1. Chapter 16
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2.  Causes about 570,000 deaths in the U.S. each year
 1,500 per day
 Leading cause of disease-related death among
people under age 75
 Second most common cause of death
 Evidence supports that most cancers could be
prevented by simple lifestyle changes
 Tobacco is responsible for about 30% of all cancer
deaths
 Poor diet and exercise habits account for another
30% of cancer deaths
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3. © 2012 McGraw-Hill Companies. All Rights Reserved. 3

4.  Definition: the abnormal and uncontrollable
multiplication of cells that can lead to death
 Tumor (neoplasm): a mass of tissue that serves no purpose
 Benign versus malignant tumors
 Benign (noncancerous) tumor: made up of cells enclosed
in a membrane that prevents their penetration of
neighboring tissues
 Malignant tumor: cancerous, can invade surrounding
tissues
 Every case of cancer begins as a change in a cell that allows
it to grow and divide when it should not
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6.  Primary tumor = cancer’s original location
 Definition: the spreading of cancer cells from the
primary tumor to another part of the body;
occurs because cancer cells do not stick to each
other as strongly as normal cells do
 Metastasizing – the traveling and seeding process of
cancerous cells
 Cells break away from primary tumor and invade
surrounding tissues or travel through the blood and
lymphatic system
 New tumors are called
 Secondary tumor or metastases
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7.  Staging = process of diagnosing cancer according to
the amount of progress it has made in the victim’s
body
 Five stages
 0 = early cancer, present only in the layer of cells
where it originated
 I, II, III = More extensive cancer, with higher numbers
indicating greater tumor size and/or the degree to
which the cancer has spread to nearby lymph nodes or
organs adjacent to the primary tumor
 IV = Advanced cancer that has spread to another organ
o Remission
 Signs and symptoms of cancer disappear
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8.  Malignant Tumors
 The behavior of tumors arising in different body
organs is characteristic of the tissue of origin
 Tumors classified according to types of cells
 Initially retain some of the original properties of the
host cell
 As they continue to multiply, become groups of rogue
cells with increasingly unpredictable behavior
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9.  Malignant Tumors
 Carcinomas: most common; arise from epithelia,
tissues that cover external body surfaces, line
internal tubes, and form the secreting portion of
glands
 Sarcomas: arise from connective and fibrous
tissues such as muscle, bone, cartilage, and
membranes covering muscle and fat
 Lymphomas: cancers of the lymph nodes
 Leukemia: cancers of the blood-forming cells in
bone marrow
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11.  1.5+million Americans are diagnosed yearly
 American Cancer Society
 Estimates that the 5-year survival rate for all
cancers diagnosed between 1995 and 2005 is 68%
 Nearly 1 in 2 men and more than 1 in 3
women will be develop cancer at some point
in their lives
 Until 1991, number of cancer deaths
increased steadily in the U.S., mostly due to
lethal lung cancers among male smokers
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12.  Since 1991, the death rate has dropped 19%
in men and 11% in women
 Prevention
 Early detection
 Improved therapy
 American Cancer Society estimates
 90% of skin cancer could be prevented
 87% of lung cancer could be prevented
 Regular screening and self-examinations could
save an additional 100,000 lives per year
 About 11.4 million living Americans have a
history of cancer
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13.  Most common cause of cancer death in the U.S.
