Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Cancer can start within the liver (primary liver cancer or
hepatocellular cancer) or spread to the liver (metastatic liver cancer) from
other sites, such as the colon. Cancer that starts in the liver, which I
will refer to simply as liver cancer, is the fifth most common cancer in the
world. In the U.S., it is among the 10 most common cancers. This cancer is more
frequent among Native Americans, Asians, Pacific Islanders, and Hispanics than among
Caucasians.
Liver cancer is a bad cancer. It has frequently spread
beyond the liver by the time it is discovered, and only 5% of patients with
liver cancer that has begun to cause symptoms survive even five years without treatment.
The only hope for patients who are at risk for liver cancer is regular surveillance so
that the cancers can be found early. Early cancers can be treated by
surgical removal (resection), destruction of the individual tumors, or liver transplantation. Although
the current techniques for surveillance are not very good at detecting early
liver cancer, newer techniques are being tested and appear to be better.
The most common diseases associated with liver cancer
are chronic viral hepatitis, alcoholism, and cirrhosis (scarring of
the liver). Moreover, chronic viral hepatitis is common in alcoholism,
and both viral hepatitis and alcoholism cause cirrhosis which usually precedes the
development of cancer. Therefore, the contributions and interrelationships
of alcohol abuse, viral hepatitis, and cirrhosis in the development of liver
cancer are complex. Despite the complexity, it is important to try to understand
the contributions of each disease so that patients at highest risk for liver cancer
can be targeted for surveillance. Theoretically, they also might be targeted
with treatments that prevent the development of liver cancer, when such
treatments are developed.
Alcohol abuse is a disease that is characterized by the sufferer having a pattern of drinking excessively despite the negative effects of alcohol on the individual's work, medical, legal, educational, and/or social life.
Alcohol abuse affects about 10% of women and 20% of men in the United States, most beginning by their mid teens.
Signs of alcohol intoxication include the smell of alcohol on the breath or skin, glazed or bloodshot eyes, the person being unusually passive or argumentative, and/or a deterioration in the person's appearance or hygiene.
Almost 2,000 people under 21 years of age die each year in car crashes in which underage drinking is involved. Alcohol is involved in nearly half of all violent deaths involving teens.
Alcoholism is a destructive pattern of alcohol use that includes a number of symptoms, including tolerance to or withdrawal from the substance, using more alcohol and/or for a longer time than planned, and trouble reducing its use.
Alcohol, especially when consumed in excess, can affect
teens, women, men, and the elderly quite differently.
Risk factors for developing a drinking problem include low self-esteem, depression, anxiety or another mood problem, as well as having parents with alcoholism.
Alcohol dependence has no one single cause and is not directly passed from one generation to another genetically. Rather, it is the result of a complex group of genetic, psychological, and environmental factors.
There is no one test that definitively indicates that someone has an alcohol-use disorder. Therefore, health-care practitioners diagnose these disorders by gathering comprehensive medical, family, and mental-health information.
There are thought to be five stages of alcoholism.
There are numerous individual treatments for alcoholism, including individual and group counseling, support groups, residential treatment, medications, drug testing, and/or relapse-prevention programs.
Some signs of a drinking problem include drinking alone, to escape problems, or for the sole purpose of getting drunk; hiding alcohol in odd places; getting irritated when you are unable to obtain alcohol to drink; and having problems because of your drinking.
While some people with alcohol dependence can cut back or stop drinking without help, most are only able to do so temporarily unless they get treatment.
There is no amount of alcohol intake that has been proven to be generally safe during pregnancy.
The long-term effects of alcohol abuse and alcoholism can be devastating and even life threatening, negatively affecting virtually every organ system.
Codependency is the tendency to interact with another person in an excessively passive or caretaking manner that negatively affects the quality of the codependent individual's life.
Adequate supervision and clear communication by parents about the negative effects of alcohol and about parental expectations regarding alcohol and other drug use can significantly decrease alcohol use in teens.
With treatment, about 70% of people with alcoholism are able to decrease the number of days they consume alcohol and improve their overall health status within
six months.
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
Gout is a condition that results from crystals of uric acid depositing in tissues of the body. Gout is a condition that can lead to abnormally elevated levels of uric acid in the
blood, recurring attacks of joint inflammation (arthritis), deposits of
hard lumps of uric acid in and around the joints, and decreased kidney
function and kidney stones.
Dizziness is a symptom that is often applies to a variety of sensations including lightheadedness and vertigo. Causes of dizziness include low blood pressure, heart problems, anemia, dehydration, and more. Treatment of dizziness depends on the cause.
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. Symptoms include weakness, fever, weight loss, night sweats and in worse cases, chest pain, shortness of breath, and coughing up blood. A person with an active infection (a positive TB skin test, abnormal chest x-ray and TB bacteria in their sputum) requires treatment with izoniazid, rifampin, ethambutol and pyrazinaide.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Pancreatitis is a rare disease in which the pancreas becomes inflamed, occurring when digestive enzymes are activated and begin attacking the pancreas causing damage to the gland. There are two types of pancreatitis, acute and chronic. Most commonly caused by alcohol or gallstones, it can lead to bleeding in the gland, serious tissue damage, infection, and cysts. Enzymes and toxins may then enter the bloodstream and seriously injure organs, such as the heart, lungs, and kidney.
