BLOOD PRODUCTION BY STEM CELLS-BLOOD DONATION NOT REQUIRED

DRNAKIPURIA@GMAIL.COM

For years, Blood is very important,nothing can replace it and it can be achieved from human body only ,so it is a greatest donation of a "man for man" as when either due to any accident injuries or missile or blastic injuries or natural disaster or most plnned sugeries to save life and to overcome blood diseases we need BLOOD and if it is not available death is certain

So scientists are working day and night since stem cell isolation and harvesting was possible to make BLOOD FROM STEM CELLS. With stem cell researchers trying to figure out how to make new organs, it may also be possible for them to create blood cells. Though the organs are obviously vital, this may be more important as so many people are affected by blood loss. Currently, since only donors can give blood, there might be excess blood of one type but very little blood of another type, meaning that some patients in need of blood may not be able to get any, even if there seems to be a sufficient amount of it available. But with statistics and accurate planning, scientists may produce all blood types in an efficient manner, helping everyone in need instead of just a few. If this will soon be possible, it makes wonder what else is in the near future. Perhaps skin replacements for patients with severe burns? Whatever else is coming ? HEART,LUNG,BRAIN,KIDNEYS,LIMBS OR A COMPLETE REPLICA OF ONE PERSON A HUMAN CLONE EITHER MALE OR FEMALE BUT ORIGANTED FROM ONE PARENT ONLY,NO MIXTURE,PURE RECARNATION OF A PERSON,OR MAN BECOMES IMMORTAL, A MONSTER WHICH WILL NEVER DIE.

(Boston) � A study led by Boston University School of Medicine has identified a novel approach to create an unlimited number of human red blood cells and platelets in vitro. In collaboration with Boston University School of Public Health (BUSPH) and Boston Medical Center (BMC), the researchers differentiated induced pluripotent stem (iPS) cells into these cell types, which are typically obtained through blood donations. This finding could potentially reduce the need for blood donations to treat patients requiring blood transfusions and could help researchers examine novel therapeutic targets to treat a variety of diseases, including sickle cell disease.
Published online in the journal Blood, the study was led by George J. Murphy, PhD, assistant professor of medicine at BUSM and co-director of the Center for Regenerative Medicine (CReM) at Boston University and BMC and performed in collaboration with David Sherr, PhD, a professor in environmental health at BUSM and BUSPH.
iPS cells are derived by reprogramming adult cells into a primitive stem cell state that are capable of differentiating into different types of cells. iPS cells can be generated from mature somatic cells, such as skin or blood cells, allowing for the development of patient-specific cells and tissues that should not elicit inappropriate immune responses, making them a powerful tool for biological research and a resource for regenerative medicine.

BLOOD DROPS ARTIFICIAL,FROM EYE NATURAL

SEXUAL MIS BELIEFS WHICH MAY HAMPER SEX-READ & ENJOY SEX
profdrram@gmail.com,+917838059592,author is sex specialist for any query on sex or its related diseases or weakness in both male and female including abortion are answered.
1. Men Reach Their Sexual Peak at 18, and Women Reach Theirs at 28
TRUE: With regard to their supply of sexual hormones, at least. Testosterone peaks at age 18 in men; women's estrogen hits its high point in their mid-20s. "But peak hormones don't mean peak sexual performance," says Marc Goldstein, M.D., a professor of reproductive medicine and urology at Cornell University's Weill Medical College. So it has got nothing with performance ,performance comes from desire ,enviornment,feeling towards each other,participation of both partner joyfully and wilfully without any harassment,mental agony or pain ,peak of hormones does not mean peak of performance small hormonal trigger at puberty push both partners for active and hard sex.

2. Semen is Low-Carb
FALSE: "Semen is mostly fruit sugar [fructose] and enzymes�not low-carb," says Dr. Goldstein. Which finally explains why many even eats or swallow it as it is tasy but not a sex diet as explained by many ,may creat harm to person swallowing it as it may be infected as person as genitourinary infection,so donot swallow it let it do the work it designed for i.e.,carrying male sperms to fertilise egg of woman for a production of baby.

3. Masturbation Yields the Strongest Orgasm
TRUE: But it's not a hard-and-fast rule, as it were. "It depends on the individual," says Jon L. Pryor, M.D., a professor of urologic surgery at the University of Minnesota. "For some it does, but for others, there's nothing that beats good ol' intercourse."excessive masturbation leads to early ejaculation or discharge of semen in intercourse so cause less satisfication by partners so should not be practised too much as habit forming may disturb satisfication and can lead to erectile dysfuction of failure of erection too if being practised in session repeatedly speially in mane above 50 and even cause infection to women if infected fingers or toys used by female for masturbation.But good if done occasionally to discharge excessive excitement and partner is absent.

