Cancer and the Athlete

1. Cancer and the Athlete

2. Breast Cancer: Breast Anatomy • A. ducts • B. lobules • C. dilated section of duct to hold milk • D. nipple • E. fat • F. pectoralis major • G. chest wall/rib cage Enlargement A. normal duct cells B. basement membrane C. lumen (center of duct)

3. Breast Cancer:Anatomy • A. Pectoralis major • B-D: Axillary Lymph Nodes • E. supraclavicular lymph nodes • F. internal mammary lymph nodes

4. Breast Cancer:Intro • To date, most inherited cases of breast cancer have been associated with two genes: • BRCA 1 (Breast Cancer gene1), BRCA 2 (Breast Cancer gene2) • Gene Function: keep breast cells growing normally and prevent cancer cell growth • When cells contain abnormalities or mutations, they are associated with increased cancer risk

5. Breast Cancer:Occurrence • All women are at risk, men-you too!!! • An average of about 1 out of seven women will get breast cancer over a 90-year lifespan • 50% of b.c. diagnosed in women over 65 • For every 100 women with b.c., 1 male will develop it

6. What you eat Decrease red meat, cheese, milk and ice cream How much you weigh and maintaining a healthy weight How much you exercise Whether you smoke Drink alcohol-how much? How often? Types of chemicals in your environment Hormone replacement therapy (estrogen) Breast Cancer:Risk Factors-Controllable

7. Breast Cancer:Risks-Uncontrollable • Age • Risk goes up as you do • Personal history of b.c.-it could return • Family History • Can increase risk, but more reports coming from families of no history

8. Certain breast changes Lump Thickness Calcifications Atypical ductal hyperplasia, etc Genetic alterations BRCA 1 & 2 Late or no pregnancy Menstrual history First one before age 12 or menopause after 55 Exposure to certain hormones Race US: Caucasian-most common Radiation therapy Breast Density “Dense” breasts increase risk Breast Cancer:Risks-Continued

9. Breast Cancer:Diagnosis • The earlier, the better! • Can take weeks due to numerous tests • Screening tests • Mammograms, ultrasound • Diagnostic tests • MRI, blood tests, bone scans, PET scans • Stages 1~4

10. Breast Cancer: DiagnosisFour Types of Breast Cancer • Ductal Carcinoma in situ (DCIS) • Lobular Carcinoma in situ (LCIS) • Invasive Ductal Carcinoma (IDC) • Invasive Lobular Carcinoma (ILC)

11. Breast CancerTreatment & Surgery • Dependent on the stage • Surgery • Breast conserving (lumpectomy) • Mastectomy • Lymph node dissection • Radiation Therapy, Chemotherapy • Herceptin (intravenous drug) • Hormonal Therapy • Tamoxifen (oral) • Acupuncture

12. Ovarian Cancer “Silent Killer” - usually didn’t notice s/s until spread too far S/S mimic digestive & bladder conditions (IBS, stress, depression) S/S will be persistant and gradually worsen, digestive or more situational

13. Ovarian Cancer – S/S Abdominal pressure, fullness, swelling or bloating Urinary urgency Pelvic discomfort or pain Persistent indigestion, gas or nausea Unexplained changes in bowel habits, such as constipation Changes in bladder habits, including a frequent need to urinate Loss of appetite or quickly feeling full Increased abdominal girth or clothes fitting tighter around your waist Pain during intercourse (dyspareunia) A persistent lack of energy Low back pain Changes in menstruation

14. Ovarian Cancer - cause Mostly unknown theory - it has to do with the tissue-repair process that follows the monthly release of an egg through a tiny tear in an ovarian follicle (ovulation) during a woman's reproductive years. The formation and division of new cells at the rupture site may set up a situation in which genetic errors occur. theory - the increased hormone levels before and during ovulation may stimulate the growth of abnormal cells.

15. Ovarian Cancer – risk factors Inherited gene mutations Family history A history of breast cancer Age. Ovarian cancer most often develops after menopause. Your risk of ovarian cancer increases with age through your late 70s. Although most cases of ovarian cancer are diagnosed in postmenopausal women, the disease also occurs in premenopausal women. Childbearing status Infertility Hormone replacement therapy (HRT) Obesity Male hormones. The medication danazol, a male hormone (androgen), is used to treat endometriosis and has been linked to an increased risk of ovarian cancer. More study is needed to further define this association.

16. Testicular Cancer • Testicular Anatomy • Also called testes or gonads • Located behind the penis • Produce sperm and testosterone

17. Testicular Cancer: Introduction • Most common cancer in men age 15-35 but can strike any male, at any time • Caucasians are the most likely group to develop it • Incidence of T.C. doubled over the last 30-40 years • Arise from two types of tumors • Stages I-III

18. What exactly causes it: Unknown Possibly tied to: Males born with undescended testicles (cryptorchidism) Corrected or not Abnormal testicular development Environmental pollutants Injury to scrotum Normal testicular development Testicular Cancer:Risk Factors

19. Testicular Cancer:Signs & Symptoms • A lump in either testicle- size can vary • Any enlargement of a testicle • A change in the consistency of a testicle (hardness) • Heaviness feeling in the scrotum • A dull ache in the lower abdominals or in the groin • A sudden collection of fluid in the scrotum • Pain or discomfort in a testicle or in scrotum • Enlargement or tenderness of the breasts

