MICROBIO 160 1st Edition Lecture 14 Outline of Last Lecture I Facts about Addiction to Nicotine II What s in Cigarettes III IV V Linking Cigarettes to Cancer Mutations of p53 and K ras in Lung Cancer Non small Cell Lung Cancer VI Small Cell Carcinoma VII Renal Cell Carcinoma and Smoking VIII Diagnosis IX Treatments X Exposure to Smoking XI Electronic Cigarettes Outline of Current Lecture I Alcohol and Cancer II Alcohol Tobacco Synergistic III Signs and Symptoms IV 5 Year Survival Rates V Liver Cancer VI Staging VII Treatments Current Lecture Alcohol and Cancer These notes represent a detailed interpretation of the professor s lecture GradeBuddy is best used as a supplement to your own notes not as a substitute Alcohol consumption is associated with increased risk of some but not all cancers of the oral cavity and pharynx esophagus larynx breast and liver o Contact derived cancer tissues that come in contact o Liver is the filter for everything that you re consuming o Alcohol is an estrogen mimic Alcohol is only a weak carcinogen Alcohol is not a mutagen Moderate alcohol consumption 2 drinks day is associated with a 25 decreased risk of heart disease o Red wine Mechanism of action Repeated exposure to alcohol causes tissue damage and cell death in areas f the body with direct alcohol contact In response surviving cells grow and replace destroyed cells The ability to trigger cell proliferation is the mechanism by which alcohol causes cancer o Start replicating out of control in order to fix the alcohol damage Study looked at several different types of cancer Relative risk how many drinks did people take per day in comparison to someone who didn t drink alcohol Alcohol and Tobacco Ac Synergistic Trend between people who smoked and people who drank higher cancer rates If you drink and smoke you are increasing your chances by 38 o Why is there a synergistic effect You are trying to heal the damage with already damaged cells Alcohol and Tobacco are a deadly combination Tobacco contains potent carcinogens Alcohol stimulates cell division Rapid proliferation of genetically damaged cells Cancers of the mouth esophagus pharynx and larynx Signs and symptoms o Leukoplakia white lesions Erythroplakia red lesions o Lump thickening in oral soft tissues soreness feeling something caught in throat difficulty chewing or swallowing ear pain difficulty moving the jaw or tongue hoarseness numbness of the tongue or other areas of the mouth swelling of the jaw Detection diagnosis o Visual exam palpation endoscopy MRI CT endoscopy bleeding o Biopsy Treatment o Surgery radiation chemo Rehabilitation and plastic surgery 5 Year survival rates Oral cancer claims a high number of deaths worldwide as almost 2 3 of the cases are detected in the advanced stages of the disease 90 for initial stages 20 25 in advanced stages usually detected in this stage One American dies from one of these types of cancer every hour the rate has increased in the past 40 years increase in smoking Liver Cancer Main Types Hepatocellular Carcinoma HCC The most frequent liver cancer Variant type patient has both HCC and cholangiocarcinoma o Rarer forms Mesenchymal tissue sarcoma Hepatoblastoma primarily developing in children Cholangiocarcinoma bile duct cancers the small tubes that carry bile to the intestines Angiosarcoma and Hemangiosarcoma blood vessel and blood by the time it is detected it is usually fairly widespread Lymphoma blood cancer but it can start to grow inside of the organs Liver Cancer Symptoms Fever weight loss loss of appetite nausea or vomiting an enlarged liver felt as a mass under the ribs on the right side yellowing of the skin and eyes jaundice pain in the abdomen or near the right shoulder blade feeling very full after a small meal itching swelling or fluid build up in the abdomen enlarged veins on the belly that become visible through the skin worsening of your condition if you have chronic hepatitis or cirrhosis an enlarged spleen felt as a mass under the ribs on the left side Diagnosis Medical history and physical exam Imaging x ray CT MRI Angiography inserting a flexible catheter into a large vein and injecting a dye to enhance vasculature during imaging uncomfortable Laparoscopy inserting flexible camera tube into abdomen bleeding Biopsy bleeding and spread of tumor Staging Liver Cancer TNM TX primary tumor cannot be assessed T0 no evidence of primary tumor T1 a single tumor Any size that hasn t grown into blood vessels T2 either a single tumor Any size that has grown into blood vessels OR more than one tumor where no tumor is larger than 5cm across T3A more than one tumor with at least one tumor larger than 5cm across T3B at least one tumor Any size that has grown into a major branch of a large vein of the liver the portal or hepatic vein T4 the tumor Any size has growninto a nearby organ other than the gallbladder OR the tumor is growing into the thin layer of tissue covering the liver Called the visceral peritoneum o NX cannot be assessed o N0 no spread to nodes o N1 spread to nodes M0 no mets M1 mets belly lungs bones Staging Once individual T N and M scores have been determined they are combined to generate an overall cancer stages o Stage I T1 N0 M0 There is a single tumor any size that has not grown into any blood vessels The cancer has not spread to nearby lymph nodes or distant sites o Stage II T2 N0 M0 Either there is a single tumor any size that has grown into blood vessels OR there are several tumors and all are 5 cm 2 inches or less across The cancer has not spread to nearby lymph nodes or distant sites o Stage IIIA T3a N0 M0 There is more than one tumor and at least one is larger than 5 cm 2 inches across The cancer has not spread to nearby lymph nodes or distant sites o Stage IIIB T3b N0 M0 At least one tumor is growing into a branch of a major vein of the liver portal vein or hepatic vein The cancer has not spread to nearby lymph nodes or distant sites o Stage IIIC T4 N0 M0 A tumor is growing into a nearby organ other than the gallbladder OR a tumor has grown into the outer covering of the liver The cancer has not spread to nearby lymph nodes or distant sites o Stage IVA Any T N1 M0 Tumors in the liver can be any size or number and they may have grown into blood vessels or nearby organs The cancer has spread to nearby lymph nodes The cancer has not spread to distant sites o Stage IVB Any T Any N M1 The cancer has spread to other parts of the body Tumors can be any size or number and
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