Understandi

ng Cancer

Karen Joyce L.
Introduction

 The last 50 years has seen a better

understanding of the causes and treatments of
cancer. Hence, the stigma, early detection and
technology has improved the prognosis of
cancer patients to an unprecedented level.
 Cancer Statistics
 553,400 Americans died of cancer 2001
 1.3 million new cases diagnosed yearly
 Cancer caused about 13% of all human deaths in 2007
(7.6 million)
 Early detection/improvements in technology have
improved prognosis for many

 What do you think are the contributing factors to

the incidence of cancer in the Philippines today?
HISTORY:

 Today, the Greek term carcinoma is the medical term for a

malignant tumor derived from epithelial cells.
 It is Celsus who translated carcinos into the Latin cancer, also
meaning crab.
 Galen used "oncos" to describe all tumours, the root for the
modern word oncology.
 Hippocrates described several kinds of cancers. He called
benign tumours oncos, Greek for swelling, and malignant
tumours carcinos, Greek for crab or crayfish.
 This name comes from the appearance of the cut surface of a
solid malignant tumour, with "the veins stretched on all sides as
the animal the crab has its feet, whence it derives its name".
 He later added the suffix -oma, Greek for swelling, giving the
name carcinoma.
 Normal Cells Vs. Cancer
Cells
 Cells represent the smallest,  Cells grow, replicate and
functional unit of our repair body organs.
existence which contains  The genetic material
cytoplasm and a nucleus (i.e. (DNA/RNA) and your
metabolism, reproduction, immune system regulate
day to day functions) this process.
 Cells have a specialized
function depending on their
location in the body.
 Cancer cells:
 Lose control over growth
and multiplication

 Do not self-destruct when

they become worn out or
damaged

 Crowd out healthy cells

Define Cancer. . .
 Cancer is a term used to describe a large group
of diseases that are characterized by a cellular
malfunction.
 Healthy cells are programmed to “know what to
do and when to do it”.
 Cancerous cells do not have this programming
and therefore grow and replicate out of control.
 They also serve no physiological function.
These cells are now termed a neoplasm.
 is a class of diseases in which a group
of cells display uncontrolled growth
(division beyond the normal limits),
invasion (intrusion on and destruction
of adjacent tissues), and sometimes
metastasis (spread to other locations in
the body via lymph or blood).
 Cancer is a large group
of diseases (over 200)
characterized by
uncontrolled growth and
spread of abnormal
cells.*

*American Cancer Society, Cancer Facts and Figures 2005

Growth of Cancer Cells
 Cancer cells reproduce
every 2-6 weeks.
2-6 weeks
 Size of cancer cells:
 One million cancer
2-6 weeks cells = head of a pin

 One billion cancer

cells = a small
grape

 230 = 1,073,741,824
= 1 billion cells
2-6 weeks
This neoplasmic mass often forms
a clumping of cells known as a
tumor.
 NEOPLASMS
Characteristics Benign Malignant

Speed of Growth Grows slowly Grows rapidly

Mode of growth Remains localized Infiltrates surrounding

tissue
Capsule Encapsulated Not encapsulated

Cell characteristic Well differentiated mature Poorly differentiated

cells; cells function poorly (anaplastic type)

Recurrence Extremely unusual when Common following surgery

surgically removed

Metastasis Never occur Very common

Effect of neoplasm Not harmful to host Always harmful

Prognosis Very good prognosis Poor prognosis

 Signs and Symptoms of
Cancer
 Change in bowel habits or bladder functions
 A sore that do not heal
 Unusual bleeding or discharge
 Thickening of breast or other parts of the body
 Indigestion or difficulty swallowing
 Obvious change in wart or mole
 Nagging coughing or hoarseness
 Unusual bleeding or discharge
 Sudden weight loss
 Types of Cancers

 Carcinomas (cells
that cover internal and
external body surfaces) Leukemia
(Blood Cells)
Lung
Lymphomas
Breast (Lymph nodes &tissues)

Colon

Bladder
Prostate Sarcomas
(Men) Cells in supportive
tissues – bones &
muscles
What are the ETIOLOGIC
FACTORS of Cancer?