4. The Average Erection Measures 8 Inches
FALSE: Relax, Shorty. It's closer to 6. and even less 4 inch,size of penis for early simple sex doesnot matter as lower 1/3rd or first 2 inch of vagina gives pleasure to female but for hard sex touching of cervix by penis gives more pleasure so here if length of penis more than woman may get more pleasure.

5. No Penis is Too Large or Too Small for Any Vagina
TRUE: But perception still wins the game in the end. "I was once at a dinner meeting with seven other sex doctors�six men and one woman," says Dr. Pryor. "The men all agreed that size doesn't matter. The woman looked at us and said, 'Think what you want. Size matters.' We all left dejected."As stated above we have explained why this lady opined for good size but excessive lengthy penis as more than 8 inch may rupture corners of vagina around cervis or called"culex" as strong stroke will damage them.

6. Oysters Make You Horny
FALSE: You make you horny. "There is no scientific evidence that oysters increase libido," says Dr. Pryor. there are many other substances like onion,garlic,dalchini,eggs,chillies,keshar said to be more sex stimulant same way many medicines prescribed until thereis prroved hormonal imbalance these drug may help otherwise "But there may be a placebo effect, so if it works, great!"

7. Green M&Ms Make You Horny
FALSE: Unless they do. Then it's true. Isn't the mind wonderful?as stated above they play slight role in arousal more it is psychological so mental status,relation between partners and enviornment is important than these medicines,never dependent upon them

8. Men Think About Sex Every 7 Seconds
FALSE: That number is tossed around a lot, but the truth is that only 23 percent of men claim to fantasize frequently. But maybe the rest are just too distracted to check the clock.sex arosal more common inmen than women but it doesnot mean so frequently and even some female get arousal frequently.

9. Cutting Out Broccoli Will Make Your Semen Taste Better
TRUE: Semen is naturally bitter with sweetness of fructose , and eating broccoli and drinking coffee can make it worse. many drugs and vegetable secretion after their digestion in blood excreted as excreted in milk of woman, urine,bile ,sweat ,differnt other discharge of our body ,so such prejudiced idea simply reflect mind set and marketing stategy rather than fact.A ray of hope for the Oral Sex Diet! can not be simplified by such advertisement.

10. Having Sex Before an Important Event�the Big Game, the Critical Presentation�Can Ruin Your Performance in the Event
FALSE: Swiss researchers performed stress tests on people 2 and 10 hours after the subjects had had sex, and found that by 10 hours, the participants were fully recovered. There was only a small dip in performance 2 hours after sex.

11. Having Sex in Water (Swimming Pool, Hot Tub, Shower) Will Kill Sperm
TRUE: Some of your swimmers may die, but it isn't an effective method of birth control, according to Dr. Pryor. Though a hot tub can overheat your testicles and kill sperm, there should be plenty left for the egg hunt.as sex in bath tub or swimming pull or in standing position may not yield good discharge in vagina so less travelling in uterus so less chance of pregnancy but very trick so millions sperm few can travel too and may bring pregnancy as for this only one sperm needed,so nver true about it do safe sex using condom even in swimming pool.

12. You Can Become Addicted to Web Porn
TRUE: But the risk is low. Only 1 percent of all people who check out Internet porn will become addicted. If you're sporting a ring, be careful: 38 percent of addicts are married.But most of internet user click these sites at least once a day or two interval so they are loved by amny although publically most cricise it and are against it ,even block for childrens and teen agers they move cybercafe to enjoy it more or MMS OR SMMS OR CHATING ON MOBLE IS RAMPANT AND BEYOND CONTROL and a silent addiction persist in most persons.

CHANGING PATTERN OF SEX BEHAVIOUR & ATTITUDE TOWARDS SEX IN SOCIETY
profdrram@gmail.com

