Zoledronic Acid: A Bisphosphonate Therapy

Zoledronic acid injection, also addressed as zoledronate, specifically is a drug prescribed for the treatment of bone diseases including high blood calcium due to cancer, bone breakdown due to cancer, osteoporosis, and Paget’s disease of bone. 

Mechanism of Action: Zoledronic acid falls under a class of substances named Bisphosphonates. It binds specifically to bone and it does not stay in your blood. The zoledronic acid injection helps in order to slow down the bone resorption (caused by osteoclasts) which enables the bone-forming cells (osteoblasts) time in order to rebuild the normal bone.

Dosage & Administration: The zoledronic acid injection is administered as an infusion into a vein for 15 minutes by your healthcare practitioner. 

Your healthcare practitioner will recommend you to consume at least 2 glasses of water (500 mL or 2 cups) prior to and following the treatment.

In order to prevent Osteoporosis, 5 mg should be given as a single dose.

In order to prevent Paget’s disease, 5 mg should be given as a single dose.

The zoledronic injection may work for over 1 year, and your healthcare professionals will inform you in case you need to be treated again. 

It is crucial to take calcium as well as vitamin D supplements as directed by your healthcare practitioner in order to reduce the probability of having reduced blood calcium levels, to prevent the loss of bone and to help rebuild the bone.

Possible Side Effects: Like all drugs, zoledronic acid injection may also be responsible for causing some unwanted adverse reactions in addition to its beneficial effects.

The most common zoledronic acid side effects include:

• Fever
• Fatigue
• Chills
• Headache
• Nausea
• Vomiting
• Abdominal pain
• Diarrhea
• Back pain
• Pain in extremity
• Influenza-like illness
• Weakness
• Pain
• Shortness of breath
• Dizziness
• Excessive sweating
• Tiredness
• Disturbed digestion
• Decreased appetite
• Non-cardiac chest pain
• Malaise (unwell feeling)
• Bone, joint or muscle pain or stiffness

Other side effects: There's possibility that some other side effects due to zoledronic acid infusion may also occur, which are listed as follows:

• Numbness
• Tingling sensations
• Allergic reactions
• Urinary tract infection
• Constipation
• High blood cholesterol levels
• Pain in jaw
• Pain in neck
• Joint sprain
• Post-traumatic pain
• Cough
• Seasonal allergy
• Vaginal dryness
• Congestion of the nose
• Pharyngolaryngeal pain 
• Increased or irregular heartbeat
• Rheumatoid arthritis/arthritis (inflammation of the joints)

Warning & Precautions:

• Administration of zoledronic acid injection is not recommended for patients aged under 18 years.
• Prior to taking zoledronate infusion talk to your doctor if you're unable to take daily calcium/vitamin D supplements. 
• Ensure that you have talked about zoledronic acid injection treatment with your healthcare practitioner. 
• In case you're taking treatment with another intravenous form of zoledronic acid 4mg, you're not allowed to be treated with the zoledronic acid injection.
• In case you're being treated with this injection, treatment should be avoided with other bisphosphonates (such as risedronate, alendronate, clodronate, etidronate, pamidronate and ibandronate) at the same time.
• Use of zoledronate is not recommended in case you are pregnant or plan to become pregnant or are breast-feeding.
• Talk to your healthcare practitioner in case you've any pain in your hip, groin, or thigh. This injection may be responsible for causing the unusual fractures in the thigh bone.
• Inform your doctor if you've a sudden headache, numbness in your limbs, confusion, trouble talking, vision problems, and trouble walking.
• Tell your healthcare team if you have kidney problems. Cases of worsening of kidney function, including kidney failure may happen when you take the zoledronic acid 4mg injection.

Drug Interactions: You need to inform your healthcare team in case you're taking or have recently taken any other drugs, including any kind of drug you have bought without a prescription. It is specifically crucial for your healthcare team to know if you are taking :

• any drugs known to be harmful to your kidneys (such as Non-Steroidal Anti-inflammatory Drugs).
• water pill (diuretics)
• aminoglycoside antibiotics (a type of drug used to treat severe infections).

Drug Overdose: In case you have received or taken too much zoledronic acid dose, contact your healthcare practitioner, hospital emergency department as soon as you can, even if there are no signs and symptoms.

Storage Guidelines: Store these injections at the room-temperature between 15°C-30°C. Original packaging should be kept unchanged as well as sealed until a healthcare practitioner administers the inj zoledronic acid. Don't forget to keep the injection and all drugs safely away from the children.

Cost: The zoledronic acid price may vary from branded (innovator) to non-branded (generic) drugs. The price for a bottle of Aclasta 5mg/100ml Infusion (Trade Name) is around 20492 INR. 

Frequently Asked Questions:

From which class of drug Zoledronic acid belongs? 

