Understanding Cancer

Heri Fadjari

Hematology – Medical Oncology DivisionDept. of Internal Medicine

Hasan Sadikin General HospitalBandung

What Is Cancer?

Different Kinds of Cancer

Lung

Breast (women)

Colon

BladderProstate (men)

Some common sarcomas:Fat

Bone

Muscle

Lymphomas:Lymph nodes

Leukemias:Bloodstream

Some common carcinomas:

Naming Cancers

Prefix Meaning

adeno- gland

chondro- cartilage

erythro- red blood cell

hemangio- blood vessels

hepato- liver

lipo- fat

lympho- lymphocyte

melano- pigment cell

myelo- bone marrow

myo- muscle

osteo- bone

Cancer Prefixes Point to Location

Loss of Normal Growth Control

Cancer cell division

Fourth orlater mutation

Third mutation

Second mutation

First mutation

Uncontrolled growth

Cell Suicide or Apoptosis

Cell damage—no repair

Normal cell division

Example of Normal Growth

Cell migration

Dermis

Dividing cells in basal layer

Dead cells shed from

outer surface

Epidermis

The Beginning of Cancerous Growth

Underlying tissue

Tumors (Neoplasms)

Underlying tissue

Invasion and Metastasis

3Cancer cells reinvade and grow at new location

1Cancer cells invade surrounding tissues and blood vessels

2Cancer cells are transported by the circulatory system to distant sites

Malignant versus Benign Tumors

Malignant (cancer) cells invade neighboring tissues, enter blood vessels, and metastasize to different sites

Time

Benign (not cancer) tumor cells grow only locally and cannot spread by invasion or metastasis

Why Cancer Is Potentially Dangerous

Melanoma cells travel through bloodstream

Melanoma(initial tumor)

Brain

Liver

Cancer Detection and Diagnosis

Early Cancer May Not Have Any Symptoms

Cervical Cancer Screening

Abnormal Pap smear

Normal Pap smear

Breast Cancer Screening

Prostate and Ovarian Cancer Screening

Colon Cancer Screening

Biopsy

Patient’stissue sample or

blood sample Genomic profile

Proteomic profile

Pathology

Microscopic Appearance of Cancer Cells

Hyperplasia

HyperplasiaNormal

Dysplasia

Hyperplasia Mild dysplasiaNormal

Carcinoma in Situ

Milddysplasia

Carcinoma in situ (severe dysplasia) Cancer

(invasive)

Normal Hyperplasia

Tumor Grading

General Relationship Between Tumor Grade and Prognosis

PatientSurvival

Rate

Years

High grade

Low grade

100%

1 2 3 4 5

Tumor Staging

Five-Year Survival Rates forPatients with Melanoma (by stage)

Stage at Time of Initial Diagnosis

100%

50%

I II III

What Causes Cancer?Some viruses or bacteria

HeredityDiet

Hormones

RadiationSome chemicals

Population-Based Studies

CANADA:Leukemia

Regions of Highest Incidence

BRAZIL:Cervicalcancer

U.S.:Coloncancer

AUSTRALIA:Skincancer

CHINA:Livercancer

U.K.:Lungcancer

JAPAN:Stomachcancer

Heredity? Behaviors? Other Factors?

100

50

50

Stomach Cancer(Number of new cases

per 100,000 people)

U.S.Japan Japanese familiesin U.S.

100

70

7

0

Colon Cancer(Number of new cases

per 100,000 people)

U.S.Japan Japanese familiesin U.S.

Tobacco Use and CancerSome Cancer-Causing Chemicals in Tobacco Smoke

Low-Strength Radiation

Annual Sunshine(UV radiation)

SkinCancer

Incidence

Most

Dallas

Pittsburgh

High

Detroit

LowLeast

High-Strength Radiation

Most

High

LowLeast

Leukemia Incidence

X-ray Dose(atomic radiation)

Lag Time

4000

3000

2000

1000

20-Year Lag Time Between Smoking and Lung Cancer

CigarettesSmoked

per Personper Year

Lung Cancer Deaths (per 100,000 people)

Year

Lung cancer (men)

Cigarette consumption (men)

1900 1920 1940 1960 1980

150

100

50

Viruses

Virus inserts and changes genes forcell growth

Cancer-linked virus

Examples of Human Cancer Viruses

Some Viruses Associated with Human Cancers

AIDS and Kaposi’s Sarcoma

Kaposi’ssarcoma

Withoutdisease

Depressedimmunesystem

HIV infection

KSHV infection

Bacteria and Stomach Cancer

H. pyloriPatient’s tissue sample

Heredity and Cancer

Inherited factor(s)

All Breast Cancer Patients

Other factor(s)

Heredity Can Affect Many Types of Cancer

Inherited Conditions That Increase Risk for Cancer

Genetic Testing

Cancer Risk and Aging

400

300

200

100

Cancer Risk and Aging

Number of Cancer Cases

(per 100,000 people)

Age of Person (in years)

Colon

Breast

0 20 40 60 80

Cancer Tends toCorrupt Surrounding Environment

Growth factors = proliferation

Blood vessel

Proteases

Cytokines

Matrix

Fibroblasts, adipocytes

Invasive

Cytokines, proteases = migration & invasion

Cancer Prevention

Cancer viruses or bacteria

Carcinogenic radiation

Carcinogenic chemicals

Avoid Tobacco

15x

10x

5x

Non-smokerCigarettes Smoked per Day

Lung Cancer Risk Increases with Cigarette Consumption

Lung Cancer

Risk

0 15 30

Protect Yourself From Excessive Sunlight

Limit Alcohol and Tobacco

40x

30x

20x

10x

Alcoholic Drinks Consumed per Day

Packs of Cigarettes Consumed per Day

Combination of Alcohol and Cigarettes Increases Risk for Cancer of the Esophagus

Risk Increase

AND

Diet: Limit Fats and Calories

0

Number of Cases (per 100,000

people)

Grams (per person per day)

Correlation Between Meat Consumption and Colon Cancer Rates in Different Countries

40

30

20

10

30020010080

Diet: Consume Fruits and Vegetables

Avoid Cancer Viruses

Noninfected women

HPV Infection Increases Risk for Cervical Cancer

Cervical Cancer

Risk

Low

High

Women infected with HPV

Industrial Pollution

1930

Incidence of Most Cancers

Year199019701950

Is There a Cancer "Epidemic"?

We would like to hear a questions from you . . .

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Breast implant

Breast augmentation

A good result, but note the excessive gap between breasts,

common in transsexual women.

Saline filled implants

Wrinkling 21% 20%Reoperation 13% 10%Loss of Nipple Sensation 10% 8%Capsular Contracture 9% 7%Implant Remova l8% 6%Asymmetry 7% 5%Intense Nipple Sensation 5% 4%Breast Pain 5% 4%Leakage/Deflation 3% 2%Implant Palpability 2% 2%Infection 2% 1%Breast Sagging 2% 1%Scarring Complications 2% 2%

Augmentation Complications

3-Year Risk RateBy PatientN=1264

By ImplantN=2528

Wrinkling Capsular contracture