 157,000 deaths per year
 Risk Factors
 Tobacco smoking contributes to 90% of lung cancer deaths
 Combined with environmental carcinogens, risk is
multiplied by a factor of 10
 Detection and treatment (difficult to detect)
 Symptoms are not detected until cancer has reached the
invasive stage
 Persistent cough, chest pain, or recurring bronchitis
 Diagnosis by CT scan, chest X-ray, sputum examination, or
fiber-optic bronchosectomy
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14.  Treatment:
 Difficult to treat
 If caught early, treated by surgery
 Only 15% are detected prior to spreading
 Radiation and chemotherapy are used in addition
 If detected early, 53% of patients are alive 5
years after diagnosis
 Overall, the survival rate is only 15%
 Phototherapy, gene therapy, and immunotherapy
(vaccines) are being studied
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15.  Third most common type of cancer
 Risk Factors
 Age: 91% occurs in ages 50 or older
 Heredity
 Lifestyle (alcohol use, smoking, exercise, nutrition)
 Polyps
 Detection and Treatment
 Screening
 Sigmoidoscopy or colonoscopy
 Examine for polyps
 Surgery is primary treatment
 Radiation and chemotherapy used prior to surgery
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16.  Most common cancer in women
 Causes almost as many deaths in women as lung
cancer
 1 in 8 American women will develop it during her
lifetime (207,000 each year)
 1 in 30 will die from the disease (40,000 deaths)
 Risk Factors
 Strong genetic factor
 Most common in women over 50
 Common causes: genetic predisposition, high fat, high
calorie diet and sedentary lifestyle, alcohol use, early onset
of menstruation, first child after age 30, obesity
 Current use of hormone replacement therapy (HRT)
 Estrogen: cancer in estrogen-responsive sites
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17.  Detection and treatment
 Early detection
 Monthly breast self-exam for all women at age 20
 Clinical breast exam by a physician every year if over 40
 Mammography: every year for women over 40
 Digital mammography (MRI)
 Ultrasonography
 Treatment
 Lump biopsy, lumpectomy, or mastectomy
 Survival rate
 98% if the cells did not metastasized
 90% for all stages at 5 years
 New strategies for treatment and prevention
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18.  Most common cancer in men
 Second leading cancer death in men
 218,000 new cases per year
 More than 32,000 deaths per year
 Risk Factors
 Age
 Genetic predisposition
 Lifestyle
 Diet
 Early detection is key
 Prostate-specific antigen (PSA) blood test
 Digital rectal exam
 Treatment
 Surgical removal of the prostate or radioactive seeding
 Survival
 All stages near 100% after 5 years
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19.  Cervical cancer - sexually transmitted
 Most cases stem from infection by the human papillomavirus (HPV)-
transmitted by unprotected sex
 Group of about 100 related viruses
 Women high in HPV 16 are at a high risk
 Smoking
 Infection by genital herpes
 Cervical cancer most common in women in their 20s and 30s
 Factors: unprotected sexual intercourse, multiple sex partners,
cigarette smoking, immunosuppression, use of oral contraceptives
 Screening:
 PAP test
 Cervical dysplasia
 All sexually active women ages 18-65 should be tested
 Treatment
 Surgery
 Chemotherapy with radiation
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20.  Uterine, or Endometrial:
 Occurs after 55
 Risk factors similar to breast cancer
 Determined by pelvic exam
 Treatment is surgery (hysterectomy)
 96% survivability after 5 years
 Ovarian Cancer:
 Difficult to detect and diagnose, may be no warning signs
 Family history or genetic factors
 Determined by
 Pelvic exam
 Ultrasound of ovaries
 Treatment is surgical removal of the ovaries, the fallopian
tubes, and the uterus
 Radiation and chemotherapy are sometimes used
 Survival rate after 5 years is 94% for tumor localized to ovary
 Survival rate after 5 years for all stages is 46%
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21.  Most common form of cancer
 1+ million cases per year
 68,000 are melanoma, the most serious type
 Easily detected and highly curable
 Risk Factors
 Exposure to ultraviolet (UV) rays during childhood
 Common cause – suntans, sunburns, tanning beds
 Caucasians are 10 times more likely than African Americans to develop
melanoma
 Types
 Basal cell and squamous cell
 Melanoma - more dangerous form, spreads rapidly
 Prevention
 Avoid long-term overexposure to sunlight
 Sunscreen, protective clothing, shade
 Detection and Treatment
 ABCD screen test
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23.  Cancersof the oral cavity, pharynx, larynx,
and nasal cavity
 Smoking and tobacco use
 Excessive use of alcohol
 Risk twice as great in men as it is in women
 50% of cancers of the tonsils and tongue are related to
HPV infection
 Treatment
 Chemotherapy, radiation, surgery
 Often develop another primary cancer of head and neck
 The 5-year survival rate is about 61%
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24.  Rare (about 1% of cancer in men)
 Most common cancer in men ages 20-35
 Much more common in white males
 Increased risk if undescended testicles
 Self-examination helps in early detection
 Tumors treated by surgical removal or chemo
 Radiation rarely used
 The 5-year survival rate is 96%
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25.  Pancreatic cancer
 3 out of 10 are linked to smoking
 Stomach cancer
 Twice as common in males
 Infected by Helicobacter pylori
 Bladder cancer
 Four times more likely in males
 Smoking is the key risk factor
 Kidney cancer
 Smoking and obesity are mild risk factors
 Brain cancer
 Develops for no apparent reason
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26.  Cancers of the white blood cells
 Starts in the bone marrow but can spread to the
lymph nodes, spleen, liver, other organs, and CNS
 Leukemia cells crowd out production of normal
blood cells
 Risk factors are unknown, but some possibilities
include smoking, radiation, infections
 Symptoms: fatigue, anemia, weight loss, infection
 About 43,000 new cases and 22,000 deaths each
year
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27.  Lymphoma
 Arising from the lymph cells
 Hodgkin’s disease
 Non-Hodgkin’s disease (NHL)
 More common
 More deadly of the two types (6th most common cancer)
 Risk factors are not well understood
 Compromised immune system are at a greater risk
 Multiple Myeloma
 Malignant plasma cells produce tumors in the bone
marrow.
