. © 2009 McGraw-Hill Higher Education. All rights reserved. 1 Chapter Nineteen Cancer: Understanding a Complex Condition

© 2009 McGraw-Hill Higher Education. All rights reserved. 2 What Is Cancer? 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 Clonal growth: replication of a single cell that produces thousands of copies of itself in an uncontrolled manner

© 2009 McGraw-Hill Higher Education. All rights reserved. 3 Healthy Cell Growth Healthy cells have a complicated system of checks and balances that control cell growth and division.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.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.Each time a cell divides, there is a possibility of mutation or an error in DNA replication. Stem cells pose a risk for cancer but have a special protective mechanism.Stem cells pose a risk for cancer but have a special protective mechanism. Stem cells are located deep within tissues and are protected from factors that increases the risk of genetic mutation (exposure to the sun, chemicals, and irritation).Stem cells are located deep within tissues and are protected from factors that increases the risk of genetic mutation (exposure to the sun, chemicals, and irritation). Stem cells can self-destruct if they experience DNA damage.Stem cells can self-destruct if they experience DNA damage.

© 2009 McGraw-Hill Higher Education. All rights reserved. 4 Cancer Cell Growth Cancer starts from a single cell that is undergoes a critical mutation caused by: –an error in duplication –in response to a exposed to a carcinogen, a cancer causing substance –Radiation Oncogene: gene that drives a cell to grow and divide regardless of signals from surrounding cells Tumor: may form (mass of extra tissues) and become either benign (slow growth) or malignant (capable of spreading to surrounding tissues) Metastasis: secondary tumor that appears when cancerous cells spread to other parts of the body

© 2009 McGraw-Hill Higher Education. All rights reserved. 5 Classifying Cancers Cancers are classified according to the tissue in which they originate called the primary site.Cancers are classified according to the tissue in which they originate called the primary site. Tumors are graded on the basis of the degree to which the tumor cells resemble healthy cells of the same tissue type, from a low grade (grade I) to a high grade (grade IV).Tumors are graded on the basis of the degree to which the tumor cells resemble healthy cells of the same tissue type, from a low grade (grade I) to a high grade (grade IV). The stage of the disease is a description of how far the cancer has spread:The stage of the disease is a description of how far the cancer has spread: –Two systems of staging: 5 categories (0 to stage 4 based on the cancer layers of cells)5 categories (0 to stage 4 based on the cancer layers of cells) TNM (tumors, nodes, metastasis ratings from 0-4)TNM (tumors, nodes, metastasis ratings from 0-4)

© 2009 McGraw-Hill Higher Education. All rights reserved. 6 Types of Cancer Four broad types of cancer are distinguished: Carcinomas : arise from epithelial tissue, (skin, lining of the intestines and body cavities, surface of body organs, outer portion of glands)Carcinomas : arise from epithelial tissue, (skin, lining of the intestines and body cavities, surface of body organs, outer portion of glands) Sarcomas : arise from connective tissue such as bone, tendon, cartilage, muscle, fat tissues)Sarcomas : arise from connective tissue such as bone, tendon, cartilage, muscle, fat tissues) Leukemias: cancers of the blood originate in the bone marrow or the lymphatic system)Leukemias: cancers of the blood originate in the bone marrow or the lymphatic system) Lymphomas (originate in lymph nodes and glands)Lymphomas (originate in lymph nodes and glands)

© 2009 McGraw-Hill Higher Education. All rights reserved. 7 Risk Factors for Cancer Family HistoryFamily History Lifestyle factorsLifestyle factors –Tobacco use –Dietary patterns –Overweight and obesity –Physical inactivity –Alcohol consumption Environmental FactorsEnvironmental Factors –Ultraviolet radiation –Other forms of radiation –Chemical and physical carcinogens –Infectious agents

© 2009 McGraw-Hill Higher Education. All rights reserved. 8 Common Cancers Lung CancerLung Cancer Leading cause of cancer death in the USLeading cause of cancer death in the US Second most commonly diagnosed cancerSecond most commonly diagnosed cancer Colon and Rectal CancerColon and Rectal Cancer 3 rd leading cause of death3 rd leading cause of death 3 rd most commonly diagnosed cancer3 rd most commonly diagnosed cancer Breast CancerBreast Cancer Second leading cause of cancer death in womenSecond leading cause of cancer death in women Prostate CancerProstate Cancer Second most common cause of cancer death in menSecond most common cause of cancer death in men Most commonly diagnosed cancer for menMost commonly diagnosed cancer for men

