Different Types of Cancer Cancer can originate almost anywhere in the body. Sarcomas (connective tissue) Ø arise from cells found in the supporting tissues of the body such as bone, cartilage, fat, connective tissue, and muscle. 138
Different Types of Cancer Hematologic malignancies Ø Lymphomas: arise in the lymph nodes and tissues of the body s immune system. Ø Leukemia's: immature blood cells that grow in the bone marrow and tend to accumulate in large numbers in the bloodstream. Ø Multiple myeloma: plasma cell line (antibodies) 139
Cancer Statistics 141
Cancer Statistics Geographic Patterns in Lung Cancer Death Rates* by State, US, 2004-2008 WA Males MT ND ME OR MN VT ID WY SD WI MI NY NH MA RI NV UT NE IA IL IN OH PA NJ DE CT CA CO KS MO KY WV VA MD DC Rate per 100,000 29.5-52.5 AZ NM OK AR TN NC SC 52.6-65.7 65.8-75.6 75.7-87.8 MS AL GA 87.9-103.0 AK TX LA FL HI Females WA MT ND ME OR MN VT ID WY SD WI MI NY NH MA RI NV UT NE IA IL IN OH PA NJ DE CT CA CO KS MO KY WV VA MD DC Rate per 100,000 16.9-36.4 AZ NM OK AR TN NC SC 36.5-41.0 41.1-44.3 44.4-47.4 MS AL GA 47.5-56.1 AK TX LA FL HI *Age adjusted to the 2000 US standard population. Source: US Mortality Data, National Center for Health Statistics, Centers for Disease Control and Prevention. American Cancer Society, Surveillance Research, 2012 142
Risk Factors for Cancer 143
What Causes Cancer? 144
Heredity and Cancer
146 Diagnostic Methods
Laboratory testing used in cancer medicine in many ways: ü To screen for cancer or precancerous conditions before a person has any symptoms of disease ü To help diagnose cancer ü To provide information about the stage of a cancer (that is, its severity); for malignant tumors, ü To plan treatment ü To determine whether a cancer is responding to treatment
Diagnostic Testing Blood Biopsy Radiology 148
gene mutation testing: presence or absence of specific inherited mutations in genes that are known to play a role in cancer development. Examples BRCA1 and BRCA2 gene Diagnostic Testing Laboratory Complete blood count (CBC). Numbers of the different types of blood cells, including red blood cells, white blood cells, and platelets Cytogenetic analysis: Changes in the number and/or structure of chromosomes in a bone marrow cells Tumor marker tests: Some measure the presence, levels, or activity of specific proteins or genes in tissue, blood, or other bodily fluids. For example: HER2, CA 125. 149
Diagnostic Testing Radiology X-rays: X-rays are the most common way to view organs and bones inside the body. ² CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your organs. You may receive a contrast material (such as dye) 150
Diagnostic Testing Radiology Ultrasound: An ultrasound device sends out sound waves that people cannot hear. The waves bounce off tissues inside your body like an echo. MRI: magnet linked to a computer is used to make detailed pictures of areas in your body. Your doctor can view these pictures on a monitor and can print them on film. 151
Diagnostic Testing Radiology PET scan: A machine makes pictures that show chemical activities in the body. 152
Diagnostic Testing Removes a sample of tissue and sends it to a lab. A pathologist looks at the tissue under a microscope. Biopsy ² The sample may be removed in several ways: q With a needle: The doctor uses a needle to withdraw tissue or fluid. q With an endoscope: uses a thin, lighted tube (an endoscope) to look at areas inside the body.. q With surgery: Surgery may be excisional or incisional 153
Diagnostic Testing Biopsy Pathology Proteomic profile Genomic profile
Microscopic Appearance of Cancer Cells 155
156 Cancer Staging
Cancer Staging What is cancer staging? Is a process determine how much cancer is in the body and where it is located. Staging describes the severity of an individual s cancer. the extent of the original (primary) tumor whether or not cancer has spread in the body. Staging also provides: Staging helps plan the appropriate treatment. Can be used to estimate the person s prognosis. Is important in identifying clinical trials that may be suitable for a particular patient. 157
Cancer Types of staging systems: Staging There are many staging systems. TNM staging system Others are specific to a particular type of cancer. Most staging systems include information about: Where the tumor is located in the body The cell type (such as, adenocarcinoma or squamous cell carcinoma) The size of the tumor Whether the cancer has spread to nearby lymph nodes Whether the cancer has spread to a different part of the body Tumor grade (abnormal the cancer cells look)
r Stagin What are the common elements of staging systems? g The common elements considered in most staging systems are as follows: ü Site of the primary tumor. ü Tumor size and number of tumors. ü Lymph node involvement (spread of cancer into lymph nodes). ü Cell type and tumor grade* (how closely the cancer cells resemble normal tissue cells). ü The presence or absence of metastasis. 159
r Stagin What is the TNM system? g The TNM system is based on: ü Extent of the tumor (T) ü Extent of spread to the lymph nodes (N) ü Presence of distant metastasis (M). A number is added to each letter to indicate the size or extent of the primary tumor and the extent of cancer spread. 160
r Stagin Primary Tumor (T) TX: Primary tumor cannot be evaluated T0: No evidence of primary tumor Tis: Carcinoma in situ (CIS; abnormal cells are present but have not spread to neighboring tissue T1, T2, T3, T4: Size and/or extent of the primary tumor Regional Lymph Nodes (N) NX: Regional lymph nodes cannot be evaluated N0: No regional lymph node involvement N1, N2, N3: number and location of lymph nodes involved. g 161
r Stagin g Distant Metastasis (M) MX: Distant metastasis cannot be evaluated M0: No distant metastasis M1: Distant metastasis is present Stage Definition: Stage 0: Carcinoma in situ. Stage I II, III: Higher numbers indicate more extensive disease: Stage IV: The cancer has spread to another organ(s). 162
r Stagin g stage Stage 0 What it means Abnormal cells are present but have not spread to nearby tissue. (CIS is not cancer but may become cancer) Stage I, Stage II, and Stage III Cancer is present. The higher the number, the larger the cancer tumor and has spread to nearby tissue Stage IV The cancer has spread to distant parts of the body. 163
r Stagin g
165 Cancer Treatment
CANCER TREATMENT GOALS
CANCER TREATMENT GOALS Adjuvant Therapy Surgery is primary treatment. Chemotherapy/biotherapy is given after surgery as an adjunct (adjuvant). Neoadjuvant Therapy Chemotherapy/biotherapy is given prior to surgery to shrink tumor bulk and load. Can limit the surgical procedure that follows therapy
Cancer Treatment: Modalities Hormonal Chemotherapy Biotherapy Radiation Surgery Bone Marrow Transplant
The treatment plan depends mainly on the type of cancer and the stage of the disease. Treatment may be given as: Local therapy (Surgery, Radiation) Systemic therapy. Purposes/goals: Curative, prophylactic, diagnostic, Staging, palliative, Adjuvant or supportive, Reconstructive/rehabilitative Cancer Treatment: Modalities 169
Surgeon removes the tumor and some tissue around it. Removing nearby tissue may help prevent the tumor from growing back. Cancer Treatment: Surgery 170
Radiation therapy is used to treat cancer and ease cancer symptoms. Kills cancer cells or slows growth by damaging their DNA. Treatment may take days or weeks to damage DNA before cancer cells will die. Purpose: Curative, Palliative Treat cancer with minimal harm to normal cells. Cancer Treatment: Radiation
Cancer Treatment: Radiation Highest energy rays are given. Divided into doses or fractions Radiation absorbed dose = RAD Amount of radiation delivered to and absorbed by tissue