Nursing Spectrum Online

Artificial Heart Systems Receive FDA Green Light

2004-11-14T19:22:00.000-08:00

Artificial Heart Systems Receive FDA Green Light

Tucson, Ariz. — The CardioWest Temporary Total Artificial Heart came off the U.S. Food and Drug Administration’s “experimental list” Oct. 18, capping 19 years of development at the University of Arizona and a nine-year study of the device as a “bridge to transplant.”

The CardioWest is an air-driven device that is placed in the chest, replacing the ventricles and all four heart valves, and has an external control console. Compared with other artificial heart systems, including the Jarvik-7 from which it evolved, the device has the shortest blood path and exposure to artificial surfaces, which reduces the risk of infection and clots, and pumps the most blood with each heartbeat.

A nine-year study of the CardioWest showed that recipients become better candidates for eventual transplantation. The results, published in the New England Journal of Medicine in August, showed that CardioWest recipients had a one-year survival rate of 70%, compared with 31% for patients in the study who did not receive the artificial heart.

That 1993-2002 study involved the University of Arizona Medical Center; Loyola Medical Center in Chicago; LDS Hospital in Salt Lake City; Saint Luke’s Medical Center in Milwaukee; and the University of Pittsburgh Medical Center.

Facts on Mesothelioma

2004-11-14T19:20:00.000-08:00

Facts on Mesothelioma:

Coming Soon.

In the early 20^th century, doctors here in the modern world began to piece together the negative health impacts of asbestos on the working man. They found an alarming rate of lung disease and death among occupations who came in regular contact with the material.

In 1927, the first workmen’s compensation disability claim for asbestos was filed. It was a man that had formerly been a foreman in an asbestos textile plant in Massachusetts. However, it wasn’t until 1930 that the US confirmed the existence of asbestos lung disease in America.

Exposure to asbestos can cause shortness of breath, as well as mesothelioma and lung cancer.

There are three types of asbestos- chrysotile asbestos, amosite asbestos and crocidolite asbestos

Types of Asbestos

2004-11-14T19:19:00.001-08:00

Types of Asbestos:

Asbestos is a soft, flaky mineral that is as flexible as cotton. However, it is fireproof. As far back as ancient Greece, asbestos was used. Even then, they called is asbestos, which means inextinguishable, in Greek. They also observed the harmful health effects. Even then the slaves developed a sickness to the lungs after working with asbestos being woven into cloth. However, the Greeks were in such awe of this amazing material that they chose to ignore the obvious ill effects it caused to their slave population.

Exposure to asbestos can cause shortness of breath, as well as mesothelioma and lung cancer.

There are three types of asbestos- chrysotile asbestos, amosite asbestos and crocidolite asbestos.

Asbestos and Mesothelioma

2004-11-14T19:19:00.000-08:00

Asbestos and Mesothelioma

While the incidence of mesothelioma in the United States remains low, there is a significant increase in mesothelioma diagnosis among males between 1970 and 1984, who had occupations that came in direct contact with asbestos.

Many of these jobs included asbestos product plants and shipbuilding facilities. There are many class actions suits taking place on behalf of these individuals.

The main cause of mesothelioma is exposure to asbestos. The fibers of the asbestos material is inhaled, and they travel to the ends of small air passages and reach the pleura. Here, they cause physical damage to the mesothelium cells, which may result in asbestos mesothelioma cancer. These asbestos fibers can also be swallowed, where they can reach the abdominal cavity. In this case, the victim may develop peritoneal mesothelioma.

Though most exposure cases to asbestos are occupational, there are also cases in which there is family exposure through either building materials or through a parent exposing the remainder of the family.

Mesothelioma

2004-11-14T19:18:00.000-08:00

Mesothelioma:

There are a few different types of Mesothelioma. Though this type of cancer is rare, it is sadly not uncommon. Malignant Mesothelioma is the most serious type of Mesothelioma cancer, and is often caused by Asbestos exposure.

There is a layer of cells that line the chest cavity, abdominal cavity and heart cavity. These cells are calles mesothelial cells. They also cover the outer surface of most organs. These cells together form a tissue called mesothelium. The mesothelium is very helpful to the organs is surrounds. It produces a special lubricating fluid for them to move around in. This fluid allows the lungs to move freely while breathing, etc. There is mesothelium in chest, known as pleura, and mesothelium in the abdomen known as peritoneum. The mesothelium surrounding the pericardial cavity is called the pericardium.

Mesothelioma cancer is cancer of this tissue. These cancer tumors may be benign, or malignant. A malignant tumor in the mesothelium is called a malignant mesothelioma. Most mesothelioma is malignant, so this type is cancer is often simply referred to as “mesothelioma”.

The various types of mesothelioma reference which part of the mesothelium it occurs within. Therefore, mesothelioma of the chest is known as pleural mesothelioma, mesothelioma of the abdomen is known as peritoneal mesothelioma, and mesothelioma of the cardiac cavity is known as pericardium mesothelioma.

There are three main types of malignant mesothelioma. These are the epitheliod type, which has the best prognosis. Second is the sarcomatoid and missed/biphasic types. Treatment for all three types is the same. Almost three fourths of mesothelioma occur in the chest cavity, and is therefore known as pelural mesothelioma.

Mesothelioma

2004-11-14T19:17:00.000-08:00

Mesothelioma lung cancer is a very serious disease which is largely caused by exposure to the material asbestos. Sadly, thousands of Americans die each year from Mesothelioma lung cancer. Included in this website is information about types of Mesothelioma, the role of asbestos in Mesothelioma cancer, Mesothelioma resources, and contact information for asbestos Mesothelioma legal information.

If you or your loved one is facing the diagnosis of Mesothelioma, research is the first step. Additional treatment information information on asbestos Mesothelioma cancer is available on the following pages. This site is not intended to be a medical resource for victors of Asbestos Mesothelioma Cancer, but can point you in the right direction to find treatment centers, information on current Mesothelioma cancer treatments and help in finding good Asbestos Mesothelioma legal advice.

JCAHO Raises Concerns About Patient Awareness During Surgery

2004-11-14T19:13:00.000-08:00

JCAHO Raises Concerns About Patient Awareness During Surgery

The Joint Commission on Accreditation of Healthcare Organizations is calling “anesthesia awareness” a problem and has made recommendations to prevent patients from regaining consciousness during surgery.

Working with the American Association of Nurse Anesthetists and the American Society of Anesthesiologists, the JCAHO asked surgeons “to be more diligent in the operating room” or use brain monitors. Before surgery, patients should be alerted to the possibility of waking from anesthesia be asked about their awareness during surgery, the JCAHO said in a notice to the 4,579 hospitals it accredits.

It’s estimated that as many as 100 patients a day regain consciousness during surgery, with 48% hearing operating room conversations, 48% having the feeling they can’t breathe, and 28% experiencing pain, according to a recent study in the journal Anesthesia & Analgesia.

Enoxaparin precautionary changes

2004-11-14T19:12:00.000-08:00

Enoxaparin precautionary changes

Prescribing information for the injectable anticoagulant enoxaparin (Lovenox) has recently changed in its use in those who are obese, underweight, elderly, or renally impaired.

Obese individuals may have delayed clearance of the medications and require closer monitoring and dosage adjustment. Patients who are underweight need close observation for the signs and symptoms of bleeding. To detect overt or occult blood loss, nurses should watch for abnormal physical assessment findings, such as increased pulse, decreased blood pressure, and hematuria, and monitor laboratory tests (hematocrit and hemoglobin, urinalysis, stool for occult blood) in acute care and post–acute care settings. Likewise, home health nurses or other caregivers must monitor and educate patients who are discharged on the drug.

Patients who have renal impairment, identified as a creatinine clearance <30>

Continued caution and close monitoring are especially important for elderly patients taking enoxaparin. The risk for medication-associated bleeding has been shown to increase with age and polypharmacy.

Obtain a detailed medication history for all medications, including prescription, over-the-counter, and herbal or natural health preparations. Pay special attention to substances with anticoagulant and antiplatelet properties, such as aspirin-containing products and herbal supplements like ginkgo biloba, garlic supplements, black cohosh, and red clover. For an extensive list of herbal supplements, visit: www.drugs.com/PDR/Coumadin_Tablets.html.

For additional information: visit www.LOVENOX.com and www.fda.gov/medwatch/SAFETY/2004/Lovenox_PI.pdf.

Reference

Lovenox. Available at: www.fda.gov/medwatch/SAFETY/2004/Lovenox_HCP.pdf. Accessed October 4, 2004.

Caution

Review current drug information before administering and monitoring medications.

Drug News is compiled by Susanne J. Pavlovich-Danis, RN, MSN, ARNP-C, CDE, who maintains a private practice in Plantation, FL, and is professor and area chair for nursing at the University of Phoenix, Fort Lauderdale.

We are searching coast to coast to honor excellence in the Nursing Profession

2004-11-14T19:07:00.000-08:00

We are searching coast to coast to honor excellence in the Nursing Profession.
We need your help!

Nursing Spectrum and NurseWeek are have
created a national program of recognizing extraordinary contributions
nurses make to their patients, each other, and the profession.

We are seeking nominations for Nursing Excellence Awards in six categories:

Advancing the Profession
Critical Care
Community Service
Leadership
Mentoring
Teaching

We will honor all regional finalists at our
Gala Award Events. Each regional category winner will then be eligible
for the National Nurse of the Year Awards.

Finalists and winners will be featured in Nursing Spectrum and NurseWeek, and Online at NursingSpectrum.com and NurseWeek.com.

Nursing Spectrum- Career Fitness Online

2004-11-14T19:06:00.000-08:00

ursing Spectrum- Career Fitness Online Terms of Service Updated December 17, 2002

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Breast cancer - Gale Encyclopedia of Alternative Medicine - by Paula FordMartin

2004-11-14T18:50:00.000-08:00

Breast cancer - Gale Encyclopedia of Alternative Medicine - by Paula FordMartin

Definition

Breast cancer is the abnormal growth and uncontrolled division of cells in the breast. Cancer cells can invade and destroy surrounding normal tissue, and can spread throughout the body via blood or lymph fluid (clear fluid bathing body cells) to start a new cancer in another part of the body.

Description

Every woman is at risk for breast cancer. When a woman lives to be 85, there is a one out of nine chance that she will develop the condition sometime during the rest of her life. As a woman ages, her risk of developing breast cancer rises dramatically regardless of her family history. The breast cancer risk of a 25-year-old woman is only one out of 19,608; by age 45, it is one in 93. In fact, 80% of all breast cancers are found in women over age 50.

Causes & symptoms

There are a number of risk factors for the development of breast cancer, including:

family history of breast cancer in mother or sister
early onset of menstruation and late menopause
reproductive history (Women who had no children or have children late in life and women who have never breastfed have increased risk.)
history of abnormal breast biopsies

However, more than 70% of women who get breast cancer have no known risk factors. While a breast cancer gene was discovered in 1994, only about 5% of breast cancers are believed to be related to the gene.

In addition, some studies suggest that high fat diets, bottle feeding instead of breastfeeding, or consuming alcohol may contribute to the risk profile. Some studies have also found that for certain women, hormone replacement therapy may contribute to the development of breast cancer. However, these findings have been criticized.

It is important to realize that not all lumps detected in the breast are cancerous. Many are benign and require only the removal of the lump. While having several risk factors may boost a woman's chances of having breast cancer, the interplay of factors is complex. The best way to assess breast cancer risk is by doing monthly self examinations to detect any lump at an early stage. The second is to have a regular mammogram, an x ray of the front and side of the breast that will detect cysts or tumors at the earliest possible stage. Seeking risk assessment consultation at one of the many breast cancer centers located throughout the United States is also helpful.

The changes in the breast that may be a sign of breast cancer include:

lump or thickening in breast or armpit
changes in a nipple (thickening, pulling in, bleeding or discharge)
dimpled or reddened skin over the breast
change in size or shape
abnormality on a mammogram

Diagnosis

More than 90% of all breast cancers are detected by mammogram (a low-dose x ray of the breast). Mammograms should be done to evaluate a suspicious lump. Screening mammograms should be ordered according to the doctor's guidelines. Despite the controversy about the cost-effectiveness of mammograms for women in their 40s, most doctors agree with the current American Cancer Society guidelines that recommend screening mammograms every year or two for women between 40 and 49, and every year after age 50. Women with a family history of breast cancer may want to have a mammogram every year after age 40.

A typical mammography screening includes two views of each breast (one from above, and one from the side). Normally, the technician examines the x-ray scans immediately to make sure no further x rays are needed, or to decide whether an ultrasound may be required.

If anything irregular is detected, such as a mass, changes from earlier mammograms, abnormalities of the skin, or enlargement of the lymph nodes, further testing may be recommended. This could include an ultrasound of the breast, a biopsy or needle sampling, or consultation with a breast surgeon.

