© 2007 McGraw-Hill Higher Education. All rights reserved. Chapter Twenty-two Cancer: Understanding a Complex Condition

© 2007 McGraw-Hill Higher Education. All rights reserved. What is Cancer? A condition of uncontrolled growth of cells A condition of 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 Develops from a single cell that goes awry, but a combination of events must occur before the cell turns into a tumor clonal growth: when the replication of cells copy themselves in an uncontrolled manner clonal growth: when the replication of cells copy themselves in an uncontrolled manner

© 2007 McGraw-Hill Higher Education. All rights reserved. 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 A special protective mechanism exists for certain cells called stem cells A special protective mechanism exists for certain cells called stem cells Stem cells can become different cells and are capable of dividing many times as well as self- destructing if exposed to a toxin Stem cells can become different cells and are capable of dividing many times as well as self- destructing if exposed to a toxin

© 2007 McGraw-Hill Higher Education. All rights reserved. Cancer Cell Growth Cancer arises from a single cell that is mutated or exposed to a carcinogen, a cancer causing substance Cancer arises from a single cell that is mutated or exposed to a carcinogen, a cancer causing substance An initiating event occurs as a result of an error in duplication or in response to a carcinogen An initiating event occurs as a result of an error in duplication or in response to a carcinogen An oncogene is a gene that drives a cell to grow and divide regardless of signals from surrounding cells An oncogene is a gene that drives a cell to grow and divide regardless of signals from surrounding cells A tumor may form (mass of extra tissues) and become either benign (slow growth) or malignant (capable of spreading to surrounding tissues) A tumor may form (mass of extra tissues) and become either benign (slow growth) or malignant (capable of spreading to surrounding tissues)

© 2007 McGraw-Hill Higher Education. All rights reserved. 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)

© 2007 McGraw-Hill Higher Education. All rights reserved. Types of Cancer Four broad types of cancer are distinguished: Four broad types of cancer are distinguished: Carcinomas (epithelial tissue, including the skin, surface of body organs, outer portion of glands) Carcinomas (epithelial tissue, including the skin, surface of body organs, outer portion of glands) Sarcomas (connective tissue such as bone, tendon, cartilage, muscle, fat tissues) Sarcomas (connective tissue such as bone, tendon, cartilage, muscle, fat tissues) Leukemias (blood and bone marrow or the lymphatic system) Leukemias (blood and bone marrow or the lymphatic system) Lymphomas (lymph nodes and glands) Lymphomas (lymph nodes and glands)

© 2007 McGraw-Hill Higher Education. All rights reserved. Risk Factors For Cancer Family History Family History Lifestyle Factors Lifestyle Factors –Tobacco Use –Dietary Patterns –Overweight and obesity –Physical inactivity –Alcohol consumption Environmental Factors Environmental Factors –Ultraviolet Radiation –Other forms of radiation –Chemical carcinogens –Infectious agents

© 2007 McGraw-Hill Higher Education. All rights reserved. Common Cancers Lung Cancer Lung Cancer Leading cause of death for men and women in the US Leading cause of death for men and women in the US Second most diagnosed cancer Second most diagnosed cancer Colon and Rectal Cancer Colon and Rectal Cancer 3 rd leading cause of death and the 3 rd most commonly diagnosed cancer 3 rd leading cause of death and the 3 rd most commonly diagnosed cancer Breast Cancer Breast Cancer Second leading cause of cancer death in women Second leading cause of cancer death in women Prostate Cancer Prostate Cancer Second most common cause of cancer death in men Second most common cause of cancer death in men Most commonly diagnosed cancer for men Most commonly diagnosed cancer for men

© 2007 McGraw-Hill Higher Education. All rights reserved. Lung Cancer Risk Factors Risk Factors –Smoking –Environmental pollutants Symptoms Symptoms –Coughing –Chest pain –Difficulty breathing

© 2007 McGraw-Hill Higher Education. All rights reserved. Lung Cancer Prevention Prevention –Remove smoke element Treatment Treatment –Surgery –Radiation –Chemotherapy –Medications

© 2007 McGraw-Hill Higher Education. All rights reserved. Colon and Rectal Cancer Risk factors Risk factors –Genetic and dietary habits Warning signs Warning signs –Change in bowel movements –Change in stool size or shape –Pain in the abdomen or blood in the stool

© 2007 McGraw-Hill Higher Education. All rights reserved. Colon and Rectal Cancer Prevention Prevention –Removal of polyps, exercise, dietary supplementation Early Detection Early Detection –Rectal exams, stool test, sigmoidoscopy, colonoscopy Treatment Treatment –Surgery, radiation, chemotherapy

© 2007 McGraw-Hill Higher Education. All rights reserved. Breast Cancer Risk factors Risk factors –Early menstrual cycle for women –Women with no children or having children later in life –Hormone replacement therapy use Prevention Prevention –Diet –Mammography –Activity levels –Pregnancy and breastfeeding decisions –Occupational hazards –New medications Treatment Treatment –Lumpectomy –Drug therapy –Chemotherapy/radiation treatments

