Aleksandra Žmegač Horvat: MEDICAL ENGLISH WORKBOOK DIGESTIVE SYSTEM I There are several processes involved in what we usually call DIGESTION. Match their medical names with their description: 1 INGESTION A rhythmic contractions of digestive structures that help the passage of food 2 MASTICATION B passage of nutrients from small intestine into blood or lymph 3 DEGLUTITION C intake of food into mouth 4 PERISTALSIS D elimination of solid wastes from the body 5 DIGESTION E chewing of food 6 ABSORPTION F chemical and mechanical breakdown of food 7 DEFECATION G swallowing of food

II WHAT IS IT IN ENGLISH? Give the general English names for the digestive structures below:

ORAL CAVITY ___________________________ HARD AND SOFT PALATE ___________________________ GINGIVA ___________________________ SALIVA ___________________________ PHARYNX ___________________________ ESOPHAGUS ___________________________ GASTER ___________________________ ILEUM ___________________________ COLON ___________________________ DUODENUM+JEJUNUM+ILEUM+ ___________________________ COLON+RECTUM III Assign each of the following functions to one of the structures from exercise II. Also, try to define the terms in italics:

• chemically and mechanically breaks down chyme from stomach with help of hepatic secretions and pancreatic juices; absorbs nutrients; transports wastes to large intestine: ____________ • transports bolus from pharynx to stomach: ____________ • mechanically breaks down food mixing it with saliva; starts digestion of

carbohydrates: ____________ • mixes bolus with gastric juice; starts digestion of proteins; moves chyme into

duodenum; when necessary, regurgitates food: ____________ • absorbs water and electrolytes from undigested wastes; forms and expels

feces by defecation reflex: ____________ • transports bolus from mouth to esophagus: ____________ DID YOU KNOW THAT...? Work in groups of 4. Each of you should read one of the following items, suggest a headline for it, and try to sum it up in one sentence. Then tell your group about what you have read. ______________________________ According to various European and American studies, the worldwide trend towards obesity is causing serious health concerns in the industrialized world. Between 10% and 25% of people in the EU have been classified as obese, and all Americans will be overweight by 2059 at the current rate of increase. The medical consequences of this trend are well known: being overweight significantly increases the risk of coronary artery disease, congestive heart failure, hypertension, diabetes, depression, deep-vein thrombosis, osteoarthritis, hip- and knee-replacement surgery – to mention only the top of the list. One more thing: it has been established that the most common cause of obesity is not overeating, but underactivity.

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Orlistat, a weight loss drug that works in the intestine, decreases the users’ fat absorption by about 30%, and, according to long-term studies, enabled more than 50% of them to lose at least 5% of their body weight. But Orlistat users have to take vitamins A, D, E, K and beta-carotene supplements, and tolerate side-effects such as frequent bowel movements. Of course, the drug is not meant to be a substitute for a healthy lifestyle – a balanced diet and exercise still remain a must! ____________________________________

Bad breath (halitosis), unpleasant as it may be, isn't an illness, but just a symptom. In some cases, the underlying cause may be diabetes, some kidney disorder or an infecion of the sinuses, bronchial tubes or gums. Another cause is foods like onions or garlic, because essential oils from such foods get into the blood, lungs and then out with each exhaled breath.

But the most common reason for bad breath are food molecules rotting in the mouth. Mouthwash masks the smell, brushing and flossing remove larger particles, but dentists suggest brushing the back of the tongue as well, where food residues and bacteria congregate. The microscopic bits that remain must be flushed down by drink or saliva (morning breath occurs because salivation shuts down at night).

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Searching for cancers and other diseases by inserting endoscopes up the rectum or down the throat can be painful, and some areas remain inaccessible. But the ‘wireless video pill’, a new diagnostic device recently introduced in our country too, allows patients to live their normal lives while it passes painlessly through their digestive systems. For 24 hours it takes two pictures a second, sending images to a small recorder worn at the waist; the data are downloaded to hospital computers for analysis. However, the capsules won't make the endoscope superflous, because endoscopes can perform biopsies and other procedures as well. Besides, this new diagnostic method has its price: ca 600 euro per capsule. GASTROINTESTINAL SYMPTOMS I Gastrointestinal symptoms are important because they can signal a large number of disorders, not only of the digestive system. Match the symptoms with their definitions: 1 ACHLORHYDRIA A abnormal frequency and liquidity of stools 2 ANOREXIA B syndrome characterized by hyperbilirubin- emia and deposition of bile pigment in the skin, mucosa and sclera, resulting in yellow appearance of the patient 3 ASCITES C bad breath 4 COLIC D absence of hydrochloric acid from gastric secretions 5 CONSTIPATION E air / gas from the stomach passed through the mouth 6 DIARRHEA F effusion and accumulation of serous fluid in the abdominal cavity 7 DYSPHAGIA G unpleasant abdominal sensation often culminating in vomiting 8 ERUCTATION H difficulty in swallowing 9 FLATUS I lack / loss of appetite 10 GASTROESOPHAGEAL J heartburn REFLUX

11 HALITOSIS K excessive amounts of fats in the feces 12 JAUNDICE L gas / air in the GI tract or expelled (ICTERUS) through the anus 13 MELENA M reflux of stomach and dudenal contents into the esophagus 14 NAUSEA N infrequent / difficult evacuation of feces 15 PYROSIS O acute abdominal pain 16 STEATORRHEA P dark stools stained with blood pigments II If chronic, GASTROESOPHAGEAL REFLUX can be a serious, sometimes life-threatening disease. Scan the text about a new, less invasive technique of diagnosing the disorder and mark the lines that give you the following information: - definition of gastroesophageal reflux - symptoms - 3 ways to diagnose it - the surgical option to cure it - how the Bravo system works and what are its advantages

Gastroesophageal reflux occurs when the valve between the esophagus and stomach (the cardiac sphincter) weakens, and gastric fluids flow back up into the esophagus and throat. The condition can cause symptoms ranging from heartburn to chest pain that can be mistaken for heart disease. Some people become hoarse and have difficulty speaking, and chronic reflux might also increase the risk of esophageal cancer. The most common way to diagnose reflux is to put a patient on treatment with antacids or other drugs, and then follow the patient to see if symptoms improve or disappear. It is also possible to diagnose reflux by examining a patient with an endoscope, a rubber tube with a camera at the end that is slipped into the esophagus of a sedated patient. Yet another option is 24-hour pH testing to monitor acid levels in the esophagus, which involves running a catheter up the patient's nose and down the back of the throat into the esophagus. To resolve the condition, in chronic cases many patients decide on minimally invasive surgery to strengthen the cardiac sphincter. The Bravo diagnosing system does without the catheter entirely and is thus more comfortable than traditional pH testing methods. It uses a small capsule that doctors attach to the wall of the esophagus near the junction to the stomach. The capsule transmits electrical signals to a pager-like device. After about a week, the capsule falls away from the wall of the esophagus and passes naturally out of the system. The Bravo system causes less nasal and throat irritation than the trans-nasal catheter. Patients can maintain their normal diet and activities, which enables more representative test results to aid diagnosis and plan treatment.

Now choose 3 of the collocations in italics and put them into sentences of your own.

