1. Oncology: Study of Cancer

2. When Normal Cells go “Rogue”
Cancer is a disease by unrestrained and excessive multiplication of body cells
Or in simpler terms
Cancer is normal cells that have begun to divide at a rapid and non organized rate

3. Rogue cell division

4. Put another way Cancer is a group of disease in which cells are:
aggressive (grow and divide without respect for normal cellular limits)
invasive (invade and destroy adjacent tissues)
sometimes metastatic (spread to other location in the body
Nearly all cancers are caused by abnormalities in the genetic material of the transformed cell

5. Cancer cells compared to Normal

6. Breast Cancer cells

7. Probability of Developing or Dying from cancer
Increase with age
43% of new cancer cases and 60% of deaths will occur among those who are at least 70 years of age
40% of women and 45% of men will develop cancer in their life time
1 in 4 Canadians will die of cancer
62% of those diagnosed will survive for 5 years
(depends on the type of cancer)

8. Definitions: sorry there are a few
Anaplasia:
Loss of differentiation of cells
Return to a more primitive cell type
Lack of orderly arrangement
Tumors
Masses or growths that arise from normal tissue
Neoplasm
New growth, benign or malignant tumors

9. Sorry still on Definitions
Remissions
Lessening of Symptoms of a disease
Carcinogens: agents that cause cancer
Chemicals, drugs, radiation, viruses
Mutations
Change in the DNA of a cell
May be caused by exposure to a carcinogen or spontaneously

10. And two more Differentiation Prognosis Specialization of cells
Expected outcome of disease
Mortality
Morbidity

11. Now we can move into our discussion on Cancer

12. Defining a Tumor Malignant Benign
Tending to become worse and results in death
Benign
Non cancerous still can cause death depending on location ie in the brain, heart, kidney

14. Defining a Tumor Encapsulated (Good) Infiltrative (Bad)
Surrounded by a capsule
Infiltrative (Bad)
Extending beyond normal tissue boundaries

15. Invasive (Very Bad)
Having the ability to enter and destroy surrounding tissue

16. Metastases (Worst)
Spread of malignant tumor to a secondary site

17. Causes of Cancer: not well understood
Environmental
Heredity: Retinoblastoma
Viruses: HPV, HIV
Spontaneous

18. Retinoblastoma

19. Environmental Chemicals & Drugs Radiation Hydrocarbons (Smoke)
Insecticides
Industrial cleaners
Insulations
Hormones
Steroids
Mercury
Radiation
UVA,UVB
Skin cancer
X-rays
Damage to cell DNA
Nuclear fusion
Chernobyl in the Ukraine
Hiroshima
Result: Leukemia

20. Viruses HIV AIDs Human Papilloma Virus Epstein-Barr virus
Kaposi Sarcoma
Human Papilloma Virus
Four strains 6,11,16,18 that cause cervical cancer
Epstein-Barr virus
Causes Burkitt’s lymphoma

21. Classification of Cancers
Types of tumors
Malignant
Benign
Types of Cancers
Carcinomas
Sarcomas
Mixed-tissue tumors

22. Benign Grows slowly Encapsulated Differentiated cells
Fibrous capsule
Differentiated cells
Resemble normal mature tissue
Do not metastasis
Do not form secondary tumors

23. Malignant: usually grows rapidly
Infiltrative & Invasive
May be initially encapsulated
Anaplasia
Resemble primitive or embryonic cells
Not capable of mature cellular function
Lack orderly arrangement
Metastasis
Travel through bloodstream or lymphatic system
Create secondary tumors

24. Carcinomas vs Sarcomas
Carcinomas: Solid tumors
Sarcomas
Epithelial tissue
Lining of external & internal body surfaces
Skin
Glands
Digestive, urinary
Reproductive
50% of tumors in women are carcinomas
Supportive & connective tissue
Bone
Adipose
Muscle
Cartilage
Bone marrow
Lymphatic/immune
Rare form of cancer
Is increasing

25. Mixed Tissue Tumors
Can contain both epithelial and supportive and connective tissue
Kidney
Ovaries
Testes

26. Factors to determine Prognosis
Location of tumor
Microscopic appearance
Grading
Degree of differentiation
Extent of spread
Metastases
Number of secondary tumors
Location of secondary tumors

27. Microscopic Grading: Four grades
Grade I
well differentiated
closely resembles original tissue cells
Grade II
less differentiated
still can determine parent cells

28. Grading:III-IV Grade III Grade IV
Even less differentiated
Grade IV
Anaplasia
Difficult to determine tumor tissue site of origin
Example is used in Papanicolaou tests (Pap smears)

29. Degree of Spread Staging 0-5
Stage I
very early
cells localized to few cell layers
Stage 2
spread to deeper cell layers
? Infiltrate to surrounding tissue

30. Stage 3-4 Stage 3 Stage 4 infiltrated surrounding tissue
contained in the primary cancer site
Stage 4
invasive to near by sites

31. Stage 5-recurrences Stage 5 Recurrent In Canada stage 5
metastases to other organs of the body via the bloodstream or lymphatic system
Recurrent
cancer cells have reappeared after treatment
In Canada stage 5

32. Lymphatic Involvement
Spread to lymph nodes is indicated by the number of nodes involved N1 infiltrate one lymph node N3 infiltrate three lymph nodes

33. Metastases M1: one site of metastasis M2: two sites of metastasis
M3: three sites of metastasis
Mx: more than four sites

34. Tumor size can also by staged
T1 small tumor present T2 larger tumor T3 progressive increase in tumor size Tx tumor so invasive unable to determine size

35. Cancer Coding
Grade 3 Stage 4 N3 Tx M3 What does this mean? What is the prognosis? Grade I Stage 2 N0 TI M0

36. Treatment
Surgery
Radiation
Chemotherapy
Biological Therapy

37. Surgery Encapsulated with limited infiltration and limited metastases
Example: stomach, breast, uterus, prostrate
Sometimes done to decrease the size of the tumor for palliative reasons
Example: decrease pain from tumor pressing on nerve

38. Radiation Therapy
Maximal dose of ionizing radiation to the tumor cells
Minimal dose to the surrounding cells
Targeted at non-differentiated cells
What is the difficulty?
Where would this be difficult to do?
Solution can be pellets. Say what?

39. Chemotherapy Drugs target rapidly dividing cells (non differentiated)
Block replication to decrease growth
Given by Intravenous (IV) and oral route
Often used with other treatments
Used in T1-4N1-4M1-3
Carcinomas, Sarcomas & Mixed-Tissue Tumors
Which body system has cells that normal divide rapidly? (hint SE of chemo)

40. Biological Agents Using immune cells to target and fight tumor cells
Researchers are focusing on NKC and T-cells
Hormones: Estrogen is used to treat prostate cancer
Creating vaccinations ie Gardasil to boost the immune response
Utilizing the MHC on phage cells to create antibodies against cancer cells