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Oncology
Lecture 16 of the Course “Medical English”
for Sophomore Medical Students of Taipei Medical University
School of Medicine Taipei Medical University
Winston W. Shen, M.D.
Professor and Chairman
Department of Psychiatry
Taipei Medical University College of Medicine
and
Chief, Department of Psychiatry
TMU-Wan Fang Medical Center
Taipei,
TAIWAN
E-mail address: [email protected]
The Schedule for the Course “Medical English”
(Version of 3/29/07)
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Week 1 (March 1)
Week 2 (March 8)
Week 3 (March 15)
Week 4 (March 22)
The Digestive System
The Respiratory System
The Cardiovascular System
The Musculoskeletal System
(Turning in a 400-word essay on “My Visit to the Clinic (Hospital)” (in double-line space hard copy)
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Week 5 (March 29)
Week 6 (April 5)
Week 7 (April 12)
Week 8 (April 19)
Week 9 (April 26)
The Central Nervous System
No class (Spring break)
Urinary and Reproductive Systems
The First Examination
Medical Records
(Turning in a 400-word essay on “My Favorite Book” (in double-line space hard copy)
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Week 10
Week 11
Week 12
Week 13
Week 14
(May 3)
(May 10)
(May 17)
(May 24)
(May 31)
Scientific Papers
Hematology
Infectious Diseases
The Second Examination
Endocrinology
(Turning in a 400-word essay on “How to Be a Good Physician” (in double line space hard copy)
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Week 15 (June 7)
Week 16 (June 14)
Week 17 (June 21)
Immunology
Oncology
Final (The Third) Examination
Oncology
(ong-kol-uh-jee)
–noun
1. the branch of medical science dealing with tumors,
including the origin, development, diagnosis, and
treatment of malignant neoplasms.
2. the study of cancer.
Cancer
(French: le cancer; German: der Krebs)
(Origin: 1350–1400; ME < L.:
lit., crab*; L s. cancr-, dissimilated
from *carcr-, with *carc-r- akin to
Gk. karkínos, Skt karkata crab)
www.reef.crc.org.au/research/fishing_fisherie
1. Pathology. a.a malignant and invasive growth or tumor, esp. one originating
in epithelium, tending to recur after excision and to metastasize to other sites.
b. any disease characterized by such growths.
2. any evil condition or thing that spreads destructively; blight.
3. (initial capital letter ) Astronomy. the Crab, a zodiacal constellation between
Gemini and Leo.
4. (initial capital letter ) Astrology.
a. the fourth sign of the zodiac: the cardinal water sign.
b. a person born under this sign, usually between June 21 and July 22.
5. (initial capital letter ) tropic of. See under tropic.
Random House Unabridged Dictionary, Random House, Inc. 2006.
Nomenclature of Cancer
Neoplasia and neoplasm* (benign or malignant) are the scientific designations
for cancerous diseases. This group contains a large number of different diseases.
Cancer is a widely used word that is usually understood as synonymous with
malignant neoplasm. It is occasionally used instead of carcinoma, a sub-group
of malignant neoplasms.
Tumor in medical language simply means swelling or lump, either neoplastic,
inflammatory or other. In common language, however, it is synonymous with
'neoplasm', either benign or malignant. This is inaccurate since some neoplasms
do not usually form tumors, for example leukemia or carcinoma in situ.
Paraneoplasia is a disturbance associated with a neoplasm but not related to the
invasion of the primary or a secondary (metastatic) tumour. Disturbances can be
hormonal, neurological, hematological, biochemical or otherwise clinical.
*Neoplasm [nee-uh-plaz-uh m] (Origin: 1860–65; neo- + plasm)
.
Classification of Cancer
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Carcinoma
Origins of cells
Carcinoma
Epithelial cells of breast, prostate, lung
and colon cancer.
Lymphoma and
leukemia
 Sarcoma
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Mesothelioma
Glioma
 Germina
 Choriocarcinoma

Blood and bone marrow cells
Connective tissue or mesenchymal cells
Mesothelial cells lining the peritoneum
and the pleura
The most common type of brain cell
Germ cells in the testicle and ovary
The placenta
T-Cells
www.sciencemuseum.org.uk/on-line/lifecycle/im
A T-cell (orange) killing a cancer cell (mauve).
Dr Andrejs Liepins/Science Photo Library
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Having recognized the invader,
different types of T-cell then have
different jobs to do.
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Some send chemical instructions
(cytokines) to the rest of the immune
system.
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Your body can then produce the
most effective weapons against the
invaders, which may be bacteria,
viruses or parasites.

