cancer and the athlete. breast cancer: breast anatomy a. ducts b. lobules c. dilated section of duct...
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Cancer and the Athlete
Breast Cancer: Breast Anatomy A. ducts B. lobules C. dilated section of duct to
hold milk D. nipple E. fat F. pectoralis major G. chest wall/rib cageEnlargement
A. normal duct cellsB. basement membraneC. lumen (center of duct)
Breast Cancer:Anatomy
A. Pectoralis major B-D: Axillary
Lymph Nodes E. supraclavicular
lymph nodes F. internal mammary
lymph nodes
Breast Cancer:Intro To date, most inherited cases of breast cancer
have been associated with two genes: BRCA 1 (Breast Cancer gene1), BRCA 2 (Breast
Cancer gene2)
Gene Function: keep breast cells growing normally and prevent cancer cell growth
When cells contain abnormalities or mutations, they are associated with increased cancer risk
Breast Cancer:Occurrence All women are at risk, men-you too!!! An average of about 1 out of seven women
will get breast cancer over a 90-year lifespan
50% of b.c. diagnosed in women over 65 For every 100 women with b.c., 1 male
will develop it
Breast Cancer:Risk Factors-Controllable What you eat
Decrease red meat, cheese, milk and ice cream
How much you weigh and maintaining a healthy weight
How much you exercise
Whether you smoke Drink alcohol-how
much? How often? Types of chemicals in
your environment Hormone replacement
therapy (estrogen)
Breast Cancer:Risks-Uncontrollable
Age Risk goes up as you do
Personal history of b.c.-it could return
Family History Can increase risk, but
more reports coming from families of no history
Breast Cancer:Risks-Continued
Certain breast changes Lump Thickness Calcifications Atypical ductal
hyperplasia, etc
Genetic alterations BRCA 1 & 2
Late or no pregnancy
Menstrual history First one before age 12
or menopause after 55 Exposure to certain
hormones Race
US: Caucasian-most common
Radiation therapy Breast Density
“Dense” breasts increase risk
Breast Cancer:Diagnosis The earlier, the better! Can take weeks due to
numerous tests Screening tests
Mammograms, ultrasound
Diagnostic tests MRI, blood tests, bone
scans, PET scans Stages 1~4
Breast Cancer: DiagnosisFour Types of Breast Cancer
Ductal Carcinoma in situ (DCIS)
Lobular Carcinoma in situ (LCIS)
Invasive Ductal Carcinoma (IDC)
Invasive Lobular Carcinoma (ILC)
Breast CancerTreatment & Surgery
Dependent on the stage Surgery
Breast conserving (lumpectomy)
Mastectomy Lymph node dissection
Radiation Therapy, Chemotherapy
Herceptin (intravenous drug) Hormonal Therapy Tamoxifen (oral) Acupuncture
Ovarian Cancer “Silent Killer” - usually didn’t notice s/s until
spread too far S/S mimic digestive & bladder conditions (IBS,
stress, depression) S/S will be persistant and gradually worsen,
digestive or more situational
Ovarian Cancer – S/S Abdominal pressure, fullness, swelling or bloating Urinary urgency Pelvic discomfort or pain Persistent indigestion, gas or nausea Unexplained changes in bowel habits, such as constipation Changes in bladder habits, including a frequent need to urinate Loss of appetite or quickly feeling full Increased abdominal girth or clothes fitting tighter around your waist Pain during intercourse (dyspareunia) A persistent lack of energy Low back pain Changes in menstruation
Ovarian Cancer - cause Mostly unknown theory - it has to do with the tissue-repair process
that follows the monthly release of an egg through a tiny tear in an ovarian follicle (ovulation) during a woman's reproductive years. The formation and division of new cells at the rupture site may set up a situation in which genetic errors occur.
theory - the increased hormone levels before and during ovulation may stimulate the growth of abnormal cells.
Ovarian Cancer – risk factors Inherited gene mutations Family history A history of breast cancer Age. Ovarian cancer most often develops after menopause. Your risk of
ovarian cancer increases with age through your late 70s. Although most cases of ovarian cancer are diagnosed in postmenopausal women, the disease also occurs in premenopausal women.
Childbearing status Infertility Hormone replacement therapy (HRT) Obesity Male hormones. The medication danazol, a male hormone (androgen), is
used to treat endometriosis and has been linked to an increased risk of ovarian cancer. More study is needed to further define this association.
