ONCOLOGY

“Having had cancer, one important thing to know is you're still the same person at the end. You're stripped down to near zero. But most people come out the other end feeling more like themselves than ever before”

-Kylie Minogue

Greek - Onkos (ονκος) = “Bulk, Mass /Tumour” - Ology = "study of"

Oncology = Medical subject dealing with the study and treatment of Cancer (Malignant Tumours)

• A physician who practices oncology is an Oncologist.

1 2013-14-v2

NEOPLASMS & TUMOURS

• NEOPLASM: from ancient Greek - neo (νεο) ="new" + plasma (πλάσμα) = "formation“/ "creation"

• Def: A mass of tissue that grows faster than normal in an uncoordinated manner. Resulting from an abnormal growth /division of cells (Neoplasia).

• TUMOR (US English)/ TUMOUR (UK English) literally means "swelling” (Latin) but is now primarily used to describe a Mass / Growth of Tissue

• This growth can be either Malignant or Benign.

• Similar in meaning to a Neoplasm.

Some Cancers like Lymphoma / Leukaemia do not manifest as tumours!!!

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Recall: CELLULAR REPRODUCTION

• A Normal Cell Cycle

• Each cell follows the ‘cell

cycle’ of Growth &

Reproduction

• Two types of Cellular

Reproduction: MITOSIS

(Somatic Cells) & MEIOSIS

(Gametes)

3

MITOSIS

• Used for growth & repair of certain Somatic cells.

• Each Daughter cell is identical to the Parent cell

• The rate of mitosis varies with each type of cell.

• Some cells can increase their reproduction rate on demand

• For example:

Epithelial cells replicate

very fast,

Skin Cells undergo continuous

Mitosis.

Nerve & Muscle Cells stop

reproducing soon after Birth

• DNA controls Mitosis

4

All cells are

DIFFERENTIATED & SPECIALIZED

Liver cells

Mucosa goblet cells

Some cells become so highly

specialized, they cannot undergo

Mitosis

Cells are Organized in a tissue & fulfill that tissue’s Purpose/ Function If cells become DISorganised and grow in an UNcontrolled manner, their Function (Purpose) gets lost.

5

• Contact Inhibition = Cessation of replication/ reproduction of cells

that contact one another.

• Cell Senescence / Aging can

alter the structure of the cells,

decrease function and even lead to cell death.

• Whilst the process of cell aging is not yet fully understood, a

number of hypotheses on ‘Telomere shortening’, with

every Reproductive Cycle, have been proposed.

• Together with ‘Contact Inhibition’, Cells have a

PROGRAMMED number of Reproductive Cycles.

CONTACT INHIBITION

& PRESET NUMBER of REPRODUCTIVE

CYCLES

6

Cancer Quotes

“Cancer cells are those

which have forgotten how

to die - and now they’re

killing me.”

Harold Pinter English playwright, screenwriter, actor,

theatre director, political activist and poet

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MUTATION

Def: Alteration in the DNA Sequence/

Number (Change in the Genetic

Information).

This can occur in the following 4 ways:

• Mutation is passed on the each Daughter cell.

• Causes for Mutations =

Chance (Spontaneous)

(Induced) Mutagenic agents e.g. X-rays, Ultra violet rays etc.

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• MUTAGEN (Latin: Origin of change) is an agent that changes the Genetic Information.

• Mutagens can be:

– Environmental Hazards, Chemicals, Radiation

– Viruses, Inflammation/ Defective Immunity

– Stress / Emotional Trauma

– Etc.

Mutations can alter :

1. The cell Function,

2. The cell Structure

3. Cause cells to Die

MUTAGEN

9

ÆTIOLOGY Cause of CANCER

• CARCINOGEN: Any agent which causes/ generates Cancers.

Chemical substances: e.g. Nitrosamines, Mold toxins,

Asbestos

Physical agents: X-rays, UV- rays

Biological carcinogens: Viruses

• CARCINOGENESIS: The process by which normal cells are transformed into cancer cells.

• In 1175 Sir Parcival Pott developed the hypothesis that

testicular and nasal cancer in chimney sweeps was

caused by Soot.

• Generally, causative factors are difficult to establish

because many cancers take many years to develop.

