Prevention and diagnosis of Cancer: medical tests related to the diagnosis of cancer
Prevention and diagnosis of Cancer
Table of contents
1. What is Cancer2. analysis of the PSA
3. skin biopsy
4 bone marrow biopsy
5 cystoscopy
6. cervical cytology
7 colonoscopy
8 colposcopy
9 scan
10 laryngoscopy
11 mammography
12 FNAC - fine needle aspiration cytology
13. Nuclear magnetic resonance (NMR)
14. computed axial tomography (CAT)
15 digital rectal
Note: this translation is only presented for educational purposes. Any translation of this web site may be inaccurate and imprecise.
1. What is Cancer
2 causes and risk factors for cancer
3 symptoms of cancer
4. complications of cancer
5 diagnosis of cancer
6. treatment of cancer
7 surgical oncology
8 radiotherapy
9 chemotherapy
10 hormone therapy
11 immunotherapy and biological treatments
12. help against cancer associations
13. Prevention of cancer
The term 'cancer' refers to all types of tumor that occurs in any tissue of the body, whose cells are uncontrolled growth, and have the ability to invade the neighboring tissues and lead to metastasis, i.e., to the development of tumors other than that in which the tumororiginated elsewhere. These cells, which have lost their initial functional features have, in addition, the ability to induce the formation of new blood vessels.
This loss of the physiological control of cell growth derived from the abnormal expression of genetic material, in such a way that all the tumors develop by the accumulation of mutations in cells that cause them. We can say that cancer is a genetic disease and that these alterations present in the DNA of tumor cells are inherited or acquired.
However, there are more than 200 different types of tumors, each of which has an origin and particular characteristics, with an evolution, prognosis and different treatment. In our special on cancer will find the most common types of cancer.
Advances in the early diagnosis of these tumors, coupled with the improvement of cancer, increasingly effective treatments, made that in recent years the mortality rate from this disease has been reduced in many countries considerably. However, each year the number of detected cases continues to grow. Without going any further, the latest data collected in Spain (year 2012) show that 215.534 tumors were diagnosed, and 2015 estimates speak of 227.000 cases.
Causes and risk factors for cancer
The majority of cancers are the result of exposure to environmental agents, who are responsible for mutations in the genes that control cell growth. However, not all individuals respond equally: to a given exposure, a person can be more susceptible to cancer than other.Thus, the development of a malignant tumor requires complex interactions between exogenous and endogenous factors that can also produce genetic alterations.
They are called carcinogens to exogenous agents that cause mutations in certain genes. Some examples would be:
• According to lifestyle carcinogens: 45% attributable risk. Within this group include tobacco smoke (cancer: Lung, larynx, oral cavity, esophagus, kidney, bladder and pancreas); chewing tobacco (oral cavity); alcohol (oral cavity, esophagus, larynx, liver); dietary factors (colon, breast, endometrial, stomach). Within the diet, there are also some substances that have been associated with a protective effect against cancer (fibers, olive oil, vitamins C and E...). Reproductive factors (breast, endometrium, ovary).
• Radiation: 5% attributable risk. Among them, the radon (lung cancer) or solar radiation (melanoma).
• Biological carcinogens: 4% attributable risk. Infectious agents most clearly associated with human cancers are: chronic infection with the hepatitis B and C with hepatocarcinoma virus; with the cervical cancer human papilloma virus; Epstein-Barr virus and BurKitt's lymphoma with carcinoma of nasopharynx; helicobacter pylori with gastric cancer.
• Occupational carcinogens: depend on the profession and their associated risks. They have a 4% attributable risk.
• Drugs: 2% attributable risk. There are a number of drugs whose use has been associated with the development of certain cancers. For example, the sequential oral contraceptives and estrogens used in the menopause increase the risk of uterine body and breast cancer. Combined oral contraceptives are potential risk factors of liver, cervix, and perhaps of breast cancer, although they reduce the incidence of uterine corpus and ovary cancer.
• Hereditary factors: (carcinogens endogenous): in addition to the above exogenous factors, there are numerous genetic and chromosomal alterations that are associated with the risk of developing cancer. Most of the genes that predispose to hereditary cancer are involved in the control of cell growth. Hereditary cancer has been associated with cancer of the breast, colorectal, ovarian, gastric, endometrial and Sarcoma and lymphomas.
Symptoms of cancer
The main manifestations of cancer are related with the location and size of the tumor, and the degree of involvement of the organs which may give rise to symptoms. The symptoms of cancer more frequent, collected in a systematic way and classified according to the affected organs are as follows:• General aspects: impairment of the general condition, fever, asthenia, anorexia and weight loss.
• Digestive: loss of appetite, dysphagia, vomiting, alteration of the bowel, bleeding, hiccups.
• Respiratory: cough, hemoptysis, dyspnea, chest pain.
• Cardiovascular: edema, dyspnea, palpitations, chest pain.
• Genitourinary: hematuria, urinary symptoms.
• Locomotive: bone pain.
• Nervous system: neurological deficit, seizures, headache, alterations of consciousness...
• Cutaneous system: alterations of the coloring (pallor, jaundice), itching, lesions, tumors, lymph nodes...
Complications of cancer
En el paciente oncológico related symptoms mentioned above, there are multiple complications arising from the presence of the tumor, and that may require urgent action, well because there is vital commitment either to avoid potential fallout. These are the most common complications of cancer:• Superior cava vein syndrome: is the clinical expression of the partial or complete obstruction of the venous return flow through the superior vena cava to the heart. The most frequent causes are lung cancer and lymphomas.
• Cardiac tamponade: is the accumulation of fluid in the pericardial, sufficient cavity to produce difficulty serious input from blood in the ventricles. The most frequent cause is the secondary pericardial effusion tumor involvement of the pericardium.
• Intestinal obstruction: is a frequent complication in advanced stages of patients with carcinoma, colorectal, ovarian, stomach, pancreas, uterus and bladder. It is usually related to an intra-abdominal mass, and is associated with poor prognosis criteria.
• Intracranial hypertension syndrome: because of the presence of occupiers of space intra or extracerebral injury (brain metastases or primary brain tumors).
• Spinal cord compression syndrome: caused by a neoplastic lesion located outside the dura mater meninges. The most frequent cause of this picture is the male lung cancer and the breast cancer in women.
• Metabolic complications: alterations of calcium, sodium, uric acid, etc.
• Disease venous thromboembolic: cancer patients have an increased risk of deep vein thrombosis (DVT) and pulmonary troboembolismo (TEP). The causes are many: the release by the tumor of substances that activate clotting, extrinsic compression of tissues, immobilization, surgery, chemotherapy and the insertion of central venous catheters.
Diagnosis of cancer
These are some of the aspects to consider in order to correct a case of cancer diagnosis:Clinical history
It must be thorough, detailed and complete. They must be picked up all the symptoms referred by the patient as well as their characteristics: home, temporal evolution, triggering factors, etc. It is essential to ask for the background; habits and exposure to toxins; treatments with drugs; allergies; labor history; family cancer history.Physical examination
It allows to know data about tumor location, size, consistency, margins, anatomical relationships, mobility, swelling, pain, ulceration or bleeding, the presence of pathological lymph nodes and the impact of the tumor on the general condition of the patient.Histopathological diagnosis
Any single malignant tumor can be considered as such if there is a definite histologic diagnosis. For this reason, before treating a patient, a histologically confirmed by biopsy, aspiration needle of solid or cystic masses or the examination of the surgical specimen is accurate.Molecular diagnosis
Its main objective is to determine the genetic abnormalities associated with mutations in the DNA. Profits at the clinical level include: establish the definitive diagnosis and classification of tumors with unique molecular alterations; possibility of early detection of tumor cells; providing prognostic information, and the possibility of selection of individualized treatment, avoiding unnecessary toxicities. Example: in breast cancer, where the HER-2neu oncogene is amplified in a 15-20% of cases, giving a worse prognosis, his determination allows the indication of specific treatment with an antibody monoclonal (trastuzumab).Endoscopic techniques
They are useful in the diagnosis of tumors that settle in the digestive tract and the bronchial tree. The digestive endoscopy (high and low) allow see the characteristics of the tumor and take biopsies, as well as the fiberoptic bronchoscopy in relation to the bronchial tree. Hysteroscopy for tumors of the endometrium and the cystoscopy for bladder tumors.Diagnostic Imaging
Different existing imaging methods are used combined in order to diagnose and assess the extent of the involvement of a tumoral lesion (staging). Among them are: simple radiology, modified barium radiology, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine techniques.Ultrasound
This innocuous technique is used to primarily assess abdominal structures: liver and biliary tumors. Endoscopic ultrasonography is important for the study of gastrointestinal and pancreatic neoplasms, because it explores the different layers of the wall of the digestive tract. Aspiration (FNA) needle under ultrasound control can be performed in almost all organs.Computed tomography (CT)
CT scan of chest provides high resolution for the study of Mediastinal structures and pulmonary regions: cancer staging of lung, malignant mesothelioma, Lung Metastases of extratoracicos tumours, esophageal cancer staging. Abdominal CT scan is useful in the study of local, lymphatic invasion and metastasis at distance of abdominal neoplasia; allows the taking of guided biopsies. It is especially useful in the evaluation of tumors and retroperitoneal lymph nodes, as well as in the study of extension of pelvic tumors. Cranial CT scan is useful for the determination of injury to brain, primary or metastatic, although the brain MRI has better performance in lesions of less than 1 cm.Nuclear magnetic resonance (NMR)
It is the best diagnostic method for image for definition, characterization, staging and follow-up of soft tissue tumors and bone tumors. MRI is the technique of choice in the diagnosis of tumors of the spine and the spinal cord.Nuclear Medicine studies
Tests may be performed such as bone scans for early detection of bone metastases; scan for diagnosis of pheochromocytoma and tumors of neural crest; scintigraphy with gallium 67 for lymphomas; isotopic regional lymphography for the detection of Sentinel lymph node in melanoma and breast cancer.Functional and metabolic (PET / CT) scans
Tomography with emission tomography (PET) is a new imaging technique that provides functional and metabolic information. The PET-CT combines two different imaging techniques, providing anatomic and functional information simultaneously; It is useful in the detection of malignant tumors, in the early stages and in the evaluation of response to the treatments.Tumor markers
They are substances that can be detected in quantities greater than normal in the blood or urine of the patients with certain types of cancer. They are produced by the tumor itself, or by the body in response to the presence of neoplasia or certain benign processes. By themselves, they are not sufficient to diagnose cancer, since in benign diseases they can rise, no rise in all people with cancer, and non-specific in general a unique neoplasm. Its main role is monitoring the response to treatment and the diagnosis of the relapse. The most frequent are:• Carcinoembryonic Antigen (CEA): rises in cancer colorectal and others such as lung, gastric, melanoma, lymphoma, breast, cancer of pancreas, cervix, bladder, kidney, thyroid, liver, ovary.
• Prostatic specific antigen (PSA): is elevated in prostate cancer.
• Alpha fetoprotein (AFP): in germinal tumors, hepatocellular carcinoma.
• Chorionic gonadotropin (B-HCG): in germinal tumors, choriocarcinoma, Trophoblastic Disease.
• Enolase (ENA) neuroespecifica: rises in carcinoma microcÃtico de pulmón, neuroblastoma.
• CA 19.9: in pancreatic, colorectal, stomach, bile duct cancer.
• CA 15.3: in breast, lung, ovarian and prostate cancer.
• CA 125: in ovarian and other cancer: uterus, pancreas, liver, colon, breast, lung, digestive tract.
• B2 microglobulin: multiple myeloma, non-Hodgkin's lymphomas.
Treatment of cancer
Today, with the application and combination of therapies against cancer, a significant percentage of cure of cancer patients is reached. In those cases where cure is not possible, the second goal of cancer treatment is the prolongation of survival, the alleviation and reduction of symptoms, and the maintenance of the quality of life. These objectives are achieved through a multidisciplinary management between the different professionals involved in the diagnosis and treatment of cancer.The therapies used for the treatment of cancer can belong to five families:
• Surgical Oncology
• Radiation therapy
• Chemotherapy
• Hormone replacement therapy
• Immunotherapy and biological therapy
Thanks to these treatments today, we can say that one of every three cancers have a greater than 80% five-year survival.
Oncological surgery
Surgery is the oldest treatment for cancer, and the only available until the beginning of the 20th century. Surgical oncology is an effective technique to heal those patients whose tumors are located. It has different functions in the treatment of cancer:• Prevention: removal of potentially malignant or premalignant lesions. Its purpose is to anticipate the degeneration of a pre-existing injury.
• Diagnosis: via surgical techniques that allow estatificar and take biopsies, both lung cancer and digestive, gynaecological tumours and lymphomas.
• Treatment itself: the primary role of the surgery is the complete removal of tumor local and regional, as well as various ganglionic areas. Also it aims more tumor control to completely remove metastasis of tumors such as colon, whenever the primary tumor is controlled.
• Alleviation and emergency surgery: control of Pleural effusions and pericardial, bone stabilization, surgical decompression, or treatments for bleeding. The derivation of gastrointestinal obstructive processes, urinary tract or biliary tract can relieve symptoms and improve quality of life.
• Rehabilitation: plastic & reconstructive surgery, or orthopedic procedures, can correct the effects of the treatment.
Radiotherapy
Radiation therapy is a local treatment modality which uses ionizing radiation. Radiation alters the genetic material of the cancer cells and destroy them by stopping its spread. Radiation is specifically targeting the tumor by minimizing the effect on healthy cells.It can be used in a multitude of tumors such as prostate cancer, tumors of head and neck, Gynecologic tumors, brain tumors and some skin tumors, etc.
Radiation therapy decreases the size of the tumors and in some cases can eradicate them.
In case of tumors that are not operable due to its size or its location, radiation therapy can be used to reduce the size of tumors, making them more accessible so that they can then be removed surgically.
Also used in palliative way as treatment of pain associated with the tumor or its metastases, or to treat very serious situations in which a tumor can compress the spinal cord, or any blood vessel as the superior cava (vena syndrome SVC).
On many occasions radiotherapy is combined with treatment with chemotherapy and surgery to increase the chances of a cancer cure.
Types of radiation therapy
There are two types of treatment, oncologists:• External radiation therapy, in which through a machine called Linear Accelerator radiation towards the part of the body with the tumor is directed. It is not painful. They are often given sessions lasting a few minutes every day, usually Monday through Friday, during a certain number of weeks depending on the tumor. Many times, the area where the treatment has been given is marked with a small sign, as a tiny tattoo, to locate the area more easily in the following sessions. This treatment does not return to the patient radioactive, so that after a session can be with other people with peace of mind.
• Internal radiation therapy, sometimes called brachytherapy, in which is placed a small amount of radioactive material, in the form of small seeds, tapes or wires, the organ where the cancer has been detected. The implant can keep a few minutes to several days in the body, or be a permanent implant. During treatment, the body emits radiation so it should limit contact of the patient with other people. When removed the implant already there is no radiation risk to other people. In the case of permanent implants, the radiation dose is very low, declines over time, and reaches only a few millimeters around the implant. Anyway, the doctor can give some recommendations, such as avoiding close contact with pregnant women or children for a short time after the placement of the implant.
Side effects of radiation therapy
The side effects associated with radiation therapy are generally mild and depend largely on the irradiated body part. It may appear:• A dermatitis or reddening of the skin near the irradiated zone.
• Tiredness.
• Diarrhea, nausea or vomiting.
• Other effects depending on the area that radiates.
Chemotherapy
What and how did chemotherapy
It chemotherapy is a series of drugs that act at different phases of the cell cycle (mode reproduce cells), with the aim of achieving cell death, if only the evil possible.The first drugs chemotherapy, nitrogen mustard, was a product used in the chemical warfare during the second world war. Casual sailors to mustard gas exposure led to the observation that the alkylating agents causing cell death in the bone marrow, so it was used in diseases such as lymphomas. Remission of childhood leukemias, Hodgkin's disease with chemotherapy combined in 1960 showed that human cancers could be treated with drugs, thus beginning the history of chemotherapy as treatment.
