Cancer - Queen's Universityresearch.cs.queensu.ca/home/cisc330/Lectures/Cancer/Cancer-Intro.pdf ·...

Copyright © Gabor Fichtinger, 2009Laboratory for Percutaneous Surgery – The Perk Lab

Cancer

A Superficial Introduction

Gabor Fichtinger, Queen’s University


Cancer – some definitionsMedical term: malignant neoplasmClass of diseases in which a group of cells display:

• uncontrolled growth (division beyond the normal limits)

• invasion (intrusion on and destruction of adjacent tissues)

• sometimes metastasis (spread to other locations in the body via lymph or blood)

• The above differentiate cancer from non-malignant (benign) growth• Most cancers are solid and form a tumor. • Some, like leukemia, do not. • This course deals mostly solid cancer i.e. tumor.


Cancer – known causes

• Mutation: chemical carcinogens• tobacco smoke, some artificial

sweeteners, some food preservatives…• Mutation: ionizing radiation• Viral or bacterial infection• Hormonal imbalances• Immune system dysfunction• Heredity• Other causes


Cancers – in this course

• Prostate• Breast• Gynecological• Liver• Bone / spine• Head and Neck• Brain• Kidney• Leukemia• Lymph nodes


Cancer – known causes

• Mutation: chemical carcinogens• tobacco smoke, some artificial

sweeteners, some food preservatives…• Mutation: ionizing radiation• Viral or bacterial infection• Hormonal imbalances• Immune system dysfunction• Heredity• Other causes


Cancer – diagnosis• Non-invasive:

• Blood serum• Palpation (i.e. feel a lump under your finger)• Imaging (CT, MRI, Ultrasound, PET, SPECT)

• Tissue biopsy• Pathologist – the doctor who examines it• Histology or histopathology – the process• “Pattern classification” problem

• Diagnosis• Staging of the disease• Treatment options…


Cancer imaging – CTLiver cancer

Kidney cancer Prostate cancer


Cancer imaging – CT

Glioblastomamultiform

Metastatic brain lesions Metastatic spine cancer


Cancer imaging – MRI

prostate breast


Cancer imaging – contrast imaging

Issues:• Toxicity• Uptake• Washout


Cancer imaging – ultrasoundProstate - TransrectalUltrasound (TRUS)

Liver - Transcutaneous Ultrasound


Cancer imaging – SPECT


Biopsy - the tools - ‘cutting’


Biopsy - the tools - ‘suction’Aspiration for serial semen analyses


Biopsy - ‘drilling & suction’Bone marrow biopsy needle

Bone biopsy needle


Biopsy - the tissue (examples)

Primary liver cancer in laparoscopy camera and pathology

Liver mets from testicular (left) and breast cancer (right)


Cancer – Diagnosisspecificity and sensitivity

IDEAL?yes

?BADno

yesno

sensitivity

specificity

Sensitivity = can I see it if it is there?Specificity = can I recognize it if I see it?


Cancer – treatment• Chemotherapy (realm of medical oncology)• Surgery

• Resection• Growth inhibition

•Thermal Ablation•Cryotherapy (freezing)•Injection•Embolization

• Radiation therapy• External beam (EBRT)• Implanted sources (brachytherapy)


Cancer – MIS tools - RFA


Cancer – MIS tools - cryo


Cancer – MIS tools - microwave


Cancer – MIS tools – HIFU needle

P o w e r L e a d W i r e s

C o o l i n g F l o w

T e m p e r a t u r e S e n s o r s

C o n t r o l l e d U l t r a s o u n d

O u t p u t U l t r a s o u n d T r a n s d u c e r s ( T u b u l a r )

O u t e r S u p p o r t S h a f t

I n s e r t i o n T i p

a )

3 Needles + Catheter-cooling

3 ACOUSTTiC™ Needles

coagulation boundary

3 Needles + Catheter

ACOUSTTiC™

Acousticx® Acoustic Medsystems, Inc

0

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1718202122

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Cancer – HDR brachytherapy

Cancer Statistics 2007A Presentation From the American Cancer Society

©2007, American Cancer Society, Inc.


