this is dr. sarkisian and we will talktoday about neoplasms and cancers and this is a very important topic foreveryone involved in healthcare either someone in clinical practice or inclinical education or research thousands or even millions of people in the worldare diagnosed with neoplasms every year and hearing that you have a tumor maycause fear, dread, anxiety upset and not
icd 9 code for rectal cancer, only for the patient but for the familyit's truly a changing turning point for everyone involved including thehealthcare provider to most of us these diagnoses may beequivalent to death sentence however we need to remember that the neoplasms andcancers are treatable at least some of
them and there is research continuing tofind ways to treat most of the common neoplasm so when we'd like todistinguish between neoplasm and tumor these terms may be used interchangeablyand tumor of course more colloquial way to put it a neoplasm is a new growth newgrowth that can be either cancerous or benign we still need to remember thatnot all the tumors and near plasma are deadly and not all of them aremalignancies however again approximately 1.3 millionpeople are diagnosed in this country with malignant neoplasms every year andthis includes all types of cancers treatable treatable very well and nontreatable and of course we need to know
for the purposes of this course and ingeneral for your further development in practice that which are the commoncancer so for man prostate cancer is the most commonly diagnosed and for womenit's the breast cancer cancers again can be diagnosed many different ways and oneof the important point earlier cancer diagnosed the better treatment can bethis is a generalization but most of the time that works and cancers areclassified according to their appearance growth patterns and which is one of theimportant points here type of body tissue where they came from let's lookat this diagram and this is very schematic representation of malignantand benign neoplasm classification so
let's look on the top of it and neoplasmare involving both benign and malignant benign neoplasm are the neoplasm thatare confined to a certain localized area and they will note spread benignneoplasms when you say tumor colloquially most likely people mean abenign neoplasm although again it can be reflecting a malignant canso again one of the important characteristics is that benign neoplasmthey are encapsulated they are localized they don't metastasize or they don'tspread and most of the time they are harmless unless they are growing in sometype of confined space such as a cranium and or provide pressure on importantblood vessel and cutting supply of blood
and nutrients and oxygen to certainareas so but most of the time your benign neoplasm is harmless and sometimeit can be a cosmetic defect which is most people would like to remove somalignant neoplasm or cancerous malignant deadly neoplasm will presentwith two main characteristics invasions and metastasis so invasion will happento spreading of the neoplasm into local or surrounding tissue and metastasiswill be a spread to distant sides metastasis can happen while lymphaticvenule or why the bloodstream when we further would like to differentiate thatneoplasm would like to talk about tissue of origin so according to the tissuefrom which they grow we will classify
them we will classify them into into the tissue type relatedclassifications depending on the location of the tumor and originationsite of the tumor they may have different names so benign tumors usuallytake tissue name and also suffix oma for tumor so benign tumor will have suffixoma after the name of the tissue such as lipomaand lipoma we know it's a tumor fatty tissue malignancies will have forinstance terms carcinoma or sarcoma added to the type of the tissue so let'stalk about differentiating between epithelial versus connective tissuemalignancies epithelial tissue if it's
harboring a near plasma normal ignanttumor will be named adenoma if it's malignant tumor it gets the change inthe name and it will be changed to adana carcinoma in general the epithelialtissue near pliers malignant neoplasm in this case will be named carcinoma againbenign tumor of epithelial tissue is adenoma malignant tumor is carcinoma sowhen we are moving toward epithelial tissue from epithelial tissue towardconnective tissue tumors so the differentiation in the names arechanging so benign tumor of connective tissue such as bone will be namedosteoma on the other hand if it's becomingmalignant it will be osteosarcoma
so sarcoma is a term that you can use inconnective tissue disorders and such as muscle fat and born and sarcomas areless common than carcinomas however the unfortunate event here thatthey will spread much more rapidly so another type of tissue that doesn't havebenign formations benign neoplasm it's lymphatic and blood forming organs andlymphatic tissues again malignancies and again they don't have a benign varietybenign counterparts for changes for knee applause so these are lymphomas andleukemias which are again malignant neoplasms of lymphatic and blood formingorgans and lymphatic tissues the leukemias and lymphomas can be on onehead very very deadly and have high
degree of mortality on the other handdepending on the variety they may have very predictable and very not a benignbut very favorable course of treatment and remission again depends on the typeof cancer of this type in other tissues it can happendifferently so and we can come up with different names for them for instance iknow you all asked the question when i was talking about epithelial tissuesaying or what about melanomas what about melanomas but melanoma forinstance is a malignancy of middle on the sides so in case of melanoma youcannot say carcinoma like basal cell carcinoma you would use the specificterm as melanoma so or brain tumors
