SPEAK benign and malignant tumors can be a health problem Malignant more probably a problem because Grow faster Metastasize Different tumors have different propensities to metastasize to different areas
Background: How Many People Alive Today Have Ever Had Cancer? The National Cancer Institute estimates that approximately 10.8 million Americans with a history of cancer were alive in January 2004. Some of these individuals were cancer-free, while others still had evidence of cancer and may have been undergoing treatment. How Many New Cases Are Expected to Occur This Year? About 1,437,180 new cancer cases are expected to be diagnosed in 2008. This estimate does not include carcinoma in situ (noninvasive cancer) of any site except urinary bladder, and does not include basal and squamous cell skin cancers. More than 1 million cases of basal and squamous cell skin cancers are expected to be diagnosed this year Cancer Facts and Figures 2008 American Cancer Society
From American Cancer Society Website
SPEAK- How a normal cell becomes cancer Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide more quickly until the person becomes an adult. After that, cells in most parts of the body divide only to replace worn-out or dying cells and to repair injuries. Cancer cells develop because of damage to DNA. This substance is in every cell and directs all of the cell's activities. Most of the time when DNA becomes damaged, either the cell dies or is able to repair the DNA. In cancer cells, the damaged DNA is not repaired. People can inherit damaged DNA, which accounts for inherited cancers. Many times though, a person’s DNA gets damaged by things in the environment, like,chemicals, viruses, tobacco smoke or too much sunlight
SPEAK- TNM staging TNM Staging is used for solid tumors, and is an acronym for the words &quot;Tumor&quot;, &quot;Nodes&quot;, and &quot;Metastases&quot;. Each of these criteria is separately listed and paired with a number to indicate the TNM stage. For example, a T1N2M0 cancer would be a cancer with a T1 tumor, N2 involvement of the lymph nodes, and no metastases (no spreading through the body). Tumor (T) refers to the primary tumor and carries a number of 0 to 4. N represents regional lymph node involvement and can also be ranked from 0 to 4. Metastasis is represented by the letter M, and is 0 if no metastasis has occurred, or else 1 if metastases are present http://www.cancer.gov/cancertopics/factsheet/detection/staging retrieved 2-20-09
Chronic stress accelerates ultraviolet-induced cutaneous carcinogenesis. Parker J, Klein SL , McClintock MK , Morison WL , Ye X , Conti CJ , Peterson N , Nousari CH , and Tausk FA Journal of the American Academy of Dermatology 51(6):919-22 2004 Dec - View abstract BACKGROUND: Physical and emotional stressors have been found to mediate a wide variety of biological changes including the facilitation of tumor progression; however most of these paradigms utilized artificial sources of neoplasms and stress. METHODS: Skh mice were exposed to carcinogenic doses of ultraviolet light ( UV ). The stressed group was subjected to the close proximity of fox urine as a source of stress from the presence of the odor of their natural predator, while the control group remained stress free. RESULTS: A significant acceleration in the development of cutaneous neoplasms was observed in mice that had been exposed to the stressor . The first tumor appeared in the group after 8 weeks, whereas nonstressed mice began to develop these by week 21. CONCLUSION: These results suggest that stress plays a role in potentiating cutaneous carcinogenesis . Add to paper collection Recommend to someone
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences ( ACE ) Study. American Journal of Preventive Medicine , 14 (4), 245-258.
