What is vaginal cancer?
Vaginal cancer happens when malignant (cancerous) cells form in the vagina. It is a very uncommon disease. The vagina, also known as the birth canal, is a hollow channel that goes from the opening of your uterus to the outside of your body.


There are two types of vaginal cancer:
Squamous cell carcinoma: This is by far the more common of the two. It happens when cancer forms in the flat, thin cells that line the vagina. This type spreads slowly and tends to stay close to where it starts. But it can move into other organs including the liver, lungs, or bones. Older women are most likely to get this form of the disease. Nearly half of all cases occur in age group of 60 & more.

Adenocarcinoma: This type starts in the glandular cells in the lining of the vagina. These cells make mucus and other fluids.

Of the two main types, Adenocarcinoma, the more likely to spread to other areas. These include the lymph nodes (organs that filter harmful substances in the body) in the groin area and the lungs.

Clear cell carcinoma: This is an even rarer form of adenocarcinoma. It is been linked with women whose mothers took a hormone called diethylstilbestrol (DES) in the early months of pregnancy. Between 1938 and 1971, doctors often prescribed this medication to pregnant women to prevent miscarriage and other problems. Doctors stopped using it in 1971. But just how long do you remain at risk if your mother was given DES? That remains unknown.

Women who haven’t been exposed to it can still get vaginal cancer, but the chances are very small. If DES isn’t a factor, clear cell carcinoma is most likely to happen after menopause.


Vaginal Cancer and HPV (Human Papilloma Virus):
About nine out of every 10 vaginal cancer cases are linked to human papilloma virus, or HPV, infection. This is the most common STI, or sexually transmitted infection. There are two different vaccines to prevent HPV. But once you have it, it will most often go away on its own without treatment. When the infection lingers, though, it can cause cancer.


Other Causes
The following things can also increase your chances of developing vaginal cancer:
Drinking alcohol
Having cervical cancer or pre-cancer
Having HIV
Smoking
Many cases of vaginal cancer aren’t linked to any specific causes.



What are the symptoms for Vaginal Cancer?
These can include pain or abnormal vaginal bleeding. But the disease often doesn’t come with any warning signs. Your doctor might find it during a routine exam or Pap test.

Other symptoms can include feeling a lump in your vagina, pain in your pelvis, and painful sex.

If you notice any of these things, it doesn’t mean you have vaginal cancer. You could just have an infection. But it’s important to get it checked out.


What are the diagnosis and treatment for Vaginal Cancer?
If a pelvic exam shows there might be cancer, your doctor may want to take a closer look with a procedure called colposcopy. She’ll use a lighted magnifying instrument, a colposcope, to check your vagina and cervix for anything abnormal.

She might take tissue samples at the same time. A specialist will study the samples under a microscope. This is called a biopsy.

If she finds cancer, your doctor will choose a treatment based on many factors. These include how close the cancer is to other organs, which type of cancer is present, how advanced it is, whether you’ve had a hysterectomy, and if you’ve had radiation treatment in your pelvic area.

Most likely, your doctor will recommend one of the following courses of action:

Surgery: This is the most common treatment. Your doctor may use a laser to cut out affected tissue or growths. In some cases, she may need to remove all or part of the vagina. Or she’ll perform a hysterectomy. This is when the uterus is taken out. Sometimes the cervix or other organs need to be removed, too.

Many women can have a normal sex life after surgery. Your doctor will need to tell you what’s safe and when. Sex can increase the chance of infection, and it can cause bleeding or strain the surgical site. How you’re healing and what kind of surgery you’ve had will make a difference in the effect on your sex life, too.

Radiation therapy: This treatment uses high-powered X-rays or other forms of radiation to kill the cancer. It might be performed using a machine that sends X-rays into your body from outside. Your doctor might also place a protected radioactive substance inside your body on or near the cancer.

Radiation treatments in the pelvic area can damage the ovaries. This cuts off estrogen production, which leads to menopause symptoms like hot flashes and vaginal dryness. If you’ve already been through menopause, these symptoms likely won’t happen.

