chapter 6 cancer. frequency and significance cancer is the 2 nd leading cause of death in the united...
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Chapter 6Cancer
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Frequency and Significance
• Cancer is the 2nd leading cause of death in the United States
• Obviously, the term cancer covers many types of malignant neoplasms
• The treatment and outcome for these various neoplasms is widely different
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Frequency and Significance
• The prognosis of cancer depends on several items:– The type of cancer– The extent of spread at the time of
discovery– The efficacy of existing therapy
• The incidence of malignant tumors is twice the mortality rate.
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Common Cancers
• The most common cancers are basal and squamous skin cell carcinomas of the skin.– These account for 99% of all skin cancers– However, they are rarely fatal
• Malignant melanoma accounts for 1% of skin cancers, but is fatal in about 20% of patients!– This discusses the “type” variable of
prognosis
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Common Cancers
• The “treatment” variable of prognosis is readily evident when discussing colon and lung cancer
• Colon cancer is cured in 50% of patients by surgical removal
• Lung cancer treatment on the other hand, is relatively ineffective—a 13% 5 year survival rate
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Etiology
• Cells must undergo an alteration called initiation to acquire autonomous growth potential
• Initiation is stimulated by carcinogens which may be physical, chemical or biologic agents
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Etiology
• Promotion is the step after initiation, and is the selective growth of the initiated cells
• Progression follows, and is the acquisition of additional DNA mutations
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Oncogenes
• Initiators turn oncogenes “on”, which leads to the proliferation of the cell through growth enhancing products
• Oncogenes are supposed to be kept in check by tumor suppressor genes; however, there can be mutations in the tumor suppressor genes that prevent them from functioning properly
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Prevention and Cure of Cancer
• While a grand idea, it is an extremely complex task that depends on the discovery of:– Oncogenes – Tumor suppressor genes– Other target genes– Initiating agents
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Local and Systemic Manifestations
• Unfortunately, many cancers are asymptomatic until very late in their course– This can affect treatment options
• Local manifestations relate to symptoms at the cancer site—pain for example.
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Local and Systemic Manifestations
• Systemic manifestations relate to symptoms not limited to the cancer site—anemia for example.
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Diagnosis
• Diagnosis can be made by a variety of tests– Biopsy– Blood smear– Cytology– Radiologic Examination– Endoscopic Examination
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TNM System
• T—tumor, the size and invasion into surrounding tissue
• N—extent of lymph node metastasis
• M—whether distant metastasis has occurred
• Stage I is localized, Stage IV is metastasis
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Treatment
• Surgical Removal
• Radiation Therapy
• Chemotherapy