 refers to a gene that helps cells grow, divide, and repair themselves. When cells have too many copies of this gene, cells -- including cancer cells -- grow faster. Experts think that women with HER2-positive breast cancer have a more aggressive disease and a higher risk of recurrence than those who do not have this type.
Images:
Female Breast
Female BreastNeedle biopsy of the breast
Needle biopsy of the breastOpen biopsy of the breast
Open biopsy of the breastBreast self-exam
Breast self-examBreast self-exam
Breast self-examBreast self-exam
Breast self-examMammary gland
Mammary glandSentinel node biopsy
Sentinel node biopsyMastectomy - series
Mastectomy - seriesBreast lump removal - series
Breast lump removal - series
Alternative Names
Cancer - breast; Carcinoma - ductal; Carcinoma - lobular
Causes, incidence, and risk factors
Over the course of a lifetime, one in eight women will be diagnosed with breast cancer.
Risk factors you cannot change include:
Age and gender -- Your risk of developing breast cancer increases as you get older. The majority of advanced breast cancer cases are found in women over age 50. Women are 100 times more likely to get breast cancer then men.
Family history of breast cancer -- You may also have a higher risk for breast cancer if you have a close relative has had breast, uterine, ovarian, or colon cancer. About 20-30% of women with breast cancer have a family history of the disease.
Genes -- Some people have genes that make them more prone to developing breast cancer. The most common gene defects are found in the BRCA1 and BRCA2 genes. These genes normally produce proteins that protect you from cancer. But if a parent passes you a defective gene, you have an increased risk for breast cancer. Women with one of these defects have up to an 80% chance of getting breast cancer sometime during their life.
Other genetic defects have been linked to breast cancer, including those found in the ATM gene, the CHEK-2 gene, and the p53 tumor suppressor gene, but these are very rare.
Menstrual cycle -- Women who get their periods early (before age 12) or went through menopause late (after age 55) have an increased risk for breast cancer.
Other risk factors include:
Alcohol use -- Drinking more than 1-2 glasses of alcohol a day may increase your risk for breast cancer.
Childbirth -- Women who have never had children or who had them only after age 30 have an increased risk for breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces your risk of breast cancer.
DES -- Women who took diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer after age 40. This drug was given to the women in the 1940s-1960s.
Hormone replacement therapy (HRT) -- You have a higher risk for breast cancer if you have received hormone replacement therapy for several years or more. Many women take HRT to reduce the symptoms of menopause.
Obesity -- Obesity has been linked to breast cancer, although this link is controversial. The theory is that obese women produce more estrogen, which can fuel the development of breast cancer.
Radiation -- If you received radiation therapy as a child or young adult to treat cancer of the chest area, you have a significantly higher risk for developing breast cancer. The younger you started such radiation, the higher your risk -- especially if the radiation was given when a female was developing breasts.
Breast implants, using antiperspirants, and wearing underwire bras do not raise your risk for breast cancer. There is no evidence of a direct link between breast cancer and induced abortion or pesticides.
The National Cancer Institute provides an online tool to help you figure out your risk of breast cancer. See:
Symptoms
Early breast cancer usually does not cause symptoms. This is why regular breast exams are important. As the cancer grows, symptoms may include:
* Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt
* Change in the size, shape, or feel of the breast or nipple -- for example, you may have redness, dimpling, or puckering that looks like the skin of an orange
* Fluid coming from the nipple -- may be bloody, clear-to-yellow, or green, and look like pus
Men get breast cancer, too. Symptoms include breast lump and breast pain and tenderness.
Symptoms of advanced breast cancer may include:
* Bone pain
* Breast pain or discomfort
* Skin ulcers
* Swelling of one arm (next to breast with cancer)
* Weight loss
Signs and tests
The doctor will ask you about your symptoms and risk factors, and then perform a physical exam, which includes both breasts, armpits, and the neck and chest area. Additional tests may include:
* Mammography to help identify the breast lump
* Breast MRI to help better identify the breast lump
* Breast ultrasound to show whether the lump is solid or fluid-filled
* Breast biopsy, needle aspiration, or breast lump removal to remove all or part of the breast lump for closer examination by a laboratory specialist
If your doctor learns that you do have breast cancer, additional tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future.
Breast cancer stages range from 0 to IV. In general, breast cancer that stays where it has started is called in situ or noninvasive breast cancer. If it spreads, it is called invasive breast cancer. The higher the number, the more advanced the cancer.
Treatment
Treatment is based on many factors, including type and stage of the cancer, whether the cancer is sensitive to certain hormones, and whether or not the cancer overproduces (overexpresses) a gene called HER2/neu.
In general, cancer treatments may include:
* Chemotherapy medicines to kill cancer cells
* Radiation therapy to destroy cancerous tissue
* Surgery to remove cancerous tissue - a lumpectomy removes the breast lump; mastectomy removes all or part of the breast and possible nearby structures
Other treatments:
* Hormonal therapy to block certain hormones that fuel cancer growth
* Targeted therapy to interfere with cancer cell grow and function
An example of hormonal therapy is the drug tamoxifen. This drug blocks the effects of estrogen, which can help breast cancer cells survive and grow. Most women with estrogen sensitive breast cancer benefit from this drug. A newer class of medicines called aromatase inhibitors, such as exemestane (Aromasin), have been shown to work just as well or even better than tamoxifen in post-menopausal women with breast cancer.