US Mortality, 2004

Source: US Mortality Public Use Data Tape 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

1. Heart Diseases 652,486 27.2

2. Cancer 553,888 23.1

3. Cerebrovascular diseases 150,074 6.3

4. Chronic lower respiratory diseases 121,987 5.1

5. Accidents (Unintentional injuries) 112,012 4.7

6. Diabetes mellitus 73,138 3.1

7. Alzheimer disease 65,965 2.8

8. Influenza & pneumonia 59,664 2.5

9. Nephritis 42,480 1.8

10. Septicemia 33,373 1.4

Rank Cause of DeathNo. of deaths

% of all deaths


Change in the US Death Rates* by Cause, 1950 & 2004

* Age-adjusted to 2000 US standard population.Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised.2004 Mortality Data: US Mortality Public Use Data Tape, 2004, NCHS, Centers for Disease Control and Prevention, 2006

19.8

180.7

48.1

586.8

193.9

50.0

185.8217.0

0

100

200

300

400

500

600

HeartDiseases

CerebrovascularDiseases

Pneumonia/Influenza

Cancer

19502004

Rate Per 100,000


2007 Estimated US Cancer Deaths*

ONS=Other nervous system.Source: American Cancer Society, 2007.

Men289,550

Women270,100

26% Lung & bronchus

15% Breast

10% Colon & rectum

6% Pancreas

6% Ovary

4% Leukemia

3% Non-Hodgkinlymphoma

3% Uterine corpus

2% Brain/ONS

2% Liver & intrahepaticbile duct

23% All other sites

Lung & bronchus 31%

Prostate 9%

Colon & rectum 9%

Pancreas 6%

Leukemia 4%

Liver & intrahepatic 4%bile duct

Esophagus 4%

Urinary bladder 3%

Non-Hodgkin 3% lymphoma

Kidney 3%

All other sites 24%


Trends in the Number of Cancer Deaths Among Men and Women, US, 1930-2004

0

50,000

100,000

150,000

200,000

250,000

300,000

1930 1940 1950 1960 1970 1980 1990 2000

Women

Men

Num

ber o

f Can

cer D

eath

s

265,000

270,000

275,000

280,000

285,000

290,000

2000 2001 2002 2003 2004

Men

Women

Source: US Mortality Public Use Data Tape, 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.


Cancer Death Rates*, All Sites Combined, All Races, US, 1975-2003

*Age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Mortality - All COD, Public-Use With State, Total U.S. (1969-2003), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2006. Underlying mortality data provided by NCHS (www.cdc.gov/nchs).

0

50

100

150

200

250

300

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

Men

Both Sexes

Rate Per 100,000

Women

Cancer Death Rates*, for Men, US,1930-2003

*Age-adjusted to the 2000 US standard population.Source: US Mortality Public Use Data Tapes 1960-2003, US Mortality Volumes 1930-1959,National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

0

20

40

60

80

10019

30

1935

1940

1945

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

Lung & bronchus

Colon & rectum

Stomach

Rate Per 100,000

Prostate

Pancreas

LiverLeukemia

Cancer Death Rates*, for Women, US,1930-2003

*Age-adjusted to the 2000 US standard population.Source: US Mortality Public Use Data Tapes 1960-2003, US Mortality Volumes 1930-1959,National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

0

20

40

60

80

10019

30

1935

1940

1945

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

Lung & bronchus

Colon & rectum

Uterus

Stomach

Breast

Ovary

Pancreas

Rate Per 100,000


239.2

144.9 153.4163.4192.4

98.8 111.6 108.8

331.0

166.4

0

50

100

150

200

250

300

350

400

White AfricanAmerican

Asian/PacificIslander

AmericanIndian/ Alaskan

Native

Hispanic†

Men Women

*Per 100,000, age-adjusted to the 2000 US standard population.† Persons of Hispanic origin may be of any race.Source: Surveillance, Epidemiology, and End Results Program, 1975-2003, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2006.

Cancer Death Rates*, by Race and Ethnicity, US,1999-2003


All sites 331.0 239.2 1.4Prostate 65.1 26.7 2.4Larynx 5.1 2.2 2.3Stomach 12.4 5.4 2.3Myeloma 8.6 4.4 2.0 Oral cavity and pharynx 6.9 3.8 1.8Esophagus 10.7 7.6 1.4Liver and intrahepatic bile duct 9.6 6.3 1.5Small intestine 0.7 0.4 1.8Colon and rectum 33.6 23.7 1.4Lung and bronchus 98.4 73.8 1.3Pancreas 15.7 12.0 1.3

Cancer Sites in Which African American Death Rates* Exceed White Death Rates* for Men, US, 1999-2003

*Per 100,000, age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2003, Division of Cancer Control and Population Sciences, National Cancer Institute, 2006.