GASTROINTESTINAL DISORDERS Match the names of some common GI disorders with their simple explanations:

1 CHOLECYSTITIS A inflammation of the small intestine 2 CHOLELITHIASIS B various GI symptoms in the otherwise normal intestine 3 CIRRHOSIS C swollen veins in the rectal and anal lining 4 DIVERTICULOSIS D protrusion of part of the stomach through the diaphragm 5 ENTERITIS E gallstones in the gallbladder 6 ESOPHAGEAL F inflammation of the peritoneum VARICES 7 GASTRITIS G protrusion of part of the intestine in the groin area 8 HEMORRHOIDS H chronic inflammation of the colon with the presence of ulcers 9 HIATAL HERNIA I side pockets (pouches) in the intestinal wall 10 IRRITABLE BOWEL J inflammation of the gallbladder SYNDROME (IBS) 11 INGUINAL HERNIA K swollen veins in the distal part of the esophagus or the upper part of the stomach 12 PEPTIC ULCER L inflammation of the stomach lining 13 PERITONITIS M chronic liver disease often associated with alcoholism 14 ULCERATIVE COLITIS N lesion of the stomach or duodenal lining

CASE REPORT: IRRITABLE BOWEL SYNDROME (IBS) Provide the missing medical terms from their definitions below: Condition description The (1) ____________ is characterized by some combination of: • (2) ____________ pain • altered bowel function, (3) ____________ or (4) ____________ • hypersecretion of (5) ____________ ____________ • (6) ____________ symptoms – (7) ____________, (8) ____________, (9) ____________ • small (10) ____________

• a feeling of incomplete evacuation after (11) ____________ A most definitive sign is (12) ____________ ____________, particularly in the descending colon. The symptoms are probably due to (13) ____________ of the colon with no demonstrable organic pathology. The condition is also known as nervous indigestion, spastic colitis, intestinal neurosis. It is important to eliminate all other possible pathologies before diagnosing IBS. 1 set of symptoms occurring together 2 pertaining to the part of the body between the thorax and the pelvis 3 infrequent/difficult evacuation of bowel 4 abnormal frequency/liquidity of stools 5 slime from the large intestine 6 pertaining to indigestion 7 excessive amounts of air/gas in the stomach or intestine 8 unpleasant abdominal sensation often culminating in vomiting 9 lack of appetite 10 stools 11 bowel evacuation 12 involuntary contraction of the bowel 13 bad/poor function

A NEW LIVER

I DID YOU KNOW THAT...? • the ancient Greeks and Romans regarded the liver as the seat of life, and

used to predict the outcome of war by looking at the livers of sacrificed animals before going into battle?

• the liver, beside the brain, is the only organ so complex that its function cannot be artificially supported or replaced in the event of damage or failure?

• living donor liver transplantation is possible because the liver — unlike any other organ in the body — has the ability to regenerate, or grow, in only a period of weeks?

II Read the text and decide whether the statements below are true or false. Mark the places which support your decision. LIVER TRANSPLANTS Several years ago, the unexpected death of a healthy donor following a liver transplant operation in New York raised questions about how justified living donor transplants are, even if the risks involved are minimal – an estimated 0.5%

to 1%. Voices were heard asking for a national moratorium on the procedure and recommending cadaver liver transplants instead. Currently, about 20,000 people in the US are on the waiting list for liver transplants, according to the United Network for Organ Sharing, which controls the allocation of cadaver organs; only about 5,000 can expect to get a transplant each year – many will die waiting. In living donor transplantation, a piece of liver is surgically removed from a living person and transplanted into a recipient, immediately after the recipient’s diseased liver has been entirely removed. After the donor liver is removed, preserved and packed for transport, it must be transplanted into the recipient within 12 to 18 hours. The surgery begins by removing the diseased liver from the four main blood vessels and other structures that hold it in place in the abdomen. After the recipient's liver is removed, the new healthy donor liver is then connected and bloodflow is restored. The final connection is made to the bile duct, a small tube that carries bile made in the liver to the intestines. After this demanding surgery, the postoperative course must be closely monitored for possible complications typically involved in live liver transplants: infection, pneumonia, blood clotting, allergic reaction to anesthesia and injury to the bile ducts or other organs. In comparison with the risks for liver donors, for kidney donors the risk of death ranges from 1 in 2,500 to 1 in 4,000. That explains why nearly 40% of kidney transplants in the US come from living donors. The operation to transplant a liver, however, is a lot trickier than the one to transplant a kidney. A living donor transplant works best when an adult donates a small portion of the liver to a child. Usually only the left lobe of the organ is required, leading to a mortality rate for living donors of 1 in 500 to 1 in 1,000. But when the recipient is another adult, as much as 60% of the donor's liver has to be removed, which makes the odds less favorable, both for the donor as well as for the recipient. Transplant centers have developed screening programs to ensure that living donors fully understand all the risks involved in their decision. But there will always be family members prepared, without much thought, to accept almost any risk for a loved one. Thus the ethical committees within the medical profession should, together with society, provide guidelines to help those involved to make the right decision in each individual case. 1. There were requests for living donor transplants to stop because of the risks involved for the recipient. 2. About one fourth of the patients on the US waiting list for liver transplants can expect to be transplanted every year. 3. A donor liver must be implanted within a day of removal. 4. Kidney donors are at greater risk of death than liver donors. 5. Kidney transplants are less complicated than liver transplants. 6. The donor mortality rate is higher in adult-child transplants.

III Now restore the original word order in the sentences describing the liver transplant procedure and then put the sentences into sequence: 1. the healthy donor liver / bloodflow / is restored / then / is connected / and __________________________________________________________ 2. be transplanted / the recipient / must / within 18 hours / into / it __________________________________________________________ 3. must / for possible complications / closely monitored / be / the postoperative course __________________________________________________________ 4. surgically / from / a portion / a healthy person / removed / is / of the liver ___________________________________________________________ 5. connected / the bile duct / finally / gets ___________________________________________________________ 6. is preserved / for transport / and / then / it / packed ___________________________________________________________ 7. that hold it in place / diseased liver / from the structures / is removed / the recipient’s ___________________________________________________________ Translate: Prema studiji objavljenoj u New England Journal of Medicine, a na temelju istraživanja provedenog u 1500 američkih bolnica, smrtnost nakon različitih kirurških zahvata to je manja što više takvih zahvata određeni kirurški tim obavlja. Tako je npr. kod srčanožilnih operacija i zahvata na prostati smrtnost 25% do 40% niža u bolnicama gdje se takve operacije obavljaju 200 ili više puta godišnje. Za neke rjeđe operacije, uključujući potpunu zamjenu kuka i odstranjenje debelog crijeva, smrtnost je značajno pala u bolnicama gdje se godišnje obavlja najmanje 10 do 50 takvih zahvata. Preporuka je studije da se pojedine bolnice specijaliziraju za specifične visokorizične zahvate, što bi rezultiralo smanjenjem rizika od smrtnog ishoda određenih operacija. CASE REPORT: ACUTE PANCREATITIS Explain the underlined medical terms using general English: A 42-year-old female presented with an acute onset of abdominal pain and vomiting. She had a recent 3-week history of upper respiratory infection and a 5-day history of diarrhea. PMH: Allergic (1) rhinitis, endometriosis, (2) hysterectomy, (3) appendectomy,

(4) cholecystectomy, (5) hypertension. Social history: The patient denied alcohol or tobacco use. Physical examination: Within normal limits with the exception of the abdomen, which was very tender to palpation, mostly around the (6) epigastric area. There were significantly decreased bowel sounds. No (7) hepatosplenomegaly. Diagnostic exams: An ultrasound of the abdomen demonstrated abundant upper abdominal bowel gas that moderately obscured the liver and totally obscured the pancreas. The gallbladder was not visualized, presumably surgically removed. No (8) biliary tract dilatation could be identified and there was mild diffuse (9) adipose infiltration of the liver. Hospital course: The patient was admitted to the medical floor with a diagnosis of (10) acute pancreatitis. She was made (11) NPO and given intravenous fluids. For pain control, she was started on intravenous meperidine via a patient-controlled (12) analgesia pump, but since this did not lessen her pain, the medication was changed to morphine with better effect. After 3 days, she required no pain medications and was started on a clear liquid diet. She tolerated this well with no recurrence of abdominal pain. 1 ___________________________________________________________ 2 ___________________________________________________________ 3 ___________________________________________________________ 4 ___________________________________________________________ 5 ___________________________________________________________ 6 ___________________________________________________________ 7 ___________________________________________________________ 8 ___________________________________________________________ 9 ___________________________________________________________ 10 ___________________________________________________________ 11 ___________________________________________________________ 12 ___________________________________________________________

