Amyloidosis is a rare disease that occurs when amyloid, a type of protein, builds up in the organs. This protein is produced in the bone marrow and can deposit in any organ or tissue. Statistics show that at least 4,000 people develop the condition in our country. It is usually diagnosed between the ages of 50 and 65. Although the disease can affect any part of the body, it mostly affects the heart, kidneys, liver, spleen, and the digestive tract, and severe amyloidosis can even result in organ failure.

Here are some of the main types of the disease based on particular symptoms:

Primary amyloidosis (AL)
The most common type, it is an acquired plasma cell disorder in which a monoclonal immunoglobin chain of protein is overproduced in the bone marrow. Primary amyloidosis (AL) is usually found in blood and urine and occurs with Waldenstrom’s macroglobulinemia, lymphoma, or, multiple myeloma. The “AL” in primary amyloidosis refers to light chains. People suffering from this type of the disease usually experience heart failure, protein in the urine, an enlarged liver, kidney failure, and an enlarged tongue.

Treating primary amyloidosis: The type of treatment provided to the patient is based on the progression of the disease. The treatment plans are three-fold:

• Supportive treatment: It refers to treating the symptoms and organ damage. Supportive treatment is helpful for treating conditions like cardiac and renal (kidney) problems that might arise due to the disease, and the main aim is to improve the quality of life.
• Source treatment: The main aim of this treatment is to stop or slow down the overproduction of amyloid at its source. It is often the most preferred treatment option in our country because it provides long-term treatment for the underlying disease.
• Combination therapy: Many patients have benefited from this type of therapy. The recent development of a new strain of medicines works effectively on the abnormal plasma cells causing AL amyloidosis, and the dosage depends on individual patients. Medicines range from traditional chemotherapy medicines, proteasome inhibitors, and immunomodulators.

Secondary amyloidosis (AA)
This type of the condition is caused by inflammatory diseases like familial Mediterranean fever, rheumatoid arthritis, granulomatous ileitis, or other chronic infections. Secondary amyloidosis usually begins in the kidney, but other organs can also be affected. The AA in secondary amyloidosis refers to the AA proteins that are deposited in the organs in the form of fibrils.

Treating secondary amyloidosis (AA): Currently, there are very few options that directly target the amyloid deposits in the case of secondary amyloidosis (AA). The main aim in treating this type of the disease is to reduce the circulating levels of the precursor protein causing inflammatory conditions like rheumatoid arthritis and renal diseases. Biological agents like anti-TNF (tumor necrosis factor) and (interleukin) IL-1 and IL-6 blockers are some of the main therapeutic options used for treating secondary amyloidosis (AA). In the case of renal failure due to this type, acute or chronic dialysis might be required.

Familial amyloidosis (ATTR)
Formerly referred to as senile systemic amyloidosis, it is an inherited form of the disease caused by a mutation in the transthyretin (TTR) gene. It produces an abnormal transthyretin gene, and the most common symptoms of this type are cardiomyopathy (enlarged heart muscles) and neuropathy (peripheral nervous system failure). The symptoms can manifest between 40 and 55 years of age. Also, there are more than 100 different mutations of familial amyloidosis, which makes it more difficult to treat the disease.

Treating familial amyloidosis (ATTR): Like secondary amyloidosis, there are very few options available for treating this type. Some FDA-approved medicines are:

• ATTR stabilizers: These medicines are used to stabilize the abnormal ATTR protein that causes the disease by preventing it from breaking into amyloid fibrils.
• ATTR silencers: These medicines act on the liver, reducing the production of TTR. They have been specifically studied on patients with nerve problems.
• Fibril disruptors: This new form of medication helps break up and clear ATTR amyloid fibrils.

Since TTR is produced in the liver, a liver transplant is also a possible treatment in some forms of familial amyloidosis.

Localized amyloidosis (ALoc)
There are many forms of ALoc amyloidosis that leads to deposits in the airway (trachea or bronchus), urinary bladder, or the eyes. It is often caused by the formation of immunoglobin light chains, and these do not originate from the bone marrow. Other types of ALoc amyloidosis are associated with endocrine proteins that are produced in the skin, heart, and other parts of the body.

Treating ALoc amyloidosis: The best way to treat this type is to treat the underlying disease. This can be either through surgery, medications, or both. Apart from this, targeting the specific protein causing the disease can also slow down the progression of the disease.

