1. [Insert name & title] [insert organization] [insert date]
Cancer Education 2014
[Insert name & title]
[insert organization]
[insert date]

2. What is Cancer? The result of out-of-control growth of abnormal cells
Normal body cells grow, divide and die in an orderly fashion
Cancer cells continue to grow and divide, instead of dying
They outlive normal cells and continue to form new abnormal cells
Normal body cells grow, divide and die. Cancer cells grow & divide, they outlive normal cells
Although there are many kinds of cancer, they all start because of out-of-control growth of abnormal cells. Normal body cells grow, divide and die in an orderly fashion. Cancer cells continue to grow and divide, instead of dying, they outlive normal cells and continue to form new abnormal cells.

3. Cancer cells develop because of damage to DNA, which directs all activities in each cell. When DNA becomes damaged, the body is usually able to repair it. In cancer cells, however, the damaged DNA is not repaired. People can inherit damaged DNA, which results in approximately 10 percent of all cancers. More often, though, a person’s DNA becomes damaged by exposure to something in the environment or random cellular events.

4. Carcinomas Sarcomas Lymphomas Leukemias The most common type of cancer
Types of Cancer
Carcinomas
The most common type of cancer
Sarcomas
Lymphomas
Leukemias
Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments.
Carcinomas
The most common type of cancer
Tumors arise from the cells that cover external and internal body surfaces
Most frequent cancers of this type in the US are lung, breast, colon, and prostate cancer
Sarcomas
Cancers that arise from cells found in the supporting tissues of the body, such as bone, cartilage, fat, connective tissue, and muscle
Lymphomas
Cancers that arise in the lymph nodes and tissues of the body’s immune system
Leukemias
Cancers of the immature blood cells that grow in the bone marrow and tend to accumulate in large numbers in the bloodstream.

5. What’s in a Name? Primary Site Metastasize Naming
Place where cancer starts
Metastasize
Can spread to other parts of the body
Naming
Always named for the place it began
If breast cancer spreads to the liver it is still called breast cancer (Not liver)

6. Cancer in Numbers Second most common cause of death in U.S.
Heart Disease is #1
Half of all men, and a third of all women, will develop cancer during their lifetime
Approximately 2 in 5 Hoosiers now living will eventually have cancer
Cost of Cancer
$216.6 Billion (2009)
Cancer is the second most common cause of death in the United States, exceeded only by heart disease. Cancer accounts for nearly 1 out of every 4 deaths. Half of all men, and a third of all women, will develop cancer during their lifetime. Another… so approximately 2 out of every 5 Indiana residents will eventually have cancer. The financial costs of cancer are high for both the person with cancer and for society as a whole.
The National Institutes of Health estimated that in 2009 the overall annual cost of cancer was $216.6 billion. This includes $86.6 billion for medical costs.

7. Cancer in Numbers Estimated New Cancer Cases for 2014
US – 1,665,540
IN – 35,560
Estimated Deaths for 2014
585,720 Americans
Nearly one in every four deaths
13,370 Hoosiers
23% of all Hoosier deaths in 2013
Estimated New Cases in Indiana for 2014
Female Breast – 4,590
Cervical – 260
Colon– 3,020
Melanoma – 1,550
Lung/Bronchus – 5,540
Prostate – 4,390

8. Now we will turn our attention to the number of new cancers projected for the US this year. The most common cancers are prostate in men and breast in women; lung and colorectal cancers are the second and third most common cancers in both men and in women.
Lung cancer is the leading cause of cancer death for both men (28%) and women (26%), followed by prostate (10%) and breast (15%), and colon & rectum (8% and 9%, respectively).

