1. Native American Cancer Support Group Training

2. What is Cancer?

3. 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) where the cells begin to grow out of control.

4. Cell Loses Control of Normal Growth
Normal cell division
Cell Suicide (Apoptosis)
Cell damage— no repair
Cancer cell division
Cancer arises from a loss of normal growth control. In normal tissues, the rates of new cell growth and old cell death are kept in balance. In cancer, this balance is disrupted. This disruption can result from uncontrolled cell growth or loss of a cell’s ability to undergo cell suicide by a process called“apoptosis.” Apoptosis, or “cell suicide,” is the mechanism by which old or damaged cells normally self-destruct.
First mutation
Second mutation
Third mutation
Fourth or later mutation
Uncontrolled growth

5. Example of Normal Growth
Dead cells shed from outer surface
Epidermis
Cell migration
Dividing cells in basal layer
To illustrate what is meant by normal growth control, consider the skin. The thin outermost layer of normal skin, called the epidermis, is roughly a dozen cells thick. Cells in the bottom row of this layer, called the basal layer, divide just fast enough to replenish cells that are continually being shed from the surface of the skin. Each time one of these basal cells divides, it produces two cells. One remains in the basal layer and retains the capacity to divide. The other migrates out of the basal layer and loses the capacity to divide. The number of dividing cells in the basal layer, therefore, stays the same.
Dermis

6. Beginning of a Cancerous Growth
During the development of skin cancer, the normal balance between cell division and cell loss is disrupted. The basal cells now divide faster than is needed to replenish the cells being shed from the surface of the skin. Each time one of these basal cells divides, the two newly formed cells will often retain the capacity to divide, thereby leading to an increase in the total number of dividing cells.
Underlying tissue

7. How a Tumor Forms Underlying tissue
This gradual increase in the number of dividing cells creates a growing mass of tissue called a “tumor” or “neoplasm.” If the rate of cell division is relatively rapid, and no “suicide” signals are in place to trigger cell death, the tumor will grow quickly in size; if the cells divide more slowly, tumor growth will be slower. But regardless of the growth rate, tumors ultimately increase in size because new cells are being produced in greater numbers than needed. As more and more of these dividing cells accumulate, the normal organization of the tissue gradually becomes disrupted.
Underlying tissue

8. How Cancer Cells Invade & Spread1
Cancer cells invade surrounding tissues and blood vessels 2
Cancer cells are moved by the circulatory system to other tissues/organs
Cancers are capable of spreading throughout the body by two mechanisms: invasion and metastasis. Invasion refers to the direct migration and penetration by cancer cells into neighboring tissues. Metastasis refers to the ability of cancer cells to penetrate into lymphatic and blood vessels, circulate through the bloodstream, and then invade normal tissues elsewhere in the body. 3
Cancer cells reinvade and grow at new location

9. Example: Melanoma Brain Melanoma cells travel through bloodstream
National Cancer Institute
Understanding Cancer and Related Topics
Understanding Cancer
Example:
Brain
Melanoma
Melanoma cells travel through bloodstream
Liver
Melanoma (initial tumor)
A malignant tumor, a “cancer,” is a more serious health problem than a benign tumor because cancer cells can spread to distant parts of the body. For example, a melanoma (a cancer of pigmented cells) arising in the skin can have cells that enter the bloodstream and spread to distant organs such as the liver or brain. Cancer cells in the liver would be called metastatic melanoma, not liver cancer. Metastases share the name of the original (“primary”) tumor. Melanoma cells growing in the brain or liver can disrupt the functions of these vital organs and so are potentially life threatening.
NCI Web site:

10. Example: Melanoma Brain Melanoma cells travel through bloodstream
National Cancer Institute
Understanding Cancer and Related Topics
Understanding Cancer
Example:
Brain
Melanoma
Melanoma cells travel through bloodstream
Liver
Melanoma (initial tumor)
A malignant tumor, a “cancer,” is a more serious health problem than a benign tumor because cancer cells can spread to distant parts of the body. For example, a melanoma (a cancer of pigmented cells) arising in the skin can have cells that enter the bloodstream and spread to distant organs such as the liver or brain. Cancer cells in the liver would be called metastatic melanoma, not liver cancer. Metastases share the name of the original (“primary”) tumor. Melanoma cells growing in the brain or liver can disrupt the functions of these vital organs and so are potentially life threatening.
NCI Web site:

11. Example: Melanoma Brain Melanoma cells travel through bloodstream
National Cancer Institute
Understanding Cancer and Related Topics
Understanding Cancer
Example:
Brain
Melanoma
Melanoma cells travel through bloodstream
Liver
Melanoma (initial tumor)
A malignant tumor, a “cancer,” is a more serious health problem than a benign tumor because cancer cells can spread to distant parts of the body. For example, a melanoma (a cancer of pigmented cells) arising in the skin can have cells that enter the bloodstream and spread to distant organs such as the liver or brain. Cancer cells in the liver would be called metastatic melanoma, not liver cancer. Metastases share the name of the original (“primary”) tumor. Melanoma cells growing in the brain or liver can disrupt the functions of these vital organs and so are potentially life threatening.
NCI Web site:

12. Example: Melanoma Brain Melanoma cells travel through bloodstream
National Cancer Institute
Understanding Cancer and Related Topics
Understanding Cancer
Example:
Brain
Melanoma
Melanoma cells travel through bloodstream
Liver
Melanoma (initial tumor)
A malignant tumor, a “cancer,” is a more serious health problem than a benign tumor because cancer cells can spread to distant parts of the body. For example, a melanoma (a cancer of pigmented cells) arising in the skin can have cells that enter the bloodstream and spread to distant organs such as the liver or brain. Cancer cells in the liver would be called metastatic melanoma, not liver cancer. Metastases share the name of the original (“primary”) tumor. Melanoma cells growing in the brain or liver can disrupt the functions of these vital organs and so are potentially life threatening.
NCI Web site:

13. Example: Melanoma Brain Melanoma cells travel through bloodstream
National Cancer Institute
Understanding Cancer and Related Topics
Understanding Cancer
Example:
Brain
Melanoma
Melanoma cells travel through bloodstream
Liver
Melanoma (initial tumor)
A malignant tumor, a “cancer,” is a more serious health problem than a benign tumor because cancer cells can spread to distant parts of the body. For example, a melanoma (a cancer of pigmented cells) arising in the skin can have cells that enter the bloodstream and spread to distant organs such as the liver or brain. Cancer cells in the liver would be called metastatic melanoma, not liver cancer. Metastases share the name of the original (“primary”) tumor. Melanoma cells growing in the brain or liver can disrupt the functions of these vital organs and so are potentially life threatening.
NCI Web site:

14. Malignant vs. Benign Tumors
Benign (not cancer) tumor cells grow only where they started to grow and cannot spread
Malignant (cancer) cells grow into neighboring tissues, enter blood vessels, and move to different sites
Tumors can be either benign or malignant.
Benign tumors are not cancer, do not spread to other parts of the body and are usually not a threat to life.
Malignant tumors are cancer.
Cells in malignant tumors can grow without control and invade or damage other parts of the body.
When cancer (malignant tumor) spreads from the original site to another part of the body it is called metastasis.
Time

15. Types Leukemias: Some common carcinomas: Lymphomas:
Bloodstream
Some common carcinomas:
Lung
Breast
Colon
Bladder
Prostate (men)
Lymphomas:
Lymph nodes
There are over 100 types different types of cancer & Treatment decisions are made by knowing the type of cancer involved.
Cancers are divided into five main
groups:
1. Carcinomas are cancers that begin with skin or tissues that line the internal organs.
2. Sarcomas are cancers that start in bone, fat, muscle, joint, nerve, blood vessel or deep skin tissues.
3. Lymphomas are cancers that start in lymph nodes or lymphoid tissues (tissues of the body’s immune system).
4. Leukemias are cancers of the white blood cells.
5. Myelomas are cancers that start in plasma cells found in the bone marrow.
Carcinomas, the most common types of cancer, arise from the cells that cover external and internal body surfaces. Lung, breast, and colon are the most frequent cancers of this type in the United States.
Sarcomas are cancers arising from cells found in the supporting tissues of the body such as bone, cartilage, fat, connective tissue, and muscle.
Lymphomas are cancers that arise in the lymph nodes and tissues of the body’s immune system.
Leukemias are cancers of the immature blood cells that grow in the bone marrow and tend to accumulate in large numbers in the bloodstream.
Some common sarcomas:
Fat
Bone
Muscle

16. Naming Cancers
Cancer Prefixes Point to Location
Prefix Meaning
adeno- gland
chondro- cartilage
erythro- red blood cell
hemangio- blood vessels
hepato- liver
lipo- fat
lympho- lymphocyte
melano- pigment cell
myelo- bone marrow
myo- muscle
osteo- bone
Doctors use different prefixes to help distinguish among the different types of cancer.
For example:
Osteo means bone.
Osteosarcoma means a sarcoma arising in the bone.

17. Early Cancer May Not Have Any Symptoms
Some people visit the doctor only when they feel pain or when they notice changes like a lump in the breast or unusual bleeding or discharge. But don’t wait until then to be checked because early cancer may not have any symptoms. That is why screening for some cancers is important, particularly as you get older. Screening methods are designed to check for cancer in people with no symptoms.

