Living With Cancer and Other Chronic Conditions

10: Living with Cancer and Other Chronic Conditions

Key Terms regulatory gene Genes that control cell specialization, replication, DNA repair, and tumor suppression. oncogenes Faulty regulatory genes that are believed to activate the development of cancer. proto-oncogenes Normal regulatory genes that may become oncogenes. metastasis The spread of cancerous cells from their site of origin to other areas of the body. benign Noncancerous; localized nonmalignant tumors contained within a fibrous membrane. tumor Mass of cells; may be cancerous (malignant) or noncancerous (benign). sclerotic changes Thickening or hardening of tissues. sigmoidoscopy Examination of the sigmoid colon (lowest section of the large intestine), using a short, flexible fiber-optic scope. colonoscopy Examination of the entire length of the colon, using a flexible fiber-optic scope to inspect the structure’s inner lining. prophylactic mastectomy Surgical removal of the breasts to prevent breast cancer in women who are at high risk of developing the disease.
Gail Score A numerical expression of the risk of developing invasive breast cancer, based on several variables, such as age at first menstrual period, age at first live birth, results of previous biopsies, and a family history of breast cancer. A score of 1.66 percent reflects a high level of risk. prostate-specific antigen (PSA) test A blood test used to identify prostate- specific antigen, an early indicator that the immune system has recognized and mounted a defense against prostate cancer.
Pap test A cancer screening procedure in which cells are removed from the cervix and examined for precancerous changes. prophylactic oophorectomy Surgical removal of the ovaries to prevent ovarian cancer in women at high risk of developing the disease. chemoprevention Cancer prevention using food, food supplements, and medications thought to bolster the immune system and reduce the damage caused by carcinogens. autoimmune An immune response against the tissues of a person’s own body. fistula An open pathway between the gastrointestinal wall and other internal organs; often caused by Crohn’s disease. gait Pattern of walking. insulin A pancreatic hormone required by the body for the effective metabolism of glucose (blood sugar). genetic predisposition An inherited tendency to develop a disease process if necessary environmental factors exist. in vitro Outside the living body, in an artificial environment.
Alzheimer’s disease (AD) Gradual development of memory loss, confusion, and loss of reasoning; eventually leads to total intellectual incapacitation, brain degeneration, and death.

Cancer: A Problem of Cell Regulation
Cell Regulation
Replacement cells come from areas of young and less specialized cells. The process of specialization required to turn the less specialized cells into mature cells is controlled by genes within the cells.
Repair genes and tumor suppressor genes can also be considered regulatory genes.
Replication, specialization, repair, and suppressor genes can become cancer-causing genes, or oncogenes. They can also be referred to as proto-oncogenes, or potential oncogenes.
Oncogene Formation
Three mechanisms—genetic mutations, viral infections, and carcinogens—can alter otherwise normal genes, causing them to become cancer-causing.
Genetic mutations develop when dividing cells miscopy genetic information. If a miscopied gene controls specialization, replication, repair, or tumor suppression, the oncogene that results will allow the formation of cancerous cells.
Aging, free radical formation and radiation are associated with the miscopying of genetic information.
The feline leukemia virus, human immunodeficiency virus (HIV), and multiple forms of the human papillomavirus (HPV) are all cancer-producing infectious agents. These viruses seek out cells, substitute some of their genetic material for some of the cell’s, and convert proto-oncogenes into oncogenes.
Carcinogens can be chemicals found in tobacco smoke, polluted air and water, toxic wastes, and even high-fat foods.
Carcinogens may work alone or in combination with co-carcinogenic promoters to alter the genetic material within cells.
The Cancerous Cell
Cancerous cells can produce an enzyme, telomerase, which blocks the cellular biological clock that informs normal cells that it is time to die.
Cancerous cells do not possess the contact inhibition (a mechanism that influences the number of cells that can occupy a particular space at a particular time), allowing them to accumulate and later the functional capacity of tissues or organs.
The absence of cellular cohesiveness (a property seen in normal cells that “keeps them at home”) allows cancer cells to spread through the circulatory or lymphatic system to distant points via metastasis.
Once migrating cancer cells arrive at a new area of the body, they rediscover cellular cohesiveness.
Cancer cells have the ability to command the circulatory system to send them additional blood supply to meet their metabolic needs and to provide additional routes for metastasis. This is called angiogenesis.
