Cancer refers to a group of diseases that are characterized by genetic mutations in normal cells that cause them to become malignant. These genetic mutations involve the following:
Oncogenes, which are mutant genes that regulate cell proliferation. Oncogenes allow accelerated proliferation of the mutated cells, resulting in the rapid growth of cancerous tumors.
tumor suppressor genes, which impede cell proliferation and suppress or prevent cell mutations. Cancer involves inactivation of tumor suppressor genes, allowing replication of mutated cells.
In the TNM system: Cancer patients who require hospice or palliative care generally suffer from advanced disease, which is defined as metastatic spread of the malignancy from the primary site to other areas of the body and/or massive tumor growth at the primary site. The staging of tumors commonly follows the primary tumor, lymph node, and metastasis (TNM) system.
The human immunodeficiency retrovirus causes acquired immunodeficiency syndrome (AIDS), in which immunity is profoundly reduced through destruction of CD4 T lymphocytes and macrophages. The CD4 recognize infected cells and foreign antibodies, activate antibody-producing lymphocytes, and orchestrate cell-mediated immunity in which infected cells and foreign antigens are destroyed. When viral loads climb and CD4 counts drop, the immune system cannot resist the development of opportunistic infections and malignancies. AIDS is defined as a CD4 count < 200/ul or occurrence of AIDS defining conditions. AIDS is a syndrome once considered rapidly fatal. However, HIV has become a chronic disease as antiretroviral drugs and drugs controlling opportunistic infections have successfully prolonged life: over 35.3 million people across the globe are living with HIV, of whom 1.3 million are North Americans. Overall, the impact of antiretroviral on survival has made it difficult to use traditional prognostic indicators, and the clinical course of HIV/AIDS is fluctuating, with considerable variation among patients, and is marked by a number of opportunistic infections requiring treatment. Effective prevention strategies, earlier diagnosis, and the use of antiretroviral therapy (ART) have all improved survival rates. Despite this, there remain approximately 20,000 AIDS deaths per year in the United States. A viral load of more than 100,000 copies of a CD4 count below 25 cells/mcl may predict a terminal condition if a patient is declining in function, choosing to forgo medication, antiretrovirals are no longer effective, or life-threatening complications have developed. Continue reading “Determining Prognosis: Patients with End-Stage AIDS (Reading & Sharing)”→