Transcript Everything About Cancer – Powerpoint

Rob Rutledge, MD, Radiation Oncologist
Associate Professor, Dalhousie University
CEO, the Healing and Cancer Foundation
HealingandCancer.org
Goals of people who have been given
a cancer diagnosis
• Maximize the chance of recovery
• Cure
• Longevity
• Feel better emotionally
• Think and function better
HealingandCancer.org
Goals of people who do not have cancer
• Don’t get it!
• Pick it up early
• Maximize cure
• Minimize treatment
• Know what to do if they or a loved one
gets a cancer diagnosis
HealingandCancer.org
Overview
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Cancer incidence and risk factors
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Treatment of cancer
What is cancer
Screening recommendations
How to get the best care from the
medica system
Working with the emotional fallout
Prevention!
HealingandCancer.org
Cancer incidence
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What’s your risk of developing a significant
cancer in your lifetime?
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40%
Women: risk of breast cancer?
1 in 9
Men: risk of prostate cancer?
Everyone: colon cancer?
1 in 14
What’s your chance of dying of cancer?
30%
HealingandCancer.org
Bermuda Cancer Incidence:
350 new cases/ year
2500 living survivors
HealingandCancer.org
Expect Cancer Incidence:
50% increase by 2020!
HealingandCancer.org
WHAT IS CANCER and ITS TREATMENT
A Layperson’s Guide
PURPOSE OF THIS PART OF TALK
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Understanding helps you feel in control
Explains how treatments work
Understand medical system
Make better decisions
Get better care
HealingandCancer.org
OVERVIEW
• Normal cell growth
• How cancer cells are made
• Properties of cancer cells
• The immune system
• Screening tests
• Making the diagnosis of cancer
• Staging tests
• Surgery, radiation and chemotherapy
HealingandCancer.org
WHAT IS CANCER?
• Cancer occurs when some cells in your
body grow in an uncontrolled way
• Many different types of cancer
• The cancer is usually named after the
part of the body from which it came
• Each person’s cancer is different
HealingandCancer.org
CELLS IN THE BODY
• The human body is made of
trillions of cells
• Each cell has its own job
• Skin cells protect our surface
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NORMAL CELLS IN YOUR BODY
• Red blood cells deliver oxygen
• Platelets help the blood clot
• White blood cells fight infection
• Many others
• Most are quiet - not dividing
• Communicate with other cells
HealingandCancer.org
THE INSTRUCTIONS IN THE CELL
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Each cell has the control centre (nucleus)
Instructions manual is made of words and sentences
(DNA)
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HOW CELLS ARE REPLACED
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Many cells die from normal wear and tear
Dying cells are replaced when cells divide
Cell division
WHEN CELLS DIVIDE
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One parent makes two daughter cells
The new cells are exactly the same
The same control centre
The same book of instructions
Normal controlled growth
• Number of cells made = number that die
HealingandCancer.org
Controlled cell growth
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Sometimes cells need to grow fast eg. With injury or
growth
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Always under control
Always stop growing fast afterwards
HealingandCancer.org
Cut in skin
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Cut in skin
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Cut in skin
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Cut in skin
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How cancer cells are made
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Cancer cell is a normal cell with many mistakes
Three ways the mistakes are created:
1) Born with mistakes in all cells – genetic
-5% of all cancers
2) Accident when cell divides - mutation
3) Substance causing cancer - Carcinogen
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Toxins, sunlight, viruses, fatty diet, obesity
HealingandCancer.org
PROBLEMS WITH THE CELL’S
INSTRUCTIONS
If the instructions read:
“STOP dividing after coming in contact with lining of
prostate”
is changed to
“KEEP dividing after coming in contact with lining of
prostate”
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The cell won’t stop growing!
