Download Cancer - Giving - Roswell Park Cancer Institute

Cancer 101
William E. Janssen, Ph.D.
Director, Cell Therapies Facility
Moffitt Cancer Center
Cindy Eller
VP for Development
Roswell Park Cancer Institute
Robert Wilkens
Chief Development Officer
Fox Chase Cancer Center
Cancer
 Abnormal cells divide
without control
 Can invade “locally” or
metastasize (spread) via
the blood or lymph
system
 Benign tumors can grow
larger, but do not spread
 Not just one disease, but
many different cancers –
underlying tissue of origin
Some symptoms of cancer
Weight loss
Dyspnea or shortness of breath
Nausea
Anorexia, or lack of appetite
Fatigue
Abnormal bleeding, bruising
NO SYMPTOMS AT ALL
Screening for Cancer
 Goal – inexpensive, highly sensitive,
specific
 Examples
 Mammograms
• Very sensitive, not very specific
sensitivit y 
specificit y 
cancers detected
cancers present
true positive test results
all positive test results
– Risk of putting women through unnecessary biopsies
 PSA test
• Sensitive, not at all specific
– Risk of un-necessary biopsies
 Total body MRI
• Sensitive, more specific, prohibitively
expensive
– Cost per true cancer detected
could exceed $1,000,000
 Other well known screening tests:
colonoscopy, PAP, self exams
Screeing Cost =
Number of tests performed to detect
ONE case of cancer
X Cost of each test
Diagnosis of cancer
Biopsy
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Incisional
Excisional
Needle (core or fine needle aspirate)
Need “tissue” to look at under the microscope to
decide what it is : the pathology report.
• Is it cancer
• What kind is it
• how to treat
Staging
 Use of radiology, scans, additional biopsies
Cancer types:
Based on which cell type is dividing
abnormally
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Carcinoma
Sarcoma
Central nervous system tumors
Melanoma
Leukemia
Lymphoma
Myeloma
SOLID TUMORS
HEMATOLOGIC
MALIGNANCIES
Carcinoma
begins in skin or lining cell
Adenocarcinoma starts in the skin cells
and the gland cells.
 Adenocarcinoma of the breast,
pancreas, thyroid , prostate
prostrate
prostate
Sarcoma
begins in the cells
muscle, bone, blood
vessels, cartilage
Melanoma
Originates in the
melanocytes, which
make pigment.
These cells can be
found in the skin,
the eyes.
Metastasis
 mĕ-tăs′tă-sis: (v) movement of body cells (esp.
cancer cells) from one part of the body to another;
(n) new tumor growth resulting from movement of
cancer cells
 Plural is metastases
 Cancer cell travels via blood or lymph tissue to a
distant organ, but maintains characteristics of the
primary tumor.
 Cancers have tendencies to metastize to specific
anatomic locations: prostate to bone, breast to
liver, brain and lung, colon to liver
Leukemia
begins in the cells
found in the bone
marrow (red blood
cells, white blood
cells, platelets)
Lymphoma and multiple
myeloma
begins in the cells of
the immune system
that fight infection
(B cells, T cells,
plasma cells)
These cells also
originate in the
bone marrow
Bone marrow
Myelo is the prefix: myelosuppression,
myelodysplastic
Bone marrow is aspirated, and biopsied in
the hip bone
Bone marrow transplant: procedure in which
the bone marrow cells are destroyed by
radiation or chemotherapy, then replaced
with banked bone marrow or blood
“hematopoietic progenitor cells” collected
from patient, or with cells from tissue type
matched donor.
Stages of cancer
Stage 1: small and confined to the
organ
Stage 2: beyond the organ +/- lymph
nodes
Stage 3: locally spread, greater than 2.
Stage 4: spread to another organ
Treatment: local
Surgery
Radiation
Treatment: systemic
Principle of treatment to kill the fastest
growing cells: earliest days of chemo and
radiation.
Hormonal manipulation in cancers such as
prostate and breast.
Little variation from center to center on the
treatment of cancers. Protocols are
standard throughout the country.
Clinical trials are well-monitored large scale
efforts to determine the best treatment
regimen
Complementary and alternative
therapies
Acupuncture proven to be effective
for chemotherapy induced nausea
and vomiting
Current clinical trials for acupuncture
for symptoms of colon cancer, for
shark cartilage and small cell lung
cancer, and for massage therapy for
cancer-related fatigue.
BUT beware the “snake oil”
The need for hope in the face of a disease
equated with death has spawned large
numbers of profiteers offering “cures”
 Examples: laetrile, radio-frequency radiation,
macrobiotic diets, etc.
 Medical tourism
The importance of scientifically based and
designed clinical trials and informed
consent
Research and Clinical Trials
Much done – much to do
A new dawn EVERY DAY
Research and Clinical Trials
Much has been done – much more still
to be done
 Many different approaches
• Genetic – modify or suppress cancer genes
• Molecular – modify or replace molecules that
directly or indirectly are driven by cancer
genes
• Immunologic – stimulate immune system to
react to cancer cells as it does to bacteria,
viruses
Research and Clinical Trials
 Different Levels of Research
 Basic – laboratory based – understanding how cancer
works and/or what agents my change that and how
 Translational – laboratory to bedside – using knowledge
gained in basic research to produce and test new
approaches in cancer patients
 Research costs
 Cost to train a new PhD researcher – ½ million dollars (new
M.D. researcher is more)
 Cost to set up a new laboratory – ¼ - ½ million dollars
 Cost to treat one patient on a clinical trial – ten thousand
dollars or more
The Goal: Remission
 Decrease (partial remission) or disappearance (complete
remission) of signs and symptoms of cancer
 In some cases – stable disease (not growing, not shrinking) is a
desireable end point
In all cases
Quality of Life
 “Cures” can be worse than disease
 Cancer “steals” from not only the afflicted
patient, but from their entire family
• Downs, ups, downs, ups
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Diagnosis
Treatment
treatment success
Relapse
reactions to treatment
 This, too, is the subject of research and
innovation
Palliative Care-usually
inpatient
Treatment of
symptoms from the
time of diagnosis
Grief specialists in
the hospital
Allowing the patient
and family voice to
be heard
Hospice
Dame Cicely Saunders
You matter because
you are you.
You matter to the last
moment of your life,
And we will do all we
can,
Not only to help you
die peacefully,
But also to live until you
die.
Take home points
It is a new language: write down the
words that you do not know and learn
them for the next time.
Ignorance is an opportunity to learn.
Don’t be shy – ask questions – you may
be surprised how many of the
“experts”don’t know the answer either