Cancer
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Cancer

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Cancer

Cancer

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  • A killer T-cell (the smaller cell on the top) has recognized a cancer cell and is attacking it with toxic chemicals that punch holes in the cancer cell’s surface.

Cancer Cancer Presentation Transcript

  • CANCER
  • 2 Looking Back Tumors are described as early as 1600 BC in ancient Egyptian writings such as the Smith papyrus Source: Courtesy of the National Library of Medicine
  • 3 Looking Back (Cont.) • Hippocrates introduced the term “carcinoma,” derived from karkinos (crab) • The ancients saw the disease as clawing its way, crab-like, through the body • Hippocrates proposed that cancer was a disease caused by an excess of black bile Source: Courtesy of the National Library of Medicine
  • 4 Looking Back (Cont.) • In 1800, Marie Francois Xavier Bichat proposed that cancer was an overgrowth of cellular tissue • Cells were identified as the fundamental unit in tumor tissue in 1830, after the invention of the microscope • Rudolph Virchow’s 1858 theory that every cell originates from another cell became the foundation for the present understanding of cancer Pfizer Inc. (2006). Chapter 5: Cancer. In Milestones in public health : Accomplishments in public health over the last 100 years (p. 83). New York, NY: Pfizer Inc.
  • CANCER Biology of Cancer
  • 6 What is Cancer? • Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells • If the spread is not controlled, cancer can result in death • Cancer affects almost every part of the human body • Cancer arises from the same material, cells, used by the body to construct its own tissues • Abnormal masses of tissue are called tumors. Tumors can be benign (non-cancerous) or malignant (cancerous) • Cancerous tumor cells differ from normal cells in many respects
  • A killer T-cell (the smaller cell on the top) has recognized a cancer cell and is attacking it with toxic chemicals that punch holes in the cancer cell’s surface. p425
  • 8 What is Cancer? • Cancer: An abnormal and uncontrolled multiplication of cells , which, if left untreated can lead to death • Cancerous tumor cells are abnormal and divide without order or control • Cancerous cells can damage nearby tissue, and invade other areas of the body (metastasize) • Every case of cancer begins as a change in a cell that allows the cell to grow and divide when it should not
  • 9 What Causes Cancer? • Cancer is caused by both external factors and internal factors that occur from metabolism (chemical processes occurring within a living cell or organism that are necessary for the maintenance of life) • These factors may act together or in sequence to initiate the formation of cancer • Examples of external factors include: (tobacco, chemicals, radiation, and infectious organisms) • Examples of internal factors include: (inherited mutations, hormones, immune conditions, and other mutations)
  • Metastasis • Metastasizing – The traveling ,spreading process of cancerous cells • Primary tumor is original location of cancer • New tumors are called secondary tumors or metastases • Can invade nearby tissue or spread to different parts of the body 10
  • Types of Cancer • The behavior of tumors arising in different body organs is characteristic of the tissue of origin • Classified according to types of cells that give rise to them • Carcinomas • Sarcomas • Lymphomas • Leukemias 11
  • 12 Leading U.S. Causes of Death, 2006 Rank Cause of Death No. of deaths Percent of all deaths 1. Diseases of the heart 636,636 26.0 2. Cancer 559,888 23.1 3. Cerebrovascular diseases 137,119 5.7 4. Chronic lower respiratory diseases 124,583 5. Accidents (unintentional 121,599 injuries) 5.0 6. Diabetes mellitus 72,449 3.0 7. Alzheimer’s disease 71,432 3.0 Influenza & pneumonia 56,326 2.3 8. 5.1 Source: US Mortality Data 2005, National Center for Health Statistics, Centers for Disease Control and Prevention, LCWK 1. Deaths, percent of total deaths, and death rate for the 15 leading causes of death in 5-year age groups, by race and sex, United States, 2006, “Cause of death (Based on the Tenth Revision, International Classification of Diseases, Second Edition, 2004), race, sex, and age.” (All races, both sexes, all ages). Retrieved May 29, 2010 from http://www.cdc.gov/nchs/data/dvs/LCWK1_2006.pdf Cancer accounts for nearly ¼ of deaths in US , exceeded only by heart diseases.
