BREAST CANCER

DESCRIPTION

Breast cancer could be a illness in which cells within the breast develop out of control. There

are distinctive sorts of breast cancer. The kind of breast cancer depends on which cells within

the breast turn into cancer. Breast cancer can start in several parts of the breast.

• Significant Risk F: Women especially age 50 yrs. old & older

• Probable F: Nulliparity & First child after age 30 yrs. old

• Controversial Risk F: Oral Contraceptives & Alcohol use

• 90% is due from genetic abnormalities

TYPES

Ductal Carcinoma In Situ (DCIS)

• Non-invasive

• Found in the lining of the breast milk duct

• Early cancer and treatable

Invasive Ductal Carcinoma (IDC)

• Also called as infiltrative ductal carcinoma.

Lobular Carcinoma In Situ (LCIS)

• Non-invasive

• Found in lobules of the breast

• Early cancer and treatable

Invasive Lobular Cancer (ILC)

 • 2nd type of common breast cancer

• Can be seen through MRI

Triple Negative Breast Cancer (TNBC)

• The three types most common receptors known to fuel breast cancer growth is not present

such as: Estrogen, Progesterone & HER-2/ neu gene

Inflammatory Breast Cancer (IBC)

• Aggressive and Fast-Growing breast cancer infiltrates lymph vessels and skin of the

breast

• No distinct lump or tumor can be felt within the breast but if lymph vessels are blocked

by the breast cancer cells, symptoms begin to appear

Metastatic Breast Cancer

• Classified as Stage 4 breast cancer. The cancer has spread to other parts of the body. This

usually includes the lungs, liver, bones or brain.

Breast Cancer During Pregnancy

• Being pregnant doesn’t cause breast cancer, but if you already have some breast cancer

cells, the hormonal changes of pregnancy may cause them to grow.

Other Types

• Most common breast cancer type is ductal carcinoma in situ (DCIS), and the rest are less

commonly seen.

SIGNS & SYMPTOMS

In general, the body produces certain warning signs. The most common is the breast lump, which

may be located anywhere along your chest wall to under your armpit. You may have nipple

bleeding or discharge, as well as related pain. There may be redness and/or swelling in any area

of the breast or in one breast and not the other, and your nipple could look flatter or caved in.

Early detection is key when it comes to any cancer and treatment options.

Early Warning Signs of Breast Cancer

● A lump in your breast or underarm

● Swelling in your armpit or near your collarbone

● Pain and tenderness

● A flat or indented area on your breast

● Breast changes

● Changes in your nipple

● Unusual nipple discharge

● A marble-like area under your skin

Breast Cancer Types and Symptoms

● Symptoms of ductal carcinoma

○ This is the most common type of breast cancer. It begins in your ducts. About 1 in

5 new breast cancers are ductal carcinoma in situ (DCIS). This means you have

cancer in the cells that line your ducts, but it hasn’t spread into nearby tissue.
 ● Symptoms of lobular carcinoma

○ Fullness, thickening, or swelling in one area

○ Nipples that are flat or point inward (inverted)

● Symptoms of invasive breast cancer

○ A lump in your breast or armpit.

○ One breast that looks different from the other

○ A rash or skin that’s thick, red, or dimpled like an orange

○ Skin sores

○ Swelling in your breast

○ Small, hard lymph nodes that may be stuck together or stuck to your skin

○ Pain in one spot

● Symptoms of triple-negative breast cancer

○ Breast cancer is called triple-negative if it doesn’t have receptors for the

hormones estrogen and progesterone and doesn’t make a lot of a protein called

HER2. This kind tends to grow and spread faster than other types, and doctors

treat it differently.

● Symptoms of metastatic breast cancer

○ pain, nipple discharge or a lump or thickening in the breast or underarm

○ pain, fractures, constipation or decreased alertness due to high calcium levels

○ shortness of breath or difficulty breathing, coughing, chest wall pain or extreme

fatigue

○ nausea, extreme fatigue, increased abdominal girth, swelling of the feet and hands

due to fluid collection and yellowing or itchy skin

○ pain, confusion, memory loss, headache, blurred or double vision, difficulty with
 speech, difficulty with movement or seizures.

