Mod 3 Class PaASU

Respond classmates post all 2 questions. Cite all work. 100-150 words. Due 28 Aug by 3cst .

1.I initially thought of this discussion a “no-brainer” immediately after reading the assignment until I read this particular article, and several others for references which changed my mind as they painted the picture in a more sensitive fashion; although we all know that there is nothing sensitive about cancer. My first thought as a medical professional was how could there be any cons that might outweigh the benefits of surgical removal of potentially cancerous cells to preserve a patient’s life or possibly even my own? Especially when I saw the horrifying images of progression from normal cells to neoplasm in Figure 11.3 in our textbook (Huether 2020) The textbook refers to Carcinoma in "Situ" or simply put as "in place” as pre-invasive epithelial tumors on page 228, and continues to explain the three fates  of CIS lesions such as they can either remain stable, progressive to metastatic cancer or actually regress and disappear. (Huether 2020) The three fates sound a lot like Russian Roulette to me, so why not choose immediate surgery? I will explain. I came across this article that caught my attention “ Treatment of low-risk ductal   carcinoma in situ: is nothing better than something?”  (2016) The article refers to ductal carcinoma in situ andbreast cancer. According to (Benson, J.R., Jatoi, I., & Toi, M. 2016) “Surgical treatment incur potential morbidity, especially when mastectomy and breast reconstruction are done for wide-spread low grade or intermediate-grade ductal carcinoma in situ. Changes include active surveillance for low-risk lesions and watchful waiting policy with intervention when invasive local recurrence after breast-conserving surgery is detected” ( Benson, J.R., Jatoi, I., & Toi, M. 2016 ) the article then continues to imply that further genetic interrogation might even lead to a reclassification of some low-grade lesions as non-cancerous entities altogether. (Benson, J.R., Jatoi, I., & Toi, M.,2016) So why not choose watchful waiting over unnecessary high-risk surgery?  Several other interesting articles also agreed with this and pointed out the risks and harms of carcinoma in situ and breast cancers in women being over-diagnosed, and at times leading to unnecessary surgeries not to exclude deformities, and potential depression, etc. Unfortunately, most journals were outdated so I cannot cite the information I found. I also must imply that my opinion on this topic might differ based on the stage of cancer, the patient’s co-morbidities, and the age of the patient. In this topic, I am going to assume that the patient is otherwise healthy.

References

Benson, J.R., Jatoi, I., & Toi, M (2016) The Lancet Oncology. Treatment of low-risk ductal carcinoma in situ: is nothing better than something? Elsevier. Retrieved on (08/2020) https://doi.org/10.1016/S1470-2045(16)30367-9

Huether Sue E & McCance, Kathryn L. 2020 Understanding Pathophysiology St. Loius, Missouri: Elsevier

 

 

 

 

2. While inflammation is the body’s defense mechanism against pathogens, damaged cells, and chemical irritants, it also has a dark side. According to Huther & McCance, “chronic inflammation has been recognized for close to 150 years as being an important factor in the development of cancer.” (p248.).  Lately, it turned out that acute inflammation contributed to the regression of cancer. However, accumulated epidemiologic studies support that chronic inflammatory diseases are frequently associated with increased risk of cancers, Lao, C., Edlin, R., Rouse, P. et al (2017). At the initial stage of inflammation, neutrophils are the first cells to migrate to the inflammatory sites under the regulation of molecules produced by rapidly responding macrophages and mast cells prestation in tissues.  As the inflammation progresses, various types of leukocytes, and other inflammatory cells are activated and attracted to the inflamed site by a signaling network involving a great number of growth factors, cytokines, and chemokines. All cells recruited to the inflammatory site contribute to tissue breakdown and are beneficial by strengthening and maintaining the defense against infection.

Chronic inflammation role in cancer development isn’t a small one. As many as one in five cancers are believed to be caused or influenced by inflammation, Lao, C., Edlin, R., Rouse, P. et al (2017).  Chronic inflammation also may result from a chronic infection, like H. pylori, which is linked to stomach cancer, and hepatitis B and hepatitis C, which are linked to liver cancers. The reason inflammation becomes chronic isn’t always apparent. It may be caused by infections that don’t go away, abnormal immune reactions to normal tissues, or certain conditions like obesity. Sometimes, cancer-causing chronic inflammation stems from a disease characterized by inflammation. In other cases, environmental factors are the culprits. Asbestos exposure, for example, increases the risk for mesothelioma. Alcohol consumption and smoking can increase the risk of cancers especially head and neck, esophageal, breast, liver, and pancreatic cancers. 

Moreover, promoting anti-inflammatory nutrients, such as fish, fruits and vegetables, lean proteins, and whole grains is a good start. Many of our foods have been genetically modified and no longer contain the necessary components of a naturally nutrient-dense food. In addition to diet, encouraging physical exercise, offering help with smoking cessation, and minimizing stress are other ways in which patients can decrease or prevent inflammation.

Reference

 

Huther S.E, & McCance (2017). Understanding pathophysiology. 6th ed. St. Louis, Mo .: Elisevie

The cost-effectiveness of active surveillance compared to watchful waiting and radical prostatectomy for low risk localised prostate cancer. BMC Cancer.