A PET is not a toy | Imaging | 08-2010
Nuclear medicine positron emission tomography PET scanning is a relatively new imaging modality, using radioactively labelled fluorine 18F-FDG , that can provide information about the location and metabolic activity of ...
Steroids in brain metastasis | Oncology | 06-2010
The dosing and schedule of steroids isn t exact, and the right answer is enough but not too much. The response to the steroids is an important prognostic factor, as ...
Right to bare arms | Oncology | 08-2009
The injunction to avoid using a patient s ipsilateral arm for phlebotomy and blood pressure dates back to the days when radical mastectomy was the norm, along with much more ...
ColonSentry — friend or foe? | Oncology | 08-2009
This is an excellent question, though I ve had to do some searching to find the answer. ColonSentry is a novel approach to screening for colorectal cancer, an idea driven ...
Chemo undermines vaccination | Oncology | 06-2009
Chemotherapy by its nature affects rapidly growing cells, so it can modulate the immune response to vaccines. I generally try to time the chemotherapy to avoid this in patients who ...
Genetics of breast cancer | Oncology | 06-2009
If you re simply asking the absolute risk of a man with breast cancer s offspring developing breast cancer versus a woman s offspring, then the man is more likely ...
Battling weight loss in cancer | Oncology | 06-2009
The simple answer is that we don t have a lot of good solutions to this awful problem. Cancer patients often find that food doesn t appeal to them. It ...
Not out of the woods yet | Oncology | 05-2009
Patients with Hodgkin s disease could have been treated with chemotherapy or radiation, and different treatments have different long-term problems. The reason for follow-up of these patients is partly to ...
Suspicious slimming | Oncology | 05-2009
Weight loss is a non-specific complaint that can mean a number of things. As always, start off with a careful history focusing initially on food intake and energy output. A ...
Free light is expensive | Hematology | 04-2009
An abnormal serum free light chain FLC ratio at baseline is an important and independent risk factor for progression of MGUS to malignancy. In a study of 1,148 patients with ...
Check symptoms for breast Ca recurrence | Oncology | 04-2009
The Canadian Medical Association Journal published several years ago a series of guidelines for breast cancer patient care including follow-up recommendations. At least three randomized clinical trials provide evidence that ...
Radon — the silent killer | Oncology | 03-2009
Radon is a radioactive gas that rsquo s colourless, odourless and usually undetectable without specialized equipment. It rsquo s a breakdown product of naturally occurring uranium in the soil and ...
Mammograms can miss lobular cancers | Oncology | 03-2009
I assume you mean after appropriate surgical intervention. Lobular carcinoma in situ is more a prognostic factor than a disease. It predicts a high incidence of not only invasive lobular ...
Does tamoxifen prevent breast cancer in at-risk women? | Oncology | 01-2009
That s a good question. Tamoxifen has been studied as a primary prevention drug for those people who had a high risk of breast cancer based on a breast cancer ...
What might one-sided gynecomastia signify? | Oncology, Endocrinology | 12-2008
Oncologist response Gynecomastia has been reported to have an incidence of between 5 and 9 from autopsy studies but in other groups 40 of normal men have palpable breast tissue. ...
Can cell phones cause cancer or not? | Oncology | 12-2008
There is no final verdict. Studies have looked at links between cellular phone use and various types of head and neck or brain tumours because of the radio frequency energy ...
What’s the significance of the “transformation zone” on a Pap? | Oncology | 11-2008
What this means is that the evaluating physician doesn t see both types of cells, i.e. squamous and columnar cells, in the sample. In other words, the transformation zone was ...
Skip hormone therapy before prostate surgery | Urology | 11-2008
Neo-adjuvant therapy prior to radical prostatectomy hasn t been accepted as the routine approach for a number of reasons. Hormone therapy may scar the region, making surgery more difficult. It ...
Diverticulosis doesn’t cause polyps | Oncology | 10-2008
I know of no relationship. Diverticulosis seems to be a purely mechanical herniation of thin areas of the bowel wall, while polyposis is related to a number of diseases where ...
