Cancer Basics &

Overview
Principles of Oncology 1
142-251-DW
Readings
 Washington and Leaver 5th Ed.
 Chapter 1

 American Cancer Society: https://www.cancer.org/

 National Cancer Institute: https://www.cancer.gov/
Key Terms See Glossary

 Adenocarcinoma  Malignant  Radiation oncologist

 Adjuvant therapy  Medical dosimetrist  Radiation therapist
 Anaplastic  Medical physicist  Radioprotectors
 Benign  Metastasize  Radiosensitizers
 Biopsy  Natural history  Restaging
 Carcinomas  Necrosis  Retrospective
studies
 Cellular  NED (no evidence of
differentiation disease)  Sarcomas
 Chemotherapeutic  Neoadjuvant therapy  Sensitive
agents
 Oncogenes  Sentinel node
 Clinical staging
 Palliation  Simulation
 Epidemiology
 Pathologic staging  Somatic cells
 Etiology
 Phase I studies  Systemic treatment
 Exophytic
 Phase II studies  Targeted therapies
 False negative
 Phase III studies  Therapeutic ratio
 False positive
 Phase IV studies  Tumor board
 Grade
 Port-a-cath  Tumor staging
 Immunotherapy
 Posttherapy staging
 In situ
 Prognosis
 Interferon
 Prospective study
 Intrathecal
Cancer
Disease of cells are characterized by
abnormal proliferation

 Autonomy
 Lacking internal signals for normal cell division

 Anaplasia
 Abnormalities within the cell structure
Differences
Normal Cells Cancer Cells
 Regular mitotic activity  Sporadic, uncontrolled activity
 Cell division - same rate as  Cell division - same rate (may
surrounding cells be faster) as surrounding cells
 Mature to perform normal  Immature cells - not capable of
cellular functions cellular function
Neoplasms (new growths)
Benign Malignant
 Slow growth  Variable growth
 Encapsulated  Usually not encapsulated
 Growth by expansion  Growth by infiltration
 Well differentiated  Well to poorly / or
 Do not spread to other undifferentiated
parts of the body and the  Metastasize
cells do not invade other  (cancer cells break away from a
tissues malignant tumor and enter the
bloodstream or lymphatic system
 Little destruction to to form secondary tumors in other
normal tissue - not fatal parts of the body)
(except pressure)
 Eventually fatal if not treated
Diagram showing two epithelial
tumours
The upper tumour is a benign
tumour that is non-invasive.
Benign tumours are usually round
in shape and encapsulated by
fibrous connective tissue.
The lower picture depicts a
malignant tumour.
It is irregularly shaped, vascular,
and it is invasive, crossing the
basement membrane.
Tissues of the Body
4 main types of tissues
 Epithelial Origin  Carcinomas
1. Epithelium
 Mesenchymal Origin  Sarcomas
2. Connective
3. Muscle
4. Nervous

Histopathology  The study of changes in tissues

caused by disease
Layers in embryo
 Primary Germ Layers:
 Endoderm
 Mesoderm
 Ectoderm
Four basic types of tissues
 Four basic types of tissues
1. Epithelium

Connective
Muscle
2. Connective tissue

3. Muscle tissue
Nervous

4. Nervous tissue
1. Epithelial
 Specialized to form the covering or lining of all internal and external
body surfaces
 Simple Epithelium  One cell thick
 Compound Epithelium  two or more cells thick

 Functions
 Protection - skin
 Sensation - nerve endings
 Secretion - hormones and lubricating fluids
 Absorption - small intestine / nutrients
 Excretion - kidney / excrete waste
 Diffusion - lungs / gases Cleaning - air passages / removing dust
 Reduce Friction - circulatory system / blood and walls of blood vessels
 Flat, surface covering cells called
squamous cells
 For example, the skin or the lining
of the throat (Head and Neck)

