Cancer is characterized by uncontrolled growth and spread of abnormal cells. If left untreated, cancer can result in death. The document discusses several types of cancer including lung cancer, the leading cause of cancer death, and colon cancer, the second most common cancer. It also covers cancer statistics, risk factors, screening, treatment milestones, and specific cancers like lung and colon cancer. Preventable lifestyle factors contribute to nearly 1/3 of cancer deaths in the US. Early detection through screening improves diagnosis and survival rates.

1. CANCER

2. 2
Looking Back
Tumors are described as
early as 1600 BC in ancient
Egyptian writings such as
the Smith papyrus
Source: Courtesy of the National Library of Medicine

3. 3
Looking Back (Cont.)
• Hippocrates introduced the
term “carcinoma,” derived
from karkinos (crab)
• The ancients saw the
disease as clawing its way,
crab-like, through the body
• Hippocrates proposed that
cancer was a disease
caused by an excess of
black bile
Source: Courtesy of the National Library of Medicine

4. 4
Looking Back (Cont.)
• In 1800, Marie Francois Xavier Bichat proposed that
cancer was an overgrowth of cellular tissue
• Cells were identified as the fundamental unit in tumor
tissue in 1830, after the invention of the microscope
• Rudolph Virchow’s 1858 theory that every cell
originates from another cell became the foundation for
the present understanding of cancer
Pfizer Inc. (2006). Chapter 5: Cancer. In Milestones in public health :
Accomplishments in public health over the last 100 years (p. 83).
New York, NY: Pfizer Inc.

5. CANCER
Biology of Cancer

6. 6
What is Cancer?
• Cancer is a group of diseases characterized by
uncontrolled growth and spread of abnormal cells
• If the spread is not controlled, cancer can result in
death
• Cancer affects almost every part of the human body
• Cancer arises from the same material, cells, used
by the body to construct its own tissues
• Abnormal masses of tissue are called tumors.
Tumors can be benign (non-cancerous) or
malignant (cancerous)
• Cancerous tumor cells differ from normal cells in
many respects

7. A killer T-cell (the smaller cell on the top)
has recognized a cancer cell and is
attacking it with toxic chemicals that punch
holes in the cancer cell’s surface.
p425

8. 8
What is Cancer?
• Cancer: An abnormal and uncontrolled multiplication of
cells , which, if left untreated can lead to death
• Cancerous tumor cells are abnormal and divide without
order or control
• Cancerous cells can damage nearby tissue, and
invade other areas of the body (metastasize)
• Every case of cancer begins as a change in a cell that
allows the cell to grow and divide when it should not

9. 9
What Causes Cancer?
• Cancer is caused by both external factors and internal
factors that occur from metabolism (chemical processes
occurring within a living cell or organism that are
necessary for the maintenance of life)
• These factors may act together or in sequence to initiate
the formation of cancer
• Examples of external factors include:
(tobacco, chemicals, radiation, and infectious organisms)
• Examples of internal factors include: (inherited
mutations, hormones, immune conditions, and other mutations)

10. Metastasis
• Metastasizing – The traveling
,spreading process of
cancerous cells
• Primary tumor is original
location of cancer
• New tumors are called
secondary tumors or
metastases
• Can invade nearby tissue or
spread to different parts of the
body
10

11. Types of Cancer
• The behavior of tumors arising in different body
organs is characteristic of the tissue of origin
• Classified according to types of cells that give rise to
them
• Carcinomas
• Sarcomas
• Lymphomas
• Leukemias
11

12. 12
Leading U.S. Causes of Death, 2006
Rank
Cause of Death
No. of
deaths
Percent of
all deaths
1.
Diseases of the heart
636,636
26.0
2.
Cancer
559,888
23.1
3.
Cerebrovascular
diseases
137,119
5.7
4.
Chronic lower
respiratory diseases
124,583
5.
Accidents (unintentional 121,599
injuries)
5.0
6.
Diabetes mellitus
72,449
3.0
7.
Alzheimer’s disease
71,432
3.0
Influenza & pneumonia
56,326
2.3
8.
5.1
Source: US Mortality Data 2005, National Center for Health Statistics, Centers for Disease Control and Prevention, LCWK 1. Deaths,
percent of total deaths, and death rate for the 15 leading causes of death in 5-year age groups, by race and sex, United States, 2006,
“Cause of death (Based on the Tenth Revision, International Classification of Diseases, Second Edition, 2004), race, sex, and age.” (All
races, both sexes, all ages). Retrieved May 29, 2010 from http://www.cdc.gov/nchs/data/dvs/LCWK1_2006.pdf
Cancer accounts for nearly ¼ of deaths in US , exceeded only by heart
diseases.

