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Cancer

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A disease in which abnormal cells divide uncontrollably. Cancer cells can invade nearby tissues and spread through the bloodstream and or lymphatic system to other parts of the body. Cancer is >100 separate diseases.

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Survivor

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An individual person after a diagnosis of cancer

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Neoplasm

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An abnormal growth(tumor) that starts from a single altered cell: a neoplasm may be a benign or malignant Cancer is a malignant neoplasm.

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Benign tumor

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A neoplasm that is not cancer and does not spread to other parts of the body Non-invasive - well defined borders - well differentiated - regular nuclei - rare mitoses

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Malignant tumor

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A neoplasm of cancer cells that may invade surrounding tissues and or spread( metastasize) to a distant areas of the body - Invasive/metastatic - irregular borders - poorly differentiated - irregular, larger nuclei - more frequent and/ or abnormal mitoses

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Carcinogen

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Any agent- chemical, physical, biological that causes cancer

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Carcinoma

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A cancerous tumor that begins in the lining layer(epithelial) of organs; > 80% of cancers of all cancers are carcinomas

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Sarcoma

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A cancer of the bone, cartilage, fat, muscle, blood vessel or other connective or supportive tissue

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Hematopoietic system

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Organs and tissues involved in the production of blood. Cancers of the hematopoietic system include leukemia, lymphomas, and myeloma

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Leukemia

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A cancer of the blood or blood forming organs

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Lymphoma

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A cancer of the lymphatic system. (lymphatic system is network of thin vessels and nodes throughout the body) Two main types are Hodgkins and nonHodgkins lymphomas

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Myeloma

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Malignant tumor of the bone marrow

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Melanoma

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Cancer that begins in the cells that produce skin coloring (melanocytes) curable in early stages

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Chemotherapy

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Treatment with a drug or combination of drugs to destroy cancer cell "poison"

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Radiotherapy

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The use of radiation treatment to kill cancer cells or stop them from dividing "burn"

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Surgery

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The excision of cancerous masses "slash"

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Targeted therapy

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Treatment that uses drugs or other agents to target cancer cells specifically while trying to avoiding harm to normal cells. Some targeted therapies block the mechanisms involved in the six hallmark of cancer

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H. Pylori

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Helicobacter pylori: BActerium that causes infalmmation and ulcers in the stomach and or small intestine- people with infections more likely to develop stomach cancer

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HBV & HCV

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Hepatitis B & C Viruses that cause hepatitis, inflammation of the liver. Long term infection may lead to liver cancer

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HPV

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Human papillomavirus that can cause abnormal tissue growth. Long term infection (types 16 & 18) can cause cervical cancer and can be risk factor of cancer of tissues affected by sexual activity

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HRT

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Hormone replacement therapy (estrogen, progesterone, etc) given to women after menopause risk factor for endometrial and breast cancers

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Mesothelioma

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A tumor affecting the lining of the chest or abdomen. Exposure to asbestos particles in the air increases the risk for developing malignant mesothelioma which is extremely lethal

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Palliative Care

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An approach that aims to improve the QOL for patients and families facing problems associated with life-threatening cancers. Provides for pain management as well as spiritual and psychological support

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Morbidity

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Any departure from expected well-being

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Mortality

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Number of deaths in a given period in a specific population. Can be expressed as absolute of per 100,000.

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Incidence

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Number of new cases arising in a given period of time in a specified population - can be expressed as absolute number or per 100,000.

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Prevalence

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Number of individuals in a defined population who been diagnosed with a specific type of cancer and who are still alive at the end of a given year (e.g. 5 year)

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Survival Rate

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Proportion or % of individuals who are still alive after a specific period of time (e.g. 5 years)

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Sir John Hill

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noted that snuff causes nasal cancer in 1761

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Percival Pott

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discovers occupational cancer of scrotium in chimney sweeps and in hands of gardeners who spread coal tar in 1775

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Rudolph Virchow

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proposed that all cells come from cells and so cancer arises from single cells in 1858

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Clunet

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shows that X rays cause cancer in animals in 1908

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80 million years ago

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Evidence of cancer cells in dinosaur fossils

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4 million years ago

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Oldest known hominid tumor found in home erectus

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3000 BC

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Evidence of cancerous cells found in mummies

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1750 BC

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Babylonian code set standard fee for surgical removal of tumors

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400 BC

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Inca mummies lesions suggestive of malignant melanoma

