HS 350

Lecture #1: Cancer

Terms 

• Oncology: study of cancer

• Neoplasms: tumors 

• Benign tumor: non cancerous not invading or rapidly spreading to other tissues

• Malignant tumor: cancerous tumor/cells

Types of cancer

• Carcinoma

  • Epithelial cells

  • Most common types: lung, breast, colon

  • Divide at a rapid rate

• Sarcoma 

  • Connective tissue

  • Most common types: bone, cartilage, muscle, fat

• Leukemia

  • Bone forming tissues 

  • Most common types: bone marrow

• Lymphoma 

  • Affects the lymphatic system 

• Multiple myeloma 

  • Affects the blood plasma cells

• Melanoma 

  • Affects melanocytes and melanin 

• Brain/spinal tumors

  • Affects glial cells or other cells in nervous system

Pathophys

• Step 0

  • Healthy cells divide and die (self destruct)

• Step 1

  • DNA mutates

  • Destruction or death 

  • Instructions of cells are blocked 

  • Environmental exposure, genetic, random errors

• Step 2

  • Hyperplasia 

  • Increased number of cancerous cells

  • Slow process 

  • Hormonal factors and inflammation speed it up 

• Step 3 

  • Dysplasia 

  • Abnormal cells 

    • Shape, size, organization 

• Step 4

  • Localized tumor 

    • Increased growth but still localized

• Step 5

  • Invasive 

  • Invasion: regional 

  • Metastasis: distant site

• Step 6

  • Clonal expansion 

  • Mass of identical cells

• Step 7 

  • Progression 

  • Increase in aggression and diversity = heterogeneity 

  • Complicates treatment 

• Step 8 

  • Final outcome 

  • More spreading, metastisizing, death

Detection and treatment 

• Mammograms 

  • Breast, chest 

• Radiographs 

  • Lung 

• Rectal exam or blood tests

  • Prostate 

• Pap smear 

  • Cervical 

• Colonoscopy or fecal occult

  • Colorectal 

Feb 20, 2025

Lecture #2: Cancer cont.

Epidemiology 

• ⅓ of cancer deaths are attributable to physical activity and diet

• ⅓ contributed to tobacco exposure

• 2nd leading cause of death

• Decrease in mortality in younger age

  • Because of decrease in smoking rates and increase in treatments

Types of cancer

• Most common 

  • Men: prostate

  • Women: breast

• Top killer cancer

  • Lung cancer

Risk factors

• Smoking 

• Sun exposure 

• Radiation 

• Genetics 

• Hormone exposure

• Obesity 

• Low physical activity 

• Bad diet

Endocrine diseases

• Pituitary gland

  • Master gland 

  • Masses 

    • Over or underproduction 

    • Usually cancer

• Functioning adenoma 

  • Benign hormone-secreting tumor 

  • Overproduction of hormones

  • One hormone is overproduced

    • Prolactinoma 

      • Increases milk production

      • Infertility 

      • Decrease sex drive

    • Growth hormone adenoma 

    • ACTH adenoma 

      • Increase in cortisol 

  • Most common in men aged 20-50 (3-13/100,000)

• Underproduction in pituitary gland 

  • Pathophys

    • >75% destruction before it can’t keep up

    • Atrophy of adrenal cortex, thyroid, ovary

  • Causes 

    • Mass 

    • Ischemia 

    • Surgery 

  • Symptoms 

    • Fatigue 

    • Weight loss 

    • General dysfunction 

• Sheehan condition 

  • During pregnancy an enlargement of anterior pituitary gland which causes an increase for blood demand

