Tools Table Window Help A Pain in the Knee (Compatibility Model ces Mailings Rev
ID: 98339 • Letter: T
Question
Tools Table Window Help A Pain in the Knee (Compatibility Model ces Mailings Reviow View ·-·-·-· Normal No Spacing Heading1Heading 2 A Pain in the Knee Dexter Robertson is a 15 year old high school student from the Bronx, New York City, who presents to the ER in February 1998 with a complaint of "dull, aching pain" in his left knee for the past month. Dexter is a track athlete on his high school team, and reports accidentally tripping and falling on his left leg during practice about the same time the pain began. He lives with his mother and two younger siblings. In addition to attending high school, he works at the local supermarket to help support his family. He says that his leg pain has been interfering with his ability to concentrate in school and to have a good social life Dexter's past medical history is unremarkable; he has never been hospitalized. His family history is positive for hypertension and alcoholism on his mother's side. The physical exam is notable for tenderness in the left knee. The knee is slightly swollen, and there is a decrease in the range of motion of the left leg. A radiograph is taken, revealing a left proximal tibial mass. A tentative diagnosis is made and Dexter is referred to Dr. Hardiman, an orthopedic surgeon at New York Presbyterian Hospital, for a definitive biopsy. The biopsy is done in March 1998, confirming the diagnosis of osteosarcoma. Dr Hardiman discusses the nature of this cancer with Dexter and his parents, and recommends an above the knee amputation. Dexter refuses to consider this option, and asks for a second opinion. Dr Hardiman refers Dexter to Dr. Ramirez at Mt. Sinai Hospital, Dr. Ramirez offers to try a new limb salvage procedure involving a total knee replacement and the placement of an expandable metal rod after resection of the tibial tumor. Dr. Ramirez informs Dexter that the operation is long (8-10 hours) and painful. . On the tenth post-operative day, Dexter is discharged home with recommended medications; some are NSAIDS He is also given instructions to begin outpatient physical therapy. He does very well over the ensuing months as he adapts to the metal prosthesis. He experiences occasional episodes of pain in his left leg. which is usually responsive to medications. Overall his prognosis and recovery are good.Explanation / Answer
3. T cells and B cells are activated that target specific tumor antigens.Some activated T cells kill tumor antigens directly or indirectly.Whereas some activated T cells acivate B cells which become antibody producing plasma cells.When a tumor cell is killed , additional antigens are released stimulating the populations of new T and B cells that recognize tumor antigens.This results in expanding cascade of immune cells trying to finish off tumor antigens.Now some activated immune cells become memory cells which remain primed to stimulate an immune response when tumor cells bearing target antigens are encountered within the body.
6.If tumor cells escape destruction, they can persist in a delicate balance of growth and immune suppression. During this equilibrium phase, the immune system is able to keep tumor cells from growing out of control, but unable to eliminate them completely. Researchers believe that the back-and-forth interactions between tumor cells and the immune system during this phase can cause tumors to develop new adaptations to evade the immune system.
In the escape phase, tumors use powerful adaptations to disrupt equilibrium and suppress the immune system. A common method deployed by tumors is to manipulate checkpoint pathways, which act as natural “brakes” for an immune response. For eg. when checkpoint pathways like CTLA-4 or PD-1 are activated, a signal is triggered that “turns off” active T cells.
7a..mmunotherapy, also called biologic therapy, is a type of cancer treatment that boosts the body's natural defenses to fight the cancer. It uses substances made by the body or in a laboratory to improve or restore immune system function. Immunotherapy may work in these ways:
Stopping or slowing the growth of cancer cells
Stopping cancer from spreading to other parts of the body
Helping the immune system work better at destroying cancer cells
There are several types of immunotherapy, including:
B. Viral structural ,capsid, or membrane proteins are made to fuse with tumor cell membrane proteins.These fused protein will be non self to the host,thus these acts as immunogenic.Now viral oncolysis would be followed by anti cancer immunization.For eg. influenza viral particles replicating in and thus lyzing cancer cells ,would construct such fused and thus immunogenic antigens.This experimental plan could be devised for the course of treatment.
Monoclonal antibodies
Non-specific immunotherapies
Oncolytic virus therapy
T-cell therapy
Cancer vaccines