Liver disease
of stomach liver and gastrointestinal tract

fighting infections and illness removing toxins (poisons), such as alcohol, from the body controlling cholesterol levels helping blood to clot (thicken) releasing bile, a liquid that breaks down fats and aids digestion

Liver disease doesn’t usually cause any obvious signs or symptoms until it’s fairly advanced and the liver is damaged.

At this stage, possible symptoms can include loss of appetite, weight loss and jaundice.


At this stage, possible symptoms can include loss of appetite, weight loss and jaundice.

Symptoms

At this stage, possible symptoms can include loss of appetite, weight loss and jaundice.

Liver tumours
of cancer, cancer types in children

There are 2 main types of primary liver cancer.

Symptoms

The most common symptom is a lump or swelling in the abdomen, which can be painful. Other possible symptoms include weight loss, a loss of appetite, feeling sick (nausea) and being sick (vomiting).

Causes

The cause of most primary liver tumours in the western world is unknown. However, in other parts of the world, hepatocellular cancer (HCC) is commonly related to the presence of liver infection. This happens in countries where mothers commonly have hepatitis B and vaccination is not readily available at birth for their children.

Children who are infected with hepatitis B have a higher risk of developing HCC in late childhood than uninfected children.

Diagnoses

A variety of tests and investigations may be needed to diagnose a liver tumour.

An ultrasound scan and X-rays will be taken, which can show if there is a tumour in the liver. Further tests, including CT (computerised tomography) scans or MRI (magnetic resonance imaging) scans, will be done to find out the extent of the disease, both inside and outside the liver. Blood tests will also be carried out.

Most hepatoblastomas and hepatocellular carcinomas produce a protein that is released into the bloodstream. This protein is known as alpha-fetoprotein (AFP). It’s possible to measure levels of AFP in the blood, which can be a useful indicator of whether the liver tumour is responding to treatment or whether it may have come back after treatment. AFP is also known as a tumour marker.

Any tests and investigations that your child needs will be explained to you.

Grouping

To assess the extent of the cancer, a grouping system called PRETEXT (pre-treatment extent of disease) is used. It uses an MRI scan to measure the amount of cancer in the liver at diagnosis. It’s also used to help establish the best treatment for each child.

This grouping system is unique to liver tumours and is increasingly used all over the world.

This grouping process is essential because liver tumours need to be removed surgically. Grouping divides the liver into four surgical areas (sectors) and gives an indication of the kind of surgery that is needed to remove the tumour. Grouping also helps doctors decide whether a liver transplant surgeon needs to be involved from the start or not.

PRETEXT 1 – 1 liver sector is affected and the tumour can be removed by straightforward surgery PRETEXT 2 – 2 adjoining sectors are affected and the tumour can be removed with more extensive surgery PRETEXT 3 – 2 or 3 sectors are affected with no 2 adjoining sectors free of disease, and the tumour can be removed with major surgery PRETEXT 4 – all 4 sectors of the liver are affected, and the tumour cannot be removed without replacing the liver with a donor liver transplant

Doctors also look at the extent of the spread of cancer beyond the liver.

In the blood vessels

Sometimes the tumour gets into the blood vessels that are entering or leaving the liver. This may affect the type of surgery needed to remove the tumour.

In the abdomen

Sometimes the tumour spreads outside the liver and into the abdomen (tummy). The tumour cannot be removed completely.

In the lungs or other organs

If the tumour spreads outside the liver through the bloodstream (metastatic disease), it usually goes to the lungs. About 1 in 5 children are found to have affected lungs when they are diagnosed. Doctors use X-rays and CT or MRI scans to assess whether the lungs are affected.

Treatments

The diagnosis is made by taking a sample of cells from the tumour (biopsy). This is done under a general anaesthetic. Once the diagnosis and staging have been confirmed, plans for treatment will be made.

Hepatoblastoma

For hepatoblastoma, the type of treatment will depend on the PRETEXT staging and whether the cancer has spread to other parts of the body (metastatic disease).

PRETEXT 1, 2 and 3 tumours are called ‘standard risk’. PRETEXT 4 is called ‘high risk’ and includes tumours that have spread to other parts of the body.

Treatment is broadly similar for all PRETEXT stages. Chemotherapy (anti-cancer drugs) is given first. The aim of chemotherapy is to shrink the tumour in the liver and hopefully get rid of any metastatic tumours. Surgery to remove any of the remaining tumour will take place after a few weeks of chemotherapy. Further chemotherapy is usually given after surgery. Your child’s doctor will give you more detailed information about the chemotherapy drugs and their side effects.

Hepatocellular carcinoma

For hepatocellular carcinoma, treatment is a little different.

The role of chemotherapy is less certain and surgery is the main treatment. Doctors usually recommend removing the tumour (if it’s small enough) at diagnosis. Chemotherapy may be given afterwards. However in many situations the tumour is too large to remove at first, and so chemotherapy is given to shrink the tumour so that surgery can be done later.

Hepatocellular tumours don’t always respond to chemotherapy as well as hepatoblastomas. For this reason, other treatments, such as chemoembolisation and targeted treatments, may be used.

Chemoembolisation

This refers to the giving of drugs directly into the artery going into the liver. Very occasionally, this may be used for hepatocellular cancer.

Targeted drugs

Targeted drugs are a group of treatments that work in a different way to conventional chemotherapy. Some drugs may cause cancer cells to die directly. Others act to cut off the blood supply to the tumour cells (antiangiogenesis drugs). Some drugs, called multi-targeted agents, work in both ways.

Research is looking into how useful targeted treatments are on their own and in combination with chemotherapy. Your child’s doctor may talk to you more about this research.

Surgery

All children, if they are able to, will have surgery following chemotherapy. If there’s cancer in the lungs, which hasn’t completely disappeared with the chemotherapy, the lungs will be operated on first. If the liver tumour can be surgically removed, the operation to do so will follow, usually a week or two later.