Biopsy of the breast is a removal of breast tissue for examination by a pathologist. An excisional biopsy is a surgical procedure in which the entire lump area and some surrounding tissue is removed for examination. If the mass is very large, an incisional biopsy is done where only a portion of the area is removed and analyzed. Needle biopsy can be done in two methods. An aspiration needle biopsy uses a very fine needle to withdraw cells and fluid from the mass for analysis. A large core needle biopsy uses a larger diameter needle to remove small pieces of tissue from the mass that can be analyzed. These analyses can determine whether the mass is benign (noncancerous) or cancerous and therefore, whether further treatment is required.

To find out if the cancer has spread to other parts of the body (metastasized), doctors remove some underarm lymph nodes to test for cancer cells that have spread and to assist in making decisions for treatment. Checking to see if there are cancer cells in the lymph nodes is also a way to tell how advanced the cancer is ("staging" cancer). Breast cancer is rated from Stage 0 to Stage IV. Staging uses the diagnostic information to tell the cancer physician (oncologist) how widespread the disease is and includes:

Stage 1. The cancer is no larger than 2 cm and no cancer cells are found in the lymph nodes.
Stage 2. The cancer is no larger than 2 cm but has spread to the lymph nodes or is larger than 2 cm but has not spread to the lymph nodes.
Stage 3A. Tumor is larger than 5 cm and has spread to the lymph nodes or is smaller than 5 cm, but has spread to the lymph nodes, which have grown into each other.
Stage 3B. Cancer has spread to tissues near the breast or to lymph nodes inside the chest wall, along the breastbone.
Stage 4. Cancer has spread to skin and lymph nodes near the collarbone or to other organs of the body.

Treatment

The best chance for successful treatment is to find breast cancer early. Breast cancer is a life-threatening disease, and a correct diagnosis and appropriate treatment with surgery, chemotherapy, and/or radiation is critical to controlling the illness.

Acupuncture and guided imagery may be useful tools in treating pain symptoms and side effects of chemotherapy associated with breast cancer. Acupuncture involves the placement of a series of thin needles into the skin at targeted locations on the body, known as acupoints, in order to harmonize the energy flow within the human body.

Guided imagery involves creating a visual mental image of pain. Once the pain can be visualized, the patient can adjust the image to make it more pleasing, and thus more manageable, to them.

A number of herbal remedies are also available to lessen pain symptoms and chemotherapy side effects ,and promote relaxation and healing. However, breast cancer patients should consult with their healthcare professional before taking them. Depending on the preparation and the type of herb, these remedies may interact with or enhance the effects of other prescribed medications.

Results of a clinical trial performed at the National Cancer Institute of Milan, Italy, have indicated that homeopathic remedies of belladonna (Atropa belladonna) can be useful in relieving the discomfort, warmth, and swelling of the skin associated with radiotherapy for breast cancer (i.e., radiodermatitis). As with all homeopathic remedies, the prescription of belladonna depends on an individual's overall symptom picture, mood, and temperament, and should be prepared by a trained homeopathic professional. When used as a homeopathic remedy, belladonna is administered in a highly diluted form to trigger the body's natural healing response without risk of belladonna poisoning or overdose. There are many other herbs that help in relieving the nausea that accompanies chemotherapy, including ginger (Zingiber officinale).

Allopathic treatment

Treatment options include surgery, chemotherapy, and radiation. Breast cancer is treated in two ways: locally to eliminate tumor cells from the breast by surgery and radiation, and to systemically destroy cancer cells that have traveled to other parts of the body. Systemic therapy includes the use of drugs in chemotherapy and hormonal treatments to reduce the amount of estrogen circulating in the blood.

Surgery

The extent of surgery depends on the type of breast cancer, whether the disease has spread, and the patient's age and health. If the tumor is less than about 1.6 inches or there is not much chance it will return, then the patient and doctor may opt for removal of the tumor alone (lumpectomy) followed by radiation therapy.

Studies have shown that conservative treatment (a lumpectomy or partial mastectomy) offers the same odds of survival as does removal of the entire breast (total mastectomy) in someone with a small breast tumor that has not spread into the nearby lymph nodes. New studies suggest that after lumpectomy, a combination of chemotherapy and radiation offers the best chance of long-term survival.

If the tumor is larger, a total (or simple) mastectomy may be needed. If the cancer has spread to the chest muscles, most doctors believe a radical mastectomy is the best solution. This operation is now used only when the cancer has spread to the chest muscle.

In a lumpectomy, the doctor removes:

The lump.
Some of the tissue around it.
Some of the lymph nodes under the arm may be removed (auxillary dissection) and tested to see if the cancer has spread there.

Even if no cancer is found in the nodes, radiation always follows lumpectomy and treatment may include chemotherapy.

In a modified radical mastectomy, the doctor removes:

the entire breast
the underarm lymph nodes
the lining over the chest muscle (but not the muscles themselves)

A radical mastectomy is almost never done, but if necessary the doctor removes:

the breast
the chest muscles
all of the lymph nodes under the arm

Surgery can be combined with breast reconstruction (creating a new breast-shaped mound), either right away or later on. Patients who want breast reconstruction should tell the doctor before surgery, since this could change the way the surgeon operates.

Removing the tumor and a border of normal tissue around it will remove the cancer while saving most of the breast tissue. However, the longer a tumor has been growing in the breast, the more likely it will be that the cancer cells have spread to the lymph nodes. These nodes under the arm or in the chest are a common place for breast cancer cells to spread. During surgery, some of the nodes are removed to check for cancer cells.

The presence of cancer cells in the lymph nodes may require more extensive surgery. If the cancer has spread to the nodes, the patient will need either radiation, chemotherapy, hormone therapy, or a combination of all three after surgery. This is called "adjuvant therapy."

Radiation

Once the cancer has been removed, the doctor may recommend radiation to destroy or shrink any remaining breast cancer cells. Radiation stops the cancer cells from dividing. It works especially well on fast-growing tumors. Unfortunately, it also stops some types of healthy cells from dividing. Healthy cells that divide quickly, like those of the skin and hair, are affected the most. This is why radiation can cause fatigue, skin problems, and hair loss .

Chemotherapy

Breast cancer surgery may be followed by chemotherapy in even the earliest stages. Chemotherapy is administered either orally or by injection into a blood vessel. It is usually given in cycles, followed by a period of time for recovery, followed by another course of drugs. Treatment time may range between four to nine months.

There may be significant side effects with some types of chemotherapy, including nausea and vomiting, temporary hair loss, mouth or vaginal sores, fatigue, weakened immune system, and infertility. However, chemotherapy for early breast cancer uses medications that cause fewer side effects.

Hormone therapy

The growth of some breast cancer cells may be slowed by the drug tamoxifen, an anti-estrogen medication. Given each day as a pill, tamoxifen travels throughout the bloodstream, slowing or stopping cancer cell growth. Tamoxifen treatment lasts at least two years, and often as long as five. Research suggests that tamoxifen may lower the chance that a breast cancer can return by between 25% and 35%.

Side effects of tamoxifen may include a slightly higher risk of cancer of the lining of the uterus (endometrial cancer). The risk increases if the drug is taken for more than five years. Other side effects include menopause-like symptoms, such as weight gain, hot flashes, and mood swings.

Other possible hormone treatments include the use of progestins, estrogens, and androgens. In rare cases, the surgeon may suggest removal of the ovaries (oophorectomy) in premenopausal women as a way of eliminating the main source of estrogen, which can boost the growth of some breast tumors.

Stem cell treatment

Stem cell treatment is used to treat advanced breast cancer. By first removing a woman's stem cells from her bone marrow or blood, the doctor can use very high doses of chemotherapy or radiation to kill cancer cells. Because this also kills healthy white blood cells, leaving the woman vulnerable to infection, the stem cells are then replaced, where they restore the body's ability to fight infection.

Expected results

The prognosis for breast cancer depends on the type and stage of cancer. Most patients can return to a normal lifestyle within a month or so after surgery. Exercises can help the patient regain strength and flexibility, and avoid building up too much fluid. Arm, shoulder, and chest exercises may aid in the patient's recovery.

It is normal after breast cancer treatment to be depressed or moody, to cry, lose appetite, or feel unworthy or less interested in sex. If these problems last for an extended time, individual counseling is appropriate. Many women have also found that attending a support group of breast cancer survivors to be an invaluable help during this stage.

Prevention

While breast cancer cannot be prevented, it can be diagnosed from a mammogram at an early stage when it is most treatable. Mammography remains the best way of detecting signs of breast cancer. A baseline mammogram should be done by age 35, so that a normal x ray can be used to compare future mammograms, even when there is no reason to believe there is a lump or cyst. In addition, women should check their own breasts at the same time each month.

In 1998, the National Surgical Adjuvant Breast and Bowel Project (NSABP) released the results of a six-year study called the Breast Cancer Prevention Trial (BCPT) that analyzed the breast cancer prevention qualities of the drug tamoxifen (Novadex). The study concluded that tamoxifen reduced the incidence of breast cancer in women at high risk of developing this disease. Researchers reported a 49% reduction in diagnoses of invasive breast cancer among women who took tamoxifen, and a 50% decrease in diagnoses of noninvasive breast tumors, such as ductal or lobular carcinoma in situ. However, the drug has also been associated with blood clotting problems and an increased risk of uterine cancer in some patients.

A clinical study comparing tamoxifen and raloxifene, an osteoporosis drug, began in 1999. Raloxifene is thought to have breast cancer prevention properties similar to tamoxifen, but with fewer harmful side effects.

Key Terms

Adjuvant therapy: Treatment involving radiation, chemotherapy (drug treatment), or hormone therapy, or a combination of all three.
Aspiration biopsy: The removal of cells in fluid or tissue from a mass or cyst using a needle for microscopic examination and diagnosis.
Benign: Not malignant, noncancerous.
Biopsy: Surgical removal and testing of tissue to determine if it is malignant.
Estrogen-receptor assay: A test to see if a breast cancer needs estrogen to grow.
Homeopathic: Healthcare practice that uses remedies and treatments that cause similar effects to the symptoms they are intended to treat in an effort to stimulate the body's natural immune response system.
Hormones: Chemical produced by glands in the body that circulate in the blood and control the actions of cells and organs. Estrogens are hormones that affect breast cancer growth.
Hormone therapy: Treating breast cancer by changing the hormone balance of the body, instead of by using cell-killing drugs.
Lumpectomy: Surgical procedure in which only the cancerous tumor is removed, together with a rim of normal tissue.
Lymph nodes: Small, bean-shaped masses of tissue scattered along the lymphatic system that act as filters: removing fluids, bacteria, or cancer cells that travel through the lymph system. Breast cancer cells in the lymph nodes under the arm or in the chest are a sign that the cancer has spread, and that it might recur.
Malignant: Cancerous.
Mammography: X-ray imaging of the breast that can often detect lesions in the tissue too small or too deep to be felt.
Progestin: A type of hormone used to treat some types of breast cancer.
Radiodermatitis: Red, irritated, and inflamed skin caused by x rays, radiation treatment, or other type of radiation exposure.

For Your Information

Books

Hirshaut, Yashar, and Peter Pressman. Breast Cancer: The Complete Handbook. New York: Bantam, 1996.
Lauersen, Niels, and Eileen Stukane. The Complete Book of Breast Care. New York: Fawcett Columbine, 1996.
Mayer's, Musa. Holding Tight, Letting Go: Living with Metastatic Breast Cancer. Sebastopol, CA: O'Reilly & Associates, 1997.
Porter, Margit Esser. Hope is Contagious: The Breast Cancer Tretament Survival Handbook. New York: Simon & Schuster, 1997.

Periodicals

Balzarini, A. et al. "Efficacy of homeopathic treatment of skin reactions during radiotherapy for breast cancer: a randomised, double-blind clinical trial." British Homeopathic Journal 89, no. 1 (January 2000): 8-12.

Organizations

American Cancer Society. (800) ACS-2345. http://www.cancer.org.
Cancer Care, Inc. 275 7th Ave., New York, NY, 10001. (800) 813-HOPE. info@cancercare.org. http://www.cancercareinc.org.
CancerNet, a cancer information service of the National Cancer Institute. (1-800-4-CANCER). http://wwwicic.nci.nih.gov.
National Alliance of Breast Cancer Organizations. 9 East 37th St., 10th floor, New York, NY 10016. (888) 80-NABCO.
The National Cancer Institute. http://www.nci.nih.gov.

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.

Colorectal cancer - Gale Encyclopedia of Alternative Medicine - by Paula Ford-Martin

2004-11-14T18:47:00.000-08:00

Colorectal cancer - Gale Encyclopedia of Alternative Medicine - by Paula Ford-Martin

Definition

Colorectal cancer is a malignancy of the colon (bowel) and/or rectum. It is the second most common cause of cancer death in the United States, and is diagnosed in over 130,000 new patients annually.

