Chapter 16

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 Causes

about 565,000 deaths in the U.S. each year

1500 per day

Leading

cause of disease related death among people under age 65. Second most common cause of death Evidence supports that most cancers could be prevented by simple lifestyle changes. Tobacco is responsible for about 30% of all cancer deaths. Poor diet and exercise habits account for another 30% of cancer deaths
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Definition: an abnormal and uncontrollable multiplication of cells or tissue that can lead to death.

Tumor: a mass of tissue that serves no purpose.

Benign versus malignant tumors Benign tumor: mass of cells enclosed in a membrane that
prevents their penetration of other tissues.

Malignant tumor: (Neoplasm) cancerous, can invade

surrounding tissues. Every case of cancer begins as a change in a cell that allows it to grow and divide when it should not.

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 Primary

tumor

Definition: the spreading of cancer cells from one part of the body to another, occurs because cancer cells do not stick to each other as strongly as normal cells.

Metastasizing the traveling and seeding process of cancerous cells Cells break away from primary tumor and invade surrounding tissues or travel through the blood and lymphatic system. New tumors are called Secondary tumor or metastases

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 Malignant

Tumors

The behavior of tumors arising in different body organs is characteristic of the tissue of origin Classified according to the types of cells.

Initially retain some of the original properties of the host cell.

Carcinomas - most common - arises from the

epithelial tissue that cover body surfaces. Linings, tubes, cavities and secretion glands.

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 Malignant

Tumors

Sarcomas: arise in connective and fibrous tissues. Bone, muscle, cartilage and membranes covering muscle or fat. Lymphomas: Cancers of the lymph nodes. Leukemia: cancer of the blood-forming cells in bone marrow.

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 1.4

million Americans are diagnosed yearly American Cancer Society

Estimates that the 5-year survival rate for all cancers diagnosed between 1996 and 2003 is 66%

in 2 men and 1 in 3 women will be develop cancer during their lifetime.

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 Since

1991 the death rate has dropped 18% in men and 10% in women

Prevention Early detection Improved therapy 90% of skin cancer could have be prevented 87% of lung cancer could have be prevented

American Cancer Society estimates

Regular screening and self-examinations could save an additional 100,000 lives per year. About 10.8 million living Americans have a history of cancer.

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 Most

common cause of cancer death in the U.S.

162,000 deaths per year Risk Factors

Tobacco smoking contributes to 87%. Combined with environmental carcinogens multiply by a factor of 10. Symptoms are not detected until cancer has reached the invasive stage. Persistent cough, chest pain, or recurring bronchitis. Diagnosis - chest x-ray or sputum examination - fiber-optic bronchosectomy.

Detection and Treatment (Difficult to detect)

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 Treatment:

Difficult to treat. Caught early treated by surgery

Only 16% are detected prior to spreading Radiation and chemotherapy are used in addition

Detected early 49% of patients are alive 5 years post. Overall the survival rate is only 15% Phototherapy, gene therapy, and immunotherapy are being studied.

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13

Second leading cancer causing death. Risk Factors

Directly linked to diet and genetic predisposition. 90% occurs after 50 yr. of age. Heredity Lifestyle Up to 1/3 of the population is genetically prone. Detection and Treatment Diet low in fat and High in fiber

Screening Sigmoidoscopy or colonoscopy Examine for polyps Surgery is primary treatment Radiation and chemotherapy used prior to surgery
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 Most

common cancer in women Causes almost as many deaths in women as lung cancer 1:7 American women will develop it during her lifetime (182,000). 1:30 Will die from the disease (41,000 deaths).

Risk Factors

Most common in women over 50 Disease of Civilization Common causes: Genetic predisposition, High fat, High calorie diet and Sedentary lifestyle, Alcohol use, early onset of menstruation, First child after 30 and obesity Current use of Hormone Replacement Therapy (HRT) Estrogen -cancer in estrogen-responsive sites
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Detection and Treatment

Early detection.

Monthly breast self-exam for all women over 20. Clinical breast exam by a physician every 3 yr. Mammography- Every 1-2 years 40-50 yr. old.

Over 50 every year.

Digital Mammography
Ultrasonography
Biopsied 98% if the cells did not metastasized 89% for all stages at 5 years 80% at 10 years

Treatment

Survival rate

New strategies for treatment and prevention

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Most common cancer in men. Second leading cancer death in men 186,000 new cases per year More than 28,000 deaths per year

Risk Factors

Early detection is key.

Age Diet Lifestyle Genetic predisposition Prostate-specific antigen (PSA) blood test Digital rectal exam Ultrasound
surgical removal of the prostate and radiation

Treatment

Survival

All stages near 100% after 5 years

17

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Cervical cancer - sexually transmitted.

Most cases stem from infection by the human papillomavirus (HPV)transmitted by unprotected sex. Group of about 100 related viruses Women high in HPV 16 are at a high risk Smoking Infection by genital herpes Factors: sexual intercourse before 18, multiple sex partners, cigarette smoking and low socioeconomic status. PAP Test

Cervical cancer most common in women in their 20s and 30s.

