Chemotherapy agents can be classified into different categories based on their mechanism of action. Topoisomerase II inhibitors, such as etoposide, prevent the re-ligation of DNA strands by forming a complex with the topoisomerase II enzyme, leading to cell cycle arrest and apoptosis. Microtubule inhibitors, like paclitaxel and vinblastine, block the formation of microtubules, which are essential for cell proliferation and signaling, resulting in cell death. Alkylating agents, such as cyclophosphamide, interfere with DNA replication by attaching an alkyl group to the guanine base of DNA. Antimetabolites, including base analogues, nucleoside analogues, nucleotide analogues, and antifolates, disrupt cell metabolism and inhibit DNA replication and repair. Topoisomerase I inhibitors, like irinotecan and topotecan, inhibit DNA transcription and replication by binding to the topoisomerase I-DNA complex. These chemotherapy agents have various side effects, including bone marrow suppression, hair loss, nausea, vomiting, and allergic reactions.

Overview of Different Types of Lymphoma

Lymphoma is a type of cancer that affects the lymphatic system, which is responsible for fighting infections and diseases. There are several types of lymphoma, each with its own unique characteristics and treatment options.

Hodgkin Lymphoma: This type of lymphoma is diagnosed by the presence of Reed-Sternberg cells, which are large malignant B cells found in lymphoid tissue. It is staged using the Ann Arbor staging system and can be treated with cyclical chemotherapy and/or radiotherapy.

Chronic Lymphocytic Leukaemia: This type of lymphoma is caused by the malignant transformation of B1 cells, a subset of B cells. It is a slow-growing cancer that may not require immediate treatment.

Waldenström Macroglobulinemia: This neoplasm is characterized by a single clone of B cells and a mixture of lymphocytes, plasma cells, and lymphoplasmacytoid cells. Treatment options include chemotherapy, immunotherapy, and stem cell transplantation.

Follicular Lymphoma: This type of lymphoma is a transformation of the B cells found in lymph node follicles. It is a slow-growing cancer that may not require immediate treatment.

Burkitt Lymphoma: This type of lymphoma is not associated with Reed-Sternberg cells and can present as either a leukemia or lymphoma. Treatment options include chemotherapy and immunotherapy.

Overall, the treatment and prognosis for lymphoma depend on the type and stage of the cancer, as well as the individual patient’s health and medical history.

Carcinoid Tumours and Neuroendocrine Tumours

Carcinoid tumours are a type of neuroendocrine tumour that originates from endocrine cells. These tumours can be found in various organs, but the most common location is the gastrointestinal tract, particularly the small intestine. The pancreas and lungs are also potential sites for carcinoid tumours. While some carcinoid tumours may not cause any symptoms, larger tumours and those located in the small intestine can lead to carcinoid syndrome. This occurs when the tumour cells release bioactive substances such as serotonin and bradykinin into the bloodstream, causing symptoms such as bronchospasm, diarrhoea, flushing, and heart damage.

Other types of neuroendocrine tumours are derived from different endocrine cell types and may secrete different hormones. Examples include insulinoma, gastrinoma (Zollinger-Ellison syndrome), VIPoma, and somatostatinoma. Not all neuroendocrine tumours are functional, meaning they may not secrete hormones even if they originate from an endocrine cell.

Treatment for carcinoid tumours typically involves surgical resection and/or somatostatin analogues such as octreotide, which can reduce the secretion of serotonin by the tumour. Most carcinoid tumours do not metastasize, but those that do may not be suitable for surgical resection depending on the extent of metastasis. However, some patients may benefit from octreotide and chemotherapy agents to manage symptoms.

Treatment Options for Malignant Dysphagia in Oesophageal Cancer Patients

Patients with oesophageal cancer often present with symptoms such as progressive dysphagia, weight loss, and anaemia. Unfortunately, these symptoms tend to appear late in the disease’s progression, making treatment more challenging. Oesophagectomy, the surgical removal of the oesophagus, is typically reserved for early-stage cancers that have not yet invaded surrounding tissues. Traditionally, malignant dysphagia was treated with repeated endoscopic dilatations. However, self-expanding metal stents (SEMS) are now the preferred treatment option for patients with malignant dysphagia.

While SEMS placement is generally safe and effective, there are some potential complications to be aware of. Early complications may include malposition, oesophageal perforation, bleeding, and stent migration. Late complications are more commonly related to eating, such as food bolus blockages or tumour overgrowth. If a food bolus blocks a stent, patients may be advised to consume a fizzy drink to help break it up. However, if this is unsuccessful, endoscopy may be required to dislodge the blockage.