Women Blame Stress For Their Breast Cancer, Attribute Positive Attitude For Remission Ask women what caused their breast cancer, and the most common answer will be stress, an unfounded belief that can affect how these women approach their treatment and survival. In a study of nearly 400 breast cancer survivors who had been disease-free for an average of nine years, 42 percent cited stress as one of the main causes of their breast cancer. This was many more than the 27 percent of the women who felt genetics was involved, the 26 percent who attributed a role to environmental factors, 24 percent who blamed hormones and 16 percent who thought diet was a contributing factor; the scientific evidence supporting these factors as potential causes of breast cancer is far stronger than that for stress. Sixty percent of the women also felt that a positive attitude helped them keep the breast cancer from returning, followed by diet (50 percent), healthy lifestyle (40 percent), exercise (40 percent), stress reduction (28 percent), prayer (26 percent), complementary therapies (11 percent), luck (4 percent) and tamoxifen (4 percent). The conviction that stress caused cancer or that a positive attitude has kept their breast cancer from recurring may give women a sense of control over the disease, say Donna E. Stewart, MD, and her associates at University Health Network and the University of Toronto. This belief can be beneficial when it helps women switch to a low-fat diet or exercise more, but can backfire in a feeling of &quot;personal failure&quot; if the disease returns. The study will be published in the March issue of Psycho-Oncology . They found that the women who believed their cancer was caused by stress were more likely to use complementary therapies and anti-depressants and were less likely to smoke, suggesting that women's beliefs about their disease may be &quot;associated with specific health behaviors used to combat the illness,&quot; the researchers say. They mailed questionnaires to 500 women who had been disease-free for at least 2 years. The questionnaires were returned by 378 of the women. Of those, 322 answered the question on what they thought caused their disease, and 330 answered the question on what kept it from returning. The questionnaire also asked the women what advice they would give another woman who was recently diagnosed with breast cancer. More than half (52 percent), said they would tell the woman to have hope, have courage and be positive. And 58 percent said they would take more control of their treatment if they had to relive the experience. The researchers recommend that health care professionals talk to women about their beliefs. The patient's &quot;views may assist in understanding how she perceives her condition, in encouraging lifestyle changes, and in framing disease management in meaningful ways that give a greater sense of personal control,&quot; said Stewart, who is professor and chair of women's health. http://www.hbns.org/newsrelease/women3-07-01.cfm
SPEAK The Nakaya study reported in this slide is important because Questionnaires were given to every person eliminating selection bias Questionnaires were given prior to development of cancer Questionnaires were psychometrically sound: the categories are valid Results do not suggest link between pre-cancer personality and development of cancer.
Research suggests though that personality affects the progression of cancer. Levy  finds apathy, depression, passivity and low energy are associated with poorer outcome Derogatis et al (1979) Metastatic Breast cancer patients: Those with more anger about diagnosis lived longer Greer et al (1979)- Breast cancer without metastasis Clinical interview separates 4 groups Deniers Fighters Accepters Helpless After 5 years, fighters and deniers did best. Problem: we still don ’ t know if this is cause or effect. We also don ’ t know if the progression could be affected by an intervention to increase assertion.  Levy, S.M., Herrberman, R.B., Maluish, A., M., Schlien, B. & Lippeman, M. (1985). Prognostic risk assessment in primary breast cancer by behavioral and immunological parameters. Health Psychology , 4 , 99-113.
Spiegel et al. (1989) reports in Lancet that breast cancer patients participating in long-term group therapy live longer and better than those in a standard-treatment control group Treatment group survives 36.6 months while those in control group survive 18.9 months. Treatment group is less depressed, copes better and has less pain and fewer fears. Problem- The control group lived only 18.9 months and this is less than would be expected if patients were selected randomly. In fact the survival rate of the general population is not significantly different from the treatment group's. Goodwin et al. (2001) New England Journal of Medicine (Vol. 345, No. 12) 235 patients randomized into supportive expressive (replicates original Spiegel) versus control group. Results of the study Improved emotional functioning, especially in those who were initially distressed Improved pain management, especially in those with higher levels of initial pain. No Survival time advantage Control survives 23.6 months Intervention survives 28.2 months Survival rates are even closer if accounting for the time since first diagnosed
Holland, Jimmie C (1987). Managing Depression in the Patient with Cancer. CA-A Cancer Journal for Clinicians 37 (6)
The statistics are from Kadan-Lottick et al. (2005). Psychiatric Disorders and Mental Health Service Use in Patients with Advanced Cancer. Most patients with cancer cope well  Only about 13-24% of patients with cancer have major depression.  Study of treatment accepters and rejecters  So, most patients were seen as not needing therapy But, if a patient was selected as needing therapy, then he or she was likely to accept therapy. Note that patients in the Linn study also accepted proffered therapy  Weisman, AD. 1979. Coping with Cancer . New York: McGraw Hill.  Holland, JC. (1987). Managing depression in the patient with cancer. CA- A Cancer Journal for Clinicians, 37, 366-371.  Worden, J. & Weisman, A.D. (1980). Do cancer patients really want counselling? General Hospital Psychiatry , 2 , 100-103.