Cancers can be “staged” into four general categories in terms of their extent and severity.
In situ cancers are early cancers present only in cells in the layer of tissue of the cancer’s origin.
Localized cancers are limited to the organ in which the cancer began.
Regional cancers have spread beyond the original site to nearby lymph nodes, organs, and/or tissues.
Distant cancers have spread from the primary site to distant organs or lymph nodes.
In situ and localized cancers have higher survival rates than regional and distant cancers.
Types of Cancer
Cancers are named according to the types of cells or tissues from which they originate:
Carcinoma. Found most frequently in the skin, nose, mouth, throat, stomach, intestinal tract, glands, nerves, breasts, urinary and genital structures, lungs, kidneys, and liver.
Sarcoma. Found in the connective tissues of the body; bone, cartilage, and tendons are the sites of sarcoma development.
Melanoma. Arises from the melanin-containing cells of skin. Found most often in people who have had extensive sun exposure. Remains among the most deadly forms of cancer.
Neuroblastoma. Originates in the immature cells found within the central nervous system.
Adenocarcinoma. Derived from cells of the endocrine glands.
Hepatoma. Originates in cells of the liver; seen more frequently in people who have experienced sclerotic changes in the liver.
Leukemia. Found in cells of the blood and blood-forming tissues; characterized by abnormal, immature white blood cell formation.
Lymphoma. Arises in cells of the lymphatic tissues or other immune system tissues.
Cancer at Selected Sites in the Body
Skin Cancer
When all three forms (melanoma, basal cell, and squamous cell) are taken into account, skin cancer is the most common kind of cancer.
About 75 percent of skin-cancer deaths are the result of malignant melanoma.
Severe sun burning during childhood and chronic sun exposure during adolescence and younger adulthood are largely responsible for skin cancer.
Occupational exposure to some hydrocarbon compounds can also cause skin cancer.
The key to successful treatment of skin cancer is early detection.
For basal cell or squamous cell cancer, a pale, wax-like, pearly module or red, scaly patch may be the first symptom.
Other types of skin cancer may be indicated by a gradual change in the appearance of an existing mole.
Melanoma usually begins as a small, mole-like growth that increases progressively in size, changes color, ulcerates, and bleeds easily.
Malignant melanoma is asymmetric, has irregular borders, changes color, and has a diameter greater than 6 mm.
When non-melanoma skin cancer is found, an almost 100 percent cure rate can be expected. When the more serious melanomas are found at an early stage, a 99 percent cure rate can be expected.
Lung Cancer
Because of the advanced stage of the disease at the time symptoms first spear, only 16 percent of all people with lung cancer survive 5 years beyond diagnosis.
Damage to three tumor suppressors on chromosome 3 is found in virtually every case of small-cell lung cancer.
Cigarette smoking is the most important behavioral factor in the development of lung cancer.
Lung cancer accounts for at least 28 percent of all cancer-caused deaths.
The incidence of lung cancer in men has shown a gradual decline over the last several years, while in women the rate of lung cancer development has remained relatively constant.
Radon may be the principal causative agent in most lung cancer found in nonsmokers.
In the opinion of experts, significant improvement in the survivability from lung cancer cannot occur in the absence of aggressive reductions in smoking, particularly among women.
Colorectal Cancer
When diagnosed in a localized sate, colorectal cancer has a relatively high survival rate of 91 percent.
Two important areas of risk for colon cancer are genetic susceptibility and dietary patterns.
Dietary risk factors include diets that are high in saturated fats from red meat and possibly too low in fruits and vegetables.
Prompt removal of polyps, small outpouchings in the lower intestinal tract wall, has been shown to lower the risk of colorectal cancer.
The development of colorectal cancer may be prevented to slowed through regular exercise, an increase in dietary calcium intake, and long-term folic acid supplementation.
Symptoms of colorectal cancer include bleeding from the rectum, blood in the stool, and a change in bowel habits.
Breast Cancer
Breast cancer is the second leading cause of death from cancer in women; nearly one in eight women will develop breast cancer in her lifetime.
The following groups of women have a higher risk of breast cancer:
Women whose menstrual periods began at an early age, or whose menopause occurred late
Women who had no children, had their first child later in life, or did not breast-feed
Women who have used hormone replacement therapy (HRT), particularly combined estrogen and progestin or combined estrogen and testosterone
Women who have a high degree of breast density or biopsy-established hyperplasia
Women whose diets are high in saturated fats, who are sedentary, or who are obese after menopause
Women who carry the BRCA1 and/or BRCA2 mutated tumor suppressor genes
BPI, p53, and HER-2 are all genes that play a role in the development of breast cancer.
