Department of Genetics and Pathology, Uppsala University, Sweden Zhi-Ping Ren MD PhD

1. Department of Genetics and Pathology, Uppsala University, Sweden??? Zhi-Ping Ren MD PhD

3. Research Institute Program of Genetics and Genomic Biology TMDT Building 101 College St. East Tower 15th Floor Toronto, Ontario M5J 1L7 Canada

4. New Progress of Cancer Diagnosis and Treatment in Western Medicine and Traditional Chinese Medicine (TCM) ?????????????

5. What is cancer?How to treat cancer?Can cancer be prevented?

6. The accurrence of cancer is a very complicated process

7. Cancer is a disease of abnormal DNA Cancer is a somatic cell genetic disease

8. Any single step goes wrong, problems will come

10. Multiple steps carcinogenesis A series of events, initiation, promotion and progression, that leads to the development of an invasive cancer

14. Each different cancer has its own pathway from benign to malignant Inherited cancer (internal cause) Sporadic cancer (external cause)

15. Incidence, mortality and cure rates of the most commonly diagnosed cancers

16. Risk factors Contact carcinogens: smoking, aflatoxin, nitrite, nitrisamine, radiation, UV light, � � etc.

17. The most important thing in cancer management is early detection Axiom: Early detection of cancer leads to cure

18. Techniques used in molecular pathology DNA level Mutation analysis Comparative genomic hybridisation (CGH) Fluorescence in situ hybridisation (FISH) Mutation screening with arrays RNA level Gene expression-transcription cDNA and oligonucleotide arrays Serial analysis of gene expression (SAGE) Detecting mutations and polymorphisms with arrays Differential display and representational difference analysis Protein level Gene expression: translation-proteomics and mass spectrometry Tissue arrays; functional genomics Other techniques used in molecular pathology Microdissection Knockout and transgenic organisms Quantitative and real-time PCR Bioinformatics and data mining Diagnostics, biomarkers and drug development � �

19. Microdissection

20. Microdissection History Laser capture microdissection. Emmert-Buck MR, Bonner RF, Smith PD, Chuaqui RF, Zhuang Z, Goldstein SR, Weiss RA, Liotta LA. Science. 1996 Nov 8;274(5289):998-1001 Sequence-based analysis of the human p53 gene based on microdissection of tumor biopsy samples. Hedrum A, Pont�n F, Ren Z-P, Lundeberg J, Pont�n J, Uhl�n M. Biotechniques. 1994 Jul;17(1):118-9, 122-4, 126-9.

22. Western ways to treat cancer Slash (operation) burn (radiation) poison (chemotherapy)

23. New development in the treatment of cancer New technologies used for operation: Accurate positioning of tumor (MRI, CT, PET) Lymph node tracking method (radiation blue dye injection and find sentinel lymph node) Surgeon controls camera and robotic instruments through remote computer console � �

24. Other new techniques used Computer assisted imagining, functional imaging analysis, nanotechnology, bioinformatics � �

25. Radiation: new imaging system precisely positioning and aiming target cells, different radiation dosage and therapy Chemotherapy (including hormonal therapy): new drug development, more specific and less toxic (find the specific pathways and blocking it specifically)

26. New methods in cancer treatment: Anti-angiogenesis, Vascular Endothelial Growth Factor (VEGF) inhibitor Immunotherapy: recognize cancer cell as foreign cell, attack the cancer cell Interferon-alfa, interleukin-2 DNA vaccines Hormonal therapy

27. Knowledge is strength Knowledge is power Knowledge saves life

28. You are the best doctor of yourselfYour knowledge will save your life Website: www.plwc.org (people live with cancer) www.asco.org (American Society of Clinical Oncology) www.mskcc.org/aboutherbs (Memorial Sloan-Kettering Cancer Center) � �

29. Colon cancer ??? 1 in 17 men and women, 95% get it over the age of 50 About 75% are sporadic; the rest together is about 25% Long nature history: from polyps to adenoma to carcinoma takes 20 years in average Colorectal cancer can be prevented: Life style (good diet-more vegetables, fruits; exercises-strongest correlation to prevent colorectal cancer); screening (polypectomy-clonoscope, sigmoidoscopy- prevents cancer-best kept secret) Risk factor: obesity, eating meat, smoking, alcohol. 5-FU, inhibit Vascular Endothelial Growth Factor (VEGF)

30. Breast cancer ??? 1 in 8 women affected 212,600 cases diagnosed and 40,200 die of the disease in 2003 Screening: 1. BRCA testing. 2. mammography screening (false negative up to 20%) Surgical prevention of breast cancer: Prophylactic mastectomy Tamoxifen, raloxifene, herceptin (Trastuzumab)

