DR.

Ola Dabous
Presented by
Alaa Mohammed Abdel
Haq
 Cancer
The body is made up of many types of cells. These cells grow and divide
in a controlled way to produce more cells as they are needed to keep the
body healthy.
When cells become old or damaged, they die and are replaced with new
cells.

However, sometimes this orderly process goes wrong. The genetic

material (DNA) of a cell can become damaged or changed, producing
mutations that affect normal cell growth and division. When this
happens, cells do not die when they should and new cells form when the
body does not need them. The extra cells may form a mass of tissue
called a tumor.

Definition
A term used for diseases in which abnormal cells divide without
control and are able to invade other tissues
• Cancer cells spread to other parts of the body through the blood
and lymph systems
• Cancer is not just one disease but many diseases
• More than 100 different types of cancer
Differences between Cancer Cells and
Normal Cell:
 Cancer Cells vs Normal Cells

Normal Cells Cancerous Cells

Stop when there's enough Uncontrolled growth
Growth

Do not respond to signals from other

Communication Respond to signals from other cells
cells

Aged/damaged cells are repaired or

Cell repair/death Cells are neither repaired or replaced
replaced

Can travel solo and throughout the

Stickiness/spread Stay together in assigned area
body

Varied sizes, larger and darker center

Appearance Uniform look under a microscope
under a microscope

Maturation Reach maturity Do not reach maturity

Evasion of immune
Can be targeted and eliminated Can "hide" and grow uninterruputed
system

Function Perform designated tasks Fail to perform designated tasks

Blood vessels grow to feed normal Blood vessels grow regardless,

Blood supply
growth and aid in repairs constantly "feeding" a tumor
Types of cells:
CANCER SYMPTOMS:
Depends on the types
Some symptoms are:
 Fatigue
 Pain
 Skin changes
 Unusual bleeding
 Persistent cough
 Fever
 Lump or area of thickening that can be felt under the skin
 Weight changes, including unintended loss or gain
 Skin changes, such as yellowing, darkening or redness of the skin,
sores that won't heal, or changes to existing moles
 Changes in bowel or bladder habits
 Persistent cough or trouble breathing
 Difficulty swallowing
 Hoarseness
 Persistent indigestion or discomfort after eating
 Persistent, unexplained muscle or joint pain
 Persistent, unexplained fevers or night sweats
 Unexplained bleeding or bruising
Behavior or lifestyle may cause cancer:
Behavioral Causes of Cancer
There are a number of behavioral factors that can lead to genetic
mutations and, as a result, lead to the development of cancer.

 Tobacco
 Tanning (excessive exposure to ultraviolet light)
 Diet (red, processed meats)
 Alcohol
 Unsafe sex (leading to viral infection)
 Inflammatory conditions, such as ulcerative colitis or obesity

Where you live or work can cause

cancer:
Environmental Causes of Cancer
 Excessive sun exposure (UV)
 Chemical carcinogen exposure
 High-dose chemotherapy and radiation (mainly in children being
treated for existing cancers)
 Hormonal drugs
 Immune-suppressing drugs (taken by transplant recipients)
 Radioactive materials, e.g., radon

Viruses or bacteria cause cancer:

Viral and Bacterial Causes of Cancer
 Human papillomavirus (HPV)
 Hepatitis B (HBV) and hepatitis C (HCV) viruses
 Epstein–Barr virus (EBV)
 Human T-lymphotropic virus
 Kaposi's sarcoma-associated herpesvirus (KSHV)
  Merkel cell polyomavirus
 Helicobacter pylori

Risk Factors for Cancer

 Age
 Alcohol
 Cancer-Causing Substances
 Chronic Inflammation
 Diet
 Hormones
 Immunosuppression
 Infectious Agents
 Obesity
 Radiation
 Sunlight
 Tobacco

Prevention
Doctors have identified several ways to reduce your risk of
cancer, such as:

