Wednesday, July 18, 2012

What Is Hypothyroidism? What Causes Hypothyroidism?

Hypothyroidism, also known as underactive thyroid, is a condition in which the thyroid gland, which supplies hormones to keep the metabolism in working order, is not functioning properly. This results in lower-than-required levels of essential hormones that are distributed to the rest of the body - undermining the body's ability to function efficiently. Hypothyroidism generally affects adults, but can affect children too. Often, the term "hypothyroidism" is used incorrectly for either myxedema or congenital hypothyroidism. Hypothyroidism refers to an underactive thyroid gland while hyperthyroidism refers to an overactive thyroid gland.

Myxedema, commonly referred to as advanced hypothyroidism, is a rare, life-threatening condition that can result from long-term undiagnosed hypothyroidism. Women are six times more likely than men to develop this form of hypothyroidism. Myxedema most commonly occurs in adults, while Congenital hypothyroidism is present from birth.

The modern English word "hypothyroidism" is derived from the ancient Greek prefix hypo, meaning "under" and the Greek words thyreos, meaning "shield" and eidos, meaning "shape or form"; hence, the shield-like shape of the thyroid gland, which protects the glottis (in the throat, where the vocal cords are located).

According to Medilexicon's medical dictionary, hypothyroidism means "Diminished production of thyroid hormone, leading to clinical manifestations of thyroid insufficiency, including low metabolic rate, tendency to gain weight, somnolence, and sometimes myxedema."
    The thyroid gland produces three main hormones:

    • Thyroxine (T-4)
    • Triiodothyronine (T-3)
    • Calcitonin
T-3 and T-4 maintain the rate at which our bodies utilize carbohydrates and fats. They also have an impact on our heart rates, and play an important role in protein synthesis. Calcitonin is a hormone that regulates the production of calcium in the blood.

The hypothalamus, a part of the brain that is in charge of hunger, thirst, body temperature, and the pituitary gland (located at the base of the hypothalamus), work together to control the release of T-3 and T-4. The hypothalamus regulates the pituitary gland's production of the thyroid-stimulating hormone (TSH); depending on the levels of T-3 and T-4 found in your bloodstream, the corresponding amount of this hormone is then released into your blood. The thyroid gland then regulates its production of hormones based on how much TSH it receives.

What causes hypothyroidism?

  • Causes of Myxedema (the adult form of this condition):

    • Thyroiditis - an autoimmune inflammation of the thyroid gland
    • Overtreatment for hyperthyroidism (overactive thyroid gland) - radiation or surgery
    • Severe iodine deficiency - resulting in a reduction in the production of thyroid hormones
    • Pituitary gland disorder
    • Lithium
    • Pregnancy - during or after, may seriously affect the fetus

  • Causes of congenital hypothyroidism (present from birth):

    • Iodine deficiency in the mother's diet during pregnancy and in that of the child after birth
    • Defective or absent thyroid gland - for unknown reasons, it doesn't develop normally

What are the risk factors for hypothyroidism?

A risk factor is something that raises the risk of developing a disease or condition. For example, smoking is a risk factor for lung cancer - it raises the risk of developing lung cancer. Old age is a risk factor for many cancers - the older you are, the higher the risk.

The most common risk factors for hypothyroidism are:
  • Being female and over 50 years of age; however anyone can develop hypothyroidism
  • Being treated with radioactive iodine (or other anti-thyroid drugs)
  • Age, people over 60 years of age have a higher risk of developing hypothyroidism
  • A close relative having an autoimmune disease
  • Radiation exposure
  • Thyroidectomy - partial surgical removal of the thyroid

What are the signs and symptoms of hypothyroidism?

The main symptoms of hypothyroidism are fatigue and lethargy. However, most symptoms take years to develop. The slower your metabolism gets, the more obvious the signs and symptoms will become. If hypothyroidism goes untreated, the signs and symptoms could become severe, such as an inflamed thyroid (goiter), slow thought processes, or depression.
  • More common symptoms include:

    • Weight gain
    • Bloated face
    • Dry, pallid, flaky skin
    • Hoarse voice
    • Amplified sensitivity to cold
    • Frail fingernails and hair (eyebrows may become thinned)
    • Constipation
    • Muscle weakness
    • Heavier than usual, or loss of, menstrual period
    • Swollen or stiff joints
    • Stiff, weak, painful muscle aches
    • Higher than usual blood cholesterol level

  • Babies born with congenital hypothyroidism often do not display any signs or symptoms. However, if present, they may include:

    • Jaundice (yellow skin)
    • Swollen face
    • Recurrent choking
    • Bulging tongue
    • Under-development - muscle tone, adult teeth
    • Fatigue
    • Constipation

  • A person with myxedema (advanced hypothyroidism) will experience:

    • Decreased breathing
    • Lower body temperature
    • Hypotension (low blood pressure)
    • Unresponsiveness (can be life-threatening)

How is hypothyroidism diagnosed?

Doctors recommend that pregnant women be tested for hypothyroidism so that if they do have it, they can take iron supplements to prevent the baby from being born with the same condition. Older women are also encouraged to be screened for the disorder annually.

Some doctors will ask the patient if they have experienced any of the symptoms of hypothyroidism or have had any previous issues with the thyroid gland.

Doctors will usually take a blood sample to detect levels of TSH and follow up with a test of thyroxine (T-4) levels. If the level of TSH is above average and the level of T-4 is below average, it means that the hypothalamus and pituitary gland are attempting to compensate for the underactivity of the thyroid by stimulating it with more TSH.

Some patients who do not experience symptoms may still have a mild form of the condition (subclinical hypothyroidism) and thus are encouraged to be screened periodically. If the patient has hypothyroidism, levels of TSH will be high, even if T-4 levels are normal.

In the case of a fetus, the blood samples can be acquired from the umbilical cord.

When a baby is born with congenital hypothyroidism, they must be diagnosed and begin treatment within the first few days. The difference from one day to the next could be the difference between a baby with a reasonably normal upbringing and one with a severe mental handicap.

What are the treatment options for hypothyroidism?

A slow or inactive thyroid gland does not produce enough T-4 (thyroxine). To restore normal body function the patient will need to take a supplement. The supplement is a synthetic thyroid hormone called levothyroxin (levoxyl, synthroid).

After a few weeks on levothyroxin, symptoms are reduced and even reversed in the case of weight gain. However, because hypothyroidism cannot be cured, doctors will urge patients to continue treatment throughout the course of their lives, incrementing the dosage as indicated by periodic checks of TSH levels, which will also help the body adjust to the increase in metabolism.

The good thing about levothyroxin is that it is relatively inexpensive and has practically no side effects. As different brands of levothyroxin have varying dosages it is important to let the doctor know if you change brands. If the patient stops taking levothyroxin at any time, signs and symptoms will return when the body has used up the last dosage of the medication.

Some medications and foods may interfere with the absorption of levothyroxine, so be sure to review this with your doctor.

If diagnosed with subclinical hypothyroidism, that is, your thyroid stimulating hormone (TSH) levels are only slightly elevated, hormone replacement therapy or supplements may do more harm than good. Review treatment options with your doctor.

How can hypothyroidism be prevented?

Hypothyroidism can only be prevented if it is caused by a lack of iodine in the diet, in which case people need to ensure their diet contains sufficient levels of iodine. Below is a list of some foods and their iodine content:
  • Iodized salt - 3,000 micrograms per 100 grams
  • Seafood - 66 micrograms per 100 grams
  • Meat - 32 micrograms per 100 grams
  • Eggs - 26 micrograms per 100 grams
  • Dairy - 13 micrograms per 100 grams
  • Bread/cereals - 10 micrograms per 100 grams
  • Fruits - 4 micrograms per 100 grams
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What Is Ovarian Cancer? What Causes Ovarian Cancer?

Ovarian cancer is any cancerous growth that may occur in different parts of the ovary. The majority of ovarian cancers arise from the epithelium (outer lining) of the ovary. According to the American Cancer Society it is the 8th most common cancer among women in the USA (excluding non-melanoma skin cancers). In the UK ovarian cancer is the fifth most common cancer among females, after breast cancer, bowel cancer, lung cancer and uterine cancer (cancer of the uterus).

Approximately 5,500 women in the UK and 21,000 women in the USA are diagnosed with ovarian cancer each year. Worldwide, around 140,000 women die of ovarian cancer every year.

Tragically, the overall five year survival rate is only 46 per cent in most developed countries (it is lower for more advanced stages). However, according to the National Cancer Institute, if diagnosis is made early, before the tumor has spread, the five year survival rate is nearer 93 per cent. In 2009 scientists in the US said that current tests for diagnosing ovarian cancer are not good enough .

Even modern screening tests for ovarian cancer, which include a blood test for the CA 125 marker, combined with ultrasound, often result in unnecessary surgery and "..are failing to catch early signs of the disease..", a study at the University of Alabama at Birmingham Comprehensive Cancer Center revealed.

What are the ovaries?

The ovary is the female gonad, while the testis is the male gonad. A gonad is a reproductive gland that produces germ cells (gametes). A male sperm is a gamete, and a female egg is also a gamete. Each human gamete has 23 chromosomes, half the number of chromosomes contained in most types of human body cells.

The ovary, also known as the egg sac, is one of a pair of reproductive glands in women. The ovaries are located at either side of the uterus (womb), in the pelvis. Each ovary is about the size and shape of an almond. The ovaries produce ova (eggs) and female hormones, such as estrogen and progesterone. These hormones regulate the menstrual cycle, pregnancy, and control the development of female characteristics, such as body shape, body hair, breasts, etc.

During the female menstrual cycle, which lasts about one month, one egg is released from one of the two ovaries - the egg travels through the fallopian tube and into the uterus. This is known as ovulation.

