oncology - cnm - oncology (2013-2014).pdf“having had cancer, one important thing to know is...
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ONCOLOGY
“Having had cancer, one important thing to know is you're still the same person at the end. You're stripped down to near zero. But most people come out the other end feeling more like themselves than ever before”
-Kylie Minogue
Greek - Onkos (ονκος) = “Bulk, Mass /Tumour” - Ology = "study of"
Oncology = Medical subject dealing with the study and treatment of Cancer (Malignant Tumours)
• A physician who practices oncology is an Oncologist.
1 2013-14-v2
NEOPLASMS & TUMOURS
• NEOPLASM: from ancient Greek - neo (νεο) ="new" + plasma (πλάσμα) = "formation“/ "creation"
• Def: A mass of tissue that grows faster than normal in an uncoordinated manner. Resulting from an abnormal growth /division of cells (Neoplasia).
• TUMOR (US English)/ TUMOUR (UK English) literally means "swelling” (Latin) but is now primarily used to describe a Mass / Growth of Tissue
• This growth can be either Malignant or Benign.
• Similar in meaning to a Neoplasm.
Some Cancers like Lymphoma / Leukaemia do not manifest as tumours!!!
2
Recall: CELLULAR REPRODUCTION
• A Normal Cell Cycle
• Each cell follows the ‘cell
cycle’ of Growth &
Reproduction
• Two types of Cellular
Reproduction: MITOSIS
(Somatic Cells) & MEIOSIS
(Gametes)
3
MITOSIS
• Used for growth & repair of certain Somatic cells.
• Each Daughter cell is identical to the Parent cell
• The rate of mitosis varies with each type of cell.
• Some cells can increase their reproduction rate on demand
• For example:
Epithelial cells replicate
very fast,
Skin Cells undergo continuous
Mitosis.
Nerve & Muscle Cells stop
reproducing soon after Birth
• DNA controls Mitosis
4
All cells are
DIFFERENTIATED & SPECIALIZED
Liver cells
Mucosa goblet cells
Some cells become so highly
specialized, they cannot undergo
Mitosis
Cells are Organized in a tissue & fulfill that tissue’s Purpose/ Function If cells become DISorganised and grow in an UNcontrolled manner, their Function (Purpose) gets lost.
5
• Contact Inhibition = Cessation of replication/ reproduction of cells
that contact one another.
• Cell Senescence / Aging can
alter the structure of the cells,
decrease function and even lead to cell death.
• Whilst the process of cell aging is not yet fully understood, a
number of hypotheses on ‘Telomere shortening’, with
every Reproductive Cycle, have been proposed.
• Together with ‘Contact Inhibition’, Cells have a
PROGRAMMED number of Reproductive Cycles.
CONTACT INHIBITION
& PRESET NUMBER of REPRODUCTIVE
CYCLES
6
Cancer Quotes
“Cancer cells are those
which have forgotten how
to die - and now they’re
killing me.”
Harold Pinter English playwright, screenwriter, actor,
theatre director, political activist and poet
7
MUTATION
Def: Alteration in the DNA Sequence/
Number (Change in the Genetic
Information).
This can occur in the following 4 ways:
• Mutation is passed on the each Daughter cell.
• Causes for Mutations =
Chance (Spontaneous)
(Induced) Mutagenic agents e.g. X-rays, Ultra violet rays etc.
8
• MUTAGEN (Latin: Origin of change) is an agent that changes the Genetic Information.
• Mutagens can be:
– Environmental Hazards, Chemicals, Radiation
– Viruses, Inflammation/ Defective Immunity
– Stress / Emotional Trauma
– Etc.
Mutations can alter :
1. The cell Function,
2. The cell Structure
3. Cause cells to Die
MUTAGEN
9
ÆTIOLOGY Cause of CANCER
• CARCINOGEN: Any agent which causes/ generates Cancers.
Chemical substances: e.g. Nitrosamines, Mold toxins,
Asbestos
Physical agents: X-rays, UV- rays
Biological carcinogens: Viruses
• CARCINOGENESIS: The process by which normal cells are transformed into cancer cells.
• In 1175 Sir Parcival Pott developed the hypothesis that
testicular and nasal cancer in chimney sweeps was
caused by Soot.
• Generally, causative factors are difficult to establish
because many cancers take many years to develop.