  • 13 Cancer Statistics • Some 1.3 million Americans are diagnosed with cancer • • • • • • each year Following heart disease, cancer is the second most common cause of death in the U.S. More than 550,000 Americans die from cancer annually The median age for the diagnosis of cancer in adults is age 67 Lung cancer is the leading cause of cancer death among men and women Cancer affects nearly one in every two men Cancer affects nearly one in every three women American Cancer Society (2008) Cancer Facts and Figures 2008. Retrieved June 10, 2010 from http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf
  • 14 Preventable Cancer Causes • Cancers caused by cigarette smoking can be prevented. In 2009, the American Cancer Society estimated that 169,000 cancer deaths would be caused by tobacco use • In 2009 scientific evidence indicated that one third of US cancer deaths of the estimated 562,340, would be related to overweight, obesity, physical inactivity, and nutrition American Cancer Society (2009), Cancer Facts and Figures 2009. Retrieved May 28, 2010 from http://www.cancer.org/downloads/STT/500809web.pdf
  • 15 2009 Estimated U.S. Cancer Deaths Lung & bronchus 30% Men 292,540 Women Lung & bronchus •26% 269,800 Breast •15% Prostate 9% Colon & rectum 9% • 9% Colon & rectum Pancreas 6% • 6% Pancreas Leukemia 4% • 5% Ovary Liver & intrahepatic bile duct 4% • 4% Non-Hodgkin lymphoma Esophagus 4% • 3% Leukemia Urinary bladder 3% • 3% Uterine corpus Non-Hodgkin lymphoma 3% • 2% Liver & intrahepatic bile duct Kidney & renal pelvis 3% • 2% Brain/ONS* 25% •25% All other sites All other sites ONS=Other nervous system. Source: American Cancer Society, “Cancer Statistics 2009: A presentation from the American Cancer Society,” * Retrieved May 29, 2010 from http://www.cancer.org/downloads/PRO/Cancer_Statistic_2009_Slides_rev.ppt#397,2,2009 Estimated US Cancer Deaths
  • 16 Cancer Death Rates* Among Men, U.S., 1930-2004 100 Rate Per 100,000 Lung & bronchus 80 60 Stomach 40 Colon & rectum Prostate 20 Pancreas 2000 1995 1990 1985 1980 1975 1970 1965 Liver 1960 1955 1950 1945 1940 1935 Leukemia 1930 0 *Age-adjusted to the 2000 US standard population. From the Cancer Statistics 2008: A Presentation from the American Cancer Society. Retrieved May 28, 2010 from http://www.acsevents.org/downloads/STT/Cancer_Statistics_2008.ppt#426,7,Cancer Death Rates* Among Men, US,1930-2004 Source: US Mortality Data 1960-2004, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
  • 17 Cancer Death Rates* Among Rate Per 100,000 Women, U.S.,1930-2004 100 80 60 40 Lung & bronchus Breast Uterus 20 Colon & rectum Stomach *Age-adjusted to the 2000 US standard population. From the Cancer Statistics 2008: A Presentation from the American Cancer Society. Retrieved May 28, 2010 from http://www.acsevents.org/downloads/STT/Cancer_Statistics_2008.ppt#427,8,Cancer Death Rates Among Women, US,1930-2004. Source: US Mortality Data 1960-2004, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. 2000 1995 1990 1985 1980 1975 1970 1965 1960 1955 Pancreas 1950 1945 1940 1935 1930 Ovary 0
  • 18 Health Disparities and Cancer • “Differences in the incidence, prevalence, mortality, and burden of diseases and other health conditions that exist among specific population groups in the United States.” • National Institutes of Health, US Department of Health and Human Services • “Differences in the incidence or prevalence of disease disability, or illness. These differences can be among racial/ethnic groups, socioeconomictogroupings, gender LaVeist, T. (2005). Minority populations and health: An introduction health disparities in the groups, united otherFrancisco : Jossey-Bass. or states. San groupings.”
  • 19 Cancer Incidence Rates* by Race and Ethnicity, 2000-2004 Men Women 800 700 600 663.7 Rate Per 100,000 556.7 500 423.9 400 421.3 396.9 359.9 321.2 285.8 300 282.4 314.2 200 100 0 White African American Asian/Pacific Islander American Indian/ Alaska Native Hispanic† *Age-adjusted to the 2000 US standard population. †Person of Hispanic origin may be of any race. From the Cancer Statistics 2008: A Presentation from the American Cancer Society, Retrieved May 29, 2010 http://www.acsevents.org/downloads/STT/Cancer_Statistics_2008.ppt#412,17,Cancer Incidence Rates* by Race and Ethnicity, 2000-2004. Source: Surveillance, Epidemiology, and End Results Program, 1975-2004, Division of Cancer Control and Population Sciences, National Cancer Institute, 2007.