Cancer of the ovary can spread to other parts of the reproductive system as well as surrounding areas, such as the stomach, vagina and uterus. Ovarian cancer more commonly occurs in women aged 65 or over, but can affect women of any age.

What is cancer?

Cancer is a class of diseases characterized by out-of-control cell growth. There are over 100 different types of cancer that occur in various parts of the body - each is classified by the type of cell that is initially affected.

Usually our cells divide (multiply, form new ones) only when old and dying ones need to be replaced. However, the controls that regulate when a cell divides as well as when a cell should die sometimes become faulty. This may result in cells not dying when they should, while additional cells are still being added - an uncontrolled accumulation of cells. Eventually a mass of cells is formed - a tumor.

Malignant and benign tumors

Tumors that stay in one place and demonstrate limited growth are usually considered to be benign. Malignant, or more dangerous tumors emerge when two things occur:
  • Invasion - the cancerous cell manages to move throughout the body using the blood or lymph systems, destroying healthy tissue - this process is called invasion.

  • Angiogenesis - the cancerous cells manage to divide and grow, making new blood vessels to feed themselves.

When a tumor manages to spread to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a serious condition that is extremely hard to treat.

Three main types of ovarian cancers (tumors)

Epithelial ovarian cancer is by far the most common form of ovarian cancer. Germ cell and stromal ovarian cancers are much less common. Ovarian cancer can also result from a cancer somewhere else in the body that has spread:
  • Epithelial ovarian cancer (epithelial ovarian tumors) - derived from cells on the surface of the ovary. It occurs mainly in adults.

  • Germ cell ovarian cancer (germ cell ovarian tumors) - derived from the egg-producing cells within the body of the ovary. This rare type of cancer more commonly affects children and teenage girls.

  • Stromal ovarian cancer (sex cord stromal tumors) - develops within the cells that hold the ovaries together.

  • Cancers from other organs in the body can spread to the ovaries - metastatic cancers - a metastatic cancer is one that spreads from where it first arose as a primary tumor to other locations in the body.

What are the symptoms of ovarian cancer?

In the early stages, ovarian cancer usually has vague symptoms which are not easy to recognize. In fact, doctors used to think that ovarian cancer had no symptoms (unfortunately, many still do). Even though healthcare professionals are much better at identifying ovarian cancer symptoms these days, patients often attribute their symptoms to other conditions, such as pre-menstrual syndrome, irritable bowel syndrome, or a temporary bladder problem.

The main difference between ovarian cancer and other possible disorders is the persistence and gradual worsening of symptoms. While most digestive disorders have fluctuating symptoms, those of ovarian cancer are more constant and steadily advancing.

The following are examples of possible early symptoms of ovarian cancer:
  • Pain in the pelvis
  • Pain on the lower side of the body
  • Pain in the lower stomach
  • Back pain
  • Indigestion or heartburn
  • Feeling full rapidly when eating
  • More frequent and urgent urination
  • Pain during sexual intercourse
  • Changes in bowel habits, such as constipation
As ovarian cancer progresses these symptoms are also possible:
  • Nausea
  • Weight loss
  • Breathlessness
  • Fatigue (tiredness)
  • Loss of appetite
Ovarian cancer is not a silent killer. A study by the National Breast and Ovarian Cancer Centre, Australia, found that 83% of women experience at least one symptom of ovarian cancer in the year prior to their diagnosis. The researchers also found that 17% of women waited more than three months after the onset of their symptoms before visiting their doctor, with 8% waiting more than six months. The most common symptoms, experienced by half of the study participants, were abdominal symptoms such as fullness and pain. Bloating, bowel or urinary symptoms were reported by approximately one third of participants.

If you experience bloating, pressure or pain in the abdomen or pelvis that persists for more than a few weeks you should see your doctor immediately. If you have already been to the doctor and ovarian cancer was not diagnosed, but treatment is not relieving symptoms, either see your doctor again or get a second opinion. It is important that the evaluation includes a pelvic examination.

People with close family members who have/had ovarian or breast cancer should see a doctor who is trained to detect ovarian cancer.

What are the causes of ovarian cancer?

Although we know that ovarian cancer, like many other cancers, is caused by cells dividing and multiplying in an unordered way, nobody completely understands why cancer of the ovary occurs. We know that the following risk factors are linked to a higher chance of developing the disease:

Family history

Most women who develop ovarian cancer do not have an inherited gene mutation. Women with close relatives who have/had ovarian cancer, as well as breast cancer, have a higher risk of developing ovarian cancer compared to other women. There are two genes - BRCA1 and BRCA2 - which significantly raise the risk. The BRCA1 and BRCA2 genes also raise the risk of breast cancer. Those genes are inherited. The BRCA1 gene is estimated to increase ovarian cancer risk by 35% to 70%, and the BRCA2 by 10% to 30%. People of Ashkenazi Jewish descent are at particularly high risk of carrying these types of gene mutations.

Women with close relatives who have/had colon cancer, prostate cancer or uterine cancer are also at higher risk of ovarian cancer.

Genetic screening can determine whether somebody carries the BRCA1 and/or BRCA2 genes. Although a test for gene mutations known to significantly increase the risk of hereditary breast or ovarian cancer has been available for more than a decade, a study by researchers from Massachusetts General Hospital found that few women with family histories of these cancers are even discussing genetic testing with their physicians or other health care providers.

After eight years of searching, an international team of scientists found that a single nucleotide polymorphisms (SNP) on chromosome 9 that is uniquely linked to ovarian cancer. The scientists estimated that women carrying that particular version of the SNP on both copies of chromosome 9 have a 40 per cent higher lifetime risk of developing ovarian cancer than women who do not carry it on either copy of chromosome 9, while women with only one copy of the variant have a 20 per cent higher lifetime risk of developing ovarian cancer than women who have none.


The majority of ovarian cancers occur in women over 65 years of age. A higher percentage of post-menopausal women develop ovarian cancer compared to pre-menopausal women.

High number of total lifetime ovulations

There is a link between the total number of ovulations during a woman's life and the risk of ovarian cancer. Four principal factors influence the total:
  • Never having been pregnant - women who have never become pregnant have a higher risk of developing ovarian cancer compared to women who have became pregnant. The more times a woman has become pregnant the lower her risk is.

  • Never having taken the contraceptive pill - women who have never been on the contraceptive pill have a higher risk of developing ovarian cancer compared to women who have. Taking the Pill for 15 years halves the risk of ovarian cancer, a study by the Collaborative Group on Epidemiological Studies of Ovarian Cancer found.

  • Early start of menstruation (early menarche) - women who started their periods at an early age have a higher risk of developing ovarian cancer.

  • Late start of menopause - women whose menopause started at a later age than average have a higher risk of developing ovarian cancer.

  • Scientists at the Centers for Disease Control and Prevention (CDC) found that survival among women with ovarian cancer is also influenced by age of menarche (when periods start) and total number of lifetime ovulatory cycles.
Some gynecologic surgeries may reduce the risk

Women who have had their fallopian tubes tied (tubal ligation) are estimated to have a 67% lower risk of ovarian cancer. A hysterectomy is said to reduce the risk by about one third.

Infertility or fertility treatment

Some studies have found a link between infertility treatment and a higher risk of ovarian cancer. Nobody is yet sure whether the risk is linked to infertility treatment, just infertility itself, or both. A Danish study published in the peer-reviewed British Medical Journal concluded that the use of fertility drugs does not increase a woman's risk of developing ovarian cancer. The study involved 54,362 women with infertility problems referred to all Danish fertility clinics between 1963 and 1998.

Breast cancer

Women who have been diagnosed with breast cancer have a higher risk of developing ovarian cancer.

HRT (Hormone replacement therapy)

HRT slightly increases a women's risk of developing ovarian cancer. Experts say the risk grows the longer the HRT continues, and returns to normal as soon as treatment stops. Danish scientists reported that compared with women who have never taken hormone therapy, those who currently take it or who have taken it in the past are at increased risk of ovarian cancer, regardless of the duration of use.

A UK study that was published in the peer-reviewed medical journal The Lancet suggested that between 1991 and 2005, an extra 1,000 women in the UK died of ovarian cancer because they were on Hormone Replacement Therapy.

Foods high in acrylamide

A study in the Netherlands found a link between acrylamide, a carcinogenic compound found in cooked, and especially burned, carbohydrate rich foods, and increased risk of endometrial and ovarian cancer in postmenopausal women.


Being obese or overweight increases the risk of developing many cancers. The more overweight you are, the higher the risk. Several studies have also shown that obese cancer patients are more likely to have faster advancing ones compared to cancer patients of normal weight. Obese older women who have never used hormone replacement therapy have nearly twice the risk of their normal weight peers of developing ovarian cancer, according to a study by the researchers at the National Cancer Institute.


Women who develop endometriosis have an approximately 30% higher risk of developing ovarian cancer compared to other women. Endometriosis is a condition in which cells that are normally found inside the uterus (endometrial cells) are found growing outside of the uterus. Danazol, a medication used to treat endometriosis has been linked to ovarian cancer risk.

Diagnosis of ovarian cancer

There is a tragic myth among many health care professionals and patients in too many countries about early stage ovarian cancer having no symptoms. A UK study, called The Target Ovarian Cancer Pathfinder study which surveyed 400 UK general practitioners and over 1,000 women, including 132 with ovarian cancer, found that 80% of GPs in the UK were wrongly of the view that women have no symptoms in the early stages of ovarian cancer. Studies in countries with top healthcare services have come up with similar findings.

The GP (general practitioner) will carry out a vaginal examination and check for any visible abnormalities in the uterus or ovaries. The doctor will also check the patient's medical history and family history. Further tests will be ordered - these are usually done by a gynecologist - a doctor who specializes in treating diseases of the female reproductive organs.

If the woman is diagnosed with ovarian cancer the doctor will want to identify its stage and grade. The stage of a cancer refers to the cancer's spread while the grade refers to how aggressively it is spreading. By identifying the stage and grade of the cancer the doctor will be able to decide on the best treatment. The stage and grade of ovarian cancer alone cannot predict how it is going to develop.

