Occasionally Preposterous, Repeatedly Scrutinizing, and Sporadically Egotistical: My Two Cents

Based. The base. The basal layer. Basal cell carcinoma (BCC). BCC plays the bass. The base is played by Steve Harris. Steve Harris is BCC. I play the bass so I am either Steve Harris or BCC. Will I ever grow up? Probably not. Alas, BCC is the word(s) of the day.  I posted about cutaneous squamous cell carcinoma (cSCC) a bit ago and BCC is his less athletic sibling. Thinking back, cSCC arises from mutations in the squamous epithelium that lines our organs and forms part of our skin. Basal cell on the other hand arises from the base layer of skin and thought to start from the stem cells that differentiate into hair follicles and sweat glands.  These stem cells usually get damaged by UV radiation (looking indirectly at you sun) but can also be damaged by smoking and high levels of toxic chemicals like arsenic. It is mostly liked to sun however, but does become more likely in those with a compromised immune system that doesn’t identify and attack the mutant cells before they proli...

I am like a kid with too many toys to play with. Except the toys are areas of interest. Oooo cancer genes! Oooo new Porsche edition! Oooo syphilis! Oooo Russian political infighting! Ooooo chemotherapy drugs! Yeah, this is my brain but not as bad as in real life. So what am I on about today you ask? Just kidding, no one asked. But its cisplatin thanks. It's like the meme of "literally no one:........." "Me: ever been abducted by aliens and do you think that has anything to do with the fact you can't even keep the weed in your yard alive?" Me in a nutshell. Peanut shell please. I love peanut butter. Ah yes, cisplatin. I decided on this rabbit hole after reading and listening to a few articles and podcasts about cancer. Cisplatin came up a lot in those studies as one of the more popular chemotherapeutic agents. Popular might be an understatement, uses include (on and off label): advanced ovarian, testicular, bladder breast, cervical, endometrial, esophageal, g...

 Is bigger better? Normally not in medicine. It is the evolutionary prerogative for living things (maybe viruses) to multiply and send their offspring into the future. So things change to make that more likely. Our drive to adapt has given us technological advances to help us live longer, on a more basic level fire helped us grow faster. We are primed to make use of what is around us, fire, and what we have, creativity and ingenuity. Why would other living things be different?  I like to but probably will end up anthropomorphizing stuff that shouldn’t be but bear with me. I don’t know if this qualifies as adaptation or evolution but dividing cells do the same thing we do albeit looking different. Bacteria gain resistance to antibiotics, plants creep into environments that previously were inhospitable, animals become city dwellers as humans expand. It is also true that cancers develop ways to grow in spite of treatment or lack of normal cell requirements.  In a past post I...

It's been a while since I decided to run my mouth about antibiotics. I figure it’s a day ending in 'Y' and I got to use the Sawz-all so it’s a good day to talk about ceftriaxone. We've talked about, or I've talked about and you've ignored me, like you should, about 1st and 2nd generation cephalosporins. In the same family tradition, the grandchildren of cephalexin and cefadroxil, the 3rd generation works in the beta-lactam business. However, the grandkids have gotten smarter and learned from their elder's mistakes.  Ceftriaxone is given IV or IM at 1-2g q8-q24 or from 50mg/kg/day for pediatric patients. The long half life is nice as it can be dosed at longer intervals. As a nurse I like this and I’m sure the patients appreciate me not giving them a new infusion every 6-8 hours. It is not removed via dialysis and for patients with liver or kidney problems no more than 2g a day should be given. Normally the max dose is 4g.   It can penetrate the blood brain ba...

 I really had to stretch that title to make it work. Or not make it work, you decide, there are only so many ways to make the mouthful that is fluorouracil work in a title. To bypass that landmine, I’ll refer to it as FU. Much easier to say. Anyways, fluorouracil/FU, what is it? FU is used to treat many cancers both topically and intravenously, warts and keloid scars via intralesional injection, skin cancer prevention, and ocular malignancies. Pretty versatile drug. So how does it work? Without getting in the weeds,  FU inhibits the creation of  deoxythymidine monophosphate to prevent DNA replication by double strand breakage. FU also acts as a pyrimidine analog, and sneaks into the place of uricil and thymine, essential parts of DNA and RNA.  Fast dividing cells naturally go through more of these compounds. FU also selectively inhibits the deoxythymidine stuff in sun damaged skin which is why when applied topically, it doesn’t melt all of your skin off. Just the bad...

In the last few posts, I talked about skin cancers and when discussing cutaneous squamous cell carcinoma (cSCC) I mentioned levels of differentiation. To recap, differentiation is the level to which cells look like normal cells of the same type and perform their intended function. Cancer does not just appear on the body like, poof, now you got cancer. It starts from normal cells that begin to function out of step with what they are supposed to be doing. It only takes a few mutations then the cell divides faster, or doesn't die when supposed to and can begin to spread.  During the first stages of this movement, the cancer cells look very similar to the cells they arose from (the squamous epithelium in this case). As the mutations continue, the cells look less and less like their originators. They may be undeveloped or misshapen, and be multiplying too quickly or with another cell function gone awry. As this happens, it becomes harder and harder to see the cells microscopically. This...

Ahhhh Ronnie James Dio, classic. Well worth your time, especially his first album in Rainbow, Ritchie Blackmore’s Rainbow. Chefs kiss. Anyways, back to cancer, the skin kind. It’s so interesting the many treatment option there are for diseases in general and skin cancers (SCs) specifically. Radiation, image guided radiation, Mohs, excision, topical chemo agents, cryotherapy, ED&C, and more. We also now have FDA approved oral treatments to prevent the further growth of, and sometimes shrink nasal cell carcinoma (BCC).  As someone who seems to take forever for any cut to heal, I like this. I also like helping Doc do the Mohs so I’m glad that is still popular but, for those who have contraindications to surgery, or lack the desire to go through that (and myriad other reasons) this is appealing. Fluorourocil, diclofenac, imiquomod are all topical methods but only approved for superficial SCs. Radiation takes a big time commitment and transportation costs. Who likes to have a chunk ...

Yes I know squamous doesn’t rhyme with squeamish but do I care? Nope. Working in dermatology, skin cancers are a commonplace occurrence in my normal working day. Aside from that they are the most common cancers in the world, though often not as reported. But it makes sense, the skin is a huge organ and always turning over cells. The WHO estimates that 2-3 million non-melanoma skin cancers (NMSC) are diagnosed yearly, that is 1/3 cancers. Melanoma is the one most people have heard of, and for good reason. With a lower incidence, estimated 130,000-150,000 a year, melanoma is a serious killer, literally. But that is for another post. Here, we talk about the squames. Squamous cell carcinoma (SCC) begins from cells in the epidermis, as opposed to melanocytes (melanoma), or the basal layer (dermis, basal cell carcinoma). SCC is not only skin however, squamous epithelial cells line our hollow organs as well. But for this post I will be referring to cutaneous SCC as cSCC. When the DNA in our s...