Oncology Pathologies Flashcards
Lung Cancer
Cancer of the lungs
Aetiology:
* 90% due to smoking. Frequently follows COPD.
* More commonly affecting men (3:1)
* Second most common malignancy in men
* Peak incidence of lung cancer is between 6-70 years of age
Main signs and symptoms:
* Dry and persistent cough
* Dyspnoea and chest pain
* Weight loss and voice hoarseness
* Haemoptysis (bloody / raspberry sputum)
* Wasting of muscles in hand (if apical tumour)
* Clubbing of nails
Diagnosis/investigations:
* Sputum culture
* FBC
* Chest X-ray
* CT scan
Allopathic treatment:
* Radio / chemo therapy
* Surgery
Alternative treatment:
* Herbs
* Nutritional supplements – antioxidants
* Plant base diet – alkalizing
* Homeopathy
* Acupuncture
Other notes:
* Five year survival rate of 15%
* 95% arise in bronchi. Diagnosed by x-ray.
* A study found that a diet rich in fruit and vegetables reduces the incidence of lung cancer by 25%
* Most commonly secondary cancers = colorectal, osteosarcoma, prostate
Colorectal Cancer
- Cancer of the colon or rectum
Aetiology:
* Locally invasive but metastatic spread may be evident before growth produces symptoms – metastasizes to the liver, lungs, brain and bone
* More common over 50 years of age
* More common in developed countries
Risk factors:
* Strong link with diet high meat, low fibre, lack of vit. D.
* Polyps, Family history
Main signs and symptoms:
* Initially few symptoms
* Rectal bleeding, blood / mucus in stool
* Obstruction causing colicky abdominal pain
* Anaemia = fatigue, pallor, etc.
* Consistent change in bowel habits (diarrhoea / constipation)
Diagnosis/investigations:
* Colonoscopy and biopsy
* Stool analysis (occult (hidden) blood and M2-PK)
* Blood test (CEA and inflammatory markers)
Allopathic treatment:
* Radio / chemo therapy
* Surgery
* Palliative
Alternative treatment:
* Herbs
* Nutritional – supplements – anti-oxidants
* Plant-based diet – alkalising
* Homeopathy
* Acupuncture
Other notes:
* Screening in developed countries often involves stool analysis and endoscopy (looking for occult blood in stool)
* Five year survival: Stage I = 93%, Stage IV = 3%
* Most colorectal tumours are on the left side, 40% are in the rectum, 25% in the descending colon, the rest in the ascending colon (left sided pain more likely)
Benign Breast Masses
(Fibroadenoma / Fibrocystic)
- Benign mass / swelling in the breast
Aetiology:
* Most prevalent in pre-menstrual women and cysts often shrink following the onset of menses
Main signs and symptoms:
* Fibrocystic breast disease often presents as breast pain / tender masses / nodules
* Typically mobile, smooth and have regular borders (this differs from a malignant mass)
* Hormones are thought to be critical in aetiology
Other notes:
* Most breast lumps are benign – these will generally be cysts of fibroadenomas
* Pain not usually associated w/ breast cancer
Ovarian cancer
- Cancer that affects the ovaries
Aetiology:
* Mostly affects women over 40 yoa
* Generally oestrogen dependant, like breast cancer
Risk factors:
* Family history
* BRCA 1&2
* Long reproductive lifespan- late menopause, early menarche
* Infertility / never given birth
* HRT
* Poor lifestyle; exercise, smokers. Obesity
* Diet rich in animal fats
* Talcum powder used between legs
Main signs and symptoms:
* Early stage symptomatic
* Vague abdominal discomfort and bloating
* Abdominal mass with pelvic pain (through seeding along peritoneum)
* 75% present with advanced disease
* Later – change in bowel habits
Diagnosis/investigations:
* Ultrasound
* CT, MRI
* Bloods: CA-125 tumour marker
Other notes:
* Most lethal gynaecological malignancy
* Prognosis: 38% survival rate
Breast cancer
- Cancer of the breast (either ductal or lobular epithelial cells)
Aetiology:
* The most common female cancer
* Can also affect men (1% of breast cancer cases – associated with alcohol consumption and liver issues)
Risk factors:
Risk Factors:
* Breast cancer cells contain receptors that hormones or other proteins can bind to and promote tumour growth
- These receptors are most commonly for oestrogen (80%)
- The two other receptor sites are for ‘progesterone’ or epidermal growth factor’
- If a tumour contains none of the three-receptor types, the breast cancer is ‘triple negative’. Accounts for 15% cases
* Therefore, most breast cancer is known to be associated with oestrogen. High oestrogen exposure increases risk. The exposure can include endogenous and exogenous oestrogen.
