Anal cancer is rare, but the number of new cases is rising. According to the American Cancer Society, in 2017, there are likely to be about 8,200 new cases, of which 5,250 will affect women and 2,950 will affect men. Around 1,100 people are expected to die from anal cancer, including 650 women and 450 men. Various risk factors are linked to anal cancer, but infection with two types of the human papilloma virus (HPV) appear to underlie 79 percent of cases. Anal cancer is rare before the age of 35 years. The average age of diagnosis is in the early 60s. Men have a 1-in-500 chance of getting anal cancer, and the risk is slightly higher in women. Symptoms and signs Diagram of the sphincter Common symptoms of anal cancer may include rectal bleeding noticeable if there is blood on feces or toilet paper pain in the anal area lumps around the anus, which may be mistaken for piles, or hemorrhoids mucus or jelly-like discharge from the anus anal itching changes in bowel movements, including diarrhea, constipation, or thinning of stools fecal incontinence, or problems controlling bowel movements bloating women may experience lower back pain as the tumor presses on the vagina women may experience vaginal dryness. Causes In anal cancer, a tumor is created by the abnormal and uncontrolled growth of cells in the anus. The anus is the area at the very end of the gastrointestinal tract. The anal canal connects the rectum to the outside of the body. It is surrounded by a muscle known as the sphincter. The sphincter controls bowel movements by contracting and relaxing. The anus is the part where the anal canal opens to the outside. The anal canal is lined with squamous cells. These flat cells look like fish scales under the microscope. Most anal cancers develop from these squamous cells. Such cancers are known as squamous cell carcinomas. The point at which the anal canal meets the rectum is called the transitional zone. The transitional zone has squamous cells and glandular cells. These produce mucus which helps the stool, or feces, pass through the anus smoothly. Most anal cancers are squamous cell carcinomas, but adenocarcinoma can also develop from the glandular cells in the anus. Risk factors Multiple risk factors have been studied that are linked to anal cancer. They include any or a combination of the following: Human papilloma virus (HPV): Some types of HPV are closely linked to anal cancer. Around 79 percent of people with anal cancer have HPV 16 or 18, and 8 percent have other types of HPV. Multiple sexual partners: This activity increases the risk of contracting HPV, which, in turn, increases the risk of anal cancer, which is a known risk factor. Receptive anal intercourse: Men and women who receive anal intercourse have a higher risk of developing anal cancer. Men who are HIV-positive and who have sex with men are up to 90 times more likely to develop anal cancer, compared with the general population. Other cancers: Women who have had vaginal or cervical cancer, and men who have had penile cancer are at higher risk of developing anal cancer. This is also linked to HPV infection. Age: Anal cancer, like most cancers, are more likely to be detected at an older age. A weakened immune system: People with HIV or AIDS and those who are taking immunosuppressant medications after a transplant are at greater risk. Smoking: Smokers have a significantly higher risk of anal and other cancers than non-smokers. Benign anal lesions: Irritable bowel disease (IBD), hemorrhoids, fistulae, or cicatrices have been linked to anal cancer. Inflammation resulting from benign anal lesions may increase the risk. Treatment Treatment for anal cancer will depend on various factors, including how big the tumor is, whether or not it has spread, where it is, and the general health of the patient. Surgery, chemotherapy, and radiation therapy are the main options. Surgery The type of surgery depends on the size and position of the tumor. Resection The surgeon removes a small tumor and some surrounding tissue. This can only be done if the anal sphincter is not affected. After this procedure, the person will still be able to pass a bowel movement. Abdominoperineal resection The anus, rectum and a section of the bowel are surgically removed, and a colostomy will be established. In a colostomy, the end of the bowel is brought out to the surface of the abdomen. A bag is placed over the stoma, or the opening. The bag collects the stools outside the body. A person with a colostomy can lead a normal life, play sports, and be sexually active. Chemotherapy and radiotherapy Most patients will probably need chemotherapy, radiation therapy, or both. Radiation therapy may be combined with chemotherapy to destroy anal cancer cells. Treatments may be given together or one after the other. This approach increases the chance of retaining an intact anal sphincter. Survival and remission rates are good. Chemotherapy uses cytotoxic drugs that prevent the cancer cells from dividing. They are given orally or by injection. Radiotherapy uses high-energy rays that destroy the cancer cells. Radiation can be delivered internally or externally. Radiotherapy and chemotherapy have adverse effects, and combining them may make the side effects more acute. Side effects may include: diarrhea or constipation soreness and blistering around the target area, which is the anus a higher susceptibility to infections during treatment fatigue loss of appetite nausea or vomiting mouth ulcers or sore mouth loss of hair narrowing and dryness of the vagina a low white blood cell count, increasing the risk of infection anemia, due to a low red blood cell count a low platelet count, raising the risk of bruising or bleeding dry skin rashes muscle and nerve problems excessive coughing and sometimes breathing difficulties fertility problems