Goldsmith, R. E., Jandorf, L., Valdimarsdottir, H., Amend, K. L., Stoudt, B. G., Rini, C., et al. (2010). Traumatic stress symptoms and breast cancer: the role of childhood abuse. Child abuse & neglect , 34 (6), 465-70. Elsevier Ltd. doi: 10.1016/j.chiabu.2009.10.007.
Redd WH, Andresen GV, Minagawa RY: Hypnotic control of anticipatory emesis in patients receiving cancer chemotherapy. J Consult Clin Psychol 50 (1): 14-9, 1982 Kolko DJ, Rickard-Figueroa JL: Effects of video games on the adverse corollaries of chemotherapy in pediatric oncology patients: a single-case analysis. J Consult Clin Psychol 53 (2): 223-8, 1985 Lyles JN, Burish TG, Krozely MG, et al.: Efficacy of relaxation training and guided imagery in reducing the aversiveness of cancer chemotherapy. J Consult Clin Psychol 50 (4): 509-24, 1982. Burish TG, Shartner CD, Lyles JN: Effectiveness of multiple muscle-site EMG biofeedback and relaxation training in reducing the aversiveness of cancer chemotherapy. Biofeedback Self Regul 6 (4): 523-35, 1981 Morrow GR, Morrell C: Behavioral treatment for the anticipatory nausea and vomiting induced by cancer chemotherapy. N Engl J Med 307 (24): 1476-80, 1982
Cancer: The Effects of Stress & Personality Outcomes of Psychological Interventions Bruce A. Sorkin, Ph.D. University of Pittsburgh Health Psychology
What is the difference between a benign and malignant tumor? Are benign tumors “o.k.?”
Cancer (Malignant tumors)
Invasion into and destruction of healthy tissue
Pieces of tumor break off and spread to distant sites by
Once implanted they grow into tumors there
Don’t invade other tissue
Metastases of Pancreatic Cancer Invading a Human Liver
Where do different cancers metastasize? (National Cancer Institute, 2010) Primary Site Metastases Lung Brain, Bones Colon Liver Prostate Bones Breast Bones, Lung, Liver, Brain
How many people have cancer? American Cancer Society (2008)
10.8 million Americans alive today either have or previously had cancer.
1,437,180 new cases of cancer will be diagnosed.
1,000,000 cases of basal and squamous cell skin cancers will be diagnosed.
What is the Lifetime Risk of Developing Cancer ? (American Cancer Society, 2008)
Normally, cells with damaged DNA die or repair the damage.
In cancer, the DNA is not repaired and the cell receives the order to keep dividing infinitely.
What Causes DNA Damage?
