cancer presentation by jahangir

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Published on March 11, 2014

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By: Jahangir khan 3rd morning Islamia university bahawalpur : By: Jahangir khan 3 rd morning Islamia university bahawalpur Cancer PowerPoint Presentation: Introduction Classification of cancer Epidemiology Sign and symptoms Mechanism Risk factors Management of cancer Cancer control in Pakistan Latest updates Introduction: Introduction Definition: Definition Cancer is a collection of diseases characterized by abnormal and uncontrolled growth of mutant cells which may or may not have the ability to invade Difference between normal and tumor cell : Difference between normal and tumor cell Unchecked growth Karyotypic differences Phenotypic differences History of cancer: History of cancer Humans have, no doubt, battled cancer throughout their existence . the first written descriptions of cancer/cancer treatment is found in around 3000 B.C From origin: From origin Signs of cancer found in bones of mummies from ancient egypt as far as 3000 BC. In 400 BC: In 400 BC “father of medicines”. The first who use the word “ Carcinos ” and “Carcinoma” to describe the word tumor. In greek word “ Karkinos ” stand for crab. Best to leave Cancer. Hippocratus 168 BC: 168 BC Was the first who believed that cancer is cureable . He thought diet and climate were directly connected to cancer. Galen 1713: 1713 Noticed the virtual absen ce of Cervical cancer in nuns and high incidence of breast cancer in the same population. Ramzzini 1757: 1757 Chimney sweep has an occupation related cancer risk. Collected under scrotum causing scrotal cancer . Percival pott 1829: 1829 Recognizes the spread of cancer. Was first who used the word “ M etastais ” which is of greek origin. Joseph claude 1878: 1878 German surgeon. Very first time performed Pyloric resection to treat stomach cancer. Thodore Billroth 1910: 1910 Provides the scientific backing to the viral theory of cancer. By injecting “Rous Sarcoma Virus” in hens. Francis Peyton 1946: 1946 Discovers that nitrogen mustard can be used in treatment of cancer. Hodgkin’s disease, Lymphosarcoma and Leukemias . Louis Goodmen 2006: 2006 FDA approves Gardasil, a vaccine that protects against the human pappilomavirus (HPV). HPV is known to be the major cause of cervical cancer. PowerPoint Presentation: Introduction Classification Epidemiology Sign and symptoms Mechanism Risk factors Management of cancer Cancer control in Pakistan Latest updates Classification of cancer: Classification of cancer Classification of cancer: Classification of cancer There are over 200 different known cancers that afflict humans There are following five ways to classify cancer Classification according to malignancy Classification according to site of origin Classification according to tissue type Classification according to grades Classification according to stages Classification according to malignancy: Classification according to malignancy Benign cancer or tumor Malignant cancer Classification according to site of origin: Classification according to site of origin By primary site of origin, cancers may be of specific types like: breast cancer, lung cancer, prostate cancer e.t.c. Classification according to tissue type : Classification according to tissue type International Classification of diseases for oncology Third Edition (ICD-O-3) Based on tissue types cancers may be classified into six major categories: 1. Carcinoma 2. Sarcoma 3. Myeloma 4. Leukemia 5. Lymphoma 6. Mixed types ( carcinosarcoma , adenosquamous carcinoma ) Classification according to grades: Classification according to grades Cancers can also be classified according to grade. The abnormality of the cells with respect to surrounding normal tissues determines the grade of the cancer. Increasing abnormality increases the grade, from 1–4. Grade 1 – well differentiated cells with slight abnormality Grade 2 – cells are moderately differentiated and slightly