Slide 1 - Home - Texas A


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Slide 1 - Home - Texas A

  1. 1. Experiencing Cancer as a Scientist, Physician and Patient
  2. 2. Introduction What is cancer?  Cancer is a cluster of rapidly growing cells which often expand beyond the normal architecture of the tissue in which they reside.  There are many different types of cancer (usually defined by location)
  3. 3. Most common cancers in US  Melanoma  Bladder cancer  Colon & Rectal cancer  Breast cancer  Skin cancer (non- melanoma) (#1)  Pancreatic cancer  Kidney cancer  Endometrial cancer  Leukemia  Lung cancer  Thyroid cancer  Prostate cancer  Non-Hodgkins lymphoma
  4. 4. Cancer rates in US: Cancer Type New Cases Deaths Skin (non-melanoma) >1,000,000 <1,000 Lung (Including Bronchus) 215,020 161,840 Breast (Female -- Male) 182,460 -- 1,990 40,480 -- 450 Leukemia (All) 44,270 21,710 Pancreatic 37,680 34,290 Esophageal 16,470 14,280 Data from NCI, 2008 -
  5. 5. Introduction Benign & malignant  Benign tumors may be quite large, but are incapable of migrating to other tissues;  Malignant tumors are “metastatic” and thus, able to migrate from the primary tumor and form a secondary tumor in a different location
  6. 6. Causes (lifestyle):  Lung – cigarette smoking  Liver – alcohol, aflatoxin (mold from food), hepatitis virus  Breast – reproductive history; genetics  Colon - diet
  7. 7. Causes (occupational): One of the first case studies reporting occupational cancer was the London physican Sir Percival Pott (1765) who noticed an excess of scrotal cancer in chimney sweeps (exposed to polycyclic aromatic hydrocarbons)
  8. 8. Causes (occupation/environment):  Lung – asbestos (and cigarette smoking)  Liver – vinyl chloride; solvents  Leukemia – benzene & radiation  Sinus – nickel  Skin, bladder – arsenic  Non-Hodgkin’s Lymphoma – farming (exposure not defined)
  9. 9. Causes (occupation/environment): Environmental chemicals may also affect the risk of cancer by damaging the immune system, altering rates of absorption or metabolism, or through promotion of initiated cancer cells.
  10. 10. Cancer Internal dose Biologically effective dose Initiated cell Preneoplasia Malignancy External exposure INITIATION PROGRESSIONPROMOTION Metabolic activation Fixation Detoxification Reactivation Excretion DNA repair Latency period Exposure (~ 1 day) Effects (~20-40 years) Steps in Carcinogenesis
  11. 11. ENVIRONMENT HEALTH GENE NUTRITION Factors affecting risk of cancer -
  12. 12. PAHs can cause cancer: Naphthalene Fluorene Anthracene Phenanthrene Fluoranthene Pyrene Chrysene Benzo(a)pyrene
  13. 13. And where do PAHs come from?  1985 Study  PAH concentration decreased downwind  Particulate genotoxic  NO correlation BaP concentration
  14. 14. Cooked Foods ● Heterocyclic amines ● Benzo(a)pyrene ● PAHs & others ● Genotoxicity increases w/ cooking temperature
  15. 15. Manufactured Gas Plant Residue  Complex mixture PAHs  Bioavailability/  Ecotoxicity - Unknown  Genetic damage reduced w/ reduced PAH level
  16. 16. Biomarker study in Azerbaijan
  17. 17. Sumgayit, Azerbaijan  Built 1950’s  Center of Petrochemical Industry for Former Soviet Union  Considered one of 10 most polluted cities in the world
  18. 18. Russia Kazakhstan Iran Caspian Sea Georgia Azerbaijan Sumgayit
  19. 19. Does the environment impact children’s health? Children’s Cancer Mortality Rates: United States Sumgayit, Azerbaijan Boys 33.1/1,000,000 Girls 26.2/1,000,000 Total approx. 60/million Total – 200/105,000 or approx 2,000/million
  20. 20. Other factors - - Genes:  BRCA1, BRCA2- breast cancer (87%)  MSR1-prostate cancer  Other genes Other factors:  Inflammation & cancer  Viral infections – HPV, hepatitis
  21. 21. Symptoms:  Lumps & bumps  Failure to achieve ignition- -(organ dysfunction)  Persistent cough  Blood in stool
  22. 22. Symptoms (cont.):  Change in size or coloration of a mole  Weight loss  “Flue-like” symptoms  Fatigue  Most symptoms of cancer can also be explained by a common ailment
  23. 23. Detection  PAP, PSA, others  Cancer antigens  Mammography  “Oscopies” CAT scan PET scan
  24. 24. Treatments * Chemotherapy *Surgery *Radiation *Other treatments *Experimental therapies
  25. 25. Prevention  Lifestyle choices - - smoking, alcohol consumption, DIET  Exercise  Occupational &/or environmental exposures  Stress
  26. 26. Prevention  For a number of cancers (e.g., lung, breast, colon) there are specific lifestyle/dietary factors that increase risk.  Knowledge of your genetic background &/or predisposition to cancer may assist in identifying appropriate means of prevention.
  27. 27. In His Own Words…..
  28. 28. Family, Friends, Nurses, Doctors • Identify a cadre of assistants…family, friends, physicians, nurses • Do a bit of homework before making decisions • Speed is usually less important than surety
  29. 29. Selecting your physician(s) is a very important step… • You will in all likelihood start with a surgeon but if your tests are positive, you may end up with a whole team including a radiologist, an oncologist, and possibly others. • You need at least one of these to be someone with whom you are comfortable and willing to ask questions and feel pretty good with their recommendations – Their recommendations are that…recommendations. – You have the right to seek a different opinion or to ask for a variation on their recommendation…
  30. 30. INFORMED Consent • Ask questions, ask questions, ask questions…. • DO NOT let us use medical- ese or technical explanations you do not understand • If you have a common sense questions, make sure we give you an answer • Don’t sign the permit until you are clear about what you are permitting
  31. 31. What do I do differently…as a physician?  I often share some of my experiences – it increases my credibility  Emphasis on some of the things Dr. Donnelly said – nutrition, sleep, exercise, support  I ask more leading questions to try to tease out those questions patients are reluctant to ask
  32. 32. What lessons did I learn that might be useful for you – either as a patient or as a family member?  Your family is hurting too – share information, allow them to help  Ditto for friends  Different people cope in different ways – allow the patient to set the direction then support them
  33. 33. What things do I recommend for you as patient?  Take it one step at a time – to look at the entire journey is too daunting  Remember – you are in control. You set the pace. You allow the next step.  Science is getting better & better…tomorrow may have new answers.
  34. 34. Protect yourself…no one will care more about your safety than you do…  Sign your site  Learn about medication names and doses  Write them down and check them each time before a dose is given  Ask about how your treatment center assures you are getting YOUR treatment and check before each treatment
  35. 35. Ditto on Dr. Donnelly’s comment- Embrace and enjoy more… Life is short for all of us…cancer just reminds us…
  36. 36. When it is time to move from cure to comfort…  Plan before it is time to implement a decision  Be sure your family is aware of your wishes  Be willing to prompt the physician when you are ready to make the change  Hospice should not be only for the last 2 days
  37. 37. In Our Own Words Dr. Nancy W. Dickey Dr. K. C. Donnelly