Cancer Warning Signs

presentation: Especially for Women

1. CANCER: Know the Warning
Signs
Donna V. Puleio, M. D.
UPMC-NW

2. Reduce the Risk……
When cancers are found early they
are nearly always easier to treat and
cure.
Knowing what to look out for gives
you a better chance of finding the
disease early

3. Reducing the Risk
Know your body so that you can
notice any changes and see a doctor
if you do.
Know what screening tests are
suggested

4. Breast Cancer
1 in 8 women will get breast cancer in
her lifetime
Breast cancer is the most common
cancer in women
This year about 200, 000 women in
the USA will develop breast cancer
Incidence increases with age

5. Breast Cancer Warning signs
Lump or thickening in breast or
underarm
Change in size of breast
Nipple discharge or tenderness
Inverted nipple
Ridges or pitting in the breast
Change in look or feel ( temperature,
swelling, redness or scaly feel)

6. ACS Guidelines Breast Cancer
Yearly mammograms starting age 40
Clinical breast exam every 3 years for
women in their 20’s and 30’s and
every year for women 40 and over.
Breast self examination option for
women starting in their 20’s

7. Breast Self Examination
Lie down and place your right arm behind
your head. The exam is done while lying
down, not standing up. This is because
when lying down the breast tissue spreads
evenly over the chest wall and is as thin as
possible, making it much easier to feel all
the breast tissue.
Use the finger pads of the 3 middle fingers
on your left hand to feel for lumps in the
right breast. Use overlapping dime-sized
circular motions of the finger pads to feel
the breast tissue.

8. Breast Self Examination
Use 3 different levels of pressure to feel all the breast tissue.
Light pressure is needed to feel the tissue closest to the
skin; medium pressure to feel a little deeper; and firm
pressure to feel the tissue closest to the chest and ribs. It is
normal to feel a firm ridge in the lower curve of each breast,
but you should tell your doctor if you feel anything else out of
the ordinary. If you're not sure how hard to press, talk with
your doctor or nurse. Use each pressure level to feel the
breast tissue before moving on to the next spot.
Move around the breast in an up and down pattern starting
at an imaginary line drawn straight down your side from the
underarm and moving across the breast to the middle of the
chest bone (sternum or breastbone). Be sure to check the
entire breast area going down until you feel only ribs and up
to the neck or collar bone (clavicle

9. Breast Self Examination
There is some evidence to suggest
that the up-and-down pattern
(sometimes called the vertical
pattern) is the most effective pattern
for covering the entire breast, without
missing any breast tissue.

10. Breast Self Examination
While standing in front of a mirror with your hands
pressing firmly down on your hips, look at your
breasts for any changes of size, shape, contour, or
dimpling, or redness or scaliness of the nipple or
breast skin. (The pressing down on the hips
position contracts the chest wall muscles and
enhances any breast changes.)
Examine each underarm while sitting up or
standing and with your arm only slightly raised so
you can easily feel in this area. Raising your arm
straight up tightens the tissue in this area and
makes it harder to examine.

11. Medicare Coverage
Mammogram screening is covered for all women with
Medicare age 40 and older every 12 months. You can also
get one baseline mammogram between ages 35 and 39.
You pay 20% of the Medicare-approved amount with no Part
B deductible. Medicare also covers new digital technologies
for mammogram screenings. Medicare provides 80%
coverage for a clinical breast exam once every 24 months,
without Part B deductible.
At this time, Medicare's cancer screening coverage
information does not include MRI in addition to mammogram
as a covered screening method for women who are at high
risk for breast cancer. If you and your doctor agree that you
are at high risk for breast cancer, you may be able to find out
more by talking with your doctor's billing service about
possible Medicare coverage for breast MRI.

12. Risk Reduction
Talk with your doctor about the risks and
benefits of hormone replacement therapy
for your specific situation
f Get at least 30 minutes of physical
activity on 5 or more days a week
a Get to and stay at a healthy weight
G Cut back to not more than 1 alcoholic
drink per day, if you drink at all

13. LUNG CANCER
The American Cancer Society's most recent estimates for
lung cancer in the United States are for 2009:
219,440 new cases of lung cancer (both small cell and non-
small cell)
159,390 deaths from lung cancer
Lung cancer (both small cell and non-small cell) is the
leading cause of cancer death for both men and women.
More people die of lung cancer than of colon, breast, and
prostate cancers combined. Lung cancer is rare in people
under the age of 45. The average lifetime chance that a man
will develop lung cancer is about 1 in 13. For a woman it is 1
in 16. These numbers include both smokers and non-
smokers. For smokers the risk is much higher, while for non-
smokers the risk is lower.

