The Neem Tree

The Neem Tree

The NEEM tree (Azadirachta indica) is a tropical evergreen tree native to India and is also found in other southeast countries. In India, neem is known as “the village pharmacy” because of its healing versatility, and it has been used in Ayurvedic medicine for more than 4,000 years due to its medicinal properties. Neem is also called ‘arista’ in Sanskrit- a word that means ‘perfect, complete and imperishable’. The seeds, bark and leaves contain compounds with proven antiseptic, antiviral, antipyretic, anti-inflammatory, anti-ulcer and antifungal uses. The Sanskrit name ‘nimba’ comes from the term ‘nimbati syasthyamdadati’ which means ‘to give good health’.

The earliest documentation of neem mentioned the fruit, seeds, oil, leaves, roots and bark for their advantageous medicinal properties. These benefits are listed in the ancient documents ‘Carak- Samhita’ and ‘Susruta-Samhita’, the books at the foundation of the Indian system of natural treatment, Ayurveda. Neem has a garlic-like odor, and a bitter taste. The various parts of this tree have many uses that aptly give neem its name in Sanskrit-“sarva roga nivarini”, meaning ‘the curer of all ailments’. Some of the most important documented uses of various parts of the neem tree are:  

	Neem oil is extracted from the seeds of the neem tree and has insecticidal and medicinal properties due to which it has been used for thousands of years in pest control, cosmetics, medicines, etc. Please see neem oil & its uses for detailed information.
	Neem seed cake (residue of neem seeds after oil extraction) when used for soil amendment or added to soil,  not only enriches the soil with organic matter but also lowers nitrogen losses by inhibiting nitrification. It also works as a nematicide.
	Neem leaves are used to treat chickenpox and warts by directly applying to the skin in a paste form or by bathing in water with neem leaves. In order to increase immunity of the body, neem leaves are also taken internally in the form of neem capsules or made into a tea. The tea is traditionally taken internally to reduce fever caused by malaria. This tea is extremely bitter. It is also used to soak feet for treating various foot fungi.  It has also been reported to work against termites. In Ayurveda, neem leaves are used in curing neuromuscular pains. Neem leaves are also used in storage of grains.
	Twigs of neem are also used in India and Africa as toothbrushes. Nowadays toothpastes with neem extracts are also available commercially.
	Neem (leaf and seed) extracts have been found to be spermicidal and thus research is being conducted to use neem extracts for making contraceptives. Neem produces pain relieving, anti-inflammatory and fever reducing compounds that can aid in the healing of cuts, burns, earaches, sprains and headaches, as well as fevers.
	Neem bark and roots also have medicinal properties. Bark & roots in powdered form are also used to control fleas & ticks on pets.
	Neem has anti-bacterial properties that help in fighting against skin infections such as acne, psoriasis, scabies, eczema, etc. Neem extracts also help in treating diabetes, AIDS, cancer, heart disease, herpes, allergies, ulcers, hepatitis and several other diseases.
	There are many active constituents of Neem.

Neem oil, leaves and neem extracts are used to manufacture health and beauty care products. Some of such products are soaps, bath powders, shampoos, lotions and creams, toothpastes, neem leaf capsules to increase immunity and as a skin purifier, insect repellents, pet care products, etc. 

Neem extracts have been approved by the U.S. Environmental Protection Agency for use on food crops. It has been proven in various research studies  that Neem is non-toxic to birds, beneficial insects or humans and protects crops from over 200 of the most costly pests.

Niacin and niacinamide (Vitamin B3)

 Niacin and niacinamide (Vitamin B3)

What is it?

Niacin and niacinamide are forms of Vitamin B3. Vitamin B3 is found in many foods including yeast, meat, fish, milk, eggs, green vegetables, beans, and cereal grains. Niacin and niacinamide are also found in many vitamin B complex supplements with other B vitamins.

Niacin is used for high cholesterol. It is also used along with other treatments for circulation problems, migraine headache, dizziness, and to reduce the diarrhea associated with cholera. Niacin is also used for preventing positive urine drug screens in people who take illegal drugs.

Niacinamide is used for treating diabetes and two skin conditions called bullous pemphigoid and granuloma annulare.

Niacin or niacinamide is used for preventing vitamin B3 deficiency and related conditions such as pellagra. Each of these forms of vitamin B3 is used for schizophrenia, hallucinations due to drugs, Alzheimer’s disease and age-related loss of thinking skills, chronic brain syndrome, depression, motion sickness, alcohol dependence, and fluid collection (edema).

