The sycotic extravaganza

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          11th feb 2010-cover story
                 INDIA TODAY
• Woke up. Got out of bed.
  (Did not) drag a comb
  across my head..." That's
  37-year-old actor and
  model Lisa Ray's way of
  poking gentle fun at her
  incurable bone marrow
  myeloma and now shaven
  head ("I still have a
  ziplock bag of my hair").


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           YELLOW DIARIES….
• That spirit has helped her find a new voice:
  her blog, Yellow Diaries, where she celebrates
  the colour of health and hope--yellow--keys in
  quick "yellow posts," sends "yellow wish" to
  browsers (5,00,000-plus) and describes the
  cutting-edge stem cell transplant that she's
  just gone through ("Now I'm full of cheerful
  stem cells, like fields of sunflowers").

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                 Lisa ray
………………….before              ……………………….after




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                   • PRESENTED BY
                     Dr.Divya Sanal.K
                     1st MD
                     DEPT OF C.R
                     GHMCT

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Defenition
            • A mass of tissue
              formed as a result of
              abnormal,excessive
              ,uncoordinated
              autonomous and
              purposeless
              proliferation of cells



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• it is Celsus who
  translated carcinosinto
  the Latin cancer, also
  meaning
  crab. Galen used
  "oncos" to
  describe all tumours,
  the root for the modern
  word oncology


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              • Hippocrates described
                several kinds of cancers.
                He called benign
.               tumours oncos, Greek for
                swelling, and malignant
                tumours carcinos, Greek
                forcrab or crayfish
              • He later added the suffix -
                oma, Greek for swelling,
                giving the
                name carcinoma.


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• This name comes from
  the appearance of the
  cut surface of a solid
  malignant tumour, with
  "the veins stretched on
  all sides as the animal
  the crab has its feet,
  whence it derives its
  name"


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          • Humor theory
          • Surgery-egypt-
            cauterisation
          • Excision,amputation,ca
            uterisation-avicenna




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• The first cause of cancer
  was identified by British
  surgeon Percivall Pott,
  who discovered in 1775
  that cancer of
  the scrotum was a
  common disease
  among chimney sweeps
• metastasis was first
  formulated by the English
  surgeon Campbell De
  Morganbetween 1871
  and 1874

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          • The genetic basis of
            cancer was recognised
            in 1902 by the German
            zoologist Theodor
            Boveri, professor
            of zoology at Munich an
            d later inWürzburg.




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• When Marie
  Curie and Pierre
  Curie discovered radiati
  on at the end of the
  19th century, they
  stumbled upon the first
  effective non-surgical
  cancer treatment



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  Nomenclature and classification
• Neoplasia =new growth
• Produced new growth
  = neoplasm/tumour
• All new growths are
  not neoplasms
• Eg:-
  embryogenesis,repair
  and
  regeneration,hyperplasi
  a and hormonal
  stimulation         www.similima.com   16
                 Types
       Benign                             Malignant

• Slow growing                       • Proliferate rapidly
• Localised                          • Spread through
• Without causing                      out the body
  much difficulty to                 • Eventually cause
  host                                 death of the host
                                     • Commonly called
                                       cancer
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 All tumors,benign as well as malignant have 2
                basic components

                          Tumour




    Parenchyma                                     Stroma



 proliferating tumor                           Fibrous connective
cells.(this determines                      tissue and bvs,on which
    the nature and                              the parenchymal
evolution of tumour)     www.similima.com
                                               tumour cells grow 18
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• Some eg: contrary to this concept:
• Melanoma-carcinoma of melanocytes
• Hepatoma-carcinoma of hepatocytes
• Lymphoma-malignant tumour of
  lymphoid tissue
• Seminoma-malignant tumour of testis
• Leukaemia-cancer of blood forming
  cells
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        Special categories of tumors


                          Tumour




Mixed      teratomas     blastomas        hamartomas   choristoma




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Mixed tumours

 When two type tumors are combined
          in same tumour


     1.Adenosquamous carcinoma
            2.Carcinosarcoma
            3.Adeno canthoma
            4.Collision tumour
        5.Pleomorphic adenoma




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                       Teratomas
• Made up of a mixture of
  various tissue types arising
  from totipotent cells derived
  from the 3 germ cell layers-
  ectoderm mesoderm and
  endoderm
• Common sites-ovaries and
  testis
• Can occur in extra gonadal
  sites also mainly in the
  midline of the body esp in
  head and neck region in
  mediastinum,retroperitoneu
  m,sacrococcygeal region etc



