Case Study

Case 1

A 48-year-old patient N. who has been smoking for 25 years works at the chemical plant where he deals with dyes and organic solvents. He visited his primary care physician with complaints of malaise, weakness, decreased appetite, and persistent cough without secretions. During the previous 3 weeks he noted the presence of blood in the urine, burning sensation in the lower abdomen aggravated by urination. The results of computer tomography scanning, x-ray, and ultrasonography attest against renal or ureter pathology in the patient. Cystoscopy reveals the proliferation of the bladder's mucosa with erosion of its surface. Biopsy of the lesion in the bladder shows the presence of malignant cells.

Questions:

What factors could be a potential cause of cancer of the bladder mucosa in this case? Substantiate your answer.

What mechanisms of the anticancer defence system could have been deficient in this patient and failed to prevent the development of tumor?

Characterize stages of carcinogenesis after the first contact

Of the bladder mucosa with carcinogen and up to the emergence of the tumor cells.

Can you exclude the possibility of metastases of the lung cancer in the bladder? Substantiate your opinion.

Case 2

Seven months after a patient had undergone a surgical removal of the stomach carcinoma and finished a course of chemotherapy he presented with an enlargement of a supraclavial lymph node. Biopsy of the swelled lymph node showed the presence of malignant cells. Some of these cells were similar to the removed tumor cells by their morphology.

Questions:

Can you attribute the appearance of the tumor cells in the lymph node to the tumor progression phenomenon? Substantiate your answer and characterize the phenomenon of tumor progression (its mechanisms and biological significance).

Do you think that the presence of the tumor cells in the lymph node is a result of the primary tumor metastases?

- a polyfocal tumor growth?

- recidivation of the stomach carcinoma?

- a new tumor growth?

Substantiate your opinion.

What factors of the anticellular defence system were ineffective in this case? What are the possible mechanisms of their action?

Case 3

A 56-year-old patient M., who has been suffering from gastric atrophy and hypoacidity for more than 20 years, complains of fatigability, weakness, a pain in the epigastrium, decreased appetite, immediate satiety after ingesting food, nausea, a considerable loss of body mass during the last 4 months, and a persistent fever. Laboratory tests showed anemia, leukocytosis, hypochlorhydria, and a decreased activity of gastric juice enzymes. Gastroscopy revealed flattening of the mucosal folds in the pyloric area, and the presence of a diffuse ("saucer-like") tumor with ulcerative alterations in the center.

Questions: