Transcript Cancer & Palliative Care - KGH Regional Cancer Centre

Basic Introduction to Cancer
Linda Robb Blenderman
Presentation
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Cancer Statistics & Prevalence
- Canada
- Global
What is Cancer?
What is Staging?
Detection of Cancer
Overview of Cancer Therapy
Symptom Management Along the Cancer Continuum
The Cancer Treatment Journey at the Kingston Regional Cancer
Centre
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What are the Seven Warning Signs of Cancer?
Statistics & Prevalence
In Canada in 2003, an estimated 139,900 new cases of cancer and
67,400 deaths will occur.
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On average every week, 2,690 Canadians will be diagnosed and
1,296 Canadians will die.
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Canadian women (2003)-an estimated 68,600 will be diagnosed
and an estimated 31,600 women will die.
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On average every week, 1,319 women will be diagnosed and
608 women will die of cancer every week.
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Canadian men (2003)-an estimated 71,300 will be diagnosed and
an estimated 35,800 men will die.
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On average every week, 1,371 men will be diagnosed and 688
men will die of cancer.
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Premature death in Canada-cancer is the leading cause of, being
responsible for almost 31% of all potential years of life lost.
Disease of older Canadians.
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Among men, 75% of new cancer cases and 82% of deaths due
to cancer occur among those who are 60 years of age and older.
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Among women, 63% of new cases and 78% of cancer deaths
occur among those who are 60 years of age and older.
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BREAST CANCER
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In 2003, an estimated 21,200 women will be diagnosed and
5,300 will die of it.
An estimated 140 men will be diagnosed and 40 will die of it.
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BREAST CANCER
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One in 9 women is expected to develop breast cancer during
her lifetime. One in 27 will die of it.
Breast cancer is the most frequently diagnosed cancer in
Canadian women.
Since 1988, breast cancer incidence rates have risen by 10%
and death rates have dropped by 19%.
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COLORECTAL CANCER
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In 2003, an estimated 18,000 Canadians (9,800 men; 8,300
women) will be diagnosed with colorectal cancer and 8,300
(4,400 men; 3,800 women) will die of it.
During a woman's lifetime she has a 1 in 16 chance of
developing colorectal cancer. One in 31 will die of it.
During a man's lifetime, he has a 1 in 15 chance of developing
colorectal cancer. One in 29 will die of it.
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COLORECTAL CANCER
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Since 1988, colorectal cancer incidence rates among women
have dropped 14% and death rates have dropped 23%.
Since 1988, colorectal cancer incidence rates among men have
dropped 8% and death rates have dropped 15 %.
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LUNG CANCER
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In 2003, an estimated 21,100 Canadians (12,200 men; 9,000
women) will be diagnosed with lung cancer and 18,800 (10,900
men; 7,900 women) will die of it.
One in 18 women will develop lung cancer during her lifetime.
One in 20 will die of it.
One in 11 men will develop lung cancer during his lifetime. One
in 12 will die of it.
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LUNG CANCER
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Lung cancer, remains the leading cause of cancer death for both
sexes in 2003. Almost one-third of the cancer deaths in men,
and almost one-quarter of the cancer deaths in women, are due
to lung cancer alone.
Since 1988, among women, lung cancer incidence rates have
risen by 30% and death rates have increased by 46%.
Since 1988, among men, lung cancer incidence rates have
dropped 22% and death rates have dropped 17 %
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PROSTATE CANCER
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In 2003, an estimated 18,800 men will be diagnosed with
prostate cancer and 4,200 will die of it.
One in 8 men will develop prostate cancer during his lifetime,
mostly after age 70. One in 28 will die of it.
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PROSTATE CANCER
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Prostate cancer is the most frequently diagnosed cancer
(excluding non-melanoma skin cancer) in Canadian men.
Since 1988, prostate cancer incidence rates have risen by 30%
and death rates have dropped by 10%.
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PREVALENCE
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The overall prevalence of cancer in the Canadian population is
approximately 2% among men and 2.5% among women, or
about 313,100 male cancer survivors and 366,700 female
cancer survivors.
Prevalence rates and counts refer to the total number of people
who are living with a diagnosis of cancer at a certain point in
time. This year’s prevalence estimates are for the number of
Canadians who were alive in 1998 within 15 years of their
cancer being diagnosed.
Totals may not add, due to rounding.
(www.cancer.ca-April, 2003)
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Global Problem of Cancer
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The most recent estimate of cancer indicates that 8.1 million
new cases are diagnosed worldwide each year. The growth rate
of cancer is 2.1% per year, a rate that is faster than the growth
rate of the world population at 1.7% per year.
There are variations in the frequency of cancer between
developed and developing countries. The most common cancers
in developed countries are lung, stomach, breast, colorectal,
and prostate cancer. The most common cancers in developing
countries are lung, stomach, breast, cervical, and esophageal
cancers.