● Symptoms of inflammatory breast cancer (IBC)

○ A breast that’s warm, swollen, and red

○ Skin that’s dimpled, leathery, or ridged

○ A nipple that turns inward

○ Unusual nipple discharge

● Symptoms of BC during pregnancy

○ dimpling or puckering of the skin

○ bloody fluid from the nipple

○ scaly skin on the breast and any unusual thickening in one area of the breast

STAGING/GRADING

Staging is the process of categorizing cancer based on the degree of the disease in the body. It is

determined by whether the cancer is invasive or noninvasive, the size of the tumor, the number of

lymph nodes involved, and whether or not it has migrated to other regions of the body. It is

considered as one of the most important factors in determining the prognosis and treatment options

since there are different treatments that are best suited on a particular breast cancer stage. This can

be performed before or after a patient undergoes surgery.

The American Joint Committee on Cancer (AJCC) TNM system is the most common tool that

physicians used to describe the stages of breast cancer. Breast cancer clinical and pathologic

staging were introduced to the system in January 2018.Furthermore, examining tissue taken during

an operation is called as the pathologic stage while the clinical stage is determined by the findings

of a physical examination, biopsy, and imaging studies.

The TNM system contains three parts and these are:

T- The extent of the primary tumor

 N - The absence or presence and extent of regional lymph node metastasis

M - The absence or presence of distant metastasis

Primary Tumor (T)- is the original, or first, tumor in the body. The “T” plus a letter or number

(0 to 4) is used to describe the size and location of the tumor.

Tx Primary tumor cannot be assessed

T0 No evidence of primary tumor

Tis Carcinoma in situ which means that the cancer

is confined within the ducts of the breast tissue

and has not spread into the surrounding tissue

of the breast.

Types (DCIS/Paget’s)

T1, T2, T3, T4 Increasing size and/or local extent of the

primary tumor

T1- tumor is ≤ 2cm

• Tm1- tumor is ≤0.1cm

• T1a- tumor is >1 mm but ≤5 mm

• T1b- tumor >5 mm but ≤10 mm

• T1c - tumor >10 mm but ≤20 mm

T2- tumor is >2 cm to ≤5 cm

T3- tumor is >5cm

T4- tumor is of any size growing into the chest wall or skin. This includes inflammatory breast

cancer.

a. T4a - tumor has grown into the chest wall.

 b. T4b -tumor has grown into the skin.

c. T4c - cancer that has grown into the chest wall and the skin.

d. T4d- inflammatory breast cancer (a rare and aggressive wherein the cancer cells block

lymph vessels in the skin of the breast)

Regional Lymph Nodes (N)- Lymph nodes near where the cancer started. These are located

under the arm (axillary lymph nodes), above and below the collarbone and under the breastbone

(internal mammary lymph nodes). N followed by a number from 0 to 3 indicates whether the

cancer has spread to lymph nodes near the breast.

Nx Regional lymph nodes cannot be assessed

N0 No regional lymph node metastasis

N1, N2, N3 Increasing involvement of regional lymph

nodes

N1- The cancer has spread to 1 to 3 axillary lymph nodes and/or the internal mammary lymph

nodes.

• N1mi- the cancer in the lymph node is larger than 0.2 mm but 2 mm or smaller.

• N1a- the cancer has spread to 1 to 3 lymph nodes under the arm with at least one area of

cancer spread greater than 2 mm across.

• N1b- the cancer has spread to internal mammary lymph nodes on the same side as the

cancer, but this spread could only be found on sentinel lymph node biopsy.

• N1c- Both N1a and N1b apply.

N2- Has spread to 4 to 9 axillary lymph nodes or it has spread to the internal mammary lymph

nodes, but not the axillary lymph nodes.

 • N2a- Cancer has spread to 4 to 9 lymph nodes under the arm, with at least one area of

cancer spread larger than 2 mm.

• N2b- Cancer has spread to one or more internal mammary lymph nodes, causing them to

become enlarged.

N3a (Either of the two)

-Cancer has spread to 10 or more axillary lymph nodes, with at least one area of cancer spread

greater than 2 mm

-Cancer has spread to the lymph nodes under the collarbone (infraclavicular nodes), with at least

one area of cancer spread greater than 2 mm.

N3b (Either of the two)

- Cancer is found in at least one axillary lymph node with at least one area of cancer spread greater

than 2 mm and has enlarged the internal mammary lymph nodes

-Cancer has spread to 4 or more axillary lymph nodes (with at least one area of cancer spread

greater than 2 mm), and tiny amounts of cancer are found in internal mammary lymph nodes on

sentinel lymph node biopsy.