Family History
Lifestyle

Environment
Lifestyle Risks
 Smoking
 Diet high fat and low in fruits and
vegetables
 Preservatives
- Nitrites (bacon, smoked meat)
- Talc (polished rice, salami, chewing gum)
- Food sweeteners
- Nitrosomines (baby nipples)
- Aflatoxins (mold in nuts, grains, milk,
cheese, peanut butter)
- Polycyclic hydrocarbons (charcoal
broiling)
 Lack of exercise
 Obesity
 Environmental Risks
 Industrial pollution/compounds
- Vinyl chloride (plastic
manufacture, asbestos
factories, construction)
- Polycyclic aromatic
hydrocarbons (refuse burning,
auto & truck emissions, oil
refineries
- Air pollution
- Fertilizers, weed killers
- Dyes (Analine dyes – beauty
shops & home use; hair bleach)
- Drugs (tobacco, alcohol)
 Physical Agents
 Radiation
- X-rays or radioactive isotopes
- Sunlight/UV rays
- Non-ionizing radio frequency radiation from mobile
phones and other similar RF sources
 Physical irritation / Trauma
- Pipe smoking
- Multiple deliveries
- Jagged tooth, irritation of the tongue, “overuse of any
body organ/part”
 Genetics
 Oncogene (hidden/repressed genetic code
for cancer that exists in all individuals) 
when exposed to carcinogens  changes in
cell structure  becomes malignant
 Regardless of the cause, several cancers are
associated with familial patterns
e.g. retinoblastoma, pheochromocytoma,
Wilm’s tumor, lung & breast cancers
 Hormones
 Estrogen – as replacement therapy
increases incidence of vaginal and
cervical adenocarcinoma
 Diethylstilbestrol (DES)
Inherited Risks
 Less than 15% of cancers
are inherited
 Gene mutations are
linked to some inherited
cancers
 Cancers that may be
caused by inherited gene
mutations are:
 Colon cancer
 Breast cancer
 Ovarian
 Prostate cancer
 Skin cancer
 Predisposing Factors
 Age - older individuals are more prone to
cancer; they have been exposed to
carcinogens longer; they may have developed
immune system alteration
 Sex
- women  more prone to breast, uterus,
cervical cancer
- Men  more prone to prostate and lung
cancer
 Urban vs Rural residence – more common among
urban dwellers than rural residents
 Geographic distribution – due to influence of
environmental factors as national diet, ethnic
customs, type of pollutions
- e.g. cancer of the stomach in Japan, breast Ca in
USA
 Occupation – e.g. chemical factory workers,
farmers, radiology department personnel
 Heredity – great risk with a family history
 Stress - depression, grief, anger, aggression,
despair or life stresses decrease
immunocompetence
- Immunodeficiency may spur the growth
and proliferation of cancer cells
 Precancerous lesions – may undergo
transformation into Ca lesions and
tumors
e.g. pigmented moles, burn scars, senile
keratosis, benign polyps, fibrocystic
disease of the breast
 Obesity - studies have linked obesity to
breast and colorectal cancer
Why Screening Tests?

The treatment of cancer is

most successful when the
cancer is detected as early
as possible, often before
symptoms occur.
 Cancer Detection
Examinations
 Cytologic Exam or  Laboratory Tests
Papanicolaou Smear - Alpha-feto-Protein
 Biopsy - Human Chorionic
 Ultrasound Gonadotropin
 Nuclear Magnetic - Prostatic Acid
Resonance Imaging Phosphatase
 Radiodiagnostic - Prostate Specific Antigen
Techniques (PSA)
 Antigen Skin Test - Carcinoembryonic
 Radiologic Exams Antigen (CEA)
Colon Cancer
 Most colon cancers
start as a polyp • A polyp

 Removing polyps
can prevent colon
cancer
• Advanced
bleeding
cancer
Colon Cancer Screening
Guidelines

 Age of 50 and older; younger if

there is a family history


 
Yearly fecal occult blood test (FOBT) or
                                                
Flexible sigmoidoscopy every 5 years or
 Yearly FOBT and sigmoidoscopy every 5 years or
 Double-contrast barium enema every 5 years or
 Colonoscopy every 10 years
Of the options above ACS prefers yearly FOBT and Sigmoidoscopy every five years
Breast Cancer
Screening Guidelines

 Yearly mammograms starting at age 40

and continuing for as long as a woman
is in good health.
 Clinical breast exams (CBE) should be
part of a periodic health exam, about
every three years for women in their
20s and 30s and every year for women
40 and over.
Breast Cancer
Screening Guidelines
 Women should report any breast change
promptly to their health care providers. Breast
self‑exam (BSE) is an option for women starting
in their 20s.
 Women at increased risk (e.g., family history,
genetic tendency, past breast cancer ) should
talk with their doctors about the benefits and
limitations of starting mammography screening
earlier, having additional tests (e.g., breast
ultrasound or MRI), or having more frequent
exams.
Cervical Cancer
Screening Guidelines
 Annual pap testing should
begin with the onset of sexual
activity or at age 18
 Investigate pros & cons of
new HPV vaccine
 Pap testing should continue
less frequently at the
discretion of the medical
provider and patient after
three or more annual tests
have been normal
Prostate Cancer
Screening Guidelines

 Men should speak to their doctor about the

pros and cons of prostate cancer screening

 Both prostate specific antigen (PSA) and

digital rectal examinations (DRE) are
recommended for men over 50 and who
choose to undergo screening for prostate
cancer
Testicular Cancer
Screening Guidelines
 Doctors agree that examination of a man’s
testicles is an important part of a general
physical exam. It is recommended that a
testicular exam be conducted during routine
cancer-related checkups.

 It is believed that it is important to make men

aware of testicular cancer and that any unusual
mass should be evaluated by a health care
provider immediately.
  The ABCD’s of melanoma (skin
Skin Cancer cancer):

 Asymmetry: one half is not

A like the other
 Border: the edges are

B jagged or irregular
 Color: the color is varied,
tan, red, black etc
C  Diameter: the diameter is
larger than 8mm (the top of
D a pencil eraser)
Skin Cancer Prevention
 It is important to:
 Protect your skin with hats, long sleeves
and sunscreen
 Do a self examination of your skin monthly
 Become familiar with any moles, freckles or
other abnormalities on your skin
 Check for changes once a month. Show
any suspicious or changing areas to your
health care provider.
Good News!

