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Gastric Adenocarcinoma

Gastric adenocarcinoma, once a frequent cause of death, is now rarely encountered. It is difficult to cure with patients presenting with advanced disease as initial symptoms are nonspecific and often ignored. Progress is currently being made, after the introduction of radiation therapy and chemotherapy. These protocols are added to the classical surgical intervention, in order to prevent disease relapse and improve survival.


Presentation

Early stage gastric adenocarcinoma patients have nonspecific symptoms, that usually do not trigger a consultation until the disease has advanced, such as dyspepsia, anorexia, low intensity, diffuse abdominal pain and weight loss [1]. As the disease progresses and the tumor occupies a larger part of the stomach or causes stomach distention, other symptoms, such as early satiety, nausea, vomiting, dysphagia, postprandial fullness appear [2]. With increasing progression, bleeding occurs, and the blood is expelled as hematemesis, melena or hematochezia. With the development of complications, the patient may experience jaundice and peritoneal or pleural effusions, due to metastases or hypoalbuminemia caused by inanition. Pedal edema may also develop due to the same cause [3] [4].

The tumor may cause metastasis in the ovary, the peritoneum or lymph nodes (supraclavicular, left axilla or periumbilical).

Paraneoplastic syndromes, such as acanthosis nigricans and dermatomyositis have been described.

