Cancer

Group of more than 100 distinct diseases characterized by the uncontrolled growth of
abnormal cells in the body. Cancer affects one in every three persons born in developed
countries and is a major cause of sickness and death throughout the world.
so ….Cancer is Abnormal uncontrolled cell division
Why cancer is very dangerous disease? Because it is too hard to be controlled
Carcinogenic substance is a substance that can cause cancer
A tumor…. Aggregation of cells in one organ with huge number.
Types of tumors
Benign tumor …….. Is the tumor that consists of normal body cells … as fibrosis…..
Malignant tumor …….. Is the tumor that consists of cancerous cells … as polyps …..
Causes of cancer:
1- smoking
2-pollutions.
3- chemical substances …. As
a) Supplying narcotics.
b) Insecticides and pesticides.
c) Applying much amount of medicine for long periods of time
4- Exposing to some radiations as ultraviolet rays
Treatments of cancer
1- Chemotherapy
2- Radiotherapy
3- by gold
4- By injection ……… the most recent way of treating caner..

Strategies for cancer prevention

As scientific evidence points to specific agents as the causes of cancer, cancer death
rates might be reduced through avoidance of these factors. One such preventative action
is to avoid smoking tobacco. In the case of certain viruses that are linked to cancer—for
example, hepatitis B virus, which is linked to liver cancer—vaccination campaigns may
reduce cancer incidence. Certain modifications of diet—such as eating more fruits,
vegetables, and legumes (e.g., peas and beans) and less red meat and saturated fats—can
increase the odds of avoiding cancer. International epidemiological and laboratory
studies provide strong evidence that a high intake of dietary fat is associated with an
increased incidence of breast, colon, rectal, and prostate cancer.

Screening and early detection 27

It is possible to screen asymptomatic individuals for various types of cancer, such as
breast, cervical, prostate, colorectal, and skin cancers. In these instances tests can detect
a precancerous condition or a tumor in an early stage so that it can be removed. For
example, self-examination of the breasts and yearly mammograms contribute
significantly to the early detection of tumors and the success of therapy. Self-exams are
also useful in detecting early stages of testicular cancer. In other cases, however, such as
when a detectable preclinical phase of a cancer is not known or there is no effective
treatment for the cancer, screening programs may not be beneficial.

Chemotherapy
Chemotherapy is the use of medication (chemicals) to treat disease. More specifically,
chemotherapy typically refers to the destruction of cancer cells. However, chemotherapy
may also include the use of antibiotics or other medications to treat any illness or
infection. Chemotherapy is the administration of chemical compounds, or drugs, to
eliminate cancer cells. Chemicals destroy cancer cells by preventing them from
multiplying. Unlike surgery or radiation therapy, which cannot treat widespread
metastases, anticancer drugs can disperse throughout the body via the bloodstream and
attack tumor cells wherever they are growing—with the exception of a few sites in the
body known as “sanctuaries,” areas where the drug does not actually reach the tumor
cells.

Chemotherapy has five possible goals

1- Total remission - to cure the patient completely. In some cases chemotherapy

alone can get rid of the cancer completely.
2- Combination therapy - chemotherapy can help other therapies, such as
radiotherapy or surgery have more effective results.
3- Delay/Prevent recurrence - chemotherapy, when used to prevent the return of a
cancer, is most often used after a tumor is removed surgically.
4- Slow down cancer progression - used mainly when the cancer is in its advanced
stages and a cure is unlikely. Chemotherapy can slow down the advancement of
the cancer.
5- To relieve symptoms - also more frequently used for patients with advanced
cancer.

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How does chemotherapy work?
 When our body cells are damaged or die, we produce new ones to replace them. This is
done in an orderly way, in a balanced way. Cancer cells do not have that orderly capacity
- their reproduction (division and growth) is out of control - more and more of them are
produced and they start to occupy more and more space, until eventually they push out
space occupied by useful cells.

