Esophageal cancer

Esophageal cancer (or oesophageal cancer) is cancer arising from the foodpipe known as the esophagus that runs between the throat and the stomach. Symptoms often include difficulty in swallowing and weight loss. Other symptoms may include pain when swallowing, a hoarse voice, enlarged lymph nodes (glands) around the collarbone, a dry cough, and possibly coughing up or vomiting blood.

The two main sub-types of the disease are esophageal squamous-cell carcinoma (often abbreviated to ESCC), which is more common in the developing world, and esophageal adenocarcinoma (EAC), which is more common in the developed world. A number of less common types also occur. Squamous-cell carcinoma arises from the epithelial cells that line the esophagus. Adenocarcinoma arises from glandular cells present in the lower third of the esophagus, often where they have already transformed to intestinal cell type (a condition known as Barrett's esophagus). The most common causes of the squamous-cell type are: tobacco, alcohol, very hot drinks, and a poor diet. The most common causes of the adenocarcinoma type are smoking tobacco, obesity, and acid reflux.

The disease is diagnosed by biopsy done by an endoscope (a fiberoptic camera). Prevention includes stopping smoking and a healthy diet. Treatment is based on the cancer's stage and location, together with the person's general condition and individual preferences. Small localized squamous-cell cancers may be treated with surgery alone with the hope of a cure. In most other cases, chemotherapy with or without radiation therapy is used along with surgery. Larger tumors may have their growth slowed with chemotherapy and radiation therapy. In the presence of extensive disease or if the affected person is not fit enough to undergo surgery, palliative care is often recommended. Outcomes are related to the extent of the disease and other medical conditions, but generally tend to be fairly poor, as diagnosis is often late. Five-year survival rates are around 13% to 18%.

As of 2012, esophageal cancer is the eighth-most common cancer globally with 456,000 new cases during the year. It caused about 400,000 deaths that year, up from 345,000 in 1990. Rates vary widely between countries, with about half of all cases occurring in China. It is around three times more common in men than in women.

Signs and symptoms



Prominent symptoms usually do not appear until the cancer has infiltrated over 60% of the circumference of the esophageal tube, by which time the tumor is already in an advanced stage. Onset of symptoms is usually caused by narrowing of the tube due to the physical presence of the tumor.

The first and the most common symptom is usually difficulty in swallowing, which is often experienced first with solid foods and later with softer foods and liquids. Pain when swallowing is less usual at first. Weight loss is often an initial symptom in cases of squamous-cell carcinoma, though not usually in cases of adenocarcinoma. Eventual weight loss due to reduced appetite and undernutrition is common. Pain behind the breastbone or in the region around the stomach often feels like heartburn. The pain can frequently be severe, worsening when food of any sort is swallowed. Another sign may be an unusually husky, raspy, or hoarse-sounding cough, a result of the tumor affecting the recurrent laryngeal nerve.

The presence of the tumor may disrupt the normal contractions of the esophagus when swallowing. This can lead to nausea and vomiting, regurgitation of food and coughing. There is also an increased risk of aspiration pneumonia due to food entering the airways through the abnormal connections (fistulas) that may develop between the esophagus and the trachea (windpipe). Early signs of this serious complication may be coughing on drinking or eating. The tumor surface may be fragile and bleed, causing vomiting of blood. Compression of local structures occurs in advanced disease, leading to such problems as upper airway obstruction and superior vena cava syndrome. Hypercalcemia (excess calcium in the blood) may occur.

If the cancer has spread elsewhere, symptoms related to metastatic disease may appear. Common sites of spread include nearby lymph nodes, the liver, lungs and bone. Liver metastasis can cause jaundice and abdominal swelling (ascites). Lung metastasis can cause, among other symptoms, impaired breathing due to excess fluid around the lungs (pleural effusion), and dyspnea (the feelings often associated with impaired breathing).

Causes and protective factors



The two main types (i.e. squamous-cell carcinoma and adenocarcinoma) have distinct sets of risk factors. Squamous-cell carcinoma is linked to lifestyle factors such as smoking and alcohol. Adenocarcinoma has been linked to effects of long-term acid reflux. Tobacco is a risk factor for both types. Both types are more common in men and in the over-60s.

Squamous-cell carcinoma

The two major risk factors for esophageal squamous-cell carcinoma are tobacco (smoking or chewing) and alcohol. The combination of tobacco and alcohol has a strong synergistic effect. Some data suggest that about half of all cases are due to tobacco and about one-third to alcohol, while over three-quarters of the cases in men are due to the combination of smoking and heavy drinking. The risks associated with alcohol appear to be linked to its aldehyde metabolite and to mutations in certain related enzymes. Such metabolic variants are relatively common in Asia.

