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Benign Prostatic Hyperplasia
Definition:
Benign prostatic hyperplasia is a non-cancerous enlargement of the prostate gland caused by changes in hormone balance and cell-growth factors, a common occurrence in older men. It is also known as benign prostatic hypertrophy and as nodular hyperplasia of the prostate. As the prostate enlarges, which happens to almost all men as they get older, it can press on the urethra (the tube that empties urine from the bladder) and cause problems with urination.
Who is at risk?
- Aged: About half of all men over 50 experience some symptoms;
- Race: White Europeans have a higher prevalence of hyperplasia compared to Asians.
Symptoms:
While BPH does not affect long-term survival, it is a major contributor to a reduced quality of life. The enlargement of the prostate causes a narrowing of the urethra. The symptoms attributed to BPH usually increase in severity over time.
Symptoms include:
- Difficulty initiating to urinate
- A hesitant, interrupted, weak stream
- Dribbling at end of urination
- Incontinence
- Sensation of incomplete bladder emptying (residual urine at bladder)
- Urgency to urinate during the day and night
- More frequent urination, especially at night (Nocturia)
- Deep discomfort in lower abdomen
BPH also can progress to worsening lower urinary tract symptoms, risk of urinary retention, bladder infection, bladder calculi, and urinary incontinence.
Treatment:
- Medication
- Finasteride (Proscar): Inhibits production of the hormone DHT, which is involved with prostate enlargement. (In some men, finasteride can shrink the prostate.)
- Alpha-blocker (terazosin, Cardura): Acts by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and to reduce bladder outlet obstruction.
- Minimally Invasive Interventions
- Transurethral Microwave Thermotherapy (TUMT): Uses microwaves to destroy excess prostate tissue.
- Transurethral Needle Ablation (TUNA): Uses low levels of radio frequency energy to burn away portions of the enlarged prostate.
- Transurethral Laser Therapy: Uses focused laser energy to remove prostate tissue.
- Balloon Dilation: Uses an expandable balloon to widen the urethra.
- Surgery
- Transurethral Surgical Resection of the Prostate (TURP): A scope is inserted through the penis to remove the enlarged portion of the prostate.
- Open Surgery - Removal of the enlarged portion of the prostate through an incision, usually in the lower abdominal area.
Prevention:
- Because prostate enlargement occurs naturally with advancing age, there are no specific primary prevention guidelines.
- It was believed that frequent ejaculation would prevent the hyperplasia by reducing the reflux of the prostatic juice, and indeed men who reported ejaculating at least once a week were less likely to have moderate to severe urinary symptoms. However, once researchers took the men's age into account, this association was no longer significant.
- Men with BPH should not take drugs containing decongestants. These drugs can worsen the symptoms of BPH.
- Medical Therapy of Prostatic Symptoms (MTOPS) Trial recently found that using finasteride and doxazosin together is more effective than either drug alone to relieve symptoms and prevent BPH progression.
Bladder Stones
Definition:
Bladder stones are hard buildups of mineral in the urinary bladder. Most bladder stones originate from the kidneys. Small kidneys stones get dislodged, seed and grow inside the bladder.
Who is at risk?
Bladder stones are more common in man over the age of 40. Inadequate fluid intake and dehydration increase the chance of bladder stones. People who have past history of kidney stones and those with a positive family history of stone disease in the urinary tract are more prone to have bladder stones.
Patients who have obstruction to the flow of urine and recurrent urinary tract infections are prone to have bladder stones. Some patients may have high blood or urine concentration of calcium or other chemicals, such as uric acid and oxalic acid that predispose them to develop bladder stones.
Symptoms:
Common symptoms of bladder stone include:
- Frequent urge to urinate
- Interruption of the urine stream
- Difficulty urinating
- Inability to urinate except in certain positions
- Blood in urine
Treatment:
Drinking large amount of water would help a patient with small bladder stones passing them out spontaneously. Otherwise, bladder stones can be removed through a small telescope called a cystoscope that is passed through the urethra to the bladder. Large stones may need to be removed using open surgery. Extracorporeal shock wave lithotripsy (ESWL, a machine using strong ultrasonic waves to break up stones) is useful for stones in other parts of the urinary tract, but has shown little efficacy in bladder stones.
Prevention:
Drinking large amounts of fluids-8 to 10 ten-ounce glasses a day-is recommended. Prompt treatment of urinary tract infections or other urologic conditions may help prevent bladder stones. Special diets are only necessary for patients with known metabolic problems.
Bladder Tumor
Definition:
An abnormal mass of cells that serve no useful bodily function grow inside the bladder. It can be benign or malignant.
Who is at risk?
Bladder cancer is four times more common in smokers. Some industrial chemicals are linked to bladder cancer. Repeated bouts of bladder infection may slightly increase the risk.
Symptoms:
The most common early symptom is passing blood painlessly in the urine. This may come and go as the tumor bleeds and stops. Larger and invasive tumors may cause urinary irritation or lower abdominal pain, especially when gone through the bladder wall.