Now a days,Sex is no more a phenomena of celebration in a closed room of four walls,people of all age enjoys it in own way but yet a bit conservative way in our country than west (as Exhibitionism or pump and show of sexual activity in public place like park,gardens ,auditorium,meeting halls,bus,train,railway airport etc and younger and female still hesitate to talk before parents an elders what to talk of doing any sexual activity.But Attitude of Sex has completely changed in youth,most teenagers have boy or girl friend,chating on mobile,social
Sites,talking,sending sms/mms iscommonly seen ,even before adult hood they have experience of sexual intercourse and after adulthood many youth both male and female enjoy toghetherness with sexuality and beside marriage leading to a family life a common understanding of living relation with intercourse is also seen .Widows are mostly remarried and even sex is performed and most wanted after 70 yrs as expectancy of life has increased markedly in both male and femalethan previous almost hidden sex infamily after 40-50 yrs when children are adult and married.
Gays and lesbians as wellas sex with trans geneder is not looked down upon as in past people listen with their association �s demand of recognition of society more silently and some even advocates for these.
Study conducted recently have shown that most boys and girls of school even know some thing about sex,by collge most of them are well acquainted with effects and side effects of sex,abnormal sex and sex without condom or un safe sex,even theyknow methods of contraception and even medical pills post pregnancy are known to them due to open advertisement of these over media in newspaper,social sites and TV.Some also know about many sexually transmitted diseases and its effect and methods to prevent them.
Picture for representation.
SOME SHOCKING RESULT OF SEX STUDY RECENTLY CONDUCTED ARE:----
� India Today Sex Survey 2012: Women are no more shy and submissive. With changing times, to watch sex seens,videos of normal and abnormal sex in different positions and ways i.e., pornography is mostly seen by youths and even older age people while on mobile or computer net ,this pornography is almost a part of most computer and mobile surfers ,an most click once or twice on these sites in day or two, pre-teen sex is no more a taboo or is much done as they mostly want to explore what it is really a SEX is so much served now adays in different magazines even photo on third page of different national and big news aper on different advertisement on tv,radio and net easily accessible on mobile and computer.
� India Today Sex Survey 2012: sex is no more expected as work of male and female a passive partner,never speaking any thing aginst male parner,woman desparately seek satisfaction and complain to husband for getting it corrected by doctor or talk to friend and even complain to parents needing its immediate correction ,it is even seen in women from small town and thes woman have broken their popular coy image
� India Today Sex Survey 2012: I want to do 'frandship' with you is still the norm in small town India, the men don't date they just ogle and even after friendship not only male and female doesnot hesistate to make sexual relation even in small town whereas it is never seen with surprise in cities and educated class.
WOMEN ARE MORE CONCERNED TO PURCHASE CONDOM FOR THEIR MALE PARTNER TO PROTECT THMESELVES FROM PREGNANCY AND SEXUAL TRANSMITTED DISEASE LIKE HIV/AIDS,SYPHILLIS,GONORRHOEA etc.,Men seem ready to get laid at any time of the day, but when it comes to buying condoms they are surprisingly shy - even in a city like Delhi.Now, more and more women are taking upon themselves to equip their partners with necessary protection for safe sex.
In a recent survey, Jamia Hamdard University's Department of Management has found that the use and awareness of condoms is still low in males in the Capital which is forcing women to take the lead. The survey included more than 2,000 women, with many of them revealing that their partners were yet to overcome hesitation to buy condoms.
Too shy to ask

"Women are coming forward to buy con-doms because their partners don't want to buy them. In our study, we found that 62 per cent of couples were using condoms, while 54 per cent of women had had a sexual relationship at least once in their lifetime where their partner did not use condoms because of shyness to buy them," said Dr. N. Ravichandran, head, Department of Management, Jamia Hamdard.
Smita Rajan, a housewife, says she often buys con-doms for her husband.
"It's been just eight months for our marriage. My husband works in a call centre, and he wants to make love to me at odd hours, just like his job. He says he doesn't get time to buy condoms, but the truth is he is shy of buying it... Now I have started buying these from grocery stores. I keep con-doms in the basket and give them along with other items for billing."
AIDS /HIV ;Sheena Shah, a student, learnt the lesson of safe sex the hard way. Shah, staying away from her family in the city, had several boyfriends.Unwilling to use condoms, she contracted HIV/AIDS last year, leading her into depression.
"I personally never wanted to use condoms because they reduced my pleasure. My boyfriends never brought condoms because they felt shy about buying them," she says.
Another housewife doesn't want to get pregnant after bearing two kids, because of the 'irrational' sexual behavior of her husband, a marketing professional. She now orders condoms from the nearby chemist shop along with other things.
Women are increasingly coming forward to safe-guard their sexual health.
While conducting the study, researchers found that in Delhi, 6 per cent women in the age group of 19-22 bought condoms because their partners felt shy, while 10 per cent women in the age group of 26-30 did so. The figure was 22 per cent in the age group of 31-36."While female condoms seem to be proving a flop show, women have started choosing condoms for their partners as per their choice to have different pleasure every time," said Ravichandran.