In summary, SEMS placement is a safe and effective treatment option for patients with malignant dysphagia caused by oesophageal cancer. While there are potential complications to be aware of, these are generally manageable with prompt medical attention. Early diagnosis and treatment are crucial for improving outcomes in patients with oesophageal cancer.

Ewing’s Tumour: A Younger Age Onset and Destructive Nature

Ewing’s tumour is a type of bone cancer that typically occurs in individuals between the ages of 5 and 30 years old. Patients with this condition often experience fever and pain, and may have an elevated erythrocyte sedimentation rate. The tumour usually affects a long bone, particularly the diaphysis, and can be found in the axial skeleton, such as the pelvis, in 40% of cases. The tumour is primarily destructive and ill-defined, eroding the cortex of the bone. Its cellular origin is not well understood, but is believed to come from undifferentiated mesenchymal cells in the medulla of the bone.

One of the characteristic features of Ewing’s tumour is an early periosteal reaction, which can be seen as a series of lamellated periosteal reactions with an onion skin appearance. This reaction occurs due to the elevation of the periosteum, which gives rise to the Codman’s triangle appearance. In cases where the tumour is large, the site of origin can be inferred from the centre of the radius of the mass.

Overall, Ewing’s tumour is a serious condition that requires prompt diagnosis and treatment. Its destructive nature and younger age onset make it a particularly challenging form of bone cancer to manage.

Distribution and Characteristics of Giant Cell Tumours

Giant cell tumours, also known as osteoclastomas, are most commonly found around the knee at the distal femur, accounting for approximately 50% of cases. The next most common site is the proximal tibia, followed by the proximal humerus and distal radius. These tumours are typically solitary, with less than 1% being multicentric.

Overall, giant cell tumours are relatively rare and tend to occur in young adults between the ages of 20 and 40. They are characterized by the presence of numerous multinucleated giant cells, which are responsible for the destruction of bone tissue. While most cases are benign, some may become malignant and spread to other parts of the body. Treatment typically involves surgical removal of the tumour, although radiation therapy and other treatments may also be used in certain cases.

PET Imaging in Cancer Diagnosis and Treatment

PET imaging is a diagnostic tool that uses radiolabelled molecules to identify areas of high metabolic activity, such as cancerous tumors. When combined with CT, PET can be more sensitive in detecting metastatic disease. However, PET has limitations in identifying blood supply and primary tumor masses, which may require other imaging techniques such as angiography or MRI. PET also cannot label tumors for easier identification during surgery, but newer techniques using fluorescent labeling are emerging. Finally, PET does not have any therapeutic effect on the tumor itself, but can be used to guide neoadjuvant therapy.

Tumour Markers and their Associated Cancers

Tumour markers are substances produced by cancer cells that can be detected in the blood. They are used to aid in the diagnosis and monitoring of cancer. Here are some common tumour markers and the cancers they are associated with:

– CA 19-9: This marker is associated with pancreatic cancer.
– CEA: This marker is associated with colorectal cancer.
– PSA: This marker is associated with prostate cancer.
– CA 125: This marker is associated with ovarian cancer.
– AFP: This marker is associated with hepatocellular carcinoma.

It is important to note that tumour markers are not always specific to one type of cancer and can also be elevated in non-cancerous conditions. Therefore, they should always be used in conjunction with other diagnostic tests and clinical evaluations.

Electrolyte Imbalances and their Symptoms

Calcium: Hypercalcaemia of malignancy is a common cause of lytic bone lesions in multiple myeloma patients. Symptoms include dehydration, which can be prevented with aggressive fluid resuscitation. Treatment involves intravenous bisphosphonate or denosumab and calcitonin to inhibit osteoclastic bone resorption.

Vitamin D: Over-medication with vitamin D can lead to hypervitaminosis D, which presents similar symptoms to hypercalcaemia. However, hypercalcaemia of malignancy is more likely in patients with lytic bone lesions.

Phosphate: Hyperphosphataemia can be caused by impaired renal excretion or massive extracellular phosphate loadings. Symptoms are similar to hypercalcaemia, but hypercalcaemia of malignancy is more likely in patients with multiple myeloma.

Sodium: Hypernatraemia presents with symptoms of thirst, lethargy, weakness, and irritability.

Potassium: Hyperkalaemia can present with symptoms of chest pain, palpitations, and weakness.

