Cancer

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Cancer
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What is cancer?

• Abnormal, uncontrolled growth of cells, which,
  if left untreated, can ultimately cause death.
  (American Cancer Society)
• Terminology
• Benign
• Malignant
• Metastasis
• In situ

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Cells and Cancer

• Two-stage model of cancer development
• Initiators
• Accumulation of DNA mutations
• Genetic insults
• Promoters
• Do not cause cancer but help it grow
• Oncogenes and Tumor Suppressors
• Good proto-oncogene
• Bad oncogene
• Tumor suppressors

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OR vs US Cancer Incidence
(CDC)
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OR vs US Cancer Deaths
(CDC)
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Non-Specific Warning Signs

• CAUTION
• C changes in bowel or bladder habits
• A a sore that doesnt 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

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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

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Types of cancer Leukemia

• Involve blood-forming cells (white blood cells)
  which are chiefly in bone marrow.
• Acute, chronic

(National Cancer Institute)
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Types of cancer Sarcoma

• Connective fibrous tissue
• Examples muscle, bone,
• cartilage, membranes covering
• muscle/fat

Source cancerhelp.org.uk
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Types of Cancer Lymphomas

• Involve lymph nodes
• Hodgkins, non-Hodgkins

Source newsimg.bbc.co.uk
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Types of Cancer Carcinoma

• Epithelial cells
• Cover external body surfaces or line internal
  tubes and cavities
• Most common type
• Examples skin, breast, uterus, prostate, lungs,
  GI tract

Source media.collegepublisher.com
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Lung Cancer
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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.

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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, decreasing current smoking
  rates by 50 could prevent 20-30 million deaths
  before 2025 and 150 million deaths by 2050.

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Breast Cancer
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Breast Cancer

• The most frequently diagnosed cancer in women.
• Risk factors
• Age, female gender, personal family history

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(National Cancer Institute, 2005)
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Types of Breast Cancer

• Ductal cancer
• Most common type of breast cancer
• Lobular cancer
• Inflammatory breast cancer

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Breast Cancer Risk Factors

• Gender
• 100x more common in women
• Age
• Genetics
• BRCA1
• BRCA2

• Diet
• Alcohol
• Physical activity
• Menarche
• Pregnancies
• Breast-feeding
• Menopause

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Mammograms
(National Cancer Institute, 2005)
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Screening / Prevention

• Mammogram recommendation
• Starting at age 40 (unless family or personal
  history) and every year as long as in good
  health.
• BSE (Breast Self-Exams)
• Starting at age 20, every month
• Clinical breast exam every year
• Chemoprevention
• Her2neu marker

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Prostate Cancer
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Prostate Cancer

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

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Risk Factors / Screening

• Age
• Strongest risk factor
• Race / ethnicity
• Diet
• Red meat
• High-fat dairy
• Genetics

• PSA blood test
• DRE digital rectal exam
• Good news
• Prostate cancer is not always life threatening

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Colorectal Cancer
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Colorectal Cancer

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

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Colorectal Cancer Risk Factors

• Age
• Over 50
• Diet
• Physical inactivity
• Obesity
• Link stronger in men

• Smoking
• Alcohol
• Diabetes (type 2)
• Increased risk
• Less favorable outcome

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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)

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Skin Cancer
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Sun Safety Quiz

• I cant get skin cancer, because my normal
  routine (such as work, drive to work, hobbies,
  and vacations) doesnt include any outdoor
  activities
• False
• If Im wearing sun screen, I can stay in the sun
  as long as I want.
• False
• Getting a base tan at an indoor tanning salon
  is a good way to prevent sunburn when I go to the
  beach later this summer.
• False (American Cancer Society)

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Skin Cancer

• Three types of skin cancer
• Basal cell carcinoma
• Most common type of skin cancer
• Squamous cell carcinoma
• Melanoma
• Deadliest form of skin cancer

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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

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Source skin cancer foundation
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Melanoma ABCs
Source skin cancer foundation
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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

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Skin Cancer Prevention

• Slip, Slop, Slap and Wrap (ACS)

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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

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Communication A few dos and donts

• Be other-oriented
• Its not about you
• Listen and listen some more
• The patient is the boss
• Its their decision
• Offer specific help

• Please avoid cliches!
• I know what youre going through
• Everything will be okay
• Well we all have to die sometime