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CANCER: Prevention and Early Detection

From the National Cancer Institute Presented By: Kelly S. Salvador, MD. Medical Oncologist Philippine Cancer Society. CANCER: Prevention and Early Detection. Understanding Cancer. Cancer CELLS TISSUES ORGANS Normally, cells grow and divide new cells

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CANCER: Prevention and Early Detection

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  1. From the National Cancer Institute Presented By: Kelly S. Salvador, MD. Medical Oncologist Philippine Cancer Society CANCER: Prevention and Early Detection

  2. Understanding Cancer • Cancer CELLS TISSUES ORGANS • Normally, cells grow and divide new cells cells grow old, they die and new cells • New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called growth or TUMOR.

  3. Understanding Cancer • Tumors may be BENIGN or MALIGNANT • Benign tumors are not cancer • Rarely life-threatening • After removing it, they usually do not grow back. • They do not invade the tissues around them. • They do not spread to other parts of the body.

  4. Understanding Cancer • Malignant tumors are cancer. • May be life-threatening. • If tumor is small, may be removed, but sometimes they grow back. • They may invade and damage nearby tissues or organs. • They can spread (metastasize) to other parts of the body.

  5. Understanding Cancer Risk Factors Doctors often cannot explain why one person develops cancer and another does not. But research shows that certain RISK FACTORS increase the chance that a person will develop cancer. These are the most common risk factors for cancer: • Growing Older - higher risk for people over 65 • Tobacco • Sunlight • Ionizing radiation • Certain chemicals and other substances • Some viruses and bacteria • Family history of cancer – could not be avoided • Alcohol • Poor diet, lack of physical activity, or being overweight

  6. Risk Factors

  7. Cancers are curable if detected EARLY and treated PROPERLY. Cancer Facts - 2005 106,844 – New Cases 72,846 – Deaths Reference: Philippine Cancer Facts and Estimate 2005

  8. Estimated Ten Leading Cancer (in Both Sexes)Philippines, 2005 • LUNG 17238 • BREAST 14043 • COLON / RECTUM 8585 • LIVER 7629 • CERVIX UTERI 7277 • PROSTATE 4254 • LEUKEMIA 4202 • STOMACH 3932 • THYROID 3521 • OVARY 3283

  9. Estimated Ten Leading Cancer (in MALE) Philippines, 2005 • LUNG 13273 • LIVER 5660 • COLON/RECTUM 4737 • PROSTATE 4254 • STOMACH 2368 • LEUKEMIA 2243 • NASOPHARYNX 1990 • ORAL CAVITY 1563 • NON-HODGKIN LYMPHOMA 1468 • LARYNX 1464

  10. Estimated Ten Leading Cancer (in FEMALES) Philippines, 2005 • BREAST 14043 • CERVIX ; UTERI 7277 • LUNG 3965 • COLON/RECTUM 3848 • OVARY 3283 • THYROID 2766 • LIVER 1969 • LEUKEMIA 1959 • CORPUS UTERI 1777 • STOMACH 1564

  11. SOME VIRUSES AND BACTERIA • Human Papillomaviruses (HPVs) -- may cause Cervical Cancer • Hepatitis B and Hepatitis C – may cause Liver Cancer • Human T-Cell Leukemia/Lymphoma virus – increase risk for Lymphoma and Leukemia • Human Immunodeficiency virus -- HIV is the virus that causes AIDS and in turn, AIDS patients may be at risk to get Lymphoma and Kaposi’s Sarcoma. • Epstein-Barr virus (EBV) -- at risk to get Lymphoma and Nasopharyngeal Carcinoma • Human Herpesvirus 8 (HHV8) – risk factor for Kaposi’s Sarcoma • Helicobacter pylori – may cause stomach ulcers, stomach cancer and lymphoma in the stomach lining.

  12. SCREENING • Breast : A Mammogram is the best tool doctors have to find breast cancer early. NCI recommends that women above age of 40 should have mammograms every 1 to 2 years. Those at high risk should speak to their doctors if they should have a mammogram before the age of 40 and how often they should be doing it. • Cervix: The Pap Test or Pap Smear is used to check cells from the cervix. Women should begin having Pap tests 3 years after they begin having sexual intercourse or when they reach age 21, whichever comes first. Most women should have a Pap test at least once every 3 years.

  13. Colon and Rectum: Fecal Occult Blood Test: Sometimes cancer or polyps bleed. Sigmoidoscopy: This lighted tube may see inside the rectum and lower part of the colon and may remove polyps. Colonoscopy: This lighted tube may see inside the rectum and entire colon and may also remove polyps. Double-contrast barium enema: This procedure involves several x-rays of the colon and rectum. The patient is given an enema with a barium solution and air is pumped into the rectum. The barium and air improve the x-ray images of the colon and rectum. Digital Rectal exam: This is often part of a routine physical exam. The doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas. A digital rectal exam allows for examination of only the lowest part of the rectum.

  14. Prevention of Lung Cancer • There is no screening procedure that can effectively prevent Lung Cancer. • To prevent Lung Cancer, one must STOP SMOKING.