Zoledronic acid specifically belongs to a class of drugs named bisphosphonates that helps in order to prevent the abnormal breakdown of bones.

What is Zoledronic acid? What is it used for?

Zoledronic acid is used in order to prevent and treat osteoporosis and fractures in patients with metastatic cancer (a cancer which spreads to newer areas of the body). This drug can also be used in order to treat hypercalcemia (elevated blood calcium levels).

How should Zoledronic acid be given? 

Zoledronic acid is given by injection into a vein.

How does Zoledronic acid act? 

Zoledronic acid acs in order to block the activity of osteoclast cells and thus reduces the bone breakdown. 

How long should I take Zoledronic acid?

This medication should be taken in the dose as well as duration recommended by healthcare professionals. Zoledronic takes around 6-month in order to show its maximum benefits on bones. Although, in certain cases, the healthcare practitioner may suggest this medication for a longer period of time. The appropriate duration will depend on the condition you're currently being treated for.

What are the commonly reported side effects of Zoledronic acid? 

Commonly reported side effects of Zoledronic acid include joint pain, high blood pressure, fever, diarrhea, and feeling tired.

What are the severe side effects of Zoledronic acid? 

Severe side effects of Zoledronic acid may include low blood calcium, osteonecrosis of the jaw and kidney problems. 

What if Zoledronic acid is used during pregnancy? 

Use of zoledronic acid during pregnancy may be responsible for harm to the baby.

NOTE: The information provided about zoledronic acid injection in this article is only for informational purposes and is not served as a substitute for the medical treatment, consultation, diagnosis, of a qualified healthcare practitioner.

Squamous Cell Carcinoma- A type of skin disease

 What is Squamous cell carcinoma of the skin?

Squamous cell carcinoma (SCC) specifically is a kind of skin cancer that originates from the squamous cells of the skin. These cells are quite different from melanocytes (from which melanomas originate) as they do not usually play a role in the color of skin but compose the maximum skin’s most superficial layer, the epidermis.

How does Squamous cell carcinoma look like?

It usually looks like wounds or elevated growths that may bleed without scratching and do not heal over time. Squamous cell carcinoma may also look like scaly patches or parts of skin covered by a thick crust, surrounded by a deep red area that looks inflamed. Some squamous cell carcinoma may also resemble warts. They usually occur in sun exposed parts such as the scalp, face, rim of the ears and the back of the hands, but may also be developed on the lips as well as the genital organs.

How common is Squamous cell carcinoma? 

On behalf of existing data, SCC is known as the second most common skin cancer in the Caucasian populations and the most common skin cancer in persons of color. 

Squamous Cell Carcinoma Causes: This disease is caused basically by cumulative exposure to the sun (ultraviolet-UV) throughout a person’s life. This may include daily year-round exposure to the sun and the more intense exposure experienced while on the months of summer. Additionally, UV exposure due to tanning bed use may also be responsible for causing the damage of skin that can lead to the formation of Squamous Cell Carcinoma.

Squamous Cell Carcinoma Risk Factors: People who are with fair skin, light hair, freckles and blue, green, or gray eyes are at comparatively higher risk of developing SCC. In addition, those patients who are with diseases such as psoriasis that have undergone phototherapy treatments, or transplant patients that take immunosuppressive medications are also at risk. Regardless of any individual’s personal medical history, extensive sun exposure is also quite associated with a higher risk of occurring this kind of skin cancer.

Using tanning beds is also responsible in order to increase the risk of Squamous Cell Carcinoma substantially. Specifically, it is believed that patients using tanning beds have a multiple times higher risk of developing Squamous Cell Carcinoma than those that do not. Patients of color may also develop Squamous Cell Carcinomas on parts of preexisting inflammatory skin conditions, burn injuries or serious trauma.

Squamous Cell Carcinoma Symptoms: Patients that have new or growing lesions on the skin, or ulcers that fail to heal should contact their dermatologist for a consultation. Patients with a history of extensive exposure to sun, phototherapy or tanning beds may occur one or multiple small red scaly patches on their skin. Sometimes such patches can be skin-colored but may feel rugged at the time of touch. 

These lesions are named actinic keratoses and usually are considered as premalignant lesions that may be responsible for causing squamous cell carcinoma. If a patient observes such a lesion they must refer to a dermatologist in order to get appropriate treatment.

Squamous Cell Carcinoma Diagnosis and Treatment: It is basically diagnosed by performing a skin biopsy. The choice of treatment for Squamous Cell Carcinoma is surgical excision. This sort of surgery usually needs the use of topical anaesthesia only. Then, the skin is closed with stitches or a skin graft. Another sort of treatment can be considered for squamous cell carcinoma is radiotherapy. This kind of treatment may need multiple sessions in order to leave an effective effect. In a few cases, a combination of surgery and radiotherapy can be used, while in a few, quite advanced tumors, chemotherapy can also be recommended. 

