Cancer part 1

Cancer
Good news Bad news
• Death rate declining • There are a lot more
for some cancers. cancers around because
• We know a lot more they are diseases of
aging.
about cancers than
ever before. • We know how to prevent
some cancers but do not
• Cancer has less apply that knowledge.
social impact cf other • There is a cancer lobby.
diseases.
 Current views on causes of
death from “Cancer USA”:
Diet 35%
Smoking 30%
Infections 10%
Work chemicals 4%
Alcohol excess 3%
Sunlight 3%
Pollution 2%
Medical and drugs 1%
Sexual promiscuity 1%
Unknown 11%
Cancer in Canada 2004 (NCIC)
Men Dead Women Dead

Lung 10,700 Lung 8,200

Colorectal 4,500 Breast 5,200

Prostate 4,200 Colorectal 3,900

Pancreas 1,600 Pancreas 1,700

NHL 1,550 Ovary 1,550

 Cancers cases in Canada
Lung 22,200 new/year
Breast 21,800
Prostate 20,500
Colon 19,000
Lymphoma (NHL) 6,500
Kidney (renal cell) 4,500
No known primary 3,500
Pancreas 3,400
Leukaemia 3,200
Thyroid 3,100
Cancer in people 20-44 years
 Cancer is:
• Uncontrolled growth of
• Abnormal cells to form
• Malignant tumour which may
• Metastasize.
 Cancer symptoms
• Weight loss
• Change in bowel habit
• General malaise
• Lumps
• Family history.
• etc
 Opinions on current state of
knowledge of cancer (MOH)
• Cancer occurs at same rate as in 1900.
• Cancer survival is about the same as in 1900.
• Type of cancer seen has changed since 1900.
• More lifestyle and occupational cancers now.
• Some treatments work well on some cancers.
• Cancer is a disease of aging.
 Laboratory cancer marker
problem
Trying to guess
what is going on
inside the cell
from what is in
the fluids outside
of it.
 Current tumour markers are:
• Made by cancer cells or in response to
them
• In an accessible fluid
• Different from health
• Detectable by an analytically sound
method
• Detected before metastasis (hopefully)
 Tumour markers are “visible”
on death of cell and/or transport out of cell
• The marker must cross basement
membrane to enter blood circulation.
• This may take metastasis
• In blood stream get :
Dilution,
Metabolism,
Excretion.
 Tumour markers are used in:
• Evaluation of risk/prevention. I
(But is early diagnosis useful?)
• Differential diagnosis
• Prognosis, staging of disease
• Amount of tumour
• Detection of metastasis.
• Showing response to treatment
Types of tumour markers in use:
Those made by the cancer:
• Oncofetal antigens
• Hormones
• Monoclonal proteins
• Enzymes
• Cell surface antigens.
Those made by the body against cancer:
• Anti inflammatory markers
 Also there are non specific
chemistry changes in cancer:
 Cancer markers: oncofetal
antigens
• CEA = colorectal +
• AFP = liver +
• hCG = germ cells +
• CA 125 = ovarian +
• CA 19.9, CA 24-25, CA 27-29 = breast
cancer
• Placental like ALP = seminomas +
 Carcinoembryonic antigen
• Developed in Montreal by Dr Gold
• Claimed to be specific marker for colon
cancer but is not
• Found in lung, breast, ovarian cancers.
Smokers, inflammatory bowel disease,
liver disease.