Tuberculosis (TB) facts

• TB is an infectious disease that's transmitted from person to person.
• There are many different types of TB.
• A bacterium, Mycobacterium tuberculosis, causes the disease.
• There are many risk factors for TB. Clinical symptoms and signs of pulmonary TB include fever, night sweats, cough, hemoptysis (coughing up blood-stained sputum), weight loss, fatigue, and chest pain.
• Physicians definitively diagnose TB by culturing mycobacteria from sputum or biopsy specimens, but health-care professionals presumptively diagnose TB by history, physical exam, skin testing, and chest X-rays.
• Treatment of TB infection is related to the type of TB infection and often requires extended treatments (months) with one or more anti-TB drugs.
• Complications of TB range from none to death and include lung, kidney, and liver problems that can be severe.
• The prognosis for appropriately treated TB infection is good. The prognosis declines in people who develop complications or who have had previous TB treatments.
• Prevention of TB involves both early treatment to reduce transmission and isolation of the infected person until they are no longer contagious. There is a vaccine against TB, but it is not used routinely in the U.S. because of efficacy issues and other problems.
• Tuberculosis (TB) is a multisystemic infectious disease caused by Mycobacterium tuberculosis, a rod-shaped bacterium. TB is the most common cause of infectious disease-related mortality worldwide (about 1.1 million to 1.7 million people die from it each year worldwide). TB symptoms can be so diffuse that TB is termed the "great imitator" by many who study infectious diseases because TB symptoms can mimic many different diseases. Additional terms are used to describe TB. The terms include consumption, Pott's disease, active, latent, pulmonary, cutaneous, and others (see the following section), and they appear in both medical and nonmedical publications. In most instances, the different terms refer to a specific type of TB with some unique symptoms or findings. The most common site (about 85%) for TB to develop is in the pulmonary tract. Humans are the only known hosts for Mycobacterium tuberculosis (although animals can get infected). TB has likely been infecting humans for many centuries; evidence of TB infections has been found in cadavers that date back to about 8000 BC, so the disease has a long history of infecting humans. The Greeks termed it as a wasting away disease (phthisis). For many European countries, TB caused death in about 25% of adults and was the leading cause of death in the U.S. until the early 1900s. Robert Koch discovered TB's cause, Mycobacterium tuberculosis, in 1882. With increased understanding of TB, public-health initiatives, treatment methods like isolation (quarantine), and the development of drugs to treat TB, the incidence of the disease, especially in developed countries, has been markedly reduced. There is a vast amount of detailed information available in the medical literature on all aspects of this potentially debilitating and lethal disease. The goal of this article is to introduce the reader to TB and help them to obtain a general knowledge about TB's cause, transmission, diagnostic tests, treatments, and prevention methods.

  Are there different types of tuberculosis (TB)?

  There are many types of tuberculosis, but the main two types are termed either active or latent TB. Active TB is when the disease is actively producing symptoms and can be transmitted to other people; latent disease is when the person is infected with Mycobacterium tuberculosis bacteria, but the bacteria are not producing symptoms (usually due to the body's immune system suppressing the bacterial growth and spread). People with latent TB usually cannot transfer Mycobacterium tuberculosis bacteria to others unless the immune system fails; the failure causes reactivation (bacterial growth is no longer suppressed) that results in active TB so the person becomes contagious.
  Many other types of TB exist in either the active or latent form. These types are named for the signs and for the body systems Mycobacterium tuberculosis preferentially infect, and these infection types vary from person to person. Consequently, pulmonary TB mainly infects the pulmonary system, cutaneous TB has skin symptoms, while miliary TB describes widespread small infected sites (lesions or granulomas about 1 mm-5 mm) found throughout body organs. It is not uncommon for some people to develop more than one type of active TB. More types will be listed in the symptoms and signs section below.
  
  

  What causes tuberculosis?

  Comment on this Share Your Story

  The cause of TB is infection of human tissue(s) by the bacterium Mycobacterium tuberculosis (mycobacteria). These bacteria are slow growing, aerobic, and can grow within body cells (an intracellular parasitic bacterium). Its unique cell wall helps protect it from the body's defenses and gives mycobacteria the ability to retain certain dyes like fuschsin (a reddish dye) after an acid rinse that rarely happens with other bacterial, fungal, or parasitic genera.
  Mycobacteria that escape destruction by body defenses may be spread by blood or lymphatic pathways to most organs, with preference to those that oxygenate well (lungs, kidneys, and bones, for example). Typical TB lesions, termed granulomas, usually consist of a central necrotic area, then a zone with macrophages, giant Langerhans cells and lymphocytes that become surrounded by immature macrophages, plasma cells, and more lymphocytes. These granulomas also contain mycobacteria. In latent infections, a fibrous capsule usually surrounds the granulomas, and in some people, the granulomas calcify, but if the immune defenses fail initially or at a later time (reactivate), the bacteria continue to spread and disrupt organ functions.