About 5.2 million deaths occur each year, 55% of which, occur
in developing countries.
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The leading causes of worldwide cancer deaths:
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Lung cancer accounts for over 900,000 deaths
Stomach cancer accounts for 600,000 deaths
Colorectal cancer accounts for 400,000 deaths
Liver cancer accounts for 400,000 deaths
Leading causes of cancer deaths in women:
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Breast cancer
Stomach cancer
Lung cancer
Leading causes of cancer deaths in men:
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Lung cancer
Stomach cancer
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What is Cancer?
Many definitions for the word cancer:
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Any definition must embody two characteristics:
The property of uncontrollable growth of cells originating
from normal tissue.
The property of killing the host by means of local tissue
invasion and/or distant spread (metastasis).
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Cancer is a group of diseases characterized by uncontrolled
cellular growth with local tissue invasion and/or systemic
metastasis.
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Metastasis-spread of cells, from a primary tumor via the
lymphatic and circulatory systems to a distant body part,
where cells give rise to another cancer.
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Micro metastasis-metastasis too small to be detected by
conventional diagnostic methods.
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Tumor-abnormal growth that can be benign or malignant.
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Anaplasia-loss of structural organization and useful function
of the cell. ‘Undifferentiated’ –literally impossible to determine
the tissue of origin e.g. muscle cells, nerve cells.
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Dysplasia-disturbance in the size, shape and organization of
cells and tissues.
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Hyperplasia-an increase in the number of cells in a tissue or
organ causing causing an increase in the bulk of the organ.
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Note-hyperplasia and dysplasia often precede the development
of many tumors by months or years, recognition and proper
treatment at this early stage in the development process may
help to prevent malignancies e.g. Pap Smear.
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What is Staging?
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A process to determine the extent of disease, and is related to
the size of the primary mass, nodal involvement and systemic
spread.
TNM classification system for many cancers:
T=tumor size and/or extent of invasion
N=nodal involvement
M=presence or absence of metastases
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Detection of Cancer
Mammography
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50-69
High Risk
Every 2 yrs.
Unless…
Clinical breast exam
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All women
Every 2 yrs.
BSE
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Adult women
Regularly
Pap test/Pelvic exam
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Sexually active and non-sexually
active women.
Every 1 to 3 yrs.
(province).
Skin Examination
F/M
All Ages
Regularly
Fecal Occult Blood Tests
F/M
Age 50 and over
High Risk
Every 2 yrs.
Unless…
Digital Rectal Exam
F/M
Age 50 and over
Prostate Specific Antigen (PSA)
M
Age 50 and over
High Risk
Testicular Self-examination
M
Age 15 and over
Regularly
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An Overview of Cancer Therapy
Surgery
Primary method for curing one-third of all cancers.
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Local treatment.
Indications:
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Pre-cancerous lesions.
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Palliative-reduce tumor burden and/or to relieve symptoms.
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Diagnosis and/or staging.
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Second-look operation.
Techniques:
 Biopsy
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Local excision
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Block dissection
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Radiotherapy
Curative or palliative intent.
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Local treatment.
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Uses X-rays to damage DNA within the cancer cells.
Indications:
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Localized tumors-skin, cervix, endometrium, breast, larynx,
Hodgkin’s disease.
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High-risk surgical candidates.
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CNS-treatment of choice.
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Palliative-pain relief for bony metastases.
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Radiosensitzer with chemotherapy.
Techniques:
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External beam-teletherapy
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Internal beam-brachytherapy
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Chemotherapy
Systemic treatment.
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Chemical agents that kill rapidly growing cells.
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Most act by damaging DNA.
Indications:
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Curative
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Adjuvant
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Neo-adjuvant
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Palliative
Administration/Cycle:
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One drug or a combination of drugs.
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Given monthly, weekly or daily depending on the disease and
drug.
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Hormonal Therapy
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Some cancers arise from tissues sensitive to hormonal growth
control (breast, prostate, endometrium) and retain their
sensitivity, even after malignant change.
The growth of a hormone-sensitive tumor may be ‘turned-off’
for many months.
Whether a tumor responds to a hormone depends on the
presence of receptors for that hormone in the tumor tissue.
Biotherapy
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Includes immunotherapy and biologic response modifier
therapy.
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Symptom Management Along the Cancer
Continuum
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Symptoms occur alone or in clusters.
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Symptoms may vary throughout Diagnosis to Palliation
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Cancer-related (oncological emergencies)
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Treatment related (acute and/or delayed)
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Seven Warning Signs
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Change in bowel or bladder habits.
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A sore that does not heal.
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Unusual bleeding or discharge.
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Thickening or lump in breast or elsewhere.
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Indigestion or difficulty in swallowing.
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Obvious change in wart or mole.
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Nagging cough or hoarseness.
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