Acoustic Neuroma

Definition

Although it's frightening to learn that you have a tumor growing inside your head, it may be somewhat comforting to know that an acoustic neuroma is noncancerous (benign) and usually slow growing. These tumors develop adjacent to your brain on a portion of the eighth cranial nerve, which runs from your brain to your inner ear. Also known as vestibular schwannoma, acoustic neuroma is one of the most common types of brain tumors.

Symptoms of acoustic neuroma, including hearing loss, develop from the tumor pressing on the nerve. But, acoustic neuromas don't invade brain tissue like cancer does.

For some people, an acoustic neuroma remains so small it never causes problems. Treatment options include regular monitoring, radiation and surgical removal.

Symptoms

The signs and symptoms of acoustic neuroma develop from a tumor pressing on cranial nerves.

As the tumor grows, it may be more likely to cause signs and symptoms, although tumor size doesn't always determine effects. It's possible for a small tumor to cause significant signs and symptoms. In many cases, however, a small tumor of less than about six-tenths of an inch — about 1.5 centimeters (cm) — may cause no signs or symptoms. Some tumors grow as large as about 2.5 inches (more than 6 cm).

Signs and symptoms may include:

• Hearing loss, usually gradual — although in some cases sudden — and occurring on only one side or more pronounced on one side
• Ringing (tinnitus) in the affected ear
• Dizziness (vertigo)
• Loss of balance
• Facial numbness and weakness

The tumor also may press on the brainstem. In rare cases, an acoustic neuroma may grow large enough to compress the brainstem and be life-threatening.

When to see your doctor
See your doctor if you notice hearing loss, particularly in one ear, or develop ringing in your ear, dizziness or have trouble with balance. Early diagnosis of an acoustic neuroma may help keep the tumor from growing large enough to cause serious consequences, such as total hearing loss or a life-threatening buildup of fluid within your skull.

Causes

Your eighth cranial (vestibulocochlear) nerve has three branches, which transmit information from your inner ear to your brain. The cochlear branch carries sound. The superior vestibular branch and the inferior vestibular branch carry information regarding balance. Most acoustic neuromas develop on a vestibular branch.

The cause of acoustic neuromas is unknown. However, the tumors, in rare cases, are an indication of neurofibromatosis 2, a genetic disorder that involves the growth of tumors on the vestibulocochlear nerve. Tumors associated with neurofibromatosis often affect the nerve on both sides (bilateral).

Risk factors

The only known risk factor for acoustic neuroma is having the rare genetic disorder neurofibromatosis 2, which involves the development of benign tumors on the vestibulocochlear nerves on both sides of your head, as well as on other nerves.

Neurofibromatosis 2 is known as an autosomal dominant disorder, meaning the mutation occurs on a nonsex chromosome (autosome) and can be passed on from only one parent (dominant gene). If either parent has this disorder, their children have a 50-50 chance of inheriting it.

Acoustic neuromas are most common in people between the ages of 30 and 60 years old.

Some evidence has suggested that persistent exposure to very loud noise or heavy cell phone use may play a role in the development of acoustic neuroma, but findings from studies looking into these associations have been inconclusive.

Complications

An acoustic neuroma may cause a variety of complications, including:

• Permanent hearing loss
• Facial numbness and weakness
• Difficulties with balance and clumsy gait

Large tumors may press on your brainstem, preventing the normal flow of fluid between your brain and spinal cord (cerebrospinal fluid). In this case, fluid can build up in your head (hydrocephalus), increasing the pressure inside your skull.

Preparing for your appointment

You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to an ear, nose and throat specialist (otolaryngologist), a neurologist, a neurosurgeon or an otolaryngologist that specializes in neurological surgeries (neurotologist).

Because there's often a lot of ground to cover during your appointment, it's a good idea to be well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Ask a family member or friend to join you, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Preparing a list of questions will help you make the most of your time with your doctor. For acoustic neuroma, some basic questions to ask your doctor include:

• What is likely causing my symptoms?
• Are there any other possible causes for my symptoms?
• What kinds of tests do I need?
• What treatment options are available?
• Which one do you recommend for me?
• What is the likelihood of side effects from each treatment option?
• What happens if I do nothing?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

Tests and diagnosis

Because signs and symptoms of acoustic neuroma are likely to develop gradually and because hearing loss, tinnitus and dizziness can be indicators of other middle and inner ear problems, it may be difficult for your doctor to detect the tumor in its early stages. Acoustic neuromas often are found during screening for other conditions.

After asking questions about your symptoms, your doctor will conduct an ear exam and may request the following tests:

• Scans. Magnetic resonance imaging (MRI) or computerized tomography (CT) scans of your head can provide images that confirm the presence of an acoustic neuroma.
• Hearing test (audiometry). During this test conducted by a hearing specialist (audiologist), you wear earphones and hear sounds directed to one ear at a time. The audiologist presents a range of sounds of various tones and asks you to indicate each time you hear the sound. Each tone is repeated at faint levels to find out when you can barely hear. The audiologist will also present various words to determine your hearing ability.
• Electronystagmography (ENG). This test evaluates balance (vestibular) function by detecting abnormal rhythmic eye movement (nystagmus) often present with inner ear conditions. The test measures your involuntary eye movements while stressing your balance in various ways.
• Brainstem auditory evoked response (BAER). This test checks hearing and neurological functions. Electrodes on your scalp and earlobes capture your brain's responses to clicking noises you hear through earphones and record the responses on a graph.

Treatments and drugs

There are three options for managing an acoustic neuroma: observation to determine whether it's growing and how fast, radiation and surgical removal.

Monitoring
If you have a small acoustic neuroma that isn't growing or is growing slowly and causes few or no signs or symptoms, you and your doctor may decide to monitor it, especially if you're an older adult or otherwise not a good candidate for treatment.

Your doctor may recommend that you have regular imaging and hearing tests to determine whether the tumor is growing and how quickly. If the scans show the tumor is growing or if the tumor causes progressive hearing loss or other difficulties, you may need to undergo treatment.

Stereotactic radiosurgery
Stereotactic radiosurgery, such as gamma-knife radiosurgery, enables doctors to deliver radiation precisely to a tumor without making an incision. The doctor attaches a lightweight headframe to your numbed scalp. Using imaging scans, your doctor pinpoints the tumor and then plots where to apply the radiation beams. This procedure often is performed under local anesthesia.

The purpose of radiosurgery is to stop the growth of a tumor. It may also be used for residual tumors — portions of a tumor that traditional brain surgery can't remove without damaging brain tissue.

It may take weeks, months or years before the effects of radiosurgery become evident. Your doctor will monitor your progress with follow-up imaging studies and hearing tests.

Surgical removal
The goal of surgery is to remove the tumor and preserve the facial nerve to prevent facial paralysis and preserve hearing. Performed under general anesthesia, this type of surgery involves removing the tumor through an incision in your skull. You may need to stay in the hospital from four to six days after the surgery, and recovery may take six weeks or more.

Acne

Definition

Zits. Pimples. Blemishes. No matter what you call them, acne can be distressing and annoyingly persistent. Acne lesions heal slowly, and when one begins to resolve, others seem to crop up. This ongoing battle and long-lasting cycle is both wearisome and frustrating.

Hormones likely play a role in the development of acne, making the condition most common in teenagers. But people of all ages can get acne. Some adult women experience mild to moderate acne due to hormonal changes associated with pregnancy, their menstrual cycles, or starting or stopping birth control pills.

Teenage and adult acne can take months or years to treat successfully. Depending on its severity, acne can cause emotional distress and lead to scarring of the skin.

The good news is that effective treatments are available. Acne treatment for mild cases usually involves self-care measures, such as washing your skin daily with a gentle cleanser and using an over-the-counter acne cream. Acne treatment for severe cases usually includes one or more prescription medications. Once acne is under control, prevention strategies can help keep your skin clear of breakouts.

Symptoms

Acne typically appears on your face, neck, chest, back and shoulders, which are the areas of your skin with the largest number of functional oil glands. Acne can take the following forms:

• Comedones (whiteheads and blackheads). Comedones (kom-uh-DO-neze) are created when the openings of hair follicles become clogged and blocked with oil secretions, dead skin cells and sometimes bacteria. When comedones are open at the skin surface they're called blackheads because of the dark appearance of the plugs in the hair follicles. When comedones are closed, they're called whiteheads — slightly raised, skin-colored bumps.
• Papules. These are small raised bumps that signal inflammation or infection in the hair follicles. Papules may be red and tender.
• Pustules. Similar to papules, pustules are red, tender bumps with white pus at their tips.
• Nodules. These are large, solid, painful lumps beneath the surface of the skin. They're formed by the buildup of secretions deep within hair follicles.
• Cysts. These are painful, pus-filled lumps beneath the surface of the skin. These boil-like infections can cause scars.