Estrogen receptor modulators block the ability of estrogen to bind with potentially malignant breast cells whose future progression toward malignancy would be fueled by access to estrogen.
Aromatase inhibitors decrease the amount of estrogen in the body, rather than block its availability to breast cells. They carry a risk of fractures and the development of osteoporosis.
The ACS recommends that mammography begin at age 40, and women should continue these examinations on an annual basis.
Prostate Cancer
Prostate cancer is the most prevalent form of cancer in males, and the second leading cause of cancer deaths.
Testicular Cancer
Cancer of the testicle is among the least common forms of cancer.
The disease is more frequently seen in White Americans and men whose testicles were undescended during childhood.
Once pesticides are concentrated in the tissues of the human body, during pregnancy they mimic estrogen. This may lead to testicular dysgenesis syndrome, or the failure of the testicles to develop normally.
Surgical intervention generally includes removal of the testicle, spermatic cord, and regional lymph nodes.
Cervical Cancer
Risk factors for this form of cancer include early age of first intercourse, large number of sex partners, history of infertility, and clinical evidence of human papillomavirus infections.
Sexual abstinence is the most effective way of reducing the risk of developing cervical cancer.
For young, sexually active women, initial screening using the Pap test should be undertaken within three years of first exposure.
Symptoms that suggest potential cervical cancer include abnormal vaginal bleeding between periods and frequent spotting.
Uterine (Endometrial) Cancer
The principal risk factor related to the development of endometrial cancer is a high estrogen level.
The following factors are related to higher levels of estrogen and, this, to the development of endometrial cancer:
Early menarche
Late menopause
Lack of ovulation
Never having given birth
Estrogen replacement therapy (ERT not moderated with progesterone)
Obesity
Use of tamoxifen (a drug used in breast cancer therapy)
History of polycystic ovary syndrome
Hereditary nonpolyposis colon cancer
Phytoestrogens protect against uterine cancer by moderating estrogen levels.
The treatment for early or localized endometrial cancer is generally surgical removal of the uterus (hysterectomy).
Ovarian Cancer
Most cases of ovarian cancer develop in women over age 40 who have not had children or began menstruation at an early age.
It is estimated that about 20 percent of all cases of ovarian cancer stem from the inheritance of either the BRAC1 or BRAC2 suppressor gene mutation.
Studies suggest that decades of HRT could be responsible for the majority of ovarian cancer.
Because of its vague symptoms, ovarian cancer has been referred to as a silent cancer.
Treatment of ovarian cancer requires surgical removal of the ovary, fallopian tubes, and uterus, followed by aggressive use of chemotherapy.
Pancreatic Cancer
More common in men than women, occurs more frequently with age, and develops most often in African American men.
Smoking is clearly a risk factor for this form of cancer, with smokers more than twice as likely to develop the disease.
Early detection of this cancer is difficult because of the absence of symptoms until late in it course.
Lymphatic Cancer
Prevention includes limiting exposure to toxic chemicals and sexually transmitted virus.
Early symptoms include enlarged lymph nodes, fever, itching, weight loss, and anemia.
Status of the “War on Cancer”
Prevention Through Risk Reduction
Know your family history.
Select and monitor your occupation carefully.
Do not use tobacco products.
Monitor environmental exposure to carcinogens.
Follow a sound diet.
Control your body weight.
Exercise regularly.
Limit your exposure to the sun.
Consume alcohol in moderation if at all.
Chronic Health Conditions
Systemic Lupus Erythematosus
The name reflects the widespread destruction of fibrous connective tissue and other tissues and the appearance in some patients of a reddish rash that imparts a characteristic “mask” to the face.
Most often seen in women who developed the condition during young adulthood.
Episodes of lupus often follow exposure to the sun, periods of fatigue, or an infectious disease.
Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD)
Both are more common in females that in males, and both can coexist in the same person.
IBS is characterized by highly uncomfortable episodes of pain, diarrhea, or constipation that are localized to the colon.
Diet, stress management, and medication can help control the issues associated with IBS.