It is necessary for the patient and their loved ones to be careful about the symptoms of the disease as the doctors will provide treatments based on the same. Supportive care like pain medications and counseling is also necessary to manage the disease.

Ovarian cancer is a form of cancer that originates in the ovaries, a part of the female reproductive system. It is the tenth most common type of cancer detected among women. Read on to know more about ovarian cancer symptoms, causes, risk factors, types, diagnosis, treatment, and prevention.

Symptoms of ovarian cancer
In the early stage of ovarian cancer, the symptoms might be non-existent. As the condition progresses, it might project symptoms that may often be misconstrued for benign health conditions. The signs and symptoms of ovarian cancer could involve the following

• Bloating or swelling in the abdomen
• Back pain
• Frequent urination
• Unexplained weight loss
• Nausea and tiredness
• Pain while having intercourse
• Discomfort or pain in the pelvic region
• Loss of appetite or quickly feeling full even after eating little food
• Constipation

Causes of ovarian cancer
Researchers haven’t been able to narrow down the exact cause of ovarian cancer as yet; however, there are multiple factors that could contribute to the development of this condition. Following are some factors that could amplify the risk of ovarian cancer in women:

• Age – Although ovarian cancer can affect a woman of any age, it is mostly observed among women aged between 50 and 60 years.
• Family history – Individuals who have two or more close relatives who have had dealt with ovarian cancer have higher chances of developing this condition.
• Hormone replacement therapy – A prolonged use of estrogen hormone replacement therapy in high doses can lead to ovarian cancer.
• Early or late menstruation – The commencement of menstruation at an early or later age can both magnify the risk of ovarian cancer.
• Inherited gene mutations – A tiny percentage of ovarian cancer is caused due to gene mutations received from parents. Breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) are known to boost the risk of ovarian cancer as well. Likewise, the gene mutations related to Lynch syndrome can also cause ovarian cancer.

Types of ovarian cancer
The types of ovarian cancer are determined according to where the tumor has originated in the ovaries. Here are the three types of ovarian cancer:

• Epithelial tumors – This type of cancer starts within the thin tissue that covers the external part of the ovaries. Epithelial tumors form approximately 90% of the ovarian cancers.
• Stromal tumors – These types of tumors arise in ovarian tissues that comprise the cells that produce hormones. As compared to other types of ovarian cancers, these tumors are usually diagnosed during the initial stages. It is estimated that stromal tumors make up around 7% of the total ovarian cancer cases.
• Germ-cell tumors – These types of tumors begin in the cells that produce eggs. Germ-cell tumors are pretty rare and usually tend to affect younger women.

Diagnosis of ovarian cancer
Depending on the symptoms, doctors can suggest one or multiple diagnostic tests. A pelvic exam is commonly recommended where the doctor examines the vagina for any abnormal growths. Imaging tests such as abdominal and pelvic ultrasound or CT scan are used to gauge the size and structure of the ovaries. Likewise, a blood test for measuring the levels of CA (cancer antigen) 125 can be suggested. However, this blood test can’t definitively claim that one is suffering from cancer. In extreme cases, if there is no conclusive diagnosis drawn, the doctor may suggest surgery to remove the tumor or a part of it for biopsy.

Treatment of ovarian cancer
Once the condition is diagnosed, the doctor will suggest a combination of procedures for its treatment. These include the following:

• Surgery – Depending on how far the cancer has spread, the doctor will recommend surgery to remove either one ovary, both the ovaries, or both ovaries and uterus.
• Chemotherapy – This is a powerful type of drug that is used for killing cancer cells. It can be used before or after the surgery, based on the diagnosis. Drugs used for chemotherapy can be taken orally, injected in the veins, or can be directly injected into the affected part.
• Targeted therapy – In this kind of therapy, drugs are used to target certain vulnerabilities of the cancer cells. It is ordinarily used in cases, where the cancer is resistant to other types of drugs or relapses after treatment.
• Palliative care – This is a specialized form of health treatment that focuses on alleviating the painful symptoms of cancer. The palliative care specialists not only work with the patient but also with family members and doctors to make it easier to cope with aggressive procedures such as chemotherapy and surgery.

Prevention
As of now, there is no foolproof way of entirely preventing ovarian cancer. There are a few measures one can take to lower its risks such as using birth control pills, considering pregnancy, breastfeeding, and surgical procedures such as tubal litigation or hysterectomy. However, it is essential that one scrutinizes the consequences of adopting any such methods. Therefore, it always makes sense to be prudent by seeking the counsel of a qualified gynecologist.