Chemotherapy (chemo) drugs interfere with a cancer cell's ability to divide and
reproduce. Chemo drugs may be applied into the bloodstream to attack cancer cells
throughout the body, or they can be delivered directly to specific cancer sites.
Chemotherapy drugs work in various ways:

 Impairing mitosis (prevent cell division) - these are known as cytotoxic drugs.
 Targeting cancer cell's food source, enzymes and hormones they require in order to
grow
 Stopping the growth of new blood vessels that supply a tumor. In a study,

Two ways of giving chemotherapy

Depending on the type of cancer, chemotherapy may be administered orally or

intravenously (directly into the vein).

 Oral chemotherapy (swallowing tablets)

These will be in the form of tablets. If the patient's health allows it he/she will be able
to take them at home. However, regular hospital visits will still be needed to check on
the patient's health and response to treatment.

It is vital that the tablets be taken exactly when specified. If the patient forgets to take
one at a specific time he/she should call the medical team immediately.
 Intravenous chemotherapy (straight into the vein)

Intravenous chemotherapy may be given as:

o An injection straight into a vein.

o Through a drip (intravenous infusion).

o Through a pump that the patient wears for several weeks or months. This is called
continuous infusion, protracted venous infusion, or ambulant infusion (meaning the
patient can walk about while receiving the medication).
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 What are the side effects of chemotherapy?
Most people immediately link chemotherapy with uncomfortable side effects. However,
side-effect management has improved considerably over the last twenty years. Many
side effects that were once inevitable can be either prevented or well controlled today.
There is no reliable way to predict how patients may react to chemotherapy. Some
experience very mild side-effect, others will have none at all, while some people will
report various symptoms.
Depending on the type of cancer and treatment, chemotherapy may have a bigger impact
on the patient's work status than radiotherapy. Women with breast cancer who receive
chemotherapy appear more likely than those treated with radiation therapy to experience
a major change in work status, according to researchers at the Dana-Farber Cancer
Institute.

Below is a list of the most commonly reported side effects:

1- Nausea and vomiting

2- Alopecia (Hair loss)
Some chemotherapy medications cause hair loss while others don't. If hair does start to
fall out this will usually happen a few weeks after treatment starts. On some occasions
the hair will just become thinner and more brittle (without falling out). Hair loss can
occur in any part of the body.

Although hair loss has no physical health consequences, it may cause distress and
embarrassment for some people. The psychological impact tends to be greater among
women than men. If you experience hair loss and find it is causing distress and
embarrassment, there are several steps you can take
3- Fatigue
Most patients receiving chemotherapy will experience some degree of fatigue. This may
be a general feeling which exists most of the day, or may only appear after certain
activities. Doctors say patients need to make sure they get plenty of rest and not to
perform tasks which are overtiring.
4- Neutropenia (low white blood cells) - Susceptibility to infections
When receiving chemotherapy the immune system will be weakened because the white
blood cell count will go down. White blood cells form part of our immune system - they
fight infection. Consequently, patients become more susceptible to infections.

Some patients will be prescribed antibiotics which may reduce their risk of developing
infections. The following precautions will help reduce the risk of infections:
5- (low blood platelet count) - Blood clotting problems
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Chemotherapy may lower the patient's blood platelet count. A platelet is a type of blood
cell that helps the blood to clot (coagulate). Coagulation is essential, otherwise bleeding
does not stop. Lower blood platelet counts linked to chemotherapy is a risk, but less so
than lower red or white blood cell counts. If you are affected you will bruise more easily,
you will be more likely to have nosebleeds and bleeding gums, and if you cut yourself it
may be harder to stop the bleeding.
Patient's whose blood platelet counts fall too low will need a blood transfusion.

