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Medical Edge Newspaper Column from Mayo Clinic
TREATING RARE CANCER MAY NOT REQUIRE BLADDER REMOVAL
DEAR MAYO CLINIC: What can you tell me about a kind of childhood
cancer called rhabdomyosarcoma? My 5-year-old grandson is being evaluated
for this condition and his mother, my daughter, is too distraught to tell
me a thing. She says my grandson faces surgical removal of his bladder.
Surely this can’t be the only option, with all the advances we read about.
— Pittsburgh
ANSWER: You’re right. There are advances that extend the lives
of childhood cancer patients. Because of such progress, it makes sense
to get a second opinion if you are presented with a permanently life-altering
treatment, such as bladder removal, that conflicts with what you’ve read
or heard elsewhere.
Rhabdomyosarcoma is a rare cancer that originates from muscle cells and
can appear in the bladder. In the past, bladder removal was a common aggressive
treatment option that was very successful in extending children’s lives.
Now, there’s a trend to preserve the bladder by using chemotherapy and
radiation to treat the cancer. This strategy has proven successful, extending
children’s lives while allowing them to maintain their bladder function.
Studies show that 55 percent of patients who underwent chemotherapy/radiation
and had no return of cancer had normal to near-normal bladder function
as they matured.
Each year, about 400 new cases of rhabdomyosarcoma are diagnosed in the
United States. Because it’s so rare, medical centers that have expertise
in the disease unite to study it. This network is a wonderful resource
for patients who are interested in participating in national trials of
new, promising treatments. Contact your nearest advanced medical center
or university for the name of a participating institution.
Carola Arndt, M.D., Pediatric Oncology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Treatment
of Rhabdomyosarcoma
Appointment
Information
More
Information on Sarcomas
DEAR MAYO CLINIC: I received three medications for an endoscopy:
2 mg of midazolam (Versed), 100 mcgs of fentanyl and 30 mg of propofol.
When I woke up, I had severe pressure and pain in my head, which has lasted
for three weeks. The doctor said the medication couldn’t be the cause.
All I want is to get rid of the headaches and get back to a normal life.
Should I see a neurologist? I need help! — Phoenix
ANSWER: Severe headaches that are new or different from previous
headaches need to be checked out.
The endoscopy (or the medications) may have had something to do with your
headaches, but three weeks of pain suggests something more than the effects
of medication.
First discuss your situation with your primary-care physician, who then
may refer you to a neurologist. The initial and most important step will
be a review of your symptoms and medical history. Your appointment should
include a physical exam and, possibly, blood tests and/or imaging studies
like a computed tomography (CT) scan or magnetic resonance imaging (MRI).
You will be asked questions such as: Have you had previous headaches?
How are the current symptoms different? Are your headaches associated
with nausea, vomiting or sensitivity to light, sounds or smells? Is it
more comfortable to remain still? Are there certain activities that make
your headache better or worse? What triggers a headache? Can the pain
awaken you from a sound sleep? Do you have any visual changes, numbness,
tingling, weakness or speech problems that occur with your headaches?
Your provider will review other medical problems that might make you susceptible
to specific types of headaches. The provider will ask about prescription
or over-the-counter medications you take that might produce a drug interaction
with medications given for the endoscopy or cause side effects.
The vast majority of headaches are due to benign causes. A thorough examination
likely will provide some reassurance and result in a treatment plan to
reduce your suffering. Options include medications that you take daily
or as needed to prevent or stop headaches, relaxation techniques or physical
therapy. A quick fix may or may not be possible, but there are many ways
to minimize and manage headaches.
David Black, M.D., Neurology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Treatment for Headaches
Appointment
Information
More
Information on Headaches
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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