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BALNEOLOGY is a branch of science that studies the properties of balneological factors (climate, mineral waters, medicinal sludge etc.), the processing methods and their application to the body in the spa, as well as in sanatorium and physio-therapeutic institutions with the purpose of treatment, recovery and prophylactically. The balneology includes sections as follows: Climato-therapy; Balneo-therapy; Balneo-tehnik; Peloido-therapy. Climato-therapy studies physical factors’ influence the external environment (air-therapy, helio-therapy and hidro-therapy) on the human body and develops ways to use the curative effect and prophylactic effect. Balneo-therapy studies healing mineral waters in terms of their origin, and the physical and chemical influence on the body in various diseases and how they are use (internal or external). Balneo-tehnik develops technical and sanitary equipment to carry out accurately technical and medical application of mineral waters and medicinal sludges. Peloido-terapy studies the origin of medicinal sludges their physico-chemical properties and the mechanisms of their action on the body in different conditions. PHYSIOTHERAPY is the science that studies the action
mechanisms of physical enviroment factors, both natural as well as performance on the human body and their using for treatment, recovery and prevention. Physiotherapy includes the following sections: general physiotherapy; special and clinic physiotherapy. General physiotherapy examines organizational and methodological bases to using accuretly the physical factor, physiological and therapeutic mechanisms of action on the body and their using in clinic. Special (clinical) physiotherapy determines the particular use of physical curative factors and it studies in the clinical specialties.
2) What is kineto - therapy?
The kinetotherapy notion has for some of us similar connotations to complementary therapies such as: aroma-therapy; cromo-therapy; melo-therapy; reflexo-therapy even bioenergy, etc. But I wish to clarify that it is the field of traditional medicine and its effects may be replace successfully by complementary therapies to the extent that they understand and accept them as a complement to classical treatments. The most reactions of people who I talk about kineto-therapy are like: "O, kineto-therapy ... I know ... massage, right?" Actually it is not so and I will explain why: If for to do a massage, reflexo-therapy, bioenergy or anything like that it requires a basic course by which they obtains a certificate. A kineto-terapeut must be licensed by the kineto-therapy faculty either part of National Academy of Physical Education and Sport or part of University of Medicine and Pharmacy. So, the kineto-therapeut must think how to use therapeutics means and how to combine them succesfully in the recovery programs. Which are these means? It can be schedules of treatment based on a series of exercises results of numerous studies and medical research, like the Bobath programe - used for the recovery of children with poor motory; the Kabath programe - indicated in particular for those with paralysis and paresis; the Williams programe – against, lumbar pain. Or exercises can be done using mekano-therapy; the hidro-therapy and the list can be continue but the subject matter is very complex. It would be like we are trying to explain the treatment prescribe by doctors.
The kinetotherapy to children:
Through specific exercises which we offer, kineto-therapy is a solution to the problems of health of children, teaching them at the same time that the exercice is a healthy and harmonious way of life. Kineto-therapy in the widest acceptance, is the sistematised exercice principle in the form of physical exercises, aiming for a therapeutic purpose. Coverage of medical specialties which profit by contribution of kineto-therapy is extremely broad and it cover both prevention of diseases and especially the recovery of health. Contraindications occur rarely, only disease in which the child is in a vital risk. In most of cases, motory development of children who benefit from kineto-therapy is favorable. But there are situations in which it appear motory difficulties and child’s motricity evolution is slow and problematic. In these cases, kineto-therapy has specific means for intervention, maintaining the motory mobility of child.
Principles and methods:
Apparently simple, kineto-therapy imposes strict rules for application which depend on child and on kineto-therapeut. Respect the principle of “primum non nocere”, meaning in the first to do nothing bad, is of paramount importance. The "non pain" rule beside the effort extenting are basic principles in kineto-therapy. Treatment rooms arranged for kineto-therapy of children is
by creating environment properly for age, is a motivating principle for kids do not bore and perceive the therapy as a game. The kineto-therapeut’s skills are an essential factor in the treatment process. His inventiveness and creativity can transform the kineto-therapeutic exercises in real hours of play, and the children became motivated to return at treatment. From kineto-therapy view the exercice is active or passive. In the active kineto-therapy, the child learns by motricity, exercises which help to maintain the balance function and exercices to occur in the execution of fine movements and complicated. When the child has no got biological resources to execute and command the exercices, the kineto-therapeut intervens through the passive therapy to reorganize "command center" which is responsible for information needed for exercices initiation, but also for restoring the integrity of the locomotory.
The effects of therapy:
The kineto-therapeutics intervention has strictly physiological effects - the formation of new correct motor program, the maintain of joint mobility, the maintaining of troficitations tissue around joints and normalizing the muscle tone. Aims to involve the whole body in motion and to prepare the child’s body for effort, it formes habit of accurate and coordinated movements. By kineto-therapy may be correct different deformation of the kids’ spine due to an incorrect position on the bank or on the chair during the classes. Kineto-therapy treats diseases of the spine, such as: ♦ cifosis; ♦ lordosis; ♦ scoliosis. By kineto-therapy can treat diseases of the children’s locomotory: congenital luxations of hips; splay or of so-named "knee in X". Children with neurological diseases like: hemiparisis, paraparisis, may benefit for a better health by practice of kinetotherapeutic exercices. Rickets, obesity and other metabolic disorders can be treated, also by kineto-therapy.
It is used for various diseases and for preventing them, in body and spiritual caring to each of us.
According to research conducted in 2000 and systematized by B.Cooke, E.Ernest, aromatherapy: “a systematic review”, which includes 6 clinical standardized studies from United States, which totaled 456 participants, aromatherapy may have a benefical effect on anxiety, but on short-time. Three other studies conducted in the European Union, group 388 participants, underlined a benefical effect of aroma-therapy for decrease of anxiety and improving state of mind of hospitalized persons or who will make a surgical intervention. One of the studies focus on patients who had to undergo a dental treatment. In the waiting room, they was put in presence of an essential lavender or orange oil, or they listened a delicate music, or didn’t have undergone any intervention - control group. The participants from the group that took part of aromatherapy treatment had a lower level of anxiety and a better state of mind than others. However, this study doesn’t allow the observation of the effect of specific essential oils, compared with the inhalation of a delightful odors. As specifies another study which included 66 women who expect to support an abortion, the calming effect of inhalation of essential oils is egual with good smells of a placebo. Improving quality of life and physical symptoms of people affected by cancer was studied. In the article "aromatherapy and massage for symptom relief in patients with cancer, D. Fellowes, K. Barnes, S.Wilkinson concluded that massage combined with aromatherapy it could improve physical condition of patients affected by cancer and, to a less extent, to reduce the anxiety and some physical symptoms such as: - Pain; - Fatigue; - Nauses; - Vomiting; - Constipation. Others dotting about reducing crabs caused by haemolysis, improvement of living conditions for children premature borned, or treatment of light sleeplessness or reduction of menopausal symptoms. Fairly recently, numerous studies have appeared in the medical literature regarding the beneficial results of aromatherapy against certain diseases: - Eczema; - Infections; - Respiratory diseases; - Postoperative nauses; - Arthritis; - Multiple sclerosis; - Reduction of birth process; - Prenatal anxiety;
- Epilepsy; - Depression. Some essential oils are irritable for skin and must be diluted with vegetal oils before the application. Oils rich in ketones, may cause neurological problems. It seems that rose-marine and camphor oil, can trigger attacks of epilepsy. Some oils may have a fotosensibilised effect; can make the skin more vulnerable to sunlight. Quite many specialists say that we must be careful in using the essentials oils during pregnancy, birth or near the new borns. Use the aromatherapy but respect strictly the indications the bottles with essential oil. Don’t ignore the contraindications and inform as well before you use them. Your health depends on these things.
