Focus on the Lung Part One: Risk and Oncogene Mutations

Lung cancer is the leading cause of cancer in the US among both men and women.
In the 1960's the Surgeon General's Report loosely associated cigarette smoking with cancers of the trachea, lung, bronchus, larynx and lip.

Within the past two decades, cigarette manufactures have changed the design of their product adding filters that remove much of the tar from inhaled tobacco smoke. These filters also retain more of the nicotine causing deeper inhalation by smokers and a longer smoke retention period within the lung to satisfy nicotine cravings. This has resulted in a shift in histology patterns with decreasing amounts of squamous cell carcinoma and increasing amounts of adenocarcinomas being reported.

Cigarette smoke emits about 4,800 compounds. Lung cancer develops from chronic exposure of cell DNA to metabolically active carcinogens. These compounds can alter and damage DNA in a number of ways including chromosonal aberrations, DNA stand breaks, and oncogene inactivation. Geneic factors also play a role in the risk of developing lung cancer.

Risk Factors: Age related increase in lung cancer is lowest in men and women who have never smoked, an intermediate risk in those that have quit at various ages, and highest in those who continue to smoke. Factors to look for include: duration of smoking, number of cigarettes per day, and age at time time of smoking cessation

• The longer one lives after cessation of smoking the greater the risk of developing lung cancer.
• The greater the consumption of tobacco, the greater the risk of developing lung cancer.

Occupational expose can also contribute to the development of lung cancer. Examples include graphite electrode manufacturing, coke oven plants, exposure to diesel exhaust, workers exposed to cadmium, and those working in the synthetic rubber and various plastics.

Predictive markers of survival metatasis, gender and weight loss. Some studies indicate that weight loss in lung cancer patients is associated with poor therapy outcome and reduction in patient survival, though how weight loss affects survival outcome is not clear.

Oncogene mutation: K-ras mutations are found in adenocarcinoma, not in small cell carcinoma, and are not associated with a patients sex, prior therapy status, or tumor extent. p53 tumor suppressor gene is inactived by mutation in more than 50% of non-small cell lung carcinomas and is found in 90% of small cell lung carcinomas. In early stage lung cancer, sputum can sometimes reveal K-ras or p53 cellular mutations. EGFR has been associated with lung tumor progression.

Information taken from the text: Oncology An Evidence Based Approach
http://www.amazon.com/Oncology-Evidence-Based-Approach-Chang/dp/0387242910

Hematopoietic and Lymphoid Neoplasms

With the 2010 changes involving hematopoietic and lymphoid neoplasms, I was searching the internet looking for some recommendation on a good book for understanding the complexity of these disorders.
I happened to read a cancer registry newsletter covering the subject and this book came highly recommended.

From Amazon.com: PDQ Hematology is a concise and focused introduction to clinical hematology. It succinctly covers the most important aspects of the field with an emphasis on clinical features, diagnosis, and treatment. PDQ Hematology thoroughly examines those conditions frequently encountered by physicians and includes general principles for more unusual or complicated diseases. The text also incorporates a discussion of malignant lymphomas as well as the usual clinical hematology topics (such as anemia and leukemia). The extensive use of tables and diagrams make this portable book an accessible and practical companion.

You can preview this reference online at:
http://www.meduweb.com/showthread.php?t=10089

Another site I found that is very helpful for any type of cancer including Hematopoietic:
http://www.cancer.gov/cancertopics/pdq

" PDQ (Physician Data Query) is NCI's comprehensive cancer database. It contains summaries on a wide range of cancer topics; a registry of 8000+ open and 19,000+ closed cancer clinical trials from around the world; and a directory of professionals who provide genetics services. PDQ also contains the NCI Dictionary of Cancer Terms, with definitions for 6000+ cancer and medical terms, and the NCI Drug Dictionary, which has information on 1200+ agents used in the treatment of cancer or cancer-related conditions."

And of course, the educational modules for understanding the reporting of Hematopoietic & Lymphoid Neoplasms can be found at:
http://www.seer.cancer.gov/tools/heme/training/

Here is a printed list of the hematopoietic coding changes for 2010:
http://publichealth.lsuhsc.edu/tumorregistry/PDF/Hematopoietic%20Histology%20Codes.pdf

Flash cards that review hematology (leukemia starts at card 77)
http://quizlet.com/507151/hematopoietic-and-lymphoid-pesek-flash-cards/

And for those of us with questions about the changes for the 2010 data:
http://health-information.advanceweb.com/Editorial/Content/Editorial.aspx?CC=223046

Cells That Live Forever, the Story of Henrietta Lacks

When Henrietta Lacks first stepped foot inside John Hopkins Hospital in Baltimore, she wasn't thinking of changing the world. She arrived at John Hopkins because she was suffering from unexplained vaginal bleeding that would later turn out to be a fatal form of cervical cancer.

The year was 1951, a time when medical science was desperately looking for malignant cells that would grow and proliferate outside the human body. If this could be accomplished, medicine would be closer to understanding and possibly finding a cure for cancer. This was no small feat, little was known about what it took keep these cells alive and contamination of the cell culture was common. Bacteria and other microorganisms could easily destroy any growing cell colony.

But all that was about to change.

Henrietta was just thirty years old when she was diagnosed. The cancer turned out to be a very aggressive type, presenting as a grape colored lesion located at the four o'clock position on the surface of the cervix. The lesion bled easily and seemed to be capable of spreading rapidly. The physician who examined Henrietta took a sample of this tissue and sent it to the lab for analysis.
Some of this tissue ended up in the hands of George Gey.

George Gey was the head of tissue culture research at Hopkins and he set about starting a culture using Henrietta cells. Amazingly these cells turned out to be quite different than any they had seen before. The cells reproduced at an astounding rate, doubling their numbers within the first twenty-four hours. It soon became apparent that George Gey was looking at the first immortal human cells. Soon other labs requested samples for cancer research and Gey responded by sending Henrietta's cells to any scientist who wanted them. Soon these cells would find their way into mass production and turn out to be instrumental in the development of the polio vaccine, drugs for the treatment of various chronic illnesses, secrets of cancer and gene mapping.

Immortality had come to Henrietta Lacks and it was found under a microscope. There, the cells taken from that first biopsy, reproduced faster than any other cells had before, even cancer cells. These cells took on life of their own living independently from the organism they had come from, reproducing and spreading on their own.

Science gave them a name HeLa cells.

In 1991, it was decided that this group of cells should be given its own genus and species: Helacyton gartleri. A new species observed developing from another.

In her short life, Henrietta Lacks had opened the door for the scientific world to take a huge step forward in the advancement of knowledge and achievement in medicine.

The book "The Immortal Life of Henrietta Lacks" can be found at Amazon.com and Barnes and Nobel book stores.