Virchow's Node
  • Several nodal metastases with eponymous names associated with gastric cancer have been described: sister Mary Joseph’s node Virchow’s node Krukenberg’s node Irish node Adenocarcinoma is by far the most common gastric malignancy, representing over 95%[radiopaedia.org]
  • Node Microscopic (histologic) images Contributed by Andrey Bychkov, M.D., Ph.D.[pathologyoutlines.com]
  • Signs may include a palpably enlarged stomach, a primary mass (rare), an enlarged liver, Virchow’s node (i.e., left supraclavicular), Sister Mary Joseph’s nodule (periumbilical), or Blumer’s shelf (metastatic tumor felt on rectal examination, with growth[aafp.org]
Weight Loss
  • A 56-year-old woman presented with epigastric pain and weight loss. Endoscopy showed an irregular depressed hyperemic lesion covered with a whitish plaque on the cardia.[ncbi.nlm.nih.gov]
  • Early stage gastric adenocarcinoma patients have nonspecific symptoms, that usually do not trigger a consultation until the disease has advanced, such as dyspepsia, anorexia, low intensity, diffuse abdominal pain and weight loss.[symptoma.com]
  • Left: 82 year-old woman who presented with early satiety and postprandial vomiting, suggestive of gastric outlet obstruction, along with weight loss and anemia.[endoatlas.com]
  • Patients may present with anorexia and weight loss (95%) as well as abdominal pain that is vague and insidious in nature.[radiopaedia.org]
Anemia
  • A natural evolution can be traced back from gastric adenocarcinoma to megaloblastic anemia due to achlorhydria in the context of chronic infection; periodic endoscopy thus seems justified to detect and treat carcinoma in early stages.[ncbi.nlm.nih.gov]
  • A 56-year-old Malaysian woman with a past medical history of iron deficiency anemia presented with lower extremity edema and progressive fatigue of 1 month's duration.[ncbi.nlm.nih.gov]
  • Initial studies revealed iron-deficiency anemia and blood in the stool.[endoatlas.com]
  • Workup should begin with a complete blood count, that might show anemia, due to blood loss or insufficient food intake due to lack of appetite.[symptoma.com]
  • The patient was admitted 1 month prior to presentation with abdominal pain, anemia, and increasing lower extremity edema.[acgcasereports.gi.org]
Fatigue
  • Fatigue, anxiety, appetite loss, and pain were among the issues most commonly reported for both randomized groups. Baseline levels of pain, appetite, constipation, and physical functioning were prognostic factors for survival.[ncbi.nlm.nih.gov]
  • A 56-year-old Malaysian woman with a past medical history of iron deficiency anemia presented with lower extremity edema and progressive fatigue of 1 month's duration.[ncbi.nlm.nih.gov]
  • […] symptoms of advanced stomach cancer are: nausea and vomiting frequent heartburn loss of appetite , sometimes accompanied by sudden weight loss constant bloating early satiety (feeling full after eating only a small amount) bloody stools jaundice excessive fatigue[healthline.com]
  • […] symptoms of advanced stomach cancer are: nausea and vomiting frequent heartburn loss of appetite, sometimes accompanied by sudden weight loss constant bloating early satiety (feeling full after eating only a small amount) bloody stools jaundice excessive fatigue[healthline.com]
  • […] include any of the following: Abdominal fullness or pain, which may occur after a small meal Dark stools Difficulty swallowing, which becomes worse over time Excessive belching General decline in health Loss of appetite Nausea Vomiting blood Weakness or fatigue[medlineplus.gov]
Familial Adenomatous Polyposis
  • Familial adenomatous polyposis . Peutz-Jeghers syndrome . Lynch syndrome . Note: Possible association with tobacco use - dependent on the study. [2] Treatment: Surgical excision.[librepathology.org]
  • adenomatous polyposis or hereditary nonpolyposis colorectal cancer.[cancer.org.au]
  • They are generally regarded as being of no significance although multiple fundic gland polyps with evidence of dysplasia can occur in familial adenomatous polyposis (FAP).[atlasgeneticsoncology.org]
  • Other inherited forms of digestive system cancer include familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer ( HNPCC ): Hereditary diffuse gastric cancer (HDGC) : HDGC is an autosomal dominant disorder and is caused by[cancerquest.org]
  • adenomatous polyposis Gastric adenomas Gastric biopsy revealing high-grade dysplasia Definite Chronic atrophic gastritis Gastric metaplasia or biopsy Helicobacter pylori infection Hereditary nonpolyposis colorectal cancer (Lynch II) Probable History[aafp.org]
Fever
  • Postoperatively, the patient had a persistent fever and was treated with albendazole for 7 days, which alleviated the fever.[ncbi.nlm.nih.gov]
  • A 78-year-old man presented with a history of progressive bilateral vision loss during the 4 previous years associated with fever of unknown origin. He underwent total gastrectomy 17 years earlier as a treatment for gastric adenocarcinoma.[ncbi.nlm.nih.gov]
  • In the MWA group, side effects were reported in eight patients who developed abdominal pain, transient fever, or nausea.[ncbi.nlm.nih.gov]
  • Muscle metastasis is usually asymptomatic, but depending on the location and degree of impairment may be associated with generalized muscle pain, muscle swelling, palpable mass, decreased range of motion, fever and weight loss ( 7 ).[ncbi.nlm.nih.gov]
  • Contact your health provider immediately [ edit ] Fever of 100.4 F (38 C) or higher, chills (possible signs of infection).[en.wikipedia.org]
Pleural Effusion
  • With the development of complications, the patient may experience jaundice and peritoneal or pleural effusions, due to metastases or hypoalbuminemia caused by inanition. Pedal edema may also develop due to the same cause.[symptoma.com]