HealingandCancer.org
PROBLEMS WITH THE CELL’S
INSTRUCTIONS
If the instructions read:
“Divide if hormone X is on the receptor”
is changed to
“Divide if hormone X,Yor Z is on the
receptor”
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The cells will keep on dividing
HealingandCancer.org
Why we don’t see more cancers
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The repair system is constantly cleaning
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The mistake is permanent after cell division
The mistake is in cell that is not dividing
An unimportant word or sentence is hit
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cells that divide often are at risk
HealingandCancer.org
WHAT IS CANCER
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Normal cell that has begun to grow fast and in an
uncontrolled way
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Requires dozens of changes to the cell
Cancer cells will grow into normal tissue
Can get into lymph and blood system to grow colonies
at a distance (metastasis)
HealingandCancer.org
NORMAL CELL TRANSFORMS TO CANCER CELLS
HealingandCancer.org
Definitions
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“Precancerous” has many but not all changes
“Benign” means just grows in place
HealingandCancer.org
EACH PERSON’S CANCER IS
DIFFERENT
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Each cancer has different set of mistakes and so
therefore a different personality
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You cannot compare yourself to others
You can always do better than expected!
HealingandCancer.org
HOW A TUMOUR GROWS
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A tumour is a collection of cancer cells
A tumour starts as one cancer cell
1 cell then 2 then 4 then 8 …..
Tumour growth if more cells are made than die
Tumour doubles in a few months
Tumour - 1 cm in size has a billion cells
HealingandCancer.org
HOW CANCERS CAUSE PROBLEMS
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Problem at the primary site, lymph nodes, and elsewhere
in the body (metastasis)
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Lump can cause pain, bleed, block a tube, slow down an
organ like kidney
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Affect whole body – fatigue
Blood system problems – reds, whites, platelets depleted
OUR TREATMENTS KILL CANCER CELLS TO STOP
THESE PROBLEMS.
HealingandCancer.org
CANCER CELLS ARE FRAGILE
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A few more changes will incapacitate the cell
Only 1 in 1000 cancer cells can reproduce
A tumour will outstrip its own blood supply
Shrink the tumor by  growth, destruction
Our immune system can kill cancer cells
HealingandCancer.org
WHITE BLOOD CELL
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SCREENING FOR CANCER
HealingandCancer.org
The importance of cancer screening
“Screening tests help
find some types of
cancer before you have
any symptoms. That
means you have them
even if you feel fine and
you have a healthy
lifestyle. They’re part of
your regular medical
care.”
Breast cancer – risk factors
Screening for breast cancer
Mammogram
Clinical Breast Exam
• Women age 50-69
screening every 2
• Performed by a
years
trained professional
• From age 40 can have to detect
yearly mammogram
abnormalities
• Decreased mortality
rates by 50%!!
# of
new
cases
50
AGE
HealingandCancer.org
Prostate cancer in Bermuda in 2011
Each year: 50 men diagnosed, 8 deaths
HealingandCancer.org
Prostate Specific Antigen PSA
 A chemical produced by both normal
prostate cells and prostate cancer cells
 Inflammation / infection of the normal
prostate cells causes the PSA to increase
 Whether or not prostate cancer cells are present
 Explains why the PSA can bounce up and down
HealingandCancer.org
PSA Screening vs. Follow up
 PSA screening is for men who do not have a diagnosis
of prostate cancer and do not have symptoms
 Men who have symptoms like problems with urination should
see their doctors right away
 My view: By age 40-50 all men should have a
conversation with the family doctor about screening
 Once there is a cancer diagnosis, PSA is an excellent
test and predicts what will happen years in advance
 Except in rare cases where cancer produces little PSA
HealingandCancer.org
UNDERSTANDING THE MEDICAL
SYSTEM
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MAKING THE DIAGNOSIS
• Symptoms or screening test
• Biopsy - take a piece of tumor
• Look under microscope
• Proves its cancer
• Type of cancer
• Starts a process
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STAGING THE CANCER
• Has the cancer spread
• Primary site, nodes, distant
• Tells about treatment and
prognosis (likely outcome)
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STAGING THE CANCER
• Blood tests
• Imaging - X-rays
• CAT Scans
• Bone scan
• MRI
• Grade – how fast growing under
microscope
• Receptors on cancer cell
• Genetics
HealingandCancer.org
Cross section of a bone with one
cancer cell – explains a ‘normal’ scan
DOCTOR’S QUESTIONS
• What is the stage?
• Can the patient be cured?
• What is the best treatment?
• How fit is the patient?
• What does the patient want?
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CAN I BE CURED?
