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  • 1. Chapter 13
 Cancer
  • 2. What Is Cancer? • Cancer is actually many diseases. • Cancer cells display abnormal: – Growth – Division – Differentiation • Cancer cells: – Metastasize – Form masses called malignant tumors – Do not stop growing and dividing at appropriate times.
  • 3. How Cancers Develop and Spread • Cancer develops only in cells with damaged genes (mutations). – Mutations can be inherited or caused by exposure to: –Low-dose radiation –Drugs –Toxic chemicals – Infection with certain viruses can cause mutations. – Lifestyle plays a major role in cancer prevention.
  • 4. How Cancers Develop and Spread Genes and Cancer Development • Oncogenes – “on” switches that speed cell growth. – Successive mutations to the hereditary material of particular body cells produce oncogenes. • Tumor-suppressor genes – “off” switches that slow cell growth. – If tumor-suppressor genes mutate, they will no longer restrict cell growth. • Benign tumors are surrounded by a fibrous capsule, and they do not spread or invade surrounding tissues.
  • 5. How Cancers Develop and Spread Metastasis – Cancer cells have the ability to spread, or metastasize, from where they develop to other parts of the body. – Cells that metastasize are called malignant – Cancer cells can enter the bloodstream or lymphatic system and travel to other parts of the body and form new tumors.
  • 6. How Cancers Develop and Spread Metastasis • Cancers are named according to the type of tissue from which they develop. – Carcinomas arise from epithelial tissue. • Tissues that line and cover internal and external body surfaces, such as skin. – Sarcomas arise from connective or muscle tissue. – Leukemias are cancers of the blood and related cells. – Lymphomas are cancers of the lymphatic system. – Cancers of the nervous system have various names.
  • 7. Cancer Detection and Staging • Cancer screening is an examination to detect cancer before a person has symptoms. • American Cancer Society recommends screening for early detection, particularly for high-risk people or people with symptoms. – Visual examination – Self-examination – Clinical (physician) examination – Laboratory testing – Scans (MRI, CAT)
  • 8. Cancer Detection and Staging • Cancer staging describes the extent of growth and metastasis of cancer. • It is useful in determining appropriate therapy. • It also helps provide prognosis. • TNM system of staging: – T describes the original tumor – N describes if cancer has reached lymph nodes – M describes if cancer has metastasized • The overall stages are I, II, III, and IV.
  • 9. Cancer Treatment • Principal forms of treatment are surgery, radiation, and chemotherapy. Surgery removes localized cancers. – Most cancer cures are accomplished by surgery. Radiation kills localized cancers: used alone or with surgery. Chemotherapy inhibits cancer cell reproduction or destroys metastasized cancer cells. – Used most often when cancer has spread • Radiation and chemotherapy also kill or damage healthy cells and may cause serious side effects (i.e., nausea, hair loss).
  • 10. Cancer Treatment Laser and Photodynamic Therapy – Lasers are high intensity lights that can be focused with great precision – Remove superficial cancers as well as those in interior body locations. – Chemical called photosensitizer reacts with special light, killing tumor cells – Tumor cells become targets for treatment because they absorb photosensitzer better than healthy cells
  • 11. Cancer Treatment Targeted Therapies – Drugs or other substances that block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression. – Small-molecule Drugs • Do a specific job, such as blocking certain enzymes and growth factor receptors, modifying the function of proteins that regulate cancer cell functions, and stopping cancerous tumors from developing new blood vessels.
  • 12. Cancer Treatment Targeted Therapies – Immunotherapy • Biomodulation (biological response modification) is the manipulation of the immune system to rid the body of its cancer. • Key to the working of the immune system is its ability to recognize an intruder as foreign.
  • 13. Cancer Treatment Bone Marrow and Peripheral Blood Stem Cell Transplants – Patients receive stem cell transplants in a process that’s like receiving a blood donation. – Used in two ways: • To resupply the bone marrow when it has been destroyed by chemotherapy or radiation. • To supply healthy stem cells to a person who has cancer of the blood-forming tissue, such as leukemia.
  • 14. Prevalent Cancers in the United States – Heredity is a risk factor. However, behavioral factors such as cigarette smoking, dietary patterns, physical activity, and weight control substantially affect the risk of cancer. – Advanced age is a significant risk factor for most cancers except certain childhood cancers, cervical and testicular cancers, and to some extent, breast cancer.