Description

Colorectal cancer occurs in either the last 6 ft (1.8 m) of intestine, known as the large bowel or colon, and/or in the rectum, where the colon terminates and waste, or feces, leaves the body. The majority of malignancies that occur in colorectal cancers are called adenocarcinomas. When an individual develops colorectal adenocarcinomas, malignant cancer cells grow inside of the colon and/or the rectum. Large clusters of these cells form structures known as tumors.

Causes & symptoms

Causes & risk factors

The exact cause of colorectal cancer is unknown. However, there are a number of known risk factors that increase the odds for developing the disease. They include:

Family history. Individuals who have one or more close relatives that were diagnosed with colorectal cancer may be at increased risk for the disease.
History of bowel disease and/or colon polyps. Certain types of colon polyps, which are tumor-like, benign outgrowths of tissue within the colon, may be an early warning sign of or a precursor to colorectal cancer. They may develop into malignancies later in life. Colon diseases that cause inflammation and irritation of the bowel, such as Crohn's disease and inflammatory bowel disease , can also increase an individual's risk of developing a colorectal malignancy.
Obesity. Overweight individuals, especially those with an apple-shaped body type (where fat is concentrated around the waist) as opposed to a pear-shaped body (where fat is stored in the hips and thighs), are at an increased risk for colorectal cancer. A high fat diet also increases an individual's chance of developing colorectal cancer.
Age. Individuals over age 50 are at an increased risk for colorectal cancer.
Sedentary lifestyle. A moderate exercise program is thought to have a preventative affect against cancer.

Symptoms

Symptoms of colorectal cancer include:

blood on the rectum or in the stool
feelings of fecal urgency (feeling as if one has to have a bowel movement all the time)
stomach and/or abdominal pain
changes in bowel habits, including constipation, diarrhea, and/or pencil-thin stools
extreme fatigue
decreased appetite

Diagnosis

The simplest screening tests for colorectal cancer include a digital rectal exam and a fecal occult blood test. In the digital rectal exam, a physician inserts a gloved finger into the rectum and feels for any irregularities. In the fecal occult blood test, stool samples are tested for traces of blood. The test can be done at home and then sent to a lab for analysis.

A flexible sigmoidoscopy and/or a colonoscopy may be performed to view the interior of the colon. The former examines the rectum and lower colon for cancer, and the latter examines the full length of the colon. During these procedures, a doctor passes a flexible tube with a tiny, fiber-optic camera device (an endoscope) through the rectum and into the colon. The doctor can then carefully examine the lining of the intestine for signs of cancer. A tissue sample (a biopsy) of the colon can also be taken through the endoscope to examine under a microscope for evidence of malignancy. Both tests can cause discomfort, and may be done under a local anesthetic if desired.

A lower GI (gastrointestinal) x ray series can be helpful in determining how much of the intestine is involved in the disease. A chalky solution called barium, which acts as a contrast agent to illuminate the gastrointestinal tract on x ray film, is administered in enema form to the patient. In some cases, air is also pumped into the rectum to provide a clearer view of the large intestine. This is called a double-contrast barium enema. The pressure in the patients abdomen from the air and barium contrasts will likely cause some discomfort.

After colorectal cancer is diagnosed, further testing is required to determine how far the cancer has spread. This procedures is known as staging. There are five different stages of colorectal cancer:

Stage 0 (carcinoma in situ). This is the earliest stage of colorectal cancer, and indicates that cancerous cells have not spread beyond the colon lining.
Stage I. The cancer has spread to the second and third layers of the inside wall of the colon, but is still contained within the colon.
Stage II. The cancer has spread beyond the colon, but it has not spread to the lymph nodes.
Stage III. The cancer has spread to a nearby lymph node, but has not spread throughout the body.
Stage IV. The cancer has spread throughout the body.

There is a sixth subtype of cancer, called recurrent, which is used to classify colorectal cancer that was treated, seemed to resolve, and has now recurred either in the colon or in another part of the body.

Treatment

The best chance for successful treatment is to detect colorectal cancer early. Colorectal cancer is a life-threatening disease, and a correct diagnosis and appropriate treatment with surgery, chemotherapy, and/or radiation is critical to controlling the illness.

Acupuncture and guided imagery may be useful tools in treating pain symptoms and improving immune function associated with colorectal cancer. Acupuncture involves the placement of a series of thin needles into the skin at targeted locations on the body, known as acupoints, in order to harmonize the energy flow within the human body.

Guided imagery involves creating a visual mental image of pain as a means of relaxation. Once the pain can be visualized, the patient can adjust the image to make it more pleasing, and thus more manageable, to them.

Movement therapies, such as yoga, t'ai chi , and qigong can aid the recovering patient. They may lessen pain symptoms, and help the person to relax and to reduce stree.

A number of herbal remedies are also available to lessen pain symptoms and promote relaxation and healing. However, cancer patients should consult with their healthcare professional before taking them. Depending on the preparation and the type of herb, these remedies may interact with or enhance the effects of other prescribed medications. Herbs which promote healing of the digestive tract include slippery elm bark (Ulmus rubra), marsh mallow root (Althaea officinalis), and goldenseal (Hydrastis canadensis).

Allopathic treatment

Treatment options include surgery, chemotherapy, and radiation. Colorectal cancer is treated in two ways, locally to eliminate tumor cells from the colon by surgery and radiation, and to systemically destroy cancer cells that have traveled to other parts of the body. Systemic therapy includes the use of chemotherapy drugs.

Surgery

The extent of surgery depends on the type of colorectal cancer, whether the disease has spread, and the patient's age and health. A surgical procedure known as a bowel resection is performed for colon cancers, where the length of colon containing the cancerous cells is removed, along with nearby tissues and lymph nodes. The two ends of the remaining colon are then sewn back together.

For cancer affecting the rectum, several other surgical methods may be employed, including local excision of the cancer (where cancerous cells and nearby tissues are cut out of the rectum) and transanal resection, where invasive cancerous tissue is removed along with normal anal tissue.

Depending on the stage of the cancer and the degree of surgery required, some patients may need to get a colostomy. A colostomy involves surgically attaching the bowel to an opening in the abdominal wall where waste is eliminated into an attached bag.

Radiation

Once the cancer has been removed, the doctor may recommend radiation treatment to destroy any remaining cancer cells. In cases where the cancer is located in hard to reach areas, radiation may be used to shrink the cancer growth or tumor. Radiation stops the cancer cells from dividing. It works especially well on fast-growing tumors. Unfortunately, it also stops some types of healthy cells from dividing. Healthy cells that divide quickly, like those of the skin and hair, are affected the most. This is why radiation can cause fatigue, skin problems, and hair loss .

Radiation therapy can be internal, where particles of radioactive materials are implanted into a tumor, or external, where energy rays (radiation) are directed at the cancer from the outside of the body. External radiation, the most common type of treatment for colorectal cancer, is usually administered five days a week for several weeks.

Chemotherapy

Colorectal cancer surgery may be followed by chemotherapy in even the earliest stages. Chemotherapy is administered either orally or by injection into a blood vessel. It is usually given in cycles, followed by a period of time for recovery, followed by another course of drugs. Treatment time may range between 4 and 9 months.

There may be significant side effects with some types of chemotherapy, including nausea and vomiting, temporary hair loss, mouth sores, skin rashes, fatigue, weakened immune system, and infertility. However, most side effects are temporary and disappear once treatment has ended.

Expected results

According to the American Cancer Society, colorectal cancers cause over 56,000 deaths each year in the United States. However, the death rate for the disease has declined steadily over the past several decades, and since 1985, the number of annual deaths due to colorectal cancer have declined at an average rate of 1.6% per year. Early detection is key to improved survival; patients with colorectal cancers that were detected early (at stage 1) have a 96% survival rate. In comparison, patients who are diagnosed with stage IV colorectal cancer only have a 5% survival rate.

Prevention

Proper diet and exercise have been shown to have a preventative effect against many types of cancers, including colorectal cancer. A well-balanced diet that consists of a minimum of five servings of fruits and vegetables and six servings of food from other plant sources (i.e., cereals, grains, pastas) is recommended by the American Cancer Society. Additionally, patients may opt for a diet of whole foods. A number of fruits and vegetables have been shown to have antioxidant properties, and may be useful in preventing cancer. These include carotenoids, which are found in fruit pigments; flavenoids found in vegetable pigments; and particularly, lycopene, which is found in tomato juice.

Recent clinical studies have also indicated that regular use of green tea (produced from the Camellia sinensis plant) may reduce the risk of certain types of cancer, including colorectal cancers. Green tea contains polyphenols, an antioxidant substance that also may inhibit the growth of existing cancer cells. In some animal studies, injections of tea extracts reduced the size of cancerous tumors. The antioxidant effects of green tea need to be studied further to more clearly define the role of the herb in cancer treatment and prevention.

Because early detection is so critical to recovery from colorectal cancer, patients considered "at risk" for the disease due to genetic, lifestyle, or environmental factors should undergo regular screening after age 50 (and possibly before, depending on the individual's personal and medical history). The American Cancer Society recommends the following screening tests:

an annual fecal occult blood test plus a flexible sigmoidoscopy every five years; OR
a colonsocopy every 10 years; OR
a double contrast barium enema every 5-10 years.

A digital rectal exam is also recommended during each screening session.

Key Terms

Adjuvant therapy: Treatment involving radiation, chemotherapy (drug treatment), hormone therapy, or a combination of all three.
Antioxidants: Enzymes which bind with free radicals to neutralize their harmful effects.
Free radicals: Reactive molecules created during cell metabolism that can cause tissue and cell damage like that which occurs in aging and with disease processes such as cancer.
Lymph nodes: Small, bean-shaped masses of tissue scattered along the lymphatic system that act as filters, removing fluids, bacteria, or cancer cells that travel through the lymph system. Cancer cells in the lymph nodes are a sign that the cancer has spread, and that it might recur.
Malignant: Cancerous.
Polyp: A benign, tumor-like outgrowth.

For Your Information

Books

Fauci, Anthony S. et al., eds. Harrison's Principles of Internal Medicine. 14th ed. New York: McGraw-Hill, 1998.
Holmes, Nancy H., ed. Illustrated Guide to Diagnostic Tests. 2nd ed. Springhouse, PA: Springhouse Corporation, 1997.

Periodicals

Mukhtar, H. and N. Ahmad. "Green tea in chemoprevention of cancer." Toxicological Sciences 52, no. 2 (December 1999): 111-7.

Organizations

National Cancer Institute. Cancer Information Service. 31 Center Drive, MSC 2580, Bethesda, MD 20892-2582. (800) 4-CANCER. TTY: (800) 332-8615. http://cancernet.nci.nih.gov
American Cancer Society. (800) ACS-2345. http://www.cancer.org

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.

Lung Cancer - Gale Encyclopedia of Alternative Medicine - by Mai Tran

2004-11-14T18:43:00.000-08:00

Lung Cancer - Gale Encyclopedia of Alternative Medicine - by Mai Tran

Definition

Lung cancer is a disease in which the cells of the lung tissues grow uncontrollably and form tumors. It is the leading cause of death from cancer among both men and women in the United States. The American Cancer Society estimated that in 1998, at least 172,000 new cases of lung cancer will have been diagnosed, and that lung cancer will account for 28% of all cancer deaths, or approximately 160,000 people.

Description

Types of lung cancer

There are two kinds of lung cancers, primary and secondary. Primary lung cancer (also called adenocarcinoma) starts in the lung itself. Primary lung cancer is divided into small cell lung cancer and non-small cell lung cancer, depending on how the cells look under the microscope. Secondary lung cancer is cancer that starts somewhere else in the body (for example, the breast or colon) and spreads to the lungs.

Small cell cancer was formerly called oat cell cancer, because the cells resemble oats in their shape. About one-fourth of all lung cancers are small cell cancers. This type is a very aggressive cancer and spreads to other organs within a short time. It is generally found in people who are heavy smokers. Non-small cell cancers account for the remaining 75% of lung cancers. They can be further subdivided into three categories.

Incidence of lung cancer

Lung cancer is rare among young adults. It is usually found in people who are 50 years of age or older, with the average age at diagnosis being 60. While the incidence of the disease is decreasing among Caucasian men, it is steadily rising among African-American men, and among both Caucasian and African-American women. This change is probably due to the increase in the number of smokers in these groups. In 1987, lung cancer replaced breast cancer as the number one cancer killer among women.

Causes & symptoms

Causes

Smoking

Tobacco smoking is the leading cause of lung cancer. Ninety percent of lung cancers can be prevented by completely giving up tobacco. Smoking marijuana cigarettes is considered yet another risk factor for cancer of the lung. These cigarettes have a higher tar content than tobacco cigarettes. In addition, they are inhaled very deeply; as a result, the smoke is held in the lungs for a longer period of time.

Exposure to asbestos and toxic chemicals

Repeated exposure to asbestos fibers, either at home or in the workplace, is also considered a risk factor for lung cancer. Studies show that compared to the general population, asbestos workers are seven times more likely to die from lung cancer. Asbestos workers who smoke increase their risk of developing lung cancer by 50-100 times. Besides asbestos, mining industry workers who are exposed to coal products or radioactive substances, such as uranium, and workers exposed to chemicals, such as arsenic, vinyl chloride, mustard gas, and other carcinogens, also have a higher than average risk of contracting lung cancer.