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250 BC

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first clinical picture of breast cancer (China) description of progression, metastasis, treatments

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100 AD

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Galen removed tumors surgically, believed melancholia chief factor in causing breast cancer- tx included diet, exorcism- topical solution

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17th century

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Germany; Netherlands lumpectomies, mastectomies being performed

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1733-1788

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France, systematic experiments on cancer- oncology becomes a medical specialty

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1779

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France- first cancer hospital founded in Reims

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1913

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American cancer society founded as the American Society for the control of Cancer. 1945 names American Cancer Society( remains world's largest voluntary healthy organization)

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1937

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National Cancer Institute comes to reality

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1939

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Association btwn smoking and lung cancer reported

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1951

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link btwn smoking and lung cancer confirmed

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1964

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first Surgeon General report on smoking and health

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1971

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National Cancer Act "War on Cancer" by Nixon administration

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Mid 1980s

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Human Genome Project initiated (pinpoint location ; function of 50,000-100,000 estimated genes)

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1994

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BRCA1 discovered

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1996

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Surgeon General report on Physical Activity ; Health published

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2000

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Human genome is mapped

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Cancer is a disease of

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genes; genes are vulnerable to mutations over lifespan

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The integrity of the genetic information is protected by __________________ that prevent DNA damage, or remove or repair damaged DNA if it occurs

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many systems

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Imperfections in these systems limit the ability to block all damage and allow both helpful and harmful mutations to occur. Cancers result when ________________ have accumulated

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Sufficient mutations

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Over lifespan cells will divide __________ times

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60-70 X

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What causes expression or suppression of genes is determined by _________________ in the cellular environment including cognitive factors

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Environmental factors

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Each time a cell divides into two new daughter cells, there is potential for an _____ in replication of the DNA

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error

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Genes include ________ and _______________ genes- factors in the cellular environment that influence their expression

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oncogens Tumor suppressor

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Cell signaling

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Regulated process necessary for the appropriate initiation, transmission, and cessation of signals at cellular level via hormones, cytokines etc.

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Gene expression

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Very complicated process by which the information within a gene is 'turned on' or 'turned off'.

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Epigenetic expression

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Altered gene expression without changing the DNA sequence- methylation plays role in silencing

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Differentiation

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Cells become specialized to perform their particular function through a process known as differentiation. In the cancer process, one characteristic of cancerous cells that are accumulating DNA damage is that they become de-differentiated.

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DNA damage ; repair

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Each time a cell divides into two new daughter cells, there is potential for an error in replication of the DNA; DNA is continuously exposed to internal and external factors that potentially can cause damage.

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Apoptosis

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Tightly regulated process of normal cell self-destruction marked by fragmentation of nuclear DNA, Cancerous cells selfishly avoid apoptosis.

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Metastases

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Cancer cells loosen their adhesion and escape the tissue of their orgin - Breaking away from tissue of orgin - Burrowing through tissue to a blood supply or lymphatic vessel - Entering circulation - Leaving circulation - Possessing the ability to live in a new environment

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Characteristics of a cancer cell

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- Lack differentiation - Have abnormal nuclei - form tumors - lost contact inhibition ( mitosis controlled by contact with neighboring cells among other mechanisms ) - undergo metastasis - undergo angiogenesis: formation of the new blood vessels to supply its growth

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Cancer cells vs. normal cells

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Cancer cells: -Nondifferentiated -Abnormal nuclei -No Apoptosis -No contact inhibition -Disorganzied, multilayered -Undergo metastasis ; angiogenesis vs -Differentiated -Normal nuclei -Apoptosis -Contact inhibition One organized layer

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Categories of cancer prevention - Primary

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prevention of disease by reducing exposure of individuals to risk factors or by increasing their resistance- preventing the occurrence

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Categories of cancer prevention - Secondary

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(the early detection and treatment of disease)

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Categories of cancer prevention - Tertiary

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use of treatment and rehabilitation to improve the outcome of cancer survivors

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Cancer care continuum

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Prevention Early detection Treatment Survivorship ; quality of life End of life care

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Ways to prevent cancer by personal lifestyle choices and behaviors

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-Avoid tobacco ; other exposures. -Exercise -Avoid sedentary behavior -Maintain favorable body composition -Rest and sleep -Avoid negative stress -Provide for yourself a mostly plant based diet

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How many years before a mass is usually detected

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8-10 years

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How many cancers are carcinomas

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greater than or equal to 80% of cancers

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Why does cancer affect some people and not others?

