The Father 0f Medicine

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Ever wonder: When was cancer discovered?  How long has cancer been around?
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Believe it or not, cancer has afflicted   people for several centuries. It is not a new disease. Find out more about the history of cancer. From www.rare-cancer.org:
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Hippocrates is credited with being the first to recognize the difference between benign and malignant tumors.  His writings describe cancers of many body sites. The swollen blood vessels around the malignant tumors so reminded him of crab claws, he called the disease karkinos (the Greek name for crab). In English this term translates to carcinos or carcinoma. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941741/
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Hippocrates was referring to the appearance of tumors. The main portion of the tumor being the crabs body and the various extensions of the tumor appear as the legs and claws of the crab. Hippocrates was the first to use the word cancer to describe tumors Cancer is derived from the Greek word karkinos which means crab It is thought Hippocrates was referring to the appearance of tumors.
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The main portion of the tumor being the crabs body and the various extensions of the tumor appear as the legs and claws of the crab..”
An outstanding doctor of ancient Greece answering to the name Hippocrates not only changed the majority of the medicine and its perception as it was known back then, but he also influences the ethics and morals of people until today.  https://www.youtube.com/watch?v=AreFKsYw96Y

Origin of the Word “Cancer”

The word “cancer” came from the father of medicine: Hippocrates, a Greek physician. Hippocrates used the Greek words carcinos and carcinoma to describe tumors, thus calling cancer “​karkinos.” The Greek terms actually were words that were used to describe a crab, which Hippocrates thought a tumor resembled.

Although Hippocrates may have named the disease “cancer,” he was certainly not the first to discover the disease. The history of cancer actually begins much earlier.

The First Documented Case of Cancer

The world’s oldest documented case of cancer hails from ancient Egypt in 1500 BC. The details were recorded on papyrus, documenting eight cases of tumors occurring on the breast. It was treated by cauterization, which destroyed tissue with a hot instrument called “the fire drill.” It was also recorded that there was no treatment for the disease, only palliative treatment.

There is evidence that the ancient Egyptians were able to tell the difference between malignant and benign tumors. According to inscriptions, surface tumors were surgically removed in a similar manner as they are removed today.

What Early Physicians Thought Caused Cancer

In Ancient Greece, much less was known about the human body than is known today, of course.

For example, Hippocrates believed that the body was composed of four fluids: blood, phlegm, yellow bile, and black bile. He believed that an excess of black bile in any given site in the body caused cancer. This was the general thought of the cause of cancer for the next 1,400 years. In ancient Egypt, it was believed that cancer was caused by the Gods.

The Birth of the Pathological Autopsy

Autopsies done by William Harvey in 1628 paved the way to learning more about human anatomy and physiology. Blood circulation was discovered, opening the doors for more research on diseases. It wasn’t until 1761 that autopsies were performed to research the cause of death in ill patients. Giovanni Morgagni of Padua was the first to do such autopsies.

 More Theories on the Causes of Cancer

The lymph theory developed in the 17th century, replacing Hippocrates’ black bile theory on the cause of cancer. The discovery of the lymphatic system gave new insight to what may cause cancer. It was believed that abnormalities in the lymphatic system was the cause.

It wasn’t until the late 19th century that Rudolph Virchow recognized that cells, even cancerous cells, derived from other cells. Other theories surfaced , such as cancer being cause by trauma, parasites, and it was thought that cancer may spread “like a liquid.” It was later concluded that cancer spread through malignant cells by German surgeon, Karl Thiersch.In 1926 a Nobel Prize was wrongfully awarded for the discovery of the cause of stomach cancer a worm.The 20th century saw the greatest progression in cancer research. Research identifying carcinogens, chemotherapy, radiation therapy and better means of diagnosis were discovered. https://www.cbsnews.com/news/the-history-of-cancer-siddhartha-mukherjee/

1 Cervical Cancer ” http://images.slideplayer.com/42/11199685/slides/slide_1.jpg

2 What is Cancer? Hippocrates was the first to use the word “cancer” to describe tumors Cancer is derived from the Greek word “karkinos” which means crab It is thought Hippocrates was referring to the appearance of tumors. The main portion of the tumor being the crabs body and the various extensions of the tumor appear as the legs and claws of the crab.