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STAGES of Carcinogenesis

1. INITIATATION: Initiating Factors ‘initiate’ first irreversible

changes to DNA i.e. Mutation. Can be related to short contact

2. PROMOTION: Promoters ‘promote’ further changes in DNA

+ increase rate of mitosis. Has to be continuous. Examples of promoters include Hormones & Chemicals

3. CANCER: Continued exposure: to carcinogens and

changes in DNA result in Cancer

Latent Period: The time between initiation and appearance of the cancer

It can be 10 – 20 years !!

11

RISK FACTORS & PREVENTION • UNAVOIDABLE:

– Genetic factors/ Family History

– Chronic Inflammation (IBD, Gastritis, GERD)

– Certain Viruses-HPV / HSV-8

– Some Environmental factors (exposure to mutagenic chemicals eg. DDT or Radiation)

• AVOIDABLE:

– Smoking

– Food Additives

– Poor Diet (Foods) e.g. excessive animal fats, red meat etc.

– Sexual Behavior

– Compromised Immunity- See next slide

– Heavy Drinking

– Excessive exposure to Sunlight

– Chronic STRESS!!! 12

HOST IMMUNITY

Long term Immunodeficiency can increase the risk for Cancer because:

1. Cytotoxic T-Lymphocytes, NK Cells and Macrophages are needed to destroy abnormal cells. (Think of cancers in HIV patients)

2. Humoral Immunity also plays a role in the protection against Cancer.

Dead cancer cell: The cell contents have

leaked out of the hole. Killer cell in front.

Small T-killer cell / Cytotoxic T- Cells

between 2 cancer cells, more cancer cells

below

Risk Factors & Prevention

13

RECALL:

TUMOURS/ NEOPLASMS

A mass of cells : Which no longer responds to normal growth control- Cells reproduce without need.

Which grows faster than normal,

Which grows in an uncoordinated manner

Whereby Atypical/ Abnormal cells eventually lose their function

– Excessive growth deprives other cells of nutrients.

– The growth may spread to other parts of the body

= METASTASIS

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BENIGN TUMOURS

+ Benign tumours usually consist of differentiated cells which appear similar to normal cells so may be functional.

- Reproduce at a higher rate than normal.

• A benign tumour is very often Encapsulated-NO Metastasis!

• It expands/ grows VERY SLOWLY & does not spread, Systemic Effects rarely seen.

• NOT life-threatening BUT Damage can result from compression of tissues (e.g. brain)

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MALIGNANT TUMOURS

• Malignant tumours are usually made of undifferentiated, non-functional cells with varied shapes and size and large nuclei

• The cells reproduce faster than normal

• Not-encapsulated- Infiltrate other tissues (Metastasise)

• Often Systemic, Can spread VERY QUICKLY to other organs.

• Life threatening due to tissue destruction & spread of tumour

• Oncology is the study of MALIGNANT tumours.

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GRADING of TUMOURS

GRADING = Measure of the Degree of cell

Differentiation / Abnormality

– Grade 1 = Tumour Cells still similar to original

cells = differentiated & specialized

– Grade 4 = Tumour Cells Undifferentiated /

many abnormal cells varying in

size and shape

NB: Not same as STAGING of Cancer / CLASSIFICATION

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EFFECTS of Malignant Tumours - CANCER

• Tumour = ‘Space- occupying’ Mass with no function. So damage results by virtue of the ‘space’ they occupy/ invade.

1. Tumours can compress nearby blood vessels leading to necrosis and inflammation of surrounding tissues.

2. In larger Tumours - Inner cells can be deprived of blood, leading to necrosis and inflammation WITHIN tumour.

3. Malignant cells do not adhere to each other. They break loose and can infiltrate other tissues- Metastasize

• ‘In situ’ = Pre-invasive state.

4. Tumour cells can secrete enzymes

which can break down other cells.

(Proteases)

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Benign or Malignant?

• Please read

introductory section in

your textbook on

benign and malignant

tumours

• Use this information to

fill in the table in your

handout and to

answer the questions

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LOCAL EFFECTS of Tumours

1. PAIN : Usually not an early

symptom of cancer. Can be

caused by pressure or

inflammation.

2. OBSTRUCTION: may occur

in tubes or ducts in the body.

3. ULCERATION or OEDEMA

can obstruct.

4. Tissue Necrosis &

Ulceration may produce

INFECTION around the

tumour (especially areas

where bacteria are naturally

present). 20

METASTASIS: SPREAD of

Malignant Tumours Metastasis: Greek: ‘Change of the

state’

• Malignant Tumours spread

via Blood or Lymph &

produce Secondary Tumours.

