PRRT and the promise it holds for cancer treatment

As we continue our conversation on Precision Medicine for cancer, a popular therapy used to treat NET tumours or Neuro Endocrine Tumours is PRRT or Peptide Receptor Radionuclide therapy.
Neuroendocrine tumours are a rare form of cancer and originate from Neuro endocrine cells in the body and hence the name.They are different from adenocarcinoma’s and often do not do not respond well to chemotherapy, the 1st line of treatment for most cancers.

By administering radioactive protein lutetium octreotate, it is possible to treat NET tumours or neuro endocrine carcinoma with precision and offset progression of disease.

PRRT for neuroendocrine tumour
PRRT treatment for metastatic cancer cells spreading and growing. Tailor-made precision medicine based on genetic profile and molecular structure of the tumour.

In PRRT a peptide or a cell targeting protein is combined with a small amount of radio active nuclide creating what is called as a radio peptide. The radio peptide when injected into the patients blood stream travels and binds to a neuro endocrine tumour, delivering a high dose of radiation to the tumours. This also limits damage to the nearby healthy tissue and hence lesser and milder side effects than chemotherapy.

What kind of cancers can be treated by PRRT?

Along with Neuroendocrine tumours, carcinoids, islet cell carcinoma of the pancreas, small cell carcinoma of the lung a form of lung cancer, pheochromocytoma (a rare tumor that forms in the adrenal glands), gastro-enteropancreatic (stomach cancer , intestine cancer and pancreas) neuroendocrine tumors, and rare thyroid cancers that are unresponsive to treatment with radio iodine are often treated with PRRT.

Role of PRRT is also being explored for treatment of prostate cancer.

When is a patient a candidate for PRRT ?

Patients with following conditions are often proposed for PRRT

  • When neuro endocrine tumours are not responsive to other lines of cancer treatment
  • When surgical removal of tumours is not possible at current stage, PRRT may be used to reduce size of the tumours.
  • PRRT is also a treatment option for last stage inoperable cancers when metastasis has set in.
    The main aim of PRRT is then to slow down progression of disease, offer relief and prolong life.

However, not all neuroendocrine tumours respond to PRRT. First an OctreoScan is done. If the patient is found to have a positive OctreoScan and meets other requirements, PRRT is proposed.

What happens during PRRT ?

For patients having a positive octreoscan, to start with an amino acid solution is delivered to protect the kidneys.

As most net tumours have a lot of a specific type of surface receptor, a protein called somatostatin. Octreotide, is a lab version of somastostatin. During PRRT, a dose of radio nuclides such as Lutetium, Yttrium are often combined with octreotide and injected into the blood stream.

Molecular imaging and scans follow to see whether the radio peptide has latched on of the tumour sites correctly.

The entire session usually lasts for about 4 hrs and is often done as an out patient procedure.

The main goals of PRRT hence are to provide symptom relief, to stop or slow tumor progression and to improve overall survival.

Advantages of PRRT ?

PRRT along with other molecular therapies or targeted therapies offer excellent results as they are tailor made keeping in mind molecular properties of the tumour and also biologic characteristics of the patient.

PRRT is offered in Germany , USA, UK and other developed countries at a significant cost, In India, a single session of PRRT costs approx USD 6300.

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Understanding Precision Medicine for Cancer.

We often hear of Precision Medicine for Cancer, but what is Precision Medicine, how is it different from standard treatment protocols and what can be the benefits for choosing Precision Medication over standard protocols?

The diagnosis and treatment of cancer at a cellular or molecular level is known as Precision Medicine.

Cancer
Precision medicine : Tailored medication for cancer based on specific patients, genetic profile .

Cancer is a heterogenous disease, with different genetic profile not only between patients with different cancers but also differences in genetic , molecular and cellular profile even within the same type of cancer.

All cancers are genetic by nature and with cellular profile changing over time even in the same patient, till now no single drug is known to cure even a single type of cancer let alone different types of cancer’s.

Standard chemotherapy protocols focus of administering standard chemotherapy drugs ( one size fits all) without taking into account cellular or genetic profile of the patient.

Precision medicine on the other hand focuses on accurate and effective treatment to each patient based on the genetic profile, the proteins feeding the tumours or the cancers.

There are sufficient number of detractors even amongst the best doctors but precision medicine or administering drugs based not a specific tailored patient profile not being the best option is a pre mature conclusion.

This week being Breast Cancer week, let’s shed some light on Precision medicine for breast cancer.

