STUDY

-used the word oncos (swelling in greek) to describe tumours. -He theorized that there are 4 types of fluid in our body Mucus, bile and blood but cancer is caused by melancolia (black fluid)= if there is imbalance and too much melancolia there will be cancer

began questioning the theory of melancolia - after tons of research on cadavers he concluded that melancolia imbalance is not real as there is no such thing as melencolia.

looked at cells under microscope- and determined “cancer comes from within our own bodies”

-began performing and perfecting mastectomies around 1882. -Under the assumption that if you remove the tumor the cancer will be gone. -However 50% of his patients actually died even after the surgery. He then began removing even more of the breast tissue but still a lot of his patients died. -William Halsted was a heavy drug user and was very stubborn. He began performing radical mastectomies- he removed the entire breast and surrounding tissue and muscles (very invasive and barbaric.) -The reason why patients were dying even after the operation (tumor removal) was metastasis (cancer had spread already to the bloodstream.)

-he would receive many slides and he had to determine whether the child patient had cancer. -The mustard gas used during ww2 could kill cells. His colleague made a less toxic version of this gas and created ‘aminopterin.’ -He observed that in animals aminopterin caused shrinking in tumors. He was denied experimentation on patients. -Sidney F. eventually experimented on a two year old twin who was on his deathbed. In the second week, he begins to start eating and by the 3rd injection the kid begins walking around. 2 months later he was cancer-free. -Sidney Farber’s experiment worked- the first drug that actually worked against leukemia. A very low dose of Aminopterin is still used today if a patient does not have a match - Today we identify the mutation in the protein of the dna/rna that has caused the tumor.

epithelial cells (keep generating new cells)- any time there is cell division you are risking getting cancer.

• Lungs are more blood rich and circulating • Late diagnosis in lung cancer due to symptoms showing up late

1930’s- 4 major reasons- -great depression, malnutrition -No refrigeration therefore highly processed meat -(nitrate processing= actually carcinogenic) -Not the right antibiotics therefore source of infections were very high - high consumption of alcohol after prohibition VS 1960’s - it was established that nitrates were carcinogens -H-pylori killing antibiotics became more available

pancreatic cancer- very hard to diagnose and they only get treated when its very bad

-Lots of smoking cigarettes after prohibition

worked to decrease the consumption of cigarettes in the United states. He confronted the republican government at the time about promoting cigarettes, and explained that they were harmful/ carcinogenic. Since many cigarette companies were paying the government at the time, he was initially unable to make progress. He continued to lobby and made partial progress as the government agreed to mention that cigarettes may be hazardous for pregnant women. Unfortunately, many people who smoked at the time were uneducated, they were told in advertisements that cigarettes have no harm to health, were approved by physicians and even encouraged by doctors. Lobbyists were paid to encourage children/ youth to start or continue smoking. However, in a turn of events, the state hired lawyers to convey a new rule to the companies; the companies would have to pay for every person who died. Companies left the United states and targeted european/ third world countries where strict regulations were not in place at the time.

● Health disparity is a notion of a subgroup of the population that are non receiving proper health care. ● The number of black people die of cancer is HIGHER than the number of white despite cancer being lowered in diagnosed rates 37 PERCENT OF DEATH CAN BE AVOIDED IF THERE WERE NO RACIAL AND ECONOMIC DISPARITIES Genetics plays a small role in health disparity. There are three major causes, which give rise to several others ● Access TO INSURANCE (1) so now proper access to ● Economic disparity ● ACCESS TO GOOD FOOD/ nutrition ● Mistrust in patients with doctors of certain races. ● Migrant health is unaddressed/ barriers ● Understaffed hospitals ● Healthcare facilities being less good in poor areas ● Limited representation in doctor ● LACK OF EDUCATION: huge disadvantage, no decent job, no insurance, no early detection, no regular access to healthcare ● Some areas where there are no actual grocery stores in 10 miles radius but liquor store and fast food are readily available. From 2000-2010 There are double people who got mammogram with insurance than without