 Leads to anemia, excessive bleeding, decreased
resistance to infection
 Age is most significant risk factor – median age is 66
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28.  The role of DNA (deoxyribonucleic acid)
 Each cells has 23 pairs of chromosomes
 Each controls the way a cell will work
 Each rung is made up of four different nucleotide bases:
 Adenine, thymine, cytosine, guanine
 A gene – smaller unit of DNA
 DNA mutations and cancer
 Changes the way the cells function
 Mutagens – radiation, certain viruses, chemical substances
 Oncogenes – a gene involved in the transformation of a
normal cell into cancer
 Tumor suppressor genes – type of oncogene that restrains
cellular growth
 Hereditary cancer risks
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29.  Cancer promoters
• Do not directly produce mutations; accelerate the
growth of cells without damaging or permanently
altering the DNA
 Cancer initiators:
• Carcinogenic agents
 UV radiation
 Tobacco use
• Cigarette smoking is a complete carcinogen
because it is a cancer initiator and promoter
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30.  Your food choices affect your cancer risk by exposing you
to potentially dangerous compounds and depriving you of
protective ones
 Dietary Fat and Meat
 American Cancer Society encourages everyone to limit their
consumption of processed and red meats
 Contributes to certain cancers:
 Colon, stomach, prostate
 Alcohol
 Fried foods
 Dietary fiber
 Fruits and vegetables
 Anticarcinogens
 Carotenoids
 Antioxidants versus free radicals
 Phytochemicals
 Sulforaphane
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31. © 2012 McGraw-Hill Companies. All Rights Reserved. 31

32.  Linked to breast and colon cancer
 Benefits of physical activity
 Speeding the movement of food through
the digestive system
 Strengthen the immune system
 Decreasing blood fat levels
 Prevention of obesity
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33.  Microbes
 About15-20% of the world’s cancers are
caused by microbes
 Viruses
 Human papillomavirus – cervical cancer
 Bacteria
 Helicobacter pylori – stomach cancer
 Epstein-Barr virus (mononucleosis) – Hodgkin’s disease,
cancer of the pharynx and some stomach cancers
 Human herpesvirus 8 – Kaposi’s sarcoma and certain
types of lymphoma
 Hepatitis B and C – cause as many as 80% of the
world’s liver cancers
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34.  Ingested chemicals
 Food industry uses preservatives and other
additives to prevent food from spoiling
 Nitrosamines – nitrates and nitrites combined
with dietary substances are a highly potent
carcinogen
 Environmental and industrial pollution
 Radiation - UV rays or man-made
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35.  Detecting:
 Self-monitoring
 Routine cancer checkups and specific screening tests
 Diagnosing:
 Biopsy
 Magnetic resonance imaging (MRI)
 Computed tomography (CT)
 Ultrasonography
 Traditional treatment:
 Surgery
 Chemotherapy
 Radiation Therapy
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36.  Beyond traditional treatments:
 Proteasome inhibitors
 Monoclonal antibodies
 Tyrosine kinase inhibitors
 Anti-angiogenesis drugs
 Biological therapies/immunotherapy
 Bone marrow and stem cell transplants
 Experimental techniques:
 Gene therapy
 Enzyme activators/blockers
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37.  About 11.4 million cancer survivors in the U.S.
 Psychological support is important
 Family and friends
 Doctors and nurses
 Organized groups
 Support groups for family and friends
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38. Chapter 16
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