ONCOLOGY

1
ONCOLOGY IMMUNE DISORDERS

• Introduction to Unit One
• Chapter 16 Text

2
Todays Class

• Immune system and cancer
• Cancer cell characteristics
• Tumor classification
• Phases of the cell cycle
• Grading and staging cancer
• Cancer statistics risk factors
• Warning signs of cancer

3
Class Objectives

• Compare the structure and function of the normal
  cell and the cancer cell.
• Discuss the connection between cancer and the
  immune system.
• Differentiate between benign and malignant
  tumors.
• Describe the classification of cancers according
  to tissue of origin, Grading and staging.
• Discuss the current trends of cancer in relation
  to incidence, prevalence and mortality of
  different types of cancer.
• Describe the warning signs of cancer.
• Discuss risk factors associated with cancer.
• Discuss the 7 steps to health.

4
Terms

• Oncology is the study of cancer
• The words cancer, neoplasm, malignant neoplasm
  and tumor are often used interchangeably, however
  tumor simply refers to a lump, mass, or swelling
• Definitions
• Neoplasm derived from Greek word neos (new)
  plasis (molding) is defined as an abnormal mass
  of tissue that serves no useful purpose and maybe
  harmful to host organism.
• Neoplasms can be either benign or malignant
• Cancer is used to refer to malignant neoplasms.
• Cancer is a disease of the cell in which the
  normal mechanisms of the control of growth and
  proliferation have been altered. It is invasive,
  spreading directly to surrounding tissue or to
  new sites in the body.
• Proliferation to grow or multiply by rapidly
  producing new tissue, parts, cells, or offspring

5
Just a Disease?

• Many people think diseases such as Cancer,
  Diabetes, or COPD are just diseases. They are
  much more than that. A disease is something that
  happens to your body. Cancer affects every aspect
  of your whole life. Its much more than a medical
  problem, it takes over your mind too. Its more
  than a simple adjustment of medication,nutrition,
  therapy or other treatment. It requires a
  complete retraining of your lifestyle. Nothing
  is spared, no part of your life is left unscathed
  (King, 1994).

6
Normal CellsThe Bodys Primary Defense
SystemProvide natural resistance innate
immunity

• Specific Function
• Ordered Rate of Proliferation
• Limited Mobility
• Controlled by DNA RNA
• Need oxygen, water nutrients
• Produce energy
• Eliminate waste

7
(No Transcript)
8
Cancer Cells Breast
Brain
9
(No Transcript)
10
Immune SystemCancer
11

• The Immune System Cancer
• What is the connection between cancer and the
  immune system?
• Cancer cells arise continually as a result of
  mutations.
• The immune system (T-cell lymphocytes,
  macrophages, antigens) recognize these cells as
  non-self and destroys them.
• Maybe good idea Immune System Review

12
Immune
Available evidence indicates, then, that the
immune system responds to cancer cells. Some
immunologists believe that it does so on a
regular basis. They theorize that the body
produces cancer cells fairly regularly, but
eliminates most of them before they can spread or
form a tumor. They believe that cancer has an
opportunity to take hold only when the immune
system performs below par. Although they are
making progress, scientists still do not
completely understand precisely how the immune
system works.
13
Even more convincing are clinical results showing
that stimulation of the immune system with
bacterial products or components of the immune
system itself can lead to tumor regression in
some patients. The link between cancer and the
immune system is also suggested by the fact that
people with an impaired immune system, such as
AIDS patients, are more likely to develop certain
cancers, including Kaposi's sarcoma, rectal
cancer and some types of lymphomas.
14
Attack
-Cancer Cell (Grey) -Immune Cells (Green) -Red
Blood Cell (Red)
15
CARCINOGENS

• Carcinogens are factors that are associated
• with cancer causation (agents that initiate or
  promote cellular transformation)
• Viruses
• Radiation
• Chemicals
• Genetic susceptibility (10 of all cancers have a
  strong genetic link)
• Host susceptibility also affected by gender,
  ethnicity, age, exercise and diet.

