#pancreatic cancer blood test markers

[queerheadcanoncentral]

Request from @gfuudb

"House and Wilson: so its like an episode of house execpt its Wilson treating a patient but he suddenly pukes blood and then collapses and then its a lil time skip of like 10 minutes and its House storming in to his office and raises his voice as he tells everyone what happened to Wilson and that their taking the case so he’s frantically having the team (of your choice whether its the original three or the second ones or a mix) give him ideas ect. And it ends in fluff pls"

(It's my first time writing anything like that so I'm sorry if it's a bit rough. Also all the medical information is from only one article to it's probably not medically accurate)

—⁠☆—⁠☆—⁠☆—⁠☆—⁠☆—⁠☆—⁠☆—⁠☆—⁠☆—⁠☆—⁠☆—⁠☆—

It was a slow morning for everyone. Especially for Wilson. No face to face meetings with patients, just some prescription renewals and an email consult or two.

Everything was going great, except a slight cough that didn't seem to want to leave him, even House hasn’t bothered him today yet.

As he was looking over an email a strong coughing fit hit him, when it subsided his stomach was turning, he got up to get another mug of water and the room started to spin, he felt the acidic saliva build up in his mouth and the contents of his stomach emptied out of him. Just for a brief second he managed to notice that the liquid on the floor was a copperish red color, before it all went dark.

“You’ll never guess what cuddy is wearing toda- Wilson?” Whether House walked in at the right moment or not is up for debate, because he did probably save his life but oh boy is he not going to let go of the position that he found Wilson in, with his ass up and his face flat on the carpet.

He promptly walked out of Wilson's office and into his own. “Cutner, Taub. Go help Wilson in his office.” If you didn’t know House you’d probably think that he is an asshole for not immediately running to help his beloved friend. But letting someone else, someone more physically able, take care of Wilson while he figures out what’s wrong with him is the best thing he could do right now. “What’s the differential for vomiting blood and loss of consciousness? Go.” “Wait, is this about Wilson? Shouldn’t we help him?” “Yes, that’s why I sent Taub and Cutner there, and we can help him even more if we figure out what’s wrong with him. Symptoms! Go!” “Could be stomach cancer,” said Thirteen. “Or pancreatic.” added Foreman. "Or esophageal.” “Good test him for cancer markers.”

“Hi Thirteen." “Oh, you’re awake. That’s good. Just need to draw some blood.” “What are you testing me for?” There was a moment of silence. The air was thick and Wilson already knew the answer. “You’re looking for cancer. That would be ironic. Spent my entire life fighting it just to end up dying from it.” “It might not be it. We’re just exploring all the possibilities.” “Yeah, yeah, I know how it goes. I’ve done this a million times.” “Has House visited you?” “No he hasn’t. And he probably won't, at least I hope that he doesn’t, because that would mean that he gave up on me.”

There isn’t much that you can do in a situation like this except sit around and pray that it isn’t the worst.

“It’s negative for all cancer markers.” The atmosphere in House’s office is gloom. The lights are off with the exception of his desk lamp. House caught his ball that he was playing with and looked up at Thirteen. “We need to biopsy. Tell Chase to get the OR ready.”

During the operation the whole team was anxiously waiting in their office. Altho they didn’t talk to or interact with Wilson all that much they still cared about him. Whether it’s because of the proximity of having their offices share a wall or because he was their bosses best friend, it doesn’t seem to matter. So when Case finally walked into their office they shot out of the seats and House came in from his, where he was locked for basically the whole day.

“Did any of you check his stomach before you ordered the biopsy?” “No, we just checked his blood for cancer markers.” answered Thirteen. “It wasn’t cancer. It’s just some peptic ulcers.” with that he left.

There was a stunned silence that was broken by- “YOU IDIOTS! You didn’t check his stomach!?” “You just told us to run a blood panel” “I’m not talking about you! I’m talking about those two idiots who don’t know that when you check in a patient with GI issues the first thing you do is look into their stomach!” “We’re so sorr-” Taub didn’t manage to finish his sentence because House was already out the door on his way to Wilson.

When Wilson woke up after his surgery, the first thing he saw was a pair of extremely blue eyes staring right into his soul… but lovingly? “How are you feeling?” “Good. Like I was hit by a bus... so is it cancer?” “No. It’s just an ulcer. They got it fixed right away.” He breathed a sigh of relief. But he had one more question on his mind. “Then why did I pass out?” “Your body was too weak to handle the strain of vomiting. You weren’t eating enough lately because it felt like something was chewing through your stomach, which it was.” “So I just take some pills and I’ll be fine.” “A while of IV nutrition first but after that,” Wilson felt House's hand on his and he intertwined their fingers with a relaxed smile. “,yeah. You’ll be fine.”

Bonus:

After Wilson gets off the IV and can eat regular food, House always makes sure that he eats a few times a day and asks if he has any symptoms to make check that the ulcer isn't coming back.

If they are hanging out at House’s place, he cooks food for him that won’t upset his stomach.

[colonoscopycostsingapore]

Pancreatic Cancer in Singapore: Navigating a Complex Diagnosis

Pancreatic cancer, a malignancy arising from the pancreas, presents a significant health concern in Singapore. Despite not being the most common cancer, it ranks as the 4th most common cause of cancer death in women and the 5th in men https://www.ardenjrsurgery.com.sg/pancreatic-cancer-singapore . This blog post delves into pancreatic cancer in Singapore, exploring risk factors, symptoms, diagnosis, treatment options, and available resources.

Understanding Pancreatic Cancer in Singapore

The pancreas, a gland located behind the stomach, plays a crucial role in digestion and blood sugar regulation. Pancreatic cancer disrupts these functions, leading to a range of health complications. While the exact causes remain unknown, several factors contribute to its development.

Risk Factors for Pancreatic Cancer

Being aware of risk factors empowers you to make informed lifestyle choices and prioritize early detection:

Age: The risk of pancreatic cancer increases with age, particularly above 65.

Smoking: Smoking is a significant risk factor, damaging pancreatic cells.

Diabetes: Having type 2 diabetes can elevate the risk of pancreatic cancer.

Obesity: Excess weight increases the risk of developing pancreatic cancer.

Chronic Pancreatitis: Long-term inflammation of the pancreas can increase cancer risk.

Family History: A family history of pancreatic cancer suggests a potential genetic predisposition.

Diet: A diet low in fruits and vegetables and high in red meat may contribute to pancreatic cancer risk.

Symptoms of Pancreatic Cancer

Pancreatic cancer is often dubbed a "silent killer" due to its vague and non-specific symptoms that may appear in later stages. Here's what to watch out for:

Abdominal pain: This can be a constant dull ache or a sharp, gnawing pain in the upper abdomen that radiates to the back.

Unexplained weight loss: You may experience weight loss even with normal eating habits.

Jaundice: Yellowing of the skin and whites of the eyes occurs when bile ducts get blocked.

Loss of appetite: You may feel full quickly or have no desire to eat.

Nausea and vomiting: These can be persistent and may include blood.

New-onset diabetes: If you haven't had diabetes before, pancreatic cancer can trigger its development.

Fatigue: You may experience constant tiredness and a lack of energy.

Diagnosis of Pancreatic Cancer in Singapore

Early diagnosis is crucial for successful treatment. If you experience any of these symptoms, consult a doctor immediately. Diagnosis may involve a combination of tests:

Blood tests: These can check for abnormalities in liver function and tumor markers.

Imaging tests: CT scans, MRI scans, and PET scans can visualize the pancreas and detect tumors.

Endoscopic ultrasound: A thin, flexible tube with a camera is inserted through the mouth or rectum to examine the pancreas closely.

Biopsy: A tissue sample is collected during endoscopy or with a needle to confirm the presence of cancer cells.

Treatment Options for Pancreatic Cancer in Singapore

The course of treatment depends on the stage and type of pancreatic cancer. Here's an overview of the common treatment options available in Singapore:

Surgery: The Whipple procedure, a complex surgery, is performed for early-stage, localized pancreatic cancer. It involves removing the head of the pancreas, part of the small intestine, and the bile duct.

Chemotherapy: Powerful drugs are used to kill cancer cells and shrink tumors. It can be administered before or after surgery or as a standalone treatment for advanced stages.

Radiation Therapy: High-energy radiation beams target and destroy cancer cells. Radiation therapy may be used before or after surgery, or in combination with chemotherapy.

Palliative care: For advanced stages where a cure is not possible, palliative care focuses on managing symptoms and improving quality of life.