Squamous Cell Carcinoma Prognosis: Most squamous cell carcinomas have an amazing prognosis, as if they are diagnosed a bit early, can be treated successfully with the help of surgical excision only. Although, about 2 to 5% of Squamous Cell Carcinomas have been reported to give metastases. Overall, the five-year relative survival rate has been reported for patients with squamous cell carcinoma.

What can individuals do in order to avoid getting an SCC (Squamous cell carcinoma)?

The use of various sun protection methods is quite necessary in order to prevent squamous cell carcinoma. These can include the rigorous use of UVA and UVB, seeking shade on the beach and wearing sun protective clothing, hats as well as sunglasses. The use of tanning beds needs also to be avoided.

NOTE: The information provided in this article is only for informational purposes and is not served as a substitute for the medical treatment, consultation, diagnosis, of a qualified healthcare practitioner.

Related:- What is Basal Cell Carcinoma

Temozolomide: An Oral Alkylating Agent

What is temozolomide: 

As an oral alkylating agent, Temozolomide is approved in order to treat newly diagnosed glioblastoma multiforme and refractory anaplastic astrocytoma. 

How is temozolomide dosed: The daily dose of temozolomide capsules for a given patient is usually calculated by the healthcare practitioner, based on the patient's body surface area (BSA). The resulting dose is then rounded off to around 5 mg.

The temozolomide dose for subsequent cycles can be adjusted according to nadir neutrophil as well as platelet counts in the previous cycle and during the time of starting the next cycle.

Treatment regimen: Temozolomide is recommended to be given for 5 consecutive days on a 28 day cycle. Patients need to continue taking temozolomide 20 mg until their healthcare practitioner determines that their disease has progressed, up to 22 months, or unt
il unacceptable adverse reactions or toxicities occur. 

How is temozolomide taken:

Patients should consume a daily dose with a full glass of water at about the same time every day. Taking the capsules on an empty stomach or at bedtime may help in order to ease the nausea. In case patients are also taking antinausea or other drugs to relieve the adverse reactions associated with temozolomide 5 mg, they are advised to take these drugs 30 minutes prior to taking temozolomide.

Apart from this, you may receive this drug by injection into a vein (intravenous). Your healthcare provider will decide the appropriate way for you to take this medicine. 

How is temozolomide capsules supplied: 

The drug temozolomide comes as capsules in 5 mg, 20 mg, 100 mg, 140 mg, 180 mg, and temozolomide 100 mg strengths. The temozolomide capsules basically contain a white capsule body with the white cap.

Possible Side Effects: Common temozolomide side effects include:

• Nausea
• Vomiting
• Headache
• Feeling tired
• Hair loss 
• Constipation
• Bruising
• Rash
• Diarrhea
• Weakness
• Fever
• Dizziness
• Memory loss
• Loss of appetite
• Viral infection
• Sleep problems
• Coordination problems
• Infusion site reactions
• Paralysis on one side of the body

Tell your healthcare practitioner about any possible side effect that bothers you or that does not go away.

Who should not take this drug: Do not take Temodar in case you:

• have had an allergic reaction to DTIC (dacarbazine), another cancer drug.
• have had a red itchy rash, or a severe allergic reaction, such as trouble breathing, swelling of the face, throat, or tongue, or severe skin reaction to temozolomide injection or any of its ingredients. If you are not sure, ask your doctor. 

Precautions: Inform your healthcare practitioner about all your medical conditions, including:

• in case you are allergic to dacarbazine (DTIC) or have had a severe allergic reaction to temozolomide injection.
• in case you have kidney problems. 
• in case you have liver problems. 
• in case you are pregnant.
• in case you are breast-feeding. This drug may pass into breast milk. You and your doctor should take a decision if you will breast-feed or take temozolomide 100 mg. You must avoid doing both without interacting with your healthcare team.

Storage Guidelines: Store the capsules at 77°F (controlled room temperature). Storage at 15°C to 30°C is permitted occasionally. The temozolomide capsules should be placed out of the reach of children and pets.

How much does temozolomide cost? 

The temozolomide cost may vary from generic to innovator drugs. Prices may range from around 2050 INR to around 25000 INR. 

NOTE: The information provided in this article is only for informational purposes and is not served as a substitute for the medical treatment, consultation, diagnosis, of a qualified healthcare practitioner.

All you need to know about Pegaspargase

What is Pegaspargase?

Pegaspargase (Oncaspar) is used for the treatment of patients with acute lymphoblastic leukemia (ALL).

The pegaspargase is a composition of Oncaspar, which is an enzyme that breaks down asparagine, an essential building block of proteins without which it is difficult to survive for cells. Healthy cells often produce asparagine for themselves, while cancer cells cannot. This medication decreases the level of asparagine in the blood cancer cells and resists the cancerous cells in order to grow.

How does pegaspargase work?

