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Chapter Ten: Living With Cancer and Other Chronic Conditions

© 2009 McGraw-Hill Higher Education. All rights reserved.

Cancer

• Regulatory genes Genes that control cell specialization,

replication, DNA repair, tumor suppression

• Oncogenes Faulty regulatory genes believed to

activate the development of cancer

• Proto-oncogenes Normal regulatory genes that may become

oncogenes

Cell regulation problem causing abnormal cell growth

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Oncogene Formation

• Three mechanisms: Genetic mutations

Miscopying of genes during cell division Viral infections

HIV HPV

Carcinogens

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The Cancerous Cell

•Characteristics: Infinite life expectancy due to telomerase Lacks contact inhibition Spreads to distant sites via metastasis Commands the circulatory system to

provide additional blood supply (angiogenesis)

Benign tumors do not spread but can be dangerous if they crowd out normal tissues

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Staging Cancer

• TNS staging system T = extent of primary tumor N = whether or not it has progressed to

regional lymph nodes S = presence or absence of metastasis

• A numerical system tracks extent of cancer spread I = In situ II = Local III = Regional IV = Distant

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How Cancer Spreads

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Types of Cancer• Carcinomas: 85% of all cancers (organs,

skin, nerves, membranes)• Sarcomas: Bone, blood, connective tissue • Lymphomas: Immune tissues/system • Leukemia: Blood and blood forming tissues • Melanoma: Sun exposure affecting the

melanin of the skin• Neuroblastoma: Originates in the CNS • Adenocarcinoma: Cells of the endocrine

glands• Hepatoma: Originates in the cells of the liver

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Cancer Cases and Deaths

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Skin Cancer

• Risk factors Severe sunburn during childhood, chronic

sun exposure during young adulthood• Prevention

Reduce exposure to sun’s rays, use sunscreens, avoid tanning booths

• Early detection Self-examination (see next slide)

• Treatment Surgery, chemotherapy, interleukin-2

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Self-Examination for Melanoma

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Normal Mole versus Malignant Melanoma

Melanoma characteristics:•A is for asymmetry•B is for border irregularity•C is for color (change)•D is for diameter > 6 mm

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Lung Cancer

• Risk factors Smoking Environmental pollutants (radon) Genetic predisposition

• Prevention Don’t smoke and avoid environmental tobacco

smoke

• Treatment (low success rate) Surgery Radiation Chemotherapy Medications

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Colorectal Cancer

• Risk factors Genetic susceptibility Dietary habits Smoking, alcohol consumption

• Prevention Removal of polyps, exercise, dietary changes

• Early detection Rectal exams, stool tests, sigmoidoscopy,

colonoscopy

• Treatment Surgery, radiation, chemotherapy

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Breast Cancer

• Risk factors Early onset of menstruation, late menopause Having no children or first child later in life Use of hormone replacement therapy Specific genetic mutations

BRCA1 BRCA2

Family history Obesity, sedentary lifestyle High degree of breast density

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Breast Cancer

• Prevention Dietary choices, limit on alcohol use Activity levels Pregnancy and breastfeeding decisions Avoidance of occupational toxins New medications Prophylactic mastectomy (for some women at very

high risk)

• Early detection Breast self-examination Mammography

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Breast Self-Exam

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Breast Cancer

• Treatment Lumpectomy Mastectomy Chemotherapy Radiation Drug therapy

Tamoxifen Trastuzumab Aromatase inhibitors

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Prostate Cancer

• Risk factors Age, African American ethnicity, family history,

dietary fat intake

• Prevention Moderation of fat intake, increased intake of

vitamin E and selenium, drug therapy

• Early detection Prostate-specific antigen (PSA) tests, rectal exam,

ultrasound

• Treatment Surgery, radiation, brachytherapy (radioactive

seeds)

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Testicular Cancer

• Risk factors Family history, environmental factors,

undescended testicles

• Prevention Self-exams, correction of undescended

testicles in children

• Early detection Self-exams, awareness of symptoms

• Treatment Surgery, chemotherapy, radiation

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Testicular Cancer: Self-Examination

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Cervical Cancer

• Risk factors HPV infection Smoking, socioeconomic factors

• Prevention Sexual abstinence Careful selection of sexual partners

• Early detection of precancerous cellular changes Pap tests

• Treatment Surgery (minor or major) Radiation/chemotherapy

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Uterine Cancer

• Risk factors Early menarche, late menopause, infertility, never

having given birth, use of estrogen replacement therapy or tamoxifen, obesity, polycystic ovary syndrome, hereditary nonpolyposis colon cancer

• Prevention Minimize high levels of estrogen, regular

gynecological care

• Treatment Surgery, radiation, chemotherapy, hormone

treatment

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Ovarian Cancer

• Prevention Similar to what is recommended for breast cancer Prophylactic oophorectomy in very high-risk

women

• Early detection (“silent”) Annual pelvic exams Awareness of potential symptoms Genetic screenings

• Treatment Surgery Chemotherapy Drug therapy

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Pancreatic Cancer

• Risk factors Male gender, smoking, high-fat diet, high alcohol

consumption

• Prevention Abstaining from tobacco and alcohol, exercise,

weight management

• Early detection (no early symptoms) CAT scan

• Treatment No effective treatment at this time Surgery, radiation, chemotherapy

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Lymphatic Cancer

• Risk factors Reduction of immune system protection,

exposure to pollutants, viral infections

• Prevention Limit exposure to chemicals

• Early detection Enlarged lymph nodes, fever, weight loss

• Treatment Surgery, radiation, chemotherapy, stem

cell transplant

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Treatment of Cancer

• Surgery• Radiation• Chemotherapy• New therapies

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Preventive Measures

• Know your family history• Select and monitor your occupation carefully• Do not use tobacco products• Monitor environmental exposure to

carcinogens• Follow a sound diet• Control your body weight• Exercise regularly• Limit your exposure to the sun• Consume alcohol in moderation, if at all

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Chronic Conditions

Systemic Lupus Erythematosus (SLE)

Autoimmune disorder in which the body attacks itself for no reason; affects women more than men; treated with long-term non-steroidal anti-inflammatory drugs

Inflammatory Bowel Disease

Inflammatory bowel disease leading to abdominal pain and discomfort; treatable with medication

Multiple Sclerosis (MS) Progressive disease that causes the myelin to be destroyed, leading to disrupted neurological function. Treatment includes immune targeted drugs, nerve blockers, and physical therapy

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Diabetes Mellitus (Type 2)

• Body is insensitive to insulin• Symptoms (develop gradually)

Thirst Hyperglycemia Numbness in the limbs

• Management Dietary modification Exercise Drug therapy

• Diagnosis: Urine and blood tests

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Diabetes Mellitus (Type 1)

• Pancreas produces no insulin at all• Symptoms (develop rapidly):

Weakness, thirst, hunger, frequent urination

• Management: Insulin must be obtained by injections or pump

• Diagnosis: Urine and blood tests

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Sickle Cell Trait/Sickle Cell Disease

• 8% of African Americans carry recessive gene for sickle-cell trait

• Red blood cells cannot pass through blood capillaries (sickle-shaped RBCs)

• Symptoms: Impaired lung function, heart failure, infections, bone changes

• Management: Drug therapy, stem cell transplant

• Diagnosis: Blood test• Prevention: Screening for the recessive gene

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Alzheimer’s Disease

Organic brain syndrome associated with aging; symptoms such as memory loss, confusion, and dementia are common; treatments are still relatively experimental

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Chapter Ten: Living With Cancer and Other Chronic Conditions