Dee Dee ricks and cynthea, millionaire and cynthea is a receptionist, huge difference when cancer Millionaire vs poor DIAGNOSIS Dd ricks gets regular mammogram and finds out there’s a suspicious lump/ suspicious lesion in breast, in jan 2015, same day she was sent for an ultrasound right away, ultrasound showed it is suspicious, in one week she had a mri and then a week later she had a biopsy She finds out she has aggressive cancer HER2 BREAST CANCER. IN CONTRAST DIAGNOSIS Cynthia feels pain in her left breast, so she talks to a couple of people who recommend a clinic 4 stops away for a free mammogram. She got a mammogram and found an extremely big lump/ several lumps in her breast, she said she has no insurance. Delays ultrasound. Pro Bono free place in bronx that does free ultrasounds ONCE A MONTH. After a month she gets an ultrasound. She gets referred for biopsy. She waited for three months. SURGERY CYNTHEA Finds out there’s a surgeon pro bono work. She finds out she has HER2 CANCER 4 months total After 2 months, surgery was done. 6 months total Chemotherapy is 50k a month. Herceptin is the best and only treatment that works for that type of breast cancer. No chemo for 8-9 months Her friend told her about a center chemo center that would allow her to get one round of free chemo. FROM THE MAMMOGRAM TO SURGERY IS IN ONE MONTH: DD rick in a month has a surgery and then an implant. She started her chemotherapy 2 months later, Cynthea asks dd ricks, and they both share a story, dd ricks feels extremely sad and says she said she would raise 1 million dollars. She was unable to form billionaire clients that she was initially working with. Cynthea finds out in 4 months that through the CT scan that meds are not working cuz cancer spreads in lungs. In a few months, she was aggressively treated. Cancer spreads in bones. Herald Freeman did the work for cynthea, the actual surgery. Dd rick raised money to ensure more centers Trump moron closed many women health centers

Many men were reluctant to go to the doctor due to the uncomfortably invasive procedure.

This would allow male patients to go to the doctors office, take a blood test, if number 0.01-1 patient was considered fine. Enormous amount of false positives which means a lot of patients were shown that psa are very high. Follow up biopsy/ ultrasound. False positives with no follow up tests resulted in patients having surgery. They created a new system. When a patient comes in, they ask specific questions and find that if the patient passed 72 hours what they ate etc, if they had spicy food the night before, psa is high, if they had sexual intercourse 24-48 hours before, psa high. If bacterial infection psa high. If condition called BPH benign prostate hyperplasia, non cancer enlargement, also high. Patrick said if ur psa is abnormal, come back in following weeks, for another psa test without doing list of things. 2-3 weeks higher, Test for diagnosis Digital rectal exam Transrectal ultrasound: ultrasound probe inserted into rectum near prostate for imaging purposes Transrectal biopsy, a probe goes through rectum, and 18 to 19 specimens, small chunk of cells, If 18 samples taken 96 percent accuracy Camera attached now helps

95% had serious side effects of prostate surgery -incontinence (loss of control over bladder) or -impotence (no erection possible)

through bladder to remove prostate (prostate gland is located behind bladder) (highly invasive surgery)

Patrick walsh was giving a talk abt prostatectomies. In Ohio State University he saw a drawing of a prostate gland with lines through it. It was a drawing done by a retired anatomy professor. Patrick calls the anatomist and asks him to explain the drawing. The professor says that in cadavers (due to formaldehyde) there are nerves all over the prostate. Based on this assumption due to the professor’s ideas he avoids the nerves on the prostate. After the surgery Walsh gives the patient his phone number. And the phone rings on his anniversary dinner after 4 months. The patient says he still gets erections and this is confirmed by his wife. After this surgery only 15% of the patients struggle with side effects. It revolutionized the field of prostate surgery. Now a robot does this surgery overseen by a urologist and the side effects have decreased by 10%.

PSA caused false positives and was very sensitive. False + could be caused by 4 things: sexual intercourse the night before, spicy food, BPH, bacterial infection. Essentially they operated on many non-cancer patients as well due to the PSA test. The incidence is now less as they do a lot more tests to confirm before diagnosis. Rules and regulations NOW: when a patient comes in with a PSA higher than 1. They retest in 3 weeks again to confirm. It is greater than 2 this time. They retest again in 2 weeks and if its higher than 3 or 4. They conduct a transrectal ultrasound. Then a transrectal biopsy if the ultrasound is suspicious. Then the nerve sparing prostate surgery is then done.

one of the most important mutated receptors and it binds to ligin EGF.

are involved in normal cell proliferation and tumor suppressor example is normal TP53 (triggers cell death/apoptosis).

is an oncogen and the tumour suppressor is broken down due to a mutation (this is in a cancer cell) Smoking, sunbathing can cause a proto-oncogen to be mutated into an oncogen. Cancer cell evades detection by immune response by masking themselves as normally functioning cells

Cancer is essentially a group of diseases (200 approx) characterized by uncontrolled growth and spread of abnormal cells. And growth of abnormal cells. Abnormal cell proliferation ‘growth’ (neoplasia)

• Crypt epithelial cells are primarily secretory in function—water and electrolytes are secreted into the intestinal lumen to solubilize the chyme and neutralize gastric acid. Grey cells are paneth cells (non-dividing, non-differentiating) they hold the crypt stable Red cells are stem cells (undifferentiated and divide every 24 hrs) they become the yellow cells Entrocytes(yellow) (rapidly dividing cells) secretory goblet cells (Blue cells) absorptive enterocytes non-dividing differentiated cells When they reach the top they die