  • 20 Cancer Death Rates* by Race and Ethnicity, U.S., 2000-2004 400 Men 350 Women 321.8 300 250 234.7 189.3 200 187.9 162.2 161.4 150 100 141.7 141.2 96.7 106.7 50 0 *Per 100,000, age-adjusted to the 2000 US standard population. † Persons of Hispanic origin may be of any race. From the Cancer White African American Asian/Pacific American Hispanic† Statistics 2008: A Presentation from the American Cancer Society, Retrieved May 28, 2010 Indian/ http://www.acsevents.org/downloads/STT/Cancer_Statistics_2008.ppt#428,9,Cancer Death Rates* by Race and Ethnicity, US, 2000-2004 Islander Alaskan Native Source: Surveillance, Epidemiology, and End Results Program, 1975-2004, Division of Cancer Control and Population Sciences, National Cancer Institute, 2007.
  • 21 Cancer Screening • Screening involves looking for early signs of a particular disease in asymptomatic people • Cancer screening seeks to find cancers as early as possible, when the chance of cure is highest
  • 22 When is Screening Helpful? • While there are several types of cancer, not all cancers have screening tests. A screening test should: • Detect the cancer early • Not give false negatives • Not give false positives • Not be unpleasant or dangerous • Be cost-effective
  • 23 Cancer Screening • Screening is used in the detection of the following cancers: • Breast (Mammography) • Cervix (Papanicolau smear) • Colon (Colonoscopy, Sigmoidoscopy, Fecal Occult Blood) • Prostate (Prostate Specific Antigen) • Identifying the majority of cancers in their early stage leads to improved diagnosis, less radical treatment, decreased mortality, and lower health care costs
  • 24 Milestones in Cancer Treatment • Until the 20th century, few cancer patients had a chance for long-term survival; however, two notable interventions, radiation therapy and chemotherapy, have improved survival rates: • Professor Wilhelm C. Roentgen’s work provided the foundation for radiation therapy for cancer • Dr. Min Chiu Li demonstrated that systemic chemotherapy could result in the cure of a widely metastatic disease Pfizer Inc. (2006). Chapter 5: Cancer. In Milestones in public health : Accomplishments in public health over the last 100 years (pp. 86-88). New York, NY: Pfizer Inc.
  • Lung Cancer • Most common cause of cancer death in the U.S. • 157,000 deaths per year • Risk factors • Tobacco contributes to 30% of all cancer deaths and 90% of lung cancer deaths • Detection • Difficult to detect • Symptoms do not usually appear until cancer has reached the invasive stage • Persistent cough, chest pain, or recurring bronchitis • Diagnosis: CT scan, chest x-ray, or sputum examination 25
  • Colon Cancer • Colon cancer: neoplasm that starts in the large intestine (colon) or the rectum (end of the colon). • category of cancer is typically referred to as "colorectal cancer." • 2nd most common cancer among both men and women in the United States • 3rd most common cause of cancer death among men and women in the United States • In 2007, approximately 153,760 adults (79,130 men and 74,630 women) in the United States will be diagnosed with colorectal cancer
  • What causes colon cancer? • No single cause • Nearly all colon cancers begin as benign polyps • Certain genetic syndromes also increase the risk of developing colon cancer. • Most colorectal cancers arise from an adenomatous polyp • Polyp: is defined as a tissue protuberance from the colon mucosa
  • Colon and Rectal Cancer • Risk factors • Directly linked to age, genetic predisposition, lifestyle habits, diet • 91% of cases occur after 50 years of age • Excessive alcohol use and smoking may increase risk • Obesity and diets rich in red and processed meats increases risk • Regular physical exercise and diets rich in fruits, vegetables, and whole grains may lower risk • Research mixed on high-fiber diets • Oral contraceptives and hormone replacement may increase risk in women 28
  • Two main types of Inherited Colon Cancers • Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome • accounts for 5% to 10% of cases • The risk of colorectal cancer in families with HNPCC is 70% to 90%, • Familial adenomatous polyposis (FAP) • approximately 1% of cases of colon cancer annually • People with FAP typically develop hundreds to thousands of colon polyps • The polyps are initially benign (noncancerous), but there is nearly a 100% chance that the polyps will develop into cancer if left untreated.
