The document discusses cancer (neoplasia) including definitions, classifications, staging, diagnostic methods, hereditary factors, symptoms, and treatments. It provides an overview of the history and development of cancer research from Hippocrates to modern classifications and therapies. Key topics covered include the TNM staging system, common cancer types and locations, diagnostic imaging techniques, hereditary cancer syndromes, and approaches to chemotherapy and combined modality treatment.

1. National Medical O. Bogomolets University General Surgery Department N1 (Head of General Surgery Department - Professor O.I. Dronov ) BASIC OF ONCOLOGY LECTOUR - PROF.O. DRONOV

4. The origin of the word cancer is credited to the Greek physician Hippocrates (460-370 B.C.), considered the "Father of Medicine" Hippocrates used the terms carcinos and carcinoma to describe non-ulcer forming and ulcer-forming tumors HIPPOCRATES (460-370 B.C.)

5. GIOVANNI BATTISTA MORGAGNI (1682-1771) In 1761, Giovanni Morgagni of Padua was the first to do something considered routine today. He performed autopsies to relate the patient's illness to the pathologic findings after death. This laid the foundation for scientific oncology, the study of cancer

6. The famous Scottish surgeon John Hunter (1728-1793) suggested that some cancers might be cured by surgery and described how the surgeon might decide which cancers to operate on. If the tumor had not invaded nearby tissue and was "moveable," he said, "There is no impropriety in removing it" JOHN HUNTER (1728-1793)

7. One of the most famous surgeons of his day, Billroth performed the first oesophagectomy, laryngectomy and gastrectomy for stomach cancer CHRISTIAN ALBERT THEODUR BILLROTH (1829-1873) His work led to "cancer operations" designed to remove all of the tumor together with the lymph nodes in the region where the tumor was located

8. Percival Pott of Saint Bartholomew's Hospital in London described in 1775 an occupational cancer in chimney sweeps, cancer of the scrotum, caused by soot collecting under their scrotum. This research led to many additional studies that identified a number of occupational carcinogenic exposures and led to public health measures to reduce cancer risk PERCIVAL POTT(1715 – 1788)

9. William Stewart Halsted, professor of surgery at Johns Hopkins University, developed the radical mastectomy during the last decade of the 19th century. His work was based in part on that of W. Sampson Handley, the London surgeon who believed that cancer spread outward by invasion from the original growth William Stewart Halsted(1852-1922)

10. He first use of aminopterin and methotrexate in the control of acute childhood leukemia, he has constant leadership in the search for chemical agents against cancer SIDNEY FARBER, M.D.-1903-1973 «FATHER OF CHEMOTHERAPY»

11. Cancers are classified by the type of cell that resembles the tumor and, therefore, the tissue presumed to be the origin of the tumor. The following general categories are usually accepted: CARCINOMA malignant tumors derived from EPITELIAL cells. This group represent the most common cancers, including the common forms of BREAST, PROSTATE, LUNG and COLON cancer. LYNPHOMA and LEUCEMIA: malignant tumors derived from BLOOD and BONE MARROW cells SARCOMA: malignant tumors derived from CONNECTIVE TISSUE, or MESENCHYMAL cells

12. MESOTELIOMA : tumors derived from the MESOTELIAL cells lining the PERITONEUM and the PLEURA GLIOMA: tumors derived from glia, the most common type of BRAIN cell GERMINOMA: tumors derived from germ cells, normally found in the TESTICAL and OVARY CHORIONCARCINOMA: malignant tumors derived from the PLACENTA

13. GASTRIC LYMPHOMA

14. SARCOMA

15. MESOTELIOMA

16. MELANOMA

17. METASTATIC MELANOMA

20. TNM CLASSIFICATION OF MALIGNANT TUMOURS (TNM) is the cancer staging system developed and maintained by the International Union Against Cancer (UICC) to achieve consensus on one globally recognised standard for classifying the extent of spread of cancer The TNM classification is also used by the American Juint Commette of Cancer (AJCC) and the International Federation of Gynecologi and Obstetrics (FIGO). In 1987, the UICC and AJCC staging systems were unified into a single staging system

25. ADRENAL NEUROBLASTOMA

26. RETINOBLASTOMA

27. EWING’S SARCOMA

28. WILMS’ TUMOR

29. Female and male infants have essentially the same overall cancer incidence rates, but white infants have substantially higher cancer rates than black infants for most cancer types Relative survival for infants is very good for neuroblastoma, WILMS’ TUMOR and RETINOBLASTOMA, and fairly good (80%) for leukemia, but not for most other types of cancer

