This document provides an overview of cancer basics including epidemiology, common cancers, pathophysiology, symptoms, diagnosis, staging, treatment, prevention and screening. Cancer is characterized by uncontrolled growth of abnormal cells that can invade locally or metastasize. It is one of the leading causes of death worldwide and risk increases with age. Both genetic and environmental factors can contribute to cancer development.

1. Cancer basics
A group of diseases characterized by
uncontrolled growth of abnormal cells,
with local invasion &/or metastasis

2. Epidemiology
 One of the commonest cause of death
in adults
 Found at all ages,
incidence increases as age advances
 ~10% are hereditary- breast, ovary, colon, brain
 Causes-
 Tobacco- oral cavity, lung, larynx, esophagus, stomach, bladder
 Ionizing radiation
 Chemotherapeutic drugs- cyclophosphamide, etoposide
 Infection- HPV, HBV/HCV, EBV, HTLV-1, H.pylori
 Hormonal imbalance- breast, uterus-endometrium, prostate

3. Common cancers
Infants- neuroblastoma
Childhood/adolescence- leukemia
Males- prostate, oral, lung, GIT
Females- breast, cervix, lung

4. Pathophysiology
 Normal cells contain-
 Proto-oncogenes that control cell growth/division & apoptosis
 Tumor suppressor genes controlling DNA/cell replication,
adhesion in tissues & interaction with immune system
 Cancer is a multistep process
 Requires-
 Activation of proto-oncogenes- dominant mutation
e.g. ras, myc, HER2/neu, EGFR, BCR-Abl
 Suppression of tumor suppression genes- recessive mutation
e.g. Rb, p53, APC, BRCA

5. Symptoms- early/warning
 Non-healing oral or skin ulcer
 Lump/swelling in breast, neck, limbs
 Dysphagia
 Hoarseness
 Hemoptysis
 Painless hematuria
 Post-menopausal bleeding
 Unexplained weight loss or anemia
 Change in a mole- size, color, ulceration

6. Paraneoplastic manifestations
 Symptoms distant from primary site
 Due to humoral factors released by
cancer cells or immune response
 Types-
 Endocrine- Cushing’s-ACTH, SIADH, hypoglycemia,
hypercalcemia-PTHrP, carcinoid-serotonin/bradykinin
 Neurological- Lambert-Eaton myasthenic syndrome,
encephalitis, cerebellar degeneration, polymyositis
 Mucocutaneous- dermatomyositis, acanthosis nigricans
 Hematological- polycythemia, anemia
hypercoagulability-DVT/endocarditis
 Other- membranous glomerulonephritis

7. M.E.N.
 Multiple endocrine neoplasia
 Autosomal dominant transmission
 MEN 1- Wermer syndrome- MEN1 gene
 Parathyroid, Pituitary, Pancreas-hormone secreting
 MEN 2a- Sipple syndrome- RET gene
 MCT, Parathyroid, Pheochromocytoma
 MEN 2b- RET gene
 Mucosal neuromas, Marfanoid body habitus, MCT, Pheo.

8. Diagnosis
 Early suspicion
 Radiological Ix, as needed
 Dx is mostly histological-
sample obtained by FNAC or biopsy
 Immunohistochemistry & cytogenetics may be
required to define cancer type
 Tumor markers- measured in blood- may be diagnostic in
clinical setting, mostly for follow-up & recurrence marker
 CA-125-ovary, PSA-prostate, CEA-colon, AFP-HCC & NSGCT,
βHCG-choriocarcinoma & NSGCT, CA-19.9-
pancreas/biliary

9. Staging
 Follows Dx
 Blood or radiological tests, as required
 Tumor.Node.Metastasis-
TNM staging for solid cancer
 Lymphoma- Ann-Arbor staging
 Leukemia- none (CLL- Rai/Binet)
 Helps plan treatment & for prognosis

10. Treatment
 Local- curative/palliative, primary/adjuvant
 Surgery- ensure free-margins
 Radiation therapy- RT
 Systemic- curative/palliative, neoadjuvant/adjuvant
 Chemotherapy- CT
 Hormonal therapy
 Immunotherapy- interferon, interleukin
 Monoclonal antibody therapy
 Organ preservation- using CT & RT
 Oral, larynx, breast, bladder, limbs

11. Prevention & Screening
 Prevention-
 Quit tobacco
 Vaccine against HBV & HPV
 Genetic testing- BRCA 1 & 2
 Healthy lifestyle- balanced diet, no obesity, limit alcohol
 Drugs, in high risk- tamoxifen, raloxifene, finasteride, rofecoxib
 Screening- early detection in asymptomatic population-
overdiagnosis & cost-physical, monetary
 Pap smear- cervical cancer
 BSE & mammography- breast cancer
 FOBT & colonoscopy- colon cancer
 PSA, DRE, TRUS- prostate cancer

12. Take home
Suspect early