Metastasis in Prostate Cancer: Common Sites and Symptoms

Prostate cancer can spread to other parts of the body, a process known as metastasis. The most common site for metastases in prostate cancer is the bone, accounting for 84% of cases. Symptoms of bone metastases include bone pain, which can be managed with analgesics and palliative radiotherapy. Bisphosphonates may also be used. Brain metastases are rare in prostate cancer and typically present with headaches and neurological symptoms. Metastases to the pancreas are also uncommon, accounting for only 2% of cases. Lung metastases occur in about 9.1% of cases, while liver metastases are reported in 10.2% of cases and may present with jaundice, loss of appetite, and abdominal swelling. Understanding the common sites and symptoms of metastases in prostate cancer can aid in early detection and management.

Wilms’ Tumour in Children

Wilms’ tumour, also known as nephroblastoma, is a type of kidney cancer that is commonly found in children. It is usually detected when a parent notices a lump while bathing or dressing their child, typically around the age of three. Unlike other types of cancer, Wilms’ tumour rarely presents with symptoms such as abdominal pain, vomiting, or hypertension.

It is important for parents to be aware of the signs and symptoms of Wilms’ tumour, as early detection can greatly improve the chances of successful treatment. Regular check-ups with a pediatrician can also help in identifying any potential issues. If a parent does notice a lump or any other unusual symptoms in their child, they should seek medical attention immediately. With prompt diagnosis and treatment, many children with Wilms’ tumour can go on to live healthy, normal lives.

Managing Pain in Terminally Ill Patients

Managing pain in terminally ill patients can be challenging, but there are several strategies that can be employed to provide relief. When prescribing narcotics, it is important to start a laxative regimen to prevent constipation. Sedation may occur in the first few days, but this typically wears off. If pain relief is inadequate, the dose should be increased, although it is important to note that cocaine may produce hallucinations. It is also important to note that addiction is not a concern in terminally ill patients. Injections are typically three times more effective than oral medication. By employing these strategies, healthcare providers can help alleviate pain and improve the quality of life for terminally ill patients.

Horner’s Syndrome and Pancoast Tumour

Horner’s syndrome is a condition characterized by ptosis and constriction of the pupil. However, in some cases, it can be a consequence of a Pancoast tumour, which is a neoplasm located at the apex of the lung that invades the chest wall and brachial plexus. This lady is likely to have a Pancoast tumour as she presents with Horner’s syndrome. On the other hand, Holmes-Adie syndrome is a condition where the pupil is larger than normal and slow to react to direct light. Peyronie’s disease is a hardening of the corpora cavernosa of the penis caused by scar tissue, while Pott’s cancer is a scrotal cancer caused by coal tar exposure. Wilms’ tumour, on the other hand, is a malignant tumour of the kidney that usually occurs in childhood.

In summary, Horner’s syndrome can be a consequence of a Pancoast tumour, which is a neoplasm located at the apex of the lung. Other conditions that present differently from Horner’s syndrome include Holmes-Adie syndrome, Peyronie’s disease, Pott’s cancer, and Wilms’ tumour. It is important to differentiate these conditions to provide appropriate management and treatment.

Appropriate Procedures for a Hospice Patient

When a patient is admitted to hospice care, their medical treatment shifts towards end-of-life measures and comfort. In this context, certain procedures may not be appropriate or beneficial for the patient.

Paracentesis is a procedure that may be helpful for a hospice patient experiencing pain due to ascites. This condition is often caused by low albumin levels, which can be due to malabsorption or liver disease.

Colonoscopy and exploratory laparotomy are invasive procedures that require sedation and post-operative pain management. These procedures are unlikely to provide added benefit to a patient with a terminal diagnosis who is on comfort measures.

Flexible sigmoidoscopy is a simpler procedure that may be used to investigate for colon masses in patients with iron deficiency anemia.

Upper gastrointestinal endoscopy may be considered for symptom relief, but is not typically indicated for a hospice patient.

In summary, the appropriateness of a medical procedure for a hospice patient should be carefully considered in the context of their end-of-life care plan.

Appropriate Procedures for a Hospice Patient

Management Options for Dyspnoea in Palliative Care Patients

Dyspnoea is a common complaint in palliative care patients and requires appropriate management. Short-acting systemic opioids have been shown to be effective in alleviating dyspnoea in terminally ill patients, but caution should be exercised in patients with certain conditions. Heliox® and benzodiazepines may also be used in certain cases, but require expertise and careful consideration. Continuous non-invasive ventilatory support may be considered if other options fail, but requires adequate support. Nebulised opioids may also be a viable option depending on the underlying cause of dyspnoea. Treatment should be tailored to the individual patient’s needs.

