Inflammatory Myopathies (IM) Inflammatory Myopathies (IM) Home Overview IM are a collection of uncommon autoimmune disorders affecting the skeletal muscles. These conditions may also present with extramuscular symptoms such as skin rash, joint inflammation, interstitial lung disease (ILD), and heart-related complications. IM are of following type: Dermatomyositis (associated with characteristic skin rash- heliotrope rash, V sign, shawl sign, occasional dysphagia)Overlap myositis (related to connective tissue disorders)Antisynthetase syndrome (ASyS) (presents with multisystem involvement, including arthritis, ILD, and myocarditis)Immune-mediated necrotizing myopathy (IMNM) (muscle predominant)Sporadic inclusion body myositis (sIBM) (muscle predominant)Earlier polymyositis was also recognized as a subtype but now the terminology has been discarded for the above-mentioned classification. Cause It is an autoimmune disease with unknown cause. Risk factors Genetic factors: The HLA 8.1 ancestral haplotype is an important risk factor in some populations.Environmental factors: These include:Exposure to ultraviolet (UV) lightSmokingInfectionsVitamin D deficiencyExposure to certain pollutantsExposure to medicationsExposure to inhaled particlesExposure to chemical agentsExposure during pregnancy and infancyOther factors: Statins can increase HMGCR expression in muscle, which may worsen autoimmunity against muscle tissue Symptoms Muscle pain or crampsMuscle weaknessFatigueDifficulty swallowing/ breathingSkin rashJoint pain and swelling Specialist to approach Neurologist Diagnosis Clinical examinationBlood tests to determine serum enzymes levels using Myositis panel which includes the auto-antibodies responsible for muscle inflammation and weakness.ElectromyographyMuscle biopsy featuresMuscle MRI patterns Treatment Corticosteroids to reduce inflammationImmunosuppressive medicationsPhysiotherapy/ speech therapyManagement of associated systemic featuresEarly diagnosis and treatment are necessary to prevent severe weakness Read more about Inflammatory Myopathies (IM) Filter Alphabet I
Gall Bladder Cancer Gall Bladder Cancer Home Overview Cancer of the gall bladder is the fifth most common cancer of the digestive system. In India, its incidence is higher in Northern India. Sometimes, gall bladder cancer is accidentally detected, when gall bladder is removed for gallstone diseases (incidental gall bladder cancer). This by itself is a rare occurrence, but it has been estimated that a silent cancer will reside in 0.2–3% of all cholecystectomies. Gall bladder removal is a very common operation. Rarely, cancer can be discovered in pathological examination of the gall bladder. These patients will then need a definitive treatment, and further surgery for complete removal of cancer. Causes and risk factors Chronic inflammation of the gall bladder – Chronic cholecystitisGall bladder polyps > 1 cm in size: Gall bladder polyps are usually small growths that arise from the gall bladder. Most polyps are usually benign and do not carry cancer risk, but it depends on the polyp size. Polyps > 1 cm are at an increased risk of being cancerous. These patients need surgery to remove the gall bladder. As such, only 0.6% of all gall bladder polyps are malignant. However, when the size exceeds 1 cm the risk of developing cancer increases.Focal thickening and irregularity/induration on the gall bladder wall–as seen on ultrasound and imaging may be associated with gall bladder cancer–and will require a cholecystectomy. Symptoms Only 30% of all gall bladder cancers are discovered preoperatively (non-incidental). The patient may present with vague symptoms including:PainVomitingWeight lossJaundice. Diagnosis Diagnosis is incidental and may be discovered during:Pathological examination: Gallbladder cancer is rarely diagnosed, when a pathological examination of the gall bladder is done. Once this diagnosis has been established, the patient would need detailed imaging tests. CT scan/PET- CT scan: Accurate diagnosis of gall bladder cancer is made on CT scanning. Further imaging (PET-CT) will be required to rule out metastases. CT scan is an accurate modality to stage the disease and define further treatment, which is stage dependent. Treatment The precise treatment plan will depend on the presence/absence of metastatic disease, lymph nodes and local extent of the