Tag Archives: Tumor

Retinoblastoma

Definition:
Retinoblastoma is an eye cancer that begins in the retina — the sensitive lining on the inside of your eye. Retinoblastoma most commonly affects young children, but can rarely occur in adults.
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Our retina is made up of nerve tissue that senses light as it comes through the front of your eye. The retina sends signals through your optic nerve to your brain, where these signals are interpreted as images.

A rare form of eye cancer, retinoblastoma is the most common form of cancer affecting the eye in children. Retinoblastoma may occur in one or both eyes.

In the developed world, Rb has one of the best cure rates of all childhood cancers (95-98%), with more than nine out of every ten sufferers surviving into adulthood.

Retinoblastoma is rare and affects approximately 1 in 15,000 live births. In the UK, around 40 to 50 new cases are diagnosed each year.

Most children are diagnosed before the age of five years old. In the UK, bilateral cases usually present within the first year with the average age at diagnosis being 9 months. Diagnosis of unilateral cases peaks between 24 and 30 months.

Classification:
There are two forms of the disease; a heritable form and non-heritable form (all cancers are considered genetic in that mutations of the genome are required for their development, but this does not imply that they are heritable, or transmitted to offspring). Approximately 55% of children with Rb have the non-heritable form. If there is no history of the disease within the family, the disease is labeled “sporadic”, but this does not necessarily indicate that it is the non-heritable form.

In about two thirds of cases,  only one eye is affected (unilateral retinoblastoma); in the other third, tumours develop in both eyes (bilateral retinoblastoma). The number and size of tumours on each eye may vary. In certain cases, the pineal gland is also affected (trilateral retinoblastoma). The position, size and quantity of tumours are considered when choosing the type of treatment for the disease.

Symptoms:
The most common and obvious sign of retinoblastoma is an abnormal appearance of the pupil, leukocoria. Other less common and less specific signs and symptoms are: deterioration of vision, a red and irritated eye, faltering growth or delayed development. Some children with retinoblastoma can develop a squint, commonly referred to as “cross-eyed” or “wall-eyed” (strabismus). Retinoblastoma presents with advanced disease in developing countries and eye enlargement is a common finding.

Depending on the position of the tumors, they may be visible during a simple eye exam using an ophthalmoscope to look through the pupil. A positive diagnosis is usually made only with an examination under anesthetic (EUA). A white eye reflection is not always a positive indication of retinoblastoma and can be caused by light being reflected badly or by other conditions such as Coats’s Disease.

In a photograph, the photographic fault red eye may be a sign of retinoblastoma, if in the photograph it is in one eye and not in the other eye. A more clear sign is “white eye” or “cat’s eye”.

The child’s vision may also start to deteriorate and the eye may become  inflamed and sometimes painful.

In two-thirds of cases the cancer is unilateral (affecting one eye). In the rest it’s bilateral.

In 95 per cent of children, the tumour develops before the age of five. Occasionally, babies are born with a retinoblastoma. There’s an increased risk of developing other tumours later in life.

Causes:
Cause of retinoblastomaIn children with the heritable genetic form of retinoblastoma there is a mutation on chromosome 13, called the RB1 gene.The genetic codes found in chromosomes control the way in which cells grow and develop within the body.  If a portion of the code is missing or altered (mutation) a cancer may develop.

The defective RB1 gene can be inherited from either parent; in some children, however, the mutation occurs in the early stages of fetal development. It is unknown what causes the gene abnormality; it is most likely to be a random mistake during the copy process which occurs when a cell divides.

Inherited forms of retinoblastomas are more likely to be bilateral; in addition, they may be associated with pinealoblastoma (also known as trilateral retinoblastoma) with a dismal outcome. The genetic codes found in chromosomes control the way in which cells grow and develop within the body.

Several methods have been developed to detect the RB1 gene mutations.  Attempts to correlate gene mutations to the stage at presentation have not shown convincing evidence of a correlation

Complications:
Recurrent retinoblastoma
Children treated for retinoblastoma have a risk of cancer returning in and around the treated eye. For this reason, your child’s doctor will schedule follow-up exams to check for recurrent retinoblastoma. The doctor may design a personalized follow-up exam schedule for your child. In most cases, this will likely involve eye exams every few months for the first few years after retinoblastoma treatment ends.

Additionally, children with the inherited form of retinoblastoma have an increased risk of developing other types of cancers in any part of the body in the years after treatment. For this reason, children with inherited retinoblastoma require long-term follow-up with a cancer doctor (oncologist).

Diagnosis:
Tests and procedures used to diagnose retinoblastoma include:

*Eye exam. A doctor who specializes in diagnosing and treating diseases of the eye (ophthalmologist) will likely conduct an eye exam to determine what’s causing your child’s signs and symptoms. For a more thorough exam, the doctor may recommend using anesthetics to keep your child still.

*Imaging tests. Scans and other imaging tests can help your child’s doctor determine whether retinoblastoma has grown to affect other structures around the eye. Imaging tests may include ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI), among others.