13. 13
Cancer Statistics
• Some 1.3 million Americans are diagnosed with cancer
•
•
•
•
•
•
each year
Following heart disease, cancer is the second most
common cause of death in the U.S.
More than 550,000 Americans die from cancer annually
The median age for the diagnosis of cancer in adults is
age 67
Lung cancer is the leading cause of cancer death among
men and women
Cancer affects nearly one in every two men
Cancer affects nearly one in every three women
American Cancer Society (2008) Cancer Facts and Figures 2008.
Retrieved June 10, 2010 from
http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf

14. 14
Preventable Cancer Causes
• Cancers caused by cigarette smoking can be prevented.
In 2009, the American Cancer Society estimated that
169,000 cancer deaths would be caused by tobacco use
• In 2009 scientific evidence indicated that one third of US
cancer deaths of the estimated 562,340, would be related
to overweight, obesity, physical inactivity, and nutrition
American Cancer Society (2009), Cancer Facts and Figures 2009.
Retrieved May 28, 2010 from http://www.cancer.org/downloads/STT/500809web.pdf

15. 15
2009 Estimated U.S. Cancer Deaths
Lung & bronchus
30%
Men
292,540
Women Lung & bronchus
•26%
269,800 Breast
•15%
Prostate
9%
Colon & rectum
9%
• 9%
Colon & rectum
Pancreas
6%
• 6%
Pancreas
Leukemia
4%
• 5%
Ovary
Liver & intrahepatic
bile duct
4%
• 4%
Non-Hodgkin
lymphoma
Esophagus
4%
• 3%
Leukemia
Urinary bladder
3%
• 3%
Uterine corpus
Non-Hodgkin
lymphoma
3%
• 2%
Liver & intrahepatic
bile duct
Kidney & renal pelvis
3%
• 2%
Brain/ONS*
25%
•25%
All other sites
All other sites
ONS=Other nervous system.
Source: American Cancer Society, “Cancer Statistics 2009: A presentation from the American Cancer Society,” *
Retrieved May 29, 2010 from
http://www.cancer.org/downloads/PRO/Cancer_Statistic_2009_Slides_rev.ppt#397,2,2009 Estimated US Cancer Deaths

16. 16
Cancer Death Rates* Among
Men, U.S., 1930-2004
100
Rate Per 100,000
Lung & bronchus
80
60
Stomach
40
Colon & rectum
Prostate
20
Pancreas
2000
1995
1990
1985
1980
1975
1970
1965
Liver
1960
1955
1950
1945
1940
1935
Leukemia
1930
0
*Age-adjusted to the 2000 US standard population. From the Cancer Statistics 2008: A Presentation from the American Cancer
Society. Retrieved May 28, 2010 from http://www.acsevents.org/downloads/STT/Cancer_Statistics_2008.ppt#426,7,Cancer Death
Rates* Among Men, US,1930-2004 Source: US Mortality Data 1960-2004, US Mortality Volumes 1930-1959, National Center for
Health Statistics, Centers for Disease Control and Prevention, 2006.

17. 17
Cancer Death Rates* Among
Rate Per 100,000
Women, U.S.,1930-2004
100
80
60
40
Lung &
bronchus
Breast
Uterus
20
Colon & rectum
Stomach
*Age-adjusted to the 2000 US standard population. From the Cancer Statistics 2008: A Presentation from the
American Cancer Society. Retrieved May 28, 2010 from
http://www.acsevents.org/downloads/STT/Cancer_Statistics_2008.ppt#427,8,Cancer Death Rates Among
Women, US,1930-2004. Source: US Mortality Data 1960-2004, US Mortality Volumes 1930-1959, National
Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
2000
1995
1990
1985
1980
1975
1970
1965
1960
1955
Pancreas
1950
1945
1940
1935
1930
Ovary
0

18. 18
Health Disparities and Cancer
• “Differences in the incidence, prevalence, mortality, and
burden of diseases and other health conditions that exist
among specific population groups in the United States.”
• National Institutes of Health, US Department of Health and Human
Services
• “Differences in the incidence or prevalence of disease
disability, or illness. These differences can be among
racial/ethnic groups, socioeconomictogroupings, gender
LaVeist, T. (2005). Minority populations and health: An introduction health disparities
in the
groups, united otherFrancisco : Jossey-Bass.
or states. San groupings.”

19. 19
Cancer Incidence Rates* by Race and
Ethnicity, 2000-2004
Men
Women
800
700
600
663.7
Rate Per 100,000
556.7
500
423.9
400
421.3
396.9
359.9
321.2
285.8
300
282.4
314.2
200
100
0
White
African American
Asian/Pacific Islander
American Indian/
Alaska Native
Hispanic†
*Age-adjusted to the 2000 US standard population. †Person of Hispanic origin may be of any race. From the Cancer Statistics 2008:
A Presentation from the American Cancer Society, Retrieved May 29, 2010
http://www.acsevents.org/downloads/STT/Cancer_Statistics_2008.ppt#412,17,Cancer Incidence Rates* by Race and Ethnicity, 2000-2004.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2004, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2007.

