Neoplasms/Cancer

Statistics

>9.7 million cases are detected each year 6.7 million people will die from cancer Every day, around 1700 Americans die of the disease 20.4 million people living with cancer in the world today 1 in 3 people will be diagnosed with cancer in the UK and 1 in 4 will die from their disease

The Global Burden of Cancer 2000

Men 5.3 million cases 3.5 million deaths
Lung Breast Colon/Rectum Stomach
499 255 558 405 398 384 543 204 471 233 279 227 260 133 111 76 33 121 68 113 86 97 47 101 101 71 34 192 114 241 166 165 234 318 902 810

Women 4.7 million cases 2.7 million deaths

337 293 370 446 105 0

Liver
Prostate Cervix uteri Oesophagus Bladder Non-Hodgkin Lymphoma Leukaemia Oral cavity Pancreas Kidney
Ovary

99
167 93 144 109 170 81 116 112 119 57

Incidence Mortality

1000 0

800

600

400

200 0 (Thousands)

200

400

600

800 100

From: D.M. Parkin The Lancet Oncology 2: 533-543 (2001)

WHO Statistics

2020 15 million people will die from cancer

Causes
Ageing Obesity Smoking

population

What is neoplasm?

Division uncontrolled cell division

Growth formation of a lump (tumour) or large numbers of abnormal white cells in the blood Mutation changes to how the cell is viewed by the immune system Spread ability to move within the body and survive in another part

Division uncontrolled cell division

Oncogenes-tumor causers
Tumour suppressor genes Suicide genes apoptosis DNA repair genes

Growth

Tumour
Pressure

on nerves Blocking organs Stopping normal function Altering nerve signals Obstructs

Mutation and Spread

Invasion

Angiogenesis-creation

of new

microcirculation

Types of Cancer
Carcinomas Sarcomas Lymphomas Leukaemias Adenomas

Often prefixed by the specific cell

What are the differences in the features of normal and cancer cells?

Malignant versus benign tumours

Normal and abnormal cell growth

Normal cell growth

Cancerous growth

Metastatic cancer

Methods of Metastasis-spread
By vascular system By lymph system By direct invasion

Good link

www.cancerresearchuk.org/cancerhelp/about-cancer.what-iscancer/grow/how-a-cancer-spreads

Carcinogenesis. Some factors to consider

Heredity Immunity Chemical Physical Viral Bacterial Lifestyle

Immunity

HIV / AIDS Immunosuppression

Viruss

Hepatitis B
Human T-cell Leukaemia virus

Epstein Barr Virus Human Papilloma Virus (HPV)

Bacterial

H. pylori Other Parasites:

Schistosoma

spp Clonorchis sinensis

Estimated Burden of Cancer from Infection Worldwide in 2000

No. of cases Liver Cervix Stomach Kaposis (HIV related) Non Hodgkin lymphoma 509,000 471,000 442,000 134,000 72,000 Agent HBV, HCV, flukes HPV H. pylori HHV-8 H. pylori, EBV, HIV % World cancer 5.1 4.7 4.4 1.3 0.7

Ano-genital
Nasopharyngeal Hodgkin disease Bladder Leukaemia Total

65,000
63,000 33,000 10,000 3,000 1,801,000

HPV
EBV EBV, HIV Schistosoma HTLV1

0.6
0.6 0.3 0.1 0.03 17.9

Chemical

Alcohol Asbestos Wood dust Rubber, plastics, dyes Tar / bitumen Aflatoxin Alkylating agents
Tobacco

Smoking

Single biggest cause of cancer 25-40% smokers die in middle age 9 in 10 lung cancers Know to cause cancer in 1950

Smoking and alcohol

Industrial pollution

Physical causes

Ultraviolet radiation

Sunlight Certain industrial sources

Radiation
Radon Cancer

treatment

Obesity

Lifestyle:
- Highly caloric diet, rich in fat, refined carbohydrates and animal protein - Low physical activity

Consequences:
- Cancer - Diabetes - Cardiovascular disease - Hypertension

Lifestyle

Age
Occupation Ethnicity

Deprivation

Survival variations

CONCORD Study (1.9 million survivors) demonstrated a clear relationship to income not only between countries but also between the ethnic groups in those countries

(Coleman et al Lancet Oncology 2008)

Diagnosis and staging

Clinical History
Normal diagnostic procedures
Scans,

xrays Blood tests Biopsy

Pathological staging

Staging

Size
Invasion Lymph nodes Metastasises

TNM Staging

T (a,is,(0),1-4): size or direct extent of the primary tumor N (0-3): degree of spread to regional lymph nodes

N0: tumor cells absent from regional lymph nodes N1: tumor cells spread to closest or small number of regional lymph nodes N2: tumor cells spread to an extent between N1 and N3. N3: tumor cells spread to most distant or numerous regional lymph nodes M0: no distant metastasis M1: metastasis to distant organs (beyond regional lymph nodes)

M (0/1): presence of metastasis

Other parameters G (1-4): the grade of the cancer cells (i.e. they are "low grade" if they appear similar to normal cells, and "high grade" if they appear poorly differentiated) R (0/1/2): the completeness of the operation (surgeryboundaries free of cancer cells or not) L (0/1): invasion into lymphatics V (0/1): invasion into vein C (1-4): a modifier of the certainty (quality) of the last mentioned parameter

Examples

Small, low grade cancer, no metastasis, no spread to regional lymph nodes, cancer completely removed, resection material seen by pathologist - pT1 pN0 M0 R0 G1; this would be considered Stage I. Large, high grade cancer, with spread to regional lymph nodes and other organs, not completely removed, seen by pathologist - pT4 pN2 M1 R1 G3; this would be considered Stage IV. Most Stage I tumors are curable; most Stage IV tumors are not.

Staging for Chronic Lymphocytic Leukemia (CLL)

There are two different systems for staging chronic lymphocytic leukemia. The Rai classification is used more often in the United States, whereas the Binet system is used more widely in Europe

Stages of Leukemia: Acute Lymphocytic Leukemia (ALL)

For adults, ALL is classified as untreated, in remission, or recurrent. For childhood ALL, risk groups are used instead of stages to describe cases of the disease. Risk groups for childhood ALL include: Standard (low) risk High risk Recurrent.

Other staging

Lymphoma: uses Ann Arbor staging

Hodgkin's Disease: follows a scale from I-IV and can be indicated further by an A or B, depending on whether a patient is non-symptomatic or has symptoms such as fevers. It is known as the "Cotswold System" or "Modified Ann Arbor Staging System".

Duke Staging System

Modified Duke A The tumor penetrates into the mucosa of the bowel wall but no further. Modified Duke B B1: tumor penetrates into, but not through the muscularis propria (the muscular layer) of the bowel wall. B2: tumor penetrates into and through the muscularis propria of the bowel wall. Modified Duke C C1: tumor penetrates into, but not through the muscularis propria of the bowel wall; there is pathologic evidence of colon cancer in the lymph nodes. C2: tumor penetrates into and through the muscularis propria of the bowel wall; there is pathologic evidence of colon cancer in the lymph nodes. Modified Duke D The tumor, which has spread beyond the confines of the lymph nodes (to organs such as the liver, lung or bone).

Summary

Cancer is a disease of Division, growth and spread

It has a number of causes many of them preventable The survival of the patient is determined by the stage of the disease, the earlier the detection or the smaller the tumour the better the survival