Oncofertility Saturday Academy

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Oncofertility Saturday Academy
Accelerating learning in the reproductive
sciences.
This work is supported by the Oncofertility Consor
tium NIH RL1 HD0058295
...exploring and expanding options for the
reproductive future of cancer survivors
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Program Objectives

• To provide high school girls with the opportunity
  to
• Learn and apply science concepts
• Learn and apply scientific processing skills by
  conducting hands-on laboratory investigations
• Learn about the variety of career choices in the
  fields of science and medicine
• Develop relationships with graduate and medical
  students, scientists, doctors, and many other
  healthcare professionals
• Learn about the college admissions process,
  academic degrees and student life
• To provide the parents of high school girls with
  the opportunity to
• To develop their awareness, knowledge, and skills
  to support their daughters interests and
  pursuits in science and medicine

...exploring and expanding options for the
reproductive future of cancer survivors
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Program Guiding Question

• How can we preserve the fertility of cancer
  patients?

...exploring and expanding options for the
reproductive future of cancer survivors
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Todays Learning Outcomes

• Describe the development of cancer.
• Describe treatment options (radiation,
  chemotherapy, surgery) available for cancer and
  how each option affects fertility.
• Describe the oncofertility patient (age, domestic
  situation, type of cancer) and explain how that
  affects decision-making.

...exploring and expanding options for the
reproductive future of cancer survivors
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How can we save fertility after cancer?

• Life preserving treatments
• Chemotherapy
• Radiation treatment
• Surgery
• Can threaten fertility

...exploring and expanding options for the
reproductive future of cancer survivors
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• More than 1.4 million new cancer patients are
  diagnosed in U.S. annually
• 10 million new cases diagnosed globally
• 10 are in their reproductive years (up to age
  45)
• Approximately 25 of breast cancer patients are
  diagnosed under the age of 45

Who is at Risk?
...exploring and expanding options for the
reproductive future of cancer survivors
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Oncofertility What is Oncofertility? A new term
that describes the effort to preserve fertility
for young people with cancer. This new field
includes basic reproductive biology, clinical
science, ethics, law, economics,
pediatric surgery, education sciences.
...exploring and expanding options for the
reproductive future of cancer survivors
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All About Cancer
This work was supported by the Oncofertility Conso
rtium NIH RL1 HD0058295
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Nicole age 27
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What is Cancer?

• Cancer is a disease that is characterized by
  abnormal cell growth.
• Cancer develops when cells in a part of the body
  begin to grow out of control. Although there are
  many kinds of cancer, they all start because of
  out-of-control growth of abnormal cells.
• Because cancer cells continue to grow and divide,
  they are different from normal cells. Instead of
  dying, they outlive normal cells and continue to
  form new abnormal cells.

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What causes Cancer?

• There are about 200 types of cancer effecting all
  of the different tissues of the body. Cancer is a
  multifactoral, meaning that there are multiple
  factors involved. There is no single cause of
  cancer.
• Some of the factors that lead to cancer are
• Carcinogens
• Age
• Genetic Make-up
• The immune System
• Viruses

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Contributing factors- Carcinogens

• The term carcinogen refers to any substance,
  radionuclide or radiation that is an agent
  directly involved in the promotion of cancer or
  in the facilitation of its propagation. Some
  common carcinogens are
• Tobacco (cigarette, pipes, cigars, chewing
  tobacco)
• Asbestos (Because it is resistant to heat it was
  used on a large scale in buildings and in
  consumer products.)
• Benzene (is an important industrial solvent and
  is an additive in gasoline)
• Formaldehyde (used for embalming and plastics)

Hazard Symbol for Carcinogen
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Contributing Factors- Age
Most types of cancer become more common as
we get older.  This is because the changes that
cause a cell to become cancerous in the first
place take a long time to develop. The changes
can happen by accident when the cell is
dividing. There have to be a number of changes to
the genes within a cell before it turns into a
cancer cell. Or they can happen because the cell
has been damaged by carcinogens and the damage is
then passed on to future 'daughter' cells when
that cell divides.  The longer we live, the more
time there is for us to accumulate these genetic
mistakes in our cells
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Contributing Factors- Genetic Make-up

• There have to be a number of genetic mutations
  within a cell before it becomes cancerous. 
  Sometimes we are born with one of these mutations
  already.  This does not mean we will get cancer. 
  But with one mutation from the outset, it makes
  it more likely statistically that we will. 
  Doctors call this 'genetic predisposition'.
• The BRCA1 and BRCA2 breast cancer genes are
  examples of genetic predisposition.  Women who
  carry one of these faulty genes have a higher
  chance of developing breast cancer than women who
  do not.