Environmental contamination

High levels of a radioactive gas (radon) that cannot be seen or smelled pose a risk for lung cancer. This gas is produced by the breakdown of uranium, and does not present any problem outdoors. In the basements of some houses that are built over soil containing natural uranium deposits, however, radon may accumulate and reach dangerous levels. Having one's house inspected for the presence of radon gas when buying or renting is a good idea. Other forms of environmental pollution (e.g., auto exhaust fumes) may also slightly increase the risk of lung cancer.

Chronic lung inflammation and scarring

Inflammation and scar tissue are sometimes produced in the lung by diseases, such as silicosis and berylliosis, which are caused by inhalation of certain minerals, tuberculosis, and certain types of pneumonia. This scarring may increase the risk of developing lung cancer.

Family history

Although the exact cause of lung cancer is not known, people with a family history of lung cancer appear to have a slightly higher risk of contracting the disease.

Symptoms

Because lung cancers tend to spread very early, only 15% are detected in their early stages. The chances of early detection, however, can be improved by seeking medical care at once if any of the following symptoms appear:

a cough that does not go away
chest pain
shortness of breath
persistent hoarseness
swelling of the neck and face
significant weight loss that is not due to dieting or vigorous exercise
fatigue and loss of appetite
bloody or brown-colored spit or phlegm (sputum)
unexplained fever
recurrent lung infections, such as bronchitis or pneumonia

However, these symptoms may be caused by diseases other than lung cancer. It is vital, however, to consult a doctor to rule out the possibility that they are the first symptoms of lung cancer.

If the lung cancer has spread to other organs, the patient may have other symptoms, such as headaches, bone fractures, pain, bleeding, or blood clots . Early detection and treatment can increase the chances of a cure for some patients. For others, it can at least prolong life.

Diagnosis

Physical examination and initial tests

If the patient's doctor suspects lung cancer, he or she will take a detailed medical history to check all the symptoms and assess the risk factors. The assessment of the patient's medical history will be followed by a complete physical examination. The doctor will examine the patient's throat to rule out other possible causes of hoarseness or coughing, and listen to the patient's breathing and the sounds made when the patient's chest and upper back are tapped (percussed). The physical examination, however, is not conclusive.

If the doctor has reason to suspect lung cancer--particularly if the patient has a history of heavy smoking or occupational exposure to substances that are known to irritate the lungs--he or she may order a chest x ray to see if there are any masses in the lungs. Special imaging techniques, such as CT scans or MRIs, may provide more precise information about the possibility, size, shape, and location of any tumors.

Sputum analysis

Sputum analysis involves microscopic examination of the cells that are either coughed up from the lungs, or are collected through a special instrument called a bronchoscope. Sputum analyses can diagnose at least 30% of lung cancers, some of which do not show up even on chest x rays. In addition, the test can help detect cancer in its very early stages, before it spreads to other regions. The sputum test does not, however, provide any information about the location of the tumor and must be followed by other tests, such as the bronchoscopy, where machines can detect cancerous cells without the need for the lung to be opened.

Lung biopsy

Lung biopsy is the most definitive diagnostic tool for cancer. It can be performed in several different ways. The doctor can perform a bronchoscopy, which involves the insertion of a slender, lighted tube, called a bronchoscope, down the patient's throat and into the lungs. In addition to viewing the passageways of the lungs, the doctor can use the bronchoscope to obtain samples of the lung tissue. In another procedure known as a needle biopsy, the location of the tumor is first identified using a CT scan or MRI. The doctor then inserts a needle through the chest wall and collects a sample of tissue from the tumor. In the third procedure, known as surgical biopsy, the chest wall is opened up and a part of the tumor, or all of it, is removed. A doctor who specializes in the study of diseased tissue (a pathologist) examines the tumor samples to identify the cancer's type and stage.

Treatment

Alternative therapies should be complementary to conventional treatment, not replace it. Before participating in any alternative treatment programs, patients should consult their doctor concerning the appropriateness and the role of such programs in patient's overall cancer treatment plan. Appropriate alternative treatments can help prolong patient's life or at least improve their quality of life, prevent recurrence of tumors, or prolonging the remission period and reduce adverse reactions to chemotherapy and radiation.

The use of beta-carotene and vitamin A supplements in lung cancer patients is controversial. Vitamin A and beta-carotene was advocated as an antioxidant that has lung-protective effects and may decrease the risk of lung cancer. However, recent studies suggest that beta-carotene supplement may have no effect or increase the risk of lung cancer in smokers. They may have no effects on nonsmokers. Therefore, use of beta-carotene supplement in lung cancer patients or as preventive measure in smokers is not recommended at the present time. However, researchers believe that patients do benefit from nature's source of beta-carotene and vitamin A. Beta-carotene in food carries all the benefits, yet does not have any harmful effects as the controversial high-dose supplements may have.

The effectiveness of many of the anticancer drugs used to treat lung cancer can be reduced when patients take megadoses of antioxidants . These antioxidants, in patients not undergoing chemotherapy, can be very helpful in protecting the body against cancer. However, taken during chemotherapy, these antioxidants protect the cancer cells from being killed by chemos. Because high-dose supplementation of antioxidants can interfere with conventional chemotherapy treatment, patients should only take them at dosages much above the recommended daily allowance (RDA) during chemotherapy or radiation therapy.

Dietary guidelines

The following dietary changes may help improve a patient's quality of life, as well as boost the immune function to better fight the disease. They may also help prevent lung cancer.

Avoid fatty and spicy foods. High-fat diet may be associated with increased risk of lung cancer. Also, lung cancer patients may have a hard time digesting heavy foods.
Eat new and exciting foods. Tasty foods stimulate appetite so that patients can eat more and have the energy to fight cancer.
Increase consumption of fresh fruits and vegetables. They are nature's best sources of antioxidants, as well as vitamins and minerals. Especially helpful are the yellow and orange fruits (orange, cantaloupes) and dark green vegetables. They contain high amounts of vitamin A and carotene.
Eat more broccoli sprouts. These young sprouts are a good source of sulforaphane, a lung cancer fighting substance.
Eat multiple (5-6) meals per day. Small meals are easier to digest.
Establish regular eating time and do not eat around bedtime.
Avoid foods containing preservatives or artificial coloring.
Monitor weight and intakes of adequate calories and protein.

Nutritional supplements

A naturopath may recommend some of the following nutritional supplements to boost the patient's immune function and help fight tumor:

Vitamins and minerals. Vitamins that are especially of benefit to cancer patients include B-complex vitamins, especially vitamins B₆, C, D, E, and K. Most important minerals are calcium, chromium, copper, iodine, molybdenum, germanium, selenium, tellurium, and zinc. Many of these vitamins and minerals are strong antioxidants or cofactors for antioxidant enzymes. However, patients should not take mega doses of these supplements without first consulting their doctor. Significant adverse or toxic effects may occur at high dosages, which is especially true for the minerals.
Other nutritional supplements that may help fight cancer and support the body. They include essential fatty acids (fish or flaxseed oil), flavonoids, pancreatic enzymes (to help digest foods), hormones such as DHEA, melatonin, or phytoestrogens.

Traditional Chinese medicine

Conventional treatment for leukemia is associated with significant side effects. These adverse effects (such as nausea, vomiting, and fatigue) can be reduced with Chinese herbal preparations. Patients should consult an experienced herbalist who will prescribe remedies to treat specific symptoms that are caused by conventional cancer treatments.

Juice therapy

Juice therapy may be helpful for patients with cancer. Patients should mix one part of pure juice with one part of water before drinking.

Homeopathy

There are conflicting evidences regarding the effectiveness of homeopathy in cancer treatment. Because cancer chemotherapy may suppress the body's response to homeopathic treatment, homeopathy may not be effective during chemotherapy. Therefore, patients should wait until after chemotherapy to try this relatively safe alternative treatment.

Acupuncture

Acupunture is the use of needles on the body to stimulate or direct the meridians (channels) of energy flow in the body. Acupuncture has not been shown to have any anticancer effects. However, it is an effective treatment for nausea, and other common side effects of chemotherapy and radiation.

Other treatments

Other alternative treatments include stress reduction, meditation, yoga, t'ai chi , and the use of guided imagery .

Allopathic treatment

Treatment for lung cancer depends on the type of cancer, its location, and its stage. The most commonly used modes of treatment are surgery, radiation therapy, and chemotherapy.

Surgery

Surgery is not usually an option for small cell lung cancers, because they have usually spread beyond the lung by the time they are diagnosed. Because non-small cell lung cancers are less aggressive, however, surgery can be used to treat them. The surgeon will decide on the type of surgery, depending on how much of the lung is affected. Surgery may be the primary method of treatment, or radiation therapy and/or chemotherapy may be used to shrink the tumor before surgery is attempted.

There are three different types of surgical operations:

Wedge resection. This procedure involves removing a small part of the lung.
Lobectomy. A lobectomy is the removal of one lobe of the lung. If the cancer is limited to one part of the lung, the surgeon will perform a lobectomy.
Pneumonectomy. A pneumonectomy is the removal of an entire lung. If the surgeon feels that removal of the entire lung is the best option for curing the cancer, a pneumonectomy will be performed.

The pain that follows surgery can be relieved by medications. A more serious side effect of surgery is the patient's increased vulnerability to bacterial and viral infections. Antibiotics, antiviral medications, and vaccines are often needed.

Radiotherapy

Radiotherapy involves the use of high-energy rays to kill cancer cells. It is used either by itself or in combination with surgery or chemotherapy. There are two types of radiotherapy treatments: external beam radiation therapy and internal (or interstitial) radiotherapy. In external radiation therapy, the radiation is delivered from a machine positioned outside the body. Internal radiotherapy uses a small pellet of radioactive materials placed inside the body in the area of the cancer.

Radiation therapy may produce such side effects as tiredness, skin rashes, upset stomach, and diarrhea. Dry or sore throats, difficulty in swallowing, and loss of hair in the treated area are all minor side effects of radiation. These may disappear either during the course of the treatment or after the treatment is over. The side effects should be discussed with the doctor.

Chemotherapy

Chemotherapy uses anticancer medications that are either given intravenously or taken by mouth (orally). These drugs enter the bloodstream and travel to all parts of the body, killing cancer cells that have spread to different organs. Chemotherapy is used as the primary treatment for cancers that have spread beyond the lung and cannot be removed by surgery. It can also be used in addition to surgery or radiation therapy.

Chemotherapy is tailored to each patient's needs. Most patients are given a combination of several different drugs. Besides killing the cancer cells, these drugs also harm normal cells. Hence, the dose has to be carefully adjusted to minimize damage to normal cells. Chemotherapy often has severe side effects, including nausea, vomiting, hair loss , anemia, weakening of the immune system, and sometimes infertility. Most of these side effects end when the treatment is over. Other medications can be given to lessen the unpleasant side effects of chemotherapy.

Expected results

If the lung cancer is detected before it has had a chance to spread to other organs, and if it is treated appropriately, at least 49% of patients can survive five years or longer after the initial diagnosis. Only 15% of lung cancers, however, are found at this early stage.

Due to improvements in surgical technique and the development of new approaches to treatment, the one-year survival rate for lung cancer has improved considerably. As of 1998, approximately 40% of patients survive for at least a year after diagnosis, as opposed to 30% that survived 20 years ago. The five-year survival rate for all stages of lung cancer is 14%.

Prevention

The best way to prevent lung cancer is not to smoke or to quit smoking if one has already started. Secondhand smoke from other people's tobacco should also be avoided when possible. Appropriate precautions should be taken when working with cancer-causing substances (carcinogens). Monitoring the diet and eating well-balanced meals that consist of whole foods, vegetables, and fruits; eliminating toxins, exercising routinely, and weight reduction; testing houses for the presence of radon gas, and removing asbestos from buildings are also useful preventive strategies.

Key Terms

Biopsy: The surgical removal and microscopic examination of living tissue for diagnostic purposes.
Bronchoscope: A thin, flexible, lighted tube that is used to view the air passages in the lungs.
Carcinogen: Any substance capable of causing cancer.
Chemotherapy: Treatment of cancer with synthetic drugs that destroy the tumor either by inhibiting the growth of cancerous cells or by killing them.
Lobectomy: Surgical removal of an entire lobe of the lung.
Pathologist: A doctor who specializes in the diagnosis of disease by studying cells and tissues under a microscope.
Pneumonectomy: Surgical removal of an entire lung.
Radiation therapy: Treatment using high energy radiation from x-ray machines, cobalt, radium, or other sources.
Sputum: Mucus or phlegm that is coughed up from the passageways of the lungs.
Stage: A term used to describe the size and extent of spread of cancer.
Wedge resection: Removal of only a small portion of a cancerous lung.

