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Introduction

Introduction. Statistics History. Origin . Word cancer Greek Hippocrates (460-370 B.C.) Carcino: non-ulcer forming Carcinoma: ulcer forming Refer to finger like spreading of disease and blood vessels which are akin to crab shape. American Cancer Society. Main Concerns. Abnormal growth

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Introduction

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  1. Introduction • Statistics • History

  2. Origin • Word cancer • Greek Hippocrates (460-370 B.C.) • Carcino: non-ulcer forming • Carcinoma: ulcer forming • Refer to finger like spreading of disease and blood vessels which are akin to crab shape American Cancer Society

  3. Main Concerns • Abnormal growth • Principal health hazard- malignant nature, invade and metastasize • Given advances in public health (sanitation, drugs and vaccines) infectious diseases have subsided resulting in CANCER AND HEART DISEASE AS MAJOR CAUSES OF DEATH

  4. General Statistics • Over 1 million new cancer cases expected 2003 (1,334,100) • In U.S.: 1/4 deaths caused by cancer • 1/2 American men • 1/3 American women American Cancer Society

  5. Statistics • 8.9 million Americans with cancer alive 1999 • Since 1990- 17 million new cases diagnosed American Cancer Society

  6. Deaths • Cancer 2nd leading cause of death in U.S. (1st heart disease) • 556,500 Americans expected die • 1,500 deaths per day American Cancer Society

  7. History • 3000-1500 B.C. Egyptian papyri describe breast cancer 8 cases of tumors Treated by cauterization (“the fire drill”) Writings say that “There is no treatment” • 1900-1600 B.C. Oldest specimen cancer Female skull:head/neck cancer & osteosarcoma www.rare-cancer.org/history.html American Cancer Society

  8. History • 2400 years ago Peruvian Incas Malignant melanoma • 1932 Louis Leakey Found oldest hominod malignant tumor Remains Homo erectus or Australopithecus Suggestive Burkitt’s lymphoma www.rare-cancer.org/history.html American Cancer Society

  9. History of diagnosis • 1761 Giovanni Morgagni Autopsies Relate patient’s illness to pathogenesis • 1728-1793 John Hunter Cancer treatment via surgery Decide which cancers to treat If tumor has not invaded nearby tissue and is movable then “there is no impropriety in removing it”. www.rare-cancer.org/history.html American Cancer Society

  10. History of diagnosis • 19th century Rudolf Virchow • Founder of cellular pathology • Using microscopes conducted modern pathologic study • Tissues removed by surgeon could now be examined • Greater role for pathologists • Assist surgeons in determining whether all cancerous tissue was removed www.rare-cancer.org/history.html American Cancer Society

  11. History of diagnosis • 19th century Stephen Paget • “Seed and Soil” Theory • Metastic tumor cells are seed, evenly distributed throughout body • Seeds only grow in appropriate conditions, called soil • 1896 William Roentgen (German prof.) • Discovered x-rays • Used to detect and then for treatment www.rare-cancer.org/history.html American Cancer Society

  12. Finding the cause • Middle ages- excess black bile collecting in various body sites • 18th century- fermenting & degenerating lymph fluid • 1800s/early 1900s- trauma chronic irritation , viral and cellular deviations www.rare-cancer.org/history.html

  13. Finding the cause • 1761- John Hill • Connection with use of tobacco • “Cautions against the Immoderate Use of Tobacco” • 1775- Percivall Pott • Occupational hazard • Cancer of the scrotum in chimney sweep caused by soot collection www.rare-cancer.org/history.html

  14. Finding the cure • 2nd century Galen (Greek physician) • 1st oncologist • Galen and Hippocrates believed cancer is side effect of melancholia • Cancer incurable • 17th century Adrian Helvetius • Performed lumpectomy & mastectomy for breast cancer: claimed curative procedure • 1728-1793 John Hunter believed cancers cured by surgery www.rare-cancer.org/history.html

  15. Finding the cure • 1880s/90s William Stewart Holsted • Remove breast, underlying muscle and lymph node tissue under the arm • Achieved 72% 5-year cure rate if disease not spread to adjoining glands • 1899 radiation by x-ray • WWI/II mustard gas • Exposure leads to low WBCs • 1940s given I.V., not inhaled www.rare-cancer.org/history.html

  16. Survival • 62% survival for all cancers combined • Considerations: living 5 years post-diagnosis • Disease-free • In remission • Under treatment with evidence of cancer