N3c- Cancer has spread to the lymph nodes above the collarbone (supraclavicular nodes) with at

least one area of cancer spread greater than 2 mm.

Distant Metastasis (M)- “M” followed by a 0 or 1 indicates whether the cancer has spread to

distant organs such as the lungs, liver, or bones.

Mx Distant metastasis cannot be assessed

M0 No distant metastasis

M1 Distant metastasis
 Breast Cancer Stages

There are 5 stages of breast cancer which starts with 0 and followed by Roman Numerals I, II, III,

IV. They are often followed by A, B, or C. The higher the number, the more advanced the cancer

is.

STAGE 0

-Early stage

-This is usually difficult to detect because a lump may not be felt during a self-examination, and

there may be no other symptoms.

-Only in the ducts of the breast tissue and has not spread to the surrounding tissue of the breast.

- Non-invasive (do not usually spread or damage other organs and tissues) or in situ cancer

- Two types:

a. Ductal carcinoma in situ (DCIS) occurs when breast cancer cells develop in the breast ducts.

This can become invasive if not detected early.

b. Lobular carcinoma in situ (LCIS) occurs when abnormal cells develop in the lobules. These

cells are not cancerous and this condition rarely becomes invasive cancer.

-Tis, N0, M0

STAGE I

- Starting with this stage, the breast cancer is already considered as invasive. This means it has

broken free to attack healthy tissue.

- Types: STAGE IA and IB

STAGE IA

- The tumor is small, invasive, and has not spread to the lymph nodes

-T1, N0, M0

STAGE IB
- Cancer has spread to the lymph nodes and the cancer in the lymph node is < 0.2 mm but >2 mm

in size.

-There is either no evidence of a tumor in the breast or the tumor in the breast is 20 mm or smaller

(T0 or T1, N1mi, M0).

STAGE II

- Cancer cells have spread beyond the original location and into the surrounding breast tissue, and

the tumor is larger than in stage 1 disease.

- Tumor may be detected during a breast self-exam as a hard lump within the breast.

STAGE IIA (Any 1 of these conditions)

- There is no evidence of a tumor in the breast, but the cancer has spread to 1 to 3 axillary lymph

nodes. It has not spread to distant parts of the body. (T0, N1, M0).

-The tumor is 20 mm or smaller and has spread to 1 to 3 axillary lymph nodes (T1, N1, M0).

-The tumor is larger than 20 mm but not larger than 50 mm and has not spread to the axillary

lymph nodes (T2, N0, M0).

STAGE IIB (Either of these conditions)

-The tumor is larger than 20 mm but not larger than 50 mm and has spread to 1 to 3 axillary lymph

nodes (T2, N1, M0).

-The tumor is larger than 50 mm but has not spread to the axillary lymph nodes (T3, N0, M0).

STAGE III

-Considered as more advanced form of invasive breast cancer.

-Cancer cells have usually not spread to more distant sites in the body, but are present in several

axillary (underarm) lymph nodes.

-The tumor may also be quite large, possibly extending to the chest wall or the skin of the breast.

STAGE IIIA (Any of these conditions)

- The cancer of any size has spread to 4 to 9 axillary lymph nodes or to internal mammary lymph
 nodes. It has not spread to other parts of the body (T0, T1, T2, or T3; N2; M0).

- The tumor is larger than 50 mm that has spread to 1 to 3 axillary lymph nodes (T3, N1, M0).

STAGE IIIB

- The tumor has spread to the chest wall or caused swelling or ulceration of the breast, or it is

diagnosed as inflammatory breast cancer.

-It may or may not have spread to up to 9 axillary or internal mammary lymph nodes. It has not

spread to other parts of the body (T4; N0, N1, or N2; M0).

STAGE IIIC

- A tumor of any size that has spread to 10 or more axillary lymph nodes, the internal mammary

lymph nodes, and/or the lymph nodes under the collarbone. It has not spread to other parts of the

body (any T, N3, M0).

STAGE IV

- Metastatic breast cancer

-The tumor can be any size and has spread to other organs, such as the bones, lungs, brain, liver,

distant lymph nodes, or chest wall (any T, any N, M1).

According to the National Cancer Institute, the 5-year survival rates for breast cancer are:

-Stage 0- 100%, Stage I- 100%, Stage II- 93%, Stage III- 72%, Stage IV-22%

-The 5-year survival rate shows how many people live for at least 5 years after being diagnosed

with breast cancer. It's based on the stage at the time of diagnosis.

Additional markers for breast cancer staging

- This is used to further identify the stage that may aid in the selection of specific medicines to

combat the disease.

• Estrogen Receptor (ER) status: The cancer has a protein called as estrogen receptor (ER-

positive).
 • Progesterone Receptor (PR) status: The cancer has a protein called as progesterone

receptor (PR-positive).

-A tumor is ER and/or PR positive if at least 1% of the cells examined have estrogen and/or

progesterone receptors

• HER2: The cancer makes the protein HER2 (human epidermal growth factor 2).

-It is a growth-promoting protein on the outside of all breast cells.

-HER2-positive are those breast cancer cells that have high levels of HER2 compared to

the normal levels.

-G: Grade of cancer refers to how different the cells look from normal.

Grading

- a way to measure how the cells look and how fast they’re growing compared to normal cells.

-3 cancer cell features are studied and each is assigned a score.

• the amount of gland formation (the cell “differentiation,” or how well the tumor cells are

trying to recreate normal glands)

• the nuclear features (the degree of "pleomorphism" or how "ugly" the tumor cells look)

• the mitotic activity (how much the tumor cells are dividing, or proliferating)

-Add the scores in order to give a final total score ranging from 3-9

-Final score is used to assign a grade between 1 and 3.

Glandular/Tubular

Differentiation

Nuclear

Pleomorphism
 Mitotic Count

Score 1 >75% of tumor forms

glands

Uniform cells with

small nuclei similar in

size to normal breast

epithelial cells

< 7 mitoses per 10 high

power fields

2 10% to 75% of tumor

forms glands

Cells larger than

normal with open

vesicular nuclei,

visible nucleoli, and

moderate variability in

size and shape

 8-15 mitoses per 10 high

power fields

3 <10% of tumor forms

glands

Cells with vesicular

nuclei, prominent

nucleoli, marked

variation in size and

shape

> 16 mitoses per 10 high

power fields

-Grade 1 (well differentiated)-The cells look similar to normal breast tissue and are growing

slowly. (Score 3, 4, or 5)

-Grade 2 (moderately differentiated)- The cells are growing at a speed of and look slightly different

from normal cells. (Score 6, 7)

-Grade 3 (poorly differentiated): The cells look very different from normal cells. They’re growing

quickly and are likely to spread. (Score 8, 9)

Example of using full staging system

The breast cancer is STAGE IB if:

 a. when the tumor size is between 2 and 5 cm(T2), it has not spread to nearby lymph node (N0)

and to distant organs such as the bones, lungs, brain, liver(M0).

b. Grade 3 or poorly differentiated

c. HER2-negative- normal amount of HER2 protein

d. ER positive- the cancer cells have estrogen receptors

e.PR positive-the cancer cells have progesterone receptors

Common tests used to determine the stages of breast cancer

• Imaging Tests

a. Chest x-ray- is a test that may be performed to determine whether the cancer has progressed to

the lungs.

b. CT scan (computed tomography)- this utilizes x-rays captured from various angles, which are

then merged by a computer to create detailed images of the inside of the body. This test is most

commonly performed to examine the chest and/or abdomen to determine whether breast cancer

has spread to other organs.

c. MRI (magnetic resonance imaging)- Rather than x-rays, this test provides detailed images using

radio waves and powerful magnets. MRIs can be more painful than CT scans because they take

longer and the patient needs to lay in a tight tube while the test is being performed.

d. PET scan (positron emission tomography- This test uses a special camera that captures images

of the parts of the body where the fluorodeoxyglucose (FDG) has accumulated. FDG is a form of

radioactive sugar injected into a vein and travels throughout the body. Also, this sugar is readily

absorbed by cancer cells.

e. Bone scan- This can help determine whether the disease has spread to the bones or not. It is

comparable to a PET scan, but it utilizes a different radioactive substance which settles in areas of

bone alteration. It can show all of the bones at once and can detect tiny regions of cancer spread

which ordinary x-rays cannot.

 • Blood tests

- Blood tests help the physician determine the overall health of a patient and decide the additional

staging tests that are beneficial. A complete blood count and a blood chemistry test, which assesses

the kidney and liver function, are two examples of blood testing.STAGING VS GRADING

STAGING

Tumor
Nodule
Metastasis
Primary tumor (T)
TX: Main tumor cannot be measured.
T0: Main tumor cannot be found.
T(is), or T in situ: The tumor is still within the confines of the normal glands and cannot metastasize.
T1, T2, T3, T4: Refers to the size and/or extent of the main tumor. The higher the number after the T,
the larger the tumor or the more it has grown into nearby tissues. T's may be further divided to provide
more detail, such as T3a and T3b.

