Cancer treatments - chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells. Chemotherapy drugs used in the treatment of cancer may be taken as tablets or, more commonly, given by intravenous drip directly into a vein.

Many different drugs are available, which generally work by killing or slowing the growth of fast-growing cells. Cancers are made up of fast-growing cells. Other fast-growing cells, such as the cells that make up hair follicles, are also affected. This is why one of the side effects of chemotherapy is hair loss. Chemotherapy medications are also known as cytotoxic or anti-cancer medications.

Different uses of chemotherapy
Depending on individual factors such as the type of cancer, where it is and the person’s age and general health, chemotherapy may be used:

• As the only form of treatment
• Together with radiotherapy
• Before surgery to shrink the tumour
• After surgery to kill off any remaining cancer cells.

Aims of chemotherapy
The major aims of chemotherapy are to:

• Cure the cancer or increase the chance of cure
• Reduce symptoms and improve quality of life
• Improve survival.

Cancer pain management

The pain of cancer is usually constant. A person with well-managed pain has an improved quality of life. They are likely to sleep better and have more energy during the day. Being as active as possible also reduces the risk of ailments like pneumonia, blood clots and bedsores, which are associated with immobility. The foundation of cancer pain management is regular medication, including paracetamol and opioid drugs, chosen to suit individual patients and to minimise side effects. Drug combinations to gain maximum benefit are common. Radiotherapy, surgery, hormone therapy and chemotherapy - if successful in reducing tumour size - may also relieve pain. Other techniques that may be helpful include relaxation therapies and acupuncture.

The drug regimen is determined by the pain
The pain experienced influences the choice of drugs and their use. Some of the factors that influence the treatment choices include:

• The location of the pain
• The severity of the pain
• The type of pain - such as sharp, tingling or aching
• Whether the pain is persistent, or comes and goes
• What activities or events make the pain worse
• What activities or events make the pain better
• The current medications
• Whether or not the current medications ease the pain to an appreciable degree
• The impact the pain has on lifestyle, such as poor quality of sleep or loss of appetite.

A range of medications
Some people respond better to certain pain-killing drugs than others, so treatment is always individually tailored. Pain relief can be provided by a range of medications, including:

• Aspirin-like drugs - these medications are used for bone pain, and pain caused by inflammation (such as pleurisy). Some people experience stomach problems, such as indigestion and bleeding, with this type of medication. Aspirin itself is generally avoided, because it is too hard on the stomach if taken regularly.
• Paracetamol - this drug is important in cancer pain control. It is usually well tolerated, doesn’t affect the stomach and won’t thin the blood. It is helpful to reduce fevers and relieve bone pain, and is often used along with opioids.
• Opioids - such as codeine and morphine. Some of the possible side effects can include nausea, vomiting, drowsiness and constipation. There is no danger of addiction if taken for pain relief purposes. There are several newer opioids available, so that one can usually be found to suit any individual. Many patients worry about taking opioids, because they are afraid to become addicted or think they should wait until they are very ill before they use these drugs. Evidence shows that it is far better to find a suitable opioid and use it regularly from the time when your pain becomes constant. This makes it easier to maintain the activities and interests you enjoy.

The different forms of medication
Pain-killing medication can be administered in different ways, including:

• Tablets or syrups - these can be taken by mouth and are simple to use. However, if nausea or vomiting is a problem, tablets or syrups may not be practical.
• Injections - injections into the skin are painless, effective and quick acting. Continuous infusions under the skin may be set up and maintained at home, using a small portable pump.
• Intravenous injections - drugs are administered directly to the bloodstream via a slender tube (catheter) inserted into a vein. The pain relief is more rapid than tablets, syrups or regular injections, but it is inconvenient for long term administration for patients who are at home.
• Spinal injections - drugs are administered though a small catheter in the back (epidural catheter). This procedure must be performed by an anaesthetist. Generally, this type of pain relief is offered when other methods fail.

Chickenpox

Chickenpox (varicella) is a highly contagious viral disease caused by varicella-zoster virus (VZV). The main symptom is a blistering skin rash. Outbreaks are more common in winter and early spring. A vaccine is available.

Chickenpox is spread by air-borne droplets from the upper respiratory tract (coughing, sneezing) or from the fluid in the skin blisters (lesions). An infected person is contagious for 1–2 days (possibly five days) before the onset of the rash and remains infectious until the blisters form scabs (usually around day five of the illness). Children with chickenpox should not go to school or kinder until the last blister has dried. You should tell your child’s school or kinder if your child gets chickenpox, as other children may need to be immunised or treated.

For most healthy people, chickenpox is mild and the person recovers fully without specific treatment. However, complications occur in approximately one per cent of cases. It is more severe in adults and anyone of any age with impaired immunity. Immunisation is the best way to prevent chickenpox.