CARDIOVASCULAR SYSTEM CIRCULATION OF BLOOD Put the following alphabetically listed structures where they belong in the description of pulmonary and systemic circulation: AORTA MITRAL VALVE RIGHT ATRIUM AORTIC VALVE PULMONARY ARTERY RIGHT VENTRICLE LEFT ATRIUM PULMONARY VALVE TRICUSPID VALVE LEFT VENTRICLE PULMONARY VEINS VENAE CAVAE LUNGS Deoxygenated blood is brought to the heart by the two largest veins in the body, the ____________ ____________. It first enters the ____________ ____________, and when that contracts, the blood is forced through the ____________ ____________ into the ____________ ____________. Its contraction pumps blood through the ____________ ____________ into the ____________ ____________, whose branches take it to the ____________. This is the place where gaseous exchange takes place and blood gets freshly oxygenated, returning to the heart by way of the ____________ ____________. Blood enters the ____________ ____________, from which it is forced, through the ____________ ____________, into the ____________ ____________. The contractions of its thick walls propel the blood through the ____________ ____________ into the ____________, whose branches carry it all over the body.

IS YOUR LIFESTYLE DEAR TO YOUR HEART? I WHAT CAN YOU DO? By adopting a healthy lifestyle you can reduce the danger of developing and dying from cardiovascular disease. Get the titles right for the following bits of advice (in some cases, there are alternatives), and then match the titles with the appropriate passages (the key words have been left out): 1 STOP A BLOOD PRESSURE 2 LOWER B WEIGHT 3 LOSE C CHOLESTEROL 4 DON’T COUNT ON D STRESS 5 REDUCE E HORMONES 6 CONTROL F SMOKING

a) Chronic ____________ can increase the risk of heart disease and lead to unhealthy habits like smoking, abusing alcohol and eating junk food. Yoga and meditation can reduce ____________; so can getting enough sleep every night. If you are depressed, get support or treatment as necessary.

b) ____________ more than doubles your chances of having a heart attack. If you quit, that risk is cut in half within two years; after 10 years, the odds return to nearly normal.

c) ____________ protect younger women against heart disease, but we know now that ____________ replacements do not protect postmenopausal women - and can actually increase the risk for women who have already had a heart attack.

d) Elevated lipids - ____________ and triglycerides – are important risk factors. Although doctors have traditionally focused on levels of LDL, HDL may be a better predictor of heart-disease risk in women. Women should maintain HDL at levels as high as possible.

e) ____________ makes the heart work harder to move blood through the body, so it puts you at higher risk of both heart disease and stroke. If you get short of breath when you are physically active, don’t ignore it. And if you have ____________, treat it with proper diet, exercise and medication if needed.

f) Carrying excess ____________, especially around the middle, increases your risk of a heart attack or stroke. ____________ can also lead to diabetes, a major risk factor. Doctors recommend a reduced-calorie diet with lots of vegetables and whole grains, plus 30 minutes of moderate aerobic exercise a day.

II DO YOU KNOW YOUR BMI? Figure out your BMI to see if you are at risk of heart disease: To figure out your body mass index (BMI), first you have to divide your weight (in kilograms) by your height (in meters), and then divide the result by your height once again. e.g. 60 (kg) : 1.67 (m) = 35.92 : 1.67 = 21.5 The body mass index, a measure of the relation of weight to height, is a common way to estimate excess weight. Most health advisers say that a BMI of under 25 is healthy, 25-30 is overweight and over 30 is obese. But according to some studies, women should aim for an even lower BMI, as it was found that the risk of heart disease actually increases above a BMI of 22, not 25. Interestingly, not only the amount of weight is important, but also how that weight is distributed. Though female fat is distributed more evenly than that of men, overweight women fall into two categories: ‘apples,’ whose fat is concentrated in

the waist, and ‘pears,’ who have fatter hips and thighs. It's now widely recognized that obese people have a greater risk of heart disease, but there is new evidence to suggest that the pearstyle fat may actually protect against attacks. A recent Danish study found that women with fat deposits in the legs, hips and buttocks were less likely to have atherosclerosis. III Work in pairs. Each of you should read one of the following items talking about the RELATION BETWEEN WEIGHT AND CARDIAC PROBLEMS problems and then tell your partner about it:

• Although it is well known that regular exercise and weight loss are good for your health, the results from a recent study of women with heart problems suggest that sometimes it’s better to be fit than thin. Active women, no matter how thin or fat, were much less likely to to have a heart attack and other cardiac problems than women who didn’t exercise. Nevertheless, weight matters: another study proved that overweight women, regardless of how much they exercised, were nine times more likely to develop diabetes than women of normal weight.

• Losing weight, especially around the waist, lowers your risk of heart disease, high blood pressure and diabetes. But this only works if you get rid of your fat the right way, by diet and exercise. Liposuction, a shortcut to a slim figure, won’t help. A study has shown that a group of women who each had about 10 kg of abdominal fat surgically removed, didn’t show any improvement in insulin sensitivity, cholesterol level, blood pressure or other risk factors for heart disease three months after the operation.

IV Test yourself: HOW MUCH DO YOU KNOW ABOUT CHOLESTEROL? Work in pairs. Cover the answers, read through the 8 statements and decide whether they are true or false, giving arguments for your opinions. Then go through the answers in turns, explaining to your partner where and why he / she went wrong.

1. The body needs cholesterol. 2. The best way to reduce cholesterol is to limit cholesterol–rich foods, such as eggs. 3. To lower your cholesterol, you should stop eating all meat. 4. Any total cholesterol level below 6.5 is fine. 5. All vegetable oils are good for the heart. 6. Lowering cholesterol can help people who have already had a heart attack. 7. Exercise can raise good cholesterol. 8. Women don't need to worry about high levels of cholesterol and heart disease.

Question 1: TRUE. Cholesterol is a soft, waxy substance that the body uses to build cell membranes and make steroid hormones, such as estrogen, testosterone and cortisone. The problem is excess cholesterol – particularly the ‘bad’ LDL cholesterol, which contributes to plaque buildup in the arteries. Question 2: FALSE. Although so-called dietary cholesterol does raise blood cholesterol in most people, saturated fat is mostly responsible. The most effective way to control blood cholesterol is to reduce foods high in saturated fat, such as full-fat cheese, cream, butter and meat. Question 3: FALSE. Red meat is high in saturated fat, which can raise cholesterol. But lean meat can be part of a healthy diet. Reduce your daily intake of lean meat to 150 g. Question 4: FALSE. For most people, total cholesterol should be under 5.5. But cholesterol comes in two basic forms. In general, ‘bad’ LDL cholesterol should be below 3.6 – unless you have heart disease or diabetes, in which case you should aim even lower. However, a low level of ‘good’ HDL cholesterol - under 1.1 - raises the risk for heart disease. Question 5: FALSE. The vegetable oils found in hard margarine and many baked products are high in saturated fat and raise blood cholesterol. Focus instead on the other vegetable oils, preferably olive, which contain mostly unsaturated fats. Question 6: TRUE. People who have had one heart attack are at higher risk for a second, but lowering cholesterol can greatly reduce that risk. If you have heart disease, your LDL level should be less than 2.7. Question 7: TRUE. Doctors recommend at least half an hour a day. Other measures that can help raise HDL include losing weight and stopping smoking. Question 8: FALSE. Before menopause, women tend to have lower cholesterol levels than men. But afterward, their levels go up, along with their risk for heart disease. FEMALE HEARTS

I In groups of 3, read about how the possible causes, manifestations and consequences of three major vascular disorders may differ in men and women. Take turns to sum up the information on one disorder for the group.