High levels of dietary exposure to nitrosamines (chemical compounds found both in tobacco smoke and certain foodstuffs) appear to be a relevant risk factor. Unfavorable dietary patterns seem to involve exposure to nitrosamines through processed and barbecued meats, pickled vegetables, etc., and a low intake of fresh foods. Other associated factors include nutritional deficiencies, low socioeconomic status, and poor oral hygiene. Chewing betel nut (areca) is an important risk factor in Asia.

Adenocarcinoma

Male predominance is particularly strong in this type of esophageal cancer, which occurs about 7 to 10 times more frequently in men. This imbalance may be related to the characteristics and interactions of other known risk factors, including acid reflux and obesity.

The long-term erosive effects of acid reflux (an extremely common condition, also known as gastroesophageal reflux disease or GERD) have been strongly linked to this type of cancer. Longstanding GERD can induce a change of cell type in the lower portion of the esophagus in response to erosion of its squamous lining. This phenomenon, known as Barrett's esophagus, seems to appear about 20 years later in women than in men, maybe due to hormonal factors. Having symptomatic GERD or bile reflux makes Barrett's esophagus more likely, which in turn raises the risk of further changes that can ultimately lead to adenocarcinoma. The risk of developing adenocarcinoma in the presence of Barrett's esophagus is unclear, and may in the past have been overestimated.

Obesity and overweight both appear to be associated with increased risk. The association with obesity seems to be the strongest of any type of obesity-related cancer, though the reasons for this remain unclear. Abdominal obesity seems to be of particular relevance, given the closeness of its association with this type of cancer, as well as with both GERD and Barrett's esophagus. This type of obesity is characteristic of men. Physiologically, it stimulates GERD and also has other chronic inflammatory effects.

EAC has one significant protective factor reducing risk for both sexes. Although Helicobacter pylori infection, which has affected over half of the world's population, is a cause of GERD and a risk factor for gastric cancer, it seems to be associated with a reduced risk of esophageal adenocarcinoma of as much as 50%. The biological explanation for a protective effect is somewhat unclear. One explanation is that some strains of H. pylori reduce stomach acid, thereby reducing damage by GERD. The decreasing rates of H. pylori infection in Western populations in recent decades have been suggested as a factor in the great increase in oesophageal adenocarcinoma over the same period. The decrease is caused by better hygiene, for example through increased refrigeration of food and less crowded households, and has also been associated with an increase in stomach cancer.

Female hormones may also have a protective effect, as EAC is not only much less common in women but develops later in life, by an average of 20 years. Although studies of many reproductive factors have not produced a clear picture, risk seems to decline for the mother in line with prolonged periods of breastfeeding.

Tobacco smoking increases risk, but the effect in esophageal adenocarcinoma is slight compared to that in squamous cell carcinoma, and alcohol has not been demonstrated to be a cause.

Related conditions

  • Head and neck cancer is associated with second primary tumors in the region, including esophageal squamous-cell carcinomas, due to field cancerization (i.e. a regional reaction to long-term carcinogenic exposure).
  • History of radiation therapy for other conditions in the chest is a risk factor for esophageal adenocarcinoma.
  • Corrosive injury to the esophagus by accidentally or intentionally swallowing caustic substances is a risk factor for squamous cell carcinoma.
  • Tylosis with esophageal cancer is a rare familial disease that has been linked to a mutation in the RHBDF2 gene: it involves thickening of the skin of the palms and soles and a high lifetime risk of squamous cell carcinoma.
  • Achalasia (i.e. lack of the involuntary reflex in the esophagus after swallowing) appears to be a risk factor for both main types of esophageal cancer, at least in men, due to stagnation of trapped food and drink.
  • Plummerâ€"Vinson syndrome (a rare disease that involves esophageal webs) is also a risk factor.
  • There is some evidence suggesting a possible causal association between human papillomavirus (HPV) and esophageal squamous-cell carcinoma. The relationship is unclear. Possible relevance of HPV could be greater in places that have a particularly high incidence of this form of the disease, as in some Asian countries, including China.
  • There is limited evidence to support an association between celiac disease and esophageal cancer.

Diagnosis



Clinical evaluation

Although an occlusive tumor may be suspected on a barium swallow or barium meal, the diagnosis is best made with esophagogastroduodenoscopy (endoscopy); this involves the passing of a flexible tube with a light and camera down the esophagus and examining the wall. Biopsies taken of suspicious lesions are then examined histologically for signs of malignancy.

Additional testing is needed to assess how much the cancer has spread (see #Staging, below). Computed tomography (CT) of the chest, abdomen and pelvis can evaluate whether the cancer has spread to adjacent tissues or distant organs (especially liver and lymph nodes). The sensitivity of a CT scan is limited by its ability to detect masses (e.g. enlarged lymph nodes or involved organs) generally larger than 1 cm. Positron emission tomography is also used to estimate the extent of the disease and is regarded as more precise than CT alone. Esophageal endoscopic ultrasound can provide staging information regarding the level of tumor invasion, and possible spread to regional lymph nodes.