There are several ways to use chemotherapy:
• As a treatment in advanced or metastatic disease, where there is an alternative of local treatment.
• As a complementary therapy (adjuvant) local treatment (surgery or radiotherapy).
• As induction therapy or neoadjuvant in patients with localized tumors. It is used as treatment prior to surgery and radiotherapy, with intention to decrease the likelihood of distant metastasis, more conservative surgery techniques, used to decrease tumor size, and promote awareness of the sensitivity of the tumor to the drugs used.
• As a direct instillation into specific regions: in the cerebrospinal fluid, pleural cavity, pericardial and peritoneal.
Mechanism of action of chemotherapy
Different drugs work in different phases of the cell cycle using the following mechanisms of action:• Direct interaction with DNA, causing damage to its structure or operation so that stops cell growth.
• Inhibiting agents of the mitotic spindle (System of the microtubules – tubulin of cell division): microtubules are structures responsible for the cellular scaffolding along which elapse between various processes of growth and cell movement. There are substances which alter the microtubules, blocking the growth of cells by preventing the correct division and reproduction of the same.
Toxicity and side effects of chemotherapy
The toxic effects associated with chemotherapy are numerous and, in some cases, can compromise the life of the patient. The most important ones can be grouped into the following:• Local and dermal toxicity: reversible alopecia, skin pigmentation changes.
• Myelosuppression: alters the body's defenses, leading to a State of increased vulnerability to infections. Nowadays, with the emergence of the colony stimulating factors, complications have declined to getting the recovery in one shorter time.
• Infections: are related with the duration and severity of the descent of the defenses and the alteration of the integrity of the barriers, such as mucous membranes and skin. They should be treated with broad-spectrum antibiotics until figures hematological recovery and cessation of the fever.
• Cardiotoxicity: anthracyclines and Taxanes are drugs which can cause congestive heart failure, and dealing with measures similar to those produced by other etiology.
• Pulmonary toxicity: damage occurs in the form of chronic Pneumonitis, which leads to pulmonary fibrosis. There is an effective treatment for their control, although the use of corticoids relieves symptoms.
• Liver toxicity: transient hepatic alterations occur with elevation of transaminases.
• GI toxicity: ulcers in the oral mucosa; nausea and vomiting; non-infectious diarrhea; constipation.
• Allergic reactions requiring, in some cases, using premedication.
• Cystitis: ifosfamide and cyclophosphamide often induce cystitis may be hemorrhagic. It prevents hydration and the use of a uroprotector (mesna).
• Neurotoxicity: may be peripheral (feeling numbness in the extremities, pain type cramping, etc.) or central. The only treatment is the removal of the drug.
• Renal toxicity: the most toxic drug for kidney is cisplatin, yielding (tubular) renal necrosis with progressive decline in kidney function.
• Gonadal toxicity: male sterility may appear. In women occurs ovarian atrophy and absence of menstruation, transient or permanent. In both cases, alterations can be reversed according to age and dose of the medication used.
• Carcinogenesis: secondary tumors, which appear after several years of having finished the treatments can be developed.
Drug resistance
One of the major causes of failure to chemotherapy is the resistance of tumors, acquired during treatment, or inherent from the beginning of the development of the tumor, to cytostatics. As a result, it is estimated that the use of several drugs (polychemotherapy) would be more effective in the treatment of tumors than monotherapy (use of a single drug).Hormone replacement therapy
Evidence of different hormonal stimuli influencing the development and evolution of some tumors is known since long ago. The discovery of the hormone receptors, and the continued development of new drugs, has led to that the hormone therapy is an essential treatment in some neoplasms, such as cancer of the breast and prostate, not only in advanced disease, but as adjuvant therapy.Hormone therapy aims to prevent the stimulus that hormone, binding to the receptor triggers on the growth of the tumor cell. This achieved, either directly on the receptors, blocking them, or on the production of hormones, reducing their levels.
The main types of hormone therapy are:
• Hormone ablative therapy: radiotherapy or surgical approach of the gonads (ovaries, testicles) to reduce the levels of circulating hormones.
• Hormone drug therapy: drugs that by different mechanisms prevent the hormones produced by the patient's own body to join their receptors in tumor cells, thus preventing its growth.
New biological treatments against cancer and immunotherapy
These treatments are not chemotherapy. Immunotherapy consists of the use of the immune defense system of the body against attacks such as infections, cancer-fighting. Some antibodies and substances in the immune system can be synthesized artificially to be employed in the treatment of cancer. Thus, they can be distinguished:• Active immunotherapy, consists of substances intended to elicit anti-tumor response by own immune cells of the patient with cancer: interferon-alpha; interleukin 2 (melanoma, kidney cancer treatment); vaccines based on antigens, viral, associated with tumor processes, such as the hepatitis B vaccine and the human papilloma virus.
• Passive immunotherapy, is to create an immunity by transfers of monoclonal antibodies directed against cell targets specific, present in the tumor cells.
These new treatments have an objective is more specific than traditional chemotherapy, which gives them greater efficiency and less toxicity.
Therapeutic targets
In recent years have emerged the so-called therapeutic targets. Referred as well to very specific sites of the functioning of the cell, usually chemical reactions necessary for cell life, and which are controlled by proteins originating in the altered genes that produce cancer. The inhibition of these targets produces cell death, to not be able to make cell part of their vital functions.One of the advantages of this type of treatment is that normal cells may not need these reactions to live, so they would be unaffected by the treatments. Some examples of these biological treatments are:
• Inhibition of epidermal growth factor receptor family: EGFR. There are drugs that block, at different levels, these receptors, achieving thus preventing cell growth. Monoclonal antibodies, targeting the extracellular part of the receiver (trastuzumab, cetuximab, panitumumab), and the small molecule inhibitor of tirosincitiasa, aimed at the intracellular part of the receiver (gefitinib, erlotinib, lapatinib, imatinib, sunitinib).
• You can also prevent the formation of new blood vessels, or angiogenesis, as fundamental phenomenon for tumor growth and further development of metastases. It is regulated by a number of substances, notably (VEGF) vascular endothelial growth factor. There are now drugs that trigger maneuvers at different levels to inhibit this process of formation of new blood vessels, thus preventing tumour growth (e.g. antibody named bevacizumab).
Help against cancer associations
In Spain, cancer patients and their families can attend numerous associations in search of support and advice. These help against cancer associations understand that this disease requires a comprehensive approach, which pay attention to physical, psychological and emotional aspects, and considered that patients should have adequate information to combat cancer successfully. In some cases, addition, own patients come together to offer their experience to others going through the same situation.Here are some of the most important help against cancer associations, although there are many more, spread throughout the Spanish geography.
Spanish Association against Cancer
As its name suggests, its aim is to fight against all types of cancer: informing, supporting and accompanying the patients and their families, promoting cancer research, and raising society of the need for action against this disease. Although it has its headquarters in Madrid, it develops its work in all Spain, and has representation in more than 2,000 locations throughout the country.• www.aecc.es
• Headquarters: c / Amador de los RÃos, 5-28010 Madrid
• Telephone number: 91-3194138
• INFOCANCER: 900.100.036
Spanish society of medical oncology (SEOM)
Scientific entity formed by specialists in Oncology, which aims to promote the scientific understanding of cancer and ensure the quality of care to patients, as well as promote initiatives to keep informed the population about the disease and preventive measures that can be taken.• www.seom.org/es/seom
• C / Conde de Aranda, 20 5 ° dcha. 28001 Madrid
• Tel.: 91 577 52 81
• seom@seom.org
Group Spanish of patients with Cancer
Its objective is to protect the interests of cancer patients, so that all have access to rapid diagnosis and the best treatment options, also facilitating their participation in clinical trials and epidemiological studies.• www.gepac.es
• C / Santa Hortensia 15, K - 28002 Madrid Office
• Tel.: 901 220 110 / 91 563 18 01
• info@aeal.es
Hull partnership
It's an organization, non-profit, aiming to fill a gap in the treatment of cancer and other serious diseases, according to the psychological and emotional aspects that have these pathologies, whose approach is part of the comprehensive treatment they need to receive patients.• http://www.asociacioncarena.com
• C / Tapineria 18, under (Miracle of the Mocadoret plaza entrance) 46001 Valencia
• Tel.: 96 392 38 98
Extremaduran Cancer Association
It provides support to cancer patients and their families, providing general information about this pathology, psychosocial assistance to quit smoking courses, company of volunteers...• www.aoex.es
• Avenue Godofredo Ortega y Muñoz, 1-local 10. 06011 Badajoz
• Tel.: 924 207 713
• aoex@badajoz.org
Foundation for children's Oncology Enrique Villacecchia
It is a private foundation, nonprofit, which provides help to children in cancer treatment in Catalonia and their families, support them and improve their quality of life during all phases of treatment,• www.fevillavecchia.es/fundacion.asp
• San Antonio Mª Claret, 167 08025 - Barcelona
• Tel.: 93 435 30 24
• fundacio@fevillavecchia.es
Desire small Foundation
This association, with headquarters in Madrid and offices in Catalonia, Navarra and Valencia seeks to fulfill a desire for children, residents in Spain, suffering from a disease chronic or with poor prognosis, disinterested and free of charge.• www.fpdeseo.org/
• Madrid Office: C / Ibiza, 4 - 4º C - 28009 Madrid
• Tel.: 91 574 12 34
• fpdeseo@fpdeseo.org
Spanish Federation of parents of children with Cancer
Consisting of 14 associations distributed by various autonomous communities, it aims to improve the quality of life of children with cancer and their families, offering emotional support and professional help to deal with the disease. In addition, they advise families in dealing with economic and social aid, and inform them of resources at your fingertips.• www.cancerinfantil.org
• Avenida Menéndez Pelayo 41 - 3º dcha. - 28009 Madrid
• Tel.: 91 557 26 26
• federacion.madrid@cancerinfantil.org
Cured of Cancer.com
Web site that provides testimonies and experiences of people who have suffered from various types of cancer. The treatments received, how it changed their lives, news, etc.• www.curadosdecancer.com
Associations according to the type of cancer
Federación Española de Cancer de Mama
It brings together 35 associations of women and provides information about this type of cancer, whose early detection is essential to get the cure. It asserts the right of patients to receive psycho-social assistance, physical rehabilitation and support to control the side effects of treatments, as well as the need to facilitate their re-employment.• http://fecma.vinagrero.es
• Civic Center Mª Cristina
• C / General Dávila, 124-39007 Santander
• Apartado de Correos 2211-39080 Santander
• info@fecma.org
Federation of Breast Cancer
It is intended to disclose information about this cancer, and support to patients with fewer resources, promoting actions to raise funds for the fight against this disease.• www.cancermama.org
• c / Enric Granados, 111, 2nd, 2nd - 08008 Barcelona
• Tel. 93-2172182
• fefoc@fefoc.org
AMMCOVA (Association of women Mastectomizadas (and affected breast cancer) in the Valencian Community)
This Association offers information and attention to women affected by breast cancer, providing counselling and advice on economic benefits, etc. They also organize courses, conferences and information sessions about this disease.• www.ammcova.com
• Martinez Cubells, 2-15 to - 46002 Valencia
• Tel.: 963-523-696
• info@ammcova.com
Andalusian Women's Association Masectomizadas (AMAMA)
This independent and non-profit association strives to prevent or reduce the physical and psychological sequelae that are left behind after a mastectomy.• www.amamagranada.com
• C / Postigo Veluti, 4 - 1º B - 18001 Granada
• Tel.: 958 28 28 82
• amamagranada@hotmail.com
Spanish Association of Lung Cancer affected
It is a non-profit organization, which aims to meet the needs of those affected by this disease, which provides free psychological assistance, and offer support to their families. It also develops a divulgative work to sensitize society and promote the prevention of this disease.• www.aeacap.org
• Pl. de L'ajuntament, 12, 8ª planta, 46002. Valencia
• Tel.: 960708657 and 902001803
• aeacap@aeacap.org
Association of uterus neck cancer of Spain
Provides information about this type of cancer, how prevent it and treat it, and the possibility of carrying out consultation with specialists in the field.• www.accudes.es
• C / thought, 27 - 3º-28020 Madrid
• info@accudes.es
EuropaColon Spain
Independent Foundation, non-profit, which seeks to involve all the European population in the fight against colorectal cancer. Its objectives include the early detection of the disease and protect the interests of patients, improving their quality of life and reducing mortality rates.• www.europacolonespana.org
• Pº de la Castellana, nº 201 - 4th-28.046 Madrid
• Tel.: 91 344 92 39
• secretaria@europacolonespana.org
Foundation against Cancer RADITIDINA (Prostate Cancer)
Website of the Foundation against Cancer to support prostate cancer patients. Among other services, it offers psychotherapy by phone the patient and consultation with experts from the web itself.• www.cancerdeprostata.org
Spanish Association of people affected by Sarcomas (AEAS)
Non-profit entity formed by people related to this type of cancer (patients, family members, medical professionals). They offer information and support, since their experience, and with the generous collaboration of medical societies, to all those affected by any type of sarcoma.• www.aeasarcomas.org
• Contact: info@aeasarcomas.org; pacientes@aeasarcomas.org
Spanish Association of people affected by lymphomas, Myelomas and leukemias (AEAL)
Patients with onco-hematological diseases Association, which provides services such as counselling, health information, and a forum where those affected by these diseases have the opportunity to share their experiences.• www.aeal.es
• C / Santa Hortensia 15, K - 28002 Madrid Office
• Tel.: 901 220 110 / 91 563 18 01
• info@aeal.es
Latin American Thyroid Cancer Association
A website that offers the possibility of contact with thyroid cancer patients and share information and experiences about this disease.• www.cancerdetiroides.org
Cancer prevention
There are two ways to address the prevention of cancer:Primary prevention of cancer
It is the set of actions that lead to the reduction of the incidence of cancer by the Elimination of possible causal factors. The European code against Cancer, sums up the most important primary preventive measures:• Do not smoke or allow it as soon as possible.
• Avoid obesity.
• Perform any physical activity of moderate daily, at least 30 minutes.
• Increase the consumption of fruits and vegetables varied (four or five daily portions), take two or three servings a day of protein, eating 30 Gr. fiber, and limit consumption of foods that contain fat saturated with animal or butters.
• It is advisable to take raw olive oil, include in your diet blue fish, vegetables and, in moderation, nuts. Some products, such as the Hawthorn, evening primrose, or crustaceans such as Krill contain fatty acids W3 (cellular antioxidants) can help reduce the chance of certain tumors.
• Consume eight glasses of water daily.
• Moderate consumption of alcohol.
• Avoid excessive exposure to the Sun.
• Implement legislation aimed at preventing any exposure to substances that may cause cancer. Application of radiation protection standards.
Secondary prevention of cancer
Primary preventive measures must be supplemented by activities of health education of the population in what is known as, in general, secondary prevention and early diagnosis. Early diagnosis is the set of activities that are intended to detect disease before it manifest itself clinically, and thus to begin treatment early. The effectiveness of the early diagnosis of cancer has been shown clearly in three cancers: breast, cervical and colorectal cancer. Health education is to show the early signs of cancer for which an individual should consult their doctor. There are public health programs that can prevent cancer or increase the possibility of curing a cancer that has already appeared:• Women from 25 years old should undergo testing for early detection of cervical cancer.
• Women from the age of 50 should undergo a mammography for the early detection of breast cancer.
• Men and women from the age of 50 should undergo testing for early detection of colon cancer.
• Immunization programs against the virus of hepatitis B, such as liver cancer prevention, and vaccination against the virus of HPV and cervical cancer prevention.
Medical tests related to the diagnosis of cancer
• Analysis of the PSA• Skin biopsy
• Bone marrow biopsy
• Cystoscopy
• Cervical cytology
• Colonoscopy
• Colposcopy
• Scan
• Laryngoscopy
• Mammography
• FNA
• MRI
• TAC
• Rectal examination
• PET
2. analysis of the PSA
PSA production depends mainly on the amount of male sex hormones and the size of the gland. PSA levels in the blood are usually very low, are considered normal levels of 4 ng/mL. There are situations in which PSA can increase in blood, such as exercise or ejaculation. Also undergo a digital rectal examination, a biopsy of prostate or the fact of having taken a urinary catheter.