Anal Fistula When an irregular false tract occurs between the inside of the rectum and the outside skin surface, an Anal Fistula forms. The anal fistula is classified according to the condition of the tract and the relation of the internal opening to the anal sphincter muscle. Most commonly, this condition develops because of an anal abscess that went untreated. The anal abscess itself is usually the result of a small gland that becomes infected. The most common symptoms are pain, recurrent swelling, pus discharge and discomfort during the discharge of stool. The most common treatment in India is a surgical treatment; the most common method is the minimally invasive Video Assisted Anal Fistula Treatment. Symptoms What are the typical symptoms of anal-fistula? Swelling around the anal area Redness around the rectal area Pus drainage Rectal pain. Causes What causes anal fistulas? It usually occurs as a result of some damage to the tissue around the anus. It begins as a sort of inflammation in the rectal area. Later, it becomes an abscess which gets regularly infected and reinfected by faeces. This causes the fistula to form near the anus. If the fistula seals over, pus can start accumulating. Because of this pus-drain, anal fistulas can be very painful. Anal fistulas usually occur because of: An injury caused by constipation Anal glands becoming infected Crohn’s disease Abscess of the large intestine

When the skin of the anus gets cut or damaged, that is called an anal fissure. It is very similar to what happens when our dry lips get chaffed. Fissures typically bleed and cause pain, which is why they are often confused with haemorrhoids/ piles. When the anal muscles are stretched too far, it usually causes strain on the anus. This can occur to people who suffer from constipation or prolonged diarrhoea. It also occurs for older patients due to decreased blood flow to the anal area. It is not uncommon for women to develop anal fissures after giving birth as well. And it can also happen to people who have Crohn’s disease. With more severe cases of anus tearing, an external lump will form on the anus. These are the sentinel piles tell-tale of chronic fissures. The issue of anal fissures can be solved by medicine or by surgery and also by laparoscopic treatment. Symptoms Some signs and symptoms of anal fissures : Pain during bowel movement Pain after the bowel movements Blood on the stool or toilet paper Anal itching Visible damage to the skin of the anus A small lump that’s close to the anal fissure. Treatments Chemical Sphincterotomy Chemical Sphincterotomy is basically a Botox Injection for anal fissures; it is a very common Treatment for Anal Fissures. If the anal fissure doesn’t heal, it’s usually because of the spasm of the internal anal sphincter muscle which reduces blood supply to that area and further aggravation occurs to the fissure during the passage of motion through a spasmodic anal canal. The Botox is injected into the anal sphincter. This injection is used to prevent spasm and cause temporary paralytic relaxation until the tissues are renewed. The effects last for three months and the anal fissure heals during that time. Percutaneous Closed Lateral Internal Sphincterotomy This surgery, popularly known as CLIS, is a quick minimal invasive surgical method performed by specialized doctors under local anaesthesia that is used to treat chronic anal fissures. It is performed on the internal part of the anal muscle, the internal anal sphincter. The surgical procedure basically lowers the pressure of the internal anal sphincter and the spasm is reduced by dividing this internal anal sphincter. The fissure is healed because anal spasm is lowered and blood flow to the area is improved. Due to the closed technique, the wound is smaller and it heals faster.

Umbilical hernia is a bulge form in abdomen. In children, it is healed on its own but if this disease occurs in adults then a surgery is needed. The surgery of Umbilical hernia is done by laparoscopic surgery and is less risky. Symptoms: Umbilical hernia is called so because these types of hernia are present near the umbilicus area or the naval area of the abdomen. When occurred in children of around 2 to 3 years, it can be seen that it heals on their own. The common symptom of this type of hernia is discomfort and severe pain. Patient suffering from umbilical hernia have severe pain and have a bulge in near the naval area. They have difficulty in lifting things. Diagnosis of Umbilical Hernia: Physical examination is done. The doctor will see if the hernia can be reduced. Further diagnosis is done with the help of X-ray and ultrasound. Treatment and Recovery: Surgeon does an incision at the naval area of the abdomen where the bulge is present. They push the tissue back inside the stomach wall. Time taken for surgery is approximately an hour. The recovery is fast as the approach used here is laparoscopic approach.