 Glandular cells called

adenomatous cells
 For example, breast cells

 Layers of stretchy cells

called transitional cells
 For example, the lining of the
bladder
2. Connective
 Connective tissue is the name for the supporting
tissues of the body. The bones, cartilage, tendons
and fibrous tissue that support the body organs.
Connective tissue cancers are called sarcomas.
Sarcomas can develop from…

 Function
 Support

 Bind

 Protect

 Insulate
3. Muscle Tissue

Soft Tissue Sarcoma: Leiomyosarcoma

 Soft tissues that make up

the different types of
muscles
 Give the ability of muscles
to contract
 Function
 Movement
4. Nervous Tissue
 Most brain tumors develop from special
connective tissue cells called glial cells that
support the nerve cells in the brain
 These cancers also get their names from the
cells they developed from
 Cancers of the glial cells are called 'gliomas‘

 Function
 Neurons  Conduct nerve impulses
 Neuroglial  Non conducting (support,
insulate and protect the neurons)
Tumor types
 Epithelial Origin  Carcinomas
 Stratified squamous epithelium  Squamous cell carcinoma
 Transitional epithelial tissue  Transitional cell carcinoma

 Glandular or Ductal  Adenocarcinomas

 Mesenchymal Origin  Sarcomas (connective, muscle, or

nervous)
Cancer
 Etiology
 Smoking

 Heredity

 Genetic

 Occupational

 Radiation

 Epidemiology
 Age

 Gender

 Geography

 Ethnicity
Cancer management
1. Incidence
 Extent or frequency of cancer occurrence
 Information is collected by the cancer registry
2. Epidemiology
 Study of the incidence of disease
3. Etiology
 Study of the cause of disease
4. Detection and diagnosis
5. Prevention
6. Treatment
1. Incidence
What kind of Surgical data
information is  Stage
important?  Lymph node involvement
 Location
 Site
 Number
 Histology  Removal

 Grade  Surgical margins

 Date and location of  Date

diagnosis
 Date and location of
positive biopsy
1. Incidence cont’d
Chemotherapy Radiation therapy
 Type  Dose
 Dosage  Dates of treatment
 Dates of treatment

Hormone therapy

Follow-up care
 Side effects
 Recurrences

 Death
Primary causes of cancer
 Chemical
 Dietary
 Microbial
 Genetic
 Bacteria
 Iatrogenic
 relating to illness
caused by medical
examination or
treatment
Primary causes of cancer
Chemical agents Dietary substances
(occupational and  Fat  breast – colon – rectum – prostate –
endometrium
environmental factors)  High total caloric intake  breast –
 Tobacco smoke  bronchus – endometrium – prostate – colon – gallbladder
mouth – pharynx – larynx –  Animal protein (particularly as red meats)
esophagus – urinary bladder -  breast – endometrium – colon
pancreas  Alcohol (particularly in smokers)  mouth –
pharynx – larynx – esophagus – and liver
 Pesticides (arsenic)  skin - (beer drinking is associated with rectal
bronchus – lung cancer)
 Asbestos  lung  Salted, pickled, smoked foods  esophagus
– stomach
 Brewing (alcohol)  liver  Nitrate and nitrite additive  intestine
 Furniture manufacturing (wood  Low fiber, vegetables and fruits  breast –
dust)  nasal passages endometrium – prostate – colon - pancreas
 Outdoor occupation (ultraviolet
light)  skin
Primary causes of cancer
Microbial agents Bacterial
 Human T-cell lymphotropic virus  H pylori  esophagus
type  leukemia
 Epstein-Barr virus  lymphoid
tissue – nasopharynx Iatrogenic
 Hepatitis B virus  liver  An iatrogenic disorder is a condition caused
 Papilloma virus  uterine – cervix by medical personnel or procedure or
through exposure to the environment of a
health care facility.

