CANCER = Malignant Tumor = Malignant Neoplasm A tissue growth: Not necessary for body s development or repair Invading healthy tissues Spreading to other sites of the body (metastasizing) Lethal because of its invasion, metabolism, and complications E. MORAN - 2018 1
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Cancer Terms to Know Origin Epithelium (lining tissue) Glands Connective tissue Bones Muscles Brain tissue (glial cells) Lymphatic glands, spleen Blood cells Name Carcinoma Adenocarcinoma Sarcoma Osteosarcoma Rhabdomyosarcoma Glioma Lymphoma Leukemia E. MORAN - 2018 3
BENIGN TUMORS Benign tumors do not invade surrounding healthy tissues Benign tumors do not spread out Benign tumors may cause complications due to their presence which may obstruct natural conduits [bronchi (airways), intestine] Terms: Adenoma, lipoma, osteoma E. MORAN - 2018 4
APOPTOSIS = PROGRAMMED CELL DEATH A highly regulated and controlled cell death. It results in changes that include, cell shrinkage, nuclear breakage, chromatin and chromosomal breakage, and global messenger RNA decay. Defective apoptotic processes have been implicated in a wide variety of diseases. An insufficient amount results in uncontrolled cell proliferation, such as cancer. Between 50 and 70 billion cells die each day due to apoptosis in the average human adult. E. MORAN - 2018 5
What Causes Cancer? Some viruses or bacteria Some chemicals Radiation Heredity Diet Hormones N. C. I. 6
Oncogenes Normal cell Normal genes regulate cell growth Cancer cell Oncogenes accelerate cell growth and division Mutated/damaged oncogene E. MORAN - 2018 7
p53 Tumor Suppressor Protein Triggers Cell Suicide p53 protein Normal cell Excessive DNA damage Cell suicide (Apoptosis) E. MORAN - 2018 8
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Cancer Risk and Aging 400 Cancer Risk and AGING Colon Number of CANCER Cases (per 100,000 people) 300 200 100 Breast 0 20 40 60 80 Age of Person (in years) N. C. I. 10
Population - Based Studies U.K.: Lung cancer Regions of Highest Incidence JAPAN: Stomach cancer CANADA: Leukemia CHINA: Liver cancer AUSTRALIA: Skin cancer U.S.: Colon cancer BRAZIL: Cervical cancer N. C. I. 11
Heredity? Behavior? Acculturation? 100 Colon Cancer (Number of new cases per 100,000 people) 100 Stomach Cancer (Number of new cases per 100,000 people) 70 50 5 0 Japan Japanese families in U.S. U.S. 7 0 Japan Japanese families in U.S. U.S. N. C. I. 12
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Malignant versus Benign Tumors Benign (not cancer) tumor cells grow only locally and cannot spread by invasion or metastasis Malignant (cancer) cells invade neighboring tissues, enter blood vessels, and metastasize to different sites Time N. C. I. 17
Development of a Malignant Tumor E. MORAN - 2018 18
LECTURE #2 19
TUMOR EMBOLUS E. MORAN - 2018 20
CANCER INVASION E. MORAN - 2018 21
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Lymph Node Structure - Schema E. MORAN - 2018 23
Left cervical lymphadenopathy (Enlarged lymph nodes) E. MORAN - 2018 24
Right Cervical (Neck) Enlarged Lymph Nodes E. MORAN - 2018 25
Swollen glands E. MORAN - 2018 26
Enlarged Glands (Lymphadenopathy) Subjective: Tender or painless (?) Objective: Acute or chronic Local or general Isolated or matted glands Differential diagnosis: Chronic infections Cancer Diagnosis: Biopsy and pathologic examination No needle biopsy E. MORAN - 2018 27
Preferential Sites of Cancer Spread LUNGS Lymph nodes, adrenal glands, bones, Liver, Brain BREAST Lymph nodes, lungs, liver, bones, brain PROSTATE Lymph nodes, spine, bones, lungs COLON Lymph nodes, liver, lungs BRAIN - Rarely to lymph nodes of the neck E. MORAN - 2018 28
ENVIRONMENT and CANCER 29
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LUNG CANCER RISK FACTORS Active tobacco smoking (87%) Passive smoking Environmental factors (asbestos, metals) E. MORAN - 2018 37
Lag Time 20-Year Lag Time Between Smoking and Lung Cancer Cigarette consumption (men) 4000 Cigarettes Smoked Person per Year 3000 2000 Lung cancer (men) 150 100 Lung Cancer Deaths (per 100,000 people) 50 1000 1900 1920 1940 1960 1980 Year E. MORAN - 2018 38
