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

What is a bowel perforation or hole in your colon and what are the symptoms? Who is at risk? And how is a perforation treated? Overview Your colon is composed of layers of smooth muscle and mucous membranes. The innermost layer, called the mucosa, is soft and pliant—similar to the tissues in your mouth. Bowel perforations occur when a hole is made in this lining, often as a result of colon surgery or serious bowel disease. A hole in the colon then allows the contents of the colon to leak into the usually sterile contents of your abdominal cavity. Symptoms The symptoms of a bowel perforation can vary and may come on slowly or rapidly depending on the underlying cause. Symptoms may include: Abdominal pain (often severe and diffuse) Severe abdominal cramping Bloating Nausea and vomiting A change in your bowel movements or habits. Rectal bleeding Fever (usually not immediately) Chills Fatigue Risk Factors Scientists have found that a number of factors may increase your risk of developing a bowel perforation. These include both factors involved in surgery or a procedure (iatrogenic causes) and bowel diseases characterized by inflammation. Risk factors may include: Recent or prior abdominal. Recent or prior pelvic surgery. Age greater than 75. History of multiple medical problems. Trauma to the abdomen or pelvis (such as in an automobile accident.) A history of diverticular disease. A history of inflammatory bowel disease. Colon cancer Use of the monoclonal antibody immunotherapy drug ipilimumab. Pelvic adhesions (scar tissue, usually related to previous surgeries.) Female gender (women typically have a more flexible colon, which can lead to accidental perforation during medical procedures, including a colonoscopy.) Diagnostic and surgical procedures involving the digestive tract, abdomen, or pelvis. Risk factors for a perforation during a colonoscopy include being female, older age, a history of diverticular disease, and bowel obstructions. Causes Bowel perforations may occur spontaneously (unexpectedly) as a result of a medical condition or instead be a complication of various diagnostic and surgical procedures which accidentally create a hole in the colon. Trauma, especially blunt trauma to the abdomen, is also an important cause of bowel perforations. Procedure associated causes include: Enema – An improperly or forcefully inserted rectal tube for an enema can rip or push through the colon lining. Bowel preparation for colonoscopy - Rarely, the bowel preparation for a colonoscopy can result in a perforation. This is more common in people with a history of constipation. Sigmoidoscopy – Although the endoscope for a flexible sigmoidoscopy is flexible, perforation remains a risk, but a rare one. Colonoscopy – The tip of the endoscope has the potential to push through the inner lining of the colon, although this is a rare complication of the procedure and is not seen in the virtual colonoscopy. Perforation of the bowel associated with a colonoscopy is more common in those who have the severe acute disease of the bowel as well as those who are on steroid medications. The colonoscopy perforation rate appears to be around 1 in 1400 people who have screening colonoscopies and 1 of 1000 people who have a therapeutic colonoscopy (for example, to remove a polyp.) Abdominal or pelvic surgery, particularly colon surgery as for colon cancer. Causes of spontaneous bowel perforation (those unrelated to surgery or procedures) include: Inflammatory bowel disease/colitis such as Crohn's disease and ulcerative colitis. The lifetime risk of a bowel perforation with Crohn's disease is between one and three percent, making this a very common cause. Severe bowel obstruction, especially when the colon is "weakened" by diverticular disease, another process, or cancer. Trauma. Ischemic bowel disease (when the blood supply to the colon is compromised.) Colon cancer. Foreign body ingestion - Most commonly due to the ingestion of fish bones, and bone fragments, as well as non-food items. Severe bowel impaction. Diagnosis If your doctor suspects a bowel perforation, she can order tests to confirm her suspicion. A simple abdominal x-ray may show gas outside the colon but is not often diagnostic. A CT scan of your abdomen with or without contrast or a barium enema or swallow may be needed. A complete blood count may show an elevation of your white blood cell count if the perforation has been present for a while, or evidence of anemia due to bleeding. Small perforations may sometimes take several imaging studies and time to accurately diagnose. Treatment Perforation of the bowel is considered a medical emergency and requires immediate treatment. Left untreated, the contents of the bowel can leak out and cause inflammation, infection and even abscesses in your abdomen. The technical name for this is peritonitis, which is a painful precursor to sepsis—or a body-wide infection. The majority of perforations are surgically repaired. Depending on the location and size of the tear, the doctor might be able to fix it through an endoscope, similar to the one used during a colonoscopy—but this is not an option for everyone. Open bowel surgery may or may not result in a stoma and colostomy: an artificial opening outside of your stomach where stool drains into a small bag until the bowel is healed. Complications Complications of untreated perforation may include: Bleeding Infection (peritonitis and sepsis) Death Complications depend on a person's general health, as well as the amount of time it has taken to diagnose and treat the perforation. Recovery During your initial recovery period, you will not be able to drink or eat anything by mouth. This is called resting the bowels and allows the inner lining time to heal properly. You will also have a nasogastric tube in place to drain the contents of your stomach for a period of time. You may receive intravenous antibiotics and nutrition for a few days if you're in the hospital. Although you may be anxious to return to your normal routine, it's important that you give your colon time to heal properly, and follow your doctor's orders. The Bottom Line Bowel perforation may occur spontaneously, such as with inflammatory bowel disease, or during surgery or diagnostic tests. Symptoms may come on rapidly, or instead slowly, and should be considered in anyone who has risk factors for a perforation combined with risk factors for the condition. When caught early, there are different treatment options available, but even with surgery (which is most often required) the bowel can often be preserved and repaired without a colostomy. Recovery can take time, both for healing, and to correct and risk factors which led to the perforation.

