Overview
- The word hepatitis comes from the Ancient Greek word hepar (root word hepat) which means ‘liver’, and the suffix Latin itis meaning inflammation.
- Its plural is hepatitides.
- This condition is recognized by the presence of inflammatory cells in the tissue of the organ.
- This condition can progress to cirrhosis and fibrosis.
- Hepatitis may occur with limited or no symptoms.
- It often leads to jaundice, anorexia (poor appetite) and malaise.
- Hepatitis is acute when it lasts less than six months.
- It is chronic when it persists longer.
- A group of viruses known as the hepatitis viruses cause most cases of hepatitis worldwide.
- It can also be due to toxins (notably alcohol, certain medications, some industrial organic solvents and plants).
- It can also be due to other infections and autoimmune diseases.

How many types of hepatitis are there?
There are five main types of hepatitis that are caused by a virus, A, B, C, D, and E – plus types X and G.

Treatment for Hepatitis A
- There is no treatment specifically for hepatitis A.
- Doctor will advise the patient to abstain from alcohol and drugs during the recovery.
- The vast majority of patients with Hepatitis A will recover spontaneously.

Treatment for Hepatitis B
- A patient with Hepatitis B needs to rest.
- He will require a diet that is high in protein and carbohydrate.
- This is to repair damaged liver cells, as well as to protect the liver.
- The doctor may prescribe interferon.
- Interferon is an antiviral agent.

Treatment for Hepatitis C
- A patient with Hepatitis C will be prescribed pegylated interferon and ribavirin.

Treatment for Hepatitis D or E
- There is no effective treatment for either Hepatitis D or E.

Treatment for Non-Viral Hepatitis
- If the patient has non-viral hepatitis, the doctor needs to remove the harmful substance.
- It will be flushed out of the stomach by hyperventilation or induced vomiting.
- Patients with drug-induced hepatitis may be prescribed corticosteroids.

How to prevent Hepatitis A?
- Wash your hands with soap after going to the toilet.
- Only consume food that has just been cooked.
- Only drink commercially bottled water, or boiled water if you unsure of local sanitation.
- Only eat fruits that you can peel if you are somewhere where sanitation is unreliable.
- Only eat raw vegetables if you are sure they have been cleaned/disinfected thoroughly.
- Get a vaccine for Hepatitis A if you travel to places where hepatitis may be endemic.

How to prevent Hepatitis B?
- Tell the partner if you are a carrier or try to find out whether he/she is a carrier.
- Practice safe sex.
- Only use clean syringes that have not been used by anyone else.
- Do not share toothbrushes, razors, or manicure instruments.
- Have a Hepatitis B series of shots if you are at risk.
- Only allow well sterilized skin perforating equipment (tattoo, acupuncture, etc.).

How to prevent Hepatitis C?
- If you are infected do not let others share your toothbrush, razor, manicure equipment.
- If you are infected cover open wounds.
- Do not share needles, toothbrushes, or manicure equipment.
- If your skin is to be pierced, make sure equipment is well sterilized (tattoo, etc.).
- Go easy on the alcohol.
- Do not share drug equipment.

How to prevent Hepatitis D?
- Use the same guidelines as for Hepatitis B.
- Only a person who is infected with Hepatitis B can become infected with Hepatitis D.

How to prevent Hepatitis E?
- Do the same as you would to protect yourself from Hepatitis A infection.

How to prevent Alcoholic Hepatitis?
- Go easy on the alcohol, or abstain from consuming alcohol.

How to prevent Toxic/Drug Induced Hepatitis?
- Make sure you know about the lethal contents of all chemicals.
- Make sure the spray is not pointing at you.
- Make sure you wear protective gear.

