Cancer

Cancer Mini Medical School: Pre-Medical Honors Program

UMDNJ-NJMS

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

Introduction

• 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.

Mitosis

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!

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?

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?

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.

Cancer Statistics

Demographics Race/Ethnicity New Cases (per 100,000)

Male New Cases (per 100,000)

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 Native

352.7 313.8

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)

Gender-Male Type Risk of

Developing Risk of Dying

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

Gender-Female Type Risk of

Developing Risk of Dying

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

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

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

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 • Hoarseness • Swelling of face or neck • Pleural effusion

http://cancertypes.tk/wp-content/uploads/2011/01/Lung_Cancer3.jpg

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

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

• Weakness or fatigue

• Unexplained weight loss

http://trialx.com/curetalk/wp-content/blogs.dir/7/files/2011/05/diseases/Colon_Cance

r-3.jpg

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

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

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.

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?

Case Study – Part 2b

Ultrasound

Mammogram

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?

Breast Cancer – Risk Factors

• Gender and Race • Caucasian women are

more likely to develop breast cancer than African-American women

• Age

• Genetics • 5-10% of breast cancer

are hereditary • BRCA1/BRCA2 are

abnormal genes that, if inherited, increase the lifetime risk 40-85%

Age Risk to develop in next 10 years

30 1 in 280 40 1 in 70 50 1 in 40 60 1 in 30

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

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

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

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

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

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?

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.

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