Regional lymph nodes (N)

NX: Cancer in nearby lymph nodes cannot be measured.
N0: There is no cancer in nearby lymph nodes.
N1, N2, N3: Refers to the number and location of lymph nodes that contain cancer. The higher the
number after the N, the more lymph nodes that contain cancer

Distant metastasis (M)

MX: Metastasis cannot be measured.
M0: Cancer has not spread to other parts of the body.
M1: Cancer has spread to other parts of the body.

TUMOR GRADING (1-4)

1. Tumor cells and tissue looks most like healthy cells and tissue. These are called well-
differentiated tumors and are considered low grade.

2. The cells and tissue are somewhat abnormal and are called moderately differentiated. These
are intermediate grade tumors.

3. Cancer cells and tissue look very abnormal. These cancers are considered poorly differentiated,
since they no longer have an architectural structure or pattern. Grade 3 tumors are considered
high grade.
4. These undifferentiated cancers have the most abnormal looking cells. These are the highest
grade and typically grow and spread faster than lower grade tumors.
 BREAST CANCER
SYMPTOMS

 A change in the size or shape of one or both breasts

 Discharge from either of your nipples, which may be streaked with blood
 A lump or swelling in either of your armpits
 Dimpling on the skin of your breasts
 A rash on or around your nipple
 Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola)
or breast skin
 Inverted nipple
 Redness or pitting of the skin over your breast (peaud'orange)

BREAST CANCER TYPES

Ductal Carcinoma In Situ (DCIS)
intraductal carcinoma or stage 0 breast cancer; noninvasive or pre invasive breast cancer.
Invasive Breast Cancer
Where the cancer cells have spread through the lining of the ducts into the surrounding breast tissue.

Types:
Invasive Ductal Carcinoma
Invasive Lobular Carcinoma
Inflammatory Breast Cancer
Triple Negative Breast Cancer

Nottingham Score for Breast Cancer

CHARACTERISTICS

Tubule Formation how much the tumor looks like normal cell structure.
Nuclear Pleomorphism how different the tumor cells look from normal cells.
Mitotic Activity how fast cells are dividing or reproducing.

STAGING
*The extent (size) of the tumor (T)
*The spread to nearby lymph nodes (N)
*The spread (metastasis) to distant sites (M)
*Estrogen Receptor (ER) status
*Progesterone Receptor (PR) status
*Her2 status
*Grade of the cancer (G)

T categories for breast cancer

 TX: Primary tumor cannot be assessed.

 T0: No evidence of primary tumor.

 Tis: Carcinoma in situ (DCIS, or Paget disease of the breast with no associated tumor mass)
  T1 (includes T1a, T1b, and T1c): Tumor is 2 cm (3/4 of an inch) or less across.

 T2: Tumor is more than 2 cm but not more than 5 cm (2 inches) across.

 T3: Tumor is more than 5 cm across.

 T4 (includes T4a, T4b, T4c, and T4d): Tumor of any size growing into the chest wall or skin.
This includes inflammatory breast cancer.

