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)

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

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 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.

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)

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

MenarchePregnanciesBreast-feedingMenopause

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 6Risk of dying: 3%

Risk Factors / Screening

Age Strongest risk factor

Race / ethnicity

Diet Red meat High-fat dairy

Genetics

PSA blood test

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 Over 50

Diet

Physical inactivity

Obesity Link stronger in men

Smoking

Alcohol

Diabetes (type 2) 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”

It’s not about you

Listen and listen some more

The patient is the boss It’s their decision

Offer specific help

Please avoid cliches! “I know what you’re

going through”

“Everything will be okay”

“Well we all have to die sometime”