Thursday 28 March 2019

Siewert classification

AC = anatomical cardia
Source: Ulla M, et al. Esophageal cancer characterization with pneumo-64-MDCT. Abdom Imaging. 2012 Aug;37(4):501-11. Available at: https://doi.org/10.1007/s00261-011-9784-z.

«The Siewert-Stein classification is a system of anatomical classification used for adenocarcinomas of the esophagogastric junction.»
Bibliographic reference: En.wikipedia.org. (2019). Siewert classification. [online] Available at: https://en.wikipedia.org/wiki/Siewert_classification [Accessed 28 Mar. 2019].

Stomach parts

«This drawing shows the parts of the anterior surface of the stomach. The body of the stomach is separated from the pyloric part by an oblique line that extends from the angular notch (incisura angularis) on the lesser curvature to the greater curvature.»
Source: Uptodate.com. (2019). UpToDate. [online] Available at: https://www.uptodate.com [Accessed 28 Mar. 2019].

Esophageal regions

«Anatomy of esophageal cancer primary site, including typical endoscopic measurements of each region measured from the incisors. Exact measurements depend on body size and height. For tumors of the EGJ and cardia, location of cancer primary site (ie, esophagus, stomach) is defined by cancer epicenter.»
v: vein
Source: Uptodate.com. (2019). UpToDate. [online] Available at: https://www.uptodate.com [Accessed 28 Mar. 2019].

Esophagus lesion
Anatomic boundaries
Distance from the incisors (cm)
Cervical
Hypopharynx to sternal notch
15 to < 20
Upper thoracic
Sternal notch to azygos vein
20 to < 25
Middle thoracic
Lower border of azygos vein to inferior pulmonary vein
25 to < 30
Distal/lower thoracic
Lower border of inferior pulmonary vein to EGJ
30 to < 40
Abdominal/EGJ
EGJ to 2 cm below EGJ
40 to 45
EGJ = esophagogastric junction
Source: Rice TW, Kelsen D, Blackstone EH, Ishwaran H, Patil DT, Bass AJ et al. 16 - Esophagus and Esophagogastric Junction. In: Amin MB, Edge SB, Greene FL, Byrd DR, Brookland RK, Washington MK, et al., ed. By: AJCC Cancer Staging Manual. 8th ed. Springer International Publishing; 2017. p. 187.

RAS (rat sarcoma) gene

«The word RAS comes from a contraction of Rat sarcoma, the tumor where the first gene of the family was identified, as part of the genome of a retrovirus isolated from a carcinogenesis protocol [3].» It is «a family of genes that make proteins involved in cell signaling pathways (cellular signal transduction [2]) that control cell growth and cell death [1].» «RAS is a guanosine-nucleotide-binding protein. Specifically, it is a single-subunit small GTPase [2]». «When RAS is switched on by incoming signals, it subsequently switches on other proteins, which ultimately turn on genes involved in cell growthdifferentiation, and survival. (...). RAS-regulated signal pathways control such processes as actin cytoskeletal integrity, cell proliferationcell differentiationcell adhesionapoptosis, and cell migration [2].» «Mutated (changed) forms of the RAS gene may be found in some types of cancer. These changes may cause cancer cells to grow and spread in the body [1].» «Mutations in RAS genes can lead to the production of permanently activated RAS proteins. As a result, this can cause unintended and overactive signaling inside the cell, even in the absence of incoming signals. (...). The 3 RAS genes in humans (HRASKRAS, and NRAS) are the most common oncogenes in human cancer; mutations that permanently activate RAS are found in 20% to 25% of all human tumors and up to 90% in certain types of cancer (e.g.pancreatic cancer). For this reason, RAS inhibitors are being studied as a treatment for cancer and other diseases with RAS overexpression [2]
«HRAS was initially isolated from the Harvey sarcoma virus. KRAS from the Kirsten sarcoma virus and NRAS was isolated by DNA [deoxyribonucleic acid]-mediated gene transfer from a human neuroblastoma cell line [3].»
«RAS gene mutations are among the most frequently mutated genes in human cancers, found in approximately 30% of all tumor types and in approximately 50% of colorectal cancer (CRC). (...). In addition, oncogenic RAS mutations cause acquired resistance to anti-epidermal growth factor receptor (EGFR) therapies such as cetuximab and panitumumab. Given its clinical relevance as an important predictive biomarker, the American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines recommend RAS testing for KRAS and NRAS mutations in exon 2 (codons 12 and 13), 3 (codons 59 and 61), and 4 (codons 117 and 146) when managing patients with metastatic colorectal cancer. [4].»
Bibliographic references:
[1] National Cancer Institute. (n.d.). NCI Dictionary of Cancer Terms. [online] Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/ras-gene-family [Accessed 28 Mar. 2019].
[2] En.wikipedia.org. (2019). Ras subfamily. [online] Available at: https://en.wikipedia.org/wiki/Ras_subfamily [Accessed 28 Mar. 2019].
[3] Pellicer A. (2011) RAS Genes. In: Schwab M. (eds) Encyclopedia of Cancer. Springer, Berlin, Heidelberg. Available at: https://doi.org/10.1007/978-3-642-16483-5_4951.
[4] Scott AJ, et alTherapeutic Approaches to RAS Mutation. Cancer J. 2016 May-Jun; 22(3): 165–174. Available at: https://dx.doi.org/10.1097/PPO.0000000000000187.

