How is cancer staging determined?

There are a number of different staging methods used for cancers and the specific staging criteria varies among cancer types. According to the NCI, the common elements considered in most staging systems are as follows:

• Site of the primary tumor
  
• Tumor size and number of tumors
  
• Lymph node involvement (spread of cancer into lymph nodes)
  
• Cell type and tumor grade* (how closely the cancer cells resemble normal tissue cells)
• The presence or absence of metastasis

However, there are two main methods that form the basis for the more specific or individual cancer type staging. The TMN staging is used for most solid tumors while the Roman numeral or stage grouping method is used by some clinicians and researchers on almost all cancer types.

The following is how the NCI describes the TNM staging system:

1. The TNM system is based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and the presence of distant metastasis (M). A number is added to each letter to indicate the size or extent of the primary tumor and the extent of cancer spread (higher number means bigger tumor or more spread).


Primary tumor (T)
TX - Primary tumor cannot be evaluated
T0 - No evidence of primary tumor
Tis - Carcinoma in situ (CIS; abnormal cells are present but have not spread to neighboring tissue; although not cancer, CIS may become cancer and is sometimes called pre-invasive cancer)
T1, T2, T3, T4 - Size and/or extent of the primary tumor
2.


Regional lymph nodes (N)
NX - Regional lymph nodes cannot be evaluated
N0 - No regional lymph node involvement
N1, N2, N3 - Involvement of regional lymph nodes (number of lymph nodes and/or extent of spread)
3.


Distant metastasis (M)
MX - Distant metastasis cannot be evaluated
M0 - No distant metastasis
M1 - Distant metastasis is present

Consequently, a person's cancer could be listed as T1N2M0, meaning it is a small tumor (T1), but has spread to some regional lymph nodes (N2), and has no detected metastasis (M0).

The Roman numeral or stage grouping method is described by the NCI as follows:

Stage	Definition
Stage 0	Carcinoma in situ.
Stage I, Stage II, and Stage III	Higher numbers indicate more extensive disease: Larger tumor size and/or spread of the cancer beyond the organ in which it first developed to nearby lymph nodes and/or organs adjacent to the location of the primary tumor
Stage IV	The cancer has spread to another organ(s).

As mentioned above, variations of these staging methods exist. For example, some cancer registries use surveillance, epidemiology, and end results program (SEER) termed summary staging. SEER groups cancer cases into five main categories:

• In situ: Abnormal cells are present only in the layer of cells in which they developed.
• Localized: Cancer is limited to the organ in which it began, without evidence of spread.
• Regional: Cancer has spread beyond the primary site to nearby lymph nodes or organs and tissues.
• Distant: Cancer has spread from the primary site to distant organs or distant lymph nodes.
• Unknown: There is not enough information to determine the stage.

Staging of cancer is important; it helps the physician to decide on the most effective therapeutic protocols, provides a basis for estimating the prognosis (outcome) for the patient, and provides a system to communicate the patient's condition to other health professionals that become involved with the patients' care. 

medicinenet.com

Symptoms of Diabetes

People can often have diabetes and be completely unaware. The main reason for this is that the symptoms, when seen on their own, seem harmless. However, the earlier diabetes is diagnosed the greater the chances are that serious complications, which can result from having diabetes, can be avoided.

Here is a list of the most common diabetes symptoms:

• Frequent urination
  Have you been going to the bathroom to urinate more often recently? Do you notice that you spend most of the day going to the toilet? When there is too much glucose (sugar) in your blood you will urinate more often. If your insulin is ineffective, or not there at all, your kidneys cannot filter the glucose back into the blood. The kidneys will take water from your blood in order to dilute the glucose - which in turn fills up your bladder.
• Disproportionate thirst
  If you are urinating more than usual, you will need to replace that lost liquid. You will be drinking more than usual. Have you been drinking more than usual lately?
• Intense hunger
  As the insulin in your blood is not working properly, or is not there at all, and your cells are not getting their energy, your body may react by trying to find more energy - food. You will become hungry.
• Weight gain
  This might be the result of the above symptom (intense hunger).
• Unusual weight loss
  This is more common among people with Diabetes Type 1. As your body is not making insulin it will seek out another energy source (the cells aren't getting glucose). Muscle tissue and fat will be broken down for energy. As Type 1 is of a more sudden onset and Type 2 is much more gradual, weight loss is more noticeable with Type 1.
• Increased fatigue
  If your insulin is not working properly, or is not there at all, glucose will not be entering your cells and providing them with energy. This will make you feel tired and listless.
• Irritability
  Irritability can be due to your lack of energy.
• Blurred vision
  This can be caused by tissue being pulled from your eye lenses. This affects your eyes' ability to focus. With proper treatment this can be treated. There are severe cases where blindness or prolonged vision problems can occur.
• Cuts and bruises don't heal properly or quickly
  Do you find cuts and bruises take a much longer time than usual to heal? When there is more sugar (glucose) in your body, its ability to heal can be undermined.
• More skin and/or yeast infections
  When there is more sugar in your body, its ability to recover from infections is affected. Women with diabetes find it especially difficult to recover from bladder and vaginal infections.
• Itchy skin
  A feeling of itchiness on your skin is sometimes a symptom of diabetes.
• Gums are red and/or swollen - Gums pull away from teeth
  If your gums are tender, red and/or swollen this could be a sign of diabetes. Your teeth could become loose as the gums pull away from them.
• Frequent gum disease/infection
  As well as the previous gum symptoms, you may experience more frequent gum disease and/or gum infections.
• Sexual dysfunction among men
  If you are over 50 and experience frequent or constant sexual dysfunction (erectile dysfunction), it could be a symptom of diabetes.
• Numbness or tingling, especially in your feet and hands
  If there is too much sugar in your body your nerves could become damaged, as could the tiny blood vessels that feed those nerves. You may experience tingling and/or numbness in your hands and feet.

