LUMPS AND BUMPS
People can be so scared of discovering whether a lump is cancerous that they avoid going to their doctor. Fortunately, most lumps are usually benign, but how can you tell if they might be cancerous and need treatment?
Benign versus malignant
Lumps are usually referred to as tumours, which may be benign or malignant. In a tumour, one particular type of cell (such as a glandular, fat or muscle cell) has escaped the normal controls on growth and started to multiply. So what's the difference between a 'benign' tumour and a 'malignant' or cancerous tumour? The most important differences are whether the tumour cells can invade into other cell types around it, and spread around the body. Benign tumours do not invade or spread. They can grow quite large without causing problems, although that doesn't mean they're totally harmless because as they grow they may start to damage the other tissues or organs around them. This is a particular problem with a brain tumour called a meningioma , which grows from cells in the membranes that surround the brain (the meninges). Although benign, the pressure within the skull from the growing meningioma can cause severe headaches and may be life threatening if the tumour is not removed. Benign tumours can cause others problems, from simply looking unsightly to releasing excess amounts of hormones. Malignant tumours invade the tissues around them. They also spread to other parts of the body by sending out cancer cells into the lymphatic system or through the blood stream. These cells are deposited in other areas of the body, particularly the lungs, liver, brain and bones, to start 'secondary' tumours (also called metastases) at the new sites. Most malignant tumours are life threatening. There are hundreds of different types of benign and malignant tumours, each having its own pattern of growth, damage and (in the case of malignant tumours) spread.
Benign tumours include:
Cysts: lumps filled with fluid. Common types include sebaceous cysts on the skin, filled with greasy sebum, and ovarian cysts
Nodules: formed in inflammatory conditions such as arthritis, sarcoid and polyarteritis
Lipomas: lumps of fat cells
Fibromas and fibroademonas: lumps of fibrous or fibrous and glandular tissue
Haematoma: lump formed by blood escaping into the tissues - simply a large bruise
Haemangioma: lump formed by extra growth of blood vessels
Papilloma: formed from skin or internal membrane cells, for example warts
Benign breast tumours
Women are advised to be 'breast aware' and on the look out for lumps. However, among younger women at least, lumps are far more likely to be benign - in women under around 40 more than nine out of ten breast lumps are benign. But these benign lumps cause a lot of anxiety until they are sorted out. The most common benign breast conditions are fibrocystic change, benign breast tumours and breast inflammation. These are common problems: fibrocystic change used to be known as fibrocystic disease but, as it affects more than 50 per cent of women at some point, it was thought that it could no longer be considered a disease. Fibroadenomas (sometimes called breast mice because they can be moved around) are particularly common in women in their 20s or 30s. In most cases these lumps are quite harmless, although now and then they may cause troublesome symptoms such as tenderness (especially as many are influenced by hormone levels and tend to get more swollen and painful along with other menstrual symptoms).and although not cancerous, they are occasionally linked with an increased risk of developing breast cancer.
Is it cancerous?
Sometimes it's fairly clear that a lump is either benign or malignant, but often further tests are required, including x-rays, ultrasound or biopsy. Often the easiest way to get an answer is simply to remove the whole lump and send it to the laboratory for analysis.
Benign lumps may not really need to be removed but this is usually the most effective way to reassure someone because, whatever the problem, it is gone.
If you find a lump
Get a doctor's opinion. No one minds checking hundreds of harmless lumps if it means that one malignant or cancerous lump is caught early.
Don't hide a lump or fret silently about it - if it does prove to be malignant the sooner it is dealt with the greater the chance of cure.
Bear in mind that most lumps, especially in younger people, are benign or relatively harmless.
HEART ATTACK
As many as one in three people will be dead within 24 hours of having a heart attack. But most people who survive the first month will still be alive five years later. So prompt treatment is essential, as is prevention.
What causes a heart attack?
The heart is a large muscular pump. It beats 70 times a minute to push blood around the body. Like any busy muscle, the heart tissues need a good supply of blood from their blood vessels, which are called the coronary arteries. Diseases that narrow the coronary arteries can cause a shortage of oxygen and essential nutrients in the heart muscle.
This triggers chest pain known as angina, especially when the heart is made to work extra hard, for example during exercise. If someone has angina, the more severe the narrowing of the arteries, the less they can do before they experience pain. If the shortage is severe and prolonged, some of the heart muscle will die, resulting in permanent damage. This is a heart attack, more technically known as a myocardial infarction or MI.
Blocked coronary arteries
The most common underlying disease for heart attacks is atherosclerosis, where fatty plaques build up on the lining of the coronary arteries. This is known as coronary artery disease, and is a gradual process that slowly limits the blood supply to the heart muscle.
How do heart attacks happen?
What usually happens in a heart attack is that one of the fatty plaques cracks and a blood clot forms on top of it. It is this clot that finally blocks the artery completely.