9. Risk Factors and Risk Reduction
Nearly all cancers of the lung, bladder, mouth, and skin could be prevented
Many cancer deaths (50-75%) are related to personal behaviors or habits
30% or more of all cancer deaths related to cigarette smoking
30% of all cancer deaths in the U.S. are related to poor nutrition & inactivity leading to obesity
Source: Cancer Trends Progress Report -, National Cancer Institute, NIH, DHHS, Bethesda, MD,

10. Strategies for Cancer Prevention
Stop using tobacco!
Maintain a reasonable weight
Adopt a physically active lifestyle
Eat a healthy diet, with a focus on plant fruits and vegetables. The more COLOR the more nutrients.
Increase fiber and reduce fat
Limit alcohol consumption
Limit exposure to the sun

11. Lifestyle Behaviors Affect Our Risk for Cancer
Of all Indiana adults
22% of adults smoke (2013)
65% are considered overweight or obese (2013)
56% of adults get less than 150 minutes of physical activity a week (2013)
Of all Indiana High School Students
13.7% smoke (2013)
14% Overweight/obese (2011)
44% 60 minutes of Physical Activity a day (2011)
About 1 in 3 cancer deaths is due to exposure to tobacco. The other 2/3 are due to other causes- genetics and other environmental causes besides smoking. Although genetic inheritance affects the risk of cancer, and cancer starts with a genetic mutation in cells, most of the difference in cancer risk is due to factors that are not inherited.

12. Why is weight so important?
Weight contributes to 188,000 cancer deaths each year.
One-third of the cancer deaths are attributed to poor nutrition, physical inactivity, overweight and obesity.
Weight is linked with higher risk for developing many cancers including cancer of the breast, colon, endometrium lining, the esophagus and kidney. Evidence suggests that obesity also increases risk for cancers of the pancreas, gallbladder, thyroid, ovary, cervix, multiple myeloma, Hodgkin lymphoma and prostate cancer. These findings are supported by both epidemiologic studies in humans and other research.

13. Early Detection/Screening
Looking for cancer BEFORE there are symptoms
May identify early cases of cancer that might never have become clinically apparent

14. What can you do?
Have annual physicals (Pap test, CBE, skin exams, vaccinations)
Avoid alcohol and tobacco products
Limit exposure to direct sunlight
Be aware of your body!

15. What is Testicular Cancer?
Testicular cancer is cancer in one or both testicles
It usually occurs in young men
This type of cancer can be treated and very often cured

16. Testicular Cancer Facts
American Cancer Society estimated that there will be 8,820 new cases of testicular cancer in 2014
An estimated 380 men will die of testicular cancer in 2014
Estimated new cases has decreased since last year

17. Types of Testicular Cancer
More than 90% of cancers of the testicle develop in special cells known as germ cells.
These are the cells that make sperm. There are two main types of germ cell tumors in men:
Seminomas
Non-seminomas
Many testicular cancers contain both seminoma and non-seminoma cells.
These mixed germ cell tumors are treated as non-seminomas because they grow and spread like non-seminomas.

18. Risk Factors Age Early Puberty Family History
About 9 of 10 occur in men years of age.
It can affect males of all ages (including infants and elderly men)
Early Puberty
Men who mature early have a higher risk due to high hormone levels
Family History
If a family history then higher risk of developing the cancer

19. Risk Factors Body Size/Type Race Undescended Testicles
Some studies have found that taller men have a somewhat higher risk, but others have not
Race
White men have 5-10 times higher risk than African-American men, and more than twice that of Asian-American men
Undescended Testicles
More likely to develop in men whose testicles have not descended (3-17 times more likely)

20. Undescended Testicle
In a fetus, the testicles normally develop inside the abdomen and descend into the scrotum before birth. In about 3% of boys, however, the testicles do not make this descent. Sometimes the testicle remains in the abdomen; in other cases, the testicle starts to descend but remains stuck in the groin area. About 14% of cases of testicular cancer occur in men with a history of undescended testicles (also called cryptorchidism).

