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Understanding Cancer



          Heri Fadjari

          Hematology – Medical Oncology Division
          Dept. of Intern...
What Is Cancer?
Different Kinds of Cancer


                             Leukemias:
Some common
                             Bloodstream
 ...
Naming Cancers

Cancer Prefixes Point to Location
Prefix     Meaning
adeno-     gland
chondro-   cartilage
erythro-   red ...
Loss of Normal Growth Control

     Normal
cell division


                                                              C...
Example of Normal Growth


  Dead cells
  shed from
outer surface


   Epidermis
                         Cell migration

...
The Beginning of Cancerous Growth




                       Underlying tissue
Tumors (Neoplasms)




               Underlying tissue
Invasion and Metastasis




            1
            Cancer cells invade
            surrounding tissues
            and ...
Malignant versus Benign Tumors
       Benign (not cancer)       Malignant (cancer)
       tumor cells grow          cells ...
Why Cancer Is Potentially Dangerous

           Brain



                        Melanoma
                        cells tr...
Cancer Detection and Diagnosis
Early Cancer May Not Have Any Symptoms
Cervical Cancer Screening


                       Normal
                       Pap smear




                       Abno...
Breast Cancer Screening
Prostate and Ovarian Cancer Screening
Colon Cancer Screening
Biopsy




                      Pathology




                   Proteomic profile




    Patient’s
tissue sample or   G...
Microscopic Appearance of Cancer Cells
Hyperplasia




Normal                 Hyperplasia
Dysplasia




Normal    Hyperplasia   Mild dysplasia
Carcinoma in Situ




Normal   Hyperplasia     Mild      Carcinoma in
                       dysplasia    situ (severe
   ...
Tumor Grading

           General Relationship Between
            Tumor Grade and Prognosis
  100%


                    ...
Tumor Staging
          Five-Year Survival Rates for
       Patients with Melanoma (by stage)
100%




50%




           ...
What Causes Cancer?
           Some viruses or bacteria




Some chemicals                    Radiation


                ...
Population-Based Studies
             Regions of Highest Incidence
U.K.:
Lung
cancer



                          JAPAN:
 ...
Heredity? Behaviors? Other Factors?

          Colon Cancer                     Stomach Cancer
         (Number of new cas...
Tobacco Use and Cancer
Some Cancer-Causing Chemicals in Tobacco Smoke
Low-Strength Radiation

    High


                                         Dallas


     Skin
   Cancer
Incidence
       ...
High-Strength Radiation

    High




Leukemia
Incidence




     Low
            Least                        Most
      ...
Lag Time

                 20-Year Lag Time Between
                 Smoking and Lung Cancer
                     Cigarett...
Viruses




                      Virus inserts
                      and changes
                      genes for
        ...
Examples of Human Cancer Viruses


    Some Viruses Associated with Human Cancers
AIDS and Kaposi’s Sarcoma


   Without
   disease


HIV infection
                  Depressed
                   immune
  ...
Bacteria and Stomach Cancer




         Patient’s    H. pylori
      tissue sample
Heredity and Cancer

                  All Breast Cancer Patients




Inherited factor(s)
Other factor(s)
Heredity Can Affect Many Types of Cancer


     Inherited Conditions That Increase Risk for Cancer
Genetic Testing
Cancer Risk and Aging

                       Cancer Risk and Aging
            400
                                      ...
Genes and Cancer
            Viruses

Chemicals             Radiation




      Heredity




                             ...
DNA Structure




                Chemical
                bases


                A
                    T
               ...
DNA Mutation
         CA AG C T A A C T
DNA

                Normal gene


         CA AG C G A A C T


                Si...
Oncogenes


Normal cell                         Normal
                                     genes
                        ...
Proto-Oncogenes and Normal Cell Growth
                  Normal Growth-Control Pathway

  Growth factor

      Receptor
  ...
Oncogenes are
   Mutant Forms of Proto-Oncogenes
        Inactive growth factor receptor         Inactive intracellular
  ...
Tumor Suppressor Genes


