Understanding Cancer

Lauren O. Searls BSN RN OCN What Is Cancer? Different Kinds of Cancer

Leukemias: Some common carcinomas: Bloodstream Lung Lymphomas: Breast (women) Lymph nodes Colon Bladder Prostate (men)

Some common sarcomas: Fat Bone

Muscle 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 Example of Normal Growth

Dead cells shed from outer surface

Epidermis Cell migration

Dividing cells in basal layer Dermis Loss of Normal Growth Control

Normal cell division

Cell Suicide or Apoptosis

Cell damage— no repair

Cancer cell division

First Second Third Fourth or mutation mutation mutation later mutation Uncontrolled growth The Beginning of Cancerous Growth

Underlying tissue Invasion and Metastasis

1 Cancer cells invade surrounding tissues and blood vessels

2 Cancer cells are transported by the circulatory system to distant sites

3 Cancer cells reinvade and grow at new location Malignant versus Benign Tumors

Benign (not cancer) Malignant (cancer) tumor cells grow cells invade only locally and cannot neighboring tissues, spread by invasion or enter blood vessels, metastasis and metastasize to different sites

Time Why Cancer Is Potentially Dangerous

Brain

Melanoma cells travel through bloodstream

Liver

Melanoma (initial tumor) Cancer Detection and Diagnosis Biopsy

Pathology

Proteomic profile

Patient’s tissue sample or blood sample Genomic profile Microscopic Appearance of Cancer Cells Cancer in 50+

WOMEN MEN • Lung • Lung • Breast • Prostate • Colon • Colon Early detection/diagnosis • Leads to better outcomes • Many types of cancer have vague or no symptoms • Preventative measures – Don’t smoke – Sun protection – Healthy diet & exercise • Regular screenings – Mammograms – Pap smears – Prostate exam Lung cancer

LOCAL SYMPTOMS SYSTEMIC SYMPTOMS • Cough • Headache • Wheezing • Pain • Difﬁculty breathing • Anemia • Chest pain • Anorexia/weight loss • Pneumonia • Fatigue • Swollen lymph nodes Lung cancer INCIDENCE RISK FACTORS • Most common cancer • Tobacco exposure for men & women in • Asbestos, arsenic, nickel US exposure • Five-year survival= • Genetic predisposition 15% • Inﬂammation (COPD, • Incidence for women emphysema) continues to rise • Diet lacking in • Deaths > breast and and carotenoids all other gynecologic, • Age 65 older breast, colorectal cancers Lung Cancer

PROGNOSIS • Clinical stage at time of diagnosis • Size and accessibility of tumor • Male and older = negative predictor of survival • Co-morbidities Prostate Cancer

SYMPTOMS STATISTICS • Asymptomatic in early • Second most common disease tumor in men • Decreased urinary ﬂow • Second-leading cause of • Hesitancy death • Urinary frequency • Accounts for 1/3 new • Nocturia cancers in men • Hematuria/pain Prostate Cancer

RISK FACTORS SCREENING • Age (75% in men >65) • Beginning age 50, • African American race digital rectal • Family history examination • BRCA1/2 mutations in • Annual prostate-speciﬁc family antigen (PSA) blood test • High fat diet • For high risk individuals, screening may begin earlier Prostate Cancer Screening Breast Cancer

• Signs and symptoms • Redness, dimpling of breast • Peau d’orange • Changes in breast shape • Bloody or yellow discharge from breast • Nipple retraction or deviation • Lump or thickening in or near breast/underarm area Breast Cancer

INCIDENCE RISK FACTORS • 1 in 8 women will • Female develop breast cancer • Increasing age • Men account for 1% of • Family/personal history all breast cancer • No children, or having • Survival rates are high children later in life – 89%= 5 years after dx • Hormone therapy after – 82%= 10 years after dx menopause – 77%= 15 years after dx • Alcohol use • Obesity Breast Cancer Screening Colon Cancer STATISTICS SCREENING • Third most commonly • Age 50+ (average risk) diagnosed cancer in US – Fecal occult blood test • Third leading cause of (FOBT) annually OR cancer deaths for both – Colonoscopy every 10 men & women years – Contrast barium enema every 5 years

Colon Cancer

SIGNS AND SYMPTOMS • Change in bowel habits • Blood in stool • Cramping pain in lower abdomen Colon Cancer NON-MODIFIABLE MODIFIABLE • Age • Diet high in red & • History of polyps processed meat • History of FAP or • Diet low in fruits/ Lynch syndrome in vegetables family • Obesity • Inﬂammatory bowel • Physical inactivity disease • Heavy alcohol use • Ashkenazi Jews and • Smoking African Americans • Diabetes Colon Cancer Screening What Causes Cancer? Some viruses or bacteria

Some chemicals Radiation

Heredity Diet Hormones Low-Strength Radiation

High

Dallas

Skin Cancer Incidence Pittsburgh Detroit

Low Least Most Annual Sunshine (UV radiation) Tobacco Use and Cancer Some Cancer-Causing Chemicals in Tobacco Smoke High-Strength Radiation

High

Leukemia Incidence

Low Least Most X-ray Dose (atomic radiation) Examples of Human Cancer Viruses

Some Viruses Associated with Human Cancers Heredity Can Affect Many Types of Cancer

Inherited Conditions That Increase Risk for Cancer Genetic Testing Cancer Risk and Aging

Cancer Risk and Aging 400 Colon

300 Breast Number of Cancer Cases 200 (per 100,000

people)

100

0 20 40 60 80 Age of Person (in years) Cancer Tends to Involve Multiple Mutations

Benign tumor cells Malignant cells invade grow only locally and neighboring tissues, enter cannot spread by blood vessels, and invasion or metastasis metastasize to different sites

Time Mutation Cells Mutations Proto-oncogenes More mutations, inactivates proliferate inactivate mutate to more genetic suppressor DNA repair oncogenes instability, gene genes metastatic disease Cancer Prevention

Carcinogenic chemicals Carcinogenic radiation

Cancer viruses or bacteria Avoid Tobacco

Lung Cancer Risk Increases with Cigarette Consumption 15x

10x Lung Cancer Risk 5x

0 15 30 Non-smoker Cigarettes Smoked per Day Protect Yourself From Excessive Sunlight Limit Alcohol and Tobacco

Combination of Alcohol and Cigarettes Increases Risk for Cancer of the Esophagus 40x

30x Risk Increase 20x

10x

Alcoholic Drinks Consumed per Day AND Packs of Cigarettes Consumed per Day Diet: Limit Fats and Calories

Correlation Between Meat Consumption and Colon Cancer Rates in Different Countries

30 Number of Cases (per 100,000 people) 20

0 80 100 200 300 Grams (per person per day) Diet: Consume Fruits and Vegetables Avoid Cancer Viruses

HPV Infection Increases Risk for Cervical Cancer High

Cervical Cancer Risk

Low Noninfected Women women infected with HPV Avoid Carcinogens at Work

Some Carcinogens in the Workplace Industrial Pollution

Incidence of Most Cancers

1930 1950 1970 1990 Year Is There a Cancer "Epidemic"? Questions?