CANCER IN THE CARIBBREAN

Objectives: You should be able to1. describe what is cancer and how it develops
2. describe cancer causing factors (carcinogens)
3. describe cancers in the caribbean - breast, prostate, cervical, lung, colon etc
3. discuss the implications of cancers in the Caribbean region
WHAT IS CANCER?
The body is made up of many types of cells. These cells grow and divide in a
controlled way to produce more cells as they are needed to keep the body
healthy. When cells become old or damaged, they die and are replaced with new
cells. Cell death is programmed as it is controlled by genes. This process is
called apoptosis. Four key types of gene are responsible for the cell division
process: proto oncogenes tell cells when to divide, tumor suppressor genes tell
cells when not to divide, suicide genes control apoptosis and tell the cell to kill
itself if something goes wrong, and DNA-repair genes instruct a cell to repair
damaged DNA.
However, sometimes this orderly process goes wrong. The genetic material
(DNA) of a cell can become damaged or changed, producing mutations that
affect normal cell growth and division. A cell's gene mutations make the cell
unable to correct DNA damage and unable to commit suicide. Similarly, cancer
is a result of mutations that inhibit oncogene and tumor suppressor gene
function, leading to uncontrollable cell growth. When this happens, cells do not
die when they should and they continue to divide uncontrollably; more cells are
being formed than is needed; these cells are malformed and do not carry out
their 'true' functions. [see youtube video: 3D animation - what is
cancer]. The extra cells may form a mass of tissue called a tumor.

The tumor being cancerous leads to the development of cancer in the affected
area of the body where it develops or it breaks off, enters blood stream or
lymphatic system and is distributed to other areas of the body where it grows,
invading normal body cells and causing cancer in these areas. CANCER IS
THEREFORE a disease caused by an uncontrolled division of abnormal
cells in a part of the body.
When a tumor successfully spreads to other parts of the body and grows,
invading and destroying other healthy tissues, it is said to have metastasized.
The tumor develops its own blood supply so the cancerous cells continue to
grow and divide as they get nutrients and oxygen from the blood. This process
itself is called metastasis, and the result is a serious condition that is very
difficult to treat.
*BE ABLE TO CLEARLY DESCRIBE HOW CANCER DEVELOPS*
WHAT CAUSES CANCER?
Carcinogens are cancer causing materials. Some common ones include:
Chemicals/Environment (environmental hazards) eg. asbestos - has
been linked to lung cancers; formaldehyde - has been linked to brain
tumors; hair dyes
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 Food additives eg. acrylamide found in potato chips, french fries;

artificial sweetners, alcohol
Genetics - Person's genetics puts them at risk of developing cancer.
BRCA1 and BRCA2 are human genes that produce tumor
suppressor proteins. These proteins help repair damaged DNA and,
therefore, play a role in ensuring the stability of the cells genetic
material. When either of these genes is mutated, or altered, such that its
protein product is not made or does not function correctly, DNA damage
may not be repaired properly. As a result, cells are more likely to develop
additional genetic alterations that can lead to cancer. A
harmful BRCA1 or BRCA2 mutation can be inherited from a persons
mother or father. Each child of a parent who carries a mutation in one of
these genes has a 50 percent chance of inheriting the mutation.
Specific inherited mutations in BRCA1 and BRCA2 increase the risk of
female breast and ovarian cancers, and they have been associated with
increased risks of several additional types of cancer.
Together, BRCA1 and BRCA2 mutations account for about 20 to 25
percent of hereditary breast cancers, In addition, mutations
in BRCA1 and BRCA2 account for around 15 percent of ovarian cancers
overall
Hormones - some hormones used to make contraceptives have been
described as cancer causing
Infectious agents eg. HIV which causes Kaposi sarcoma, non - Hodgkin
lymphoma, cervical cancer, anal cancer etc. People infected with HIV are
several thousand times more likely than uninfected people to be
diagnosed with Kaposi sarcoma, 70 times more likely to be diagnosed
with non-Hodgkin lymphoma, and, among women, at least 5 times more
likely to be diagnosed with cervical cancer, 25 times more likely for anal
cancer, 5 times more likely for liver cancer etc. Human Papilloma Virus
(HPV) causes cervical cancer and some types of anal, penile, vaginal,
head and neck cancers. Hepatitis B and Hepatitis C virus causes liver
cancer.
Radiation eg. UV light, gamma and x-rays
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*BE ABLE TO STATE THE NAMES & GIVES EGS. OF

CARCINOGENS*
CANCER & THE CARIBBEAN
Non-communicable diseases, including cancer, are overtaking infectious disease as
the leading health-care threat in middle-income and low-income countries. Latin
American and Caribbean countries are struggling to respond to increasing morbidity
and death from advanced disease.
Cancer mortality rates vary for men and women as well as across countries. In Latin
American and Caribbean men, the majority of cancer deaths are due to prostate
cancer, followed by lung, stomach and colorectal cancers; and in women, breast
cancer, followed by stomach, lung, cervical and colorectal cancers. Cancers
associated with digestive system is on the rise due to poor diet and excessive
consumption of fatty foods. Obesity and lack of physical activity are risk factors for
these cancers.
The large number of deaths from breast and cervical cancer in Latin America and
the Caribbean is very disconcerting, since cervical cancer is largely preventable, and
breast cancer can be detected early and treated successfully, This points to the need
to improve screening and treatment, especially for women in rural and remote areas,
where access to health services is especially limited.
FACTORS CAUSING DIFFICULTY IN TREATING CANCER
Health ministries and health-care systems in these countries face many challenges
caring for patients with advanced cancer:
- inadequate funding
- inequitable distribution of resources and services
-inadequate numbers, training, and distribution of health-care personnel and
equipment
-lack of adequate care for many populations based on socioeconomic, geographic,
ethnic
-current systems geared toward the needs of wealthy, urban minorities at a cost to the
entire population.
This burgeoning cancer problem threatens to cause widespread suffering and
economic peril to the countries of Latin America. Prompt and deliberate actions
must be taken to avoid this scenario. Increasing efforts towards prevention of cancer
and avoidance of advanced, stage IV disease will reduce suffering and mortality and
will make overall cancer care more affordable.
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FIGHTING CANCER
Expanding immunization against infections that cause certain types of cancer,
such as cervical cancer (HPV) and liver cancer (hepatitis B).
Strengthening public health policies for cancer prevention, including policies on
tobacco control, alcohol reduction, diet and physical activity.
Enhancing regulations on and protection against carcinogens in the workplace
and in the environment.
Improving quality of and access to screening programs, especially for early
detection of prostate, cervical and breast cancers.
Improving the quality of radiotherapy services.
Expanding access to cancer drugs and palliative care.
Strengthening cancer information systems and registries.

How is Cancer Treated?

Surgery

Radiation

Chemotherapy

Immunotherapy

Gene therapy

Hormone therapy

Using targeted cancer therapy (using monoclonal antibodies) - we covered

this in detail