Treatment:
An operation called cystoscopy is often needed. The surgeon would pass a small telescope called a cystoscope through the urinary orifice to examine the tumor directly and see if other part of the bladder is affected. Small tumors may be removed with instruments passed through the cystoscope. Larger tumors would need open surgery to remove part of or the entire bladder. Patients may also need radiation treatment and anti-cancer drugs, which can be instilled directly into the bladder. Immunotherapy, aiming at stimulating the patient's immune system with strong vaccines, has shown some favorable results.
Prevention:
Do not smoke. Workers who deal with chemicals need to follow good work safety practices. Drinking large amount of fluids may help as well as eating a diet rich in fruits and vegetables. Frequent checking the urine for blood may pick up early cases.
Brain Tumor
Definition:
A brain tumor is an abnormal growth of tissue in the brain. Primary brain tumors originate in the brain whereas secondary or metastatic brain tumors occur when cancer cells spread from another part of the body to the brain. The cause of primary brain tumors is unknown and the secondary brain tumors are most apt to occur in patients who have:
- Breast cancer
- Colon cancer
- Kidney cancer
- Lung cancer
- Melanoma (a highly malignant tumor of pigment forming cells of the skin)
A benign brain tumor is composed of non-cancerous cells and does not metastasize beyond the part of the brain where it originates. A brain tumor is considered malignant if it contains cancer cells, or if it is composed of harmless cells located in an area where it suppresses one or more vital functions.
Who is at risk?
- Brain tumors can develop at any age, but are most common in children between the ages of 3-12, and in adults aged 40-70;
- Primary tumors of the brain and central nervous system are often associated with HIV infection.
Symptoms:
Symptoms of brain tumors are related to:
- Size and location of the tumor
- Increase in pressure within the brain
- Pressure on surrounding structures of the brain
Involving Frontal lobe - Changes in personality. Unsteady walking posture or weakness of one side of the body. Loss of smell, occasional speech difficulties.
Involving Parietal lobe - Difficulty in expressing or understanding words, and problems with writing or reading. Difficulty in co-ordinating certain movements. Numbness or weakness on one side of the body.
Involving Occipital lobe - Loss of vision on one side.
Involving Temporal lobe - Fits may cause strange sensations: With a feeling of fear or intense familiarity, strange smells or blackouts. Occasional speech difficulties.
Involving Cerebellum - Lack of co-ordination which affects walking and speech (dysarthria), unsteadiness, vomiting and neck stiffness and involuntary flickering movement of the eyes (nystagmus).
Involving Brain stem - Unsteadiness and an unco-ordinated walk. Facial weakness, an one-sided smile or dropping eyelid. Double vision. Rarely, vomiting or headache just after waking; difficulty in speaking and swallowing. Symptoms may appear gradually.
Treatment:
Management of brain tumors often requires multidisciplinary teams of highly skilled specialists and decisions are based on:
- Results of diagnostic tests
- Tumor size, position, and growth pattern
- The patient's health history and current medical status
- The wishes of the patient and his family
- Surgery is often the first treatment for primary brain tumors. However, certain tumors may not need to be operated on or would be best treated by radiotherapy.
- Radiotherapy (usually to the whole head) is given to shrink and control the secondary brain tumor. Radiosurgery or stereotactic radiotherapy may sometimes be used.
- Chemotherapy or hormonal therapy may also be helpful, depending on the type of primary cancer the tumor has spread from.
- Stroid and anti-epileptic medications are sometimes used to reduce swelling of brain and to control seizures.
- Gene therapy is still under undergoing research. Genetic engineered material is transported to tumor cells by viruses that infect tumor cells and convert them to normal cells, stop their growth, or kill them.
Prevention:
Best to avoid association and risk factors of the primary and metastatic brain tumors.
- Avoid risk factors of HIV infection (primary brain tumor).
- Avoid poor nutrition and a low-fibre diet (colon cancer).
- Stop smoking (lung cancer).
- Avoid excessive use of alcohol (liver cancer).
- Avoid excessive exposure to the sun (melanoma).
- Monthly self-examinations of the breasts and testicles to detect breast and testicular cancer at their early stages.
Breast Cancer
Definition:
Breast cancer is an abnormal growth of cells within the breast. Breast cancer is not a single disease but rather a group of diseases that can develop in the ducts, the lobules or other parts of the breast. Breast cancer has surpassed lung cancer as the most common cancer among females in Hong Kong since the early 1990's. One in 24 women in Hong Kong might have this disease. It accounts for almost 20% of all new cancer cases in females diagnosed in Hong Kong.
Who is at risk?
- Women: Who have more breast cells that are exposed to effects of female hormones;
- Aging: The risk increases with age;
- People with genetic risk factors: About 5% to 10% of breast cancer cases are hereditary as a result of gene changes (mutations);
- BRCA1 and BRCA2 genes (commonest).
