A cancer, is thought to develop from a cell in which the
normal mechanisms for control of growth and proliferation
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are altered.
Current evidence supports the concept of carcinogenesis as
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a multistage process that is genetically regulatedThe first step in this process is initiation, which requires
exposure of normal cells to carcinogenic substances.
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Substances that may act as carcinogens or initiators includechemical, physical, and biologic agents
Two major classes of genes are involved in carcinogenesis:
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oncogenes and tumor suppressor genes
PATHOLOGY OF CANCER
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Tumors may arise from any of four basictissue types
? Epithelial tissue
? Connective tissue (Muscle, bone, and cartilage)
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? Lymphoid tissue? Nerve tissue
Malignant cells are divided into those of epithelial
origin or the other tissue types.
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? Carcinomas are malignant growths arising from epithelial
cel s.
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? Sarcomas are malignant growths of muscle or connectivetissue.
? Adenocarcinoma is a malignant tumor arising from
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glandular tissue.
TUMOR CHARACTERISTICS
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? Invade and destroy the surrounding tissue.? The cel s are genetical y unstable
? Loss of normal cel architecture results in cel s that are
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atypical of their origin.
? Lose the ability to perform their usual functions.
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? Metastasize, and consequently, recurrences are commonafter removal or destruction of the primary tumor.
THE THREE AXES OF CANCER CLASSIFICATION
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? Topographic siteTopographic
Histologic type
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? Histology
site
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(disease site)? Anatomic extent
(Staging)
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Patient'sAnatomic extent
Disease (TNM)
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Staging: Why?? To aid the clinician in planning treatment
? To give some indication of prognosis
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? To assist in evaluating the results of treatment
? To facilitate the exchange of information between treatment
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centers? To contribute to continuing investigations of human
malignancies
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ANATOMIC STAGING
Based on three components
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T
The extent of the primary tumor
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NThe absence or presence and extent of regional
lymph node metastasis
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M
The absence or presence of distant metastasis
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TUMOR (T): COLORECTAL CANCER--- Content provided by FirstRanker.com ---
TUMOR (T): LUNG CANCER
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T1 T2
T3
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T4CLINICAL, PATHOLOGIC, COLLABORATIVE STAGING
Clinical (cT, cN, cM)
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Beforeinitiationofprimarytreatment
Importantindecidngprimarytreatment
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Pathologic (pT, pN, pM)Fromresctedtisues
Collaborative (CS)
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Clinical,pathologicstaging&nonanatomic(site-specifc)factors
LIMITATIONS OF STAGING
Not used in hematologic malignancies
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Ann Arbor Staging SystemNot used in pediatric cancer
Not useful in rare diseases
Not enough cases to stratify T, N, M (Merkel Cel Cancer)
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Lumping different histopathologic subtypes (Soft tissuesarcoma: multiple histologies)
Dominated by anatomic pathology and histology (size,
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nodes, histopathology, grade)
Gradual y incorporating other prognostic variables
DESCRIPTORS
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Suffix
m
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Presence of multiple primary TpT(m)NM
Prefix
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y
Post initial treatment (staging
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ycTNM orafter preop treatment)
ypTNM
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r
Recurrent tumor after a disease rTNM
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free intervala
Autopsy
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aTNM
OTHER FACTORS
Histopathologic subtype
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Adenocarcinoma, SCCAHistology/Grade
Poor, mod, wel differentiated, Undifferentiated
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Lymphovascular invasionResidual tumor
RX, R0 ? 2 resections
Site-specific factors
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? Breast: ER, PR, Her2-neu
? Thyroid: Age
? CRC: Microsatel ite instability, MMR, K-ras status
? Prostate: PSA, Gleason's Score
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STAGING IN THE FUTURE?
Essential
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TNM categories Histologic gradeFactors
Extramural venous invasion Obstruction
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Quality of surgeryAdditional
Grade Tumor perforation
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Factors
Perineural invasion Invasion pattern
Medul ary type CEA serum level
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Number of lymph nodes resectedPeritumoral lymphoid reaction
New and
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Microsatel ite instability LOH 18q statusPromising
Factors
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P53 DNA ploidy
VEGF, K-ras expression 20q copy number
Greene, CA Cancer J Clin
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2008; 58:180-90
MANAGEMENT
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? Prevention
? Screening
? Diagnosis
? Treatment
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? Rehabilitation? Follow-up care
? Palliative care
? Terminal Care
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MULTIDISCIPLINARY APPROACHFOR MANAGEMENT
Surgery
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NutritionRadiation
Cancer
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Management
Radiology
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ChemotherapyPathology
GOALS OF CANCER TREATMENT
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1- Primary goal
Cure the patient
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Render him clinically and pathologically free ofdisease and return their life expectancy to that of
healthy individuals of the same age and sex.
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GOALS OF CANCER TREATMENT2- The best alternative goal
To prolong survival while maintaining the
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patient's functional status and quality of life.
3- The 3rd goal
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Relieve symptoms such as pain for patientsin whom the likelihood of cure or prolonged
survival is very low
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SURGERY
Long considered the most important aspect of cancer
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treatment for solid tumoursControls the disease local y
May be curative for many tumours especial y if caught
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early
RADIATION THERAPY
? Local therapy
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? Causes DNA damage to cancer cells and
leads to their death
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? May be curative on its ownCHEMOTHERAPY
? Multitude of drugs developed to kil cancer cel s
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? DNA damage, RNA damage, inhibit cell growth and
division, antimetabolites
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? Can be used as sole modality for cure (hematologicmalignancies) or as adjunct to either surgery or radiation to
cure
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? May also be given to incurable individuals to palliateNEW PARADIGM OF TREATMENT
? Target unique proteins/genes/structures in cancer cells with novel
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agents? Differential toxicity between the tumour cell and normal tissues
? More specificity for tumours makes cancer kill greater
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? Combine newer treatments with traditional strategies
? Molecular profiling
Oncogenes, protooncogenes, apoptotic markers, cytogenetics
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