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Cancer - Penis

Definition

Cancer of the penis is cancer that starts in the penis, an organ that makes up part of the male reproductive system.

Alternative Names

Penile cancer; Squamous cell cancer - penis

Causes

The exact cause is unknown.

Smegma, a cheese-like, foul-smelling substance found under the foreskin of the penis may increase the risk of penis cancer.

Uncircumcised men who do not keep the area under the foreskin clean and men with a history of genital warts or human papillomavirus (HPV) are at higher risk for this rare disorder.

Symptoms

• Genital lesions on the penis
• Painless sore on penis (occasionally, the lesion may cause pain)
• Penis pain and bleeding from the penis (may occur with advanced disease)

Exams and Tests

The health care provider will perform a physical exam, which may reveal a non-tender lesion that looks like a pimple or wart. This growth is typically near the end of the penis.

A biopsy of the growth is needed to confirm if it is cancer.

Treatment

Treatment depends on the location of the tumor and how much it has spread.

In general, cancer treatment includes:

• Chemotherapy -- uses medicines to kill cancer cells
• Radiation -- using high powered x-rays to kill cancer cells
• Surgery - cuts out and removes the cancer

If the tumor is small and near the tip of the penis, surgery may be done to remove only the cancerous part of the penis. This is called a partial penectomy.

For more severe tumors, total removal of the penis (total penectomy) is often necessary. A new opening will be created in the groin area to allow urine to exit the body. This procedure is called a urethrostomy.

Chemotherapy may be used along with surgery. Bleomycin is usually the chemotherapy drug of choice for treating penile cancer.

Radiation therapy is often recommended in combination with surgery. A type of radiation therapy called external beam therapy is often used. This method delivers radiation to the penis from outside the body. External beam radiation therapy is usually performed 5 days a week for 6 - 8 weeks.

Support Groups

It is recommended that you discuss your fears and concerns regarding sexual function and body image prior to surgery. Joining a support group where members share common experiences and problems may help relieve the stress associated with diagnosis and treatment of penile cancer.

See cancer - support group.

Outlook (Prognosis)

The outcome can be good with early diagnosis and treatment. The 5-year survival rate for penile cancers is 65%. Urination and sexual function can often be maintained even when a significant portion of the penis is removed.

Possible Complications

Cancer of the penis frequently spreads to other parts of the body (metastasizes) early in the course of the disease.

When to Contact a Medical Professional

Call your health care provider if symptoms of penis cancer develop.

Prevention

Circumcision may decrease the risk. Men who are not circumcised should be taught at an early age the importance of cleaning beneath the foreskin as part of their personal hygiene. Good personal hygiene and safer sexual practices, such as abstinence, limiting the number of sexual partners, and use of condoms to prevent genital herpes infection, may decrease the risk of developing penile cancer.

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Insect Bites And Stings

Definition

Insect bites and stings can cause an immediate skin reaction. The bite from fire ants and the sting from bees, wasps, and hornets are usually painful. Bites caused by mosquitoes, fleas, and mites are more likely to cause itching than pain.

Alternative Names

Bedbug bite; Bee sting; Bites - insects, bees, and spiders; Black widow spider bite; Brown recluse bite; Flea bite; Honey bee or hornet sting; Lice bites; Mite bite; Scorpion bite; Spider bite; Wasp sting; Yellow jacket sting

Considerations

In most cases, bites and stings can be easily treated at home. However, some people have a severe allergic reaction to insect bites and stings. This is a life-threatening allergic reaction known as anaphylaxis, and it requires urgent emergency care. Severe reactions can affect the whole body and may occur very quickly, often within minutes. These severe reactions can be rapidly fatal if untreated. Call 911 if you are with someone who has trouble breathing or goes

into shock.

Some spider bites, like those of the black widow or brown recluse, are also

serious and can be life-threatening. Most spider bites, however, are harmless. If bitten by an insect or spider, bring it for identification if this can be done quickly and safely.

Symptoms

The non-emergency symptoms vary according to the type of insect and the individual. Most people have localized pain, redness, swelling, or itching. You may also feel burning, numbness, or tingling.