Overview
- The word hepatitis comes from the Ancient Greek word hepar (root word hepat) which means ‘liver’, and the suffix Latin itis meaning inflammation.
- Its plural is hepatitides.
- This condition is recognized by the presence of inflammatory cells in the tissue of the organ.
- This condition can progress to cirrhosis and fibrosis.
- Hepatitis may occur with limited or no symptoms.
- It often leads to jaundice, anorexia (poor appetite) and malaise.
- Hepatitis is acute when it lasts less than six months.
- It is chronic when it persists longer.
- A group of viruses known as the hepatitis viruses cause most cases of hepatitis worldwide.
- It can also be due to toxins (notably alcohol, certain medications, some industrial organic solvents and plants).
- It can also be due to other infections and autoimmune diseases.

How many types of hepatitis are there?
There are five main types of hepatitis that are caused by a virus, A, B, C, D, and E – plus types X and G.

How is Hepatitis diagnosed?
- A blood test is usually needed to determine if a person has hepatitis.
- It is also important to stay well hydrated by drinking lots of fluids.
- Hepatitis B and C can sometimes be treated with medications.
- Some forms of medication used to treat hepatitis C are only approved for use in adults.
- Although treatments for hepatitis B and C are becoming more effective.

Diagnosis of Hepatitis A (HAV)
- A blood test showing the presence of IgM anti-HAV in serum.
- It confirms the diagnosis of acute hepatitis A infection.
- Symptoms of this virus strain include nausea, vomiting, and diarrhea.

Diagnosis of Hepatitis B (HBV)
Acute HBV infection is diagnosed by a simple blood test detecting the presence of hepatitis B surface antigen (HBsAg) and IgM antibody to hepatitis B core antigen (anti-HBc IgM).

The following antibody variations can occur, each having a specific implication.

- Anti-HBs +:
Indicates individual has been vaccinated, has received immune globulin, is immune, or is an infant who has received antibodies from its mother.

- Anti-HBc +:
Indicates past or present infection and lasts indefinitely. Also may be detected in someone who has received immune globulin or an infant who has received antibodies from its mother.

- IgM anti-HBc +:
Indicates recent infection with HBV, usually within 4-6 months.

- HBeAg +:
Indicates active viral replication and high infectivity.

- HBsAg +:
Indicates acute or chronic HBV. Persistence for 6 months after acute infection indicates progression to chronic HBV.

Diagnosis of Hepatitis C (HCV)
- Infection by the hepatitis C virus can be determined by a blood test that detects HCV antibodies in the blood.
- This test is not a part of a routine physical
- People must ask their doctor for hepatitis C test
- If the initial test is positive, a second test should be done to confirm the diagnosis and liver enzymes (a blood test) should be measured.
- Anti-HCV (antibodies to the virus) may not be present in the first four weeks of infection
- HCV infection may be identified by the presence of anti-HCV in approximately 60% of people as early as 5-8 weeks after exposure.
- In some individuals HCV antibodies may not be detected for 5-12 months. HCV-RNA and RT-PCR tests can determine HCV presence in as little as 1-2 weeks.
- A liver biopsy can identify the type and degree of damage (and can determine the severity of the disease).
- The disease may gradually progress over a period of 10-40 years.

Diagnosis of Hepatitis D (HDV)
- A positive test for anti-HDV in a patient with acute hepatitis B indicates HBV/ HDV co-infection.
- Patients with chronic hepatitis B and a positive HDV test are super-infected.

Diagnosis of Hepatitis E (HEV)
- Testing for anti-HEV is usually reserved for returning travelers from the developing world in whom hepatitis is present.
- Other hepatitis viruses cannot be detected.
- Currently there is no treatment for HEV.

Overview
- The word hepatitis comes from the Ancient Greek word hepar (root word hepat) which means ‘liver’, and the suffix Latin itis meaning inflammation.
- Its plural is hepatitides.
- This condition is recognized by the presence of inflammatory cells in the tissue of the organ.
- This condition can progress to cirrhosis and fibrosis.
- Hepatitis may occur with limited or no symptoms.
- It often leads to jaundice, anorexia (poor appetite) and malaise.
- Hepatitis is acute when it lasts less than six months.
- It is chronic when it persists longer.
- A group of viruses known as the hepatitis viruses cause most cases of hepatitis worldwide.
- It can also be due to toxins (notably alcohol, certain medications, some industrial organic solvents and plants).
- It can also be due to other infections and autoimmune diseases.