If the tumour involves all 4 sectors of the liver (PRETEXT 4), a liver transplant will be necessary. This is recommended for hepatoblastoma but only in particular circumstances for hepatocellular carcinoma. In a transplant, the whole liver is removed and replaced with a liver from another person.

This will be discussed with you from the beginning, and you will be given the opportunity to think about donating half of your liver, or for your child to have a liver from a donor. The transplant team will be there to answer all of your questions. A liver transplant is only possible if all the cancer outside the liver has gone.

Side effects of treatment

Treatment often causes side effects, and your child’s doctor will discuss these with you before treatment starts. Side effects can include:

feeling sick (nausea) and being sick (vomiting) hair loss an increased risk of infection bruising and bleeding tiredness diarrhoea

Late side effects

The chemotherapy used to treat liver cancer can cause late side effects. These may include hearing problems, kidney problems and possibly heart problems. There will be a slightly increased risk of your child developing another type of cancer later in life. Most children will develop some late effects and need to have some follow-up tests. Your child’s doctor or nurse will tell you more about any possible late side effects.

Recurrence

If the cancer comes back after initial treatment, this is known as a recurrence. It can come back in the liver or in other parts of the body. If the cancer comes back, often (before anything is seen on scans) the levels of alpha-fetoprotein (AFP) in the child’s blood will start to rise again and reaches levels of over 100. Small rises in AFP can occur in the weeks after surgery, as the liver regenerates as much as it can.

Clinical trials

Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for children’s cancer. If appropriate, your child’s medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is often provided to help explain things.

Taking part in a research trial is completely voluntary, and you’ll be given plenty of time to decide if it’s right for your child.

Treatment guidelines

Sometimes, clinical trials are not available for your child’s tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Children’s Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines.

Follow-up care

When the treatment ends, your child will have regular blood tests to measure the level of AFP in the blood (if appropriate), as well as scans and chest X-rays. More than three quarters of children with hepatoblastoma are cured, and for children with small tumours that are confined to the liver, the outlook is even better. The outcome for hepatocellular carcinoma is not quite as good. The staff at the hospital can give you information about the likely outcome for your child.

Loss of libido
of sexual and reproductive

It’s often linked to professional and personal stress, or important life-changing events such as pregnancy, childbirth or breastfeeding.

However, an unexpected loss of libido – especially when it lasts for a long time or keeps returning – can also indicate an underlying personal, medical or lifestyle problem, which can be upsetting to both partners in a relationship.

If you’re concerned about your libido, especially if your diminished sex drive distresses you or affects your relationship, make an appointment to see your GP to discuss any underlying causes and possible medical or psychological treatments.

Doctors at your nearest family planning clinic, Integrated Sexual Health clinic, or Contraceptive and Sexual Health (CASH) clinic may also be able to help.

In the meantime, you may find the following information useful. It explains some of the most common reasons for loss of libido.


However, an unexpected loss of libido – especially when it lasts for a long time or keeps returning – can also indicate an underlying personal, medical or lifestyle problem, which can be upsetting to both partners in a relationship.

If you’re concerned about your libido, especially if your diminished sex drive distresses you or affects your relationship, make an appointment to see your GP to discuss any underlying causes and possible medical or psychological treatments.

Doctors at your nearest family planning clinic, Integrated Sexual Health clinic, or Contraceptive and Sexual Health (CASH) clinic may also be able to help.

In the meantime, you may find the following information useful. It explains some of the most common reasons for loss of libido.


If you’re concerned about your libido, especially if your diminished sex drive distresses you or affects your relationship, make an appointment to see your GP to discuss any underlying causes and possible medical or psychological treatments.

Doctors at your nearest family planning clinic, Integrated Sexual Health clinic, or Contraceptive and Sexual Health (CASH) clinic may also be able to help.

In the meantime, you may find the following information useful. It explains some of the most common reasons for loss of libido.

Lung cancer
of cancer, cancer types in adults

Lung cancer is one of the most common and serious types of cancer. 

There are usually no signs or symptoms in the early stages of lung cancer, but many people with the condition eventually develop symptoms including:

a persistent cough coughing up blood persistent breathlessness unexplained tiredness and weight loss an ache or pain when breathing or coughing

You should speak to your GP if you have these symptoms.

Read more about the symptoms of lung cancer

Symptoms

Symptoms of lung cancer develop as the condition progresses and there are usually no signs or symptoms in the early stages.

The main symptoms of lung cancer are:

a cough that doesn’t go away after 2 or 3 weeks a long-standing cough that gets worse persistent chest infections coughing up blood an ache or pain when breathing or coughing persistent breathlessness persistent tiredness or lack of energy loss of appetite or unexplained weight loss

Less common symptoms of lung cancer include:

changes in the appearance of your fingers, such as becoming more curved or their ends becoming larger (this is known as finger clubbing) a high temperature (fever) of 38C (100.4F) or above  difficulty swallowing or pain when swallowing wheezing a hoarse voice  swelling of your face or neck persistent chest or shoulder pain

If you have any of these, you should speak to your GP.

Read further information:

Cancer Research UK: Symptoms of lung cancer Macmillan Cancer Support: Signs and Symptoms of lung cancer 

Causes

Most cases of lung cancer are caused by smoking, although people who have never smoked can also develop the condition.

Diagnoses

Speak to your GP if you have symptoms of lung cancer, such as breathlessness or a persistent cough.

Your GP will ask about your general health and what symptoms you’ve been experiencing. They may examine you and ask you to breathe into a device called a spirometer, which measures how much air you breathe in and out.

You may be asked to have a blood test to rule out some of the possible causes of your symptoms, such as a chest infection.

In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of lung cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected lung cancer.

