SlideShare a Scribd company logo
Winston W. Tan MD FACP
Associate Professor of Medicine
Hematology/Oncology
Mayo Clinic Florida
Conflict of interest
none
• Discuss the principles of cancer pathophysiology.
• Describe the principles of staging and diagnosing
cancer
• List at least two principles for therapy of cancer
Objectives
 Extrinsic factors- smoking, virus, sun, radiation
 Intrinsic factors- genetics
 Population risk is often reported relative to another
population
Risk of Cancer
 Nucleic acid structure
 Organization of gene
 Structure of DNA and RNA
Molecular Biology
 Diagnosis
 Stage
 Plan of treatment
 Surgery
 Radiation
 Combined
 Chemotherapy or targeted treatment
Steps
 Routine histo-pathologic examination
 Immuno-histochemistry for classification
 Histologic diagnosis and classification of cancer
 Cytogenetics and flow cytometry
 Tumor markers
Diagnosis:Surgical pathology
 X-ray
 Ultrasound
 CT scan
 MRI
 PET scan
Diagnosis: Radiologic imaging
Incidence Mortality Prevalence
Lung Lung breast
Breast stomach colorectal
Stomach liver prostate
Leading causes of Cancer incidence,
mortality and prevalence worldwide
 Localized
 Systemic
 Stage I and II localized
 Stage III locally advanced
 Stage IV metastatic
Staging
 Most common use is in advanced and metastatic
disease
 Adjuvant
 Neoadjuvant
Chemotherapy
 Combination chemotherapy has become the standard
for majority of cancer therapy
 Biologic targeted therapies are quickly entering
standard pratices
Clinical Pharmacology
 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
 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
 Wilm’ s tumor
 Testicular cancer
 Osteosarcoma
 Breast cancer
 Colon cancer
Cancers effectively treated with
adjuvant chemotherapy
 Soft tissue sarcoma
 Osteosarcoma
 Anal cancer
 Bladder cancer
 Larynx cancer
 Esophageal cancer
 Locally advanced breast cancer
Tumors effectively treated with neo-
adjuvant chemotherapy
 Gestational choriocarcinoma
 Testicular cancer
 Hodgkins lymphoma
 Acute lymphoid leukemia
 Non-hodgkins lymphoma
 Hairy cell leukemia
Cancers curable with chemotherapy
alone
 Immune system
 T lymphocytes
 T cell recognize antigen
 T cell receptor interaction
 Eg. Interleukin- 2, rituximab, trastuzumab
 Ipilumimab
 Pd-1 inhibitors
Biologic therapy
 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
 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
 FNA
 Core biopsy
 Needle localization
 Excision biopsy
 Incisional biospy
Diagnosis
 Tumor size
 Axillary involvement
 Histologic type
 Histologic grade
 Steroid receptor
 Her2 status
Prognostic markers
 T O non-invasive breast cancer
 Stage I
 Stage II
 Stage III
 Stage IV
Staging
 Tumor size
 Grade
 Estrogen
 Her-2
 Axillary node
Pathology
 Sentinel node
 Axillary node dissection
 Node status as basis for therapy
Node evaluation
 SERM- tamoxifen, raloxifene
 Aromatase inhibitors
Anastrazole
Letrozole
exemestane
Anti-estrogen treatment
 Surgery- mastectomy, lumpectomy
 Radiation
 Chemotherapy
Treatment
 Adjuvant
 Neoadjuvant
 Metastatic disease
Chemotherapy indications
 Tamoxifen
 Arimidex
 Exemestane
 letrozole
Antiestrogen
 Most common cancer in men
 173,770 new cases
 160,000 deaths
 Smoking
Lung Cancer
 Lung biopsy
 Mediastinoscopy
 PET/CT
 Staging
Diagnosis
 EGFR
 RAS
 ALK
Tumor markers for personalize
medicine
 Stage IIIA or B
 Downstage disease
 Chemotherapy-radiation
Radiation
 Adjuvant
 Stage I-B to Stage II
 Metastatic treatment
 Adenocarcinoma or not
 EGFR
 ALK
Chemotherapy
 Most common cancer in men
 200,000
 Mortality 27, 000
 PSA
 Rectal examination
 biopsy
Prostate Cancer
From Prostate Cancer: with a Dose of Reality and a Slice of Humor
 Testicular mass
 Pathology
 Seminoma
 nonseminoma
Testicular cancer
 Stage 1
 Stage II node
 Stage III lung or others
Staging
 Stage I resection, options
 Stage II radiation
 Stage III chemotherapy
Seminoma treatment
 Stage I resection
 Stage II retroperitoneal node dissection
 Size 5 cm and greater chemotherapy
 Stage III chemotherapy
Non-seminoma
 ALL
 AML
 CML
 CLL
Leukemias
 Chemotherapy
 Bone marrow transplant
 Immunotherapy/monoclonal antibodies
Treatment
 Induction
 Consolidation
 maintenance
ALL
Capture the Moment: Patient/Caregiver Cancer
Education Symposium: Complimentary

