Warts and verrucas
of skin hair and nails

Most people will have warts at some point in their life. They tend to affect children and teenagers more than adults.

Warts are caused by certain strains of the human papilloma virus (HPV).

More images of warts Source: dermnetnz.org Source: dermnetnz.org


Warts are caused by certain strains of the human papilloma virus (HPV).

More images of warts Source: dermnetnz.org Source: dermnetnz.org


There are lots of different strains of HPV and these cause different types of warts.

HPV causes too much keratin (a hard protein) to develop in the top skin layer (epidermis). The extra keratin produces the rough, hard texture of a wart.

Causes

Warts are caused by certain strains of the human papilloma virus (HPV).

There are lots of different strains of HPV and these cause different types of warts.

HPV causes too much keratin (a hard protein) to develop in the top skin layer (epidermis). The extra keratin produces the rough, hard texture of a wart.

Treatments

Warts and verrucas aren’t usually serious and can be treated by a pharmacist.

Your pharmacist will give you advice about the best treatment for you.

Find your nearest pharmacy

Speak to a GP if you have a: growth on your skin that you’re worried about wart or verruca that keeps coming back wart or verruca that’s very large or painful wart that bleeds wart that changes in how it looks wart on your face or genitals


Warts usually clear up without treatment.

The length of time it takes for a wart to disappear will vary from person to person. It can take up to 2 years for the virus to leave your system and for warts to disappear. Warts tend to last longer in older children and adults.

Leaving the wart to go away by itself is one option. But, you may want to consider treatment if your wart is:

painful in an awkward position causing you distress or embarrassment

A wart will sometimes return following treatment.


Common ways to treat warts and verrucas include:

salicylic acid – available from pharmacies in creams, gels, paints and medicated plasters cryotherapy – liquid nitrogen is applied to the wart to freeze and destroy affected skin cells chemical treatments – chemicals are applied to warts to kill affected skin cells

Surgery is not usually recommended for warts.

Preventions

There are steps you can take to lower your chances of getting warts, and prevent them spreading to others.

Do keep your feet dry change your socks every day take care when shaving – the virus can be spread easily if you cut yourself wear gloves when using shared gym equipment if you have a wart on your hand wear pool slippers or flip flops in communal changing rooms and showers cover the wart or verruca with a waterproof plaster or a verruca sock when swimming or while doing PE at school

Don’t do not touch other people’s warts do not share towels, flannels or other personal items with someone who has a wart do not share shoes or socks with someone who has a verruca do not scratch or pick a wart or verruca – it’ll encourage the HPV to spread to other parts of your body

Whooping cough
of infections and poisoning

It causes repeated coughing bouts that can last for 2 to 3 months or more, and can make babies and young children in particular very ill.

Whooping cough is spread in the droplets of the coughs or sneezes of someone with the infection.


Whooping cough is spread in the droplets of the coughs or sneezes of someone with the infection.

Symptoms

The first symptoms of whooping cough are similar to those of a cold, such as a runny nose, red and watery eyes, a sore throat, and a slightly raised temperature.

Intense coughing bouts start about a week later.

The bouts usually last a few minutes at a time and tend to be more common at night.

Coughing usually brings up thick mucus and may be followed by vomiting.

Between coughs, you or your child may gasp for breath – this may cause a ‘whoop’ sound, although not everyone has this.

The strain of coughing can cause the face to become very red, and there may be some slight bleeding under the skin or in the eyes.

Young children can sometimes briefly turn blue (cyanosis) if they have trouble breathing – this often looks worse than it is and their breathing should start again quickly.

In very young babies, the cough may not be particularly noticeable, but there may be brief periods where they stop breathing.

The bouts will eventually start to become less severe and less frequent over time, but it may be a few months before they stop completely.

Treatments

Phone 999 or go to A&E if: You or your child: have significant breathing difficulties, such as long periods of breathlessness or choking, shallow breathing, periods where breathing stops, or dusky, blue skin  develop signs of serious complications of whooping cough, such as fits (seizures) or pneumonia

Speak to your GP practice or phone 111 if: You or your child: have symptoms of whooping cough have had a cough for more than 3 weeks have a cough that is particularly severe or is getting worse


Treatment for whooping cough depends on your age and how long you’ve had the infection.

Children under 6 months who are very ill and people with severe symptoms will usually be admitted to hospital for treatment.

People diagnosed during the first 3 weeks of infection may be prescribed antibiotics to take at home. These will help stop the infection spreading to others, but may not reduce the symptoms.

