Category: Medicine Hat News

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Inflammation of the Pancreas Should Not be Ignored

In the last column we discussed about pancreatic cancer. Today, we will briefly discuss inflammation of the pancreas which can be serious too.

The pancreas lies in the upper abdomen behind the stomach. Its function is to produce digestive enzymes and hormones such as insulin.

Pancreatitis is a chemical inflammation of the pancreas caused by its own digestive enzymes. Pancreatitis has two forms: acute and chronic.

Most common causes of pancreatitis are gallstones and alcohol abuse. Sometimes no cause can be found. That leaves the patient and the doctor frustrated.

Patients with acute pancreatitis present with abdominal pain, nausea, vomiting, fever and a rapid pulse. The diagnosis is made by a blood test to measure blood level of enzyme lipase. All pancreatitis patients require intravenous fluids, oxygen and pain killers to stabilize their condition. If the condition is due to gallstones then the patient will need surgical removal of the gallbladder.

An abdominal ultrasound is taken to look for gallstones and a CAT (computerized axial tomography) scan to look for inflammation or destruction of the pancreas. CAT scans are also useful in detecting cyst formation in the pancreas.

In about 20 percent of cases, acute pancreatitis can be severe, with many complications. Severe cases may cause dehydration and low blood pressure and the condition may become life threatening. The vital organs such as heart, lungs, or kidneys may fail. If bleeding occurs in the pancreas, shock and sometimes even death follow.

Chronic pancreatitis can present as episodes of acute inflammation in a previously damaged pancreas. There is intermittent or persistent abdominal pain. The chronic destruction of pancreatic tissue causes malabsorption of fat and diabetes.

Chronic pancreatitis is most often caused by alcoholism and alcohol abuse. Sometimes the cause of chronic pancreatitis cannot be determined. But any condition that causes repeated episodes of acute pancreatitis may result in chronic pancreatitis.

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Steve Jobs – a Victim of Pancreatic Cancer

Pancreatic cancer has taken another life. The prognosis for pancreatic cancer is dismal. The overall five year survival rate is less than two percent, the worst of any cancer. Only 20 percent of the patients will be diagnosed at a stage where surgery may offer hope.

Last time I wrote about pancreatic cancer was in 1996. That was the year my sister, Gulshan, age 60, passed away within three months of diagnosis of pancreatic cancer. Steve Jobs was 56. He lived for four years after having had a diagnosis of pancreatic cancer. He also received a liver transplant.

It has been 15 years since my sister died. Has anything changed to improve the prognosis of patients diagnosed with pancreatic cancer?

Before we look into that, let us look at some numbers. The Canadian Cancer Society’s document “Canadian Cancer Statistics 2010” says that in 2010, Canada will continue to see an increase in the number of individuals diagnosed with and dying from cancer. Every hour of every day, an average of 20 people will be diagnosed with some type of cancer and eight people will die from cancer.

Fifty per cent of the newly diagnosed cancer patients will be suffering from lung, colorectal, prostate and breast cancers. Cancer of the pancreas is 12th on the list of estimated number of new cases. About 4,000 new cases will be diagnosed – this will be equally divided amongst males and females. Almost the same number of people will die of pancreatic cancer each year. Death from pancreatic cancer is fifth on the list after lung, colorectal, breast and prostate.

An article in the Scientific American (January 2011) says that one of the reasons why the prognosis is so dismal in pancreatic cancer is that the disease is not typically diagnosed until 15 years after the first cancer-causing mutations appear, by which point the cancer has spread and become highly aggressive.

What does that mean? That means there may be plenty of time for doctors to intervene before pancreatic cancer becomes lethal. Then the tumour can be successfully removed and the prognosis can be improved with appropriate chemotherapy and radiotherapy, if indicated.

The article says researchers from John Hopkins found that cancer cells appear 10 years after the first cancer-causing mutation arises and that another five years pass before the cancer cells spread and become deadly. Research like this and many others gives hope for the future. In the last two years scientists have brought screening techniques for pancreatic cancer closer to reality.

The article says that these technologies are not available commercially but progress is expected to increase in the next decade. In the meantime, doctors should consider using CT and MRI scans to screen patients who are at high risk because of family history of the disease. Is that practical or economically feasible? There is no defined protocol for this and there are advantages and disadvantages of using CT or MRI scans as a screening tool in otherwise healthy individuals.

What causes pancreatic cancer? The precise cause is unknown. Smoking and chronic inflammation are suspected in the causation of the disease. An estimated 5-10 percent of pancreatic cancers are inherited and additional 10-20 percent may have other significant genetic influence. Most patients present with jaundice, abdominal pain, weight loss, or no appetite. By that time it is too late.

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Chlamydia, Gonorrhea and Syphilis on the Rise

Recent memo from Alberta Health Services’ South Zone office warns physicians about the significant rise of sexually transmitted diseases (STD) in Southern Alberta. In 2009, Alberta reported the highest STD rates across the country. Most significant is the increase in syphilis.

