Osteoporosis
of muscle bone and joints, conditions

Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a minor fall or sudden impact causes a bone fracture.

The most common injuries in people with osteoporosis are:

wrist fractures hip fractures fractures of the spinal bones (vertebrae)

However, they can also occur in other bones, such as in the arm or pelvis. Sometimes a cough or sneeze can cause a rib fracture or the partial collapse of one of the bones of the spine.

Osteoporosis isn’t usually painful until a fracture occurs, but spinal fractures are a common cause of long-term (chronic) pain.

Although a fracture is the first sign of osteoporosis, some older people develop the characteristic stooped (bent forward) posture. It happens when the bones in the spine have fractured, making it difficult to support the weight of the body.

Causes

Losing bone is a normal part of the ageing process, but some people lose bone density much faster than normal. This can lead to osteoporosis and an increased risk of fractures.

Women also lose bone rapidly in the first few years after the menopause (when monthly periods stop and the ovaries stop producing an egg). Women are more at risk of osteoporosis than men, particularly if the menopause begins early (before the age of 45).

Many other factors can also increase the risk of developing osteoporosis, including:

long-term use of high-dose oral corticosteroids other medical conditions – such as inflammatory conditions, hormone-related conditions, or malabsorption problems a family history of osteoporosis – particularly history of a hip fracture in a parent long-term use of certain medications which can affect bone strength or hormone levels having a low body mass index (BMI) heavy drinking and smoking

Read more about the causes of osteoporosis.


Osteoporosis causes bones to become less dense and more fragile. Some people are more at risk than others.

Bones are at their thickest and strongest in your early adult life and their density increases until your late 20s. You gradually start losing bone density from around the age of 35.

This happens to everyone, but some people develop osteoporosis and lose bone density much faster than normal. This means they’re at greater risk of a fracture.

Diagnoses

Risk assessment tools

If your doctor suspects you have osteoporosis, they can make an assessment using an online programme, such as FRAX or Q-Fracture.

These tools help to predict a person’s risk of fracture between the ages of 40 and 90. The algorithms used give a 10-year probability of hip fracture and a 10-year probability of a major fracture in the spine, hip, shoulder or forearm.

DEXA scan

They may also refer you for a DEXA (DXA) scan to measure your bone mineral density. It’s a short, painless procedure that takes about five minutes, depending on the part of the body being scanned.

Your bone mineral density can be compared to the bone mineral density of a healthy young adult and someone who’s the same age and sex as you. The difference is calculated as a standard deviation (SD) and is called a T score.

Standard deviation is a measure of variability based on an average or expected value. A T score of:

above -1 SD is normal  between -1 and -2.5 SD is defined as decreased bone mineral density compared with peak bone mass below -2.5 is defined as osteoporosis

Treatments

Treatment for osteoporosis is based on treating and preventing fractures, and using medication to strengthen bones.

The decision about whether you need treatment depends on your risk of fracture. This will be based on a number of factors such as your age, sex and the results of your DEXA scan.

If you need treatment, your doctor can suggest the safest and most effective treatment plan for you.

Read more about how osteoporosis is treated.



Although a diagnosis of osteoporosis is based on the results of your bone mineral density scan (DEXA or DXA scan), the decision about what treatment you need – if any – is also based on a number of other factors. These include your:

age sex risk of fracture previous injury history

If you’ve been diagnosed with osteoporosis because you’ve had a fracture, you should still receive treatment to try to reduce your risk of further fractures.

You may not need or want to take medication to treat osteoporosis. However, you should ensure you’re maintaining sufficient levels of calcium and vitamin D. To achieve this, your healthcare team will ask you about your diet and may recommend making changes or taking supplements.

Preventions

If you’re at risk of developing osteoporosis, you should take steps to help keep your bones healthy. This may include:

taking regular exercise healthy eating – including foods rich in calcium and vitamin D making lifestyle changes – such as giving up smoking and reducing your alcohol consumption

Read more about preventing osteoporosis.


Your genes are responsible for determining your height and the strength of your skeleton, but lifestyle factors such as diet and exercise influence how healthy your bones are.

Osteosarcoma
of cancer, cancer types in children

More children than ever are surviving childhood cancer. There are new and better drugs and treatments. But it remains devastating to hear that your child has cancer, and at times it can feel overwhelming. There are many healthcare professionals and support organisations to help you through this difficult time.

Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your child’s specialist will give you more detailed information. If you have any questions it’s important to ask the specialist doctor or nurse who knows your child’s individual situation.

Osteosarcoma often starts at the end of the long bones, where new bone tissue forms as a young person grows. Any bone in the body can be affected. The most common sites are in the arms and legs, particularly around the knee and shoulder joints.

There are several different types of osteosarcoma. Most occur in the centre of the bone. There are also rare subtypes, such as parosteal, periosteal, telangiectatic, and small cell osteosarcoma.


Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your child’s specialist will give you more detailed information. If you have any questions it’s important to ask the specialist doctor or nurse who knows your child’s individual situation.

Osteosarcoma often starts at the end of the long bones, where new bone tissue forms as a young person grows. Any bone in the body can be affected. The most common sites are in the arms and legs, particularly around the knee and shoulder joints.

There are several different types of osteosarcoma. Most occur in the centre of the bone. There are also rare subtypes, such as parosteal, periosteal, telangiectatic, and small cell osteosarcoma.


Osteosarcoma often starts at the end of the long bones, where new bone tissue forms as a young person grows. Any bone in the body can be affected. The most common sites are in the arms and legs, particularly around the knee and shoulder joints.

There are several different types of osteosarcoma. Most occur in the centre of the bone. There are also rare subtypes, such as parosteal, periosteal, telangiectatic, and small cell osteosarcoma.

Symptoms

Pain in the affected bone is the most common symptom. This pain may initially come and go, and then gradually become more severe and constant especially at night. There may also be swelling around the affected bone. Osteosarcoma is sometimes discovered when a bone that has been weakened by cancer breaks after the person has had a minor fall or accident. Some patients may develop a limp if the tumour is in the leg or pelvis.

These symptoms can be caused by many things other than cancer. However, any persistent bone pain should be checked by your child’s doctor. Symptoms are often attributed to a sporting injury.

Causes

There has been a lot of research into the causes of osteosarcoma but, like most childhood cancers, a definite cause is unknown. There are a few risk factors that have been associated with osteosarcoma. Children who have hereditary retinoblastoma (a rare tumour of the eye) have an increased risk of developing osteosarcoma. Children who have previously had radiotherapy and chemotherapy also have an increased risk of developing osteosarcoma. It is not caused by injuries or damage to the bone, although an injury may draw attention to a bone tumour.

Diagnoses

Usually you begin by seeing your GP, who will examine your child and may arrange tests or X-rays. If a bone tumour is suspected, the doctor will refer your child directly to a specialist hospital or bone tumour centre for further tests.

The doctor at the hospital will take your child’s full medical history. They will then do a physical examination. This will include an examination of the painful bone to check for any swelling or tenderness. Your child will probably have a blood test to check their general health.

A variety of tests and investigations may be needed to diagnose osteosarcoma. An X-ray of the painful part of the bone will usually identify a tumour, although sometimes they can be difficult to see.

A small piece of the tumour will be removed and looked at under a microscope. This is called a biopsy. It’s a small operation, performed under a general anaesthetic.

Other tests are done to check whether the cancer has spread to other parts of the body. These include a chest X-ray, blood tests, a bone scan and an MRI or CT scan.

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

Treatments

Treatment will depend on a number of factors including the size, position, and stage of the tumour.

Chemotherapy

Chemotherapy is a very important part of treatment for osteosarcoma. Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells, and is usually given to shrink the main tumour before surgery. It’s also given after the tumour has been removed by surgery, to help reduce the risk of the cancer coming back (recurring). It’s common for a combination of drugs to be used.

Radiotherapy

Radiotherapy may occasionally be given. This treats cancer by using high energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells.

Surgery

The type and extent of surgery depends on the position and size of the tumour in the body. This surgery will need to be carried out at a specialist orthopaedic centre, and your child should be referred to one.

