A process of physical and biological changes that occur when normal healthy cells are transformed into cancer cells

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1 What is Cancer?

2 A process of physical and biological changes that occur when normal healthy cells are transformed into cancer cells

3 What is Cancer? Cancer is an umbrella term Describes a collection of diseases that share common features and characteristics Estimated there are more than 200 types of cancer Wide diversity of types of cell in the body each has the potential to develop into a cancer

4 Incidence The number of people who have, or have had cancer Those who are most likely to be affected The most commonly occurring cancers

5 CANCER in UK - Incidence Effects 1 in 2 More than a third (36%) of cancers are diagnosed in people aged 75 and over. Cancer relatively rare in children less than 1%. 2 nd most common cause of death I in 4 deaths is caused by cancer 4 in 10 cancer cases in the UK are linked with lifestyle choices Worldwide population 6 billion 14.1 million new cases worldwide cancer (CR UK 2012) 8.2 million deaths (CR UK 2012) Will rise to 20 million by 2020 with 12 million deaths

6 The 10 Most Common Cancers: 2013 Numbers of Cases, Males, UK

7 The 10 Most Common Cancers: 2013 Numbers of Cases, Females, UK

8 The 20 Most Common Cancers in 2013 Number of New Cases, UK

9 Cancer as a chronic disease Chronic diseases Shaped by periods of acute and intensive illness followed by periods of remission People with cancer are living for longer Challenge of living with a chronic, but life threatening illness Challenges the portrayal/ perception of cancer Concept of the survivor having increasing relevance in cancer care

10 Cultural perspectives Images and beliefs surrounding cancer Cancer has a special mystique Given meaning far beyond the rational and biological facts of the disease (Flanagan and Holmes 2000) Negative associations create the context within which patients live with cancer Patients and family have to cope with more than the physical consequences of cancer

11 What causes cancer? Tobacco Pollution Car exhaust fumes Radiation Sun Mines Chemicals Benzene Formaldehyde Mineral oils Asbestos Lifestyle alcohol, diet, obesity Age Weak immune systems organ transplant Viruses Human Papilloma Virus Cervix Epstein Barr Virus (glandular fever) HIV Burkitts Lymphoma Inheritance & familial cancer

12 Genetic make up There need to be a number of genetic mutations within a cell before it becomes cancerous An inherited mutation does not mean you will get cancer In some cases an inherited mutation can make it more likely statistically you will develop cancer during your lifetime This is called genetic predisposition

13 Normal cell growth Carefully controlled process reproduce themselves exactly stop reproducing at the right time stick together in the right place Cell division triggered by the death of a cell Self destruct if they are damaged Cell reproduction and cell death carefully balanced

14 Damaged Gene Cell clock decides when it is time to divide Damaged genes will cause errors in the code and can lead to mutation Specialist genes regulate growth if these are damaged growth may go on uncontrolled More mutational changes can occur causing the cells to look and behave less like the parent cells. DNA Gene A

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16 Characteristics of cancer cells Growth Reproduction not subject to the constraints exerted on a normal cell Loss of degree of cell differentiation Mutational differences The ability to spread Loss of contact inhibition Cancer cells loose contact inhibition and continue to divide when they come into contact with other cells Prolonged or indefinite life span Normal cells have a fixed life span and stop dividing or functioning when that point is reached

17 Growth Doubling time Time it takes for a cancer to double in size 30 times One billion cells (marble size) Can be detected by X- ray or palpation 10 more doublings One trillion Usually the point at which life cannot be sustained For much of its growth cancer is undetectable

18 The rate of growth The rate of growth for different cancers varies greatly from hours to years Cancer growth is often a sustained and constant process rather than a rapid one The characteristics of the parent cell influence the rate of growth static, expanding, renewing

19 However! The rate of growth. Growth is not always a constant process Many cancer cells die Poor blood supply Influence of immune and inflammatory system Unsuccessful mytosis It is unknown whether all cancers grow exponentially throughout their development Some may slow down as they get larger The influence of the doubling time is important but the rate of growth can be more complicated

20 Growth curve for cancer Lethal limit Treatment Limit of detection Immune system can handle Cure

21 The degree of cellular differentiation The degree to which the cancer cell resembles the parent cell Well differentiated close resemblance Undifferentiated little or no resemblance Poorly differentiated tend to divide more frequently and spread more easily

22 The ability to spread metastases

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24 Benign tumours Usually grow quite slowly Do not spread to other parts of the body Usually have a covering made up of normal cells Cells are quite similar to normal cells They only cause problems if they grow very large, become uncomfortable or unsightly, press on body organs, take up space inside the skill or release hormone's that affect how the body works

25 Tests and investigations X Ray Blood tests Bone marrow Bone scan CT scan Cystoscopy Endoscopy Lumber puncture MRI PET Ultrasound

26 Tumour Markers Tumour markers are substances found in the blood, urine, stool and other bodily fluids or tissues of some patients with cancer Tumour markers may be used to help cancer diagnosis Can predict a patients response to treatment

27 Treatment What do we need to know about cancer before we can treat it? Size Has it moved from the tissue of origin Has it spread Where has it spread Are there any lymph nodes involved How many lymph nodes