The location of the tumor is generally measured by the distance from the teeth. The esophagus (25 cm or 10 in long) is commonly divided into three parts for purposes of determining the location. Adenocarcinomas tend to occur nearer the stomach and squamous cell carcinomas nearer the throat, but either may arise anywhere in the esophagus.

Types

Esophageal cancers are typically carcinomas which arise from the epithelium, or surface lining, of the esophagus. Most esophageal cancers fall into one of two classes: esophageal squamous-cell carcinomas (ESCC), which are similar to head and neck cancer in their appearance and association with tobacco and alcohol consumption, and esophageal adenocarcinomas (EAC), which are often associated with a history of GERD and Barrett's esophagus. A general rule of thumb is that a cancer in the upper two-thirds is likely to be ESCC and one in the lower one-third EAC.

Rare histologic types of esophageal cancer include different variants of squamous-cell carcinoma, and non-epithelial tumors, such as leiomyosarcoma, malignant melanoma, rhabdomyosarcoma, lymphoma, among others.

Staging

Staging is based on the TNM staging system, which classifies the amount of tumor invasion (T), involvement of lymph nodes (N), and distant metastasis (M). The currently preferred classification is the 2010 AJCC staging system for cancer of the esophagus and the esophagogastric junction. To help guide clinical decision making, this system also incorporates information on cell type (ESCC, EAC, etc.), grade (degree of differentiation â€" an indication of the biological aggressiveness of the cancer cells), and tumor location (upper, middle, lower, or junctional).


Prevention



Prevention includes stopping smoking or chewing tobacco. Overcoming addiction to areca chewing in Asia is another promising strategy for the prevention of esophageal squamous-cell carcinoma.

According to the National Cancer Institute, "diets high in cruciferous (cabbage, broccoli/broccolini, cauliflower, Brussels sprouts) and green and yellow vegetables and fruits are associated with a decreased risk of esophageal cancer." Dietary fiber is thought to be protective, especially against esophageal adenocarcinoma.

Screening

People with Barrett esophagus (a change in the cells lining the lower esophagus) are at much higher risk, and may receive regular endoscopic screening for the early signs of cancer. Because the benefit of screening for adenocarcinoma in people without symptoms is unclear, it is not recommended in the United States. Some areas of the world with high rates of squamous-carcinoma have screening programs.

Management



Treatment is best managed by a multidisciplinary team covering the various specialties involved. Adequate nutrition needs to be assured, and appropriate dental care is essential. Factors that influence treatment decisions include the stage and cellular type of cancer (EAC, ESCC, and other types), along with the person's general condition and any other diseases that are present.

In general, treatment with a curative intention is restricted to localized disease, without distant metastasis: in such cases a combined approach that includes surgery may be considered. Disease that is widespread, metastatic or recurrent is managed palliatively: in this case, chemotherapy may be used to lengthen survival, while treatments such as radiotherapy or stenting may be used to relieve symptoms and make it easier to swallow.

Surgery

Early-stage EAC may be treated by surgical removal of all or part of the esophagus (esophagectomy), although this is a difficult operation with a relatively high risk of mortality or post-operative difficulties. The benefits of surgery are less clear for early-stage ESCC. There are a number of surgical options, and the best choices for particular situations remain the subject of research and discussion. As well as the characteristics and location of the tumor, other factors include the condition of the patient, and the type of operation to which the surgical team are most used. The likely quality of life after treatment is a relevant factor when considering the possibility of surgery. Surgical outcomes are likely to be better in large centers where the procedures are frequently performed. If the cancer has spread to other parts of the body, esophagectomy is nowadays not normally be performed.

Endoscopic mucosal resection (EMR) is the removal of small tumors that only involve the mucosa or lining of the esophagus.

Esophagectomy is the removal of a segment of the esophagus; as this shortens the length of the remaining esophagus, some other segment of the digestive tract is pulled up through the chest cavity and interposed. This is usually the stomach or part of the large intestine (colon) or jejunum. Reconnection of the stomach to a shortened esophagus is called an esophagogastric anastomosis.

Esophagectomy can be performed using several methods. The choice of the surgical approach depends on the characteristics and location of the tumor, and the preference of the surgeon. Clear evidence from clinical trials for which approaches give the best outcomes in different circumstances is lacking. A first decision, regarding the point of entry, is between a transhiatial and a transthoracic procedure. The more recent transhiatial approach avoids the need to open the chest; instead the surgeon enters the body through an incision in the lower abdomen and another in the neck. The lower part of the esophagus is freed from the surrounding tissues and cut away as necessary. The stomach is then pushed through the esophageal hiatus (the hole where the esophagus passes through the diaphragm) and is joined to the remaining upper part of the esophagus at the neck.