• Cured = never comes back
• Adjuvant = extra treatment in case
there are cells left over
• In remission – cancer cells are in
the body
• Aim for many years of great quality
• Only treat if benefits > risks
HealingandCancer.org
SURGERY
• Usually if tumor in one area
• Operation - tumor removed
• Effect on normal tissue
• There is a chance of cancer left
behind at that site
• already spread but not visible
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CHEMOTHERAPY
• Given by medical oncologist
• Whole body treatment
• Injection into veins or pills
• Kills / neutralizes cancer cells
• Given in courses over weeks
• Affects fast-growing cells
• Newer therapies target cancer cells
so fewer side effects
HealingandCancer.org
CHEMO SIDE EFFECTS
• The type of chemo differs
• Each person tolerates chemo
differently
• Your doctor monitors
• Specific side effects for each
type of chemo
HealingandCancer.org
CHEMO SIDE EFFECTS
• Whole body side-effects
• Fatigue / tiredness
• Nausea and vomiting
• Hair loss
• Low blood cells
• Sore mouth and throat
HealingandCancer.org
Targeted chemotherapy
• Targeted means goes after only
the cancer cells
• New targeted treatments may
have very few side effects
HealingandCancer.org
RADIATION TREATMENT
• Radiotherapy
• Given by radiation oncologist
• Ionizing x-rays - kills cells
• External and internal
• Side effects in the area only
• High-tech ways spare normal tissue:
IMRT, stereotactic, stereosurgery,
gammaknife, protons
HealingandCancer.org
RADIATION TREATMENT
HOW TREATMENT WORKS
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HOW TREATMENT WORKS
• Damage the cancer cells
• Mistakes in instructions
• Cells can’t divide
• Cancer cells die or become
dormant
HealingandCancer.org
HORMONE TREATMENT
• Blocks hormone pathways on
cancer cells so cells die
• Taken as pill or injection
• Sometimes increase cure
• Side effects – hot flushes…
HealingandCancer.org
RADIATION THERAPY PLANNING
AND LOGISTICS
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CONSULTATION
Creation of immobilization device
Shell / “mask”HealingandCancer.org
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SIMULATION
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Patient
“Markings”
positioning
for breast
radiotherapy
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CT SIMULATION
TATOOS
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Contouring
DOSIMETRY
Breast Radiotherapy Distributions
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TREATMENT SET UP
Linear Accelerator Console
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RADIATION TREATMENT
Modern
Radiation
Therapy:
Stereotactic
Radiosurgery
Brain
Metastasis
Treatment
HealingandCancer.org
What is Complete Cancer Care?
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Understanding what’s happening to you
Getting the best from the medical system
Empowering yourself with healthy lifestyle
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Exercise, diet, sleep, relaxation techniques
Settling the mind
Remember what’s most important
HealingandCancer.org
Use What Works For You
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There is no one best way
We are all unique
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Different strategies work best for various
personalities
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Use your rational mind and listen to your
own inner wisdom
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Your strategy will change with time
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Different needs at diagnosis, on treatment and in
follow up
HealingandCancer.org
Purpose of Information
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Learn to speak the language of the
medical system
Increase your sense of control and
well-being
Help you make the best medical
decisions
Empower yourself with nonmedical ways to improve your
health and outcome
HealingandCancer.org
Too Much Information?
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If information gathering is making you tired
If you find conflicting information
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See your doctor to clarify
Trust what you are doing is the best for you
HealingandCancer.org
Understanding Cancer and
the Medical System
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Best Sources of Information
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Your physician/oncologist - individualizes the
information and gives you the best medical advice
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Prepare for these conversations by researching and
understanding breast cancer in advance
HealingandCancer.org
Sources of General Information
about Cancer and its Treatment
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Librarian at a cancer centre or hospital
National Cancer Institute (USA) -www.cancer.gov
National not-for-profits focused on your type of cancer
HealingandCancer.org
How to Get the Most from the Health
Care System
Learn to advocate for yourself by:
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Preparing for each doctor’s visit
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Drawing on extra services if needed
Contacting your doctor/nurse if you have questions or
concerns
Asking for a second opinion if needed
HealingandCancer.org
Getting the Most from
your Doctor’s Visit
Before the visit:
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Create a concise summary of symptoms
Bring a list of current medications and allergies
Write down your questions before the visit
Someone should accompany you
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Decide who will make record of the visit
You may create a file with all your test results
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You can get a copy by visiting medical records
HealingandCancer.org
Getting the Most From
Your Doctor’s Visit
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Be honest and open
Speak up if you’re feeling overwhelmed: “I’m not sure I
understand”
Wait until the summary then ask all your questions
Take notes or record the interview
Find out what to expect
Know what to do for each side effect
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When do I need to act?