• Often first metastases appear

in regional Lymph Nodes.

• Venous & Lymphatic flow

usually endangers Lungs &

Liver most.

• Cells in the Secondary Tumour

are similar to the Parent

Tumour.

Secondary tumours in the liver

spread from the pancreas

Metastasis of Abdominal Tumours

http://www.drmulier.com/3%20en%20pat%20info%20hipec.html 21

SPREAD of Malignant Tumours

1. In situ, non invasive

2. Invasion:

Local spread by e.g. lytic enzymes

3. Seeding:

Spread of cancer cells in body fluids or along membranes

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SYSTEMIC EFFECTS

of Cancer

1. WEIGHT LOSS & CACHEXIA

• Cachexia = Loss of weight, muscle atrophy, fatigue, weakness and involuntary wasting away.

• Cancer patients can still have a strong appetite!!

2. ANAEMIA - An effect of:

• Malnutrition,

• Chronic Bleeding from an ulcerated tumour or

• Bone marrow Depression.

3. INFILTRATION & EROSION OF BLOOD

VESSELS

4. INFECTION- With Advancing Tumours the host

resistance breaks down and gives way to infections

e.g. Pneumonia

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5. PARA-NEOPLASTIC SYNDROMES

Group of Diseases /Symptoms that are the CONSEQUENCES of Cancer in the body, NOT due directly to local presence of cancer cells.

‘Additional Problems’ to the tumour

itself.

e.g. Lung cancers may produce ACTH leading to Cushing’s Syndrome (excess corticosteroids)

•Para-neoplastic Syndrome results in two major effects:

– Can confuse diagnosis

– Additional problem to cope with.

SYSTEMIC EFFECTS of Cancer

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EARLY WARNING SIGNS

of Cancer

1. Unusual bleeding or discharge

2. Anaemia and persistent fatigue

3. Change in bowel or bladder habits

4. A change in appearance of a wart or mole

5. A sore which does not heal

6. Unexplained weight loss

7. Persistent cough or hoarseness

8. A solid Lump

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MOST IMPORTANT SYMPTOMS

in Most Kinds of Cancer

• The FIRST STAGES of cancer usually show VERY FEW SYMPTOMS.

• LATER STAGES usually present with:

– Swollen Lymph Nodes

– Weight Loss

– Anaemia

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DIAGNOSTIC TESTS

Benefit of diagnostic tests:

1. Early detection

2. Monitoring

• However!!!! NO Diagnostic Test is 100% reliable

• False Positive or false Negative results are possible

1. BLOOD TESTS

2. TUMOUR MARKERS

3. IMAGING

4. BIOPSIES

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1. BLOOD TESTS

These include:

• Haemoglobin

• Erythrocytes

• Leukocytes (leukaemia)

Tx / Therapy can cause :

- Erythrocytopenia

- Leukopenia

- Thrombocytopenia

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2. TUMOUR MARKERS

– Proteins, enzymes, hormones etc. produced by some Malignant cells.

– Found in the Blood, Urine, Stool or Tissues

– They can be used for Screening / Diagnosis or Monitoring. e.g.

• CEA Carcinoembryonic Antigen

• PSA Prostate Specific Antigen

• HCG Human Chorionic

Gonadotropin

• Tumour-M2-PK

http://www.medindia.net/patients/patientinfo/tumor-markers-for-cancer-diagnosis-and-prognosis.htm 29

TUMOUR MARKER EXAMPLES • CEA – Carcinoembryonic Antigen

A glycoprotein involved in cell adhesion. Normally produced during foetal development but the production of CEA stops before Birth.

Tests for Metastatic Carcinoma, Malignancy

Cannot test for Location

May be elevated in Smokers & in some Non-neoplastic conditions like Ulcerative Colitis, Pancreatitis & Cirrhosis

• PSA – Prostate Specific Antigen

A protein produced by the cells of the Prostate Gland & present in small quantities in the Serum of healthy men.

May be elevated in the presence of Prostate Cancer & in other Prostate Disorders e.g. Benign Prostate Hyperplasia.

Tests for (1) Cancer Activity Level (2) Location (3) Recurrence /Residual Cancer in the prostate.

Cannot test if Malignant / Benign ( False ‘+ves’ ) 30

• HCG – Human Chorionic Gonadotropin

Males do not naturally produce β-hCG

Can test for cancer in some locations – pancreas, pituitary, placenta, testicles

Also elevated in pregnancy!!

