Polyps are growths of tissue that may be attached by a stalk-like structure (a pedicle). Polyps are commonly found in organs with many blood vessels. Such organs include the uterus, colon, and nose.
Some polyps are cancerous (malignant) and the cancer cells are likely to spread. Most polyps are noncancerous (benign). The most common site of polyps that are treated is the colon.
How a polyp biopsy is done depends on the location:
· Colonoscopy or flexible sigmoidoscopy explores the large bowel
For areas of the body that can be seen or where the polyp can be felt, a numbing medicine is applied to the skin. Then a small piece of the tissue that appears to be abnormal is removed. This tissue is sent to a laboratory. There, it is tested to see if it is cancerous.
A decreased appetite is almost always seen among elderly adults, and no physical cause may be found. But emotions such as sadness, depression, or grief can lead to a loss of appetite.
Cancer can also cause decreased appetite. You may lose weight without trying. Cancers that may cause you to lose your appetite include:
People with cancer or a chronic illness need to increase their protein and calorie intake by eating high-calorie, nutritious snacks or several small meals during the day. Liquid protein drinks may be helpful.
Family members should try to supply favorite foods to help stimulate the person's appetite.
Keep a record of what you eat and drink for 24 hours. This is called a diet history.
Call your health care provider if you are losing a lot of weight without trying.
Seek medical help if decreased appetite occurs along with other signs of depression, drug or alcohol abuse, or an eating disorder.
For loss of appetite caused by taking medications, ask your health care provider about changing the dosage or drug. Do not stop taking medications without first talking to your health care provider.
The health care provider will perform a physical exam and will check your height and weight.
The health care provider will ask about diet and medical history. Questions may include:
· Is the decreased appetite severe or mild?
· Have you lost any weight? How much?
· Is the decreased appetite a new symptom?
· If so, did it start after an upsetting event, such as the death of a family member or friend?
· What other symptoms are present?
Tests may be done to determine the cause of decreased appetite. These may include imaging tests, such as x-ray or ultrasound. Blood and urine tests may also be ordered.
In cases of severe malnutrition, nutrients are given through a vein (intravenously). This may require a hospital stay.
Multiple myeloma is a cancer that forms in a type of white blood cell called a plasma cell. Plasma cells help you fight infections by making antibodies that recognize and attack germs.
Multiple myeloma causes cancer cells to accumulate in the bone marrow, where they crowd out healthy blood cells. Rather than produce helpful antibodies, the cancer cells produce abnormal proteins that can cause kidney problems.
Treatment for multiple myeloma isn't always necessary. If you're not experiencing signs and symptoms, you may not require treatment. If signs and symptoms develop, a number of treatments can help control your multiple myeloma.
Signs and symptoms of multiple myeloma can vary and, early in the disease, there may be none.
When signs and symptoms do occur, they can include:
Make an appointment with your doctor if you have any persistent signs and symptoms that worry you.
It's not clear what causes myeloma.
Doctors know that myeloma begins with one abnormal plasma cell in your bone marrow — the soft, blood-producing tissue that fills in the center of most of your bones. The abnormal cell multiplies rapidly.
Because cancer cells don't mature and then die as normal cells do, they accumulate, eventually overwhelming the production of healthy cells. In the bone marrow, myeloma cells crowd out healthy white blood cells and red blood cells, leading to fatigue and an inability to fight infections.
The myeloma cells continue trying to produce antibodies, as healthy plasma cells do, but the myeloma cells produce abnormal antibodies that the body can't use. Instead, the abnormal antibodies (monoclonal proteins, or M proteins) build up in the body and cause problems, such as damage to the kidneys.
Multiple myeloma almost always starts out as a relatively benign condition called monoclonal gammopathy of undetermined significance (MGUS).
In the United States, about 3 percent of people older than age 50 have MGUS. Each year, about 1 percent of people with MGUS develop multiple myeloma or a related cancer.
MGUS, like multiple myeloma, is marked by the presence of M proteins — produced by abnormal plasma cells — in your blood. However, in MGUS, the levels of M proteins are lower and no damage to the body occurs.
Factors that may increase your risk of multiple myeloma include:
· Increasing age. Your risk of multiple myeloma increases as you age, with most people diagnosed in their mid-60s.
· Male sex. Men are more likely to develop the disease than are women.
· Black race. Blacks are about twice as likely to develop multiple myeloma as are whites.
· History of a monoclonal gammopathy of undetermined significance (MGUS). Every year 1 percent of the people with MGUS in the United States develop multiple myeloma.