N categories for breast cancer

 NX: Nearby lymph nodes cannot be assessed (for example, if they were removed previously).
 N0: Cancer has not spread to nearby lymph nodes.
 N0(i+): The area of cancer spread contains fewer than 200 cells and is smaller than 0.2 mm.
The abbreviation "i+" means that a small number of cancer cells (called isolated tumor cells)
were seen in routine stains or when a special type of staining technique, called
immunohistochemistry, was used.
 N0(mol+): Cancer cells cannot be seen in underarm lymph nodes (even using special stains),
but traces of cancer cells were detected using a technique called RT-PCR. RT-PCR is a
molecular test that can find very small numbers of cancer cells. (This test is not often used to
find breast cancer cells in lymph nodes because the results do not influence treatment
decisions.)
 N1: Cancer has spread to 1 to 3 axillary (underarm) lymph node(s), and/or tiny amounts of
cancer are found in internal mammary lymph nodes (those near the breast bone) on sentinel
lymph node biopsy.
 N1mi: Micrometastases (tiny areas of cancer spread) in the lymph nodes under the arm. The
areas of cancer spread in the lymph nodes are at least 0.2mm across, but not larger than 2mm.
 N1a: Cancer has spread to 1 to 3 lymph nodes under the arm with at least one area of cancer
spread greater than 2 mm across.
 N1b: Cancer has spread to internal mammary lymph nodes on the same side as the cancer, but
this spread could only be found on sentinel lymph node biopsy (it did not cause the lymph nodes
to become enlarged).
 N1c: Both N1a and N1b apply.
 N2: Cancer has spread to 4 to 9 lymph nodes under the arm, or cancer has enlarged the
internal mammary lymph nodes
 N2a: Cancer has spread to 4 to 9 lymph nodes under the arm, with at least one area of cancer
spread larger than 2 mm.
 N2b: Cancer has spread to one or more internal mammary lymph nodes, causing them to
become enlarged.
 N3: Any of the following:
 N3a: either:
 Cancer has spread to 10 or more axillary lymph nodes, with at least one area of cancer
spread greater than 2 mm,
OR
 Cancer has spread to the lymph nodes under the collarbone (infraclavicular nodes), with
at least one area of cancer spread greater than 2 mm.
 N3b: either:
 Cancer is found in at least one axillary lymph node (with at least one area of cancer spread
greater than 2 mm) and has enlarged the internal mammary lymph nodes
  Cancer has spread to 4 or more axillary lymph nodes (with at least one area of cancer spread
greater than 2 mm), and tiny amounts of cancer are found in internal mammary lymph nodes on
sentinel lymph node biopsy.
 N3c: Cancer has spread to the lymph nodes above the collarbone (supraclavicular nodes) with
at least one area of cancer spread greater than 2 mm.

M categories for breast cancer

 M0: No distant spread is found on x-rays (or other imaging tests) or by physical exam
 Cm0(i+): Small numbers of cancer cells are found in blood or bone marrow (found only by
special tests),or tiny areas of cancer spread (no larger than 0.2 mm) are found in lymph
nodes away from the underarm, collarbone, or internal mammary areas.
 M1: Cancer has spread to distant organs (most of ten to the bones, lungs, brain, or liver).
 LUNG CANCER
SYMPTOMS

 A persistent cough
 Coughing up blood
 Persistent breathlessness
 Unexplained tiredness and weight loss
 An ache or pain when breathing or coughing

BREAST CANCER TYPES

Non-small-cell lung cancer
The most common form, accounting for more than 87% of cases. It can be one of three types:
squamous cell carcinoma, adenocarcinoma or large-cell carcinoma.
Small-cell lung cancer
A less common form that usually spreads faster than non-small-cell lung cancer.

STAGING

 Stage 1: Cancer is found in the lung, but it has not spread outside the lung.
•1a: <3cm
•1b: >3 but <4 cm
Criteria**
•Main bronchus, innermost tissue that wraps around the lung
•Either a portion of or the entire lung has collapsed or has pneumonitis
 Stage 2: Cancer is found in the lung and nearby lymph nodes
•2A: >4 cm but <5cm **
•2B: 5 cm with LN **; <7 cm nut >5 cm and 1 additional tumor
 Stage 3: lung and lymph nodes in the middle of the chest.
3A
 5 cm with LN **
 5 cm but <7cm and additional one tumor**
 7cm and one additional tumor in different lobe
3B
 5cm and LN above the collarbone or LN on the other side of the chest**
3C
 Any size+LN+additional tumor

 Stage 4: Cancer has spread to both lungs, into the area around the lungs, or to distant organs.

Stage 4A: The lung cancer tumor is any size, may have reached the lymph nodes, and meets at least
one of the following criteria:

At least one tumor has formed in the lung opposite to where the original tumor formed.

The cancer has reached the sac around the heart or the tissues wrapping around the lungs.

The cancer has spread to fluid surrounding the heart or lungs.

The cancer has reached an organ far away from the lung, such as the brain, liver or kidney.

Stage 4B: The cancer has reached various places in at least one organ far away from the lung.

STAGES OF SCLC
Limited stage
the cancer has only reached one area of the chest

Extensive stage
Extensive stage means the cancer has spread throughout the lung and may have metastasized to the
other lung, to lymph nodes in the opposite area of the chest, to fluid surrounding the lung or other
locations such as the bones.
 OVARIAN CANCER
SYMPTOMS

 Bloating
 Pelvic or abdominal pain
 Early satiety (feeling full quickly) or difficulty eating
 A need to urinate frequently or urgently
LESS COMMON

 Back pain
 Extreme tiredness
 Weight loss
 Pain during sex
 Acid reflux
 Constipation or upset stomach
 Unusual belly swelling
 Menstrual changes

STAGING
Stage 1 Ovarian Cancer

 Stage1A: Cancer is found inside a single ovary.