Other Ways to Reduce

the Risks of Developing
Cancer…
How Far Have We Come ?
Five year survival rate:
 1913 - 10%

 2005 - 66%

 Advances in cancer
research continue
How do we
prevent
Cancer then?
Avoid Smoking or Chewing
Tobacco
 Cigarette smoking is  Smoking increases the
the leading cause of risk of mouth,
esophagus, lung, and
preventable death
larynx cancers.
almost worldwide
 Second hand smoke
affects everyone
 Fruits and Vegetables
Decrease Cancer Risks
 Cancer rates could
decline by up to
20% if everyone
consumed 5 fruits and
vegetables a day!*
 Cancer fighting
substances:
 Antioxidants
 Dietary fiber
 Carotenoids
*American Institute for Cancer Research, 1998.
 Flavenoids
 About 30% of cancers are caused due to improper nutrition; eating not
healthy foods or eating unhealthy foods. The American Cancer Society
has the following recommendations:
 Eat five or more servings of vegetables (green and dark yellow,
broccoli, Brussels sprouts, cabbage, spinach, etc.) and fruits each
day. Eat plenty of beans and whole-grain (14 oz daily). Note that you
are 2 to 3 times more susceptible to stomach cancer if you do not eat
fruits and vegetables.
There are many high-fat items in the "Salad Bars". Load your plate
with fresh vegetables, fruits, beans, whole grains, and low-fat
dressing. Avoid creamy dressings.
 Limit on fats (30% of daily req’t.). Eat low fat foods. Avoid fast foods
rich in fats. High-fat foods may increase the risk of prostate, colon,
rectum and uterus cancers.
 Eat spicy foods specially containing chillies. Chillies contain capsaicin
which may offer protection against cancer. Capsaicin holds the key to
the next generation of anti-cancer drugs, reported the online Jan
2007 edition of Daily Mail.
Vitamin D & Cancer

 Cedric Garland, Professor of family and preventive

medicine at the UC San Diego School of Medicine,
reports in the Annals of Epidemiology (June 2009)
that cancer develops when cells lose the ability to
stick together in a healthy, normal way
 The key factor to this initial triggering of a
malignancy could be a vitamin D deficiency.
 Sufficient vitamin D prevents prostate cancer,
breast cancer, ovarian cancer and colon cancer.
 Limit Alcohol to No More Than
 Men – 2 drinks per day
 Women - 1 drink per day
 Drinking alcohol, even low amounts,
raises the risk of certain cancers in
women, according to a new study by
professor Naomi Allen of the University
of Oxford and reported in February,
2009 in the Journal of the National
Cancer Institute.
 Low to moderate alcohol consumption
is associated with a significant increase
in the risk of breast, liver, rectum, and
upper aero-digestive tract cancers.
Reduce Your Skin Exposure to
the Sun
 Limit time outside,
between 10 a.m. & 4 p.m.
 Wear protective clothing.

 
Use wide-brimmed hats
and sunglasses.
                                                  
 Prevent sunburns,
     especially for children
under 18. Use waterproof
sunscreen of SPF 15 or
higher. Reapply as
directed.
 Avoid tanning beds.
Exercise & Maintain a healthy
weight
 Exercise for 30 minutes or
more at least 3 days a
week.

• Keep weight normal.

• Obesity is a risk
factor for prostate,
colon, rectum, uterus,
ovaries, and breast
cancers.
 Limit on Salt
 People who regularly eat soup could be
raising their risk of stomach cancer because
of its high salt content, warns a study
(January 2009) by Dr Rachel Thompson,
science programme manager for the World
Cancer Research Fund (WCRF).
 Limit added salt intake to 2,400 milligrams of
salt in a day. Stick to low sodium diet.
 Avoid Excessive use of
Cosmetics
 Health experts say that excessive usage of cosmetics
by children enhances their risk to various types of
cancer and other problems later in life.
 Most of cosmetic products use potentially dangerous
chemicals like parabens and phthalates.
 The parabens chemical have been recently found in
breast cancer tissues. This chemical can affect the
hormone oestrogen.
 The phthalates are linked to lower sperm counts in
men, premature breast development and allergies.
186,550
The number of lives that could be
saved each year if we ate a healthy
diet and exercised regularly

186,550
The number of lives that could be
saved each year with no tobacco

American Cancer Society

Therapeutic Modalities for
Cancer
 Surgical interventions
 Chemotherapy
 Radiation therapy
 Immunotherapy
 Bone Marrow Transplantation
 Surgical Interventions

 Preventive Surgery – removal of precancerous

lesions or benign tumors
 Diagnostic Surgery – biopsy
 Curative Surgery – removal of an entire tumor
(en bloc resection)
 Reconstructive Surgery – improvement of
structure & function of an organ
 Palliative Surgery – relief of distressing signs and
symptoms; retardation of metastasis