Surgery may include removing the whole limb (amputation) or part of the affected bone, which is then replaced by some form of false limb (prosthesis). If only part of the affected bone is removed, this is known as limb-sparing surgery. Most children will be considered for limb-sparing surgery.

Amputation

Sometimes amputation of the limb is unavoidable if the cancer is affecting the surrounding blood vessels and nerves.

After amputation, a false limb will be fitted and will be regularly adjusted as your child grows. False limbs can work very well. It should be possible for your child to join in with normal activities and even sports.

Limb-sparing surgery

There are 2 ways that limb-sparing surgery may be done:

replacing the bone with a prosthesis (a specially designed artificial part) replacing the affected bone with bone taken from another part of the body (bone graft)

After this type of surgery, children will usually be able to use their limbs almost normally. However, they are advised not to participate in any contact sports. This is because any damage to the bone graft or prosthesis may require another major operation to repair or replace it.

If your child is growing, the limb prosthesis will need to be lengthened as the bone grows. This may mean there are extra short stays in hospital, although some prostheses can be lengthened as an outpatient procedure.

New treatments for osteosarcoma

Mifamurtide, also called Mepact®, is a new type of biological therapy treatment. It may be offered to your child if they have had a surgical resection to remove the osteosarcoma and the tumour has not spread. It will be given along with chemotherapy after surgery to try and stop the osteosarcoma coming back. Mifamurtide is a relatively new drug and so more research needs to be done to fully understand its side effects and how to use it best.

Side effects of treatment

Treatment often causes side effects, and your child’s doctor will discuss these with you before the treatment starts. Any possible side effects will depend upon the treatment being given and the part of the body that’s being treated.

Chemotherapy side effects

Some general side effects of chemotherapy can include:

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

Radiotherapy side effects

Radiotherapy can cause irritation or soreness of the skin in the area being treated and general tiredness.

Surgery side effects

If your child is having surgery, the surgeon will explain the possible complications of the surgery that your child is having.

Late side effects

A small number of children may develop late side effects, sometimes many years later. These include a reduction in bone growth, reduced fertility, a change in heart function, and a slight increase in the risk of developing another cancer in later life.

Your child’s doctor or nurse will talk to you and monitor your child for any potential late effects.

Clinical trials

Many children have their treatment as part of a clinical research trial, if there is a suitable one open. 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 will be 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. Your child’s doctor can tell you if there are any trials available that might be suitable 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

Many children with osteosarcoma are cured. However, your child may need to have surgery to lengthen the affected limb as they grow. Your child will have regular check-ups and X-rays in the paediatric or adolescent oncology clinic, and at the orthopaedic centre.

If you have specific concerns about your child’s condition and treatment, it’s best to discuss them with your child’s doctor, who knows the situation in detail.

Otitis externa
of ears nose and throat

Otitis externa is a condition that causes inflammation (redness and swelling) of the external ear canal, which is the tube between the outer ear and eardrum.

Otitis externa is often referred to as “swimmer’s ear” because repeated exposure to water can make the ear canal more vulnerable to inflammation.

Symptoms of otitis externa include:

ear pain, which can be severe itchiness in the ear canal a discharge of liquid or pus from the ear some degree of temporary hearing loss

Usually only one ear is affected.

With treatment, these symptoms should clear up within a few days. However, some cases can persist for several months or longer.

Read more about the symptoms of otitis externa

Symptoms

Otitis externa can cause a number of different symptoms affecting the ear and the surrounding area.

Symptoms can include:

ear pain itching and irritation in and around your ear canal redness and swelling of your outer ear and ear canal a feeling of pressure and fullness inside your ear scaly skin in and around your ear canal, which may peel off discharge from your ear, which can be either thin and watery or thick and pus-like tenderness when you move your ear or jaw swollen and sore glands in your throat some hearing loss

Otitis externa sometimes occurs if a hair follicle inside the ear becomes infected by bacteria and develops into a spot (pimple) or boil.

If this happens, you may be able to see the pimple or boil in a mirror. However, don’t attempt to squeeze any pimples or boils in your ear, as this could lead to the infection spreading elsewhere.


In some cases, the symptoms of otitis externa can persist for several months, or sometimes years. This is known as chronic otitis externa.

Symptoms of chronic otitis externa can include:

a constant itch in and around your ear canal discomfort and pain in your ear that becomes worse when you move it – this is usually much milder than in short-term otitis externa a thin, watery discharge from your ear a lack of earwax a build-up of thick, dry skin in your ear canal, known as stenosis, which can narrow your ear canal and affect your hearing


The advice below should help to relieve your symptoms to some extent and help to prevent complications:

avoid getting your affected ear wet – wearing a shower cap while showering and bathing can help, but you should avoid swimming until the condition has fully cleared remove any discharge or debris by gently swabbing your outer ear with cotton wool, being careful not to damage it – don’t stick cotton wool or a cotton bud inside your ear remove anything from your affected ear that may cause an allergic reaction, such as hearing aids, ear plugs and earrings use painkillers such as paracetamol or ibuprofen to relieve ear pain – these aren’t suitable for everyone, so make sure you check the information leaflet that comes with the medication first; if you’re still unsure, check with your GP, practice nurse or pharmacist if your condition is caused by a boil in your ear, placing a warm flannel or cloth over the affected ear can help it heal faster

Causes

Most cases of otitis externa are caused by a bacterial infection, although the condition can also be caused by:

irritation fungal infections allergies

There are a number of things that can make you more likely to develop otitis externa, including:

damaging the skin inside your ear regularly getting water in your ear

Getting water in your ear is particularly significant, because this can cause you to scratch inside your ear, and the moisture also provides an ideal environment for bacteria to grow.

Read more about the causes of otitis externa.


There are several different causes of otitis externa. A number of things can also increase your chance of developing the condition.


Causes of otitis externa can include:

a bacterial infection – usually by bacteria called Pseudomonas aeruginosa or Staphylococcus aureus seborrheic dermatitis – a common skin condition where the naturally greasy areas of your skin become irritated and inflamed, which can sometimes affect the ears a middle ear infection (otitis media) – discharge produced by an infection deeper in the ear can sometimes lead to otitis externa a fungal infection – such as from the Aspergillus variety and the Candida albicans variety (which also causes thrush); fungal infections are more common if you use antibacterial or steroid ear drops for a long time irritation or an allergic reaction – otitis externa can occur because of a reaction to something that comes into contact with your ears, such as ear medication, ear plugs, shampoo or sweat

Otitis externa can also return after previous treatment if you don’t complete the full course of recommended treatment.

Treatments

You should see your GP if you may have otitis externa.

Your GP will ask about your symptoms and whether you regularly use any items that are inserted into your ears, such as hearing aids or ear plugs. They may also examine inside your ear using an instrument called an otoscope.

If you have recurring episodes of otitis externa that haven’t responded to treatment, your GP may take a swab of the inside of your ear. This will be tested to help determine what type of infection you have, if any, so appropriate medication can be prescribed.


Otitis externa sometimes gets better without treatment, but it can take several weeks. Your GP can prescribe ear drop medication that usually improves the symptoms within a few days.

There are a number of different types of ear drops that may be used to treat otitis externa, but they all tend to be used several times a day for about a week. 

Your GP may refer you to a specialist for further treatment and advice if symptoms are severe or they fail to respond to treatment.

Read more about treating otitis externa


Otitis externa can usually be treated effectively with ear drops prescribed by your GP and some simple self-care techniques.

In most cases, your symptoms will start to improve within a few days of starting treatment.

If your symptoms are severe or they fail to respond to initial treatment, your GP may refer you to a specialist for further treatment and advice.


While otitis externa can clear up by itself, this can take several weeks without treatment. Your GP can usually prescribe medicated ear drops that speed up the healing process. These usually need to be taken several times a day for about a week.

There are four main types of ear drops used to treat otitis externa:

antibiotic ear drops – this can treat an underlying bacterial infection corticosteroid ear drops – this can help to reduce swelling antifungal ear drops – this can treat an underlying fungal infection acidic ear drops – this can help kill bacteria

Sometimes you may be given medication that’s a combination of the above, such as antibiotic and corticosteroid ear drops.