6(Inflammation of the mucous membrane)

Chemotherapy attacks rapidly dividing cells, such as blood cells, bone marrow cells, and
cells of the mucous membranes that line the digestive system - this includes the mouth,
esophagus, stomach, intestines, and the rectum to the anus. Chemotherapy may damage
and even destroy some of those mucous membrane cells.
7- Loss of appetite

Loss of appetite is a common side effect of chemotherapy. It is possible that the

chemotherapy, or the cancer itself, affects the body's metabolism. If the loss of appetite
is just due to the chemotherapy it will come back when the treatment is finished -
although this may sometimes take a few weeks.
8- Libido (sex drive) and fertility
for a significant proportion of patients, chemotherapy may result in a lower sex drive
(less interest in sex). This is temporary and usually returns after treatment is completed.
Depending on the type of medication administered, chemotherapy may also damage
men's sperm. Some women may become infertile. In most cases - though not all -
fertility returns after treatment is over.
Men who wish to father children and women who plan to become pregnant one day
should discuss possible options with their doctors before starting treatment. It is possible
to freeze sperm and embryos.

Radiation therapy
Radiation therapy is the use of ionizing radiation—X rays, gamma rays, or subatomic
particles such as neutrons—to destroy cancer cells. Approximately 50 percent of all
individuals diagnosed with cancer receive radiation therapy. Only surgery is more
commonly used.

Cells are destroyed by radiation either because they sustain so much genetic damage that
they cannot replicate or because the radiation induces apoptosis (or programmed cell
death). Cancer cells are more sensitive to radiation than are healthy cells because they
31
are continuously proliferating. This factor renders them less able to recover from
radiation damage than normal cells, which are not always reproducing.

Different ranges, or voltages, of radiation are used in clinical practice. The lowest range
is called superficial radiation; the medium range is called orthovoltage; and the high
range is called supervoltage. Two techniques are used to deliver radiation therapy in the
clinic: brachytherapy and teletherapy. In brachytherapy, also called internal radiation
therapy, the source of radiation is placed directly into the tumour or within a nearby
body cavity. Some of the substances used are radioactive isotopes of iridium, cesium,
gold, and iodine. The devices used to contain the radioactive substances are diverse in
form (e.g., tubes, needles, grains, and wires). Sometimes the radioactive source is
delivered to the tumour through tubes and then withdrawn—an approach called remote
brachytherapy. Teletherapy, or external radiation therapy, uses a device such as a clinical
linear accelerator to deliver orthovoltage or supervoltage radiation at a distance from the
patient. The energy beam can be modified to adapt the dose distribution to the volume of
tissue being irradiated.

Once the decision has been made to use external beam radiation, a series of pretreatment
procedures are performed. First, the precise location of the tumour is identified by means
of magnetic resonance imaging (MRI). Next, the appropriate energy level is selected,
and the beam distribution and dose distribution are carefully determined so as to
maximize the therapeutic effect and minimize damage to healthy tissues. Precise
irradiation requires devices (casts) that carefully position the patient. Sometimes
markings are used to position and delimit the fields. This is necessary because radiation
is administered in repeated small doses, called fractions. Fractionation minimizes
complications and, when given at equal doses, allows for a more effective cure. For
some tumours—including cancer of the uterine cervix, larynx, breast, and prostate, as
well as Hodgkin disease and seminoma (a type of testicular cancer)—curative doses of
radiation can be applied without causing serious damage to surrounding tissues.

The undesirable effects of radiation therapy are divided into acute and late effects. Acute
effects occur in rapidly renewing tissues, such as the linings of the oral cavity, pharynx,
intestine, urinary bladder, and vagina. Late effects, which are related to the total dose of
radiation received, include scar formation (fibrosis), tissue loss, and creation of abnormal
openings (fistulae). Secondary effects can be minimized by internal radiation, a form of
therapy that delivers a high dose of radiation to the tumour with less exposure to normal
tissues.