  Normal cell                            Normal
                                         genes
  ...
Tumor Suppressor Genes
           Act Like a Brake Pedal
                      Tumor Suppressor
                        Ge...
p53 Tumor Suppressor Protein
       Triggers Cell Suicide

              p53 protein




Normal cell   Excessive DNA damag...
DNA Repair Genes



            Normal DNA repair
                 T C GA C
Base pair
mismatch                        No c...
Cancer Tends to Involve Multiple Mutations
        Benign tumor cells         Malignant cells invade
        grow only loc...
Mutations and Cancer

   Genes Implicated in Cancer
Cancer Tends to
Corrupt Surrounding Environment
Growth factors = proliferation
                                 Invasive

...
Cancer Prevention

                  Carcinogenic
                   chemicals
   Carcinogenic
     radiation


Cancer vir...
Avoid Tobacco

                   Lung Cancer Risk Increases
                   with Cigarette Consumption
         15x


...
Protect Yourself From Excessive Sunlight
Limit Alcohol and Tobacco
    Combination of Alcohol and Cigarettes
 Increases Risk for Cancer of the Esophagus
          ...
Diet: Limit Fats and Calories
             Correlation Between Meat Consumption and
              Colon Cancer Rates in Di...
Diet: Consume Fruits and Vegetables
Avoid Cancer Viruses

              HPV Infection Increases
      High
              Risk for Cervical Cancer




Cervical...
Avoid Carcinogens at Work

   Some Carcinogens in the Workplace
Industrial Pollution




 Incidence of
Most Cancers




            1930     1950          1970   1990
                   ...
Is There a Cancer "Epidemic"?
We would like to hear a questions from you . . .
.
Breast implant




Breast augmentation
A good result, but note
   the excessive gap
    between breasts,
       common in
 transsexual women.
Saline filled implants
Augmentation                    3-Year Risk Rate
  Complications            By Patient       By Implant
                  ...
Wrinkling   Capsular contracture
Understanding cancer
Understanding cancer
Understanding cancer
Understanding cancer
Understanding cancer
Understanding cancer
Understanding cancer
Understanding cancer
Understanding cancer
Understanding cancer
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Transcript of "Understanding cancer"