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Blastomas /embryomas
                 • A group of malignant
                   tumours which arise from
                   embryonal or partially
                   differentiated cellswhich
                   would normally form
                   blastema of organs and
                   tissues during embryogenesis
                 • In infants and children<5 yrs
                 • Eg:neuroblastoma,nephroblas
                   toma(wilm’s
                   tumour),hepatoblastoma,retin
                   oblastoma,medulloblastoma,p
                   ulmonary blastoma

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               Hamartoma
• Benign tumour
• Mature but
  disorganised cells of
  tissue indigenous to
  the particular organ
• Eg:hamartoma of lung
  consist of mature
  cartilage,mature
  smooth muscle and
  epithelium

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choristoma
             • Ectopic islands
               of normal
               tissue
             • A heterotopia
             • Not a true
               tumour

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 Charactristics of
     tumors

Rate of        Macroscopic               Microscopic
growth          features                  features

            Local
                                   metastasis
          invasion


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Rate of growth
             • Rate of division and
               destruction of tumor
               cells
             • Degree of
               differentiation
             • Regulation of tumor
               growth
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Growth factors secreted by tumour cells
       •EGF-epidermal growth factor
       •FGF-fibroblast growth factor
     •PDGF-platelet derived growth factor
       •CSF-colony stimulating factor
     •TGF-B-transforming growth factor-B
             •IL-interleukins
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 Macroscopic appearance
• Clinically
• Gross
  appearance
• Difference
  between
  benign and
  malignant

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Microscopic appearance
                  • Microscopic pattern
                  • Cytomorphology of
                    neoplastic
                    cells(differentiation
                    and anaplasia)
                  • Tumour angiogenesis
                  • Inflamatory rxn




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       epithelial             mesenchymal                       mixed                haemopoetic

• Acini                  • Arraged as interlacing       • Teratoma from         • Often have none,or
• Sheets                   bundles,fascicles or           totipotent cells        little stromal support
• Columns/cords            whorls                       • Pleomorphic           • Eg:-
• Arranged in solid or   • Lying seperated by             adenoma of salivary     leukemia,lymphoma
  pappilary patter         each other by                  gland
                           intercellular matrix         • Fibroadenoma of
                           substance                      breast
                                                        • Carcinosarcoma of
                                                          uterus




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         Cytomorphology of neoplastic
        cells(differentiation and anaplasia


Extend of morphological                  ANAPLASIA is lack of
&functional resemblence of               differentiation
parenchymal tumour cells to              Characteristic feature of
corresponding normal cells—              malignant tumours
DIFFERENTIATION
                                         • Poorly differntiated have high
•   WELL DIFFERENTIATED
•   POORLY DIFFERENTIATED/
                                           degree of anaplasia
•   UNDIFFERENTIATED/
•   DEDIFFERENTIATED




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Tumor angiogenesis and stroma
   Tumor
                                           Tumour stroma
angiogenesis
                                            Scanty,soft ,fleshy&
Microvascular density
                                            excessive,hard gritty


                                                Medullary&
  Central necrosis
                                           Scirrhous(desmoplasia)


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               Inflammatory rxn
• In and around tumours
• Result of ulceration in cancer when there is secondary
  infection
• May be a/c or c/c
• Due to cell mediated immunological response by the
  host in an attempt to destroy the tumour
• In some cases,such an immune response improves the
  prognosis
• Eg:- seminoma,malignant melanoma,lymphoepithelioma
  of throat,medullary carcinoma of
  breast,choriocarcinoma
• Wharthin’s tumor of salivary glands
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      Local invation
• Benign—expand and
  push aside the surronding
  normal tissue without
  invading,infiltrating and
  metastasising
• Malignant-enlarge by
  expansion,encapsulate(
  well diff.follicular ca of
  thyroid,with
  invasion,infiltration,destr
  uction of surrounding
  tiisue and metastasis
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Metastasis (distant spread)
                    • Spread of tumor by
                      invasion in such a way
                      that discontinous
                      secondary tumor mass
                      or masses are formed at
                      the site of lodgement
                    • Exceptions:--
                    • 1.glioma of CNS
                    • 2.basal cell ca of skin