Myth-busting: Tongue Cancer Risk Factors

Tongue cancer is a rare form of oral carcinoma, accounting for only 2% of overall cancers. While it can be associated with human papillomavirus (HPV), there are several misconceptions about its risk factors. Contrary to popular belief, smoking and alcohol are known risk factors, while coconut ingestion is not. Betel nut ingestion, on the other hand, is associated with an increased risk of tongue cancer. It is important to note that tongue cancer usually metastasises to the upper cervical and submandibular nodes, not the lower cervical nodes. However, early detection and treatment with a combination of surgery and chemoradiotherapy can often lead to a cure.

Risk of Malignancy Associated with HTLV-1

Between the time frame of 1:10 and 1:20, it is believed that individuals may develop malignancy associated with HTLV-1, specifically adult T cell leukaemia/lymphoma. This suggests that a small percentage of individuals infected with HTLV-1 may be at risk for developing this type of cancer. It is important for individuals who are infected with HTLV-1 to be aware of this potential risk and to regularly monitor their health for any signs or symptoms of malignancy. Early detection and treatment can greatly improve the chances of successful outcomes for those affected.

Paget’s Disease of Bone

Paget’s disease of bone is a condition that typically affects individuals in their later years. It is characterized by a disruption in the normal process of bone repair, resulting in the formation of weak bones that are prone to fractures. Specifically, the repair process ends at the stage of vascular osteoid bone, which is not as strong as fully mineralized bone.

Unfortunately, Paget’s disease of bone can also lead to complications such as osteogenic sarcoma, which occurs in approximately 5% of cases. As such, it is important for individuals with this condition to receive appropriate medical care and monitoring to prevent further complications.

Urgent Management for a Patient with Acute Neck Pain and Malignancy

Explanation:

When a patient with malignancy presents with acute neck pain and focal neurological deficits, urgent investigation is necessary. This is particularly important for patients with multiple myeloma, who are at risk for developing plasmacytomas, which can cause spinal cord compression or pathological fractures. In this case, an urgent magnetic resonance imaging (MRI) of the whole spine is needed to assess for spinal cord compression.

While blood cultures may be important in other situations, they would not affect the management of this patient. Instead, the focus should be on obtaining a diagnosis and definitive treatment. Plasmacytomas are radiosensitive, so urgent radiotherapy is indicated for treatment.

Although analgesia and pain assessment are necessary, they are not the top priority. Physiotherapy assessment for hand weakness may be beneficial, but it does not need to be done urgently. An X-ray of the cervical spine is not sensitive enough to detect all plasmacytomas, so an MRI of the whole spine is necessary to assess for multiple levels of disease.

In summary, urgent management for a patient with acute neck pain and malignancy includes an urgent MRI of the whole spine to assess for spinal cord compression, followed by urgent radiotherapy for treatment.

Chemotherapy Options for Ovarian Cancer

Platinum-based drugs, such as carboplatin and cisplatin, are the primary treatment for ovarian cancer. Carboplatin is preferred over cisplatin due to its lower risk of kidney and nerve damage. For germ cell tumors of the testicles or ovaries, a combination of bleomycin, cisplatin, and etoposide (BEP) may be used.

While Taxol® can be used alone, it is not as effective as when combined with a platinum-based drug. In 2002, the National Institute for Health and Care Excellence (NICE) recommended the addition of Taxol® as a first-line drug for ovarian cancer treatment, based on large multicenter randomized trials. Overall, the choice of chemotherapy depends on the type and stage of ovarian cancer, as well as individual patient factors.

Treatment Options for Small Cell Lung Cancer

Small cell lung cancer is a type of lung cancer that is often treated with a combination of chemotherapy and radiotherapy. According to NICE guidelines, concurrent chemoradiotherapy is the recommended first-line treatment for limited-stage disease. Radiotherapy alone is less effective than combination therapy.

Surgery is not routinely recommended for limited disease, but may be considered for patients with very early stage disease. Interferon-alpha is no longer recommended for small cell lung cancer.

For patients with extensive metastatic disease, palliative chemotherapy may be offered. However, this decision should be discussed with the patient. In the case of a patient without significant co-morbidities and no metastases, other treatment options may be considered.