• Tumour-M2-PK

Not an organ-specific tumour marker, so it mat be elevated in many tumour types.

Increased Stool Levels are being investigated as a method of screening for Colorectal Tumours and Plasma levels may be used for follow-up screenings in various other cancers.

TUMOUR MARKER EXAMPLES

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Most Common Tumour Markers

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Affected Organ Useful Tumour Marker

Breast CA 15-3, CEA, MCA

Ovaries CA 125, CA 72-4, CEA

Uterus CEA, - HCG

Cervix SCC, CEA, CA 125

Intestine CEA, CA 19-9

Liver AFP, CEA

Stomach CA 72-4, CEA, CA 19-9

Pancreas CA 19-9

Lungs, bronchi NSE, CEA, Cyfra 21-1

Testes - HCG, AFP, LDH

Prostate PSA, SP

Urinary bladder TPA

ENT tumours SCC, CEA

Thyroid Thyroglobulin, Calcitonin

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3. IMAGING

• Techniques include:

a. X-rays

b. MRI (magnetic resonance imaging)

c. CT: Computed Tomography (Tomography is

imaging by sections or sectioning)

d. RADIOISOTOPES

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4. BIOPSIES

• A small sample of

tissue is removed

and examined

histologically.

• Malignant cells have

an undifferentiated

cell structure.

(Falsification by

inflammation e.g. in

cervix swab) 34

STAGING of Cancer:

CLASSIFICATION

Recall: GRADING = Rating the Tumour according to the degree of abnormality of the cells. The Grade increases (from 1 – 4), with the degree of abnormality.

• STAGING = Classification of Malignant Tumours according to the extent of the disease at the time of diagnosis.

• May be repeated at further critical points.

Purpose: For PROGNOSIS & MONITORING

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STAGING of Cancer: CLASSIFICATION

• There are several types of staging methods.

• The Tumour, Node, Metastases (TNM) System

classifies cancer by:

• T: Size of primary Tumour

• N: Degree of involvement of lymph Nodes/ regional spread N0 = No lymph node involvement

N1- 4 = Increasing degrees of lymph node involvement

Nx = Lymph node involvement cannot be assessed

• M:Presence of Metastases M0 = No evidence of distant metastases

M1 = Evidence of distant metastases

http://www.cancer.gov/cancertopics/pdq/treatment/pancreatic/Patient/page2 36

http://www.oncologychannel.com/staging.shtml

Stage 0 - Cancer in situ (Tis, N0, M0) Stage I - Cancer limited to Tissue of

Origin, Evidence of Tumour Growth (T1, N0,M0)

Stage II - Limited Local spread of Cancerous cells Stage III - Extensive Local and Regional spread Stage IV - Distant Metastasis

e.g. Stage 1 = T1 – Tumour less than 2cm,

N0 - No lymph node involvement,

M0 – No metastasis.

STAGING of Cancer:

CLASSIFICATION

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TREATMENT

Basic Conventional Treatment:

• Combined or Single

‒ Surgery

‒ Chemotherapy

‒ Radiation

• Treatment can be

‒ CURATIVE

‒ PALLIATIVE = Medical Care/Treatment concentrating on reducing symptom severity or slowing disease progress rather than curing it. This is especially seen in the Late Stages where prevention of Obstruction / Ulceration/ Infection etc. becomes paramount.

Please see

the next 3

slides

38

Treatment: SURGERY Removal of the tumour, surrounding tissue and lymph

nodes.

http://www.cancerhelp.org.uk/type/breast-cancer/treatment/surgery/types-of-breast-cancer-surgery

PROSTATECTOMY The removal of the prostate gland.

ORCHIECTOMY A form of castration / removal of the testes

For more info on Prostate Cancer Treatment please visit:

http://www.prostate-cancer.com/index.cfm

For more info on Testicular Cancer Treatment please visit:

http://www.cancerhelp.org.uk/type/testicular-cancer/

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Treatment: RADIATION THERAPY

• Causes Mutations in targeted DNA, preventing mitosis or causing cell death.

• Affects those cells which divide most rapidly (both cancer cells and normal cell which divide regularly)

Adverse Effects:

– Bone marrow Depression (leading to Aplastic/ Hypoplastic Anaemia with Pancytopenia)

– Epithelial cell damage:

Inflamed skin, hair loss,

gut ulceration etc.