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         Metastasis

           Routes

•Lymphatic
•Blood
•Along body cavity and
 natural passages
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                Lymphatic spread
• Carcinomas
• Lnvolvement of lymph
  nodes by malignant cells in
  2 ways:-
• 1.lymphatic permeation
• 2.lymphatic emboli
• Regional nodal
  metastasis,eg:-ca breast to
  axillary lymph nodes,ca
  thyroid to lateral cervical
  lymph nodes,bronchogenic
  ca to hilar and paratracheal
  lymphnodes


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• Regional lymphadenites of
  sinus histiocytosis
• Skip metastasis
• Retrograde metastasis
• Virchow’s lymphnode




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       Haematogenous spread
• Sarcoma
• Live,lungs,brain,bones,
  kidney and adrenals
• Seed-soil theory
• Spleen,heart,skeletal
  muscles
• Systemic veins-lungs
• Portal veins-liver


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• Arterial spread-rare
• Retrograde spread eg:-vertebral
  metastasis in ca thyroid and
  prostate
• Metastasis may grow bigger than
  primary tumour




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                       Spread along body cavity & natural
                                   passages
                        Along serosal wall of                                         Unusual for malignant




                                                          Along epeithelial surface
Transcoelomic spread


                        coelomic cavity so that                                       ones
                        tumor fragments break off                                     Exceptions:-
                        to be carried in the
                        coelomic fluid and are                                        F.T from endometrium to
                        implanted elsewhere in                                        ovaries/vice versa
                        the body cavity                                               Through the bronchus into
                        Eg:-krukenberg tumor                                          alveoli
                        Ca ovary                                                      Through the ureters from
                                                                                      the kidneys in to lower
                        Pseudomyxoma peritoni                                         urinary tract
                        Ca bronchus and breast
                        seeding to the pleura and
                        pericardium

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          Malignant tumors of                             By sugeon’s
Via CSF




                                           Implantation
          ependyma and lepto                              scalpel,needles,sutures,
          meninges                                        Or direct contact such
                                                          as transfer of cancer of
                                                          lower lip to upper lip




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                                 Aggressive
                                   clonal
                                proliferation


            Survival and                        Tumor cell
              growth                            loosening




                                                             T.CELL—ECM
extravasation
                                                              interaction




                Thrombus                        Degradation
                formation                         of ECM


                                   Entry to
                                  cappilary
                                    lumen
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      Possible Health Concerns...
• Cancer governs the chest, breasts, elbows, stomach
  and digestion, womb and female reproductive organs.
  Cancer, which can affect any part of the body, is
  sometimes said to have taken its name from this sign,
  which can therefore afflict its subjects with
  imperfections anywhere.
• This is incorrect, however, the derivation of cancer
  being the Latin cancer meaning gangrene as well as
  crab. nevertheless, Cancerians are said to be liable to
  breast cancer and to suffer from pleurisy, dropsy, piles
  and varicose veins. The excitability mentioned above
  can lead to weak digestion, gastritis and other stomach
  ills, and there is a tendency to coughs and weakness of
  vision.
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       Grading and staging
• Are two systems
  to determine
  the prognosis
  and choice of
  treatment after
  a malignant
  tumor is
  detected     www.similima.com   47
Grading                  Staging
• The macroscopic • Extent of
  and microscopic    spread of
  degree of          tumors with in
  differentiation of the patients
  tumors

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Grading        • Based on:-
               • 1.degree of anaplasia
               • 2.the rate of growth




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          Grading

GRADE I        WELL
          DIFFERENTIATED
                                < 25%
                              ANAPLASTIC



GRADE       MODERATELY         25-50%
  II
GRADE       MODERATELY         50-75%
  III
GRADE         POORLY
                                 >75%
            /ANAPLASTIC
  IV
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                           Staging
• Extend of spread
  assesed by 3 ways
• 1.clinical examination
• 2.investigations
• 3.pathological
  examination of tissues
  removed




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            Staging



    T                               A

N       M                       J       C
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      CANCER INCIDENCE
• 20% of all
  deaths,world
  wide
• Lung ca in males
• Breast ca in
  females
• a/c leukaemia in
  children
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                   Epidemiology
 PREDISPOSING       PREMALIGNANT           HORMONES AND
   FACTORS           CONDITIONS               CANCER
• Familial /        • Carcinoma in         • oestrogen
  genetic             situ                 • Contraceptive
• Racial/           • Some benign            hormones
  geographic          tumors               • Anabolic
• Environmental/    • Miscellaneous          steroids
  cultural            conditions           • Hormone
• Age                                        dependant
• sex                                        tumors