This type of therapy also can irritate healthy tissue. Your vagina might get swollen and tender. Sex may be painful.

Chemotherapy (“Chemo”): This kills or stops the growth of cancer cells using medications. You might take them by mouth or get them through an IV. If you have squamous cell vaginal cancer, your doctor might prescribe a chemo treatment in lotion or cream form.

Many patients lose their sex drive when they get chemo. Plus, the physical side effects, like nausea, hair loss, and changes in body weight can cause feelings of insecurity. Knowing that the physical side effects will improve when treatment stops can help a lot.


Can you Prevent Vaginal Cancer?
The best way to guard against it is to avoid being exposed to HPV. There are two vaccines, Gardasil and Gardasil 9, available to prevent vaginal cancer. Gardasil protects you from the four most common types of HPV. Gardasil 9 covers nine types of HPV.

If you don’t want the vaccine, you might try the following lifestyle changes. Studies show they may help to reduce your risk of vaginal cancer:
Wait to have sex until your late teen years or beyond
Don’t have sex with more than one partner
Don’t have sex with someone who has more than one partner
Use condoms during sex
Get regular Pap exams
If you smoke, stop. If you don’t smoke, don’t start.

What is Uveitis?
Uveitis is a general term describing a group of inflammatory diseases that produces swelling and destroys eye tissues. These diseases can slightly reduce vision or lead to severe vision loss. The term “uveitis” is used because the diseases often affect a part of the eye called the uvea. Nevertheless, uveitis is not limited to the uvea. These diseases also affect the lens, retina, optic nerve, and vitreous, producing reduced vision or blindness.

Uveitis may be caused by problems or diseases occurring in the eye or it can be part of an inflammatory disease affecting other parts of the body.

It can happen at all ages and primarily affects people between 20 and 60 years old.

Uveitis can last for a short (acute) or a long (chronic) time. The severest forms of uveitis reoccur many times.

Eye care professionals may describe the disease more specifically as:
Anterior uveitis
Intermediate uveitis
Posterior uveitis
Panuveitis uveitis
Eye care professionals may also describe the disease as infectious or noninfectious uveitis.



What is the Uvea and What Parts of the Eye are Most Affected by Uveitis?
The uvea is the middle layer of the eye which contains much of the eye’s blood vessels (see diagram). This is one way that inflammatory cells can enter the eye. Located between the sclera, the eye’s white outer coat, and the inner layer of the eye, called the retina, the uvea consists of the iris, ciliary body, and choroid:

Iris: The colored circle at the front of the eye. It defines eye color, secretes nutrients to keep the lens healthy, and controls the amount of light that enters the eye by adjusting the size of the pupil.

Ciliary Body: It is located between the iris and the choroid. It helps the eye focus by controlling the shape of the lens and it provides nutrients to keep the lens healthy.

Choroid: A thin, spongy network of blood vessels, which primarily provides nutrients to the retina.

Uveitis disrupts vision by primarily causing problems with the lens, retina, optic nerve, and vitreous



What Causes Uveitis?
Uveitis is caused by inflammatory responses inside the eye. Inflammation is the body’s natural response to tissue damage, germs, or toxins. It produces swelling, redness, heat, and destroys tissues as certain white blood cells rush to the affected part of the body to contain or eliminate the insult.

Uveitis may be caused by:

An attack from the body’s own immune system (autoimmunity)
Infections or tumors occurring within the eye or in other parts of the body
Bruises to the eye
Toxins that may penetrate the eye
The disease will cause symptoms, such as decreased vision, pain, light sensitivity, and increased floaters. In many cases the cause is unknown.



What are different types of Uveitis?
Uveitis is usually classified by where it occurs in the eye.

What is Anterior Uveitis?
Anterior uveitis occurs in the front of the eye. It is the most common form of uveitis, predominantly occurring in young and middle-aged people. Many cases occur in healthy people and may only affect one eye but some are associated with rheumatologic, skin, gastrointestinal, lung and infectious diseases.