21. Warning Signs
Small hard, painless lump on the front or side of the testicle
Swelling or tenderness in the body (groin, breast or neck)
Sudden collection of fluid or blood in the scrotum
Change in the way the testicle feels
Enlarged testicle
Dull ache in the groin
Back pain/Upset Stomach
Urinary Problems
In 9 out of 10 cases, the man has a lump on a testicle. The lump is often painless, but it can be uncomfortable. The man may notice the testicle is enlarged or swollen. Men with testicular cancer often feel heaviness or aching in the belly or scrotum.

22. Testicular Self Awareness
Men need to be aware of testicular cancer and to see a doctor right away if they find a lump on a testicle.
Regular testicular self-exams have not been studied enough to show if they lower the risk of dying from this cancer.
Men with risk factors, such as an undescended testicle, previous testicular cancer, or a family member who has had this cancer should seriously think about monthly self-exams. If you have risk factors, talk it over with a doctor.

23. Testicular self exam Once a month
After a shower, examine each testicle gently with both hands
It is NORMAL for one testicle to be larger than the other
Should not feel any pain when doing the exam
Here are instructions on how to do it if you and a doctor decide self-exam is right for you. The USPSTF recommends against testicular self-exams, and these should only be performed after a conversation has happened with a doctor.

24. Testicular Self-Exam Examine each testicle with both hands
Place the index and middle fingers under the testicle with the thumbs on top
Roll the testicle gently between the thumbs and fingers
Find the epididymis (soft tube-like structure behind the testicle)
Become familiar with this structure so as not to confuse it for a lump
Cancerous lumps are usually found on the sides of the testicle but can be up front
If you feel a lump or have other signs see a doctor right away
The best time to perform the self-exam is during or after a bath or shower, when the skin of the scrotum is relaxed. To perform a testicular self-exam:
Hold the penis out of the way and examine each testicle separately.
Hold the testicle between the thumbs and fingers with both hands and roll it gently between the fingers.
Look and feel for any hard lumps or nodules (smooth rounded masses) or any change in the size, shape, or consistency of the testes. You should be aware that each normal testis has an epididymis, which appears as a small "bump" on the upper or middle outer side of the testis. Normal testicles also contain blood vessels, supporting tissues, and tubes that conduct sperm. Some men may confuse these with cancer. If you have any doubts, ask your doctor. Sometimes, the testicle can be enlarged because fluid has collected around it. This is called a hydrocele. Other times, the veins in the testicle can dilate and cause enlargement and lumpiness around the testicle. This is called a varicocele. To be sure you have one of these conditions and not a tumor, you need to have a doctor examine you.
If you choose to examine your testicles, you will become familiar with what is normal and what is different.

25. The best time to perform the self-exam is during or after a bath or shower, when the skin of the scrotum is relaxed. To perform a testicular self-exam:
Hold the penis out of the way and examine each testicle separately.
Hold the testicle between the thumbs and fingers with both hands and roll it gently between the fingers.
Look and feel for any hard lumps or nodules (smooth rounded masses) or any change in the size, shape, or consistency of the testes. You should be aware that each normal testis has an epididymis, which appears as a small "bump" on the upper or middle outer side of the testis. Normal testicles also contain blood vessels, supporting tissues, and tubes that conduct sperm. Some men may confuse these with cancer. If you have any doubts, ask your doctor. Sometimes, the testicle can be enlarged because fluid has collected around it. This is called a hydrocele. Other times, the veins in the testicle can dilate and cause enlargement and lumpiness around the testicle. This is called a varicocele. To be sure you have one of these conditions and not a tumor, you need to have a doctor examine you.
If you choose to examine your testicles, you will become familiar with what is normal and what is different.

27. Skin Cancer Facts There are three types of skin cancer
Early detection and treatment are very important with all types cancer
More than TWO million cases of skin cancer are diagnosed in the United States each year.