– Sterility

– General Fatigue

40

Treatment: CHEMOTHERAPY

• A combination of different drugs designed to influence rapidly dividing cells

• They interfere with protein synthesis and DNA replication at different points in the mitosis cycle

• Different drug combinations are chosen for different types of cancer

Adverse effects:

– Bone marrow Depression

– Vomiting

– Hair loss

– Organ Damage

41

The Chemotherapy Experience:

• “During chemo, you're more tired than you've ever been. It's like a cloud passing over the sun, and suddenly you're out. You don't know how you'll answer the door when your groceries are delivered. But you also find that you're stronger than you've ever been. You're clear. Your mortality is at optimal distance, not up so close that it obscures everything else, but close enough to give you depth perception. Previously, it has taken you weeks, months, or years to discover the meaning of an experience. Now it's instantaneous.”

Melissa Bank

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Other Drugs used in Cancer

Treatment

• HORMONES: – Glucocorticoids

– Oestrogens or Anti - androgen drugs for prostate cancer

– Tamoxifen to block oestrogen receptors

• BIOLOGIC RESPONSE MODIFIERS – Interferon etc.

• ANALGESICS (Pain Killers)

43

COMPLEMENTARY TREATMENT

NUTRITION – Maintaining nutrient levels

– Support through the side effects of treatment

– Immune support

MISTLETOE (Iscador Therapy) – Active ingredients, viscotoxins and lectins, can kill cells by

1. Damaging cellular membranes,

2. Stopping protein synthesis

3. Stimulating the immune system.

– See handout for further info

THYMUS EXTRACT – Orally administered calf thymus extracts have been found to

be quite effective in restoring and enhancing immune function

– Thymus extract has also been shown to normalize the ratio of T helper cells to suppressor cells

44

PROGNOSIS

• A CURE for cancer is generally defined as a 5 year survival without reoccurrence

• In some cases, several periods of REMISSION (the state of absence of disease activity / Period during which the symptoms of a disease lessen in severity or subside ) may occur before the cancer becomes Terminal

• The Death Rates vary for different types of Cancer and is very dependent on the Individuals Circumstances

45

Quiz

• Teams of 4

• Decide on a team name

• 30 Questions

• Possible 51 marks

• Write neatly so the

marking team can read

you answers!

46

TYPES of Cancer There are more than 200 Types of Cancer, each with different

causes, symptoms and treatments.

• CARCINOMAS - Cancers which form in EPITHELIAL CELLS/ TISSUES lining Skin, Mouth, Nose, Throat, Respiratory Tract, Genitourinary Tract, Gastrointestinal Tract. Can form Solid Tumours invading the Lung, Breast, Prostate, Skin, Stomach & Colon/Rectum.

• SARCOMAS – Cancers which develop in CONNECTIVE TISSUE- Bone, Cartilage, Muscles, Tendons etc.

• LEUKAEMIAS – Cancers which evolve in BLOOD & BONE MARROW. Abnormal white blood cells produced travel throughout the bloodstream damaging the spleen and other tissues. They do NOT form solid tumours.

47

http://www.cancerresearchuk.org/cancer-info/cancerstats/keyfacts/Allcancerscombined/

KEY FACTS

• Every 2 minutes someone in the UK is diagnosed with

Cancer.

• More than 1 in 3 people in the UK will develop some

form of Cancer during their lifetime.

• Cancer can develop at any age, but is most common in

older people. More than 3 out of 5 Cancers are

diagnosed in people aged 65 and over.

• Around 1% Cancers occur in children, teenagers and

young adults (up to age 24).

• Overall cancer incidence rates in Great Britain have

increased by more than a 1/3rd (22% in Males & by

42% in Females) since the mid-1970s.

48

http://www.cancerresearchuk.org/cancer-info/cancerstats/keyfacts/Allcancerscombined/

KEY FACTS

Most common forms include: Lung Cancer Bowel/ Colorectal Cancer Breast Cancer .

• There have been large increases in the incidence of many cancers

strongly linked to lifestyle choices, such

as Kidney, Liver, Malignant Melanoma, Oral & Uterine.

• Over the last decade the incidence rate of Stomach cancer has

decreased by more than a ¼ for both sexes. The male Lung cancer

incidence rate has decreased by almost a 1/6th .

• Worldwide there were estimated to be around 12.7 million new

cases of cancer in 2008, and over half of these were in developing

countries.

• Cancer is the number one fear for the British public, feared ahead of

debt, knife crime, Alzheimer’s disease and losing a job.

