Cancer Overview II

Francis G. Kazoba BSc.RTT

 Cancer Signs & Symptoms
• Pain
 Eg. Bone cancer often hurts from the beginning.
• Weight loss
 Almost half of people who have cancer lose weight. It’s often one of the early signs.
• Fatigue
 Cancer-related weight loss can leave you exhausted
• Fever
 A high fever that last for more than 3 days.
 Cancer Signs & Symptoms
• Changes in the skin.
 unusual or new moles, bumps, or marks on the may be because of skin
cancer.
 The skin can also provide clues to other kinds of cancers. If it’s darkened,
looks yellow or red, itches, or sprouts more hair, or if you have an
unexplained rash, it could be a sign of liver, ovarian, or kidney cancer or
lymphoma.
 Cancer Signs & Symptoms
• Cough or hoarseness of the voice
 A cough is one sign of lung cancer and hoarseness may mean cancer of
the voice box (larynx) or thyroid gland.
• Sores
 Spots that bleed and won’t go away are also signs of skin cancer. Oral
cancer can start as sores in your mouth. Smoking, tobacco chewing , or
drinking a lot of alcohol increase the risk.
 Cancer Signs & Symptoms
• Unusual bleeding
 Cancer can make blood show up where it shouldn’t be. Excessive bleeding
after menstrual bleeding could be a sign of cervical cancer. Tumors along
your urinary tract can cause blood in your urine.
• Anemia
 Cancers like leukemia, lymphoma, and multiple myeloma can
damage bone marrow hence causes poor production of blood.
 Common Cancer Symptoms in Men
• The most common cancers in men are prostate, lung, and colorectal.
• Symptoms of cancer in men include:
 Trouble peeing associated with blood in the urine (hematuria)
• A lump and pain in the scrotum. 
 These might mean testicular cancer.
Common Cancer Symptoms in Women
• The types that affect women most are breast, the uterus, cervix, vagina,
or vulva.
• Symptoms of cancer in women include
 Vaginal bleeding or discharge
 Changes in appetite
 Breast changes
Cancer Signs & Symptoms
 Cancer diagnosis
• Diagnosing cancer at its earliest stages often provides the best chance for
a cure.
• For a few cancers, studies show that screening tests can save lives by
diagnosing cancer early.
• For other cancers, screening tests are recommended only for people with
increased risk.
 Cancer diagnosis
• Cancer diagnosis involves
 Physical examination.
 Laboratory tests.
 Imaging tests.
 Biopsy.
 Cancer diagnosis
• Physical examination
 This involves examination of areas of the body that feels like having
lumps that may indicate cancer.
 During a physical examination abnormalities such as changes in skin color
or enlargement of an organ are observed that may indicate the presence of
cancer.
 Cancer diagnosis
• Laboratory tests
 Laboratory tests, such as urine and blood tests, may help in identification
of abnormalities that can be caused by cancer.
 For instance people with leukemia, a common blood test called complete
blood count (CBC) may reveal an unusual number or type of white blood
cells.
 Cancer diagnosis
• Imaging tests
 Imaging tests allow examination of bones and internal organs in a non
invasive way.
 Imaging tests used in diagnosing cancer may include a computerized
tomography (CT) scan, bone scan, magnetic resonance imaging
(MRI), positron emission tomography (PET) scan, ultrasound and X-
ray, among others.
 Cancer diagnosis
• Biopsy
 During a biopsy, a collection of a sample of cells of a specific area of the
body is taken for testing in the laboratory.
 There are several ways of collecting a sample, knowing biopsy procedure
right for an individual depends on type of cancer and its location.
 In most situations, a biopsy procedure is the most correct way to
definitively diagnose cancer.
Cancer diagnosis
 Staging
• Staging is a way of describing or classifying a cancer based on the extent of cancer
in the body.
• The stage is often based on
 The size of the tumor,
 Which parts of the organ have cancer
 Whether the cancer has spread (metastasis) from where it started to other parts of
the body and
 Where it has spread.
 Staging
• Staging is a way of describing or classifying a cancer based on the extent of cancer
in the body.
• The stage is often based on
 The size of the tumor,
 Which parts of the organ have cancer
 Whether the cancer has spread (metastasis) from where it started to other parts of
the body and
 Where it has spread.
 Staging
• Grading is a way of classifying cancer cells based on their appearance
and behavior when viewed under a microscope.
• It involves
• Knowing how different the cancer cells look from normal cells,
• How frequently they are dividing (mitotic activity) and
• How likely they are to spread to new locations.
 Staging
• Staging act as a common way to describe the size and spread of cancers.
• The staging of cancer is used to:
 Help in treatment planning.
 Predict a patient’s outlook, the course of the disease or the chance of recovery (prognosis)
 Predict how successful the treatment will work.
 Create groups of people to study and compare in clinical trials.
• Cancers in the same part of the body (such as colon cancer) with the same stage tend to
have a similar prognosis and are usually treated the same.