The traditional transthoracic approach enters the body through the chest, and has a number of variations. The thoracoabdominal approach opens the abdominal and thoracic cavities together, the two-stage Ivor Lewis (also called Lewisâ€"Tanner) approach involves an initial laparotomy and construction of a gastric tube, followed by a right thoracotomy to excise the tumor and create an esophagogastric anastomosis. The three-stage McKeown approach adds a third incision in the neck to complete the cervical anastomosis. Recent approaches by some surgeons use what is called extended esophagectomy, where more surrounding tissue, including lymph nodes, is removed en bloc.

If the person cannot swallow at all, an esophageal stent may be inserted to keep the esophagus open; stents may also assist in occluding fistulas. A nasogastric tube may be necessary to continue feeding while treatment for the tumor is given, and some patients require a gastrostomy (feeding hole in the skin that gives direct access to the stomach). The latter two are especially important if the patient tends to aspirate food or saliva into the airways, predisposing for aspiration pneumonia.

Chemotherapy and radiotherapy

Chemotherapy depends on the tumor type, but tends to be cisplatin-based (or carboplatin or oxaliplatin) every three weeks with fluorouracil (5-FU) either continuously or every three weeks. In more recent studies, addition of epirubicin was better than other comparable regimens in advanced nonresectable cancer. Chemotherapy may be given after surgery (adjuvant, i.e. to reduce risk of recurrence), before surgery (neoadjuvant) or if surgery is not possible; in this case, cisplatin and 5-FU are used. Ongoing trials compare various combinations of chemotherapy; the phase II/III REAL-2 trial â€" for example â€" compares four regimens containing epirubicin and either cisplatin or oxaliplatin, and either continuously infused fluorouracil or capecitabine.

Radiotherapy is given before, during, or after chemotherapy or surgery, and sometimes on its own to control symptoms. In patients with localised disease but contraindications to surgery, "radical radiotherapy" may be used with curative intent.

Other approaches

Forms of endoscopic therapy have been used for stage 0 and I disease: endoscopic mucosal resection (EMR) and mucosal ablation using radiofrequency ablation, photodynamic therapy, Nd-YAG laser, or argon plasma coagulation.

Laser therapy is the use of high-intensity light to destroy tumor cells while affecting only the treated area. This is typically done if the cancer cannot be removed by surgery. The relief of a blockage can help with pain and difficulty swallowing. Photodynamic therapy, a type of laser therapy, involves the use of drugs that are absorbed by cancer cells; when exposed to a special light, the drugs become active and destroy the cancer cells.

Follow-up

Patients are followed closely after a treatment regimen has been completed. Frequently, other treatments are used to improve symptoms and maximize nutrition.

Prognosis



In general, the prognosis of esophageal cancer is quite poor, because most patients present with advanced disease. By the time the first symptoms (such as difficulty swallowing) appear, the cancer has already well progressed. The overall five-year survival rate (5YSR) in the United States is around 15%, with most people dying within the first year of diagnosis. The latest survival data for England and Wales (patients diagnosed during 2007) show that only one in ten people will survive esophageal cancer for at least ten years.

Individualized prognosis depends largely on stage. Those with cancer restricted entirely to the esophageal mucosa have about an 80% 5YSR, but submucosal involvement brings this down to less than 50%. Extension into the muscularis propria (muscle layer of the esophagus) suggests a 20% 5YSR, and extension to the structures adjacent to the esophagus predict a 7% 5YSR. Patients with distant metastases (who are not candidates for curative surgery) have a less than 3% 5YSR.

Epidemiology



Esophageal cancer is the eighth most frequently diagnosed cancer worldwide, and because of its poor prognosis it is the sixth most common cause of cancer-related death. It caused about 400,000 deaths in 2012, accounting for about 5% of all cancer deaths (about 456,000 new cases were diagnosed, representing about 3% of all cancers).

ESCC comprises 60â€"70% of all cases of esophageal cancer worldwide, while EAC accounts for a further 20â€"30% (melanomas, leiomyosarcomas, carcinoids and lymphomas are less common types). The incidence of the two main types of esophageal cancer varies greatly between different geographical areas. In general, ESCC is more common in the developing world, and EAC is more common in the developed world.

The worldwide incidence rate of ESCC in 2012 was 5.2 new cases per 100,000 person-years, with a male predominance (7.7 per 100,000 in men vs. 2.8 in women). It was the common type in 90% of the countries studied. ESCC is particularly frequent in the so-called "Asian esophageal cancer belt", an area that passes through northern China, southern Russia, north-eastern Iran, northern Afghanistan and eastern Turkey. In 2012, about 80% of ESCC cases worldwide occurred in central and south-eastern Asia, and over half (53%) of all cases were in China. The countries with the highest estimated national incidence rates were (in Asia) Mongolia and Turkmenistan and (in Africa) Malawi, Kenya and Uganda. The problem of esophageal cancer has long been recognized in the eastern and southern parts of Sub-Saharan Africa, where ESCC appears to predominate.

