NURS 330 March 9, 2015

Agenda Return and review group project Breast Cancer Lecture Prostate & Testicular Cancers Lecture Distribute Study Guide In-Class Assignment

Final Exam Mon, March 16, 2015 7:30pm – 10pm 100 Questions, each worth 2 points Multiple Choice, T/F, Fill-in-the-blank Study Guide will be emailed to students on Mon, March 9, 2015.

The following presentation on Cancer is from the American Cancer Society. It has been authorized for use in this class by Chrissy Kim, Manager, Healthcare/Corporate Initiatives

What is Cancer? Cancer occurs when cells in a part of the body begin to grow out of control. Normal cells divide and grow in an orderly fashion, but cancer cells do not. They continue to grow and crowd out normal cells. Although there are many kinds of cancer, they all have in common this out-of-control growth of cells.

Cancer (cont) Sometimes cancer cells break away from a tumor and spread to other parts of the body through the blood or lymph system. They can settle in new places and form new tumors. When this happens, it is called metastasis. Cancer that has spread in this way is called metastatic cancer. Even when cancer has spread to a new place in the body, it is still named after the part of the body where it started. For example, if prostate cancer spreads to the bones, it is still called prostate cancer. If breast cancer spreads to the lungs, it is still breast cancer. When cancer comes back in a person who appeared to be free of the disease after treatment, it is called a recurrence.

Survival Rates 5-year localized survival rate Localized cancer is cancer that, at the time of diagnosis, had not spread to additional sites within the body. Typically, the earlier a cancer is detected and diagnosed, the more successful the treatment, thus enhancing the survival rate.

Survival Rates 5-year overall survival rate The 5-year survival rates represent persons who are living 5 years after diagnosis, whether disease-free, in remission, or under treatment. They do not imply that 5-year survivors have been permanently cured of cancer.

The Breast Main function is to produce milk for breastfeeding 2 main types of tissues: glandular tissues Lobules – milk production Ducts – milk passages to the nipples supporting (stromal) tissues Fatty & Fibrous connective tissue Give breast their size, shape and support

Breast Changes Changes in the breasts may be caused either by benign conditions or cancer Benign Breast Conditions Never life threatening; very common Some may increase the risk of developing breast cancer fibrocystic changes benign breast tumors breast inflammation Breast Cancer - Life threatening

Breast Changes It is often not possible to tell the difference between benign and cancerous conditions based on symptoms alone More tests will be needed Some benign breast conditions may not cause any symptoms and may be found during a mammogram or a breast biopsy.

What Is Breast Cancer? Breast cancer is a malignant (cancerous) tumor that develops from cells in the breast. Most breast lumps are benign (not cancerous). Early detection is very important because the cancer can spread if not treated at its earliest stages.

The American Cancer Society’s Estimates The American Cancer Society's most recent estimates for breast cancer in the United States are for 2013: About 232,340 new cases of invasive breast cancer will be diagnosed in women. About 64,640 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is non-invasive and is the earliest form of breast cancer). About 39,620 women will die from breast cancer

Who Is At Risk? Two factors greatly influence the risk of developing breast cancer: 1. Being a woman The disease is over 100 times more common in women than in men. 2. Age Approximately 77% of women with breast cancer are age 50 or older at the time of diagnosis.

Why Are Older Women More At Risk? Exposure to reproductive hormones, like estrogen, over a lifetime may increase the risk. This is influenced by: Age Age of first menstrual period Number of pregnancies Age at menopause History of taking medication that contains estrogen

Other Risk Factors Family history of breast cancer Having a first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman’s risk. Most women with breast cancer do not have a first-degree relative with the disease. History of noncancerous breast disease Never having children or having first live birth after age 30

Other Risk Factors Starting monthly periods before age 12 Starting menopause after age 55 More than 5 years of postmenopausal estrogen replacement therapy Use of alcohol, especially two or more drinks daily Obesity, especially excessive weight gain Physical inactivity

Reducing Your Risk Limit alcohol use. Engage in regular physical activity. Maintain a healthy weight. Eat a healthy, balanced diet that includes at least five servings of fruits and vegetables every day.