49

http://www.cancerresearchuk.org/cancer-info/cancerstats/keyfacts/Allcancerscombined/

KEY FACTS

• Cancer causes more than 1in 4 of all Deaths in the UK.

(> ¾ Cancer deaths occur in people aged 65 and over.)

• More than 1in 5 of all Cancer Deaths are from Lung

Cancer.

• Cancer Death rates in the UK have fallen by around 1/5th

over the last 30 years and by 10% over the last decade.

• Cancer survival rates in the UK have doubled in the last

40 years.

• ½ of people diagnosed with cancer now survive their

disease for at least 5 years.

• Almost 3/4 of Children are now cured of their disease,

compared with around a quarter in the late 1960s.

50

LUNG CANCER

• ~190,000 new cases in the EU per year

• ~180,000 deaths in the EU per year

• Peak incidence 60 -70 year old

• Men are 3x more likely to develop lung cancer

• Mortality is dropping in men and increasing in women due to changes in smoking habits

51

Lung Cancer: Signs & Symptoms

• Dry and persistent cough

• Little sputum, some blood possible

• Pain behind the sternum or in the back

• Recurrent Chest infections

• IN LATER STAGES: Bloody or Raspberry

jelly- like sputum, Hoarseness.

52

COLO-RECTAL CANCER

• ~210,000 new cases in the EU per year

• ~110,000 deaths

• Greatest incidence: 50+ age group

• More common in developed countries and rare in Africa and Asia

• Incidence has increased in Japan due to Westernized Diets

53

Colo-Rectal Cancer: Risk Factors

• Suspected DIETARY PROMOTERS:

– High meat consumption

– High fat consumption

– High calorific intake

– High alcohol intake

– Low fiber diet

• Suspected HEREDITARY COMPONENT in some cancers (Family History)

• Increases incidence in CHRONIC IBD-(Crohn’s, Ulcerative Colitis)

54

Colo-Rectal Cancer:

General Signs & Symptoms

1. CHANGE in bowel habit:

Alternating Diarrhoea and

Constipation

2. Anal bleeding

3. Blood in stool (occult blood

test)

4. Mucus on stool

5. Stool mixed with flatulence

6. Anaemia (chronic blood loss)

7. Colicky abdominal pain

(obstruction)

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• Generally BENIGN

but larger Polyps

may turn Cancerous

• Often no symptoms

but can cause

Constipation or

Diarrhoea or Blood

in the Stool

POLYPS

56

BREAST CANCER

• 210,000 new cases in the EU per year

• 76,000 deaths

• Most COMMON cancer in WOMEN

• Peak age 50-70 yrs

• 0.5 – 1% of cases in men

• Much more common in Western cultures than in the Far East, particularly Japan

• Approx. 5% of cases genetic origin

57

Breast Cancer:

Signs & Symptoms

http://medicalyx.com/category/breast-cancer/ 58

1. Painless, Unilateral Lump, especially in

upper outer quadrant

Lump is often Stuck to the skin

2. Enlargement of Axillary Lymph Nodes

3. Skin Changes i.e.

– Dimpling/ Puckering of the breast

skin

– Redness/ Heat/ Rash (Nipple/ Skin)

4. Change in Size/ Shape of one/ both

Breasts/ Nipples = Asymmetry of

breasts

5. Retracted (Pulled-in)/ deviated Nipple.

6. Discharge/ Bleeding from the nipple

7. Pain in either of your breasts or armpits

NOT related to your period

Before breast reconstruction

Breast Reconstruction

Lumpectomy and

immediate breast

reconstruction

59

OVARIAN CANCER

• 6,000 cases in the UK

• 4,000 deaths per year

• Mostly in women over 40, who have never given birth and are of higher socio-economic class

• Maybe Genetic link

Seeding

60

Ovarian Cancer:

Signs & Symptoms – Mostly no symptoms for a

long time

– Vague abdominal

discomfort

– Pelvic pain

– Abdominal swelling

Later:

– Changes in bowel and

urinary habits

– General symptoms

61

CERVICAL CANCER

• Most common cancer in YOUNG WOMEN, but thanks

to an effective nationwide screening programme, fewer

women than ever are dying of cervical cancer.

• 20% of all cancers in women

• 4,500 cases per year

• A number of factors increase

the Risk of developing Cervical cancer: 1. The presence of Human Papilloma Virus infection 2. Sexual behaviour (sex at an early age and many

partners) 3. Smoking

62

Cervical Cancer:

Signs & Symptoms

Often there are NO SYMPTOMS when abnormal cells have developed or in the early stages of the disease. Women are encouraged to attend regular cervical screening.