 Stage1B: Cancer is found inside both ovaries.
 Stage1C: Cancer is found inside one or both ovaries and one of the following is true:

o cancer is also found on the outside surface of one or both ovaries or

o the capsule (outer covering) of the ovary has ruptured (broken open) or
o cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of
the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity)

Stage 2 Ovarian Cancer

 Stage 2 A Cancer has spread to the uterus and/or fallopian tubes

 Stage 2 B Cancer has spread to other tissue within the pelvis
 Stage 2 C Cancer is found inside one or both ovaries and has spread to the uterus and/or
fallopian tubes, or to other tissue within the pelvis Also, one of the following is true:

o Cancer is found on the outside surface of one or both ovaries; or

o the capsule(outer covering)of the ovary has ruptured(broken open);or
o cancer cells are found in the fluid of the peritoneal cavity or in washings of the peritoneum
 COLON CANCER
SYMPTOMS

 A persistent blood in your poo –that happens for no obvious reason or is associated with a
change in bowel habit
 A persistent change in your bowel habit –which is usually having to poo more and your poo may
also become more runny
 Persistent lower abdominal (tummy) pain, bloating or discomfort –that's always caused by
eating and may be associated with loss of appetite or significant unintentional weight loss

STAGING
T categories for colon cancer
 TX: The primary tumor cannot be evaluated.
 T0 (T plus zero): There is no evidence of cancer in the colon or rectum.
 Tis: Refers to carcinoma in situ (also called cancer in situ). Cancer cells are found only in the
epithelium or lamina propria, which are the top layers lining the inside of the colon or rectum.
 T1: The tumor has grown into the submucosa, which is the layer of tissue underneath the
mucosa or lining of the colon.
 T2: The tumor has grown into the muscularis propria, a deeper, thick layer of muscle that
contract to force along the contents of the intestines.
 T3: The tumor has grown through the muscularis propria and into the subserosa, which is a thin
layer of connective tissue beneath the outer layer of some parts of the large intestine, or it has
grown into tissues surrounding the colon or rectum.
 T4a: The tumor has grown into the surface of the visceral peritoneum, which means it has
grown through all layers of the colon.
 T4b: The tumor has grown into or has attached to other organs or structures.

N categories for colon cancer

 NX: The regional lymph nodes cannot be evaluated.
 N0 (N plus zero): There is no spread to regional lymph nodes.
 N1a: There are tumor cells found in 1 regional lymph node.
 N1b: There are tumor cells found in 2 or 3 regional lymph nodes.
 N1c: There are nodules made up of tumor cells found in the structures near the colon that do
not appear to be lymph nodes.
 N2a: There are tumor cells found in 4 to 6 regional lymph nodes.
 N2b: There are tumor cells found in 7 or more regional lymph nodes.

M categories for colon cancer

 M0 (M plus zero): The disease has not spread to a distant part of the body.
 M1a: The cancer has spread to 1 other part of the body beyond the colon or rectum.
 M1b: The cancer has spread to more than 1 part of the body other than the colon or rectum.
 M1c: The cancer has spread to the peritoneal surface
COLON GRADING

 GX: The tumor grade cannot be identified.

 G1: The cells are more like healthy cells, called well differentiated.
 G2: The cells are somewhat like healthy cells, called moderately differentiated.
 G3: The cells look less like healthy cells, called poorly differentiated.
 G4: The cells barely look like healthy cells, called undifferentiated.

