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YourHealthTodayChapter15.pptx

15: Cancer

Your Health Today, 6th edition

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What Is Cancer?

Cancer is a condition characterized by the uncontrolled growth of cells

Develops from a single cell that goes awry; but a combination of events must occur before the cell turns into a tumor

The process is called clonal growth: replication of a single cell that produces thousands of copies of itself in an uncontrolled manner

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Figure 15.1 10 most common types of cancer, new diagnoses and estimated deaths, 2015.

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Source: National Cancer Institute, National Institutes of Health, “Number of New Cases and Deaths,” SEER Stat Fact Sheets, http://seer.cancer. gov/statfacts/html/all.html.

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Healthy Cell Growth

Healthy cells have a complicated system of checks and balances that control cell growth and division

Healthy cells divide when needed to replace cells that have died or been sloughed off

Each time a cell divides, there is a possibility of mutation or an error in DNA replication

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Healthy Cell Growth (2)

Stem cells: undifferentiated cells that can give rise to specialized cells

Because they do not have predetermined number of cell divisions they pose a risk for cancer

Stem cells are located deep within tissues and are protected from factors that increase the risk of genetic mutations (exposure to the sun, chemicals, and irritation)

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Cancer Cell Growth

Cancer starts from a single cell that undergoes a critical mutation

Initiating event in the cell’s DNA allows a cell to evade normal cell restraints

Error in duplication

Exposure to a carcinogen (cancer-causing substance)

Radiation

Escaping all the control mechanisms to become a cancer may take many years

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Cancer Cell Growth (2)

Oncogene: gene that drives a cell to grow and divide regardless of signals from surrounding cells

Tumor: a mass of extra tissues that may form into either a benign or malignant tumor

Benign tumor: slow growth, unlikely to spread

Malignant tumor: capable of spread to surrounding tissues

Metastasis: cancer that has spread from one part of the body to another

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Classifying Cancers

Cancers are classified according to the tissue in which they originate, called the primary site

Most commonly the brain, liver, and bone marrow

Cancer still at its primary site is localized

When metastasized, it is invasive

Extent determines prognosis, or likely outcome

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Classifying Cancers (2)

Stage of the disease is a description of how far the cancer has spread

One common staging system:

Stage 0: cancer in situ (present only in the layer of cells where it began)

Stage I: small and localized

Stages II and III: locally advanced; may involve lymph nodes

Stage IV: metastasized to distant sites

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Types of Cancer

Carcinomas: arise from epithelial tissue (skin, lining of the intestines and body cavities, surface of body organs, outer portions of glands)

Sarcomas: arise in connective tissue (bone, tendon, cartilage, muscle, fat tissues)

Leukemias: cancers of the blood that originate in the bone marrow or the lymphatic system

Lymphomas: cancers that originate in lymph nodes or glands

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Risk Factors for Cancer

Family history

Family history of cancer alters some cancer screening recommendations

Genes interact with environmental exposures and lifestyle behaviors to alter risk

Lifestyle factors

Tobacco use

Nutrition and physical activity

Overweight and obesity

Alcohol consumption

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Risk Factors for Cancer (2)

Social and economic factors

Social determinants of health influence risk behaviors, access to health care, and quality of health care

Environmental factors

Sunlight and other sources of ultraviolet radiation

Other forms of radiation

Chemical and physical carcinogens

Infectious agents

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Cancer Screening

Treatment is more successful the earlier the cancer is identified

Screening tests: given to a large group of people to identify a smaller group who are at higher risk for a specific disease or condition

Key to early detection of cancer

With some cancers, no test has been shown to be effective without increasing harm

Genetic screening can assess cancer risk

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Cancer Treatments

Surgery

Remove the cancer, remove the affected organ; used to treat cancer that has spread

Chemotherapy

Drug treatment administered to the entire body to kill cancer cells

Radiation

Directed to a specific area; used with surgery or chemotherapy, or to control pain

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Cancer Treatments (2)

Biological therapies

Aim to enhance the immune system’s ability to fight cancer (immunotherapy) or reduce side effects of chemotherapy

Bone marrow transplantation

Initially for cancer of the white blood cells (leukemia, lymphoma); now sometimes used when bone marrow cells have been killed in chemotherapy

Gene therapy and genetic testing

Gene therapy is still in the clinical trials stage

Genetic testing may become important in “precision medicine”

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Cancer Treatments (3)

Clinical trials

Research studies to test new drugs and treatment regimens

Complementary and integrative medicine

Currently a hot topic for research

Used at higher rates by cancer patients and survivors, but none have been shown to cure cancers

Some supplements may interact with cancer treatments and should be used with caution and under supervision

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Breast Cancer

Second leading cause of cancer death in women

Risk factors:

Early first menstruation

Late onset of menopause

Family history

Older age

Higher socioeconomic class

Having no children or having children after 30

Obesity

Hormone replacement after menopause

More than two alcoholic beverages a day

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Breast Cancer (2)