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- depends on your immune system at that day and at that instant - people that are overweight can overwhelm the system - genetically predisposition to have a higher risk

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Detection

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X rays, CAT scans, blood tests, bone marrow biopsy

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Grade

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How bad do the cells look?

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Stage

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Where has the cancer spread? - Tumor- extent of the primary tumor -Nodes (lymph) - absence or presence of lymph node involvement -Metastases - absense or presence of metastases Staging "in situ" layers of cells where developed have not penetrated beyond the original layer

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Stages of Cancer -I

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Earliest stage - only local involvement

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Stages of Cancer -II

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Locally advanced - may involve larger tumor ;/or lymph nodes

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Stages of Cancer -III

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Locally advanced may involve extensions into surrounding tissue ;/or more lymph nodes.

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Stages of Cancer -IV

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Cancer has spread to distant areas of the body i.e. metastasized.

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Carcinogens include:

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Nuclear Waste (E) Sun (E) Alcohol (I) Arsenic (E) Pollution (E) Inflammation (I) Estrogen (I) Radioactive (uranium) (E) Radon (E) Microwave (I) Pfoa (popcorn liner) (I) Formaldehyde (E) Retroviruses (E) Viruses (HIV) (E) Nitrates (I) Hormones/Steroids (I) Asbestos (E) Chemicals (benzene) (E)

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Carcinogens- the factors are both _________ and _______

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Endogenous (internal, nature ) Exogenous (environmental, nurture)

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Endogenous

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Immune status DNA Hormone exposure Cognitive processes

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Exogenous

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Tobacco exposure Infectious agent Chemical exposure Radiation

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How do single inherited genes affect cancer?

answer

only 5-10% of cancers are linked to single inherited genes Individuals with inherited germ line mutations will not definitely get cancer but have an increased risk of developing cancer compared with the general population

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Somatic gene changes

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develops during the life course, they are not passed on to offspring Caused by external factors such as radiation or carcinogens or other factors that affects normal metabolism

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Reactive oxygen

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species generated through normal oxidative metabolism have the potential to cause extensive DNA damage

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Inflammation

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is a physiological response to infection, foreign bodies, stress, trauma, or chemical or other irritation, and in the acute phase can be helpful. However, chronic inflammation can result in DNA damage and cancer promotion. A chronic inflammatory environment can increase proliferation and differentiation, inhibit apoptosis (programmed cell death), and induce angiogenesis (generation of new blood vessels).

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Recognition of altered self

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allows the immune system to generate a response to tumor. If the immune does not recognize as such tumor can get a foot hold and begin to grow.

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Immune status and chronic inflammation

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may explain patterns of cancer in different parts of the world. Cancers caused by infectious agents (e.g. liver and cervix are more common in low-income countries). Undernutrition a factor with deficiencies in specific micronutrients, suppresses most immune functions and may fail to contain chronic inflammation. By contrast, hormone-related cancers such as those of the breast and prostate are more common in developed countries.

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Tobacco use

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cigarette smoke contains at least 80 known mutagenic carcinogens, including arsenic, cadmium, ammonia, formaldehyde, and benzopyrene. Each will have a separate mechanism for causing cancer. Cigarette smoke is a powerful carcinogen and also a source of oxidative stress.

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Infectious agents

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including hepatitis viruses, the bacterium H pylori, and parasites also promote cancer by causing chronic inflammation

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How much is the relative risk of smoking

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Relative risk of 25x is 2500 times more at risk for cancer b/c of smoking...

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How many deaths does secondhand smoke cause?

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Secondhand smoke causes 38,000 deaths...nearly as much as breast cancer (40,000 deaths) 15% is inhaled, 85% goes into air

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Ionizing radiation

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and UV radiation damage DNA and act as carcinogens. Ionizing radiation comes from cosmic radiation (air travel increases exposure), natural radioactivity present in rocks/soil, ugh X-rays, or atomic radiation. Increases the risk in particular leukemias, breast and thyroid cancers

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UVa damages

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DNA through generation of reactive oxygen species. UV radiation causes both malignant melanoma and non-melanoma skin cancer. Sunburns

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What are the four main cancer-causing infectious agents

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Helicobacter pylori; human papillomavirus, and hepatitis B ; C are responsible for most infection-related cancers globally (gastric, cervical, liver cancers, respectively)

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Where is cervical cancer a leading cause of cancer deaths among women?

answer

women in many less developed regions of the world, where screening ; treatment is limited or unavailable

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PCBs

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Polychlorinated biphenyls (PCBs), organic compounds previously used in plasticizers, adhesives, paints, and various oils, do not readily degrade. Chemicals that become concentrated in the food chain

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What are examples of contributing factors?

