Cancer Overview and Survival Rates

Selected Cancers Overview

• Lung, prostate, breast, and colorectal cancers account for 50% of all new cancer cases yearly.
• Leading cause of premature death in Canada: 1 in 4 Canadians die from cancer.
• Age over 70 accounts for 60% of cancer deaths.
• Lung cancer accounts for 27% of cancer deaths yearly.
• 5-year survival rate: approximately 60%.
• Breast cancer accounts for 28% of new cancer cases in women.
• Prostate cancer accounts for 27% of new cancer cases in men.

Cancers in Young Adults (15-25)

• Lymphomas (Hodgkin and Non-Hodgkin) are the most common cancer type.
• Thyroid cancer (M & F) and testicular cancer (M) are also common
• Melanoma (M & F)
• 10,000 new diagnoses annually, 2/3 in women.
• Mortality decreasing; approximately 2,000 deaths yearly.
• Key prevention focuses on smoking cessation, sun protection, Pap tests, and HPV vaccination.

Cancers in Children (0-15)

• Little understood, theories point to genetics, environmental factors, radiation, and drug exposures.
• Leading cause of non-injury related death.
• About 850 children diagnosed annually.
• 135 deaths each year, but mortality is declining.
• 82% survival rate (declining).
• Males have 1.2x higher incidence than females.
• Highest incidence in children aged 0-4 years.

Cancer in Childhood

• Common types: leukemia, CNS cancers, and lymphomas.
• Childhood tumors have a shorter latency period, faster growth, and tend to be more aggressive, often migrating to other parts of the body.

Cancer in Childhood (Warning Signs & Diagnosis/Treatment)

• Warning signs include prolonged fever, unexplained weight loss, and growing masses.
• Diagnostic and treatment approaches are similar to those used in adult cancers, but dosages are adjusted based on the child's age and condition.
• Long-term follow-up is necessary to monitor for late effects in survivors

Lung Cancer

• Second leading cause of cancer.
• 5-year survival rate: 13% (M), 17% (F)
• Risk factors: smoking and occupational exposures.
• Arises from epithelial cells that line the lungs, is aggressive, invasive, and metastasizes.
• Four subtypes: small cell, non-small cell (large cell carcinoma, squamous cell, and adenocarcinoma).
• All types of lung cancer can cause paraneoplastic syndromes.

Small Cell Lung Cancer

• Distinct cell type; small, round, oval cells clustered together.
• Strong association with smoking.
• Highly malignant, tends to metastasize early.
• Treatment typically involves chemotherapy and/or radiation; surgery is not recommended.
• High mortality rate (typically 50% die within 12-15 weeks)

Non-Small Cell Lung Cancers

• Squamous cell carcinoma: Typically male smokers, associated with smoking, arising in central bronchi, may be detected by sputum cytology, more treatable.
• Adenocarcinoma: Most common in women and non-smokers, arises in bronchioles or alveoli, more peripherally located, poorer prognosis, associated with lung scarring from conditions like TB.
• Large Cell Carcinomas: Large polygonal cells, difficult to determine underlying cell type (anaplasia). Arise in the periphery of the lung and soon invade bronchi and larger airways. Early metastasis is frequent, and prognosis is poor.

Lung Cancer Manifestations

• Often a subtle onset until it's advanced.
• Can mimic other respiratory illnesses.
• Manifestations vary by tumor location, spread, and paraneoplastic syndromes.
• Earliest signs often include chronic cough, shortness of breath (SOB), wheezing, hemoptysis (coughing up blood), pain, hoarseness, and dysphagia (difficulty swallowing).
• Common late manifestations include fatigue and weight loss.

Lung Cancer Complications

• Superior vena cava syndrome: Tumor or lymph nodes compress the SVC, interrupting blood flow, and interfering with drainage from the head, neck, and chest.
• Pleural effusion: Fluid collection involving pleural layers, causing lung compression and shortness of breath (dyspnea).
• Paraneoplastic syndromes: Tumors producing bioactive products like hypercalcemia (parathyroid hormone, squamous cell CA), Cushing syndrome (ACTH, small cell CA), SIADH (inappropriate antidiuretic hormone, small cell CA), hematologic disorders (adenocarcinoma), and neuromuscular syndromes (small cell lung CA).

Lung Cancer Metastasis

• Spread through lymphatic and vascular systems.
• Present in approximately 50% of patients at diagnosis.
• 90% of patients develop metastasis at some point.

Diagnostics: Lung Cancer

• Diagnosis typically involves a patient history, physical examination, chest X-rays (CXR), bronchoscopy, sputum cytology, and percutaneous lung tissue biopsy.
• Additional tests, such as CT, MRI, and ultrasound, help to define tumor stage and identify metastasis.

