Introduction to Cancer

basics?
Statistics
◼ >9.7 million cases are detected
each year
◼ 6.7 million people will die from
cancer
◼ Every day, around 1700
Americans die of the disease
◼ 20.4 million people living with
cancer in the world today
◼ 1 in 3 people will be diagnosed
with cancer in the UK and 1 in 4
will die from their disease
The Global Burden of Cancer 2000
Men Women

5.3 million cases 4.7 million cases

3.5 million deaths 2.7 million deaths

902 337
Lung 810 293
105
Breast 370 0
499 446
Colon/Rectum 255 234
Stomach 558 318
405 241
Liver 398 166
384 165
Prostate 543
204
Cervix uteri 471
233
Oesophagus 279 133
227 111
Bladder 260 76
99 33
Non-Hodgkin
167 121
Lymphoma 93 68
144 113
Leukaemia 109 86
170 97
Oral cavity 81 47
116 101 Incidence
Pancreas 112 101
Mortality
Kidney 119 71
57 34
Ovary 192
114

1000 800 600 400 200 0 200 400 600 800 100
0 (Thousands)

From: D.M. Parkin The Lancet Oncology 2: 533-543 (2001)

WHO Statistics
◼ 2020 15 million people will die from cancer

◼ Causes
 Ageing population
 Obesity
 Smoking
The burden of cancer
◼ 6% of NHS hospital expenditure
◼ $/€/£ etc millions spent on research
◼ Substantial financial burdens upon families
and carers
◼ Physical and emotional burden
Personal views of cancer
“in the popular “Cancer forces us to
imagination cancer confront our lack of
equals death” control over our own
or others death”

Kleinman (1988)
(Susan Sontag,1977)
What is Cancer?
◼ Division – uncontrolled cell division

◼ Growth – formation of a lump (tumour) or large

numbers of abnormal white cells in the blood

◼ Mutation – changes to how the cell is viewed by

the immune system

◼ Spread – ability to move within the body and

survive in another part
Division – uncontrolled cell division

◼ Oncogenes

◼ Tumour suppressor genes – p53

◼ Suicide genes – apoptosis

◼ DNA repair genes

Growth
◼ Tumour
 Pressure on nerves
 Blocking organs
 Stopping normal function
 Altering nerve signals
 Fungating
Mutation and Spread

◼ Invasion

◼ Angiogenesis
Types of Cancer
◼ Carcinomas
◼ Sarcomas
◼ Lymphomas
◼ Leukaemias
◼ Adenomas

◼ Often prefixed by the specific cell

What are the differences in the
features of normal and cancer cells?
Malignant versus benign
tumours
Normal and abnormal cell
growth
Normal cell growth
Cancerous growth
Metastatic cancer
What causes cancer?
Carcinogenesis.
Some factors to consider…
◼ Heredity
◼ Immunity
◼ Chemical
◼ Physical
◼ Viral
◼ Bacterial
◼ Lifestyle
Heredity
◼ 5-10% of Cancers

◼ ?15% of all
cancers

◼ Molecular biology
and Human
Genome Project
Heredity ◼ Genes isolated for
several classic familial
cancer syndromes:
 RB1 (retinoblastoma)
 APC (familial polyposis)
 Human Non Polyposis
Colon Cancer (HNPCC)
 BRCA 1&2 (breast
cancer)
 p53 (many cancers)
Immunity

◼ HIV / AIDS

◼ Immunosuppression
Virus’s
◼ Hepatitis B

◼ Human T-cell
Leukaemia virus

◼ Epstein Barr Virus

◼ Human Papilloma
Virus (HPV)
Bacterial ◼ H. pylori

◼ Other Parasites:
 Schistosoma spp
 Clonorchis sinensis
Estimated Burden of Cancer from Infection Worldwide in 2000

No. of cases Agent % World

cancer

Liver 509,000 HBV, HCV, flukes 5.1

Cervix 471,000 HPV 4.7
Stomach 442,000 H. pylori 4.4
Kaposi’s (HIV related) 134,000 HHV-8 1.3
Non Hodgkin lymphoma 72,000 H. pylori, EBV, HIV 0.7
Ano-genital 65,000 HPV 0.6
Nasopharyngeal 63,000 EBV 0.6
Hodgkin disease 33,000 EBV, HIV 0.3
Bladder 10,000 Schistosoma 0.1
Leukaemia 3,000 HTLV1 0.03

Total 1,801,000 17.9

Chemical
◼ Alcohol
◼ Asbestos
◼ Wood dust
◼ Rubber, plastics, dyes
◼ Tar / bitumen
◼ Aflatoxin
◼ Alkylating agents

◼ Tobacco
Smoking
◼ Single biggest cause
of cancer
◼ 25-40% smokers die
in middle age
◼ 9 in 10 lung cancers
◼ Know to cause cancer
in 1950
Smoking and alcohol
Industrial pollution
Physical causes

