1. Cancer Dr. Raid Jastania

2. Cancer In the US: 1.3 million new cancer cases in 2002 >500,000 death of cancer Increase cancer death in men due to lung cancer Drop cancer death in women due to drop in gastric, uterine and colon cancer

3. Cancer: Geographic and Environmental Factors In a study 65% of cancer is due to environmental factors 26-42 % due to inherited factors –Breast cancer common in the US –Stomach cancer common in Japan –Liver cancer common in Africa

4. 2007 Estimated US Cancer Cases *Excludes basal and squamous cell skin cancers. Source: American Cancer Society, 2007. Men 766,860 Women 678,060 26%Breast 15%Lung & bronchus 11%Colon & rectum 6%Uterine corpus 4%Non-Hodgkin lymphoma 4%Melanoma of skin 4% Thyroid 3%Ovary 3%Kidney 3%Leukemia 21%All Other Sites Prostate29% Lung & bronchus15% Colon & rectum10% Urinary bladder7% Non-Hodgkin4% lymphoma Melanoma of skin4% Kidney4% Leukemia 3% Oral cavity3% Pancreas2% All Other Sites19%

5. KSA-CIR 2003

13. Cancer Age: –Generally cancer increases with age –Most mortality 55-75 years –10% of death in children <15y Heredity: –Inherited cancer syndromes –Familial cancer –Autosomal recessive syndromes of defective DNA repair Carcinogens

14. Preneoplastic Disorders Persistent regeneration: –Ulcer, fistula: resulting in squamous cell carcinoma –Liver cirrhosis: resulting in hepatocellular carcinoma Hyperplasia and dysplasia: –Endometrial carcinoma –Adenoma of colon Metaplasia: –Barrett’s esophagus –Squamous metaplasia of bronchial epithelium Atrophy: –Chronic atrophic gastritis Inflammatory diseases –Ulcerative colitis

18. Screening for Cancer Breast cancer screening Cervical cancer screening Colon cancer screening Others: lung, prostate

19. Clinical Features Mass Local effect: function, structure Generalized (systemic) effect Complications

20. Clinical Features Local effect: –Location: small 1 cm pituitary adenoma is more serious than 10 cm leiomyoma of the uterus –Eg. GI cancer: causes abdominal pain, intestinal obstruction, change in bowel habits. –Lung cancer: causes cough, hemoptysis, chest pain –Pancreatic cancer: causes obstructive jaundice. –Prostate cancer: causes urine obstruction.

21. Clinical Features Local effect: –Functional effect: –Pituitary adenoma may secrete: ACTH, TSH, GH, LH, FSH –Adrenal cortical adenoma: steroid hormone, aldosterone –Thyroid cancer: usually non functional

22. Clinical Features Generalized effect: –Cancer cachexia: Loss of body mass (weight loss) Weakness, anorexia, anemia Mechanism: –Anorexia, taste change, CNS change, appetite change –Increase in the basal metabolic rate by mediators eg. TNF, IL-1 –Paraneoplastic Syndormes 10-15% of cancer Hypercalcemia due to PTH-related protein Cushing syndrome due to ACTH-like hormone Hypercoagulability and endocarditis

23. Clinical Features Complications of tumors –Ulceration –Bleeding –Infections –Infarction –obstruction

24. Diagnosis Pathology –Biopsy, excisional biopsy, incisional biopsy, core biopsy, tru-cut biopsy –Ultasound-guided biopsy, CT-guided biopsy –FNA –Cytology –Excision, resection: local, wide excision Biochemical markers for tumors –Hormones, enzymes, and other markers –PSA (prostatic specific antigen): Prostate cancer –CEA (carcino embryonic antigen): colon cancer –Uses: detection, determine response, follow up

25. Diagnosis Pathology Biochemical markers for tumors Molecular/Genetic studies: –Cytogenetics –PCR –FISH

26. Grading of Cancer Grading is estimation of tumor aggressiveness based on morphology –Nuclear grade (cytology) –Architectural grade Grades: different systems –2 grades: low, high grade –3 grades: well, moderately, poorly differentiated –4 grades: grade1, 2, 3, 4

30. Staging of Cancer Staging is determination of the extent of the spread of the tumor Include: tumor size, spread and metastasis Different systems for staging TNM staging: T: tumor, N: lymph node, M: metastasis AJC staging: American Joint Committee Use: for planning of management, and determining prognosis

31. Outcome of cancer Prognosis: –Usually estimated by 5-year survival –For statistical purposes –To plan management