More Related Content

What's hot

Molecular basis of thyroid neoplasm subhasish
Molecular basis of thyroid neoplasm  subhasishMolecular basis of thyroid neoplasm  subhasish
Molecular basis of thyroid neoplasm subhasish
Subhasish Saha
 
Management of cancer
Management of cancerManagement of cancer
Management of cancer
meducationdotnet
 
Treating Cancer
Treating CancerTreating Cancer
Treating Cancer
a.crandon
 
Cancer
CancerCancer
General Interventions for Clients with Cancer
General Interventions for Clients with CancerGeneral Interventions for Clients with Cancer
General Interventions for Clients with Cancer
byronrn17
 
1 Introduction To Oncology
1 Introduction To Oncology1 Introduction To Oncology
1 Introduction To Oncology
Miami Dade
 
Thyroid cancer
Thyroid cancerThyroid cancer
Thyroid cancer
Mohammed Fathy
 
Approach to thyroid cancer
Approach to thyroid cancerApproach to thyroid cancer
Approach to thyroid cancer
MohammedAlHinai18
 
Thyroid carcinoma
Thyroid carcinomaThyroid carcinoma
Thyroid carcinoma
ajith joseph
 
Cancer treatment
Cancer treatment Cancer treatment
Cancer treatment
Amany Elsayed
 
Breast cancer written report
Breast cancer written reportBreast cancer written report
Breast cancer written report
Timothy Zagada
 
Cancer
CancerCancer
Cancer
raj kumar
 
Cancer Ppt 2008
Cancer Ppt 2008Cancer Ppt 2008
Cancer Ppt 2008
NorthTec
 
Thyroid cancer ppt
Thyroid cancer ppt Thyroid cancer ppt
Thyroid cancer ppt
pendom11
 
Thyroid cancer etiology 2
Thyroid cancer etiology 2Thyroid cancer etiology 2
Thyroid cancer etiology 2
Anaparti Rasagna
 
Thyroid Disease
Thyroid DiseaseThyroid Disease
Thyroid Disease
Flavio Guzmán
 
Lung Cancerrr.pdf
Lung Cancerrr.pdfLung Cancerrr.pdf
Lung Cancerrr.pdf
samehmohammed22
 
Breast cancer
Breast cancerBreast cancer
Breast cancer
Bashir BnYunus
 
An introduction to thyroid cancer
An introduction to thyroid cancerAn introduction to thyroid cancer
An introduction to thyroid cancer
Creative-Biolabs
 
Aetiology of human cancer
Aetiology of human cancerAetiology of human cancer
Aetiology of human cancer
Dr./ Ihab Samy
 

What's hot (20)

Molecular basis of thyroid neoplasm subhasish
Molecular basis of thyroid neoplasm  subhasishMolecular basis of thyroid neoplasm  subhasish
Molecular basis of thyroid neoplasm subhasish
 
Management of cancer
Management of cancerManagement of cancer
Management of cancer
 
