1. I don’t want Cancer- What do I do? Petra Ketterl, MD Medical Oncologist Physician Advisor Tulsa, Oklahoma

2. Is cancer contagious? Importance of the Lymph System Cancer prevention and the Environment: Chronic Inflammation Good and Bad Bacteria: Gut Dysbiosis

3. Is Cancer Contagious? Mostly no No amount of sex, kissing, touching, sharing meals, breathing the same air can spread established cancers from one person to another Cancer cells from one person cannot live in another person

4. Of course there always are exceptions!

5. Exception 1: Organ Transplant/Medications After organ transplant– a few cases of cancer from a transplanted organ But: organ transplants  higher risk of cancer  Anti-rejection drugs weaken immune system to allow the organ to be accepted in the body but you also can’t attack pre-cancer cells or viruses which cause cancer

6. A weak immune system will be unable to get rid of cancer cells

7. Exception 2: Transfer during Pregnancy A Mother’s cancer rarely affects baby Melanoma can spread to placenta and fetus

8. So… You can’t catch cancer from a person who already has cancer

9. But you CAN catch Germs which can cause Cancer…. Infections/ Germs (bacteria and viruses) CAN be passed to another person A healthy immune system can fight off the infections Some cancers are caused by germs So: cancer cannot be spread by contact, but cancer-causing germs can be Usually spread by sex or blood exposure

10. Bacteria causing Cancer- H Pylori You may not know you have it Causes chronic gastritis, duodenal and gastric ulcers Risk of developing a stomach cancer is 2-6X Need to be tested if you have history of ulcer Spread by fecal-oral, oral-oral route Wash hands, food, drink safe water

12. Bacteria causing Cancer- H. Pylori Helicobacter pylori  cancer of the stomach Lymphoma of the stomach (gastric lymphoma) and stomach cancer (gastric adenocarcinoma) Higher risk in hospital workers

13. Types of Viruses causing Cancer HPV Human Papilloma Virus  cancer of cervix, vagina, vulva, penis, anus, mouth, throat, head and neck  higher risk if smoking, alcohol  sexually transmitted virus

14. Types of Viruses causing Cancer Epstein-Barr virus (EBV)  nose and throat cancer (nasopharyngeal)  lymphoma of the stomach, Hodgkin lymphoma, Burkitt lymphoma  viral illness from EBV also called mononucleosis or Mono

15. Types of Viruses causing Cancer Hepatitis B and C  liver cancer (hepatocellular carcinoma) Human herpes virus Type 8 (HHV-8)  a skin cancer called Kaposi’s sarcoma, mostly in AIDS Human T-lymphotropic virus -1  CLL leukemia, Non-Hodgkin lymphoma NHL

16. Cancer and HIV HIV virus weakens the immune system Causes AIDS  causes cancers esp “unusual” lymphomas  more common in HIV patients -- weak immune system or other viruses

17. Cancer-Causing Parasites Some worms called flukes can cause bladder and bile duct cancers

18. The Case of the Tasmanian Devil

19. So IS cancer contagious?????

20. Well mostly no but: Tasmanian Devils Cancer cells are being passed by physical contact – Harper’s Magazine April 2008 Their immune system does not recognize the cancer cells as coming from another animal

21. MOST Cancers are NOT caused by Infections Cancer happens when:  something changes a cell’s DNA (DNA is the genetic blueprint of the cell) 1. Inherited 2. developed during life - sun damage, tobacco, virus, toxins - chronic inflammation - lack of good nutrition

22. The Stepchild of The Medical Field The Stepchild of The Medical Field The Lymphatic System

23. Importance of the Lymphatic System Vital part of the immune system Part of the circulatory system

24. Lymphatic System Network of organs and lymphatic vessels Transports clear fluid called lymph fluid Lymph fluid contains white blood cells White blood cells fight infection

25. Lymphatic System

26. Other Functions of the Lymphatic System Transports fats from stomach and bowels to liver Gets rid of toxins and waste Filters out bacteria Manages fluid levels in body

28. The Spleen

29. Spleen- The Body’s Filter Controls amount of red blood cells Removes bacteria/ germs Helps fight infection Makes and activates white blood cells called lymphocytes  to fend off infections Lymphocytes produce antibodies to kill infections (virus, bacteria, parasites) If you loose your spleen you are more prone to get infections

31. Lymph Nodes

32. Lymph Nodes The Smaller Filters > 500 lymph nodes in body Occur in clusters Produces lymphocytes to fight infection Filters and removes foreign particles (bacteria, cancer cells)

33. Lymphatic System- Fluid Fluid/ plasma leaves cells in body once it delivers nutrients and removes waste Most plasma fluid returns to blood vessels/ veins Remainder becomes lymph Lymphatic vessels connect to blood vessels near the heart

35. Diseases of the Lymphatic System Enlargement of lymph nodes = lymphadenopathy (infection, inflammation, cancer) Lymphedema = swelling of body parts due to lymph channel blockage (surgery, radiation, cancer) Cancers of the lymphatic system = Lymphoma

36. Lymphadenopathy Swollen Lymph Nodes

37. Lymphedema swollen body parts

38. Importance of Movement of Lymph Fluid - There is twice as much lymph fluid than blood - Move from between cells (interstitial fluid) to blood vessels - No pump (like blood system  heart) - Valves - Valves open with pressure (skeletal muscle contraction, diaphragm) - Diaphragm moves lymph fluid: inhale  increases pressure in abdomen and less pressure in chest  fluid moves up, valves prevent it from going back down