 Stop smoking. If you smoke, quit. If you don't smoke, don't start.
Smoking is linked to several types of cancer — not just lung cancer.
Stopping now will reduce your risk of cancer in the future.
 Avoid excessive sun exposure. Harmful ultraviolet (UV) rays from
the sun can increase your risk of skin cancer. Limit your sun
exposure by staying in the shade, wearing protective clothing or
applying sunscreen.
 Eat a healthy diet. Choose a diet rich in fruits and vegetables.
Select whole grains and lean proteins. Limit your intake of
processed meats.
 Exercise most days of the week. Regular exercise is linked to a
lower risk of cancer. Aim for at least 30 minutes of exercise most
days of the week. If you haven't been exercising regularly, start out
slowly and work your way up to 30 minutes or longer.
 Maintain a healthy weight. Being overweight or obese may
increase your risk of cancer. Work to achieve and maintain a healthy
weight through a combination of a healthy diet and regular exercise.
 Drink alcohol in moderation, if you choose to drink. If you
choose to drink alcohol, do so in moderation. For healthy adults, that
means up to one drink a day for women and up to two drinks a day
for men.
 Schedule cancer screening exams. Talk to your doctor about what
types of cancer screening exams are best for you based on your risk
factors.
 Ask your doctor about immunizations. Certain viruses increase
your risk of cancer. Immunizations may help prevent those viruses,
including hepatitis B, which increases the risk of liver cancer, and
human papillomavirus (HPV), which increases the risk of cervical
cancer and other cancers. Ask your doctor whether immunization
against these viruses is appropriate for you.

The types of tumors:

 Cancerous: Malignant or cancerous tumors can spread into

nearby tissue, glands and other parts of the body. The new tumors
are metastases (mets). Cancerous tumors can come back after
treatment (cancer recurrence). These tumors can be life-threatening.
 Noncancerous: Benign tumors are not cancerous and are rarely
life-threatening. They’re localized, which means they don’t
typically affect nearby tissue or spread to other parts of the body.
Many noncancerous tumors don’t need treatment. But some
noncancerous tumors press on other body parts and do need
medical care.
  Precancerous: These noncancerous tumors can become cancerous
if not treated.

From a histological standpoint there are hundreds of different

cancers, which are grouped into six major categories:
 Carcinoma
 Sarcoma
 Myeloma
 Leukemia
 Lymphoma
 Mixed Types

Carcinoma
Carcinoma refers to a malignant neoplasm of epithelial origin or cancer
of the internal or external lining of the body. Carcinomas, malignancies
of epithelial tissue, account for 80 to 90 percent of all cancer cases.
Epithelial tissue is found throughout the body. It is present in the skin, as
well as the covering and lining of organs and internal passageways, such
as the gastrointestinal tract.
Carcinomas are divided into two major subtypes: adenocarcinoma,
which develops in an organ or gland, and squamous cell carcinoma,
which originates in the squamous epithelium.
Adenocarcinomas generally occur in mucus membranes and are first
seen as a thickened plaque-like white mucosa. They often spread easily
through the soft tissue where they occur. Squamous cell carcinomas
occur in many areas of the body.
Most carcinomas affect organs or glands capable of secretion, such as
the breasts, which produce milk, or the lungs, which secrete mucus,
or colon or prostate or bladder.

Sarcoma
Sarcoma refers to cancer that originates in supportive and
connective tissues such as bones, tendons, cartilage, muscle, and
fat. Generally occurring in young adults, the most common
sarcoma often develops as a painful mass on the bone. Sarcoma
tumors usually resemble the tissue in which they grow.
Examples of sarcomas are:
 Osteosarcoma or osteogenic sarcoma (bone)
 Chondrosarcoma (cartilage)
 Leiomyosarcoma (smooth muscle)
 Rhabdomyosarcoma (skeletal muscle)
 Mesothelial sarcoma or mesothelioma (membranous lining of body
cavities)
 Fibrosarcoma (fibrous tissue)
 Angiosarcoma or hemangioendothelioma (blood vessels)
 Liposarcoma (adipose tissue)
 Glioma or astrocytoma (neurogenic connective tissue found in the
brain)
 Myxosarcoma (primitive embryonic connective tissue)
 Mesenchymous or mixed mesodermal tumor (mixed connective
tissue types)
Myeloma
Myeloma is cancer that originates in the plasma cells of bone marrow.
The plasma cells produce some of the proteins found in blood.

Leukemia
Leukemias ("liquid cancers" or "blood cancers") are cancers of the bone
marrow (the site of blood cell production). The word leukemia means
"white blood" in Greek. The disease is often associated with the
overproduction of immature white blood cells. These immature white
blood cells do not perform as well as they should, therefore the patient is
often prone to infection. Leukemia also affects red blood cells and can
cause poor blood clotting and fatigue due to anemia. Examples of
leukemia include:
 Myelogenous or granulocytic leukemia (malignancy of the
myeloid and granulocytic white blood cell series)
 Lymphatic, lymphocytic, or lymphoblastic leukemia (malignancy
of the lymphoid and lymphocytic blood cell series)
 Polycythemia vera or erythremia (malignancy of various blood cell
products, but with red cells predominating)