Living with Pancreatic Cancer

Following treatment, regular follow-up appointments with your doctor are essential to monitor for recurrence. Depending on the type of treatment received, dietary modifications and pain management strategies may be recommended to improve your quality of life.

Singapore’s Healthcare System and Pancreatic Cancer

Singapore's advanced healthcare system offers hope. Several public and private hospitals have highly skilled oncologists specializing in pancreatic cancer treatment. These facilities provide access to cutting-edge technologies and comprehensive treatment plans.

Living Beyond Pancreatic Cancer: Hope and Support in Singapore

While a pancreatic cancer diagnosis can be life-altering, Singapore offers a supportive environment for navigating this challenging journey. Here's how you can access resources and build a strong support system:

Empowering Yourself with Knowledge

Singapore Cancer Society (SCS): The SCS website [visit website] provides a wealth of information on pancreatic cancer, treatment options, and coping strategies.

National Cancer Centre Singapore (NCCS): The NCCS patient education library [visit website] offers downloadable resources and educational materials on pancreatic cancer.

Connecting with Others

Support Groups: Joining a support group allows you to connect with others facing similar challenges. The SCS and NCCS facilitate support groups specifically for pancreatic cancer patients and their families.

Online communities: Online forums and social media groups connect you with a wider community of patients and caregivers for sharing experiences and emotional support.

Maintaining Well-being

Nutrition: A registered dietitian can help develop a personalized eating plan to manage weight loss, improve digestion, and address any dietary restrictions caused by treatment.

Pain Management: Your doctor can recommend pain medication and strategies like physical therapy or massage therapy to manage pain associated with pancreatic cancer.

Mental Health Support: Coping with a serious illness can take a toll on mental well-being. Consider seeking counseling or joining support groups focused on emotional well-being during cancer treatment.

Looking Towards the Future

Living with pancreatic cancer requires a multi-pronged approach. By prioritizing medical care, connecting with support systems, and focusing on well-being, you can manage the challenges and improve your quality of life.

Remember: Early detection is paramount. If you experience any potential symptoms, don't hesitate to consult a doctor. With advancements in treatment modalities and Singapore's robust healthcare system, there is hope for a positive outcome.

Disclaimer: This blog post provides general information only and should not be considered a substitute for professional medical advice. Always consult your doctor for personalized guidance on pancreatic cancer diagnosis, treatment, and management.

[cancerconsultindia]

What is the Metastatic Cancer?

When cancer spreads through the body from where it first formed, it is called metastatic cancer. This article’s objective is to cover all the aspects of metastatic cancer, including its causes, symptoms, diagnosis, and treatment options from Dr. Manish Singhal from CCI, the best breast cancer doctor in Noida, and the emotional roller-coaster that follows.

What is Metastatic Cancer?

It occurs when cells break away from a primary tumor and travel through lymph or blood to a new site in the body. These “traveler” cells of the primary tumor develop into secondary tumors elsewhere in the body, such as other organs or tissues. In other words, they are made up of cells that closely resemble those that make up the original (primary) tumor but not the organ in which they are found.

For example, if breast cancer moves to another organ, like the lungs, lung cells will not be seen in them. Otherwise, this would be called lung cancer. Instead, these will still be breast cancers that have invaded the lungs. For this one needs breast cancer treatment in Noida.

How Does Cancer Spread?

Cancer metastasis involves several complex steps:

1. Invasion

cancer cells invade nearby normal tissue.

2. Intravasation

This is when cancer cells move into nearby blood vessels or lymphatic vessels.

3. Circulation

The movement of cancers via the bloodstream/lymphatic system

4. Extravasation

This is when cancer sticks itself out of blood/lymph vessels into new tissues

5. Proliferation

The number increase and growth of cancers in this place

6. Angiogenesis

Development of new blood vessels for feeding nutrients and oxygen supply purposes on tumor area which has now become metastatic.

Common Sites of Metastasis

Each type of cancer tends to spread most commonly to certain areas within the body- The most common sites for metastasis include;

Bones

Breast, prostate, and lung cancers often spread to the bones.

Liver

Colorectal, pancreatic, and breast cancers commonly metastasize to the liver.

Lungs

Bladder, kidney, colorectal, and breast cancer often spread to the lungs.

Brain

Lung, melanoma, renal, and breast cancer frequently metastasize in the brain.

Symptoms of Metastatic Cancer

The symptoms associated with metastatic cancer depend on where it is in the body. Some common symptoms include:

Bone metastasis

Bone pain, fractures, and increased calcium levels

Liver metastasis

Jaundice, abdominal bloating, and poor appetite

Lung metastasis

Shortness of breath, persistent cough (or wheezing) and chest pain

Brain metastasis

Headaches, seizures, or convulsions as well as neurologic deficits.

These signs tend to appear slowly over time; they can also be mistaken for other things making it hard to diagnose them early enough.

Diagnosis of metastatic cancer

Diagnosis of metastatic cancer involves several steps and various diagnostic tools, such as:

1. Medical History and Physical Examination

Through detailed examination, an oncologist in Noida tries to understand the patient’s symptoms and medical history.

2. Imaging Tests

X-rays, CT scans, MRI scans, PET scans, and bone scans are used to detect the presence and extent of metastases.

3. Biopsy

Microscopic examination of a sample of tissue from the suspected metastatic tumor to confirm, if it is cancerous or benign and identify the type of malignant cells.

4. Blood Tests

These tests can give information to an oncologist in Noida about your overall health, and organ function, as well as help identify certain tumor markers.

Treatment of Metastatic Cancer

The main goals in treating metastatic cancer are to control its spread and alleviate symptoms by improving the quality of life for patients. Options include but are not limited to:

1. Systemic Therapies

Chemotherapy

Administration of drugs that kill any rapidly dividing cell within the body.

Hormone Therapy

To block hormones that stimulate growth in some types, such as breast or prostate gland cancers. It is often applied in breast cancer treatment in Noida.

Targeted Therapy 

These drugs are specifically designed to target specific genetic molecular defects known as mutations within cancer cells only.

Immunotherapy

 It enhances the immune system’s ability to identify the presence of different forms like viruses or bacteria and then activate an adaptive response against them by producing antibodies by themselves towards fighting off such foreign substances when they invade body organs.

2. Local Treatments

Radiation

Radiations use high-energy rays directed at tumors or areas where cancer cells are present – this kills those cells present in these regions without harming other bodily tissues around them; thus shrinking cancers down until they shrink away on their own accord due to natural death process called apoptosis without causing any harm whatsoever.

Surgery

Procedures like laparoscopic resection are often used by a cancer doctor in Delhi to remove a tumor or metastasis from the affected area when feasible.

3. Palliative Care

Focuses on palliating symptoms and improving the quality of life for those with advanced cancer, such as pain management, nutritional support, and counseling.

Advances in Metastatic Cancer Treatment

In recent years, significant progress has been made in the treatment of metastatic cancer, mostly through targeted therapies and immunotherapies. It includes Breast Cancer Treatment in Delhi. Notable among these developments are:

Personalized Medicine

Customizing treatment based on genetic information obtained from tumor samples taken during surgical removal operations carried out specifically against different types/originations sites within patients’ bodies where malignant masses have been identified presents itself option available so far;

Checkpoint Inhibitors

 Immunotherapy agents that can help the immune system recognize and destroy neoplastic cells.

CAR-T Cell Therapy

An immunotherapy approach that modifies a patient’s T-cells is employed by a cancer doctor in Delhi to recognize and kill cancers in a better way.

PARP Inhibitors

Targeted therapy medications are appropriate for some gene mutations as with BRCA-altered malignancies.

Conclusion

Metastatic cancer is a very challenging condition to diagnose, but comprehending it and the options for Breast Cancer Treatment in Delhi can enable patients and their families to tread through this difficult path. Incessant improvement of the prognosis and quality of life among people with metastatic cancer has been fostered by innovations in medical science. 

Being well-informed, accessing appropriate healthcare from Dr. Manish Singhal from CCI, the best breast cancer doctor in Noida, obtaining practical help, or working hand-in-hand with emotional supporters enables individuals diagnosed with metastatic cancer to remain hopeful while facing difficulties that lie ahead. As we look at the future journey ahead, taking every step toward understanding and controlling the disease can have enormous effects on those whose lives have been touched by metastatic cancer.

[bertis24]

Proteomics-Based Blood Test Solution for the Early Diagnosis of Breast Cancer | BERTIS

BERTIS, a proteomics technology company that uses bioinformatics and proteomics to find key biomarkers for detecting cancers and various diseases. Bertis stands out in the field of quantitative proteomics with its comprehensive technology platform. They encompass the entire process, from identifying protein biomarkers to developing diagnostic solutions. This allows them to conduct in-depth research and development on diagnostic solutions for various cancers and major diseases.