more abnormal Grade 3 – cells are poorly differentiated and very abnormal Grade 4 – cells are immature and primitive and undifferentiated Grade5- cell lack all type of differentiation and function Classification according to stages: Classification according to stages Cancers are also classified individually according to their stage. There are several types of staging methods. The most commonly used method uses classification in terms of tumor size (T), the degree of regional spread or node involvement (N), and distant metastasis (M). This is called the TNM staging. PowerPoint Presentation: Stages may be divided according to the TNM staging classification. Stage 0 indicates cancer being in situ or limited to surface cells. stage I indicates cancer being limited to the tissue of origin. Stage II indicates limited local spread Stage III indicates extensive local and regional spread stage IV is advanced cancer with distant spread and metastasis. Reviewed by April Cashin-Garbutt , BA Hons ( Cantab ) Epidemiology : Epidemiology Estimated incidence of cancer by site and sex: Estimated incidence of cancer by site and sex PowerPoint Presentation: Introduction Classification Epidemiology Sign and symptoms Mechanism Risk factors Management of cancer Cancer control in Pakistan Latest updates Sign and symptoms: Sign and symptoms PowerPoint Presentation: What are common symptoms ?   PowerPoint Presentation: Introduction Classification Epidemiology Sign and symptoms Mechanism Risk factors Management of cancer Cancer control in Pakistan Latest updates Mechanism : Mechanism Recall the definition: Recall the definition Cancer is a collection of diseases characterized by abnormal and uncontrolled growth of mutant cells which may or may not have the ability to invade . Cell Growth: Cell Growth PowerPoint Presentation: 45 Cancer Cell Do Not Grow Faster Than Normal Cells Rather, Their Growth is Just Uncontrolled PowerPoint Presentation: 46 Proliferation Differentiation Death Transit Proliferating Exiting Renewing Cellular equilibrium PowerPoint Presentation: 47 Proliferation Differentiation Death Cancer: disruption of cellular equilibrium Mutation: Mutation What is mutation?: What is mutation? In genetics, a mutation is a change of the nucleotide sequence of the genome of an organism Means of mutation: Means of mutation Positive mutation or addition mutation Genomic amplification Translocation Point mutation Gene overexprassion Negative mutation or deletion mutation Gene slicing Gene deletion Hypermethylation PowerPoint Presentation: There are following Potential sites for mutation Targeted genes: 1. Proto-oncogenes (oncogenes) 2. Tumor suppressor genes 3. Genes controlling apoptosis 4. Genes regulating DNA repair Other genes involved: Genes regulating angiogenesis Genes enhancing invasion and metastasis PowerPoint Presentation: Class I: Growth Factors Class II: Receptors for Growth Factors and Hormones Class III: Intracellular Signal Transducers Class IV: Nuclear Transcription Factors Class V: Cell-Cycle Control Proteins Five types of proteins encoded by proto- oncogenes participate in control of cell growth: Cell Signaling and Anti apoptosis : Cell Signaling and Anti apoptosis Pathways of cancer cell signaling: Pathways of cancer cell signaling Met signaling pathway (tyrosine kinase receptors) HER pathway Apoptotic pathways Minor signiling pathways Growth and anti aging: Growth and anti aging PowerPoint Presentation: Hahn, W. C. et. al. N Engl J Med 2002;347:1593-1603 Telomeres, Telomerase, and Cancer angiogenesis: angiogenesis Metastasis: Metastasis PowerPoint Presentation: Introduction Classification Epidemiology Sign and symptoms Mechanism Risk factors Management of cancer Cancer control in Pakistan Latest updates Risk factors: Risk factors Etiology of cancer: Etiology of cancer PowerPoint Presentation: What causes cancer ?   PowerPoint Presentation: What causes cancer ?   