There are other, rarer causes of a heart attack, such as a dissection or splitting of the wall of the coronary artery.
How many people are affected?
The UK has one of the worst heart attack rates in the world. It's estimated that someone has a heart attack every two minutes in the UK. More than 1.4 million people have angina and each year about 275,000 people have a heart attack. Of these, more than 120,000 are fatal. Heart attacks are responsible for one in four deaths in men and one in six deaths in women. They are more common among older people.
Risk factors
The biggest single risk factor for heart attack is smoking. Other causes include high cholesterol, high blood pressure, diabetes and a family history of heart disease.
There are many steps you can take to change your lifestyle and reduce your risk.
Different types of heart attack
When someone goes into hospital with pain or other symptoms suggesting coronary heart disease, a diagnosis of acute coronary syndrome (ACS) is made. The next step is to work out which part of the heart is affected, and how badly. This is done by studying an electrocardiogram (ECG) and other tests, in particular a blood test that measures levels of a chemical called troponin, which is released from damaged heart muscle cells. There are several different types of heart attack. The area of the heart that's affected has important implications for what sort of complications there may be, how well the patient will recover and the treatment they should be given. For example, if a heart attack affects the inferior (underneath) surface of the heart, which sits against the diaphragm, there is a greater risk of abnormal heart rhythms, because the electrical conducting system of the heart is disrupted. If the heart attack affects the anterior (front wall) of the heart, there is more likely to be damage to the left ventricle, which is responsible for pumping blood around the body, leading to low blood pressure and heart failure. Sometimes a heart attack doesn't affect the full thickness of the heart muscle and may not produce typical changes on an ECG. This sort of heart attack may require different treatment.
Rapid treatment saves lives
About half of those who have a heart attack die within 28 days. Most people who survive the first month will still be alive five years later, but many are left with long-term heart problems. One in three people dies within 24 hours. Most of these deaths are sudden, occurring within one hour of onset of symptoms and before reaching hospital, and are often due to dangerous heart rhythms. Heart attacks must be recognised and treated as quickly as possible because once a coronary artery is blocked, the heart muscle will die within four to six hours. Rapid treatment reduces the risk of sudden death and prevents long-term complications. Don't wait to call for help - this could make treatment less effective.
Treatment
When a heart attack is suspected, drugs such as aspirin may be given immediately to improve blood flow through the coronary arteries. Pain relief, oxygen and other treatments may also be given. When a heart attack has been diagnosed, one of two methods may be used to try to reopen the blocked artery. Drugs that dissolve the blood clots blocking the artery have greatly improved the treatment of heart attacks. These drugs, known as thrombolytics or 'clot busters', can restore blood flow in about 60 per cent of cases, although sometimes the artery blocks again later on. These drugs aren't suitable for everyone and there is a risk of bleeding. As many as two per cent of those treated will have a dangerous brain haemorrhage as a result. Thrombolytics must be given as soon as possible after symptoms start and certainly within 12 hours.
The other method is an operation called percutaneous transluminal coronary angioplasty or PCI. It involves inserting a tube into the coronary arteries. The tube carries a deflated balloon that can be inflated in the blocked area to push against the artery walls and open the vessel. In general, PCI produces slightly better long-term results than thrombolytic drugs but it must be carried out in a specialised centre.
Recovering from a heart attack
Not so long ago, a heart attack meant weeks of bed rest. Nowadays, people may spend just a few days in hospital, but a much longer process of rehabilitation is important to help the person recover fully, deal with common problems such as depression and reduce the risk of a second attack.
If you suspect a heart attack, get medical help immediately
Everyone's experience is different but common symptoms include :
chest pain, usually a central, crushing pain, which may travel into the left arm or up into the neck or jaw, and persists for more than a few minutes
sometimes the pain doesn't fit this pattern, or is confused with indigestion
some people having a heart attack don't have any pain
shortness of breath
nausea or vomiting
sweating
feeling light-headed or dizzy
palpitations or an abnormal heart rate
DIZZINESS
There are various causes behind feelings of dizziness. We explain some of those causes and what you can do to help yourself. Feeling dizzy is a fairly universal human experience, but we all tend to mean slightly different things when describing our dizziness. Some people may be describing a sense of light-headedness, while others simply mean they feel wobbly on their feet. They may have a feeling that the room is whirling around (although this is more properly called vertigo, especially if accompanied by nausea and vomiting).
But being dizzy doesn't pinpoint one particular problem - instead, it may be a feature of a huge and varied range of medical problems.
Viral infections
Viral infections are one of the commonest causes of dizziness, possibly because they, or the fever they induce, can upset the brain and nervous system. If the virus causes a respiratory infection that affects the air passages in the head or the ear, then dizziness may be the result of a disruption of the inner ear. In labyrinthitis, the fluid-filled canals in the inner ear that play a vital part in control of balance become inflamed. This leads to dizziness and, in severe cases, vomiting and fainting whenever the head is moved.
