Cancer A Superficial Introduction

Transcription

1 Cancer A Superficial Introduction Gabor Fichtinger, Queen s University

2 Cancer some definitions Medical term: malignant neoplasm Class of diseases in which a group of cells display: uncontrolled growth (division beyond the normal limits) invasion (intrusion on and destruction of adjacent tissues) sometimes metastasis (spread to other locations in the body via lymph or blood) The above differentiate cancer from non-malignant (benign) growth Most cancers are solid and form a tumor. Some, like leukemia, do not. This course deals mostly solid cancer i.e. tumor.

3 Cancer known causes Mutation: chemical carcinogens tobacco smoke, some artificial sweeteners, some food preservatives Mutation: ionizing radiation Viral or bacterial infection Hormonal imbalances Immune system dysfunction Heredity Other causes

4 Cancers in this course Prostate Breast Gynecological Liver Bone / spine Head and Neck Brain Kidney Leukemia Lymph nodes

5 Cancer known causes Mutation: chemical carcinogens tobacco smoke, some artificial sweeteners, some food preservatives Mutation: ionizing radiation Viral or bacterial infection Hormonal imbalances Immune system dysfunction Heredity Other causes

6 Cancer diagnosis Non-invasive: Blood serum Palpation (i.e. feel a lump under your finger) Imaging (CT, MRI, Ultrasound, PET, SPECT) Tissue biopsy Pathologist the doctor who examines it Histology or histopathology the process Pattern classification problem Diagnosis Staging of the disease Treatment options

7 Cancer imaging CT Liver cancer Kidney cancer Prostate cancer

8 Cancer imaging CT Glioblastoma multiform Metastatic brain lesions Metastatic spine cancer

9 Cancer imaging MRI prostate breast

10 Cancer imaging contrast imaging Issues: Toxicity Uptake Washout

11 Cancer imaging ultrasound Prostate - Transrectal Ultrasound (TRUS) Liver - Transcutaneous Ultrasound

12 Cancer imaging SPECT

13 Biopsy - the tools - cutting

14 Biopsy - the tools - suction Aspiration for serial semen analyses

15 Biopsy - drilling & suction Bone marrow biopsy needle Bone biopsy needle

16 Biopsy - the tissue (examples) Primary liver cancer in laparoscopy camera and pathology Liver mets from testicular (left) and breast cancer (right)

17 Cancer Diagnosis specificity and sensitivity sensitivity no yes specificity no BAD? yes? IDEAL Sensitivity = can I see it if it is there? Specificity = can I recognize it if I see it?

18 Cancer treatment Chemotherapy (realm of medical oncology) Surgery Resection Growth inhibition Thermal Ablation Cryotherapy (freezing) Injection Embolization Radiation therapy External beam (EBRT) Implanted sources (brachytherapy)

19 Cancer MIS tools - RFA

20 Cancer MIS tools - cryo

21 Cancer MIS tools - microwave

22 Cancer MIS tools HIFU needle a ) C o n t r o l l e d U l t r a s o u n d O u t p u t U l t r a s o u n d T r a n s d u c e r s ( T u b u l a r ) O u t e r S u p p o r t S h a f t coagulation boundary 3 ACOUSTTiC Needles ACOUSTTiC 3 Needles + Catheter 3 Needles + Catheter-cooling C o o l i n g F l o w I n s e r t i o n T i p T e m p e r a t u r e S e n s o r s P o w e r L e a d W i r e s o sector o sector R di ld h f o sector o sector Acousticx Acoustic Medsystems, Inc

23 Cancer HDR brachytherapy

24 Cancer Statistics 2007 A Presentation From the American Cancer Society 2007, American Cancer Society, Inc.

25 US Mortality, 2004 Rank Cause of Death No. of deaths % of all deaths 1. Heart Diseases 652, Cancer 553, Cerebrovascular diseases 150, Chronic lower respiratory diseases 121, Accidents (Unintentional injuries) 112, Diabetes mellitus 73, Alzheimer disease 65, Influenza & pneumonia 59, Nephritis 42, Septicemia 33, Source: US Mortality Public Use Data Tape 2004, National Center for Health Statistics, Centers for Disease Control Laboratory and Prevention, for Percutaneous Surgery The Perk Lab

26 Change in the US Death Rates* by Cause, 1950 & 2004 Rate Per 100, Heart Diseases Cerebrovascular Diseases Pneumonia/ Influenza Cancer * Age-adjusted to 2000 US standard population. Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised Mortality Data: US Mortality Public Use Data Tape, 2004, NCHS, Centers for Disease Control and Laboratory Prevention, for Percutaneous 2006 Surgery The Perk Lab

27 2007 Estimated US Cancer Deaths* Lung & bronchus 31% Prostate 9% Men 289,550 Women 270,100 26% Lung & bronchus 15% Breast Colon & rectum 9% 10% Colon & rectum Pancreas 6% 6% Pancreas Leukemia 4% 6% Ovary Liver & intrahepatic 4% bile duct Esophagus 4% 4% Leukemia 3% Non-Hodgkin lymphoma Urinary bladder 3% 3% Uterine corpus Non-Hodgkin 3% lymphoma Kidney 3% 2% Brain/ONS 2% Liver & intrahepatic bile duct All other sites 24% 23% All other sites ONS=Other nervous system. Laboratory Source: for Percutaneous American Cancer Surgery Society, The Perk Lab