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Obesity Sedentary behavior Lack of moderate-vigorous physical activity

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Obesity in adults

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in 2010 more than 55% of adults were overweight or obese in every state. It has reached epidemic proportions in the US. . The percentage of adults age 20 to 74 who are obese increased from the late 1970s to 2000, with the largest increases occurring in the 1990s. During this time, similar trends were observed among men and women. In the past decade, obesity trends in women have remained relatively stable while among men, prevalence increased from 28% during 1999-2002 to 36% during 2009-2010.

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Obesity in children

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In fact, over the past three decades the proportion of obese children has more than doubled among children 2-5 years and 6-11 years, and tripled among adolescents 12-19 years. However, in the past decade, obesity prevalence among children and adolescents has appeared to stabilize.

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Fruit servings and vegetables

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The American Cancer Society recommends that individuals eat at least 2.5 cups of vegetables and fruits a day for cancer prevention. About one in three adults 25 years and older consumed the recommended fruit servings in 2011, regardless of racial/ethnicity. Similar to vegetable consumption, less educated adults were less likely than those who were more educated to consume 2 or more fruit servings with the exception of Hispanics.

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How does stress affect you?

answer

-"I don't get mad- I grow a tumor instead" -There is a strong connection between stress, the immune system and cancer. -Cancer cells signal the immune system to let them alone and support growth -Stress dampens the immune system allowing cancer to get a foot hold. -Stress has a strong mind-body factor that is the subject of growing body of current research.

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HPA pathway for stress

answer

Hypothalamus--> pituitary --> adrenal pathway

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Total number of cancer deaths averted from 1991 to 2009 in men and women

answer

Almost 1.2 million cancer deaths were averted as a result of almost two decades of consistent declines in cancer deaths rates. Weve been able to avert cancer deaths more for men than for women

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Treatments

answer

-Classic cancer therapies target rapidly dividing cells -Cancer treatments often incorporate surgery, radiation, ; systemic treatments that are specific to each patient ; cancer type. -Target the DNA -Ionizing radiation -Chemotherapy - it is systematic(affects the whole body by entering the blood stream

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Side effects of treatments

answer

Many side effects -Hair loss -Weakened immune system -Problems with GI tract

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Radio-therapy

answer

Radiotherapy high energy rays are used to damage cancer cells and stop them from growing and dividing. As much as possible surrounding tissue is spared Implants are used as well sometimes in combination with external source radiation. Unlike chemotherapy and like surgery - radiotherapy is a local treatment.

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Hallmarks of cancer

answer

Growth signal autonomy - evasion of growth inhibitory signals - evasion of apoptosis - unlimited replication - sustained angiogenesis -Invasion and metastasis

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Hallmark of Cancer I

answer

Growth signal autonomy -Unlike normal cells, cancer cells are not dependent on external growth factors to stimulate their division. -Instead, they can generate their own signals or respond to lower concentrations of external signals. -This frees cancer cells from the growth constraints of normal cells. Also cancer cells are not recognized as 'self'; thus stealthily grow.

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Hallmark of cancer II

answer

Evasion of growth inhibitory signals

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Hallmark of cancer III

answer

Evasion of apoptosis

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Hallmark of cancer IV

answer

Unlimited replication

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Hallmark of cancer V

answer

Sustained angiogenesis

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Hallmark of cancer VI

answer

Invasion ; metastasis

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Growth signal autonomy

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Autocrine loops Over-expression of receptor Receptor is always 'on' Downstream signals

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Evasion to antigrowth signals

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2 hallmark of cancer Normal cells receive growth inhibitory signals. Indeed, most cells of the body are quiescent and not actively dividing. Normal cells respond to negative environmental signals such as contact with other cells. Cancer cells have acquired mutations that interfere with these pathways and so do not respond to growth inhibitory signals.

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Evasion of Apoptosis

answer

Apoptosis is the tightly regulated process of cell death that controls cell numbers, removes damaged cells, and prevents damaged cells being replicated Cells break into small membrane-surrounded fragments (apoptotic bodies) that are phagocytosed without inducing inflammation. Apoptosis is induced by events such as damaged DNA- in cancer apoptosis is not induced. This avoidance of apoptosis allows further opportunity for additional mutations to develop.