Pegaspargase is specifically involved in breaking down the amino acid asparagine to aspartic acid as well as ammonia. 

The leukemic cells are not able to produce their asparagine and depend on circulating the asparagine for the growth; apart from this, the asparaginase deprives the leukemic cells in order to circulate the asparagine responsible for death of the leukemic cell.

How Oncaspar is given?

Pegaspargase Injection should be administered as an intravenous (IV) infusion over 1-2 hours or maybe given as an intramuscular injection (IM).

Possible side effects: Like all medications, oncaspar can cause side effects, although not everybody gets them.

Very common side effects are as follows:

• Weight loss
• Leg pain
• Chest pain
• Shortness of breath
• Loss of appetite
• General weakness
• Vomiting
• Diarrhoea
• Nausea
• Increased blood sugar levels
• Changes in the function of the pancreas

Common adverse reactions may include:

• Ascites
• Fever and flu-like symptoms
• Mouth sores
• Back, joint or abdominal pain
• High levels of fat
• Increased cholesterol
• Low potassium in blood
• Decreased number of red blood cells

There are some rare pegaspargase side effects, which may include:

• Headache
• Confusion
• Seizures and visual loss 
• Reversible posterior leukoencephalopathy syndrome (RPLS)

warnings and precautions:

Discuss with your doctor prior to receiving pegaspargase. It may inappropriate or not suitable for individuals:

1. If individuals have had serious allergic reactions, for instance itching, flushing or swelling of the airways, because major allergic reactions to this drug may occur.
2. If individuals suffer from a bleeding disorder or have serious blood clots.
3. If individuals get a fever. It may make you comparatively more susceptible to the infections.
4. If individuals have had poor liver function or are taking other medicines which may be harmful for liver. When this drug  is used along with other cancer treatments, liver and central nervous system damage may occur.
5. If individuals suffer from abdominal pain. Inflammation of the pancreas, that in some cases causes death, may develop with pegaspargase injection treatment.
6. This medicine may lead to fluctuations in clotting factors and can increase the risk of bleeding/clotting.
7. If individuals are the parents of a child and are taking treatment with this drug, talk to your doctor if any of the above terms apply to your child.
8. If individuals are pregnant or breast-feeding, or are planning to have a baby, ask your healthcare team for advice prior to using this medication. 

Who should not use Pegaspargase? 

1. Patients who are allergic to pegaspargase or to any of the other ingredients of this medicine.
2. Patients who have severe hepatic disease.
3. Patients who have ever had pancreatitis.
4. Patients who have ever had severe bleeding following asparaginase therapy.
5. Patients who have ever had blood clots following asparaginase therapy.

Inform your doctor in case any of such terms apply to you. In case you are a parent of a child who is taking treatment with pegaspargase, please discuss with your doctor if any of them apply to your child.

If you are given too much Oncaspar: As a healthcare practitioner will administer the oncaspar, it is quite unlikely patients will be given wrong dosage. 

In the event of an accidental drug overdose, patients will be monitored by the healthcare team and treated accordingly.

In case you want to know something on the use of this drug, ask your doctor.

How to store Oncaspar? 

Keep the oncaspar 3750 out of the sight and reach of children. Should be stored in the refrigerator (2°C-8°C).

Freezing of medication is not recommended. Following the medicinal product has been reconstituted and diluted, the solution must be used as soon as possible. If the diluted solution can not be used immediately, it should be stored at 2°C-8°C for up to 48 hours.

NOTE: The information provided in this article is only for informational purposes and is not served as a substitute for the medical treatment, consultation, diagnosis, of a qualified healthcare practitioner.

Addition of Pemetrexed and Carboplatin to Gefitinib Doubled PFS in Patients with EGFR-Mutant NSCLC

On behalf of derived outcomes of a randomized phase 3 study came into view in the Journal of Clinical Oncology, adding pemetrexed and carboplatin to gefitinib significantly enhanced the progression free survival and OS for participants with NSCLC and EGFR-sensitizing mutations. 

Although data suggests that the clinically relevant severe toxicities have been observed twice as often with the combination regimen than with gefitinib alone.

According to Vanita Noronha, MD, MBBS, professor in the department of medical oncology at Tata Memorial Hospital in Mumbai, India, and colleagues, “Apart from the detection of molecular target and using medications, believed to bind to the target, cure and long-term remission elude us,” “Resistance inevitably occurs within 8-12 months. Number of ways have been implemented in order to reduce the emergence of resistance. One strategy involved in order to combine the cytotoxic chemotherapy with an EGFR TKI.” She added. 

Between August 2016 and August 2018, in an open-label study conducted by Noronha and colleagues, total 350 participants enrolled with advanced, chemotherapy-naive, EGFR-mutated Non-Small Cell Lung Cancer. About 18% of participants had brain metastases and 21% found with an ECOG performance status of 2.

