this powerpoint contains cancer definition, mechanism, types of cancer, treatments of cancer.

1. CANCER
LOGESH KUMAR S
M.PHARM (PHARMACOLOGY)

2. ORIGIN OFTHEWORD
“CANCER”
■ The disease was first called cancer by Greek physician Hippocrates (460-370 BC). He is
considered the “Father of Medicine.” Hippocrates used the terms carcinos and
carcinoma to describe non-ulcer forming and ulcer-forming tumors. In Greek this
means a crab.The description was names after the crab because the finger-like
spreading projections from a cancer called to mind the shape of a crab.
■ Later Roman physician,Celsus (28-50 BC) translated the Greek term into cancer, the
Latin word for crab.
■ It was Galen (130-200AD), another Roman physician, who used the term oncos (Greek
for swelling) to describe tumors. Oncos is the root word for oncology or study of
cancers

3. CANCER
■ In the most basic terms, cancer refers to cells that grow out-of-control and invade other
tissues. Cells may become cancerous due to the accumulation of defects, or mutations, in
their DNA. Certain inherited genetic defects (for example, BRCA1 and BRCA2 mutations)
and infections can increase the risk of cancer.
■ Certain genes control the life cycle—the growth, function, division, and death—of a cell.
When these genes are damaged, the balance between normal cell growth and death is lost.
Cancer cells are caused by DNA damage and out-of-control cell growth.

4. Benign
vs
Malignant
Tumors
There are two main classifications of tumors.
One is known as benign and the other as
malignant.
A benign tumor is a tumor that does not
invade its surrounding tissue or spread around
the body.
A malignant tumor is a tumor that may
invade its surrounding tissue or spread around
the body.

5. STAGES OF CANCER
TheTNM classification of a cancer usually
correlates to one of the following five stages.
■ Stage 0:This refers to cancer that is "in situ,"
meaning that cancerous cells are confined to
their site of origin.This type of cancer has not
spread and is not invading other tissues.
■ Stage I – Stage III:These higher stages of
cancer correspond to larger tumors and/or
greater extent of disease. Cancers in these
stages may have spread beyond the site of
origin to invade regional lymph nodes, tissues,
or organs.
■ Stage IV:This type of cancer has spread to
distant lymph nodes, tissues, or organs in the
body far away from the site of origin.

6. Causes of cancer
■ Cancer is caused by accumulated damage to genes. Such changes may be due to
chance or to exposure to a cancer causing substance.
■ The substances that cause cancer are called carcinogens.A carcinogen may be a
chemical substance, such as certain molecules in tobacco smoke.The cause of cancer
may be environmental agents, viral or genetic factors.

7. CAUSE
OF
CANCER
BIOLOGICAL OR
INTERNAL
FACTORS AGE
•Gender
• Inherited genetic
defects
•Skin type
LIFESTYLE-
RELATED
FACTORS
Tobacco
Alcohol
Food-related factors
ENVIRONMENTS
FACTORS
Asbestos fibres
Tar and pitch
polynuclear
hydrocarbons
Metal compounds
Plastic chemicals
BACTERIA AND
VIRUSES
Helicobacter pylori
HBV, HCV
HPV
EBV
RADIATION
ionising radiation (e.g.
X-ray radiation, soil
radon)
non-ionised radiation
(the sun’s ultraviolet
radiation
DRUGS
Antineoplastic agents
Hormones
Medicines that cause
immune deficiency

8. Drivers of Cancer
■ The genetic changes that contribute to cancer tend to affect three main types of genes—
– proto-oncogenes,
– tumor suppressor genes
– DNA repair genes.
These changes are sometimes called “drivers” of cancer.
■ Proto-oncogenes are involved in normal cell growth and division. However, when these genes are
altered in certain ways or are more active than normal, they may become cancer-causing genes (or
oncogenes), allowing cells to grow and survive when they should not.
■ Tumor suppressor genes are also involved in controlling cell growth and division. Cells with certain
alterations in tumor suppressor genes may divide in an uncontrolled manner.
■ DNA repair genes are involved in fixing damaged DNA.Cells with mutations in these genes tend to
develop additional mutations in other genes.Together, these mutations may cause the cells to
become cancerous.

