New insight into how excess belly fat may increase cancer risk

New insight into how excess belly fat may increase cancer risk

New insight into how excess belly fat may increase cancer risk

“Belly fat releases proteins that fuel the growth of malignant [cancerous] cells,” the Mail Online reports.

It’s long been known that obesity is an independent risk factor for a number of cancers, including breast, bowel and liver cancer. But it’s less clear why this is the case.

This question has become more pressing, as it’s estimated obesity will soon overtake smoking as the leading preventable cause of cancer in the developed world.

A new study has investigated the possible biological mechanisms behind this link. Researchers focused on visceral adipose tissue, the fat that coats internal organs. Visceral fat leads to a bigger waist size and more belly fat.

The researchers found excess visceral fat stimulated the growth of normal, healthy cells and may promote cancerous change by releasing a protein called fibroblast growth factor-2 (FGF2).

But visceral fat wasn’t able to stimulate growth when cells lacked FGF2 receptors. Receptors are specialised parts of cells designed to respond to certain chemical signals.

The researchers suggest the findings could pave the way for important cancer prevention strategies targeting FGF2. But this research is still in its very early stages.

Maintaining a healthy weight is one of the most effective ways of reducing your risk of cancer, as well as a number of other serious health conditions.

Where did the story come from?

The study was carried out by researchers in the US from several institutions, including Michigan State University and the Yale School of Medicine.

Although the study wasn’t directly funded by any organisation, individual authors received grants from different funding bodies, including the US National Institutes of Health and the Office of the Assistant Secretary of Defense for Health Affairs’ Breast Cancer Research Program.

The study was published in the peer-reviewed journal Oncogene. It’s available on an open access basis and can be read for free online.

Generally, the Mail Online’s coverage was accurate. Their coverage also referenced a narrative review from July 2017 on the influence of visceral fat on health outcomes, but we’re unable to comment on the accuracy of the reporting on that study.

What kind of research was this?

This animal and laboratory study aimed to investigate the relationship between excess body fat, specifically fat around the organs (visceral adipose tissue), and cancer risk.

There’s plenty of evidence to confirm the link between having excess visceral fat and the risk of developing cardiovascular disease and type 2 diabetes.

Recent evidence suggests excess visceral fat may also be linked to the risk of developing breast and colon cancer.

But the exact biological mechanisms aren’t well understood. The researchers hoped to study in more detail how visceral fat causes a normal, healthy cell to progress into a cancerous one.

Early-stage research is very useful for improving our understanding of mechanisms that occur at a cellular level. But even though mice are genetically similar to humans in many ways, we aren’t identical.

That being said, regardless of whether human or animal cell lines are being studied, there could be external factors playing a role in the association that can’t be explored, such as whether or not someone smokes.

What did the research involve?

The study involved both research in mice and tests on human fat cells in the laboratory.

The mice were either fed a low-fat diet, high-fat diet or normal diet, and were induced to grow cancerous cells using ultraviolet-B rays. Their visceral fat was then collected and any tumours were analysed.

The researchers also obtained samples of visceral fat tissue from mice and cancer-free obese human subjects. They studied whether incubating this tissue with the epithelial cells that line organs caused cancer.

What were the basic results?

The researchers found visceral fat tissue stimulated the growth of a protein called fibroblast growth factor-2 (FGF2) in some cases if the FGF2 receptors were present.

This in turn stimulated the growth of epithelial cells, which may have the possibility of turning malignant (cancerous).

In the live mice, the researchers also discovered that circulating levels of FGF2 were associated with the formation of non-melanoma tumours.

How did the researchers interpret the results?

The researchers suggest that the release of FGF2 could be a pathway by which visceral adipose tissue leads to tumour generation.

They concluded that, “These data therefore suggest FGF2 stimulation of [FGF2 receptors] as a previously unappreciated link between [visceral adipose tissue] and cell transformation.

“This key finding begins to inform how [high-fat diets] and/or visceral adiposity elevate cancer risk, previously suggested only via epidemiological studies.”