The investigators differentiated patients on the basis of performance status and EGFR mutation type and randomly assigned them 1:1 to gefitinib 250 mg orally once per day alone (n = 176; median age, 56 years; range, 27-78) or with pemetrexed 500 mg/m2 IV and carboplatin IV area under the curve 5 each 3 weeks for the four cycles (n =174; median age, 54 years; range, 27-75). The combination regimen was followed by maintenance pemetrexed 500 mg/m2 IV every three weeks.

The progression free survival represents as the primary endpoint, and OS, toxicity and RR represent as the secondary endpoints. The researchers specified survival endpoints in the intention in order to treat the population. The median follow-up reported about 17 months.

About 80% of participants treated with gefitinib and chemotherapy, completed all four cycles of pemetrexed and carboplatin. Outcomes represented ORR of about 75.3% among participants in the combination population and 62.5% in the gefitinib-only population. Participants in the combination population had longer median progression free survival than those in the gefitinib-only population. The combination population had significantly longer median overall survival than the gefitinib population.

About 50% of patients in the combination population experienced grade 3 or higher toxicities; maximum because of the chemo induced myelosuppression and nephrotoxicity, compared with 25.3% of those in the gefitinib population.

Researchers have written, “Adding pemetrexed and carboplatin to gefitinib prolonged PFS (progression free survival) and overall survival, but also be responsible for increasing the toxicity."

Also, Jennifer Byrne stated that, "The pemetrexed, carboplatin and gefitinib, together appeared as a new standard first-line therapy for patients with the EGFR-mutant Non-Small Cell Lung Cancer.” 

Spinal cord Tumor: All you need to know about

The spinal cord tumours specifically occur when abnormal cells grow and form a mass or a lump. The tumour is known as benign (not cancerous) or malignant (cancerous), but both types may be serious and may need urgent treatment. 

Types of Spinal Tumors: 

There are basically three main types of spinal tumors, which are classified on behalf of their location:

Extradural and Intradural (intradural-intramedullary and intradural-extramedullary): Intradural-intramedullary tumors occurs within the dura and spinal cord parenchyma, although Intradural-extramedullary tumors occurs within the dura but outside the spinal cord parenchyma.

Extradural: Extradural tumors occur outside the dura mater lining and are most commonly known as metastatic.

Intradural: Intradural tumors occur inside the dura mater lining and are further subdivided into intramedullary and extramedullary tumors. 

Symptoms of Spinal Tumours:

The most commonly reported symptom of spinal tumors is nocturnal back pain. Other common symptoms may include:

• Muscle weakness
• Sensory loss
• Difficulty walking
• Loss of bowel and bladder control 

Tests & Investigations: Tests as well as investigations carried out in a local hospital or local neuroscience centre. Your healthcare provider will refer you required tests accordingly. If you are taking treatment for any other cancer and your healthcare team find that your symptoms are caused by the cancer spreading to your spine they will perform the tests. Your care team may refer you to a neurosurgeon or spinal surgeon, specialises in operations on the spine.

X-rays of your spine may provide the piece of important information. Apart from this, spinal tumours are usually investigated with the help of MRI scan or a CT scan and possibly by a biopsy or a bone scan.

MRI scan: It mainly uses strong magnetic fields and radio waves in order to produce the pictures of the spine that provide more details than an X-ray.

CT scan: This computerised tomography scan is a specifically X-ray that is able to take pictures of your spine from different angles.

Bone scan: This test is used in order to diagnose the tumours or cancer located in the bone. For this test, a very small amount of a radioactive chemical is injected into your vein.

Biopsy: This is basically an operation in order to remove a small sample of a tumour that is sent to a pathologist for examination. You will be prescribed for a biopsy if your healthcare provider is unsure from the results of your scans what type of tumour you have.

Treatments of Spinal cord tumor: 

There are 4 major types of treatment options for spinal tumours named surgery, radiotherapy, radiosurgery and chemotherapy.

Surgery: In order to treat non-malignant spinal tumours, surgery is most commonly used but it may also be used for the treatment of some malignant tumours. 

Surgery is prescribed in order to remove as much of the tumour as possible without damaging the spinal cord or the nerves surrounding the tumour. Following successful removal of all of a tumour may increase the probability of a good or full recovery. Although it may also reduce the risk of the tumour recurring. Surgery may not be suitable for every individual. Your healthcare provider team will discuss the appropriate treatment options with you.

Radiotherapy: It is basically prescribed in order to treat malignant tumours and tumours that can’t be removed with surgery.

Radiotherapy may also be prescribed following surgery for the treatment of any tumour cells that are difficult to be removed. In case you have had surgery, you will be given time in order to recover before receiving radiotherapy treatment.

