Cancer

this powerpoint contains cancer definition, mechanism, types of cancer, treatments of cancer.

1. CANCER LOGESH KUMAR S M.PHARM (PHARMACOLOGY)

2. ORIGIN OF THE WORD “CANCER” The disease was first called cancer by Greek physician Hippocrates (460-370 BC). He is considered the “Father of Medicine.” Hippocrates used the terms carcinos and carcinoma to describe non-ulcer forming and ulcer-forming tumors. In Greek this means a crab. The description was names after the crab because the finger-like spreading projections from a cancer called to mind the shape of a crab. Later Roman physician, Celsus (28-50 BC) translated the Greek term into cancer, the Latin word for crab. It was Galen (130-200 AD), another Roman physician, who used the term oncos (Greek for swelling) to describe tumors. Oncos is the root word for oncology or study of cancers

3. CANCER In the most basic terms, cancer refers to cells that grow out-of-control and invade other tissues. Cells may become cancerous due to the accumulation of defects, or mutations, in their DNA. Certain inherited genetic defects (for example, BRCA1 and BRCA2 mutations) and infections can increase the risk of cancer. Certain genes control the life cycle—the growth, function, division, and death—of a cell. When these genes are damaged, the balance between normal cell growth and death is lost. Cancer cells are caused by DNA damage and out-of-control cell growth.

4. Benign vs Malignant Tumors There are two main classifications of tumors. One is known as benign and the other as malignant. A  benign tumor  is a tumor that does not invade its surrounding tissue or spread around the body. A  malignant tumor  is a tumor that may invade its surrounding tissue or spread around the body.

5. STAGES OF CANCER The TNM classification of a cancer usually correlates to one of the following five stages. Stage 0: This refers to cancer that is "in situ," meaning that cancerous cells are confined to their site of origin. This type of cancer has not spread and is not invading other tissues. Stage I – Stage III: These higher stages of cancer correspond to larger tumors and/or greater extent of disease. Cancers in these stages may have spread beyond the site of origin to invade regional lymph nodes, tissues, or organs. Stage IV: This type of cancer has spread to distant lymph nodes, tissues, or organs in the body far away from the site of origin.

6. Causes of cancer Cancer is caused by accumulated damage to genes. Such changes may be due to chance or to exposure to a cancer causing substance. The substances that cause cancer are called carcinogens. A carcinogen may be a chemical substance, such as certain molecules in tobacco smoke. The cause of cancer may be environmental agents, viral or genetic factors.

7. Drivers of Cancer The genetic changes that contribute to cancer tend to affect three main types of genes— proto-oncogenes,  tumor suppressor genes DNA repair genes. These changes are sometimes called “drivers” of cancer. Proto-oncogenes are involved in normal cell growth and division. However, when these genes are altered in certain ways or are more active than normal, they may become cancer-causing genes (or oncogenes), allowing cells to grow and survive when they should not. Tumor suppressor genes are also involved in controlling cell growth and division. Cells with certain alterations in tumor suppressor genes may divide in an uncontrolled manner. DNA repair genes are involved in fixing damaged DNA. Cells with mutations in these genes tend to develop additional mutations in other genes. Together, these mutations may cause the cells to become cancerous.

8. STATISTICS In 2018, an estimated 1,735,350 new cases of cancer will be diagnosed in the United States and 609,640 people will die from the disease. The number of new cases of cancer is 439.2 per 100,000 men and women per year (based on 2011–2015 cases). The number of cancer deaths is 163.5 per 100,000 men and women per year (based on 2011–2015 deaths). Cancer mortality is higher among men than women (196.8 per 100,000 men and 139.6 per 100,000 women). In 2016, there were an estimated 15.5 million cancer survivors in the United States. The number of cancer survivors is expected to increase to 20.3 million by 2026. Approximately 38.4% of men and women will be diagnosed with cancer at some point during their lifetimes (based on 2013–2015 data). In 2017, an estimated 15,270 children and adolescents ages 0 to 19 were diagnosed with cancer and 1,790 died of the disease.

