Cancer
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Cancer 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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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

Growth of Tumor

Vascularization

Invasion

Attachment to endothelium

Transport Interaction with Vascular Components

Retraction

Underlapping

Overlapping

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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Kaposi’s 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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Prostate Cancer

Prostate Anatomy




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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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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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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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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 don’t contribute to cancer mortality.


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Sexual Behavior

  • Kaposi’s Sarcoma and Non-Hodgkin’s 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 workers:cancer 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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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”

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.

Loners & Emotional Suppression

16% Cancer Incidence

30 years later

Beginning of Study


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Cancer Survival and Psychosocial Factors and Cancer Incidence

  • 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 and Cancer Incidence

  • 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 and Cancer Incidence

  • 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


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