"Condom use particularly among individuals and high-risk population, should be promoted as one a health product rather than a spacing device as they not only protect pregnancy but prevent many diseases like HIV /AIDS/WHITE DICHARGE,SYPHILLIS,GONORRHOEA,LYMPHOGRENULUM VENERUM,GRANULAM INGUINALE,HERPES SIMPLEX,DUCREY�S ULCER That is why NACO IS DISTRIBUTING FREE CONDOMS TO ALL HIGH RISK GROPUS LIKE MIGRATORYY PEOPLE AS TRUCK DRIVERS,LABOURERS FLYING AND COMMERCIAL SEX WORKERS,HIV POSITIVE PERSONS IN ART CENTRES,DRUG USERS AND MEN TO MEN SEX WORKERS ATTENDING STD CLINIC IN ICTC CNTRES,ART CENTRES AND DROPPING OUT CNTRES AND OTHER SURVEILLNACE CENTRES.
FOR CONDOM SIPLE CONDOM SOLD BY GOVENRN OF INDIA OR HINDUSTAN LATEX/RUBBER COMPANY IS GOOD ONE AS IT IS VERY LESS COSTLY BESIDE IT MANY FLAVOURED SCENTED SHINING AND ARTIFICIALY SILICONE AND OTHER SOFT CONDOMS ARE ALSO AVIALABLE AND ADVERTISED IN TV OR NEWS PAPER.IF CONDOM IS NOT TORN OR BROKEN IT WORKS NICELY AND IT IS EASY TO USE ONLY THING IS THAT WE SHOULD USED TO PRACTICE IT FEMALE PARTNER SHOULD COMPELL TO MALE PARTNER TO USE IT IF HE HESISITATES TO USE IT IN NAME OF LESS SATISFICATION OR NO TIMEOF PATIENCE AFTER AROUSAL AS THESE AR NOT ALL IMPORTANT EXCEPT PSYCHOLOGICALLY FELT ANF ARTICULATED.
(Names have been changed to protect the identity of women)

ARTIFICIAL OXYGEN : GREATEST INVENTION OF THIS CENTURY
DRNAKIPURIA.GMAIL.COM
Oxygen is most important gas for our life on this earth or inside sea or in open sky or moutains if lack of oxygen either not present in surrounding as on himalayan heights,space,moon,mars,saturn planet or inside sea or even in suffocated gathering or chowcked halls or leakage of gas during industrial pollutions,nuclear or bomb explosions ,it leads to severe respiratory distrss and if not rescued or provided oxygen in minutes we can die.Oxygen not going inside our lung during drowning or chocking or smoothering or hanging condition or where our respiratory effort is paralysed due to diseases of lung,thoracic cage or brain or any other metabolic disease or even reaching lung but not circulated by blood to our different body parts as in cardiac failure or many congenital shunts or advanced multi system failure condition if no or less oxygen no beaking of glucose particles in cell so no production of ATPS in mitochondria or no production of energy cell to perform different function of cell/tissue/organ/system or Body resulting in death.
Therefore,oxygen is very imortant for our survival or survival of every living particles ,even plant who can utilise carbon dioxide for nutrition need oxygen too but all animals need it badly even if oxygen but either oxygen carrying pipe or trachea blocked or diseases or lung where change of gas (oxygen in,carbon di oxide out)happens is diseases or red blood cells or RBCs are less in number then oxygen deprivation occurs so if BLOOD IS LET OUT as in anaemic condition where replaced by water or during surgery or during accident or crush injuries then our body needs BLOOD immediately to carry oxygen to our different cells but if Blood not available person may die even supplying excessive oxygen .
Therefore scientist all over the world are trying hard to manufacture a particle like RBC OR BLOOD which can carry oxygen to our body if injected inside our body and if such substance instead of getting blood through lung after travelling from our nose and air pipe,trachea to lung if this particle can be oaded with oxygen outside body in laboratory then it will help us in two ways in serious emergency life saving condition,first BLOOD OR RBC not required second even whole respiratory tract not working even then as there will be no need of ventilators in icu for few minutes to hrs ,thee particles will carry oxygen to heart(so heart will not stop)to Brain (so all vital centres will work) to kidneys (waste secreted)to Liver and intestines so all metabolic process will remain intact.
SUCH PARTICLES HAS BEEN INVENTED AND IT WILL BE USED BY ASTRAUNOTS FOR ITS SPACE PROGRAMME TOO and such particles has been developed by nano technology so every few amount will be needed to make our survival possible for minutes to hr only.
A team at Boston Children�s Hospital have invented a micro-particle that can be injected into your bloodstream to oxygenate your blood � without any help being required from your lungs.

The particles are able to keep a patient alive for up to 30 minutes after respiratory failure � which is normally enough time to prevent a heart attack or brain damage due to oxygen deprivation.

Each particle contains three to four times more oxygen than each of our own red blood cells. The oxygen is stored with a cell membrane made of fat. The membrane can be made of other materials but one issue in the past was that the particles became lodged in the body�s capillaries. These fat membranes however, are much more flexible and prevent this problem from happening.