20. Testicular Cancer:Diagnosis • Again, the earlier, the better! • Complete personal & family history • Complete physical exam • Temp, pulse, BP • Careful scrotal exam • Ultrasound, chest x-ray, blood and urine tests • Inguinal orchiectomy for tissue sample

21. Testicular Cancer:Treatment • Almost always curable-this condition responds well to treatment • Important to find out whether it has spread • CT scan or CAT scan used • Radiation Therapy • Chemotherapy • Surveillance- regular testing

22. Testicular Cancer:Surgery • Inguinal Orchiectomy • RPLND (Retroperitoneal Lymph Node Dissection) • Remove lymph nodes in abdomen • Tumors spread to other areas may be partly or entirely removed

23. Hodgkin’s Disease (Lymphoma)Intro • Uncommon cancer of the lymphatic system • Cells in the lymphatics grow abnormally and may spread beyond • As it progresses, it compromises your body’s ability to fight infection

24. Hodgkin’s vs. Non-Hodgkin’s Lymphoma Presents of Reed-Sternberg cell As Hodgkin’s has decreased over past 30 years (1% of cancers) , Non-Hodgin’s has increased by more than 70% NHL – age 40-70, but some subtypes (29 different) are most common in children; more common in males & caucasians

25. Hodgkin’s DiseaseOccurrence • Most commonly affects people between the ages of 15-40 and 55+ • Each year ~1,300 Americans die of this • This once highly fatal disease is now highly treatable

26. Hodgkin’s DiseaseCauses • Exact cause is unknown • Abnormal B cells form, do not die as they should and keep producing more abnormal cells

27. Hodgkin’s DiseaseRisk Factors • Family History • May also be related to environmental exposures • Gender: males are more likely to develop it • Compromised immune system: HIV/AIDS, Organ transplant with meds to suppress immune system response

28. Hodgkin’s DiseaseSigns & Symptoms • Initially • Similar to flu; fever, fatigue, night sweats • Eventually tumors may develop • Painless swelling of lymph nodes in your neck, armpits or groin

29. Hodgkin’s DiseaseDiagnosis • Difficult to diagnose due to similarities to other conditions • Orderly spread: the pattern is orderly, progressing from one group of nodes to the next • Only rare skipping: the disease rarely skips over an area of lymph nodes as it spreads

30. Hodgkin’s DiseaseDiagnosis • Biopsy of enlarged lymph node is needed • Changes in make-up and characteristics (presence of Reed Stemberg cells-abnormal B cells) • X-rays, CT scan, MRI • PET scan (positron emission tomography) • Bone marrow biopsy • Blood tests • Exploratory surgery if disease predominantly in abdomen • Stages I-IV

31. Hodgkin’s DiseaseTreatment • Depends on: • Stage of disease • Number and regions of lymph nodes affected • Whether one or both sides of diaphragm involved • Age • Symptoms • Pregnant • Overall health status

32. Goal: Destroy as many malignant cells as possible Bring disease into remission Stage I/II: 80%+ survive 10+ years with proper treatment Widespread Hodgkin’s: 60% live for 5 years Options Radiation Chemotherapy Bone marrow transplant Coping Know what to expect Strong support system Time for self Hodgkin’s DiseaseTreatment

33. Detection/PreventionBreast Cancer: Self Exam -Step 1 • Begin by observing your breasts in the mirror • Look for: • Usual size, shape, color • Evenly shaped without distortion or swelling • Bring to doctor’s attention if you find: • Dimpling, puckering, bulging of skin • Change in nipple position • Redness, soreness, rash or swelling

34. Breast Cancer:Self Exam-Step 2 & 3 • Raise arms and look for same changes • While at mirror, gently squeeze each nipple between finger and thumb • Check for discharge • Milky, yellow or blood

35. Breast Cancer:Self Exam-Step 4 • When lying down, feel breast with first 2 fingers • Firm, smooth touch • Cover top to bottom, side to side

36. Breast Cancer:Self Exam-Step 5 • Feel when standing or sitting • Suggestion: wet the skin • Cover breast in same manner (movements)

37. Testicular Cancer:Self-Exam 1 • Starting at age 15 is an effective way to detect t.c. at an early-and very curable- stage • Best performed after a warm shower or bath • Heat relaxes the scrotum, making it easier to spot abnormalities • Stand in front of the mirror • Check for scrotal skin swelling

38. Testicular Cancer:Self-Exam Step 2 • Examine each testicle with both hands • Place index & middle fingers under the testicle with thumbs on top • Roll testicle gently between thumbs and fingers • You shouldn’t feel any pain • If one seems slightly larger, its normal

39. Testicular Cancer:Self-Exam Step 3 • Find the epididymis-the soft, tubelike structure behind the testicle-Do not mistake this for a lump • Cancerous lumps are usually found on the sides of the testicle, but can also show on the front • Lumps on the epididymis are not cancerous

40. Cancer in General • Any unusual symptoms should be reported without delay!! • Follow-up doctor exams as well as self-exams are very important! • Follow-up care depends on the different types and stages of cancer

41. How Activity Helps Athletes Psychologically • Aspect-Just as important • Enjoyable, has meaning and purpose • Builds confidence • Facilitates sense of control • Develops new skills • Social interaction • Makes use of mind & spirit • Keep them involved with their Team

42. Some References • MayoClinic.org • Breastcancer.org • Nationalbreastcancer.org • Schnirring, Lisa. (2004). Can Exercise Improve Breast Cancer Survival? The Physician and Sports Medicine. Vol 32: Issue 5.