Infection in Cancer - Ministry of Healthjknj.moh.gov.my/jsm/day2/Infections in Cancer - Dr. Tang...

Infection in CancerJohor Scientific Meeting 2015

6 October 2015

Dr Tang Weng HengClinical Oncologist

MBBS (Malaya) MCO (Malaya)

Pusat Rawatan OnkologiHospital Sultan Ismail, Johor Bahru

Outline

• Introduction

• Mechanism

• Aetiology

• Examples• Epidemiology

• Management

• Update

• Prevention

• Conclusion

Introduction

• Infection – communicable disease

• Cancer – non-communicable disease

• What is the link?

Introduction

• Infections are linked to 15-20% of cancers• Viruses

• Bacteria

• Parasites

American Cancer Society 2015

Mechanisms

• How do infections lead to cancers?• Viruses hijack cellular mechanism causing unregulated growth

• Chronic inflammation

• Immunosuppressed state

American Cancer Society 2015

Oncogene & Proto-oncogene

Chronic Inflammation & Cancer

Chronic Inflammation & Cancer

Immunosuppression & Cancer

• Congenital

• Therapy-induced

• Acquired

Immunosuppression & Cancer

Goedert J. Epidemiology of acquired immune deficiency syndrome malignancies. Semin Oncol 27:390-401, 2000.Penn I. Cancers of the anogenital region in renal transplant recipients. Analysis of 65 cases. Cancer 58(3):611-616, 1986.Penn I. Tumors of the immunocompromised patient. Annu Rev Med 39:63-73, 1988.

Immunosuppression & Cancer

Cancers in HIV

• AIDS defining cancers• Kaposi’s HHV-8

• NHL EBV, HHV-8

• Cervical cancer HPV

• Non-AIDS defining• Anal HPV

• Hodgkin’s EBV

• Oropharyngeal SCC HPV

• HCC HBV, HCV

HPV and Cervical Cancer3rd most common

GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012.

HPV and Cervical Cancer

• Landoni

HPV and Cervical Cancer

• Prevention with vaccination

HPV and Cervical Cancer

• Pap smear

HPV and Oropharyngeal Cancer

HPV and Oropharyngeal Cancer

HPV and Oropharyngeal Cancer

• Personalised cancer treatment

• More LN involvement, but better prognosis

• Deintensification?

HPV and Anal Cancer

HPV and Anal Cancer

• Organ preservation

EBV and NPC

• Incidence – 8th most common

• Epidemiology

• Pathology – WHO type I, II, III

• East Asian disease

GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012.

EBV and NPC

• IMRT• What is IMRT?

• Advantages of IMRT• Parotid sparing

• Improved local control

• Lateral retropharygeal LN’s

• Photon-electron matching uncertainty

• Dose painting

EBV and NPC

• IMRT• What is IMRT?

• Advantages of IMRT• Parotid sparing

• Improved local control

• Lateral retropharygeal LN’s

• Photon-electron matching uncertainty

• Dose painting

EBV and NPC

• IMRT• What is IMRT?

• Advantages of IMRT• Parotid sparing

• Improved local control

• Lateral retropharygeal LN’s

• Photon-electron matching uncertainty

• Dose painting

EBV and NPC

• IMRT• What is IMRT?

• Advantages of IMRT• Parotid sparing

• Improved local control

• Lateral retropharygeal LN’s

• Photon-electron matching uncertainty

• Dose painting

HIV and Cancer

• AIDS defining illness• NHL

• Non-AIDS defining illness• Hodgkin’s

HIV and Non-Hodgkin’s Lymphoma

• CMT

• Improved tumour control

• Improved OS

HIV and Hodgkin’s Lymphoma

• CMT

HIV and HL

• Less is more

HIV and HL

• Less is more

• Moving away from extended field

• Focussing on involved site

6th most common

GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012.

Helicobacter pylori and Gastric Cancer

Helicobacter pylori and Gastric Cancer

• Pathogenesis

Helicobacter pylori and Gastric Cancer

• Pathogenesis

Helicobacter pylori and Gastric Cancer

• MacDonald’s trial

• First trial to show OS benefit with adjuvant Rx

Helicobacter pylori and Gastric Cancer• Role after D2 LND

• ARTIST subgroup

HBV and HCV in HCC

•12th most common

GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012.

HBV and HCV in HCC

• Pathogenesis

HBV and HCV in HCC

• Patient• ECOG performance status• Cirrhotic liver• Comorbid

• Tumour• Number• Location

• Treatment• Surgery +/-• Liver transplantation• RFA • TACE• SABR

Barcelona Clinic Liver Cancer staging classification

SABR in HCC

• Inoperable

• Unresectable

Schistosomiasis and Bladder Cancer• Incidence of bladder cancer

• Uncommon

• Schistosomiasis is uncommon in Malaysia

• More prevalent in Middle East and Africa

• Migration

Schistosomiasis and Bladder Cancer

• Combined modality therapy

• Bladder preservation strategy

Conclusions

Cancer is

• NCD

• Infective aetiology – communicable

• Potentially curable• Early detection, early stage, early referral

• Screening

• Education

• Treatable

• Preventable

What we do in oncology and medicine

• To cure sometimes

• To relieve often

• To comfort always

Acknowledgement

• Dr Mohd Roslan Harun

• Dr Lim Chun Sen

• Dr Myat Soe Khine

• Multidisciplinary teams from HSI, HSA, various hospitals in Johor

• Medical officers

• Nurses

• Physicists

• Radiation therapists

• Pharmacists

• Dieticians

• Patients

Acknowledgement

• Family

Thank you for your kind attention

Dr Tang Weng Heng

Clinical Oncologist

MBBS (Malaya) MCO (Malaya)

Pusat Rawatan Onkologi

Hospital Sultan Ismail, Johor Bahru

016-2454269

07-3565000 ext 1104

tangwengheng@gmail.com