Treatments

Treatment depends on the type of cancer, how far it’s spread and how good your general health is.

If the condition is diagnosed early and the cancerous cells are confined to a small area, surgery to remove the affected area of lung is usually recommended.

If surgery is unsuitable due to your general health, radiotherapy to destroy the cancerous cells may be recommended instead.

If the cancer has spread too far for surgery or radiotherapy to be effective, chemotherapy is usually used.

Read more about treating lung cancer


Treatment for lung cancer is carried out by a team of specialists who will work together to provide the best possible treatment.

This team contains all the specialists required to make a proper diagnosis, to stage your cancer and to plan the best treatment. If you want to know more, ask your specialist about this.

The type of treatment you’ll receive for lung cancer depends on several factors, including:

the type of lung cancer you have (non-small-cell or small-cell cancer) the size and position of the cancer how far advanced your cancer is (the stage) your overall health

Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours.

The main treatment options include surgery, radiotherapy and chemotherapy. Depending on your type of cancer and how advanced it is, you may receive a combination of these treatments.


Your treatment plan depends on whether you have non-small-cell lung cancer or small-cell lung cancer.

Non-small-cell lung cancer

If you have non-small-cell lung cancer that’s confined to one lung and you’re in good general health, you’ll probably have surgery to remove the cancerous cells. This may be followed by a course of chemotherapy to destroy any cancer cells that may have remained in the body.

If the cancer hasn’t spread too far but surgery isn’t possible (for example, if your general health means you have an increased risk of developing complications), radiotherapy to destroy the cancerous cells will usually be recommended. In some cases, this may be combined with chemotherapy (known as chemoradiotherapy).

If the cancer has spread too far for surgery or radiotherapy to be effective, chemotherapy is usually recommended. If the cancer starts to grow again after initial chemotherapy treatment, another course of treatment may be recommended.

In some cases, a treatment called biological or targeted therapy may be recommended as an alternative to chemotherapy, or after chemotherapy. Biological therapies are medications that can control or stop the growth of cancer cells. 

Small-cell lung cancer

Small-cell lung cancer is usually treated with chemotherapy, either on its own or in combination with radiotherapy. This can help to prolong life and relieve symptoms.

Surgery isn’t usually used to treat this type of lung cancer. This is because the cancer has often already spread to other areas of the body by the time it’s diagnosed. However, if the cancer is found very early, surgery may be used. In these cases, chemotherapy or radiotherapy may be given after surgery to help reduce the risk of the cancer returning.


As well as surgery, radiotherapy and chemotherapy, there are a number of other treatments that are sometimes used to treat lung cancer. 

Biological therapies

Biological therapies are newer medications. They’re sometimes recommended as an alternative treatment to chemotherapy for non-small-cell cancer that has spread too far for surgery or radiotherapy to be effective.

Examples of biological therapies include erlotinib and gefitinib. These are also called growth factor inhibitors because they work by disrupting the growth of the cancer cells.

Biological therapies are only suitable for people who have certain proteins in their cancerous cells. Your doctor may be able to request tests on a small sample of cells removed from your lung (biopsy) to determine whether these treatments are likely to be suitable for you.

Radiofrequency ablation

Radiofrequency ablation is a new type of treatment that can treat non-small-cell lung cancer diagnosed at an early stage.

The doctor carrying out the treatment uses a computerised tomography (CT) scanner to guide a needle to the site of the tumour. The needle will be pressed into the tumour and radio waves will be sent through the needle. These waves generate heat, which kills the cancer cells.

The most common complication of radiofrequency ablation is that a pocket of air gets trapped between the inner and outer layer of your lungs (pneumothorax). This can be treated by placing a tube into the lungs to drain away the trapped air.

Cryotherapy

Cryotherapy is a treatment that can be used if the cancer starts to block your airways. This is known as endobronchial obstruction, and it can cause symptoms such as:

breathing problems a cough coughing up blood

Cryotherapy is performed in a similar way to internal radiotherapy, except that instead of using a radioactive source, a device known as a cryoprobe is placed against the tumour. The cryoprobe can generate very cold temperatures, which help to shrink the tumour.

Photodynamic therapy

Photodynamic therapy (PDT) is a treatment that can be used to treat early-stage lung cancer when a person is unable or unwilling to have surgery. It can also be used to remove a tumour that’s blocking the airways.

Photodynamic therapy is carried out in 2 stages. Firstly, you’ll be given an injection of a medication that makes the cells in your body very sensitive to light.

The next stage is carried out 24 to 72 hours later. A thin tube will be guided to the site of the tumour, and a laser will be beamed through it. The cancerous cells, which are now more sensitive to light, will be destroyed by the laser beam.

Side effects of photodynamic therapy can include inflammation of the airways and a build-up of fluid in the lungs. Both these side effects can cause symptoms of breathlessness and lung and throat pain. However, these symptoms should gradually pass as your lungs recover from the effects of the treatment.

Preventions

If you smoke, the best way to prevent lung cancer and other serious conditions is to stop smoking as soon as possible.

However long you have been smoking, it’s always worth quitting. Every year you don’t smoke decreases your risk of getting serious illnesses, such as lung cancer. After 10 years of not smoking, your chances of developing lung cancer falls to half that of someone who smokes. Quit Your Way Scotland can offer advice and encouragement to help you quit smoking. 

Your GP or pharmacist can also give you help and advice about giving up smoking.

Lupus
of immune system

Lupus is a complex and poorly understood condition that affects many parts of the body and causes symptoms ranging from mild to life-threatening.

Symptoms

SLE can cause a wide range of symptoms, depending on the areas of the body that are affected. The most common symptoms are:

fatigue (extreme tiredness) rashes – particularly on the face, wrists and hands joint pain and swelling

As the symptoms of SLE can be similar to a number of other conditions, many of which are more common, it can be difficult to diagnose.