31. METASTASIS IS THE SPREAD OF CANCER FROM ITS PRIMARY SITE TO OTHER PLACES IN THE BODY Over 10% of patients presenting to oncologial units will have metastases without a primary tumor found. In these cases, doctors refer to the primary tumor as "unknown" or "occult", and the patient is said to have cancer of unknown primary origin The use of immunohistochemystri has permitted pathologists to give an identity to many of these metastases. However, imaging of the indicated area only occasionally reveals a primary. In rare cases (e.g. of melanoma ) no primary tumor is found even on autopsy. It is therefore thought that some primary tumors can regress completely, but leave their metastases behind

32. Lymph node with clusters of tumor cells, atypical, with carcinomatous character (H&E, ob. x10)

33. BRAIN METASTASES

34. BONE METASTASES

35. LIVER METASTASES

36. SKIN METASTASES

40. Systemic symptoms : weight loss, poor apprtite and caxecia(wasting), excessive sweating (night sweat), anemia and specific paraneoplastic phrenomena, i.e. specific conditions that are due to an active cancer, such as thrombosis or hormonal changes Every single item in the above list can be caused by a variety of conditions (a list of which is referred to as the differential diagnosis). Cancer may be a common or uncommon cause of each item

42. CT SCAN: PANCREATIC TUMOR WITH LIVER METASTASES

43. Transverse and sagittal ultrasound images show an hepatocellular carcinoma in a cirrhotic liver In same patient, Gadolinium contrast MR image shows transient enhancement of the tumor during the arterial phase

44. Unfavourable prognosis tumour. High-resolution T2-weighted fast spin-echo image and corresponding histological wholemount section. The MRI scan shows widespread discontinuous tumour deposits (arrows) (representing either nodes replaced by tumour or tumour satellites) within the mesorectum, but not extending to the mesorectal fascia (arrow heads). This is confirmed as node-positive disease on corresponding wholemount histology section

45. MRI: LUNG’S TUMOR

46. MRI: BRAIN’S TUMOR

47. PET scans show the metabolic activity of different areas in the body using radioactively labelled glucose. Areas of high glucose consumption are represented as dark spots, and signify areas of growth. The PET scan can also show whether the cancer has metastasized, or spread to other areas in the body .In this picture the brain and genitalia show high metabolic activity as well - this is because the brain requires a vast amount of energy to function, and the genitalia are the site of sperm production (meiosis) PET SCAN

48. PET SCAN

50. IMMUNOHISTOCHEMISTRY is a method of analyzing and identifying cell types based on the binding of antibodies to specific components of the cell. It is sometimes referred to as immunocytochemistry CD 117 positive

54. PHYSICAL EXAMINATION Breasts were assymetric, the left being enlarged, reddened and painful. There was some nipple discharge. The left breast was tender with a single, firm and irregular mass evident on palpation . The supraclavicular lymph nodes were enlarged

58. CHEMOTHERAPY is the treatment of cancer with drugs ("anticancer drugs") that can destroy cancer cells. It interferes with cell division in various possible ways, e.g. with the duplication of DNA or the separation of newly formed chromosomes. Most forms of chemotherapy target all rapidly dividing cells and are not specific for cancer cells. Hence, chemotherapy has the potential to harm healthy tissue, especially those tissues that have a high replacement rate (e.g. intestinal lining). These cells usually repair themselves after chemotherapy

59. COMBINED MODALITY CHEMOTHERAPY is the use of drugs with other CANCER TREATMENT, such as RADIATION THERARYor SURGERY. Most cancers are now treated in this way COMBINATION CHEMOTHERAPY is a similar practice which involves treating a patient with a number of different drugs simultaneously. The drugs differ in their mechanism and side effects. The biggest advantage is minimising the chances of resistance developing to any one agent

60. In NEOADJUVANT chemotherapy ( pre operative treatment) initial chemotherapy is aimed for shrinking the primary tumour, thereby rendering local therapy (surgery or radiotherapy) less destructive or more effective

61. ADJUVANT CHEMOTHERAPY ( post operative treatment) can be used when there is little evidence of cancer present, but there is risk of recurrence. This can help reduce chances of resistance developing if the tumour does develop. It is also useful in killing any cancerous cells which have spread to other parts of the body. This is often effective as the newly growing tumours are fast-dividing, and therefore very susceptible

62. PALLIATIVE CHEMOTHERAPY is given without curative intent, but simply to decrease tumor load and increase life expectancy. For these regimens, a better toxicity profile is generally expected

64. PREVENTIVE (PROPHYLACTIC) SURGERY is done to remove body tissue that is not malignant (cancerous) but is likely to become malignant. For example, this type of surgery may be used if you have a precancerous condition such as polyps in the colon