Causes

Three factors contribute to the formation of acne:

• Overproduction of oil (sebum)
• Irregular shedding of dead skin cells resulting in irritation of the hair follicles of your skin
• Buildup of bacteria

Acne occurs when the hair follicles become plugged with oil and dead skin cells. Each follicle is connected to sebaceous glands. These glands secrete an oily substance known as sebum to lubricate your hair and skin. Sebum normally travels up along the hair shafts and then out through the opening of the hair follicle onto the surface of your skin. When your body produces an excess amount of sebum and dead skin cells, the two can build up in the hair follicle and form together as a soft plug.

This plug may cause the follicle wall to bulge and produce a whitehead. Or, the plug may be open to the surface and may darken, causing a blackhead. Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected. Blockages and inflammation that develop deep inside hair follicles produce lumps beneath the surface of your skin called cysts. Other pores in your skin, which are the openings of the sweat glands onto your skin, aren't normally involved in acne.

It's not known what causes the increased production of sebum that leads to acne. But a number of factors — including hormones, bacteria, certain medications and heredity — play a role.

Contrary to what some people think, foods have little effect on acne. Acne also isn't caused by dirt. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals irritates the skin and can make acne worse.

Risk factors

Hormonal changes in your body can provoke or aggravate acne. Such changes are common in:

• Teenagers, both in boys and girls
• Women and girls, two to seven days before their periods
• Pregnant women
• People using certain medications, including cortisone

Other risk factors include:

• Direct skin exposure to greasy or oily substances, or to certain cosmetics
• A family history of acne — if your parents had acne, you're likely to develop it too
• Friction or pressure on your skin caused by items such as telephones or cell phones, helmets, tight collars and backpacks

When to seek medical advice

Acne treatments work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection, reducing the inflammation or doing all four. With most prescription acne treatments, you may not see results for four to eight weeks, and your skin may get worse before it gets better.

Your doctor or dermatologist may recommend a prescription medication you apply to your skin (topical medication) or take by mouth (oral medication). Oral prescription medications for acne should not be used during pregnancy, especially during the first trimester.

Types of acne treatments include:

• Topical treatments. Acne lotions may dry up the oil, kill bacteria and promote sloughing of dead skin cells. Over-the-counter lotions are generally mild and contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or lactic acid as their active ingredient. These products can be helpful for very mild acne. If your acne doesn't respond to these treatments, you may want to see a doctor or dermatologist to get a stronger prescription lotion. Tretinoin (Avita, Retin-A, Renova) and adapalene (Differin) are examples of topical prescription products derived from vitamin A. They work by promoting cell turnover and preventing plugging of the hair follicles. A number of topical antibiotics also are available. They work by killing excess skin bacteria. Often, a combination of such products is required to achieve optimal results.
• Antibiotics. For moderate to severe acne, prescription oral antibiotics may be needed to reduce bacteria and fight inflammation. You may need to take these antibiotics for months, and you may need to use them in combination with topical products.
• Isotretinoin. For deep cysts, antibiotics may not be enough. Isotretinoin (Accutane) is a powerful medication available for scarring cystic acne or acne that doesn't respond to other treatments. This medicine is reserved for the most severe forms of acne. It's very effective, but people who take it need close monitoring by a dermatologist because of the possibility of severe side effects. Isotretinoin is associated with severe birth defects, so it can't be taken by pregnant women or women who may become pregnant during the course of treatment or within several weeks of concluding treatment. In fact, the drug carries such serious potential side effects that women of reproductive age must participate in a Food and Drug Administration-approved monitoring program to receive a prescription for the drug. In addition, isotretinoin may increase the levels of triglycerides and cholesterol in the blood and may increase liver enzyme levels. Although cause and effect hasn't been proved, studies have reported the development of inflammatory bowel disease with isotretinoin use.
• Oral contraceptives. Oral contraceptives, including a combination of norgestimate and ethinyl estradiol (Ortho-Cyclen, Ortho Tri-Cyclen), have been shown to improve acne in women. However, oral contraceptives may cause other side effects that you'll want to discuss with your doctor.
• Laser and light therapy. Laser- and light-based therapies reach the deeper layers of skin without harming the skin's surface. Laser treatment is thought to damage the oil (sebaceous) glands, causing them to produce less oil. Light therapy targets the bacterium that causes acne inflammation. These therapies can also improve skin texture and lessen the appearance of scars, so they may be good treatment choices for people with both active acne and acne scars.
• Cosmetic procedures. Chemical peels and microdermabrasion may be helpful in controlling acne. These cosmetic procedures — which have traditionally been used to lessen the appearance of fine lines, sun damage and minor facial scars — are most effective when used in combination with other acne treatments.

Acne scar treatment
Doctors may be able to use certain procedures to diminish scars left by acne. These include fillers, dermabrasion, intense light therapy and laser resurfacing.

• Soft tissue fillers. Collagen or fat can be injected under the skin and into scars to fill out or stretch the skin, making the scars less noticeable. Results from this acne scar treatment are temporary, so you'd need to repeat the injections periodically.
• Dermabrasion. Usually reserved for more severe scarring, dermabrasion involves removing the top layer of skin with a rapidly rotating wire brush. Surface scars may be completely removed and deeper acne scars may appear less noticeable. Dermabrasion may cause pigmentation changes for people with darker skin.
• Microdermabrasion. This newer acne scar treatment involves a hand-held device that blows crystals onto skin. These crystals gently abrade or "polish" the skin's surface. Then, a vacuum tube removes the crystals and skin cells. Because just the surface cells are removed, the skin isn't damaged. However, results are subtle and scars may still be noticeable, even after several sessions.
• Laser, light source and radiofrequency treatments. In laser resurfacing, a laser beam destroys the outer layer of skin (epidermis) and heats the underlying skin (dermis). As the wound heals, new skin forms. Less intense lasers (nonablative lasers), pulsed light sources and radiofrequency devices don't injure the epidermis. These treatments heat the dermis and cause new skin formation. After several treatments, acne scars may appear less noticeable. This means shorter recovery times, but treatment typically needs to be repeated more often and results are subtle.
• Skin surgery. A minor procedure (punch excision) cuts out individual acne scars. Stitches or a skin graft repairs the hole left at the scar site.

Prevention

Once your acne improves or clears, you may need to continue your acne medication or other treatment to prevent new acne breakouts. In some cases, you might need to use a topical medication on acne-prone areas, continue taking oral contraceptives or attend ongoing light therapy sessions to keep your skin clear. Talk to your doctor about how you can prevent new eruptions.

You can also prevent new acne breakouts with self-care measures, such as washing your skin with a gentle cleanser and avoiding touching or picking at the problem areas. Other acne prevention tips include:

• Wash acne-prone areas only twice a day. Washing removes excess oil and dead skin cells. But too much washing can irritate the skin. Wash areas daily with a gentle cleanser and use oil-free, water-based skin-care products.
• Use an over-the-counter acne cream or gel to help dry excess oil. Look for products containing benzoyl peroxide or salicylic acid as the active ingredient.
• Avoid heavy foundation makeup. Choose powder cosmetics over cream products because they're less irritating.
• Remove makeup before going to bed. Going to sleep with cosmetics on your skin can clog tiny openings of the hair follicles (pores). Also, be sure to throw out old makeup and clean your cosmetic brushes and applicators regularly with soapy water.
• Wear loosefitting clothing. Tightfitting clothing traps heat and moisture and can irritate your skin. Also, whenever possible, avoid tightfitting straps, backpacks, helmets or sports equipment to prevent friction against your skin.
• Shower after exercising or doing strenuous work. Oil and sweat on your skin can trap dirt and bacteria.

Lifestyle and home remedies

You can avoid or control most acne with good basic skin care and the following self-care techniques:

• Wash problem areas with a gentle cleanser. Products such as facial scrubs, astringents and masks generally aren't recommended because they tend to irritate skin, which can worsen acne. Excessive washing and scrubbing also can irritate skin. If you tend to develop acne around your hairline, shampoo your hair frequently.
• Try over-the-counter acne lotion to dry excess oil and promote peeling. Look for products containing benzoyl peroxide or salicylic acid as the active ingredient.
• Avoid irritants. You may want to avoid oily or greasy cosmetics, sunscreens, hair-styling products or acne concealers. Use products labeled "water-based" or "noncomedogenic." For some people, the sun worsens acne. Additionally, some acne medications can make you more susceptible to the sun's rays. Check with your doctor to see if your medication is one of these, and if so, stay out of the sun as much as possible and anytime you have to be in the sun, use sunscreen that doesn't clog your pores.
• Watch what touches your face. Keep your hair clean and off your face. Also avoid resting your hands or objects such as telephone receivers on your face. Tight clothing or hats also can pose a problem, especially if you'll be sweating. Sweat, dirt and oils can contribute to acne.
• Don't pick or squeeze blemishes. Picking or squeezing can cause infection or scarring. Most acne will clear up without this kind of intervention. If you need aggressive treatment, see your doctor or dermatologist.

Anterior Cruciate Ligament Injury

Definition

An ACL injury is the tearing of the anterior cruciate (KROO-she-ate) ligament in your knee. An ACL injury may make your knee feel unstable or loose, and your knee may "give way" if you return to your sport too quickly.

Although an active lifestyle benefits your overall health, exercise isn't always easy on your knees. The anterior cruciate ligament is especially susceptible to the demands of certain sports, such as volleyball, gymnastics, basketball, soccer and football.

