1. Oncology The study of cancer

2. What is cancer? Any malignant growth or tumor caused by abnormal and uncontrolled cell division May be a tumor but it doesn’t have to be Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (spreading)

3. Is cancer increasing worldwide? 3.2 million new cancer cases diagnosed since 2004 53% new cancers in men 47% new cancers in women 1.7 million deaths each year

4. How is cancer managed? 1.Primary prevention 2.Screening 3.Treatment 4.Palliative care

5. Treatment Types 1.Surgery (local treatment) 2.Radiotherapy (local treatment) 3.Medical oncology (systemic treatment) –Chemotherapy –Hormonal therapy –Targeted therapy

6. Treatment is multidisciplinary! Surgery Radiotherapy Medical oncology

7. What is palliative care? The care of patients with a terminal illness, not with the intent of trying to cure them, but to relieve their symptoms. Palliative care consists of relief of pain and nausea, as well as psychological, social and spiritual support services.

8. Basic scientific principles: Cancer biology Tumor immunology Etiology (cause) Clinical research Pathology (disease process) Therapy Prevention

9. Medical Management With the new advances in molecular biology and a lot of new drugs on the market, treating cancer has become very complex.

10. Treatments Treatments are usually COMBINED but the side effects from these treatments can be combined and exacerbated. Basic knowledge of internal medicine is essential to prevent, recognize and treat the toxicities.

11. Why are cancer cases increasing ? Aging population Older patients have many concomitant chronic conditions –Cardiovascular –Diabetes –Impaired kidney and liver function

13. Clinical trials Enormous load of new drugs coming from basic research Must be offered to patients in clinical trials Clinical trials occur with placebos Most new cancer drugs are “targeted therapy” type (drugs directed to certain profile of targets in a tumor)

14. Patient Attitudes Cancer is typically feared/dreaded because: 1. may be present in advanced stage but asymptomatic 2. may occur after many years of remission 3. a healthy life style doesn’t ensure that one won’t get cancer.

15. Patient Attitudes Cancer can affect patient at all Levels of functioning: 1. intellectual 2. self-concept – breadwinner may become dependent 3. patient may become more dependent on others 4. changes in body image

16. Patient Attitudes Cancer impacts the entire family: 1. period of diagnosis and initial treatment 2. if cancer is considered “curable” – survivorship ensues 3. watchful/waiting for recurrence 4. if metastatic (spread), chronicity of disease continues

17. Cancer Risk-Factors Bladder: white, asbestos or coal exposure Colon: family, aging, sedentary, diet Gastric: non-white, family, A type blood, ulcers Leukemia: child, old age, Downs syndrome, family, benzene exposure, radiologist, chemist, miner Lung: smoker, family, environmental pollution, radon exposure

18. Cancer Risk-Factors Skin: sun damage, family, fair hair/skin, age Breast: family (especially familial prior to menopause), early or late menopause, birth of first child after age 30, Jewish, white, single, age Prostate: black, age, venereal disease, sexual activity.

20. Radiation therapy

21. Care of patients receiving RADIATION Side effects include: erythemia (redness) at radiation site fatigue nausea anorexia depression

22. Chemotherapy

23. Care of patients receiving CHEMOTHERAPY Side effects include: extensive hair loss anemia constipation anorexia ulcers amenorrhea sterility neuropathy