disease. In most instances, wherein the cancer is localised to the gall bladder (which is usually the case), further surgery is requiredSurgery is the only definitive treatment with potential for cure. Hence, wherever possible, surgery should be done. Furthermore, surgery is only done, when the cancer is localised to the gall bladder and the surrounding structures including regional lymph nodes, and has not extensively spread to either within the abdomen or elsewhere. Since the gall bladder resides at the base of the liver, surgery for cancer involvesGall bladder removalRemoval of part of the liver, wherein the gall bladder resides (segment 4b/5)Regional draining of lymph nodesSometimes more extensive surgery will be required to remove the cancer.Chemotherapy: Surgery remains the cornerstone of management of gall bladder cancer. However, chemotherapy plays a role in the treatment and would be required following surgery. Chemotherapy is also sometimes required preoperatively prior to surgery. Read more about Gall Bladder Cancer Filter Alphabet G
Liver Cancer (Hepatocellular Carcinoma (HCC)) Liver Cancer (Hepatocellular Carcinoma (HCC)) Home Overview Hepatocellular carcinoma (HCC), commonly referred to as primary liver cancer, originates in the liver. It most often develops in individuals with chronic liver disease or cirrhosis.Cirrhosis develops within a liver when it gets damaged by liver disease – hepatitis (B, C); alcohol, fatty liver disease (NAFLD), autoimmune liver disease and others. Cirrhosis is irreversible and over time predisposes to the development of liver cancer (among other complications). Types Hepatocellular Carcinoma (HCC): The most common type, arising from hepatocytes, the primary liver cells.Intrahepatic Cholangiocarcinoma: Cancer originating in the bile ducts within the liver.Fibrolamellar Carcinoma: A rare subtype of HCC seen in younger individuals without underlying liver disease. Causes Liver cancer typically results from genetic mutations in liver cells, causing uncontrolled growth and tumour formation. Risk factors Chronic liver disease:Cirrhosis caused by hepatitis B or C infection.Non-alcoholic fatty liver disease (NAFLD).Alcohol-induced liver damage.Lifestyle factors:Heavy alcohol consumption.Obesity and poor dietary habits.Environmental and genetic factors:Exposure to aflatoxins (contaminants in food).Genetic predisposition to liver diseases. Symptoms Liver cancer often remains asymptomatic in its early stages. Common symptoms include:Persistent abdominal pain or discomfort.Loss of appetite and significant weight loss.Fatigue and weakness.A feeling of heaviness in the upper abdomen.Jaundice (yellowing of skin and eyes).Swelling in the abdomen due to fluid accumulation (ascites). Diagnosis Ultrasound: Often detects liver cancer incidentally during routine check-ups or screening in high-risk individuals.Alpha-Fetoprotein (AFP) Test: A tumour marker elevated in many cases of HCC.CT and MRI Scans: Provide detailed images to assess tumour size, location, and spread.PET-CT Scan: Helps determine whether cancer has metastasised to other parts of the body.Liver Function Tests: Evaluate the liver’s overall health.Biopsy: Confirms the diagnosis by analysing tissue samples. Treatment Treatment for liver cancer depends on tumour size, extent of disease, liver function, and overall health. Options include:SurgeryHepatectomy: Removal of the cancerous portion of the liver. Suitable for patients with localised tumours and preserved liver function.Can be performed using open surgery, laparoscopy, or robotic-assisted techniques.Liver TransplantationRecommended for patients with cirrhosis and localised liver cancer.Involves replacing the diseased liver with a healthy one from a deceased or living donor.Ablative TherapiesRadiofrequency Ablation (RFA) or Microwave Ablation (MWA): Destroy tumours using heat generated by electrical currents or microwaves.Transarterial TherapiesTransarterial Chemoembolization (TACE): Delivers chemotherapy directly to the tumour via blood vessels, cutting off its blood supply.Transarterial Radioembolization (TARE): Uses radioactive beads to target and destroy the tumour.Systemic TreatmentsChemotherapy: Oral or intravenous medications to control advanced cases.Targeted Therapy: Medications like sorafenib that block specific cancer cell pathways.Immunotherapy: Drugs that enhance the immune system's ability to fight cancer cells. Prevention Avoid excessive alcohol consumption and maintain a healthy weight.Get vaccinated against hepatitis B and seek treatment for hepatitis C if diagnosed.Regular screening for high-risk individuals, particularly those with cirrhosis.Consume a balanced diet and avoid exposure to aflatoxins. Read more about Liver Cancer (Hepatocellular Carcinoma (HCC)) Filter Alphabet L