People who’ve had whooping cough for more than 3 weeks won’t normally need any specific treatment, as they’re no longer contagious and antibiotics are unlikely to help.

While you’re recovering at home, it can help to get plenty of rest, drink lots of fluids, clean away mucus and sick from your or your child’s mouth, and take painkillers such as paracetamol or ibuprofen for a fever.

Avoid using cough medicines, as they’re not suitable for young children and are unlikely to be of much help.

Complications

Babies and young children under 6 months are usually most severely affected by whooping cough.

They’re at an increased risk of:

dehydration breathing difficulties weight loss pneumonia – an infection of the lungs fits (seizures) kidney problems brain damage caused by a lack of oxygen reaching the brain death – although this is very rare

Older children and adults tend to be less severely affected, although they may experience problems caused by repeated coughing, such as nosebleeds, bruised ribs or a hernia.

Wilms’ tumour
of cancer, cancer types in children

More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past.

It is 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.

Wilms’ tumour is a type of kidney cancer that was named after Dr Max Wilms, who first described it. It’s thought to come from very specialised cells in the embryo known as metanephric blastema. These cells are involved in the development of the child’s kidneys while they are in the womb. The cells usually disappear at birth, but in many children with Wilms’ tumour, clusters of primitive kidneys cells, called nephrogenic rests can still be found.

The kidneys are a pair of organs found at the back of the abdomen. They clean the blood by removing excess fluids and waste products, which are then converted into urine.


It is 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.

Wilms’ tumour is a type of kidney cancer that was named after Dr Max Wilms, who first described it. It’s thought to come from very specialised cells in the embryo known as metanephric blastema. These cells are involved in the development of the child’s kidneys while they are in the womb. The cells usually disappear at birth, but in many children with Wilms’ tumour, clusters of primitive kidneys cells, called nephrogenic rests can still be found.

The kidneys are a pair of organs found at the back of the abdomen. They clean the blood by removing excess fluids and waste products, which are then converted into urine.


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.

Wilms’ tumour is a type of kidney cancer that was named after Dr Max Wilms, who first described it. It’s thought to come from very specialised cells in the embryo known as metanephric blastema. These cells are involved in the development of the child’s kidneys while they are in the womb. The cells usually disappear at birth, but in many children with Wilms’ tumour, clusters of primitive kidneys cells, called nephrogenic rests can still be found.

The kidneys are a pair of organs found at the back of the abdomen. They clean the blood by removing excess fluids and waste products, which are then converted into urine.

Symptoms

The most common symptom is a swollen abdomen, which is usually painless. Sometimes a parent or carer may feel a lump in the abdomen which can be quite large. Occasionally, the tumour may bleed slightly and this can irritate the kidney and may be painful. There may be blood in your child’s urine (pee), or their blood pressure may be raised. The child may also have a high temperature (fever), upset stomach, weight loss or a lack of appetite.

Causes

In most children, the causes of Wilms’ tumour are unknown. Very rarely, people who develop Wilms’ tumour have other specific conditions which are present at birth (congenital malformations). These include the lack of an iris in the eye (aniridia), abnormalities of the genitals, and a condition where one side of the body is slightly larger than the other (hemihypertrophy).

In 1 in 100 people with Wilms’ tumour, another family member will also have Wilms’ tumour.

Diagnoses

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

An abdominal ultrasound scan is usually the first thing that is done. This will be followed by an MRI and/or CT scan of the abdomen and chest. These scans help doctors to identify exactly where the tumour is and whether it has spread beyond the kidney. This is known as staging. Urine and blood samples will also be taken to check your child’s kidney function and general health. Most children will go on to have a biopsy, where a sample of tissue is taken from the tumour to confirm the diagnosis. Any tests and investigations that your child needs will be explained to you.

Staging

The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps doctors decide on the most appropriate treatment.

In the case of a Wilms’ tumour, the stage is finalised after surgery to remove the tumour. As most Wilms’ tumour patients receive chemotherapy before surgery, you may not know the exact stage of your child’s tumour straight away. An exception is that babies under 6 months old usually have surgery straight away.

Stage 1

The tumour is only affecting the kidney and has not begun to spread. It can be completely removed with surgery.

Stage 2

The tumour has begun to spread beyond the kidney to nearby structures, but it’s still possible to remove it completely with surgery.

Stage 3

The tumour has spread beyond the kidney; either because the tumour has burst before (or during) the operation, has spread to lymph glands (nodes), or has not been completely removed by surgery.

Stage 4

The tumour has spread to other parts of the body such as the lungs or liver. Tumours in other parts of the body are known as metastases.

Stage 5

There are tumours in both kidneys (bilateral Wilms’ tumour).