What are risk factors for tuberculosis?

There are many risk factors for developing tuberculosis. Certain groups of people have a high risk, such as people who work in hospitals and other areas where TB-infected people may reside (jails, nursing homes, group homes for HIV patients, homeless shelters). Close association with drug users, or people with known TB infections are also at higher risk. Other people at high risk include the following:

• Visitors and immigrants from areas known to have high incidence of TB
• Children and the elderly with weakened immune systems (especially those with a positive TB skin test, see below)
• Patients with HIV infection
• Drug abusers, especially IV drug abuse
• Head and neck cancer patients
• Transplant patients
• Diabetics
• Kidney disease patients
• People undergoing immunosuppressive therapy
• Silicosis

What are tuberculosis symptoms and signs?

Comment on this Read 3 Comments Share Your Story

Although there are a number of TB types, pulmonary TB is responsible for the majority (about 85%) of TB infections. Consequently, pulmonary TB symptoms and signs may occur with or even before other types of TB are diagnosed. The classical clinical symptoms and signs of pulmonary TB include fever, night sweats, cough, hemoptysis (coughing up blood-stained sputum), weight loss, fatigue, and chest pain. The elderly may just exhibit pneumonitis.
Other types are loosely classified as extra pulmonary and often have symptoms that are nonspecific but frequently localized to the involved site. The following includes the signs and symptoms of additional types of TB:

• Skeletal TB (also termed Pott's disease): spinal pain, back stiffness, paralysis is possible
• TB meningitis: headaches (variable in length but persistent), mental changes, coma
• TB arthritis: usually pain in a single joint (hips and knees most common)
• Genitourinary TB: dysuria, flank pain, increased frequency, masses or lumps (granulomas)
• Gastrointestinal TB: difficulty swallowing, nonhealing ulcers, abdominal pain, malabsorption, diarrhea (may be bloody)
• Miliary TB: many small nodules widespread in organs that resemble millet seeds (hence its name)
• Pleural TB: empyema and pleural effusions
• MDR TB: patients infected with TB bacteria that are resistant to multiple drugs
• XDR TB: patients infected with TB bacteria that are resistant to some of the most effective anti-TB medications; XDR stands for extensively drug resistant

• How do physicians diagnose tuberculosis?

  Comment on this Read 21 Comments Share Your Story
  Because TB may occur as either a latent or active form, the definitive diagnosis of active TB depends on the culture of mycobacteria from sputum or tissue biopsy. However, it may take weeks for these slow-growing bacteria to grow on specialized media. Since patients with latent TB do not require isolation or immediate drug therapy, it is useful to determine if a person is either not infected, has a latent infection, or is actively infected with transmissible TB bacteria. Consequently, doctors needed a presumptive test(s) that could reasonably assure that the person was infected or not so therapy could begin. After getting a patient's history and physical exam data, the next usual test is the skin test (termed the Mantoux tuberculin skin test or the tuberculin skin test or TST). The test involves injecting tuberculin (an extract made from killed mycobacteria) into the skin. In about 48-72 hours, the skin is examined for induration (swelling) by a qualified person; a positive test (induration) strongly suggests the patient has either been exposed to live mycobacteria or is actively infected. Another test, IGRA (interferon-gamma release assays) can measure the immune response to Mycobacterium tuberculosis. Other quick tests are useful; chest X-rays can give evidence of lung infection while a sputum smear stained with certain dyes that are retained mainly (but not exclusively) by mycobacteria can show the presence of the bacterium. These tests, when examined by a doctor, are useful in establishing a presumptive diagnosis of either latent or active TB, and most doctors will initiate treatment based on their judgment of these tests. In addition, some of these tests are useful in the U.S. and elsewhere only in people who are not vaccinated with a TB vaccine (see below) but are less useful in vaccinated people. For some patients, culture studies still should be completed to determine the drug susceptibility of an infecting TB strain.
  Other tests have been developed. For example, a PCR test (polymerase chain reaction) to detect TB antigens and the LED-FM microscopic technique to identify TB organisms with microscopy may be used. Two other TB blood tests (also called interferon-gamma release assays or IGRAs) have been approved by the FDA and measure how strongly the body's immune system reacts to TB bacteria. IGRAs are recommended in testing patients who have been vaccinated against TB (see prevention section below).
  People with positive symptoms, positive blood tests, sputum smear, or culture positive are considered infected with TB and contagious. Physicians diagnose and treat people with latent TB infections (LTBI) according to the following 2013 CDC criteria:
  
