1. Causes of CancerCauses of Cancer
 Defective cellular growthDefective cellular growth
– Stem cellsStem cells
– Generation timeGeneration time
– Contact InhibitorContact Inhibitor
 Defective cellular differentiationDefective cellular differentiation
– Exposure to carcinogensExposure to carcinogens
– Moves to less mature formMoves to less mature form
– Leads to invasion and metastasisLeads to invasion and metastasis

2. Characteristics ofCharacteristics of
Normal CellsNormal Cells
 Limited Cell DivisionLimited Cell Division
 Specific MorphologySpecific Morphology
 SmallSmall Nuclear-Cytoplasmic RatioNuclear-Cytoplasmic Ratio
 Perform Specific DifferentiatedPerform Specific Differentiated
FunctionsFunctions
 Adhere tightly together…Adhere tightly together…
 Are nonmigratoryAre nonmigratory
 Grow in anGrow in an orderly and wellorderly and well
differentiateddifferentiated mannermanner
 Are contact inhibitedAre contact inhibited

3. Characteristics of EarlyCharacteristics of Early
Embryonic CellsEmbryonic Cells
 Demonstrate rapid and continuous cellDemonstrate rapid and continuous cell
divisiondivision
 Show anaplastic morphologyShow anaplastic morphology
 Have aHave a largelarge nuclear-cytoplasmic rationuclear-cytoplasmic ratio
 Perform no differentiated functionsPerform no differentiated functions
 Adhere loosely togetherAdhere loosely together
 Are able to migrateAre able to migrate
 Are not contact inhibited.Are not contact inhibited.

4. Characteristics ofCharacteristics of
Benign CellsBenign Cells
 Demonstrate continuous orDemonstrate continuous or inappropriateinappropriate
cell growth.cell growth.
 Show specific morphologyShow specific morphology
 Have aHave a smallsmall nuclear-cytoplasmic rationuclear-cytoplasmic ratio
 Perform differentiated functionsPerform differentiated functions
 Adhere tightly togetherAdhere tightly together
 Are nonmigratoryAre nonmigratory
 Grow in an orderly and well regulatedGrow in an orderly and well regulated
fashion.fashion.

5. Characteristics ofCharacteristics of
Malignant CellsMalignant Cells
 Demonstrate rapid or continuous cellularDemonstrate rapid or continuous cellular
division.division.
 ShowShow anaplastic morphologyanaplastic morphology
 Have aHave a largelarge nuclear-cytoplasmic rationuclear-cytoplasmic ratio
 Lose some or all differentiated functionsLose some or all differentiated functions
 Adhere loosely togetherAdhere loosely together
 Are able to migrateAre able to migrate
 Grow by invasionGrow by invasion
 AreAre not contact-inhibitednot contact-inhibited

6. DefinitionsDefinitions
 AnaplasiaAnaplasia
 AnaplasticAnaplastic
 CarcinogenCarcinogen
 CarcinomaCarcinoma

7.  HyperplasiaHyperplasia
 HypertrophyHypertrophy
 MetastasisMetastasis
 NeoplasiaNeoplasia
 NeoplasmNeoplasm

8. Stages of CarcinogenesisStages of Carcinogenesis
(Oncogenesis)(Oncogenesis)
 InitiationInitiation
 PromotionPromotion
 ProgressionProgression
 MetastasisMetastasis

9. Common Steps inCommon Steps in
MetastasisMetastasis
 Extension into Surrounding TissuesExtension into Surrounding Tissues
 Penetration into Blood VesselsPenetration into Blood Vessels
 Release of Tumor CellsRelease of Tumor Cells
 Invasion of Tissue at the Site ofInvasion of Tissue at the Site of
ArrestArrest

10. Immune ResponseImmune Response
 Attempts to destroy abnormal cellsAttempts to destroy abnormal cells
 Surface AntigensSurface Antigens
– Used as tracers to indicate success ofUsed as tracers to indicate success of
treatmenttreatment
– CEA (carcinoembrionic antigen) - GI tractCEA (carcinoembrionic antigen) - GI tract
– AFP (alphafetoprotein) - liverAFP (alphafetoprotein) - liver
– CA 125 - ovarianCA 125 - ovarian
– PSA – prostatePSA – prostate

11. Cancer Grade and StageCancer Grade and Stage
 Grading;Grading; ClassifiesClassifies cellularcellular
aspectsaspects of a cancer.of a cancer.
 Staging;Staging; ClassifiesClassifies clinicalclinical
aspectsaspects of the cancer.of the cancer.