Meniere's disease is another problem of the inner ear, this time resulting from degenerative changes or aging, rather than infection. In this condition, the dizziness and vertigo is also associated with deafness and tinnitus (ringing in the ears).
Low blood pressure
If your normal blood pressure tends to be low, you're more likely to suffer with dizzy spells. In Europe, doctors usually treat low blood pressure (or hypotension as it is known) but in the UK it's considered to be a variation of normal.
Many attacks of dizziness are caused by momentary (and harmless) drops in blood pressure, which causes a transient reduction in the blood supply to the brain. This typically happens when someone gets up suddenly from a sitting or lying position, when it's known as postural or orthostatic hypotension. Postural hypotension may be aggravated by certain medications, especially some of the medicines used to control high blood pressure.
In elderly people with arthritis of the spine in the neck, tilting their head back or twisting it from side to side can temporarily cut off the blood supply to part of the brain and induce dizziness. This is called vertebrobasilar insufficiency. More serious disruption of the blood supply to the brain, such as a transient ischaemic attack or stroke, may cause dizziness.
Anxiety
Another common cause of repeated dizzy spells, especially in younger people, is anxiety and panic attacks, especially when accompanied by hyperventilation. In this condition, the person over breathes because of anxiety. This causes changes in the body chemistry, which lead to symptoms such as tingling fingers, headache and dizziness. It can become a vicious circle of symptoms and anxiety. Many people don't even realise that they've anxiety that makes them hyperventilate.
Blood sugar levels
Another thing to look out for when someone has dizzy spells is low blood sugar (hypoglycaemia). This is easily tested for and remedied by eating some sugary food.
Other rarer causes of dizziness include: many drug treatments, migraine, abnormal heart rhythms, stress and simple tiredness, anaemia, acute intoxication by alcohol or drugs and carbon monoxide poisoning (from a blocked flue).
Warning signs
In most cases, dizziness is a minor annoyance. But there are a few warning signs that there may be a more serious underlying problem. The most important one is loss of consciousness. If someone complains of feeling dizzy on several occasions and then passes out, they should be seen by a doctor. It may be a simple faint that can be easily explained. But if this happens more than once ithey must get checked over.
Other possible danger signs include intense and new headaches (although dizziness can be a regular feature of migraines), strange sensations or memory changes, odd behaviour, a family history of diabetes or epilepsy.
POST-TRAUMATIC STRESS DISORDER
The symptoms of post-traumatic stress disorder usually develop within three months of a traumatic event. For many people, post-traumatic stress disorder (PTSD) conjures up images of Vietnam war veterans. Although their experiences did bring the problem into the spotlight, PTSD was first described more than 100 years ago among people involved in train accidents. PTSD is now recognised as a debilitating consequence of been involved in, or witnessing alarming events, from natural disasters to sudden unexpected bereavement, or even been diagnosed with a serious illness. However, the greatest risk of PTSD is from violent attacks.
Could you have PTSD?
The symptoms of PTSD usually develop within three months of a traumatic event, although they can take up to a year to appear and must persist for at least a month for it to be diagnosed. There are three main types of symptoms:
Intrusion, the event is constantly revisited in the persons mind:
flashbacks (sudden unwanted vivid memories, such as reliving the event)
painful emotions.
Avoidance:
numbness and loss of deep feelings
depression, guilt and anxiety
retreat from relationships
avoidance of activities that may trigger memories of the event
avoidance of dealing with the grief and anger
avoidance of symptoms by using "self-medication" with alcohol or drugs, problems with drug and alcohol abuse
Increased arousal, the feeling of constant threat can lead to:
very short temper
irritable emotions
anger
difficulty concentrating
disrupted sleep and nightmares
poor mental and work performance
Research
Research is helping to point out specific areas of the brain that are involved in PTSD, particularly in generating the state of anxiety and fear, which is typical of the condition. For example, there is some evidence that an area deep within the brain called the Amygdala, which is thought to control the body's fear response, may be abnormally activated in PTSD. Other research has found abnormalities in the production of hormones the body creates when stressed, levels of naturally produced opiate chemicals and eurotransmitters - the chemicals that control brain cell activity.
Psychological therapies
People can recover from PTSD within months, but for some the condition can last for many years. Treatment is based on a combination of psychological therapies and medication such as drugs for depression and anxiety.
Cognitive-behavioural therapy can help people understand the condition and thought processes. Through breathing techniques and anger control patients can learn how to change their behaviour or reaction to their symptoms.
Exposure therapy can also be helpful, although it may seem stressful at first as it involves confronting the fears and reliving the event, with the therapist, to help the person learn how to cope.