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 40 30 Number of Cases (per 100,000 people) 20 10 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? .