Conclusion

This animal and laboratory study investigated the possible cellular relationship between excess body fat – specifically fat around the body organs – and cancer risk.

It seems one key mechanism by which excess visceral fat could stimulate healthy cells to develop into cancerous ones could be through FGF2 levels.

The researchers hope their study could pave the way for possible cancer prevention strategies by stopping FGF2 production in obese people with excess belly fat.

They even go as far as suggesting that blocking FGF2 receptors could be one part of a treatment approach after a diagnosis of breast or skin cancer.

But it’s too early to speculate about the implications of this research. Early-stage animal and laboratory studies like this one are useful for better understanding mechanisms that occur at a cellular level.

We don’t know that this is the whole answer. Various genetic, health and lifestyle factors are likely to be play a combined role in the association between body fat and cancer development.

Find out more about losing weight.

Radiotherapy – how is it used to treat cancer

Radiotherapy

Radiotherapy

Radiotherapy is a treatment where radiation is used to kill cancer cells.

There are many different ways you can have radiotherapy, but they all work in a similar way.

They damage cancer cells and stop them from growing or spreading in the body.

 

When radiotherapy is used

Radiotherapy may be used in the early stages of cancer or after it has started to spread.

It can be used to:

try to cure the cancer completely (curative radiotherapy)

make other treatments more effective – for example, it can be combined with chemotherapy (chemoradiation) or used before surgery (neo-adjuvant radiotherapy)

reduce the risk of the cancer coming back after surgery (adjuvant radiotherapy)

relieve symptoms if a cure isn’t possible (palliative radiotherapy)

Radiotherapy is generally considered the most effective cancer treatment after surgery, but how well it works varies from person to person.

Ask your doctors about the chances of treatment being successful for you.

Types of radiotherapy

Radiotherapy can be given in several ways. Your doctors will recommend the best type for you.

The most common types are:

radiotherapy given by a machine (external radiotherapy) - where a machine is used to carefully aim beams of radiation at the cancer

radiotherapy implants (brachytherapy) - where small pieces of radioactive metal are (usually temporarily) placed inside your body near the cancer

radiotherapy injections, capsules or drinks (radioisotope therapy) - where radioactive liquid is swallowed or injected into your blood

Treatment is usually given in hospital. You can normally go home soon after external radiotherapy, but you may need to stay in hospital for a few days if you have implants or radioisotope therapy.

Most people have several treatment sessions, which are typically spread over the course of a few weeks.

Read more about what happens during radiotherapy.

Side effects of radiotherapy

As well as killing cancer cells, radiotherapy can damage some healthy cells in the area being treated.

This can cause some side effects, such as:

sore, red skin

feeling tired most of the time

hair loss in the area being treated

feeling sick

losing your appetite

a sore mouth

diarrhoea

Many of these side effects can be treated or prevented and most will pass after treatment stops.

External radiotherapy doesn't make you radioactive, as the radiation passes through your body.

The radiation from implants or injections can stay in your body for a few days, so you may need to stay in hospital and avoid close contact with other people for a few days as a precaution.

Read more about the side effects of radiotherapy.

Clinical trials and medical research – find out more here

Clinical trials and medical research

Clinical trials and medical research

A clinical trial compares the effects of one treatment with another. It may involve patients, healthy people, or both.

[Original article on NHS Choices website]

 

How do I take part in a clinical trial?

You can ask your doctor or a patient organisation if they know of any clinical trials that you may be eligible to join.

You can also search for information on a number of websites and register your interest in taking part in research. The main ones are described below.

UK Clinical Trials Gateway

The UK Clinical Trials Gateway (UKCTG) website pulls through information about clinical trials and other research from several different UK registers. If you sign up to it, researchers can contact you about research that might be suitable for you.

You can also search the UKCTG site in various ways to find trials relevant to you, and you can contact researchers yourself.

WHO International Clinical Trials

The World Health Organization’s Clinical Trials Search Portal provides access to clinical trials in countries all around the world.

Charities

For some conditions, you can find out about clinical trials from the websites of charities.