What is a PSA test
The reason that the PSA is best known is as a good marker for prostate cancer. When it appears a tumor in the prostate PSA production goes awry and increases its concentration in blood. It is considered a PSA suspicious if it is higher than 10 ng/mL. When PSA is between 4 and 10 ng/mL is recommended to study why which is high, without being so strong the suspicion of prostate cancer. The PSA test also serves to detect other diseases of the prostate such as benign prostate hyperplasia or infection of the prostate gland (prostatitis).For years it has been thought that PSA could be a good method of early detection of prostate cancer in the general population. After many studies and experience, it can be concluded that PSA is not useful for detecting prostate cancer in patients who have no symptoms that make suspected prostate pathology. Ultimately there are cases of cancer of prostate PSA elevation and, above all, many of the cases that have elevated PSA do so for other reasons and undergo a prostate biopsy unnecessarily. In addition, prostate cancer is a disease that does not need treatment in early stages, and his diagnosis only increases the anxiety in the person suffering.
Therefore, the analysis of prostate should be performed only when the doctor sees it, it will be when your results to determine a diagnosis and specific treatment.
The PSA test It is a test of easy preparation and little aggressive, it's a simple blood test. Its results should be interpreted with caution. Test which is still today the most useful for detecting prostate cancer early is to perform a digital rectal examination annually from 50 years of age.
When doing a PSA test
A single PSA (prostate specific antigen) test is recommended to the following persons and in the following circumstances:Suspicious rectal: with rectal can feel the prostate, see its volume and consistency. When the prostate is too hard can be a test of the PSA last time to see their levels in blood.
Urinary symptoms: people who suffer from prostate may have symptoms when they urinate. Normally it costs them more time urination, tends to be choppy and at the end of may have leakage of urine for a while.
Screening for prostate cancer in over 50 years: today make a PSA for the diagnosis of prostate cancer is a recommendation that has been proven useless. In addition, it is normal that with age the PSA levels increase, since the prostate grow in size.
Staging of prostate cancer: after a biopsy that there is a prostate tumor is already known, the PSA can help determine to what degree it is. Higher PSA levels have been associated with tumors more aggressive and more widespread by the body.
Control of relapses: patients who removed the prostate by a tumor should be tracked periodically which can perform a PSA determination. It is normal to have very low levels in blood, but if there is a recurrence of the tumor may appear in blood clearly.
People with a family history of prostate cancer: the role of PSA as a method of early detection of cancer is under discussion in these cases. On the one hand it is people with higher risk than normal of having prostate cancer and the test will be more useful, on the other hand, prostate cancer is very common in any 60-year-old male, so there is not much difference with other people without family members who have had cancer.
Preparation for a PSA test
If they are going to do an PSA test these are the issues that you must consider when go prepared to test:Duration: usually takes very little time, what it takes to be a blood analysis: seconds or minutes. Results take rather longer to receive, usually several days.
Admission: admission is never needed. The PSA test is a test that can be done at a time.
Is necessary to be accompanied?: , isn't just a prick to get analytics. It is not usually very painful and is minimally invasive, so you can only attend the clinic and return in the same way.
Drugs: don't need to take any prior medication. Although Yes there to tell your doctor all medications you are taking at that time, since some drugs can increase or decrease the levels of PSA. Many of them are easy to relate (medications for benign hyperplasia of prostate, for example), but others may go unnoticed (e.g. treatments for baldness).
Food: an analysis of PSA before you can eat normally, you don't have to go on fasting. But it is frequent to seize the prick of Analytics to measure yourself with other parameters in blood (sugar, cholesterol, etc.), it is best that you reports before or directly go on fasting if analytics is early.
Clothes: you can wear normal street clothes.
Documents: is advisable to go with your health insurance card, although most of the times is sufficient to bring the wheel with which the doctor sent you proof.
Pregnancy and breast-feeding: the evaluation of the PSA is a test that is performed only in men, so it makes no sense that the pregnancy or breast feeding are important factors for a man. Yes, it should be noted that the test does not imply any difficulty to find a baby with your partner, although recent ejaculation can be the result of the PSA.
Contraindications: there are no contraindications for the analysis of the PSA. So just rating if it really is worth the test and the results would serve as something.
How a PSA test
When you reach the query for you an PSA test (prostate specific antigen) your doctor will make you some general questions about your state of health: important diseases, risk factors, lifestyle, work place and mostly insist on voiding or urinary symptoms (if it costs you to urinate, or do it in a choppy manner, etc). The doctor will ask the PSA test when necessary. After perform you a general physical examination, and assess the realization of a rectal examination accompanied or not measuring the levels of PSA in the blood.Days after this first visit, you cite for you blood PSA. It is recommended that the five previous days do not make you intense physical exercise (gym, running, football...) to prevent the PSA data is changed. If between the query and the performance of the test they have made you a digital rectal examination or a catheterisation will have to remind you that you tell the doctor to collect the results, since these tests can alter PSA levels in blood.
The day of the analytics can make a normal life. In case of doubt it is better to go to analysis in fasting, if do you other tests. You must not go nervous, it's just a routine blood test. When you arrive at the clinic they ask you the wheel and then make you go to the room of blood extractions. There you sentarás on a Chair and discover you arm. The nurse will use an antiseptic substance to clean the area to puncture and then prick a vein in the forearm with a needle. Take one small tube of blood.
Once taken the sample they will leave you a cotton to pressure puncture site for a while to avoid bleeding and bruises are formed. You can then go for breakfast, if you have not already done so, and to make your daily routine until days or weeks later give you results in the doctor.
Complications of the PSA website
Complications analysis of PSA are virtually non-existent. It is a safe test that does not entail risks for persons who are subjected to it. The only risk is to know about false positive test results requiring more aggressive testing.The PSA test results
The results of the analysis of PSA (prostate specific antigen) may take several weeks since the blood is collected for study. To pick them up there to keep another appointment, since the documentation alone can not be interpreted by the patient. In consultation, the doctor will be the most appropriate interpretation of the results of the analytical.When PSA levels are less than 4 ng/mL in blood is considered that alterations there are no. It is important to note that that does not rule out outright form of prostate cancer, PSA levels may be low in some tumors and may also decrease by medication or other situations.
If PSA levels are higher than 10 ng/mL in blood their cause should be considered. It is important to tell the doctor if you have situations that they have been able to raise PSA prior analytics. Rectal will be compulsory, if it has not already, and valuing all your aspects will decide whether or not to perform a prostate biopsy.
When PSA levels between 4-10 ng/mL is difficult to make a direct decision. Once more the rest of tests are decisive. Sometimes you can choose to perform an analysis of the fraction-free PSA, which consists of study percentage of PSA is free in plasma, instead of going to other proteins. A more specific test that provides more data to consider is considered.
In people who already have a known prostate disease (cancer, benign prostatic hyperplasia, infections, etc.) the PSA test serves to control the disease through periodic analytical. Normally, PSA levels will be constant or decrease. If there is suddenly a sudden elevation of PSA will make us think that the disease goes wrong or has been extended.
3. skin biopsy
Thanks to her has been diagnose diseases that could not be decrypted only with the exploration of the dermatologist. The main advantage that has the skin on other biopsies biopsy is that it is a body with very easy access, so you can take samples in a way very little invasive.
This ease of access has made that cutaneous biopsy will become a daily test in dermatology. In addition, risks associated are rare and usually not very serious. You can be performed in less than 20 minutes and the hospitalization is not necessary. Although it is a simple test allows knowing the patient's skin disease deeply, and so provide you with the most appropriate treatment.
There are three types of skin biopsies:
Punch or punchbiopsy: is performed with a hollow cylinder of sharp edges that a circular sample of skin from few millimeters in diameter.
Surgical biopsy: it is done with a scalpel, its size may vary according to the need for the study. Lets get subcutaneous fatty tissue.
Excisional biopsy: realized with scalpel and to be biopsied is caught all the skin lesion, eliminating it.
When doing a skin biopsy
Skin biopsy is a medical test that is performed for the following reasons:A definitive diagnosis: Although many of the skin lesions may be diagnosed at a glance by a dermatologist, sometimes it is necessary to study under a microscope injured skin provide additional information that will help specialist to decide on a specific diagnosis.
Isolation of microorganisms: the skin sample can be processed in a microbiology laboratory to check for bacteria, fungus, virus, or parasite responsible for cutaneous lesions.
Molecular study: Although the specific diagnosis of a skin lesion is known, it is sometimes necessary to perform a skin biopsy to study biochemical components that help us to determine their severity and their most appropriate treatment.
Genetic study: on many occasions, to diagnose a genetic disease it is necessary to obtain cellular tissue from any part of our body to study their chromosomes. The skin is a tissue that is frequently used for this purpose because of its easy availability.
Stem cell therapy: Although today it is in phase of study, expected that in the future the skin removed with a biopsy can serve to extract stem cells.
Preparation for skin biopsy
If you are going to perform a skin biopsy these are issues that you must consider when go ready to test:Duration: the test will last a total of 15 to 20 minutes. The biopsy itself will last from three to five minutes, the rest consists of the preparation of the material and the biopsy area.
Income: cutaneous biopsy can be performed in a query, a priests room or an operating room either. Hospital admission is not required in any case.
Is necessary to be accompanied?: no need to be accompanied to a cutaneous biopsy, but it is recommended. There are particularly sensitive people who can get dizzy with the test, but in the vast majority of the time will not notice anything.
Drugs: don't need to take any prior medication. Although it must be communicated to the doctor all the medicines taken regularly, especially antiplatelet agents, such as the add, or blood thinners, as the Sintrom. It is important to also inform of allergies to medications or anaesthetics, if you have them.
Food: don't need to stay in fasting prior to testing or after. If for any reason it should go on fasting to test the doctor would let you know in advance.
Clothing: can make the skin biopsy with the same clothes every day. When you get to the hospital or doctor's office ask you you to discover the part of the body that goes to biopsiarse.
Documents: is essential to bring with you the steering wheel which shows the performance of this test. The health insurance card is recommended. Normally you will not you any document after the test because it takes time to analyze the results.
Pregnancy and breast-feeding: cutaneous biopsy is not contraindicated in pregnancy or lactation, but that State should know because some alterations of the skin can be explained by these States unless they are necessarily pathological.
Contraindications: skin biopsy does not have any specific contraindication. Just be must evaluate the usefulness of the test and if it can help the patient to understand their disease.
How the skin biopsy
First, the dermatologist will evaluate in prior consultation if necessary or not to perform a skin biopsy. If deemed useful will inform you of how it's performed, what information we can provide and what are the possible risks involved. It will give you a document informed consent summarizing the main characteristics and you will have to sign it if you agree with its realization. Often it is only necessary to give an oral consent.Skin biopsy may make you it the same day or in another different appointment. When go to make ask you, first of all, you discover the part of the body that go to biopsy. The dermatologist will mark with a pen or marker the skin lesion biopsy owed and will begin to prepare the area.
First and foremost is washing your hands and with some gloves will clean the area with an antiseptic that would eliminate the germs that could be on the surface of the skin. Then prepare the material needed to perform the biopsy and gloves will be changed by a few sterile. With them you can handle all the sterile material without polluting it.
First it numb eye area with a small subcutaneous injection. This prick can hurt a little and to introduce the anesthetic can moderately escocer. This will be the only step that you may be uncomfortable, then the area is numbed and you will not notice anything else. If at some point in the process you sintieses back pain will only have to notify the doctor and he will make you more anesthesia.
When the skin to biopsy area is numbed shall be to cut the skin to study sample. Punch biopsies will be used the punch, a few cylinders with sharp edge that you just have to press against the skin. If it is a surgical or Excisional biopsy will be directly used a scalpel. Once cut the piece of skin removed with pliers and cut its base to remove it. The piece of skin gets into a boat that keeps it until its study in the laboratory.
Once the biopsy, wound that remains should be sutured. The extracted fragment of skin does not usually exceed the centimetre, so do not worry by the wound and subsequent scar. In the majority of cases is sufficient to close the wound with one or two stitches and then the scar is almost invisible. He thinks that many times you have become larger wounds that did not leave marks on your skin.
When you have finished you will put a dressing which you can withdraw within 24 hours. You will have stitches you to remove a doctor or nurse at your usual Health Center, let them 7 to 14 days, depending on the area of the region of the biopsied skin. Then you can get dressed and pick up your things, it is not necessary for you to wait to any kind of documentation, since the results take time and you will be given another appointment.
Complications of skin biopsy
All biopsies have risks to be invasive tests, albeit slightly. They tend to be infrequent complications and in the majority of cases have easy solutions. They can appear during or after the test. Some of the most common cutaneous biopsy are:• Bleeding from the point of biopsy.
• Local infection with fever.
• Reaction to anesthesia during the test.
• Opening of the biopsy wound spontaneously.
• SCAR keloid when cure.
Skin biopsy results
The results of the skin biopsy may take to be between one week and one month. The waiting time, it therefore tends to be long and requires patience and tranquility. The reason is that the sample biopsied need to be processed in order to study it properly. The following tests will be held on this sample:Histological staining: using special dyes cells are colored and can be observed under the microscope directly.
Immunofluorescence studies: you can attach fluorescent substances to certain components of the cells and thus verify its existence.
Microbiological cultures: If infection is suspected sample can be grown in appropriate media that allow the growth of microorganisms.
Molecular studies: specific proteins that classified the types of cells that contain the sample can be identified.
All of these tests will be performed by the physician. Along with the symptoms, analytical studies and biopsy specialist can perform an accurate diagnosis most of the times. So you can explain what happens to you, and what are the treatments available to solve your skin disease.
4 bone marrow biopsy
It is a test that is often carried out for the study of hematologic diseases such as anaemia, tumours and rare diseases. Thanks to it, have been achieved cure diseases that at the beginning of the 20th century were considered untreatable.
Their risks are similar to those of other types of biopsy and, however, the majority of the people has a special fear to be held because it is related to pain. Actually the bone marrow biopsy is a test that causes some pain, but current techniques have much diminished damage caused before, both in intensity and duration (only lasts a few seconds).
Although it appears that the bone marrow has a difficult access, is it easily reachable through superficial bones with a fine needle. It is an invasive technique, but little aggressive, and is performed easily without the need of a hospital admission. It takes less than half an hour and allows you to understand the disease of the patient with depth to provide you with the most appropriate treatment.
When a bone marrow biopsy is done
Bone marrow biopsy is a test that is carried out or requested when the following alterations in a person:Anemia of unknown cause: Although the most frequent causes of anaemia lack of iron or of specific vitamins, sometimes the reason is not known there are a low number of red blood cells in the blood. A bone marrow biopsy would know if there is a primary disturbance in blood stem cells.
Leukopenia: in the same way that anemia is decrease of red blood cells in blood, leukopenia is the decrease of white blood cells in blood. A transient leukopenia may appear in specific situations of infection in elderly people, but most of the time indicates a primary disease of the bone marrow that one must study.
Thrombocytopenia: thus calls the decline in the number of platelets in the blood. Their decline may be due to external diseases, but when they have ruled out the bone marrow should be studied to see what is the main cause of the thrombocytopenia.
Bone marrow Aplasia: is the combination of anemia, leukopenia, and thrombocytopenia. The bone marrow is consumed until already it can not produce any blood cell more.
Leukemia: one of the most common tumors of the white blood cells. Leukemia can be diagnosed through a blood test, but it is important to know if there is involvement of the bone marrow to know its gravity.
Lymphoma: another also frequent tumor of the white cells. In this case the first organs affected are the lymph nodes, but you can also pass into the blood and thus affect the bone marrow.
Multiple myeloma: is a tumor of the white cells type B that are responsible for producing antibodies that defend us against infections. This tumour appears initially in the bone marrow and the biopsy helps to know its features.
Myelofibrosis: in this disease the bone marrow atrophy until it literally dry. The biopsy is not possible because there is no fabric, but precisely by performing this test ensures the diagnosis.