If you have persistent or troublesome symptoms that you think could be caused by SLE, you should see your GP so they can try to determine the cause.

Read more about the symptoms of lupus and diagnosing lupus. 


Symptoms of systemic lupus erythematosus (SLE) can vary widely from person to person. Some people may only experience a few mild symptoms, whereas others may be more severely affected.

Even if you usually have mild symptoms, SLE can “flare-up”, with symptoms becoming more severe or new symptoms developing.


The 3 main symptoms of SLE are fatigue, joint pain and rashes.

Fatigue

Fatigue is one of the most common symptoms of SLE. You may feel very tired even though you get plenty of sleep. Carrying out everyday tasks, such as housework or office work, can leave you feeling exhausted.

Many people with SLE find that fatigue is the most distressing and disruptive aspect of SLE because it has a negative impact on their work and social life.

Joint pain

If you have SLE, you are likely to experience joint pain in your hands and feet. You may find the pain changes from one set of joints to another quite quickly, and is usually worse in the morning.

Unlike some other conditions that affect the joints, SLE is unlikely to cause your joints to become permanently damaged or deformed.

Rashes

Many people with SLE develop rashes on their skin – most commonly on the face, wrists and hands. A rash over the cheeks and the bridge of the nose is particularly common and is known as a “butterfly rash” or “malar rash”.

Rashes caused by SLE may get better after a few days or weeks, but can last longer or even be permanent.

Rashes caused by SLE can sometimes be itchy or painful, and they may get worse if they are exposed to sunlight. This is known as “photosensitivity”.


SLE can also cause a wide range of symptoms. However, you’re unlikely to have all of the symptoms listed below, and many people with the condition will only experience the main symptoms.

Other features of SLE may include:

a fever (high temperature) swollen lymph glands (small glands found throughout your body, including in your neck, armpits and groin) recurring mouth ulcers hair loss (alopecia) high blood pressure (hypertension) headaches and migraines stomach (abdominal) pain chest pain depression  dry eyes memory loss seizures (fits) problems thinking clearly and difficulty telling the difference between reality and imagination (psychosis) shortness of breath Raynaud’s phenomenon a condition that limits the blood supply to your hands and feet when it is cold ankle swelling and fluid retention (oedema)

Causes

SLE is an autoimmune condition, which means it is caused by problems with the immune system. For reasons not yet understood, the immune system in people with SLE starts to attack and inflame healthy cells, tissue and organs.

As with other more common autoimmune conditions, such as rheumatoid arthritis, it is thought a combination of genetic and environmental factors may be responsible for triggering SLE in certain people.

Read more about the causes of lupus.


Systemic lupus erythematosus (SLE) is an autoimmune condition, which means it is caused by problems with the immune system.

The immune system is the body’s natural defence against illness and infection. When the immune system detects the presence of an infectious agent, such as bacteria or a virus, it sends white blood cells and antibodies to attack it.

In cases of SLE, antibodies released by the immune system can attack healthy tissue, cells and organs.

It’s not clear exactly why this happens, although most experts think SLE has more than one cause. It has been suggested that there may be a number of genetic factors that make people more susceptible to the condition, and that it also takes one or more environmental factors to trigger SLE in those who are susceptible.

Possible genetic and environmental factors are discussed in more detail below.

Diagnoses

Systemic lupus erythematosus (SLE) can be difficult to diagnose, as it has similar symptoms to several other, far more common, conditions.

Diagnosis may also be difficult because symptoms can vary greatly from person to person, and they may change over time. For example, there may be periods where your symptoms are not very noticeable, or times when they flare up and become more severe.

For a confident diagnosis of SLE to be made, you will need to have several symptoms of lupus and a number of blood tests may need to be carried out.


Some of the blood tests that may be carried out are described below.

Erythrocyte sedimentation rate (ESR) test

A blood test called the erythrocyte sedimentation rate (ESR) test can be used to determine whether there is any inflammation in your body.

This can be useful in diagnosing SLE because the condition can cause many areas of the body to become inflamed (swell), including the joints and internal organs.

The test works by measuring how long it takes for red blood cells to fall to the bottom of a test tube. The quicker they fall, the more likely it is that there are high levels of inflammation.

Anti-nuclear antibody test

An anti-nuclear antibody test checks whether there is a certain type of antibody cell in your blood, known as the anti-nuclear antibody. Approximately 95% of people with SLE have this antibody.

However, it is possible to have the anti-nuclear antibody without having SLE, so the anti-nuclear antibody test is not a definitive way of testing for the condition. Other blood tests will also be needed to confirm the diagnosis.

Anti-DNA antibody test

An anti-DNA test also checks for a certain type of antibody in your blood, known as the anti-DNA antibody. If you have the anti-DNA antibody, it is highly likely that you have SLE. However, the antibody is only found in around 70% of people with the condition.

The level of anti-DNA antibodies increases when SLE is more active, so during a flare-up of symptoms your reading from this test may be greater than normal.

Complement level test

Complement is a chemical in the blood that forms part of your immune system. The level of this chemical may be tested to check how active your SLE is. The level of complement in your blood decreases when SLE is more active.


Once you have been diagnosed with SLE, you will normally need regular monitoring to see how the condition is affecting your body.

If you have SLE it is possible you may develop other conditions, such as kidney problems. Monitoring your condition will allow your doctor to check for these complications and, if necessary, treat them as soon as possible.

You may need to have scans, such as an X-ray, ultrasound scan, magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan to check whether SLE is affecting your internal organs.

Read more about the complications of lupus.

Treatments

There is currently no cure for SLE, but there are different medications that can help relieve many of the symptoms and reduce the chances of organ damage.

