Major Types of Cancer

Major Types of Cancer • Leukemias and Lymphomas • Childhood Solid Tumors • Adult Solid Tumors Leukemias and Lymphomas • Leukemias are derived from the bloodforming cells of the bone marrow • Bone marrow cells are instrumental for the immune system Bone Marrow • Stem cells are present in the bone marrow • B-cells originate, differentiate and mature in the bone marrow – Antibodies are derived from B-cells • T-cells originate in bone marrow Fig 12-1 A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some "storage diseases" in which abnormal metabolic products are stored in certain bone marrow cells. Acute Lymphocytic Leukemia (ALL) • 3,600 new cases of ALL are diagnosed each year in the United States • Most common type of leukemia under the age of 19 • ALL results from an acquired (not inherited) genetic injury to the DNA of a single cell in the bone marrow http://www.leukemia-lymphoma.org/all_page?item_id=7049 ALL Characteristics • The rapid reproduction of the abnormal lymphocytes results in high white blood cell counts, and low levels of red blood cells http://www.acute-leukemia-and-symptoms.com ALL Treatment • The primary treatment of ALL is chemotherapy • Radiation therapy may be used in certain cases • Bone marrow transplantation is being studied in clinical trials • 80% children are cured of the disease. Children over one year of age and younger than ten are most likely to be cured. http://www.cancer.gov http://www.acute-leukemia-andsymptoms.com Treatment Phases for ALL • 1st stage is called induction therapy – purpose is to kill as many of the leukemia cells as possible and make patients go into remission. • Once in remission with no signs of leukemia, patients enter 2nd phase continuation therapy – Tries to kill any remaining leukemia cells. – A patient may receive chemotherapy for up to several years to stay in remission. http://www.cancer.gov ALL Survival Rates • Adults with ALL have a 30-40% long-term survival prognosis • Overall survival rates for children with ALL are 80% • Survival rates for adults with ALL drop to 10-20% percent when there are negative prognostic factors or if the individual is over 60 http://www.acute-leukemia-and-symptoms.com Acute myelogenous leukemia (AML) This microscope image shows AML cells (acute myeloblastic leukemia; also referred to as ANLL, acute nonlymphocytic leukemia). Certain internal cell structures are typical of AML. These include prominent nucleoli (red arrows) and cytoplasmic granules (grainy structures inside the cell which indicate some degree of cell maturation--black arrow). AML Characteristics • About 10,500 new cases of AML are diagnosed each year in the United States • Acute myeloid leukemia progresses quickly • AML can occur in adults or children http://www.cancer.gov AML Treatment • The primary treatment of AML is chemotherapy • Radiation therapy may be used in certain cases http://www.cancer.gov Acute Leukemia Symptoms • • • • • • • • • • Anemia Fatigue Fever Heightened rate of infection Blood clots Severe bleeding Easy bruising Bone pain Abdominal swelling (caused by swollen liver or spleen) Swollen lymph nodes http://www.acute-leukemia-and-symptoms.com Chronic Lymphocytic Leukemia(CLL) • Each year, nearly 7,300 people in the US are diagnosed with CLL • CLL results from an acquired (not inherited) injury to the DNA of a single cell in the bone marrow CLL Characteristics http://www.chronic-leukemia-and-symptoms.com CLL Treatment • After CLL has been diagnosed, tests are done to find out how far the cancer has spread in the blood and bone marrow http://www.cancer.gov CLL Stages • • • Stage 0 – There are too many lymphocytes in the blood, but there are no other symptoms of leukemia. Stage 0 chronic lymphocytic leukemia is indolent (slow-growing). Stage I – There are too many lymphocytes in the blood and the lymph nodes are larger than normal. Stage II – There are too many lymphocytes in the blood, the liver or spleen is larger than normal, and the lymph nodes may be larger than normal. • • Stage III – There are too many lymphocytes in the blood and there are too few red blood cells (anemia). The lymph nodes, liver, or spleen may be larger than normal. Stage IV – There are too many lymphocytes in the blood and too few platelets (thrombocytopenia). The lymph nodes, liver, or spleen may be larger than normal and there may be too few red blood cells (anemia). http://www.cancer.gov CLL Treatments • Watchful waiting – Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change. This is also called observation. During this time, problems caused by the disease, such as infection, are treated. • Radiation therapy – External radiation therapy uses a machine outside the body to send