CLASSIFICATION CAUSES MECHANISUM OF CA SPREAD TREATMENT PREVENTION PALLIATION CHEMOTHERAPY RADIATION SURVEY AND RESEARCH BY STEPHIN GEORGE THOMAS, MANIPAL HOSPITAL, GOA

2. Introduction Signs and Classification
Conclusion
to cancer symptoms of cancer
Mechanisms
Treatment Cancer
History of cancer
and staging research
cells
Characteristics Radiation and
Causes Vaccination
of cancer cells chemotherapy

3. CANCER
• Cancer (malignant neoplasm) is a
class of diseases in which a group
of cells display uncontrolled growth,
invasion and sometimes metastasis.
• Cancer is the world’s second leading
cause of death.
• Tumor, is any abnormal swelling, lump or mass.
- Neoplasm, is the scientific term to describe an abnormal
proliferation of genetically altered cells.
- Neoplasm's can be benign or malignant.

4. • Benign neoplasm or benign tumors:
Tumors that lacks the ability to
metastasize.
• Malignant neoplasm or malignant tumors:
Synonymous with cancer.
Cells invades and metastasize to spread
rapidly.

5. • Hippocrates used the Greek words carcinos and carcinoma to
describes tumors thus calling cancerkarkinos.
• World’s oldest documented case of ancient Egypt in 1500 b.c
• Treated by cauterization, a method to destroy tissue with a hot
instrument called “the fire drill”.

6. Cont…
• Rudolph Virchow in late 19th century recognized that even
cancerous cell were derived from other cells.
• Marie Curie and Pierre Curie discovered radiation by the end of
the 19th century, the first effective non- surgical treatment.
• Cancer chemotherapy was started by Louis Goodman and
Alfred Gilman in the 1940s with the use of nitrogen mustared.
• Sidney Farder targeted cancer using folic acid antagonist as drugs.

7. Estimated numbers of new cases and deaths
for each common cancer type in 2010
Cancer Type Estimated New Cases Estimated Deaths
Bladder 70,530 14,680
Breast (Female – Male) 207,090 – 1,970 39,840 – 390
Colon and Rectal (Combined) 142,570 51,370
Uterine 43,470 7,950
Kidney (Renal Cell) Cancer 53,581 11,997
Leukemia 43,050 21,840
Lung (Including Bronchus) 222,520 157,300
Pancreatic 43,140 36,800
Prostate 217,730 32,050
Thyroid 44,670 1,690

8. Factors believed to be the
causes of cancer

9. Cont..
Causes of cancer
• Chemicals
• Diet and exercise
• Unknown causes
• Infection
• Radiation
• Heredity
• Physical agents
• Physical trauma and inflammation
• Hormones

10. Characteristics of cancer cell
Self-sufficient Immortality Sustained Invasion and
growth signals Motility • Resistance to cell angiogenesis metastasis
• Constitutively High motility death. • Cells allowed to • Benign cells grows
activated growth behaviour of cells • Activated anti- cell grow and spread. locally while
factor signalling. results in easy death signalling. malignant cells
• Resistance to anti- spread of malignant • Inactivated cell invade neighboring
growth signals. cells to other tissues. death pathway tissues enter blood
vessels and
metastasize to
different sites.

11. Mechanism of cancer cell formation

12. Signs and symptoms
• Local symptoms
Hemorrhage Ulceration Pain
• Systemic symptoms
Weight loss Fatigue
Sweating Immunological
• Symptoms of metastasis
Lymph nodes Hepatomegaly
Splenomegaly Fracture
Neurological
• Other symptoms
Chills Fever Loss of appetite Malaise

13. Classification of cancer
Breast Uterine Cervical Ovarian Leukemia
Pancreas Oral Cavity Colorectal Prostate Skin
Testicular Urinary Bladder Bronchus and
Lung

14. Breast cancer
• Breast cancer is a malignant tumor that starts from cells of the breast.
• The most common form of cancer among women.
• The second most common cause of cancer related mortality.
Incidence and Risk factors
• Female (1% male)
• Aging
• Relative (mother /sister)
• Obesity
• Menstrual history
- early on set
- late menopause
• Child birth
- After the age of 30yrs