Some people use niacin or niacinamide for acne, leprosy, attention deficit-hyperactivity disorder (ADHD), memory loss, arthritis, preventing premenstrual headache, improving digestion, protecting against toxins and pollutants, reducing the effects of aging, lowering blood pressure, improving circulation, promoting relaxation, improving orgasm, and preventing cataracts.

Niacinamide is applied to the skin for treating a skin condition called inflammatory acne vulgaris.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for NIACIN AND NIACINAMIDE (VITAMIN B3) are as follows:

Likely effective for...

• High cholesterol. Only niacin seems to lower cholesterol, not niacinamide. Some niacin products are FDA-approved prescription products for treating high cholesterol. These prescription niacin products typically come in high strengths of 500 mg or higher. Dietary supplement forms of niacin usually come in strengths of 250 mg or less. Since very high doses of niacin are required for high cholesterol, dietary supplement niacin usually isn’t appropriate.
• Treatment and prevention of niacin deficiency, and certain conditions related to niacin deficiency such as pellagra. Both niacin and niacinamide are approved by the U.S. Food and Drug Administration (FDA) for these uses. Niacinamide is sometimes preferred because it doesn’t cause “flushing,” (redness, itching and tingling), a side effect of niacin treatment.

Possibly effective for...

• Osteoarthritis. Taking niacinamide seems to improve joint flexibility and reduce pain and swelling. Some people who take niacinamide might be able to cut down on standard painkilling medications.
• Alzheimer’s disease. People who consume higher amounts of niacin from food and multivitamin sources seem to have a lower risk of getting Alzheimer’s disease than people who consume less niacin. But there is no evidence that taking a stand-alone niacin supplement helps to prevent Alzheimer’s disease.
• Hardening of the arteries (atherosclerosis).
• Reducing the risk of a second heart attack in men with heart or circulatory disorders.
• Diarrhea from an infection called cholera.
• Diabetes, types 1 and 2.
• Prevention and treatment of cataracts, an eye condition.

Insufficient evidence to rate effectiveness for...

• Attention deficit-hyperactivity disorder (ADHD). There is conflicting evidence regarding the usefulness of niacinamide in combination with other vitamins for the treatment of ADHD.
• Migraine headache.
• Dizziness.
• Depression.
• Motion sickness.
• Alcohol dependence.
• Improving orgasm.
• Acne.
• Other conditions.

More evidence is needed to rate niacin and niacinamide for these uses.

How does it work?

Niacinamide can be made from niacin in the body. Niacin is converted to niacinamide when it is taken in amounts greater than what is needed by the body. Niacin and niacinamide are easily dissolved in water and are well-absorbed when taken by mouth.

Niacin and niacinamide are required for the proper function of fats and sugars in the body and to maintain healthy cells. At high doses, niacin and niacinamide can have different effects. Niacin might help people with heart disease because of its beneficial effects on clotting. It may also improve levels of a certain type of fat called triglycerides in the blood. Niacinamide has no beneficial effects on fats and should not be used for treating high cholesterol or high fat levels in the blood.

Niacin deficiency can cause a condition called pellagra, which causes skin irritation, diarrhea, and dementia. Pellagra was common in the early twentieth century, but is less common now, since foods are now fortified with niacin. Pellagra has been virtually eliminated in western culture.

People with poor diet, alcoholism, and some types of slow-growing tumors called carcinoid tumors might be at risk for niacin deficiency.

Are there safety concerns?

Niacin and niacinamide are LIKELY SAFE for most people when taken by mouth. A common minor side effect of niacin is a flushing reaction. This might cause burning, tingling, itching, and redness of the face, arms, and chest, as well as headaches. Starting with small doses of niacin and taking 325 mg of aspirin before each dose of niacin will help reduce the flushing reaction. Usually, this reaction goes away as the body gets used to the medication. Alcohol can make the flushing reaction worse. Avoid large amounts of alcohol while taking niacin.

Other minor side effects of niacin and niacinamide are stomach upset, intestinal gas, dizziness, pain in the mouth, and other problems.

When doses of over 3 grams per day of niacin are taken, more serious side effects can happen. These include liver problems, gout, ulcers of the digestive tract, loss of vision, high blood sugar, irregular heartbeat, and other serious problems. Similar side effects can happen with large doses of niacinamide.