How many types of hepatitis are there?
There are five main types of hepatitis that are caused by a virus, A, B, C, D, and E – plus types X and G.
- Hepatitis A
This is caused by eating infected food or water.
- Hepatitis B
This is an STD (sexually transmitted disease).
- Hepatitis C
Hepatitis C is usually spread through direct contact with the blood of a person who has the disease.
- Hepatitis D
Only a person who is already infected with Hepatitis B can become infected with Hepatitis D.
- Hepatitis E
A person can become infected by drinking water that contains HEV (Hepatitis E Virus).
- Hepatitis X
If hepatitis cannot be attributed to the viruses of hepatitis A, B, C, D, or E, it is called Hepatitis X.
- Hepatitis G:
This is a type of hepatitis caused by the Hepatitis G virus (HGV).

Causes of Hepatitis
- Non-viral infection
- Autoimmune hepatitis
- Non-alcoholic steatohepatitis
- Alcoholic hepatitis
- Drug induced
- Other toxins
- Metabolic disorders
- Obstructive
- Autoimmune

What are the signs and symptoms of hepatitis?
The four main symptoms of hepatitis are:

1. Jaundice
- This is the classic symptom of hepatitis.
- This is an accumulation of a chemical called bilirubin in the body’s tissues.
- The liver usually processes this chemical as a waste product but during this condition it is not able to do that job.
- This chemical accumulates in the blood and starts to leak out into body tissue.
- When enough of this chemical accumulates it’s possible to see a yellow color in the skin, urine and especially around the whites of the eyes.

2. Loss of Appetite
- Loss of appetite is also called anorexia.
- It is often the first symptom of acute hepatitis.
- It is being replaced by nausea and vomiting on further progress

3. Fatigue
- Fatigue is a debilitating tiredness.
- It is a big source of frustration for people with liver disease.
- The liver is a vital organ in metabolizing and storing energy.
- When the liver is damaged, extreme weakness is common.

4. Muscle and Joint Aches
- Pain in the muscles and joints can last from days to weeks.
- These are more common in acute hepatitis than in chronic hepatitis.

Symptoms of Acute phase of Hepatitis
The initial phase of hepatitis is called the acute phase. The symptoms are like a mild flu, and may include:
- Diarrhea
- Fatigue
- Loss of appetite
- Mild fever
- Muscle or joint aches
- Nausea
- Slight abdominal pain
- Vomiting
- Weight loss

As the patient gets worse, these symptoms may follow:
- Circulation problems (only toxic/drug-induced hepatitis)
- Dark urine
- Dizziness (only toxic/drug-induced hepatitis)
- Drowsiness (only toxic/drug-induced hepatitis)
- Enlarged spleen (only alcoholic hepatitis)
- Headache (only toxic/drug-induced hepatitis)
- Hives
- Itchy skin
- Light colored feces, the feces may contain pus
- Yellow skin, whites of eyes, tongue (jaundice)

How many types of hepatitis are there?
There are five main types of hepatitis that are caused by a virus, A, B, C, D, and E – plus types X and G.
- Hepatitis A
This is caused by eating infected food or water.
- Hepatitis B
This is an STD (sexually transmitted disease).
- Hepatitis C
Hepatitis C is usually spread through direct contact with the blood of a person who has the disease.
- Hepatitis D
Only a person who is already infected with Hepatitis B can become infected with Hepatitis D.
- Hepatitis E
A person can become infected by drinking water that contains HEV (Hepatitis E Virus).
- Hepatitis X
If hepatitis cannot be attributed to the viruses of hepatitis A, B, C, D, or E, it is called Hepatitis X.
- Hepatitis G:
This is a type of hepatitis caused by the Hepatitis G virus (HGV).