These medications include:

hydroxychloroquine – a medicine that has historically been used to treat malaria, but can also help treat some symptoms of SLE corticosteroids – anti-inflammatory medications immunosuppressants – a group of medicines that suppress your immune system

With good levels of support from friends, family and healthcare professionals, many people with SLE are able to manage their condition effectively.

Read more about treating lupus.


You should see your GP if you have persistent or troublesome symptoms that you think could be caused by SLE.

While it is likely that your symptoms are being caused by a more common condition, it is important to see a doctor for a diagnosis.

Read more about diagnosing lupus.


There is currently no cure for systemic lupus erythematosus (SLE), but treatments that can ease the symptoms and make it easier to live with are available.

In most cases, treatment will involve a combination of self-care measures and medication.

Complications

If your symptoms of systemic lupus erythematosus (SLE) are mild or well-controlled, you may find it barely affects your day-to-day life and that you do not have any complications.

However, for some people, SLE can be a more serious condition that can cause life-threatening complications. Some of these complications are outlined below.


SLE does not usually affect fertility, but it can increase your risk of experiencing pregnancy complications, such as:

pre-eclampsia (a condition that causes high blood pressure during pregnancy) premature delivery miscarriage stillbirth

Some children of women with SLE can also be born with heart block (where electrical pulses that control the beating of the heart are disrupted) and rashes. This is known as “neonatal lupus syndrome”.

If you have SLE and are thinking of having a baby, it is best to plan this carefully with your doctors if possible. The risk of complications is higher if you become pregnant during periods where your symptoms are particularly severe, so you will usually be advised to try to avoid getting pregnant until your symptoms are better controlled.

If you do become pregnant, you will need to be monitored closely by your specialist and by an obstetrician, so they can check for any problems.

Lyme disease
of infections and poisoning

Symptoms

Some people with Lyme disease also have flu-like symptoms in the early stages, like:

tiredness (fatigue) muscle pain joint pain headaches a high temperature (fever) chills neck stiffness

Treatments

Speak to a GP if: You’ve been bitten by a tick and you: develop a rash have flu-like symptoms Remember to tell them you’ve been bitten by a tick.

Lymphoedema
of blood and lymph

Lymphoedema is a chronic (long-term) condition that causes swelling in the body’s tissues. It can affect any part of the body, but usually develops in the arms or legs.

Other symptoms of lymphoedema can include an aching, heavy feeling in affected body parts and difficulty moving them.

Lymphoedema can get worse if it’s not treated, so you should speak to a doctor if you think you may have the condition.

Read more about the symptoms of lymphoedema and diagnosing lymphoedema

Symptoms

The main symptom of lymphoedema is swelling in all or part of a limb or another part of the body, which can cause problems fitting into clothes, or jewellery and watches starting to feel tight.

At first, the swelling may come and go. It may get worse during the day and then go down overnight. Without treatment, it will usually become more severe and persistent.

Other symptoms in an affected body part can include:

an aching, heavy feeling difficulty with movement repeated skin infections the skin becoming hard and tight folds developing in the skin wart-like growths developing on the skin a leakage of fluid through the skin

When these symptoms start depends on what is causing the condition.

If lymphoedema is caused by abnormal development of the lymphatic system (a network of channels and glands distributed throughout the body that remove unwanted bacteria and particles from the body), the symptoms can develop at any age, but most commonly start during infancy, adolescence or early adulthood.

In these cases, the swelling may start on one side of the body to begin with, although the other side will usually become swollen as well over time – particularly the lower leg.

If lymphoedema is caused by damage to the lymphatic system, the symptoms can develop at any time. For example, if your lymphatic system is damaged due to treatment for breast cancer, lymphoedema may not develop for several months or even years.

Read more about the causes of lymphoedema

Causes

Lymphoedema is caused by a problem with the lymphatic system. This is a network of vessels and glands distributed throughout the body. Its major functions are helping to fight infection and drain excess fluid from tissues.

Abnormal development of the lymphatic system, damage to it, and/or an increase in fluid in the body tissues can all lead to lymphoedema.

There are two main types of lymphoedema:

primary lymphoedema – caused by faulty genes affecting the development of the lymphatic system; it can develop at any age, but usually occurs in early adulthood secondary lymphoedema – caused by damage to the lymphatic system or problems with the movement and drainage of fluid in the lymphatic system, often due to an infection, injury, cancer treatment, inflammation of the limb or a lack of limb movement 

Read more about the causes of lymphoedema


There are two types of lymphoedema, called primary and secondary lymphoedema, which have different causes.

The main causes of primary and secondary lymphoedema are outlined below.

Diagnoses

If you’re being treated for cancer and are at risk of developing lymphoedema, you’ll be monitored for the condition afterwards. Otherwise, see your GP if you experience symptoms of swelling.

There are a number of specialist lymphoedema treatment centres in the UK. Your doctor may refer you to one of these for further assessment. A list of treatment centres near you is available from the Lymphoedema Support Network.

In many cases, it’s possible to make a diagnosis of lymphoedema by:

asking about your symptoms and medical history examining the affected body part and measuring the distance around it to see if it’s enlarged 


Although not necessary in most cases, further tests may occasionally be used to assess and monitor your condition. These tests are explained below.

Measuring limb volume

In some cases, tests to calculate the volume of an affected limb may be carried out. These may include:

a tape measure to measure the circumference of the limb at certain intervals, to calculate its volume water displacement – where you place the affected limb in a tank of water and the amount of water that is displaced is measured to calculate the volume of the limb perometry – infrared light is used to measure the outline of an affected limb and calculate its volume

Bioimpedance testing

During a bioimpedance test, electrodes (small metallic discs) are placed on different parts of your body. The electrodes release a small and painless electric charge that is measured using a handheld device. Changes in the strength of the current can indicate the presence of fluid in your tissue.