• No symptoms or physical findings suggestive of TB disease
• TST or IGRA result is usually positive
• Chest radiograph is typically normal
• If done, respiratory specimens are smear and culture negative
• Cannot spread TB bacteria to others
• Should consider treatment for LTBI to prevent TB disease (strongly advised by the CDC)

• What is the treatment for tuberculosis?

  Comment on this Read 11 Comments Share Your Story
  The treatment for TB depends on the type of TB infection and drug sensitivity of the mycobacteria. For latent TB, three anti-TB drugs are used in four different recommended schedules. The drugs are isoniazid (INH), rifampin (RIF; Rifadin), and rifapentine (RPT; Priftin) and the 2013 CDC's four recommended schedules are below and are chosen by the treating doctor based on the patients overall health and type of TB the patient was likely exposed to.
  
 
 
 


  Latent TB Infection Treatment Regimens

  Drugs	Duration	Interval	Minimum Doses
  Isoniazid	9 months	Daily Twice weekly	270 76
  Isoniazid	6 months	Daily Twice weekly	180 52
  Isoniazid and Rifapentine	3 months	Once weekly	12
  Rifampin	4 months	Daily	120
  Table reproduced from the CDC; http://www.cdc.gov/tb/topic/treatment/default.htm

  First-line drugs used to treat active TB are INH, RIF, ethambutol (EMB; Myambutol), and pyrazinamide. The CDC offers a guide for the basic treatment schedules for active TB as follows:
  

  Basic TB Disease Treatment Regimens

  Preferred Regimen	Alternative Regimen	Alternative Regimen
  Initial Phase Daily INH, RIF, PZA, and EMB* for 56 doses (8 weeks)	Initial Phase Daily INH, RIF, PZA, and EMB* for 14 doses (2 weeks), then twice weekly for 12 doses (6 weeks)	Initial Phase Thrice-weekly INH, RIF, PZA, and EMB* for 24 doses (8 weeks)
  Continuation Phase Daily INH and RIF for 126 doses (18 weeks) or twice-weekly INH and RIF for 36 doses (18 weeks)	Continuation Phase Twice-weekly INH and RIF for 36 doses (18 weeks)	Continuation Phase Thrice-weekly INH and RIF for 54 doses (18 weeks)
  *EMB can be discontinued if drug susceptibility studies demonstrate susceptibility to first-line drugs; Table reproduced from http://www.cdc.gov/tb/topic/treatment/tbdisease.htm#2

  Treatment of drug-resistant TB can be difficult. Patients with these infections are recommended by the CDC to involve infectious-disease specialists as there are multiple approaches that involve other anti-TB drugs and variable treatment schedules that can be used. In addition, there are new drugs and treatment schedules being developed and approved by the FDA. The infectious-disease consultant may be aware of these newest treatments that may benefit specific patients. For example, bedaquiline (Sirturo) has been approved for treatment of MDR TB.
  In some patients, the lung destruction may be severe and the only treatment left may be surgical resection of the diseased lung tissue.

• What are complications of tuberculosis?

  Although some people may develop no complications, others range from mild to severe complications, including death. Some of the more severe complications include lung function damage, bone pain (spine, ribs, and joints), meningitis, kidney and/or liver malfunction, cardiac tamponade, and visual disturbances.
  
  

  What is the prognosis of tuberculosis?

  Comment on this Share Your Story
  For most people, the prognosis of TB is good if they complete the treatment protocols. The recurrence rate of TB is low (0%-14%) and some may be due to reinfection. Drug-resistant TB is more difficult to treat, and the prognosis is not as good. The same prognosis occurs for those patients who are immunocompromised, in the elderly, and in patients with previous infection and treatment for TB.
  
  

  How can people prevent tuberculosis?