If the tumour comes back after initial treatment, this is known as recurrent cancer or relapse.

Treatments

Treatment is planned by specialists in children’s tumours and cancers. This is usually based in a children’s oncology unit within a main hospital, but some treatment may be given closer to home.

Treatment will depend on a number of factors including how the cells appear under the microscope (histology) and the stage of the tumour. Treatment may include chemotherapy, radiotherapy or surgery.

Surgery

All children with Wilms’ tumour will have surgery. Initially, this may only involve taking a small sample of cells from the tumour to confirm the diagnosis. This is called a biopsy and is usually done under a general anaesthetic using a needle inserted through the skin.

Apart from very young children (under 6 months), most patients will receive chemotherapy before having a bigger operation to remove the entire tumour. The operation usually involves removing the whole of the affected kidney (nephrectomy).

After examining the whole tumour under the microscope, Wilms’ tumours can be divided into a number of risk groups based on knowledge about how these different types of tumours are likely to behave. The treatment following surgery will depend on these risk groups. The risk groups are known as LOW, STANDARD (or INTERMEDIATE), and HIGH.

The majority of tumours are in the ‘standard risk’ group. So-called ‘low risk’ tumours require less treatment than standard risk tumours.

Two types of Wilms’ tumour – anaplastic and blastemal – are considered to be ‘higher risk’ than other Wilms’ tumours and require more intensive (stronger) chemotherapy.

Anaplastic Wilms’ tumour

About 5% to 10% of Wilms’ tumours have an appearance called anaplasia, which means the cells look very disorganised under a microscope.

Blastemal Wilms’ tumour

This group of high-risk tumours cannot be identified by looking at the biopsy because they occur when a particular type of early kidney cell survives the pre-surgery chemotherapy. These cells are known as blastemal cells. Tumours, where most of these cells survive chemotherapy, are called blastemal tumours.

Other kidney tumours

Other, less common types of kidney tumours may occur in children. These are usually only recognised after surgery to obtain a tumour sample. ‘Clear cell sarcoma’ and ‘malignant rhabdoid tumour’ of the kidney are 2 types of cancerous tumour, with their own treatment recommendations.

Congenital mesoblastic nephroma is a non-cancerous (benign) tumour that occurs in very young children. This type of tumour usually only needs surgery and no other treatment.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It’s usually given as an injection or drip into a vein (intravenously). Chemotherapy given before surgery is called neoadjuvant chemotherapy.

What doctors find out about the tumour after surgery – for example, how the cells look under the microscope and how far the cancer has spread – helps them to decide whether additional chemotherapy should be given (adjuvant chemotherapy). This is to help reduce the risk of the cancer coming back (recurring). This chemotherapy may be given as inpatient or outpatient depending on tumour staging and risk group.

Radiotherapy

Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells.

Not all children with Wilms’ tumour need radiotherapy. For those that do, the area to be treated depends on the stage of the tumour at diagnosis. Some children receive radiotherapy to the area around the affected kidney or, less commonly, to the whole abdomen. If the tumour has spread to the lungs, then lung radiotherapy may be needed but this depends on how well the cancer responds to initial chemotherapy; it’s not always needed.

Radiotherapy may occasionally be used to shrink tumours that are too large to remove surgically. This will, ideally, allow an operation to be done. Radiotherapy can also be used when tumours have spread elsewhere in the body.

Treatment for bilateral Wilms’ tumour

In about 1 in 20 cases, Wilms’ tumour affects both kidneys. Treatment usually involves surgery to both. The aim of the treatment is to remove as much of the cancer as possible, while leaving as much healthy kidney as possible. Chemotherapy is always given. Sometimes radiotherapy is needed as well.

Side effects of treatment

Treatment for Wilms’ tumour often causes side effects. Your child’s doctor will discuss this with you before treatment starts. Many side effects are expected and managed effectively. Side effects can include feeling sick (nausea) and being sick (vomiting), hair loss, bruising and bleeding, tiredness, diarrhoea, and an increased risk of infection. Less common effects may include impact on the heart, kidneys, and liver.

Late side effects

A small number of children may develop late side effects, sometimes many years later. These include a possible reduction in bone growth, a change in the way the heart and lungs work, and a slight increase in their risk of developing another cancer in later life. Infertility is a possible late side effect, although this is rare.

Your child’s doctor or nurse will talk to you about any possible late side effects. These will depend on the exact treatments given.