Diagnosis of diabetes

Diabetes can often be detected by carrying out a urine test, which finds out whether excess glucose is present. This is normally backed up by a blood test, which measures blood glucose levels and can confirm if the cause of your symptoms is diabetes.

If you are worried that you may have some of the above symptoms, you are recommended to talk to your Doctor or a qualified health professional. 

medicalnewstoday.com

New Tactic For Controlling Blood Sugar In Diabetes Contradicts Current View Of The Disease

Increased low-grade inflammation in the body resulting from obesity is widely viewed as contributing to type 2 diabetes. Going against this long-held belief, researchers from Children's Hospital Boston report that two proteins activated by inflammation are actually crucial for maintaining good blood sugar levels and that boosting the activity of these proteins can normalize blood sugar in severely obese and diabetic mice.

The research, led by Umut Ozcan, MD, in the Division of Endocrinology at Children's, is reported in the October issue of Nature Medicine, published online September 4.

"This finding is completely contrary to the general dogma in the diabetes field that low-grade inflammation in obesity causes insulin resistance and type 2 diabetes," says Ozcan. "For 20 years, this inflammation has been seen as detrimental, whereas it is actually beneficial."

Ozcan's team previously showed that obesity places stress on the endoplasmic reticulum (ER), a structure in the cell where proteins are assembled, folded and dispatched to do jobs for the cell. This so-called "ER stress" impairs the body's response to insulin in maintaining appropriate blood glucose levels, and is a key link between obesity and type 2 diabetes. Last year, Ozcan and colleagues showed that a protein that relieves ER stress, called XBP1s, cannot function in obese mice. Earlier this year, they showed that activating XBP1s artificially in the liver normalized high blood sugar in obese, insulin-resistant type 2 diabetic mice (as well as lean, insulin-deficient type 1 diabetic mice).

The new study shows that a second protein triggered by inflammatory signals, p38 MAPK, chemically alters XBP1s, enhancing its activity -- and that without these alterations, XBP1s cannot function to maintain normal glucose levels. The study further showed that obese mice have reduced p38 MAPK activity, and that re-activating p38 MAPK in the liver reduced their ER stress, increased insulin sensitivity and glucose tolerance, and significantly reduced blood glucose levels.

Together, the findings suggest that either increasing p38 MAPK activity -- despite its being an inflammatory signal -- or increasing XBP-1 activity by other means could represent new therapeutic options for diabetes.

The study also suggests a new model for understanding type 2 diabetes, in which obesity may interfere with the ability of people's cells to respond to inflammatory signals. "It may be that inflammatory pathways are not working optimally and there could be a resistance to cytokines which mediates the inflammation," Ozcan says. "This could be a paradigm shift for the field."

The researchers also raise a possible down side in using p38 MAPK inhibitors to treat inflammatory diseases such as Crohn's disease, psoriasis and asthma. "These therapeutic approaches should ... be evaluated within the context of our results, and in light of the possibility that inhibition of XBP1s activity also decreases the ability of the cell to cope with the inflammatory conditions," they write.

The study (doi:10.1038/nm.2449) was supported by the National Institutes of Health and the Timothy Murphy funds provided to the Division of Endocrinology, Children's Hospital Boston. Jaemin Lee, Ph.D., and Cheng Sun, Ph.D., were co-first authors on the paper.

medicalnewstoday.com

What is diabetes? What causes diabetes?

Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood - it is the principal source of fuel for our bodies.

