Hospitals & Asylums
Oncology HA-18-9-13
By Anthony J. Sanders
A leper said to Jesus, "if you are willing you can heal me" (Mark 1:40)(Luke 5:12)
I. Anatomy and Physiology of the Tissues
1. Skin
2. Hair and nails
3. Histologic tissues
II. Dermatology
1. Eczema and Dermatitis
2. Burns
3. Acne, impetigo, leprosy, bacterial and mycobacterial infections
4. Warts, herpes and viral infections
5. Tinea and fungal infections
6. Lice, mites and parasitic infestations
7. Psoriasis
8. Lupus erythematosus
9. Pigmentary disorders
10. Hair loss, dandruff and nail infections
11. Heredity disease and aging
III. Cancer
A. Neoplasia
1. Skin cancer
2. Tumors of the central nervous system
3. Cancers of the head, neck and lung
4. Vascular neoplasm
5. Abdominal cancer
6. Female neoplasia
7. Male neoplasia
8. Urogenital cancer
9. Myeloma
10. Leukemia
11. Lymphoma
12. Bone and soft tissue sarcomas and endocrine cancer
IV. Treatment
1. Toxicology
2. Diagnosis
3. Surgery and Radiation
4. Medicine
5. Exercise
6. Diet
Charts
I.1.1 Skin
I.1.2 Epidermis
I.1.3 Dermis
I.1.4 The Two Types of Sweat Glands in Humans
I.2.1 Hair
I.2.2 Nails
I.2.3 Fingerprints
I.3.1 Tissues
I.3.2 Slides of Epithelial Cells
I.3.3 Slides of Connective Tissues
I.3.4 Slides of Muscles Cells
I.3.5 Slides of Neurons and Nerves
II.1.1 Eczema
II.1.2 Actinic Keratosis
II.1.3 Hives
II.1.4 Bullous Pemphigoid
II.2.1 Degrees of Skin Burn
II.2.2 Mesh Skin Graft
II.3.1 Types of Acne
II.3.2 Impetigo
II.3.3 Boil
II.3.4 Leprosy
II.4.1 Herpes simplex
II.4.2 Chickenpox
II.4.3 Types of Warts
II.5.1 Athlete's foot
II.5.2 Tinea versicolor
II.5.3 Candidiasis (thrush)
II.6.1 Lice and nits in hair
II.6.2 Scabies
II.7.1 Psoriasis
II.8.1 Butterfly rash
II.8.2 Monitoring for Lupus Medication Side-effects
II.9.1 Chloasma
II.9.2 Vitiligo
II.9.3 Types of Skin Pigmentation
II.9.4 Malignant Melanoma
II.10.1 Male Pattern Hairloss
II.10.2 Alopecia areata
II.11.1 Ichthyosis
III.A.1 Estimated Cancer Type Percentages in the United States in 1991
III.A.2 Death Rate as a Percentage of Total Cancer Deaths in Selected Countries During the Period 1984-1986
III.A.3 Trends in the Five-Year Survival Rates of Cancer 1960-1985
III.A.4 Five-Year Survival of American Children Diagnosed with Cancer <15; 1973-1981
III.1.1 Types of Skin Cancer
III.1.2 Squamous and Basal Cell Carcinomas of the Skin
III.1.3 Mole Chart
III.1.4 Mycosis Fungoides
III.2.1 Symptoms of Central Nervous System Tumors
III.2.2 CNS Tumor Frequency, Median Age, Survival and Treatment
III.3.1 Staging System for Head and Neck Cancers
III.3.2 Staging System for Lung Cancer
III.3.3 Combination Chemotherapy Regimens Commonly Used in Small Cell Lung Cancer
III.5.1 Staging for Esophageal Cancer
III.5.2 Gastric Cancer Staging
III.5.3 Colon Cancer Staging
III.5.4 Staging for Anal Cancer
III.6,1 Staging System for Breast Cancer
III.6.2 Chemotherapy Regimens for Breast Cancer
III.6.3 Staging for Cervical Cancer
III.6.4 Combination Chemotherapy for Cervical Carcinoma
III.6.5 Staging for Carcinoma of the Ovary
III.6.6 Survival Rates for Combination Chemotherapy Regimens for Ovarian Cancer
III.6.7 Staging for Carcinoma of the Endometrium
III.6.8 Staging for Cancer of Vulva
III.6.9 Staging of Gestational Trophoblastic Neoplasms
III.7.1 Prostate Cancer Staging System
III.7.2 Penile Cancer Staging System
III.7.3 Common Chemotherapy Regimens for Testicular Cancer
III.8.1 Renal Cell Cancer Staging System
III.8.2 Bladder Cancer Staging System
III.9.1 Common Laboratory Features of Plasma Cell Dyscracias and Myeloma
III.9.2 Chemotherapy for Multiple Myeloma, Plasma Cell Dyscracias, Waldenström macroglobulinemia and Langerhans’ cell histiocytoses
III.10.1 Differential Diagnosis of Leukemias
III.10.2 Chemotherapy for Leukemia
III.11.1 Non-Hodgkin’s Lymphomas
III.11.2 Chemotherapy for Lymphoma
III.12.1 Staging System for Soft-Tissue Sarcomas
IV.1.1 Radiation Exposure Due to Medical Tests
IV.1.2 Toxicity Profile for Selected Chemotherapeutic Agents
IV.2.1 Common Skin Diseases
IV.2.2 Common Laboratory Stains
IV.2.3 X-ray of Thoracic Tumor
IV.3.1 Wide Excision of Malignant Melanoma on Neck
IV.3.2 Radiation Complications
IV.4.1 Equivalent Doses of Glucocorticoid Drugs
IV.4.2 Comprehensive Tumor Treatment
IV.6.1 Vitamin and Mineral Deficiencies
IV.6.2 Herbal Remedies for Cancer
I. Anatomy and Physiology of the Tissues
1. Skin