radiation toward the cancer – Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer – The way the radiation therapy is given depends on the type and stage of the cancer being treated. • Chemotherapy • Surgery – Splenectomy is surgery to remove the spleen http://www.cancer.gov Chronic Myelogenous Leukemia (CML) • About 4,300 new cases of CML are diagnosed each year in the United States http://www.leukemia-lymphoma.org/ CML Characteristics http://www.chronic-leukemia-and-symptoms.com CML Genetic Abnormality • Presence of a genetic abnormality in blood cells, called the Philadelphia chromosome http://www.leukemia-lymphoma.org/ CML Phases • Chronic phase – There are 5% or fewer blast cells in the blood and bone marrow. • Accelerated phase – There are 6% to 30% blast cells in the blood and bone marrow. • Blastic phase – There are 30% or more blast cells in the blood or bone marrow. When tiredness, fever, and an enlarged spleen occur during the blastic phase, it is called blast crisis. http://www.cancer.gov CML Treatment • Chemotherapy • Other drug therapy – Imatinib (Gleevec) is a new type of cancer drug, called a tyrosine kinase inhibitor. It blocks the enzyme, tyrosine kinase, that causes stem cells to develop into more white blood cells (granulocytes or blasts) than the body needs. • Biologic therapy – Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. • High-dose chemotherapy with stem cell transplantation – After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. Donor lymphocyte infusion (DLI) • • Donor lymphocyte infusion (DLI) Surgery – Splenectomy is surgery to remove the spleen. http://www.cancer.gov Chronic Leukemia Symptoms • • • • • • • • Fatigue Fever Weight loss Splenomegaly Anemia Neutropenia Hypogammaglobulinema Leukostatis Hodgkin’s Disease • 7,600 new cases of Hodgkin's disease in the US • About 1,300 people will die of the disease • Most common in: – early adulthood (ages 15-40) – late adulthood (after age 55) http://www.cancer.org HD • Malignant lymphoma (cancer of lymphatic tissue) • Reed-Sternberg cells: type of malignant B lymphocyte http://www.cancer.org HD subtypes • • • • Nodular Sclerosis Mixed Cellularity Lymphocyte Predominant Lymphocyte Depleted http://www.lymphoma-and-symptoms.com Treatment and Staging • Staging based on the number of lymph nodes affected • Treatments vary according to the type, stage and grade of the tumor, as well as the age and general health of the patient • 80% curable HD Treatment • • • • • • • Radiation therapy Chemotherapy combination therapies Steroids Bone marrow transplant Surgery Antibody-based therapies www.information-on-hodgkins-disease.com Non-Hodgkin’s Lymphoma • Lymphoma which does not involve ReedSteenberg cells • Tissues which may be affected: – Lymph nodes – Spleen – Thymus gland – Adenoids and tonsils – Stomach and intestinal tract – Bone marrow Treatment • Radiation therapy • Chemotherapy HD vs NHD • HD tends to spread to adjacent nodes • NHL often skips, randomly, to other parts of the body. http://www.lymphoma-and-symptoms.com HD vs NHD http://www.oncologychannel.com/nonhodgkins/facts.shtml Lymphoma Symptoms • painless swollen lymph nodes, in the neck, chest, armpit, groin or spleen • sweating and/or fever, especially at night • abnormal tiredness • weight loss • loss of appetite • persistent itching • persistent cough • persistent breathlessness (especially if the chest is affected) • pain in the lymph nodes after drinking alcohol http://www.lymphoma-and-symptoms.com Multiple Myeloma • Plasma cell cancer • 45,000 people in the United States living with multiple myeloma • 14,600 new cases of multiple myeloma are diagnosed each year http://www.multiplemyeloma.org/ MM Characteristics • • • • M protein Chemical messengers inhibit apoptosis Myeloma cells promote angiogenesis Mature myeloma cells may fail to activate the immune system http://www.multiplemyeloma.org/ MM Symptoms • Kidney problems • Pain – A common early symptom of multiple myeloma is pain in the lower back or in the ribs • Fatigue • Anemia • Recurrent infection http://www.multiplemyeloma.org/ MM Treatment • Chemotherapy • Bone marrow transplantation • Radiation therapy http://www.multiplemyeloma.org/ Childhood Solid Tumors • • • • • Brain tumors Neuroblastoma Wilms’ tumors Bone tumors Soft-tissue sarcomas Childhood Cancer Incidence Brain tumors • 18,300 Americans will be diagnosed with malignant brain, spinal cord and other nervous system tumors . Approximately 13,100 people will die from brain, spinal cord, and other nervous system cancer • http://www.nlm.nih.gov/medlineplus/tutorials/braincancer/ oc119101.html http://www.cancer.org Childhood brain tumors • Brain and spinal cords tumors comprise 21% of malignant