The pap smear test or Papanicolau test is a test of the cells of the cervix and endocervix, done to detect any pre-malignant or malignant changes of the cervix. This would help in the detection of cervical cancer at an early stage. Detection of a cancer at an early stage would help in the better management of the patient and may lead to increased chances of survival.

How is Pap test done?

A pap test is usually performed by a Gynaecologist. The patient is placed in Sim’s position, with both legs separated and raised. This position enables easy insertion of the speculum into the vagina. The cervix is identified. Using a wooden spatula, the inside of the cervix is scraped. A brush is inserted into the cervix and a brushing of the inside of the cervix is taken as well. These samples are put in a preservative and sent to the lab for microscopic examination.

Is the procedure painful?

Pap test is not painful. But there might be slight discomfort because of the position and because of the feeling of the speculum inside the vagina. There might be slight bleeding after the procedure, but would subside soon.

What are the possible results of Pap test?

Pap test aims at finding any precancerous or cancerous changes in the cervix. The potential pre cancerous changes are cervical intraepithelial neoplasia or cervical dysplasia. The abnormal changes are usually caused by human papilloma virus which is the common cause of sexually transmitted diseases.

The abnormal results usually seen are

1. atypical glandular cells.
2. atypical squamous cells of undetermined significance.
3. low grade squamous intraepithelial lesion.
4. high grade squamous intraepithelial lesion.
5. squamous cell carcinoma.

Is it necessary to have a pap test?

For every sexually active woman, it is better to have a pap test as soon as she becomes sexually active. And it is advised for a sexually active woman who has not had a pap test to have the test done immediately after 35 years, at least once a year.

Are there any risks of a pap smear test?

There is no risk of pap test.

Are there any precautions to be followed before the test?

If you are scheduled to have a pap smear, you should avoid the following for the previous 24 hours.

1. douching.
2. intercourse.
3. tub bath.
4. tampons.

You should intimate the physician of the following.

1. suspected pregnancy.
2. previous history of papsmear- normal or abnormal.
3. intake of medications including oral contraceptive pills.

Any abnormal changes detected would be investigated further to diagnose cancer and manage effectively.

The incidence of breast cancer world-wide is huge. It is the most common cancer among women, much more than lung cancer and cervical cancer. The incidence reported from different parts of the world varies though, as in many of the underdeveloped countries, there are not adequate means to detect the cancer at an early stage or are underreported.

What is breast cancer?

It is a cancer originating in the breast cells in the human body. There are different classifications of the cancer. The main ones are ductal carcinoma, malignant cancer in the ducts of the breast and invasive lobular carcinoma, a malignancy in the lobules.

Detecting the signs and symptoms of the breast cancer at an early stage would ensure proper treatment at the right time, and increased chances of recovery. Many people are not even aware of the symptoms they should be on a look out.

What are the symptoms of breast cancer?

The first symptom the woman would experience is most commonly a lump, which appears different from the breast tissue. In most cases, the woman would identify the lump herself while examination or while taking a bath.

The other symptoms would be

1. changes in breast size or shape.
2. skin dippling.
3. nipple inversion
4. spontaneous single nipple discharge
5. occasionally, pain or tenderness
6. lump or nodule in the axilla (armpit) of the same side.

In cases where the cancer invades the dermal lymphatics, skin inflammation also might be present. If the cancer has spread to other locations within the body, before detection, it means it has already metastasized. The presenting symptoms might be different. The symptoms might include

1. bone pain denotes metastasis in the bone
2. shortness of breath means spread in the lungs
3. loss of appetite means metastasis in liver
4. weight loss
5. jaundice
6. headache, neurological pain or weakness- brain metastasis.

Another symptom complex of breast cancer would be Paget’s disease of the breast. The disease manifests in a complex of symptoms. They are

1. eczema of the skin
2. tingling
3. itching
4. increased sensitivity and burning
5. pain etc

Why is early detection of the symptoms necessary?

Early detection of any of the symptoms would lead to investigations and early diagnosis of the disease. In many instances, the lump detected might be a benign lump, but it is not safe to make an assumption that every lump is benign. If you feel any of the symptoms, it is better to consult your physician who would request for furthur investigations.