Imaging tests

Imaging tests may also be used to help diagnose and monitor lymphoedema. These include:

a lymphoscintigraph – you are injected with a radioactive dye that can be tracked using a special scanner; this shows how the dye moves through your lymphatic system and can check for any blockages a magnetic resonance imaging (MRI) scan – which uses a strong magnetic field and radio waves to produce detailed images of the inside of your body  an ultrasound scan – which uses high-frequency sound waves to create an image of the inside of your body a computerised tomography (CT) scan – which uses X-rays and a computer to create detailed images of the lymph nodes

These scans can be used to create a clearer picture of the affected tissue.

Treatments

There is no cure for lymphoedema, but it is usually possible to control the main symptoms using techniques to minimise fluid build-up and stimulate the flow of fluid through the lymphatic system.

These include wearing compression garments, taking good care of your skin, moving and exercising regularly, having a healthy diet and lifestyle, and using specialised massage techniques.

Read more about treating lymphoedema and preventing lymphoedema


If you are at risk of developing lymphoedema because you have had treatment for cancer, you may be offered an assessment for the condition as part of your treatment aftercare plan. Speak to your consultant or specialist nurse if you have any concerns.

If you think you may have lymphoedema, but not as a result of treatment for cancer, see your GP.

Read more about diagnosing lymphoedema


The recommended treatment for lymphoedema is decongestive lymphatic therapy (DLT).

DLT is not a cure for lymphoedema, but it can help control the symptoms. Although it takes time and effort, the treatment can be used to effectively control your lymphoedema.

Preventions

It’s not possible to completely prevent lymphoedema, but the following steps may help reduce your chances of developing the condition.

If you already have lymphoedema, this advice may stop it getting worse.

Complications

The build-up of fluid in the tissues of people with lymphoedema means they are more vulnerable to infection.

In particular, a bacterial infection of the skin called cellulitis is commonly reported in people with the condition.

Read more about the complications of lymphoedema


Cellulitis is the most common complication of lymphoedema, but psychological issues can also occur as a result of the condition.

These complications are explained below.

Lymphogranuloma venereum (LGV)
of sexual and reproductive

LGV is relatively rare in Scotland and is mostly acquired by men who have sex with men. LGV in women is very rare.

If your chlamydia test is positive, and your symptoms suggest that you may have LGV, the lab will do a further test for LGV.


If your chlamydia test is positive, and your symptoms suggest that you may have LGV, the lab will do a further test for LGV.

Symptoms

Some people with LGV may have no symptoms but can still pass on the infection to their partner(s).

Symptoms can include swollen lymph glands in the groin on one or both sides or an ulcer or sore on the penis, vagina or around the anus.

You may notice some anal symptoms such as:

blood or pus from the anus on underwear or after using toilet paper pain in the anal area when pooing or having receptive anal sex constipation, painful straining or loose poos when trying to open the bowels a feeling of incomplete emptying after opening the bowels

Diagnoses

If you think you may have LGV you should make an appointment with your GP or local sexual health services.

When testing for LGV, a swab is taken from the back passage (rectum), vagina, throat or an ulcer (if you have one). A pee (urine) sample can also be used.

If this sample tests positive for chlamydia and your doctor or nurse thinks you might have LGV infection, the sample undergoes further testing for LGV. This can take up to 3 weeks.

Treatments

LGV is usually treated with an antibiotic called doxycycline which is taken twice a day for 3 weeks. Sometimes different antibiotics are used.

As the result of the LGV test can take 3 weeks to come back, your doctor may advise you to start treatment before the final result is available.

If left untreated, LGV can cause scarring and swelling of the skin. It can also cause permanent swelling of the genitals. Rectal infection can also cause swelling and scarring resulting in the risk of long term bowel complications. Rarely the infection may spread via the bloodstream causing inflammation of the joints or liver.

If your infection is untreated you may pass it onto other sexual partners.

Malaria
of infections and poisoning

Malaria is a serious tropical disease spread by mosquitoes. If it isn’t diagnosed and treated quickly, it can be fatal.

A single mosquito bite is all it takes for someone to become infected.

Symptoms

It’s important to be aware of the symptoms of malaria if you’re travelling to areas where there’s a high risk of the disease. This means that you can get medical attention quickly.

Symptoms are similar to those of flu and usually appear 6 to 30 days after the mosquito bite, but it can sometimes take up to a year for symptoms to start.

The initial symptoms of malaria include:

a high temperature (fever) headache sweats chills muscle aches or pains vomiting and or diarrhoea

These symptoms can start mild and may be difficult to identify as malaria.

Causes

Malaria is caused by the Plasmodium parasite. The parasite is spread to humans through the bites of infected mosquitoes.

There are 5 different types of Plasmodium parasite that cause malaria in humans. They are found in different parts of the world (but do overlap in certain areas) and vary in terms of how severe the infection can be.

All malaria infections cause the same symptoms and require immediate medical attention. It’s not possible to find out which type of malaria you have from symptoms alone.

Types of malaria parasite Plasmodium falciparum – mainly found in Africa, it’s the most common type of malaria parasite and is responsible for most malaria deaths worldwide, though treatment does cure the infection. Plasmodium vivax – mainly found in Asia and South America, this parasite causes milder symptoms but it can stay in the liver for years which can result in symptoms reoccurring if it isn’t treated properly. Plasmodium ovale – fairly uncommon and usually found in West Africa. Plasmodium malariae – this is quite rare and usually only found in Africa. Plasmodium knowlesi – this is very rare and found in parts of southeast Asia.

Treatments

Malaria is a serious illness that can get worse very quickly. It can be fatal if not treated quickly.

The effects of malaria are usually more severe in:

babies young children pregnant women older people

Phone 111 or go to A&E if: you or your child develop symptoms of malaria during or after a visit to an area where the disease is found, even if it has been several weeks, months or a year after you return from travelling You must tell the healthcare professional that you have been in a country with a risk of malaria, including any brief stopovers.