Treating Cancer
Treating CancerTreating Cancer
Treating Cancer
 
Cancer
CancerCancer
Cancer
 
General Interventions for Clients with Cancer
General Interventions for Clients with CancerGeneral Interventions for Clients with Cancer
General Interventions for Clients with Cancer
 
1 Introduction To Oncology
1 Introduction To Oncology1 Introduction To Oncology
1 Introduction To Oncology
 
Thyroid cancer
Thyroid cancerThyroid cancer
Thyroid cancer
 
Approach to thyroid cancer
Approach to thyroid cancerApproach to thyroid cancer
Approach to thyroid cancer
 
Thyroid carcinoma
Thyroid carcinomaThyroid carcinoma
Thyroid carcinoma
 
Cancer treatment
Cancer treatment Cancer treatment
Cancer treatment
 
Breast cancer written report
Breast cancer written reportBreast cancer written report
Breast cancer written report
 
Cancer
CancerCancer
Cancer
 
Cancer Ppt 2008
Cancer Ppt 2008Cancer Ppt 2008
Cancer Ppt 2008
 
Thyroid cancer ppt
Thyroid cancer ppt Thyroid cancer ppt
Thyroid cancer ppt
 
Thyroid cancer etiology 2
Thyroid cancer etiology 2Thyroid cancer etiology 2
Thyroid cancer etiology 2
 
Thyroid Disease
Thyroid DiseaseThyroid Disease
Thyroid Disease
 
Lung Cancerrr.pdf
Lung Cancerrr.pdfLung Cancerrr.pdf
Lung Cancerrr.pdf
 
Breast cancer
Breast cancerBreast cancer
Breast cancer
 
An introduction to thyroid cancer
An introduction to thyroid cancerAn introduction to thyroid cancer
An introduction to thyroid cancer
 
Aetiology of human cancer
Aetiology of human cancerAetiology of human cancer
Aetiology of human cancer
 

Similar to Basic Principles

Terminal illness care
Terminal illness careTerminal illness care
Terminal illness care
Mohammad Asif
 
Human Bio Iii Oncology I
Human Bio Iii Oncology IHuman Bio Iii Oncology I
Human Bio Iii Oncology I
MedicineAndHealthCancer
 
BM
BMBM
Discuss the pathology of bladder cancers
Discuss the pathology of bladder cancersDiscuss the pathology of bladder cancers
Discuss the pathology of bladder cancers
Jim Badmus
 
Breast Cancer Awareness
Breast Cancer AwarenessBreast Cancer Awareness
Breast Cancer Awareness
Queens Library
 
Uterine Cancer
Uterine CancerUterine Cancer
#10 Breast Cancer.pdf
#10 Breast Cancer.pdf#10 Breast Cancer.pdf
#10 Breast Cancer.pdf
AseelAlharbi10
 
Oncology Introduction.
Oncology Introduction.Oncology Introduction.
Oncology Introduction.
Shaikhani.
 
Medicine 5th year, 1st & 2nd/part one lectures (Dr. Abdulla Sharief)
Medicine 5th year, 1st & 2nd/part one lectures (Dr. Abdulla Sharief)Medicine 5th year, 1st & 2nd/part one lectures (Dr. Abdulla Sharief)
Medicine 5th year, 1st & 2nd/part one lectures (Dr. Abdulla Sharief)
College of Medicine, Sulaymaniyah
 
Womens Health 16
Womens Health 16Womens Health 16
Womens Health 16
amoeba1945
 
Slide shrae assignment
Slide shrae assignmentSlide shrae assignment
Slide shrae assignment
Ndwandwe
 
Urological Malignancies
Urological MalignanciesUrological Malignancies
Urological Malignancies
jehh87
 
Endometrial Cancer; Evidence Based Approach
Endometrial Cancer; Evidence Based ApproachEndometrial Cancer; Evidence Based Approach
Endometrial Cancer; Evidence Based Approach
Faculty of Medicine - Benha University
 
