1. © 2011 McGraw-Hill Higher Education. All rights reserved. Chapter Eleven: Living With Cancer

2. © 2011 McGraw-Hill Higher Education. All rights reserved. What is cancer? A generic term to describe a condition where cells have lost control of themselves. They take on several characteristics common among many cancers, but likely with a distinct cause and variable prognosis

3. © 2011 McGraw-Hill Higher Education. All rights reserved. What causes a cancer? A genetic mutation that leads to loss of cell cycle control and genetic editing.

4. © 2011 McGraw-Hill Higher Education. All rights reserved. Cancer Regulatory genes Genes that control cell specialization, replication, DNA repair, tumor suppression Oncogenes Faulty regulatory genes believed to activate the development of cancer Proto-oncogenes Normal regulatory genes that may become oncogenes Cell regulation problem causing abnormal cell growth

5. © 2011 McGraw-Hill Higher Education. All rights reserved. When you look at tumors, they will have defects in: P53 tumor suppressor protein "the guardian of the genome“genome HNPCC MEN1 BRCA

6. © 2011 McGraw-Hill Higher Education. All rights reserved. Oncogene Formation Three mechanisms: Genetic mutations  Miscopying of genes during cell division Viral infections  HIV  HPV Carcinogens

7. © 2011 McGraw-Hill Higher Education. All rights reserved. Telomeres Normal cells have limited lifespan Replication of chromosomes shortens them Telomeres protect ends Once telomeres run out, chromosomes lose end genes

8. © 2011 McGraw-Hill Higher Education. All rights reserved. The Cancerous Cell Characteristics: Infinite life expectancy due to telomerase Lacks contact inhibition Spreads to distant sites via metastasis Commands the circulatory system to provide additional blood supply (angiogenesis) Benign tumors do not spread but can be dangerous if they crowd out normal tissues

9. © 2011 McGraw-Hill Higher Education. All rights reserved. Staging Cancer TNM staging system T = extent of primary tumor N = whether or not it has progressed to regional lymph nodes M = presence or absence of metastasis A numerical system tracks extent of cancer spread I = In situ II = Local III = Regional IV = Distant

10. © 2011 McGraw-Hill Higher Education. All rights reserved. How Cancer Spreads

11. © 2011 McGraw-Hill Higher Education. All rights reserved. Types of Cancer Carcinomas: 85% of all cancers (organs, skin, nerves, membranes) Sarcomas: Bone, blood, connective tissue Lymphomas: Immune tissues/system Leukemia: Blood and blood forming tissues Melanoma: Sun exposure affecting the melanin of the skin Neuroblastoma: Originates in the CNS Adenocarcinoma: Cells of the endocrine glands Hepatoma: Originates in the cells of the liver

12. © 2011 McGraw-Hill Higher Education. All rights reserved. Cancer Cases and Deaths

13. © 2011 McGraw-Hill Higher Education. All rights reserved. Skin Cancer Risk factors Severe sunburn during childhood, chronic sun exposure during young adulthood Prevention Reduce exposure to sun’s rays, use sunscreens, avoid tanning booths Early detection Self-examination (see next slide) Treatment Surgery, chemotherapy, interleukin-2

14. © 2011 McGraw-Hill Higher Education. All rights reserved. Self-Examination for Melanoma

15. © 2011 McGraw-Hill Higher Education. All rights reserved. Normal Mole versus Malignant Melanoma Melanoma characteristics: A is for asymmetry B is for border irregularity C is for color (change) D is for diameter > 6 mm

16. © 2011 McGraw-Hill Higher Education. All rights reserved. Lung Cancer Risk factors Smoking Environmental pollutants (radon) Genetic predisposition Prevention Don’t smoke and avoid environmental tobacco smoke Treatment (low success rate) Surgery Radiation Chemotherapy Medications

17. © 2011 McGraw-Hill Higher Education. All rights reserved. Colorectal Cancer Risk factors Genetic susceptibility Dietary habits Smoking, alcohol consumption Prevention Removal of polyps, exercise, dietary changes Early detection Rectal exams, stool tests, sigmoidoscopy, colonoscopy Treatment Surgery, radiation, chemotherapy

18. © 2011 McGraw-Hill Higher Education. All rights reserved. Breast Cancer Risk factors Early onset of menstruation, late menopause Having no children or first child later in life Use of hormone replacement therapy Specific genetic mutations  BRCA1  BRCA2 Family history Obesity, sedentary lifestyle High degree of breast density

19. © 2011 McGraw-Hill Higher Education. All rights reserved. Breast Cancer Prevention Dietary choices, limit on alcohol use Activity levels Pregnancy and breastfeeding decisions Avoidance of occupational toxins New medications Prophylactic mastectomy (for some women at very high risk) Early detection Breast self-examination Mammography