• When symptoms do occur

( in later stages) they include:

–Bleeding after sexual

intercourse

–Bleeding between

menstrual periods

–An unusual vaginal

discharge

63

LIVER CANCER

• Mostly following Liver Cirrhosis

Symptoms:

– Portal vein hypertension

– Pain radiating into the back

– Jaundice

– Fever

• Liver cancer is more common as Secondary cancer.

• 1/3 of malignant tumours form Liver Metastases

Caputs’ medusa

(Distended, engorged umbilical veins)

64

STOMACH CANCER

• 75,000 new cases in the EU per year

• 60,000 deaths per year

• Peak occurrence 50-70 yrs

• Male to female ratio 1½ : 1

• Higher incidence in the Far East

• Less often / Low in Blood group O

• More often in Blood group A

65

Stomach Cancer:

Predisposing Factors

– Chronic Gastritis

– LOW stomach acid

– Nitrosamines

(cosmetics, rubber,

beer, meat, tobacco

byproducts)

66

Stomach Cancer:

General Signs & Symptoms

– Pain in the stomach area

– Nausea, low appetite, vomiting (blood)

– Disgust for meat

Later

– Anorexia

– Weight loss

67

OESOPHAGEAL CANCER

• 25,000 new cases in the EU per year

• 23,000 deaths per year

• Male to female ratio 3:1

• Peak incidence 60 -70 yrs

• Strong link to:

1. Tobacco smoking

2. Alcohol consumption

3. Chronic Acid Reflux

68

Oesophageal Cancer:

Signs & Symptoms

– Problems Swallowing

– Loss of appetite

– Regurgitation of food

– Non-sour reflux

– Retro-sternal

discomfort

– Weight loss

– Severe Coughing after

swallowing

69

PANCREATIC CANCER

• 38,000 new cases per

year

• 38,000 deaths per

year

• Peak occurrence:

50-80 years

http://www.maldivesdivetravel.com/maldives-blog/pancreatic-cancer-and-

scuba-diving.html 70

Pancreatic Cancer: Risk factors

– Tobacco smoking

– High fat and meat

consumption

– High coffee/alcohol

consumption

– Exposure to DDT

– Chronic Pancreatitis

Poor PROGNOSIS:

10-20% reach post 5 year survival stage

Operation on pancreatic cancer

71

Pancreatic Cancer:

Signs & Symptoms

• Lack of early symptoms

• Later:

– Jaundice / icterus

– Dark urine

– Pale stools

– Skin itching

– Pain radiating to the back

– Fatty stools

– Diabetes mellitus

http://www.nigerianbestforum.com/generaltopics/pancreatic-cancer-its-symptoms-and-causes/ 72

PROSTATE CANCER

• Ranks 3rd for deaths from Cancer in the UK

(1st lung cancer, 2nd colon cancer)

• 14,000 per annum, incidence rising

• Rare below 45 years, more common in 70+

• More common in:

– Married men

– Men with high

numbers of

sexual partners

– With STDs

http://kisbyto.blogspot.co.uk/2013/03/prostate-cancer-month.html

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Prostate Cancer:

Signs & Symptoms

• NO early symptoms

• Screening by rectal examination

• PSA Test

Later: Like BPH

• Increased urinating frequency

• Nocturia

• Dribbling

Back pain can indicate Bone Metastases

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Metastases from Prostate Cancer

75

BLADDER CANCER

• 12,500 cases in

the UK per year

• 2x more

common in men

• mostly in 70-80

year age group

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Bladder Cancer: Causes

– Chemical

Carcinogens

– Smoking

– Chronic irritation of bladder lining

Cigarette smoking is the leading cause of bladder cancer !!

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Bladder Cancer: General Signs & Symptoms

– Painless Haematuria

– Frequency, urgency and

Dysuria

• Cough with expectoration of

blood with/without bone pain

can indicate Bone Metastases

In a novel experiment, a team of scientists and dog trainers

have put this traditional canine behaviour to good use –

sniffing human urine to detect bladder cancer sufferers. 24 September 2004. New Scientist.com news service

Dogs trained to sniff out

bladder cancer

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TESTICULAR CANCER

• Most common

cancer in YOUNG

MEN aged 15-35yrs

79

Testicular Cancer:

Sgs, Sxs & Prevention

Hard, Painless usually Unilateral mass

Prevention:

Regular, monthly self examination

•See your notes of the reproductive system

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SKIN CANCER

Itching & / Bleeding Non-healing Ulceration 81

SKIN CANCER

• Visible, easily detected

and develops slowly =

Good prognosis

• Highest rate of

re-occurrence

• Usually arise on head,

neck or back

• Most common in fair

skinned people aged

40+

• Cases are on the

increase

82

Basal Cell Carcinoma

• Raised, smooth, pearly bump on the sun-exposed skin of the head,

neck or shoulders.