Examples are:

Arthritis Research UK: current clinical trials and studies

Cancer Research UK: find a clinical trial

Multiple Sclerosis Society: MS clinical trials

Target Ovarian Cancer: clinical trials information centre

Why join a clinical trial?

Clinical trials help doctors understand how to treat a particular disease or condition. It may benefit you, or others like you, in the future.

If you take part in a clinical trial, you may be one of the first people to benefit from a new treatment.

However, there is also a chance that the new treatment turns out to be no better, or worse, than the standard treatment.

To hear other people’s experiences of taking part in a clinical trial, visit healthtalk.org: clinical trials.

Will I get paid?

Some clinical trials offer payment, which can vary from hundreds to thousands of pounds depending on what is involved and expected from you. Some trials don’t offer payment and just cover your travel expenses.

It’s important to find out about the inconvenience and risks involved before you sign up, and to carefully weigh up whether it is worth it.

Bear in mind:

it can be time consuming – you may be expected to attend a number of screening and follow-up sessions, and some trials require you to stay overnight

there may be restrictions on what you can and cannot do – for example, you may be asked to not eat or drink alcohol for a period of time

you may experience unknown side effects from the treatment

What happens in a clinical trial?

Testing a new medicine

All clinical trials of new medicines go through a series of phases to test whether they are safe and whether they work.

The medicines will usually be tested against another treatment called a control. This will either be a dummy treatment (a placebo) or a standard treatment already in use. Learn more about the placebo effect.

Phase one trials:

A small number of people, who may be healthy volunteers, are given the medicine.

The drug is being trialled in human volunteers for the first time.

Researchers test for side effects and calculate what the right dose might be to use in treatment.

Researchers start with small doses and only increase the dose if the volunteers don’t experience any side effects, or if they only experience minor side effects.

Phase two trials:

The new medicine is tested on a larger group of people who are ill. This is to get a better idea of its effects in the short term.

Phase three trials:

Carried out on medicines that have passed phases one and two.

The medicine is tested in larger groups of people who are ill, and compared against an existing treatment or a placebo to see if it’s better in practice and if it has important side effects.

Trials often last a year or more and involve several thousand patients.

Phase four trials:

The safety, side effects and effectiveness of the medicine continue to be studied while it is being used in practice.

Not required for every medicine.

Only carried out on medicines that have passed all the previous stages and have been given marketing licences – a licence means the medicine can be made available on prescription.

Control groups, randomisation and blinding

If you take part in a clinical trial, you will usually be randomly assigned to either the:

treatment group – where you’ll be given the treatment being assessed, or

control group – where you’ll be given an existing standard treatment, or a placebo if no proven standard treatment exists

While the treatments are different in the two groups, researchers try to keep as many of the other conditions the same as possible.

For example, both groups should have people of a similar age, with a similar proportion of men and women, who are in similar overall health.

In most trials, a computer will be used to randomly decide which group each patient will be allocated to.

Many trials are set up so nobody knows who’s been allocated to receive which treatment. This is known as blinding, and it helps reduce the effects of bias when comparing the outcomes of the treatments.

What should I know before I sign up?

When you express interest in a trial, a doctor or nurse is likely to tell you something about it in person. You’ll also be given some printed information to take away. You may come back with some questions you feel haven’t been answered.

General questions

What is the aim of the trial and how will it help people?

Who is funding the trial?

What treatment will I get if I do not take part in the trial?

How long is the trial expected to last, and how long will I have to take part?

How long will it be before the results of the trial are known?

What will happen if I stop the trial treatment or leave the trial before it ends?

What would happen if something went wrong? It’s rare for patients to be harmed by trial treatments, but you may want to ask about compensation if this were to happen.

Practical questions

How much of my time will be needed?

Will I need to take time off work?

Will I be paid?

Will the costs of my travel to take part in the trial be covered?

If the trial is testing a new drug, will I have to collect it from the hospital, will it be sent to me by post, or will I get it through my doctor?

Will I have to complete questionnaires or keep a diary?