20. 20
Cancer Death Rates* by Race and
Ethnicity, U.S., 2000-2004
400
Men
350
Women
321.8
300
250
234.7
189.3
200
187.9
162.2
161.4
150
100
141.7
141.2
96.7
106.7
50
0
*Per 100,000, age-adjusted to the 2000 US standard population. † Persons of Hispanic origin may be of any race. From the Cancer
White
African American Asian/Pacific American
Hispanic†
Statistics 2008: A Presentation from the American Cancer Society, Retrieved May 28, 2010 Indian/
http://www.acsevents.org/downloads/STT/Cancer_Statistics_2008.ppt#428,9,Cancer Death Rates* by Race and Ethnicity, US, 2000-2004
Islander
Alaskan Native
Source: Surveillance, Epidemiology, and End Results Program, 1975-2004, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2007.

21. 21
Cancer Screening
• Screening involves looking for early signs of a particular
disease in asymptomatic people
• Cancer screening seeks to find cancers as early as
possible, when the chance of cure is highest

22. 22
When is Screening Helpful?
• While there are several types of cancer, not all cancers
have screening tests. A screening test should:
• Detect the cancer early
• Not give false negatives
• Not give false positives
• Not be unpleasant or dangerous
• Be cost-effective

23. 23
Cancer Screening
• Screening is used in the detection of the following
cancers:
• Breast (Mammography)
• Cervix (Papanicolau smear)
• Colon (Colonoscopy, Sigmoidoscopy, Fecal Occult Blood)
• Prostate (Prostate Specific Antigen)
• Identifying the majority of cancers in their early stage
leads to improved diagnosis, less radical
treatment, decreased mortality, and lower health care
costs

24. 24
Milestones in Cancer Treatment
• Until the 20th century, few cancer patients had a chance
for long-term survival; however, two notable
interventions, radiation therapy and chemotherapy, have
improved survival rates:
• Professor Wilhelm C. Roentgen’s work provided the foundation for
radiation therapy for cancer
• Dr. Min Chiu Li demonstrated that systemic chemotherapy could
result in the cure of a widely metastatic disease
Pfizer Inc. (2006). Chapter 5: Cancer. In Milestones in public health : Accomplishments in
public health over the last 100 years (pp. 86-88). New York, NY: Pfizer Inc.

25. Lung Cancer
• Most common cause of
cancer death in the U.S.
• 157,000 deaths per year
• Risk factors
• Tobacco contributes to 30% of all
cancer deaths and 90% of lung
cancer deaths
• Detection
• Difficult to detect
• Symptoms do not usually appear
until cancer has reached the
invasive stage
• Persistent cough, chest pain, or
recurring bronchitis
• Diagnosis: CT scan, chest x-ray, or
sputum examination
25

26. Colon Cancer
• Colon cancer: neoplasm that starts in the large intestine
(colon) or the rectum (end of the colon).
• category of cancer is typically referred to as "colorectal cancer."
• 2nd most common cancer among both men and women in
the United States
• 3rd most common cause of cancer death among men and
women in the United States
• In 2007, approximately 153,760 adults (79,130 men and
74,630 women) in the United States will be diagnosed
with colorectal cancer

27. What causes colon cancer?
• No single cause
• Nearly all colon cancers begin as
benign polyps
• Certain genetic syndromes also
increase the risk of developing
colon cancer.
• Most colorectal cancers arise from
an adenomatous polyp
• Polyp: is defined as a tissue
protuberance from the colon mucosa

28. Colon and Rectal Cancer
• Risk factors
• Directly linked to age, genetic predisposition, lifestyle habits, diet
• 91% of cases occur after 50 years of age
• Excessive alcohol use and smoking may increase risk
• Obesity and diets rich in red and processed meats increases risk
• Regular physical exercise and diets rich in fruits, vegetables, and whole
grains may lower risk
• Research mixed on high-fiber diets
• Oral contraceptives and hormone replacement may increase risk in
women
28

29. Two main types of
Inherited Colon Cancers
• Hereditary nonpolyposis colorectal cancer
(HNPCC) or Lynch syndrome
• accounts for 5% to 10% of cases
• The risk of colorectal cancer in families with HNPCC is
70% to 90%,
• Familial adenomatous polyposis (FAP)
• approximately 1% of cases of colon cancer annually
• People with FAP typically develop hundreds to
thousands of colon polyps
• The polyps are initially benign (noncancerous), but
there is nearly a 100% chance that the polyps will
develop into cancer if left untreated.