Early diagnosis of Pancreatic Cancer

Pancreatic cancer is the worst cancer with a 5-year relative survival rate of only 11%. While effective early diagnostic methods for pancreatic cancer are currently lacking, BERTIS is developing a technology that enables early diagnosis of pancreatic cancer with a small blood sample. Through research, we have identified 10 protein biomarkers as a diagnostic marker panel for pancreatic cancer. Following algorithm development and validation, we have uncovered a combination of markers that demonstrates a high accuracy of 98% and is applicable in clinical settings. The number of deaths and new cases with pancreatic cancer are increasing every year worldwide and it is a fatal cancer in which the number of deaths per new cases in a year is significantly low when compared with other cancers.

Development Process The pancreas is located deep inside the body; behind the stomach, connected to the duodenum and bile ducts, adjacent to the spleen. This location makes pancreatic cancer difficult to detect and hence spreads quickly throughout the body. Nearly half of patients (52%) are diagnosed with pancreatic cancer in the distant metastasis stage when cancer cells have already spread to other organs. In this condition, the relative survival rate is only 3.1%. Early diagnosis is of the utmost importance with this cancer.

Click here to contact Bertis

View more: World’s First Proteomics-Based Blood Test Solution for the Early Diagnosis of Breast Cancer

[slwkorea]

Proteomics-Based Blood Test Solution for the Early Diagnosis of Breast Cancer | BERTIS  

BERTIS, a proteomics technology company that uses bioinformatics and proteomics to find key biomarkers for detecting cancers and various diseases. Bertis stands out in the field of quantitative proteomics with its comprehensive technology platform. They encompass the entire process, from identifying protein biomarkers to developing diagnostic solutions. This allows them to conduct in-depth research and development on diagnostic solutions for various cancers and major diseases.

Early diagnosis of Pancreatic Cancer

Pancreatic cancer is the worst cancer with a 5-year relative survival rate of only 11%. While effective early diagnostic methods for pancreatic cancer are currently lacking, BERTIS is developing a technology that enables early diagnosis of pancreatic cancer with a small blood sample. Through research, we have identified 10 protein biomarkers as a diagnostic marker panel for pancreatic cancer. Following algorithm development and validation, we have uncovered a combination of markers that demonstrates a high accuracy of 98% and is applicable in clinical settings. The number of deaths and new cases with pancreatic cancer are increasing every year worldwide and it is a fatal cancer in which the number of deaths per new cases in a year is significantly low when compared with other cancers.

Development Process

The pancreas is located deep inside the body; behind the stomach, connected to the duodenum and bile ducts, adjacent to the spleen. This location makes pancreatic cancer difficult to detect and hence spreads quickly throughout the body. Nearly half of patients (52%) are diagnosed with pancreatic cancer in the distant metastasis stage when cancer cells have already spread to other organs. In this condition, the relative survival rate is only 3.1%. Early diagnosis is of the utmost importance with this cancer.

Click here to contact Bertis

View more: World’s First Proteomics-Based Blood Test Solution for the Early Diagnosis of Breast Cancer

[drpriya]

There are no specific blood tests that can definitively detect pancreatic cancer on their own. However, there are certain blood markers and tests that can be used in conjunction with other diagnostic methods to help assess the possibility of pancreatic cancer or monitor the disease's progression.

Some of the blood tests that may be considered in the evaluation of pancreatic cancer include:

CA 19-9 (Carbohydrate Antigen 19-9): CA 19-9 is a tumor marker that is often elevated in people with pancreatic cancer. However, it is not specific to pancreatic cancer and can be elevated in other medical conditions as well. CA 19-9 is most commonly used to monitor treatment response and disease progression in individuals with known pancreatic cancer.

CEA (Carcinoembryonic Antigen): CEA is another tumor marker that can be elevated in various types of cancer, including pancreatic cancer. Like CA 19-9, CEA is not specific to pancreatic cancer and is used in conjunction with other diagnostic tests.

Complete Blood Count (CBC): A CBC can provide information about the number of different blood cells, which can be affected by pancreatic cancer or its treatment.

Liver Function Tests: These tests measure the levels of certain liver enzymes and substances in the blood. Abnormal liver function test results can be a sign of pancreatic cancer or other liver-related issues.

Note that while these blood tests can raise suspicion of pancreatic cancer, they are not definitive diagnostic tools on their own. To confirm the presence of pancreatic cancer, further diagnostic procedures such as imaging tests, endoscopic examinations, and biopsies are typically required.

For the general population, the focus of a full-body checkup or general health screening typically includes monitoring for common health issues like high blood pressure, cholesterol levels, diabetes, and early detection of more prevalent cancers such as breast, colon, or prostate cancer. While these screenings are important, they are not specific for pancreatic cancer. Get full body checkups done to detect pancreatic cancer and other health diseases early.

[lustgarten22]

What Cancers Can Cause Elevated Liver Enzymes?

Elevated liver enzymes are a common sign of liver damage, irritation, or inflammation. However, they can also be a sign of other serious health conditions, including pancreatic cancer.

Pancreatic cancer is a rare but deadly cancer that begins in the pancreas, a small organ located in the abdomen. The pancreas produces enzymes that help with digestion and hormones that help regulate blood sugar.

There is no definitive blood test for pancreatic cancer. However, elevated liver enzymes can be a sign of the disease. Other symptoms of pancreatic cancer include:

Abdominal pain

Jaundice

Weight loss

Fatigue

Nausea and vomiting

Dark urine

Pale stools

If you have elevated liver enzymes and any of the other symptoms of pancreatic cancer, it is important to see a doctor right away. Early diagnosis and treatment can improve the chances of survival for pancreatic cancer.

Pancreatic Cancer Blood Test

There are a number of blood tests that can be used to screen for pancreatic cancer. These tests include:

CA 19-9: This is a tumor marker that is often elevated in people with pancreatic cancer. However, it can also be elevated in people with other conditions, such as liver disease.

CEA: This is another tumor marker that can be elevated in people with pancreatic cancer. However, it is not as specific as CA 19-9.

Lipase: This enzyme is produced by the pancreas. Elevated levels of lipase can be a sign of pancreatic cancer, but it can also be elevated in people with other conditions, such as pancreatitis.

If you have elevated liver enzymes or any of the other symptoms of pancreatic cancer, your doctor may order a combination of blood tests to help diagnose the condition.

If you are concerned about what cancers cause elevated liver enzymes, it is important to talk to your doctor. They can help you determine the cause of your elevated enzymes and recommend the appropriate treatment.

[medidectindia]

The Power of Cancer Screening Blood Tests: Early Detection and Finding a Cancer Specialist Near You

Cancer, a formidable adversary, has affected countless lives around the world. However, advancements in medical technology have provided a glimmer of hope in the fight against this devastating disease. Among these medical breakthroughs, cancer screening blood tests stand out as a powerful tool for early detection. In this article, we will delve into the significance of cancer screening blood tests, their role in the detection of cancer, and how they can lead you to find a cancer specialist near you.

Understanding Cancer Screening Blood Tests

Cancer screening blood tests, also known as liquid biopsies or blood-based cancer tests, are non-invasive diagnostic procedures that analyze a person's blood sample to detect the presence of cancer-related biomarkers. These biomarkers can include specific proteins, circulating tumor cells (CTCs), cell-free DNA (cfDNA), or RNA fragments shed by tumors into the bloodstream. The analysis of these biomarkers helps identify the presence of cancer cells or tumor DNA in the body, enabling early detection and potential intervention.

The Significance of Early Detection

Early detection of cancer is crucial as it significantly improves the chances of successful treatment and enhances patient outcomes. Traditional cancer screening methods, such as mammograms, colonoscopies, and Pap smears, have been instrumental in detecting certain types of cancer. However, they may have limitations in terms of invasiveness, inconvenience, and detection at advanced stages.

Cancer screening blood tests offer a promising alternative, especially for individuals at high risk or those with vague symptoms that could indicate cancer. By detecting cancer at its earliest stages, patients have a higher likelihood of receiving less aggressive and more effective treatment options, leading to an improved quality of life and increased survival rates.

Types of Cancer Detected by Blood Tests

Cancer screening blood tests have proven effective in detecting various types of cancer, including but not limited to:

Breast Cancer: Blood tests can identify specific proteins like CA 15-3 and CA 27.29, which may indicate the presence of breast cancer cells.

Prostate Cancer: Prostate-specific antigen (PSA) levels in the blood can be elevated in men with prostate cancer.