Once treatment is complete and the inflammation has settled, your doctor may want to re-examine your ear to check for any underlying physical problems that could have contributed to the condition, such as having an abnormal or perforated (torn) ear drum.

Applying ear drops

Ear drops may not work as well if they’re not used in the right way, so it’s important to apply them correctly. Ideally, ask somebody else to apply the drops for you, as this makes the process much easier.

You (or your helper) will need to follow these steps:

gently remove any discharge, earwax or debris from your outer ear using a twist of cotton wool warm the ear drops by holding them in your hands for a few minutes, as cold ear drops can make you feel dizzy lie on your side with your affected ear facing up before applying the drops directly into your external ear canal gently push and pull your ear for about 30 seconds to work the drops in and get any trapped air out stay lying down for three to five minutes, to ensure the ear drops don’t come out of your ear canal leave the ear canal open to dry

Other treatments

If necessary, there are some other treatments your GP can provide to help treat otitis externa, such as:

stronger prescription painkillers such as codeine for severe cases antibiotic tablets or capsules to treat a severe infection – an antibiotic called flucloxacillin is usually the preferred choice treatment for underlying skin conditions that may aggravate your otitis externa, such as seborrheic dermatitis, psoriasis or eczema if a boil develops inside your ear, your GP may decide to pierce it with a sterile needle and drain the pus – this is known as incision and drainage, and you shouldn’t attempt to do it yourself


If necessary, your GP may refer you to a specialist for further treatment.

The specialist may decide to remove earwax from inside your ears to help make ear drops more effective. This can be done in a number of ways:

syringing or irrigation – where water is injected through the nozzle of a syringe into the ear canal to dislodge and wash away any earwax micro suction – where a small suction device is used to remove any earwax, discharge and debris from your outer ear and ear canal dry swabbing – this gently mops out earwax from your ear canal

You may also need an ear wick, which is a soft cotton gauze plug covered with medication and inserted into your ear canal.

An ear wick allows the medication to reach the end of your ear canal. It should be changed every two to three days.


If you develop otitis externa and you have allergies, tell your GP or practice nurse. Ear drops that contain certain substances, such as neomycin, are more likely to cause an allergic reaction. Your GP, practice nurse or pharmacist can advise you about which ear drops are most suitable for you. If you have an allergic reaction to anything that is placed inside your ears, such as hearing aids, earplugs or earrings, remove the item. A mild allergic reaction will usually clear up on its own. Using hypoallergenic products (products that have a lower potential for causing allergic reactions) may also help. Seek medical advice for any other skin conditions, such as psoriasis or eczema, so they can be treated using the right medication. Try using acidifying ear drops or spray to help keep your ears clean, particularly before and after swimming. These are available without a prescription in most pharmacies and may help to prevent otitis externa recurring.

Preventions

To help reduce your chances of developing otitis externa, you should avoid inserting cotton wool buds and other things into your ears (including your fingers), as this can damage the sensitive skin in your ear canal.

If you’re a regular swimmer, consider using ear plugs when swimming or wearing a swimming cap to cover your ears and protect them from water.

You should also try to avoid getting water, soap or shampoo into your ears when you have a shower or bath.

Read more about preventing otitis externa


It’s not always possible to prevent otitis externa, but you can reduce your risk of developing the condition.


If you develop otitis externa and you have allergies, tell your GP or practice nurse. Ear drops that contain certain substances, such as neomycin, are more likely to cause an allergic reaction. Your GP, practice nurse or pharmacist can advise you about which ear drops are most suitable for you. If you have an allergic reaction to anything that is placed inside your ears, such as hearing aids, earplugs or earrings, remove the item. A mild allergic reaction will usually clear up on its own. Using hypoallergenic products (products that have a lower potential for causing allergic reactions) may also help. Seek medical advice for any other skin conditions, such as psoriasis or eczema, so they can be treated using the right medication. Try using acidifying ear drops or spray to help keep your ears clean, particularly before and after swimming. These are available without a prescription in most pharmacies and may help to prevent otitis externa recurring.

Complications

Complications of otitis externa are uncommon, but some can be very serious.

One rare complication of otitis externa is necrotising otitis externa, which is where an infection spreads from the ear canal into the surrounding bone.

This requires prompt treatment with antibiotics and sometimes surgery, as it can be fatal if left untreated.

Read more about the complications of otitis externa


Although complications associated with otitis externa are uncommon, there’s a small risk of further problems developing.

Some of the main complications of otitis externa are described below.

Ovarian cancer
of cancer, cancer types in adults

Ovarian cancer is most common in women and anyone with ovaries who has been through the menopause (usually over the age of 50). It can affect women and anyone with ovaries of any age.

As the symptoms of ovarian cancer can be similar to those of other conditions, it can be difficult to recognise. However, there are early symptoms to look out for, such as persistent bloating, pain in the pelvis and lower stomach, and difficulty eating.

It’s important to speak to your GP if you experience these symptoms, particularly over a long period of time. Read more about how ovarian cancer is diagnosed.

The ovaries are a pair of small organs in the female reproductive system that contain and release an egg once a month. This is known as ovulation.

Different types of ovarian cancer affect different parts of the ovaries. Epithelial ovarian cancer, which affects the surface layers of the ovary, is the most common type. This topic focuses on epithelial ovarian cancer.

Symptoms

The symptoms of ovarian cancer can be difficult to recognise, particularly in its early stages.

This is because they are often the same as symptoms of other less serious conditions, such as irritable bowel syndrome (IBS) or pre-menstrual syndrome (PMS).

However, 3 main symptoms are more frequent:

increased abdominal size and persistent bloating (not bloating that comes and goes) persistent pelvic and abdominal pain difficulty eating and feeling full quickly, or feeling nauseous

Other symptoms, such as back pain, needing to pass urine more frequently than usual, and pain during sex may be the result of other conditions in the pelvic area. However, they may be a sign of ovarian cancer.

If you have these types of symptoms, try keeping a diary to record how many of these symptoms you have over a longer period. Bear in mind that ovarian cancer is rare in women and anyone with ovaries under 40 years of age.

Speak to your GP if you have these symptoms regularly (on most days for 3 weeks or more). Although it’s unlikely they’re being caused by a serious problem, it’s best to check.

If you’ve already seen your GP and the symptoms continue or get worse, you should go back and explain this. You know your body better than anyone.

Causes

The exact cause of ovarian cancer is unknown, but certain things are thought to increase a woman’s risk of developing the condition, such as age, the number of eggs the ovaries release and whether someone in your family has had ovarian or breast cancer in the past. However, only 1 in 10 cases of ovarian cancer has a genetic link.

Read more about the causes of ovarian cancer


Several possible causes of ovarian cancer have been identified, along with risks that may make developing the condition more likely.

Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means that cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour.

In ovarian cancer, cells in the ovary start to change and grow abnormally. If the cancer isn’t identified at an early stage, it can spread to the abdomen and pelvis, including other parts of the female reproductive system.

Diagnoses

Speak to your GP as soon as possible if you have any symptoms of ovarian cancer.

Your GP will gently feel your tummy (abdomen) and ask you about your symptoms, general health and whether there’s a history of ovarian or breast cancer in your family.

They may carry out an internal examination and may take a blood sample or refer you for an ultrasound scan.

If needed, you may also be referred to a specialist (a gynaecologist or gynaecological oncologist) at a hospital.

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


You may have a blood test to look for a protein called CA125 in your blood. CA125 is produced by some ovarian cancer cells. A very high level of CA125 may indicate that you have ovarian cancer.

However, CA125 isn’t specific to ovarian cancer and it can be raised in conditions including endometriosis, fibroids, pelvic inflammatory disease and pregnancy, so a raised CA125 level doesn’t definitely mean you have ovarian cancer.

The Lab Tests Online UK website has more information on the CA125 test.