10
STAGES of Carcinogenesis
1. INITIATATION: Initiating Factors ‘initiate’ first irreversible
changes to DNA i.e. Mutation. Can be related to short contact
2. PROMOTION: Promoters ‘promote’ further changes in DNA
+ increase rate of mitosis. Has to be continuous. Examples of promoters include Hormones & Chemicals
3. CANCER: Continued exposure: to carcinogens and
changes in DNA result in Cancer
Latent Period: The time between initiation and appearance of the cancer
It can be 10 – 20 years !!
11
RISK FACTORS & PREVENTION • UNAVOIDABLE:
– Genetic factors/ Family History
– Chronic Inflammation (IBD, Gastritis, GERD)
– Certain Viruses-HPV / HSV-8
– Some Environmental factors (exposure to mutagenic chemicals eg. DDT or Radiation)
• AVOIDABLE:
– Smoking
– Food Additives
– Poor Diet (Foods) e.g. excessive animal fats, red meat etc.
– Sexual Behavior
– Compromised Immunity- See next slide
– Heavy Drinking
– Excessive exposure to Sunlight
– Chronic STRESS!!! 12
HOST IMMUNITY
Long term Immunodeficiency can increase the risk for Cancer because:
1. Cytotoxic T-Lymphocytes, NK Cells and Macrophages are needed to destroy abnormal cells. (Think of cancers in HIV patients)
2. Humoral Immunity also plays a role in the protection against Cancer.
Dead cancer cell: The cell contents have
leaked out of the hole. Killer cell in front.
Small T-killer cell / Cytotoxic T- Cells
between 2 cancer cells, more cancer cells
below
Risk Factors & Prevention
13
RECALL:
TUMOURS/ NEOPLASMS
A mass of cells : Which no longer responds to normal growth control- Cells reproduce without need.
Which grows faster than normal,
Which grows in an uncoordinated manner
Whereby Atypical/ Abnormal cells eventually lose their function
– Excessive growth deprives other cells of nutrients.
– The growth may spread to other parts of the body
= METASTASIS
14
BENIGN TUMOURS
+ Benign tumours usually consist of differentiated cells which appear similar to normal cells so may be functional.
- Reproduce at a higher rate than normal.
• A benign tumour is very often Encapsulated-NO Metastasis!
• It expands/ grows VERY SLOWLY & does not spread, Systemic Effects rarely seen.
• NOT life-threatening BUT Damage can result from compression of tissues (e.g. brain)
15
MALIGNANT TUMOURS
• Malignant tumours are usually made of undifferentiated, non-functional cells with varied shapes and size and large nuclei
• The cells reproduce faster than normal
• Not-encapsulated- Infiltrate other tissues (Metastasise)
• Often Systemic, Can spread VERY QUICKLY to other organs.
• Life threatening due to tissue destruction & spread of tumour
• Oncology is the study of MALIGNANT tumours.
16
GRADING of TUMOURS
GRADING = Measure of the Degree of cell
Differentiation / Abnormality
– Grade 1 = Tumour Cells still similar to original
cells = differentiated & specialized
– Grade 4 = Tumour Cells Undifferentiated /
many abnormal cells varying in
size and shape
NB: Not same as STAGING of Cancer / CLASSIFICATION
17
EFFECTS of Malignant Tumours - CANCER
• Tumour = ‘Space- occupying’ Mass with no function. So damage results by virtue of the ‘space’ they occupy/ invade.
1. Tumours can compress nearby blood vessels leading to necrosis and inflammation of surrounding tissues.
2. In larger Tumours - Inner cells can be deprived of blood, leading to necrosis and inflammation WITHIN tumour.
3. Malignant cells do not adhere to each other. They break loose and can infiltrate other tissues- Metastasize
• ‘In situ’ = Pre-invasive state.
4. Tumour cells can secrete enzymes
which can break down other cells.
(Proteases)
18
Benign or Malignant?
• Please read
introductory section in
your textbook on
benign and malignant
tumours
• Use this information to
fill in the table in your
handout and to
answer the questions
19
LOCAL EFFECTS of Tumours
1. PAIN : Usually not an early
symptom of cancer. Can be
caused by pressure or
inflammation.
2. OBSTRUCTION: may occur
in tubes or ducts in the body.
3. ULCERATION or OEDEMA
can obstruct.
4. Tissue Necrosis &
Ulceration may produce
INFECTION around the
tumour (especially areas
where bacteria are naturally
present). 20
METASTASIS: SPREAD of
Malignant Tumours Metastasis: Greek: ‘Change of the
state’
• Malignant Tumours spread
via Blood or Lymph &
produce Secondary Tumours.
