Cancer Chapter - The Healthy Woman

Cancer
Cancer is one of the most common causes of death in American
women. But thanks to improved cancer screening and treatment,
you have a better chance of beating cancer than ever before.
About 66 percent of people diagnosed with cancer between
1996 and 2002 survived for at least 5 years. As the science of
cancer detection and treatment continues to advance, even more
people will survive cancer in the future.
What is cancer?
Cancer is a disease in which abnormal
cells grow, divide, and spread, often
forming a mass called a tumor. Although
any abnormal growth is a tumor, some
tumors are benign (bih-NYN) (not
cancer) and some are malignant (muh-
LIG-nuhnt) (cancer). Cancers may
invade nearby tissues and metastasize
(muh-TASS-tuh-syz), or spread to other
parts of the body. Cancer can develop in
almost any part of the body. In two types
of cancer, leukemia (loo-KEE-mee-uh)
and lymphoma (lim-FOH-muh), tumors
do not form. Instead, cancer cells spread
throughout the blood and the immune
What causes cancer?
system, respectively.
A number of factors may affect your can-
Even if you haven’t been diagnosed with cer risk—your chances of developing can-
cancer, it is important to know that there cer in your lifetime. Your family history,
are steps you can take to:
personal history, and environment al play
a part. Some risk factors are beyond your
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reduce your chances of getting
cancer
control, such as age and family history.
But you can change some aspects of your
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detect cancer early
behavior or environment to reduce your
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make sure you get the treatment you
risk. Keep in mind that most women with
need
these risk factors wil never have cancer.
Cancer
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Body Parts That Can Be
Inherited risk
Affected by Cancer
Inherited genetic mutations, on their
own, cause very few cancers. Several
Others:
Brain
Glands
common types of cancer tend to run in
Eyes
Muscles
families. These include breast cancer,
Nerves
Mouth
ovarian cancer, colon cancer, melanoma
Bones
Spinal Cord
(me-luh-NOH-muh), and lung cancer.
Trachea
Thyroid
However, environment and behavior also
Blood and
Blood Vessels
Lung
affect the development of these cancers.
Heart
Stomach
If you have a family history of a certain
Skin
Kidney
type of cancer, it does not mean that you
Esophagus
Pancreas
will develop that disease. Talk to your
Liver
doctor about cancer in your family. You
Large Intestine
may need to take steps to reduce your
Small Intestine
Uterus
risk or be screened more often or at an
Bladder
Ovary
earlier age.
Vagina
Cervix
Tobacco use
Tobacco use is one of the leading causes
of cancer. It increases the risk of cancers
of the lung, larynx, mouth, nose, phar-
Genetic Mutations
ynx, esophagus, pancreas, kidney, bladder,
Changes to a cell’s DNA, called ge-
liver, cervix, and stomach. Tobacco use
netic mutations, may cause the cell to
causes 30 percent of all cancer deaths
become cancerous. Most of the muta-
tions that cause cancer are caused by
and 87 percent of lung cancer deaths in
the environment, behavior (such as
the United States.
smoking cigarettes), or chance. But
Smoking not only causes cancer in
some cancer-causing mutations are
smokers, but also may raise the risk of
inherited. For more information about
lung cancer for nonsmokers who breathe
genetics and health, see page 408 of
in secondhand smoke.
the Appendix.
You can reduce your risk of lung cancer
and other cancers by not smoking or us-
Age
ing other tobacco products. You should
Age is the most important risk factor
also avoid secondhand smoke. If you
for cancer. Most cancers—77 percent—
currently smoke, quitting can lower your
occur in persons who are 55 years old or
risk of cancer.
older. For this reason, you will need more
tests and checkups to detect early signs
For more information on the benefits
of cancer as you get older.
of quitting smoking, see the Respiratory
Health chapter on page 279.
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You can reduce your risk by avoiding
Breast and Ovarian Cancer:
drinking alcohol to excess. If you drink
Inherited Risk Factors
alcohol, do it in moderation.