9. STATISTICS
■ In 2018, an estimated 1,735,350 new cases of cancer will be diagnosed in the United States
and 609,640 people will die from the disease.
■ The number of new cases of cancer is 439.2 per 100,000 men and women per year (based on
2011–2015 cases).
■ The number of cancer deaths is 163.5 per 100,000 men and women per year (based on 2011–
2015 deaths).
■ Cancer mortality is higher among men than women (196.8 per 100,000 men and 139.6 per
100,000 women). In 2016, there were an estimated 15.5 million cancer survivors in the United
States.The number of cancer survivors is expected to increase to 20.3 million by 2026.
■ Approximately 38.4% of men and women will be diagnosed with cancer at some point during
their lifetimes (based on 2013–2015 data).
■ In 2017, an estimated 15,270 children and adolescents ages 0 to 19 were diagnosed with
cancer and 1,790 died of the disease.

11. TYPES OF CANCER
Cancer can occur anywhere in the body. Broadly, cancers are classified as either
– solid (for example breast, lung, or prostate cancers) or
– liquid (blood cancers).
Cancer is further classified according to the tissue in which it arises.
– Carcinoma
– Sarcoma
– Leukemia
– Lymphoma
– Myeloma
– Melanoma

12. COMMONTYPES OF
CANCER■ BladderCancer
■ Breast Cancer
■ Colon and Rectal Cancer
■ Endometrial Cancer
■ Kidney Cancer
■ Leukemia
■ Liver
■ Lung Cancer
■ Melanoma
■ Non-Hodgkin Lymphoma
■ Pancreatic Cancer
■ Prostate Cancer
■ Thyroid Cancer

13. CANCER
TREATME
NTS
CHEMOTHE
RAPY
SURGERY
RADIATION
THERAPY
IMMUNOTH
ERAPY
TARGETED
THERAPY
HORMONE
THERAPY
STEM CELL
TRANSPLA
NT
PRECISION
MEDICINE

14. Surgery
When used to treat cancer, surgery is a
procedure in which a surgeon removes cancer
from your body. Learn the different ways that
surgery is used against cancer and what you can
expect before, during, and after surgery.
Surgery involves :
Remove the entire tumor
Debulk a tumor
Ease cancer symptoms

15. Surgery that do not involve cuts with scalpels :
Cryosurgery
Cryosurgery is a type of treatment in which extreme cold produced by liquid nitrogen
or argon gas is used to destroy abnormal tissue. Cryosurgery may be used to treat early-stage
skin cancer, retinoblastoma, and precancerous growths on the skin and cervix. Cryosurgery is
also called cryotherapy.
cryosurgery can be an effective treatment for the following:
■ Retinoblastoma (a childhood cancer that affects the retina of the eye). Doctors have found
that cryosurgery is most effective when the tumor is small and only in certain parts of the
retina.
■ Early-stage skin cancers (both basal cell and squamous cell carcinomas).
■ Precancerous skin growths known as actinic keratosis.
■ Precancerous conditions of the cervix known as cervical intraepithelial neoplasia (abnormal
cell changes in the cervix that can develop into cervical cancer).

16. Lasers
This is a type of treatment in which powerful beams of light are used to cut
through tissue. Lasers can focus very accurately on tiny areas, so they can be used for
precise surgeries. Lasers can also be used to shrink or destroy tumors or growths that
might turn into cancer.
Three types of lasers are used to treat cancer:
■ CO and argon lasers can cut the skin’s surface without going into deeper layers.Thus,
they can be used to remove superficial cancers, such as skin cancer. In contrast, the
Nd:YAG laser is more commonly applied through an endoscope to treat internal
organs, such as the uterus, esophagus, and colon.
■ Neodymium:yttrium-aluminum-garnet Nd:YAG laser light can also travel through
optical fibers into specific areas of the body during LITT.Argon lasers are often used to
activate the drugs used in PDT

17. ■ Hyperthermia
Hyperthermia is a type of treatment in which small areas of body tissue are
exposed to high temperatures.The high heat can damage and kill cancer cells or make
them more sensitive to radiation and certain chemotherapy drugs. Radiofrequency
ablation is one type of hyperthermia that uses high-energy radio waves to generate
heat. Hyperthermia is not widely available and is being studied in clinical trials.
■ Different methods of hyperthermia
– Whole-body hyperthermia
– Local hyperthermia
■ External
■ Intraluminal or endocavitary
■ Interstitial
– Regional hyperthermia
■ Deep tissue
■ Regional perfusion
■ Continuous hyperthermic peritoneal perfusion (CHPP)

