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Cancer

Cancer. Outline. Introduction Important types Causes Prevention Screening. 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)

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Cancer

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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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