The National Institute for Health and Care Excellence (NICE) has produced guidance that recommends testing for CA125 if you frequently experience: 

bloating feeling full quickly and/or loss of appetite  pelvic or abdominal pain  needing to urinate urgently and/or frequently  

Read the full NICE guidance about the recognition and initial management of ovarian cancer (PDF, 179kb).

If you experience unexplained weight loss, fatigue or changes in your bowel habits, such as diarrhoea or constipation, you may also be tested for CA125.

If you’re 50 or over and you’ve experienced symptoms that could suggest irritable bowel syndrome (IBS) in the last 12 months, such as bloating, abdominal pain or changes in your bowel habits, your GP should test your CA125 level.

Around half of all women and anyone with ovaries with early-stage ovarian cancer have a raised level of CA125 in their blood. If your CA125 level is raised, you’ll be referred for an ultrasound scan.


If you’ve been diagnosed with ovarian cancer, you may have further tests to see how large the cancer is and if it’s spread. This is called staging.

Other tests you may have include:

a chest X-ray a CT scan or MRI scan abdominal fluid aspiration – a thin needle is passed into your abdomen, so that a fluid sample can be taken and tested for cancerous cells  laparoscopy – a thin tube with a camera on the end is inserted through a small incision in your lower abdomen, so that your ovaries can be examined; a small tissue sample may also be taken from your ovaries for testing (a biopsy)

Staging helps your doctors to decide on the best kind of treatment for your condition. However, it’s important to remember that the stage of your ovarian cancer alone cannot predict how your condition will progress.

The Cancer Research UK website has more information on further tests for ovarian cancer.

Treatments

The treatment you receive for ovarian cancer will depend on several things, including the stage of your cancer and your general health. Chemotherapy is the main treatment for ovarian cancer, but your treatment will usually involve a combination of surgery and chemotherapy.

Read more about how ovarian cancer is treated

As with most types of cancer, the outlook for ovarian cancer will depend on the stage it’s at when diagnosed – that is, how far the cancer has advanced.

Being diagnosed with ovarian cancer can affect daily life in many ways. However, support is available for many aspects of living with ovarian cancer, including emotional, financial and long-term health issues.

Preventions

There’s currently no reliable screening test for ovarian cancer. However, there are a number of things that may help to prevent ovarian cancer.

Ovarian cancer: Teenagers and young adults
of cancer, cancer types in teenagers and young adults

This section is for teenagers and young adults. It’s about a type of cancer called ovarian cancer.

We have more info for young people about:

germ cell tumours of the ovary – causes and symptoms having tests for ovarian cancer  treating ovarian cancer

For more information about ovarian cancer in women of all ages, read our general ovarian cancer section.

Ovarian cancer starts in the ovaries, which are part of the reproductive system. This is in the lower part of your tummy (abdomen), in the area between your hips (called the pelvis). Your reproductive system is made up of your vagina and the organs involved in getting pregnant and having a baby.

Symptoms

pain or swelling in your tummy (abdomen)  a feeling of fullness or bloating in your tummy needing to pee more often irregular periods

Remember – these symptoms happen for lots of reasons other than cancer. But if you have any of them it’s important to speak to your GP.

Causes

The cause of germ cell tumours is unknown. Research into possible causes is going on all the time.

Germ cells are a normal part of the ovary, but something causes them to change. This makes them grow too quickly and make a tumour.

Diagnoses

There are some tests that you might have at your doctor’s or at the hospital, to help them see if you have ovarian cancer.

Treatments

Most girls and young women can be cured of germ cell tumours of the ovary.

Your treatment will depend on the type of germ cell tumour you have and whether it has spread outside the ovaries. Treatment is usually a combination of surgery and chemotherapy, although you may only need surgery.

Before you have treatment, your specialist needs to know the type of germ cell tumour you have and what stage it is. The stage of a cancer describes the size of the tumour and whether it has spread outside the ovary to any other parts of your body.

Your specialist will tell you the exact stage of the cancer after the operation to remove your ovary. Most germ cell tumours are diagnosed early when they’re in one or sometimes both ovaries but haven’t spread anywhere else in the body. Waiting to hear about the stage of the cancer can be worrying. But this information is important because it helps your doctors plan the right treatment.

Another important part of ovarian cancer treatment is to try to make sure it doesn’t make you infertile (unable to get pregnant). Your doctors will think very carefully about this when planning your treatment.

Ovarian cyst
of womens health, middle years around 25 to 50 years, periods and menstrual health

Most ovarian cysts are generally harmless and disappear without treatment in a few months.

Small cysts are normal in the ovary. There may only be a problem is there are a large number of cysts, they’re persistent, or become particularly large.

Ovarian cysts may affect both ovaries at the same time, or they may only affect one.

What are ovaries? The ovaries are part of the female reproductive system. They are 2 small, bean-shaped organs, one each side of the womb (uterus). The ovaries have 2 main functions. They are: to release an egg around every 28 days as part of the menstrual cycle to release the female sex hormones, oestrogen and progesterone

Types of ovarian cyst The 2 main types of ovarian are: functional ovarian cysts (most common) – develop as part of the menstrual cycle and are usually harmless and short-lived pathological ovarian cysts (much less common) – occur due to abnormal cell growth Ovarian cysts can sometimes also be caused by an underlying condition, such as endometriosis. The vast majority of ovarian cysts are non-cancerous (benign). But a small number are cancerous (malignant).


Small cysts are normal in the ovary. There may only be a problem is there are a large number of cysts, they’re persistent, or become particularly large.

Ovarian cysts may affect both ovaries at the same time, or they may only affect one.

What are ovaries? The ovaries are part of the female reproductive system. They are 2 small, bean-shaped organs, one each side of the womb (uterus). The ovaries have 2 main functions. They are: to release an egg around every 28 days as part of the menstrual cycle to release the female sex hormones, oestrogen and progesterone

Types of ovarian cyst The 2 main types of ovarian are: functional ovarian cysts (most common) – develop as part of the menstrual cycle and are usually harmless and short-lived pathological ovarian cysts (much less common) – occur due to abnormal cell growth Ovarian cysts can sometimes also be caused by an underlying condition, such as endometriosis. The vast majority of ovarian cysts are non-cancerous (benign). But a small number are cancerous (malignant).


Ovarian cysts may affect both ovaries at the same time, or they may only affect one.

What are ovaries? The ovaries are part of the female reproductive system. They are 2 small, bean-shaped organs, one each side of the womb (uterus). The ovaries have 2 main functions. They are: to release an egg around every 28 days as part of the menstrual cycle to release the female sex hormones, oestrogen and progesterone

Types of ovarian cyst The 2 main types of ovarian are: functional ovarian cysts (most common) – develop as part of the menstrual cycle and are usually harmless and short-lived pathological ovarian cysts (much less common) – occur due to abnormal cell growth Ovarian cysts can sometimes also be caused by an underlying condition, such as endometriosis. The vast majority of ovarian cysts are non-cancerous (benign). But a small number are cancerous (malignant).

Symptoms

Most cysts are found by chance during a scan. They’re unlikely to cause any symptoms unless they’re large or abnormal.

An ovarian cyst will usually only cause symptoms if it splits (ruptures), is very large, or it blocks the blood supply to the ovaries.

Contact your GP practice if: you have sudden, severe pelvic pain If your GP is closed, phone 111.

Contact your GP practice if: You’re worried about your symptoms or you regularly have: pelvic pain – this can range from a dull, heavy sensation to a sudden, severe and sharp pain pain during sex difficulty having a poo a frequent need to urinate heavy periods, irregular periods or lighter periods than normal bloating and a swollen tummy feeling very full after only eating a little difficulty getting pregnant If your GP practice is closed, phone 111.

Useful information for your doctor

It can be helpful to keep a note of your period dates and symptoms using a calendar, a diary or an app. You can then discuss this with your doctor who can decide if any tests or treatments might be needed.