◼ Ultraviolet radiation
 Sunlight
 Certain industrial sources

◼Radiation
Radon
Cancer treatment
Obesity Lifestyle:
- Highly caloric diet, rich in
fat, refined carbohydrates
and animal protein
- Low physical activity
Consequences:
- Cancer
- Diabetes
- Cardiovascular
disease
- Hypertension
Lifestyle
◼ Age

◼ Occupation

◼ Ethnicity

◼ Deprivation
Survival variations
◼ CONCORD Study (1.9 million survivors)
demonstrated a clear relationship to
income not only between countries but
also between the ethnic groups in those
countries
 (Coleman et al Lancet Oncology 2008)
Diagnosis and staging
◼ Clinical History

◼ Normal diagnostic procedures

 Scans, xrays
 Blood tests
 Biopsy

◼ Pathological staging
Staging
◼ Size

◼ Invasion

◼ Lymph nodes

◼ Metastasises
TNM Staging
◼ T (a,is,(0),1-4): size or direct extent of the primary tumor
◼ N (0-3): degree of spread to regional lymph nodes
 N0: tumor cells absent from regional lymph nodes
 N1: tumor cells spread to closest or small number of regional
lymph nodes
 N2: tumor cells spread to an extent between N1 and N3.
 N3: tumor cells spread to most distant or numerous regional
lymph nodes
◼ M (0/1): presence of metastasis
 M0: no distant metastasis
 M1: metastasis to distant organs (beyond regional lymph nodes)
◼ Other parameters
◼ G (1-4): the grade of the cancer cells (i.e. they are "low
grade" if they appear similar to normal cells, and "high
grade" if they appear poorly differentiated)
◼ R (0/1/2): the completeness of the operation (surgery-
boundaries free of cancer cells or not)
◼ L (0/1): invasion into lymphatics
◼ V (0/1): invasion into vein
◼ C (1-4): a modifier of the certainty (quality) of the last
mentioned parameter
Examples
◼ Small, low grade cancer, no metastasis, no spread to
regional lymph nodes, cancer completely removed,
resection material seen by pathologist - pT1 pN0 M0 R0
G1; this would be considered Stage I.

◼ Large, high grade cancer, with spread to regional lymph

nodes and other organs, not completely removed, seen
by pathologist - pT4 pN2 M1 R1 G3; this would be
considered Stage IV.

◼ Most Stage I tumors are curable; most Stage IV tumors

are not.
Staging for Chronic Lymphocytic
Leukemia (CLL)

◼ There are two different systems for staging

chronic lymphocytic leukemia. The Rai
classification is used more often in the United
States, whereas the Binet system is used more
widely in Europe
Stages of Leukemia: Acute
Lymphocytic Leukemia (ALL)

◼ For adults, ALL is classified as untreated, in remission,

or recurrent. For childhood ALL, risk groups are used
instead of stages to describe cases of the disease. Risk
groups for childhood ALL include:

◼ Standard (low) risk

◼ High risk
◼ Recurrent.
Other staging
◼ Lymphoma: uses Ann Arbor staging

◼ Hodgkin's Disease: follows a scale from I-IV and

can be indicated further by an A or B, depending
on whether a patient is non-symptomatic or has
symptoms such as fevers. It is known as the
"Cotswold System" or "Modified Ann Arbor
Staging System".
Duke Staging System

◼ Modified Duke A The tumor penetrates into the mucosa of the

bowel wall but no further.
◼ Modified Duke B B1: tumor penetrates into, but not through the
muscularis propria (the muscular layer) of the bowel wall. B2: tumor
penetrates into and through the muscularis propria of the bowel wall.
◼ Modified Duke C C1: tumor penetrates into, but not through the
muscularis propria of the bowel wall; there is pathologic evidence of
colon cancer in the lymph nodes. C2: tumor penetrates into and
through the muscularis propria of the bowel wall; there is pathologic
evidence of colon cancer in the lymph nodes.
◼ Modified Duke D The tumor, which has spread beyond the
confines of the lymph nodes (to organs such as the liver, lung or
bone).
Summary
◼ Cancer is a disease of
Division, growth and
spread

◼ It has a number of causes

many of them
preventable

◼ The survival of the patient

is determined by the
stage of the disease, the
earlier the detection or
the smaller the tumour
the better the survival
 10 Rules to Avoid Cancer

1. Don’t smoke
2. Don’t smoke.
3. Don’t smoke.
4. Avoid exposure to other known carcinogens,
including aflatoxin, asbestos and UV light.
5. Enjoy a healthy diet, moderate in calories,
salt and fat, and low in alcohol.
6. Eat fresh fruit and vegetables several times a day.
7. Be physically active and avoid obesity.
8. Have vaccination against, or early detection/treatment
of, cancer causing chronic infections.
9. Have the right genes.
10. Have good luck !