  • There were 2 treatment-related grade 5 AEs (acute kidney injury and pleural effusion). Pembrolizumab is approved for several indications, including as a treatment for patients with lung cancer, melanoma, Hodgkin lymphoma, and other types of cancer.[onclive.com]
  • There were two treatment-related grade 5 AEs (acute kidney injury and pleural effusion). Keytruda is approved for several indications, including as a treatment for patients with lung cancer, melanoma, Hodgkin lymphoma, and other types of cancer.[curetoday.com]
Nausea
  • This 65-year-old patient was admitted with nausea, vomiting and abdominal pain, in addition to loss of weight (13 Kg in 3 months).[ncbi.nlm.nih.gov]
  • In the MWA group, side effects were reported in eight patients who developed abdominal pain, transient fever, or nausea.[ncbi.nlm.nih.gov]
  • As the disease progresses and the tumor occupies a larger part of the stomach or causes stomach distention, other symptoms, such as early satiety, nausea, vomiting, dysphagia, postprandial fullness appear.[symptoma.com]
  • Right: 70 year-old man with melena as his only presenting symptom; no nausea, vomiting, early satiety or pain. Endoscopy revealed a partially obstructing adenocarcinoma, seen here from the antrum.[endoatlas.com]
  • Nausea, vomiting, and early satiety may occur with bulky tumors that obstruct the gastrointestinal lumen or infiltrative lesions that impair stomach distension 2.[radiopaedia.org]
Vomiting
  • This 65-year-old patient was admitted with nausea, vomiting and abdominal pain, in addition to loss of weight (13 Kg in 3 months).[ncbi.nlm.nih.gov]
  • Left: 82 year-old woman who presented with early satiety and postprandial vomiting, suggestive of gastric outlet obstruction, along with weight loss and anemia.[endoatlas.com]
  • As the disease progresses and the tumor occupies a larger part of the stomach or causes stomach distention, other symptoms, such as early satiety, nausea, vomiting, dysphagia, postprandial fullness appear.[symptoma.com]
  • Nausea, vomiting, and early satiety may occur with bulky tumors that obstruct the gastrointestinal lumen or infiltrative lesions that impair stomach distension 2.[radiopaedia.org]
Abdominal Pain
  • Abdominal pain is a frequent complaint in the pediatric emergency department. A 13-year-old boy presented with complaints of abdominal pain, hematemesis, headache, and leg pain.[ncbi.nlm.nih.gov]
  • This 65-year-old patient was admitted with nausea, vomiting and abdominal pain, in addition to loss of weight (13 Kg in 3 months).[ncbi.nlm.nih.gov]
  • A 12-year-old boy was admitted to the hospital with complaint of abdominal pain. X-ray revealed free air density below the diaphragm. Emergent laparotomy showed perforated stomach.[ncbi.nlm.nih.gov]
  • In the MWA group, side effects were reported in eight patients who developed abdominal pain, transient fever, or nausea.[ncbi.nlm.nih.gov]
  • The tunor extended into the second portion of the duodenum. 51 year-old woman who had undergone EGD one month previously for symptoms of abdominal pain.[endoatlas.com]
Loss of Appetite
  • Some of the most common symptoms of advanced stomach cancer are: nausea and vomiting frequent heartburn loss of appetite , sometimes accompanied by sudden weight loss constant bloating early satiety (feeling full after eating only a small amount) bloody[healthline.com]
  • Some of the most common symptoms of advanced stomach cancer are: nausea and vomiting frequent heartburn loss of appetite, sometimes accompanied by sudden weight loss constant bloating early satiety (feeling full after eating only a small amount) bloody[healthline.com]
  • Symptoms of stomach cancer are often vague, such as loss of appetite and weight. Gastric cancer is diagnosed via a biopsy of stomach tissue during an endoscopy . Also called stomach cancer.[medicinenet.com]
  • They include: persistent indigestion and heartburn trapped wind and frequent burping feeling very full or bloated after meals persistent stomach pain Symptoms of advanced stomach cancer can include: blood in your poo, or black poo loss of appetite weight[nhs.uk]
  • […] of appetite Nausea Vomiting blood Weakness or fatigue Weight loss Diagnosis is often delayed because symptoms may not occur in the early stages of the disease.[medlineplus.gov]
Early Satiety
  • Left: 82 year-old woman who presented with early satiety and postprandial vomiting, suggestive of gastric outlet obstruction, along with weight loss and anemia.[endoatlas.com]
  • As the disease progresses and the tumor occupies a larger part of the stomach or causes stomach distention, other symptoms, such as early satiety, nausea, vomiting, dysphagia, postprandial fullness appear.[symptoma.com]
  • Nausea, vomiting, and early satiety may occur with bulky tumors that obstruct the gastrointestinal lumen or infiltrative lesions that impair stomach distension 2.[radiopaedia.org]
  • Some of the most common symptoms of advanced stomach cancer are: nausea and vomiting frequent heartburn loss of appetite , sometimes accompanied by sudden weight loss constant bloating early satiety (feeling full after eating only a small amount) bloody[healthline.com]
Peripheral Neuropathy
  • neuropathy grade 2 Inability to tolerate intravenous hydration e.g due to cardiac disease Co-morbidities (based on clinical judgement by the investigator) that in the view of the investigator would preclude the safe administration of cisplatin.[clinicaltrials.gov]
  • Side effects may include: tiredness nausea and vomiting nerve damage ( peripheral neuropathy ) hair loss diarrhoea anaemia (a lack of red blood cells) weight loss skin changes – such as redness, swelling and a tingling sensation in the palms of the hands[nhs.uk]
  • Grade III/IV neutropenia occurred in 33%, and grade III peripheral neuropathy in 7.4% of patients [ 79 ].[annonc.oxfordjournals.org]