Friday 22 March 2019

Spinal cord end

«In humans, the spinal cord stops growing in infancy and the end of the spinal cord is about the level of the third lumbar vertebra, or L3, at birth. Because the bones of the vertebral column continue to grow, by about 12 months of age, the end of the cord reaches its permanent position at the level of L1 or L2 (closer to the head). However, due to normal anatomical variations, the final cord end position may occur anywhere from the twelfth thoracic vertebra (T12) to L3.»

Source: Spine and Pelvis [Internet]. Musculoskeletal Key. 2016 [cited 2019 Jul 7]. Available from: https://musculoskeletalkey.com/spine-and-pelvis-3/.

Bibliographic reference: En.m.wikipedia.org. (n.d.). Cauda equina. [online] Available at: https://en.m.wikipedia.org/wiki/Cauda_equina [Accessed 27 Mar. 2019].

Thursday 21 March 2019

Hypopharynx

«The hypopharynx or laryngopharynx forms the most inferior portion of the pharynx, being the continuation of the oropharynx superiorly and both the larynx and esophagus inferiorly. The hypopharynx begins as the continuation of the oropharynx at the pharyngoepiglottic fold (which is at the level of the hyoid bone) superiorly, and extends inferiorly to the level of the inferior aspect of the cricoid cartilage, where it continues as the cervical esophagus. It is a mucosa-lined, muscular tube with its posterolateral walls formed by the inferior constrictor muscle and anterior wall by laryngeal cartilages. It forms part of the pharyngeal mucosal space.
The  boundaries are:
  • anteriorly: post-cricoid mucosa, posterior cricoarytenoid muscle;
  • posteriorly: mucosal wall, middle and inferior constrictor muscles;
  • superiorly: hyoid bone, glossoepiglottic and pharyngoepiglottic folds;
  • inferiorly: cricoid cartilage, cricopharyngeus muscle.
Three subsites of the hypopharynx are described, being pertinent to localize where squamous cell carcinoma arises:
  • pyriform sinus;
  • posterior wall;
  • post-cricoid region/pharyngo-esophageal junction: forms the anterior wall [1].»
«Embryologically, the larynx interjects into the hypopharynx anteriorly and is therefore considered a separate structure. Hypopharyngeal cancers are often named for their location, including pyriform sinus, lateral pharyngeal wall, posterior pharyngeal wall, or post-cricoid pharynx [2].»


Illustration of the pharynx:
Source: Commons.wikimedia.org. (n.d.). File:2411 Pharynx.jpg - Wikimedia Commons. [online] Available at: https://commons.wikimedia.org/wiki/File:2411_Pharynx.jpg [Accessed 21 Mar. 2019].