Idiopathic Intracranial Hypertension (IIH) Idiopathic Intracranial Hypertension (IIH) Home Overview Idiopathic intracranial hypertension (referred to as benign intracranial hypertension, pseudotumor cerebri) is typically seen in middle-aged obese females. It is precipitated by hormonal therapies, PCOS, excessive vitamin A intake or some medications like tetracyclines. Causes Caused due to raised cerebrospinal fluid pressure. Symptoms Early morning headache that worsens on lying downBlurring of visionDouble visionRinging of earsNausea and vomitingOccasional confusion, disorientation Specialist to approach Neurologist Diagnosis CSF manometry to check CSF pressure. Value above 18 cm of water is suggestive of IIHFundus examination may show papilloedemaMRI brain may show flattening of optic nerve head, empty sella, tortuosity of optic nerve Treatment Medications to reduce CSF formation and pressureCSF drainageVentriculoperitoneal shunt in medication refractory casesStenting of venous sinuses if venous sinus thrombosis is the cause of increased CSF pressureOptic nerve fenestration of excessive CSF pressure around optic nerve is causing vision loss Read more about Idiopathic Intracranial Hypertension (IIH) Filter Alphabet I
Huntington’s Disease Huntington’s Disease Home Overview Huntington’s disease is an untreatable, autosomal dominant genetic movement disorder. The disease shows anticipation, meaning subsequent generations are affected at an earlier age. It usually starts at 40–50 years of age. Causes CAG nucleotide repeats expansion in the huntingtin gene HTT Risk factors HereditaryChild has a 50% chance of developing if parent has itIf the child does not develop the disease, it will not be passed onNo family history identified for 1-3% of people with Huntington disease Symptoms Altered body posturesUncontrollable dance-like movements (chorea)Issues with behaviour, sentiments, and thoughtsParkinsonism (associated with juvenile onset Westphal variant)Psychiatric features (personality changes, aggressive behaviour)DystoniaDementiaProgressive weight loss Specialist to approach Neurologist Diagnosis Family history and clinical evaluation of symptomsGenetic testingMRI Brain to determine caudate head atrophy Treatment Symptomatic treatment for chorea and dystoniaAntipsychotics for behaviour managementPrevention of repetitive falls due to chorea Read more about Huntington’s Disease Filter Alphabet H
Colorectal Cancer Colorectal Cancer Home Overview Colorectal cancer arises from abnormal cell growth in the colon or rectum, leading to tumour formation. This cancer may occur in different segments of the large intestine, and its management has evolved significantly due to advancements in minimally invasive surgical techniques. Types The main types of colorectal cancer include:Adenocarcinoma: The most common type, accounting for over 90% of cases, originating in the glandular cells lining the colon and rectum.Carcinoid Tumours: Develop in the hormone-producing cells of the intestine.Gastrointestinal Stromal Tumours (GIST): Rare tumours originating in the connective tissues.Lymphomas and Sarcomas: Rare types of colorectal cancers that arise in the lymphatic or connective tissues. Causes Colorectal cancer develops due to genetic mutations in the cells of the colon or rectum, leading to uncontrolled growth and tumour formation. Risk factors Lifestyle Factors:Diet high in red and processed meats.Sedentary lifestyle and obesity.Smoking and excessive alcohol consumption.Medical Conditions:Family history of colorectal cancer or inherited syndromes (e.g., Lynch syndrome).History of polyps or inflammatory bowel disease (Crohn’s disease, ulcerative colitis).Type 2 diabetes.Age and Genetics:Risk increases after age 50.Mutations in genes like APC, KRAS, and TP53. Symptoms In the early stages, symptoms may be mild or absent. As the disease progresses, the following symptoms can appear:Changes in bowel habits (diarrhoea, constipation, or