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CancerCHAPTER15
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WhatIsCancer?Conditioncharacterizedbytheuncontrolledgrowthofcells
Developsfromasinglecellthatgoesawry,butacombinationofeventsmustoccurbeforethecellturnsintoatumor
Clonalgrowth:replicationofasinglecellthatproducesthousandsofcopiesofitselfinanuncontrolledmanner
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LeadingSitesofNewCancerCasesandDeaths,2011
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HealthyCellGrowthHealthycellshaveacomplicatedsystemofchecksandbalancesthatcontrolcellgrowthanddivision
Healthycellsdividewhenneededtoreplacecellsthathavediedorbeensloughedoff
Eachtimeacelldivides,thereisapossibilityofmutationoranerrorinDNAreplication• Cellareprogrammedtoonlydivideacertainnumberoftimes
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HealthyCellGrowthBecausestemcellsdonothavepredeterminednumberofcelldivisionstheyposeariskforcancer
Stemcellsarelocateddeepwithintissuesandareprotectedfromfactorsthatincreasetheriskofgeneticmutations(exposuretothesun,chemicals,andirritation)
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CancerCellGrowth•Cancerstartsfromasinglecellthatundergoesacriticalmutationcausedby:– Anerrorinduplication– Exposuretoacarcinogen (cancer-causingsubstance)– Radiation
•Oncogene:genethatdrivesacelltogrowanddivideregardlessofsignalsfromsurroundingcells
•Tumor:amassofextratissuesthatmayformintoeitherabenign (slowgrowth)ormalignant (capableofspreadingtosurroundingtissues)tumor
•Metastasis:secondarytumorthatappearswhencancerouscellsspreadtootherpartsofthebody
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ClassifyingCancersCancersareclassifiedaccordingtothetissueinwhichtheyoriginate,calledtheprimarysite◦ Mostcommonsitesofmetastasesarebrain,liver,bonemarrow
Cancerstillatitsprimarysiteislocalized
Whenmetastasized,itisinvasive◦ Extentofmetastasisdeterminesprognosis
Stageofthedisease:howfarithasspread◦ Stage0:cancerinsitu
◦ StageI:smallandlocalized
◦ StagesIIandIII:locallyadvanced,mayinvolvelymphnodes
◦ StageIV:metastasizedtodistantsitesCOPYRIGHT © 2015 MCGRAW-HILL EDUCATION. ALL RIGHTS
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TypesofCancerFourbroadtypesofcancer:◦ Carcinomas:arisefromepithelial tissue (skin,liningoftheintestinesandbodycavities,surfaceofbodyorgans,outerportionofglands)
◦ Sarcomas :arisefromconnectivetissue(bone,tendon,cartilage,muscle,fattissues)
◦ Leukemias:cancersofthebloodwhichoriginateinthebonemarroworthelymphaticsystem
◦ Lymphomas:cancersthatoriginateinlymphnodesandglands
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RiskFactorsforCancerFamilyhistory◦ Afamilyhistoryofcanceralterssomecancerscreeningrecommendations◦ Genesinteractwithenvironmentalexposuresandlifestylebehaviorstoalterrisk
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RiskFactorsforCancerLifestylefactors◦ Tobaccouse◦ Nutritionandphysicalactivity◦ Overweightandobesity◦ Alcoholconsumption
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RiskFactorsforCancerSocialandeconomicfactors◦ Socialdeterminantsofhealthinfluenceriskbehaviors,accesstohealthcare,andqualityofhealthcare
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RiskFactorsforCancerEnvironmentalfactors◦ Sunlightandothersourcesofultravioletradiation◦ Otherformsofradiation◦ Chemicalandphysicalcarcinogens◦ Infectiousagents
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CancerDeathRatesbySite
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LungCancerLeadingcauseofcancerdeathintheU.S.
Secondmostcommonlydiagnosedcancer
Riskfactors:◦ Useoftobaccoproductsinanyform◦ Exposuretocarcinogenicchemicals,arsenic,radon,asbestos,radiation,airpollution,andenvironmentaltobaccosmoke
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LungCancerSymptoms:◦ Coughing
◦ Blood-streakedsputum
◦ Chestpain
◦ Difficultybreathing
◦ Recurrentlunginfections
Prevention:removeexposuretotobaccosmokeorothertypesofsmoke
Treatment:surgery,radiation,chemotherapy;radiationandchemotherapycombination
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ColonandRectalCancerThirdleadingcauseofcancerdeath
Thirdmostcommonlydiagnosedcancer
Riskfactors:◦ Age◦ Geneticanddietaryhabits◦ Personalorfamilyhistoryofcolonpolyps,inflammatoryboweldisease,colorectalcancer
◦ Smoking,obesity,physicalinactivity,diethighinfatorredorprocessedmeat,dietinadequateinfruitandvegetables
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ColonandRectalCancerWarningsigns◦ Changeinbowelmovements◦ Changeinstoolsizeorshape◦ Painintheabdomenorbloodinthestool
Earlydetection:◦ Rectalexams,stooltest,sigmoidoscopy,colonoscopy,double-contrastbariumenema,CTcolonography
Treatment◦ Surgery,radiationand/orchemotherapy
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BreastCancer•Secondleadingcauseofcancerdeathinwomen
•Riskfactors:– Earlyfirstmenstruation– Lateonsetofmenopause– Familyhistory– Olderage– Highersocioeconomicclass– Womenwithnochildrenorhavingchildrenafter30
– Obesityaftermenopause– Hormonereplacementtherapyuse– Drinkingmorethantwoalcoholicbeveragesaday
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BreastCancerPrevention:◦ Diet,exercise◦ Maintaininghealthybodyweight◦ Pregnancyandbreastfeedingdecisions