Treatment of an ACL injury may include surgery to replace the torn ligament, along with an intense rehabilitation program. As for prevention, if your favorite sport involves pivoting or jumping, a proper training program can help you avoid an ACL injury.

Symptoms

At the time of an ACL injury, signs and symptoms may include:

• A loud "pop" sound
• Severe pain
• Knee swelling that usually worsens for hours after the injury occurs
• A feeling of instability or "giving way" with weight bearing

Once the swelling subsides, your knee may still feel unstable. It may feel as if it's going to "give way" during twisting or pivoting movements.

When to see a doctor
If you experience any of the signs and symptoms of ACL injury — a popping sound, severe knee pain, a swollen knee or a feeling that your knee is giving out — see a doctor. Also see your doctor if your knee feels loose or unable to support your weight. In general, the longer you wait to start treatment, the longer it will take to get better.

Causes

Ligaments are strong bands of tissue that attach one bone to another. The ACL, one of two ligaments that cross in the middle of the knee, connects your thighbone (femur) to your shinbone (tibia) and helps stabilize your knee joint.

Most ACL injuries happen during sports and fitness activities. The ligament may tear when you slow down suddenly to change direction or pivot with your foot firmly planted, twisting or overextending your knee.

Sports that involve running, turning sharply, pivoting and jumping — especially basketball, soccer and gymnastics — put your knee at risk. The ACL can also tear when the tibia is pushed forward below the femur, such as during a fall in downhill skiing. A football tackle or motor vehicle accident also can cause an ACL injury. However, most ACL injuries occur without such contact.

Risk factors

ACL injuries are most common among:

• Athletes. If you engage in certain sports, such as those that rely on cut-and-run techniques (basketball, soccer, football) you're more at risk of an ACL injury.
• Women. Women are significantly more likely to have an ACL tear than are men participating in the same sports. Women tend to have imbalanced thigh muscles, with stronger muscles at the front of the thigh (quadriceps), compared with those at the back of the thigh (hamstrings). The hamstrings help protect the shinbone from sliding too far forward. When landing from a jump, some women may land in a position that increases stress on the ACL.

Complications

In the short term, you'll have to stop doing the activities that cause pain until your injured ligament has healed. You may have to take time off work, school and sports.

Other complications may include:

• Torn meniscus. In many cases, an ACL injury also results in a tear of the meniscus — the cartilage in your knee between the thighbone and shinbone. A cartilage tear increases the risk of future joint problems.
• Arthritis. A common long-term complication is the early onset of knee osteoarthritis, in which joint cartilage deteriorates and its smooth surface roughens. About half the people with an ACL tear develop osteoarthritis in the involved joint 10 to 20 years later. Arthritis may occur even if you have surgery to reconstruct the ligament.

Preparing for your appointment

You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to an orthopedist, an orthopaedic surgeon or a sports medicine specialist.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including what you were doing when you first started experiencing the symptoms.
• Ask a family member or friend to join you, if possible. Sometimes it can be difficult to soak up all the information and treatment options provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your appointment. List your questions from most important to least important in case time runs out. For an ACL injury, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need? Will these tests definitively diagnose my condition?
• What treatment options are available?
• Which do you recommend for my situation?
• If I choose not to have surgery, how long might recovery take?
• If I don't have surgery, what signs and symptoms would indicate a need for surgery?
• If I have surgery, what's the average recovery time?
• What activity restrictions do I need to follow?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• What were you doing at the time?
• Did you experience immediate swelling?
• Have your symptoms been continuous, or occasional?
• How severe are your symptoms?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Does your knee ever "lock" or feel blocked when you're trying to move it?
• Do you ever feel that your knee is unstable or unable to support your weight?

What you can do in the meantime
If you've injured your knee, don't move the joint. Use a splint to keep your knee protected in a comfortable position until a doctor examines it. Avoid returning to a sport or activity until you've had the injury evaluated.

Tests and diagnosis

To diagnose a torn ACL, your doctor first wants to know as much as possible about the injury, such as whether you heard or felt your knee pop, whether your knee swelled up afterward and if you were able to continue being physically active.

Swelling that occurs shortly after the injury usually means there's blood in the joint from torn blood vessels in the damaged ligament. Your doctor may decide to draw the blood out with a needle and syringe. This can reduce pain and make it easier to examine the knee joint.

Your doctor examines your knee in a variety of positions to assess whether or not your ACL is torn. Two common exams are:

• Lachman's test. In this test you lie on your back on the exam table with your injured leg bent at a 30-degree angle and your foot flat on the table. Your doctor then moves the lower portion of your injured leg forward from the knee. If your leg moves freely without reaching a firm endpoint, you have a tear in your ACL.
• Pivot shift test. For this test, your injured leg is extended, and your doctor rotates your foot at the same time he or she applies pressure to the outside of your knee and bends your knee. Signs of instability in your shinbone suggest an ACL tear.

Often the diagnosis can be made on the basis of the physical exam alone, but you may need X-rays to rule out a bone fracture. If your doctor has questions about the cause or extent of your injury, he or she may order a magnetic resonance imaging (MRI) scan, a painless procedure that uses magnetic fields to create an image of the soft tissues of your body. An MRI can show the extent of ACL injury and whether other knee ligaments or joint cartilage also are injured.

Treatments and drugs

Initial treatment for an ACL injury aims to reduce pain and swelling in your knee, regain normal joint movement and strengthen the muscles around your knee. You and your doctor will then decide if you need surgery plus rehabilitation or intense rehabilitation alone.

Which option is right for you depends on several factors, including the extent of damage to your knee and your willingness to modify your activities. When a young child whose bones are still growing injures his or her ACL, doctors may recommend postponing surgery until the child's bones have stopped growing.

Short term
To treat the acute injury:

• Use ice. When you're awake, try to ice your knee at least every two hours for 20 minutes at a time.
• Elevate your knee.
• Take pain relievers such as ibuprofen (Advil, Motrin, others) as needed.
• Wrap an elastic bandage around your knee.
• Use a splint or walk with crutches if needed.
• Work with a physical therapist on range-of-motion and muscle-strengthening exercises.

Surgery
A torn ACL can't be sewn back together. The ligament is reconstructed by taking a piece of tendon from another part of your leg and connecting it to the thighbone and shinbone (autograft). If your own tendons don't provide the best replacement for the injured ligament, your doctor may recommend using a tendon from a cadaver (allograft). The cadavers used for allografts have been carefully screened and tested for diseases.

You may consider surgery if:

• Your knee is unstable and gives way during daily activities or sports
• You're very active and want to resume heavy work, sports or other recreational activities
• Other parts of your knee, such as the meniscus or other ligaments, were also injured
• You want to prevent further injury to your knee

ACL reconstruction surgery is an outpatient procedure using arthroscopic techniques. The surgeon inserts a thin instrument (arthroscope) with a light and a small camera into one or two small incisions. This allows your surgeon to see the inside of your knee joint and make the repairs.

After surgery you'll go through a rehabilitation program. In addition to working with a physical therapist, you may wear a knee brace and you'll need to avoid activities that put undue stress on your knee. Most people can return to their sports about six months after surgery. About nine in 10 people who undergo ACL reconstruction report good to excellent results and satisfactory knee stability, according to the American Academy of Orthopaedic Surgeons.

Nonsurgical rehabilitation
A rehabilitation program without surgery involves physical therapy, modifying your activities and knee bracing. This approach can be effective as long as you're willing to give up the sports and other activities that place extra stress on your knee. You may want to consider rehabilitation alone if:

• You have a partial tear
• You don't participate in sports that involve cutting, pivoting or jumping
• Your knee isn't painful or unstable during normal activities
• You lead a fairly sedentary life
• Your knee cartilage hasn't been damaged
• You have advanced knee arthritis

Prevention

To reduce your chance of an ACL injury, follow these tips:

• Improve your conditioning. Training programs that have been shown to be effective in helping to prevent ACL injuries typically include stretching and strengthening exercises, aerobic conditioning, plyometric exercises, "jump training" and risk-awareness training. Exercises that improve balance also can help when done in conjunction with other training exercises.
• Strengthen your hamstrings (women). Women athletes should take care to strengthen and stretch their hamstring muscles as well as their quadriceps.
• Keep fit year-round. If you're on a seasonal sports team, stay conditioned all year. This will help with your balance, strength and coordination when the next season starts.
• Use proper techniques when playing sports or exercising. If your sport involves jumping, learn how to land safely. Learn to do cutting maneuvers in a crouched posture with a slight bend at the knee and hip.
• Check your gear. In downhill skiing, make sure your ski bindings are adjusted correctly by a trained professional so that your skis will release when you fall.

Using a knee brace during sports doesn't reduce your risk of injury - and may provide a false sense of security.

Achilles Tendinitis

Definition

Achilles tendinitis is present when your Achilles tendon becomes inflamed or irritated.

Often, Achilles tendinitis results from sports that place a lot of stress on your calf muscles and Achilles tendon, such as basketball. Achilles tendinitis also is often associated with a sudden increase in the intensity or frequency of exercise.