Other types of T-cells recognize
and kill virus-infected cells directly.
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Some help B-cells to make
antibodies, which circulate and
bind to antigens.
B-Cells

B-cells make antibodies. Mike
Clark, Cambridge University
With the help of T-cells, B-cells make
special Y-shaped proteins called
antibodies.
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Antibodies stick to antigens on the
surface of germs, stopping them in
their tracks, creating clumps that alert
your body to the presence of intruders.

Your body then starts to make toxic
substances to fight them.

Patrolling defender cells called
phagocytes engulf and destroy
antibody-covered
intruders.
AJCC Stage Groupings
Stage 0
Tis, N0, M0
Stage I
T1, N0, M0
T2, N0, M0
Stage IIA
T3, N0, M0
Stage IIB
T4, N0, M0
Stage IIIA
T1, N1, M0
T2, N1, M0
Stage IIIB
T3, N1, M0
T4, N1, M0
Stage IIIC
Any T, N2, M0
Stage IV
Any T, Any N, M1
TNM System of Anatomic Staging
of Colorectal Cancer
Tx: No description of the tumor's extent is
possible because of incomplete information.
T0 The cancer is in the earliest stage. It involves
only the mucosa. It has not grown beyond
the muscularis mucosa (inner muscle layer)
of the colon or rectum. This stage is also
known as carcinoma in situ or intramucosal
carcinoma.
T1: The cancer has grown through the
muscularis mucosa and extends into the
submucosa.
T2: The cancer has grown through the the
submucosa, and extends into the muscularis
propria.
T3: The cancer has grown completely through the
muscularis propria into the subserosa but not
to any neighboring organs or tissues.
T4: The cancer has spread completely through the
wall of the colon or rectum into nearby
tissues or organs. \
N Categories for Colorectal Cancer
N categories indicate whether or not the cancer
has spread to nearby lymph nodes and, if so,
how many lymph nodes are involved.
Nx: No description of lymph node involvement is
possible because of incomplete information.
N0: No lymph node involvement is found.
N1: Cancer cells found in 1 to 3 nearby lymph nodes.
N2: Cancer cells found in 4 or more nearby lymph
nodes.
M Categories for Colorectal Cancer
M categories indicate whether or not the cancer has
spread to distant organs, such as the liver, lungs,
or distant lymph nodes.
Mx: No description of distant spread is possible
because of incomplete information.
M0: No distant spread is seen.
M1: Distant spread is present
Symptoms Caused by Malignant Diseases
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Mass effects
Ablation by crowding
or by invasion
Obstruction of vessels,
tubes , and ducts
Raptures of blood
vessels
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Remote effects
(paraneoplastic
syndromes)
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Ectopic hormone production
Neuropathies and CNS
abnormalities
Dermatologic abnormalities
Metabolic disorders
◘ Anorexia, weight loss
◘ Fever
◘ Chronic inflammation
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Hematologic disorders
Immunosuppression
Collagen vascular disorders
Psychosocial
effects
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Loss of control
Acceptance of
personal finitude
Fear of pain and
mutilation
Separation and
loneliness
Response of Tumor to Chemotherapy
 Acute lymphocystic leukemia
 Acute myelogenous leukemia
 Ewing’s sarcoma
 Gestational trophoblastic carcinoma
 Hodgkin’s lymphoma
 Non Hodgkin lymphoma
▪ Burkitt’s lymphoma
▪ Diffuse large cell lymphoma
▪ Follicular mixed lymphoma
 Rhabdomyosarcoma
 Testicular carcinoma
 Wilms’ Tumor
Chemotherapy for Colorectal Cancer
 Adjuvant (after surgery) chemotherapy
One regimen involves the
combination of infusional 5-fluorouracil, leucovorin, and
oxaliplatin (FOLFOX) 5-fluorouracil (5-FU) or Capecitabine
(Xeloda®) Leucovorin
[aj-uh-vuh nt] –adjective
1. serving to help or assist; auxiliary.
(LV, Folinic Acid),
2. Medicine/Medical. utilizing drugs, radiation therapy,
Oxaliplatin (Eloxatin®) or other means of supplemental treatment following
cancer surgery.
 Chemotherapy for metastatic disease
The first line chemotherapy regimens involve the
combination of infusional 5-fluorouracil, leucovorin,
and oxaliplatin (FOLFOX) with bevacizumab or infusional
5-fluorouracil, leucovorin, and irinotecan
Mucus-producing Lung Cancer Cells
Bizarre nuclei
Bizarre glands
Mucus lakes
Necrotic debris
http://www.pathguy.com/histo/098.htm
Glandular Carcinoma Cells
Some very large nuclei.
Since the nucleus does not know
exactly how to pack the extra
chromosomes, the nuclear membrane
usually shows some wrinkles, like an
overpacked suitcase.
www.pathguy.com/histo/014.jpg
Also as a result of problems
with packing, and/or from
having an excess of genes
that aren't really doing anything,
cancer nuclei tend to have big
clumpy blocks of heterochromatin.
As a general rule, the more bizarre
the nuclei, the more aggressive
the cancer.
www.webmd.com
Colon and Rectal Cancer
http://www1.wfubmc.edu/NR/rdo
nlyres/2F328E0F-5016-479C921215E74B27CE5B/30267/image00
2.jpg
http://www.brighamandwomens
.org/generalsurg/Images/01_col
http://www.brighamandwomens
onca_polyp_lg.jpg
.org/generalsurg/Images/01_col
onca_polyp_lg.jpg
Breast Cancer: Mammogram
anatomy.med.umich.edu/. ../pectoral.html
Prostate Cancer
Stage T1: Tumor is microscopic and
confined to prostate but is undetectable
by a digital rectal exam (DRE) or by
ultrasound. Usually discovered by PSA
tests or biopsies.
Stage T2: Tumor is confined to prostate
and can be detected by DRE or
ultrasound.
http://www.malecare.org/prostate-cancer_sam2.jpg
Stage T3 or T4: In stage T3, the cancer
has spread to tissue adjacent to the
prostate or to the seminal vesicles. Stage
T4 tumors have spread to organs near the
prostate, such as the bladder.
Stage N+ or M+: Cancer has spread to
pelvic lymph nodes (N+) or to lymph
nodes, organs, or bones distant from the
prostate (M+).
http://www.bidmc.harvard.edu/display.asp?node_id=4466
my.webmd.com/hw/health_ guide_atoz/zm6038.asp
Lung Cancer
The most common and mostly preventable cancer
in men and women
Cancer vs. normal lung histology
www.svgs.k12.va.us/.../slide0084_image087.jpg
FOLFOX Therapy
For Colorectal Cancer
FOL– fluorouracil (5-FU)
F – folinic acid (leucovorin®)
OX – oxaliplatin (Eloxatin®)
FOLFIRI Therapy
For Colorectal Cancer
FOL– fluorouracil (5-FU)
F–
folinic acid (leucovorin®)
IRI – irinotican (Camptosar®)
Gefitinib (Irresa®)
An Inhibitor of Epidermal Growth Factor Receptor (EGRF)