What is Intermediate Uveitis?
Intermediate uveitis is commonly seen in young adults. The center of the inflammation often appears in the vitreous (see diagram). It has been linked to several disorders including, sarcoidosis and multiple sclerosis.

What is Posterior Uveitis?
Posterior uveitis is the least common form of uveitis. It primarily occurs in the back of the eye, often involving both the retina and the choroid. It is often called choroditis or chorioretinitis. There are many infectious and non-infectious causes to posterior uveitis.

What is Pan-Uveitis?
Pan-uveitis is a term used when all three major parts of the eye are affected by inflammation. Behcet’s disease is one of the most well-known forms of pan-uveitis and it greatly damages the retina.

Intermediate, posterior, and pan-uveitis are the most severe and highly recurrent forms of uveitis. They often cause blindness if left untreated.



Diseases Associated with Uveitis:
Uveitis can be associated with many diseases including:

AIDS
Ankylosing spondylitis
Behcet’s syndrome
CMV retinitis
Herpes zoster infection
Histoplasmosis
Kawasaki disease
Multiple sclerosis
Psoriasis
Reactive arthritis
Rheumatoid arthritis
Sarcoidosis
Syphilis
Toxoplasmosis
Tuberculosis
Ulcerative colitis
Vogt Koyanagi Harada’s disease
Symptoms and Detection



What are the symptoms?
Uveitis can affect one or both eyes. Symptoms may develop rapidly and can include:
Blurred vision
Dark, floating spots in the vision (floaters)
Eye pain
Redness of the eye
Sensitivity to light (photophobia)
Anyone suffering eye pain, severe light sensitivity, and any change in vision should immediately be examined by an ophthalmologist.

The signs and symptoms of uveitis depend on the type of inflammation.

Acute anterior uveitis may occur in one or both eyes and in adults is characterized by eye pain, blurred vision, sensitivity to light, a small pupil, and redness.

Intermediate uveitis causes blurred vision and floaters. Usually it is not associated with pain.

Posterior uveitis can produce vision loss. This type of uveitis can only be detected during an eye examination.



How is uveitis detected?
Diagnosis of uveitis includes a thorough examination and the recording of the patient’s complete medical history. Laboratory tests may be done to rule out an infection or an autoimmune disorder.

A central nervous system evaluation will often be performed on patients with a subgroup of intermediate uveitis, called pars planitis, to determine whether they have multiple sclerosis which is often associated with pars planitis.

The eye exams used, include:

An Eye Chart or Visual Acuity Test: This test measures whether a patient’s vision has decreased.

A Funduscopic Exam: The pupil is widened (dilated) with eye drops and then a light is shown through with an instrument called an ophthalmoscope to noninvasively inspect the back, inside part of the eye.

Ocular Pressure: An instrument, such a tonometer or a tonopen, measures the pressure inside the eye. Drops that numb the eye may be used for this test.

A Slit Lamp Exam: A slit lamp noninvasively inspects much of the eye. It can inspect the front and back parts of the eye and some lamps may be equipped with a tonometer to measure eye pressure. A dye called fluorescein, which makes blood vessels easier to see, may be added to the eye during the examination. The dye only temporarily stains the eye.



How is Uveitis Treated?
Uveitis treatments primarily try to eliminate inflammation, alleviate pain, prevent further tissue damage, and restore any loss of vision. Treatments depend on the type of uveitis a patient displays. Some, such as using corticosteroid eye drops and injections around the eye or inside the eye, may exclusively target the eye whereas other treatments, such immunosuppressive agents taken by mouth, may be used when the disease is occurring in both eyes, particularly in the back of both eyes.

An eye care professional will usually prescribe steroidal anti-inflammatory medication that can be taken as eye drops, swallowed as a pill, injected around or into the eye, infused into the blood intravenously, or, released into the eye via a capsule that is surgically implanted inside the eye. Long-term steroid use may produce side effects such as stomach ulcers, osteoporosis (bone thinning), diabetes, cataracts, glaucoma, cardiovascular disease, weight gain, fluid retention, and Cushing’s syndrome. Usually other agents are started if it appears that patients need moderate or high doses of oral steroids for more than 3 months.