Chemical carcinogens Polycyclic aromatic hydrocarbons These are pro-carcinogens, requiring metabolic conversion by hydroxylation to form ultimate carcinogens. . Aromatic amines. requires conversion by hydroxylation in the liver into the active carcinogenic metabolite, 1-hydroxy-2-naphthylamine. the carcinogenic effect is masked immediately by conjugation with glucuronic acid in the liver. (conjugated metabolite ) deconjugated in the urinary tract by the enzyme glucuronidase , thus exposing the urothelium to the active carcinogen . . PowerPoint Presentation: Chemical carcinogens Nitrosamines Dietary nitrates they are readily metabolized by commensal bacteria within the gut and converted to carcinogenic nitrosamines by combination with secondary amines and amides. Alkylating agents, bind directly to DNA cause gene mutation PowerPoint Presentation: What causes cancer ?   Biological agents Viruses Human tumors producing viruses include: carcinoma of the cervix (human papillomaviruses ) nasopharyngeal carcinoma (Epstein-Barr virus) hepatocellular carcinoma (hepatitis B and C viruses ) Bacteria Helicobacter pylori ,, is now strongly connected with pathogenesis of gastric lymphomas. Initially, the lesions are dependent on the continuing presence of H. pylori (the lymphoma regresses if the bacteria are eradicated), but eventually the lymphoma becomes fully autonomous . PowerPoint Presentation: What causes cancer ?   Biological agents Fungi A flatoxins produced by Aspergillus flavus . Parasites   There are two common carcinogenic parasites Schistosoma bladder carcinoma, Clonorchis sinensis , (the Chinese liver fluke)dwells in the bile ducts, where it induces an inflammatory reaction, epithelial hyperplasia and sometimes eventually adenocarcinoma of the bile ducts (cholangiocarcinoma). PowerPoint Presentation: What causes cancer ?   Radiant energy All radionuclides are carcinogens , although Carcinogenicity of radiation depends of the type of radiation type of exposure, penetration . For example, alpha radiation has low penetration and is not a hazard outside the body, but emitters are carcinogenic when inhaled or ingested Mechanism of action It may directly alter cellular DNA It may dislodge ion from water & other molecules of the cells,thus result in the formation of highly reactive free radical, that cause damage. Higher-energy radiation, including ultraviolet radiation (present in sunlight ), x-rays, and gamma radiation , generally is carcinogenic, if received in sufficient doses. Occupational carcinogens : Occupational carcinogens Carcinogen Associated cancer sites or types Occupational uses or sources Arsenic and its compounds Lung Skin Hemangiosarcoma Component of: Alloys Electrical and semiconductor devices Medications (e.g. melarsoprol ) Herbicides Fungicides Animal dips Drinking water from contaminated aquifers. Asbestos Lungs Asbestosis Gastrointestinal tract Pleural Mesothelioma Peritoneal Mesothelioma Not in widespread use, but found in: Constructions Roofing papers Floor tiles Fire-resistant textiles Friction linings (only outside Europe) Replacement friction linings for automobiles still may contain asbestos PowerPoint Presentation: Benzene Leukemia Hodgkin lymphoma Light fuel oil Former use as solvent and fumigant Printing Lithography Paint Rubber Dry cleaning Adhesives Coatings Detergents Beryllium and its compounds Lung Missile fuel Lightweight alloys Aerospace applications Nuclear reactors Cadmium and its compounds Prostate Yellow pigments Phosphors Solders Batteries Metal paintings and coatings Hexavalent chromium (VI) compounds Lung Paints Pigments Preservatives Diesel exhaust Lung [ Bladder Exhaust gas from Diesel engines PowerPoint Presentation: Ethylene oxide Leukemia Ripening agent for fruits and nuts Rocket propellant Fumigant for foodstuffs and textiles Sterilant for hospital equipment Nickel Nose Lung Nickel plating Ferrous alloys Ceramics Batteries Stainless-steel welding byproduct Radon and its decay products Lung Uranium decay Quarries and mines Cellars and poorly ventilated places PowerPoint Presentation: Vinyl chloride Hemangiosarcoma Liver Refrigerant