Complications of multiple myeloma include:
· Frequent infections. Myeloma cells inhibit your body's ability to fight infections.
· Bone problems. Multiple myeloma also can affect your bones, leading to bone pain, thinning bones and broken bones.
· Reduced kidney function. Multiple myeloma may cause problems with kidney function, including kidney failure. Higher calcium levels in the blood related to eroding bones can interfere with your kidneys' ability to filter your blood's waste. The proteins produced by the myeloma cells can cause similar problems.
· Low red blood cell count (anemia). As myeloma cells crowd out normal blood cells, multiple myeloma can also cause anemia and other blood problems.
If you have any signs or symptoms that worry you, make an appointment with your doctor.
If you're diagnosed with multiple myeloma, you'll likely be referred to a doctor who specializes in treating blood and bone marrow disorders (hematologist) or a doctor who specializes in treating cancer (oncologist).
Because appointments can be brief and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready and know what to expect from your doctor.
· Note symptoms you're experiencing. If you have had signs and symptoms of illness or are just not feeling well, write down those details before your appointment. Your doctor will also want to know when you first noticed these symptoms and whether they've changed over time.
· List other medical conditions. Your doctor will be especially interested to know if you've been diagnosed with any other plasma disorders, such as monoclonal gammopathy of undetermined significance (MGUS).
· Make a list of your medications. Include any prescription or over-the-counter medications you're taking, as well as all vitamins, supplements and herbal remedies.
· Take a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
· Write down questions to ask your doctor.
Questions to ask your doctor at your initial appointment include:
· What may be causing my symptoms or condition?
· Are there any other possible causes?
· What kinds of tests do I need?
· What do you recommend for next steps in determining my diagnosis and treatment?
· Are there any restrictions that I need to follow in the meantime?
Questions to consider if your doctor refers you to a specialist include:
· Do I have multiple myeloma?
· What stage of myeloma do I have?
· Does my myeloma have any high-risk features?
· What are the goals of treatment in my case?
· What treatment do you recommend?
· I have these other health problems. How can I best treat them together with multiple myeloma?
· What are the possible side effects of treatment?
· If the first treatment isn't successful, what will we try next?
· Am I a candidate for stem cell transplantation?
· Do I need a medicine to strengthen my bones?
· What is the outlook for my condition?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
Your doctor is likely to ask you a number of questions. Thinking about your answers ahead of time can help you make the most of your appointment. A doctor who sees you for possible multiple myeloma may ask:
· What are your symptoms, if any?
· When did you first begin experiencing symptoms?
· How have your symptoms changed over time?
· Do your symptoms include bone pain? Where?
· Do your symptoms include nausea, lost appetite or weight loss?
· Do your symptoms include weakness or fatigue?
· Have you had repeated infections, such as pneumonia, sinusitis, bladder or kidney infections, skin infections, or shingles?
· Have you noticed any changes in your bowel habits?
· Have you been more thirsty or urinated more than usual?
· What else concerns you?
· Do you have any family history of plasma disorders such as MGUS?
· Have you been diagnosed or treated for any other medical conditions?
· Do you have a history of blood clots?
· What medications are you taking?
In some cases, your doctor may detect multiple myeloma accidentally when you undergo a blood test for some other condition. In other cases, your doctor may suspect multiple myeloma based on your signs and symptoms.
Tests and procedures used to diagnose multiple myeloma include:
· Blood tests. Laboratory analysis of your blood may reveal the M proteins produced by myeloma cells. Another abnormal protein produced by myeloma cells — called beta-2-microglobulin — may be detected in your blood and give your doctor clues about the aggressiveness of your myeloma.
Additionally, blood tests to examine your kidney function, blood cell counts, calcium levels and uric acid levels can give your doctor clues about your diagnosis.
· Urine tests. Analysis of your urine may show M proteins, which are referred to as Bence Jones proteins when they're detected in urine.
· Examination of your bone marrow. Your doctor may remove a sample of bone marrow for laboratory testing. The sample is collected with a long needle inserted into a bone (bone marrow aspiration and biopsy).
In the lab, the sample is examined for myeloma cells. Specialized tests, such as fluorescence in situ hybridization (FISH) can analyze myeloma cells to understand their chromosome abnormalities. Tests are also done to measure the rate at which the myeloma cells are dividing.
· Imaging tests. Imaging tests may be recommended to detect bone problems associated with multiple myeloma. Tests may include X-ray, MRI, CT or positron emission tomography (PET).
