Bagi Ilmu

Cancer of the Pancreas - Pancreatic Cancer

Pancreatic cancer occurs when cells within the pancreas undergo changes that make the cells grow and divide uncontrollably.
What is going on in the body?

The pancreas is a gland located in the middle part of the upper abdomen. Insulin is produced by the pancreas to help the body regulate blood glucose. The pancreas also produces substances to help the body digest food. When a cell in the pancreas becomes cancerous, it grows into a tumor that destroys the tissue around it.

A tumor in the pancreas tends to quickly invade the nearby liver. Eventually, the liver will be affected, and part of it will be destroyed. The cancer can also metastasize, or spread, through the bloodstream to other parts of the body. Pancreatic cancer is usually found late in the disease when it is most likely to be fatal.
What are the causes and risks of the disease?

Cigarette smoking significantly increases a person’s risk for pancreatic cancer. It is not clear if other factors also increase the risk. The influence of alcohol and caffeine on the development of this cancer is uncertain and controversial.
Symptoms & Signs
What are the signs and symptoms of the disease?

Most people do not realize they have pancreatic cancer until it has advanced into the liver. At that time, the person will have symptoms related to the destruction of the liver. Unexplained weight loss is the most common symptom. Other symptoms may include:
jaundice, or yellowing of the skin and eyes
nausea and vomiting
pain in the middle to upper part of the abdomen that may spread to the back

Diagnosis & Tests
How is the disease diagnosed?

Diagnosis of pancreatic cancer begins with a medical history and physical exam. The healthcare provider may order tests, including:
an abdominal CT scan
a biopsy to remove a small piece of tissue for examination
CT scans and specialized X-rays to determine if the cancer has spread

Prevention & Expectations
What can be done to prevent the disease?

Individuals who smoke can lower their risk for pancreatic cancer if they quit smoking. Some studies suggest that people who have had a tonsillectomy or various allergies may be at less risk for pancreatic cancer, but more research is needed.
What are the long-term effects of the disease?

If found early, the cancer can sometimes be controlled for a period of time. However, pancreatic cancer usually causes death. The average survival is 4.1 months.
What are the risks to others?

Pancreatic cancer is not contagious and poses no risk to others.
Treatment & Monitoring
What are the treatments for the disease?

Treatment varies depending upon the extent of the disease. If the disease is localized and the tumor is small, surgical removal of the tumor may offer long-term control of the cancer. Chemotherapy with radiation therapy may be offered once a small tumor is removed. This may be helpful in slowing the return of the tumor.

Most pancreatic cancers are found when the tumors are too large to remove. Large tumors may block the intestines. Surgery may be performed to bypass the blockage and relieve symptoms such as nausea and vomiting. Chemotherapy may be offered to relieve symptoms, such as pain, by shrinking the tumor. Advanced pancreatic cancer is not usually curable.
What are the side effects of the treatments?

Most people treated with surgery generally heal without difficulty. The effects of radiation therapy are temporary and will resolve after completion. During therapy, the person is likely to experience nausea, skin burning, temporarily lowered blood cell counts, and difficulty swallowing. Medicines will help control the nausea.

Chemotherapy given to a person with early-stage disease makes the radiation work better. By itself, the chemotherapy can cause mouth sores, stomach upset, fatigue, hair loss, and increased risk of infections. Radiation may intensify some of the side effects, but this is temporary. Chemotherapy given to treat late-stage cancers is usually well tolerated. It is given to relieve symptoms.
What happens after treatment for the disease?

Pancreatic cancer is likely to progress, even with treatment. As the cancer progresses, treatments can be given to make the person more comfortable.
How is the disease monitored?

Someone with pancreatic cancer will have regular visits with the healthcare provider. CT scans will indicate the progress of the disease. When the liver is damaged by cancer, it will begin to fail. Liver function tests will also indicate how well the liver is functioning. As different interventions are used to bring comfort, the person will be monitored closely. Any new or worsening symptoms should be reported to the healthcare provider

What Is Cancer?

Cancer is actually a group of many related diseases that all have to do with cells. Cells are the very small units that make up all living things, including the human body. There are billions of cells in each person’s body.

