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.