Women with a family history of breast
Ultraviolet (UV) rays
or ovarian cancer may inherit mutated
genes that increase their risk of de-
The sun’s UV rays cause most skin can-
veloping these diseases. Mutations of
cers. The amount of UV rays in sunlight
the BRCA1 or BRCA2 genes are most
depends on the time of day, season, and
strongly linked to these cancers, but
location. There are more UV rays at mid-
other genes also play a role. Inherited
day, during the summer months, and
mutated genes cause only about 5 to
at locations close to the equator. How-
10 percent of breast and ovarian can-
ever, you may be exposed whenever you
cers. And even women who inherit these
mutated genes may not develop cancer.
are outdoors during the day—even on
cloudy days. Water and snow, which re-
If you have a family history of breast or
flect sunlight back toward your skin, can
ovarian cancer, talk to your doctor. Ge-
also increase your UV exposure.
netic counseling can help you decide
if testing for BRCA mutations might
You can reduce your risk by protecting
be helpful. If you do test positive, your
your skin from UV rays.
doctor may suggest:
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Avoid sun exposure between 10 am
• additional screening tests
and 4 pm, when the sun’s rays are the
• taking tamoxifen or an aromatase
most damaging.
inhibitor, a drug that reduces breast
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Wear protective clothing and a hat
cancer risk
that shades your face.
• surgery to remove the breasts or
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ovaries to prevent cancer
Avoid artificial UV rays from tanning
beds or sunlamps.
For more information about genetics
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and health, see page 408 of the Ap-
If you plan to spend time outside, ap-
pendix.
ply sunscreen 30 to 60 minutes before
you go out.
Excessive alcohol intake
Drinking alcohol is a risk factor in can-
cers of the mouth, pharynx, esophagus,
larynx, and liver. It may increase your
risk of breast, colon, and rectal cancers.
When drinking alcohol is combined
with tobacco use, the risks of mouth,
pharyngeal, and esophageal cancers are
further increased. However, low or mod-
erate alcohol intake may lower your risk
of heart disease.
Cancer
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Apply a broad-spectrum sunscreen
Birth control pills also contain female
with a sun protective factor (SPF) of
hormones. The pill lowers the risk of
at least 15. Reapply it after sweating or endometrial and ovarian cancers. But it
bathing.
may increase the risk of cervical, liver,
Some medications
and breast cancers. Today, birth control
pills contain lower hormone levels than
The female hormones estrogen and pro-
in the past. So the effects of the pill on
gesterone (proh-JESS-tuh-rohn) affect
cancer risk may be reduced.
the growth and development of certain
cancers. Drugs that contain these female Drugs used to suppress the immune
hormones affect cancer risk.
system during an organ transplant may
also lead to cancer, especially lymphoma.
Menopausal hormone therapy (MHT)
Chemotherapy drugs, used to treat many
relieves the symptoms of menopause and types of cancer, may cause leukemia.
may prevent osteoporosis (OSS-tee-oh-
Cancer survivors are at higher risk of this
puh-ROH-suhss). There are two types of disease.
MHT. Both types affect cancer risk:
You can learn more by talking to your
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Estrogen-only MHT increases the
doctor about the benefits and risks of
risk of endometrial cancer and ovarian these medications.
cancer. Progestin is added to MHT to
reduce endometrial cancer risk.
Substances in the home, workplace, and
the environment
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Combined MHT, which contains es-
trogen and progesterone or progestin,
Some chemicals, particles, metals, radio-
increases the risk of breast cancer. But active materials, and other substances can
it lowers the risk of colon cancer.
increase your risk of developing cancer.
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Radon is a radioactive gas. It can
build up in underground spaces, such
as basements, if there is not enough
airflow.
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Asbestos is a fibrous material that was
widely used in building insulation
until 1980.
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Secondhand smoke includes smoke
from burning cigarettes and exhaled
smoke.
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Air pollution is caused by substances
and fine particles released into the air.
Sources may include motor vehicles,
power plants that burn fossil fuels, and
factories.
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Infections
Some infections may increase your risk
of developing cancer.
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Human papillomavirus (HPV) is the
most common sexually transmitted
infection in the United States. HPV
is the primary cause of most cervical
cancers. There is a new HPV vaccine
available for girls and young women.
