Gall bladder stones mostly affects obese females who are in middle age, but even the males and females who are in other age groups can also be affected by this problem.

Nowadays it is not an uncommon disease seen in general surgical wards. patients can present with right upper abdominal pain which might radiate to back. They can also have a swinging fever due to infection.Initial stage in ward hospital treatment is indicated to investigate and treat the acute stage.

Most of the abdominal pains are due to surgical causes.Abdominal pain can be generalized abdominal pain or can occur in specialized regions of the abdomen.
If the abdominal pain is severe in nature and generalized,last for more than half hour duration it could be a surgical problem needing an operation.If so avoid eating or drinking and go to nearest hospital for further management.

Lets see some special types of abdominal pains.

Acute Appendicitis

Trauma is one of the main causes for mortality and morbidity in young productive population in the world. Even in sri lanka there is no difference to this. Road traffic accidents, domestic, occupational and sports accidents account for major part of it.
At present in sri lanka war and war related injuries also have contributed to cripple the young population.

Breast cancer is one of the commonest cancers in women in the world as well as in Sri Lanka. It is also one of the curable cancers if detected early. Any woman would dread getting cancer of the breast. Cancer subjects the individual and the family to considerable emotional stress. If you or someone known to you has been diagnosed to have breast cancer, it is important that you understand the disease, since ignorance breeds myths.

Considerable advances in the knowledge have taken place in the last two decades and many more patients are being cured. Number of treatment options and various treatment schedules are available. Due to the revolutions in information technology, vast pool of ‘knowledge’ is open to the public, which invariably will cause confusion. This series of articles is an attempt to provide basic information related to breast cancer treatment, after treatment care and rehabilitation, which will support you in order to be a well informed patient who can fight the disease with a more realistic and practical approach.

Normal breast.
The normal breast consist of many segments called lobules that merge together to give a smooth contour. The nipple areola complex is located in the center where ducts from all lobules converge. Breast size and consistency also change with the menstrual cycle and it is important to know hoe your breast actually feel on different days. The lumpiness, which may wax and wane with menstrual cycle, are generally not cancers. With ageing, breasts become lax and wrinkles may appear on the overlying skin. Lumps in women especially after menopause should never be neglected. Breast tissue extends to the armpit and it also contains lymph glands. These lymph glands collect and filter ‘lymph’, a special type of tissue fluid, from the breast. These may enlarge in cancer when the cancer cells get trapped in them.

What is cancer?
Our body is made up of ‘very tiny structures’ called cells. Normally, cells reproduce ‘regularly and systematically ‘under the control of genes, as part of wear and tear. A tumour develops only when this process becomes irregular and uncontrolled. A tumour can be benign or malignant. Benign tumours do not spread to many other part of the body. A malignant tumour is a cancer because it has ability to spread beyond the original site, forming metastasis or secondary tumours. Cancers also spread locally invading adjacent structures.

What is a breast lump or tumour ?
‘Tumour’ is a Latin word for any swelling. Generally a tumour is felt as a lump in the breast, which can occur at any age. A tumour can be benign or malignant (cancer) which should be examined by a doctor confirmed by investigations. If a lump is felt in the breast, do not neglect or panic and you should consult a doctor without delay!

Is every breast lump a cancer?
No! Only one out of ten breast lumps is a cancer. Is very likely that your lump is benign therefore do not panic. Consult a doctor early.

What causes breast cancer?
The causes of breast cancer are still not fully understood, but there are identified risk factors.

Risk factors for breast cancer development;
Women with family history of breast cancer (involving mother, grand mother, sisters, or maternal aunts).

Women who have had breast cancer in one breast.

There is a slightly increased risk in women who; have their first child birth late in life, have no children, had an early menarche, have a late menopause.

Women who have a exposure to hormonal treatment (contraceptive, hormone replacement therapy).

Women who have breast fed their babies for at least a year have a lower risk of developing breast cancer.

Obese female have a higher risk of developing breast cancer.

What are the signs of breast cancer?
A lump is the usual presentation of breast cancer. Pain in the breast is commonly due to non-malignant causes but a few patients with breast cancer complaints of pain or discomfort.

Clinical features of breast cancer.
Painless lump
Change in contour of breast
Dimpling of skin over breast
Nodules in skin of breast (late stage)
Ulcer (late stage)
Indrawing of nipple
Blood stained nipple discharge
Rash or ulcer over nipple
Lump or fullness of armpit (late stage)

Some of these signs can be a manifestation of a non-malignant disease.
In the presence of any of the above features you should consult your doctor.

How does the doctor diagnose breast cancer?
When you see a doctor for a lump in the breast, he would examine your breast thoroughly. It may not always be possible for him to say what the lump is?
Hence you should undergo some tests to be sure about the character of the lump.

Commonly used tests are;
Fine Needle Aspiration Cytology (FNAC)
Biopsy
Mammography
Ultrasound scan of the breast

Fine Needle Aspiration Cytology:
This involves taking out a few cells from the lump with a thin needle and examining under a microscope. This is a simple procedure done as an outpatient, and which does not need anaesthesia.

Biopsy
This can be either ‘Tru-Cut biopsy or excision biopsy. Tru-Cut biopsy is done with a special biopsy needle, under local anesthesia. A small part of the lump is taken out for histological examination in this technique.
Excision biopsy is necessary when other investigations are inconclusive.
This involves removal of the lump under general anaesthesia for histological examination.

Mammography
This is a special type of X-ray of the breast to detect breast diseases. It allows your doctor to assess the extent of the disease in the affected breast and ascertain whether there is any abnormality the opposite breast. The procedure involves mild compression of the breasts followed by exposure to X-rays. It may cause some discomfort, which disappears immediately after the procedure.

Ultrasound scan of the breast
This technique provides images of the breast in the evaluation of breast disease. It does not cause any radiation exposure to the patient. Generally mammography is supplemented with sonography of the breast. Both these imaging tests are useful to detect tumour and to assess its extent.

Results of FNAC and/or biopsy combined with imaging tests are essential in addition to clinical evaluation, in making the definitive diagnosis of breast cancer.
In addition your doctor may also ask for other like a chest X-ray, abdominal ultrasound scan, blood tests and bone scans accordingly. These are required to see if the cancer has spread. Do not be worry if your doctor does not order these tests since these tests may not be indicated in women with early stage cancer.

What are the various treatment options?

Treatment options for breast cancer

Surgery
Radiotherapy
Hormonal therapy
Chemotherapy

Today the breast cancer is best managed in the multidisciplinary team setting, with the involvement of surgeons specialized in breast surgery, medical oncologists, pathologist, radiologists and breast care nurse. They will choose the best treatment modality after many considerations like stage of the disease, logistics of treatment implementation and your choices. Hence two patients may receive different treatments. At present we have four established treatment modalities;

Delmon Hospital
No.58, Galle Rd., Wellawatte.
Tel : 503295

Asiri Hospitals
181, Kirula Road,Narahenpita,
Colombo 05,Colombo
Tel: 500608 ~ 11, 593930,
593929, 508766, 508767,
074513939, 07451

Arogya Hospital (Pvt) Ltd.
Gampaha, Sri Lanka
Tel : 033 24592

Durdans Hospitals
Colombo 03, Sri Lanka
Tel : 575205-7, 575402-3

Nawaloka Hospitals (pvt) Ltd
Colombo 2, Sri Lanka
Tel : 304444-56

Sri Jayawardenapura General Hospital
Nugegoda, Sri Lanka
Tel : 863610-9 Fax : 863661