Targeted therapy, also called biologic therapy, is a newer type of cancer treatment. This therapy uses special anti-cancer drugs that identify certain changes in a cell that can lead to cancer. One such drug is trastuzumab (Herceptin). For women with stage IV HER2-positive breast cancer, Herceptin plus chemotherapy has been shown to be work better than chemotherapy alone. Studies have also shown that in women with early stage HER2-positive breast cancer, this medicine plus chemotherapy cuts the risk of the cancer coming back by 50%.
Cancer treatment may be local or systemic.
* Local treatments involve only the area of disease. Radiation and surgery are forms of local treatment.
* Systemic treatments affect the entire body. Chemotherapy is a type of systemic treatment.
Most women receive a combination of treatments. For women with stage I, II, or III breast cancer, the main goal is to treat the cancer and prevent it from returning. For women with stage IV cancer, the goal is to improve symptoms and help them live longer. In most cases, stage IV breast cancer cannot be cured.
Stage 0 -- Lumpectomy plus radiation or mastectomy is the standard treatment. There is some controversy on how best to treat DCIS.
Stage I and II -- Lumpectomy plus radiation or mastectomy with some sort of lymph node removal is standard treatment. Hormone therapy, chemotherapy, and biologic therapy may also be recommended following surgery.
Stage III -- Treatment involves surgery possibly followed by chemotherapy, hormone therapy, and biologic therapy.
Stage IV -- Treatment may involve surgery, radiation, chemotherapy, hormonal therapy, or a combination of such treatments.
Support Groups
Talking about your disease and treatment with others who share common experiences and problems can be helpful. See: Cancer support group
Expectations (prognosis)
How well you do after being treated for breast cancer depends on many things. The more advanced your cancer, the poorer the outcome.
The 5-year survival rate refers to the number of patients who live at least 5 years after their cancer is found. According to the American Cancer Society (ACS), the 5-year survival rates for persons with breast cancer that is appropriately treated are as follows:
* 100% for stage 0
* 100% for stage I
* 92% for stage IIA
* 81% for stage IIB
* 67% for stage IIIA
* 54% for stage IIIB
* 20% for stage IV
Complications
New, improved treatments are helping persons with breast cancer live longer than ever before. However, even with treatment, breast cancer can spread to other parts of the body. Sometimes, cancer returns even after the entire tumor is removed and nearby lymph nodes are found to be cancer-free.
You may experience side effects or complications from cancer treatment. For example, radiation therapy may cause temporary swelling of the breast, and aches and pains around the area. Ask your doctor about the side effects you may have during treatment.
Calling your health care provider
Contact your health care provider for an appointment if:
* You have a breast or armpit lump
* You are a woman age 40 or older and have not had a mammogram in the last year
* You are a woman age 35 or older and have a mother or sister with breast cancer, or have already had cancer of the breast, uterus, ovary, or colon.
* You do not know how or need help learning how to perform a breast self-examination
Prevention
Many risk factors -- such as your genes and family history -- cannot be controlled. However, a healthy diet and a few lifestyle changes may reduce your overall chance of cancer in general.
Breast cancer is more easily treated and often curable if it is found early.
Early detection involves:
* Breast self-exams (BSE)
* Clinical breast exams by a medical professional
* Screening mammography
Most experts recommend that women age 20 and older examine their breasts once a month during the week following the menstrual period.
Women between the ages 20 and 39 should have a doctor examine their breasts at least once every 3 years. After age 40, women should a clinical breast exam every year.
Mammography is the most effective way of detecting breast cancer early.
Screening recommendations:
* The American Cancer Society recommends mammogram screening every year for all women age 40 and older. The National Cancer Institute (NCI) recommends mammogram screening every 1-2 years for women age 40 and older.
* If you are high risk, experts say you should start getting a mammogram at age 30. Certain women at high risk of breast cancer should also have a breast MRI along with their yearly mammogram. Ask your doctor if you need an MRI.
* For those at high risk, including those who have or had a close family member with the disease, annual mammograms should begin 10 years earlier than the age at which the relative was diagnosed.
Questions have been raised about the benefit of screening mammography in women under age 50 and over the age of 69. Annual mammograms in women between 50 and 69 have been show to save lives. But while screening can also detect early breast cancer in younger and older women, it has not been shown to save lives.
This is a topic filled with controversy. A woman needs to have an informed and balanced discussion with her doctor, along with doing additional reading and researching on her own, to determine if mammography is right for her.
Women at very high risk for breast cancer may consider preventive (prophylactic) mastectomy, which is the surgical removal of the breasts. Possible candidates for this procedure may include those who have already had one breast removed due to cancer, women with a strong family history of breast cancer, and persons with genes or genetic mutations that raise their risk of breast cancer.
References
Saslow D, Boetes C, Burke W, et al. American cancer society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007 Mar-Apr;57(2):75-89.
Lehman CD, Gatsonis C, Kuhl CK, et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 2007 Mar 29;356(13):1295-303. Epub 2007 Mar 28.
Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med. 2005 Oct 20;353(16):1659-72.
Romond EH, Perez EA, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005 Oct 20;353(16):1673-84.
Menard S, Pupa SM, Campiglio M, Tagliabue E. Biologic and therapeutic role of HER2 in cancer. Oncogene. 2003 Sep 29;22(42):6570-8.
Breast cancer is a cancer that starts in the tissues of the breast.
There are two main types of breast cancer:
* Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type.
* Lobular carcinoma starts in parts of the breast, called lobules, that produce milk.
In rare cases, breast cancer can start in other areas of the breast.
Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast cancer tumor to grow. Such cancer is called estrogen receptor positive cancer or ER positive cancer.
Some women have what's called HER2-positive breast cancer. HER2 refers to a gene that helps cells grow, divide, and repair themselves. When cells have too many copies of this gene, cells -- including cancer cells -- grow faster. Experts think that women with HER2-positive breast cancer have a more aggressive disease and a higher risk of recurrence than those who do not have this type.
Images:
Female Breast
Female BreastNeedle biopsy of the breast
Needle biopsy of the breastOpen biopsy of the breast
Open biopsy of the breastBreast self-exam
Breast self-examBreast self-exam
Breast self-examBreast self-exam
Breast self-examMammary gland
Mammary glandSentinel node biopsy
Sentinel node biopsyMastectomy - series
Mastectomy - seriesBreast lump removal - series
Breast lump removal - series
Alternative Names
Cancer - breast; Carcinoma - ductal; Carcinoma - lobular
Causes, incidence, and risk factors
Over the course of a lifetime, one in eight women will be diagnosed with breast cancer.
Risk factors you cannot change include:
Age and gender -- Your risk of developing breast cancer increases as you get older. The majority of advanced breast cancer cases are found in women over age 50. Women are 100 times more likely to get breast cancer then men.
Family history of breast cancer -- You may also have a higher risk for breast cancer if you have a close relative has had breast, uterine, ovarian, or colon cancer. About 20-30% of women with breast cancer have a family history of the disease.
Genes -- Some people have genes that make them more prone to developing breast cancer. The most common gene defects are found in the BRCA1 and BRCA2 genes. These genes normally produce proteins that protect you from cancer. But if a parent passes you a defective gene, you have an increased risk for breast cancer. Women with one of these defects have up to an 80% chance of getting breast cancer sometime during their life.
Other genetic defects have been linked to breast cancer, including those found in the ATM gene, the CHEK-2 gene, and the p53 tumor suppressor gene, but these are very rare.
Menstrual cycle -- Women who get their periods early (before age 12) or went through menopause late (after age 55) have an increased risk for breast cancer.
Other risk factors include:
Alcohol use -- Drinking more than 1-2 glasses of alcohol a day may increase your risk for breast cancer.
Childbirth -- Women who have never had children or who had them only after age 30 have an increased risk for breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces your risk of breast cancer.
DES -- Women who took diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer after age 40. This drug was given to the women in the 1940s-1960s.
Hormone replacement therapy (HRT) -- You have a higher risk for breast cancer if you have received hormone replacement therapy for several years or more. Many women take HRT to reduce the symptoms of menopause.
Obesity -- Obesity has been linked to breast cancer, although this link is controversial. The theory is that obese women produce more estrogen, which can fuel the development of breast cancer.
Radiation -- If you received radiation therapy as a child or young adult to treat cancer of the chest area, you have a significantly higher risk for developing breast cancer. The younger you started such radiation, the higher your risk -- especially if the radiation was given when a female was developing breasts.
Breast implants, using antiperspirants, and wearing underwire bras do not raise your risk for breast cancer. There is no evidence of a direct link between breast cancer and induced abortion or pesticides.
The National Cancer Institute provides an online tool to help you figure out your risk of breast cancer. See:
Symptoms
Early breast cancer usually does not cause symptoms. This is why regular breast exams are important. As the cancer grows, symptoms may include:
* Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt
* Change in the size, shape, or feel of the breast or nipple -- for example, you may have redness, dimpling, or puckering that looks like the skin of an orange
* Fluid coming from the nipple -- may be bloody, clear-to-yellow, or green, and look like pus
Men get breast cancer, too. Symptoms include breast lump and breast pain and tenderness.
Symptoms of advanced breast cancer may include:
* Bone pain
* Breast pain or discomfort
* Skin ulcers
* Swelling of one arm (next to breast with cancer)
* Weight loss
Signs and tests
The doctor will ask you about your symptoms and risk factors, and then perform a physical exam, which includes both breasts, armpits, and the neck and chest area. Additional tests may include:
* Mammography to help identify the breast lump
* Breast MRI to help better identify the breast lump
* Breast ultrasound to show whether the lump is solid or fluid-filled
* Breast biopsy, needle aspiration, or breast lump removal to remove all or part of the breast lump for closer examination by a laboratory specialist
If your doctor learns that you do have breast cancer, additional tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future.
Breast cancer stages range from 0 to IV. In general, breast cancer that stays where it has started is called in situ or noninvasive breast cancer. If it spreads, it is called invasive breast cancer. The higher the number, the more advanced the cancer.