childhood tumors • Most tumors are primary- originated in the brain • Benign and malignant http://www.cancer.org Childhood brain cancer types • Astrocytoma • Oligodendrogliomas • Ependymomas http://www.cancer.org Astrocytoma • Astrocyte cancer • A star-shaped cell of the nervous system which provides nutrients, support and insulation for neurons. • Spread through brain • Good prognosis for: – Juvenile pilocytic astrocytomas – Subependymal giant cell astrocytomas http://www.cancer.org Oligodendrogliomas • Oligodendrocytes • A type of glial cell that myelinates axons in the central nervous system. • Spread to other sites http://www.cancer.org Ependymomas • Ependymal cells • Line the ventricles (large spaces filled with CSF) • Ependymomas may block the exit of CSF causing the ventricle to become very large - a condition called hydrocephalus http://www.cancer.org % Cancer http://www.cancer.org Brain tumor treatment • Treatment options often depend on the type of tumor and its location within the brain • Complete or near complete removal of the tumor is often possible. • If the tumor cannot be completely removed, radiation therapy and/or chemotherapy may also be given. http://www.cancer.gov Treatment • Surgery • Radiation therapy • Chemotherapy http://www.cancer.gov Neuroblastoma • Neuro indicates "nerves," while blastoma refers to a cancer that affects immature or developing cells • Neurons (nerve cells) are the main component of the brain and spinal cord and of the nerves that connect them to the rest of the body http://www.cancer.org Neuroblastoma Statistics • Neuroblastoma is by far the most common cancer in infants • 3rd most common type of cancer in children • There are approximately 650 new cases of neuroblastoma each year • In as many as 7 of 10 cases, the disease is not diagnosed until it has already spread (metastasized) http://www.cancer.org Neuroblastoma treatment • Surgery, chemotherapy, and/or radiation therapy • Two or all three of these treatments may be combined for some children http://www.cancer.org Treatment • Low risk: Surgery, except for those few children that might be symptomatic. Chemotherapy may be required to control the symptoms. • Intermediate risk: For children at intermediate risk, 4 to 8 cycles (1 or 2 courses) of chemotherapy are usually given before or after surgery to control the disease. Second look surgery (discussed below) or radiation therapy may also be required. • High risk: For children at high risk, very intensive chemotherapy including stem cell transplant (bone marrow or peripheral blood) is being used. Surgery and/or radiation may be part of this treatment regimen. Biologic agents such as 13cis retinoic acid are often given for 6 months after therapy is completed. http://www.cancer.org Prognosis Wilms’ Tumor • Kidney cell cancer • Accounts for 95 % of pediatric renal cancers occurring before age fifteen Stages • Stage I: Cancer is found only in the kidney and can be completely removed by surgery • Stage II: Cancer has spread beyond the kidney, to fat or soft tissue or blood vessels. The cancer can be completely removed by surgery • Stage III: Cancer has spread within the abdomen and cannot be completely removed by surgery. The cancer may have spread to the lymph nodes (small bean-shaped structures found throughout the body that produce and store infection-fighting cells) near the kidney, blood vessels, or the peritoneum (tissue that lines the abdomen and covers most organs in the abdomen) • Stage IV: Cancer has spread to other parts of the body, such as the lungs, liver, bone, and/or brain • Stage V: Cancer cells are found in both kidneys when the disease is first diagnosed Treatment • Surgery • Chemotherapy • Radiation therapy Surgery • Partial nephrectomy removes the cancer and part of the kidney around the cancer. This operation is usually used only in special cases, such as when the other kidney is damaged or has already been removed. • Simple nephrectomy removes the whole kidney. The kidney on the other side of the body can take over filtering blood. • Radical nephrectomy removes the whole kidney with the tissues around it. Some lymph nodes in the area may also be removed. Bone Tumors • Osteosarcoma – osteoblasts (cells that manufacture bone) – Sometimes spreads elsewhere • Ewing’s tumors Treatment • Benign bone tumors may not require treatment but may be assessed periodically to check for progression or regression. Surgical removal may be necessary. • Treatment for malignant tumors that have spread to bone depends upon the primary tissue or organ involved. Radiation therapy with chemotherapy or hormone therapy is commonly used. Treatment • Primary malignant tumors of bone (tumors that start in the bone) are rare