Acute Causes

1. Viral hepatitis:
- Hepatitis A, B, C, D, and E.
- Yellow fever
- Adenoviruses
- Parvovirus B19

2. Non-viral infection
- Toxoplasma
- Leptospira
- Q fever
- Rocky mountain spotted fever
- Alcohol
- Toxins: Amanita toxin in mushrooms, carbon tetrachloride, asafetida
- Drugs: Paracetamol, amoxycillin, antituberculosis medicines, minocycline and many others (see longer list below).
- Ischemic hepatitis (circulatory insufficiency)
- Pregnancy
- Auto immune conditions, e.g., systemic lupus erythematosus (SLE)
- Metabolic diseases, e.g., Wilson’s disease

Chronic Causes
Viral hepatitis:
- Hepatitis B with or without hepatitis D.
- Hepatitis C (neither hepatitis A nor hepatitis E causes chronic hepatitis).

Autoimmune Causes
- Alcohol
- Drugs
- Methyldopa
- Nitrofurantoin
- Isoniazid
- Ketoconazole

Heredity Causes
- Wilson’s disease.
- Alpha 1-antitrypsin deficiency.
- Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic hepatitis.

Alcoholic Hepatitis Causes
- Long term alcohol consumption.
- Patients with chronic alcoholic liver disease.
- Alcoholic cirrhosis.

A large number of drugs can cause hepatitis:
- Agomelatine (antidepressant).
- Allopurinol.
- Amitriptyline (antidepressant).
- Amiodarone (antiarrhythmic).
- Atomoxetine.
- Azathioprine.
- Halothane (a specific type of anesthetic gas).
- Hormonal contraceptives.
- Ibuprofen and indomethacin (NSAIDs).
- Isoniazid (INH), rifampicin, and pyrazinamide (tuberculosis-specific antibiotics).
- Ketoconazole (antifungal).
- Loratadine (antihistamine).
- Methotrexate (immune suppressant).
- Methyldopa (antihypertensive).
- Minocycline (tetracycline antibiotic).
- Nifedipine (antihypertensive).
- Nitrofurantoin (antibiotic).
- Paracetamol (acetaminophen in the United States) can cause hepatitis when taken in an overdose. The severity of liver damage may be limited by prompt administration of acetylcysteine.
- Phenytoin and valproic acid (antiepileptics).
- Troglitazone (antidiabetic, withdrawn in 2000 for causing hepatitis).
- Zidovudine (antiretroviral i.e., against HIV).
- Some herbs and nutritional supplements.

Other Toxins that can cause hepatitis:
- Amatoxin-containing mushrooms.
- White phosphorus, an industrial toxin and war chemical.
- Carbon tetrachloride.
- Cylindrospermopsin, a toxin from the cyanobacterium Cylindrospermopsis raciborskii and other cyanobacteria.

Metabolic disorders can cause hepatitis:
- Hemochromatosis (due to iron accumulation).
- Wilson’s disease(copper accumulation) can cause liver inflammation.
- Necrosis.
- Non-alcoholic steatohepatitis (NASH) is effectively a consequence of metabolic syndrome.

In primary sclerosing cholangitis :
- The intrahepatic and extrahepatic bile ducts become inflamed,
- scarred and thickened (sclerotic),
- narrowed,
- finally obstructed.

Obstruction of the ducts can lead to:
- abdominal pain,
- itching,
- jaundice,
- infection in the bile ducts (cholangitis),
- liver scarring that leads to liver cirrhosis,
- liver failure.