If you travel to an area that has malaria, you are at risk of the infection. It’s very important that you take precautions to prevent the disease and get treatment immediately if symptoms do develop.


If malaria is diagnosed and treated quickly, you should fully recover. Treatment should be started as soon as possible.

Treatment begins in a hospital to make sure complications don’t suddenly develop. Treatment is with tablets or capsules. If someone is very ill, treatment will be given through a drip into a vein in the arm (intravenously).

Treatment for malaria can leave you feeling very tired and weak for several weeks.

The type of medicine and how long you need to take it will depend on:

the type of malaria you have the severity of your symptoms whether you took preventative antimalarial tablets your age whether you’re pregnant

Preventions

If you travel to an area that has malaria, you are at risk of the infection. It’s very important that you take precautions to prevent the disease and get treatment immediately if symptoms do develop.


Malaria can often be avoided using the ABCD approach to prevention, which stands for:

Awareness of risk – find out whether you’re at risk of getting malaria Bite prevention – use insect repellent, cover your skin with clothing, and use a mosquito net to avoid mosquito bites Check whether you need to take antimalarial prevention tablets by visiting a travel health clinic – if you do, make sure you take the right antimalarial tablets at the right dose and finish the course Diagnosis – seek immediate medical advice if you have malaria symptoms, including up to a year after you return from travelling


Avoiding mosquito bites is one of the best ways to prevent malaria. This is particularly important during early evening and at night when mosquitoes bite.

There are several steps you can take to avoid being bitten.

Do mosquitoes can’t bite through clothing so wear light, loose-fitting clothing that will cover your arms and legsapply insect repellent to all areas of your skin that are not covered by clothing, including your face and neckremember to reapply insect repellent frequentlysleep under a mosquito net that’s been treated with an insecticide, or in a room with effective air conditioning

The most effective repellents contain 50% diethyltoluamide (DEET). These are available in:

sprays roll-ons sticks creams

There’s no evidence to suggest that other remedies protect against malaria, such as homeopathic remedies, electronic buzzers, vitamins B1 or B12, garlic, yeast extract spread (Marmite), tea tree oils or bath oils.

Further information on mosquito bite prevention is available from the fitfortravel website.

Complications

Malaria is a serious illness that can be fatal if not diagnosed and treated quickly. Severe complications of malaria can occur within hours or days of the first symptoms. This means it is important to seek urgent medical help as soon as possible.

Anaemia

The destruction of red blood cells by the malaria parasite can cause severe anaemia.

Anaemia is a condition where the red blood cells are unable to carry enough oxygen to the body’s muscles and organs. This can leave you feeling drowsy, weak and faint.

Cerebral malaria

In rare cases, malaria can affect the brain. This is known as cerebral malaria which can cause your brain to swell, sometimes leading to permanent brain damage. It can also cause fits (seizures) or coma.


Other complications that can arise as a result of severe malaria include:

liver failure and jaundice – yellowing of the skin and whites of the eyes shock – a sudden drop in blood pressure pulmonary oedema – a build-up of fluid in the lungs acute respiratory distress syndrome (ARDS) abnormally low blood sugar – hypoglycaemia kidney failure swelling and rupturing of the spleen dehydration

Malignant brain tumour (cancerous)
of cancer, cancer types in adults

A malignant brain tumour is a fast-growing cancer that spreads to other areas of the brain and spine.

Generally, brain tumours are graded from 1 to 4, according to their behaviour, such as how fast they grow and how likely they are to grow back after treatment. A malignant brain tumour is either grade 3 or 4, whereas grade 1 or 2 tumours are usually classed as benign or non-cancerous. 

Most malignant tumours are secondary cancers, which means they started in another part of the body and spread to the brain. Primary brain tumours are those that started in the brain.

These pages focus on high-grade brain tumours. For information about grade 1 or 2 tumours, read our pages on low-grade (benign) brain tumours.

Symptoms

The symptoms of a malignant brain tumour depend on how big it is and where it is in the brain.

Common symptoms include:

severe, persistent headaches seizures (fits) persistent nausea, vomiting and drowsiness mental or behavioural changes, such as memory problems or changes in personality progressive weakness or paralysis on one side of the body, vision problems, or speech problems

Speak to your GP if you have persistent symptoms of a brain tumour. While it’s unlikely to be a tumour, it’s best to be sure by getting a proper diagnosis.

Read more about the symptoms of malignant brain tumours and diagnosing malignant brain tumours.


The symptoms of a malignant brain tumour depend on how big it is and where it is in the brain.

When symptoms do occur, it is because the brain tumour is either putting pressure on the brain or preventing an area of the brain from functioning properly.


Different areas of the brain control different functions, so the symptoms caused by a brain tumour will depend on where the tumour is located. For example, a tumour affecting:

the frontal lobe may cause changes in personality, weakness in one side of the body and loss of smell the temporal lobe may cause forgetfulness, language problems (aphasia) and seizures the parietal lobe may cause aphasia and numbness or weakness in one side of the body the occipital lobe may cause loss of vision on one side the cerebellum may cause a loss of co-ordination, flickering of the eyes, vomiting and a stiff neck the brain stem may cause unsteadiness and difficulty walking, facial weakness, double vision, and difficulty speaking (dysarthria) and swallowing (dysphagia)


You may also be given medication to relieve some of the symptoms you may have as a result of your brain tumour.

These may include:

anticonvulsants to prevent seizures (fits) corticosteroids to reduce swelling and pressure in the brain painkillers to treat headaches anti-emetics to prevent vomiting

Depending on your circumstances, these medications may be given before, after, or instead of surgery.