9. TYPES OF CANCER Cancer can occur anywhere in the body. Broadly, cancers are classified as either solid (for example breast, lung, or prostate cancers) or liquid (blood cancers). Cancer is further classified according to the tissue in which it arises. Carcinoma Sarcoma Leukemia Lymphoma Myeloma Melanoma

10. COMMON TYPES OF CANCER Bladder Cancer Breast Cancer Colon and Rectal Cancer Endometrial Cancer Kidney Cancer Leukemia Liver Lung Cancer Melanoma Non-Hodgkin Lymphoma Pancreatic Cancer Prostate Cancer Thyroid Cancer

11. Surgery When used to treat cancer, surgery is a procedure in which a surgeon removes cancer from your body. Learn the different ways that surgery is used against cancer and what you can expect before, during, and after surgery. Surgery involves : Remove the entire tumor Debulk a tumor Ease cancer symptoms

12. Surgery that do not involve cuts with scalpels : Cryosurgery Cryosurgery is a type of treatment in which extreme cold produced by liquid nitrogen or argon gas is used to destroy abnormal tissue. Cryosurgery may be used to treat early-stage skin cancer, retinoblastoma, and precancerous growths on the skin and cervix. Cryosurgery is also called cryotherapy. cryosurgery can be an effective treatment for the following: Retinoblastoma (a childhood cancer that affects the retina of the eye). Doctors have found that cryosurgery is most effective when the tumor is small and only in certain parts of the retina. Early-stage skin cancers (both basal cell and squamous cell carcinomas). Precancerous skin growths known as actinic keratosis. Precancerous conditions of the cervix known as cervical intraepithelial neoplasia (abnormal cell changes in the cervix that can develop into cervical cancer).

13. Lasers This is a type of treatment in which powerful beams of light are used to cut through tissue. Lasers can focus very accurately on tiny areas, so they can be used for precise surgeries. Lasers can also be used to shrink or destroy tumors or growths that might turn into cancer. Three types of lasers are used to treat cancer: CO and argon lasers can cut the skin’s surface without going into deeper layers. Thus, they can be used to remove superficial cancers, such as skin cancer. In contrast, the Nd:YAG laser is more commonly applied through an endoscope to treat internal organs, such as the uterus, esophagus, and colon. Neodymium:yttrium-aluminum-garnet Nd:YAG laser light can also travel through optical fibers into specific areas of the body during LITT. Argon lasers are often used to activate the drugs used in PDT

14. Hyperthermia Hyperthermia is a type of treatment in which small areas of body tissue are exposed to high temperatures. The high heat can damage and kill cancer cells or make them more sensitive to radiation and certain chemotherapy drugs. Radiofrequency ablation is one type of hyperthermia that uses high-energy radio waves to generate heat. Hyperthermia is not widely available and is being studied in clinical trials. Different methods of hyperthermia Whole-body hyperthermia Local hyperthermia External Intraluminal or endocavitary Interstitial Regional hyperthermia Deep tissue Regional perfusion Continuous hyperthermic peritoneal perfusion (CHPP)

15. Photodynamic Therapy Photodynamic therapy is a type of treatment that uses drugs which react to a certain type of light. When the tumor is exposed to this light, these drugs become active and kill nearby cancer cells. Photodynamic therapy is used most often to treat or relieve symptoms caused by skin cancer, mycosis fungoides, and non-small cell lung cancer. To date, the FDA has approved the photosensitizing agent called porfimer sodium, or Photofrin ®, for use in PDT to treat or relieve the symptoms of esophageal cancer and non-small cell lung cancer. Porfimer sodium is approved to relieve symptoms of esophageal cancer when the cancer obstructs the esophagus or when the cancer cannot be satisfactorily treated with laser therapy alone. Porfimer sodium is used to treat nonsmall cell lung cancer in patients for whom the usual treatments are not appropriate, and to relieve symptoms in patients with non-small cell lung cancer that obstructs the airways. In 2003, the FDA approved porfimer sodium for the treatment of precancerous lesions in patients with Barrett esophagus, a condition that can lead to esophageal cancer.

16. Radiation Therapy Radiation therapy is a type of cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors. Learn about the types of radiation, why side effects happen, which ones you might have, and more. Types of Radiation Therapy There are two main types of radiation therapy External Beam Radiation Therapy Internal Radiation Therapy

17. External Beam Radiation Therapy External beam radiation therapy comes from a machine that aims radiation at your cancer. The machine is large and may be noisy. It does not touch you, but can move around you, sending radiation to a part of your body from many directions. External beam radiation therapy is a local treatment, which means it treats a specific part of your body. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body. Types of Beams Used in Radiation Therapy Radiation beams used in external radiation therapy come from three types of particles: Photons Protons Electrons

18. Types of External Beam Radiation Therapy 3-D conformal radiation therapy 3-D conformal radiation therapy is a common type of external beam radiation therapy. It uses images from CT, MRI, and PET scans to precisely plan the treatment area, a process called simulation. A computer program is used to analyze the images and to design radiation beams that conform to the shape of the tumor . Intensity-modulated radiation therapy (IMRT) IMRT is a type of 3-D conformal radiation therapy. Like 3-D conformal radiation, radiation beams are aimed at the tumor from several directions. IMRT uses many more smaller beams than 3-D conformal and the strength of the beams in some areas can be changed to give higher doses to certain parts of the tumor.

