Melanoma Part 2.

Surgeon or dermatologist cuts off the melanoma. Then, Pathologist (doctor specializing in lab diagnostics) looks the sample under microscope.


He classifies the tumor. The grade of the tumor gives the clue to the chances of your survival.


There are several classifications


Breslow classification measure the penetration of the lesion into skin by millimeters. Know that > 0.75 mm is already dangerous, but > 4 mm is wacking.


What is 4 mm. It is nothing. Right? Take a ruler and check how 1 mm looks and how 4 mm looks.


So this is why it is important to catch melanoma early.


There is also Clarks classification that measures penetration of the melanoma into the skin and other layers.


TNM classification standardizes the grading.


You can not know the grade unless you excise and measure the melanoma penetration under microscope. It is not a do-it-yourself project. Surgeon and pathologist will do it.


The time of evolvement 1-2 years.


The frequency of melanoma is increasing. It might be because of more people get sun damage. Also other reasons may play role.


Treatment of melanoma includes surgical removal, chemotherapy, immunotherapy, radiation therapy.


Keywords: Melanoma, mole, nevus, dermatology, pathology, surgeon, doctor.


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Melanoma. Part 1.

How to spot malignant mole?


This morning you took a bath. The warm water feels so nice during the cold winter day.
There was some funny skin itching on you back. You looked in the mirror, turned this way , that way. There is small mole on your back You remember this spot had been there for years, since childhood. Did this spot get that strange itching?


Recently you have heard the news that there are more than 50000 of new melanoma cases every year. This number grows 3% a year.


What is going on? Is this small spot on you back went out of control?


Several types of skin tumors exist. Many are slow growers. Many give rare metastasis. Simple removal cure majority of skin tumors.


Melanoma brings troubles big time.


Melanos = black, oma = tumor.


You can detect melanoma by self-exam. Skin cancers show themselves much easier than any other types of cancer.


In the same time you can cure melanoma by simple surgical resection. However, catch this tumor in early stage. Late stage metastasize. Surgeon can not cut off every metastasis in your body.


There are numerous sites dedicated to melanoma self-exam. Just type in the word "melanoma" into any search engine. Follow instructions.


Fair skin people have more chances of getting melanoma. However, dark skin people develop melanoma too.


Everybody has moles. Women even use moles to charm. How to find if your mole became dangerous?


Dangerous signs include ABCD:


Asymmetry


Border


Color


Diameter


A- asymmetry. Suspicious mole does not look like a round or oval blot. Often, early melanoma looks rather like a blot with an odd shape.


B- borders. Borders become irregular, uneven, fuzzy. The edges of the blots become notched.


C- color. Color of normal mole should be more or less homogenous. Change in color is very suspicious . There are shades of brown, black, tan, red. Mottled color is suspicious.


D- diameter. Change in diameter is suspicious too. Mole that is bigger than 6 mm is suspicious. Everybody compares 6 mm to a pencil eraser (though few people actually use it extensively). Just to get idea about the borderline size.


Besides ABCD there could be other signs of dangerous mole: <

br> E - enlargement and elevation over the time


Also worrisome signs include easy bleeding and erythema (redness) around the mole.


Itching and pain in the side of mole make you suspicious as well.


History of melanoma in Family should also raise suspicions.


Some skin problems look like melanoma, but are actually harmless. Anyway, do not gamble with them. Even experienced physician can not always tell if the lesion is malignant or not. It is better to be safe then, sorry and check the troubling changes soon.


Some rare types of melanoma exist. Because even obvious melanomas are not always diagnosed on time, the unusual types becomes much more deadlier. Often doctor sees them too late.


Melanoma under the nails. Melanoma of mucous membranes. (Mouth, nose or guts) Amelanotic melanoma - this one is not even colored.


The treatment will be excision with margins and biopsy, but most important of course is to catch melanoma


Know that the treatment depends on the thickness of the tumor and the presence of distant metastasis.





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Kidney Cancer Treatment.

How do they treat renal cancer?



Surgery is the main choice. Surgeon will do nephrectomy. Nephros=kidney. Ectomy =removal.
They remove kidney and all the tissue around.