 Staging
• Physicians use examination and tests to stage a cancer.
• The examinations and tests show where the cancer is and approximately
how much cancer is in the body.
• To stage a cancer, physician may do a physical examination, blood tests,
imaging tests or a biopsy.
• The tissue with cancer may also be observed during surgery or after the
tissue is removed by surgery.
 Staging systems
• Different staging systems are used for different types of cancer.
• The most common staging system used is the TNM system.
• TNM stands for 
 T -tumor
 N, node (lymph node) and 
 M -metastasis
 Staging systems
• It is used to stage most solid tumor cancers like breast or prostate cancer
which form lumps.
• Other staging systems are used to stage some types of solid cancers and
cancers of the blood and immune system, such as some types of leukemia
and lymphomas.
Staging systems
 TNM staging system
 T stands for tumor.
 It describes the size of the main (primary) tumor.
 It also describes if the tumor has grown into other parts of the organ with
cancer or tissues around the organ.
 T is usually given as a number from 1 to 4. A higher number means that
the tumor is larger. It may also mean that the tumor has grown deeper into
the organ or into nearby tissues.
 TNM staging system
 N stands for lymph nodes.
 It describes whether cancer has spread to lymph nodes around the organ.
 N0 means the cancer hasn’t spread to any nearby lymph nodes.
 N1, N2 or N3 means cancer has spread to lymph nodes. N1 to N3 can also
describe the number of lymph nodes that contain cancer as well as their
size and location.
 TNM staging system
• M stands for metastasis. It describes whether the cancer has spread to other
parts of the body through the blood or Lymphatic system
• M0 means that cancer has not spread to other parts of the body. M1 means that
it has spread to other parts of the body.
• Sometimes the lowercase letter a, b or c is used to subdivide the tumor, lymph
nodes or metastasis categories to make them more specific (for example, T1a).
Lowercase “is” is added after T (Tis) to describe a carcinoma in situ.
•  
 Types of TNM staging
• Solid tumor cancers may be given both a clinical and pathologic stage.
• Clinical stage is given before treatment and it is based on the results of
exams and tests such as imaging tests done when the cancer is found (at
the time of diagnosis).
• Physicians often choose a treatment based on the clinical stage.
• The clinical stage is shown by a lowercase “c” before the letters TNM on
some medical reports.
 Types of TNM staging
• Pathologic stage is based on the results of tests and exams done when the cancer is
found and what is learned about the cancer during surgery and when looking at the
tissue after it is removed by surgery.
• It gives more information about the cancer than the clinical stage.
• The pathologic stage is shown by a lowercase “p” before the letters TNM on a
pathology report.
• The clinical and pathologic stages of a cancer can be different. For example, during
surgery the doctor may find cancer in an area that didn’t show up on an imaging test
so the pathologic stage may result in a higher stage.
 Staging
• Other staging systems are used for certain types of cancer:
 Ovarian, endometrial, cervical, vaginal and vulvar cancers are often staged using the
International Federation of Gynecology and Obstetrics (FIGO) staging system. The
FIGO system is based on the TNM system.
 Non-Hodgkin lymphoma uses the Ann Arbor Staging System.
 Hodgkin lymphoma uses the Cotswold staging system.
 Chronic lymphocytic leukemia (CLL) uses the Rai and Benet staging systems.
 Multiple myeloma uses the International and the Durie-Salmon staging systems.
 Stage grouping
• Physicians use the TNM description to assign an overall stage from 0 to 4
for many types of cancer.
• Stages 1 to 4 are usually given as the Roman numerals I, II, III and IV.
• Generally, the higher the number, the more the cancer has spread.
Sometimes stages are subdivided using the letters A, B and C.
 Stage grouping
• stage 0 – Carcinoma in situ i.e. a precancerous change
• stage 1 – the tumor is usually small and hasn’t grown outside of the organ
it started in
• stages 2 and 3 – the tumor is larger or has grown outside of the organ it
started in to nearby tissue
• stage 4 – the cancer has spread through the blood or  Lymphatic system to
a distant site in the body (metastatic spread)
Stage grouping
 Staging
• Other ways to describe the stage may be the use of words like local,
localized, regional, locally advanced, distant, advanced or metastatic.
• Local and localized mean that the cancer is only in the organ where it
started and has not spread to other parts of the body.
• Regional and locally advanced mean close to or around the organ.
• Distant, advanced and metastatic mean in a part of the body farther from
the organ of cancer original.
 Factors that affect the stage
• Other factors that are used to determine the stage for some types of cancer include:
 Grade
 cancer cell type
-(such as  Adenocarcinoma Or Squamous cell (carcinoma)
 Tumor marker
-Levels (such as PSA in men with prostate cancer)
 genetic information about the cancer (such as which genes Are mutated)
Grading
 Restaging
• Restaging helps doctors plan further treatment when cancer comes back or
gets worse after the initial treatment.
• Restaging doesn’t mean that a stage 2 cancer changes to a stage 3 cancer.