Breast cancer treatment in India beyond surgical options of lumpectomy, mastectomy involves administering chemotherapy and radiotherapy, with chemotherapy being the first line of treatment.

Difference in outcomes depends upon whether the patient has been tested for HER2(human epidermal growth factor receptor 2), ER, PR or not.

For patients testing positive for HER 2, addition of trastuzumab to chemotherapy slows down disease progression. Lapatinib plus chemotherapy (i.e., capecitabine) achieved a longer median time to disease progression compared with chemotherapy alone.

A combination of pertuzumab, trastuzumab, and chemotherapy further improved the median overall survival time to a median of almost 5 years compared with a combination of only trastuzumab and chemotherapy for a median of 3 and half years.

Similarly treatment with ado-trastuzumab emtansine, a conjugate of a HER2 monoclonal antibody and a cytotoxic drug, significantly improved the length of progression-free survival and overall survival with lower adverse effects when compared with lapatinib and chemotherapy

The above examples clearly show how genetic profiling, identification of key mutations like the Bcr-Ablfusion or HER2 can benefit a large number of breast cancer patients.

Genetic profiling also enables identification of molecular targets for intervention.Cell death is caused by a combination of deficiencies in the expression of two or more genes, whereas deficiency in only one of these genes can increase viability or enhance multiplication of mutant cells. For example, BRCA (mutant gene responsible for particularly aggressive breast cancers( and poly ADP ribose polymerase (PARP) genes were found to have a synthetic lethal relationship.

For example, by using olaparib, a PARP inhibitor, to treat BRCA-mutant ovarian cancer patients, the progression-free survival of BRCA-mutant ovarian cancer patients was significantly prolonged by olaparib compared with standard chemotherapy protocols.

This methodology focusses on identifying cancer vulnerabilities and subsequent tailored treatment based on patient profile.

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Decoding CyberKnife, for cancer treatment and benign tumours

We often get queries on CyberKnife and what is CyberKnife used for ?

CyberKnife is an excellent treatment option for treating cancer’s such as prostate cancer, gliomas ,brain cancer, kidney cancer, lung cancer, spine cancer, cancer of the pancreas, head and neck cancer, liver cancer, early stage -localised breast cancer and several types of malignant tumours, benign tumours and several other medical conditions.
CyberKnife delivers stereostatic radiation( SBRT) with extreme precision and a tissue margin of 1-5mm

Non invasive, CybeKnife vaporises a brain tumour

Cyber knife is totally non invasive and offers hope for inoperable localised cancers such as small cell lung cancer,for inoperable lesions where there is no other alternative for the patient to be treated.
CyberKnife can spot the exact size, shape and location of the tumor and delivers highly concentrated beams of radiation with precision ranging from 1 to 5 mm and this leads to minimal damage and bleeding.

Since CyberKnife treatment is totally non invasive, it is used for treatment of inoperable cancers as an alternate to surgery or as an alternative to surgery to minimise trauma, avoid complications and reduce risk.

Most patients can be treated several times with the CyberKnife and even treated again or retreated with minimal side effects leading to a better quality of life.For example for prostate cancer, even for a repeat surgery, CyberKnife can be used very successfully.

CyberKnife treatment is FDA approved and can spot patient movement even while breathing. The radiation beams can be aimed from several directions, thereby never losing the precision which is hall mark of a CyberKnife treatment.

CyberKnife treatment usually gets completed in 3 to 5 sessions spread over a week. Most patients can lead normal lives post CyberKnife treatment Most CyberKnife treatments are covered by insurance providers all over the world.

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Since the treatment involves a high degree of expertise, CyberKnife treatment is not offered by most hospitals.

The stage, location and size of the tumour or the cancer plays an important role, hence multiple teams of doctors and oncologists need to be involved before a decision on  use of CyberKnife as treatment option can be arrived.
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Diabetes- The soft and silent killer !

The minute most of us hear “Diabetes”, we think of Blood Sugar.

Blood sugar is elevated level of sugar or glucose in the blood which if unchecked overtime, leads to diabetes. Diabetes is a disease in which the body’s ability to produce or respond to insulin is impaired, resulting in abnormal metabolism of carbohydrates, inability of our body to convert sugar into glucose and subsequently elevated levels of glucose in the blood.

We all know about Type 1 Diabetes, Type 2 Diabetes but whats important is what happens in the body, when we have elevated levels of sugar in the body for long.

