ONCOLOGY epidemiology.

The reasons of malignant tumor formation.

Morbidity, structure, statistics and dynamics.
International TNM classification of malignant tumors.
Organization and tasks of oncological care.
Fight against cancer, dispensary, prophylaxis.
Ivano-Frankivsk National Medical University
Department of Oncology
Oncology
(from greek oncos - is a tumour, lgos - is
science)
- is science, which studies reasons of
beginnings, mechanism of development and
clinical symptoms of tumor, and also methods of
their diagnostics, treatment and prophylaxis.
Tumors
Benign
mature
expansive growth
atypical tissue
no metastasis
Malignant
immature
infiltrative growth
atypical cells
metastasis
Cancer
Cancer is one of the most common diseases in
the developed world:
1 in 4 deaths are due to cancer
1 in 17 deaths are due to lung cancer
Lung cancer is the most common cancer in men
Breast cancer is the most common cancer in
women
There are over 100 different forms of cancer
Cancer
The division of normal cells is precisely
controlled. New cells are only formed for growth
or to replace dead ones.
Cancerous cells divide repeatedly out of control
even though they are not needed, they crowd
out other normal cells and function abnormally.
They can also destroy the correct functioning of
major organs.
For 75 years of life malignant tumours
strike each 3-4 man and
each 4-5 woman!
Notice about the patient whose disease has
been diagnosed for the first time in his\her life
as cancer or other malignant neoplasm form
090/ should be filled by the doctor, who has
detected this disease. This notice should be
given within three days and the patient will be
sent to the regional oncology dispensary.

Protocol of the neglected cancer case
form 027-2/
Medical records
necessary to fill on the cancer patients:
Visual forms of cancer:
Tumors of lips, cavity of mouth, skin,
thyroid, eye, breast, external genitals
and cervix of the uterus, penis and
prostate, anus and ampullary part of
rectum.
Morbidity of malignant tumors

National cancer-registr of Ukraine, 2006
Men Women
19,5% Breast
12,8% Skin
8,2% Uterine corpus
6,5% Colon
6,4% Stomach
6,2% Cervix
5,3% Rectum
4,9% Ovary
4% Lung and bronchus
2,5% Pancreas
23,7% All other sites
Lung and bronchus 19,5%
Skin 10%
Stomach 9,6%
Prostate 7,6%
Rectum 6,1%
Colon 5,8%
Urinary bladder 5,5%
Kidney 3,6%
Pancreas 3,4%
Larynx 3,3%
All other sites 25,6%

Mortality of malignant tumors
National cancer-registr of Ukraine, 2006
Men Women
20,3% Breast
10,2% Stomach
8% Colon
6,8% Rectum
6,2% Ovary
5,9% Lung and bronchus
5,7% Cervix
5,4% Uterine corpus
4,4% Pancreas
2,8% Leukemia
24,3% All other sites
Lung and bronchus 26%
Stomach 12,1%
Prostate 6,3%
Rectum 6,2%
Colon 5,7%
Pancreas 4,5%
Urinary bladder 4,3%
Larynx 3,3%
Kidney 3,2%
Oral cavity 3%
All other sites 25,4%

The notice should contain all components of
oncology diagnosis pointed out correctly:


1. Name of the tumor according to the international
morphological classification of malignant neoplasms.
2. Localization, including the name of organ or anatomic
part.
3. Stage according to the NM system.
4. Clinical group, which is considered as a relative notion
and determines doctors approaches in relation to the
diagnostics, therapy and medical examination of a
cancer patient.
Morphological classification of malignant
neoplasms
Cancer combines tumors from epithelium (from pavement epithelium
- epidermoid cancer, from glandular epithelium - adenocarcinoma)

Sarcoma is a malignant tumor from connective tissue (fibro-,
chondro-, osteo-, rhabdomyo- and leiomyosarcomas, liposarcoma).

Hemoblastoses are malignant neoplasms of blood system
systemic leukemia
tumors (lymphogranulomatosis and non-Hodgkin's lymphomas)

Tumors with APUDsystem apudomas (pheochromocytoma,
melanomas, small cell carcinoma of lungs, medullary carcinoma of
thyroid gland, carcinoid).