In some cases it possible to remove only part of kidney. However for kidney cancer it us usually
not an option. Kidney requires a lot of blood, has a lot of blood vessels. It tends to bleed
significantly if cut. That bleeding is very difficult to stop. Besides urine makes a lot of problem
by leaking into surrounding tissue and leading eventually to infections. This is why they usually
remove whole kidney.



Having only one kidney left, makes you vulnerable. The remaining kidney usually will
compensate. It will grow bigger and produce more urine. Alas, it is still only one kidney left.



The removal of kidney cures you only if it is early stage. If tumor grows beyond the kidney
capsule or metastasizes, you options include radiation therapy, chemotherapy and
immunotherapy. Interferon and interleukin 2 activate immune system. Doctors use them to treat
renal cancer cases.



There are some other options exist. You should discuss the options with your doctor. Oncologist
will give you more information for your particular case.



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Kidney Cancer. What would doctor order if he suspects kidney cancer?

What would doctor order if he suspects kidney cancer?



First, any doctor collects you detailed medical history, performs thorough physical exam and
orders some simple tests - like blood test and especially urine test. Urine test (named
urinalysis) can show microscopic blood. If doctor really suspects kidney cancer, he may order

CT scan (computerized tomography)

Ultrasound

Intravenous pyelography (X ray image of special dye excretion). Excretion means ridding off.

MRI (magnetic resonance imaging)




If doctor suspects metastases, he orders:

Chest X-ray

Bone scan

CT

MRI



To plan for surgery he orders:

CT

MRI

Ultrasound

Arteriography - X-ray image of the dye in the blood vessels of kidneys.



Do not expect that all of this test will be done. Some of them will be done for sure.






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Kidney Cancer. Part 4.

When do you suspect renal cancer?



You start to worry if:

Here is blood in urine (doctors name it hematuria . Haematos=blood. Uria=urine)

You loose weight with no good reason. (If you exercise and balance your diet, it is actually very
good reason to loose weight. Do it)

You are always tired, fatigued.

You have unexplained fever

You go to a routine exam and find that your blood pressure is very high

Your legs and ankles swell.



There could be hundreds of other conditions and diseases that can cause those signs. However,
you should be always suspicious. There is a term: Cancer Awareness. It is much easier to treat
tumor in an early stage. Late stage is often deadly. Renal cancer is notorious for that it goes
unnoticed until late stages. So, do not become crazy if you get those signs. But do not take them lightly as well. Check with your doctor.



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Kidney Cancer. Part 3.

What is kidney (renal) cancer?



Risk factors for renal cancer:



If you a male, you have twice more chances to have kidney cancer then female
If you are older than 50 years old, your have more chances to develop renal cancer. (Children
have most commonly special type of kidney cancers - Wilms tumor)



Asbestos, Cadmium, organic solvents, paints increase risk of getting kidney cancer. Check your
job place.



Kidney cancer grows more often in obese people, the people who eat fat-rich food. Researchers found the link between obesity and up to 20% of renal cancers.



Special genetic disorder (von Hippel Lindau disease) associates with renal cancer.






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Kidney cancer. Part 2.

It is 1:30 AM. Pager goes off.

A nurse calls (they just had shift, fresh nurse came in).

Doctor, Patient so and so made just 100 ml of urine in last shift (8 hours). What are you going todo?


Ms. X had colon resection last afternoon.


Does patient had history of CHF or renal failure?

Not, that I know of.


OK, give her bolus 500 ml of Normal saline and call me again in an hour

At 2:30. Dr patient so and so still puts just 15 ml of urine an hour.

OK. Lets give her 500 more of NS and check it in an hour.

At 3:30. Doctor, Patient did not make the urine .

Now you really need to evaluate patient carefully.

Any surgery is a trauma. As any trauma the fluid is going out of blood vessels and into damagedtissue . This sort of natural protective mechanism - to keep spreading of infection from thedamaged area around the rest of your body. But that protective mechanism removes the fluid from bloodvessels. Blood becomes partially more concentrated. Yet worse: there are lees blood goingthrough the kidneys.


