Cancer

1. Cancer • Cancer named by Hippocrates – Crab • Cancer is not just one disease but rather a group of diseases. • All forms of cancer cause cells in the body to change and grow out of control. • Most types of cancer cells form a lump or mass called a tumor.

2. What is Cancer? • All cancers have neoplastic growth, altered cells with nearly unlimited growth. • Benign localized • Malignant spread much more threatening • Metastatic cancer cells move to other parts of the body

3. Tumor • Increase in the number of undifferentiated cells creates a growing mass of tissue called a "tumor" or "neoplasm."

4. Benign vs. Malignant • Benign tumors are tumors that cannot spread by invasion or metastasis; hence, they only grow locally. • Malignant tumor spread into surrounding tissue

5. Metastasis • Malignant tumors can spread through blood stream and lymph to distant sites • Lung, liver, bone and brain are common sites of metastasis

6. Types of cancer • Carcinomas - Epithelial tissue 85% • skin • stomach lining • mucous membranes • Sarcomas - Connective tissue (2%) • bones, muscles, cartilage • Leukemias - Blood (8%) • Lymphomas – Originate in lymphatic system (5%).

7. Effects of Cancer • Proliferation of cancer cells at each site interferes with normal cell development and functioning. • Vascularization of tumors robs body of nutrients • Produces pain as it creates pressure on tissues and nerves and blocks flow of body fluids. • Most experience severe pain in later stages.

8. How does cancer cause death? • DIRECT - spreading to a vital organ and takes nutrients the organ needs causing the organ to fail. • INDIRECT - weakening the victim, impairing appetite and immune functioning.

9. Second leading cause of death in the U. S. Overall death rates fell an average of 1.6% over the last 10 years Rates are in different for different cancers Up for liver & pancreas Down for 7 of the 15 top cancers Men Lung Prostate Colon Rectum Pancreas Women Lung Breast Colon Rectum Pancreas Cancer - Mortality

10. Cancer Death Rates*, for Men, US,1930-2003 Lung & bronchus Rate Per 100,000 Stomach Prostate Colon & rectum Pancreas Leukemia Liver

11. Cancer Death Rates*, for Women, US,1930-2003 Rate Per 100,000 Lung & bronchus Uterus Breast Colon & rectum Stomach Ovary Pancreas

12. Cancer Mortality – North Carolina

13. 2007 Estimated US Cancer Cases Men766,860 Women678,060 • 26% Breast • 15% Lung & bronchus • 11% Colon & rectum • 6% Uterine corpus • 4% Non-Hodgkin lymphoma • 4% Melanoma of skin • 4% Thyroid • 3% Ovary • 3% Kidney • 3% Leukemia • 21% All Other Sites Prostate 29% Lung & bronchus 15% Colon & rectum 10% Urinary bladder 7% Non-Hodgkin 4% lymphoma Melanoma of skin 4% Kidney 4% Leukemia 3% Oral cavity 3% Pancreas 2% All Other Sites 19%

14. Lifetime Probability of Cancer, Men Site Risk All sites 1 in 2 Prostate 1 in 6 Lung & bronchus 1 in 13 Colon & rectum 1 in 17 Urinary bladder 1 in 29 Non-Hodgkin lymphoma 1 in 47 Melanoma 1 in 57 Leukemia 1 in 69 Oral cavity 1 in 71 Kidney 1 in 72 Stomach 1 in 79

15. Lifetime Probability of Cancer, Women Site Risk All sites 1 in 3 Breast 1 in 8 Lung & bronchus 1 in 17 Colon & rectum 1 in 18 Uterine corpus 1 in 37 Non-Hodgkin lymphoma 1 in 56 Ovary 1 in 58 Pancreas 1 in 80 Melanoma 1 in 81 Urinary bladder 1 in 88 Uterine cervix 1 in 123

16. 1900 – 1993 large increase in mortality Decreasing somewhat since 1993 for most sites Lung cancer is exception Different cancers have different rates of decline and increase Diagnostic issues and other disease issues muddle the picture Improved diagnosis Increase in lung cancer in women Cancers related to AIDS Control of other diseases Increase in environmental carcinogens Cancer Mortality

17. Cancer & Ethnicity • Anglo men – higher rates of bladder cancer. • Hispanics – lowest rates of lung cancer but women have highest rates of cervix cancer. • Blacks – highest rates of prostate cancer. • Japanese – highest rates of stomach cancer. • Chinese Americans lowest rates of liver cancer. • Northern Europeans – high rates of breast cancer.

18. What Causes Cancer? • Cancer is a “genetic” disease but >70% are not inherited • Cancer is a disease of exposure to numerous risk factors • Exposure damages DNA, thus altering gene expression ultimately leading to cancer • Figuring out exact cause it too complex at this point so we focus on RISK FACTORS

19. RISK FACTORS FOR CANCER

20. Non-controllable Risk Factors • Environmental • Certain chemical exposures • Radiation • Nuclear Powerplants? • Powerlines? • Inherent Factors • Family History – Seems so for some forms of breast and colon cancer • Age

21. Controllable Risk Factors

22. Smoking and Cancer • One-third of the 500,000 cancer deaths annually in the United States are caused by cigarette smoking • 90% of lung cancer deaths in men and 80%in women caused by smoking.