In 2008, a report in the Canadian Medical Association Journal (CMAJ August 12, 2008) said that Alberta launched a $2 million campaign to combat the rise of sexually transmitted disease a day after releasing figures indicating skyrocketing rates of gonorrhea and chlamydia among young people in the province. The ads were meant to encourage condom use and regular testing for the disease. But the incidence of STD continues to rise.

STD is also on the rise in other western countries. In the United Kingdom, cases of syphilis among people aged 45 to 64 increased 139 per cent between 2002 and 2006. Cases of chlamydia rose 51 per cent.

In March 2008, U.S. Centers for Disease Control and Prevention reported that one in four teenage girls in the U.S. has a STD. An estimated 3.2 million teenage girls in that country are at risk for health problems such as infertility and cervical cancer because they have chlamydia, trichomoniasis, herpes simplex virus or human papillomavirus (causes genital warts).

Cases of syphilis have particularly increased among men having sex with men. In this group, there is also a high incidence of HIV. If a person has sex with someone who has STD then the risk of contracting the disease is extremely high. It does not matter whether a person is heterosexual or homosexual.

You are at risk of having STD if you ever had sex, if you had many sex partners, if you had sex with someone who has had many sex partners and/or you had sex without using condom.

Long term consequences of STD can be serious and sometime life threatening. Chlamydia and gonorrhea can cause pelvic inflammatory disease in women and infection of testicular area in men. This may render a person sterile. Viral warts can cause cancer of the cervix or penis. Syphilis can cause infection of the nervous system, mental problems, blindness and death. Other illnesses related to STD are hepatitis, genital herpes and AIDS.

You can lower the risk of STD by having sex with someone who is not having sex with anyone else – a monogamous relationship, who does not have STD and by always using a condom until your relationship has been established with your partner.

Primary prevention of STD can be achieved by preventing exposure by identifying at-risk individuals, performing a thorough assessment accompanied by patient-centred counselling and education and immunization when appropriate, says one of the CMAJ articles.

Secondary prevention is aimed at preventing or limiting further spread by decreasing the prevalence of STDs through detection in at-risk populations, counselling, conducting partner notification and treating infected individuals and contacts.

Practicing safe sex is the best way to stay out of trouble. Same rules apply to men and women, whether they are homosexual or heterosexual.

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Anal Cancer Can be Misdiagnosed as Hemorrhoids

Anal Cancer

You may recall, Farrah Fawcett, one of the Charlie’s Angels, was diagnosed with anal cancer in 2006. Three years later she died.

There is no need to panic. Anal cancer is fairly uncommon. It accounts for about one to two per cent of gastrointestinal cancers. About 4,000 new cases of anal cancer are diagnosed each year in the U.S.A., about half in women. Approximately 600 people will die of the disease each year.

In Canada, incidence of anal canal tumours is approximately 515 cases per year with annual incidence rate of 1.3 per 100,000 population. Review of cancer registry by researchers has shown that the incidence of anal cancer in Canada is increasing.

Anal cancers can be just outside the anus (perianal) or inside the anus. The anal canal extends from the anal verge to the upper border of the anal sphincters, and is approximately four to five cm in length. The skin for a five cm radius around the anal verge is called the perianal skin or anal margin.

What are the risk factors for developing anal cancer?

We do not know the exact cause of most anal cancers. But we know certain risk factors are linked to anal cancer. Most people with anal cancer are over 50 years old. Having anal warts significantly increases the risk. Anal warts are caused by infection with the human papilloma virus (HPV).

Persons who participate in anal sex are at an increased risk. Use of condoms is highly recommended to reduce the risk. Harmful chemicals from smoking increase the risk as well. People with weakened immune systems, such as transplant patients who must take drugs to suppress their immune systems and patients with HIV (human immunodeficiency virus) infection, are at a somewhat higher risk.

People with long-standing anal fistulas or open wounds are at a slightly higher risk. People who have had pelvic radiation therapy for rectal, prostate, bladder or cervical cancer are at an increased risk.

What are the symptoms of anal cancer?

Mostly they are no different than symptoms of hemorrhoids. That is why patients should stop saying, “Doctor, my hemorrhoids acting up again.” When you see your doctor, say what symptoms you have and let him/her make the diagnosis.

Most patients will complain about bleeding, itching, feeling of a lump, may have pain, narrowing of stools, discharge and staining of underwear and in advanced cases there may be enlarged groin lymph glands.

Biopsy is required to confirm the diagnosis. Treatment of anal cancer depends on the extent of the problem and may include surgery, radiotherapy and chemotherapy. Anal cancer can be prevented or picked up in early stages by eliminating the risk factors mentioned earlier and having your butt checked out on a regular basis. Follow the protocol for screening for anal, rectal and colon cancer. For more information, visit my website: www.nbharwani.com.

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