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Cancer
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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.
1
What is Cancer?

All cancers have
neoplastic
growth, altered
cells with nearly
unlimited growth.

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Benign localized
Malignant spread
much more
threatening
Metastatic cancer
cells move to other
parts of the body
2
Tumor

Increase in the
number of
undifferentiated
cells creates a
growing mass of
tissue called a
"tumor" or
"neoplasm."
3
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
4
Metastasis

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Malignant tumors
can spread through
blood stream and
lymph to distant
sites
Lung, liver, bone
and brain are
common sites of
metastasis
5
Types of cancer
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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%).
6
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.

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Most experience severe pain in later stages.
7
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.
8
Cancer - Mortality
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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
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Up for liver & pancreas
Down for 7 of the 15
top cancers
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Men
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Lung
Prostate
Colon
Rectum
Pancreas
Women
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Lung
Breast
Colon
Rectum
Pancreas
9
Cancer Death Rates*, for Men,
US,1930-2003
100
Lung & bronchus
80
Rate Per 100,000
60
Stomach
Prostate
40
Colon & rectum
20
Pancreas
2000
1995
1990
1985
1980
1975
1970
1965
1960
1955
Liver
1950
1945
1940
1935
0
1930
Leukemia
10
Cancer Death Rates*, for Women,
US,1930-2003
100
80
Rate Per 100,000
60
Lung & bronchus
40
Uterus
Breast
Colon & rectum
Stomach
20
Ovary
2000
1995
1990
1985
1980
1975
1970
1965
1960
1955
1950
1945
1940
1935
Pancreas
1930
0
11
Cancer Mortality – North
Carolina
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2007 Estimated US Cancer Cases
Men
766,860
Women
678,060
Prostate
29%
26%
Breast
Lung & bronchus
15%
15%
Lung & bronchus
Colon & rectum
10%
11%
Colon & rectum
Urinary bladder
7%
6%
Uterine corpus
Non-Hodgkin
lymphoma
4%
Melanoma of skin
4%
Kidney
4%
Leukemia
3%
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4%
Oral cavity
3%
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3% Ovary
Pancreas
2%

3% Kidney
All Other Sites
19%

4% Non-Hodgkin
lymphoma
4%
Melanoma of skin
Thyroid
3%
Leukemia
21%
All Other Sites
13
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
14
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
15
Cancer Mortality
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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
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Improved diagnosis
Increase in lung
cancer in women
Cancers related to
AIDS
Control of other
diseases
Increase in
environmental
carcinogens
16
Cancer & Ethnicity
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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.
17
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
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RISK FACTORS FOR CANCER
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Non-controllable Risk
Factors
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Environmental
Certain chemical exposures
 Radiation
 Nuclear Powerplants?
 Powerlines?
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Inherent Factors
Family History – Seems so for some forms of
breast and colon cancer
 Age
20
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Controllable Risk Factors
21
Smoking and Cancer
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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.
22
Smoking and Cancer

Cigarette smoking
has synergistic
effect with other
environmental
pollutants.
23
Cancer and Diet
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One-third of cancer
deaths is caused by
a variety of dietary
factors.

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Foods high in
carcinogens
Foods that have
too much animal
fat and not enough
fiber
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American Cancer Society
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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.
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Alcohol and Cancer
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Alcohol implicated
in cancers of the
tongue, tonsils,
esophagus,and
liver
Related to breast
cancer >2
drinks/day in
women
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Alcohol and Synergism
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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.
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Physical activity
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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
28
Ultraviolet Light and Cancer
Good example of
interaction
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light-skinned
people near the
equator have
higher risk
Dramatic rise since
1970’s
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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
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ABCD’s of Skin Cancer
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A stands for ASYMMETRY
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B stands for BORDER IRREGULARITY
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Benign moles have smooth edges whereas
melanoma are busily invading and tend to have
irregular edges.
C stands for COLOR.
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One half of the mole doesn't match the other half.
Melanoma tend to be irregular.
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
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If the mole is greater than 6 mm (about the size of
a pea), then there is a greater chance that it is
malignant.
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Sexual Behavior and Cancer
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AIDS
Kaposi’s sarcoma
 non-Hodgkins lymphoma
 Invasive cervical cancer
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Certain sexual practices can
contribute to cancer risk.
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Cervical cancer
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Psychological Factors
33
Stress and cancer
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Methodological issues
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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
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Palesh et. al, (2007)
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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 diseasefree interval
34
Thornton et al, (2007)
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113 women with
breast cancer
Assessed at
diagnosis & 4, 8,
12, 18 months
after
Perceived stress
and immune
function
35
Suppression of Emotion
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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
36
cancer
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.
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Treatment and Survival
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Treatment & Side Effects of
Cancer
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Surgery
Radiation
Chemotherapy
Hormonal treatment –
Breast Prostate
Uterine and some
Leukemias
Immunotherapy –
Convince immune
system to attack
tumor
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Loss of hair
Burns
Nausea
Vomiting
Fatigue
Sterility
Pain
Loss of function
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Survival
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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
40
Relative Survival by Cancer Site
Site
1974-1976
1983-1985
1992-1998

All sites
50
52
62
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Breast (female)
75
78
86

Colon & rectum
50
57
62
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Leukemia
34
41
46
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Lung & bronchus
12
14
15
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Melanoma
80
85
89
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Non-Hodgkin lymphoma
47
54
55
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Ovary
37
41
53
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Pancreas
3
3
4
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Prostate
67
75
97
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Urinary bladder
73
78
82
41
Psychosocial Factors in Survival
42
“Fighting Spirit” and Cancer
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Those who fight angrily against the
diagnosis survive longer
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Depression and hopelessness did
appear to predict an increased risk of
dying in 5 years
43
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

44
Group Psychotherapy
Data suggests that group therapy can
increase survival time
 Supportive in nature
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Strong Social Support
 Similar Diagnosis
 Educational Component
 Information on Coping Strategies
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Mindfulness and Cancer
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Mindfulness-Based Stress Reduction
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A program of stress reduction used in other
contexts (chronic pain, stress-reduction)
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Recent review of the literature (Smith et. al,
2005) found that MBSR w/cancer patients led
to:
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8-10 week group format
Meditational + Educational/Discussion Components
Improved mood
Improved sleep
Reduction in stress
Positive immunological profile in post-surgical cancer
patients
These were generally dose-response effects
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A Model of Psych
Interventions & Cancer
47