  A vaccine against TB is commercially available; it is termed BCG, or Bacille Calmette-Guerin vaccine. However, the vaccine is not recommended for use in the U.S. because of the low risk for TB infections. Also, the vaccine is highly variable in its ability to prevent adult pulmonary disease. Another problem is that the vaccine may interfere with the interpretation of the tuberculin skin test. Despite this, a number of countries still use it to reduce childhood infections and miliary disease. Consequently, the CDC makes this recommendation: "The BCG vaccine should be considered only for very select persons who meet specific criteria and in consultation with a TB expert."
  
  Currently, people who have active TB are suggested to be treated using isolation techniques along with anti-TB drugs to prevent spread according to the CDC. The CDC suggests that patients with probable active TB be isolated in a private room with negative pressure (air exhausted to outside or through a high-efficiency particulate air filter). Further, staff taking care of them must wear high-efficiency disposable masks sufficient to filter out any airborne mycobacteria. Continued isolation is suggested until sputum smears are negative for three consecutive determinations (usually after approximately two to four weeks of treatment).
• source:medicinenet.com

Targeted Drugs Among Successes Against Cancer But aging population and increasing obesity threaten progress

TUESDAY, Sept. 16, 2014 (HealthDay News) -- About 14.5 million U.S.cancer survivors are alive today, compared to just 3 million in 1971, the American Association for Cancer Research reported Tuesday.

These individuals amount to 4 percent of the population and include nearly 380,000 survivors of childhood cancer, according to the association's annual progress report. The paper outlines advances in prevention, identification, research and treatment of cancer and details some of the challenges ahead.

But these numbers can be somewhat misleading unless they take into account advances in identifying cancers earlier, said Dr. Otis Brawley, chief medical officer of the American Cancer Society.

Survival rates refer to how long a person lives with cancer (including inremission) while mortality rates refer to the death rate, but survival will be longer if the cancer is found earlier, even if the person dies at the same time they would have.

"People don't want to live longer with cancer," Brawley said. "They want to not die with cancer." But he said mortality rates have also seen big drops, including an overall decline of 22 percent in cancer deaths from 1991 to 2011.

"Prevention has been the biggest contributor, with smoking cessation as a bigger overall driver of the decline in mortality" than scientific treatment advances, Brawley said. "People who stopped smoking in the 1960s and 1970s did not die in the 1990s and beyond, and that's why it took until 1991 for mortality to start going down big-time."

Yet two looming issues may have a significant impact on increasing cancer rates in the future, the report noted.

One is the currently aging population. Most cancers occur in people aged 65 and older, and the number of Americans in this age group is expected to double by the year 2060, the report said.

That portends an increase in cancer diagnoses from 1.6 million in the United States in 2014 to an estimated 2.4 million in 2035, the report stated.

The other issue relates to widespread obesity. The report notes that one-third of all newly diagnosed cancers in the United States are related to being overweight or obese. These include esophageal, colorectal, endometrial, gallbladder, kidney, pancreatic and postmenopausal breast cancers.

"One of the great threats in terms of cancer in the U.S. is the increasing obesity rates," Brawley said. "We think it's the high levels of insulin that obese people have in their blood because insulin spurs on tumor development."

As smoking rates continue declining, "the leading cause of cancer in the U.S. may very well be obesity rather than tobacco use soon," Brawley said.

Another challenge related to cancer prevention, detection and treatment in the United States are health care access disparities for racial and ethnic minorities and poorer people.

Lower incomes are the primary driver of these disparities, Brawley said.

"There is a whole slew of issues with education and access," he said, noting that the black-white disparity in cancer deaths seen in the general population is particularly striking when compared to a population with equal access to care.

"When you start looking at black women treated for breast cancer in military hospitals," for example, Brawley said, "you end up with a population of black women whose outcomes look a lot more like those of white women than those of black women in the U.S. overall. Access to care and equalization of care is really important."

Also noteworthy, the Food and Drug Administration approved six new anticancer drugs in the past year and allowed new uses for five existing anticancer therapeutics, the report said. The FDA has also approved two imaging agents for uses related to cancer.

The new drugs were approved to treat certain types of stomach cancer, thyroid cancer, leukemia, lymphoma, non-Hodgkin lymphoma,pancreatic cancer, melanoma, lung cancer and breast cancer.

Dr. Tomasz Beer, deputy director of the Knight Cancer Center at Oregon Health and Science University, said it was particularly interesting that only one of the six newly approved therapies was achemotherapy drug.

