Christina Laukaitis, MD, PhD, FACP 6/21/12

What Is Cancer? The term “cancer” refers to more than 100 different diseases that begin in the cells, the body’s basic unit of life.

What Is Cancer? Cancer develops when cells grow and form more cells without order or control Under normal circumstances, new cell growth and old cell death are kept in balance In cancer, this balance is disrupted

Normal Tissue

Beginning of Cancerous Growth

Cancerous Tumor

What Is Cancer? Cancer develops when cells grow and form more cells without order or control Under normal circumstances, new cell growth and old cell death are kept in balance In cancer, this balance is disrupted

Why is cell overgrowth a problem? Non-functional cells crowd out original ones Tissue no longer works right For example, can’t swallow food, can’t make urine Energy is going into making cancer cells Rest of body can’t maintain itself Person is tired, loses weight Cancer spreads to other organs Metastasis These get crowded with cancer and don’t work

Types of Cancer There are over 100 different types of cancer Start in different tissues, involve different cell types Treatment depends on the type of cancer

The body protects itself from cancer Cells are instructed to destroy themselves when they malfunction or aren’t needed Mutations can mess up this instruction Some people are born with these mutations The immune cells destroy malfunctioning cells Diabetes and some medications make the immune system less effective HIV affects the immune system

Cancers are named by where they start 1. Carcinomas begin in skin or tissues that line the internal organs 2. Sarcomas start in bone, fat, muscle, joint, nerve, blood vessel or deep skin tissues 3. Lymphomas start in lymph nodes or lymphoid tissues (tissues of the body’s immune system) 4. Leukemia is cancer of the white blood cells 5. Myelomas start in plasma cells found in bone marrow A tumor that has metastasized (spread) keeps its original name “Breast cancer metastatic to the bone”

In Summary Cancer comes from cells that grow out of control As cells become more out of control, they can spread to other parts of the body Cancer is named based on the location where it started

What increases the risk of cancer? Age Exposures & infections Family history

New AZ cancer cases for AI by age

Exposures that increase cancer risk Radiation (Uranium, X-rays) Leukemia Sun Skin cancer Tobacco smoke Lung and bladder cancers Arsenic Liver, lung, kidney, bladder cancer Alcohol Liver and pancreas cancer Other chemicals & hormones

Infections that increase cancer risk Hepatitis B & C Liver cancer Human Papilloma Virus (HPV) Cervical and penis cancers There is now a vaccination for teenagers! Human Immunodeficiency Virus (HIV) Certain skin cancers (Kaposi’s Sarcoma) Lymphoma Cervical cancer

Cancer in the family? If a parent, brother or sister had a certain kind of cancer, a person’s risk of getting that cancer is doubled Average risk of colon cancer: 5%  Risk if a parent or sibling had colon cancer: 10% 

Screening for cancer in family Start screening for specific cancers 10 years before it happened in a relative If a mother had breast cancer at age 49, her daughters should start mammograms by 39

Cancers that often run in families Breast Ovarian Colon Kidney Endocrine Pheochromocytoma Medullary thyroid cancer Skin Prostate Pancreatic

Summary Cancer becomes more likely as a person gets older Exposures and infections can increase cancer risk Some families are more affected by cancer than others

Cancer Screening and Prevention Checking for cancer in a person who does not have any symptoms of the disease is called screening.

Cancer Screening and Prevention The goal of cancer screening is to discover and stop a cancerous tumor before it grows and spreads (metastasizes) This is called early detection

Cancer Screening and Prevention Medical screening tests are effective tools for early detection of cancer A few types of cancer can be detected early by specific tests

Early detection = more survivors StageWhere is the cancer?5-year survival 0 In the original tissue in the organ 95%  1 Outside the original tissue, just in the organ 90%  2 Large tumor or spread to 1-2 sites outside organ 80%  3 Spread to one area of the body 60%  4Spread throughout the body5% 

Breast Kidney Prostate Colorectal Top 4 cancers for AI Most common cancers (2011)

Screening tests for common types of cancer Breast - screening mammogram Cervix - Pap test Colon - fecal occult blood test or fecal immunotest, colonoscopy, sigmoidoscopy Prostate - digital rectal exam, PSA Skin – checking skin for unusual growths

Screening recommendations Women Men Colon cancer screening from age Mammogram every 1-2 years from 40 or 50 Pap smear every 3 years from ; every 3-5 years from Colon cancer screening from Discuss prostate cancer screening with physician from 50

Challenges to Cancer Screening and Early Detection  Difficulty getting to clinic  Fear of cancer  Lack of knowledge  Modesty  Communication  Illness beliefs

Possible Symptoms of Cancer There are many different symptoms known to be associated with certain types of cancers. A symptom is a sign that something is not right in the body but does NOT always indicate cancer.

Pay attention to your body if there is... Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening, lump, or swelling in the breast or any other part of the body Indigestion or difficulty swallowing Change in wart or mole Nagging cough or hoarseness Blood in urine

Pay attention to unexplained symptoms such as… Continuing weight loss Fever Fatigue Pain

Symptoms of specific cancers Breast—lump in breast, skin change, nipple discharge Ovarian—bloating, change in bowel habits, abdominal size growth, abdominal or pelvic pain Colon—constipation & diarrhea, low blood counts Thyroid—neck lump Kidney—back pain, blood in urine Uterine—postmenopausal vaginal bleeding Prostate—problems urinating, back pain Skin—non-healing sores, moles that change colors Lung—cough, multiple pneumonias

Cancer Risk Exam & Test Results Symptoms Family History Medical Problems Habits & Exposures

How can you prevent cancer? Don’t get old? Choose good parents? Live a healthy life!

Maintain a healthy weight Be active 30+ minutes of moderate exercise 5 days per week

Eat a healthy diet 5 or more servings of vegetables and fruits each day Choose whole grains over processed (refined) grains Limit processed and red meats

Choose other healthy habits Don’t drink alcohol, or do so only in moderation <1 drink per day for a woman <2 drinks per day for a man Don’t smoke!

Get recommended screening Pap smear every 3 years from age Mammograms every 1-2 years starting between Colonoscopy every 10 years from age Discuss PSA and rectal exam after age 50

Summary Pursue a healthy lifestyle Get recommended screening Know your family history Be aware of your body Get suspicious changes checked quickly If something doesn’t seem right, keep pushing until you understand what is wrong

The body is composed of cells

Cells are organized into tissues that form organs

The organs of the body do jobs

A cell’s instructions are in its nucleus

Cell instructions are written in DNA DNA instructions RNA messenger Protein workers

What Is Cancer? The term “cancer” refers to more than 100 different diseases that begin in the cells, the body’s basic unit of life.

Activity If the roof leaks, destroy the cell and build a new one

Activity

If the roof leaks, destroy the cell and make a new one

If the roof leaks, make a new cell

Make a new cell

Mutations change cell instructions Mistakes can happen during copying The more times a cell is copied, the higher the risk of a mutation occurring Some people’s cells don’t proofread well Mistakes can happen because of outside forces