Question

Choose one disease process or injury that you would like to learn more about. Decide on...

Choose one disease process or injury that you would like to learn more about. Decide on an organ system or organ, and then choose a disorder that is different from those already presented in Braun and Anderson (2017). For example, if you wish to learn more about cancer, choose a cancer that is not included in chapter 7 (perhaps choose Melanoma) or if you would like to know more about heart disease, choose something different from topics presented in chapter 16 (perhaps disorders of dysrhythmias such as atrial fibrillation). Any disease, disorder, or injury that is not fully discussed in the Clinical Models sections of the text will work. Also, diabetes cannot be utilized as it is fully presented in chapter 20.

You will be investigating the disease from the cellular level through treatment. Review the grading rubric below for the required elements of the paper. Submit the paper by 11:59 PM MT Sunday of week 6.

This assignment focuses on:

CO5      Describe the various types of tumors including causes, symptoms, structure, and behavior

CO6      Describe clinical manifestations associated with pathogenesis of body systems

CO7      Define the basic approach to diagnosis and the use of diagnostic procedures of human disease

CO8      Define the basic approach to treatment of various disorders based on current medical science and clinical practice

CO9      Summarize the physiological basis of pain, pain phenomena, and pain management

Disease is cancer: First portion of the questions

Cancer has a complex Pathophysiology. Pathologists are physicians who are concerned primarily with the study of disease in all its aspects. This includes cause of the disease, diagnosis, how the disease develops (pathogenesis), mechanism and natural course of the disease. They also deal with biochemical features, progression, and prognosis or outcome of the disease.

Pathology of cancers and other complex disorders have undergone a sea change after development of technologies like immunohistochemistry, flow cytometry, and molecular biologic approaches to cancer diagnosis.

Genetic changes

In normal cells, genes regulate growth, maturity and death of the cells. Genetic changes can occur at many levels. There could be a gain or loss of entire chromosomes or a single point mutation affecting a single DNA nucleotide.

There are two broad categories of genes which are affected by these change:

  • Oncogenes – these are cancer causing genes. They may be normal genes which are expressed at inappropriately high levels in patients with cancers or they may be altered or changed normal genes due to mutation. In both cases these genes lead to cancerous changes in the tissues.
  • Tumor suppressor genes – these genes normally inhibit cell division and prevent survival of cells that have damaged DNA. In patients with cancer these tumor suppressor genes are often disabled. This is caused by cancer-promoting genetic changes. Typically, changes in many genes are required to transform a normal cell into a cancer cell.

Genomic amplification

Sometimes there may be genomic amplification. Here a cell gains many copies (often 20 or more) of a small chromosomal locus, usually containing one or more oncogenes and adjacent genetic material.

Homework Answers

Answer #1

Ans

Co1=

Cancer has a complex Pathophysiology. Pathologists are physicians who are concerned primarily with the study of disease in all its aspects. This includes cause of the disease, diagnosis, how the disease develops (pathogenesis), mechanism and natural course of the disease. They also deal with biochemical features, progression, and prognosis or outcome of the disease.

Pathology of cancers and other complex disorders have undergone a sea change after development of technologies like immunohistochemistry, flow cytometry, and molecular biologic approaches to cancer diagnosis.

Genetic changes

In normal cells, genes regulate growth, maturity and death of the cells. Genetic changes can occur at many levels. There could be a gain or loss of entire chromosomes or a single point mutation affecting a single DNA nucleotide.

There are two broad categories of genes which are affected by these change:

  • Oncogenes – these are cancer causing genes. They may be normal genes which are expressed at inappropriately high levels in patients with cancers or they may be altered or changed normal genes due to mutation. In both cases these genes lead to cancerous changes in the tissues.
  • Tumor suppressor genes – these genes normally inhibit cell division and prevent survival of cells that have damaged DNA. In patients with cancer these tumor suppressor genes are often disabled. This is caused by cancer-promoting genetic changes. Typically, changes in many genes are required to transform a normal cell into a cancer cell.

Genomic amplification

Sometimes there may be genomic amplification. Here a cell gains many copies (often 20 or more) of a small chromosomal locus, usually containing one or more oncogenes and adjacent genetic material.

Point mutations

Point mutations occur at single nucleotides. There may be deletions, and insertions especially at the promoter region of the gene. This changes the protein coded for by the particular gene. Disruption of a single gene may also result from integration of genomic material from a DNA virus or retrovirus. This may lead to formation of Oncogenes.

Translocation is yet another process when two separate chromosomal regions become abnormally fused, often at a characteristic location. A common example is Philadelphia chromosome, or translocation of chromosomes 9 and 22, which occurs in chronic myelogenous leukaemia, and results in production of the BCR-abl fusion protein, an oncogenic tyrosine kinase.