Production of polyvinyl chloride Adhesive for plastics Former use in pressurized containers Shift work that involves circadian disruption Breast Smoking Lung Radium-226 , Radium-224 , Plutonium-238, Plutonium-239 and other alpha particle emitters with high atomic weight Bone Liver Nuclear fuel processing Mechanisms of carcinogenicity: Mechanisms of carcinogenicity Genotoxins cause irreversible genetic damage or mutations by binding to DNA . like N- nitroso -N- methylurea (NMU) or ultraviolet light and ionizing radiation . Certain viruses can also act as carcinogens by interacting with DNA. Nongenotoxins do not directly affect DNA but act in other ways to promote growth. These include hormones and some organic compounds . Risk factors: Risk factors F ood ( Reports from the Food Standards Agency have found that the known animal carcinogen acrylamide is generated in fried or overheated carbohydrate foods (such as french fries and potato chips ). Smooking Over or underweight Circadian disruption ( Multiple studies have documented a link between night shift work and the increased incidence of breast cancer ) Age Race or family history( breast, blood, stomach, colon, prostate, uterus, ovaries, eye and lung cancer) Hormone( oral contraceptives) Immune system ( Sleep disturbances, diet, drugs) S tress Factors Believed to Contribute to Global Causes of Cancer (2008): Factors Believed to Contribute to Global Causes of Cancer (2008) Figure 16.2 PowerPoint Presentation: Introduction Classification Epidemiology Sign and symptoms Mechanism Risk factors Management of cancer Cancer control in Pakistan Latest updates Management of cancer: Management of cancer Diagnosis: Diagnosis First case history collected General diagnosis(imaging techniques etc.) Differential diagnosis (Tumor marker & radio diagnostic techniques etc.) Exact diagnosis (Biopsy & DNA finger printing ,Gel electrophoresis etc.) Imaging techniques: Imaging techniques X-ray Ultrasound CT scan MRI PET Mammography Tumor marker: Tumor marker Tumor markers (also known as biomarkers) are substances which are either specifically produced against tumor by body or found at higher than normal levels in the blood, urine, or body tissue of some people with cancer. CA-125 Mainly ovarian cancer, but may also be elevated in for example endometrial cancer, fallopian tube cancer, lung cancer, breast cancer and gastrointestinal cancer Radio diagnostics: Radio diagnostics Different radioactive substances are used in combination with a carrier molecule 99m Tc 131 I 198 Au 47 Ca Biopsy: Biopsy Biopsy is the removal of tissue for the purpose of diagnostic examination. There are following types of biopsy Fine needle aspiration biopsy Bone marrow biopsy Endoscopic Genetic techniques: Genetic techniques DNA finger printing Gel electrophoresis TREATMENT Goals : TREATMENT Goals TREATMENT : TREATMENT SURGERY RADIOTHERAPY CHEMOTHERAPY GENE THERAPY PALVATITIC CARE Surgery: Surgery Aim of surgery Removal of primary disease Removal of metastatic disease Palliation Diagnosis and staging Prevention Reconstruction Method of surgery mastectomy(removing the whole organ) Lumpectomy (tissue that contains the cancer and some of the surrounding tissue ) Laser surgery Cryosurgery Electro surgery Laparoscopic surgery RADIOTHERAPY: RADIOTHERAPY Mechanism of action Direct hit theory Radiolysis of water Method of Radiotherapy External beam (telegraphy) Brachytherapy Permanent seed implants Chemotherapy: Chemotherapy Aims of therapy Curative chemotherapy Adjuvant chemotherapy Palliative chemotherapy Classification of chemotherapeutic agents of cancer chemotherapy: Classification of chemotherapeutic agents of cancer chemotherapy ALKYLING AGENTS ANTIMETABOLITES NATURAL PRODUCTS HORMONES AND ANTAGONISTS MISCELLANEOUS AND AGENTS ALKYLING AGENT: ALKYLING AGENT Classification of chemotherapeutic agents of cancer chemotherapy: Classification of chemotherapeutic agents of cancer chemotherapy ALKYLING AGENTS Nitrogen mustard Mechlorethamine Cyclophosphamide Ifofamide Melphalan