nursing.elitecme.com Page 3 Complete Your CE Test Online - Click Here Table 1. Estimated numbers of cases and deaths for common cancers in the United States, 2016. Excerpted from American Cancer Society: Cancer facts and figures 2016 [14]. Cancer type* New cases expected in 2016 Expected deaths in 2016 Breast cancers (women and men). 246,6000 + 2,600 40,450 + 440 Cancers of the lung and bronchus. 224,390 158,080 Prostate cancers. 180,890 26,120 Colon and rectal cancers. 134,490 49,190 Bladder cancers. 76,960 16,390 Melanomas. 76,380 10,130 Non-Hodgkin lymphoma. 72,580 20,150 Thyroid cancers. 64,300 1,980 Renal cell and renal pelvis cancers. 62,700 14,240 Leukemias (all types). 60,140 24,400 Endometrial cancers. 60,050 10,470 Pancreatic cancers. 53,070 41,780 *This table does not include skin cancers or most other in situ cancers. About five million skin cancers are expected to be diagnosed in 2016. Costs of cancer Cancer treatment involves a lot of medical care, and the financial aspects of this cannot be dismissed. There is a growing awareness among healthcare professionals that the cost of cancer care is rising quickly. The term “financial toxicity” has made its way into the medical lexicon, indicating that there are patients who cannot afford recommended treatments or prescriptions [80]. This directly affects patient care and outcomes. The Agency for Health Care Research and Quality (AHRQ) reported that each year from 2012-2013 [273]: ● ● More than 1.1 million people had inpatient hospital stays related to cancer. ● ● 14.5 million people had hospital outpatient visits or office visits related to cancer. ● ● More than five million people had prescription medicines related to cancer. Medical expenses have increased, with outpatient costs increasing much faster relative to inpatient costs as cancer care increasingly moves to outpatient models. The AHRQ Medical Expenditure Panel Survey (MEPS) found that in U.S. dollars (USD) [260]: ● ● Medical spending to treat cancer increased from $56.8 billion in 2001 (adjusted for inflation to 2011 USD) to $88.3 billion in 2011. ● ● Inpatient expenses were 47% of total spending for cancer treatment in 2001, but went down to 35% by 2011. ● ● The cost for ambulatory and outpatient care and treatment of cancer went up from $25.5 billion in 2001 to $43.8 billion in 2011. ● ● Prescription medications from retail pharmacies for cancer climbed from $2 billion in 2001 to $10 billion in 2011. (See also“Financial Impacts” in “Emotional & Family Effects.”) WHAT IS CANCER? Although individuals often speak of cancer like it is a singular illness, the National Cancer Institute describes cancer as a collection of more than 100 related diseases [202]. Other organizations that keep track have calculated different numbers of cancers [4]. A cancer can begin almost anywhere in the human body as each body contains trillions of cells. All cancers share the characteristics of abnormal cells growing at uncontrolled/abnormal rates that continue to divide and traffic or grow into surrounding tissues [202]. Normal cell development Normally, human cells grow and divide to form new cells as needed by the body. Normal cells are able to perform their specific functions: they respond to signals and cytokines; and cell division is inhibited by contact and other mechanisms [244]. When cells grow old or become damaged, they die, a process known as apoptosis or programmed cell death. Waste products are removed and new cells are generated to take the place of the dead cells [202]. Abnormal cell development When a cancer develops, the orderly process of normal cell division, death, and replacement breaks down. As cells become more and more abnormal, old or damaged cells survive when they should die, and new cells form when they are not needed. These extra cells become able to divide without stopping and may form solid masses or abnormal cells that may be found in the circulatory system [202]. These abnormal cells take over nutrients and blood supply in the area of the cancer, at the expense of the normal cells. Not all cancer cells grow at the same speed, but they tend to reproduce more rapidly than normal cells. Many cancers form solid tumors or tissue masses. Cancers of the blood, e.g. leukemias, generally do not form solid tumors as abnormal cells reproduce in the hematopoietic (blood-forming) or lymphatic organs of the body [202]. Cancerous tumors can spread into or invade nearby tissues, growing and expanding past normal tissue borders. Another way that cancerous tumors spread is through some cancer cells “breaking off” and traveling to other locations in the body via blood circulation or the lymphatic system. Some of these migrating abnormal cells form metastases far from the original tumor [202]. Genetic changes in cancer Cancers have a genetic component, meaning that the abnormal cell cycles are caused by mutations to genes that control the way cells function, especially those that direct growth and division [202]. It often takes many mutations before a cell becomes cancerous. Genetic mutations are constantly happening as cells divide and typically, the errors are detected and the body is able to repair them, while other errors cause malfunction or death of the cell. Some genetic mutations do not cause observable effect on the cell function, but others mutations can start or continue in a chain of events that lead to cancer [26]. Germline vs. acquired genetic mutations Genetic changes that can start a cell on a cancerous path or that allow abnormal cells to grow and divide can be inherited from parents. Germline mutations, because humans begin from a single sperm and a single egg combining DNA (deoxyribonucleic acid), are present in all body cells. Inherited germline mutations can be passed on to offspring depending on recombination and reproduction events. Even seemingly