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. The trial may include comparing the standard treatment with a new or modified version. It may just involve collecting patient and tumour details including response to treatment to increase specialists’ knowledge. 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 will 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

Most children with Wilms’ tumour are cured. If the cancer comes back, it’s usually within the first 2 years. When one kidney is removed, the other will be able to work normally and can take over the work of the other kidney.

Very few children have long-term kidney problems. Your child will have regular check-ups to look for any recurrence or problems following treatment.

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.

Womb (uterus) cancer
of cancer, cancer types in adults

Cancer of the womb (uterus) is a common cancer that affects the female reproductive system. It’s also called uterine cancer and endometrial cancer.

Abnormal vaginal bleeding is the most common symptom of womb cancer.

If you have been through the menopause, any vaginal bleeding is considered abnormal. If you have not yet been through the menopause, unusual bleeding may include bleeding between your periods.

You should speak to your GP as soon as possible if you experience any unusual vaginal bleeding. While it’s unlikely to be caused by womb cancer, it’s best to be sure.

Your GP will examine you and ask about your symptoms. They will refer you to a specialist for further tests if they suspect you may have a serious problem, or if they are unsure about a diagnosis.

Read more about the symptoms of womb cancer and diagnosing womb cancer

Symptoms

The most common symptom of womb cancer is abnormal bleeding from the vagina, although most people with abnormal bleeding don’t have cancer.

Bleeding may start as light bleeding accompanied by a watery discharge, which may get heavier over time. Most women and anyone with a womb diagnosed with womb cancer have been through the menopause, so any vaginal bleeding will be unusual.

In women and anyone with a womb who hasn’t been through the menopause, unusual vaginal bleeding may consist of:

periods that are heavier than usual vaginal bleeding in between normal periods

Less common symptoms include pain in the lower abdomen (tummy) and pain during sex.

If womb cancer reaches a more advanced stage, it may cause additional symptoms. These include:

pain in the back, legs, or pelvis loss of appetite tiredness nausea

Causes

It’s not clear exactly what causes womb cancer, but certain things can increase your risk of developing the condition.

A hormone imbalance is one of the most important risks for womb cancer. Specifically, your risk is increased if you have high levels of a hormone called oestrogen in your body.

A number of things can cause this hormone imbalance, including obesity, diabetes, and hormone replacement therapy (HRT). There is also a small increase in the risk of womb cancer with long-term use of the breast cancer drug tamoxifen.

It’s not always possible to prevent womb cancer, but some things are thought to reduce your risk. This includes maintaining a healthy weight and the long-term use of some types of contraception.

Read more about the causes of womb cancer


It’s not known exactly what causes womb cancer, but certain things can increase your risk of developing it.

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

If left untreated, cancer can grow and spread to other parts of your body, either directly or through the blood and lymphatic system.

Diagnoses

You should visit your GP if you have abnormal vaginal bleeding. While it’s unlikely to be caused by womb cancer, it’s best to be sure.

Your GP will probably carry out a physical examination of your pelvic area, including your vagina, womb, ovaries, and bladder. They will ask about your symptoms, when they happen, and how often.

You may be referred to a specialist in conditions of the female reproductive organs (a gynaecologist) for further tests.

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


A blood test can sometimes help diagnose womb cancer. This is because some cancerous tumours release certain chemicals into your blood, known as tumour markers, which can be detected during a blood test.

However, this type of test isn’t very reliable. The presence of these chemicals doesn’t mean you definitely have womb cancer. Some people with womb cancer don’t have these chemicals in their blood.

Read further information:

Cancer Research UK: womb cancer tests Macmillan: how womb cancer is diagnosed


If you’re diagnosed with womb cancer, you may have further tests to help determine the stage of the cancer. Staging the cancer will allow the doctors to work out how large the cancer is, whether or not it has spread, and the best treatment options for you.

These tests may include:

a chest X-ray – where radiation is used to check if the cancer has spread to the lungs magnetic resonance imaging (MRI) – where magnetic fields are used to create a detailed image of the inside of your body to check if the cancer has spread a computerised tomography (CT) scan – where a series of X-rays are used to create a detailed image of the inside of your body to check if the cancer has spread further blood tests – these are usually done to check your general health and how well some of your organs are functioning

Read treating womb cancer for more information about staging.

Treatments

The most common treatment for womb cancer is the surgical removal of the womb (hysterectomy).

A hysterectomy can cure womb cancer in its early stages, but you will no longer be able to get pregnant. Surgery for womb cancer is also likely to include the removal of the ovaries and fallopian tubes.

Radiotherapy or chemotherapy are also sometimes used, often in conjunction with surgery.

A type of hormone therapy may be used if you are yet to go through the menopause and would still like to have children.

