Another day another dollar! I’m earning my passage today. Darling daughter, Ellen, has been supporting me all week whilst Elaine nears the end of her job at the University St Andrews (one week to go, yippee!). Now today we are returning the favour and re-locating her and all her mobile devices back to Glasgow. Setting off early, so the shower is going to have to cope with three heavy-user demands (Rank Ellen> Colin> Elaine; or something like that). We need to be on our way by 09:00am.
Speaking of passages, I had a bad evening last night – the 5 day thing happened again, but fortunately the earth moved at 20:00h, well actually a mole hill moved, but that is better than a worm-hole (infinitely smaller – literally!). I was in so much pain at one point I took a double dose of laxative. Hope I don’t regret it whilst we head for the M8.
Now, where are we, technically that is? Oh yes, diarrhoea, I suspect, but hope against. This is shit, let’s start again – technically!
I have a stomach cancer called a poorly differentiated adenocarcinoma. What does that mean? Fortunately there’s a system for better understanding what phrases like that really mean, and they can be helpful in determining treatment.
Pay attention, this is going to get easier and easier!
During embryonic, foetal, neonatal and later life most cells (cytology) in our bodies are growing and produce tissues (histology) such as the lining of our bladders, eyes, and of course our guts (epithelium-lined mucosa), and in my case a key bit – the stomach or gastric portion of the alimentary canal (intestine).
Other cells produce muscle layers (which may be smooth, striped or striated, or found only in the heart as cardiac type (also striated, by the way, but branched too); others produce connective tissues including fat, lymph, blood, bone marrow and so on; still others, develop nerve cells or neurones.
Some tissues and organs like the liver, kidney, spleen and lung mainly comprise one major type of tissue whereas others, such as the lining of fat around our internal organs, our omentum for example, may be very diffuse and have several types of tissue such as connective tissues, fat, smooth muscle, as well neurones and blood vessels. The latter are themselves very complex, having three or four layers depending upon wall thickness (from the inside to out: endothelium – special epithelium, smooth muscle, loose or fibrous connective tissue, and may contain blood vessels as well as nerve fibres and neurones too, sitting in the most outer layer, the serosa, again depending upon wall thickness.
Other cells (when looked at down a light microscope) however, can look very grand, special, (and even plump – if we are not being fattist) and distinguished from surrounding tissues, often with special names. The parenchymal cells of the liver are good examples; as are the epithelial cells lining the inner stomach – the square or tall, columnar epithelial layer. These contrast very well with the typically flat or squamous epithelial layers we have in the linings of hollow internal organs such as the bladder, vagina, lungs etc; or on the external parts of our bodies such as our head, hands and souls of our feet, (Great British Rock band of the 1970s, by the way. Try out “Head, Hands and Feet” on Island pink label Vinyl, 1971 Yummy!).
Head, Hands and Feet in concert in 1971 at TOGWT – find out!
All of these cell types take up stains to differing degrees when preparing tissues for examination under a microscope, and they produce beautiful, gorgeous coloured patterns. En passant, this helps histologists and pathologists (and histopathologists – mustn’t forget them!) identify when there may be too much or too little of some tissue component present – compared to what might normally(!) be expected – based on centuries of anatomy, and experience, of course.
So what, I hear you say? Well, this is key to describing cancers, but you need some more information first! In the embryo, most cells outwardly (if we have a light microscope to view them) look pretty much the same and might be said to be unspecialised, undistinguished or poorly differentiated. They reproduce themselves very fast by diving in two, grow bigger again, repeat then repeat – a signal-controlled process. Once a critical mass of cells is reached tissue formation takes place and specialisation or differentiation starts to happen, and thus we form all of our specialised tissues, organs and systems that make up the body.
If this signal process goes wrong, for example in cancer, cells that might normally (there’s that word again) differentiate don’t do so, and instead grow in an uncontrolled way, eventually forming a fairly ugly, undistinguished thing we call a “lump”. Get that buggar (!) off me; have a ‘lumpectomy’ straight away (to be safe), if you find one (unless it’s a cyst, of course). Even then, you might have one removed – to be sure!
You need one more thing to complete the picture – sorry! So that (histo-)pathologists can have a whole branch of medicine’s nomenclature to themselves when cells and tissues start to become abnormal they give the type of tissues a new, but related name. So, abnormal epithelial tissues are named Carcinoma, muscle or connective tissue tumours become Sarcoma, as two large categories of cancers. A Lipoma (I have one on left shoulder) is a fatty lump!
The more distinguished a cancer turns out to be from a particular location in the body the even fancier a name it can have, such as microglioma or astrocytoma (specialised neurone tumours); or Leukaemia, Lymphoma (specialised connective tissue tumours of blood and lymph glands, respectively) etc. Do you know there’s a tumour called a Teratoma? It sprouts skin, hair and even teeth, sometimes, inside an enclosed sac, often very large. If such a sac is located in or near female ovaries the ‘bump’ produced can be confused with pregnancy! Much more information can be found at the Cancer Research Campaign web site (http://www.cancerresearchuk.org, Accessed 27 November 2015).
So there we have it. I have a poorly differentiated adenocarcinoma growing from around the middle of my gastric (stomach) inner mucosal lining. And sod’s law, wouldn’t you know, it has grown backwards through the mucosa, penetrated the smooth muscle of the stomach wall, its surrounding connective tissues of the serosa and into my abdomen. Fortunately, it has only spread to a few (well had – we don’t know what the new CT scan picture would reveal now) surrounding lymph nodes. Maybe I’ll talk a little more about well-differentiated cancers later? Watch this space …..
When anyone asks you, “Now what’s Colin got again?”, you can tell ’em (in scientific discourse). But don’t forget to tell them, he might not have had one at all if had he heeded earlier warning signs of a belly-ache! So endeth today’s lesson!
I’m off to the shower before damned daughter gets up.
See ya’s all again tomorrow!