When treated promptly, Achilles tendinitis is often short-lived. Left untreated, Achilles tendinitis could cause persistent pain or cause your tendon to tear (rupture). If so, you may need surgery to correct the damage.

Fortunately, rest and over-the-counter medications to reduce your pain and inflammation may be all the treatment you need for Achilles tendinitis.

Symptoms

The signs and symptoms of Achilles tendinitis often develop gradually. They include:

• Dull ache or pain when pushing off your foot during walking or when rising on your toes
• Tenderness over your Achilles tendon
• Stiffness that lessens as your tendon warms up
• Mild swelling or a "bump" on your tendon
• A crackling or creaking sound when you touch or move your Achilles tendon

You may notice that the affected tendon is sore when you get up in the morning or after you've rested, improves slightly once you start moving around, and then worsens again when you increase your activity level.

If you have sudden pain and swelling near your heel and are unable to bend your foot downward or walk normally, you may have ruptured your Achilles tendon. If you've ruptured the tendon completely, you won't be able to rise on your toes on the injured leg. You may feel as if you've been kicked in the back of your ankle. See your doctor immediately if you suspect you have an Achilles tendon rupture.

Causes

Your Achilles tendon is the large band of tissues connecting the muscles in the back of your calf to your heel bone. Also called the heel cord, the Achilles tendon is used when you walk, run, jump, or push up on your toes.

When you place a large amount of stress on your Achilles tendon too quickly, it can become inflamed from tiny tears that occur during the activity. A sudden increase in a repetitive activity that involves the Achilles tendon can be to blame. A number of other factors can cause Achilles tendinitis, including:

• Improper conditioning. Achilles tendinitis is most common among athletes whose bodies aren't properly conditioned for their sport or activity. Inadequate flexibility and strength of the calf muscles can contribute to overload of the tendon. Frequent stops and starts during the activity, as well as activities that require repeated jumping — such as basketball or tennis — also can increase your risk of Achilles tendinitis.
• Too much, too soon. Achilles tendinitis resulting from overuse can occur when you begin a new exercise regimen. If you're just beginning a new exercise program, be sure to stretch before and after exercising, and start slowly, increasing your activity over time. Don't push yourself too quickly. If you're a runner, excessive hill running can contribute to Achilles tendinitis.
• Flattened arch. Flattening of the arch of your foot (excessive pronation) can place you at increased risk of developing Achilles tendinitis. This is because of the extra stress placed on you Achilles tendon when walking. If you have excessive pronation, be sure to wear shoes with appropriate support to avoid further aggravating your Achilles tendon.
• Trauma or infection. In some cases, inflammation of the Achilles tendon is due to trauma or infection near the tendon.

When to seek medical advice

If you experience pain around your Achilles tendon that worsens with activity, call your doctor for an evaluation and to discuss treatment options.

See your doctor if you experience persistent pain near the back of your heel in the area of your Achilles tendon, and especially if the pain doesn't markedly improve within one to two weeks despite self-care measures. See your doctor immediately if you experience signs or symptoms of an Achilles tendon rupture.

Tests and diagnosis

To diagnose Achilles tendinitis, your doctor will examine your foot and may have an X-ray taken of the area to rule out other causes of your pain. He or she will also ask questions about your physical activity.

If your doctor suspects that your Achilles tendon has torn, he or she may order an MRI scan, a painless procedure that uses magnetic fields to create a computer image of the soft tissues of your body.

Complications

Achilles tendinitis can progress to a degenerative condition called Achilles tendinosis, in which the tendon begins to lose its organized structure, making the tendon weaker and more fibrous. Continued stress to your Achilles tendon could cause it to tear (rupture), which may require surgery to correct the damage

Treatments and drugs

If you've tried self-care measures, such as rest, ice and over-the-counter pain relievers, and they aren't working for you, your doctor may suggest other Achilles tendinitis treatments:

• Orthotic devices. A temporary foot insert (orthotic device) that elevates your heel within your shoe may relieve strain on the stretched tendon. Your doctor also might prescribe special heel pads or cups to wear in your shoes to cushion and support your heel, or a splint to wear at night that will keep the Achilles tendon stretched while you sleep.
• Boot and crutches. In severe cases, your doctor may suggest a walking boot or have you use crutches to enable the tendon to heal.
• Surgery. Nonsurgical treatments, including physical therapy and perhaps a change in your exercise program, should allow the tendon to heal and repair itself over a period of weeks. If these treatments aren't effective, surgery to remove the inflamed tissue from around the tendon may be necessary; however, this is usually a last resort.

If left untreated and if the tendon continues to sustain small tears through exercise and repeated movement, the tendon can rupture under excessive stress.

Prevention

While it may not be possible to prevent Achilles tendinitis, you can take measures to reduce your risk:

• Increase your activity level gradually. If you're just beginning an exercise regimen, don't feel like you have to be marathon-ready in record time. Starting slowly will help you determine your limits and follow a sensible exercise program.
• Take it easy. Avoid activities that place excessive stress on your tendons, especially for prolonged periods. If you participate in a strenuous activity, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest.
• Choose your shoes carefully. The shoes you wear while exercising should provide adequate cushion for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace shoes that show excessive wear. If your shoes are in good condition but don't support your feet, try arch supports in both shoes.
• Stretch daily. Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendinitis.
• Strengthen your calf muscles. Performing exercises such as toe raises, especially with a slow return to the ground after each toe raise, trains the muscle-tendon unit to withstand more loading force.
• Cross-train. Alternate impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.

Lifestyle and home remedies

If you think you may have Achilles tendinitis, help speed your recovery and prevent further problems by trying these at-home care methods:

• Rest. Avoid activities that increase the pain or swelling. Don't try to work or play through the pain. Rest is essential to tissue healing. But this doesn't mean complete bed rest. You can do other activities and exercises that don't stress the injured tendon, especially low-impact activities, such as bicycling.
• Ice. To decrease pain, muscle spasm and swelling, apply ice to the injured area for up to 20 minutes, several times a day. Ice packs, ice massage or ice water slush baths all can help. For an ice massage, freeze a plastic foam cup full of water so that you can hold the cup while applying the ice directly to the skin.
• Compression. Because swelling can result in loss of motion in an injured joint, compress the area until the swelling has ceased. Wraps or compressive elastic bandages are best.
• Elevation. Raise the affected ankle above the level of your heart to reduce swelling. It's especially important to use this position at night.

Keep moving
Although rest is a key part of treating tendinitis, prolonged inactivity can cause stiffness in your joints. Move the injured ankle through its full range of motion and perform gentle Achilles tendon stretches to maintain joint flexibility.

Anti-inflammatory medications
You can also try nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin, others) or products containing acetaminophen (Tylenol, others) to try to reduce the discomfort associated with tendinitis.

Be sure to talk to your doctor if you feel you need NSAIDs for an extended time because some of these drugs should be used for only short periods — around seven to 10 days — to avoid complications.

If you take NSAIDs frequently or take more than the recommended dose, these medications can cause stomach pain, stomach bleeding and ulcers. Rarely, prolonged use can disrupt normal kidney function. If you have liver problems, talk to your doctor before using products containing acetaminophen.

Diseases and Conditions

A

Absence seizure (petit mal seizure)

Acanthosis Nigricans

Achilles Tendinitis

Anterior Cruciate Ligament Injury

Acne

Acanthosis Nigricans

Definition

Acanthosis nigricans is a skin condition characterized by dark, thick, velvety skin in body folds and creases. Most often, acanthosis nigricans affects your armpits, groin and neck.

With acanthosis nigricans, you may naturally be concerned about the appearance of your skin. Some steps may help lighten the affected areas of your skin. There's no specific treatment for acanthosis nigricans — but treating any underlying conditions, such as diabetes and obesity, may cause the changes in your skin changes to fade.

Symptoms

Characteristics of acanthosis nigricans include:

• Skin changes. Skin changes are the only signs of acanthosis nigricans. You'll notice dark, thick, velvety skin in body folds and creases — typically in your armpits, groin and neck. Sometimes the lips, palms or soles of the feet are affected as well.
• Slow progression. The skin changes appear slowly, sometimes over months or years.
• Possible itching. Rarely, the affected areas may itch.

Causes

Acanthosis nigricans is often associated with conditions that increase your insulin level, such as type 2 diabetes or being overweight. If your insulin level is too high, the extra insulin may trigger activity in your skin cells. This may cause the characteristic skin changes.

In some cases, acanthosis nigricans is inherited. Certain medications — such as human growth hormone, oral contraceptives and large doses of niacin — can contribute to the condition. Other hormone problems, endocrine disorders or tumors may play a role as well. Rarely, acanthosis nigricans is associated with certain types of cancer.

Risk factors

Acanthosis nigricans can begin at any age. It's most obvious in people who have dark skin.

When to seek medical advice

Consult your doctor if you notice changes in your skin — especially if the changes appear suddenly. You may have an underlying condition that needs treatment.

Tests and diagnosis

Acanthosis nigricans is typically detected during a skin exam. Rarely, a small skin sample is removed (biopsy) for examination in a lab.

