1. Chapter Eleven Living with Cancer
and Chronic Conditions
Chapter Eleven: Living with Cancer and Chronic Conditions
Illnesses are disruptive, affecting one’s overall life routines. Once an illness becomes chronic (develops slowly and persists for a long period of time), one must be able to function on a daily and limited basis. Cancer will be discussed in detail followed by other long-term illnesses that can affect one’s life negatively.

2. Status of Cancer Today
Annually, over 1.2 million people developed cancer [U.S. 2002]
Contributing factors could be:
aging
tobacco use
high fat foods
pollution
no health insurance
lack of education
Over one half million Americans died from cancer in 1999 with over 1.2 million new cases of cancer were diagnosed that year. Cancer prevention still becomes a challenge for many since there are many factors that contribute to the disease and potentially others that we still don’t know about as of yet.
Factors we do know about are:
Aging of the population
failure to curb tobacco use
consumption of high fat foods and convenience foods
urbanization resulting in more and different forms of pollution
the amount of uninsured people have increased which prevents early detection
the ability to recognize cancer due to the lack of information or ignorance.

3. Cell Regulation Cells perform important daily functions
Regulatory genes – responsible for monitoring cell replication, specialization, DNA repair, and suppression
Oncogenes – faulty regulatory genes that fail to function properly
Proto oncogenes –normal regulatory genes that may become oncogenes
Cancer is the 2nd leading cause of death in the United States. Cancer reflects cell dysfunction, which normal cells band together to perform a prescribed function fail.
Tissues of the body lose cells over time. This loss requires replacements of immature cells into specialized ones which is carefully controlled by genes within the cell. Once the cells become specialized, they copy or replicate themselves. These processes are monitored by regulatory genes. Failure to regulate specialization and replication results in abnormal growth called cancer cells.
Regulatory genes receive help to remove or suppress abnormal cells development from suppressor genes known as p53 genes. These repair genes join regulatory genes to prevent further development of abnormal cells.
Proto oncogenes are the specialization, replication, repair, and suppressor genes that have the potential to become cancer causing cells.
Oncogenes are the cancer causing genes that were produced by proto oncogenes.

4. Oncogene Formation All cells have proto oncogenes
3 mechanisms that contribute to oncogene formation:
genetic mutations
viral infections
presence of carcinogens, environmental agents
All cells have proto oncogenes. There are 3 mechanisms that have received a lot of attention for their roles of creating oncogenes.
Genetic mutations develop when dividing cells miscopy genetic information. If that gene that is miscopied is a proto oncogene, the oncogene that results will stimulate the formation of cancerous cells. Factors such as aging, free radicals, radiation, and carcinogens are associated with the miscopying of genetic information that comprises the genes found with the cell, including those intended to prevent cancer.
viral infections such as HIV, herpes, and genital warts have been identified as causing cancer. These viruses seek out cells of a particular type, such as those of the immune system and alter their genetic material to convert these cells into virus producing cells. The change the make up of one or more of the regulatory genes, converting these proto oncogenes into oncogenes.
Presence of environmental agents known as carcinogens can convert proto oncogenes into oncogenes. Chemicals found in tobacco smoke, polluted air and water, toxic wastes, and high fat foods may convert proto oncogenes into oncogenes. These carcinogens can work alone or in combination of other chemicals.

5. Characteristics of a Cancerous Cell
Infinite life expectancy (telomerase enzyme)
Absence of contact inhibition
Absence of cellular cohesiveness (metastasis)
Ability to control extra blood supply (angiogenesis potential)
The cancer cell has similarities and differences compared to normal cells.
Life expectancy is infinite since cancer cells produce the enzyme telomerase that blocks the biological clock that tells a normal cell to die. Cancer cells do not necessarily divide more quickly than normal cells, either at the same or slower rate.
Cancer cells lack contact inhibition ( a control mechanism that influences the number of cells that cay occupy a particular space). They can accumulate and eventually alter the structure of a body organ or break through its wall into another area (invasion).
3) The absence of cellular cohesiveness (a property of cells that keeps them at home) allows cancer cells to spread through the circulatory or lymphatic system to distant points. This is called Metastasis.
4) Angiogenesis potential is the final characteristic a cancer cell possesses. Cancer cells have the ability to control extra blood supply to meet their metabolic needs and provide additional routes for metastasis.