Co2=

It's important to know that side effects vary by cancer type, treatment, individual traits and many other factors. You should also know that some side effects lessen over time, and others may not appear until months or years after treatment.

  • More: Social and emotional effects of cancer and cancer treatment

Anemia: Chemotherapy, radiation therapy and some cancer types can deplete red blood cells, leaving you tired, lightheaded and short of breath. Your provider can test for anemia and recommend remedies such as rest and a healthy diet.

Bleeding and bruising (thrombocytopenia): Chemotherapy and targeted therapies can deplete platelets — cells that clot blood to stop bleeding. This can leave you vulnerable to bruising and bleeding. Talk with your provider if you notice changes.

Bone loss (osteoporosis): Cancer and treatments such as chemotherapy can lead to bone loss. Weight-bearing exercise, proper nutrition and supplements can help. Bone-density screenings are also recommended.

Cancer recurrence: Cancer survivors face the possibility that their cancer will return. Cancer treatment can also increase the risk that a patient will develop a new type of cancer. Talk with your provider about regular screenings and other follow-up appointments. If cancer runs in your family, you might want to consider genetic counseling and risk assessment.

Constipation: Chemotherapy and pain medications can cause constipation. A high-fiber diet and lots of liquids can help. Talk with your provider before taking any medications. Our cancer dietitians are also available to help.

Diabetes: Cancer medications can raise your blood sugar levels (hyperglycemia), increasing your risk of developing diabetes even after treatment. Let your doctor know if you have dizziness, light-headedness, or increased thirst or urination.

Diarrhea: Cancer and treatments can lead to diarrhea, putting you at risk of losing too much fluid. Call your provider if you feel lightheaded, have a fever or have dark yellow urine or are not urinating.

Dry mouth: Radiation therapy, especially to your head or neck, can affect your salivary glands. Dry mouth (xerostomia) can affect your sense of taste and your appetite. You also might find it harder to swallow, sleep and speak. Saliva substitutes, sugarless gum or candy, humidifiers or medications can help. Our cancer dietitians can also offer remedies.

Eye problems: Chemotherapy can increase the risk of dry eye syndrome and cataracts. Specialists at the OHSU Casey Eye Institute can provide expert treatment.

Fatigue: Feeling tired is common among cancer survivors. Exercise, relaxation skills and strategies to preserve your energy can help.

Hair loss: Chemotherapy and radiation therapy can cause temporary hair loss.

Hearing loss: Chemotherapy medications and high doses of radiation therapy to the brain can damage hearing. Let your provider know right away if you notice changes.

Heart issues: Chemotherapy and radiation to the chest can damage the heart and blood vessels. Your provider might recommend a healthy diet, weight loss, exercise, medications and other steps.

Hormonal changes: Hormone treatments to fight cancer can cause side effects such as joint pain, fatigue, memory loss, mood changes, reduced sex drive and weight gain. Your provider might suggest hormone replacement or couples therapy to help intimacy.

Hypothyroidism: Radiation therapy can cause your thyroid gland to produce too little thyroid hormone. Effects can include constipation, dry skin, temperature sensitivity and weight gain. Medication can help.

Incontinence: Newer surgical techniques have made this less likely, but urine leakage can be a problem if you had your prostate or bladder removed because of cancer. Treatment may include exercises, behavior management, medication, and in some cases, surgery.

Infection: Chemotherapy can deplete infection-fighting white blood cells, leaving you vulnerable to infections. Hand-washing, staying clean and using extra care with food safety are preventive measures.

Infertility: Some types of radiation and chemotherapy can damage your ability to have children. We can recommend fertility services before treatment to increase your options.

Learning and memory problems: Chemotherapy can cause trouble with memory, concentration or finding the right word, a condition often called "chemo brain." Our rehabilitation services can help.

Loss of appetite: Cancer treatments can make food less appealing and can cause nausea and vomiting. It's important to talk with your provider before you're dehydrated or severely underweight. Our cancer dietitians can also help.

Lung issues: Chemotherapy or chest radiation therapy can damage the lungs. Oxygen therapy, weight loss, exercise, medication and stopping smoking might be recommended.

Lymphedema: The removal of lymph nodes can leave the body's lymph system unable to drain fluid from parts of the body. This can result in fluid buildup, swelling and pain. Exercise, massage and compression garments are among remedies. OHSU rehabilitation experts can help.

Nausea and vomiting: Some types of chemotherapy and radiation and some types of cancer, particularly brain tumors, can cause nausea and vomiting. Medications, dietary changes, alternative medicine and other remedies can help. Our cancer dietitians can offer options.