If the cause of acanthosis nigricans is unclear, your doctor may recommend blood tests, X-rays or other tests to look for possible underlying causes.

Treatments and drugs

There's no specific treatment for acanthosis nigricans. Treating any underlying conditions may cause the skin changes to fade, however. If you're overweight, losing excess pounds can help. Sometimes dietary changes are helpful, too.

Lightening affected areas
If you're concerned about the appearance of your skin, your doctor may prescribe a cream or lotion to help lighten the affected areas. Some of these lotions contain modified vitamin A products, such as tretinoin (Retin-A, others), or other medications. Sometimes oral medications, such as isotretinoin (Accutane, others), are helpful. Fish oil supplements also may be recommended. Dermabrasion or laser therapy may help reduce the thickness of certain affected areas.

Absence seizure (petit mal seizure)

Definition

Absence seizure — also known as petit mal seizure — involves a brief, sudden lapse of conscious activity. Occurring most often in children, an absence seizure may look like the person is merely staring into space for a few seconds.

Compared with other types of epileptic seizures, absence seizures appear mild. But that doesn't mean they can't be dangerous. Children with a history of absence seizure must be supervised carefully while swimming or bathing, because of the danger of drowning. Teens and adults may also be restricted from driving and other potentially hazardous activities.

Absence seizures can usually be controlled with anti-seizure medications. Many children outgrow absence seizures in their teen years, though some may eventually develop grand mal seizures.

Symptoms

Signs of absence seizures include:

• Staring, without unusual movement
• Lip smacking
• Fluttering eyelids
• Chewing
• Hand movements
• Small movements of both arms

Absence seizures last only a few seconds. Full recovery is almost instantaneous. Afterward, there is no confusion, but also no memory of the incident. Some people experience hundreds of these episodes each day, which interferes with their performance at school or work.

Children who are walking or doing other complex tasks during a seizure probably won't fall, though they'll be unaware.

Absence seizures may occur for some time before an adult notices them, because they're so brief. A noticeable decline in a child's learning ability may be the first sign of this disorder. Teachers also may comment about a child's inability to pay attention.

When to see a doctor
Most of the time, no first aid is necessary for an absence seizure. Contact your doctor if it's the first time you've noticed a seizure or if a new type of seizure occurs. People who have absence seizures can also experience other types of seizures.

Seek immediate medical attention if you observe automatic behaviors — performing such activities as eating or moving without being aware of it — or prolonged confusion. These can be a symptom of a dangerous condition called absence status epilepticus. Additionally, any seizure lasting more than five minutes requires immediate medical attention.

Causes

Often, no underlying cause can be found for absence seizures. Many children appear to have a genetic predisposition to them. Sometimes hyperventilation can trigger an absence seizure.

In general, seizures are caused by abnormal nerve cell (neuron) activity in the brain. The brain's nerve cells normally communicate with each other by sending electrical and chemical signals across the synapses that connect the cells. In people who have seizures, the brain's usual electrical activity is altered. During an absence seizure, these electrical signals repeat themselves over and over in a three-second pattern.

People who have seizures may also have altered levels of neurotransmitters, which are the chemical messengers that help the nerve cells communicate with one another.

This type of seizure may be more prevalent in children because there are more synapses in a growing brain. Many children gradually outgrow absence seizures over months to years.

Complications

While most children outgrow absence seizures, some people continue to have these types of seizures throughout their lives. In some cases, people who have absence seizures eventually begin experiencing full convulsions (grand mal or generalized tonic-clonic seizures).

Other complications can include:

• Learning difficulties
• Absence status epilepticus, a condition in which seizure behavior lasts longer than a few minutes

Preparing for your appointment

You're likely to start by first seeing your family doctor or a general practitioner. However, you or your child will probably be referred to a doctor who specializes in nervous system disorders (neurologist).

Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you or your child are experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of all medications, as well as any vitamins or supplements, that you or your child takes.
• Write down questions to ask the doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For absence seizure, some basic questions to ask your doctor include:

• What's the most likely cause of these symptoms?
• Are there other possible causes?
• What kinds of tests are needed? Do these tests require any special preparation?
• Is this condition temporary or long lasting?
• What treatments are available, and which do you recommend?
• What types of side effects can I expect from treatment?
• Are there any alternatives to the primary approach that you're suggesting?
• Are there any activity restrictions that need to be followed?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?
• Can my child also develop the grand mal type of seizure?
• How long will my child need to take medication?
• Can my child participate in physical activities, such as soccer, football and swimming?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you or your child first begin experiencing symptoms?
• How often have the symptoms occurred?
• Can you describe a typical seizure?
• How long do the seizures last?
• Are you or your child aware of what happened?

Tests and diagnosis

Some children experience episodes that resemble absence seizures, but aren't truly seizures. Such episodes can usually be interrupted by calling the child's name or by touching his or her shoulder. True absence seizures, on the other hand, can't be interrupted by voice or touch. They also tend to occur right in the middle of a child's conversation or physical activity.

For a proper diagnosis, your doctor will ask for a detailed description of the seizures. Blood tests can help rule out other potential causes of seizures, such as a chemical imbalance or the presence of toxic substances. Other tests may include:

• Electroencephalography (EEG). This painless procedure measures the waves of electrical activity in the brain. The brain waves are transmitted to the EEG machine via small electrodes attached to the scalp with paste or an elastic cap. Your child may be asked to hyperventilate or look at flickering lights, in an attempt to provoke a seizure. During a seizure, there's a difference in the normal pattern seen on the EEG.
• Brain scans. Tests such as magnetic resonance imaging (MRI) can produce very detailed images of the brain, which can help rule out other types of problems such as a stroke or a brain tumor. This test is not painful, but your child will need to hold very still for long periods of time. Talk with your doctor about the possible use of sedation, especially for young children.

Treatments and drugs

Many medications can effectively reduce or eliminate the number of absence seizures. Finding the right medication and dosage can be complex, requiring a period of trial and error. Taking the medications on a regular schedule is crucial to maintaining the proper drug levels in the blood.

Often, the first drug prescribed for absence seizures is ethosuximide (Zarontin). However, other medications, such as valproic acid (Depakene) and lamotrigine (Lamictal), also are effective at controlling seizures. Your doctor will likely start at the lowest dose of medication possible, and increase the dosage as needed to control the seizures. Most children can discontinue anti-seizure medications, under a doctor's supervision, after they've been seizure-free for two years.

Female adults who need treatment for absence seizures are advised against using valproic acid while trying to conceive or during pregnancy, because the drug has been associated with higher risk of serious complications for the baby. Women who can't achieve seizure control on any other medication need to speak with their doctors about the potential risks.

Lifestyle and home remedies

A person with absence seizures may elect to wear a medical bracelet for identification for emergency medical reasons. The bracelet should state whom to contact in an emergency and what medications you use. It's also a good idea to let teachers, coaches and child care workers know about the seizures and tell them what to do in an emergency.

Types of Cancer : Stomach Cancer

Definition

Stomach cancer is cancer that occurs in the stomach — the muscular sac located in the upper middle of your abdomen, just below your ribs. Your stomach is responsible for receiving and holding the food you eat and then helping to break down and digest it.

Another term for stomach cancer is gastric cancer. These two terms most often refer to stomach cancer that begins in the mucus-producing cells on the inside lining of the stomach (adenocarcinoma). Adenocarcinoma is the most common type of stomach cancer.

Stomach cancer is uncommon in the United States, and the number of people diagnosed with the disease each year is declining. Stomach cancer is much more common in other areas of the world, particularly Japan.

Symptoms

Signs and symptoms of stomach cancer may include:

• Fatigue
• Feeling bloated after eating
• Feeling full after eating little
• Heartburn
• Indigestion
• Nausea
• Stomach pain
• Vomiting
• Weight loss

When to see a doctor
If you have signs and symptoms that worry you, make an appointment with your doctor. Your doctor will likely investigate more common causes of these signs and symptoms first.

Causes

Doctors aren't sure what causes stomach cancer. There is a strong correlation between a diet high in smoked, salted and pickled foods and stomach cancer. As the use of refrigeration for preserving foods has increased around the world, the rates of stomach cancer have declined.

In general, cancer begins when an error (mutation) occurs in a cell's DNA. The mutation causes the cell to grow and divide at a rapid rate and to continue living when normal cells would die. The accumulating cancerous cells form a tumor that can invade nearby structures. And cancer cells can break off from the tumor to spread throughout the body.

Types of stomach cancer
The cells that form the tumor determine the type of stomach cancer. The type of cells in your stomach cancer helps determine your treatment options. Types of stomach cancer include:

• Cancer that begins in the glandular cells (adenocarcinoma). The glandular cells that line the inside of the stomach secrete a protective layer of mucus to shield the lining of the stomach from the acidic digestive juices. Adenocarcinoma accounts for more than 90 percent of all stomach cancers.
• Cancer that begins in immune system cells (lymphoma). The walls of the stomach contain a small number of immune system cells that can develop cancer. Lymphoma in the stomach is rare.
• Cancer that begins in hormone-producing cells (carcinoid cancer). Hormone-producing cells can develop carcinoid cancer. Carcinoid cancer is rare.
• Cancer that begins in nervous system tissues. A gastrointestinal stromal tumor (GIST) begins in specific nervous system cells found in your stomach. GIST is a very rare form of cancer.

