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Oncotype DX

Oncotype DX test measures the levels of specific genes that may indicate the presence of cancer cells. This test helps check the risk of recurrence of breast cancer. This test makes use of breast cancer biopsy and studies the patient where the cancer is hormone-receptor positive. Then the Oncotype DX test draws up a recurrence score. A high recurrence score indicates higher chances of cancer recurrence. But this has to be seen along with other factors such as the age of the patient, grade of cancer and size of cancer. This test costs about $3,500. In many cases, the Oncotype DX test helps in deciding whether a woman must go in for chemotherapy and hormonal therapy post surgery for breast cancer. Typically those with low recurrence score may not need to undergo chemotherapy. The Oncotype DX test aids in tailoring treatment to suit the individual needs of each patient.

Pigmentation

Melanin is responsible for imparting color to the skin, hair and iris of the eyes. Levels of melanin depend on race and amount of sunlight exposure. Melanin production increases with exposure to the skin so as to protect the skin against harmful ultraviolet rays. Skin pigmentation disorders occur as a result of the body producing either too much or too little melanin. Skin pigmentation creates a darker or lighter skin tone that may be blotchy and uneven. Sun damage is probably the leading cause of skin pigmentation problems. Other factors include drug reactions, hormonal changes, genetic factors and medications.


Hormonal therapy, childbirth or birth control pills can cause skin pigmentation changes. Many people suffer from skin pigmentation problems as a result of locally increased skin pigment production. They appear as age spots, moles, liver spots or hyper pigmentation after local skin damage. Freckles are another variation in pigmentation of the skin. They are caused but by uneven release of the pigment.

Hypopigmentation or loss of skin pigmentation is a condition where the body does not produce sufficient melanin. Sometimes after an ulcer, blister, burn, or infection heals, the skin loses some of its pigment in that area. Albino is one who suffers total hypopigmentation at birth.


Vitiligo: Vitiligo is another form of hypo pigmentation caused by the loss of pigment-producing cells in the skin (melanocytes). These white patches are very sensitive to the sun. This skin pigmentation disorder affects nearly 2% of the population and is more evident in those with darker skin. Some scientists believe vitiligo may be caused by an autoimmune disorder. It is also linked to hyperthyroidism and Addison's Disease that affects the adrenal glands.

Hyper Pigmentation is a condition where the body produces too much melanin thereby causing it to become darker than usual. Hyper pigmentation can occur due to excessive sun bathing or drug reactions. Many a time wounds and scars leave a darker patch of skin. Birthmarks, moles, and aging spots are also indications of hyper pigmentation. It is important to keep on the alert for any change in size, color or texture for indications of skin cancer.

Lichen Simplex Chronicus: This skin pigmentation disorder is characterized by dark patches of skin accompanied with severe itching. This can lead to permanent scarring and infection if untreated.

Melasma: This hyper pigmentation condition is a fallout of pregnancy hormones. A dark mask appears over the cheeks, bridge of the nose and the neck. This skin pigmentation condition is also known as chloasma and can be treated with prescription creams and over-the-counter products.

Birthmarks: This type of skin pigmentation appears at birth or in the few weeks following birth. These birthmarks do not generally pose any health risks.

Port-wine Stains: These skin pigmentation spots are caused by abnormal development of capillaries and appear as a red or purple mark on the body.

Poikiloderma: This skin condition is characterized by areas of increased and decreased pigmentation; indicative of sun damage.


Cervicitis

An inflammation of the cervix mainly due to an infection is Cervicitis. The infected cells of the cervix become irritated and may become red, swollen and ooze mucus and pus. They could bleed easily when touched. The most important cause of Cervicitis is sexually transmitted disease although many women do not test positive for any type of infection though contracted with Cervicitis.


Symptoms of Cervicitis

Many women do not exhibit any symptoms and if tested may be positive for Cervicitis. If present, the signs and symptoms include:


  • Vaginal discharge which could be grayish or pale yellow.
  • Abnormal vaginal bleeding or bleeding after sex, between periods.
  • Pain during sexual intercourse.
  • Pelvic or abdominal pain, fever in some cases.
  • Vaginal irritation
  • Pain in the vagina
  • Pressure or heaviness in the pelvis.

Serious symptoms might indicate a life-threatening condition and immediate medical care should be sought. If Cervicitis is suspected during pregnancy, there could be life-threatening symptoms including - high fever, severe nausea and vomiting and severe pelvic pain.


Causes of Cervicitis

Cervicitis is most often caused by an infection caught during sexual activity. Some sexually transmitted diseases include gonorrhea, Chlamydia, Herpes Virus and Trichomoniasis. Other possible causes for Cervicitis are:


  • Use of a diaphragm or cervical cap insertion into the pelvic area.
  • Allergy to condoms and latex
  • Chemical exposure
  • Many sexual partners
  • High risk sexual behavior
  • Sex at an early age.

When the vagina is overwhelmed by unhealthy and harmful bacteria, it can cause Cervicitis. Hormonal imbalance with relatively low estrogen or high progesterone may interfere with the body's ability to maintain healthy cervical tissue. Cancer treatment and radiation therapy can also cause Cervicitis.


Diagnosing Cervicitis

A doctor first gets a closer look at the cervix when Cervicitis is suspected. Then the doctor will swab the cervix, collect vaginal fluid and see how it bleeds. The patient's sexual history is noted. A routine examination of the cervix is conducted if you are pregnant or the doctor thinks that there is high risk for sexually transmitted disease like gonorrhea or Chlamydia. Inspection of the discharge under a microscope may show Trichomoniasis or Bacterial Vaginosis. Pap smear is also done. Rarely, colposcopy and biopsy of the cervix is necessary to rule out cancer.


Reducing risk of Cervicitis

You can reduce or lower the risk of Cervicitis by:


  • Avoiding known allergens.
  • Avoiding sexual intercourse.
  • Monogamous sexual partner.
  • Following instructions while using diaphragm or cervical cap.
  • Getting tested for STD infections annually.
  • Getting vaccinated against human papilloma virus.
  • Using condoms during sexual intercourse.

Treatment

If sexually transmitted infection is not the cause, then you do not need treatment for Cervicitis. If an infection is suspected, the main goal would be to eliminate the infection and prevent it from spreading to the uterus and fallopian tubes, in case of pregnancy.

In case of bacterial infections such as Chlamydia, Gonorrhea and others, antibiotics are used for treatment. Antiviral drugs may be used to treat herpes infections. Hormonal therapy with estrogen and progesterone may be used in women who have reached menopause. When such treatments fail, and Cervicitis is still present for a long time, then cryosurgery, electro cauterization and laser therapy are adopted.


The doctor would prescribe the line of treatment depending upon the cause of infection. The doctor may advice antibiotics, antifungal medications and antiviral medications. The doctor may also recommend treating the partner to rule out chances of infection again. It is recommended to avoid sexual contact till the partner has finished treatment.


If medications such as Antibiotics do not work in some cases, there are other options available recently:
Loop Electro surgical Excision Procedure (LEEP)
Cryotherapy, Electrocoagulation or Laser to cauterize the affected tissue.


Tips to prevent Cervicitis

Avoid chemical irritants such as deodorant tampons. When inserting any foreign objects into the vagina, make sure that they are properly placed. Be in a monogamous sexual relationship. Use latex condom every time of sex to lower the risk of getting sexually transmitted infections. A condom must be properly used every time.


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Bibliography / Reference

Collection of Pages - Last revised Date: November 11, 2019