Symptoms
The symptoms of chickenpox include:

* The person develops a low-grade fever.
* The person experiences general discomfort, illness or lack of wellbeing (malaise).
* A skin rash appears as little blisters surrounded by irregular-shaped patches of inflamed skin (‘dew drop on a rose petal’).
* The rash usually starts on the body, then progresses to include the head and limbs.
* Ulcers may develop in certain areas, including the mouth and vagina.
* The rash is intensely itchy.
* The little blisters burst and develop crusts, usually about day five.

How it is spread
Chickenpox is spread by air-borne droplets from the upper respiratory tract (when the infected person coughs or sneezes) or from touching the fluid in the skin blisters (lesions). An infected person is contagious for 1–2 days (possibly five days) before the onset of the rash and remains infectious until the blisters form scabs (usually around day five of the illness).

The time from infection to appearance of the rash (incubation period) for chickenpox is around 14–16 days. A few days prior to the rash appears, the person may feel feverish with a sore throat and headache. Their skin may be marked for some months after the rash has cleared.

Children with chickenpox should not go to school or kinder until the last blister has dried or until all blisters are covered. You should tell your child’s school or kinder if your child gets chickenpox, as other children may need to be immunised or treated.

Immediate Treatment for Injuries

If you suffer an injury during exercise, following a few simple recommendations can help you recover quickly and avoid a chronic problem. If you feel acute pain while exercising, you should:

* Stop exercising immediately.
* Wrap the injured part in a compression bandage.
* Apply ice to the injured part.
* Elevate the injured part to reduce swelling.
* Get to a physician for a proper diagnosis of any serious injury.

What should I do if I get injured?

Obviously a serious trauma injury, such as a broken bone or ruptured ligaments, will require immediate medical attention, but most injuries are not so dramatic, and some may even respond simply to rest.

When you get injured, there is typically swelling, redness, tenderness and increased temperature. This inflammatory response is how the body tries to heal itself – it is the body's attempt to dispose of blood (from torn tissue) and damaged cells.

Excessive swelling (oedema) can interfere with the initial healing process, so it's important in the early first aid treatment of sports injury to help limit this swelling. The acronym NICER is a useful reminder:

* N = non-steroidal anti-inflammatory drugs, such as ibuprofen, which reduce inflammation and swelling, and alleviate pain (remember to check the label for contraindications).
* I = ice, or cold therapy, since this decreases pain and limits the extent of the swelling. Ice should never be placed directly against the skin. The time for which a tissue should be cooled depends upon the site and severity of the injury.
* C = compression, usually in the form of a compression bandage. This mechanically limits the amount of swelling by restricting the amount of space in and around the injury.
* E = elevation. This also helps control swelling since fluid is drained more effectively from the injury.
* R = restricted activity. To allow the healing process to proceed, the injured area must be rested initially.


Who's the best person to treat my injury?

If your injury is minor – not much more than a little stiffness or soreness – it may be that you have simply been doing a little too much too soon and the affected area just needs rest.

However, there may be underlying reason for the soreness, extrinsic or intrinsic, and it never pays to ignore an injury, especially when it may be very easy to locate its cause.

Start with a sports physiotherapist if the problem seems to be related to sport, or you've had it before, or with your GP, who may then suggest you see one or more of various therapists. You could be referred for:

* Physiotherapy - this covers a well-established group of treatments or techniques, frequently involving physical manipulation of the affected area. It's offered in hospitals, on the high street, in doctors' surgeries, and often in gyms and sports centres. Physiotherapy is a very broad term and many physiotherapists specialise in a particular area of the body, so you may need some guidance in choosing the right therapist for you. Physiotherapy is available on the NHS, but these days you usually have to wait weeks and months. If you can decide to see a physio privately, you can refer yourself directly.

* Podiatry - podiatrists specialise in diagnosis and treatment of disorders affecting the foot and lower limb. They can provide relief of painful symptoms and also preventive care for people with conditions that may affect the health of their feet. A podiatrist might prescribe and manufacture orthoses - specialist insoles that can address problems like pronation by holding the foot in a stable position and preventing it rolling inwards. Podiatry is rarely offered on the NHS, so you'll probably have to pay to see a podiatrist privately.

* Osteopathy - this is a complementary therapy that focuses on musculo-skeletal problems. It concentrates primarily on problems with muscles, joints and nerves and employs a range of physical and manual techniques. In the UK it's considered a complementary therapy, so access to osteopathy on the NHS is limited, but some osteopaths work alongside GPs, and GPs are permitted to refer patients to them. You can also go to see them privately without referral.

* Chiropractic - chiropractors use physical manipulation to treat problems with joints, bones and muscles, and the effects they have on the nervous system. Chiropractors place particular emphasis on the spine, which is why they tend to be associated with treating bad backs. Like osteopathy, chiropractic is only available as an NHS treatment in some areas, depending on the policy of the local primary care trust, or you can see them privately without referral.

