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ONCOLOGY & IMMUNE
DISORDERS
Introduction to Unit One
Chapter 16 Text
Today’s Class:
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Immune system and cancer
Cancer cell characteristics
Tumor classification
Phases of the cell cycle
Grading and staging cancer
Cancer statistics & risk factors
Warning signs of cancer
Class Objectives:
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Compare the structure and function of the normal cell
and the cancer cell.
Discuss the connection between cancer and the
immune system.
Differentiate between benign and malignant tumors.
Describe the classification of cancers according to
tissue of origin, Grading and staging.
Discuss the current trends of cancer in relation to
incidence, prevalence and mortality of different types
of cancer.
Describe the warning signs of cancer.
Discuss risk factors associated with cancer.
Discuss the 7 steps to health.
Terms:
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Oncology : is the study of cancer
The words cancer, neoplasm, malignant neoplasm and tumor are often used
interchangeably, however tumor simply refers to a lump, mass, or swelling
Definitions:
 Neoplasm derived from Greek word neos (new) & plasis (molding) is defined as an
abnormal mass of tissue that serves no useful purpose and maybe harmful to host
organism.
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Neoplasms can be either benign or malignant
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Cancer: is used to refer to malignant neoplasms.
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Cancer is a disease of the cell in which the normal mechanisms of the control of
growth and proliferation have been altered. It is invasive, spreading directly to
surrounding tissue or to new sites in the body.
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Proliferation : to grow or multiply by rapidly producing new tissue, parts, cells, or
offspring
Just a Disease?
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Many people think diseases such as Cancer,
Diabetes, or COPD are just diseases. They are
much more than that. A disease is something that
happens to your body. Cancer affects every aspect
of your whole life. Its much more than a medical
problem, it takes over your mind too. It’s more
than a simple adjustment of medication,nutrition,
therapy or other treatment. It requires a complete
retraining of your lifestyle. Nothing is spared, no
part of your life is left unscathed (King, 1994).
Normal Cells
The Body’s Primary Defense System
Provide natural resistance & innate immunity
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Specific Function
Ordered Rate of
Proliferation
Limited Mobility
Controlled by DNA &
RNA
Need oxygen, water &
nutrients
Produce energy
Eliminate waste
Cancer Cells:
Breast
Brain
Immune System…
Cancer
The Immune System & Cancer
What is the connection between cancer and the
immune system?
•Cancer cells arise continually as a result of mutations.
•The immune system (T-cell lymphocytes, macrophages, &
antigens) recognize these cells as non-self and destroys
them.
Maybe good idea: Immune System Review
Available evidence indicates, then,
that the immune system responds to
cancer cells. Some immunologists believe
that it does so on a regular basis. They
theorize that the body produces cancer cells
fairly regularly, but eliminates most of them
before they can spread or form a tumor.
They believe that cancer has an opportunity
to take hold only when the immune system
performs below par. Although they are
making progress, scientists still do not
completely understand precisely how the
immune system works.
Even more convincing are clinical results showing
that stimulation of the immune system with bacterial
products or components of the immune system itself
can lead to tumor regression in some patients. The
link between cancer and the immune system is also
suggested by the fact that people with an impaired
immune system, such as AIDS patients, are more
likely to develop certain cancers, including Kaposi's
sarcoma, rectal cancer and some types of
lymphomas.
Attack:
-Cancer Cell
(Grey)
-Immune
Cells (Green)
-Red Blood
Cell (Red)
CARCINOGENS
Carcinogens are factors that are associated
with cancer causation: (agents that initiate or
promote cellular transformation)
1. Viruses
2. Radiation
3. Chemicals
4. Genetic susceptibility (10% of all cancers have
a strong genetic link)
5. Host susceptibility also affected by gender,
ethnicity, age, exercise and diet.
Viruses and Bacteria
CARCINOGENS
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Viruses: hard to determine, difficult to isolate,
incorporate themselves into the genetic structure of
cells and alter tem
• Epstein-Barr virus: Burkitt’s lymphoma, nasopharyngeal
cancers, non-Hodgkins and Hodgkins
• HSVII: liver
• Hepatitis B: liver cancer
• HPV 16, 18, 33 dysplasia and cervical cancer
• Human t-lymphotropic virus: lymphocytic leukemia and
lymphoma
• HIV virus: Karposi’s sarcoma
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Bacteria: associated with an increased incidence of
gastric malignancy, perhaps secondary to
inflammation and injury of gastric cells
Chemical Carcinogens
Cellular Dysfunctions in Cancer
1.
Defect in cellular proliferation
a- defect in normal balance between
cellular proliferation and cell death.
b- loss of Contact inhibition & doubling time
2.
Defect in cellular differentiation
a- (defect in cancer ) normally an orderly
process that progresses from immaturity to
maturity.
b- (defect in cancer) as normal cells
differentiate they become capable of
carrying out specific functions
Cellular Differentiation
Cancer
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Cancer has an opportunity to take hold only
when the immune system performs below par
(immature, old, or weak).