Cancer happens when cells that are not normal grow and spread very fast. Normal body cells grow and divide and know to stop growing. Over time, they also die. Unlike these normal cells, cancer cells just continue to grow and divide out of control and don’t die when they’re supposed to.

Cancer cells usually group or clump together to form tumors (say: too-mers). A growing tumor becomes a lump of cancer cells that can destroy the normal cells around the tumor and damage the body’s healthy tissues. This can make someone very sick.

Sometimes cancer cells break away from the original tumor and travel to other areas of the body, where they keep growing and can go on to form new tumors. This is how cancer spreads. The spread of a tumor to a new place in the body is called metastasis (say: meh-tas-tuh-sis).
Causes of Cancer

You probably know a kid who had chickenpox — maybe even you. But you probably don’t know any kids who’ve had cancer. If you packed a large football stadium with kids, probably only one child in that stadium would have cancer.

Doctors aren’t sure why some people get cancer and others don’t. They do know that cancer is not contagious. You can’t catch it from someone else who has it — cancer isn’t caused by germs, like colds or the flu are. So don’t be afraid of other kids — or anyone else — with cancer. You can talk to, play with, and hug someone with cancer.

Kids can’t get cancer from anything they do either. Some kids think that a bump on the head causes brain cancer or that bad people get cancer. This isn’t true! Kids don’t do anything wrong to get cancer. But some unhealthy habits, especially cigarette smoking or drinking too much alcohol every day, can make you a lot more likely to get cancer when you become an adult.
Finding Out About Cancer

It can take a while for a doctor to figure out a kid has cancer. That’s because the symptoms cancer can cause — weight loss, fevers, swollen glands, or feeling overly tired or sick for a while — usually are not caused by cancer. When a kid has these problems, it’s often caused by something less serious, like an infection. With medical testing, the doctor can figure out what’s causing the trouble.

If the doctor suspects cancer, he or she can do tests to figure out if that’s the problem. A doctor might order X-rays and blood tests and recommend the person go to see an oncologist (say: on-kah-luh-jist). An oncologist is a doctor who takes care of and treats cancer patients. The oncologist will likely run other tests to find out if someone really has cancer. If so, tests can determine what kind of cancer it is and if it has spread to other parts of the body. Based on the results, the doctor will decide the best way to treat it.

One test that an oncologist (or a surgeon) may perform is a biopsy (say: by-op-see). During a biopsy, a piece of tissue is removed from a tumor or a place in the body where cancer is suspected, like the bone marrow. Don’t worry — someone getting this test will get special medicine to keep him or her comfortable during the biopsy. The sample that’s collected will be examined under a microscope for cancer cells.

The sooner cancer is found and treatment begins, the better someone’s chances are for a full recovery and cure.
Treating Cancer Carefully

Cancer is treated with surgery, chemotherapy, or radiation — or sometimes a combination of these treatments. The choice of treatment depends on:

    the type of cancer someone has (the kind of abnormal cells causing the cancer)
    the stage of the tumor (meaning how much the cancer has spread within the body, if at all)

Surgery is the oldest form of treatment for cancer — 3 out of every 5 people with cancer will have an operation to remove it. During surgery, the doctor tries to take out as many cancer cells as possible. Some healthy cells or tissue may also be removed to make sure that all the cancer is gone.

Chemotherapy (say: kee-mo-ther-uh-pee) is the use of anti-cancer medicines (drugs) to treat cancer. These medicines are sometimes taken as a pill, but usually are given through a special intravenous (say: in-truh-vee-nus) line, also called an IV. An IV is a tiny plastic catheter (straw-like tube) that is put into a vein through someone’s skin, usually on the arm. The catheter is attached to a bag that holds the medicine. The medicine flows from the bag into a vein, which puts the medicine into the blood, where it can travel throughout the body and attack cancer cells.

Chemotherapy is usually given over a number of weeks to months. Often, a permanent catheter is placed under the skin into a larger blood vessel of the upper chest. This way, a person can easily get several courses of chemotherapy and other medicines through this catheter without having a new IV needle put in. The catheter remains under the skin until all the cancer treatment is completed.