Treatment Options for Pain Relief in Metastatic Prostate Cancer Patients

External beam radiation therapy (EBRT) is the preferred treatment for pain relief in men with castration-resistant prostate cancer (CRPC). It has a success rate of 60-80% in providing complete or partial pain relief in palliative care management. Bisphosphonates can also be prescribed in combination with other agents for mild to moderate pain relief in hormone-resistant prostate cancer patients. Enzalutamide, an antineoplastic, antiandrogen systemic drug, is not preferred in rapidly progressing cases of CRPC. Radium-223, an alpha-particle-emitting radiopharmaceutical agent, is contraindicated in cases with visceral metastases. Stereotactic body radiotherapy (STBRT) is the preferred modality for pain relief in metastatic prostate cancer patients with longer survival times, using targeted irradiation to minimize damage to adjacent normal tissues.

Genetic Mutations and Their Associated Risks

Inherited genetic mutations can increase the risk of developing certain diseases, including cancer. The BRCA1 and BRCA2 genes are associated with an increased incidence of breast and ovarian cancers, with a 50% chance of inheritance from a parent. Mutations in these genes significantly increase the lifetime risk of developing these malignancies, with women with the BRCA1 mutation having a 72% risk of developing breast cancer and a 44% risk of developing ovarian cancer. The APC gene is associated with familial polyposis and an increased risk of colorectal cancer, while mutations in the PKD1 gene are associated with polycystic kidney disease. The delta F508 gene mutation causes cystic fibrosis, and mutations in the RAS gene are implicated in a wide range of malignancies. Understanding these genetic mutations and their associated risks can aid in early detection and prevention efforts.

Treatment Options for Oral Candida Infection During Chemotherapy

During chemotherapy, patients may experience immunosuppression, which can lead to oral candida infection. There are several treatment options available for this condition, including oral fluconazole, nystatin mouthwash, and oral mycafungin. However, the most appropriate choice for mild to moderate oral candida infection is oral fluconazole, as it is more likely to prevent or delay recurrence than nystatin. Intravenous amphotericin B and oral voriconazole are not recommended for this condition, as they are used for systemic fungal infections and other types of fungal infections, respectively. It is important for healthcare providers to consider the patient’s individual needs and medical history when selecting a treatment option.

Risk Factors for Bladder Cancer

Bladder cancer is a type of cancer that affects the bladder, a hollow organ in the lower abdomen that stores urine. There are several risk factors that can increase the likelihood of developing bladder cancer. One of the most significant risk factors is smoking, which can cause harmful chemicals to accumulate in the bladder and increase the risk of cancer. Exposure to aniline dyes in the printing and textile industry, as well as rubber manufacture, can also increase the risk of bladder cancer. Additionally, the use of cyclophosphamide, a chemotherapy drug, can increase the risk of bladder cancer. Schistosomiasis, a parasitic infection that is common in certain parts of the world, is also a risk factor for bladder cancer, particularly for squamous cell carcinoma of the bladder. It is important to be aware of these risk factors and take steps to reduce your risk of developing bladder cancer.

Liposarcoma is a type of sarcoma that commonly affects adults in their 40s to 60s. It typically develops in the deep soft tissues of the proximal extremities and retroperitoneum and can grow into large tumors. There are different histological variants of liposarcoma, with varying degrees of malignancy. All types of liposarcoma have a high likelihood of recurring locally unless completely removed.

Adenocarcinoma is a type of cancer that originates from glandular tissue in organs such as the oesophagus, pancreas, prostate, cervix, stomach, colorectal, and lungs. It does not arise in soft tissues.

Melanoma is a type of skin cancer that can occur in younger patients and often arises from pre-existing moles. Suspicious signs include changes in size, shape, color, itching, crusting, bleeding, inflammation, or sensory changes. Melanomas can metastasize.

Hamartoma is a benign neoplasm that consists of normal tissues in a disorganized mass. The most common type is pulmonary hamartoma, which grows at the same rate as surrounding tissue.

Lymphoma is a type of cancer that results from the malignant proliferation of lymphocytes. It typically presents with lymphadenopathy and constitutional symptoms, and may also involve organs such as the liver and spleen. Matted nodes of this size are unlikely to be caused by lymphoma.

Understanding Hodgkin’s Lymphoma: Symptoms, Diagnosis, and Management

Hodgkin’s lymphoma is a type of cancer that typically affects individuals between the ages of 15 and 35 years and those above the age of 55. Common symptoms include unexplained fever, weight loss, fatigue, and lymphadenopathy in the neck, axilla, and groin. Diagnosis is made through fine needle aspiration of enlarged lymph nodes, which reveals the presence of Reed-Sternberg cells, giant cells with a multilobed or bilobed nucleus and prominent eosinophilic nucleoli. Risk factors for Hodgkin’s lymphoma include Epstein-Barr virus (EBV) infection, HIV infection, and a family history of the disease. Management involves radiation and chemotherapy, and survival rates have been improving, with 5-year survival reaching 85% in some recent studies.