4) Diseases in physio-kineto-therapy
With spas treatments, the modern man may treat his various diseases of the body, which related to the locomotory, spinal column, the muscles, also through aromatherapy can treat some mental illnessis such as depression and anxiety. One of the most common diseases of spinal column which is treated by physio-therapy, is the discopaty (lumbar, cervical, thoracic). Spinal column is composed of vertebrae, intervertebral disk, ligaments and joint capsules. Deterioration of intervertebral disk from the spine is known as discopaty. The discopaty known as "intervertebaral disc disease" manifests by severe and pain, acute at the level of certain areas of the spine (column cervical, thoracic or lumbar). The most frequently affected disks arebetween vertebrae L4-L5 or L5-S1. The supraponderability, repeated trauma, old age and maximum lumbar spine demands due to rasing of some loads from incorrect positions (hiperextensif) are factors that predispose to the occurrence of lumbar discopaty. Depending on the region in which it occurred the damage of intervertebral disk, discophaty can be classified as follows: - discophaty-cervical; - discophaty-lumbar; - discophaty-thoracic. It should be noted that medical recovery of patients diagnosted with lumbar discophaty so common, or cervical discophaty which is equally frequent, is not done at home (at the patient's home), but in a kineto-therapy room (medical gymnastics) equipped with some proper apparatus (espalier; pulley; ergonomic bicycle; walking sticks; weights and various others). Treatment of vertebral discopaty is for a long time and each patient must follow it with earnestness and perseverance. In the first phase of recovery is treated symptoms (pain, discomfort). This is possible only by carrying out some sessions of physiotherapy (ultrasound and electrotherapy). For a more effective recovery is recommended physiotherapy sessions associated with therapeutic massage (carefully!-Not relaxation massage). Therapeutic massage and relaxation massage are different by maneuvers which are applied and by intensity with appling them. When the pain disappeared completely and the inflammation goes down it follows the second phase of recovery - medical gymnastics (kinetotherapy). At this stage is treated the cause of disease. In our country it used a program of medical recovery for lumbar discophaty known as the Williams Program. The exercises which are part of the Williams Program help to consolidation of abdominal muscles and strengthen of paravertebrale muscles brought the spinal column in a position as physiological (normaly). Lumbar discopaty may worsen by breaking of intervertebral disk producing the most serious form of discopaty - hernia disk. Other forms of discopaty are lombosciatics and disk protrusia. Very serious cases of lumbar disk hernia or rupture of cervical disk is treated only by surgery. Indication for surgery is given by doctor specialist in neuro-surgeon. Before appeal to the surgery the patient should make an investigation called NMR (nuclear magnetic resonance).
The lumbar vertebral discophaty:
Is characterized by back pain located in lumbar region (classic pain of hips) and affects on the average of 75-80% from active adults, regardless of sex or age, in some moment of their lives. Lumbar pain is also called lombalgy and may evolves towards lumbago crisis, being accompanied by blockage of the area due the contraction of muscles that support the spinal column. Pain in lumbar region may radiate to the buttock or down to the knee or to the leg. This situation is called lombosciatics and can be a sign of disk hernia if it associates a degree of paresis, meaning affected limb moves difficultly or leg we "escape" to some movements. Lumbar discophaty is a deterioration of the intervertebral disk from the lumbar spine. Spinal column consists of vertebrae (like nuts) put one over another. Between these vertebrae are intervertebrale disk. Vertebral disks are made up of cartilages (like some gaskets between two nuts). Which are the parts spine? - Cervical spinal column (the neck); - Spinal column dorsal (thoracic); - From the neck to where ends the ribs (in the lungs’ region); - Lumbar spinal column; - From the end of ribs to the pelvis; Sacred spinal column; Coccigian spinal column; Vertebral’s holes placed one above the other forms a vertebral canal is passing the spinal cord. Spinal cord is formed by a bundle of nerve fibers. These nerve fibers start from the brain and transmitt controls from the brain to the entire body. Fibers start from the spinal column through the spaces between the vertebrae (where there are intervertebrals disks). If disks are not integral, then the vertebrae move closer one to another and pinch the nerve that exits between them. Vertebral disk damage in the lumbar spine called lumbar discophaty. If the intervertebral disk of lumbar vertebrae is deteriorated a lot and it breaks them it occur disk hernia. The lumbar discophaty back pain. The pain can transmit in front the abdomen or on leg. How is lumbar pain discopatia? The pain is appears on back (his pain). The pain is more intense when the spine is moving or in some positions (sitting on chair, standing up, trepidations). The back can feel hurt also cough or sneeze. When pain from lumbar discophaty appear? In lumbar discophaty case pain occurs when the spinal column is more solicitated:standing up for a long time; split; bounce; lifting up driving car for a long time and especially at the big trepidations.
Attention! Many people confuse this pain with kidney pain. In lumbar discophaty back pain increases if spinal column is moving. It is not appropriate to make massages (especially vigorous, energetical massages) because nerve irritation produced by massage adds to irritation due to the vertebrae that are approaching (altered intervertebral disk) to nerves which are irritated during the lumbar discophaty it produces some damage (ret nervous fiber) which can not be fixed, whether it is made surgery later. What lumbar discophaty to do to treat?Ask family doctor what to do to treat lumbar discophaty! It may exacerbate by breaking of intervertebral disk and disk hernia when there is no other solution than surgery. Surgery indication is made only practitioner of neuro-surgeon. If it recommend surgery to this advice should be followed it means that is only solution to treatment. Ask the doctor about your back pain, do not treat you as you heard from neighbors, on radio or television. Treatment of lumbar discophaty: Disk hernia consists of: - reducing the pain; - promotting cure of invalid tissues; - regional miorelaxing; - return to the previous mobility; - education to prevent installation of other episodes; - return to its previous activities.
Due the weather from outside which is oscillating and also the temperature, which goes up or falls, but standing in the current, or in a poor position – with shoulders set down and head bent goes to appearing of neck discophaty, which represents those neck and shoulders pain, which appear both to children and to adults. Cervical Discophaty is a deterioration of the intervertebral disc from the cervical spine. For you have idea about the location of this disk, you must know that a spinal column consists vertebrae positioned one above the other and between these vertebrae are intervertebrale disk. You can get rid of this discomfort or illness appealing the SPA on the wide burdock, known as Lipan. Spinal column occupies a central position in the locomotory apparatus. "Only one who knows in what way is involved in the game column static and dynamic forces of the human body, can properly integrate the importance of this organ central to thinking in diagnosing and treatment" (Schmore-Iughanns). Spinal column in the human body carries out the following functions: - Office support (support an individual trunk posture printing feature) - Function protection (protect spinal cord against mechanical aggression) - Function of mobility (the complexity of the building gives the body its ability to move and to move in space) - Function morfogenetics (particularities spine mechanics turn the shape and placement eviscerated thoraco-abdominal). Vertebral spinal column consists of a sequence of 33-34 pieces bone called vertebra. It is part of a very complex structures called axial organ. The axial complex is a structural and functional which to participate: - The last bone (vertebrae that make up the spinal column) - Conjuctiva comprising the fibrous structure and the elastic connection between vertebrae (intervertebrale discs, joint capsules, ligaments) - The muscle (muscle spine) - The neuro-vascular (spinal cord, nerve roots, blood vessels). Altering any of these components reflect negatively on the whole organ function axial. Means such as alarming disturbances may be caused by pathological changes of the vertebrae or discs intervertebrale. How to connect vertebrae between them? The vertebrals discs are linked by intervertebrale the joints unsinovials while apofisis joints are linked by sinovials joints. Between the vertebrae are found and ligaments along with the intervertebral disk and joint capsules formed segment mobility. The most important segment of mobility is the intervertebral disk. What is the intervertebral disc? Intervertebral disc is located in the space between vertebral corpii on that separate, but I solidarizeaza and at the same time. Intervertebal disc cavity is devoid of joints, not possess any membrane Sinovial and liquid Sinovial. Therefore it is included among articulations nesinoviale. The disc consists of a peripheral portion, composed of fibrous tissue conjuncitv called fibrous ring and a central portion of gelatinous matter, which is called core pulp. Ring fiber is more resistant than in the previous posterior. In the ring fiber blades into fibrous
tissue, arranged concentrically around the core leg. These blades contain collagen fibers that insert on the side of the body adjacent to the two neighboring vertebrae, which is located between the intervertebral disk. Concentric ring of blades fiber are 15-20 in number of core pulp before and after only 7-10, explaining low resistance requirements of the area. Core leg traps water and develop an explosive force. Pulp core is a spherical gelatinous nature situated central fast fiber ring at the periphery. It is very rich in water and avid in its abstraction - hydrophilic. Exert compression on the formation of fibrous ring and nearby vertebral body. Force explosive kernel the vertebrals corps back leg and put in a fiber ring tension, which tends to approach him again. Through complex mechanisms, core and leg traps normally attracts water and thus develop the high pressures inside the explosive shattering force. The vertebral discs with intervertebrals made a precomprimat. Due to explosive force of leg core, the system developed by corpii vertebral discs and is located under continuous pressure, even in a state of rest. Such a system is called technique "precomprimat. Precomprimarea substantially increases the strength and elasticity. Due to this property kernela pulp disks intervertebrals increase elasticity of the spine and absorb mechanical shocks. When hydrophilic decreases the core leg, reduce power and explosive installation disc degeneration. Pressure from the pulp core at the same time increase the load.