*Consulting with other doctors. Your child’s doctor may refer you to other specialists, such as a doctor who specializes in treating cancer (oncologist), a genetic counselor or a surgeon.

Treatment:
Treatment of retinoblastoma varies from country to country.  The first priority is to preserve the life of the child, then to preserve the vision and thirdly to minimize any complications or side effects of the treatment. The exact course of treatment will depend on the individual case and will be decided by the ophthalmologist in discussion with the paediatric oncologist.

Many treatment options exist, including chemotherapy (administered locally via a thin catheter threaded through the groin, through the aorta and the neck, into the optic vessels), cryotherapy, radioactive plaques, laser therapy, external beam radiotherapy and surgical removal of the eyeball.  Any combinations of these treatments may be adopted.

In recent years, there has been an effort to find alternatives to enucleation and radiation therapy.

Prognosis;
Treatment for retinoblastoma has one of the highest success rates of all childhood cancers – nine out of ten children can be cured.

Prevention:
In most cases, doctors aren’t sure what causes retinoblastoma, so there’s no proven way to prevent the disease.

Prevention for families with inherited retinoblastoma
In families with the inherited form of retinoblastoma, preventing retinoblastoma may not be possible. However, genetic testing enables families to know which children have an increased risk of retinoblastoma, so eye exams can begin at an early age. That way, retinoblastoma may be diagnosed very early — when the tumor is small and a chance for a cure and preservation of vision is still possible.

If your doctor determines that your child’s retinoblastoma was caused by an inherited genetic mutation, your family may be referred to a genetic counselor.

Genetic testing can be used to determine whether:

*Your child with retinoblastoma is at risk of other related cancers
*Your other children are at risk of retinoblastoma and other related cancers, so they can start eye exams at an early age
*You and your partner have the possibility of passing the genetic mutation on to future children

The genetic counselor can discuss the risks and benefits of genetic testing and help you decide whether you, your partner or your other children will be tested for the genetic mutation.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/in_depth/cancer/retinoblastoma1.shtml
http://en.wikipedia.org/wiki/Retinoblastoma
http://www.mayoclinic.com/health/retinoblastoma/DS00786
http://trialx.com/curebyte/2011/06/02/retinoblastoma-photos-and-a-listing-of-clinical-trials/

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Chemotherapy

Definition:
Chemotherapy is a medical treatment that is needed in order to stop cancer cells from growing and its tracks. Chemotherapy is extremely effective in treating cancer. It is even more effective when it is used with other treatments like radiotherapy. It is also sometimes needed to relief the symptoms, and it is design to give a longer life by causing the disease to go into remission-the stage in which there are no active symptoms.  Chemotherapy works differently than surgery or radiotherapy – two other treatments designed to fight against the cancer as well. Chemotherapy drugs travel throughout the whole body. This is important because it allows the durgs to reach part of the body where the cancer cells may have spread out. In combination with surgery means that fewer surgical procedures need to be done. Follow-up surgery can often be avoided if chemotherapy is used.

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On the other hand, radiation therapy, or radiotherapy, is the use of high energy rays to treat such disease. Is it very important to know that radiation causes damage to cancer cells, so they stop growing. With each treatment, more of the cells die and the tumor shrinks. The dead cells break down and are carried away by the blood, eventually passing out of the body. Normal cells that are also exposed to the radiation process start to repair themselves afterwards, and the process lasts just a few hours. You might be concerned that radiation hurts, but is actually quite painless. Also, in case you are wondering, the radiation gets into your body and then passes out -it does not cause you to become radioactive.

To understand how chemotherapy works, it is helpful to know some basics about the cells of the body. Everything in your body is made up of cells. A group of cells is called tissue and tissues make up all the organs, the major structures of your body. Tissue stays healthy because cells grow and reproduce, new cells replace the ones that are damaged because of injury. This means that a combination of drugs may be used to attack cancer cells so that each drug can attack the cells in a different phase.

Cancer is a disease in which abnormal cells in the body grow and multiply at a very high rate. There are more than 100 specific types of cancer cells. Cancer also may involve the spread of abnormal cells around the body. Normal cells in our body grow, divide, and die in a way that maintains health and does not damage the body. A majority for the cancer cases are due to age issues because of the fact that in adulthood your cells divide only to replace worn-out or dying cells, or in other cases, to repair injuries. Cells make up all living tissue and stronger throughout your childhood. But cancer cells continue to grow and divide, even though they are no serving in any of the vital functions, and can spread to other parts in the body. These cells clump together and form tumors (lumps) that may destroy normal tissue. If cells break off from a tumor, they can travel  throughout the blood stream or the lymphatic system. When they settle in and grow; eventually, forming other tumors. When a tumor spreads out to a new place, it is called metastasis. Even when cancer spreads, it’s called by the name of the body where it originally started and developed. Leukemia, a type of cancer growing, does not usually form a tumor, it is an exception to the rule. The cancer cells get into the blood and the organs that make blood bone narrow, then they circulate through other tissues, where they eventually develop and grow.