  1. 1. Understanding Cancer Heri Fadjari Hematology – Medical Oncology Division Dept. of Internal Medicine Hasan Sadikin General Hospital Bandung
  2. 2. What Is Cancer?
  3. 3. Different Kinds of Cancer Leukemias: Some common Bloodstream carcinomas: Lung Lymphomas: Lymph nodes Breast (women) Colon Some common sarcomas: Bladder Fat Prostate (men) Bone Muscle
  4. 4. Naming Cancers Cancer Prefixes Point to Location Prefix Meaning adeno- gland chondro- cartilage erythro- red blood cell hemangio- blood vessels hepato- liver lipo- fat lympho- lymphocyte melano- pigment cell myelo- bone marrow myo- muscle osteo- bone
  5. 5. Loss of Normal Growth Control Normal cell division Cell Suicide or Apoptosis Cell damage— no repair Cancer cell division First Second Third Fourth or mutation mutation mutation later mutation Uncontrolled growth
  6. 6. Example of Normal Growth Dead cells shed from outer surface Epidermis Cell migration Dividing cells in basal layer Dermis
  7. 7. The Beginning of Cancerous Growth Underlying tissue
  8. 8. Tumors (Neoplasms) Underlying tissue
  9. 9. Invasion and Metastasis 1 Cancer cells invade surrounding tissues and blood vessels 2 Cancer cells are transported by the circulatory system to distant sites 3 Cancer cells reinvade and grow at new location
  10. 10. Malignant versus Benign Tumors Benign (not cancer) Malignant (cancer) tumor cells grow cells invade only locally and cannot neighboring tissues, spread by invasion or enter blood vessels, metastasis and metastasize to different sites Time
  11. 11. Why Cancer Is Potentially Dangerous Brain Melanoma cells travel through bloodstream Liver Melanoma (initial tumor)
  12. 12. Cancer Detection and Diagnosis
  13. 13. Early Cancer May Not Have Any Symptoms
  14. 14. Cervical Cancer Screening Normal Pap smear Abnormal Pap smear
  15. 15. Breast Cancer Screening
  16. 16. Prostate and Ovarian Cancer Screening
  17. 17. Colon Cancer Screening
  18. 18. Biopsy Pathology Proteomic profile Patient’s tissue sample or Genomic profile blood sample
  19. 19. Microscopic Appearance of Cancer Cells
  20. 20. Hyperplasia Normal Hyperplasia
  21. 21. Dysplasia Normal Hyperplasia Mild dysplasia
  22. 22. Carcinoma in Situ Normal Hyperplasia Mild Carcinoma in dysplasia situ (severe dysplasia) Cancer (invasive)
  23. 23. Tumor Grading General Relationship Between Tumor Grade and Prognosis 100% Low grade Patient Survival Rate High grade 1 2 3 4 5 Years
  24. 24. Tumor Staging Five-Year Survival Rates for Patients with Melanoma (by stage) 100% 50% I II III Stage at Time of Initial Diagnosis
  25. 25. What Causes Cancer? Some viruses or bacteria Some chemicals Radiation Heredity Diet Hormones
  26. 26. Population-Based Studies Regions of Highest Incidence U.K.: Lung cancer JAPAN: Stomach cancer CANADA: Leukemia U.S.: CHINA: Colon Liver cancer cancer BRAZIL: Cervical AUSTRALIA: cancer Skin cancer
  27. 27. Heredity? Behaviors? Other Factors? Colon Cancer Stomach Cancer (Number of new cases (Number of new cases per 100,000 people) per 100,000 people) 100 100 70 50 7 5 0 0 Japan Japanese U.S. Japan Japanese U.S. families families in U.S. in U.S.
  28. 28. Tobacco Use and Cancer Some Cancer-Causing Chemicals in Tobacco Smoke
  29. 29. Low-Strength Radiation High Dallas Skin Cancer Incidence Pittsburgh Detroit Low Least Most Annual Sunshine (UV radiation)
  30. 30. High-Strength Radiation High Leukemia Incidence Low Least Most X-ray Dose (atomic radiation)
  31. 31. Lag Time 20-Year Lag Time Between Smoking and Lung Cancer Cigarette consumption (men) 4000 Lung 150 Cigarettes 3000 cancer Smoked Lung Cancer (men) per Person 100 Deaths (per per Year 100,000 people) 2000 50 1000 1900 1920 1940 1960 1980 Year
  32. 32. Viruses Virus inserts and changes genes for cell growth Cancer-linked virus
  33. 33. Examples of Human Cancer Viruses Some Viruses Associated with Human Cancers
  34. 34. AIDS and Kaposi’s Sarcoma Without disease HIV infection Depressed immune system KSHV infection Kaposi’s sarcoma
  35. 35. Bacteria and Stomach Cancer Patient’s H. pylori tissue sample
  36. 36. Heredity and Cancer All Breast Cancer Patients Inherited factor(s) Other factor(s)
  37. 37. Heredity Can Affect Many Types of Cancer Inherited Conditions That Increase Risk for Cancer
  38. 38. Genetic Testing
