THINGS TO BE AWARE OF ABOUT PROSTATE AND LUNG CANCER. Lawrence Lackey Jr., M.D. Internal Medicine 6001 W. Outer Dr. Ste 114

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1 THINGS TO BE AWARE OF ABOUT PROSTATE AND LUNG CANCER Lawrence Lackey Jr., M.D. Internal Medicine 6001 W. Outer Dr. Ste 114

2 WHAT IS CANCER? The body is made up of hundreds of millions of living cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries.

3 WHAT IS CANCER? Cancer begins when cells in a part of the body start to grow out of control. There are many kinds of cancer, but they all start because of outof-control growth of abnormal cells.

4 WHAT IS CANCER? Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells. Cancer cells can also invade (grow into) other tissues, something that normal cells cannot do. Growing out of control and invading other tissues are what makes a cell a cancer cell.

5 WHAT IS CANCER SCREENING? Clinical testing designed to identify the presence of a specific cancer in an asymptomatic individual or population thought to be at risk of that specific cancer. The intent is to find cancers at the earliest possible stage in their development, in order to improve the chances for disease cure.

6 The best results for cancer screening are in: Colorectal cancer Cervical cancer Breast cancer

7 PROSTATE CANCER EPIDEMIOLOGY: Prostate cancer is the most common cancer in men and the 2nd most common cause of cancer deaths in men Life time risk for men in the U.S. of getting cancer is one out of six. Lifetime risk of a man dying of prostate cancer is one out of 30 There were approximately 220,000 new cases of prostate cancer diagnosed in the U.S. in 2008, with about 27,000 deaths in the U.S. annually.

8 Increasing age Ethnicity RISK FACTORS: Highest in African-American males Next highest in U.S. Caucasian males Lowest in Asian-American males First degree relatives A man with a father or brother with prostate cancer has an approximate 2x increase of developing prostate cancer.

9 RISK FACTORS: First degree relatives A man with a father or brother with prostate cancer has an approximate 2x increase of developing prostate cancer. Diet?? A high fat and low veggie diet may slightly increase the risk of prostate cancer The most recent trials have not shown selenium and Vitamin E not to increase survival Lycopenes (found in tomatoes) may be beneficial

10 RISK FACTORS: BPH and Prostatitis Chronic BPH and prostatitis appear to slightly increase the risk of the development of prostate cancer. Thus diagnosis and treatment of these conditions could make a difference Let your physician know if you have persistence of any of these symptoms: Decreased urinary stream Frequent urinating at night Dribbling at the end of urination Incomplete urination A split urinary stream

11 PSA SCREENING (controversial) ACP/ASIM USPSTF ACS American Urological Society

12 DIAGNOSIS AND PROGNOSIS: Digital rectal exam PSA, PSA velocity, free PSA, PSA density Plus TNM Stage Plus Gleason Score

13 TREATMENT: Options for no treatment Surgery (usually robotic) for early stage disease Radiation therapy Anti-androgen therapy Chemotherapy

14 LUNG CANCER EPIDEMIOLOGY: The leading cause of cancer death in the U.S. for both men and women In 2008, there were 213,000 new cases of lung cancer diagnosed in the U.S. 115, 000 cases were men 99,000 cases were women though breast cancer is the most common cancer in women, lung cancer is the #1 cause of cancer death in women. Approximately 70% of patients were over the age of 65, while less than 3% were under the age of 45

15 LUNG CANCER Overall, this cancer has a very poor prognosis. Only approximately 14% of patients live greater than 5 years. Despite this prognosis, there are long term survivors. Based on cancer registries there are, to date, 330,000 long term survivors.

16 RISK FACTORS: Cigarette smoking About 95% of lung cancers in men are caused by cigarette smoking About 80% of lung cancers in women are caused by cigarette smoking Passive smoking There is supportive evidence (though not level A) that there is some increased risk of lung cancer associated with passive cigarette smoke inhalation.