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Unlimited replication

answer

Normal cells divide a finite number of times. Once they have replicated ~60 or 70 times they stop — a process termed senescence, which is thought to constitute a protective mechanism against unlimited proliferation. Among other processes, number of cell doublings is controlled by telomeres. As cells divide, telomeres are shortened when short enough division stops- cancer cells maintain their telomere length contributing to endless replication. Telomere: The end of a chromosome characterized by repetitive nucleotide sequences. Are involved in the replication and stability of DNA molecules

question

Sustained angiogenesis

answer

Most cells within tissues reside within 100 mm of a capillary blood vessel. The generation of blood vessels in adults is fairly constant and tightly controlled by a balance of angiogenesis inducers and inhibitors. As a cancer progresses, it acquires the ability to induce angiogenesis thereby providing its own accessible supply of blood.

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Tissue Invasion ; Metastasis

answer

Normal cells in solid tissues maintain their position in the body and generally do not migrate. As a cancer increases uncontrollably, it eventually reaches the membrane encapsulating the organ. Tumor cells secrete enzymes which digest the membrane and allow the cancer to invade adjacent tissue. Once through, cancer cells access other sites in the body via the blood and lymphatic systems - common characteristic of cancer deaths.

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What is the list of the types of cancers women are at risk to getting?

answer

Breast 1 in 3 Lung 1 in 8 Colon 1 in 16

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Estimated new cases

answer

In men it is prostate 26% In women it is breast 29% and then lungs is after at 13%

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Estimated deaths

answer

Lungs for both sexes at 26% and then prostate in men and breast for women

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Cancer incidence rates by sex

answer

from 1975 to 2009 incidence rates increased and then decreased and for men theres a slight bump due to screening for prostate cancer

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PSA

answer

prostate specific antigen blood testing caused the erratic trend in cancer incidence rates among men

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Trends in 5 year relative cancer survival rates

answer

survival rates for most cancers (all of those presented on this slide) have improved significantly since the 1970s, due largely to earlier detection and/or advances in treatment. Survival rates have markedly increased for cancers of the prostate, breast, colon, and rectum, and for leukemia. Progress has been slower for cancers of the pancreas and lung and bronchus

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Cancer prevention ; control

answer

Exercise Avoid sedentary behavior Do not use tobacco products Rest and sleep Avoiding negative stress Consume a mostly plant based diet Follow recommended screening guidelines Prevention is not elimination - just reduction in occurrence. The reality is that we probably will not find a "cure" for "cancer" nor totally prevent it.

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Cancer research funding

answer

8% survivorship 12% to prevention 35% treatment 37% biology

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What is stress?

answer

Psychophysiological process, usually a negative emotional state that is both the product of appraisal of situational and psychological factors and an impetus for coping.

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Integrative oncology

answer

The practice of medicine that reaffirms the importance of the relationship btwn practicioner and patient, focuses on the whole person, is informed by evidence, makes use of all appropriate therapeutic approaches, providers, and discipline to achieve optimal health and healing

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Can purposeful mindful meditation change brain anatomy?

answer

Yes

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Stress, immune system and cancer?

answer

Chronic stress decreases your immune system and makes you more prone to cancerous cells

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Multiplier effect

answer

When a person is part of two or more underrepresented groups. For example a hispanic female

question

Why is it important to have good data that represent underrepresented groups?

answer

Racial and ethnic minorities and medically underserved populations experience unequal suffering and unequal death from cancer compared to the population as a whole. These populations are of importance to the health status of the nation as they continue to rapidly increase in size and, as a whole, move towards becoming the "majority" population.

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Why is it important to have underrepresented groups in clinical trials?

answer

If we do not adequately address the health disparities of these populations, the national Healthy People 2010 objectives, including the unequal burden of cancer, will not be achieved. Not all drugs work for every human being

question

CEO roundtable, what was it and why?

answer

CEOs agreed to ask and answer one important question: What are we doing in our own companies with respect to cancer awareness, prevention, early diagnosis, and optimal treatment?

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What percent of the population is illiterate?

answer

25% I think

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What does CPRIT stand for?

answer

Cancer Prevention Research Institute of Texas

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What is the ICC

answer

A national multidisciplinary and multicultural nonprofit education and advocacy organization

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