14. Lung Cancer
Warning Signs
Wheezing or shortness of breath
Chronic cough or chest pain

15. Lung Cancer early detection
No screening test have been proven
to diagnose lung cancer early enough
to improve survival

16. Lung Cancer Risk Factors
Smoking
Asbestos exposure
Exposure to Uranium, arsenic, vinyl
chloride
Exposure to second hand smoke

17. Lung Cancer Risk Reduction
Quit Smoking
Avoid areas where people are
smoking
Consider radon testing

18. Medicare Coverage
May cover tobacco cessation
counseling (you pay 20% of the
medicare approved amount after you
meet the yearly deductible)
Medicare part D may cover some pre
scription drugs to help you stop
smoking

19. COLON CANCER
The American Cancer Society's most
recent estimates for colorectal cancer in
the United States are for 2009:
106,100 new cases of colon cancer
40,870 new cases of rectal cancer
49,920 deaths from colorectal cancer
Not counting skin cancers, colorectal
cancer is the third most common cancer
found in men and women in this country.
The risk of a person having colorecal
cancer in their lifetime is about 1 in 19.

20. Colon Cancer Warning Signs
A change in your bowel habits,
including diarrhea or constipation or a
change in the consistency of your stool
for more than a couple of weeks
Rectal bleeding or blood in your stool
Persistent abdominal discomfort, such
as cramps, gas or pain
A feeling that your bowel doesn't empty
completely
Weakness or fatigue
Unexplained weight loss

21. Colon Cancer Early Detection
Starting at age 50,* you should follow one of the 6 options below.
The tests that are designed to find both early cancer and polyps are
preferred if these tests are available to you and you are willing to
have one of these more invasive tests. Talk to your doctor about
which test is best for you.
Tests that can find polyps and cancer:
Double contrast barium enema every 5 years
Flexible sigmoidoscopy every 5 years
Colonoscopy every 10 years
CT colonography (virtual colonoscopy) every 5 years
Tests that mainly find cancer:
Yearly take-home package for fecal occult blood test (FOBT), or
fecal immunochemical test (FIT)

22. Colon Cancer Risk Factors
Colorectal cancer or polyps in a parent, sibling, or
child younger than 60 (or in 2 such relatives of any
age)
Colorectal cancer syndromes in your family
You have had colorectal cancer or adenomatous
polyps
You have or have had chronic inflammatory bowel
disease for several years

23. Colon Cancer Risk Factors
Has anyone in your family had colon or rectal
cancer?
c Do you have a colorectal cancer syndrome in
your family, such as familial adenomatous
polyposis (FAP) or hereditary nonpolyposis colon
cancer (HNPCC, also called Lynch syndrome)?
c Have you ever had a type of intestinal polyp
called an adenomatous polyp?
c Have you had chronic inflammatory bowel
disease such as Crohn’s disease or
ulcerative colitis

24. Colon Cancer Risk Factors
Are you over 50 years of age?
Do you eat a lot of red meat (beef, pork,
lamb) or processed meats (luncheon meat,
hotdogs, bacon)?
Are you physically inactive?
Are you overweight?
Do you use tobacco?
Do you average more than 1 alcoholic
drink per day?

25. Colon Cancer risk reduction
Follow early detection guidelines to find and remove
adenomatous polyps before they become cancer
a Get at least 30-45 minutes of physical activity on at least 5
days per week.
Get to and stay at a healthy weight
G Eat plenty of fruits, vegetables, and whole-grain foods,
and limit processed meats, and red meats
a Quit smoking
Q Cut back to not more than 1 alcoholic drink per day,
if you drink

