© 2012 McGraw-Hill Companies. All Rights Reserved. Chapter 16

© 2012 McGraw-Hill Companies. All Rights Reserved.  Causes about 570,000 deaths in the U.S. each year  1,500 per day  Leading cause of disease-related death among people under age 75  Second most common cause of death  Evidence supports that most cancers could be prevented by simple lifestyle changes  Tobacco is responsible for about 30% of all cancer deaths  Poor diet and exercise habits account for another 30% of cancer deaths 2

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 Definition: the abnormal and uncontrollable multiplication of cells that can lead to death  Tumor (neoplasm): a mass of tissue that serves no purpose  Benign versus malignant tumors  Benign (noncancerous) tumor : made up of cells enclosed in a membrane that prevents their penetration of neighboring tissues  Malignant tumor : cancerous, can invade surrounding tissues  Every case of cancer begins as a change in a cell that allows it to grow and divide when it should not 4

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 Primary tumor = cancer’s original location  Definition: the spreading of cancer cells from the primary tumor to another part of the body; occurs because cancer cells do not stick to each other as strongly as normal cells do Metastasizing – the traveling and seeding process of cancerous cells Cells break away from primary tumor and invade surrounding tissues or travel through the blood and lymphatic system New tumors are called Secondary tumor or metastases 6

© 2012 McGraw-Hill Companies. All Rights Reserved.  Staging = process of diagnosing cancer according to the amount of progress it has made in the victim’s body  Five stages  0 = early cancer, present only in the layer of cells where it originated  I, II, III = More extensive cancer, with higher numbers indicating greater tumor size and/or the degree to which the cancer has spread to nearby lymph nodes or organs adjacent to the primary tumor  IV = Advanced cancer that has spread to another organ o Remission  Signs and symptoms of cancer disappear 7

© 2012 McGraw-Hill Companies. All Rights Reserved.  Malignant Tumors  The behavior of tumors arising in different body organs is characteristic of the tissue of origin  Tumors classified according to types of cells Initially retain some of the original properties of the host cell As they continue to multiply, become groups of rogue cells with increasingly unpredictable behavior 8

© 2012 McGraw-Hill Companies. All Rights Reserved.  Malignant Tumors  Carcinomas: most common; arise from epithelia, tissues that cover external body surfaces, line internal tubes, and form the secreting portion of glands  Sarcomas: arise from connective and fibrous tissues such as muscle, bone, cartilage, and membranes covering muscle and fat  Lymphomas: cancers of the lymph nodes  Leukemia: cancers of the blood-forming cells in bone marrow 9

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© 2012 McGraw-Hill Companies. All Rights Reserved.  1.5+ million Americans are diagnosed yearly  American Cancer Society  Estimates that the 5-year survival rate for all cancers diagnosed between 1995 and 2005 is 68%  Nearly 1 in 2 men and more than 1 in 3 women will be develop cancer at some point in their lives  Until 1991, number of cancer deaths increased steadily in the U.S., mostly due to lethal lung cancers among male smokers 11

© 2012 McGraw-Hill Companies. All Rights Reserved.  Since 1991, the death rate has dropped 19% in men and 11% in women  Prevention  Early detection  Improved therapy  American Cancer Society estimates  90% of skin cancer could be prevented  87% of lung cancer could be prevented  Regular screening and self-examinations could save an additional 100,000 lives per year  About 11.4 million living Americans have a history of cancer 12

© 2012 McGraw-Hill Companies. All Rights Reserved.  Most common cause of cancer death in the U.S.  157,000 deaths per year  Risk Factors Tobacco smoking contributes to 90% of lung cancer deaths Combined with environmental carcinogens, risk is multiplied by a factor of 10  Detection and treatment (difficult to detect) Symptoms are not detected until cancer has reached the invasive stage Persistent cough, chest pain, or recurring bronchitis Diagnosis by CT scan, chest X-ray, sputum examination, or fiber-optic bronchosectomy 13

© 2012 McGraw-Hill Companies. All Rights Reserved.  Treatment:  Difficult to treat  If caught early, treated by surgery Only 15% are detected prior to spreading Radiation and chemotherapy are used in addition  If detected early, 53% of patients are alive 5 years after diagnosis  Overall, the survival rate is only 15%  Phototherapy, gene therapy, and immunotherapy (vaccines) are being studied 14

© 2012 McGraw-Hill Companies. All Rights Reserved.  Third most common type of cancer  Risk Factors Age: 91% occurs in ages 50 or older Heredity Lifestyle (alcohol use, smoking, exercise, nutrition) Polyps  Detection and Treatment Screening Sigmoidoscopy or colonoscopy Examine for polyps Surgery is primary treatment Radiation and chemotherapy used prior to surgery 15