Radiotherapy specifically uses X-rays as well as gamma rays in order to damage or destroy the tumour. The treatment also helps by slowing down the growth of tumour and lengthens the time prior to it regrows. Sometimes, the radiotherapy destroyed the tumour completely.

Side Effects of Radiotherapy: 

The commonly reported side effects of radiotherapy may include:

• Inflammation of the skin
• Similar to sunburn
• Bone fractures
• Bone marrow suppression 

Radiosurgery: Likewise radiotherapy, radiosurgery may be prescribed when surgery is not appropriate or as an additional treatment following surgery. This treatment is basically not a surgical and does not involve any cuts. It acts by targeting a higher dose of radiation at the tumour for damaging and destroying the tumour cells. The treatment takes place by a machine named a linear accelerator (LINAC) or gamma knife.

Chemotherapy: It specifically uses drugs to destroy the tumour cells. There are several types of chemotherapy. A few chemotherapy medicines are consumed by mouth and others are recommended to be given via a drip into a vein. 

The drug Temozolomide is recommended as a chemotherapy for treating spinal cord tumor. 

Chemotherapy mainly used for patients with secondary (metastatic) spinal tumours. 

Side Effects of Chemotherapy: The possible side effects of chemo may vary depending on the specific drug used. They include:

• nausea 
• vomiting
• tiredness
• hair loss
• reduced resistance to infection

You should discuss these possible side effects with the specialist providing your treatment.

Steroids: These are prescribed in order to reduce the spine swelling. This relieves pressure on the spinal cord and nerves and reduces the risk of damage to the spinal cord. Steroids are recommended to be given with radiotherapy or surgery. You need to keep taking steroids for a while following your radiotherapy or surgery.

Dexamethasone is one of the most widely used steroid for the spinal cord tumor. 

Steroids may be responsible for causing side effects. Signs and symptoms may include:

• increased appetite
• weight gain
• indigestion
• acne
• stretch marks
• muscle weakness
• diabetes
• sleep disturbance
• feeling restless or agitated

Pain-relief Medications: For people with spinal tumours, pain-relief drugs are used mainly to control back or neck pain. They might be combined with other drugs to control nausea and vomiting. If a morphine-based drug is used it might be combined with a drug to reduce the risk of constipation, which can be a side effect.

Apart from all these, there are some other type of treatment options exists, which are as follows:

• Orthotics
• Physiotherapy
• Occupational therapy
• Bladder and bowel management

Read:- All about skin cancer

Detailed discussion on Skin Cancer

Skin cancer: All cells in the body, including skin cells, repair and are replaced all the time in order to ensure the health of the tissue they form.

In the case of an unbalanced process, growth may become uncontrolled and a collection of abnormal cells may develop in a part of the skin.

Risk Factors: Any individual may develop skin cancer, but it is quite common in older people. The risk is also higher in those people who have:

• Freckled or fair skin.
• Fair hair & blue/green eyes. 
• Had short but intense exposure to UV radiation.
• Actively tanned or used solariums
• Worked outdoors
• A weakened immune system
• Lots of moles on the body or moles with an irregular shape and uneven color. 
• Family history of skin cancer. 
• Certain skin conditions such as sunspots. 

Types of Skin Cancer: 

The 4 main skin cancer are BCC (basal cell carcinoma), SCC (squamous cell carcinoma), melanoma and Merkel cell Carcinoma. 

BCC and SCC are also known as non-melanoma skin cancer or keratinocyte cancers. 

Merkel cell carcinoma and angiosarcoma are the rare non-melanoma skin cancer. They are treated in a different way from BCC and SCC.

Solar Keratoses (Sunspots): These are basically not a skin cancer, but are a warning that you are more likely to get skin cancer.

It is associated with red, flattish scaling areas, and appears on the sun-exposed skin.

Signs: flat, scaly spot that feels rough; often the colour of your skin or red. 

1. BCC - Basal Cell Carcinoma:

Basal cell carcinoma is the most common of all skin cancers. It occurs from the bottom layer of the skin surface and grows gradually over several months. It virtually never spreads to other areas of the body. It can exist in several ways ranging from the red scaly patch of the skin, to pearly lump (prominent blood vessels) on the surface. If it is not treated on time, it will continue to grow and may be responsible for causing ulceration of the skin. 

Signs:

• Occurs on the body that have more exposure to the sun, such as the face, head, neck, shoulders,  lower legs, lower arms but may occur anywhere on the body. 
• May seems as a pearl-coloured lump.
• May bleed and turned inflamed; may appear to heal then turned inflamed again. 

2. SCC - Squamous Cell Carcinoma: 

Squamous cell carcinoma is the second most common type of skin cancer. Unlike BCCs, it has the ability in order to spread to other areas of the body. The risk of this occurring depends on its location, size, and its subtype. It exists on sun-damaged skin as a pink/red lump on the skin which may be tender. Often it may have an ulcerated centre. Generally, they grow rapidly than BCCs.