• Often first metastases appear
in regional Lymph Nodes.
• Venous & Lymphatic flow
usually endangers Lungs &
Liver most.
• Cells in the Secondary Tumour
are similar to the Parent
Tumour.
Secondary tumours in the liver
spread from the pancreas
Metastasis of Abdominal Tumours
http://www.drmulier.com/3%20en%20pat%20info%20hipec.html 21
SPREAD of Malignant Tumours
1. In situ, non invasive
2. Invasion:
Local spread by e.g. lytic enzymes
3. Seeding:
Spread of cancer cells in body fluids or along membranes
22
SYSTEMIC EFFECTS
of Cancer
1. WEIGHT LOSS & CACHEXIA
• Cachexia = Loss of weight, muscle atrophy, fatigue, weakness and involuntary wasting away.
• Cancer patients can still have a strong appetite!!
2. ANAEMIA - An effect of:
• Malnutrition,
• Chronic Bleeding from an ulcerated tumour or
• Bone marrow Depression.
3. INFILTRATION & EROSION OF BLOOD
VESSELS
4. INFECTION- With Advancing Tumours the host
resistance breaks down and gives way to infections
e.g. Pneumonia
23
5. PARA-NEOPLASTIC SYNDROMES
Group of Diseases /Symptoms that are the CONSEQUENCES of Cancer in the body, NOT due directly to local presence of cancer cells.
‘Additional Problems’ to the tumour
itself.
e.g. Lung cancers may produce ACTH leading to Cushing’s Syndrome (excess corticosteroids)
•Para-neoplastic Syndrome results in two major effects:
– Can confuse diagnosis
– Additional problem to cope with.
SYSTEMIC EFFECTS of Cancer
24
EARLY WARNING SIGNS
of Cancer
1. Unusual bleeding or discharge
2. Anaemia and persistent fatigue
3. Change in bowel or bladder habits
4. A change in appearance of a wart or mole
5. A sore which does not heal
6. Unexplained weight loss
7. Persistent cough or hoarseness
8. A solid Lump
25
MOST IMPORTANT SYMPTOMS
in Most Kinds of Cancer
• The FIRST STAGES of cancer usually show VERY FEW SYMPTOMS.
• LATER STAGES usually present with:
– Swollen Lymph Nodes
– Weight Loss
– Anaemia
26
DIAGNOSTIC TESTS
Benefit of diagnostic tests:
1. Early detection
2. Monitoring
• However!!!! NO Diagnostic Test is 100% reliable
• False Positive or false Negative results are possible
1. BLOOD TESTS
2. TUMOUR MARKERS
3. IMAGING
4. BIOPSIES
27
1. BLOOD TESTS
These include:
• Haemoglobin
• Erythrocytes
• Leukocytes (leukaemia)
Tx / Therapy can cause :
- Erythrocytopenia
- Leukopenia
- Thrombocytopenia
28
2. TUMOUR MARKERS
– Proteins, enzymes, hormones etc. produced by some Malignant cells.
– Found in the Blood, Urine, Stool or Tissues
– They can be used for Screening / Diagnosis or Monitoring. e.g.
• CEA Carcinoembryonic Antigen
• PSA Prostate Specific Antigen
• HCG Human Chorionic
Gonadotropin
• Tumour-M2-PK
http://www.medindia.net/patients/patientinfo/tumor-markers-for-cancer-diagnosis-and-prognosis.htm 29
TUMOUR MARKER EXAMPLES • CEA – Carcinoembryonic Antigen
A glycoprotein involved in cell adhesion. Normally produced during foetal development but the production of CEA stops before Birth.
Tests for Metastatic Carcinoma, Malignancy
Cannot test for Location
May be elevated in Smokers & in some Non-neoplastic conditions like Ulcerative Colitis, Pancreatitis & Cirrhosis
• PSA – Prostate Specific Antigen
A protein produced by the cells of the Prostate Gland & present in small quantities in the Serum of healthy men.
May be elevated in the presence of Prostate Cancer & in other Prostate Disorders e.g. Benign Prostate Hyperplasia.
Tests for (1) Cancer Activity Level (2) Location (3) Recurrence /Residual Cancer in the prostate.
Cannot test if Malignant / Benign ( False ‘+ves’ ) 30
• HCG – Human Chorionic Gonadotropin
Males do not naturally produce β-hCG
Can test for cancer in some locations – pancreas, pituitary, placenta, testicles
Also elevated in pregnancy!!