which are originating in glial cells ofthe brain will be gliomas so gliomas are benign in appearancethey do not metastasize but they still considered malignant because most of thegliomas are fatal so examples you know again adenoma will come up from granularepithelium and it will be benign neoplasm something coming out fromsquamous epithelium will be epithelium something coming from fat tissues lipomaand for instance if fat tissue turns into malignant neoplasm it will beliposarcoma and these classifications are fairly clear card with theexceptions that i mentioned previously so again
when malignant neoplasm appears usuallysome type of genetic mutation is to blame genetic mutation can take placesecondary to disruption of genetic code by radiation viruses differentcarcinogens or different chemicals and we can have a big list of householdchemicals pesticides herbicides insects insects items or they all may bepresenting themselves as carcinogen the research determined many otherpossibilities of carcinogens such as burned cooking oils and excess incertain dietary certain dietary ingredients such as fat trans fats andall but all of these all of the substances can be determined ascarcinogens because they are
cancer-causing the viruses andradiations this are separate entities because they are not chemical structuresand they cause genetic mutation by a different mechanism but the end resultis the same and end result is disruption disruption of the genetic code anddevelopment of malignant neoplasm so malignant neoplasms do not have thestructure and the purpose of the normal cells normal cells have a purpose normalselves have controlled division but cancer cells they do not follow anypattern it's difficult sometime to even determine where the actual medicinecame from what was the tissue of origin uncle genesis occurs when cancer tissuesactually grow and to further define this
it's uncle genesis is a geneticmechanism where normal cells are transformed into cancerous cellscarcinogenic agents will affect the dna of the cell and lead to dna damage whicheventually will result in malignancy so the diagram here pictures how the damageoccurs and how it affects the growth of the tissues and change into malignantnir plus the key point here is unregulated cell differentiation andgrowth that's the main problem with cancer who are having unregulated celldifferentiation and growth they steal nutrients and oxygen bloodsupply from other places in the body and they uncontrollably grow so malignanttumor takes over the body which
eventually results in that of course ifit's not treated so another problem with cancerous tissues or growth is tissueinvention invasion and metastasis i'm sorryso invading into surrounding tissue may damage vital organ and vital functionand this invention occurs by a process of growing endings from the originaltumor as well as process of metastasis or seeding the cancer cells into remotelocations by using now lymphatic supply or blood supply or proto-oncogenes are normal genes thatregulate cell growth uncle genes or mutation that lead touncontrolled cell growth if the growth
is autonomous because cell grows byitself it's not regulated by any factors from the body it doesn't obey theuniform program that entire body obeys so some of the oncogene or growthfactors receptors different enzymes and transcription factors growth factorswill bind to receptors on cell structure which will activate signaling enzymesinside the cell and that in turn activates special proteins that we calltranscription factors in style inside of cell nucleus the activated transcriptionfactor will facilitate the turning on of the genes required for cell growth andproliferation so they promote autonomous cell growth in cancer cells in theabsence of normal growth promoting
signals so in this can point because ofthe point mutations chromosome translocations or chromosomeapplications again to recap this that for cell to grow autonomously anduncontrollably you need to have oncogenes present andthese oncogenes are factors growth factors signaling enzymestranscription factors that would disrupt or would turn on the genes that requiredfor so growth and proliferation so basically the whole process promotesuncontrolled rote tumor suppressor genes are brakes that body has to stop thecancerous or malignant growth and they would stop normally a gene that out ofcontrol
there are numbers and numbers ofsuppressor genes identified one of the examples is p53 gene and mutations inp53 can result in long breast and colon cancer the importance of this study andresearch of p53 mutations is that p53 again is p53 mutations or to blame forthree leading types of cancer again in lung breast and colon so even a singlegenetic event can activate an oncogene but remember that there are two copiesof each gene from each parent so it takes two hits to inactivate both copiesof suppressor gene so two mutations needs to occur loss of both alleles of agene must be inactivated this is referred to as a loss of heterozygosityso or shortly you can call it l or h so
loss of it heterozygosity it shouldhappen to make all this process of genetic mutation of suppressor gene tooccur again remember because of we have two copies of each gene we need twomutation to occur which will lead to loss of heterozygosity dna repair occurssecondary to presence of cycling's cycling's are important in making surethat the cell produced the proteins needed for separation of the chromosomesso cyclones will check that the dna has been correctly duplicated and cyclingproteins whether measure whether cell has growth large enough to divide sobasicly cycling's regulate the whole process but it's they are checkpointsand cycling's need again to check the