What are the possible side effects of my treatment?

How could the treatments affect me physically and emotionally?

Who can I contact if I have a problem?

Will someone be available 24 hours a day?

How do I find out the results of the trial?

Things to weigh up

As with any treatment, you can’t be sure of the outcome. You may be given a new treatment that turns out not to be as effective as the standard treatment. Also, it’s possible you’ll experience unexpected side effects.

And bear in mind that you may have to visit your place of treatment more often, or have more tests, treatments or monitoring, than you would if you were receiving the standard treatment in usual care.

Leaving a trial

You may decide to stop taking part in a trial if your condition is getting worse or if you feel the treatment isn’t helping you. You can also choose to leave at any point without giving a reason and without it affecting the care you receive.

Results

At the end of the trial, the researchers should publish the results and make them available to anyone who took part and wanted to know the results. If the researchers don’t offer you the results and you want to know, ask for them.

Some research funders, such as the National Institute for Health Research (NIHR), have websites where they publish the results of the research they have supported.

How are trials regulated and judged ethical?

Role of the MHRA

Before a clinical trial of a new medicine can begin, a government agency called the Medicines and Healthcare products Regulatory Agency (MHRA) needs to review and authorise it.

The MHRA inspects sites where trials take place to make sure they’re conducted in line with good clinical practice.

Role of the HRA

The Health Research Authority (HRA) works to protect and promote the interests of patients and the public in health research. It is responsible for research ethics committees up and down the country.

All medical research involving people in the UK, whether in the NHS or the private sector, first has to be approved by an independent research ethics committee. The committee protects the rights and interests of the people who will be in the trial.

How are trial results used to improve treatment?

Clinical trials can help:

prevent illnesses by testing a vaccine

detect or diagnose illnesses by testing a scan or blood test

treat illnesses by testing new or existing medicines

find out how best to provide psychological support

find out how people can control their symptoms or improve their quality of life – for example, by testing how a particular diet affects a condition

Many clinical trials are designed to show whether new medicines work as expected. These results are sent to the MHRA, which decides whether to allow the company making the medicine to market it for a particular use.

Licensing a treatment

If research has identified a new medicine, the MHRA must license it before it can be marketed. Licensing shows a treatment has met certain standards of safety and effectiveness.

Safety must be monitored carefully over the first few years of a newly licensed treatment. This is because rare side effects that weren’t obvious in clinical trials may show up for the first time.

In England and Wales, the National Institute for Health and Care Excellence (NICE) decides whether the NHS should provide treatments.

Where can I find results from trials that are relevant to me?

The results of clinical trials are usually published in specialist medical journals and online libraries of evidence.

Some of the most well-known examples are:

You can use a search engine such as Google to look for articles and read summaries (abstracts). But you can’t usually see the full articles without a subscription to the journal.

Also, research papers are not written in plain English and often use many medical, scientific and statistical terms. They can be very difficult to understand.

Coverage in newspapers

You’ll often see stories about research findings in mainstream media. But while news stories are easier to read than original research papers, sometimes the findings are exaggerated or sensationalised.

The NHS website aims to make this clearer for you. Behind the Headlines is an independent service that analyses health stories that make the news.

It aims to explain the facts behind the headlines and give a better understanding of the research that was carried out.

Twenty painful health conditions

Don't let the pain destroy you

Don’t let the pain destroy you

Some illnesses can be excruciating. Here are 20 health conditions that cause notoriously severe pain. They’re not ranked in any particular order.

1. Shingles

Shingles is one of the most painful medical conditions you can be unlucky enough to experience. Caused by the varicella-zoster virus, which also causes chickenpox, it’s characterised by a rash or crop of blisters on one side of your body, often around the waistline.

The pain of shingles tends to be burning or tingling and often affects only one side of your body. It can be so bad that you experience an excruciating stab of pain when someone simply brushes lightly against the affected skin or a breeze wafts over it.

Some people who have had shingles can develop a persistent pain called postherpetic neuralgia.

Read more about shingles and the shingles vaccine.

