David Levy

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David Levy

• Oncologist
• Weston Park, Sheffield

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Cancer-what is it?
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Cancer

• Slowly develops
• As we are living
• longer risk is greater
• More survivors now

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Cancer top ten
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Women
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Men
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Movers
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Types of Cancer

• Name depends on where it arises from
• Squamous- Skin
• Adeno- Glandular

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Cancer development

• Multiple genetic events
• Pre cancerous lesions-
• DCIS- in situ
• LCIS
• Polyps-adenoma
• CIN

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Benign or Malignant

• Adeno- ma
• Adeno- carcinoma
• Squamous cell carcinoma- SCC

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WHO Grading Scheme for Astrocytomas
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Astrocytoma Progression
Cell of origin
Histopath Features
p53mt, LOH17p, 22q PDGF overexpression
Astrocytoma
Hypercellularity pleomorphism
LOH 19q, 9p, Rb,
Anaplastic Astrocytoma
Mitoses
LOH 10q, DCC loss
Necrosis Vasc prolif
Glioblastoma
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Causes
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Causes

• Smoking
• Diet
• Alcohol
• Genetic
• Sunlight
• Occupation
• X-rays
• Infections

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More types
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Lung

• Often descriptive
• Large cell
• Small cell

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Mesothelioma
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Lymphoma

• Hodgkins
• Non-Hodgkins
• Can arise
• anywhere

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Sarcomas
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Sarcomas

• Also occur anywhere
• Odd names
• Liposarcoma
• Fibrosarcoma
• Malignant Fibrous Histioytoma

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Skin Tumours
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Skin

• Basal Cell- never (almost) metastasise
• Squamous cell
• Melanoma
• Lymphoma/Sarcomas

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Melanoma
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Germ Cell tumours

• Nightmare
• Can we benign or malignant

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Childrens

• Leukaemia
• Lymphoma
• Brains
• Blastomas

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What does not help is

• Wart on the bladder
• Skin wart
• Mitogenic lesion

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Cancer is invasive-it spreads
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How

• Locally
• Lymph nodes
• Blood
• Through spaces

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Locally
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Lymph nodes
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Blood
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Spaces
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So staging is important

• TNM
• Dukes
• Ann Arbor

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So staging is important

• Tumour- size, invasion locally
• Node- number, size
• Metastasis yes/no
• Grade

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Grade

• Differentiation
• Well
• Moderate
• Poor
• Anaplastic

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And other tests are now undertaken

• Hormone receptor status
• HER-2
• Genetic analysis
• Why?

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Customising patient care

• No two patients are the same
• No two tumours are the same
• Now have some markers to help offer the best
  treatment that patient needs for that tumour

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Performance status

• 0 Normal
• 1 Capable of light work
• 2 Up gt 50 of day, self-caring
• 3 Up lt50 of day
• 4 In bed

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Patients are not just tumours
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They are multi-dimensional
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Cancer- survivorship
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Thank you

• Questions

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Going further on cancer waits

• Discussion

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Currently

• Only one-third of cancer patients come through
  the 2WW- benefit from 62 day target
• What of others?
• What about subsequent treatments?

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Questions (1)

• Should all patients with a breast problem be seen
  within two weeks?
• Should the same be applied to patients with bowel
  problems. Experts have told us that two weeks
  would be very difficult to achieve straight away.
  Our thoughts are that we should aim for two
  weeks over time. Would four to six weeks be a
  more realistic aim initially?

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Questions (2)

• Is it right that 31 days should apply to second
  and subsequent treatments? Where might this
  cause problems and should it be based on the
  patient being ready for treatment?

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Questions (3)

• Do you agree that screen detected cases should be
  on a 62 day pathway
• Should hospital specialists be able to
  fast-track patients if cancer is suspected?

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Over to you