The stage of a cancer doesn’t change. But a tumor initially staged as a T2
may be described as a T3 or T4 if the cancer has grown larger or grown
into nearby tissues.
• This may be found with further tests after treatment when restaging is
done, it is shown with a lowercase “r” before the letters TNM on a
medical report
 Cancer Treatment
• Once cancer is diagnosed, the patient may require medical treatment and
specialized care for months, and often years.
• The principal modes of therapy – surgery, radiotherapy and
chemotherapy.
• Treatment modality may be given alone or in combination.
 Cancer Treatment
• Treatment options include surgery, cancer medicines and/or radiotherapy, administered alone or in
combination.
• A multidisciplinary team of cancer professionals recommends the best possible treatment plan based
on tumor type, cancer stage, clinical and other factors.
• The choice of treatment should be informed by patients’ preferences and consider the capacity of the
health system.
• Palliative care, which focuses on improving the quality of life of patients and their families, is an
essential component of cancer care. Survivorship care includes a detailed plan for monitoring cancer
recurrence and detection of new cancers, assessing and managing long-term effects associated with
cancer and/or its treatment, and services to ensure that cancer survivor needs are met.
 Cancer Treatment
• Strong emphasis is now placed on the development of specialized cancer centers in
which evidence-based multimodality therapy is applied, subject to evaluation by
appropriately designed trials.
• After successful treatment, specific rehabilitation ( Palliative care ) may be needed.
• When cancer treatment is not curative, maintaining the highest possible quality of life
is challenging process.
• For many patients, supportive and palliative care are essential and this often involves
a range of professional services that extends beyond the discipline of oncology.
Cancer Treatment
 Surgery
• Surgical oncology is emerging as a specialist discipline; recent advances
include more precise identification of the tumor margin, leading to
reduced local recurrence.
• The greatly elevated cancer risk in individuals with familial cancer
syndromes increasingly raises the prospect of preventive surgery, e.g.
mastectomy in carriers of BRCA1/2 mutations and colectomy in patients
with familial colony cancer.
Surgery
 Radiotherapy
• It is estimated that 50% of all patients who are diagnosed with cancer in
the world would currently benefit at some stage of their illness from
radiotherapy.
• This could be either as part of radical therapy with curative intent or as
palliation for pain or other symptoms.
• The delivery of radiotherapy requires long-term planning in the
construction of facilities as well as specialized doctors, physicists and
technicians.
Radiotherapy
Radiotherapy
 Chemotherapy
• Chemotherapy is a drug treatment that uses powerful chemicals to kill
fast-growing cells in your body.
• Chemotherapy is most often used to treat cancer, since cancer cells grow and
multiply much more quickly than most cells in the body.
• The goals of chemotherapy depend on the type of cancer and how far it has
spread.
• Sometimes, the goal of treatment is to get rid of all the cancer and keep it
from coming back.
 Chemotherapy
• Chemotherapy can be used in the following situations
 Before surgery or radiation therapy to shrink tumors. This is called neoadjuvant
chemotherapy.
 After surgery or radiation therapy to destroy any remaining cancer cells this is called
adjuvant chemotherapy.
 As the only treatment for example, to treat cancers of the blood or lymphatic system, such as
leukemia and lymphoma.
 For cancer that comes back after treatment, called recurrent cancer.
 For cancer that has spread to other parts of the body, called metastatic cancer.
Chemotherapy
Chemotherapy
 Cancer Prevention
• Between 30% and 50% of cancer deaths could be prevented by
modifying or avoiding key risk factors and implementing existing
evidence-based prevention strategies.
• The cancer burden can also be reduced through early detection of cancer
and management of patients who develop cancer.
• Prevention also offers the most cost-effective long-term strategy for the
control of cancer.
 Cancer Prevention
 avoid tobacco use, including cigarettes and smokeless tobacco
 maintain a healthy weight
 eat a healthy diet with plenty of fruit and vegetables
 exercise regularly
 limit alcohol use
 practice safe sex 
 Cancer Prevention
 get vaccinated against hepatitis B and human papillomavirus (HPV)
 reduce exposure to ultraviolet radiation
 prevent unnecessary ionizing radiation exposure (e.g. minimize occupational exposure,
ensure safe and appropriate medical use of radiation in diagnosis and treatment)
 avoid urban air pollution and indoor smoke from household use of solid fuels
 get regular medical care
 some chronic infections are also risk factors for cancer. People in low- and middle-
income countries are more likely to develop cancer through chronic infections
 Cancer Prevention
• Cancer is more likely to respond to effective treatment when identified early,
resulting in a greater probability of surviving as well as less morbidity and less
expensive treatment.
• There are two distinct strategies that promote early detection:
 Early diagnosis identifies symptomatic cancer cases at the earliest possible stage
 Screening aims to identify individuals with abnormalities suggestive of a specific
cancer or pre-cancer who have not developed any symptoms and refer them
promptly for diagnosis and treatment.