Chemotherapy damages cancer cells, but it also can damage normal cells. Damage to these cells is what causes the side effects of chemotherapy treatment. For instance normal cells that divide quickly, such as blood cells and the cells of hair follicles, are more likely to be damaged by chemotherapy medications. In other words, in healthy cells the damage does not last, and many only happen on the days you are actually taking the drugs. Chemotherapy is usually given is several cycles. Depending on the drug and combination, it may last to a few hours, days, or weeks.

How Chemotherapy Is Given
Just as other medicines can be taken in various forms, there are several ways to get chemotherapy. In most cases, it’s given intravenously into a vein, also referred to as an IV. An IV is a tiny tube inserted into a vein through the skin, usually in the arm. The IV is attached to a bag that holds the medicine. The chemo medicine flows from the bag into the vein, which puts the medicine into the bloodstream. Once the medicine is in the blood, it can travel through the body and attack cancer cells.

Sometimes, a permanent IV called a catheter is placed under the skin into a larger blood vessel of the upper chest. That way, a child can get chemotherapy and other medicines through the catheter without having to always use a vein in the arm. The catheter remains under the skin until all the cancer treatment is completed. It can also be used to obtain blood samples and for other treatments, such as blood transfusions, without repeated needle sticks.

Chemo also can be:

•taken as a pill, capsule, or liquid that is swallowed
•given by injection into a muscle or the skin
•injected into spinal fluid through a needle inserted into a fluid-filled space in the lower spine (below the spinal cord)

Chemotherapy is sometimes used along with other cancer treatments, such as radiation therapy, surgery, or biological therapy (the use of substances to boost the body’s immune system while fighting cancer).

Lots of kids and teens receive combination therapy, which is the use of two or more cancer-fighting drugs. In many cases, combination therapy lessens the chance that a child’s cancer will become resistant to one type of drug — and improves the chances that the cancer will be cured.

When and Where Chemotherapy Is Given
Depending on the method used to administer chemotherapy, it may be given at a hospital, cancer treatment center, doctor’s office, or at home. Many kids receive chemotherapy on an outpatient basis at a clinic or hospital. Others may need to be hospitalized to monitor or treat side effects.

Kids may receive chemotherapy every day, every week, or every month. Doctors sometimes use the term “cycles” to describe a child’s chemotherapy because the treatment periods are interspersed with periods of rest so the child can recover and regain strength.

Dosage :
Dosage of chemotherapy can be difficult: If the dose is too low, it will be ineffective against the tumor, whereas, at excessive doses, the toxicity (side effects, neutropenia) will be intolerable to the patient. This has led to the formation of detailed “dosing schemes” in most hospitals, which give guidance on the correct dose and adjustment in case of toxicity. In immunotherapy, they are in principle used in smaller dosages than in the treatment of malignant diseases.

In most cases, the dose is adjusted for the patient’s body surface area, a measure that correlates with blood volume. The BSA is usually calculated with a mathematical formula or a nomogram, using a patient’s weight and height, rather than by direct measurement.

Side Effects:
Although chemo often effectively damages or eliminates cancer cells, it also can damage normal, healthy cells. And this can lead to some uncomfortable side effects.

The good news is that most side effects are temporary — as the body’s normal cells recover, the side effects gradually go away.

Cancer treatment is multifaceted — that is, patients receive a lot of care (i.e., fluid and nutrition support, transfusion support, physical therapy, and medicines) to help them tolerate the treatments and treat or prevent side effects such as nausea and vomiting.

It’s difficult to pinpoint which side effects a  patient might experience, how long they’ll last, and when they’ll end.

The common side effects are:
1.Fatigue
2.Discomfort and Pain
3.Skin Damage or Changes
4.Hair Loss and Scalp Sensitivity
5.Mouth, Gum, and Throat Sores
6.Gastrointestinal Problems

Other side effects are:
•Anemia
•Blood Clotting
•Increased Risk of Infection

Chemo may cause a reduction in white blood cells, which are part of the immune system and help the body to fight infection. Therefore,  the patient  is more vulnerable to developing infections during and after chemo.

•Long-Term Side Effects
Chemotherapy can cause long-term side effects (sometimes called late effects), depending on the type and dose of chemotherapy and whether it was combined with radiation. These effects may involve any organ, including the heart, lungs, brain, kidneys, liver, thyroid gland, and reproductive organs. Some types of chemotherapy drugs may also increase the risk of cancer later in life. Receiving chemo during childhood also may place some kids at risk for delayed growth and cognitive development, depending on the child’s age, the type of drug used, the dosage, and whether chemotherapy was used in addition to radiation therapy.

Newer anticancer drugs act directly against abnormal proteins in cancer cells; this is termed targeted therapy and is technically not chemotherapy.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://englendd.wordpress.com/2011/06/05/chemotherapy/
http://kidshealth.org/parent/system/ill/chemotherapy.html#
http://en.wikipedia.org/wiki/Chemotherapy

http://medicineworld.org/cancer/lead/11-2008/concurrent-chemotherapy-in-lung-cancer.html

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Torticollis

 

Alternative Names : Wry neck; Loxia

DEFINITION:
Torticollis is a twisted neck in which the head is tipped to one side, while the chin is turned to the other.It is a stiff neck associated with muscle spasm, classically causing lateral flexion contracture of the cervical spine musculature. The muscles affected are principally those supplied by the spinal accessory nerve.