Dr. John Kheir first began looking at ways to oxygenate the blood without breathing due to a tragic experience with one of his patients, a young girl. She was suffering from pneumonia and at one point her lungs started to fill with blood. It took 25 minutes to remove the blood from her lungs, but unfortunately it wasn�t enough time to prevent a cardiac arrest, leaving the girl in a serious condition which eventually lead to her death.

Potential uses for the new technology include medical, military and private. Military uses could include covert teams being able to stay submerged for 30 minutes at a time without having to come up for air. Private sector could include rescue teams being better protected, or an oil rig crew being able to fix underwater damage without the need for scuba equipment.

Introduction
Bowel cancer is a general term for cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon cancer or rectal cancer.
Symptoms of bowel cancer include blood in your stools (faeces), an unexplained change in your bowel habits, such as prolonged diarrhoea or constipation, and unexplained weight loss.
Cancer can sometimes start in the small bowel (small intestine), but small bowel cancer is much rarer than large bowel cancer.
Who is affected by bowel cancer?
Bbowel cancer is the third most common type of cancer.
Approximately 72% of bowel cancer cases develop in people who are 65 or over. Two-thirds of bowel cancers develop in the colon, with the remaining third developing in the rectum.
Who's at risk?
Things that increase your risk of getting bowel cancer include:
Age � around 72% of people diagnosed with bowel cancer are over 65
Diet � a diet high in fibre and low in saturated fat could reduce your bowel cancer risk, a diet high in red or processed meats can increase your risk
Healthy weight � leaner people are less likely to develop bowel cancer than obese people
Exercise � being inactive increases the risk of getting bowel cancer
Alcohol and smoking � high alcohol intake and smoking may increase your chances of getting bowel cancer
Family history and inherited conditions � aving a close relative with bowel cancer puts you at much greater risk of developing the disease.
Related conditions � having certain bowel conditions can put you more at risk of getting bowel cancer
Bowel cancer screening
Currently, everyone between the ages of 60 and 69 should go for bowel cancer screening every two years.
Screening is carried out by taking a small stool sample and testing it for the presence of blood (faecal occult blood test).
In addition, an extra screening test is being introduced over the next three years for all people at age 55. This test involves a camera examination of the lower bowel called a flexible sigmoidoscopy.
Screening plays an important part in the fight against bowel cancer because the earlier the cancer is diagnosed, the greater the chance it can be cured completely.
Treatment and outlook
Bowel cancer can be treated using a combination of surgery, chemotherapy, radiotherapy and, in some cases, biological therapy. As with most types of cancer, the chance of a complete cure depends on how far the cancer has advanced by the time it is diagnosed.
If bowel cancer is diagnosed in its earliest stages, the chance of surviving a further five years is 90%, and a complete cure is usually possible. However, bowel cancer diagnosed in its most advanced stage only has a five-year survival rate of 6% and a complete cure is unlikely.
Signs and symptoms of bowel cancer
Early bowel cancer may have no symptoms and some symptoms of later bowel cancer can also occur in people with less serious medical problems, such as haemorrhoids(piles).
See Dr. B C Shah if you notice any of the symptoms below.
The initial symptoms of bowel cancer include:
Blood in your stools (faeces) or bleeding from your rectum
A change to your normal bowel habits that persists for more than three weeks, such as diarrhoea, constipation or passing stools more frequently than usual
Abdominal pain
Unexplained weight loss
As bowel cancer progresses, it can sometimes cause bleeding inside the bowel. Eventually, this can lead to your body not having enough red blood cells. This is known as anaemia.
Symptoms of anaemia include:
Fatigue
Breathlessness
In some cases, bowel cancer can cause an obstruction in the bowel. Symptoms of a bowel obstruction include:
A feeling of bloating, usually around the belly button
Abdominal pain
Constipation
Vomiting
When to seek medical advice
Visit Dr. B C Shah if you have any of the symptoms above. While the symptoms are unlikely to be the result of bowel cancer, these types of symptoms always need to be investigated further.
Causes of bowel cancer
Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour.
Most cases of bowel cancer first develop inside clumps of cells on the inner lining of the bowel. These clumps are known as polyps. However, if you develop polyps, it does not necessarily mean you will get bowel cancer.
Exactly what causes cancer to develop inside the bowel is still unknown. However, research has shown several factors may make you more likely to develop it.
Family history
There is evidence that bowel cancer can run in families. Around 20% of people who develop bowel cancer have a close relative (mother, father, brother or sister) or a second-degree relative (grandparent, uncle or aunt) who have also had bowel cancer.
It is estimated that if you have one close relative with a history of bowel cancer, your risk of getting bowel cancer is doubled. If you have two close relatives with a history of bowel cancer, your risk increases four-fold.
Diet