28. Basal and Squamous Cell Carcinoma
Basal Cell (Most common form)
80% of new skin cancer cases
90% found on the head, neck, and other high exposure areas
High cure rate
Once diagnosed 40% chance of getting another basal cell cancer within five years
Squamous Cell (2nd most common form)
90% cure rate
More than 300,000 new cases diagnosed annually

29. Melanoma Melanoma is the most deadly form of skin cancer
One American dies of melanoma every hour
Melanoma is the most common form of cancer for year-olds
The second most common form of cancer for year-olds
Melanoma affects people of every age and ethnicity.
Melanoma can develop anywhere on the body, even on the palms of the hands or bottoms of the feet.
IF detected early, melanoma is considered curable.

30. Melanoma 76,690 expected new diagnoses in 2013
Ten times more common in whites than African-Americans
Before age of 40
Rates are higher in women
After age of 40
Rates are almost two times higher in men
Rates are increasing by almost 3% per year since 2004

31. Melanoma Survival Rate
Five year survival rate is 99% (if tumor is spotted when only a spot on the skin
Five year survival rate drops to 15% if the fast growing cancer has spread

32. A = Asymmetry B = Border C = Color D = Diameter E = Evolution
One half of the mole or lesion doesn’t match the other
B = Border
Melanomas often have blurred, notched, ragged or uneven edges
C = Color
Moles with varied shades of black, brown, and tan often are the first signs of melanoma. Colors of red, white and blue also may appear as melanomas progress. Sometimes they are very dark or even clear with a pink tone.
D = Diameter
Moles that grow larger than a pencil eraser are cause for concern (about 6mm, 1/4 inch thick in diameter) although smaller moles may also show changes.
E = Evolution
The mole has been growing or has changed its shape or color.

34. Avoid Sun Damage Wear hats and protective clothing when in the sun
Do NOT visit tanning booths. Their effects can be as dangerous as the sun’s UV rays
Wear sunscreen that protects from both UVA and UVB rays and use an SPF of 30 or higher (Natural ingredients like zinc oxide are helpful)
Seek shade during the hours of 10:00 am to 4:00 pm if you do not have access to protective clothing
Wear sunglasses to protect against ocular melanoma

35. Skin Cancer Summary Women watch your LEGS
Look for new spots
About 70% do not emerge from moles
Women watch your LEGS
Women tend to get melanomas on their legs and calves
Guys should monitor the top of your ears and head especially closely
Many hats for men don't shade the ears, and balding men often forget to protect their hairless pates. Both are common sites for squamous and basal cell carcinoma.
Don't overlook the places where the sun doesn't shine
Many melanomas show up in armpits, hands, belly buttons, underneath hair, the bottom of the feet, and other places that don't get much direct light
Have a second pair of eyes look

36. Breast Cancer Facts
Breast cancer is the most common type of cancer found in women in the United States
It is the 2nd leading cause of cancer death among women age 40-59
1 in 8 women will develop breast cancer in their lifetime
When breast cancer is confined to the breast the 5 year survival rate is over 98 percent
A woman dies from breast cancer every 74 seconds around the world
Men can get breast cancer!
Rare, but does happen.
2,000 men will be diagnosed this year, 400 will die (Nationally)

37. Risk Factors Risk factors do not cause breast cancer
Risk factors are associated with an increased chance of getting breast cancer
Some risk factors can be controlled and others can’t be changed
First a few words about risk factors in general.
Risk factors are not the cause of breast cancer – remember I just said that we don’t know what causes it.
Researchers have, however, identified a number of factors that increase a woman’s chances of getting breast cancer.
Some women have many risk factors but never get breast cancer - having several risk factors for breast cancer does not mean that a woman will get breast cancer. It means that her chances of getting the disease are higher than women who have fewer risk factors.
Even if a woman does not have any of the identified risk factors, she can still develop breast cancer. Many women with breast cancer do not have any known risk factors aside from being female.
The two most important risk factors for breast cancer are being female and getting older. Of course, we can’t do anything about either of those factors.
There are, however, some lifestyle choices that you can make to reduce risk.