Organ damage: Cancer treatment can lead to organ damage, even years later. Talk with your provider about any new changes you notice. Preventive steps include proper nutrition and exercise, and avoiding smoking and too much alcohol.

Pain: Pain may result from cancer, surgery, nerve damage caused by chemotherapy or other factors. Your provider can offer medications and other remedies.

Peripheral neuropathy: Chemotherapy, surgery or radiation can damage peripheral nerves, the nerves that transmit messages to and from the brain and spinal cord. Our doctors carefully monitor treatment to lessen nerve damage, and our rehabilitation specialists can help you manage symptoms.

Premature aging: Cancer and cancer treatment can speed some signs of aging. Chemotherapy can bring on early menopause, for example, increasing the risk of osteoporosis. Men may have erectile dysfunction and higher risk of osteoporosis. Talk with your provider about treatment options if you notice changes.

Sexual dysfunction: Cancer treatments can lead to sexual side effects such as erectile dysfunction or early menopause. Our care providers understand this and can recommend effective treatments. OHSU also offers the area's only program to support the sexual health of women affected by cancer.

Skin problems: Chemotherapy and radiation therapy can leave skin dry, itchy, peeling or red. Lotions, skin protection and other steps can help.

Sleep problems: Difficulty sleeping is common among cancer patients. Talk with your provider about remedies such as behavioral therapy, medication and bedtime habits.

Co3=

These ‘normal’ cells act as the body’s basic building blocks and possess specific characteristics that enable them to maintain correct functioning of tissues, organs, and organ systems. Normal cells:

  • control their growth using external signals, meaning they only grow and divide when required,
  • undergo programmed cell death (apoptosis) as part of normal development, to maintain tissue homeostasis, and in response to unrepairable damage,
  • ‘stick together’ by maintaining selective adhesions that they progressively adjust which ensures they remain in their intended location,
  • differentiate into specialized cells with specific functions meaning they can adopt different physical characteristics despite having the same genome.

Cancer is a complex genetic disease that is caused by specific changes to the genes in one cell or group of cells. These changes disrupt normal cell function – specifically affecting how a cell grows and divides. In contrast to normal cells, cancer cells don't stop growing and dividing, this uncontrolled cell growth results in the formation of a tumor. Cancer cells have more genetic changes compared to normal cells, however not all changes cause cancer, they may be a result of it. The genetic changes that contribute to cancer usually affect three specific types of gene; proto-oncogenes, tumor suppressor genes, and DNA repair genes.

Normal Cell vs Cancer Cell – The Key Differences


Cell shape: Normal human cells come in many shapes and sizes – as they differentiate and adopt specialized functions their shape changes accordingly – for instance a red blood cell looks very different to a nerve cell. Different types of cells do not look alike, but, if you analyze cells of the same cell type they will look extremely similar, maintaining a uniform shape.

For years researchers have been peering down microscopes, looking for distinct features that can help them determine the difference between a cancer cell and normal cell. Cancer cells are misshapen, and appear as a chaotic collection of cells, in an array of shapes and sizes. Researchers have been investigating the relationship between cancer cell shape and a patients’ outlook, and whether cell shape may also help to distinguish between the different types of cancer.

Nucleus: In normal cells the nucleus has a smooth appearance and maintains a uniform, spheroid shape. Several structural components are involved in the regulation of nuclear morphology. One of these structural components is the nuclear lamina. Cancer cell nuclei are frequently misshapen and bulges known as “blebs” can often be observed in cells’ nuclear membranes. Research suggests that this ‘blebbing’ is caused by an imbalance in the proteins that constitute the nuclear lamina which leads to separation of the lamina fibers.

Chromatin: The fine, evenly distributed chromatin found in normal cells transforms into coarse, chromatin in cancer cells – aggregating into irregular clumps that vary in both size and shape.

Nucleolus: Tumor aggressiveness and clinical outcome can both be measured by observing the morphology of a cancer cell’s nucleolus/ nucleoli. The nucleolus becomes increasingly enlarged and more irregular in cancer cells – cells can have multiple nucleoli within the nucleus.

Blood supply: Angiogenesis is defined as the development of new blood vessels that form from pre-existing vasculature. Angiogenesis is a vital process in normal cells that occurs during development, growth, and wound healing. However, it is also implicated in the growth of cancer, through the tumor’s ability to secrete chemical signals that stimulate angiogenesis.