"I think the public may not know that cancer therapy is not just chemotherapy anymore," Beer said. "What's new now is focusing on biologic agents that are targeted, and immunotherapy agents. What you're seeing in this report is a sign of what's to come."

Those five new drugs are targeted cancer therapies, which fight cancer differently from chemotherapy. Chemotherapy works by killing all cells in an area, including both normal and cancerous cells.

Targeted therapies, however, focus on specific molecules to prevent a tumor from growing or a cancer from progressing and spreading. These therapies might interfere with blood vessel development in a tumor, kill only cancer cells or, in the case of immunotherapy, help the immune system identify and kill cancer cells.

Dr. Carlos Arteaga, president of the American Association for Cancer Research, highlights the progress being made. "We're witnessing quite a transformative change in the way we treat patients with cancer," he said.

"As a result of advances like these, Americans today are more likely to survive a cancer diagnosis and then enjoy a higher quality of life than at any other time in history," Arteaga, who is director of the Center for Cancer Targeted Therapies at Vanderbilt-Ingram Cancer Center in Nashville, said.

One recent discovery that could lead to new treatments for a type of lung cancer reveals where cancer research is heading.

A study released Sept. 16 in the journal Clinical Cancer Researchdescribes two mutations that cause lung cancer resistance to a drug called alectinib.

Alectinib was developed to inhibit the expression of the ALK gene that causes growth of some non-small cell lung cancers -- the most common form of lung cancer -- after the cancer has become resistant to an older drug called crizotinib.

Discovering these mutations helped researchers understand how the cancer becomes resistant to alectinib. The researchers then successfully used a new drug, ceritinib (brand name: Zykadia), to treat a patient whose lung cancer had become resistant to alectinib.

"These studies have been invaluable in learning how ALK-positive cancers become resistant to different ALK inhibitors and in identifying the best therapeutic strategies that will re-induce remissions," said study author Dr. Jeffrey Engelman, director of the Center for Thoracic Cancers at the Massachusetts General Hospital Cancer Center, in a news release.

Blood Test May Identify Status of Prostate Cancer

May help doctors pinpoint best treatment, researchers say

WEDNESDAY, Sept. 17, 2014 (HealthDay News) -- A blood test that measures DNA from a prostate cancer tumor could provide doctors with a better assessment of the state of a man's disease, a new study suggests.

If used routinely, this blood test could reveal when treatment for advanced prostate cancer stops working and actually begins promoting tumor growth, the researchers suggested.

"Our study showed that a steroid treatment given to patients with advanced prostate cancer and often initially very effective started to activate harmful mutations and coincided with the cancer starting to grow again," study leader Dr. Gerhardt Attard, from the Institute of Cancer Research (ICR) in London, explained in an ICR news release.

"In the future, we hope to routinely monitor genetic mutations in patients with advanced disease using just a blood test -- enabling us to stop treatments when they become disease drivers and select the next best treatment option. We need to confirm these findings in larger numbers of patients, but using these types of blood tests could allow true personalization of treatment for prostate cancer patients, based on the cancer mutations we detect," he explained.

Using a blood test to measure circulating tumor DNA levels is less expensive and less invasive than needle biopsies. This test could be an effective way to monitor the emergence of treatment-resistant prostate cancer, the study published on Sept. 17 in Science Translational Medicine suggested.

"Drug resistance is the single biggest challenge we face in cancerresearch and treatment, and we are just beginning to understand how its development is driven by evolutionary pressures on tumors," Paul Workman, interim chief executive at the ICR, said in the news release.

This discovery "reveals how some cancer treatments can actually favor the survival of the nastiest cancer cells, and sets out the rationale for repeated monitoring of patients using blood tests, in order to track and intervene in the evolution of their cancers," Workman said.

"There are currently too few treatment options for men living with advanced stage prostate cancer. Not only do we desperately need to find more treatments for this group of men, we also need to understand more about when those that are available stop working and why," Dr. Matthew Hobbs, deputy director of research at Prostate Cancer UK, said in the news release.

"This research is important as it shows that there might be a new way to monitor how a man's cancer is changing during treatment, and that could help us to pinpoint the stage at which some drugs stop being effective. In the future, this could arm doctors with the knowledge they need to ensure that no time is wasted between a drug that stops working for a man and him moving on to another effective treatment," Hobbs said.