Signs:

• Occurs on areas of the body most often exposed to the sun, such as the neck, head, hands, forearms and lower legs, but may develop anywhere on the body. 
• May bleed and turned inflamed, and is often tender to touch. 
• Often appears as a thickened, red, scaly or rapidly growing lump. 
• Quite common as you get older. 

3. Melanoma: 

It is basically the most serious form of skin cancer, that arises from the pigment-producing cells in the skin called melanocytes. It is one of the most common causes of death due to skin cancer worldwide.

Cure of melanoma is related to how deep it has spread on the skin when diagnosed. The earlier it is found, the greater the chance of cure. Melanoma mainly arises from a new or changing mole on the skin, although rarely may occur on the palms skin, the soles and even the nails.

Knowing about the ABCDE warning signs of the melanoma may help you find an initial stage melanoma.

A: Stands for the ASYMMETRY; one half is unlike the other half. 

B: Stands for the BORDER; irregular, scalloped or poorly defined border.

C: Stands for the COLOR; may vary from one part to another; shades of tan & brown, black; sometimes white, red or blue. 

D: Stands for the DIAMETER; while melanomas are usually higher than the 6mm when diagnosed, they may be smaller.

E: Represents EVOLVING; a mole or skin lesion that seems different.

Signs:

• Occurs as a maiden or existing spot on the body that changes shape, size, or color over a few weeks to months. 
• Often has either a flat or raised surface. 
• Probably more than 1 color (blue, brown, black, red, white, pink light grey, or the color of skin). 

4. Merkel cell carcinoma: 

It is mainly a kind of rare cancer associated with skin. Merkel cell carcinoma traditionally believed to arise from the Merkel cells, specialised cells involved in the sensation of “touch”, situated in the basal layer of the skin epidermis. 

Signs:

The initial sign is a fast-growing, painless tumor on the skin. The tumor may be skin-colored and may appear in shades of blue, red, or purple. The maximum Merkel cell carcinomas occur on the face, neck or head, but they may appear anywhere on the body, even on parts not exposed to the sunlight.

Causes of Skin Cancer: 

The major cause of all sorts of skin cancer is overexposure to the Ultraviolet radiation. Approximately 95% of skin cancers are due to UV exposure. When the unprotected skin is exposed to the UV radiation, the structure, as well as behaviour of the cells, may change. 

Sun produced the UV radiation, but it may also come from artificial sources, such as sun beds. 

UV radiation can't be felt or seen and it is not related to the temperature. It may cause:

• sunburn
• premature skin ageing
• damage to skin cells, which may lead to skin cancer.

Treatment of Skin Cancer: 

Skin cancer is treated in different ways. Treatment basically depends on your general health, size, type, and location of the cancer, , any medications you are consuming (these may affect the amount of bleeding as well as healing time), whether the cancer has reached other organs of your body.

In case the biopsy has removed all the cancer, you may be not recommended for any further treatment.

SURGERY: For skin cancer, surgery is one of the most common treatments. The procedure type you have basically depends on the size as well as position of the cancer. 

Maximum small skin cancers are removed by a dermatologist or GP. A surgeon is required in order to treat more complex cases.

Mohs surgery: Mohs surgery is usually performed under the local anaesthetic by a dermatologist. 

It is prescribed for the treatment of skin cancers that have started to spread deep into the skin or recurred. It may also be prescribed for cancers in areas that are difficult to treat, such as close the eye or on the nose, ears and lips. Mohs surgery is more expensive than other types of surgery. 

CURETTAGE & ELECTRODESSICATION: Curettage and electrodessication (or cautery) is prescribed for the treatment of some BCCs and squamous cell carcinoma in situ (Bowen’s disease). It is performed by a dermatologist. 

The healthcare provider will give you a local anaesthetic and then scoop out the cancer using a small, sharp, spoon-shaped instrument addressed as a curette. 

Low-level heat (cautery or electrodessication) will be applied in order to stop the bleeding and destroy any remaining cancer. The wound would heal within a few weeks, leaving a flat, round, small, white scar.

CRYOTHERAPY: Cryotherapy/Cryosurgery, is a way that uses the liquid nitrogen in order to remove some small BCCs & sunspots. 

The healthcare provider, usually a dermatologist, sprays liquid nitrogen onto the sunspot or skin cancer and a small area of skin around it. You may experience a stinging or burning sensation, which may last a few minutes. The liquid nitrogen basically freezes and kills the abnormal skin cells and creates a wound. In a few cases, the procedure may be required to be repeated. 

The treated area will be sore and red. A blister may be formed within a day. 

TOPICAL TREATMENTS: Some skin spots and cancers should be treated with creams or gels. These are known as topical treatments. They may contain immunotherapy or chemo drugs, and are prescribed by healthcare practitioners. You need to use these treatments only on the particular spots or parts that your healthcare professional has asked you in order to treat. Never use leftover cream for the treatment of new spots that have not been assessed by your healthcare provider.