15. Differential diagnosis Treatment
• Non surgical intervention
- Chemotherapy
- Radiation therapy
- Hormonal therapy
Prevention
• Surgical Intervention
- Reduction of fat in diet
- Self breast examination - Breast reconstruction
- Mammogram after age 40 - Oophorectomy
(with family history at age 30 ). - Ablative therapy

16. Uterine cancer
Uterine cancer (Endometrial cancer ) develops when the cells that
make up the inner lining of the uterus become abnormal and grow
uncontrollably.
Incidence and Risk factors
4th most common type of cancer among women.
• Age
• Obesity
• Diabetes
• Hypertension
• Irregular menstrual periods
• Estrogen replacement therapy

17. Differential diagnosis Treatment
• Endometrial biopsy • Hysterectomy
• Dilatation and curettage • Laparotomy
• Transvaginal ultrasound • Radiation
• Chemotherapy
• Hysteroscopy
• Hormonal therapy
Prevention
• Report any abnormal vaginal bleeding in postmenopausal women.
• Controlling obesity, blood pressure, diabetes.

18. Cervical cancer
• Cancer of the cervix (the lower end of the uterus or womb).
• The human papilloma virus (HPV) is thought to be a co-factor
in the development of cervical cancers.
• Cervical cancers develop more rapidly in HIV +ve than in
HIV -ve women.
• About half of the sexually transmitted
HPVs are associated with cervical
cancer. These “high-risk” HPVs produce
a protein that can cause cervical
epithelial cells to grow uncontrollably.

19. Differential diagnosis Treatment
• Pap smear (above 25yrs) • Cryosurgery
• Cauterization or diathermy
• Laser surgery
• Radial hysterectomy
• pelvic exenteration (extensive
• Colposcopic biopsy surgery)
• Schiller test • Chemotherapy
• Endocervical curettage • Radiation
Preventive measures
Avoid sex in early age, avoid numerous partners, practice the use of
condom, regular screening in high risk case.

20. Ovarian cancer
• Ovarian cancer is cancer of the ovaries, the egg releasing and
hormone-producing organs of the female reproductive tract.
• Ovarian cancer can develop at any age, but is most likely to occur
in women 50 years or older.
• Ovarian cancer is the fifth most common cancer among women.
Risk factors
•Idiopathic
• High fat diet
• Family History
• Have never been pregnant.
• Early menstruation (before age 12) and late menopause.
• The use of talcum powder in the genital area. (contains particles of
asbestos, a known carcinogen.)

21. Differential diagnosis Treatment
• Complete medical history and • Chemotherapy
assess all the risk factors • Radiation
• Through bi-manual pelvic • Surgery to remove
examination tumour (called tissue
• CA-125 assay debulking)
• CT and MRI • Removal of the ovary is
• Colour Doppler called Oophorectomy
• Lower GI series, barium enema • Hysterectomy.
• Diagnostic laparoscopy
Prevention
• Since the cause of ovarian cancer is not known, it is not possible
to fully prevent the disease.

22. Prostate cancer
• Prostate cancer is a disease where cells of the prostate become
abnormal and start to grow uncontrollably, forming tumours.
• Prostate cancer is a malignancy of one of the major
male sex glands, along with the testicles and the seminal
vesicles.
Incidence and Risk factors
• Cause of prostate cancer is not known.
• Age over 55.
• African-American heritage.
• Family history of the disease.
• High fat diet
• Men with high plasma testosterone levels.
• Occupational exposure to cadmium or rubber.

23. Differential diagnosis Treatment
• Digital rectal examination (DRE) • Radical Prostatectomy
• prostate-specific antigen(PSA) • Cryosurgery
• Transrectal ultrasound • Hormone Therapy
• Prostate biopsy • Orchiectomy
• Transurethral • Watchful Waiting
• Resection of the prostate (TURP) • Radiation Therapy
• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
Prevention
• Because the cause of the cancer is not
known, there is no definite way to
prevent prostate cancer.

