1. Cancer

2. Cancer • 2nd leading cause of death. What do you think is the 1st? • 1 out of 4 deaths is due to some form of cancer • 1/3 of the cancers are attributed or linked to conditions such as: • Obesity • Physical inactivity • Nutritional problems • Smoking • Other lifestyle factors

3. What is Cancer? • Classified by the tissues or blood cells from which it originates. • Most cancers are derived from epithelial tissues called carcinoma • Adenocarcinoma – glandular tissue • Sarcoma – connective, muscle, & bones • Gliomas – brain & spinal cord tissue • Melanoma – pigment cells • Myeloma – plasma cells • Lymphoma – lymph cells • Leukemia – leukocytes • Erythroleukemia - erythrocytes

4. What is Cancer? • First develops as a mutation in a single cell. • The mutated cell never matures into a mature normal cells • The cell reproduces at a fast rate (usually faster than normal cells) • Uncontrolled growing cells invades nearby tissue • If the growing cells invade other tissues in other locations, the term is metastasis

5. Causes of cancer • Malfunction of genes that controls cell growth • Carcinogenesis – cell’s transformation from normal to cancer • Virus factor – HPV, Herpes simplex, Hep B, Hep C, HIV, Epstein Barr • Overexposed cells – Skin cancer • Air – Tobacco – lung, bladder, throat, mouth, pancreatic • Asbestos – lung cancer • Immune factor - transplant patients develop Kaposi’s sarcoma or non-Hodgkin’s lymphoma • Genetics – 5-10% are hereditary • Food – colorectal cancer (high protein, high fat, nitrates) • Hormones – Estrogen linked to breast cancer

6. Screening • See Handout

7. Cancer metastasis • Cancer mets by 3 ways • Circulation through the blood & lymphatic system • Travel through the vein, commonly to liver & lungs • Accidental transplantation during surgery • Spreading to adjacent organs & tissues • Seeding – Cancer penetrate the wall of an organ, move into a body cavity, & spread throughout the area

8. Breast Cancer • Most common cancer affecting women • 1/7 women develop breast cancer by the age of 85 • No exact cause • 5% linked to genes BBCA 1 & BBCA 2 (inherited by mother or father); if you have the gene, you have a 80% chance of having breast cancer • Also linked to ovarian cancer (20 - 40% chance)

9. Classified into 2 common types • Ductal (most common) • Carcinoma in situ • Infiltrating (invasive) • Develops within the ducts • Lobular • Carcinoma in situ • Infiltrating (invasive) • Develops within the lobes • Invasive – 90% break through the duct walls & encroach on other breast tissues • Non-invasive – confined to duct in which they originate

10. Risk Factors • Family History • Radiation exposure • Premenopausal woman older than age 45 • Obesity • Age • Recent use of hormonal contraceptives • Early onset of menses or late menopause • Nulligravida • First pregnancy after age 30 • High fat diet • Colon, endometrial, or ovarian cancer • Postmenopausal hormone therapy (progestin & estrogen) • Alcohol use • Benign breast disease

11. Diagnosis • Self – breast exam • Mammography • Fine needle aspiration & excision biopsy • Hormone receptor assay • Ultrasonography • Bone scans, CAT scan for mets • Ductal lavage

12. Treatment • Lumpectomy in well – defined tumors • Radiation follows • Mastectomy • Partial – tumor & wedge of normal tissue • Total – removal all breast tissue • Modified Radical – entire breast, axillary nodes, & lining of chest wall • Chemotherapy • Common cyclophosphamide, methotrexate, doxurubicin, & fluorouracil • Hormone therapy

13. Lung Cancer • Largely preventable • Number 1 cancer killer of both men & women of the world • 2 major classes • Small Cell (20%) • Hormonal cells in the lung • Include oat cell, intermediate, combined • Very aggressive; usually already metastasized when diagnosed • Non-small cell most common • Adenocarcinoma – most common. In bronchial epithelium & mets early; appears as infiltrates; not usually associated with smoking • Squamous cell – squamous bronchial epithelium; central located. Found on chest xray. Mets late. Usually mets to bones • Large cell – highly anaplastic; aggressive; mets early • PROGNOSIS: ABOUT 13% SURVIVE 5 YEARS AFTER DX