Colorectal Cancer: Blood tests can detect CEA (carcinoembryonic antigen) and CA 19-9, which may be elevated in patients with colorectal cancer.

Lung Cancer: Blood tests can identify certain genetic mutations or alterations in the blood that may be associated with lung cancer.

Ovarian Cancer: CA 125, a protein marker, can be detected through blood tests and may be indicative of ovarian cancer.

Pancreatic Cancer: Certain proteins like CA 19-9 may be elevated in individuals with pancreatic cancer.

The Role of Cancer Specialists

Once a cancer screening blood test indicates abnormal results or raises suspicion of cancer, the next crucial step is to consult a cancer specialist. Cancer specialists, also known as oncologists, are medical professionals with specialized training and expertise in diagnosing and treating various types of cancer.

Finding a Cancer Specialist Near You

Finding a qualified and experienced cancer specialist is essential to ensure accurate diagnosis, effective treatment, and compassionate care. Here are some steps to help you find a cancer specialist near you:

Consult with Your Primary Care Physician: If you have undergone a cancer screening blood test or are experiencing concerning symptoms, start by consulting your primary care physician. They can assess your test results and recommend further evaluation if necessary.

Seek Referrals: Your primary care physician can provide referrals to reputable cancer specialists or oncology centers in your area.

Utilize Online Resources: There are several online platforms that provide directories of cancer specialists based on your location and the type of cancer you may be dealing with.

Check for Board Certification: Ensure that the cancer specialist you choose is board-certified and has the necessary credentials and experience in treating your specific type of cancer.

Read Patient Reviews: Reading patient reviews and testimonials can offer valuable insights into the quality of care provided by the cancer specialist.

Consider Second Opinions: If you have received a cancer diagnosis, consider seeking a second opinion from another reputable cancer specialist. This can provide you with additional perspectives and treatment options.

Conclusion

Cancer screening blood tests have emerged as a groundbreaking tool in the early detection of cancer, offering hope for improved outcomes and better patient experiences. By identifying specific biomarkers in the blood, these tests can detect various types of cancer, prompting timely intervention and treatment. Should a cancer screening blood test indicate abnormal results, it is vital to consult a qualified cancer specialist. These experts play a pivotal role in diagnosing and designing personalized treatment plans, leading to the best possible chance of overcoming cancer's challenges. Remember, early detection and access to a cancer specialist near you can make all the difference in the battle against cancer.

[medtalksblog]

Understanding SGOT and SGPT Tests

SGOT and SGPT are vital examinations in the medical realm for evaluating liver functionality. Representing Serum Glutamic Oxaloacetic Transaminase and Serum Glutamic Pyruvic Transaminase, they are also known as AST (Aspartate Transaminase) and ALT (Alanine Transaminase). These tests gauge the levels of two enzymes in the body—SGOT in the heart, skeletal muscles, and kidneys, and SGPT in the liver.

Significance of SGOT and SGPT Tests

The liver, a crucial organ, plays a pivotal role in the body's metabolic processes. Its primary task is blood detoxification by processing and filtering harmful waste through enzyme production and secretion, ensuring a smooth and efficient process.

SGPT and SGOT, common liver enzymes, elevate in the blood when the liver undergoes damage or inflammation, disrupting the equilibrium. These markers aid in diagnosing various liver ailments, including hepatitis, cirrhosis, liver cancer, and other conditions affecting liver function. They also monitor the effectiveness of specific medications or treatments for liver diseases.

Levels and Causes of Elevated SGOT and SGPT Levels

Normal SGPT and SGOT ranges in a patient's serum should typically be between 7-56 units/liter and 8-45 units/liter, respectively. Levels exceeding 56 units/liter for SGPT and 50 units/liter for men or 45 units/liter for women for SGOT indicate serious concerns, suggesting an underlying chronic condition.

Increased SGPT and SGOT levels often point to liver damage due to conditions like acute viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, cirrhosis, and liver cancer. Other clinical situations like kidney disease, celiac disease, heart attack, diabetes, obesity, infectious mononucleosis, gallbladder inflammation, inflammation of skin and muscles, pancreatitis, etc., can also contribute to SGOT/SGPT imbalance.

Moreover, factors such as alcohol abuse, specific medications, intense exercise, or muscle damage may lead to elevated levels. Seeking healthcare guidance is crucial to determine the cause and receive proper treatment. Regular monitoring of liver enzymes aids in early liver disease detection, preventing long-term damage.

Symptoms of High SGOT & SGPT Levels

While elevated SGOT and SGPT levels usually show no noticeable symptoms, some individuals may experience mild indications like constant fatigue, nausea, vomiting, and abdominal discomfort. Severe cases of liver disease may manifest symptoms such as jaundice, breathlessness, leg and abdomen swelling, dark-colored urine, and pale stools.

Experiencing any symptoms necessitates immediate medical attention. If elevated SGOT and SGPT levels are detected, further testing or necessary treatment is decided by the physician.

[gicancerindia]

Liver Metastases (Liver Secondary): Understanding Spread and Treatment

Liver Metastases (Liver Secondary): Understanding Spread and Treatment

Introduction:

Liver metastases, also known as liver secondaries, are a significant health concern associated with the spread of cancer cells from primary tumors to the liver. This condition occurs when cancer cells detach from their original site and migrate through the bloodstream or lymphatic system, eventually forming new tumors in the liver. Understanding the causes, symptoms, diagnosis, and treatment options for liver metastases is crucial for patients, caregivers, and healthcare professionals alike.

Causes and Risk Factors:

Liver metastases most commonly occur as a result of the spread of cancer from other organs, rather than originating in the liver itself. Several types of cancers are known to have a higher propensity for liver metastases, including colorectal cancer, breast cancer, lung cancer, pancreatic cancer, and gastrointestinal tumors. The likelihood of liver metastases can vary depending on the aggressiveness of the primary tumor and its ability to invade neighboring tissues or metastasize to distant sites.

Symptoms:

Liver metastases may not cause noticeable symptoms in the early stages. However, as the tumors grow and affect liver function, various signs and symptoms may arise. These can include:

Abdominal pain or discomfort

Unexplained weight loss

Loss of appetite

Fatigue or weakness

Jaundice (yellowing of the skin and eyes)

Ascites (accumulation of fluid in the abdomen)

Nausea and vomiting

Enlarged liver (hepatomegaly)

Diagnosis:

Detecting liver metastases involves a comprehensive diagnostic approach. Physicians may employ the following techniques:

Imaging tests: Computed tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET) scans can help visualize the liver and identify the presence of tumors.

Liver biopsy: A small sample of liver tissue is obtained and examined under a microscope to confirm the presence of metastatic cancer cells.

Blood tests: Liver function tests and tumor marker tests (e.g., CEA for colorectal cancer) help assess liver function and monitor cancer progression.

Treatment Options:

The treatment of liver metastases depends on various factors, including the primary cancer type, the extent of liver involvement, the overall health of the patient, and individual preferences. Treatment options may include:

Surgery: Surgical resection, or removal, of liver metastases may be possible in certain cases where the tumors are limited and haven't spread extensively.

Radiofrequency ablation (RFA): This procedure uses heat to destroy tumors in the liver. It is suitable for smaller tumors and patients who cannot undergo surgery.

Systemic therapy: Chemotherapy, targeted therapy, and immunotherapy are systemic treatment options that can help control the growth of liver metastases and manage the primary cancer.

Radiation therapy: It may be used to target liver metastases and alleviate symptoms, particularly when surgery is not feasible.

Palliative care: For patients with advanced liver metastases, palliative care focuses on improving quality of life by managing symptoms, providing pain relief, and offering emotional support.

Conclusion:

Liver metastases, or liver secondaries, occur when cancer cells spread from primary tumors to the liver. Early detection, accurate diagnosis, and appropriate treatment are vital in managing this condition effectively. Collaboration between healthcare professionals, advanced imaging techniques, and the development of targeted therapies have significantly improved the prognosis for patients with liver metastases, offering hope and enhanced quality of life.

[mambasoftwares]

Back Pain Associated with Pancreatic or Stomach Cancer

Introduction:

Back pain can arise due to various reasons, and it is essential to identify the underlying cause for effective diagnosis and treatment. While most instances of back pain are not directly linked to cancer, in some cases, persistent or severe back pain can be an indication of an underlying malignancy, such as pancreatic or stomach cancer. In this article, we will explore the relationship between back pain and these specific types of cancer, highlighting the symptoms, risk factors, and available treatment options.

