1. (c) 2005 The McGraw-Hill Companies, Inc. All rights reserved. Chapter Eleven: Living With Cancer

2. Cancer Regulatory gene process – copying, replicating normal cells on a regular basis Regulatory gene process – copying, replicating normal cells on a regular basis Oncogenes – cancer-causing genes affecting 4 types of gene processes Oncogenes – cancer-causing genes affecting 4 types of gene processes specialization specialization replication replication repair repair suppression genes suppression genes Proto-oncogenes = potential cancer genes affecting the 4 phases of gene process Proto-oncogenes = potential cancer genes affecting the 4 phases of gene process Cell regulation problem causing abnormal cell growth

3. Oncogene Formation Three mechanisms are responsible for this Three mechanisms are responsible for this Genetic mutations Genetic mutations Viral infections Viral infections Carcinogens Carcinogens

4. The Cancerous Cell The following characteristics separate them from non-cancerous cells (benign) The following characteristics separate them from non-cancerous cells (benign) Infinite life expectancy due to telomerase Infinite life expectancy due to telomerase Lacks contact inhibition Lacks contact inhibition Process of metastasis (see Figure 11-1) Process of metastasis (see Figure 11-1) Angiogenesis capability to command the circulatory system, when needed Angiogenesis capability to command the circulatory system, when needed Benign tumors do not spread but can be dangerous if they crowd out normal tissues

5. Staging Cancer There has been an identification system known as the TNS staging system There has been an identification system known as the TNS staging system T = recognizes the extent of malignancy T = recognizes the extent of malignancy N = progressed or not to the lymph node N = progressed or not to the lymph node S = presence or absence of metastasis S = presence or absence of metastasis A numerical system tracks the extent of the growth potential of cancer (I, II, III, or IV)

6. Types of Cancer Carcinomas – 85% of all cancers tend to be classified here (organs, skin, nerves, membranes) Carcinomas – 85% of all cancers tend to be classified here (organs, skin, nerves, membranes) Sarcomas – bone, blood, connective tissue (2% of malignant cancers) Sarcomas – bone, blood, connective tissue (2% of malignant cancers) Lymphomas – immune tissues/system (i.e., Hodgkins Disease) Lymphomas – immune tissues/system (i.e., Hodgkins Disease) Leukemia - blood and blood forming tissues (bone marrow) Leukemia - blood and blood forming tissues (bone marrow) Melanoma-sun exposed affecting the melanin of the skin Melanoma-sun exposed affecting the melanin of the skin Neuroblastoma- originates in the CNS of children Neuroblastoma- originates in the CNS of children Adenocarcinoma-cells of the endocrine glands Adenocarcinoma-cells of the endocrine glands Hepatoma- originates in the cells of the liver Hepatoma- originates in the cells of the liver

7. Lung Cancer Risk Factors Risk Factors Smoking Smoking Environmental pollutants Environmental pollutants Prevention Prevention Remove smoke element Remove smoke element Treatment Treatment Surgery Surgery Radiation Radiation Chemotherapy Chemotherapy Medications Medications Full recovery remains unlikely in all but a small percentages of cases

8. Breast Cancer Risk factors Risk factors Early menstrual cycle for women Early menstrual cycle for women Women with no children or having children later in life Women with no children or having children later in life Hormone replacement therapy use Hormone replacement therapy use Prevention Prevention Diet Diet Mammography Mammography Activity levels Activity levels Pregnancy and breastfeeding decisions Pregnancy and breastfeeding decisions Occupational hazards Occupational hazards New medications New medications Treatment Treatment Lumpectomy Lumpectomy Drug therapy Drug therapy Chemotherapy/radiation treatments Chemotherapy/radiation treatments

9. Preventive Measures, cont’d Self checks for breast cancer Breast cancer is still the #1 cause for women

10. Cervical Cancer Risk factors Risk factors HPV infection HPV infection Smoking and socioeconomic factors Smoking and socioeconomic factors Prevention Prevention Sexual abstinence Sexual abstinence Pap tests Pap tests Careful selection of sexual partners Careful selection of sexual partners Treatment Treatment Surgery (minor or major) Surgery (minor or major) Radiation/chemotherapy Radiation/chemotherapy

11. Uterine 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 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 Minimize high levels of estrogen and regular physician care Treatment Treatment Surgery, radiation, chemotherapy, hormone treatment Surgery, radiation, chemotherapy, hormone treatment