 “http://images.slideplayer.com/42/11199685/slides/slide_2.jpg” 

 

 3 What is Cancer? Changes to the DNA of a cell (mutations) lead to cellular damage Mutations enable cancer cells to divide continuously, without the need for normal signals In some cancers the unchecked growth results in a mass, called a tumor Cancerous cells may invade other parts of the body interfering with normal body functions.” http://images.slideplayer.com/42/11199685/slides/slide_3.jpg

4 What is Cancer? Although cancer is often referred to as if it were a single disease, it         is really a diverse group of diseases that affects many different organs and cell types        The likelihood of developing any particular cancer depends on an individual’s genetics, environment, and lifestyle. The occurrence of some cancers may be prevented/reduced by wise lifestyle choices.” http://images.slideplayer.com/42/11199685/slides/slide_4.jpg

5 What Causes Cancer? Some known cancer causing agents (carcinogens) with which you might interact: How to reduce your cancer risk: Tobacco (cigarettes and smokeless) Viruses (HPV, EBV) UV Radiation (sun, tanning bed) DON’T: Smoke DO: make healthy lifestyle choices DO: get available vaccines DO: use sunscreen DON’T: excessively exposure yourself to UV radiation (tanning beds, sun).” http://images.slideplayer.com/42/11199685/slides/slide_5.jpg

6 What is Cervical Cancer? Cervical cancer is a slow developing cancer that starts in the interior lining of the cervix. Almost all cases begin with changes caused by the human papillomavirus (HPV), a sexually transmitted infection. Over time the changes caused by HPV build up and a pre-cancerous condition called cervical intraepithelial neoplasia (CIN) develops. CIN can progress to cervical cancer, but this is not always the case. Image Courtesy of QIAGEN www.qiagen.com ” http://images.slideplayer.com/42/11199685/slides/slide_6.jpg

7 What is a Cervix? 1.Fallopian (uterine) Tubes – location of fertilization of an egg by a sperm cell 2.Ovaries – produce and store gametes (eggs) and produce the female sex hormones, estrogen and progesterone 3.Uterus (womb) – location where fertilized egg develops into a fetus and is nourished until birth. Note that the walls of the uterus are thick and lined with muscles 4.Cervix – region connecting the uterus to the vagina 5.Vagina – passageway for menstrual blood and babies during childbirth.” http://images.slideplayer.com/42/11199685/slides/slide_7.jpg

8 More About the Cervix The cervix is the lower portion of the uterus and it plays an important role in reproduction The narrow cervical canal connects the uterus to the vagina and allows passage of menstrual fluid During pregnancy the muscles of the cervix support the weight of the fetus During childbirth the muscles relax and the opening widens (dilates) allowing the fetus to pass through the cervical canal and out of the vagina.

Note: Cervical abnormalities can result in miscarriage Endocervix Ectocervix Endocervix Ectocervix cervix uterus vagina http://images.slideplayer.com/42/11199685/slides/slide_8.jpg

9 More About Cervical Cancer Cervical cancer is most often diagnosed in middle-aged women, with half of those diagnosed between the ages of 35 and 55. It is rarely seen in women younger than 20 and approximately 20% of cases are in women over age of 65. Cervical cancer is not often diagnosed in young women, but this does not mean young women are not at risk. Cervical cancers that develop in older women frequently result from HPV infections that occurred many years earlier. HPV infection, which can occur     at any age, greatly increases the risk for cervical cancer. http://images.slideplayer.com/42/11199685/slides/slide_9.jpg

10 How Common is Cervical Cancer? Cervical Cancer Statistics 2007 (estimated) Worldwide cases: 555, 094 Worldwide deaths: 309,808 US cases: 11,150 US deaths: 3,670 In 2007 cervical cancer was second only to breast cancer as the most commonly diagnosed cancer in women worldwide In the United States the estimated yearly costs of cervical Human Papillomavirus (HPV) related disease is at least $2.25 billion and may be as high as $4.6 billion. cervical cancer is a global issue and does not discriminate.” http://images.slideplayer.com/42/11199685/slides/slide_10.jpg

