Cancer

1
Cancer

• Cancer named by Hippocrates Crab
• Cancer is not just one disease but rather a group
  of diseases.
• All forms of cancer cause cells in the body to
  change and grow out of control.
• Most types of cancer cells form a lump or mass
  called a tumor.

2
What is Cancer?

• All cancers have neoplastic growth, altered cells
  with nearly unlimited growth.
• Benign localized
• Malignant spread much more threatening
• Metastatic cancer cells move to other parts of
  the body

3
Tumor

• Increase in the number of undifferentiated cells
  creates a growing mass of tissue called a "tumor"
  or "neoplasm."

4
Benign vs. Malignant

• Benign tumors are tumors that cannot spread by
  invasion or metastasis hence, they only grow
  locally.
• Malignant tumor spread into surrounding tissue

5
Metastasis

• Malignant tumors can spread through blood stream
  and lymph to distant sites
• Lung, liver, bone and brain are common sites of
  metastasis

6
Types of cancer

• Carcinomas - Epithelial tissue 85
• skin
• stomach lining
• mucous membranes
• Sarcomas - Connective tissue (2)
• bones, muscles, cartilage
• Leukemias - Blood (8)
• Lymphomas Originate in lymphatic system (5).

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Effects of Cancer

• Proliferation of cancer cells at each site
  interferes with normal cell development and
  functioning.
• Vascularization of tumors robs body of nutrients
• Produces pain as it creates pressure on tissues
  and nerves and blocks flow of body fluids.
• Most experience severe pain in later stages.

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How does cancer cause death?

• DIRECT - spreading to a vital organ and takes
  nutrients the organ needs causing the organ to
  fail.
• INDIRECT - weakening the victim, impairing
  appetite and immune functioning.

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Cancer - Mortality

• Second leading cause of death in the U. S.
• Overall death rates fell an average of 1.6 over
  the last 10 years
• Rates are in different for different cancers
• Up for liver pancreas
• Down for 7 of the 15 top cancers

• Men
• Lung
• Prostate
• Colon
• Rectum
• Pancreas
• Women
• Lung
• Breast
• Colon
• Rectum
• Pancreas

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Cancer Death Rates, for Men, US,1930-2003
Lung bronchus
Rate Per 100,000
Stomach
Prostate
Colon rectum
Pancreas
Liver
Leukemia
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Cancer Death Rates, for Women, US,1930-2003
Rate Per 100,000
Lung bronchus
Uterus
Breast
Colon rectum
Stomach
Ovary
Pancreas
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Cancer Mortality North Carolina
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2007 Estimated US Cancer Cases
Men766,860
Women678,060

• 26 Breast
• 15 Lung bronchus
• 11 Colon rectum
• 6 Uterine corpus
• 4 Non-Hodgkin lymphoma
• 4 Melanoma of skin
• 4 Thyroid
• 3 Ovary
• 3 Kidney
• 3 Leukemia
• 21 All Other Sites

Prostate 29 Lung bronchus 15 Colon
rectum 10 Urinary bladder 7 Non-Hodgkin 4
lymphoma Melanoma of
skin 4 Kidney 4 Leukemia 3 Oral
cavity 3 Pancreas 2 All Other Sites 19
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Lifetime Probability of Cancer, Men
Site
Risk
All sites 1 in 2 Prostate 1 in 6 Lung
bronchus 1 in 13 Colon rectum 1 in
17 Urinary bladder 1 in 29 Non-Hodgkin
lymphoma 1 in 47 Melanoma 1 in 57 Leukemia 1
in 69 Oral cavity 1 in 71 Kidney 1 in
72 Stomach 1 in 79
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Lifetime Probability of Cancer, Women
Site
Risk
All sites 1 in 3 Breast 1 in 8 Lung
bronchus 1 in 17 Colon rectum 1 in
18 Uterine corpus 1 in 37 Non-Hodgkin
lymphoma 1 in 56 Ovary 1 in
58 Pancreas 1 in 80 Melanoma 1 in
81 Urinary bladder 1 in 88 Uterine cervix 1
in 123
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Cancer Mortality

• 1900 1993 large increase in mortality
• Decreasing somewhat since 1993 for most sites
• Lung cancer is exception
• Different cancers have different rates of decline
  and increase
• Diagnostic issues and other disease issues muddle
  the picture

• Improved diagnosis
• Increase in lung cancer in women
• Cancers related to AIDS
• Control of other diseases
• Increase in environmental carcinogens

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Cancer Ethnicity

• Anglo men higher rates of bladder cancer.
• Hispanics lowest rates of lung cancer but women
  have highest rates of cervix cancer.
• Blacks highest rates of prostate cancer.
• Japanese highest rates of stomach cancer.
• Chinese Americans lowest rates of liver cancer.
• Northern Europeans high rates of breast cancer.

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What Causes Cancer?

• Cancer is a genetic disease but gt70 are not
  inherited
• Cancer is a disease of exposure to numerous risk
  factors
• Exposure damages DNA, thus altering gene
  expression ultimately leading to cancer
• Figuring out exact cause it too complex at this
  point so we focus on RISK FACTORS

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• RISK FACTORS FOR CANCER

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Non-controllable Risk Factors

• Environmental
• Certain chemical exposures
• Radiation
• Nuclear Powerplants?
• Powerlines?
• Inherent Factors
• Family History Seems so for some forms of
  breast and colon cancer
• Age

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Controllable Risk Factors
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Smoking and Cancer

• One-third of the 500,000 cancer deaths annually
  in the United States are caused by cigarette
  smoking
• 90 of lung cancer deaths in men and 80in women
  caused by smoking.