Common Effects and Risks associated with high sugar levels and diabetes are:

Diabetes
Diabetes complications affected organs. diabetes affects nerves, kidneys, eyes, vessels, heart, brain and skin

Risk of stroke: Diabetes or elevated sugar levels, increase our risk of stroke, about 4 times more than non diabetics

Risk of Heart Disease:  Diabetes increases risk of heart attack , heart disease. As the blood vessels get damaged, it puts the heart under pressure and an increased risk of heart attacks.  High glucose levels also lead to fatty deposits. Coupled with obesity, high blood pressure, it puts you at a severe risk and an angioplasty  or an open heart bypass surgery may even be required.

Risk of Cataract: Diabetics are at an increased risk of developing cataracts

Risk of Glaucoma: Glaucoma risk is significantly more for diabetics. If left untreated, Glaucoma can lead to blindness.

Risk of Pancreas Malfunction: A malfunction in pancreas leads to diabetes and higher blood sugar levels in turn continue to damage the pancreas.
Risk of Gastroparesis:   Increase in blood sugar levels also makes it hard for the  stomach to empty completely. This also in turn leads to an increase in blood sugar levels. Nausea, vomiting, bloating, and heartburn are common symptoms.
Risk of Kidney Damage:  Unchecked High sugar levels and diabetes, damages the kidneys, leads to diabetic neuropathy and eventually one may need a dialysis or even a kidney transplant.
Risk of Nerve Damage: Diabetics often  have tingling sensation in the foot and suffer from nerve damage. Lack of sensation or peripheral neuropathy is dangerous as due to lack of sensation, one may fail to notice injuries

.
Foot Problems:  Unchecked diabetes can lead to diabetic foot where the entire foot may even need to be amputated.
Ketoacidosis:   In absence of insulin,  the body uses alternate hormones to turn fat into energy, which creates a high level of toxic chemicals such as acids and  ketones, which may lead to a condition called diabetic ketoacidosis.  Diabetic ketoacidosis  often leads to loss of consciousness and other life threatening complications. A Fruity Breath or a sweet smelling breath is often an indicator of diabetes and calls for a check on blood sugar levels.
Visual Problems:  Diabetics often face visual problems, as high glucose levels often lead to swollen, leaky blood vessels in the eye, leading to a condition called diabetic retinopathy.  These vision problems,  may even lead to partial or total loss of vision Vision problems can be gradual hence routine eye checkups if you are diabetic or have pre diabetes are a must.

Risk of damage to blood vessels:  High blood sugar levels or high glucose levels,
restrict blood flow, damaging the blood vessels.

As unchecked diabetes, leads to a host of problems, it is important to make life style changes. Pre diabetes conditions can be reversed by exercise and dietary changes.  Type 2 diabetes can be controlled and even reversed if significant life style changes are made.

One of the most important life style change is to Quit smoking as diabetes and smoking leads to an enhanced risk of heart disease.

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High Uric Acid levels ! Is there something to worry about ?

Uric acid is produced naturally by the body as a result of metabolism. Our kidneys filter and throw out uric acid normally.

In some cases, the body produces more uric acid than it can excrete or the kidneys are not able to excrete uric acid being produced, it leads to a rise of uric acid levels and leads to a condition called hyperuricemia.

Hyperuricemia is defined as an excess of uric acid in the bloodstream. If your uric acid is in excess of 7 mg/dL – you may have hyperuricemia.

Hyperuricemia has a few major health effects. They are as follows :

Gout
Gout

Gout : It is defined as a type of arthritis that causes inflammation in the smaller bones of the joints. Typically, chalky deposits of uric acid called “tophi” deposit as lumps under the skin causing severe pain and redness specially in the base of the big toe over a long period of time. This tophaceous gout compresses the nerves and is visible to the naked eye – making it disfiguring and making the pain worse. Gout, is characterised by episodes of intense pain. Sometimes uric acid crystals start to deposit in other joints such as elbow, knee, fingers, hand etc and may also damage surrounding cartilege.
Though extremely rare, sometimes, due to damage of the cartilage a joint replacement surgery such as total knee replacement may be required.

Doctors very rarely let patients come to this stage though and prescribe medication to take care of the pain and to shrink the uric acid crystals.

Incase Tophi or the uric acid crystals become too large or become infected, a surgery though rare, may be needed to remove crystals.

Large Tophi may also affect the range of movement of the joint such as hand or knee and a simple surgery may be required.