Some concern has been raised about stroke risk in people taking niacin. In one large study, people who took high doses of niacin had a two-fold greater risk of stroke compared to those not taking niacin. But it is unclear if this outcome was due to niacin or some other unknown factor. Previous research has not identified any stroke risk related to taking niacin. Most experts believe that it is too soon to jump to any conclusions about niacin and strokes.

Niacinamide is POSSIBLY SAFE when used appropriately in children.

Special precautions & warnings:

Pregnancy and breast-feeding: Niacin and niacinamide are LIKELY SAFE for pregnant and breast-feeding women when taken in the recommended amounts. The recommended amount of niacin for pregnant or breast-feeding women is 30 mg per day for women under 18 years of age, and 35 mg for women over 18.
Allergies: Niacin and niacinamide can make allergies more severe because they cause histamine, the chemical responsible for allergic symptoms, to be released. .
Heart disease/unstable angina: Large amounts of niacin and niacinamide can increase the risk of irregular heartbeat. Use with caution.
Diabetes: Niacin and niacinamide might increase blood sugar. People with diabetes who take niacin or niacinamide should check their blood sugar carefully.
Gallbladder disease: Niacin and niacinamide might make gallbladder disease worse.
Gout: Large amounts of niacin or niacinamide might bring on gout.
Low blood pressure: Don’t take niacin or niacinamide if you have low blood pressure. Your blood pressure might drop too much.
Liver disease: Niacin or niacinamide might increase liver damage. Don’t use them if you have liver disease.
Kidney disease: Niacin might accumulate in people with kidney disease and cause harm. Don’t use them if you have kidney disease.
Stomach or intestinal ulcers: Niacin or niacinamide might make ulcers worse. Don’t use them if you have ulcers.
Surgery: Niacin and niacinamide might interfere with blood sugar control during and after surgery. Stop taking niacin or niacinamide at least 2 weeks before a scheduled surgery.

Are there interactions with medications?

Moderate

Be cautious with this combination.

Alcohol (Ethanol)

Niacin can cause flushing and itchiness. Consuming alcohol along with niacin might make the flushing and itching worse. There is also some concern that consuming alcohol with niacin might increase the chance of having liver damage.

Allopurinol (Zyloprim)

Allopurinol (Zyloprim) is used to treat gout. Taking large doses of niacin might worsen gout and decrease the effectiveness of allopurinol (Zyloprim).

Carbamazepine (Tegretol)

Carbamazepine (Tegretol) is broken down by the body. There is some concern that niacinamide might decrease how fast the body breaks down carbamazepine (Tegretol). But there is not enough information to know if this is important.

Clonidine (Catapres)

Clonidine and niacin both lower blood pressure. Taking niacin with clonidine might cause your blood pressure to become too low.

Medications for diabetes (Antidiabetes drugs)

Long-term use of niacin and niacinamide might increase blood sugar. By increasing blood sugar, niacin and niacinamide might decrease the effectiveness of diabetes medications. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.

Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), metformin (Glucophage), nateglinide (Starlix), repaglinide (Prandin), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.

Medications used for lowering cholesterol (Bile acid sequestrants)

Some medications for lowering cholesterol called bile acid sequestrants can decrease how much niacin or niacinamide the body absorbs. This might reduce the effectiveness of niacin or niacinamide. Take niacin or niacinamide and the medications at least 4-6 hours apart.

Some of these medications used for lowering cholesterol include cholestyramine (Questran) and colestipol (Colestid).

Medications used for lowering cholesterol (Statins)

Niacin can adversely affect the muscles. Some medications used for lowering cholesterol called statins can also affect the muscles. Taking niacin along with these medications might increase the risk of muscle problems.

Some of these medications used for high cholesterol include rosuvastatin (Crestor), atorvastatin (Lipitor), lovastatin (Mevacor), pravastatin (Pravachol), fluvastatin (Lescol), and simvastatin (Zocor).

Primidone (Mysoline)

Primidone (Mysoline) is broken down by the body. There is some concern that niacinamide might decrease how fast the body breaks down primidone (Mysoline). But there is not enough information to know if this is important.

Probenecid

Probenecid is used to treat gout. Taking large doses of niacin might worsen gout and decrease the effectiveness of probenecid.

Sulfinpyrazone (Anturane)

Sulfinpyrazone (Anturane) is used to treat gout. Taking large doses of niacin might worsen gout and decrease the effectiveness of sulfinpyrazone (Anturane).