Other immunosuppressive agents that are commonly used include medications such as methotrexate, mycophenolate, azathioprine, and cyclosporine. These treatments require regular blood tests to monitor for possible side effects. In some cases, biologic response modifiers (BRM), or biologics, such as, adalimumab, infliximab, daclizumab, abatacept, and rituximab are used. These drugs target specific elements of the immune system. Some of these drugs may increase the risk of having cancer.

What is Urticaria pigmentosa?
Urticaria pigmentosa is a skin disease that produces patches of darker skin and very bad itching. Hives can develop when these skin areas are rubbed.

What are the causes?
Urticaria pigmentosa occurs when there are too many inflammatory cells (mast cells) in the skin. Mast cells are immune system cells that help the body fight infections. Mast cells make and release histamine, which causes nearby tissues to become swollen and inflamed. Things that can trigger histamine release and skin symptoms include:
Rubbing the skin
Infections
Exercise
Drinking hot liquids, eating spicy food
Sunlight, exposure to cold
Drugs, such as aspirin or other NSAIDs, codeine, morphine, x-ray dye, some anesthesia drugs, alcohol
Urticaria pigmentosa is most common in children. It can also occur in adults.

What are the symptoms?
The main symptom is brownish patches on the skin. These patches contain histamine. When histamine is triggered, the patches develop into hive-like bumps. Younger children may develop a blister that is filled with fluid if the bump is scratched. The face may also get red quickly.
In severe cases, below symptoms may occur:
Diarrhea
Fainting (uncommon)
Headache
Rapid heartbeat

What are the available tests?
The health care provider will examine the skin. The provider may suspect urticarial pigmentosa when the skin patches are rubbed and raised bumps (hives) develop. This is called the Darier sign. Tests to check for this condition are:
Skin biopsy to look for a higher number of mast cells
Urine histamine
Blood tests for blood cell counts and blood tryptase levels (tryptase is an enzyme found in mast cells)

What are the treatments?
Antihistamine medicines can help relieve symptoms such as itching and flushing. Talk to your provider about which type of antihistamine to use. Corticosteroids applied on the skin and light therapy can also be used in
some cases. Your Doctor may prescribe other kinds of medicine to treat symptoms of severe and unusual forms of urticaria pigmentosa.
Outlook (Prognosis)
Urticaria pigmentosa goes away by puberty in about half of affected children. Symptoms usually get better in others as they grow into adulthood.
In adults, urticaria pigmentosa can lead to systemic mastocytosis. This is a serious condition that can affect bones, the brain, nerves, and the digestive system.

Possible Complications:
The main problems are discomfort from itching and concern about the appearance of the spots. Other problems such as diarrhea and fainting are rare. Bee stings may also cause a bad allergic reaction in people with urticaria pigmentosa. Ask your doctor if you should carry an epinephrine kit to use if you get a bee sting.

When to Contact a Medical Professional?
Call your doctor if you notice symptoms of urticaria pigmentosa.

What Is Urethral Cancer?
When you use the bathroom, urine moves from your bladder through a tube called the urethra. The urethra goes through the prostate and the penis in men. In women, the tube is shorter and ends just above the opening to the vagina. If you have urethral cancer, cells in the area grow abnormally and out of control. Doctors don’t know what causes this rare form of cancer.

Who are at Risk?
People over age 60 are at high risk. Your risk might be higher, if you have had bladder cancer, frequent urinary tract infections, or sexually transmitted diseases that lead to an inflammation of the urethra.
Urethral cancer has been linked to human papilloma virus, especially HPV 16. The HPV vaccine protects against type 16. Doctors recommend it for girls and boys at ages 11 or 12. But females can get the vaccine through age 26 and males through age 21.