Kidney Stones : Kidney stones are defined as a hard mass formed in the kidneys due to insoluble calcium compounds. Initially, the kidney stones are small and pass out with the urine; however, over time the kidney stones become larger and block the urinary tract causing a difficulty in the passing of urine and urinary tract infections due to the buildup of bacteria in the tract. A high level of Uric acid is also a predictor and indicate’s renal dysfunction well in advance before the dialysis stage or the kidney transplant stage .
In patient’s with Rheumatoid arthritis or RA, high uric acid levels, call for a visit to the doctor.

Possible surgeries and procedure to take care of kidney stones are SWL(Shockwave lithotripsy), Ureteroscopy, PCNL(Percutaneous Nephrolithotomy ).

PCNL is best for treatment of medium to large stones , for complex stones or if there are too many stones in one kidney and needs a good, trained urologist.

Ureteroscopy is slightly more invasive than Shockwave lithotripsy but is good for stones which are very small and also way down in the urinary tract.

The best way to take care of gout related problems is to prevent hyperuricemia.

The following natural remedies are easy to implement and help prevent hyperuricemia :
Lemon Juice : Lemon is a natural antioxidant and contrary to popular belief, helps neutralise the uric acid in the body. A glass of lukewarm lemon juice water in the mornings before breakfast may go a long way in preventing uric acid buildup.
Apple Vinegar : Vinegar contains malic acid that helps to breakdown uric acid and make the solution alkaline. A glass of water with 2 tablespoons of apple vinegar has anti – inflammatory benefits.
Water : It is supposed to flush out toxins from the body and regulate kidney function. 8-10 glasses of water a day help dilute uric acid in the body and help excrete out the same from the body. Additionally, care should be taken to include water rich fruits such as watermelon and vegetables such as cucumber in ones diet.
Berries : Cherries and other purple or blue coloured berries contain anthocyanin that have anti- inflammatory and anti- oxidant properties and that help lower uric acid in the body. A bowl of cherries a day greatly reduces the risk of hyperuricemia.
These natural remedies are suggested to be followed post a doctor consultation and are by no means an alternative to prescription medication which is critical for treatment of gout.

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Bowel Cancer- Are there a few red flags to watch out for ?

Bowel cancer is defined as cancer of the bowel or parts of bowel. Depending upon where the cancer is based, it is also known as colon cancer, rectal cancer or colorectal cancer.

Colon cancer is cancer of the rectum. Rectal cancer is cancer of the rectum.

Colorectal cancer is cancer affecting the colon and the rectum.

Most colon cancers are lethal simply because they are diagnosed at a very late stage. Most patients present themselves with symptoms and often visit doctors but symptoms are often missed .

A short guide on awareness of possible symptoms, which are red flags but are often missed during doctor visits.

ColonCancer
Bowel, colon and rectal colorectal cancer symptoms causes risk factors diagnosis
  • Blood in the stool which shows rectal Bleeding
  • Change in Bowel Habits
  • Diarrhoea
  • Abdominal Pain

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Is your tooth pain, an indicator of disease ?

 

Tooth ache,Ddental problems
Tooth Ache, Dental Problems, Health Problems

Teeth: As per Merriam Webster, teeth are defined as the hard bony appendages that are borne on the jaws in the mouth or pharynx and exist for eating food and as weapons of offense and defense.
Over the years, modern physicists have discovered that there is indeed a direct relationship between teeth and Qi ( Energy ). The Chinese found a way to measure Qi and map the pathways – this led them to the conclusion that if Qi was normal, there was good blood flow in the body ; however, if there was disturbed Qi – it symbolised disease and disturbed blood flow.

According to them, teeth are indicative of the state of internal organs in the body and hence pain often indicates trouble in the connected body organ. One’s lips are related to the spleen, teeth are related to various organs in the body, the gum is related to the stomach, and the tongue is related to the heart.

Below are a few health problems which our teeth, gums and tongue indicate :

  • The normal colour of lips is bright red and moist. Dry lips indicate pathogenic dryness, Pale lips indicate blood shortage or anemia, and purple lips indicate coldness or poor circulation.
  • Dry teeth indicate insufficient liquid in the kidneys.
  • Pale gums indicate blood deficiency, Red and swollen lips indicate stomach fire, and Bleeding from the swollen gums indicates the blood vessel damage. Furthermore, the various teeth in the mouth also indicate the state of various organs.

