Oncological Deseases ENG

8/11/2019 Oncological Deseases ENG

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ONCOLOGYepidemiology.The reasons of malignant tumor formation.

Morbidity, structure, statistics and dynamics.

International TNM classification of malignant tumors.Organization and tasks of oncological care.

Fight against cancer, dispensary, prophylaxis.

Ivano-Frankivsk National Medical UniversityDepartment of Oncology


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Oncology

(from greek oncos- is a tumour, lgos- isscience)

- is science, which studies reasons ofbeginnings, mechanism of development andclinical symptoms of tumor, and also methods oftheir diagnostics, treatment and prophylaxis.


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Tumors

Benign

mature

expansive growth atypical tissue

no metastasis

Malignant

immature

infiltrative growth atypical cells

metastasis


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Cancer

Cancer is one of the most common diseases inthe developed world:

1 in 4 deaths are due to cancer 1 in 17 deaths are due to lung cancer

Lung cancer is the most common cancer in men

Breast cancer is the most common cancer inwomen

There are over 100 different forms of cancer


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Cancer

The division of normal cells is preciselycontrolled. New cells are only formed for growth

or to replace dead ones. Cancerous cells divide repeatedly out of control

even though they are not needed, they crowdout other normal cells and function abnormally.

They can also destroy the correct functioning ofmajor organs.


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For 75 years of life malignant tumours

strike each 3-4 manandeach 4-5 woman!


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Notice about the patient whose disease hasbeen diagnosed for the first time in his\her lifeas cancer or other malignant neoplasmform

090/should be filled by the doctor, who hasdetected this disease. This notice should begiven within three days and the patient will besent to the regional oncology dispensary.

Protocol of the neglected cancer case

form 027-2/

Medical recordsnecessary to fill on the cancer patients:


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Visual forms of cancer:

Tumors of lips, cavity of mouth, skin,thyroid, eye, breast, external genitalsand cervix of the uterus, penis andprostate, anus and ampullary part ofrectum.


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Morbidityof malignant tumors

National cancer-registr of Ukraine,2006

Men Women

19,5% Breast

12,8% Skin

8,2% Uterine corpus

6,5% Colon

6,4% Stomach

6,2% Cervix

5,3% Rectum

4,9% Ovary

4% Lung and bronchus2,5% Pancreas

23,7% All other sites

Lung and bronchus 19,5%

Skin 10%

Stomach 9,6%

Prostate 7,6%

Rectum 6,1%

Colon 5,8%

Urinary bladder 5,5%

Kidney 3,6%

Pancreas 3,4%

Larynx 3,3%

All other sites 25,6%


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Mortalityof malignant tumors

National cancer-registr of Ukraine,2006

Men Women

20,3% Breast

10,2% Stomach

8% Colon

6,8% Rectum

6,2% Ovary

5,9% Lung and bronchus

5,7% Cervix

5,4% Uterine corpus

4,4% Pancreas

2,8% Leukemia

24,3% All other sites

Lung and bronchus 26%Stomach 12,1%

Prostate 6,3%

Rectum 6,2%

Colon 5,7%

Pancreas 4,5%

Urinary bladder 4,3%

Larynx 3,3%

Kidney 3,2%

Oral cavity 3%

All other sites 25,4%


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Morphological classification of malignantneoplasms

Cancercombines tumors from epithelium (from pavement epithelium- epidermoid cancer, from glandular epithelium - adenocarcinoma)

Sarcomais a malignant tumor from connective tissue (fibro-,chondro-, osteo-, rhabdomyo- and leiomyosarcomas, liposarcoma).

Hemoblastosesare malignant neoplasms of blood system systemicleukemia tumors (lymphogranulomatosis and non-Hodgkin's lymphomas)

Tumors with APUDsystemapudomas (pheochromocytoma,

melanomas, small cell carcinoma of lungs, medullary carcinoma ofthyroid gland, carcinoid).

Rare formsof such tumors are the following: from trophoblastchorionepithelioma, from embryonal remains - teratoblastoma,seminoma


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International TNM classification of malignant tumors

T1is a tumor up to 2cm or occupies one layer of organ wall2is a tumor up to 5 cm or infiltrates several layers of organ wall

3is a tumor more than 5 cm or extends to all the layers oforgan wall or surrounding cellular tissue

4is a tumor that extends to vascular organs.

N0- metastases in regional lymphatic nodes are absentN1- metastatic spread to local nodes

N2- is foreseen for cervical cancer, colon cancer,

N3- is determined when there are breast cancer, lungs

cancer, cancer of kidneys, cancer of urinary bladder,testicle cancer and tumors of head and neck.