18. PhotodynamicTherapy
Photodynamic therapy is a type of treatment that uses drugs which react to a
certain type of light.When the tumor is exposed to this light, these drugs become active
and kill nearby cancer cells. Photodynamic therapy is used most often to treat or
relieve symptoms caused by skin cancer, mycosis fungoides, and non-small cell lung
cancer.
■ To date, the FDA has approved the photosensitizing agent called porfimer sodium, or
Photofrin®, for use in PDT to treat or relieve the symptoms of esophageal cancer and
non-small cell lung cancer.
■ Porfimer sodium is approved to relieve symptoms of esophageal cancer when the
cancer obstructs the esophagus or when the cancer cannot be satisfactorily treated
with laser therapy alone.
■ Porfimer sodium is used to treat nonsmall cell lung cancer in patients for whom the
usual treatments are not appropriate, and to relieve symptoms in patients with non-
small cell lung cancer that obstructs the airways.
■ In 2003, the FDA approved porfimer sodium for the treatment of precancerous lesions
in patients with Barrett esophagus, a condition that can lead to esophageal cancer.

19. Radiation
Therapy
Radiation therapy is a type of cancer
treatment that uses high doses of radiation
to kill cancer cells and shrink tumors. Learn
about the types of radiation, why side
effects happen, which ones you might
have, and more.
Types of Radiation Therapy
There are two main types of
radiation therapy
• External Beam Radiation Therapy
• Internal Radiation Therapy

20. External Beam RadiationTherapy
■ External beam radiation therapy comes from a machine that aims radiation at your cancer.
The machine is large and may be noisy. It does not touch you, but can move around you,
sending radiation to a part of your body from many directions.
■ External beam radiation therapy is a local treatment, which means it treats a specific part
of your body. For example, if you have cancer in your lung, you will have radiation only to
your chest, not to your whole body.
Types of Beams Used in Radiation Therapy
Radiation beams used in external radiation therapy come from three types of particles:
– Photons
– Protons
– Electrons

21. Types of External Beam RadiationTherapy
■ 3-D conformal radiation therapy
3-D conformal radiation therapy is a common type of external beam radiation
therapy. It uses images from CT, MRI, and PET scans to precisely plan the treatment area,
a process called simulation.A computer program is used to analyze the images and to
design radiation beams that conform to the shape of the tumor.
■ Intensity-modulated radiation therapy (IMRT)
IMRT is a type of 3-D conformal radiation therapy. Like 3-D conformal radiation,
radiation beams are aimed at the tumor from several directions. IMRT uses many more
smaller beams than 3-D conformal and the strength of the beams in some areas can be
changed to give higher doses to certain parts of the tumor.

22. ■ Image-guided radiation therapy (IGRT)
IGRT is a type of IMRT. However, it uses imaging scans not only for treatment planning
before radiation therapy sessions, but also during radiation therapy sessions.
During treatment, you will have repeated scans, such as CT, MRI, or PET scans.These
scans are processed by computers to detect changes in the tumor’s size and location.The
repeated imaging allows for your position or the radiation dose to be adjusted during
treatment, if needed.These adjustments can improve the accuracy of treatment and help
spare normal tissue.
■ Tomotherapy®
Tomotherapy® is a type of IMRT that uses a machine that is a combination of a CT
scanner and an external-beam radiation machine.
Tomotherapy® machines take images of the tumor right before treatment sessions to
allow for very precise tumor targeting and sparing of normal tissues. It rotates around you
during treatment, delivering radiation in a spiral pattern, slice by slice.Tomotherapy® might be
better at sparing normal tissue than 3-D conformal radiation therapy, but it has not been
tested in clinical trials to be sure.

23. ■ Stereotactic radiosurgery
Stereotactic radiosurgery is the use of focused, high-energy beams to treat small tumors
with well defined edges in the brain and central nervous system. It may be an option if surgery is
too risky due to your age or other health problems or if the tumor cannot safely be reached with
surgery. Gamma Knife is a type of stereotactic radiosurgery.
You will be placed in a head frame or some other device to make sure you do not move
during treatment. In stereotactic radiosurgery, many small beams of radiation are aimed at the
tumor from different directions. Each beam has very little effect on the tissue it passes through,
but a precisely targeted dose of radiation is delivered to the site where all the beams come
together.

