2. Objectives
• Gain a basic understanding of the normal cell
cycle and how cancer develops
• Appreciate the variations in cancer rates
amongst the different ethnicities and between
genders
• Understand the risk factors and symptoms of
common cancers, including lung, colon, skin,
breast, and prostate cancers
• Apply knowledge to a case study
3. Introduction
Mitosis
• Cancer is the
uncontrolled spread and
growth of abnormal cells
in the body.
• Normal cells know when
to multiply or die, but
cancer cells do not.
4. Not all tumors are
cancer!
• Benign tumors: Abnormal growth of cells that
form a mass
• Do not typically metastasize (spread) or recur
after being removed
• Can still cause problems by compressing nerves
or blood vessels.
• Malignant=Cancer!
5. Case Study – Part 1a
• A 46-year-old overweight Caucasian woman
comes into the doctor’s office for a
mammogram. She is nervous because one
week ago, while showering, she felt a mass in
her left breast and a “lump” in her left axilla
(armpit).
• Besides the palpable masses, what other parts
of this woman’s history are relevant?
• What additional questions would you want to
ask?
6. Case Study – Part 1b
• Besides the palpable masses, what other parts
of this woman’s history are relevant?
• 46 years old – increasing age is a risk factor
• Caucasian – higher rates of breast cancer in
Caucasian women
• Overweight – increasing weight is a risk factor
• What additional questions would you want to
ask?
• Past history?
• Family history?
• Diet, exercise, smoking, alcohol habits?
7. Case Study – Part 1c
• The woman states that she has no previous
history of benign breast tumors, but her mother
was diagnosed with breast cancer at 48 and
successfully treated. Her diet is heavy in fatty
foods and she rarely exercises. She denies
smoking and consumes 1-3 alcoholic drinks a
week.
9. Demographics
Race/Ethnicity New Cases (per 100,000) New Cases (per 100,000)
Male Female
All Races 541.8 412.3
White 542.7 423.1
Black 627.1 398.3
Asian/Pacific Islander 342.6 299.4
American Indian/Alaska 352.7 313.8
Native
Hispanic 402.0 324.1
Rates are based on cases diagnosed in 2005-2009 from the National Cancer
Institute’s Surveillance Epidemiology and End Results (SEER)
10. Gender-Male
Type Risk of Risk of Dying
Developing From
Percent (%) 1 in Percent (%) 1 in
All invasive sites 44.29 2 23.20 4
Prostate 16.22 6 2.79 36
Lung and bronchus 7.67 13 6.95 14
Bladder (includes in situ) 3.80 26 0.85 118
Melanoma of the skin 2.36 42 0.40 250
Non-Hodgkin lymphoma 2.30 43 0.88 114
Kidney and renal pelvis 1.88 53 0.60 167
Leukemia 1.52 66 1.00 100
Liver and bile duct 1.06 94 0.77 130
11. Gender-Female
Type Risk of Risk of Dying
Developing From
Percent (%) 1 in Percent (%) 1 in
All invasive sites 37.76 3 19.58 5
Breast 12.15 8 2.81 36
Lung and bronchus 6.35 16 5.05 20
Colon and rectum 4.97 20 2.01 50
Uterine corpus 2.58 39 0.53 189
Non-Hodgkin lymphoma 1.92 52 0.73 137
Melanoma of the skin 1.56 64 0.21 476
Pancreas 1.41 71 1.26 79
Thyroid 1.34 75 0.07 1,429
12. Cancer Symptoms
• Sometimes there may be no symptoms at all, or
symptoms at very late stages
• Common symptoms include: unexplained
weight loss, fatigue, fever, pain, skin changes
• Screening by a doctor is the best way to detect
cancer early
13. Lung Cancer – Risk
Factors
• Cigarette Smoking:
• About 90% of lung cancers arise through cigarette
smoking.
• Risk depends on how long a person has smoked,
the amount of cigarettes smoked, and the age at
which smoking began
• Other Risk Factors: second hand smoke, air
pollution, asbestos, chronic lung diseases
(Tuberculosis, COPD), radon exposure
• Radon is a by-product of radium, present in indoor
and outdoor air.
• About 12% of lung cancer deaths are attributed to
radon
14. Lung Cancer –
Symptoms
• Coughing
• Coughing up blood
• Shortness of breath
• Fatigue
• Wheezing
• Pain in the chest, shoulder,
upper back, or arm
• Repeated pneumonia or
bronchitis
• Loss of appetite and
weight loss
• General pain http://cancertypes.tk/wp-
content/uploads/2011/01/Lung_Cancer3.jpg
• Hoarseness
• Swelling of face or neck
• Pleural effusion
15. Colon Cancer – Risk
Factors
• Most develop as colorectal polyps that later become
cancerous
• Genetic: if a family member has had colon cancer,
the risk is significantly higher
• Cigarette smoking
• Diet: High fat, low calcium, folate, and fiber increase
risk
• Diets low in fruits and vegetables may also increase
risk
• Ulcerative colitis and Crohn’s disease
16. Colon Cancer –
Symptoms
• Change in bowel habits,
including diarrhea,
constipation or a change in
the consistency of stool for
greater than 2 weeks
• Rectal bleeding or blood in
stool
• Persistent abdominal
discomfort (cramps, gas,
pain)
• A feeling that your bowel
doesn't empty completely http://trialx.com/curetalk/wp-
content/blogs.dir/7/files/2011/05/diseases/Colon_Cance
r-3.jpg
• Weakness or fatigue
• Unexplained weight loss
17. Skin Cancer – Risk
Factors
• UV Rays
• UVB rays cause a much greater risk than UVA
• UVA rays increase the damaging effects of UVB
• As elevation increases, UV light gets stronger
• Heredity: family history
• People with fair skin and a northern European heritage appear
to be most susceptible
• Multiple or atypical moles
• Exposure to coal and arsenic compounds
• Repeated exposure to x-rays
• Scars from disease and burns
18. Skin Cancer –
Symptoms
• Any change on the skin, especially in the size or
color of a mole or other darkly pigmented
growth or spot, or a new growth
• Scaliness, oozing, bleeding, or change in the
appearance of a bump or nodule
• The spread of pigmentation beyond its border
• Ex. dark coloring that spreads past the edge of a
mole or mark
• A change in sensation, itchiness, tenderness, or
pain
19. Skin Cancer - ABCDE
• ABCDE is a mnemonic that can help differentiate between
benign moles and moles that should be examined by a
physician.