Back Pain as a Symptom of Pancreatic or Stomach Cancer:

Back pain associated with pancreatic or stomach cancer may be caused by the tumor itself or due to the cancer's effects on surrounding tissues and organs. Although back pain is a common complaint among individuals with various conditions, certain characteristics can help differentiate it as a potential symptom of cancer. The following factors may indicate the presence of pancreatic or stomach cancer:

Location and Persistence: Back pain caused by pancreatic or stomach cancer typically originates in the upper abdomen or the mid-back region. It may gradually radiate to the sides, lower back, or shoulder blades. Unlike typical muscle strains, this pain tends to persist and may worsen over time.

Severity and Intensity: The back pain associated with these cancers can be severe, unrelenting, and may interfere with daily activities, especially if the tumor has invaded nearby nerves or bones.

Additional Symptoms: Patients with pancreatic or stomach cancer may also experience weight loss, loss of appetite, indigestion, nausea, vomiting, jaundice (yellowing of the skin and eyes), and fatigue. These symptoms, when combined with back pain, should prompt further investigation.

Risk Factors:

Several risk factors increase the likelihood of developing pancreatic or stomach cancer and subsequently experiencing associated back pain. These risk factors include:

Age: The incidence of pancreatic and stomach cancers increases with age, typically affecting individuals over the age of 50.

Smoking: Cigarette smoking has been strongly associated with an increased risk of pancreatic cancer.

Family History: A family history of pancreatic or stomach cancer can elevate an individual's risk.

Chronic Pancreatitis or Stomach Inflammation: Long-standing inflammation of the pancreas (pancreatitis) or stomach can raise the likelihood of developing cancer in these organs.

Treatment Options:

When back pain is suspected to be related to pancreatic or stomach cancer, it is crucial to seek medical attention promptly. Diagnosing the underlying malignancy is essential for appropriate treatment. Physicians may recommend the following diagnostic procedures:

Imaging Tests: Computed tomography (CT) scans, magnetic resonance imaging (MRI), or positron emission tomography (PET) scans can help identify the presence, location, and extent of the tumor.

Biopsy: A tissue sample is obtained from the suspected cancer site to confirm the diagnosis through microscopic examination.

Blood Tests: Certain blood markers, such as CA19-9 for pancreatic cancer or CEA for stomach cancer, can provide additional information to aid in diagnosis.

Treatment for pancreatic or stomach cancer may involve a combination of surgery, chemotherapy, radiation therapy, and targeted therapies, depending on the stage and characteristics of the cancer.

Conclusion:

Back pain, especially when accompanied by other concerning symptoms, should not be ignored, as it may be an indication of an underlying pancreatic or stomach cancer. Early detection and prompt medical intervention are vital for successful treatment outcomes. If you or someone you know is experiencing persistent or severe back pain, it is important to consult a healthcare professional for a thorough evaluation and appropriate management.

[candyswift-ny]

CAR-T Cell Therapy & Surgery for Solid Tumor Treatment: The Whole is Greater Than Sum of Parts

The past decade has witnessed ongoing progress in immune therapy to ameliorate human health. As an emerging technique, chimeric antigen receptor (CAR) T-cell therapy has the advantages of specific killing of cancer cells, a high remission rate of cancer-induced symptoms, rapid tumor eradication, and long-lasting tumor immunity, opening a new window for tumor treatment.

CAR T cell therapy works by reprogramming patients' own immune cells to attack their tumor cells. A recent study conducted by researchers in the Perelman School of Medicine at the University of Pennsylvania found that this therapy may also enhance the effectiveness of surgery for solid tumors.

The study is published in Science Advances on Jan. 11, 2023, titled “Chimeric antigen receptor T cells as adjuvant therapy for unresectable adenocarcinoma”, and reports that the research found a method to allow the mice to survive the tumor recurrence.

Surgery is highly effective if the solid tumor has not spread. The main obstacle is that during the surgery, it’s usually hard for surgeons to clearly distinguish a tumor from the surrounding healthy tissues. Thus, post-surgical recurrence due to remaining microscopic tumor cells is common.

The research team tried to find an answer to this obstacle with an eye to applying an anti-tumor treatment to kill any residual tumor cells immediately after tumor removal, and they tested with CAR T cells for two cancer types: triple-negative breast cancer (TNBC), which lacks all of the three major breast cancer markers, and pancreatic ductal adenocarcinoma (PDA), the most common type of pancreatic cancer. Both types are notoriously hard to cure.

The CAR T cells were engineered to home in on the protein mesothelin, a surface marker on both types of tumor cell in the experiments. Without the CAR T cell and fibrin gel, the remaining tumor tissue grew and the mice succumbed within about seven weeks. With the gel, however, residual tumor tissue swiftly disappeared in 19 of 20 mice, and these animals survived without wound-healing complications or other apparent side effects for the remainder of the observation period.

Further experiments showed that CAR T cells targeting mesothelin have the potential to attack healthy cells bearing that protein marker after intravenous injection, and the toxicity was decreased by local injection of the CAR T cells compared to direct injection of the cells into the blood.

“This study demonstrates the promise of CAR T as an add-on to surgery for solid tumors. And this approach can be broadened to deliver other cellular therapies and anticancer agents in addition to CAR T cells, potentially boosting the antitumor effectiveness even further.” commented a scientist at Creative Biolabs, a biotech company providing TCR and CAR T therapy development services as well as ready-to-use TCR and CAR T&NK cell construction products.

Researchers all over the world are trying to enhance the effectiveness and safety of CAR T-cell therapy, and it’s believed that this direction will be a big step toward curing cancer.

[gi-surgeon-in-delhi]

Gastrointestinal Cancer Surgery in Delhi

Gastrointestinal Cancer Surgery in Delhi

What are Gastrointestinal(GI) Cancers?

Gastrointestinal tract pertains to the part of the body which helps in digestion, assimilation and excretion of the eaten food materials. It starts from the esophagus, goes onto stomach, small intestine, large intestine, rectum and ends at anus(the anal opening or the excretory orifice). Its approximate length is 6 meters. It also involves other accessory organs which aid in digestion like, liver, gallbladder and biliary system and pancreas.

Gastrointestinal(GI) cancer is the term given to cancer affecting any of these organs.

What are the General features of GI Cancers?

Majority of these cancers are lifestyle related. They are the result of one or more lifestyle related problems such as

Obesity Alcohol Smoking

So it implies that majority of these cancers can be prevented by adoption of healthy lifestyle.

These cancers are very much amenable to screening. Such as for colorectal cancers- Colonoscopy can be easily performed. Similarly in some countries like Japan there is screening program for esophageal and stomach cancers by the use of Upper GI Endoscopy.

Certain infections are known to cause cancers in the GI System like Hepatitis B and hepatitis C for liver cancer. These infections are treatable now and Hepatitis B infection is preventable by the use of vaccine available.

The risk of these cancers increases with age especially after 50 years of age. But recently the incidence is increasing rapidly in the younger age group. It may be lifestyle related or genetically modulated.

What are different GI Cancers?

The major types of cancers are:-

Esophageal (food pipe) Cancer Stomach Cancer Colorectal Cancers Gallbladder Cancer Pancreatic Cancer Liver Cancer

What are the symptoms of GI Cancers?

Unfortunately these cancers do not cause much symptoms early or cause symptoms which are easily ignored. The symptoms depend upon the location of the cancer. The major symptoms of GI Cancers are

Abdominal Pain is a common feature for gallbladder and pancreatic cancer. Pain can be there in colonic cancers also.

Esophageal cancers patients have difficulty in swallowing

Stomach cancer patients have symptoms of indigestion or hyepracidityor vomiting after meals.

Gallbladder cancer present with right upper abdominal pain and sometimes jaundice

Pancreatic cancers can have pain and jaundice.

Colorectal cancers present with either bleeding from anal orifice or recent onset constipation or black colored stools or sometimes even as appendicitis pain

Loss of appetite and loss of weight

How are GI Cancers Diagnosed?

The diagnosis of the disease. If your doctor suspects GI cancer depending upon your symptoms he may advise one or more of the following investigations:

Endoscopy to look for any change in the lining of the esophagus, stomach or early small intestine.

Colonoscopy to check for polyps, cancers into the large intestine

Imaging like CT scan, MRI, PET Scan depending upon the disease as prescribed by the doctor

Biopsy of the lesions seen in during endoscopy or lesions seen on imaging as the case may be

Blood Investigations involving routine blood tests and certain tumor markers like CEA, CA19-9 and others.

What is the treatment of GI Cancers?

