My Seminar( 2003) Sri

8/8/2019 My Seminar( 2003) Sri

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Definition

Epidemiology

Classification

Signs & Symptoms

Causes

Pathophysiology

Prevention

Diagnosis

Management

Prognosis


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Cancer

Cancer is a class of diseases in which a group of cellsdisplay

Uncontrolled Growth

Invasion

Metastasis

These three malignant properties of cancersdifferentiate them from benign tumors, which areself-limited, and do not invade or metastasize.


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The branch of medicine concerned with the study,diagnosis, treatment, and prevention of cancer isoncology

oncos describes all tumours- coined by Galen.

Oncology

Oncology is concerned with:

Diagnosis Therapy Follow-upPalliative

care


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Death rate from malignant cancer

in 2004

The death rate from malignant neoplasm in India in the year 2007 was105-130 per 100,000 inhabitants


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Most common cancers in males, by occurrence in males, by mortality

in females, by occurrence in females, by mortality

Current status of cancer occurrence and mortality

in males and females


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As of 2004, worldwide cancer caused 13% of all

deaths (7.4 million).

The leading causes were: Lung cancer (1.3 million deaths/year) Stomach cancer (803,000 deaths) Colorectal cancer (639,000 deaths) Liver cancer (610,000 deaths) Breast cancer (519,000 deaths).

In the developed world, one in three people willdevelop cancer during their lifetimes.


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Difference between a normalcell and cancer cell.


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Classification

Cancers are classified by the type of cell thatresembles the tumor and, therefore, the tissuepresumed to be the origin of the tumor.

These are the histology and the location,respectively.

Examples of general categories include:

Carcinoma Sarcoma Lymphoma and Leukemia Germ cell tumor(Totipotent cells) Blastic tumor or blastoma


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Benign tumors (which are not cancers) are named

using -oma as a suffix with the organ name as the

root.

For instance, a benign tumor of the smooth muscle

of the uterus is called leiomyoma

Benign tumors


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Large cell carcinoma Basal cell carcinoma

Kaposis sarcoma Osteosarcoma


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Germ cell tumor

LymphomaLeukemia


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Signs & Symptoms

Roughly, cancer symptomscan be divided into threegroups:

Symptoms of cancermetastasis depend on thelocation of the tumor

:

Unusual swelling

Hemorrhage (bleeding) Pain and/or ulceration


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:

Weight loss

Poor appetite

Fatigue and cachexia (wasting) Excessive sweating (night sweats) Anemia Specific paraneoplastic phenomena

Thrombosis

:

Enlarged lymph nodes

Cough Hemoptysis Hepatomegaly (enlarged liver) Bone pain, Fracture of affected bones

Neurological symptoms.


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Every symptom in the above list can be caused bya variety of conditions (a list of which is referred toas the differential diagnosis).

Cancer may be a common or uncommon cause ofeach item.


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Causes

Research about cancer causes often falls into the

following categories:

Mutation:Chemical carcinogensIonizing radiation

Infection

Hormonal imbalances

Immune system dysfunction

Heredity

Other causes


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Pathophysiology


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Cancer Process

There are four scientific theories that are the basisfor the alternative and complementary therapies.

1.Formation of blood vessels by cancer cells

2.Encapsulation process

3.Signaling process

4.Deficiencies in cancer patients


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1

2

3

Cancer Process


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Prevention

Cancer prevention is defined as active measures todecrease the incidence of cancer.

Primary preventionSecondary prevention

Modifiable ("lifestyle") risk factors Diet Vitamin supplementation

Chemoprevention Genetic testing Vaccination Screening


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Modifiable ("lifestyle") risk factors

Majority of cancer risk factors are environmental orlifestyle-related. Examples of modifiable cancer risk factors

Alcohol consumption Smoking

Physical inactivity Being obese/over weight Sexually transmitted diseases(human papilloma virus)

Use of exogenous hormones Exposure to UV and ionizing radiations Certain occupational and chemical exposures


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Diet

Obesity increases the risk of developing the cancer Substantial link between diet and cancer in case ofimmigrants Dietary interventions for primary cancer risk

reduction generally gain support from epidemiologicalassociation studies. Examples

Meat consumptionCoffee consumption

Primary risk factors

A secondary prevention study showed thatconsumption of a plant-based diet and lifestylechanges resulted in a reduction in cancer markers


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Recommendations of WCRF/AICRExperts

(1)Reducing intake of foods and drinks thatpromote weight gain, namely energy-densefoods and sugary drinks,

(2)Eating mostly foods of plant origin,(3)Limiting intake of red meat and avoiding

processed meat,(4)Limiting consumption of alcoholic beverages,

and(5)Reducing intake of salt and avoiding mouldy

cereals (grains) or pulses (legumes).


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Anti-cancer effect of mushrooms

Medicinal mushrooms upregulate the immune system.

Examples Agaricus blazei

Maitake

Trametes versicolor

Anti-cancer effect is due to the presence of -glucans( known as biological response modifiers .

Specifically, beta-glucans stimulate the innate branch ofthe immune system.


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Vitamin Supplementation

Has not been proven effective in prevention of cancer. Patients are increasingly advised to consume fruitsand vegetables for maximal health benefits.

Low levels of vitamin D is correlated with increasedcancer risk. Beta-carotene supplementation has been found toincrease slightly, risks of lung cancer. Folic acid supplementation has not been foundeffective in preventing colon cancer and may increasecolon polyps


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Chemoprevention

Many high-quality clinical trials support the use ofsome medications in defined circumstances.

Examples:

Tamoxifen( SERM )

Raloxifene ( SERM ) Finasteride( 5- alpha reductase inhibitor )


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Genetic testing

Available for certain cancer-related genetic mutations.

Carriers of genetic mutations that increase risk forcancer incidence can undergo enhanced surveillance,chemoprevention, or risk-reducing surgery.

Early identification of inherited genetic risk for cancer,along with cancer-preventing interventions such as

surgery or enhanced surveillance, can be lifesaving forhigh-risk individuals.


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Gene Cancer types Availability

BRCA1, BRCA2 Breast, ovarian, pancreaticCo erciall availa le

for clinical speci ens

MLH1, MSH2,

MSH6, PMS1, PMS2

Colon, uterine, s all owel,

sto ach, urinar tract

Co erciall availa le

for clinical speci ens


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Vaccination

Prophylactic vaccines have been developed.

Examples : Human Papilloma virus Vaccines

(Gardasil and Cervarix are commercially

available )

Hepatitis B vaccine


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Screening

To detect unsuspected cancers in an asymptomaticpopulation Can lead to earlier diagnosis in some cases Examples of some screening procedures

Colonoscopy Prostrate specific antigen test Prostrate biopsy Medical imaging


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My Seminar( 2003) Sri

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