In Western countries, EAC has become the dominant form of the disease, following an increase in incidence over recent decades (in contrast to the incidence of ESCC, which has remained largely stable). In 2012, the global incidence rate for EAC was 0.7 per 100,000 with a strong male predominance (1.1 per 100,000 in men vs. 0.3 in women) Areas with particularly high incidence rates include northern and western Europe, north America and Oceania. The countries with highest recorded rates were the UK, Netherlands, Eire, Iceland and New Zealand.

USA

In the United States, esophageal cancer is the seventh-leading cause of cancer death among males (making up 4% of the total). The National Cancer Institute estimated there were about 18,000 new cases and more than 15,000 deaths from esophageal cancer in 2013 (the American Cancer Society estimated that during 2014, about 18,170 new esophageal cancer cases will be diagnosed, resulting in 15,450 deaths). The squamous-cell carcinoma type is more common among African American males with a history of heavy smoking or alcohol use. Until the 1970s, squamous-cell carcinoma accounted for the vast majority of esophageal cancers in the United States. In recent decades, incidence of adenocarcinoma of the esophagus (which is associated with Barrett's esophagus) steadily rose in the United States to the point that it has now surpassed squamous-cell carcinoma. In contrast to squamous-cell carcinoma, esophageal adenocarcinoma is more common in Caucasian men (over the age of 60) than it is in African Americans. Multiple reports indicate esophageal adenocarcinoma incidence has increased during the past 20 years, especially in non-Hispanic white men. Esophageal adenocarcinoma age-adjusted incidence increased in New Mexico from 1973 to 1997. This increase was found in non-Hispanic whites and Hispanics and became predominant in non-Hispanic whites. Esophageal cancer incidence and mortality rates for African Americans continue to be higher than the rate for Causasians. However, incidence and mortality of esophageal cancer has significantly decreased among African Americans since the early 1980s, whereas with Caucasians it has continued to increase. Between 1975 and 2004, incidence of the adenocarcinoma type increased among white American males by over 460% and among white American females by 335%.

UK

The incidence of esophageal adenocarcinoma has risen considerably in the UK in recent decades. Overall, esophageal cancer is the thirteenth most common cancer in the UK (around 8,300 people were diagnosed with the disease in 2011), and it is the sixth most common cause of cancer death (around 7,700 people died in 2012).

Research directions



The risk of esophageal squamous-cell carcinoma may be reduced in people using aspirin or related NSAIDs, but in the absence of randomized controlled trials the current evidence is inconclusive.



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    2017 MY MOTHER WAS DIAGNOSED OF HERPES/ KNOWN AS GENITAL WARTS ,I SPENT A LOT OF MONEY ON HER MEDICATION TILL A POINT I EVEN LOST HOPE,BECAUSE MY MOTHER WAS GRADUALLY DYING AND LOST HER MEMORY TOO, I WAS SO DESPERATE TO GET MY MOTHER BACK TO NORMAL, ONE DAY MY UNCLE WHO LIVES IN LONDON UNITED KINGDOM TOLD ME ABOUT DR OLIHA ,WHO HELPED HIM GET RID OF HERPES /GENITAL WART WITH HERBAL MEDICINE AND HIS HERBAL SOAP ,I WAS SO SHOCKED WHEN HE TOLD ME ABOUT THIS ,ALTHOUGH I NEVER BELIEVE IN HERB BUT, I KEEP TO BELIEVE BECAUSE MY UNCLE CAN'T TELL ME LIES WHEN IT COMES TO HEALTH CONDITION I CONTACTED DR OLIHA VIA HIS EMAIL; OLIHA.MIRACLEMEDICINE@GMAIL.COM , YOU CAN TALK TO HIM VIA CALL OR WHATSAPP MESSENGER ON +2349038382931 , HE REPLIED AND ASK ME TO SEND MY HOME ADDRESS AND MY MOTHER'S DETAIL AND THEN I PURCHASED THE HERBAL MEDICINE,SENT ME THE HERBAL MEDICINE THROUGH COURIER SERVICE, WHEN I RECEIVED THIS HERBAL MEDICINE USED IT FOR 2 WEEKS, AND 4 DAYS OF USAGE THE WARTS FELL OFF, MY MOTHER I NOW TOTALLY CURED AND MY MOTHER IS LIVING FREE AND HAPPY AGAIN. YOU CAN TALK TO DR VIA HIS MOBILE NUMBER OR WHATS APP HIM ON +2349038382931.ALL THANKS TO DOCTOR DR OLIHA