For Your Information

Books

Dollinger, Malin, Ernest H. Rosenbaum, and Greg Cable. Everyone's Guide to Cancer Therapy. Kansas City, MO: Somerville House Books Limited, 1994.
Labriola, Dan. Complementary Cancer Therapies: Combining Traditional and Alternative Approaches for the Best Possible Outcome. Roseville, CA: Prima Health, 2000.
"Lung Cancer." In Reader's Digest Guide to Medical Cures and Treatments. Canada: The Reader's Digest Association, Inc., 1996.
Morra, Marion E., and Eve Potts. Choices. New York: Avon Books, 1994.
"Pulmonary Disorders: Tumors of the Lung." In The Merck Manual of Diagnosis and Therapy, edited by Robert Berkow, et al. Rahway, NJ: Merck Research Laboratories, 1992.

Organizations

American Cancer Society. 1599 Clifton Road, N.E., Atlanta, GA 30329. (800)227-2345.
American Lung Association. 1740 Broadway, New York, NY 10019-4374. (800) 586-4872.
Cancer Research Institute. 681 Fifth Avenue, New York, NY 10022. (800) 992-2623.
National Cancer Institute (National Institutes of Health). 9000 Rockville Pike, Bethesda, MD 20892. (800) 422-6237.

Other

"Beta Carotene and Vitamin A Halted in Lung Cancer Prevention Trial." Medical Sciences Bulletin. http://pharminfo.com.
Rosenberg, Z'ev. "Treating the Undesirable Effect of Radiation and Chemotherapy with Chinese Medicine." Oriental Chinese Journal. http://www.healthypeople.com.

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.

Ovarian cancer - Gale Encyclopedia of Medicine

2004-11-14T18:40:00.000-08:00

Ovarian cancer - Gale Encyclopedia of Medicine

Definition

Ovarian cancer is a disease in which the cells in the ovaries become abnormal and start to grow uncontrollably, forming tumors. Ninety percent of all ovarian cancers develop in the cells that line the surface of the ovaries and are called "epithelial cell tumors."

Description

The ovaries are a pair of almond-shaped organs that lie in the pelvis on either side of the uterus. The fallopian tubes connect the ovaries to the uterus. The ovaries produce and release an egg each month during the menstrual cycle. In addition, they also produce the female hormones estrogen and progesterone, which regulate and maintain the secondary female sexual characteristics.

Ovarian cancer is the fifth most common cancer among women in the United States. It accounts for 4% of all cancers in women. However, the death rate due to this cancer is higher than that of any other cancer among women. The American Cancer Society estimates that in 1998, at least 26,000 new cases will be diagnosed in the United States, and there will be at least 14,500 deaths due to ovarian cancer.

Ovarian cancer can develop at any age, but more than half the cases are among women who are 65 years or older. The incidence of the disease is higher among white women. Only 50% of the women who are diagnosed with ovarian cancer will survive five years after initial diagnosis. This is because at the time of initial diagnosis, the cancer is usually in an advanced stage. It is difficult to diagnose ovarian cancer early, because often there are no warning symptoms and the disease grows relatively quickly. In addition, the ovaries are situated deep in the pelvis and, therefore, small tumors cannot be detected easily during a routine physical examination.

Causes & symptoms

The actual cause of ovarian cancer is not known, but several factors are known to increase one's chances of developing the disease. These are called risk factors.

Age may be considered a risk factor for ovarian cancer, because the incidence of the disease increases with age. Half of all cases are diagnosed after age 65. Race may be another risk factor for the disease, since the incidence of the disease is noted to be the highest among white women and lowest among blacks. A high-fat diet may have something to do with an increased incidence of ovarian cancer, because when Asian women move to the more affluent western countries and adopt a diet that is rich in fat, the incidence of ovarian cancer among them rises.

A family history of ovarian cancer puts a woman at an increased risk for developing the disease. Women who have even one close relative with the disease increase their risk threefold. In addition, if a woman has had breast cancer, she is at an increased risk for ovarian cancer.

Starting to menstruate at a very early age (before age 12) and late menopause seems to put women at a higher risk for ovarian cancer. It is believed that the longer a woman ovulates, the higher is her risk of ovarian cancer (some researchers pin the blame on exposure to estrogen during the monthly cycles). Since ovulation occurs only during the childbearing years, the longer she menstruates, the greater is the risk. Pregnancy gives a break from ovulation and exposure to estrogen for nine months. Hence, multiple pregnancies actually appear to reduce the risk of ovarian cancer. Similarly, since oral contraceptives suppress ovulation and reduce exposure to estrogen, women who take birth control pills have a lower incidence of the disease. One study has shown that prolonged use of certain fertility drugs, such as clomiphene citrate, may increase a woman's risk of developing ovarian tumors.

There have been some studies that have suggested that the use of talcum powder in the genital area may double one's risk of getting the cancer. The incidence of ovarian cancer is higher than normal among female workers exposed to asbestos. Since talc contains particles of asbestos, some researchers believe that is what accounts for the increased risk.

Ovarian cancer has no specific signs or symptoms in the early stages of the disease. There may be some vague, non-specific symptoms, which are often ignored. However, if any of the symptoms persist, it is essential to have them evaluated by a doctor immediately. Only a physician can assess whether the symptoms are an indication of early ovarian cancer. The patient may experience the following symptoms:

Pain or swelling in the abdomen
Bloating, and general feeling of abdominal discomfort
Constipation, nausea or vomiting
Loss of appetite, fatigue
Unexplained weight gain (generally due to an accumulation of fluid in the abdomen)
Vaginal bleeding in post-menopausal women.

Diagnosis

If ovarian cancer is suspected, the physician typically begins the diagnosis by taking a complete medical history to assess all the risk factors. A thorough pelvic examination is conducted. Blood tests to determine the level of a particular blood protein, CA125, may be ordered. This protein is usually elevated when a woman has ovarian cancer. However, it is not a definitive test because the levels may also rise in other gynecologic conditions, such as endometriosis and ectopic pregnancies. Ultrasound may be used to check the size of the ovaries.

In order to determine if the tumor is benign or cancerous, surgery is necessary. If the tumor appears to be small from the imaging tests, then a procedure known as laparoscopy may be used. A tiny incision is made in the abdomen and a slender, hollow, lighted instrument is inserted through it. This enables the doctor to view the ovary more closely and to obtain a piece of tissue for microscopic examination. If the tumor appears large, a laparotomy is performed under general anesthesia. This procedure combines both diagnosis and treatment for ovarian cancer, because the tumor is often completely removed during the procedure. A piece of the tissue that is removed will be microscopically examined to determine whether the tumor was benign or malignant. Surgery confirms the diagnosis, but ovarian cancer is often strongly suspected prior to surgery based on symptoms and ultrasound. The goal of surgery is to completely remove the cancer, but often this is not possible.

Standard imaging techniques such as computed tomography scans (CT scans) and magnetic resonance imaging (MRI) may be used to determine if the disease has spread to other parts of the body.

Treatment

The cornerstone of treatment for ovarian cancer is surgery. It is aimed at removing as much of the cancer as possible. Chemotherapy, which involves the use of anticancer drugs to kill the cancer cells, is usually administered after the surgery to destroy any remaining cancer. Radiation therapy is not routinely used for ovarian cancer.

The type of surgery depends on the extent of spread of the disease. In most procedures, the ovaries, uterus, and fallopian tubes are completely removed. In rare cases, if the cancer is not very aggressive and the woman is young and has not had children, a more conservative approach may be adopted. Only one ovary may be removed, and, if possible, the fallopian tubes and the uterus may be left intact.

Occasionally, in addition to the female reproductive organs, the appendix may also be removed. The liver and the intestine will be examined for signs of cancer and may be biopsied. Ovarian cancer spreads contiguously, which means that it moves to the organs that are next to it. The intestines, the diaphragm (which separates the abdominal cavity from the chest cavity), and the omentum (a sheet-like tissue that connects parts of the abdominal cavity)--indeed, the entire surface of the abdominal cavity--may be studded with disease. In these cases, extensive surgery may be needed to remove as much as possible.

Prognosis

Most often ovarian cancer is not diagnosed until it is in an advanced stage, making it the most deadly of all the female reproductive cancers. More than 50% of the women who are diagnosed with the disease die within five years. If ovarian cancer is diagnosed while it is still localized to the ovary, more than 90% of the patients will survive five years or more. However, only 24% of all cancers are found at this early stage.

Prevention

Since there is no known cause for ovarian cancer, it is not possible to prevent the disease. Nevertheless, there are ways to reduce one's risks of developing the disease.

Currently genetic tests are available which can help to determine whether a woman who has a family history of breast, endometrial, or ovarian cancer has inherited the mutated gene that predisposes her to these cancers. (This mutation affects only a few women, however.) If the woman tests positive for the mutation, then she can opt to have her ovaries removed (oophorectomy). However, this means that the woman cannot have any more children. Even without testing for the mutated gene, some women with strong family histories of ovarian cancer may consider having her ovaries removed as a preventative measure (prophylactic oophorectomy).

Procedures such as tubal ligation (in which the fallopian tubes are blocked or cut off) and hysterectomy (in which the uterus is removed) appear to reduce the risk of ovarian cancer. If a woman undergoes one of the procedures, she can also consider having her ovaries removed to eliminate the risk of ovarian cancer. Having one or more children, preferably having the first before age 30, and breastfeeding may decrease one's risk of developing the disease.

There are no simple tests or screening procedures to detect ovarian cancer in its early stages. High-risk women are therefore advised to undergo periodic screening with the transvaginal ultrasound or a blood test for CA125 protein.

The American Cancer Society recommends annual pelvic examinations for all women after age 40, in order to increase the chances of early detection of ovarian cancer.

Key Terms

Computed tomography (CT) scan: A series of x rays that are put together by a computer in order to form detailed pictures of areas inside the body.
Ectopic pregnancy: A pregnancy that results when the fused egg and sperm implants itself in the fallopian tubes (or other places in the body) instead of the womb.
Endometriosis: A condition that causes an inflammation of the inner lining of the uterus and sometimes results in heavy vaginal bleeding.
Laparoscopy: A diagnostic procedure in which a small incision is made in the abdomen and a slender, hollow, lighted instrument is passed through it. The doctor can view the ovaries more closely through the laparoscope, and if necessary, obtain tissue samples for biopsy.
Laparotomy: An operation in which the abdominal cavity is opened up.
Magnetic resonance imaging (MRI): A medical procedure used for diagnostic purposes in which pictures of areas inside the body can be created using a magnet linked to a computer.
Transvaginal ultrasound: A procedure in which a device is inserted through the vagina and sound waves are bounced off the ovary walls. The echoes created by the reflected sound waves can be used to image the ovaries.

For Your Information

Books

Berkow, Robert, et al., eds. Merck Manual of Diagnosis and Therapy, 16th ed. Merck Research Laboratories, 1992.
Dollinger, Malin. Everyone's Guide to Cancer Therapy. Somerville House Books Limited, 1994.
Morra, Marion E. Choices. Avon Books, 1994.
Murphy, Gerald P. Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment and Recovery. American Cancer Society, 1997.
Organizations
American Cancer Society. 1599 Clifton Road, N.E. Atlanta, Georgia 30329. (800) 227-2345. http://www.cancer.org.
Cancer Research Institute. 681 Fifth Avenue, New York, N.Y. 10022. (800) 992-2623. http://www.cancerresearch.org.
Gilda Radner Familial Ovarian Cancer Registry. Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263. (800) 682-7426.
Gynecologic Cancer Foundation. 401 North Michigan Avenue, Chicago, IL 60611. (800) 444-4441.
National Cancer Institute. 9000 Rockville Pike, Building 31, room 10A16, Bethesda, Maryland, 20892. (800) 422-6237. http://wwwicic.nci.nih.gov.
Oncolink. University of Pennsylvania Cancer Center. http://cancer.med.upenn.edu.

Gale Encyclopedia of Medicine. Gale Research, 1999.

Prostate Cancer - Gale Encyclopedia of Alternative Medicine - by Kathleen Wright

2004-11-14T18:36:00.001-08:00

Prostate Cancer - Gale Encyclopedia of Alternative Medicine - by Kathleen Wright

Definition

Prostate cancer is a disease in which the cells of the prostate become abnormal and start to grow uncontrollably, forming tumors. Tumors that can spread to other parts of the body are called malignant tumors or cancers. Tumors that incapable of spreading are said to be benign.

Description

Prostate cancer is the most common cancer among men in the United States, and is the second leading cause of cancer deaths. The American Cancer Society (ACS) estimates that in 1998, at least 185,000 new cases of prostate cancer will be diagnosed, and it will be the cause of at least 40,000 deaths. Although prostate cancer may be very slow-growing, it is a heterogeneous disease and can be quite aggressive, especially in younger men. When the disease is slow-growing, it may often go undetected. Because it may take many years for the cancer to develop, many men with the disease will probably die of other causes, rather than from the cancer itself.