  • 15. Prevalent Cancers in the United States Cancers Caused By or Related to Tobacco Use • Lung Cancer – Lung cancer is the leading cause of cancer deaths – Signs and Symptoms • Chronic cough, excess sputum, wheezing, chest pain, and lung infection. • Chest X-rays, MRI and CT scans; analyses of the types of cells in the sputum; and fiber optic examination of the bronchial passageways assist in diagnoses.
  • 16. Prevalent Cancers in the United States Cancers Caused By or Related to Tobacco Use • Lung Cancer – Risk factors and prevention • The number of cigarettes smoked/day • The number of years a person smokes • How deeply he or she inhales • Smoking high-tar or unfiltered cigarettes • Quitting smoking reduces the risk of developing lung cancer, after 10 years it will be about half that of a person who continued to smoke.
  • 17. Prevalent Cancers in the United States Cancers Caused By or Related to Tobacco Use • Lung Cancer – Risk factors and prevention (cont.) • High consumption of alcoholic beverages and obesity • Passive smoking is associated with a 20% to 30% increase in lung cancer risk. • Asbestos particle inhalation • Radon Gas exposure appears to multiply the carcinogenic effects of tobacco smoke.
  • 18. Prevalent Cancers in the United States Cancers Caused By or Related to Tobacco Use • Lung Cancer – Treatment • Physicians treat lung cancer with surgery, radiation, and chemotherapy.
  • 19. Prevalent Cancers in the United States Cancers Caused By or Related to Tobacco Use • Cancers of the Larynx, Oral Cavity, and Esophagus – Caused by tobacco & alcohol use as well as HPV – Hoarse voice, difficulty swallowing, and a sore throat may indicate larynx cancer. – Recurrent heartburn may indicate esophageal cancer. – Oral cancer tumors are easy to detect because they are visible but they metastasize quickly.
  • 20. Prevalent Cancers in the United States Cancers Caused By or Related to Tobacco Use • Cancers of the Kidney and Bladder – Come in contact with inhaled carcinogens after the substances enter the bloodstream. – Blood in the urine is a sign of kidney or bladder cancer. Frequent, urgent, or difficult urination are also signs of bladder cancer. – Men who are over 50 years old and are heavy smokers have a high risk of these cancers.
  • 21. Prevalent Cancers in the United States Cancers Caused By or Related to Tobacco Use • Cancers of the Pancreas – “silent” cancer because its early symptoms (nausea, vomiting, weakness and discomfort in the abdomen) are vague and, therefore, the disease often is undetected as it progresses. – Obesity, a high-fat diet, physical inactivity, and diabetes are other risk factors for the disease. – Only 6% of people who have pancreatic cancer survive beyond 5 years.
  • 22. Prevalent Cancers in the United States Cancers Caused By or Related to Tobacco Use • Acute Myeloid Leukemia – This form of cancer affects blood-producing cells in bone marrow. – As a result of this disease, fewer white blood cells are produced, particularly the ones that combat bacterial infections. – Exposure to benzene and ionizing radiation increases the risk of AML. – Benzene and substances that emit ionizing radiation are in cigarette smoke.
  • 23. Prevalent Cancers in the United States Cancers Related to Diet • Each year, poor diet and lack of physical activity (including obesity) account for about one-third of cancer deaths in the United States.
  • 24. Prevalent Cancers in the United States Cancers Related to Diet • Cancer of the Stomach – incidence of and death rate from stomach cancer has declined dramatically over the past 60 to 70 years in the United States. – “silent” in its early stages. Symptoms may be attributed to minor intestinal upsets. – Risk increases with age – Diets high in salt-cured, nitrate-cured, or smoked foods consuming alcohol and cigarette smoking also are risk factors
  • 25. Prevalent Cancers in the United States Cancers Related to Diet • Cancer of the Colon and Rectum – Colorectal cancer is the third most deadly cancer in the United States. – Signs and symptoms depend on location of the tumor. – Abdominal pain, change in bowel habits, and blood in the stools are important signs.
  • 26. Prevalent Cancers in the United States Cancers Related to Diet • Cancer of the Colon and Rectum – Risk factors include: advanced age; heredity; personal or family history of colorectal polyps or inflammatory bowel disease; physical inactivity; obesity; diets high in fat and/or red meat; inadequate intake of fruits and vegetables; smoking cigarettes; and having more than one alcoholic drink/day.
  • 27. Prevalent Cancers in the United States Cancers Related to Diet • Cancer of the Colon and Rectum – Low-dose aspirin, exercising moderately and consistently, consuming a diet that contains adequate amounts of fruits, vegetables, and whole grains; replaces red and processed meats with chicken and fish; and replacing most saturated fats with unsaturated fats can reduce the risk of colorectal cancer.