12. Histologic ClassHistologic Class
 I - Well differentiatedI - Well differentiated
 II - Moderate differentiationII - Moderate differentiation
 III - Poor differentiationIII - Poor differentiation
 IV - Immature & UndifferentiatedIV - Immature & Undifferentiated

13. Clinical StagingClinical Staging
 O - Ca in situO - Ca in situ
 I (A) - Localized growthI (A) - Localized growth
 II (B) - Limited local growthII (B) - Limited local growth
 III (C) - Extensive local and regionalIII (C) - Extensive local and regional
growthgrowth
 IV (D) - MetastasisIV (D) - Metastasis

14. TNM ClassificationTNM Classification
 T - Primary tumorT - Primary tumor
 N - Regional lymph nodesN - Regional lymph nodes
 M - Distant metastasisM - Distant metastasis
– TTisis NNoo MMoo
– TT
44
NN
33
MM
11

15. GoalGoal
 Education and early detectionEducation and early detection
 CC
 AA
 UU
 TT
 II
 OO
 NN

16. Surgical InterventionsSurgical Interventions
 BiopsyBiopsy
 CureCure
 Control - DebulkingControl - Debulking
 PalliativePalliative
 StagingStaging
 ReconstructiveReconstructive
 ProphylaxisProphylaxis

17. RadiationRadiation
 Destroys cells, causes inflammatory responseDestroys cells, causes inflammatory response
 Side EffectsSide Effects
 Goals:Goals:
– CureCure
– ControlControl
– PalliativePalliative
 Radiation RecallRadiation Recall
 ExternalExternal
 ImplantsImplants
 IsotopesIsotopes

18. ChemotherapyChemotherapy
 Cell Cycle Non-specificCell Cycle Non-specific
– Alkylating –Cytoxan, Leukeran, N.MustardAlkylating –Cytoxan, Leukeran, N.Mustard
– Antitumor antibiotics - AdriamycinAntitumor antibiotics - Adriamycin
– Nitrosoureas –Carmustine, HydroureaNitrosoureas –Carmustine, Hydrourea
– Corticosteroids –Prednisone, DecadronCorticosteroids –Prednisone, Decadron
– Hormones –Estrogen, Provera, AndrogenHormones –Estrogen, Provera, Androgen
 Cell Cycle SpecificCell Cycle Specific
– Antimetabolities –Methotrexate, 5-FUAntimetabolities –Methotrexate, 5-FU
– Plant Alkaloids (Miotic Inhibitors) –Vinblastine,Plant Alkaloids (Miotic Inhibitors) –Vinblastine,
VincristineVincristine
 CisplatinCisplatin
 TamoxifenTamoxifen

19. Synergistic EffectSynergistic Effect
 The total is greater than the individualThe total is greater than the individual
partsparts
 Each agent has:Each agent has:
– action against canceraction against cancer
– different site of actiondifferent site of action
– different organ toxicity or time of toxicitydifferent organ toxicity or time of toxicity

20. MOPP ProtocolMOPP Protocol
Complete
response
Agent Action Toxicity
20% Mustargen DNA Marrow – 10
days
↓ 10% Oncovin Mitosis Neurotoxic
↓ 10% Procarbazine RNA
Synthesis
Marrow – 21
days
↓ 5% Prednisone Cell
membrane
Immune
suppression
80% Synergistic Effect

21. Side EffectsSide Effects
Cluster the common onesCluster the common ones ::
bone marrow suppressionbone marrow suppression
alopeciaalopecia
nausea and vomitingnausea and vomiting
AdriamycinAdriamycin - Cardiac- Cardiac
CisplatinCisplatin – Renal– Renal