The following tests are used to diagnose ovarian cancer:
  • Blood test

    There is a cancer marker called CA 125 (cancer antigen 125) which is made by certain cells in the body. A high blood level of CA 125 may indicate the presence of cancer, but could also be due to something else, such as infections of the lining of the abdomen and chest, menstruation, pregnancy, endometriosis, or liver disease. This blood test is just one test among others, designed to help the doctor make a diagnosis. Normal blood levels of CA125 alone do not definitely mean there is no cancer either. They are just indications.

  • Ultrasound

    This is a device that uses high frequency sound waves which create an image on a monitor of the ovaries and their surroundings. A transvaginal ultrasound device may be inserted into the vagina, while an external device may be placed next to the stomach. Ultrasound scans help doctors see the size and texture of the ovaries, as well as any cysts.

  • Laparoscopy and possibly Endoscopy

    A laparoscope - a thin viewing tube with a camera at the end - is inserted into the patient through a small incision in the lower abdomen. The doctor can examine the ovaries in detail, and can also take a biopsy (extract a small sample of tissue for examination). The patient will undergo a general anesthetic for this procedure. The doctor may carry out an endoscopy to determine whether the cancer has spread to the digestive system.

  • Colonoscopy

    If the patient has had bleeding from the rectum, or constipation the doctor may order a colonoscopy to examine the large intestine (colon). The colonoscope - a thin tube with a camera at the end - will be inserted into the rectum.

  • Abdominal fluid aspiration

    If the patient's abdomen is swollen the doctor may decide to carry out this test. A build up of fluid in the abdomen might indicate that the ovarian cancer has spread. A thin needle goes through the skin into the abdomen and a sample of the liquid is extracted. Some of the liquid may be drained into a bag if there is a lot of it (abdominal tap). The fluid is checked in the laboratory for cancer cells.

  • Chest X-ray

    This test will help the doctor see if the cancer has spread to the lungs, or to the pleural space surrounding the lungs.

  • CT (computerized tomography) scan

    X-rays are used to create a 3-dimensional picture of the target area.

  • MRI (magnetic resonance imaging) scan

    Magnets and radio waves produce 2-dimensional and 3-dimensional pictures of the target area.

    Combined positron emission tomography (PET) and computed tomography (CT) scanning of patients in the early stages of ovarian cancer can enable physicians to determine whether the cancer has spread to nearby lymph nodes without having to perform surgery, reported scientists at San Gerardo Hospital, Monza, Italy.

The 4 stages of ovarian cancer

Ovarian cancer is classified into four stages, with stage 4 being the most advanced.
  • Stage 1 - the cancer is confined to one or both ovaries. This is subdivided into three groups:

    • Stage 1a - the cancer is confined to just one ovary (contained inside it).
    • Stage 1b - the cancer is confined to both ovaries (contained inside them).
    • Stage 1c - either 1a or 1b, but there is come cancer on the surface of one or both ovaries, or cancer cells are found in fluid extracted from inside the abdomen during surgery, or the ovary bursts during or before surgery.

  • Stage 2 - the cancer has spread to the uterus, fallopian tubes or some other areas in the pelvis (tummy area). This is subdivided into 3 groups:

    • 2a - the cancer has spread into the uterus (womb) or the fallopian tubes.
    • 2b - the cancer has spread into other tissues in the pelvis, such as the rectum or bladder.
    • 2c - 2a and 2b, and there is cancer on the surface of one or both ovaries, or cancer cells are identified in fluid extracted from inside the abdomen during surgery, or the ovary bursts during or before surgery.

  • Stage 3 - the cancer has spread into the peritoneum (the lining of the abdomen), or to the lymph nodes in the upper abdomen, groin or behind the uterus. Most ovarian cancers are diagnosed at this stage. This stage is divided into three subgroups:

    • 3a - an examination with a microscope of tissue taken from the peritoneum (lining of the abdomen) or the omentum (fatty layer over the top of the intestines) detects cancer cells.
    • 3b - tumor growths are identified in the peritoneum 2cm or smaller.
    • 3c - tumor growths larger than 2cm are identified in the peritoneum. Cancer is found in the lymph nodes in the groin, behind the womb or the upper abdomen.

  • Stage 4 - the cancer has spread beyond the abdomen to other parts of the body, including such organs as the lungs or the liver. If cancer is just found on the surface of the liver, but not inside it, it is still stage 3.

What is the treatment for ovarian cancer?

Treatment for ovarian cancer consists of surgery, chemotherapy, a combination of surgery with chemotherapy, and sometimes radiotherapy. The kind of treatment depends on many factors, including the type of ovarian cancer, its stage and grade, as well as the general health of the patient.

Some studies have indicated that specialized hospitals tend to have better survival rates for ovarian cancer patients, compared to general hospitals. Dutch ovarian cancer patients who were treated at a semispecialized or specialized hospital survived longer than those treated at a general hospital, reported researchers at the University Medical Center Utrecht in The Netherlands.


The surgical removal of the cancer is performed in the vast majority of ovarian cancer cases, and is often the first treatment the patient will undergo.

Unless the ovarian cancer is very low grade, the patient will require an extensive operation that includes the removal of both ovaries, the fallopian tubes, the uterus, nearby lymph nodes, and the omentum (a fold of fatty abdominal tissue). Cancer often spreads into the omentum. In most cases the operation will be carried out by a gynecologic oncologist surgeon - a specialist in surgery for women with cancer of the reproductive organs. This operation, sometimes referred to as a total hysterectomy, will mean that the woman will begin her menopause immediately. Recent research by Canadian scientists found that premature removal of the ovaries increases the risk of lung cancer.

If the cancer is confined to just one of the ovaries the surgeon may just remove the affected ovary and the adjoining fallopian tube. The woman will have a chance of being able to conceive. If both ovaries are removed it will not be possible to conceive.

Surgery for ovarian cancer will require a hospital stay of up to two weeks, plus a recovery period of at least six weeks when the patient gets back home.


Chemotherapy is the use of chemicals (medication) to treat any disease - more specifically in this text, it refers to the destruction of cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing. When health care professionals talk about chemotherapy today, they generally tend to refer more to cytotoxic medication than others. Chemotherapy for ovarian cancer, as well as most other cancers, is used to target cancer cells that surgery cannot or did not remove.

Patients will typically receive a combination of carboplatin (Paraplatin) and paclitaxel (Taxol) intravenously (injected into the bloodstream). As it is injected into the bloodstream it can target cancer cells in the reproductive system, as well as any cancer cells that may have reached elsewhere in the body.

Treatment usually involves 6 to 12 chemotherapy sessions which will be given three to four weeks apart so that the body has time to recover. One session usually consists of a 3-hour gradual injection of the medicine into the body; sometimes it may be extended to 24 hours. Extended injections require an overnight stay in hospital.

Compounds in cranberries may help improve the effectiveness of platinum drugs that are used in chemotherapy to fight ovarian cancer, scientists at Rutgers University found.

Monitoring response to chemotherapy

Tests will be carried out to determine how well the chemotherapy is working. This will include blood tests to see if levels of CA125 have dropped, and imaging scans to see if tumors have shrunk. Sometimes the surgeon may want to have another look inside.

The patient will be in remission if all tests are clear of cancer. In remission means the cancer is under control.

If cancer is still present after chemotherapy treatment doctors will switch to other treatments. Patients who did not respond well to a specific type of chemotherapy treatment are unlikely to respond well if the same treatment is done again. This may involve another type of chemotherapy, such as intraperitoneal chemotherapy, in which the medication is aimed at the stomach, or radiotherapy.

Researchers in the Duke Comprehensive Cancer Center reported that the addition of a chemotherapeutic drug for leukemia - dasatinib (Sprycel) - to a standard regimen of two other chemotherapy drugs appears to enhance the response of certain ovarian cancers to treatment, according to a pre-clinical study. Study leader, Deanna Teoh, M.D. said "These findings indicate that we may be able to direct the use of a targeted therapy like dasatinib based on gene expression pathways in select ovarian cancers."

Side effects of chemotherapy

Chemotherapy targets rapidly dividing cells. Unfortunately, healthy rapidly dividing cells, such as red and white blood cells and hair follicles may also be affected. The severity and types of side effects depend on the type of medication, number of treatments, and some aspects of the patient and their general health. This may result in the following side effects:
  • Nausea, vomiting - medication for this may be given intravenously during chemotherapy sessions.
  • Diarrhea.
  • Hair loss.
  • Loss of appetite.
  • Mouth sores.
  • Anemia.
  • Infections because the white blood cell count is low (leucopenia).
In the vast majority of cases the damaged healthy cells repair themselves rapidly after treatment is over and the side-effects will soon disappear.


Radiation is not the mainstay of ovarian cancer treatment - it is not generally considered effective for ovarian cancer. It may be used if there are small traces of cancer in the reproductive system, or to treat the symptoms of advanced cancer. External radiotherapy may be used to clear traces of cancer left after chemotherapy, while internal radiotherapy may be used for advanced cancer. Radiotherapy may cause the following symptoms; some symptoms may not appear until a long time after treatment is over:
  • Bladder infections
  • Diarrhea
  • Constipation
  • Irritation, darkening of your skin that the radiation beams hit
  • Nausea
  • Frequent urination
  • Abdominal pain
Diptheria toxin-enconding DNA

Scientists at Lankenau Institute for Medical Research found that nanoparticle delivery of diphtheria toxin-encoding DNA selectively expressed in ovarian cancer cells reduced the burden of ovarian tumors in mice. Lead researcher, Janet Sawicki, Ph.D said "We now have a potential new therapy for the treatment of advanced ovarian cancer that has promise for targeting tumor cells and leaving healthy cells healthy.".
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Mother Gives Birth To Twins With Different Fathers, US

11-month old Dallas-born twins Justin and Jordan have different fathers, a phenomenon known as heteropaternal superfecundation that is so rare there are only a handful of documented cases in the world.

