Ladprao General Hospital : thailand hospital, insurance, assurance, medicine, surgery, cosmetic, dermatology, neurology, checkup, check up, insurance, hemodialysis, rehabilitation, pediatric, dental, Infertile, health

สาขา Branch of doctor

ชื่อแพทย์ Name of doctor

ท่านสามารถทำการเลือกสาขา (ความเชี่ยวชาญ) หรือรายชื่อแพทย์
เพื่อทำการตรวจสอบเวลาออกตรวจของแพทย์

สอบถามรายละเอียดเพิ่มเติมได้ที่
เคาน์เตอร์ประชาสัมพันธ์ โทร.0-2932-2929 ต่อ 2001, 2002, 2003, 2004
Email : ladprao@ladpraohospital.com

Mesothelioma is a rare form of cancer in which malignant (cancerous) cells are found in the mesothelium, a protective sac that covers most of the body’s internal organs. Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles.

What is mesothelioma? 
Mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.

What are the risk factors for mesothelioma? 
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos.
Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person’s risk of developing cancer of the air passageways in the lung.

What are the symptoms of mesothelioma? 
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis.

How is mesothelioma diagnosed? 
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient’s medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.

How is mesothelioma treated? 
Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient’s age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy). 
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy). 
To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. 
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts. 
Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.
The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.

Age and health history can affect the risk of developing breast cancer. 
Anything that increases your chance of getting a disease is called a risk factor. Risk factors for breast cancer include the following:
Older age. 
Menstruating at an early age. 
Older age at first birth or never having given birth. 
A personal history of breast cancer or benign (noncancer) breast disease. 
A mother or sister with breast cancer. 
Treatment with radiation therapy to the breast/chest. 
Breast tissue that is dense on a mammogram. 
Taking hormones such as estrogen and progesterone. 
Drinking alcoholic beverages. 
Being white.

Breast cancer is sometimes caused by inherited gene mutations (changes). 
The genes in cells carry the hereditary information that is received from a person’s parents. Hereditary breast cancer makes up approximately 5% to 10% of all breast cancer. Some altered genes related to breast cancer are more common in certain ethnic groups.
Women who have an altered gene related to breast cancer and who have had breast cancer in one breast have an increased risk of developing breast cancer in the other breast. These women also have an increased risk of developing ovarian cancer, and may have an increased risk of developing other cancers. Men who have an altered gene related to breast cancer also have an increased risk of developing this disease. (For more information, refer to the PDQ summary on Male Breast Cancer Treatment.)
Tests have been developed that can detect altered genes. These genetic tests are sometimes done for members of families with a high risk of cancer. (Refer to the PDQ summaries on Screening for Breast Cancer, Prevention of Breast Cancer, and Genetics of Breast and Ovarian Cancer for more information.)

Tests that examine the breasts are used to detect (find) and diagnose breast cancer. 
A doctor should be seen if changes in the breast are noticed. The following tests and procedures may be used:
Mammogram: An x-ray of the breast. 
Mammography of the right breast. 
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, the doctor may need to cut out a small piece of the lump. Four types of biopsies are as follows: 
Excisional biopsy: The removal of an entire lump or suspicious tissue. 
Incisional biopsy: The removal of part of a lump or suspicious tissue. 
Core biopsy: The removal of part of a lump or suspicious tissue using a wide needle. 
Needle biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle. This procedure is also called a fine-needle biopsy.
Estrogen and progesterone receptor test: A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If cancer is found in the breast, tissue from the tumor is checked in the laboratory to find out whether estrogen and progesterone could affect the way cancer grows. The test results show whether hormone therapy may stop the cancer from growing. 
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Certain factors affect prognosis (chance of recovery) and treatment options. 
The prognosis (chance of recovery) and treatment options depend on the following:
The stage of the cancer (whether it is in the breast only or has spread to lymph nodes or other places in the body). 
The type of breast cancer. 
Estrogen-receptor and progesterone-receptor levels in the tumor tissue. 
A woman’s age, general health, and menopausal status (whether a woman is still having menstrual periods). 
Whether the cancer has just been diagnosed or has recurred (come back).

What Is Diabetes?
The Balance of Glucose and Insulin:
Diabetes is a disorder that affects the way your body uses food for energy. Normally, the sugar you take in is digested and broken down to a simple sugar, known as glucose. The glucose then circulates in your blood where it waits to enter cells to be used as fuel. Insulin, a hormone produced by the pancreas, helps move the glucose into cells. A healthy pancreas adjusts the amount of insulin based on the level of glucose. But, if you have diabetes, this process breaks down, and blood sugar levels become too high.