24. Leukemia
• Leukemia is a cancer of white blood cells.
• The cancerous cells are immature forms called
blasts that cannot properly fight infection;
and patient become ill.
• A rapidly progressing cancer that starts in the blood forming
cells of the bone marrow.
• May be acute or chronic with a slow onset and persistent
symptoms over a period of years.
• Leukemia affects the bone marrow causing anemia, leukopenia,
the production of immature cell, thrombocytopenia and a
decline in immunity.

25. Differential diagnosis Treatment
• Microscope to identify • Bone marrow transplantation
abnormal red cells.
• Radiation therapy
• Chemotherapy
• Bone marrow aspiration
•Biopsy
Prevention
• This cancer is very rare and its causes are also largely unknown,
no specific preventive measures can be recommended.
• High doses of radiation and exposure to the chemical benzene.

26. Colorectal cancer
• Cancer of the colon is the disease characterized by the development
of malignant cells in the lining or epithelium of large intestine.
• Causes of colon cancer is environmental in the sporadic cases(80%),
and genetic in the heredity predisposed cases (20%).
• Colon cancer is more common in
industrialized nations and diets high in
fat, red meat, total calories, and alcohol.
• The incidence increases substantially
after age 50 and doubles with each
succeeding decade.
• Ulcerative colitis and Crohn’s colitis
are at increased risk.

27. Differential diagnosis Treatment
• Colonoscopy(direct • Colostomy
visualization) • Radiation therapy
• Digital rectal exam (DRE). • Chemotherapy
• Fecal occult blood test • Alternative and
(FOBT) complementary therapies
• Double contrast barium (Large doses of
enema (DCBE) – X rays vitamins, fibre, and green
• Biopsy of suspicious tissue. tea).
Prevention
• Diets high in fibre.
• Avoiding obesity, cigarettes and alcohol.

28. Lung cancer
• Lung cancer is a disease in which the cells
of the lung tissues grow uncontrollably.
• Primary lung cancer starts in the lung itself,
and is divided into small cell lung cancer and
non-small cell lung cancer.
•The tumor can reduce the capacity of the
lungs, or block the air movement as result,
patient gets less oxygen into the blood and patients feel short of
breath.
Risk factors
• Tobacco smoking accounts for nearly 90% of
all lung cancers.
• Smoking marijuana cigarettes.
• Second hand smoke cause lung cancer among
non-smokers.

29. • Exposure to radon (colourless,
Differential diagnosis
odourless gas that sometimes
accumulates in the basement • Chest x ray
of homes, cause lung cancer).
• Sputum analysis
• Lung biopsy
• Asbestos, coal products, and • Bronchoscopy
radioactive substances. • CT scan
• Air pollution • MRI

30. Treatment Prevention
• Wedge resection • Giving up tobacco can prevent
• Lobectomy most lung cancers.
• Pneumonectomy • Second hand smoke from other
• Radiotherapy people’s tobacco should also be
• Chemotherapy avoided.
• Alternative therapies
(Shark cartilage and mistletoe) • Appropriate precautions
- Clinical trials are going on should be taken when working
with carcinogens.
• Testing houses for the presence
of radon gas.
• Remove asbestos from
buildings.

31. Pancreatic cancer
• It is the most common neoplasm affecting the pancreas.
• The occurrence of pancreatic
cancer has been linked to
diabetes mellitus, alcohol use,
history of previous pancreatitis,
smoking, ingestion of high fat diet
and exposure to environmental
chemicals.
• Symptoms usually do not occur
until the tumor is large; therefore
the prognosis is poor.

32. Differential diagnosis Treatment
• Axial CT image with IV contrast
• Whipple procedure
• Pancreatectomy
• Chemotherapy
• Liver function tests
• Computed tomography (CT scan) • Radiation therapy
• Endoscopic ultrasound (EUS)
• Endoscopic needle biopsy
Prevention
• ACS recommends keeping a healthy weight, and increasing
consumption of fruits, vegetables, and whole grains, while decreasing
red meat intake, although there is no consistent evidence this will
prevent or reduce pancreatic cancer.