1578185 - McGraw-Hill Professional ©CHAPTER 175Overview
1578185 - McGraw-Hill Professional ©CHAPTER 175Overview 1578185 - McGraw-Hill Professional ©CHAPTER 175Overview
1578185 - McGraw-Hill Professional ©CHAPTER 175Overview
KiyokoSlagleis
 
1578185 - McGraw-Hill Professional ©CHAPTER 175Overview
1578185 - McGraw-Hill Professional ©CHAPTER 175Overview 1578185 - McGraw-Hill Professional ©CHAPTER 175Overview
1578185 - McGraw-Hill Professional ©CHAPTER 175Overview
AnastaciaShadelb
 
Oncology 101 2013
Oncology 101 2013Oncology 101 2013
Oncology 101 2013
derosaMSKCC
 
Endometrial Cancer
Endometrial CancerEndometrial Cancer
Endometrial Cancer
Dhammike Silva
 
Multiple Primary Tumors.pptx
Multiple Primary Tumors.pptxMultiple Primary Tumors.pptx
Multiple Primary Tumors.pptx
Aya Agoncillo
 
Decision making in early & advanced colorectal cancer
Decision making in early & advanced colorectal cancerDecision making in early & advanced colorectal cancer
Decision making in early & advanced colorectal cancer
mostafa hegazy
 
Advanced colorectal cancer
Advanced colorectal cancerAdvanced colorectal cancer
Advanced colorectal cancer
mostafa hegazy
 

Similar to Basic Principles (20)

Terminal illness care
Terminal illness careTerminal illness care
Terminal illness care
 
Human Bio Iii Oncology I
Human Bio Iii Oncology IHuman Bio Iii Oncology I
Human Bio Iii Oncology I
 
BM
BMBM
BM
 
Discuss the pathology of bladder cancers
Discuss the pathology of bladder cancersDiscuss the pathology of bladder cancers
Discuss the pathology of bladder cancers
 
Breast Cancer Awareness
Breast Cancer AwarenessBreast Cancer Awareness
Breast Cancer Awareness
 
Uterine Cancer
Uterine CancerUterine Cancer
Uterine Cancer
 
#10 Breast Cancer.pdf
#10 Breast Cancer.pdf#10 Breast Cancer.pdf
#10 Breast Cancer.pdf
 
Oncology Introduction.
Oncology Introduction.Oncology Introduction.
Oncology Introduction.
 
Medicine 5th year, 1st & 2nd/part one lectures (Dr. Abdulla Sharief)
Medicine 5th year, 1st & 2nd/part one lectures (Dr. Abdulla Sharief)Medicine 5th year, 1st & 2nd/part one lectures (Dr. Abdulla Sharief)
Medicine 5th year, 1st & 2nd/part one lectures (Dr. Abdulla Sharief)
 
Womens Health 16
Womens Health 16Womens Health 16
Womens Health 16
 
Slide shrae assignment
Slide shrae assignmentSlide shrae assignment
Slide shrae assignment
 
Urological Malignancies
Urological MalignanciesUrological Malignancies
Urological Malignancies
 
Endometrial Cancer; Evidence Based Approach
Endometrial Cancer; Evidence Based ApproachEndometrial Cancer; Evidence Based Approach
Endometrial Cancer; Evidence Based Approach
 
1578185 - McGraw-Hill Professional ©CHAPTER 175Overview
1578185 - McGraw-Hill Professional ©CHAPTER 175Overview 1578185 - McGraw-Hill Professional ©CHAPTER 175Overview
1578185 - McGraw-Hill Professional ©CHAPTER 175Overview
 
1578185 - McGraw-Hill Professional ©CHAPTER 175Overview
1578185 - McGraw-Hill Professional ©CHAPTER 175Overview 1578185 - McGraw-Hill Professional ©CHAPTER 175Overview
1578185 - McGraw-Hill Professional ©CHAPTER 175Overview
 
Oncology 101 2013
Oncology 101 2013Oncology 101 2013
Oncology 101 2013
 
Endometrial Cancer
Endometrial CancerEndometrial Cancer
Endometrial Cancer
 
Multiple Primary Tumors.pptx
Multiple Primary Tumors.pptxMultiple Primary Tumors.pptx
Multiple Primary Tumors.pptx
 
