causes

Causes of skin cancer

Ultraviolet (UV) light exposure, most commonly from sunlight, is overwhelmingly the most frequent cause of skin cancer.

Other important causes of skin cancer include the following:

• Use of tanning booths
  
  
• Immunosuppression-impairment of the immune system, which protects the body from foreign entities, such as germs or substances that cause an allergic reaction. This may occur as a consequence of some diseases or can be due to medications prescribed to combat autoimmune diseases or prevent organ transplant rejection.
  
  
• Exposure to unusually high levels of x rays
  
  
• Contact with certain chemicals-arsenic (miners, sheep shearers, and farmers), hydrocarbons in tar, oils, and soot (may cause squamous cell carcinoma)

The following people are at the greatest risk:

• People with fair skin, especially types that freckle, sunburn easily, or become painful in the sun
  
  
• People with light (blond or red) hair and blue or green eyes
• People who have already been treated for skin cancer
  
  
• People with numerous moles, unusual moles, or large moles that were present at birth
  
  
• People with close family members who have developed skin cancer
  
  
• People who had at least one severe sunburn early in life

Basal cell carcinomas and squamous cell carcinomas are more common in older people. Melanomas are more common in younger people. For example, melanoma is the most common cancer in people 25-29 years of age.

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Types

Types of skin cancer

Three types of skin cancer account for nearly 100% of all diagnosed cases. Each of these three cancers begins in a different type of cell within the skin, and each cancer is named for the type of cell in which it begins. Skin cancers are divided into one of two classes - nonmelanoma skin cancers and melanoma. Melanoma is the deadliest form of skin cancer.

The different types of skin cancer are:



Basal cell carcinoma (BCC):
The most common cancer in humans, BCC develops in more than 1 million people every year in the United States alone. About 80% of all skin cancers are BCC, a cancer that develops in the basal cells - skin cells located in the lowest layer of the epidermis. BCC can take several forms. It can appear as a shiny translucent or pearly nodule, a sore that continuously heals and then re-opens, a pink slightly elevated growth, reddish irritated patches of skin, or a waxy scar. Most BCCs appear on skin with a history of exposure to the sun, such as the face, ears, scalp, and upper trunk. These tumors tend to grow slowly and can take years to reach ½ inch in size. While these tumors very rarely metastasize (cancer spreads to other parts of the body), dermatologists encourage early diagnosis and treatment to prevent extensive damage to surrounding tissue.

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skin cancer

What is skin cancer

Skin cancer is the most common form of cancer in the United States. The two most common types are basal cell cancer and squamous cell cancer. They usually form on the head, face, neck, hands and arms. Another type of skin cancer,melanoma , is more dangerous but less common.

Anyone can get skin cancer, but it is more common in people who

• Spend a lot of time in the sun or have been sunburned
• Have light-colored skin, hair and eyes
• Have a family member with skin cancer
• Are over age 50

You should have your doctor check any suspicious skin markings and any changes in the way your skin looks. Treatment is more likely to work well when cancer is found early. If not treated, some types of skin cancer cells can spread to other tissues and organs.

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Treatment

Treatment of gall stones

Surgery

Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones. (Asymptomatic gallstones usually do not need treatment.) Each year more than 500,000 Americans have gallbladder surgery. The surgery is called cholecystectomy.

The standard surgery is called laparoscopic cholecystectomy. For this operation, the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a closeup view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures. Then the cystic duct is cut and the gallbladder removed through one of the small incisions.

Because the abdominal muscles are not cut during laparoscopic surgery, patients have less pain and fewer complications than they would have had after surgery using a large incision across the abdomen. Recovery usually involves only one night in the hospital, followed by several days of restricted activity at home.