The skin is the largest organ in the body, and it fulfills many vital functions. It forms a protective barrier between the body and the environment and plays an important role in the immune system by detecting infections. It helps regulate the body's temperature, preventing overheating by sweating and it protect against damage from ultraviolet (UV) radiation. As a sensory organ, the skin helps discern conditions in the outside world – temperature, texture, vibrations – and is a medium for social and sexual communication (Davenport et al '03: 8). The skin is about one millimeter thick. Skin is composed of three layers: the epidermis, the dermis, and the subcutaneous tissue (hypodermis) (Greaves '00: 175). The epidermis is nonvascular and varies in thickness from 0.04 mm on the eyelid to 1.6 mm on the palms. In decreasing number, the four types of cells in the epidermis are: keratinocytes, melanocytes, Langerhans cells, and Merkel cells. Beneath the epidermis is the dermis, which has two layers. The papillary layer is superficial, and the reticular layer is deeper. Collagen constitutes approximately 70% of the dry weight of the dermis. Elastic fibers which give skin its elastic properties, constitute approximately 1%. The reticular layer merges with the subcutaneous fascia at its deepest aspect (Tran, Turk & Baldwin '04: 355). The skin, hair and nails develop early in the life of the embryo: the basal layer of the epidermis begins to develop just four weeks after conception. By seven weeks, flat cells overlying the basal layer form the periderm, which is cast off at about 24 weeks and replaced by more complicated double-layered structure of the epidermis and dermis. The function of the periderm is not wholly understood, but it is probably concerned with the absorption of nutrients. Nails start to take shape 10 weeks after conception. The dermis (mesoderm) develops at 11 weeks and by 12 weeks, indented basal buds of the epidermis form the hair bulbs, with dermal papillae supplying vessels and nerves to the epidermal structures. By 17 weeks, fingerprint ridges are determined and sebaceous glands are becoming active under the influence of maternal hormones that cross the placenta. This sebaceous activity continues until a baby is about six months old, then it tapers off until puberty (Davenport et al '03: 9).
The skin is composed of tissue that grows, differentiates and renews itself constantly. Since the skin is a barrier between the internal organs and the external environment, it is uniquely subjected to noxious external agents and is also a sensitive reflection of internal disease. The skin is divided into three rather distinct layers. From inside out, they are the subcutaneous tissue, the dermis and the epidermis. The subcutaneous tissue, is a layer that serves as a receptacle for the formation and the storage of fat, is a locus of highly dynamic lipid metabolism, and supports the blood vessels and the nerves that pass for the tissues beneath to the dermis above. The deeper hair follicles and the sweat glands originate in this layer. The dermis (Corium) is a layer made up of connective tissue, cellular elements and ground substance. It has a rich blood and nerve supply. The sebaceous glands and the shorter hair follicles originate in the dermis. Anatomically, the corium can be divided into papillary (upper) and reticular (lower) layers. The connective tissue consists of collagen fibers, elastic fibers, and reticular fibers. All of these, but most importantly the collagen fibers, contribute to the support and the elasticity of the skin. The collagenous fibers are made up of eosinophilic acellular proteins responsible for nearly a fourth of man's overall protein mass. These fibrils are composed of covalently cross-linked and overlapping units called tropocollagen molecules. When tannic acid or the salts of heavy metals, such as dichromates, are combined with collagen, the result is leather. Elastic fibers are thinner than most collagen fibers and are entwined among them. They are composed of the protein elastin. Elastic fibers do not readily take up acid or basic stains such as hematoxylin and eosin, but they can be stained with Verhoeff's stain. Reticular fibers are thought to be immature collagen fibers, since their physical and chemical properties similar. They can be stained with silver (Foots stain). Reticulum fibers are sparse in normal skin but are abundant in certain pathological conditions of the skin such as the granulomas of tuberculosis, syphilis, and sarcoidosis, and in the mesodermal tumors such as histiocytomas, sarcomas and lymphomas (Sauer '85: 2).