First Aid

For emergencies (severe reactions):

1. Check the person's airways and breathing. If necessary, call 911 and begin rescue breathing and CPR.
2. Reassure the person. Try to keep him or her calm.
3. Remove nearby rings and constricting items because the affected area may swell.
4. Use the person's Epi-pen or other emergency kit, if they have one. (Some people who have serious insect reactions carry it with them.)
5. If appropriate, treat the person for signs of shock. Remain with the person until medical help arrives.

General steps for most bites and stings:

1. Remove the stinger if still present by scraping the back of a credit card or other straight-edged object across the stinger. Do not use tweezers -- these may squeeze the venom sac and increase the amount of venom released.
2. Wash the site thoroughly with soap and water.
3. Place ice (wrapped in a washcloth) on the site of the sting for 10 minutes and then off for 10 minutes. Repeat this process.
4. If necessary, take an antihistamine, or apply creams that reduce itching.
5. Over the next several days, watch for signs of infection (such as increasing redness, swelling, or pain).

DO NOT

• Do NOT apply a tourniquet.
• Do NOT give the person stimulants, aspirin, or other pain medication unless prescribed by the doctor.

When to Contact a Medical Professional

Call 911 if the person is having a severe reaction:

• Trouble breathing, wheezing, shortness of breath
• Swelling anywhere on the face
• Throat feels tight
• Feeling weak
• Turning blue

Prevention

• Avoid provoking insects whenever possible.
• Avoid rapid, jerky movements around insect hives or nests.
• Avoid perfumes and floral-patterned or dark clothing.
• Use appropriate insect repellants and protective clothing.
• Use caution when eating outdoors, especially with sweetened beverages or in areas around garbage cans, which often attract bees.
• For those who have a serious allergy to insect bites or stings, carry an emergency epinephrine kit (which requires a prescription). Friends and family should be taught how to use it if you have a reaction. Wear a medical ID bracelet.

References

Goldman L, Ausiello D, eds. Cecil Textbook of Medicine, 22nd ed. Philadelphia, Pa: Saunders; 2004.

Noble J, Greene HL, Levinsen W, eds. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001.

Auerbach PS, ed. Wilderness Medicine. 4th ed. St. Louis, Mo: Mosby; 2001.

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Sodium Carbonate Poisoning

Definition

Sodium carbonate (also known as washing soda or soda ash) is a chemical found in many household and industrial products. This article focuses on poisoning due to sodium carbonate.

Alternative Names

Sal soda poisoning; Soda ash poisoning; Disodium salt poisoning; Carbonic acid poisoning; Washing soda poisoning

Poisonous Ingredient

Sodium carbonate

Where Found

• Automatic dishwashing soaps
• Clinitest tablets
• Glass products
• Pulp and paper products
• Some bleaches
• Some bubble bath solutions
• Some steam iron cleaners

Note: This list is not all inclusive.

Symptoms

Symptoms may include:

• Breathing problems due to throat swelling
• Collapse
• Diarrhea
• Drooling
• Eye irration, redness, and pain
• Hoarseness
• Low blood pressure (may develop rapidly)
• Severe pain in the mouth, throat, chest, or abdominal area
• Shock
• Skin irritation
• Swallowing difficulty
• Vomiting

Home Care

Seek immediate medical help. Do NOT make a person throw up unless told to do so by Poison Control or a health care professional.

If the chemical is on the skin or in the eyes, flush with lots of water for at least 15 minutes.

If the chemical was swallowed, immediately give the person one glass of water or milk, unless instructed otherwise by a health care provider. Do NOT give water or milk if the patient is having symptoms (such as vomiting, convulsions, or a decreased level of alertness) that make it hard to swallow.

If the person breathed in the poison, immediately move him or her to fresh air.

Before Calling Emergency

If readily available, determine the following information:

• The patient's age, weight, and condition
• The name of the product (ingredients and strengths, if known)
• The time it was swallowed
• The amount swallowed

Poison Control

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Take the container with you to the hospital, if possible.

See: Poison control center - emergency number

What to Expect at the Emergency Room

The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The patient may receive:

• Endoscopy -- camera down the throat to see burns in the esophagus and the stomach
• Fluids
• Oxygen
• X-rays of chest and abdomen

Outlook (Prognosis)

Sodium carbonate is usually not very toxic. However, if you swallow very large amounts, you may have symptoms. In this rare situation, long-term effects, even death, are possible if you do not receive quick and aggressive treatment.

