WHAT IS CANCER AND CANCER TREATMENT? A Layperson

1
WHAT IS CANCER AND CANCER TREATMENT?A
Laypersons Guide

• Rob Rutledge MD FRCPC

2
PURPOSE OF TALK

• Understanding helps you feel in control
• Explains how treatments work
• Understand medical system
• Make better decisions
• Get better care

3
OVERVIEW

• Normal cell growth
• How cancer cells are made
• Properties of cancer cells
• The immune system
• Making the diagnosis of cancer
• Staging tests
• Surgery, radiation and chemotherapy
• Talking to your doctor and nurse

4
WHAT IS CANCER?

• Cancer occurs when some cells in your body grow
  in an uncontrolled way
• Many different types of cancer
• The cancer is usually named after the part of the
  body from which it came
• eg. Breast carcinoma from the breast
• Lymphoma from the lymph system
• Each persons cancer is different

5
CELLS IN THE BODY

• The human body is made of trillions of cells
• Each cell has its own job
• Skin cells protect our surface

6
NORMAL CELLS IN YOUR BODY

• Red blood cells deliver oxygen
• Platelets help the blood clot
• White blood cells fight infection
• Many others
• Most are quiet - not dividing
• Communicate with other cells

7
THE NORMAL CELL

• The nucleus is the control centre
• The DNA are the instructions for the cell

8
(No Transcript)
9
HOW CELLS ARE REPLACED

• Many cells die from normal wear and tear
• Dying cells are replaced when cells divide

10
Cell division
11
WHEN CELLS DIVIDE

• One parent makes two daughter cells
• The new cells are exactly the same
• The same control centre
• The same book of instructions
• Normal controlled growth
• Number of cells made number that die

12
Normal cell division
13
Controlled cell growth

• Sometimes cells need to grow fast eg. With
  injury or growth
• Always under control
• Always stop growing fast afterwards

14
Cut in skin
15
Cut in skin
16
Cut in skin
17
Cut in skin
18
THE INSTRUCTIONS IN THE CELL

• Each cell has the control centre (nucleus)
• Instructions manual is made of words and
  sentences (DNA)

19
How cancer cells are made

• Cancer cell is a normal cell with
  many mistakes
• Three ways the mistakes are created
• 1) Born with mistakes in all cells - genetic
• 2) Accident when cell divides - mutation
• 3) Substance causing cancer - Carcinogen
• Toxins, sunlight, viruses, fatty diet

20
PROBLEMS WITH THE CELLS INSTRUCTIONS

• If the instructions read
• STOP dividing after coming in contact with more
  cells
• is changed to
• KEEP dividing after coming in contact with more
  cells
• The cell wont stop growing!

21
PROBLEMS WITH THE CELLS INSTRUCTIONS

• If the instructions read
• Divide if hormone X is on the receptor is
  changed to
• Divide if hormone X,Yor Z is on the receptor
• The cells will keep on dividing

22
Why dont we see more cancers

• The repair system is constantly cleaning
• The mistake is in cell that is not dividing
• An unimportant word or sentence is hit
• The mistake is permanent after cell division
• cells that divide often are at risk

23
WHAT IS CANCER

• Normal cell that has begun to grow fast and in an
  uncontrolled way
• Requires dozens of changes to the cell
• Cancer cells will grow into normal tissue
• Can get into lymph and blood system to grow
  colonies at a distance (metastasis)

24
Definitions

• Precancerous has many but not all changes
• Benign means just grows in place

25
EACH PERSONS CANCER IS DIFFERENT

• Each cancer has different mistakes and a
  different personality
• You cannot compare yourself to others
• You can always do better than expected!

26
HOW A TUMOR GROWS

• A tumor is a collection of cancer cells
• A tumor starts as one cancer cell
• 1 cell then 2 then 4 then 8 ..
• Tumor growth if more cells are made than die
• Tumor doubles in a few months
• Tumor - 1 cm in size has a billion cells

27

• CREATION OF A TUMOR

28

• Cancer
• Cells

29
HOW CANCERS CAUSE PROBLEMS

• Problem at the primary site, lymph nodes, and
  elsewhere in the body (metastasis)
• Lump can cause pain, bleed, block a tube, slow
  down an organ like kidney
• Affect whole body - fatigue
• OUR TREATMENTS KILL CANCER CELLS TO STOP THESE
  PROBLEMS

30
CANCER CELLS ARE FRAGILE

• A few more changes will incapacitate the cell
• Only 1 in 1000 cancer cells can reproduce
• A tumour will outstrip its own blood supply
• Shrink the tumor by ? growth, ?destruction
• Our immune system can kill cancer cells

31
WHITE BLOOD CELL
32
Antibodies to cancer cells
Antibodies
33
A POSITIVE ATTITUDE ENHANCES IMMUNE FUNCTION !
34
UNDERSTANDING THE MEDICAL SYSTEM
35
MAKING A DIAGNOSIS