© 2007 McGraw-Hill Higher Education. All rights reserved. Prostate Cancer Risk factors Risk factors –Age, dietary fat intake, genetic link Symptoms during the advanced stage Symptoms during the advanced stage –Associated with difficulty urinating or pain in the pelvic region, or blood in the urine Early Detection Early Detection –PSA screenings, digital rectal exam Treatment Treatment –Surgery, radiation, hormonal medications, chemotherapy

© 2007 McGraw-Hill Higher Education. All rights reserved. Cancers of the Female Reproductive System Cancer can develop throughout the female reproductive system but occur more frequently in the following areas: Cancer can develop throughout the female reproductive system but occur more frequently in the following areas: Cervix Cervix Uterus Uterus Ovaries Ovaries

© 2007 McGraw-Hill Higher Education. All rights reserved. Cervical Cancer Risk factors Risk factors –HPV infection (cervical dysplasia) –Smoking and socioeconomic factors Prevention Prevention –Sexual abstinence –Pap tests –Careful selection of sexual partners Treatment Treatment –Surgery (minor or major) –Radiation/chemotherapy

© 2007 McGraw-Hill Higher Education. All rights reserved. Uterine Cancer [Endometrial Cancer] Risk Factors Risk Factors –Early menarche, late menopause, lack of ovulation, never having given birth, ERT, use of tamoxifen, and also in diabetics, obese, and hypertensive women Prevention Prevention –Minimize high levels of estrogen and regular physician care Treatment Treatment –Surgery, radiation, chemotherapy, hormone treatment

© 2007 McGraw-Hill Higher Education. All rights reserved. Ovarian Cancer The leading gynecological cause of cancer death and the fourth overall cause of cancer in women The leading gynecological cause of cancer death and the fourth overall cause of cancer in women –Prevention Similar to what is recommended for breast cancer Similar to what is recommended for breast cancer Prophylactic oophorectomy Prophylactic oophorectomy –Early Detection Referred as the “silent cancer” Referred as the “silent cancer” –Annual pelvic exams –Genetic screenings –Treatment Surgery Surgery Chemotherapy Chemotherapy Drug therapy Drug therapy

© 2007 McGraw-Hill Higher Education. All rights reserved. Skin Cancer There are 3 types of skin cancer that exist: There are 3 types of skin cancer that exist: 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 factors Risk factors –Severe sunburn during childhood, chronic sun exposure during young adulthood Prevention Prevention –Reduce exposure to sun’s rays, use sunscreens Early Detection Early Detection –American Cancer Society guidelines (next slide) Treatment Treatment –Surgery, chemotherapy, interleukin-2

© 2007 McGraw-Hill Higher Education. All rights reserved. American Cancer Society Guidelines (Figure 22.3) A A symmetry B B order irregularity C C olor change D D iameter greater than 6mm

© 2007 McGraw-Hill Higher Education. All rights reserved. Testicular Cancer The most common cancer for men aged years The most common cancer for men aged years –Risk factors Family history, environmental factors Family history, environmental factors –Prevention Self exams Self exams –Early Detection Observations and self exams Observations and self exams –Treatment Surgery, chemotherapy, radiation Surgery, chemotherapy, radiation

© 2007 McGraw-Hill Higher Education. All rights reserved. Oral Cancer Cancers that develop in the mouth or the pharynx Cancers that develop in the mouth or the pharynx Risk factors include: Risk factors include: Cigarettes, cigars, pipes or smokeless tobacco Cigarettes, cigars, pipes or smokeless tobacco High levels of alcohol consumption High levels of alcohol consumption Early signs include: Early signs include: Persistent sore in the mouth Persistent sore in the mouth Lump or bump that won’t heal Lump or bump that won’t heal Patch of white or red along the gums or cheeks Patch of white or red along the gums or cheeks Treatment Treatment Surgery Surgery Chemotherapy Chemotherapy Radiation Radiation

© 2007 McGraw-Hill Higher Education. All rights reserved. Leukemia Group of cancers that originate in the bone marrow or other parts of the body where white blood cells form Group of cancers that originate in the bone marrow or other parts of the body where white blood cells form Results in the overproduction of one type of white blood cell which leads to increased risk of infection, anemia, and bleeding Results in the overproduction of one type of white blood cell which leads to increased risk of infection, anemia, and bleeding Risk factors are: Risk factors are: Cigarette smoking and exposure to chemicals Cigarette smoking and exposure to chemicals Ionizing radiation exposure Ionizing radiation exposure Infection with a virus Infection with a virus Treatment Treatment Chemotherapy Chemotherapy Possible bone marrow transplant Possible bone marrow transplant

© 2007 McGraw-Hill Higher Education. All rights reserved. Cancer Treatments Surgery (removal of tissue) Surgery (removal of tissue) Chemotherapy (drug treatment which interfere with rapid cell division) Chemotherapy (drug treatment which interfere 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 Therapies Biological Therapies –Immunotherapy medications Bone Marrow Transplantation Bone Marrow Transplantation Gene Therapy and Genetic Testing Gene Therapy and Genetic Testing

© 2007 McGraw-Hill Higher Education. All rights reserved. Chapter Twenty-two Cancer: Understanding a Complex Condition