Internal Medicine

Just want to share some of notes that managed to copy during lectures, not perfect and complete. These notes may or may not help you. If anyone has additional notes regarding IM, please share!

Internal Medicine

Lecture 2 & 3: Biology of Tumor Growth & Clinical Aspect of Tumor growth

A . Fundamental principles of genetic basis of cancer:

Nonlethal genetic damage is the basis of carcinogenesis à may be hereditary or acquired

B . Components of Tumor Mass:

1.       Cancer mass

2.       Normal cells

3.       BV, matrix

4.       Infiltrative components e.g. macrophages, neutrophil

C . Factor influencing tumor progression:

1.       Growth fraction (how many cancer cells are actually proliferating:

a.       Lymphoma ~ 90%

b.      Prostate cancer ~ very2 low

2.       Rate of proliferation (Doubling Time)

a.       The lesser the doubling time, the faster the rate of growth

b.      E.g. : cervical cancer : 90-100 days ; lymphoma : 1 month

3.       Cell loss

a.       Amount of cells that undergo apoptosis after completing the doubling time

b.      Most do not undergo apoptosis, one of the reasons is p53 tumor suppressor gene is defective.

*not all cancer cells are proliferating cells, usually ~70% are

*cancer has many causes, not a uniform disease

*majority of cancer is chronic: in-situàinvadesàmetastasis

D . Purpose of Treatments:

1.       Curative intent

2.       Palliative intent

Where 1/3 is curable, preventable and palliable

E. Treatment modalities

1.       Surgery

2.       Radiation therapy

3.       Chemotherapy

4.       Biological response

*Terminal state & terminal care:

- life is very limited

- <6 months

Lecture 4 & 5: Cancer and Grading Staging & Ionizing Radiation and Radiation Hazards

*Grading – looking at some properties of the cells

*Staging – where it has limited to and where it has gone(metastasize)

**Classifying includes grading and staging

A . Historical Perspective

1.       Broder-grading cancer cells: increase of histological differences, higher grading

2.       Gleason: prostate cancer

3.       Blom-Richardson: Breast cancer

4.       Fuhrman: Kidney cancer

#Classical Grading

~   1,2,3,4:

§  Well differentiated – resembles original cells

§  Moderately differentiated

§  Poorly differentiated, anaplastic

§  Undifferentiated

     ~ Other features used in grading:

§  Presence or absence of specific receptor; e.g. breast cell has estrogen receptor

§  Biological markers; e.g CEA

#Why staging and grading is needed?

§  To know the extent of tumor for prognosis and treatment purposes

§  To standardize between different centres and groups of people managing cancer

§  Data-base for studies and researches

#Some staging systems:

§  TNM WHO staging (use almost for all cancer except O&G type of cancer):

o   T- Topography

o   N- lymph Nodes

o   M- Metastasize

§  FIGO (federation of Gynecologists and Obstetrics)

#Effects of massive doses of radiation: if the radiation causes…

§  Brain death : immediate effects

§  Gut death : 1-5 days

§  Bone marrow death : 2-4 weeks

# Effects of therapeutic doses:

§  Little by little in long time, then the tumor mass get killed