19. Image-guided radiation therapy (IGRT) IGRT is a type of IMRT. However, it uses imaging scans not only for treatment planning before radiation therapy sessions, but also during radiation therapy sessions. During treatment, you will have repeated scans, such as CT, MRI, or PET scans. These scans are processed by computers to detect changes in the tumor’s size and location. The repeated imaging allows for your position or the radiation dose to be adjusted during treatment, if needed. These adjustments can improve the accuracy of treatment and help spare normal tissue. Tomotherapy ® Tomotherapy ® is a type of IMRT that uses a machine that is a combination of a CT scanner and an external-beam radiation machine. Tomotherapy ® machines take images of the tumor right before treatment sessions to allow for very precise tumor targeting and sparing of normal tissues. It rotates around you during treatment, delivering radiation in a spiral pattern, slice by slice. Tomotherapy ® might be better at sparing normal tissue than 3-D conformal radiation therapy, but it has not been tested in clinical trials to be sure.

20. Stereotactic radiosurgery Stereotactic radiosurgery is the use of focused, high-energy beams to treat small tumors with well defined edges in the brain and central nervous system. It may be an option if surgery is too risky due to your age or other health problems or if the tumor cannot safely be reached with surgery. Gamma Knife is a type of stereotactic radiosurgery. You will be placed in a head frame or some other device to make sure you do not move during treatment. In stereotactic radiosurgery, many small beams of radiation are aimed at the tumor from different directions. Each beam has very little effect on the tissue it passes through, but a precisely targeted dose of radiation is delivered to the site where all the beams come together.

21. Internal Radiation Therapy Internal radiation therapy is a treatment in which a source of radiation is put inside your body. The radiation source can be solid or liquid. Internal radiation therapy with a solid source is called brachytherapy. In this type of treatment, seeds, ribbons, or capsules that contain a radiation source are placed in your body, in or near the tumor. Like external beam radiation therapy, brachytherapy is a local treatment and treats only a specific part of your body. Techniques for placing brachytherapy include: Interstitial brachytherapy, in which the radiation source is placed within the tumor. This technique is used for prostate cancer, for instance. Intracavity brachytherapy, in which the radiation source is placed within a body cavity or a cavity created by surgery. For example, radiation can be placed in the vagina to treat cervical or endometrial cancer. Episcleral brachytherapy, in which the radiation source is attached to the eye. This technique is used totreat melanoma of the eye.

22. Types of Brachytherapy There are three types of brachytherapy: Low-dose rate (LDR) implants: In this type of brachytherapy, the radiation source stays in place for 1 to 7 days. You are likely to be in the hospital during this time. Once your treatment is finished, your doctor will remove the radiation source and the catheter or applicator. High-dose rate (HDR) implants: In this type of brachytherapy, the radiation source is left in place for just 10 to 20 minutes at a time and then taken out. You may have treatment twice a day for 2 to 5 days or once a week for 2 to 5 weeks. The schedule depends on your type of cancer. During the course of treatment, your catheter or applicator may stay in place, or it may be put in place before each treatment. You may be in the hospital during this time, or you may make daily trips to the hospital to have the radiation source put in place. As with LDR implants, your doctor will remove the catheter or applicator once you have finished treatment.

23. Permanent implants: After the radiation source is put in place, the catheter is removed. The implants remain in your body for the rest of your life, but the radiation gets weaker each day. As time goes on, almost all the radiation will go away. When the radiation is first put in place, you may need to limit your time around other people and take other safety measures. Be extra careful not to spend time with children or pregnant women.

24. Chemotherapy Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to kill cancer cells. Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. Chemotherapy is used to: Treat cancer Chemotherapy can be used to cure cancer, lessen the chance it will return, or stop or slow its growth. Ease cancer symptoms Chemotherapy can be used to shrink tumors that arecausing pain and other problems.

25. When used with other treatments, chemotherapy can: Make a tumor smaller before surgery or radiation therapy. This is called neoadjuvant chemotherapy. Destroy cancer cells that may remain after treatment with surgery or radiation therapy. This is called adjuvant chemotherapy. Help other treatments work better. Kill cancer cells that have returned or spread to other parts of your body.

