Cancer

1. Cancer Vipin patidar www..vipinpatidar.wordpress.com

2. Cancer is a group of diseases in which cells (malignant cells) are – • - aggressive (grow and divide without respect to normal limits) • - invasive(invade and destroy adjacent tissues) • - and sometimes metastatic(spread to other locations in the body). www..vipinpatidar.wordpress.com

3. As against these benign tumors are – • - self-limited in their growth • - not invasive • - do not metastasize (although some benign tumor types are capable of becoming malignant) www..vipinpatidar.wordpress.com

4. (A). When normal cells are damaged beyond repair, they are eliminated by apoptosis. (B). Cancer cells avoid apoptosis and continue to multiply in an unregulated manner. www..vipinpatidar.wordpress.com

5. Classification and Nomenclature related to cancers • Tumor: any abnormal swelling, lump or mass. • Neoplasm: scientific term to describe an abnormal proliferation of genetically altered cells. • Tumours and Neoplasms can be benign or malignant • Malignant neoplasm / tumor: synonymous with cancer, where cells invade surrounding tissues. • Benign neoplasm / tumor:a growth that stops growing by itself, does not invade other tissues and does not form metastases. www..vipinpatidar.wordpress.com

6. Recurrence: New tumors that appear a the site of the original tumor after surgery. • Metastasis: New tumors that appear far from the original tumor. • Transformation: The concept that a low-grade tumor transforms to a high-grade tumor over time. • Chemotherapy: Treatment with drugs. • Radiation therapy: Treatment with radiations. • Adjuvant therapy: Treatment, either chemotherapy or radiation therapy, given after surgery to kill the remaining cancer cells. www..vipinpatidar.wordpress.com

7. Carcinoma: Malignant tumors derived from epithelial cells. Eg: breast, prostate, lung and colon cancer. • Sarcoma:Malignant tumors derived from connective tissue, or mesenchymal cells. • Lymphoma and leukemia: Malignancies derived from hematopoietic (blood-forming) cells • Germ cell tumor:Tumors derived from totipotent cells (cells which can differentiate into any cell type). In adults most often found in the testicle and ovary; in fetuses, babies, and young children most often found on the body midline, particularly at the tip of the tailbone • Blastic tumor:A tumor (usually malignant) which resembles an immature or embryonic tissue. Many of these tumors are most common in children. www..vipinpatidar.wordpress.com

8. Malignant tumors (cancers) are usually named using -carcinoma, -sarcoma or -blastoma as a suffix, with the Latin or Greek word for the organ of origin as the root. • - a cancer of the liver is called hepatocarcinoma • - a cancer of the fat cells is called liposarcoma. • For common cancers, the English organ name is used. • - the most common type of breast cancer is called ductal carcinoma of the breast or mammary ductal carcinoma. Here, the adjective ductal refers to the appearance of the cancer under the microscope, resembling normal breast ducts. www..vipinpatidar.wordpress.com

9. Cancer Epidemiology • Cancer affects people at all ages, even fetuses, but risk for the more common varieties increases with age. • Deaths due to cancer are about 13% of all deaths. • Cancer is projected to become the leading cause of death worldwide in the year 2010, according to a new edition of the World Cancer Report from the International Agency for Research on Cancer. • Cases of cancer doubled globally between 1975 and 2000, will double again by 2020, and will nearly triple by 2030, says the report. • During the year 2008, there were an estimated 12 million new cancer diagnoses and more than 7 million deaths worldwide. • The projected numbers for 2030 are 20 to 26 million new diagnoses and 13 to 17 million deaths. www..vipinpatidar.wordpress.com

10. Cancer Epidemiology cont…. • Adult cancers www..vipinpatidar.wordpress.com

11. Factors causing cancers • Nearly all cancers are caused by abnormalities in the genetic material of the transformed cells (cells which acquire properties of cancer). • These abnormalities may be due to the effects of carcinogens (cancer-causing substances), such as • - tobacco smoke • - radiation • - chemicals • - infectious agents. www..vipinpatidar.wordpress.com