Cervical spinal stenosis:
The term stenosis, a decrease pathological defines a permanent channel or hole (a pinch of a channel or hole). Spinal stenosis cervical spinal canal is shrinking neck. Spinal canal is the area bounded by the vertebrae that can be found in the spinal cord. Spinal cord is composed of parts of nerves which cross the spinal canal to the brain to the lower lumbar area. These nerves are responsible for the sensitivity and mobility of the territories which they inerves. In cervical spinal stenosis, the spinal canal narrows and can compress nerve roots in place leaving the spinal cord or irritate even the spinal cord. The first 7 vertebrae of the spine, which stretch from the base of the skull to the upper thoracic area, forming the segment of the cervical spine or cervical column. The compretion nerves and spinal cord in the cervical spinal canal can cause functional disorders in the spinal cord, stiffness, pain and paraesthesia in the neck, upper and lower limbs. Cervical spinal stenosis may be invalid if it is damaged spinal cord.
Symptoms that may be occur if cervical stenosis:
Many people aged over 50 years with shrinking but the spinal canal, however, presents no symptoms. Cervical spinal stenosis does not produce symptoms until the spinal cord or nerves are compressed. Symptoms appear gradually in a long period of time and include: - Stiffness, neck, shoulders, arms, hands or lower limbs pain; - Balance disorder; - Prevent or tarsirea legs during walking.
Cervical stenosis can have causes the following:
Cervical spinal stenosis is often produced by changes in shape and spinal canal typically occurs in people over 50 years. Due to age, producing thickening of the tissues that make the connection between the bones (ligaments), distructions of the tissues that encase the bones (cartilages) and excessive growth of bone at the extremity articulations. All these changes can lead to shrinking spinal canal (spinal stenosis).
In the eighteenth century, London physician Percival Pott made the first link between cancer and environmental agents when he noted a high incidence of scrotal cancer among chimney sweeps. He hypothesized that it was caused by exposure to coals and tars. Out of this observation grew the two-stage model of cancer development by 1) initiators and 2) promoters. In the years since Pott's observations a wide range of chemicals, radiation sources, viruses and bacteria have been implicated in the development of cancer. The initial experimental studies of carcinogenesis were conducted in animals. Chemicals able to react with DNA and non-reactive compounds were both tested for their ability to cause cancer. The model used was mouse skin carcinogenesis. In this system researchers painted test chemicals on the skin and observed the growth of tumors. Researchers found that application of a DNA reactive substance only resulted in tumor formation when the animals were further treated with another non-reactive substance. A compound that reacts with DNA and somehow changes the genetic makeup of the cell is called a mutagen. The mutagens that predispose cells to develop tumors are called initiators and the non-reactive compounds that stimulate tumor development are called promoters. Approximately 70% of known mutagens are also carcinogens--cancer-causing compounds. A compound that acts as both an initiator and a promoter is referred to as a 'complete carcinogen' because tumor development can occur without the application of another compound. Cancer (medical term: malignant neoplasm) is a class of diseases in which a group of cells display uncontrolled growth (division beyond the normal limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other locations in the body via lymph or blood). These three malignant properties of cancers differentiate them from benign tumors, which are self-limited, do not invade or metastasize. Most cancers form a tumor but some, like leukemia, do not. The branch of medicine concerned with the study, diagnosis, treatment, and prevention of cancer is oncology. Cancer may affect people at all ages, even fetuses, but the risk for most varieties increases with age. Cancer causes about 13% of all deaths. According to the American Cancer Society, 7.6 million people died from cancer in the world during 2007. Cancers can affect all animals. Nearly all cancers are caused by abnormalities in the genetic material of the transformed . cells These abnormalities may be due to the effects of carcinogens, such as tobacco smoke, radiation, chemicals, or infectious agents. Other cancer-promoting genetic abnormalities may be randomly acquired through errors in DNA replication, or are inherited, and thus present in all cells from birth. The heritability of cancers are usually affected by complex interactions between carcinogens and the host's genome. New aspects of the genetics of cancer pathogenesis, such as DNA methylation, and microRNAs are increasingly recognized as important.
Genetic abnormalities found in cancer typically affect two general classes of genes. Cancer-promoting oncogenes are typically activated in cancer cells, giving those cells new properties, such as hyperactive growth and division, protection against programmed cell death, loss of respect for normal tissue boundaries, and the ability to become established in diverse tissue environments. Tumor suppressor genes are then inactivated in cancer cells, resulting in the loss of normal functions in those cells, such as accurate DNA replication, control over the cell cycle, orientation and adhesion within tissues, and interaction with protective cells of the immune system. Diagnosis usually requires the histological examination of a tissue biopsy specimen by a pathologist, although the initial indication of malignancy can be symptoms or radiographic imaging abnormalities. Most cancers can be treated and some cured, depending on the specific type, location, and stage. Once diagnosed, cancer is usually treated with a combination of surgery, chemotherapy and radiotherapy. As research develops, treatments are becoming more specific for different varieties of cancer. There has been significant progress in the development of targeted therapy drugs that act specifically on detectable molecular abnormalities in certain tumors, and which minimize damage to normal cells. The prognosis of cancer patients is most influenced by the type of cancer, as well as the stage, or extent of the disease. In addition, histological grading and the presence of specific molecular markers can also be useful in establishing prognosis, as well as in determining individual treatments. The Cancer Development section contains information on the following: ♦ Cancer Initiation ♦ Cancer Promotion ♦ Cancer Progression ♦ Carcinogens ♦ Environmental Agents ♦ Viruses and Bacteria ♦ Chronic Inflammation ♦ Carcinogens Table ♦ Cancer Development Summary Sheet Initiation is the first step in the two-stage model of cancer development. Initiators, if not already reactive with DNA, are altered (frequently they are made electrophilic) via drugmetabolizing enzymes in the body and are then able to cause changes in DNA (mutations). Since many initiators must be metabolized before becoming active, initiators are often specific to particular tissue types or species. The effects of initiators are irreversible; once a particular cell has been affected by an initiator it is susceptible to promotion until its death. Since initiation is the result of permanent genetic change, any daughter cells produced from the division of the mutated cell will also carry the mutation. In studies of mouse skin carcinogenesis, a linear relationship has been observed between the dose of initiator and the quantity of tumors that can be produced, thus any exposure to the initiator increases risk and this risk increases indefinitely with higher levels of exposure. Once a cell has been mutated by an initiator, it is susceptible to the effects of promoters. These compounds promote the proliferation of the cell, giving rise to a large number of daughter cells
containing the mutation created by the initiator. Promoters have no effect when the organism in question has not been previously treated with an initiator. Unlike initiators, promoters do not covalently bind to DNA or macromolecules within the cell. Many bind to receptors on the cell surface in order to affect intra-cellular pathways that lead to increased cell proliferation. There are two general categories of promoters: specific promoters that interact with receptors on or in target cells of defined tissues and nonspecific promoters that alter gene expression without the presence of a known receptor. Promoters are often specific for a particular tissue or species due to their interaction with receptors that are present in different amounts in different tissue types. While the risk of tumor growth with promoter application is dose-dependent, there is both a threshold and a maximum effect of promoters. Very low doses of promoters will not lead to tumor development and extremely high doses will not produce more risk than moderate levels of exposure. In mice, repeated promoter applications on initiator-exposed skin produces benign papillomas. Most of these papillomas regress after treatment is stopped, but some progress to cancer. The frequency of progression suggests that the papillomas that progress to cancer have acquired an additional, spontaneous, mutation. The term progression, coined by Leslie Foulds, refers to the stepwise transformation of a benign tumor to a neoplasm and to malignancy. Progression is associated with a karyotypic change since virtually all tumors that advance are aneuploid (have the wrong number of chromosomes). This karyotypic change is coupled with an increased growth rate, invasiveness, metastasis and an alteration in biochemistry and morphology. Since the 1940s, scientists have isolated compounds and tested their ability to induce cancer. Substances which can cause cancer are known as carcinogens. The process of cancer development is called carcinogenesis. There had been a suspicion that carcinogens functioned by causing DNA mutations. One observation supporting this was that x-rays, which damage DNA, lead to an increased incidence of cancer. Bacteria have proven to be good models for determining the mutagenic potential of compounds. Bruce Ames, a biochemist, developed an assay to identify potential mutagens. The Ames test works 'backwards' from what one might expect. The test starts with mutant bacteria and looks for chemicals that can change them back into normal (wild type) bacteria. In the Ames test, a potential mutagen is placed on a paper disc in the center of a petri dish on which only bacterial cells that mutate are able to grow. The mutagenic potential of the compound in question is determined by the amount of bacterial growth seen. Information obtained in this way was shown to be comparable to results from tests in rodents. Researchers have also manipulated mouse cells to make them potential targets for carcinogens and have transferred genes from cancerous cells into healthy mice--all of which have led to the conclusion that mutations in key genes can lead to the changes that result in cancer.