When our food is digested the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present - insulin makes it possible for our cells to take in the glucose.

Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, and lowers the blood sugar level.

A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body either does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements. 

Why is it called Diabetes Mellitus?

Diabetes comes from Greek, and it means a siphon. Aretus the Cappadocian, a Greek physician during the second century A.D., named the condition diabainein. He described patients who were passing too much water (polyuria) - like a siphon. The word became "diabetes" from the English adoption of the Medieval Latin diabetes.

In 1675 Thomas Willis added mellitus to the term, although it is commonly referred to simply as diabetes. Mel in Latin means honey; the urine and blood of people with diabetes has excess glucose, and glucose is sweet like honey. Diabetes mellitus could literally mean "siphoning off sweet water".

In ancient China people observed that ants would be attracted to some people's urine, because it was sweet. The term "Sweet Urine Disease" was coined. 

There are three main types of diabetes:

Diabetes Type 1 - You produce no insulin at all.
Diabetes Type 2 - You don't produce enough insulin, or your insulin is not working properly.
Gestational Diabetes - You develop diabetes just during your pregnancy.

(World Health Organization)

Diabetes Types 1 & 2 are chronic medical conditions - this means that they are persistent and perpetual. Gestational Diabetes usually resolves itself after the birth of the child. 

Treatment is effective and important

All types of diabetes are treatable, but Type 1 and Type 2 diabetes last a lifetime; there is no known cure. The patient receives regular insulin, which became medically available in 1921. The treatment for a patient with Type 1 is mainly injected insulin, plus some dietary and exercise adherence.

Patients with Type 2 are usually treated with tablets, exercise and a special diet, but sometimes insulin injections are also required.

If diabetes is not adequately controlled the patient has a significantly higher risk of developing complications, such as hypoglycemia, ketoacidosis, and nonketotic hypersosmolar coma. Longer term complications could be cardiovascular disease, retinal damage, chronic kidney failure, nerve damage, poor healing of wounds, gangrene on the feet which may lead to amputation, and erectile dysfunction.

medicalnewstoday.com

How is cancer diagnosed?

A physical exam and medical history, especially the history of symptoms, are the first steps in diagnosing cancer. In many instances, the medical caregiver will order a number of tests, most of which will be determined by the type of cancer and where it is suspected to be located in or on the person's body. In addition, most caregivers will order a complete blood count, electrolyte levels and, in some cases, other blood studies that may give additional information (for example, a PSA or prostate specific antigen test may guide the caregiver to do additional tests, such as a prostate biopsy).

Imaging studies are commonly used to help physicians detect abnormalities in the body that may be cancer. X-rays, CT and MRI scans, and ultrasound are common tools used to examine the body. Other tests such as endoscopy, which with variations in the equipment used, can allow visualization of tissues in the intestinal tract, throat, and bronchi that may be cancerous. In areas that cannot be well visualized (inside bones or some lymph nodes, for example), radionuclide scanning is often used. The test involves ingestion or IV injection of a weakly radioactive substance that can be concentrated and detected in abnormal tissue.

The preceding tests can be very good at localizing abnormalities in the body; many clinicians consider that some of the tests provide presumptive evidence for the diagnosis of cancer. However, in most patients, the definitive diagnosis of cancer is based on the examination of a tissue sample from the tissue that may be cancerous by a qualified pathologist. Some biopsy samples are relatively simple to procure (for example, skin biopsy or intestinal tissue biopsy done with an endoscope equipped with a biopsy attachment). Other biopsies may require surgery (for example, brain tissue or lymph node biopsy). In some instances, the surgery to diagnose the cancer may result in a cure if all of the cancerous tissue is removed at the time of biopsy.

The biopsy can provide more than the definitive diagnosis of cancer; it can identify the cancer type (for example, a primary or metastatic type of brain cancer) and the "stage" of the cancerous cells. The stage or cancer staging is a way for clinicians and researchers to estimate how advanced or how severe the disease is. The following section describes the general staging methods for cancers. 

medicinenet.com

Medical Bankruptcies Continue Increasing, Despite Massachusetts Reform

Since Massachusetts implemented its landmark 2006 legislation which made the purchase of health insurance compulsory, the number of personal bankruptcies associated to medical bills or illness has increased, researchers revealed in American Journal of Medicine. Total medical bankruptcies rose from 7,504 in 2007 to 10,093 in 2009 in the state.

However, the actual share of all Massachusetts bankruptcies caused by a medical factor dropped from 59.3% to 52.9%. during the same period.

As the Obama administration's health law follows many of the patterns of the Massachusetts plan, including the obligatory purchase of health insurance, this latest finding may have implications for the country as a whole. One of the administration's most powerful arguments in favor of the new federal law was to address the medical bankruptcy problem.

