KANKER

Cancer : a group of more than 150 disease processes

characterized by uncontrolled growth and spread of
cells. A group of variable tissue responses that result in
uncontrolled cell growth (McCance & Roberts, 1998;
Fraumeni, 1982).

Factors linked to cancer : environmental exposures,

lifestyle practices, medical interventions, genetic traits,
viruses, familial susceptibility, and aging.
the Initiation-Promotion-Progression
Theory

Rous and Kidd (1941), cancer development

The initiation stage of carcinogenesis DNA is damaged or altered

(exposure to a carcinogen, or errors in DNA replication and repair)
Environmental hazards (ionizing and non-ionizing radiation), biological
factors (hormones and viruses).

Promotion Stage Promoting agents cause the altered cells to grow,

proliferate, and develop into tumors, Environmental pollutants, drugs,
and hormones. Biological changes of the promoters are reversible
through lifestyle factors that include diet, hormones, and a healthy
immune system (McCance & Roberts, 1998).
Cancer cells differ from normal cells in size,
structure, function, and growth rate.
 Environmental exposures and lifestyle practices the major
risk factors in the development of cancer.

The major lifestyle factors : smoking, alcohol, diet, medical

practices, and ultraviolet exposures.

Smoking
Major risk factor for heart disease and cancer
Tobacco exposure is the single largest preventable cause of
early death
> 30% of all cancer deaths are directly related to smoking
Causes a 3x increase in urinary tract cancers
Established cause in cancers of the bladder, pancreas, larynx,
mouth, and esophagus
Ductal carcinoma in situ
 Inasive ductal carcinoma

Human mammary epithelial cell Michigan cancer foundation

Food factors

High dietary fat contributing factor to endometrial, breast, prostate, ovarian, and
rectal cancers

Increase bile acids and cholesterol metabolites colorectal cancers

Diets low in fiber increased rates of colon cancer.

Food additives and food preparation cancer-causing agents

Nitrates, salts, and saccharin

Nitrates and salts (preserve foods) increase rates of glandular stomach cancers

Excessively smoked or broiled fish or meat, or repeatedly reused fats for frying foods
release Benzo(a)pyrene and other polycyclic hydrocarbons

Obesity increased risk for cancers of the breast, the ovaries, and the endometrium in
females higher levels of estrogen
Alcohol consumption

Increased rates of : upper respiratory tract, digestive

tract, breast, colorectum, and liver cancer

Impairments in the immune function or the inability of the

liver to clear the body of carcinogens, or from decreases
in cell membrane permeability in the breast

Increased rectal cell proliferation or growth in the rat

due to mechanism involved in the promotion of
colorectal cancers

Alcohol + tobacco usage increased rates of cancer in

the mouth, pharynx, larynx, esophagus, and liver
drugs

Androgen -anabolic steroids used to promote athletic

performance and prevent muscle wasting cause cancers in
the liver, prostate, and breast

Estrogen replacement medications and steroid

contraceptives may contribute to increased risk for
developing cancers of the endometrium, vagina, ovaries,
and breast

Immunosuppressants, such as those used in transplant

procedures, are linked to lymphomas, skin cancer, and soft
tissue sarcomas. Interestingly, some chemotherapeutic
drugs used to treat cancer, such as alkylating agents, are
linked to cancers of the bladder and to leukemia
Enviromental factor

Air and ground pollution, occupational hazards, ultraviolet radiation, and radon gas. Air and ground
pollution caused by industrial emissions and insecticides

Arsenic from pesticide applications, and from mining and smelting, contaminates groundwater and
causes lung, skin, and liver cancers

Industrial glues and varnish, as well as benzene byproducts from the petroleum industry, may contribute
to increases in leukemia

Asbestos, mustard gas, heavy metals, aromatic hydrocarbons, and halogenated organic compounds
from water chlorination are associated with increases in lung, bladder, liver, and pancreatic cancers

Radon gas trapped in houses contributes to an estimated 10% of lung and larynx cancers

Increases in ultraviolet exposures from tanning lamps and from diminished ozone levels contributes to
increases in skin cancers and melanomas