20. © 2011 McGraw-Hill Higher Education. All rights reserved. Breast Self-Exam

21. © 2011 McGraw-Hill Higher Education. All rights reserved. Breast Cancer Treatment Surgery Chemotherapy Radiation therapy Hormone therapy Targeted therapy  Herceptin  Gleevac  Avastin

22. © 2011 McGraw-Hill Higher Education. All rights reserved. Prostate Cancer Location of the Prostate Gland within the Male Reproductive System

23. © 2011 McGraw-Hill Higher Education. All rights reserved. Prostate Cancer Risk factors Age, African American ethnicity, family history, dietary fat intake Prevention Moderation of fat intake, increased intake of vitamin E and selenium, drug therapy Early detection Prostate-specific antigen (PSA) tests, ultrasound rectal exam Treatment Surgery, radiation, brachytherapy (radioactive seeds)

24. © 2011 McGraw-Hill Higher Education. All rights reserved. Testicular Cancer Risk factors Family history, environmental factors, undescended testicles Prevention Self-exams, correction of undescended testicles in children Early detection Self-exams, awareness of symptoms Treatment Surgery, chemotherapy, radiation

25. © 2011 McGraw-Hill Higher Education. All rights reserved. Testicular Cancer: Self-Examination

26. © 2011 McGraw-Hill Higher Education. All rights reserved. Cervical Cancer Risk factors HPV infection Smoking, socioeconomic factors Prevention Sexual abstinence Careful selection of sexual partners Early detection of precancerous cellular changes Pap tests Treatment Surgery (minor or major) Radiation/chemotherapy

27. © 2011 McGraw-Hill Higher Education. All rights reserved. Uterine Cancer Risk factors Early menarche, late menopause, infertility, never having given birth, use of estrogen replacement therapy or tamoxifen, obesity, polycystic ovary syndrome, hereditary nonpolyposis colon cancer Prevention Minimize high levels of estrogen, regular gynecological care Treatment Surgery, radiation, chemotherapy, hormone treatment

28. © 2011 McGraw-Hill Higher Education. All rights reserved. Vaginal Cancer Risk factors Prenatal exposure to DES Early detection Pap test Treatment Surgery

29. © 2011 McGraw-Hill Higher Education. All rights reserved. Colon cancer Colorectal cancers develop slowly over years. Most cancers start as a polyp Polyps commonly arise in the sixth decade of life Calcium intake, aspirin, and vitamin D help prevent polyp to tumor progression Fiber helps scrape early tumors away.

30. © 2011 McGraw-Hill Higher Education. All rights reserved. Ovarian Cancer Prevention Similar to what is recommended for breast cancer Prophylactic oophorectomy Early detection (“silent”) Annual pelvic exams Awareness of potential symptoms Tests  OvaSura, CA125, and HE4 Genetic screenings Treatment Surgery, chemotherapy, drug therapy

31. © 2011 McGraw-Hill Higher Education. All rights reserved. Pancreatic Cancer Risk factors Male gender, smoking, high-fat diet, high alcohol consumption Prevention Abstaining from tobacco and alcohol, exercise, weight management Early detection (no early symptoms) CAT scan Treatment No effective treatment at this time Surgery, radiation, chemotherapy

32. © 2011 McGraw-Hill Higher Education. All rights reserved. Lymphatic Cancer Risk factors Reduction of immune system protection, exposure to pollutants, viral infections Prevention Limit exposure to chemicals Early detection Enlarged lymph nodes, fever, weight loss Treatment Radiation, chemotherapy, stem cell transplant

33. © 2011 McGraw-Hill Higher Education. All rights reserved. Throat cancer HPV implicated 67% of oropharangeal cancers Increases risk 8 fold.

34. © 2011 McGraw-Hill Higher Education. All rights reserved. C C hange in bowel/bladder habits A A sore that does not heal U U nusual bleeding or discharge T T hickening of tissues (schlerotic change) I I ndigestion or difficulty swallowing O O bvious change in a wart/mole N N agging cough Preventive Measures: Cancer Warning Signals

35. © 2011 McGraw-Hill Higher Education. All rights reserved. Preventive Measures Know your family history Select and monitor your occupation carefully Do not use tobacco products Monitor environmental exposure to carcinogens Follow a sound diet Control your body weight Exercise regularly Limit your exposure to the sun Consume alcohol in moderation, if at all

36. © 2011 McGraw-Hill Higher Education. All rights reserved. What else? New stuff on the horizon http://abcnews.go.com/Health/Cance rPreventionAndTreatment/aspirin-cut- cancer-risk- research/story?id=15965380 Aspirin a day to keep cancer at bay http://cancer.stanford.edu/informatio n/geneticsAndCancer/genesCause.ht ml How genes cause cancer

37. © 2011 McGraw-Hill Higher Education. All rights reserved. Chapter Eleven: Living With Cancer