Their parents Mia Washington and her fiancée James Harrison went public with their news last week when they contacted FOX4 to tell their story.

Admitting she was having an affair with another man at the time the twins were conceived, Washington said she was shocked that it had happened to her:

"I have twins, but they're by different fathers," she told the TV news company.

Washington and Harrison noticed that the twins had different facial features and decided to have a paternity test. They went to Dallas DNA Lab Clear Diagnostics who said they had never seen a result like this before and that there was a 99.999 per cent chance that Justin and Jordan were fathered by different men.

The highly probable result is that Jordan is Harrison's biological son and Justin's biological father is the man Washington had an affair with.

Lab Clear Diagnostics' president Genny Thibodeaux described the news as "very crazy", and "most people don't believe it can happen".

Dr Chris Dreiling, from the Paediatric Association of Dallas, who has not met the family, told Fox News that a woman can release more than one egg during ovulation, and if she has intercourse with more than one partner at around that time, then sperm from different partners can fertilize each egg:

"Because sperm cells take a while to travel and eggs take a while to travel there can be an overlap," said Dreiling, explaining that it was a very rare event and likely to be "the only time that we will ever see this occur in the city of Dallas".

Harrison said he will bring up the two boys as his own. He said he has forgiven his fiancée and promised to stay with her.

He said they are taking it day by day, "it's going to take time to build that trust like we had", he added.

Washington said she felt wary at first, thinking he would try but then give up and leave. But she said that has not happened.

"James is a good man; he's a great father and genuinely loves both of the twins," said Washington, adding that as far as she was concerned he was the father of both boys because "he's the one there every morning when they get up and every night when they go to sleep".

Washington said she regrets her mistake and wants other people to know that this can happen.

"Don't put yourself in my shoes, because it can hurt and it does hurt, but you still have to go on with life". She had this advice for other women:

"Be careful about starting an affair - look what happened to me. Think hard about the consequences first, because the most bizarre things can happen when you least expect it!"

Washington said she will tell her sons about their different DNA when they are old enough to understand. She has no plans to tell the other father, although she did say "if when he is older Justin wants to meet his real dad then that's his decision".

Although rare in humans, heteropaternal superfecundation is more common in other animals such as cats and dogs, a fact that is well known to professional breeders. Some kennel clubs for instance allow the registration of litters to more than one male dog or "sire", a phenomenon called "multi-siring", and you can purchase DNA test kits from them for that purpose.

Sources: myFox DALLAS/FORTWORTH, Daily Mail, American Kennel Club.
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What Is Cervical Cancer? What Causes Cervical Cancer?

Cervical cancer, or cancer of the cervix, is cancer of the entrance to the uterus (womb). The cervix is the narrow part of the lower uterus, often referred to as the neck of the womb. Cervical cancer occurs most commonly in women over the age of 30.

The American Cancer Society estimates that 11,270 diagnoses of cervical cancer will be made by the end of 2009 in the USA. Over 4,000 women in the USA die from cervical cancer each year.

The National Health Service (NHS), UK, says that over 3,000 women are diagnosed with cervical cancer each year in the UK. Cervical cancer caused 941 deaths in the UK in 2007. According to the World Health Organization (WHO) at least 200,000 women worldwide die of cervical cancer each year. WHO adds that if the HPV vaccine is administered globally, hundreds of thousands of lives each year could eventually be saved.

Cancer research UK reported that the rate of women diagnosed with the cervical cancer in the UK has halved from 16 per 100,000 in 1988 to 8 per 100,000 according to the latest figures - the NHS (National Health Service) Cervical Screening Programme began in 1988.

What is the cervix?

The cervix, or the neck of the womb, and the womb are both parts of a female reproductive system. The female reproductive system consists of:
  • Vagina
  • Womb (uterus), which includes the cervix
  • Ovaries
Women have two ovaries, one on either side of the lower abdomen (pelvis). Each month one of the ovaries produces an egg. Each ovary is connected to the uterus by a tube called the Fallopian tube.

In between each menstrual period an egg travels down one of the fallopian tubes and into the uterus. They alternate - one month may be the left side, and the next month the right side. When the egg enters the womb its lining thickens in preparation; in case the egg is fertilized by a man's sperm. If fertilization does not occur the thickened lining of the uterus is shed - a period (menses) occurs.

The cervix is the opening from the uterus to the vagina. It is a tight muscle that is normally firmly shut, with a small opening to allow the sperm through and the flow from a menstrual period. During labor (childbirth) the cervix opens.

There are two main types of cervical cancer

  • Ectocervix - flat cells - squamous cell cervical cancer

    The ectocervix is the portion of the cervix that projects into the vagina, also known and the portio vaginalis. It is about 3 cm long and 2.5 cm wide. There are flat cells on the outer surface of the ectocervix. These fish scale-like cells can become cancerous, leading to squamous cell cervical cancer.

    Squamous cells - flat cells that look like fish scales. The word comes from Latin "squama" meaning "the scale of a fish or serpent". Our outer-layer skin cells are squamous cells, as well as the passages of the respiratory and digestive tracts, and the linings of hollow internal organs.

  • Endocervix - glandular cells - adenocarcinoma of the cervix

    The endocervix is the inside of the cervix. There are glandular cells lining the endocervix; these cells produce mucus. These glandular cells can become cancerous, leading to adenocarcinoma of the cervix.

    Adenocarcinoma - any cancer that develops in the lining or inner surface of an organ.
Transformation zone

This is where cervical cells are most likely to become cancerous. The transformation zone is located around the opening of the cervix, leading on to the endocervical canal (narrow passageway running up the cervix into the uterus). During cervical screening doctors and nurses will focus on this area.

What are the symptoms of cervical cancer?

Often during the early stages people may experience no symptoms at all. That is why women should have regular cervical smear tests.

The most common symptoms are:
  • Bleeding between periods
  • Bleeding after sexual intercourse
  • Bleeding in post-menopausal women
  • Discomfort during sexual intercourse
  • Smelly vaginal discharge
  • Vaginal discharge tinged with blood
  • Pelvic pain

What are the causes of cervical cancer?

Cancer is the result of the uncontrolled division of abnormal cells. Most of the cells in our body have a set lifespan; when they die new cells are produced to replace them. Abnormal cells can have two problems: 1. They don't die. 2. They continue dividing. This results in an excessive accumulation of cells which eventually form a lump - a tumor. Scientists are not completely sure why cells become cancerous. However, there are some risk factors which are known to increase the risk of developing cervical cancer. These risk factors include:
  • HPV (human papilloma virus)

    Human papilloma virus infection is a sexually transmitted virus. There are over 100 different types of HPVs - 15 types can cause cervical cancer; probably 99% of them. In addition there are a number of types which can cause genital warts. It is estimated that HPV types 16 and 18 cause about 70% of cases cervical cancer while HPV types 6 and 11 cause 90% of genital warts.

    Other HPV types can cause cervical intra-epithelial neoplasia (CIN) - the growth of abnormal cells on the surface of the cervix.

  • Many sexual partners, becoming sexually active early

    Cervical cancer-causing HPV types are nearly always transmitted as a result of sexual contact with an infected individual. Women who have had many sexual partners generally have a higher risk of becoming infected with HPV, which raises their risk of developing cervical cancer. There is also a link between becoming sexually active at a young age and a higher risk of cervical cancer.

    If a woman develops cervical cancer it does not mean she had several sexual partners, or became sexually active earlier than most other females. It is just a risk factor. Women who only ever had one sexual partner can develop cervical cancer.

  • Smoking

    Smoking increases the risk of developing many cancers, including cervical cancer.

  • Weakened immune system

    People with weakened immune systems, such as those with HIV/AIDS, or transplant recipients taking immunosuppressive medications have a higher risk of developing cervical cancer.

  • Certain genetic factors

    Scientists at Albert Einstein College of Medicine of Yeshiva University found that women with certain gene variations appear to be protected against cervical cancer.

  • Long-term mental stress

    A woman who experiences high levels of stress over a sustained period may be undermining her ability to fight off HPV and be at increased risk of developing cervical cancer it can cause, scientists at the Fox Chase Cancer Center reported.

  • Giving birth at a very young age

    Women who gave birth before the age of 17 are significantly more likely to develop cervical cancer compared to women who had their first baby when they were aged 25 or over.

  • Several pregnancies

    Women who have had at least three children in separate pregnancies are more likely to develop cervical cancer compared to women who never had children.

  • Contraceptive pill

    Long-term use of the contraceptive pill slightly raises a woman's risk.

  • Other sexually transmitted diseases (STD)

    Women who become infected with chlamydia, gonorrhea, or syphilis have a higher risk of developing cervical cancer. Scientists at the Medical University of South Carolina found that HPV infections last longer if Chlamydia also is present.

  • Socio-economic status

    Studies in several countries have revealed that women in deprived areas have significantly higher rates of cervical cancer, compared to women who live in other areas. Studies have also found higher rates in women of working age in manual jobs, compared to women in non-manual jobs. The most likely reason is a difference in the proportion of women who have regular screening. Scientists at King's College London found that some areas in South East England had rates that were three times higher than neighbouring areas.

How is cervical cancer diagnosed?

The earlier cervical cancer is diagnosed the more successfully it can be treated.
  • Cervical screening - LBC or Pap smear test

    In the USA over 11,000 women are diagnosed with invasive cervical cancer each year and about 4,000 die of it. The majority of these deaths could be prevented if all women had undergone cervical screening. US authorities say a female should start screening at the age of 21, or within three years of her first sexual encounter - whichever occurs first.

