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Understanding cancer
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  • 1. Understanding Cancer Heri Fadjari Hematology – Medical Oncology Division Dept. of Internal Medicine Hasan Sadikin General Hospital Bandung
  • 2. What Is Cancer?
  • 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. 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. 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. Example of Normal Growth Dead cells shed from outer surface Epidermis Cell migration Dividing cells in basal layer Dermis
  • 7. The Beginning of Cancerous Growth Underlying tissue
  • 8. Tumors (Neoplasms) Underlying tissue
  • 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. 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. Why Cancer Is Potentially Dangerous Brain Melanoma cells travel through bloodstream Liver Melanoma (initial tumor)
  • 12. Cancer Detection and Diagnosis
  • 13. Early Cancer May Not Have Any Symptoms
  • 14. Cervical Cancer Screening Normal Pap smear Abnormal Pap smear
  • 15. Breast Cancer Screening
  • 16. Prostate and Ovarian Cancer Screening
  • 17. Colon Cancer Screening
  • 18. Biopsy Pathology Proteomic profile Patient’s tissue sample or Genomic profile blood sample
  • 19. Microscopic Appearance of Cancer Cells
  • 20. Hyperplasia Normal Hyperplasia
  • 21. Dysplasia Normal Hyperplasia Mild dysplasia
  • 22. Carcinoma in Situ Normal Hyperplasia Mild Carcinoma in dysplasia situ (severe dysplasia) Cancer (invasive)
  • 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. Tumor Staging Five-Year Survival Rates for Patients with Melanoma (by stage) 100% 50% I II III Stage at Time of Initial Diagnosis
  • 25. What Causes Cancer? Some viruses or bacteria Some chemicals Radiation Heredity Diet Hormones
  • 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. 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. Tobacco Use and Cancer Some Cancer-Causing Chemicals in Tobacco Smoke
  • 29. Low-Strength Radiation High Dallas Skin Cancer Incidence Pittsburgh Detroit Low Least Most Annual Sunshine (UV radiation)
  • 30. High-Strength Radiation High Leukemia Incidence Low Least Most X-ray Dose (atomic radiation)
  • 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. Viruses Virus inserts and changes genes for cell growth Cancer-linked virus
  • 33. Examples of Human Cancer Viruses Some Viruses Associated with Human Cancers
  • 34. AIDS and Kaposi’s Sarcoma Without disease HIV infection Depressed immune system KSHV infection Kaposi’s sarcoma
  • 35. Bacteria and Stomach Cancer Patient’s H. pylori tissue sample
  • 36. Heredity and Cancer All Breast Cancer Patients Inherited factor(s) Other factor(s)
  • 37. Heredity Can Affect Many Types of Cancer Inherited Conditions That Increase Risk for Cancer
  • 38. Genetic Testing
  • 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. Genes and Cancer Viruses Chemicals Radiation Heredity Chromosomes are DNA molecules
  • 41. DNA Structure Chemical bases A T C G DNA molecule
  • 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. Oncogenes Normal cell Normal genes regulate cell growth Oncogenes Cancer cell accelerate cell growth and division Mutated/damaged oncogene
  • 44. Proto-Oncogenes and Normal Cell Growth Normal Growth-Control Pathway Growth factor Receptor Signaling enzymes Transcription factors DNA Cell nucleus Cell proliferation
  • 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. 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. 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. p53 Tumor Suppressor Protein Triggers Cell Suicide p53 protein Normal cell Excessive DNA damage Cell suicide (Apoptosis)
  • 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. 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. Mutations and Cancer Genes Implicated in Cancer
  • 52. Cancer Tends to Corrupt Surrounding Environment Growth factors = proliferation Invasive Matrix Proteases Fibroblasts, adipocytes Cytokines Blood vessel Cytokines, proteases = migration & invasion
  • 53. Cancer Prevention Carcinogenic chemicals Carcinogenic radiation Cancer viruses or bacteria
  • 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. Protect Yourself From Excessive Sunlight
  • 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. 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. Diet: Consume Fruits and Vegetables
  • 59. Avoid Cancer Viruses HPV Infection Increases High Risk for Cervical Cancer Cervical Cancer Risk Low Noninfected Women women infected with HPV
  • 60. Avoid Carcinogens at Work Some Carcinogens in the Workplace
  • 61. Industrial Pollution Incidence of Most Cancers 1930 1950 1970 1990 Year
  • 62. Is There a Cancer "Epidemic"?
  • 63. We would like to hear a questions from you . . . .
  • 64. Breast implant Breast augmentation
  • 65. A good result, but note the excessive gap between breasts, common in transsexual women.
  • 66. Saline filled implants
  • 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. Wrinkling Capsular contracture