Imiquimod: It is a sort of immunotherapy that causes the body’s immune system in order to destroy cancerous cells. 

It is prescribed in order to treat superficial BCCs, Bowen’s disease (squamous cell carcinoma in situ) and sunspots. 

You should apply it directly to the affected area every night, usually 5 days a week for 6 weeks.

5-fluorouracil (5-FU): The fluorouracil 5 cream is mainly a type of chemo drug. 

It is prescribed for treating superficial BCCs, sunspots &, sometimes Bowen’s disease. 

The fluorouracil cream acts more effectively on the face and scalp. Your healthcare provider or dermatologist will instruct you how to apply the cream and how often. Many people use this cream twice daily for 2 to 3 weeks. Fluorouracil may need to be used for longer for some skin cancers. While using the cream, you will be more sensitive to the ultraviolet radiation and you should stay out of the sun. 

Ingenol mebutate: It should be applied to the affected sunspots once daily for 2-3 days.

Adverse reactions may include skin flaking or scaling, reddening, crusting or scabbing, blisters, and mild swelling. 

These adverse reactions should disappear within the 2 weeks of treatment finishing.

TARGETED THERAPY: Targeted therapy drugs are prescribed in order to treat melanoma and some non-melanoma skin cancers, such as rare cases of advanced basal cell carcinoma.

Dabrafenib (Tafinlar): Dabrafenib may be used (together with MEK inhibitor trametinib) following surgery in patients with stage III melanoma, where it is effective in order to lower the risk of the cancer coming back.

Trametinib (Mekinist): It is prescribed for the treatment of melanoma that has spread or difficult to be removed completely.

Trametinib may also be recommended together with dabrafenib following surgery in patients with stage III melanoma, where it may act by lowering the risk of the cancer coming back.

Some other drugs can be also recommended, these are as follows:

• Cobimetinib (Cotellic)
• Binimetinib (Mektovi)
• Encorafenib (Braftovi)
• Vismodegib (Erivedge)
• Sonidegib (Odomzo)
• Vemurafenib (Zelboraf)

IMMUNOTHERAPY: Checkpoint inhibitors and cytokines are a couple of types of immunotherapy medications that may be prescribed for treating some cases of Merkel cell carcinoma and melanoma. The medicines are designed in order to trigger the immune system to identify and attack cancer cells.

Some major immunotherapy medications are as follows:

• Pembrolizumab (Keytruda)
• Nivolumab (Opdivo)
• Atezolizumab (Tecentriq)
• Ipilimumab (Yervoy)
• Interleukin-2 (IL-2)

PHOTODYNAMIC THERAPY: PDT uses a cream and a light source in order to make your cancer sensitive to light. It is recommended for the treatment of sunspots, superficial BCCs and squamous cell carcinoma in situ/Bowen’s disease. 

Adverse reactions may include swelling and redness, which usually ease following a few days. PDT is commonly responsible for causing stinging, burning or tender feeling in the treatment area, mainly to the face. 

RADIATION THERAPY: Radiotherapy mainly uses radiation (x-rays or electron beams) in order to damage or kill cancerous cells. It is recommended for BCC or SCC in such areas that are hard to treat with the help of surgery, such as the face. Sometimes this therapy is also recommended following surgery in order to block the cancer from coming back or spreading.

REMOVING LYMPH NODES: In case your cancer has spread, your healthcare provider may remove the lymph nodes in an operation that is known as lymph node dissection. This is effective by reducing the chance of the cancer spreading to other organs or coming back. In order to know more, speak to your doctor.

Prognosis: Prognosis indicates expected outcome of a particular disease. Your treating healthcare professional is an appropriate person in order to interact about your prognosis. Maximum BCCs as well as SCCs can be successfully treated, especially if detected early.

Apart from this, most of the non-melanoma skin cancers do not pose a serious risk to your health. 

How can I prevent skin cancer? 

It is believed that sun exposure is the most preventable risk factor for all skin cancers.

Following several things you must need to do:

• Use a broad-spectrum, water-resistant sunscreen with SPF of 30 or more to the entire area not covered by clothes. The potential of “Broad-spectrum” helps in order to protect ultraviolet A (UVA) as well as ultraviolet B (UVB) rays.
• Always wear a long-sleeved shirt, pants, a wide-brimmed hat, and sunglasses, where possible.
• Seek shade when appropriate.
• Caution is required near water, snow, and sand because they reflect and intensify the damaging rays of the sun, which may increase the chances of sunburn.
• Vitamin D should be taken through a healthy diet that may include vitamin supplements. Avoid seeking the sun.
• Tanning beds should be avoided. UV light from the sun and tanning beds may be responsible for causing skin cancer as well as wrinkling.