17 RISK FACTORS: Radon About 15,000 annual lung cancer deaths are attributed to radon Basements have the highest radon levels, and the EPA recommends initial testing Occupational exposure (i.e. asbestos, etc)

18 SCREENING: Currently there are no successful screening modalities Yearly spiral CT scans can pick up smaller more curable lesions. A recent clinical trial, demonstrated that earlier detection did not translate into increased survival or even in decreased number of advanced lung cancers in the screened group

19 CLINICAL PRESENTATION (i.e. things to look out for) Persistent cough esp. if associated with: Wheezing Coughing up blood Shortness or breath Persistent hoarseness (recurrent laryngeal nerve)

20 Unexplained worsening shoulder or scapula pain with or without weakness in that upper extremity. Pancost Tumor

21 Brachial Plexiopathopy

22 Horner s Syndrome On one side of the face Small pupil Droopy eyelid Inability to sweat

23 Superior Vena Cava Syndrome Swelling of the face and upper extremity on one side

24 Hypertrophic Osteoarthropathy Severe joint and surrounding soft tissue swelling.

25 Clubbing

26 DIAGNOSIS Chest X-ray CT scan PET scan Mediastinotomy

27 TREATMENT Curative intent vs. palliation Surgery Radiation therapy Chemotherapy

28 Breast & Colon Cancer Prevention Kieva L. Bland, M.D Meyers Detroit, MI

29 Breast Cancer Prevention No one can prevent Breast Cancer Measures can be taken to reduce risk Most important to know your pre-existing risk factors

30 Risk Factors Female Age Family History 1 st degree (mother, sister, father, brother) Genetic predisposition ( e.g. BRCA gene determined by testing) Estrogen Exposure Menarche (when periods started) Menopause (when periods ended) Hormone Replacement therapy Pregnancies Breast biopsies with abnormal results Previous History of Breast Cancer

31 Screening Knowing your risks encourages proper screening. Recent recommendations advocating a change in screening to mammograms starting at age 50 and only every 2 years are NOT being adopted by the major organizations involved in breast cancer care.

32 American Cancer Society Breast Cancer Screening Recommendations Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health. Clinical breast exam (CBE) should be part of a periodic health exam, about every 3 years for women in their 20s and 30s and every year for women 40 and over. Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20s.

33 American Society of Breast Surgeons The American Society of Breast Surgeons is strongly opposed to the recommendations released November 16, 2009 by the United States Preventive Services Task Force (USPSTF). The Society will continue to advocate for routine annual mammography screening for all women beginning at age 40. Mammography screening reduces breast cancer mortality and saves lives.

34 Healthy Living = Risk Reduction Maintain Healthy Weight Exercise Regularly Avoid excessive fat intake, especially saturated fats (meat fat) Eat fruits and vegetables for antioxidants Avoid excessive alcohol Vitamin D and multivitamins

35 High Risk Patients Your physician can calculate your risk based on a few simple questions. If you are high risk then there are other methods to reduce your risk as well. Chemoprevention (with medications) Surgery (in appropriate cases)

36 Remember Breast cancer cannot be prevented but the risk for developing it can be reduced. Screening (mammograms and breast exams) detects breast cancer at earlier stages which increases survival. Stage 5-year Relative Survival Rate 0 100% I 100% II 86% III 57% IV 20%

37 Colorectal Cancer Prevention

38 Colorectal Cancer Risk Factors Diet (Red meat, high fat, low fiber, excessive consumption of meats cooked at very high temperatures) Sedentary lifestyle Overweight Smoking Excessive alcohol use Type 2 Diabetes

39 Colorectal Cancer Risk Factors Some risk factors are out of your control: Age Ulcerative Colitis Crohn s Disease Development of Polyps Genetic predisposition for polyp syndromes or cancer

40 Polyps

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42 How do you screen for colorectal cancer? Have your stool checked for blood every year Get a colonoscopy/sigmoidoscopy every 5-10 years Other tests available include: Barium enemas Virtual Colonoscopy by CT scan

43 Colonoscopy

44 Colonscopy can actually prevent cancer if polyps are removed that have cancerous potentional. Getting regularly scheduled screening can potentially prevent cancer development or improve survival if diagnosed by catching at an earlier stage.

45 Risk reduction, screening, and survival go hand in hand for breast cancer and colon cancer.