2. Cluster headaches

Imagine giving birth without painkillers once or twice a day for up to 10 weeks at a time and you have some idea of the sheer misery of cluster headaches.

Cluster headaches are also called ‘suicide headaches’ because they’re so excruciatingly painful they’ve been known to drive people to take their own lives. They tend to come on very suddenly without warning causing a sharp, stabbing pain around one eye. Attacks can be as short as 15 minutes or last three hours or more.

They’re acknowledged to be the most painful type of headache, worse even than severe migraines. In fact, experts have suggested that cluster headache may be the most painful condition known to medical science.

Read more about cluster headaches.

Find your local headache clinic.

3. Frozen shoulder

This condition isn’t just extremely painful, it can also last for several years unless it’s properly treated.

In frozen shoulder, the joint becomes so tight and stiff that it’s virtually impossible to carry out simple movements such as raising your arm. Daily activities like taking off a T-shirt, lifting a kettle, putting on a coat, even combing your hair, become an ordeal.

It’s not clear what causes frozen shoulder, but it can happen after a shoulder or arm injury and is more common in people with diabetes.

Either shoulder can be affected but it’s usually the non-dominant one – that’s your left shoulder if you’re right handed or your right shoulder if you’re left handed.

Pharmacy or prescription painkillers usually help, along with shoulder exercises.

Read more about frozen shoulder.

4. Broken bones

A broken or cracked bone is known as a fracture. Common examples are broken ankle, broken hip, broken arm and broken nose.

If the break is small, it’s possible not to feel any pain at all, but generally it really hurts to break a bone, especially when you try to move it. The pain is often described as feeling like a deep ache.

Broken bones can heal by themselves, but they may need to be lined up and fixed in position so they set properly. As a general rule, the older you are and the bigger the bone that’s broken, the longer it will take to heal.

5. Complex Regional Pain Syndrome (CRPS)

With Complex Regional Pain Syndrome (CRPS), a severe pain follows an injury to bone and soft tissue. It can happen to anyone at any age, but is most common in women in their 40s and 50s.

The burning pain of CRPS is continuous and intense, often out of all proportion to the severity of the original injury. It usually affects one of the arms, legs, hands or feet.

Often the pain spreads to the entire arm or leg, even though the initial injury might have been only to a finger or toe. Sometimes, the pain even travels to the opposite extremity.

The pain of CRPS can go on for years, and there’s currently no cure as such. Treatments, such as physical therapy, talking therapy and medications, aim to help those with CRPS get on with their lives.

Read more about CRPS.

6. Heart attack

If you have a heart attack, you usually get a pain in the centre of your chest – often described as a sensation of heaviness, tightness or squeezing that can be so bad it causes you to collapse.

The pain can feel like really bad indigestion and sometimes spreads to your jaw, neck, back, arms or stomach.

If you suspect you or someone else is having a heart attack, call for emergency help straight away.

Read more about heart attack.

Read 64-year-old Derek’s real-life description of what it feels like to have a heart attack.

7. Slipped disc

Back pain affects eight out of 10 people at some point in their lives and one of the most common causes of back pain is a slipped disc, often the result of a twisting or lifting injury. What happens in this medical condition is that one of the discs in the spine ruptures and the gel inside leaks out.

Most people with a slipped disc experience sudden and severe lower back pain, which is usually eased by lying down and is often made worse if you move your back, cough or sneeze. A slipped disc can often cause leg pain as well as, or instead of, back pain.

In most cases of slipped disc, the pain eases gradually over several weeks. Painkillers can help.

Read more about slipped disc.

8. Cancer

Most people with advanced cancer experience pain, either from the tumours themselves or as a side effect of cancer treatment such as chemotherapy or radiation.

Although the pain can be very severe, it doesn’t always mean the cancer is growing. A very small tumour that is pressing on a nerve can be agonising, while a large tumour somewhere else may cause little or no pain.

Cancer pain can vary in sensation, duration and intensity depending on the type of cancer you have and the stage that it’s reached, but it’s almost always possible to get cancer pain under control with prescribed painkillers.