Kidneys require certain amount of blood to work. You know that to filtrate the fluid into urine youneed pressure. Like if you filtrate something through a paper. The more is pressure, the more isfiltration.

No blood - no pressure. This is why you give normal saline.

But let say you are wrong and there is enough blood in vessels, enough pressure, the fluid isreplaced.

Just kidneys do not work well.

Patient have 5 liters of blood , you give 1 more liter of fluid. Where does it all go?

If there is 5 liter bottle and you pour one more litter. Here are now 6 liters. Where does it go?

It goes everywhere.

Apparently it filtrates into tissue.

I am so puffy, doctor - complains the patient

If kidneys work well it is not a big deal. Sooner or later- usually at day 3 - fluid from tissue willreturn back to vessels and your kidneys filtrate excess of fluid into your urine.

In realilty patient is usually not a 20 year-old Hollywood beach boy. Real patient is usually 70years old bed-ridden chronically ill patient with CHF (heart does not pump the blood wellthrough the kidneys ) and Diabetes (kidney are damage in the first place). Besides, there are other15 diagnosis, and list of 30 different medications including steroids and colchicine for her rheumatoid arthritis and gout.

Colchicine certainly relives gout.

Sure. But it can also damage kidney when overdosed.

OK, where does the fluid go now?

It goes where it is easier to go. Lungs.

Right here and right now at 3 AM you have a problem with fluid overload. You listen patent's lungs.

Plop-Plop. There are small bubbles. Crackles. Patient almost drowns in his own fluid. You needto boost oxygen to help him to breath easier. Then try to rid off the fluid.Maybe kidney will respond to diuretics (medication that increase production of urine).

Or maybe they will not, because the patient has the history of diabetes, hypertension andrheumatoid arthritis. Now she develops acute renal failure (kidneys are shut down and do notreact to diuretics).


Then you really have a problem. You try this, you try that.

Several methods exist. Everything fails.

Eventually (fortunately it is rare) you call Nephrologist (doctor who looks for kidneys) and ask ifhe can schedule emergent dialysis. Right here , right now.

Obviously, Nephrologist, the guy who left hospital yesterday at 9 PM, kissed his children at 11 -bye-bye, good night - and was going back at 7 a.m. today, is not very happy that you wake himup at 4 AM.

But what could we do? This is life.


All this is just to illustrate how important kidneys are.

Not surprising is that kidneys consume huge amount energy, require a lot of blood and lot of oxygen.This is a super efficient waste removal plant. Maybe couple of other organs could be compared as working the same hard. Brain and heart.

Liver also cleans some toxic wast. Though, the liver way is different. Also liver removes less waste than kidneys.

You can replace kidneys with dialysis. However, dialysis is not exactly the same kidney.

Dialysis allows just to filtrate fluid. It does not filtrate so efficiently as kidneys (because kidneyshave some additional mechanisms to remove waste) .


Dialysis does not concentrate back.

You rapidly loose good stuff on dialysis too.

Besides there are problems with access. Infections at the site of access plague the care for dialysis patients.

The machine consits of complicated mechanism, that artificial kidney outside of your body. The machine wheighs half ton, binds you to the bed for three hours every couple days etc, etc.


It is good when kidneys work well.



Kidneys may develop cancer too (as any other organ).




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Kidney Cancer. Part 1.

Renal cancer

Your kidneys make urine.

There are only 2 kidneys.


But, gosh how important they are

You may loose 2 legs, 2 arms, one eye and half of your gut and still live 20 years from now on.

You loose both kidneys and you would not live more then a week (unless getting dialysis).Dialysis is sort of artificial kidney, huge complicated machine.

Kidneys clean your blood. For an average person, if your whole body wold be all blood, it wouldbe cleaned twice a day.

An average person actually has around 5 liters of blood (little bit more than a gallon). Your heartpumps that blood through your kidneys 30 times a day . 150 liters every day.

The clean fluid is taken back to the blood and the waste is concentrated to around 1.5 liters ofurine. Hence the concentration is about 10 times.