  17. Costs • 2002 $171.6 billion • $60.9 billion (35%) direct medical • $15.5 billion (9%) indirect morbidity • $95.2 billion (56%) indirect mortality • Lack of health care for many patients American Cancer Society

  18. California • Most new cancer cases 125,000 • Most cancer-related deaths 52,200

  19. Types of Cancer • 11 different types of cancer= 80% of all cancers in the U.S.

  20. Most Frequent Types of Cancers • Skin 600,000 • Lung • Colon/rectum • Breast • Prostate

  21. Change in cancer frequencies • Increase in lung cancer • Decrease in stomach, uterine cervix cancers

  22. Cancer Death Rates*, for Men, US, 1930-1999 Rate Per 100,000 Lung Prostate Stomach Colon and rectum Pancreas Leukemia Liver *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes 1960-1999, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002.

  23. Cancer Death Rates*, for Women, US,1930-1999 Rate Per 100,000 Lung Uterus Breast Colon and rectum Stomach Ovary Pancreas *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes 1960-1999, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002.

  24. 2003 Estimated US Cancer Deaths* Men285,900 Women270,600 Lung & bronchus 31% Prostate 10% Colon & rectum 10% Pancreas 5% Non-Hodgkin 4%lymphoma Leukemia 4% Esophagus 4% Liver/intrahepatic 3%bile duct Urinary bladder 3% Kidney 3% All other sites 22% • 25% Lung & bronchus • 15% Breast • 11% Colon & rectum • 6% Pancreas • 5% Ovary • 4% Non-Hodgkin lymphoma • 4% Leukemia • 3% Uterine corpus • 2% Brain/ONS • 2% Multiple myeloma • 23% All other sites ONS=Other nervous system. *Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: American Cancer Society, 2003.

  25. Why we don’t have a cancer cure? • Cancer is self • Drugs are against rapidly dividing cells • Need to find unique properties of cancerous cells

  26. Classification • 2 methods to classify cancer • Histology: which tissue it originates • Primary site: location in the body http://training.seer.cancer.gov/module_cancer _disease/unit3_categories2_by_histology.html

  27. Histology • Carcinoma • Sarcoma • Myeloma • Leukemia • Lymphoma • Mixed Types http://training.seer.cancer.gov/module_cancer _disease/unit3_categories2_by_histology.html

  28. Carcinoma • Epithelium: lining of the body, skin, internal organs, 80-90% cancers • 2 subtypes • Adenocarcinoma • Organ/gland • Mucous membranes • At first-plaque like white mucosa • Squamous cell carcinoma: squamous epithelium http://training.seer.cancer.gov/module_cancer _disease/unit3_categories2_by_histology.html

  29. Sarcoma/Myeloma • Sarcoma • Supportive/connective tissue • Bones, tendons, cartilage, muscle, fat • In young adults: painful mass • Myeloma • Plasma cells of the bone marrow http://training.seer.cancer.gov/module_cancer _disease/unit3_categories2_by_histology.html

  30. Leukemia • “Liquid cancers” or “blood cancers” • Cancers of the bone marrow • Overproduction of immature white blood cells • Dysfunctional cells • Patients susceptible to infection • Can also impact RBCs- poor clotting, fatigue and anemia http://training.seer.cancer.gov/module_cancer _disease/unit3_categories2_by_histology.html

  31. Lymphoma • “solid cancers” • Glands or nodes of the lymphatic system • Vessels, nodes, organs or lymphocytes • Specific organs- stomach, brain, breast • 2 subtypes • Hodgkins: contains Reed-Sternberg cells • Non-Hodgkins http://training.seer.cancer.gov/module_cancer _disease/unit3_categories2_by_histology.html

  32. Primary Sites • Skin • Lung • Breast • Prostate • Colon and rectum • Uterine Corpus http://training.seer.cancer.gov/module_cancer _disease/unit3_categories2_by_histology.html

  33. Skin • Basal cell, squamous cell • Face, ears, extremities • Treatable if detected and treated early • Melanoma • Melanocytes: pigment cells present in deepest layers of skin • More lethal due to quick metastasis http://training.seer.cancer.gov/module_cancer _disease/unit3_categories2_by_histology.html

  34. Lung • Difficult to detect due to lack of symptoms • When disease advanced • Persistent cough • Sputum w/ blood • Chest pain • Chronic pneumonia/ bronchitis • Greatest increase in cancer types due to increased smoking http://training.seer.cancer.gov/module_cancer _disease/unit3_categories2_by_histology.html

