LUNG CANCER

THE DETAILED DESCRIPTION OF LUNG CANCER

About:-

• Lung cancer is a disease caused by uncontrolled cell growth in tissues of the lungs.
• If it remains without treatment this growth can spread beyond the lung by process called Metastasis into the nearby tissues or the other parts of body.
• Most cancers that start in lungs are primary lung cancers are Carcinomas that derive from epithelial cells.
• The main types of lung cancer are small-cell lung carcinoma (SCLC) also called oat cell cancer and Non small cell lung carcinoma (NSCLC).
• The common symptoms are coughing of blood, weight loss and shortness of breath.
• It also causes by long term exposure to tobacco smoke , which causes 80-90 % of lung cancers.
• Non smokers effect for 10-15 % lung cancer cases, and also causes by genetic factors, radon gas, asbestos and air pollution including Second hand smoke.
• Lung cancer is identified by Computed tomography (CT scan) and chest radiograph.
• Common treatments are Surgery, Chemotherapy and radiotherapy.
• SCLC responds to Chemotherapy and radiotherapy while NSCLC responds to Surgery.
• Overall 15 % of people in the United States are recognised by lung cancer and surviving five years after diagnosis.
• Lung cancer is the most common cause of cancer related death in Men and Women and responsible for 1.38 million deaths as 2008 survey.

Signs and symptoms:-

• Respiratory symptoms : coughing, coughing up blood, shortness of breath.
• Systemic symptoms : weight loss, fever and clubbing of finger nails.
• Symptom due to local compress: Chest pain, Bone pain, difficulty swallowing.
• If the cancer cause in airway, it may obstruct airflow, causing breathing difficulties.

Causes:

• Cancer develops following genetic damage to DNA.
• This genetic damage affects the normal functions of the cell, including cell proliferation, programmed cell death(apoptosis) and DNA repair.
• As more damage accumulates, the risk of cancer increases.

Smoking:

• Smoking particularly of cigarettes is main factor of lung cancer.
• Nicotine appears to depress the immune response to cancerous growths in exposed tissues.
• In the year 2000, 90 % of lung cancer deaths in men and 70 %  in women is by smoking.
• Non smokers means inhalation of smoke from another's smoke.
• Investigation of Side stream smoke suggest it is more dangerous than direct smoke.

Radon gas:

• Radon gas is a colourless and odourless gas  generated by breakdown of radio active radium which in turn is the decay product of uranium, found in the earth's crust.
• The United States Environmental Protection Agency (EPA) states that one in 15 homes in the US has radon levels above the recommended guideline of 4 picocuries per litre.

Asbestos:

• Asbestos can cause a variety of lung diseases including lung cancers.
• Tobacco smoking and asbestos have a synergistic effect on the formation of lung cancer.
• It can also cause cancer of pleura called mesothelioma.

Air pollution:

• Increased risk of lung cancer from indoor air pollution related to the burning of wood, charcoal, dung or crop residue for cooking and heating.
• Women exposed to indoor coal smoke have about twice the risk and burning of biomass products known as suspected carcinogens.

Prevention:

• Prevention is the most cost-effective means of decreasing lung cancer development.
• In most countries industrial and domestic carcinogens have been identified and banned, but tobacco smoking is still widespread.
• Eliminating tobacco smoking is a primary goal in the prevention of lung cancer.
• Policy interventions to decrease passive smoking in public areas such as restaurants and work places have become more common in many Western countries.
• The World Health Organisation has called for governments to institute a total ban on tobacco advertising to prevent young people to taking up smoking.
• The long term use of supplemental vitamin A , vitamin C , vitamin D ,vitamin E does not reduce the risk of lung cancer.
• Some studies suggest people who eat diets with a higher proportion of vegetables and fruit tend have a lower risk.
• More rigorous studies have not demonstrated a clear association.

Keywords:-

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SMOKING

SMOKING 

WHAT IS SMOKING ?

HOW DO CIGARETTES DAMAGE HEALTH ?

MAJOR DISEASES CAUSED BY SMOKING

Smoking is a practise in which a substance , most commonly Tobacco, is burned and tasted or inhaled.This is a primarily practised as a route of administration for recreational drug use , as combustion releases the active substances in drugs such as nicotine and makes them available for absorption to the lungs.It can also be done as a part of rituals , to induce trances and spiritual enlightenment.