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           Familial/genetic factors
•   Retinoblastoma
•   Familial polyposis coli
•   MEN
•   Vonrecklinghausen’s ds
•   Ca breast
•   DNA-chromosomal
    instability syndromes



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Racial/geographic factors
                   • White europeans and
                     americans
                   • Black africans
                   • Japanese
                   • South east asian
                   • Indians




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   Environmental/cultural factors
• Cigrette smoking
• Alcohol abuse
• Alcohol and tobacco
  together
• Ca cx
• Penile ca
• Betal nut ca
• Industril substance
• Diet

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  Age
          • In 50-ies
          • a/c leukemia in
            children
          • Also
            neuroblstoma,nephrobl
            astoma/wilm’s
            tumor,retinoblastoma,
            hepatoblastoma,rhabd
            omyosarcoma,ewing’s
            sarcoma,teratoma and
            cns tumors
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sex




                         • More in men
                         • Ca breast
      www.similima.com   • Ca lungs      59
      Premalignant condition

 Carcinoma      • Intra epithelial neoplasia/CIN
   insitu       • Oral leukoplakia



Some benign     • Multiple villous adenoma-adenocarcinoma
  tumours       • Neurofibroma-sarcoma



Miscellaneous   • Inflamatory and hyperplastic conditions
                • Ulcerative colitis,cirrhosis,c/c bronchitis,illfitting
 conditions       denture,old burn scar(marjolin’s?)


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Hormones and cancer

                          Contraceptive
  oestrogen
                             hormones




  Anabolic                   Hormone
                            dependent
   steroids                  tumours


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Cancer pathogenesis




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             •These are initiation; the initial changes in the
             cellular behaviour,
Initiation


         • promotion; the process of initiated cells
           progressing through the carcinogenic
promotion process and changing phenotypically and


             •progression; whereby it evolves fully and
             expresses out.
Progrssion

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carcinogenesis

     Biological


      Physical


     Chemical




    Molecular

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           Biological carcinogenesis

                 1.Schistosoma
                haematobium–                                 Helicobacter
                sq.cell ca of U.B               Bacteria    pylori-gastric
Parasite
                 2.Chlonorchis                             lymphoma and
                    sinensis-                                 carcinoma
              cholangiocarcinoma




               Aspergillus flavus                            DNA VIRUS
Fungus                                            virus
                 (aflatoxin)—                                    &
                hepatocellular                               RNA VIRUS
                 ca(with HBV)

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Viral oncogenesis

                Vertical




                Routes




  Horizontal                      Inoculation

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       DNA oncogenic virus
Here direct access to the host cell nucleus
and are incorporated into the genome of
                 host cell




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              DNA ONCOGENIC VIRUSES
              VIRUS            HOST             ASSOCIATED TUMOR
1.PAPOVA VIRUSES
Human pappiloma virus        Humans          Ca cx, sq.cell.ca, skin
                                             ca.warts
Sv-40 virus                  Humans          ? mesothelioma
2.HERPES VIRUS
EBV                          Humans          Burkitt’s
                                             lymphoma,nasopharyngeal
                                             ca
Human herpes virus           Humans          Kaposi’s sarcoma’
8(kaposi sarcoma herpes                      Bcell lymphoma
virus)
3.ADENOVIRUS
4.POX VIRUS                  Humans          Molluscum,pappiloma
5.HEPDNA VIRUS
Hepatitis B virus            Humans          Hepatocellular carcinoma
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               RNA ONCOGENIC VIRUSES-
                    RETROVIRUS
All retroviruses are not oncogenic
Contain enzyme--             Viral
                                         RNA

                                                  REVERSE
                                                TRANSCRIPTI
    reverse transcriptase
                                                    ON




                                        Viral
                                        DNA




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     a/c                  Slow
transforming          transforming
   viruses               viruses




   HTLV                      HCV




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gag   pol             env   tat