Screening:

Cervical dysplasia All sexually active women ages 18-65 should be tested

Treatment

Surgery Cryoscopic probe Localized laser Vaccination of girls as young as 9 and women through age 26

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Uterine, or Endometrial:

Ovarian Cancer:

Occurs after 55 Risk factors similar to breast cancer Determined by Pelvic Exam Treatment is surgery 95% survivability after 5 years Difficult to detect and diagnosis, No warning signs Family history or genetic factors Determined

Treatment is surgical removal of the ovaries, the fallopian tubes, and the uterus. Radiation and Chemotherapy are sometimes used. Survival rate after 5 years is 92% for localized tumor Survival rate after 5 years for all stages is 45%

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Pelvic Exam Ultrasound of ovaries

Most common form

1 million cases per year 62,500 are melanoma

Most serious

Easily detected and highly curable

Risk Factors
Exposure to ultraviolet rays during childhood Common cause - sunburns and suntans Caucasians are 10X more likely than African Americans to develop melanoma

Types:

Basal and Squamous Melanoma - more dangerous form

Avoid long term overexposure to sunlight

Prevention

Blistering and peeling sunburns

Detection and Treatment

ABCD screen test

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Oral Cancer

Lip, tongue, mouth, and throat Smoking and tobacco use Rare Most common n men age 20-35 3 out of 10 are linked to smoking Twice as common in males Infected by Helicobacter pylori Three times more likely in males Smoking is the key risk factor Smoking and obesity are mild risk factors Develops for no apparent reason

Testicular Cancer

Pancreatic Cancer

Stomach Cancer

Bladder Cancer

Kidney Cancer

Brain Cancer

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 Cancers

of the white blood cells.

Starts in the bone marrow but spread to the lymph nodes, spleen, liver, other organs and CNS. Abnormal production of immature white blood cells; rapidly growing cells displace red blood cell precursors Immature WBCs cannot fight off infections Risk factors are unknown 20% of cases of adult leukemia are related to smoking About 44,000 new cases and 22,ooo deaths each year.
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 Lymphoma

Arising from the lymph cells

Hodgkins disease Non-Hodgkins disease (NHL) More common More deadly (6th most common cancer) Risk factors are not well understood

Compromised immune system are at a greater risk

Multiple

Myeloma

Malignant plasma cells produce tumors in the bone marrow.

Leads to anemia, excessive bleeding and decreased resistance to infection Age is most significant risk factor average age is 70
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The Role of DNA (Deoxyribonucleic acid)

Each cells has 23 pairs of chromosomes

Each controls the way a cell will work Each rung is made up of four different nucleotide bases: Adenine, thymine, cytosine and guanine A gene smaller unit of DNA

DNA Mutations and Cancer

Changes the way the cells function Mutagens radiation, certain viruses and chemical substances Oncogenes a gene involved in the transformation of a normal cell into cancer Tumor suppressor genes type of oncogene that restrains cellular growth

Hereditary Cancer Risks

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 Cancer

promoters

Do not directly produce mutations, they accelerate the growth of cells without damaging of permanently altering the DNA. Estrogen

Cancer

initiators:

Carcinogenic agents
UV radiation

Cigarette

smoking is a complete carcinogen because it is a cancer initiator and promoter.

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26

Your food choices affect your cancer risk by exposing you to potential dangerous compounds and depriving you protective ones. Dietary Fat and Meat

American Cancer Society encourages everyone to limit their consumption of processed and red meats.

Contributes to certain cancers: Colon, stomach, and prostate

Alcohol Fried Foods Dietary Fiber Fruits and Vegetables

Anticarcinogens Carotenoids Antioxidants versus Free radicals Phytochemicals Sulforaphane

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 Linked

to breast and colon cancer. Benefits of Physical Activity

Speeding the movement of food through the digestive system Strengthen the immune system Decreasing blood fat levels Prevention of obesity

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 About

15% of the worlds cancers are caused by microbes

Viruses

Human papillomavirus cervical cancer Helicobacter pylori stomach cancer Epstein-Barr virus (mononucleosis) Hodgkins disease, cancer of the pharynx and some stomach cancers Human herpesvirus 8 Kaposis sarcoma and certain types of lymphomia Hepatitis B and C cause as many as 80% of the worlds liver cancers.

Bacteria

Parasites
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 Ingested

Chemicals

Nitrosamines Nitrates and nitrites combining with dietary substances - highly potent carcinogen

Environmental

and Industrial pollution Radiation - UV rays or man made

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Detecting:

Self-monitoring CAUTION acronym Biopsy Magnetic resonance imaging (MRI) Computed tomography (CT) Ultrasonography Surgery Chemotherapy Radiation Therapy Gene therapy Bone marrow and Stem Cell transplants Biological therapies Proteasome inhibitors Anti-angiogenesis drugs Enzyme activators/blockers
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Diagnosing:

Treatment:

New and Experimental:

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 More

than 10 million cancer survivors in the

U.S. Economic prejudice

Face prejudice from health insurers

Refuse to issue renewal

Financial

impact Psychological support is important

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Lifestyle choices Avoid tobacco Controlling diet and weight Regular exercise Protecting skin from the sun Avoiding environmental and occupational carcinogens Recommended screening tests

Follow

the American Cancer Societys recommendations.

Appropriate timing and methods for screenings Be aware of the early signs and symptoms
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Chapter 16

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