Co4=Acute wounds normally heal in an orderly and efficient manner, and progress smoothly through the four distinct, but overlapping phases of wound healing: haemostasis, inflammation, proliferation and remodelling .In contrast, chronic wounds will similarly begin the healing process, but will have prolonged inflammatory, proliferative, or remodelling phases, resulting in tissue fibrosis and in non-healing ulcers. the process of wound healing is complex and involves a variety of specialized cells, such as platelets, macrophages, fibroblasts, epithelial and endothelial cells. These cells interact with each other and with the extracellular matrix. In addition to the various cellular interactions, healing is also influenced by the action of proteins and glycoproteins, such as cytokines, chemokines, growth factors, inhibitors, and their receptors. Each stage of wound healing has certain milestones that must occur in order for normal healing to progress. In order to identify the differences inherent in chronic wounds that prevent healing, it is important to review the process of healing

Phases of Acute Wound Healing

Haemostasis

Haemostasis occurs immediately following an injury.To prevent exsanguination, vasoconstriction occurs and platelets undergo activation, adhesion and aggregation at the site of injury. Platelets become activated when exposed to extravascular collagen (such as type I collagen), which they detect via specific integrin receptors, cell surface receptors that mediate a cell’s interactions with the extracellular matrix. Once in contact with collagen, platelets release the soluble mediators (growth factors and cyclic AMP) and adhesive glycoproteins, which signal them to become sticky and aggregate. The key glycoproteins released from the platelet alpha granules include fibrinogen, fibronectin, thrombospondin, and von Willebrand factor. As platelet aggregation proceeds, clotting factors are released resulting in the deposition of a fibrin clot at the site of injury. The fibrin clot serves as a provisional matrix. the aggregated platelets become trapped in the fibrin web and provide the bulk of the clot . Their membranes provide a surface on which inactive clotting enzyme proteases are bound, become activated and accelerate the clotting cascade.

Growth factors are also released from the platelet alpha granules, and include platelet derived growth factor (PDGF), transforming growth factor beta (TGF-β), transforming growth factor alpha (TGF-α), basic fibroblast growth factor (bFGF), insulin-like growth factor-1 (IGF-1), and vascular endothelial growth factor (VEGF). Major growth factor families are presented .Neutrophils and monocytes are then recruited by PDGF and TGF-β from the vasculature to initiate the inflammatory response. A breakdown fragment generated from complement, C5a, and a bacterial waste product, f-Met-Leu-Phe, also provide additional chemotactic signals for the recruitment of neutrophils to the site of injury. Meanwhile, endothelial cells are activated by VEGF, TGF-α and bFGF to initiate angiogenesis. Fibroblasts are then activated and recruited by PDGF to migrate to the wound site and begin production of collagen and glycosaminoglycans, proteins in the extracellular matrix which facilitate cellular migration and interactions with the matrix supporting framework. Thus, the healing process begins with hemostasis, platelet deposition at the site of injury, and interactions of soluble mediators and growth factors with the extracellular matrix to set the stage for subsequent healing events.

Inflammation

Inflammation, the next stage of wound healing occurs within the first 24 hours after injury and can last for up to 2 weeks in normal wounds and significantly longer in chronic non-healing wounds .Mast cells release granules filled with enzymes, histamine and other active amines, which are responsible for the characteristic signs of inflammation, the rubor (redness), calor (heat), tumor (swelling) and dolor (pain) around the wound site. Neutrophils, monocytes, and macrophages are the key cells during the inflammatory phase. They cleanse the wound of infection and debris and release soluble mediators such as proinflammatory cytokines (including IL-1, IL-6, IL-8, and TNF-α), and growth factors (such as PDGF, TGF-β, TGF-α, IGF-1, and FGF) that are involved in the recruitment and activation of fibroblasts and epithelial cells in preparation for the next phase in healing. Cytokines that play important roles in regulating inflammation in wound healing .

  • Proliferation – fibroblasts, supported by new capillaries, proliferate and synthesize disorganized ECM. Basal epithelial cells proliferate and migrate over the granulation tissue to close the wound surface.
  • Remodelling – fibroblast and capillary density decreases, and initial scar tissue is removed and replaced by ECM that is more similar to normal skin. ECM remodelling is the result of the balanced, regulated activity of proteases.

Cellular functions during the different phases of wound healing are regulated by key cytokines, chemokines and growth factors. Cell actions are also influenced by interaction with components of the ECM through their integrin receptors and adhesion molecules. MMPs produced by epidermal cells, fibroblasts and vascular endothelial cells assist in migration of the cells, while proteolytic enzymes produced by neutrophils and macrophages remove denatured ECM components and assist in remodelling of initial scar tissue.

Thanku so much

Co5=various types of tumor

Bladder tumor

Ovarian tumor

breast tumor

uterine tumor

oral tumor

pancreatic tumor etc

Please like my answer for appreciation ?

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