    ReplyDelete
  12. I'm 55-year-old from Korean, I was diagnosed with second-stage liver cancer following a scheduled examination to monitor liver cirrhosis. I had lost a lot of weight. A CT scan revealed three tumors; one in the center of my liver in damaged tissue and two in healthy portions of my liver. No chemotherapy or radiotherapy treatment was prescribed due to my age, the number of liver tumors. One month following my diagnosis I began taking 12 (350 point) Salvestrol supplements per day, commensurate with my body weight. This comprised six Salvestrol Shield (350 point) capsules and six Salvestrol Gold (350 point) capsules, spread through the day by taking two of each capsule after each main meal. This level of Salvestrol supplementation (4,000 points per day) was maintained for four months. In addition, I began a program of breathing exercises, chi exercises, meditation, stretching and stress avoidance. Due to the variety of conditions that I suffered from, I received ongoing medical examinations. Eleven months after commencing Salvestrol supplementation But all invalid so I keep searching for a herbal cure online that how I came across a testimony appreciating Dr Itua on how he cured her HIV/Herpes, I contacted him through email he listed above, Dr Itua sent me his herbal medicine for cancer to drink for two weeks to cure I paid him for the delivering then I received my herbal medicine and drank it for two weeks and I was cured until now I'm all clear of cancer, I will advise you to contact Dr Itua Herbal Center On Email...drituaherbalcenter@gmail.com. WhatsApps Number...+2348149277967. If you are suffering from Diseases listed below, Cancer, HIV/Aids, Herpes Virus, Hepatitis, Chronic Illness. Lupus,Fibromyalgia.

    ReplyDelete

  13. I was in trouble when my doctor told me that i have been diagnosed with
    herpes and i know my family will face a serious problem . when i am gone i
    lost hope and wept most of the time, but one day i was surfing the internet
    i saw Dr. omohan herbal home contact number online i called him and he
    guided me. i asked him for solutions and he started the remedy for my
    health thank God,now everything is fine i am cured by Dr. omohan herbal
    medicine am very thankful to Dr. omohan and very happy with my hobby and
    family email him on (dromohanherbalmedicine@gmail.com) call/whatsapp number +2348164816038

    He can as well cure the following disease;

    Herpes,
    Asthma,
    Cancer,
    HSV1, &
    HSV2,
    Hepatitis B,
    HIV/AID ETC.

    ReplyDelete
  14. GREETINGS everyone out there.. my name is (Robert Lora) I am from CANADA i will never forget the help Dr Ogudugu render to me in my marital life. I have been married for 8 years now and my husband and i love each other very dearly. After 6 years of our marriage my husband suddenly change he was having an affair with a lady outside our marriage, my husband just came home one day he pick up his things and left me and the kids to his mistress outside at this time i was confuse not knowing what to do again because i have lost my husband and my marriage too. i was searching for help in the internet, i saw many people sharing testimony on how Dr Ogudugu help them out with their marital problems so i contacted the email of Dr Ogudugu i told him my problem and i was told to be calm that i have come to the right place were i can get back my husband within the next 48hours, to my greatest surprise my husband came to my office begging me on his knees that i should find a place in my heart to forgive him, that he will never cheat on me again, i quickly ask him up that i have forgiven him. Friends your case is not too hard why don't you give Dr Ogudugu a chance, because i know they will help you to fix your relationship with your Ex Partner. Dr Ogudugu his the best spell caster around to solve any problem for you.
    {1} HIV/AIDS
    {2CANCER
    {3}HERPES
    {4}DIABETES
    (5}HERPERTITIS B

    Email: GREATOGUDUGU@GMAIL.COM
    Call/WhatsApp:+27663492930

    ReplyDelete
  15. I was in trouble when my doctor told me that I have been diagnosed with HERPES and I know my family will face a serious problem when I am gone I lost hope and wept most of the time, but one day I was browing through the internet when I saw Dr.oso herbal home contact number online I called him and he guided me. I asked him for solutions and he started the remedy for my health thank God, now everything is fine I am cured by Dr.oso herbal medicine am very thankful to Dr.oso and very happy with my hobby and family email him on drosoherbahome@gmail.com/ dr.osoherberhome1@outlook.com CALL/WHATSAPP +2348162084839 can so well cure the following disease;

    Herpes, Asthma, Cancer,Diabetes , HIV ETC.

    ReplyDelete

  16. I was depressed when doctor told me that I have been diagnosed with Herpes disease… I thought about my Family, I know my Family will face a serious problem when I'm gone, I lost hope and I wept all day, but one day I was searching the internet I found Dr.ezomo contact number. +2349069171173 I called him and he guided me. I asked him for solutions and he started the remedies for my health. Thank God, now everything is fine, I'm cured by Dr.ezomo herbal medicine, I'm very thankful to Dr.ezomo and very happy with my hubby and family. email him on dr.ezomorootandherbals@gmail.com or you can also reach him through WhatsApp number+2349069171173
    He can also cure so many sickness
    {1}HIV And AIDS
    {2}Diabetes
    {3}Epilepsy
    {4}Blood Cancer
    {5}HPV
    {7}ALS
    {8}Hepatitis