But, Hobbs also noted that this is preliminary research and that the study size was small -- just 16 men. He agreed with Attard that the findings need to be confirmed in a larger study.

The researchers cautioned that any patients currently taking medication for advanced prostate cancer should continue to take their medications as prescribed and discuss any concerns about their treatment with their doctor.

Advanced Prostate Cancer: Frequently Asked Questions

If you just learned that you or a loved one has advanced prostate cancer, you may have many questions and concerns. By taking the time to research your condition, you've taken a good first step. Here are answers to the most common questions. After looking over these answers, click on other articles in this guide to find in-depth information about treatments, side effects, and other issues that affect you and your family.

What is advanced prostate cancer?

Prostate cancer is defined as ''advanced'' when it spreads outside the prostate gland. It may spread to nearby tissues, lymph nodes, bones, or other parts of the body. When it is spread beyond the tissues directly adjacent to the prostate gland, it is called metastatic prostate cancer.

Can advanced prostate cancer be cured?

No cure exists for advanced prostate cancer, but treatments may greatly extend life and reduce symptoms. A look at treatments:

• Most prostate cancer grows in response to male hormones (androgens) in the body, such as testosterone. That’s why one of the first treatments for advanced prostate cancer is to decrease these hormone levels (called androgen deprivation therapy). There are several medications that can do this, including Leupron (leuprolide), Trelstar (triptorelin), or Zoladex (goserelin). These drugs work to reduce testosterone levels to those seen in castrated patients. Other hormonal treatments include antiandrogens, estrogen- and progesterone-type drugs and cortisone derivatives. If these stop working, the drugs Zytiga (abiraterone) or Xtandi (enzalutamide) may still be effective. The most frequent side effects from hormone therapy include reduced sex drive, impotence, erectile dysfunction, infertility, and bone loss. Your doctor may be able to help prevent some side effects, such as bone loss. In the past, it was common for doctors to recommend surgical removal of the testicles to decrease hormone levels. This is usually not necessary, because medications typically work, though such medications are more expensive than the surgical procedure to remove the testes (bilateral orchiectomy). The use of medical rather than surgical treatment offers the option of stopping -- sometimes temporarily, sometimes permanently -- the medicines if the side effects are intolerable, or if the patient or doctor prefers. The surgery is not reversible.
• If hormone therapy ultimately fails to slow the growth of the cancer, the next step may be a prostate cancer "vaccine" called Provenge (sipuleucel-T). Most men who take Provenge survive at least 2 years after starting the treatment. Provenge isn't your everyday vaccine. It's a therapy created by taking immune cells from a patient, genetically engineering them to fight prostate cancer, and then putting them back into the patient. It's used for men with few or no symptoms and when advanced prostate cancer no longer responds to hormone therapy. Though relatively new, Provenge appears to be remarkably safe. However, clinical trials suggested the treatment might cause a slightly increased risk of stroke. The most common side effect is chills, which occurs in most men. Other common side effects include fatigue, fever, back pain, and nausea.
• Chemotherapy is another option when hormone therapy stops working. Only a few chemotherapy medications have been shown to work for advanced prostate cancer. The chemotherapy drug Taxotere, when taken with the steroid prednisone, can help extend survival in some men. When Taxotere stops working, the chemotherapy drug called Jevtana (carbazitaxel) can help extend survival in some men. Possible side effects of Taxotere include nausea, hair loss, and decreased production of blood cells. Men may also develop fluid retention and pain, tingling, or numbness in the fingers or toes. Jevtana has side effects similar to Taxotere.
• One drug, Xofigo (Radium -223), is approved for use in men who have advanced prostate cancer that has spread only to the bones. Candidates should have also received androgen deprivation therapy. Xofigo, given by injection once a month, works by binding to minerals within bones to deliver radiation directly to bone tumors. A study of 809 men showed that those taking Xofigo lived an average of 3 months longer than those taking a placebo.   

External beam radiation therapy may be used to reduce pain from bone metastases in advanced prostate cancer.

source:http://www.webmd.com/

Shoulder Bursitis

What is shoulder bursitis?

A bursa is a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. The plural of bursa is bursae. There are 160 bursae in the body. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees.

Bursitis is inflammation of a bursa. Injury or inflammation of a bursa around the shoulder joint occurs causes shoulder bursitis.

How does a bursa become inflamed?