Two diseases that fall under the label IBD are ulcerative colitis and Crohn’s disease.
Treatment for ulcerative colitis includes dietary changes, enteral (tube) feeding, “gut rest,” antidiarrheal medications, and the use of corticosteroids when symptoms have been present for a long duration.
Crohn’s disease is treated with immunosuppressive drugs, which produce antibodies aimed against tumor necrosis factor, and are intended to counter the immune system’s destruction of elements within the intestinal wall.
Multiple Sclerosis
In this disease, the cells that produce myelin are destroyed and myelin production ceases. Eventually, the vital functions of the body can no longer be carried out.
The virus most commonly found in the spinal fluid of persons with progressive MS is the varicella zoster virus (VZV).
MS usually first appears during the young adult years, and may take on of four forms, depending on the interplay of periods of stabilization (remitting), renewed deterioration (relapsing), continuous deterioration (progressive), or combinations of all these.
In addition to drug therapy, psychotherapy is an important adjunct to the treatment of MS; profound periods of depression often accompany the initial diagnosis of this condition.
Diabetes Mellitus
A trigger mechanism begins a process through which the body cells become increasingly less sensitive to the presence of insulin. The growing ineffectiveness of insulin in getting glucose into cells results in the buildup of glucose in the blood.
Elevated levels of glucose in the blood lead to hyperglycemia.
For many adults with diabetes, dietary modification, weight loss, and regular exercise is the only treatment required to maintain an acceptable glucose level.
For people whose condition is more advances, a hypoglycemia agent must be used.
In addition to genetic predisposition and obesity, unresolved stress appears to be involved in the development of hyperglycemic states.
In type 1 diabetes, the body does not produce insulin at all.
Sickle-Cell Trait and Sickle-Cell Disease
Sickle-cell abnormalities are virtually unique to African Americans.
Those who inherit the sickle-cell trait may not develop the disease but can transmit the gene for abnormal hemoglobin to their children.
In the fully-expressed disease form, red blood cells are elongated, crescent-shaped, and unable to pass through the body’s minute capillaries. The body respond by removing these abnormal blood cells very quickly, which causes anemia.
The disease form of the condition can cause many serious medical problems, including impaired lung function, congestive heart failure, gallbladder infections, bone changes, and abnormalities of the eyes and skin.
Alzheimer’s Disease
In the advanced stages, people with Alzheimer’s disease become incontinent, show infantile behavior, and finally become incapacitated as brain tissue is destroyed.
Early-onset AD (before age 65), account for approximately 25 percent of all AD patients and is an inherited form of the disease.
Late-onset AD (after age 65), is the most prevalent form of the disease.
Three drugs provide temporary improvement in intellectual function during the early stages of the disease by inhibiting the breakdown of acetylcholine, whose diminished availability is the basis of the disease.

Summary
Cancer is a condition in which the body is unable to control the specialization, replication, and repair of cells or the suppression of abnormal cell formation.
A variety of agents, including genetic mutations, viruses, and carcinogens, stimulate the conversion of regulatory genes (proto-oncogenes) into oncogenes.
Cigarette smoking is a principal player in the development of nearly 30 percent of all forms of cancer.
Early detection based on self-examination and screening is the basis for the early identification of several cancers.
Systemic lupus erythematosus (SLE) is an autoimmune condition in which the immune system fails to recognize the body’s own connective tissues and instead interprets them as being foreign.
Irritable bowel syndrome and inflammatory bowel disease reflect differing levels of hypersensitivity on the part of the immune system to tissues of the gastrointestinal tract.
Multiple sclerosis (MS) results from a continuing attack by the immune system on cells within the nervous system that produce myelin, the insulating material critical in the functioning of the brain and spinal cord.
Types 1 and 2 diabetes mellitus and metabolic disorders involving difficulties in the production or recognition of insulin, thus depriving the body of its normal ability to manage blood glucose utilization. Type 3 diabetes is the combination of types 1 and 2 in the same individual.
Sickle-cell disease is an inherited abnormality involving the presence of two recessive genes that result in the production of abnormal hemoglobin, thus reducing oxygen-carrying capacity. Sickle-cell trait involves the presence of a single-recessive gene for the disease condition, resulting in the person’s being a carrier of the condition.
Alzheimer’s is a disease that results, over time, in a profound state of dementia in which the brain is unable to continue producing a neurotransmitter critical to cognitive functioning.