Dementia is a significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. There are different criteria classification schemes for dementias such as cortical, subcortical, progressive, primary, and secondary dementias. Other conditions and medication reactions can also cause dementia. Dementia is diagnosed based on a certain set of criteria. Treatment for dementia is generally focused on the symptoms of the disease.
Rosacea is a skin disease that causes redness of the forehead, chin, and lower half of the nose. In addition to inflammation of the facial skin, symptoms include dilation of the blood vessels and pimples (acne rosacea) in the middle third of the face. Oral and topical antibiotics are treatments for rosacea. If left untreated, rhinophyma (a disfiguring nose condition) may result.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
The term oral cancer includes cancer of the mouth (oral cavity) and the back of the mouth (oropharynx). Red and white patches inside the mouth, bleeding, loose teeth, pain upon swallowing, a lump in the neck, earache, and a sore on your lip or in your mouth that won't heal are all symptoms of oral cancer. Treatment for oral cancer depends upon the staging of the disease and usually involves surgery, radiation therapy, or chemotherapy.
Esophageal cancer is a disease in which malignant cells form in the esophagus. Risk factors of cancer of the esophagus include smoking, heavy alcohol use, Barrett's esophagus, being male and being over age 60. Severe weight loss, vomiting, hoarseness, coughing up blood, painful swallowing, and pain in the throat or back are symptoms. Treatment depends upon the size, location and staging of the cancer and the health of the patient.
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Schizophrenia is a disabling brain disorder that may cause hallucinations and delusions and affect a person's ability to communicate and pay attention. Symptoms of psychosis appear in men in their late teens and early 20s and in women in their mid-20s to early 30s. With treatment involving the use of antipsychotic medications and psychosocial treatment, schizophrenia patients can lead rewarding and meaningful lives.
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
Suicide is the process of intentionally ending one's own life. Approximately 1 million people worldwide commit suicide each year, and 10 million to 20 million attempt suicide annually.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Borderline personality disorder is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with borderline personality disorder (BPD) suffer from a disorder of emotion regulation.
Rhabdomyolysis is a rapid deterioration and destruction of skeletal muscle. Some of the causes of rhabdomyolysis include severe burns, muscle trauma, coma, seizures, electrolyte imbalance, medications (statins), viruses, bacteria. Treatment of rhabdomyolysis depends on the cause.
Cushing's syndrome, sometimes referred to as hypercortisolism, is a hormonal disorder caused by prolonged exposure to high levels of the hormone cortisol. Symptoms may include obesity, thinning arms and legs, a rounded face, and increased fat around the neck. Some causes of Cushing's syndrome is from taking glucocorticoid hormones such as prednisone for inflammatory diseases. Treatment for Cushing's syndrome depends on the cause.
Drug addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
Encephalopathy means brain disease, damage, or malfunction. Causes of encephalopathy are varied and numerous. The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors, and coma. Treatment of encephalopathy depends on the type of encephalopathy (anoxia, diabetic, Hashimoto's, hepatic, hyper - hypotensive, infectious, metabolic, infections, uremic, or Wernicke's) are examples of types of encephalopathy.
Antisocial personality disorder (ASPD) has many symptoms, signs, and causes. Therapy is one treatment option for antisocial personality disorder. It is closely related to other personality disorders (PD), such as borderline personality disorder and narcissistic personality disorder.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Neuropathic pain is chronic pain resulting from injury to the nervous system. The injury can be to the central nervous system (brain and spinal cord) or the peripheral nervous system (nerves outside the brain and spinal cord).
Pancreatic cysts are collections of fluid within the pancreas. Some are benign, malignant, or pseudocysts. There are two major types of pancreatic cysts, inflammatory cysts and non-inflammatory cysts. Non-inflammatory cysts include: serous cyst adenomas, mucinous cyst adenomas, intraductal papillary mucinous neoplasm (IPMN), and solid pseudopapillary tumor of the pancreas. Symptoms of pancreatic cysts include abdominal pain, jaundice, fever, chills, and sepsis. Treatment depends on the type of cyst, and patient health.
Cirrhosis is a complication of many liver diseases that
is characterized by abnormal structure and function of the liver. The diseases
that lead to cirrhosis do so because they injure and kill liver cells, and the
inflammation and repair that is associated with the dying liver cells causes
scar tissue to form. The liver cells that do not die multiply in an attempt to
replace the cells that have died. This results in clusters of newly-formed liver
cells (regenerative nodules) within the scar tissue. There are many causes of
cirrhosis; they include chemicals (such as alcohol, fat, and certain
medications), viruses, toxic metals
(such as iron and copper that accumulate in
the liver as a result of genetic diseases), and autoimmune liver disease in
which the body's immune system attacks the liver.
Why does cirrhosis cause problems?
The liver is an important organ in the body. It performs
many...
Cancer can start within the liver (primary 
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