COMMON SOLID TUMORS BY PROFESSOR AHMED ABDELWARITH FEB 2014.
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Transcript of COMMON SOLID TUMORS BY PROFESSOR AHMED ABDELWARITH FEB 2014.
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COMMON SOLID TUMORS
BY PROFESSOR AHMED ABDELWARITH
FEB 2014
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Different types of cells
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G0
• Constantly dividing cell types include
1- skin cells, 2- GIT 3-blood cells in the
bone marrow.• Constantly dividing
cells have a higher risk of becoming malignant and develop cancer, dividing uncontrollably
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DIVIDING CELLS IN HUMAN BODY• cytotoxic drugs, such as used in treatment of
cancer, work by inhibiting the proliferation of dividing cells, the malignant cells as the desired target .
However, this has the adverse effect against the cells normally dividing in the body, and Hair, skin, GI tract and bone marrow.
MYELOSUPRESSION
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G0
• Stable cells : multiply only when needed.
• most of the time in the quiescent G0 phase
• but can be stimulated to enter the cell cycle when needed.
• Examples include: the liver,
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G0
• Permanent cells: do not have a division potential
NeuronsMuscle cellsWhen damaged ( by
radiotherapy ) they can not be replaced
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Definitions
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Defining Cancer
Cancer is a term used for diseases in which abnormal cells divide and escape the body control.
These cells are able to: 1-Invade surrounding tissues 2-Send distant metastases.
3- Lost their functions
Depressed immunity
To exclude Benign tumors
To exclude locally malignant
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Abnormal cell division Normal cell division
Cth toxicityHairEpitheliumNailsGerm cellsBone marrow
Escape body control
Suppressed immunityDisease-Drugs-Infective agents
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DNA controls cell functions
Cell division
Nucleolus control the cell function
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What causes cancer?- Cell devision is controlled by the
genes which are formed of DNA- Cancer arises from the mutation of
a normal gene resulted from DNA defect
Mutated genes that cause cancer are activated pro-oncogene (genes related to cell division) called oncogenes.
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Causes of Cancer• • DNA Mutations• – Radiation – and other environmental factors
(Tobacco, Alcohol, Radon, Asbestos, etc)• – Random somatic mutations• – Inherited germ line mutations
• Infectious agents• – Viral• • HPV – cervical cancer• • Hepatitis – liver cancer
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When to suspect cancer?
Cancer Signs and Symptoms-Cancer gives most people no symptoms or signs that exclusively indicate the disease. -Unfortunately, every complaint or symptom of cancer can be explained by a harmless condition as well.
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1- When to suspect cancer?
Cancer Signs and Symptoms
What are the clues???????-Persistent P-Progressive P-Disabling D
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Cancer Signs and Symptoms
What are the clues???????- Symptoms & Signs changes according to the site of origin
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Cancer Signs and Symptoms
Think about the pathology and site:- Mass that is able to invade locally and spread distantly
Mass
lump
Pressure =on vital organs
Blood vessels = bleedingNerves = pain
Obstruction =of lumens
To bone, brain, lung, liver
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Cancer Signs and Symptoms
Do not forget the constitutional symptoms:
-Fatigue-Fever -Sweating-Wt loss
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Classification Of Solid Tumors
Solid Tumors Epithelial tissues Connective tissues Surface glandular Bone Soft tissues
Carcinoma Sarcoma
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Cancers are classified by the Type of cell that the tumor cells presumed to be originating from.• Carcinoma: Cancers derived from epithelial cells. This
is the most common cancers, breast, prostate, lung, pancreas, and colon.
• Sarcoma: Cancers arising from connective tissue (i.e. bone, cartilage, fat, nerve), each of which develop from cells originating in mesenchymal cells outside the bone marrow.
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OTHER TUMOR TYPES• Germ cell tumor: Cancers derived from pluripotent
cells, in the testicle or the ovary (seminoma and dysgerminoma, respectively).
• Blastoma: Cancers derived from immature "precursor" cells or embryonic tissue.
most common in children. blastoma as a suffix, with the Latin or Greek word
for the organ or tissue of origin as the root. hepatoblastoma,
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EarlyLocally
Advanced
General Staging of solid malignancies
Metastatic
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Early
Locally
Advanced
Staging of Lung Cancer
Metastatic
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COMMON SOLID TUMORS
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COMMON SOLID TUMORS IN KSA
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2009 Estimated US Cancer Cases*
*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.Source: American Cancer Society, 2009.
