2. cancer
• Cancer is one of the most common diseases in
the developed world:
• 1 in 4 deaths are due to cancer
• 1 in 17 deaths are due to lung cancer
• Lung cancer is the most common cancer in men
• Breast cancer is the most common cancer in
women
• There are over 100 different forms of cancer
3. • Cancer is a group of diseases characterized by
uncontrolled growth and spread of abnormal
cells.
• Cancer is caused by external factors and
internal factors which may act together to
initiate or promote carcinogenesis.
– External Factors – chemicals, radiation, viruses,
and lifestyle
– internal Factors – hormones, immune condition,
and inherited mutations
6. Cancer prevention?
• Cancer prevention is defined as active
measures to decrease the risk of cancer.
• Cancer is considered as the largely
preventable disease.
• Prevention offers the most cost-effective long-
term strategy for the control of cancer as 30-
40% of cancers can be prevented, and one-
third of cancers can be cured through early
diagnosis and treatment.
9. What Is Chemoprevention?
• The science of trying to apply natural and
synthetic compounds to interfere with the
earliest stages of carcinogenesis, before
invasive cancer appears
10. The Ideal Chemo preventive
Agent
• Is effective
• Easily administered
• Preferably once/twice day
• Little or ideally no toxicity
• Affordable
11. Strategy#1-dietary strategy for cancer
prevention
• 30% to 40% of all cancers may be prevented by changes in diet and
physical activity.
• Increase antioxidants by eating a variety of anti-oxidant rich fruits
and vegetables including nuts, seeds , herbs and spices.
• Antioxidants supplements mainly contain:-
1.Vitamin a,c,e,d and k
2.alpha-lipoic acid
3.co-enzyme q10
4. Falvanoids from plants including lycopene, resveratrol and
quercetin.
5. Carotenoids
6.selenium
16. Strategy#2 lifestyle strategy for cancer
prevention
• Maintain a healthy body weight.
• Be active, whether you walk with friends or sign
up for yoga class, set a fitness goal.
• Don’t miss regular check –ups with doctor
• Reduce your sodium intake.
• Switch to whole grains. Instead of white rice go
for brown rice.
• Choose water when you are thirsty. Reduce
intake of sweet drinks such as iced tea
• Avoid smoked or grilled food
17. • Quit smoking
• Protect your skin
• Limit red meat and animal fat
• Know your personal and family medical
history
• Get screened for cancer regularly
• Increase your physical activity
19. Surgery:
• Surgery was the first modality used
successfully in the treatment of cancer.
• It is the only curative therapy for many
common solid tumors.
• The most important determinant of a
successful surgical therapy are the absence of
distant metastases and no local infiltration.
20. Cont:
• Microscopic invasion of surrounding normal tissue
will necessitate multiple frozen section.
• Resection or sampling of regional lymph node is
usually indicated.
• Surgery may be used for palliation in patients for
whom cure is not possible.
• Has significant role in cancer prevention.
21. Surgery for prevention:
• Patients with conditions that predispose them
to certain cancers or with genetic traits
Associated with cancer can have normal life
span with prophylactic surgery.
-colectomy .
-oophorectomy.
-thyroidectomy.
-removal of premalignant skin lesion .
23. Radiation therapy:
• Radiation therapy: is a local modality used in the
treatment of cancer .
• Success depend in the difference in the radio
sensitivity between the tumor and normal tissue.
• It involves the administration of ionizing radiation in
the form of x-ray or gamma rays to the tumor site.
• Method of delivery: External beam(teletherapy).
Internal beam therapy(Brachytherapy).
24. BRACHYTHERAPY
• Internal radiation treatment achieved by
implanting radioactive material directly into
the tumor or very close to it.
• Sometimes called internal radiation therapy.
• Prefix “brachy” – from Greek for “short range”
25. WHY BRACHYTHERAPY
• Delivering the high dose of radiation to the
tumor
• Sparing of the surrounding normal tissues
• Delivered in a short period of time
– Tumor repopulation
• Limited to localized tumors
26. It is used to treat cancers of the:
• Head and neck, including mouth and lip
• Breast cancer
• Lung cancer
• Oesophagus , rectum, and bile duct
• Prostate
• Cervix, womb and vagina
27. TELETHERAPY
• Teletherapy or External Beam Radiation
Therapy" involves delivery of therapeutic
radiation from a source
• that is placed away
• from the body.
28. Cont:
• Radiation therapy is planned and performed
by a team of nurses, dosimetrists,physician
and radiation oncologist.
• A course of radiation therapy is preceded by a
simulation session in which low-energy beam
are used to produce radiograghic images that
indicate the exact beam location.
29. Cont:
• Radiation therapy is usually delivered in fractionated
doses such as 180 to 300 cGy per day,five times a
week for a total course of 5-8 weeks.
• Radiation therapy with curative intent is the main
treatment in limited stage Hodgkin’s disease,some
NHL,limited stage of prostate,gynecologic
tumors&CNS tumor .