26. Medicare
Medicare covers colorectal screening tests to help find pre-
cancerous polyps (growths in the colon) so they can be removed
before they turn into cancer.
For people with Medicare aged 50 and older at average risk of
colorectal cancer, coverage includes:
fecal occult blood test (FOBT) every 12 months
flexible sigmoidoscopy once every 4 years
colonoscopy once every 10 years (but not within 4 years of a
flexible sigmoidoscopy)
barium enema once every 4 years (instead of colonoscopy or
flexible sigmoidoscopy)
For people with Medicare aged 50 and older at high risk for colon
cancer, Medicare pays for some tests at shorter intervals:
colonoscopy once every 2 years (with no minimum age specified)
barium enema once every 2 years (instead of colonoscopy or
flexible sigmoidoscopy)

27. Ovarian Cancer
Ovarian cancer is the ninth most common
cancer in women (not counting skin
cancer). It ranks fifth as the cause of
cancer death in women. Around two-thirds
of women with ovarian cancer are 55 or
older. It is slightly more common in white
women that African-American women.
A woman's risk of getting invasive ovarian
cancer during her lifetime is about 1 in 71.
Her lifetime chance of dying from invasive
ovarian cancer is about 1 in 95.

28. Ovarian Cancer Warning signs
Watching for and reporting signs and symptoms
may allow earlier detection. Although all these
symptoms can have other causes, see your doctor
if you have these almost daily for more than a few
weeks:
Bloating
Pain in the pelvis or abdomen
Trouble eating or feeling full quickly
Urinary urgency or frequency

29. Ovarian Cancer early detection
There are no effective and proven screening tests
for early detection of ovarian cancer.
If your mother, sister, or daughter has had ovarian
cancer or breast cancer, or if your parent, sibling,
or child has had colorectal cancer, you are at high
risk of ovarian cancer. If you have had breast
cancer, you are also at high risk. You may want to
talk to your doctor about:
Pelvic exam
Pelvic ultrasound
CA-125 blood test

30. Ovarian Cancer Risk Factors
Have you already gone through menopause?
H Did you begin menstruating before age 12, or go through
menopause after age 50?
m Did you have your first child after age 30 (or have no children)?
D Has your mother, sister, or daughter had ovarian or breast
cancer?
c Has one of your parents, siblings, or children had colorectal
cancer?
c Does anyone in your family have hereditary nonpolyposis
colorectal cancer (HNPCC, also called Lynch syndrome), or are you
at risk for HNPCC?
a Have you had breast cancer?
H Have you been on estrogen replacement therapy

31. CERVICAL CANCER
The American Cancer Society's most
recent estimates for cervical cancer in
the United States are for 2009:
about 11,270 new cases of invasive
cervical cancer will be diagnosed.
about 4,070 women will die from
cervical cancer.

32. Cervical Cancer Warning signs
Abnormal Vaginal Bleeding/spotting
Bleeding/spotting after intercourse
Pelvic Pain
Blood in urine
Back pain
Pain with intercourse

33. Cervical Cancer Early Detection
Yearly Pap test to begin about 3 years after you first have
sex, or by age 21, whichever is earlier.
After age 30, if you have had 3 normal test results in a row,
you may be tested every 2-3 years with Pap or liquid Pap
tests, or every 3 years with an HPV DNA test plus a Pap.
If you are 70 years old or older, and have had 3 or more
normal Pap tests in a row with no abnormal Pap tests in the
past 10 years, you may choose to stop Pap testing
If you have had a total hysterectomy and you are not at high
risk (see below), you may choose to stop Pap testing after 3
or more normal Pap tests in a row,

34. Cervical Cancer risk factors
Have you ever been told that you had
human papilloma virus (HPV)?
h Have you ever had genital warts?
H Do you smoke?
D Do you have human immunodeficiency
virus (HIV) infection or AIDS?
v Did your mother take diethylstilbestrol
(DES) when she was pregnant with you?

35. Cervical Cancer risk reduction
If you are sexually active, you can reduce your risk of getting HPV
and cervical cancer by:
Practicing safer sex by using condoms each time you have sex
P Quit smoking
Q Have regular Pap tests
Vaccination: The HPV vaccine is given in a 3-dose series to fight
HPV infection. HPV vaccine must be given before the woman is
infected. The HPV vaccine:
is best given between ages 11 and 13 (may be given as young as
age 9)
may be given between ages 13 and 18 to "catch up"
is of uncertain value for women aged 19-26
does not replace

36. Endometrial Cancer

37. Endometrial Cancer
42,160 new cases of uterus cancer (most
of these will be endometrial cancer--
cancers that start in the lining of the uterus)
7,780 deaths from endometrial cancer
In this country, cancer of the endometrium
is the most common cancer found in
women's reproductive organs. The chance
of a woman having this cancer during her
lifetime is about one in 41.