14. Lung Cancer • Decreased occurrence since 1990 • 80-90% lung cancer is caused by smoking • # of cigarettes & length of smoking impact the occurrence of cancer • COPD increases risk for lung cancer

15. Patient presentation • Hemoptysis • Enlarged supraclavicular node (especially in smokers) • Pneumonia that does not clear up with antibiotics • May present with endocrine disorder such as Cushing’s

16. Diagnostic Testing • Chest x-ray • Cytological sputum • Bronchoscopy • Needle biopsy • CT scan • Bone scan

17. Treatment • Surgery • Radiation • Chemotherapy • Cyclophosphamide, doxorubicin, vincreitine • Patient usually have recurrence 7 – 14 months

18. Malignant Melanoma • 7th most common cancer in US but only 4% of all skin cancer • Slightly more common in women. WHY? • What age group do you think?? • What cells do you think this cancer occurs? • Melanocytes are located in: • Skin • Meninges • Alimentary canal • Respiratory canal • Lymph nodes

19. Common factors • Sun exposure • Fair traits • Nevi • Family history • Immunosuppresion

20. Metastasis • Spreads through the lymphatic & vascular system • Usually to regional lymph nodes, skin, liver, lungs, & CNS • COMMON SITES FOR TUMOR: Men – head & neck Women – legs

21. Diagnosis • Excisional biopsy • Punch biopsy • Chest x ray, CT, Bone scan, MRI for mets

22. Colorectal Cancer • 10-15% of all new cancer • Equal in both sexes & 3rd most cancer deaths • Usually progresses slowly • Most common people older than 50 (primary risk factor) • Colon Polyps • High fat, low fiber • Pre-existing conditions • Ulcerative colitis • Crohn’s disease • Hereditary nonpolyposis colorectal carcinoma • Pelvic cancers

23. Couch Potato Factor • Smoking • Alcohol consumption • Obesity • Physical inactivity • Aspirin and estrogen replacement may help prevent

24. Early stages • No real symptoms • Rectal bleeding in stool • Change in bowel habits • Cramping pain in lower abdomen

25. Diagnostic testing • Digital rectal examination • Fecal occult test • Proctoscopy • Colonoscopy • CT • Liver function test • Carcinoembryonic antigen

26. Treatment • Surgery • Chemotherapy • Oxaliplagin • Radiation

27. Hodgkin’s disease • Painless • Cause is unknown but may be linked to a virus • Enlargement of the lymph nodes, spleen, & other lymphatic tissue • May be linked to Epstein Barr virus; herbicide

28. Signs & symptoms • Painless swelling of lymph nodes, usually in neck then axilla • Night sweats • Cancerous mass in spleen, liver, & bones • Painless swelling of the face & neck • Anemia • Jaundice • Nerve pain • Increased susceptibility to infection • Intermittent fever

29. Testing • Lymph node biopsy for the presence of Reed-Sternberg cells, nodular fibrosis & necrosis • Bone marrow, liver, mediastinal & spleen biopsy • Chest x ray, CT • Hematologica l tests

30. Leukemia • ALL – Acute Lymphocytic Leukemia • 80% of childhood leukemia • 81% 5 yrsurvivial rate • AML – Acute Myeloid Leukemia • Most common in adults • Survivial is 1 year • CLL – Chronic Lymphocytic Leukemia • Most benign & slowest progression • Most common in elderly • CML – Chronic myeloid Leukemia • Most common in middle age • 20% of leukemia

31. Prostate Cancer • Most common cancer affecting men • 2nd cause of death • African American men are 2x more likely to die • Most common is Adenocarcinoma • Slow growing • Progression is usually Prostate to capsule along the ejaculatory ducts to the seminal vesicles

32. Risk Factors • Age (usually over 65 yo) • Diet high in saturated fats • Ethnicity

33. Survival • 70% at 5 years when it is localized in prostate • Metastasized: survival is 35% • Fatal when it has bone metastasis

34. Signs & Symptoms • Usually no symptoms at early stage • Advanced diseases: • Slow Urinary Stream • Hematuria • Urinary hesitancy • Incomplete bladder emptying • dysuria

35. Testing • DRE • Biopsy • Blood levels of prostate – specific antigen (PSA) • Transrectal prostatic ultrasonography • Bone scan • MRI

36. Staging • See packet