Lymphoma
Lymphomas develop in the glands or nodes of the lymphatic system, a
network of vessels, nodes, and organs (specifically the spleen, tonsils,
and thymus) that purify bodily fluids and produce infection-fighting
white blood cells, or lymphocytes. Unlike the leukemias which are
sometimes called "liquid cancers," lymphomas are "solid cancers."
Lymphomas may also occur in specific organs such as
the stomach, breast or brain. These lymphomas are referred to as extra
nodal lymphomas. The lymphomas are subclassified into two
categories: Hodgkin lymphoma and Non-Hodgkin lymphoma. The
presence of Reed-Sternberg cells in Hodgkin lymphoma diagnostically
distinguishes Hodgkin lymphoma from Non-Hodgkin lymphoma.

Mixed Types
The type components may be within one category or from
different categories. Some examples are:
 adenosquamous carcinoma
 mixed mesodermal tumor

 carcinosarcoma

 teratocarcinoma

In the next section, you will be provided with a comprehensive list of

tissue types and the tumors

The TNM system helps to establish the anatomic extent of the disease,
and the combination of the three factors can serve to define the overall
stage of the tumor. This method allows for simplification, with cancers
staged from I-IV, with stage IV being the most severe stage. Stage 0 is
used to indicate carcinoma in situ, which is not considered cancerous but
may become cancer in the future. Stage V is used exclusively in Wilms
tumors and occurs when both kidneys have involvement at initial
diagnosis.[9] A simplified version of cancer staging and its relation to
TNM classification is listed below.
 Stage 0 - Indicates carcinoma in situ. Tis, N0, M0.
 Stage I - Localized cancer. T1-T2, N0, M0.
 Stage II - Locally advanced cancer, early stages. T2-T4, N0, M0.
 Stage III - Locally advanced cancer, late stages. T1-T4, N1-N3,
M0.
 Stage IV - Metastatic cancer. T1-T4, N1-N3, M1.
The TNM staging system for cancer
Doctors use the TNM staging system for most types of cancer. The
TNM system uses letters and numbers to describe the tumor (T), lymph
nodes (N), whether or not the cancer has spread or metastases (M). Each
letter and number tell you something about the cancer. The specific
definitions for each category are different for each type of cancer that is
staged using this system. Learn more specific staging information for
each

Type of cancer.
Tumor (T): The letter T and the number after it describe the tumor by
answering these questions:
 How large is the primary tumor?

 Does it go into other tissues or organs in the same area?

 Where is it located?
The letter T is followed by a letter, number, or combination of letters
after it. This gives additional information about the tumor. The different
letters and numbers that may see include:
 TX means that there is no information about the tumor or it cannot
be measured.
 T0 means that there is no evidence of a tumor.
 Tis refers to a tumor "in situ." This means that the tumor is only
found in the cells where it started. It has not spread to any
surrounding tissue.
 T1-T4 describe the size and location of the tumor, on a scale of 1
to 4. A larger tumor or a tumor that has grown deeper into nearby
tissue will get a higher number.

Oncogenes :
Proto-oncogenes are genes that normally help cells grow and divide to
make new cells, or to help cells stay alive. When a proto-oncogene
mutates (changes) or there are too many copies of it, it can become
turned on (activated) when it is not supposed to be, at which point it's
now called an oncogene. When this happens, the cell can start to grow
out of control, which might lead to cancer.

Oncogenes are activated versions of normal cellular genes

involved in

⚫regulating cell replication

•Growth

•Survival

•Differentiation

•Motility

Oncogenes were first described in association with the retroviruses.

Eg. Rous sarcoma virus (contains the v-src oncogene) - induces

sarcomas in chickens.

Oncogenes become activated by:

genetic mutations
⚫chromosomal translocations

•Gene amplification

Classification of oncogenes:
Oncogenes may be divided into five groups based on the functional and
biochemical properties of protein products of their normal proto-
oncogene counterparts.

(1) growth factors

(2) growth factor receptors

(3) signal transducers

(4) Transcription factors

(5) regulators of cell death

cancer metastasis
Cancer defines as a population of cells that have lost their normal
controls of growth and differentiation and are proliferating without
check

Metastasis is the process by which a tumor cell leaves the primary

tumor, travels to a distant site via the circulatory system, and
establishes a secondary tumor
5 major steps in metastasis
1. Invasion and infiltration of surrounding normal host tissue

2. Release of neoplastic cells

3. Survival in the circulation

4. Arrest in the capillary beds of distant organs

5. Penetration of the lymphatic or blood vessel walls followed by

growth of the disseminated tumor cells
Angiogenesis:
Definition:

* The formation of new blood vessels out of pre-existing capillaries.

