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Cancer is a disease that affects around one-third of the human population, irrespective of nationality or ethnic origins.
There are many types of cancer,
but they all have one thing in common - they begin as rebel or mutant cells.
A Leading cause of morbidity and mortality worldwide
Annual incidence estimated at 10 million
Accounted for around 7.9 million deaths in 2009
> 70% of all cancer deaths occur in low and middle-income countries
By 2030, cases and deaths will increase by 69% and 72% respectively
Cancer EpidemiologyHistorical Perspective
British surgeon, Percival Pott reported probably
the first description of occupational carcinogenesis
in the form of scrotum cancer among chimney sweeps.
due to exposure to soot.
1700s: tobacco and cancer
Reports of cancer risks associated with tobacco in the 18th century
included snuff taking and nasal cancer, reported by Hill in 1761, and pipe smoking and lip cancer by von Soemmering in 1795.
Tight corsets and cancer
Rigoni-Stern, Italian physician, observed that
married women in the city were getting cervical cancer, but nuns in nearby convents weren't.
He also observed that nuns had higher rates of breast cancer, and suggested that the nuns' corsets were too tight
Tobacco and Lung Cancer
Asbestos and Lung Cancer
Leather Industry and Nasal Cancer
Dyes and Bladder Cancer
Ionizing Radiation and Many Cancers
DES and Vaginal Adenocarcinoma
EBV and Burkitt's Lymphoma
HPV and Cervical Cancer
Cancer Deaths Globally
The metastatic spread of cancer to vital organs of the body may result in massive tissue destruction, loss of life-sustaining functions and ultimately, the untimely death of the human host.
Worldwide, cancer causes more than 7.7 million deaths per year, about 13% of the 60 million annual deaths from all causes.
Across all age groups, cancer currently ranks second behind heart disease as a leading cause of global death (World Health Organization, 2010).
Global Cancer Deaths: Male
More than 4.3 million men died from cancer in the world during 2007 (ACS, 2007).
More than one million men died from lung cancer and other malignancies of the respiratory tract
Nearly two million died from malignancies of the gastrointestinal tract
An additional 10% of male cancer deaths were caused by malignancies of the genitourinary tract (prostate, kidneys, bladder).
Global Cancer Deaths: Female
More than 3.3 million women died from cancer in the world population during 2007 (American Cancer Society, 2007).
Breast cancer caused the most deaths (more than 465,000) followed closely by lung cancer (more than 376,000).
Gastrointestinal cancers (i.e., stomach, liver, esophagus and pancreas) together accounted for about one million deaths.
Malignancies of the genitourinary tract (i.e., uterine cervix and ovaries) caused another 450,000 deaths.
Cancer Deaths in Developing Versus Developed Nations, Men, 2007
Among men living in developing nations, the total number of deaths due to either liver cancer or stomach cancer was more than 3.5 times higher than in developed nations reflecting high rates of infection by liver viruses (HBV and HCV) and stomach bacteria (Helicobacter Pylorus) plus contamination of food supplies by molds that produce highly carcinogenic aflatoxins.
Deaths from colorectal cancer or prostate cancer, however, occurred more frequently in developed nations partly due to intake of diets high in fat and calories and low in fiber, fruits and vegetables.
Lung cancer and other cancers arising from tobacco smoking caused the most male deaths in all populations.
Cancer Deaths in Developing Versus Developed Nations, Females, 2007
Among women living in developing nations, cancer of the uterine cervix caused the greatest number of deaths, principally due to lack of screening for premalignant dysplastic lesions of the cervical mucosa.
Breast cancer was the leading cause of cancer death in developed nations and ranked second in developing nations.
Cancer Deaths in the US
Approximately 1.5 million new cases of invasive cancer are diagnosed annually in the United States.
In 2007, more than 565,000 persons died from cancer.
LUNG CANCER IS THE LEADING CAUSE OF CANCER DEATHS
IN BOTH MEN AND WOMEN.
Cancer mortality and incidence rates vary considerably by race and by gender.