There are two main types of full-blown diabetes. People with Type 1 diabetes are completely unable to produce insulin. People with Type 2 diabetes can produce insulin, but their cells don't respond to it. In either case, the glucose can't move into the cells and blood glucose levels can become high. Over time, these high glucose levels can cause serious complications.
Pre-Diabetes:
Pre-diabetes means that the cells in your body are becoming resistant to insulin or your pancreas is not producing as much insulin as required. Your blood glucose levels are higher than normal, but not high enough to be called diabetes. This is also known as "impaired fasting glucose" or "impaired glucose tolerance". A diagnosis of pre-diabetes is a warning sign that diabetes will develop later. The good news: You can prevent the development of Type 2 diabetes by losing weight, making changes in your diet and exercising.

Top Warning Signs of Diabetes

Losing Weight Without Trying: 
This symptom is more noticeable with Type 1 diabetes. In Type 1, the pancreas stops making insulin, possibly due to a viral attack on pancreas cells or because an autoimmune response makes the body attack the insulin producing cells. The body desperately looks for an energy source because the cells aren't getting glucose. It starts to break down muscle tissue and fat for energy. Type 2 happens gradually with increasing insulin resistance so weight loss is not as noticeable.

Weakness and Fatigue: 
It's that bad boy glucose again. Glucose from the food we eat travels into the bloodstream where insulin is supposed to help it transition into the cells of our body. The cells use it to produce the energy we need to live. When the insulin isn't there or if the cells don't react to it anymore, then the glucose stays outside the cells in the bloodstream. The cells become energy starved and you feel tired and run down.

Tingling or Numbness in Your Hands, Legs or Feet: 
This symptom is called neuropathy. It occurs gradually over time as consistently high glucose in the blood damages the nervous system, particularly in the extremities. Type 2 diabetes is a gradual onset, and people are often not aware that they have it. Therefore, blood sugar might have been high for more than a few years before a diagnosis is made. Nerve damage can creep up without our knowledge. Neuropathy can very often improve when tighter blood glucose control is achieved.

Other Signs and Symptoms That Can Occur: 
Blurred vision, skin that is dry or itchy, frequent infections or cuts and bruises that take a long time to heal are also signs that something is amiss. Again, when these signs are associated with diabetes, they are the result of high glucose levels in the body. If you notice any of the above signs, schedule an appointment with your doctor. He or she will be able to tell you if you have reason to be concerned about a diagnosis of diabetes.

Treatments for Diabetes
In type 1 diabetes, the body does not produce insulin, which is needed to take sugar (glucose) from the blood to the cells. You can learn more about these conditions and how to prevent them in this section. You will also find helpful information about insulin, diagnostic tests and tips on what to expect from your health care provider.

Hypoglycemia
Hypoglycemia, or low blood glucose, can happen even during those times when you're doing all you can to manage your diabetes.

Hyperglycemia
Hyperglycemia is a major cause of many of the complications that happen to people who have diabetes. For this reason, it's important to know what hyperglycemia is, what its symptoms are, and how to treat it.

Ketoacidosis
Ketoacidosis is a serious condition where the body has dangerously high levels of ketones -- or acids that build up in the blood -- and it can lead to diabetic coma (passing out for a long time) or even death.

Managing Your Blood Glucose
Keeping your blood glucose as close to normal as possible helps you feel better and reduces the risk of long-term complications of diabetes. Learn about checking your blood glucose, tight diabetes control, and an A1C test.

About Insulin and other drugs
In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been destroyed. They need insulin shots to use glucose from meals. Learn more about insulin and other drugs.

Insulin Pumps
Learn how you can use an insulin pump to help manage your diabetes.

Transplantation
Diabetes sometimes damages kidneys so badly that they no longer work. When kidneys fail, one option is a kidney transplant. There are also pancreas transplants, as well as islet cell transplants.

Related Conditions
Learn more about celiac disease, hemochromatosis and frozen shoulder, and how they relate to type 1 diabetes, in this section.

Cancer of Cervix 
The cervix is the part of the uterus connected to the upper vagina. It is the structure that dilates during childbirth to allow the baby to traverse the birth canal. There are two major types of cancer that develop from the cervix. Squamous cell cancers arise from the squamous epithelium that covers the visible part of the cervix. Adenocarcinomas arise from the glandular lining of the endocervical canal. About 85% of cervical cancers are squamous cell cancers and the remainder adenocarcinomas. Each of these major types has several subtypes that may require special treatment; otherwise they are all managed similarly. Squamous cell cancers are unique because there is a well established progression through premalignant changes before a cancer develops. These premalignant changes are easy to detect by a simple screening test called the Pap test.