23
Smoking and Cancer

• Cigarette smoking has synergistic effect with
  other environmental pollutants.

24
Cancer and Diet

• One-third of cancer deaths is caused by a variety
  of dietary factors.

• Foods high in carcinogens
• Foods that have too much animal fat and not
  enough fiber

25
American Cancer Society

• To reduce your cancer risk, follow an overall
  dietary pattern that includes
• A high proportion of plant foods (fruits,
  vegetables, grains, and beans)
• Limited amounts of meat, dairy, and other
  high-fat foods
• A balance of caloric intake and physical
  activity.

26
Alcohol and Cancer

• Alcohol implicated in cancers of the tongue,
  tonsils, esophagus,and liver
• Related to breast cancer gt2 drinks/day in women

27
Alcohol and Synergism

• Alcohol may have a synergistic effect
• Clear for tobacco. The risk is 50 higher is one
  smokes AND drinks than the additive risks of each
  one.

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Physical activity

• Good example of correlational research
• health causes exercise
• exercise causes health
• Mixed results
• Two recent studies showing that exercising four
  hours a week reduces chances of breast cancer in
  young women
• Prostate cancer in men

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Ultraviolet Light and Cancer

• Good example of interaction
• light-skinned people near the equator have higher
  risk
• Dramatic rise since 1970s

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Types of Skin Cancer

• Basal Cell Carcinoma Slow growth doesnt spread
  much if at all
• Squamous Cell Carcinoma Grow more quickly than
  the above an can spread
• Malignant Melanoma Grows quickly and spreads.
  Occurs on or near moles

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ABCDs of Skin Cancer

• A stands for ASYMMETRY
• One half of the mole doesn't match the other
  half. Melanoma tend to be irregular.
• B stands for BORDER IRREGULARITY
• Benign moles have smooth edges whereas melanoma
  are busily invading and tend to have irregular
  edges.
• C stands for COLOR.
• If the color is intensely black, possibly with a
  bluish tint, or the color is uneven across the
  mole, this is suspicious of a melanoma.
• D stands for DIAMETER
• If the mole is greater than 6 mm (about the size
  of a pea), then there is a greater chance that it
  is malignant.

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Sexual Behavior and Cancer

• AIDS
• Kaposis sarcoma
• non-Hodgkins lymphoma
• Invasive cervical cancer
• Certain sexual practices can contribute to cancer
  risk.
• Cervical cancer

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Psychological Factors
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Stress and cancer

• Methodological issues
• prospective versus retrospective studies.
• Regular stress lessened risk but a single major
  event increased it.
• Negatively related were ability to express anger
  and living a busy lifestyle.
• Positively related to cancer were bereavement and
  denying the existence of problems

• Palesh et. al, (2007)
• Studied role of trauma and stress in tumor
  recurrence in women with BC
• 94 women with reccurrence of BC
• Trauma and stress was related to shorter
  disease-free interval

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Thornton et al, (2007)

• 113 women with breast cancer
• Assessed at diagnosis 4, 8, 12, 18 months after
• Perceived stress and immune function

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Suppression of Emotion

• One study of females w/breast cancer found those
  who suppressed emotion were more likely to
  develop cancer.
• Similar results found in study of veterans and
  cancer in general.
• Medical students who had more cancer in those who
  suppressed emotion versus those who acted out
  behaviors
• Penedo et. Al, (2006) Suppression of anger
  related to decrease in NKCC in men with prostate
  cancer

37
Depression and Cancer

• Depression may cause people to have a higher
  mortality but not morbidity for cancer.
• Some studies have found this relationship some
  havent.

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• Treatment and Survival

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Treatment Side Effects of Cancer

• Surgery
• Radiation
• Chemotherapy
• Hormonal treatment Breast Prostate Uterine and
  some Leukemias
• Immunotherapy Convince immune system to attack
  tumor

• Loss of hair
• Burns
• Nausea
• Vomiting
• Fatigue
• Sterility
• Pain
• Loss of function

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Survival

• More than half of all cancer patients survive at
  least five years
• Remission not Cure
• Cancer is beaten down it is unknown if it is
  every fully removed in some cases

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Relative Survival by Cancer Site
1983-1985
1992-1998
Site
1974-1976
     

• All sites 50 52 62
• Breast (female) 75 78 86
• Colon rectum 50 57 62
• Leukemia 34 41 46
• Lung bronchus 12 14 15
• Melanoma 80 85 89
• Non-Hodgkin lymphoma 47 54 55
• Ovary 37 41 53
• Pancreas 3 3 4
• Prostate 67 75 97
• Urinary bladder 73 78 82

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• Psychosocial Factors in Survival

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Fighting Spirit and Cancer

• Those who fight angrily against the diagnosis
  survive longer
• Depression and hopelessness did appear to predict
  an increased risk of dying in 5 years

44
Social Support and Cancer

• After controlling for early detection and
  treatment married people lived longer.
• Mechanism seems to be through social support and
  size of social network.
• Social isolation increases mortality

45
Group Psychotherapy

• Data suggests that group therapy can increase
  survival time
• Supportive in nature
• Strong Social Support
• Similar Diagnosis
• Educational Component
• Information on Coping Strategies

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Mindfulness and Cancer

• Mindfulness-Based Stress Reduction
• A program of stress reduction used in other
  contexts (chronic pain, stress-reduction)
• 8-10 week group format
• Meditational Educational/Discussion Components
• Recent review of the literature (Smith et. al,
  2005) found that MBSR w/cancer patients led to
• Improved mood
• Improved sleep
• Reduction in stress
• Positive immunological profile in post-surgical
  cancer patients
• These were generally dose-response effects

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A Model of Psych Interventions Cancer