Cancer
Cancer
700,000
A group of over 100 600,000
500,000
diseases
400,000
Second leading cause 300,000
200,000
of death in the US
100,000
0
Deaths, 2007; CDC
H
e
a
r
t
C
a
n
c
e
r
S
t
r
o
k
e
R
e
s
p
A
c
c
i
d
e
n
t
Characteristics of Cancer
Cancer cells do not engulf healthy cells
Cancer cells outcompete healthy cells
for nutrients
Cancer cells multiply uncontrollably
Cancer cells often shaped irregularly
Characteristics of Cancer
QuickTime™ and a
decompressor
are needed to see this picture.
Cancer cells
generally live longer
than healthy cells
Cancer cells
typically lack useful
functions
How Cancer
Develops (Bupa, UK, via
Youtube)
Image Source: Public domain (NIH), licensed by Jeanne
Kelly of Aaardvark Inc.
Basic Vocabulary
Benign tumor = noncancerous tumor
Malignant tumor = cancerous tumor
Metastasis =
spread of cancer cells to a distant site
Staging =
a system used to ascertain cancer
severity
Benign Tumors: Examples
Syringoma (skinsight.com)
Cherry hemangioma (skinsight.com)
Pyogenic granuloma (skinsight.com)
Malignant Tumors: Examples
Metastasis
Image source: in the public domain
Staging
Size/state of tumor, if applicable
If metastasis has occurred, to what degree
If lymph tissue is involved, to what degree
Example: TNM Staging (tumor - lymph node metastasis)
Staging Example (National Cancer Institute)
About Cancer
Cancer classification:


Type of tissue from where cancer originates
Where cancer first develops
Cancer name:


Named after body tissue of origin e.g. lung cancer
When cancer metastasizes, the name remains the
same e.g. cancer beginning in the breast and
spreading to another site is known as breast
cancer
Classifications of Cancer
Carcinoma

Cancer of epithelial tissue
 Covers organs, glands, mucous membranes
 Examples: lung, skin, colon
 Most cancers are carcinomas
Sarcoma

Cancer of connective tissues
 Examples: fat, bones, tendons, muscles
Classifications of Cancer
Leukemia

“Cancer of the blood”
 Affects blood-forming cells
 Begins in the bone marrow and spreads to
blood
Lymphoma

Cancer of the lymphatic system
 Lymphatic system fights infection

Hodgkin’s and non-Hodgkin’s lymphomas
Examples of Cancer
Skin cancer (sensitive photo)
Breast cancer (sensitive photo)
Testicular cancer (sensitive photo)
Bone cancer (sensitive photo)
Colon cancer (sensitive photo or illustration)
Lung cancer (sensitive photo)
Leukemia
2011 Estimated New Cancer
Cases, US*
Men
822,300
Women
774,370
Prostate
29%
30% Breast
Lung & bronchus
14%
14% Lung & bronchus
Colon & rectum
9%
9%
Colon & rectum
Urinary bladder
6%
6%
Uterine corpus
Melanoma of skin
5%
5%
Kidney & renal pelvis
5%
4% Non-Hodgkin
lymphoma
Non-Hodgkin lymphoma
4%
Oral cavity
3%
Leukemia
3%
Pancreas
3%
All Other Sites
~20%
4%
Thyroid
Melanoma of skin
3% Ovary
3% Kidney & renal pelvis
3% Pancreas
~20%All Other Sites
*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.
Source: American Cancer Society, 2011.
Incidence, US
Most frequently-occurring forms of cancer


Breast cancer among women
Prostate cancer among men
Incidence in states, per 100,000 (male/female)






Washington state: 525/410
Oklahoma: 602/432
Maine: 599/456
Louisiana: 605/403
Colorado: 496/388
US: 543/409
Source: National Cancer Institute, 2007
Incidence: A Different
Example Worldwide
Stomach cancer




Fourth most common cause of cancer worldwide
Second leading cause of cancer-causing death
worldwide (WHO)
Incidence varies across the world
Largely thought due to diet (salted, pickled foods;
few vegetables & fruits), though genetics play a
role
Incidence: A Different
Example Worldwide
New Cancer Cases By Site,
US
Dependent upon 5000
4500
site, area
4000
population, regional3500
3000
culture
2500
Source: CDC
2000
1500
1000
500
0
WA st
Okla
Lou
Col
WADC
Br Col Lu Pr
2011 Estimated US Cancer
Deaths*
Lung & bronchus
28%
Prostate
11%
Men
300,430
Women
271,520
26% Lung & bronchus
15% Breast
Colon & rectum
8%
Pancreas
6%
Liver & intrahepatic
bile duct
4%
Leukemia
4%
Esophagus
4%
4% Non-Hodgkin
lymphoma
Urinary bladder
4%
3% Leukemia
Non-Hodgkin
lymphoma
3%
Kidney & renal pelvis
3%
All other sites
9% Colon & rectum
7% Pancreas
6% Ovary
25%
3% Uterine corpus
2% Liver & intrahepatic
bile duct
2% Brain/ONS
23%
ONS=Other nervous system.
Source: American Cancer Society, 2011.
All other sites
Mortality, US
Among all cancer forms, those causing
highest mortality:


Lung cancer among men
Lung cancer among women
Mortality across states, all sites





Washington state - 210/156
Oklahoma - 249/163
Colorado - 184/134
DC - 241/174
Louisiana - 250/159
Source: Centers for Disease Control
Mortality, World (All Sites)
US = 121/91
Australia - 126/84
Chile - 123/93
Croatia - 196/101
Israel - 116/92
Japan - 129/68
Hungary - 229/122
Source: GLOBOCAN
Cancer Survival*(%) by Race
1999-2006
Site
White
African
American
Absolute
Difference
All Sites
69
59
10
Breast (female)
91
78
13
Colon
67
55
12
Esophagus
20
13
7
Leukemia
56
47
9
Non-Hodgkin lymphoma
71
60
11
Oral cavity
65
45
20
Prostate
100
97
3
Rectum
70
60
10
Urinary bladder
82
66
16
Uterine cervix
73
64
9
Uterine corpus
86
61
25
*5-year relative survival rates based on cancer patients diagnosed from 1999 to 2006.
Source: Altekruse SF, Kosary CL, Krapcho M, et al (eds.). SEER Cancer Statistics Review, 1975-2007, National Cancer Institute, Bethesda, MD,
seer.cancer.gov/csr/1975_2007/, 2010.
Risk Factors for Cancer
Tobacco
Diet
Heavy alcohol consumption
Viral infections
Inactivity
Obesity
Environmental factors
Genetics, age, race, family history
5000
100
4500
90
4000
80
3500
3000
70
Per capita cigarette
consumption
60
2500
50
Male lung cancer
death rate
2000
40
1500
30
1000
20
500
Female lung cancer
death rate
0
1900
1905
1910
1915
1920
1925
1930
1935
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
0
10
Age-Adjusted Lung Cancer Death
Rates*
Per Capita Cigarette Consumption
Tobacco Use in the US, 1900-2004
Year
*Age-adjusted to 2000 US standard population.
Source: Death rates: US Mortality Data, 1960-2004, US Mortality Volumes, 1930-1959, National Center for Health
Statistics, Centers for Disease Control and Prevention, 2006. Cigarette consumption: US Department of
Agriculture, 1900-2004.
Trends in Consumption of Five or More Recommended Vegetable
and Fruit Servings for Cancer Prevention, Adults 18 and Older, US,
1994-2005
35
Prevalence (%)
30
25
24.2
24.4
24.1
24.4
23.6
24.3
1994
1996
1998
2000
2003
2005
20
15
10
5
0
Year
Note: Data from participating states and the District of Columbia were aggregated to represent the United
States.
Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape
(2000, 2003, 2005), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease
Control and Prevention, 1997, 1999, 2000, 2001, 2004, 2006.
Trends in Prevalence (%) of High School Students Attending PE
Class Daily, by Grade, US, 1991-2005
70
60
Prevalence (%)
50
40
30
20
10
0
1991
1993
1995
1997
1999
2001
2003
2005
Year
Source: Youth Risk Behavior Surveillance System, 1991-2003, National Center for Chronic Disease
Prevention and Health Promotion, Centers for Disease Control and Prevention, 2004. MMWR
2004;53(36):844-847. 2005: Youth Risk Behavior Surveillance System, 2005. MMWR Morb Mortal
Wkly Rep. 2006;55(SS-5).
Trends in Overweight* Prevalence (%), Adults 18 and Older, US,
1992-2006
1992
1995
1998
Less than 50%
2006
50 to 55%
More than 55%
State did not participate in survey
*Body mass index of 25.0 kg/m2or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM (1984-1995,
1998) and Public Use Data Tape (2004, 2006), National Center for Chronic Disease Prevention and Health Promotion,
Centers for Disease Control and Prevention, 1997, 2000, 2005, 2007.
Obesity and Cancer
Hormones


Fat cells secrete estrogen; greater fat = greater
risk
Greater fat in midsection disrupts insulin
metabolism
Mechanics

Obesity leads to acid reflux, increasing risk of
esophageal cancer
Nutrition

Lack of proper nutrients reduces protection
Obesity and Cancer
Some forms of cancer show stronger link






Breast
Uterus
Colon (men)
Gall bladder
NEJM Study: ovarian, stomach, prostate, liver,
pancreas, cervix
2001 Swedish study: lymphoma, larynx
Environment and Cancer
Pollution
Pesticides
Prescription medication
in the ground water
Radiation
BPA
2010 President’s Panel:
risk is underestimated
Environment and Cancer
CA: In July 2011 set
limit for hexavalent
chromium (chromium-6)
in water (Brockovich)
Environmental Working
Group: 2010 report on
35 cities: 31 tested
positive for chromium-6
Issues: carcinogen
combination, timing,
amount of exposure
General Warning Signs
C - Change in bowel/bladder
habits
A - A sore that won’t heal
U - Unusual bleeding or discharge
T - Thickness or lump
I - Indigestion or difficulty
swallowing
O - Obvious change in wart or
mole
N - Nagging cough or hoarseness