and require treatment at centers with experience treating these cancers. • After biopsy, a combination of chemotherapy and surgery is usually necessary. Radiation therapy may be needed before or after surgery. Ewing’s Tumor • James Ewing • Most frequently occurs in teenagers • Symptoms: pain, stiffness, tenderness in the bone, fever, pain, elevated white blood cell count Ewing’s Tumor Ewing’s Tumor Treatment • Surgery • Radiation therapy • Chemotherapy • Greater than 60% of patients are longterm survivors Soft-tissue • Soft tissue refers to tissues that connect, support, or surround other structures and organs of the body. • Soft tissue includes muscles, tendons (bands of fiber that connect muscles to bones), fibrous tissues, fat, blood vessels, nerves, and synovial tissues (tissues around joints). Soft-tissue Sarcomas • About 50% occur in the extremities (the arms, legs, hands, or feet) • 40% occur in the trunk (chest, back, hips, shoulders, and abdomen) • 10% occur in the head and neck Soft-tissue Sarcoma • In 2000: estimated 8,100 new cases of soft tissue sarcoma in the United States • Approximately 850 to 900 of these cases will occur among children and adolescents under age 20 Symptoms • Early: painless lump or swelling • Later: pain or soreness, as it presses against nearby nerves and muscles Treatment • Surgery • Radiation therapy • Chemotherapy Adult Solid Tumors Lung Cancers • Accounts for approximately 15% cases • Leads to 28% cancer deaths • 80-90% lung cancers caused by smoking Risk factors • Tobacco use • Radon exposure • Asbestos exposure Oncogenes/TSG • Mutations in the p53 tumor supressor gene • RB mutations • Ras oncogenes Types of lung cancers • Small-cell carcinoma – cells appear small and round when viewed under the microscope (also called oat cell lung cancer) • Nonsmall-cell carcinoma – includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma Small Cell Lung Cancer Adenocarcinoma • Adenocarcinoma usually develops on the outer boundaries of the lungs and is more commonly found in women than in men. Symptoms • coughing, chest pain, and shortness of breath • Consult doctor for: – – – – – – – – – – A cough that doesn’t go away Shortness of breath Chest pain that doesn’t go away Wheezing Coughing up blood Hoarseness Swelling of the face and neck Loss of appetite Unexplained weight loss Unusual tiredness http://www.cancer.gov Diagnosis • • • • X-ray Sputum Biopsy Bronchoscopy. The doctor puts a bronchoscope (a thin, lighted tube) into the mouth or nose and down through the windpipe to look into the breathing passages. Through this tube, the doctor can collect cells or small samples of tissue. Needle aspiration. A needle is inserted through the chest into the tumor to remove a sample of tissue. Thoracentesis. Using a needle, the doctor removes a sample of the fluid that surrounds the lungs to check for cancer cells. Thoracotomy. Surgery to open the chest is sometimes needed to diagnose lung cancer. This procedure is a major operation performed in a hospital. • • • Treatment • Surgery • Chemotherapy • Radiation • 5 year survival rate 15% Colon and rectum • 15% cancer incidence • 12% mortality • Colon cancer twice as common as rectal carcimona Risk factors • • • • Family member Inflammatory bowel disease Ulcerative colitis High fat/low fiber diets Mutations • Early rask oncogene, APC and MCC tumor suppressor genes • Progression accompanied by mutations in p53 and DCC tumor suppressor genes Symptoms This cancer usually does NOT exhibit signs in its early stages. As the disease progresses, any of the following may be seen: · Blood in the stool · Diarrhea · Constipation · Bowel obstruction, causing nausea, vomiting and abdominal distention · Abdominal pain · Pelvic pain · Anemia · Weight loss · Loss of appetite · Fatigue http://www.colorectal-cancer.net Treatments • • • • Surgery Chemotherapy Radiation therapy Other types of treatment are being tested in clinical trials, including biologic therapy http://www.cancer.gov Breast Cancer • 14% cancers • 9% cancer mortality • 1/10 women will develop disease Risk factors • • • • • • • Mother/sisters with breast cancer Cancer in one breast No children 1st child after the age of 35 Early menarche (<12) Late menopause (>55) Obesity Types • ~90% arise in the ducts • Can get lobular and Paget’s (nipple) Treatment • Surgery/radiation • Chemotherapy • Hormone therapy • Carcinoma in situ 90% curable, only 20% if metastasized to distant sites Prostate Cancer • 10% cancer cases • 6% cancer mortality • 1/11 men will develop disease • 80% cases >65 age Treatments • Surgical treatments involves removal of the entire prostate gland and surrounding tissue • Radiation treatment deals with unwanted side effects