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Chemicals and metals in pesticides,
solvents (paint thinners, grease remov-
This vaccine and regular screening
ers, and dry cleaning chemicals), and
can reduce infections and cancer risk.
other substances may increase cancer
(See page 134 of the Sexually Trans-
risk.
mitted Infections chapter for more
information.)
Workers in agriculture, mining, manu-
l
facturing, and other industries may be
Hepatitis B and hepatitis C viruses
exposed to carcinogens more often and
may be transmitted by injected drug
at higher concentrations. Therefore, they
use, intimate sexual contact, or contact
may have an even greater cancer risk.
with infected blood. Infection may
lead to liver cancer. These viruses are
You can reduce your risk by avoiding
more common in Asia than in the
or reducing your exposure to cancer-
United States. Because of this, Asian
causing substances at home and at work.
American women who have recently
Ten Most Common Cancers in
Ten Cancers Responsible
American Women*
for the Most Deaths Among
Breast cancer
American Women*
Lung cancer
Lung cancer
Colon and rectal cancers
Breast cancer
Endometrial cancer
Colon and rectal cancers
Non-Hodgkin lymphoma
Pancreatic cancer
Melanoma (skin cancer)
Ovarian cancer
Ovarian cancer
Non-Hodgkin lymphoma
Thyroid cancer
Leukemia
Pancreatic cancer
Endometrial cancer
Leukemia
Brain tumors
Myeloma
*2000–2004
Cancer
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immigrated have a higher risk of in-
fection and liver cancer.
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Helicobacter pylori (H. pylori) bacteria
cause a common stomach infection
that increases the risk of developing
stomach cancer. H. pylori is more com-
mon in developing countries than in
the United States. Recent immigrants
from Asia or Latin America have a
greater chance of infection and risk for
stomach cancer.
You can reduce your risk by taking
steps to prevent infection when possible.
Vaccines are available for HPV and the
hepatitis B virus. If you think you may be
at high risk for any of these infections,
talk to your doctor about tests and
treatments.
Types of cancer
The following chart lists some common
types of cancer in women, along with
conditions other than cancer. Even if you
their risk factors and symptoms. Some
have these symptoms, you may not have
of these symptoms can be caused by
cancer.
Cancers Affecting Women: Risk Factors and Symptoms
Brain tumors
Risk factors*
• Age
• Family history
Symptoms†
• Severe headaches
• Nausea
• Problems with speech, vision, or hearing
• Loss of balance
• Changes in mood or personality
• Memory loss
• Seizures
• Numbness in extremities
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Cancers Affecting Women: Risk Factors and Symptoms
Breast cancer
Risk factors*
• Age
• Family history
• High breast tissue density
• Hyperplasia (an increase in number of cells in the breast; detected by a
biopsy)
• X-ray exposure, particularly at young ages or high doses
• Early onset of menstruation and/or late menopause
• Never having children
• Having first child after age 30
• Use of birth control pills (within 10 years of stopping use, risk returns to
normal)
• Overweight or obesity after menopause
• Use of menopausal hormone therapy containing both estrogen and
progestin
• Excessive alcohol consumption
• Inherited mutations of BRCA1 and BRCA2 genes
Symptoms†
• Abnormalities (may be detected by a mammogram‡)
• A lump in the breast (may be detected by a mammogram‡)
• Changes in the breast (See page 160 of the Reproductive Health chapter
for more information.)