• Tumour-M2-PK
Not an organ-specific tumour marker, so it mat be elevated in many tumour types.
Increased Stool Levels are being investigated as a method of screening for Colorectal Tumours and Plasma levels may be used for follow-up screenings in various other cancers.
TUMOUR MARKER EXAMPLES
31
Most Common Tumour Markers
32
Affected Organ Useful Tumour Marker
Breast CA 15-3, CEA, MCA
Ovaries CA 125, CA 72-4, CEA
Uterus CEA, - HCG
Cervix SCC, CEA, CA 125
Intestine CEA, CA 19-9
Liver AFP, CEA
Stomach CA 72-4, CEA, CA 19-9
Pancreas CA 19-9
Lungs, bronchi NSE, CEA, Cyfra 21-1
Testes - HCG, AFP, LDH
Prostate PSA, SP
Urinary bladder TPA
ENT tumours SCC, CEA
Thyroid Thyroglobulin, Calcitonin
32
3. IMAGING
• Techniques include:
a. X-rays
b. MRI (magnetic resonance imaging)
c. CT: Computed Tomography (Tomography is
imaging by sections or sectioning)
d. RADIOISOTOPES
33
4. BIOPSIES
• A small sample of
tissue is removed
and examined
histologically.
• Malignant cells have
an undifferentiated
cell structure.
(Falsification by
inflammation e.g. in
cervix swab) 34
STAGING of Cancer:
CLASSIFICATION
Recall: GRADING = Rating the Tumour according to the degree of abnormality of the cells. The Grade increases (from 1 – 4), with the degree of abnormality.
• STAGING = Classification of Malignant Tumours according to the extent of the disease at the time of diagnosis.
• May be repeated at further critical points.
Purpose: For PROGNOSIS & MONITORING
35
STAGING of Cancer: CLASSIFICATION
• There are several types of staging methods.
• The Tumour, Node, Metastases (TNM) System
classifies cancer by:
• T: Size of primary Tumour
• N: Degree of involvement of lymph Nodes/ regional spread N0 = No lymph node involvement
N1- 4 = Increasing degrees of lymph node involvement
Nx = Lymph node involvement cannot be assessed
• M:Presence of Metastases M0 = No evidence of distant metastases
M1 = Evidence of distant metastases
http://www.cancer.gov/cancertopics/pdq/treatment/pancreatic/Patient/page2 36
http://www.oncologychannel.com/staging.shtml
Stage 0 - Cancer in situ (Tis, N0, M0) Stage I - Cancer limited to Tissue of
Origin, Evidence of Tumour Growth (T1, N0,M0)
Stage II - Limited Local spread of Cancerous cells Stage III - Extensive Local and Regional spread Stage IV - Distant Metastasis
e.g. Stage 1 = T1 – Tumour less than 2cm,
N0 - No lymph node involvement,
M0 – No metastasis.
STAGING of Cancer:
CLASSIFICATION
37
TREATMENT
Basic Conventional Treatment:
• Combined or Single
‒ Surgery
‒ Chemotherapy
‒ Radiation
• Treatment can be
‒ CURATIVE
‒ PALLIATIVE = Medical Care/Treatment concentrating on reducing symptom severity or slowing disease progress rather than curing it. This is especially seen in the Late Stages where prevention of Obstruction / Ulceration/ Infection etc. becomes paramount.
Please see
the next 3
slides
38
Treatment: SURGERY Removal of the tumour, surrounding tissue and lymph
nodes.
http://www.cancerhelp.org.uk/type/breast-cancer/treatment/surgery/types-of-breast-cancer-surgery
PROSTATECTOMY The removal of the prostate gland.
ORCHIECTOMY A form of castration / removal of the testes
For more info on Prostate Cancer Treatment please visit:
http://www.prostate-cancer.com/index.cfm
For more info on Testicular Cancer Treatment please visit:
http://www.cancerhelp.org.uk/type/testicular-cancer/
39
Treatment: RADIATION THERAPY
• Causes Mutations in targeted DNA, preventing mitosis or causing cell death.
• Affects those cells which divide most rapidly (both cancer cells and normal cell which divide regularly)
Adverse Effects:
– Bone marrow Depression (leading to Aplastic/ Hypoplastic Anaemia with Pancytopenia)
– Epithelial cell damage:
Inflamed skin, hair loss,
gut ulceration etc.
