Chapter 10 Cardiovascular

Disease and Cancer

Cigarette Smoking and CVD

• Smoking is a major risk factor for CVD (as well as lung and other cancers).

• Carbon monoxide, nicotine, and other substances in cigarette smoke constrict and injure arteries.

• Secondhand smoke is a CVD (and cancer) risk factor.

• Health risks for smoking decline the earlier a woman quits.

Cancer • Cancer: disease caused by uncontrolled

cellular growth or reproduction • Tumor: any abnormal cell growth

– Benign (contained) – Malignant (growing/spreading)

• Metastasis: the process of cancer spreading throughout the body

• Carcinogen: a substance that can cause cancer

Cancer and Women • Cancer is the second-leading cause of death in

the United States. • 75% of cancers are diagnosed in people aged 55

and older. • Breast cancer is the most common cancer in

women. • Second most common = lung cancer, but causes

the most deaths (lower survival rate) • Third most common cancer = colorectal • Fourth most common cancer = endometrial

Breast Conditions • Most women will find a lump in their breast at

some point in their lives. In 9 of 10 cases, this is not cancer.

• Benign breast diseases – Fibrocystic breast disease (cystic mastitis) – Hyperplasia – Fibroadenoma

Breast Conditions Breast cancer is a frightening, misunderstood issue in women’s health. It can usually be successfully treated if detected early. •Five levels

– In situ: Too small to be felt; nearly 100% 5-year survival rate

– Stage I: < 2 cm in size, localized – Stage II: 2–5 cm in size, localized – Stage III: > 5 cm in size, grown into chest wall, skin,

or lymph nodes – Stage IV: Growth spread to other parts of body

Risk Factors for Breast Cancer • Gender • Age • Family history • Never had children or first child after 30 • Early menarche (before 12) or late menopause

(after 55) • Consumption of high-fat diet or alcohol • Environmental factors • Obesity • Oral contraceptive use?

Breast Cancer Screening • Breast self-exam • Clinical breast exam • Mammography

Treatment • Lumpectomy • Partial or segmental mastectomy • Simple mastectomy • Radical mastectomy • Modified radical mastectomy • Chemotherapy, radiation therapy, and

hormone therapy may be used alongside surgery to improve chances of recovery.

Lung Cancer • Cigarette smoking is responsible for almost

every case of lung cancer, the deadliest form of cancer for men and women.

• Lung cancer often spreads to other parts of the body before it can be detected.

• Common symptoms are persistent cough, weight loss, bloody sputum, recurring bronchitis, pneumonia, and chest pain.

• Treatment is very difficult but can include surgery, radiotherapy, and chemotherapy.

Cervical Cancer • Caused by “high risk” strains of HPV • Modern medicine has the potential to prevent

almost all cases of cervical cancer. • Screening: Pap smear, HPV test (for women 30

and over) • Vaccination can prevent most, but not all, cases

of cervical cancer (screening still needed). • Treatment: cyrosurgery, cone biopsy, laser cone

biopsy

Gynecological Conditions Benign uterine conditions •Fibroids •Endometriosis—when it grows into wall of uterus, called adenomyosis •Endometrial hyperplasia •Treatments include: hormone therapy or surgery (myomectomy, laparoscopy, hysterectomy)

Malignant Uterine Tumors • Risk factors

– Age (over 50) – Obesity, diabetes, high blood pressure, smoking – Early menarche or late menopause – History of infertility – Family or personal history of other cancers – Long-term high-dose ERT – Use of Tamoxifen for breast cancer

• Difficult to detect—too high up to be found on a pelvic examination

• Treatment may involve surgery and/or radiotherapy.

Ovarian Growths Benign ovarian growths •Cysts—follicular, hemorrhagic, epithelial, dermoid •Polycystic ovarian syndrome Ovarian cancer •A deadly, stealthy, and largely misunderstood form of cancer. •Risk factors: no children, early menstruation, late menopause, pregnancy after age 30, previous cancer, long- term use of some fertility drugs •Early symptoms: pelvic pressure, abdominal swelling, gas pains, indigestion, vague abdominal discomfort •Treatment: surgery, radiotherapy, chemotherapy

Cervical Cancer • Caused by human papilloma virus (HPV), a

common sexually transmitted virus • Only high-risk strains of HPV can cause cervical

cancer • Most women with high-risk HPV will not develop

cervical cancer • Easily treated if found early (Pap smear, HPV test) • A vaccine can protect against some high-risk

strains of HPV

Colorectal Cancer • Risk factors: Increasing age and familial

adenomatous polyposis (FAP) are major risk factors; high-fat, low-fiber diet is also a risk factor.