A large invasive ductal carcinoma in a mastectomy specimen. Cancers are classified by the type of cell that resembles the tumor and, therefore, the tissue presumed to be the origin of the tumor. These are the histology and the location, respectively. Examples of general categories include: Carcinoma: Malignant tumors derived from epithelial cells. This group represents the most common cancers, including the common forms of breast, prostate, lung and colon cancer. Sarcoma: Malignant tumors derived from connective tissue, or mesenchymal cells. Lymphoma and leukemia: Malignancies derived from hematopoietic (blood-forming) cells.
Germ cell tumor: Tumors derived from totipotent cells. In adults most often found in the testicle and ovary; in fetuses, babies, and young children most often found on the body midline, particularly at the tip of the tailbone; in horses most often found at the poll (base of the skull). Blastic tumor or blastoma: A tumor (usually malignant) which resembles an immature or embryonic tissue. Many of these tumors are most common in children. Malignant tumors (cancers) are usually named using -carcinoma, -sarcoma or -blastoma as a suffix, with the Latin or Greek word for the organ of origin as the root. For instance, a cancer of the liver is called hepatocarcinoma; a cancer of the fat cells is called liposarcoma. For common cancers, the English organ name is used. For instance, the most common type of breast cancer is called ductal carcinoma of the breast or mammary ductal carcinoma. Here, the adjective ductal refers to the appearance of the cancer under the microscope, resembling normal breast ducts. Benign tumors (which are not cancers) are named using -oma as a suffix with the organ name as the root. For instance, a benign tumor of the smooth muscle of the uterus is called leiomyoma (the common name of this frequent tumor is fibroid). Unfortunately, some cancers also use the -oma suffix, examples being melanoma and seminoma.
Threatment of cancer:
Cancer can be threat through more medicals metods; like surgical oncology; chemotherapy; acupuncture; radiation therapy; biotherapy or immunotherapy. Certain types of cancer are treated most effectively by simply removing the tumor surgically. Surgery is the oldest form of treating cancer and can also have an important role in diagnosing and staging of cancer. The expert surgeons at Cancer Treatment Centers of America are skilled in the most sophisticated surgical techniques. Surgery is done for many reasons, often to accomplish one or more of these goals: preventative (or prophylactic) surgery, diagnostic surgery, staging surgery, curative surgery, debulking (or cytoreductive) surgery, palliative surgery, supportive surgery and restorative (or reconstructive) surgery. Chemotherapy is the treatment of cancer with drugs that can destroy cancer cells by impeding their growth and reproduction. These drugs often are called "anticancer" drugs. Chemotherapy drugs are given intravenously, by injection or by mouth. Chemotherapy is often used alone, or in conjunction with radiation therapy or surgery. Chemotherapy can have many unpleasant side effects, such as nausea, vomiting, hair loss and 16
mouth sores. New, and usually effective, approaches to prevent or moderate these side effects will be utilized to help you through your chemotherapy treatment. The fractionated dose approach may diminish the side effects, particularly nausea and vomiting. In addition to offering many standard chemotherapy protocols, your care team at Cancer Treatment Centers of America will continually revise our chemotherapy protocols to reflect new treatments. Chemoembolization is an innovative method used by the experts at Cancer Treatment Centers of America to treat certain types of liver cancer, whether the tumor began in the liver (liver cancer) or spread to it from another organ (metastasized to the liver). It involves injecting chemotherapy directly into the blood vessels that feed the liver tumor. If you and your CTCA care team determine that chemoembolization is the proper treatment for you, a small catheter will be inserted through a needle (with X-ray guidance) into your femoral artery, located in your groin. The radiologist will then thread the catheter up through your aorta (the largest artery, located in your heart) and into the artery in your liver, which is the one that feeds the tumor. Chemotherapy, mixed with a microsphere is injected directly through the catheter into this artery and into the tumor. When blood flow in the artery stops due to the blockage from the microsphere, the catheter is then removed. This procedure provides a high concentration of chemotherapy into the tumor and provides, what is usually, a temporary cut off of the arterial blood supply to the tumor. There are many possible side effects from chemoembolization, since it involves both chemotherapy and the possible destruction of normal liver tissue as well as tumor. Most people experience some pain, fever, loss of appetite and fatigue. The overall risk of serious complication is related to your general underlying health, as well as the overall function of their liver. Radiation therapy is one of the three traditional primary forms of medical treatment used by the experts at Cancer Treatment Centers of America to treat your cancer, and for relief of symptoms. It may be used alone or in combination with surgery or chemotherapy, almost anywhere within your body. Innovative new techniques have evolved and are still evolving, enabling delivery of higher radiation doses to cancer cells and limited doses to your normal tissue. Acupuncture is a form of ancient Chinese medicine in which fine, sterile needles are applied to specific areas of the body, or acupoints, to stimulate energy flow (or “chi”). The needles are usually left in place for a few minutes (skilled acupuncturists cause virtually no pain). Energy is believed to circulate throughout the body along specific pathways called meridians. When energy is flowing freely through the meridians, the immune system is stimulated, which is thought to bring on a healing response and balance. When the flow of energy is disturbed or off-balance, pain or illness may occur. A goal of acupuncture is to restore balance and healthy energy flow to the body to control pain and other symptoms. Worldwide, acupuncture is sometimes used for conditions in which conventional approaches have failed, or as a complement to traditional medicine. In the United States and Europe, acupuncture is primarily used to control pain and relieve symptoms of disease, but not to cure the disease itself. Some people find acupuncture useful for helping to stop an addictive behavior, such as smoking or alcoholism. Others may find it useful for relieving ailments such as headaches, low back pain, fibromyalgia, asthma, or carpal tunnel syndrome.
Acupuncture in Cancer:
Acupuncture is not used by itself as a treatment for cancer. Rather, it is used in combination with traditional cancer treatment options to help relieve symptoms related to cancer and cancer treatment. In some cases, acupuncture may help to alleviate treatmentrelated side effects, such as nausea and vomiting, as well as other common symptoms, such as stress. Some individuals also find that acupuncture helps relieve fatigue, pain and neuropathy associated with cancer and its treatment.
Biotherapy / Immunotherapy:
We at Cancer Treatment Centers of America believe that cancer treatment is enhanced first by understanding, and then utilizing, your body's own power of protection, known as the immune system. Immunotherapy (sometimes called biological therapy, biotherapy, or biological response modifier therapy) uses your body’s immune system, either directly or indirectly, to fight cancer or to lessen the side effects that may be caused by some cancer treatments. Cancer may develop when the immune system breaks down or is not functioning adequately. Biotherapy is designed to repair, stimulate, or enhance your body’s own immune responses. Treatments such as interferon and colony stimulating factors are used now at CTCA, either alone, or in conjunction with other modalities such as surgery, radiation and chemotherapy. Biotherapy may be used to: • Stop, control, or suppress processes that permit cancer growth; • Make cancer cells more recognizable, and therefore more susceptible, to destruction by your immune system; • Boost the killing power of your immune system cells, such as T-cells, NK-cells, and macrophages; • Alter cancer cells' growth patterns to promote behavior like that of healthy cells; • Block or reverse the process that changes a normal cell or a pre-cancerous cell into a cancerous cell; • Enhance your body’s ability to repair or replace normal cells damaged or destroyed by other forms of cancer treatment, such as chemotherapy or radiation; • Prevent cancer cells from spreading to other parts of your body.