Site African American White Ratio of African American/White


All sites 192.4 163.4 1.2Stomach 6.0 2.7 2.2Myeloma 6.4 2.9 2.2Uterine cervix 5.1 2.4 2.1Esophagus 3.0 1.7 1.8 Larynx 0.9 0.5 1.8Uterine corpus 7.1 3.9 1.8Small intestine 0.5 0.3 1.7Pancreas 12.5 9.0 1.4Colon and rectum 23.7 16.4 1.4Liver and intrahepatic bile duct 3.8 2.8 1.4Breast 34.4 25.4 1.4Urinary bladder 2.9 2.3 1.3Gallbladder 1.0 0.8 1.3Oral cavity and pharynx 1.8 1.5 1.2

Cancer Sites in Which African American Death Rates* Exceed White Death Rates* for Women, US, 1999-2003

*Per 100,000, age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2003, Division of Cancer Control and Population Sciences, National Cancer Institute, 2006.

Site African American WhiteRatio of African American/White


0

50

100

150

200

250

300

350

400

450

500

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

African American men

White men

African American women

White women

Rate Per 100,000

Cancer Death Rates* by Sex and Race, US, 1975-2003

*Age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2003, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2006.


2007 Estimated US Cancer Cases*

*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.Source: American Cancer Society, 2007.

Men766,860

Women678,060

26% Breast

15% Lung & bronchus

11% Colon & rectum

6% Uterine corpus

4% Non-Hodgkinlymphoma

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-Hodgkin 4% lymphoma

Melanoma of skin 4%

Kidney 4%

Leukemia 3%

Oral cavity 3%

Pancreas 2%

All Other Sites 19%


Cancer Incidence Rates*, All Sites Combined, All Races, 1975-2003

*Age-adjusted to the 2000 US standard population and adjusted for delay in reporting.Source: Surveillance, Epidemiology, and End Results Program, 1973-2003, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2006.

0

100

200

300

400

500

600

700

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

Both Sexes

Men

Women

Rate Per 100,000

Cancer Incidence Rates* for Men, 1975-2003

*Age-adjusted to the 2000 US standard population and adjusted for delays in reporting.Source: Surveillance, Epidemiology, and End Results Program, 1975-2003, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2006.

0

50

100

150

200

250

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

Prostate

Lung & bronchus

Colon and rectum

Urinary bladder

Non-Hodgkin lymphoma

Rate Per 100,000

Melanoma of the skin

Cancer Incidence Rates* for Women, 1975-2003

*Age-adjusted to the 2000 US standard population and adjusted for delays in reporting.Source: Surveillance, Epidemiology, and End Results Program, 1975-2003, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2006.

0

50

100

150

200

250

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

Colon and rectum

Rate Per 100,000

Breast

Lung & bronchus

Uterine CorpusOvary

Non-Hodgkin lymphoma

Cancer Incidence Rates* by Race and Ethnicity, 1999-2003

*Age-adjusted to the 2000 US standard population.†Person of Hispanic origin may be of any race.Sources: Howe HL, et al. Annual report to the nation on the status of cancer 1975-2003; SEER, 1975-2003,Division of Cancer Control and Population Sciences, National Cancer Institute, 2006.

555.0

385.5 359.9421.1

383.8

303.3 305.0 327.2

639.8

444.1

0

100

200

300

400

500

600

700

800

White African American Asian/Pacific Islander American Indian/Alaska Native

Hispanic†

Men Women

Rate Per 100,000


Cancer Incidence Rates* by Sex and Race, All Sites, 1975-2003

*Age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2003, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2006.

0

100

200

300

400

500

600

700

800

900

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

African-American men

White men

White women

African-American women

Rate Per 100,000


* For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 2001 to 2003.

Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.1.1 Statistical Research and Applications Branch, NCI, 2006. http://srab.cancer.gov/devcan

Lifetime Probability of Developing Cancer, by Site, Men, 2001-2003*

† All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder.

Site RiskAll sites† 1 in 2Prostate 1 in 6Lung and bronchus 1 in 12Colon and rectum 1 in 17Urinary bladder‡ 1 in 28Non-Hodgkin lymphoma 1 in 47Melanoma 1 in 49Kidney 1 in 61Leukemia 1 in 67Oral Cavity 1 in 72Stomach 1 in 89

‡ Includes invasive and in situ cancer cases

Lifetime Probability of Developing Cancer, by Site, Women, US, 2001-2003*

Site RiskAll sites† 1 in 3Breast 1 in 8Lung & bronchus 1 in 16Colon & rectum 1 in 19Uterine corpus 1 in 40Non-Hodgkin lymphoma 1 in 55Ovary 1 in 69Melanoma 1 in 73Pancreas 1 in 79Urinary bladder‡ 1 in 87Uterine cervix 1 in 138

Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.1.1 Statistical Research and Applications Branch, NCI, 2006. http://srab.cancer.gov/devcan

* For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 2001 to 2003.† All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder.‡ Includes invasive and in situ cancer cases


All Sites 68 57 11Breast (female) 90 77 13Colon 66 54 12Esophagus 17 12 5Leukemia 50 39 11Non-Hodgkin lymphoma 64 56 8Oral cavity 62 40 22Prostate 100 98 2Rectum 66 59 7Urinary bladder 83 65 18Uterine cervix 75 66 9Uterine corpus 86 61 25

Cancer Survival*(%) by Site and Race,1996-2002

*5-year relative survival rates based on cancer patients diagnosed from 1996 to 2002 and followed through 2003. Source: Surveillance, Epidemiology, and End Results Program, 1975-2003, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2006.