Symptoms of primary sclerosing cholangitis:
- Most patients with early primary sclerosing cholangitis have no symptoms.
- The presence of primary sclerosing cholangitis is recognized only because of abnormally elevated blood levels of liver enzymes (particularly alkaline phosphatase levels).
- This is often recognized along with a routine physical examination.
Early symptoms of primary sclerosing cholangitis include
- Fatigue
- bodily itching (pruritus)

With the progress of the disease:
- Patients may develop jaundice (yellowing of skin and darkening of urine).
- Jaundice is due to the accumulation of bilirubin in the body.
- The bilirubin accumulates because it is not able to be eliminated in the bile.
- This is due to prolonged obstruction of the bile ducts.
- The accumulation of bilirubin turns the skin and whites of the eye (sclera) yellow.
- It may be due to accumulation of bile salts in the body.
- It is as a result of obstruction of the bile ducts.

As primary sclerosing cholangitis progresses, patients typically develop:
- Right upper abdominal pain,
- Fever,
- Fatigue,
- Pruritus
- Jaundice
- These patients also are at risk of developing primary sclerosing cholangitis complications.
- The patients with the autoimmune form of primary sclerosing cholangitis have more rapid symptoms of abdominal pain, jaundice and fever.

In primary sclerosing cholangitis :
- The intrahepatic and extrahepatic bile ducts become inflamed,
- scarred and thickened (sclerotic),
- narrowed,
- finally obstructed.

Obstruction of the ducts can lead to:
- abdominal pain,
- itching,
- jaundice,
- infection in the bile ducts (cholangitis),
- liver scarring that leads to liver cirrhosis,
- liver failure.

Diagnosis of primary sclerosing cholangitis includes:
- Blood tests
- Radiologic tests
- Colonoscopy

The treatment of primary sclerosing cholangitis includes:
- Cholestyramine (Questran) or rifampin(Rifadin) to diminish itching.
- Antibiotics for infection, specifically cholangitis.
- Vitamin D and calcium to prevent bone loss (osteoporosis).
- Medications such as ursodiol (UDCA) to retard the progression of primary sclerosing cholangitis.
- ERCP with balloon dilatation.
- Stenting (a procedure in which the bile ducts are stretched open) for primary sclerosing cholangitis patients with dominant extra-hepatic duct strictures.
- Liver transplantation for patients with advanced cirrhosis.

Medications
- Ursodiol (UDCA),
- Prednisone,
- Methotrexate(Rheumatrex, Trexall),
- Colchicine,
- 6-mercaptopurine,
- Tacrolimus (Prograf),
- Cyclosporine (Neoral, Gengraf)

UDCA
- Ursodiol (UDCA) is a bile acid.
- This is given orally and replaces other bile acids in the body.
- UDCA is believed to protect against damaging effects of other bile acids on the liver cells.
- It also can induce formation of antioxidants.
- UDCA is the most extensively studied medication for primary sclerosing cholangitis.
- Its standard doses are15 mg/kg/day.
- It has been shown to improve fatigue, and improve blood levels of liver enzymes in these patients.
- Higher doses (20-30 mg/kg/day) UDCA has been shown to improve blood liver enzymes.
- It also decreases bile duct inflammation, and decrease liver scarring.
- UDCA is safe and well tolerated.
- It may improve bile duct disease and retard the development of liver cirrhosis.
- UDCA may decrease colon cancer risk in patients with both primary sclerosing cholangitis and chronic ulcerative colitis.

Treatment of dominant strictures
- Dominant strictures are major narrowing in the extrahepatic bile ducts.
- Dominant strictures of the extrahepatic bile ducts occur in 7%-20% of primary sclerosing cholangitis patients.
- ERCP and balloon dilatation (stretching) of the stricture can improve symptoms and abnormal blood levels of liver enzymes and bilirubin.
- Successful dilatation of dominant strictures decreases the risk of developing cholangitis.
- ERCP and dilatation of dominant strictures should be done in centers with highly experienced physicians.
- In ERCP, doctors often also perform brush cytology of the dominant strictures to exclude cholangiocarcinoma.
- Surgery is another treatment for dominant extrahepatic strictures.
- Surgical resection of the stricture followed by creation of a choledocho-jejunostomy which is an artificial passage for bile formed by attaching the bile duct from above the stricture directly into the small intestine.
- This can improve symptoms, delay liver transplantation, and lower the risk of cholangiocarcinoma.