Melanoma is the most serious cancer of the skin. It begins in certain cells in the
skin called melanocytes. In some parts of the world, especially among Western countries, the number of people who develop melanoma is increasing faster than any other cancer. In the United States, for example, the number of new cases of melanoma has more than doubled in the past 20 years. Melanocytes are found throughout the lower part of the epidermis. They produce melanin, the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes produce more pigment, causing the skin to tan, or darken. Sometimes, clusters of melanocytes and surrounding tissue form benign (noncancerous) growths called moles. (Doctors also call a mole a nevus; the plural is nevi.) Moles are very common. Most people have between 10 and 40 of these flesh-colored, pink, tan, or brown areas on the skin. Moles can be flat or raised. They are usually round or oval and smaller than a
pencil eraser. They may be present at birth or may appear later on—usually before age 40. Moles generally grow or change only slightly over a long period of time. They tend to fade away in older people. When moles are surgically removed, they normally do not return. Melanoma occurs when melanocytes (pigment cells) become malignant. Most pigment cells are in the skin; when melanoma starts in the skin, the disease is called cutaneous melanoma. Melanoma may also occur in the eye and is called ocular melanoma or intraocular melanoma. Rarely, melanoma may arise in the meninges, the digestive tract, lymph nodes, or other areas where melanocytes are found. Melanoma can occur on any skin surface. In men, it is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma often develops on the lower legs. Melanoma is rare in African Americans and others with dark skin. When it does develop in dark-skinned people, it tends to occur under the fingernails or toenails, or on the palms or soles. The chance of developing melanoma increases with age, but this disease affects people of all age groups. Melanoma is one of the most common cancers in young adults. When melanoma spreads, cancer cells are also found in the lymph nodes (also called lymph glands). If the cancer has reached the lymph nodes, it may mean that cancer cells have spread to other parts of the body, such as the liver, lungs, or brain. In such cases, the cancer cells in the new tumor are still melanoma cells, and the disease is called metastatic melanoma rather than liver, lung, or brain cancer. At Cancer Treatment Centers of America (CTCA), we use many tools to help you fight melanoma on all fronts. A powerful combination of traditional and new, innovative therapies are provided by cancer experts who work with you to determine the appropriate combination of therapies, which may include: Surgery is often used as a treatment for melanoma. There are several types of surgery depending on the stage and location of cancer. Metronomic Chemotherapy divides a powerful dose of chemotherapy drugs into smaller doses, given over several days. This approach exposes cancer cells to the drugs for a longer period of time, while also seeking to reduce the unpleasant side effects often experienced with larger doses. Biotherapy/Immunotherapy is a treatment that is sometimes used for melanoma. Immunotherapy causes the body's own natural defenses (immune system) to attack the cancer. In addition to the therapies described above, CTCA enriches your treatment by offering complementary/alternative therapies such as naturopathic medicine, nutrition therapy, mindbody medicine, image enhancement, and spiritual support. CTCA is with you every step of the way in what truly is the fight of your life. Cancer is a group of more than 100 different diseases that can occur within any part of the body. Cancer occurs when cells become abnormal and keep dividing and forming more cells without control or order. Normally, cells divide within the body to produce more cells only when the body needs them. If cells keep dividing when new cells are not needed, a mass of tissue forms. This mass of extra tissue, called a growth or tumor, can be benign (not cancerous) or malignant (cancerous.) According to the National Cancer Institute, This year, an estimated 1.2 million Americans will be diagnosed with cancer. Avoiding tobacco use is the single most important step Americans can take to reduce the cancer burden in this country. The NCI’s 2001 Cancer
Progress Report offers these suggestions for behavioral and exposure changes to prevent cancer: • Not using cigarettes or other tobacco products • Not drinking too much alcohol • Eating five or more daily servings of fruits and vegetables • Eating a low-fat diet • Maintaining or reaching a healthy weight • Being physically active • Protecting skin from sunlight • Certain chemicals in the environment are known to cause cancer: • Secondhand smoke (also known as environmental tobacco smoke) • Radon in the home • Benzene in the air • Avoiding exposure to these substances will also greatly reduce the likelihood of developing cancer. There are a number of different methods used to treat cancer. Surgery, radiation and chemotherapy are three common forms of treatment that have been used effectively for a number of years. At Cancer Treatment Centers of America, we use many tools to help you fight cancer on all fronts. Your type of cancer, the extent of your disease, and your general state of health are all influential factors in determining the most appropriate treatment combination. A powerful combination of proven traditional and new, innovative therapies are provided by cancer experts who work with you to determine the most effective combination. CTCA is with you every step of the way in what truly is the fight of your life. Population (epidemiological) and laboratory studies have led to the discovery of many potential environmental factors in the initiation, promotion and progression of cancer. Starting with Pott's observations in the 18th century, certain occupations have been associated with an increased risk of cancer development. The recognition of increased scrotal cancer in chimney sweeps due to coal and tar exposure was followed by an observation in a British factory that all men distilling 2-napthylamine developed bladder cancer. Nickel refining, leather working and woodworking have also been associated with an increased risk of specific cancers due to chronic exposure to carcinogenic chemicals. Exposure to mustard gas, used as a chemical warfare agent in World War I has been associated with a higher risk of respiratory-tract and lung cancers due to its mutagenic properties. Of interest, some chemotherapy drugs are derivatives of mustad gas and are useful for the very same reason; they are highly mutagenic. There have also been associations made between different geographical regions and particular cancers. Stomach cancer is 5-6 times higher among Japanese men, attributed to the consumption of fermented foods; breast cancer is 20 times higher among American women, attributed to the high fat American diet; and liver cancer is 10 times higher in Africa, which correlates with high rates of Hepatitis B infection. Liver cancer may also be caused by aflatoxin, a food contaminant produced by fungi. This compound is prevalent in grain stores in tropical and subtropical regions because the moist grain is a very good place for the fungi to live.
The impact of many environmental factors can be reduced by making healthy lifestyle choices. One of the most potent carcinogens in humans is benzo[a]-pyrene, a compound found in cigarette smoke. In fact, the tar fraction of cigarette smoke includes both initiators and promoters, making it especially dangerous. Alcohol is a promoter of carcinogenesis in humans, as is asbestos. Additionally, UV radiation, from exposure to the sun or tanning beds, is a powerful initiator in humans and is a cause of skin cancer. Tamoxifen, a chemotherapeutic agent used to combat estrogen receptor positive (ER+) breast cancer, increases the risk of endometrial cancer by increasing the rate of endometrial cell proliferation. For this reason, long-term tamoxifen treatment is losing popularity in favor of aromatase inhibitors. Estrogens themselves may also be important in the promotion of tumors, particularly in post-menopausal women receiving exogenous estrogens, due to their ability to increase mammary and endometrial cell division rates. This is an area of active research. There are actually factors that can predispose an unborn to the development of cancer later in life. These include exposure to radiation or the synthetic estrogen diethylstilbestrol. These factors produce genetic damage in utero that can lead to cancer development upon exposure to promoting factors after birth. Certain viruses and bacteria have also been associated with the initiation and promotion of tumor growth based on both epidemiological and experimental evidence. Some DNA viruses contain genes whose products can take control of cell division in the host cell. They promote the development of tumors by increasing proliferation rates and shutting down the normal systems that prevent cells from dividing. These viruses include human papillomavirus (HPV), the most significant risk factor for the development of cervical cancer. Similarly, an RNA virus, human T-cell leukemia virus type 1 (HTLV-1) leads to adult T-cell leukemia by stimulating the proliferation of infected T-cells. Epstein-Barr virus (EBV) is another virus that increases cell proliferation. This virus also protects infected cells from death (apoptosis). EBV infects more than 90% of the world's adult population and has been implicated as a cause of Burkitt's lymphoma, nasopharyngeal carcinoma and gastric lymphoma. Experimental evidence in rats and from human tumors, has implicated the JC virus (a polyomavirus)in brain tumors, particularly medulloblastomas. Some viruses also have indirect actions on tumor development. Hepatitis B causes damage that leads to increased cell division and inflammation in the liver, potentially promoting the growth of tumors. The human immunodeficiency virus (HIV) greatly reduces the function of the immune system and is the cause of AIDS. HIV infection may also make patients susceptible to infection by a type of human herpes virus 8 (HHV8), a risk factor for Kaposi's sarcoma. In addition to chemicals and radiation, another source of mutation is viruses. Viruses are very small 'organisms' that can infect the cells of other animals or plants. Humans are susceptible to a large number of different viruses. Viruses are not the same as bacteria although both can cause human disease. Treatments that cure bacterial infections are not useful in the treatment of viral infection. Some examples of viruses include the agent that causes the flu (influenza virus) and the causative agent of AIDS, the human immunodeficiency virus (HIV). Viruses can disrupt cell behavior in several different ways. They can directly cause DNA damage (mutations) by inserting their genomes into the DNA of the host cell. The integration can disrupt important regulatory genes.
The viruses may contain their own genes that disrupt the regulation of the cell. This process may be beneficial to the virus if it allows for rapid production of progeny but can be seriously detrimental to the host. Some viruses actually carry altered versions of genes that they have picked up from previous host cells. These altered genes no longer function properly, and when they are inserted into a new host cell, they cause disregulation and can lead to cancerous growth. Through their mutagenic activity or their effects on cell behavior, viruses play a significant role in the development of particular cancers in many different animals, including humans. Viruses have also been a major target of scientific investigation with respect to cancer. Some of the earliest work on the identification of oncogenes and tumor suppressors utilized viruses. Viruses can be divided into two rough categories, those that have DNA as their genetic material and those that have RNA as their genetic material. Both kinds of virus have been found to be associated with cancers of different types. The cancers known to be associated with a specific virus are: • Epstein-Barr Virus (EBV) - Burkitt's Lymphoma • Hepatitis B Virus (HBV) - Liver Cancer • Hepatitis C Virus (HCV) - Liver Cancer • Human Herpesvirus 8 (HH8) - Kaposi's Sarcoma • Human Papillomavirus (HPV) - Cervical Cancer may also cause head and neck, anal, and penile cancer • Human T-cell Lymphotropic Virus 1 (HTLV) - Adult T-cell Leukemia • Epstein-Barr Virus (EBV) Associated Cancer: Lymphoproliferative disease, most commonly Burkitt's Lymphoma. There is increasing evidence EBV is also associated with Hodgkin lymphoma. Prevalence: It's estimated that more than 90% of the World population is infected with EBV. EBV is responsible for infectious mononucleosis (the 'kissing disease') Transmission: Mechanism of transmission generally unknown, possibly through saliva Infection: EBV Infection usually begins in the epithelial cells of the oropharynx, posterior nasopharynx and parathyroid glands. From there EBV infects B cells and persistent infection is established. Almost all cases of EBV infection are controlled by the immune system and infected individuals are asymptomatic (have no symptoms of infection). Carcinogenic Potential: B cell Infection is necessary for EBV mediated carcinogenesis. Only a small percentage of infections lead to cancer, most cases arising in immunocompromised or transplanted individuals. These patients are especially susceptible because they lack sufficient immune function to inhibit the growth of infected B cells. EBV-mediated carcinogenesis is most likely caused by the actions of viral gene products. Two proteins in particular are thought to play a major role in B cell immortalization; latent membrane proteins (LMP's) and EBV nuclear antigen (EBNA's). LMP1 is inserted into the host cell membrane and acts as an activated growth factor receptor, resulting in unregulated growth. EBNA's affect the cell in many different ways; one pathway leads to altered activity of tumor suppressors including Rb, p53, and Arf.