• Also can use in palliative &emergency setting.
30. Depending on the type and stage of
your cancer, radiotherapy has different
goals:
• Curative treatment – to cure cancer and
reduce the risk of it recurring.
• Palliative treatment – to relieve symptoms
such as pain, pressure or bleeding.
31. DOSE
• The amount of radiation used in photon radiation
therapy is measured in gray (Gy),
• A unit of absorbed radiation equal to the dose of
one joule of energy absorbed per kilogram of
matter, or 100 rads.
• For curative cases, the typical dose for a solid
epithelial tumor ranges from 60 to 80 Gy, while
lymphomas are treated with 20 to 40 Gy.
• Preventive (adjuvant) doses are typically around
45–60 Gy in 1.8–2 Gy fractions (for breast, head,
and neck cancers.)
32. Complication of radiation:
• There is two types of toxicity ,acute and long term
toxicity.
• Systemic symptoms such as Fatigue,local skin
reaction,GI toxicity,oropharyngeal
mucositis&xerostomia.myelosuppression.
• Long-term sequelae:may occur many months or
years after radiation therapy.
• Radiation therapy is known to be
mutagenic,carcinogenic,and teratogen,and having
increased risk of developing both secondary
leukemia and solid tumor.
34. Chemotherapy:
• Systemic chemotherapy is the main treatment
available for disseminated malignant diseases.
• Progress in chemotherapy resulted in cure for
several tumors.
• Chemotherapy usually require multiple cycles.
35. Classification of cytotoxic drug:
• Cytotoxic agent can be roughly categorized
based on their activity in relation to the cell
cycle.
phase nonspecific. phase specific
cytotoxic drug
36. Cont :
• What is the difference between phase specific &
phase non specific?…..
• Phase non-specific:
– The drugs generally have a linear dose-response
curve( the drug administration ,the the
fraction of cell killed).
• Phase specific:
– Above a certain dosage level,further increase in
drug doesn’t result in more cell killing.but you can
play with duration of infusion.
39. Antitumor Antibiotics
Cell cycle non-specific agents
Variety of mechanisms: prevents DNA replication,
RNA production,
or both
Anthracyclines
Anthracenediones
Actinomycin D (dactinomycin) – DNA intercalator,
inhibits topoisomerase II also
Bleomycin – inhibits DNA synthesis, G2-phase
specific
Mitomycin C – functions as alkylator
40. They interfere with DNA and RNA growth by
substituting for the normal building blocks of RNA and
DNA.
These agents damage cells during the S phase
Commonly used to treat......
•leukemias,
•cancers of the breast
•ovary,
•intestinal tract,
as well as other types of cancer.
Antimetabolites
41. Cell-cycle Directed Anti-neoplastic Drugs
Cell Cycle Phase Drug Target
Go – G1 Taxol Microtubules (stabilize)
S-Phase Ara-C (Cytosine
arabinoside)
DNA synthesis
S- G2 VP-16 (Etoposide) Topoisomerase II
M Vinca-alkaloids
Taxol
Microtubule disrupters
Microtubule stabilizer
Non-cell-cycle specific Alkylating agents:
Cis-platinum
Cyclophosphamide
Nucleophiles (e.g. DNA)
42. Complication of Chemotherapy:
• Every chemotherapeutic will have some
deleterious side effect on normal tissue .
• E.G; Myelosuppression,nausea&vomiting,
Stomatitis,and alopecia are the most frequently
observed side effects.
43. • Chemotherapy targets cells which are dividing
rapidly.
• Chemotherapy cannot distinguish between
normal cells and cancer cells
• Healthy Cells which have a high rate of growth
and multiplication include cells of the bone
marrow, hair, GI mucosa and skin.
44. Combined Modality Therapies for Cancer
Surgery and Radiation
Adjuvant Chemotherapy: Surgery and Chemotherapy
Radio-sensitizers: Chemotherapy and Radiation
Chemotherapy and Host-Response Modification
• Induction of Differentiation by Chemotherapeutic Agents
• Induction of Apoptosis by Chemotherapeutic Agents
Immunotherapy and Gene Therapy
Genetically Engineered T-Cells
Combined
45. Immunotherapy of Cancer
• Potentially Highly Tumor-Specific
• Can be Effective Against Disseminated Disease Including
Unrecognized Micro-metastases
• Three main group of immunotherapy use to treat cancer –
• Cell based therapy
• Antibody therapy
• Cytokine therapy
46. Host-Response Modification in Cancer
Management
Potentially Less Intrusive than Other More-Aggressive
Modalities
Treating Host Supporting Cells to Reduce their ability to
promote tumor growth (e.g. anti-angiogenesis)
Host stromal cell interactions supporting tumor growth:
47. Gene Therapy for Cancer
• Potentially Highly Tumor-Specific
• Accessibility of Cell Targets Is a Major Obstacle
for General Application
• May Have Great Value in Combined Modality
Approaches
• Potentially Dangerous Side-Reactions from Viral
Vector Delivery Agents