Signs and symptoms:

Persistent lump; skin swelling, redness, or bumpiness; change in nipple appearance or discharge

Screening and detection:

Breast self-exam; mammogram screening; biopsy

Treatment:

Lumpectomy: removal of the tumor and some breast tissue around

Mastectomy: removal of the entire breast

Five-year survival rate for all stages is 89%

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Lung Cancer

Leading cause of cancer death in the United States

Second most commonly diagnosed cancer

Risk factors:

Use of tobacco products in any form

Exposure to carcinogenic chemicals, arsenic, radon, asbestos, radiation, air pollution, and environmental tobacco smoke

Signs and symptoms:

Coughing; blood-streaked sputum; chest pain; difficulty breathing; recurrent lung infections

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Lung Cancer (2)

Screening and detection:

No recommended screening for the general population

Low-dose CT screening for high-risk individuals

Bronchoscopy: fiber-optic device inserted into the lungs to examine lung tissue for signs of cancer

Treatment: surgery, radiation, or a combination of radiation and chemotherapy

One-year survival rate is 44%

Five-year survival rate is 17%

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Prostate Cancer

Second most common cause of cancer death in men

Most commonly diagnosed cancer in men

Risk factors:

Age, family history; being Black

Possibly a high-fat diet

Signs and symptoms:

In early stages, usually none

In advanced prostate cancer, difficulty urinating; pain in the pelvic region; pain with urination; or blood in the urine

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Prostate Cancer (2)

Screening and detection

Digital rectal exam; prostate-specific antigen (PSA) test

Treatment

In early stages and younger men: surgery and radiation, sometimes in combination with chemotherapy; and hormonal medication

In later stages: chemotherapy, radiation, and hormonal medication

Vaccine approved in 2010 appears to prolong life

Five-year survival rate for all stages: nearly 100%

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Colon and Rectal Cancer

Third leading cause of cancer death

Third most commonly diagnosed cancer

Risk factors:

Age

Personal or family history of colon polyps, inflammatory bowel disease, or colorectal cancer

Colon polyps: growths that may progress to colon cancer

Smoking, alcohol use, obesity, physical inactivity, a diet high in fat or red or processed meat and inadequate fruits and vegetables

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Colon and Rectal Cancer (2)

Signs and symptoms:

Change in bowel movements; change in stool size or shape; pain in the abdomen; blood in the stool

Screening and detection:

Flexible sigmoidoscopy

Colonoscopy

Double-contrast barium enema

CT colonoscopy

Treatment: surgery; radiation and/or chemotherapy

Five-year survival rate is 65%

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Figure 15.2 Colon.

A colonoscopy allows the entire colon to be examined and facilitates the removal of growths, such as polyps, that may become cancerous.

Source: Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, 11th ed., by T. Fahey. Copyright © 2014 The McGraw- Hill Companies. Reprinted by permission of The McGraw-Hill Companies, Inc.

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Skin Cancer

Basal cell carcinoma, squamous cell carcinoma, and melanoma

Basal cell and squamous cell carcinomas are often curable

Melanoma is more likely to be fatal

All forms are linked directly to ultraviolet light exposure—both UVA and UVB

Stay out of the sun during midday

Wear protective clothing

Use a broad-spectrum sunscreen with a sun-protective factor (SPF) of 15 or higher

Wear sunglasses with UV protection

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Skin Cancer: Melanoma

Risk factors:

Personal history

Large number of moles

Fair skin and sun sensitivity increases risk

Signs and symptoms: changes in a mole

Screening and detection: self-exam and evaluation by a health care provider

Treatment: surgery; chemotherapy and immunotherapy in advanced stages

Overall five-year survival rate is 92%

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Figure 15.3 The ABCDE evaluation of moles for melanoma.

A—Asymmetry: Is one half unlike the other?

B—Border irregularity: Does it have an uneven, scalloped edge rather than a clearly defined border?

C—Color variation: Is the color uniform, or does it vary from one area to another, from tan to brown to black, or from white to red to blue?

D—Diameter larger than ¼ inch: At its widest point, is the growth as large as, or larger than, a pencil eraser?

E—Evolving: Is it evolving or changing?

Source: “What to Look For: The ABCDEs of Melanoma,” 2014, American Academy of Dermatology, www.aad.org/spot-skin-cancer/ understanding-skin-cancer/how-do-i-check-my-skin/what-to-look-for.