Men766,130
Women713,220
27% Breast
14% Lung & bronchus
10% Colon & rectum
6% Uterine corpus
4% Non-Hodgkin lymphoma
4% Melanoma of skin
4% Thyroid
3% Kidney & renal pelvis
3% Ovary
3% Pancreas
22% All Other Sites
Prostate 25%
Lung & bronchus 15%
Colon & rectum 10%
Urinary bladder 7%
Melanoma of skin 5%
Non-Hodgkin5% lymphoma
Kidney & renal pelvis 5%
Leukemia 3%
Oral cavity 3%
Pancreas 3%
All Other Sites 19%
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COMMON SOLID TUMORS
• In the U.S., The three most common cancers:
• Men: Prostate, lung, colorectal
• Women: Breast, colorectal, lung
• In the KSA., The three most common cancers:
• Men: colorectal, Lymphoma, leukemia
• Women: Breast, Thyroid, colorectal,
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STUDY OF SOLID TUMORS
• EPIDEMILOGY• AETIOLOGY• PATHOLOGY• CLINICAL PRESENTATION• STAGING• MANGEMENT• PROGNOSIS
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•BREAST CANCER•COLON CANCER
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1st most common cancer in females.
2nd leading cause of death.
Breast Cancer Facts
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Brest cancer staging
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BREAST CANCERSurvival by stage
Stage I 90%Stage IIA
Stage IIB
Stage IIIA
Stage IIIBStage IV< 10%
Percent surviving
100
80
60
40
20
01 2 3 4 5 6
Years after diagnosis
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WE NEED EARLY DETECTION
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It Is A Simple Equation
LATE PRESENTATION+
ADVANCED STAGE=
POOR OUTCOME
EARLY PRESENTATION+
EARLY STAGE=
GOOD OUTCOME
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A Good Health Plan
1.Mammograms
2.Self Awareness (Monthly Self Exams) (BSE)
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Why?When?What?Which?
Suspect Breast Cancer
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Many good reasons to suspect breast
cancer
Why?
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Remember: Breast cancer : - Most common cancer in females.- Wide age range 20 - +70y.- Breast cancer can occur during
pregnancy ,during lactation.- Breast cancer can occur in pre,
peri and post menopausal females.
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Is one of the most important and the first step in
diagnosing Early Breast cancer
Suspecting Breast Cancer
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Risk factorsHistory of breast cancer
Family history of breast cancer, especially infirst-degree relatives
Benign breast diseases / atypical hyperplasia
Early menarche, late menopause
Late first pregnancy/no pregnancy
Exogenous estrogens
Radiation ( HD)
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WhatTo do
If you Suspect Breast Cancer?
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- Do not just reassure the patient
- Do not give hormonal therapy
- Do not give antibiotics.
If youSuspect Breast
Cancer
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If youSuspect Breast
Cancer
Careful history &Careful physical ex
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Warning signs and symptoms:-Painless lump or thickening (can be painful)-Thickening or swelling that persist-Nipple pain or retraction -Nipple discharge-Breast skin irritation or dimpling
Warning Signs
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BREAST CANCERBreast palpation
BREAST CANCERBreast palpation
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BREAST CANCERRegional nodes assessmentBREAST CANCER
Regional nodes assessment
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FNA
Palpable mass
Diagnostic imaging
- mammogram- ultrasound
Physical examination
Equivocal orsuspicious
Short-termfollow-up
Normal
+ve
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FNA
Normal
Physical examination
Screening mammogram
Suspicious
–ve
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FNA
Palpable mass
Diagnostic imaging
- mammogram- ultrasound
Physical examination
Equivocal orsuspicious
Short-termfollow-up
Normal
+ve
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Is one of the most important steps in diagnosing
Early Breast cancer.