A bursa can become inflamed from injury, infection (rare in the shoulder), or an underlying rheumatic condition. Examples include infection of the bursa in front of the knee from a knee scraping on asphalt (septic prepatellar bursitis), inflammation of the elbow bursa from gout crystals (gouty olecranon bursitis), or injury as subtle as lifting a bag of groceries into the car, which could inflame the shoulder bursa (shoulder bursitis).

What are shoulder bursitis symptoms and signs? How is shoulder bursitis diagnosed

Bursitis is typically identified by localized pain or swelling, tenderness, and pain with motion of the tissues in the affected area. X-ray testing can sometimes detect calcifications in the bursa when bursitis has been chronic or recurrent. MRI scanning (magnetic resonance imaging) can also define bursitis. Shoulder bursitis is often accompanied by tendinitis of tendons adjacent to the affected bursa in the shoulder. Shoulder bursitis causes focal tenderness of the inflamed tissues. It can also cause a "pinching" pain when the elbow is moved away from the body, referred to as an "impingement" sign.

How is shoulder bursitis treated?

The treatment of any form of bursitis depends on whether or not it involves infection. Infection of a shoulder bursa is uncommon, and bursitis that develops there is usually from injury. Bursitis that is not infected (as from injury or an underlying rheumatic disease) can be treated with ice compresses, rest, and anti-inflammatory and pain medications. Occasionally, it requires aspiration of the bursa fluid. This procedure involves removal of the fluid with a needle and syringe under sterile conditions and can be performed in the doctor's office. Sometimes the fluid is sent to the laboratory for further analysis. Noninfectious shoulder bursitis can also be treated with an injection of cortisone medication into the swollen bursa. This is sometimes done at the same time as the aspiration procedure. Physical therapy can sometimes be used to aid the recovery from bursitis, especially when it is accompanied by a frozen shoulder.

Infectious (septic) bursitis, again which is uncommon in the shoulder, requires even further evaluation and aggressive treatment. The bursal fluid can be examined in the laboratory to identify the microbes causing the infection. Septic bursitis requires antibiotic therapy, sometimes intravenously. Repeated aspiration of the inflamed fluid may be required. Surgical drainage and removal of the infected bursa sac (bursectomy) may also be necessary. Generally, the adjacent joint functions normally after the surgical wound heals.

What is the prognosis (outlook) for shoulder bursitis?

The outlook is generally excellent for a full recovery with shoulder bursitis. If the bursitis is accompanied by scarring around the shoulder joint (adhesive capsulitis or "frozen shoulder"), it can require long-term physical therapy

Can shoulder bursitis be prevented?

By avoiding overuse of the shoulder by excessive straining the shoulder and gradual exercise training, shoulder bursitis can be prevented.
source:medicinenet.com

Too Much Sitting Tied to Risks for Certain Cancers

Too Much Sitting Tied to Risks for Certain Cancers

Those with the most chair time had worse odds for colon, endometrial cancers, researchers suggest

Share this:

Font size:

AAA

WebMD News from HealthDay

By Brenda Goodman

HealthDay Reporter

MONDAY, June 16, 2014 (HealthDay News) -- You may want to stand up to read this.

A new study suggests that people who spend the bulk of their day sitting -- whether behind the wheel, in front of the TV or working at a computer -- appear to have an increased risk for certain kinds of cancers.

Previous studies have tied too much time spent sedentary to a variety of health problems, including heart disease, blood clots, a large waistline, higher blood sugar and insulin, generally poor physical functioning, and even early death.

For the new study, researchers zeroed in on 43 studies that specifically looked at the link between sitting and nearly 70,000 cases of cancer.

After combining the results from individual studies -- a statistical tool that helps to reveal trends in research -- there was good news and bad news.

The good news? Being sedentary did not appear to be linked to every kind of cancer. Scientists found no relationship between sitting and breast, ovarian, testicular or prostate cancers, or cancers of the stomach, esophagus and kidneys, or non-Hodgkin lymphoma.

The bad news was that there did seem to be a consistent relationship between hours spent sitting and an increased risk for colon and endometrial cancers.

People who spent the most time sitting during the day had a 24 percent increased risk of getting colon cancer compared to those who logged the least number of hours in a chair, according to the study.

When the researchers looked just at time spent watching TV, the risk jumped even more. Those who clocked the most hours glued to the tube had a 54 percent increased risk of colon cancer compared to those who watched the least.

That may be because viewers tend to consume unhealthy snacks and drinks while watching TV, said study author Daniela Schmid, an epidemiologist at the University of Regensburg in Germany.