12. Other ways in which cancer-promoting genetic abnormalities are acquired are – • - randomly acquired through errors in DNA replication • - inherited from parents and thus present in all cells from birth. • There are complex interactions between carcinogens and the host genome. That is why some people develop cancer after exposure to a known carcinogen. www..vipinpatidar.wordpress.com

13. Genetics behind cancers!! • Genetic abnormalities found in cancer affect two general classes of genes. • Oncogenes • Tumour suppressor genes www..vipinpatidar.wordpress.com

14. Oncogenes(Cancer-promoting genes) are often activated in cancer cells, giving these cells new properties, such as – • - hyperactive growth and division • - protection against programmed cell death (apoptosis) • - loss of respect for normal tissue boundaries • - the ability to become established in diverse tissue environments. www..vipinpatidar.wordpress.com

15. 2. Tumor suppressor genesare often inactivated in cancer cells, resulting in the loss of normal functions in those cells, such as - - accurate DNA replication - control over the cell cycle - orientation and adhesion within tissues - interaction with protective cells of the immune system. www..vipinpatidar.wordpress.com

16. Role of viral infections • Viruses are responsible for 15% of human cancers. • Viruses that are known to cause cancer are – • - Human papillomavirus (HPV) and cervical cancer • - Hepatitis B and liver cancer www..vipinpatidar.wordpress.com

17. Role of viral infections cont… • When the virus infects a cell it inserts a part of its own DNA near the cell growth genes causing cell division. • The group of changed cells that are formed from the first cell dividing all have the same viral DNA near the cell growth genes. • This group of changed cells are now special because one of the normal controls on growth has been lost. www..vipinpatidar.wordpress.com

18. Signs and symptoms • Cancer symptoms can be divided into three groups: • Local symptoms: • - unusual lumps or swelling (tumor), • - hemorrhage (bleeding), • - pain and/or ulceration. • - Compression of surrounding tissues may cause symptoms such as jaundice (yellowing the eyes and skin). www..vipinpatidar.wordpress.com

19. Symptoms of metastasis (spreading) • - enlarged lymph nodes • - cough and hemoptysis • - hepatomegaly (enlarged liver) • - bone pain • - fracture of affected bones • - neurological symptoms. • Although advanced cancer may cause pain, it is often not the first symptom. www..vipinpatidar.wordpress.com

20. Signs and symptoms cont…. Systemic symptoms: - weight loss - poor appetite - fatigue - wasting - excessive sweating (night sweats) - anemia www..vipinpatidar.wordpress.com

21. Diagnosis • Most cancers are initially recognized either because signs or symptoms appear or through screening. • Eg: A recent study published in the April 2008 issue of Annals of Internal Medicine shows that HPV was widely spread among women receivingcervical screening in the United States. • However, neither appearance of signs and symptoms not screening tests lead to a definitive diagnosis, which usually requires the opinion of a pathologist. www..vipinpatidar.wordpress.com

22. Investigation • People with suspected cancer are investigated with blood tests, X-rays, CT scans and endoscopy. Chest x-ray showing lung cancer in the left lung. www..vipinpatidar.wordpress.com

23. Biopsy • Definitive diagnosis of most malignancies must be confirmed by histological examination of the cancerous cells by a pathologist. • Tissue can be obtained from a biopsy or surgery. • The tissue diagnosis indicates the type of cell that is proliferating and other features of the tumor. • This information is useful to evaluate the prognosis of this patient and choose the best treatment. • Cytogenetics and immunohistochemistry may provide information about future behavior of the cancer (prognosis) and best treatment. www..vipinpatidar.wordpress.com

24. T N M CLASSIFICATION • T-The extent of the primary tumor. • N- The absence or presence of regional lymph node metastasis. • M- The absence or presence of distant metastasis. www..vipinpatidar.wordpress.com

25. Cont.. PRIMARY TUMOR(T)- Tx- Primary tumor can not be assessed. To- No evidence of primary tumor. Tis- Carcinoma in situ. T1,T2,T3,T4- Increasing size or local extent of the primary tumor. REGIONAL LYMPH NODES(N)- Nx- Regional lymph node can not be assess. No- No regional lymph node metastasis. N1,N2,N3- Increasing involment of lymph nodes. DISTANT METASTASIS(M)- Mx- Distant metastasis can not be assessed. Mo- No distant metastasis. M1- Distant metastasis. www..vipinpatidar.wordpress.com