If the surgeon discovers any obstacles to the laparoscopic procedure, such as infection or scarring from other operations, the operating team may have to switch to open surgery. In some cases the obstacles are known before surgery, and an open surgery is planned. It is called "open" surgery because the surgeon has to make a 5- to 8-inch incision in the abdomen to remove the gallbladder. This is a major surgery and may require about a 2- to 7-day stay in the hospital and several more weeks at home to recover. Open surgery is required in about 5 percent of gallbladder operations.

The most common complication in gallbladder surgery is injury to the bile ducts. An injured common bile duct can leak bile and cause a painful and potentially dangerous infection. Mild injuries can sometimes be treated nonsurgically. Major injury, however, is more serious and requires additional surgery.

If gallstones are in the bile ducts, the surgeon may use ERCP in removing them before or during the gallbladder surgery. Once the endoscope is in the small intestine, the surgeon locates the affected bile duct. An instrument on the endoscope is used to cut the duct, and the stone is captured in a tiny basket and removed with the endoscope. This two-step procedure is called ERCP with endoscopic sphincterotomy.

Occasionally, a person who has had a cholecystectomy is diagnosed with a gallstone in the bile ducts weeks, months, or even years after the surgery. The two-step ERCP procedure is usually successful in removing the stone.

Nonsurgical Treatment

Nonsurgical approaches are used only in special situations such as when a patient's condition prevents using an anesthetic and only for cholesterol stones. Stones recur after nonsurgical treatment about half the time.

• Oral dissolution therapy. Drugs made from bile acid are used to dissolve the stones. The drugs, ursodiol (Actigall) and chenodiol (Chenix), work best for small cholesterol stones. Months or years of treatment may be necessary before all the stones dissolve. Both drugs cause mild diarrhea, and chenodiol may temporarily raise levels of blood cholesterol and the liver enzyme transaminase.
• Contact dissolution therapy. This experimental procedure involves injecting a drug directly into the gallbladder to dissolve stones. The drug methyl tert butyl can dissolve some stones in 1 to 3 days, but it must be used very carefully because it is a flammable anesthetic that can be toxic. The procedure is being tested in patients with symptomatic, noncalcified cholesterol stones.
• Extracorporeal shockwave lithotripsy (ESWL). This treatment uses shock waves to break up stones into tiny pieces that can pass through the bile ducts without causing blockages. Attacks of biliary colic (intense pain) are common after treatment, and ESWL's success rate is not very high. Remaining stones can sometimes be dissolved with medication.

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Risk

Riskof gall stones

People at risk for gallstones include

• women—especially women who are pregnant, use hormone replacement therapy, or take birth control pills
• people over age 60
• American Indians
• Mexican Americans
• overweight or obese men and women
• people who fast or lose a lot of weight quickly
• people with a family history of gallstones
• people with diabetes
• people who take cholesterol-lowering drugs.

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symptoms

Symptoms of gallstones

As gallstones move into the bile ducts and create blockage, pressure increases in the gallbladder and one or more symptoms may occur. Symptoms of blocked bile ducts are often called a gallbladder “attack” because they occur suddenly. Gallbladder attacks often follow fatty meals, and they may occur during the night. A typical attack can cause

• steady pain in the right upper abdomen that increases rapidly and lasts from 30 minutes to several hours
• pain in the back between the shoulder blades
• pain under the right shoulder

Notify your doctor if you think you have experienced a gallbladder attack. Although these attacks often pass as gallstones move, your gallbladder can become infected and rupture if a blockage remains.

People with any of the following symptoms should see a doctor immediately:

• prolonged pain—more than 5 hours
• nausea and vomiting
• fever—even low-grade—or chills
• yellowish color of the skin or whites of the eyes
• clay-colored stools

Many people with gallstones have no symptoms; these gallstones are called “silent stones.” They do not interfere with gallbladder, liver, or pancreas function and do not need treatment.

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causes

causes of gall bladder stones

Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty completely or often enough. The reason these imbalances occur is not known.

The cause of pigment stones is not fully understood. The stones tend to develop in people who have liver cirrhosis, biliary tract infections, or hereditary blood disorders—such as sickle cell anemia—in which the liver makes too much bilirubin.