T categories for colon cancer

 Stage0: Tis (T)
 Stage 1: T1 or T2
 Stage 2
 Stage IIA: T3
 Stage IIB: T4a
 Stage IIC: T4b
 Stage 3
 Stage IIIA (Group 1): T1-T2
 Stage IIIA (Group 2): T1
 Stage IIIB (Group 1): T3-T4a
 Stage IIIB (Group 2): T2-T3
 Stage IIIB (Group 3): T1-T2
 Stage IIIC (Group 1): T4a
 Stage IIIC (Group 2): T3-T4a
 Stage IIIC (Group 3): T4b
 Stage IV
 Stage IVA (Group 1):
 Stage IVB (Group 2):

N categories for colon cancer

 Stage0: no metastasis
 Stage 1: no metastasis
 Stage 2
 Stage IIA: no metastasis
 Stage IIB: no metastasis
 Stage IIC: no metastasis
 Stage 3
Stage IIIA (Group 1): no metastasis
Stage IIIA (Group 2): no metastasis
Stage IIIB (Group 1): no metastasis
Stage IIIB (Group 2): no metastasis
Stage IIIB (Group 3): no metastasis
Stage IIIC (Group 1): no metastasis
Stage IIIC (Group 2): no metastasis
Stage IIIC (Group 3): no metastasis
Stage IVA (Group 1): no metastasis
Stage IVB (Group 2): metastasis in 1+ organ
M categories for colon cancer
 Stage0: no metastasis
 Stage 1: no metastasis
 Stage 2
 Stage IIA: no metastasis
 Stage IIB: no metastasis
 Stage IIC: no metastasis Stage 3
Stage IIIA (Group 1): metastasis in 1-3 nodes
Stage IIIA (Group 2): metastasis in 4-6 nodes
Stage IIIB (Group 1): metastasis in 1-3 nodes
Stage IIIB (Group 2): metastasis in 4-6 nodes
Stage IIIB (Group 3): metastasis in 7+ nodes
Stage IIIC (Group 1): metastasis in 4-6 nodes
Stage IIIC (Group 2): metastasis in 7+ nodes
Stage IIIC (Group 3): metastasis in 1-3 nodes
Stage IVA (Group 1): metastasis in 1+ nodes
Stage IVB (Group 2): metastasis in 1+ nodes
 PROSTATE CANCER
SYMPTOMS

 Trouble and/or pain when urinating

 Blood in the urine or semen
 Bone pain
 Erectile dysfunction
 Dull pain in the lower pelvic area
 Pain and edema in the legs and feet

TYPES OF PROSTATE CANCER

Acinar adenocarcinoma
Ductal adenocarcinoma
Transitional cell (or urothelial) cancer
Squamous cell cancer
Small cell prostate cancer

HODGKIN’S LYMPHOMA
A cancer of the lymphatic system which affects people of any age, but is most common in people
between 20 and 40 years old and those over 55.

SYMPTOMS

 Painless swelling of lymph nodes in your neck, armpits or groin

 Persistent fatigue
 Fever
 Night sweats
 Unexplained weight loss
 Severe itching
 Increased sensitivity to the effects of alcohol or pain in your
 lymph nodes after drinking alcohol

TYPES OF HODGKIN’S LYMPHOMA

Classical Hodgkin's lymphoma
Classical Hodgkin's lymphoma is the more common type of this disease People diagnosed with this
disease have large, abnormal cells called Reed Sternberg cells in their lymph nodes

SUBTYPES of classical Hodgkin's lymphoma include

 Nodular sclerosis Hodgkin's lymphoma

 Mixed cellularity Hodgkin's lymphoma
 Lymphocyte depleted Hodgkin's lymphoma
 Lymphocyte rich Hodgkin's lymphoma
Non-Hodgkin's lymphoma
Non-Hodgkin's lymphoma is a type of cancer that begins in your lymphatic system, which is part of the body's
germ-fighting immune system. In non-Hodgkin's lymphoma, white blood cells called lymphocytes grow
abnormally and can form growths (tumors) throughout the body.

SIGNS AND SYMPTOMS of non-Hodgkin's lymphoma may include:

 Swollen lymph nodes in your neck, armpits or groin
 Abdominal pain or swelling
 Chest pain, coughing or trouble breathing
 Persistent fatigue
 Fever
 Night sweats
 Unexplained weight loss

B cells and T cells

Bcells
A type of lymphocyte that fights infection by producing antibodies to neutralize foreign
invaders. Mostnon-Hodgkin's lymphoma arises from B ells. Subtypes of non-Hodgkin's
lymphoma that involve Bcells include diffuse large B-cell lymphoma,follicular lymphoma,
mantle cell lymphoma and Burkitt lymphoma.
Tcells
A type of lymphocyte that's involved in killing foreign invaders directly. Non-Hodgkin's
lymphoma occurs much less often in T cells. Subtypes of non-Hodgkin's lymphoma that
involve T cells include peripheral T-cell lymphoma and cutaneous T-cell lymphoma.