Genetic  Ex. Tamoxifen given to breast ca patient –

chance of getting endometrial ca
 Inherited disorder characterized by
the early onset of hundreds to  Some chemotherapeutic agents increase the
thousands of adenomatous polyps risk of getting a second cancer (decrease the
 Familial adenomatous polyposis immune system)
(FAP)
 Increased risk factor for specific sites
Lung Colon Skin

Family history of polyps

Ulcerated colitis / Crohn’s UV exposure

Smoking tobacco Obesity / increasing age

 Increased risk factor for specific sites
Breast Ovary Endometrial

 Family history of breast cancer  Family history of breast, endometrial or colorectal

cancer
 History of breast cancer in other breast
 Never having children
 Diet high in fat
 Beginning to menstruate early
 Nulliparity or first child after age 30
 Entering menopause late
 Early menarche
 A history of infertility
 Late menopause
 Being over 50 (but can occur sooner)
Increased risk factor for specific sites
Prostate Head & Neck
7 Warning signs of cancer

C hange in bowel or bladder habits.

A sore that does not heal.
U nusual bleeding or discharge.
T hickening or lump in the breast, testes, or elsewhere.
I ndigestion or difficulty swallowing.
O bvious change in the size, color, shape, or thickness of a wart or mole.
N agging cough or hoarseness.
Stages of tumor development

Hyperplasia
 Abnormal increase in the number of normal cells

Dysplasia
 Abnormal changes in cellular shape, size, or organization
Cancer prophylaxis
 Inhibitors
Treatment Modalities
Treatment modalities

 Chemotherapy  Systemic

 Surgery  Local

 Radiation therapy  Local

 Hormone therapy  can also be used for breast (Tamoxifen) and

prostate cancers (Zoladex)
Treatment of choice

 Treatment decisions are based on the…

 Type of disease  Aggressiveness of cancer
 Location of the cancer  Predictability of cancer
 Amount of cancer  Morbidity and mortality rates of treatment procedure
 Extent of spread  Cure rate of treatment procedure

 Other decisions that also need to be considered are…

 Overall health
 Age
 Ability to cope with certain side effects
 Other medical conditions
 Previous cancer treatments
Treatment of choice
Tumor boards
 Cancer specialists work together to review information and
determine the most appropriate treatment plan for all newly
diagnosed cancers
 Multidisciplinary Team
 Surgeons
 Radiation oncologists
 Medical oncologists
 Nurses
 Basic principle of all therapy is to cure the cancer with minimal
damage to normal function and structure
 Benefits of the treatment must outweigh the associated risks!
Medical terms
 Neoadjuvant (pre main treatment)
 To shrink a tumor before the main treatment

 Adjuvant (post main treatment)

 After initial treatment to try to stop cancer from recurring

 Concomitant
 Refers to administering medical treatment at the same
time as another therapy
Radiation Oncology
Advantages
 Preserve function
 Good cosmetic results
Limitations
 Localized tumors
 Proximity of tumor to critical structures
 Medical condition of the patient
Methods of delivery
 External beam (EBRT)
 Source of radiation is produced outside the
patient’s body
 Brachytherapy
 Source of radiation is placed next to or directly
in the tumor
Radiation Oncology
 Definitive treatment for the primary malignancy
 To reduce the bulk of disease prior to surgery
 To sterilize the surgical post-operative bed (known or
suspected residual disease)
 Treatment of metastases
 Treatment of local disease for palliation
 Treatment of oncologic emergencies
Treatment machines

 Cobalt 60  1.25 MeV not used

 Orthovoltage  150 – 500 kVp
 Linear Accelerator  6MV / 18MV + electrons
 Tomotherapy  6MV

 The Gray (Gy) is the unit of radiation that measures the

amount of energy absorbed in 1 kg of material
 1 Gy = 100cGy
Brachytherapy
HDR – High dose-rate