Polycythemia vera: it is the polar opposite of anemia, here red blood cells are excessive and they make blood viscous. So blood flow is dense and slows metabolism, among other symptoms.
Infections: some infections affect in particular cells progenitors of blood. One of them is visceral leishmaniasis, a parasitic disease relatively common in exotic regions of Asia and South America.
Amyloidosis: occurs when certain proteins of the organism are synthesized evil, so that they cease to be soluble, and accumulate in organs throughout the body. The primary form is diagnosed with a bone marrow biopsy.
Cell therapy: treatment with stem cell research today, is booming. Many of these therapies are based on extracting stem cells from the bone marrow, modify them in the laboratory and implanted them in other areas of the body. He is currently a therapy study of which is not known its effectiveness.
How bone marrow biopsy
First, the doctor will assess in a consultation if necessary or not performing a bone marrow biopsy. If deemed necessary will inform you of why it thinks, how it's performed, what information we can provide and what are the possible risks. It will give you an informed consent document summarizing the main characteristics and you will have to sign it if you agree with its realization.Bone marrow biopsy may make you it the same day or in another different appointment. When going to ask you in the first place that you change your clothes and views a comfortable gown for you and for the doctor that perform you the test. Then will measure you all vital signs such as blood pressure, heart rate, respiratory rate and temperature, to check that you are in optimal conditions to put you to the test.
Sometimes placed you a via vein in the arm if it had introduced some medically during the conduct of the test, although it is not common. Sometimes will offer you some relaxing drug remain sedated during the test, it is recommended if you are nervous or have you are particularly sensitive to pain.
Prepared once you will be asked you to tumbes on a stretcher in a position that facilitates the realization of the test. The bones where usually do the biopsy are the sternum (in the center of the chest), the iliac Crest (at the hip), tibia (in the leg) and vertebrae (on the back). Usually take the biopsy of the iliac Crest, if there are no impediments, so they ask you that you place lying on side and to relax.
To proceed with the biopsy, the first thing that will is clean the skin where it is made with alcohol or iodine compounds. So remove any contaminants germs from the skin surface. Then they will inject an anesthetic and most deep from the surface. You will feel a slight prick of the needle, and then a burning sensation at the very moment in which the anesthesia gets. Thus, this area of the body will be asleep and insensitive.
Then they introduce a longer needle to reach the bone and go through it, then you will notice a pressure very strong in bone, for some people is painful and for others is simple intense pressure. The first needle will carry out a vacuum to pick up blood and loose cells, then take a small cylinder of tissue.
Once the biopsy needles be removed. It is normal that the puncture point blood slightly, apply continued pressure for a few minutes to stop the bleeding. Then they placed an bandage or a compression dressing and you'll be ready to go home. It will not need to wait the results since they need to be processed for a time and at first glance not seen no alteration. The bandage must hold for at least two days, is normal in the days after the test to have pain in the area and need to take some pain reliever you your doctor will prescribe.
Complications of bone marrow biopsy
All biopsies have risks to be evidence that invade the body organs, albeit slightly. They tend to be infrequent complications and in the majority of cases have easy solutions. They can appear during or after the test, whenever they arise should go to the emergency room.Some of the most common complications in bone marrow biopsy are:
• Bleeding from the point of biopsy.
• Local infection with fever.
• Uncontrollable pain.
• Reaction to anesthesia during the test.
• Drilling of other organs (very unlikely).
Preparation for bone marrow biopsy
If you are performing a bone marrow biopsy these are issues you must keep in mind to go well prepared to test:Duration: the test will last a total of 15 to 20 minutes. The biopsy itself will be one minute, the rest consists of the preparation of the material and biopsy area.
Income: bone marrow biopsy can be performed on a query or a room of cures, in such a way that it does not require hospital admission.
Is necessary to be accompanied?: it is not necessary to be accompanied, but yes it is recommended, as there are sensitive people who are sore or something queasy after the test.
Drugs: don't need to take any prior medication. Should be communicated to the doctor all the medicines taken regularly and will decide if we will suspend any. It is important to also inform of allergies to medications or other products, if you have them.
Food: it is not necessary to remain in fasting prior to testing or after. Take a light meal and avoid taking all day coffee, alcohol and other exciting substances, including also the day prior to the test. If for any reason it should go on fasting to test the doctor you warn.
Clothes: you can perform the test with the same clothes every day. When you get to the hospital or doctor can give you a gown to change you should see fit, although often is enough to discover the part of the body that goes to biopsiarse.
Documents: is essential to bring with you the steering wheel which shows the performance of this test. The health insurance card is recommended. Normally you will not you any document after the test because it takes time to analyze the results.
Pregnancy and breast-feeding: bone marrow biopsy is not contraindicated during pregnancy or during lactation, but that State should know because some biological constants that are studied will be altered from itself during these stages.
Contraindications: this type of biopsy does not have any specific contraindication.
Bone marrow biopsy results
The bone marrow biopsy results may take from one week up to a month. The waiting time, it therefore tends to be long and requires patience and tranquility. The reason is that the sample biopsied can not be analyzed at the time. The following analysis will be carried out on this sample:Histological staining: using special dyes cells are colored and can be observed under the microscope directly.
Immunofluorescence studies: you can attach fluorescent substances to certain components of the cells and thus verify its existence.
Microbiological cultures: If infection is suspected sample can be grown in appropriate media that allow the growth of microorganisms.
Molecular studies: specific proteins that classified the types of cells that contain the sample can be identified.
All of these tests will be performed by the physician. Along with the symptoms, analytical studies and biopsy the doctor will already have sufficient information most of the times to be able to make a diagnosis. So you can explain what happens to you, and what are the treatments available to solve your disease.
5 cystoscopy
Flexible: more comfortable for the patient, allows to visualize the inside of the bladder in a quick way for a first analysis.
Rigid: much more bothersome to the patient; in fact, local anesthesia is almost obligatory. Its main advantage is that it allows to visualize the inside of the bladder with much more clarity, because your camera's higher resolution. In addition, the rigid tube has several recesses by which instruments (forceps, rubber bands, scalpels, etc) can be entered.
The cystoscope was invented in 1877 by the German doctor Maximilian Nitze. At first it was a tube simple hollow which enabled viewing stones inside the bladder and gross alterations of the urethra, but soon added you a light and crevices, allowing you to manipulate the inside of the urinary tract. That is how emerged the first endoscopic interventions in history, long before Arthroscopy or laparoscopy. Dr. Nitze, in addition, used that same device to visualize the inside of the esophagus, stomach and larynx, although it was not as useful as when used to view the inside of the urethra.
Cystoscopy, therefore, is part of the minimally invasive techniques which save major surgery and complications associated with this, such as infections of surgical wounds.
When doing a cystoscopy
A cystoscopy is performed when you want to visualize the inside of the urinary bladder and urethra path to confirm a specific diagnosis. It also allows to take biopsies of the walls of the urethra and bladder and, if necessary, diseases can be treated. The most frequent indications of cystoscopy are:Check if there is cancer in the walls of the urinary tract, and take biopsies to observe suspicious alterations.
Direct sampling of urine to analyze if there is infection, thus preventing contamination of the sample passes through the urethra and go outside.
Diagnose urinary tract malformations and repair them if possible.
Diagnosis and, occasionally, treatment of the benign prostate hypertrophy, which close the urethra, preventing the passage of urine.
Solve the urethral stenosis by Transurethral resections (TUR), which widen the inside of the urethra.
Remove urinary bladder in or impacted stones in the urethra.
Diagnose the presence of cysts, polyps, diverticula, and other pathological formations of the wall of the bladder. Sometimes they can be solved through cystoscopy.
Study in depth chronic cystitis which have not been resolved with antibiotics.
Identify ulcers in the urinary mucosa and take samples thereof if necessary.
Study the presence of blood in the urine, if its origin is a hemorrhage of the lower urinary tract.
Preparation for cystoscopy
If you will perform a cystoscopy, these are the issues that you must take into account in preparation prior to the test:Duration: cystoscopy has a variable duration according to the technique that will be used. It can last a few minutes (if it is only necessary for the diagnosis or biopsy), or more than half hour (if any surgical treatment should be performed).
Income: cystoscopy can be done on an outpatient basis. You can put yourself to the test and go your home a little while. However, if it is necessary to carry out any surgical intervention is usually done in an operating room to take extra hygiene measures and regional anesthesia, and I can stay in observation longer.
Is it necessary to be accompanied?: Yes, it is recommended to carry a passenger when performing any surgical intervention during cystoscopy. However, it is not necessary to be accompanied when it comes to timely diagnostic cystoscopy.
Drugs: is not necessary to take any prior medication. Should be communicated to the doctor all the medicines taken regularly, and will decide which suspend or maintain. You should avoid taking medications that hamper the clotting of blood two weeks prior to the cystoscopy if you perform any surgery, such as aspirin, ibuprofen and other NSAIDs.
Food: is not necessary to stay in fasting prior to testing. Yes it is recommended to drink plenty of water the days after the test.
Clothing: can go to the appointment with the urologist with the same clothes every day. If the cystoscopy is performed in the operating room they will give you a comfortable robe to change it by the street clothes.
Documents: is advisable to take the medical history that details the urologic diseases, if you have them, although the doctor will already have it with him. Before you undergo surgery you will sign the informed consent, which you agree to make yourself the technique and you will know the potential risks. If the test is only diagnostic enough with oral consent.
Pregnancy and lactation: cystoscopy is not contraindicated in these situations, but if it is a risk pregnancy it is best to perform it only if we face a serious situation.
Contraindications: does not have any specific contraindication.
How cystoscopy
Firstly they will ask you if you're agree with you undergo cystoscopy, and testing can be done with a flexible cystoscope in consultation at the same time, if what we want is just to observe the inside of the bladder a few minutes or even take a biopsy. But if you want to perform any surgical technique you will have to sign a written consent and is performed in the operating room anesthesia, so you don't feel any pain throughout the procedure.The anesthesia can be of three types: general, regional or local. The most frequent is to perform with regional anaesthesia wherever possible. For this practice you a small puncture in his back to anesthetize the nerve roots in the spinal cord directly. Thus, UTI to intervene will not have sensitivity and you'll be awake all the time, although you can sedate yourself so that you are more relaxed. Local anesthesia is not useful in this type of testing, but general anesthesia can be if used occasionally.
Before inserting the cystoscope, inlet of the urethra and genitals are disinfected. You will cover with a surgical sheet to limit the area. Usually wash the inside of the urethra with a liquid antiseptic, which also takes a little anesthesia to numb so the walls of the urethra.
It is then when the urologist inserted through the urethra the cystoscope. It can be very annoying and even painful at first. The camera allows to visualize the inside of the bladder and, at the same time, introduces normal saline into the bladder to defuse it. When the bladder is filled with serum it is normal that you feel urge to urinate.
The instruments that are inserted into the bladder are very varied: forceps, scissors, handles of coagulation, etc. With them the urologist will get solve the problem that exists. Throughout the procedure is recorded on video so that it can be displayed later by the physician or by yourself. If the test is a biopsy will be sufficient to use tweezers that caught a piece of the internal lining of the bladder, and you can feel a brief prick at that time.
When the intervention is completed the cystoscope is removed. It is normal that the urethra remains distressed for a few hours, and even make you urinate blood for a few days.
Complications of cystoscopy
In general, if they have a cystoscopy you not presentarás no complications and is only recommended to drink between 4 and 6 glasses of water per day to maintain a proper flow of urine. You must see a doctor when you notice fever, chills, pain, or decrease in the amount of urine.Complications in cystoscopy are not very frequent. Some that occur occasionally are:
The urethra or bladder wall damage. It may be from a small wound to a total rupture of the wall. They may be due to an error of the urologist or by anatomical abnormalities of the patient.
Urine infection after a cystoscopy. When it happens, antibiotic treatment is necessary. If the infection rises to the kidneys causing pyelonephritis treatment antibiotic should be provided intravenously.
Infection of the prostate, i.e., prostatitis. In this case the infection should be treated with an intravenous antibiotic.
Complications of anesthesia (respiratory depression, sedation allergies, nerve paralysis, etc).
Results of cystoscopy
When a diagnostic cystoscopy is performed in consultation, the urologist can get the test results at the same time. So then you can propose a solution or treatment if there is a problem.If a biopsy performed during cystoscopy or takes samples to cultivate microbes, results may take several weeks.
In case of performing any treatment via cystoscopic, the results are very positive. After undergoing the technique is needed very little time to recover, and can go home the same day if all has gone well.
6. cervical cytology
Cytology cervical cervical or also called commonly Pap smear, vaginal smear or Pap test, in honor of a Greek doctor who developed this technique in the first half of the 20th century.
The objective of this test is to detect the existence of a cervical cancer of uterus, or precancerous lesions in the same, as soon as possible in order to treat it as early as possible. In almost all cases, cervical cancer is associated with an infection by a virus called the human papilloma virus (HPV), acquired sexually. This virus causes changes in the morphology and structures of the cells of the cervix which makes that they can transform into malignant cells. The scraping is done during the test includes these cells, which may have pre-malignant changes indicative of that are evolving into cancer, or may already be cancer cells.
HPV in samples taken from the cervix can also be detected. Therefore some of the samples that are taken from the cervix is sent to the lab to investigate the presence of this virus. However, still not been determined clearly when the detection of HPV and its utility test should be performed.
When should I do a cervical cytology?
Recommendations to make a cervical cytology change across countries and even change between medical institutions within the same country. In general it is recommended to start making them three years of onset of sexual relations, starting from age 21-25 depending on the countries, and repeat them at least every three years. Most common controls may be recommended if the previous results are not entirely normal or the woman has some factors that can facilitate the appearance of tumors, such as infection with HIV or other immune disorders.When it has been five years of the last PAP, some organizations recommend annual Pap during the first two years and then every three years. Pregnant women and women who are vaccinated for HPV should also perform their cervical cytology with normality.
In the event that you perform a cytology together with a test for the detection of HPV, and both tests are negative, it is recommended to repeat cytology after five years.
When is it not necessary to do a Pap smear?
Cytology in very young women, age 21-25, are not recommended because before that age of cervical cancer is extremely rare. Moreover, in young women and adolescents is frequent that there are alterations in the cytology disappear spontaneously. Nor has been shown to be effective screening with cytology in young women. In general is not recommended to perform the test for the detection of HPV before age 30.There to do a PAP to women who have not had sexual intercourse. This is because that cervical cancer is practically always associated infection by the human papillomavirus which is acquired through sexual. If you have not had sex, there was no infection by this virus or risk of cancer of the cervix. Women over 65 - 70, could stop to Pap smears if they have three normal Pap smears in the last 10 years, and the last has been done in the last five years, but it depends on if they remain sexually active.
Finally, there is also no that do Pap smears to women who have undergone a total hysterectomy for a benign disease, i.e. who is has removed completely the uterus fibroids or other pathology not tumor. If it has already removed this body, it is not possible that a cancer appears in the cervix. Pap smears are continuing if there has been a history of precancerous lesions or if the uterus has removed because of cancer of the cervix.
Preparation for a cervical cytology
These are the issues that you must consider when ready for a cervical cytology:Duration: the test is performed in a few minutes.
Entry: the test is done on an outpatient basis.
Is necessary to be accompanied?: don't have to be accompanied by although it might help if it makes you feel more relaxed.
Drugs: is not necessary to take any prior medication. You can take your usual medication.
Food: don't have to go on fasting.
Clothing: you can wear any clothes you want, but it is important that you can undress easily from waist down.
Documents: in general any document does not lack.
Contraindications: You don't want to do the cytology if she is menstruating because the rule may be difficult interpretation of the sample. Pap smears don't occur in very young women or who have never had sexual relations.
Pregnancy and lactation: not contraindicate the realization of the test although it is important to tell your doctor the possibility of that is pregnant.
Other considerations on cervical cytology
It is important to avoid sexual intercourse, DOUCHING and using tampons or vaginal creams 24-48 hours before the test.You can be more comfortable if you empty the bladder and the bowel prior to testing.
If you are allergic to latex should warn their doctor explore it with gloves made of other materials like vinyl.