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INTERMISSION 41
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Low-Strength Radiation High Dallas Skin Cancer Incidence Detroit Pittsburgh Low Least Annual Sunshine (UV radiation) Most E. MORAN - 2018 48
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High-Strength Radiation High Leukemia Incidence Low Least X-ray Dose (atomic radiation) Most N. C. I. 50
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Bacteria and Cancer Helicobacter pylori Stomach cancer Chlamydia trachomatis greater risk of cervical cancer E. MORAN - 2018 56
Bacteria and Stomach Cancer Patient s tissue sample H. pylori E. MORAN - 2018 57
STOMACH CANCER H. pylori - 2/3 of world s population harbors the bacterium - Second cause of cancer deaths worldwide H. pylori inflammation reactive O species cytokines mutations cancer - 6-8 fold increase compared to non-infected individuals H. pylori reduced risk of gastroesophageal (cardia) cancer less acidity. E. MORAN - 2018 58
Human Viruses and Cancer Virus Hepatitis B and C Human Cancer Liver, pancreas, breast cancer Herpes virus Nasopharyngeal carcinoma, Lymphomas Human Papilloma Virus Cervical cancer, skin cancer E. MORAN - 2018 59
Avoid Cancer Viruses High HPV Infection Increases Risk for Cervical Cancer Cervical Cancer Risk Low Noninfected women Women infected with HPV N. C. I. 60
CANCER PREVENTION 61
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NUTRITION and CANCER Overnutrition - Colon, breast, and prostate cancer Undernutrition - Esophagus, stomach, and liver cancer E. MORAN - 2018 64
Limit Alcohol and Tobacco Combination of Alcohol and Cigarettes Increases Risk for Cancer of the Esophagus 40x Risk Increase 30x 20x 10x Alcoholic Drinks Consumed per Day Packs of Cigarettes Consumed per Day AND E. MORAN - 2018 65
Diet: Limit Fats and Calories Correlation Between Meat Consumption and Colon Cancer Rates in Different Countries 40 Number of cancer cases (per 100,000 people) 30 20 10 0 80 100 200 300 Grams (per person per day) E. MORAN - 2018 66
Cancer Death Rates 0f OBESE Compared to that of INDIVIDUALS with Normal Body Weight (BMI < 25) 70% 60% 50% Men Women 52% 62% 40% 30% 20% 10% 0% 30.0-34.9 35.0-39.9 40 or more E. MORAN - 2018 67
OBESITY and CANCER New Findings ~30% of US adults are obese (BMI > 30) ~35% of USadults are overweight (BMI 25-30) Women: Uterine cancer 6-fold Men: Kidney cancer x 5-fold Liver cancer 6-fold Colorectal cancer ~1.75-fold E. MORAN - 2018 68
Recommendations for Cancer Prevention 1. Be as lean as possible within the normal range of body weight. 2. Be physically active as part of everyday life. 3. Do not smoke. 4. Limit consumption of energy-dense foods; avoid sugary drinks. 5. Eat mostly foods of plant origin. 6. Limit intake of red meat; avoid processed meat. 7. Limit alcoholic drinks. 8. Limit consumption of salt; avoid moldy cereals (grains) or pulses (legumes). 3. Aim to meet nutritional needs through diet alone. E. MORAN - 2018 69
Diet: Consume Fruits and Vegetables N. C. I. 70
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CANCER CHEMOPREVENTION 79
CHEMOPREVENTIVE SUBSTANCES IN FOOD (I) Flavonoids - Green plants, fruits, vegetables, tea, coffee, wine Indoles - Cruciferous vegetables Organic Isothiocyanates - Cruciferous vegetables Monoterpenes - Citrus fruits Phenolic Acids - Fruits, vegetables, nuts, coffee, tea Phytic Acid - Legumes, cereals Protease Inhibitors - Seeds, grains, legumes
CHEMOPREVENTIVE SUBSTANCES IN FOOD (II) Carotenoids - Fruits, cereals, vegetables Chlorophyllin - Leafy vegetables Coumarins - Vegetables, citrus fruits, nuts, beans, grains Diallyl Sulphides - Garlic, onions Dietary Fiber - Grains, seeds, berries, fruit skin, legumes,
NUTRITIVE CHEMOPREVENTIVE AGENTS (III) Agents Major Food Source Mode of Action Vitamin A Vegetables, Antioxidant fruits Vitamin C Fruits (citrus), Antioxidant vegetables Vitamin E Vegetable oils Antioxidant Selenium Meat, eggs, Antioxidant dairy products Calcium Dairy products Binds bile and fatty acids
The doctor of the future will give no drugs, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of human disease. - Thomas A. Edison 83