If you’re seeing your doctor, there are some useful pieces of information to think about beforehand:

the first day of your last period (when it started) how many days your period usually lasts what was the shortest time between your periods (from the first day of one period to the first day of the next) what was the longest time between your periods (from the first day of one period to the first day of the next) how often you need to change your period products on a heavy day if you are over 25, when you had your last smear test

Diagnoses

If your GP thinks you may have an ovarian cyst, you may be referred for an ultrasound scan. This is carried out by using a probe placed inside your vagina.

As this is a very intimate examination, the doctor who performs it will have another person (chaperone) present. You can ask for a female doctor to carry it out. If there isn’t a female doctor available, you can ask if there’s a female health professional who could carry out the examination.

If a cyst is identified during the ultrasound scan, you may need to have this monitored with a repeat ultrasound scan in a few weeks. Or your doctor may refer you to a gynaecologist, who specialises in female reproductive health.

Your doctor may also arrange blood tests to check for any other conditions.

Treatments

In most cases, ovarian cysts disappear in a few months without treatment. A follow-up ultrasound scan may be used to confirm this.

Most ovarian cysts do not need treatment or surgery.

Treatment will depend on:

size and appearance of the cysts whether you have any symptoms whether you’re post-menopausal (due to the slightly higher risk of ovarian cancer)

If you’re post-menopausal, you’ll usually have regular ultrasound scans and blood tests over the course of a year to monitor the cyst.

Large cysts, those causing symptoms, and those that could be cancerous, may need to be surgically removed.

Your care team can talk with you about what to expect, and answer any questions you have.

Types of surgery There are 2 types of surgery used to remove ovarian cysts: laparoscopy laparotomy These are usually carried out under general anaesthetic. Laparoscopy Most cysts can be removed using laparoscopy. This is a type of keyhole surgery. Small cuts are made in your tummy and gas is blown into the pelvis to allow the surgeon to access your ovaries. A laparoscopy is a procedure where a camera (a laparoscope) is inserted into the pelvis via a small cut near the belly button so the surgeon can see your internal organs. The surgeon then removes the cyst through the small cuts in your skin. After the cyst has been removed, the cuts will be closed using dissolvable stitches. A laparoscopy is preferred because it causes less pain and has a quicker recovery time. You’ll usually be able to go home on the same day or the following day. Laparotomy If your cyst is particularly large, or there is a chance it could be cancerous, a laparotomy may be recommended. During a laparotomy, a single, larger cut is made in your tummy to give the surgeon better access to the cyst. The whole cyst and ovary may be removed and sent to a laboratory to check whether it’s cancerous. Stitches or staples will be used to close the incision. You may need to stay in hospital for a few days after the procedure.

After the surgery After the ovarian cyst has been removed, you’ll feel pain in your tummy. This should improve in a day or two. If you have had a laparoscopy, you’ll probably need to take things easy for 2 weeks. Recovery after a laparotomy will usually take longer, possibly around 6 to 8 weeks. If the cyst has been sent for testing, the results should come back in a few weeks. Your doctor will discuss with you whether you need any further treatment. Contact your GP if you notice the following symptoms after surgery, as they may indicate an infection: heavy bleeding severe pain or swelling in your abdomen a high temperature (fever) dark or smelly vaginal discharge

Your fertility after surgery If you have not been through the menopause, your surgeon will try to preserve as much of your reproductive system as they can. Make sure you discuss your fertility concerns with your surgeon before your operation. It’s often possible to just remove the cyst and leave both ovaries intact, which means your fertility should be largely unaffected. If one of your ovaries needs to be removed, the remaining ovary will still release hormones and eggs as usual. Your fertility shouldn’t be significantly affected. But you may find it slightly harder to get pregnant. Occasionally, it may be necessary to remove both ovaries. This will trigger an early menopause. You’ll no longer produce any eggs and will not be able to get pregnant. It may still be possible to have a baby by having a donated egg implanted into your womb. You can speak to your doctor for more information about this. If you’ve been through the menopause, both ovaries may be removed because they no longer produce eggs.

Overactive thyroid
of glands

Overactive thyroid (also known as hyperthyroidism) is a relatively common hormonal condition that occurs when there is too much thyroid hormone in the body.

Excess levels of thyroid hormones can then speed up the body’s metabolism, triggering a range of symptoms, such as:

nervousness and anxiety hyperactivity – where a person can’t stay still and is full of nervous energy unexplained or unplanned weight loss  swelling of the thyroid gland, which causes a noticeable lump, known as a goitre, to form in the throat

The severity, frequency and range of symptoms can vary from person to person.

Read more about the symptoms of an overactive thyroid gland

Symptoms

An overactive thyroid (hyperthyroidism) has many signs and symptoms, although it is unlikely you would develop all of them.


If you have hyperthyroidism, you may experience some of the following symptoms:

hyperactivity mood swings – such as anxiety, irritability and nervousness difficulty sleeping (insomnia) feeling tired all the time (fatigue) muscle weakness needing to poo or pee more frequently excess fats in your poo – which can make them greasy and difficult to flush down the toilet (steatorrhoea) sensitivity to heat and excess sweating unexplained or unexpected weight loss – despite having an increased appetite (though in a small number of cases, the increase in appetite can lead to weight gain) very infrequent or light periods, or periods stopping altogether infertility loss of interest in sex 

If you have diabetes, your diabetic symptoms, such as extreme thirst and tiredness, may be made worse by hyperthyroidism.

Causes

The thyroid gland is found in the neck. It produces hormones that are released into the bloodstream to control the body’s growth and metabolism. These hormones are called thyroxine and triiodothyronine.

They affect processes such as heart rate and body temperature, and help convert food into energy to keep the body going.

In hyperthyroidism, the thyroid gland produces too much thyroxine or triiodothyronine, which speeds up the body’s metabolism.

There are several possible underlying causes, the most common being Graves’ disease, in which the body’s immune system targets the thyroid gland and causes it to produce too much of the thyroid hormones.

Read more about the causes of an overactive thyroid gland


Overactive thyroid (hyperthyroidism) occurs when your thyroid gland produces too much of the thyroid hormones thyroxine or triiodothyronine.

Overproduction of thyroid hormones can be caused by a number of conditions.


If tests confirm an overactive thyroid gland, you may be referred for further tests to determine the underlying cause.

An additional test that may be used is an isotope thyroid scan. This involves swallowing small amounts of a radioactive substance (an isotope), usually technetium, in capsule or liquid form.

A scan is then used to measure how much of the isotope has been absorbed by your thyroid gland.

If your thyroid gland absorbs a high amount of the isotope, it is likely the underlying cause is either Graves’ disease or thyroid nodules.

If the amount is low, the underlying cause could be due to:

swelling (inflammation) of the thyroid gland (thyroiditis), often caused by your immune system mistakenly attacking thyroid tissue or, less commonly, by infection having too much iodine in your diet in rare cases, thyroid cancer

Diagnoses

See your GP if you think you may have an overactive thyroid gland (hyperthyroidism).

A diagnosis will be based on your symptoms and the results of blood tests that assess how well your thyroid gland is working. These are known as thyroid function tests.


Your GP will take a sample of your blood and test it for levels of:

thyroid-stimulating hormone (TSH) thyroxine and triiodothyronine (the thyroid hormones)

TSH is made in the pituitary gland in your brain and controls the production of thyroxine and triiodothyronine.

When the level of thyroxine and triiodothyronine in your blood are normal, your pituitary gland releases a normal level of TSH. When thyroid hormone production becomes excessive, the pituitary gland stops releasing TSH.  

When the level of thyroxine or triiodothyronine drops, the pituitary gland produces more TSH to boost it.

If you have an overactive thyroid, the thyroid function test will show that levels of TSH in your blood are consistently lower than normal. Low levels of TSH mean your thyroid gland is overactive and likely to be making excessive thyroid hormones. This is the first part of the thyroid function test.

Your GP will then test your blood for levels of thyroxine and triiodothyronine. If you have an overactive thyroid, you will have higher than normal levels of both these hormones.

Subclinical overactive thyroid gland

In some cases, tests may show you have normal thyroid hormone levels, but low or suppressed levels of TSH.