© 2009 McGraw-Hill Higher Education. All rights reserved. 9

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© 2009 McGraw-Hill Higher Education. All rights reserved. 11 Lung Cancer Risk FactorsRisk Factors –Smoking –Exposure to carcinogenic chemicals, arsenic, radon, asbestos, radiation, air pollution, and environmental tobacco smoke SymptomsSymptoms –Coughing –Blood-streaked sputum –Chest pain –Difficulty breathing –Recurrent lung infections

© 2009 McGraw-Hill Higher Education. All rights reserved. 12 Lung Cancer PreventionPrevention –Remove smoke element TreatmentTreatment –Surgery –Radiation –Chemotherapy –Radiation and Chemotherapy combination

© 2009 McGraw-Hill Higher Education. All rights reserved. 13 Colon and Rectal Cancer Risk factorsRisk factors –Age –Genetic and dietary habits –Personal or family history of colon polyps, inflammatory bowel disease, colorectal cancer –Smoking, obesity, physical inactivity, diet high in fat or red or processed meat, diet inadequate in fruit and vegetables Warning signsWarning signs –Change in bowel movements –Change in stool size or shape –Pain in the abdomen or blood in the stool

© 2009 McGraw-Hill Higher Education. All rights reserved. 14 Colon and Rectal Cancer Early DetectionEarly Detection –Rectal exams, stool test, sigmoidoscopy, colonoscopy, double-contrast barium enema, CT colonography TreatmentTreatment –Surgery, radiation and/or chemotherapy

© 2009 McGraw-Hill Higher Education. All rights reserved. 15 Breast Cancer Risk factors –Early first menstruation –Late onset of menopause –Family history –Older age –Higher socioeconomic class –Women with no children or having children after 30 –Obesity after menopause –Hormone replacement therapy use –Drinking more than two alcoholic beverages a day

© 2009 McGraw-Hill Higher Education. All rights reserved. 16 Breast Cancer PreventionPrevention –Diet –Exercise –Maintaining healthy body weight –Pregnancy and breastfeeding decisions DetectionDetection –Breast self-exam –Mammography TreatmentTreatment –Lumpectomy –Mastectomy –Radiation and/or chemotherapy treatments See Highlight on Health: Breast Self-Exam, page 411 © Royalty-Free/Corbis

© 2009 McGraw-Hill Higher Education. All rights reserved. 17 Prostate Cancer Risk factorsRisk factors –Age –Family history –Being Black –High-fat diet Symptoms during the advanced stageSymptoms during the advanced stage –Difficulty urinating –Pain in the pelvic region –Pain with urination –Blood in the urine

© 2009 McGraw-Hill Higher Education. All rights reserved. 18 Prostate Cancer Early DetectionEarly Detection –Digital rectal exam –Prostrate-specific antigen (PSA) screenings TreatmentTreatment –Surgery –Radiation, sometimes in combination with chemotherapy –Hormonal medications

© 2009 McGraw-Hill Higher Education. All rights reserved. 19 Cancers of the Female Reproductive System Cancer can develop throughout the female reproductive system but occurs more frequently in the following areas: CervixCervix UterusUterus OvariesOvaries

© 2009 McGraw-Hill Higher Education. All rights reserved. 20 Cervical Cancer Risk factorsRisk factors –HPV infection (cervical dysplasia), tobacco use, immuno-suppression, multiple births, early sexual activity, multiple sex partners, socioeconomic status, and nutritional status Early detection through PAP test has significantly reduced the rates of cervical cancer and mortality.Early detection through PAP test has significantly reduced the rates of cervical cancer and mortality. TreatmentTreatment –Electrocoagulation –Cryotherapy –Surgery –Radiation/chemotherapy

© 2009 McGraw-Hill Higher Education. All rights reserved. 21 Uterine Cancer (Endometrial Cancer) Risk FactorsRisk Factors –Early menarche, late-onset menopause, irregular ovulation, infrequent periods, never having given birth, ERT, use of tamoxifen, and also in diabetics, obese, and hypertensive women PreventionPrevention –Minimize high levels of estrogen and have regular physician care TreatmentTreatment –Surgery, radiation, chemotherapy, hormonal treatment