    Dental
    Teeth, how tooth pain is an indicator of poor health
  • Bladder, Kidney and Ears : Link to Upper and Lower Incisors
  • Liver and Gall Bladder: Canine Teeth
  • Lungs: Pre Molars
  • Stomach Heart, Pancreas and Spleen : Molars

But, does this mean that the damage of the teeth is responsible for all internal damages?
Thankfully, no. However pain in various teeth may indicate problems with specific body organs.

Given below are the connections between the teeth and the organs :

  • As the top and bottom 4 incisors are directly related to the kidney and bladder. Pain in upper and lower incisors could mean infection or inflammation in the kidney, inflammation of the prostate gland or even middle ear infection.
  • As top and bottom 2 canines are directly related to the liver and bladder. Thus pain in your canines could indicate a Hepatitis A,B. C infection or inflammation of the gall bladder.
  • Lungs and large intestines are related to the top and bottom 4 bicuspids or premolars, pain may indicate, inflammation of the colon, bronchitis, asthma, other lung problems such as COPD.
  • The first and second molars are directly related to the spleen and stomach and pain could indicate gastric problems, pancreatitis and even ulcers.
  • The third molars or the wisdom teeth are directly related to the small intestine and the heart and pain may indicate cardiac disease, coronary heart disease and even congenital heart defects such as PDA, TOF, Fontan, VSD, ASD , ASO,  AV Canal and may even pre empt a CABG or an Angioplasty
  • Build up of plaque in the arteries, problems with arteries, varicose veins may be the actual trouble spots if you have pain in the sixth lower teeth.
  • Thyroid problems such as hypothyroidism, sinus, spleen and even inflammation of ovaries may be the real reason behind pain in sixth upper teeth.
  • Arthritis, problems with colon, pain in joints such as knee, elbow and shoulder may be the reasons for pain in the upper and lower fourth teeth.

So next time you have tooth pain, look for the real reason before heading for a tooth extraction or  ( RCT) root canal treatmentA tooth pain, may be a warning in disguise for you to watch out and take care of the impending health problem?

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Stomach Cancer- Why does it catch us unawares ?

Stomach cancer is defined as the growth of cancerous cells in the stomach lining.
According to the National Cancer Institute (NCI), there will be approximately 24,590 new cases of stomach cancer every year.

Stomach cancer
Clinical stages of stomach cancer. How stomach cancer spreads?

Stomach cancer is often left undiagnosed because it doesn’t have many early symptoms – it is diagnosed when cancer spreads to other parts of the human body.

A few early signs are:
Nausea and Vomiting: Nausea is defined as a feeling of queasiness at the back of your throat or stomach. Vomiting, on the other hand, is defined as the contraction of your stomach muscles that push the digested food back through your oesophagus. Both nausea and vomiting may be early symptoms of stomach cancer especially if one’s blood shows in the vomit.
Bloating: If one faces bloating, which doesn’t ease up and persistent, it calls for a visit to the doctor and an ultrasound at least to start with.

H. Pylori Infection: If one suffers from frequent indigestion, bloating,one must get tested for bacterial Infection with H pylori, as it is the most prominent indication of people developing stomach cancer later.

Research has shown that people suffering from H.Pylori infections have a much incidence of stomach cancers.

Weight loss: Stomach tumours cause blockages, preventing food from passing into the stomach or into the intestines causing loss of appetite. Similarly, stomach cancer causes energy from food to be burned at a faster rate which combined with nutritional loss causes weight loss.

Stomach Pain: Unexplained stomach pain , the kind which persists is also a warning sign that something may be wrong.

Frequent HeartBurns:  Frequent heartburns could be because of ulcers and may also indicate that everything is not ok.

Inability to eat: As the tumour progresses, it blocks various parts of the digestive system. Coupled with body’s inability to digest food,  there is a reduced appetite, which at a later stage is often total inability to eat and digest food.

As the symptoms are so generic, they are often missed leading to diagnosis at a much later stage when the cancer has spread or metastatised to other parts of the body.

Is there a co-relation between our habits and stomach cancer?
Food: Food and stomach cancer have a direct relationship. The right dietary intake can lower the risk of stomach cancer. Storage of food through refrigeration instead of by smoking, salting and pickling also reduces the risk because the nitrates and nitrites in smoked food increase the risk of stomach cancer.
Smoking: The use of tobacco increases the risk of stomach cancer. It is said that the rate of risk of stomach cancer is doubled in smokers as compared to non-smokers. This is because smoking reduces the production of natural substances that protect the stomach and duodenum from tissue damage. Additionally, smoking promotes the duodenum reflux and increases the acidity of the duodenum making it vulnerable to H. Pylori bacteria. Smoking also constricts the blood vessels in the stomach reducing the blood flow in the stomach. All these mechanisms strengthen the link between stomach cancer and smoking.

