Cancer and Sarcoma Vocabulary Lesson Gina D’Amato, MD Director of Clinical Research Georgia Cancer Specialists affiliated with Northside Hospital Cancer Institute

Definition of Cancer Cancer is the uncontrolled growth of abnormal cells in the body Cancerous cells are also called malignant cells Cancer grows out of normal cells in the body Normal cells multiply when the body needs them, and die when the body doesn't need them Cancer appears to occur when the growth of cells in the body is out of control and cells divide too quickly It can also occur when cells forget how to die There are many different kinds of cancers Cancer can develop in almost any organ or tissue, such as the lung, colon, breast, skin, bones, or nerve tissue

Oncology The study of cancer Oncologist – a physician who treats cancer patients Medical oncologist Hematologist/oncologist (Hem/Onc) Pediatric oncologist Surgical oncologist Radiation oncologist Gynecologist/oncologist (Gyn/Onc) Orthopedic oncologist

Healthy Cells Cells represent the smallest functional unit of our existence. They contain cytoplasm and a nucleus (i.e., metabolism, reproduction, day-to-day functions) Cells have a specialized function depending on their location in the body Cells grow, replicate, and repair body organs The genetic material (DNA/RNA) and your immune system regulate this process

Biology 101 DNA Mitosis Chromosomes

This neoplasmic mass often forms a clumping of cells known as a tumor

Cancer cells have the ability to spread to another location in the body either locally or distally through the lymph system or the blood stream

Cancer Terms: Tumor Groups Solid tumors Hematologic malignancy By system

Cancer Types Hematological malignancies Solid tumors Lymphomas Leukemias Multiple myeloma Myelodysplastic syndrome (MDS) Myeloproliferative neoplasms (MPNs) Solid tumors Carcinomas Sarcomas Melanoma Central nervous system (CNS) tumors

Cancer Nomenclature Most cancers are named for the organ or type of cell in which they start

Cancer Types: Definitions Carcinoma – cancer of skin or tissues that line or cover internal organs (epithelial cells) Sarcoma – cancer of bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue Melanoma – cancer of the melanocytes (cells that produce melanin, i.e., skin pigment) CNS cancers – cancers of the tissues of the brain and spinal cord Leukemia – cancer of the immature white blood cells of the bone marrow Lymphoma – cancer of mature white blood cells that originate in the lymph nodes Multiple myeloma – cancer of the plasma cells (antibody producing) in the bone marrow MPN – myeloproliferative neoplasm: group of diseases where bone marrow cells make excess cells and can eventually develop into leukemia MDS – myelodysplastic syndromes: group of diseases where the bone marrow do not produce enough cells and can eventually develop into leukemia

US Cancer Incidence Rates 2018 Cancerc US Incidence Rate Total Men Women All Sites 1,735,350 856,370 878,980 Breast Cancer 268,670 2550 266,120 Lung Cancer 234,030 121,680 112,350 Blood Cancer 174,250 98,000 76,250 Prostate Cancer 164,690 Colon Cancer 97,220 49,690 47,530 Melanoma 91,270 55,150 36,120 Lymphoma 83,180 46,570 36,610 Bladder Cancer 81,190 62,380 18,810 Kidney Cancer 65,340 42,680 22,660 Leukemia 60,300 35,030 25,270 Pancreas 55,440 29,200 26,240 Thyroid Cancer 53,990 13,090 40,900 Rectal cancer 42,220 25,920 17,110 Cancer US Incidence Rate Total Men Women Head and Neck Cancer 51,540 37,160 14,380 Liver Cancer 42,220 30,610 11,610 Multiple Myeloma 30,770 16,400 14,370 Stomach Cancer 26,240 16,520 9,720 Ovarian Cancer 22,240 Esophageal Cancer 17,290 13,480 3,810 Neuroendocrine Tumor ~15,000 Cervical Cancer 13,240 Sarcoma – Soft Tissues 13,040 7,370 5,670 Testicular Cancer 9310 9,310 Sarcoma – Bone and Cartilage 3,450 1,940 1,510

Diagnostic Procedures Biopsy Remove tissue (sample) from an area that may be cancer Fine needle aspiration (FNA) biopsy Can be ultrasound (US) or computed tomography (CT)-guided Core needle biopsy Excisional or incisional biopsy Endoscopy Pharyngoscopy, laryngoscopy, colonoscopy, cystoscopy, broncoscopy Endoscopic ultrasound Laparoscopy, thoracoscopy, mediastinoscopy Open surgical exploration (laparotomy or thoracotomy)

Pathology

Grade and Stage Grade refers to the pathology Stage refers to where the cancer is in your body and determines prognosis

Grading Low Grade Normal High Grade

Cancer Treatment Terms Cure Remission Response Complete response Partial response Minor/minimal response Progression NED (no evidence of disease)

Cancer Treatment Localized therapy Focuses on one area Surgery Radiation “directed therapy” Radio Frequency Ablation SIRS Spheres Chemoembolization Systemic therapy- Medications

Systemic Therapy Chemotherapy-kills cells that are growing and dividing doxorubicin (Adriamycin), Ifosfamide (Ifex), gemcitabine (Gemzar), docetaxel (Taxotere), trabectidin (Yondelis), eribulin (Halaven), cisplatin (Platinol), etoposide (VP-16) “Targeted” therapy- tries to stop the signal that tells the cell to grow and divide and so if they don’t get the signal to grow and divide then they die Immunotherapy – uses your immune system to fight the cancer. Current effective treatments tries to block the signal that comes from the cancer cell to shut down the immune system 2018

Cancer Treatment Terms Cure Remission Response Complete response Partial response Minor/minimal response Progression NED (no evidence of disease)

What is Sarcoma? Cancer that starts out from connective tissue cells Cells that make up bone, muscle, fat, cells that surround organs, cells that surround blood vessels, cells that surround nerves Unlike other cancers (breast, prostate, colon) sarcomas can children, young adults and older adults Divided into 2 categories: Bone- children>adults Soft tissue- adults>children Over 200 different subtypes Named after the what we believe is the original cell

List of Soft Tissue sarcoma subtypes

Bone Sarcomas Osteosarcoma Chondrosarcoma Ewing’s Sarcoma 2018

Cancer Terms Aggressive Hereditary Genetic Metastatic

Mass Lesion Nodule

How do we know if sarcoma is in your body? Blood test? No Imaging Xrays CT scan MRI PETscan

What does Hope mean? Sarcoma Alliance!!!! 2018