© 2009 McGraw-Hill Higher Education. All rights reserved. 22 Ovarian Cancer The leading gynecological cause of cancer death and the fifth overall cause of cancer in womenThe leading gynecological cause of cancer death and the fifth overall cause of cancer in women –Risk factors Family historyFamily history Personal history of breast, colon, or endometrial cancerPersonal history of breast, colon, or endometrial cancer –Prevention Using oral contraceptionUsing oral contraception PregnancyPregnancy BreastfeedingBreastfeeding Avoiding postmenopausal hormone replacement therapyAvoiding postmenopausal hormone replacement therapy –Treatment Surgery, chemotherapy, drug therapySurgery, chemotherapy, drug therapy

© 2009 McGraw-Hill Higher Education. All rights reserved. 23 Skin Cancer 3 forms of skin cancer:3 forms of skin cancer: Basal cell cancer (lesions and sores)Basal cell cancer (lesions and sores) Squamous cell cancer (raised bumps and sores)Squamous cell cancer (raised bumps and sores) Melanoma (spreads quickly )Melanoma (spreads quickly ) Risk factorsRisk factors –Severe sunburn during childhood, chronic sun exposure during young adulthood, cumulative sun exposure –Large number of moles –Family history PreventionPrevention –Reduce exposure to sun’s rays, use sunscreen TreatmentTreatment –Surgery, local removal, chemotherapy, immunotherapy

© 2009 McGraw-Hill Higher Education. All rights reserved. 24 The ABCD Evaluation of Moles for Melanoma

© 2009 McGraw-Hill Higher Education. All rights reserved. 25 Testicular Cancer Most common cancer for men aged –Risk factors Family history, personal history of testicular cancer in other testicle, abnormal development of the testes, history of undescended testicle, infertility or abnormal sperm –Detection Self exams –Treatment Surgery, chemotherapy, radiation

© 2009 McGraw-Hill Higher Education. All rights reserved. 26 Oral Cancer Cancers that develop in the mouth or the pharynx Risk factors include: Cigarettes, cigars, pipes, smokeless tobacco High levels of alcohol consumption Early signs include: Persistent sore in the mouth Lump or bump that won’t heal Patch of white or red along the gums or cheeks Treatment Surgery Chemotherapy Radiation © MedioImages/PictureQuest

© 2009 McGraw-Hill Higher Education. All rights reserved. 27 Leukemia Group of cancers that originate in the bone marrow or other parts of the body where white blood cells formGroup of cancers that originate in the bone marrow or other parts of the body where white blood cells form Overproduction of one type of white blood cell and can lead to increased risk of infection, anemia, and bleedingOverproduction of one type of white blood cell and can lead to increased risk of infection, anemia, and bleeding Risk factors are:Risk factors are: Cigarette smoking and exposure to chemicalsCigarette smoking and exposure to chemicals Ionizing radiation exposureIonizing radiation exposure Infection with a virusInfection with a virus TreatmentTreatment ChemotherapyChemotherapy Possible bone marrow transplantPossible bone marrow transplant

© 2009 McGraw-Hill Higher Education. All rights reserved. 28 Lymphoma Cancers that originate in the lymph system, part of the body’s immune systemCancers that originate in the lymph system, part of the body’s immune system –Hodgkin’s lymphoma –Non-Hodgkin’s lymphoma Risk factors are:Risk factors are: Infections, medications, or genetic change that weaken the immune systemInfections, medications, or genetic change that weaken the immune system Radiation, herbicides, insecticides, and some chemical exposuresRadiation, herbicides, insecticides, and some chemical exposures TreatmentTreatment Often includes a combination of surgery, chemotherapy, and radiationOften includes a combination of surgery, chemotherapy, and radiation Can sometimes involve immunotherapy or bone marrow transplantCan sometimes involve immunotherapy or bone marrow transplant

© 2009 McGraw-Hill Higher Education. All rights reserved. 29 Cancer Treatments Surgery (removal of tissue)Surgery (removal of tissue) Chemotherapy (drug treatment that interferes with rapid cell division)Chemotherapy (drug treatment that interferes with rapid cell division) Radiation (alters DNA which can destroy cancer cells with minimal damage to surrounding tissues)Radiation (alters DNA which can destroy cancer cells with minimal damage to surrounding tissues) Biological TherapiesBiological Therapies –Immunotherapy medications Bone Marrow TransplantationBone Marrow Transplantation Gene Therapy and Genetic TestingGene Therapy and Genetic Testing Complementary and Alternative MedicineComplementary and Alternative Medicine Clinical TrialsClinical Trials

. © 2009 McGraw-Hill Higher Education. All rights reserved. 30 Chapter Nineteen Cancer: Understanding a Complex Condition