11 What Kinds of Cervical Cancer Are There? There are two main types of cervical cancer: Squamous cell carcinoma The majority of cervical cancer cases (80- 90%) are of this type. This cancer type often originates where the ectocervix joins the endocervix  Adenocarcinoma This type constitutes the other 10-20% of cervical cancer and develops in the mucous producing glands of the endocervix. In rare cases, cervical cancer can be a mix of both adenocarcinoma and squamous cell carcinoma cervical squamous cell carcinoma.” http://images.slideplayer.com/42/11199685/slides/slide_11.jpg

12 Does Cervical Cancer Have Any Symptoms? Precancerous changes and early stage cancer usually have no symptoms (are asymptomatic) Symptoms of later stage disease may include: – pain, if lymph nodes are involved – bleeding, caused by the tumor – vaginal discharge – pelvic or back pain cervical cancer viewed with colposcope.” http://images.slideplayer.com/42/11199685/slides/slide_12.jpg

13 How Does Cervical Cancer Develop? There are 3 steps necessary for cervical cancer development 1. HPV infection 2. Progression to cervical intraepithelial neoplasia (CIN) 3. Invasion CIN Infected Cervix HPV Infection HPV Clearance Normal Cervix Normal Cervix Cancer Progression Regression HPV infection must persist for more than one year Invasion.” http://images.slideplayer.com/42/11199685/slides/slide_13.jpg

14 Tell Me More About CIN Cervical Intraepithelial Neoplasia (CIN) Long term HPV infection can lead to abnormal cellular changes. If these changes accumulate a condition called Cervical Intraepithelial Neoplasia (CIN) develops. There are 3 stages (grades) of CIN: CIN 1, CIN 2, CIN 3. Some, but NOT ALL, cases of CIN can progress to cervical cancer. CIN can also regress, returning the cervix to normal high grade CIN 3.” http://images.slideplayer.com/42/11199685/slides/slide_14.jpg

15 What are the Stages of CIN? CIN1  Rarely (~1%) develops into invasive cervical cancer, about 20% will progress to CIN2 CIN 2. About 30% of CIN2 will progress to CIN 3 CIN3  About 40% will progress to cancer; usually develops after long term HPV 16 or 18 infection.” http://images.slideplayer.com/42/11199685/slides/slide_

16 Can Cervical Cancer be Detected? Detection Types Because early cervical cancer is generally asymptomatic, regular screening is the best way to detect precancerous lesions.  Pap Test Recommended yearly for women over 21 or within 3 years of becoming sexually active. HPV tests are not normally recommended for women under 30.

After age 30, HPV tests are recommended with a Pap test Colposcopy. Used when abnormal findings are present on Pap test and a positive HPV test. ” http://images.slideplayer.com/42/11199685/slides/slide_16.jpg

17 Tell Me More About the Pap Test Pap Test A doctor or a specially trained healthcare professional inserts a cervical brush or spatula though the vagina and cells are wiped from the surface of the cervix and placed on a slide or in a vial. The cells are then examined under a microscope for abnormalities that could indicate pre-cancerous or cancerous conditions.”  http://images.slideplayer.com/42/11199685/slides/slide_17.jpg

18 Tell Me More About the HPV Test HPV Test A sample of cells is taken from the cervix during a pelvic examination, using a brush or spatula. The sample is placed into a preservative and sent to a lab for testing. The lab tests the sample for the presence of HPV DNA. A positive test indicates HPV infection, but a positive result does not indicate CIN or cervical cancer. Follow up procedures (pap test and colposcopy) are recommended. If an HPV infection is present in the cervix, HPV DNA will be detectable The test detects HPV DNA.”  http://images.slideplayer.com/42/11199685/slides/slide_18.jpg

19 Tell Me More About Colposcopy Colposcopy A colposcopy is done using an instrument called a colposcope. A colposcope is a special microscope that can magnify the cervix up to 16 times its actual size. It allows the physician to examine the linings and other structures of the cervix. Colposcope View of Cervix with Colposcope.” http://images.slideplayer.com/42/11199685/slides/slide_19.jpg

20 Are There Cervical Cancer Risk Factors? The Main Risk Factor Human papillomavirus (HPV) HPV has been found in over 95% of cervical cancer cases. But, most cases of HPV infection will clear within 1 to 2 years and will NOT cause cervical cancer.

