Cancer - Overview

Cancer is an abnormal growth of cells. Cancer cells rapidly reproduce despite restriction of space, nutrients shared by other cells, or signals sent from the body to stop reproduction. Cancer cells are often shaped differently from healthy cells, they do not function properly, and they can spread to many areas of the body. Tumors, abnormal growth of tissue, are clusters of cells that are capable of growing and dividing uncontrollably; their growth is not regulated.

Important terms:

Benign (noncancerous):Benign tumors tend to grow slowly and do not spread.

Malignant (cancerous):Malignant tumors can grow rapidly, invade and destroy nearby normal tissues, and spread throughout the body

Locally invasive:The tumor can invade the tissues surrounding it by sending out "fingers" of cancerous cells into the normal tissue.

Metastatic:The tumor can send cells into other tissues in the body, which may be distant from the original tumor.

Primary tumor:

Primary tumor: The original tumor is called the "primary tumor." Its cells, which travel through the body, can begin the formation of new tumors in other organs. These new tumors are referred to as "secondary tumors." The cancerous cells travel through the blood (circulatory system) or lymphatic system to form secondary tumors.

The lymphatic system is a series of small vessels that collect waste from cells, carrying it into larger vessels, and finally into lymph nodes. Lymph fluid eventually drains into the bloodstream.

Type Of Cancer

Cancer is not just one disease but rather a group of diseases, all of which cause cells in the body to change and grow out of control. Cancers are classified either according to the kind of fluid or tissue from which they originate, or according to the location in the body where they first developed. In addition, some cancers are of mixed types.

The following five broad categories of cancer:

Carcinoma:

A carcinoma is a cancer found in body tissue known as epithelial tissue that covers or lines surfaces of organs, glands, or body structures. For example, a cancer of the lining of the stomach is called a carcinoma. Many carcinomas affect organs or glands that are involved with secretion, such as breasts that produce milk. Carcinomas account for 80 percent to 90 percent of all cancer cases.

Sarcoma:

A sarcoma is a malignant tumor growing from connective tissues, such as cartilage, fat, muscle, tendons, and bones. The most common sarcoma, a tumor on the bone, usually occurs in young adults. Examples of sarcoma include osteosarcoma (bone) and chondrosarcoma (cartilage).

Lymphoma:

Lymphoma refers to a cancer that originates in the nodes or glands of the lymphatic system, whose job it is to produce white blood cells and clean body fluids, or in organs such as the brain and breast. Lymphomas are classified into two categories: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.

Myeloma:

Myeloma grows in the plasma cells of bone marrow. In some cases, the myeloma cells collect in one bone and form a single tumor, called a plasmacytoma. However, in other cases, the myeloma cells collect in many bones, forming many bone tumors. This is called multiple myeloma.

Leukemia:

Leukemia, also known as blood cancer, is a cancer of the bone marrow that keeps the marrow from producing normal red and white blood cells and platelets. White blood cells are needed to resist infection. Red blood cells are needed to prevent anemia. Platelets keep the body from easily bruising and bleeding.

Cholestrol Overview

Cholesterol is a waxy steroid and is transported in the blood plasma of all animals. It is the main sterol synthesized by animals - small amounts are also synthesized in plants and fungi. A sterol is a steroid sub-group. It is a building block for cell membranes and for hormones like estrogen and testosterone. About 80% of the body's cholesterol is produced by the liver, while the rest comes from our diet. The main sources of dietary cholesterol are meat, poultry, fish, and dairy products. Organ meats, such as liver, are especially high in cholesterol content, while foods of plant origin contain no cholesterol. After a meal, dietary cholesterol is absorbed from the intestine and stored in the liver. The liver is able to regulate cholesterol levels in the blood stream and can secrete cholesterol if it is needed by the body. LDL cholesterol is called "bad cholesterol", because elevated levels of LDL are associated with an increased risk of coronary heart disease, stroke, and peripheral artery disease. LDL lipoprotein deposits cholesterol along the inside of artery walls, causing the formation of a hard, thick substance called cholesterol plaque. Over time, cholesterol plaque causes thickening of the artery walls and narrowing of the arteries, a process called atherosclerosis, which decreases blood flow through the narrowed area.

Goal values:

1) Less than 70 mg/dL for those with heart or blood vessel disease and for other patients at very high risk of heart disease (those with metabolic syndrome)

2) Less than 100 mg/dL for high risk patients (e.g., some patients who have multiple heart disease risk factors)

3) Less than 130 mg/dL for individuals who are at low risk for coronary artery disease

4) HDL cholesterol is called the "good cholesterol" because HDL particles prevent atherosclerosis by extracting cholesterol from the artery walls and disposing of them through the liver. Thus, high levels of LDL cholesterol and low levels of HDL cholesterol (high LDL/HDL ratios) are risk factors for atherosclerosis, while low levels of LDL cholesterol and high levels of HDL cholesterol (low LDL/HDL ratios) are desirable and protect against heart ailments.