Radiation therapy is often combined with surgery. Although surgery is most useful in
removing a localized tumor, it may fail to remove cells that have spread beyond the
32
margins of the surgical procedure. Conversely, radiation therapy is most effective at
eradicating undetected disease at the periphery of the tumor and least effective in killing
cells at the center of large tumors. Thus, in certain situations—such as the limited
excision of a breast tumour (lumpectomy) followed by radiation therapy—the
weaknesses of each therapy are offset by the strengths of the other.

Biological therapies

Biological therapy has emerged as an important “fourth” accepted method as a result of

gains made in understanding the immune defenses against cancer. Progress in
biotechnology has provided necessary quantities of biochemical molecules to support
this therapy.

Angiogenesis inhibitors

Since the progression of tumors requires the development of capillaries (a process

known as angiogenesis) that supply tumor cells with oxygen and nutrients, interfering
with this essential step is a promising therapeutic approach. Antiangiogenic drugs have
been shown in animal studies to shrink tumours by destroying the capillaries that
surround them and by preventing the production of new vessels. An angiogenesis
inhibitor called bevacizumab (Avastin™) was approved by the Food and Drug
Administration in 2004 for the treatment of metastatic colorectal cancer. Bevacizumab
works by binding to and inhibiting the action of vascular endothelial growth factor
(VEGF), which normally stimulates angiogenesis. However, bevacizumab is not
effective when administered alone and therefore is given in combination with traditional
chemotherapeutic agents used to treat colorectal cancer, such as 5-fluorouracil (5-FU)
and irinotecan. Angiogenesis inhibitors remain an object of intensive research.

Immunotherapy

Tumor-associated antigens are present on tumor cells, but they also are found on the
surface of normal cells; in addition, these antigens are not specific to a certain type of
tumor but are seen in a variety of cancers. Despite the lack of tumor specificity, some
tumor-associated antigens can serve as targets for attack by components of the immune
system. For instance, antibodies can be produced that recognize a specific tumor antigen,
and these antibodies can be linked to a variety of compounds—such as chemotherapeutic
drugs and radioactive isotopes—that damage cancer cells. In this way the antibody
serves as a sort of “magic bullet” that delivers the therapeutic agent directly to the tumor
cell. In other cases a chemotherapeutic agent attached to an antibody destroys cancer
cells by interacting with receptors on their surfaces that trigger apoptosis.
33
Another immunologic approach to treating cancer is the so-called tumor vaccine. The
object of a cancer vaccine is to stimulate components of the immune system, such as T
cells, to recognize, attack, and destroy cancer cells. Tumour vaccines have been created
by using a number of different substances, including tumour antigens and inactivated
cancer cells.

Tumour-associated antigens also can be used as tumour markers. Because elevated

levels of tumour-associated antigens indicate that the presence of a tumour is likely, they
remain a useful tool either in screening for the recurrence of previously treated cancers
or in preventive screening. For example, prostate-specific antigen (PSA) is used to
screen for carcinoma of the prostate.

Other biological response modifiers that have been developed include interferon, tumour
necrosis factor, and various interleukins. Interleukin-2, for example, stimulates the
growth of a wide range of antigen-fighting cells, including several kinds that can kill
cancer cells.

Gene therapy

Knowledge about the genetic defects that lead to cancer suggests that cancer can be
treated by fixing these altered genes. One strategy is to replace a defective gene with its
normal counterpart, using methods of recombinant DNA technology. Researchers are
exploring methods that can insert genes into tumor cells.

Leukemia
Leukemia (American English) or leukaemia (British English) is a type of cancer of
the blood or bone marrow characterized by an abnormal increase of immature white
blood cells called "blasts". Leukemia is a broad term covering a spectrum of diseases. In
turn, it is part of the even broader group of diseases affecting the blood, bone marrow,
and lymphoid system
Leukemia is a treatable disease. Most treatments involve chemotherapy, medical
radiation therapy, or hormone treatments. The rate of cure depends on the type of
leukemia as well as the age of the patient. Children are more likely to be permanently
cured than adults. Even when a complete cure is unlikely, most people with a chronic
leukemia and many people with an acute leukemia can be successfully treated for years.

