1. 12 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter

2. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-2 Cancer  What Is Cancer?  Common Cancers  The Causes of Cancer  Detecting and Treating Cancer

3. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-3 Introduction  Cancer: Abnormal, uncontrolled multiplication of cells, which, if left untreated, can ultimately cause death  Cancer is responsible for 1 out of every 4 deaths in the US each year, and it is the second most common cause of death after heart disease

4. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-4 Tumors  Tumor: A mass of tissue that serves no physiological purpose; also called a neoplasm  Benign tumor: A tumor that is not cancerous  Malignant tumor: A tumor that is cancerous and capable of spreading  Lymphatic system: A system of vessels that returns proteins, lipids, and other substances from fluid in the tissues to the circulatory system

5. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-5 Tumors  Malignant cell divides without regard for normal control mechanisms  Produces a mass of abnormal cells  Eventually detected  A few cancers, like leukemia, do not produce a mass

6. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-6 FIGURE 121 Annual number of cancer deaths attributable to smoking SOURCE: American Cancer Society 2013 Cancer Facts and Figures, 2013 Atlanta, GA: American Cancer Society

7. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-7 FIGURE 122 Cancer cases and deaths by site and sex SOURCE: American Cancer Society 2013 Cancer Facts and Figures, 2013 Atlanta, Ga: American Cancer Society

8. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-8 Metastasis  Metastasis: Spread of cancer cells from one part of the body to another  Occurs because cancer cells do not stick to each other as strongly as normal cells do and therefore may not remain at the site of the original location  To control the cancer, every cancerous cell must be removed

9. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-9 Lung Cancer  Lung cancer most common cause of cancer death in the U.S.  Responsible for about 159,000 deaths a year  Tobacco smoke accounts for 87% of lung cancer deaths  When combined with other carcinogens, risk for smokers can increase 10 times or more ▪ Carcinogen: Any substance that causes cancer

10. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-10 Lung Cancer  Symptoms include persistent cough, chest pain, or recurring bronchitis  Most often treated by combination of surgery, radiation, and chemotherapy  Chemotherapy: The treatment of cancer with chemicals that destroy cancerous cells  Only 15% of lung cancer patients are alive 5 years after diagnosis

11. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-11 Colon and Rectal Cancer  91% of cases are diagnosed in people age 50 and older  Many cancers arise from preexisting polyps  Many cases of colon cancers may be due to inherited gene mutations  Protective lifestyles can affect colon cancer risk, including good nutrition, physical activity, and not smoking

12. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-12 Colon and Rectal Cancer  Symptoms include changes in bowel habits and bleeding from the rectum  Tests can detect small amounts of blood in the stool  Rectal exam can detect some tumors, as can a colonoscopy  Exams should be performed yearly after age 50

13. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-13 FIGURE 12.3 Colonoscopy

14. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-14 Breast Cancer  Breast cancer is most common cancer in women and is second to lung cancer in the number of cancer deaths among women

15. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-15 Breast Cancer  Risk factors  Strong genetic factor  Other risk factors: ▪ Early first menstruation, or late-onset menopause ▪ Having no children or having a first child after age 30 ▪ Hormone replacement therapy ▪ Being obese ▪ Using alcohol

16. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-16 Breast Cancer  Risk factors  Female hormone estrogen may be common element in some risk factors ▪ Estrogen promotes cell growth in responsive tissues, so increased estrogen exposure may raise the risk of breast cancer ▪ Fat cells produce estrogen, and estrogen levels are higher in obese women ▪ Alcohol increases estrogen in the blood

17. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-17 Breast Cancer  Prevention  Eat low-fat, vegetable-rich diet  Exercise regularly  Limit alcohol intake  Maintain a healthy body weight

18. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-18 Breast Cancer  Detection  Mammogram: Low-dose X-ray of the breasts used for early detection of breast cancer  Clinical breast exam  Breast self-exams

19. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-19 Breast Cancer  Detection  Biopsy: Removal and examination of small piece of body tissue for purpose of diagnosis  Ultrasonography: An imaging method in which inaudible high-pitched sound (ultrasound) is bounced off body structures to create an image on a monitor

20. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-20 Breast Cancer  Treatment  Lumps can be scanned by ultrasonography and biopsied to check for malignancy ▪ If a lump is cancerous, several surgical treatments may be used ▪ Chemotherapy or radiation treatment also used  Several drugs developed for preventing and treating breast cancer  If discovered early, patients have about 98% chance of surviving more than 5 years

21. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-21 Prostate Cancer  Prostate cancer is most common cancer in men and second leading cause of cancer death in men  Age is the strongest predictor with 97% of cases occurring in men over age 50  Prostate-specific antigen (PSA) blood test: Diagnostic test for prostate cancer that measures blood levels of PSA

22. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-22 Prostate Cancer  Treatment is usually removal of the prostate, but radiation may be used  5-year survival rate is now nearly 100%  Small slow-growing tumors in older men may be treated with watchful waiting

23. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-23 Cancer of the Female Reproductive Tract  Cervical cancer  Most cases stem from infection by HPV  Pap test: Scraping of cells from cervix for examination to detect cancer ▪ Abnormal cells removed surgically or by destroying them with ultracold probe or localized laser treatment  Two HPV vaccines approved by the FDA

24. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-24 Cancer of the Female Reproductive Tract  Uterine or Endometrial cancer  Cancer of the lining of the uterus most often occurs after age 55  Usually detectable by pelvic examination  Uterine cancer treated surgically by removing the uterus

25. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-25 Cancer of the Female Reproductive Tract  Ovarian cancer  Ovarian cancer rare compared with uterine cancer, but it causes more deaths ▪ Often diagnosed late in its development  Lowering woman’s lifetime number of ovulation cycles reduces risk ▪ Symptoms: bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, urinary problems ▪ Treated by surgical removal of ovaries, fallopian tubes, and uterus

26. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-26 Skin Cancer  Skin cancer most common cancer  Linked to exposure to UV radiation from the sun  Melanoma: A malignant tumor of the skin that arises from pigmented cells, usually a mole  Ultraviolet (UV) radiation: Light rays of a specific wavelength, emitted by the sun; most UV rays are blocked by the ozone layer in the upper atmosphere

27. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-27 Skin Cancer  Basal cell carcinomas and squamous cell carcinomas are 95% of skin cancers  Basal cell carcinoma: Cancer of deepest layers of the skin  Squamous cell carcinoma: Cancer of the surface layers of the skin

28. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-28 Skin Cancer  Melanoma most dangerous skin cancer because it spreads rapidly  Usually occurs at site of mole, which becomes enlarged, mottled, and irregular in surface or borders  Melanomas most common on the back, chest, abdomen, and lower legs

29. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-29 FIGURE 12.4 The ABCD test for melanoma

30. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-30 Head and Neck Cancers  Cancers of the oral cavity, pharynx, larynx, and nasal cavity  Trace to cigarette, cigar, or pipe smoking, the use of spit tobacco, and excessive consumption of alcohol  Head and neck cancers twice as great in men and most frequently in men over 40  Chemotherapy, radiation, or surgery used to treat head and neck cancers

31. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-31 Testicular Cancer  Testicular cancer is most common cancer among men ages 20 to 35, but it is rare  Regular self-examination  Tumors treated by surgical removal and, if the tumor has spread, by chemotherapy

32. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-32 Other Cancers  Pancreatic cancer kills 38,000 Americans annually  Usually well advanced when detected  There is no effective cure available  Bladder cancer  Men 4 times more likely to have it  Smoking is key risk factor  Symptoms: blood in the urine, increased frequency of urination

33. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-33 Other Cancers  Kidney cancer usually occurs over 50  Smoking, obesity, and family history are mild risk factors ▪ Symptoms: fatigue, pain in the side, and blood in the urine  Brain cancer can arise from most cell types found in the brain  Ionizing radiation a risk factor  Some brain tumors curable

34. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-34 Common Cancers  Leukemia is cancer of white blood cells  Starts in bone marrow but can spread to other organs and the central nervous system  Lymphoma is a form of cancer that begins in the lymph nodes  May spread to almost any part of the body

35. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-35 The Role of DNA  DNA basics  Chromosomes: Threadlike bodies in a cell nucleus that contain molecules of DNA; most human cells contain 23 pairs of chromosomes ▪ DNA: Deoxyronucleic acid, a chemical substance that carries genetic information ▪ Gene: A section of a chromosome that contains the instructions for making a particular protein; the basic unit of heredity

36. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-36 The Role of DNA  DNA mutations and cancer  Mutation is any change in makeup of a gene ▪ Some mutations inherited ▪ Others caused by environmental agents  Oncogene: A gene involved in the transformation of a normal cell into a cancer cell  Cancer Promoters ▪ Some substances accelerate growth of cells, which means less time for a cell to repair DNA damage caused by other factors

37. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-37 Tobacco Use  Smoking responsible for up to 90% of lung cancers and for about 30% of all cancer deaths  Tobacco use responsible for nearly one in five American deaths each year

38. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-38 Dietary Factors  Dietary fat and meat  Diets high in fats and meat may contribute to colon, prostate, and stomach cancer  Omega-6 polyunsaturated fats associated with a higher risk of certain cancers  Alcohol  Associated with several cancers  Alcohol and tobacco interact as risk factors for oral cancer

39. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-39 Dietary Factors  Fried food  High levels of acrylamide found in starch-based foods that is fried or baked at high temperatures ▪ Acrylamide is also found in tobacco  Fiber  Experts recommend a high-fiber diet for its overall positive effect on health

40. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-40 Dietary Factors  Fruits and vegetables  Researchers identified mechanisms by which food components may act against cancer ▪ Carotenoid: yellow-to-red plant pigments that can be converted to vitamin A by the liver; many act as antioxidants or have other anti-cancer effects ▪ Phytochemical: Naturally occurring substance found in plant foods that may help prevent chronic diseases such as cancer and heart disease

41. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-41 TABLE 12.1 Foods with Phytochemicals

42. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-42 Obesity and Inactivity  The ACS recommends maintaining a healthy weight throughout life by balancing caloric intake with physical activity  The ACS also recommends achieving and maintaining a healthy weight if you are currently overweight or obese

43. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-43 Carcinogens in the Environment  Ingested chemicals  Some food additives potentially dangerous including the nitrates and nitrites found in processed meats  Environmental and industrial pollution  Less than 2% of cancer deaths caused by general environmental pollution  Exposure to carcinogenic materials in workplace is a more serious problem

44. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-44 Carcinogens in the Environment  Radiation  All sources of radiation are potentially carcinogenic  Successful efforts made to reduce radiation needed for necessary medical X-rays  Microbes  About 15 to 20% of world’s cancers caused by microbes ▪ HPV ▪ Epstein-Barr virus

45. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-45 FIGURE 12.5 Body weight and cancer mortality SOURCE: Calle, E E, et al 2003 Overweight, obesity, and: mortality from cancer in a prospectively studied cohort of US adults New England Journal of Medicine 348(17): 1625–1638

46. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 12-46 Detecting and Treating Cancer  Detecting cancer  Self-monitoring ▪ Be aware of risk factors ▪ Report changes to a physician  Treating cancer  Surgery  For most cancers, surgery most useful treatment  Chemotherapy  Radiation