1. WHAT IS CANCER AND CANCER TREATMENT? A Layperson’s Guide

2. PURPOSE OF TALK Understanding helps you feel in control Explains how treatments work Understand medical system Make better decisions Get better care

3. OVERVIEW Normal cell growth How cancer cells are made Properties of cancer cells The immune system Making the diagnosis of cancer Staging tests Surgery, radiation and chemotherapy Talking to your doctor and nurse

4. WHAT IS CANCER? Cancer occurs when some cells in your body grow in an uncontrolled way Many different types of cancer The cancer is usually named after the part of the body from which it came eg. Breast carcinoma from the breast Lymphoma from the lymph system Each person’s cancer is different

5. CELLS IN THE BODY The human body is made of trillions of cells Each cell has its own job Skin cells protect our surface

6. NORMAL CELLS IN YOUR BODY Red blood cells deliver oxygen Platelets help the blood clot White blood cells fight infection Many others Most are quiet - not dividing Communicate with other cells

7. THE NORMAL CELL The nucleus is the control centre The DNA are the instructions for the cell

9. HOW CELLS ARE REPLACED Many cells die from normal wear and tear Dying cells are replaced when cells divide

10. Cell division

11. WHEN CELLS DIVIDE One parent makes two daughter cells The new cells are exactly the same The same control centre The same book of instructions Normal controlled growth –Number of cells made = number that die

12. Normal cell division

13. Controlled cell growth Sometimes cells need to grow fast eg. With injury or growth Always under control Always stop growing fast afterwards

14. Cut in skin

18. THE INSTRUCTIONS IN THE CELL Each cell has the control centre (nucleus) Instructions manual is made of words and sentences (DNA)

19. How cancer cells are made Cancer cell is a normal cell with many mistakes Three ways the mistakes are created: 1) Born with mistakes in all cells - genetic 2) Accident when cell divides - mutation 3) Substance causing cancer - Carcinogen –Toxins, sunlight, viruses, fatty diet

20. PROBLEMS WITH THE CELL’S INSTRUCTIONS If the instructions read: “STOP dividing after coming in contact with more cells” is changed to “KEEP dividing after coming in contact with more cells” The cell won’t stop growing!

21. PROBLEMS WITH THE CELL’S INSTRUCTIONS If the instructions read: “ Divide if hormone X is on the receptor” is changed to “Divide if hormone X,Yor Z is on the receptor” The cells will keep on dividing

22. Why don’t we see more cancers The repair system is constantly cleaning The mistake is in cell that is not dividing An unimportant word or sentence is hit The mistake is permanent after cell division –cells that divide often are at risk

23. WHAT IS CANCER Normal cell that has begun to grow fast and in an uncontrolled way Requires dozens of changes to the cell Cancer cells will grow into normal tissue Can get into lymph and blood system to grow colonies at a distance (metastasis)

24. Definitions “Precancerous” has many but not all changes “Benign” means just grows in place

25. EACH PERSON’S CANCER IS DIFFERENT Each cancer has different mistakes and a different personality You cannot compare yourself to others You can always do better than expected!

26. HOW A TUMOR GROWS A tumor is a collection of cancer cells A tumor starts as one cancer cell 1 cell then 2 then 4 then 8 ….. Tumor growth if more cells are made than die Tumor doubles in a few months Tumor - 1 cm in size has a billion cells

27. CREATION OF A TUMOR

28. Cancer Cells

29. HOW CANCERS CAUSE PROBLEMS Problem at the primary site, lymph nodes, and elsewhere in the body (metastasis) Lump can cause pain, bleed, block a tube, slow down an organ like kidney Affect whole body - fatigue OUR TREATMENTS KILL CANCER CELLS TO STOP THESE PROBLEMS

30. CANCER CELLS ARE FRAGILE A few more changes will incapacitate the cell Only 1 in 1000 cancer cells can reproduce A tumour will outstrip its own blood supply Shrink the tumor by  growth,  destruction Our immune system can kill cancer cells