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Symptoms:
•Limited range of motion of the head
•Headache
•Head tremor
•Neck pain
•Shoulder is higher on one side of the body
•Stiffness of neck muscles
•Swelling of the neck muscles (possibly present at birth)

Types of Torticollis:

Temporary Torticollis: This type of wry neck usually disappears after one or two days. It can be caused by:

*swollen lymph nodes
*an ear infection
*a cold
*an injury to the head and neck that causes swelling

Fixed Torticollis:  Fixed torticollis is also called acute torticollis or permanent torticollis. It is usually due to a problem with muscle or bone structure.

Muscular Torticollis:
This is the most common type of fixed torticollis. It is caused by scarring or tight muscles on one side of the neck

Klippel-Feil Syndrome:
This is a congenital form of wry neck. It occurs when the bones in an infant’s neck have formed incorrectly. Children born with this condition may have difficulty with hearing and vision.

Cervical Dystonia:
This rare disorder is sometimes referred to as spasmodic torticollis. It causes neck muscles to contract in spasms. If you have cervical dystonia, your head twists or turns painfully to one side. It may also tilt forward or backward. Cervical dystonia sometimes goes away without treatment. However, there is a risk of recurrence.

This type of wry neck  or Torticollis can happen to anyone. However, it is most commonly diagnosed in middle age. It affects more women than men.

CAUSES:
Torticollis  can be inherited. It can also develop in the womb. This may happen if the fetus’ head is in the wrong position. It can also be caused by damage to the muscles or blood supply to the neck.

Anyone can develop wry neck after a muscle or nervous system injury. However, most of the time, the cause of wry neck is not known. This is called idiopathic torticollis.

DIAGNOSIS:
Evaluation of a child with torticollis begins with history taking to determine circumstances surrounding birth and any possibility of trauma or associated symptoms. Physical examination reveals decreased rotation and bending to the side opposite from the affected muscle. Some say that congenital cases more often involve the right side, but there is not complete agreement about this in published studies. Evaluation should include a thorough neurologic examination, and the possibility of associated conditions such as developmental dysplasia of the hip and clubfoot should be examined. Radiographs of the cervical spine should be obtained to rule out obvious bony abnormality, and MRI should be considered if there is concern about structural problems or other conditions.

Evaluation by an ophthalmologist should be considered in children to ensure that the torticollis is not caused by vision problems (IV cranial nerve palsy, nystagmus-associated “null position,” etc.). Most cases in infants respond well to physical therapy. Other causes should be treated as noted above.

TREATMENT:
Common treatments  might involve a multi-phase process:

1.Low-impact exercise to increase strong form neck stability
2.Manipulation of the neck by a chiropractor, physical therapist, or D.O.†
3.Extended heat application.
4.Repetitive shiatsu massage.

†An Osteopathic Physician (D.O.) may choose to use Cranial techniques to properly position the occipital condyles – thereby relieving compression of cranial nerve XI in children with Torticollis. This is an example of Osteopathic Manipulative Treatment.

Acquired torticollis:
Acquired torticollis occurs because of another problem and usually presents in previously normal children and adults…..

*A self-limiting spontaneously occurring form of torticollis with one or more painful neck muscles is by far the most common (‘stiff neck’) and will pass spontaneously in 1–4 weeks. Usually the sternocleidomastoid muscle or the trapezius muscle is involved. Sometimes draughts, colds or unusual postures are implicated; however in many cases no clear cause is found. These episodes are rarely seen by doctors other than a family physician.

*Trauma to the neck can cause atlantoaxial rotatory subluxation, in which the two vertebrae closest to the skull slide with respect to each other, tearing stabilizing ligaments; this condition is treated with traction to reduce the subluxation, followed by bracing or casting until the ligamentous injury heals.

*Tumors of the skull base (posterior fossa tumors) can compress the nerve supply to the neck and cause torticollis, and these problems must be treated surgically.

*Infections in the posterior pharynx can irritate the nerves supplying the neck muscles and cause torticollis, and these infections may be treated with antibiotics if they are not too severe, but could require surgical debridement in intractable cases.

*Ear infections and surgical removal of the adenoids can cause an entity known as Grisel’s syndrome, a subluxation of the upper cervical joints, mostly the atlantoaxial joint, due to inflammatory laxity of the ligaments caused by an infection. This bridge must either be broken through manipulation of the neck, or surgically resected.

*The use of certain drugs, such as antipsychotics, can cause torticollis.

*Antiemetics – Neuroleptic Class – Phenothiazines

There are many other rare causes of torticollis.

Spasmodic torticollis:
Torticollis with recurrent but transient contraction of the muscles of the neck and esp. of the sternocleidomastoid. “intermittent torticollis . “cervical dystonia”

TREATMENT: Botulinum toxin has been used to inhibit the spastic contractions of the affected muscles.

