Cancer Risk Management Chapter Outline Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Chapter 11 Cancer Risk Management

Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Key terms Cancer: Group of diseases characterized by uncontrolled growth and spread of abnormal cells Benign: Noncancerous Malignant: Cancerous

Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Key terms Deoxyribonucleic acid (DNA): Genetic substance of which genes are made; molecule that contains cell’s genetic code Ribonucleic acid (RNA): Genetic material that guides the formation of cell proteins

Key terms Oncogenes: Genes that initiate cell division Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Key terms Oncogenes: Genes that initiate cell division Suppressor genes: Genes that deactivate the process of cell division Angiogenesis: Formation of blood capillaries Metastasis: The movement of cells from one part of the body to another

Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Cancer development More than 100 types of cancer can develop in the body The process of cancer begins with an alteration in DNA Within DNA are oncogenes and tumor suppressor genes, which normally work together to repair and replace cells Defects in these genes ultimately allow the cell to grow into a tumor; defects are caused by External factors such as radiation, chemicals, and viruses Internal factors such as immune conditions, hormones, and genetic mutations Cancer starts with the abnormal growth of one cell, which then can multiply into billions of cancerous cells

Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Cancer development A critical turning point in the development of cancer is when a tumor reaches about one million cells At this stage, it is referred to as carcinoma in situ An undetected tumor may go for months or years without any significant growth While encapsulated, it does not pose a serious threat to human health To grow, tumors require more oxygen and nutrients

Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Cancer development In time, a few cancer cells start producing chemicals that enhance angiogenesis (capillary or blood vessel formation into the tumor) Angiogenesis is the precursor of metastasis Through the new blood vessels formed by angiogenesis: Cancerous cells break away from a malignant tumor Migrate to other parts of the body Can cause new cancers

Figure 11.4 How cancer starts and spreads

Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Cancer development Once cancer cells metastasize, treatment becomes more difficult Therapy can kill most cancer cells, but a few cells might become resistant to treatment Treatment-resistant cells can grow into a new tumor that will not respond to the same treatment

Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Cancer statistics Cancer is the second leading cause of death in the U.S. About 23% of all yearly deaths are caused by cancer Aproximately 1 in 2 men and 1 in 3 women in the U.S. will develop cancer More than 550,000 Americans die from cancer each year More than 1.3 million new cases are diagnosed each year

Death rates for major cancer sites Figure 11.5 Death rates for major cancer sites © American Cancer Society

Death rates for major cancer sites Figure 11.5 Death rates for major cancer sites © American Cancer Society

Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Critical thinking Have you ever had or do you now have any family members with cancer? Can you identify lifestyle or environmental factors as possible contributors to the disease? If not, are you concerned about your genetic predisposition, and are you making lifestyle changes to decrease your risk?

Cancer-causing factors Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Cancer-causing factors As much as 80% of all human cancer is related to lifestyle or environmental factors Diet Obesity Tobacco use Sedentary lifestyle Excessive use of alcohol Exposure to occupational hazards

Cancer-causing factors Figure 11.7 Cancer-causing factors SOURCE: Harvard Center for Cancer Prevention. Causes of Human Cancer, Harvard Report on Cancer Prevention, 1 (1996).

Guidelines for preventing cancer Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Guidelines for preventing cancer Get proper nutrition Abstain from tobacco Avoid excessive sun exposure Monitor estrogen, radiation exposure, and potential occupational hazards Engage in physical activity Maintain recommended body weight

Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Dietary guidelines Predominately a vegetarian diet (high in fiber and low in fat) Should include a variety of fruits and vegetables, in particular cruciferous vegetables The use of tea, soy products, calcium, and omega-3 fats is encouraged Adequate fiber intake is recommended (25 to 38 gr/day) Protein intake should be kept within the recommended guidelines Alcohol, if used at all, should be consumed in moderation (1 to 2 servings per day) Grilling of meats at high temperatures is discouraged

Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Dietary guidelines Consume ample amounts of fruits and vegetables which are high in antioxidants and phytochemicals Antioxidants seem to Absorb free radicals before they can cause damage Interrupt the sequence of reactions once damage has begun Phytochemicals (plant chemicals) seem to prevent cancer by blocking the formation of cancerous tumors and disrupting the process at almost every step of the way