ANGINA

Women vs. men: More women than men complain of chest pain, but in relatively few women angina is accurately diagnosed. Doctors are just beginning to realize that any chest pain in women, even younger women, could be a sign of heart trouble.

HEART ATTACK Women vs. men: Women tend to experience heart attacks 10 to 20 years later than men, but a woman's first heart attack is more likely to be fatal. Many women don't experience the classic symptoms that men feel – pain in the chest and arm and shortness of breath. Some doctors believe this is because heart attacks in women may have more to do with spasms in the heart vessels than with blocked arteries.

CONGESTIVE HEART FAILURE Women vs. men: One in five women with congestive heart failure will die within one year of their diagnosis, probably because women tend to be older and their disease more advanced when they receive the diagnosis. For the same reasons, twice as many women as men who have a heart attack will be disabled by heart failure.

II Read the text about HEART ATTACKS IN MEN AND WOMEN and mark the passages which contain the following information: - the main risk factors for heart attacks in both sexes - the physiology of a heart attack - how an angiogram is performed - patterns of vessel blockage in women - the difference in plaque buildup in men and women - the difference in the symptoms of a heart attack - how angioplasty is performed - the risks of angioplasty for women in the past - drug dosage concerns in the treatment of women

The more scientists learn about female hearts, the more they realize that females aren't just smaller versions of males. There are subtle but important differences in how women's cardiovascular systems respond to various factors which may cause heart disease. It has been established that female hormones protect women against heart disease before menopause, although doctors aren’t sure how. But all the benefits of female hormones disappear with menopause and women end up with more or less the same risk of heart disease as men. Smoking is the most dangerous risk factor for both sexes, followed by diabetes, high blood pressure, high cholesterol levels, excess weight and physical inactivity. Some factors, however, seem to affect women more severely than men. In fact,

smoking and diabetes completely counteract the protective benefits a woman normally enjoys before menopause. Cardiologists are confident that they understand how heart attacks occur in men. Plaque, built up over decades on the inside of a coronary artery, becomes unstable and bursts, triggering a clot that blocks a blood vessel. Doctors can see these plaques by means of an angiogram, in which a catheter is threaded through an artery in the groin or leg up to the arteries of the heart and a dye is then released to make blockages easier to spot. Bursting plaques, the immediate triggers of a heart attack, may not be as significant for women as for men. Doctors have noticed that some of their female heart-attack patients show few signs of artery-clogging plaques on their angiograms. It seems their blockages don't occur in the major arteries of the heart, where angiograms are performed and bypasses are most effective. It may be that blood flow is restricted in the smaller vessels that branch off the coronary arteries. And perhaps the problem isn't plaques at all but the fact that these smaller blood vessels are more prone to spasm, closing suddenly at the slightest trigger, cutting off the flow of blood to parts of the heart. It is also possible that plaques, whether in the main coronary arteries or the smaller vessels, behave differently in women. Unlike men, women tend to distribute all the ‘garbage’ associated with atherosclerosis, such as saturated fat and oxidized waste products, more evenly throughout the arteries. So although women generally avoid the big plaques that kill so many men in early middle age, the continuing buildup in women's arteries may make itself felt in their 60s or later. Also, the classical symptoms of a heart attck – chest pain that radiates into the left arm - are more diffuse in women and can include severe breathlessness, sweating, nausea, vomiting and pain in the neck, arms and shoulders. Women often don't interpret the symptoms correctly, which puts them at greater risk. Finally, American studies suggest that women may at last be benefiting as much as men from angioplasty, a procedure in which doctors use catheters and balloons to open up dangerously narrowed arteries and insert stents to keep the arteries open. In the past, catheters and stents were all made in one standard size – to fit men's larger arteries. As a result, women suffered more complications and a much higher risk of death from angioplasty. Also, until about three years ago doctors prescribed the same doses of the anticoagulant heparin for men and women, leading to greater internal bleeding in women. Smaller catheters and stents and lower doses should give women better results. HEART ATTACK I CASE REPORT: MYOCARDIAL INFARCTION Provide the missing medical terms from their definition below: A 33 year-old-man was admitted to our emergency department complaining of 5 hours of severe crushing chest pain.

On physical examination, paleness and cold sweating were noted. His (1) ____________ and (2) ____________ blood pressures were 110 and 80 mmHg respectively, and his (3) ____________ ____________ was 90 /minute. The (4) ____________ showed (5) ____________ ____________, and was consistent with an (6) ____________ ____________ ____________ ____________. . . . We decided to perform primary (7) ____________ coronary intervention (PCI). (8) ____________ ____________ and left (9) ____________ were performed. The left coronary system was imaged at left and right oblique, right cranial and caudal and anteroposterior cranial positions. Significant coronary artery (10) ____________ ____________ narrowing was observed in the mid segment of the left anterior descending coronary artery at left anterior oblique cranial position on coronary (11) ____________. The right coronary artery was normal. The left ventricular angiography showed (12) ____________ and (13) ____________ ____________. PCI was cancelled and medical follow up was decided. The patient was transferred to coronary care unit for medical treatment. . . . A normal hemoglobin level was achieved after ten hours. Three hours after the patient was admitted to the emergency department, his chest pain had completely disappeared, ST elevations had come to an (14) ____________ line and frequent ventricular (15) ____________ were observed on the monitor. Myocardial enzyme values taken after twenty-four hours were elevated to a level three times greater than normal. . . . At the one year follow-up visit, our patient was healthy and had no cardiac complaints. 1 occurring during the contraction of the heart 2 occurring during the dilatation of the heart 3 number of ventricular contractions per min 4 procedure of recording the el. activity of the heart muscle 5 normal heart rhythm originating in the SA node 6 sudden-onset, situated in the AV septum, heart attack 7 performed through the skin 8 radiographic visualization of the blood vessels of the heart 9 radiography of a ventricle of the heart 10 pertaining to the lumen during systole 11 radiographic record of blood vessels 12 located at the apex 13 at the front and side, abnormally decreased mobility 14 showing no variation in electric potential 15 premature contractions of the heart independent of the normal rhythm

II Read about CARDIOPULMONARY RESUSCITATION (CPR) in cases of cardiac arrest and sum up the text in 1 sentence. The high number of deaths after cardiac arrests is often blamed on the time delay between collapse and treatment. In the US, in out-of-hospital cases this delay averages 8 minutes. In situations where the patient can be treated within a minute or two with automated external defibrillators (AEDs), an immediately delivered shock is the best option. However, in out-of-hospital cases CPR seems to be of benefit. According to recent reports, the provision of approximately 90 seconds of CPR prior to use of AED is associated with increased survival when response intervals are 4 minutes or longer. This conclusion is the result of a study which investigated the effect of providing 90 seconds of CPR before defibrillation in patients who had had out-of-hospital cardiac arrests. The survival of 478 patients who received CPR before defibrillation during a 36-month period was compared with the survival of 639 similar patients treated in the 42 months before CPR was introduced. The researchers reported that provision of CPR was associated with an improvement in survival from 24% to 30%. Also, the percentage of survivors with good neurological function on discharge increased from 71% to 79%. Although these results are encouraging, researchers think that further clinical trials are necessary before they are accepted as all-conclusive.

III Read the text about INFLAMMATION as a possible contributing factor in heart attacks and decide whether the statements below are true or false. Mark the places which support your decision.