Workup

The clinician taking patient history should inquire about previous Helicobacter pylori infection or autoimmune gastritis, knowing that these conditions are predisposing factors for gastric adenocarcinoma.

Workup should begin with a complete blood count, that might show anemia, due to blood loss or insufficient food intake due to lack of appetite. The clinician should also recommend liver function tests (keeping in mind that gastric adenocarcinoma may cause hepatic metastasis) and tumor markers such as carcinoembryonic antigen and cancer antigen 19-9. Even if these antigens are absent, the diagnosis cannot be excluded.

Imaging studies in association with histologic findings confirm or disprove the diagnosis. Upper digestive endoscopy is at this time the gold standard for gastric adenocarcinoma diagnosis [5], as it allows tumor detection and biopsy. Endoscopic methods even allow tumor excision if found in the early stages. Classical endoscopy limitation resides in incomplete staging evaluation, but this can be overcome with endoscopic ultrasonography [6].

Mucosal aspect can also be evaluated using upper gastrointestinal barium study, that involves a lower amount of irradiation than a computer tomogram. The latter can also evaluate invasion of neighboring structures and lymphadenopathy [7]. Liver, bone and peritoneal metastasis are better defined by magnetic resonance, so if symptoms dictate, this should be the method of choice [8]. However, MRI is not as useful in describing gastric lesions per se, because a contrast agent is unavailable [8]. Barium study accuracy can be improved by using double contrast or compressive views.

Once a lesion has been documented, it is important to evaluate the histologic aspect. Adenocarcinomas (tubular, mucinous, papillary, signet-ring cells or undifferentiated) are far more frequent than lymphomas, stromal tumors, carcinoids, adenoacantomas, and squamous cell carcinomas, and account for more than 90% of gastric cancers [9].

Recent studies have described the importance of certain serum glycan patterns as markers for the risk of gastric cancer development [10].

Helicobacter Pylori
  • The rapid urease test, histological examination, and serum anti-Helicobacter pylori antibody indicated that the patient was Helicobacter pylori negative. Gastric mucosal atrophy was not evident on esophagogastroduodenoscopy.[ncbi.nlm.nih.gov]
  • Adenocarcinoma and lymphoma represent the two most common malignant tumours of the stomach, with both neoplasms being associated with infection by Helicobacter pylori.[ncbi.nlm.nih.gov]
  • Between the procedures, he successfully completed Helicobacter pylori eradication therapy. In May 2015, upper endoscopy screening showed two elevated lesions on the gastric fundus, and en bloc resection by ESD was performed.[ncbi.nlm.nih.gov]
  • The histological and serological findings indicated the absence of Helicobacter pylori infection. The present case demonstrates a new histological subtype of gastric adenocarcinoma, which has characteristic endoscopic findings.[ncbi.nlm.nih.gov]
  • The patient had no history of Helicobacter pylori (H. pylori) eradication.[ncbi.nlm.nih.gov]
Gastric Lesion
  • Two cycles of chemotherapy consisted of oral S-1 and intravenous cisplatin (SPIRITS regimen); this was markedly effective to reduce the primary gastric lesion and almost all the metastatic lesions.[ncbi.nlm.nih.gov]
  • An 87-year-old man was referred to our institution for endoscopic resection of a gastric lesion. The tumor was classified as type 0-I   IIa according to the Paris classification.[ncbi.nlm.nih.gov]
  • However, MRI is not as useful in describing gastric lesions per se, because a contrast agent is unavailable. Barium study accuracy can be improved by using double contrast or compressive views.[symptoma.com]
  • Intestinal type adenocarcinoma is preceded by a sequence of gastric lesions known as Correa s cascade and is the histologic type associated with the global decrease in gastric cancer rates.[ncbi.nlm.nih.gov]
  • This radiographic study provides preliminary information that may help the physician determine if a gastric lesion is present and whether the lesion has benign or malignant features.[aafp.org]
Pleural Effusion
  • With the development of complications, the patient may experience jaundice and peritoneal or pleural effusions, due to metastases or hypoalbuminemia caused by inanition. Pedal edema may also develop due to the same cause.[symptoma.com]
  • There were 2 treatment-related grade 5 AEs (acute kidney injury and pleural effusion). Pembrolizumab is approved for several indications, including as a treatment for patients with lung cancer, melanoma, Hodgkin lymphoma, and other types of cancer.[onclive.com]
  • There were two treatment-related grade 5 AEs (acute kidney injury and pleural effusion). Keytruda is approved for several indications, including as a treatment for patients with lung cancer, melanoma, Hodgkin lymphoma, and other types of cancer.[curetoday.com]