What does it mean varicose veins endovenous ablation? vein-ablation-procedureVaricose pathology and its best methods of treatment have been developed for the last decades. Duplex ultrasound testing and its widespread promotion influence on varicose pathology treatment. Duplex ultrasound testing gives a doctor an opportunity to examine the reason of varicose veins appearance. Blood flows through arteria from the heart into legs and back to the heart through veins. Duplex ultrasound image depicts veins and gives an opportunity to check the blood flow. Ultrasound testing should be done while treating any varicose pathology in order to find out the blood flow direction that leads to varicose veins appearance. Leg veins have non-return valves that that block the blood from running down. If the valves do not work properly (so called ineffective valves), the blood inspissates and leads to varicose veins. Individual plan of treatment will be worked out for every patient, after an ultrasound testing and after veins examination by a doctor. Individual plan of treatment consists of: Endovenous laser ablation means a closure of an injured vessel by using laser energy. Endovenous radiowave ablation a closure of an injured vessel by using radiowave energy. Ultrasound sclerotherapy means that a special medicine (called sclerosant) is used to block veins. Miniflebectomy is a surgical removal of damaged veins with minimal cuts (5mm). Preparation of varicose veins to ablation csm_mapping_prae_op_1_01_9be4aee32cA surgeon will discuss with a patient, beafore planning the procedure, all the nuances of the procedure, probable complications, all the advantages and disadvantages of treatment and probable alternatives. A patient should inform a surgeon about all the medicine he or she takes in, about disease he or she has and about allergies ( local anesthetic allergy or allergy n medicine that is used during scleropherapy). A surgeon, before a procedure, may advise you to stop using blood thinners drugs, nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen etc) or can offer alternative drugs. Come to a procedure in comfortable clothes, all the jewellery should be erased as well. Special supportive tights should be worn after the procedure. They may be bought in pharmasy or a patient may buy them in our clinic. Supportive tights should be worn for 24 hours after a procedure (or longer according to doctor’s order ), and then tights should be worn for 5-10 days. Moderate pain and irritation may appear during the several days after the treatment, a surgeon will reccomend you suitable analgetic. Veins treatment is done by local anesthesia and general anesthesia is not needed. Laser and radiowave ablation Ultrasound veins testing has been done before the treatment. It has been done in order to identify the size of treated area. A leg is washed and shaved if it is needed, it is also aseptisized. If laser energy is used during the procedure, the special glasses will be given to a patient. Laser or radiowave probe is injected under local anesthesia. Laser or radiowave catheter, under ultrasound control, is injected into injured veins through small holes. Injured area treatment has been done under local anesthesia. Laser ray or radiowave catheter sends energy pulse that closes veins. A detector moves through a vein and closes it step by step. Veins, that are situated nearby, are remained intacted. Later laser ray or radiowave catheter is erased, bleeding is stopped by pressure. The cut is tapd by plaster. Supportive tights are put on the legs. After the treatment images-8Discomfort, measurable pain, swelling and bruises may appear after the treatment.Taking into consideration swelling and bruises can appear and the fact that you should wear supportive tights we reccomend you to plan your treatment during cold season. Partial loss of sensetivity may appear in treated area for some days. In some cases the recovery may last up to 6 months. Inflammation may, rarely, appear after 7 -21 days and it may last up to 10 days. If a patient feels intention in a shin-bone, swelling or redness of a treated area please contact the clinic. Mostly all of treated veins disappear after the procedure; some of them may be noticed during 6 months. Skin colour may be yellow in treated area, the colour will disappear in some weeks. How long veins ablation treatment takes? The treatment takes 45-60 minutes. If a surgeon reccomends you to compound the treatment with other varicose veins prosedures (for example,withminiflebectomy, sclerotherapy) it takes 1,5-2 hours. If two legs need to be treated, we reccomend to take two procedures within one month (one leg may be treated for oneprocedure ). Supportive tights or stockings should be worn for 30-45 minutes every day. Are there any complications of endovenous ablation? Endovenous ablation is quite safe and does not have any complications. There are not any scars left after the treatment. One patient out of 1000 may have wound infection. Antibiotics treatment is needed in case of inflammation. Some patients seldom have swelling and bruises, supportive tights will help in this case. Complications based on nerve injury are quite uncommon. One patient out of twenty may have an inflammatory reaction of treated veins that may be treated easily by using nonsteroidal anti-inflammatory drugs (ibuprofen, for example, and etc.). Cooling compress is quite effective as well. Deep vein thrombosis is a dangerous complication. In order to prevent it, we maintain a control after the treatment. Varicose veins are a chronic issue, even after the treatment it can appear in other areas. According to some investigations the ablation method proves its effectiveness. It is effective in 85-97% even in 10 years after the treatment. Endovenous ablation advantages There is no need to do any surgical cuts in case of intravenous ablation. 