Furthermore, Obama's recent proposal to allow states to opt out of the nationwide reforms may undermine even more the inadequate standards for health cover that were included in the 2010 legislation. Nationwide plans may become even skimpier, possibly resulting in Massachusetts-like medical bankruptcies.

The authors wrote:

"Health costs in the state have risen sharply since reform was enacted. Even before the changes in health care laws, most medical bankruptcies in Massachusetts - as in other states - afflicted middle-class families with health insurance. High premium costs and gaps in coverage - co-payments, deductibles and uncovered services - often left insured families liable for substantial out-of-pocket costs. None of that changed. For example, under Massachusetts' reform, the least expensive individual coverage available to a 56-year-old Bostonian carries a premium of $5,616, a deductible of $2,000, and covers only 80 percent of the next $15,000 in costs for covered services."

Dr. David Himmelstein, study leader, said:

"Massachusetts' health reform, like the national law modeled after it, takes many of the uninsured and makes them underinsured, typically giving them a skimpy, defective private policy that's like an umbrella that melts in the rain: the protection's not there when you need it.

(In the case of Massachusetts) . . . . while we can't completely rule out the possibility that the reform reduced medical bankruptcies, any reduction is certainly small,"

The researchers report that in a previous study they discovered that 62.1% of bankruptcies throughout the USA in 2009 were caused by medical issues. That study was often quoted by President Obama and advocates for congressional reform. The study also revealed that 77.9% of those bankrupt individuals were insured when their illness began, including 60.3% who had private insurance.

Historically, Massachusetts has always had fewer medical bankruptcies than other parts of the country, the authors note. The state has a stronger safety net, which includes public hospitals and a free medical care system for the poor which had already existed before recent reforms came in.

The 51% increase in Massachusetts' total bankruptcy numbers between 2007 and 2009 was not as steep as it was in most of the other federal jurisdictions.

| Massachusetts' health law was passed in 2006 and become fully implemented two years later. The share of residents who were uninsured dropped from 10.4% to 4.4% between 2006 and 2009, a 58% fall. Massachusetts still has the lowest rate of any state in America.

Bankruptcies tend to occur several months after the onset of a financial shock. Therefore, the early 2007 and mid-2009 surveys do provide a good picture of the before and after effects of the health reform.

Co-author Dr. Steffie Woolhandler, said:

"American families need the kind of comprehensive coverage that protects people in nations with single-payer national health insurance, such as Canada."

"Medical bankruptcy in Massachusetts: Has health reform made a difference?"
David U. Himmelstein, M.D., Deborah Thorne, Ph.D., and Steffie Woolhandler, M.D., M.P.H.
American Journal of Medicine, March 2011 (print edition).

Written by Christian Nordqvist
Copyright: Medical News Today
 

What are the different types of cancer?

There are over 200 types of cancer; far too numerous to include in this introductory article. However, the NCI lists several general categories (see list in first section of this article). This list is expanded below to list more specific types of cancers found in each general category; it is not all inclusive and the cancers listed in quotes are the general names of some cancers:

• Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs -- "skin, lung, colon, pancreatic, ovarian cancers," epithelial, squamous and basal cell carcinomas, melanomas, papillomas, and adenomas
• Sarcoma: Cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue -- "bone, soft tissue cancers," osteosarcoma, synovialsarcoma, liposarcoma, angiosarcoma, rhabdosarcoma, and fibrosarcoma
• Leukemia: Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood -- "leukemia," lymphoblastic leukemias (ALL and CLL), myelogenous leukemias (AML and CML), T-cell leukemia, and hairy-cell leukemia
• Lymphoma and myeloma: Cancers that begin in the cells of the immune system -- "lymphoma," T-cell lymphomas, B-cell lymphomas, Hodgkin lymphomas, non-Hodgkin lymphoma, and lymphoproliferative lymphomas
• Central nervous system cancers: Cancers that begin in the tissues of the brain and spinal cord -- "brain and spinal cord tumors," gliomas, meningiomas, pituitary adenomas, vestibular schwannomas, primary CNS lymphomas, and primitive neuroectodermal tumors

Not included in the above types listed are metastatic cancers; this is because metastatic cancer cells usually arise from a cell type listed above and the major difference from the above types is that these cells are now present in a tissue from which the cancer cells did not originally develop. Consequently, if the terms "metastatic cancer" is used, for accuracy, the tissue from which the cancer cells arose should be included. For example, a patient may say they have or are diagnosed with "metastatic cancer" but the more accurate statement is "metastatic (breast, lung, colon, or other type) cancer." 

medicinenet.com