Minor

Be watchful with this combination.

Aspirin

Aspirin is often used with niacin to reduce the flushing caused by niacin. Taking high doses of aspirin might decrease how fast the body gets rid of niacin. This could cause there to be too much niacin in the body and possibly lead to side effects. But the low doses of aspirin most commonly used for niacin-related flushing don't seem to be a problem.

Nicotine patch (Transdermal nicotine)

Niacin can sometimes cause flushing and dizziness. The nicotine patch can also cause flushing and dizziness. Taking niacin or niacinamide and using a nicotine patch can increase the possibility of becoming flushed and dizzy.

Are there interactions with herbs and supplements?

Antioxidants

A combination of niacin and the prescription drug simvastatin (Zocor) raises HDL (high density lipoprotein) cholesterol ("good cholesterol") in people with coronary heart disease and low HDL levels. But taking niacin along with combinations of antioxidants (selenium, vitamin C, vitamin E, and beta-carotene) seems to blunt this rise in HDL. It is not known whether this effect happens in people who don't have coronary heart disease.

Chromium

Taking niacin and chromium together might lower blood sugar. If you have diabetes and take chromium and niacin supplements together, monitor your blood sugar to make sure it doesn't get too low.

Herbs and supplements that might harm the liver

Niacin, especially in higher doses can cause liver damage. Taking niacin along with other herbs or supplements that might harm the liver could increase this risk. Some of these products include androstenedione, borage leaf, chaparral, comfrey, dehydroepiandrosterone (DHEA), germander, kava, pennyroyal oil, red yeast, and others.

Kombucha tea

There is some concern that kombucha tea might decrease niacin absorption. But this needs to be studied more.

Zinc

The body can make niacin. People who are malnourished and have niacin deficiency, such as chronic alcoholics, make extra niacin if they take zinc. There might be an increased risk of niacin-related side effects such as flushing and itching if niacin and zinc are taken together.

Are there interactions with foods?

Hot drinks

Niacin can cause flushing and itching. These effects might be increased if niacin is taken with a hot drink.

What dose is used?

The following doses have been studied in scientific research:
BY MOUTH:

• For high cholesterol: The effects of niacin are dose-dependent. The biggest increases in HDL and decreases in triglycerides occur at 1200-1500 mg/day. Niacin’s greatest effects on LDL occur at 2000-3000 mg/day.
• To prevent heart disease in people with high cholesterol: Niacin 4 grams daily.
• For preventing and treating vitamin B3 deficiency: Doses of nicotinic acid and niacinamide are considered equivalent. For mild vitamin B3 deficiency, niacin or niacinamide 50-100 mg per day is used. For pellagra in adults, niacin or niacinamide 300-500 mg daily is given in divided doses. For pellagra in children, niacin or niacinamide 100-300 mg daily is given in divided doses. For Hartnup disease, niacin or niacinamide 50-200 mg daily.
• For reducing fluid loss caused by cholera toxin: Niacin 2 grams daily.
• To prevent type 1 diabetes in high-risk children: Sustained-release niacinamide 1.2 grams/m² (body surface area) per day.
• To slow disease progression of newly diagnosed type 1 diabetes: Niacinamide 25 mg/kg daily.
• For treating osteoarthritis: Niacinamide 3 grams per day in divided doses.
• For reduced risk of cataracts: A daily dietary intake of approximately 44 mg of niacin.
• For preventing Alzheimer’s disease: 17-45 mg of niacin from food and multivitamins. Food sources high in niacin include meat, fish, beans, nuts, coffee, and fortified grains and cereals. Note that there is no reliable evidence that taking a stand-alone niacin supplement will help to prevent Alzheimer’s disease.

The daily recommended dietary allowances (RDAs) of niacin are: Infants 0-6 months, 2 mg; Infants 7-12 months, 4 mg; Children 1-3 years, 6 mg; Children 4-8 years, 8 mg; Children 9-13 years, 12 mg; Men 14 years and older, 16 mg; Women 14 years and older, 14 mg; Pregnant women, 18 mg; and Lactating women, 17 mg. The maximum daily dose of niacin is: Children 1-3 years, 10 mg; Children 4-8 years, 15 mg; Children 9-13 years, 20 mg; Adults, including Pregnant and Lactating women, 14-18 years, 30 mg; and Adults, including pregnant and breast-feeding women, older than 18 years, 35 mg.