– Sterility
– General Fatigue
40
Treatment: CHEMOTHERAPY
• A combination of different drugs designed to influence rapidly dividing cells
• They interfere with protein synthesis and DNA replication at different points in the mitosis cycle
• Different drug combinations are chosen for different types of cancer
Adverse effects:
– Bone marrow Depression
– Vomiting
– Hair loss
– Organ Damage
41
The Chemotherapy Experience:
• “During chemo, you're more tired than you've ever been. It's like a cloud passing over the sun, and suddenly you're out. You don't know how you'll answer the door when your groceries are delivered. But you also find that you're stronger than you've ever been. You're clear. Your mortality is at optimal distance, not up so close that it obscures everything else, but close enough to give you depth perception. Previously, it has taken you weeks, months, or years to discover the meaning of an experience. Now it's instantaneous.”
Melissa Bank
42
Other Drugs used in Cancer
Treatment
• HORMONES: – Glucocorticoids
– Oestrogens or Anti - androgen drugs for prostate cancer
– Tamoxifen to block oestrogen receptors
• BIOLOGIC RESPONSE MODIFIERS – Interferon etc.
• ANALGESICS (Pain Killers)
43
COMPLEMENTARY TREATMENT
NUTRITION – Maintaining nutrient levels
– Support through the side effects of treatment
– Immune support
MISTLETOE (Iscador Therapy) – Active ingredients, viscotoxins and lectins, can kill cells by
1. Damaging cellular membranes,
2. Stopping protein synthesis
3. Stimulating the immune system.
– See handout for further info
THYMUS EXTRACT – Orally administered calf thymus extracts have been found to
be quite effective in restoring and enhancing immune function
– Thymus extract has also been shown to normalize the ratio of T helper cells to suppressor cells
44
PROGNOSIS
• A CURE for cancer is generally defined as a 5 year survival without reoccurrence
• In some cases, several periods of REMISSION (the state of absence of disease activity / Period during which the symptoms of a disease lessen in severity or subside ) may occur before the cancer becomes Terminal
• The Death Rates vary for different types of Cancer and is very dependent on the Individuals Circumstances
45
Quiz
• Teams of 4
• Decide on a team name
• 30 Questions
• Possible 51 marks
• Write neatly so the
marking team can read
you answers!
46
TYPES of Cancer There are more than 200 Types of Cancer, each with different
causes, symptoms and treatments.
• CARCINOMAS - Cancers which form in EPITHELIAL CELLS/ TISSUES lining Skin, Mouth, Nose, Throat, Respiratory Tract, Genitourinary Tract, Gastrointestinal Tract. Can form Solid Tumours invading the Lung, Breast, Prostate, Skin, Stomach & Colon/Rectum.
• SARCOMAS – Cancers which develop in CONNECTIVE TISSUE- Bone, Cartilage, Muscles, Tendons etc.
• LEUKAEMIAS – Cancers which evolve in BLOOD & BONE MARROW. Abnormal white blood cells produced travel throughout the bloodstream damaging the spleen and other tissues. They do NOT form solid tumours.
47
http://www.cancerresearchuk.org/cancer-info/cancerstats/keyfacts/Allcancerscombined/
KEY FACTS
• Every 2 minutes someone in the UK is diagnosed with
Cancer.
• More than 1 in 3 people in the UK will develop some
form of Cancer during their lifetime.
• Cancer can develop at any age, but is most common in
older people. More than 3 out of 5 Cancers are
diagnosed in people aged 65 and over.
• Around 1% Cancers occur in children, teenagers and
young adults (up to age 24).
• Overall cancer incidence rates in Great Britain have
increased by more than a 1/3rd (22% in Males & by
42% in Females) since the mid-1970s.
48
http://www.cancerresearchuk.org/cancer-info/cancerstats/keyfacts/Allcancerscombined/
KEY FACTS
Most common forms include: Lung Cancer Bowel/ Colorectal Cancer Breast Cancer .
• There have been large increases in the incidence of many cancers
strongly linked to lifestyle choices, such
as Kidney, Liver, Malignant Melanoma, Oral & Uterine.
• Over the last decade the incidence rate of Stomach cancer has
decreased by more than a ¼ for both sexes. The male Lung cancer
incidence rate has decreased by almost a 1/6th .
• Worldwide there were estimated to be around 12.7 million new
cases of cancer in 2008, and over half of these were in developing
countries.
• Cancer is the number one fear for the British public, feared ahead of
debt, knife crime, Alzheimer’s disease and losing a job.