Treatment
Treatment is based on many factors, including type and stage of the cancer, whether the cancer is sensitive to certain hormones, and whether or not the cancer overproduces (overexpresses) a gene called HER2/neu.
In general, cancer treatments may include:
* Chemotherapy medicines to kill cancer cells
* Radiation therapy to destroy cancerous tissue
* Surgery to remove cancerous tissue - a lumpectomy removes the breast lump; mastectomy removes all or part of the breast and possible nearby structures
Other treatments:
* Hormonal therapy to block certain hormones that fuel cancer growth
* Targeted therapy to interfere with cancer cell grow and function
An example of hormonal therapy is the drug tamoxifen. This drug blocks the effects of estrogen, which can help breast cancer cells survive and grow. Most women with estrogen sensitive breast cancer benefit from this drug. A newer class of medicines called aromatase inhibitors, such as exemestane (Aromasin), have been shown to work just as well or even better than tamoxifen in post-menopausal women with breast cancer.
Targeted therapy, also called biologic therapy, is a newer type of cancer treatment. This therapy uses special anti-cancer drugs that identify certain changes in a cell that can lead to cancer. One such drug is trastuzumab (Herceptin). For women with stage IV HER2-positive breast cancer, Herceptin plus chemotherapy has been shown to be work better than chemotherapy alone. Studies have also shown that in women with early stage HER2-positive breast cancer, this medicine plus chemotherapy cuts the risk of the cancer coming back by 50%.
Cancer treatment may be local or systemic.
* Local treatments involve only the area of disease. Radiation and surgery are forms of local treatment.
* Systemic treatments affect the entire body. Chemotherapy is a type of systemic treatment.
Most women receive a combination of treatments. For women with stage I, II, or III breast cancer, the main goal is to treat the cancer and prevent it from returning. For women with stage IV cancer, the goal is to improve symptoms and help them live longer. In most cases, stage IV breast cancer cannot be cured.
Stage 0 -- Lumpectomy plus radiation or mastectomy is the standard treatment. There is some controversy on how best to treat DCIS.
Stage I and II -- Lumpectomy plus radiation or mastectomy with some sort of lymph node removal is standard treatment. Hormone therapy, chemotherapy, and biologic therapy may also be recommended following surgery.
Stage III -- Treatment involves surgery possibly followed by chemotherapy, hormone therapy, and biologic therapy.
Stage IV -- Treatment may involve surgery, radiation, chemotherapy, hormonal therapy, or a combination of such treatments.
Support Groups
Talking about your disease and treatment with others who share common experiences and problems can be helpful. See: Cancer support group
Expectations (prognosis)
How well you do after being treated for breast cancer depends on many things. The more advanced your cancer, the poorer the outcome.
The 5-year survival rate refers to the number of patients who live at least 5 years after their cancer is found. According to the American Cancer Society (ACS), the 5-year survival rates for persons with breast cancer that is appropriately treated are as follows:
* 100% for stage 0
* 100% for stage I
* 92% for stage IIA
* 81% for stage IIB
* 67% for stage IIIA
* 54% for stage IIIB
* 20% for stage IV
Complications
New, improved treatments are helping persons with breast cancer live longer than ever before. However, even with treatment, breast cancer can spread to other parts of the body. Sometimes, cancer returns even after the entire tumor is removed and nearby lymph nodes are found to be cancer-free.
You may experience side effects or complications from cancer treatment. For example, radiation therapy may cause temporary swelling of the breast, and aches and pains around the area. Ask your doctor about the side effects you may have during treatment.
Calling your health care provider
Contact your health care provider for an appointment if:
* You have a breast or armpit lump
* You are a woman age 40 or older and have not had a mammogram in the last year
* You are a woman age 35 or older and have a mother or sister with breast cancer, or have already had cancer of the breast, uterus, ovary, or colon.
* You do not know how or need help learning how to perform a breast self-examination
Prevention
Many risk factors -- such as your genes and family history -- cannot be controlled. However, a healthy diet and a few lifestyle changes may reduce your overall chance of cancer in general.
Breast cancer is more easily treated and often curable if it is found early.
Early detection involves:
* Breast self-exams (BSE)
* Clinical breast exams by a medical professional
* Screening mammography
Most experts recommend that women age 20 and older examine their breasts once a month during the week following the menstrual period.
Women between the ages 20 and 39 should have a doctor examine their breasts at least once every 3 years. After age 40, women should a clinical breast exam every year.
Mammography is the most effective way of detecting breast cancer early.
Screening recommendations:
* The American Cancer Society recommends mammogram screening every year for all women age 40 and older. The National Cancer Institute (NCI) recommends mammogram screening every 1-2 years for women age 40 and older.
* If you are high risk, experts say you should start getting a mammogram at age 30. Certain women at high risk of breast cancer should also have a breast MRI along with their yearly mammogram. Ask your doctor if you need an MRI.
* For those at high risk, including those who have or had a close family member with the disease, annual mammograms should begin 10 years earlier than the age at which the relative was diagnosed.