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Macular degeneration What is it?

Also known as: age-related macular degeneration (ARMD or AMD), age-related maculopathy (ARM), aged macular degeneration, and senile macular degeneration

What is it?

Macular degeneration is a condition in which the part of the eye called the macula becomes damaged. The macula is the central area of the retina. It contains hundreds of nerve endings, packed closely together, and is responsible for the sharpness of the visual image in the center of your field of vision. If the macula is damaged, you no longer have crisp central vision.

Who gets it?

Macular degeneration is a common problem for many people as they get older, both men and women. In fact, it is the most common cause of legal blindness in people over the age of 60. However, this condition is more common in whites than in African Americans, and tends to run in families. People who smoke and eat a diet that is high in saturated fats and low in antioxidants are at greater risk for developing macular degeneration as they age.

What causes it?

Macular degeneration is thought to be caused by hardening and blocking of the arteries (called arteriosclerosis) in the blood vessels that supply the retina. There are two forms of macular degeneration, wet and dry. With wet, also called exudative, macular degeneration, new, fragile blood vessels grow beneath the retina and leak blood and fluid. The leaks form a mound that is often surrounded by small areas of bleeding. This mound eventually shrinks, leaving a scar. The scarring and bleeding can quickly damage the macula. Dry, or atrophic, macular degeneration gradually breaks down the retina's dark-colored cell layer. There is no scarring, blood, or other fluid leakage. Both types of macular degeneration cause a blind spot to form in the center of the person's vision. However, the dry form is more common, and the loss of central vision progresses more slowly and is less severe. Other types of macular degeneration, which are not as common, include cystoid macular degeneration, diabetic macular degeneration, and senile disciform degeneration, also known as Kuhnt-Junius macular degeneration.

What are the symptoms?

The symptoms of macular degeneration may begin with distorted vision in one eye. For example, with the wet form of macular degeneration, straight lines might begin to appear wavy and a central blind spot develops. With the dry form, words may appear blurred or hazy and colors may look dim or gray. The loss of vision can occur slowly or suddenly, but it is always painless. While macular degeneration severely damages the patient's vision, it rarely leads to total blindness. It also has no effect on side (peripheral) vision. Macular degeneration usually affects both eyes, but may affect one eye before the other.

How is it diagnosed?

Macular degeneration is diagnosed according to the types of symptoms described by the patient and an examination of the retina. By putting drops in the eyes to dilate, or widen, the pupils, an eye care specialist (opthamalogist) can see physical changes in the macula sometimes even before symptoms begin. An instrument called an ophthalmoscope magnifies the retina in greater detail. The opthamalogist will also perform a visual field test to check for blank spots in the central vision. Patients who are suspected of having macular degeneration are usually given a central visual field test, called an Amsler grid, to take home with them.

The Amsler grid is printed on a piece of paper and consists of thin lines in a grid formation, with a dot in the center of the page. Patients are told to call the doctor if the lines appear wavy or missing when looking at the dot in the center of the page. The opthamalogist may perform a test called fluorescein angiography to check the retina more closely. With this test, the ophthalmologist injects a special dye into a vein, waits for the dye to reach the retina, then takes photographs of the retina. The photographs show any leaking blood vessels. Patients with macular degeneration are checked frequently for the progression of the disease.

What is the treatment?

There is currently no treatment for the dry form of macular degeneration, but it does progress very slowly. Visual aids, such as large print books, magnifying glasses, and telephones with large print, touch-tone dials are helpful. Wet form macular degeneration can be treated with laser surgery, called laser photocoagulation. Laser photocoagulation is a painless treatment in which a laser beam is aimed through the eye to destroy any new blood vessels and seal off those that are leaking. During the treatment, you may see bright flashes of light. Your vision will remain blurred for a few hours after the procedure and you may feel some discomfort in the eyes. The results of laser photocoagulation may be temporary and will only slow the progression of the disease. Another form of treatment for the wet form of macular degeneration is radiation therapy with either x-rays or a proton beam. Radiation therapy, like laser therapy, damages the abnormally growing blood vessels, but does not harm the nerve cells in the retina. Eating a diet that is rich in the antioxidants beta carotene; vitamins A, C and E; and the minerals selenium and zinc may help prevent or slow the progression of macular degeneration. Good sources of antioxidants include citrus fruits, cauliflower, broccoli, nuts, seeds, orange and yellow vegetables, cherries, blackberries, and blueberries. Other treatments still being studied include drug therapies to slow the growth of blood vessels, subretinal surgery, and photodynamic therapy (PDT). Your doctor can discuss the options with you and recommend the best type of treatment for your condition.