Colon cancer in the family: when to screen | Gastroenterology | 09-2008
A person with a first-degree relative who had colon cancer should have the next colonoscopy 5 years after the first. Though this individual may be at average risk because his ...
Colon cancer in the family: when to screen | Oncology | 09-2008
The frequency of screening for your patient would be no different from that of the general population -- every 3-10 years. A history of colon cancer in a 73-year-old wouldn't ...
Next steps after a positive Pap | Oncology | 07-2008
You should refer the patient to a gynecologist, or in larger centres, a gynecologic oncologist. Likely, a colposcopy will be arranged, where the cervix will be examined under better magnification ...
Does ASA prevent colon cancer? | Oncology | 06-2008
ASA is an inhibitor of COX-1 and -2, and it does have a role to play in the formation of colon cancer. This has been shown in both animals and ...
Follow-up on thyroid cancer patients | Oncology | 05-2008
Thyroid cancer follow-up recommendations are available through the American Thyroid Association. Guidelines vary somewhat from one institute to another and depend on the risk of recurrence based on stage and ...
Is intestinal metaplasia reversible? | Gastroenterology | 02-2008
Certain types of intestinal metaplasia -- the less differentiated, i.e. not closely resembling the small intestine -- are considered to be precancerous. If caused by H. pylori, eradication is beneficial, ...
The black bowel: melanosis coli | Gastroenterology | 09-2007
Melanosis coli, a condition seen in patients using harsh laxatives like senna, is reversible on stopping the herbal supplement. Other than indicating long-term use to the clinician, it has no ...
Prescribing raloxifene to prevent breast Ca | Clinical Pharmacology, Oncology | 06-2007
The question about the appropriate use of raloxifene for breast cancer prevention is an interesting and evolving one. Raloxifene is a selective estrogen receptor modifier that was originally developed to ...
Best imaging for esophageal cancer staging | Imaging | 05-2007
Accurate pre-therapy staging is very important for the treatment of esophageal carcinoma. For centres that provide the service, EUS is considered a vital part of the initial protocol for those ...
Flow cytometry: when is it useful? | Allergy | 10-2006
Flow cytometry may be used to calculate the number of CD4 lymphocytes present in the blood. CD4 is the cell surface marker for T helper cells and these are destroyed ...
Flow cytometry: when is it useful? | Hematology | 10-2006
Flow cytometry is the measurement of numerous cell properties as the cells move in single file in a fluid column and intercept a beam of laser light. In a hematology ...
Do infertility drugs predispose to ovarian cancer? | Obstetrics Gynecology | 10-2006
There's no good scientific evidence that infertility treatments per se increase the likelihood of ovarian cancer, although theoretically, with superovulation on a long-term basis, it does make sense that the ...
Is HRT safe when risk of breast Ca is high? | Obstetrics Gynecology | 09-2006
The decision to use HRT in any patient is often a risk vs benefit scenario, weighing the severity of symptoms and the resultant quality of life against the likelihood of ...
Can dermoid cysts lead to cancer? | Obstetrics Gynecology | 09-2006
Dermoid cysts are the most common tumour of the ovary, yet despite this, their overall incidence is low. If a patient had a benign dermoid cyst removed in the past, ...
CT scans: are incidental nodules worrisome? | Respirology | 09-2006
Clinical history can be helpful, beyond the CT x-ray appearance of the nodules. If the patient hasn't had a previous primary malignancy that might result in metastasis, the odds of ...
Celiac disease: does diet protect against cancer? | Gastroenterology | 04-2006
While the exact risk profile for malignancy isn't known, it's generally believed that patients with celiac disease have increased numbers of lymphomas and intestinal tract cancers. Does a gluten-free diet ...
Are transformation zone cells essential on Pap? | Obstetrics Gynecology | 02-2006
A Pap smear isn't satisfactory as a screen for cervical cancer unless the transformation zone is sampled. I would repeat the Pap smear three months later. At times, it's difficult ...
Can artificial sweeteners lead to cancer? | Oncology | 11-2005
According to DeVita's Cancer Principles And Practice Of Oncology, 7th Edition, amp quot Coffee, tea and artificial sweeteners have not been shown to be independent risk factors. amp quot The ...