Liver transplantation
The reasons for liver transplant in primary sclerosing cholangitis patients are similar to those in other forms of end-stage liver disease. They are:
- Internal bleeding due to rupture of esophageal varices.
- Severe ascites that are refractory to medical treatment.
- Frequent episodes of bacterial cholangitis.
- Hepatic encephalopathy.

In primary sclerosing cholangitis :
- The intrahepatic and extrahepatic bile ducts become inflamed,
- scarred and thickened (sclerotic),
- narrowed,
- finally obstructed.

Obstruction of the ducts can lead to:
- abdominal pain,
- itching,
- jaundice,
- infection in the bile ducts (cholangitis),
- liver scarring that leads to liver cirrhosis,
- liver failure.

The diagnosis of primary sclerosing cholangitis inclde:
- It is suspected from the symptoms (such as fatigue, itching, and jaundice).
- Abnormal laboratory tests (such as abnormally elevated blood levels of alkaline phosphatase and other liver enzymes).
- It is confirmed by demonstration of abnormally thickened bile ducts using special radiological tests.

It is also important to exclude diseases that can mimic primary sclerosing cholangitis like:
- primary biliary cirrhosis(PBC)
- gallstones in the bile ducts
- bile duct cancers
- strictures

Blood Tests
- The blood level of alkaline phosphates is usually elevated in primary sclerosing cholangitis.
- The blood levels of other liver enzymes (AST and ALT) may also be mildly elevated.
- Except in those patients with the autoimmune form of primary sclerosing cholangitis, the bilirubin usually is normal.
- It gradually increases as the disease progress.
- Antimitochondrial antibody (AMA), which is elevated in patients with PBC, is usually normal in these patients.

Radiologic Tests
- Endoscopic retrograde cholangio-pancreatography (ERCP).
- Magnetic resonance cholangio-pancreatography (MRCP).
- These are commonly performed to visualize the intrahepatic and extrahepatic ducts.
- These ducts are typically normal in appearance in patients with PBC.
- In primary sclerosing cholangitis patients, these ducts have a beaded appearance (multiple narrowings along the ducts with areas of widening in between).
- MRCP is noninvasive and safe.
- ERCP is more invasive and carries a 5%-6% chance of causing an attack of acute pancreatitis.
- However, ERCP has the advantage of obtaining cell samples (a process called brush cytology) from the bile ducts.
- Brush cytology is not very accurate.
- It can help to diagnose cholangiocarcinoma.
- During ERCP, doctor can also insert balloons and stents across major areas of narrowing (dominant strictures).
- This is done to relieve obstruction and treat infection.

Colonoscopy
- Patients with primary sclerosing cholangitis have a high likelihood of also having ulcerative colitis.
- Patients with primary sclerosing cholangitis and ulcerative colitis have higher risks of developing colon cancer.
- Colonoscopy is important to both diagnose ulcerative colitis and for early detection of cancer.
- It is also used to study the precancerous conditions.

In primary sclerosing cholangitis :
- The intrahepatic and extrahepatic bile ducts become inflamed,
- scarred and thickened (sclerotic),
- narrowed,
- finally obstructed.

Obstruction of the ducts can lead to:
- abdominal pain,
- itching,
- jaundice,
- infection in the bile ducts (cholangitis),
- liver scarring that leads to liver cirrhosis,
- liver failure.

How common is primary sclerosing cholangitis?
- Primary sclerosing cholangitis is a rare disease.
- An estimated prevalence in the United States of 6 per 100,000 people.
- It is more common in men then in women; approximately 70% of primary sclerosing cholangitis patients are men.
- The mean age at diagnosis of primary sclerosing cholangitis is around 40 years of age.
- There is a strong association between primary sclerosing cholangitis and chronic ulcerative colitis.
- Primary sclerosing cholangitis can also occur alone or in association.
- This usually occurs with Crohn’s disease, a disease of the intestines that is related to ulcerative colitis.