34
Leukemia can affect people at any age. In 2000 approximately 256,000 children and
adults around the world developed some form of leukemia, and 209,000 died from
it. About 90% of all leukemias are diagnosed in adults.
Clinically and pathologically, leukemia is subdivided into a variety of large groups. The
first division is between its acute and chronic forms:

 Acute leukemia is characterized by a rapid increase in the number of immature blood

cells. Crowding due to such cells makes the bone marrow unable to produce healthy
blood cells. Immediate treatment is required in acute leukemia due to the rapid
progression and accumulation of the malignant cells, which then spill over into the
bloodstream and spread to other organs of the body. Acute forms of leukemia are the
most common forms of leukemia in children
 Chronic leukemia is characterized by the excessive build up of relatively mature, but
still abnormal, white blood cells. Typically taking months or years to progress, the
cells are produced at a much higher rate than normal, resulting in many abnormal
white blood cells. Whereas acute leukemia must be treated immediately, chronic
forms are sometimes monitored for some time before treatment to ensure maximum
effectiveness of therapy. Chronic leukemia mostly occurs in older people, but can
theoretically occur in any age group.
Signs and symptoms
Common symptoms of chronic or acute leukemia
Damage to the bone marrow, by way of displacing the normal bone marrow cells with
higher numbers of immature white blood cells, results in a lack of blood platelets, which
are important in the blood clotting process. This means people with leukemia may easily
become bruised, bleed excessively, or develop pinprick bleeds (petechiae).
White blood cells, which are involved in fighting pathogens, may be suppressed or
dysfunctional. This could cause the patient's immune system to be unable to fight off a
simple infection or to start attacking other body cells. Because leukemia prevents the
immune system from working normally, some patients experience frequent infection,
ranging from infected tonsils, sores in the mouth, or diarrhea to life-
threatening pneumonia or opportunistic infections.
Finally, the red blood cell deficiency leads to anemia, which may
cause dyspnea and pallor.
Some patients experience other symptoms, such as feeling sick, having fevers, chills,
night sweats, feeling fatigued and other flu-like symptoms. Some patients experience
nausea or a feeling of fullness due to an enlarged liver and spleen; this can result in
unintentional weight loss. Blasts affected by the disease may come together and become
35
swollen in the liver or in the lymph nodes causing pain and leading to nausea.[15]
If the leukemic cells invade the central nervous system, then neurological symptoms
(notably headaches) can occur. All symptoms associated with leukemia can be attributed
to other diseases. Consequently, leukemia is always diagnosed through medical tests.
The word leukemia, which means 'white blood', is derived from the disease's namesake
high white blood cell counts that most leukemia patients have before treatment. The high
number of white blood cells are apparent when a blood sample is viewed under a
microscope. Frequently, these extra white blood cells are immature or dysfunctional.
The excessive number of cells can also interfere with the level of other cells, causing a
harmful imbalance in the blood count.
Some leukemia patients do not have high white blood cell counts visible during a regular
blood count. This less-common condition is called aleukemia. The bone marrow still
contains cancerous white blood cells which disrupt the normal production of blood cells,
but they remain in the marrow instead of entering the bloodstream, where they would be
visible in a blood test. For an aleukemic patient, the white blood cell counts in the
bloodstream can be normal or low. Aleukemia can occur in any of the four major types
of leukemia, and is particularly common in hairy cell leukemia

Modern treatment of cancer:-

A )By injection with non-spreadable toxic material:-
Steps of injection of liver:-
1- Insert a Catheter…..( the Catheter is a very thing long elastic tube used to take
liquids from and to the body) from the femoral artery through small hole to reach
the liver.
2- Insert stain in the catheter to identify the place and edges of the tumor…… the
malignant cells can absorb the stain 10 times more than the normal cells.
3- Insert other stain in the catheter to identify the blood vessels that come from the
tumor.
4- Insert a chemical substance can close theses blood vessels to prevent the injection
to come out of the tumor.
5- Insert in the catheter a special toxic that causes death to malignant cells and
because we closed the blood vessels that comes from the tumor before injection…
malignant cells will not be able to move outside the tumor then the toxic destroy
them.