38. Endometrial Cancer Warning Signs
Unusual bleeding or Discharge
Bleeding after intercourse
Pain with urination or when having a
bowel movement
Pain with intercourse
Pelvic pain
Fibroids that grow quickly especially
after menopause

39. Endometrial Cancer early detection
There is no simple screening test that has been proven to
diagnose endometrial cancer early enough to improve
survival.
Talk with your doctor, especially at the time of menopause,
about the risks and symptoms of endometrial cancer
Watch for and report any abnormal vaginal bleeding or
spotting, or any bleeding after menopause, and report it to
your doctor
If you have or are at risk for HNPCC, consider yearly testing
with endometrial biopsy beginning at age 35

40. Endometrial Cancer Risk factors
Do you or anyone in your family have hereditary nonpolyposis colorectal
cancer (HNPCC, also called Lynch syndrome)?
Are you over age 40?
Did you begin menstruating before age 12, or go through menopause after
age 50?
Do you have a history of infertility or never giving birth?
Are you obese (very overweight)?
Do you eat a lot of animal fat?
Do you have diabetes?
Have you taken tamoxifen or long-term estrogen replacement therapy
without progesterone (if you still have your uterus)?
Have you had breast or ovarian cancer?
Have you had radiation therapy to your pelvis?

41. SKIN CANCER
Cancer of the skin (including melanoma and non-
melanoma skin cancer) is the most common of all
cancers. It accounts for about half of all cancers.
The exact number of basal and squamous cell
cancers is not known for certain. This means that
the numbers given here are estimates.
More than 1 million basal and squamous cell skin
cancers are found each year each year. Most of
these (about 800,000 to 900,000) are basal cell
cancers. Squamous cell cancer is less common –
there are about 200,000 to 300,000 cases per
year.

42. SKIN CANCER
Melanoma is a cancer that begins in
the melanocytes..
Skin cancer is the most common of all
cancers. Melanoma accounts for less
than 5% of skin cancer cases. But it
causes most skin cancer deaths

43. Skin Cancer
Melanoma is a cancer that begins in the melanocytes..

44. SKIN CANCER WARNING SIGNS
Sores that do not heal
Any wart, mole or freckle that
changes color, size , shape or loses
its definite borders

45. SKIN CANCER WARNING SIGNS
ABCD rule
Asymmetry: One half of the mole does not match
the other half.
Border irregularity: The edges of the mole are
irregular or not smooth. They may look ragged,
blurred, or notched.
Color: The color over the mole is not the same all
over. There may be shades of tan, brown, or
black, and sometimes patches of pink, red, blue,
or white.
Diameter: The mole is larger than about ¼ inch--
about the size of a pencil eraser-- although
sometimes melanomas can be smaller.

46. SKIN CANCER EARLY
DETECTION
Regular self exam:
Become familiar with any moles, freckles, or other spots on
your skin. Use mirrors or have a family member or close
friend look at areas you can’t see (ears, scalp, lower back).
For more information on skin self-exam, read Skin Cancer
Prevention and Early Detection on www.cancer.org.
Check for skin changes once a month. Show any suspicious
or changing areas to your doctor
Cancer-related check-up (including skin exam) with your
doctor is recommended during regular visits for people age
20 and older, especially those with risk factors for skin
cancer

47. SKIN CANCER RISK REDUCTION
Stay out of the sun as much as possible, especially between 10 AM
and 4 PM
Wear a broad-brimmed hat, a shirt, and UV-protective sunglasses
when out in the sun
Use a sunscreen with an SPF of 15 or higher, and reapply it often
Wear wrap-around sunglasses with at least 99% UV absorption,
labeled as blocking UVA and UVB light; or "UV absorption to 400
nm," which means UVA and UVB protection
Do not use tanning beds or sunlamps
Protect young children from excess sun exposure
Check your skin often for abnormal or changing areas, especially
moles, and have them examined by your doctor

48. MORE INFORMATION
AMERICAN CANCER SOCIETY
www.cancer.org
National Cancer Institute
www.cancer.gov