12. Ovarian Cancer Prevention Prevention Similar to what is recommended for breast cancer Similar to what is recommended for breast cancer Prophylactic oophorectomy Prophylactic oophorectomy Early Detection Early Detection Referred as the “silent cancer” Referred as the “silent cancer” Annual pelvic exams Annual pelvic exams Genetic screenings Genetic screenings Treatment Treatment Surgery Surgery Chemotherapy Chemotherapy Drug therapy Drug therapy

13. Prostate Cancer Risk factors Risk factors Age, dietary fat intake, genetic link Age, dietary fat intake, genetic link Prevention Prevention Dietary intake of Vitamin E and selenium, drug therapy Dietary intake of Vitamin E and selenium, drug therapy Early Detection Early Detection PSA screenings, ultrasound rectal exam PSA screenings, ultrasound rectal exam Treatment Treatment Surgery, radiation, brachytherapy Surgery, radiation, brachytherapy

14. Testicular Cancer Risk factors Risk factors Family history, environmental factors Family history, environmental factors Prevention Prevention Self exams Self exams Early Detection Early Detection Observations and self exams Observations and self exams Treatment Treatment Surgery, chemotherapy, radiation Surgery, chemotherapy, radiation

15. Preventive Measures, cont’d Self checks for testicular cancer Testicular cancer is the #1 cause for men aged 18-35

16. Colorectal Cancer Risk factors Risk factors Genetic and dietary habits Genetic and dietary habits Prevention Prevention Removal of polyps, exercise, dietary supplementation Removal of polyps, exercise, dietary supplementation Early Detection Early Detection Rectal exams, stool test, sigmoidoscopy, colonoscopy Rectal exams, stool test, sigmoidoscopy, colonoscopy Treatment Treatment Surgery, radiation, chemotherapy Surgery, radiation, chemotherapy

17. Pancreatic Cancer Risk Factors Risk Factors More common in men, smoking, high fat diets and high alcohol consumption More common in men, smoking, high fat diets and high alcohol consumption Prevention Prevention Abstaining from smoking, alcohol, promote exercise and wt. loss Abstaining from smoking, alcohol, promote exercise and wt. loss Early detection Early detection CAT scan CAT scan Treatment Treatment No effective treatment at this time No effective treatment at this time

18. Lymphatic Cancer Risk Factors Risk Factors Reduction of immune system, exposure to pollutants, viral infections Reduction of immune system, exposure to pollutants, viral infections Prevention Prevention Limit exposure to chemicals Limit exposure to chemicals Early Detection Early Detection Enlarged lymph nodes, fever, wt. loss Enlarged lymph nodes, fever, wt. loss Treatment Treatment Surgery, radiation, chemotherapy, stem cell transplant Surgery, radiation, chemotherapy, stem cell transplant

19. Skin Cancer Risk factors Risk factors Severe sunburn during childhood, chronic sun exposure during young adulthood Severe sunburn during childhood, chronic sun exposure during young adulthood Prevention Prevention Reduce exposure to sun’s rays, use sunscreens, Reduce exposure to sun’s rays, use sunscreens, Early Detection Early Detection American Cancer Society guidelines (next slide) American Cancer Society guidelines (next slide) Treatment Treatment Surgery, chemotherapy, interleukin-2 Surgery, chemotherapy, interleukin-2

20. American Cancer Society Figure 11-3) Promote early detection (i.e., self checks for skin cancer) A A symmetry B B order irregularity C C olor change D D iameter greater than 6mm E E levation (raised margins)

21. Preventive Measures Identify the 7 warning signs of cancer C C hange in bowel/bladder habits A A sore that does not heal U U nusual bleeding or discharge T T hickening of tissues (schlerotic change) I I ndigestion or difficulty swallowing O O bvious change in a wart/mole N N agging cough

22. See your doctor regularly See your doctor regularly Decrease your exposure to hazardous chemicals/pollutants Decrease your exposure to hazardous chemicals/pollutants Modify dietary habits and promote fiber intake Modify dietary habits and promote fiber intake Understand the concepts of “anti-oxidants” Understand the concepts of “anti-oxidants” Partake in regular forms of physical activity Partake in regular forms of physical activity Practice healthy sexual behaviors Practice healthy sexual behaviors Preventive Measures, cont’d

23. (c) 2005 The McGraw-Hill Companies, Inc. All rights reserved. Chapter Eleven: Living With Cancer