Co-Factors  increase the ability of HPV to cause cervical cancer.  These include: Smoking! Other sexually transmitted infections (STI), including the human immunodeficiency virus (HIV), chlamydia, and the herpes virus Additional risk factors, including genetics and diet, are being actively researched.” http://images.slideplayer.com/42/11199685/slides/slide_20.jpg

21 The Main Risk Factor Human papillomavirus (HPV) HPV has been found in over      95% of cervical cancer cases. But, most cases of HPV infection will clear within 1 to 2 years and will NOT cause cervical cancer. Human papillomavirus is one of the most common sexually transmitted infections (STI) in the United States.

Recent studies have shown that over 25% of all women are infected. Infection rates among women aged 20-24 may be as high as 44%. Men can also be infected by HPV and transmit it to women. In fact prevalence may be higher in men than women. More on HPV later So HPV is the Main Cause? ” http://images.slideplayer.com/42/11199685/slides/slide_21.jpg

22 Cervical Cancer, HPV, and Smoking Nicotine (the addictive compound found in cigarettes) has been found in the cervical secretions of women that smoke. This indicates other cancer causing compounds found in cigarettes also may collect in the cervix.

A recent study of 346 US women aged 18-35 found a correlation between cigarette smoking and cervical cancer. Women who are current or previous smokers had significantly longer HPV infections than women who never smoked.” http://images.slideplayer.com/42/11199685/slides/slide_22.jpg

23 The Human Papillo…What? The Human Papillomavirus The human papillomavirus is a group of over 200 genetically different viruses. It is a sexually transmitted infection (STI) and is the main cause of cervical cancer worldwide. What’s a Virus? Viruses are very small infectious particles, responsible for diseases that include the common cold, the flu, AIDS, and chicken pox. The smallest known virus is 20 nanometers across (a nanometer is about 35-millionths of an inch). For comparison, a human hair is about 65,000 nanometers in diameter or about 4,000 times larger. What’s a papillomavirus Papillomaviruses were first discovered in the early 20 th century and named for their ability to cause papillomas (warts).” http://images.slideplayer.com/42/11199685/slides/slide_23.jpg

24 What Exactly is a Virus? “a kind of borrowed life” Viruses don’t fit neatly into a category of living or non-living. They have some characteristics of living things, but they are not made of cells and lack equipment for self reproduction. Because of this, they can only reproduce within a host cell. Tell Me More About Viruses Human Immunodeficiency Virus (HIV) Human Papillomavirus (HPV).” http://images.slideplayer.com/42/11199685/slides/slide_24.jpg

25 Virus Structure Viruses come in all shapes and sizes, but they are usually composed of a genome and a surrounding shell (capsid) Viral Capsid  protein shell that surrounds and protects the viral genome made up of various protein subunits called capsomeres Viral Genome Contains genetic information; DNA or RNA that may be either double or single stranded Organized as either linear or circular molecules Circular Genome Tell Me More About Viruses.”  http://images.slideplayer.com/42/11199685/slides/slide_25.jpg

26 How do Viruses Reproduce? 1.Virus binds host cell and inserts genome 2.Host    cellular machinery begins to replicate the viral genome and produce viral proteins.            3. Viral molecules self-assemble into new viruses (virions) and exit the cell A single infecting virus can produce many copies of itself, often hundreds or thousands at a      time. When the viruses exit the host cell they are capable of infecting other cells,  spreading the infection.     http://images.slideplayer.com/42/11199685/slides/slide_26.jpg