26. Chemotherapy may be given in many ways. Some common ways include: Oral The chemotherapy comes in pills, capsules, or liquids that you swallow Intravenous (IV) The chemotherapy goes directly into a vein Injection The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly Intrathecal The chemotherapy is injected into the space between the layers of tissue that cover the brain and spinal cord Intraperitoneal (IP) The chemotherapy goes directly into the peritoneal cavity, which is the area in your body that contains organs such as your intestines, stomach, and liver Intra-arterial (IA) The chemotherapy is injected directly into the artery that leads to the cancer Topical The chemotherapy comes in a cream that you rub onto your skin

27. Immunotherapy to Treat Cancer Immunotherapy is a type of cancer treatment that helps your immune system fight cancer. This page covers the types of immunotherapy, how it is used against cancer, and what you can expect during treatment. Types of immunotherapy Immune checkpoint inhibitors T-cell transfer therapy Monoclonal antibodies Treatment vaccines Immune system modulators

28. Immune checkpoint inhibitors These are drugs that block immune checkpoints. These checkpoints are a normal part of the immune system and keep immune responses from being too strong. By blocking them, these drugs allow immune cells to respond more strongly to cancer.

29. T-cell transfer therapy T-cell transfer therapy , which is a treatment that boosts the natural ability of your T cells to fight cancer. In this treatment, immune cells are taken from your tumor. Those that are most active against your cancer are selected or changed in the lab to better attack your cancer cells, grown in large batches, and put back into your body through a needle in a vein. T-cell transfer therapy may also be called adoptive cell therapy, adoptive immunotherapy, or immune cell therapy.

30. Monoclonal antibodies Monoclonal antibodies , which are immune system proteins created in the lab that are designed to bind to specific targets on cancer cells. Some monoclonal antibodies mark cancer cells so that they will be better seen and destroyed by the immune system. Such monoclonal antibodies are a type of immunotherapy. Monoclonal antibodies may also be called therapeutic antibodies.

31. Treatment vaccines Treatment vaccines , which work against cancer by boosting your immune system’s response to cancer cells. Treatment vaccines are different from the ones that help prevent disease. Learn more about cancer treatment vaccines. Sipuleucel -T is used to treat men with prostate cancer: That has spread to other parts of the body Who have few or no symptoms Whose cancer does not respond to hormone treatment T-VEC is used to treat some patients with melanoma that returns after surgery and cannot be removed with more surgery.

32. Immune system modulators Immune system modulators , which enhance the body’s immune response against cancer. Some of these agents affect specific parts of the immune system, whereas others affect the immune system in a more general way. Types of immune-modulating agents include: Cytokines Interferons (INFs) .  Interleukins (ILs) BCG Immunomodulatory drugs Thalidomide ( Thalomid ®) Lenalidomide ( Revlimid ®)

33. Targeted Therapy Targeted therapy is a type of cancer treatment that targets the changes in cancer cells that help them grow, divide, and spread. Learn how targeted therapy works against cancer and about common side effects that may occur.

34. Most targeted therapies are either small-molecule drugs or monoclonal antibodies. Small-molecule drugs  are small enough to enter cells easily, so they are used for targets that are inside cells. Monoclonal antibodies,  also known as therapeutic antibodies, are proteins produced in the lab. These proteins are designed to attach to specific targets found on cancer cells. Some monoclonal antibodies mark cancer cells so that they will be better seen and destroyed by the immune system. Other monoclonal antibodies directly stop cancer cells from growing or cause them to self-destruct. Still others carry toxins to cancer cells.

35. ROLE OF TARGETED THERAPY IN CANCER Help the immune system destroy cancer cells. Stop cancer cells from growing Stop signals that help form blood vessels Deliver cell-killing substances to cancer cells Cause cancer cell death Starve cancer of the hormones it needs to grow

36. Hormone Therapy Hormone therapy is a treatment that slows or stops the growth of breast and prostate cancers that use hormones to grow.

37. Hormone therapy is used to: Treat cancer.  Hormone therapy can lessen the chance that cancer will return or stop or slow its growth. Ease cancer symptoms.  Hormone therapy may be used to reduce or prevent symptoms in men with prostate cancer who are not able to have surgery or radiation therapy. Types of Hormone Therapy Hormone therapy falls into two broad groups, those that block the body’s ability to produce hormones and those that interfere with how hormones behave in the body

38. Stem Cell Transplant Stem cell transplants are procedures that restore blood-forming stem cells in cancer patients who have had theirs destroyed by very high doses of chemotherapy or radiation therapy.

39. Types of Stem Cell Transplants Autologous, which means the stem cells come from you, the patient Allogeneic, which means the stem cells come from someone else. The donor may be a blood relative but can also be someone who is not related. Syngeneic, which means the stem cells come from your identical twin, if you have one

40. Precision Medicine Precision medicine helps doctors select treatments that are most likely to help patients based on a genetic understanding of their disease..