    The test looks for abnormal changes in the cells of the cervix. If left untreated some abnormal cells can eventually develop into cancer. Cervical screening does not detect cancer.

    Cervical screening used to be the old pap smear test - which is still used in many parts of the world. More recently, testing using LBC (liquid based cytology) has become more commonplace. A sample of cells is taken from the cervix. The doctor or nurse inserts a speculum - an instrument used to widen the opening of the vagina so that the cervix is more easily visible - and uses a spatula which is brushed around the cervix. The procedure is just mildly uncomfortable for the majority of women. If abnormal cells are there, there is a good chance they will be detected, but not not always.

      What is LBC (liquid based cytology)?

      Cytology is the medical and scientific study of cells - diagnosing diseases and conditions by examining tissue samples (cell samples) from the body. With liquid based cytology the sample is collected in much the same way as a conventional smear. However, instead of smearing the sample onto a microscope slide, the head of the brush where the sample cells are caught is broken off and placed in a small glass vial which contains preservative fluid - sometimes it can be rinsed directly into the preservative fluid. In the laboratory it is spun and treated to remove mucus, pus and other materials. A random sample of the remaining cells is taken. A thin layer of the cells is placed on a microscope slide and examined.
    The test is not designed for diagnosing cancer. It is designed to check the health of the cervix and to detect early changes in the cells, which could develop into cancer in the future.

    The best time to have the test is in the middle of the menstrual cycle - between periods.

    If the test results show abnormal cells in the cervix the doctor will refer the patient to a gynecologist. In the UK the patient may also be referred to a nurse colposcopist.

  • HPV DNA test - also known as just "HPV test". This test determines whether the patient is infected with any of the HPV types that are most likely to cause cervical cancer. This involves collecting cells from the cervix for lab testing. The test can detect high risk HPV strains in cell DNA before any cervix cell abnormalities appear. A British study found that the combination of HPV testing with regular liquid-based cytology (LBC) screening does not improve the detection of cervical cancer compared with LBC screening alone. An eight-year trial involving more than 130,000 women published in The New England Journal of Medicine found that that in low-resource settings a single round of HPV testing significantly reduces the numbers of advanced cervical cancers and deaths, compared with Pap (cytology) testing.
If the patient experiences signs and symptoms of cervical cancer, or if the Pap test revealed abnormal cells, the patient may undergo additional tests:
  • Biopsy - a small piece of tissue will be taken. The patient will be anesthetized for this.

  • Colposcopy - this is performed in the doctor's office. A speculum is placed to hold the vagina open and the gynecologist looks at the cervix through a colposcope - a lighted magnifying instrument specifically designed for examining the tissues of the vagina and the cervix. If the doctor is still unable to see the abnormal area clearly a cone biopsy or LETTZ may be done.

  • Cone biopsy - a small cone-shaped section of the abnormal tissue is taken from the cervix for examination under a microscope. The patient is usually under local anesthetic; sometimes general anesthetic is used. The biopsy may indicate whether the abnormal cells are CIN 1, 2 or 3, or whether deeper levels of the cervix are affected.

  • LLETZ - a diathermy (wire loop with an electric current) is used to remove abnormal tissue. The tissue is sent to the lab to be checked. This is a common treatment for CIN.

  • Blood tests - a blood test will reveal the number of blood cells, as well as identifying any liver or kidney problems.

  • Chest x-ray - this is to determine the health of the patient's lungs and heart.

  • Examination under anesthetic (EUA) - this allows the doctor to examine the vagina and cervix more thoroughly. The patient is under a general anesthetic. The doctor may also check the bladder with a cystoscope, or/and the colon and rectum with a procto-sigmoidoscope to determine whether the cancer has spread. During this whole procedure the doctor may take a biopsy of the bladder, colon/rectum and the lining of the uterus.

  • CT (computerized tomography) scan - a CT scanner emits a series of narrow beams through the human body as it moves through an arc, unlike an X-ray machine which sends just one radiation beam. The final picture is far more detailed than an X-ray one. Inside the CT scanner there is an X-ray detector which can see hundreds of different levels of density. It can see tissues inside a solid organ. This data is transmitted to a computer, which builds up a 3-D cross-sectional picture of the part of the body and displays it on the screen. The doctor will have a much better idea of the size and position of the cancer.

    The patient will have to have a barium drink beforehand. The barium appears white on the scan. Just before the scan a tampon may be placed into the vagina, and a barium liquid may be placed into the rectum. The whole scan takes from 10 to 30 minutes.

  • MRI (magnetic resonance imaging scan) - an MRI does not use X-rays; it uses magnets and radio waves to build up cross-sectional images of the targeted part of the body. The patient lies very still on a couch inside a long tube which enters a doughnut-like machine. As the machine can become noise patients will usually be given earphones so that they can listen to music - some may even let you bring your own tunes. All metal items should be removed beforehand because the MRI machine is a powerful magnet. If you have any metal in your body, such as a pacemaker or surgical clips you cannot have an MRI scan. By using high-MRI with a special vaginal coil, a technique to measure the movement of water within tissue, researchers may be able to identify cervical cancer in its early stages, researchers at Cancer Research UK Clinical Magnetic Resonance Research Group reported.

  • Pelvic ultrasound - this is a device that uses high frequency sound waves which create an image on a monitor of the target area. The patient will be asked to drink plenty of fluids beforehand so that the bladder is full and a clear picture can be viewed. A transvaginal ultrasound device may be inserted into the vagina, or an external device may be placed next to the stomach.

  • Pretreatment MRI and PET/CT for cervical cancer may direct more women to optimal therapy choices and spare many women potential long-term morbidity and complications of trimodality therapy (surgery followed by chemoradiation), according to a study performed at the Institute for Technology Assessment in Boston.

What are the stages of cervical cancer?

After carrying out the various tests the doctor will determine the stage of the cancer. The stage of a cancer refers to how far it has spread. Determining the stage of the cancer is important because it is the main factor in deciding on treatment options. Cancers have various staging systems. In cervical cancer, stages are numbered from 0 to 4. If you have CIN it means you have abnormal cells, it is not the same as cervical cancer and the stages below do not apply, except for perhaps stage 0.
  • Stage 0 - Carcinoma in situ (stage 0)

    Even though there are only abnormal cells on the surface layer of the cervix and this is not considered to be part of the cervical cancer staging system, many doctors will call this Stage 0. It is not an invasive cancer; the cells have not left the area where they started to grow. This is the same as CIN 3.

  • Stage 1 cervical cancer

    The cancer is only in the cervix (the neck of the uterus, womb). This stage is divided into:

    • Stage 1A - cancer is microscopic; it can only be viewed through a microscope. This stage is divided into two:
      1A1 - cancer has grown into less than 3 mm of the cervical tissue, and is less than 7mm wide.
      1A2 - cancer has grown 3-5mm into cervical tissue, and is less than 7mm wide.

    • Stage 1B - cancer is larger and is usually visible with the naked eye, but is confined to the cervical tissue and has not spread. This stage is divided into two:
      1B1 - cancer is no larger than 4cm.
      1B2 - cancer is larger than 4cm.
    This stage of cervical cancer is generally treated with surgery or radiotherapy. For patients at Stage 1B2 a combination of chemotherapy and radiotherapy may be recommended sometimes.

  • Stage 2 cervical cancer

    The cancer includes the cervix and uterus, but has not yet spread into the pelvic wall or lower portions of the vagina. It is divided into two stages:

    • Stage 2A - the cancer has reached the top of the vagina.
    • Stage 2B - the cancer has reached tissue around the cervix.
    Treatment for Stage 2A usually consists of surgery or radiotherapy, and sometimes both. Treatment for Stage 2B invariably consists of a combination of radiotherapy and chemotherapy.

  • Stage 3 cervical cancer

    The cancer has spread beyond the cervix and uterus and has reached the surrounding structures of the pelvic area, the lower portion of the vagina, and the pelvic wall (muscles and ligaments that line the pelvis). The cancer growth may have blocked the ureter (the tube that carries urine from the kidneys to the bladder). It is divided into two stages:

    • Stage 3A - the cancer has reached the lower third of the vagina, but not the pelvic wall.
    • Stage 3B - the cancer has grown through the pelvic wall, or is blocking one ureter or both of them.
    The most common treatment option for this stage is a combination of chemotherapy and radiotherapy.

  • Stage 4 cervical cancer

    Advanced cancer; the cancer has spread to nearby organs, such as the bladder or rectum, or it has spread further into other parts of the body, such as the liver, lungs or bones. This is divided into two stages:

    • Stage 4A - the cancer has reached the bladder or rectum (nearby organs).
    • Stage 4B - the cancer has spread further, possibly including the lungs, liver or bones.

What are the treatment options for cervical cancer?

It is important to ask questions about any aspects of your treatment that you are not sure about, or anything that worries you. Talking about the benefits and disadvantages of various options with an expert, such as a gynecologist, gynecological nurse or your GP (general practitioner, primary care physician) will help you understand the process. Some people find it useful to write down a list of questions, while others appreciate the company and support of a relative or close friend when they go to the doctor.

Cancer treatments can sometimes be complex and bewildering and not that straightforward for lay people to figure out. Doctors and health care professionals are used to people asking questions, and they should also be used to and should not mind explaining things again and again. Even if you worry that the hospital staff may be too busy to answer your questions, they should be eager to answer your them thoroughly so that you know how the therapies may possibly affect you.

Cervical cancer treatment options include surgery, radiotherapy, chemotherapy, or combinations. Deciding on the kind of treatment depends on several factors, such as the stage of the cancer, as well as the patient's age and general state of health.

Treatment for early stage cervical cancer - cancer that is confined to the cervix - has a success rate of 85% to 90%. The further the cancer has spread out of the area it originated from, the lower the success rate tends to be.