    ReplyDelete
  17. I am John Danilla from UK( northern ireland), i want to share a
    testimony on how a powerful spell caster cured my HIV disease, i was
    diagnosed of this disease, in the year 2009, last week i saw a testimony on
    Dr.Akioya on how he cured an HIV patient, so i contacted him through phone
    call and he asked me to email him, which idid, so he told me that all my
    problems is over and then he decided to do an healing spell spell for me so
    after he finished it, he told me to wait for just 24 hours and then i
    should go for a test, so i really did as he had said, so my greatest
    surprised when i went to the hospital to go for an HIV test, the Medical
    doctor diagnosed that, i am now HIV negetative at first i was amazed and
    now i have come to realise that this spell caster Dr. Akioya is a very
    powerful one and a real spell caster. So viewers of this should please join
    me in my celebration for i am the happiest man on earth today and if you
    want to contact him, you can do this via his email
    (drakioya17spellhome@gmail.com or call him or whatsapp him
    +2347019562805.

    ReplyDelete
  18. Grateful to DR UDI for all his help for my life, my partner was having Herpes Simplex Virus, and we were planing on getting married, when we decided to get ourselves tested first and we found out that my Girlfriend was HSV 2 Positive, my Girlfriend was so unhappy, because this was a barrier for us to get married, so i went out to search out a remedy for my partner, and it was so surprising how DR UDI has been a blessing and healing to the masses, after reading about his work on a blog i immediately emailed him: [Drudiherbalhome@gmail .com] and he wrote back to me that my Girlfriend will be OK and that we we get married this same year, i couldn't believe it, after doing all that is needed to be done, i was surprise that after 2weeks of using his medicine my Girlfriend went to the doc and was diagnose negative. For more info contact his email (drudiherbalhome@gmail .com) or call or what-app him via +2348051243538 and you will get your illness cure.

    ReplyDelete


  19. WHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. My names are Robert Mary
    I’m a citizen of United Kingdom, My younger sister was Sick of
    breast cancer and her name is Robert Jane, I and my family have taking
    her to all kind of hospital in UK still yet no good result. I decided
    to go to the internet and search for cancer cure so that was how I
    find a lady called Sarah peter she was testifies to the world about
    the goodness of a herbal man who has the root and half to cure all
    kind of disease and the herbal email was there. So I decided to
    contact the herbal man for my younger sister help to cure her breast
    cancer. I contacted him and told him my problem he told me that I
    should not worry that my sister cancer will be cure, he told me that
    there is a medicine that he is going to give me that I will cook it
    and give it to my sister to drink for one week, so I ask how can I
    receive the cure that I am in UK, he told me
    That I will pay for the delivery service. The courier service can
    transport it to me so he told me the amount I will pay, so my dad paid
    for the delivery fee. two days later I receive the cure from the
    courier service so I used it as the herbal man instructed me to,
    before the week complete my sister cancer was healed and it was like a
    dream to me not knowing that it was physical I and my family were very
    happy about the miracle of Doctor so my dad wanted to pay him 5
    million us dollars the herbal man did not accept the offer from my dad,but I don't know why he did not accept the offer,he only said
    I should tell the world about him and his miracle he perform so am now
    here to tell the world about him if you or your relative is having any
    kind of disease that you can't get from the hospital please contact
    Dr.ogididanspelltemple@gmail.com or WhatsApp +2347067393105,message him on instragram dr.ogididan or website ogididanherbalhome.wordpress.com for the cure, he will help you out
    with any problems you have.To get more information you can message me via email robertmary8947@gmail.com

    ReplyDelete
  20. Dr. Iyabiye is a herbal specialist he treat/cure HEPATITIS and CIRRHOSIS and other deadly diseases. My name is Russel and I was ones a victim of chronic hepatitis B and liver cirrhosis, I got cured with his medication and I am safe and free now. I am testifying to his great work so that you too can be safe from hepatitis or any life threatening disease. His contacts are: iyabiyehealinghome@gmail.com Call/Whatsapp: +2348072229413

