Oncology Introduction for 4th class med students.

1. Oncology Dr.Abdulla Sherif.

3. SYNONYMS FOR MALIGNANT DISEASE Definition Synonym New growth: includes benign disease Neoplasia Swelling: includes benign/inflammatory disease Tumour Malignancy of epithelial cell origin Cancer, carcinoma Malignancy of mesothelial cell origin Sarcoma Malignancy of lymphoid organs (usually glands ) Lymphoma Malignancy of white blood cells Leukaemia

13. CANCERS WITH POTENTIAL FOR SCREENING Benefits Method of screening Ca Reduced mortality Mammography BC ?Reduced mortality (indirectly inferred) Cervical smear cytology Cervical Ca Possible reduced mortality Serum prostate-specific antigen(PSA) level PC Possible reduced mortality Single flexible sigmoidoscopy Faecal occult blood test CRC

17. Site/tumour Symptom Stomach, colon, bronchus, endometrium, bladder, kidney Haemorrhage Breast, lymph node (any site), testicle Lump Bone (primary sarcoma, secondary) Pain Melanoma, basal cell carcinoma (rodent ulcer) Skin abnormality Oesophagus, stomach, anus, skin Ulcer Bronchus Gastro-oesophageal Colon, rectum Obstruction Pain, cough, recurrent infection Odynophagia, dysphagia, early satiety, vomiting Altered bowel habit, pain, distension Ovary, gastric cancer Abdominal swelling (ascites) Metastatic cancer (breast, prostate, kidney, bronchus, thyroid) Fracture

19. NON-METASTATIC MANIFESTATIONS OF Ca Gastrointestinal tumours Weight loss and anorexia Any Fatigue Myeloma, breast, renal tumours Hypercalcaemia Pancreas and other gastrointestinal tumours Prothrombotic tendency Hormonal effects Small-cell lung cancer (SIADH) Ectopic adrenocorticotrophic hormone (ACTH) Neuropathies and myopathies Small-cell lung cancer Eaton-Lambert myasthenia-like syndrome Subacute cerebellar degeneration Skin abnormalities Gastro-oesophageal tumours Acanthosis nigricans Gastric, lung tumours Dermatomyositis/polymyositis

22. IMMUNOHISTOCHEMISTRY MARKERS Tumour type Routine use? Oncogene? Name Neural crest origin (e.g. melanoma) Yes No S-100 Small-cell cancer (e.g. lung) Yes No Cam 5.2 Colon and other gastrointestinal tumours Yes No Carcinoembryonic antigen (CEA) Ovary Yes No CA-125 Breast cancer (present in other tumours, e.g. ovary) Yes No Oestrogen receptor (ER) Breast cancer (present in other tumours, e.g. lung, ovary, gastric) No Yes Her-2

24. Blood tumor markers: Tumours Normally detected? Fetal antigen? Name Gastrointestinal tract, lung, breast Yes Yes Carcinoembryonic antigen (CEA) Ovary Yes Yes CA-125 Hepatocellular carcinoma and malignant teratoma Yes (very low) Yes β-Fetoprotein (AFP) Most, reflecting tumour burden or necrosis Yes No Lactate dehydrogenase (LDH) Prostate, some breast cancers Yes No Prostate-specific antigen (PSA) Malignant teratoma, seminoma, choriocarcinoma, gastrointestinal tumours Only in pregnancy No Human chorionic gonadotrophin (HCG)

27. STAGING TESTS Less common/geographical variation Common Primary Bone marrow, CT of abdomen/thorax Chest X-ray, bone scan Breast Bone scan CT abdomen and thorax, bone marrow Lymphoma Bone scan, CT pelvis Prostate Ultrasound, CT liver Colon Chest X-ray, CT chest and upper abdomen Lung

28. TNM CLASSIFICATION Extent of primary tumour T * Extent of regional lymph node involvement N * Presence or absence of metastases M Extent of disease Excised tumour T0 Increases in primary tumour size T1 T2 T3 Increased involvement of nodes Increases in involvement N1 N2 N3 Presence of metastases Not present M0 Present M1