Goal value:

Greater than 40 mg/dL

Total cholesterol is the sum of LDL (low density) cholesterol, HDL (high density) cholesterol, VLDL (very low density) cholesterol, and IDL (intermediate density) cholesterol.

Goal values:

75-169 mg/dL for those age 20 and younger

100-199 mg/dL for those over age 21

Cleft Lip & Palate - Overview

Cleft lip and cleft palate are facial and oral malformations that occur very early in pregnancy, while the baby is developing inside its mother. Cleft results when there is not enough tissue in the mouth or lip area, and the tissue that is available does not join together properly. This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum. Cleft lip and cleft palate can occur on one or both sides of the mouth. Because the lip and the palate develop separately, it is possible to have a cleft lip without a cleft palate, a cleft palate without a cleft lip, or both a cleft lip and cleft palate together.

A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front portion of the roof of the mouth) and/or the soft palate (the soft back portion of the roof of the mouth).

In most cases, the cause of cleft lip and cleft palate is not known and these conditions cannot be prevented. Most scientists believe clefts are due to a combination of genetic and environmental factors. There appears to be a greater chance of clefting in a newborn if a sibling, parent, or relative has had the problem. Another potential cause may be related to a medication a mother may have taken during her pregnancy. Some antiseizure/anticonvulsant medications, acne treatment medications containing Accutane, a drug commonly used for treating cancer, arthritis, and psoriasis, may cause cleft lip and/or cleft palate.

Because clefting causes very clear physical changes, it's easy to diagnose. Prenatal ultrasound can sometimes determine if a cleft exists in an unborn child. If the clefting has not been detected in an ultrasound before the baby's birth, a physical examination of the mouth, nose, and palate confirms the presence of cleft lip or cleft palate after a child’s birth. Sometimes diagnostic testing may be conducted to determine or rule out the presence of other abnormalities.

Speech problems: Children with cleft lip or cleft palate may also have trouble speaking. These children’s voices don’t carry well, the voice may take on a nasal sound, and the speech may be difficult to understand. Not all children have these problems, and surgery may fix these problems entirely for some. For others, a special doctor called a speech pathologist will work with the child to resolve speech difficulties.

Dental problems:Children with clefts are more prone to a larger than average number of cavities and often have missing, extra, malformed, or displaced teeth requiring dental and orthodontic treatments. In addition, children with cleft palate often have an alveolar ridge defect. The alveolus is the bony upper gum that contains teeth. A defect in the alveolus can (1) displace, tip, or rotate permanent teeth, (2) prevent permanent teeth from appearing, and (3) prevent the alveolar ridge from forming. These problems can be fixed through oral surgery. 4. Can cause premature loss of erupting canines, and incisors.

Eating problems:With a separation or opening in the palate, food and liquids can pass from the mouth back through the nose. Fortunately, specially designed baby bottles and nipples that help keep fluids flowing downward toward the stomach are available. Children with a cleft palate may need to wear a man-made palate to help them eat properly and ensure that they are receiving adequate nutrition until surgical treatment is provided.

Ear infections and hearing loss:Children with cleft palate are at increased risk of ear infections since they are more prone to fluid buildup in the middle ear. If left untreated, ear infections can cause hearing loss. To prevent this from happening, children with cleft palate usually need special tubes placed in the eardrums to aid fluid drainage, and their hearing needs to be checked once a year.

Because of the number of oral health and medical problems associated with a cleft lip or cleft palate, a team of doctors and other specialists is usually involved in the care of these children. Members of a cleft lip and palate team typically include:

• 1) Plastic surgeon to evaluate and perform necessary surgeries on the lip and/or palate
• 2) Otolaryngologist (an ear, nose, and throat doctor) to evaluate hearing problems and consider treatment options for hearing problems
• 3) Oral surgeon to reposition segments of the upper jaw when needed, to improve function and appearance, and to repair the cleft of the gum
• 4) Orthodontist to straighten and reposition teeth
• 5) Prosthodontist to make artificial teeth and dental appliances to improve the appearance and to meet functional requirements for eating and speaking
• 6) Speech pathologist to assess speech and feeding problems
• 7) Speech therapist to work with child to improve speech
• 8) Audiologist (a specialist in communication disorders involving a hearing impairment) to assess and monitor hearing
• 9) Nurse coordinator to provide ongoing supervision of the child’s health
• 10) Social worker/psychologist to support the family and assess any adjustment problems
• 11) Geneticist to help parents and adult patients understand the chances of having more children with these conditions

A cleft lip may require one or two surgeries depending on the extent of the repair needed. The initial surgery is usually performed by the time a baby is 3 months old.