0remote metastases are absent

1remote metastases are present


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CLINICAL GROUPS OF CANCER PATIENTS

I - includes all patients suspected to have cancer. Thissymbol obligates the doctor to confirm or withdraw diagnosis

within the 10 days period.I - includes all patients with pre-tumor pathology

II - includes patients with malignant neoplasm, who needspecial therapy and there is hope to recover - (clinical groupII) or remission - (clinical group II).

IIIincludes practically healthy people who have alreadyundergone radical therapy

IV - includes patients with the IV stage of the disease. Mostof them have only symptomatic treatment (including surgery

when there are complications, radiation therapy to relievefrom pain syndrome, chemotherapy to improve life qualityand duration).


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Treatment of oncologic patients

By radical we mean such treatment when afterits application there are no any tumor growthfocuses left, which can be determined by clinical,immunological, roentgenological, radioisotope,endoscopic and morphologic methods ofdiagnostics.

Palliative treatmentis the one when after itsfulfillment unliquidated tumor focuses are leftboth in the area of primary focus location and inremote organs.

Symptomatic treatment includes elimination ofcomplications that threaten the life of a cancerpatient.


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Special treatment

Basic methodssurgical

- radiation therapy

- chemotherapy

Second methodshormonotherapy

- immunotherapy


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What causes cancer?

Cancer arises from the mutationof a normal gene.

Mutated genes that cause cancer are calledoncogenes.

It is thought that several mutations need to occur

to give rise to cancer Cells that are old or not functioning properly

normally self destruct and are replaced by newcells.

However, cancerous cells do not self destruct andcontinue to divide rapidly producing millions of newcancerous cells.


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A factor which brings about a mutation iscalled a mutagen.

A mutagen is mutagenic.

Any agent that causes cancer is called acarcinogenand is described ascarcinogenic.

So some mutagens are carcinogenic.


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Carcinogens Ionising radiationX Rays, UV light

Chemicalstar from cigarettes

Virus infectionpapilloma virus can beresponsible for cervical cancer.

Hereditary predispositionSome families are

more susceptible to getting certain cancers.Remember you cant inherit cancerits just thatyou maybe more susceptible to getting it.


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Benign or malignant?

Benign tumoursdo not spread from their site of origin,but can crowd out (squash) surrounding cells eg braintumour, warts.

Malignant tumourscan spread from the original site

and cause secondary tumours. This is calledmetastasis. They interfere with neighbouring cells andcan block blood vessels, the gut, glands, lungs etc.

Why are secondary tumours so bad?

Both types of tumour can tire the body out as theyboth need a huge amount of nutrients to sustain the

rapid growth and division of the cells.


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The Development of Cancer

Within every nucleus of every one of thehuman body's 30 trillion cells exists DNA,

the substance that contains theinformation needed to make and controlevery cell within the body. Here is a close-

up view of a tiny fragment of DNA.


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2 Mutation of DNA


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2. Mutation of DNA

Here is the same section of DNA but from another cell. If youcan imagine that DNA is a twisted ladder, then each rung of theladder is a pair of joined molecules, or a base pair. With thissection of DNA, one of the base pairs is different from the

original.

This DNA has suffered a mutation, either through mis-copying(when its parent cell divided), or through the damaging effectsof exposure to radiation or a chemical carcinogen.

3 G ti ll lt d ll


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3. Genetically altered cell

Body cells replicate through mitosis, they respond totheir surrounding cells and replicate only to replaceother cells. Sometimes a genetic mutationwill cause acell and its descendants to reproduce even thoughreplacement cells are not needed.

The DNA of the cell highlighted above has a mutationthat causes the cell to replicate even though thistissue doesn't need replacement cells at this time or atthis place.

4 S d d d t ti


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4. Spread and second mutation

The genetically altered cells have, over time, reproducedunchecked, crowding out the surrounding normal cells. Thegrowth may contain one million cells and be the size of apinhead. At this point the cells continue to look the same as the

surrounding healthy cells.After about a million divisions, there's a good chance that oneof the new cells will have mutated further. This cell, nowcarrying two mutant genes, could have an altered appearanceand be even more prone to reproduce unchecked.

5 Third mutation


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5. Third mutation

Not all mutations that lead to cancerous cells result in the cellsreproducing at a faster, more uncontrolled rate. For example, amutation may simply cause a cell to keep from self-destructing.All normal cells have surveillance mechanisms that look fordamage or for problems with their own control systems. If such

problems are found, the cell destroys itself.Over time and after many cell divisions, a third mutationmayarise. If the mutation gives the cell some further advantage,that cell will grow more vigorously than its predecessors andthus speed up the growth of the tumour.

