Cancer
What is cancer?
 “Abnormal, uncontrolled growth of cells, which, if
left untreated, can ultimately cause death.” (American Cancer
Society)
 Terminology:
 Benign
 Malignant
 Metastasis
 In situ
Cells and Cancer
 Two-stage model of cancer development:
 Initiators
Accumulation of DNA mutations
 “Genetic insults”


Promoters

Do not cause cancer but help it grow
 Oncogenes and Tumor Suppressors
 “Good” = proto-oncogene
 “Bad” = oncogene
 Tumor suppressors
OR vs US: Cancer Incidence
(CDC)
OR vs US: Cancer Deaths
(CDC)
Non-Specific Warning Signs
 CAUTION:
 C: changes in bowel or bladder habits
 A: a sore that doesn’t heal
 U: unusual thickening or discharge
 T: thickening or lump in the breast or any other part of the
body
 I: indigestion or difficulty swallowing
 O: an obvious change in wart or mole
 N: a nagging cough or hoarseness
Cancer Staging
 T: The extent of primary tumor
 N: absence of presence of lymph node involvement
 M: presence of distance metastasis
 Stages: I, II, III, IV
 Five year “Gold standard”
Types of cancer: Leukemia
 Involve blood-forming
cells (white blood cells)
which are chiefly in bone
marrow.

Acute, chronic
(National Cancer Institute)
Types of cancer: Sarcoma
 Connective & fibrous tissue
 Examples: muscle, bone,
cartilage, membranes covering
muscle/fat
Source: cancerhelp.org.uk
Types of Cancer: Lymphomas
 Involve lymph nodes
 Hodgkins, non-Hodgkins
Source:
newsimg.bbc.co.uk
Types of Cancer: Carcinoma
 Epithelial cells

Cover external body
surfaces or line internal
tubes and cavities
 Most common type
 Examples: skin, breast,
uterus, prostate, lungs,
GI tract
Source:
media.collegepublisher.com
Lung Cancer
Lung Cancer continued
 Types:


Non-small cell
Small cell
 Symptoms:

Most lung cancers are
silent

When symptoms occur:

Cough, shortness of
breath, chest pain, loss of
appetite, blood in sputum.
Lung Cancer: Risk Factor
 Most common malignant disease worldwide
 Leading cause of cancer deaths.
 Tobacco smoke accounts for approximately 90% of
all lung cancers.

According to the WHO, decreasing current smoking rates by
50% could prevent 20-30 million deaths before 2025 and 150
million deaths by 2050.
Breast Cancer
Breast Cancer
 The most frequently diagnosed cancer in women.
 Risk factors:
 Age, female gender, personal family history
(National Cancer Institute, 2005)
Types of Breast Cancer
 Ductal cancer
 Most common type of breast cancer
 Lobular cancer
 Inflammatory breast cancer
Breast Cancer: Risk Factors
 Gender

100x more common in
women
 Age
 Genetics


BRCA1
BRCA2
 Diet

Alcohol
 Physical activity
 Menarche
 Pregnancies
 Breast-feeding
 Menopause
Mammograms
(National Cancer Institute, 2005)
Screening / Prevention
 Mammogram recommendation
 Starting at age 40 (unless family or personal history) and every
year as long as “in good health.”
 BSE (Breast Self-Exams)
 Starting at age 20, every month
 Clinical breast exam every year
 Chemoprevention
 Her2neu marker
Prostate Cancer
Prostate Cancer
 The most common
cancer for men.
 Lifetime risk: 1 in 6
 Risk of dying: 3%
Risk Factors / Screening
 Age

Strongest risk factor
 Race / ethnicity
 Diet


 PSA blood test
Red meat
High-fat dairy
 Genetics
 DRE – digital rectal
exam
 Good news

Prostate cancer is not
always life threatening
Colorectal Cancer
Colorectal Cancer
 More common in Western societies.
 Almost 100% preventable with screening and polyp
removal.
Colorectal Cancer: Risk Factors
 Age

 Smoking
Over 50
 Alcohol
 Diet
 Diabetes (type 2)
 Physical inactivity


 Obesity

Link stronger in men
Increased risk
Less favorable outcome
Screening
 Colonoscopy
 Recommended first colonoscopy at age 50; every 5-10 years

Unless family history / personal symptoms

Good news: colon cancer usually slow growing

Other screenings:
FOBT (Fecal Occult Blood Test)
 sDNA (Stool DNA tests)

Skin Cancer
Sun Safety Quiz
 “I can’t get skin cancer, because my normal routine (such as
work, drive to work, hobbies, and vacations) doesn’t
include any outdoor activities”

False
 “If I’m wearing sun screen, I can stay in the sun as long as I
want.”

False
 “Getting a ‘base tan’ at an indoor tanning salon is a good
way to prevent sunburn when I go to the beach later this
summer.”

False
(American Cancer Society)
Skin Cancer
 Three types of skin
cancer:

Basal cell carcinoma



Most common type of skin
cancer
Squamous cell carcinoma
Melanoma

Deadliest form of skin
cancer
Skin Cancers
 Skin cancer is the most common form of cancer
 However…. Basal cell and squamous cell are not reported to
cancer registries

Basal cell


About 8 of 10 skin cancers
Squamous cell

About 2 of 10 skin cancers
Source: skin cancer foundation
Melanoma – ABC’s
Source: skin cancer foundation
Skin Cancer: Risk Factors
 SUN (Obviously!)
 Specifically UV exposure
 Age / Gender
 Before age 40 – higher risk for women
 After age 40 –higher risk for men
 Melanoma is one of the common cancers in people younger
than 30.
 Smoking
Skin Cancer Prevention
 “Slip, Slop, Slap … and Wrap” (ACS)
Wrapping up chronic diseases
 Responses differ from person to person
 Grief






Loss of body part, control, independence, security, certainty of
future
Physical / Mental fatigue
Depression
Shock / disbelief
Denial
Anger
Communication: A few do’s and don’ts
 Be “other-oriented”
 Please avoid cliches!

“I know what you’re going
through”

“Everything will be okay”

“Well we all have to die
sometime”
 It’s not about you
 Listen and listen some
more
 The patient is the boss

It’s their decision
 Offer specific help