Highway maintenance workers and roofers exposed to bitumen fumes and coal tar fumes from asphalt
are at increased risk for cancers of the lung, stomach, and skin, as well as leukemia
Age and Genetic factor

Age : single best predictor of the risk of developing cancer

Rates for the development of cancer begin to increase at 40 years of age and
then increase rapidly at 50 years of age

Related to the increased likelihood of cumulative effects from environmental

exposures, the potential for long latency periods, and increased opportunities for
multi-stage processes to occur with aging

Genetic or inherited cancers and familial susceptibility : small percentage of

cancers
Part of the genetic line cancer can be inherited by succeeding generations
(autosomal dominant, autosomal recessive, and X-linked transmission) familial
breast cancer, familial polyposis of the colon, adenomas of the colon,
retinoblastomas (a childhood cancer of the eye), Wilms tumor (a childhood cancer
of the kidney), and neurofibromatosis
Somatic or general body cell cancer will not be passed to future generations.
Virus

Oncogenic viruses infect normal cells and cause alterations in the

cell's genetic material cause specific types of malignant and
benign cancers in susceptible individuals by allowing uncontrolled
growth in cells.

Affect DNA (cancers in the cervix, liver, anogenital area, mouth,

larynx, nasal and paranasal tissues, and conjunctival tissues) or RNA
(Human T-cell leukemia)

Interestingly, infection by an oncogenetic virus does not necessarily

lead to the development of cancer. In some industrial regions, the
Epstein-Barr virus, which causes Burkitt lymphoma, nasopharyngeal
cancer, and B-cell lymphoma, has an infection rate of up to 90% of
the young adult population; however, low numbers of infected
individuals in these areas develop cancer (McCance & Roberts,
1998).
Seven Warning Signs of Cancer

1. Change in bowel or bladder habits

2. A sore that does not heal

3. Unusual bleeding or discharge

4. Thickening or lump in the breast or elsewhere

5. Indigestion or difficulty swallowing

6. Obvious change in a wart or mole

7. A nagging cough or hoarseness

Diagnosis

Type, location, the extent of the disease.

Timely screenings breast self-examinations,

mammography, prostate screenings, chest X-rays, and
colonoscopy

Laboratory tests, X-rays, CT scans, ultrasound

examinations, bone scans, liver and spleen scans, and
biopsy analysis
Diagnosis
Staging and Classification

Staging establish treatment options, predict life expectancy,

and determine the prognosis for a complete recovery.

Factors noted in staging include:

Location and size of the primary site of the tumor

Extent of lymph node involvement

Presence or absence of metastasis

Type of tumor and the tumor-host relationship

 American Joint Committee on Cancer using the TNM
Clinical Classification System.

T stands for tumor, N stands for node, and M stands for

metastasis based on criteria for classification by
specific anatomic sites.

Staging of cancer Stages 0 to IV Describe the extent

of the disease

0 indicates undetectable, and I, II, III, and IV indicate a

progressive increase in the size or the extent of the
disease.
Tumor (T) codes:

TX: Cannot be assessed

T0: No evidence of a primary tumor
Tis: Carcinoma in situ
T1, T2, T3, and T4: Increasing size, local extent, or both, of primary tumor

Regional lymph node (N) codes:

NX: Cannot be assessed

N0: No metastasis
N1, N2, and N3: Increasing involvement of regional lymph nodes

Metastasis (M) codes:

MX: Cannot be assessed

M0: No distant metastasis

M1: Distant metastasis

Stage Code Description

Stage
Tis Cancer in situ (encapsulated)
0
Cancer is limited to original site
Stage I T2, N0, M0
or organ
Cancer has spread to
Stage II T2, N1, M0 surrounding tissue in the same
anatomic region
Stage High probability of metastatic
T3, N2, M0
III disease
Stage Metastatic spread to other
T4, N3, M1
IV anatomic region
Mouth cancer
Esophageal cancer
Lung cancer
Stomach cancer
Bowel cancer
Cancer of bladder
Prostate cancer
Testicular cancer
Brain cancer
Cervix cancer
Breast cancer
Skin cancer