How is a cervical cytology?
Cervical cytology is carried out in a health centre and is carried out by the doctor, nurse or any other trained health professional. Prior to performing the test will inform you of the procedure, which lasts just a few minutes and the possible inconvenience may cause, since it just has risks.The female tomb is face-up on a special table that facilitates the exploration of the genital area. A Speculum is inserted into the vagina, which is an instrument with two valves that are separated and allow open the vaginal cavity and observe in the background of the cervix. With a small spatula and brush is a soft scraping on the inside and on the outside of the neck of uterus. Take several samples that extend into small glass that looks under a microscope, or enters a preservative fluid for further consideration.
It is very rare that this test may cause complications. There may be a minimum bleeding that causes a vaginal spotting small, but that is considered normal. The risk of infection is minimal. It is not a painful test, although the inclusion of the Speculum can be uncomfortable when the woman is not relaxed.
Results of a cervical cytology
The PAP cytology results are usually available within two weeks. It is advisable to go to pick up the result and not assume everything is normal because the results you are not delivered in a few weeks. The doctor will give you the results and will indicate the need for any treatment or other complementary explorations.The results of a cervical cytology is often report follows:
Normal cytology, in which there is no evidence of malignant cells.
Inadequate cytology, which not is has been able to study properly sample so what is good to repeat it.
ASCUS, an acronym which comes from the English (atypical squamous cells of undetermined significance) and which translates as 'atypia of undetermined significance'. This result is quite common and means that the cells are not quite normal, but that changes that do not have a meaning clear. In many cases, these changes disappear spontaneously and require no treatment. In any case this diagnosis requires tighter control and to worsen abnormal changes may require treatment.
Low grade or SIL intraepithelial lesion (squamous intraepithelial lesions) of low grade. This means that cells have been found with abnormal changes caused by HPV. Called intraepithelial because they are cells that are within the layer that surrounds the neck of the uterus and epithelium. Like the ASCUS, low-grade SIL may disappear spontaneously and require no treatment, but requires more frequent controls if they develop into malignant cells.
High intraepithelial lesion grade or SIL of high degree. They are cells with large abnormalities and a high probability of evolving into cancer if not treated. Sometimes high grade SIL classified into several categories according to the degree of abnormality of the cells. These changes do not tend to disappear spontaneously and often require a more comprehensive study and treatment.
Squamous cell carcinoma. It means that they have been detected cancerous cells on cytology. This finding is very uncommon in people who have been properly made its revisions.
Limitations or errors in the results of cervical cytology
Although cervical cytology is one of the best tests of screening there in medicine, and has managed to decrease the incidence of cervical cancer by 50%, admittedly has some limitations. Sometimes, cytology does not detect cancerous cells that do exist, what is called a false negative, or conversely, can diagnose that there are abnormal cells when there is cancer, what we call false positive.These errors can occur because samples are taken in areas where it is not the tumor or errors in the processing or analysis of the sample. That is why it is important to go to centers with good quality controls and get tested regularly.
7 colonoscopy
To perform a colonoscopy, it is necessary that the intestine is well clean of fecal remains. This requires preparation of the colon by means of some laxatives that are taken orally or enemas. These substances are given during the day or two days prior to the test and produce abundant diarrhoea, what gets the colon cleanse.
Reasons to perform a colonoscopy
The most common reasons that the realization of a colonoscopy may be requested are as follows:• As a colon cancer screening test.
• Especially in people with a family history of colon cancer or in over 50 years.
• Study of episodes of bleeding rectum (rectal bleeding) or after the appearance of blood in the stool.
• To study chronic diarrhea.
• In cases of anemia iron deficiency (due to lack of iron) when it is suspected to be due to a chronic bleeding from the colon.
• In cases of sudden and unexplained weight loss that may cause to suspect a colon cancer.
• To study with more detail any alteration which has appeared in another test that examines the colon called barium enema.
• To diagnose and monitor an IBD like Crohn's disease or ulcerative colitis.
• The study of abdominal pain, chronic.
Sometimes, it is not necessary to explore all of the colon but only its final part. So the colonoscope is inserted by year but moves only by their final parts, i.e. by the rectum, the sigma and the descending colon. This test is called rectosigmoidoscopia. If some pathological finding is the doctor usually will advance the colonoscope until the end performing full colonoscopy.
Preparation for a colonoscopy
These are the issues that you must consider in preparation for a colonoscopy before you undergo this test:Duration: the test is performed in about 30-45 minutes although it may take longer depending on the findings, which are or if some therapeutic procedure is carried out or take biopsies.
Entry: the test is done on an outpatient basis.
Is necessary to be accompanied?: is usually administer a sedative so the patient stays quiet during the test, so it is recommended that someone accompany you to take you home then.
Drugs: for testing will need to clean the colon during 1-2 days prior to the procedure. They will give you instructions to do so through laxatives for Administration via orally or by enema. Diet to be followed during this period depends on the type of laxative that would provide. Generally we recommend a low residue diet, why you should not eat vegetables, potatoes, or fruits from 48 hours prior to testing. The night before, you can only take liquids. These instructions can be changed, as he is sometimes recommended to follow a liquid diet 24 hours before the test. In any case, you will be given a sheet of instructions that must be followed strictly.
Food: in general it is possible that you can have breakfast sugary coffee or tea, but you must follow the instructions of your doctor in this sense.
Clothing: you can wear any clothes you want to but it should be easy to remove, as they will remove you most of the clothes and will facilitate you a hospital gown.
Documents: should be informed consent, which is a role where they explain you what is the test and its potential risks. You should read it carefully and take it signed. You must take the wheel of the test request.
Contraindications: You should not do a colonoscopy in the following cases:
• Pathologies that may worsen if carried out the test as in intestinal perforation, infections of the colon as acute diverticulitis, in cases of peritonitis, or after an operation on the recent colon.
• Pathologies in which is not useful as in upper gastrointestinal bleeding (eg: haemorrhage gastric or duodenal) or irritable bowel syndrome.
• Serious or "unstable" patients with significant hypotension, severe arrhythmia, etc.
• Pregnancy, especially in the second and third quarters.
• Intolerance or allergy to percutaneous solutions given for cleaning the intestine.
• Serious coagulation disorders.
Pregnancy and lactation: in general the test should be avoided during pregnancy although occasionally it can be if it is considered that the benefits outweigh the risks. In such a case we must try to do it without sedation or with the minimum possible sedation. Breastfeeding in general is not a contraindication performing the test. Solutions to clean the bowel percutaneous tend to be compatible with breastfeeding, although some could give diarrhea in breastfed infants. Sedation is usually not contraindicate breastfeeding unless there is risk of infant respiratory depression. Always should inform the physician of the possibility of pregnancy or if it is breastfeeding if you can postpone the test or replaced by another more secure.
Other considerations prior to colonoscopy
You must tell your doctor if you have allergies to medications, particularly to anaesthetics.If you are taking iron supplements or aspirin may tell you to stop taking them the 7-14 days prior to the test. This is due to that aspirin faciliaria bleeding in case that take a biopsy or remove a polyp, and the iron is needed is stuck on the wall of the intestine and hinders their exploration. The doctor will instruct you when to resume this medication.
If you are taking anticoagulants, it is very important to warn the doctor, then it will be necessary to temporarily suspend them. The doctor will give you instructions in this sense depending on the anticoagulant that take.
You must also tell if you've had a test with contrast of the colon in the four previous days as a barium enema. Barium used as contrast can remain in the intestine and make it difficult to scan.
How a colonoscopy
The test is often make a doctor specializing in digestive tract with a wizard that can be nurses. Initially take an IV in your arm. There passes a drug that will make you to be relaxed and drowsy during the test. It is possible to then not remember much about the procedure.They will tell you to undress and put on a hospital gown. They defeated him on a stretcher on the left side and with knees bent toward chest. Initially the doctor will make you a rectal carefully exploring anal hole with a finger and some substance lubricant and anesthetic above the glove. Then proceed to introduce the scope previously lubricated by the anal opening and progress it slowly by the colon. In an attached screen the doctor can see the entire surface of the colon clear.
One can notice some abdominal cramps or the need to defecate or expel gases. Do not feel uncomfortable for this reason, because through the colonoscope is inserted air to defuse the colon and facilitate exploration. The expulsion of gases is therefore completely normal. Simply breathe deeply and slowly to relax the abdominal muscles. During the test you may be asked to change position to facilitate the movement of the colonoscope, and might be given some intravenous medications to relax the bowel.
The doctor has tools such as microtweezers, capsula, etc., that you can get the channels that has the scope and which allow you to perform some diagnostic or therapeutic procedures. For example, can suck secretions, take a biopsy, removing a polyp coagulate bleeding, remove a body odd, etc.
After all, the scope be taken off carefully with what it is expected to leave enough gas in the intestine, which will relieve him if I noticed any abdominal discomfort. Finally it will proceed to clean the anal area with paper and leave him 1-2 hours under observation in an enclosed room until it recovers the sedative effect. It is recommended that you do not drive or operate dangerous machinery during the 12 hours following the test. Your doctor will instruct you when you can eat normally and restart normal activities. This depends on the procedure that have yet done you and medication which provided him. When you are allowed to, drink plenty of fluids to recover losses of liquid that it may have suffered with diarrhea caused to prepare for the test.
Complications of a colonoscopy
Colonoscopy is a very safe test. It is also rare to have side effects from drugs that can be administered as sedatives. The most annoying thing of the procedure probably preparing the colon laxatives, since it causes a watery diarrhea which can be annoying.During the test you can feel embarrassed by the procedure. There is no reason to do so. You may notice abdominal discomfort, but they tend to be small because they will be given sedatives and analgesics. If you experience pain, please tell it to the doctor during the test.
After the procedure you will feel drowsy for a few hours and is likely to not remember much of what happened. You may also notice abdominal bloating and gas, which will go out little by little. If you've had a biopsy or have had your a polyp removed you can see traces of blood in the stool for a few days. It is very rare that there is a serious complication for a colonoscopy.
Sometimes the colonoscope can damage the surface of the mucosa and cause bleeding. In rare cases the procedure may cause cardiac arrhythmias. Some cases of perforation of the intestine with the colonoscope, have been which is a completely exceptional circumstance. If after the test Note intense bleeding, severe abdominal pain, fever, intense dizziness, vomiting, or note the swollen and hard belly, you should immediately contact your doctor.
The colonoscopy results
During the test is the surface of the intestine with what your doctor can diagnose directly many pathologies. It is possible that later you any results the day of the test. The specialist will make a written report that will give you a few days of the test, possibly along with some photos of possible pathological as ulcers or polyps findings. Where biopsies are taken, the samples will be studied under a microscope by a pathologist and a report will be made separately with this result. You can also that you have caught samples for microbiological study of possible intestinal infections. This will result in a third report by a specialist in microbiology. All these results may take several weeks to be available.The result report will include data on the quality of the preparation of the intestine, where has been reached with the colonoscope, the medication that has been given him and possible eventualities that have occurred during the test. Describe the appearance of the bowel and possible pathologies detected as polyps, diverticula, tumors, ulcers, bleeding, inflammation, hemorrhoids, etc. Specify possible diagnostic or therapeutic procedures undertaken as the outlet of biopsy or removal of polyps, and to which lab extracted samples have been sent. The report will be completed in a few weeks with the results of these samples.
It is advisable to go to pick up the result and not assume everything is normal because the results you are not delivered in a few weeks. The doctor has asked the test will give you the results and will instruct you if it is necessary to other complementary examinations or to follow any treatment.
8 colposcopy
As do a colposcopy
Colposcopy is performed by means of a special microscope called a colposcope. Through the colposcope gets very expanded view of the cervix at the end of the vagina.During the test the female tomb is face-up on a special table with the legs apart. A Speculum will be inserted to separate the vaginal walls. The doctor observes the cervix and stained its surface with different liquids, such as acetic acid or the lugol, to highlight areas where there may be abnormal cells. These suspicious regions can biopsy to study them later or, occasionally, they can be removed in its entirety.
Take samples using a pair of pliers or, if there are no visible injuries, the inside of the cervix is gently scraped for a sample. A treatment of the suspected area with different instruments can sometimes be be (through heat, cold, excision of the lesion, etc).
Colposcopy complications are extremely rare, and the risk of infection is very low.
It is not a painful test, and the introduction of the Speculum does not usually be uncomfortable if the woman is relaxed.
A light stinging sensation you can feel when the doctor stained with acetic acid or lugol's neck to highlight abnormal areas. In addition, you may notice some slight pinch or cramp in the pelvic region if biopsies are taken or any treatment on the neck.
During the test, or after it, there may be some bleeding.
After the test
After the colposcopy most women can make a normal life.When an injury has been treated, it is usually applied a paste which facilitates healing and that can produce a brownish flow for a few days.
If there have been interventions on the cervix should not use tampons, do not put anything into the vagina, or have sex for at least a week after the test, or until your doctor tells you to. Your doctor may also recommend not to lift weights or do vigorous exercises for a few days.
This test will not prevent you to get pregnant in the future.
If after the completion of the test appears bleeding or major abdominal pain, foul-smelling vaginal discharge, fever or any other symptoms that worry you, you should consult your doctor.
Preparation for colposcopy
These are the issues that you must consider when you undergo a colposcopy:Duration: the test is performed in 10-15 minutes, although it may take more time if any treatment is done.
Entry: the test is usually done on an outpatient basis, and the patient can go home the same day after its completion.
Is necessary to be accompanied?: don't have to be accompanied by although it might help if it makes you feel more relaxed.
Drugs: don't need to take any medication prior to this test. You can take your usual medication. If taken anticoagulants, check with your doctor.
Food: don't have to go on fasting.
Clothing: can wear the clothes you want.
Documents: prior to a colposcopy physician will explain the test and will provide you with an information sheet (informed consent), which must be signed, and which details the procedure and potential associated side effects. Please read this document carefully and ask the doctor questions as it considers necessary before fimarlo.
Contraindications: does not agree to perform a colposcopy during menstruation, because blood may interfere with the scan. No sexual intercourse, place any product within the vagina, nor be Douches, 24 hours prior to the test.
Pregnancy and lactation: not contraindicate the realization of the test although it is important to tell your doctor the possibility of that is pregnant.
Other considerations
You can be more comfortable if you empty the bladder and the bowel prior to testing.When should I do a colposcopy?
A colposcopy is usually done when the woman has a cytology of the cervix where abnormal cells which can be cancerous or precursor of cervical cancer are detected. It is considered the second step of the cervical cancer screening after cervical cytology. This test is sometimes requested when your doctor suspects any cervical pathology following a gynaecological review.Colposcopy results
The result of the study of the samples that have been taken during a colposcopy is usually available in two or three weeks.Although there are different classifications, the result of colposcopy is usually report in the following manner:
Normal findings.
Abnormal findings: specifies the territory that affect (by within the canal of the cervix or outside), the type of discovery (abnormal, dotted vessels, etc.), and if the alteration is more or less important.
Suspicion of invasive cancer: when a suspicious lesion of cancer that goes beyond the surface of the neck and get inside.
Unsatisfactory colposcopy: when not has been able to perform well the technique.
Various finds: when inflammation, ulcers, or other diseases not related to cancer.
Your doctor will inform you about the results of the test, and will tell you if you need new revisions, or if you need to perform other procedures.
9 scan
The interpretation of the test depends on the body that we want to study and also the suspected diagnosis that you have in mind. The test can be used to detect tumors, ensure the good functioning of a gland, identify failures of blood perfusion, checking the existence of active infections, etc.
The Administration of a radiopharmaceutical that designates the affected parts of the bodies that we want to study is required for its realization. A radiopharmaceutical is a molecule capable of attached to specific proteins and cells. The cells can be inflammatory (designated infection or immune processes), cancer (tumors detected), blood (draws the blood supply) or any other type. Each radiopharmaceutical therefore has a specific role and is different for each organ and suspected diagnosis.
This molecule is attached to a radioactive isotope that emits detectable energy by means of cameras sensitive to radiation. Therefore it is a technique that involves a previous preparation and subsequent care somewhat cumbersome, that makes that this is not done urgently, but it is used in patients or as out-patient study.
