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Neoplasia Nuggets

quiz:
What kind of cancer is it "better" to have, fast or slow growing?

We're told it's "better" to have a fast growing tumor because the existing therapies for cancer predominantly work by killing cells that are in the process of dividing, which works better on a cancer when it's going to town. Personally, I'm not convinced, because I'm not convinced that the conventional therapies are the best approach. So many people suffer and die not from the cancer but from the treatment. The more I study, the more I understand and sympathize with the people who chose to entirely forgo modern cancer treatment. Ten out of ten people die. It's not about death, it's about how you choose to live. Not that I plan to broadly recommend an alternative-medicine-only strategy in my practice; outcomes depend so much on the specifics. But this post is about generalities.

--cervical cancer is #one killer of females in the world but not in the US (dt early detection: paps)
--lung cancer is second in occurrence but first in lethality for both genders (US)

INCIDENCE
--1/2 of males and 1/3 of females in the US get cancer
--there are many many many missed diagnoses
--many people die of it before they even know they have it
--most common cancers for females (US):
----32% breast
----12% lung
----11% colon/rectum (2003)
--top three in occurence for males (US):
----33% prostate
----14% lung
----11% colon/rectum (2003)

DEATH
--number one cancer killer of females (world): cervical
--top three killer of females (US):
----25% lung,
----15% breast
----11% colon/rectum
--top cancer killer of males (world): hepatocellular (liver)
--top three killers of males (US):
----31% lung
----10% prostate
----10% colon/rectum

--tumor = neoplasm
--cyst = fluid filled
--microinvasion = single cell at a time, "micromets", not yet visible
--gross invasion = a lymph node or more is infested
--metastasis via: seeding (ovarian), iatrogenic (knife, needle), lymphatics, blood (hematogenous)
--importance of pt preparation for biopsy to minimize the chance of the needle causing metastasis
--top 5 sites for metastasis: lymph nodes, lung, liver, bone, brain
--rare places for metastasis: muscle (all kinds), spleen, cartilage, testis
--liver = favorite site for metastases because all blood goes here, lots of nutrients too, a "party down the block" in KW's analogy....cancer is a disagreeable teenager, doesn't want to grow up, won't behave itself and do something productive, just wants to eat, grow and travel
--prostate cancer likes to metastasize to bone, causes osteoblastic (bone increasing) mets
--types of cancer that like to met to bone: breast, kidney, thyroid, lung (previous four osteolytic), prostate

important of early diagnosis
--smallest clinically detectable mass is a billion (10 to the 9th) cells
--largest mass that is compatible with life is a trillion (10 to the 12th) cells
--that's 10 doublings between the smallest detectable and the largest survivable mass

appearance
--anaplasia = loss of differentiation, does not resemble normal structure, ex: oat cell carcinoma of lung
--dysplasia = partial loss of differentiation, on its way to being malignant, ex: cervical, big/multiple nuclei, less cytoplasm
--metaplasia = cells change type defensively, ex: in smokers, columnar epithelium turns squamous (tougher), or with acid reflux from the stomach there is Barrett esophagus, in which normally squamous cells turn columnar (more like stomach lining)
--benign tumor appears round in shape, is well differentiated (similar to normal histology), encapsulated, slow growing, very rarely metastasizes, can compress local structures (ex: uterine fibroids) and secrete hormones (fx as gland)
--malignant tumors often shaped like cauliflower head, can be ulcer or expansive, less organized than parent tissue, grows more rapidly, invades locally, can and will metastasize
--primary tumor tends to be in one or a few large masses
--metastases tend to be smaller and scattered

stages
--indicate the growth & spread of the neoplasm
--specific to the type of neoplasm so there is no rule that prevails for all types
--having said that, and merging several sources, and knowing that five stages are represented here, the order goes something like this:
--stage 0 = CIN, cancer in situ, has not crossed basement membrane
--stage 1 is just a mass, say under 1 cm
--stage 2 may have local metastases ie to a lymph node, bigger than 1 cm
--stage 3 has expanded to more lymph nodes and/or invaded locally
--stage 4 <--- distant metastases

grades
--determined by pathologist
--low grade = well differentiated (not as far gone)
--high grade = poorly differentiated

the TNM
--tumor size (1-3)
--nodes (0-2)
--metastasis (0 or 1)
--T1N1M0 is small tumor that is in local nodes with no metastases
--T3N2M1 sounds like stage 4

--squamous = flat, refers to epithelial cells
--sarcoma = cancer involving connective tissue, muscle, cartilage, bone
--liquid tumors = leukemia, lymphoma
--blastoma = aggressive, ex: retinal
--teratoma = mass of ectopic tissue, with structures from multiple developmental layers, mixed tissue, bone, teeth, hair are common, B9 or malignant, aka dermoid cyst when fluid filled, forms from ovary or testicular cells

ETIOLOGY:
--you could say "everything causes cancer"
--or you see for yourself what patterns there may be, based on research
--diet and lifestyle factors account for 65-90% of cancers depending on who you consult
--smoking
--inactivity
--dietary fats/sugars-->multiple myelomas due to increased insulin and TGF
--low fiber consumption (poor toxin elimination)
--alcohol
--UV radiation
--gamma rays (xrays) -->thyroid cancer
--soot --> scrotal cancer (chimney sweeps)
--prescription hormones: estrogen, testosterone
--aflatoxin (peanuts, etc-->stomach/liver)
--pickled veggies --> stomach
--vinyl chloride --> liver (hepangio sarcoma, rare)
--botanicals: safrole (sassafrins) in root beer
--pesticides, herbicides (liquid tumors, multiple myeloma)
--electric fields, (electric blankets)
--radon (gas) -->lung
--solvents
----benzene in canned drinks --> colorectal, leukemia
----xylene-->colon
----stylene-->prostate
--toxic metals
----nickel, chromium,mercury, cadmium, lead aerosolized-->lung larynx, bladder
----arsenic (wood playground preservative)-->skin
--INFECTIONS
----HPV-->cervical, throat, condyloma aneinata
----EBV-->Burketts lymphoma
----HIV-->Kaposi sarcoma
----H. pylori-->stomach, duodenum, GI lymphoma
----Shistosoma sp.-->bladder

CARCINOGENS
--smoked food, smoked cigarettes-->damage DNA

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