49
http://www.cancerresearchuk.org/cancer-info/cancerstats/keyfacts/Allcancerscombined/
KEY FACTS
• Cancer causes more than 1in 4 of all Deaths in the UK.
(> ¾ Cancer deaths occur in people aged 65 and over.)
• More than 1in 5 of all Cancer Deaths are from Lung
Cancer.
• Cancer Death rates in the UK have fallen by around 1/5th
over the last 30 years and by 10% over the last decade.
• Cancer survival rates in the UK have doubled in the last
40 years.
• ½ of people diagnosed with cancer now survive their
disease for at least 5 years.
• Almost 3/4 of Children are now cured of their disease,
compared with around a quarter in the late 1960s.
50
LUNG CANCER
• ~190,000 new cases in the EU per year
• ~180,000 deaths in the EU per year
• Peak incidence 60 -70 year old
• Men are 3x more likely to develop lung cancer
• Mortality is dropping in men and increasing in women due to changes in smoking habits
51
Lung Cancer: Signs & Symptoms
• Dry and persistent cough
• Little sputum, some blood possible
• Pain behind the sternum or in the back
• Recurrent Chest infections
• IN LATER STAGES: Bloody or Raspberry
jelly- like sputum, Hoarseness.
52
COLO-RECTAL CANCER
• ~210,000 new cases in the EU per year
• ~110,000 deaths
• Greatest incidence: 50+ age group
• More common in developed countries and rare in Africa and Asia
• Incidence has increased in Japan due to Westernized Diets
53
Colo-Rectal Cancer: Risk Factors
• Suspected DIETARY PROMOTERS:
– High meat consumption
– High fat consumption
– High calorific intake
– High alcohol intake
– Low fiber diet
• Suspected HEREDITARY COMPONENT in some cancers (Family History)
• Increases incidence in CHRONIC IBD-(Crohn’s, Ulcerative Colitis)
54
Colo-Rectal Cancer:
General Signs & Symptoms
1. CHANGE in bowel habit:
Alternating Diarrhoea and
Constipation
2. Anal bleeding
3. Blood in stool (occult blood
test)
4. Mucus on stool
5. Stool mixed with flatulence
6. Anaemia (chronic blood loss)
7. Colicky abdominal pain
(obstruction)
55
• Generally BENIGN
but larger Polyps
may turn Cancerous
• Often no symptoms
but can cause
Constipation or
Diarrhoea or Blood
in the Stool
POLYPS
56
BREAST CANCER
• 210,000 new cases in the EU per year
• 76,000 deaths
• Most COMMON cancer in WOMEN
• Peak age 50-70 yrs
• 0.5 – 1% of cases in men
• Much more common in Western cultures than in the Far East, particularly Japan
• Approx. 5% of cases genetic origin
57
Breast Cancer:
Signs & Symptoms
http://medicalyx.com/category/breast-cancer/ 58
1. Painless, Unilateral Lump, especially in
upper outer quadrant
Lump is often Stuck to the skin
2. Enlargement of Axillary Lymph Nodes
3. Skin Changes i.e.
– Dimpling/ Puckering of the breast
skin
– Redness/ Heat/ Rash (Nipple/ Skin)
4. Change in Size/ Shape of one/ both
Breasts/ Nipples = Asymmetry of
breasts
5. Retracted (Pulled-in)/ deviated Nipple.
6. Discharge/ Bleeding from the nipple
7. Pain in either of your breasts or armpits
NOT related to your period
Before breast reconstruction
Breast Reconstruction
Lumpectomy and
immediate breast
reconstruction
59
OVARIAN CANCER
• 6,000 cases in the UK
• 4,000 deaths per year
• Mostly in women over 40, who have never given birth and are of higher socio-economic class
• Maybe Genetic link
Seeding
60
Ovarian Cancer:
Signs & Symptoms – Mostly no symptoms for a
long time
– Vague abdominal
discomfort
– Pelvic pain
– Abdominal swelling
Later:
– Changes in bowel and
urinary habits
– General symptoms
61
CERVICAL CANCER
• Most common cancer in YOUNG WOMEN, but thanks
to an effective nationwide screening programme, fewer
women than ever are dying of cervical cancer.
• 20% of all cancers in women
• 4,500 cases per year
• A number of factors increase
the Risk of developing Cervical cancer: 1. The presence of Human Papilloma Virus infection 2. Sexual behaviour (sex at an early age and many
partners) 3. Smoking
62
Cervical Cancer:
Signs & Symptoms
Often there are NO SYMPTOMS when abnormal cells have developed or in the early stages of the disease. Women are encouraged to attend regular cervical screening.