«The hypopharynx is the longest of the 3 segments of the pharynx. It is wide superiorly and progressively narrows toward the level of the cricopharyngeal muscle. It is bounded anteriorly by the posterior face of the cricoid cartilage. The parts of the hypopharynx that lie partly to each side of the larynx form the pyriform sinuses or fossae [2].»
Source: [2].

Source: [2].

Bibliographic references:
[1] Deng, F. and Knipe, H. (2018). Hypopharynx | Radiology Reference Article | Radiopaedia.org. [online] Radiopaedia.org. Available at: https://radiopaedia.org/articles/hypopharynx [Accessed 21 Mar. 2019].

[2] Quon, H. and Goldenberg, D. (2017). Hypopharyngeal Cancer: Overview, Clinical Presentation, Etiology and Risk Factors. [online] Emedicine.medscape.com. Available at: https://emedicine.medscape.com/article/1375268-overview [Accessed 21 Mar. 2019].

Thursday 14 March 2019

Primary treatment

It is «the first treatment given for a disease. It is often part of a standard set of treatments, such as surgery followed by chemotherapy and radiation. When used by itself, primary treatment is the one accepted as the best treatment. If it doesn’t cure the disease or it causes severe side effects, other treatment may be added or used instead. Also called first-line therapy, induction therapy, and primary therapy.»
Bibliographic reference: National Cancer Institute. NCI Dictionary of Cancer Terms. Primary treatment. Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/primary-treatment. Accessed 2019 Mar 14.

Monday 11 March 2019

Cancer-related survival

It is the time from diagnosis of cancer, or the start of treatment for cancer, to the date of death related to primary cancer.
Bibliographic reference: Wu YC, et al. Long-term results of pathological stage I non-small cell lung cancer: validation of using the number of totally removed lymph nodes as a staging control. Eur J Cardiothorac Surg. 2003 Dec;24(6):994-1001. Available at: https://doi.org/10.1016/S1010-7940(03)00567-0.

Late side effects of radiotherapy

Toxicity typically occurring more than 3 months after treatment.
Bibliographic reference: Peach MS, et al. Systematic Review of the Relationship between Acute and Late Gastrointestinal Toxicity after Radiotherapy for Prostate Cancer. Prostate Cancer. 2015;2015:624736. Available at: https://doi.org/10.1155/2015/624736.

Acute side effects of radiotherapy

Toxicity typically occurring within 3 months of treatment.
Bibliographic reference: Peach MS, et al. Systematic Review of the Relationship between Acute and Late Gastrointestinal Toxicity after Radiotherapy for Prostate Cancer. Prostate Cancer. 2015;2015:624736. Available at: https://doi.org/10.1155/2015/624736.

Saturday 9 March 2019

Definitive treatment

«The treatment plan for a disease or disorder that has been chosen as the best one for a patient after all other choices have been considered [1]». It is «any therapy generally accepted as a specific cure of a disease [2]». It «is the first clinical intervention intended to manage a patient's disease, condition or injury and avoid further clinical interventions [3]». It is «a therapy that may be final, superior to others, curative, or all of those [4]». For example, definitive radiation is the «administration of radiation as a sole or first therapy, usually for cancer, with curative intent [5]».
Bibliographic references:
[1] National Cancer Institute. NCI Dictionary of Cancer Terms(n.d.). Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/definitive-treatment [Accessed 9 Mar. 2019].
[2] TheFreeDictionary.com. (n.d.). definitive treatment. [online] Available at: https://medical-dictionary.thefreedictionary.com/definitive+treatment [Accessed 9 Mar. 2019].
[3] Datadictionary.nhs.uk. (2018). Supporting Information: First Definitive Treatment. [online] Available at: https://www.datadictionary.nhs.uk/data_dictionary/nhs_business_definitions/f/first_definitive_treatment_de.asp?shownav=1 [Accessed 9 Mar. 2019].
[4] En.wikipedia.org. (2019). Therapy. [online] Available at: https://en.wikipedia.org/wiki/Therapy#Lines_of_therapy [Accessed 9 Mar. 2019].
[5] TheFreeDictionary.com. (n.d.). definitive radiation. [online] Available at: https://medical-dictionary.thefreedictionary.com/definitive+radiation [Accessed 9 Mar. 2019].