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     Mode of DNA viral oncogenesis
• Host cell infected by DNA oncogenic virus may have
  one of the following 2 results-Replication:with
  consequent lysis of infected cell and release of virions
  which results in cell death,but no neoplastic
  transformation
• integration:viral DNA may integrate in to host cell DNA
  which results in neoplastic transformation of host cell.
• A feature essential for host cell transformation is the
  expresion of virus specific T(transforming
  protein)antigens immediately after infection of host
  cells by DNA oncogenic viruses
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Mechanism of RNA VIRAL
     oncogenesis


                        Reverse
                      transcripta
                          se


cDNA




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     CHEMICAL CARCINOGENESIS
INITIATION                       PROMOTION
• DIRECT ACTING                  • EG-PHORBOL
   CARCINOGENS                     ESTERS,PHENOLS,HORMON
• INDIRECT ACTING                  ES,ARTIFICIAL
   CARCINOGENS-                    SWEETNERS,AND DRUGS
   PROCARCINOGENS                  LIKE PHENOBARBITOL
• METABLOIC ACTIVATION           • DIFFERENCE FROM
• REACTIVE ELECTROPHILES           INTIATORS
• TARGET MOLECULES
• THE INITIATED CELL

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      Direct acting                                Indirect acting


                                Target cell
    No                                               Metabolic
metabolic                                            activation
activation
                          Reactive electrophiles


              intiation
                            Target molecules



                          Permenant DNAdamage



                           Clonal proliferation
                                                   promotion

                             Neoplastic cell
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        Directly acting carcinogens
                                              Anti ca
                Alkylating                   drugs,b-
                 agents                    propionolact
                                           one,epoxides
Direct acting
  chemical
carcinogens                                   Acetyle
                                             imidazole
                acylating
                                             Dimethyl
                 agents                      carbamyl
                                              chloride




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Indirectly acting carcinogens-
       procarcinogens
• Ca lung                                                  • Ca bladder
• ,skin,                                                   • Hepatocellular ca
• oralcavity,s
• arcoma


                        Polycyclic
                                         Aromatic amines
                        aromatic
                                           and azodyes
                      hydrocarbons




                        Naturally        Miscellaneous-
                        ocurring         asbestos,metals
                        products               etc

• Hepatocellular ca                                        • Ca
                                                             lung,skin,stomach
                                                             etc
                               www.similima.com                                  77
  TESTS FOR CHEMICAL
   CARCINOGENICITY


EXPERIMENTAL INDUCTION
       TEST FOR
 MUTAGENECITY(AMES’S
         TEST)

        www.similima.com   78
               PHYSICAL
            CARCINOGENESIS



    RADIATION                       NON RADIATION
UV LIGHT &IONISING              VARIOUS FORMS OF
     RADIATION                       INJURY


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Molecular pathogenesis of cancer
Monoclonality of        • Most human cancers arise from a
   tumors                 single clone of cells by mutation


Genetic theory of       • Normal and abnormal cell growth
    cancer                is under genetic control

Genetic regulators of   • In normal cell growth-4 regulatory genes
    normal and          • In cancer-3 process
 abnormal mitosis
Multistep process of
cancer growth and                    Multihit process
   progression
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       Cancer related genes and cell
       growth(hallmarks of cancer)
Growth promoting genes                        Excessive and autonomous growth

Growth suprressing anti oncogenes             Refractoriness to growth inhibition

Genes regulating apoptosis and cancer         Escaping cell death by apptosis

Telomeres and telomerase in cancer            Avoiding cellular aging

Cancer angiogenesis                           Continued perfusion of cancer

Cancer dissemination                          Invasion and distant metastasis

Mutator genes and cancer                      DNA damage and repair system

Clonal aggressiveness                         Cancer progression and tumour
                                              heterogeneity
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    Growth promoting genes
Excessive and autonomous growth
• Mutated form of normal            • Mechanism of
  proto-oncogenes in                  activation—
  cancer—ONCOGENES
                                    • 1.point mutations and
• Mutation in structure of
  gene                                deletion
• Lacking of growth-                • 2.chromosomal
  promoting signals of                translocation
  protooncogenes
                                    • 3.gene amplification
• They act by over expression
  oto promote autonomous
  and excessive cellular
  proliferation
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    Growth suprressing anti oncogenes
    Refractoriness to growth inhibition