Self-care tips

Because early detection of any disease is extremely important, it's important to have regular eye exams, especially as you get older. You can help lower your risk for developing macular degeneration by not smoking and eating a diet that is rich in green, leafy vegetables and yellow vegetables, and low in saturated fat. Take an antioxidant vitamin supplement, especially vitamin A, to protect your eyes.

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This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.

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A bladder infection What is it?

What is it?

A bladder infection is an inflammation of the urinary bladder. The inner lining of the bladder becomes inflamed, and the urine becomes full of bacteria.

Who gets it?

Bladder infections are more common among women than men because of their shorter urethra, making it easer for bacteria from the anus or genital area to reach the bladder. Bladder infections often occur in young women who have just become sexually active and have sexual intercourse often. In addition, bladder infections can occur anytime the flow of urine is blocked or emptying of the bladder is incomplete due to an enlarged prostate in men or pregnancy in women.

What causes it?

Bacteria that have traveled up the urethra and into the bladder usually cause bladder infections. The most common bacteria associated with bladder infections in women include Escherichia coli (about eighty percent of cases), Staphylococcus saprophyticus , Klebsiella, Enterobacter , and Proteus species. Risk factors include sexual intercourse, use of a diaphragm for birth control, an abnormally short urethra, diabetes or chronic dehydration, the absence of a specific enzyme in vaginal secretions, inadequate personal hygiene and pregnancy.

In males, bladder infections are often the result of kidney complications or prostate infections. Bladder infections in men are most likely to be caused by E. coli or another gram-negative bacterium.

What are the symptoms?

Symptoms of a bladder infection in both men and women include painful urination, a sudden strong desire to urinate, an increase in the frequency of urination, cloudy urine that spells bad, and blood in the urine. Large quantities of blood in the urine may be caused by an acute bladder infection. Many patients also experience fever, pain in the lower back, nausea and vomiting and shaking chills.

How is it diagnosed?

To diagnose a bladder infection, the doctor will examine the patient and may test both the blood and urine. A laboratory test of the urine will reveal if bacteria is present, which usually indicates infection. The doctor may also examine the patient’s abdomen and lower back to check for bladder or kidney enlargements.

Female patients may also require a pelvic examination. Female patients with a reoccurring infection may also be given an ultrasound test of the kidneys and bladder to check for structural abnormalities.

What is the treatment?

Bladder infections are usually easily treated with antibiotics to kill the bacteria and prevent the spread of infection to the kidneys. Treatment for women is usually short-term; most patients respond within three days. Men do not respond as well to short-term treatment and may require seven to ten days of oral antibiotics. The doctor may also prescribe Pyridium, a medicine that helps reduce the pain and spasm of the bladder during the first couple of days.

Over fifty percent of older men with a bladder infection also suffer from infection of the prostate gland, so the doctor will treat that with antibiotics as well.

A minority of women with complicated bladder infections may require surgical treatment to prevent recurrent infections. Surgery is also used to treat reflux problems (movement of the urine backwards) or other anatomical abnormalities in males.

The patient may be asked to provide another sample of urine to be tested after all antibiotics have been take to make sure the infection is gone. Prompt treatment of a bladder infection with antibiotics usually controls the infection and relieves the symptoms in a day or two.

Self-care tips

To prevent another bladder infection, the female patient should drink large amounts of fluid, urinate frequently and empty the bladder each time, particularly after intercourse, and properly clean the area around the urethra. Female patients should also wipe from front to back after a bowel movement and wash the genital area after each bath or shower.

In males, the primary preventive measure is prompt treatment of prostate infections, drinking large amounts of fluid and frequently emptying the bladder. Men, especially if uncircumcised, should always wash the penis (gently pulling back the foreskin) during bathing.

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This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.

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