Oncology Lecture 16 of the Course “Medical English” for Sophomore Medical Students of Taipei Medical University

School of Medicine Taipei Medical University

Winston W. Shen, M.D.

Professor and ChairmanDepartment of Psychiatry

Taipei Medical University College of Medicine and

Chief, Department of Psychiatry TMU-Wan Fang Medical Center

Taipei, TAIWAN

E-mail address: Shenwinw@gmail.com

The Schedule for the Course “Medical English” (Version of 3/29/07) Week 1 (March 1) The Digestive System

Week 2 (March 8) The Respiratory System Week 3 (March 15) The Cardiovascular System Week 4 (March 22) The Musculoskeletal System (Turning in a 400-word essay on “My Visit to the Clinic (Hospital)” (in double-line space hard copy)

Week 5 (March 29) The Central Nervous System Week 6 (April 5) No class (Spring break) Week 7 (April 12) Urinary and Reproductive Systems Week 8 (April 19) The First Examination Week 9 (April 26) Medical Records (Turning in a 400-word essay on “My Favorite Book” (in double-line space hard copy)

Week 10 (May 3) Scientific Papers Week 11 (May 10) Hematology Week 12 (May 17) Infectious Diseases Week 13 (May 24) The Second Examination Week 14 (May 31) Endocrinology (Turning in a 400-word essay on “How to Be a Good Physician” (in double line space hard copy)

Week 15 (June 7) Immunology Week 16 (June 14) Oncology Week 17 (June 21) Final (The Third) Examination

Oncology (ong-kol-uh-jee)

–noun

1. the branch of medical science dealing with tumors, including the origin, development, diagnosis, and treatment of malignant neoplasms.

2. the study of cancer.

(Origin: 1350–1400; ME < L.: lit., crab*; L s. cancr-, dissimilated from *carcr-, with *carc-r- akin to Gk. karkínos, Skt karkata crab)

Cancer

1. Pathology. a.a malignant and invasive growth or tumor, esp. one originating in epithelium, tending to recur after excision and to metastasize to other sites. b. any disease characterized by such growths. 2. any evil condition or thing that spreads destructively; blight. 3. (initial capital letter ) Astronomy. the Crab, a zodiacal constellation between Gemini and Leo. 4. (initial capital letter ) Astrology. a. the fourth sign of the zodiac: the cardinal water sign. b. a person born under this sign, usually between June 21 and July 22. 5. (initial capital letter ) tropic of. See under tropic.

(French: le cancer; German: der Krebs)

www.reef.crc.org.au/research/fishing_fisherie

Random House Unabridged Dictionary, Random House, Inc. 2006.

Nomenclature of Cancer Neoplasia and neoplasm* (benign or malignant) are the scientific designations for cancerous diseases. This group contains a large number of different diseases.

Cancer is a widely used word that is usually understood as synonymous with malignant neoplasm. It is occasionally used instead of carcinoma, a sub-group of malignant neoplasms.

Tumor in medical language simply means swelling or lump, either neoplastic, inflammatory or other. In common language, however, it is synonymous with 'neoplasm', either benign or malignant. This is inaccurate since some neoplasms do not usually form tumors, for example leukemia or carcinoma in situ.

Paraneoplasia is a disturbance associated with a neoplasm but not related to the invasion of the primary or a secondary (metastatic) tumour. Disturbances can be hormonal, neurological, hematological, biochemical or otherwise clinical.*Neoplasm [nee-uh-plaz-uh m] (Origin: 1860–65; neo- + plasm)

Classification of Cancer

.

Carcinoma

Lymphoma and leukemia Sarcoma Mesothelioma

Glioma Germina Choriocarcinoma

Epithelial cells of breast, prostate, lung and colon cancer.

Blood and bone marrow cells

Connective tissue or mesenchymal cells Mesothelial cells lining the peritoneum and the pleuraThe most common type of brain cell

Germ cells in the testicle and ovary

The placenta

Carcinoma Origins of cells

Having recognized the invader, different types of T-cell then have different jobs to do. Some send chemical instructions (cytokines) to the rest of the immune system. Your body can then produce the most effective weapons against the invaders, which may be bacteria, viruses or parasites. Other types of T-cells recognize and kill virus-infected cells directly. Some help B-cells to make antibodies, which circulate and bind to antigens.A T-cell (orange) killing a cancer cell (mauve).

