introduction to cancer basics? candy cooley, manager national genetics education and development...
TRANSCRIPT
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Introduction to Cancer basics?
Candy Cooley, Manager National Genetics Education and Development Centre
cancernursing.org online lecture March 2009
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Statistics >9.7 million cases are detected
each year 6.7 million people will die from
cancer Every day, around 1700
Americans die of the disease 20.4 million people living with
cancer in the world today 1 in 3 people will be diagnosed
with cancer in the UK and 1 in 4 will die from their disease
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Lung
Breast
Colon/Rectum
Stomach
Liver
Prostate
Cervix uteri
Oesophagus
Bladder
Non-Hodgkin
Lymphoma
Leukaemia
Oral cavity
Pancreas
Kidney
Ovary
1000 800 600 400 200 0 200 400 600 8001000
Men Women
From: D.M. Parkin The Lancet Oncology 2: 533-543 (2001)
(Thousands)
Incidence
Mortality
337293
1050370
241318
446234
165166
471233
133111
7633
12168
11386
4797
101101
3471
192114
810902
558405
255499
398384
204543
279
260227
99
93167
144109
81170
116112
57119
5.3 million cases3.5 million deaths
4.7 million cases2.7 million deaths
The Global Burden of Cancer 2000
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WHO Statistics
2020 15 million people will die from cancer
CausesAgeing populationObesitySmoking
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The burden of cancer
6% of NHS hospital expenditure
$/€/£ etc millions spent on research
Substantial financial burdens upon families and carers
Physical and emotional burden
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Personal views of cancer
“in the popular imagination cancer equals death”
(Susan Sontag,1977)
“Cancer forces us to confront our lack of control over our own or others death”
Kleinman (1988)
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What is Cancer?
Division – uncontrolled cell division
Growth – formation of a lump (tumour) or large numbers of abnormal white cells in the blood
Mutation – changes to how the cell is viewed by the immune system
Spread – ability to move within the body and survive in another part
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Division – uncontrolled cell division
Oncogenes
Tumour suppressor genes – p53
Suicide genes – apoptosis
DNA repair genes
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Growth
TumourPressure on nervesBlocking organsStopping normal functionAltering nerve signalsFungating
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Mutation and Spread
Invasion
Angiogenesis
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Types of Cancer
Carcinomas Sarcomas Lymphomas Leukaemias Adenomas
Often prefixed by the specific cell
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What are the differences in the features of normal and cancer cells?
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Malignant versus benign tumours
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Normal and abnormal cell growth
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Normal cell growth
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Cancerous growth
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Metastatic cancer
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What causes cancer?
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Carcinogenesis. Some factors to consider… Heredity Immunity Chemical Physical Viral Bacterial Lifestyle
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Heredity 5-10% of Cancers
?15% of all
cancers
Molecular biology
and Human
Genome Project
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Heredity Genes isolated for
several classic familial
cancer syndromes:
RB1 (retinoblastoma)
APC (familial polyposis)
Human Non Polyposis
Colon Cancer (HNPCC)
BRCA 1&2 (breast
cancer)
p53 (many cancers)
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Immunity
HIV / AIDS
Immunosuppression
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Virus’s
Hepatitis B
Human T-cell
Leukaemia virus
Epstein Barr Virus
Human Papilloma
Virus (HPV)
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Bacterial H. pylori
Other Parasites: Schistosoma spp Clonorchis sinensis
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Estimated Burden of Cancer from Infection Worldwide in 2000
Liver 509,000 HBV, HCV, flukes 5.1
Cervix 471,000 HPV 4.7
Stomach 442,000 H. pylori 4.4
Kaposi’s (HIV related) 134,000 HHV-8 1.3
Non Hodgkin lymphoma 72,000 H. pylori, EBV, HIV 0.7
Ano-genital 65,000 HPV 0.6
Nasopharyngeal 63,000 EBV 0.6
Hodgkin disease 33,000 EBV, HIV 0.3
Bladder 10,000 Schistosoma 0.1
Leukaemia 3,000 HTLV1 0.03
Total 1,801,000 17.9
No. of cases Agent % Worldcancer
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Chemical
Alcohol Asbestos Wood dust Rubber, plastics, dyes Tar / bitumen Aflatoxin Alkylating agents
Tobacco
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Smoking
Single biggest cause of cancer
25-40% smokers die in middle age
9 in 10 lung cancers Know to cause cancer
in 1950
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Smoking and alcohol
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Industrial pollution