Men have about 30% higher cancer death rates than women.
African American men have the highest death rates from cancers of the lung and bronchus, prostate, and colon and rectum compared to any of the other racial or ethnic groups in the United States.
Cancer Mortality among U.S. Men, 1930-2007
More than half of all cancer deaths in US men are due to cancers of the lung and bronchus, prostate, colon and rectum.
While lung cancer mortality has declined slightly since about 1990, the male death rates from lung cancer are still more than double that of any other anatomic site.
Prostate cancer surpassed colorectal cancer in 1987 as the second leading cause of cancer deaths in men.
The mortality rates from both prostate cancer and colorectal cancer show evidence of a gradual decline in the past decade.
Mortality rates from other malignancies have remained constant, except for stomach cancer rate which have declined dramatically beginning in about 1930 (American Cancer Society, 2011).
Cancer Mortality in U.S. Women, 1930-2007
Cancers of the lung and bronchus, breast, and colon and rectum account for more than half of all cancer deaths among U.S. women.
Lung cancer surpassed breast cancer as the leading cause of cancer death in women in 1987.
Since 1950, lung cancer mortality among women has increased by more than 600% and now accounts for about 25% of all female cancer deaths.
Breast cancer mortality remained remarkably constant throughout the 20th century but appears to be slightly declining in recent years.
Mortality rates from cervical cancer and stomach cancer declined dramatically during 1930-2011.
Colorectal cancer mortality among has gradually declined since the 1950s (American Cancer Society, 2011).
Two thirds of U.S. cancer deaths are due to cancers of the lung, breast, prostate, colon and rectum.
Lung cancer is the top cause of cancer death in US men and women
Worldwide, cancer causes more than 7.7 million deaths per year,
More than 4.3 million men died from cancer in the world during 2007
More than 3.3 million women died from cancer in the world population during 2007
Neoplasia is new, uncontrolled growth of cells that is not under physiologic control.
A "tumor" or "mass lesion" is simply a "growth" or "enlargement"
The term "cancer" implies malignancy, but neoplasms can be sub classified as either benign or malignant.
Fibroadenoma (benign breast tumor)
Pituitary adenoma etc
Malignant Tumors (Cancer)
Somatic Mutation Theory of Cancer
In the Somatic Mutation Theory, carcinogenesis results from accumulation of two or more somatic mutations that favor neoplastic development (Knudson, 2001)
Cancer arises from a single mutated cell that develops into a cancerous tumor with cell replication and accumulation of multiple DNA mutations over time.
Epigenetic Theory of Cancer
The Epigenetic Theory proposes that cancer develops due to activation or deactivation of certain genes that impact upon mechanisms of cell survival and cell division, but in the absence of mutations that alter the DNA sequence (Verma, Maruvada and Srivastara, 2003; Momparler, 2003) .
....alter the conformation of the DNA and determine whether genes, e.g., tumor suppressor genes, are expressed or suppressed.
Theory of Cancer
More than a century ago, the famous German pathologist, Rudolph Virchow, suggested that chronic inflammation leads to cancer development by increasing uncontrolled cellular proliferation (Virchow, 1863; Balkwill and Mantovani, 2001).
Molecular Basis of Cancer
NON-lethal genetic damage
A tumor is formed by the clonal expansion of a single precursor cell (monoclonal)
Carcinogenesis is a multistep process
Risk Factors for Cancer
Melanomas 6x incidence New Zealand vs. Iceland
Blacks have low incidence of melanoma, so do normally pigmented areas like areolae on white people
Smoking and alcohol abuse
Overweight = 50% increase in cancer
Environmental vs. racial factors
Japanese immigrants to USA
Human papilloma virus (HPV) and cervical cancer
Hepatitis B virus (HBV) and liver cancer (Africa, Asia)
Epstein-Barr Virus (EBV) and lymphoma
Environmental vs. racial factors
Breast cancer incidence rates have historically been 4-7 times higher in the United States than in China or Japan
When Chinese, Japanese, or Filipino women migrate to the United States, breast cancer risk rises over several generations and approaches that among U.S. Whites.