Prostate cancer affects African American men twice as often as it does Caucasian men, and the mortality rate among African Americans is also two times higher. African Americans have the highest rate of prostate cancer in the world.

The prostate, testicles, and seminal vesicles are the major male sex glands. These three glands together secrete the fluid that makes up semen. The prostate is about the size of a walnut and lies just behind the urinary bladder. A tumor in the prostate interferes with proper control of the bladder and normal sexual functions. Often, the first symptom of prostate cancer to develop is difficulty in urinating. However, because the same symptom can be caused by a very common, noncancerous condition of the prostate (benign prostatic hyperplasia), it does not always mean that prostate cancer is present.

As the prostate cancer grows, some of the cells break off and spread to other parts of the body through the lymph or the blood. The most common sites to which it spreads are the lymph nodes, the lungs, and various bones around the hips and the pelvic region.

Causes & symptoms

The cause of prostate cancer is not known, however, it is found mainly in men over the age of 55. The average age at diagnosis is 72. In fact, 80% of the prostate cancer cases occur in men over the age of 65. As men grow older, the likelihood of getting prostate cancer increases. While only 1 in 100,000 men will get prostate cancer under the age of 40, the frequency rises to 1,326 cases in 100,000, for men between the ages of 70 and 74. Hence, age appears to be a risk factor for prostate cancer. Race may be another contributing factor, because African-Americans have the highest rate of prostate cancer in the world.

Some studies have shown that a family history of prostate cancer puts a man at a higher risk for developing this disease. In addition, there is some evidence to suggest that a diet high in fat increases the risk of prostate cancer. Workers in the electroplating and welding industries who are exposed to the metal cadmium and rubber industry workers appear to have a higher than average risk of getting this disease. Research has indicated that men with high plasma testosterone levels also may be at an increased risk.

Frequently, prostate cancer has no symptoms, and the disease is diagnosed when the patient goes for a routine screening examination. However, occasionally, when the tumor becomes large or the cancer has spread to the nearby tissues, the following symptoms may be seen:

weak or interrupted flow of the urine
frequent urination (especially at night)
difficulty starting urination
inability to urinate
pain or burning sensation when urinating
blood in the urine
persistent pain in lower back, hips, or thighs (bone pain)
painful ejaculation

Diagnosis

Prostate cancer is curable when detected early. However, because the early stages of prostate cancer may not have any visible symptoms, it often goes undetected until the patient goes for a routine physical examination. Diagnosis of the disease is made using some or all of the following tests.

Digital rectal examination (DRE)

In order to perform this test, the doctor puts a gloved, lubricated finger (digit) into the rectum to feel for any lumps in the prostate. The rectum lies just behind the prostate gland, and a majority of prostate tumors begin in the posterior region of the prostate. If the doctor does detect an abnormality, he or she may order more tests in order to confirm these findings.

Blood tests

Blood tests are used to measure the amounts of certain protein markers, such as prostate-specific antigen (PSA), found circulating in the blood. The cells lining the prostate generally make this protein and a small amount can be detected in the bloodstream. However, prostate cancers produce a lot of this protein, and it can be easily detected in the blood. Hence, when PSA is found in the blood in higher than normal amounts for the patient's particular age group, cancer may be present.

Transrectal ultrasound

A small probe is placed in the rectum, and sound waves are released from the probe. These sound waves bounce off the prostate tissue and an image is created. Since normal prostate tissue and prostate tumors reflect the sound waves differently, the test can be used to detect tumors quite efficiently. Though the insertion of the probe into the rectum may be slightly uncomfortable, the procedure is generally painless and takes only 20 minutes.

Prostate biopsy

If cancer is suspected from the results of any of the above tests, the doctor will remove a small piece of prostate tissue with a hollow needle. This sample is then checked under the microscope for the presence of cancerous cells. Prostate biopsy is the most definitive diagnostic tool for prostate cancer.

If cancer is detected during the microscopic examination of the prostate tissue, the pathologist will "grade" the tumor using a method called the Gleason system. This means that he or she will score the tumor on a scale of 1-10 to indicate how aggressive the tumor is. Tumors with a lower score are less likely to grow and spread than are tumors with higher scores. The Gleason system is different from "staging" of the cancer. When a doctor stages a cancer, he or she gives it a number that indicates whether it has spread, as well as the extent of its spread. In Stage I, the cancer is localized in the prostate in one area, while in the last stage, Stage IV, the cancer cells have spread to other parts of the body.

X rays and imaging techniques

A chest x ray may be ordered to determine whether the cancer has spread to the lungs. Imaging techniques (such as computed tomography scans and magnetic resonance imaging), where a computer is used to generate a detailed picture of the prostate and areas nearby, may be done to get a clearer view of the internal organs. A bone scan also may be used to check whether the cancer has spread to the bone.

Treatment

The doctor and the patient will decide on the treatment mode after considering many factors. Such factors include the patient's age, the stage of the tumor, his general health, and the presence of any co-existing illnesses have to be considered. In addition, the patient's personal preferences and the risks and benefits of each treatment protocol are also taken into account before any decision is made.

Various natural remedies used to treat noncancerous prostate problems can be implemented with the approval of a medical doctor along with the recommended medical care. Prostate enlargement is a precursor to prostate cancer, and many alternative treatments are available to alleviate benign prostate enlargement. Among those is the herb saw palmetto , which has shown to be highly effective in the treatment of prostate enlargement. In addition, treatment that focus on strengthening the immune system of the cancer patient can be helpful, using physiologic and psychologic therapies.

Visualization of a healthy, cancer-free body, and of cancer cells as weak and confused is believed to be healing imagery. Numerous studies affirm the power of a positive mental attitude in assisting conventional medical treatment to be more effective, while at the same time, minimizing undesirable side effects of chemotherapy or radiation.

Compounds contained in maitake mushrooms are believed to enhance the immune response and slow the growth of tumors. One study by a homeopathic physician, Dr. Abram Ber of Phoenix, Arizona, found that patients with prostate cancer treated with maitake mushroom tablets reported a decrease in the urge to urinate, along with improvement in the flow of urine.

Watchful waiting

Watchful waiting means no immediate treatment is recommended, but doctors keep the patient under careful observation. This option is generally used in older patients when the tumor is not very aggressive and the patients have other, more life-threatening illnesses. Prostate cancer in older men tends to be slow-growing. Therefore, the risk of the patient dying from prostate cancer, rather than from other causes, is relatively small.

Allopathic treatment

Surgery

For early stage prostate cancer, surgery is the best option and the most common one. Radical prostatectomy involves complete removal of the prostate. During the surgery, a sample of the lymph nodes near the prostate is removed to determine whether the cancer has spread beyond the prostate gland. Because the seminal vesicles (the gland where the sperm is made) are removed along with the prostate, infertility is a side effect of this type of surgery. In

Prostate Cancer - Gale Encyclopedia of Alternative Medicine - by Kathleen Wright

2004-11-14T18:36:00.000-08:00

Prostate Cancer - Gale Encyclopedia of Alternative Medicine - by Kathleen Wright

Definition

Description

Causes & symptoms

weak or interrupted flow of the urine
frequent urination (especially at night)
difficulty starting urination
inability to urinate
pain or burning sensation when urinating
blood in the urine
persistent pain in lower back, hips, or thighs (bone pain)
painful ejaculation

Diagnosis

Digital rectal examination (DRE)

Blood tests

Transrectal ultrasound

Prostate biopsy

X rays and imaging techniques

Treatment

Watchful waiting

Allopathic treatment

Surgery

In a different surgical method, known as the transurethral resection procedure or TURP, only the cancerous portion of the prostate is removed, by using a small wire loop that is introduced into the prostate through the urethra. This technique is most often used in men who cannot have a radical prostatectomy due to age or other illness, and it is rarely recommended.

Radiation therapy

Radiation therapy involves the use of high-energy x rays to kill cancer cells or to shrink tumors. It can be used instead of surgery for early stages of cancer. The radiation can either be administered from a machine outside the body (external beam radiation), or small radioactive pellets can be implanted in the prostate gland in the area surrounding the tumor.

Hormone therapy

Hormone therapy is commonly used when the cancer is in an advanced stage and has spread to other parts of the body. Prostate cells need the male hormone testosterone to grow. Decreasing the levels of this hormone, or inhibiting its activity, will cause the cancer to shrink. Hormone levels can be decreased in several ways. Orchiectomy is a surgical procedure that involves complete removal of the testicles, leading to a decrease in the levels of testosterone. Alternatively, drugs (such as LHRH agonists or anti-androgens) that bind to the male hormone testosterone and block its activity can be given. Another method "tricks" the body by administering the female hormone estrogen. When this is given, the body senses the presence of a sex hormone and stops producing testosterone. However, there are some unpleasant side effects to hormone therapy. Depending on the does of estrogen, men may have "hot flashes," enlargement and tenderness of the breasts, impotence or loss of sexual desire, as well as the risks of blood clots , heart attacks, and strokes.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. The drugs can either be taken as a pill or injected into the body through a needle that is inserted into a blood vessel. This type of treatment is called systemic treatment, because the drug enters the blood stream, travels through the whole body, and kills the cancer cells that are outside the prostate. Chemotherapy is sometimes used to treat prostate cancer that has recurred after other treatment. Further research is ongoing to find more drugs that are effective for the treatment of prostate cancer.

Expected results

According to the American Cancer Society, the survival rate for all stages of prostate cancer combined has increased from 50-87% over the last 30 years. Due to early detection and better screening methods, nearly 60% of the tumors are diagnosed while they are still confined to the prostate gland. The five-year survival rate for early stage cancers is almost 99%. Sixty three percent of the patients survive 10 years, and 51% survive 15 years after initial diagnosis.

Prevention

Because the cause of the cancer is not known, there is no definite way to prevent prostate cancer. However, the American Cancer Society recommends that all men over age 40 have an annual rectal exam and that men have an annual PSA test beginning at age 50. Those who have a higher than average risk, including African American men and men with a family history of prostate cancer, should begin annual PSA testing even earlier, starting at age 45.

A diet low in fat may slow the progression of prostate cancer. Hence, in order to reduce the risk of prostrate cancer, the American Cancer Society recommends a diet rich in fruits, vegetables, and dietary fiber, and low in red meat and saturated fats. Intake of lycopene, which is found in cooked tomatoes or tomato sauce, is also thought to help reduce the risk of prostate cancer.

Key Terms

Anti-androgen drugs: Drugs that block the activity of the male hormone.
Benign: A term for a tumor that does not spread and is not life-threatening.
Benign prostatic hyperplasia (BPH): A noncancerous condition of the prostate that causes growth of the prostate tissue, thus enlarging the prostate and obstructing urination.
Biopsy: The surgical removal and microscopic examination of living tissue for diagnostic purposes.
Chemotherapy: Treatment of the cancer with synthetic drugs that destroy the tumor either by inhibiting the growth of the cancerous cells or by killing the cancer cells.
Estrogen: A female sex hormone.
Hormone therapy: Treatment for prostate cancer, that involves reducing the levels of the male hormone testosterone, so that the growth of the prostate cancer cells is inhibited.
Lymph nodes: Small bean-shaped structures that are scattered along the lymphatic vessels. These nodes serve as filters and retain any bacteria or cancer cells that are travelling through the system.
Malignant: A tumor that is capable of spreading to other organs and poses a serious threat to a person's life.
Prostatectomy: The surgical removal of the prostate gland.
Radiation therapy: Treatment using high energy radiation from x-ray machines, cobalt, radium, or other sources.
Rectum: The last 5-6 in (13-16 cm) of the intestine that leads to the anus.
Semen: A whitish, opaque fluid containing sperm released at ejaculation.
Seminal vesicles: The pouches above the prostate that store semen.
Testicles: Two egg-shaped glands that produce sperm and sex hormones.
Testosterone: A male sex hormone produced mainly by the testicles.
Trans-rectal ultrasound: A procedure where a probe is placed in the rectum. High-frequency sound waves that cannot be heard by humans are sent out from the probe and reflected by the prostate. These sound waves produce a pattern of echoes which are then used by the computer to create sonograms, or pictures of areas inside the body.

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.

Anesthesia

2004-11-14T18:33:00.000-08:00

Anesthesia

Anesthesia (AE), also anaesthesia (BE), is the process of blocking the perception of pain and other sensations. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. There are several forms of anesthesia:

general anesthesia � with reversible loss of consciousness
local anesthesia � with reversible loss of sensation in a (small) part of the body by localized administration of anesthetic drugs at the affected site.
regional anesthesia � with reversible loss of sensation and possibly movement in a region of the body by selective blockade of sections of the spinal cord or nerves supplying the region.

Doctors specialising in the administration of anesthetics are known as anesthesiologists (AE) or anaesthetists (BE). Nurses specialising in the administration of anesthetics are known as nurse anesthetists (AE).

History

Non pharmacological methods

Hypnotism and acupuncture have a long history of use as anaesthetic techniques.