27 Are There Different Types of HPV? There are over 200 described genetically      different types of HPV Some HPV types are responsible for common warts plantar      warts Other types infect the genital tract; these are divided into high risk and low risk  High risk – responsible for the majority of cervical cancer Types 16 and 18 cause ~70%     of cervical cancer cases. Low risk – not thought to cause cancer Types 6 and 11 cause a large percentage of genital warts Add images of plantar and genital warts ” http://images.slideplayer.com/42/11199685/slides/slide_27.jpg

28 How Can I Reduce My Risk? Prevention of HPV  Abstinence (not having sex), is the only completely effective method of HPV prevention HPV can be transmitted by oral and anal sex as well as vaginal intercourse  Ways for sexually active individulals to reduce risk Use a condom! Condoms will not provide complete protection against HPV, but they will reduce the chance of getting it.

Remember: condoms also help reduce the risk of unwanted pregnancy and other STI’s, including: HIV, gonorrhea, Chlamydia, herpes, hepatitis, syphilis, among others. Reduce number of sexual partners! The chances of getting HPV increase with number of sexual partners. Studies have shown that women with multiple (>1) sexual partners have an increased risk for HPV and for CIN. ” http://images.slideplayer.com/42/11199685/slides/slide_28.jpg

29 How is HPV Transmitted Ways HPV is Passed From Person to Person: Skin to skin sexual contact with a partner who is infected with HPV is the most common way HPV is passed. Sexual contact includes: intercourse oral sex genital to genital contact Not passed through: toilet seats doorknobs water fountains.” http://images.slideplayer.com/42/11199685/slides/slide_29.jpg

30 How Does HPV Cause Cervical Cancer? p53 E6 E7 Rb HPV E6 inhibits the function of p53 E7 inhibits the function of Rb p53 is a protein that controls response to cellular stress including DNA damage and viral infection. Rb is a protein that can prevent cell division  by blocking the activity of transcription factors Two of the proteins made by the human papillomavirus are strongly associated with the development of cervical cancer.” http://images.slideplayer.com/42/11199685/slides/slide_30.jpg

31 Of Great Importance… HPV Vaccines Gardasil ® What is it? Gardasil ® is a vaccine approved by the Food and Drug Administration (FDA)  to  protect  against  four types of HPV: 6, 11, 16, and 18  Who can get it?  The CDC and FDA recommends girls and women aged 9-26 should get the vaccine.  Why 6, 11, 16, and 18? Types 6 and 11 cause most cases of genital warts Types 16 and 18 are high-risk types that can cause cervical cancer (~70%)  How effective is it?  Studies have shown the vaccine to be almost 100% effective  in preventing diseases caused by the 4 types of HPV it covers.” http://images.slideplayer.com/42/11199685/slides/slide_31.jpg

32 Of Great Importance… HPV Vaccines Cervarix™  What is it? Cervarix ™ is an HPV vaccine produced by GlaxoSmithKline that has not yet been approved by the Food and Drug Administration (FDA). It has been approved in Australia and Europe.  What does     it protect against? Cervarix  protects against types 16 and 18. These are high-risk types  that cause cervical cancer over 70% of all cervical cancer cases.” http://images.slideplayer.com/42/11199685/slides/slide_32.jpg

33 The human immune system is a complex collection of cells and proteins that function to protect the body from foreign matter,  both living and nonliving.  A Closer Look: Vaccines Two types of immune cells involved in protection against viruses are T cells and B cells. Both cell types are activated when they encounter viral proteins (antigens).” http://images.slideplayer.com/42/11199685/slides/slide_33.jpg

34 Upon Activation: B cells – produce large amounts of proteins called antibodies which move throughout the circulatory system binding the specific antigen for which they were created. T cells – reproduce thousands of times and enter the bloodstream searching for their corresponding antigen. When antibodies and T cells encounter the antigen, they begin a process that leads to the destruction and removal of the antigen. The presence of antibodies against HPV in a vaccinated person prevents infection by the virus. A Closer Look: Vaccines!!!

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Published on Jan 14, 2016

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