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Physical causes
Ultraviolet radiation Sunlight Certain industrial sources
RadiationRadonCancer treatment
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Obesity Lifestyle:- Highly caloric diet, rich in fat, refined carbohydrates and animal protein- Low physical activity
Consequences:- Cancer - Diabetes- Cardiovascular disease- Hypertension
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Lifestyle
Age
Occupation
Ethnicity
Deprivation
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Survival variations
CONCORD Study (1.9 million survivors) demonstrated a clear relationship to income not only between countries but also between the ethnic groups in those countries
(Coleman et al Lancet Oncology 2008)
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Diagnosis and staging
Clinical History
Normal diagnostic procedures Scans, xrays Blood tests Biopsy
Pathological staging
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Staging
Size
Invasion
Lymph nodes
Metastasises
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TNM Staging
T (a,is,(0),1-4): size or direct extent of the primary tumor N (0-3): degree of spread to regional lymph nodes
N0: tumor cells absent from regional lymph nodes N1: tumor cells spread to closest or small number of regional
lymph nodes N2: tumor cells spread to an extent between N1 and N3. N3: tumor cells spread to most distant or numerous regional
lymph nodes M (0/1): presence of metastasis
M0: no distant metastasis M1: metastasis to distant organs (beyond regional lymph nodes)
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Other parameters G (1-4): the grade of the cancer cells (i.e. they are "low
grade" if they appear similar to normal cells, and "high grade" if they appear poorly differentiated)
R (0/1/2): the completeness of the operation (surgery-boundaries free of cancer cells or not)
L (0/1): invasion into lymphatics V (0/1): invasion into vein C (1-4): a modifier of the certainty (quality) of the last
mentioned parameter
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Examples Small, low grade cancer, no metastasis, no spread to
regional lymph nodes, cancer completely removed, resection material seen by pathologist - pT1 pN0 M0 R0 G1; this would be considered Stage I.
Large, high grade cancer, with spread to regional lymph nodes and other organs, not completely removed, seen by pathologist - pT4 pN2 M1 R1 G3; this would be considered Stage IV.
Most Stage I tumors are curable; most Stage IV tumors are not.
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Staging for Chronic Lymphocytic Leukemia (CLL)
There are two different systems for staging chronic lymphocytic leukemia. The Rai classification is used more often in the United States, whereas the Binet system is used more widely in Europe
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Stages of Leukemia: Acute Lymphocytic Leukemia (ALL)
For adults, ALL is classified as untreated, in remission, or recurrent. For childhood ALL, risk groups are used instead of stages to describe cases of the disease. Risk groups for childhood ALL include:
Standard (low) risk High risk Recurrent.
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Other staging
Lymphoma: uses Ann Arbor staging
Hodgkin's Disease: follows a scale from I-IV and can be indicated further by an A or B, depending on whether a patient is non-symptomatic or has symptoms such as fevers. It is known as the "Cotswold System" or "Modified Ann Arbor Staging System".
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Duke Staging System
Modified Duke A The tumor penetrates into the mucosa of the bowel wall but no further.
Modified Duke B B1: tumor penetrates into, but not through the muscularis propria (the muscular layer) of the bowel wall. B2: tumor penetrates into and through the muscularis propria of the bowel wall.
Modified Duke C C1: tumor penetrates into, but not through the muscularis propria of the bowel wall; there is pathologic evidence of colon cancer in the lymph nodes. C2: tumor penetrates into and through the muscularis propria of the bowel wall; there is pathologic evidence of colon cancer in the lymph nodes.
Modified Duke D The tumor, which has spread beyond the confines of the lymph nodes (to organs such as the liver, lung or bone).
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Summary
Cancer is a disease of Division, growth and spread
It has a number of causes many of them preventable
The survival of the patient is determined by the stage of the disease, the earlier the detection or the smaller the tumour the better the survival
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10 Rules to Avoid Cancer
2. Don’t smoke.3. Don’t smoke.4. Avoid exposure to other known carcinogens, including aflatoxin, asbestos and UV light.
6. Eat fresh fruit and vegetables several times a day.7. Be physically active and avoid obesity.
8. Have vaccination against, or early detection/treatmentof, cancer causing chronic infections.
9. Have the right genes.
10. Have good luck !
5. Enjoy a healthy diet, moderate in calories, salt and fat, and low in alcohol.
1. Don’t smoke
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