INVOLVES:
Sprouting
Splitting
Remodeling of the existing vessels

Cancer treatment:
 Surgery. The goal of surgery is to remove the cancer or as much of
the cancer as possible.
 Chemotherapy. Chemotherapy uses drugs to kill cancer cells.
 Radiation therapy. Radiation therapy uses high-powered energy
beams, such as X-rays or protons, to kill cancer cells. Radiation
treatment can come from a machine outside your body (external
beam radiation), or it can be placed inside your body
(brachytherapy).
 Bone marrow transplant. Your bone marrow is the material inside
your bones that makes blood cells from blood stem cells. A bone
marrow transplant, also knowns as a stem cell transplant, can use
your own bone marrow stem cells or those from a donor.
 A bone marrow transplant allows your doctor to use higher doses of
chemotherapy to treat your cancer. It may also be used to replace
diseased bone marrow.

 Immunotherapy. Immunotherapy, also known as biological

therapy, uses your body's immune system to fight cancer. Cancer
can survive unchecked in your body because your immune system
doesn't recognize it as an intruder. Immunotherapy can help your
immune system "see" the cancer and attack it.
 Hormone therapy. Some types of cancer are fueled by your body's
hormones. Examples include breast cancer and prostate cancer.
Removing those hormones from the body or blocking their effects
may cause the cancer cells to stop growing.
 Targeted drug therapy. Targeted drug treatment focuses on
specific abnormalities within cancer cells that allow them to survive.
 Cryoablation. This treatment kills cancer cells with cold. During
cryoablation, a thin, wandlike needle (cryoprobe) is inserted through
your skin and directly into the cancerous tumor. A gas is pumped
into the cryoprobe in order to freeze the tissue. Then the tissue is
allowed to thaw. The freezing and thawing process is repeated
several times during the same treatment session in order to kill the
cancer cells.
 Radiofrequency ablation. This treatment uses electrical energy to
heat cancer cells, causing them to die. During radiofrequency
ablation, a doctor guides a thin needle through the skin or through
an incision and into the cancer tissue. High-frequency energy passes
through the needle and causes the surrounding tissue to heat up,
killing the nearby cells.
 Clinical trials. Clinical trials are studies to investigate new ways of
treating cancer. Thousands of cancer clinical trials are underway.
References
1. Sapin MR. [Lymphatic system and its significance in immune
processes]. Morfologiia. 2007; 131(1):18-22. [PubMed]

2. Lotfollahzadeh S, Recio-Boiles A, Cagir B. StatPearls

[Internet]. StatPearls Publishing; Treasure Island (FL): Jun 3, 2023. Colon
Cancer. [PMC free article] [PubMed]

3.Lotfollahzadeh S, Kashyap S, Tsoris A, Recio-Boiles A, Babiker

HM. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 4,
2023. Rectal Cancer. [PubMed]

4. Desai JP, Moustarah F. StatPearls [Internet]. StatPearls Publishing;

Treasure Island (FL): Sep 26, 2022. Peritoneal Metastasis. [PubMed]

5. Wiggers T, Arends JW, Volovics A. Regression analysis of prognostic

factors in colorectal cancer after curative resections. Dis Colon
Rectum. 1988 Jan; 31(1):33-41. [PubMed]
6. Chapuis PH, Dent OF, Fisher R, Newland RC, Pheils MT, Smyth E,
Colquhoun K. A multivariate analysis of clinical and pathological variables
in prognosis after resection of large bowel cancer. Br J Surg. 1985 Sep;
72(9):698-702. [PubMed]

7. Blenkinsopp WK, Stewart-Brown S, Blesovsky L, Kearney G, Fielding

LP. Histopathology reporting in large bowel cancer. J Clin Pathol. 1981
May; 34(5):509-13. [PMC free article] [PubMed]

8.Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE,
Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP. The Eighth
Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a
population-based to a more "personalized" approach to cancer staging. CA
Cancer J Clin. 2017 Mar; 67(2):93-99. [PubMed]

9. Leslie SW, Sajjad H, Murphy PB. StatPearls [Internet]. StatPearls

Publishing; Treasure Island (FL): May 30, 2023. Wilms Tumor. [PubMed]
10. Pawlowski J, Jones III WE. StatPearls [Internet]. StatPearls Publishing;
Treasure Island (FL): Feb 28, 2023. Radiation Therapy for Anal Cancer.
[PubMed]