If tests indicate you have multiple myeloma, your doctor will use the information gathered from the diagnostic tests to classify your disease as stage 1, stage 2 or stage 3. Stage 1 indicates a less-aggressive disease and stage 3 indicates an aggressive disease that may affect bone, kidneys and other organs.
Your multiple myeloma may also be assigned a risk category, which indicates the aggressiveness of your disease.
Your multiple myeloma stage and risk category help your doctor understand your prognosis and your treatment options.
If you're experiencing symptoms, treatment can help relieve pain, control complications of the disease, stabilize your condition and slow the progress of the disease.
If you have multiple myeloma but aren't experiencing any symptoms (smoldering multiple myeloma), you may not need treatment. However, your doctor will regularly monitor your condition for signs the disease is progressing. This may involve periodic blood and urine tests.
If you develop signs and symptoms or your multiple myeloma shows signs of progression, you and your doctor may decide to begin treatment.
Though there's no cure for multiple myeloma, with good treatment results you can usually return to near-normal activity.
Standard treatment options include:
· Targeted therapy. Targeted drug treatment focuses on specific abnormalities within cancer cells that allow them to survive. Bortezomib (Velcade) and carfilzomib (Kyprolis) are targeted drugs that block the action of a substance in myeloma cells that breaks down proteins. This action causes myeloma cells to die. Both medications are administered through a vein in your arm.
· Biological therapy. Biological therapy drugs use your body's immune system to fight myeloma cells. The drugs thalidomide (Thalomid), lenalidomide (Revlimid) and pomalidomide (Pomalyst) enhance the immune system cells that identify and attack cancer cells. These medications are taken in pill form.
· Chemotherapy. Chemotherapy drugs kill fast-growing cells, including myeloma cells. Chemotherapy drugs can be given through a vein in your arm or taken in pill form. High doses of chemotherapy drugs are used before a stem cell transplant.
· Corticosteroids. Corticosteroids, such as prednisone and dexamethasone, regulate the immune system to control inflammation in the body. They also are active against myeloma cells. Corticosteroids can be taken in pill form or administered through a vein in your arm.
· Stem cell transplantation. A stem cell transplant is a procedure to replace your diseased bone marrow with healthy bone marrow.
Before a stem cell transplant, blood-forming stem cells are collected from your blood. You then receive high doses of chemotherapy to destroy your diseased bone marrow. Then your stem cells are infused into your body, where they travel to your bones and begin rebuilding your bone marrow.
· Radiation therapy. This treatment uses beams of energy, such as X-rays, to damage myeloma cells and stop their growth. Radiation therapy may be used to quickly shrink myeloma cells in a specific area — for instance, when a collection of abnormal plasma cells form a tumor (plasmacytoma) that's causing pain or destroying a bone.
Which combination of treatments you're likely to receive will depend on whether you're considered a good candidate for stem cell transplant. This depends on the risk of your disease progressing, your age and your overall health.
· If you're considered a candidate for stem cell transplant, your initial therapy will likely include a combination of treatments, such as targeted therapy, biological therapy, corticosteroids and, sometimes, chemotherapy.
Your stem cells will likely be collected after you've undergone a few months of treatment. You may undergo the stem cell transplant soon after your cells are collected or the transplant may be delayed until after a relapse, if it occurs. In some cases, doctors recommend two stem cell transplants for people with multiple myeloma.
After your stem cell transplant, you'll likely receive targeted therapy or biological therapy as a maintenance treatment to prevent a recurrence of myeloma.
· If you're not considered a candidate for stem cell transplant, your initial therapy will likely include chemotherapy combined with corticosteroids, targeted therapy or biological therapy.
In select cases, doctors use a reduced-intensity stem cell transplant in older people who are in very good health but can't tolerate the strong chemotherapy doses used in a traditional stem cell transplant. A reduced-intensity or "mini" stem cell transplant uses lower doses of chemotherapy.
· If your myeloma recurs or doesn't respond to treatment, your doctor may recommend repeating another course of the treatment that initially helped you. Another option is trying one or more of the other treatments typically used as first line therapy, either alone or in combination.
Research on a number of new treatment options is ongoing, and you may be eligible for a clinical trial in order to gain access to those experimental treatments. Talk to your doctor about what clinical trials may be available to you.
Because multiple myeloma can cause a number of complications, you may also need treatment for those specific conditions. For example:
· Bone pain. Pain medications, radiation therapy and surgery may help control bone pain.
· Kidney complications. People with severe kidney damage may need dialysis.
