Debate Chamber Medicine Course – day one

Below are my notes from day one of this course that I went on today.

Oncology

Definitions

Cancer – an abnormal group of cells

Benignnon-invasive = very slow growth, does not cause a problem

Malignant locally invasive = spreads to a nearby area

Metastaticinvasive = via blood/lymph to rest of body

Angiogenesis – development of blood vessels around tumour to supply it with nutrients for growth

 

How tumour cell invades an area in body

Tumour cell breaks through collagen fibres (for strength and elasticity) surrounding epithelial cells then squeezes through the gaps between epithelial cells by intravasation. This gap is left open and other less aggressive tumour cells can pass through causing more of a problem.

Cancer is a defect of DNA leading to a different sequence of amino acids being coded for.

 

Types of Cancer

Carcinoma

  • Most common
  • In epithelial cells including breast and lung

Sarcoma

  • Rarer
  • Tissues formed from embryonic mesoderm including fat, bone, muscle, cartilage
  • Lipoma which affects fatty tissue and malignant shwannoma which is cancer of the protective layer of neurones (shwann cells produce myelin for the myelin sheath)

 

Pancreatic Cancer

  • Known as silent killer due to lack of symptoms
  • Non-specific symptoms including epigastric pain, loss of appetite, vomiting, weight loss, painless jaundice, steatorrhea, trousseau sign, diabetes mellitus
  • Risk factors: genetic, age, smoking, poor diet, chronic pancreatitis
  • Low survival rate at 25% in a year’s time and less than 5% in five years’ time

 

Leukemia

  • Cancer of the blood or bone marrow
  • Caused by an uncontrolled increase in white blood cells known as ‘blasts’ crowding out other cells
  • More common in childhood
  • Bone marrow biopsy to prove, or lumbar puncture testing cerebrospinal fluids (CSF)
  • If any cells are found in CSF, the tumour is able to reach the brain

 

Genes associate with cancer

  • Oncogene – stimulate growth
  • Tumor suppressor – inhibit growth
  • Repair genes – limit mistakes
  • PSA – excess produced when prostate tumour present
  • BRCA1 – may lead to ovarian or breast cancer

 

Cancer staging

  • Gleason System for prostate cancer

A number is chosen from 1 to 5 (normal to very metastatic) so that complexity of each person’s condition can be noted

  • TNM staging for all cancers

T = condition of primary tumour (T1-T4)

N = extent of lymph node involvement (N0-N2)

M = extent of distant metastasis (M0 or M1)

Higher numbers indicate lower survival rate

  • Diagnosis

Putting information together concerning genetics, results of protein tests, scans and biopsies.

Concerns surrounding genetic screening include high cost at around £400-2000, counselling for those with worrying results, whether they are completely reliable, expensive and high-risk prophylactic (preventative) surgery may be required.

 

Scans

  • X-Rays
  • MRI
  • CT Scan

 

Treatment – usually a combination of the following

  • Chemotherapy attacks rapidly dividing cells, hence loss of hair, weight loss (gut cells) and anaemia (RBCs)
  • Radiotherapy where a radioactive source is fired at the cancerous cells
  • Operation to remove tumour eg. Mastectomy
  • Bone marrow transplant
  • Hormone treatment eg. Tamoxifem

 

Extra information

  • Spleen converts red blood cell into bilirubin and uncontrolled release of bilirubin causes jaundice
  • Ending in ‘-itis’ = inflammation
  • Theories of cancer’s cause include bacteria, viruses, genetics, immune system
  • It is possible to screen for genes that are linked with disease including DMD (muscular dystrophy), LDLR (heart disease), and MLH1 (colon cancer)
  • Measure symptoms by a change to ‘normal’, although everyone’s base line is different form one another so there is no point comparing patients’ symptoms to each other

 

Final activity

The last thing we did was to read a case study about a patient and present a summary then come up with a differential diagnosis, a final diagnosis, staging and treatment. I really enjoyed this activity as we had the chance to put the science that we learned today into practice.

 

 

Emily Buchanan

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