Questions have been raised about the benefit of screening mammography in women under age 50 and over the age of 69. Annual mammograms in women between 50 and 69 have been show to save lives. But while screening can also detect early breast cancer in younger and older women, it has not been shown to save lives.
This is a topic filled with controversy. A woman needs to have an informed and balanced discussion with her doctor, along with doing additional reading and researching on her own, to determine if mammography is right for her.
Women at very high risk for breast cancer may consider preventive (prophylactic) mastectomy, which is the surgical removal of the breasts. Possible candidates for this procedure may include those who have already had one breast removed due to cancer, women with a strong family history of breast cancer, and persons with genes or genetic mutations that raise their risk of breast cancer.
References
Saslow D, Boetes C, Burke W, et al. American cancer society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007 Mar-Apr;57(2):75-89.
Lehman CD, Gatsonis C, Kuhl CK, et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 2007 Mar 29;356(13):1295-303. Epub 2007 Mar 28.
Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med. 2005 Oct 20;353(16):1659-72.
Romond EH, Perez EA, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005 Oct 20;353(16):1673-84.
Menard S, Pupa SM, Campiglio M, Tagliabue E. Biologic and therapeutic role of HER2 in cancer. Oncogene. 2003 Sep 29;22(42):6570-8.
Prostate Cancer
Definition
Prostate cancer is cancer that grows in prostate gland. The prostate is a small, walnut-sized structure that makes up part of a man's reproductive system. It wraps around the urethra, the tube that carries urine out of the body.
Images:
Male reproductive anatomy
Male reproductive anatomyMale urinary tract
Male urinary tractBPH
BPHProstate cancer
Prostate cancerPSA blood test
PSA blood testProstatectomy - series
Prostatectomy - seriesTURP - series
TURP - series
Alternative Names
Cancer - prostate
Causes, incidence, and risk factors
The cause of prostate cancer is unknown, although some studies have shown a relationship between high dietary fat intake and increased testosterone levels. When testosterone levels are lowered either by surgical removal of the testicles (castration, orchiectomy) or by medication, prostate cancer can slowly get better.
There is no known association with benign prostatic hyperplasia (BPH).
Prostate cancer is the third most common cause of death from cancer in men of all ages and is the most common cause of death from cancer in men over 75 years old. Prostate cancer is rarely found in men younger than 40.
Men at higher risk include African-America men older than 60, farmers, tire plant workers, painters, and men exposed to cadmium. The lowest number of cases occurs in Japanese men and those who do not eat meat (vegetarians).
Prostate cancers are grouped according to how quickly they spread and how different they are from the surrounding prostate tissue. This is called staging. There are several different ways to stage tumors, a common one being the A-B-C-D staging system, also known as the Whitmore-Jewett system:
* Stage A: Tumor is not felt on physical examination, and is usually detected by accident after prostate surgery is done for other reasons.
* Stage B: Tumor is only in the prostate and usually detected during a physical exam or with a blood test (PSA test).
* Stage C: Tumor has spread beyond the prostate but is not in the lymph nodes.
* Stage D: Tumor has spread (metastasized) to lymph nodes or other parts of the body, such as the bone and lungs.
This system also contains several substages.
Symptoms
With the advent of PSA testing, most prostate cancers are now found before they cause symptoms. Additionally, while most of the symptoms listed below can be associated with prostate cancer, they are more likely to be associated with non-cancerous conditions.
* Urinary hesitancy (delayed or slowed start of urinary stream)
* Urinary dribbling, especially immediately after urinating
* Urinary retention
* Pain with urination
* Pain with ejaculation
* Lower back pain
* Pain with bowel movement
Additional symptoms that may be associated with this disease:
* Excessive urination at night
* Incontinence
* Bone pain or tenderness
* Hematuria (blood in the urine)
* Abdominal pain
* Anemia
* Unintentional weight loss
* Lethargy
Signs and tests
A rectal exam often reveals an enlarged prostate with a hard, irregular surface. A number of tests may be done to confirm the diagnosis of prostate cancer.
* PSA test may be high, although non-cancerous enlargement of the prostate can also increase PSA levels.
* Free PSA may help tell the difference between BPH and prostate cancer.
* Urinalysis may show blood in the urine.
* Urine or prostatic fluid cytology may reveal unusual cells.
* Prostate biopsy confirms the diagnosis.
* CT scans may be done to see if the cancer has spread.
* A bone scan may be done to see if the cancer has spread.
* Chest x-ray may be done to see if the cancer has spread.
A newer test called AMACR is more sensitive for determining the presence of prostate cancer than the PSA test.
Treatment
The appropriate treatment of prostate cancer is often controversial. Treatment options vary based on the stage of the tumor. In the early stages, surgery and radiation therapy may be used to remove or kill the tumor.
Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to remove the testes, or chemotherapy.
Surgery, radiation therapy, and hormonal therapy can interfere with sexual desire or performance on either a temporary or permanent basis. Discuss your concerns with your health care provider.
SURGERY
Surgery is usually only recommended after thorough evaluation and discussion of all treatment options. A man considering surgery should be aware of the benefits and risks of the procedure.
