CANCER 101

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CANCER 101

• What causes cancer and how is it treated?
  

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What Is Cancer?
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Cancer is a disease of cells. Cancer arises
from normal cells that have been altered in some
way.
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Determining Factors
Genetic heritage Immune function Exposure to
carcinogens
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Determining Factors
Genetic heritage Immune function Exposure to
carcinogens
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All cancer is genetic. What does this mean?
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What Causes Cancer?

• Mutations in genes and DNA

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What Causes Cancer?

• Mutations in genes and DNA
• Genes are small pieces of DNA
• DNA is a big book of recipes
• Chromosomes are the chapters in the recipe book
• Genes are the individual recipes

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What Causes Cancer?

• Mutations in genes and DNA
• Genes are small pieces of DNA that are found in
  chromosomes
• Genes make proteins which are needed for all of
  the bodys functions

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Humans have 23 pairs of chromosomestotal is 46.
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2 major groups of genes are involved in cancer
formation

• Oncogenes
• Stimulate cell growth
• Tumor Suppressor Genes
• Restrain cell growth

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When proto-oncogenes become altered (mutated),
they are called oncogenes. Cells then grow
uncontrollably.
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Tumor Suppressor Genes
Genes that block the growth of cells or result in
the death of cells.
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Loss of Normal Growth Control
Normal cell division
Cell Suicide or Apoptosis
Cell damageno repair
Cancer cell division
Fourth orlater mutation
Third mutation
Second mutation
First mutation
Uncontrolled growth
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Carcinogenesis

• The process by which normal cells transform into
  malignant ones
• A multi-step process

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Cancer Tends to Involve Multiple Mutations
Malignant cells invade neighboring tissues, enter
blood vessels, and metastasize to different sites
Benign tumor cells grow only locally and cannot
spread by invasion or metastasis
Time
More mutations, more genetic instability,
metastatic disease
Proto-oncogenes mutate to oncogenes
Mutations inactivate DNA repair genes
Cells proliferate
Mutation inactivates suppressor gene
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What Causes Cancer?

• Mutations in genes and DNA resulting from
• Repeated injuries to cells
• Repair process mistakes

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DNA Repair Genes
Genes correct any errors. Mutations in DNA
repair genes leads to accumulations of DNA
errors.
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Determining Factors
Genetic heritage Immune function Exposure to
carcinogens
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Who Gets Cancer?

• Children lt 2 years of age
• People gt 60 years of age
• People with AIDS
• People on long-term
• immunosuppressive drugs

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All cancer is genetic.

• Hereditary
• 5 to 10 of all cancers
• Born with a known gene mutation
• Family history
• Gene mutation unknown
• Acquired (sporadic)
• Age

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Determining Factors
Genetic heritage Immune function Exposure to
carcinogens
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What Causes Cancer?
Heredity Diet Hormones
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Known Carcinogens

• Viruses
• HTLV-1, HPV, HBV, EBV
• Chemicals
• Tobacco, alcohol, industrial agents
• Physical factors
• UV rays, radiation, asbestos
• Other factors
• Estrogens, diet, passive smoking

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Population-Based Studies
Regions of Highest Incidence
U.K. Lung cancer
JAPAN Stomach cancer
CANADA Leukemia
U.S.Colon cancer
CHINA Liver cancer
BRAZIL Cervical cancer
AUSTRALIA Skin cancer
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RISK FACTORS FOR BREAST CANCER

• Inherited gene mutations or family history
• BRCA1 or BRCA2
• First-degree relatives with breast cancer
• Environmental
• Estrogen
• Personal
• Female gender
• Age over 65
• Prior breast cancer

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RISK FACTORS FOR LUNG CANCER

• Environmental
• Cigarette smoking, greatest risk (87)
• Second-hand smoke
• Exposure to asbestos, other carcinogens

American Cancer Society, Cancer Facts and
Figures, 2004 DeVita et al., Cancer Principles
Practice of Oncology, 2001 Yarbro et al.,
Cancer Nursing, 2000
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RISK FACTORS FOR COLON CANCER

• Personal
• Age over 50
• Medical conditions (e.g. ulcerative colitis)
• Inherited genetic mutations or family history
• FAP (Familial adenomatous polyposis)
• First-degree relative with colorectal cancer
• Lifestyle
• High fat/low fiber diet
• Alcohol intake
• Smoking

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Why Cancer Is Potentially Dangerous
Brain
Melanoma cells travel through bloodstream
Liver
Melanoma(initial tumor)
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Classifications