Symptoms The most common sign of breast cancer is a new lump or mass. Other signs include: Generalized swelling of part of a breast (even if no distinct lump is felt) Skin irritation or dimpling

Symptoms – other signs (cont) Nipple pain or retraction (turning inward) Redness or scaliness of the nipple or breast skin Discharge other than breast milk

Detection Methods Nearly all breast cancers can be successfully treated if detected early. A mammogram is the best method for detecting breast cancer because often it can identify cancer before physical symptoms develop. All women should have regular breast examinations by a health provider.

The American Cancer Society’s Screening Recommendations Clinical Breast Exam should be part of a periodic health exam, about every three years for women in their 20s and 30s, and every year for women 40 and older. Women should know how their breasts normally feel and report any breast change promptly to their health care provider. Breast Self Examination is an option for women starting in their 20s.

The American Cancer Society’s Screening Recommendations Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health. Women at increased risk (e.g., family history, genetic tendency, past breast cancer) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests (i.e., breast ultrasound and MRI), or having more frequent exams.

Breast Self Exam Beginning in their 20s, women should be told about the benefits and limitations of BSE. Women should be aware of how their breasts normally feel and report any new breast changes to a health professional as soon as they are found. Finding a breast change does not mean that a cancer is present.

Treatment Treatment is most successful when breast cancer is detected early. Often two or more treatment methods are used. Patients should thoroughly discuss treatment options with their doctors.

Treatment Options Breast conservation surgery* Mastectomy* * In both cases, the lymph nodes under the arm may also be removed.

Treatment Options Chemotherapy Hormone therapy Uses anticancer drugs that attack cancer cells and normal cells. These drugs usually are given by injection or by mouth. Hormone therapy Uses hormones (chemicals made in the body that affect cell activity) or drugs that interfere with hormone production.

Treatment Options Monoclonal antibody therapy Radiation therapy Uses substances that locate and bind to cancer cells. Can be used alone or to deliver drugs, toxins, or radioactive material directly to tumor cells. Radiation therapy Uses high-energy rays to shrink or kill cancer cells.

Survival Rates 5-year localized survival rate is 98% 5-year overall survival rate is 80%

Hope For The Future Scientists are continually learning more about breast cancer, including how lifestyle, environment, and other factors affect risk. Examining the role of physical activity, weight gain or loss, diet, hormone replacement therapy, and environment on breast cancer risks. Determining the best use of genetic testing to find gene mutations (BRCA1 and BRCA2) that may increase breast cancer risks.

The Bottom Line Nearly all breast cancers can be treated successfully if found early. The key is early detection! Breast cancer risk may be reduced by being physically active, maintaining a healthy weight, and reducing alcohol use.

BSE http://beawarefoundation.org/breast-self-exam-video

Testicular Cancer

What Is Testicular Cancer? Testicular cancer can develop in one or both testicles in men and boys. Contained in a sac of skin called the scrotum, the testicles are the part of the male reproductive system that produces sperm and male hormones (like testosterone). Very rare cancer but is the most common cancer found in men ages 15 - 35

The American Cancer Society’s Estimates In the United States during 2013: 7,920 new cases of testicular cancer Deaths per year: 370 men Testicular cancer is not common; about 1 in 270 men will develop testicular cancer in their lifetime.

Risk Factors The main risk factors for testicular cancer include: Race Family history Being born with an undescended testicle Cryptorchidism Because these risks cannot be avoided, it is not currently known how to prevent most cases of testicular cancer.

Risk Factors (cont) Although testicular cancers usually occur in patients between the ages of 15 and 40, they can affect males of any age, including infants and elderly men. The risk among White men is about five times higher than among African American men. Men who have had cancer in one testicle are at increased risk for developing cancer in the other testicle.

What Are Other Risk Factors? If a man’s close family members have had testicular cancer, he is at greater risk. Men who had an undescended testicle as a baby are at increased risk (3 out of every 100 male infants). Men who have had cancer in one testicle are at increased risk for developing cancer in the other testicle.

Other Risk Factors Some jobs may put men at increased risk for testicular cancer. Examples include being one of the following: Miner Oil or gas worker Janitor Leather worker Recent studies found no evidence that having a vasectomy increases a man’s risk of developing the disease.

Reducing Your Risk The main risk factors for testicular cancer include: Race Family history Being born with an undescended testicle Because these risks cannot be avoided, it is not currently known how to prevent most cases of testicular cancer.

