Repro Cancers Review

Breast Disease 24 (2005,2006) 17–35

Estrogen exposure across the life courseHigh estrogen exposure increases risk of breast, ovarian, and endometrial cancers

Alcohol intake: increases conversion of testosterone to estrogen

Role of energy balance in cancer development

Exp Diabetes Res. 2012;2012:789174

Other risk factors• HPV

– Persistent infection necessary for cervical cancer to develop– Other risk factors are mainly things that are associated with

increased sexual activity• PCOS

– Anovulation prolonged estrogen secretion increased risk of endometrial cancer

– Evidence for breast and ovarian cancer is shaky • BRCA1 & BRCA2 mutations

– Genes code for tumor suppressor genes– Mutations increase risk of breast and ovarian cancer

GI Review

Mouth & pharynx

• Dental illness problems chewing• Certain illness and medication problems

salivating– Exs: Sjorgren’s syndrome: autoimmune attack of

salivary glands; anti-diarrheal drugs• Problems swallowing– Exs: ALS, spinal cord injury, stroke

Esophagus

• Gastroesophageal reflux disease (GERD)– Risk factors: babies, pregnancy, obesity, lying down,

smoking, certain foods, lupus– Consequences: heartburn; Barrett’s esophagus; dental

cavities• Hiatal hernia– Can cause GERD

• Barrett’s Esophagus– Caused by GERD– Consequences: esophageal cancer

Stomach

• Peptic ulcers – risk factors weaken mucosal layer: H. pylori

infection, NSAIDS (inhibit prostaglandins), hypersecretion of acid

Intestines | 1

• Irritable bowel syndrome (IBS): cramping, diarrhea and/or constipation, passing of mucous stools– Cause unknown

• Irritable bowel disease (IBD): more severe– Exs: Crohn’s disease, ulcerative colitis– Treated with corticosteroids

Intestines | 2

• Vomiting: controlled by vomiting center in medulla; protects against ingesting toxins– Consequences of severe vomiting: • dehydration (↓blood volume ↓ blood pressure)• metabolic alkalosis (lose high amounts of HCl (acid)

blood becomes alkaline)• hypokalemia (↓blood volume ↑ aldosterone

release retain Na+ and water excrete K+)• Malnutrition (excess loss of calories)

Intestines | 3

• Diarrhea: leading cause of death worldwide in children – consequences of extreme diarrhea• dehydration (↓blood volume ↓ blood pressure)• metabolic acidosis (lose high amounts of KHCO3

(base) blood becomes acidic)• hypokalemia (↓blood volume ↑ aldosterone

release retain Na+ and water excrete K+)

Intestines | 4

• Osmotic diarrhea: retention of unabsorbable substances in intestines--> water follows– Ex: lactose intolerance

• Secretory diarrhea: excessive intestinal mucosal secretion of large volume of fluid & electrolytes– Ex: cholera

Intestines | 5

• Diarrhea due to malabsorption: presence of unabsorbed material in gut; can cause water loss by osmosis and other factors– Ex: celiac disease

• Loss of intestinal villi (decreased absorptive surface)• Loss of intestinal enzymes and hormones• Inflammation

• Hemorrhagic diarrhea: caused by infectious agent, results in bloody stool– Ex: certain E. coli strains

• Diarrhea due to altered motility: fast transit– Ex: dumping syndrome after gastric bypass surgery

Pancreas | 1

• Acute pancreatitis: acute inflammation and destructive autodigestion of pancreas– Causes: alcohol abuse; gallstones– Consequences: pain, nausea, vomiting, fever,

shock (low blood pressure), increased serum amylase and lipase, jaundice, acidosis, hyperkalemia

Pancreas | 2

• Chronic pancreatitis: chronic inflammation resulting in fibrosis, calcification, and loss of exocrine function– Causes: mainly alcoholism– Consequences: pancreatic insufficiency (fat in

stool & diarrhea); supplementation with insulin and pancreatic enzymes

• Pancreatic cancer: highly fatal

Liver | 1

• Cirrhosis: gradual degeneration of liver cells, replaced with scar tissue– Causes: mainly alcoholism– Consequences:

• portal hypertension (fibrosis causes backup of blood in hepatic portal vein)

• ascites (accumulation of watery fluid in peritoneal cavity due to portal hypertension and increased vascular permeability from inflammation)

• Infection (blood from intestine liver may be infected)• Edema (reduced albumin production fluid build up in

tissues)• Neurological disorders (build up of ammonia)

Liver | 2– Consequences continued: • Increased bleeding (reduced clotting factors and vit K)• Endocrine disorders (reduced binding proteins for fat-

soluble hormones)• Jaundice, diarrhea, fatty stool• Problems with glucose metabolism (hypoglycemia from

lack of gluconeogenesis; hyperglycemia from bypass of hepatic portal system)• Problems with lipid metabolism• Increased serum aminotransferase and alkaline

phosphatase• Problems with salt and water balance

QUESTIONS

1. Celiac disease can result in A. AnemiaB. Osteoporosis C. Short stature (if acquired in childhood) D. Miscarriage E. All of the above

2. When the lower esophageal sphincter is pushed into the thoracic cavity, it is known as A. Barrett’s esophagusB. HeartburnC. Hiatal herniaD. Peptic ulcer

3. Irritable Bowel Disease (IBD) is typically treated with which drug to reduce inflammation?A. Corticosteroids B. Vitamin B12 supplementation C. Antibiotics D. Antacids

4. Excessive vomiting can ______ blood pH and excessive diarrhea can _______ blood pH.A. Lower, lower B. Lower, raise C. Raise, lower D. Raise, raise

(low pH=more acidic; high pH=more alkaline)

5. Excessive vomiting can ______ blood potassium levels and excessive diarrhea can _______ blood potassium levels.A. Lower, lower B. Lower, raise C. Raise, lower D. Raise, raise

6. Angiogenesis refers to A. Limitless potential to replicateB. Ability to form new blood vesselsC. Ability of a tumor to metastasize D. Increased cellular proliferation

7. Which of the following statements is true?A. Oncogenes are never expressed in normal cellsB. Functional tumor suppressor genes increase the

likelihood of cancer development C. Overexpression of an oncogene can contribute

to cancer developmentD. HER2 is an example of a tumor suppressor gene

8. In the US, incidence rates of these cancers are higher in Caucasians vs. African Americans (choose all that apply)A. Testicular cancerB. Prostate cancerC. Breast cancerD. Endometrial cancer