38. Risk Factors Two Major Risk Factors Other Risk Factors?
Being a Woman
Getting Older
Other Risk Factors?
Modifiable factors can lower risk
Breastfeeding, physical activity, and maintaining a healthy body weight
HAVE THE STUDENTS TRY AND COME UP WITH OTHER RISK FACTORS
Gender
Age
Genetic risk factors
Family history
Personal history
Race
Dense breast tissue
Menstrual history
Earlier breast radiation
Alcohol consumption
Not having children or having them later in life
Recent use of birth control pills & HRT.
Not breast-feeding
Smoking might increase risk, particularly for women who start smoking as teens.
Being overweight or obese
Lack of exercise
Gender: Simply being a woman is the main risk for breast cancer. While men also get the disease, it is about 100 times more common in women than in men.
Age: The chance of getting breast cancer goes up as a woman gets older. About 2 out of 3 women with invasive breast cancer are age 55 or older when the cancer is found.
Genetic risk factors: About 5% to 10% of breast cancers are thought to be linked to inherited changes (mutations) in certain genes. The most common gene changes are those of the BRCA1 and BRCA2 genes. Women with these gene changes have up to an 80% chance of getting breast cancer during their lifetimes. Other gene changes may raise breast cancer risk as well.
Family history: Breast cancer risk is higher among women whose close blood relatives have this disease. The relatives can be from either the mother's or father's side of the family. Having a mother, sister, or daughter with breast cancer about doubles a woman's risk. (It's important to note that 70% to 80% of women who get breast cancer do not have a family history of this disease.)
Personal history of breast cancer: A woman with cancer in one breast has a greater chance of getting a new cancer in the other breast or in another part of the same breast. This is different from a return of the first cancer (which is called recurrence).
Race: White women are slightly more likely to get breast cancer than are African-American women. But African American women are more likely to die of this cancer. At least part of the reason seems to be because African-American women have faster growing tumors. Asian, Hispanic, and American Indian women have a lower risk of getting breast cancer.
Dense breast tissue: Dense breast tissue means there is more glandular tissue and less fatty tissue. Women with denser breast tissue have a higher risk of breast cancer. Dense breast tissue can also make it harder for doctors to spot problems on mammograms.
Menstrual periods: Women who began having periods early (before age 12) or who went through the change of life (menopause) after the age of 55 have a slightly increased risk of breast cancer. They have had more menstrual periods and as a result have been exposed to more of the hormones estrogen and progesterone.
Earlier breast radiation: Women who have had radiation treatment to the chest area (as treatment for another cancer) earlier in life have a greatly increased risk of breast cancer.
Not having children or having them later in life: Women who have had not had children, or who had their first child after age 30, have a slightly higher risk of breast cancer. Being pregnant more than once and at an early age reduces breast cancer risk. Pregnancy reduces a woman's total number of lifetime menstrual cycles, which may be the reason for this effect.
Recent use of birth control pills: Studies have found that women who are using birth control pills have a slightly greater risk of breast cancer than women who have never used them. Women who stopped using the pill more than 10 years ago do not seem to have any increased risk. It's a good idea to talk to your doctor about the risks and benefits of birth control pills.
Postmenopausal hormone therapy (PHT): Postmenopausal hormone therapy (also known as hormone replacement therapy or HRT), has been used for many years to help relieve symptoms of menopause and to help prevent thinning of the bones (osteoporosis). There are 2 main types of PHT. For women who still have a womb (uterus), doctors generally prescribe estrogen and progesterone (known as combined PHT). Estrogen alone can increase the risk of cancer of the uterus, so progesterone is added to help prevent this. For women who no longer have a uterus (those who've had a hysterectomy), estrogen alone can be prescribed. This is commonly known as estrogen replacement therapy (ERT).
Not breast-feeding: Some studies have shown that breast-feeding slightly lowers breast cancer risk, especially if the breast-feeding lasts 1½ to 2 years. This could be because breast-feeding lowers a woman's total number of menstrual periods, as does pregnancy
Alcohol: Use of alcohol is clearly linked to an increased risk of getting breast cancer. Women who have one drink a day have a very small increased risk. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who drink no alcohol. The American Cancer Society suggests limiting the amount you drink to one drink a day.
Being overweight or obese: Being overweight or obese is linked to a higher risk of breast cancer, especially for women after change of life and if the weight gain took place during adulthood. Also, the risk seems to be higher if the extra fat is in the waist area. But the link between weight and breast cancer risk is complex, and studies of fat in the diet as it relates to breast cancer risk have often given conflicting results. The American Cancer Society recommends you maintain a healthy weight throughout your life and avoid gaining too much weight.
Lack of exercise: Studies show that exercise reduces breast cancer risk. The only question is how much exercise is needed. One study found that as little as 1 hour and 15 minutes to 2½ hours of brisk walking per week reduced the risk by 18%. Walking 10 hours a week reduced the risk a little more. The American Cancer Society suggests that you exercise for 45 to 60 minutes 5 or more days a week.