SYMPTOMS
There may be no symptoms of a very early cervical cancer, but by the time it is large enough to detect visually it is usually symptomatic with abnormal bleeding. Often this abnormal bleeding occurs after sexual intercourse. Cancers must make new blood vessels as they grow. These new blood vessels are often abnormal and break easily which is why bleeding is a sign of cancer. The cancer also outgrows some of its blood supply, so portions of it are deficient in oxygen. This causes some of the cells to die and for the tissue to become infected. In the cervix this causes a watery or foul discharge that will be noticeable and resistant to most treatments for the usual vaginal infections.

As the cancer increases in size it usually grows laterally toward the pelvic wall. The tubes from the kidneys (ureters) that bring urine to the bladder pass through this area and they are easily obstructed. If that happens to both of the ureters, then this will result in renal failure, coma and death. If the cancer grows into the pelvic wall it will press on the nerves that go to the leg and cause unremitting leg pain. These are symptoms of an advanced cancer. Premalignant changes have no symptoms and are usually not noticeable on visual examination.

Cervical cancers usually do not spread early. They tend to be slow growing and cause most of their problems in the pelvis. Although distant metastases occur they are usually late events. Cervical cancers can spread by way of the lymphatic system. The lymphatic vessels drain from the cervix to clusters of lymph glands along the pelvic wall. The lymphatics follow the large blood vessels so the route of drainage is upward along the pelvic wall, then along the midline of the backbone and then to the chest. If the pelvic lymph nodes on one side of the pelvis become obstructed with cancer then that will cause swelling in the leg on that side. This is another sign of advanced cancer.

TREATMENT
In general, cancers of the cervix are treated with radiation. The major exceptions are for those that are stage I and some that are stage IV. Stage IA cancers that invade less than 3mm deep can sometimes be treated by simple hysterectomy or even in special cases by cone biopsy. All other Stage I cancers are treated either by radical surgery or radical radiation. Some stage IIA cancers can also be considered for surgery. Otherwise, all stage II, III and IV cancers are treated with radiation. Occasionally ultra-radical surgery is done on some stage IVA cancers. Surgery for stage IB and some IIA cancers requires a radical hysterectomy and removal of the pelvic lymph nodes. Radical hysterectomy means that the cervix is removed by staying as far away from it and the cancer as possible. A regular or simple hysterectomy removes the cervix by staying as close to it as possible.

Cancer surgery requires that the cancer be removed with as good a margin of uninvolved tissue as can safely be taken. The radical hysterectomy technique removes all the supporting ligaments to the cervix which means that the dissection is very close to the bladder and to the rectum. The ureters have to be dissected out and the tissue around them removed. A radical hysterectomy with removal of the lymph nodes takes about 4 hours to perform. A simple hysterectomy takes only about 1-2 hours. The ovaries are not a part of the problem with cervical cancer and can be left in place. If after surgery the pathology indicates that there are positive lymph nodes or that the surgical margins are close, then pelvic irradiation with or without chemotherapy may be advised.

Ultraradical pelvic surgery for advanced or recurrent cancer means that all the pelvic organs are removed. The uterus and cervix, vagina, bladder and rectum are removed. Sometimes a vagina can be reconstructed. If the rectum can be reattached then there will be no need for a colostomy. Sometimes a continent urinary reservoir can be constructed. Otherwise a bag will have to be placed for the urine to drain through an ostomy in the abdominal wall. This ultra-radical surgery is done if there is an extensive cancer involving the bladder or rectum, but without spread beyond these structures. It is also done for cancers that recur after pelvic radiation if they are confined to the pelvis.

Radiation therapy usually requires a treatment each day, five days a week, for about five weeks. Each treatment takes only several minutes. This is called external or teletherapy. The entire pelvic area is irradiated by an x-ray beam usually generated by a linear accelerator. Everything in the pelvis is irradiated, bladder, rectum, large intestine, small intestine, bone and skin. Following this treatment, a radioactive source is placed inside the cervix and vagina and left in place several hours or several days. This is called an implant, radium implant, intracavitary implant or any of several other names. A more accurate term is brachytherapy which means slow therapy.

Often when cancer of the cervix is being treated with radiation, chemotherapy is also given to increase the effects of the radiation. Otherwise, chemotherapy is not used as initial treatment for cancer of the cervix. There are some investigational studies in which chemotherapy is given first and then either surgery or radiation performed.

Complications from treatment with surgery are related to anesthesia and injury to other organs such as the bladder and ureters. There is also the risk associated with blood transfusions and infection. These complications usually occur early and are remediable. Radiation complications can occur years later and are difficult to fix.