Dr Andrejs Liepins/Science Photo Library

www.sciencemuseum.org.uk/on-line/lifecycle/im

T-Cells

With the help of T-cells, B-cells make special Y-shaped proteins called antibodies.

Antibodies stick to antigens on the surface of germs, stopping them in their tracks, creating clumps that alert your body to the presence of intruders.

Your body then starts to make toxic substances to fight them.

Patrolling defender cells called phagocytes engulf and destroy antibody-covered intruders.

B-cells make antibodies. Mike Clark, Cambridge University

B-Cells

Stage 0 Tis, N0, M0

Stage I T1, N0, M0 T2, N0, M0

Stage IIA T3, N0, M0

Stage IIB T4, N0, M0

Stage IIIA T1, N1, M0 T2, N1, M0

Stage IIIB T3, N1, M0 T4, N1, M0

Stage IIIC Any T, N2, M0

Stage IV Any T, Any N, M1

AJCC Stage Groupings

Tx: No description of the tumor's extent is possible because of incomplete information.

T0 The cancer is in the earliest stage. It involves only the mucosa. It has not grown beyond the muscularis mucosa (inner muscle layer) of the colon or rectum. This stage is also known as carcinoma in situ or intramucosal carcinoma.

T1: The cancer has grown through the muscularis mucosa and extends into the submucosa.

T2: The cancer has grown through the the submucosa, and extends into the muscularis propria.

T3: The cancer has grown completely through the muscularis propria into the subserosa but not to any neighboring organs or tissues.

T4: The cancer has spread completely through the wall of the colon or rectum into nearby tissues or organs. \

M Categories for Colorectal Cancer

M categories indicate whether or not the cancer has

spread to distant organs, such as the liver, lungs, or distant lymph nodes.

Mx: No description of distant spread is possible because of incomplete information.

M0: No distant spread is seen.

M1: Distant spread is present

N Categories for Colorectal Cancer

N categories indicate whether or not the cancer has spread to nearby lymph nodes and, if so, how many lymph nodes are involved.

Nx: No description of lymph node involvement is possible because of incomplete information.

N0: No lymph node involvement is found.

N1: Cancer cells found in 1 to 3 nearby lymph nodes.

N2: Cancer cells found in 4 or more nearby lymph nodes.

TNM System of Anatomic Staging of Colorectal Cancer

Symptoms Caused by Malignant Diseases Mass effects Ablation by crowding or by invasion Obstruction of vessels, tubes , and ducts Raptures of blood vessels

Remote effects (paraneoplastic syndromes) Ectopic hormone production Neuropathies and CNS abnormalities Dermatologic abnormalities Metabolic disorders

◘ Anorexia, weight loss ◘ Fever ◘ Chronic inflammation

Hematologic disorders Immunosuppression Collagen vascular disorders

Psychosocial effects

Loss of control Acceptance of personal finitude Fear of pain and mutilation Separation and loneliness

Acute lymphocystic leukemia Acute myelogenous leukemia Ewing’s sarcoma Gestational trophoblastic carcinoma Hodgkin’s lymphoma Non Hodgkin lymphoma ▪ Burkitt’s lymphoma ▪ Diffuse large cell lymphoma ▪ Follicular mixed lymphoma

Rhabdomyosarcoma Testicular carcinoma Wilms’ Tumor

Response of Tumor to Chemotherapy

Adjuvant (after surgery) chemotherapy

One regimen involves the combination of infusional 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) 5-fluorouracil (5-FU) or Capecitabine (Xeloda®) Leucovorin (LV, Folinic Acid), Oxaliplatin (Eloxatin®)

Chemotherapy for metastatic disease The first line chemotherapy regimens involve the combination of infusional 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) with bevacizumab or infusional 5-fluorouracil, leucovorin, and irinotecan

Chemotherapy for Colorectal Cancer

[aj-uh-vuh nt] –adjective 1. serving to help or assist; auxiliary. 2. Medicine/Medical. utilizing drugs, radiation therapy, or other means of supplemental treatment following cancer surgery.