Rare forms of such tumors are the following: from trophoblast
chorionepithelioma, from embryonal remains - teratoblastoma,
seminoma
International TNM classification of malignant tumors
T1 is a tumor up to 2cm or occupies one layer of organ wall
2 is a tumor up to 5 cm or infiltrates several layers of organ wall
3 is a tumor more than 5 cm or extends to all the layers of
organ wall or surrounding cellular tissue
4 is a tumor that extends to vascular organs.
N0 - metastases in regional lymphatic nodes are absent
N1 - metastatic spread to local nodes
N2 - is foreseen for cervical cancer, colon cancer,
N3 - is determined when there are breast cancer, lungs
cancer, cancer of kidneys, cancer of urinary bladder,
testicle cancer and tumors of head and neck.
0 remote metastases are absent
1 remote metastases are present

CLINICAL GROUPS OF CANCER PATIENTS
I - includes all patients suspected to have cancer. This
symbol obligates the doctor to confirm or withdraw diagnosis
within the 10 days period.
I - includes all patients with pre-tumor pathology

II - includes patients with malignant neoplasm, who need
special therapy and there is hope to recover - (clinical group
II) or remission - (clinical group II).

III includes practically healthy people who have already
undergone radical therapy

IV - includes patients with the IV stage of the disease. Most
of them have only symptomatic treatment (including surgery
when there are complications, radiation therapy to relieve
from pain syndrome, chemotherapy to improve life quality
and duration).

Treatment of oncologic patients
By radical we mean such treatment when after
its application there are no any tumor growth
focuses left, which can be determined by clinical,
immunological, roentgenological, radioisotope,
endoscopic and morphologic methods of
diagnostics.
Palliative treatment is the one when after its
fulfillment unliquidated tumor focuses are left
both in the area of primary focus location and in
remote organs.
Symptomatic treatment includes elimination of
complications that threaten the life of a cancer
patient.
Special treatment
Basic methods surgical
- radiation therapy
- chemotherapy

Second methods hormonotherapy
- immunotherapy

What causes cancer?
Cancer arises from the mutation of a normal gene.
Mutated genes that cause cancer are called
oncogenes.
It is thought that several mutations need to occur
to give rise to cancer
Cells that are old or not functioning properly
normally self destruct and are replaced by new
cells.
However, cancerous cells do not self destruct and
continue to divide rapidly producing millions of new
cancerous cells.
A factor which brings about a mutation is
called a mutagen.

A mutagen is mutagenic.

Any agent that causes cancer is called a
carcinogen and is described as
carcinogenic.

So some mutagens are carcinogenic.
Carcinogens
Ionising radiation X Rays, UV light

Chemicals tar from cigarettes

Virus infection papilloma virus can be
responsible for cervical cancer.

Hereditary predisposition Some families are
more susceptible to getting certain cancers.
Remember you cant inherit cancer its just that
you maybe more susceptible to getting it.
Benign or malignant?
Benign tumours do not spread from their site of origin,
but can crowd out (squash) surrounding cells eg brain
tumour, warts.

Malignant tumours can spread from the original site
and cause secondary tumours. This is called
metastasis. They interfere with neighbouring cells and
can block blood vessels, the gut, glands, lungs etc.

Why are secondary tumours so bad?

Both types of tumour can tire the body out as they
both need a huge amount of nutrients to sustain the
rapid growth and division of the cells.
The Development of Cancer
Within every nucleus of every one of the
human body's 30 trillion cells exists DNA,
the substance that contains the
information needed to make and control
every cell within the body. Here is a close-
up view of a tiny fragment of DNA.

1. DNA of a normal cell
This piece of DNA is an exact copy of the DNA from
which it came. When the parent cell divided to create
two cells, the cell's DNA also divided, creating two
identical copies of the original DNA.

2. Mutation of DNA
Here is the same section of DNA but from another cell. If you
can imagine that DNA is a twisted ladder, then each rung of the
ladder is a pair of joined molecules, or a base pair. With this
section of DNA, one of the base pairs is different from the
original.

This DNA has suffered a mutation, either through mis-copying
(when its parent cell divided), or through the damaging effects
of exposure to radiation or a chemical carcinogen.


3. Genetically altered cell
Body cells replicate through mitosis, they respond to
their surrounding cells and replicate only to replace
other cells. Sometimes a genetic mutation will cause a
cell and its descendants to reproduce even though
replacement cells are not needed.

The DNA of the cell highlighted above has a mutation
that causes the cell to replicate even though this
tissue doesn't need replacement cells at this time or at
this place.

4. Spread and second mutation
The genetically altered cells have, over time, reproduced
unchecked, crowding out the surrounding normal cells. The
growth may contain one million cells and be the size of a
pinhead. At this point the cells continue to look the same as the
surrounding healthy cells.

After about a million divisions, there's a good chance that one
of the new cells will have mutated further. This cell, now
carrying two mutant genes, could have an altered appearance
and be even more prone to reproduce unchecked.