- Risk Factors 1;
- Oestrogen ahs the ability to promote the growth of breast cancer cells (as it does at puberty and in pregnancy). Oestrogen is a hormone that will always promote the growth in the body
- BRCA1 or BRCA2 mutations increase the risk of breast (and ovarian) cancer. However, it is essential to consider the environment these genes are bathed in. These mutations only account for 5% of all breast cancer.
- A longer ‘reproductive life’ (early menarche, late menopause = higher oestrogen exposure), the combined oral contraceptive pill and HRT
- BPA (in plastics) – mimics oestrogen
- Risk factors 2:
- IGF-1 promotes breast cancer in women with high oestrogen levels (IGF-1 high in dairy)
- Breast quadrants and breast cancer; once oestrogen is metabolized, it has to leave the breast via the upper lateral quadrant, where most cancers occur
- Aluminum is found within many antiperspirants, which may be absorbed and cause oestrogen-like hormonal effects
- Parabens in deodorant can also mimic oestrogen (found in breast tumours)
- Upper medial quadrant tumours are becoming more common (mobile phones?)
Endogenous = from within, exogenous = from outside
Main signs and symptoms:
* Asymptomatic usually
* Painless, unilateral fixed lump (benign breast tumours are very common and typically present as mobile lumps)
* Overlying skin changes; i.e. dimpling, ‘orange peel’ appearance
* Asymmetry of breasts, inverted and discharging nipple
* Enlarged axillary lymph nodes
Diagnosis/investigations:
Mammography:
* An X-ray that directs radiation into breasts.
* Mammography looks for the presence of tumours – these tumours would have to reach a certain size before becoming visible on an x-ray (=
* Mammography increases breast cancer risk
Thermography:
* A safer and more effective method of detecting earlier pathological cancerous changes
* As already mentioned, as cancer cells divide they must undergo angiogenesis (increases the local temperature)
Allopathic treatment:
* Radiotherapy, Chemotherapy, Surgery
* Hormonal therapy; if oestrogen positive – ‘Tamoxifen’ (blocks oestrogen receptors). This can cause hot flushes, joint pains, osteoporosis, DVTs and sleep irregularities
Alternative treatment:
* Supporting oestrogen detoxification and elimination – plant based diet, diet high in fruit, vegetables
* Reduce obesity and alcohol, Ozone therapy (O3 rather than O2)
* Herbs – shitake mushrooms, green tea
* Homeopathy and Acupuncture
Complications:
* Metastatic spread via lymphatics
Cervical Cancer
- A cancer that is found anywhere in the cervix
Aetiology:
* Most common cancer I young women – commonly 25-35 years of age
* Persistent HPV infection (strains 16 + 18 cause 70%)
* Sexual behaviour (multiple partners, young age)
* Smoking, COPD
Main signs and symptoms:
* Non specific symptoms
* Abnormal vaginal bleeding (after sexual intercourse, between menstrual periods)
* Vaginal discharge
* White / red patches on cervix
Diagnosis/investigations:
Screening;
* 30% detected by screening
* Smear; detect cancerous & pre-cancerous changes
Diagnosis:
* Biopsy and histological examination
* MRI > CT
Allopathic treatment:
* Surgical – hysterectomy (preferred up to stage 2), Chemo-radiotherapy
Alternative treatment:
* Herbs
* Nutritional supplements – anti-oxidants
* Plant based diet – alkalising
* Homeopathy and acupuncture
Other notes:
* Accounts for 20% of all cancers in women
* 4,500 cases per year
Liver Cancer
- Primary liver cancer forms in the tissues of the liver
- Secondary liver cancer - metastasized from another part of the body
Aetiology:
* More common in men over 60 yeo
* Associated with liver cirrhosis; alcohol, toxins = necrosis > chronic inflammation and cell proliferation
* Hepatitis b/C = viral integration into host genome (host DNA deletions; oncogenes activated)
Necrosis = cell / tissue death, Genome =complete set of genes in a cell
Main signs and symptoms:
* In the advanced stages; Jaundice, ascites, hepatomegaly
* Pruritis (itchy skin), bleeding oesophageal varices (dark stools/vomiting blood -secondary to portal hypertension), weight loss
* Vomiting, loss of appetite, feeling very full after eating, feeling sick, pain or swelling in the abdomen, fatigue and weakness
Hepato = liver, -megaly = enlargemn, ,Aascites = fluid in peritoneum
Allopathic treatment:
* Surgery – transplant, portal vein embolisation
Alternative treatment:
* Herbs
* Nutritional supplements
* Plant based diet rich in nutrients and anti-oxidants
* Alkalising the body
* Homeopathy and Acupuncture
Other notes:
* Usually co-exists with liver-cirrhosis
Gastric Cancer
- Cancer that forms in the tissues lining the stomach (AKA stomach cancer
Gastric = of the stomach
Aetiology:
* Diet rich in salted, pickled and smoked foods (N-nitroso compounds)
* Male, smoking, age (55+)
* H.pylori infection
* Low fruit and vegetables diet
Main signs and symptoms:
* Early stages: Persistent indigestion, frequent burping, heartburn, feeling full quickly when eating, bloated, abdominal discomfort
* Advanced stages: Black blood in stools (black / tarry stool), loss of appetite, weight loss, tiredness, anaemia, jaundice (metastasis to portal vein)
Diagnosis/investigations:
* Blood in stool. Endoscopy, biopsy
* Tumour markers: CEA and CA 19-9
Allopathic treatment:
* Herbs
* Nutritional supplements – anti-oxidants
* Diet is essential for all forms of cancer – plant based diet rich in nutrients & antioxidants, alkalising body
* Homeopathy and acupuncture
Alternative treatment:
* Gastrectomy
* Chemo / Radiotherapy
Other notes:
* 2nd cause of cancer related death in the world (highest rates in Eastern Asia, with the highest rates worldwide being Korea and Japan)
Oesophageal cancer
- Cancer that affects the oesophagus
Aetiology:
* Chronic irritation, alcohol, smoking
* GORD and Barrett’s oesophagus
* Obesity, low fruit and veg diet, age
Main signs and symptoms:
* Few early symptoms, later obstruction may occur
* Dysphagia (Red flag!)
* Anorexia and melaena (due to oesophageal bleeding)
Allopathic treatment:
* Herbs
* Nutritional supplements – antioxidants
* Diet is essential –plant based diet rich in nutrients and antioxidants
* Alkalising the body
Other notes:
* A common aggressive cancer with a poor prognosis
Pancreatic Cancer
- Cancer of the pancreas
Pathophysiology:
* Most arise from exocrine cells
* Less commonly from endocrine Islet cells (pancreatic neuroendocrine tumour)
Aetiology:
* Common in older people, uncommon in people under 40 years – poor prognosis
Cause is unknown, but risks include;
* Age, smoking, family history (germ line defects in 5-10%)
* Other health conditions (diabetes, chronic pancreatitis, H.pylori)
Main signs and symptoms:
* Asymptomatic early
* Epigastric pain radiating to the back
* Unexplained weight loss, anorexia and fatigue
* Jaundice
* Post-prandial nausea
* Glucose intolerance (Neuroendocrine tumours)
Endocrine = hormones
Allopathic treatment:
* Surgery
* Chemo / Radiotherapy (adverse effects)
* Palliative care
Alternative treatment:
* Nutritional supplements and primarily plant based diet rich in nutrients and antioxidants, alkalising the body
* Herbs, homeopathy and acupuncture
Other notes:
* Approx 60% metastatic at diagnosis
* Poor prognosis – average life expectancy from diagnosis is 6 months
Prostate Cancer
- Cancer that forms in the tissues of the prostate
Aetiology:
* Most common cancer in men
* Generally 50+ years
Main signs and symptoms:
* Same urinary symptoms as BPH
* Key symptoms include nocturia and haematuria
* Back pain can indicate bone metastases
* Poor urinary flow
* Stop / start, dribbling
Dysphagia = difficulty swallowing, meaena = black tarry stools)
Diagnosis/investigations:
* Elevated PSA
* Digital rectal examination
* Biopsy
Allopathic treatment:
* Radiotherapy (localized, non invasive), Chemotherapy
* Androgen deprivation therapy
* Surgery (removal)–50% never recover urinary/erectile function
Alternative treatment:
* Obesity is a significant risk factor
* High meat consumption (esp. char-grilled), dairy and saturated fats, refined sugars increase risk
* Fish, fruit, vegetables, soy and a plant based diet show to have protective factors
* Herbs – Boswellia (frankiscence), carotenoids (antioxidants), green tea
Other notes:
* Most common cancer in men – increasing incidence
* 90% of prostate cancer never grows out of the capsule
Bladder Cancer
- Cancer that forms in the tissues of the bladder
Pathophysiology:
* Commonly originates from transitional epithelial cells in the bladder
Aetiology:
* 2 x more common in men and most common between 70-80 yoa
* Smoking (amines / hydrocarbons = carcinogens = pool in the bladder and induce mutations)
* Chronic cystitis, increasing age, catheterisation
Main signs and symptoms:
* Painless haematuria (90%)
* Increased urine frequency, urgency, dysuria
* Bone metastases (with pain e.g. in spine)
Cysto = referring to bladder, -ectomy = removal, dysuria = painful urination
Diagnosis/investigations:
* Transurethral resection or cystectomy
Testicular Cancer
- Cancer that forms in one or both of the testicles
Aetiology:
* Most common cancer in young men (15-35 yrs)
* Higher risk if undescended testis and family history
* Cause not fully known
Main signs and symptoms:
* Hard, painless, unilateral mass (95% present with a lump on testes)
* Dragging sensation and dull ache
* Metastasises to bone, brain, lungs and liver
Allopathic treatment:
* Orchidectomy
Alternative treatment:
Support:
* Regular, monthly self-examination
* Herbs
* Nutritional supplements – antioxidants
* Diet is essential for all forms of cancer – primarily plant based diet rich in nutrients and antioxidants
* Homeopathy and acupuncture
Other notes:
* Excellent prognosis if caught early; Orchidectomy
Skin Cancers
- Cancer that forms in the tissues of the skin
- Skin cancer types differ based on the cells affected
Aetiology:
* Most common in fair skinned people aged 40+
* Cases are on the increase. Strong connection to UV light exposure and the chemicals in sunscreens
Main signs and symptoms:
* Usually arise on head, neck or back (sun-exposed areas most commonly)
- Asymmetry; unsymmetrical halves of lesions / moles may signify be malignancy
- Border; Non-malignant tumours = smooth, regular border. Early melanoma = jagged or uneven
- Colour; One colour = good sign. Melanomas have a variety of colours, particularly shades of black, brown, pink, tan. Also can be blue, red and other colours
- Diameter; non-malignant skin cancers tend to be smaller than ¼ inch in diameter. Melanomas are usually larger
- Evolving; Changes in colour, elevation, size or shape, or if new symptoms arise such as bleeding, itchiness, crusting, it could be dangerous
Other notes:
* Highest rate of reoccurrence
* Visible, generally easily detected and develop slowly = good prognosis
Squamous Cell Carcinoma
(Non melanoma skin cancer)
- Malignant tumour from keratanised epithelial cells
Main signs and symptoms:
* A red, scaling, thickened nodule / patch on sun-exposed skin
* Some are firm hard nodules with central necrosis = ulcer / bleeding
* When not treated, it may develop into a large mass
Other notes:
* Second most common skin cancer
* It is dangerous, but not nearly as dangerous as a melanoma
Basal Cell Carcinoma
(Non melanoma skin cancer)
- Cancer that begins in the lower part of the epidermis
Main signs and symptoms:
* Raised, smooth, pearly bump on the sun-exposed skin of the head, neck or shoulders
* Sometimes small blood vessels can be seen within the seen within the tumour
* Crusting and bleeding in the centre of the tumour is often mistaken for a sore that does not heal
Allopathic treatment:
* Good prognosis -with proper treatment can be eliminated, without scarring
Other notes:
* The most common skin cancer
Melanoma
(Skin Cancers)
- A form of cancer that begins in melanocytes
Aetiology:
* Women > men 30-50 yrs
* Pale skin, sun exposure
Main signs and symptoms:
* Often brown / black lesions, occasionally pink or red in colour
* Warning signs that might indicaye a malignant melanoma inc. change in size, shape, colour, elevation of a mole or new mole
Allopathic treatment:
* Surgical
* Chemotherpay
Other notes:
* Most spread out within epidermis (can be in-situ)
* 5 year survival rate = 80%
Bone Tumours
- Bone tumours develop when cells within a bone divide uncontrollably, forming a lump or mass.
- Can be benign or malignant
- Osteosarcoma = malignant bone tumour. Can be primary or secondary
Pathophysiology:
* Primary osteosarcomas rapidly metastasise (often to the lung)
Aetiology:
* Primary Osteosarcomas most commonly affect teenagers
* Malignant bone tumours are most commonly secondary tumours. The spine is commonly affected due to a venous network in the spine
* Malignant bone tumours cause worsening pain that becomes unremitting. The pain can wake the patient at night and causes systemic symptoms e.g. weight loss, malaise, fatigue, night sweats
Main signs and symptoms:
* Primary Osteosarcomas typically occur around the knee or in the humerus (i.e. consider knee pain)
Brain Tumours
- A brain tumour is a growth in the brain.
- Can be benign or malignant.