A large body of evidence suggests a diet high in red and processed meat can increase your risk of developing bowel cancer. For this reason, the Department of Health advises people who eat more than 90 grams (cooked weight) of red and processed meat a day to cut down to 70 grams.
There is also good evidence that a diet high in fibre and low in saturated fat could help reduce your bowel cancer risk. Cancer experts think this is because this type of diet encourages regular bowel movements.
Smoking
People who smoke cigarettes are 25% more likely to develop bowel cancer, other types of cancer and heart disease than people who do not smoke.
Alcohol
A major study, called the EPIC study, showed alcohol was associated with bowel cancer risk. Even small amounts of alcohol can put you at higher risk of getting bowel cancer. The EPIC study found that for every two units of alcohol a person drinks each day, their risk of bowel cancer goes up by 8%.
Obesity
Obesity is linked to an increased risk of bowel cancer. Obese men are 50% more likely to develop bowel cancer than people with a healthy weight. Morbidly obese men, who have a body mass index (BMI) of over 40, are twice as likely to develop bowel cancer.
Obese women have a small increased risk of developing the condition, and morbidly obese women are 50% more likely to develop bowel cancer than women with a healthy weight.
Inactivity
People who are physically inactive have a higher risk of developing bowel cancer. You can help reduce your risk of bowel and other cancers by being physically active every day. Your risk could be cut by up to one-fifth if you do an hour of vigorous exercise every day or two hours of moderate exercise (such as vacuum cleaning or brisk walking).
Digestive disorders
Some conditions may put you at a higher risk of developing bowel cancer. People with Crohn�s disease are 2-3 times more likely to develop bowel cancer. The risk of developing bowel cancer is much higher in people with ulcerative colitis, and as many as 1 in 20 of these people will go on to develop it.
Genetic conditions
There are two rare inherited conditions that can cause bowel cancer. They are:
Familial adenomatous polyposis (FAP)
Hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome
FAP affects 1 in 10,000 people. The condition triggers the growth of non-cancerous polyps inside the bowel. Although the polyps are non-cancerous, there is a high risk that, over time, at least one will turn cancerous. Almost all people with FAP will have bowel cancer by the time they are 50 years of age.
People with FAP have such a high risk of getting bowel cancer, they are often advised to have their large bowel removed by surgery before they reach the age of 25. Families affected can find support and advice from the FAP registry at St Mark�s Hospital, London.
HNPCC is a type of bowel cancer caused by a mutated gene. An estimated 2-5% of all cases of bowel cancer are due to HNPCC. Around 90% of men and 70% of women with the
As with FAP, removing the bowel as a precautionary measure is usually recommended in people with HNPCC.
Diagnosing bowel cancer
When you first see Dr. B C Shah he will ask about your symptoms and whether you have a family history of bowel cancer.
Dr. B C Shah will then carry out a physical examination known as a digital rectal examination (DRE). A DRE involves Dr. B C Shah gently placing a finger into your anus, and then up into your rectum.
A DRE is a useful way of checking whether there is a noticeable lump inside your rectum. This is found in an estimated 40-80% of cases of rectal cancer.
A DRE is not painful, but some people may find it a little embarrassing.
If your symptoms suggest you may have bowel cancer, or the diagnosis is uncertain, you will be referred to your local hospital for further examination.
Further examination
Two tests are commonly used to confirm a diagnosis of bowel cancer:
A sigmoidoscopy is an examination of your rectum and some of your large bowel.
A colonoscopy is an examination of all of your large bowel.
Sigmoidoscopy
A sigmoidoscopy uses a device called a sigmoidoscope, which is a thin, flexible tube attached to a small camera and light.
The sigmoidoscope is inserted into your rectum and then up into your bowel. The camera relays images to a monitor. This allows the doctor to check for any abnormal areas within the rectum or bowel that could be the result of cancer.
A sigmoidoscopy can also be used to remove small samples of suspected cancerous tissue so they can be tested in the lab. This is known as a biopsy.
A sigmoidoscopy is not usually painful, but can feel uncomfortable. Most people go home after the examination has been completed.
Colonoscopy
A colonoscopy is similar to a sigmoidoscopy except a longer tube, called a colonoscope, is used to examine your entire bowel.
Your bowel needs to be empty when a colonoscopy is performed, so you will be given a special diet to eat for a few days before the examination and a laxative (medication to help empty your bowel) on the morning of the examination.
You will be given a sedative to help you relax, after which the doctor will insert the colonoscope into your rectum and move it along the length of your large bowel. As with a sigmoidoscope, the colonoscope can be used to obtain a biopsy, as well as relaying images of any abnormal areas.
A colonoscopy usually takes about one hour to complete, and most people can go home once they have recovered from the effects of the sedative. After the procedure, you will probably feel drowsy for a while, so arrange for someone to accompany you home.
Further testing
If a diagnosis of bowel cancer is confirmed, further testing is usually carried out for two reasons:
to check if the cancer has spread from the bowel to other parts of the body
to help decide on the most effective treatment for you
These tests can include:
A computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan to provide a detailed image of your bowel and other organs
Ultrasound scans, which can be used to look inside other organs, such as your liver, to see if the cancer has spread there
Chest X-rays, which can be used to assess the state of your heart and lungs
Blood tests to detect a special protein, known as a tumour marker, released by the cancerous cells in some cases of bowel cancer
Staging and grading
Once the above examinations and tests have been completed, it should be possible to determine the stage and grade of your cancer. Staging refers to how far your cancer has advanced. Grading relates to how aggressive and likely to spread your cancer is.
Stage 1 � the cancer is still contained within the lining of the bowel or rectum
Stage 2 � the cancer has spread into the layer of muscle surrounding the bowel
Stage 3 � the cancer has spread into nearby lymph nodes
Stage 4 � the cancer has spread into another part of the body, such as the liver
This is a simplified guide. Stage 2 is divided into further categories called A and B and stage 3 is divided into A, B and C.
There are three grades of bowel cancer:
Grade 1 is a cancer that grows slowly and has a low chance of spreading beyond the bowel
Grade 2 is a cancer that grows moderately and has a medium chance of spreading beyond the bowel
Grade 3 is a cancer that grows rapidly and has a high chance of spreading beyond the bowel
If you are not sure what stage or grade of cancer you have, ask your doctor.
Treating bowel cancer
People with bowel cancer should be cared for by a multidisciplinary team (MDT). This is a team of specialists who work together to provide the best treatment and care.
The team often consists of a Dr. B C Shah, an oncologist (a radiotherapy and chemotherapy specialist), a radiologist, pathologist, radiographer and a specialist nurse. Other members may include a physiotherapist, dietitian and occupational therapist, and you may have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
The type and size of the cancer
Your general health
Whether the cancer has spread to other parts of your body
What grade it is
There are several treatments for bowel cancer, including:
Surgery
Chemotherapy
Radiotherapy
Biological therapy
Surgery is usually the main treatment for bowel cancer, but in about one in five cases, the cancer is too advanced to be removed by surgery. If you have surgery, you may also need chemotherapy, radiotherapy or biological therapy, depending on your particular case.
Your treatment plan
Your recommended treatment plan will depend on the stage and location of your bowel cancer.
If the cancer is confined to your rectum, radiotherapy will usually be used to shrink the tumour, then surgery may be used to remove the tumour. Sometimes, radiotherapy is combined with chemotherapy, which is known as chemoradiation.
If you have stage 1 bowel cancer, it should be possible to surgically remove the cancer and no further treatment will be required.
If you have stage 2 or 3 bowel cancer, surgery may be used to remove the cancer and, in some cases, nearby lymph nodes. Surgery is usually followed by a course of chemotherapy to stop the cancer returning.
It is not usually possible to cure stage 4 (advanced) cancer. However, symptoms can be controlled and the spread of the cancer can be slowed using a combination of surgery, chemotherapy, radiotherapy and biological therapy where appropriate.
Preventing bowel cancer
There are several ways to reduce your risk of developing bowel cancer.
Diet
Research suggests a low-fat, high-fibre diet that includes plenty of fresh fruit and vegetables (at least five portions a day) and wholegrains can help reduce your risk of getting bowel cancer. It can also reduce your risk of developing other types of cancer and heart disease.
It is recommended you do not eat a lot of processed meat and red meat. The Department of Health advises people who eat more than 90 grams (cooked weight) of red and processed meat a day to cut down to 70 grams. .
Exercise
There is strong evidence to suggest regular exercise can lower the risk of developing bowel and other cancers.
It is recommended adults exercise for at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (i.e. cycling or fast walking) every week.
Healthy weight
Try to maintain a healthy weight. Changes to your diet and an increase in physical activities will help keep your weight under control. Find out if you are a healthy weight with the Healthy weight calculator.
Smoking
If you smoke, giving up will reduce your risk of developing bowel and other cancers.
Dr. B C Shah can also provide help, support and advice if you want to give up smoking.
How screening for bowel cancer works
Bowel cancer can be present for a long time before any symptoms appear. If bowel cancer is detected before symptoms appear, it is easier to treat and there is a better chance of surviving the disease.
Screening for bowel cancer called an FOBt (faecal occult blood test) is done at a pathology Lab. A tiny stool samples on a special card. The card is then checked at the laboratory for traces of blood.
Results
There are three types of result:
Normal: no blood was found in the samples. Screening will be offered again in two years� time.
Unclear: there were possible traces of blood that could be caused by factors other than cancer, such as haemorrhoids (piles) or stomach ulcers. If you have an unclear result, you will be asked to repeat the test kit up to twice more.