Although cardiologists always urge their patients to reduce the fat in their diet, still half of all heart attacks in the US occur in people with normal cholesterol levels. Now research has shown that inflammation might be another significant contributing factor. It seems that a similar process like the one initiated by the body's immune system against the joints in arthritis may also be occurring in the blood vessels of the heart. No one knows exactly what triggers the immune system in heart patients - it could be fatty deposits or bacteria or the toxins in cigarette smoke or the physical strain caused by high blood pressure. As the immune system becomes active, white blood cells, clotting factors and a number of other factors of the body's defense system gather and begin to build up inside a vessel wall, forming plaques. The most dangerous plaques are those prone to rupture, as the explosive release of clotting factors and other cells into the blood can cause a heart attack. Thus noticing, tracking and measuring inflammation is of great importance in the process of prevention. This can be done by testing for C-reactive protein (CRP), produced wherever there is inflammation. It has been proved that those with low

levels of ‘bad’ cholesterol (LDL) but high levels of CRP, as measured by a new supersensitive test, suffered the same rate of heart attacks as those with high levels of LDL and low CRP. That doesn’t mean that CRP testing should replace cholesterol testing. Lipids tell us how much plaque has built up in an artery, and CRP tells us how likely that plaque is to rupture and cause a heart attack. Fortunately, there are some efficient medications to keep inflammation under control. Aspirin may protect against heart disease not only by keeping clots from forming but also by controlling inflammation. And the newest studies show that even some of the statin drugs, traditionally used to lower cholesterol, are good for decreasing CRP levels as well. 1. The majority of heart attacks in the US are caused by elevated cholesterol levels. 2. The immune system appears to have an important role in triggering attacks in heart patients. 3. High CRP levels are in direct proportion to inflammatory processes and therefore also to plaques that are likely to rupture and cause a heart attack. 4. Statins are drugs primarily used to lower CRP.

IV Read about a new technique of HEART IMAGING which might be Relevant in the process of prevention. As you are reading, supply the correct forms of the words in brackets. Mark the lines that answer the following questions: 1. Why did cardiologists find images of the heart unreliable until recently? 2. How is EBCT different from traditional CT scanning of the heart? 3. How do calcium deposits in the heart relate to the possibility of a heart attack?

Until recently, most cardiologists put little value on pictures of the heart. They assumed that it was impossible to get a truly accurate image of an organ in constant motion. But with (1) ____________ (IMPROVE) in the technology for taking freeze-frames of the beating heart, physicians have started to (2) ____________ (RELIABLE) more and more on images of the heart not just for looking at problem areas but also to (3) ____________ (PREDICTION) the (4) ____________ (LIKELY) of future heart trouble.

The newest device, an ultrafast form of computer scanning called electron-beam computer tomography (EBCT), notices the (5) ____________ (PRESENT) of tiny deposits of calcium in the heart. One study based on the scan showed that patients who build up 20% or more calcium each year have an 18-fold greater chance of suffering a heart attack than those with less calcium in their hearts. Although it is not yet clear whether calcium deposits spotted by EBCT can

(6) ____________ (ACCURATE) predict who will go on to have a heart attack, at least it is one more test that cardiologists can use to decide how (7) ____________ (AGGRESSION) to treat a patient who is at risk.

ARRHYTHMIA I Arrhythmia (dysrhythmia) is any variation from the normal rhythm of the heartbeat. Match the types of arrhythmia and associated occurrences with their definitions: 1 CARDIAC ARREST A failure of normal conduction of impulses from atria to ventricles; transient or permanent 2 CARDIOVERSION B rapid, regular contractions of atria or ventricles 3 FIBRILLATION C subjective sensation of rapid or irregular heartbeat 4 FLUTTER D establishing a normal heart rhythm by electroshock (defibrillation) 5 HEART BLOCK E rapid, irrregular contractions of atria or ventricles 6 PALPITATION F sudden stop in heart movement caused by heart block or ventricular fibrillation II Read about the traditional surgical way of treating certain kinds of arrhythmia, and new research which promises a minimally invasive procedure. LESS INVASIVE TREATMENT FOR ARRHYTHMIA Atrial fibrillation, causing painful symptoms and accounting for about 15% of all heart attacks, affects more than 2 million Americans. Medication can alleviate symptoms in some patients, but it cannot cure the problem. Normally, electric signals trigger the synchronized contraction of muscles in the heart's two upper chambers, the atria. The electrical impulse begins at the sinus node (SA), then spreads across the upper chambers, the atria. Next, the impulses reach the atrioventricular node (AV), signaling the ventricles to contract from the bottom up. In atrial fibrillation, the atria convulse with erratic electrical charges. The AV node gets mixed signals about when to ‘fire,’ and the result is a dangerously rapid, irregular heartbeat. Blood pools in the atria; clotting is possible, leading to a stroke. Twenty years ago, surgeons developed a cure called the Maze procedure to control these erratic impulses. In the procedure, surgeons make small, strategically placed incisions in the atria. The incisions generate scar tissue that

serves as a barrier, trapping abnormal electric signals in a ‘maze.’ Only one path remains intact, guiding impulses to their correct destination. With a success rate of more than 90%, the Maze procedure revolutionized the treatment of atrial fibrillation. However, it is technically difficult and therefore not performed frequently. As surgeons must temporarily stop the heart in order to make the incisions, not all patients are healthy enough to endure the operation. Now researchers have developed an alternative: bipolar radiofrequency. The method uses two electrodes that pass a current through a section of heart tissue. Like Maze procedure incisions, radiofrequency energy causes scar tissue that blocks the abnormal impulses responsible for atrial fibrillation. So far researchers have tested this procedure on animals, at four of the standard Maze incision locations. Each lesion took nine seconds to complete, as compared with Maze incisions, which take 5 to 10 minutes to create. Preliminary findings suggest that the procedure is safe to do in human patients. Now rephrase the following sentences as suggested:

1. 20 years ago, surgeons developed the Maze procedure to control erratic impulses. The Maze procedure _________________________________________ 2. In this procedure, surgeons make small incisions in the atria. Small incisions ______________________________________________ 3. To do that, they must temporarily stop the heart. The heart ___________________________________________________ 4. The incisions generate scar tissue. Scar tissue __________________________________________________ 5. The scar tissue traps abnormal electric signals in a maze. Abnormal electric signals _______________________________________ 6. One intact path guides impulses to their correct destination. Impulses ____________________________________________________ 7. Now researchers have developed the bipolar radiofrequency procedure. The bipolar radiofrequency procedure ______________________________ 8. In this method, they create scar tissue by means of an electric current. Scar tissue ____________________________________________________ 9. They haven’t tested this procedure on humans yet. This procedure _________________________________________________

PSYCHIATRY CLINICAL SYMPTOMS I Below are some of the most frequently mentioned psychiatric clinical symptoms. Match them with their definitions: 1 AMNESIA A fixed false belief in spite of logical evidence to the contrary 2 ANXIETY B delusions of persecution or grandeur 3 APATHY C state of hyperexcitability and hyperactivity 4 COMPULSION D lack / loss of memory 5 DELUSION E exaggerated feeling of physical / mental well-being 6 DYSPHORIA F emotional state ranging from uneasiness to dread, often accompanied by palpitations and chest tightness 7 EUPHORIA G uncontrollable impulse to perform an action repeatedly and unnecessarily 8 MANIA H involuntary, persistent and recurring idea or image that is distressing 9 OBSESSION I restlessness, fatigue, hopelessness 10 PARANOIA J lack of emotion, indifference II Now make adjectives from the nouns above. Some of them are often used in everyday speech. Give examples:

1. _________________ 2. _________________ 3. _________________ 4. _________________ 5. _________________ 6. _________________ 7. _________________ 8. _________________ 9. _________________ 10. e.g. paranoid - Don’t be paranoid, the teacher doesn’t hate you, and you’ll pass. PSYCHIATRIC DISORDERS I Sort out the following disorders into the categories below and say what you know about some of them: ANOREXIA NERVOSA DEPRESSIVE PARANOID BIPOLAR NARCISSISTIC PTSD

