Cancer is characterized by uncontrolled cell growth and spread. Some key points: - Lung cancer is the most common cancer in men and breast cancer is most common in women. - Risk factors include tobacco use, obesity, viruses, chemicals, radiation, and genetic mutations. - Prevention focuses on healthy behaviors like not smoking, diet, exercise and limiting sun exposure. - Treatment involves surgery, radiation, chemotherapy and other approaches depending on cancer type and stage. Combined therapies are often used but all treatments can cause side effects.

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

4. Factors Believed to Contribute to
Global Causes of Cancer

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.

7. Preventable risk factors
• Tobacco
• Obesity
• Physical inactivity
• Alcohol
• Sun exposure
• Infections
• Pollution

8. STRATEGIES FOR CANCER
PREVENTION
AND
MANAGEMENT

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. Mechanisms of Chemoprevention
• Antioxidants: defense against radicals
• Anti-proliferative agents
• Anti-hormonal compounds
• Disruption of mutational gain or loss of function

12. 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

13. Foods that contain antioxidants:
• VITAMIN A- CARROTS, SWEET POTATOES, MEAT
• VITAMINC- CHERRIES, PEPPERS, BERRIES,
CABBAGE, BROCOLI, CITRUS
• VITAMIN E-WALNUTS, SESAME SEEDS
• VITAMIN D- COD LIVER OIL, SALMON, EGGS,
FORTIFIED FOODS
• VITAMIN K-CAULIFLOWER, SPROUTS, BEANS
• SELENIUM-INCLUDES SEAFOODS
• ALPHA LIPOIC ACID-SPINACH, BROCOLI
• CO-ENXYME Q10-MEAT, SEAFOOD

14. FLAVONOIDS
• CLASS OF PLANT SECONDARY METABOLOITIES
• HAVE ANTIOXIDANTL ACTIVITY
• Knowns as vitamin p
• Found in fruits and vegetables

15. classification
• Flavonols- compounds:- quercetin , kaempferol (e.g- cherry
tomato, apple, blueberry)
• Flavones-compounds:- apegenin, tricetin,
heptamethoxyflavone (e.g-parsley, celery)
• Flavanones-compounds:-dihydroquercetin, hesperetin (e.g-orange
juice)
• Flavanols-compounds-taxifolin (e.g-cocoa, chocolates)
• Catechins-compounds-egcg(epigallocatechin gallate) (e.g-tea,
apricot)
• Isoflavones-compounds:- genistein (e.g-soy, cheese)
• Anthocyanins-componds-cyaniding (e.g-grapes, strawberry)

17. 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

18. • 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. Modalities of treatment:
• 1-local therapy:
– -surgery.
– -radiation therapy.
• 2-systemic treatment:
– chemotherapy.
– Monoclonal antibodies.
– Radioactive material.
• 3-supportive care.
• 4-non-conventional therapy.

20. 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.

21. 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.

22. 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:

24. 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).

25. 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”

26. 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

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. 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.)

31. 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.

32. Chemotherapy:

33. 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.

34. Classification of cytotoxic drug:
• Cytotoxic agent can be roughly categorized
based on their activity in relation to the cell
cycle.
cytotoxic drug
phase nonspecific. phase specific

35. 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.

36. What are the chemotherapeutic
agent?…..

37. Chemotherapeutic agents:
• Alkylating agents: Cyclophosphamide
• Antitumor antibiotic
• Antimetabolites

38. 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

39. Antimetabolites
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.

40. 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)

41. 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.

42. • 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.

43. 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
Chemotherapy with Ultra-sonic Disruption?
Combined

44. Immunotherapy of Cancer
• Potentially Highly Tumor-Specific
• Can be Effective Against Disseminated Disease Including
Unrecognized Micro-metastases
• Probably of Limited Value Against Extensive Advanced
Disease
• Can Involve Severe, Sudden Onset Life-threatening
Treatment-limiting Side-Reactions
• Limited by Tumor Heterogeneity, Selection for
Unresponsive Variants, and Emergence of
Immune-Escape

45. 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:

46. 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