Cancer. “Abnormal, uncontrolled growth of cells, which, if left untreated, can ultimately cause...

Cancer

Cancer

“Abnormal, uncontrolled growth of cells, which, if left untreated, can ultimately cause death.”

Benign: not cancerousMalignant: Cancerous – capable of invading surrounding structures.

Metastasis: Spread to other tissues

(CDC)

Cancer Incidence: Males

Cancer Incidence: Females

(CDC)

Cancer Incidence: Males and Females

(CDC)

Top 10 cancer deaths

(CDC)

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.

OR vs US: Cancer Incidence

(CDC)

OR vs US: Cancer Deaths

(CDC)

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

T: the extent of primary tumor

N: absence of presence of lymph node involvement

M: presence of distance metastasis

Stages: I, II, III, IV

Prevention

Screening

Chemotherapy

Radiation Therapy

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

Source: cancerhelp.org.uk

Types of cancer: Sarcoma

Connective & fibrous tissue

Examples: muscle, bone, cartilage, membranes covering

muscle/fat

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.

Occurs most often in young adults

Most common symptoms: Painless swelling of the

lymph nodes

Patient’s with HIV or other immunosuppressive disorders at higher risk.

Most common symptoms: Painless swelling of

the lymph nodes.

Source: media.collegepublisher.com

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

Lung Cancer

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

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 1st full term pregnancy (>30 yrs)No childbirth or lactationLater 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 1st-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 risk9+ 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

Prostate Cancer

The most common cancer for men.

Lifetime risk: 1 in 6Risk of dying: 3%

Risk increases with: Age Family history Race / ethnicity

Symptoms:Symptoms: Screenings:Screenings:

Blood in the urineFrequent urinationPain or burning

while urinatingPain in lower back,

pelvis region

DRE

PSA

Tests are fairly accurate

Screenings should begin at age 50

Prostate Cancer continued

Colorectal Cancer

Colorectal Cancer

More common in Western societies.

Almost 100% preventable with screening and polyp removal.

Non-ModifiableNon-Modifiable Modifiable Modifiable

Age

Family history

Obesity

Physical inactivity

Smoking

Heavy alcohol consumption

Diet high in processed foods.

Colorectal Cancer Risk Factors

Skin Cancer

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

Melanoma – ABC’s

Source: skin cancer foundation

Skin Cancer Risk Factors

Skin fairness

Family history

Sun exposure Even one blistering

sun burn increases your risk

Lifetime sun exposure Tanning

Tanning beds??

Tanning beds increase risk for all 3 types of skin cancer.

Any tanning accelerates the aging process. “genetic hits”

Responses to life-threatening diseases

Responses

Grief for loss of: Body part, control, roles, financial security, certainty

of future, health

Physical and mental fatigue Ex: overwhelmed, blank out

DepressionShock/disbeliefAnger/guiltInformation 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 diagnosisListen, 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 contactMaintain 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”