Chemicals (like in tobacco smoke)
Mechanical irritants (asbestos)
Radiation (X-rays, Sunlight, Tanning Beds)
A closer look at tobacco smoke: Chemical Carcinogens
Benzopyrene is found in cigarette smoke
Is toxicated (metabolized into a more toxic compound) into an epoxide (type of organic compound) that irreversably attaches to nuclear DNA. This can either
Mutate the cell and cause programmed cell death (apoptosis)
Mutate the cell but inhibit apoptosis and lead to cancer
Other cancerous tobacco substances
Polynuclear aromatic hydrocarbons
Source: Feng, Z.; Hu, W.; Hu, Y.; Tang, M. (2006). "Acrolein is a major cigarette-related lung cancer agent: Preferential binding at p53 mutational hotspots and inhibition of DNA repair". Proceedings of the National Academy of Sciences of the United States of America 103 (42): 15404–15409. Bibcode 2006PNAS..10315404F . doi : 10.1073/pnas.0607031103 . PMC 1592536 . PMID 17030796
A closer look at cigarette smoke: Radioactive Carcinogens
Cigarette smoke also contains
Because the tar in cigarette smoke does not dissolve in lung fluid these radioactive particles are not readily expelled and thus have a longer time to undergo radioactive decay
These particles linger in secondhand smoke and are a particular problem because people inhale more deeply and for longer times when breathing normally.
Source: alpha-Radiation dose at bronchial bifurcations of smokers from indoor exposure to radon progeny . EA Martell. PNAS March 1, 1983, 80 (5) 1285-1289 .
Does psychotherapy increase the lifespan (survival) of people with cancer?
Does psychotherapy improve the mood and general sense of life satisfaction in people with cancer?
Can psychotherapy decrease specific cancer treatment side effects like nausea and vomiting after chemotherapy?
Does psychotherapy increase the lifespan (survival) of people with cancer?
Psychotherapy does not increase survival time.
Spiegal (1989) study that suggested that group support improves survival for breast cancer patients was flawed.
Goodwin et al. (2001) New England Journal of Medicine (Vol. 345, No. 12)
Replicated the study with 235 patients
Improved emotional functioning and pain management
No survival advantage
Several other studies with breast cancer and other cancers fail to find that psychological therapy improves survival times.
Does psychotherapy improve the mood and general sense of life satisfaction in people with cancer?
Positive effects of psychotherapy in cancer
Improved family function
Improved ability to function in early stage cancers
Initial Psychological Reactions to the Diagnosis of Cancer
Acute Stress Response
Lasts about 7-10 days
Resolves with consultation and onset of treatment
Loss of concentration
Loss of appetite
Initial (first year) response to cancer
Most patients with depression or post traumatic symptoms return to normal baseline within 1 year.
At risk for onset of prolonged depression
Prior emotional adjustment problem
Low levels of social support
Rates of Psychological Illness in Patients with Advanced Cancer
Estimates of rates of psychopathology in advanced cancer patients vary between about 12% and 47%.
7-13% have Major Depression
3-4% have Generalized Anxiety Disorder
5% have Panic Disorder
2.5% have PTSD
8% have encephalopathy from cancer or treatment.
4% have Personality Disorder
Source: Kadan-Lottick et al. (2005). Psychiatric Disorders and Mental Health Service Use in Patients with Advanced Cancer.
History of Child Abuse Increases the Risk of Developing Trauma Symptoms for Breast Cancer Patients Goldsmith et al. (2010)
Goldsmith et al. (2010) gave questionnaires on child abuse and cancer trauma symptoms to women with newly diagnosed breast cancer.
Physical, Sexual and Emotional abuse are all associated with the development of intrusive symptoms of stress disorder and Emotional Abuse was particularly strongly linked with cancer trauma symptoms .
Psychotherapy is underutilized in cancer treatment.
Utilization of mental health is seen in 28% of all patients.
Only 55% of those with major psychiatric disorders were seen by mental health.
Frequently mental health was not assessed by Oncologists.
90% of patients were willing to see mental health when it was recommended
Conclusion: Ask patients about mental health symptoms. They are willing to discuss them with physicians and be referred to mental health this is especially important in high risk populations like those with abuse history, prior mental illness or low levels of support.
Psychotherapy decreases specific cancer treatment side effects like nausea and vomiting after chemotherapy.
Anticipatory Nausea Occurs in 29% of chemotherapy patients