What are the symptoms of Urethral Cancer?
You may not have any symptoms at first. Over time, you might notice it is hard for you to pee. Maybe you have a weak urine flow or can’t hold it when you do have to go. Or perhaps you go to the bathroom more often, especially at night. You might see blood in the toilet or notice a discharge from your urethra. A swollen spot or a painless lump may appear in your groin or penis. These aren’t always signs of cancer, but can be signs of something else. See your doctor to know for sure.


Types of Urethral Cancer:
There are three types; squamous cell carcinoma, transitional cell carcinoma, and adenocarcinoma.

Squamous cell carcinoma: In women, it starts in the part of the urethra near the bladder. In men, it forms in the cells that line the urethra in the penis. This is the most common kind of urethral cancer.

Transitional cell carcinoma: In women, cancer cells grow near where the urethra opens. In men, they grow where the tube passes through the prostate.

Adenocarcinoma: In this form of the disease, cancerous cells begin to grow in the glands around the urethra.

How Is It Diagnosed?
If you have problems when you pee or any of the symptoms listed above, see your doctor. He’ll ask questions about your medical history and do a physical exam. This may include a pelvic and rectal exam. Your doctor might order blood tests and ask for a urine sample to look for abnormal cells. He may recommend a cystoscopy. That’s where he uses a tool called a cystoscope to examine the inside of your urethra. He may do a biopsy. That means he’ll take cells from the urethra and bladder and look at them under a microscope to see if they’re cancerous.

If your doctor finds that you have urethral cancer, he will order more tests to see if cancer has spread to other parts of your body. (Cancer cells can move to other parts of your body through tissue, blood, and the lymph system). These tests may include chest X-rays, a CT scan of the pelvis and abdomen, or a magnetic resonance imaging test (MRI) of the pelvis.

A procedure called urethrography can help your doctor see if there is cancer in tissue close to the urethra. This is a series of X-rays your doctor performs after he injects ink into the urethra and bladder.

How Is It Treated?
Most often it is treated through surgery. But that depends on where the cancer is located. Sometimes, doctors can get rid of it just by removing the tumor. Other times, the urethra and bladder may be taken out. Your surgeon will need to make a new place for your body to store urine and build another way for the body to release it. After surgery, you may need to wear a bag outside your body to collect the urine.
The vagina or part of or all of the penis might also be removed. Plastic surgery may be performed to reconstruct the reproductive organs.

Your doctor may use radiation or chemotherapy (“chemo”), either with or without surgery, to kill cancer cells. He may also use something called “active surveillance” to monitor cancer. This means you’re not given treatment right away. Instead, your doctor will perform tests often to see if cancer gets worse. If it does, he’ll develop a treatment plan.

What is Urinary Retention?
Most people feel uncomfortable discussing bladder control problems with their friends, family and doctor. But if you are unable to empty your bladder, you’re not alone. Urinary retention is defined as the inability to completely or partially empty the bladder. Suffering from urinary retention means you may be unable to start urination or if you are able to start, you can not fully empty your bladder.


What are the symptoms?
Symptoms of urinary retention may include:
Difficulty starting to urinate
Difficulty fully emptying the bladder
Weak dribble or stream of urine
Loss of small amounts of urine during the day
Inability to feel when bladder is full
Increased abdominal pressure
Lack of urge to urinate
Strained efforts to push urine out of the bladder
Frequent urination
Nocturia (waking up more than two times at night to urinate)

What are the causes?
There are two general types of urinary retention; obstructive and non-obstructive. If there is an obstruction (for example, kidney stones), urine cannot flow freely through the urinary track. Non-obstructive causes include a weak bladder muscle and nerve problems that interfere with signals between the brain and the bladder. If the nerves aren’t working properly, the brain may not get the message that the bladder is full.
Some of the most common causes of non-obstructive urinary retention are:
Stroke
Vaginal childbirth
Pelvic injury or trauma
Impaired muscle or nerve function due to medication or anaesthesia
Accidents that injure the brain or spinal cord
Obstructive retention may result from:
Cancer
Kidney or bladder stones
Enlarged prostate (BPH) in men

Diagnosis:
Talk to your doctor about your symptoms and how they affect your daily life. Your doctor will make a diagnosis based on your symptoms.