Cervical cancer
Risk factors*
• Human papillomavirus (HPV); a vaccine can now prevent infection with
strains of the virus responsible for most cervical cancers; condoms also
offer partial protection
Symptoms†
• Abnormal cells (can be detected by Pap test‡)
• Abnormal vaginal bleeding
Colon and rectal cancers
Risk factors*
• Age
• Family history
• History of inflammatory bowel disease
• Obesity
• Smoking
• Excessive alcohol consumption
• Inherited genetic mutations
Symptoms†
• Polyps or tumors (can be detected by screening tests‡)
• Blood in stool (may be detected by screening tests‡)
• Changes in bowel habits
• Pain or cramping
Cancer
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Cancers Affecting Women: Risk Factors and Symptoms
Endometrial cancer
Risk factors*
• Use of estrogen-only menopausal therapy (in women with an intact uterus)
• Early onset of menstruation and/or late menopause
• Never having children
• Obesity
Symptoms†
• Abnormal uterine bleeding, especially after menopause
Leukemia
Risk factors*
• Exposure to benzene or ionizing radiation
• Cancer radiation treatment
• Down syndrome and some other genetic abnormalities
• Retrovirus human T-cell leukemia/lymphoma virus-1 (HTLV-1)
Symptoms†
• Fatigue
• Paleness
• Weight loss
• Repeated infections
• Fever
• Easy bruising
• Nosebleeds
Liver cancer
Risk factors*
• Age
• Family history
• Hepatitis B or hepatitis C infection
• Cirrhosis (sur-ROH-suhss)
• Exposure to a toxic substance, aflatoxin, in mold that grows in nuts, seeds,
and legumes
Symptoms†
• Abdominal pain on the right side
• Abdominal swelling
• Weight loss
• Loss of appetite
• Fatigue
• Nausea
• Jaundice
• Fever
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Cancers Affecting Women: Risk Factors and Symptoms
Lung cancer
Risk factors*
• Smoking
• Exposure to airborne carcinogens such as asbestos, radon, secondhand
smoke, some chemicals and metals, and air pollution
Symptoms†
• Cough that does not go away
• Cough that produces blood
• Chest pain
• Repeated pneumonia (noo-MOH-nyuh) or bronchitis
Lymphoma (Hodgkin and non-Hodgkin lymphomas)
Risk factors*
• Reduced immune function due to autoimmune (aw-toh-ih-MYOON) disorders
• Infection with HIV, retrovirus human T-cell leukemia/lymphoma virus-1
(HTLV-1), or hepatitis C
• Family history
• Workplace exposures to herbicides and other chemicals
• Medications that reduce immune function for organ transplant
Symptoms†
• Swollen lymph nodes
• Night sweats
• Fatigue
• Weight loss
• Fever
Myeloma (cancer of plasma cells in blood)
Risk factors*
• Age
• History of a condition called monoclonal gammopathy of undetermined sig-
nificance (MGUS)
Symptoms
• Pain in or broken bones of the back and spine
• Fatigue
• Thirst
• Repeated infections or fevers
Oral cavity and pharyngeal cancers
Risk factors*
• Tobacco use (including cigarettes, cigars, pipes, and smokeless tobacco
products)
• Excessive alcohol consumption
Symptoms†
• Sores that bleed and/or do not heal
• Lumps or thickening
• Ear pain
• A mass on the neck
• Cough that produces blood
• Red or white patch that does not go away
• Difficulties chewing or swallowing
Cancer
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Cancers Affecting Women: Risk Factors and Symptoms
Ovarian cancer
Risk factors*
• Age
• Use of estrogen-only menopausal hormone therapy
• Overweight and obesity
• Personal or family history of breast cancer
• Mutations of BRCA1 and BRCA2 genes
• Personal or family history of hereditary nonpolypsis colon cancer (HNPCC)
Symptoms†
• Bloating
• Pelvic or abdominal pain
• Difficulty eating or feeling full quickly
• Digestive problems
• Urinary problems (urgency or frequency)
• Fatigue
• Back pain
• Abnormal vaginal bleeding
Pancreatic cancer
Risk factors*
• Smoking
• Chronic pancreatitis (PAN-kree-uh-TYT-uhss)
• Diabetes
• Cirrhosis
• Obesity
Symptoms†
• Weight loss
• Abdominal discomfort
• Jaundice
Skin cancer (melanoma, basal cell, and squamous cell cancers)
Risk factors*
• Personal or family history of skin cancer
• Many moles or large moles
• Sunburning easily
• Natural blonde or red hair
• Personal history of major sunburns and use of tanning booths
• Workplace exposure to certain substances
Symptoms†
• Changes in the skin, such as a new growth, change in an existing growth, or
sores that do not heal
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