The treatment of the GI Cancers involves surgery, chemotherapy and radiation being applied in different combinations. The treatment is dependent upon the clinical stage of the disease. If the tumor is early diagnosed surgery may be what all is needed. But in certain scenarios chemotherapy and radiation are required to be given before the surgery. Similarly chemotherapy and radiation may also be required after the surgery.

Surgery performed can be open or Laparoscopic (keyhole or Minimally Invasive). Surgery aims at complete removal of the tumor along with a margin of normal tissue and then restore the normal GI Function. For liver cancer transplantation is also possible in certain cases.

TAG- Gastrointestinal Cancer Doctor in Delhi, Gastrointestinal Cancer surgery in Delhi

[tremendouspersonarbiter]

HPB Surgeon in Hyderabad - Dr. N. Subrahmaneswara Babu

  Home  /  HPB Surgery

What is an HPB Surgery?

The name of the surgery itself may sound like a mouthful. HPB stands for Hipato Pancreato Biliary. This surgery caters to the benign and malignant diseases that breed in one’s liver, pancreas, and biliary tree. A biliary tree consists of the gallbladder and bile ducts.

Jointly, the above-mentioned lot is responsible for over 3600 functions in the body. This is why the extreme necessity to eliminate all the problems in this organ system arises.

HPB (Hepato Pancreato Biliary) Guide:

Skim through this HPB guide that covers every important aspect of this disease, its causes, symptoms, and Treatments.

HPB conditions

The HPB surgical procedure will work to eliminate medical conditions such as:

Primary liver cancer:

Liver tumor removal

The most common liver tumor to metastasize in this organ is known as colorectal cancer which can be cured only after the complete surgical removal of the disease.

Another metastasizing tumor in the liver is the neuroendocrine tumor of the gastrointestinal tract.

Benign and malignant diseases of the pancreas –

Pancreatic tumors are common but the development of neuroendocrine tumors of the pancreas as well as cystic tumors is also common.

Surgical removal of all pancreatic malignancies poses a cure for all the patients affected.

When the tumor is located at the head of the pancreas, a Whipple resection and a blood vessel reconstruction may be called for. You can read more about the Whipple procedure in another blog of ours.

As for the removal of tumors located in the body and tail of the pancreas, minimal techniques will be used to rid the patient of this ailment. This surgical procedure is known as distal pancreatectomy.

In many cases, patients may have to have their bile ducts reconstructed entirely. This will depend on the extent of damage that the tumor has done up until that point and whether the tumor is blocking the bile duct or not.

Gallstones (tiny particles that get lodged in the gallbladder)

To better understand HPB surgery, envision it as being a humongous tree with its branches acting as the cures for the various hepatic pancreatobilary diseases it treats.

HPB Surgical Procedures

Certain procedures have been applauded for mitigating the inconveniences caused by the above conditions. They are:

Ablation therapies in which heat is transported through a small tube to kill the tumors

Resections involve cutting out a deceased portion of an organ.

Irreversible electroporation or IRE uses jolts of electricity so that they can poke holes in the pancreas or the liver to decimate the tumor

The Diagnosis & Symptoms

The diagnosis for each disease is different. When carrying out an HPB surgery, the following medical tests for the respective diseases shall be carried out:

LIVER DISEASE: Liver-function tests, Ultrasound

ADVANCED LIVER DISEASE: Fibroscanor Acoustic Radiation Force Impulse Imaging (ARFI)

iii. LIVER CANCER: CT scan, MRI, Tumor markers

ACUTE PANCREATITIS: CT scan, S. Amylose, Endoscopic Retrograde Cholangiopancreatography (ERCP)

CHRONIC PANCREATIC DISEASE: CT scan, Endoscopic Retrograde Cholangiopancreatography (ERCP)

PANCREATIC CANCER: CT scan, Endoscopic Retrograde Cholangiopancreatography (ERCP), Tumor markers, Endoscopic Ultrasound (EUS)

vii. BILE DUCT OBSTRUCTION: Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde Cholangiopancreatography (ERCP), Endoscopic Ultrasound (EUS), Ultrasonography

viii. BILE DUCT CANCER: Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde Cholangiopancreatography (ERCP), Endoscopic Ultrasound (EUS), CT scan

Symptoms for all the above diseases can be delayed, meaning that they may show up in patients when it is too late. There are going to be several distinguished surgical centers that will rule out the possibility of you undergoing HPB surgery or catching the symptoms when they have not had ample time to harm all your vital organs.

Hence, start seeing routine-health checkups as a necessity instead of a nuisance.

Life after HPB surgery:

If you are a patient who is lined up to undergo this surgery or if you are their family member, there’s good news regarding this cryptic procedure and it is that over the years, its mortality and morbidity rates have reduced remarkably.

Recovery promises satisfactory pain control after the surgery so that the patient does not feel uneasy or lost. The antithesis of this will result in a neuroendocrine stress response which is never ideal for a patient who has just undergone this surgery.

As medical science takes giant leaps every day, it has also discovered new pain control methods for HPB surgery. Dr. N.S. Babu or their team should also not prescribe you medications because they may result in chronic opiate dependence.

Diet after HPB surgery:

After undergoing this tremendously complicated surgery, you as a patient or someone you know who is going to be a patient will be advised to go on an oral liquid diet and soft diet. As for the conditions, there will surely be a dietician/nutritionist who will instruct you more about the after-surgery diet.

If you are going to be up for the HPB surgery soon, make an honest effort to stay fit and active before it happens. Hope for the best too as this surgery is medically modernized and the surgeons conducting it only want the best outcomes for you.

Talk To Dr. N. S. Babu:

Dr. N. S. Babu and their team has a dedicated and caring approach and will seek to find you the earliest appointment possible with one of the best HPB surgeon in Hyderabad – Dr. N. S. Babu for your needs. For more information about our comprehensive treatment options, or to request an appointment with the best gastro care clinic in Hyderabad. Call us on 9443355668.

[chimaeracabra]

Anion gap, alk/acidosis, lipase, A1C, UUN, labs, specialized labs, clinical presentation, BUN, Creatinine 

Anion gap (will cover this in more depth with diabetes) is calculated from sodium level – (chloride + bicarbonate). You could do (sodium + potassium) – (chloride + bicarbonate). Potassium contributes so little that it’s often omitted, however. Anion gap means something else is contributing to the acid-base balance, not just the exchange of chloride for bicarbonate, for example.

Metabolic acidosis: Low pH, a low HCO3- concentration. Compensatory hyperventilation that contributes to a decreased pCO2. Most common causes: Inability of kidneys to excrete dietary hydrogen ion load, increase in hydrogen ion generation due to an addition of hydrogen ions or a loss of bicarbonate

Metabolic alkalosis: High pH, a high bicarbonate- concentration, and compensatory hypoventilation that contributes to an increased pCO2. Most common causes: loss of gastric acid from vomiting or nasogastric suction, loss of intravascular volume and chloride from diuretic use. Overtreatment of metabolic acidosis with bicarbonate. Excess of acetate in PN (parenteral nutrition), which becomes metabolized to bicarbonate

A1C distinguishes between diabetes and hyperglycemia associated with metabolic stress

 Protein: Again:

First start by converting the protein intake of the patient (94g in this example) to grams of nitrogen. Second, calculate their nitrogen balance. We find that the patient is in negative nitrogen balance. Nitrogen balance should be the same amount of nitrogen coming into the body as is coming out in the urine. Third: Correct the deficit to get into nitrogen balance. Take that -2g of deficit that they are at (take the minus sign away), and multiply that by 6.25g of protein (1g of nitrogen = 6.25g of protein). Correcting the deficit of nitrogen finds that the patient will require 12.5 more grams of protein just to get into nitrogen balance. Fourth, we still need the patient to be in positive nitrogen balance, so, we increase protein and shoot for 2g more protein to promote anabolism (goal for anabolism is +2-4g of nitrogen a day more). So, that low end we are aiming for is 2g of nitrogen: 2N (6.25g of protein/1g of nitrogen) = 12.5g of protein needed to put the patient in positive nitrogen balance. Fifth, we want to try to promote anabolism, so we have to add the amount of protein that puts the patient at nitrogen balance to the amount of protein that puts the patient in positive nitrogen balance, and add the sum of those two to the amount of protein the patient is taking in (the 94g). Hence the new protein goal is 94g + 12.5g + 12.5g = 119g of protein/day or approximately 120g of protein per day.

Remember: even though you prescribed 100g of protein a day, the patient only actually got 94g. So, that’s why you use 94g in these calculations.