• When symptoms do occur
( in later stages) they include:
–Bleeding after sexual
intercourse
–Bleeding between
menstrual periods
–An unusual vaginal
discharge
63
LIVER CANCER
• Mostly following Liver Cirrhosis
Symptoms:
– Portal vein hypertension
– Pain radiating into the back
– Jaundice
– Fever
• Liver cancer is more common as Secondary cancer.
• 1/3 of malignant tumours form Liver Metastases
Caputs’ medusa
(Distended, engorged umbilical veins)
64
STOMACH CANCER
• 75,000 new cases in the EU per year
• 60,000 deaths per year
• Peak occurrence 50-70 yrs
• Male to female ratio 1½ : 1
• Higher incidence in the Far East
• Less often / Low in Blood group O
• More often in Blood group A
65
Stomach Cancer:
Predisposing Factors
– Chronic Gastritis
– LOW stomach acid
– Nitrosamines
(cosmetics, rubber,
beer, meat, tobacco
byproducts)
66
Stomach Cancer:
General Signs & Symptoms
– Pain in the stomach area
– Nausea, low appetite, vomiting (blood)
– Disgust for meat
Later
– Anorexia
– Weight loss
67
OESOPHAGEAL CANCER
• 25,000 new cases in the EU per year
• 23,000 deaths per year
• Male to female ratio 3:1
• Peak incidence 60 -70 yrs
• Strong link to:
1. Tobacco smoking
2. Alcohol consumption
3. Chronic Acid Reflux
68
Oesophageal Cancer:
Signs & Symptoms
– Problems Swallowing
– Loss of appetite
– Regurgitation of food
– Non-sour reflux
– Retro-sternal
discomfort
– Weight loss
– Severe Coughing after
swallowing
69
PANCREATIC CANCER
• 38,000 new cases per
year
• 38,000 deaths per
year
• Peak occurrence:
50-80 years
http://www.maldivesdivetravel.com/maldives-blog/pancreatic-cancer-and-
scuba-diving.html 70
Pancreatic Cancer: Risk factors
– Tobacco smoking
– High fat and meat
consumption
– High coffee/alcohol
consumption
– Exposure to DDT
– Chronic Pancreatitis
Poor PROGNOSIS:
10-20% reach post 5 year survival stage
Operation on pancreatic cancer
71
Pancreatic Cancer:
Signs & Symptoms
• Lack of early symptoms
• Later:
– Jaundice / icterus
– Dark urine
– Pale stools
– Skin itching
– Pain radiating to the back
– Fatty stools
– Diabetes mellitus
http://www.nigerianbestforum.com/generaltopics/pancreatic-cancer-its-symptoms-and-causes/ 72
PROSTATE CANCER
• Ranks 3rd for deaths from Cancer in the UK
(1st lung cancer, 2nd colon cancer)
• 14,000 per annum, incidence rising
• Rare below 45 years, more common in 70+
• More common in:
– Married men
– Men with high
numbers of
sexual partners
– With STDs
http://kisbyto.blogspot.co.uk/2013/03/prostate-cancer-month.html
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Prostate Cancer:
Signs & Symptoms
• NO early symptoms
• Screening by rectal examination
• PSA Test
Later: Like BPH
• Increased urinating frequency
• Nocturia
• Dribbling
Back pain can indicate Bone Metastases
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Metastases from Prostate Cancer
75
BLADDER CANCER
• 12,500 cases in
the UK per year
• 2x more
common in men
• mostly in 70-80
year age group
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Bladder Cancer: Causes
– Chemical
Carcinogens
– Smoking
– Chronic irritation of bladder lining
Cigarette smoking is the leading cause of bladder cancer !!