• RB GENE-retinoblastoma,osteosarcoma
• TP53 GENE-ca lung,head,neck ,colon,breast
• TGF-B-ca pancreas,colon,stomach
• APC GENE-ca colon
• OTHER ANTO ONCOGENES-WT 1 &2-wilm’s
  tumor,
• NF 1 AND 2-neurofibromas 1 & 2,
• BRCA1,BRCA2-ca breast.ovary
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Genes regulating apoptosis and cancer
   Escaping cell death by apptosis




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     Cancer angiogenesis
Continued perfusion of cancer




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  MUTATOR GENES AND CANCER
 DNA DAMAGE AND REPAIR SYSTEM
hereditory non poly posis colon cancer-lynch
syndrome
ataxia telangiectasia(at)-atm
xeroderma pigmentosum
bloom syndrome
hereditary breast cancer


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   Clinical aspects of neoplasia
                 • Effect of tumor on host
 Tumor host      • Host response against tumor

inter relation
     ship

                 • Histological
    Lab          • Cytological
                 • Histochemistry &cytochemistry
diagnosis of     • immunochemistry
                 • Electron microscopy
   cancer        • Tumor markers
                 • Modern aids
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                               Local
                              effects



                                         Ca
                                      cachexia

Effect of tumor
    on host


                                        fever




                                PNS
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• Compression                                                     • Asthenia
• Mechanical obstruction                                          • Anorexia
• Tissue destruction                                              • Cacchectin/TNF-a &IL-1
• Infarction
• Ulceration
                       Effect of tumor on host
• h/ge




                           Local effects           Ca cachexia




                                                 Paraneoplastic
                              Fever
                                                   syndrome

• In hodgkins ds                                                  • 10-15% in advanced ca
• Adenoca of kidney                                               • Eaanifestation of latent
• Osteogenic sarcoma                                                carliest m


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         Paraneoplastic syndrome
•   Endocrine
•   Neuromuscular
•   Osseus ,joints and soft tissue
•   Haematologic
•   Gastrointestinal
•   Renal sydrome
•   Cutaneous
•   Amyloidosis
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  PARA NEOPLASTIC SYNDROME
                  • Hypercalcaemia,cushing’s
  ENDOCRINE         syndrome,inappropriate anti diuresis
                  • Hypoglycaemia,carcinoid sydrome,polycythemia



                  • Myesthenia gravis
NEUROMUSCULAR     • Neuromuscular disorder




OSSEUS,JNT,SOFT   • Hypertrophic osteoarthropathy
    TISSUE        • Clubbing of fingers



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                   • Thrombophlebitis,non bacterialthrombotic
HAEMATOLOGICAL       endeocarditis,
                   • DIC,anaemia



GASTROINTESTINAL   • malabsorption




                   • Nephrotic syndrome
     RENAL


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              • Acanthosis nigricans,seborrheic
CUTANEOUS       keratosis,exfoliative dermatitis




              • primary
AMYLOIDOSIS   • secondary


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Host response




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           Host response
            Tumor                                       Immune
           antigens                                     response




                                                            Cell
                                                          mediated

 Tumor                  tumor                                        Inhibitory
specific              associated              humoral                /regulator
antigen                antigen                                           y

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        TUMOR MARKERS


ONCOFETAL   CYTOPLASMIC
                                        ENZYMES
 ANTIGENS     PROTEINS

                                 SECRETED
      HORMONES                    CANCER
                                 ANTIGENS


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    OCCUPATIONAL HAZARDS
       Etiology                           Site of malignancy
       arsenic                              Lung,skin, liver
       asbestos                                  Lung
       benzene                                 Leukemia
      benzidine                                 Bladder
      chromium                                   Lung
       radiation                          Numerous lacation
     Mustard gas                                 Lung
Polycyclic hydrocarbons                        Lung, skin
     Vinylchloride                       Angio-sarcoma of liver
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      Prognostic markers
  clinical                         Molecular
     Size                                    C-met

    Grade                                    CD 44

Vascular invasion                      Oestrogen receptors

     Nodal
                                          EGF receptor
  involvement

                                          Angiogenesis

                                            MAGNA
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Prevention
• prevention emphasizes
  the identification and
  manipulation of these
  genetic, biologic, and
  environmental factors
  in the cascade that is
  the causal pathway of
  cancer..
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          1.Health Education and
             Healthy Habits
          2.Cessation of Smoking.
          3.Increasing Physical
             Activity
          4.Diet Modification
          5.Energy Balancing
          6.Sun Avoidance
          7.Interventional
             Prophylaxis of Cancer.
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       Cancer chemoprevention
• This is the use of            • The potential points of
  specific natural or             intervention in the
  synthetic chemical              prevention of cancer
  agents to reverse,              are the genetic and
  suppress, or prevent            epigenetic changes in
  carcinogenesis before           its causal pathway
  the development of
  perceivable malignancy.



