Over 500,000 people in the United States and over 8 million people worldwide are dying every year from cancer. As people live longer, the incidence of cancer is rising worldwide and the disease is expected to strike over 20 million people annually by 2030. This open course is designed for people who would like to develop an understanding of cancer and how it is prevented, diagnosed, and treated. The course introduces the molecular biology of cancer (oncogenes and tumor suppressor genes) as well as the biologic hallmarks of cancer. The course also describes the risk factors for the major cancers worldwide, including lung cancer, breast cancer, colon cancer, prostate cancer, liver cancer, and stomach cancer. We explain how cancer is staged, the major ways cancer is found by imaging, and how the major cancers are treated. In addition to the core materials, this course includes two Honors lessons devoted to cancers of the liver and prostate. Upon successful completion of this course, you will be able to: - Identify the major types of cancer worldwide. (Lecture 1) - Describe how genes contribute to the risk and growth of cancer. (Lecture 2) - List and describe the ten cellular hallmarks of cancer. (Lecture 3) - Define metastasis, and identify the major steps in the metastatic process. (Lecture 4) - Describe the role of imaging in the screening, diagnosis, staging, and treatments of cancer. (Lecture 5) - Explain how cancer is treated. (Lecture 6) We hope that this course gives you a basic understanding of cancer biology and treatment. The course is not designed for patients seeking treatment guidance – but it can help you understand how cancer develops and provides a framework for understanding cancer diagnosis and treatment.
Incidence and Etiology of Cancer
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En provenance du cours de Johns Hopkins University
Introduction to the Biology of Cancer
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Incidence and Etiology of Cancer
In this first week, we'll get a high-level introduction to the basics of cancer biology as well as incidence and common types of cancer.
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Kenneth J. Pienta, M.D.The Donald S. Coffey Professor of Urology
The James Buchanan Brady Urological Institute
[MUSIC]
Hello and welcome to the Johns Hopkins School of Medicine course
on the Introduction to Cancer Biology.
My name is Ken Pienta and I'm a professor or Urology,
Oncology, and Pharmacology at the Johns Hopkins School of Medicine.
And I've been a cancer researcher and physician for over 25 years.
We put this course together because cancer is one of the most
devastating diseases that strikes men, women,
boys and girls in the US and as we will show you worldwide.
It is a disease that is increasing, it is a disease that's increasing in
incidents as well as every year it kills more and more people.
We hate cancer, we want to find ways to find cancer and treat cancer.
We are hoping that this introduction will give you a sense of the problem.
Not only how it affects people and their families, but
the biology of how it starts, and what many of the questions are in
learning how to try to understand cancer better, and to treat cancer better.
So we are offering this course as a way to attract you to the field.
To understand cancer better, to contribute to understanding cancer better.
To contributing to diagnosing it.
To contributing to treating it.
To hopefully finding a cure someday for this devastating disease.
This first lecture is going to be on the Incidence and Etiology of Cancer.
At the end of this module you will be able to define cancer,
understand where cancer starts, identify the most common types of cancer and
identify the risk factors for the common types of cancer.
The lecture outline we're going to go through the cancer terms and definitions,
the incidence in men and women, globally in the US of cancer overall,
and then we're going to talk about the six most common cancers worldwide,
lung cancer, colon cancer, breast cancer, prostate cancer, and
stomach, and liver cancer.
Let's start with cancer terms and definitions.
What is cancer?
In it's simplest form, it means uncontrolled growth.
It's the disease caused by an uncontrolled division
of abnormal cells in the part of the body.
It's often also referred to as a tumor.
Tumor is defined as a swelling of a part of the body, generally without
inflammation, caused by an abnormal growth of tissue whether benign of malignant.
Cancer is also sometimes referred to as a neoplasm.
Which is defined as a new and abnormal growth of tissue in some part of the body.
At its heart, cancer is a genetic disease.
It is caused by an accumulation of detrimental variations in the genome over
the course of a lifetime.
These are a lot of terms that are new, and will be described in subsequent lectures.
It's important to remember that most of the time a single mutation in your
genes is not sufficient to induce cancer formation.
Where does the word cancer come from?