presence of the proteins for werenecessary for chromosome separations cycling's check the duplication of thedna and making sure that it's correct and cycling's would measure that cell isbig enough and large enough to demonite normally cells have the program deathcalled apoptosis while cancerous cells can divide indefinitely so there is noapoptosis in cancerous cells and they are not only surviving but they alsocontinue to replicate and when telomeres shorten with each replication in anormal cell eventually it comes to the point when the cell isn't able to divideand but still the telomers are restored by enzymetelomerase so when the cells i'm sorry
when the telomeres become too short thattelomerase doesn't work anymore while in cancer cells telomerase isactivated and it keeps repairing the telomeres until indefinitely and thecancerous cells can replicate because telomeres or me maintaining their landand they are able to or they are enabling the cell to replicate hela cellis a cancerous cell that has been obtained from a young woman 31 year oldhenrietta lacks upon her death from cervical cancer it was in 1951 and thecells are still living in multiplying i'm sure you probably heard about thecontribution that it made to science and to overall medicine and differentdifferent aspects of human activities
and development to name a few this helacells were used for polio research and in 1955 the vaccine was created that washelping and what which helped to nearly erase the polio disease but again helacell is slightly different from other cancer cells because when at that timein early fifties the cancer cell samples were obtained they usually wouldreplicate for a short time but they eventually would dieoutside of the host organism however the hela cells would multiplyuncontrollably and some scientists speculate that the total weight of allthat multiplied from the original hela cell sample is about 20 tons or more andagain this is an interesting issue and
part of it is an issue in bioethics andi will stop right here after saying that tissue samples were obtained from thepatient from henrietta lacks without her consent and you can further research theissue and discuss in your ethics class if you'd like to it to me it's veryfascinating and you may research about the further development but again tocomplete this slide we need to remember that the telomerase is activated incancer cells and they will continue to divide and hela cells are the perfectexample of that normally even with all the genetic abnormalities tumors cannotgrow without blood supply blood supply as it was needed for tumor growth aswell as for metastasis so in normal
situation in healthy body angiogenesisonly occurs in two cases first of all in wound healingwe'll know both in secondary and primary wound healing the angiogenesis willoccur and also in the us during the proliferation stage of the menstrualcycle but otherwise the angiogenesis is pretty abnormal process and if thereexcept those two cases and angiogenesis will be one of the signs of tumors tumorgrowth this is the article was one we talked about it and the one i wanted youto review so the research was carried out using sidebandthe sole or tbz which is quite common antifungal drug but it has been shownthat tbz would inhibit angiogenesis in
vivo and xenopus embryos and thenprocessor i put a picture it's one of the cornerstone of modern geneticresearch and especially the embryonic research research on embryos of xenopusbecause genetically they are fairly similar to human cells and they are goodsubjects for research and i don't know if there is a monument for examplesomewhere but they certainly deserve it and on these pictures you see twocomputer-generated images which one is in control session and the other thexenopus embryo that is in tbd environment and the embryo with tpz youcan see that the vessels orange developed the vessels are missing wereon the normal embryo they are present
and there are several pictures that ithink the most prominent ones are e and f pictures where you can see thehighlight and contrast pictures and again xenopus embryos have been used inresearch for quite a long time and there is a special contribution to science bythis rogues and the robot they served ingenetic research how malignant transformation occurs and what are thesteps first of all initiation phase aninitiation phase that cell damage occurs and it changes the genes that normallywould keep the cell from chain malignant changes and these are tumor suppressorgenes apoptosis agents and the transform
to promotional period or latency periodtime between the self initiation and into actual tumor the tumor thedetectable tumor without the growth is still occurring but we have no means todetect it at that point so last phase is the occurrence oremergence of the detectable tumor and it's quite small still it's about onecentimeter in size but one centimeter in size means that we have one billioncells already so the growth is xx potential growth and cell rapidlydivides if we bring the example of hela cell we talked about in hela cells theirgrowth doubling time is only 24 hours why normal cells may take 36 so thesecells the malignant cells have in
