Smudge Cells

These are artifacts that occur in the blood smears of patients with chronic lymphocytic leukaemia. They happen because the cells are rather fragile.

Memory aids make life better.

Therefore!

Smudge cells are associated with CLL.

References

  1. LabCE. (2018). Smudge Cells. [online] Available at: https://www.labce.com/spg48905_smudge_cells.aspx [Accessed 11 Sep. 2018].
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Colon Cancer Polyp Conditions

Familial Adenomatous Polyposis

  • Many benign polyps form in the colon, but they can become malignant if the colon is not removed
  • Average age of affected individual developing colon cancer is 39
  • Mostly commonly, is due to autosomal dominant mutation in APC gene
  • Memory aid: FAP and APC both have 3 letters

Hereditary Non-Polyposis Colorectal Cancer

  • Also called Lynch syndrome
  • Increased risk of colorectal cancer and other cancers
  • Associated with increased risk of endometrial cancer in females
  • Colon polyps can occur earlier than in the general population but not in greater numbers
  • Autosomal dominant inheritance but can be due to mutations in a variety of genes, some of which have 3 or 5 letters
  • Memory aid: the one that’s not FAP

References

  1. Genetics Home Reference. (2018). Familial adenomatous polyposis. [online] Available at: https://ghr.nlm.nih.gov/condition/familial-adenomatous-polyposis#genes [Accessed 22 Jul. 2018].
  2. Genetics Home Reference. (2018). Lynch syndrome. [online] Available at: https://ghr.nlm.nih.gov/condition/lynch-syndrome#genes [Accessed 22 Jul. 2018].

Human Herpesvirus Associations

Sometimes, memory aids and mnemonics fall conveniently into place. Other times, the only way to remember something is through its inconvenience, by taking the opposite of whatever it totally should have been.

HHV-6

  • Associated with roseola
  • Memory aid: roseola has 7 letters, which is inconveniently not 6 but certainly less than 8

HHV-8

  • Associated with Kaposi sarcoma
  • Memory aid: Kaposi has 6 letters, so it is not HHV-6, while Kaposi’s has 8 characters in it

Podcast 020: Medical Oncology With Dr Fran Boyle

Malignancy is the enemy, ironically composed of cells from the self.

In this episode, Dr Fran talks about life as a medical oncologist.

Podcast

About the guest speaker

Dr Fran Boyle is a medical oncologist.at North Sydney’s Mater Hospital, where she is Director of the Patricia Ritchie Centre for Cancer Care and Research, and Professor of Medical Oncology at the University of Sydney. She is involved in the oncology teaching program of the Sydney Medical School and in communication skills training through the Pam McLean Centre.

Professor Fran’s clinical practice at the Poche Centre focuses on breast cancer and melanoma. Her current research interests include clinical trials of new cancer treatments, psychosocial and supportive care, and communication. Fran chairs the Board of Directors of the ANZ Breast Cancer Trials Group, and is a founding Director of the Australian Clinical Trials Alliance. She was honoured with Membership of the Order of Australia in 2008 for services to cancer research, advocacy, policy development and professional education.

Music credits

Opening and closing themes by Lily Chen.

Aromatase Inhibitors

Breast cancer can be oestrogen-sensitive, so a treatment target for such types is to inhibit oestrogen.

In premenopausal women, selective oestrogen receptor modulators, more conveniently called SERMs, include tamoxifen. This particular medication acts as an oestrogen receptor antagonist at the breast but an oestrogen receptor agonist at the uterus, which is why it minority increases the risk of endometrial cancer.

In postmenopausal women, aromatase inhibitors are an option. These interrupt the production of oestrogen by suppressing the action of the enzyme aromatase. Anastrazole and letrozole are the names to know here; they’re non-steroidal, reversible binders of aromatase from the third generation of aromatase inhibitors.

Why are aromatase inhibitors less effective in premenopausal women? Premenopausal women have a large quantity of aromatase in the ovary. Note that ovarian aromatase is sensitive to changes in the gonadotropin LH, which is produced by the pituitary gland. If aromatase is suppressed with an aromatase inhibitor, gonadotropins increase in response, according to the usual feedback pattern, which stimulates more ovarian aromatase. This makes aromatase inhibitors less proficient at inhibiting oestrogen production in the ovary in such a group.

References

  1. Fabian, C. J. (2007). The what, why and how of aromatase inhibitors: hormonal agents for treatment and prevention of breast cancer. International Journal of Clinical Practice, 61(12), 2051–2063. http://doi.org/10.1111/j.1742-1241.2007.01587.x

Contraindications To Lumbar Puncture

A lumbar puncture is a procedure that involving drawing out cerebrospinal fluid, fondly known as CSF. For example, it can be used to check CSF for immune cells and glucose levels in suspected meningitis.

Lumbar puncture is considered an invasive procedure. But even with that aside, it’s not appropriate for everyone. That is, it does not suit all patients.

Contraindications to lumbar puncture are:

  • Skin infection at the lumbar puncture site
  • Uncorrected coagulopathy
  • Increased intracranial pressure
  • Trauma to the spinal cord

References

  1. Queen’s University School of Medicine. (n.d.). Contraindications. [online] Available at: https://meds.queensu.ca/central/assets/modules/lumbar_puncture/contraindications.html [Accessed 2 Feb. 2018].

Why Don’t NSAIDs Cause Malignancy?

Do topical NSAIDs increase the risk of skin cancer? After all, NSAIDs dampen inflammation and immune suppression is a factor that can promote malignancy. The answer is no!

For, on the contrary, research focuses more on the potential of using NSAIDs in the fight against cancer. How can this be?

Think of the mechanism of NSAIDs. They’re non-steroidal anti-inflammatory drugs, meaning they’re medications that reduce inflammation without being from the corticosteroid class.

NSAIDs indirectly inhibit prostaglandin synthesis by directly inhibiting COX enzymes. This provides anti-inflammatory effects and analgesia.

Prostaglandins play a starring role in situations such as fever.

In contrast, other things that are associated with increased malignancy risk have different ways of working.

For example, HIV impacts CD-4 T cells.

Meanwhile, chemotherapy agents have different mechanisms. For example, vincristine disruptively acts on microtubules.

Let’s not forget UV rays, which wreak havoc on the DNA process by inducing mutations.

These are just some of the villains of medicine. Thankfully, there are emerging medications that meet them in combat. But that’s a story for another day!