Foreign-born Asians have some of the lowest breast cancer rates in the world, but their risk increases quickly when they adopt a Western diet and lifestyle.
1) Infectious Pathogens
Nitrosamine and amides (tar, nitrites)
Vinyl chloride angiosarcoma
PolyChlorinated Biphenyls (PCBs)
Natural Plant and Microbial Products
Aflatoxin B1 Hepatomas
Cycasin from cycads
Safrole from sassafras
Betel nuts Oral SCC
UV: BCC, SCC, MM
IONIZING: photons and particulate
Hematopoetic and Thyroid (90%/15yrs) tumors in fallout victims
Radiation - X-rays and other procedures used in medicine (medical tests and therapies)
Radioactive substances used in industry
Nuclear power generators
Radioactivity (e.g., radioactive fallout) from the production and detonation (primarily for testing purposes) of nuclear weapons.
Infectious Pathogen Carcinogens
Human papilloma virus Cervical cancer
Epstein-Barr Virus Nasopharyngeal cancer
Hepatitis B virus HepatoCellular Carcinoma (Liver)
Human herpes virus-8 Kaposi sarcoma
Helicobacter Pylori (bacteria) == Gastric cancer
Streptococcus bovis == Colorectal carcinoma
Schistosomiasis hematobium == Bladder cancer
Transformation & Progression
Self-sufficiency in growth signals
Insensitivity to growth-inhibiting signals
Evasion of apoptosis
Defects in DNA repair: "Spell checker"
Limitless replicative potential: Telomerase
GROWTH SUPPRESSOR GENES
Problems of GROWTH SUPPRESSION, result in GROWTH being UN-regulated.
Cancer cells - immortal cells
TUMOR SUPPRESSOR GENES
Genes which, when mutated, lose their normal ability to suppress cell growth
NF-1,2 NEURAL TUMORS
WT-1 WILMS TUMOR
Metastatic cancer is a cancer that has spread from the part of the body where it started (the primary site) to other parts of the body.
Breast cancer that spreads to and forms a metastatic tumor in the lung is metastatic breast cancer, not lung cancer
When cancer cells break away from a tumor, they can travel to other areas of the body through the
the lymph system (which contains a collection of vessels that carry fluid and immune system cells).
Types of Cancer
Carcinoma - most common type of cancer. They are formed by epithelial cells,
Sarcoma - form in bone and soft tissues, including muscle, fat, blood vessels, lymph vessels, and fibrous tissue
Leukemia - begin in the blood-forming tissue of the bone marrow
Lymphoma - begins in lymphocytes (T cells or B cells).
Multiple Myeloma- begins in plasma cells
Melanoma - cancer that begins in cells that become melanocytes, which are specialized cells that make melanin (the pigment that gives skin its color).
Clinical Features of Cancer
Unexplained weight loss
Fever - Less often, fever may be an early sign of cancer, such as blood cancers like leukemia or lymphoma.
Unusual bleeding or discharge
Change in bowel habits or bladder function
Skin changes - These signs and symptoms include:
Darker looking skin (hyperpigmentation)
Yellowish skin and eyes (jaundice)
Reddened skin (erythema)
PREVENTIVE MEASURES to Reduce Cancer Risk.
Stay away from tobacco.
Get to and stay at a healthy weight.
Get moving with regular physical activity.
Eat healthy with plenty of fruits and vegetables.
Limit how much alcohol you drink (if you drink at all).
Protect your skin.
Know yourself, your family history, and your risks.
Get regular check-ups and cancer screening tests.
Pap test and human papillomavirus (HPV) testing starting at age 21 repeat every 3 yrs
Yearly mammograms starting at age 40
Colonoscopy, sigmoidoscopy, and high-sensitivity fecal occult blood tests (FOBTs) beginning at age 50
Regular breast self-exams
Clinical breast exams every 3 yrs
PSA test starting from 45-50 yrs
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