Infection in CancerJohor Scientific Meeting 2015
6 October 2015
Dr Tang Weng HengClinical Oncologist
MBBS (Malaya) MCO (Malaya)
Pusat Rawatan OnkologiHospital Sultan Ismail, Johor Bahru
Outline
• Introduction
• Mechanism
• Aetiology
• Examples• Epidemiology
• Management
• Update
• Prevention
• Conclusion
Introduction
• Infection – communicable disease
• Cancer – non-communicable disease
• What is the link?
Introduction
• Infections are linked to 15-20% of cancers• Viruses
• Bacteria
• Parasites
American Cancer Society 2015
Mechanisms
• How do infections lead to cancers?• Viruses hijack cellular mechanism causing unregulated growth
• Chronic inflammation
• Immunosuppressed state
American Cancer Society 2015
Oncogene & Proto-oncogene
Chronic Inflammation & Cancer
Chronic Inflammation & Cancer
Immunosuppression & Cancer
• Congenital
• Therapy-induced
• Acquired
Immunosuppression & Cancer
Goedert J. Epidemiology of acquired immune deficiency syndrome malignancies. Semin Oncol 27:390-401, 2000.Penn I. Cancers of the anogenital region in renal transplant recipients. Analysis of 65 cases. Cancer 58(3):611-616, 1986.Penn I. Tumors of the immunocompromised patient. Annu Rev Med 39:63-73, 1988.
Immunosuppression & Cancer
Cancers in HIV
• AIDS defining cancers• Kaposi’s HHV-8
• NHL EBV, HHV-8
• Cervical cancer HPV
• Non-AIDS defining• Anal HPV
• Hodgkin’s EBV
• Oropharyngeal SCC HPV
• HCC HBV, HCV
HPV and Cervical Cancer3rd most common
GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012.
HPV and Cervical Cancer
• Landoni
HPV and Cervical Cancer
• Prevention with vaccination
HPV and Cervical Cancer
• Pap smear
HPV and Oropharyngeal Cancer
HPV and Oropharyngeal Cancer
HPV and Oropharyngeal Cancer
• Personalised cancer treatment
• More LN involvement, but better prognosis
• Deintensification?
HPV and Anal Cancer
HPV and Anal Cancer
• Organ preservation
EBV and NPC
• Incidence – 8th most common
• Epidemiology
• Pathology – WHO type I, II, III
• East Asian disease
GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012.
EBV and NPC
• IMRT• What is IMRT?
• Advantages of IMRT• Parotid sparing
• Improved local control
• Lateral retropharygeal LN’s
• Photon-electron matching uncertainty
• Dose painting
EBV and NPC
• IMRT• What is IMRT?
• Advantages of IMRT• Parotid sparing
• Improved local control
• Lateral retropharygeal LN’s
• Photon-electron matching uncertainty
• Dose painting
EBV and NPC
• IMRT• What is IMRT?
• Advantages of IMRT• Parotid sparing
• Improved local control
• Lateral retropharygeal LN’s
• Photon-electron matching uncertainty
• Dose painting
EBV and NPC
• IMRT• What is IMRT?
• Advantages of IMRT• Parotid sparing
• Improved local control
• Lateral retropharygeal LN’s
• Photon-electron matching uncertainty
• Dose painting
HIV and Cancer
• AIDS defining illness• NHL
• Non-AIDS defining illness• Hodgkin’s
HIV and Non-Hodgkin’s Lymphoma
• CMT
• Improved tumour control
• Improved OS
HIV and Hodgkin’s Lymphoma
• CMT
HIV and HL
• Less is more
HIV and HL
• Less is more
• Moving away from extended field
• Focussing on involved site
6th most common
GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012.
Helicobacter pylori and Gastric Cancer
Helicobacter pylori and Gastric Cancer
• Pathogenesis
Helicobacter pylori and Gastric Cancer
• Pathogenesis
Helicobacter pylori and Gastric Cancer
• MacDonald’s trial
• First trial to show OS benefit with adjuvant Rx
Helicobacter pylori and Gastric Cancer• Role after D2 LND
• ARTIST subgroup
HBV and HCV in HCC
•12th most common
GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012.
HBV and HCV in HCC
• Pathogenesis
HBV and HCV in HCC
• Patient• ECOG performance status• Cirrhotic liver• Comorbid
• Tumour• Number• Location
• Treatment• Surgery +/-• Liver transplantation• RFA • TACE• SABR
Barcelona Clinic Liver Cancer staging classification
SABR in HCC
• Inoperable
• Unresectable
Schistosomiasis and Bladder Cancer• Incidence of bladder cancer
• Uncommon
• Schistosomiasis is uncommon in Malaysia
• More prevalent in Middle East and Africa
• Migration
Schistosomiasis and Bladder Cancer
• Combined modality therapy
• Bladder preservation strategy
Conclusions
Cancer is
• NCD
• Infective aetiology – communicable
• Potentially curable• Early detection, early stage, early referral
• Screening
• Education
• Treatable
• Preventable
What we do in oncology and medicine
• To cure sometimes
• To relieve often
• To comfort always
Acknowledgement
• Dr Mohd Roslan Harun
• Dr Lim Chun Sen
• Dr Myat Soe Khine
• Multidisciplinary teams from HSI, HSA, various hospitals in Johor
• Medical officers
• Nurses
• Physicists
• Radiation therapists
• Pharmacists
• Dieticians
• Patients
Acknowledgement
• Family
Thank you for your kind attention
Dr Tang Weng Heng
Clinical Oncologist
MBBS (Malaya) MCO (Malaya)
Pusat Rawatan Onkologi
Hospital Sultan Ismail, Johor Bahru
016-2454269
07-3565000 ext 1104