Cancer

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Cancer
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What is Cancer?

• Group of diseases characterized by new cells that
  divide and grow unrestrained.
• Johannes Muller discovered that tumors were made
  up of cells.
• Neoplasm New growth. Neoplastic growths rob
  nutrients and provide no benefit to the organism

Ovarian Cancer Cell
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Four Types of Malignant Growth

• Carcinoma- Epithelial tissue cancers. Smooth
  linings of inner outer surfaces of body.
• Sarcoma- Connective tissue involvement, bone,
  cartilage, and muscle.
• Leukemia- Cancers arising in the blood, stem
  cells in bone marrow.
• Lymphoma- Cancer of the lymphatic system.
• Carcinomas account for about 85 of all cancers.
  Another 10 are Sarcomas and Leukemias.
• Carcinoma rates increase with age. Sarcoma, which
  accounts for about 2 of cancers, has a constant
  rate across the lifespan

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Carcinoma

• Risk increases with age, probably due to
  cumulative effects of exposure to environmental
  carcinogens.

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Types of Neoplasms

• Benign Remain localized, in one place.
• Malignant tend to spread, or metastasize, and
  establish secondary colonies. They destroy
  surrounding tissue
• Cells seem to be limited to about 50 divisions in
  a lifetime. Cancer cell have no such limits and
  become like a parasite.

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Metastasis

• Refers to the ability of cancers to spread via
  the blood and lymph systems.
• New cell colonies established at sites distant
  from the original tumor.

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Metastasis
Vascularization
Growth of Tumor
Invasion
Attachment to endothelium
Transport Interaction with Vascular Components
Underlapping
Overlapping
Retraction
Invasion through Basement Membrane
Establishment of Micrometastases
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Skin Cancers

• Melanoma Most dangerous form of skin cancer
  because it metastasizes. Cancer arising in the
  Melanin, or skin pigment.
• A Asymmetry
• B Border Irregularity
• C Color Variation
• D Diameter 6 mm, or about the size of a
  pencil eraser

Maureen Reagan died of metastatic melanoma (brain
and bone involvement) in 2001 at age 60.
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Basal and Squamous Cell Carcinomas

• Basal cell carcinoma affects 800,000 Americans
  each year. It is the most common of all cancers
• Squamous cell carcinoma, the second most common
  skin cancer, afflicts more than 200,000 Americans
  each year. Squamous cell cancers may occur on all
  areas of the body including mucous membranes.
• Both are most common in areas exposed to the sun

Basal Cell Carcinoma
Squamous Cell Carcinoma
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Kaposis Sarcoma

• Rare form of skin cancer, but not uncommon among
  AIDS patients.
• May be fatal if lungs or other internal organs
  are affected.

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Breast Cancer
7 cents from the sale of each stamp went to fund
breast cancer research
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Breast Anatomy
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Ethnicity and Breast Cancer
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Tamoxifen and Breast Cancer
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Prostate Cancer
Prostate Anatomy
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Prostate Cancer Deaths by Age
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Digital Rectal Exam for Prostate Tumors
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Prostate Cancer
Stage A Deep tumor. May not be detected by
digital-rectal exam
Stage B Tumor may be detected by DRE or
ultrasound
Stage D Metastasis to bone and lymph nodes
Stage C Spread to surrounding tissue
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Trans-urethral Resection
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Colorectal Cancer
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Development of Colon Cancer
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Eric Davis

• In June 1997, at age 34, he underwent surgery to
  remove a baseball-sized colorectal cancer tumor.
  By September he was back in the line-up.

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Screening for Colon Cancer

• British advertising campaign to prompt screening
  for colon cancer.

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Brain Cancer

• Glioma, or cancer arising in the glial cells of
  the brain. Note its position inside a ventricle.

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Brain Cancer
MRI showing no tumor (left) and three months
later (right)
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Behavioral Risk Factors

• Smoking
• Diet
• Alcohol
• Exercise
• Ultraviolet Light
• Sexual Behavior

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Smoking

• Primary cause of preventable death in the U.S.
  (400,000/year)
• About 90 of lung cancer cases are smoking
  related (80 in women).
• Smoking is also related to other forms of cancer
  (e.g, bladder, pancreas, leukemia).
• Relative risk of lung cancer is about 9 times
  greater in smokers than in nonsmokers.
• Smokers tend to show and optimistic bias and
  underestimate the risks associated with smoking.

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Safe Smoking?