Who you should call in case of problems?
HealingandCancer.org
After Your Doctor’s Visit
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Keep a journal and list of results
If need be ask for a family conference
You are the most important
person
You or a ‘family member’ may be
able to do the talking
Call to clarify information or ask
for appointment
You are entitled to a second
opinion
HealingandCancer.org
Getting More Physical Care
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Multiple services are available in medical system
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Nutrition
Psychology
Home care nursing
Rehabilitation
Spiritual care
Palliative Care Team
Social worker can help coordinate if needed
Ask your nurse or doctor
Talk to an expert
HealingandCancer.org
Understanding the Emotional Aspects
of Cancer
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Normal to feel any and every emotion including:
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Shock
Worried, scared or anxious
Guilty
Lonely
Sad or hopeless
Angry
These emotions can be exaggerated or come out
unexpectedly
HealingandCancer.org
Dealing with Difficult Emotions
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There’s no one right way
Find a wise person to talk to
Realize emotions change with time
Be kind to yourself
HealingandCancer.org
When to Get Help with Emotional
Problems
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Emotional distress is expected but if you:
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Feel overly depressed e.g., crying constantly
Are withdrawing from all social contact
Unable to enjoy life / feel hopeless
Are so distressed can’t decide on treatment
Can’t sleep because of anxiety
Can’t talk about cancer because it brings up terrible
memories
Talk to a psychologist
HealingandCancer.org
How to Get Help with Emotional
Distress
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Tell your oncologist or nurse during the next
appointment
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Schedule a visit to your family doctor
Call the psychologist / counsellor at the cancer centre
Find another expert
Support groups
HealingandCancer.org
Support Groups
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Gathering of people with a similar issue, usually for
2-4 hours a month
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Can help you with:
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Getting information
Learning ways to cope
Practical tips and support
A safe place to express your
emotions
Improve quality of life!
HealingandCancer.org
Complementary/Integrated Medicine
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Find a balance between doing
research + following intuition
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Tell your doctor what you’re taking
and doing
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Don’t forego proven treatments
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Conventional Medicine
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Scientific method relies on proof
Clinical trials
Documentation of toxicity
Doctor as therapist / consultant
Risks vs. benefits
Breast cancer - higher cure rates
HealingandCancer.org
Disadvantages of Complementary
Medicine
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Can be expensive
Some practitioners make unproven and false claims
Some toxicities unknown
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Cancer centre librarian can do search on natural medicines
database
Beware of extreme diets
HealingandCancer.org
What to Ask your CAM Practitioner
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Credentials of practitioner
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Where they trained, for how long…?
Evidence of benefits of treatment
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Any randomized trials?
Toxicity of treatment
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Documented?
Does it interact with other medications?
Benefit vs. risks?
What is the total cost?
HealingandCancer.org
Empowering the body
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What’s good in prevention is good for those who have
had a diagnosis
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Don’t let slow growing cells turn into fast growing cells
HealingandCancer.org
EXERCISE
The Benefits of Exercise
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Effective way to improve energy, sleep,
mood and overall health
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You need to listen to your body to guide
yourself
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Individualize to phase of journey
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Slowly increase activity each week
After recovery, aim for at least 30 minutes
5+ days/week
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How much do you exercise each week?