* Removal of prostate gland (radical prostatectomy) is often recommended for treatment of stage A and B prostate cancers. This is a lengthy procedure, usually done using general or spinal anesthesia. An surgical cut is made through the abdomen or perineal area. You may remain in the hospital for 5 to 7 days. Possible complications include impotence and urinary incontinence, although nerve-sparing procedures may reduce the risk of these complications. This surgery should be done by a urologist with extensive experience doing this specific procedure.
* Orchiectomy alters hormone production and may be recommended for metastatic cancer. There may be some bruising and swelling initially after surgery, but this will gradually go away. The loss of testosterone production may lead to problems with sexual function, osteoporosis (thinning of the bones), and loss of muscle mass.
RADIATION THERAPY
Radiation therapy is used primarily to treat prostate cancers classified as stages A, B, or C. Whether radiation is as good as prostate removal is a debatable topic, and the decision about which to choose can be difficult. In patients whose health makes the risk of surgery unacceptably high, radiation therapy is often the preferred alternative. Radiation therapy to the prostate gland is either external or internal:
* External beam radiation therapy is done in a radiation oncology center by specially trained radiation oncologists, usually on an outpatient basis. Prior to treatment, a therapist will mark the part of the body that is to be treated with a special pen. The radiation is delivered to the prostate gland using a device that resembles a normal x-ray machine. The treatment itself is generally painless. Side effects may include loss of appetite, fatigue, skin reactions such as redness and irritation, rectal burning or injury, diarrhea, cystitis (inflamed bladder), and blood in urine. External beam radiation therapy is usually done 5 days a week for 6 - 8 weeks.
* Internal radiation therapy places radioactive seeds inside you, directly in or near the tumor. This is called brachytherapy. A surgeon makes a small cut in the area to inject the seeds. They are so small, you don't feel them. The seeds can be temporary or permanent. Because internal radiation therapy is directed to the prostate, it reduces damage to the tissues surrounding the prostate. Side effects may include pain, swelling or bruising in your penis or scrotum, red-brown urine or semen, impotence, incontinence, and diarrhea.
* Radiation is sometimes used for pain relief when cancer has spread to the bone.
MEDICATIONS
Medicines can be used to adjust the levels of testosterone. This is called hormonal manipulation. Since prostate tumors require testosterone to grow, reducing the testosterone level often works very well in preventing further growth and spread of the cancer. Hormone manipulation is mainly used to relieve symptoms in men whose cancer has spread. Hormone manipulation may also be done by surgically removing the testes.
The drugs Lupron or Zoladex are also being used to treat advanced prostate cancer. These medicines block the production of testosterone. The procedure is often called chemical castration, because it has the same result as surgical removal of the testes. However, it is reversible, unlike surgery. The drugs must be given by injection, usually every 3 months. Possible side effects include nausea and vomiting, hot flashes, anemia, lethargy, osteoporosis, reduced sexual desire, and erectile dysfunction (impotence).
Other medications used for hormonal therapy include androgen-blocking agents (such as flutamide) which prevent testosterone from attaching to prostate cells. Possible side effects include erectile dysfunction, loss of sexual desire, liver problems, diarrhea, and enlarged breasts.
Chemotherapy is often used to treat prostate cancers that are resistant to hormonal treatments. An oncology specialist will usually recommend a single drug or a combination of drugs. Chemotherapy medications that may be used to treat prostate cancer include:
* Mitoxantrone
* Prednisone
* Paclitaxel
* Docetaxel
* Estramustine
* Adriamycin
After the first round of chemotherapy, most men receive further doses on an outpatient basis at a clinic or physician's office. Side effects depend on the drug given and how often and how long you take it. Some of the side effects for the most commonly used chemotherapy drugs for prostate cancer include:
* Blood clots
* Bruising
* Dry skin
* Fatigue
* Fluid retention
* Hair loss
* Lowering of your white cells, red cells or platelets
* Mouth sores
* Nausea
* Tingling or numbness in hands and feet
* Upset stomach
* Weight gain
MONITORING
You will be closely watched to make sure the cancer does not spread. This involves routine doctor's check ups. Monitoring will include:
* Serial PSA blood test (usually every 3 months to 1 year)
* Bone scan or CT scan to check for spreading of the cancers
* Complete blood count (CBC) to monitor for signs and symptoms of anemia
* Monitoring for other signs and symptoms, such as fatigue, weight loss, increased pain, decreased bowel and bladder function, and weakness
Support Groups
The stress of illness may be eased by joining a support group whose members share common experiences and problems. See support group - prostate cancer.
Expectations (prognosis)
The outcome varies greatly, primarily because the disease is found in older men who may have a variety of other complicating diseases or conditions, such as cardiac or respiratory disease, or disabilities that immobilize or greatly decrease activities.
Complications
Impotence is a potential complication after prostatectomy or radiation therapy. Recent improvements in surgical procedures have made this complication occur less often. Urinary incontinence is another possible complication. Medications can have side effects, including hot flashes and loss of sexual desire.
Calling your health care provider
Call for an appointment if you are a man older than 50 who has:
* Never been screened for prostate cancer (by rectal exam and PSA level determination)
* Not had regular, annual exams
* A family history of prostate cancer
You should discuss the advantages and disadvantages to PSA screening with your health care provider.