• Sometimes small blood vessels can be seen within the tumour.

• Crusting and Bleeding in the centre of the tumour frequently

develops.

• It is often mistaken for a sore that does not heal.

This form of Skin Cancer is the least deadly and with proper treatment

can be completely eliminated, often without scarring.

83

Squamous Cell

Carcinoma

• A red, scaling, thickened patch on sun-exposed skin.

• Some are firm hard nodules and dome shaped like

keratoacanthomas.

• Ulceration and bleeding may occur.

When SCC is not treated, it may develop into a large mass.

SCC is the 2nd most common skin cancer.

It is dangerous, but not nearly as dangerous as a Melanoma.

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Melanoma

Most melanomas are brown to black looking lesions.

Unfortunately, a few melanomas are pink, red or fleshy in

colour; these are called Amelanotic melanomas.

Warning signs that might indicate a malignant melanoma

include CHANGE in: Size, Shape, Colour or Elevation of a

mole.

Other signs are the appearance of a new mole during

adulthood or new Pain, Itching, Ulceration or Bleeding. 85

SKIN METASTASES

• Skin

metastases 2

years after

breast

amputation

86

LIPOMA – Non Cancerous

• A lipoma is a BENIGN & slow growing tumour composed of adipose tissue.

• It is the most common form of soft- tissue tumour.

• Lipomas are soft to the touch, usually movable, generally painless & under 1cm diameter (but can enlarge to sizes greater than 6cm.)

• Very rarely, malignant transformation has occurred.

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LEUKAEMIA

• 9th most common cancer in MEN in the UK

• 12th most common cancer in women in the UK.

• More than 6,000 new cases in the UK per year.

• Most common form of CHILDHOOD cancer, BUT is 3x more common in Adults.

88

LEUKAEMIA

• The term ‘Leukaemia’ is used to describe a number of

cancers of the Blood Cells (Bone Marrow).

• There are two main categories of Leukaemia - ACUTE

and CHRONIC:

• Acute Leukaemia: Develops quickly with a rapid in

immature WBC production, accumulating & disrupting the

function of many tissues and organs.

Can cause FATAL COMPLICATIONS in a very short period of

time.

• Chronic Leukaemia: Develops more slowly. Presents with slightly abnormal cells that do not function optimally.

May remain Asymptomatic for years.

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LEUKAEMIA • Additionally, Acute & Chronic Leukaemia may

be classified according to the type of white

blood cell affected.

• This split divides Leukaemia into:

1. Myeloid (Myelogenous) Leukaemia - Affects bone marrow cells that go on to form Granulocytes (BEN), RBCs & Platelets.

2. Lymphoid (Lymphoblastic /Lymphocytic) Leukaemia - Affects bone marrow cells that go on to form Lymphocytes. Mostly B- Lymphocytes.

• N.B. production of abnormal, WBCs leads to production of

healthy WBCs , RBCs & Platelets

(esp. in Myeloid Leukaemia). • Leukaemia may thus be categorised as:

Acute / Chronic Myeloid Leukaemia

Acute / Chronic Lymphoid Leukaemia

90

Leukaemia: Signs & Symptoms

• Often NO symptoms or may be VAGUE

and NON-SPECIFIC (similar to a flu-like

illness).

Common Sgs & Sxs include:

• Excessive bruising or bleeding

• Generalised weakness and fatigue

• Anaemia

• Frequent infections and fever

• Involuntary Weight loss

• Pain in the bones and joints

• Breathlessness

• Enlarged lymph glands, liver +/ spleen

• Abdominal discomfort http://www.galen.co.uk/?page=oncology 91

Cancer Quotes

“It has been an extraordinary experience and, in many ways, extremely positive”

- Marianne Faithful

“My cancer scare changed my life. I'm grateful for every new, healthy day I have. It has helped me prioritize my life”

- Olivia Newton-John

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