CANCER

CLINICAL DIAGNOSIS,
PREVENTION AND MANAGEMENT
ANDI WAHYUDI PABABBARI

Fakultas Kedokteran Universitas Tadulako

Palu
What is Cancer?
Normal Cells versus Cancer Cells

Source: National Cancer Institute,2014

Benign versus Malignant Tumors

Benign Malignant
• Non-cancerous • Cancerous
• Do not grow • Invade tissue
into other or spread
tissue
Source: National Cancer Institute – What is Cancer. 2015.
Different Kinds of Cancer
• Start in the cells that cover external and internal organs
Carcinomas or glands

• Start in cells in the supporting tissues of the body, such

Sarcomas as bone, cartilage, fat, connective tissue, and muscle

• Start in the lymph nodes and tissues of the body’s

Lymphomas immune system

• Start in the immature blood cells that grow in the bone

Leukemias marrow

Source: National Cancer Institute – What is Cancer. 2015.

How are cancers named?
adeno- • gland

chondro- • cartilage

erythro- • red blood cell

hemangio- • blood vessels

hepato- • liver

lipo- • fat

lympho- • lymphocyte

melano- • pigment cell

myelo- • bone marrow

myo- • muscle

osteo- • Bone
Source: National Cancer Institute, 2009
Invasion and Metastasis

Source: National Cancer Institute, 2014

Checkpoint
What factors may increase risk for cancer?
a) Tobacco
b) Diet
c) Alcohol
d) Physical Activity
e) Obesity
f) All of the above
Source: National Cancer Institute, 2014.
Cancer Risk Factors

• Some infections
• Immunosuppressive medicine
• Radiation
• Inherited genes

Lynch
BRCA 1 BRCA 2
Syndrome
Sources: National Cancer Institute, 2014; National Cancer Institute, 2015;
American Society of Clinical Oncology, 2014; National Cancer Institute, 2013.
Cancer Prevention
Americans can prevent 1/3 of the most common cancers.

• Staying lean
• Eating smart
Preventable
• Moving more
Cancers

1/3 of breast cancers

1/2 of colorectal cancers
2/3 of esophageal cancers

Source: American Institute for Cancer Research. 2015.

Cancer Prevention
Although there is no way to completely prevent a diagnosis of cancer, health
behaviors can reduce the risk for cancer.

Avoid Excessive Consume Fruits

Avoid Tobacco
Sun Exposure and Vegetables

Avoid Cancer
Limit Alcohol Viruses Exercise regularly

Avoid Exposure to Get screening

Carcinogens at tests and go to
Work check-ups

Source: National Cancer Institute – Understanding Cancer Series, 2009

Signs and Symptoms
Someone with cancer may have general symptoms such as unexplained
weight loss; fever; fatigue, which is extreme tiredness; pain; or changes
in the skin or eyes.

They may also have symptoms that vary and are related to the type of
cancer they have.

Always refer patients to a clinician or the health care team if asked to

explain symptoms or diagnosis.

Source: National Cancer Institute – Understanding Cancer Series, 2009

Early Cancer May Not Have Any
Symptoms
Some patients may visit the doctor only when they feel pain or when
they notice changes like a lump in the breast or unusual bleeding or
discharge.

However, early cancer may not have any symptoms, which is why
routine screenings and doctor’s visits are so vital for early detection.
Cancer Detection and Diagnosis

• Cancer can be diagnosed with biopsies, blood tests, urine tests, colonoscopies
or sigmoidoscopies, x-rays, ultrasounds, bone scans, CT scans, MRI’s and/or
surgery.
• When cancer is found, a doctor will determine what type it is and how fast it
is growing.
• In some cases, finding cancer early may decrease a person’s risk of dying
from the cancer.
• For this reason, improving our methods for early detection is currently a high
priority.
Source: National Cancer Institute – Understanding Cancer Series, 2009
Screening
U.S. Preventive Services Task Force (USPSTF)
American Cancer Society (ACS)
American College of Obstetricians and Gynecologists (ACOG)
Cancer screening programmes National
target
Bowel screening 60%
Men and women aged 60 to 74 invites up to 75
Testing kit received in the post.
6 stool samples needed.

Breast screening
Women aged 50 to 70.
Women over 70 can request screening.
Mammography National
target
80%
Cervical screening
Women aged 25 to 64 in England
National
Every 3 years up to age 49, then every 5 years target

Cytology 80%
Cervical Cancer Screening

Source: National Cancer Institute, 2009

Breast Cancer Screening

Source: National Cancer Institute—Mammograms. 2014

Prostate Cancer

Source: National Cancer Institute – Alan Hoofring (Illustrator). N.d.