Prevention
There is no known prevention. Following a vegetarian, low-fat diet or one similar to the traditional Japanese diet may lower risk. Early identification (as opposed to prevention) is now possible by yearly screening of men over 40 or 50 years old through digital rectal examination (DRE) and PSA blood test.
There is a debate, however, as to whether PSA testing should be done in all men. There are several potential downsides to PSA testing. The first is that a high PSA does not always mean a patient has prostate cancer. The second is that health care providers are detecting and treating some very early-stage prostate cancers that may never have caused the patient any harm. The decision about whether to pursue a PSA should be based on a discussion between patient and health care provider.
Prostate cancer is cancer that grows in prostate gland. The prostate is a small, walnut-sized structure that makes up part of a man's reproductive system. It wraps around the urethra, the tube that carries urine out of the body.
Images:
Male reproductive anatomy
Male reproductive anatomyMale urinary tract
Male urinary tractBPH
BPHProstate cancer
Prostate cancerPSA blood test
PSA blood testProstatectomy - series
Prostatectomy - seriesTURP - series
TURP - series
Alternative Names
Cancer - prostate
Causes, incidence, and risk factors
The cause of prostate cancer is unknown, although some studies have shown a relationship between high dietary fat intake and increased testosterone levels. When testosterone levels are lowered either by surgical removal of the testicles (castration, orchiectomy) or by medication, prostate cancer can slowly get better.
There is no known association with benign prostatic hyperplasia (BPH).
Prostate cancer is the third most common cause of death from cancer in men of all ages and is the most common cause of death from cancer in men over 75 years old. Prostate cancer is rarely found in men younger than 40.
Men at higher risk include African-America men older than 60, farmers, tire plant workers, painters, and men exposed to cadmium. The lowest number of cases occurs in Japanese men and those who do not eat meat (vegetarians).
Prostate cancers are grouped according to how quickly they spread and how different they are from the surrounding prostate tissue. This is called staging. There are several different ways to stage tumors, a common one being the A-B-C-D staging system, also known as the Whitmore-Jewett system:
* Stage A: Tumor is not felt on physical examination, and is usually detected by accident after prostate surgery is done for other reasons.
* Stage B: Tumor is only in the prostate and usually detected during a physical exam or with a blood test (PSA test).
* Stage C: Tumor has spread beyond the prostate but is not in the lymph nodes.
* Stage D: Tumor has spread (metastasized) to lymph nodes or other parts of the body, such as the bone and lungs.
This system also contains several substages.
Symptoms
With the advent of PSA testing, most prostate cancers are now found before they cause symptoms. Additionally, while most of the symptoms listed below can be associated with prostate cancer, they are more likely to be associated with non-cancerous conditions.
* Urinary hesitancy (delayed or slowed start of urinary stream)
* Urinary dribbling, especially immediately after urinating
* Urinary retention
* Pain with urination
* Pain with ejaculation
* Lower back pain
* Pain with bowel movement
Additional symptoms that may be associated with this disease:
* Excessive urination at night
* Incontinence
* Bone pain or tenderness
* Hematuria (blood in the urine)
* Abdominal pain
* Anemia
* Unintentional weight loss
* Lethargy
Signs and tests
A rectal exam often reveals an enlarged prostate with a hard, irregular surface. A number of tests may be done to confirm the diagnosis of prostate cancer.
* PSA test may be high, although non-cancerous enlargement of the prostate can also increase PSA levels.
* Free PSA may help tell the difference between BPH and prostate cancer.
* Urinalysis may show blood in the urine.
* Urine or prostatic fluid cytology may reveal unusual cells.
* Prostate biopsy confirms the diagnosis.
* CT scans may be done to see if the cancer has spread.
* A bone scan may be done to see if the cancer has spread.
* Chest x-ray may be done to see if the cancer has spread.
A newer test called AMACR is more sensitive for determining the presence of prostate cancer than the PSA test.
Treatment
The appropriate treatment of prostate cancer is often controversial. Treatment options vary based on the stage of the tumor. In the early stages, surgery and radiation therapy may be used to remove or kill the tumor.
Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to remove the testes, or chemotherapy.
Surgery, radiation therapy, and hormonal therapy can interfere with sexual desire or performance on either a temporary or permanent basis. Discuss your concerns with your health care provider.
SURGERY
Surgery is usually only recommended after thorough evaluation and discussion of all treatment options. A man considering surgery should be aware of the benefits and risks of the procedure.
* Removal of prostate gland (radical prostatectomy) is often recommended for treatment of stage A and B prostate cancers. This is a lengthy procedure, usually done using general or spinal anesthesia. An surgical cut is made through the abdomen or perineal area. You may remain in the hospital for 5 to 7 days. Possible complications include impotence and urinary incontinence, although nerve-sparing procedures may reduce the risk of these complications. This surgery should be done by a urologist with extensive experience doing this specific procedure.
* Orchiectomy alters hormone production and may be recommended for metastatic cancer. There may be some bruising and swelling initially after surgery, but this will gradually go away. The loss of testosterone production may lead to problems with sexual function, osteoporosis (thinning of the bones), and loss of muscle mass.