The epidermis is the most superficial of the three layers of the skin and average skin thickness about the width of the mark of a sharp pencil, or less than 1 mm. There are two distinct types of cells in the epidermis, the keratinocytes and the dendritic cells, or clear cells. The keratinocytes, or keratin-forming cells, are found in the basal layer and give rise to all other the other cells of the stratified epidermis. The dendritic cells are of three types: (1) melanocytes (melanin-forming cells, (2) Langerhans cells, and (3) indeterminate dendritic cells. The epidermis is divided into five layers. From inside out, they include the following: the living layers (1) basal layer, (2) prickle layer, (3) granular layer, (4) lucid layer, and (5) horny layer – the dead end product. The basal layer of cells lies next to the corium and contains both keratin-forming and melanin forming cells The basal layer cells are shaped like upturned bricks. They are anchored to a basement membrane from which threads extend down to anchor the membrane to the upper dermis. The keratin-forming cells can be thought of as stem cells, which are capable of progressive differentiation into the cell forms higher up in the epidermis. It normally requires 3 or 4 weeks for the epidermis to replicate itself by the process of division and differentiation. This cell turnover is greatly accelerated in such diseases as psoriasis and ichthyosiform erythroderma. The melanin-forming cells, or melanocytes, are sandwiched between the more numerous keratin-forming cells in the basal layer. Melanin pigmentation in the skin, whether increased or decreased, is influenced by many local and systemic factors. The melanocyte-stimulating hormone form the pituitary is the most potent melanizing agent. The prickle layer, or stratum malpighii, is made up of several layers of epidermal cells, chiefly of polyhedral shape. The prickle cell layer is composed mainly of keratinocytes packed closely together. This layer gets its name from the existence of a network of cytoplasmic threads called prickles, or intercellular bridges, that extend between the cells. These prickles are most readily visible in this layer, but, to a lesser extent are present between all the cells of the epidermis. The third layer is the granular layer. Here the cells are flatter and contain protein granules called keratohyaline granules. The granular layer is made up of flattened keratinocytes that contain not only granules of the protein keratohyaline but also lamellar granules that produce a "cement" that binds the cells together. The lucid layer is next and appears as a translucent line of flat cells. This layer of the skin is present only on the palms and the soles. The granular and the lucid layers make up the transitional layer of the epidermis and act as a barrier to the inward transfer of noxious substances and outward loss of water. The outermost layer of the epidermis is the horny layer. The horny layer (stratum corneum) sits above the granular layer. By now the cells are flattened, with no nuclei or granules. The cells of the horny layer overlap each other like tiles, with the edges stuck together with a fatty "cement" ideal for waterproofing purposes. The horny layer varies in thickness according to the region of the body, it is thickest on the soles of the feet. It is made up of stratified layers of dead keratinized cells that are constantly shedding. The chemical protein in these cells - keratin – is capable of absorbing vast amounts of water. This is readily seen during bathing, when the skin of the palms and the soles becomes white and swollen. The normal oral mucous membrane does not have any granular layer of horny layer (Sauer '85: 3, 4).
Epidermis
The epidermis renews itself constantly by cell division in its deepest layer, the basal layer. Keratinocyte cells produced by division of the basal player are pushed toward the surface to become, in turn, the prickly cell layer, the granular level, and the horny layer, also called the stratum corneum, where they die. As the cells ascend toward the surface, they alter in structure and function. The time it takes for cells to pass from the basal cell layer to the horny layer is about 14 days. It takes another 14 days or so for cells in the horny layer to die and be rubbed off by daily wear and tear. The epidermis varies in depth from 5 cells to 30 cells, depending on the part of the body. The thickness of the skin at any one part of the body always remains constant – the cells lost at the skin surface are balanced by the new skin cells produced in the basal layer. Complex systems of cell growth regulation come into action to speed up to slow down cell division and maturation in the epidermis. Approximately 30,000 dead skin cells are shed form the epidermis every minute (Davenport '03: 18, 19). The epidermis is largely made up of keratin – a protein that in effect provides the body with a protective coating. It is keratin that keeps too much moisture from evaporating form the surface of the skin. Keratin is virtually impenetrable by harmful substance and also has anti-bacterial properties. Keratin is also a major constituent of the epidermal appendages, the hair and nails. Ninety-five percent of all cells in the epidermis are keratinocytes – these are the cells that slowly move upward for the basal layer to the skin's surface. They contain keratin – the main structural protein of the epidermis. Threads of keratin within keratinocytes in the basal and prickle cell layers gradually combine to form bundles that interweave and then become stuck together by a "cement" produced by granules in the granular layer. By the time they reach the horny layer, they form a mat that is an almost impenetrable barrier that stops substances from passing into and out of the body. Interspersed among the basal cells are the melanocytes, adapted nerve tissue cells that send out projections called dendrites between the epidermal cells. They produce the melanin that gives skin its color. Merkel cells (or disks) are concentrated in areas around hair follicles in the basal layer, and probably transmit the sensation of light touch to the brain. Other nerve ending in the skin are sensitive to deeper pressure and temperature changes. Langerhans cells are found in the prickle cell layer, and, like melanocytes, they are dendritic cells. The first line of defense against environmental hazards, they seize harmful microorganisms and deliver them to lymphocytes in the dermis so an immune response can be generated (Davenport et al '03: 19). In normal skin the entire process of keratinocytes dividing, moving from the basal layer area of the epidermis to the cornified outer layer of the skin, and being shed into the surrounding environmental takes about 28 days (Mackie '92: 9).