Read more about cancer.

Find your local cancer support services.

9. Arthritis

People with arthritis endure constant and often agonising joint pain, usually in the hips, knees, wrists or fingers.

The pain can come on suddenly or over time and is often linked with muscle aches and stiffness in the joints.

Various different types of arthritis can cause joint damage, including rheumatoid arthritis, osteoarthritis and lupus.

According to Arthritis Care, whatever type of arthritis you have, exercise is one of the best ways to keep pain at bay. Your doctor or a physiotherapist can help you pick an exercise programme that will suit you.

Read more about arthritis.

Find your local arthritis support services.

10. Migraine

A migraine headache is much more painful than a conventional headache and tends to last for longer, with the worst ones persisting for up to three days or more.

Because migraines can cause vomiting and extreme sensitivity to light and sound as well as intense throbbing pain, all that many with migraine can do is find a dark, quiet place to lie down until their headache is over.

Medications can help reduce the frequency and severity of migraines. If treatment hasn’t worked for you in the past, talk to your doctor about trying a different migraine headache medication.

Find out more about migraine and read a true-life account of what it’s like to have migraine.

Find your local migraine clinic.

11. Sciatica

Sciatica is the name given to an aching pain running down the leg. It’s caused when the sciatic nerve – the longest nerve in the body, which stretches from your back to your feet – has been pinched or irritated by damage to the back. It’s often caused by a slipped disc.

Sciatica is different to general back pain – the pain of sciatica hardly affects your back at all but instead radiates out from your lower back, down the buttocks and into one or both of the legs, right down to the calf.

Most people find their sciatica goes away by itself within a few days or weeks. A combination of self-help measures such as over-the-counter painkillers, exercise and hot or cold packs can usually relieve the pain in the meantime.

Read more about sciatica.

Watch this video of one man’s experience of the pain of sciatica.

12. Kidney stones

Passing a kidney stone produces a sudden, incredibly sharp, cramping pain in your lower back or the side of your abdomen, or occasionally in your groin, which may last for minutes or hours, with pain-free intervals in between.

The pain often begins in the middle of the night and can be so vicious that those who experience it may feel the need to go to A&E.

In fact, most kidney stones will be small enough to be passed out in your urine at home – and thankfully the pain disappears once the stone has been passed.

Read more about kidney stones.

13. Appendicitis

Appendicitis is a painful swelling of the appendix, a finger-like pouch attached to the gut wall. It’s most common in children, who typically complain of pain in the middle of their tummy that comes and goes. The pain then shifts to the lower right side of the tummy and gets a lot worse.

Appendicitis is a medical emergency that usually needs an urgent operation to remove the appendix before it bursts.

Most children recover from having their appendix removed within a few days and experience no ill-effects from the operation.

Read more about appendicitis.

Watch this animation to learn about the causes and treatment of appendicitis.

14. Trigeminal neuralgia

The pain of trigeminal neuralgia is often described as feeling like an electric shock shooting through the face. Others have described intense sensations of burning or stabbing. They often describe a trigger area on their face that’s so sensitive that touching or even air currents can trigger an episode.

Trigeminal neuralgia, also known as Fothergill’s disease, is characterised by bouts of extremely severe one-sided facial pain that comes and goes unpredictably in sudden attacks.

Usual painkillers have no effect, but prescribed anticonvulsant drugs (used for epilepsy) can dampen the pain.

Read more about trigeminal neuralgia.

15. Pancreatitis

Pancreatitis is inflammation of the pancreas, a banana-sized organ that’s part of the digestive system, and its most common symptom is awful abdominal pain.

It can happen as a one-off event (acute) or the pancreatitis can keep coming back (chronic). Acute pancreatitis, though, is more painful and is often a medical emergency needing hospital treatment, including to control the pain.

The pain of acute pancreatitis is similar, and easy at first to confuse with, that of another painful and serious condition called cholecystitis, where the gallbladder becomes inflamed, usually because of gallstones.