6 Fourth mutation


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6. Fourth mutation

The new type of cells grow rapidly, allowing formore opportunities for mutations. The nextmutation paves the way for the development of

an even more aggressive cancer.

At this point the tumour is still contained.

7 B e king th o gh the memb ne


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7. Breaking through the membrane

The newer, wilder cells created by another mutation areable to push their way through the epithelial tissue'sbasement membrane, which is a meshwork of proteinthat normally creates a barrier. The invasive cells in this

tumour are no longer contained.

At this point the cancer is still too small to be detected.

8 A i i


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8. Angiogenesis

Often during the development of earlier stages of the tumour,or perhaps by the time the tumour has broken through thebasement membrane (as pictured above), angiogenesis takesplace.Angiogenesis is the recruitment of blood vessels fromthe network of neighbouring vessels.

Without blood and the nutrients it carries, a tumour would beunable to continue growing. With the new blood supply,however, the growth of the tumour accelerates; it sooncontains thousand million cellsand, now the size of a smallgrape, is large enough to be detected as a lump

9 Invasion and dispersal


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9.Invasion and dispersal

The tumour has now invaded the tissuebeyond thebasement membrane.

Individual cells from the tumour enter into the networkof newly formed blood vessels, using these vessels ashighways by which they can move to other parts of thebody. A tumour as small as a gram can send out amillion tumour cells into blood vessels a day.

10 T ll Wh k


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10. Tumour cellstravel -

metastasis

What makes mosttumours so lethal istheir ability tometastasize -- that is,establish new tumoursites at other locationsthroughout the body.Secondary tumours.

Metastasis is nowunderway, as tumourcells from the originalcancer growth travel

throughout the body.Most of these cells willdie soon after enteringthe blood or lymphcirculation.

11 M t t i


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11. Metastasis

To form a secondary tumour, a tumour cell needs toleave the vessel system and invade tissue. The cell must

attach itselfto a vessel's wall. Once this is done, it canwork its way through the vessel and enter the tissue.

Although perhaps less than one in 10,000 tumour cellswill survive long enough to establish a new tumour site,a few survivors can escape and initiate new coloniesof

the cancer.

N ti l l f fi ht i t


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National plan of fight against acancer

Prophylaxis

Skrining and early recognition of cancer

Help an oncological patient Teaching of specialists

Scientific researches and epidemical control


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Prophylaxis

Complex programCanceris not sentencewith the aim to increase informational level inUkrainian population in this problem and to

create a positive perception e.g. canceris acured disease.

Fight against smoking!

Control of carcinogenic adverse

in environment and working places


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Cancer screening and early diagnostics

Screening has to recognize pre-tumor states inpeople categories without any signs of disease:

- breast cancer

- cervical cancer- colon cancer

- melanoma

- prostate cancer


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Care in oncological patients

diagnostics and treatment

psychological care

rehabilitation and dispensary

social and informational care

palliative treatment

The basis for early diagnostics is determined by the level of


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The basis for early diagnostics is determined by the level ofoncologic alarm, which includes the following:

knowledge of early cancer symptoms;

knowledge of clinical picture, diagnostics, clinical examinationand therapy of patients with pre-tumor states;

knowledge of organization principles of oncology aid andpurposeful patient referral to oncology establishment;

studious thorough examination of each person, who appeal toa medical establishment (fulfillment of obligatory clinical

examination minimum)

in all the cases of the so-called difficult diagnostics thereshould be the purpose to primarily exclude the cancer inpatient


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THE OBLIGATORY CLINICAL EXAMINATION MINIMUM INCLUDES:

Obtaining case history according to the systems having the aimto find the signs of disorder of organ functions and also

determine risk factors for the cancer development with furthercomplex (extended) examination of organs and systems, thathave very close relation to the revealed risk factors andsymptoms.

Examination of skin, mucous, peripheral lymph nodes,methodical examination of breast.

In the room for patients' examination for the men: there shouldbe examination and palpation of external male genital organsand digital investigation of rectum having the aim to detectprostate pathology and ampullary part of rectum.

In the room for patients' examination for the women: there

should be conducted vaginal touch with taking pap-test fromcervix and rectal examination. Breast examination is alsoperformed here.

- Chest X-Ray should be done in three projections. - Blood and urine analyses. - Ultrasonic scanning of liver, kidneys, uterus and adnexa uteri.


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Oncological Deseases ENG