This is known a subclinical overactive thyroid gland. If you are diagnosed with subclinical overactive thyroid, you may not need treatment.

In most cases, the reduced level of TSH in your blood returns to normal within a couple of months and your subclinical hyperthyroidism will resolve by itself.

However, you will need a further thyroid function test so your condition can be monitored.

Treatments

An overactive thyroid usually responds well to treatment, and most people are able to control their symptoms.

The 3 most widely used treatments for an overactive thyroid gland are:

thionamides – a group of medications, including carbimazole and methimazole, that stop the thyroid gland producing too much thyroid hormone radioiodine treatment – a radioactive substance called iodine that helps shrink the thyroid gland, reducing its activity (the radiation contained in iodine is a very low dose and does not pose a threat to health) surgery – in a small number of cases surgery may be required to remove some or all of the thyroid gland, particularly if there is a large goitre

Beta-blockers may also sometimes be used to temporarily relieve many symptoms of an overactive thyroid gland, although it doesn’t target the thyroid gland itself.

It’s common for treatment to lead to the thyroid not producing enough hormones. This is known as having an underactive thyroid gland (hypothyroidism). However, an underactive thyroid is not usually serious and is easily treated.

Read more about the treatment of an overactive thyroid gland


See your GP if you are experiencing any of these symptoms. They may not be the result of an overactive thyroid gland, but they will need further investigation.

It might be useful to make a list of your symptoms, as this can often be helpful in determining the correct diagnosis.


If you are diagnosed with an overactive thyroid gland (hyperthyroidism), your GP will refer you to a specialist in hormonal conditions (endocrinologist) to plan your treatment.


Radioiodine treatment is a form of radiotherapy used to treat most types of overactive thyroid. Radioactive iodine shrinks your thyroid gland, reducing the amount of thyroid hormone it can produce.

Radioiodine treatment is given either as a drink or a capsule to swallow. The dose of radioactivity in the radioiodine is very low and is not harmful.

Radioiodine treatment is not suitable if you are pregnant or breastfeeding, and may not be suitable if you have eye problems, such as double vision or prominent (bulging) eyes.

Women should avoid getting pregnant for at least 6 months after having radioiodine treatment. Men should not father a child for at least 4 months after having radioiodine treatment.

Most people only require a single dose of radioiodine treatment. If a further follow-up dose is required, it is usually given 6 to 12 months after the first dosage.

A short course of thionamides treatment may be given a few weeks before radioiodine treatment, as this can lead to a more rapid relief of symptoms.

Complications

Around 1 in 20 people with Graves’ disease will also develop symptoms affecting their eyes, such as:

double vision sensitivity to light (photophobia) tearing (excess production of tears)

This is known as Graves’ ophthalmopathy and should be seen by a doctor who specialises in treating eye conditions (an ophthalmologist).

A rarer and more serious complication is a sudden and severe flare-up of symptoms, known as a thyroid storm. A thyroid storm can be life-threatening, as it causes severe dehydration and heart problems.

Read more about the complications of an overactive thyroid gland


Several complications can occur with an overactive thyroid (hyperthyroidism), particularly if the condition is not treated.

Paget’s disease of the nipple
of cancer, cancer types in adults

Paget’s disease of the nipple, also known as Paget’s disease of the breast, is a rare type of breast cancer.

The term Paget’s disease of the nipple is used to distinguish the condition from Paget’s disease of the bone, which occurs when the normal cycle of bone growth is disrupted, leading to the bones becoming weak and deformed.

A similar type of skin cancer can also occur in other parts of the body.

The rest of this section will use the term Paget’s disease to refer to Paget’s disease of the nipple or breast.

Symptoms

Paget’s disease usually affects the skin of one nipple and produces eczema-like symptoms, appearing as an itchy, red rash on the nipple that can extend to the darker area of surrounding skin (the areola).

It can also appear as a small ulcer or dry, red, flaky patches of skin similar to psoriasis.

Other possible symptoms include:

itchiness or a burning sensation – alongside visible changes to the nipple bleeding from the skin of the nipple

If you’re experiencing itchiness, burning or bleeding but the nipple looks normal and isn’t red, dry or scaly – this is extremely unlikely to be Paget’s disease but should still be checked by a doctor.

Causes

Paget’s disease is usually a sign of breast cancer in tissue behind the nipple, or breast tissue away from the nipple.

The breast cancer can either be:

invasive – where cancerous cells invade the surrounding breast tissue non-invasive – where the cancerous cells are contained in one or more areas of the breast and are unable to spread

In a small amount of cases, the only evidence of Paget’s disease is the nipple changes.

In about half of all cases of Paget’s disease of the nipple, a lump is found in the breast. The majority of people with a lump will have invasive breast cancer, although this does not necessarily mean it has spread.

Most people with Paget’s disease of the nipple who don’t have a lump will have non-invasive breast cancer.

Diagnoses

You should visit your GP if you notice any changes in the skin of your nipple or areola (the darker area of skin around the nipple).

As Paget’s disease is a form of breast cancer, the sooner it’s diagnosed, the better the outcome is likely to be.

Speak to your GP if you develop a lump in your breast. While most breast lumps are not cancerous, it’s important you have it checked out.

Read more about:

the symptoms of breast cancer how Paget’s disease is diagnosed


As Paget’s disease of the nipple is usually a sign of breast cancer, it’s very important you speak to your GP if you notice changes to the tissue or skin of your breast.

In particular, you should tell your GP if you notice any changes to:

the skin of your nipple or areola (the darker area of skin around the nipple) your breasts, particularly lumps in your breast 

Paget’s disease of the nipple can sometimes be confused with eczema, a skin condition that also causes red, itchy and dry skin.

Therefore, you should visit your GP for a diagnosis rather than assuming you have eczema. Paget’s disease is a form of breast cancer and the sooner it’s diagnosed, the better the outcome is likely to be.

Your GP will examine both breasts, even if you only have a problem with one of them. They may also ask you:

about your symptoms and how long you have had them whether you have a history of eczema, or have eczema anywhere else on your body whether you have a personal or family history of breast cancer your age and whether you have experienced the menopause (when a woman’s monthly periods stop) whether you’re taking any medication, including hormone replacement therapy (HRT), which is used to treat some of the symptoms of the menopause, or the oral contraceptive pill how much alcohol you drink how much you weigh and if you have recently gained weight

If your GP thinks you may have breast cancer, they will refer you to a specialist breast clinic for tests. 


There are a number of other tests that can be used if a diagnosis of breast cancer is confirmed and help determine what types of treatment might be used.

Treatments

Paget’s disease is treated in the same way as breast cancer. 

Surgery is usually the first line of treatment but unlike other forms of breast cancer, it involves removing breast tissue that includes the nipple and areola.

This may be followed by a combination of:

chemotherapy – where powerful medication is used to destroy cancerous cells radiotherapy – where controlled doses of high-energy radiation are used to destroy cancerous cells biological or hormone therapy – which can be used to treat certain types of cancer 

If Paget’s disease is detected and treated in its early stages, there’s a good chance of recovery. Read more about how Paget’s disease is treated.


Paget’s disease of the nipple is often associated with other forms of breast cancer.

It’s usually treated in the same way as more common types of breast cancer, either by removing the cancerous section of the breast or sometimes by removing the entire breast – a procedure known as a mastectomy.

You can discuss any concerns you have with your oncologist (cancer specialist) who will be able to explain each phase of your treatment.


After your surgery, you may need further treatment if you have invasive breast cancer, where the cancerous cells have spread into other tissue in your breast.

If you had non-invasive breast cancer, where the breast cancer cells were contained in one area of your breast, surgery may be all the treatment you need.

Other types of treatment for breast cancer include:

chemotherapy – cytotoxic medication that prevents cancer cells from dividing and growing is used to destroy cancer cells radiotherapy – where controlled doses of high-energy radiation, usually X-rays, are used to destroy cancer cells biological therapy – if your breast cancer is HER2 positive, biological therapy, usually a medication called trastuzumab, can be used to treat the cancer by stopping the effects of HER2 and helping your immune system fight off cancer cells hormone therapy – if your breast cancer is hormone-receptor positive, hormone therapy can be used to treat the cancer by lowering the levels of hormones in your body or stopping their effects

Preventions

Modifying certain lifestyle factors, such as reducing alcohol intake and regular exercise, may reduce your risk of developing certain types of cancer, including breast cancer. However, these factors remain controversial.