addition to uncontrolled growth theyhave faster growth time compared to normal self grading and staging are twoimportant concepts in cancer diagnostics and treatment and they important becausethey allow us to determine the development of the disease the extent towhich the disease is developed and planned that treatment accordingly andalso predict the possibility of cure when we talk about grading we aretalking about the degree of differentiationif tissue is well differentiated like a normal tissue that's lower grade that'sgreat one it's if tissue is very similar to normal tissue it's great one the whendifferentiation starts to disappear the
grading will increase so great for willbe much less differentiated versus grade two most of the time the grading will benumbered by roman numerals from one to four roman numerals however in prostatecancers case we may use five stages of i mean five grades for grading themalignancy and let obtained by using gleason grading in gleason grading againwe're looking to differentiation of the tissue and again grade one will be verysimilar to normal tissue very well differentiated when we're going tocreate five its undifferentiated the color changes here it's the artisticinterpretation more red means or cancer the higher grade but inreality of course that the cells won't
be changing from green to red but againit's the degree of differentiation the next concept is staging of the cancerand staging determines the extent of spread of neoplasm we can developstaging from clinical examination imaging studies biopsies and evensurgical exploration with biopsies so staging again performed by numericalnumbers from one to four and the system is very similar to grading but againstaging is spread and grading is differentiation or degree of abnormalityso staging will show is it's how well spread the cancer is tnm system can begreat can be used for staging and in that system tumors are staged accordingto the size of the extent of primary
tumor number of lymph nodes involved andmetastases present in the other remote sites so but here on this this is simple staging i'msorry representation in thispicture and again depending on the extent depending on an extent ofmetastasis invasion of the tissues the staging can be performedso in this staging system stage zero will signify carcinoma insitu stage one stage two and stage three basically reflect the extent of thedisease so is two more big or small did it spread beyond the worgen in which itfirst developed and is it in lymph nodes and organs that adjacent to the locationof primary tumor and stage four will be
the cancer spread to other organs tnmsystem is an important classification system and it gives you better idea ofwhat's going on and that compared to simple staging system so if we have tn munder t who are examining the primary tumor and its size like primary tumor ifit cannot be evaluated or there is no evidence of primary tumor like carcinomaand pseudo you can put t 0 and n stands for regional lymph node and if we havecarcinoma 0 we can put t 0 n 0 in this case and also add c is like abnormalcells present but they didn't spread when carcinoma 0 becomes cancer we mayhave the size of the primary tumor described by as t 1 t 2 t 3 t 4 size andextent of primary team tumor so t is
always the primary tumor and as i saidit was referring to lymph nodes if there is nothing in the lymph nodes you maysay n 0 and if there is some involvement goes on you may place a number that andone and two and they reflect the number of lymph nodes and the extent of spreadso distant metastasis if there is no way to evaluate knows it's m 0 and if let'ssay there is one and one so let's look at this examples breast cancer examplewe're looking at t 3 into m 0 so t 3 reflects relatively large number a largetumor that spread to nearing lymph nodes but thankfully not to other parts of thebody there is no metastasis the next example is prostate cancer he to n 0 m 0this explains to you that tumor is
located only in the prostate there is nolymphatic spread and there is no metastatic spread so this is very verybright prognosis for this patient because this can be operated anddepending on findings it he may or even may not require any further chemotherapyand radiation or other treatment modalities in this case but again torecap on all of these all stagings and gradings these are reef subjectivesystems unfortunately there is no such a thing as a ruler to put onpatient and measure staging and grading so these are all interpretation butbecause of consistency of the standard of staging and grading this may reflectrelatively well the condition of what
happens the condition of what happens tothe patient so again staging will show you the size and the extent and gradingis differentiation so staging basically what happened to the tumor and creatinghow bad they are and you may develop your own systems how to memorize thisbut again you know zeroes in tnm system are good and numerical values greater itis the worse is usually the prognosis i put a link here from cancer.gov and it'svery simple explanation of staging and i actually took examples of breast cancerand prostate cancer from there and you can read it if you are interested tolearn more about staging and grading but this slide gives you the essence of thetnm system
causes of cancers are multifactorialthere is no certain cause we can pinpoint that can contribute todevelopment of certain cancer although there are strong links between certaincancers and exposure to certain factors however some patients will developcancer and others want so some researcher contribute the cancerdevelopment to failure of immune system because the immune system has a capacityto repair damage in cure by dna or removed cancerous cells however we stilldon't know why some people respond to factors that cause cancer and othersdon't progression of the cancer after the initiation of the exposure can berather rapid and depending on diagnostic