  • 28. Prevalent Cancers in the United States Cancers Related to Hormone Function • Breast Cancer – Breast cancer is the second leading cancer killer of women in the United States – Signs and Symptoms • Changes in the breast tissue, including lumps in the breast; dimpling, thickening, discoloration, irritation, or scaling of the breast skin; tenderness of the nipple or nipple discharge; and swelling or distortion of the breast.
  • 29. Prevalent Cancers in the United States Cancers Related to Hormone Function • Breast Cancer – Risk factors • Family history – first –degree relative • Age (20-70)
  • 30. Prevalent Cancers in the United States Cancers Related to Hormone Function • Breast Cancer – Risk factors • High cumulative exposure to ovarian hormones, particularly estrogen –Early menarche (younger than age 12) –Late menopause (older than age 55) –Not bearing children –Currently taking oral contraceptives –High-fat diet and obesity may contribute to estrogen levels
  • 31. Prevalent Cancers in the United States Cancers Related to Hormone Function • Breast Cancer – Early Detection • Breast self-examinations are now considered optional by the American Cancer Society. • Clinical breast exams • Mammography – Treatment : • Lumpectomy • Radiation • Total mastectomy • Chemotherapy • Radical mastectomy • Hormonal • Modified radical mastectomy
  • 32. Prevalent Cancers in the United States Cancers Related to Hormone Function • Endometrial Cancer – The endometrium is the lining of the uterus. – Endometrial cancer is most common in postmenopausal women. – Primary symptom is abnormal uterine bleeding. – Pap tests for cervical cancer do not reveal endometrial cancer. • Endometrial biopsy is needed.
  • 33. Prevalent Cancers in the United States Cancers Related to Hormone Function • Endometrial Cancer – Primary risk factor is high cumulative exposure to estrogen. • Hormone replacement therapy involving estrogen without progesterone is a risk factor as well. – Using combination oral contraceptives reduces risk. – Treatments include total hysterectomy, radiation, hormones and/or chemotherapy.
  • 34. Prevalent Cancers in the United States Cancers Related to Viral Infection • Cervical Cancer • The incidence has declined dramatically since 1960 due to Pap test screening. • Most women have no signs or symptoms when diagnosed with the disease. • Most often develops in women 20 to 40 years of age. • Treatments include surgery, radiation, laser treatment, and cryotherapy.
  • 35. Prevalent Cancers in the United States Cancers Related to Viral Infection • Cervical Cancer – A causal association exists between infection with human papillomavirus (HPV) and cervical cancer. • Causes genital warts • Is sexually transmitted • Risk of infection increases with an increased number of sexual partners and/or nonmonogamous partners • Women who became sexually active before age 17 have higher risk
  • 36. Prevalent Cancers in the United States Cancers Related to Viral Infection • Cervical Cancer – Long-term use of oral contraceptives is associated with an increased risk of cervical cancer. – The vaccine, Gardasil, prevents infection with four types of HPV. – The American Cancer Society (ACS) recommends that all women should have annual Pap tests three years after their first vaginal intercourse but not later than age 21.