Radiation (say: ray-dee-ay-shun) therapy uses high-energy waves, such as X-rays (invisible waves that can pass through most parts of the body), to damage and destroy cancer cells. It can cause tumors to shrink and even go away completely. Radiation therapy is one of the most common treatments for cancer. Many people with cancer find it goes away after receiving radiation treatments.

With both chemotherapy and radiation, kids may experience side effects. A side effect is an extra problem that’s caused by the treatment. Radiation and anti-cancer drugs are very good at destroying cancer cells but, unfortunately, they also destroy healthy cells. This can cause problems such as loss of appetite, tiredness, vomiting, or hair loss. With radiation, a person might have red or irritated skin in the area that’s being treated. But all these problems go away and hair grows back after the treatment is over. During the treatment, certain medicines can help a kid feel better.

While treatment is still going on, a kid might not be able to attend school or be around crowds of people — the kid needs to rest and avoid getting infections, such as the flu, when he or she already isn’t feeling well. The body may have more trouble fighting off infections because of the cancer or side effects of the treatment.
Getting Better

Remission (say: ree-mih-shun) is a great word for anyone who has cancer. It means all signs of cancer are gone from the body. After surgery or treatment with radiation or chemotherapy, a doctor will then do tests to see if the cancer is still there. If there are no signs of cancer, then the kid is in remission.

Remission is the goal when any kid with cancer goes to the hospital for treatment. Sometimes, this means additional chemotherapy might be needed for a while to keep cancer cells from coming back. And luckily, for many kids, continued remission is the very happy end of their cancer experience

Asthma and its Types.

chronic inflammatory disorder of the airways that causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough

triad of intermittent and reversible airway obstruction, chronic bronchial inflammation with eosinophils, and
bronchial smooth muscle cell hypertrophy and hyperreactivity

increase in airway responsiveness (bronchospasm)

Types:

extrinsic or atopic: due to IgE and TH2-mediated immune responses to environmental antigens

intrinsic or non-atopic: triggered by non-immune stimuli such as aspirin; viruses; cold; psychological stress; exercise; and inhaled irritants

Drug-Induced Asthma: eg aspirin, probably because it inhibits the cyclooxygenase pathway without affecting the lipoxygenase route

Occupational Asthma: eg, fumes (epoxy resins, plastics), organic and chemical dusts (wood, cotton, platinum), gases (toluene)

Atopic Asthma- Pathogenesis:

Triggering factors: dusts, pollen, animal dander, and foods

Associated with other atopic manifestations like allergic rhinitis, urticaria, or eczema.

hypertrophy of bronchial smooth muscle and deposition of subepithelial collagen; aka airway remodeling

excessive TH2 reaction against environmental antigens.

Cytokines produced by TH2 cells account for most of the features of asthma-IL-4 stimulates IgE production, IL-5 activates eosinophils, and IL-13 stimulates mucus production

Atopic Asthma:

Acute attack consists of

immediate response: Exposure of IgE-coated mast cells to the same antigen causes cross-linking of IgE and release of mediators like Leukotrienes C4, D4,E4, Acetylcholine, Histamine, Prostaglandin D2: which cause bronchoconstriction, increase vascular permeability, and increase mucin secretion

late-phase reaction: Eosinophils are particularly important in the late phase, as they can amplify and sustain the inflammatory response without additional exposure to the triggering antigen by releasing different chemical mediators themselves

status asthmaticus:

may last for hours and even days
hypercapnia, acidosis, and severe hypoxia may be fatal
Maynot respond to bronchodilators
May need artificial ventilatory support under sedation and paralysis

Morphology:

lungs are overdistended because of overinflation, and there may be small areas of atelectasis

occlusion of bronchi and bronchioles by thick, tenacious mucus plugs
M/E:

whorls of shed epithelium (Curschmann spirals)

Numerous eosinophils

Charcot-Leyden crystals (made of eosinophil proteins)

Airway remodeling: includes:

thickening of the basement membrane
Edema and prominence of eosinophils and mast cells
increase in the size of the submucosal glands
Hypertrophy of the bronchial muscle walls