A Guide to Understanding Cancer

What is Cancer? Group of more than 100 related genetic diseases Reference 1 Group of more than 100 related genetic diseases Can start almost anywhere in the body when abnormal cells undergo uncontrolled cell division due to changes in their DNA Can form tumors that may invade local tissues and spread to other parts of the body

How Does Cancer Start? Cells become cancerous due to DNA damage, having the genetic information mutated and not fixed—cells keep dividing with the mutation, making it harder to eradicate the whole problem, as now every cell in that area will have the modified DNA

How Cancer Spreads Reference 2 Malignant tumors will invade local tissues and spread to other parts of the body; benign tumors will not The spread of cancer cells to other places in the body is called metastasis Cancer cells can travel through blood or lymph to other parts of the body to form new tumors

How Common Is Cancer? About 39.6% of men and women will be diagnosed with cancer during their lifetime, although the rates are higher for men. It is estimated that there will be more than 1.5 million new cancer diagnoses and more than 589,000 deaths from some form of cancer in the United States this year. It is expected that new cancer cases will rise from 14 million in 2012 to 22 million within two decades.

Major Categories of Cancer Carcinoma Sarcoma Leukemia Lymphoma Melanoma Most common cancer, forms in epithelial cells, ex: adenocarcinoma, basal cell carcinoma, squamous cell carcinoma Difficult to detect, forms in bone, muscle, fat, blood vessels, other soft tissues Forms in blood-forming tissue or bone marrow Form in white blood cells of the immune system, lymph nodes/lymph vessels Forms in cells that become melanocytes (make melanin), mostly in skin Reference 5

Causes of Cancer Risk of cancer increases with age Lifestyle Alcohol, tobacco, obesity Carcinogens in air, water, food, materials Certain viruses, bacteria, and other parasites Radiation Sunlight Genetics and family history *Tobacco is the leading cause of cancer and death from cancer Most common new cases in ages 65-74 Alcohol: the more you drink, the higher the risk No safe level of tobacco use UV radiation from sunlight and tanning beds Mutations in DNA, genetic changes can be inherited, errors in cell division

Signs and Symptoms Seven warning signs of cancer: C: Change in bowel or bladder habits A: A sore that does not heal U: Unusual bleeding or discharge T: Thickening or lump in the breasts or elsewhere I: Indigestion of difficulty in swallowing O: Obvious change in a wart or a mole N: Nagging cough or hoarseness * Having these symptoms does not necessarily mean you have cancer It is best to be safe and go see a doctor Early cancer does not usually cause pain

When To See a Doctor If symptoms persist or are severe, see a doctor No signs and symptoms should be ignored or overlooked Treatment works best when cancer is found early It is important to see a doctor periodically as cancer can be found even without symptoms Preventative checkups are a great idea Reference 11

Prevention Around 1/3 of cancer cases are preventable Do not smoke or use other tobacco products Drink alcohol in moderation Keep a healthy diet Maintain an ideal weight Exercise Minimize exposure to sun and wear sunblock Smoking: tobacco is one of biggest risk factors—20% of cancer deaths Diet: more fruit and veggies, less fat and red meat, more fiber Reference 12

Cancer Treatment Surgery Radiation therapy Chemotherapy Stem cell transplant Immunotherapy Hormone therapy Reference 13 Remove tumors/ cancerous cells Use high doses of radiation Use drugs Restore stem cells of blood (used with radiation and chemotherapy) Enhance immune system to fight cancer Cancer uses hormones to progress

Treatment Side Effects Reaction to cancer treatment varies from person to person Anemia Appetite/ weight loss Bleeding and bruising Urinary problems Pain Nausea and vomiting Hair loss Fatigue Edema Others Anemia: Not enough red blood cells—causes tiredness, dizziness Bleeding: From low # of platelets Edema: excess fluid in tissues, causes swelling Chemo and radiation have many side effects Reference 14

Figure 1 displays the number of new malignant cancer cases (incidence) and cancer deaths (mortality) in Utah residents in 2010. •In 2010, 9,233 Utahns were diagnosed with cancer and 2,810 died of cancer. Cancer is the second leading cause of death in Utah and the United States, exceeded only by heart disease. •Five cancer sites alone account for more than half of all new cancer diagnoses. These include prostate (18.7%), breast (13.9%), melanoma of the skin (8.2%), colon and rectum (7.5%), and lung and bronchus (6.1%) cancers. •The most common causes of death from cancer in Utah were lung and bronchus (16.3%), breast (9.2%), colon and rectum (8.9%), prostate (7.9%), and pancreas (7.3%). These five sites accounted for nearly 50% of cancer deaths in Utah. •The number of new cases (214) and deaths (204) from pancreatic cancer were very close in Utah in 2010. In contrast, thyroid cancer was diagnosed in 433 Utahns, but caused fewer than 10 death Reference 4