stool narrowing).Blood in the stool or rectal bleeding.Abdominal pain or cramping.Unexplained weight loss.Fatigue and weakness.Persistent feeling of incomplete bowel evacuation. Diagnosis The diagnosis of colorectal cancer involves a combination of the following:Screening Tests:Colonoscopy: The gold standard for detecting polyps and tumours.Faecal Occult Blood Test (FOBT) or Faecal Immunochemical Test (FIT): Detects hidden blood in stool.Imaging Studies:CT Colonography (virtual colonoscopy).MRI and CT scans for staging and detecting metastases.Biopsy: Tissue samples taken during colonoscopy to confirm cancer diagnosis.Blood Tests: EA (carcinoembryonic antigen) levels to monitor treatment response. Treatment Treatment options depend on the stage, location, and patient factors:Early-Stage Cancer:Polypectomy: Removal of polyps during a colonoscopy.Endoscopic Mucosal Resection (EMR): For larger, localised tumours.Locally Advanced Cancer:Surgery:- Open, Laparoscopic, or Robotic Approaches for tumour removal.- Total Mesorectal Excision (TME) for rectal cancer.Neoadjuvant Therapy: Chemotherapy or radiotherapy before surgery to shrink tumours.Advanced Cancer:Chemotherapy: Used to shrink tumours or as adjuvant therapy post-surgery.Targeted Therapy: Monoclonal antibodies (e.g., bevacizumab) targeting cancer pathways.Immunotherapy: For certain patients with high microsatellite instability (MSI-H).Palliative Care: To manage symptoms and improve quality of life in metastatic cases. Technical advancements Neo-Adjuvant Chemo and Radiotherapy: Modern radiotherapy techniques have enabled sphincter-preserving surgeries for low rectal tumours, reducing the need for more invasive procedures like abdomino-perineal resection (APR), which often result in incontinence or stoma formation.Total Mesorectal Excision (TME): Introduced by Heald et al., this technique emphasizes precise dissection along the mesorectal plane, ensuring complete removal of vasculo-lymphatic pathways and reducing local recurrence. TME is pivotal for achieving optimal oncological outcomes.Complete Mesocolic Excision (CME) with Central Vascular Ligation (CVL): Hohenberger et al. extended the principles of TME to colonic cancers, emphasizing the removal of intact mesocolic tissue and extensive lymph node dissection. This approach has been associated with better oncological outcomes and reduced systemic disease spread.Laparoscopic Colorectal Surgery (LCS): Minimally invasive laparoscopic techniques have evolved significantly, offering comparable long-term outcomes to open surgery for colorectal cancer. Short-term benefits, including faster recovery, reduced pain, and shorter hospital stays, have been well-documented in multiple studies.Robotic Colorectal Surgery (RCS): Robotic surgery addresses many limitations of laparoscopy, such as restricted instrument mobility, tremor amplification, and the absence of three-dimensional vision. With robotic systems like the da Vinci Surgical System, surgeons gain enhanced precision, better ergonomics, and improved control over surgical instruments.Advantages of Robotic SurgeryEnhanced Precision: Greater maneuverability with EndoWrist instruments.Improved Ergonomics: Surgeons experience reduced fatigue and better control.Reduced Conversion Rates: Studies report conversion rates as low as 0–4.9%.Positive Oncological Outcomes: Comparable or superior lymph node yields, low circumferential resection margin (CRM) positivity, and reduced local recurrence rates.Supporting Evidence for Robotic SurgerySeveral prospective and retrospective studies validate the safety and efficacy of robotic colorectal surgery. For instance:Long-term outcomes demonstrate three-year disease-free survival rates of 73.7% to 79.2% and overall survival rates of 92% to 97%.Studies, including hybrid and fully robotic approaches, consistently show promising results for rectal cancer management. 