The origin of the word cancer is from the Greek karkinos, or crab.
And it was termed this because the Greek physicians Hippocrates and
Galen, among others,
noted how a cancer looked like a crab as tumors had swollen veins along the skin.
It then evolved to the Latin term cancer which also means crab or
later, malignant tumor.
Interestingly enough in the old English, cancer meant spreading sore or cancer.
The study of cancer is oncology, and where does the word oncology come from?
It literally means a branch of science that deals with tumors and cancers.
The word onco means bulk or mass or tumor, while logy means study.
So it's the study of a bulk or a tumor.
An important word in cancer is metastasis.
Metastasis is the spreading of cancer from a primary site to distant organs and
it literally comes from the Greek word metastasis, which is removing,
removal or migration, a changing, a change, or revolution.
So again the metastasis, which means the spread of cancer from primary site,
to distant organs is an important to learn early in the study of cancer.
Where does cancer start?
Cancers are classified according to the tissue where they originate.
There are four main types.
Carcinomas arise in epithelial tissue that is found in the internal and
external linings of the body.
Adenocarcinomas, which are the most common form of cancer develop in an organ or
gland.
For example, prostate cancer, breast cancer, liver cancer.
Squamous cell carcinomas develop in the squamous epithelium of organs,
including the skin, bladder, esophagus, and lung.
Sarcomas, which account for less than 10% of all cancers, arise from
connective tissue that is found in bones, tendons, cartilage, muscle, and fat.
Leukemias are cancers of the blood that originate in the bone marrow and
Lymphoma refers to cancers that develop in the lymph system.
This is a schematic of what cancer looks like.
In this case, cancer of the cervix.
On the left hand side, you can see normal cells lining an organ and
you can see that each cell looks the same.
And each nucleus, inside the cell which contains the DNA, looks the same.
The first step towards cancer is hyperplasia,
where you get a growth in the number of cells.
It's a proliferation in the number of cells, and
they start to look a little bit atypical.
As cancer progresses you get mild dysplasia where the cells start to bunch
up on each other and they start to have abnormal nuclei and abnormal shapes.
This gets more severe and you develop carcinoma in situ or cancer in place.
This is where the cells are growing in an uncontrolled fashion,
they look abnormal and their nuclei look abnormal.
When cancer starts to invade in metastasis that's when we refer to it as a carcinoma.
Let's look at some examples.
Here's a histology slide of prostrate cancer or a carcinoma.
Prostate cancer is an adenocarcinoma.
Here in the slide you can see large, normal glands with an epithelia lining.
As you develop low-grade cancer you see that the glands get smaller and
bunched up.
And then as the cancer gets worse and becomes high-grade,
on the right hand side you see lose all the gland architecture.
And you just have bunched up cells.
This is even clearer in this example of sarcoma.
Which in this particular case is a Ewing sarcoma.
On the left you see normal connective tissue,
with lots of space between the cells.
And, on the right, you see how the cancer is just uncontrolled growth.
A proliferation of cells.
You can see big nuclei there.
Cells that don't look normal.
There's just a huge difference that is very obvious between the left and
the right hand side of the slides.
Here is leukemia which again starts in the bone marrow and circulates into the blood.
This is an example of acute lymphobastic leukemia.
The red blood cells that carry your oxygen are the small doughnuts that you see
in the background and they're carrying iron and oxygen to oxygenate your blood.
The leukemia cells are just a proliferation of what we call blasts,
over growth of cells with big nuclei, big cytoplasm and
this is what acute lymphoblastic leukemia looks like.
Again, it's a proliferation uncontrolled growth
of a certain type of cell that then takes over the blood in body.
This is an example of a mantle cell lymphoma.
Again, all you see in this picture
is an over-growth of cells that are out of shape.
They're different shapes and different sizes.
And the lymph node, the normal lymph node is totally effaced in this picture.
It is nothing but cancer cells.
And they start in the lymph node so they are called lymphoma.
This ends our section on cancer terms and definitions where we
explained what cancer is, where it starts, and gave you some
examples of what cancer looks like as it starts in those various organs.
We are now going to move on and talk about the instance of some of these cancers.
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