Treatment

  • Treatment at an academic center was associated with improved OS.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: The promising results for endoscopic treatment in this study showed that early endoscopic treatment using a covered SEMS for EJL might be a feasible, safe, and effective method in selected patients.[ncbi.nlm.nih.gov]
  • Treatment with intravitreal anti-vascular endothelial growth factor therapy warrants further evaluation.[ncbi.nlm.nih.gov]
  • PURPOSE: New stage grouping classifications for clinical (cStage) and post-neoadjuvant treatment (ypStage) stage for gastric adenocarcinoma have been proposed for the eighth edition of the AJCC manual.[ncbi.nlm.nih.gov]
  • The patient disease and treatment assessment (PTDATA) form was also provided to English-speaking participants.[ncbi.nlm.nih.gov]

Prognosis

  • Discussion and conclusion Serum CEA is shown to be significantly associated with poor prognosis for gastric cancer patients.[ncbi.nlm.nih.gov]
  • Both hepatoid adenocarcinoma and neuroendocrine differentiation are the factors leading to a poor prognosis of gastric cancer. However, there is still no specific treatment.[ncbi.nlm.nih.gov]
  • The high‑ and low‑risk samples identified by the prognosis model presented a remarkable difference in total survival time, indicating its robustness and sensitivity as the prognosis genes for gastric adenocarcinoma.[ncbi.nlm.nih.gov]
  • Local advanced gastric carcinoma has a very poor prognosis. When a T4 gastric carcinoma has invaded the surrounding tissues and organs, curative resection is unlikely.[ncbi.nlm.nih.gov]
  • Intestinal-type cancers are common and reported to have a better prognosis compared to diffuse cancers.[ncbi.nlm.nih.gov]

Etiology

  • In the absence of signs and symptoms of other etiologies of lactic acidosis, physicians should consider malignancy-associated type B lactic acidosis.[ncbi.nlm.nih.gov]
  • The prompt diagnosis is important for optimize the etiology evaluation and therapeutically approach." [Indexed for MEDLINE] Free full text[ncbi.nlm.nih.gov]
  • The patient was referred for further evaluation and subsequent surgical resection of the tumor.Acanthosis nigricans (AN) is a hyperkeratotic mucocutaneous eruption of heterogenous etiology, which is characterized by hyperpigmentation, velvety cutaneous[ncbi.nlm.nih.gov]
  • The etiology of the cirrhosis was most likely nonalcoholic fatty liver disease, given the patient’s long history of diabetes mellitus II and exclusion of etiologies to include alcohol, viral, autoimmune, metabolic, and biliary tract disease.[acgcasereports.gi.org]
  • Etiology Gastric cancer continues to be one of the leading causes of cancer-related death. A significant development in the epidemiology of gastric carcinoma has been the recognition of the association with Helicobacter pylori infection.[radiopaedia.org]