3-Pyridine Carboxamide, 3-Pyridinecarboxylic Acid, Acide Nicotinique, Acide Pyridine-Carboxylique-3, Amide de l’Acide Nicotinique, Anti-Blacktongue Factor, Antipellagra Factor, B Complex Vitamin, Complexe de Vitamines B, Facteur Anti-Pellagre, Niacin-Niacinamide, Niacin/Niacinamide, Niacina y Niacinamida, Niacinamide, Niacine, Niacine et Niacinamide, Nicamid, Nicosedine, Nicotinamide, Nicotinic Acid, Nicotinic Acid Amide, Nicotylamidum, Pellagra Preventing Factor, Vitamin B3, Vitamin PP, Vitamina B3, Vitamine B3, Vitamine PP.

Methodology

To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.

References

1. FDA statement on the AIM-HIGH trial. http://www.fda.gov/Drugs/DrugSafety/ PostmarketDrugSafetyInformationforPatientsand Providers/ucm256841.htm. (Accessed 3 June 2011).
2. NIH News. NIH stops clinical trial on combination cholesterol treatment. May 26, 2011. http://www.nih.gov/news/health/may2011/nhlbi-26.htm. (Accessed 3 June 2011).
3. PL Detail-Document, Niacin Plus Statin to Reduce Cardiovascular Risk: AIM-HIGH Study. Pharmacist's Letter/Prescriber's Letter. July 2011.
4. Karthikeyan K, Thappa DM. Pellagra and skin. Int J Dermatol 2002;41:476-81.
5. Hendricks WM. Pellagra and pellagralike dermatoses: etiology, differential diagnosis, dermatopathology, and treatment. Semin Dermatol 1991;10:282-92.
6. Bingham LG, Verma SB. A photodistributed rash. (Self-Assessment examination of the American Academy of Dermatology). J Am Acad Dermatol 2005;52:929-32.
7. Nahata MC. Chloramphenicol. In: Evans WE, Schentag JJ, Jusko WJ (eds). Applied Pharmacokinetics: Principles of Therapeutic Drug Monitoring. 3rd ed., Vancouver, WA: Applied Therapeutics, Inc., 1992.
8. Jorgensen J. Pellagra probably due to pyrazinamide: development during combined chemotherapy of tuberculosis. Int J Dermatol 1983;22:44-5.
9. Ding RW, Kolbe K, Merz B, et al. Pharmacokinetics of nicotinic acid-salicylic acid interaction. Clin Pharmacol Ther 1989;46:642-7.
10. Lyon VB, Fairley JA. Anticonvulsant-induced pellagra. J Am Acad Dermatol 2002;46:597-9

Prostate cancer

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Prostate cancer is cancer that starts in the prostate gland. The prostate is a small, walnut-sized structure that makes up part of a man's reproductive system. It wraps around the urethra, the tube that carries urine out of the body.

Causes

Prostate cancer is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40.
People who are at higher risk include:

• African American men, who are also likely to develop cancer at every age
• Men who are older than 60
• Men who have a father or brother with prostate cancer

Other people at risk include:

• Men who have been around Agent Orange
• Men who use too much alcohol
• Farmers
• Men who eat a diet high in fat, especially animal fat
• Tire plant workers
• Painters
• Men who have been around cadmium

Prostate cancer is less common in people who do not eat meat (vegetarians).
A common problem in almost all men as they grow older is an enlarged prostate. This is called benign prostatic hyperplasia, or BPH. It does not raise your risk of prostate cancer. However, it can increase your PSA blood test results.

Symptoms

The PSA blood test is often done to screen men for prostate cancer. Because of PSA testing, most prostate cancers are now found before they cause any symptoms.
The symptoms listed below can occur with prostate cancer, usually at a late stage. These symptoms can also be caused by other prostate problems:

• Delayed or slowed start of urinary stream
• Dribbling or leakage of urine, most often after urinating
• Slow urinary stream
• Straining when urinating, or not being able to empty out all of the urine
• Blood in the urine or semen
• Bone pain or tenderness, most often in the lower back and pelvic bones (only when the cancer has spread)

Exams and Tests

A biopsy is needed to tell if you have prostate cancer. A sample of tissue is removed from the prostate and sent to a lab.
Your doctor may recommend a prostate biopsy if:

• You have high PSA level
• A rectal exam shows a large prostate or a hard, uneven surface