39. Breast Cancer Symptoms in Men
Possible symptoms of breast cancer to watch for include:
A lump or swelling, which is usually (but not always) painless
Skin dimpling or puckering
Nipple retraction (turning inward)
Redness or scaling of the nipple or breast skin
Discharge from the nipple
If you notice any breast changes, you should see your health care professional as soon as possible. 

40. HPV and Cancer Genital human papillomavirus (HPV) is a common virus.
Most sexually active people in the U.S. will have HPV at some time in their lives.
There are more than 40 types of HPV that are passed on through sexual contact.
These types can infect the genital areas of men, including the skin on and around the penis or anus. They can also infect the mouth and throat.

41. HPV and Cancer
Cancers of the penis, anus and oropharynx are uncommon, and only a subset of these cancers are actually related to HPV. Each year in the U.S. there are about:
400 men who get HPV-related cancer of the penis
1,500 men who get HPV-related cancer of the anus
5,600 men who get cancers of the oropharynx (back of throat)
Many of these cancers are also related to tobacco and alcohol use

42. HPV and Cancer Currently, there is no HPV test recommended for men.
The only approved HPV tests on the market are for screening women for cervical cancer.
They are not useful for screening for HPV-related cancers or genital warts in men.

43. HPV Vaccination HPV vaccine available boys and men ages 11-26
Can protect against the types of HPV that most commonly cause problems in men
CDC recommendation
All boys ages 11 or 12
Men through age 21, who have not already received all three doses
The HPV vaccine is very safe and effective
Studies show that the vaccine can protect men against genital warts and anal cancers.
Other protections likely, including cancers of the penis and oropharynx (back of throat, including base of tongue and tonsils)
However, no vaccine studies for these outcomes
If you are 26 or younger, there is an HPV vaccine that can help protect you against the types of HPV that most commonly cause problems in men. The CDC recommends the HPV vaccine for all boys ages 11 or 12, and for males through age 21, who have not already received all three doses. The HPV vaccine is very safe and effective, with no serious side effects. Studies show that the vaccine can protect men against genital warts and anal cancers. It is likely that this vaccine also protects men from other HPV-related cancers, like cancers of the penis and oropharynx (back of throat, including base of tongue and tonsils), but there are no vaccine studies that have evaluated these outcomes.

44. Possible Signs of Cancer
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lumps in breast or elsewhere
Indigestion or problems with swallowing
Obvious change on wart or mole
Nagging cough or hoarseness
Several types of cancer MAY NOT provide symptoms before they cause changes in the body

45. Know your body! Remember
Have annual physicals (Pap test, CBE, skin exams).
Avoid alcohol and tobacco products (including secondhand smoke).
Limit exposure to direct sunlight.
Know your body!