65. FAMILIAL ADENOMATOUS POLYPOSIS

66. DIAGNOSTIC SURGERY is used to get a tissue sample to tell whether or not it is cancerous or to tell what type of cancer it is The diagnosis of cancer often can be confirmed only by looking at the cells under a microscope. Several surgical techniques can be used to obtain a sample. These are described in the next section

67. FINE NEEDLE ASPIRATION BIOPSY Fine needle aspiration (FNA) uses a very thin needle attached to a syringe to withdraw a small amount of tissue from a tumor. If the tumor canВ’t be felt near the surface of the body, the needle can be guided into the tumor by viewing it with an imaging technique such as an ultrasound or computed tomography scan. The main advantage of FNA is that it does not require a surgical incision (cutting through the skin). A drawback is that in some cases the needle canВ’t remove enough tissue for a definite diagnosis. A more invasive type of biopsy may then be needed

68. NEEDLE CORE BIOPSY This type of biopsy uses a slightly larger needle. The advantage of core biopsy is that it usually collects enough of a sample to diagnose the tumor. A core biopsy can be aspirated (removed) with a needle if the tumor can be felt at the surface. Core biopsies can also be guided by imaging techniques if the tumor is too deep to be felt

69. EXCISIONAL OR INCISIONAL BIOPSY These procedures involve a surgeon cutting through the skin to remove the entire tumor (excisional biopsy) or a small part of a large tumor (incisional biopsy). They can often be done with local or regional anesthesia (numbing medicine used just in the area of the biopsy). If the tumor is inside the chest or abdomen, general anesthesia (putting you into a deep sleep) may be needed.

70. STAGING SURGERY helps determine the extent and the amount of disease. While the physical exam and the results of lab and imaging tests can help determine the clinical stage of the cancer, surgical staging is usually a more accurate assessment of how far the cancer has spread

71. CURATIVE SURGERY is the removal of a tumor when it appears to be confined to one area. It is done when there is hope of taking out all of the cancer. Curative surgery is thought of as primary treatment of the cancer. It may be used alone or along with chemotherapy or radiation therapy, which can be given before or after the operation. In some cases, radiation therapy is actually used during an operation (intraoperative radiation therapy)

72. TOTAL MESORECTAL EXCISION (TME)

73. PANCREATECTOMY+GASTRECTOMY+ LYMPHADENECTOMY

74. DEBULKING (CYTOREDUCTIVE) SURGERY is done when removing a tumor entirely would cause too much damage to an organ or surrounding areas. In these cases, the doctor may remove as much of the tumor as possible and then try to treat whatВ’s left with radiation therapy or chemotherapy. Debulking surgery is commonly used for advanced cancer of the ovary

75. PALLIATIVE SURGERY is used to treat complications of advanced disease. It is not intended to cure the cancer. It can also be used to correct a problem that is causing discomfort or disability. For example, some cancers in the abdomen may grow large enough to obstruct (block off) the intestine. This may require surgery for effective relief. Palliative surgery may also be used to treat pain when it is hard to control by other means

76. RIGHT HEMIHEPATECTOMY+CRYOABLATION OF RESIDUAL TUMOR

77. Supportive surgery is used to help with other types of treatment. For example, a vascular access device such as a catheter port can be surgically placed into a large vein. The catheter can then be used to deliver chemotherapy treatments or draw blood for testing, reducing the number of needle sticks needed

78. restorative (reconstructive) surgery is used to restore a personв’s appearance or the function of an organ or body part after primary surgery. examples include breast reconstruction after mastectomy or the use of tissue flaps, bone grafts, or prosthetic (metal or plastic) materials after surgery for oral cavity cancers RESTORATIVE (RECONSTRUCTIVE) SURGERY

79. RESTORATIVE (RECONSTRUCTIVE) SURGERY The transverse rectus abdominis myocutaneous (TRAM) flap surgery involves construction of a breast from the lower abdominal skin and fatty tissue. In a pedicled TRAM procedure, the tissue's own blood supply remains attached and the lower abdominal tissue is rotated into position on the chest. The tissue is then tunneled under the skin to the chest area, where it is brought through the mastectomy incision

80. LASER SURGERY A LASER IS A HIGHLY FOCUSED AND POWERFUL BEAM OF LIGHT ENERGY, WHICH CAN BE USED IN MEDICINE FOR VERY PRECISE SURGICAL WORK SUCH AS REPAIRING A DAMAGED RETINA IN THE EYE. IT CAN ALSO BE USED TO CUT THROUGH TISSUE (INSTEAD OF USING A SCALPEL) OR TO VAPORIZE CANCERS OF THE CERVIX, LARYNX (VOICE BOX), LIVER, RECTUM, OR SKIN