26. STAGES OF NSCLC • STAGE I Cancer at this stage has invaded the underlying lung tissue but hasn't spread to the lymph nodes. • STAGE II This stage cancer has spread to neighboring lymph nodes or invaded the chest wall. • STAGE IIIA At this stage, cancer has spread from the lung to lymph nodes in the center of the chest • STAGE IIIB The cancer has spread locally to areas as blood vessel, heart, trachea • STAGE IV The cancer has spread to other parts of the body, such as the liver, bones or brain. www..vipinpatidar.wordpress.com

27. STAGES GROUPING FOR L.C. www..vipinpatidar.wordpress.com

28. Treatment for lung cancer depends on the stage of cancer and may include surgery to remove the cancer, or the use of radiation or medicine (chemotherapy) to kill the cancer. A combination of treatments may also be used. Treatment www..vipinpatidar.wordpress.com

29. RADIATION THERAPY Radiation therapy (RT) may cure stage I or stage II non-small cell lung cancer in patients with poor preexisting lung function, but it is used most often in stage II disease. Daily doses for 5 to 6 weeks, for a total of 5,000 to 6,000 rad. The patient may be placed on a split schedule of two courses with 2 to 3 weeks of rest before the next course to allow normal tissues to recover and the tumor to shrink. Patients receiving palliative radiation therapy undergo 1 to 2 weeks of therapy, for a total of 2,000 to 4,000 rad. Medical Treatment www..vipinpatidar.wordpress.com

30. Cont.. SIDE EFFECTS- Early effect- 1. Skin reaction 2. nausea,vomiting,esophagitis.anorexia. 3. Fatigue. Late effect- 1.pneumonitis,pericarditis,plural effusion www..vipinpatidar.wordpress.com

31. CHEMOTHERAPY Patients who have not received previous chemo­therapy, and who are maintaining their weight seem to respond better to chemo­therapy and to survive longer. The highest response rate has been observed in regimens containing cisplatin. www..vipinpatidar.wordpress.com

32. Criteria used to determine the patient s eligibility for chemotherapy • No medical contraindi­cations, evidence of disease progression, the presence of measurable disease • A life expectancy of longer than 2 months • A clear understanding of the risks and ben­efits associated with treatment. www..vipinpatidar.wordpress.com

33. PALLIATIVE AND TERMINAL CARE Palliative care or hospice care refers to medical or nursing care to reduce symptoms and suffering without attempting to cure the underlying disease. Because only a small number of people with lung cancer are cured, relief from suffering becomes the primary goal for many. www..vipinpatidar.wordpress.com

34. Cont.. The patient, his or her family, and the doctor will probably recognize when the patient has reached this point. Whenever possible, the transition to palliative care should be planned in advance. Planning should begin with a 3-way conversation between the patient, someone representing the patient (if he or she is too ill to participate), and the health care provider. During these meetings likely outcomes, medical issues, and any fears or uncertainties can be discussed. www..vipinpatidar.wordpress.com

35. Cont.. Palliative care may be given at home, in a hospital if home care is not possible, or in a special hospice. Palliative care consists mainly of treatments to relieve shortness of breath and pain. Breathlessness will be treated with oxygen and medications such as opioids, which are narcotic drugs such as opium, morphine, methadone, and heroin. Pain management includes anti-inflammatory medications and opioids. The patient is encouraged to participate in determining doses of the pain medication, because how much is needed to block pain will vary from day to day. Other symptoms, such as anxiety, lack of sleep and depression, are treated with appropriate medications and, in some cases, complementary therapies. www..vipinpatidar.wordpress.com

36. Surgery is the preferred treatment for patients with early stage NSCLC. Unfortunately, 60-80% of all patients who have advanced or metastatic disease is not suitable for surgery. People who have NSCLC that has not spread can tolerate surgery provided they have adequate lung function. A portion of a lobe, a full lobe, or an entire lung may be removed. The extent of removal depends on the size of the tumor, its location, and how far it has spread. Surgery www..vipinpatidar.wordpress.com