• The most common method of smoking today is through Cigarettes , primarily industrially manufactured but also hand-rolled from loose tobacco and rolling paper .
• Other smoking implements including pipes ,cigars, beedes, hookha's, vaporizers and bongs.
• It has been suggested that smoking related disease kills one half of long term smokers but these diseases may also contracted by non- smokers .
• A 2007 report states that , each year about 4.9 million people die as a result of smoking .
• Smoking is one of the most common forms of the recreational drug use .
• Tobacco smoking is today by far the most popular form of smoking and is pactised by one Billion people in the majority of all human societies .
• Less common drugs for smoking include cannabis and opium.
• Some of substances are classified as hard narcotics like heroin.
• But the use of these is very limited as they often not commercially available.
• Perception surrounding smoking has varied over time and from one place to another ; Holy and sinful.
• Sophisticated and vulgar, a panacea and deadly health hazard.
• Only relatively recently , and primarily and industrialized western countries , has smoking came to be viewed in a decidedly negative light .
• The inherent health hazards of smoking have caused many countries such as singapore to institue high taxes on tobaco products and anti-smoking campaings are launched every year in an attempt to curb tobacco smoking.

HISTORY

Early Uses :

•  The history of smoking dates back to as early as 5000BC in Shamanistic rituals.
• Many ancient civilizations such as Babylonians ,Indians and chinese burnt incense as a part of religious rituals.
• Cannabis smoking was introduced to Sub-saharan Africa through Ethiopia .
• And the east african coast by either indian or arab traders in the 13th century or earlier and spread on the same trade routes as those that carried coffee which originated in highlands of ethiopia.
• It was smoked in calabashed water pipes with terra cota, smoking bowls.
• Apparently and ethiopian invention which was later conveyed to eastern, soutern and central Africa.
• Popularization :

• A French man named Jean nicot ,
• From france tobacco spread to England .
• The first report of smoking englishmen is of a sailor in bristol in 1566, seen "emmiting smoke from his nostrils" .
• Like tea , coffee , opium, tobacco was just one of many intoxicants that was originally used as a form of machine .

Health risks :

• Most people know that smoking can cause lung cancer.
• But it can also cause many other cancers and illness.
• Smoking directly causes over 100,000 deaths in UK each year and contributes to many more .
• Of these deaths about 42,800 are from smoking related cancers , 30,600 from cardiovascular disease and 29,100 slowly die from emphysema and other chronic lung diseases.
• How do cigarettes damage health :

• Cigarettes contain more than 4000 chemical compounds and at least 400  toxic components.
• When u inhale a cigarette burns at 700 C at tip and around 60 C in the core .
• This heat breaks down the tobacco to produce various toxins .
• As a cigarette burns the res idues are concerntrated through the butts.
• The products that are more damaging are :
• tar, a carcinogen (substance that causes cancer).
• Nicotin is addictive and increases cholestral levels in your body.
•  Carbonmonoxide reduces the oxygen in the body.
• Components of the gas and particulate phases cause chronic obstructive pulmonary disorder(COPD).
• The damage caused is influenced by :
• No.of cigarettes smoked .
• Whether the cigarette has a filter.
• How the tobacco has been prepared.
• Smoking affects how long u live :

• Of the 300 people who die every day in UK as a result of smoking , many are comparitively younger smokers.

The number of people under the age of 70 who die from smoking - released diseases exceeds the total figure for deaths caused by breast cancer , AIDS , Traffic accidents and drug addiction.

Cardiovascular Disease :

• Coronary thrombosis : a blood clot in the arteries supplying the the heart , which can lead to a heart attack, around 30 % are caused by smoking.
• Cerebral thrombosis : the vessels to the brain can become blocked, which can lead to collapse, stroke and paralysis.
• Damage to the brain's blood supply is also an important cause of dimentia.
• If the kidneys arteries are affected , then high blood pressure or kidney failure results.
• Blockage to the vascular supply to the legs may lead to gangrene and amputation.
• Cancer :

• Smokers are more likely to get cancer than non-smokers .
• This is particularly true of lung cancer , throat cancer and mouth cancer, which hardly ever effect non-smokers.
• Bladder cancer .
• Cancer of Oesophagus.
• Cancer of the kidneys .
• Cancer of the Pancreas.
• Cervical cancer.

Other risks :

• Smokers run an increased risk of cataracts.
• Smokers take 25% more than sick days year than non-smokers.
• Smoking stains your teeth and gums.
• Smoking causes an acid taste in the mouth and contributes the development of ulcers.