Even if your cancer is advanced and the chances of a cure are small, treatment can still help to relieve symptoms and prolong your life.

Read more about treating womb cancer


If you have postmenopausal vaginal bleeding, or notice a change in the normal pattern of your period, visit your GP.

Only 1 in 10 cases of unusual vaginal bleeding after the menopause are caused by womb cancer, so it’s unlikely your symptoms will be caused by this condition.

However, if you have unusual vaginal bleeding, it’s important to get the cause of your symptoms investigated. The bleeding may be the result of a number of other potentially serious health conditions, such as:

endometriosis – where tissue that behaves like the lining of the womb is found on the outside of the womb fibroids – non-cancerous growths that can develop inside the uterus polyps in the womb lining

Other types of gynaecological cancer can also cause unusual vaginal bleeding, particularly cervical cancer.

Read further information:

Cancer Research UK: womb cancer symptoms Macmillan: symptoms of womb cancer  


Health professionals use a staging system to describe how far womb cancer has advanced. These stages are:

stage 1 – the cancer is still contained inside the womb (uterus) stage 2 – the cancer has spread to the neck of the womb (the cervix) stage 3 – the cancer has spread outside the womb into nearby tissues in the pelvis or the lymph nodes stage 4 – the cancer has spread to the soft tissues of the abdomen, or into other organs, such as the bladder, bowel, liver, or lungs

Your chances of surviving womb cancer depend on the stage at which it’s diagnosed.

Read further information:

Cancer Research UK: stages of womb cancer Cancer Research UK: statistics and outlook for womb cancer


The main treatment for womb cancer is to remove the womb (hysterectomy), together with the ovaries and fallopian tubes. This is sometimes followed by radiotherapy or chemotherapy to try to kill any possible remaining cancer cells, depending on the stage and grade of the cancer.


Having a hysterectomy means you will no longer be able to get pregnant. Younger women who haven’t already reached the menopause may not want to have their womb and ovaries removed if they wish to have children.

In this case, under very specific circumstances it may be possible to treat the cancer using hormone therapy.


Advanced womb cancer requires a different course of treatment, usually depending more on chemotherapy.

Advanced cancer may not be curable, but the treatment aims to achieve a remission, where the cancer shrinks, making you feel normal and able to enjoy life to the full.

Even if there’s no chance of a cure, surgery may be carried out to remove as much of the cancer as possible.

Radiotherapy, chemotherapy or hormone therapy can reduce symptoms such as pain by shrinking the cancer or slowing its growth.

Read further information:

Cancer Research UK: controlling symptoms of advanced womb cancer Cancer Research UK: which treatment for womb cancer?

Yellow fever
of infections and poisoning

The condition can be prevented with a vaccination and is a very rare cause of illness in travellers.

Between 1999 and 2018, there were 12 cases of yellow fever reported among European travellers. None of these travellers were vaccinated, 5 of these cases occurred in 2018.

If you’re planning to visit places where yellow fever infection is found, you should seek travel health advice before you travel. A map and list of countries where yellow fever is found is available on the NHS Fit for Travel website.


Between 1999 and 2018, there were 12 cases of yellow fever reported among European travellers. None of these travellers were vaccinated, 5 of these cases occurred in 2018.

If you’re planning to visit places where yellow fever infection is found, you should seek travel health advice before you travel. A map and list of countries where yellow fever is found is available on the NHS Fit for Travel website.


If you’re planning to visit places where yellow fever infection is found, you should seek travel health advice before you travel. A map and list of countries where yellow fever is found is available on the NHS Fit for Travel website.

Symptoms

The symptoms of yellow fever occur in 2 stages. The initial symptoms develop 3 to 6 days after infection, and can include:

a high temperature (fever) a headache nausea or vomiting muscle pain, including backache loss of appetite

This stage will usually pass after 3 to 4 days and most people will make a full recovery.

However, around 15% of people go on to develop more serious problems, including jaundice (yellowing of the skin and whites of the eyes), kidney failure and bleeding from the mouth, nose, eyes or stomach (causing blood in your vomit and stools).

Up to half of those who experience these symptoms will die.

Treatments

You should see a doctor as soon as possible if you develop symptoms of yellow fever and are currently travelling in an area where the virus is found, or have recently returned from one of these areas.

To help determine whether you have yellow fever, the doctor will want to know exactly where you have been travelling and what symptoms you have. A blood test will be needed to confirm the diagnosis.


There is no specific treatment for yellow fever, but you will be monitored and the symptoms can be treated.

You will be admitted to hospital for assessment and supportive care.