16
Viruses and Bacteria CARCINOGENS

• Viruses hard to determine, difficult to isolate,
  incorporate themselves into the genetic structure
  of cells and alter tem
• Epstein-Barr virus Burkitts lymphoma,
  nasopharyngeal cancers, non-Hodgkins and Hodgkins
• HSVII liver
• Hepatitis B liver cancer
• HPV 16, 18, 33 dysplasia and cervical cancer
• Human t-lymphotropic virus lymphocytic leukemia
  and lymphoma
• HIV virus Karposis sarcoma
• Bacteria associated with an increased incidence
  of gastric malignancy, perhaps secondary to
  inflammation and injury of gastric cells

17
Chemical Carcinogens
18
Cellular Dysfunctions in Cancer

• Defect in cellular proliferation
• a- defect in normal balance between cellular
  proliferation and cell death.
• b- loss of Contact inhibition doubling time
• Defect in cellular differentiation
• a- (defect in cancer ) normally an orderly
  process that progresses from immaturity to
  maturity.
• b- (defect in cancer) as normal cells
  differentiate they become capable of carrying out
  specific functions

19
Cellular Differentiation
20
Cancer

• Cancer has an opportunity to take hold only when
  the immune system performs below par (immature,
  old, or weak).
• Chronic illness, malnutrition, use of
  immunosuppressive drugs contribute to failure of
  the immune system
• Apoptosis cell suicide. In the process of
  carcinogenesis genetic damage to mutated cells
  may result in a mutated cell not
  self-destructing.

21
Normal Cellular Differentiation (specialization
maturity of cells)
differentiation
22
Cancer Cells

• Less dependent on oxygen (anaerobic)
• Variable shapes sizes
• Loose contact inhibition (dont respect
  boundaries)
• Are less adherent and more mobile
• Less differentiated (no specialization, no
  specific function) leads to loss of normal
  function
• Abnormal growth (rapid cell growth)

23
Broad Phases of the Cell Cycle

• Go
• G1
• S
• G2
• M

24
Cell Cycle

• G0 resting phase
• G1 cellular contents including RNA and protein
  are synthesized
• S synthesis phase each of the 46 chromosomes is
  duplicated by the cell
• G2 the cell double checks the duplicated
  chromosomes for error, making any needed repairs
• Mitosis cellular division and production of 2 new
  cells

25
Gene expression protein synthesis
Growth protein synthesis
26
G1 / G0

• G0 is the resting phase of the cell, cells are
  not in the phase of cellular division
• The G1 (Gap 1) phase is characterized by RNA and
  protein synthesis. This enables the cell to grow
  and to produce all the necessary proteins for DNA
  synthesis.
• Period of time cell is in G1 varies, depending on
  cell type and proliferation activity.

Why Important?
27
? Answer

• It primes the cell to enter the next phase S

28
S Phase

• Synthesis phase (S phase) the cell replicates its
  DNA...so it now has 2 complete sets of DNA.
• Lasts 6-8 hours
• Cell proliferation can be measured in a lab, i.e.
  patho report refers to of cells in S phase.
• Why would the cell want 2 complete sets of DNA?

29
Answer

• This allows the cell to divide into two daughter
  cells, each with a complete copy of DNA. But,
  before the cell can do this, it needs to enter
  the third phase of the cell cycle the G2 (Gap 2)
  phase.

30
G2

• During the G2 phase, the cell again undergoes
  growth and protein synthesis (it needs enough
  proteins for 2 cells!)...priming it to be able to
  divide.
• Once this is complete the cell finally enters the
  fourth and final phase of the cell cycle the M
  (Mitosis) phase.

31
M (Mitosis) Phase

• During the M phase, the cell splits apart (called
  cytokinesis) into two daughter cells. Now, the
  cycle has been completed!