While it seems a very innovative practice, the scan is one of the first imaging techniques that have been used in medicine. So the experience in its interpretation is wide and there are a large number of studies on their safety. It is normal that the words 'radioactivity' or 'isotope' thinking that it is a dangerous test, however, the radiation is a natural source of energy and every day we are exposed to radioactive energy that comes from the rocks and soil, mainly. The dose of radioactivity has been much lower years and today the benefits of this test outweigh the risks.
When a scan is done
We can divide the indications of the scan according to the organs to study with her. In each one there are different uses of this test:Bone scan:
• Detect bone tumors or Metastases of tumours of other organs of the body.• Identify sources of infection (osteomyelitis, spondylodiscitis, etc.).
• Study of bone pain of unknown causes.
• Evaluate diseases of bone metabolism: osteoporosis, osteomalacia, Paget's disease, hyperparathyroidism...
• Identify bone fractures when routine radiographs are dubious and are not sufficient to diagnose them.
Renal scan:
• Global study of the kidneys when CT cannot be performed with radiocontrast by allergy or severe renal impairment.• Signs of rejection in transplanted kidney.
• Identify possible kidney damage and scars on children who have reflux vesicoureteral (RVU), which predisposes to repeated infections.
Endocrine scan:
• Study of thyroid: is one of the most common uses of the scan.1 detect thyroid nodules and guide if they are benign or malignant.
2 study the overall functioning of the thyroid gland, if it is hiperactivada or little working.
3. check the existence of goiter and what their activity.
• Study of adrenal glands:
1. full study of the adrenal glands when the TAC was not enough.
2. identify a pheochromocytoma, a product derived from the adrenaline-producing tumor.
3. to identify a neuroblastoma, a tumor that appears in children of congenital form.
Ventilation/perfusion scan:
• Assessment of pulmonary thromboembolism, to check parts of the lungs that lack them blood flow while you get them properly air through the bronchi.• Study perfusion isolation of specific regions of the body, to identify infection or ischemia.
Digestive scan:
• Detection of Meckel's Diverticulum, a malformation of the gastrointestinal tract that can produce very far from stomach ulcers in the wall of the small intestine.• Study of digestive bleeding.
• Assessment of the liver function and bile ducts associated for the diagnosis of congenital malformations.
• Identify rare intestinal tumors.
Heart scans:
• Identify very early episodes of ischemia with exercise.Neurological scan:
• Research of nerve pathways of neurotransmitters in the brain.Preparation for the scan
If you are performing a scan these are issues you must keep in mind to help you prepare for the test:Duration: the test usually lasts two to three hours, since the administration of the radiopharmaceutical until you can leave the hospital.
Admission: admission is not needed, it can be done on an outpatient basis.
Is necessary to be accompanied?: not, is a painless and not invasive, so you can only attend the clinic and return in the same way.
Drugs: don't need to take any prior medication. You must tell your doctor all the medicines that you eat so that you assess whether to modify any or not.
Food: many times it is recommended to go on fasting to the scan. Ask your doctor when send you the test.
Clothing: is better to go with comfortable clothes at the hospital will be changed by a gown to make it easy to expose part of the body being studied.
Documents: pretest you will be asked to sign informed consent which will explain why it is necessary to perform the scan and the potential risks involved. You only need to carry the health insurance card and the wheel of the test the day you go to do it. Normally you will not you any report of results.
Pregnancy and breast-feeding: the scan is a test fully prohibited during pregnancy, since it implies an exposure to radioactivity. If there is minimal risk of being pregnant you should get a pregnancy test before to dismiss it (even women carrying the IUD should do it). Breastfeeding is also a contraindication for the scan, as 2-3 days after the test it is recommended not to keep close contact with small children, because they are more sensitive to radioactivity.
Contraindications: pregnancy, breastfeeding and allergy to the radiopharmaceutical are absolute contraindications. Other more relative contraindications according to each concrete with renal or hepatic insufficiency, and having another scan the two months prior to the test.
How is the scan
When you arrive at the clinic to make you a scan, they will call you that passes to a room of nursing where will be administered a radiopharmaceutical intravenously. To spend the radiopharmaceutical to the blood you may notice heat or cold, depends on the supplied molecule. The radiopharmaceutical will be different according to the organ and pathology to study (for example, for the thyroid is the iodine-131 and for infections 67 gallium). Sometimes the radiopharmaceutical may be given by mouth or inhaled form.You have to wait an hour until the radiopharmaceutical begins to take effect and be able to track the area to study with the camera. Meanwhile, you can go to a dressing room where you will change your clothes for a more comfortable gown and leave your personal belongings. Sometimes you don't need to put on a gown and you can spend with your street clothes and then you here the part of the body wanting to explore you. Sometimes also need to wait that long, it is necessary to track the camera minutes after the administration of the radiopharmaceutical and perform serial during the hour after images.
When you have passed an hour you will be taken to the room where the appliance that performs the scan, you'll see a table or Chair and beside a machine with an arm that can move and head towards the area of the body to study. You will be asked to lean on the table in a specific position according to the area who want to measure. If we study the thyroid you tumbarás you face up to capture the neck area. If you measure the kidneys you are sitting or lying down with an outdoor lumbar back area. Once settled you won't need to worry about anything else, just be relax and remain still.
The sanitary technician will handle the machine and begin measuring the radiation that emits the radiopharmaceutical when it is attached to the cells and proteins. Sometimes not only performs a fixed image of radiation, a video that see the radiopharmaceutical distribution through circulation can be blood or moving the organ to study. This is an important advantage over static such as x-ray or computed tomography Imaging tests.
Throughout this process you won't feel anything. A few minutes later the sanitary technician will tell you that the test has finished and you can already get up from the couch. You can also ask you to wait a few minutes in the waiting room to check that you don't have any dizziness or late adverse reaction to administration of the radiopharmaceutical.
After the test you won't feel anything unusual in the area in which that have measured the radioactivity. You can collect your things from the dressing room and leave the clinic in the same way that you've come. For the next 2-3 days is recommended to avoid contact with young children or people with Hematology, since you emitirás radioactivity that the days will decrease to disappear.
Complications of the scan
The complications of the scan are very similar to other imaging tests that require before administering a substance that allows to visualize organs (such as the intravenous contrast). The most frequent complication is the allergy to the radiopharmaceutical, usually mild allergic reactions and anaphylactic shock is very rare.To be a test that uses radiation, there is an increased risk of developing tumors in the long run. It should take into account this fact to only put to the test when necessary, though the risk is minimal and the benefits are greater. Indeed, there are studies showing that reduced doses of radiation can reduce the risk to develop tumors, since they eliminate potentially malignant cells.
It is not necessary to use lead radiation shields in any case, since the radiopharmaceutical is delivered intravenously and also reach throughout the body.
Results of the scan
The results of the scan are obtained at the same time make it, but it is necessary a physician specializing in this type of evidence to interpret them. The doctor who is usually responsible for the scan is nuclear medicine specialist, who oversees the test and analyses the results obtained writing a report that will give to the doctor who has commissioned the test (rheumatologist, pulmonologist, endocrinologist, etc).The results will be interpreted very differently depending on the studied organ and the context of the patient. Some of the more frequent the scan results would be:
Bone scan:
• Tumors or metastases: it sees an increase in radiation in the form of more or less defined nodules.• Infection: is an increased radiation diffuse areas that appears a few minutes after the administration of the radiopharmaceutical.
• Metabolic diseases: there are bone loss and the issuance of global radiation in osteoporosis or osteomalacia. Paget's disease is a bone metabolism, so it will appear areas with radiation increased in size and intensity.
• Fractures: sees an increase in radiation in recent fractures by active inflammation. If they are old fractures radiation may be less by focal bone mass decrease.
Renal scan:
• Chronic renal failure: see kidney areas that do not emit radiation by fibrosis.• Reflux vesicoureteral: If there are scars are identified by a decrease in the radiation, sometimes in the form of star.
Endocrine scan:
• Study of thyroid:1 nodules hiperfuncionantes: looks focal increased radiation. They tend to be benign tumors.
2 nodules hipocaptantes: see focal decrease of radiation. They tend to be malignant tumors.
3. hyperthyroidism: increased global radiation. Typical of Graves disease.
4. hypothyroidism: overall decrease of radiation.
5. Thyroiditis: absence of radiation on a global basis by destruction of the thyroid gland.
• Study of adrenal glands:
1 pheochromocytoma or neuroblastoma: increased focal radiation. Depending on the age of the patient and the used radiopharmaceutical is suspected one or another tumor.
Ventilation/perfusion scan:
• Pulmonary thromboembolism: see decrease in the radiation of the areas little perfundidas with a normal ventilation radiation emission.Digestive scan:
• Meckel's diverticulum: increased radiation located at a midpoint of the small intestine (near the navel).• Digestive bleeding: is detected radiation of red blood cells marked within the digestive tract.
• Malformation Hepatobiliary: absence of radiation in the bile ducts.
Heart scans:
• Coronary ischemia: decrease of radiation in localized areas of the wall of the heart, are detected by performing moderate physical exercise.Neurological scan:
• Research: traces of radiation emission can be brain nerve pathways of specific molecules.10 laryngoscopy
The pharynx has three parts: the nasopharynx (just behind the nose), Oropharynx (in the background of the mouth), and the hypopharynx (which connects to the esophagus and the airway). Laryngoscope, which is called the unit that held the laryngoscopy, allows to observe the three parts and the upper part of the larynx, where in addition the vocal cords will be.
Since there is this technique have been developed different laryngoscopes, that are used today are:
Indirect laryngoscope: is a rigid bar that is inserted through the mouth until the end of the language. In the end you have a mirror which reflects the upper part of the larynx and hypopharynx. Only allows the display, other procedures are not performed with him.
Rigid direct laryngoscope: consists of a small rigid joystick that is inserted through the mouth and move the tongue forward, in such a way that the larynx can be seen directly at a glance. It is a technique that requires that the person is unconscious or anesthetized, since it would be extremely upset if not. It is the instrument that most Anesthetists and the medical intensivists, used since it allows them to intubate the Airways.
Flexible direct laryngoscope or fibrolaringosopio: is the most widely used routinely in conscious people. It is a small flexible tube containing optical fibers with a camera on the end. It is inserted through the nose and pharynx up to lower part flows through.
When a laryngoscopy is made
Laryngoscopy is a useful technique in the following situations or health problems:Study of chronic throat pain: laryngoscopy serves to identify lesions which can cause sore throat for more than three weeks and does not respond to standard medical treatment.
Alterations of voice: can diagnose diseases of vocal cords. Before for this purpose, you must wait three weeks because in many cases are transitory laryngitis that do not require study.
Chronic cough: when a person begins to cough for more than three weeks or habitual cough changes shape, should be studied to verify that no alterations in the upper airway.
Suspicion of cancer: laryngoscopy can observe if there are tumors of the Airways above, very frequent in smokers.
Choking: confirms the blocking of foreign elements upper airway. Sometimes it allows you to reach them and pull them.
Difficulty swallowing: this test allows to discard physical injuries that hamper the action of swallowing. You can see live the movement of the pharyngeal muscles.
Taken from biopsies: suspicious masses of cancer, polyps of vocal cords or chronic ulcers, you can take samples with a small pair of tweezers or needle.
The airway intubation: anaesthetists and intensivists doctors used the laryngoscope in people unconscious to observe the upper airway and to introduce a hollow tube that allows to ventilate the patient and keep your breathing artificially.
How laryngoscopy
First, the doctor will assess if it may be useful to perform the laryngoscopy. If so one day one will quote you to carry it out or you will be at that time. The day of the test must carry out a normal life, and you can eat or drink just before the procedure. When you arrive at the clinic they ask you that you sit in a Chair and relax.When you are comfortable you will introduce you a thin, flexible tube through one of the nostrils. When ask you that you finish as if you were drinking a drink of water. You will notice a strange feeling, as if you had some food into the throat. Despite this does not tend to feel strong nausea and it is very rare that des arcades. The best is to be relaxed and keep a regular and rhythmic breathing.
Once inside the Otolaryngologist will see inside the walls of the pharynx. It will look for alterations or malformations. Then be set at the top of the larynx made the same observations, and will focus on the vocal cords. Maybe calling you that you speak, you make a high-pitched sound and some serious. Thus the vocal cords move and you can see if there is any paralysis or injury (polyps, ulcers, edema...).
It will then leave the fibrolaringoscopio without stopping in more observations. If it is necessary to perform some procedure, the doctor will decide if hacelro at the same time or quote you for another day. It depends on the urgency of the same and if necessary suspend any medication before.
In the case of the direct laringoscopias, you'll be anesthetized or unconscious, so it does not you will notice nothing. When you recover the knowledge it is frequent that notes any discomfort in the throat or any alteration in the voice. The culprit is usually the laryngoscopy itself, but of the airway intubation.
Complications of laryngoscopy
Laryngoscopy tends not to have complications. However, some of the problems that can occur are:• Nausea with or without vomiting.
• Injury with bleeding from the tongue, nose, pharynx or larynx.
• Transmission of infections, especially if there has been an injury before.
• Spasm of the vocal cords, which can be closed when that region of the airway is handled.
• Typical complications of anesthesia (allergy, arrhythmias, etc.) when used for intubation.
Preparation for laryngoscopy
Let's focus on direct flexible laryngoscopy or fibrolaringoscopia, since it is the most common procedure in a consultation to explain the preparation of laryngoscopy. Rigid direct laryngoscopy is used in emergencies (without preparation) or to carry out Surgery Anesthesia (for which the preparation for this test would be the surgery).If they are going to perform a fibrolaringoscopia these are the issues you should keep in mind to go well prepared to test:
Duration: the test lasts a short time. Less than five minutes may be sufficient. In the case of some procedure (biopsies, aspirates, extraction of foreign elements, etc) the duration may be higher, but normally not exceed half an hour, because more time would be annoying.
Income: the fibrolaringoscopia can be done in a clinic or in a hospital. Income is not necessary.
Is necessary to be accompanied?: do not need to be accompanied. It is a little annoying and low risk test. Although if they are going to perform some procedure it may be good idea to have someone accompany you to go more quiet.
Drugs: don't need to take any prior medication. Should be communicated to the doctor all the medicines taken regularly and will decide which suspend or maintain, especially if you take antiplatelet drugs (aspirin, ibuprofen...) or anticoagulants (acenocoumarol, dabigatran) that may hinder the taking of biopsies.
Food: it is not necessary to remain in fasting hours before the test or after. Nausea that causes the fibrolaringoscopia they are minimal, but it is prudent to not have eaten just before the test case. In the case of the laringoscopias rigid if it is necessary to stay in fasting, as requested before a surgery.
Clothes: you can go to the quote from the test with the same clothes every day.
Documents: is essential to bring with you the steering wheel which shows the performance of this test. The health insurance card is recommended. After the laryngoscopy deliver you a report, but if they have collected samples they will take a time to analyse them.
Pregnancy and lactation: this technique is not contraindicated in pregnancy or lactation.
Contraindications: laryngoscopy does not have any specific contraindication. In people with anatomical disorders of the nose or pharynx may be difficult to perform this test.
Results of the laringosocopia
During laryngoscopy the doctor will go watching injuries and disorders of the upper airway. At the same time you can perform Diagnostics with enough safety, since there are very typical alterations that are identified with the naked eye. At other times you will need to perform any test sample (biopsy, crops...) to confirm the diagnosis.All the results of the laryngoscopy will write them in a report that you can make at the end of the consultation and surrender in hand, or if it is extensive may prefer to write it calmly and send it to you or the doctor who has asked you to test. When there is outstanding evidence it will wait for results to give a definitive diagnosis. In this report you can also include photos that you have made during the test, something very useful when it is necessary to track if you change known lesions.
When you pick up the report, the doctor will explain the alterations that have been throughout the study. Following the results, it will propose more testing if he deems it necessary or will provide possible solutions to the problem you have, whether medical or surgical interventions.
11 mammography
When should I get a mammogram?