techniques of course early diagnostic isalways favorable but depending on the agnostic technique the treatment may bedelayed and one of the main points here that diagnostics should be performedearly and suspicion for cancers should be treated with all seriousness andthose patients should be evaluated and assessed as thoroughly as possible alsoof course we have our screening methods so if recovery occurs after thetreatment from cancer we do not use the word cure of course and we're using wordremission unfortunately some cancer will result in terminal calm and at thatpoint we need to think about facilitating them and of life measuresand
initiating hospice care there are manycauses of cancers chemical carcinogens are present everywhere and some of themhave industrial origin such as asbestos is very well known linked to lung cancerand nickel was causing cancer for industrial workers hormones are linkedto development of certain cancers such as prostate and breast cancer and estrogen production in female can leadexcessive estrogen production of course can lead to the cancer of breast anduterus prostate cancers are testosterone dependent and one of the treatment foror one of the palliative treatment to slow down or even inhibit is estrogentreatment and halting the testosterone
production but again these are the twoof the best examples estrogen and testosterone and their correlation tothe cancers radiation is another cause for cancer and when we're talking aboutradiation we know about ultraviolet exposure the ultraviolet exposure canresult in skin cancers we need to remember here that skin cancers candevelop differently in case of basal and squamous cell carcinomas it's thecumulative damage occurred over the years wow malignant melanoma the mostdangerous type is occurring secondary to blistering sun burns in cured inchildhood so the bottom line encourage your patients to use the protectionespecially
in pediatric populations where theprevention can truly result in elimination of the cancer further in thelife viruses can be another cause for cancer and the best example is humanpapillomavirus and correlation to it of it to cervical cancer and geneticpredisposition may play significant role in developing the cancer again as it wassaid before some people may develop cancer being exposed to exactly samefactors while others will not have cancer development cancer prevention is important topic in healthcare nowadaysand one of the easiest ways to prevent it it's to avoid carcinogens carcinogenscan be detected as industrial
carcinogens as well as environmentalsuch as smoking although there is no strong link with alcohol but with somecancers alcohol certainly can play a role as it was said skin protection mayplay a role in cancer development also avoiding air polluted regions mayprevent development of the cancer further in the life another important topic is the hormonetherapy and its effect on development of cancer it's important if you are let'ssay using contraception or hormone replacement therapy for your patient isto adjust the therapy to minimally effective one because increasing hormonetherapy may certainly reflect in
incidence of cancer calorie intake andexercise these two go together and i want to be boring you with the detailsyou but body fat can contribute to chronic inflammation and chronicinflammation may result in cancers of many different types screening isimportant there are proven screening techniques and there are questionableones and there are is major revision of screening techniques still mammogramsself breast examinations or one of those valued technique while nowadaysscreening for prostate cancer with digital rectal exam becoming more of anarchaic known effective way of screening and we'll talk about this well we'retalking about those disorders in further
meetings colonoscopy is anothereffective way to screen for colon cancers and the result certainly visiblenowadays with which reflects reduction in colon cancer rates overall inpopulation monthly examinations important in cancer prevention and thisin will breast exam and testicular exam at the same time regular check-ups likepap smears for females and prostate exams for malesand it's becoming questionable questionable practice nowadays and it'snot encouraged anymore rectal examination for males and female may beof lesser value nowadays considering the limitations of those exams howevercolonoscopy for screening purposes is
certainly one of the greatest howevercolonoscopy for screening purposes is one of the greatest tools so frequencyof cancer is an important consideration it's still second leading cause of thatgender effect is important to consider because some males are affected bycertain cancers while females are affected by other cancers again prostateand breast cancer lung cancer used to be male dominated disease however the shiftnowadays is towards female population developing more cancer it's a reflectionof overall reduction of smoking rates among male population age contributingfactor to cancer and for instance there is a statement about prostate cancerthat every man may develop prostate
cancer depending how long they live sowith age you certainly may develop cancers however some people don't livethat long most common cancers again as we talked in the beginning breast cancerfor women and prostate cancer for men and also colon cancer frequency of cancer is different formale and female patient and on this slide i want to show you frequency forgeneral population and by frequency we mean the occurrence of cancer so thisshows the most common cancers in excluding skin cancers which are themost common ones and most common type of cancers is basal and squamous carcinomaswhich are very treatable because they