81. SOME SURGERIES CAN BE MADE LESS INVASIVE BY USING LASER LIGHT. FOR EXAMPLE, WITH FIBER OPTICS THE LIGHT CAN BE DIRECTED TO PARTS OF THE BODY WITHOUT HAVING TO MAKE A LARGE INCISION LASER SURGERY IS ALSO CALLED PHOTOABLATION OR PHOTOCOAGULATION. THIS TYPE OF SURGERY IS OFTEN USED TO RELIEVE SYMPTOMS, SUCH AS WHEN LARGE TUMORS PRESS ON THE WINDPIPE OR ESOPHAGUS, CAUSING PROBLEMS WITH BREATHING OR EATING

82. CRYOSURGERY CRYOSURGERY INVOLVES THE USE OF A LIQUID NITROGEN SPRAY OR A VERY COLD PROBE TO FREEZE AND KILL ABNORMAL CELLS. THIS TECHNIQUE IS SOMETIMES USED TO TREAT PRECANCEROUS CONDITIONS SUCH AS THOSE AFFECTING THE CERVIX. CRYOSURGERY IS ALSO BEING STUDIED AS A TREATMENT OF SOME CANCERS SUCH AS THOSE OF THE PROSTATE

83. CRYOABLATION OF LIVER METASTASES

84. ELECTROSURGERY HIGH-FREQUENCY ELECTRICAL CURRENT CAN BE USED TO DESTROY CELLS. IT IS USED FOR SOME CANCERS OF THE SKIN AND MOUTH

85. MOHS SURGERY MOHS MICROGRAPHIC SURGERY, ALSO CALLED MICROSCOPICALLY CONTROLLED SURGERY, IS A TECHNIQUE TO REMOVE CERTAIN SKIN CANCERS BY SHAVING OFF ONE LAYER AT A TIME. AFTER EACH LAYER IS REMOVED, A SPECIALLY TRAINED DERMATOLOGIST OR PATHOLOGIST LOOKS AT THE TISSUE LAYER UNDER A MICROSCOPE. WHEN ALL THE CELLS LOOK NORMAL UNDER THE MICROSCOPE, THE SURGEON STOPS REMOVING LAYERS OF TISSUE

86. THIS TECHNIQUE IS USED WHEN THE EXTENT OF THE CANCER IS NOT KNOWN OR WHEN AS MUCH HEALTHY TISSUE AS POSSIBLE NEEDS TO BE PRESERVED (AS IN CANCERS AROUND THE EYE). IT IS PERFORMED UNDER LOCAL ANESTHESIA BY A SPECIALLY TRAINED SURGEON

87. CHEMOSURGERY IS AN OLDER NAME FOR THIS SURGERY AND REFERS TO CERTAIN CHEMICALS APPLIED TO THE TISSUE BEFORE IT IS REMOVED THE PROCEDURE DOES NOT INVOLVE USE OF CANCER CHEMOTHERAPY DRUGS

88. OTHER FORMS OF SURGERY HIGH INTENSITY FOCUSED ULTRASOUND MICROWAVES OR RADIO WAVES (RADIOFREQUENCY ABLATION) GAMMA KNIFE AND CYBERKNIFE

89. PRE- Gamma Knife , 6-weeks POST- Gamma Knife severe left arm paralysis paralysis resolved

90. RADIOFREQUENCY ABLATION

92. The American Cancer Society has issued guidelines for the use of the prophylactic human papillomavirus vaccine to prevent cervical intraepithelial neoplasia and cervical cancer. The new guidelines, published in the January/February issue of CA: Cancer Journal for Clinicians , address who should be vaccinated and at what age, and summarize policy and implementation issues and implications for screening, based on a formal review of the available evidence

93. SPECIFIC RECOMMENDATIONS FOR HPV VACCINATION ARE AS FOLLOWS: Routine HPV vaccination is recommended for girls 11 and 12 years old Girls as young as age 9 years can receive HPV vaccination. HPV vaccination is also recommended for teenaged girls 13 to 18 years old to catch up on missed vaccine or to complete the vaccination series.

94. The evidence is insufficient at this time to recommend for or against universal vaccination of women 19 to 26 years old in the general population. A decision about whether to vaccinate a woman 19 to 26 years old should be based on an informed discussion between the woman and her healthcare provider regarding her risk for previous HPV exposure and her potential benefit from vaccination. Ideally, the HPV vaccine should be administered before potential exposure to genital HPV through sexual intercourse, because the potential benefit is likely to decrease with an increasing number of lifetime sexual partners. HPV vaccination is not currently recommended for women older than age 26 years or for males.