33. Oral cancer
• Cancer of the mouth or the oral cavity and the oropharynx.
• Oral cavity includes the mouth including
the lips, lining on the lips and buccal
mucosa, teeth, tongue, floor of the mouth,
hard palate.
• The oropharynx includes the back of the
tongue, the soft palate, and the tonsils.
• More than 90% of malignant tumours of the
oral cavity and oropharynx are squamous cell
carcinoma.
• The major risk factors for oral and
oropharyngeal cancers are smoking and
alcohol consumption.

34. Differential diagnosis Treatment
• Pharyngoscopy • Maxillectomy
• Laryngoscopy • Moh’s surgery
• Panendoscopy
• Laryngectomy
• Fine-needle aspiration
(FNA) biopsy • Tracheotomy
• CT scan • Radiation therapy
• MRI • Chemotherapy
• Panorex
Prevention
• Smoking cessation and elimination of
alcohol, and maintaining a balanced
diet with fruits, vegetables, and whole
grain are key to returning to a normal life
for patients suffering from oral cancers.

35. Skin cancer
• Skin neoplasm's are skin growths with
differing causes and varying degrees of
malignancy.
• Types of skin cancer: basal cell carcinoma
(BCC), squamous cell carcinoma (SCC)
and malignant melanoma.
• Exposure to ultraviolet light and X rays,
suppression of the immune system, and
genetic factors seem to increase the risk
that this will happen. However the exact
cause, is not known.

36. Differential diagnosis Treatment
• Skin biopsy • Moh’s surgery
• Electrodessication and
curettage
• Cryosurgery,
• Laser surgery
• Radiation therapy
• Chemotherapy.
Prevention
• Wear protective clothing and a wide-brimmed hat in the sun.
• Stay out of the sun from 10 A.M. to 4 P.M.
• Use a sunscreen that has a sun protection factor (SPF) of at least 15.
• Avoid sun tanning booths.

37. Testicular cancer
• Testicular cancer is a disease in which cancer
cells are discovered in one or both testicles.
• Testicular cancer accounts for less then 2%
of all cancers in men, it is the most commonly
seen cancer in young men aged 15 to 35.
• It is also one of the most curable.
Risk factors
• The exact causes of testicular cancer are unknown
• Cryptorchidism or undescended testicles.
• Men infected with HIV.

38. Differential diagnosis Treatment
• Ultrasound • Orchiectomy
• Tumor markers • Retroperitoneal lymph
• CT scan node dissection
• Lymphangiography • Radiation therapy
• Chemotherapy
Prevention
• The main risk factors cryptorchidism, family history of the disease,
are unavoidable since they are present at birth. In addition, many
men diagnosed with the disease have no known
risk factors. Because of these reasons, it is
not possible to prevent most incidences of
testicular cancer.

39. Treatment and Staging
Stage Description Treatment Options
Stage 0 Absence of invasion of Excision / laser therapy
surrounding tissues
Stage I Localized metastasis present Surgery
Stage II Cancers are localized to one part Surgery + Chemotherapy/
of the body and involvement of Radiation
lymph nodes
Stage III Cancers are locally advanced and Combination of
spread to adjacent tissues chemotherapy and radiation
after surgery
Stage IV Cancers are metastasized or Chemotherapy and/or
spread to other organs or palliative (maintenance) care
throughout the body

40. Radiation
• Radiation treatment, also known as radiotherapy,
destroys cancer by focusing high-energy rays on
the cancer cells. This causes damage to the
molecules that make up the cancer cells and
leads them to commit suicide.
• Radiotherapy utilizes high-energy gamma rays
that are emitted from metals such as radium or high energy x-rays that
are created in a special machine.
• Early radiation treatments caused severe side-effects because the energy
beams would damage normal, healthy tissue, but technologies have
improved so that beams can be more accurately targeted.
• Radiotherapy is used to shrink a tumor or destroy cancer cells.