Colorectal Cancer Screening

Fecal occult blood test (FOBT)

• Detects small amounts of blood in stool

Sigmoidoscopy
• Uses lighted instrument in rectum and lower colon

Colonoscopy
• Uses lighted instrument in colon, including upper colon
Source: National Cancer Institute – Tests to Detect Colorectal Cancer
and Polyps. 2014
Lung Cancer Screening

Source: US Preventive Services Task Force. 2013

Biopsy

Source: National Cancer Institute, 2010

Microscopic Appearance of Cancer Cells

Normal connective tissue Cancerous connective tissue

Source: National Cancer Institute – Dr. Cecil Fox (Photographer)

Tumor Grading
General Relationship Between
Tumor Grade and Prognosis
100%

Low grade
Patient
Survival
Rate
High grade

1 2 3 4 5
Years
Source: National Cancer Institute – Understanding Cancer Series, 2009
Cancer Staging
• Is helpful to a doctor when planning the appropriate treatment

• Is used when estimating a person’s chance of recovery

• Can aid in identifying appropriate clinical trials that are suitable for a
patient

• Is used to help care providers exchange information about a patient

and any results of clinical trials

Source: National Cancer Institute – Understanding Cancer Series, 2009

TNM Staging System

T N M
Amount of tumor Lymph nodes Metastasis (spread)
• TX: Tumor cannot • NX: Lymph nodes • MX: Metastasis
be evaluated cannot be cannot be
• T0: No evidence of evaluated evaluated
tumor • N0: No lymph • M0: No metastasis
• Tis: Carcinoma in node involvement • M1: Metastasis is
situ • N1-N3: Degree of present
• T1-T4: Size/extent regional lymph
of tumor node involvement

Source: National Cancer Institute – Cancer Staging, 2015

TNM Staging System
Stage 0 • Carcinoma in situ

• Higher numbers mean the

Stage I,
disease is more extensive, such
Stage II,
as larger tumor size and/or
Stage III
spread

Stage IV • Spread to distant tissues/organs

Source: National Cancer Institute – Cancer Staging, 2015
Personalized Medicine

Source: American Society of Clinical Oncology – What is Personalized

Cancer Medicine? 2015
How are genetic tests used?

• Gene mutations play a role in the

development of all cancers
• In some cases, inherited mutations may
play a major role
Cancer treatment
Depends on cancer type and stage
• Surgery
• Radiation
• Chemotherapy
• Targeted therapy
• Palliative treatment

Source: National Cancer Institute – Understanding Cancer Series, 2009

Surgery and Radiation
• Surgery
• Radiation
Possible side effects include:
• swelling
• skin changes
• fatigue

Source: National Cancer Institute – Understanding Cancer Series, 2009

Chemotherapy
Possible side effects:
• Fatigue
• Nausea
• Vomiting
• Hair Loss
• Mouth sores
• Pain

Source: National Cancer Institute – Understanding Cancer Series, 2009

Neo-adjuvant and Adjuvant Treatment

Neo-adjuvant Adjuvant
(Given after)
(Given before)
Chemotherapy
Chemotherapy
Radiation therapy
Radiation therapy
Hormone therapy
Hormone therapy
Targeted therapy
Biological therapy
Targeted Therapy
• “Molecularly targeted drugs” or “precision medicines”
• Tumor tissue is tested
• Different from standard chemotherapy
• Some types of targeted therapies:
- Hormone therapy, angiogenesis inhibitors,
immunotherapies, monoclonal antibodies

Source: National Cancer Institute – Targeted Cancer Therapies. 2013

Hormone Therapy
Drugs given to block the body’s natural hormones
to slow or stop the growth of cancer

Breast Prostate
cancer cancer
Side effects depend on the drug used
Palliative Medicine
• Pain
• Nutrition
• Psychosocial
• Religion
• Family Support
• Environment
Complementary and Alternative Medicine

“A group of diverse medical and health care

systems, practices and products that are not
generally considered to be part of the conventional
medicine.”

Sources: Smith Center for Healing and the Arts, 2014; National Center for
Complimentary and Alternative Medicine, 2013
Supportive Care Services
Psychosocial support services

Rehabilitation
• Lymphedema therapy
• Physical therapy
• Occupational therapy
• Speech therapy

Spiritual support/chaplaincy services

Hospice
Comparing Complementary and
Alternative Medicine
Complementary Alternative
Used together with conventional Used in place of conventional
medicine medicine
Example: Using acupuncture for pain Example: Using traditional
management, while also using medicine from other cultures to
medications and physical therapy.
treat cancer instead of
chemotherapy, radiation or
surgery recommended by a
medical doctor
Complementary Health Approaches
• Nutrition
• Supplements
• Meditation
• Chiropractic
• Acupuncture
• Massage
Possible Benefits of Complementary
Approaches
Improve response to standard medical treatment

Manage side effects of cancer treatment

Prevent or manage cancer symptoms

Improve survival

Enhance a sense of well-being and quality of life

Source: Smith Center for Healing and the Arts, 2014

Possible Risks of Complementary
Approaches

• Few studies on safety and effectiveness

• No approaches work beyond a shadow of doubt
• Can harm patients
• Can interfere with drugs
Evidence-based Cancer Information
American Cancer Society
• cancer.org

American Society of Clinical Oncology

• cancer.net

Centers for Disease Control and Prevention

• cdc.gov

LIVESTRONG
• livestrong.org

National Cancer Institute

• cancer.gov

U.S. Preventive Services Task Force

• http://www.uspreventiveservicestaskforce.org
Thank You