Causes

Different areas of the brain control different functions, so the symptoms caused by a brain tumour will depend on where the tumour is located. For example, a tumour affecting:

the frontal lobe may cause changes in personality, weakness in one side of the body and loss of smell the temporal lobe may cause forgetfulness, language problems (aphasia) and seizures the parietal lobe may cause aphasia and numbness or weakness in one side of the body the occipital lobe may cause loss of vision on one side the cerebellum may cause a loss of co-ordination, flickering of the eyes, vomiting and a stiff neck the brain stem may cause unsteadiness and difficulty walking, facial weakness, double vision, and difficulty speaking (dysarthria) and swallowing (dysphagia)


Most malignant brain tumours are caused by a cancer that started somewhere else in the body and spread to the brain, through the bloodstream. These are known as secondary tumours.

Cancers that can spread to the brain include lung cancer, breast cancer, bowel cancer and melanoma skin cancer.

Some primary malignant brain cancers (cancerous tumours that start in the brain) are caused by a previously benign brain tumour becoming cancerous, but usually the exact reason why a primary tumour develops is unknown.


There have been reports in the media about a possible connection between brain tumours and the radiofrequency (RF) energy emitted by mobile phones. RF energy produces heat, which can increase body temperature and damage tissue exposed to it.

However, it’s thought that the amount of RF energy people are exposed to from mobile phones is too low to produce significant tissue heating or an increase in body temperature.

Research is underway to establish whether RF energy has any long-term health effects, but the balance of evidence currently available suggests that it’s unlikely mobile phones cause health problems.

Diagnoses

Speak to your GP if you develop any of the symptoms of a malignant brain tumour, such as a persistent and severe headache.

Your GP will examine you and ask about your symptoms. They may also carry out a simple neurological examination.

If they suspect you may have a tumour, or they are not sure what’s causing your symptoms, you’ll probably be referred to a neurologist (brain and nerve specialist).


Other tests you may have to help diagnose a brain tumour include:

a computerised tomography (CT) scan – this produces a detailed picture of your brain using a series of X-rays a magnetic resonance imaging (MRI) scan – this produces a detailed picture of your brain using a strong magnetic field and radio waves   an electroencephalogram (EEG) – where electrodes attached to your scalp record your brain activity to look for any abnormalities

If a tumour is suspected, a biopsy (surgical removal of a small piece of tissue) may be taken to establish the type of tumour and the most effective treatment.

Under anaesthetic, a small hole (known as a burr hole) is made in the skull and a very fine needle is used to obtain a sample of tumour tissue. You’ll probably need to stay in hospital for a few days afterwards.

Treatments

A primary malignant brain tumour needs to be treated as soon as possible, because it can spread and damage other parts of the brain and spinal cord.

Surgery will usually need to be carried out to remove as much of the tumour as possible. This may be followed by radiotherapy and/or chemotherapy to kill any cancerous cells left behind and reduce the chances of the tumour regrowing.

However, malignant tumours will often eventually return after treatment. If this happens, or if you have a secondary tumour, a cure isn’t usually possible and treatment can instead be used to improve symptoms and prolong life.

Read more about treating malignant brain tumours.


It’s important to speak to a doctor if you develop persistent and worrying symptoms that may be caused by a brain tumour. While it’s unlikely that you have a tumour, it’s best to be sure by getting a proper diagnosis.

If your GP is unable to identify a more likely cause of your symptoms, they may refer you to a neurologist for further assessment and tests, such as a brain scan.

Read more about diagnosing malignant brain tumours.


If you have a malignant brain tumour, you’ll usually need surgery to remove as much of it as possible. Radiotherapy and/or chemotherapy may then be used to treat any remaining cancerous tissue.

The aim of this is to remove or destroy as much of the tumour as possible, ideally getting rid of the cancerous cells completely. However, this isn’t always possible and most malignant brain tumours will eventually return after treatment.

If your tumour does return after treatment, or you have a secondary brain tumour (where cancer has spread to your brain from another part of your body), a cure isn’t usually possible. Treatment can instead be used to control your symptoms and prolong life.


There are a number of different treatments for malignant brain tumours, and deciding on what you feel is the best treatment can be confusing.

A group of different specialists called a multidisciplinary team (MDT) will be involved in your care and will recommend what they think is the best treatment option for you, but the final decision will be yours.

Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions that you’d like to ask. For example, you may want to find out the advantages and disadvantages of particular treatments.


You may also be given medication to relieve some of the symptoms you may have as a result of your brain tumour.

These may include:

anticonvulsants to prevent seizures (fits) corticosteroids to reduce swelling and pressure in the brain painkillers to treat headaches anti-emetics to prevent vomiting

Depending on your circumstances, these medications may be given before, after, or instead of surgery.


If your tumour is at an advanced stage or in a difficult place in the brain, a cure may not be possible and treatment may only be able to control the cancer for a period of time. This means you will be getting the side effects of treatment without getting rid of the tumour.

In this situation, it may be difficult to decide whether or not to go ahead with treatment. Talk to your doctor about what will happen if you choose not to be treated, so you can make an informed decision.

If you decide not to have treatment, you will still be given palliative care, which will control your symptoms and make you as comfortable as possible.


Problems caused by a brain tumour don’t always resolve as soon as the tumour is removed or treated. For example, some people have persistent weakness, seizures (fits), difficulty walking and speech problems.

In these cases, you may need extra support to help you overcome or adapt to any problems you have. This may include therapies such as:

physiotherapy – to help with any movement problems you have occupational therapy – to identify any problems you’re having with daily activities and arrange for any equipment or alterations to your home that may help speech therapy – to help you with any communication or swallowing problems

Some people may also need to continue taking medication for seizures for a few months or more after their tumour has been treated or removed.

The National Institute for Health and Care Excellence (NICE) has made recommendations on the standards of care that brain tumour patients should receive. For more information, see the service guidance for improving outcomes for people with brain and other central nervous system tumours.