5. Third mutation
Not all mutations that lead to cancerous cells result in the cells
reproducing at a faster, more uncontrolled rate. For example, a
mutation may simply cause a cell to keep from self-destructing.
All normal cells have surveillance mechanisms that look for
damage or for problems with their own control systems. If such
problems are found, the cell destroys itself.

Over time and after many cell divisions, a third mutation may
arise. If the mutation gives the cell some further advantage,
that cell will grow more vigorously than its predecessors and
thus speed up the growth of the tumour.

6. Fourth mutation
The new type of cells grow rapidly, allowing for
more opportunities for mutations. The next
mutation paves the way for the development of
an even more aggressive cancer.

At this point the tumour is still contained.


7. Breaking through the membrane
The newer, wilder cells created by another mutation are
able to push their way through the epithelial tissue's
basement membrane, which is a meshwork of protein
that normally creates a barrier. The invasive cells in this
tumour are no longer contained.

At this point the cancer is still too small to be detected.

8. Angiogenesis
Often during the development of earlier stages of the tumour,
or perhaps by the time the tumour has broken through the
basement membrane (as pictured above), angiogenesis takes
place. Angiogenesis is the recruitment of blood vessels from
the network of neighbouring vessels.
Without blood and the nutrients it carries, a tumour would be
unable to continue growing. With the new blood supply,
however, the growth of the tumour accelerates; it soon
contains thousand million cells and, now the size of a small
grape, is large enough to be detected as a lump

9.Invasion and dispersal
The tumour has now invaded the tissue beyond the
basement membrane.

Individual cells from the tumour enter into the network
of newly formed blood vessels, using these vessels as
highways by which they can move to other parts of the
body. A tumour as small as a gram can send out a
million tumour cells into blood vessels a day.

10. Tumour cells
travel -
metastasis
What makes most
tumours so lethal is
their ability to
metastasize -- that is,
establish new tumour
sites at other locations
throughout the body.
Secondary tumours.

Metastasis is now
underway, as tumour
cells from the original
cancer growth travel
throughout the body.
Most of these cells will
die soon after entering
the blood or lymph
circulation.


11. Metastasis
To form a secondary tumour, a tumour cell needs to
leave the vessel system and invade tissue. The cell must
attach itself to a vessel's wall. Once this is done, it can
work its way through the vessel and enter the tissue.

Although perhaps less than one in 10,000 tumour cells
will survive long enough to establish a new tumour site,
a few survivors can escape and initiate new colonies of
the cancer.


National plan of fight against a
cancer
Prophylaxis
Skrining and early recognition of cancer
Help an oncological patient
Teaching of specialists
Scientific researches and epidemical control
Prophylaxis
From data of International Association of
Fight against Cancer all of about 80%
types of cancer are predefined external
factors, and consequently potentially can
be warned (IARC, 2003).
Prophylaxis
Complex program Cancer is not sentence
with the aim to increase informational level in
Ukrainian population in this problem and to
create a positive perception e.g. cancer is a
cured disease.
Fight against smoking!
Control of carcinogenic adverse
in environment and working places
Cancer screening and early diagnostics
Screening has to recognize pre-tumor states in
people categories without any signs of disease:
- breast cancer
- cervical cancer
- colon cancer
- melanoma
- prostate cancer
Care in oncological patients
diagnostics and treatment
psychological care
rehabilitation and dispensary
social and informational care
palliative treatment

The basis for early diagnostics is determined by the level of
oncologic alarm, which includes the following:
knowledge of early cancer symptoms;

knowledge of clinical picture, diagnostics, clinical examination
and therapy of patients with pre-tumor states;

knowledge of organization principles of oncology aid and
purposeful patient referral to oncology establishment;

studious thorough examination of each person, who appeal to
a medical establishment (fulfillment of obligatory clinical
examination minimum)

in all the cases of the so-called difficult diagnostics there
should be the purpose to primarily exclude the cancer in
patient
THE OBLIGATORY CLINICAL EXAMINATION MINIMUM INCLUDES:
Obtaining case history according to the systems having the aim
to find the signs of disorder of organ functions and also
determine risk factors for the cancer development with further
complex (extended) examination of organs and systems, that
have very close relation to the revealed risk factors and
symptoms.
Examination of skin, mucous, peripheral lymph nodes,
methodical examination of breast.
In the room for patients' examination for the men: there should
be examination and palpation of external male genital organs
and digital investigation of rectum having the aim to detect
prostate pathology and ampullary part of rectum.
In the room for patients' examination for the women: there
should be conducted vaginal touch with taking pap-test from
cervix and rectal examination. Breast examination is also
performed here.
- Chest X-Ray should be done in three projections.
- Blood and urine analyses.
- Ultrasonic scanning of liver, kidneys, uterus and adnexa uteri.