• Discovering the cancer by
• a) symptoms - tests
• b) no symptoms screening
• eg. mammogram, blood test
• Early detection - better

36
MAKING THE DIAGNOSIS

• Biopsy - take a piece of tumor
• Look under microscope
• Proves its cancer
• Type of cancer
• Starts a process

37
(No Transcript)
38
STAGING THE CANCER

• Has the cancer spread
• Primary site, nodes, distant
• Tells about treatment and
• prognosis (likely outcome)

39
STAGING THE CANCER

• Blood tests
• Imaging - X-rays
• CAT Scans
• Bone scan
• MRI
• Grade - microscope
• Receptors on cancer cell
• Genetics

40
Cross section of a bone with one cancer cell
41
DOCTORS QUESTIONS

• What is the stage?
• Can the patient be cured?
• What is the best treatment?
• How fit is the patient?
• What does the patient want?

42
THE CONSULTATION

• Referral to Oncologist
• Consultation - first visit
• Surgeon
• Medical Oncologist - chemo
• Radiation Oncologist

43
SURGERY

• Usually if tumor in one area
• Operation - tumor removed
• Effect on normal tissue
• There is a chance of cancer left behind
• already spread but not visible

44
CHEMOTHERAPY

• Whole body treatment
• Injection into veins or pills
• Kills cancer cells
• Given in courses over weeks
• Affects fast-growing cells

45
CHEMO SIDE EFFECTS

• The type of chemo differs
• Each person is different
• Your doctor monitors
• Specific side effects for each

46
CHEMO SIDE EFFECTS

• Whole body side-effects
• Fatigue / tiredness
• Nausea and vomiting
• Hair loss
• Low blood cells
• Sore mouth and throat

47
RADIATION TREATMENT

• Radiotherapy, cobalt
• Ionizing x-rays - kills cells
• External and internal
• Side effects in the area only
• Spare as much normal tissue

48
RADIATION TREATMENT
49
HOW TREATMENT WORKS
50
HOW TREATMENT WORKS

• Damage the cancer cells
• Mistakes in instructions
• Cells cant divide
• Cancer cells die

51
HORMONE TREATMENT

• Blocks hormones so cells die
• Taken as pill or injection
• Sometimes increase cure
• Side effects hot flushes

52
CAN I BE CURED?

• Cured never comes back
• Adjuvant extra treatment in case there are
  cells left over
• In remission cancer cells are in the body
• Aim for many years of great quality
• Treatment if benefits gt risks

53
EXAMPLE CASE

• 50 yr old lady - mammogram
• Biopsy shows cancer
• Lump / lymph nodes removed
• Staging tests all clear
• 20 chance cells elsewhere

54
CASE (Continued)

• Should she have chemo ??
• Will improve survival by 5
• 12 weeks and side effects ??
• Radiation kills cells in breast

55
OTHER SERVICES

• Nurse can be invaluable
• Referrals to any service
• Social worker can co-ordinate
• Nutrition
• Psychology
• Pastoral care
• Cancer society- Network

56
CHOICES

• You can decide
• a) Use doctor as consultant
• b) Tell doctor to decide
• Understand - pros and cons
• Get more information or a second opinion

57
CONSENT FORM

• Permission for treatment
• Consent - a discussion
• Outlines options
• Lists common and severe side effects
• Chance for questions

58
CLINICAL TRIALS

• Trial measure scientifically
• Research - find better way
• Cleared by ethics board
• Closer follow-up
• You dont have to agree

59
HOW TO GET MOST FROM YOUR DOCTOR

• Before visit
• Symptoms and medications
• Ask family or a friend along
• Write down questions

60
HOW TO GET MOST FROM YOUR DOCTOR

• At the doctors office
• Be honest and open
• Feeling overwhelmed - say so
• Ask important question first
• Take notes - clarify

61
HOW TO GET MOST FROM YOUR DOCTOR

• After visit
• Keep a journal
• What you learned
• What to do if side effects
• KNOW WHO TO CALL

62
PROBLEMS WITH DOCTOR

• Bring family or friend
• Call to clarify or for appt.
• Ask for second opinion
• Doctor should serve you

63
SUMMARY

• Understand the system to get good care
• Treatment is individualized
• Know yourself
• QUESTIONS

64
(No Transcript)
65
(No Transcript)
66
SUMMARY

• Cancer occurs when a normal cell starts to grow
  in an uncontrolled way
• Treatment can kill off the cancer cells
• Learn more to make good choices
• Time for questions

67
NEGOTIATING THE MEDICAL SYSTEM

• Educate yourself - ask questions
• Identify one Oncologist as the contact
• Be clear about whats important to you
• If poor communications - bring family or a friend
  or ask for a second opinion