are visible on the surface and they areslow-growing and excision or surgical treatment removal is very verybeneficial and has good relapse i'm sorrygood remission rate so this type of procedures can be done of course inphysician's office dermatology's or depends on the practice and usuallyagain have good success rate malignant melanoma is as i was saying it's adeadly skin a form cancer and approximately 1% of all skinmalignancies will be malignant melanoma so for the simplicity wise i includedhere only non skin cancer so most common cancer is lung cancer followed by coloncancer breast uterus and prostate again
when you see at this list you may thinkthat prevention may be actually very beneficial because most of the cancersin this colon may be either prevented by avoiding certain lifestyle choices or bediscovered relatively early in their developmentsecondary to screening techniques but again lung cancer rates may dramaticallydecreased if the smoking dangers will be eliminated but again this is mostcontemporary list you may find something different from different sources butagain lung cancer dominates this list and most of the time you see it'stopping the list of cancers when you look at female and male distribution ofcases of cancer prostate cancer
dominates for male patientsapproximately 25% of cases discovered in a year and breast cancer for femalepatient approximately again 25 26 % of casesdiscovered in a year but for both male and female lists the lung cancer will besecond and colon will be third so because breast and prostate cancers areso gender specific they don't make to the top of the list and went withlooking at general population again lung cancer is the most common one diagnostics again this is a generaloverview of diagnostics for cancer and the main main concept with diagnosticsis the early treatment the using
diagnostic for early treatment sometimesdays can make difference for the surgical excision that say aggressivecolon cancers and usually treatment should follow prognosis diagnosis veryrapidly very promptly and prognosis is the best if treated early becauseif you lose time you may let the cancer to spread exceptions are against skincancers as basal cell carcinoma squamous cell carcinoma but those are exceptioncancers and a small delay in treatment may not be that instrumental or may notbe that significant if we compare it to other type of cancer again when we'retalking about skin cancers we exclude malignant melanoma which may be verydeadly and may require rapid very prompt
treatment when there is a suspicion thebiopsy is recommend at some time the cancer presentation will be so obviousso already the patient will be scheduled for removal in some organs presence oftumor or neoplasm regardless is malignant or benign may be having verydrastic consequences and removal will be warranted even without discovering whatit is and most of the time most of the tumorsregardless malignant or benign will be removed at some point routine screeningsmay be helpful and by screenings we again breast cancer screenings and coloncancer screening with routine colonoscopies and we'll talk about thescreening guidelines about those
diseases when we talk about them inparticular but again screening can be very helpful prostate cancer screeningis becoming more and more controversial and i will talk about it later in thecourse general sinus symptoms of cancer pain isone of the hallmarks of cancer unfortunately in patients with diagnosedcancer and especially metastasize cancer may have significant amount of pain andmay require very aggressive pain management and introduction of unusuallyhigh for other pain presentations doses of opiates and other pain controlmedications so if you work on cancer world you probably will agree with methat medication may be dispensed quite
often and in larger doses then let's sayif you compare it to even such high pain management floor such as orthopaedicobstruction may occur and why obstruction we are talking aboutobstruction of the blood vessels or obstruction of a docked or obstructionof the colon in this case you know obstruction may be relatively good thingbecause obstruction may cause symptoms and sometimes that will lead to furtherexamination and discovery of the tumor however obstruction may present withvery critical conditions and may be developing quite rapidly and theimportant that obstruction need to be addressed also very quickly hemorrhageis another consequence of the cancer and
hemorrhage can be developed secondary todisruption of the vessels or and invasion of the cancer as well as mostof the malignancies are highly vascular and angiogenesis is rampant in thesestructures and even small manipulation will cause bleeding depending on thesize of the tumor the amount of hemorrhage may be very significant andpatient may present with chronic anemia secondary to this so patient may beasymptomatic in the at the time of the onset of disease but may have anemia asa sign of cancer anemia may be warranting for a very thoroughexamination and unexplained anemia is always a red sign you cannot say thispatient is old that's where they live