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THYROID

UNDERSTANDING THE THYROID PROBLEMS

-

THE BASICS

HYPOTHYROIDISM,HYPERTHYROIDISM,

CANCERS

Thyroid :

• The Thyroid or Thyroid gland is one of the largest endocrine glands.
• It is found in the neck , below the thyroid cartillage(which forms the adam's apple or laryngeal prominence).
• The thyroid gland controls how quickly the body uses energy, makes proteins , and controls how sensitive the body is to other hormones.
• It participates in these processes by producing thyroid hormones .
• The principle ones being triiodothyronine and thyroxine which can sometimes referred as tetriaodothyronine .
• These hormones regulate the growth and function of many other systems in the body.
• (T3 & T4) are synthesized from iodine and tyrosine.
• The thyroid also produces calsitonin , which plays a role in calcium homeostatis.
• Hormonal output from the thyroid is regulated by thyroid - stimulating hormone (TSH) produced by anterior pituitary , which itself is regulated by thyrotropi - releasing homone (TRH) produced by hypothalamus.

Anatomy :

• The thyroid gland is butterfly shaped organ and is composed of two cone like lobes or wings ,Lobus dexter and lobus sinister, connected via isthamus.
• This organ is situated on the anterior side of neck, lying against the larynx and trachea , reaching posteriorly Oesophagus and cartiod sheath .
• It starts cranially at oblique line on thyoid cartillage (just below the adam's apple) and extends inferiorly to approximately to fifth or sixth tracheal ring ,
• It is difficult to demarcate , the glands upper and lower border with vertebral levels because it moves position in relation to these during swallowing .
• It is covered by thin fibrous sheath, the capsula glandulae thyroidia, composed of an internal and external layer.
• The external layer continuous with the pretracheal fascia and posteriorolaterally continuous with the cartiod sheath .

• This gland is covered with anteriorly with infrahyoid muscles and laterally with the sternocleidomastoid muscle also known as sternomastoid muscle .
• Between the two layers of the capsule on the posterior side of the lobes, there are on each side two parathyroid lobes .
• In a healthy person the gland is not visible yet can be palpated as a soft mass.
• Having the patient neck flex slightly to the side when being palpated may help in this examination.
• Thus when the patient swallows, the gland moves superiorly as does the whole larynx.
• The Thyroid is supplied with arterial blood from the superior thyroid artery a branch of external cartiod artery and the inferior thyroid artery.
• The venous blood is drained via superior thyroid veins , draining in the internal jugular vein and via inferior thyroid veins draining via the plexus thyroideus impar in the left bracheocephalic vein.
• Lymphatic drainage passed frequently the lateral deep cervical lymph nodes and the pre-parathracheal lymph nodes , 
• The gland is supplied by the parasymphathetic nerve input from the superior laryngeal nerve and the recurrent laryngeal nerve.

(T3 & T4) regulation :

• The production of thyroxine(T3) and triiodothyronine(T4) is regulated by thyoid - stimulating hormone (TSH), and released by the anterior pituitary.
• The thyroid and thyrotropes form a negative feedback loop;
• TSH production is suppressed , when the T4 levels are high.
• The TSH production itself is modulated by thytotropin - releasing hormone (TRH), which is produced by hypothalamus and screated at an increased rate in situations such as cold exposure .
• TSH production is blunted by stomatostatin(SRIH),and excessively high blood iodide concerntration.
• An additional hormone produced by the thyroid contributes to the regulation of blood calcium levels .
• parafollicular cells produce calcitonin in responce to hypercalcemia, 
• calcitonin stimultes movment of calcium into bone,in opposition to the effects of parathyroid hormone (PTH), however calcitonin seems far essential than PTH as calcium metabolism remains clinically normal after the removal of thyroid , but not the parathyroids.

DISORDERS

Hypothyroidism :

• It is the under production of thyroid hormones T3 &T4.
•  Hypothyroid diorders may occur as a result of 
• Congenital thyroid abnormalities (thyroid defeciency at birth).
• Autoimmune disorders , such as hashimoto's thyroiditis.
• Iodine defeciency (more likely in poorer countries ) or 
• The removal of thyroid following surgery to treat severe hypothyroidism and /thyroid cancer .

Typical symptoms are abnormal weight gain , tiredness, baldness , cold intolerence, and bradycardia .

• Hypothyroidism is treated with Hormone replacement theraphy such as levothyroxine.
• Negative feedback mechanisms result in growth of thyroid gland when thyroid hormones are being produced in sufficiently low quantities .
• as a means of increasing the thyroid output .
• However where the hypothyroidism is caused is caused by iodine insufficiency , the thyroid is unable to produce T3 & T4 and as a result the thyroid may continue to grow to form a non toxic goitor .
• It is termed non-toxic as it does not produce toxic quantities of thyroid hormones , despite its size.