Other conditions that may present with similar symptoms include tuberculosis (TB), non-Hodgkin’s lymphoma, and acute lymphoblastic leukemia (ALL). TB typically presents with respiratory problems, a productive cough, and night fevers, but can also cause lymphadenopathy. Non-Hodgkin’s lymphoma is a collective term used to describe all lymphomas apart from Hodgkin’s lymphoma, and is characterized by the absence of Reed-Sternberg cells. ALL is a rapidly progressive acute leukemia associated with an increase in the number of immature lymphoid cells called lymphoblasts, and can present with general weakness, anemia, lymphadenopathy, weight loss, and hepatosplenomegaly.

EBV is a virus that causes infectious mononucleosis, also known as glandular fever. It is transmitted through infected saliva and mostly affects young individuals, presenting with cervical lymphadenopathy, fever, tonsillar enlargement with white exudate, and palatal petechiae. EBV is also associated with some forms of lymphoma, predominantly Burkitt’s lymphoma, but also Hodgkin’s and diffuse large B cell lymphoma.

Tumor Markers and Their Association with Specific Cancers

Tumor markers are substances produced by cancer cells that can be detected in the blood. These markers can be used to screen for and monitor certain types of cancer. Here are some examples of tumor markers and their association with specific cancers:

– Alphafetoprotein (AFP) and hepatocellular carcinoma: AFP is raised in 80% of patients with hepatocellular carcinoma. High-risk patients should be offered 6-monthly screening with a combination of hepatic ultrasound and AFP level.
– CA 15-3 and breast cancer: CA 15-3 is associated with breast cancer.
– CA 19-9 and pancreatic and biliary tract cancers: CA 19-9 is associated with pancreatic and biliary tract cancers.
– CA 125 and ovarian cancer: CA 125 is associated with ovarian cancer.
– Prostate-specific antigen (PSA) and prostatic cancer: PSA is associated with prostatic cancer and benign prostatic hypertrophy.
– Testicular cancer: Testicular cancer can be associated with AFP, human chorionic gonadotropin (hCG) and lactate dehydrogenase (LDH), depending on the tumor type.

It is important to note that tumor markers are not always specific to one type of cancer and can also be elevated in non-cancerous conditions. Therefore, tumor markers should always be interpreted in conjunction with other diagnostic tests and clinical findings.

Tumour Markers: Types and Uses

Tumour markers are substances produced by cancer cells or normal cells in response to cancer. They can be used to diagnose cancer, monitor treatment response, and detect recurrence. Here are some common tumour markers and their uses:

Carcinoembryonic antigen (CEA): This glycoprotein is found in normal mucosal cells but increases in adenocarcinoma, particularly colorectal cancer. It is used to monitor disease, rather than as a diagnostic tool.

CA-19-9: This intracellular adhesion molecule is highly specific for pancreatic and biliary tract cancers but may also be elevated in other cancers. It has a role in predicting metastatic disease.

Alpha fetoprotein (AFP): This tumour marker is used for hepatocellular carcinoma and non-seminomatous germ cell tumours. It can be used to screen for hepatocellular carcinomas, especially in high-risk patients.

C-reactive protein (CRP): This marker indicates acute inflammation and is not specific to cancer.

CA-125: This glycoprotein is a marker for ovarian cancer but can also be elevated in other intra-abdominal cancers and non-malignant conditions. It is mainly used for monitoring after treatment and if ovarian cancer is suspected.

In conclusion, tumour markers have various uses in cancer diagnosis and management. However, they should always be interpreted in conjunction with other clinical and imaging findings.

Medications for Appetite Stimulation and Mood Improvement in a Patient with Anorexia

Mirtazapine is an antidepressant that can also stimulate appetite, making it a suitable option for a patient with anorexia who needs both mood improvement and increased food intake. Dexamethasone can also be used to boost appetite in the short term. However, metoclopramide is not effective for mood improvement and would require dual therapy with another medication. Megestrol, a progestin, is indicated for anorexia, cachexia, or significant weight loss, but it does not address mood issues. Trazodone, on the other hand, is an antidepressant but may not be the first choice for a patient with anorexia as it can cause weight loss and anorexia as side effects.