Testicular Cancer Testicular Anatomy
Also called testes or gonads
Located behind the penis
Produce sperm and testosterone
Testicular Cancer: Introduction Most common cancer in men age 15-35 but
can strike any male, at any time Caucasians are the most likely group to
develop it Incidence of T.C. doubled over the last 30-
40 years Arise from two types of tumors Stages I-III
Testicular Cancer:Risk Factors What exactly causes it:
Unknown Possibly tied to:
Males born with undescended testicles (cryptorchidism) Corrected or not
Abnormal testicular development
Environmental pollutants
Injury to scrotum
Normal testicular development
Testicular Cancer:Signs & Symptoms A lump in either testicle- size can vary Any enlargement of a testicle A change in the consistency of a testicle (hardness) Heaviness feeling in the scrotum A dull ache in the lower abdominals or in the groin A sudden collection of fluid in the scrotum Pain or discomfort in a testicle or in scrotum Enlargement or tenderness of the breasts
Testicular Cancer:Diagnosis Again, the earlier, the
better! Complete personal &
family history Complete physical exam
Temp, pulse, BP Careful scrotal exam Ultrasound, chest x-ray,
blood and urine tests Inguinal orchiectomy for
tissue sample
Testicular Cancer:Treatment Almost always curable-this condition
responds well to treatment Important to find out whether it has spread
CT scan or CAT scan used Radiation Therapy Chemotherapy Surveillance- regular testing
Testicular Cancer:Surgery Inguinal Orchiectomy RPLND (Retroperitoneal Lymph Node
Dissection) Remove lymph nodes in abdomen
Tumors spread to other areas may be partly or entirely removed
Hodgkin’s Disease (Lymphoma)Intro Uncommon cancer of the lymphatic system Cells in the lymphatics grow abnormally
and may spread beyond As it progresses, it compromises your
body’s ability to fight infection
Hodgkin’s vs. Non-Hodgkin’s Lymphoma Presents of Reed-Sternberg cell As Hodgkin’s has decreased over past 30
years (1% of cancers) , Non-Hodgin’s has increased by more than 70%
NHL – age 40-70, but some subtypes (29 different) are most common in children; more common in males & caucasians
Hodgkin’s DiseaseOccurrence Most commonly
affects people between the ages of 15-40 and 55+
Each year ~1,300 Americans die of this
This once highly fatal disease is now highly treatable
Hodgkin’s DiseaseCauses Exact cause is unknown Abnormal B cells form, do not die as
they should and keep producing more abnormal cells
Hodgkin’s DiseaseRisk Factors
Family History May also be related to environmental
exposures Gender: males are more likely to develop it Compromised immune system: HIV/AIDS,
Organ transplant with meds to suppress immune system response
Hodgkin’s DiseaseSigns & Symptoms
Initially Similar to flu; fever,
fatigue, night sweats Eventually tumors
may develop
Painless swelling of lymph nodes in your neck, armpits or groin
Hodgkin’s DiseaseDiagnosis Difficult to diagnose due to similarities to
other conditions Orderly spread: the pattern is orderly,
progressing from one group of nodes to the next
Only rare skipping: the disease rarely skips over an area of lymph nodes as it spreads
Hodgkin’s DiseaseDiagnosis Biopsy of enlarged lymph node is needed
Changes in make-up and characteristics (presence of Reed Stemberg cells-abnormal B cells)
X-rays, CT scan, MRI PET scan (positron emission tomography) Bone marrow biopsy Blood tests Exploratory surgery if disease predominantly in
abdomen Stages I-IV
Hodgkin’s DiseaseTreatment Depends on:
Stage of disease Number and regions of lymph nodes affected Whether one or both sides of diaphragm involved Age Symptoms Pregnant Overall health status
Hodgkin’s DiseaseTreatment Goal:
Destroy as many malignant cells as possible
Bring disease into remission
Stage I/II: 80%+ survive 10+ years with proper treatment
Widespread Hodgkin’s: 60% live for 5 years
Options Radiation Chemotherapy Bone marrow
transplant Coping
Know what to expect Strong support
system Time for self
Detection/PreventionBreast Cancer: Self Exam -Step 1
Begin by observing your breasts in the mirror
Look for: Usual size, shape, color Evenly shaped without
distortion or swelling Bring to doctor’s attention
if you find: Dimpling, puckering,
bulging of skin Change in nipple position Redness, soreness, rash or
swelling
Breast Cancer:Self Exam-Step 2 & 3 Raise arms and look
for same changes While at mirror,
gently squeeze each nipple between finger and thumb Check for discharge
Milky, yellow or blood
Breast Cancer:Self Exam-Step 4
When lying down, feel breast with first 2 fingers Firm, smooth touch
Cover top to bottom, side to side
Breast Cancer:Self Exam-Step 5 Feel when standing or
sitting Suggestion: wet the
skin Cover breast in same
manner (movements)
Testicular Cancer:Self-Exam 1 Starting at age 15 is an effective way to detect t.c.
at an early-and very curable- stage Best performed after a warm shower or bath
Heat relaxes the scrotum, making it easier to spot abnormalities
Stand in front of the mirror Check for scrotal skin swelling
Testicular Cancer:Self-Exam Step 2 Examine each testicle with both hands
Place index & middle fingers under the testicle with thumbs on top
Roll testicle gently between thumbs and fingers You shouldn’t feel any pain
If one seems slightly larger, its normal
Testicular Cancer:Self-Exam Step 3
Find the epididymis-the soft, tubelike structure behind the testicle-Do not mistake this for a lump
Cancerous lumps are usually found on the sides of the testicle, but can also show on the front Lumps on the epididymis
are not cancerous
Cancer in General Any unusual symptoms
should be reported without delay!!
Follow-up doctor exams as well as self-exams are very important!
Follow-up care depends on the different types and stages of cancer
How Activity Helps Athletes Psychologically Aspect-Just as important Enjoyable, has meaning
and purpose Builds confidence Facilitates sense of control Develops new skills Social interaction Makes use of mind & spirit Keep them involved with
their Team
Some References MayoClinic.org Breastcancer.org Nationalbreastcancer.org Schnirring, Lisa. (2004). Can Exercise
Improve Breast Cancer Survival? The Physician and Sports Medicine. Vol 32: Issue 5.