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Skin Cancer: Basil Cell and Squamous Cell Carcinomas

Risk factors:

Fair skin; blonde, red, or light brown hair; blue, green, or hazel eyes; and freckles and moles

Cumulative sun exposure and age

Signs and symptoms:

Basal cell: a new skin growth; a raised, domelike lesion; or a sore that never heals

Squamous cell: red, scaly area that does not go away; a sore that does not heal; or a raised, crusty sore

Screening and detection: monitoring and evaluation

Treatment: local removal and destruction

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Lymphoma

Cancers that originate in the lymph system, part of the body’s immune system

Hodgkin’s lymphoma; non-Hodgkin’s lymphoma

Risk factors:

Infections, medications, or genetic changes that weaken the immune system, along with exposure to radiation, herbicides, insecticides, and some other chemicals

Bacterium H. pylori for stomach lymphoma

Signs and symptoms:

Swollen lymph nodes, weight loss, fever, other symptoms depending on where it originates

Lymphoma (2)

Screening and detection:

No screening for those without symptoms

Biopsy and imaging studies

Treatment:

Often includes a combination of surgery, chemotherapy, and radiation; can sometimes involve immunotherapy or bone marrow transplant

Five-year survival rate for Hodgkin’s lymphoma: 86%

Five-year survival rate for non-Hodgkin’s: 70%

Figure 15.4 The lymph system.

Structures include the lymph nodes and lymph vessels, the adenoids/ tonsils, the thymus gland, the spleen, and the bone marrow. Clusters of lymph nodes can occur anywhere along the lymphatic vessels. Prominent areas include the neck (cervical lymph nodes), armpits (axillary lymph nodes), and groin (inguinal lymph nodes).

Common Cancers in the Young

At higher frequency in young people:

Cancers of the reproductive system

Leukemia

Associated behaviors are especially common among young people:

Oral cancers

Cervical Cancer

Risk factors:

HPV infection, tobacco use, immunosuppression, multiple births, early sexual activity, multiple sex partners, socioeconomic status, and nutritional status

Three vaccines are currently available

Screening and detection: early detection through the Pap test has reduced incidence and mortality rates

Treatment: removal or destruction of precursor cells

Five-year survival rate overall is 68%; the rate is 92% if the disease is localized

Uterine Cancer

Also called endometrial cancer

Risk factors: increased estrogen, obesity, diabetes, early menarche, late-onset menopause, irregular ovulation, infrequent periods

Signs and symptoms: abnormal uterine bleeding, pelvic pain, low back pain

Screening and detection: endometrial biopsy

Treatment: hysterectomy; other treatments depending on the stage

Overall, five-year survival rate is 82%

Ovarian Cancer

Leading gynecological cause of cancer death and the fifth overall cause of cancer death in women

If diagnosed early, however, survival rate is as high as 92%

Risk factors: family history; personal history; tobacco use and being overweight

Signs and symptoms: in later stages, swelling of the abdomen, bloating, or vague pain

Screening tests are being evaluated

Treatment: surgery, chemotherapy, drug therapy

Testicular Cancer

Most common cancer for men aged 20–35

Risk factors:

History of an undescended testicle; family/personal history of testicular cancer; abnormal development of the testes; infertility or abnormal sperm

Signs and symptoms: painless lump; swelling or discomfort

Screening and detection: self-exam; ultrasound

Treatment: surgery, chemotherapy, and radiation

Cure rate at all stages is 95%

Leukemia

Group of cancers originating in the bone marrow or other parts of the body where white blood cells form

Involves overproduction of one type of white blood cell

Risk factors: smoking and chemical exposure (benzene); ionizing radiation; infection with HTLV-1

Signs and symptoms: fatigue, infection, weight loss, fevers, easy bleeding and bruising

Screening and detection: blood test or biopsy

Treatment: chemotherapy, blood transfusion

Five-year survival rates range from 26% to 82%

Oral Cancers

Cancers that develop in the mouth or the pharynx

Risk factors: tobacco, high alcohol consumption, HPV

Signs and symptoms:

Persistent sore in the mouth; lump or bump; patch of white or red along the gums or cheeks

Late signs include pain or difficulty swallowing or chewing

Screening and detection: doctor or dentist as part of routine care

Treatment: surgery, chemotherapy, radiation

Five-year survival rate for all stages is 63%

Living with Cancer

If you or a family member is diagnosed with cancer:

Participate in decisions about treatment

Be an informed consumer

Consider how you will interact with others

Consider school or work obligations

Enlist support

Know what physical changes are likely to occur

Consider sperm or egg donation and freezing

Spiritual beliefs and practices can be important

Don’t think about cancer all the time

In Review

What is cancer?

What causes cancer?

How is cancer detected and treated?

What are the most common cancers?

Appendix A

Long image descriptions

Figure 15.1 10 Most Common Cancers Appendix

Overall, new cases diagnosed in 2015, from most to least, were breast cancer (female); lung and bronchus cancers; prostate cancer; colon and rectum cancers; bladder cancer; melanoma (skin); non-Hodgkin’s lymphoma; thyroid cancer; kidney and renal cancers; and endometrial (uterine) cancer.

In the same year, deaths most to least resulted from lung and bronchus cancers; colon and rectum cancers; breast cancer (female); prostate cancer; non-Hodgkin lymphoma; bladder cancer; kidney and renal cancers; melanoma (skin); endometrial (uterine) cancer; and thyroid cancer.

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