         A valid 24-hour urine collection can be difficult to collect

       Conversion factor of UUN to total nitrogen excretion may not be accurate in certain conditions: burns, major wounds, diarrhea, vomiting

       Factor of 0.85 converts UUN to TUN

       Assumes that 85% of urinary nitrogen is from urea

       Other nitrogen sources in urine= ammonia, proteins

       Conditions that alter or increase ammonia excretion will lead to underestimation

       Ex if Adam had liver disease and ammonia excretion was higher/ UUN only 75%

◦       UUN = 13   (13/0.75) = 17 (vs 15)

       Diminished renal function alters results

  For the most part you are addressing whether the patient is renal insufficient or dehydrated. BUN:Cre ratio, if high BUN and Cre is normal, then it's usually dehydration. If the BUN and Cre are high, it's often renal failure.

 LABS:

K+, Cr, and Phosphate are often looked at when assessing kidney function. K+, Mg2+, phosphate are often looked at together as well

Refeeding syndrome (hemodilution, hemodynamics) is indicated by labs. Lab error (e.g. blood that has been sitting out too long, things degrade), stress impacts labs, components of the blood (e.g. serum iron) need to be looked at with other portions of bloodwork. Disease states affect labs. High blood glucose can begin to displace sodium, causing sodium to appear low (false low result), like in diabetic ketoacidosis.

 •       Think about which labs are affected by which organ system

•       Lungs: chloride, acetate

•       Kidneys: BUN, creatinine, potassium, phosphorus, albumin, calcium

•       Heart: Sodium, BUN (volume status)

•       Pancreas: Blood glucose, serum lipase

•       Liver: Liver function tests

•       Liver disease: colloidal pressure AKA oncotic pressure. With liver disease, you’re not going to make as much visceral proteins (like albumin), which hang onto the water portion of the blood. If albumin is not hanging on, it will start to seep out and accumulate in different places (third spacing).

•       Pleural effusions are seen commonly in malignancy. Ascites from cancer, for example. Just because patient doesn't have liver disease doesn't mean they won't have issues with fluid. Extra fluid creates a dilution efffect (causing sodium and albumin, calcium, etc. appear low. If you take those labs at face value, you can be thrown off.

Liver disease: colloidal pressure AKA oncotic pressure. With liver disease, you’re not going to make as much visceral proteins (like albumin), which hang onto the water portion of the blood. If albumin is not hanging on, it will start to seep out and accumulate in different places (third spacing).

Pleural effusions are seen commonly in malignancy. Ascites from cancer, for example. Just because patient doesn't have liver disease doesn't mean they won't have issues with fluid. Extra fluid creates a dilution effect (causing sodium and albumin, calcium, etc. appear low. If you take those labs at face value, you can be thrown off.

 Serum sodium doesn't really relate to dietary sodium. Serum sodium is a marker of fluid status, because salt is like a sponge and pulls in a lot of fluid. So, if sodium is really low, often times there’s a fluid issue going on. High sodium indicates a fluid deficit.

 •       Potassium: 3.4– 5.1 mmol/L

•       Magnesium: 1.7 – 2.6 mg/dL

•       Low magnesium can make it difficult to successfully replete potassium and phosphorus (SO YOU WANT TO MAKE SURE MAGNESIUM IS NORMAL)

•       Phosphorus: 2.4 – 4.3 mg/dL

Story: Patient with a phosphorus of 7 starting nutrition at a slow rate, but then his team gave him a bunch of dextrose-containing fluids to correct a sodium issue, and his phosphorus then dipped to a 2! This results from massive refeeding. The trends in your potassium, magnesium, phosphorus are important. What essentially happened was that the glucose (dextrose) activated insulin, and insulin activation caused a massive shift intracellularly of phosphorus, leading to lower levels of phosphorus in the blood. When not eating much, your cells aren’t taking in magnesium and phosphorus, etc. So, again, sugar stimulates intracellular shift because insulin will activate when sugar is reintroduced, leading to even lower blood levels of minerals. Your heart won’t have enough potassium to beat properly, your lungs won’t have enough phosphorus to breathe well. Certain diuretics can lead to potassium deficiency, E.g. thiamin follows potassium (Wernicke's Encephalopathy), certain diuretics that are potassium wasting come with a risk of thiamin deficiency. Can fix this by prophylactically give thiamin in anticipation of potassium drop.

CONSEQUENCES OF REPLETING TOO QUICKLY

•       Low potassium: cardiac arrhythmia, cardiac arrest

•       Low magnesium: seizure, coma

•       Low phosphorus: respiratory distress, difficulty breathing/getting off mechanical ventilation

 Patients who are at risk for refeeding syndrome can have a number of different conditions to begin with:

•       Anorexia nervosa

•       Chronic alcoholism

•       Cancer

•       Post-surgery (NPO for many days pre- and post-op)

•       Elderly (poor dentition, reduced thirst/taste sensation)

•       Uncontrolled diabetes mellitus (electrolyte abnormalities, polyuria)

•       Critically ill and unfed for >7 days

•       Inflammatory bowel disease, chronic pancreatitis, short bowel syndrome

•       Cystic fibrosis

•       Long-term antacid use (phosphorus levels are often low 2/2 magnesium and aluminum salts in the medications)

•       Long term diuretic use (potassium-wasting) such as with CHF

•       Patients who are vomiting frequently

Patients with poor blood levels at baseline (K/Mg/P) will be at risk of intracellular shifts and thus lower blood lab values. Patients with SBD have reduced absorptive capacity, for example, and are at risk for refeeding syndrome.

•       When a patient is experiencing hyperkalemia (K+ > 5.1 mmol/L), there are a number of treatments a Team may utilize

•       50% Dextrose ampule + Insulin

•       Calcium Gluconate

•       Kayexalate or Lokelma

•       Why would we use these medications? (insulin will stimulate intracellular K+ shift, Lokelma and Kayexalate bind potassium)

Giving dextrose and insulin mimics refeeding. So, you are pulling potassium out of the blood and giving it to the cells.

Giving dextrose and insulin mimics refeeding. So, you are pulling potassium out of the blood and giving it to the cells. With renal patients who are often in a hyperkalemic state, kayexalate and lokelma will stop potassium absorption in GI tract. When someone’s potassium hits the ceiling, arrhythmia can occur. Calcium is given to offset that. If a pt is hyperkalemic and EKG changes are seen, patient is given 2g of calcium. Calcium gluconate is the preferred IV administration for hypocalcemia (Severe symptomatic hypocalcemia should be corrected promptly with IV administration of calcium gluconate over 10 minutes to control symptoms. Calcium gluconate is the preferred salt for peripheral venous administration to avoid extravasation—leakage of liquid into surrounding tissue.)

 Specialized labs: Liver function tests give you enzymes (alanine aminotransferase and aspartate aminotransferase, ALT and AST) and you are also given bilirubin as s measure of liver function, as bilirubin is a waste product of heme metabolism. When liver is not functioning well, bilirubin won't be cleared well. At that point, liver is also not good at clearing minerals such as copper and manganese.

 Liver function tests give you enzymes (alanine aminotransferase and aspartate aminotransferase, ALT and AST) and you are also given bilirubin as s measure of liver function, as bilirubin is a waste product of heme metabolism. When liver is not functioning well, bilirubin won't be cleared well. At that point, liver is also not good at clearing minerals such as copper and manganese.

When T. bili is >5 mg/dL, give PO multivitamin without minerals, or remove copper and manganese from your TPN (total parenteral nutrition) solution

If patient is eating, give them a multivitamin without minerals. If patient is on TPN, remove copper and manganese, as toxicity of these can risk brain damage.

Blood and iron studies: Hemoglobin is the last thing to change. Look at ferritin as an earlier sign. Hematocrit can respond to anemia, but also to an overflow of other blood cells. Professor Trussler works with blood in the heme oncology setting. White blood cells in certain type of malignancies (e.g. leukemia) are elevated. Blood smear can count white blood cells and immature white blood cells (blasts). High blasts signals that something is wrong in bone marrow and they’re pumping a lot of immature white blood cells out. Also, immature blasts are a measure of whether someone’s chemotherapy has been effective. Treatment decisions can be made on this.

Absolute number of neutrophils can be used to determine treatment decisions. Low neutrophil count can be used as a guideline for a neutropenic (low bacteria) diet.

A1C: 3-month average blood glucose. When someone is acutely ill, you can see high glucose in the blood, but this is not diabetes, it’s “stress hyperglycemia” (due to injury). But if this is prolonged, an A1C can help you see if they have undiagnosed prediabetes. A1C is useful for newly diagnosed diabetic patients.