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Lung Cancer Lung Cancer Home Overview Lung cancer develops when abnormal cells in the lungs grow and multiply uncontrollably, forming a tumour. Over time, this tumour may spread (metastasise) to other parts of the body. Types Non-small cell lung cancer (NSCLC)Small cell lung cancer (SCLC)Lung carcinoid tumour Causes and risk factors Smoking (leading cause)Passive exposure to second-hand smokeOccupational exposure to harmful substances like fumes, soot, and arsenic Exposure to asbestosPre-existing lung conditions like fibrosis and emphysema Symptoms Persistent coughing or wheezingChest pain or discomfortShortness of breath or extreme fatigueCoughing up blood or rusty-coloured sputumRecurrent respiratory infections Diagnosis Imaging tests: CT, PET, or MRI scans, particularly of the brain in advanced casesBiopsy: CT guided or EBUS (Endobronchial Ultrasound) biopsyNodal staging: Mediastinoscopy or EBUS for lymph node evaluationSputum cytology: Microscopic analysis of sputum samplesPulmonary function tests: To assess lung capacity and function for operable casesCardiac evaluation: To ensure surgical readiness for operable lung cancers Treatment Surgery: Performed using conventional technique, VATS, or robotic methodsChemotherapyRadiation therapyTargeted therapy Designed for specific genetic mutations in cancer cellsImmunotherapy: Boosts the immune system to fight cancerThe treatment options depend on the cancer stage and medical condition of the patient. Either one or different combinations of the above therapies may be used for the individual. Prevention Quit smokingAvoid exposure to second-hand smokeSmokers may consider low-dose CT scans for early detection after consulting a physicianMaintain a healthy diet with regular exercise Prognosis and Survival Rate Prognosis varies significantly based on the stage of cancer at diagnosis, the patient’s overall health, and the response to treatment. Read more about Lung Cancer Filter Alphabet L
Oesophageal Cancer Oesophageal Cancer Home Overview Oesophageal cancer develops when abnormal cells in the lining of the oesophagus grow and multiply uncontrollably, leading to the formation of a tumour. Types The most common subtypes of oesophageal cancer are:Adenocarcinoma: typically occurs in the lower third of the oesophagusSquamous cell carcinoma: Most often found in the middle and upper third of the oesophagusManagement strategies for both subtypes differ slightly based on specific pathology. Causes and risk factors SmokingAlcohol consumptionGERD (Gastroesophageal Reflux Disease)Barrett's oesophagusChewing tobacco, although less risky than smoking for oesophageal cancer, can still increase the risk by causing hyperacidity due to its irritant properties. Symptoms Early stages: Refractory hyperacidityDifficulty swallowing solids or liquids, with food often feeling stuck in the oesophagusAdvanced stages:Unexplained weight lossFrequent vomiting after eating Pain in the chest or backHoarseness or change in voice Diagnosis Upper Gastrointestinal (GI) endoscopyEndoscopic ultrasonography (EUS)BiopsyImaging tests, including CT and PET-CT scansBarium swallow, although commonly used in the past, is now sparingly used for diagnosing oesophageal carcinoma. Treatment Very Early Stages:Endoscopic Mucosal Resection (EMR) or Endoscopic Submucosal Dissection (ESD)Surgical removal of the oesophagus may be recommended, using conventional, video-assisted thoracoscopic surgery (VATS), or robotic approachesLocally Advanced Cases:For squamous cell carcinoma, treatment typically involves a combination of chemotherapy and radiotherapy in smaller doses, followed by surgery.For adenocarcinoma, the sequence may involve administering chemotherapy first, followed by surgery, and subsequent chemotherapy as a follow-up.Locally Advanced Cases Not Suitable For Surgery: A combination of definitive chemotherapy and radiation therapy maybe advocatedCases with Metastatic Disease (spread beyond the oesophagus to the other organs of the body):Chemotherapy or immunotherapy maybe used to manage the diseaseStenting can be performed to alleviate swallowing difficulties and improve quality of like Prevention Avoid smoking and tobacco consumption in any formAvoid or limit alcohol consumptionManage GERD (hyperacidity)Follow a healthy and balanced diet Prognosis and Survival Rate Outcomes depend on the stage at diagnosis, overall health, and the chosen treatment approach. Seeking help If symptoms arise, consult a thoracic surgeon or a medical/radiation oncologist.The specialist will recommend a treatment plan best suited for you based on your age, medical fitness, and the stage of the disease. Read more about Oesophageal Cancer Filter Alphabet O