39. How do Lymphatic Valves work?

40. Boost your Lymphatic System 80% of people have a sluggish lymphatic system

41. Boost your Lymphatic System 1. Breathe deeply  pump that lymph! 2. Get moving – rebounding on a mini- trampoline, stretching, aerobic exercise 3. Drink plenty of water (esp lemon water) 4. Eat fruit on an empty stomach – enzymes and acids are lymph cleansers 5. Eat green vegetables (chlorophyll helps clean lymph)

43. Mini Trampoline

44. Boost your Lymphatic System 6. Eat raw unsalted nuts and seeds  healthy fatty acids 7. Lymph-boosting teas: astralagus, ecchinacea, goldenseal, wild indigo root 8. Dry brush skin before showering (natural bristle brush, circular motions upward from feet to torso and fingers to chest) 9. Alternate hot and cold showers for several minutes

45. Dry Brushing Dry Brushing

47. Boost your Lymphatic System 10. Gentle massage for lymph-stimulation and freeing trapped toxins 11. Acupuncture 12. Inversion table 13. Yoga 14. Legs up the Wall 15. Use a standing desk

48. Risk Factors for Cancer Age Alcohol Cancer-causing substances Chronic inflammation Diet Hormones Immunosuppression Infections Obesity Radiation Sunlight Tobacco

49. Inflammation The Cause of all (or at least a lot of) problems

50. Inflammation Helps our Body Inflammation = normal body response helps injured tissues to heal and protects from outside irritants Inflammatory process  chemicals are released by damaged tissue  White blood cells go to the injury, make cells divide and grow to rebuild tissue and repair  Once wound heals, inflammatory process ends

51. Chronic Inflammation Is not “normal” Inflammatory process may begin without an injury Does not end when it should

52. Chronic Inflammation Risk Factors/ Causes Mostly unknown Infections which don’t go away Abnormal immune reactions to normal tissues Obesity Smoking High sugar intake High saturated fat diet Increasing age

54. Diseases related to Chronic Inflammation Heart disease Diabetes Alzheimer’s Stroke Kidney disease Chronic lower respiratory disease Cancer

55. Chronic Inflammation and Cancer Over time chronic inflammation  DNA damage  first step to cancer Example: chronic inflammatory bowel disease (ulcerative colitis, Crohn’s disease) can lead to colon cancer

57. Obesity and Chronic Inflammation Fat cells produce cytokines = hormones which set inflammation into motion

58. Testing for Chronic Inflammation High sensitivity C-reactive protein (hs- CRP) Homocysteine level Apolipoprotein B to A1 ratio

59. Natural Protection against Chronic Inflammation Dietary fiber (whole grains) Fish oil Sesame, flax seed Curcumin Magnesium DHEA (?) Green Tea Low-glycemic diet Less total and saturated fat and cholesterol Increased exercise

60. Low Glycemic Diet

61. Drugs which help with Chronic Inflammation Pentoxifylline - usually used for patients with small blood vessel disease of the limbs Metformin

62. Metformin Treatment for diabetes Suppresses chronic inflammation May slow aging and slow tumor growth

63. Last (for today) but not Least… Death begins in the Gut Ellie Metchnikoff

64. The Gut/ Digestive System

66. How does your gut get unhealthy?

67. It’s about the Bugs!

68. “Normal” Bacteria and Gut Flora help digestion protect body from bad bacteria

69. Bad Bacteria – Bacterial Overgrowth Illness occurs -- when amount of friendly bacteria is reduced -- when bad bacteria increase

70. Gut Dysbiosis = microbe imbalance on or inside the body Associated with illnesses like: inflammatory bowel disease, chronic fatigue syndrome, obesity, cancer, bacterial vaginosis, colitis

71. Causes of Dysbiosis Antibiotic exposure Birth control pills or hormones Steroids (prednisone, cortisone) Alcohol Inappropriate diet, high sugar intake Stress Pesticides on our food Aspirin Bacterial toxins from bad bacteria

72. Effects of Dysbiosis Damage to good or friendly bacterial colonies allow the bad bacteria to grow Bad bacteria can excrete waste products which are toxic to you

73. Leaky Gut

74. Leaky Gut Syndrome Lining of intestines is the natural barrier to bad things If it breaks down like from dysbiosis, bad bacteria, viruses, parasites  undigested food gets into the bloodstream This overly activates your immune system May get autoimmune diseases

77. Conditions Caused by Dysbiosis IBS – Irritable Bowel Syndrome Acne Food allergies Chronic fatigue Depression

78. Conditions associated with Leaky Gut Syndrome Bloating and weight gain Chronic Fatigue Syndrome Celiac disease Crohn’s Disease/ Ulcerative Colitis Hives, acne, eczema, psoriasis Allergies/ Food allergies Inflammatory joint disease/ arthritis/ Rheumatoid Arthritis Intestinal infections Pancreatic insufficiency Irritable Bowel Syndrome Joint pain

79. The Good News You can change the bad back to good bacteria!

80. Getting rid of Bad Bacteria Eating yoghurt, acidophilus milk, kefir that contains good bacteria Probiotic capsules Prebiotic capsules (FOS) fructo- oligosaccharides are good food for good bacteria