There are two types of mammography, screening and the diagnostic:Screening mammography is performed in asymptomatic women. It allows the detection of breast cancer in very early stages of its development, so it increases the likelihood for curative treatment at an early stage. Although changes in different countries, in general screening (in English screening) is recommended every 1-2 years for women between 40 and 50 years, and each year in women over 50 years. Sometimes it is recommended to perform a screening in women under age 40 with a family history of breast cancer, history of mammary pathologies, or very dense breasts. The effectiveness of screening has been shown clearly even in women over the age of 80 years.
Diagnostic mammography is performed in symptomatic, for example women when there is an abnormal the nipple discharge, when it is felt a breast nodule, or of screening mammography is not normal. Diagnostic mammography takes more time than the screening, because x-rays are performed in different positions to properly study the possible tumor and the surrounding tissue. In women with implants breast or history / personal breast cancer often are made as screening diagnostic mammography techniques to increase the sensitivity of the test.
Preparation for mammography
These are the issues that you must consider when you undergo a mammogram:Duration: the test takes about 15-30 minutes.
Entry: the test is done on an outpatient basis.
Is necessary to be accompanied?: don't have to be accompanied by although it might help if it makes you feel more relaxed.
Drugs: is not necessary to take any prior medication. You can take your usual medication.
Food: don't have to go on fasting.
Clothing: can wear any clothes desired but something that is easy to remove, because you will be asked to leave bare should be chest. Nor should carry metal objects (earrings, bracelets, etc.) because they will be asked to remove them during the test.
Documents: can carry previous reports with information about their health, and mammograms earlier if it is necessary to compare them with that is to be performed.
Contraindications: there are no absolute contraindications. It is not usually done in women below 30 years because breast tissue is denser and the test is not reliable. It is advisable to inform the physician of the possibility of being pregnant or if it is giving suck.
Pregnancy and lactation: the realization of a mammogram is considered safe during pregnancy and breast-feeding because the radiation dose is very low. However, moms are more dense during pregnancy and lactation, so the test is less reliable. You should consult your doctor about the risk and profit making, or postpone the test, or the possibility of replace it with other evidence such as breast ultrasound.
Other considerations
Do not use deodorant, talcum powder, or any type of lotion or cream on your breasts or underarms the day of the test, as it could interfere with the result of the same.The best time to perform the test is one week after the rule as it is when your breasts are least sensitive.
It should inform the physician of the use of hormonal, background on breast surgeries treatments, or if you have personal or family breast cancer history.
How is a mammogram
For the realization of the mammography you will be asked to undress and remove jewelry and metal objects from the waist up. They provide a disposable gown to cover. It examines each breast individually. To do so, compress the breast between two sheets of plastic. This compression allows to obtain images with less radiation dose and quality of the entire breast. Usually images above are taken down and one side of the breast to the other. They may be necessary images from other positions. A few small marks on the skin are sometimes made to locate regions that should be studied closely, or skin lesions. In the moment in which the images are taken we have to remain very still and you may be asked to keep a moment breathing. The technician who takes x-ray will be in an adjacent room from which activate the emission of x-rays. After the test, you may be asked to wait a bit, because the technician will examine the images and tell you if it is necessary to repeat any of them.• The potential complications of this test is very limited:
• Radiation is extremely small for what is considered a very safe test.
• There is no remaining radiation into the body after the procedure.
• Compression of the breast between two plates can be a bit annoying. Where compression is painful, you can tell the technician perform the test with one lower compression.
The mammogram results
Following the completion of the test, a medical specialist will carefully examine images. The result is usually available within a few days. If they don't give results in a few days, you should ask for them and not assume that the test is normal.It should bear in mind that mammography has some limitations. You may not detect any cancer, giving rise to what in medicine we call false negatives, or can be mistakenly diagnosed cancer when there it, what we call false positives.
In general, the results can be the following:
All normal.
Discovery of a benign, non-cancerous, lesion requiring no different from the usual follow-up.
Discovery of a probably benign lesion, but that requires a narrower track.
Discovery of a lesion suspected of being malignant by suggesting it to consider carrying out a biopsy.
Finding of injury with high probability of being malignant. It is suggested to take measures for a precise diagnosis.
Your doctor will inform you about the results of the test and will instruct you if it needs new revisions or performing other procedures.
12 FNAC - fine needle aspiration cytology
PAAF first held in 1981 in New York (USA). The medical team that made her studying diagnostic methods minimally invasive that avoid perform biopsies open through conventional surgery. Thanks to the development of the FNAP have avoided thousands of surgeries in the world, and the complications of infections, necrosis or scarring injuries has declined precipitously.
The test can get two kinds of material: pieces of tissue or cells. When cells are obtained only a cytological study is possible. The pathologist (which specializes in the microscopic evaluation of tissues) can tell if obtained cells are benign, malignant, or describe alterations, but cannot define if it's a tumor or its degree of malignancy.
When pieces of tissue are obtained can be a histological study. In this case Yes you can see what kind of cancer are and what is the degree of malignancy. Sometimes refers to BAG (thick needle biopsy) when the material obtained is large enough.
When doing a Fna
The Fna or fine needle aspiration is a test that is performed when the following alterations in a person:Thyroid nodule: before a nodule in the thyroid gland that does not capture iodine on a scan or does not produce thyroid hormone, a Fna should be done to rule out malignancy.
Breast nodule: when it is a recent appearance in a breast nodule felt should be a Fna. In young women most of the time will be benign fibroids that have no importance. If the nodule is not palpable, and only has detected by mammogram this test may not be carried out and will have to perform a biopsy with a Harpoon.
Adenopathy: lymph nodes are called to the lymph nodes that are swollen or enlarged. Occur most frequently in the neck, armpits, or English primarily, although they can appear anywhere on the body. When duran enlarged more than 2 - 4 weeks with no identifiable cause should study by PAAF.
Skin growths: when it appears a nodule or a lump in the skin without any reason their cells using Fna can study. Sometimes decides to perform a skin biopsy directly if it is superficial.
Study of internal organs: some organs which are within us not you can study directly with a needle blind. In such cases used computed tomography (CT) as a guide. Thus studies of the pancreas, kidney, unknown masses can be...
Samples of liver and lung: although they are internal organs is not necessary to use TC as a guide because its size and location allowed puncturing them directly through the skin.
Preparation for the Fna
If you will perform (FNAB) fine needle aspiration cytology these are the issues that you must take into account:Duration: the test will last a total of 15 to 20 minutes. The biopsy itself will be one minute, the rest consists of the preparation of the material and the biopsy area.
Income: PAAF can be a query or a room of cures, in such a way that it does not require hospital admission. If you are entered they made you the FNAP in the same bedroom whenever possible.
Is necessary to be accompanied?: there is no why he accompanied, but yes it is recommended, as there are sensitive people who are sore or something queasy after the test.
Drugs: don't need to take any prior medication. Must be communicated to the doctor all the medicines taken regularly, and will decide if we will suspend any. Ibuprofenos, aspirin and other anti-inflammatory drugs should be avoided one week before the test. It may be necessary to suspend blood thinners such as warfarin or acenocoumarol the drugs. It is important to also inform of allergies to medications or other products, if you have them. Sometimes the doctor will prescribe you an antibiotic to take a few hours before the test and thus prevent the emergence of possible infections.
Food: should remain in fasting 8 hours before the test. If it is in the morning simply that not you breakfast or drink anything before the FNAP.
Clothes: you can perform the test with the same clothes every day. When you get to the hospital or doctor can give you a gown to change you should see fit, although often is enough to discover the part of the body that is going to puncture it.
Documents: it is important to bring with you the steering wheel which shows the performance of this test. The health insurance card is recommended. Normally you will not you any document after the test because it takes time to analyze the results.
Pregnancy and breast-feeding: the FNAB is not contraindicated in pregnancy or lactation, but that State should be aware that some organs studied will be altered from itself during these stages.
Contraindications: the masses that may not be felt can be a limitation for the test, unless they are in the abdomen or chest and it can guide the puncture with the TC.
How the Fna
First your doctor will assess in a consultation if necessary or not to perform (FNAB) fine needle aspiration. If deemed necessary will inform you of why it thinks, how it's performed, what information we can provide, and what are the possible risks. It will give you an informed consent document summarizing the main characteristics and you will have to sign it if you agree with its realization.PAAF may make you it that day, but the most common is that you cited in another time. It is common to perform a blood test prior to put you to the test with an included study of coagulation. When they go it to ask you first of all that you change your clothes and views a comfortable gown for you and for the pathologist. You have to keep in mind is a minimally invasive and not particularly painful, so it is not necessary that monitor you vital signs (blood pressure, heart rate, etc.) thoroughly.
Sometimes they will offer you some relaxing drug to make you stay sedated during the test; It is recommended if you are nervous or are particularly sensitive to pain. Once you are ready ask you you to tumbes on a stretcher in a position that facilitates the realization of the test. If the Fna in thyroid ask you stay seated.
To proceed to biopsy the first thing that will is clean the skin in the area where it is made with alcohol or iodine compounds. So remove any contaminants germs from the skin surface. Then they inject an anesthetic and deeper levels from the skin surface. You will feel a slight prick of the needle, and then a burning sensation at the very moment in which penetrates the anesthesia. So that part of the body will be asleep and insensitive. Then they entered a long, hollow needle to reach the nodule to study. Through this needle is introduced another fine that will be sucked to get loose cells, and then catch a small cylinder of tissue if necessary.
Once the FNAP be removed the needles. It is normal that the puncture point blood a little; apply pressure continued for a few minutes to stop the bleeding. Then they placed a bandage or a compression dressing and you'll be ready to go home. It will not need to wait on the results, since they need to be processed for a time, and at first glance not seen any alteration. The bandage must hold for at least two days, and it is normal that the days after the test have manipulated pain in the area and need to take some pain reliever you your doctor will prescribe.
Complications of PAAF
All tissue sample outlets have risks to dealing with evidence that invade the body organs, albeit slightly.The complications of the Fnac or fine-needle aspiration cytology tend to be rare and in most cases have a easy solution. They can appear during or after the test, and whenever they arise you should go to the emergency room.
Some of the most common complications associated with PAAF are:
Local infection with fever, swelling and heat.
Bleeding from the point of biopsy.
Uncontrollable pain.
Reaction to anesthesia during the test.
Pneumothorax (at the Fnac of lung).
Perforation of other organs (very unlikely).
Local spread of a tumor (unlikely).
The FNAB results
The results of the Fnac or puncture fine needle aspiration may take from one week up to a month. The waiting time, it therefore tends to be long, and requires patience and tranquility. The reason is that the aspirate sample can not be analyzed at the time. The following analysis will be carried out on this sample:Cytological study: are the cells one by one and in small clusters. Their nuclei, which may be signs of malignancy can be studied as well.
Histological staining: using special dyes cells are colored and can be observed under the microscope directly. The most widely used staining is hematoxylin-eosin.
Immunofluorescence studies: you can attach fluorescent substances to certain components of the cells and thus verify its existence.
Microbiological cultures: If infection is suspected sample can be grown in appropriate media that allow the growth of microorganisms. It is a common in the lymph nodes that are suspected secondary to tuberculosis.
Molecular studies: specific proteins that classified the types of cells that contain the sample can be identified.
All of these tests will be performed by the physician. Along with the symptoms, analytical studies and the FNAP, specialist can make a diagnosis most of the times. So you can explain what happens to you, and what are the treatments available to solve your disease.
13. Nuclear magnetic resonance (NMR)
Magnetic resonance imaging allows to obtain very detailed images of the body, in two and three dimensions, and from any perspective. It can provide information on diseases that are not with other imaging such as ultrasound or CT techniques. It is also used when other imaging tests, are contraindicated to as for example in case of allergy to iodinated contrast used in CT.
To carry out the patient must get into a machine, that patients describe as a big washing machine, and must remain still in its interior for 30-60 minutes. RMNM devices exist to Open that can be used in people with claustrophobia. These devices are not available in many centers and images that are obtained have poorer quality than those obtained with the standard closed devices.
Why is a nuclear magnetic resonance
MRI is usually done on a specific part of the body in which suspected illness. The most common reasons why the realization of an MRI can be requested are:In the head you can see tumors, abscesses, aneurysms, bleeding, heart attacks or nerve damage. It can also serve to study pathologies in the eyes and ear or brain degenerative diseases.
In the chest is widely used to study cardiac Anatomy or pathology of coronary arteries. It is also used in the study of breast cancer or tumors of the lung.
Abdomen and pelvis allows you to study with great detail organs such as the pancreas, the kidneys or liver, the uterus and the ovaries in women, or the prostate in males. There you can find tumors, infections, malformations, etc.
The blood vessels are very well with the NMR. View thrombus, strokes, aneurysms, malformations, or bleeding.
MRI can diagnose many problems in bones and joints such as arthritis, fractures, ligaments, tendons and cartilage problems. In addition, as in other organs, tumors or infections can be. Used much to study problems of spine as the Herniated discs, as it allows to see in great detail the intervertebral discs, spinal cord and nerves that come out of the bone marrow. Also used frequently in the knee problems, to study their different ligaments or meniscus.
On many occasions, to perform this technique, it is necessary to manage a liquid called contrast that highlights the organs studied, and facilitates the interpretation of the images. The most widely used contrast is called gadolinium and unlike the contrast used to make a TAC, it is not composed of iodine, so it is unlikely that cause side effects or allergic. This contrast dye is administered intravenously.
Preparation for magnetic resonance imaging
These are the issues that you must consider when you undergo a magnetic resonance imaging:Duration: the test is performed in about 30-60 minutes, although sometimes it can last more.
Entry: the test can be done on an outpatient basis.
Is necessary to be accompanied?: don't have to be accompanied by, although it might help if it makes you feel more relaxed. Where the test produce much anxiety, or if the patient cannot be still inside the appliance, are often a relaxing medication. In such a case, it will need to be accompanied by someone who can drive you home.
Drugs: is not necessary to take any prior medication.
Food: depends on the organ being studied. In some tests that include the abdomen or pelvis may be necessary to do not eat food or water for several hours before the test.
Clothing: you can wear any clothes you want, but it should be easy to remove. You don't want to carry metal objects (earrings, bracelets, etc.), because they will be asked to remove them during the test.
Documents: should be informed consent, which is a role where they explain you what is the test and its potential risks. You should read it carefully and take it signed. You must take the wheel of the test request.
Contraindications: You should not do a colonoscopy in the following cases:
• If you are allergic to such as gadolinium MRI contrast media. In this case the test without contrast may be performed.
• The presence of metallic material in the body, such as plates, screws, heart valves, pacemakers, shrapnel, etc. This is because all materials are attracted to the magnetic field which is created within the resonance apparatus and may be dangerous. However, many materials that are deployed today allow the realization of an MRI. This feature is reflected in the specifications of the product.
• The use of intrauterine devices (IUDS), because the IUD may have metallic substances such as copper.
• Patients with claustrophobia that not tolerated to be inside the device during the test. In these cases, you can perform a sedation of the patient or use open NMR devices.
• Patients who can not remain still during the test. You can also solve this problem with sedation.
• Very obese patients who do not climb on the appliance. In this case also open NMR devices can be used.
• Patients with severe renal or hepatic insufficiency, or some diseases such as sickle cell anemia, in which the contrast can worsen the picture. In these cases the test without contrast can be.
• In some cases of recent surgery on a blood vessel.
• Clinically "unstable" patients, i.e., that they are very serious and they may require some medication, or even urgent cardiopulmonary resuscitation maneuvers, because inside the machine not can be properly monitored and can be complicated his attention.
Pregnancy and lactation: risks that can have the test on the fetus are not known. Therefore, in general is not recommended testing during pregnancy, especially during the first trimester. The contrast used, gadolinium, crosses the placenta and the effect that may have on the fetus is unknown. However, if the benefits of the test outweigh the possible risks can be the RMN whenever mother is sufficiently informed.