Because the other types of stomach cancer are rare, when people use the term "stomach cancer" they generally are referring to adenocarcinoma.

Risk factors

Factors that increase your risk of stomach cancer include:

• A diet high in salty and smoked foods
• A diet low in fruits and vegetables
• Eating foods contaminated with aflatoxin fungus
• Family history of stomach cancer
• Infection with Helicobacter pylori
• Long-term stomach inflammation (chronic gastritis)
• Pernicious anemia
• Smoking
• Stomach polyps

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. If your doctor suspects you may have a stomach problem, you may be referred to a doctor who specializes in gastrointestinal diseases (gastroenterologist). Once stomach cancer is diagnosed you may be referred to a cancer specialist (oncologist) or a surgeon who specializes in operating on the digestive tract.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For stomach cancer, some basic questions to ask your doctor include:

• What type of stomach cancer do I have?
• How advanced is my stomach cancer?
• What other kinds of tests do I need?
• What are my treatment options?
• How successful are the treatments?
• What are the benefits and risks of each option?
• Is there one option you feel is best for me?
• How will treatment affect my life? Can I continue to work?
• Should I seek a second opinion? What will that cost, and will my insurance cover it?
• Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

Tests and diagnosis

Tests and procedures used to diagnose stomach cancer include:

• A tiny camera to see inside your stomach (upper endoscopy). A thin tube containing a tiny camera is passed down your throat and into your stomach. Your doctor can look for signs of cancer. If any suspicious areas are found, a piece of tissue can be collected for analysis (biopsy).
• Imaging tests. Imaging tests used to look for stomach cancer include computerized tomography (CT) and a special type of X-ray sometimes called a barium swallow.

Determining the extent (stage) of stomach cancer
The stage of your stomach cancer helps your doctor decide which treatments may be best for you. Tests and procedures used to determine the stage of cancer include:

• Imaging tests. Tests may include CT, positron emission tomography (PET) and X-ray.
• Exploratory surgery. Your doctor may recommend surgery to look for signs that your cancer has spread beyond your stomach within your abdomen. Exploratory surgery is usually done laproscopically. This means the surgeon makes several small incisions in your abdomen and inserts a special camera that transmits images to a monitor in the operating room.

Other staging tests may be used, depending on your situation.

Stages of stomach cancer
The stages of adenocarcinoma stomach cancer include:

• Stage I. At this stage, the tumor is limited to the layer of tissue that lines the inside of the stomach. Cancer cells may also have spread to nearby lymph nodes.
• Stage II. The cancer at this stage has spread deeper, growing into the muscle layer of the stomach wall. Cancer may also have spread to the lymph nodes.
• Stage III. At this stage, the cancer may have grown through all the layers of the stomach. Or it may be a smaller cancer that has spread more extensively to the lymph nodes.
• Stage IV. This stage of cancer extends beyond the stomach, growing into nearby structures. Or it is a smaller cancer that has spread to distant areas of the body.

Treatments and drugs

Your treatment options for stomach cancer depend on the stage of your cancer, your overall health and your preferences. Treatment for the adenocarcinoma type of stomach cancer may include:

Surgery
The goal of surgery is to remove all of the stomach cancer and a margin of healthy tissue, when possible. Options include:

• Removing early-stage tumors from the stomach lining. Very small cancers limited to the inside lining of the stomach may be removed using endoscopy. The endoscope is a lighted tube with a camera that's passed down your throat into your stomach. The doctor uses special tools to remove the cancer and a margin of healthy tissue.
• Removing a portion of the stomach (subtotal gastrectomy). During subtotal gastrectomy, the surgeon removes only the portion of the stomach affected by cancer.
• Removing the entire stomach (total gastrectomy). Total gastrectomy involves removing the entire stomach and some surrounding tissue. The esophagus is then connected directly to the small intestine to allow food to move through your digestive system.
• Removing lymph nodes to look for cancer. The surgeon examines and removes lymph nodes in your abdomen to look for cancer cells.
• Surgery to relieve signs and symptoms. Removing part of the stomach may relieve signs and symptoms of a growing tumor in people with advanced stomach cancer. In this case, surgery can't cure stomach cancer, but it can make you more comfortable.

Surgery carries a risk of bleeding and infection. If all or part of your stomach is removed, you may experience digestive problems, such as diarrhea, vomiting and dumping syndrome, which occurs when the small intestine fills too quickly with undigested food.

Radiation therapy
Radiation therapy uses high-powered beams of energy to kill cancer cells. The energy beams come from a machine that moves around you as you lie on a table.

Radiation therapy can be used before surgery (neoadjuvant radiation) to shrink a stomach tumor so it's more easily removed. Radiation therapy can also be used after surgery (adjuvant radiation) to kill any cancer cells that might remain around your stomach. Radiation is often combined with chemotherapy. In cases of advanced cancer, radiation therapy may be used to relieve side effects caused by a large tumor.

Radiation therapy to your stomach can cause diarrhea, indigestion, nausea and vomiting.

Chemotherapy
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs travel throughout your body, killing cancer cells that may have spread beyond the stomach.

Chemotherapy can be given before surgery (neoadjuvant chemotherapy) to help shrink a tumor so it can be more easily removed. Chemotherapy is also used after surgery (adjuvant chemotherapy) to kill any cancer cells that might remain in the body. Chemotherapy is often combined with radiation therapy. Chemotherapy may be used alone in people with advanced stomach cancer to help relieve signs and symptoms.

Chemotherapy side effects depend on which drugs are used. The type of stomach cancer you have determines which chemotherapy drugs you'll receive.

Clinical trials
Clinical trials are studies of new treatments and new ways of using existing treatments. Participating in a clinical trial may give you a chance to try the latest treatments. But clinical trials can't guarantee a cure. In some cases, researchers might not be certain of a new treatment's side effects.

Ask your doctor whether you may be eligible for a clinical trial. Together you can discuss the benefits and risks.

Types of Cancer : Inflammatory Breast Cancer

Definition

Inflammatory breast cancer is a rare but aggressive type of breast cancer that develops rapidly, making the affected breast red, swollen and tender. It's a locally advanced cancer, meaning it has spread from its point of origin to nearby tissue and possibly to nearby lymph nodes.

The early signs of more-common forms of breast cancer — a breast lump or suspicious area on a routine, screening mammogram — are often absent in inflammatory breast cancer. Instead, the breast may appear normal until tumor cells invade and block lymphatic vessels in the overlying skin. Fluid backs up, and the breast swells and becomes discolored.

Inflammatory breast cancer can easily be confused with a breast infection, but if it's cancer, symptoms won't go away with antibiotics. Seek medical attention promptly if you notice skin changes on your breast, to help distinguish a breast infection from other breast disorders.

Inflammatory breast cancer accounts for between 1 percent and 6 percent of all breast cancer cases in the United States. Survival rates are lower than those observed in other locally advanced breast cancers. But new treatment approaches offer greater odds for survival than ever before.

Symptoms

Despite its name, inflammatory breast cancer does not cause inflammation the way an infection does. Signs and symptoms include:

• Rapid change in the appearance of one breast, over the course of days or weeks
• Thickness, heaviness or visible enlargement of one breast
• Discoloration, giving the breast a red, purple, pink or bruised appearance
• Unusual warmth of the affected breast
• Dimpling or ridges on the skin of the affected breast, similar to an orange peel
• Itching
• Tenderness, pain or aching
• Enlarged lymph nodes under the arm, above the collarbone or below the collarbone
• Flattening or turning inward of the nipple
• Swollen or crusted skin on the nipple
• Change in color of the skin around the nipple (areola)

Other conditions have symptoms resembling those of inflammatory breast cancer. A breast infection (mastitis) also causes redness, swelling and pain, but breast infections usually develop during breast-feeding. With an infection, you're likely to have a fever, which is unusual (but not unheard of) in inflammatory breast cancer.

Breast surgery or radiation therapy may block the lymphatic vessels in breast skin, temporarily making the breast swell and become discolored. When caused by surgery or radiation treatments, however, these changes gradually subside.

Causes

As with other types of breast cancer, the exact cause of inflammatory breast cancer is unknown. All cancers are characterized by unregulated cell division, starting with one abnormal cell, in this case usually in one of the breast's ducts. In inflammatory breast cancer, the abnormal cells rapidly infiltrate and clog the lymphatic vessels in the skin over your breast. The blockage in the lymphatic vessels causes red, swollen and dimpled skin — a classic sign of inflammatory breast cancer.

Risk factors

Inflammatory breast cancer tends to affect women at an average age of 59 — about three to seven years younger than the average age at which other types of breast cancer are diagnosed. Men can develop the disease, but at an older age. Black women are slightly more likely than are white women to have inflammatory breast cancer.