  15. Prevention of Liver Cancer • Hepa-B Vaccination • Regular check-up on Hepa-B virus • Regulate intake of alcohol

  16. Early Detection for Cervical Cancer • Pap smear can detect early Cervix cancer and pre-cancerous lesions. • Pap Smear should be done 3 years after the first vaginal intercourse. • After the initial Pap Smear, it should be done every year for 3 years, if the result from consecutive test is negative, if not, it should be done yearly. • Women without sexual experience should have Pap Smear after reaching the age of 35.

  17. Prevention of Cervical Cancer • Delay on the first sexual intercourse • One partner relationship between partners • Use of barrier contraceptives like condoms during sexual intercourse

  18. WARNING SYMPTOMS OF CANCER • A thickening or lump in the breast or any other part of the body • A new mole or a change in an existing mole • A sore that does not heal • Hoarseness or a cough that does not go away • Change in bowel or bladder habits • Discomfort after eating • A hard time swallowing • Weight gain or loss with no known reason • Unusual bleeding or discharge • Feeling weak or very tired

  19. DIAGNOSIS • Lab Tests Tests of the blood, urine or other fluids can help doctors make a diagnosis. • Imaging Procedures X-rays Ultrasound CT Scan Radionuclide Scan MRI PET Scan

  20. BIOPSY The doctor removes a sample of tissue and sends it to a lab. A pathologist looks at the tissue under a microscope. The sample may be removed in several ways: • With a needle • With an endoscope

  21. TREATMENT 1. Team Involved • Surgical Oncologist • Medical Oncologist • Radiation Oncologist • Hematologic Oncologist 2. Methods Primary Goal: is to cure the cancer Other cases: to control the disease or to remove symptoms as long as possible • Surgery – neoadjuvant, adjuvant, palliative • Chemotherapy – neoadjuvant, adjuvant, palliative • Radiation – external beam or internal like implant • Hormonal therapy • Stem cell transplantation

  22. NUTRITION & PHYSICAL ACTIVITIES Recommendations for Individual Choices: • Maintain a healthy weight throughout life. • Balance caloric intake with physical activity. • Avoid excessive weight gain throughout life. • Achieve and maintain a healthy weight if currently overweight or obese.

  23. Adopt a physically active lifestyle. Adults: Engage in at least 30mins. of moderate to vigorous physical activity, above usual activities, on 5 or more days of the week; 45 to 60 mins. of intentional physical activity are preferable. Children and Adolescents: Engage in at least 60 mins. per day of moderate to vigorous physical activity at least 5 days per week.

  24. Eat a healthy diet, with an emphasis on plant sources. Choose food or beverages in amounts that help achieve and maintain a healthy weight. Eat 5 or more servings of a variety of vegetables and fruits everyday. Choose whole grains in preference to processed (refined) grains. Limit consumption of processed and red meats If you drink alcoholic beverages, limit consumption. Drink no more than 1 drink per day for women, and 2 per day for men.

  25. COMMON QUESTIONS ABOUT DIET AND CANCER INCREASE RISK • Alcohol – limit to 1 drink per day for women and 2 drinks per day for men. A drink is defined as 12 ounces of beer or 5 ounces of wine or 1.5 ounces of 80-proof distilled spirits Increase risk of the mouth, pharynx, larynx, esophagus, liver and breast. More risk if combine drinking and tobacco.

  26. 2. Aspartame – does not show increased risk 3. Bioengineered Foods – are made by adding genes from other plants or organicms to increase a plant’s resistance to pest or other spoilages, are not found to increase nor decrease cancer risk. 4. Little evidence that the total amount of fat consumed affects cancer risk. But diets high in fat tend to be high in calories and may contribute to obesity, which in turn is linked with an increased risk of several types of cancer. 5. Flourides – not found to increase cancer risk

  27. 6. Food Additives – No evidence to increase cancer risk. 7. Irradiated food – do not increase cancer risk 8. Processed meat or Meat preserved by methods involving smoke or salt increase colorectal and stomach cancer. 9. Frying, broiling, grilling meat may increase cancer risk. 10. Obesity – increase risk in breast, colon, endometrial, esophagus and kidney cancer. 11. Pesticides & Herbicides – no increased risk for cancer if used in small amounts enough to protect vegetables from pests. 12. Saccharin – not carcinogenic

  28. 13. Soy Supplement – no evidence to reduce cancer risk, high doses of soy increase risk of breast and endometrial cancer 14. Supplement – high dose may actually increase cancer risk

  29. Decreased Risk • Antioxidants which include Vitamins C and E, carotenoids and other phytochemicals (from food sources) and not from food supplements. • Beta-carotene, an anti-oxidant chemically realted to Vitamin A found in vegetables and fruits may be helpful, but in high doses of this supplement given to smokers may actually cause increase risk of lung cancer. • Calcium may reduce risk for colorectal cancer but there is evidence that the high calcium intake through supplements may increase risk of prostate cancer.