In animals:.CLICK & SEE
The condition can also occur in animals, usually as a result of an inner ear infection but sometimes as a result of an injury. It is seen largely in domestic rodents and rabbits, but may also appear in dogs and other different animals.

Possible ComplicationsComplications may include:

•Muscle swelling due to constant tension
•Neurological symptoms due to compressed nerve roots

Prognosis:
The condition may be easier to correct in infants and children. If the condition becomes chronic, numbness and tingling may develop as nerve roots become compressed in the neck.

The muscle itself may become large (hypertrophic) due to constant stimulation and exercise.

Botulinum toxin injections often provide substantial relief.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Torticollis
http://www.nlm.nih.gov/medlineplus/ency/article/000749.htm
http://www.umm.edu/imagepages/19090.htm

http://commons.wikimedia.org/wiki/File:Sternocleidomastoideus.png

http://www.healthline.com/health/torticollis#Causes2

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Meningioma (mostly benign brain tumour)

 

Definition:
A meningioma is a tumor that arises from the meninges — the membranes that surround your brain and spinal cord. Most meningiomas are noncancerous (benign), though, rarely, a meningioma may be cancerous (malignant). Some meningiomas are classified as atypical, meaning they’re neither benign nor malignant, but rather something in between.

Symptoms typically appear gradually and vary depending on the location and brain area affected. Because these are slow growing tumors, not all meningiomas need to be treated immediately.A meningioma that causes no significant signs and symptoms may be monitored over time. Treatment options focus on removing the tumor and relieving the compression on the brain

Three layers of membranes, called meninges, lying just under the skull, protect the brain and spinal cord. From the outermost layer inward they are: the dura mater, arachnoid mater, and pia mater. A meningioma grows from the arachnoid cells that form the middle layer, and are firmly attached to the dura. Some meningiomas contain cysts or calcified mineral deposits, and others contain hundreds of tiny blood vessels. Because meningiomas tend to grow inward, they commonly cause pressure on the brain or spinal cord. They can also grow outward causing the skull to thicken (hyperostosis).

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Pic-1.Meningiomas grow from the dura covering of the brain. As the tumor grows, it compresses and displaces normal brain tissue. Increasing size, pressure and swelling cause neurologic symptoms.

The World Health Organization (WHO) developed a classification system for all known tumor types, including meningiomas. Tumors are classified by their cell type and grade by viewing the cells taken during a biopsy under a microscope. Treatment varies depending on the grade of your meningioma.

•WHO, Grade I meningiomas are the slowest growing. If the tumor is not causing symptoms, it may be best to observe its growth over time with periodic MRI scans. If there is a chance the tumor will grow enough in your lifetime to cause symptoms, then surgical removal may be recommended. Most Grade I meningiomas are treated with surgery and continued observation.

•WHO, Grade II meningiomas are called atypical. They are slightly more aggressive in growth than Grade I and have a slightly higher risk of recurrence. Surgery is the first line treatment for these types of meningiomas. Some Grade II meningiomas require radiation after surgery.

•WHO, Grade III meningiomas are the most aggressive and are called malignant or anaplastic. Malignant meningiomas account for less than 1% of all meningiomas. Surgery is the first line treatment for Grade III meningiomas followed by radiation. If the tumor recurs, chemotherapy is used.

Meningiomas represent about 20% of all primary brain tumors and 12% of all spinal cord tumors. They can occur in children, but most often occur in adults between the ages of 40 and 60 years. Most meningiomas are benign (not cancerous), as less than 10% of meningiomas are malignant. While malignant meningiomas occur in both women and men, benign meningiomas occur most often in women.

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Symptoms:
mall tumors (e.g., < 2.0 cm) are usually incidental findings at autopsy without having caused symptoms. Larger tumors can cause symptoms depending on the size and location.

*Focal seizures may be caused by meningiomas that overlie the cerebrum.

*Progressive spastic weakness in legs and incontinence may be caused by tumors that overlie the parasagittal frontoparietal region.

*Sylvian tumors may cause myriad motor, sensory, aphasic, and seizure symptoms, depending on the location.

*Increased intracranial pressure eventually occurs, but is less frequent than in gliomas.

Meningiomas grow slowly; it may take years before they cause symptoms. Some people with meningiomas have no symptoms. The tumor may be found incidentally on a diagnostic scan performed for another reason such as a trauma.  Larger tumors can cause symptoms depending on the size and location. They often first appear as headaches and seizures, primarily due to increased pressure of the growing tumor. Weakness in the arms or legs, or loss of sensation, may occur with spinal cord meningiomas.

Meningiomas are often named according to their location and symptoms:
•Convexity meningiomas: grow on the surface of the brain. They may not produce symptoms until they reach a large size. Symptoms include seizures, neurological deficits, or headaches.

•Falx and parasagittal meningiomas: grow from the dural fold, called the falx, which runs between the left and right sides of the brain. The falx contains two large blood vessels (superior and inferior sagittal sinuses). Because of the danger of injuring the sinuses, removing a tumor in the falx or parasagittal region can be difficult. Symptoms may include personality changes, headache, vision problems, and arm or leg weakness.