Decision making in early & advanced colorectal cancer
Decision making in early & advanced colorectal cancerDecision making in early & advanced colorectal cancer
Decision making in early & advanced colorectal cancer
 
Advanced colorectal cancer
Advanced colorectal cancerAdvanced colorectal cancer
Advanced colorectal cancer
 

Recently uploaded

Empowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondEmpowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
Empowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
Health Catalyst
 
The positive impact of SGRT – The Berkshire Cancer Centre experience
The positive impact of SGRT – The Berkshire Cancer Centre experienceThe positive impact of SGRT – The Berkshire Cancer Centre experience
The positive impact of SGRT – The Berkshire Cancer Centre experience
SGRT Community
 
Rate Controlled Drug Delivery Systems.pdf
Rate Controlled Drug Delivery Systems.pdfRate Controlled Drug Delivery Systems.pdf
Rate Controlled Drug Delivery Systems.pdf
Rajarambapu College of Pharmacy Kasegaon Dist Sangli
 
Unlocking the Secrets to Safe Patient Handling.pdf
Unlocking the Secrets to Safe Patient Handling.pdfUnlocking the Secrets to Safe Patient Handling.pdf
Unlocking the Secrets to Safe Patient Handling.pdf
Lift Ability
 
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...
The Lifesciences Magazine
 
PrudentRx's Function in the Management of Chronic Illnesses
PrudentRx's Function in the Management of Chronic IllnessesPrudentRx's Function in the Management of Chronic Illnesses
PrudentRx's Function in the Management of Chronic Illnesses
PrudentRx Program
 
Letter to MREC - application to conduct study
Letter to MREC - application to conduct studyLetter to MREC - application to conduct study
Letter to MREC - application to conduct study
Azreen Aj
 
Top massage center in ajman chandrima Spa
Top massage center in ajman chandrima  SpaTop massage center in ajman chandrima  Spa
Top massage center in ajman chandrima Spa
Chandrima Spa Ajman
 
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)
bkling
 
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)
blessyjannu21
 
Professional Secrecy: Forensic Medicine Lecture
Professional Secrecy: Forensic Medicine LectureProfessional Secrecy: Forensic Medicine Lecture
Professional Secrecy: Forensic Medicine Lecture
DIVYANSHU740006
 
CANSA support - Caring for Cancer Patients' Caregivers
CANSA support - Caring for Cancer Patients' CaregiversCANSA support - Caring for Cancer Patients' Caregivers
CANSA support - Caring for Cancer Patients' Caregivers
CANSA The Cancer Association of South Africa
 
KEY Points of Leicester travel clinic In London doc.docx
KEY Points of Leicester travel clinic In London doc.docxKEY Points of Leicester travel clinic In London doc.docx
KEY Points of Leicester travel clinic In London doc.docx
NX Healthcare
 
How Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdf
How Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdfHow Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdf
How Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdf
Dharma Homoeopathy
 
Vicarious movements or trick movements_AB.pdf
Vicarious movements or trick movements_AB.pdfVicarious movements or trick movements_AB.pdf
Vicarious movements or trick movements_AB.pdf
Arunima620542
 
CCSN_June_06 2024_jones. Cancer Rehabpptx
CCSN_June_06 2024_jones. Cancer RehabpptxCCSN_June_06 2024_jones. Cancer Rehabpptx
CCSN_June_06 2024_jones. Cancer Rehabpptx
Canadian Cancer Survivor Network
 
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in Cardiology
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in CardiologyDr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in Cardiology
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in Cardiology
R3 Stem Cell
 
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...
nirahealhty
 
PrudentRx: A Resource for Patient Education and Engagement
PrudentRx: A Resource for Patient Education and EngagementPrudentRx: A Resource for Patient Education and Engagement
PrudentRx: A Resource for Patient Education and Engagement
PrudentRx Program
 
