cancer dr. raid jastania. cancer in the us: 1.3 million new cancer cases in 2002 >500,000 death...
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Cancer
Dr. Raid Jastania
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
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
2007 Estimated US Cancer Cases2007 Estimated US Cancer Cases
*Excludes basal and squamous cell skin cancers. Source: American Cancer Society, 2007.
Men766,860
Women678,060
•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
Prostate 29%
Lung & bronchus 15%
Colon & rectum 10%
Urinary bladder 7%
Non-Hodgkin4% lymphoma
Melanoma of skin 4%
Kidney 4%
Leukemia 3%
Oral cavity 3%
Pancreas 2%
All Other Sites 19%
KSA-CIR 2003KSA-CIR 2003
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
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
Screening for Cancer
• Breast cancer screening
• Cervical cancer screening
• Colon cancer screening
• Others: lung, prostate
Clinical Features
• Mass
• Local effect: function, structure
• Generalized (systemic) effect
• Complications
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.
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
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
Clinical Features• Complications of tumors
– Ulceration– Bleeding– Infections– Infarction– obstruction
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
Diagnosis• Pathology
• Biochemical markers for tumors
• Molecular/Genetic studies:– Cytogenetics– PCR– FISH
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
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
Outcome of cancer
• Prognosis:– Usually estimated by 5-year survival– For statistical purposes– To plan management