• Solid tumors
• Carcinomas
• Sarcomas
• Liquid tumors
• Hematological malignancies
• Lymphomas
• Hodgkin
• Non-Hodgkin lymphoma
• Leukemias

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Different Kinds of Cancer
Leukemias Bloodstream
Some common carcinomas
Lung Breast (women) Colon Bladder Prost
ate (men)
Lymphomas Lymph nodes
Some common sarcomas Fat Bone Muscle
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Naming Cancers
Cancer Prefixes Point to Location
Prefix Meaning adeno- gland chondro- cartilage ery
thro- red blood cell hemangio- blood
vessels hepato- liver lipo- fat lympho- lymphocyte
melano- pigment cell myelo- bone
marrow myo- muscle osteo- bone
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Staging

• Determines the extent of cancer
• TNM system for solid tumors
• Ann Arbor staging for lymphomas

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Current Cancer Treatment Approaches

• 4 main goals of cancer treatment
• Disease prevention
• Cure
• Control of disease
• Palliation

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Combinations of Treatments

• Multimodality
• Conventional treatments
• Newer treatments

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Strategies of Cancer Treatment

• Neoadjuvant
• Given before the main treatment
• Goal is to shrink the tumor
• Adjuvant
• Given after the primary treatment
• Goal is to increase the chance of long-term
  disease-free survival
• Palliative
• Given for cancer that has spread
• Goal is disease control

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Types of Cancer Treatments

• Surgery
• Radiation
• Chemotherapy
• Hormone therapy
• Targeted therapy

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Cancer Treatment Options
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Surgery

• Preventive (or prophylactic)
• Removes tissue at high risk of developing cancer
• Surgery to facilitate diagnosis
• Biopsies remove suspicious tissue for diagnostic
  analysis
• Common biopsy techniques
• Needle aspiration
• Core biopsy
• Incisional
• Excisional
• Stereotactic

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Radiation

• Ionizing radiation is used for cancer treatment
• Kills cells by direct and indirect damage to DNA

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Radiation Types of radiation

• Local
• External beam
• Linear accelerator
• Xrays (intermediate to deep treatment)
• Electron beam (shallow treatment)
• Cobalt-60 emission of gamma rays
• Brachytherapy (sealed source)
• Systemic
• Unsealed sources

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Radiation

• Newer methods and improved technologies
• Intensity-modulated radiation therapy (IMRT)
• Stereotactic radiation therapy (e.g. Gamma Knife)
• Proton therapy

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Chemotherapy

• Chemotherapy is a common treatment for a variety
  of cancers

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Chemotherapy

• Cancer cells are more sensitive to chemotherapy
  than healthy cells because they divide more
  frequently.

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Why do symptoms occur?

• Chemotherapy affects rapidly dividing cells
• Cancer cells are rapidly dividing
• Other cells in our bodies are also rapidly
  dividing
• Blood cells in the bone marrow
• Hair follicles
• Cells in the digestive tract
• Reproductive system

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Side Effects of Chemotherapy

• Bone marrow suppression
• Anemia, infection, bleeding
• GI toxicities
• Nausea, vomiting, diarrhea, constipation, mouth
  sores
• Skin effects
• Hand-food syndrome, rash, hair loss
• Organ toxicity
• Cardiotoxicity, pulmonary toxicity,
  neurotoxicity, kidneys
• Long-term effects
• Infertility, secondary leukemia

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How is chemotherapy given?

• Orally
• Intravenously
• Subcutaneously or intramuscularly
• Into a body cavity
• Into an artery
• Into the spinal fluid

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How does chemotherapy work?

• Chemotherapy uses powerful drugs to stop the
  growth of cancer cells.

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Hormone Therapy

• Certain tumors need estrogen and testosterone to
  grow
• Breast
• Prostate
• Hormone therapy targets these cancers in 2 ways
• Reduces hormone levels
• Interferes with the bodys ability to use the
  hormones

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Targeted Therapy

• Interferes with specific molecules required for
  tumor development and growth
• A more recent approach to cancer treatment
• More specific to tumors

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Targeted Therapy Pathways
Bell et al, 2005 Klein et al, 2005 Guertin et
al, 2005
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Types of Targeted Therapies

• Monoclonal antibodies
• Tyrosine kinase inhibitors

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Summary

• Cancer development is a complex, multistep
  process of genetic mutation
• The goals of cancer therapy are prevention, cure,
  control or palliation
• Oncology advancements have revealed therapies
  that can be tailored to patients needs