For a normal person you would expect production of 40-60 ml of urine an hour. Right aftersurgery a person produces 30-50ml of urine an hour. Surgeons are very concerned if a patientdoes not make enough urine after any surgery. Abdominal surgery or heart surgery or brainsurgery. You name it.




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Bladder cancer. What are the signs?

What are the signs?

How would you find bladder cancer? Not an easy answer.

Bladder may contain around 300- 600 ml of urine and even more, if stretched. The tumor of 600 ml would fit easily. You even didn't notice it until it is too late. Just imagine a lump of 600 ml somewhere at the back of your head. You would notice it immediately.

Bladder has a room for growth.

From the other hand, bladder cancer gives you some clues much earlier.

What can it do? First, as many other tumors, it may easily bleed. Blood in your urine is very suspicious.

Second, that nasty lump is hanging over there, inside, bumps into the walls of the bladder, irritates everything around and causes frequent urination.

Third, if it stacks somewhere in the tubes (there are 2 tubes leading form kidney to bladder - ureters, and one tube leading from bladder to outside - urethra), it may cause pain or decrease outflow of urine.

Also, if the cancer invades into the wall of bladder and pinches nerves, it would cause pain.

Now, the signs suspicious for bladder cancer would be:

- Blood-stained urine (or microcopic blood in urine)

- Frequent urination

- Pain during urination

- Weak urine stream

If this is a male 60, smoker for 30 years, one pack per day - think twice, please.

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Bladder cancer. Intro

Bladder cancer.

Your urine is stored in your bladder. It makes sense. If there is no bladder exist, then urine would leak non-stop.

Bladder helps you to keep it in until it is time for bathroom. Isn't it nice?

Well, you may develop bladder cancer.

Urine in your bladder is a fluid with concentrated toxic waste. Because urine is sitting in your bladder, those toxic substances act on the cells lining the bladder inside. Cells mutate and transform into malignant (bad ones).

Now, it is not surprising that person of some professions have higher rate of bladder cancer. This is true for the people working with aromatic chemicals (chemicals that have aromatic ring in their molecules). Example of chemicals - different organic solvents used for painting or other purpose.

Probably, by the same mechanism, the chance of bladder cancer is significantly increased in smokers. Tobacco smoke contains many of the same chemicals.

Those chemicals go into your lungs (they take toll over there). They also affect mouth, throat and larynx. They go into your stomach and do harm over there. Finally, through the lungs they go into your blood. Kidneys clear the blood and concentrate chemicals in urine.

Here we are.

Smokers have higher chance of getting bladder cancer.

Also as for majority of other cancers, older people have a greater risk of bladder cancer. Men suffer bladder cancer 4 times more often then female. (Bunch of explanations exists. Doesn't matter, just remember it).


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Cancer treatment

Depending on the type and stage of the tumor your may include surgery, radiation therapy, chemotherapy, hormone therapy, immunotherapy, some experimental types of therapies. Most commonly treating tumors requires more than one type of cancer therapy.


*Surgery

Surgery is the main treatment for early tumors that have not metastasized. Your surgeon may need to remove a lot of normal tissue around the tumor. Often it is impossible. The tumor may sit near or within a vital nerve, vessel or organ.

*Radiation Therapy

X rays or gamma ray cause genetic damage of cancerous cells. Side effects include fatigue, skin problems, decreased appetite.

*Chemotherapy

Anticancer drugs combat cancer, interfere with making new DNA in cancer cells’, stop them dividing,activate programmed cell death. Most common combination in cancer treatments is surgery or radiation followed by chemotherapy.

*Hormone Therapy

Hormone Therapy is used for breast and prostate cancer, and other cancers that depend on sex hormones to grow.

*Immunotherapy.

Your own immune system fights cancer cells. Immunotherapy uses antibodies mostly. Another type - using killed bacteria (BCG) that boosts your own immune sytem. One more approach - to use differnt immune cell actvators (like interlukins, interferons). Monoclonal antibody are produced artificially. Monoclonal antibody target cancer cells with precision. Your blood cells might be taken out, activated in lab and returned back to hunt cancer cells. There are some atoher therpaies in develpmet like angiogeneisis inhibitors - tha deprive cancer cells form blood and oxygen.

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