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= Getting heart rate to 65% of max
< 3 times per week
3 times for 30min
3 times for 60 min
6 times for 30 min
6 times for 60 min
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Empowering ourselve
NUTRITION
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Empowering ourselve
The Importance of Nutrition
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Effective way to improve your overall health
Individualize to what works for you
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Different diet during different phases of treatment
Ask your doctor and/or professional nutritionist if
persistent problems with:
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Ongoing unintentional weight loss or loss of muscle
Nausea and vomiting
Diarrhea / constipation
Treatment affecting the GI tract
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General Nutrition Advice
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Choose a variety of food from all food groups daily
5-10 servings of fruits and vegetables/day
Choose lower fat food groups
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Fat to make up < 20% of caloric intake
Choose high fiber foods
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Whole grain breads and cereals
Drink plenty of healthful fluids
Maintain healthy weight
HealingandCancer.org
Taking Your Vitamins
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Ask your doctor
Off therapy minimum:
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Vitamin D 1000 IU / day
Calcium 1,600 mg / day
Healthy diet should provide the rest
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How many servings of fruits / vegetables
do you eat daily?
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Less than five
5-10 servings
5-10 serv. + low fat
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Empowering ourselve
Maintaining a
reasonable
weight
HealingandCancer.org
Calculate your Body Mass Index
BMI > 20
22 24 26 28 30 32 34 36 38
Height
60 inches
102
112 123 133 143 153 164 174 184 195
62 in
109
120 131 142 153 164 175 186 196 207
64 in
116
128 140 151 163 174 186 197 209 221
66 in
124
136 148 161 173 186 198 210 223 236
68 in
131
144 158 171 184 197 210 223 236 249
70 in
139
153 167 181 195 209 223 236 250 264
72 in
147
162 177 191 206 221 235 250 264 279
74 in
155
171 186 202 218 233 249 264 280 296
Where is your Body Mass
Index?
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Green zone
Yellow zone
Red zone
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Empowering ourselve
SLEEP
HealingandCancer.org
Empowering ourselve
The Importance of Sleep
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Association between poor sleeping
habits and recurrence (e.g., night
shift workers)
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Melatonin experiments (hormone)
which suppresses cancer cells
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Need an average of 7-8 hours of
sleep per night
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Take care of yourself
HealingandCancer.org
SLEEP 7-8 HOURS PER NIGHT
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YES
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NO
HealingandCancer.org
Empowering ourselve
RELAXATION
Practice Relaxation
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Learn to relax
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Proven to improve overall health
Practice relaxation
techniques (i.e., yoga,
meditation, Tai Chi) to
calm the mind
Decreases heart disease, mental illness, hypertension,
and diabetes
HealingandCancer.org
How often do you practice a
relaxation technique each week?
• = slowing down your mind
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meditation, yoga, tai chi etc
Never
Once per week
2-5 times
6 or more times
HealingandCancer.org
Empowering ourselve
ADD UP YOUR SCORE
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Exercise - 3 times a week
Eat 5-10 fruits and veggies daily
Maintain a reasonable weight
Sleep 7-8 hours nightly
Practice a relaxation technique
HealingandCancer.org
Empowering ourselve
HOW DID YOU SCORE out of 10?
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5 : You’re lying
4 : You can’t count
3: You’re amazing
2: At least your honest
1: Welcome to Bermuda
0: Go straight home
HealingandCancer.org
What can you do to reduce your risk?
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Don’t smoke (reduces risk by 1/3)
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Maintain a reasonable weight
Exercise
Eat a plant-based, low-fat diet, high in fruits and
veggies
Limit alcohol consumption
Take vitamin D - 1000 IU/day
Avoid sunburns
HealingandCancer.org
What can you do to reduce your risk?
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How much can you reduce your risk of
developing cancer by exercising, eating a
healthy diet, and maintaining a lean weight?
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33%
HealingandCancer.org
Advice for Family Members
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Be open and honest about you’re feelings
Take your cue from the person with the diagnosis
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Information seeker and distributor
Enjoy the laughs in the midst of the difficulties
HealingandCancer.org
Praise for The Healing Circle
“A book for anyone who has ever sought their
wholeness in the midst of a cancer crisis. Don’t
go to your Doctor’s office without it”
Rachel Remen MD, Kitchen table wisdom
“By drawing on the wisdom and experience
shared in this book, life’s difficulties can truly
become blessing which help us heal our lives.”
Bernie Siegel MD, Love, Medicine and Miracles
“The Healing Circle takes us into the realm
where integration of body, mind and spirit –
our true wellness – can be found.”
Gabor Mate, MD, When the Body says No
To learn more or to order books please visit
www.healingandcancer.org
or email [email protected]