Weird Medical Facts

What do Gottlieb Burckhardt, Egas Moniz, and Walter Freeman have in common?  Other than the fact that I had never heard of them before researching this topic, it turns out that they were all dudes who lobotomized their patients.

photo by OpenSkyMedia

A lobotomy is a brain surgery that cuts the connectors between the front bits and the back bits of the brain.  European doctors started performing the procedure on mental patients in the early 20th century, along with other radical therapies for extreme mental illness and insanity.  Other procedures included electroshock (or electroconvulsive) therapy, drug-induced deep sleep therapy, and more.

I am not, by any means, denouncing the entire psychiatric community for coming up with risky, damaging, and invasive radical treatments to try out on helpless mental patients.  Nope.  Not me.  Anyway…

Gottlieb Burckhardt was a psychiatrist in the late 1800’s and he performed lobotomies on six patients with varied diagnoses.  Two of the patients simply became more subdued, one died shortly after surgery, two were unaffected altogether, and one seemed to improve but then later committed suicide.

Egas Moniz was a Portuguese neurologist changed the surgery a bit – he drilled holes into the heads and injected alcohol to kill the frontal lobes.  I guess that didn’t work, because he came up with a tool called a leucotome that was really just a wire loop that scrambled stuff around in the patient’s heads.  This work, which took place in the mid-thirties, had better success rates than one would expect, earned Moniz the 1949 Nobel Prize for medicine.

Walter Freeman studied Moniz’s work and along with a guy named James Watts altered the practice and created their own procedure.  Called the Freeman-Watts procedure, they would drill into the scalp, and then later would go in through the eye socket.

1949 was the big year for lobotomies, with more than 18608 lobotomies taking place in the United States by 1951.  JFK’s sister had a lobotomy when she was 23 and she was never OK after that.  Same with Tennessee Williams’ sister Rose.  Other people, like Howard Dully and Alys Robi turned out just fine, but at the same time lots of people died.

That’s probably why they don’t do them anymore.

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Understanding Staging Lung Cancer

Staging is the process by which once lung cancer is confirmed, the degree to which the cancer has established itself and how it presents in a patient is categorized.  This is essential if an appropriate and effective treatment regime is to be recommended and implemented in a lung cancer patient.
Staging is frequently referred to as “TNM” by oncologists (cancer specialists).

TNM refers to the three main factors used in staging:

•    Primary Tumor (T) – whether there is a tumor or tumors which can be established;
•    Lymph Nodes (N) – whether the cancer has occurred in the lymph nodes; and
•    Metastasis (M) – whether the cancer has spread to or from other parts of the body.

Each of these factors is further assessed to provide more detailed clarification.  For instance, where a tumor cannot be located but it is confirmed by the presence of cancer cells, the assessment will be TX.
A detailed explanation follows:

Primary Tumor (T)
TX – no tumor is located but is confirmed by presence of cancer cells
T0 – no evidence of a primary tumor

T1 – primary tumor of less than 3cm and not in the main bronchus
T2 – primary tumor which is any of the following:

•    Larger than 3cm
•    Is present in the main bronchus or other important parts of the lung

T3 – primary tumor of any size invading surrounding tissue or chest wall
T4 – as T3 but affecting the heart, trachea, great blood vessels – more serious than a T3 tumor
Regional Lymph Nodes (N)

Lymph nodes are small, bean shaped objects which are reservoirs of immune cells and materials vital to protect the body.  Regional lymph nodes refers to those lymph nodes in the surrounding vicinity of the lungs.
NX – no assessment

N0 – no regional lymph node metastasis (i.e. the lung cancer has not spread to the lymph nodes)

N1, N2 and N3 – metastasis has occurred to increasing severity

Distant Metastasis (M)

Metastasis refers to the spreading of the cancer to or from other parts of the body.  This is important because primary cancer (i.e. cancer which has originated at that location in the lung) is susceptible to treatment by surgery whereas metastasized lung cancer usually is not).