BORDERLINE OBSESSIVE-COMPULSIVE SCHIZOID BULIMIA PANIC • anxiety disorders: ____________________ ____________________ ____________________ • eating disorders: ____________________ ____________________ • mood disorders: _____________________ _____________________ • personality disorders: _____________________ _____________________ _____________________ _____________________ II Now associate each of the following groups of symptoms with one of the disorders above: A severe dysphoria, appetite disturbances, insomnia or hypersomnia, fatigue, hopelessness, difficulty concentrating, recurrent thoughts of death or suicide B emotionally cold and distant, indifferent to praise or criticism, or the feelings of others, lack of interest in social relationships or family life C recurrent thoughts and repetitive acts (rituals) performed to relieve anxiety, often interfering with personal and social functioning D instability of mood, interpersonal relationships and sense of self; impulsive acts and emotions, alternative involvement with and rejection of people E because of a disturbance in the perception of one’s body, the refusal to maintain a minimally normal weight, achieved by excessive dieting plus overactivity F alternating manic and depressive episodes G intense fear, insomnia, nightmares and other symptoms caused by a traumatic event H continually suspicious, mistrustful, jealous; easily offended due to misinterpretation of people’s remarks and motives, but not psychotic I binge eating followed by purging J intense fear or discomfort accompanied by physical symptoms like palpitations, sweating, breathlessness, dizziness K intense preoccupation with oneself, sense of self-importance, lack of social empathy, arrogance, constant need of admiration

DEPRESSION According to the Harvard School of Public Health projections for the most frequent causes of disability and death in the next decades, depression will soon be topping the list along with cardiovascular diseases. Only during the 90’s, the number of people in the US being treated for depression has grown more than three times, while twice as many people are on antidepressants than roughly 15 years ago. The ratio between psychotherapeutic and medical treatment for depression has changed in favor of drug treatment, which is logical in view of a better class of drugs available now, besides being much less expensive than therapists. Work in groups of 3. First exchange any facts on depression that you have learned, including information on cases you might know from personal experience. Then each of you should read about one of the approaches to treatment and share what you have read with the group. 1. MEDICAL THERAPY FOR DEPRESSION There are different classes of antidepressant medications. Each type works differently and has different side effects. Studies have shown that up to 70% of patients on antidepressants recover from their depression in three to six weeks, provided that the dose is sufficient and that the medication is taken as prescribed. Once it has been established which medication works best for the individual, the goal of treatment is complete relief of depressive symptoms. To achieve that goal, doctors should get the necessary feedback from their patiens concerning how they feel. If there is improvement in three to six weeks, but some symptoms are still present, the doctor will probably increase the dose of the antidepressant. If the patient cannot tolerate a higher dose, the doctor may switch to another medication. If symptoms are no better or worse after three or four weeks, the doctor should suggest a different antidepressant. If two adequate antidepressant regimens fail to help an individual, he or she is considered to have treatment-resistant depression and should see a psychiatrist immediately. Once depression is under control, patients should continue taking their medications at the same dose for 9 to 12 months to prevent a relapse. After a second depressive episode, the doctor may prescribe an antidepressant for as long as two years. Patients who have had three or more episodes of depression have a very high risk of recurrence. These patients may need to take an antidepressant for an indefinite period (possibly for life) to decrease the chance of future depressive episodes.

2. PSYCHOTHERAPY FOR DEPRESSION Psychotherapy offers people the opportunity to identify the factors that contribute to their depression and to deal effectively with the psychological, behavioral, interpersonal and situational causes. There are several therapheutical approaches that can help depressed individuals recover. Trained therapists can work with depressed individuals to: • identify the life problems that contribute to their depression, and help them

understand which aspects of those problems they may be able to solve or improve;

• define options and set realistic goals for the future which will work towards restoring the patient’s mental and emotional well-being;

• identify negative or distorted thinking patterns that contribute to feelings of hopelessness and helplessness that accompany depression, and help support a more positive outlook on life; • help the patient regain a sense of control and pleasure in life. There is some evidence that ongoing psychotherapy may lessen the chance of future episodes of depression or reduce their intensity. Through therapy, people can learn skills to avoid unnecessary suffering from later bouts of depression. 3. DEPRESSION AND NUTRITION The fact that nutrition plays an important role in depression is not well known as yet, although a number of studies have found that vitamin deficiencies are more prevalent among subjects with depression compared to healthy individuals. Vitamin deficiencies that have been found include vitamin B1, vitamin B6, vitamin B12 and folic acid deficiency. Besides some other functions, these vitamins play important roles in neurotransmitter metabolism. Severe folic acid and vitamin B12 deficiency in themselves causes symptoms of depression. Other scientific studies have shown that not only can vitamin deficiencies be detected in patients with depression, but also that a vitamin supplementation program in some subjects can alleviate many of the symptoms. Low folic acid levels, in particular, are also known to result in a poor response to antidepressants. Although it is clear that nutrition plays an important role in depression, there is much more to be learned about it concerning this disorder. Removing vitamin and mineral deficiencies and optimizing your nutritional status might be of help in removing your risk of developing depression as well as in treating the condition. PLUS... • The latest studies have shown that drugs precribed to treat depression in

children actually increase suicidal thoughts and behavior in about 4% of them. As a consequence, the British government decided to prohibit use of

most antidepressants in children and teens, while the FDA obliged all antidepressant manufacturers to add black-box warnings to doctors, making them aware of the risk.

SCHIZOPHRENIA Scan the text on new insights into the physiology of schizophrenia and the new medications in use. Note down some of the information below the text: In paranoid schizophrenia, the patient becomes convinced of beliefs unrelated to reality, hears voices or sees images that exist nowhere but in his mind. Neuroscientists have now traced such hallucinations to malfunctions of the brain. Scanning the brains of schizophrenics while they were having hallucinations, they found evidence of activity in the parts of the sensory cortex that process movement, color and objects. Deep within the brain during hallucinations, structures involved in memory (the hippocampus), emotions (the amygdala) and consciousness (the thalamus) all light up like lamps. Usually sensory signals are transported deep into the brain, where they link up with memories and emotions. But the neuronal traffic might go the other way, too, with activity in the emotional and memory regions triggering voices and visions. Scientists still can’t explain why the content of hallucinations differs from patient to patient, but it probably reflects personal experience. So while some parts of the schizophrenic mind are hyperactive, another key brain area is nearly silent. Schizophrenia is marked by abnormally low activity in the frontal lobes. These regions control the emotional system, provide insight and evaluate sensory information. In other words, they provide a reality check. The absence of a reality check makes ‘willing’ oneself out of schizophrenia practically impossible. Even among people who have had the illness for decades, and who have periods of clarity thanks to medication, only some learn to distinguish between the voices everyone hears and the voices only they can hear. Identifying what happens in the brain during schizophrenic hallucinations doesn’t mean understanding why they happen. The old theory that cold, rejecting mothers make their children schizophrenic has long been discredited. Scientists now know that the age of the father may be a contributing factor. The 0.5% risk of a 25-year-old potential father nearly doubles when he is 40, and triples when he passes 50. Viruses or stresses that interfere with a fetus's brain development also raise the risk; mothers who suffer rubella or malnutrition while pregnant have a greater chance of bearing children who develop the disease. And if there is schizophrenia in family, you run a higher-than-average risk of developing it. There is, as yet, no cure for schizophrenia. But drugs can alleviate the symptoms. Schizophrenics have a surplus of the neurochemical dopamine. Thorazine, an early antipsychotic, blocked dopamine receptors, with the result that dopamine had no effect on neurons. But since dopamine is also involved in movement, Thorazine leaves patients slow and stiff, with the characteristic way

of walking called the ‘Thorazine shuffle.’ Dopamine also flows through circuits responsible for attention and pleasure, so Thorazine puts patients in a mental fog and deadens feelings. The new antipsychotics, called ‘atypicals,’ allow people with schizophrenia to hold jobs and have families. Still, they increase appetite, and may alter metabolism, resulting in considerable weight gain. Another side effect is foggy thinking and a loss of libido. For the time being, even the new drugs are only treatment, and not a cure. • symptoms of paranoid schizophrenia: • brain structures involved in hallucinatory episodes: • less active parts of the brain: • former theory on the cause of schizophrenia: • new theories on possible contributing factors: • excessive neurotransmitter: • function and drawbacks of Thorazine: ANOREXIA NERVOSA vs. BULIMIA NERVOSA Read the text which focuses on the type of personality typically affected by these increasingly frequent eating disorders and fill in some of the information in the table below:

In many ways, these two disorders are very similar. Both typically begin after a period of dieting, in some cases accompanied by excessive use of diet pills. People with either disorder believe that they weigh too much regardless of their actual weight or appearance. They are pathologically afraid of becoming obese and preoccupied with food, weight, and appearance. They are also typically prone to feelings of depression, anxiety, and the need to be perfect. However, there are also certain differences. Although people with either eating disorder worry about the opinions of others, those with bulimia nervosa tend to be more concerned about pleasing others, being attractive and having intimate relationships. While the typical anorectic is adolescent, bulimia usually presents in somewhat older persons. On the positive side, people with bulimia nervosa display fewer of the obsessive qualities that drive people with anorexia nervosa to control their caloric intake so strictly. On the negative side, they are more likely to suffer from mood swings, become easily frustrated or bored, and have trouble controlling their impulses; changing friends and relationships frequently is typical. Also, more than one-third of bulimics display the characteristics of a personality disorder. Another key difference between these two eating disorders are the medical complications that accompany each. Only half of women with bulimia nervosa are amenorrheic or have very irregular menstrual periods, compared to almost all

of those with anorexia nervosa. While the main problem in anorectics is undernourishment which, if untreated, may be fatal, in bulimcs, who usually manage to maintain an almost normal body weight, repeated vomiting frequently exposes the teeth and gums to hydrochloric acid, resulting in serious dental problems, such as the erosion of enamel and even the loss of teeth. Moreover, frequent vomiting or chronic diarrhea (from the use of laxatives) can cause dangerous potassium deficiencies, which may lead to weakness, intestinal disorders, kidney disease, or heart damage. ANOREXIA N. BULIMIA N. Type of personality typically affected

Accompanying medical complications

PLACEBO EFFECT IN ACTION Everyone knows the meaning of ‘placebo effect’, but researchers managed to see it in action, so to speak, by using an imaging technique that maps differences in blood flow in the brain. The test persons were first given harmless but painful electric shocks, and then a cream they were told would relieve the pain, but which actually didn’t contain any active substances. After the cream was applied, scans of the brain nerve activity showed visible changes. The regions involved in easing pain became more active, while the regions which sense pain became quieter, thus proving that just the expectation of relief may actually provide it. Or, to put it differently, it could be called a victory of mind over matter.

ONCOLOGY CANCER VOCABULARY Match these frequent oncological terms with their definitions: 1 ANAPLASIA A actively destroying the surrounding tissue 2 BENIGN B new, abnormal growth 3 CARCINOGEN C disappearance / decrease of the disease symptoms 4 CARCINOMA D diffusing / accumulating in surrounding tissues 5 CHEMOTHERAPY E the transfer of disease from one structure to another not directly connected with it 6 DIFFERENTIATION F assessment of the spread of a tumor within the body 7 ENCAPSULATED G treatment of disease by ionizing radiation 8 EXCISIONAL BIOPSY H tumor (usu. malignant) arising from connective tissue 9 GRADING I loss of differentiation of cells (dedifferentiation) 10 INFILTRATIVE J treatment of disease by chemical agents 11 IN SITU K cancer-producing substance 12 INVASIVE L biopsy of a lesion including a significant margin of healthy tissue 13 MALIGNANT M not recurrent, favorable for recovery (opp. of malignant) 14 METASTASIS N return of a disease after apparent cessation 15 NEOPLASM O development of specialized forms, character, and function of cells and tissues 16 RADIOTHERAPY P microscopic assessment of the degeee of maturity / differentiation of a tumor 17 RELAPSE Q enclosed in a capsule 18 REMISSION R anaplastic, invasive, metastatic (of tumors) 9 SARCOMA S malignant new growth consisting of epithelial cells 20 STAGING T in the place of origin, without invasion of neighbouring tissues BENIGN OR MALIGNANT? Sort out the following characteristics of benign and malignant neoplasms in the form of opposed pairs into the table below: • infiltrative and invasive • grow slowly • well-differentiated • metastatic

• encapsulated and noninvasive • multiply rapidly • nonmetastatic • anaplastic and undifferentated BENIGN NEOPLSMS MALIGNANT NEOPLASMS

HOW CANCER DEVELOPS Before turning cancerous, cells go through a series of changes. Only when scientists understand the way that happens at the molecular level, they can design drugs to stop the process. A decade ago, there were about one hundred medicines in research as potential anticancer agents. Today there are more than four hundred of them. I Look at the 5 STEPS OF CANCER DEVELOPMENT and put them into sequence: A The tumor’s appetite grows In a process called angiogenesis, malignant cells secrete chemicals that attract and promote the formation of new blood vessels. With a steady supply of nutrients, the tumor can grow without limits. B The mistakes accumulate It becomes harder and harder for the cells to maintain normal growth, as genes that should be on get turned off and those that should be off are turned on. C The cancer spreads Particles of the tumor break off and, in a process called metastasis, migrate through the blood and lymphatic systems. Eventually the runaway cells invade other parts of the body and initiate the growth of distant tumors.

D A mistake happens in the cell Sooner or later, exposure to ultraviolet light, chemicals from the environment or even the byproducts of normal metabolism damage one of the genes in a cell. In most cases this does not lead to cancer. E The cells turn cancerous Free of normal restraints, the now malignant cells break all the rules. They divide uncontrollably, become less attached to their neighbors and invade the space occupied by normal cells. II Now look at the WEAPONS in development and those currently used TO FIGHT THE CANCER at each level and assign them to the appropriate steps above: Step _____ weapons: Antiangiogenesis In clinical trials, agents attack the tumor’s blood supply in an effort to prevent the flow of nutrients. Step _____ weapons: Cancer prevention This stage involves eating right, not smoking and avoiding sunburns. Antioxidants like vitamin E may also help. Steps _____ and _____ weapons: Surgery / Chemotherapy / Radiation Surgery: Early detection leads to less invasive operations and more cures. Chemotherapy: Although less toxic than before, these poisons still kill both healthy and cancerous cells. Radiation: Even though radiation beams are localized, they still kill a large amount of healthy cells. Step _____ weapons: Targeted therapy

Targeted therapy is a general term that refers to a medication that targets a specific pathway in the growth or development of a tumor. The targets are various molecules known or suspected to have a role in cancer formation. The various approaches include: Antigrowth: A generation of new drugs that aim to block the biological signals that promote cancer-cell growth. Cell suicide: Unlike healthy cells, which die at the end of their natural life span or when they are no longer needed, cancer cells continue

reproducing themselves uncontrollably, and often resist conventional treatments aimed at forcing them to commit suicide by damaging them. Experimental drugs try to destroy their specific defense mechanisms. Immune booster: Since cancer cells typically evade the immune system, different vaccines are currently evaluated in large human trials. They fall into 2 groups: therapeutic vaccines, designed to stimulate the immune system to recognize and attack cancer cells withoput harming healthy cells, and prophylactic vaccines, which stimulate the immune system to attack cancer-causing viruses and prevent viral infections. Microradiation: Radioactive isotopes attached to monoclonal antibodies form radioimmunotherapy agents which target specific cancer cells.