  • Major shock causes an infarct pituitary gland 

• Posterior pituitary gland 

  • Antidiuretic 

  • Increased urine production causes it to be very diluted

  • Genetic defect 

  • Trauma 

  • Very rare

• Thyroid 

  • Hyperthyroidism 

    • Overactive thyroid 

  • Causes 

    • Overmedication 

    • Primary hyperthyroidism 

    • Secondary: pituitary gland damage 

• Graves disease 

  • Pathophys 

    • Hyperthyroidism 

    • Autoimmune disease 

      • Antithyroid and antibodies 

  • Epi 

    • 80-90% of hyperthyroid cases

    • 90% is female 

    • 1% of population under 40 

  • Symptoms 

    • Weight loss

    • Sweating 

    • Heat intolerance 

    • Increased appetite 

    • Diarrhea 

  • Treatment 

    • Medication or drugs to reduce production 

    • Surgery to remove thyroid 

    • Radioactive iodine 

• Hypothyroidism 

  • Underactive thyroid 

  • Primary or secondary 

  • Pathophysiology 

    • Low iodine 

  • Signs and symptoms 

    • Myxedema 

      • Firm inelastic swelling 

    • Fluid sacs under eyes 

    • Loss of hair 

    • Cold intolerance 

    • Weight gain 

    • Reduced appetite 

    • Hate rate failure 

  • Epi 

    • 0.3% clinical level 

    • 4.3% subclinical level 

• Goiter 

  • Enlarged thyroid 

  • Underdeveloped countries

  • Unknown cause or lack of iodine 

• Thyroiditis 

  • Inflammation of the thyroid 

  • Painful 

Feb 25, 2025

Lecture #3: Endocrine diseases

Adrenal gland 

• Cushing’s syndrome 

  • Causes: downstream, adrenal cortex tumor, overmedication 

  • Pathophys: overproduction of cortisol 

  • Overproduction of aldosterone = High BP

• Congenital adrenal hyperplasia 

  • Corticosteroid production is interrupted or prevented 

  • Ambiguous genitalia 

  • Decrease in aldosterone = low BP 

• Addison’s disease 

  • Insufficiency of corticosteroids

  • Autoimmune 

  • Rare 

• So far in endocrine diseases… all are rare 

  • Makes up 4.78% of the population 

  • 4% are ones already mentioned 

  • 4% are related to diabetes

Diabetes 

• Pathophys: insulin and blood sugar

• Type 1

  • Pancreas does not secrete enough insulin 

  • Genetic and/or autoimmune 

  • Immune system attacks islet cells (insulin producers) 

  • Youth onset

  • How it should work 

    • Increased blood glucose triggers insulin release which opens channels in muscles for glucose to go through which increases glucose uptake 

• Type 2

  • Insulin is produced but not effective 

  • Usually adult onset 

  • Lifestyle and genetic 

  • Insulin resistant 

  • The problem is target cells 

  • Obesity 

  • Pre-diabetes: high insulin production, normal blood glucose 

  • Full diabetes: decreased insulin production, stops regulating blood glucose 

• Gestational diabetes

  • Only during pregnancy, works like type 2

  • Signs and symptoms ST: rapid deep breathing, fruity breath 

    • Keytones: byproduct of fat-burning keto acidosis

    • Glycosuria: sugar in urine, high urine output, volume depletion

  • Signs and symptoms LT: vascular, kidney, and eye disease, peripheral neuropathy 

    • Result of sharp spikes and falls in blood glucose 

Feb 27, 2025

Lecture #4: Pancreatic diseases

Diabetes cont. 

• Epi facts: 

  • Type 1- 0.5% of the population 10% of total diabetes cases

  • Type 2- 10% of the population 90% of all diabetes cases

  • Gestational- 2-3% of pregnancies 

• Risk factors

  • Type 1- genetic 

  • Type 2- lifestyle(obesity), family history, low activity, age, minoritized groups, alcohol, and genetic 

  • Gestational- genetic, lifestyle, obesity, low activity

• Diagnosis  

  • Oral glucose tolerance test

    • >200mg/dl = diabetes

  • Fasting blood glucose

    • >126 mg/dl = diabetes

  • Hb1AC

    • >6.5% = diabetes

    • Glucose is stuck to hemoglobin

• Treatment 

  • Type 1- insulin injections

  • Type 2- 1st line of defense: lifestyle(PA and diet), 2nd line of defense: oral medication, monitoring 

Pancreas 

• Pancreatitis 

  • Two types: acute and chronic

  • Inflammation of the pancreas

• Acute pancreatitis 

  • Causes: 50% gallstones, 66% alcohol, 10% unknown, Other: trauma, measles, etc. 

  • Digestive juices are blocked

  • Auto digest

  • Leaks more enzymes, which leads to more auto-digestion 

  • Swelling 

• Chronic pancreatitis

  • Repeated acute pancreatitis -> damaged beyond repair

  • Causes fibrosis 

  • ⅔ is caused by alcoholism 

  • Signs and symptoms: weight loss, abdominal pain, digestive issues

  • Within five years of diagnosis, 50% of patients die

  • Epi facts: 

    • men: 45/100,000 women: 35/100,000

    • Gallstones: 3-7% cause pancreatitis

  • Risk factors: 

    • Age 

    • Men #alcoholics

    • Alcohol consumption 

    • Genetic factors 

    • African Americans: 2x the risk 

    • Diet: red meats

  • Treatment: 

    • Eating low-fat diet 

    • Vitamin and mineral supplements

    • Take enzymes with meals 

• Pancreatic cancer 

  • 4th most common cause of death in men 

  • 5th most common cause of death in women 

  • 1st sign- upper abdominal pain or back

  • 2nd sign- weight loss

    • If you notice these signs it’s too late for treatment 

  • ½ will die within 6 weeks 

  • 10% survive past year one 

  • <1% survive past ten years 

GI diseases 

• Involve breaches or mechanical failure 

• Open to outside, populated by bacteria, very vasculature -> hemorrhage

• GI bleeding terms 

  • Hematemosis: vomiting blood

    • Red blood: from the esophagus 

    • Brown or black blood: digested

  • Hematochezia: blood in the stool 

    • Red blood: lower GI (colon/rectum)