© 2012 McGraw-Hill Companies. All Rights Reserved.  Most common cancer in women  Causes almost as many deaths in women as lung cancer  1 in 8 American women will develop it during her lifetime (207,000 each year)  1 in 30 will die from the disease (40,000 deaths)  Risk Factors Strong genetic factor Most common in women over 50 Common causes: genetic predisposition, high fat, high calorie diet and sedentary lifestyle, alcohol use, early onset of menstruation, first child after age 30, obesity Current use of hormone replacement therapy (HRT) Estrogen: cancer in estrogen-responsive sites 16

© 2012 McGraw-Hill Companies. All Rights Reserved.  Detection and treatment  Early detection Monthly breast self-exam for all women at age 20 Clinical breast exam by a physician every year if over 40 Mammography: every year for women over 40 Digital mammography (MRI) Ultrasonography  Treatment Lump biopsy, lumpectomy, or mastectomy  Survival rate 98% if the cells did not metastasized 90% for all stages at 5 years  New strategies for treatment and prevention 17

© 2012 McGraw-Hill Companies. All Rights Reserved.  Most common cancer in men  Second leading cancer death in men  218,000 new cases per year  More than 32,000 deaths per year  Risk Factors Age Genetic predisposition Lifestyle Diet  Early detection is key Prostate-specific antigen (PSA) blood test Digital rectal exam  Treatment Surgical removal of the prostate or radioactive seeding  Survival All stages near 100% after 5 years 18

© 2012 McGraw-Hill Companies. All Rights Reserved.  Cervical cancer - sexually transmitted Most cases stem from infection by the human papillomavirus (HPV)- transmitted by unprotected sex Group of about 100 related viruses Women high in HPV 16 are at a high risk Smoking Infection by genital herpes  Cervical cancer most common in women in their 20s and 30s Factors: unprotected sexual intercourse, multiple sex partners, cigarette smoking, immunosuppression, use of oral contraceptives  Screening: PAP test Cervical dysplasia All sexually active women ages should be tested  Treatment Surgery Chemotherapy with radiation 19

© 2012 McGraw-Hill Companies. All Rights Reserved.  Uterine, or Endometrial:  Occurs after 55  Risk factors similar to breast cancer  Determined by pelvic exam  Treatment is surgery (hysterectomy)  96% survivability after 5 years  Ovarian Cancer:  Difficult to detect and diagnose, may be no warning signs  Family history or genetic factors  Determined by Pelvic exam Ultrasound of ovaries  Treatment is surgical removal of the ovaries, the fallopian tubes, and the uterus  Radiation and chemotherapy are sometimes used  Survival rate after 5 years is 94% for tumor localized to ovary  Survival rate after 5 years for all stages is 46% 20

© 2012 McGraw-Hill Companies. All Rights Reserved.  Most common form of cancer  1+ million cases per year  68,000 are melanoma, the most serious type  Easily detected and highly curable  Risk Factors  Exposure to ultraviolet (UV) rays during childhood  Common cause – suntans, sunburns, tanning beds  Caucasians are 10 times more likely than African Americans to develop melanoma  Types Basal cell and squamous cell Melanoma - more dangerous form, spreads rapidly  Prevention Avoid long-term overexposure to sunlight Sunscreen, protective clothing, shade  Detection and Treatment ABCD screen test 21

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© 2012 McGraw-Hill Companies. All Rights Reserved.  Cancers of the oral cavity, pharynx, larynx, and nasal cavity  Smoking and tobacco use  Excessive use of alcohol  Risk twice as great in men as it is in women  50% of cancers of the tonsils and tongue are related to HPV infection  Treatment Chemotherapy, radiation, surgery Often develop another primary cancer of head and neck The 5-year survival rate is about 61% 23

© 2012 McGraw-Hill Companies. All Rights Reserved.  Rare (about 1% of cancer in men)  Most common cancer in men ages  Much more common in white males  Increased risk if undescended testicles  Self-examination helps in early detection  Tumors treated by surgical removal or chemo  Radiation rarely used  The 5-year survival rate is 96% 24

© 2012 McGraw-Hill Companies. All Rights Reserved.  Pancreatic cancer  3 out of 10 are linked to smoking  Stomach cancer  Twice as common in males  Infected by Helicobacter pylori  Bladder cancer  Four times more likely in males  Smoking is the key risk factor  Kidney cancer  Smoking and obesity are mild risk factors  Brain cancer  Develops for no apparent reason 25