Cell Division and Mitosis:
During a lifetime, many of the cells that make up the body age and die. These cells must be replaced so that the body can continue functioning optimally. Reasons that cells are lost and must be replaced include the following: Sloughing off of epithelial cells such as those lining the skin and intestines. The old, worn out cells on the surface of the tissues are constantly replaced. A special case of this is the monthly replacement of the cells lining the uterus in pre-menopausal women. Wound healing requires that cells in the area of the damage multiply to replace those lost. Viral diseases such as hepatitis may also cause damage to organs that then need to replace lost cells. Replacement of the cells that make up blood. Red blood cells carry oxygen to tissues. White blood cells such as B and T lymphocytes are part of the body's immune system and help to ward off infections. Most of these cells have very short lifespans and must be constantly replaced. The precursors of these cells are located in bone marrow. These precursors, or stem cells, must reproduce at a very high rate to maintain adequate amounts of the blood cells. The process by which a cell reproduces to create two identical copies of itself is known as mitosis. The goal of mitosis is the formation of two identical cells from a single parent cell. The cells formed are known as daughter cells. In order for this to happen, the following must occur: • The genetic material, the DNA in chromosomes, must be faithfully copied. This occurs via a process known as replication. • The organelles, such as mitochondria, must be distributed so that each daughter cell receives an adequate amount to function. • The cytoplasm of the cell must be physically separated into two different cells. • As we will see, many of the features of cancer cells are due to defects in the genes that control cell division. The cell division process occurs as an orderly progression through four different stages. These four stages are collectively known as the cell cycle. The following pages describe the cell cycle in detail.
Cancer Cell Division:
When it comes to cell division, cancer cells break just about all the rules! Cancer cells can divide without appropriate external signals. This is analogous to a car moving without having pressure applied to the gas pedal. An example would be the growth of a breast cancer cell without the need for estrogen, a normal growth factor. Some breast cancer cells actually lose the ability to respond to estrogen by turning off expression of the receptor for estrogen within the cell. These cells can still reproduce by bypassing the need for the external growth signal. Cancer cells do not exhibit contact inhibition. While most cells can tell if they are being 'crowded' by nearby cells, cancer cells no longer respond to this stop signal. The continued growth leads to the piling up of the cells and the formation of a tumor mass. Cancer cells can divide without receiving the 'all clear' signal. While normal cells will stop division in the presence of genetic (DNA) damage, cancer cells will continue to divide. The results of this are 'daughter' cells that contain abnormal DNA or
even abnormal numbers of chromosomes. These mutant cells are even more abnormal than the 'parent' cell. In this manner, cancer cells can evolve to become progressively more abnormal. Continued cell division leads to the formation of tumors. The genetic instability that results from aberrant division contributes to the drug resistance seen in many cancers. Mutations in specific genes can alter the behavior of cells in a manner that leads to increased tumor growth or development. The next chapter will examine a few of the best-studied examples of these genes. More information on this topic may be found in Chapter 8 of The Biology of Cancer by Robert A. Weinberg.
Cell Division Control Introduction:
Cell division is a normal process. Mechanisms exist to ensure DNA replication occurs correctly and the environmental conditions are favorable for cell division. Replication errors may also be corrected after they occur. Normal cells stop dividing when there is genetic damage or conditions are not favorable. Cancer cells continue to divide even when conditions are not appropriate.
Cell Division Signaling:
Most cells in the body are not actively dividing, but are carrying out their normal functions. Cells divide in response to external signals in the form of protein or steroid growth factors. Cells stop dividing for several reasons, including: A lack of positive external signals The cell senses that it is surrounded on all sides by other cells-contact dependent (density dependent) inhibition Most cells seem to have a pre-programmed limit of the number of times they can divide Cell Division in Cancer Cells Cancer cells can divide without appropriate external signals. Cancer cells do no exhibit contact inhibition. Cancer cells continue dividing in the presence of genetic damage. The uninhibited, continued division of genetically damaged cells can lead to tumor formation.
Mutation and Cancer:
The abnormal behaviors demonstrated by cancer cells are the result of a series of mutations in key regulatory genes. The cells become progressively more abnormal as more genes become damaged. Often, the genes that are in control of DNA repair become damaged themselves, rendering the cells even more susceptible to ever-increasing levels of genetic mayhem. Most cancers are thought to arise from a single mutant precursor cell. As that cell divides, the resulting 'daughter' cells may acquire different mutations and different behaviors over a period of time. Those cells that gain an advantage in division or resistance to cell death will tend to take over the population. In this way, the tumor cells are able to gain a wide range of capabilities that are not normally seen in the healthy version of the cell type represented. The changes in behavior seen in cancer cells are the focus of the Tumor Biology chapter of the site.
Since genetic changes and the resulting changes in cell behavior are at the heart of cancer biology, we will now take a look at some of the different kinds of genetic changes (mutations) seen in cancer and then examine the causes of these changes.
Cancer Detection and Diagnosis
One of the key problems in the treatment of cancer is the early detection of the disease. Often, cancer is detected in its later stages, when it has compromised the function of one or more vital organ systems and is widespread throughout the body. Methods for the early detection of cancer are of utmost importance and are an active area of current research. After the initial detection of a cancerous growth, accurate diagnosis and staging of the disease are essential for the design of a treatment plan. This process is dependent on clinical testing and the observations of physicians. It is important for cancer patients and their families to understand the results given to them so that they can take an active role in the planning of the treatment protocol to be used. This chapter discusses some of the detection methods currently in use for several different cancer types. Also discussed are some possible tests that are still under investigation. There is a section dedicated to describing the results presented in pathology (path.) reports and a section that describes the process of cancer staging. Detecting cancers early is an important step in preventing significant health problems. Almost universally, cancers are easier to treat when detected early. Because early-stage cancers are small and often have no symptoms, researchers have been trying to develop simple, inexpensive screening procedures that are sensitive enough to detect these cancers. Such tests must be inexpensive and easy because performing invasive, expensive procedures on otherwise healthy people would be unethical and would be inefficient at the population level. Blood tests are a common and straightforward means of screening people for cancer in its early stages. If a chemical in the blood that signals the presence of even a small tumor can be detected, the cancer could be treated sooner and would be more likely to be cured. When a test is performed to detect a disease, there are four possible outcomes. If a test indicates that a patient has a disease that the patient does indeed have, this is called a true positive. However, if the test indicates that a patient has a disease when she does not, it is called a false positive. If the test indicates the patient is disease-free, and this is indeed the case, it is called a true negative. Finally, if the test indicates the patient is healthy when in fact the patient has the disease
Frequently Asked Questions: False Positives and Negatives
What is a false positive test result? A false positive test result is one that leads a physician to suspect a disease or condition is present when one is NOT really there. What is a false positive test result? A false negative test result is one that leads a physician to think a patient does not have a particular disease or condition when they actually DO have it. What causes false-positive test results? There are many reasons why a test result may indicate the presence of a condition that is not really there. These include human error and the limits of the techniques used. Example 1 (imaging): Many different types of imaging techniques are now used to diagnose disease. These include mamography, CT, PET, MRI, ultrasound and combinations of these.