41. Chemotherapy
• Chemotherapy utilizes chemicals that interfere
with the cell division process, damaging proteins
or DNA, so that cancer cells will commit suicide.
• These treatments target any rapidly dividing cells
(not necessarily just cancer cells), but normal cells
usually can recover from any chemical induced
damage while cancer cells cannot.
• Chemotherapy is generally used to treat cancer that has spread or
metastasized because the medicines travel throughout the entire body.
•Chemotherapy treatment occurs in cycles so the
body has time to heal between doses.
• Common side effects such as hair
loss, nausea, fatigue, and vomiting.

42. Vaccination
• Vaccines have been developed that prevent some
infection by some viruses that are associated with
cancer, and therapeutic vaccines are in
development to stimulate an immune response
against cancer specific epitopes.
• Human papillomavirus vaccine (Gardasil and Cervarix) decreases
the risk of developing cervical cancer.
• The hepatitis B vaccine prevents infection with hepatitis B virus and thus
decreases the risk of liver cancer.
• Cervarix which protects against the more dangerous HPV 16,18 strains only.
• In 2009, Gardasil was approved for protection against genital warts.
• In 2010, the Gardasil vaccine was approved for protection against anal
cancer.

43. USPSTF Recommendations
• The U.S. Preventive Services Task Force (USPSTF) strongly recommends
cervical cancer screening in women who are sexually active at least until
the age of 65.
• Routine screening is recommended for bladder
cancer, pancreatic cancer, ovarian cancer in
women, or prostate cancer and testicular cancer
in men below 75.
• Americans to be screened for colorectal cancer via fecal occult blood
testing, Sigmoidoscopy, or colonoscopy starting at age 40 until age 75.
• Mammography for breast cancer screening every 2 years for those
40 - 74 years.
• There is insufficient evidence to recommend for or against screening for
skin cancer, oral cancer, lung cancer, or prostate cancer in men under 75.

44. Genetic testing
Genetic testing for individuals at high-risk of certain cancers is
recommended. Carriers of these mutations may than undergo
enhanced surveillance, chemoprevention, or preventative surgery to
reduce their subsequent risk.
Gene Cancer types
BRCA1, BRCA2 Breast, ovarian, pancreatic
HNPCC, MLH1, MSH2, Colon, uterine, small bowel,
MSH6, PMS1, PMS2 stomach, urinary tract

45. Palliation
• Palliative care is a specialized area of healthcare
that focuses on relieving and preventing the sufferings of patients.
• Unlike hospice care, palliative medicine is for patients in all disease
stages, including treatment for curable illnesses which is chronic, as
well as patients who are nearing to the end of life.
• Multidisciplinary approach allows the palliative care team to
address physical, emotional, spiritual and social concerns that arise
with advanced illness.

46. Cancer research
Cancer research is the intense scientific effort to understand disease processes
and discover possible therapies.
Research about cancer causes focuses:
• Agents (e.g. viruses) and events (e.g. mutations)
•The consequences of those genetic changes which
lead to further progression of the cancer.
• The precise nature of the genetic damage, and the genes which are affected .
Leading cancer research organizations and projects
- American Association for Cancer Research
- The American Cancer Society (ACS)
- The American Society of Clinical Oncology
- The National Cancer Institute
- National Comprehensive Cancer Network
- Cancer Genome Atlas project at the NCI
- The European Organization for Research and Treatment of Cancer.

47. Vegetables & Fruits in cancer – A review
• An research in 206 human and 22 animals done in Chicago on Oct 1996
by World Cancer Research, London.
• The evidence for protective effect of greater
vegetable and fruit consumption is consistent for
cancer of stomach, esophagus. lungs, oral cavity and
pharynx, endometrium, pancreas and colon.
• Raw vegetables, allium vegetables, carrots, green
vegetables and tomatoes.
• Dithiolthion, Isothiocynates, Isoflavones,
Phytosterols, Vitamin C & E, Lutine, Folic Acid,
Beta-carotine, Lycopine, Selenium, Flavonoids,
Dietary Fiber, Proteases Inhibitors, Indole-3-carbinal
are some substances present in fruits and vegetables.

48. Presented to u by Stephin George Thomas, Kerala. Mob:09526696110
Manipal Universal Learning