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Autosomal Dominant Inheritance

• Each child has 50 chance of inheriting the
  mutation
• No skipped generations
• Equally transmitted by men and women

Normal
Affected
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Ovarian Cancer InheritanceBRCA 1 Family
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Risk Estimate of BRCA 1 Mutation
Prob. ofBRCA1
Involved
Cancer
Age
Self Breast lt30 12 Self Ovary lt50 7 Self
Sister Breast/Ovary lt50 46 Self
Sister Ovary/Ovary lt50 61 gt2 Cases/gt1
Case Breast/Ovary Any 82
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Contributing Factors- The Immune System

• People who have problems with their immune
  systems are more likely to get some forms of
  cancer.
• This group includes people who
• - Have had an organ transplant and take
  drugs to suppress their immune systems to stop
  organ rejection
• - Have AIDS
• - Are born with a rare medical syndrome that
  effects their immunity
• The kinds of cancers that affect these people
  fall into two categories
• 1- Cancers that are caused by viruses, like
  cervical cancer which is caused by HPV
• 2- Lymphoma

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Contributing Factors- Viruses

• Viruses can help to cause some types of cancers.
  But that does not mean that these cancers can be
  caught like an infection. What happens is that
  the viruses cause genetic changes in cells that
  make them more likely to become cancerous
• The following cancers and viruses are linked
• - Cervical Cancer and the genital warts
  virus, HPV
• - Primary liver cancer and Hepatitis B
• - T cell Leukemia and the Human T Cell
  Leukemia Virus

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Who is effected by Cancer?

• Cancer may affect people at all ages, even
  fetuses, but risk for the more common varieties
  tends to increase with age. Cancer does not
  discriminate, it affects people of all races,
  sexes, religions, and economic backgrounds.
• Cancer causes about 13 of all deaths. According
  to the American Cancer Society, 7.6 million
  people died from cancer in the world during 2007.
• Apart from humans, cancer may affect other
  animals and plants.

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Cancer Treatments

• For so long, many people feared cancer more than
  other illnesses because the diagnosis often meant
  death. But advances in treatment are changing
  that. Cancer survivorship is becoming a whole new
  field.
• Some of the most prevalent cancers are turning
  out to be the most curable. A case in point
  breast cancer. Fifty years ago, there was a
  single drug to treat it. Now there are more than
  15, so if one drug stops working for a patient,
  she can find help from another. Even patients
  with advanced cancer now often live strikingly
  normal lives.
• More people are surviving cancer than ever
  before.
• Some of the most common treatments are
• - Chemotherapy
• - Hormone Therapy
• - Radiotherapy
• - Removal by surgery
• - Other/experimental treatments

The logo from the Global Campaign for Cancer
Survivorship
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Treatment Options-Chemotherapy

• Chemotherapy is the use of chemical substances to
  treat disease. In its modern-day use, it refers
  to cytotoxic drugs used to treat cancer or the
  combination of these drugs into a standardized
  treatment program.
• Cancer chemotherapy is not new. It has been
  helping people beat cancer since the early 1950s.
  The chemo drugs your doctor suggests have been
  tested again and again. Careful research shows
  they work. Partly because of chemo, many people
  with cancer live full and happy lives.
• Chemotherapy can be administered orally or
  intravenously
• Some side effects include nausea, diarrhea,
  anemia, hair loss, memory loss, depression of
  immune system.

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Treatment Options- Hormone Therapy
Hormone Therapy for cancer alters the hormones
in your body to help control or cure certain
types of cancers. The therapy either reduces the
level of specific hormone in your body or alters
the cancers ability to use these hormones to
grow and spread. How does Hormone Therapy work?
Specific types of tumors - most commonly
tumors of the breast and of the prostate -rely on
hormones such as estrogen and testosterone to
survive and grow. By altering the cancers
hormone supply, hormone therapy can make tumors
shrink. This method of treatment only works on
hormone sensitive tumors. Examples of Cancers
that are hormone receptive - Breast -
Prostate - Ovarian - Endometrial Side
effects include fatigue, hot flashes,
osteoporosis, weight gain, mood swings
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Treatments Options- Radiotherapy