23. Smoking and Cancer • Cigarette smoking has synergistic effect with other environmental pollutants.

24. One-third of cancer deaths is caused by a variety of dietary factors. Foods high in carcinogens Foods that have too much animal fat and not enough fiber Cancer and Diet

25. American Cancer Society • To reduce your cancer risk, follow an overall dietary pattern that includes: • A high proportion of plant foods (fruits, vegetables, grains, and beans) • Limited amounts of meat, dairy, and other high-fat foods • A balance of caloric intake and physical activity.

26. Alcohol and Cancer • Alcohol implicated in cancers of the tongue, tonsils, esophagus,and liver • Related to breast cancer >2 drinks/day in women

27. Alcohol and Synergism • Alcohol may have a synergistic effect • Clear for tobacco. The risk is 50% higher is one smokes AND drinks than the additive risks of each one.

28. Physical activity • Good example of correlational research • health causes exercise • exercise causes health • Mixed results • Two recent studies showing that exercising four hours a week reduces chances of breast cancer in young women • Prostate cancer in men

29. Ultraviolet Light and Cancer Good example of interaction • light-skinned people near the equator have higher risk • Dramatic rise since 1970’s

30. Types of Skin Cancer • Basal Cell Carcinoma – Slow growth doesn’t spread much if at all • Squamous Cell Carcinoma – Grow more quickly than the above an can spread • Malignant Melanoma – Grows quickly and spreads. Occurs on or near moles

31. ABCD’s of Skin Cancer • A stands for ASYMMETRY • One half of the mole doesn't match the other half. Melanoma tend to be irregular. • B stands for BORDER IRREGULARITY • Benign moles have smooth edges whereas melanoma are busily invading and tend to have irregular edges. • C stands for COLOR. • If the color is intensely black, possibly with a bluish tint, or the color is uneven across the mole, this is suspicious of a melanoma. • D stands for DIAMETER • If the mole is greater than 6 mm (about the size of a pea), then there is a greater chance that it is malignant.

32. Sexual Behavior and Cancer • AIDS • Kaposi’s sarcoma • non-Hodgkins lymphoma • Invasive cervical cancer • Certain sexual practices can contribute to cancer risk. • Cervical cancer

33. Psychological Factors

34. Methodological issues prospective versus retrospective studies. Regular stress lessened risk but a single major event increased it. Negatively related were ability to express anger and living a busy lifestyle. Positively related to cancer were bereavement and denying the existence of problems Palesh et. al, (2007) Studied role of trauma and stress in tumor recurrence in women with BC 94 women with reccurrence of BC Trauma and stress was related to shorter disease-free interval Stress and cancer

35. Thornton et al, (2007) • 113 women with breast cancer • Assessed at diagnosis & 4, 8, 12, 18 months after • Perceived stress and immune function

36. Suppression of Emotion • One study of females w/breast cancer found those who suppressed emotion were more likely to develop cancer. • Similar results found in study of veterans and cancer in general. • Medical students who had more cancer in those who suppressed emotion versus those who acted out behaviors • Penedo et. Al, (2006) – Suppression of anger related to decrease in NKCC in men with prostate cancer

37. Depression and Cancer • Depression may cause people to have a higher mortality but not morbidity for cancer. • Some studies have found this relationship some haven’t.

38. Treatment and Survival

39. Surgery Radiation Chemotherapy Hormonal treatment – Breast Prostate Uterine and some Leukemias Immunotherapy – Convince immune system to attack tumor Loss of hair Burns Nausea Vomiting Fatigue Sterility Pain Loss of function Treatment & Side Effects of Cancer

40. Survival • More than half of all cancer patients survive at least five years • Remission not Cure • Cancer is beaten down it is unknown if it is every fully removed in some cases

41. Relative Survival by Cancer Site 1983-1985 1992-1998 Site 1974-1976 • All sites 50 52 62 • Breast (female) 75 78 86 • Colon & rectum 50 57 62 • Leukemia 34 41 46 • Lung & bronchus 12 14 15 • Melanoma 80 85 89 • Non-Hodgkin lymphoma 47 54 55 • Ovary 37 41 53 • Pancreas 3 3 4 • Prostate 67 75 97 • Urinary bladder 73 78 82

42. Psychosocial Factors in Survival

43. “Fighting Spirit” and Cancer • Those who fight angrily against the diagnosis survive longer • Depression and hopelessness did appear to predict an increased risk of dying in 5 years

44. Social Support and Cancer • After controlling for early detection and treatment married people lived longer. • Mechanism seems to be through social support and size of social network. • Social isolation increases mortality

45. Group Psychotherapy • Data suggests that group therapy can increase survival time • Supportive in nature • Strong Social Support • Similar Diagnosis • Educational Component • Information on Coping Strategies

46. Mindfulness and Cancer • Mindfulness-Based Stress Reduction • A program of stress reduction used in other contexts (chronic pain, stress-reduction) • 8-10 week group format • Meditational + Educational/Discussion Components • Recent review of the literature (Smith et. al, 2005) found that MBSR w/cancer patients led to: • Improved mood • Improved sleep • Reduction in stress • Positive immunological profile in post-surgical cancer patients • These were generally dose-response effects

47. A Model of Psych Interventions & Cancer