What causes primary sclerosing cholangitis?
- The cause of primary sclerosing cholangitis is not known.
- A small subset (approximately 10%) of primary sclerosing cholangitis patients has a rapidly progressive form of the disease.
- This includes early onset of abdominal pain, and itching.
- This responds dramatically to treatment with corticosteroids.
- Since corticosteroids (such as prednisone) are medications for treating immune diseases primary sclerosing cholangitis patients are believed to have an immune disorder that causes their primary sclerosing cholangitis.

Immune diseases include:
- Ulcerative colitis
- Crohn’s disease
- Systemic lupus erythematosus

Primary Sclerosing Cholangitis at a Glance
- Primary sclerosing cholangitis is a chronic, progressive disease of the liver.
- The cause of primary sclerosing cholangitis is not known.
- Though an immune cause is suspected in at least a minority of patients.
- Primary sclerosing cholangitis has a strong association with ulcerative colitis and cancer of the bile ducts.
- The primary symptoms of primary sclerosing cholangitis are due to obstruction of the bile ducts and also cirrhosis of the liver.
- Primary sclerosing cholangitis is diagnosed on the basis of abnormal blood tests and radiologic imaging of the bile ducts.
-Primary sclerosing cholangitis is treated with medications, endoscopy, and liver transplantation.

What is Brain Tumor?
Brain tumors can either originate from within the brain (“primary brain tumors”). From cancer cells that have metastasized from other organs or tissues (“secondary brain tumors”). Primary brain tumors can be derived from the over twenty different cell types that make up the brain and its linings.

What are Primary Brain Tumor?
Primary tumors can be cancerous (malignant) or benign. These tumours start in the brain and do not spread. They rarely spread beyond the central nervous system. The tumor is still taking up space in the skull. They can cause serious complications and symptoms.

Primary Brain Tumor Types in Adults

- Gliomas
Tumors derived from astrocytes:
- Anaplastic astrocytoma (“grade III”)
- Glioblastoma multiforme
Tumors derived from oligodendrocytes:
- Oligodendrocytes
- Oligodendrogliomas
Tumors derived from ependymal cells:
- Ependymomas
- Anaplastic ependymomas
Meningiomas
- Consequences of intracranial hypertension.
- Dysfunction Irritation.

What are Secondary Brain Tumor?
- These tumours are often called metastatic tumors.
- They are the result of cancer cells originating from another part of the body.
- They are spread to the brain.
- Secondary brain tumors often indicate advanced stages of disease.
- Both cancerous primary and secondary tumors are life threatening.
- These types of tumors are usually very aggressive.
- Secondary tumors means a cancerous neoplasm that has developed in another organ elsewhere in the body
- These cancer cells have leaked from that primary tumor and then entered the lymphatic system and blood vessels.
- They then circulate through the bloodstream.
- They are then deposited in the brain.
- These cells continue growing and dividing.
- They become another invasive neoplasm of the primary cancer’s tissue.
- Secondary tumors of the brain are very common in the terminal phases of patients.

Other Types of Growth
1. Low-grade vs. high-grade:
- Low-grade tumors are slow-growing.
- High-grade tumors are fast-growing and aggressive.
- High-grade tumors can invade nearby tissue or spread elsewhere in the body.
- They are also more likely to recur after treatment.
- They are generally associated with a worse outlook.

2. Localized vs. Invasive:
- Localized tumor is confined to one area.
- It is generally easier to remove.
- It’s in an accessible part of the brain.
- An invasive tumor has spread to surrounding areas.
- It is more difficult or impossible to remove completely.

Signals and Causes
Signal Number 1:
- First headache complaint from person over 50 years old.
Possible Cause:
- Brain tumor, arteriïtis temporalis.