• Warning signs: blood in stool, cramping in lower abdomen

• Screening: digital rectal exam, sigmoidoscopy, fecal occult blood testing, colonoscopy

• Treatment: surgery, radiotherapy, chemotherapy

Skin Cancer • Melanomas vs. nonmelanomas (basal cell and squamous

cell carcinomas) • Risk factors: UV from sunlight, moles, family history, race • Screening and diagnosis: skin exam looking for ABCD

– Asymmetry – Border irregularities – Color irregularities – Diameter

• Treatment: surgery, radiation therapy, electrodessication, cryosurgery, laser therapy

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Reducing Your Risk of CVD and Cancer

• Importance of preventive lifestyle habits • Knowledge of family history, genetic risks • Importance of screening for early detection

What are you doing to reduce your risk of CVD and cancer?

Chapter 10 Cardiovascular

Disease and Cancer

Cardiovascular Disease and Cancer

The greatest causes of death in the United States • Cardiovascular disease

– Heart disease – Cerebrovascular disease (stroke)

• Cancer – Can affect any area – In women, most likely to affect breasts, lung,

reproductive system and skin

Cardiovascular Disease Figures: 2013

• 289,758 U.S. women died of heart disease—the leading cause of death in women.

• 75,287 U.S. women died of stroke—the third leading cause of death in women.

• More women than men die of stroke each year.

Economic Dimensions • Direct costs: health expenditures, hospital and

nursing home services, medications, home health care

• Indirect costs: lost productivity (both to people with CVD and their caretakers)

Cardiovascular System

Figure 10-3

Coronary Heart Disease (CHD) • Occurs when the

coronary arteries become blocked or narrowed with plaque

• Clots forming in an artery can also lead to blockages.

• Can lead to a heart attack (death of part of the heart)

Figure 10-3

If Plaque Causes CHD, What Causes Plaque?

• CHD begins with plaque buildup inside the lining of the coronary arteries.

• Plaque begins with LDL cholesterol moving inside the arteries; white blood cells can also get stuck inside the lining and die.

• Plaque can grow until it takes up 95% of the space in an artery.

Figure 10-5

Other Forms of Heart Disease Congestive heart failure (CHF) • Weak heart muscles that cannot perform the

pumping function with proper vigor • Often a disease of older women who have

suffered heart damage from other causes Arrhythmias • Problems with the heartbeat (fast, slow, or

irregular)

Other Forms of Heart Disease Rheumatic heart disease • Results from bacterial infection with

Streptococcus, which can cause damage to heart valves; can usually be cured with antibiotics

Angina pectoris • Chest pain resulting from insufficient supply of

blood (oxygen) to heart muscle • Disease of the extremities (arms/legs) in which

blood supply is diminished, resulting in lack of nutrients and oxygen

Metabolic Syndrome • Group of diseases that occur together and

cause CVD • Risk factors

– Elevated waist circumference – High blood lipid levels – Low HDL levels – High blood cholesterol levels – Elevated fasting blood glucose level

• Metabolic syndrome is a greater risk for women than it is for men.

Cerebrovascular Disease (Stroke)

• Blood vessels either within or leading to the brain becomes damaged, blocked, or burst.

• This leads to portions of the brain being unable to receive oxygen, and thus dying.

• Often survivors have a long, difficult recovery process—many thought processes and physical actions may have to be relearned.

Stroke Types of stroke

– Ischemic stroke: the most common type, caused by a cerebral thrombus or embolism

– Hemorrhagic stroke: caused by ruptured blood vessels such as an aneurysm

• Possible warning signs: transient ischemic attacks (TIAs)—brief memory loss, garbled speech, or other symptoms

Figure 10-6: Cerebrovascular

Accident

Recovery from a Stroke Recovery statistics • 50 to 70% of survivors regain functional

independence. • 15 to 30% are permanently disabled. • 20% require institutional care within 3 months of onset. • 25% die within a year (risk of death and future strokes

increases with age). Rehabilitation • Depends on area affected—may require physicians,

nurses, physical therapy, speech therapy, mental health professionals, or others

Risk Factors for CVD

• Age • Genetics • Race • Obesity • Smoking

• Hypertension • Elevated cholesterol • Sedentary lifestyle • Diabetes • Menopause

CVD Gender Differences • Before menopause, women’s hormones, in

general, protect them from CVD; with menopause, the risk increases more sharply.

• Symptoms and signs of a heart attack vary among genders; women tend to have somewhat different symptoms. – Fewer sharp, intense pains – Less shortness of breath – More cold sweats, nausea, dizziness

• Women more likely to die from heart attack

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