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What are the five most common types of cancer?
Breast
Prostate
Lung and Bronchus
Colon and Rectum
Melanoma of the skin
What is cancer?
A disease in which some of the body's cell grow uncontrollably and spread to other parts of the body
What is a tumor?
A abnormal cell growth
What can cancer cells do inside the body?
§ Grow in the absence of signals telling them to grow.
§ Ignore signals that normally tell cells to stop dividing or to die.
§ Invade into nearby areas and spread to other areas of the body.
§ Tell blood vessels to grow toward tumors.
§ Hide from the immune system.
§ Trick the immune system into helping cancer cells stay alive and grow,
§ Accumulate multiple changes in their chromosomes, such as duplications and deletions of chromosome parts.
§ Rely on different kinds of nutrients than normal cells.
How can cancer be genetic?
§ It is caused by genes that control how cells function, grow and divide.
§ Genetic changes cause cancer because of errors that occur as cells divide, damage to DNA caused by harmful substances in the environment (carcinogens), inherited from parents ( germline).
True/false: with increase in age the bodies ability to repair or eliminate damage DNA before they turn cancerous decreases.
True
These cancer genes are considered accelerators that push cells to divide:
Oncogenes
These cells are the normal cells that once activated turn into
Oncogenes:
Proto-oncogenes
What are two examples of oncogenes?
ALK (lung cancer)
BCR-ABL ( chronic myeloid leukemia)
These genes are considered like car brakes:
Tumor suppressor genes
What is the normal function of tumor suppressor genes?
They are supposed to inhibit inappropriate cellular growth and proliferation.
What is the mechanism behind tumor suppression genes causing cancer?
There are alterations that can lead to loss of control over normal growth.
What are examples of tumor suppressor genes that can cause cancer?
BRCA( breast, ovarian)
Tp53
What is the normal function of DNA repair genes?
They help to repair the DNA that is damaged due to carcinogens.
How do DNA repair genes cause cancer?
Deficiency in these genes allow for accumulation of genetic alterations
What happens if DNA repair genes does not correct the problem?
The error is not corrected and this leads to alterations that activates oncogenes or inactivates tumor suppressor genes.
What are examples of DNA repair genes?
PARP1
MGMT
What are risk factors for developing cancer?
§ Older age
§ Smoking, high-fat diet , certain occupations/working with toxic chemicals.
§ Family history: Inheritance and genetics
§ Genetic disorders: wisott-aldrich, Beckwith Wiedemann syndrome
§ Viral infections: No vaccine: EBV, HIV, polyomavirus. Vaccine: Hepatitis B, HPV
§ Environmental exposure: pesticides, fertilizers, coal, benzene, radiation
§ Cancer therapy: alkylating agents, radiation
What ways can you prevent cancer?
§ Medications ( breast and colon have medications that can help reduce risk)
§ Avoid things that are known to cause cancer.
§ Screening tests
§ Treatment for infections that are known to increase the risk of cancer ( hepatitis C, HIV, H. Pylori)
§ Surgery
§ Vaccines
What are some risk reducing medical interventions for cancer?
§ Colorectal cancer chemoprevention: low dose aspirin
§ Breast cancer chemoprevention: tamoxifen, raloxifene, exemestane, anastrozole
§ Breast, ovarian, uterine cancer surgical prevention: mastectomy, saplingo-oophrorectomy
What lifestyle things can a person do in order to help lower risk of getting cancer?
§ Do not smoke.
§ Have a healthy weight.
§ Exercise
§ Eat healthy.
§ Limit alcohol intake
§ Protect skin from harmful UV rays.
§ Assess cancer risk, family history, individual history.
§ Have regular check0ups and cancer screening tests.
§ Get vaccinated ( HPV, HepB)
§ Use sunscreen.
Warring signs of Cancer:
§ C: Change in bowel or bladder habits.
§ A: a sore that does not heal.
§ U: unusual bleeding or discharge.
§ T: thickening or lump in breast or elsewhere.
§ I: indigestion or difficulty swallowing.
§ O: obvious change in wart or mole.
§ N: nagging cough or hoarseness.
Breast cancer screening: females
Age 40 - 44: yearly mammograms are optional
Age45- 54: begin yearly mammograms
Age greater than or equal to 55: mammograms every 2 years or continue yearly
Prostate cancer: males
Age greater than or equal 50
Colon Cancer Screening: Males and Females
Age > 45:
Stool based tests ( if positive follow up with colonoscopy): fecal occult blood test or fecal immunochemical test ( yearly) , stool DNA test ( 3 years)
Visual exams of colon/rectum: Colonoscopy ( gold standard: every 10 years) , sigmoidoscopy ( 5 years) , CT colonography ( 5 years)
Lung Cancer Screening: Males and Females
Age 50-80
Low dose CT scan of chest if all of the following:
> 20 pack year smoking history
still smoking or quit smoking < 15 years.