Injury

Injury or bodily injury is damage or harm caused to the structure or function of the body caused by an outside agent or force, which may be physical or chemical. Personal Injury also refers to damage caused to the reputation of another rather than physical harm to the body. A severe and life-threatening injury is referred to as a physical trauma.
Types of injury
Minor abrasion injury.

* Bruise is a hemorrhage under the skin caused by contusion.
* Wound: cuts and grazes are injuries to or through the skin, that cause bleeding (i.e., a laceration).
* Burns are injuries caused by excess heat, chemical exposure, or sometimes cold (frostbite).
* Fractures are injuries to bones.
* Joint dislocation is a displacement of a bone from its normal joint, such as a dislocated shoulder or finger.
* Concussion is mild traumatic brain injury caused by a blow, without any penetration into the skull or brain.
* Sprain is an injury which occurs to ligaments caused by a sudden over stretching; a strain injures muscles.
* Shock is a serious medical condition where the tissues cannot obtain sufficient oxygen and nutrients.
* Amputation is the removal of a body extremity by trauma or surgery.
* Serious bodily injury is any injury or injuries to the body that substantially risks death of the victim.

Diamantina River

The Diamantina River is a river in Queensland, Australia. Rising north-west of Longreach,[1] it flows in a south-westerly direction through central Queensland and Channel Country to form the Warburton River,[2] which, in extremely wet years, flows as far as Lake Eyre.[3] The length of the river is approximately 900 km, and the basin is approximately 157,000 km2,[4] of which most (140,000 km2) is used for agriculture.

Most of the basin of the Diamantina is very flat: even the highest points in the northeast do not reach 500 metres (1600 feet) above sea level and Lake Eyre itself is sixteen metres below sea level. Apart from a few streams near Winton (the largest town in the basin) almost all rivers in the basin flow southwestwards towards Birdsville. The major feature of the river's sluggish course is Diamantina National Park about halfway between Winton and Birdsville. Apart from the national park, almost all land in the basin is used for grazing cattle and sheep; though numbers fluctuate greatly and considerable skill is required on the part of graziers.

The climate of the basin is hot and arid. In January, temperatures throughout the basin average around 37°C (98°F) during the day and decline only to about 24°C (75°F) at night. In winter, they typically range from 25°C (77°F) during the day to 11°C (52°F) at night. On occasions, however, frost has been reported in all areas of the basin: Winton has recorded minima as low as -1.8°C (29°F).

Rainfall is heavily concentrated between December and March: averages for these four months range from 310mm (12 inches) at Winton and Kynuna to around 90mm (3.5 inches) at Birdsville. In the rest of the year rainfall is very scanty and only on the rarest occasions are significant falls reported: throughout most of the basin the average rainfall between May and September totals around 40mm (1.5 inches). However, the rainfall of the basin, as with all of the Lake Eyre Basin, is exceedingly erratic and catastropic droughts and floods tend to be the normal state of affairs throughout this region. In the northern part of the basin, annual rainfalls as high as 1,100 millimetres (43 inches) were reported in 1894, 1950, 1974 and 2000, whilst even in Birdsville annual totals as high as 550 millimetres (22 inches) have been reported. In dry years such as 1902, 1905, 1928, 1961, 1965 and 2002, almost the whole basin reported totals under 100mm (4 inches). There can also be significant variation from station to station over small areas: although the annual averages and variability at Winton and Kynuna are almost alike, the actual totals at the two stations can differ by as much as 200mm (8 inches) in some years due to isolated very heavy rainfalls.

The soils in the region are mainly grey and brown Vertisols, with some Fluvents in the drier areas. Although they do not have high phosphate contents, they have adequate levels of most other nutrients: consequently when rainfall is abundant the grasses within the basin are extremely nutritious, especially in the lower reaches of the river around Birdsville, which is a primary region for cattle fattening in years when rainfall further north is adequate to flood the region.

The river was named by William Landsborough in 1866 for Lady Diamantina Bowen (nee Roma), wife of Sir George Ferguson Bowen, the first Governor of Queensland.

Liver Cancer

Your liver is the largest organ inside your body. It filters harmful substances from the blood, digests fats from food and stores the sugar that your body uses for energy. Primary liver cancer starts in the liver. Metastatic liver cancer starts somewhere else and spreads to your liver.

Risk factors for primary liver cancer include

* Having hepatitis
* Having cirrhosis, or scarring of liver
* Being male
* Low weight at birth

Symptoms can include a lump or pain on the right side of your abdomen and yellowing of the skin. However, you may not have symptoms and the cancer may not be found until it is advanced. This makes it harder to treat. Treatment options include surgery, radiation, chemotherapy or liver transplantation.