Site White%

DifferenceAfrican

American


Five-year Relative Survival (%)* during Three Time Periods By Cancer Site

*5-year relative survival rates based on follow up of patients through 2003. †Recent changes in classification of ovarian cancer have affected 1996-2002 survival rates.Source: Surveillance, Epidemiology, and End Results Program, 1975-2003, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2006.

Site 1975-1977 1984-1986 1996-2002All sites 50 53 66Breast (female) 75 79 89Colon 51 59 65Leukemia 35 42 49Lung and bronchus 13 13 16Melanoma 82 86 92Non-Hodgkin lymphoma 48 53 63Ovary 37 40 45Pancreas 2 3 5Prostate 69 76 100Rectum 49 57 66Urinary bladder 73 78 82

†


Cancer Incidence & Death Rates* in Children 0-14 Years, 1975-2003

0

2

4

6

8

10

12

14

16

18

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

Incidence

Mortality

Rate Per 100,000

*Age-adjusted to the 2000 Standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2003, Division of Cancer Control and Population Sciences, National Cancer Institute, 2006.


Tobacco Use in the US, 1900-2003

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

1900

1905

1910

1915

1920

1925

1930

1935

1940

1945

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

Year

Per C

apita

Cig

aret

te C

onsu

mpt

ion

0

10

20

30

40

50

60

70

80

90

100

Age-

Adj

uste

d Lu

ng C

ance

r Dea

th

Rat

es*

*Age-adjusted to 2000 US standard population. Source: Death rates: US Mortality Public Use Tapes, 1960-2003, US Mortality Volumes, 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2005. Cigarette consumption: US Department of Agriculture, 1900-2003.

Per capita cigarette consumption

Male lung cancer death rate

Female lung cancer death rate


Trends in Cigarette Smoking Prevalence* (%), by Gender, Adults 18 and Older, US, 1965-2005

*Redesign of survey in 1997 may affect trends.Source: National Health Interview Survey, 1965-2005, National Center for Health Statistics, Centers for DiseaseControl and Prevention, 2006.

0

10

20

30

40

50

60

1965

1974

1979

1983

1985

1990

1992

1994

1995

1997

1998

1999

2000

2001

2002

2003

2004

2005

Year

Pre

vale

nce

(%)

Men

Women


Trends in per capita cigarette consumption for selected states and the average consumption across all states, 1980-2003

0

20

40

60

80

100

120

140

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002

Year

Per C

apita

Sal

es (#

of P

acks

) United States

MassachusettsCalifornia

Data from: Orzechowski W, Walker RC. The tax burden on tobacco: historical compilation 2003: Volume 36. Arlington (VA): Orzechowski and Walker; 2003.


Trends in Prevalence (%) of No Leisure-Time Physical Activity, by Educational Attainment, Adults 18 and Older, US, 1992-2005

Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Educational attainment is for adults 25 and older.Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape (2000, 2002, 2004, 2005), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2001, 2003, 2005, 2006.

05

1015202530354045505560

1992

1994

1996

1998

2000

2002

2003

2004

2005

Year

Prev

alen

ce (%

)

Adults with less than a high school education

All adults


Trends in Obesity* Prevalence (%), By Gender, Adults Aged 20 to 74, US, 1960-2004†

*Obesity is defined as a body mass index of 30 kg/m2 or greater. † Age adjusted to the 2000 US standard population. Source: National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 2003-2004: National Health and Nutrition Examination Survey Public Use Data Files, 2003-2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

1311

161512

1715

13

17

2321

26

3128

3433 3235

0

5

10

15

20

25

30

35

40

45

Both sexes Men Women

Prev

alen

ce (%

)

NHES I (1960-62) NHANES I (1971-74) NHANES II (1976-80)NHANES III (1988-94) NHANES 1999-2002 NHANES 2003-2004


Trends in Overweight* Prevalence (%), Adults 18 and Older, US, 1992-2005

1992 1995

1998

Less than 50% 50 to 55% More than 55% State did not participate in survey

*Body mass index of 25.0 kg/m2or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM (1984-1995, 1998) and Public Use Data Tape (2004, 2005), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 2000, 2005, 2006.

2005

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