Overview of Cancer Mylene Freires Advanced Nurse Practitioner, Haematology
Aim of the Presentation Review basic concepts of cancer Gain some understanding of the socio-economic impact of cancer
Order of Presentation: A. Global Cancer Statistics and in the UK B. Cancer Basic Concepts C. Grading, Risk Factors and Genetics D. Diagnosis and Staging E. Prognosis and Treatment
Why is Cancer everyone s business? Personal reasons Professional reasons Socio-economic impact
A. Worldwide Cancer Statistics: In 2012, 14.1 million of new cases worldwide 8.2 million deaths worldwide 33% are linked with smoking; 6% alcohol drinking prevalent in Europe and America Higher in males then females
UK statistics: < X X Survivors in 10 years
UK statistics,2015 New cases 359,960 Deaths 163,444 Only 50% survive cancer for 10 years or more 42% of Cancers are preventable More males than females Incidence rates are highest in people aged 85 to 89
Most common cancers: Lung -1/5 of all cancer deaths Bowel Prostate Breast
Financial Impact to Economy: Loss of people from the labour force 50,000 deaths = 585 million loss and across their lifetime = 6.8 billion
Financial Impact to: Families and communities: Loss Caregivers Loss or Reduced Income = 570-860/month Increased costs related to inpatient and outpatient attendances Loss of Vital volunteers 236 million/year
Cancer Survivors:
Cancer Survivors estimated contribution: 1.8 million survivors = 6.9 million contribution through paid employment Informal care = 258 million hours Volunteering = 52 million hours Domestic work = 1.5 billion hours
Financial Cost Cancer Survivors social contribution is estimated at: 16.7 billion
B. Cancer Basics: What is Cancer?
Cell Cycle
Phases of cell cycle G1, S & G2 Known as the interphase Cells spend more time in interphase than mitosis At each phase there are check points, if conditions are right proteins determine whether enter into the next phase If conditions not right will stay in GO Phase ( resting phase)
G0 Known as the resting phase. The cell is not currently in it s cycle. G1 Cell increases in size checkpoints occur prior to Synthesis Synthesis The cell replicates G2- The gap between synthesis and mitosis another checkpoint prior to mitosis
Mitosis ( Also known as cell division) Cell growth stops and cells divide into 2 daughter cells. Goes through 4 phases during this phase Prophase Metaphase Anaphase Telophase Cytokinesis
What is Cancer? - Is a collection of related disease. - A complex disease with variable presentation, development and outcome from one patient to another. It is a multi-step process- involving cellular metabolic and behavioural changes leading to untimely and excessive proliferation. Cumulative modifications in the genetic programmes that control cell proliferation, lifespans and the ability to escape the immune system.
Why cells become malignant?
Three Conditions In Cancer Transformation: cells should proceed to divide only when they receive appropriate signals when confronted by stressful or improper conditions for DNA replication, cells activate self-destruction programmes rather than allow DNA replication to proceed in conditions where genes may become damaged normal cells divide only a limited number of times
Genetic Drivers in Cancer: Proto-oncogenes- (KRAS)
Tumour suppressor genes (TP53 and RB1)
DNA Repair Genes
Cells become cancerous due to the accumulation of defects, or mutations, in their DNA Certain inherited genetic defects (for example, BRCA1 and BRCA2 mutations) and infections can increase the risk of cancer. Environmental factors (for example, air, pollution, poor life style choices eg smoking alcohol can increase cancer
Sources of DNA Damage:
Cancer occurs when when certain cells in the body keep dividing without the ability to stop Feeds off the body ( contributes to weight loss) Carcinogenesis- or oncogenesis or tumorigenesis is the actual formation of a cancer, whereby normal cells are transformed into cancer cells. The process is characterized by a progression of changes at the cellular, genetic, and epigenetic level that ultimately reprogram a cell to undergo uncontrolled cell division, thereby forming a malignant mass.
Types of Cancers: Solid tumours Carcinoma adenocarcinoma basal cell carcinoma squamous cell carcinoma transitional cell carcinoma Sarcoma Melanoma Brain and Spinal Cord Tumours Other Tumours: germ cell tumours Haematological Malignancies Leukaemias Lymphomas Multiple Myelomas
C. Grading Tumours: Well-differentiated tumours Poorly differentiated or undifferentiated Assigned with numerical grade and is not the same as cancer staging Or Grade 1 Grade II Grade III
D. Cancer Staging: Refers to the location and extent of the tumour spread 4 Factors: Location of Primary tumour tumour size and extent Lymph node involvement Presence or absence of metastasis
TNM staging system T : size and extent the main tumour N : number of nearby lymph nodes with cancer M : metastasized Numbers after each letter provides more details e.g: Primary tumour (T) TX: main tumour cannot be measured T0: main tumour cannot be found T1, T2 etc: refers to the size and/ or extent of main tumour
Regional Lymph Nodes: NX: cancer in lymph nodes cannot be measured N0: No cancer in nearby lymph nodes N1, N2, N3: Number and location of lymph nodes with cancer; Distant Metastasis: (M) MX: metastasis cannot be measured M0: cancer has not spread M1: Cancer has spread
Stage Stage 0 Stage I, II and III Meaning Abnormal cells are present but not spread nearby tissue i.e CIS Cancer is present. The higher the number, the larger the cancer tumour and spread Stage IV Cancer has spread to other parts
Other staging categories: In situ Abnormal cells but have not spread Localised Limited to the place where it started with no sign of spread Regional Has spread to nearby lymph node, tissues or organs Distant Has spread to distant parts of the body Unknown Not enough information
E. Prognosis in Cancer: prediction about a patient s future Refers to the likelihood of response to treatment and survival
Factors affecting Prognosis of Cancer: The type of cancer and where it is in The stage of the cancer, which refers to the size and if it has spread The cancer s grade, which refers to how abnormal the cancer cells look under a microscope. Grade provides clues about how quickly the cancer is likely to grow and spread. Certain traits of the cancer cells Age and fitness before cancer Response to treatment
F. Treatments for Cancer: Chemotherapy Surgery Radiation Therapy. Immunotherapy. Targeted Therapy. Hormone Therapy. Stem Cell Transplant. Precision Medicine
Thank you. Email: Mylene.Freires@bfwhospitals.nhs.uk
Resources: National Cancer Institute Cancer Research UK UK Statistics office www.ilcuk.org.uk Macmillan