RADIATION THERAPY
Radiation therapy is used primarily to treat prostate cancers classified as stages A, B, or C. Whether radiation is as good as prostate removal is a debatable topic, and the decision about which to choose can be difficult. In patients whose health makes the risk of surgery unacceptably high, radiation therapy is often the preferred alternative. Radiation therapy to the prostate gland is either external or internal:
* External beam radiation therapy is done in a radiation oncology center by specially trained radiation oncologists, usually on an outpatient basis. Prior to treatment, a therapist will mark the part of the body that is to be treated with a special pen. The radiation is delivered to the prostate gland using a device that resembles a normal x-ray machine. The treatment itself is generally painless. Side effects may include loss of appetite, fatigue, skin reactions such as redness and irritation, rectal burning or injury, diarrhea, cystitis (inflamed bladder), and blood in urine. External beam radiation therapy is usually done 5 days a week for 6 - 8 weeks.
* Internal radiation therapy places radioactive seeds inside you, directly in or near the tumor. This is called brachytherapy. A surgeon makes a small cut in the area to inject the seeds. They are so small, you don't feel them. The seeds can be temporary or permanent. Because internal radiation therapy is directed to the prostate, it reduces damage to the tissues surrounding the prostate. Side effects may include pain, swelling or bruising in your penis or scrotum, red-brown urine or semen, impotence, incontinence, and diarrhea.
* Radiation is sometimes used for pain relief when cancer has spread to the bone.
MEDICATIONS
Medicines can be used to adjust the levels of testosterone. This is called hormonal manipulation. Since prostate tumors require testosterone to grow, reducing the testosterone level often works very well in preventing further growth and spread of the cancer. Hormone manipulation is mainly used to relieve symptoms in men whose cancer has spread. Hormone manipulation may also be done by surgically removing the testes.
The drugs Lupron or Zoladex are also being used to treat advanced prostate cancer. These medicines block the production of testosterone. The procedure is often called chemical castration, because it has the same result as surgical removal of the testes. However, it is reversible, unlike surgery. The drugs must be given by injection, usually every 3 months. Possible side effects include nausea and vomiting, hot flashes, anemia, lethargy, osteoporosis, reduced sexual desire, and erectile dysfunction (impotence).
Other medications used for hormonal therapy include androgen-blocking agents (such as flutamide) which prevent testosterone from attaching to prostate cells. Possible side effects include erectile dysfunction, loss of sexual desire, liver problems, diarrhea, and enlarged breasts.
Chemotherapy is often used to treat prostate cancers that are resistant to hormonal treatments. An oncology specialist will usually recommend a single drug or a combination of drugs. Chemotherapy medications that may be used to treat prostate cancer include:
* Mitoxantrone
* Prednisone
* Paclitaxel
* Docetaxel
* Estramustine
* Adriamycin
After the first round of chemotherapy, most men receive further doses on an outpatient basis at a clinic or physician's office. Side effects depend on the drug given and how often and how long you take it. Some of the side effects for the most commonly used chemotherapy drugs for prostate cancer include:
* Blood clots
* Bruising
* Dry skin
* Fatigue
* Fluid retention
* Hair loss
* Lowering of your white cells, red cells or platelets
* Mouth sores
* Nausea
* Tingling or numbness in hands and feet
* Upset stomach
* Weight gain
MONITORING
You will be closely watched to make sure the cancer does not spread. This involves routine doctor's check ups. Monitoring will include:
* Serial PSA blood test (usually every 3 months to 1 year)
* Bone scan or CT scan to check for spreading of the cancers
* Complete blood count (CBC) to monitor for signs and symptoms of anemia
* Monitoring for other signs and symptoms, such as fatigue, weight loss, increased pain, decreased bowel and bladder function, and weakness
Support Groups
The stress of illness may be eased by joining a support group whose members share common experiences and problems. See support group - prostate cancer.
Expectations (prognosis)
The outcome varies greatly, primarily because the disease is found in older men who may have a variety of other complicating diseases or conditions, such as cardiac or respiratory disease, or disabilities that immobilize or greatly decrease activities.
Complications
Impotence is a potential complication after prostatectomy or radiation therapy. Recent improvements in surgical procedures have made this complication occur less often. Urinary incontinence is another possible complication. Medications can have side effects, including hot flashes and loss of sexual desire.
Calling your health care provider
Call for an appointment if you are a man older than 50 who has:
* Never been screened for prostate cancer (by rectal exam and PSA level determination)
* Not had regular, annual exams
* A family history of prostate cancer
You should discuss the advantages and disadvantages to PSA screening with your health care provider.
Prevention
There is no known prevention. Following a vegetarian, low-fat diet or one similar to the traditional Japanese diet may lower risk. Early identification (as opposed to prevention) is now possible by yearly screening of men over 40 or 50 years old through digital rectal examination (DRE) and PSA blood test.
There is a debate, however, as to whether PSA testing should be done in all men. There are several potential downsides to PSA testing. The first is that a high PSA does not always mean a patient has prostate cancer. The second is that health care providers are detecting and treating some very early-stage prostate cancers that may never have caused the patient any harm. The decision about whether to pursue a PSA should be based on a discussion between patient and health care provider.
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