• More than half of all people with cancer receive
  some type of radiation therapy to kill cancer
  cells. Radiation therapy may be your only cancer
  treatment, or it may be used in conjunction with
  other cancer treatments, such as surgery and
  chemotherapy.
• Radiation therapy also called radiotherapy or
  X-ray therapy involves treating cancer with
  beams of high-energy particles, or waves
  (radiation), such as gamma rays or X-rays.
• A doctor may suggest radiation therapy as an
  option at different times during a cancer
  treatment and for different reasons, including
• - Before surgery, to shrink a cancerous
  tumor (neoadjuvant therapy)
• - During surgery, to direct large doses of
  radiation directly at a tumor
• - After surgery, to stop the growth of any
  remaining cancer cells (adjuvant therapy)
• - In combination with other treatments, such
  as chemotherapy, to destroy cancer cells
• Radiation is administered in different ways
• Internally- this type of radiation can be
  given intravenously through an IV, by mouth or it
  can be injected into a body cavity. Also, the
  radioactive material can be encased in wires,
  seeds, capsules or tubes (catheters) and is
  placed inside the tumor or very close to it.
• Externally- In external radiation,
  treatment comes from a machine outside your body.
  External beam radiation is the most common
  radiation treatment method used. This radiation
  comes from a machine such as a linear
  accelerator. It allows your doctor to treat large
  areas of your body and multiple areas if your
  cancer has spread.
• Side effects include- hair loss at the site,
  fatigue, nausea, diarrhea

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Treatment Options- Surgery Removing the Cancer

• Cancer Surgery is an operation to repair or
  remove part of your body to diagnose or treat a
  condition remains the foundation of cancer
  treatment. Cancer surgery may be used to achieve
  any number of goals, from diagnosing cancer to
  treating it to relieving the symptoms it causes.
  Cancer surgery may be a stand alone treatment, or
  it may be used in conjunction with other
  treatments methods.
• Surgery is often used for
• - Cancer prevention
• - Diagnosis
• - Staging
• - Primary treatment
• - Debulking
• - Relieving symptoms or side effects
• Cancer surgery continues to evolve. Researchers
  are investigating other surgical techniques with
  an eye toward less invasive procedures.

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Survival and Surgical Effort Surgeon Tendency
OS for surgeons using radical procedures in gt70
vs. lt40 of cases during time of study
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The Left Para-aortic Nodes
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Para-aortic Lymphadenectomy
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Argon Beam Destruction of tumor implants
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Liver CT scan 2/95
2.8 cm lesion
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Liver CT after liver cryotx
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Liver CT, 6 years later
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Focus on Womens Health

• Most types of cancer can effect everyone but
  there are several types that only effect women.
• Some cancers that frequently affect women
• Cervical
• Uterine
• Breast (effects some men)
• Ovarian
• Endometrial
• Vaginal

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Hysterectomy as a treatment option

• Different types of Hysterectomy
• Partial (subtotal) hysterectomy. Removes the
  uterus but leaves the cervix in place. By keeping
  the cervix, your risk of cervical cancer remains,
  so you'll still need regular Pap tests for
  screening.
• Total hysterectomy. Removes the uterus, including
  the cervix.
• Hysterectomy and bilateral salpingo-oophorectomy.
  Removes the uterus, cervix, fallopian tubes and
  ovaries. If you haven't already experienced
  menopause, removing your ovaries initiates it.
• Radical hysterectomy. Extends farther, removing
  the upper portion of the vagina and some
  surrounding tissue and lymph nodes. Surgeons use
  this procedure for certain forms of cancer.

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Reasons for Hysterectomy

• Gynecologic cancer. For cancer of the uterus or
  cervix a hysterectomy may be the best treatment
  option. Depending on the specific cancer and how
  advanced it is, other options might include
  radiation or chemotherapy.
• Fibroids. Hysterectomy is the only certain,
  permanent solution for fibroids benign uterine
  tumors that cause persistent bleeding, anemia,
  pelvic pain or bladder pressure. Nonsurgical
  treatments of fibroids however are a possibility.
  
• Endometriosis. In endometriosis, tissue lining
  the inside of the uterus (endometrium) grows
  outside the uterus on the ovaries, fallopian
  tubes, or other pelvic or abdominal organs.
  Hysterectomy may be used when medication or
  conservative surgery doesn't improve things.
• Uterine prolapse. Descent of the uterus into your
  vagina can happen when the supporting ligaments
  and tissues weaken. Uterine prolapse can lead to
  urinary incontinence, pelvic pressure or
  difficulty with bowel movements. Hysterectomy may
  be necessary to achieve satisfactory repair of
  these conditions.
• Persistent vaginal bleeding. Heavy, irregular
  periods that last many days each cycle, may
  require a hysterectomy when the bleeding can't be
  controlled by nonsurgical methods.
• Chronic pelvic pain. Occasionally, surgery is a
  necessary last resort for women who experience
  chronic pelvic pain that clearly arises in the
  uterus. However, many forms of pelvic pain aren't
  cured by hysterectomy, and this operative
  approach can be a tragic mistake. Patients should
  seek careful evaluation before proceeding with
  such a radical strategy.

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Surgery
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Abdominal Hysterectomy
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Pelvic Laparoscopy
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Major advances have been made in the field of
womens health and womens health research