All of these techniques produce images that are then interpreted by physicians or trained technicians. Because image quality and experience factor into every test, there is always the chance that a result will be misreported. This will typically result in additional tests to confirm the result. Example 2 (blood tests): A blood test commonly used to detect prostate cancer measures amounts of prostate specific antigen (PSA), a protein. This test is used because many prostate cancers over produce this protein. However, there are other reasons that a man's PSA levels can go up. These include inflammation and infection. In these cases, it is possible that a PSA test would come back positive, potentially leading to unnecessary additional procedures. What causes false-negative test results? Example 1 (imaging): Because young women have dense breast tissue, it may be difficult to identify a small cancerous growth on a mammogram, especially if it is the first exam because there is nothing with which to compare the results. Example 2 (blood tests): As described in the previous question, the PSA test is used to detect prostate cancers. Because not all prostate cancers increased amounts of PSA, it is possible for a screening exam to miss a case of prostate cancer. Is there anything I can do to reduce the chance of a false-positive or false-negative test result? While there is nothing that a patient can do about the limitations of any particular test, there are things that you can do to reduce your chances of obtaining an incorrect result. Make sure you follow all the pre-test instructions. As an example, before a colonoscopy, it is important to make sure that you clear out your digestive system so that no small polyps or other abnormalities will be blocked from view. Make sure that the individual/facility performing the test is fully accredited with the appropriate organization. This can usually be done online. Write down any questions you have about the test beforehand and bring them with you to ask. Dont hesitate to seek additional testing from a different provider.
Sensitivity and Specificity of Medical Tests
When referring to the accuracy of a medical test, statisticians use the words sensitivity and specificity. Sensitivity refers to the proportion of the times that a test yields true positives. The closer the sensitivity is to 100%, the more likely a positive result actually means that the patient has a disease. Specificity refers to the proportion of the time that a test yields true negatives. The closer the specificity is to 100%, the more likely a negative result means that the patient is truly disease-free. A perfect test gives only true positives and true negatives, and the worst possible test would be the same as guessing. While many medical tests are highly accurate, all tests used in medicine fall somewhere in between these two extremes. This uncertainty raises some difficult issues. A test that yields a positive result will usually lead to the performance of a second, more accurate test. If the second test used is still simple and non-invasive, then a preliminary test that yields a high number of false positives may be acceptable. If the second test is difficult to perform or risky, the initial blood test may lead many people to have unnecessary medical procedures. If the first test is imperfect it may incorrectly indicate that patients are healthy, when in fact they are not. If the disease is mild and will probably not hurt the patient's health, then the blood
test does little harm when it is wrong. If the disease is serious, the blood test may prevent patients from obtaining necessary treatments. The value of any blood test is a balance between the sensitivity and specificity of the test, and the severity of the disease detected. It is important that patients discuss the sensitivity and specificity of tests given with their physician. What does 'sensitivity' mean when used to describe medical tests? No medical test is perfect. It is important to know the limitations of any test so you can judge how to factor in the test results to your treatment decisions. The sensitivity of a medical test is a measure of how well the test identifies people who have a particular disease. Example: Suppose there is a group of ten women and three of them have breast cancer. If all of the women are given a test to detect the cancer and it finds two of the three, the test has only 66% (2/3) sensitivity. What does 'specificity' mean when used to describe medical tests? No medical test is perfect. It is important to know the limitations of any test so you can judge how to factor in the test results to your treatment decisions. The specificity of a medical test is a measure of how well the test identifies people who do not have a particular disease. In other words, specificity is a way of measuring whether or not the test inaccurately flags normal people as having a condition. Example: We will use the same sample as above; 10 women, 3 of who have cancer. If the test identifies all three cancer patients but flags any normal women as having the disease, it would have 100% sensitivity but reduced specificity. The more normal women the test identifies as having cancer, the lower the specificity of the test. Why would a medical test have reduced specificity or sensitivity? No medical test is perfect. Tests can give false positive or false negative results because of the limits of technology, human error or machine error. Any of these can lead to reduced specificity and/or sensitivity for a test. Is there anything I can do to reduce the chances that my test result will be incorrect? While there is nothing that a patient can do about the limitations of any particular test, there are things that you can do to reduce your chances of obtaining an incorrect result. Make sure that you follow all the pre-test instructions. As an example, before a colonoscopy, it is important to make sure that you clear out your digestive system so that no small polyps or other abnormalities will be blocked from view. Make sure that the individual/facility performing the test is fully accredited with the appropriate organization. This can usually be done online. Write down any questions you have about the test beforehand and bring them with you to ask. Don't hesitate to seek additional testing from a different provider.
The Role of Mutation in Cancer
Mutations in key regulatory genes ( tumor suppressors and proto-oncogenes ) alter the behavior of cells and can potentially lead to the unregulated growth seen in cancer. For almost all types of cancer studied to date, it seems as if the transition from a normal, healthy cell to a cancer cell is step-wise progression that requires genetic changes in several different oncogenes and tumor suppressors. This is one reason why cancer is much more prevalent in older individuals. In order to generate a cancer cell, a series of mutations must occur in the same cell. Since the likelihood of any gene becoming mutated is very low, it stands to reason that the chance of several different mutations occuring in the same cell is truly
very unlikely. For this reason, the cells in a 70 year old body have had more time to accumulate the changes needed to form cancer cells but those in a child are much less likely to have acquired the requisite genetic changes. Of course, some children do get cancer but it is much more common in older individuals. The graph below shows colon cancer rates in the United States as a function of age. The graph was obtained from the National Cancer Institute.
By looking at the shape of curves like the ones shown above, it has been concluded that several independent genetic changes are required to create cells that become cancerous. In the laboratory, researchers have been attempting to create tumor cells by altering or introducing key regulatory proteins. Several studies have attempted to define the minimal number of genetic changes needed to create a cancer cell, with intriguing results. To complicate matters, it is clear that the changes needed to create a cancer cell can be accomplished in many different ways. Although all cancers have to overcome the same spectrum of regulatory functions in order to grow and progress, the genes involved may differ. In addition, the order in which the genes become de-regulated or lost may also vary. As an example, colon cancer tumors from two different individuals may involve very different sets of tumor suppressors and oncogenes, even though the outcome (cancer)is the same. The great heterogeneity seen in cancer, even those of the same organ, means that diagnosis and treatment are complicated. Current advances in the molecular classification of tumors should allow the rational design of treatment protocols based on the actual genes involved in any given case. New diagnostic tests may involve the screening of hundreds or thousands of genes to create a personalized profile of the tumor in an individual. This information should allow for the tailoring of cancer treatments geared to the individual. For more information on this see the Genomics/Proteomics subsection. The genetic changes that lead to unregulated cell growth may be acquired in two different ways. It is possible that the mutation can occur gradually over a number of years, leading to the 28
development of a 'sporadic' case of cancer. Alternatively, it is possible to inherit dysfunctional genes leading to the development of a familial form of a particular cancer type. Some examples of cancers with known hereditary components include: Breast cancer- Inheritance of mutant versions of the BRCA1 and BRCA2 genes are known risk factors. Although many, if not most, individuals with breast cancer do not have detectable alterations in these genes, having a mutant form increases the likelihood of developing breast cancer. Colon cancer- Defects in DNA repair genes such as MSH2 are known to predispose individuals to hereditary non-polyposis colorectal cancer (HNPCC). Retinoblastoma- Defects in the Rb tumor suppressor gene are known to cause this eye cancer and several other types of cancers. More on this particular disease can be found in the chapter on Rb This is an incomplete list of the known inherited cancer types, and it is certain that more inherited forms of cancer will identified as the genetics of various types of cancer are clarified. More information on this topic may be found in Chapters 2 and 4 of The Biology of Cancer by Robert A. Weinberg.
Cancer arising in the lymphatic system, called lymphoma, is the most commonly occuring blood cancer. Approximately 1,000 people worlwide are diagnosed with lymphoma every day. The cells affected by this disease are part of the body's immune system. In 2008, the American Cancer Society estimates that 74,340 new lymphoma cases would be diagnosed and 20,510 cancer deaths due to lymphoma would occur in the United States. The lymphatic system is composed of a vast network of tubes (vessels) and grapelike clusters called lymph nodes. The vessels transport colorless fluid called lymph and cells of the immune system (lymphocytes) throughout the body. The lymphatic system resembles a river system. Small capillaries carry lymph into larger vessels which eventually drain into two large lymph vessels that empty into blood vessels at the base of the neck. The lymphatic system serves many purposes including: filtration, transport of fluid and initiation of immune responses. The vessels of the lymphatic system are responsible for absorbing and filtering the fluid which surrounds the cells and tissues of the body. Lymph nodes are small sac-like structures located along the lymph vessels. They are home to lymphocytes, a type of white blood cell. Lymph nodes store lymphocytes and help control the immune response by allowing lymphocytes to come into contact with foreign materials (antigens) in a manner that stimulates their activity. All lymphocytes originate from stem cells in the bone marrow but they are not all the same. The two main categories of lymphocytes are B cells and T cells. B cells fully develop in the bone marrow. T cells leave the bone marrow in an immature state and continue to develop in the thymus and other organs. T cells and B cells play different roles in the immune system and their functions are described more fully in the Vaccine section. The extensive nature of the lymphatic network allows it to serve as a way for cancer cells to spread throughout the body. Cancer metastasis frequently occurs via migration of cancer cells through the lymphatic system. Cancer cells of these patients are usually abnormal B-cells referred to as a Reed-Sternberg (R-S) cells. Although less commonly observed, R-S cells may also develop from T-cells. R-S cells most often develop in lymph nodes located in the upper body regions and spread to neighboring lymph nodes via lymphatic vessels. There are two distinct types of Hodgkin's lymphoma: classical and non-classical Hodgkin's lymphoma.
