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Understanding Cancer: Types, Causes, Prevention, and Screening

Learn about the different types of cancer, its causes, and how to prevent it through primary and secondary methods. Discover the importance of cancer screening for early detection and effective management.

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Understanding Cancer: Types, Causes, Prevention, and Screening

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  1. Cancer

  2. Outline • Introduction • Important types • Causes • Prevention • Screening

  3. Definition • Abnormal growth of cells • Invade adjacent tissues, distant organs • Carcinomas: arise-epithelial cells : internal surfaces of organs • Sarcomas: mesodermal cells-connective tissues (ex. Fat, bone) • Lymphomas, myelomas, leukaemias: arising from cells of bone marrow and immune system

  4. Problem Statement: World • 14 million new cases per year • Expected to rise to 22 million in next 2 decades • Large variation: different regions • Lung cancer: most deaths

  5. India ICMR data: • Men: lung, oral cavity, pharynx, oesophagus, stomach • Women: cervical, breast • Screening, management: limited

  6. Time trends • Earlier: sixth leading cause death • Second leading cause now • Longer life expectancy • Accurate diagnosis • Rise in cigarette smoking

  7. Hospital data: 50% of the cancers: Cancer cervix Cancer oropharynx

  8. Causes

  9. Environmental: tobacco

  10. Continued…. • Alcohol • Dietary factors: Smoked fish, beef consumption and high fat diet. Food additives and food contaminants • Occupational: benzene, arsenic, cadmium, asbestos • Viruses: Hepatitis B, C, HPV, EBV • Parasites: schistosomiasis-bladder • Lifestyle, habits • Radiation

  11. Continued….. • Genetic: • Retinoblastoma • Leukaemia: Mongols • Difficult to identify

  12. Cancer Control: Primary and Secondary • Primary prevention: • Control of tobacco, alcohol • Personal hygiene • Radiation • Occupational • Immunization: HBV and HPV • Treat Pre-cancerous lesions • Legislations: Control of environmental pollutants • Cancer Education

  13. Early Warning Signs/ Danger signals of Cancer • Lump/hard area in the breast • Change: wart/mole • Persistent change: bowel, bladder • Persistent cough/hoarseness • Excessive/unexplained bleeding: menstrual cycle • Blood loss from any natural orifice • Sore: does not heal • Unexplained weight loss

  14. Continued…… • Secondary prevention: • Cancer registration: Cancer Registries Assess magnitude, study time trends, epidemiological investigation, plan operational activities in all areas of cancer control • Hospital based • Population based

  15. Continued….. • Early detection: Screening followed by appropriate management • Treatment: Based on the staging Palliative treatment, Pain relief

  16. Cancer screening • Search: unrecognized malignancy-rapidly applied tests • Best possible protection • Pre-malignant lesions • 75%: accessible body parts

  17. Methods of cancer screening • Mass screening: comprehensive cancer detection examination • Mass screening of single sites • Selective screening: High risk screening

  18. Risk factors of cancer • Warning signals of cancer • Types of cancer registry • Methods of cancer screening

  19. Types of Cancer • Cancer Cervix • Cancer Breast • Cancer Lung • Oral Cancer

  20. Cancer cervix • Second most: women • Developing countries: most common: 88% of all cancers • India: number one killer-women • HPV: 90%, multiple partners, personal hygiene, • Age: increases from 25 to 45, falls off • Genital warts:

  21. Risk factors

  22. Screening for Cancer Cervix • CA-in-situ: Pap Smear: beginning, every 3 years • Periodic pelvic examination • Visual Inspection: 5% Acetic Acid • With Magnification • Well-defined opaque aceto-white lesions near squamo-columnar junction or whitening of the ulcerative growth on the cervix • Hospital: investigation, management

  23. Continued…. • Prevention and control: • Primary: personal hygiene, education • Secondary: Radical surgery, chemotherapy • Prognosis: depends on stage

  24. Review • Warning signals of cancer • Types of cancer registry • Methods of cancer screening • Risk factors for cervical cancer • Screening methods for cervical cancer

  25. Breast cancer • Most frequent cancer: women • Developed, developing • India: 1 lakh new cases; 12%: malignant • Ranks as the fifth cause of death from cancer

  26. Risk factors • Age: 35 and above, bimodal, 65 years • Suppose under 40: second- three times • Indian: decade earlier • Family history: mother/sister • Parity: Delayed late thirties-high risk • Unmarried

  27. Continued….. • Early menarche, late menopause • Elevated oestrogen, progesterone • Diet: high fat, obesity • High socio-economic status

  28. Breast cancer screening • Breast self examination: • Start: 40 years • One fixed day every month

  29. Continued….. • Clinical examination by physician • Mammography: yearly starting at 50 years • Most sensitive but not specific • Exposure to radiation • Equipment, skills

  30. Prevention • Primary: • Reduce obesity, increase physical activity • Diet, weight control • Secondary: • Early diagnosis, treatment • Follow-up: recurrence

  31. Oral Cancer • One of the ten most common cancers • Males> Females

  32. Epidemiology: • Tobacco: 90% of oral cancers are linked to tobacco, side of the mouth: quid kept • Alcohol • Preceded by pre-cancerous lesions: Leukoplakia • High-risk groups • Cultural: bidi, hookah, snuff • Most common: betel quid: betel leaf, arecanut, lime, tobacco Mixture (khaini: tobacco flakes and lime): mouth-small amounts

  33. Prevention • Primary: Education, legislation • Secondary: early detection, surgery, radiotherapy • Training of Primary health workers

  34. Lung cancer • Most common: men • High fatality • India: 58,000 new cases (90% men)

  35. Risk factors • Age and sex: 1/3 deaths below 65 years • Smoking: • Number, age of starting, nicotine, tar content • Passive smoking • Tar, carbon monoxide, nicotine • Interfere: oxygen delivery-CVD • Bidi: more carcinogens • Air pollution • Occupational: asbestos, arsenic

  36. Prevention • Primary: • Education • Legislation: COTPA • Smoking cessation • Secondary: • Early detection: chest X-ray, sputum cytology • Less attractive , most expensive

  37. Review • Screening methods for cervical cancer • Screening methods for breast cancer • Age to start breast self examination • Risk factors: • Breast cancer • Cervical cancer

  38. NPCDCS- Cancer component • Launched: 1976 • Integrated: 2010 • Objectives: • Primary Prevention: Health education • Secondary: Early detection and diagnosis by screening and self examination method • Tertiary: strengthen institutions to offer comprehensive treatment including palliative care

  39. Schemes • Regional Cancer Centre Schemes: Strengthening of existing centers to manage complicated cases. Offered Rs 3 crores • Oncology Wing Development Scheme: Assistance provided to purchase cobalt unit and other equipment including infrastructure. • NGO involvement: IEC activities and early cancer detection. Financial assistance offered to the NGOs • IEC activities: Anti tobacco legislation and tobacco awareness campaigns • Research, training: Activities at central level: Development of manuals for health professionals, cytology, palliative care and tobacco cessation

  40. Services • Diagnostic, surgery, chemotherapy, palliative care services: Available at 100 district hospitals • Each district: Rs.1 crore/ annum : Day care chemotherapy facilities • Facility for lab investigations including mammography • Home based palliative care in 100 districts

  41. Questions • Short essays (5 or 2 marks): • Warning signs of cancer • Cancer registries and uses • Screening for cancer cervix • Screening for cancer breast • Measures to prevent smoking • Strategies under NPCDCS

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