Abnormal: blood was definitely found in the samples. Again, this could be from piles or bowel polyps(small growths not usually cancerous). If you have an abnormal result, you will be offered an appointment with Dr. B C Shah to discuss having an examination of the bowel, called a colonoscopy.
Colonoscopy
A colonoscopy is an investigation of the lining of the large bowel (colon). A thin flexible tube with a tiny camera on the end is passed into your bottom and guided around the bowel. Only around 2 in every 100 people completing the FOBt kit will have an abnormal result and will be offered a colonoscopy. Of those who have a colonoscopy, only about one in 10 will have cancer.
New screening test
As well as the FOBt described above, an additional screening test is being rolled out by 2016. This involves inviting people at age 55 to have a one-off flexible sigmoidoscopy test to examine the lower bowel with a camera.
If the flexible sigmoidoscopy shows polyps, the person will then be offered a full colonoscopy . Both FOBt and flexible sigmoidoscopy screening tests have been shown to reduce the risk of dying of bowel cancer.
Living with bowel cancer
Being diagnosed with cancer is a tough challenge for most people. There are several ways to find support to help you cope.
Not all of them work for everybody. but one or more should be helpful:
Talk to your friends and family. They can be a powerful support system.
Get in touch with others in the same situation as you
Learn about your condition
Don't try to do too much at once
Make time for yourself.
Talk to others
Dr. B C Shah may be able to reassure you if you have questions, or you may find it helpful to talk to a trained counsellor, psychologist . Dr. B C Shah will have information on these.
Having cancer can cause a range of emotions. These may include shock, anxiety, relief, sadness and depression. Different people deal with serious problems in different ways. It is hard to predict how knowing you have cancer will affect you. However, you and your loved ones may find it helpful to know about the feelings that people diagnosed with cancer have reported.
Recovering from colon or rectal surgery
Surgeons and anaesthetists have found that using an �enhanced recovery programme� after bowel cancer surgery helps patients recover more quickly.
Most hospitals now use this programme. It involves giving you more information before the operation about what to expect, avoiding giving you strong laxatives to clean the bowel before surgery, and in some cases giving you a sugary drink two hours before the operation to give you energy.
During and after the operation, the anaesthetist controls the amount of IV fluid you need very carefully, and after the operation you will be given painkillers that allow you to get up and out of bed by the next day.
Most people will be able to eat a light diet the day after their operation.
To reduce the risk of deep vein thrombosis (blood clots in the legs), you may be given special compression stockings that help prevent blood clots, or a regular injection with heparin until you are fully mobile.
A nurse or physiotherapist will help you get out of bed and regain your strength so you can go home again within a few days.
With the enhanced recovery programme, most people are well enough to go home within five to six days of their operation. The timing depends on when you and Dr. B C Shah agree you are well enough to go home.
Coping with colostomy
If you need a colostomy, you may feel worried about how you look and how others will react to you. Information and advice about living with a stoma (including stoma care, stoma products and �stoma-friendly� diets) is available via the ileostomy and colostomy topics.
Diet after bowel surgery
If you have had part of your colon removed, it is likely that your stools (faeces) will be looser because one of the functions of the colon is to absorb water from the stools. This may mean that you experience repeated episodes of diarrhoea
You should inform Dr. B C Shah if diarrhoea becomes a problem because medication is available to help control symptoms.
You may find some foods upset your bowels, particularly during the first few months after your operation.
Different foods can upset different people, but food and drink that is commonly known to cause problems include:
Rich and fatty food
Fruit and vegetables that are high in fibre, such as beans, cabbages, apples and bananas
Fizzy drinks, such as cola and beer
You may find it useful to keep a food diary to record the effects of different foods on your bowel.
If you find that you are having continual problems with your bowels as a result of your diet, and/or you are finding it difficult to maintain a healthy diet, you should contact Dr. B C Shah. You may need to be referred to a dietitian for further advice.
Sex and bowel cancers
Having cancer and its treatment may affect how you feel about relationships and sex. Although most people are able to enjoy a normal sex life after bowel cancer treatment, if you have had a colostomy you may feel self-conscious or uncomfortable.
Talking about how you feel with your partner may help you both to support each other. Or you may feel you�d like to talk to someone else about your feelings. Dr. B C Shah will be able to help.
Financial concerns
A diagnosis of cancer can cause money problems because you are unable to work or someone you are close to has to stop working to look after you.
Dealing with dying
If you are told there is nothing more that can be done to treat your bowel cancer, Dr. B C Shah will still provide you with support and pain relief. This is called palliative care. Support is also available for your family and friends.