6. Benign vs. malignant growths are not always safe
Types of Cancers
Carcinoma
Sarcoma
Lymphoma
Leukemia
Listed above are the 4 major categories of cancer:
Carcinomas are found most frequently in the skin, nose, mouth, throat, stomach, intestinal tract, glands, nerves, breasts, urinary and genital structures, lungs, kidneys, and liver. 85% of all malignant tumors are classified as carcinomas.
Sarcomas are formed in the connective tissues of the body: bone, cartilage, and tendons. Only 2% are considered malignant.
Lymphomas affect cells in the lymphatic tissues or immune system tissues: Hodgkin’s disease (abnormal amount of white cell production and decreased resistance), lymphosarcomas.
Leukemia are found in cells of the blood and blood forming tissues: characterized by abnormal immature white blood cell formation, multiple forms found in children and adults.
Benign vs. malignant growths are not always safe

7. Benign vs. malignant growths are not always safe
Types of Cancers, cont.
melanoma
neuroblastoma
adenocarcinoma
hepatoma
Listed above are the 4 major categories of cancer:
Carcinomas are found most frequently in the skin, nose, mouth, throat, stomach, intestinal tract, glands, nerves, breasts, urinary and genital structures, lungs, kidneys, and liver. 85% of all malignant tumors are classified as carcinomas.
Sarcomas are formed in the connective tissues of the body: bone, cartilage, and tendons. Only 2% are considered malignant.
Lymphomas affect cells in the lymphatic tissues or immune system tissues: Hodgkin’s disease (abnormal amount of white cell production and decreased resistance), lymphosarcomas.
Leukemia are found in cells of the blood and blood forming tissues: characterized by abnormal immature white blood cell formation, multiple forms found in children and adults.
Benign vs. malignant growths are not always safe

8. How Cancer Spreads
By looking at the slide, locomotion is the movement essential to the process or metastasis (spread of cancer). Scientists have identified a protein that causes cancer cells to grow arms or pseudopodia, enabling them to move to other parts of the body.

9. Common Cancer Sites of the Body
Lung
Breast
Uterus
Vagina
Ovary
Lymph
Cervix
Prostate
Testicle
Colon/rectum
Pancreas
Skin
The above organs have a high rate of cancer. Regular screening procedures can lead to early identification of cancer at these sites.

10. Self-Check (Breast)
The following explains visually how to properly perform a self breast exam for women.
In the shower
Before a mirror
Lying down
Breast cancer can also occur in men. Therefore, this examination should be performed monthly by men. Regular inspection shows what is normal for you and will give you confidence in your examination techniques.

11. Self-Check (Testicles)
It usually takes about 3 minutes to perform a testicular self check. The best time is after a warm bath or shower, when the scrotal skin is most relaxed.
Roll each testicle gently between the thumb and fingers of both hands
Check for any growth or nodules (they should be small and extremely hard).
See your physician promptly if you discover anything suspicious.

12. ABCDE’s of Skin Cancer Asymmetry Border Color Diameter Elevation
The American Cancer Society recommends that you remember and follow the following guidelines for determining skin cancer, especially melanoma. Melanoma starts off with a small mole like growth that increases progressively in the following steps:
Asymmetry: One half is unlike the other half
Border: becomes irregular or poorly defined
Color: varies from one area to another; shades of tan, brown, or black
Diameter: is larger than 6 mm (size of a pencil eraser)
Elevation: starts to raise along the margins.