  • 37. Prevalent Cancers in the United States Cancers Related to Viral Infection • Cervical Cancer – Treatment • Surgery • Electrocoagulation • Cryotherapy • Carbon dioxide laser surgery
  • 38. Prevalent Cancers in the United States Cancers Related to Ultraviolet Radiation • Related to exposure to ultraviolet (UV) radiation from the sun as well as tanning beds. • Three types of UV radiation: UVA, UVB, and UVC. • All types are harmful and have potential to cause skin cancer. • UVA is associated with sunburn, skin cancer formation, and premature aging effects. • Artificial UV sources may also generate UVC rays • UVC is potent cancer-causing radiation
  • 39. Prevalent Cancers in the United States Cancers Related to Ultraviolet Radiation Basal cell carcinoma – May look like moles, or pimples with pearl-like borders – May crust, scale, and bleed – Treatment • Removed by surgery and cryotherapy • Cure rate is high
  • 40. Prevalent Cancers in the United States Cancers Related to Ultraviolet Radiation Squamous Cell Carcinoma – Flat, red, scaling lesions – May be slightly elevated – Also develops in dark-skinned populations from chemical exposure, X-rays, burns, and chronic skin ulcers – Treatment • Removed by surgery and cryotherapy
  • 41. Prevalent Cancers in the United States Cancers Related to Ultraviolet Radiation Malignant Melanoma – Deadly skin cancer – Most frequent cancer in women aged 25 to 29 and second most frequent cancer in women aged 30 to 34 – Fair-skinned people have higher risk than darkskinned people • Highest risk: people with light blue eyes, very light hair, and skin that burns easily and freckles rather than tans
  • 42. Prevalent Cancers in the United States Cancers Related to Ultraviolet Radiation Malignant Melanoma – Check skin regularly for skin legions that: • Are asymmetrical • Have irregular borders • Have multiple colors • Have a diameter greater than pencil eraser – Prevention • Limit sun exposure • Use sunscreens • Where protective clothing when exposed to sunlight • Avoid artificial sources of UV light (i.e., tanning beds)
  • 43. Prevalent Cancers in the United States Cancers Related to Ultraviolet Radiation Prostate Cancer • The most prevalent cancer in men • Signs and symptoms that may be nonspecific: – Uneven flow of urine – Incomplete emptying of bladder – Reduced urine flow – Urinating more frequently at night • Signs and symptoms likely to be related to prostate cancer: – Pain in the pelvis – Sudden development of impotence – Blood in the urine
  • 44. Prevalent Cancers in the United States Cancers Related to Ultraviolet Radiation Prostate Cancer – Risk factors • Location: men living in North America and northwestern Europe • Race: African Americans and Jamaicans of African descent have the highest prostate incidence rate • Advanced age • Heredity • Obesity and high-fat diet
  • 45. Prevalent Cancers in the United States Cancers Related to Ultraviolet Radiation Prostate Cancer – An annual digital rectal exam and PSA blood test is recommended for men older than 50. – Prostate cancer is often slow growing, and most patients die of other causes. – “Watchful waiting” is often treatment of choice, although recent research challenges this view.
  • 46. Prevalent Cancers in the United States Cancers Related to Ultraviolet Radiation Testicular Cancer – Testicular cancer is rare and highly curable – Signs and symptoms • Painless, swollen testis • Sensation of heaviness or aching in the testis • Small lump in one testis
  • 47. Prevalent Cancers in the United States Cancers Related to Ultraviolet Radiation Testicular Cancer – Risk factors • Age: strikes primarily teenagers and men between the ages of 15 and 35 • Failure for testis to descend into scrotal sac by age 6 – Detection • Conduct testicular self-exam each month after a warm bath or shower
  • 48. Prevalent Cancers in the United States Cancers Related to Ultraviolet Radiation Ovarian Cancer – No signs and symptoms in early stage. – As disease progresses: • Frequent urination or bloating • Pressure in the abdomen • Vaginal bleeding in postmenopausal women • Irregular or heavy menses in premenopausal women – Occurs most often after menopause.
  • 49. Prevalent Cancers in the United States Cancers Related to Ultraviolet Radiation Ovarian Cancer – Risk factors • Advanced age (85% to 90% develop in postmenopausal women) • Early menarche • Late menopause • Not bearing children • Living in a Western country • Obesity • Use of oral contraceptives reduces risk
  • 50. Prevalent Cancers in the United States Cancers Related to Ultraviolet Radiation Ovarian Cancer – Detection • No accurate routine screening test for women at average risk is available. • Pelvic examination, transvaginal ultrasound, and blood tests can detect abnormalities. – Treatment • Surgery • Chemotherapy • Radiation
  • 51. Reducing Your Risk for Cancer • Eat a diet low in fat and red meats, especially high-fat and processed meats. • Eat a variety of fruits and vegetables daily. • Follow ACS’s recommendations for cancer screening tests. • Men should conduct monthly testicular selfexaminations. • Know warning signs of cancer and see your health care provider immediately if you detect any.
  • 52. Reducing Your Risk for Cancer • Sexually active people should use condoms to avoid contacting HPV. • Maintain a healthy weight. • Women should consult with their health care providers about risks of using oral contraceptives or hormone replacement therapy. • Exercise most days of the week. • When in the sun, takes steps to limit UV radiation exposure.
  • 53. Reducing Your Risk for Cancer • • • • • • • • • Don’t smoke or chew tobacco. Avoid secondhand smoke. Don’t drink excessive amounts of alcohol. Avoid unnecessary exposure to ionizing radiation, such as x-rays and UV light. Don’t lie in the sun or tanning beds. Avoid direct sun exposure between 10 a.m. and 4 p.m. Avoid exposure to toxic chemicals and fumes. Avoid asbestos dust and radon gas. Avoid eating cured or smoked meats.