Treatment: Lung Cancer

• Therapy approach depends on the cancer type (small cell vs. non-small cell).
• Chemotherapy and/or radiation therapy are often used.
• Surgery may be an option in some cases, particularly for non-small cell types.
• Palliative treatment may be needed to manage advanced or extensive disease.
• Prognosis is typically poor.

Colorectal Cancer

• Adenomatous polyps are benign tumors arising from epithelial mucosal lining of intestines.
• Classified and named according to growth patterns (tubular, villous, tubulovillous).
• Overgrowth due to crypt cell abnormalities accumulating mucosal cells called polyps.
• Risk factors include age over 50, family history of colorectal cancer, gastrointestinal (GI) conditions like ulcerative colitis, and the presence of polyps.
• One-third of people with colorectal adenocarcinoma die from the disease.

Colorectal Cancer Manifestations

• Early symptoms are often subtle and non-specific.
• The most common cause for seeking medical attention is observing blood in the stool (occult blood).

Colorectal Cancer Diagnostics

• Diagnosis typically involves a patient history, physical exam (DRE - digital rectal exam), occult blood stool test, sigmoidoscopy or colonoscopy, barium X-ray, histology analysis of tumor specimens, blood tests for tumor markers, and other imaging tests (CT, MRI) to assess for spread.

Colorectal Cancer Screening/Treatment

• Canada recommends screening for colorectal cancer beginning at age 50.
• Annual occult blood stool tests and sigmoidoscopy or barium enemas every 5 years are often part of the screening process.
• Treatment often involves surgical removal (colectomy, colon resection, colostomy), pre/post-operative radiation, and chemotherapy, and if the case is advanced palliative treatment.
• Prognosis depends on stage, amount of bowel involved, and if metastasis is present at the time of diagnosis.

Testicular Cancer

• Most common cancer in males aged 15-35.
• 5-year survival rate is exceptionally high (>95%), highly curable.
• Etiology is unclear but predisposing factors are likely related to cryptorchidism (undescended testes), genetics, and issues during testicular development.
• Most common in Caucasians.
• Usually arises from germ cells. They are capable of differentiating into different cell types, including secreting hormones.
• They may be classified as seminomas or non-seminomas.

Testicular Cancer Manifestations

• Early signs typically include a slightly enlarged testicle, with some mild discomfort.
• Other symptoms can include aches in the groin or abdomen, scrotal heaviness, and gynecomastia (in more advanced stages).

Testicular Cancer Diagnostics

• Diagnosis involves early detection via patient history, physical examination, ultrasound, CT, or MRI scans, blood tests for tumor markers, and histology analysis.

Testicular Cancer Treatment

• Treatment typically involves orchiectomy (surgical removal of the testicle) and chemotherapy, radiation therapy, and ongoing follow-up care.
• Prognosis is very good if detected early.

Prostate Cancer

• Benign prostatic hyperplasia (BPH) is an age-related non-malignant enlargement of the prostate gland. It's characterized by the formation of large, discrete lesions in the periurethral region of the prostate.

• Symptoms can include trouble starting urination, nocturia (frequent urination at night), and urinary retention.

• Prostate cancer has an unknown cause but risk factors include age, race, heredity, hormone levels, and environmental influences.

• Prostatic adenocarcinoma is the most common type.

• Often asymptomatic in early stages, but symptoms like urinary urgency, frequency, nocturia, pain, or the presence of blood in seminal fluid may suggest advanced metastatic spread requiring diagnostic investigation.

Prostate Cancer Diagnostics/Treatment

• Diagnosis often involves biopsy, Gleason grading score, tumor marker analysis, and staging tests to assess for spread (e.g., CT scans of the chest, abdomen, and pelvis; ultrasound; lymphangiography; radiographic methods).
• Treatment options include watchful waiting, surgery (radical prostatectomy), radiation therapy, high-intensity focused ultrasound, chemotherapy, cryosurgery, hormonal therapy, and combinations of treatments.

Prostate Cancer-Protective Factors

• Dietary factors such as lycopene, selenium, and vitamin E may offer some protection.
• Chemoprevention using 5a-reductase inhibitors like finasteride has shown promise in preventing prostate cancer development in men unaffected by BPH.