- Ataxia-telangiectasia mutation- impair in repairing damaged DNA.
- CHEK-2 gene mutation.
- p53 tumor suppressor gene mutation.
- People with family history of breast cancer: Having one first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman's risk, and having two first-degree relatives increases her risk five-fold. Women with a father or brother who have breast cancer also have an increased risk;
- Women with personal history of breast cancer;
- Caucasians: Asian women have a lower risk than white;
- Previous abnormal breast biopsy: Especially with hyperplasia changes;
- Women who menstruate at an early age (before age 12);
- Woman who have late menopause (after 55);
- Women who have not had children: Having multiple pregnancies and becoming pregnant at an early age reduces breast cancer risk;
- Women taking oral contraceptive use;
- Women taking Hormone Replacement Therapy: Estrogens and progesterone combined increase your risk of breast cancer;
- Women who drink alcohol: An average daily drink contains about 15 grams of alcohol may increase your lifetime risk of breast cancer by 10 percent;
- Obese individuals: Especially for women after menopause;
- People with sedentary lifestyle: Exercise would reduce the risk.
Symptoms:
- Early breast cancer has no symptoms. It is not painful.
- Most breast cancer is discovered before symptoms are present, either by finding an abnormality on mammography or feeling a breast lump.
- You may also notice a lump under your arm or above your collarbone.
- Other possible symptoms are breast discharge, nipple inversion, or changes in the skin overlying the breast.
Treatment:
- Surgery: Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.
- Lumpectomy: Remove the tumor (lump) and some normal tissue around it.
- Partial mastectomy: Remove the part of the breast that contains cancer and some normal tissue around it.
- Total mastectomy: Remove the whole breast that contains cancer.
- Modified radical mastectomy: Remove the whole breast that contains cancer, lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
- Radical mastectomy: Remove the breast that contains cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm.
- Breast reconstruction may be considered in patients having mastectomy.
- Treatment given after surgery to increase the chances of a cure is called adjuvant therapy.
- Radiation therapy: There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, wires, or catheters that are placed directly into or near the cancer.
- Chemotherapy: A cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. High-dose chemotherapy followed by bone marrow transplantation or peripheral blood stem cell transplantation does not work better than standard chemotherapy.
- Hormone therapy: A cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Tamoxifen is often given to patients with early stages of breast cancer and those with Metastatic breast cancer.
Prevention:
Clinical exams and mammography won't prevent breast cancer. But these important procedures can help detect cancer in its earliest stages. The sooner you receive a diagnosis, the more options you have, the more effective your treatment and the better your overall prognosis may be. Different authorities have recommended mammography for screening ranging from after age of 40-50 every 2-3 years.
- Discuss long-term hormone therapy with your doctor. The Women's Health Initiative study raised concerns about the use of hormone therapy for symptoms of menopause because of increased risk of breast cancer and lack of protection of cardiovascular events.
- Reduce alcohol.
- Maintain a healthy weight particularly after menopause.
- Stay physically active. The Nurses' Health Study found that women who exercised for at least one hour a day reduced their breast cancer risk by 18 percent.
- Potential preventive therapies but further research required.
- Women who had had breast cancer and took aspirin had reduction in risk.
- Oleic acid, the main component of olive oil, appears to suppress the action of the most important gene that predispose breast cancer.
- Others include retinoids and flaxseed.
Bulimia
Definition:
Bulimia is an eating disorder characterized by recurrent episodes of binge eating followed by self-induced vomiting or diarrhoea, sometimes with drugs, to compensate and to prevent weight gain.
Who is at risk?
The eating disorder is more common in affluent societies. Bulimia usually begins in adolescence or early adulthood. It is nine times more common in woman. Patients are often of perfectionist personality and are high achievers. There is a higher incidence in certain occupations such as models, dancers, gymnastics and athletes.
Symptoms:
During an eating binge, the patient may consume large amount of food until stopped by abdominal pain, sleep, or interruption by others. The preferred food is usually sweet and high in calories. The patient would then induce vomiting by drugs or putting a finger in the throat. Some would resort to using drugs such as diuretics and laxatives. The bulimic patient may appear thin and emaciated, and his/her weight frequently fluctuates widely.
Other symptoms that a bulimic patient may present with include abdominal pain and menstrual irregularities. Others would suffer from side effects of drugs or consequences of excessive vomiting, which could lead to imbalance of electrolytes in the body fluids.
Treatment:
Eating disorders need to be treated with a combination of drugs and psychotherapy. Counselling would aim at resolving psychological conflicts and helping the patient to understand the basis of the behaviour and teaching her self-control strategies. Those severely affected would need to be treated in institutions.
Prevention:
Bulimia can go on in secret for a long time before others suspect something unusual. The prevalence of eating disorders is affected by the culture of the society. For individuals, prevention should focus on catching the eating disorder early in its development, so treatment can begin before it is getting severe enough to cause harm to the patient's body and sense of self.