MX – no assessment of distant metastasis
M0 – no distant metastasis has occurred

M1 – distant metastasis has occurred and includes separate tumor(s) in other parts of the lung or body
Allocation of a Stage

After assessment of the tumor, lymph nodes and metastases, a stage is allocated which depends on the findings of how many tumors, where they are located and how they have spread?

The stages are allocated as follows:

Occult carcinoma – TX, NO, MO – cancer is present because of the presence of cancer cells but it cannot be located or assessed.  This is not allocated a distinct stage but is classed as an “unknown” or medical wildcard.

Stage 0 – any Tumor, N0 and M0
Stage IA – T1, N0, M0
Stage IB – T2, N0, M0
Stage IIA – T1, N1, M0
Stage IIB – T2, N1, M0 or T3, N0, M0
Stage IIIA – T1-T2, N2, M0 or T3, N1-N2, M0
Stage IIIB – Any T, N3, M0 or T4, any N, M0
Stage IV – Any T, Any N, M1

This is obviously a complicated exercise which may require repeated visits to the hospital and your doctor, but it is vital to effective treatment that this staging process is properly conducted.  How well staging is conducted has a direct bearing on survival rates of patients with lung cancer.

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Explaining Medical Terminology Associated with Lung Cancer Treatment

Medical terminology is baffling for any layman and when we are confronted with a condition as serious as lung cancer, it helps to relieve some of the stress if you understand some of the terminology.  Your doctor will help you with understanding what is happening and the treatment regime which is available, but you can also do much to help yourself by learning more about the condition and its cure.

Diagnostic Tools and Techniques

Lung cancer is usually discovered because of a routine chest x-ray or because symptoms occur which send them to the doctor, such as persistent coughing or coughing up blood.  These are not conclusive indicators of lung cancer but prompt further investigation.

Lung cancer can be diagnosed using a combination of the following:

CT Scan – this is a tool using x-rays which provides a detailed picture of the lungs and any abnormality.  The CT stands for Computed Tomography.

PET Scan – PET stands for Positive Emission Tomography and is a non-invasive procedure which highlights the tumor by using an injection of mildly radioactive glucose solution – cancer tumors use a lot of energy and the raw material is glucose sugar – if you have a cancer tumor, it will show up because the radioactive sugars will concentrate around it.

Bronchoscopy – is the insertion of a tube which has a camera and swab or biopsy-taking scalpel on the end of it.  A biopsy is simply a small tissue sample which is taken from the affected area of the lung and sent to the lab for testing for cancer cells.  A bronchoscopy can be mildly discomforting as the tube is inserted through the nose or mouth to reach the major airways so a swab or biopsy can be taken.

Needle Biopsy – the doctor will use the results of a CT Scan to guide a needle into the affected area of the lung so a tissue sample can be taken for testing.

Surgical Biopsy – if the abnormality is in a difficult to access part of the lung or is too small for a needle to accurately find it, then a small incision is made through which the surgeon is able to remove part of the lung containing the affected tissue.  The tissue is then tested for cancer cells in the pathology lab.

Staging or TNM

Staging – the process by which a cancer is categorized based on a number of factors; the result is used to determine an effective and appropriate treatment regime.

TNM – staging is frequently referred to as “TNM” which stands for the three main factors – the presence of a Tumor, the cancer being present in the Lymph Nodes, and the spreading of the cancer to or from other parts of the body, referred to as Metastasizing.

Primary Cancer – this refers to a cancer which has originated at that spot and has not occurred because it has spread from another part of the body.  Surgery is frequently used to treat early forms of primary lung cancer backed by chemotherapy or radiation treatment.
Metastasized Cancer – this refers to a cancer tumor which has originated elsewhere in the body and has spread to the lungs.  It is not usually treated by surgery unless the cancer is non-aggressive and not too large.

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