1. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Human Diseases A Systemic Approach Sixth Edition Chapter 4 Neoplasms Mary Lou Mulvihill Mark Zelman Paul Holdaway Elaine Tompary Jill Raymond

2. Chapter 4 Neoplasms Slide 10Genetics of Cancer Slide 10Genetics of Cancer Slide 12Leukemia Slide 12Leukemia Slide 21Breast Examinations Slide 21Breast Examinations Slide 29Skin Cancer Slide 29Skin Cancer Multimedia Asset Directory Return to Directory Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

3. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Neoplasia  Uncontrolled growth of cells  Neoplasm or tumor: a mass of cells that grow more rapidly than normal cells – Benign: noncancerous – Malignant: consists of rapidly dividing cells that accumulate uncontrollably and invade normal tissue and have the ability to metastasize or generate independent tumors at distant sites.

4. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Characteristics of Benign Tumors  Classified according to tissue of origin  Encapsulated with clearly defined edges  Do not metastasize or recur following surgery  Differentiated; resembles the tissue from which it grew

5. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Benign Tumors  Glandular – adenoma  Fatty – lipoma  Muscle – myoma  Vascular – angioma  Epithelial – papilloma  Brain – Menigioma

6. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Cancer Statistics  Cancer is the second most common leading cause of death in the United States.  More than 10 million people are diagnosed with cancer every year (WHO).  It is estimated that there will be 15 million new cases every year by 2020.  Cancer causes six million deaths every year or 12% of the deaths worldwide. – Lung, colorectal, and stomach cancer are among the five most common cancers in the world for both men and women. Among men, lung and stomach cancer are the most common cancers worldwide. Cervical and breast cancer are the most common cancers among women.

7. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Cellular Regulation Regulators Growth Factors Growth Inhibitors CyclinsApoptosis

8. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Cancer Progression Transformation Initiation Promotion Progression Change in genetic material prepares the cell to become cancerous

9. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Causes of Cancer  Heredity  Environment  Tobacco  Chemicals  Radiation  Nutrition and physical activity  Infections  Immune disorders

10. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Click on the screenshot to view a video on the topic of the genetics of cancer. Return to Directory

11. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Classification of Cancer  Carcinoma – epithelial cells  Sarcoma – connective tissue  Mixed Cancer – epithelial and connective tissue  Lymphoma – Lymphoid tissue  Leukemia – white blood cells  Melanoma – melanin

12. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Click on the screenshot to view a video on the topic of leukemia. Return to Directory

13. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.  Vary with the site of the primary tumor and extent of metastasis  Pain and nutritional wasting are signs of advanced disease.  Cancer pain results from the effects of treatment or secondary syndromes caused by the mechanical and pathological effects of cancer.  Several metabolic abnormalities play a role in nutritional wasting or cancer cachexia. Causes of Cancer

14. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.  Changes in bowel or bladder habits  A sore that does not heal  Unusual bleeding or discharge  Thickening or lump in the breast or any other part of the body  Indigestion or difficulty swallowing  An obvious change in a wart or mole  A nagging cough or hoarseness – (American Cancer Society) Non-specific Warning Signs of Cancer

15. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Head and Neck Cancer  Heterogeneous cancers  Symptoms: throat pain, mucosal ulcers, persistent nasal bleeding, hearing loss, or swallowing difficulties

16. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Lung Cancer  A new or changing cough, hoarseness  Hemoptysis or bloody sputum  Shortness of breath and chest pain  Common tumors of the lung include small cell carcinoma, squamous cell carcinoma, and adenocarcinoma.  Adenocarcinoma is the most common type of lung cancer that occurs in nonsmokers.

17. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gastric Cancer  Anorexia  Distaste for meat  Weight loss  Weakness  Dysphagia

18. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Colorectal Cancer  Intestinal polyps  Right-sided tumors – dull abdominal pain, bleeding, weakness, anemia  Left-sided tumors – changes in bowel habits, bleeding, gas, constipation, obstruction, and increased use of laxatives

19. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Liver Cancer  Vague abdominal pain, fever, anorexia  Jaundice, ascites, cachexia  Abdominal mass  Number and size and portal vein involvement determine prognosis

20. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Breast Cancer  Breast lumps, spontaneous discharge  Serous, blood, or water discharge  Life threatening with extensive lymph node involvement, and metastasis to the lungs and liver

21. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Click on the screenshot to view a video on the topic of breast examinations. Return to Directory

22. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Cancer of the Uterine Cervix  Early stages: vaginal discharge, bleeding, postcoital spotting  Physical findings: appearance of gray discolored areas; appearance of obvious masses  Invasive spread to the pelvic structures and along lymph node chains

23. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Ovarian Cancer  Asymptomatic early  Any pelvic mass suspicious after menopause  Nonspecific symptoms: irregular menstruation, urinary frequency, constipation, abnormal vaginal bleeding, and abdominal bloating and discomfort

24. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Prostate Cancer  Difficulty passing urine  Pain in lower abdomen  Presence of tumor markers – PSA

25. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Testicular Cancer  Painless enlargement  Occurs in younger ages  Germ cell involvement  Higher risk if testes are retained in the abdomen  Tumor marker – alpha-feto protein and beta human chorionic gonadotropin

26. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Renal Cancer  Kidney is a frequent metastatic site for cancer in the lungs, ovary, colon, or breast  Hematuria  Steady dull flank pain  Weight loss  Leg edema due to obstruction of lymphatic tissue

27. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Lymphoma  Single site or many  Hodgkins and non-Hodgkins lymphoma  Lymphadenopathy  Fevers, night sweats, weight loss  Pain in the abdomen – splenomegaly

28. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Diagnosis of Cancer  Screening recommendations  Tumor markers  Scans (MRI)  Endoscopy  Ultrasound  Biopsy

29. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Click on the screenshot to view a video on the topic of skin cancer. Return to Directory

30. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Cancer Staging  T – the extent of primary tumor  N – absence or presence of lymph node involvement  M – the presence of distance metastasis  Stages: I, II, III, IV

31. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Cancer Treatment  Prevention  Chemoprevention  Screening  Chemotherapy  Radiation Therapy  Surgery

32. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Table 4-5: American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention

33. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Table 4-6: American Cancer Society Prevention Measures for Melanoma and Other Skin Cancers.