Here’s a great question about the inheritance pattern of retinoblastoma. I love this type of question, because it forces you to really think about something you would normally just accept. (more…)
Q. I just had a quick question as I was going through some immunology notes and wondering if you could clarify what they mean when a person develops an anti antibody? (more…)
Q. How is comedocarcinoma malignant but also still in situ, that is, confined to the ducts and noninvasive? Is not invasiveness one of the criteria for malignancy? (more…)
Q. I’m will be starting my pathology residency in about a year. Any suggestions for getting prepared for residency? I have been reviewing www.enjoypath.com and others, but wanted to get your opinion.
A. Good for you! When many people think of pathology (do many people think of pathology?), they think of surgical pathology – stuff that comes out of the operating room, biopsies, etc. But there are many other parts to a pathology residency, such as hematopathology, microbiology, forensic pathology, and blood banking. I’ll run through some of the books used in these areas, then I’ll tell you what I would have done if I knew then what I know now.
Surgical pathology: Rosai’s Surgical Pathology is probably the most commonly-used book; another good source is the set of AFIP Fascicles (there’s a fascicle on pretty much every organ system). These sources are too in-depth for you now (with one exception that I’ll mention in a minute), and probably too expensive. They’re more for reference than for reading through on a Sunday night. You’ll use them until you’re nauseated when you’re a resident though.
Hematopathology: The best source for this is the AFIP Fascicle on the subject: Tumors of the Bone Marrow. This is the exception to what I said above about reading the fascicles before residency – this one would be great to go through ahead of time. There’s a lot to learn, and if you go through it once, it will make a lot more sense when you get to it in your residency. It’s small enough that you can certainly get through it in a few months.
Microbiology: We used Koneman in our residency program, and I think it is a good textbook. It’s more than you’d want to go through ahead of time though; I’d use something like Clinical Microbiology Made Ridiculously Simple. It has nice drawings and mnemonics, which is something you need in microbiology.
Forensic pathology: A couple good ones for this are put out by DiMaio: a textbook (long) and a handbook (short).
Blood banking: We used McCullough’s Transfusion Medicine text in residency. Nice and short and readable. Here’s a fun game that you might want to try too.
I think if I had it to do over again, I would do three things:
1. Read Robbins. All of it. Maybe twice. I know, I know, it is a “med-school” textbook, but we used it all the time in residency. So did the attendings at times, by the way. It’s no small feat, but should be possible in a year, and it would prepare you well. You might even take notes on the histologic appearance of different tumors and diseases; you would have those to refer to during residency. You can look at websites too (like Webpath and Ed’s Pathology Notes) – and you should – but Robbins will give you a systematic and thorough review.
2. Read the AFIP bone marrow fascicle. I actually did this before my med school rotation in hematopathology, and I was so glad I did. It will make you shine when you get to your rotation.
3. Not worry about the other stuff. The other rotations will be easy enough to go through without advance preparation.
Good luck!
Today’s post, authored by a very smart guest cytogeneticist, nicely describes array-based comparative genomic hybridization, a very cool DNA test that gives us a way to detect genetic abnormalities that are too small to be seen under the microscope. (more…)
We were talking about developmental pathology the other day in class – trisomies, sex chromosome numerical abnormalities, microdeletion syndromes etc. – and the term “uniparental disomy” came up. (more…)
One of the reasons our cells die is because they are inherently programmed to have only 60 to 70 doublings. That’s it. After that, they die.
Why is that? (more…)
Recently, we talked about how cancer is caused by non-lethal genetic mutation.
There are different ways to answer this important and difficult question. (more…)
One of the things that researchers are studying like crazy is the process by which cancer takes root and grows in the body. Our diet plays a huge role in this process (witness the much lower incidence of cancers in India, for example, despite the much higher incidence of carcinogens!). Â For your own health, and for the health of your future patients, I highly recommend David Servan-Schreiber’s book, Anticancer: A New Way of Life, which came out last year. David is an MD who developed brain cancer and went through successful medical treatment. However, his tumor recurred, and at that point he decided he needed to change his way of life. This book describes the effects diet and stress have on the growth of cancer – and before you blow that off as being too foofy or alternative, you should know that he backs up every point he makes with tons of research from accomplished scientists at respected places like Harvard and M.D. Anderson. Much of this post is from information described in David’s book.
The process of tumor growth is much like the growth of weeds. Tumors grow in three phases: 1) initiation, 2) promotion, and 3) progression. Initiation is the phase when a seed settles in the soil, promotion is the phase when the seed becomes a plant, and progression is the phase when the plant becomes a weed (developing beyond control, invading flower beds and growing right up to the sidewalk).
Initiation (the planting of the seed) depends largely on our genes and on toxins (radiation, carcinogens, etc.). But promotion (the growth of the seed) depends on having the right survival conditions: favorable soil, water, and sun. The cool thing is that promotion is reversible! If you can change the tumor’s environment, you can prevent it from spreading. Diet plays a role – probably a big role – in the creation of a favorable vs. unfavorable tumor environment.
Here are some dietary substances that create a fertile soil for cancers:
Refined sugars (drive up proinflammatory insulin and insulin-like growth factor, or IGF)
Insufficient omega-3s/excess omega-6s (favor inflammation)
Growth hormones in meat and non-organic dairy products (stimulate IGF)
Okay, what diet does this sound like? Lots of sugar, bad fats, and meat – the typical Western diet.
So, what should we eat? In addition to avoiding saturated fat, sugar, meat and non-organic stuff, a good cancer-fighting diet would include some/all of the following:
Catechins (in green tea) – inhibit angiogenesis
Phytoestrogens (in soy products) – block overstimulation of tumors by estrogen; prevent angiogenesis
Curcumin (in turmeric) – inhibits inflammation, inhibits angiogenesis, promotes apoptosis in tumor cells
Ellagic acid (in berries) – inhibits angiogenesis, blocks transformation of environmental carcinogens into toxic substances
Anthocyanidins (in blueberries, cranberries, cinnamon, dark chocolate) – promote apoptosis in tumor cells
Terpenes (in mint, thyme, marjoram, oregano, basil, rosemary) – inhibit tumor cell invasion, promote apoptosis in tumor cells, inhibit angiogenesis
Gingerol (in ginger) – inhibits inflammation and angiogenesis
Sulforaphane, indole-3-carbinol (in cruciform veggies) – prevent precancerous cells from becoming malignant; promote apoptosis of tumor cells, inhibit angiogenesis
Sulfur compounds (in garlic and onions) – reduce carcinogenic effects of nitrosamines (created in overgrilled meat and present in tobacco); promote apoptosis in tumor cells; help regulate blood sugar levels.
Lycopene (in carrots, yams, other bright colored veggies and fruits) – stimulates NK cells to become more aggressive; inhibits tumor cell growth
Long-chain omega-3 fatty acids (in fatty fish) – reduce cancer cell growth, prevent metastasis
Vitamin D (sun, cod liver oil, milk (tiny amount), vitamins) – dramatically reduces risk of several cancers
Polyphenols (red wine, chocolate) – block NF-kappa B (important in all three stages of cancer development: initiation, promotion, progression), limit angiogenesis
Photo credit: L’eau Bleue (http://www.flickr.com/photos/8175535@N05/3536354514/), under cc license.
Recent Comments