Neoplasms Cancer

8/13/2019 Neoplasms Cancer

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Neoplasms/Cancer


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Statistics >9.7 million cases are detected

each year

6.7 million people will die fromcancer

Every day, around 1700Americans die of the disease

20.4 million people living withcancer in the world today

1 in 3 people will be diagnosed

with cancer in the UK and 1 in 4will die from their disease


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Lung

Breast

Colon/Rectum

Stomach

Liver

Prostate

Cervix uteriOesophagus

Bladder

Non-Hodgkin

Lymphoma

Leukaemia

Oral cavity

PancreasKidney

Ovary

1000 800 600 400 200 0 200 400 600 800 100

0

Men Women

From: D.M. Parkin The Lancet Oncology 2: 533-543 (2001)

(Thousands)

Incidence

Mortality

337293

105

0370

241318

446234

165166

471233

133111

7633

12168

11386

4797

101

101

3471

192114

810902

558405

255499

398384

204543

279

260

227

99

93167

144109

81170

116

112

57119

5.3 million cases

3.5 million deaths

4.7 million cases

2.7 million deaths

The Global Burden of Cancer 2000


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WHO Statistics

2020 15 million people will die from cancer

Causes

Ageing population

Obesity

Smoking


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What is neoplasm?

Divisionuncontrolled cell division

Growthformation of a lump (tumour) or largenumbers of abnormal white cells in the blood

Mutationchanges to how the cell is viewed by

the immune system

Spreadability to move within the body andsurvive in another part


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Divisionuncontrolled cell division

Oncogenes-tumor causers

Tumour suppressor genes

Suicide genesapoptosis

DNA repair genes


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Growth

Tumour

Pressure on nerves

Blocking organs

Stopping normal function

Altering nerve signals

Obstructs


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Mutation and Spread

Invasion

Angiogenesis-creation of new

microcirculation


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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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Methods of Metastasis-spread

By vascular system

By lymph system

By direct invasion


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Good link

www.cancerresearchuk.org/cancer-

help/about-cancer.what-is-

cancer/grow/how-a-cancer-spreads
http://www.cancerresearchuk.org/cancer-help/abouthttp://www.cancerresearchuk.org/cancer-help/abouthttp://www.cancerresearchuk.org/cancer-help/abouthttp://www.cancerresearchuk.org/cancer-help/abouthttp://www.cancerresearchuk.org/cancer-help/about


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Carcinogenesis.

Some factors to consider Heredity

Immunity

Chemical Physical

Viral

Bacterial Lifestyle
http://www.alternative-cancer.net/images/Cancer_cell,%20brain.jpg


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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

Liver 509,000 HBV, HCV, flukes 5.1

Cervix 471,000 HPV 4.7

Stomach 442,000 H. py lor i 4.4

Kaposis(HIV related) 134,000 HHV-8 1.3Non Hodgkin lymphoma 72,000 H. py lor i, 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 diein 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

SunlightCertain industrial sources

Radiation

Radon

Cancer treatment


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Obesity Lifestyle:- Highly caloric diet, rich infat, 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 butalso 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 lymphnodes

N1: tumor cells spread to closest or small number of regionallymph nodes

N2: tumor cells spread to an extent between N1 and N3.

N3: tumor cells spread to most distant or numerous regionallymph nodes

M(0/1): presence of metastasis M0: no distant metastasis

M1: metastasis to distant organs (beyond regional lymph nodes)
http://en.wikipedia.org/wiki/Carcinoma_in_situhttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Lymphhttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Lymphhttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Carcinoma_in_situ


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Other parameters

G(1-4): the grade of the cancer cells (i.e. they are "lowgrade" 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 R0G1; this would be considered Stage I.

Large, high grade cancer, with spread to regional lymphnodes and other organs, not completely removed, seenby pathologist - pT4 pN2 M1 R1 G3; this would beconsidered Stage IV.

Most Stage I tumors are curable; most Stage IV tumorsare not.


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Staging for Chronic Lymphocytic

Leukemia (CLL)

There are two different systems for staging

chronic lymphocytic leukemia. The Raiclassification 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. Riskgroups 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 andcan 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 ArborStaging System".


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Duke Staging System

Modified Duke AThe tumor penetrates into the mucosa of thebowel wall but no further.

Modified Duke BB1: tumor penetrates into, but not through themuscularis 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 ofcolon cancer in the lymph nodes. C2: tumor penetrates into andthrough the muscularis propria of the bowel wall; there is pathologicevidence of colon cancer in the lymph nodes.

Modified Duke DThe tumor, which has spread beyond theconfines of the lymph nodes (to organs such as the liver, lung orbone).


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Summary

Cancer is a disease ofDivision, growth andspread

It has a number of causesmany of thempreventable

The survival of the patientis determined by thestage of the disease, theearlier the detection orthe smaller the tumourthe better the survival

Neoplasms Cancer

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