Cervical Cancer Screening: Females
Age 25-65
Pap smear ever 3 years or Pap Smear + HPV DNA test every 5 years
What is the journey of a cancer patient?
-they get diagnosed and worked up
-their cancer gets put into the stage it is in
-they start undergoing treatment
-their response to treatment is evaluated
-the patient is monitored for side effects or adverse events
-if the patient is not responding they may have a relapse or cancer is progressing
- some patient may be getting better/cured.
How does a patient get diagnosed with cancer?
-The doctor will take a biopsy of the tissue
-After biopsy is taking than there is a pathological assessment to help report a definitive diagnosis to identify drug targets
-Imaging happens in order to help determine the extent of the disease
-extended lab panel helps to prepare for treatment, risk stratify patient
-rule out other diseases that may look like cancer
What is grading in regards to cancer?
`-it is the description of a tumor based on how abnormal the tumor cells and the tissues look under the microscope
What is staging in regards to cancer?
-it helps to define the extent of the disease
What are the methods used to help a doctor stage a patients cancer?
-MRI
-CT scan
-PET
What are the types of staging?
-Stage 0: abnormal cells are present but have not spread to nearby tissue
-Stage I-III: cancer is present. The higher the number the larger the cancer tumor and the more it has spread into nearby tissue.
-Stage IV: The cancer has spread to distant parts of the body
Solid tumor staging:
-T:
size and extent of primary tumor
T0: main tumor cannot be found
T1-4: higher the number= larger tumor or more it has grown into nearby tissues
-N:
Number of nearby lymph nodes that have cancer.
N0: no cancer in the nearby lymph nodes
N1-3: higher number= more lymph nodes that contain cancer
-M:
Whether the cancer was metastasized or spread
M0: cancer has not spread to other parts of the body
M1: cancer has spread to other parts of the body
What are the goals for cancer treatment?
§ Curative intent: for patient administered to patients with local or regional disease. Administered to cure the patient.
§ Life extending extent: administered to patients with metastatic disease to slow progression of cancer and prolong survival by months to years.
§ Palliative intent: given to patients with the goal of reducing symptoms.
Performance Status
What are some treatments that are used to treat cancer?
o Surgery:
§ Remove the tumor.
§ Debulk a tumor
§ Ease cancer symptoms.
o Radiation:
§ Use of high doses of radiation to kill cancer cells and shrink tumors by damaging their DNA.
§ Takes days or weeks of treatment before DNA is damaged enough for cancer cells to die.
o Antineoplastic agents
o Stem cell transplant
What is the treatment plan for treating solid tumors?
o Neoadjuvant
o Surgery
o Adjuvant
o Maintenance
What is the treatment plan for treating hematologic malignancy?
o Induction
o Consolidation
o Maintenance
What is considered complete response/remission?
-complete disappearance of all cancer without evidence of new disease for at least 1 month after treatment
What is considered partial response to cancer treatment?
-25%-30% or greater decrease in tumor size from baseline and no evidence of any disease for at least 1 month.
What is considered stable disease?
-no change in tumor size
What would be considered progression in disease?
-20-25% increase in size or development of new lesions while receiving treatment
What is considered relapse, recurrent or refractory in cancer treatment?
-return of disease or the signs and symptoms of disease after a period of improvement
-recurs after eradicated
-refractory to treatment ( no response to treatment)
This is when a high dose combination is giving initial to induce a complete response:
-Induction
This happens after successful induction to kill undetectable disease and prolong remission:
-consolidation
This type of treatment happens before a person receives surgery in order to shrink tumor to allow for complete surgical resection:
-neoadjuvant
This type of treatment happens after surgery to help destroy residual cells and prevent recurrence:
-adjuvant
What happens during maintenance period?
-treatment is continued for a long period of time after response.
-Prevent relapse and prolong PFS
What happens in the salvage stage of cancer treatment?
-treatment after the cancer has not responded to convential therapies to induce a response.
What happens in palliative care for cancer patients?
-Provides relief from cancer burden patients.
-Help to increase the quality of life
What is the role of an oncology pharmacist?
o Prescribe anticancer treatment and supportive care.
o Counsel patients in clinic on their anti-cancer treatments and supportive care regimens.
o Review labs, allergies, drug-to drug interactions, and review clinic guidelines.
o Monitor patients on active therapy and make recommendations to adjust treatment and/or add supportive care treatments for treatment-related adverse effects.
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