CANCER

Looking Back

2

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

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

3

Source: Courtesy of the National Library of Medicine

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

4

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.

CANCERBiology of Cancer

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

6

p425

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.

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

8

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)

9

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

Leading U.S. Causes of Death, 200612

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 5.1

5. Accidents (unintentional injuries)

121,599 5.0

6. Diabetes mellitus 72,449 3.0

7. Alzheimer’s disease 71,432 3.0

8. Influenza & pneumonia

56,326 2.3

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

Men292,540

Women269,800

•26% Lung & bronchus

•15% Breast

• 9% Colon & rectum

• 6% Pancreas

• 5% Ovary

• 4% Non-Hodgkin lymphoma

• 3% Leukemia

• 3% Uterine corpus

• 2% Liver & intrahepaticbile duct

• 2% Brain/ONS*

•25% All other sites

Lung & bronchus 30%

Prostate 9%

Colon & rectum 9%

Pancreas 6%

Leukemia 4%

Liver & intrahepatic 4%bile duct

Esophagus 4%

Urinary bladder 3%

Non-Hodgkin 3% lymphoma

Kidney & renal pelvis 3%

All other sites 25%

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

0

20

40

60

80

10019

30

1935

1940

1945

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

Lung & bronchus

Colon & rectum

Stomach

Rate Per 100,000

Prostate

Pancreas

LiverLeukemia

*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 Women, U.S.,1930-2004

*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.

Uterus

0

20

40

60

80

100

1930

1935

1940

1945

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

Lung & bronchus

Colon & rectumStomach

Breast

Ovary Pancreas

Rate Per 100,000

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, socioeconomic groupings, gender groups, or other groupings.”

LaVeist, T. (2005). Minority populations and health: An introduction to health disparitiesin the united states. San Francisco : Jossey-Bass.

19

Cancer Incidence Rates* by Race and Ethnicity, 2000-2004

556.7

359.9321.2

423.9396.9

285.8 282.4314.2

663.7

421.3

0

100

200

300

400

500

600

700

800

White African American Asian/Pacific Islander American Indian/Alaska Native

Hispanic†

Men Women

Rate Per 100,000

*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, 2010http://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 andPopulation Sciences, National Cancer Institute, 2007.

20

Cancer Death Rates* by Race and Ethnicity, U.S., 2000-2004

White African Amer-ican

Asian/Pacific Is-lander

American In-dian/ Alaskan

Native

Hispanic†0

50

100

150

200

250

300

350

400

234.7

321.8

141.7

187.9162.2161.4

189.3

96.7

141.2

106.7

Men Women

*Per 100,000, age-adjusted to the 2000 US standard population. † Persons of Hispanic origin may be of any race. From the Cancer Statistics 2008: A Presentation from the American Cancer Society, Retrieved May 28, 2010 http://www.acsevents.org/downloads/STT/Cancer_Statistics_2008.ppt#428,9,Cancer Death Rates* by Race and Ethnicity, US, 2000-2004Source: Surveillance, Epidemiology, and End Results Program, 1975-2004, Division of Cancer Control andPopulation 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

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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

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

04/10/2023Chapter fifteen © 2012 McGraw-Hill Higher Education. All rights reserved. 33

Testicular CancerSymptoms• 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

04/10/2023Chapter fifteen © 2012 McGraw-Hill Higher Education. All rights reserved. 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

Forman et al. Ann Rev Nutr, 2004

ion