The results are reported using what is called a Gleason grade and a Gleason score.
The Gleason grade tells you how fast the cancer might spread. It grades tumors on a scale of 1 - 5. You may have different grades of cancer in one biopsy sample. The two main grades are added together. This gives you the Gleason score. The higher your Gleason score, the more likely the cancer is to have spread past the prostate:

• Scores 2 - 5: Low-grade prostate cancer
• Scores 6 - 7: Intermediate- (or in the middle) grade cancer. Most prostate cancers fall into this group.
• Scores 8 - 10: High-grade cancer

The following tests may be done to determine whether the cancer has spread:

• CT scan
• Bone scan

The PSA blood test will also be used to monitor your cancer after treatment. Often, PSA levels will begin to rise before there are any symptoms. An abnormal digital rectal exam may be the only sign of prostate cancer (even if the PSA is normal).

Treatment

Treatment depends on many things, including your Gleason score and your overall health. Your doctor will discuss your treatment options.
For early-stage prostate cancer, this may include:

• Surgery (radical prostatectomy)
• Radiation therapy, including brachytherapy and proton therapy

If you are older, your doctor may recommend simply monitoring the cancer with PSA tests and biopsies.
If the prostate cancer has spread, treatment may include:

• Hormone therapy (medicines to reduce testosterone levels)
• Surgery
• Chemotherapy

Surgery, radiation therapy, and hormone therapy can affect your sexual desire or performance. Problems with urine control are common after surgery and radiation therapy. Discuss your concerns with your health care provider.
After treatment for prostate cancer, you will be closely watched to make sure the cancer does not spread. This involves routine doctor check-ups, including PSA blood tests (usually every 3 months to 1 year).
See also:

• Prostate cancer - stages
• Prostate radiation - discharge

Support Groups

You can ease the stress of illness by joining a support group whose members share common experiences and problems. See: Support group - prostate cancer

Outlook (Prognosis)

How well you do depends on whether the cancer has spread outside the prostate gland and how abnormal the cancer cells are (the Gleason score) when you are diagnosed.
Many patients can be cured if their prostate cancer has not spread. Some patients whose cancer has not spread very much outside the prostate gland can also be cured.
Hormone treatment can improve survival, even in patients who cannot be cured.

Possible Complications

The complications of prostate cancer are mostly due to different treatments.

When to Contact a Medical Professional

Discuss the advantages and disadvantages to PSA screening with your health care provider.

Prevention

You may lower your risk of prostate cancer by eating a diet that is:

• High in omega-3 fatty acids
• Low-fat
• Similar to the traditional Japanese diet
• Vegetarian

Finasteride (Proscar, generic) and dutasteride (Avodart) are drugs used to treat prostate enlargement (benign prostatic hyperplasia, or BPH). If you do not have prostate cancer and your PSA score is 3.0 or lower, ask your health care provider about the pros and cons of taking these drugs to prevent prostate cancer.

Alternative Names

Cancer - prostate; Biopsy - prostate; Prostate biopsy; Gleason score

References

Theoret MR, Ning YM, Zhang JJ, et al. The risks and benefits of 5a-reductase inhibitors for prostate-cancer prevention. N Engl J Med. 2011;365:97-99.
Antonarakis ES, Eisenberger MA. Expanding treatment options for metastatic prostate cancer. N Engl J Med. 2011;364:2055-2058.
Andriole GL, Crawford ED, Grubb RI 3rd, Buys SS, Chia D, Church TR, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360:1310-1319.
Babaian RJ, Donnelly B, Bahn D, Baust JG, Dineen M, Ellis D, et al. Best practice statement on cryosurgery for the treatment of localized prostate cancer. J Urol. 2008;180:1993-2004.
Schrader FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360:1320-1328.
Walsh PC. Chemoprevention of prostate cancer. N Engl J Med. 2010;362:1237-1238.
Wilt TJ, MacDonald R, et al. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med. 2008;148:435-448.

Cancer

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Cancer is the uncontrolled growth of abnormal cells in the body. Cancerous cells are also called malignant cells.