Endometrial Cancer

• Endometrial (uterine) cancer is most commonly diagnosed as adenocarcinoma, usually in postmenopausal women (55-65 years old);
• Predisposing factors include prolonged estrogen stimulation, obesity, conditions that alter estrogen levels (anovulatory cycles, estrogen-secreting neoplasms, and unopposed estrogen therapy), and age-related issues.
• In women under 40, it is less common.
• Two types recognized-Type I, arising in women with estrogen excess and well-differentiated, and Type II related to endometrial atrophy and age-related mutations; poorer prognostic.

Endometrial Cancer Manifestations/Diagnostics/Treatment

• Manifestations often include abnormal, frequently painless bleeding. Later symptoms can develop, such as cramping, pelvic pain, lower abdominal discomfort, and post-coital bleeding; Enlarged lymph nodes may also be present.
• Diagnosis involves trans-vaginal ultrasound, endometrial biopsy, and dilation and curettage (D&C).
• Treatment options include surgery to remove the uterus and possibly radiation in some cases depending on extent of spread.
• Typically, 5-year survival is high (90%) if identified and treated early.

Breast Cancer

• Leading cause of cancer deaths in females.
• Rates are increasing due to improved detection methods.
• 5-year survival rate is 87%.
• Risk factors include gender and age, family (or personal history of breast cancer), history of benign breast disease, hormonal influences (early menarche, late menopause), pregnancies, and BRCA1/2 gene mutations.

Breast Cancer Manifestations/Diagnostics/Treatment/Hormonal Therapy

• Manifestations include a palpable mass, painlessness, firmness, poorly defined borders, puckering, nipple retraction, unusual discharge, or change in shape.
• Diagnosis includes physical examination, mammograms, ultrasounds, possible needle aspiration, possible lumpectomy, and analysis of biopsy specimens. Histology studies are performed and hormone-receptor status assessed.
• Treatment options include surgery, radiation, chemotherapy, and hormonal manipulation, such as with tamoxifen.
• Prognosis correlates with lymph node involvement.

Nevi and Skin Cancers

• Nevi (moles) are benign, congenital or acquired tumors of skin.
• Melanocytic nevi are pigmented skin lesions arising from melanocyte proliferation in the epidermis or dermis (tan-to-deep brown, uniformly pigmented, small papules with well-defined rounded borders).
• Junctional nevi, the most common, grow into nests along the dermal-epidermal junction. Compound nevi have epidermal and dermal components.
• Dysplastic nevi can transform into malignant melanoma. They are frequently large (>5 mm), flat, and pebbly.
• Vast majority of dysplastic nevi are stable; changes in size, color, thickness, itching, or bleeding require prompt attention.

Malignant Melanoma

• Malignant tumor of melanocytes.
• Rapid incline in recent decades, likely due to increased UV exposure.
• Risk factors include family history, fair/light hair and skin, tendency to freckle, history of sunburns as a child, and presence of atypical moles (dysplastic nevus syndrome).

Malignant Melanoma (Manifestations/Classification/Diagnostics/Treatment)

• Manifestations include diverse size and shape, slightly raised, black/brown, frequently irregular borders, uneven surfaces, development from preexisting nevi or similar growths, often with mottled shades of red, blue, and white;
• Classification is based on radial and vertical growth patterns; Superficial spreading (70%), Nodular (15-30%), Lentigo maligna (4-10%), and Acral lentiginous (2-4%) are the most frequent.
• Diagnosis requires biopsy and TNM staging using tumor, lymph nodes, and metastasis characteristics.
• Treatment is usually surgical excision; chemotherapy effectiveness is limited.

Basal Cell Carcinoma

• Common invasive cancer in humans.
• Originates from the non-keratinizing basal cells of the epidermis.
• Typically slow-growing, spreads widely and deeply if left untreated but rarely metastasizes.
• Typically arises in fair-skinned individuals with prolonged sun exposure.
• Risk factors include tumor size (greater than 2 cm), location on central face/ears, chronic exposure, and incomplete excision or perivascular/perineural involvement.
• Two common types- nodular and superficial.

Squamous Cell Carcinoma

• Second most frequent malignant skin cancer often in sun-exposed regions in older people.
• Risk factors include high UV exposure and occupational exposures (tars, coal dust). Men tend to be more susceptible.
• Two types: Intraepidermal and Invasive.
• Manifestations include red/scaling, keratotic, slightly elevated lesions, irregular borders, and shallow chronic ulcers which may develop persistent crusts along with raised reddened borders.
• Typically found in sun-exposed areas (nose, forehead, lower lip, back of the hand, and ear).

Test your knowledge on various types of cancer, their statistics, and common types associated with different age groups. This quiz covers lung cancer details, survival rates, and the most prevalent cancers in both men and women. Challenge yourself to see how well you understand cancer manifestations and their implications.