 Chronic illness, malnutrition, use of
immunosuppressive drugs contribute to failure of
the immune system
 Apoptosis: “cell suicide”. In the process of
carcinogenesis genetic damage to mutated cells
may result in a mutated cell not self-destructing.
Normal Cellular Differentiation
(specialization & maturity of cells)
Fertilized ova
endoderm
mesoderm
ectoderm
Mature cells of
•Trachea
•Lungs
•epithelium
Mature cells of
•Muscles
•Bones
•Connective tissue
Mature cells of the
•Brain
•Skin
•glands
Cancer Cells
 Less
dependent on oxygen (anaerobic)
 Variable shapes & sizes
 Loose contact inhibition (don’t respect boundaries)
 Are less adherent and more mobile
 Less differentiated (no specialization, no specific
function) leads to loss of normal function
 Abnormal growth (rapid cell growth)
Broad Phases of the Cell
Cycle
•Go
• G1
•S
• G2
•M
Cell Cycle
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G0 resting phase
G1 cellular contents including RNA and protein
are synthesized
S synthesis phase each of the 46
chromosomes is duplicated by the cell
G2 the cell “double checks” the duplicated
chromosomes for error, making any needed
repairs
Mitosis cellular division and production of 2 new
cells
Gene expression &
protein synthesis
Growth & protein
synthesis
G1 / G0
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G0 is the resting phase of the cell, cells are not in the
phase of cellular division
 The G1 (Gap 1) phase is characterized by RNA
and protein synthesis. This enables the cell to
grow and to produce all the necessary
proteins for DNA synthesis.
 Period of time cell is in G1 varies, depending
on cell type and proliferation activity.
? Answer
It
primes the cell to
enter the next phase: S
S Phase
 Synthesis
phase (S phase) the cell
replicates its DNA...so it now has 2
complete sets of DNA.
 Lasts 6-8 hours
 Cell proliferation can be measured
in a lab, i.e. patho report refers to %
of cells in S phase.
 Why would the cell want 2 complete
sets of DNA?
Answer
 This
allows the cell to divide into
two daughter cells, each with a
complete copy of DNA. But, before
the cell can do this, it needs to enter
the third phase of the cell cycle: the
G2 (Gap 2) phase.
G2
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During the G2 phase, the cell again
undergoes growth and protein
synthesis (it needs enough proteins for
2 cells!)...priming it to be able to
divide.
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Once this is complete the cell finally
enters the fourth and final phase of the
cell cycle: the M (Mitosis) phase.
M (Mitosis) Phase
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the M phase, the cell
splits apart (called cytokinesis)
into two daughter cells. Now,
the cycle has been completed!
What do the cells do now?
Two choices:
Start the cycle again by
entering G1
 2) Become quiescent by
entering G0
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What problems arise with
this cycle?
Answer
 Once
the cell gets going there is not
stopping it!
 Cancer cells rapidly divide and quickly
spread
WHY All This Interest in Cell Division?
One of the main clinical interests of cell
cycle control is CANCER.
 Cancer can be very briefly described as
uncontrolled cell growth and
proliferation (as well as metastasis, or
the invasiveness of cancerous cells into
other tissues).
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Chemotherapeutic Agents
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Drugs that are cell cycle specific and destroy
cells actively reproducing by means of the cell
cycle.
 Many agents are specific to certain phases of
the cycle. Most affect cells in the S phase by
interfering with DNA & RNA synthesis Others
are specific to the M phase ( prevent mitosis).
Classification of Cancer
Tumors can be classifies according
to :
1. Anatomic site
2. Histological analysis (grading)
3. Extent of disease (staging)
Neoplasm Classification: Anatomic Site
1. According to Cell type
2. Tissue of origin
NB Named according to origin of tissue they
arise from generally with oma (means tumor)
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Epithelial (carcinomas)
Connective (sarcoma)
lymphatic (lymphoma)
CNS (gliomas)
Blood forming (leukemias)
Carcinoma in situ (pre-invasive epithelial)
3. Whether Benign or Malignant
4. Degree of Differentiation
Comparison of Benign and
Malignant Neoplasms
MALIGNANT
BENIGN
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Encapsulated
Noninvasive
Highly Differentiated
Mitosis Rare
Slow Growth
Little/ No Anaplasia
No Metastasis
Doesn't normally
recur
Not usually harmful
Prognosis good
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Nonencapsulated
Invasive
Poorly Differentiated
Mitosis Common
Rapid Growth
Anaplastic (loss of
function & differentiation)
Metastasis
Can recur
Always harmful
Prognosis depends
Tumor Staging and
Grading
Grading:
 Identification
of the type of tissue
from which the tumor originated and
the degree to which the tumor cells
retain the functional and structural
characteristics of the tissue or origin
Thus evaluate cell’s appearance and
degree of differentiation
CANCER
 Grading:
refers to the classification of
tumor cells. The appearance of cells and
the degree of differentiation are
evaluated.
 Cancer cells progress from low grade and
well differentiated to high grade and poorly
differentiated.
 Metastasis implies spread, extension and
penetration
Terminology: Recognize these
words!