Herbal derivatives

The first herbal anaesthesia was administered in prehistory. Opium and hemp were two of the most important herbs used. They were ingested or burned and the smoke inhaled. Alcohol was also used, its vasodilatory properties being unknown. In China, Taoist medical practitioners developed anaesthesia by means of acupuncture. In South America preparations from datura, effectively scopolamine, were used as was coca. In Medieval Europe various preparations of mandrake were tried as was henbane (hyoscyamine).

Early gases and vapours

The development of effective anaesthetics in the 19th century was, with Listerian techniques, one of the keys to successful surgery. Henry Hill Hickman experimented with carbon dioxide in the 1820s. The anaesthetic qualities of nitrous oxide (isolated by Joseph Priestley) were discovered by the British chemist Humphry Davy about 1795 when he was an assistant to Thomas Beddoes and reported in a paper in 1800. But initially the medical uses of laughing gas were limited - its main role was in entertainment. It was used in December 1844 for painless tooth extraction by American dentist Horace Wells. Demonstrating it the following year, at Massachusetts General Hospital, he made a mistake and the extractee suffered considerable pain. This lost Wells any support. Another dentist, William E. Clarke, performed an extraction in January, 1842 using a different chemical, sulfuric ether (discovered in 1540). In March, 1842 in Danielsville, Georgia, Dr. Crawford Williamson Long was the first to use anaesthesia during an operation; giving it to a boy before excising a cyst from his neck, however, he did not publisize this information until later . On the 16th of October 1846, another dentist, William Thomas Green Morton, invited to the Massachusetts General Hospital, performed the first public demonstration of sulfuric ether as an anesthetic agent, for a patient undergoing an excision of a tumour from his neck. Despite Morton's efforts to keep "his" compound a secret, which he named "Letheon" and received a US patent, the news of the discovery and the nature of the compound spread very quickly to Europe in late 1846. Here, respected surgeons including Liston, Dieffenbach, Pirogoff, and Syme undertook numerous operations with ether. Ether had a number of drawbacks and was quickly replaced with chloroform. Discovered in 1831 its use in anaesthesia is usually linked to James Young Simpson. Who, in a wide-ranging study of organic compounds, found chloroform's efficacy in 1847. Its use spread quickly and gained royal approval in 1853 when John Snow gave it to Queen Victoria during the birth of Prince Leopold. That's it.

Local anaesthetics

The first effective local anaesthetic was cocaine. Isolated in 1859 it was first used by Karl Koller in ophthalmic surgery in 1884. Halsted. Prior to that doctors had used a salt and ice mix for the numbing effects of cold - which could only have limited application. Similar numbing was also induced by a spray of ether or ethyl chloride. Cocaine soon produced a number of derivatives and safer replacements, including procaine (1905), Eucaine (1900), Stovaine (1904), lidocaine (1943).

Early opioids

Opioids were first used by Racoviceanu-Pitesti, who reported his work in 1901.

The twentieth century

MAC (minimum alveolar concentration) is defined as the %inhalational agent required to stop 50% of people moving to a surgical stimulus, in the absence of nitrous oxide (a carrier gas) and an opiod premed.
Thiopental (first used 1934
intravenous, Benzodiazepine)
Propofol (2,6-di-isopropyl-phenol)
Etomidate (an imidazole derrivative)
Ketamine (a phencyclidine derrivative, as is 'Angel Dust/Special K')
Curare (1942)
Fentanyl (d 1960 Paul Jannsen) fentanyl citrate
Halothane (d 1951 Charles W. Suckling, 1956 James Raventos) MAC, non-explosive/non-flammable. Halothane hepatitis, malignant hyperthermia, hepatotoxic
Succinylcholine
Enflurane (d 1963 u 1972), Isoflurane (d 1965 u 1971), Desflurane, Sevoflurane
New synthetic opioids - meperidine, alfentanil, sufentanil (1981), remifentanil
Neurosteroids

Choice of anesthetic technique

The choice of anesthetic technique is a complex one, requiring consideration of both patient and surgical factors.

In certain patient populations, however, regional anesthesia may be safer than general anesthesia. Neuraxial blockade reduces the risk of deep vein thrombosis, pulmonary embolism, transfusion, pneumonia, respiratory depression, myocardial infarction and renal failure[1] (http://bmj.bmjjournals.com/cgi/content/full/321/7275/1493)[2] (http://bmj.bmjjournals.com/cgi/eletters/321/7275/1493).

Link to original copy

Women and mesothelioma - editorials from Chest by Dorsett D. Smith

2004-11-14T18:27:00.000-08:00

Women and mesothelioma - editorials from Chest by Dorsett D. Smith

In this issue of CHEST (see page 2224), Metintas and coworkers compared the relative risk of women vs men for a malignant pleural mesothelioma (MPM) due to environmental amphibole asbestos exposure. The relative risk was higher for women than for men: 159.8 per 100,000 vs 114.8 per 100,000, respectively. A previous study from a different area of Turkey called Karain Village, where there had been environmental exposure to a highly carcinogenic fibrous zeolite called erionite, also demonstrated a female sex predilection for MPM with a risk ratio of 440.9 per 100,000 for women vs 298.1 per 100,000 for men. (1) North American, Australian, and European cohorts have always shown a much lower risk for women. (2-4) Why the difference?

First of all, we do not know if this difference is simply due to higher exposures in women. In many of these small Turkish villages, the whitewashing of homes is done by women, which is the procedure associated with the highest levels of exposure. Women spend more time in the home than men, who may work in an area with lower exposure. The authors have evaluated their cohort and cannot find any significant difference in exposure levels between men and women! Traditional work-associated cohorts are predominately men since many trades commonly associated with asbestos exposure historically excluded women. This in turn means that men are overrepresented in mesothelioma cohorts. I am unaware of any North American, Australian, South African, or European cohort where sufficient numbers of women were equally exposed to the same asbestos fiber type at the same intensity for sufficient periods to evaluate the relative risk of MPM for women. Could there be a physiologic explanation for this difference?

Deposition patterns may vary by mouth vs nose breathing, or deeper slower respirations vs shallow respirations. Lung volume influences fiber deposition and retention, particularly at low functional residual capacity, such as pregnancy. (5) Generally, fiber deposition by impaction, sedimentation, and interception increases in major airways based on lung size. People who are taller and have longer tracheas and larger lungs have more deposition in the ciliated airways than shorter, smaller people who tend to have greater alveolar deposition at the same level of exposure. (6) The role of body size needs to be further studied but could explain an increased female risk for mesothelioma. The effect of lung size on fiber retention might suggest that children would retain more asbestos fibers at the same exposure level than adults, but this is unproven and only speculative at this time.

Women seem also to be more susceptible to malignant peritoneal mesothelioma than men. In men, the risk increases up to fivefold with increasing exposure. In women, the relative risk for spontaneous malignant peritoneal mesothelioma is increased. Asbestos-related malignant peritoneal mesothelioma did not increase above moderate exposure in one study (7) as opposed to men, where the risk increases continually with dose. Of course the reasonable question is: Is peritoneal mesothelioma misdiagnosed in women? Both ovarian cancer and malignant peritoneal mesothelioma derive from the same tissue, the coelomic epithelium from which the ovarian surface epithelium is derived. (8) Pathologists, in the past, have had difficulty distinguishing histologically between epithelioid malignant mesothelioma of the peritoneum and serous adenocarcinoma of the ovary or extraovarian tissues. (9) An association between perineal talc usage and MPM was made in 1982 when these women were exposed to older talc preparations containing tremolite asbestos. (10) In older cohorts prior to modern tissue immunohistochemical staining and electron microscopic techniques, accurate diagnosis may have been a problem, but with current histopathologic techniques this is not a significant problem today. (11) The environmental pathology research group in Great Britain concluded on review of 177 cases of both pleural and peritoneal mesotheliomas in women that 98% had an elevated fiber burden to amphibole asbestos. The high percentage of women with elevated amphibole asbestos in this British cohort reflects a selection bias since the opposite has been the American experience, where only a minority of women with a mesothelioma of any type have a history of asbestos exposure. (12) The pathology of malignant mesothelioma is the same in men and women. (13)

The other important issue raised by this study of Metintas and coworkers is the relationship between asbestos dose and latency. The latency time was the same for both sexes and was 59.2 years. Early reviews of the effect of asbestos dose and latency suggested that latency was not greatly affected by the degree of exposure. (14) Previous reviews have noted a decline in mesothelioma incidence rates after age 70 years, thought to be due to death from competing causes and the death of those individuals with the highest exposures. (15) More recent cohorts have shown longer latency times since first exposure, frequently > 50 years since the first exposure to amphibole asbestos, suggesting that with lower exposures latency time increases. (16) These data are still consistent with the hypothesis of Peto, (17) relating risk to a linear effect of fiber type and dose to the risk of mesothelioma multiplied by time of first exposure to the exponent 3-4. This has obvious public health consequences, since it suggests that people who are now healthier than their predecessors and will live longer are at risk for MPM due to low-dose amphibole asbestos exposure. These mesotheliomas would not have been seen in this older population if they had a shorter life span. How much of the increased incidence of mesothelioma in Europe (18) is due to the improved health of the general population and consequently a longer life expectancy is unclear. Certain viral infections, such as SV40, may play an important role in the pathogenesis of mesotheliomias in the certain Western countries but not in Turkey. (19) The role of genetic factors in susceptibility to mesotheliomia is an area of active research but is still unclear. (20)

Dorsett D. Smith, MD, FCCP

Everett, WA

REFERENCES

(1) Metinas M, Hillerdal G, Metinas S. Malignant mesothelioma due to environmental exposure to erionite: follow-up of a Turkish emigrant cohort. Eur Respir J 1999; 13:523-526

(2) Riback J, Lilis R, Suzuki Y, et al. Malignant mesothelioma in a cohort of asbestos insulation workers: clinical presentation, diagnosis, and causes of death. Br J Ind Med 1988; 45:182-187

(3) Hansen J, De Klerk NH, Musk AW, et al. Environmental exposure to Crocidolite and mesothelioma, exposure response relationships. Am J Respir Crit Care Med 1998; 157:69-75

(4) Albin M, Magnani C, Krestev S, et al. Asbestos and cancer: an overview of current trends in Europe. Environ Health Perspect 1999; 107:289-298

(5) Becklake MR. Asbestos-related diseases of the lung and other organs: their epidemiology and implications for clinical practice. Am Rev Respir Dis 1976; 114:187-227

(6) Becklake MR, Toyota B, Stewart M, et al. Lung structure as a risk factor in adverse pulmonary responses to asbestos exposure. Am Rev Respir Dis 1983; 128:385-388

(7) Cocco P, Dosemeci M. Peritoneal cancer and occupational exposure to asbestos: results from applications of a job-exposure matrix, Am J Ind Med 1999; 35:9-14

(8) Heller DS, Gordon RE, Clement PB, et al. Presence of asbestos in peritoneal malignant mesotheliomas in women. Int J Gynecol Cancer 1999; 9:452-455

(9) Bollinger DJ, Wick MR, Dehner LP, et al. Peritoneal malignant mesothelioma vs serous papillary adenocarcinoma. Am J Surg Pathol 1989; 13:659-670

(10) Cramer D, Welch W, Scully RE. Ovarian cancer and talc: a case control study. Cancer 1982; 50:372-376

(11) Kerrigan S, Clement P, Turnnir R, et al. Diffuse malignant mesothelioma of the peritoneum in women. Cancer 2002; 94:378-385

(12) Spiratas R, Heineman EF, Bernstein L, et al. Malignant mesothelioma: attributable risk of asbestos exposure. Occup Environ Med 1994; 51:804-811

(13) Dawson A, Gibbs AR, Pooley FD, et al. Malignant mesothelioma in women. Thorax 1993; 48:269-274

(14) Mowe G, Gylseth B, Hartveit F, et al. Occupational asbestos exposure, lung-fiber concentration and latency time in malignant mesothelioma. Scand J Work Environ Health 1984; 10:293-298

(15) de Klerk NH, Armstrong BK. The epidemiology of asbestos and mesothelioma In: Henderson DW, Shilkin KB, Langlois SL, et al, eds, Malignant mesothelioma. New York, NY: Hemisphere Publishing Corporation, 1992; 223-250

(16) Bianchi C, Brollo A, Ramani L, et al. Asbestos exposure in malignant mesothelioma of the pleura: a survey of 557 cases. Ind Health 2001; 39:161-167

(17) Peto J, Problems in dose response and risk assessment: the example asbestos. Banbury Rep 1985; 19:89-97

(18) Peto J, Decarli A, La Vecchia C, et al. The European mesothelioma epidemic. Br J Cancer 1999; 79:666-672

(19) De Rienzo A, Tor M, Sterman D, et al. Detection of SV40 DNA sequences in malignant mesotheliomia from the United States but not from Turkey. J Cell Biochem 2002; 84:455-459

(20) Carbone M, Kratzke R, Testa J. The pathogenesis of mesotheliomia. Semin Oncol 2002; 29:2-17

Dr. Smith is Clinical Professor of Medicine, Division of Pulmonary Disease and Critical Care, Department of Medicine, University of Washington.