Pathophysiology:
* Brain tumours that grow rapidly aggressively are often referred to as ‘high-grade tumours’, whilst slower replicating tumours are ‘low-grade’.
* High-grade tumours include ‘gliomas and ‘’glioblastoma’
* Low-garde tumours include ‘meningiomas’
Aetiology:
* Most intracranial tumours are metastases from other tumours (10x more > primaries). Common primary sites include the lung, breast, stomach & prostate
* Can occur at any age, mostl commonly occur in those between 50-70, as well as children / young adults.
* Possible links with mobile phone use
Main signs and symptoms:
Due to Intracranial pressure:
* Unexplained headaches – worse in mornings
* Vomiting & nausea, seizures
* Double vision, behaviour changes, slurred speech
* Signs: Papilloedema
Other notes:
* Both benign & malignant tumours account for significant mortality. As these tumours grow, they cause severe effects due to the space-limiting structure of the cranium.
Lymphoma
- A malignancy of lymphatic cells (i.e. cancer of the lymphatic system).
- Two main types of lymphoma; Non-Hodgkin’s and Hodgkin’s lymphoma (Non Hodgkin’s is 5x more common)
Lymph = lymphatic, -oma = tumour
Pathophysiology:
* Differs from Leukaemia where the malignancy arises from the bone marrow
* Most lymphomas involve B lymphocytes
Aetiology:
* Non-Hodgkin’s; Peak age 50 yrs+ & children / young adults
* Hodgkin’s; Peak age 20-35 years and is also a common paediatric malignancy
Main signs and symptoms:
Risk Factors:
* Epstein-Barr Virus (EBV) has been found in 50% of patients with Hodgkin’s lymphoma
* Other risk factors include HIV and general immunosuppression
* Exposure to pesticides and herbicides, chemotherapy and radiotherapy
* Signs and Symptoms:
* Commonly presents as enlarged and asymptomatic lymph node in neck
* Chest discomfort, cough, dyspnoea (thymus can be affected)
* Drenching night sweats, fever, weight-loss
* Lymphadenopathy, hepatomegaly, splenomegaly
Diagnosis/investigations:
* Biopsy of lymph node (surgical or fine needle)
* Blood tests: raised ESR, leukocytosis, lymphopenia, anaemia & HIV testing
Allopathic treatment:
* Chemotherapy is the main treatment approach (however this is well recogised to cause secondary tumours)
Alternative treatment:
* Cancer support using herbal medicines
* Nutrition and nutritional supplements
* Homeopathy and acupuncture
Leukaemia
- A group of bone marrow cancers, characterized by abnormal over production of leukocytes.
- Divided into acute or chronic leukaemia’s. There are four types of Leukaemia:
1. Acute myelogenous leukaemia (AML)
2. Acute lymphocytic leaukaemia (ALL)
3. Chronic myelogenous leukaemia (CML)
4. Chronic lymphocytic leaukaemia (CLL)
N.B: Myelogenous = from myeloid cell linage (all other blood cells inc WBC, RBC, Thrombocytes)
Lymphocytic = lymphoid lines (B & T lymphocytes & NK cells)
Pathophysiology:
* Uncontrolled proliferation = suppressed erythrocyte production (= anaemia) & thrombocytes (=thrombocytopenia)
* Acute leukaemia’s; Rapid onset, more aggressive course. Immature cells (>20% - blast cells in bone marrow)
* Chronic leukaemia’s; Insidious onset and more differentiated cells
Acute Leukaemia’s
Age; All ages
Onset; Sudden
Leukaemic cells; Immature (-blasts)
Anaemia; Prominent
Thrombocytopenia; Prominent
Leukocyte count; Variable
Lymph node enlargement; Mild
Splenomegaly; Mild
Chronic Leukaemia’s
Age; Usually adults
Onset; Insidious
Leukaemic cells; Mature
Anaemia; Mild
Thrombocytopenia; Mild
Leukocyte count; Increased
Lymph node enlargement; Prominent
Splenomegaly; Prominent
Main signs and symptoms:
* Malaise, anaemia (fatigue, pallor etc), frequent infections, easy bleeding / bruising
* Fever, weight loss
* Splenomegaly (abdominal swelling / discomfort)
* Lymphnode enlargement
Diagnosis/investigations:
* Full blood count; anaemia, low thrombocytes, variable leukocyte count
* Blood film (viewing sample of blood)
* Bone marrow biopsy
Allopathic treatment:
* Chemotherapy and radiotherapy
* Bone marrow transplant
(Relapse is common)
Alternative treatment:
* Cancer support using herbal medicines, nutrition and supplements
* Homeopathy