Good response for non-small-cell cancer lung
cancer (NSCLC) and is related to EGRF tyrosine
receptor.
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Differing from squamaous cell carcinoma,
patients with NSCLC adenocarcinoma has
better response especially among female and
nonsmoker patients.

The Oriental patients have better response
rate to gefitinib compared to Western
counterparts.
Vascular Endothelial Growth Factor
(VEGF)
www.math.uci.edu/.../Angiogenesis.png
VEGF been demonstrated to be a
major contributor to angiogenesis,
increasing the number of
capillaries
in a given network. Initial in vitro
studies demonstrated that bovine
capillary endothelial cells will
proliferate and show signs of tube
structures upon stimulation by
VEGF and bFGF, although the
results were more pronounced with
VEGF.
Bevacizumah
(Avastin®)
Avastin® is the first U.S. Food and Drug Administration
(FDA) approved therapy in 2004 designed to inhibit
angiogenesis, the process by which new blood vessels
develop and carry vital nutrients to a tumor.
Avastin® is approved, in combination with intravenous
5-fluorouracil-based (5-FU) chemotherapy, for first- or
second-line treatment of patients with metastatic
carcinoma of the colon or rectum and in combination
with carboplatin and paclitaxel for the first-line
treatment of patients with unresectable, locally advanced,
recurrent or metastatic non-squamous non-small cell lung
cancer (NSCLC).