Figure 2 presents the Utah-U. S. incidence rate ratio (IRR) Figure 2 presents the Utah-U.S. incidence rate ratio (IRR). The IRR was calculated from the five-year, 2006 to 2010, age-adjusted cancer incidence rates in Utah and the United States (excluding Utah). The IRR indicates which cancer sites in Utah were above or below the U.S. age-adjusted incidence rate. This information is important for understanding Utah’s unique cancer burden. •Utah’s cancer incidence rate was 11% lower than the national rate and is routinely one of the lowest cancer incidence rates in the nation. The age-adjusted incidence rate in Utah from 2006-2010 was 418.6 cases per 100,000 Utahns. •Utah’s low overall cancer rate is driven in part by the exceptionally low incidence rate of lung and bronchus cancer. The lung and bronchus incidence rate in Utah from 2006-2010 was 28.1 cases per 100,000 Utahns, which was a remarkable 57% lower than the national rate. •In contrast, the incidence rate of melanoma of the skin in Utah was a striking 61% higher than the U.S. incidence rate and was the highest rate in the nation. The age-adjusted incidence rate of melanoma of the skin in Utah from 2006-2010 was 31 cases per 100,000 Utahns while the U.S. rate was 19.3 cases per 100,000 U.S residents. Reference 4

Figure 4 presents the annual age-adjusted incidence (new cases) and mortality (deaths) rates for Utah and the U.S. from 1973-2010. Monitoring historical changes in rates over time (long-term trends) is important for understanding cancer patterns and the effectiveness of cancer control efforts. •Cancer incidence has consistently been lower in Utah as compared to the U.S. From 1973-1989 incidence rates in Utah rose by a small, but significant 0.9%* per year. This was similar to the pattern seen in the rest of the nation. •In the late-1980s to the mid-1990s the introduction of prostate-specific antigen (PSA) screening impacted cancer incidence rates across the nation. A sharp rise and decline in incidence is visible. •Utah experienced a significant increase in cancer incidence rates of 2.3%* per year from 1995-1999. However since 1999, cancer incidence rates in Utah have remained fairly flat with no significant increase or decrease. In contrast since 1999, national cancer incidence rates have fallen by 0.5%* annually. •Cancer mortality rates in Utah have remained below U.S. rates for nearly forty years. For decades mortality rates nationwide remained fairly stable. However since 1998, mortality rates in Utah have decreased by 1.6%* per year, while national rates have fallen at a slower rate of 1.5%* per year. Reference 4

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References Gallagher, James. "Cancer Discovery Offers Hope of Tackling Spread of Disease." Chill4us Careers. BBC News, 15 Aug. 2011. Web. 20 May 2015. 2. "Can Cancer Cells Spread from One Person to Another?" Ask an Expert (ABC Science). ABC Science, 23 Oct. 2012. Web. 20 May 2015. "Cancer." WHO. N.p., Feb. 2015. Web. 22 May 2015. Stanford, Janet L. Page 10-12. Cancer in Utah. Salt Lake City: Utah Cancer Registry, 1996. N. pag. Print. "What Is Cancer?" National Cancer Institute. N.p., 9 Feb. 2015. Web. 22 May 2015. “Cancer Statistics" National Cancer Institute. N.p., 9 Feb. 2015. Web. 22 May 2015. “Types of Treatment" National Cancer Institute. N.p., 29 Apr. 2015. Web. 22 May 2015. “Side Effects" National Cancer Institute. N.p., 29 Apr. 2015. Web. 22 May 2015. “Risk Factors of Cancer" National Cancer Institute. N.p., 29 Apr. 2015. Web. 22 May 2015. "Cancer Prevention." WHO. N.p., 2015. Web. 22 May 2015. “Symptoms" National Cancer Institute. N.p., 5 Mar. 2015. Web. 22 May 2015. Chen, Suephy. "It’s Melanoma Awareness Monday: Reduce Your Risk."Emory Healthcare. N.p., 4 May 2015. Web. 22 May 2015. "Here’s Why Radiation and Chemotherapy Should Not Be The Only Two Approved Treatments For Cancer." CollectiveEvolution RSS. N.p., 29 Mar. 2014. Web. 22 May 2015.  "Cookeville Regional Medical Center." CRMC Health. N.p., n.d. Web. 22 May 2015.