Hemorrhoids are varicose (enlarged and swollen) veins around the outside of the anus or in the lower rectum. The rectum is the last part of the bowel that leads to the anus, the opening at the end of the bowel where fecal matter leaves the body. Everyone has hemorrhoidal tissue in this area that’s made up of blood vessels, connective tissue, and some muscle. These “cushions” don’t always become enlarged or distended, but as we age, this phenomenon becomes more common — causing what we call hemorrhoids, also known as piles. Hemorrhoids can be caused in a number of ways, often by straining to make a bowel movement. Lifting heavy objects, along with other activities that may cause straining, can also lead to hemorrhoids. Experiencing increased pressure during pregnancy and being overweight are other contributing factors. Hemorrhoids may be painful and particularly bothersome if they are recurrent, but they are not dangerous or life-threatening, and symptoms usually go away within a few days. There are plenty of effective ways to treat them, as well as options for the less common types of hemorrhoids that may be more problematic.

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.

Appendicitis is the swelling of the appendix which is present in the right side of the abdominal region. It is generally a 5-10 cm tube connected to the large intestine. If it is not treated at the right time it can burst out, spilling infection in the abdominal cavity that can be more fatal. Appendicitis can occur anytime between the age of 10 to 30. Both men and women can suffer from this condition. The infectious material or the puss which is formed inside the appendix can be more dangerous to life as it spreads in the entire abdominal cavity. Patient suffering from appendicitis ignore this because it seems like a common stomach pain. There are many causes that can cause appendicitis out of which one common cause is the blockage or obstruction in appendix. Obstruction can cause due to the bacteria multiply inside the organ causing the increase in the infection inside the appendix forming a puss. Symptoms: Patient suffering from appendicitis commonly have a pain in the right side of the abdomen. A raise temperature, means, they may feel that they are having fever. Nausea and vomiting, other symptoms includes abdominal swelling, inability to pass wind, painful urination. Dr Jiten Chowdhry notes that these treatments can cause appendix to burst if the patient is suffering from appendicitis. If you have tenderness in the right side of the consult a doctor. Diagnosis: Abdominal examination is done to detect the inflammation. A urine test is done. Rectal examination, CT scan and blood test is done to diagnose the appendicitis condition properly. Treatment and Recovery: Laparoscopic surgery is performed where a small incision is done in the lower right side. The recovery time is very short and the patient can get discharged within 3 to 4 days of the surgery.

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.