  35. Breast • 1 in 8 women develop disease • Ductal carcinoma • Women more likely when • >50 yrs age • Cancer in 1 breast • Mother/sister • Overweight / high fat diet • Early menarche/ late menopause http://training.seer.cancer.gov/module_cancer _disease/unit3_categories2_by_histology.html

  36. Breast • Prevention regimens • Monthly breast exams • Most lumps not cancerous • Periodic mammograms after 40 yrs age http://training.seer.cancer.gov/module_cancer _disease/unit3_categories2_by_histology.html

  37. Prostate • Prostate enlarge and block urethra/bladder • Symptoms • Weak/ interrupted flow • Urinating often • Difficulty urinating • Pain/burning, blood in urine • Pain in back, hips, pelvis • Often no symptoms http://training.seer.cancer.gov/module_cancer _disease/unit3_categories2_by_histology.html

  38. Colon/Rectum • In large intestine, 70% colon, 30% rectum • Symptoms • Blood in stool • Constipation • Diarrhea http://training.seer.cancer.gov/module_cancer _disease/unit3_categories2_by_histology.html

  39. Uterine Corpus • Uterus • Most frequently >60 yrs age • Symptoms: abnormal uterine bleeding • No/ little insight into causes http://training.seer.cancer.gov/module_cancer _disease/unit3_categories2_by_histology.html

  40. Environmental Factors • Lifestyle choices • Natural and medical radiation • Workplace exposures • Drugs • Substances in air, water and soil • Infectious diseases http://ehp.niehs.nih.gov/roc/tenth/intro.pdf

  41. Carcinogens • Agents that cause cancer • Types 1)React w/ DNA mutations alter function of regulatory genes 2)Stimulate cell proliferation enhance initial outgrowth of cells 3)Inhibit normal function of immune system

  42. Studies • Epidemiological studies • Natural experiments • Animal studies • Laboratory tests http://www.intelihealth.com/IH/ihtIH/WSIHW000/8096/8363/185432.html?d=dmtContent

  43. Genetic vs. Environmental • Assess epidemiologic studies with target populations • 1st generation vs 2nd generation migratory population • Example Japanese in Hawaii and California whose cancer incidence went from Japanese levels to American

  44. 10 ten environmental risks Risk Factor Lifetime Risk 1. Excessive sun exposure 1 in 3 2. Cigarette smoking (one pack or + p/day) 8 in 100 3. Natural radon in indoor air at home 1 in 100 4. Outside radiation 1 in 1,000 5. Environmental tobacco smoke (in room with a smoker) 7 in 10,000 6. Human-made chemicals in indoor air at home 2 in 10,000 7. Outdoor air in industrialized areas 1 in 10,000 8. Human-made chemicals in drinking water 1 in 100,000 9. Human-made chemicals in most foods (including pesticides) 1 in 100,000 or less 10. Chemical exposure at uncontrolled hazardous-waste sites 1 in 10,000 to 1,000 http://www.intelihealth.com/IH/ihtIH/WSIHW000/8096/8363/185432.html?d=dmtContent

  45. Classification scheme • Known to be carcinogen • Reasonably accepted to be human carcinogen http://ehp.niehs.nih.gov/roc/tenth/intro.pdf

  46. http://ehp.niehs.nih.gov/roc/tenth/intro.pdf

  47. Tobacco • CIGARETTE SMOKING RESPONSIBLE FOR 1/3 OF ALL CANCER DEATHS • Exact carcinogen(s) in tobacco smoke unknown • Contributes 80-90% of lung cancers • Other cancers: oral cavity, pharynx, larynx, esophagus, bladder, kidney, pancreas

  48. Lung cancer • Incidence lung cancer 10x greater since 1930 • Lag time 20 years between increase smoking and resultant increase in lung cancer • Impact of smoking • Amount of smoking • Years of smoking • Inhalation • Smoke cessation results in “catch-up” with non-smokers

  49. Alcohol • Excessive alcohol results increased risk • Oral cavity • Pharynx • Larynx • Esophagus • Liver- cirrhosis leads to excessive cell proliferation

  50. Synergism • Effects alcohol exerted in combination with smoking • In animals, alcohol, individually, weak carcinogen • Could be other ingredients, not alcohol • Synergism could account for many other cancers

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