How do you detect a symptom of the breast cancer?

Many women detect a lump in their breast while bathing themselves. That would be an accidental detection of a symptom. But it is better to be pro- active and do a breast self examination once a month. If not anything else, this would prove helpful in the detection of a lump and you can go for further investigation.

What is breast self examination?

It includes visual examination and palpation of both the breasts. Inspection is done for any changes in the skin texture, any change in size or shape of the breast and any nipple retraction. Palpation is done to check for any lumps either in the breasts or in the axillary area and for any discharge from the nipple.

Does mammogram help in detecting breast cancer?

Yes, it sure does. Mammogram is a Xray examination of the breast and detects any lumps or tumors in the breast. It is quite fast and reliable. Because of the increased incidence of breast cancer, in many countries, mammogram is ordered as a screening test for older women. If you are older than 40 years, it is advised to have a mammogram once a year or at least once in two years.

Whatever the means of detection of the breast cancer, the earliest the cancer is detected, the better the management would be and the life span of the patient is improved.

The basic cause of diabetes is the autoimmune destruction of beta cells in the pancreas. As a result of this, the production of the insulin is decreased, increasing the blood sugar in the blood.

The symptoms of DM type 2 are
1. polydipsia
2. polyuria
3. polyphagia
4. Unexpected weight loss and lethargy.

If you have any of these symptoms, you need to get evaluated for diabetes. The earliest diabetes is detected, the better its management would be. There are several complications which may occur because of diabetes, hence it is always better to get diagnosed at the earliest.

The first line of management of diabetes is diet and exercise.

Diet and Exercise
In many cases, the blood sugar levels may come under control and remain there only by changing the diet pattern. Increased intake of fiber, decreased carbohydrates and fats, and increased protein intake would aid in the control of blood sugar levels.

Oral medicines
The onset of type 2 Diabetes Mellitus is usually in late 40s. At this age, changing the existing dietary pattern and exercise in an individual is difficult, though not impossible. Most of the people have a sedentary life style and making an immediate change may not be feasible. So as a mode of treatment, medicines in the form of tablets are introduced. These are agents which control the level of blood sugar. In type 2 DM, the pancreas cells continue producing insulin, but the cells develop a resistance to insulin, and in these cases, oral medicines are effective.

There are several types of oral medicines for type 2 Diabetes Mellitus. Some of them are,
1. sulfonlyureas- the medicines stimulate the pancreas and result in increased production of insulin.
2. biguanides- these medicines increase the insulin’s capability to move glucose into different cells in the body.
3. thiazolidineiones- these improve insulin’s effectiveness in the body cells.

Some of the common oral medicines in use today are
1. Actos. This is a thiazolidineiones type of oral medicine for diabetes. This is also once a day pill. There are different doses of the medicine and so can be adjusted according to your requirement.
2. Glimepiride (Amaryl). This is a sulfonlyurea type of oral medicine for diabetes. It is usually given as once a day dose along with the main meal of the day.
3. Avandia. This medicine has been associated with the worsening of certain existing heart conditions. If you develop any untoward symptom while on the medicine, immediately contact the physician.
4. Glipizide (Glucotrol). This is another sulfonlyurea type of oral medicine for type 2 DM. This is usually taken once a day, 30 minutes before the meal.
5. Glyburide ( Glucovance). This is also a sulfonylurea type of medicine.

Side effects of oral medicines for type 2 DM
1. Hypoglycemia. This is the most important side effect that occurs while the patient is on oral medicines. The level of blood glucose falls to a very low level and symptoms like dizziness, nausea, hunger and even unconscious may develop.
2. Some of the oral medications for type 2 Diabetes Mellitus may aggravate certain symptoms of other diseases. Of there are any untoward symptom while you are taking the medicine, immediately inform the physician.

Type 2 DM is a disease condition which can be kept under control with proper medicines, diet and exercise. And this is also a condition if not taken care of, may worsen and have very serious complications involving all the parts of the nbody.