Cancer risks

Abstain from tobacco use Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Abstain from tobacco use The biggest carcinogenic exposure in the workplace is cigarette smoke Of all cancers, at least 28% are tied to smoking, and 87% of lung cancers are tied to smoking Use of smokeless tobacco increases the risk for mouth, larynx, throat, and esophageal cancers

Avoiding excessive sun Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Avoiding excessive sun Excessive exposure to ultraviolet radiation (both UVB and UVA rays) contributes to skin cancer 1 in every 6 Americans will develop some type of skin cancer The most common sites of skin cancer are those areas exposed to the sun most often (face, neck, and back of the hands) Nearly 90% of the almost 1 million yearly cases of basal cell or squamous cell skin cancers in the U.S. could be prevented by protecting the skin from the sun Melanoma is the most deadly form of skin cancer, causing 7,700 yearly deaths

Avoiding excessive sun Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Avoiding excessive sun Tanning of the skin is the body’s natural reaction to permanent damage from too much sun Even small doses of sunlight add up to a greater risk for skin cancer and premature aging Avoid sun exposure between 10:00 am and 4:00 pm Sun lamps and tanning parlors provide mainly ultraviolet A rays (UVA) and have been linked to melanoma

Avoiding excessive sun Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Avoiding excessive sun Apply sunscreen lotion about 30 minutes before lengthy exposure to the sun A sun protection factor (SPF) of at least 15 is recommended When swimming or sweating, reapply waterproof sunscreens often (sunscreens lose strength when diluted)

Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Critical thinking What significance does a “healthy tan” have in your social life? Are you a “sun-worshiper,” or are you concerned about skin damage, premature aging, and potential skin cancer in your future?

Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Monitoring estrogen, radiation exposure, & potential occupational hazards Use of estrogen therapy has been linked to endometrial cancer in some studies Exposure to radiation increases the risk for cancer (use the lowest dose possible to keep cancer risk down) Occupational hazards increase the risk for cancer Examples include asbestos fibers, nickel and uranium dusts, chromium compounds, vinyl chloride, and bischlormethyl ether Cigarette smoking magnifies the risk from occupational hazards

Maintain physical activity Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Maintain physical activity An active lifestyle seems to have a protective effect against cancer Cancer mortality in active men and women is lower A daily 30-minute moderate-intensity exercise program lowers the risk for colon cancer and may lower the risk for cancers of the breast and reproductive system

Association between physical fitness and cancer mortality Figure 11.9

Warning signals of cancer Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Warning signals of cancer Change in bowel or bladder habits Sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty in swallowing Obvious change in wart or mole Nagging cough or hoarseness

Recommended check ups Cancer-related checkup Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Recommended check ups Cancer-related checkup Every 3 years for people 20–40 Every year for people age 40 and older Might include examinations for Cancers of the thyroid, oral cavity, skin, lymph nodes, testes, and ovaries Some nonmalignant diseases

Recommended check ups Breast check up Women 40 and older should Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Recommended check ups Breast check up Women 40 and older should Have an annual mammogram Have an annual clinical breast examination (CBE) (conducted close to and before mammogram) Perform monthly breast self-examination (BSE) Women 20–39 should Have a clinical breast examination every 3 years Perform monthly BSE

Recommended check ups Colon & rectum check up Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Recommended check ups Colon & rectum check up Beginning at age 50, men and women at average risk should follow one of the examination schedules below: Fecal occult blood test (FOBT) every year, or Flexible sigmoidoscopy every 5 years, or FOBT every year and flexible sigmoidoscopy every 5 years, or Double-contrast barium enema every 5 years, or Colonoscopy every 10 years

Recommended check ups Prostate checkup Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Recommended check ups Prostate checkup Beginning at age 50, men with life expectancy of at least 10 years should have the choice of having these tests annually A prostate-specific antigen (PSA) test A digital rectal exam Men at high risk should begin testing at age 45

Recommended check ups Uterus check up Cancer Development Incidence of Cancer Common Sites of Cancer Assessing Your Risks Guidelines for Preventing Cancer Warning Signals of Cancer Recommended Check Ups Recommended check ups Uterus check up Cervix: All sexually active women or women 18 and older should have these tests each year (less frequent after three consecutive tests with normal findings) Pap test Pelvic examination Endometrium: Beginning at age 35, women with or at risk for hereditary non-polyposis colon cancer should be offered an endometrial biopsy annually

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