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Basic information

Basic information. PowerPoints in Yengage : Community Medicine : III Year MBBS- 2013 Regular Assignments Chapters to be covered: Non-Communicable Diseases ( Lecture+Tutorials ) Demography, Family Planning Preventive medicine in obstetrics, paediatrics , geriatrics Mental Health Genetics

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Basic information

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  1. Basic information • PowerPoints in Yengage: Community Medicine : III Year MBBS- 2013 Regular • Assignments • Chapters to be covered: • Non-Communicable Diseases (Lecture+Tutorials) • Demography, Family Planning • Preventive medicine in obstetrics, paediatrics, geriatrics • Mental Health • Genetics • Disaster

  2. Cancer Dr. Pracheth R, Department of Community Medicine

  3. Outline • What is cancer ? • Important types • Causes • Prevention • Screening

  4. Definition • Abnormal growth of cells • Invade adjacent tissues, distant organs • Carcinomas: arise-epithelial cells : internal surfaces of organs • Sarcomas: mesodermal cells-connective tissues • Lymphomas, myelomas, leukaemias

  5. Problem Statement: World • 12.7 million people., 7.6 million deaths • Large variation: different regions • Lung cancer: most deaths • Highest : affluent societies

  6. India • 9.4 lakh new cases • Men: lung, oral cavity, pharynx, oesophagus, stomach • Women: cervical, breast • Screening, management: limited

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

  8. Causes • Environmental: tobacco

  9. Continued…. • Alcohol • Dietary factors • Occupational: benzene, arsenic, cadmium, asbestos • Viruses: Hepatitis B, C, HPV, EBV • Parasites: schistosomiasis-bladder • Lifestyle • Radiation

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

  11. Cancer Control • Primary prevention: • Control of tobacco, alcohol • Personal hygiene • Radiation • Occupational • Immunization • Treat Pre-cancerous lesions • Legislations

  12. Continued…… • Cancer education: motivate-early diagnosis, treatment * • Lump/hard area • Change: wart/mole • Persistent change: bowel, bladder • Persistent cough/hoarseness • Excessive/unexplained bleeding • Sore: does not heal • Unexplained weight loss

  13. Continued…… • Secondary prevention: • Cancer registration:* • Assess magnitude, plan services • Incidence • Time trend • Hospital based • Population based: area

  14. Continued….. • Early detection • Treatment

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

  16. Methods of cancer screening • Mass screening: comprehensive cancer detection examination • Mass screening of single sites • Selective screening

  17. 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 • Hospital: investigation, management • Colposcopy: same visit • Pap- smear, biopsy: back up

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

  19. How to perform ?

  20. When to consult a doctor Painless Lump Inverted nipple Skin dimpling Skin changes Nipple discharge Armpit swelling

  21. Continued….. • Palpation by physician • Mammography: yearly starting at 50 years • Most sensitive • Exposure to radiation • Equipment, skills • Biopsy: false positive

  22. Oral Cancer • One of the ten most common cancers • India: 9.8/1 lakh • Males> Females • Epidemiology: • Tobacco: 90%, side of the mouth • Alcohol • Pre-cancerous stage • High-risk group

  23. Continued…. • Cultural: bidi, hookah, snuff • Most common: betel quid: betel leaf, arecanut, lime, tobacco • Mixture (khaini): mouth-small amounts • AP: epidermoid carcinoma of hard palate- reverse smoking cigar (chutta)

  24. Prevention • Primary: education, legislation • Secondary: early detection, surgery, radiotherapy • Primary health workers : link

  25. Cancer cervix • Second most: women • Developing countries: most common: 88% • India: number one killer-women • Disease: Normal epithelium-dysplasia-CA in situ-Invasive cancer • HPV: 90%, multiple partners, personal hygiene, necessary but not sufficient

  26. Risk factors

  27. Continued…. • Age: increases from 25 to 45, falls off • Genital warts: • Prevention and control: • Primary: personal hygiene, education • Secondary: Radical surgery, chemotherapy • Prognosis: depends on stage

  28. Breast cancer • Most frequent cancer: women • Developed, developing • India: 1 lakh new cases; 12%: malignant

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

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

  31. Prevention • Primary: • Age at menarche increased: reduce obesity, increase physical activity • Diet, weight control • Secondary: • Early diagnosis, treatment • Follow-up: recurrence

  32. Lung cancer • Most common: men • High fatality • India: 58,000 new cases (90% men): 51,000 died

  33. Risk factors • Age and sex: 1/3 deaths below 65 years • Smoking: • Number, age of starting, nicotine, tar content, length of cigarettes • Passive smoking • Tar, carbon monoxide, nicotine • Interfere: myocardial oxygen delivery-CVD • Bidi: more carcinogens

  34. Continued… • Air pollution • Occupational: asbestos, arsenic

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

  36. NPCDCS- Cancer component • Launched: 1976 • Integrated: 2010 • Objectives: • Primary: education • Secondary • Tertiary: strengthen institutions

  37. Schemes • Regional Cancer Centre Schemes • Oncology Wing Development Scheme • NGO involvement • IEC activities • Research, training

  38. Services • Diagnostic, surgery, chemotherapy, palliative care • Each district: Rs.1 crore: • Chemotherapy drugs • Facilities: investigation, treatment

  39. Questions • Short essays (3 marks): • Warning signs of cancer • Primordial prevention of cancer • Cancer registries and uses • Early detection of cancer • Screening for cancer cervix • Screening for cancer breast • Passive smoking • Measures to prevent smoking

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