Screening is also used to help detect breast cancer early. The NHS Breast Screening Programme provides free breast screening every 3 years for all women in the UK who are 47 years of age or over.

Read more about preventing breast cancer.


A number of factors can help reduce your risk of developing breast cancer, including Paget’s disease of the nipple.

Pancreatic cancer
of cancer, cancer types in adults

Pancreatic cancer is caused by the abnormal and uncontrolled growth of cells in the pancreas – a large gland that’s part of the digestive system.

Around half of all new cases are diagnosed in people aged 75 or over. It’s uncommon in people under 40 years of age.

Symptoms

In the early stages, a tumour in the pancreas doesn’t usually cause any symptoms, which can make it difficult to diagnose.

It’s important to remember that these symptoms can be caused by many different conditions, and aren’t usually the result of cancer. But you should contact your GP if you’re concerned, or if these symptoms start suddenly.

The first noticeable symptoms of pancreatic cancer are often:

pain in the back or stomach area – which may come and go at first and is often worse when you lie down or after you’ve eaten unexpected weight loss jaundice – the most obvious sign is yellowing of the skin and whites of the eyes; it also causes your urine to be dark yellow or orange and your stools (faeces) to be pale-coloured

Other possible symptoms of pancreatic cancer include:

nausea and vomiting bowel changes fever and shivering indigestion blood clots

You may also develop symptoms of diabetes if you have pancreatic cancer, because it can produce chemicals that interfere with the normal effect of insulin.

Endocrine pancreatic cancer

There are also a number of different endocrine tumours that cause different symptoms, depending on the hormone the tumour produces.


In its early stages, pancreatic cancer rarely causes symptoms.

The pancreas is actually 2 glands in one, and symptoms depend on which part is affected. This is because:

the exocrine pancreas produces digestive enzymes, which break down food so they can be absorbed by your body the endocrine pancreas produces hormones – including insulin, which keeps your blood sugar levels stable

Most cases of pancreatic cancer are in the exocrine pancreas, and the 3 most common symptoms are:

pain in the stomach or back jaundice weight loss

It’s important to remember that these symptoms can be caused by many different health conditions and aren’t usually the result of cancer. However, you should contact your GP if you’re concerned, or if you suddenly develop these symptoms.


Other possible symptoms of pancreatic cancer include:

itching (if you have jaundice) nausea and vomiting bowel changes fever and shivering indigestion blood clots

Causes

It’s not fully understood what causes pancreatic cancer, but a number of risk factors for developing the condition have been identified.

Risk factors for pancreatic cancer include:

age – it mainly affects people who are 50 to 80 years of age  smoking – around 1 in 3 cases is associated with using cigarettes, cigars or chewing tobacco having a history of certain health conditions – such as diabetes, chronic pancreatitis (long-term inflammation of the pancreas), stomach ulcer and Helicobacter pylori infection (a stomach infection)

In about 1 in 10 cases, pancreatic cancer is inherited from a person’s parents. Certain genes also increase your chances of getting pancreatitis, which in turn increases your risk of developing cancer of the pancreas.

Cancer Research UK has more information on risk factors and causes on their website


The exact cause of pancreatic cancer isn’t fully understood. However, there are a number of risk factors that can increase your chances of developing it.

Diagnoses

Your GP will first ask about your general health and carry out a physical examination. They may examine your tummy (abdomen) for a lump and to see whether your liver is enlarged.

They’ll also check your skin and eyes for signs of jaundice and may request a urine sample and blood test.

If your GP suspects pancreatic cancer, you’ll usually be referred to a specialist at a hospital for further investigation. You may have either:

an ultrasound scan a computerised tomography (CT) scan a magnetic resonance imaging (MRI) scan a positron emission tomography (PET) scan – where you’re given an injection of a very small amount of radioactive medication, known as a tracer, which helps to show up cancers in an image

Depending on the results of a scan, further tests may include:

an endoluminal ultrasonography (EUS) endoscopy – a type of endoscopy which allows close-up ultrasound pictures to be taken of your pancreas  an endoscopic retrograde cholangiopancreatography (ERCP) – a type of endoscopy which is used to inject a special dye into your bile and pancreatic ducts; the dye will show up on an X-ray and highlight any tumours a laparoscopy – a surgical procedure that allows the surgeon to see inside your body using a laparoscopy (a thin, flexible microscope)

A biopsy, where a small sample is taken from a suspected tumour, may also be carried out during these procedures.

NICE guidelines

In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of pancreatic cancer and refer people for the right tests faster.

To find out if you should be referred for further tests for suspected pancreatic cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral.


In the early stages, pancreatic cancer often causes no symptoms. This can make it difficult to diagnose.

If you visit your GP with symptoms of pancreatic cancer, they will probably examine your eyes and skin for signs of jaundice.

They may also test your urine for bile, or carry out a blood test. This is because jaundice can sometimes be a sign of pancreatic cancer.

Your GP may also examine your tummy (abdomen) to feel for any swelling or abnormality. The pancreas is quite well-hidden within the body because it’s covered by part of the bowel. This can make it difficult to feel for tumours during a physical examination.

If your GP suspects pancreatic cancer, you’ll be referred for further testing at a hospital. 

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

Treatments

Cancer of the pancreas is difficult to treat. It rarely causes any symptoms in the early stages, so it’s often not detected until the cancer is fairly advanced. If the tumour is large, treating the cancer will be more difficult.

If you’ve been diagnosed with pancreatic cancer, your treatment will depend on the type and location of your cancer, and how far it’s advanced. Your age, general health and personal preferences will also be taken into consideration.

The first aim will be to completely remove the tumour and any other cancerous cells. If this isn’t possible, treatment will focus on preventing the tumour growing and causing further harm to your body.

The 3 main treatments for pancreatic cancer are:

surgery chemotherapy radiotherapy

Some types of pancreatic cancer only require one form of treatment, whereas others may require 2 types of treatment or a combination of all 3.

Read more about treating pancreatic cancer.


Treatment for pancreatic cancer depends on the type, location and stage of your cancer (how far it’s spread).

Your age, general health and personal preferences will also be taken into consideration when deciding on your treatment plan.

The first aim will be to completely remove the tumour and any other cancerous cells in your body.

If this isn’t possible, the focus will be on preventing the tumour growing and causing further harm.

Sometimes it’s not possible to get rid of the cancer or slow it down, so treatment will aim to relieve your symptoms and make you as comfortable as possible.

Cancer of the pancreas is very difficult to treat. In its early stages, this type of cancer rarely causes symptoms, so it’s often not detected until it’s quite advanced. If the tumour is large or has spread, treating or curing the cancer is much harder.


Deciding what treatment is best for you can be a difficult process. There’s a lot to take in, so it’s important to talk about the possible alternatives with a family member or friend.

You should also have an in-depth discussion with your doctor, who can tell you the pros and cons of the treatments available to you.

If at any stage you don’t understand the treatment options being explained to you, make sure you ask your doctor for more details.

There are 3 main ways that cancer of the pancreas can be treated:

surgery chemotherapy radiotherapy

Some types of pancreatic cancer only require one form of treatment, whereas others may require 2 or a combination of all 3.

Cancer Research UK has more information about types of treatment for pancreatic cancer.

Surgery

Surgery is usually the only way pancreatic cancer can be completely cured. However, as the condition is usually advanced by the time it’s diagnosed, surgery is only suitable for around 15 to 20% of people.

However, this isn’t a suitable option if your tumour has wrapped itself around important blood vessels. If your cancer has spread to other areas of the body, surgically removing the tumour won’t cure you.

Surgery for pancreatic cancer is usually only an option for people who have a good general level of health. This is because pancreas surgery is often long and complex, and the recovery process can be slow.