Epidemiology

  • Author information 1 Cancer Epidemiology Unit, National Centre for Epidemiology, Instituto de Salud Carlos III, Av/Monforte de Lemos, 5, 28029, Madrid, Spain. acastello@isciii.es. 2 Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP[ncbi.nlm.nih.gov]
  • National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain. 7 Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro, Madrid, Spain. 8 Cancer Prevention and Control Program, Catalan Institute of Oncology[ncbi.nlm.nih.gov]
  • METHODS: The study used the Surveillance Epidemiology and End Results (SEER) database to examine overall survival for patients with the diagnosis of gastric adenocarcinoma between 1988 and 2013.[ncbi.nlm.nih.gov]
  • DOI: Published January 2001 Abstract Epidemiology of gastric adenocarcinoma suggests that intestinal-type and diffuse-type cancers develop through distinct causal pathways.[cebp.aacrjournals.org]
  • A significant development in the epidemiology of gastric carcinoma has been the recognition of the association with Helicobacter pylori infection. Most gastric cancers occur sporadically, whereas 8-10% have an inherited genetic component.[radiopaedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management . 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 54. Gunderson LL, Donohue JH, Alberts SR. Ashman JB, Jaroszewski DE, eds.[medlineplus.gov]
  • In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. . Accessed March 23, 2016. Gastric cancer.[mayoclinic.org]

Prevention

  • KEYWORDS: Adenocarcinoma; Diet, Mediterranean; Diet, Western; Population attributable fraction; Prevention and control; Principal component analysis; Stomach neoplasms[ncbi.nlm.nih.gov]
  • Rac1 inhibition in gastric adenocarcinoma cells blocks EMT and CSC phenotypes, and thus may prevent metastasis and augment chemotherapy.[ncbi.nlm.nih.gov]
  • Helicobacter pylori infection contributes to the development of many endemic GACs, and pre-emptive eradication or early treatment of this bacterial infection might provide effective primary prevention.[ncbi.nlm.nih.gov]
  • Country, San Sebastián, Spain. 6 Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain. 7 Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro, Madrid, Spain. 8 Cancer Prevention[ncbi.nlm.nih.gov]
  • These protocols are added to the classical surgical intervention, in order to prevent disease relapse and improve survival.[symptoma.com]

References

Article

  1. Fenogilo-Preiser C, Carneiro F, Correa P, et al. Gastric carcinoma. In: Hamilton S, Aaltonin L, eds. Pathology and Genetics. Tumors of the Digestive System, vol 1. Lyon, France: Lyon Press; 2000;37–52.
  2. Gore R. Gastrointestinal cancer. Radiol Clin North Am. 1997;35:295–310.
  3. Albert C. Clinical Aspects of Gastric Cancer. Gastrointestinal Cancers: Biology, Diagnosis, and Therapy. Philadelphia: Lippincott-Raven. 1995;197–216.
  4. Livingston E. Stomach and duodenum. In: Norton J, Bollinger R, Chang A, et al., eds. Surgery. Basic Science and Clinical Evidence. New York: Springer-Verlag; 2001;489–515.
  5. Karpeh M, Brennan M. Gastric carcinoma. Ann Surg Oncol. 1998;5:650–656.
  6. Willis S, Truong S, Gribnitz S, et al. Endoscopic ultrasonography in the preoperative staging of gastric cancer: accuracy and impact on surgical therapy. Surg Endosc. 2000;14:951–954.
  7. Kuntz C, Herfarth C. Imaging diagnosis for staging of gastric cancer. Semin Surg Oncol. 1999;17:96–102.
  8. Motohara T, Semelka RC. MRI in staging of gastric cancer. Abdom Imaging. 2002;27:376–383.
  9. Avital I, Pisters PWT, Kelsen DP, Willett CG. Cancer of the Stomach. DeVita VT, Lawrence TS, Rosenberg SA. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2011; 924-54.
  10. Waknine Y. Researchers Discover 'Glycan Fingerprint' for Gastric Cancer. Medscape. http://www.medscape.com/viewarticle/818637. Published January 03, 2014. Accessed January 30, 2017

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Last updated: 2019-07-11 20:48