Causes

Cancer grows out of normal cells in the body. Normal cells multiply when the body needs them, and die when the body doesn't need them. Cancer appears to occur when the growth of cells in the body is out of control and cells divide too quickly. It can also occur when cells forget how to die.
There are many different kinds of cancer. Cancer can develop in almost any organ or tissue, such as the lung, colon, breast, skin, bones, or nerve tissue.
There are many causes of cancer, including:

• Benzene and other chemicals
• Drinking excess alcohol
• Environmental toxins, such as certain poisonous mushrooms and a type of poison that can grow on peanut plants (aflatoxins)
• Excessive sunlight exposure
• Genetic problems
• Obesity
• Radiation
• Viruses

However, the cause of many cancers remains unknown.
The most common cause of cancer-related death is lung cancer.
The three most common cancers in men in the United States are:

• Prostate cancer
• Lung cancer
• Colon cancer

In women in the United States, the three most common cancers are:

• Breast cancer
• Colon cancer
• Lung cancer

Some cancers are more common in certain parts of the world. For example, in Japan, there are many cases of stomach cancer, but in the United States, this type of cancer is unusual. Differences in diet or environmental factors may play a role.
Some other types of cancers include:

• Brain cancer
• Cervical cancer
• Hodgkin's lymphoma
• Kidney cancer
• Leukemia
• Liver cancer
• Non-Hodgkin's lymphoma
• Ovarian cancer
• Skin cancer
• Testicular cancer
• Thyroid cancer
• Uterine cancer

Symptoms

Symptoms of cancer depend on the type and location of the cancer. For example, lung cancer can cause coughing, shortness of breath, or chest pain. Colon cancer often causes diarrhea, constipation, and blood in the stool.
Some cancers may not have any symptoms at all. In certain cancers, such as pancreatic cancer, symptoms often do not start until the disease has reached an advanced stage.
The following symptoms can occur with most cancers:

• Chills
• Fatigue
• Fever
• Loss of appetite
• Malaise
• Night sweats
• Weight loss

Exams and Tests

Like symptoms, the signs of cancer vary based on the type and location of the tumor. Common tests include the following:

• Biopsy of the tumor
• Blood tests (which look for chemicals such as tumor markers)
• Bone marrow biopsy (for lymphoma or leukemia)
• Chest x-ray
• Complete blood count (CBC)
• CT scan
• Liver function tests
• MRI scan

Most cancers are diagnosed by biopsy. Depending on the location of the tumor, the biopsy may be a simple procedure or a serious operation. Most patients with cancer have CT scans to determine the exact location and size of the tumor or tumors.
A cancer diagnosis is difficult to cope with. It is important, however, that you discuss the type, size, and location of the cancer with your doctor when you are diagnosed. You also will want to ask about treatment options, along with their benefits and risks.
It's a good idea to have someone with you at the doctor's office to help you get through the diagnosis. If you have trouble asking questions after hearing about your diagnosis, the person you bring with you can ask them for you.

Treatment

Treatment varies based on the type of cancer and its stage. The stage of a cancer refers to how much it has grown and whether the tumor has spread from its original location.

• If the cancer is confined to one location and has not spread, the most common treatment approach is surgery to cure the cancer. This is often the case with skin cancers, as well as cancers of the lung, breast, and colon.
• If the tumor has spread to local lymph nodes only, sometimes these can be removed.
• If surgery cannot remove all of the cancer, the options for treatment include radiation, chemotherapy, or both. Some cancers require a combination of surgery, radiation, and chemotherapy.
• Lymphoma, or cancer of the lymph glands, is rarely treated with surgery. Chemotherapy and radiation therapy are most often used to treat lymphoma.

Although treatment for cancer can be difficult, there are many ways to keep up your strength.
If you have radiation treatment, know that:

• Radiation treatment is painless.
• Treatment is usually scheduled every weekday.
• You should allow 30 minutes for each treatment session, although the treatment itself usually takes only a few minutes.
• You should get plenty of rest and eat a well-balanced diet during the course of your radiation therapy.
• Skin in the treated area may become sensitive and easily irritated.
• Side effects of radiation treatment are usually temporary. They vary depending on the area of the body that is being treated.

If you are going through chemotherapy, you should eat right. Chemotherapy causes your immune system to weaken, so you should avoid people with colds or the flu. You should also get plenty of rest, and don't feel as though you have to accomplish tasks all at once.
It will help you to talk with family, friends, or a support group about your feelings. Work with your health care providers throughout your treatment. Helping yourself can make you feel more in control.

Support Groups

The diagnosis and treatment of cancer often causes a lot of anxiety and can affect a person's entire life. There are many resources for cancer patients.
See: Cancer resources

Outlook (Prognosis)

The outlook depends on the type of cancer and the stage of the cancerr when diagnosed. 
Some cancers can be cured. Other cancers that are not curable can still be treated effectively. Some patients can live for many years with cancer. Other tumors are quickly life threatening.