When to seek medical advice

If you have an apparent breast infection that fails to improve despite a week of treatment with antibiotics, ask your doctor to do a further breast evaluation. This may include imaging studies such as ultrasound, mammogram or MRI scan and a biopsy. If test results show no signs of cancer, but your signs and symptoms appear to be getting worse, talk with your doctor about performing another biopsy — especially one that includes a skin sample — or ask for a referral to a breast specialist.

Tests and diagnosis

A diagnosis of inflammatory breast cancer is based on your medical history, your physical examination and an excisional biopsy — taking a small sample of skin and some of the underlying tissue to examine under a microscope. An excisional biopsy that includes the skin is helpful because a hallmark of inflammatory breast cancer is finding tightly packed clumps of cancer cells (tumor emboli) in the lymphatic vessels of the skin. Imaging tests — mammogram and breast ultrasound — also may be used to confirm the diagnosis by showing areas of skin thickening.

If the biopsy results confirm that you have inflammatory breast cancer, the next step is to determine how advanced your cancer is — its stage, or extent and severity. Your doctor may perform additional tests, such as a CT scan of your chest and abdomen, chest X-ray, and bone scan, to check for the presence of cancer cells in other parts of your body (metastases).

Your cancer will also be tested for the presence or absence of receptors for the hormones estrogen and progesterone, and to see if the cancer produces too much of a protein called HER2. Inflammatory breast cancers are often hormone receptor negative and HER2-positive.

Inflammatory breast cancer is classified as stage IIIB or stage IV breast cancer. Stage IIIB is locally advanced cancer — meaning it has spread to nearby lymph nodes and to the fibrous connective tissue inside the breast. Stage IV cancer has spread to other parts of your body, such as bones or liver. About one-third of newly diagnosed inflammatory breast cancers are stage IV.

Treatments and drugs

Treatment for inflammatory breast cancer starts with chemotherapy, followed by surgery and radiation therapy. This combined-treatment approach has improved the outlook for women with inflammatory breast cancer. About half the women diagnosed with the condition survive five or more years, and nearly one-third are alive 20 years after diagnosis.

Chemotherapy (anti-cancer drugs)
Treatment of inflammatory breast cancer usually begins with several rounds of chemotherapy to kill or control cancer cells. This pre-surgical treatment, referred to as neoadjuvant therapy, is needed to shrink the cancer and resolve skin problems before the operation, since swelling can prevent the surgical incision from healing properly. The exact number of chemotherapy treatments will depend on how well the cancer responds to the treatments.

Surgery
After chemotherapy, women with inflammatory breast cancer usually have an operation to remove the affected breast (mastectomy). Surgery alone — without chemotherapy — offers a much smaller chance of a cure. Breast-conserving surgery (lumpectomy) isn't recommended for women with inflammatory breast cancer. Most women receive additional doses of chemotherapy after healing from the operation.

Radiation therapy
After surgery and any further chemotherapy, a course of radiation therapy is given to kill any remaining cancer cells in the breast and under your arm. This can help decrease the chance of cancer coming back in the area. Radiation typically involves about 30 treatments over six weeks.

Further treatments
Even after treatment with chemotherapy, surgery and radiation, recurrence rates remain high for inflammatory breast cancer. Because of this, your doctor may recommend further treatment (adjuvant therapy) to prevent the cancer from returning. This might include more chemotherapy or hormone therapy if your cancer tests positive for estrogen receptors. Hormone therapy, such as tamoxifen or anastrozole (Arimidex), interferes with the effects of the female hormone estrogen, which can promote cancer cell growth.

If your cancer is HER2-positive, your doctor will recommend a course of trastuzumab (Herceptin). You may also be offered the opportunity to participate in a clinical trial to test new treatments for inflammatory breast cancer.

Types of Cancer : Pancreatic Cancer

Definition

Pancreatic cancer begins in the tissues of your pancreas — a large organ that lies horizontally behind the lower part of your stomach. Your pancreas secretes enzymes that aid digestion and hormones that help regulate the metabolism of sugars.

Pancreatic cancer often has a poor prognosis, even when diagnosed early. Pancreatic cancer typically spreads rapidly and is seldom detected in its early stages, which is a major reason why it's a leading cause of cancer death. Signs and symptoms may not appear until pancreatic cancer is quite advanced and surgical removal isn't possible.

Symptoms

Signs and symptoms of pancreatic cancer often don't occur until the disease is advanced. When signs and symptoms do appear, they may include:

• Upper abdominal pain that may radiate to your back
• Yellowing of your skin and the whites of your eyes (jaundice)
• Loss of appetite
• Weight loss
• Depression

Causes

Pancreatic cancer occurs when cells in your pancreas develop genetic mutations. These mutations cause the cells to grow uncontrollably and to continue living after normal cells would die. These accumulating cells can form a tumor.

Understanding your pancreas
Your pancreas is about 6 inches (15 centimeters) long and looks something like a pear lying on its side. The pancreas is a crucial part of your digestive system. It secretes hormones, including insulin, to help your body process sugar. And it produces digestive juices to help your body digest food.

Types of pancreatic cancer
The types of cells involved in a pancreatic cancer help determine the best treatment. Types of pancreatic cancer include:

• Cancer that forms in the pancreas ducts (adenocarcinoma). Cells that line the ducts of the pancreas help produce digestive juices. The majority of pancreatic cancers are adenocarcinomas. Sometimes these cancers are called exocrine tumors.
• Cancer that forms in the hormone-producing cells. Cancer that forms in the hormone-producing cells of the pancreas is called endocrine cancer. Endocrine cancers of the pancreas are very rare.

Risk factors

Factors that may increase your risk of pancreatic cancer include:

• Smoking.
• Being overweight or obese.
• Personal or family history of chronic inflammation of the pancreas (pancreatitis).
• Personal or family history of pancreatic cancer.
• Family history of genetic syndromes that can increase cancer risk, including a BRCA2 gene mutation, Peutz-Jeghers syndrome, Lynch syndrome and familial atypical mole-malignant melanoma (FAMMM).
• Older age. Pancreatic cancer occurs most often in older adults. Most people diagnosed with pancreatic cancer are in their 70s and 80s.
• Being black. Pancreatic cancer occurs more frequently in blacks than in whites.

When to seek medical advice

See your doctor if you experience an unexplained weight loss, abdominal pain, jaundice, or other signs and symptoms that bother you. Many diseases and conditions other than cancer may cause similar signs and symptoms, so your doctor will check for these conditions as well as for pancreatic cancer.

Tests and diagnosis

Researchers are studying ways to detect pancreatic cancer early. However, it isn't clear who should undergo screening and which screening tests may most reliably find pancreatic cancer in its earliest stages. Currently no standard screening exists for pancreatic cancer.

Diagnosing pancreatic cancer
If your doctor suspects pancreatic cancer, you may have one or more of the following tests to diagnose the cancer:

• Ultrasound. Ultrasound uses high-frequency sound waves to create moving images of your internal organs, including your pancreas. The ultrasound sensor (transducer) is placed on your upper abdomen to obtain images.
• Computerized tomography (CT) scan. CT scan uses X-ray images to help your doctor visualize your internal organs. In some cases you may receive an injection of dye into a vein in your arm to help highlight the areas your doctor wants to see.
• Magnetic resonance imaging (MRI). MRI uses a powerful magnetic field and radio waves to create images of your pancreas.
• Endoscopic retrograde cholangiopancreatography (ERCP). This procedure uses a dye to highlight the bile ducts in your pancreas. During ERCP, a thin, flexible tube (endoscope) is gently passed down your throat, through your stomach and into the upper part of your small intestine. Air is used to inflate your intestinal tract so that your doctor can more easily see the openings of your pancreatic and bile ducts. A dye is then injected into the ducts through a small hollow tube (catheter) that's passed through the endoscope. Finally, X-rays are taken of the ducts. A tissue or cell sample (biopsy) can be collected during ERCP.
• Endoscopic ultrasound (EUS). EUS uses an ultrasound device to make images of your pancreas from inside your abdomen. The ultrasound device is passed through an endoscope into your stomach in order to obtain the images. Your doctor may also collect a sample of cells (biopsy) during EUS.
• Percutaneous transhepatic cholangiography (PTC). PTC involves injecting a dye into your liver to highlight your bile ducts. Your doctor carefully inserts a thin needle into your liver and injects the dye into the bile ducts in your liver. A special X-ray machine (fluoroscope) tracks the dye as it moves through the ducts.
• Biopsy. During a biopsy, your doctor obtains a small sample of tissue from the pancreas for examination under a microscope. A biopsy sample can be obtained by inserting a needle through your skin and into your pancreas (fine-needle aspiration). Or it can be done using endoscopic ultrasound to guide special tools into your pancreas where a sample of cells can be obtained for testing.