30. Detection and treatment
• Since colorectal cancer is one of the most treatable forms
of cancer if identified early, people diagnosed with
HNPCC, or those considered at increased risk based on
their family history, often benefit from increased
screening.
• Survival 91% if detected early, 65% overall

31. Signs and Symptoms
• Signs and symptoms of colon cancer may
include:
• A change in bowel habits, including diarrhea or
•
•
•
•
•
•
constipation or a change in the consistency of stool for
more than a couple of weeks
Rectal bleeding or blood in stool (melena)
Persistent abdominal discomfort, such as cramps, gas
or pain
Abdominal pain with a bowel movement
A feeling that your bowel doesn't empty completely
Weakness or fatigue
Unexplained weight loss

32. Treatment
• Surgery
• most common treatment for colon cancer
• Chemotherapy
• reduces the chance of reoccurrence
• Radiotherapy
• Colon cancer is not typically treated with radiation therapy
• Follow-Up Testing

33. 12/8/2013Chapter fifteen
© 2012 McGraw-Hill Higher Education. All rights reserved.
Testicular Cancer
• Most common form of ca in men between ages of 15 - 35.
• can occur in older men, and rarely, in younger boys
• one of the most treatable and curable cancers (95% if
caught early (stage 1)
• Factors that may increase:
• Abnormal testicle development
• History of Undescended testicle
• Other possible causes : exposure to certain
chemicals, HIV. family hx of testicular cancer
• Caucasian men more likely than African-American &
Asian-American men to develop this type of ca.
• 2 main types of testicular cancer:
• Seminoma: slow-growing form usually found in men in
their 30s & 40s; usually just in testes, but can spread to
the lymph nodes; very sensitive to radiation therapy.
• Nonseminoma: more common type; tends to grow quickly
33

34. 12/8/2013Chapter fifteen
© 2012 McGraw-Hill Higher Education. All rights reserved.
Testicular Cancer
Symptoms
• may be no symptoms or may have discomfort / pain in
testicle, or a feeling of heaviness in the scrotum
• Pain in the back or lower abdomen
• Lump , swelling, enlargement in either testicle
• Excess development of breast tissue (gynecomastia),
• S/s in other parts of body, such as the lungs, abdomen, pelvis,
Signs and tests
• Physical exam typically reveals firm lump (mass) in 1 of
testicles.
• When flashlight held up to scrotum, light doesn’ t pass
through lump.
• Blood tests for tumor markers:
• Ultrasound of scrotum
Treatment
• Surgery, Radiation
• Chemotherapy
34

35. Prostate Cancer
• Most common cancer in men
• 2nd leading cause of cancer death
in men
• Nearly 218,000 new cases per year
• More than 32,000 deaths per year
• Risk factors
• Age
• Genetic predisposition/family history
• Diet
• Lifestyle
• History of STDs
• Type 2 diabetes and insulin resistance
• Detection
• Prostate-specific antigen (PSA) blood test
• Digital rectal examination
• Yearly screening beginning between
ages 40-50
• Treatment
• Surgical removal of the prostate and
radiation
• Implantation of radioactive seeds
• 5-year survival rate is nearly 100%
35

36. Breast Cancer
• Most common cancer in women
• 1 in 8 American women will
develop it during her lifetime; 1 in
30 women will die from the disease
• About 200,000 American women are
diagnosed each year and 41,000
women die from it each year
• Risk factors
• rises quickly with age, about 50% occurring
•
•
•
•
•
•
•
•
in women ages 45-65
Genetic predisposition/family history
Early onset of menstruation
Late onset of menopause
Having first child after 30
Having no children
Hormone replacement therapy
Estrogen connection
Obesity, diet, and alcohol use
36

37. Breast Cancer
• Detection and Treatment
• Early detection – cure most likely when cancer is
detected early
• Monthly breast self-exam for all women over 20
• Clinical breast exam by a physician every 3 years
(every year for women over 40)
• Mammography- Every 1 year for women over 40
• MRIs
• Treatment
• Ultrasonography
• Biopsy
• Lump found to be harmless growth in 90% of
cases
• Surgery: lumpectomy, mastectomy
37

38. Breast Cancer
• Survival rate
• 98% if the cells haven’t metastasized
• 90% for all stages at 5 years
• New strategies for treatment and
prevention
• SERMs (tamoxifen, raloxifene)
• Monoclonal antibodies (trastuzumab):
Antibodies designed to bind to specific
cancer-related targets

39. Multi-Stage Carcinogenesis:
Targets for Cancer Prevention
ion
Forman et al. Ann Rev Nutr, 2004