28 Trends in the Number of Cancer Deaths Among Men and Women, US, , ,000 Men 285,000 Men 250, ,000 Number of Cancer Deaths 200, , ,000 Women 275, ,000 Women 265, , Source: US Mortality Public Use Data Tape, 2004, National Center for Health Statistics, Centers for Disease Laboratory Control for and Percutaneous Prevention, Surgery The Perk Lab

29 Cancer Death Rates*, All Sites Combined, All Races, US, Rate Per 100,000 Men Both Sexes Women *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results (SEER) Program ( SEER*Stat Database: Mortality - All COD, Public-Use With State, Total U.S. ( ), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April Underlying mortality data Laboratory provided for Percutaneous by NCHS ( Surgery The Perk Lab

30 Cancer Death Rates*, for Men, US, Rate Per 100,000 Lung & bronchus Stomach 40 Colon & rectum Prostate 20 Pancreas 0 Leukemia Liver *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes , US Mortality Volumes , National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

31 Cancer Death Rates*, for Women, US, Rate Per 100, Uterus Breast Lung & bronchus 20 Stomach Colon & rectum Ovary 0 Pancreas *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes , US Mortality Volumes , National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

32 Cancer Death Rates*, by Race and Ethnicity, US, Men Women White African American Asian/Pacific Islander American Indian/ Alaskan Native Hispanic *Per 100,000, age-adjusted to the 2000 US standard population. Persons of Hispanic origin may be of any race. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2006.

33 Cancer Sites in Which African American Death Rates* Exceed White Death Rates* for Men, US, Site African American White Ratio of African American/White All sites Prostate Larynx Stomach Myeloma Oral cavity and pharynx Esophagus Liver and intrahepatic bile duct Small intestine Colon and rectum Lung and bronchus Pancreas *Per 100,000, age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control Laboratory and Population for Percutaneous Sciences, Surgery National The Perk Cancer Lab Institute, 2006.

34 Cancer Sites in Which African American Death Rates* Exceed White Death Rates* for Women, US, Site African American White Ratio of African American/White All sites Stomach Myeloma Uterine cervix Esophagus Larynx Uterine corpus Small intestine Pancreas Colon and rectum Liver and intrahepatic bile duct Breast Urinary bladder Gallbladder Oral cavity and pharynx *Per 100,000, age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control Laboratory and Population for Percutaneous Sciences, Surgery National The Perk Cancer Lab Institute, 2006.

35 Cancer Death Rates* by Sex and Race, US, Rate Per 100,000 African American men White men African American women White women *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Laboratory Population for Percutaneous Sciences, Surgery National The Cancer Perk Lab Institute, 2006.

36 2007 Estimated US Cancer Cases* Men 766,860 Women 678,060 Prostate 29% Lung & bronchus 15% Colon & rectum 10% Urinary bladder 7% Non-Hodgkin 4% lymphoma Melanoma of skin 4% Kidney 4% Leukemia 3% Oral cavity 3% Pancreas 2% All Other Sites 19% 26% Breast 15% Lung & bronchus 11% Colon & rectum 6% Uterine corpus 4% Non-Hodgkin lymphoma 4% Melanoma of skin 4% Thyroid 3% Ovary 3% Kidney 3% Leukemia 21% All Other Sites *Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Laboratory Source: for American Percutaneous Cancer Surgery Society, The Perk Lab

37 Cancer Incidence Rates*, All Sites Combined, All Races, Rate Per 100, Men 500 Both Sexes 400 Women *Age-adjusted to the 2000 US standard population and adjusted for delay in reporting. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Laboratory Population for Percutaneous Sciences, Surgery National The Cancer Perk Lab Institute, 2006.

38 Cancer Incidence Rates* for Men, Rate Per 100, Prostate Lung & bronchus 50 Colon and rectum Urinary bladder 0 Non-Hodgkin lymphoma Melanoma of the skin *Age-adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2006.

39 Cancer Incidence Rates* for Women, Rate Per 100, Breast Colon and rectum Lung & bronchus Uterine Corpus Ovary Non-Hodgkin lymphoma *Age-adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2006.

40 Cancer Incidence Rates* by Race and Ethnicity, Rate Per 100, Men Women White African American Asian/Pacific Islander American Indian/ Alaska Native Hispanic *Age-adjusted to the 2000 US standard population. Person of Hispanic origin may be of any race. Sources: Howe HL, et al. Annual report to the nation on the status of cancer ; SEER, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2006.

41 Cancer Incidence Rates* by Sex and Race, All Sites, Rate Per 100, African-American men White women White men African-American women *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Laboratory Population for Percutaneous Sciences, Surgery National The Cancer Perk Lab Institute, 2006.

