WHAT IS CANCER AND WHAT IS CANCER AND CANCER TREATMENT?CANCER TREATMENT?

A Layperson’s GuideA Layperson’s Guide

PURPOSE OF TALKPURPOSE OF TALK

• Understanding helps you feel in control

• Explains how treatments work

• Understand medical system

• Make better decisions

• Get better care

OVERVIEWOVERVIEW• 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

WHAT IS CANCER?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

CELLS IN THE BODYCELLS IN THE BODY

• The human body is made of trillions of cells

• Each cell has its own job

• Skin cells protect our surface

NORMAL CELLS IN YOUR BODYNORMAL 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

THE NORMAL CELLTHE NORMAL CELL

• The nucleus is the control centre

• The DNA are the instructions for the cell

HOW CELLS ARE REPLACEDHOW CELLS ARE REPLACED

• Many cells die from normal wear and tear

• Dying cells are replaced when cells divide

Cell divisionCell division

WHEN CELLS DIVIDEWHEN 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

Normal cell divisionNormal cell division

Controlled cell growthControlled cell growth

• Sometimes cells need to grow fast eg. With injury or growth

• Always under control

• Always stop growing fast afterwards

Cut in skinCut in skin

Cut in skinCut in skin

Cut in skinCut in skin

Cut in skinCut in skin

THE INSTRUCTIONS IN THE CELLTHE INSTRUCTIONS IN THE CELL

• Each cell has the control centre (nucleus)

• Instructions manual is made of words and sentences (DNA)

How cancer cells are madeHow 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

PROBLEMS WITH THE PROBLEMS WITH THE CELL’S INSTRUCTIONSCELL’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!

PROBLEMS WITH THE PROBLEMS WITH THE CELL’S INSTRUCTIONSCELL’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

Why don’t we see more cancersWhy 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

WHAT IS CANCER 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)

Definitions Definitions

• “Precancerous” has many but not all changes

• “Benign” means just grows in place

EACH PERSON’S CANCER EACH PERSON’S CANCER IS DIFFERENTIS DIFFERENT

• Each cancer has different mistakes and a different personality

• You cannot compare yourself to others

• You can always do better than expected!

HOW A TUMOR GROWSHOW 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

CREATION OF A TUMOR

HOW CANCERS CAUSE PROBLEMSHOW 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

CANCER CELLS ARE FRAGILECANCER 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

WHITE BLOOD CELLWHITE BLOOD CELL

Antibodies to cancer cells Antibodies to cancer cells

UNDERSTANDING THE UNDERSTANDING THE MEDICAL SYSTEMMEDICAL SYSTEM

MAKING A DIAGNOSISMAKING A DIAGNOSIS

• Discovering the cancer by

a) symptoms - tests

b) no symptoms = screening

eg. mammogram, blood test

• Early detection - better

MAKING THE DIAGNOSISMAKING THE DIAGNOSIS

• Biopsy - take a piece of tumor

• Look under microscope

• Proves its cancer

• Type of cancer

• Starts a process

STAGING THE CANCERSTAGING THE CANCER

• Has the cancer spread

• Primary site, nodes, distant

• Tells about treatment and

prognosis (likely outcome)

STAGING THE CANCERSTAGING THE CANCER• Blood tests• Imaging - X-rays• CAT Scans

Bone scanMRI

• Grade - microscope• Receptors on cancer cell• Genetics

Cross section of a bone Cross section of a bone with one cancer cellwith one cancer cell

DOCTOR’S QUESTIONSDOCTOR’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?

THE CONSULTATIONTHE CONSULTATION

• Referral to Oncologist

• Consultation - first visit

• Surgeon

• Medical Oncologist - chemo

• Radiation Oncologist

SURGERYSURGERY

• 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

CHEMOTHERAPYCHEMOTHERAPY

• Whole body treatment

• Injection into veins or pills

• Kills cancer cells

• Given in courses over weeks

• Affects fast-growing cells

CHEMO SIDE EFFECTSCHEMO SIDE EFFECTS

• The type of chemo differs

• Each person is different

• Your doctor monitors

• Specific side effects for each

CHEMO SIDE EFFECTSCHEMO SIDE EFFECTS

• Whole body side-effects• Fatigue / tiredness• Nausea and vomiting• Hair loss• Low blood cells• Sore mouth and throat

RADIATION TREATMENTRADIATION TREATMENT

• Radiotherapy, cobalt

• Ionizing x-rays - kills cells

• External and internal

• Side effects in the area only

• Spare as much normal tissue

RADIATION TREATMENTRADIATION TREATMENT

HOW TREATMENT WORKSHOW TREATMENT WORKS

HOW TREATMENT WORKSHOW TREATMENT WORKS

• Damage the cancer cells

• Mistakes in instructions

• Cells can’t divide • Cancer cells die

HORMONE TREATMENTHORMONE TREATMENT

• Blocks hormones so cells die

• Taken as pill or injection

• Sometimes increase cure

• Side effects – hot flushes…

CAN I BE CURED?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

EXAMPLE CASE EXAMPLE CASE

• 50 yr old lady - mammogram

• Biopsy shows cancer

• Lump / lymph nodes removed

• Staging tests all clear

• 20% chance cells elsewhere

CASE (Continued)CASE (Continued)

• Should she have chemo ??

• Will improve survival by 5%

• 12 weeks and side effects ??

• Radiation kills cells in breast

OTHER SERVICESOTHER SERVICES

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

CHOICESCHOICES

• You can decide:a) Use doctor as consultantb) Tell doctor to decide

• Understand - pros and cons• Get more information or a

second opinion

CONSENT FORMCONSENT FORM

• Permission for treatment• Consent - a discussion• Outlines options• Lists common and severe

side effects• Chance for questions

CLINICAL TRIALSCLINICAL TRIALS

• Trial = measure scientifically

• Research - find better way

• Cleared by ethics board

• Closer follow-up

• You don’t have to agree

HOW TO GET MOST HOW TO GET MOST FROM YOUR DOCTORFROM YOUR DOCTOR

Before visit:

• Symptoms and medications

• Ask family or a friend along

• Write down questions

HOW TO GET MOST HOW TO GET MOST FROM YOUR DOCTORFROM YOUR DOCTOR

At the doctor’s office:

• Be honest and open

• Feeling overwhelmed - say so

• Ask important question first

• Take notes - clarify

HOW TO GET MOST HOW TO GET MOST FROM YOUR DOCTORFROM YOUR DOCTOR

After visit:

• Keep a journal

• What you learned

• What to do if side effects

• KNOW WHO TO CALL

PROBLEMS WITH PROBLEMS WITH DOCTORDOCTOR

• Bring family or friend

• Call to clarify or for appt.

• Ask for second opinion

• Doctor should serve you

SUMMARYSUMMARY

• Understand the system to get good care

• Treatment is individualized

• Know yourself

• QUESTIONS

SUMMARYSUMMARY

• 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

NEGOTIATING THE MEDICAL NEGOTIATING THE MEDICAL SYSTEMSYSTEM

• 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