    • Brown/black: upper GI 

  • Melena: black stool 

  • Occult: only detected by chemical test

Mar 4, 2025

Lecture #5: GI conditions

Upper GI 

• Esophageal varices: enlarged veins in the esophagus 

  • Cause: when blood flow to liver is obstructed due to liver cirrhosis 

  • Swollen veins break which is life threatening 

• Mallory-Weis: laceration in the esophageal membrane

  • Either really low in esophagus or in upper stomach 

  • Cause: violent vomiting, eating disorders, high alcohol consumption 

• Acute stress ulcers: erosion or sore that develops on the stomach lining

  • Cause: extreme stress (psychological or physical)

  • Treatment: reduce stress

  • Can lead to hospitalization 

• Acute gastritis: sudden inflammation of stomach lining

  • Cause: NSAIDs, excessive alcohol consumption, infections, stress

  • Treatment: resolves on its own, may require other medication 

• Peptic ulcers: sores caused by exposure to stomach acid

  • Lower esophagus, stomach, or duodenum

Small intestines 

• Intussusception: lining of the intestines folds over itself

  • Sliding or telescope part of the intestine

  • Leads to decrease blood flow, swelling, and a blockage

  • Only happens in children 

  • Medical emergency 

• Ischemic bowel disease: blood flow to a portion of the intestines is reduced or blocked

  • Causes severe pain, nausea, vomiting, bloody stools

  • Long term: death of tissue, emergency 

  • Causes: blood clots, atherosclerosis, drop in BP

• Meckel diverticulum: small pouch in the wall of the small intestine 

  • Caused by remnants of umbilical cord 

  • Congenital 

  • Complications: bleeding and infection

Large intestines

• Inflammatory bowel disease: 

  • Ulcerative colitis: chronic inflammation of colon and/or rectum 

    • Sores and inflammation in lining of large intestines

  • Crohn’s disease: impacts any part of GI

    • Autoimmune disease that attacks the linings of the GI 

• Diverticulosis or diverticulitis

  • Small, bulging pouches in the walls of the digestive tract -Diverticulosis 

  • If pouches become infected/inflamed -diverticulitis 

  • Causes pain, fever, bowel movement problems

Rectum or anus 

• Anal fissures: small tear or crack in lining of the anus 

  • Bleeding and pain during bowel movements

  • Cause: constipation or trauma

• Hemorrhoids: swollen veins in lower part of rectum or anus 

  • Cause discomfort, itching, and bleeding during bowel movements

• Angio dysplasia: abnormal fragile blood vessels in GI, most commonly in colon

  • Cause bleeding, anemia, blood in the stool, rectal bleeding

• Colon cancer: cancer in the colon 

  • Starts as benign polyps causing cancer

Mar 6, 2025

Lecture #6: GI conditions cont. 

Nonbleeding conditions

• GERD: heartburn

  • Pathophys: gastric acid comes back into esophagus from the stomach 

  • Causes: abnormal relaxation of lower esophageal sphincter, hernia where stomach comes over the diaphragm, obesity, smoking, alcohol abuse

  • Symptoms: heartburn, lower chest pain, sore throat

  • Treatment: lifestyle, diet, stop smoking, weight loss, smaller meals, eating at least 2-3 hours before sleep, elevate the head before bed or after eating, medications, antacids

  • Epi: >40% of population experience this each month

• Irritable bowel syndrome(IBS)

  • Diagnosis: >3 months of abdominal pain with no other known cause

  • Symptoms: bloating, excessive gas, diarrhea, mucus in the stool

  • Epi: very common, 10-15% prevalence globally

Liver diseases

• Hepatitis: inflammation of the liver

  • Causes: viral infections, certain medications, toxins, autoimmune disease, alcohol(sometimes)

  • Can be A, B, or C: these are viral infections

• Cirrhosis: late-stage scarring or fibrosis of the liver, healthy liver tissue is replaced with scar tissue

  • Steps: 

    • Fatty liver where fat is stored abnormally in hepatocytes, liver looks yellow and greasy(reversible)

    • Progresses to hepatitis, liver looks inflamed and damaged with scar tissue(reversible)

    • Once there is enough scar tissue it is called cirrhosis(not reversible)

  • Treatment: liver transplant, early intervention to act as prevention

  • Causes: alcohol has direct evidence for causing cirrhosis, about 200g of ethanol per day(about 14 drinks per day), could be lower given genetics, obesity, genetics, diabetes, viruses, non-alcohol related fatty liver disease, autoimmune disease, medication or toxins

  • Epi: 16% of alcoholics get cirrhosis

  • Prognosis: not good 

Mar 11, 2025