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