Winston Tan

1. Winston W. Tan MD FACP
Associate Professor of Medicine
Hematology/Oncology
Mayo Clinic Florida

2. Conflict of interest
none

3. • Discuss the principles of cancer pathophysiology.
• Describe the principles of staging and diagnosing
cancer
• List at least two principles for therapy of cancer
Objectives

5.  Extrinsic factors- smoking, virus, sun, radiation
 Intrinsic factors- genetics
 Population risk is often reported relative to another
population
Risk of Cancer

6.  Nucleic acid structure
 Organization of gene
 Structure of DNA and RNA
Molecular Biology

7.  Diagnosis
 Stage
 Plan of treatment
 Surgery
 Radiation
 Combined
 Chemotherapy or targeted treatment
Steps

8.  Routine histo-pathologic examination
 Immuno-histochemistry for classification
 Histologic diagnosis and classification of cancer
 Cytogenetics and flow cytometry
 Tumor markers
Diagnosis:Surgical pathology

9.  X-ray
 Ultrasound
 CT scan
 MRI
 PET scan
Diagnosis: Radiologic imaging

11. Incidence Mortality Prevalence
Lung Lung breast
Breast stomach colorectal
Stomach liver prostate
Leading causes of Cancer incidence,
mortality and prevalence worldwide

12.  Localized
 Systemic
 Stage I and II localized
 Stage III locally advanced
 Stage IV metastatic
Staging

13.  Most common use is in advanced and metastatic
disease
 Adjuvant
 Neoadjuvant
Chemotherapy

14.  Combination chemotherapy has become the standard
for majority of cancer therapy
 Biologic targeted therapies are quickly entering
standard pratices
Clinical Pharmacology

15.  Maximal cell kill within a range of tolerable toxicity
 Broad coverage in resistant cell lines
 Prevention of drug resistance
 Stimulation of cellular cycle through cellular stress
Combination chemotherapy

16.  Effective therapy must be available
 Known tumor must be removed by surgery
 Chemotherapy started postoperatively
 Chemotherapy given at maximum tolerated dose
 Chemotherapy for a limited period of time
Abeloff et al
Principles of adjuvant chemotherapy

17.  Wilm’ s tumor
 Testicular cancer
 Osteosarcoma
 Breast cancer
 Colon cancer
Cancers effectively treated with
adjuvant chemotherapy

18.  Soft tissue sarcoma
 Osteosarcoma
 Anal cancer
 Bladder cancer
 Larynx cancer
 Esophageal cancer
 Locally advanced breast cancer
Tumors effectively treated with neo-
adjuvant chemotherapy

19.  Gestational choriocarcinoma
 Testicular cancer
 Hodgkins lymphoma
 Acute lymphoid leukemia
 Non-hodgkins lymphoma
 Hairy cell leukemia
Cancers curable with chemotherapy
alone

20.  Immune system
 T lymphocytes
 T cell recognize antigen
 T cell receptor interaction
 Eg. Interleukin- 2, rituximab, trastuzumab
 Ipilumimab
 Pd-1 inhibitors
Biologic therapy

21.  Most common cancer in women
 215,000 women each year and 1450 men
 40,000 deaths
 1:8 women will have breast cancer
 American Cancer Society 2009
Breast Cancer

22.  Female
 BRCA1, 2
 Family history of breast cancer
 Age 50
 Benign breast disease
 Nulli-parity
 Age at first birth 30
 Age at menarche
 Radiation
 Oral contraceptives
 Alcohol consumption
 Increased body mass index
Risk factor for breast Cancer

24.  FNA
 Core biopsy
 Needle localization
 Excision biopsy
 Incisional biospy
Diagnosis

25.  Tumor size
 Axillary involvement
 Histologic type
 Histologic grade
 Steroid receptor
 Her2 status
Prognostic markers

26.  T O non-invasive breast cancer
 Stage I
 Stage II
 Stage III
 Stage IV
Staging

27.  Tumor size
 Grade
 Estrogen
 Her-2
 Axillary node
Pathology

29.  Sentinel node
 Axillary node dissection
 Node status as basis for therapy
Node evaluation

30.  SERM- tamoxifen, raloxifene
 Aromatase inhibitors
Anastrazole
Letrozole
exemestane
Anti-estrogen treatment

31.  Surgery- mastectomy, lumpectomy
 Radiation
 Chemotherapy
Treatment

32.  Adjuvant
 Neoadjuvant
 Metastatic disease
Chemotherapy indications

33.  Tamoxifen
 Arimidex
 Exemestane
 letrozole
Antiestrogen

34.  Most common cancer in men
 173,770 new cases
 160,000 deaths
 Smoking
Lung Cancer

36.  Lung biopsy
 Mediastinoscopy
 PET/CT
 Staging
Diagnosis

37.  EGFR
 RAS
 ALK
Tumor markers for personalize
medicine

38.  Stage IIIA or B
 Downstage disease
 Chemotherapy-radiation
Radiation

39.  Adjuvant
 Stage I-B to Stage II
 Metastatic treatment
 Adenocarcinoma or not
 EGFR
 ALK
Chemotherapy

40.  Most common cancer in men
 200,000
 Mortality 27, 000
 PSA
 Rectal examination
 biopsy
Prostate Cancer

41. From Prostate Cancer: with a Dose of Reality and a Slice of Humor

42.  Testicular mass
 Pathology
 Seminoma
 nonseminoma
Testicular cancer

43.  Stage 1
 Stage II node
 Stage III lung or others
Staging

44.  Stage I resection, options
 Stage II radiation
 Stage III chemotherapy
Seminoma treatment

45.  Stage I resection
 Stage II retroperitoneal node dissection
 Size 5 cm and greater chemotherapy
 Stage III chemotherapy
Non-seminoma

47.  ALL
 AML
 CML
 CLL
Leukemias

48.  Chemotherapy
 Bone marrow transplant
 Immunotherapy/monoclonal antibodies
Treatment

49.  Induction
 Consolidation
 maintenance
ALL

50. Capture the Moment: Patient/Caregiver Cancer
Education Symposium: Complimentary