cancer clinical pharmacy 6.5

clinical cancer 1,2,3 6.5 /

what is cancer?

• process by which abnormal cells divide uncontrollably e.g. hyperplasia

• with the ability to invade nearby tissues - only cancer does this

what are the attributes of cancer?

• look at the attributes of cancer

• we can target this - drug treatment

what is a carcinoma?

• it is a cancer which begins in the epithelial tissues

• epithelial tissues line all the organs of the body and body cavities

• e.g. skin, chest, abdomen, lungs

how are carcinomas named?

• based on the type of epithelial cell they affect

what are the names of the types of carcinomas - what tissue do they effect?

• squamous cell carcinoma

flat cells covering surface of membranes e.g. skin, throat, oesophagus

• adenocarcinoma

affect glandular cells called adenomatous cells. glandular cells produce fluids/mucous to lubricate passages e.g. GI tract lining

• transitional cell carcinoma

affect cells in the transitional epithelium - cells which expand e.g. lining of bladder

• basal cell carcinoma

found in deepest layer of skin cells - in basal layer

what are sarcomas?

• bone or soft tissue- 89%

• soft tissue: nerve, blood vessels, lymph vessels, muscle, tendons, ligaments, cartilage

• peaks in adolescents during growth spurt

• not common - 5,300 each year

how are blood cancers categorised?

• hematopoetitic stem cells make all components of blood

• based on which progenitor cell has a mutation

• myeloid - leukaemia

• lymphoid - lymphoma

• under lymphoma is plasma - myeloma

what is the issue with a mutation in the hematopoetic stem cell?

• if there is a mutation in the myeloid progenitor cell it means all other cells in the path will be affected - not normal

how many people have cancer each year?

• 20 million

• 10 million die

• 33% because of smoking

what are WHO’s 4 pillars approached to cancer?

• Prevention

• early detection e.g. screening - can reduce it by 1/3

• diagnosis and treatment

• palliative care

what are common risks for cancer- for preventable cases

• tobacco

• infections e.g. HOV, viral hepatitis B

• alcohol

• obesity

• air pollution

• 40% of cancers are preventable which is why public health is important

cancer stats in UK

• approx 385,000 new cases of cancer in the UK per year

• 1 person every 2 minutes

• nearly half diagnosed at stage 3 or 4 (metastasized)

• breast, prostate, lung, bowel most common - make up nearly half of cancers in Uk

• men can also have breast cancer!!

how common is breast cancer?

• 15% of cases each year in the UK

• 1 in 7 women

• 75% survive after 10 years of diagnosis

• 23% are preventable

• 8% linked to obesity

• 8% linked to alcohol consumption

• genetic risk- BRCA1 or BRCA2 gene 45-60% risk by age 70

how common is prostate cancer?

• 14% of all NEW cases

• 1 in 6 men

• 78% survive 10 years or more

• no significant risk factors so don’t know how many cases are preventable

• often asymptomatic, lots have it without knowing

how common is lung cancer?

• 13% of new cancers

• 2nd most common for both men and women

• 10% survive after 10yrs

• 79% of cases are preventable

• 72% by smoking

• 5% by ionising radiation

• workplace exposure e.g. asbestos and air pollution

how common is bowel cancer?

• 11% new cases

• 3rd most common in both men and women

• 53% of patients survive after 10 years

• 54% of cases are preventable

• 28% by eating too little fibre

• 13% obesity

• 6% excessive alcohol consumption

• 7% smoking

prognosis by stage

• risk of cure after 1 year depending on stage of cancer

why is screening good

• early diagnosis before symptoms appear

• means catching at earlier stages

what are common warning signs of cancer

• can see that most of these symptoms are not just associated with cancer

what are common tests used for initial diagnosis?

• blood tests - FBC, LFTs, U&Es, bone profile, tumour markers

often during initial investigation to narrow down issue

• biopsy - mass, lymph node,

• x-ray - chest e.g. lung

• ultrasound - breast, gynaecological masses

these are the most accessible initial testing

what are more complex tests used for diagnosis?

• Computerised Tomography CT - 3D image using X-ray of chosen area

• positron emission tomography PET - patient injected with radio-labelled fluorodeoxyglucose 18F-FDG to identify metabolically active areas of the body (cancer cells as they will use up more glucose then other cells)

• PET-CT combination

what are tumour markers

• can support diagnosis

• PSA - protein specific antigen for prostate cancer

• CA125 - ovarian

• CA15-3 breast

• CA19-9 pancreas or bild duct cancer

• CEA carcioembryonic antigen - bowel cancer

• if you have one of these tumour markers, it doesnt mean you have the cancer