Early stage cancer treatment options

Surgery is commonly used when the cancer is confined to the cervix. Radiotherapy may be used after surgery if the doctor believes there may still be cancer cells inside the body. Radiotherapy may also be used to reduce the risk of recurrence (cancer coming back). If the surgeon wants to shrink the tumor in order to make it easier to operate, the patient may receive chemotherapy - however, this is not so common.

The options for surgery in the early stages may include:
  • Cone biopsy (conization) - this procedure may also be used to remove any abnormality. The surgeon uses a scalpel to remove a cone-shaped piece of cervical tissue.

  • Laser surgery - a narrow beam of intense light destroys cancerous and precancerous cells.

  • LEEP (loop electrosurgical excision procedure) - a wire loop which has an electric current cuts through tissue removing cells from the mouth of the cervix.

  • Cryosurgery - cancerous and precancerous cells are destroyed by freezing them.

  • Hysterectomy - the cancerous and precancerous areas, as well as the cervix and the uterus are surgically removed. This is not common and is only done in certain cases of noninvasive cervical cancer.
Advanced cancer

When the cancer has spread beyond the cervix surgery is not usually an option. Advanced cancer is also referred to as invasive cancer because it has invaded other areas, not just where it started off. This type of cancer requires more extensive treatment. The patient will typically be treated with either radiotherapy or a combination of radiotherapy and chemotherapy. In the later stages of cancer palliative therapy is administered to relieve symptoms and improve quality of life.
  • Radiotherapy

    Radiotherapy is also known as radiation therapy, radiation oncology and XRT. It is used for treating cancer, thyroid disorders and some blood disorders. Approximately 40% of cancer patients undergo some kind of radiotherapy. It involves the use of beams of high-energy X-rays or particles (radiation) to destroy cancer cells. Radiotherapy works by damaging the DNA inside the tumor cells, destroying their ability to reproduce.

    This may be delivered externally or internally (brachytherapy) by placing radioactive material near the cervix. For patients with advanced cervical cancer radiation combined cisplatin-based chemotherapy is the most effective treatment, according to gynecologic oncologists.

    Radiation that is aimed in the pelvic area may cause the following side effects; some of them may not emerge until well after the treatment is over:

    • Diarrhea
    • Nausea
    • Upset stomach
    • Bladder irritation
    • Narrowing of the vagina
    • Interrupted menstrual cycle
    • Early menopause

  • Chemotherapy

    Chemotherapy is the use of chemicals (medication) to treat any disease - more specifically in this text, it refers to the destruction of cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing. When health care professionals talk about chemotherapy today, they tend to refer more to cytotoxic medication than others. Chemotherapy for cervical cancer, as well as most other cancers, is used to target cancer cells that surgery cannot or did not remove, or to help the symptoms of patients with advanced cancer.

    Cisplatin, a chemotherapy drug, is frequently used in combination with radiotherapy.

    Side effects of chemotherapy may vary, and depend a lot on the specific drug being used. Below is a list of the more common side effects:

    • Diarrhea
    • Nausea
    • Hair loss
    • Fatigue
    • Infertility
    • Early menopause

  • Clinical trials

    For some patients, participating in a clinical trial may be their best treatment option. Many current treatments are the results of clinical trials. Clinical trials are an integral part of the cancer research process. A clinical trial is carried out to determine how safe and effective new treatments are, and whether they are better than existing ones.

    A participant in a clinical trial may either receive the standard treatment, or the new treatment. A clinical trial compares a number of patients on the new treatment to a group of patients on an existing treatment. Sometimes a clinical trial may also have a group of patients taking a placebo (dummy drug).

    Clinical trial participants contribute to cancer research and innovation.

Prevention of cervical cancer

  • HPV (human papilloma virus) vaccine

    The link between the development of cervical cancer and some types of HPV is clear. At least 70% of all cases of cervical cancer occur because of 2 types of HPVs for which there is a vaccine. If every female adheres to current HPV vaccination programs the total number of female deaths from cervical cancer globally will drop by hundreds of thousands each year.

    Public health authorities in most countries now offer the HPV vaccine as part of their childhood immunization program. UK authorities say girls should be given the vaccine when they are 12 to 13 years of age - in three doses over a six month period.

  • Safe sex

    The HPV vaccine only protects against two HPV strains. There are others which can cause cervical cancer. Using a condom during sex helps protect from HPV infection. HPV is a sexually transmitted infection.

  • Cervical screening

    Regular cervical screening will make it much more likely that signs are picked up early on and dealt with before cancer develops at all or too far.

  • Have few sexual partners

    The more sexual partners a woman has the higher is her risk of developing cervical cancer.

  • Delay first sexual intercourse

    The younger a female is when she has her first sexual intercourse the higher is her risk of developing cervical cancer. The longer she delays it, the lower her risk.

  • Don't smoke

    People who smoke have a higher risk of developing cervical cancer than people who don't. If you are concerned about the anxiety and stress of quitting smoking, ask your doctor to help you. There are many help groups - research indicates that quitting smoking can be achieved more successfully if you have support.
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What Is Jaundice? What Causes Jaundice? What Is Icterus?

Jaundice, also known as icterus, is a term used to describe a yellowish tinge to the skin and sclerae (the white part of the eye) that is caused by hyperbilirubinemia (an excess of bilirubin in the blood). Body fluids may also be yellow. The color of the skin and sclerae varies depending on levels of bilirubin; mildly elevated levels display yellow skin and sclerae, while highly elevated levels display brown.

Bilirubin (bil-ih-ROO-bin) is a yellow colored substance that is responsible for the yellowing of the skin and sclerae. Bilirubin is a waste product that remains in the bloodstream after the iron is removed from the hemoglobin, which is released from the degradation of erythrocytes (cells that contain hemoglobin and can carry oxygen to the body). When there is an excess of bilirubin it may leak out into surrounding tissues, saturating them with this yellow substance.

Bilirubin that is circulating freely in the blood is called unconjugated bilirubin. One of the liver's functions is to filter out waste, such as bilirubin, from the blood. Once it is in the liver, other chemicals latch on to the bilirubin, creating a substance called conjugated bilirubin, which is secreted in bile (a digestive juice released by the liver) and then excreted. Bilirubin is what gives feces its brown color.

The modern English word "jaundice" is derived from the middle French word jaunisse. Jaun means "yellow" and -isse means "-ness"; hence the middle French word jaunisse, which means "yellowness".

According to MediLexicon's medical dictionary, jaundice is:
"A yellowish staining of the integument, sclerae, deeper tissues, and excretions with bile pigments, resulting from increased levels in the plasma."

There are three main types of jaundice:

  • Hepatocellular jaundice - a type of jaundice that occurs as a result of liver disease or injury.

  • Hemolytic jaundice - a type of jaundice that occurs as a result of hemolysis (an accelerated breakdown of erythrocytes - red blood cells) leading to an increase in production of bilirubin.

  • Obstructive jaundice - a type of jaundice that occurs as a result of an obstruction in the bile duct (a system of tubes that carries bile from the liver to the gallbladder and small intestine), which prevents bilirubin from leaving the liver.
Jaundice, not to be confused with infant jaundice, is usually a sign of an underlying disorder.

What causes jaundice?

Jaundice most often occurs as a result of an underlying disorder that either causes tissues to become over-saturated with bilirubin or prevents the liver from disposing of bilirubin.

Some underlying conditions that may cause jaundice are:
  • Acute inflammation of the liver - may impair the ability of the liver to conjugate and secrete bilirubin, resulting in a buildup of bilirubin.

  • Inflammation of the bile duct - may prevent the secretion of bile and removal of bilirubin, causing jaundice.

  • Obstruction of the bile duct - prevents the liver from disposing of bilirubin, which results in hyperbilirubinemia.

  • Hemolytic anemia - Production of bilirubin increases when large quantities of erythrocytes are broken down.

  • Gilbert's syndrome - an inherited condition that impairs the ability of enzymes (biomolecules that provoke chemical reactions between substances) to process the excretion of bile.

  • Cholestasis-a condition in which the flow of bile from the liver is interrupted. The bile containing conjugated bilirubin remains in the liver instead of being excreted.
More rare conditions that may cause jaundice include:
  • Crigler-Najjar syndrome - an inherited condition that impairs the specific enzyme responsible for processing bilirubin, resulting in an excess of bilirubin.

  • Dubin-Johnson syndrome - an inherited form of chronic jaundice that prevents conjugated bilirubin from being secreted out of the liver's cells.

  • Pseudojaundice - a harmless form of jaundice in which the yellowing of the skin results from an excess of beta-carotene, not from an excess of bilirubin; usually from eating lots of carrots, pumpkin, or melon.

What are the signs and symptoms of jaundice?

The most pervasive sign of jaundice is a yellow tinge to the skin and sclerae (whites of the eyes). This usually starts at the head and spreads down the body.

Other symptoms of jaundice include:
  • Pruritis (itchiness)
  • Fatigue
  • Abdominal pain - typically indicates a blockage of the bile duct.
  • Weight loss
  • Vomiting
  • Fever
  • Paler than usual stools
  • Dark urine

How is jaundice diagnosed?

Doctors will most likely diagnose jaundice based on the patient's history and a physical exam, paying close attention to the abdomen. Doctors will be feeling for masses (tumors) in the abdomen and/or checking the firmness of the liver; a firm liver indicates cirrhosis, while a rock-hard liver indicates cancer.

The severity of jaundice is determined by several tests, the first of which is a liver function test to find out whether or not the liver is functioning properly.

If the cause of your symptoms cannot be identified, your doctor may require blood tests to check levels of bilirubin and evaluate the composition of the blood. Some of these tests include:
  • Bilirubin tests - a high level of unconjugated bilirubin relative to levels of conjugated bilirubin indicate hemolysis (accelerated break down of erythrocytes)

  • Full blood count (FBC), or complete blood count (CBC) - measures levels of erythrocytes (red blood cells), leukocytes (white blood cells), and thrombocytes (platelets).