Possible Complications

Complications depend on the type and stage of cancer. The cancer may spread.

When to Contact a Medical Professional

Contact your health care provider if you develop symptoms of cancer.

Prevention

You can reduce the risk of getting a cancerous (malignant) tumor by:

• Eating a healthy diet
• Exercising regularly
• Limiting alcohol
• Maintaining a healthy weight
• Minimizing your exposure to radiation and toxic chemicals
• Not smoking or chewing tobacco
• Reducing sun exposure, especially if you burn easily

Cancer screenings, such as mammography and breast examination for breast cancer and colonoscopy for colon cancer, may help catch these cancers at their early stages when they are most treatable. Some people at high risk for developing certain cancers can take medication to reduce their risk.

Alternative Names

Carcinoma; Malignant tumor

References

Moscow JA, Cowan KH. Biology of cancer. In Goldman L, SchaferAI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 185.
Thun MJ, Jemal A. Epidemiology of cancer. In Goldman L,Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 183.

Endoscopes

Endoscopes Provider Reviews are provided below. If you would like assistance in obtaining a quotation we provide a free "Get Quote" email forwarding service and will direct your enquiry to the relevant provider/supplier requesting that they contact you directly. We provide this as a free service to site visitors in accordance with site terms and conditions. Please note that any commercial transactions that may subsequently take place are strictly between the supplier/provider and the site visitor, the operators of News-Medical.net are not a party to any transaction and do not endorse any of the products or services or provide any representations or warranties that they are suitable to the personal circumstances of any individual site visitor.

FCN-15X Endoscope from Pentax

 

With a slim 4.9 mm insertion tube, the FCN-15X allows for easy introduction and increased maneuverability even through strictured areas. It features a large 2.2 mm working channel for improved irrigation, and a remarkably wide viewing angle of 125° in air and 83° in water, offering a large viewing area and simplifying orientation to help shorten procedure time.

Specifications

Channel Diameter (mm)	2.2
Insertion Tube Diameter (mm)	4.9
Working Length (mm)	350
Angulation (Up/Down)	180/130
Angle of View	125° (air) / 83° (water)

Accessories

	CS6002SN CLEANING BRUSH (SHORT)		CS6015ST CLEANING BRUSH
	CS-C3S CYLINDER CLEANING BRUSH		OF-B137 IRRIGATION VALVE
	OF-B190 RUBBER INLET SEAL		OF-B75 SUCTION CHANNEL CLEANING ADAPTER
	OF-B81 O-RING SET		OF-C3 SOAKING CAP
	OF-C5 ETO VENTING CAP		OF-D3 EYESHIELD
	OF-Z11 SILICONE OIL

Early Vision Screening Associated With Better Eyesight In Children With Amblyopia

 

Children who screen positive for amblyopia, reduced vision in one eye, before age 2 appear to have better visual outcomes than those whose vision problems are detected during screenings between ages 2 and 4, according to a new report.

Screening for amblyopia typically consists of visual acuity screening--where patients are asked to read letters on a chart--along with an examination to detect cataract, problems with eye alignment and other risk factors for the condition, according to background information in the article. Conventional visual acuity testing requires that children are old enough to cover one eye and read visual charts, whereas objective screening for risk factors and newer techniques involving taking photographs of the eye (photoscreening) can be performed in younger children.
Between 1996 and 2006, Alaska Blind Child Discovery--a cooperative, charitable research effort to offer vision screening to Alaskan children--used photoscreening to detect visual problems in 21,367 rural and urban Alaskan children through grade 2. Valerie G. Kirk and colleagues at Ophthalmic Associates, Anchorage, assessed the 94 children who screened positive before age 4 and were treated and followed for at least two years.
After amblyopia treatment, the 36 children who were screened before age 2 had better vision than the 58 who were screened between ages 2 and 4. "Despite similar levels of amblyogenic risk factors, the proportion of children failing to reach a visual acuity of 20/40 was significantly less among those screened before age 2 years (5 percent) than in those screened from ages older than 2 years and younger than 4 years (17 percent)," the authors write.
"Very early photoscreening yields better visual outcomes in amblyopia treatment compared with later photoscreening in preschool-aged children," they conclude.
Journal reference: Arch Ophthalmol. 2008;126[4]:489-492.