Staging pancreatic cancer
Once a diagnosis of pancreatic cancer is confirmed, your doctor will work to determine the extent, or stage, of the cancer. Your cancer's stage helps determine what treatments are available to you. In order to determine the stage of your pancreatic cancer, your doctor may recommend:

• Laparoscopy. Laparoscopy uses a lighted tube with a video camera to explore your pancreas and surrounding tissue. The surgeon passes the laparoscope through an incision in your abdomen. The camera on the end of the scope transmits video to a screen in the operating room. This allows your doctor to look for signs cancer has spread within your abdomen.
• Chest X-ray. A chest X-ray helps your doctor look for signs that cancer has spread to your lungs.
• CT scan. CT scans allow your doctor to see your pancreas and assess whether the cancer has spread to nearby tissues, lymph nodes or other organs.
• MRI. MRI images may show if the cancer has spread beyond the pancreas.
• Positron emission tomography (PET) scan. PET scans use a radioactive tracer injected into a vein in order to help your doctor look for areas where cancer has spread beyond the pancreas. PET scans aren't typically used for pancreatic cancer, but they may offer another way to examine unusual areas found with a CT scan or MRI.
• Bone scan. Bone scans use radioactive tracers to look for evidence that cancer cells have spread to your bones.
• Blood test. Your doctor may test your blood for specific proteins (tumor markers) shed by pancreatic cancer cells. One tumor marker test used in pancreatic cancer is called CA19-9. Some research indicates that the more elevated your level of CA19-9 is, the more advanced the cancer. But the test isn't always reliable, and it isn't clear how best to use the CA19-9 test results. Some doctors measure your levels before, during and after treatment. Others use it to gauge your prognosis.

Stages of pancreatic cancer
The stages of pancreatic cancer can be expressed in different ways. One description of the stages uses three broad categories:

• Resectable. All the tumor nodules can be removed.
• Locally advanced. The tumor can no longer be removed with surgery because the cancer has spread to tissues around the pancreas or into the blood vessels.
• Metastatic. At this stage, the cancer has spread to distant organs, such as the lungs and liver.

Another description of the stages uses numerals:

• Stage I. Cancer is confined to the pancreas.
• Stage II. Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes.
• Stage III. Cancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph nodes.
• Stage IV. Cancer has spread to distant sites beyond the pancreas, such as the liver, lungs and the lining that surrounds your abdominal organs (peritoneum).

Complications

As pancreatic cancer progresses, it can cause complications such as:

• Jaundice. Pancreatic cancer that blocks the liver's bile duct can cause jaundice. Signs include yellow skin and eyes, dark-colored urine and very pale stools.

  Your doctor may recommend that a plastic or metal tube (stent) be placed inside the bile duct to hold it open. In some cases a bypass may be needed to create a new way for bile to flow from the liver to the intestines.

• Pain. A growing tumor may press on nerves in your abdomen, causing pain that can become severe. Pain medications can help you feel more comfortable. Radiation therapy may help stop tumor growth temporarily to give you some relief.

  In severe cases, your doctor may recommend a procedure to inject alcohol into the nerves that control pain in your abdomen (celiac plexus block). This procedure stops the nerves from sending pain signals to your brain.

• Bowel obstruction. Pancreatic cancer that grows into or presses on the small intestine (duodenum) can block the flow of digested food from your stomach into your intestines.

  Your doctor may recommend a tube (stent) be placed in your small intestine to hold it open. Or bypass surgery may be necessary to attach your stomach to a lower point in your intestines that isn't blocked by cancer.

• Weight loss. A number of factors may cause weight loss in people with pancreatic cancer. Nausea and vomiting caused by cancer treatments or a tumor pressing on your stomach may make it difficult to eat. Or your body may have difficulty properly processing nutrients from food because your pancreas isn't making enough digestive juices.

  Your doctor will work to correct the factors contributing to your weight loss. Pancreatic enzyme supplements may be recommended to aid in digestion. Try to maintain your weight by adding extra calories where you can and making mealtime as pleasant and relaxed as possible.

• Death. Pancreatic cancer leads to death for most people diagnosed with the disease. Even people diagnosed when their cancer is at an early stage face a high risk of recurrence and death.

Treatments and drugs

Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your age, overall health and personal preferences. The first goal of pancreatic cancer treatment is to eliminate the cancer, when possible. When that isn't an option, the focus may be on preventing the pancreatic cancer from growing or causing more harm. When pancreatic cancer is advanced and treatments aren't likely to offer a benefit, your doctor may suggest ways to relieve symptoms and make you as comfortable as possible.

Surgery
Only a small portion of pancreatic cancers are considered resectable — that is, they have a good chance of being removed completely with surgery. Once the cancer has spread beyond the pancreas to other organs, lymph nodes or blood vessels, surgery is usually no longer an option. When surgery is possible, your surgeon may recommend:

• Surgery for tumors in the pancreatic head. If your pancreatic cancer is located in the head of the pancreas, you may consider an operation called a Whipple procedure (pancreatoduodenectomy). The Whipple procedure involves removing the head of your pancreas, as well as a portion of your small intestine (duodenum), your gallbladder and part of your bile duct. Part of your stomach may be removed as well. Your surgeon reconnects the remaining parts of your pancreas, stomach and intestines to allow you to digest food.

  Whipple surgery carries a risk of infection and bleeding. It can cause temporary diabetes until your pancreas recovers from surgery. And some people experience nausea and vomiting that can occur if the stomach has difficulty emptying after surgery (delayed gastric emptying). Expect a long recovery after a Whipple procedure. You'll spend 10 days or more in the hospital and then recover for several more weeks at home.

• Surgery for tumors in the pancreatic tail and body. Surgery to remove the tail of the pancreas or the tail and a small portion of the body is called distal pancreatectomy. Your surgeon may also remove your spleen. Surgery carries a risk of bleeding and infection.

Research shows pancreatic cancer surgery tends to cause fewer complications when done by experienced surgeons. Don't hesitate to ask about your surgeon's experience with pancreatic cancer surgery. If you have any doubts, get a second opinion.

Radiation therapy
Radiation therapy uses high-energy beams to destroy cancer cells. You may receive radiation treatments before or after cancer surgery, often in combination with chemotherapy. Or, your doctor may recommend a combination of radiation and chemotherapy treatments when your cancer can't be treated surgically.

Radiation therapy can come from a machine outside your body (external beam radiation), or it can be placed inside your body near your cancer (brachytherapy). Radiation therapy can also be used during surgery (intraoperative radiation).

Chemotherapy
Chemotherapy uses drugs to help kill cancer cells. Chemotherapy can be injected into a vein or taken orally. You may receive only one chemotherapy drug, or you may receive a combination of chemotherapy drugs.

Chemotherapy can also be combined with radiation therapy (chemoradiation). Chemoradiation is typically used to treat cancer that has spread beyond the pancreas, but only to nearby organs and not to distant regions of the body. This combination may also be used after surgery to reduce the risk that pancreatic cancer may recur.

In people with advanced pancreatic cancer, chemotherapy may be combined with targeted drug therapy.

Targeted drug therapy
Targeted drug therapy is an emerging area of cancer treatment. Targeted drugs attack specific abnormalities within cancer cells. The targeted drug erlotinib (Tarceva) blocks chemicals that signal cancer cells to grow and divide. Erlotinib is usually combined with chemotherapy for use in people with advanced pancreatic cancer.

Many other targeted drug treatments are under investigation in clinical trials. One such drug being studied is cetuximab (Erbitux), which targets the same signals as erlotinib but goes about it a different way.

Clinical trials
Clinical trials are studies to test new forms of treatment, such as new drugs, new approaches to surgery or radiation treatments, and novel methods such as gene therapy. If the treatment being studied proves to be safer or more effective than are current treatments, it will become the new standard of care.

Clinical trials can't guarantee a cure, and they may have serious or unexpected side effects. On the other hand, cancer clinical trials are closely monitored by the federal government to ensure they're conducted as safely as possible. And they offer access to treatments that wouldn't otherwise be available to you.

Talk to your doctor about what clinical trials are available and whether these may be appropriate for you.

New treatments currently under investigation in clinical trials include:

• Drugs that stop cancer from growing new blood vessels. Drugs called angiogenesis inhibitors may help stop cancer from using new blood vessels to get the nutrients it needs to grow. Blood vessels also give cancer cells a pathway to spread to other parts of the body.
• Pancreatic cancer vaccines. Cancer vaccines are being studied to treat cancer, rather than prevent disease, as vaccines are traditionally used. Cancer treatment vaccines use various strategies to enhance the immune system to help it recognize cancer cells as intruders. In one example, a vaccine may help train the immune system to attack a certain protein secreted by pancreatic cancer cells.

Prevention

Although there's no proven way to prevent pancreatic cancer, you can take steps to reduce your risk, including:

• Quit smoking. If you smoke, quit. Talk to your doctor about ways to help you quit, including support groups, medications and nicotine replacement therapy. If you don't smoke, don't start.
• Maintain a healthy weight. Being overweight increases your risk of pancreatic cancer. If you need to lose weight, aim for a slow, steady weight loss — 1 or 2 pounds (0.5 or 1 kilogram) a week. Combine daily exercise with a plant-focused diet with smaller portions to help you lose weight.
• Exercise regularly. Aim for 30 minutes of exercise on most days. If you're not used to exercising, start out slowly and work up to your goal.
• Eat a healthy diet. A diet full of colorful fruits and vegetables and whole grains is good for you, and may help reduce your risk of cancer.