· Infections. Your doctor may recommend certain vaccines to prevent infections, such as the flu and pneumonia.
· Bone loss. Your doctor may recommend medications called bisphosphonates, such as pamidronate (Aredia) or zoledronic acid (Zometa), to help prevent bone loss.
· Anemia. If you have persistent anemia, your doctor may recommend medications to increase your red blood cell count.
No alternative medicines have been found to treat multiple myeloma. But alternative medicine may help you cope with the side effects of myeloma and myeloma treatment.
Talk to your doctor about your options, such as:
· Acupuncture
· Aromatherapy
· Massage
· Meditation
· Relaxation techniques
Talk with your doctor before trying any of these techniques to make sure they don't pose any risks for you.
A cancer diagnosis can be shocking and devastating. With time, you'll find ways to cope with the stress and uncertainty of living with cancer. Until you find what works best for you, consider trying to:
· Learn enough to make decisions about your care. Learn enough about multiple myeloma so that you can participate in making decisions about your treatment and care. Ask your doctor about your treatment options and their side effects.
You may find additional help gathering information through your local library and online. Start with the National Cancer Institute and the International Myeloma Foundation.
· Maintain a strong support system. Having a strong support system can help you cope with issues and anxieties that might occur. Your friends and family may be willing to offer support.
You might also find that support from a formal support group or others coping with cancer may be helpful. Friends you meet in support groups may be willing to share practical advice for coping with cancer and cancer treatment. Support groups are also available online.
· Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But don't choose goals you can't possibly reach. You may not be able to work a 40-hour week, for example, but you may be able to work at least part time. In fact, many people find that continuing to work during cancer treatment can be helpful in maintaining some normalcy.
· Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer. Also, plan ahead for the downtimes when you may need to rest more or limit what you do.
Gastrointestinal (GI) bleeding refers to any bleeding that starts in the gastrointestinal tract.
Bleeding may come from any site along the GI tract, but is often divided into:
· Upper GI bleeding: The upper GI tract includes the esophagus (the tube from the mouth to the stomach), stomach, and first part of the small intestine.
· Lower GI bleeding: The lower GI tract includes much of the small intestine, large intestine or bowels, rectum, and anus.
The amount of GI bleeding may be so small that it can only be detected on a lab test such as the fecal occult blood test. Other signs of GI bleeding include:
· Dark, tarry stools
· Larger amounts of blood passed from the rectum
· Small amounts of blood in the toilet bowl, on toilet paper, or in streaks on stool (feces)
· Vomiting blood
Massive bleeding from the GI tract can be dangerous. However, even very small amounts of bleeding that occur over a long period of time can lead to problems such as anemia or low blood counts.
Once a bleeding site is found, many therapies are available to stop the bleeding or treat the cause.
Your provider may discover GI bleeding during an exam at your office visit.
GI bleeding can be an emergency condition that requires immediate medical care. Treatment may involve:
· Blood transfusions
· Fluids and medicines through a vein
· Esophagogastroduodenoscopy (EGD). A thin tube with a camera on the end is passed through your mouth into your esophagus, stomach, and small intestine
· A tube is placed through your mouth into the stomach to drain the stomach contents (gastric lavage)
Once your condition is stable, you will have a physical exam and a detailed exam of your abdomen. You will also be asked questions about your symptoms, including:
· When did you first notice symptoms?
· Did you have black, tarry stools or red blood in the stools?
· Have you vomited blood?
· Did you vomit material that looks like coffee grounds?
· Do you have a history of peptic or duodenal ulcers?
· Have you ever had symptoms like this before?
· What other symptoms do you have?
Tests that may be done include:
· Abdominal CT scan
· Abdominal MRI scan
· Abdominal x-ray
· Angiography
· Bleeding scan (tagged red blood cell scan)
· Blood clotting tests
· Capsule endoscopy (camera pill that is swallowed to look at the small intestine)
· Colonoscopy
· Complete blood count (CBC), clotting tests, platelet count, and other laboratory tests
Cancer that begins in glandular (secretory) cells. Glandular cells are found in tissue that lines certain internal organs and makes and releases substances in the body, such as mucus, digestive juices, or other fluids. Most cancers of the breast, pancreas, lung, prostate, and colon are adenocarcinomas.
Adenocarcinoma in-situ is a condition in which abnormal cells are found in the glandular tissue that lines certain internal organs, such as the uterus, cervix, lung, pancreas, and colon. Adenocarcinoma in situ, which occurs most often in the cervix, may become cancer and spread to nearby normal tissue. Also called AIS.