• A – asymmetry
• B – border (blurry or jagged border)
• C – color (more than one hue)
• D – diameter (larger than a pencil eraser)
• E – elevation (raised above the surface of the skin)
• If a mole has any of these characteristics, have it examined by
a physician.
20. Case Study – Part 2a
• A density (next slide) in the left breast was seen
on the mammogram and the doctor ordered an
ultrasound. The ultrasound (next slide) revealed
the size of the breast mass to be 15 x 14 x 15
mm and the axillary mass to be 35 x 29 x 14
mm. The doctor referred the woman to a
surgeon who biopsied both masses. He also
ordered a chest X-ray and a bone scan.
• Why were a chest X-ray and bone scan
ordered?
22. Case Study – Part 2c
• Why were a chest X-ray and bone scan ordered?
• The doctor ordered these scans to ensure that no other tumors
existed in the patient.
• An MRI confirmed the malignancy in the left breast and
enlarged lymph node. It also showed no satellite lesions and a
normal right breast. The surgeon referred the patient to a
medical oncologist and a radiotherapist and the plan is for her
to undergo neo-adjuvant chemotherapy, followed by surgery,
and then radiation therapy.
• What is neo-adjuvant chemotherapy?
23. Breast Cancer – Risk
Factors
• Gender and Race
• Caucasian women are
more likely to develop
breast cancer than Age Risk to
African-American develop in
women next 10 years
• Age 30 1 in 280
40 1 in 70
• Genetics
50 1 in 40
• 5-10% of breast cancer
are hereditary 60 1 in 30
• BRCA1/BRCA2 are
abnormal genes that, if
inherited, increase the
lifetime risk 40-85%
24. Breast Cancer – Risk
Factors
• Hormones
• Early onset of menstruation (11 years or younger) or late
menopause (55 years or older) have slightly increased
risk
• Lifestyle and diet
• High dietary intake of fat
• Being overweight or obese
• Alcohol
• Regular exercise may decrease the risk
• Benign breast disease
• Predispose to later development of breast cancer
• Environmental
• Radiation treatment increases risk much later on
25. Breast Cancer –
Symptoms
• Breast lump or lump in the
armpit that is hard, has
uneven edges, and usually
does not hurt
• Change in the size, shape, or
feel of the breast or nipple
• Fluid coming from the nipple
• Bone pain
• Breast pain or discomfort
• Skin ulcers
• Swelling of one arm (next to
the breast with cancer)
• Weight loss
26. Prostate Cancer –
Risk Factors
• Not completely known
• Age
• 1 in 100,000 for men
aged 40, 1,146 in
100,000 for men age
85
• Race: African American
men 1.6x more likely
than Caucasian to be
diagnosed and 2.4x more
likely to die from it
• Asian-Americans
have much lower
chance
27. Prostate Cancer – Risk
Factors
• Genetic
• Men with a family history, especially a 1st degree relative (ex.
Father or brother) are at an increased risk
• Risk may be 2-3x greater than those without family history
• Infection
• Recent evidence suggests role of sexually transmitted
diseases as a causative factor
• People who have had STIs have a 1.4x greater chance of
developing prostate cancer than the rest of the population
• Diet
• High fat
• Obesity may lead to more aggressive cancer, giving poorer
outcomes after treatment
• Chemical agents
• Ex. Cadmium
28. Prostate Cancer –
Symptoms
• Trouble urinating
• Decreased force in the stream of urine
• Blood in the urine
• Blood in the semen
• Swelling in the legs
• Discomfort in the pelvic area
• Bone pain
29. Case Study – Part 3a
• What is neo-adjuvant chemotherapy?
• Neo-adjuvant therapies are treatments given prior to the
main treatment. Oftentimes, the neo-adjuvant therapy aims
to shrink or reduce the size of the tumor before surgery is
performed.
• After tolerating her treatment and showing a dramatic
clinical response, the patient underwent a mastectomy
and sentinel lymph node biopsy 6 months after her
initial presentation.
• What is a sentinel lymph node biopsy?
30. Case Study – Part 3b
• What is a sentinel lymph node biopsy?
• Because tissues drain much of their fluid into the
lymphatic system, cancer cells that have spread can
often be found in the lymph nodes. This can warn
doctors of spreading cancer cells.
• The pathology examination found no residual
carcinoma in either the breast or lymph nodes. The
patient plans to undergo breast reconstruction after
completing her radiation therapy. She has tolerated
her treatments with minimal side effects and no
complications.
31. Early Detection
• Early detection is the best way to catch cancer and
to give the best possible outcome after treatment
• For example, self-breast exams for women age 20
and above with mammograms beginning at age 40
• PSA blood tests for men and digital rectal
examinations to detect prostate cancer beginning at
age 50
• CDC currently recommends against using the PSA
screening test for men who do not show symptoms
• Be aware of your body!
• Treatments include chemotherapy, radiation,
surgery and other medications