•Olfactory groove meningiomas: grow along the olfactory nerves that run between the brain and the nose. These tumors often cause a loss of smell. They can compress the frontal lobes causing personality changes that may be mistaken for depression. They can also compress the optic nerves to the eyes, causing visual problems such as loss of specific areas within your field of vision, or even blindness.

•Sphenoid meningiomas: grow along the sphenoid ridge, which lies behind the eyes. These tumors can cause visual problems, loss of sensation in the face, or facial numbness. Tumors in this location can sometimes encase the major blood vessels of the brain (e.g. cavernous sinus, or carotid arteries) as well as the cranial nerves in the area making them difficult to completely remove.

•Posterior fossa meningiomas: grow along the underside of the brain near the brainstem and cerebellum. These tumors can compress the cranial nerves causing facial symptoms or loss of hearing. Petroclival tumors can compress the trigeminal nerve, resulting in facial pain (trigeminal neuralgia) or spasms of the facial muscles. Foramen magnum meningiomas grow near the area where the spinal cord connects to the brain and can cause headaches, or other signs of brainstem compression such as difficulty walking.

•Intraventricular meningiomas: grow inside the fluid-filled ventricles deep inside the brain. They can block the flow of cerebrospinal fluid (CSF) causing hydrocephalus, which can produce headaches and dizziness.

•Intraorbital meningiomas: grow around the eye sockets of the skull and can cause pressure in the eyes to build up, giving a bulging appearance. They can also cause loss of vision.

•Spinal meningiomas: grow predominantly in the thoracic spine. They can cause back pain (typically at night) or loss of sensation and paralysis of the legs from compression of the spinal nerves.

Causes:
Scientists are not certain what causes meningioma tumors, although several theories are being investigated. Most agree that a malformed chromosome is the most common abnormality in meningiomas, but the cause of this abnormality is unknown.Most cases are sporadic while some are familial. Persons who have undergone radiation to the scalp are more at risk for developing meningiomas. People with a genetic disorder known as neurofibromatosis type 2 (NF2) are more likely to develop meningiomas. Of people with malignant meningiomas, a higher percent have mutations in NF2. Studies have also found that patients who received radiation treatment to the head for medulloblastomas, ependymomas, or other tumors are at higher risk for developing meningiomas later in life secondary to the radiation.

 

Diagnosis:
First, the doctor will ask about your personal and family medical history and perform a complete physical examination. In addition to checking your general health, the doctor performs a neurological exam. This includes checks for mental status and memory, cranial nerve function (sight, hearing, smell, tongue and facial movement), muscle strength, coordination, reflexes, and response to pain. If a problem is found, the doctor may order diagnostic imaging tests such as computerized tomography (CT) or magnetic resonance imaging (MRI) scans to help determine the size, location, and type of tumor, if one exists . Skull x-rays may be obtained if the tumor is believed to involve the bone. For spinal cord tumors, a myelogram may be done, and in some cases, angiograms, or x-rays of the blood vessels, are necessary. The diagnosis can be confirmed by a biopsy.

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Risk Factors:
*Radiation treatment. Radiation therapy that involves radiation to the head may increase the risk of a meningioma.

*Female hormones. Meningiomas are more common in women, leading doctors to believe that female hormones may play a role.

*An inherited nervous system disorder. The rare disorder neurofibromatosis type 2 increases the risk of meningioma and other brain tumors.
Treatment:
The treatment you receive for a meningioma depends on many factors, including the size of your meningioma, where it’s situated and how aggressive it’s believed to be. Your doctor will also take into consideration your overall health and your goals for treatment.

Wait-and-see approach
Immediate treatment isn’t necessary for everyone with a meningioma. A small, slow-growing meningioma that isn’t causing signs or symptoms may not require treatment.

If the plan is not to undergo treatment for your meningioma, you’ll likely have brain scans periodically to evaluate your meningioma and look for signs that it’s growing. Your doctor creates a personalized follow-up schedule for you. For instance, you might undergo brain scans every few months at first and then have scans done annually. If your doctor determines your meningioma is growing and needs to be treated, you have several treatment options.

Surgery
If your meningioma causes signs and symptoms or shows signs that it’s growing, your doctor may recommend surgery. Surgeons work to remove the meningioma completely. But because a meningioma may occur near many delicate structures in the brain or spinal cord, it isn’t always possible to remove the entire tumor. In those cases, surgeons remove as much of the meningioma as possible.

The type of treatment, if any, you need after surgery depends on several factors.

*If no visible tumor remains, then no further treatment may be necessary. However, you will have periodic follow-up scans.

*If the tumor is benign and only a small piece remained, then your doctor may recommend periodic follow-up scans only. In some cases, small, leftover tumors may be treated with a form of radiation treatment called stereotactic radiosurgery.

*If the tumor is atypical or malignant, you’ll likely need radiation.