42 Lifetime Probability of Developing Cancer, by Site, Men, * Site Risk All sites 1 in 2 Prostate 1 in 6 Lung and bronchus 1 in 12 Colon and rectum 1 in 17 Urinary bladder 1 in 28 Non-Hodgkin lymphoma 1 in 47 Melanoma 1 in 49 Kidney 1 in 61 Leukemia 1 in 67 Oral Cavity 1 in 72 Stomach 1 in 89 * For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 2001 to All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder. Includes invasive and in situ cancer cases Source: DevCan: Probability of Developing or Dying of Cancer Software, Version Statistical Research and Laboratory Applications for Percutaneous Branch, Surgery NCI, The Perk Lab

43 Lifetime Probability of Developing Cancer, by Site, Women, US, * Site Risk All sites 1 in 3 Breast 1 in 8 Lung & bronchus 1 in 16 Colon & rectum 1 in 19 Uterine corpus 1 in 40 Non-Hodgkin lymphoma 1 in 55 Ovary 1 in 69 Melanoma 1 in 73 Pancreas 1 in 79 Urinary bladder 1 in 87 Uterine cervix 1 in 138 * For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 2001 to All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder. Includes invasive and in situ cancer cases Source: DevCan: Probability of Developing or Dying of Cancer Software, Version Statistical Research and Applications Branch, NCI,

44 Cancer Survival*(%) by Site and Race, Site White African American % Difference All Sites Breast (female) Colon Esophagus Leukemia Non-Hodgkin lymphoma Oral cavity Prostate Rectum Urinary bladder Uterine cervix Uterine corpus *5-year relative survival rates based on cancer patients diagnosed from 1996 to 2002 and followed through Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Laboratory Population for Percutaneous Sciences, Surgery National The Cancer Perk Lab Institute, 2006.

45 Five-year Relative Survival (%)* during Three Time Periods By Cancer Site Site All sites Breast (female) Colon Leukemia Lung and bronchus Melanoma Non-Hodgkin lymphoma Ovary Pancreas Prostate Rectum Urinary bladder *5-year relative survival rates based on follow up of patients through Recent changes in classification of ovarian cancer have affected survival rates. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Laboratory Population for Percutaneous Sciences, National Surgery Cancer The Perk Institute, Lab 2006.

46 Cancer Incidence & Death Rates* in Children 0-14 Years, Rate Per 100, Incidence Mortality *Age-adjusted to the 2000 Standard population. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Laboratory Population for Percutaneous Sciences, Surgery National The Cancer Perk Institute, Lab 2006.

47 Tobacco Use in the US, Per Capita Cigarette Consumption Per capita cigarette consumption Male lung cancer death rate Female lung cancer death rate Age-Adjusted Lung Cancer Death Rates* Year *Age-adjusted to 2000 US standard population. Source: Death rates: US Mortality Public Use Tapes, , US Mortality Volumes, , National Center for Health Statistics, Centers for Disease Control and Prevention, Cigarette consumption: US Department of Agriculture,

48 Trends in Cigarette Smoking Prevalence* (%), by Gender, Adults 18 and Older, US, Prevalence (%) Women Men Year *Redesign of survey in 1997 may affect trends. Source: National Health Interview Survey, , National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

49 Trends in per capita cigarette consumption for selected states and the average consumption across all states, Per Capita Sales (# of Packs) California United States Massachusetts Year Data from: Orzechowski W, Walker RC. The tax burden on tobacco: historical compilation 2003: Volume 36. Arlington (VA): Orzechowski and Walker; 2003.

50 Trends in Prevalence (%) of No Leisure-Time Physical Activity, by Educational Attainment, Adults 18 and Older, US, Prevalence (%) Adults with less than a high school education All adults Year Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Educational attainment is for adults 25 and older. Source: Behavioral Risk Factor Surveillance System CD-ROM ( , 1996, 1998) and Public Use Data Tape (2000, 2002, 2004, 2005), National Center for Chronic Disease Prevention and Health Promotion, Centers for Laboratory Disease for Percutaneous Control and Surgery Prevention, The 1997, Perk Lab 1999, 2000, 2001, 2003, 2005, 2006.

51 Trends in Obesity* Prevalence (%), By Gender, Adults Aged 20 to 74, US, Prevalence (%) Both sexes Men Women NHES I ( ) NHANES I ( ) NHANES II ( ) NHANES III ( ) NHANES NHANES *Obesity is defined as a body mass index of 30 kg/m 2 or greater. Age adjusted to the 2000 US standard population. Source: National Health Examination Survey , National Health and Nutrition Examination Survey, , , , , National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, : National Health and Nutrition Examination Survey Public Use Data Files, , National Center for Health Laboratory Statistics, for Percutaneous Centers for Surgery Disease The Control Perk and Lab Prevention, 2006.

52 Trends in Overweight* Prevalence (%), Adults 18 and Older, US, Less than 50% 50 to 55% More than 55% State did not participate in survey *Body mass index of 25.0 kg/m 2 or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM ( , 1998) and Public Use Data Tape (2004, 2005), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 2000, 2005, 2006.