conclusionSuspecting Breast
Cancer
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ConclusionIf you
Suspect Breast Cancer
-Careful Hist & Ex-Perform Bilateral mamogram + breast US+/- Fine needle aspiration
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1-EARLY DIAGOSIS
2-EARLY &PROPER INTERVENTION
To improve patientsPrognosis
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LOCAL THERAPYSURGERY
RADIOTHERAPY
SYSTEMIC THERAPY- CHEOTHERAPY
- HORMONAL THERAPY- BIOLOGICAL THERAPY
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COLON CANCER
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American Cancer Society
Colon cancer is the second leading cause of cancer deaths
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What is the Colon• The Colon is a long, coiled,
tubular digestive tract• It basically acts as a waste
processor• Takes digested food in the
form of Solid waste pushing it out of the rectum and anus
• The Colorectal tube is a prime location for the development and growth of small polyps or tumors
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Risk factors of colon cancer
• Older age. About 90 percent of people diagnosed with colon cancer are older than 50. Colon cancer can occur in younger people, but it occurs much less frequently.
• A personal history of colorectal cancer or polyps. If you've already had colon cancer or adenomatous polyps, you have a greater risk of colon cancer in the future.
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Risk factors of colon cancer
• Inflammatory intestinal conditions. ulcerative colitis and Crohn's disease,
• Inherited syndromes that increase colon cancer risk.. familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, which is also known as Lynch syndrome.
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Risk factors of colon cancer
• Family history of colon cancer and colon polyps. a parent, sibling or child with the disease.
• Low-fiber, high-fat diet.. • A sedentary lifestyle.
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Risk factors of colon cancer
• Diabetes. insulin resistance may have an increased risk of colon cancer.
• Obesity. • Smoking. People who smoke cigarettes may have an
increased risk of colon cancer. • Alcohol. Heavy use of alcohol may increase your risk
of colon cancer. • Radiation therapy for cancer
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• Why does constipation is a risk factor?
constipation
Waste stagnation
Bacterial action
carcinogens
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Colon Cancer Pathogenesis
• It starts with a simple cell the mutates and grows into a polyps
• If a polyp is allowed to remain in the colon it can grow into a cancerous tumor that can invade other organs.
• Colon cancer is the second leading cause of cancer deaths
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Colon; The Cancer Its Self
• If a polyp is allowed to remain in the colon it can grow into a cancerous tumor that can invade other organs.
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Signs & Symptoms It can occur at any age but mostly if your of 45 years of age
• Change in bowel habits• Blood in Stool
– Bright red – Very dark red– Black/Tarry Stool
• Diarrhea• Constipation • Does your bowel feel like it
emptied completely?
• General abdominal discomfort– Gas pains– Bloating– Fullness– Cramps
• Weight loss w/ no explained reason
• Constant tiredness• Vomiting (coffee grounds)
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Symptoms of Colon Cancer
• And Unexplained Fatigue
• Unexplained iron deficiency anemia
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Colon cancer staging
II IIII IIIIII IVIV
ConfinedConfinedTo wallTo wall
Beyond Beyond the wallthe wall
Nodal Nodal involvementinvolvement
MetastasesMetastases
5y OS= 90% 60-80% 30-60% < 5%
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• Why does this contribute to a better survival?
Early detection:
Early detection
Earlystage
Bettersurvival
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• 1- Occult blood in stools• 2- Colonoscopy, • 3- Better imaging,• 4- Better public and physician
awareness.
Early detection:
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MANGEMENT OF COLON CANCER
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EarlyLocally
Advanced
MANGEMENT OF COLON CANCER
Metastatic
SURGERYSURGERY+ ADJUVANT CHEMOTHERAPY
CHEMOTHERAPY+SURGERY
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CAN WE PREVENT BREAST or colon
CANCER?
MAY 2011
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Different Strategies for Cancer Prevention
Avoid theses factors
IDENTIFY Etiological
factors -1-Passive
Prevention
eg. SMOOKING, ASPESTOS
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•General health maintenance• Eat a healthy diet• Don’t smoke• Don’t drink too much• Exercise/ maintain optimal weight
-1-Passive
Prevention
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Lubet,2000
TRY TO AVOID THE Risk Factors for Breast Cancer
• Weight Gain /obesity• Estrogen & Progestin use • Alcohol use
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Not good enoughIn high risk people
Social change isdifficult and takesa long time
NOT AN EASY TASK
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Different Strategies for Cancer Prevention
Discover pre-malignant
lesions
Get rid of them before developing
invasive cancer-2-
Active prevention
eg. Colonic polyps &DCIS
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• Eliminate or prevent pre-invasive disease before invasion developsChemopreventi
onSurgery
-2-Active
prevention