Chlorambucil Methylhydrazine derivatives Procarbazine Alkyl sulfonate Busulfan Nitrosoureas Carmustine Streptozocin Bendamustine Triazenes Decarbazine Temozolomide Platinum coordination complexes Cisplantin Carboplatin Oxaliplatin PowerPoint Presentation: They have property to form carbonium ion intermediate or related transition complexes that are directly related to the alkylation of DNA. Disturb synthesis of DNA and cell division ANTIMETABOLITES: ANTIMETABOLITES Classification of chemotherapeutic agents of cancer chemotherapy: Classification of chemotherapeutic agents of cancer chemotherapy ANTIMETABOLITES Folic acid analogs Methotrexate Pemetrexed Pyrimidine analogs 5-Fluorouracil Cytarabine 5-aza-cytidine Doxy-5-aza-cytidine Purine analogs & related inhibitors 6-Mercaptopurine Pentostatin Fludarabine Clofarabine Nelarabine NATURAL PRODUCTS: NATURAL PRODUCTS Classification of chemotherapeutic agents of cancer chemotherapy: Classification of chemotherapeutic agents of cancer chemotherapy NATURAL PRODUCTS Vinca alkaloids Vinblastinne Vinorelbine Vincristine Taxans Paclitaxel Docetaxel Epipodophylotoxins Etoposide Teniposide Camptothecins Topotecan Irinotecan Antibiotics Dactinomycin Daunoruicin Doxorubicin Echinocandins Yondelis Anthracenedione Mitoxantrone Mitomycin C Enzymes L- Asparaginase HORMONES AND ANTAGONISTS: HORMONES AND ANTAGONISTS Classification of chemotherapeutic agents of cancer chemotherapy: Classification of chemotherapeutic agents of cancer chemotherapy HORMONES AND ANTAGONISTS Adrenocorttical suppressants Mitotane Adrenocorticosteroid prednisone Progestins Hydroxyprogestirone caproate Estrogens Diethylstilbestrol Ethinyl estradiol Anti- estrogens Timoxifen Toremifene Aromatase inhibitors Anastrozole Letrozole exemestane Androgens Testosterone propionate Anti androgens Flutamide Casodex GnRH analog Leuprolide MISCELLANEOUS AND AGENTS: MISCELLANEOUS AND AGENTS Classification of chemotherapeutic agents of cancer chemotherapy: Classification of chemotherapeutic agents of cancer chemotherapy MISCELLANEOUS AND AGENTS Substituted urea Hydroxy urea Differentiating agents Tretinoin Arsenic trioxide Histone deacetylase inhibitors Protien tyrosine kinase inhibitors Dasatinib Nilotinib Gefitinib Erlotinib Sorafenib Sunitinib Lapatinib Proteasome inhibitors Bortazomib Biological response modifier Interferon alpha Interlukin -2 Immunomodulators Thalidomide lenalidomide mTOR inhibitors & Monoclonal antibodies Temisirolimus everolimus PowerPoint Presentation: GENE THERAPY Tumor can be cured by gene therapy . PALLIATIVE CARE Management of ADRs & symptoms: Management of ADRs & symptoms Management of symptoms pain inflammation and other symptoms Management of ADRs Thrombocytopenia & anemia Nausea & vomiting Skin toxicities alopecia WHO pain ladder: WHO pain ladder PowerPoint Presentation: Introduction Classification Epidemiology Sign and symptoms Mechanism Risk factors Management of cancer Cancer control in Pakistan Latest updates Cancer control in Pakistan: Cancer control in Pakistan Cancer control in Pakistan PAEC: Cancer control in Pakistan PAEC IN 1956,the   Pakistan Atomic Energy Commission  (PAEC) was established. PAEC sat up the nuclear medicines lab and facilities throughout the country provided the facilities of diagnosis and treatment of cancer to the patients from all over the country employing Nuclear Techniques at its Medical Centers. sponsored the research program in the field of radiochemistry and biochemistry. sat up the research institutes all over the country, some of them are below: PowerPoint Presentation: Institute of Nuclear Medicine, Oncology and Radiotherapy Atomic Energy Medical Centre (AEMC) Multan Institute of Nuclear Medicine and Radiotherapy (MINAR) Institute of Nuclear Medicine & Oncology (INMOL) Punjab Institute of Nuclear Medicines (PINUM) Institute of Radiotherapy & Nuclear Medicine (IRNUM) Centre for Nuclear Medicines (CENUM) Nuclear Institute of Medicine & Radiotherapy (NIMRA) Centre for Nuclear Medicine & Radiotherapy (CENAR) Bahawalpur