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Bladder Cancer: General Signs & Symptoms
– Painless Haematuria
– Frequency, urgency and
Dysuria
• Cough with expectoration of
blood with/without bone pain
can indicate Bone Metastases
In a novel experiment, a team of scientists and dog trainers
have put this traditional canine behaviour to good use –
sniffing human urine to detect bladder cancer sufferers. 24 September 2004. New Scientist.com news service
Dogs trained to sniff out
bladder cancer
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TESTICULAR CANCER
• Most common
cancer in YOUNG
MEN aged 15-35yrs
79
Testicular Cancer:
Sgs, Sxs & Prevention
Hard, Painless usually Unilateral mass
Prevention:
Regular, monthly self examination
•See your notes of the reproductive system
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SKIN CANCER
Itching & / Bleeding Non-healing Ulceration 81
SKIN CANCER
• Visible, easily detected
and develops slowly =
Good prognosis
• Highest rate of
re-occurrence
• Usually arise on head,
neck or back
• Most common in fair
skinned people aged
40+
• Cases are on the
increase
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Basal Cell Carcinoma
• Raised, smooth, pearly bump on the sun-exposed skin of the head,
neck or shoulders.
• Sometimes small blood vessels can be seen within the tumour.
• Crusting and Bleeding in the centre of the tumour frequently
develops.
• It is often mistaken for a sore that does not heal.
This form of Skin Cancer is the least deadly and with proper treatment
can be completely eliminated, often without scarring.
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Squamous Cell
Carcinoma
• A red, scaling, thickened patch on sun-exposed skin.
• Some are firm hard nodules and dome shaped like
keratoacanthomas.
• Ulceration and bleeding may occur.
When SCC is not treated, it may develop into a large mass.
SCC is the 2nd most common skin cancer.
It is dangerous, but not nearly as dangerous as a Melanoma.
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Melanoma
Most melanomas are brown to black looking lesions.
Unfortunately, a few melanomas are pink, red or fleshy in
colour; these are called Amelanotic melanomas.
Warning signs that might indicate a malignant melanoma
include CHANGE in: Size, Shape, Colour or Elevation of a
mole.
Other signs are the appearance of a new mole during
adulthood or new Pain, Itching, Ulceration or Bleeding. 85
SKIN METASTASES
• Skin
metastases 2
years after
breast
amputation
86
LIPOMA – Non Cancerous
• A lipoma is a BENIGN & slow growing tumour composed of adipose tissue.
• It is the most common form of soft- tissue tumour.
• Lipomas are soft to the touch, usually movable, generally painless & under 1cm diameter (but can enlarge to sizes greater than 6cm.)
• Very rarely, malignant transformation has occurred.
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LEUKAEMIA
• 9th most common cancer in MEN in the UK
• 12th most common cancer in women in the UK.
• More than 6,000 new cases in the UK per year.
• Most common form of CHILDHOOD cancer, BUT is 3x more common in Adults.
88
LEUKAEMIA
• The term ‘Leukaemia’ is used to describe a number of
cancers of the Blood Cells (Bone Marrow).
• There are two main categories of Leukaemia - ACUTE
and CHRONIC:
• Acute Leukaemia: Develops quickly with a rapid in
immature WBC production, accumulating & disrupting the
function of many tissues and organs.
Can cause FATAL COMPLICATIONS in a very short period of
time.
• Chronic Leukaemia: Develops more slowly. Presents with slightly abnormal cells that do not function optimally.
May remain Asymptomatic for years.
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LEUKAEMIA • Additionally, Acute & Chronic Leukaemia may
be classified according to the type of white
blood cell affected.
• This split divides Leukaemia into:
1. Myeloid (Myelogenous) Leukaemia - Affects bone marrow cells that go on to form Granulocytes (BEN), RBCs & Platelets.
2. Lymphoid (Lymphoblastic /Lymphocytic) Leukaemia - Affects bone marrow cells that go on to form Lymphocytes. Mostly B- Lymphocytes.
• N.B. production of abnormal, WBCs leads to production of
healthy WBCs , RBCs & Platelets
(esp. in Myeloid Leukaemia). • Leukaemia may thus be categorised as:
Acute / Chronic Myeloid Leukaemia
Acute / Chronic Lymphoid Leukaemia
90
Leukaemia: Signs & Symptoms
• Often NO symptoms or may be VAGUE
and NON-SPECIFIC (similar to a flu-like
illness).
Common Sgs & Sxs include:
• Excessive bruising or bleeding
• Generalised weakness and fatigue
• Anaemia
• Frequent infections and fever
• Involuntary Weight loss
• Pain in the bones and joints
• Breathlessness
• Enlarged lymph glands, liver +/ spleen
• Abdominal discomfort http://www.galen.co.uk/?page=oncology 91
Cancer Quotes
“It has been an extraordinary experience and, in many ways, extremely positive”
- Marianne Faithful
“My cancer scare changed my life. I'm grateful for every new, healthy day I have. It has helped me prioritize my life”
- Olivia Newton-John
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