Lipase: You shouldn't be seeing a lot of lipase in the bloodstream, as this indicates pancreatic damage (e.g. pancreatitis)

 Vitamin and mineral labs get expensive, so you don't want to be checking EVERYTHING for every situation. There are some vitamins and minerals where a serum lab isn't going to be helpful. E.g. pyridoxine (B6), Per the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.), you need serum B6, 24-urinary B6, erythrocyte AST, and erythrocyte ALT to assess sufficiency of B6.

Common vitamin labs:

·      Someone who is having trouble absorbing fat will be at risk for vitamin A deficiency. Vitamin A is key to skin integrity and building (a pressure injury/injuries not healing well may indicate vitamin A deficiency), with substance use disorder deficiency comes up because you’re generating a lot of free radical damage from substance use disorders and the vitamin A is getting used up for that. Vitamin A is protein bound (RBP), so you can look at C-reactive protein in combination with this, because vitamin A may look low when it's not (falsely low result).

·      B12 is worth looking at, esp. for vegans, vegetarians, elderly, heavy alcohol or substance users, and patients with IBD.

·      Vitamin C builds collagen matrix for skin, thus wounds could cause a vitamin C deficiency in wound patients. Dialysis causes water loss, so you can lose vitamin C. COVID-19 may cause a vitamin C deficiency (the antioxidant vitamin is getting used up).

·      Check vitamin D, after it's activated by the kidneys a second time, that active form doesn't last very long, so it may not give you a good result. Vitamin D labs are good to check for elderly patients who don’t synthesize enough vitamin D, and for kidney injury patients because their kidneys aren’t activating as much vitamin D. Checking vitamin D for oncology patients is also great, because they may have some complications in certain cancer treatments. COVID-19 appears to be affecting vitamin D levels.

·      Vitamin E is good to check in a patient who is malabsorbing fat. If you think someone is malabsorbing, the team can do more work up.

 Less common vitamin labs:

If the vitamin is water soluble, there’s less risk of toxicity, so you can give it prophylactically. For example, folate costs about $1, so it can be given for 3 days prophylactically.

B1 (thiamin) is given prophylactically if you think the patient is deficient. At Brigham and Women’s, if you anticipate that someone might refeed, you give them thiamin for the first few days that they’re getting nutrition support to anticipate that shift with potassium.

Professor T doesn’t usually check vitamin K often, because gut microbiota make vitamin K. Prothrombin (PT-INR, a marker of blood clotting) is a better indicator of vitamin K sufficiency because the clotting factors in your blood need vitamin K to work. If you were truly functionally deficient, you would have trouble clotting.

Common mineral labs

Both copper and ceruloplasmin must be low in order to diagnose a true copper deficiency. Bariatric patients tend to be low, esp. in Roux-en-Y gastric bypass patients, as the surgery is bypassing some of the areas where copper is absorbed. Wouldn't normally suspect a copper deficiency unless there's some sort of malabsorptive process occurring.

Zinc deficiency is caused by (and can also cause) diarrhea. If you have someone with diarrhea that isn’t resolving, it could be due to zinc deficiency, and also zinc could be causing the diarrhea. Zinc is lower in stressed state. If a patient is borderline deficient and their CRP is very high, you may want to hold off on repleting zinc, and then check zinc levels again.

Selenium, like zinc, decreases when someone has diarrhea, but can also cause diarrhea as a side effect of deficiency. Selenium will be low in substance use disorder patients, as it participates in antioxidant functioning (where antioxidants get used up).

 Less common mineral labs:

Manganese: No good lab test to measure for this. If worried patient is getting too much, try to just remove it. E.g. taking manganese out of total parenteral nutrition, or giving a supplement that doesn’t have manganese. Manganese toxicity can cause brain damage

Chromium: No real lab measure for chromium, either, but people on long term TPN might develop this deficiency. Sometimes chromium is given prophylactically. People who are diabetic can be low in chromium, but it is difficult to figure out because you can’t check this mineral.

Specialty Lab

•       Fecal Calprotectin

•       Marker of inflammatory bowel disease

•       Protein released by immune cells (neutrophils) at sites of inflammation in the GI tract, which is then excreted in the stool

•       Low level (10-50 mcg/mg): likely IBS or viral infection

•       Moderate level (>50 mcg/mg): potential IBD flare or worsening inflammatory condition such as parasitic infection

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the pancreaticobiliary system

Oliver McDonald, MD/PhD

gland - groups of cells that secrete any substances

exocrine - secretes into body cavities

endocrine - secretes into bloodstream

pancreas - head, body, and tail

pancreas histology - shows nuclei, cytoplasm, and lumen

1. main pancreatic tissue structure - acinar-ductal units

exocrine acinar cells in a small circle unit

lumen in middle is connected to lumen in duct, which is made of ductal cells and lined with epithelial cells

polarized cell units - “sacs”, or acini - acinar cell nuclei are at basolateral side of cell, and cytoplasm juts into the circle of cells towards the lumen

acinar-ductal system is shaped a bit like a cross, with three acinar arms

2. skeleton framework outside of pancreatic cells - from base to surface:

basement membrane upon which “cross” sits

then stroma, which support the epithelial cells surrounding the ducts - made of stiff collagens | separate cross from epithelia

proteoglycans, which allow pancreas to be flexible - hydrophilic, attracts water for bending and moving

blood vessels, which vascularize pancreatic tissue

pancreatic functions

pancreas makes digestive enzymes (amylase, lipase, proteases)

pancreatic lipase breaks fats down for further hepatocyte emulsification

liver hepatocytes make bile from exocrine cells, which capture bilirubin protein from dead red blood cells and emulsifies fats

functional pathways between liver and pancreas are made by different ducts

hepatic bile ducts drain bile into head of pancreas, meet up with pancreatic duct, and drains into small intestine

cystic duct from bile ducts drains extra bile into gallbladder, for when excess fats are unexpectedly received for emulsification

case study: painless jaundice and weight loss

physical examination: no other abnormalities

diagnostic assays: 

large bilirubin elevation indicates either blood or liver injury

mild liver function test increases

jaundice, bilirubin, and liver function marker increases indicate liver abnormality

CT scan: mass lesion in head of pancreas, where bile ducts drain into pancreatic duct

most likely outcome from CT image: bile becomes backed up in the liver because the drainage system is lesions

build-up is toxic and kills hepatocytes, which elevates liver function markers (explaining diagnostic assay results)

built-up bile goes out into bloodstream; bilirubin in bile deposits in skin and creates visible jaundice

lesion in pancreatic head also shows spots on liver, possible migration of malignant pancreatic tumor cells through blood vessels to liver

tissue analysis: obtain tissue portions via surgical resection or needle-biopsy (biopsy is specifically diagnostic)

biopsy - ultrasound for liver spots, then use needle to pull tissue out

results from case study: liver spots show misshapen pancreatic ducts, indicating metastatic pancreatic ductal adenocarcinoma 

(adenocarcinoma: glandular cancer)

conclusion: no cure, only palliative chemotherapies available

jaundiced – give biliary stent to alleviate jaundice

death within three weeks of diagnosis

autopsy: tumor mass in pancreas, spots in liver imaging

tumor pushes into blood vessels in pancreas

thousands of pancreatic cancer tumors in liver and lungs

cancer progression in the pancreas

1. normal pancreatic duct, lined with epithelial cells

2. cancer: oncogenes and tumor suppressor genes are mutated

oncogenes acquire a gain-of-function mutation and cells proliferate

first few mutations are known as “neoplasia”, precancerous growths - pancreatic duct undergoes neoplastic transformation in structure

low-grade dysplasia - still within the origin organ/area, morphology is still alright

tumor suppressors acquire loss-of-function mutation and cells proliferate intensely | still a precursor lesion

high-grade dysplasia - morphology is distorted

when cancerous cells acquire metastatic movement functions and leave the origin site, this is a cancerous growth

3. invasion of cancerous epithelial duct cells into stroma and metastasis 

precursor lesions are benign and can be removed without incident

primary tumor growth in primary pancreas organ (asymptomatic silent growth, 5-10 years)

malignant lesions migrating into the stroma have access to blood vessels, through which they can metastasize 

metastatic cascade must occur for successful metastasis

1. tumor cell dissemination into bloodstream (most die in circulation)

2. disseminated cells land onto another organ and “colonize” it (could still stay benign)

3. seeded cells spread and grow in “outgrowth” (this is now a malignant metastatic cancer)

oligo-metastatic cancer - just a few sprouting sites, could be removed

widely metastatic cancer - sprout thousands of tumors in a relatively short amount of time | chemo-resistant and not removable by surgery

weight loss because tumor cells consume glucose and other metabolites

as long as malignant tumor has not metastasized, it can still be removed