  • Hepatitis A, B, and C tests
If an obstruction of the liver is suspected, the liver's structure will be looked at with the help of imaging tests. Some of these tests include:
  • Magnetic resonance imaging (MRI) - uses magnetic signals to create image "slices" of the soft tissues of the human body. MRIs can also be manipulated in such a way that the cause and location of a bile duct obstruction can be identified.

  • Abdominal ultrasonography (ultrasound) - uses high frequency sound waves to create a two-dimensional image of the soft tissues inside the human body. It is especially useful in identifying gallstones, although tumors and dilated bile ducts may also show.

  • Computerized tomography (CT) scan, or computerized axial tomography (CAT) scan - uses a thin X-ray beam to create image "slices" of soft tissues in the body. It is especially useful in identifying tumors and dilated bile ducts.

  • Endoscopic retrograde cholangiopancreatography (ERCP) - the patient swallows an endoscope (a tube) that reaches down to the bile duct. An x-ray contrast solution is then secreted to reveal the contrast-filled bile duct in an x-ray. This imaging test is the most useful in identifying the cause and location of a bile duct obstruction.
A liver biopsy is particularly useful in checking for inflammation, cirrhosis, cancer, and fatty liver. This test involves injecting a needle through the skin and into the liver to obtain a sample of the tissue, which is examined under a microscope.

What are the treatment options for jaundice?

Treatment of jaundice typically requires a diagnosis of the specific cause in order to select suitable treatment options. Treatment would target the specific cause, rather than the jaundice itself.

Anemia-induced jaundice may be treated by increasing the amount of iron in the blood; either by taking iron-supplements or eating more iron-rich foods.

Hepatitis-induced jaundice may be treated with anti-viral or steroid medications.

Obstruction-induced jaundice may be treated via surgery to remove the obstruction.

Medication-induced jaundice is treated by selecting an alternative medication and by discontinuing medications that caused jaundice.

What complications could occur from jaundice?

The symptom pruritis (itching) can sometimes be so intense that patients scratch their skin raw, have insomnia, or even commit suicide.

Most complications that arise are a result of the underlying cause of jaundice, not from jaundice itself. For example, jaundice caused by a bile duct obstruction may lead to uncontrolled bleeding due to a deficiency of vitamins needed for normal blood clotting.

How can jaundice be prevented?

Jaundice is related to the function of the liver, so it is essential that you maintain this vital organ's health by eating a balanced diet, exercising at least 30 minutes five times a week, and refraining from exceeding recommended amounts of alcohol.
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What Is Exophthalmos? What Causes Exophthalmos?

Exophthalmos, or exophthalmia, is a protruding eyeball anteriorly out of the orbit (eye socket). The Greek word ophthalmos means "eye" and the Greek word ex means "out". Exophthalmos can be either bilateral (both eyes bulge out) or unilateral (just one eye bulges out). Doctors use an exophthalmometer to measure the degree of exophthalmos.

Depending on the severity of the exophthalmos, if it is left untreated the eye lids may fail to close during sleep, resulting in corneal dryness and eventual damage. People with exophthalmos also risk developing superior limbic keratoconjunctivitis, where the area above the cornea becomes inflamed because of the friction that occurs when the patient blinks. Some patients may experience compression of the optic nerve or ophthalmic artery, which can eventually affect the patient's eyesight, leading to blindness.

Exophthalmos is not a condition, but rather a sign of a condition, usually caused by something wrong with the thyroid gland.

According to Medilexicon's medical dictionary, exophthalmos is "Protrusion of one or both eyeballs; can be congenital and familial, or due to pathology, such as a retroorbital tumor (usually unilateral) or thyroid disease (usually bilateral)."

What are the signs and symptoms of exophthalmos?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor notice. For example, pain may be a symptoms while a rash may be a sign.

The most noticeable sign of exophthalmos are bulging or protruding eyeballs (either one or both). If the patient has Graves' disease, a thyroid condition, the bulging develops because the tissues in the eyeballs swell, and the number of cells in the eye increases - resulting in larger eyes which push forward from their orbits (sockets). The human eye sockets are rigid and cannot expand to accommodate the larger eyeball. As the eyeball protrudes the eyelid is forced apart, giving the patient a staring expression with a higher-than normal proportion of the whites of the eyes exposed.

Graves' disease is the most common cause of bulging eyeballs. Signs and symptoms of Graves' disease include:
  • Pain in the eyes
  • Dry eyes
  • Eye irritation
  • Sensitivity to light (photophobia)
  • Lacrimation - eye secretions and shedding of tears
  • Diplopia - double vision caused by the weakening of the eye muscles
  • Progressive blindness, if the optic nerve is compressed
  • Difficulty in moving eyes - as the eye muscles weaken the patient may find it harder to move the eyes. In some cases the eyes may turn inwards (amblyopia).
The following non-ocular signs and symptoms are also possible with Graves' disease:
  • Irregular heartbeats (arrhythmia, palpitations)
  • Anxiety
  • Raised appetite
  • Sleeping problems (insomnia)

What are the causes of exophthalmos?

Graves' disease, an autoimmune disease that causes hyperthyroidism (thyroid gland produces too much thyroid hormone) is the most common cause of exophthalmos. Thyroid problems generally are common causes.

The thyroid gland - the thyroid gland is in the neck, below the Adam's apple. It produces hormones which help to regulate growth and the rate of chemical reactions (metabolism) by which the body uses energy. The thyroid gland produces thyroxine and triiodothyronine.

Thyroid eye disease - also known as TO (thyroid orbitopathy), is a condition in which the soft tissues and muscles surrounding the eyes become swollen and inflamed. This condition is closely linked to hyperthyroidism (overactive thyroid gland), and sometimes hypothyroidism (underactive thyroid gland).

Exophthalmos does not necessarily occur during the onset of hyperthyroidism or hypothyroidism. The eyes may start bulging long after a thyroid problem starts; and even before.

Autoimmune diseases - healthy people's immune systems attack pathogens; organisms and substances that are bad for us, such as some bacteria, viruses, parasites, cancer cells and fungi. If the person's immune system starts attacking good tissue they have an autoimmune disease - the immune system is attacking parts of the person's body that are needed for good health. Graves' disease is an example of an autoimmune disease. Experts are not sure why autoimmune diseases, such as Graves' disease occur.

If the patient's immune system attacks the thyroid gland it often reacts by producing more hormones than normal. The excess thyroid hormone, as well as the autoimmune antibodies may attack the muscles and soft tissue surrounding the eyes, causing:
  • Dry eyes (often described as gritty eyes)
  • Redness
  • Puffy eyes
  • Inflammation and swelling
  • Problems with eyesight
  • Exophthalmos (bulging or protruding eyes)
Inherited diseases - some diseases which may affect the eyes are inherited, the patient has acquired the faulty genes from their parents or grandparents. Graves' disease is an example of a hereditary disease.

Proptosis (eyeball protrusion, one eye) - the presence of something in the eye-socket can cause proptosis, such as:
  • A cancerous tumor
  • Mucocoele (mucus-filled cyst)
  • A blood clot
  • Trauma (eye injury)
  • Sinus infection
Anybody who notices that one or both eyes are starting to bulge should see their doctor immediately.

How is exophthalmos diagnosed?

In most cases the protrusion or bulging of the eyeballs from the sockets, with much more of the whites of the eyes exposed, is enough for the doctor to diagnose exophthalmos fairly easily. However, as mentioned earlier, exophthalmos is a sign of some disease or condition, and is not a disease in itself. Therefore, if a GP (general practitioner, primary care physician) suspects exophthalmos the patient will probably be referred to an eye specialist - an ophthalmologist. The ophthalmologist will most likely order further tests before confirming a diagnosis.

The following tests may be ordered:

A blood test - this will probably be a thyroid function test to see whether the thyroid gland is healthy.

Exophthalmometer - this instrument measures the degree of eyeball protrusion as well as determining how well the patient can move their eyes. Patients with exophthalmos will be able to look upwards without moving their eyebrows.

Imaging scans - in order to examine the orbit (socket) the doctor may order a CT (computerized tomography) scan or an MRI (magnetic resonance imaging) scan. A scan may also detect a tumor, or any abnormalities in or around the eyes.

What are the treatment options for exophthalmos?

As exophthalmos tends to be a progressive disease - symptoms get worse over time - the ophthalmologist will wish to monitor the patient regularly. Treatment depends on several factors, including the cause, as well as the patient's age and general health.

Thyroid problems - the doctor will treat whatever is causing the thyroid problem so that thyroid hormone levels are brought back to normal. Usually, effective thyroid treatment results in the restoration of normal vision and the appearance of the eyes.

If the patient has Graves' disease thyroid treatment might make no difference to the appearance of the eyes. On occasions the affected vision and appearance of the eyes cannot be improved.

It is important to see your doctor as soon as you notice any bulging of the eyes. Treatment is much more effective if it can begin early.

Surgery - if there is a problem with the connection between the arteries and veins in the eyes the patient may have to undergo surgery. In severe cases the bony floors of the eye sockets may have to be surgically removed (surgical orbital decompression). The procedure allows excess material to move down into the extra space in the antrum (maxillary sinus) by the surgical intervention.

Eye drops - if the patient suffers from dry eyes, eye drops will help keep the eyeballs moist - it is important to keep the cornea lubricated.

Eyeshades - eyeshades may be required if the patient suffers from photophobia (oversensitivity to light).

Corticosteroids - for patients whose eyes are especially painful or swollen (inflamed), the doctor may prescribe corticosteroids. Corticosteroids are effective in reducing swelling and inflammation.

A tumor - most likely the doctor will talk to the patient about removing the tumor surgically, as well as using chemotherapy, radiotherapy (radiation therapy), or a combination.

What are the possible complications of exophthalmos?

