Introduction to Cancer basics?

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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

• gt9.7 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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The Global Burden of Cancer 2000
Women
Men
5.3 million cases 3.5 million deaths
4.7 million cases 2.7 million deaths
902
337
Lung Breast Colon/Rectum Stomach Liver Prostate Ce
rvix uteri Oesophagus Bladder Non-Hodgkin
Lymphoma Leukaemia Oral cavity Pancreas Kidney Ova
ry
293
810
1050
370
499
446
234
255
318
558
241
405
166
398
384
165
543
204
471
233
133
279
111
227
260
76
33
99
121
167
68
93
113
144
86
109
97
170
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Incidence Mortality
101
116
101
112
71
119
34
57
192
114
1000 800 600 400 200 0 200 400 600 800 1000
(Thousands)
From D.M. Parkin The Lancet Oncology 2
533-543 (2001)
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WHO Statistics

• 2020 15 million people will die from cancer
• Causes
• Ageing population
• Obesity
• Smoking

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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

• Tumour
• Pressure on nerves
• Blocking organs
• Stopping normal function
• Altering nerve signals
• Fungating

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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 12 (breast cancer)
• p53 (many cancers)

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Immunity

• HIV / AIDS
• Immunosuppression

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Viruss

• 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
No. of cases Agent World cancer
Liver 509,000 HBV, HCV, flukes 5.1 Cervix 471,000
HPV
4.7 Stomach 442,000 H. pylori 4.4 Kaposis (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 3,0
00 HTLV1 0.03 Total 1,801,000 17.9
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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
• Radiation
• Radon
• Cancer 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
1. Dont smoke
2. Dont smoke.
3. Dont smoke.
4. Avoid exposure to other known carcinogens,
including aflatoxin, asbestos and UV light.
5. Enjoy a healthy diet, moderate in calories,
salt and fat, and low in alcohol.
6. Eat fresh fruit and vegetables several times
a day.
7. Be physically active and avoid obesity.
8. Have vaccination against, or early
detection/treatment of, cancer causing chronic
infections.
9. Have the right genes.
10. Have good luck !
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Thank You!