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gallstones

What is gallstones

Gallstones are small, pebble-like substances that develop in the gallbladder. The gallbladder is a small, pear-shaped sac located below your liver in the right upper abdomen. Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. The liquid—called bile—helps the body digest fats. Bile is made in the liver, then stored in the gallbladder until the body needs it. The gallbladder contracts and pushes the bile into a tube—called the common bile duct—that carries it to the small intestine, where it helps with digestion.

Bile contains water, cholesterol, fats, bile salts, proteins, and bilirubin—a waste product. Bile salts break up fat, and bilirubin gives bile and stool a yellowish-brown color. If the liquid bile contains too much cholesterol, bile salts, or bilirubin, it can harden into gallstones.

The two types of gallstones are cholesterol stones and pigment stones. Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Pigment stones are small, dark stones made of bilirubin. Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or a combination of the two.
The two types of gallstones are cholesterol stones and pigment stones. Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Pigment stones are small, dark stones made of bilirubin. Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or a combination of the two.

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Self-Care

Treatment of kidney stones

Self-Care at Home:

• Prevention is always the preferable way to treat kidney stones. Remaining well hydrated and keeping the urine dilute will help prevent kidney stones from forming.
  
  
• Those who have never passed a kidney stone may not appreciate the severity of the symptoms. There is little a person can do with debilitating pain and vomiting other than seek emergency care. If this is the first episode and no previous diagnosis has been established, it is important to be seen by a physician as well. For those who have a history of stones, then home therapy may be appropriate. Most kidney stones, given time, will pass on their own, and treatment is directed towards symptom control. The patient should be instructed to consume oral fluids. Ibuprofen can be used as an anti-inflammatory agent, and if further pain medication is needed, contacting the primary care provider may allow stronger narcotic pain medication to be prescribed.
  
  
• Please note, if there is fever associated with the symptoms of a kidney stone, this becomes a more urgent problem, and medical care should be accessed immediately.

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Symptoms

Symptoms of kidney stones

Many kidney stones don't move and are too small to cause any symptoms. However, if a kidney stone causes a blockage, or moves into your ureter, you may:

• have severe pain or ache on one or both sides of your back
• get sudden spasms of excruciating pain - this usually starts in the back below your ribs, before radiating around your abdomen, and sometimes to your groin and genitals
• have bloody or cloudy urine
• feel sick or vomit
• feel a frequent urge to urinate, or a burning sensation during urination
• get fever and chills

You can also have these symptoms if you have a urinary tract infection (UTI) or cystitis. If you have one or more of these symptoms, you should ask your GP for advice.

The pain of kidney stones - referred to as 'renal colic' - can be very severe. It begins as soon as the stone becomes stuck in the ureter and tends to come in waves. It's not usually associated with the size of the kidney stone - sometimes small stones can cause more pain than very large ones.

Small kidney stones are usually passed out of the body within a day or so and mostly within four weeks of the onset of symptoms. The bigger the stone the less likely it is to pass out of the body spontaneously. Stones greater than 5mm (a quarter of an inch) in diameter are the least likely to pass without medical help.

If you're pregnant and have any symptoms of kidney stones, see your GP straight away.

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What do my kidneys do?

Your kidneys are bean-shaped organs, each about the size of your fist. They are located near the middle of your back, just below the rib cage, one on each side of the spine. The kidneys are sophisticated trash collectors. Every day, your kidneys process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water. The wastes and extra water become urine, which flows to your bladder through tubes called ureters. Your bladder stores urine until
you go to the bathroom.

The wastes in your blood come from the normal breakdown of active muscle and from the food you eat. Your body uses the food for energy and self-repair. After your body has taken what it needs from the food, wastes are sent to the blood. If your kidneys did not remove these wastes, they would build up in the blood and damage your body.

In addition to removing wastes, your kidneys help control blood pressure. They also help make red blood cells and keep your bones strong.

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