and their hemoglobin is nine so theyfind again old and young or relative termsanemia meanwhile or hemoglobin levels or not so again if the your anemia yourhemoglobin levels are lower than your guidelines your lab guidelines so it'sdefinitely warrants you to for further evaluation one of the common evaluationtech strategies will be to re-examine patient for renal disorders which may besign of aplastic anemia but in in this case when patient may have a cancerousgrowth one of the common strategies is evaluation of the gi tract to look fortumors or malignant polyps that may present with slow bleeds and overall slow reduction of hemoglobin levels
so in this case in both cases if itpresents like anemia of chronic disease the size of the cells and color of thecells may be normal but the amount of the cells of normal so anemia of chronicdisease may be actually in signifying the cancers especially the cancers of gitract if cancer is invading bone structures it's quite possible thatpatients will present with unexplained fractures and which may be sign ofmetastasis and bone invasions or in the in case of osteosarcoma this definitelywill be one of the signs of presence of the primary tumor infection secondary tosuppress lying of the immune system are quite common and one of the key visualcharacteristics of the cancers will be
cachexia when patient losing weight andcachexia occurs secondary to increased metabolic demands of the body and ifwhich is secondary to increased metabolic demands of the growing tumoron control so your patients may have even sufficient caloric intake but stilllose weight at the same time patient may present with loss of appetite and inaddition to lots of appetite patient may have may have cupcake co secondary toincreased metabolic demands of the tumor in this case we can prescribe patientsomething that some pharmaceuticals that may contribute to increase of appetitesuch as mayonnaise to complete this presentation i wouldlike to talk about cancer treatments
very briefly and there are differenttreatment modalities for cancer you can see in your patient but the treatmentshave numerous side effects especially chemotherapy radiation as well ashormonal treatment but don't forget that these are last life-saving last resorttreatment so some of your patients may focus on side-effects and be resistantto receive the treatment because of that but however your job is to explain thebenefits of the treatment as well as the side effects what i'm talking about it'sthe concept of informed consent means we don't give any treatment in anycondition without patient or patients families patient is not able to makedecision for treatment so the treatment
surgery surgical excision may be verysuccessful modality of treatment if it's done early at it in the timeline of theprogression of the disease if the cancer is metastasized surgery may take apalliative and bi palliative i don't mean the end-of-life role but thepalliative role which may reduce that's a compression on vital organs willreduce the size of the tumor but at that time surgery may be followed bychemotherapy and radiation chemotherapy is a systemic treatment and is inaddition to attacking the primary tumor it may also affect the metastasis againthe details of this will be in subsequent chapters and lectures as wellas in your formica therapeutics course
radiation is alocal treatment and radiation is local targeted treatment which may be of thepurpose to shrink the tumor or it may even be a palliative treatment toprevent cancer from spreading radiation techniques improved vastly within lastfew decades to give you an example when we talked about henrietta lacks case inher case the cervix was packed with radium and it's not seed but it's like apacking with the gods type of material and she patient was sent hometoday's radiations treatment i hardly highly i'm sorry it are highly targetedand focused and that may affect only affect only the tumor itself but againradiation has all side effects and one
of the most visible ones will be theradiation burn you will see on the patient skin as well as it can affectand be actually carcinogenic for the staff in the hospital and at that timeof course strict radiation prevention radiation exposure prevention techniquesshould be utilized and staff should be protected hormones is one of the commonmodalities of treatment and hormones can be used for breast and prostate canceras you know some and most of the breast cancer are is estrogen sensitive andmost prostate cancers are testosterone sensitive so by increasing the amount ofcounter hormone we may reduce the size of the tumor when we're talking aboutprostate cancer prostate cancer usually
is not an ogrerecive disease but it can spread relatively slow so at that time somepatients and usually it's depending on patient age comorbidities may opt outfor hormone treatment at that time patient given doses of estrogen whichkeeps the tumor size under control or even may shrink the tumor most of thetime patient male patient will experience the side effects related toexcess estrogen and may have gynecomastia hair loss and other relatedconditions such as thinning of the voice but again the decision is usually madeafter a thorough discussion with the patient about the modalities usuallyyounger patients may opt out for more
radical treatments such as surgicalprostatectomy in breast cancer cases hormonal treatments can play palliativerole and treatment with testosterone is fairly common if it's a palliative careand it's something known operate but known the tumor is not feasible tooperate at that time giving testosterone may keep the initial tumor as well asthe metastasis from growing or growing rapidly which can buy some time and be atype of palliative treatment again this concludes the cancer or neoplasmslecture please again contact me if you have any questions and i will see younext time and hope you will enjoy the next lecture
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