Initial Hyperthyroidism followed by Hypothyroidism :

• This is the over production of T3 & T4 , there are two types
• Hashimoto's thyroiditis & postpartum thyroiditis.
• Hashimoto's disease is an autoimmune disorder, whereby the body's immune system reacts with thyroid tissues in an attempt to destroy it .
• At the beginning , the gland may be overactive, and then bcomes underactive as the gland is damaged resulting in too little thyoid hormone production or hypothyroidism.
• Also more common individuals with Hashimoto's thyroiditis are type 1 diabetes and celiac disease.
• Postpartum thyroiditis occurs in females following the birth of child,
• After child , the gland becomes inflammed and the condition initially presents with the overactivity of the gland followed by underactivity.
• The etiology is not always known , but can sometimes be attributed to autoimmunity such as Hashimoto's thyroiditis or grave's disease.

Cancers :

• In most cases, thyroid cancer presents as a painless mass in the neck .
• It is unusual for thyroid cancers to present with symptoms ,unless they have been neglected .
• One may be able to feel a hard nodule in the neck .
• Diagnosis is made using a needle biopsy and various radiological studies.

Non- cancerous nodules :

• Many individuals find the nodules in the neck .
• Doctors usually perform a needle aspiration biopsy of thyroid to determine the status of the nodules .
• If the nodule found to be non-cancerous and no other treatment is required.
•  If the nodule is suspecious then surgery is recommended.

Other disorders:

• Limited research shows that seasonal allergies may trigger episodes of hypo or hype-hyperthyroidism.
• An ectopic thyroid is an entire or parts of the thyroid located in another part of the body then what is the usual case.
• Same rapid cycling versions of bipolar disorder seem to have a complex relationship with thyroid disfunction, however the specifics of the relationship are poorly understood.

Preventive tips :

 A healthy diet, exercise, proper nutrition and stress reduction can all minimise the chance of developing thyroid disease.

Keywords :

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DIABETOLOGY

Best hospitals DIABETOLOGY:

1. All India Institute of Medical Sciences, Delhi
2. Dr Mohan's Diabetes Specialities Centre, Chennai
3.Christion Medical College,Vellore
4. Postgraduate Institute of Medical Education & Research, Chandigharh
5. M.V. Hospital for Diabetes, Chennai
6. Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
7.Apollo Hospitals, Grams Lance, Chennai
8. Medanta - The Medicity, Gurgaon, Delhi
9. Amrita Instutute of Medical Sciences, Kochi
10. Indraprastha Apollo Hospitals, Delhi
 Long goodbye the way ponting quit - on his own terms- fulfilled at least partially the pact every sportsman makes with himself
where he became only the second batsman after Don Bradman to make three in a single series.
When Ponting called it a day, he made one thing clear:

"This is not a decsion that's been made by the selectors, this a decision tha't been made by me. There were probablymoments when they thought long and hard about end ing my career and I'm glad I've got the opportunity to fin-ish this way and on my terms".
Way-and is the dream of every sportsman, The fadtasy involves quitting at the top, winning the final match for your team, and moving aside without any regrets, It is fough, as Tendulkar is descovering now. When you know nothing except the game and then that is taken away from you, nothing remains but a dark abyss. No country has a system that helps players psychologciflly at the end of thier careers. To the world.
      Drivad made the point that palyers used to the adulation and respect of being at the top of one profession find it difficult to adjust to being second best in any other. Hence the temptation to postpone the ineitable.
I have a friend on a wheelchair who loves to drive.Once holiday we drove for miles. He told me the destination was incidental, the drive iself was fulfilment: "it is when I am in control: The cric ket field is where Tendulkar is in comtrol, and it is understandable if he doesn't t want to let go Sport can be cruel. Before you properly moun the passing of one champion, another is ready to take his place.

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Best Hospitals

  Well cornell Medical College in the UK are developing a nanoparticle tracking analysis technology to facillitate cance metastasis reserach i9t will help detect cancer earier, predict aggresswiveness fo the tumour and assess risk of cencer recurrence. US based pharmaceutical company Merck & Co. has edevelped an experimental drug which has The drug MK - 3475 is admin istered by infusion and it enables the immune system to target the cancer cells. The tahlequah City Hospital in Oklahama, the US, has fused PET asnd Ct scan to detect minute fluctuations in the body's metabolism ca\used by tumour or abnormal cell growth. the 3d images can distinguish between bening and cancerous tumours, thus eliminating unnecessary tests.

the cancer cell, "says Dr Sapna Nangia, consultant, radiation oncology, Apollo Hospital, Delhi.