Is TSH suppression after cancer lifelong? | Endocrinology | 10-2005
Patients with papillary or follicular thyroid cancer are treated with thyroid hormone suppressions lifelong. We know the disease can reappear decades after diagnosis, and suppression of TSH may help reduce ...
Does finasteride prevent prostate cancer? | Urology | 09-2005
Finasteride might lower the risk of developing prostate cancer by as much as 25 , according to the large U.S. study cited above. The recommendation for its use, however, is ...
Tracking down a persistent cough | Respirology | 07-2005
As the patient has had a bronchoscopy and chest CT that are reportedly normal, it's highly unlikely that his cough is secondary to a recurrence of lung cancer involving his ...
Should streak ovaries be removed? | Obstetrics Gynecology | 05-2005
The term amp quot streak gonads amp quot often refers to ovaries that have undergone premature failure. The most extreme example is Turner's syndrome. This patient unlikely has an intersex ...
Teenager at high breast Ca risk | Obstetrics Gynecology | 03-2005
The history of injectable medroxyprogesterone is interesting in that studies in dogs on this medication have shown an increased risk of breast cancer, but this has never been proven to ...
Screening for smokers' cancer | Respirology | 10-2004
There are ongoing trials to try to answer this question. Presently, CT scans can't be recommended as cost-effective. The problem is that many benign lesions will appear in surgery -- ...
Latent lymphadenopathy workup | Infection | 09-2004
The observation that your otherwise healthy patient is asymptomatic and that there's been no change over several years is good evidence against many ominous diagnoses. The infectious disease differential diagnosis ...
PET imaging: not for the average Canadian | Imaging | 02-2003
PET imaging has been available for more than 30 years, but it's been evolving rather slowly from a pure research tool to a technique with great clinical potential in the ...
How should we screen for colon cancer? | Gastroenterology | 06-2002
Most of the well-known guidelines emphasize performing a flexible sigmoidoscopy at the age of 50 for an average-risk patient. If this is negative, then do annual stool testing for occult ...
MEDULLARY THYROID CARCINOMA: ALL IN THE FAMILY? | Endocrinology | 02-2002
Patients with medullary thyroid carcinoma are routinely given genetic testing to identify whether they have a mutation in the ret gene. If a mutation is found, family members should be ...
TOUGH DECISIONS CHEMO IN PALLIATIVE CARE | Oncology | 08-2001
In many patients with advanced cancer, the objective of chemotherapy is to produce a tumour remission in hopes of reducing symptoms or delaying onset of symptoms of advanced cancer. Chemotherapy ...
MEDICAL MARIJUANA: WHAT'S LEGAL? | Oncology | 04-2000
The drug nabilone Cesamet , a synthetic cannabinoid, has been available in Canada for many years. It's given as a tablet orally for chemotherapy-induced nausea and vomiting. The antiemetic effect ...
EXTRA BREAST CA RISK WITH THE PILL? | Oncology | 01-1997
If oral contraceptives increase the risk of breast cancer, the magnitude of increase is quite small. Oral contraceptives actually reduce the risk of ovarian cancer. Thus, from an oncology standpoint ...
HOW TO REDUCE SPINAL TAP STRESS IN KIDS | Pediatrics | 01-1997
Generally speaking, children who warrant a lumbar puncture are too sick, too young, or, in the case of oncology patients, too fed up with hospitals to be easily distracted or ...
CERVICITIS OR SQUAMOUS DYSPLASIA? | Obstetrics Gynecology | 03-1995
If the Pap test result indicates a cervicitis then cultures should be taken to exclude an infection, the Pap test should be repeated within five to six months. If there ...
OMINOUS SYMPTOM OF BREAST CANCER? | Obstetrics Gynecology | 05-1994
A bloody nipple discharge can be brownish in appearance and reflect an underlying carcinoma. An intraductal papilloma is the cause of most cases of spontaneous single duct nipple discharge. A ...
Colposcopy for class 2 Pap smear? | Obstetrics Gynecology | 02-1994
A class II Pap smear usually includes smears that have inflammatory cells or squamous or glandular atypia. A recent report has documented 81 of this category to have inflammatory atypia, ...
