A Smoker with a Chronic Cough

Heavy Smoking
1. Atleast 20 cigarettes (one or more pack daily)
  1. for long time leads to
    1. damage and destruction of the protective cilia of the respiratory tract
      1. Building up of mucous, body induces
        causing wet cough(white,yellow-green,or blood tinged)
        Smoker's cough
        Causes(medical): cold upper respiratory tract infection, whooping cough, foreign body, irritation due to pollution, asthma, laryngitis
        Symptoms: shortness of breath chest pain wheezing crackling
2. Other effects on the body:
  1. Head
    1. Brain
      1. Strokes Altered activity Anxiety addiction
    2. Eyes
      1. Muscular degeneration
        Blindness
      2. Cataract
    3. Nose
      1. Less smell sense
    4. Teeth
      1. Discoloration and stains
      2. Plaque
      3. Loose teeth
      4. Gum disease( gingivitis)
    5. Mouth and Throat
      1. Lip, Mouth, throat, and larynx cancer
      2. Sore throat
      3. Reduced sense of taste
      4. Breath smells of smoke
  2. Respiration and lungs
    1. Lung Cancer
      1. History Taking
        Exposure to radon gas
        Exposure to certain chemicals
        Air pollution
        Previous lung disease
        A family history of lung cancer
        Past cancer treatment
        Lowered Immunity
        Previous smoking related cancers
        Physical examination
        Enlargement of supraclavicular lymph nodes
        Respiratory System
        Centrally Located obstructing tumors
        peripheral lesions
        Pleural Effusion
        Respiratory Insufficiency
        Upper airway obstruction
      2. investigations
        Blood tests
        Blood protein testing
        Certain abnormal immune system proteins(immunoglobulin )
        Complete blood count
        Abnormal number of cells
        Tumor markers
        Cacinomembryonic Antigen
        Lung function Test
        spirometry
        gas diffusion
        inhalation challenge test
        exercise stress test
        body plethysmorgraphy
        Radiation
        x-ray
        shows a visible nodule or mass
        CT-scan
        Detailed x-ray images of tissues and organs
        PET
        observe metabolic processed
        sputum cytology
        Examines a sample of sputum (mucous) under microscope to determine whether abnormal cells are present
        Bronchoscopy
        Look at your airway
        Biopsy
        examination of tissue from a living tissue
        Bone marrow biopsy
        Endoscopic biopsy
        Needle biopsy
        Getting Diagnosed with cancer
        Reactions to grief
        Denial Anger Bargaining Depression Acceptance
        Coping Mechanisms
        Emotional focused
        Short Term
        Problem focused
        Long term
    2. Asthma
    3. cold and flu
    4. Pneumonia
    5. Chronic Obstructive Pulmonary Disease
  3. Heart
    1. Heart attack
    2. harms, blocks, and weakens heart arteries
  4. Abdomen
    1. stomach and duodenal ulcers
    2. Stomach, pancreas, and colon cancer
  5. Bones
    1. Osteoporosis
    2. Hip and bone fractures
  6. Liver
    1. liver cancer
  7. Chest
    1. oesophagus
  8. Female and Male reproductive organs
    1. Cervix cancer
    2. Infertility and a delay in conception
    3. reduced sperm number
  9. Immune system
    1. Weak
  10. Blood
    1. Leukemia
  11. Burns
    1. Burns caused by tobacco
  12. Legs and feet
    1. Increases leg pain and gangrene
      1. Peripheral vascular disease
  13. Wound and surgery
    1. Long healing time
Histopathology
1. Tumors
  1. Malignant
    1. Rapid
    2. Invasion
    3. not encapsulated
    4. Usually recurrence occurs
    5. Wide range of differentiation
    6. Usually fatal
    7. metastasis is there
      1. 1- losing E- cadherin molecules , local degradation of basement membrane and interstitial tissues, cells extrude pseudopodia 2-Angiogensis 3-vascular invasion and spread 4-establishment of a new colony
    8. Normal nuclei, few mitotic figures, normal cells , uniform size and shape of cells
    9. Anaplastic
      1. Cells lose their normal polarity, cellular pleomorphism , nuclei are bizzare ,pleomorphic, and hyperchromatic. Increased N/C ratio, coarse clumped chromatin, prominent large nucleoli, numerous and atypical mitotic figures. tumor giant cells
        Anaplastic histology
  2. benign
    1. slow growth
    2. Expansion
    3. Encapsulated
    4. No recurrence if it is completely removed
    5. Not fatal unless it is in vital sites
    6. No metastasis
    7. Well differentiated
    8. Hyperchromatic, increased N/C ratio ,abnromal mitotic figures , pleomorphism
How cancer deveops
1. A genetic damage in
  1. proto oncogene
    1. Normally,
      1. Help regulate cell growth
    2. Mutated
      1. Oncogenes
        Product that helps to accelerate cell growth or cell division
  2. Tumor suppressor gene
    1. Normally :Act to inhibit cellular growth and division
    2. When it is mutated, no inhibitory effect
      1. Leading to increased growth+proliferation
  3. DNA repair genes
    1. Activation of TP53 by phosphorylation
      1. Transcription of cyclin dependent kinase inhibitor A (p21)
        No RB phosphorylation
        G1-S block in cell cycle
        Helps cell to repair DNA
    2. Normally
    3. Mutation
      1. Loss of TP53 or mutation of TP53
        DNA damage goes unpaired
        becomes fixed in dividing cells
        malignant transformation
  4. Apoptosis genes
2. inherited
  1. Autosomal dominant
  2. Autosomal recessive
3. acquired
  1. chemicals
    1. Directly Acting
      1. Alkylating Agents
    2. Indirectly Acting
      1. Aromatic Amines
      2. Polycyclic Aromatic hydrocarbons
    3. Natural Plant or microbial products
      1. Aflatoxin B1 toxin produced by Aspergillus Flavus
      2. Insecticides and fungicides
  2. microbes
    1. HTLV-1
      1. Adult T cell leukemia
    2. HPV
      1. Benign warts
      2. Cervical Cancer
    3. EPV
      1. Nasopharangeal carcinoma
    4. Hepatitis B and C
      1. Hepatocellular carcinoma
    5. HHV-8
      1. Kaposi sarcoma
  3. radiation
    1. Ionizing Radiation
      1. X-ray
      2. Nuclear Fission
      3. Radinucleotide
    2. Ultraviolet Radiation
      1. From sun
        can cause skin cancer
  4. spontaneous mutation
    1. Arise naturally
      1. Oxidative stress
Epidemiology of Cancer
1. 5 most common cancer types in UAE
  1. Leukemia
  2. Thyroid
  3. Lymph nodes
  4. Breast
  5. Colorectal
2. Leading causes of death related to cancer
  1. Liver
  2. Breast
  3. Colorectal
  4. Leukemia
  5. Lung
Registry of Cancer
1. Abudhabi central cancer registry
  1. E- cancer registry
2. Tawam oncolgy center
  1. Central cancer registry
    1. Population based
  2. Tawam cancer registry
    1. Hospital based
      1. To find ways to control and prevent cancer . To identify risk factors
Prevention of cancer
1. Stopping tobacco smoking
  1. Raising Tobacco price
  2. Restricting smoking in public places
  3. Awareness programs

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A Smoker with a Chronic Cough

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	Created by Fatma Shwaylia about 8 years ago