24. Internal RadiationTherapy
■ Internal radiation therapy is a treatment in which a source of radiation is put inside your
body.The radiation source can be solid or liquid.
■ Internal radiation therapy with a solid source is called brachytherapy. In this type of
treatment, seeds, ribbons, or capsules that contain a radiation source are placed in your
body, in or near the tumor. Like external beam radiation therapy, brachytherapy is a local
treatment and treats only a specific part of your body.
Techniques for placing brachytherapy include:
■ Interstitial brachytherapy, in which the radiation source is placed within the tumor.This
technique is used for prostate cancer, for instance.
■ Intracavity brachytherapy, in which the radiation source is placed within a body cavity or a
cavity created by surgery. For example, radiation can be placed in the vagina to treat
cervical or endometrial cancer.
■ Episcleral brachytherapy, in which the radiation source is attached to the eye.This
technique is used totreat melanoma of the eye.

25. Types of Brachytherapy
There are three types of brachytherapy:
■ Low-dose rate (LDR) implants:
In this type of brachytherapy, the radiation source stays in place for 1 to 7 days.
You are likely to be in the hospital during this time. Once your treatment is finished, your
doctor will remove the radiation source and the catheter or applicator.
■ High-dose rate (HDR) implants:
In this type of brachytherapy, the radiation source is left in place for just 10 to 20
minutes at a time and then taken out.You may have treatment twice a day for 2 to 5 days
or once a week for 2 to 5 weeks.The schedule depends on your type of cancer. During the
course of treatment, your catheter or applicator may stay in place, or it may be put in
place before each treatment.You may be in the hospital during this time, or you may
make daily trips to the hospital to have the radiation source put in place.As with LDR
implants, your doctor will remove the catheter or applicator once you have finished
treatment.

26. ■ Permanent implants:
After the radiation source is put in place, the catheter is removed.The implants
remain in your body for the rest of your life, but the radiation gets weaker each day.As
time goes on, almost all the radiation will go away.When the radiation is first put in place,
you may need to limit your time around other people and take other safety measures. Be
extra careful not to spend time withchildren or pregnant women.

27. Chemotherapy
Chemotherapy (also called chemo) is a type of
cancer treatment that uses drugs to kill cancer
cells.
Chemotherapy works by stopping or slowing the
growth of cancer cells, which grow and divide
quickly. Chemotherapy is used to:
• Treat cancer
Chemotherapy can be used to cure cancer,
lessen the chance it will return, or stop or slow
its growth.
• Ease cancer symptoms
Chemotherapy can be used to shrink tumors
that arecausing pain and other problems.

28. When used with other treatments, chemotherapy can:
■ Make a tumor smaller before surgery or radiation therapy.This is called neoadjuvant
chemotherapy.
■ Destroy cancer cells that may remain after treatment with surgery or radiation therapy.This is
called adjuvant chemotherapy.
■ Help other treatments work better.
■ Kill cancer cells that have returned or spread to other parts of your body.

29. Chemotherapy may be given in many ways. Some common ways include:
■ Oral
The chemotherapy comes in pills, capsules, or liquids that you swallow
■ Intravenous (IV)
The chemotherapy goes directly into a vein
■ Injection
The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin
in the fatty part of your arm, leg, or belly
■ Intrathecal
The chemotherapy is injected into the space between the layers of tissue that cover the brain and
spinal cord
■ Intraperitoneal (IP)
The chemotherapy goes directly into the peritoneal cavity, which is the area in your body that
contains organs such as your intestines, stomach, and liver
■ Intra-arterial (IA)
The chemotherapy is injected directly into the artery that leads to the cancer
■ Topical
The chemotherapy comes in a cream that you rub onto your skin

30. Immunotherapy toTreat Cancer
Immunotherapy is a type of cancer treatment that helps your immune system
fight cancer.This page covers the types of immunotherapy, how it is used against cancer,
and what you can expect during treatment.
■ Types of immunotherapy
– Immune checkpoint inhibitors
– T-cell transfer therapy
– Monoclonal antibodies
– Treatment vaccines
– Immune system modulators

31. Immune
checkpoint
inhibitors
These are drugs that block
immune checkpoints.These checkpoints
are a normal part of the immune system
and keep immune responses from being
too strong. By blocking them, these drugs
allow immune cells to respond more
strongly to cancer.