Tips for Pet Care in winters How to take care of pets.
Tips for Pet Care in winters How to take care of pets.Tips for Pet Care in winters How to take care of pets.
Tips for Pet Care in winters How to take care of pets.
Dinesh Chauhan
 

Recently uploaded (20)

Empowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondEmpowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
Empowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
 
The positive impact of SGRT – The Berkshire Cancer Centre experience
The positive impact of SGRT – The Berkshire Cancer Centre experienceThe positive impact of SGRT – The Berkshire Cancer Centre experience
The positive impact of SGRT – The Berkshire Cancer Centre experience
 
Rate Controlled Drug Delivery Systems.pdf
Rate Controlled Drug Delivery Systems.pdfRate Controlled Drug Delivery Systems.pdf
Rate Controlled Drug Delivery Systems.pdf
 
Unlocking the Secrets to Safe Patient Handling.pdf
Unlocking the Secrets to Safe Patient Handling.pdfUnlocking the Secrets to Safe Patient Handling.pdf
Unlocking the Secrets to Safe Patient Handling.pdf
 
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...
 
PrudentRx's Function in the Management of Chronic Illnesses
PrudentRx's Function in the Management of Chronic IllnessesPrudentRx's Function in the Management of Chronic Illnesses
PrudentRx's Function in the Management of Chronic Illnesses
 
Letter to MREC - application to conduct study
Letter to MREC - application to conduct studyLetter to MREC - application to conduct study
Letter to MREC - application to conduct study
 
Top massage center in ajman chandrima Spa
Top massage center in ajman chandrima  SpaTop massage center in ajman chandrima  Spa
Top massage center in ajman chandrima Spa
 
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)
 
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)
 
Professional Secrecy: Forensic Medicine Lecture
Professional Secrecy: Forensic Medicine LectureProfessional Secrecy: Forensic Medicine Lecture
Professional Secrecy: Forensic Medicine Lecture
 
CANSA support - Caring for Cancer Patients' Caregivers
CANSA support - Caring for Cancer Patients' CaregiversCANSA support - Caring for Cancer Patients' Caregivers
CANSA support - Caring for Cancer Patients' Caregivers
 
KEY Points of Leicester travel clinic In London doc.docx
KEY Points of Leicester travel clinic In London doc.docxKEY Points of Leicester travel clinic In London doc.docx
KEY Points of Leicester travel clinic In London doc.docx
 
How Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdf
How Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdfHow Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdf
How Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdf
 
Vicarious movements or trick movements_AB.pdf
Vicarious movements or trick movements_AB.pdfVicarious movements or trick movements_AB.pdf
Vicarious movements or trick movements_AB.pdf
 
CCSN_June_06 2024_jones. Cancer Rehabpptx
CCSN_June_06 2024_jones. Cancer RehabpptxCCSN_June_06 2024_jones. Cancer Rehabpptx
CCSN_June_06 2024_jones. Cancer Rehabpptx
 
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in Cardiology
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in CardiologyDr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in Cardiology
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in Cardiology
 
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...
 
PrudentRx: A Resource for Patient Education and Engagement
PrudentRx: A Resource for Patient Education and EngagementPrudentRx: A Resource for Patient Education and Engagement
PrudentRx: A Resource for Patient Education and Engagement
 
Tips for Pet Care in winters How to take care of pets.
Tips for Pet Care in winters How to take care of pets.Tips for Pet Care in winters How to take care of pets.
Tips for Pet Care in winters How to take care of pets.
 

Basic Principles

  • 1. Winston W. Tan MD FACP Associate Professor of Medicine Hematology/Oncology Mayo Clinic Florida
  • 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
  • 4.
  • 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
  • 10.
  • 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
  • 23.
  • 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
  • 28.
  • 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
  • 35.
  • 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
  • 46.
  • 47.  ALL  AML  CML  CLL Leukemias
  • 48.  Chemotherapy  Bone marrow transplant  Immunotherapy/monoclonal antibodies Treatment
  • 50. Capture the Moment: Patient/Caregiver Cancer Education Symposium: Complimentary