31. Lung cancer ?? 85% to 90% caused by cigarette smoking 164,000 new cases in the U.S. M:F=1.2:1; Deaths 156,900 (96%) in 2000 CT screening is not sensitive enough No demonstration of decreased mortality in screened population Best treatment so far: surgery. Unresectable stage: chemotherapy is worth the effort �Trial and Error� No good testing methods

32. Prostate cancer ???? Most common cancer in American men 320,000 new cases diagnosed 2005, 1/10 death anticipated in the U.S. We do not have specific genetic testing in prostate cancer. PSA test is not specific. Treatment options: watchful waiting, radical prostatectomy Hormonal therapy + chemotherapy Prevention? Beta-carotene 7 years clinical trial FDA not proved

33. Cervical cancer ??? 500,000 women worldwide die of cervical cancer annually 12,200 new diagnosed, 4,100 deaths in the US per year Screening test: Pap smear test (collect cells) reducing mortality 70% Sexually transmitted Known causes HPV DNA found in 99.8% cervical cancer Can be prevented by screening and follow-up Can nearly always be cured if detected early Cryotherapy, laser vaporization, conization, trahelectomy HPV vaccine

34. Ovarian cancer ??? 1 in 57 women 25,580 diagnosed; 16,090 die in 2004 in the US Risk factors: nulliparity: 30-60% increased; breast feeding decreased; oral contraceptives 30-60% decreased Difficult detect, symptom is non-specific

35. Skin cancer ??? Melanoma, Non-melanoma 1 in 53 USA will get melanoma Self observing, pay attention to your every parts of your body leads to early detection Sun light, hair dye,� �

36. Head and neck cancer ???? 53,000 men and women diagnosed, 5% of all cancer in the US but ranks 6th for worldwide cancer diagnosis Risk factor: Tobacco + alcohol = 90% exposed; poor or low amount of fruit and vegetable Tobacco: contain over 40 different carcinogens Persistent oral sore, screening leads to early detection

37. Brain tumor ??? Etiology is basically unknown 17,000 new primary brain diagnosed per year in the US (100,000 matastatic) More than 100 types of brain tumor Each has separate pathologic features Distinct biology Different treatment and outcomes No good treatment methods No good detection methods. No role for screening as in breast cancer Early detection DO NOT leads to cure

38. Western medicine Based on scientific evidence focuses on find out the etiology, pathology and the external cause of the disease and seek to treat it accordingly

39. Western Medicine is clearly not the only way to treat cancer Tumor can not be resection Metastatic tumors Do not response to chemotherapy or radiotherapy Too weak to be treated � �

40. Side effects and toxicity of western treatment Nausea, fatigue, diarrhea, acneiform rash, etc, etc Many patients can not complete their treatment Prophylactic ectomy is hard to accept � �

41. Western Medicine and Traditional Chinese Medicine are completely different both in theory and in practice, but both serve the same object � the patient

42. Traditional Chinese Medicine (TCM) Absorbed Chinese philosophy, culture and science, and summarized the experience of the Chinese people in fighting against disease. Based on observations and experiences accumulated over several thousands of years Focuses on the patient and try to cultivate and activate the patient�s internal repair power (increasing immune response against the disease).

43. Western Medicine treat disease TCM treat patient Western Medicine and TCM will not interfere with each other In many aspects, they help and support each other

44. Can TCM alone cure cancer? Not scientifically approved, but TCM can prevent it. TCM play a very important complementary role in cancer treatment

45. Cultivate and activate the patient�s internal repair power is extremely important For example: Likelihood of getting HPV infection has been estimated to be 75% or more in life time In younger women, the body�s immune system fights off the virus with no ill effects Cervical cancer occur most often in women 30 years of age or older

46. State of Dynamic Equilibrium

47. �????????� �????????�???? �with sufficient healthy qi inside the body, pathogenic factors will have no way to invade the body� �if pathogenic factors invade the body, qi in the body must be deficient� Haungdi Neijing

48. ???????????????, ???????? If our immune system and repair ability is intact, we will not suffer from tumor

49. �?????????��Good doctor treat disease, best doctor prevent it�

50. Characteristics of Traditional Chinese Medicine Holism The Body, an Organic Whole Unification of Human and Nature World Treatment Based upon Syndrome Differentiation ????, ????, ????.

51. ????:????, ????, ????, ???? Therapeutic principles of TCM Concentrating treatment on the root cause Strenthening healthy qi and eliminating pathogenic factors Regulation of yin and yang Abidance by individuality, locality and seasons

52. Prevention Principles of TCM Prevention of the Occurrence of Diseases and Prevention of Progresses of Diseases Physical Exercises Taking care of the Body, Avoiding Over-exertion Keep Optimistic Regular life, variety of food, etc. Herbs used for medicinal prevention

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71. Enjoy Healthy Life ??????