  30. 4. No evidence that low fasting blood cholesterol may decrease cancer risk. 5. Drinking coffee does not increase risk of breast cancer but may heighten symptoms of fibrocystic breast lumps. 6. Eating high amounts of fiber may help reduce cancer risks. 7. Little evidence that omega 3 fatty acid, olive, canola oil reduce cancer risk. 8. Fish not found to decrease cancer risk.

  31. 9. Folate, which is Vitamin B found in vegetables, fruits and enriched grain products decrease cancers of the colon, rectum and breast. 10. Garlic – no evidence that it can reduce cancer risk. 11. Lycopene – not sure if it is the substance that reduce cancer risk. 12. Organic food – no evidence that it reduces cancer risk. 13. Physical activity – lowers the risk to develop cancer of the colon and breast

  32. 14. Selenium – decreases risk of cancer of the lung, colon and prostate. 15. Tea – not proven to decrease cancer risk. 16. Cruciferous vegetables – cabbage family including brocolli, cauliflower, brussels sprout and kale reduce the risk for colorectal cancer. 17. Vitamin D – reduce risk for cancers of the colon, prostate and breast. 18. Vitamin E – lowers risk for prostate cancer.

  33. TUMOUR GRADING AND STAGING • Tumour grading is usually of importance in assessing prognosis. It refers to the degree of malignancy or differentiation of tumour tissue based on histological evaluation, and is often expressed in 4 categories: • Grade 1(G1) --- Well differentiated (about a quarter of cells undifferentiated) • Grade 2(G2)--- Moderately undifferentiated (about half of cells undifferentiated) • Grade 3(G3)--- Markedly undifferentiated (about three quarters of cells undifferentiated) • Grade 4(G4)--- Undifferentiated (almost all cells undifferentiated)

  34. Tumour staging is determined by a comprehensive evaluation using diagnostic tools for categorising the growth and spread of tumours. It involves classifying the extent of the malignant tumour.  • One classification is known as the TNM system.  T stands for primary tumour, N is regional nodes whereas M represents metastasis.

  35. TNM • Tis---Pre-invasive carcinoma (carcinoma in situ • T0---No evidence of a primary tumour • T1---Small tumour, restricted to organ of origin • T2---Large but restricted to organ of origin • T3---Some invasion of adjacent tissue • T4---Massive invasion of adjacent tissue and/or organs • TX---Unable to assess primary tumour

  36. N0---No regional lymph node involvement • N1, N2, N3---Increasing involvement of regional lymph nodes • N4---Involvement of juxta-regional lymph nodes • NX---Unable to assess regional and/or juxta-regional lymph nodes • M0---No distant metastases • M1---Distant metastases present • MX---Unable to assess distant metastases

  37. Sometimes, the tumour staging has an additional letter “p” before TNM. This indicates post-surgical histopathological staging. • C FACTORS • The letter C placed before TNM provides information on which type of diagnostic instrument was used to diagnose the tumour and the extent of its growth. • C1Using an X-Ray examinationC2Using special equipment, for e.g. endoscopyC3Using exploratory surgery C4 using histopathological results C5 using autopsy results

  38. ALTERNATIVE STAGING • Stage I---Tumour is localised • Stage II---There is presence of adjacent tissue invasion • Stage III---Some regional lymph nodes involved • Stage IV---Distant metastases present

  39. Some specific tumour stagings consist of: • (a)Hodgkin’s and/or Non-Hodgkin’s diseaseAnn Arbor • (b)Malignant melanomasClark and Breslow systems • (c)Cervical cancerCIN • (d)Colorectal cancersDukes • (e)Gynaecological tumours FIGO (Federation Internationale de Gynecologie et d’Obstetrique) • (f)Prostate carcinomaFlocks/VACURG • (g)Urinary bladderMarshall • (h)Chronic lymphatic leukaemia RAI

  40. TUMOUR MARKERS • Tumour markers are substances found in the blood, urine or body tissues created by the tumour itself or as a result of the body’s reaction to the tumour.  However, it should be remembered that tumour markers are not to be used alone as a diagnostic tool because they can also be elevated in people without tumours.  Not all affected cancer patients have raised tumour markers.  In the early stages, the levels could be normal. • They are more useful in monitoring the progress of cancer once diagnosed. • Among the tumour markers: (a)Alpha-foetoprotein (AFP) for ovarian, liver, testis cancer (b)Carcinoembryonic antigen (CEA) for breast, colon, lung cancer (c)Human chorionic gonadotropin (HCG) for uterine choriocarcinoma, ovarian cancer, testicular cancer(d)Prostate Specific Antigen (PSA) for prostate cancer

  41. HOW INSURABLE ARE THE FOLLOWING CANCERS? • There are four main types of thyroid cancer: 1.      Papillary carcinoma 2.      Follicular carcinoma 3.      Medullary thyroid carcinoma 4.      Anaplastic carcinoma • Carcinoid tumors : • Gastro-intestinal • Lung

  42. End of PresentationQ & A:Discussion Thank You Very Much!!!

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