© 2012 McGraw-Hill Companies. All Rights Reserved.  Cancers of the white blood cells  Starts in the bone marrow but can spread to the lymph nodes, spleen, liver, other organs, and CNS  Leukemia cells crowd out production of normal blood cells  Risk factors are unknown, but some possibilities include smoking, radiation, infections  Symptoms: fatigue, anemia, weight loss, infection  About 43,000 new cases and 22,000 deaths each year 26

© 2012 McGraw-Hill Companies. All Rights Reserved.  Lymphoma  Arising from the lymph cells Hodgkin’s disease Non-Hodgkin’s disease (NHL) More common More deadly of the two types (6 th most common cancer) Risk factors are not well understood  Compromised immune system are at a greater risk  Multiple Myeloma  Malignant plasma cells produce tumors in the bone marrow. Leads to anemia, excessive bleeding, decreased resistance to infection Age is most significant risk factor – median age is 66 27

© 2012 McGraw-Hill Companies. All Rights Reserved.  The role of DNA (deoxyribonucleic acid)  Each cells has 23 pairs of chromosomes Each controls the way a cell will work Each rung is made up of four different nucleotide bases: Adenine, thymine, cytosine, guanine A gene – smaller unit of DNA  DNA mutations and cancer  Changes the way the cells function  Mutagens – radiation, certain viruses, chemical substances  Oncogenes – a gene involved in the transformation of a normal cell into cancer  Tumor suppressor genes – type of oncogene that restrains cellular growth  Hereditary cancer risks 28

© 2012 McGraw-Hill Companies. All Rights Reserved.  Cancer promoters Do not directly produce mutations; accelerate the growth of cells without damaging or permanently altering the DNA  Cancer initiators: Carcinogenic agents UV radiation  Tobacco use Cigarette smoking is a complete carcinogen because it is a cancer initiator and promoter 29

© 2012 McGraw-Hill Companies. All Rights Reserved.  Your food choices affect your cancer risk by exposing you to potentially dangerous compounds and depriving you of protective ones  Dietary Fat and Meat  American Cancer Society encourages everyone to limit their consumption of processed and red meats Contributes to certain cancers: Colon, stomach, prostate  Alcohol  Fried foods  Dietary fiber  Fruits and vegetables Anticarcinogens Carotenoids Antioxidants versus free radicals Phytochemicals Sulforaphane 30

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© 2012 McGraw-Hill Companies. All Rights Reserved.  Linked to breast and colon cancer  Benefits of physical activity  Speeding the movement of food through the digestive system  Strengthen the immune system  Decreasing blood fat levels  Prevention of obesity 32

© 2012 McGraw-Hill Companies. All Rights Reserved.  Microbes  About 15-20% of the world’s cancers are caused by microbes  Viruses Human papillomavirus – cervical cancer  Bacteria Helicobacter pylori – stomach cancer Epstein-Barr virus (mononucleosis) – Hodgkin’s disease, cancer of the pharynx and some stomach cancers Human herpesvirus 8 – Kaposi’s sarcoma and certain types of lymphoma Hepatitis B and C – cause as many as 80% of the world’s liver cancers 33

© 2012 McGraw-Hill Companies. All Rights Reserved.  Ingested chemicals  Food industry uses preservatives and other additives to prevent food from spoiling  Nitrosamines – nitrates and nitrites combined with dietary substances are a highly potent carcinogen  Environmental and industrial pollution  Radiation - UV rays or man-made 34

© 2012 McGraw-Hill Companies. All Rights Reserved.  Detecting:  Self-monitoring  Routine cancer checkups and specific screening tests  Diagnosing:  Biopsy  Magnetic resonance imaging (MRI)  Computed tomography (CT)  Ultrasonography  Traditional treatment:  Surgery  Chemotherapy  Radiation Therapy 35

© 2012 McGraw-Hill Companies. All Rights Reserved.  Beyond traditional treatments:  Proteasome inhibitors  Monoclonal antibodies  Tyrosine kinase inhibitors  Anti-angiogenesis drugs  Biological therapies/immunotherapy  Bone marrow and stem cell transplants  Experimental techniques:  Gene therapy  Enzyme activators/blockers 36

© 2012 McGraw-Hill Companies. All Rights Reserved.  About 11.4 million cancer survivors in the U.S.  Psychological support is important  Family and friends  Doctors and nurses  Organized groups  Support groups for family and friends 37

© 2012 McGraw-Hill Companies. All Rights Reserved. Chapter 16