Signal Number 2:
- First migraine attack in person over 40 years old.
Possible Cause:
- Brain tumor.

Signal Number 3:
- Headache in person under 6 years old.
Possible Cause:
- Brain tumor, hydrocephalus.

Signal Number 4:
- Person over 50 years old with pain at temples.
Possible Cause:
- Arteriïtis temporalis

Signal Number 5:
- Pregnancy with unknown headache.
Possible Cause:
- Pre-eclampsia.

Signal Number 6:
- Increased headaches after trauma.
Possible Cause:
- Sub/Epidural hematoma.

Signal Number 7:
- Severe headaches and very high blood pressure.
Possible Cause:
- Malignant hypertension.

Signal Number 8:
- Acute severe headache.
Possible Cause:
- Meningitis, CVA (Cerebrovascular accident or stroke), subarachnoidal hemorrhage.

Signal Number 9:
- Headache and fever (with reduced consciousness).
Possible Cause:
- Meningitis.

Signal Number 10:
- Stiffness of the neck/neurological dysfunction.
Possible Cause:
- Meningitis, brain tumor.

Signal Number 11:
- Headache with signs of elevated intracranial pressure.
Possible Cause:
- Brain tumor.

Signal Number 12:
- Focal neurological dysfunction.
Possible Cause:
- Brain tumor.

Signal Number 13:
- Early morning vomiting or vomiting unrelated to headache or other illness.
Possible Cause:
- Brain tumor.

Signal Number 14:
- Behavioral changes or rapid decline in school results.
Possible Cause:
- Brain tumor.

The most common types of bone cancer includes:
- Osteosarcoma,
- Ewing’s sarcoma,
- Chondrosarcoma,
- Malignant fibrous histiocytoma,
- Fibrosarcoma,
- Chordoma

Diagnosis of bone cancer:
- Check for a complete medical history.
- A description of your symptoms can help.
- A complete physical examination can help find the cause of your symptoms.
- Testing your muscle strength.
- Sensation to touch
- Reflexes
- Certain blood tests
- Plain X-rays
Benign tumors are more likely to have a smooth border while malignant tumors have a ragged border on X-ray images.

- A CT scan
- An MRI (magnetic resonance imaging).
- Positron emission tomography (PET) scan.
- An angiogram, which is an x-ray of blood vessels.
- A bone scan.
- Obtain a biopsy sample of the tumor.
- Get examined in the laboratory by a pathologist.
- Determine what kind of tumor it is.

What is the treatment for bone cancer?
The best treatment is based on:
- the type of bone cancer,
- the location of the cancer,
- how aggressive the cancer is,
- whether or not the cancer has invaded surrounding or distant tissues (metastasized).

The main types of treatment for bone cancer:
- Surgery,
- Chemotherapy,
- Radiation therapy
- Cryosurgery
These can be used either individually or combined with each other.

Process of Cryosurgery
- This method is the use of liquid nitrogen to freeze and kill cancer cells.
- This technique can sometimes be used instead of conventional surgery to destroy the tumor.
- The application of liquid nitrogen as a local adjuvant to curettage in the treatment of bone tumors was first introduced three decades ago.
- Cryosurgery was shown to achieve excellent local control.
- It is used for a variety of benign-aggressive and malignant bone tumors.
- Cryosurgery can cause significant morbidity if performed inappropriately.

An effective and safe procedure must follow these consecutive steps:
- Adequate exposure of the tumor cavity.
- Meticulous curettage and burr drilling.
- Soft-tissue mobilization and protection.
- Introduction of LN to the tumor cavity.
- Internal fixation of the cavity after cryotherapy.
- Protection of the operated bone throughout the healing period.

Side effects
- The exposure of normal bone and soft tissues (skin, muscles, nerves, and blood vessels) to the freezing effect of LN can result in significant morbidity.
- Early studies of the use of cryosurgery in the treatment of bone high complication rates, mostly pathological fractures and infections.