Read more about pancreatitis.

16. Gout

Gout is one of the most painful forms of arthritis where swelling and severe pain develops in a joint, often the base of the big toe, to the point where even touching or moving the toe can be agony.

Many people associate gout with Henry VIII and good living, but it’s a myth that gout is caused by binge drinking and gorging on rich food. Although it’s more likely in people who eat a lot of red meat and drink beer, anyone can get gout, even teetotal vegetarians!

According to Arthritis Care, in an attack of gout the joint starts to ache then swells up and becomes red, hot and extremely painful. The joint may look as if it has a boil on it, or the skin can become shiny and peeling.

An attack can last between one and 10 days. There can be permanent damage to the joint if you get recurrent attacks, so it’s wise to consider medication to stave off further bouts.

Read more about gout.

17. Endometriosis

One in 10 women in the UK experiences the painful gynaecological condition endometriosis, where cells like the ones in the lining of the womb are found elsewhere in the body.

While some women with endometriosis have no symptoms at all, others have lots of pain – pelvic pain, period pain and pain during and after sex.

Although there’s no cure for endometriosis, there are treatments that can relieve the pain and shrink or slow endometriosis growth.

Here, Michelle, a mum of two, describes life with endometriosis.

Read more about endometriosis.

18. Stomach ulcer

An ulcer is a sore or hole that forms in the lining of the stomach. For the one in 10 of us that will have a stomach ulcer at some point, it causes a gnawing or burning pain in the abdomen, often between meals and in the early hours of the morning.

Ulcer pain is usually relieved by eating or taking a type of medicine called antacids.

It’s important to take your medication because an untreated ulcer can become perforated, which is an excruciatingly painful medical condition where the ulcer burns through the stomach wall letting digestive juices and food leak into the abdominal cavity. A perforated ulcer is a medical emergency and usually needs to be operated on immediately.

Read more about stomach ulcer.

19. Fibromyalgia

The exact cause of fibromyalgia isn’t known but it can cause widespread aches and pains all over the body, usually as lots of tender areas on the back of the neck, shoulders, lower back, hips, shins, elbows and knees. People with fibromyalgia often say they ache all over.

Quite often the pain and stiffness is worse in the morning and you may have more pain in muscle groups that you use repetitively.

While fibromyalgia is a lifelong condition, treatment including painkillers and exercise, can ease discomfort.

Read more about fibromyalgia.

20. Pain after an operation

It’s common to have some pain after surgery, though the intensity of the pain will vary according to the type of operation.

But too much pain after surgery is not a good thing and you should never feel you have to ‘tough it out’.

There are lots of effective painkillers on offer to keep your pain after surgery under control, and, in addition to making you more comfortable, experts say that well-controlled pain will help you get better faster and prevent long-term problems.

Read more about what happens after having an operation.

Eye cancer – what are the signs, symptoms and treatments of eye cancer?

Eye cancer

Eye cancer

Between 500 and 600 cases of eye cancer (ocular cancer) are diagnosed in the UK each year.

There are a number of different types of cancer that affect the eyes, including:

eye melanoma

squamous cell carcinoma

lymphoma

retinoblastoma – a childhood cancer

Cancer can also sometimes develop in the tissues surrounding your eyeball or spread to the eye from other parts of the body, such as the lungs or breasts.

This topic focuses on melanoma of the eye, one of the most common types of eye cancer. The Cancer Research UK website has more information about the other types of eye cancer.

 

Symptoms of eye cancer

Eye cancer doesn’t always cause obvious symptoms and may only be picked up during a routine eye test.

Symptoms of eye cancer can include:

shadows, flashes of light, or wiggly lines in your vision

blurred vision

a dark patch in your eye that’s getting bigger

partial or total loss of vision

bulging of one eye

a lump on your eyelid or in your eye that’s increasing in size

pain in or around your eye, although this is rare

These symptoms can also be caused by more minor eye conditions, so they’re not necessarily a sign of cancer. However, it’s important to get the symptoms checked by a doctor as soon as possible.