Repair of a cleft palate often requires multiple surgeries over the course of 18 years. The first surgery to repair the palate usually occurs when the baby is between 3 and 6 months old to close the lip. The second surgery is usually from 9-12 months old and creates a functional palate, reduces the chances that fluid will develop in the middle ears, and aids in the proper development of the teeth and facial bones.

Additional surgeries may be performed to improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabilize and realign the jaw. Final repairs of the scars left by the initial surgery will probably not be performed until adolescence, when the facial structure is more fully developed.

Congenital Clubfoot Overview

Congenital clubfoot is present at birth (the definition of "congenital") and affects the foot and/or ankle. There is no known cause for clubfoot, and it is twice as common in male children as it is in female children. In children with clubfoot, there is a slight imbalance in muscle forces in the lower leg resulting in the foot deformity. Often, the foot is "kidney-shaped." About 50 percent of the time, both feet are affected with clubfoot. Although there is no known cause for congenital clubfoot, some doctors believe the use of drugs or alcohol during pregnancy or the presence of other diseases can cause it. Until recently, 85 percent of children with congenital clubfoot required extensive surgery to correct their deformity. Now 90 percent children can be corrected without surgery or with minor procedures using a new casting technique.

Although different types of clubfoot exist, the condition is usually accompanied by the following foot deformities:

• Varus: An inversion of the heel that causes the front of the foot to turn inward.
• Adduction of the forefoot: the forefoot is pulled downward.
• Plantar flexion: Twisting of the ankle.
• Cavus foot deformity: An unusually high arch in the foot.

Medical TreatmentsIn some cases, clubfoot can be corrected via exercise, stretching of the heel cord and casting. Corrective casting employs gentle stretching of the foot with application of a holding cast to maintain corrected position. The manipulation and casting are repeated on a weekly basis until the deformity is either corrected or the degree of correction plateaus.

Surgical TreatmentsSurgery for children with congenital clubfoot is best done prior to walking age as walking then will not be significantly delayed. The goal of surgery is to lengthen the heel cord and correct the forefoot and hindfoot. Clubfoot surgery can be performed after 1 year of age, however results typically are less satisfying.

Risks of congenital clubfoot surgery include nerve injury, infection, bleeding, and stiffness. Refrain from eating or drinking anything after midnight the night before surgery.Typically the foot is immobilized in a cast for six to eight weeks after surgery at which time the cast is removed and motion exercises are begun.

Because congenital clubfoot can relapse over time, it is important to monitor the condition, especially during the first two or three years of children's lives. Special shoes are necessary until age 3 or 4 to prevent relapse.

Hydrocele Hernia Overview

A hydrocele is a collection of fluid in the scrotum. The baby's scrotum will appear swollen or large and may fluctuate in size throughout the day. A hydrocele usually does not need to be surgically repaired, since it usually goes away on its own within six to 12 months. If the hydrocele does not resolve on its own, then it needs to be surgically repaired to prevent further complications. The surgery takes about an hour and is usually an outpatient procedure.

There are two types of hydroceles:

Communicating Hydrocele - This is a hydrocele that has contact (or communication) with the fluids of the abdominal cavity. A communicating hydrocele is caused by the failure of the processus vaginalis (the thin membrane that extends through the inguinal canal and descends into the scrotum) to close completely during prenatal development. If this membrane remains open, there is a potential for both a hernia and a hydrocele to develop.

Non-communicating Hydrocele - This condition might be present at birth or might develop years later for no obvious reason. A non-communicating hydrocele usually remains the same size or has a very slow growth.

An anesthesiologist (a physician who specializes in pain relief) gives your child general anesthesia, which puts him asleep. A small incision, or cut, (2 cm.) is made in the skin fold of the groin. The hydrocele "sac" containing the fluid is identified. The surgeon empties the fluid from the sac. The sac is removed. The muscle wall is reinforced with stitches to prevent a recurrent hernia or hydrocele.

Usually, children feel fine again the evening after surgery or by the next morning. For four weeks after surgery, your child should avoid straddle toys, climbing, bike riding, roughhousing, etc. Oral pain medication is prescribed at the time of discharge. As soon as the child is able, he can resume normal eating habits and activities. Sponge bath is recommended the day after surgery. Tub baths are permitted two days after surgery.

Some minor swelling can be seen around the incision. This is normal. However, call health care provider should intervene if the child has:

• 1) A fever
• 2) Excessive swelling
• 3) Redness
• 4) Bleeding
• 5) Increasing pain