Mucus-producing Lung Cancer Cells

Bizarre nuclei

Bizarre glands

Mucus lakes

Necrotic debris

http://www.pathguy.com/histo/098.htm

Some very large nuclei.

www.pathguy.com/histo/014.jpg

Glandular Carcinoma Cells

Since the nucleus does not know exactly how to pack the extra chromosomes, the nuclear membrane usually shows some wrinkles, like an overpacked suitcase.

Also as a result of problems with packing, and/or from having an excess of genes that aren't really doing anything, cancer nuclei tend to have big clumpy blocks of heterochromatin. As a general rule, the more bizarre the nuclei, the more aggressive the cancer.

http://www.brighamandwomens.org/generalsurg/Images/01_colonca_polyp_lg.jpg

http://www1.wfubmc.edu/NR/rdonlyres/2F328E0F-5016-479C-9212-15E74B27CE5B/30267/image002.jpg

Colon and Rectal Cancer www.webmd.com

http://www.brighamandwomens.org/generalsurg/Images/

01_colonca_polyp_lg.jpg

http://www1.wfubmc.edu/NR/rdonlyres/2F328E0F-5016-479C-9212-15E74B27CE5B/30267/image002.jpg

Breast Cancer: Mammogram

anatomy.med.umich.edu/. ../pectoral.html

Prostate Cancer

http://www.malecare.org/prostate-cancer_sam2.jpg

my.webmd.com/hw/health_ guide_atoz/zm6038.asp

Stage T1: Tumor is microscopic and confined to prostate but is undetectable by a digital rectal exam (DRE) or by ultrasound. Usually discovered by PSA tests or biopsies.

Stage T2: Tumor is confined to prostate and can be detected by DRE or ultrasound.

Stage T3 or T4: In stage T3, the cancer has spread to tissue adjacent to the prostate or to the seminal vesicles. Stage T4 tumors have spread to organs near the prostate, such as the bladder.

Stage N+ or M+: Cancer has spread to pelvic lymph nodes (N+) or to lymph nodes, organs, or bones distant from the prostate (M+).

http://www.bidmc.harvard.edu/display.asp?node_id=4466

Lung Cancer The most common and mostly preventable cancer in men and women

Cancer vs. normal lung histology

www.svgs.k12.va.us/.../slide0084_image087.jpg

FOLFOX Therapy For Colorectal Cancer

FOL– fluorouracil (5-FU) F – folinic acid (leucovorin®) OX – oxaliplatin (Eloxatin®)

FOLFIRI Therapy For Colorectal Cancer

FOL– fluorouracil (5-FU)

F – folinic acid (leucovorin®)

IRI – irinotican (Camptosar®)

Gefitinib (Irresa®) An Inhibitor of Epidermal Growth Factor Receptor (EGRF)

Good response for non-small-cell cancer lung cancer (NSCLC) and is related to EGRF tyrosine receptor.

Differing from squamaous cell carcinoma, patients with NSCLC adenocarcinoma has better response especially among female and nonsmoker patients.

The Oriental patients have better response rate to gefitinib compared to Western counterparts.

VEGF been demonstrated to be a major contributor to angiogenesis, increasing the number of capillaries in a given network. Initial in vitro studies demonstrated that bovine capillary endothelial cells will proliferate and show signs of tube structures upon stimulation by VEGF and bFGF, although the results were more pronounced withVEGF.

Vascular Endothelial Growth Factor (VEGF)

www.math.uci.edu/.../Angiogenesis.png

Avastin® is the first U.S. Food and Drug Administration(FDA) approved therapy in 2004 designed to inhibit angiogenesis, the process by which new blood vessels develop and carry vital nutrients to a tumor.

Avastin® is approved, in combination with intravenous 5-fluorouracil-based (5-FU) chemotherapy, for first- or second-line treatment of patients with metastatic carcinoma of the colon or rectum and in combination with carboplatin and paclitaxel for the first-line treatment of patients with unresectable, locally advanced,recurrent or metastatic non-squamous non-small cell lung cancer (NSCLC).

Bevacizumah (Avastin®)