18. How is Cancer Detected & Diagnosed?
Detecting cancer early can affect the outcome of the disease for some cancers. When cancer is found, a doctor will determine what type it is and how fast it is growing. He or she will also determine whether cancer cells have invaded nearby healthy tissue or spread (metastasized) to other parts of the body. In some cases, finding cancer early may decrease a person’s risk of dying from the cancer. For this reason, improving our methods for early detection is currently a high priority for cancer researchers.
The goal of early detection is to discover and stop a cancerous tumor before it grows and spreads (metastasizes). Checking for cancer in a person who does not have any symptoms of the disease is called screening

19. Cancer Screening & Prevention
Screening tests for common types of cancer:
Breast – Screening Mammogram
Cervix – Pap Test
Colon – fecal occult blood test, colonoscopy, sigmoidoscopy
Prostate – PSA test

20. Barriers to Screening Examples of barriers include: - Fear of cancer
- Lack of knowledge
- Modesty
- Communication
- Illness beliefs
There are many barriers that affect one’s decision to participate in cancer screening and early detection.

21. Possible Symptoms
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 and does NOT always indicate cancer.
There are many barriers that affect one’s decision to participate in cancer screening and early detection.

22. Possible Symptoms 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
Recent change in wart or mole
Nagging cough or hoarseness
Unexplained symptoms such as:
Progressive weight loss
Fever
Fatigue
Pain

23. Diagnosis of Cancer
To diagnose the presence of cancer, a doctor must remove a piece of affected tissue (biopsy) and look at it under a microscope.
A biopsy is the surgical removal of a small piece of tissue for microscopic examination.
Microscopic examination of the tissue also helps the doctor determine the “aggressiveness” or the behavior of the cancer.

24. Diagnosis of Cancer
Once the cancer diagnosis has been made, more testing may be necessary to determine the primary site (where the cancer started).
The primary site helps determine the type of treatment of the cancer.

25. Staging
In situ: Early cancer that has not spread to neighboring tissues.
Local: Cancer is found only in the organ where it started to grow.
Regional: Cancer has spread to the surrounding tissues or lymph nodes.
Distant: Cancer has spread to other organs and systems of the body.
Staging is the process that tells the doctor how far the cancer has spread in the body.
The staging of cancer is important because of the following reasons:
Determines the extent of disease
Treatment is determined by stage
Determines patient’s prognosis

26. Treatment
For many American Indians diagnosed with cancer, treatment often involves a blend of both Western and traditional medicine.
Both methods are necessary to fight against cancer.

27. Western vs. Traditional Approaches to Cancer Treatment
Science based.
Focuses on the physical aspect of disease.
A team of special doctors work together to develop a treatment plan to fit each person’s situation.
Traditional
A traditional healer establishes a long-term relationship with the person and their family.
Treatment plan focus is on the “whole person”.
AI/AN are most likely to benefit when treatment is focused on a holistic approach that involves a blending of both Western and traditional medicine.

28. Treatment Treatment for cancer depends on several factors including:
Type of cancer
The size, location and stage of the disease
General health of the individual

29. Treatment A treatment plan may include the following: Surgery
Chemotherapy
Radiation Therapy
Hormone Therapy
Biologic Therapy
Clinical Trial
Surgery: Removal of the cancerous tumor and possibly the surrounding tissue and lymph nodes near the tumor.
Chemotherapy: The use of drugs to kill cancer cells.
Biological Therapy (Immunotherapy): Helps the body’s natural ability (immune system) to fight disease or protects the body from some of the side effects of cancer treatment.
Radiation Therapy: The use of high-energy rays to kill cancer cells or stop them from growing and dividing.
Hormone Therapy: Used against certain cancers that depend on hormones for their growth.
Clinical Trials: Research studies that evaluate promising new therapies and answer scientific questions

30. Treatment Side Effects:
Side effects of cancer treatment result from damage to healthy cells and tissues in additional to the cancer cells.
Depend of the type and extent of treatment.
May include: nausea/vomiting, fatigue, numbness, lymphedema, pain, sleep, sexual side effects Others?
Fatigue is one of the most common and distressing side effects of cancer and its treatment. Fatigue from cancer treatment is often more intense than the feelings of being tired we all have from time to time. Learn about cancer-related fatigue and how to manage it here.
Lymphedema is a build-up of lymph fluid in the fatty tissues just under your skin. This build-up causes swelling (or edema), most often in the arms or legs. Lymphedema can result from surgery or radiation therapy to treat certain cancers. Go here to learn more about lymphedema.

31. Survivorship

32. Resources
Native American Cancer Research:

33. Resources
Native Circle:

34. Resources American Cancer Society:

35. Resources American Cancer Society: Online Support Communities
‘Road to Recovery’ – Rides to Treatment
‘Hope Lodge’ – Rides to Treatment
‘TLC’ – Hair Loss & Mastectomy Products
‘Reach to Recovery’ – Breast Cancer Support
‘Man to Man’ – Prostate Cancer Support
‘I Can Cope’ – Cancer Education Classes
‘Look Good Feel Better’ for Teens
Patient Navigation Services
Number:

36. Resources National Cancer Institute: www.cancer.gov

37. Resources
Journey Forward:

38. Resources
LIVESTRONG:

39. Resources
Iowa Cancer Consortium:

40. Special thanks to Cancer 101 slides developed by the National Cancer Institute and the NW Tribal Cancer Control Project.