Cancer

“Abnormal, uncontrolled growth of cells, which, if left untreated, can ultimately cause death.”



Benign: not cancerous
Malignant: Cancerous – capable of invading surrounding structures.
Metastasis: Spread to other tissues

Cancer Incidence: Males
(CDC)

Cancer Incidence: Females
(CDC)

Cancer Incidence: Males and Females
(CDC)

(CDC)
Top 10 cancer deaths

Cancer Disparities
 African-Americans continue to have the greatest burden.

Both for mortality and morbidity
 Why?


Lack of health insurance, barriers to early detection, unequal access to improved treatments.
Genetics may play a part in some ethnicities / cancers.

(CDC)
OR vs US: Cancer Incidence

(CDC)
OR vs US: Cancer Deaths

What causes cancer?
 Accumulation of DNA mutations

“genetic hits” or “genetic insults”

Usually takes years even decades
 “Genetic Insults” may be internal or external


Internal: inherited genetic mutations; random biological mistakes; free radicals
External:

Tobacco smoke = #1 gene-damaging carcinogen

Radiation

Viruses

Two-Stage Theory of carcinogenesis
 Initiators (genetic insults)
 Promoters

Growth Promoters
 Helps cancer cells grow
 Promoters do not cause cancer

Examples of cancer promoters:

Hormones

Electromagnetic waves

Iron

Hyper-insulin

Stress-related cortisol

Obesity

Non-specific warning signs:
 CAUTION:

C: changes in bowel or bladder habits


A: a sore throat that doesn’t heal
U: unusual thickening of 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
(American Cancer Society)

Cancer Staging & Treatment

Prevention



T: the extent of primary tumor
N: absence of presence of lymph node involvement
M: presence of distance metastasis
 Screening
 Chemotherapy

Radiation Therapy
 Stages: I, II, III, IV
 Surgery

Types of cancer: Leukemia

Involve blood-forming cells (white blood cells) which are chiefly in bone marrow.

Acute, chronic
(National Cancer Institute)

Leukemia
 Overproduction of white blood cells suppresses the production of red blood cells and platelets.
 Etiology: Unknown
 Symptoms:

Fever, swollen lymph nodes, abnormal bleeding, weight loss, unexplained bruising

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

Hodgkin’s vs Non-Hodgkin’s

Distinguished from non-
Hodgkin’s lymphoma by particular type of cell:
Reed-Sternberg cell.

Patient’s with HIV or other immunosuppressive disorders at higher risk.
 Occurs most often in young adults
 Most common symptoms:

Painless swelling of the lymph nodes
 Most common symptoms:

Painless swelling of the lymph nodes.

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
 Most common malignant disease worldwide

Leading cause of cancer deaths.
 Tobacco smoke accounts for more than 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.

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.

Oral cancers: #1 risk = tobacco

Breast Cancer

The most frequently diagnosed cancer in women.
 Risk factors:

Age, female gender, personal family history

(National Cancer Institute, 2005)

Breast Cancer: Risk Factors
 1. Being Female

227,000 females vs 1,500 males per year diagnosed.

Females have more breast cells than males

Females have more estrogen exposure than males

Increase in estrogen exposure





Earlier age at onset of menses (<12 yrs)
Later age 1 st full term pregnancy (>30 yrs)
No childbirth or lactation
Later age at menopause (after 55)
Hormone Replacement Therapy (HRT) 5+ years

Age as a risk factor
 Increasing age increases risk

Cumulative effect of genetic insults
 77% of all breast cancer cases occur in women over the age of 50.

Premenopausal breast cancer is increasing though

Genetics as risk factor
 5-10% cases have breast cancer in 1 st -degree relative
 Could be due to:


Genetic influences
Environmental influences


Chance
Combination of above

Nutrition as risk factor
 Fat intake may cause increased risk

Type of fat may be more important than amount

Olive oil and fish oils may be protective
 Meat consumption



Red meat linked to breast cancer in some studies
May be associated with:

Saturated fat, amines, pesticides, hormones, antibiotics
Salt water fish may have protective effect with omega-3 fatty acids

Nutrition as risk factor continued
 Fruits, vegetables (and fiber) appear to be protective

Antioxidants protect against free radicals

Phytoestrogens may block estradiol and increase “good” estrogen.

