1. Cancer

2. Terminology Oncology (onc/o-, -ology) Neoplasia (neo-, -plasia)
Tumor (-oma)
Benign
Malignant
Metastasis
Cancer, Carcinogen (carcin/o-)

3. Additional Terminology
Differentiation
Poorly
Divergent (mixed tumors) = pleomorphic
Heterotrophic
Anaplasia
Dysplasia
Carcinoma in situ (CIS)
Mature and immature
Autonomy

4. Risk Factors for Cancer
Sex and reproductive history
Race and geographical location
Infection (virus, STDs)
Immunosuppression
Age
Family history
Nutrition
Environment (chemicals, drugs, toxins)
Lifestyle (exercise)
Occupation

5. Cancer Types: Male / Female

6. Risk Factors

8. Creation of Cancer
Hep B
Hep C
HPV
Herpes
HTLV
Epstein Barr

9. Telomeres and Immortality

10. Chromosomal Translocation Mutations
Berkett’s Lymphoma
CML

11. Epigenics Lifestyle and environment changes gene expression
Silencing of gene expression by hypermethylation

12. Genetic Changes that can occur
Activate oncogenes
Inactivate tumor suppressor genes
Inactivate genes that regulate apoptosis
Inactivate genes that regulate DNA repair
Inactivate genes that regulate cell cycle
Inactivate genes that regulate membrane proteins

13. Oncogenes and their functions
Growth Factors
Overexpression
Amplication
Point mutations
Signal Transduction
Translocations
Nuclear regulation
Amplification
Cyclins

14. p53: Tumor Suppressor Gene
p53 regulates cell cycle, DNA repair, and apoptosis

15. Rb: Tumor Suppressor Gene
Rb normally inhibits the cell cycle

16. Ras: Signal Transducer

17. APC: Adhesion protein
Loss of adhesion proteins allows for metastasis

18. Cancer Clusters

19. Environmental factors
Carcinogens
Air pollution
Ionizing radiation
UVR
Nutrition
Obesity
Alcohol

20. Immune System
Surveillance
Chronic Inflammation
ROS

21. NK Lymphocytes

22. Immunosupression

23. Benign v.s. Malignant

24. Anaplastic characteristics
Hyperchromic nuclei
1:1 cytoplasmic ratio
Variable size and shape of cell
Atypical and numerous spindle cells
Prominent nucleoli
Loss of polarity
Mitotic figures

25. Cancer cell structure

29. Cancer cells

30. Cytological Changes
metaplasia
carcinoma

31. Cell Cycle of Cancer

32. Cancer cell functions

33. Clinical Manifestations
Pain:
Pressure tumor and fluid
inflammatory mediators (IL-1, IL-6, TNF-a)
Fatigue: inflammatory mediators
Cachexia: change in appetite center
CBC changes
Anemia: chronic bleeding, cancer growth, Tx
Leukopenia: metastasis, Tx
Thrombocytopenia: metastasis, Tx
Infections: 2nd to Tx
Hormonal imbalance (hypercalcemia)

34. Tumor Staging Stage 1 Stage 2 Stage 3 Stage 4 Local
Well differentiated
Stage 2
Invasive
Moderate differentiation
Stage 3
L.N. spread
Poorly differentiated
Stage 4
Distant Sites
Undifferentiated

35. TNM classification T = primary tumor mass N = regional lymph node
M = metastasis
X = cannot be assessed
0 = not present
Number increase
Growth of mass
Spread to other L.N. T
TX, T0, Ti.s.
T1, T2, T3, T4 N
NX, N0,
N1, N2, N3 M
MX, M0,
M1, M2

36. Tumor Size

37. L.N.

38. Metastasis (MX, M0, M1, M2)

39. Cancer progression & spread
BV growth
Decrease in cell to cell adhesion
Cells through tissue planes
Body cavity, BV, or Lymphatic spread
Tissue selectivity

40. Primary and Secondary Sites
Liver and Lung are frequently involved secondary sites

41. Favorable Sites

42. Ovarian Cancer Metastasis Sites

43. Liver Mets

44. Lung Mets

45. Brain Met (secondary to Lung Cancer)

46. Tumor Treatment Chemotherapy Radiation Surgery Immune BM transplant
Gene Therapy

47. Chemotherapy Alkylating agents Nonspecific Cross link DNA Drugs
Cyclophoshamide
Cisplatin
Antimetabolites
Block DNA synthesis in S phase
Methotrextrate
Mercaptopurine
Antitumor AB
Block enzymes nonspecifically
Change cell membrane
Doxorubicin
Plant Alkaloids
Block DNA replication
Block enzymes in M phase
Vinblastine
Vincristine
Topoisomerase inhibitors
Prevents DNA reassembling in S
Doxorubricin

48. Secondary Effects of Chemotherapy

49. Radiation Therapy

50. BM Transplant

51. Immunotherapy

52. Antibodies to target Antigens

54. Nanotechnology

55. Cancer Screening Tests

56. Cancer Rapid Test Kits Alpha Fetoprotein (AFP)
Present only in fetus
+ = germ cell tumor
Carcinoma Embryonic Antigen (CEA)
Colorectal cancers
Colitis
Fecal Occult Blood (FOB)
Detect colon and rectal bleeding
Prostate Specific Antigen (PSA)
BPH, Infection, Inflammation
Prostate cancer

57. Detection: CTC chip

60. Cancer Susceptibility

61. Cancer Types Cells of Origin Epithelial Benign Adenoma Papilloma Polyp
Cystadenoma
Malignant
Adenosarcoma
Carcinoma
C.T.
Fibroma
Chondroma
Sarcomas
Germ Cells
Teratoma
Dermoid cyst

62. Tumor Sources

64. Germ Cell Tumors

65. Teratomas and Dermoid Cyst

66. Factors in Childhood Cancers
Mesoderm
Leukemias
Neuroblastoma
Wilms Tumor
Osteosarcoma
Ewing sarcoma
Rhabdomyosarcoma
Retinoblastoma
Cells of origin
Genetic
Congential
Prenatal Exposure

67. Etiology of Childhood Cancers

68. Childhood Cancers

69. ALL

70. Adult Cancers
Epithelial and Endothelial Tumors
Environmental Factors

71. Adult Cancers

72. Adult Cancer Death Rates

73. Cancer vs Heart Disease

74. Cancer Summary
Outcomes
Death
Palliative
Curative
5 years symptom free

75. Cancer Animations http://www.insidecancer.org/

76. Questions?