32
What do the cells do now?

• Two choices
• 1) Start the cycle again by entering G1
• 2) Become quiescent by entering G0
• What problems arise with this cycle?

33
Answer

• Once the cell gets going there is not stopping
  it!
• Cancer cells rapidly divide and quickly spread

34
WHY All This Interest in Cell Division?

• One of the main clinical interests of cell cycle
  control is CANCER.
• Cancer can be very briefly described as
  uncontrolled cell growth and proliferation (as
  well as metastasis, or the invasiveness of
  cancerous cells into other tissues).

35
Chemotherapeutic Agents

• Drugs that are cell cycle specific and destroy
  cells actively reproducing by means of the cell
  cycle.
• Many agents are specific to certain phases of the
  cycle. Most affect cells in the S phase by
  interfering with DNA RNA synthesis Others are
  specific to the M phase ( prevent mitosis).

36
Classification of Cancer

• Tumors can be classifies according to
• Anatomic site
• Histological analysis (grading)
• Extent of disease (staging)

37
Neoplasm Classification Anatomic Site

• 1. According to Cell type
• 2. Tissue of origin
• NB Named according to origin of tissue they arise
  from generally with oma (means tumor)
• Epithelial (carcinomas)
• Connective (sarcoma)
• lymphatic (lymphoma)
• CNS (gliomas)
• Blood forming (leukemias)
• Carcinoma in situ (pre-invasive epithelial)
• 3. Whether Benign or Malignant
• 4. Degree of Differentiation

38
Comparison of Benign and Malignant Neoplasms

• BENIGN
• Encapsulated
• Noninvasive
• Highly Differentiated
• Mitosis Rare
• Slow Growth
• Little/ No Anaplasia
• No Metastasis
• Doesn't normally recur
• Not usually harmful
• Prognosis good

• MALIGNANT
• Nonencapsulated
• Invasive
• Poorly Differentiated
• Mitosis Common
• Rapid Growth
• Anaplastic (loss of function differentiation)
• Metastasis
• Can recur
• Always harmful
• Prognosis depends

39
(No Transcript)
40
Tumor Staging and Grading
41
Grading

• Identification of the type of tissue
• from which the tumor originated and the degree
  to which the tumor cells retain the functional
  and structural characteristics of the tissue or
  origin
• Thus evaluate cells appearance and degree of
  differentiation

42
CANCER

• Grading refers to the classification of tumor
  cells. The appearance of cells and the degree of
  differentiation are evaluated.
• Cancer cells progress from low grade and well
  differentiated to high grade and poorly
  differentiated.
• Metastasis implies spread, extension and
  penetration

43
Terminology Recognize these words!

• Structural changes
• hyperplasia (increase proliferation)
• metaplasia (degree of abnormality)
• dysplasia (abnormal)
• Anaplasia (malignant)
• neoplasm (new abnormal growth)

44
Grading

• Grade I cells differ slightly from normal (mild
  dysplasia) and are well differentiated.
• Grade II Cells are more abnormal (moderate
  dyplasia) and moderately differentiated.
• Grade III Cells are very abnormal (severe
  dysplasia) and poorly differentiated.
• Grade IV Cells are immature and primitive
  (anaplasia) and undifferentiated. (cell of origin
  is difficult to determine).

45
This illustration shows Dr Gleason's own
simplified drawing of the five Gleason grades of
prostate cancer. Grade 1 appears on the far left
and grade 5 on the far right. Adapted from
Gleason DF (1997).
46
Staging (TNM)

• Staging determines the size of the tumor and the
  existance of metastases.
• Refer to text regarding Staging of Cancer
• Tumor (T) TX, T0, Tis, T1-4
• Regional Lymph Nodes (N) NX, N0, N1-3
• Distant Metastasis (M) MX, M0, M1

47
TNM STAGING CLASSIFICATION
48

• Hint, Hint!!
• On a test or exam I will ask you to correctly
  interpret TNM or Grading.

