1. Cancer

2. What is cancer? “Abnormal, uncontrolled growth of cells, which, if left untreated, can ultimately cause death.” (ACS) Terminology:  Benign  Malignant  Metastasis  In Situ

4. (Cotugna, 2013)

9. NCI, 2014)

11. OR vs US: Cancer Incidence (CDC)

12. OR vs US: Cancer Incidence

13. OR vs US: Cancer Deaths (CDC)

14. OR vs US: Cancer Deaths

15. Non-Specific Warning Signs CAUTION:  C: changes in bowel or bladder habits  A: a sore that doesn’t heal  U: unusual thickening or discharge  T: thickening or lump in the breast or any other part of the body  I: indigestion or difficulty swallowing  O: an obvious change in wart or mole  N: a nagging cough or hoarseness

16. Cancer Staging T: The extent of primary tumor N: absence of presence of lymph node involvement M: presence of distance metastasis Stages: I, II, III, IV Five year “Gold standard”

18. Lung Cancer

19. Lung Cancer continued Types:  Non-small cell  Small cell Symptoms:  Most lung cancers are silent  When symptoms occur:  Cough, shortness of breath, chest pain, loss of appetite, blood in sputum.

20. Lung Cancer: Risk Factor Most common malignant disease worldwide  Leading cause of cancer deaths. Tobacco smoke accounts for approximately 90% of all lung cancers.  According to the WHO (n.d.), decreasing current smoking rates by 50% could prevent 20-30 million deaths before 2025 and 150 million deaths by 2050.

22. Breast Cancer

23. Types of Breast Cancer Ductal cancer  Most common type of breast cancer Lobular cancer Inflammatory breast cancer

24. Mammograms (National Cancer Institute, 2005)

25. Screening / Prevention Mammogram recommendation  Starting at age 45 (unless family or personal history)  Starting at age 55; every other year BSE (Breast Self-Exams)  Starting at age 20, every month  Clinical breast exam every year Chemoprevention  Her2neu marker

27. Prostate Cancer

28. The most common cancer for men. Lifetime risk: 1 in 6 Risk of dying: 3%

29. Colorectal Cancer

30. More common in Western societies. Almost 100% preventable with screening and polyp removal.

31. Screening Colonoscopy  Recommended first colonoscopy at age 50; every 5-10 years  Unless family history / personal symptoms  Good news: colon cancer usually slow growing  Other screenings:  FOBT (Fecal Occult Blood Test)  sDNA (Stool DNA tests)

32. Skin Cancer

33. Three types of skin cancer:  Basal cell carcinoma  Most common type of skin cancer  Squamous cell carcinoma  Melanoma  Deadliest form of skin cancer

34. Skin Cancers Skin cancer is the most common form of cancer  However…. Basal cell and squamous cell are not reported to cancer registries  Basal cell  About 8 of 10 skin cancers  Squamous cell  About 2 of 10 skin cancers

35. Source: skin cancer foundation

36. Melanoma – ABC’s Source: skin cancer foundation

37. Skin Cancer: Risk Factors SUN (Obviously!)  Specifically UV exposure Age / Gender  Before age 40 – higher risk for women  After age 40 –higher risk for men  Melanoma is one of the common cancers in people younger than 30. Smoking

38. Skin Cancer Prevention “Slip, Slop, Slap … and Wrap” (ACS)

39. Wrapping up chronic diseases Responses differ from person to person  Grief  Loss of body part, control, independence, security, certainty of future  Physical / Mental fatigue  Depression  Shock / disbelief  Denial  Anger

40. Communication: A few do’s and don’ts Be “other-oriented” It’s not about you Listen and listen some more The patient is the boss  It’s their decision Offer specific help Please avoid cliches!  “I know what you’re going through”  “Everything will be okay”  “Well we all have to die sometime”