1. Cancer 101 William E. Janssen, Ph.D. Director, Cell Therapies Facility Moffitt Cancer Center Cindy Eller VP for Development Roswell Park Cancer Institute Robert Wilkens Chief Development Officer Fox Chase Cancer Center

2. Cancer  Abnormal cells divide without control  Can invade “locally” or metastasize (spread) via the blood or lymph system  Benign tumors can grow larger, but do not spread  Not just one disease, but many different cancers – underlying tissue of origin

3. Some symptoms of cancer  Weight loss  Dyspnea or shortness of breath  Nausea  Anorexia, or lack of appetite  Fatigue  Abnormal bleeding, bruising  NO SYMPTOMS AT ALL

4. Screening for Cancer  Goal – inexpensive, highly sensitive, specific  Examples  Mammograms Very sensitive, not very specific –Risk of putting women through un- necessary biopsies  PSA test Sensitive, not at all specific –Risk of un-necessary biopsies  Total body MRI Sensitive, more specific, prohibitively expensive –Cost per true cancer detected could exceed $1,000,000  Other well known screening tests: colonoscopy, PAP, self exams Screeing Cost = Number of tests performed to detect ONE case of cancer X Cost of each test

5. Diagnosis of cancer  Biopsy  Incisional  Excisional  Needle (core or fine needle aspirate)  Need “tissue” to look at under the microscope to decide what it is : the pathology report. Is it cancer What kind is it how to treat  Staging  Use of radiology, scans, additional biopsies

6. Cancer types:  Based on which cell type is dividing abnormally  Carcinoma  Sarcoma  Central nervous system tumors  Melanoma  Leukemia  Lymphoma  Myeloma SOLID TUMORS HEMATOLOGIC MALIGNANCIES

7. Carcinoma  begins in skin or lining cell  Adenocarcinoma starts in the skin cells and the gland cells.  Adenocarcinoma of the breast, pancreas, thyroid, prostate prostate prostrate

8. Sarcoma begins in the cells muscle, bone, blood vessels, cartilage

9. Melanoma  Originates in the melanocytes, which make pigment. These cells can be found in the skin, the eyes.

10. Metastasis  mĕ-tăs′tă-sis: (v) movement of body cells (esp. cancer cells) from one part of the body to another; (n) new tumor growth resulting from movement of cancer cells  Plural is metastases  Cancer cell travels via blood or lymph tissue to a distant organ, but maintains characteristics of the primary tumor.  Cancers have tendencies to metastize to specific anatomic locations: prostate to bone, breast to liver, brain and lung, colon to liver

11. Leukemia begins in the cells found in the bone marrow (red blood cells, white blood cells, platelets)

12. Lymphoma and multiple myeloma  begins in the cells of the immune system that fight infection (B cells, T cells, plasma cells)  These cells also originate in the bone marrow

13. Bone marrow  Myelo is the prefix: myelosuppression, myelodysplastic  Bone marrow is aspirated, and biopsied in the hip bone  Bone marrow transplant: procedure in which the bone marrow cells are destroyed by radiation or chemotherapy, then replaced with banked bone marrow or blood “hematopoietic progenitor cells” collected from patient, or with cells from tissue type matched donor.

14. Stages of cancer  Stage 1: small and confined to the organ  Stage 2: beyond the organ +/- lymph nodes  Stage 3: locally spread, greater than 2.  Stage 4: spread to another organ

15. Treatment: local  Surgery  Radiation

16. Treatment: systemic  Principle of treatment to kill the fastest growing cells: earliest days of chemo and radiation.  Hormonal manipulation in cancers such as prostate and breast.  Little variation from center to center on the treatment of cancers. Protocols are standard throughout the country.  Clinical trials are well-monitored large scale efforts to determine the best treatment regimen

17. Complementary and alternative therapies  Acupuncture proven to be effective for chemotherapy induced nausea and vomiting  Current clinical trials for acupuncture for symptoms of colon cancer, for shark cartilage and small cell lung cancer, and for massage therapy for cancer-related fatigue.

18. BUT beware the “snake oil”  The need for hope in the face of a disease equated with death has spawned large numbers of profiteers offering “cures”  Examples: laetrile, radio-frequency radiation, macrobiotic diets, etc.  Medical tourism  The importance of scientifically based and designed clinical trials and informed consent

19. Research and Clinical Trials  Much done – much to do  A new dawn EVERY DAY

20. Research and Clinical Trials  Much has been done – much more still to be done  Many different approaches Genetic – modify or suppress cancer genes Molecular – modify or replace molecules that directly or indirectly are driven by cancer genes Immunologic – stimulate immune system to react to cancer cells as it does to bacteria, viruses

21. Research and Clinical Trials  Different Levels of Research  Basic – laboratory based – understanding how cancer works and/or what agents my change that and how  Translational – laboratory to bedside – using knowledge gained in basic research to produce and test new approaches in cancer patients  Research costs  Cost to train a new PhD researcher – ½ million dollars (new M.D. researcher is more)  Cost to set up a new laboratory – ¼ - ½ million dollars  Cost to treat one patient on a clinical trial – ten thousand dollars or more

22. The Goal: Remission  Decrease (partial remission) or disappearance (complete remission) of signs and symptoms of cancer  In some cases – stable disease (not growing, not shrinking) is a desireable end point

23. In all cases  Quality of Life  “Cures” can be worse than disease  Cancer “steals” from not only the afflicted patient, but from their entire family Downs, ups, downs, ups –Diagnosis –Treatment –treatment success –Relapse –reactions to treatment  This, too, is the subject of research and innovation

24. Palliative Care-usually inpatient  Treatment of symptoms from the time of diagnosis  Grief specialists in the hospital  Allowing the patient and family voice to be heard

25. Hospice Dame Cicely Saunders You matter because you are you. You matter to the last moment of your life, And we will do all we can, Not only to help you die peacefully, But also to live until you die.

26. Take home points  It is a new language: write down the words that you do not know and learn them for the next time.  Ignorance is an opportunity to learn.  Don’t be shy – ask questions – you may be surprised how many of the “experts”don’t know the answer either