49
Sample Question

• A client receives a report from a biopsy with
  results TO, NO and MO. This indicates
• A. no evidence of a primary tumor, lymph node
  involvement and metastasis.
• B. no primary tumor, but evidence of a degree of
  distant metastasis.
• C. a primary tumor and regional nodes
  involvement.
• D. carcinoma in situ.

50

• Answer to previous question is A

51
Leading Cause of Death in Canada

• Heart
• Cancer
• CVA
• COPD
• Pneumonia Flu
• Diabetes Mellitus
• Suicide

52
Highlights Canadian Cancer Statistics 2010

• An estimated 6,000 new cases of cancer and 2,700
  deaths from cancer are expected to occur in Nova
  Scotia in 2009. (Nationally, those figures are
  171,000 and 72,600 respectively.)
• In Nova Scotia, the most common cancers among men
  include prostate, lung and colorectal, and among
  women, breast, lung and colorectal.
• The five-year relative survival rate for all
  cancers combined is 62 per cent, an improvement
  of 4.5 per cent over the past 10 years.
• In Nova Scotia, the improvement in survival was
  greatest for non-Hodgkin lymphoma in men and lung
  cancer in women.
• About 40 per cent of Canadian women and 45 per
  cent of men will develop cancer during their
  lifetimes.
• About 24 per cent of women and 29 per cent of
  men, or approximately one out of four Canadians,
  is expected to die from cancer.

53
Highlights 2010 Cancer in Canadian adolescents
and young people (15 to 29 years of age)

• In the past five years in Nova Scotia, there were
  312 young people diagnosed with some form of
  cancer, which represents approximately 62 young
  people annually.
• Approximately 2,075 young people in Canada
  between 15 and 29 years of age are diagnosed each
  year with cancer with about 326 deaths per year
  in this age group.
• The five-year survival for this age group is 85
  per cent a five per cent increase from
  19921995.
• The overall cancer incidence rate has risen since
  1996. The death rate has declined since 1992.
• Lymphomas are one of the most commonly diagnosed
  types of cancer in both sexes, along with thyroid
  cancer in females and testicular cancer in males.
  
• Leukemia accounts for the most cancer deaths in
  each sex.

54
Canadian Cancer Society 2011

• Lung cancer remains by far the leading cause of
  death from cancer.
• Canada is one of the few nations in the world
  with a cancer registry system that allows cancer
  patterns to be monitored and compared across the
  entire population. Such comparisons can provide
  valuable information for research, knowledge
  exchange, planning and decision-making

55
Nova Scotia Stats

• estimated 5200 new cases all types cancers
• 2500 deaths are expected
• 720 men Dx Prostrate Ca
• 710 women Dx Breast Ca
• Lung Ca leading cause death both genders 870 new
  Dx
• 690 estimated to die lung Ca

56
WARNING SIGNSCAUTION

• C Change in bowel or bladder
• A A sore that does not heal
• U Unusual bleeding or discharge
• T Thickening or lump
• I Indigestion or difficulty swallowing
• O Obvious change in wart or mole
• N Nagging cough or hoarseness

57
Risk Reduction for Developing Cancerthe 7 Steps
to Health

• Step 1 Dont smoke
• Step 2 Eat healthy food
• Step 3 Be active
• Step 4 Be sensible in the sun
• Step 5 Follow cancer screening guidelines
• Step 6 Report changes in your health
• Step 7 Use caution with hazardous
  materials

58
(No Transcript)
59
Mesothelioma

• Large mesothelioma around the right lung (left
  side of image) on CT scan

60
Information

• www.cancer.ca

61

• Cancer Care Nova Scotia
• www.cancercare.ns.ca

62

• students should be able to
• Discuss the biological processes by which normal
  cells become cancerous
• Discuss current research that has consequences
  for people with cancer
• Understand medical treatment under development
• Ramifications of support persons nurses
  involved in their care