Tobacco as risk factor
 Studies show both active and passive exposure to smoke increases risk of breast cancer
 ETS (second-hand smoke) appears to be greater risk
 Family history of breast cancer and smoking increases risk

Alcohol as risk factor



3-9 drinks per week = 30% increased risk
9+ drinks per week = 60% increased risk

More risky for women under 30 years old
Alcohol:


Increases estrogen levels

2 drinks increase estrogen levels 30%
Damages cells

Harms enzymes that repair DNA damage

Obesity as risk factor
 Associated with post-menopausal breast cancer
 Estrogen levels depends on body fat %

Physical inactivity as risk factor


4 hours of exercise a week leads to decreased risk of breast cancer in women under the age of 40.

Stronger protective effect for early teens
Exercise may:


Decrease estrogen exposure
Increase immune function

Reduce fat

Environmental factors as risk factor
 Exposure to carcinogens and hormone disruptors
 Since WWI, more than 70,000 man-made chemicals introduced into air, food, water, ground, and commercial products

Only fraction have been tested for effects on human health

Risk factors and breast cancer
 50-70% of breast cancers cannot be attributed to any known specific cause
 Most cancer cases are sporadic

Occurs in a scattered or random manner
 We do not understand what causes the majority of breast cancer cases

Risk Reduction vs Prevention
 No guaranteed method to prevent breast cancer
 “Breast Cancer Prevention Diet” changed to “Breast
Cancer Reduction Diet”
 Lifestyle changes may reduce risk and improve general health and well-being

Mammograms
 Mammograms = detection. Not prevention



X-ray image of breast used to screen for and diagnose breast cancer
Not perfect: 1 in 4 false negatives

Miss 10% of cancer overall; miss 40% of cancer in premenopausal women
1 in 5 false positives

Suspicious results when really not cancer

Decreases cost effectiveness; takes emotional toll

(National Cancer Institute, 2005)

Mammogram recommendations
 Women 50 and over:

Once every 1 to 2 years
 Women 40-49:


“It’s up to the woman and her doctor”
Get a baseline
 Women with family history:

10 years before age family member was first diagnosed

Breast Self Exams
 Many breast cancers are discovered by the woman or her partner
 Start breast self exams at age 20

At end of menstrual cycle

Genetic Testing for Breast Cancer
 BRCA1 and BRCA2

Genetic alternations linked to early onset breast cancer


60-85% lifetime probability of breast cancer
40-60% lifetime probability of ovarian cancer
 Tests are now commercially available


$2,400: usually not covered by insurance
Ethical concerns

Prostate Cancer

The most common cancer for men.


Lifetime risk: 1 in 6
Risk of dying: 3%
 Risk increases with:

Age


Family history
Race / ethnicity

Prostate Cancer continued
Symptoms:




Blood in the urine
Frequent urination
Pain or burning while urinating
Pain in lower back, pelvis region
Screenings:

DRE
 PSA
 Tests are fairly accurate

Screenings should begin at age 50

Colorectal Cancer
 More common in Western societies.
 Almost 100% preventable with screening and polyp removal.

Colorectal Cancer Risk Factors
Non-Modifiable
 Age
 Family history
Modifiable
 Obesity
 Physical inactivity
 Smoking
 Heavy alcohol consumption
 Diet high in processed foods.

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

Source: skin cancer foundation

Source: skin cancer foundation
Melanoma – ABC’s

Skin Cancer Risk Factors

Skin fairness

Tanning beds??
 Family history
 Sun exposure


Even one blistering sun burn increases your risk
Lifetime sun exposure

Tanning

Tanning beds increase risk for all 3 types of skin cancer.

Any tanning accelerates the aging process.

“genetic hits”

Responses






Grief for loss of:

Body part, control, roles, financial security, certainty of future, health
Physical and mental fatigue

Ex: overwhelmed, blank out
Depression
Shock/disbelief
Anger/guilt
Information seeking or not

Denial

Communicating with a newly diagnosed patient




Be “other-oriented”
It’s not about you – it’s about the person with the diagnosis
Listen, don’t interrupt, allow silence

Shut up and listen!
That person is the boss. She/he may ask you what you think, and you can tell them – but in the end, she/he makes the decisions.

Individual Reactions
 No magic words are the “right thing” to say or do in all circumstances and for all situations



Body language: keep eye contact
Maintain physical closeness

Respect their mood, but don’t pull away
Take care of yourself too.

Caregivers need down time and strength to carry on

What NOT to say




“I know what you’re going through…” or “I know how you must feel…”
“Everything will be fine…” or “Don’t worry, be happy”, “It’s okay…”


Minimized their concerns
May not turn out ok
Avoid cliches

“You could be hit by a truck tomorrow.”
Don’t talk about what you don’t know

What you can do…
 Offer specific help


What help is at home?

Running an errand, caring for pets or children, bring food
NOT: “If there is anything I can do, let me know”