An Introduction To Cancer And Basic Cancer Vocabulary

An Introduction to Cancerand Basic Cancer VocabularyMarc B. Garnick, MDBeth Israel Deaconess Medical CenterHarvard Medical School, BostonMedical Director Cancer ProgramsNortheast Hospital Corporation, Beverly

OverviewCancer Basics: What Is Cancer?Causes, Risk Factors, & PreventionEarly Detection, Diagnosis, &StagingTreatment Overview

What Is Cancer?Abnormal and unregulated proliferation (growth) of cells, arisingfrom cells of a specific organGeneral name for a group of more than 100 diseases Although many kinds, they all start because abnormal cells grow(proliferate) uncontrolledCancer cells have the ability to create their own blood supply,break away from the organ of origin, travel, and spread to otherorgans of the bodyMorbidity and mortality arise predominantly from organ damagecaused by local growth and metastases to distant anatomic areas

Cancer Cell BasicsDifference between cancer cell and normal cell:Normal cell: Knowsand stays in its place of origin Knows when to replicate and when to die 2009 Nobel Prize – telomeres help determine longevityCancer cell: Doesnot know when to stop growing and proliferating Can travel (metastasize) from organ of origin to any placewithin the body

How a Normal CellBecomes CancerousWhat happens to the cell that allowscancer to develop?

Multistep Carcinogenesis

Major Risk FactorsGenetic predispositionTobacco use Alcohol excessLack of physical activityEnvironment and DietVirusSun exposure

How Cancers DifferTumor Types

Cancer/Carcinoma (“solid” tumors)Generally refers to cancers that arise from epithelial surfaces and cellsthat line glands: tePancreas ThyroidKidneyTestisOvaryAdrenalsLiverCervix

Major Types of CarcinomasAdenocarcinoma Any gland (breast, prostate, lung, pancreas, ovary, colon )Squamous cell carcinoma Any surface or lining of mucous membrane(skin, lung, head and neck)Others Urothelial (bladder), islet (pancreas)

The Hematologic Malignancies:Lymphomas and Leukemias“Liquid” TumorsTumors of lymph nodes and blood cells

Types of LymphomasHodgkin’s lymphomaNon-Hodgkin’s lymphomaCharacteristic appearance andclinical presentationSpecific type of cellVarious typesSpecific response to therapyWide variety of pathologic subtypesWide range of presentations andoutcomesDiffering treatments than for Hodgkin’slymphoma

The LeukemiasMalignant cells arising from cells of the bonemarrow white cells (myeloid cells, lymphoid cells,monocytes)red cells (erythroleukemia)platelets (megakaryocytic leukemias)plasma cells (myeloma)

SarcomasNeither carcinoma nor hematologic malignancyArise from soft tissues or boneWide spectrum of sites and presentationsOsteosarcoma (bone)Chondrosarcoma (cartilage)Synovial cell sarcoma (joint)Leiomyosarcoma (muscle)Liposarcoma (fat)Rhabdomyosarcoma (primitive muscle)Angiosarcoma (blood vessel, Kaposi’s)

How Is Cancer Diagnosed?(“7 warning signs”)Symptomatic CoughRectal bleedingPalpation of breast lumpWeight lossSkin abnormality- change in a freckle or mole, red areasCoughing up blood/chest painChange in bowel habitsAbdominal painBlood in urineDifficulty swallowingHoarseness

How Is Cancer Diagnosed?Asymptomatic Blood test – PSA, other markersScreening study(ies) – PAP, PSA, colonoscopy,mammogram, total-body CT scanAsymptomatic pick up on physical examLeads to radiographic or surgical biopsy and thento pathology PATHOLOGIST MAKES THE DIAGNOSISOF CANCER

Multidisciplinary StrategiesPrimary adiologistPathologistMedical OncologistRadiation OncologistSurgical SpecialistNurse/Nurse OncologistSocial WorkerFinancial PlannerTumor Registrar/DemographicsClinical Trials CoordinatorCommunity Outreach and Support“It takes a village” .Multidisciplinary ClinicConcept

Major Cancers for Panel Discussion andWhat the NHC and BIDMC are DoingNon–small-cell lungcancerBreast cancerColorectal cancerPancreatic cancerHepatocellular cancerProstateSkinThoracic multidisciplinaryMDC)Breast MDCMultidisciplinary Discussion atTumor BoardsMDC in formation; Seedprogram with Dr KaplanIn house expert, Dr Rodgers

How Cancer SpreadsMetastases

Tumor ProgressionTargeting Opportunities

Early Detection,Diagnosis and Staging

Frangioni JV. “New technologies for human cancer imaging.”J. Clin. Oncol. 2008; 26: 4012-21.

Lung Cancer /enlarge/lung-tumor.html

Staging Considerations

What Is Staging?Process of finding out how far the cancer has spreadVital step in determining treatment choices; also gives a cleareridea of the outlook for recoveryThere is more than one system for staging TNM system is used most often Biopsy, CT, MRI, PET, Ultrasound, blood tests allhelp determine stage

Staging Using TNM and Group StagingT Tumor sizeN Node statusM Presence or absence of metastasesG Degree of differentiationLetters or numbers after the T, N, and M give more detailsabout each of these factorsOnce established, T, N, and M are then subgrouped into stageclass (Stage I to Stage IV)

A Few Comments aboutGenomics and Genetics

Gene Expression for Breast Cancer

The FutureChemoprevention – the ability to use drugs or lifestylemodifications to prevent cancer from developingImprovement in staging – detecting many fewer cells oridentifying blood tests that tell about the presence of cancerDetermining a specific “finger print” of an individual's cancerSelecting a specific treatment, based upon the likelihood of thecancer to respond to that treatment AND minimizing theside effects of treatment

A Thought for the Day“Tell me and I forget.Teach me and I remember.Involve me and I learn.”– Benjamin Franklin

Cancer Cell Basics Difference between cancer cell and normal cell: Normal cell: Knows and stays in its place of origin Knows when to replicate and when to die 2009 Nobel Prize – telomeres help determine longevity Cancer cell: Does not know when to stop growing and proliferating Can travel (metastasize) from organ of origin to any place within the body