 Uses radioactive materials such as cesium-137, palladium

103, iodine 125 and iridium-192 (Glen)
 Radioactive sources are placed next to or directly into the tumour
(target volume)
 High energy is delivered to the tumour (target volume)
 Nearby normal tissues receive very little dose
 Brachytherapy techniques
 Interstitial (eg. prostate or breast)
 Intracavitary (eg. cervical or endometrial)
 Interluminal (eg. esophagus or bronchial tree)
 Brachytherapy for Prostate (interstitial)
Criteria for treatment
 Any tumour stage (T1 – T3)
 Almost any size prostate gland (large glands
will require hormone therapy prior to
brachytherapy)
 No known spread of cancer to other parts of the
body, like the bones or lymph nodes
 PSA less than 20.0 ng/mL or 20 μg/L
 Intermediate Gleason score (staging):
 A Gleason score of 6 is low grade, 7 is
intermediate grade, and a score of 8 to 10 is
high grade cancer
 Previous trans-urethral resection of prostate
(TURP) is okay, but there may be a higher
chance of urinary control problems 40

 Reasonable health http://www.youtube.com/watch?v=nyTEmYLSTak

Brachytherapy for Breast (interstitial)

Criteria for treatment

 early stage
 small tumour size
 location
 no nodal involvement
 Brachytherapy for Cervix (intracavitary)
 Radioactive isotopes can be introduced directly
into the uterine cavity and vaginal fornices with
special applicators
 Points of interest usually include the maximal
rectal and bladder dose, as well as the dose to
the standard points: A and B

42
Surgical Oncology
Advantages Plays a role in
 Instantaneous  Diagnosis  biopsy
 Successful for small lesions  Treatment 
debulking and
Limitations
resection
 Size and extent of tumor
 Palliation relieve
 Poor cosmetic effect pain or pressure on
 Some tumors may be adjacent structures
inaccessible  Reconstruction
 Medical condition of the
patient
Medical Oncology
Chemotherapy
 Uses cytotoxic drugs and hormones
 Targets tumor cells of the primary tumor and cancer
cells throughout body
 Advantages
 Systemic treatment
 Targets malignant cells

 Limitations
 Large tumors
 Medical condition of the patient
Role of Chemotherapy
 Curative treatment  As a treatment on its own

 Neoadjuvant  To shrink a tumor before surgery or

radiotherapy
 Adjuvant  To try to stop cancer from recurring after
surgery or radiotherapy
 Concomitant  Combo (chemo-radiation) improves
therapeutic effect

 Palliative treatment  Decrease tumor load and increase

life expectancy
Chemotherapy
Types
 The majority of chemotherapeutic drugs
can be divided into…
 Alkylating agents
 Antimetabolites
 Anthracyclines
 Plant alkaloids
 Topoisomerase inhibitors
 All of these drugs affect cell division or
DNA synthesis
 Most chemo drugs work by impairing
mitosis (cell division), effectively
targeting fast-dividing cells
Common chemotherapy drugs
 Cisplatin  ENT, bladder, ovary, and testes
 Cyclophosphamide  lymphoma, breast cancer, and ovarian
carcinoma
 Doxorubicin (Adriamycin)  breast cancer, lymphoma, and
multiple myeloma
 Fluorouracil (5-FU)  colon, breast, stomach, and head & neck
 Methotrexate  breast, lung, blood, bone, and lymph system
 Paclitaxel (Taxol)  breast, ovary, and lung
 Vincristine  leukemia and lymphoma
 Vinblastine  lymphoma and cancers of the testis and head &
neck
Chemotherapy
Side effects
 Nausea and vomiting
 Diarrhea or constipation
 Fatigue

 Hair loss (alopecia)

Adverse effects
 Depression of the immune system, which can result in
potentially fatal infections
 Mild to severe anemia
 Decrease in platelets – cause bleeding
Principles of treatment
Curative treatment
 Aim is to eliminate the primary tumor(s)

Palliative treatment
 For patient comfort and prolonged survival
 Relief of symptoms such as pain or bleeding
QUESTIONS ?