Correspondence to: Dorsett D. Smith, MD, FCCP, 4310 Colby Ave, Everett, WA 98203; e-mail: chestdis@ix.netcom.com

Hospice Nursing

2004-11-14T18:25:00.000-08:00

Hospice nurse Deborah Houston-Schrenzel remembers her first significant experience with death. She was 4 years old and visiting the grave of her friend's father.

"I was there kneeling on the ground, and all of a sudden everyone was crying and hugging," she recalls. "Everyone felt better, and I thought, �This isn't hard. People should be there for each other.'"

Houston-Schrenzel thinks that experience helped propel her into a career serving the ill and dying. More than 40 years after that day in an Ohio cemetery, she landed her first job as a hospice nurse.

A Growing Field

More patients are choosing hospice care. While 246,000 elected hospice in 1992, by 2002 that number had risen to 885,000. Accordingly, the ranks of the country's hospice nurses have increased. In 2002, nearly 25,000 hospice nurses were employed by members of the National Hospice and Palliative Care Organization.

Hospice nurses cite compassion, comfort with dying and a desire to help make a person's death peaceful as the top criteria for those seeking to enter the field. Hospice nurses are generally registered nurses who receive additional training in pain and symptom management and other end-of-life issues throughout their careers. The National Board for Certification of Hospice and Palliative Nurses offers voluntary certification.

Inge Corless, PhD, a former hospice nurse who is now a professor at the MGH Institute of Health Professions in Boston, advises those who are interested in hospice nursing to gain at least one year of non-hospice nursing experience to hone clinical skills and determine how comfortable they are with death. Experienced hospice nurses can advance to supervisory roles or go into teaching like Corless.

While some regard hospice nursing as depressing, others see it as rewarding work. "The reward is helping someone truly live until they die and in providing an opportunity so they can enjoy the time they have left," Corless says. "There's satisfaction in helping someone to die well."

Part of the Healthcare Team

Hospice nurses are part of a patient's healthcare team, which can include other nurses, physicians, clergy, home health aides, volunteers and others. Some hospice nurses are assigned to patients in home settings, while others work in tertiary care centers or in-patient hospices.

Houston-Schrenzel works for the Visiting Nurse Association (VNA) of Greater Philadelphia, a member of the Visiting Nurse Associations of America. After a varied career in healthcare, she took the VNA job to fulfill her longstanding desire to work as a hospice nurse.

Her routine is typical for hospice nurses. She starts each day by checking voice mail to find out how her patients fared overnight. Then she plans her workday, deciding which patients require visits and which need medication adjustments. Depending on a patient's needs, a visit may last for 15 minutes or an hour or more. The patient's comfort is her main focus.

"We treat each patient as an individual," she says. "Our goal is to keep them at maximum comfort so they can do the things they want to do."

Helping Patients Experience a Good Death

Helping the patient and his loved ones come to terms with death is a momentous and rewarding undertaking.

Houston-Schrenzel watched a 12-year-old boy with cancer carry out the wishes detailed in his will, doling out favorite possessions along with wishes for his parents to take care of each other. Houston-Schrenzel marveled at his devotion to family and friends.

Houston-Schrenzel was at the boy's bed when he died. His death was the peaceful, loving experience she desires for all patients.

"Not everyone can do this, which is why I think very few of us end up in this field," she says. "You have to have done a lot of work emotionally, spiritually [and] psychologically to handle this sort of thing. While there is sorrow, it's tremendously satisfying for someone to be able to leave this world comfortably and smoothly."

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Nurse anesthetist

2004-11-14T18:24:00.000-08:00

Nurse anesthetist

From Wikipedia, the free encyclopedia.

A nurse anesthetist (AE) is a Nurse trained to administer anesthesia.

Training varies depending on the country. In the United States, for example, training is overseen by the American Association of Nurse Anesthetists.

In the U.S., nurse anesthetists complete nursing school, and then take between one and three years of additional training. They are certified by the Council on Certification of Nurse Anesthetists (CCNA).

American Association of Nurse Anesthetists (http://www.aana.com/)
Council on Certification of Nurse Anesthetists

Return to Nursing

2004-11-14T18:21:00.000-08:00

Thinking of reentering the nursing profession after a hiatus? You're not alone. Many nurses take time off to raise kids, care for parents or try a different line of work.

Getting your foot back in the door after an extended absence requires determination and dedication, but the current nursing shortage could make you a hot commodity. Experts offer these tips on returning to nursing after a break:

Explore Your Options

You don't have to return to the same type of nursing job you left. Attend career fairs and talk to nurses in settings besides acute care to get a feel for the range of jobs available, says Donna Cardillo, RN, a career coach, speaker and author in Sea Girt, New Jersey.

Susan Kohl-Malone, MS, RN, left nursing for almost eight years to raise her four kids. After a period of soul-searching, Kohl-Malone, who had previously been a certified diabetes educator, concluded her ideal job would involve teaching and working with women and children. On a former professor's recommendation, Kohl-Malone took a job as a school nurse at a K-12 private school. "I knew in my heart this was the job for me," Kohl-Malone says. Now she is getting the additional certification she needs to work in New Jersey public schools.

Research Reentry Requirements

Check with the state nursing association or board of nursing for your state's requirements for reentering the profession. At a minimum, you'll need to renew your license if it expires. You may also need to meet a continuing-education or hours-practiced requirement. Some employers offer refresher courses or orientation programs to help experienced nurses prepare to reenter the field.

Start Studying

Embark on an independent-study program. For example, you can read the latest version of your state's nursing practice act and ethical code on your own. Buy an NCLEX-RN prep book and study the sections related to your desired practice area, says Patricia Yoder-Wise, EdD, RN, a professor at Texas Tech University Health Sciences Center. Such independent study "helps nurses regain confidence about their decision-making and fact-recalling abilities," she says.

Update Your Skills

If you aren't proficient with basic word processing, data entry or Internet searches, take a computer course, Yoder-Wise suggests. And don't forget to update your resume.

Get Involved

When Kohl-Malone decided to pursue school nursing, she joined her local school nurses' association and attended educational sessions on topics ranging from asthma and ADHD to helping kids through divorce. Joining a specialty nursing organization or your local chapter of Sigma Theta Tau, the nursing honor society, will help you reconnect to the profession and provide you with great networking opportunities, Cardillo notes.

Recognize Your Value

With nurses in short supply in many specialties and many parts of the country, the time is right for you to return to the field. Negotiate fair compensation and retirement benefits, says Cheryl Peterson, RN, a senior policy fellow at the American Nurses Association. "Recognize the expertise and maturity you're bringing back into the profession, and use that as leverage for negotiating," she explains.

Yoder-Wise reminds nurses not to sell themselves short. "Unless you have simply been sitting at home and literally doing nothing, you have gained some life experiences that can only contribute to returning to nursing," she says. For example, you may have honed your communication skills, learned to work more effectively with a team or gained an appreciation for the intensity of nursing because your other work was boring. "Whatever it was, use it to your advantage," Yoder-Wise says.

Don't Give Up

Some doors may slam in your face on your way to finding the right nursing position, but be persistent. Before deciding to focus on school nursing, Kohl-Malone interviewed for other nursing jobs, but not getting the other positions may have been for the best. "The closed doors helped me to continue to look deeper to find what I really wanted to do," she says.

The reentry process may seem daunting, but don't be intimidated. "Most nurses have a sound basis of knowledge on which to build," Peterson says.

Be Realistic

Once you've scored your dream job, remember that it could take up to a year to fully adjust and get acclimated to your working environment. Be patient and set small, realistic goals, Cardillo advises. "Reentering the nursing profession takes a lot of courage, but you'll definitely be able to get back to where you want to be," she says.

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Wet nurse

2004-11-14T18:20:00.000-08:00

A wet nurse is a woman who nurses a baby not her own. A wet nurse may be employed if the birth mother of a baby is unable to breast feed her baby for a variety of reasons. Some reasons may include use of certain drugs (prescription or illegal), illness or inoperative breasts. Also members of higher classes would have their children wet-nursed.

Through the recent widespread availability of infant formula, wet nurses are not very common or needed in developed countries.

Though not widely known in developed countries, a woman who has never been pregnant may produce milk. Through frequent stimulation of the areolae and nipples, a woman may begin lactating and, therefore, be able to nurse. The use of a wet nurse is still a common practice in many developing countries.

original copy

Nursing

2004-11-14T18:19:00.000-08:00

Nursing is a discipline focused on assisting individuals, families and communities in attaining, re-attaining and maintaining optimal health and functioning. Modern definitions of nursing define it as a science and an art that focuses on quality of life as defined by persons and families. Nursing is not only concerned about health and functioning but with quality of living and dying, lived experience, and universal lived experiences of health.

Like other maturing disciplines, nursing has developed different theories that are aligned with diverging philosophical beliefs and paradigms or worldviews. Nursing theories help nurses to direct their activities in order to accomplish specific goals with people. Nursing is a knowledge based discipline committed to the betterment of humankind.

A nurse practices nursing as a profession. There are a number of educational paths to becoming a professional nurse and in many countries, nursing practice is regulated by law. Advanced practice nurses include nurses with advanced education, generally at the graduate school level. Advanced practice nurses include nurse practitioners, clinical nurse specialists, certified nurse midwives and nurse anesthetists. There also are some nurse researchers who have PhDs in nursing or other fields and study human responses to health and illness in many settings. There are other nurses with PhDs who practice with persons who are changing their health patterns. Nurses help people figure out what they need to go on, what they see as possible, how they want to change, how they can move toward their hopes and dreams.

Nurses acknowledge that the nursing profession is an essential part of the society from which it has grown. The authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. The American Nurses' Association (1980) has defined nursing as "the diagnosis and treatment of human responses to actual or potential health problems." Just as medical diagnoses help in the planning, implementing, and evaluation of medical care, Nursing diagnoses help in the planning, implementing, and evaluation of nursing care.

Nurses practice in a wide range of settings from hospital to visiting people in their homes. Nursing is the most diverse of all healthcare professions. It is a universal phenomenon appearing in some form in every culture.

original copy

Nursing

2004-11-14T18:16:00.000-08:00

From Wikipedia, the free encyclopedia.

Note: This article is on the medical profession of nursing. For the activities of a wet nurse, see Breastfeeding.

Nursing is a discipline focused on assisting individuals, families and communities in attaining, re-attaining and maintaining optimal health and functioning. Modern definitions of nursing define it as a science and an art that focuses on quality of life as defined by persons and families. Nursing is not only concerned about health and functioning but with quality of living and dying, lived experience, and universal lived experiences of health.

A nurse practices nursing as a profession. There are a number of educational paths to becoming a professional nurse and in many countries, nursing practice is regulated by law. Advanced practice nurses include nurses with advanced education, generally at the graduate school level. Advanced practice nurses include nurse practitioners, clinical nurse specialists, certified nurse midwives and nurse anesthetists. There also are nurse researchers who have PhDs in nursing or other fields and study human responses to health and illness in many settings. There are other nurses with PhDs who practice with persons who are changing their health patterns. Nurses help people figure out what they need to go on, what they see as possible, how they want to change, how they can move toward their hopes and dreams.

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Breast cancer - Gale Encyclopedia of Alternative Medicine - by Paula FordMartin

Breast cancer - Gale Encyclopedia of Alternative Medicine - by Paula FordMartin

Definition

Description

Causes & symptoms

Diagnosis

Treatment

Allopathic treatment

Surgery

Radiation

Chemotherapy

Hormone therapy

Stem cell treatment

Expected results

Prevention

Key Terms

Further Reading

For Your Information

Books

Periodicals

Organizations

Colorectal cancer - Gale Encyclopedia of Alternative Medicine - by Paula Ford-Martin

Colorectal cancer - Gale Encyclopedia of Alternative Medicine - by Paula Ford-Martin

Definition

Description

Causes & symptoms

Causes & risk factors

Symptoms

Diagnosis

Treatment

Allopathic treatment

Surgery

Radiation

Chemotherapy

Expected results

Prevention

Key Terms

Further Reading

For Your Information

Books

Periodicals

Organizations

Lung Cancer - Gale Encyclopedia of Alternative Medicine - by Mai Tran

Lung Cancer - Gale Encyclopedia of Alternative Medicine - by Mai Tran

Definition

Description

Types of lung cancer

Incidence of lung cancer

Causes & symptoms

Causes

Symptoms

Diagnosis

Physical examination and initial tests

Sputum analysis

Lung biopsy

Treatment

Dietary guidelines

Nutritional supplements

Traditional Chinese medicine

Juice therapy

Homeopathy

Acupuncture

Other treatments

Allopathic treatment

Surgery

Radiotherapy

Chemotherapy

Expected results

Prevention