  • Detection and treatment • Since colorectal cancer is one of the most treatable forms of cancer if identified early, people diagnosed with HNPCC, or those considered at increased risk based on their family history, often benefit from increased screening. • Survival 91% if detected early, 65% overall
  • Signs and Symptoms • Signs and symptoms of colon cancer may include: • A change in bowel habits, including diarrhea or • • • • • • constipation or a change in the consistency of stool for more than a couple of weeks Rectal bleeding or blood in stool (melena) Persistent abdominal discomfort, such as cramps, gas or pain Abdominal pain with a bowel movement A feeling that your bowel doesn't empty completely Weakness or fatigue Unexplained weight loss
  • Treatment • Surgery • most common treatment for colon cancer • Chemotherapy • reduces the chance of reoccurrence • Radiotherapy • Colon cancer is not typically treated with radiation therapy • Follow-Up Testing
  • 12/8/2013Chapter fifteen © 2012 McGraw-Hill Higher Education. All rights reserved. Testicular Cancer • Most common form of ca in men between ages of 15 - 35. • can occur in older men, and rarely, in younger boys • one of the most treatable and curable cancers (95% if caught early (stage 1) • Factors that may increase: • Abnormal testicle development • History of Undescended testicle • Other possible causes : exposure to certain chemicals, HIV. family hx of testicular cancer • Caucasian men more likely than African-American & Asian-American men to develop this type of ca. • 2 main types of testicular cancer: • Seminoma: slow-growing form usually found in men in their 30s & 40s; usually just in testes, but can spread to the lymph nodes; very sensitive to radiation therapy. • Nonseminoma: more common type; tends to grow quickly 33
  • 12/8/2013Chapter fifteen © 2012 McGraw-Hill Higher Education. All rights reserved. Testicular Cancer Symptoms • may be no symptoms or may have discomfort / pain in testicle, or a feeling of heaviness in the scrotum • Pain in the back or lower abdomen • Lump , swelling, enlargement in either testicle • Excess development of breast tissue (gynecomastia), • S/s in other parts of body, such as the lungs, abdomen, pelvis, Signs and tests • Physical exam typically reveals firm lump (mass) in 1 of testicles. • When flashlight held up to scrotum, light doesn’ t pass through lump. • Blood tests for tumor markers: • Ultrasound of scrotum Treatment • Surgery, Radiation • Chemotherapy 34
  • Prostate Cancer • Most common cancer in men • 2nd leading cause of cancer death in men • Nearly 218,000 new cases per year • More than 32,000 deaths per year • Risk factors • Age • Genetic predisposition/family history • Diet • Lifestyle • History of STDs • Type 2 diabetes and insulin resistance • Detection • Prostate-specific antigen (PSA) blood test • Digital rectal examination • Yearly screening beginning between ages 40-50 • Treatment • Surgical removal of the prostate and radiation • Implantation of radioactive seeds • 5-year survival rate is nearly 100% 35
  • Breast Cancer • Most common cancer in women • 1 in 8 American women will develop it during her lifetime; 1 in 30 women will die from the disease • About 200,000 American women are diagnosed each year and 41,000 women die from it each year • Risk factors • rises quickly with age, about 50% occurring • • • • • • • • in women ages 45-65 Genetic predisposition/family history Early onset of menstruation Late onset of menopause Having first child after 30 Having no children Hormone replacement therapy Estrogen connection Obesity, diet, and alcohol use 36
  • Breast Cancer • Detection and Treatment • Early detection – cure most likely when cancer is detected early • Monthly breast self-exam for all women over 20 • Clinical breast exam by a physician every 3 years (every year for women over 40) • Mammography- Every 1 year for women over 40 • MRIs • Treatment • Ultrasonography • Biopsy • Lump found to be harmless growth in 90% of cases • Surgery: lumpectomy, mastectomy 37
  • Breast Cancer • Survival rate • 98% if the cells haven’t metastasized • 90% for all stages at 5 years • New strategies for treatment and prevention • SERMs (tamoxifen, raloxifene) • Monoclonal antibodies (trastuzumab): Antibodies designed to bind to specific cancer-related targets
  • Multi-Stage Carcinogenesis: Targets for Cancer Prevention ion Forman et al. Ann Rev Nutr, 2004