    ReplyDelete
  21. HELLO EVERYONE.. FEW MUNINETS TO REDY THIS INFOR ON HERPES CURE 2018..
    2017 MY MOTHER WAS DIAGNOSED OF HERPES/ KNOWN AS GENITAL WARTS ,I SPENT A LOT OF MONEY ON HER MEDICATION TILL A POINT I EVEN LOST HOPE,BECAUSE MY MOTHER WAS GRADUALLY DYING AND LOST HER MEMORY TOO, I WAS SO DESPERATE TO GET MY MOTHER BACK TO NORMAL, ONE DAY MY UNCLE WHO LIVES IN LONDON UNITED KINGDOM TOLD ME ABOUT DR OLIHA ,WHO HELPED HIM GET RID OF HERPES /GENITAL WART WITH HERBAL MEDICINE AND HIS HERBAL SOAP ,I WAS SO SHOCKED WHEN HE TOLD ME ABOUT THIS ,ALTHOUGH I NEVER BELIEVE IN HERB BUT, I KEEP TO BELIEVE BECAUSE MY UNCLE CAN'T TELL ME LIES WHEN IT COMES TO HEALTH CONDITION I CONTACTED DR OLIHA VIA HIS EMAIL; OLIHA.MIRACLEMEDICINE@GMAIL.COM , YOU CAN TALK TO HIM VIA CALL OR WHATSAPP MESSENGER ON +2349038382931 , HE REPLIED AND ASK ME TO SEND MY HOME ADDRESS AND MY MOTHER'S DETAIL AND THEN I PURCHASED THE HERBAL MEDICINE,SENT ME THE HERBAL MEDICINE THROUGH COURIER SERVICE, WHEN I RECEIVED THIS HERBAL MEDICINE USED IT FOR 2 WEEKS, AND 4 DAYS OF USAGE THE WARTS FELL OFF, MY MOTHER I NOW TOTALLY CURED AND MY MOTHER IS LIVING FREE AND HAPPY AGAIN. YOU CAN TALK TO DR VIA HIS MOBILE NUMBER OR WHATS APP HIM ON +2349038382931.ALL THANKS TO DOCTOR DR OLIHA

    ReplyDelete
  22. I'm 61 years old, I contracted hpv in 2011' I has be taking lot treatment for it and some months ago the wart stated coming out seriously, I used lot recommendation because there was lot warts around my anus and was so embarrassed. but today I'm totally happy I got the virus eliminated by using natural treatment from Dr Onokun herbal center after his treatment I got cured. all the warts went away' seriously believed Dr Onokun he have the cure for human papillomavirus because he has eliminated hpv been in my body since 2011, Dr Onokun make it possible for me. Here is Dr Onokun email to reach him: Dronokunherbalcure@gmail.com  he is welled capable of curing terrible diseases.  

    ReplyDelete
  23. Happiness is all i see now I never thought that I will live on
    earth before the year runs out. I have been suffering from a
    deadly disease (Herpes) for the past 3 years now; I had spent
    a lot of money going from one places to another, from
    churches to churches, hospitals have been my home every day
    residence. Constant checks up have been my hobby not until
    this faithful day, I was searching through the internet, I saw a
    testimony on how pp him +2348154637647 Dr Lucky, helped
    someone in curing his Herpes disease, quickly I copied his
    email which is (drluckyherbalcure@gmail.com) just to give
    him a test I spoke to him, he asked me to do some certain
    things which I did, he told me that he is going to provide the
    herbal cure to me, which he did, then he asked me to go for
    medical checkup after some days after using the herbal cure, I
    was free from the deadly disease, he only asked me to post
    the testimony through the whole world, faithfully am doing it
    now, please brothers and sisters, he is great, I owe him in
    return. if you are having a similar problem just email him on
    (drluckyherbalcure@gmail.com) or Call him or WhatsApp him
    +2348154637647

    ReplyDelete
  24. I’m here to testify about what DR. ISIBOR did for me. I have been suffering from (GENITAL HERPES VIRUS) disease for the past 3 years and had constant pain and inching, especially in my private part. During the first year, I had faith in God that i would be cured someday.This disease started circulating all over my body and I have been taking treatment from my doctor, few weeks ago I came across a testimony of Rose Smith on the internet testifying about a Man called DR. ISIBOR on how he cured her from 7 years HSV 2. And she also gave the email address of this man, advise anybody to contact him for help on any kind of diseases that he would be of help, so I emailed him telling him about my (HSV 2) he told me not to worry that I was going to be cured!! Well, I never doubted him I have faith he can cure me too,, DR. ISIBOR prepared and sent me Healing Oil, Soap, roots and herbs which I took. In the first one week, I started experiencing changes all over me, after four weeks of using his Roots/ Herbs, Oil and Soap, I was totally cured. no more inching , pain on me anymore as DR. ISIBOR assured me. After some time I went to my doctor to do another test behold the result came out negative. So friends my advise is if you have such disease or know anyone who suffers from it or any other disease like HPV, HIV, ALS, CANCER etc. you can contact DR. ISIBOR for help via email} drisiborspellhome@gmail.com or call +2348107855231

    ReplyDelete
  25. Can't still believe that i got cured from Genital Herpes through herbal treatment from Dr LUCKY who I met through the internet, I actually couldn't believe it at first because it sounded impossible to me knowing how far I have gone just to get rid of it. Dr LUCKY send me his medicine which I took as instructed and here I am living a happy life once again, a big thanks to Dr LUCKY , I am sure there are many herbal doctors out there but Dr LUCKY did it for me, contact him on Email him; { drluckyherbalcure@gmail.com }

    ReplyDelete