Melanoma of the eye

Melanoma is cancer that develops from pigment-producing cells called melanocytes. Most melanomas develop in the skin, but it’s also possible for them to occur in other parts of the body, including the eye.

Eye melanoma most commonly affects the eyeball. Doctors sometimes call it uveal or choroidal melanoma, depending on exactly which part of your eye is affected.

It can also affect the conjunctiva, the thin layer that covers the front of the eye, or the eyelid.

What causes eye melanoma?

Eye melanoma occurs when the pigment-producing cells in the eyes divide and multiply too rapidly. This produces a lump of tissue known as a tumour.

It’s not clear exactly why this occurs, but the following factors may increase the risk of it happening:

lighter eye colour – if you have blue, grey or green eyes, you have a higher risk of developing eye melanoma compared with people who have brown eyes

white or pale skin – eye melanoma mostly affects white people and is more common in those with fair skin

unusual moles – if you have irregularly shaped or unusually coloured moles, you’re more at risk of developing skin cancer and eye melanoma

use of sunbeds – there’s some evidence to suggest that exposing yourself to ultraviolet (UV) radiation from sunbeds, for example, can increase your risk of eye melanoma

overexposure to sunlight – this increases your risk of skin cancer, and may also be a risk factor for eye melanoma

The risk of developing eye melanoma also increases with age, with most cases being diagnosed in people in their 50s.

Read about the risk factors for other types of eye cancer on the Cancer Research UK website.

Diagnosing melanoma of the eye

If your GP or optician (optometrist) suspects you have a serious problem with your eyes, they will refer you to a specialist eye doctor called an ophthalmologist for an assessment.

If they suspect you have melanoma of the eye, they’ll refer you to a specialist centre for eye cancer. There are four centres in the UK, located in London, Sheffield, Liverpool, and Glasgow.

It’s likely you’ll have a number of different tests at the centre, including:

an eye examination – to look at the structures of your eyes in more detail and check for abnormalities

an ultrasound scan of your eye – a small probe placed over your closed eye uses high-frequency sound waves to create an image of the inside of your eye; this allows your doctor to find out more about the position of the tumour and its size

a fluorescein angiogram – where photographs of the suspected cancer are taken using a special camera after dye has been injected into your bloodstream to highlight the tumour

Occasionally, a thin needle may be used to remove a small sample of cells from the tumour (biopsy). The genetic information in these cells is analysed to give an indication of the chances of the cancer spreading or coming back.

Treatments for eye melanoma

Treatment for melanoma of the eye depends on the size and location of the tumour. Your care team will explain each treatment option in detail, including the benefits and any potential complications.

Treatment will aim to conserve the affected eye whenever possible.

The main treatments for eye melanoma are:

brachytherapy – tiny plates lined with radioactive material called plaques are inserted near the tumour and left in place for up to a week to kill the cancerous cells

external radiotherapy – a machine is used to carefully aim beams of radiation at the tumour to kill the cancerous cells

surgery to remove the tumour or part of the eye – this may be possible if the tumour is small and you still have some vision in your eye

removal of the eye (enucleation) – this may be necessary if the tumour is large or you’ve lost your vision; the eye will eventually be replaced with an artificial eye that matches your other eye

Chemotherapy is rarely used for eye melanoma, but may be suitable for other types of eye cancer.

The Cancer Research UK website has more information about the treatment options for eye cancer and the types of eye cancer surgery.

Outlook for eye melanoma

The outlook for melanoma of the eye depends on how big the cancer is at the time it’s diagnosed and exactly which parts of the eye are affected.

Overall:

about 8 out of every 10 people (80%) diagnosed with a small eye melanoma will live for at least five years after diagnosis

about 7 out of every 10 people (70%) diagnosed with a medium-sized eye melanoma will live for at least five years after diagnosis

about 5 out of every 10 people (50%) diagnosed with a large eye melanoma will live for at least five years after diagnosis

The Cancer Research UK website has more information about the stages of eye cancer and statistics and outlook for eye cancer.