 Structural
changes
 hyperplasia (increase proliferation)
 metaplasia (degree of abnormality)
 dysplasia (abnormal)
 Anaplasia (malignant)
 neoplasm (new abnormal growth)
Grading
 Grade
I: cells differ slightly from normal
(mild dysplasia) and are well differentiated.
 Grade II: Cells are more abnormal
(moderate dyplasia) and moderately
differentiated.
 Grade III: Cells are very abnormal (severe
dysplasia) and poorly differentiated.
 Grade IV: Cells are immature and primitive
(anaplasia) and undifferentiated. (cell of
origin is difficult to determine).
This illustration shows Dr Gleason's own
simplified drawing of the five Gleason
grades of prostate cancer. Grade 1 appears
on the far left and grade 5 on the far right.
Adapted from Gleason DF (1997).
Staging (TNM)
Staging determines the size of the tumor
and the existance of metastases.
Refer to text regarding Staging of Cancer
 Tumor
(T): TX, T0, Tis, T1-4
 Regional Lymph Nodes (N): NX, N0, N1-3
 Distant Metastasis (M): MX, M0, M1
TNM STAGING CLASSIFICATION
Tumor T0
Tis
T1,T2, T3, T4
Nodes No
N1a,N2a
N1b, N2b, N3b
Nx
Metas Mo
M1,M2,M3
No evidence
Tumor in situ
Ascending degrees of tumor size &
involvement
No abnormal regional nodes
Regional nodes, no metastasis
Regional nodes, metastasis
suspected
Regional nodes can’t be assessed
clinically
No evidence of distant metastatic
Ascending degrees of metastatic
involvement of host including
distant nodes
Hint, Hint!!
 On
a test or exam
I will ask you to
correctly interpret
TNM & or
Grading.
Sample Question:
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A client receives a report from a biopsy with
results TO, NO and MO. This indicates:
A. no evidence of a primary tumor, lymph node
involvement and metastasis.
 B. no primary tumor, but evidence of a degree of
distant metastasis.
 C. a primary tumor and regional nodes
involvement.
 D. carcinoma in situ.
 Answer
to previous question is: A
Leading Cause of Death in
Canada
 Heart
 Cancer
 CVA
 COPD
 Pneumonia
& Flu
 Diabetes Mellitus
 Suicide
Highlights: Canadian Cancer Statistics 2010
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An estimated 6,000 new cases of cancer and 2,700 deaths from
cancer are expected to occur in Nova Scotia in 2009. (Nationally,
those figures are 171,000 and 72,600 respectively.)
In Nova Scotia, the most common cancers among men include
prostate, lung and colorectal, and among women, breast, lung and
colorectal.
The five-year relative survival rate for all cancers combined is 62 per
cent, an improvement of 4.5 per cent over the past 10 years.*
In Nova Scotia, the improvement in survival was greatest for nonHodgkin lymphoma in men and lung cancer in women.
About 40 per cent of Canadian women and 45 per cent of men will
develop cancer during their lifetimes.
About 24 per cent of women and 29 per cent of men, or
approximately one out of four Canadians, is expected to die from
cancer.
Highlights 2010: Cancer in Canadian
adolescents and young people (15 to 29 years
of age)
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In the past five years in Nova Scotia, there were 312 young people
diagnosed with some form of cancer, which represents
approximately 62 young people annually.
Approximately 2,075 young people in Canada between 15 and 29
years of age are diagnosed each year with cancer with about 326
deaths per year in this age group.
The five-year survival for this age group is 85 per cent – a five per
cent increase from 1992–1995.
The overall cancer incidence rate has risen since 1996. The death
rate has declined since 1992.
Lymphomas are one of the most commonly diagnosed types of
cancer in both sexes, along with thyroid cancer in females and
testicular cancer in males.
Leukemia accounts for the most cancer deaths in each sex.
Canadian Cancer Society 2011
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Lung cancer remains by far the leading cause of
death from cancer.
 Canada is one of the few nations in the world
with a cancer registry system that allows cancer
patterns to be monitored and compared across
the entire population. Such comparisons can
provide valuable information for research,
knowledge exchange, planning and decisionmaking
Nova Scotia Stats:
 estimated
5200 new cases all types
cancers
 2500 deaths are expected
 720 men Dx Prostrate Ca
 710 women Dx Breast Ca
 Lung Ca leading cause death both
genders 870 new Dx
 690 estimated to die lung Ca
WARNING SIGNS
CAUTION
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Change in bowel or bladder
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
Risk Reduction for Developing Cancer:
the 7 Steps to Health
1: Don’t smoke
 Step 2: Eat healthy food
 Step 3: Be active
 Step 4: Be sensible in the sun
 Step 5: Follow cancer screening guidelines
 Step 6: Report changes in your health
 Step 7: Use caution with hazardous
materials
 Step
Mesothelioma
Large mesothelioma
around the right lung
(left side of image) on
CT scan
Information:
www.cancer.ca
Cancer Care Nova Scotia
www.cancercare.ns.ca
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students should be able to:
Discuss the biological processes by which normal cells
become cancerous
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Discuss current research that has consequences for
people with cancer
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Understand medical treatment under development
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Ramifications of support persons & nurses involved in
their care