36
b) By using gold:-
Gold has the ability to trace the malignant cells through the body so it can run to capture
and invade malignant cells.
Disadvantages of treating cancer with gold:-
1- It is very expensive.
2- It cannot treat all malignant cells.
3- It causes other harms of the body.
c) By using radiations:-
Some radiations can destroy the malignant cells by exposing the part of the body that is
suffering from cancer to concentrated radiations.
Disadvantages of treating cancer with radiations:-
1- It can only treat the external organs as breast and skin.
2- It must be concentrated on a specific organ only.
3- It cannot treat blood cancer leukemia.

Questions
Write the scientific term:-
1- Uncontrolled abnormal cell division
2- Aggregation of cells in one organ with huge number.
3- The tumor that consists of normal body cells.
4- The tumor that consists of cancerous cells.
5- Cancer of the blood.
6- Lowest range of radiotherapy
7- Medium range of radiotherapy.
8- High range of radiotherapy
9- Internal radiation therapy
10- External radiation therapy
11- MRI
12- The trade name of Bevacizumab
13- Immature white blood cells.

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Define:-
1- Alopecia………………………………………………………………………………
…………………………………………………………………………………………
 ……………………………………………………………………………………..…
2- Neutropenia……………………………………………………………………………
…………………………………………………………………………………………
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3- Apoptosis………………………………………………………………………………
…………………………………………………………………………..
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………..….
4- Tumor
…………………………………………………………………………………………
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5- Malignant tumor
…………………………………………………………………………………………
………….
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6- Benign tumor
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7- Cancer
…………………………………………………………………………………………
…………………………………………………………………………………...
………………………………………………………………………………………….
.….
8- Chemotherapy
…………………………………………………………………………………………
…………………………………………………………………………………………
………………………………………………………………………………….…...….
9- Radiotherapy……………………………………………………………………………
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………....
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10- Sanctuaries…………………………………………………………………………
…………………………………………………………………………………………
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11- Cancer pump
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12- Cancer drip
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13- Brachytherapy
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14- Libido
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15- Teletherapy…………………………………………………………………………
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16- Leukemia
…………………………………………………………………………………………
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17- Antiangiogenic drugs
……………………………………………………………………………………..
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18- Angiogenesis.
…………………………………………………………………………………………
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19- Bevacizumab
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20- Blasts
…………………………………………………………………………………………
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21- Angiogenesis inhibitors

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 …………………………………………………………………………………………
…………………………………………………………………………………………
Complete:-
1- From chemicals that can cause cancer
…………………………………………………. , ………………………… and
……………………………………………………..……………………….
2- From causes of cancer ……………………………………………… ,
………………………………………….. , ………………………………………. .,
………………………………………………………..
3- Radiotherapy radiations are ………………………………………….. ,
………………………………………. , …………………………………………..
Write the effect of chemotherapy on the followings…………..
1- Immune system.
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2- Platelets.
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 3- Hair.
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4- Mucous membrane of digestive system
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4- Libido
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5- appetite
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Chemotherapy has five possible goals mention them with explanation.

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Chemotherapy can cause bleeding …………… discuss with explanation

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Two ways of giving chemotherapy…………… discuss with explanation

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Write short notes on:- 42
1- Biological therapies.
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2- Treating of cancer by angiogenesis inhibitors

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3- Immunotherapy
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Genetherapy 43
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Compare and contrast between

1- Chronic and acute leukemia
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2- Chemotherapy and radiotherapy
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3- Malignant tumor and benign tumor.
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