Surgery may pose risks including infection and bleeding. The specific risks of your surgery will depend on where your meningioma is located. For instance, surgery to remove a meningioma that occurs around the optic nerve can lead to vision loss. Ask your surgeon about the specific risks of your surgery…..click & see

A craniotomy is cut in the skull to expose the tumor. After the tumor is removed, brain tissue can re-expand in the cavity……..click & see

Radiation therapy
If your meningioma can’t be completely removed, your doctor may recommend radiation therapy following surgery. The goal of radiation therapy is to destroy any remaining meningioma cells and reduce the chance that your meningioma may recur. Radiation therapy uses a large machine to aim high-powered energy beams at the tumor cells.

Advances in radiation therapy increase the dose of radiation to the meningioma while reducing radiation to healthy tissue. These include fractionated stereotactic radiotherapy (SRT) and intensity-modulated radiotherapy (IMRT).

Radiosurgery
Radiosurgery is a type of radiation treatment that aims several beams of powerful radiation at a precise point. Contrary to its name, radiosurgery doesn’t involve scalpels or incisions. Radiosurgery typically is done in an outpatient setting in a few hours. Radiosurgery may be an option for people with meningiomas that can’t be removed with conventional surgery or for meningiomas that recur despite treatment.

Fractionated radiation
For tumors too large for radiosurgery or those in an area that can’t tolerate the high intensity of radiosurgery — such as near the optic nerve — a possible option is fractionated radiation. This involves delivering the radiation in small fractions over time. For example, this approach might require one treatment a day for 30 days.

Drugs
For people with meningiomas that recur or don’t respond to surgery and radiation, doctors are trying different system treatments. Unfortunately, most chemotherapy has not proved valuable, but some drugs, such as hydroxyurea (Droxia, Hydrea), are sometimes used. Other drugs are being tested as well, such as those that inhibit the formation of blood vessels (angiogenesis inhibitors). Much more study is needed.

Complications:
A meningioma and its treatment, typically surgery and radiation therapy, can cause long-term complications, including:

*Difficulty concentrating

*Memory loss

*Personality changes

*Seizures

Your doctor can treat some complications and refer you to specialists to help you cope with other complications.

Alternative Medications:
Alternative medicine treatments can’t treat meningiomas, but some may help provide relief from treatment side effects or help you cope with the stress of having a meningioma.

Alternative medicine therapies that may be helpful include:

*Acupuncture

*Hypnosis

*Massage

*Meditation

*Music therapy

*Relaxation exercises

Discuss options with your doctor.

Coping and support
Being diagnosed with a meningioma can be overwhelming. As you come to terms with your diagnosis, your life can be turned upside down with visits to doctors and surgeons as you prepare for your treatment. To help you cope, try to:

*Learn everything you can about meningiomas. Ask your health care team where you can get more information about meningioma and your treatment options. Visit your local library and ask a librarian to help you track down reliable resources for more information, including online sources. Write down your questions so that you’ll remember to ask them at your next appointment with your doctor. The more you know about your condition, the better prepared you’ll be to make decisions about your treatment.

*Build a support network. Having friends and family supporting you can be valuable. You may find it helps to have someone to talk to about your emotions. Other people who may provide support include social workers and psychologists — ask your doctor for a referral if you feel that you need someone else to talk to. Talk with your pastor, rabbi or other spiritual leader. Other people with meningiomas can offer a unique perspective, so consider joining a support group – whether it’s in your community or online. Ask your health care team about brain tumor or meningioma support groups in your area, or contact the American Brain Tumor Association.

*Take care of yourself. Try to stay healthy during your treatment for a meningioma by taking care of yourself. Eat a diet rich in fruits and vegetables, and get moderate exercise daily if your doctor allows it. Get enough sleep so that you wake feeling rested. Reduce stress in your life by focusing on what’s important to you. These measures won’t cure your meningioma, but they may help you feel better as you recover from surgery or help you to cope during radiation therapy.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.mayfieldclinic.com/PE-MENI.htm
http://en.wikipedia.org/wiki/Meningioma
http://www.mayoclinic.com/health/meningioma/DS00901
http://www.bbc.co.uk/health/physical_health/conditions/braintumourbenign.shtml

Lipomas

Definition:
A lipoma is a slow-growing, fatty lump that’s most often situated between your skin and the underlying muscle layer. Often a lipoma is easy to identify because it moves readily with slight finger pressure. It’s doughy to touch and usually not tender

 

You may click to see the picture

A lipoma is a benign tumor composed of adipose tissue. It is the most common form of soft tissue tumor. Lipomas are soft to the touch, usually movable, and are generally painless. Many lipomas are small (under one centimeter diameter) but can enlarge to sizes greater than six centimeters. Lipomas are commonly found in adults from 40 to 60 years of age, but can also be found in children. Some sources claim that malignant transformation can occur, while others say that this has yet to be convincingly documented
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Symptoms & Types:
There are several subtypes of lipoma:

*Angiolipoleiomyoma is an acquired, solitary, asymptomatic acral nodule, characterized histologically by well-circumscribed subcutaneous tumors composed of smooth muscle cells, blood vessels, connective tissue, and fat.