• Cigars and Pipes carry relative risks of 2.9 and
  2.5, respectively for lung cancer. Lower than for
  cigarettes, but still considered moderate.
• Cigars Cigarettes RR 6.9
• Pipes Cigarettes RR 8.1

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Diet
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Alcohol

• Alcohol implicated in cancers of tonsils, tongue,
  pancreas, and liver.
• Alcoholism associated with cirrhosis of the
  liver, and cirrhotic livers more prone to cancer.
• Liver cancer is not a leading cause of death
  among alcoholics, however.
• Alcohol interacts with smoking to increase risk
  of laryngeal cancer.

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Exercise
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Ultraviolet Light

• Sun exposure, fair skin, and not using sunscreen
  are risk factors for skin cancer.
• Lifetime exposure and occasional severe sunburn
  increase risk of skin cancer.
• Wear sunscreen and protective clothing. Young,
  white men with no skin cancer history are the
  least likely to take precautions

Malignant melanoma is a form of skin cancer that
can be fatal. Other forms generally dont
contribute to cancer mortality.
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Sexual Behavior

• Kaposis Sarcoma and Non-Hodgkins Lymphoma are
  related to AIDS.
• Invasive cervical cancer risk factors
• 1. Multiple partners
• 2. Low SES
• 3. Early 1st sexual experience
• 4. Early pregnancies
• 5. Male sex partners who have had
  multiple partners

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Environmental Risk Factors

• Radiation
• Asbestos
• Pesticides
• Benzene
• Nickel
• Vinyl Chloride
• Some Petroleum Products

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Environmental Risk Factors Evidence

• Nuclear power plant workerscancer death rates
  increase with increased radiation exposure (men
  only).
• Also, death rates from cardiovascular disease
  (men and women) and accidents (men only)
  increased.
• Radiation exposure contributes to all-cause
  mortality in these workers

Living near a nuclear power plant does not
increase cancer risk.
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Power Lines

• No evidence that living near power lines
  increases cancer risk.
• Occupational exposure to magnetic fields also
  unrelated to cancer risk.

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Aspartame

• No evidence that Aspartame (Nutrasweet) is
  related to brain cancer.
• Aspartame is metabolized to aspartic acid,
  phenylalanine, and methanol, which occur
  naturally in larger quantities in many other
  foods.
• Because it breaks down into these components
  before absorption, it has no opportunity to
  affect organs.

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Inherent Risk Factors

• Family History
• Ethnic Background
• Age

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Family History
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Ethnic Background
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Age
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Psychological Risk Factors

• Depression no clear relationship to cancer. No
  relationship between depression and incidence of
  cancer and no evidence of a causal relationship

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Suppression of Emotion

• No evidence of a cancer-prone, or Type C
  personality.
• Suppression of emotion shows a consistent
  relationship with cancer incidence.

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30-year Prospective Follow-up Study of Emotional
Suppression and Cancer Incidence
1 Cancer Incidence
Acting Out
Loners
Emotional Suppression
16 Cancer Incidence
30 years later
Beginning of Study

• Shaffer, J.W., Graves, P.L., Swank, R.T.,
  Pearson, T.A. (1987). Clustering of personality
  traits in youth and subsequent development of
  cancer among physicians. Journal of Behavioral
  Medicine, 10, 441-447.

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Cancer Survival and Psychosocial Factors

• Cancer patients who are depressed, anxious,
  guilty, and alienated live longer than
  hopeless/helpless patients. Fighting Spirit.
• Married cancer patients live longer than
  unmarried cancer patients, even when controlling
  for early diagnosis and treatment among married
  patients.
• Married patients have a greater degree of social
  support and more extensive social networks.
  These provide
• 1. Access to information
• 2. Sense of personal control
• 3. Self Esteem
• 4. Optimism

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Psychotherapy and Survival

• Psychotherapy can help alleviate stress and
  increase sense of well-being.
• The ability of psychotherapy to extend survival
  time is less well-established.
• Speigel, et.al, (1989) found that women with
  metastatic breast cancer lived about 18 months
  longer if they received weekly, 90-minute,
  support group meetings, compared to women who
  received only medical treatment. Assignment to
  treatment conditions was random.

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Psychotherapy and Survival

• Review of literature on psychotherapy and cancer
  survival was less impressive. Some studies were
  able to show a benefit, some were not.
• Studies that showed a benefit for psychotherapy
  had the following components
• 1. Social support
• 2. Group therapy with patients who
• have the same cancer
• 3. An educational component
• 4. Training in coping strategies