For endometrial -- or uterine -- cancer, the risks were even higher. There was a 32 percent increased risk for women who spent the most time seated compared to those who sat the least, and a 66 percent increased risk for those who watched the most TV, the study authors said.

Moreover, every two-hour increase in sitting time was linked to an 8 percent increased risk of colon cancer and a 10 percent increased risk of endometrial cancer.

The risks remained even for "active couch potatoes" -- folks who squeeze in some time at the gym but still spend most of their day off their feet. This suggests that regular exercise can't offset the risks of too much sitting, the study authors said.

The findings, published June 16 in the Journal of the National Cancer Institute, make sense to Dr. Graham Colditz. He's the associate director for prevention and control at Washington University's Siteman Cancer Center in St. Louis.

"High blood sugar and high insulin is a clear sort of pathway to colon cancer, and we know from intervention studies that walking lowers insulin and getting up after meals lowers blood sugar compared to sitting," said Colditz, who was not involved in the research.

As for endometrial cancer, "Obesity is a phenomenally strong cause. In fact, it is the main modifiable risk factor for endometrial cancer," he said.

"So for me, the likely scenario there is that the sitting, the weight gain and obesity really go together and exacerbate the risk of endometrial cancer," he added.

Because the studies included in the review only looked at broad relationships, they can't prove that sitting, by itself, causes cancer. But the findings appeared to be remarkably consistent across studies, so Colditz thinks they should be taken seriously.

The study authors agree.

"Cutting down on TV viewing and sedentary time is just as important as becoming more active," said Schmid. "For those whose jobs require them to sit at a desk most of the day, we recommend breaking up the time spent sitting by incorporating short bouts of light activity into the daily routine," she added.

SOURCE:Web MD

How Do I Know If I Have Leukemia?

How Do I Know If I Have Leukemia?

Because many types of leukemia show no obvious symptoms early in the disease, leukemia may be diagnosed incidentally during a physical exam or as a result of routine blood testing. If a person appears pale, has enlarged lymph nodes, swollen gums, an enlarged liver or spleen, significant bruising, bleeding, fever, persistent infections, fatigue, or a small pinpoint rash, the doctor should suspect leukemia. A blood test showing an abnormal white cell count may suggest the diagnosis. To confirm the diagnosis and identify the specific type of leukemia, a needle biopsy and aspiration of bone marrow from a pelvic bone will need to be done to test for leukemic cells, DNA markers, and chromosome changes in the bone marrow. 

Important factors in leukemia include the age of the patient, the type of leukemia, and the chromosomal abnormalities found in leukemia cells and bone marrow.

Recommended Related to Cancer

Chronic Lymphocytic Leukemia

Important It is possible that the main title of the report Chronic Lymphocytic Leukemia is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Read the Chronic Lymphocytic Leukemia article > >

What Are the Treatments for Leukemia?

While the reported incidence of leukemia has not changed much since the 1950s, more people are surviving longer thanks mainly to advances in chemotherapy. Childhood leukemia (3 out of 4 cases in children is ALL), for example, represents one of the most dramatic success stories of cancer treatment. The five-year survival rate for children with ALL has risen to about 85% today.

For acute leukemia, the immediate goal of treatment is remission. The patient undergoes chemotherapy in a hospital and stays in a private room to reduce the chance of infection. Since acute leukemia patients have extremely low counts of healthy blood cells, they are given blood and platelet transfusions to help prevent or stop bleeding. They receive antibiotics to prevent or treat infection. Medications to control treatment-related side effects are given as well.

People with acute leukemia are likely to attain remission when chemotherapy is used as the primary treatment. To keep the disease under control, they will then receive consolidation chemotherapy for 1-4 months to get rid of any remaining malignant cells.

Patients with ALL will receive intermittent treatment usually for up to two years. After obtaining a complete remission, some patients with acute myeloid leukemia (AML) may require an allogeneic stem cell transplant. This requires a willing donor with compatible tissue type and genetic characteristics -- preferably a family member. Other donor sources could include a matched unrelated donor or umbilical blood.

A stem cell transplant has three stages: induction, conditioning, and transplantation. First, the individual’s white blood cell count is brought under control by chemotherapy. Then a single dose of chemotherapy may be given followed by a conditioning regimen of high dose chemotherapy. This will destroy the individual’s bone marrow and any residual leukemia cells that may be present. Then the donor cells will be infused.

source:Web MD