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*Angiolipoma is a painful subcutaneous nodule, having all other features of a typical lipoma.
Chondroid lipomas are deep-seated, firm, yellow tumors that characteristically occur on the legs of women.

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*Corpus callosum lipoma is a rare congenital condition which may or may not present with symptoms. Lipomas are usually relatively small with diameters of about 1–3 cm, but in rare cases they can grow over several years into “giant lipomas” that are 10–20 cm across and weigh up to 4–5 kg.

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*Hibernoma is a lipoma of brown fat.

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*Intradermal spindle cell lipoma is distinct in that it most commonly affects women, and has a wide distribution, occurring with relatively equal frequency on the head and neck, trunk, and upper and lower extremities….click & see

*Neural fibrolipoma is an overgrowth of fibro-fatty tissue along a nerve trunk that often leads to nerve compression.click & see

 

*Pleomorphic lipomas, like spindle-cell lipomas, occur for the most part on the backs and necks of elderly men, and are characterized by floret giant cells with overlapping nuclei...click & see

*Spindle-cell lipoma is an asymptomatic, slow-growing subcutaneous tumor that has a predilection for the posterior back, neck, and shoulders of older men…..click & see

*Superficial subcutaneous lipoma, the most common type of lipoma, lies just below the surface of the skin. Most occur on the trunk, thighs and the forearms, although they may be found anywhere in the body where fat is located….click & see
Causes:
The exact cause of lipomas is unknown. Lipomas tend to run in families, so genetic factors likely play a role in their development.But the tendency to develop a lipoma is not necessarily hereditary although hereditary conditions, such as familial multiple lipomatosis, may include lipoma development. Genetic studies in mice from the laboratory of Santa J. Ono have shown a correlation between the HMG I-C gene (previously identified as a gene related to obesity) and lipoma development. These studies support prior epidemiologic data in humans showing a correlation between HMG I-C and mesenchymal tumors.

Cases have been reported where minor injuries are alleged to have triggered the growth of a lipoma, called “post-traumatic lipomas.” However, the link between trauma and the development of lipomas is controversial.
Diagnosis:
The diagnosis for lipoma is a simple physical examination by a health care provider. Because lipoma resembles another tumor which is cancerous, liposarcoma, a doctor may perform a biopsy of the tumor.(A tissue sample removal (biopsy) for lab examination).

An ultrasound or other imaging test, such as an MRI or CT scan,may be required  if the lipoma is large, has unusual features or appears to be deeper than the fatty tissue.

Liposarcomas — cancerous tumors in fatty tissues — grow rapidly, don’t move under the skin and are usually painful. A biopsy, MRI or CT scan is typically done if your doctor suspects liposarcoma.

Treatment:
Usually, treatment of a lipoma is not necessary, unless the tumor becomes painful or restricts movement. They are usually removed for cosmetic reasons, if they grow very large, or for histopathology to check that they are not a more dangerous type of tumor such as a liposarcoma.

Lipomas are normally removed by simple excision. The removal can often be done under local anaesthetic, and take less than 30 minutes. This cures the majority of cases, with about 1-2% of lipomas recurring after excision. Liposuction is another option if the lipoma is soft and has a small connective tissue component. Liposuction typically results in less scarring; however, with large lipomas it may fail to remove the entire tumor, which can lead to re-growth.

There are new methods being developed that are supposed to remove the lipomas without scarring. One of them is removal by the use of injection of compounds that trigger lipolysis, such as steroids or phosphatidylcholine.

Prognosis:
Lipomas are rarely life-threatening and the common subcutaneous lipomas are not a serious condition. Lipomas growing in internal organs can be more dangerous, for example lipomas in the gastrointestinal tract can cause bleeding, ulceration and painful obstructions. Malignant transformation of lipomas into liposarcomas is very rare and most liposarcomas are not produced from pre-existing benign lesions, although a few cases of malignant transformation have been described for bone and kidney lipomas. It is possible these few reported cases were well-differentiated liposarcomas in which the subtle malignant characteristics were missed when the tumour was first examined. Deep lipomas have a greater tendency to recur than superficial lipomas, because complete surgical removal of deep lipomas is not always possible

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Lipoma
http://www.mayoclinic.com/health/lipoma/DS00634
http://www.nlm.nih.gov/medlineplus/ency/imagepages/1209.htm
http://www.helium.com/items/1297816-lipoma-diagnosis-and-treatment
http://www.mdguidelines.com/lipoma
http://www.kmle.co.kr/search.php?Search=angiolipoleiomyoma
http://www.cholinergicurticaria.net/2008/10/13/could-angiolipomas-or-tumors-cause-cholinergic-urticaria/
http://www.med.uc.edu/neurorad/webpage/eua.html
http://www.lookfordiagnosis.com/mesh_info.php?term=Lipoma&lang=1
http://radiographics.rsna.org/content/19/5/1253.full
http://www.medscape.com/content/2001/00/40/56/405672/art-nf1001.01.fig1.jpg