CANCER NEWS I In groups of 3, read two of the items each and suggest headlines for them. Then share your information with the group: ______________________________ It is well known that stress is accompanied by increased glucocorticoid secretion, which can inhibit the immune system (that is why these steroids are often used in the treatment of autoimmune diseases). Consequently, there is evidence that prolonged stress can result in an increased incidence of cancer. ______________________________ According to a recent paper in the British Medical Journal, 20% of mothers who had been diagnosed with cancer don’t discuss their illness with their children, even if they are facing surgery. It is felt that parents in this situation should get expert help in deciding if, how and when to talk with their children in order to avoid unnecessary anxiety within the family. But in any case, talking is better than keeping silent, experts agree.

______________________________ Three recent studies revealed potentially useful, but by no means conclusive, links between breast cancer and diet. Mexican researchers reported that a high-carbohydrate diet, typical of that country, seems to increase the risk of breast cancer. They explained that increased levels of insulin resulting from such a diet could trigger cells to grow abnormally. A Danish study found that girls experiencing peak growth early in puberty, before the age of 14, were at greater risk of developing breast cancer later in life. The

study linked the tendency of increased average height in women to increased milk consumption. A US study showed that women taking aspirin at least 4 times a week for 3 months reduced their risk of developing breast cancer by 30%. ______________________________ Researchers have concluded that physical activity doesn’t need to be too demanding to reduce the risk of breast cancer. They investigated the relation between recreational physical activity in adulthood and incidence of breast cancer in about 75,000 postmenopausal women from the Women’s Health Initiative study. It was found that women who did up to 2.5 h per week of brisk walking had an 18% decreased risk of breast cancer compared with inactive women. Additionally, the effect of exercise was most pronounced in women in the lowest bodyweight group.

______________________________ Heat-sensitive pads that are put into the bra at the doctor’s office may be a new way to detect breast diseases, including cancer. Unlike mammograms, the pads produce no radiation exposure, and they are effective on the dense breast tissue of younger women. They rely on the fact that cancer cells have a more active metabolism than normal cells and consequently generate more heat. The pads have been approved for use as an addition to standard screening. They may prove most useful to women under 40, who do not usually have mammograms unless a suspicious lump is detected by physical examination. The pads may be able to detect breast changes much earlier than a physical exam, although it is not certain yet whether they can detect breast diseases earlier than mammograms; but they might be used by older women between mammograms. _____________________________ Researchers say that it’s best to follow a lumpectomy for noninvasive breast cancer with radiation therapy. An eight-year study shows that women who have had the X-ray treatments cut their odds of a relapse in half. II Now translate the last item. III Work in groups of 4. Read the text and do 2 of the following tasks each. Then show your group the results and compare them with the other groups: NO MORE HAIR LOSS US scientists have discovered a substance that could protect cancer patients from chemotherapy-induced hair loss. Applied to the skin, the substance slows down the division cycle of epithelial cells.

It is well known that cytotoxins used in the therapy of certain kinds of cancer usually affect hair cells as well, because they, like cancerous tissue, also divide rapidly. The newly discovered substance, currently undergoing clinical trials, is expected to be specially effective in cases of lung cancer.

Task 1: Suggest an alternative headline for the text. Task 2: Write down synonyms for the bolded words. Task 3: Write a one-sentence summary of the text. Task 4: Decide whether the following statement is true or false and mark the line(s) which helped you: Cancer cells, unlike hair cells, are characterized by rapid division. Task 5: Write down all the verbs and adjectives commonly used with the word therapy. Task 6: Use some of the underlined and bolded words in sentences of your own, in a different medical context. Task 7: Write short explanations of the underlined words. Task 8: Translate the sentence in italics. BREAST SELF-EXAMINATION Read about possible DRAWBACKS OF BREAST SELF-EXAMINATION and then decide whether the following statements are true or false. Mark the lines that helped you decide: A new study of women with a family history of breast cancer in the UK adds to evidence that excessive breast self-examination is counterproductive, because it increases anxiety and may make early detection of breast cancer more difficult. 833 women aged 17-77 years, from families with histories of breast cancer were surveyed. 18% claimed to examine their breasts daily or weekly, 56% once or twice a month, and 26% rarely. General anxiety and cancer-specific anxiety were lowest among women who examined themselves least often, and highest among the hypervigilant women. Women who examine their breasts may be unaware that it can be normal to have lumps and may interpret any they find as evidence of cancer. This reinforces feelings of anxiety and may reduce the efficacy of the procedure itself.

The official policy is now one of breast awareness rather than self-examination. In self-examination, if a woman finds a lump she gets worried, but if she does not find a lump, she still gets worried because she assumes that she has missed it. The emphasis now is to check for normality and only see your doctor if something in your breast suddenly changes. Women are advised to examine their breasts once a month. Fundamentally, there is no evidence that frequent self-examination allows women to detect cancers in a way that will influence the course of the disease – although time is important, a few days more or less don’t matter for the chance of a successful outcome. 1. The women that took part in the study belonged to a higher risk group. 2. Anxiety grew proportionally with the frequency of self-examination. 3. All lumps are evidence of cancer. 4. Physicians suggest women should check for normality rather than

abnormality. 5. The advice for women is a weekly check. 6. The outcome of the detected cancer depends on whether the woman has

consulted a doctor within days of its detection. Vocabulary check - suggest SYNONYMS for the words from the text that could be substituted in the same context:

excessive _______________ efficacy _______________

detection _______________ awareness _______________

surveyed _______________ assumes _______________

claimed _______________ fundamentally _______________

CANCER RESEARCH Scan the paragraphs below and mark the key words that helped you decide which of them talk about: 1 traditional cancer treatments 2 new approaches to the problem 3 the importance of timing in prevention, detection and diagnosis 4 research costs 5 future goals and hopes in cancer treatment

A Experts agree: the earlier a cancer is diagnosed, the better your chances of controlling it. And thanks to a growing understanding of the cancer cell's natural life cycle, doctors are learning how to detect the disease at its very earliest stages. Other researchers are focusing on an even earlier stage, trying to lower the risk of developing cancer at all. Here the most exciting work centers on the cyclooxygenase inhibitor called COX-2. This compound is contained in a pain reliever originally developed to fight pain and inflammation in many medical conditions (e.g. osteoarthritis and rheumatoid arthritis) by blocking specific enzymes produced in response to inflammation. Since it was found that the same enzymes are produced by precancerous and cancerous tissue, the hope is that COX-2 may be useful in preventing a wider range of cancers, including colorectal, head and neck, bladder, lung and breast cancers. B Eventually, the goal is to detect precisely which molecular processes have gone wrong in an individual patient's cancer. Rather than being identified as lung cancer or breast cancer or kidney cancer, tumors will be tagged as, for example, COX-2 positive. In conclusion, the researchers' biggest hope for the future is that the new therapies could transform cancer from an uncontrollable, frequently lethal illness to a chronic but manageable one similar to diabetes and high blood pressure. C

Although in many countries basic research into cancer biology is funded by national cancer institutes, the majority of drug development is done by for-profit pharmaceutical firms. US companies claim that it costs them between $500 million and $1 billion to bring a single new medicine to market – partly because it can take 15 years for the elaborate testing in animals and humans required by the law and partly because for every medicine finally approved, there are 5,000 others that fail. The drug companies count on that one success to pay for the 5,000 failures.

D In the course of their research scientists have accumulated a lot of information about how cancer works at the molecular level, from its first awakening in the DNA of a single cell's nucleus to its overall attack on the body. Armed with that information, they have been developing an assortment of weapons to attack the disease at every stage of its development. Many of these therapies are just beginning to reach clinical trials and won't be available to save lives for years to come.

Unlike chemotherapy and radiation, which use carpet-bombing tactics that destroy cancer cells and healthy cells alike, these new medicines are like snipers, targeting cancer cells alone. E Apart from surgery, which almost always leaves behind some malignant cells, the standard treatment for most cancers continues to be radiation and chemotherapy – relatively crude disease-fighting weapons that have limited effectiveness and leave patients weak and nauseated.