Treatment of stomach cancer involves, surgery if detected at an early stage, followed by chemotherapy as the 1st line of treatment.

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Anaemic ! Could it be You ?

sickle cell anemia
anemia

Anaemia is very common medical condition, where the body does not produce enough healthy red blood cells or excessively destructs blood cells.
Most people have anaemia due to poor dietary habits and inadequate nutrition while certain forms of anaemia are hereditary.
Some of the early warning signs , which are common across all 400 types of anaemia are:

anemia symptoms
Early warning sign and symptoms that may appear in anemia

Fatigue : The most common warning sign of anaemia is fatigue. It occurs because the body doesn’t have enough Red Blood Cells to carry haemoglobin which contains oxygen to the cells leading to exhaustion.

Pale Skin : Paleness of the skin is usually dependent on the thickness and density of blood vessels below the skin. A lack of red blood cells due to anaemia

A very pale pallor can also be due to sickle cell anaemia ( a medical condition where abnormally shaped red blood cells block the flow of blood).

Swollen or Sore tongue : A big warning sign of anaemia is an anaemia tongue wherein ones tongue gets inflamed due to low iron levels in the body. The surface of the tongue can often smoothen out or your tongue can morph into different shades.

Swollen Hands and feet : Swollen hands and feet are a symptom of sickle cell anaemia. In sickle cell anaemia, the sickle shaped red blood cells clump together and block the flow of blood in the body – leading to the blood flow being cut off from the tissues and organs.

Shortness of breath : This occurs because the red blood cells carrying oxygen have less haemoglobin and less capacity to bind oxygen causing shortness of breath.

Brittle nails : Nails have a protective hard layer called keratin that protects the soft tissue in your nails. Lack of red blood cell production due to anaemia prohibits the growth of nails. Ridges and banding in the nails are often indicators of anaemia.

Appetite for inedible items : Pica is defined as a craving to chew or eat substances of no nutritional value such as ice, paper, chalk, pencils, wall putty etc. These unusual cravings in order to satiate the body’s appetite for iron must not be ignored as it is the first sign of anaemia.

Sickle cell anaemia is a very severe form of anaemia and is often inherited. Although those suffering from anaemia and sickle cell disease suffer from fatigue, pale pallor, shortness of breath, people suffering from just anemia rarely suffer from frequent chest infections or have painful crisis

Sicklers or people suffering from sickle cell anaemia, often have painful crisis situations, when the haemoglobin can even drop to between 1 and 3 leading to even death within few hours.

Sickles often suffer from organ damage and  may need a hip replacement . a shoulder replacement or rarely even a knee replacement.

Although Sickle cell anaemia can be managed with hydroxy urea, if the patients has reached a point where he or she suffers from chest infections, frequent painful crisis, or needs a hip replacement or shoulder replacement, a bone marrow transplant should be considered.

A bone marrow transplant, with matching donors has more than an 85% success rate and is the only possible cure and treatment for sickle cell anaemia.

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Swollen Legs and Feet ! Could it be something serious ?

kidney disease
Edema, swelling in legs

Many of us have swollen limbs, especially legs , ankles, feet which feel soft and cushiony due to water retention.

More often swollen legs and feet can be due to inactivity, sitting and standing at one position without moving.

This pulls the fluid down towards lower limbs, making them swell.

The swelling due to water retention is called edema.

However swollen legs and feet are often a sign of serious health problems such as kidney disease, cardio vascular problems or heart disease, liver disease, hormones being taken during HRT, deep vein thrombosis and sometimes even medication for diabetes and anti depressants.

Chronic pulmonary embolism may also lead to thromboembolism where a blood clot may travel to other parts of the body.

Incase the blood clot travels to the brain, it could lead to partial paralysis and even a stroke. Blood thinners may be advised to reduce risk of clotting.
As a 1st check, your doctor may prescribe diuretics and ask you to cut down on salt.

Then a few diagnostic tests such KFT( Kidney Function test), LFT( Liver function test), Echo, ECG may be advised.

Do watch out for signs like pain in one limb, heat generated in one limb, loss of consciousness, shortness of breath, fast or rapid heart beat and rush to the doctor as you may be experiencing thromboembolism.

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