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        Cancer chemoprevention
• In chemoprevention               • The agents used for
  cancer can be prevented            chemoprevention are
  or controlled by                   substances having
  interfering with the               antimutagenic,
  factors that cause cancer          antioxidant, anti-
  initiation, promotion, or          inflammatory,
  progression                        antiproliferative, or pro-
                                     apoptotic activity (or a
                                     combination of these).
                                     We may call them
                                     ‘retrocarcinogenetic’
                                     agents.

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        Cancer chemoprevention
• Another area of                 • So it is postulated that
  chemoprevention is                prevention of these
  vaccination. It seems             diseases by vaccination
  that several infections           can effectively prevent
  can lead to the                   possible carcinosis too.
  development of
  carcinosis.




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            INTERESTINGLY..
  some known antioxidants and other
apparently anti carcinogenic agents have
   been found to be actually inducing
   cancers or increasing its incidence



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           Surgical prevention.
• Some organs in some persons have the increased
  tendency to attract cancer. This can be triggered
  by some diseases as well. For example there is
  increased chance for colon cancer in some
  individuals and this can get triggered by familial
  polyposis or ulcerative colitis. In such persons
  surgical removal of the organ or organs is advised
  and practiced as cancer prophylaxis. In another
  example orchiectomy is found to be effective for
  androgen deprivation in prostate cancer. Similarly
  oophorectomy is effective in hormone-
  dependent breast cancer.
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                  Screening.
• Screening is aimed at detecting malignancy early
  in asymptomatic individuals so that the morbidity
  and mortality can be reduced
• This is usually done in high-risk population.
• Some of the screening tests are sigmoidoscopy
  (colon cancer), breast clinical examination along
  with mammography (breast cancer), fecal occult
  blood testing (GI tract cancer), prostate-specific
  antigen (prostate cancer) etc. There are a number
  of genetic testing also.
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          MANAGEMENT


GENERAL              SURGERY                    CHEMOTHERAPY




      RADIOTHERAPY                      MEDICINAL




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               MATERIA MEDICA
• drugs those have a greater tendency for destruction work
  well in cancer both for palliation or cure. Toxic metals like
  Arsenic, Phosphorus, poisons like Lachesis, Crotalus, acids
  like Acid. nit., Acid. sulph. etc. are very effective.
• As for the second group of pain palliation Calendula,
  Chamomilla, Condurango, Echinacea, Euphorbinum, Nux
  vomica, Piscidium, Radium brom., Tarantula cub., X-ray etc.
  can be useful. It is worth mentioning again that if one have
  some symptom similarity also for the selection of these
  drugs it will work wonderfully
• Drugs like Carcinosin, Medorrhinum or Thuja can be used
  as intercurrent even for palliation.


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              Constitutional remedies
                                                     •   The Natums -Nat.murNat. s ulph




•   Thuja .                                          • The Natums-Nat.murNat.
•   Lachesis                                           sulph
•   Iodum .                                          • The Carbos:-Carb.veg,Carb.an
•   Silicea                                          • Graphitis
•   Lycopodium                                       • Causticum
•   Sulphur                                          • Ars.alb
•   Sepia
•   Petroleum
                                                     • Phosphorus
•   The Calcarias :-Cal.fl , Cal.carb,Cal.           • Mercurius
    Iod ,Cal. Oxalica Cal. Silicate                  • Cinnabaris or mercurius
•   Lapis albus (calcium silico fluoride)              sulphuratus rubber
•   The Kalis :- Kali carb ,Kali bi ,Kali iod –      • Nitric acid
    ,Kali ars,Kali cy-
                                                     • Nux vom & ignatia –



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            MY REFERENCES
• HARSHMOHAN’S TEXT
  BOOK OF PATHOLOGY
• www.similima.com
• www.indiatoday.in
• Park’s social and
  preventive medicine




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Thank you   www.similima.com   115

				
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