In severe cases patients may not be able to close their eyes properly, especially when they are asleep. This can cause the cornea to dry out and become damaged. If the cornea dries out too much there is a much higher risk of infection or ulcers, which can damage vision.

People with exophthalmos or proptosis are more susceptible to developing conjunctivitis.
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What Is Ataxia? What Causes Ataxia?

Ataxia is a lack of muscle coordination which may affect speech, eye movements, the ability to swallow, walking, picking up objects and other voluntary movements. A person with persistent ataxia may have damage in the part of the brain that controls muscle coordination - the cerebellum. Ataxia may have several causes, including multiple sclerosis, a head injury, alcohol abuse, stroke, cerebral palsy, a faulty gene, or a tumor. Ataxia may also be a symptom of incoordination linked to infections.

There are different types of ataxias including Friedreich's ataxia and spinocerebellar ataxia type 6. A less common type is ataxia telangiectasia. According to Ataxia UK, there are over 40 known forms of inherited ataxias - new forms continue to be identified as scientific techniques improve.

The International Ataxia Awareness Day is observed on September 25 each year.

According to Medilexicon's medical dictionary, ataxia is " An inability to coordinate muscle activity during voluntary movement; most often results from disorders of the cerebellum or the posterior columns of the spinal cord; may involve the limbs, head, or trunk."

The term ataxia may also be used more broadly to indicate a lack of coordination in a physiological process, such as optic ataxia (usually part of Balint's syndrome which includes a lack of coordination between visual inputs and hand movements), or ataxic respiration (uncoordinated respiratory movements, usually due to dysfunction of the respiratory centers of the medulla oblongata).

The English word "ataxia" comes from the Ancient Greek word ataksia meaning "disorder". The Ancient Greek word taksia means "order".

Some types of ataxias

Cerebellar ataxia

This is ataxia caused by a dysfunction of the cerebellum - a region in the brain which is involved in the assimilation of sensory perception, coordination and motor control. Cerebellar ataxia causes some basic neurological problems, such as:
  • Floppiness (hypotonia).
  • Lack of co-ordination between organs, muscles, limbs or joints (asynergy).
  • Impaired ability to control distance, power, and speed of an arm, hand, leg or eye movement (dysmetria).
  • Difficulty in accurately estimating how much time has passed (dyschronometria).
  • An inability to perform rapid, alternating movements (dysdiadochokinesia).
How the patient is affected depends on which parts of the cerebellar are lesioned, and whether lesions occur on one side (unilateral) or both sides (bilateral).

If the vestibulocerebellum is affected the patient's balance and eye movement control will be affected. The patient will typically stand with feet wide apart in order to gain better balance and avoid swaying backwards and forwards (posterior-anterior oscillations). Even when the patient's eyes are open balance is difficult when the feet are together.

If the spinocerebellum is affected the patient will have an unusual gait, with unequal steps, sideways steps, and uncertain starts and stops. The spinocerebellum regulates body and limb movements.

If the cerebrocerebellum is affected the patient will have problems carrying out voluntary, planned movements. The head, eyes, limbs and torso may tremble as voluntary moves are carried out. Speech may be slurred, with variations in rhythm and loudness.

Sensory ataxia

This is ataxia due to loss of proprioception. Proprioception is the sense of the relative position of neighboring parts of the body. It is a sense that indicates whether the body is moving with the required effort, and also where the various parts of the body are located in relation to each other. Even if I am blindfolded I know through proprioception if my arm is above my head or hanging down in front of me, by my side, or behind me.

A patient with sensory ataxia typically has an unsteady stomping gait, with the heel striking hard as it touches the ground with each step. Postural instability becomes worse in poorly lit environments. If a doctor asks the patient to stand with eyes closed and feet together his/her instability will clearly worsen. This is because loss of proprioception makes the patient much more reliant on visual data.

The patient may find it hard to perform smoothly coordinated voluntary movements with the limbs, trunk, pharynx, larynx, and eyes.

Vestibular ataxia

The vestibular system is affected. In acute (sudden) unilateral cases the patient may experience vertigo, nausea, and vomiting. In slow-onset chronic bilateral cases the patient may only experience unsteadiness, giddiness.

What are the symptoms of ataxia?

Symptoms may vary depending on the severity and type of ataxia, of which there are many. If the ataxia is caused by an injury or another health condition, symptoms may emerge at any age, and may well improve and eventually disappear.

Initial ataxia symptoms usually include:
  • Poor limb coordination.
  • Dysarthria - slurred and slow speech that is difficult to produce. The patient may also have difficulties controlling volume, rhythm, and pitch.
If the ataxia advances other symptoms may also appear:
  • Swallowing difficulties, which may sometimes result in choking or coughing.
  • Facial expressions become less apparent.
  • Tremors - parts of the body may shake or tremble unintentionally.
  • Nystagmus - involuntary rapid rhythmic repetitious eye movement. Movements may be vertical, horizontal, or circular.
  • Pes cavus - a foot with too high an arch.
  • Cold feet - because of a lack of muscle activity.
  • Problems with balance.
  • Walking difficulties - in severe cases the patient may need a wheelchair.
  • Vision problems.
  • Hearing problems.
  • Depression - as a result of having to live and cope with the symptoms.
Cerebellar ataxias

Cerebellar ataxia early onset usually emerges between the ages of 4 and 26. Late onset ataxia generally appears after the patient is 20 years old. Late-onset ataxias usually present less severe symptoms, compared to early-onset ataxia.

Ataxia telangiectasia symptoms generally include:
  • Small veins appear around the corner of the eyes, cheeks and ears.
  • Physical and sexual development is usually delayed.
Friedreich's ataxia symptoms generally include:
  • The spine curves sideways (scoliosis).
  • The heart muscle becomes weaker (cardiomyopathy).
  • Diabetes.
For patients whose symptoms are caused by injury or illness, symptoms often improve over time, and eventually go away completely.

What are the causes of ataxia?

Vitamin B12 deficiency - as well as other neurological abnormalities, vitamin B12 deficiency can cause overlapping cerebellar and sensory ataxia.

Ataxia can be a symptom of another health condition, it can also be inherited or non-inherited.

Inherited ataxia

This means the ataxia is caused by a genetic fault inherited either from the mother or father, or both. A faulty gene that is passed down through generations can cause cerebellar ataxia - in some cases its severity worsens from one generation to the next and the age of onset gets younger. This type of worsening inherited ataxia is known as anticipation.

The chances of inheriting ataxia from a parent depends on the type of ataxia that parent has. For a person to develop Friedreich's ataxia the faulty gene would need to be carried by both the mother and the father (recessive inheritance). Spinocerebellar ataxia, on the other hand, only requires one parent to carry the defective gene (dominant inheritance), and each of his/her offspring would have a 50% risk of developing the condition.

Non-inherited ataxia

Even without a family history of ataxia some people may still develop the condition. In some cases, experts never find out what the cause was. The following procedures and circumstances can cause ataxia:
  • Brain surgery.
  • Head injury.
  • Alcohol abuse.
  • Drug abuse.
  • Infections, such as chicken pox (usually goes away after infection has gone).
  • A brain tumor.
  • Exposure to toxic chemicals.
  • Multiple sclerosis, cerebral palsy, and some other neurological conditions.
  • Malformation of the cerebellum while the baby is still in the womb.

How is Ataxia diagnosed?

A doctor who suspects the patient may have ataxia will refer him/her to a neurologist - a doctor specialized in diagnosis, treatment and prevention of conditions and illnesses related to the nervous system.

The specialist will check the patient's medical history for cause factors, such as brain injury, as well as the patient's family history for indications of inheritance. The following tests may also be ordered:
  • Magnetic resonance imaging (MRI) or Computerized Tomography (CT) scan - to determine whether there is any brain damage.

  • Genetic tests - to determine whether the patient has inherited ataxia.

  • Blood tests - some types of ataxia affect the make up of blood.

  • Urine tests - urinalysis may suggest specific systemic abnormalities that are linked to some forms of ataxia. If the specialist suspects Wilson's disease the patient may be asked for a 24-hour urine collection to determine how much copper is in the system.
In some cases the specialist never knows what caused the ataxia, this is known as sporadic or idiopathic ataxia.

Reaching a conclusive diagnosis of ataxia can sometimes take a long time because the symptoms could point to several other conditions.

What is the treatment for ataxia?

Although ataxia is not curable, a great deal can be done to ease symptoms and improve the quality of life of the patient. Treatment for coordination and balance problems usually involves the use of adaptive devices which help the patient attain as much independence as possible. These may include the use of a cane (walking stick), crutches, walker or a wheelchair. Symptoms such as tremor, stiffness, spasticity, sleep disorders, muscle weakness, depression (or frustration, sadness and anger) may be addressed with targeted physical therapy, speech therapy, medications and counseling.
  • Occupational therapy - the occupational therapist can help the patient manage better around the house and work. This may involve some home adaptations, wheelchair assessments, and making the kitchen more practical for the patient.

  • Speech therapy - the speech therapist can help with swallowing, coughing, choking and speech problems. If speech becomes very difficult the speech therapist can help the patient learn how to use speech aids.

  • Orthopedic care - this can help patients with curvature of the spine (scoliosis).

  • Physical therapy (physiotherapy) - a physical therapist (physiotherapist) can help maintain strength and improve mobility.

  • Counseling - patients with ataxia commonly become frustrated and depressed; this usually results from having to cope with some symptoms which affect physical mobility and coordination. Talking to a well qualified counselor, such as a psychotherapist can help.

  • Supplements and nutrition - some patients with ataxia have very low levels of vitamin E and require supplements and/or a special diet. As sensitivity to gluten is more common among ataxia patients, a gluten-free diet also helps.

  • Medication - some patients with ataxia telangiectasia are prescribed gamma-globulin injections to boost their immune systems. There are also drugs for muscle spasms and uncontrollable eye movements.
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