2 mm cuts have been done during the treatment and there is no need of saturation. In comparison with surgical intervention there are less complications and pain during endovenous ablation. Endovenous ablation treatment is a minimally invasive alternative of surgical intervention. The majority of patients stop complaining about itch, swelling and heavy legs after the procedure. Patients may quickly turn to daily routine. When should patients feel the result of the treatment? The result of endovenous ablation appears immediately in 95-100% cases and it remains the same in 85-97% cases in ten years. Due to the results of investigations, radio-wave ablation treatment proves its effectiveness in 99.6% cases for a term of two years Not so many investigations are held that could show us how patients spend their daily life after the treatment, but life becomes better. Endovenous ablation is regarded as a “gold standard” in many developed countries. Treatment in Estmedica Clinic The majority of modern, widespread technologies and different methods of varicose treatment are acceptable in our clinic. World leaders in medicine sphere teach our doctors. They use different treatment methods that provide minimally invasive treatment of varicose veins.

Hernias will not go away by themselves. Surgery is the only way to repair a hernia. A hernia repair returns the organ or structure to its proper place and fixes the weakened area of muscle or tissue. Having surgery is a big decision. It can be tempting to put it off, and that may be okay in some cases. Before you decide, make sure you understand the risks and benefits of your decision. Here are some things to consider and discuss with the doctor who is helping you make the decision. How Is the Hernia Affecting You? The first thing to consider is whether or not you are experiencing symptoms. Not everyone has symptoms with a hernia, especially small ones. When symptoms occur, the most common one is pain. Others can include a feeling of heaviness or fullness in the belly or groin. Whether you have symptoms or not, a hernia can also interfere with your leisure activities and your work. So you also need to recognize if you are taking time off from work or interests due to your hernia. Delaying surgery may mean you spend more time away from work and fun instead of returning to activities after recovery. If you have symptoms, especially pain, your doctor is likely to recommend surgery. But what if you don’t have symptoms or they are minimal? In this case, your doctor may recommend watchful waiting. Before you agree to watchful waiting, be sure your doctor knows the whole story. Be honest about any limitations your hernia puts on your time and activities. What Are the Risks of Waiting? 1. Hernias can become incarcerated. One potentially serious risk of not fixing a hernia is that it can become trapped outside the abdominal wall—or incarcerated. This can cut off the blood supply to the hernia and obstruct the bowel, resulting in a strangulated hernia. This requires urgent surgical repair. Not all hernias progress to this point, but it is a risk nonetheless. Avoiding an emergency situation that you can’t control is one reason to consider not delaying surgery. 2. Hernias grow. A more likely scenario is that your hernia will continue to grow and weaken with time. This is likely to increase your symptoms, including pain, and cause more changes to your lifestyle. Surgeons know that smaller hernias are easier to repair than larger hernias. Going ahead with surgery instead of delaying it can prevent your symptoms from getting worse. It can also help you avoid losing work or missing activities. 3. Hernias require surgery eventually. Even if you aren’t having symptoms, you may still want to consider having surgery sooner rather than later. Surgery for a hernia is somewhat inevitable in most cases. Research shows that most people with hernias have surgery within 10 years. Keep in mind that delaying surgery until your hernia is larger and the muscles are weaker may make surgery and recovery more difficult. 4. Your overall health may change. Your age may determine whether waiting is a risk for you. Putting off surgery for years down the road may mean you are not in as good overall health or physical shape. This will also affect your surgery and recovery. So having surgery at a younger age can be beneficial. However, if you are elderly (older than about 75 years of age), not very active, and your hernia isn’t causing problems, it may be better to not fix it. The risks of surgery may outweigh the benefit of repair. Making the Decision Surgery is never convenient and life is always busy. Being in control of when you have surgery is a huge benefit of not delaying your hernia repair. You can schedule your surgery at your convenience. And if you are a candidate for laparoscopic hernia surgery, you’ll be back to life and work sooner than in years past. Surgery should be easier on you and recovery will likely be smoother at a younger age and with a smaller hernia. Ultimately, your doctor is best able to help you decide whether watchful waiting or surgery is the best option for you.