  39. 39. Cancer Risk and Aging Cancer Risk and Aging 400 Colon 300 Breast Number of Cancer Cases 200 (per 100,000 people) 100 0 20 40 60 80 Age of Person (in years)
  40. 40. Genes and Cancer Viruses Chemicals Radiation Heredity Chromosomes are DNA molecules
  41. 41. DNA Structure Chemical bases A T C G DNA molecule
  42. 42. DNA Mutation CA AG C T A A C T DNA Normal gene CA AG C G A A C T Single base change CA A G G CG C T A A C T Additions C T CA A G A A C T Deletions
  43. 43. Oncogenes Normal cell Normal genes regulate cell growth Oncogenes Cancer cell accelerate cell growth and division Mutated/damaged oncogene
  44. 44. Proto-Oncogenes and Normal Cell Growth Normal Growth-Control Pathway Growth factor Receptor Signaling enzymes Transcription factors DNA Cell nucleus Cell proliferation
  45. 45. Oncogenes are Mutant Forms of Proto-Oncogenes Inactive growth factor receptor Inactive intracellular signaling protein Signaling protein from active oncogene Activated gene regulatory protein Transcription Cell proliferation driven by internal oncogene signaling
  46. 46. Tumor Suppressor Genes Normal cell Normal genes prevent cancer Remove or inactivate tumor suppressor genes Cancer cell Damage to both genes leads to cancer Mutated/inactivated tumor suppressor genes
  47. 47. Tumor Suppressor Genes Act Like a Brake Pedal Tumor Suppressor Gene Proteins Growth factor Receptor Signaling enzymes Transcription factors Cell nucleus DNA Cell proliferation
  48. 48. p53 Tumor Suppressor Protein Triggers Cell Suicide p53 protein Normal cell Excessive DNA damage Cell suicide (Apoptosis)
  49. 49. DNA Repair Genes Normal DNA repair T C GA C Base pair mismatch No cancer TC TAC AG C T G TCTAC TCT AC AG C T G Cancer AG TG AG A T G No DNA repair
  50. 50. Cancer Tends to Involve Multiple Mutations Benign tumor cells Malignant cells invade grow only locally and neighboring tissues, enter cannot spread by blood vessels, and invasion or metastasis metastasize to different sites Time Mutation Cells Mutations Proto-oncogenes More mutations, inactivates proliferate inactivate mutate to more genetic suppressor DNA repair oncogenes instability, gene genes metastatic disease
  51. 51. Mutations and Cancer Genes Implicated in Cancer
  52. 52. Cancer Tends to Corrupt Surrounding Environment Growth factors = proliferation Invasive Matrix Proteases Fibroblasts, adipocytes Cytokines Blood vessel Cytokines, proteases = migration & invasion
  53. 53. Cancer Prevention Carcinogenic chemicals Carcinogenic radiation Cancer viruses or bacteria
  54. 54. Avoid Tobacco Lung Cancer Risk Increases with Cigarette Consumption 15x 10x Lung Cancer Risk 5x 0 15 30 Non-smoker Cigarettes Smoked per Day
  55. 55. Protect Yourself From Excessive Sunlight
  56. 56. Limit Alcohol and Tobacco Combination of Alcohol and Cigarettes Increases Risk for Cancer of the Esophagus 40x 30x Risk Increase 20x 10x Alcoholic Drinks Consumed per Day AND Packs of Cigarettes Consumed per Day
  57. 57. Diet: Limit Fats and Calories Correlation Between Meat Consumption and Colon Cancer Rates in Different Countries 40 30 Number of Cases (per 100,000 people) 20 10 0 80 100 200 300 Grams (per person per day)
  58. 58. Diet: Consume Fruits and Vegetables
  59. 59. Avoid Cancer Viruses HPV Infection Increases High Risk for Cervical Cancer Cervical Cancer Risk Low Noninfected Women women infected with HPV
  60. 60. Avoid Carcinogens at Work Some Carcinogens in the Workplace
  61. 61. Industrial Pollution Incidence of Most Cancers 1930 1950 1970 1990 Year
  62. 62. Is There a Cancer "Epidemic"?
  63. 63. We would like to hear a questions from you . . . .
  64. 64. Breast implant Breast augmentation
  65. 65. A good result, but note the excessive gap between breasts, common in transsexual women.
  66. 66. Saline filled implants
  67. 67. Augmentation 3-Year Risk Rate Complications By Patient By Implant N=1264 N=2528 Wrinkling 21% 20% Reoperation 13% 10% Loss of Nipple Sensation 10% 8% Capsular Contracture 9% 7% Implant Remova l8% 6% Asymmetry 7% 5% Intense Nipple Sensation 5% 4% Breast Pain 5% 4% Leakage/Deflation 3% 2% Implant Palpability 2% 2% Infection 2% 1% Breast Sagging 2% 1% Scarring Complications 2% 2%
  68. 68. Wrinkling Capsular contracture
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