Regarding breastfeeding, medium contrast manufacturers indicate that it is you should not breast-feed the baby for 24-48 hours after administration. However, American and European Radiology societies consider that the amount of gadolinium which is excreted into milk probably does not have toxic effects on the baby. Therefore, based on available data, they suggest that there is no risk in continue breastfeeding. Anyway, those mothers who are concerned about the risk that your child may have this slight exposure to contrast, can avoid breastfeeding during the 24 hours following the completion of the procedure. During these 24 hours the mother can remove the milk through a pump and discard. In anticipation of this period that won't be breastfeeding, the mother can also remove milk before testing, and store enough to cover the child's needs 24 hours.
Other considerations
Not do exercise immediately before the test and be as relaxed as possible, because any movement can alter the result should.In addition to all metal objects, should remove any patch that may have on the skin, as if they carry something metal content may result in Burns.
How magnetic resonance imaging
The unit in which the test is cubic-shaped and inside moves a stretcher that is where lies down the patient, usually face up. The stretcher is moved inside the hub and there remains throughout the test. In general, it is necessary to change the clothes by a hospital gown. They will make you take off all metal objects, since they interfere with the x-ray images and can move with the magnetic field. If it is necessary the administration of contrast you will pick up a venous pathway in the arm and introduced the contrast there moments before the test. They can also give you a medication to be more relaxed. Inside the device can hold you arms, head and chest with straps to prevent movement. Also put a device in the chest that detects the respiration and heart rate.Inside the unit, you will hear the noise of a fan and you will feel air moving. You will also hear a noise rattling while the images are taken. Sometimes a headset with which you can listen to music provided him. This can help reduce noise and can help relax you.
During the procedure, a technician will be watching you from an adjoining room and will instruct you to not move. You can sometimes tell you that you do not breathe for a few seconds. You can contact the technician if he deems it necessary.
MRI is a very safe test. The magnetic field which applies does not have any detrimental effect on the body. Sometimes you can feel something hot or cold with the introduction of the contrast. Fortunately, the allergic reaction to the contrast used for MRI are very rare. Somewhat annoying can be remain still long on the couch and you can feel some claustrophobia. People who have fillings may feel a little tingling in the mouth. It is normal to feel some heat in the area that is being explored. You can contact the technician who is doing the test in case of any major discomfort.
The greatest risk of NMR is derived from a possible movement of any metallic object that has in the body due to the strong magnetic field. For this reason, it is very important to remove all metal objects or notify the technician about any materials you may have implanted. You must also remove any patch that may lead to the skin, because if you hold something metal may lead to Burns.
People with tattoos might experience some irritation on the skin.
Results of the magnetic resonance imaging
The images obtained by NMR can be seen immediately. However, their interpretation requires much expertise and is carried out by medical radiologists. This specialist will make a written report that will give you a few days of the test along with the images obtained.The result report will include data on the technique used, if it was necessary the use of contrast, and the findings found. The type of discovery can vary greatly depending on the pathology and studied organ. Often benign or malignant, tumors, signs that indicate various infections such as abscesses, inflammation or pathology found in bones, such as fractures or malformations. In the spine can see Herniated discs and affectations of the spinal cord or nerve roots coming out of the bone marrow. In the knee, they will tell you if there is any ligament or the meniscus involvement. In relation to the vessels that irrigate the various organs, you can find thrombus, vascular infarcts (due to the blockage of an artery) or bleeding. In the liver, you can very well see the bile and detect if there are any obstructions or tumors at that level.
It is sometimes necessary to repeat the test to see how evolve different injuries, either spontaneously or after any treatment. The doctor has asked the test will give you the results and will indicate the need to do any therapy or other complementary explorations.
14. computed axial tomography (CAT)
In which cases is performed a CT scan or CT scan?
The most common reasons that the realization of a CT or computed tomography may be requested are as follows:In the case of trauma to detect bleeding, lesions of the internal organs or fractures.
To diagnose tumors and see its possible extension.
To study diseases of the spinal cord or spinal column.
To diagnose certain infections.
To guide some interventions such as the taking of biopsies or drainage of abscesses.
On many occasions, it is necessary to manage a liquid called contrast, which tends to be a compound of iodine, and that highlights in images obtained with the TAC, which facilitates the interpretation of the test. This contrast medium is usually administered intravenously, although they may also administer via oral or rare times, in other ways.
Prior preparation for a TAC
If you will make you a TAC these are the issues that you must provide in advance:Duration: the test is performed in a few minutes. What takes longer is undress and take a venous route when the administration of intravenous contrast injection is needed. If you perform an intervention as an outlet of biopsies or drainage of an abscess can last more.
Entry: the test can be done on an outpatient basis.
Is necessary to be accompanied?: don't have to be accompanied by, although it might help if it makes you feel more relaxed.
Drugs: is not necessary to take any prior medication.
Food: depends on the organ being studied, in general it is necessary to go on fasting if administer you a contrast.
Clothing: you can wear any clothes you want, but it should be easy to remove. You don't want to carry metal objects (earrings, bracelets, etc.), because they will be asked to remove them during the test.
Documents: should be informed consent, which is a role where they explain you what is the test and its potential risks. You should read it carefully and take it signed. It has to take the wheel of the test request.
Other considerations
The use of an anti-diabetic drug called metformin may be associated with severe side effects when administered with intravenous contrast. That is why, in some patients, particularly in patients with kidney, heart or liver, disease it should stop taking metformin before performing a CT with contrast and it may be necessary to monitor kidney function prior to reintroduce it.It should be noted the technician the possibility of having allergies to iodine or the iodinated contrast, because it is a contraindication for the realization of a CT scan with contrast
Not exercising immediately before the test and be as relaxed as possible, because any movement can alter the result should
Contraindications of TAC
It should not be a TAC in the following cases:If you have allergies to iodine or dye can be proof, but avoiding the administration of contrast.
The contrast by mouth is contraindicated in cases of suspicion of perforation of the digestive tract and prior to an endoscopy or surgery involving the digestive tract.
The use of intravenous contrast is contraindicated if there is renal or cardiac disease serious and in some tumors such as pheochromocytoma or myeloma. It is also contraindicated in the case of some diseases of the thyroid, as iodine which carries the contrast may be harmful for the thyroid.
Pregnancy is a contraindication for the test, with or without contrast.
The TAC during pregnancy and lactation
The TAC should be avoided in pregnancy, especially during the first quarter, because of the risk of radiation to the fetus. Breastfeeding in general is not a contraindication performing the test, even if administered intravenous contrast. The amount of contrast that can be excreted by the milk is less than 1% of the administered and the amount baby absorbed through the intestine is less than 1% of what they eat. Therefore, the amount that can reach the baby is so small that it is not recommended to stop breastfeeding to perform a CT scan with contrast.However, those mothers who are concerned about the risk that you may have about your child this minimal exposure to contrast, can avoid breastfeeding during the 24 hours following the completion of the procedure. This is the time that it takes to eliminate all the contrast of the blood of the mother. During these 24 hours the mother can remove the milk through a pump and discard. In anticipation of this period that won't be breastfeeding, the mother can remove milk before testing and store enough to cover the needs of the child for 24 hours.
Procedure: how is a CT
The device which is a CT scanner or scanner, donut -shaped and inside moves a stretcher that is where lies down the patient, usually face up. The table moves on the inside hole of the scanner for a few seconds and then going doing multiple x-rays. Unlike MRI, this test does not usually cause claustrophobia, because the patient does not remain within a closed site. Noise is not heard.In general, it is necessary to change the clothes by a hospital gown. If you perform a cranial CT it is generally not necessary to change clothes. They will make you take off all metal objects because they interfere in radiographic images.
In case that contrast is administered oral are given to drink previously tested a kind of porridge containing barium. If the contrast is intravenously they will pick up a venous pathway in the arm and introduced the contrast there moments before the shooting.
During the procedure, a technician will be watching him through a glass from an adjoining room and will instruct you that does not move. You can sometimes tell you that you do not breathe for a few seconds. At the end of the test, if they have administered contrast, can tell you to wait a few minutes in an adjacent room if an allergic reaction appear.
The TAC is a very safe test. The more severe reaction may be an allergy to the contrast oral or intravenous. The symptoms of this allergy can range from a feeling of heat and the appearance of a skin rash, to a very severe allergic reaction called anaphylactic shock. But quiet, there will always be a health care Manager to solve these rare eventualities. Allergy is often immediately after administration of contrast. However, very rarely, you may receive allergy hours after contrast administration, causing itching, difficulty swallowing or breathing. In such a case you should urgently contact a doctor.
Intravenous contrast sometimes gives some heat into the body through the vein. When getting out of the vein during its introduction can cause local inflammatory reactions.
Intravenous contrast in rare cases can cause kidney failure. This was more frequent in the past with contrast media that is no longer used. On the other hand, the dose of radiation that is received in a TAC is very small and does not produce side effects.
Results of a CT scan
The images obtained by the CT scanner can be seen immediately. However, their interpretation requires much expertise and is carried out by medical radiologists. This specialist will make a written report that will give you a few days of the test along with the radiographic images obtained.The result report will include data on the technique used, if it was necessary the use of contrast and the findings found. The type of discovery can vary greatly depending on the pathology and studied organ. Many times you can find tumors benign or malignant, signs that indicate various infections like abscesses or cavity in any organ, or pathology in the bones, such as fractures or malformations. In relation to the vessels that irrigate the various organs, you can find thrombus, vascular infarcts (due to the blockage of an artery) or bleeding. It is often necessary to repeat the test to see how to evolve different injuries either spontaneously or with treatment.
It is advisable to go to pick up the result and not assume everything is normal because the results you are not delivered in a few weeks. The doctor has asked the test will give you the results and will instruct you to need to make other complementary examinations or treatment.
15 digital rectal
Although it seems an aggressive test, the rectal examination is painless, lasts a few seconds, and is tremendously useful. It is a test that is performed very often, both the doctor and the emergency room of any hospital. It allows the diagnosis of digestive diseases, Oncology and urological, which in many cases would be fatal diseases if not for their early detection thanks to the digital rectal examination. That is why what the rectal not only occurs in a particular specialty, but it is a test of general medicine that can perform any primary care physician, and also quite frequently urologists and gastroenterologists.
For all these reasons must not be fear of rectal, his bad press is not deserved, and plays a key role in medicine. Sometimes is not enough to make a simple rectal or this indicates that something is not going well, and is due to value the use of other more complex techniques such as the rectoscopia, sigmoidoscopy or colonoscopy, all of which consist of see the inside of the digestive tract through flexible hoses of cameras.
When a digital rectal examination is done
This test is used to diagnose diseases or observe their evolution towards improvement or worsening. The situations in which it is indicated perform a rectal examination are:Rectorragia: thus is called in medicine to the expulsion of blood per year, because it is mixed with feces or not. Blood may be bright red, which indicates that the bleeding occurs at the end of the digestive tract, or dark and smelly, that indicates that the bleeding is more superior and the blood is digested.
Prostate symptoms: symptoms that may indicate a problem of prostate in men are difficulty to urinate, interrupt the expulsion of urine, and even acute retention of urine. It usually indicates that there is a benign prostate hyperplasia, and rectal is key in its diagnosis since it will feel an elastic prostate and not soft, as it is usual.
Prostate cancer: tumors of the prostate in men do not usually provide any type of symptom, and not related to benign prostate hyperplasia. Why rectal becomes the cornerstone in its early diagnosis; with him is palpable prostate gland with hard nodules. All men over the age of 50 should undergo this test annually, because it is the only way to prevent prostate cancer (no analytical data replaces it, not even the PSA).
Prostatitis: although it is not common, prostate can become infected during the course of a complicated UTI. A rectal examination would cause pain, and that data would help the diagnosis.
Rectal cancer: just as with prostate cancer, rectal can feel a lump on the inside of the rectum and allow an early diagnosis. Although it is useful, it is less effective in prostate cancer, because the tumor may be more above and finger would not touch it.
Examination of gynaecological unit: on routine gynecological scan is frequent a rectal examination. Thanks to it is seen and felt indirectly the internal female sexual organs.
Fecaloma: named to the disproportionate accumulation of stool in the rectum, of such a size that cannot be it drive itself only and produces constipation, pain, and intestinal obstruction in some cases. Rectal can feel it, and can even help to mobilize it and eject it.
Hemorrhoids: rectal allows detecting Internal hemorrhoids and figure out how big are outer.
Anal fissures: this scan you can check the number of cracks, its depth and its gravity.
Anal fistula: fistula consists of the formation of a channel between the inner wall of the rectum and the skin around the year. This causes much pain and loss of stool without control. The rectal examination can identify the inner hole.
Perianal abscesses: when there is a bag of pus around the anus, rectal can detect and help to delimit it, for later planning surgery evacuadora.
Crohn's disease: the formation of complicated fistulas (towards the vagina, skin, bladder, etc) are common in this disease. The digital rectal examination is the simplest method to detect them.
Preparation for rectal
If you will perform a rectal examination , these are issues that you must take into account:Duration: seconds. Rectal takes very little time to complete, and does not require a thorough preparation. Just notes that it has started, the doctor is already ending.
Income: the digital rectal examination is done on an outpatient basis. It is not necessary to enter for this test.
Is necessary to be accompanied?: is not necessary. It is a simple test and almost non-invasive. After it you will feel no discomfort or you will be unable to perform any type of activity.
Drugs: don't need to take any prior medication. Medicines that you are taking very seldom can affect this test. Only reports the doctor common medicines that you take, or if you've eaten food that can stain Lee; Thus you will avoid that it alarmed if your color is different from the usual.
Food: it is not necessary to keep fasting; You can eat and drink what you want before and after.
Clothes: you can keep the appointment with any type of clothing. Keep in mind that many times it is a test that is performed spontaneously, so it is normal that people go with any type of clothing.
Documents: don't need to take any special documentation.
Pregnancy and breast-feeding: is a test that can be performed safely during pregnancy and lactation.
Contraindications: do a rectal examination when there is acute complications of anal diseases. For example, in the hemorrhoidal thrombosis. A relative contraindication to is avoid increasing the pain to the patient.
How rectal
When you go to the doctor for any reason, he may think that perform a rectal examination may be useful for your diagnostic process. Will you know, you will explain what is the test and the reasons for its realization, and then ask your oral consent. If you agree, I will tell you that you tumbes on a stretcher and you discover from waist down.They can perform the rectal you in different positions. One fairly common is to ask you to tumbes sideways with bent legs and holding you knees with hands. It may also be done if you are a lying mouth up and with the legs elevated, as the gynecologist consultation or, sometimes, the urologist.
The doctor will be two gloves on each hand and one of them will miss lubricant on his index finger. Taking advantage of the position, it will look outside of the year in search of significant alterations (hemorrhoids, warts, fissures, etc). Then notify you that it is going to proceed to insert the index finger throughout the year, with calm, but in a direct way. You can recommend you catch air or relax, although sometimes is so short that it is not worth.
Once inserted the finger, the doctor will feel the inside of the rectum, will check that there are no masses, and will use to examine the prostate to men or the vaginal wall to the women. Then it will turn the finger to be able to feel the back wall of the rectum and act followed, it will draw it gently. When you're out you will notice your finger to study the color of stool, if it is that they have spotted something.
Once the test you can take cover again and get dressed. Exam not dirty you underwear, or cause you any discomfort. Although explained in detail may be extensive, in practice lasts less than 20 seconds.
Rectal complications
Rectal complications are very rare. In a few cases may cause some tearing small rectal Mucosa, and if cause it there would be no greater importance. Isolated cases of triggered arrhythmias when performing this test, have been anecdotally, but cases barely reach the ten and it was always serious heart sick.Results of the rectal
Rectal examination allows the doctor examine the inside of the rectum in real time, so it can be interpreted immediately what has been observed and establish a successful diagnosis.However, the doctor usually use this test as an exploratory data and adds it to the report which describes all the alterations, if any. A rectal examination results report will describe all parts of the rectum, the prostate in males, or vagina in women, as well as the State of the outer year.
When the results of a rectal examination provide pathological data, a diagnosis, which can be definitive, is carried out or serve to plan a test more specific. For example, if you suspect a lump in the rectum can be indicated a colonoscopy, with or without biopsy, or if a prostate tumor is suspected, a PSA test and a biopsy may be done.