Classical Hodgkin's Lymphoma: This lymphoma features R-S cells with a classical appearance. It may be diagnosed as Nodular Sclerosis Hodgkin Disease, Mixed Cellularity Hodgkin's Disease, Lymphocyte-Rich Hodgkin Disease or Lymphocyte-Depleted Hodgkin Disease. Non-classical Hodgkin's Lymphoma: This lymphoma features larger cancer cells that are variants of R-S cells and is most often found in the nodes of the upper body, arms and neck. The cancerous cells of non-Hodgkin lymphoma patients may be either T or B cells. In the United States, approximately 15% of cases of non-Hodgkin lymphoma cases develop from T lymphocytes and 85% develop from B lymphocytes. Normal white blood cells may develop into over thirty different variations of abnormal cells, each classified as a distinct type of non-Hodgkin lymphoma. The American Cancer Society estimates approximately 66,120 (89%) of the 74,340 lymphoma cases diagnosed in the United States in 2008 will be classified as non-Hodgkin lymphoma. Burkitt’s lymphoma is an aggressive form of non-Hodgkin lymphoma involving B cells. It occurs as the result of chromosome translocation involving the Myc gene. Translocation disrupts Myc expression leading to abnormal cell growth and proliferation. The rate of cell division in Burkitt’s lymphoma is one of the highest among human tumors. It was first described by Dr. Denis Burkitt in 1958 while he was working in Uganda. Burkitt’s lymphoma was later discovered to be highly associated with the Epstein-Barr virus; this was the first time a virus was linked to a form of cancer. The WHO describes three clinical variants of Burkitt’s lymphoma: endemic, sporadic, and immunodeficiency-associated. Endemic Burkitt’s lymphoma primarily refers to cases occurring in African children. This type usually involves the facial bones, especially the jaw, maxilla, and orbit. The Epstein-Barr virus (EBV) is associated with over 90% of endemic Burkitt’s lymphoma. Sporadic Burkitt’s lymphoma refers to cases occurring in no specific geographic or climatic region. This type usually involves the abdomen. Unlike endemic lymphoma, infection with EBV is found in only about 20% of sporadic lymphoma. It accounts for 40-50% of childhood non-Hodgkin’s lymphoma, but only 1-2% of adult lymphomas in Western Europe and the United States. Immunodeficiency-associated Burkitts lymphoma refers to cases occurring in patients infected with HIV, transplant patients (most often solid organ), or individuals with other immune system disorders. BL accounts for 30-40% of non-Hodgkin’s lymphomas diagnosed in HIV infected individuals. However, HIV is not directly related to cancer formation. EBV is found in 30-40% of these cases of Burkitt’s lymphoma.
The cause of the majority of lymphoma cases is unknown. However, several factors may influence one's risk of developing lymphoma. The relative effects of these factors in any given case of cancer is variable and very difficult to determine with accuracy at this time. Some of these risk factors are discussed below. Sex: Specific subtypes of non-Hodgkin lymphoma, such as follicular lymphoma, are predominant in women; however, non-Hodgkin lymphoma is overall more common in men. Mantle cell lymphoma shows the highest predisposition in males (70% of cases are men). Geography: Non-Hodgkin lymphoma is most common in developed regions of the world, specifically the United Sates, Australia, New Zealand and Europe. Epstein Barr virus (EBV), a type of herpes virus that infects B lymphocytes, increases a person's risk of developing fast growing lymphomas. In Africa and Southeast Asia, EBV is related to the development of Burkitt lymphoma and Hodgkin's lymphoma. Genetics: As discussed in the Genetic Change section DNA mutations can cause cancer by enhancing cell division and/or reducing tumor suppressor mechanisms. Lymphoma is rarely caused by inherited mutations in the DNA sequence and there is no increased risk of lymphoma in children of lymphoma patients. Age: The incidence of lymphoma peaks in individuals over 70 years of age. Non-Hodgkin lymphoma is rarely observed in children and most commonly develops in older adults. Less than 1% of non-Hodgkin lymphoma diagnoses reported in 2001 occurred in children under the age of 15 years. The age groups most frequently affected by Hodgkin's lymphoma are early adults (age 15-40) and late adults (above 55).
150 of those terms medicinals:
1. allergies = alergii 2. anthropology = antropologie 3. anxiety = anxietate 4. acupuncture = acupunctura 5. acute = acut 6. anesthesy = anestezie 7. analgesy = analgezie 8. blood = sange 9. cancer = cancer 10. cardiovascular = cardiovascular 11. cadaver = cadavru 12. clinical = clinic 13. diseases = boli 14. diagnosis = diagnostic 15. depression = depresie 16. hyperthyroidism = hipertiroidism 17. heart = inima 18. osteoporosis = osteopareza 19. treatment = tratament 20. neoplasm = neplasm 21. infections = infectii 22. therapeutics = terapeutic 23. organisms = organisme 24. digestive system = sistem digestiv 25. cells = celule 26. endocrine system = sistem endocrin 27. immune system = sistem imunitar
28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60.
nervous system = sistem nervos organs = organe erythrocytes = eritrocite therapy = terapie lymphocyte = limfocite biopsy = biopsie symptoms = simptome cytoplasm = citoplasma brain = creier chemotherapy = chimioterapie cholesterol = cholesterol chronic = cronic hepatitis = hepatita cirrhosis = ciroza heme = hem hemoglobine = hemoglobina hemorrhage = hemoragie methabolism = metabolism myalgy = durere musculara pathogen = patogen vaccine = vaccin vein = vena varices = varice viral hepatitis = hepatita virala eczema = eczema pain = durere vomiting = voma discopathy = discopatie hygiene = igiena to sterilize = a steriliza thermometer = termometru disinfectant = dezinfectant prophylactic = profilactic
61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. 93.
paralysis = paralizie paresis = pareza muscle = muschi lordosis = lordoza scoliosis = scolioza luxation = luxatie congenital = congenital hips = solduri vertebral column = coloana vertebrala artrology = artrologie motricity = motricitate joint = jonctiuni to splay = a disloca tissue = tesut rickets = rahitism obesity = obezitate nausea = greata epilepsy = epilepsie sclerosis = scleroza arthritis = artrita infection = infectie constipation = constipatie fatique = oboseala patients = pacienti neurological = neuro-chirurgical neuron-surgeon = neuro-chirurg skin = fata ligaments = ligamente cervical = cervical thoracic = tiracic lumbar = lombar recovery = recuperare ribs = coaste
94. nerves = nervi 95. fibers = fibre 96. vertebrals = vertebre 97. pelvis = pelvis 98. abdominal = abdominal 99. to prescribe = a prescrie 100. disk hernia = hernie de disc 101. lancet = bisturiu 102. syringe = seringa 103. dressing = pansament 104. splint = atela 105. recipe = reteta 106. abortion = avort 107. invalid = bolnav; invalid 108. intestine = intestin 109. intestinal = intestinal 110. to intern = a interna 111. insulin = insulina 112. spine = coloana vertebrala 113. spleen = splina 114. diabetes = diabet 115. doctor = doctor 116. surgeory = chirurgie 117. surgeon = chirurg 118. surgical = chirurgical 119. syphilis = sifilis 120. sword-cut = rana; cicatrice 121. symptom = symptom 122. neurotik = bolnav cu nervii 123. neuroastheny = neuro astenie 124. thrombophlebite = tromboflebita 125. tuberculosis = tuberculoza 126. tubercular = tuberculos
127. abortive = premature 128. acne = acnee 129. affection = afectiune; boala 130. authopsy = autopsie 131. arm = brat 132. hand = mana 133. appendicitis = apendicita 134. appendix = apendice 135. analysis = analiza 136. ambulance = ambulanta 137. antidote = antidote 138. bones = oase 139. prostate = prostata 140. infertility = infertilitate 141. abdominal pain = durere abdominala 142. abscess = abces 143. electrocardiogram = electrocardiograma 144. trauma = trauma 145. meningitis = meningita 146. testicle = testicul 147. testosterone = testosteron 148. tumor = tumoare 149. enterocolysis = enterocolita 150. ventricular tachycardia = tahicardie ventriculara
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