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Cancer

Cancer. Terminology. Oncology (onc/o-, -ology) Neoplasia (neo-, -plasia) Tumor (-oma) Benign Malignant Metastasis Cancer, Carcinogen (carcin/o-). Additional Terminology. Differentiation Poorly Divergent (mixed tumors) = pleomorphic Heterotrophic Anaplasia Dysplasia

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Cancer

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  1. Cancer

  2. Terminology • Oncology (onc/o-, -ology) • Neoplasia (neo-, -plasia) • Tumor (-oma) • Benign • Malignant • Metastasis • Cancer, Carcinogen (carcin/o-)

  3. Additional Terminology • Differentiation • Poorly • Divergent (mixed tumors) = pleomorphic • Heterotrophic • Anaplasia • Dysplasia • Carcinoma in situ (CIS) • Mature and immature • Autonomy

  4. Risk Factors for Cancer • Sex and reproductive history • Race and geographical location • Infection (virus, STDs) • Immunosuppression • Age • Family history • Nutrition • Environment (chemicals, drugs, toxins) • Lifestyle (exercise) • Occupation

  5. Cancer Types: Male / Female

  6. Risk Factors

  7. Creation of Cancer Hep B Hep C HPV Herpes HTLV Epstein Barr

  8. Telomeres and Immortality

  9. Chromosomal Translocation Mutations Berkett’s Lymphoma CML

  10. Epigenics • Lifestyle and environment changes gene expression • Silencing of gene expression by hypermethylation • http://www.pbs.org/wgbh/nova/sciencenow/3411/02.html

  11. Genetic Changes that can occur • Activate oncogenes • Inactivate tumor suppressor genes • Inactivate genes that regulate apoptosis • Inactivate genes that regulate DNA repair • Inactivate genes that regulate cell cycle • Inactivate genes that regulate membrane proteins

  12. Oncogenes and their functions • Growth Factors • Overexpression • Amplication • Point mutations • Signal Transduction • Point mutations • Translocations • Nuclear regulation • Amplification • Translocations • Cyclins • Amplification

  13. p53: Tumor Suppressor Gene p53 regulates cell cycle, DNA repair, and apoptosis

  14. Rb: Tumor Suppressor Gene Rb normally inhibits the cell cycle

  15. Ras: Signal Transducer

  16. APC: Adhesion protein Loss of adhesion proteins allows for metastasis

  17. Cancer Clusters

  18. Environmental factors • Carcinogens • Air pollution • Ionizing radiation • UVR • Nutrition • Obesity • Alcohol

  19. Immune System • Surveillance • Chronic Inflammation • ROS

  20. NK Lymphocytes

  21. Immunosupression

  22. Benign v.s. Malignant

  23. Anaplastic characteristics • Hyperchromic nuclei • 1:1 cytoplasmic ratio • Variable size and shape of cell • Atypical and numerous spindle cells • Prominent nucleoli • Loss of polarity • Mitotic figures

  24. Cancer cell structure

  25. Cancer cells

  26. Cytological Changes metaplasia carcinoma

  27. Cell Cycle of Cancer

  28. Cancer cell functions

  29. Clinical Manifestations • Pain: • Pressure tumor and fluid • inflammatory mediators (IL-1, IL-6, TNF-a) • Fatigue: inflammatory mediators • Cachexia: change in appetite center • CBC changes • Anemia: chronic bleeding, cancer growth, Tx • Leukopenia: metastasis, Tx • Thrombocytopenia: metastasis, Tx • Infections: 2nd to Tx • Hormonal imbalance (hypercalcemia)

  30. Tumor Staging • Stage 1 • Local • Well differentiated • Stage 2 • Invasive • Moderate differentiation • Stage 3 • L.N. spread • Poorly differentiated • Stage 4 • Distant Sites • Undifferentiated

  31. T = primary tumor mass N = regional lymph node M = metastasis X = cannot be assessed 0 = not present Number increase Growth of mass Spread to other L.N. T TX, T0, Ti.s. T1, T2, T3, T4 N NX, N0, N1, N2, N3 M MX, M0, M1, M2 TNM classification

  32. Tumor Size

  33. L.N.

  34. Metastasis (MX, M0, M1, M2)

  35. Cancer progression & spread • BV growth • Decrease in cell to cell adhesion • Cells through tissue planes • Body cavity, BV, or Lymphatic spread • Tissue selectivity

  36. Primary and Secondary Sites Liver and Lung are frequently involved secondary sites

  37. Favorable Sites

  38. Ovarian Cancer Metastasis Sites

  39. Liver Mets

  40. Lung Mets

  41. Brain Met (secondary to Lung Cancer)

  42. Tumor Treatment • Chemotherapy • Radiation • Surgery • Immune • BM transplant • Gene Therapy

  43. Chemotherapy • Alkylating agents • Nonspecific Cross link DNA • Drugs • Cyclophoshamide • Cisplatin • Antimetabolites • Block DNA synthesis in S phase • Drugs • Methotrextrate • Mercaptopurine • Antitumor AB • Block enzymes nonspecifically • Change cell membrane • Drugs • Doxorubicin • Plant Alkaloids • Block DNA replication • Block enzymes in M phase • Drugs • Vinblastine • Vincristine • Topoisomerase inhibitors • Prevents DNA reassembling in S • Drugs • Doxorubricin

  44. Secondary Effects of Chemotherapy

  45. Radiation Therapy

  46. BM Transplant

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