Dr. Fatih Selçuk Biricik

Koç University Hospital - Medical Oncology


Cancer is the uncontrolled or abnormal transformation, growth and proliferation of DNA after a damage in DNA. We are able to get rid of these damaged DNA cells and mutation with a program that we call "apoptosis" and continue our life with normal healthy cells. Both disrupted apoptosis, or even mutation changes can result in cancer development.

Cancer gives some symptoms according to the organ or tissue that is placed in the body after it has been formed. For example, a tumor located in the brain may lead to headache, pancreas can cause jaundice and abdominal pain in an established tumor. However, in some cases, the cancer can give no symptoms. Generally, early-stage cancers give fewer symptoms.

That's why it is very important to recognize cancer early. Early diagnosis prevents both the symptoms of cancer and permits permanent treatment of the cancer with a completely curative approach.

Most cancer-related deaths are caused by lung, colon, and breast cancer. Early diagnosis of these common cancers in this regard is saving the life of the patient.

Early detection of lung cancer, the leading cause of death from cancer, is not often possible, but annual chest X-ray is recommended for active or passive smokers, and chest tomography is recommended once a year after the age of 55 years for healthy persons who smoke at least one pack of cigarettes a day for 15 years.

Self-breast examination and mammographic approaches are recommended for breast cancer screening and early diagnosis. Mammography is recommended once a year for every woman after the age of 40, with the suggestion of European and American guides. If there is a breast cancer story in the family, screening programs should be performed more frequently. Proof of genetic risk for breast and overies-cancer is based on the detection of BRCA1 or BRCA2 mutations. These mutation analyzes can be performed by some centers in our country and a genetic risk tree is created.

In this way, for the early detection of prostate cancer in men, after the age of 50 years, are recommended prostate examination and PSA analysis.

For cervical cancer, cervical smear screening programs after age 21 will save lives with early diagnosis. Also among the most serious steps taken in recent years in the protection against cervical cancer is vaccines against HPV.

In the early diagnosis and screening of colon cancer, it is recommended to have occult blood tests after 40 years of age and colonoscopic evaluations after 50 years of age.

Diagnosis in cancer is determined after clinical, radiological and pathologic findings. Radiologic evaluations can be performed with direct management such as radiography, ultrasonography, computed tomography, magnetic resonance imaging, barium graphs. In addition, recently PET / CT examination helps in determing the diagnosis and follow-up procedure.

Positron Emission Tomography / Computerized Tomography (PET / CT) is a diagnostic tool used to diagnose, decide the treatment and follow up procedure, also to evaluate the response of treatment in cancer patients. PET / CT consists of two different modalities. While PET provides information about the function and metabolism of the cell by providing glucose uptake into the cell, CT provides anatomic assessment. In many diseases, it allows early and accurate diagnosis by looking at the metabolic changes caused by the disease before any visible anatomic changes occur. It also facilitates the disease phase by showing the area where the disease spreads, thanks to the PET / CT evaluation of the whole body.

Another important diagnostic method is pathological analysis, which allows definitive diagnosis. This examination is based on the examination under a microscope of a piece taken by a biopsy needle tool from a tissue that is thought to be tumorous. In the field of pathology and diagnostification, on recent years are done giant steps. Now, for lung cancer and colon cancer, along with many types of cancer, it is not enaugh the pathological diagnosis of the disease. In addition to this diagnosis, molecular analysis can now be performed on the tumor and can be documented mutation analyzes related to the disease. The presence of mutation analysis can predict whether the patient will benefit from targeted therapies. One of the best known clinical examples of this condition is the use of a drug named Erlotinib in patients with lung adenocarcinoma and EGFR mutation. In the case of lung adenocarcinoma, a drug called Krizotinib can be used in the presence of ALK mutation. With these innovations in this pathology, targeted therapies in cancer can be used in a better and correct way, with individualized therapies, done especially for the patient.

Cancer therapy is a subject that requires a multidisciplinary approach. For this purpose; approaches to cancer patients are: a cancer surgeon (who can remove the damaged part and the dangerous part around it), chemotherapy (to eradicate cancer cells with medication), radiotherapy (radiation of tumor cells or place where the tumor is removed), but in some special cases these clusters can be made even more specific. For example in thyroid cancer, radioactive iodine treatment is a specific treatment.

In recent years, the most inovative treatment therapy is immunotherapy. Once the relationship between cancer cells and the immune system has been thoroughly defined, new drug applications and clinical trials can be initiated. These studies, which are carried out with different approaches are now applied; such as monoclonal antibodies, dendritic cell therapy, LAK treatment (rapid lymphocyte activated with lymphocine), TIL therapy (Infiltration of T lymphocyte inside tumor). Program of killing cells 1(PD-1) by developing preparations  Anti-PDL-1, by putting cells against one another , is until now the greatest vision for today's cancer treatment.

The most frequent disease in which immunotherapy is used is malignant melanoma.

Malignant melanoma is a disease that originated from inside the skind and it is spread over the surface. Despite the use of various cytotoxic agents, adequate response to treatment was lacking, for this reason researches continued. In this context, treatment has been expanded with agents such as dacarbazine, interleukin 2, and with the use of immunomodulator drugs. This change in treatment has contributed in malignant melanoma treatment and gave results with 10 months longevity.

Studies have shown that some of malignant melanoma patients have a mutation in the B-RAF (BRAF) coding gene, and it has been shown that the majority of these mutations are due to the substitution of valine and glutamate at the 600th codon. Based on this information, BRAF inhibitors that act as inhibitors in the presence of this mutation can be developed and used.

As two important drugs in this group, murafenib and dabrafenib act as specific inhibitors of the mutant BRAF kinase. Vemurafenib significantly increased 6-month survival (84% and 64%) while dacarbazin reduces death risk at a rate of 63% and 74% the risk of disease progression. Compared with dacarbazine in patients with BRAF V600E mutation in Dabrafenib, it improved the cure from illness within 2.7 months to 5.1 months.

It is evident that immunotherapy is now a therapeutic approach that directly affects survival in patients. Apart from malign melanoma, lung, bladder, kidney and many other organ types of cancer have entered the field of treatment and are promising good hopes.

As a result, early detection of cancer is very important and lifesaving. Based on the sensitivity and examination methods, a diagnose can be found on the right time. In addition, the innovations observed in the field of pathology provide individualized treatment options for each individual. So far the development of immunotherapy and cancer vaccines, even though not a definitive solution, are a huge hope for cancer treatment.