13. 7 Warning Signs of Cancer
Change in bowel/bladder habits
A sore that won’t heal
Unusual bleeding
Thickening or lump
Indigestion
Obvious change in wart/mole
Nagging cough
Listed above are the seven warning signs of cancer, which the acronym CAUTION will help you remember possible signs and serve as a from for early detection.
If you have a warning sign that persists for more than 5 days, see your physician.

14. Treatment for Cancer Surgery Radiation Chemotherapy Immunotherapy
Alternative cancer therapies
In today’s approach to cancer treatment, new forms of experimental methods are becoming more available. One or more of the following approaches may be combined. A brief description for each treatment is given below.
Surgery: removal of tissue that contains cancerous cells.
radiation: is used to alter cancer cells’ genetic material during the cell division. Careful planning of the length of exposure and the time of treatment must be precise.
Chemotherapy: Drugs used to destroying cancer cells’ ability to use important materials or carry out cell division. Side effects are often experienced.
Immunotherapy: uses a variety of substances to trigger the patient’s immune system to attack cancer cells or prevent them from becoming activated. Interferon, monoclonal antibodies, interleukin-2, tumor necrosis factor, and bone marrow growth regulators are examples.
Alternative cancer therapies: These are non-conventional methods used to treat or prevent cancer e.g chiropractic manipulation, acupressure, ayurveda (Indian lifestyle), biofeedback, homeopathy (use of toxic substances), naturopathy (natural remedies), reflexology, oxidizing agents, therapeutic touch, visualization, and acupuncture.

15. Risk Reduction Know family history Select occupation carefully
Avoid tobacco
Eat properly
Monitor environmental exposure to carcinogens
Common sense states you recognize the following factors to either reduce or at least minimize the development of cancer.

16. Risk Reduction (cont’d)
Control body weight
Exercise regularly
Limit UV rays
Consume alcohol moderately
A wellness oriented lifestyle is the best weapon in the personal war against cancer. However, in the final analysis, all risk factor reduction is relative. Regardless of your personal lifestyle, you can educate others, give comfort and support those who are living with cancer, and aid in the funding of research for a possible cure.

17. Other Chronic Health Conditions
Systemic lupus erythematosus
Crohn’s Disease
Multiple Sclerosis
Diabetes mellitus (Type 1 and 2)
Alzheimer’s Disease
Sickle Cell Disease
In addition to the chronic conditions of cancer, adults can experience other chronic health conditions. A brief description for each disease will follow.
Systemic lupus erythematosus: Lupus is the most familiar of auto immune disorders. This is the concentrated efforts of the immune system to attack its own tissues, causing inflammation of joints, stiffness, fatigue, destruction of connective tissue, appearing as a reddish rash or mask to the face.
Crohn’s Disease: A form of Inflammatory Bowel Disease which causes a breakdown of the intestinal wall, causing abdominal pain, fever, diarrhea, weight loss, and rectal bleeding.
Multiple sclerosis: myelin cells are destroyed affecting nervous responses. Deterioration of the nervous system function impairs physical and mental processes.
Diabetes Mellitus: type one-the body does not produce any insulin and must rely on outside sources to function. Insulin is produced by the pancreas and allow sugar (glucose) to be absorbed into cells.
Diabetes (type 2) –metabolic disorder where the body does create insulin but not enough to allow glucose to enter the cells. Usually a process over time where the body develops a resistance towards insulin.
Alzheimer’s Disease: a form of dementia associated with aging often confused with mild depression. Memory loss, confusion, and a loss of normal thought process are common traits for this disease.
Sickle Cell Disease: Inherited condition afflicting African Americans where red blood cells are unable to pass through capillaries due to the crescent shaped cells (sickle cell anemia). Can impair lung function, create congestive heart failure, gallbladder infections, bone changes, and abnormalities of the eye and skin.

18. Chapter Eleven Living with Cancer and Chronic Conditions
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