Risk Factors (cont) Since none of these risks can be prevented, the best protection is awareness of risks and symptoms, early detection, and prompt treatment. Men at risk may want to perform a monthly self-exam Testicular Self Exam (TSE)

Testicular Self Exam (TSE) The best time to perform the self-exam is during or after a bath or shower, when the skin of the scrotum is relaxed. American Cancer Society. 2006

Symptoms Lump or swelling in either testicle Enlargement of a testicle 90% of cases Often painless or slightly uncomfortable Enlargement of a testicle Feeling of heaviness in the scrotum Dull ache in the lower abdomen or groin Sudden collection of fluid in the scrotum Enlargement or tenderness of the breasts

Detection Methods In 90% of cases, men have a lump or swelling in a testicle. Any swelling or aching in the testicles should be examined by a doctor without delay. Men at risk may want to perform a monthly self-exam.

Diagnosis Medical History and Physical Exam Ultrasound Blood Tests

Treatment Testicular cancer is highly treatable, usually curable, and relatively rare. Treatment is most successful when cancer is detected early. Often two or more treatment methods are used. Patients should thoroughly discuss treatment options with their doctors.

Treatment Options There are three main treatment options: Surgery An operation to remove cancer cells. Radiation therapy Uses high-energy rays to shrink or kill cancer cells. Chemotherapy Uses anticancer drugs that attack cancer cells and normal cells. The drugs are usually given by injection or by mouth.

Survival Rates 5-year localized survival rate is 99% 5-year overall survival rate is 95% Survival rates drop to 76% when cancer has spread to distant organs, which underlines the need for early action.

TSE http://www.thefamilygp.com/testicle_self_examination.aspx

Prostate Cancer

What Is Prostate Cancer? In American men, prostate cancer is the most common cancer and the second leading cause of cancer death. The prostate gland is walnut-sized and is located in front of the rectum, behind the penis, and under the bladder. Most prostate cancers grow very slowly, but when they spread, they can do so quickly.

The American Cancer Society’s Estimates In the United States during 2013: 238,590 new cases of prostate cancer Deaths per year: 29,720

The Prostate Gland Urinary Bladder Prostate Gland

Three Greatest Risk Factors Being a man Only men develop prostate cancer, typically those ages 50 and older. Age More than 70% of prostate cancers are diagnosed in men over 65. Race: African American men have the highest prostate cancer incidence rates in the world. The rates of prostate cancer death for African American men are more than twice the rates for White men.

Other Risk Factors About 5 to 10% of prostate cancers may be inherited. Eating a high-fat diet especially a diet high in saturated fat, found primarily in animal sources, such as red meat and dairy products—may play a part in causing prostate cancer.

Symptoms Most early cases of prostate cancer cause no symptoms, but some early signs may be: Frequent urination, especially at night. Difficulty starting urination or inability to urinate. Weak or painful urination.

Diagnosis Prostate-Specific Antigen (PSA) Digital Rectal Exam (DRE) blood test Digital Rectal Exam (DRE) rectal exam All men 50 years of age and older should ask their physicians about having the PSA test and a DRE every year. At a younger age if at high risk

Treatment Treatment is most successful when prostate cancer is detected early. Often two or more treatment methods are used. Patients should thoroughly discuss treatment options with their doctors.

Treatment If prostate cancer is detected early, is slow growing, and is not causing symptoms, “watchful waiting” may be chosen initially, especially for older men. Active treatment is started if the cancer begins to grow more quickly or symptoms appear.

Treatment (active) Options Surgery Removal of the prostate, called prostatectomy, is the most commonly chosen surgical treatment. Radiation therapy Uses high-energy rays to shrink or kill cancer cells.

Treatment Options (cont) Chemotherapy Uses anticancer drugs that attack cancer cells and normal cells. The drugs are usually given by injection or by mouth. Hormone therapy Treatment with hormones or drugs that interfere with hormone production or action, or the surgical removal of hormone producing glands.

Survival Rates 5-year localized survival rate is 100% 5-year overall survival rate is 99%

Prevention All men 50 and older should talk to their doctors about having annual DRE and PSA tests to help find prostate cancer early. Men who are at high risk for prostate cancer (African Americans or men with a first-degree relative diagnosed with prostate cancer at a young age) should begin testing at age 45. Prostate cancer is less likely to be curable once it has spread; however, with annual screening, prostate cancer can be detected before this occurs.