There are many other patient-centric developments/ Intra-operative radiotherapy that offers six weeks of radiation on the table in two days is also an attractive option for patients who are unable to travel for radiation sessions. Robotic surgery. theough expensi9ve, is shouwing results in surgeries of the pelvic area. Most patients undergoing chemotherapy complained of nausea earlier. Now dueto bettor drugs 90 per cent patients do not complain of it. " says Dr Anil Herror; oncoswurgeon Fortis Hospital, Mumbai, Also there are drugs that imporove blood count after chemo therapy; improving immunity

The bottom  line from the cancer doctors is that cancer care is becoming more patient-friendly While the battle with the de3adly disease contin use better tretment option make the patient are also taken care of cancer.

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BEST HOSPITALS ONCOLOGY

BEST hospitals ONCOLOGY:

Tata Memorial Hospital, Mumbai
All India Institute Medical Sciences, Delhi
The Cancer Institute, Adyar, Chennai
Apollo Speciality Hospital, Chennai
The Gujarat Canbcer & Research Instite, Ahmedabad
Rajiv Gandhi Cancer Institute and  Reserch Centre, Delhi
Kidwai Memorial Institute of Oncology, Bangalore
Regional Cancer Centr, Thiruvanthapuram
HCG, Bangalore
Postgraduate Institute of Medical Education & Research Chandigarh
Best multi- speciality hospitals INDORE
CHL- Apollo Hospital
Bombay Hospital
Choithram Hospital
Gokuldas Hospital
Maharaja Yashwantrao Hopital

fear losing their feminity: says Dr Vani Parmar, breast surgical oncoloist tgata Memorial Centre, Mumbai.
Onceoplastic and reconstruction surgery is also playing an important role in improving the quality of life confindence and postive imag. To day oncoplastic surgery is considered to be a part of treatment universally. Insurance companies shoud.also understand this and cover its expenses, says Dr c. Koppikar, breast recon structrion surgeon, Pune.
In  rediation, too, targeted pro cedures are showing good results. Steriotactic radiosurgery is used for treating brain disorders in a focused manner in a single dose; Transarterial Radioembolisation helps reduce the size of the tumour before surgery. Adaptive radiotherapy is also an improvement, which takes into consideration the margins of errors and motion so that healthy cell are protected. "The next to come is biologically directed radiation therapy that is targeted according to the biology of the future of joint replacement surgeries would be in oru institution has one of the best equipped bone and joint departments in india with highly qualitfed and experienced surgeons and state-of the art infrastruclure. This department focuses on both primary and revions jointg replacemnt surgeries, complex joint reconstruction, Dr J.V. srinivas, Forthis Hospital, Banerghatta Road, Bangalore 

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Best hospitals NEWROLOGY IN INDIA

NEWROLOGY:

1 National institute of mental health and neurosciences, bangalore
2 All india institute of medical sciences, dehli
3 sree chitra tirunal institute for medical sciences and technology, thiruvananthapuram
4 postgraduate institute of medical education & research, chandigarh
5 christian medical collage, vellore
6 vidyasagar institute for medical health, neuro & allied sciences, delhi
7 apollo hospitals, greams lane, chennai
8 king-edward memorial hospital, mumbai
9 G.B Pant Hospital, Delhi
    which mean a lot to me. His orientation and attention have also improved a lot, though it is not as good as his pre-morbid days. He now takes up simple takes, too.
   the therapy has been a blessing for patients like pradeep. " neuro  faceback can treat a vast array of brain disorders , says dr jamuna rajeswarwn, associate professor at the neuropsychology unit of the department of clinical psychology at the nimhans. " our studies have shown the effectiveness of neurofaceback in achoholics and patients with brain injury. we looked at the changes in the patients brain pre-and post- neu-rofeedback and have seen a significant improvement in stroke patients and autistic children suffering from at-twntion deficit hyperactivity disorder (ADHD)."

   BEST MULTI-SPECIALITY  HOSPITALS  AHMADABAD
1 APOLLO HOSPITALS
2 STERLING  HOSPITALS
3 SHALBY HOSPITALS
4 SAL HOSPITALS
5 CARE INSTITU OF MEDICAL SCIENCES
   

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