Institute for Nuclear Oncology (BINO) Larkana Institute of Nuclear Medicine and Radiotherapy (LINAR) Nuclear Medicine Oncology & Radiotherapy Institute (NORI) Institute Of Nuclear Medicine Oncology & Radiotherapy (INOR ) PowerPoint Presentation: Shaukat Khanum Memorial Cancer Hospital & Research Centre Founded in 29 December 1994 by  Imran Khan ( LAHORE, KARACHI, PESHAWAR, ISLAMABAD) BAITUL SAKOON CANCER HOSPITAL KARACHI children Cancer Foundation Hospital Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN) Pakistan Requests IAEA to Conduct Cancer Assessment Mission(07:jan:2013) : Pakistan Requests IAEA to Conduct Cancer Assessment Mission(07:jan:2013) In order to accomplish this task the IAEA will assemble a team of experts who will meet with a broad range of cancer control stakeholders from the relevant federal ministries and provincial health departments, the Pakistan Atomic Energy Commission (PAEC), oncology centres , regional hospitals, public and private institutions, primary health care facilities and university training institutions. The  imPACT  Mission to Pakistan is expected to be conducted within the next twelve months, subject to availability of resources. PowerPoint Presentation: Introduction Classification Epidemiology Sign and symptoms Mechanism Risk factors Management of cancer Cancer control in Pakistan Latest updates Latest updates: Latest updates Major area of work: Major area of work Nanotechnology Immunotherapy Nanotechnology: Nanotechnology Nanotechnology: Nanotechnology Nanopore Nanotubes Quantum dots MIT Koch institute of cancer research: MIT Koch institute of cancer research These nanoparticles created by MIT engineers can act as synthetic biomarkers for disease. The researchers, led by Sangeeta Bhatia, have developed nanoparticles MIT Koch institute of cancer research: MIT Koch institute of cancer research Daniel Anderson, the Samuel A. Goldblith Associate Professor of Chemical Engineering Immunotherapy: Immunotherapy Our duties & struggles: Our duties & struggles PowerPoint Presentation: 131 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? My Idea: My Idea references: references Robbins basic pathology Pathophysiology the biologic basis for disease in adult and children Kathryn L.Mc Cance & Sue E.Huether Current medical diagnosis & treatment 2012 Rang &Dale Pharmacology Lippincott Illustrated reviews Pharmacology PowerPoint Presentation: International journal of oncology The new England journal of medicine Koch institute of oncology UK cancer research society American Cancer society GEGNENTECH Biooncology corporation of London Health science journal vol 5 Adjei A A 2001 Blocking oncogenic Ras signaling for cancer therapy PowerPoint Presentation: Blume-jensen P.hunter T 2001 Oncogenic kinase signaling Buys CHCM 2000 Tolemeres, tolemerase and cancer N Engle JMed . Aberg, P., Nicander, I., Hansson, J., Geladi, P., Holmgren, U, Ollmar , S., 2004. Skin cancer identification using multifrequency electrical impedance – a potential screening tool. Bhattacharyya, M., et al., 2008. Using MRI to plan breastconserving surgery following neoadjuvant chemotherapy for early breast cancer. British Journal of Cancer PowerPoint Presentation: Chen, W., et al., 2005. Imaging proliferation in brain tumors with 18F-FLT PET: comparison with 18F-FDG. Journal of Nuclear Medicine 46 as an early biomarker of response in metastatic renal cell carcinoma ( mRCC ) under anti- angiogenic treatment. 2007 ASCO Annual Meeting Proceedings Part I. Journal of Clinical Oncology 25 (18S) (abstract 14003). Franceschini , M.A., et al., 1997. Frequency PowerPoint Presentation: Garcia, H., and Lijinsky, W. Studies of the Tumorigenic Effect in feeding Nitrosamino Acids and of Low Doses of Amines and Nitrite to rats .Z. Krebsforsch.1973. PowerPoint Presentation: Fournier, L., et al., 2007. Dynamic contrast-enhanced CT (DCE-CT) Weinberg R A 1996 How cancer arises, Sci Am Sept www.cancer.org www.cancerresearchuk.org www.hsj.org

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