22. ComplicationsComplications
 Pain ControlPain Control
 Bone Marrow SuppressionBone Marrow Suppression
– Infection - NeutropeniaInfection - Neutropenia
– HemorrhageHemorrhage
– AnemiaAnemia
 InfarctionInfarction
 Superior Vena Cava SyndromeSuperior Vena Cava Syndrome
 Spinal Cord CompressionSpinal Cord Compression
 Tumor Lysis SyndromeTumor Lysis Syndrome

23. CommonCommon
Problems/ComplicationsProblems/Complications
Associated With CancerAssociated With Cancer
 Tumor Lysis Syndrome (TLS);Tumor Lysis Syndrome (TLS);
Destruction of cells (lysis)Destruction of cells (lysis)
Release of Purine and Potassium (K+) into BloodstreamRelease of Purine and Potassium (K+) into Bloodstream
Purines converted to uric acid (in liver) K+ into BloodstreamPurines converted to uric acid (in liver) K+ into Bloodstream
HyperuricemiaHyperuricemia HyperkalemiaHyperkalemia
Obstruction of Kidney TubulesObstruction of Kidney Tubules
ARFARF

24. ParaneoplasticParaneoplastic
SyndromesSyndromes
 Secretion of InsulinSecretion of Insulin
 Secretion of ACTHSecretion of ACTH
 HypercalcemiaHypercalcemia
 SIADHSIADH

25. SIADH - Syndrome ofSIADH - Syndrome of
Inappropriate ADHInappropriate ADH
 ADH releaseADH release
 Water Reabsorption into circulation -RenalWater Reabsorption into circulation -Renal
TubulesTubules
 Extravascular FluidExtravascular Fluid
 Plasma OsmolalityPlasma Osmolality
 Glomerular Filtration RateGlomerular Filtration Rate
 Serum Sodium LevelsSerum Sodium Levels
CEREBRAL EDEMACEREBRAL EDEMA

26. LeukemiaLeukemia
 AML - Acute MyelogenousAML - Acute Myelogenous
– Age of Onset (15-39 yrs), usually affects adultsAge of Onset (15-39 yrs), usually affects adults
– Prognosis is generally poor, best with bone marrowPrognosis is generally poor, best with bone marrow
transplanttransplant
– Most common type of leukemiaMost common type of leukemia
– Equal incidence in males and femalesEqual incidence in males and females
 ALL - Acute LymphocyticALL - Acute Lymphocytic
– Age of Onset (<15 yrs), usually affects children,Age of Onset (<15 yrs), usually affects children,
accounts for approx 10% of adult leukemia'saccounts for approx 10% of adult leukemia's
– Prognosis is poorer for adults than for childrenPrognosis is poorer for adults than for children
– Fever & BleedingFever & Bleeding
– Increased incidence in malesIncreased incidence in males

27. LeukemiaLeukemia
 CML - Chronic MyelogenousCML - Chronic Myelogenous
– Age of Onset (>50 yrs)Age of Onset (>50 yrs)
– Involves liver & spleenInvolves liver & spleen
– Blastic CrisisBlastic Crisis
 CLL - Chronic LymphocyticCLL - Chronic Lymphocytic
– Older patients – over 50Older patients – over 50
– Lymph node involvementLymph node involvement

28. LymphomaLymphoma
 Lymph systemLymph system
 Lymphocytes & histiocytes (macrophages)Lymphocytes & histiocytes (macrophages)
 HodgkinsHodgkins
– 15-35 and over 50 yrs.15-35 and over 50 yrs.
 Non-HodgkinsNon-Hodgkins
– Outside of lymph nodesOutside of lymph nodes
– Wide spread before DxWide spread before Dx
 Multiple MyelomaMultiple Myeloma
– Infiltrates marrowInfiltrates marrow
– destroys bonedestroys bone

29. BreastBreast
 Early detection - EducationEarly detection - Education
 Treatment optionsTreatment options
 Mastectomy careMastectomy care
 ReferralsReferrals

30. GynecologicalGynecological
 CervicalCervical
 EndometrialEndometrial
 OvarianOvarian

31. Genetics and CancerGenetics and Cancer
 BRCABRCA