Sometimes the risks of surgery can outweigh the potential benefits.

Your doctor will discuss with you whether surgery is a suitable option.

Whipple procedure

The Whipple procedure is the most common operation used to treat pancreatic cancer, and involves removing the head of the pancreas.

Your surgeon must also remove the first part of your small intestine (bowel), your gall bladder (which stores bile) and part of your bile duct. Sometimes, part of the stomach also has to be removed.

The end of the bile duct and the remaining part of your pancreas is connected to your small intestine. This allows bile and the hormones and enzymes produced by the pancreas to still be released into your system.

After this type of surgery, about one in three people need to take enzymes to help them digest food.

The Whipple procedure involves long and intensive surgery, but it’s easier to recover from than a total pancreatectomy.

Distal pancreatectomy

A distal pancreatectomy involves removing the tail and body of your pancreas.

Your spleen will usually also be removed at the same time. Part of your stomach, bowel, left adrenal gland, left kidney and left diaphragm (the muscle that separates the chest cavity from the abdomen) may also be removed.

Like the Whipple procedure, a distal pancreatectomy is a long and complex operation that won’t be carried out unless your doctor thinks it’s necessary.

Total pancreatectomy

During a total pancreatectomy, your entire pancreas will be removed. This is sometimes necessary due to the position of the tumour.

Your surgeon will also remove your:

bile duct gall bladder spleen part of your small intestine part of your stomach (sometimes) surrounding lymph nodes (part of the immune system)

After a total pancreatectomy, you’ll need to take enzymes to help your digestive system digest food. You’ll also have diabetes for the rest of your life because the pancreas produces insulin – the hormone that regulates blood sugar.

Removing your spleen can increase your risk of developing infections and may also affect your blood’s ability to clot. This means you’ll be on penicillin (or an alternative antibiotic if you’re allergic to it) for the rest of your life, and you’ll need to have regular vaccinations.

Sometimes, you may need to take tablets for a short period to stop the platelets in your blood sticking to each other. Platelets are a type of blood cell that cause your blood to clot (thicken).

Surgery to ease your symptoms

Although surgery may not be a suitable way of removing your tumour, you may be offered it to help ease your symptoms.

This type of surgery won’t cure your cancer, but will mean that your condition is easier to manage, and it will make you more comfortable.

To help control jaundice, a stent can be placed in your bile duct using endoscopic retrograde cholangiopancreatography (ERCP). This will help keep the bile duct open and prevent bilirubin – the yellow chemical in bile – from building up and causing jaundice.

If a stent isn’t a suitable option for you, you may need an operation to bypass your blocked bile duct. Your surgeon will cut the bile duct just above the blockage and reconnect it to your intestine, which allows your bile to drain away.

These types of surgery are much less intensive than surgery carried out on the pancreas. The recovery time is much quicker, and people find that their jaundice improves significantly.

Panic disorder
of mental health

Panic disorder is where you have recurring and regular panic attacks, often for no apparent reason.

Everyone experiences feelings of anxiety and panic at certain times during their lifetime. It’s a natural response to stressful or dangerous situations.

However, for someone with panic disorder, feelings of anxiety, stress and panic occur regularly and at any time.

Symptoms

The symptoms of a panic attack can be very frightening and distressing.

Symptoms tend to occur suddenly, without warning and often for no apparent reason.

As well as overwhelming feelings of anxiety, a panic attack can also cause a variety of other symptoms, including:

a sensation that your heart is beating irregularly (palpitations) sweating trembling hot flushes chills shortness of breath  a choking sensation chest pain nausea dizziness feeling faint numbness or pins and needles dry mouth a need to go to the toilet ringing in your ears  a feeling of dread or a fear of dying a churning stomach a tingling sensation in your fingers shivering shaking

The physical symptoms of a panic attack are unpleasant, and they can also be accompanied by thoughts of fear and terror.

For this reason, people with panic disorder start to fear the next attack, which creates a cycle of living in ‘fear of fear’ and adds to the sense of panic.

Sometimes, the symptoms of a panic attack can be so intense they can make you feel like you’re having a heart attack.

However, it’s important to be aware that symptoms such as a racing heartbeat and shortness of breath won’t result in you having a heart attack. Although panic attacks can often be frightening, they don’t cause any physical harm. People who have had panic disorder for some time usually learn to recognise this ‘heart attack sensation’ and become more aware of how to control their symptoms.

Most panic attacks last for five to 20 minutes. Some attacks have been reported to have lasted up to an hour. However, it’s likely that in these cases one attack occurred straight after another or high levels of anxiety were felt after the first attack.

Causes

As with many mental health conditions, the exact cause of panic disorder isn’t fully understood.

However, it’s thought the condition is probably linked to a combination of physical and psychological factors.

Read about the possible causes of panic disorder.

It’s important to be aware that some physical conditions and disorders can have similar symptoms to those of anxiety. For example:

mitral valve prolapse postural orthostatic tachycardic syndrome (POTS) anaemia paroxysmal atrial tachycardia – episodes of rapid and regular heartbeats that begin and end abruptly thyrotoxicosis – where large amounts of thyroid hormones are released into the bloodstream, causing rapid heartbeat, sweating, tremor and anxiety poorly controlled diabetes adrenal tumours – growths that develop on the adrenal glands (two triangular-shaped glands that form part of the kidneys) carcinoid syndrome – a set of symptoms caused by some carcinoid tumours that can develop in the cells of the endocrine system (glands that produce and secrete hormones) Zollinger-Ellison syndrome – causes overproduction of insulin and low blood sugar (hypoglycaemia)


As with many mental health conditions, the exact cause of panic disorder isn’t fully understood.

It’s thought that panic disorder is probably caused by a combination of physical and psychological factors. Some of these factors are outlined below.

Diagnoses

See your GP if you have symptoms of anxiety or panic disorder (see above).

You may be diagnosed with panic disorder if you experience recurrent and unexpected panic attacks followed by at least one month of continuous worry or concern about having further attacks.

Read more about how panic disorder is diagnosed.


Everyone who has panic disorder will experience panic attacks.

However, not everyone who has panic attacks is diagnosed with panic disorder.

Treatments

The aim of treating panic disorder is to reduce the number of panic attacks you have and ease the severity of your symptoms.

Psychological therapy and medication are the two main types of treatment for panic disorder.

Read more about treating panic disorder and things you can do to help yourself during a panic attack.

Having panic disorder may affect your ability to drive. It’s your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving ability.

GOV.UK has further information and advice about driving with a disability or health condition.


The main aim in treating panic disorder is to reduce the number of panic attacks and ease the severity of symptoms.

Psychological therapy and medication are the two main types of treatment for panic disorder.

Depending on your individual circumstances, you may need one of these treatment types or a combination of the two.

If you’re offered psychological therapy, it will probably be in the form of cognitive behavioural therapy (CBT). If this doesn’t work, medication may be recommended.

Before starting any form of treatment, your GP will discuss all of the options with you, outlining the advantages of each type and making you aware of any possible risks or side effects.

No single treatment works for everyone and you may need to try a number of treatments before finding one that works for you. The treatment that’s recommended will depend on your general level of health, the severity of your condition and your personal preferences.

It’s important you understand what your treatment will involve. If you don’t understand something your GP has told you, ask them to explain it in more detail.

Complications

Panic disorder is treatable, but to make a full recovery it’s important that you seek medical help as soon as possible. Treatment for panic disorder is much more effective if it’s given at an early stage.

Left untreated, panic disorder can become a very debilitating and isolating illness. It can also increase your risk of developing other mental health conditions, such as agoraphobia or other phobias.

Agoraphobia is a fear of being in situations where escape might be difficult, or help wouldn’t be available if things go wrong.

Read more about the complications of panic disorder.


Panic disorder is a treatable condition, but to make a full recovery it’s very important you seek medical help as soon as possible.

This is because treatment for panic disorder is much more effective if it’s given at an early stage.

Left undiagnosed and untreated, panic disorder can become a debilitating and isolating illness. It can also increase your risk of developing other psychological conditions.