32. T-cell transfer
therapy
T-cell transfer therapy, which is
a treatment that boosts the natural
ability of yourT cells to fight cancer. In
this treatment, immune cells are taken
from your tumor.Those that are most
active against your cancer are selected or
changed in the lab to better attack your
cancer cells, grown in large batches, and
put back into your body through a needle
in a vein.T-cell transfer therapy may also
be called adoptive cell therapy, adoptive
immunotherapy, or immune cell therapy.

33. Monoclonal
antibodies
Monoclonal antibodies, which
are immune system proteins created in the
lab that are designed to bind to specific
targets on cancer cells. Some monoclonal
antibodies mark cancer cells so that they
will be better seen and destroyed by the
immune system. Such monoclonal
antibodies are a type of immunotherapy.
Monoclonal antibodies may also be called
therapeutic antibodies.

34. Treatment vaccines
Treatment vaccines, which work against cancer by boosting your immune
system’s response to cancer cells.Treatment vaccines are different from the ones that
help prevent disease. Learn more about cancer treatment vaccines.
■ Sipuleucel-T is used to treat men with prostate cancer:
– That has spread to other parts of the body
– Who have few or no symptoms
– Whose cancer does not respond to hormone treatment
■ T-VEC is used to treat some patients with melanoma that returns after surgery
and cannot be removed with more surgery.

35. Immune system modulators
Immune system modulators, which enhance the body’s immune response
against cancer. Some of these agents affect specific parts of the immune system, whereas
others affect the immune system in a more general way.
Types of immune-modulating agents include:
– Cytokines
■ Interferons (INFs).
■ Interleukins (ILs)
– BCG
– Immunomodulatory drugs
■ Thalidomide (Thalomid®)
■ Lenalidomide (Revlimid®)

36. TargetedTherapy
Targeted therapy is a
type of cancer treatment
that targets the changes in
cancer cells that help them
grow, divide, and spread.
Learn how targeted therapy
works against cancer and
about common side effects
that may occur.

37. Most targeted therapies are either small-molecule drugs or monoclonal
antibodies.
■ Small-molecule drugs are small enough to enter cells easily, so they are
used for targets that are inside cells.
■ Monoclonal antibodies, also known as therapeutic antibodies, are
proteins produced in the lab.These proteins are designed to attach to
specific targets found on cancer cells. Some monoclonal antibodies
mark cancer cells so that they will be better seen and destroyed by the
immune system. Other monoclonal antibodies directly stop cancer cells
from growing or cause them to self-destruct. Still others carry toxins to
cancer cells.

38. ROLE OFTARGETEDTHERAPY IN CANCER
– Help the immune system destroy cancer cells.
– Stop cancer cells from growing
– Stop signals that help form blood vessels
– Deliver cell-killing substances to cancer cells
– Cause cancer cell death
– Starve cancer of the hormones it needs to grow

39. Hormone
Therapy
Hormone therapy is a
treatment that slows or
stops the growth of breast
and prostate cancers that
use hormones to grow.

40. Hormone therapy is used to:
■ Treat cancer. Hormone therapy can lessen the chance that cancer will return or stop or slow its
growth.
■ Ease cancer symptoms. Hormone therapy may be used to reduce or prevent symptoms in
men with prostate cancer who are not able to have surgery or radiation therapy.
Types of HormoneTherapy
Hormone therapy falls into two broad groups, those that block the body’s ability to
produce hormones and those that interfere with how hormones behave in the body

41. Stem CellTransplant
Stem cell transplants
are procedures that restore
blood-forming stem cells in
cancer patients who have
had theirs destroyed by very
high doses of chemotherapy
or radiation therapy.

42. Types of Stem CellTransplants
■ Autologous, which means the stem cells come from you, the patient
■ Allogeneic, which means the stem cells come from someone else.The
donor may be a blood relative but can also be someone who is not
related.
■ Syngeneic, which means the stem cells come from your identical twin, if
you have one

43. Precision
Medicine
Precision medicine
helps doctors select
treatments that are most
likely to help patients based
on a genetic understanding
of their disease..