Horner’s Syndrome Horner’s Syndrome Home Overview Horner’s syndrome is a rare type of oculosympathetic nerve palsy wherein the sympathetic nerves that control the eyes and face are damaged. Causes Lesion of the primary neuronLesion of the postganglionic neuronTrauma to the brachial plexusBrainstem tumour, stroke, syrinx of the preganglionic neuronCarotid artery ischemiaTumours (e.g. Pancoast) or infection of the lung apexDissecting carotid aneurysmInternal jugular vein catheterizationMiddle cranial fossa neoplasmMigraine Risk factors Trauma to the neck or head, or damage to the nerves or carotid artery during birth or surgeryBenign or malignant tumours in the lungs, thyroid, hypothalamus, or cervical nerves Middle ear infections or other infections Stroke, aneurysm, embolism, or carotid artery dissectionMigraines or cluster headachesFamily historyMultiple sclerosis or other diseases that affect the protective covering of neurons Symptoms Small sized pupilEye retractionDrooping of eye lid or elevation of lower eyelidDecreased sweating over side of face affectedPallor of side of face affected Specialist to approach Neurologist Treatment Treatment of underlying conditionNo specific cure Read more about Horner’s Syndrome Filter Alphabet H
Oral (Mouth) Cancer Oral (Mouth) Cancer Home Overview The oral cavity consists of essential structures, including the lips, gums, cheeks, tongue, floor of the mouth, palate, and jaws (mandible and maxilla).When the cells lining these vital areas grow and multiply uncontrollably, they form malignant tumours, broadly termed as “oral cancer”. Among men in our country, oral cancer is the most common cancer and is strongly associated with tobacco chewing habits and poor oral hygiene.The most prevalent type of oral cancer, accounting for over 95% of cases, is squamous cell carcinoma (SCC). Causes and risk factors The primary cause for oral SCC is tobacco consumption, through smoking or chewing. Chewing habits involve substances like betel nut, lime, and other condiments (e.g., maava, masala). These are particularly harmful and produce serious effects on the oral lining, leading to oral submucous fibrosis, a condition frequently associated with oral cancer.Other factors include:Oral pre-malignant lesions, such as leucoplakia (white patches) and erythroplakia (red patches), often linked to chewing habits.Poor oral and dental hygiene, including damaged or sharp teeth.Alcohol, which acts as a compounding risk factor. Symptoms The most common symptom is a painless sore or ulcer that does not heal and may be accompanied by swelling.As the disease progresses, additional symptoms may include:Localized or radiating pain (e.g., to the ear or temple)Difficulty in mouth openingFoul breathDisturbances in chewing, swallowing, and speech Diagnosis Early diagnosis requires awareness and a high index of suspicion.The most common diagnostic method is punch biopsy, which can be easily performed in the clinic.Imaging techniques such as CT, MRI, or PET scans are essential for assessing the extent of the disease, staging it, and planning treatment.Unfortunately, many patients present with advanced-stage cancers (Stages III and IV), despite the oral cavity being an accessible area. Treatment Surgery remains the mainstay for treatment across all stages of oral cancer and is often the sole treatment for early cases. For advanced cancers (Stages III and IV), radiotherapy and chemotherapy may be added to improve outcomes. Emerging systemic therapies, such as targeted and immunotherapy, are expanding treatment options.Further technological advances have provided benefits:Advanced imaging techniques enable precise treatment planning.3-D printing and modelling significantly enhance restorative efforts.Routine use of microvascular reconstruction has transformed surgical outcomes, improving survival and quality of life.Molecular and genetic sequencing now assist in managing complex cases. Prevention The most effective prevention strategy involves raising awareness and eliminating tobacco use and other chewing habits, which are responsible for over 50% of all cancers and related deaths.Promoting good oral and dental hygiene is also critical in combating the “cancer epidemic”.Early diagnosis plays a vital role in improving outcomes. Seeking help If you suspect or have been diagnosed with oral cancer, consult a surgical oncologist who specialises in its treatment. Read more about Oral (Mouth) Cancer Filter Alphabet O