31. WHITE BLOOD CELL

32. Antibodies to cancer cells

33. A POSITIVE ATTITUDE ENHANCES IMMUNE FUNCTION !

34. UNDERSTANDING THE MEDICAL SYSTEM

35. MAKING A DIAGNOSIS Discovering the cancer by a) symptoms - tests b) no symptoms = screening eg. mammogram, blood test Early detection - better

36. MAKING THE DIAGNOSIS Biopsy - take a piece of tumor Look under microscope Proves its cancer Type of cancer Starts a process

38. STAGING THE CANCER Has the cancer spread Primary site, nodes, distant Tells about treatment and prognosis (likely outcome)

39. STAGING THE CANCER Blood tests Imaging - X-rays CAT Scans Bone scan MRI Grade - microscope Receptors on cancer cell Genetics

40. Cross section of a bone with one cancer cell

41. DOCTOR’S QUESTIONS What is the stage? Can the patient be cured? What is the best treatment? How fit is the patient? What does the patient want?

42. THE CONSULTATION Referral to Oncologist Consultation - first visit Surgeon Medical Oncologist - chemo Radiation Oncologist

43. SURGERY Usually if tumor in one area Operation - tumor removed Effect on normal tissue There is a chance of cancer left behind –already spread but not visible

44. CHEMOTHERAPY Whole body treatment Injection into veins or pills Kills cancer cells Given in courses over weeks Affects fast-growing cells

45. CHEMO SIDE EFFECTS The type of chemo differs Each person is different Your doctor monitors Specific side effects for each

46. CHEMO SIDE EFFECTS Whole body side-effects Fatigue / tiredness Nausea and vomiting Hair loss Low blood cells Sore mouth and throat

47. RADIATION TREATMENT Radiotherapy, cobalt Ionizing x-rays - kills cells External and internal Side effects in the area only Spare as much normal tissue

48. RADIATION TREATMENT

49. HOW TREATMENT WORKS

50. Damage the cancer cells Mistakes in instructions Cells can’t divide Cancer cells die

51. HORMONE TREATMENT Blocks hormones so cells die Taken as pill or injection Sometimes increase cure Side effects – hot flushes…

52. CAN I BE CURED? Cured = never comes back Adjuvant = extra treatment in case there are cells left over In remission – cancer cells are in the body –Aim for many years of great quality Treatment if benefits > risks

53. EXAMPLE CASE 50 yr old lady - mammogram Biopsy shows cancer Lump / lymph nodes removed Staging tests all clear 20% chance cells elsewhere

54. CASE (Continued) Should she have chemo ?? Will improve survival by 5% 12 weeks and side effects ?? Radiation kills cells in breast

55. OTHER SERVICES Nurse can be invaluable Referrals to any service Social worker can co-ordinate Nutrition Psychology Pastoral care Cancer society- Network

56. CHOICES You can decide: a) Use doctor as consultant b) Tell doctor to decide Understand - pros and cons Get more information or a second opinion

57. CONSENT FORM Permission for treatment Consent - a discussion Outlines options Lists common and severe side effects Chance for questions

58. CLINICAL TRIALS Trial = measure scientifically Research - find better way Cleared by ethics board Closer follow-up You don’t have to agree

59. HOW TO GET MOST FROM YOUR DOCTOR Before visit: Symptoms and medications Ask family or a friend along Write down questions

60. HOW TO GET MOST FROM YOUR DOCTOR At the doctor’s office: Be honest and open Feeling overwhelmed - say so Ask important question first Take notes - clarify

61. HOW TO GET MOST FROM YOUR DOCTOR After visit: Keep a journal What you learned What to do if side effects KNOW WHO TO CALL

62. PROBLEMS WITH DOCTOR Bring family or friend Call to clarify or for appt. Ask for second opinion Doctor should serve you

63. SUMMARY Understand the system to get good care Treatment is individualized Know yourself QUESTIONS

66. SUMMARY Cancer occurs when a normal cell starts to grow in an uncontrolled way Treatment can kill off the cancer cells Learn more to make good choices Time for questions

67. NEGOTIATING THE MEDICAL SYSTEM Educate yourself - ask questions Identify one Oncologist as the contact Be clear about what’s important to you If poor communications - bring family or a friend or ask for a second opinion