Detection:◦ Breastself-exam◦ Mammography
Treatment:◦ Lumpectomy◦ Mastectomy◦ Radiationand/orchemotherapytreatments
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ProstateCancerSecondmostcommoncauseofcancerdeathinmen
Mostcommonlydiagnosedcancerformen
Riskfactors◦ Age,familyhistory◦ Race◦ High-fatdiet
Symptomsduringtheadvancedstage◦ Difficultyurinating◦ Paininthepelvicregion◦ Painwithurination◦ Bloodintheurine
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ProstateCancerEarlydetection◦ Digitalrectalexam◦ Prostate-specificantigen(PSA)screenings
Treatment◦ Surgery◦ Radiation,sometimesincombinationwithchemotherapy◦ Hormonalmedications
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CervicalCancerRiskfactors:◦ HPVinfection,tobaccouse,immunosuppression,multiplebirths,earlysexualactivity,multiplesexpartners,socioeconomicstatus,andnutritionalstatus
EarlydetectionthroughPaptesthassignificantlyreducedtheratesofcervicalcancerandmortality
Treatment:removalordestructionofprecursorcells• Invasivecervicalcancertreatedwithcombinationofsurgery,localradiation,andchemotherapy
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UterineCancer(EndometrialCancer)Riskfactors:◦ Exposuretoestrogen:Obesity,estrogenreplacementtherapywithoutprogesterone
◦ Earlymenarche,late-onsetmenopause,irregularovulation,infrequentperiods
Prevention:◦ Minimizehighlevelsofestrogenandhaveregularphysiciancare
Treatment:◦ Hysterectomy;radiation,chemotherapy,hormonaltreatment
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OvarianCancerTheleadinggynecologicalcauseofcancerdeathandthefifthoverallcauseofcancerdeathinwomen
Riskfactors:familyhistory;personalhistoryofbreast,colon,orendometrialcancer
Prevention:◦ Usingoralcontraception◦ Pregnancy,breastfeeding◦ Avoidingpostmenopausalhormonereplacementtherapy
Treatment:surgery,chemotherapy,drugtherapy
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SkinCancerThreeformsofskincancer:◦ Basalcellcarcinoma:lesionsandsores◦ Squamouscellcarcinoma:raisedbumpsandsores◦ Melanoma:spreadsquickly
Riskfactors◦ Cumulativesunexposure◦ Largenumberofmoles◦ Familyhistory
Prevention:reduceexposuretosun
Treatment:surgery,localremoval,radiation
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TheABCDEEvaluationofMolesforMelanoma
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TesticularCancerMostcommoncancerformenaged20–35
Riskfactors:◦ Familyhistory,personalhistoryoftesticularcancerinothertesticle,abnormaldevelopmentofthetestes,andinfertilityorabnormalsperm
Detection:◦ Self-exams◦ Medicalexams
Treatment:◦ Surgery,chemotherapy,andradiation
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OralCancerCancersthatdevelopinthemouthorthepharynx
Riskfactors:◦ Useofcigarettes,cigars,pipes,and/orsmokelesstobacco◦ Highlevelsofalcoholconsumption◦ HPV
Earlysignsinclude:◦ Persistentsoreinthemouth◦ Lumporbumpthatwon’theal◦ Patchofwhiteorredalongthegumsorcheeks
Treatment:surgery,chemotherapy,radiation
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LeukemiaGroupofcancersthatoriginateinthebonemarroworotherpartsofthebodywherewhitebloodcellsform
Involvestheoverproductionofonetypeofwhitebloodcellandcanleadtoincreasedriskofinfection,anemia,andbleeding
Riskfactors:◦ Cigarettesmokingandexposuretochemicals◦ Ionizingradiationexposure◦ Infectionwithavirus
Treatment:chemotherapy,possiblebonemarrowtransplant
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LymphomaCancersthatoriginateinthelymphsystem,partofthebody’simmunesystem◦ Hodgkin’slymphoma;non-Hodgkin’slymphoma
Riskfactors:◦ Infections,medications,orgeneticchangethatweakenstheimmunesystem
◦ Radiation,herbicides,insecticides,andsomechemicalexposures
Treatment:◦ Oftenincludesacombinationofsurgery,chemotherapy,andradiation
◦ Cansometimesinvolveimmunotherapyorbonemarrowtransplant
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TheLymphSystem
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CancerScreeningEarlydetectionisthekeytosuccessfultreatment
Screeningtestsarethekeytoearlydetection
Notestthusfarhasbeenshowntoimprovedetectionofsomecancers,includingovariancancers,withoutincreasingharm
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CancerTreatments•Surgery:removaloftissue
•Chemotherapy:drugtreatmentthatinterfereswithrapidcelldivision
•Radiation:destroycancercellswithminimaldamagetosurroundingslower-dividingtissues
•Biologicaltherapies:immunotherapymedications
•Bonemarrowtransplantation
•Genetherapyandgenetictesting
•Clinicaltrials
•ComplementaryandalternativemedicineCOPYRIGHT © 2015 MCGRAW-HILL EDUCATION. ALL RIGHTS
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LivingwithCancerIfyouorafamilymemberisdiagnosedwithcancer:◦ Participateindecisionsabouttreatment◦ Beaninformedconsumer◦ Considerhowyouwillinteractwithothers◦ Considerschoolorworkobligations◦ Enlistsupport◦ Knowwhatphysicalchangesarelikelytooccur◦ Considerspermoreggdonationandfreezing◦ Spiritualbeliefsandpracticescanbeimportant◦ Don’tthinkaboutcancerallthetime
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InReviewWhatiscancer?
Whatcausescancer?
Whatarethemostcommoncancers?
Howiscancerdetectedandtreated?
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