Common Cancers in India, their increasing incidence

“Common Cancers in India, their increasing incidence. Symptoms which need immediate attention”

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Dr Kaushal KalraMD, DM-Medical Oncology( AIIMS, New Delhi)

VMMC & Safdarjung Hospital

Introduction to oncology

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What is Oncology?

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Oncology• Prevention• Diagnosis• Treatment

Cancer

Uncontrolled cell growth/division

Cancer

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• Where in human body?

• Can originate in almost any body organ

• How many types of cancer?

• More than 200 types of cancer

Terms related to cancer

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• Neoplasia

• Neoplasm

• Differentiation

• Anaplasia

• Benign

• Malignant

• Metastasis

Benign tumours

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Usually encapsulated Well-defined borders Slow growing and limited to one area Cancer cells are similar to the cell of origine Possible growth displacement (but not invasion)

to adjacent tissue

Malignant tumours

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Not encapsulated; not cohesive, and irregular pattern of growth

No well-defined borders Growth into adjacent cells rather than

displacing or pushing them aside Rapid growth through rapid cell division and

multiplication No resemblance to the cell of origin Invasion and metastasis

Classification of cancers

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Carcinomas– Solid tumors that originate from epithelial tissue

• Tissue that covers external and internal body surfaces, lining of vessels, body cavities, glands, and organs

Sarcomas– Originate from supportive and connective tissue

• Bone, fat, muscle, and cartilage

Lymphomas – Arise in the lymph nodes and tissues of the body’s immune

system.

Leukemias – Cancers of the immature blood cells that grow in the bone

marrow

Cancer Incidence in World Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020.

The most common in 2020 (in terms of new cases of cancer) were:

•Breast (2.26 million cases);

•Lung (2.21 million cases);

•Colon and rectum (1.93 million cases);

•Prostate (1.41 million cases);

•Skin (non-melanoma) (1.20 million cases); and

•Stomach (1.09 million cases).

The most common causes of cancer death in 2020 were:

Lung (1.80 million deaths);

•Colon and rectum (935 000 deaths);

•Liver (830 000 deaths);

•Stomach (769 000 deaths); and

•Breast (685 000 deaths).

Cancer Incidence Rate In India

*Source: Globocan 2020 & 2018.

Major Cancers In 2020

*Source: Globocan 2020.

Top 5 most frequent cancers excluding non-melanoma skin cancer

Males Females Both sexes

Lip, oral cavity Breast Breast

Lung Cervix uteri Lip, oral cavity

Stomach Ovary Cervix uteri

Colorectum Lip, oral cavity Lung

Oesophagus Colorectum Colorectum

Causes of cancer

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Lifestyle

Smoking Alcohol Unhealthy eating habits Weight and obesity Lack of physical activity

Causes of cancer

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Cancer is a genetic disease

Over activation of oncogenes Inactivation of tumour suppressor genes Mutations in DNA repair genes Family history

Causes of cancer

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Environmental factors

UV-light, x-rays, ionizing radiation Pollution Chemical exposure viruses and bacteria

Biology of cancer

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Reducing the cancer burden

Between 30 and 50% of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies.

The cancer burden can also be reduced through early detection of cancer and appropriate treatment and care of patients who develop cancer.

Many cancers have a high chance of cure if diagnosed early and treated appropriately.

Preventing cancer Cancer risk can be reduced by:

•Not using tobacco;

•Maintaining a healthy body weight;

•Eating a healthy diet, including fruit and vegetables;

•Doing physical activity on a regular basis;

•Avoiding harmful use of alcohol;

•Getting vaccinated against HPV and hepatitis B if you belong to a group for which vaccination is recommended;

•Ensuring safe and appropriate use of radiation in health care (for diagnostic and therapeutic purposes);

•Minimizing occupational exposure to ionizing radiation; and

•Reducing exposure to outdoor air pollution and indoor air pollution, including radon (a radioactive gas produced from the natural decay of uranium, which can accumulate in buildings — homes, schools and workplaces).

Preventing cancer

Early detection

Cancer mortality can be reduced if cases are detected and treated early. There are two components of early detection.

Early Diagnosis Screening

Early Diagnosis When identified early, cancer is more likely to respond to treatment and can result in a greater probability of survival and less morbidity, as well as less expensive treatment

Early diagnosis consists of three components:

•Being aware of the symptoms of different forms of cancer and of the importance of seeking medical advice if you are concerned;

•Access to clinical evaluation and diagnostic services; and

•Timely referral to treatment services.

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Screening

Screening aims to identify individuals with findings suggestive of a specific cancer or pre-cancer before they have developed symptoms. When abnormalities are identified during screening, further tests to establish (or not) a diagnosis should follow, as should referral for treatment if needed.

Screening programmes are effective for some but not all cancer types and in general are far more complex and resource-intensive than early diagnosis as they require special equipment and dedicated personnel.

Screening

•Breast cancer: One in 25 women has a chance of getting breast cancer in India. Screening by mammography for women over 45 or post menopause, Clinical breast exam by a doctor and self breast exam are methods of early detection.

•Oral cancer: This is among the top cancers in India due to rampant use of chewing tobacco and smoking. High consumption of alcohol is also a risk factor. Doctors check for red or white patches in the mouth and for lumps in the mouth and throat. A regular dental check for sharp edges of teeth is also recommended.

•Cervical cancer: This cancer is 2nd highest among women in India. This can be detected in the pre - cancerous stage and treated before it turns into cancer. Screening tests are Pap smear, VIA and HPV.

•Colorectal cancer: This is also a common cancer and tests can be done to detect it early.

•Prostate Cancer: This is a cancer that affects older men and there are screening tests for this cancer.

Signs to detect early stages of cancer

Common Symptoms Needs Immediate

Attention

Lung Cancer

•A persistent cough that doesn’t go away and gets worse over time

• Coughing up Blood

Wheezing or shortness of breath

•Constant chest pain Bone pain

•Hoarseness or other voice changes

•Regular lung infections (like pneumonia or bronchitis)

•Losing weight without trying

•Not feeling hungry

•Frequent headaches

• Blood clots


Attention

Breast Cancer

A new lump or mass in your breast , Armpit, or around your collarbone

Swelling in your breast

Irritation, dimpling (which may cause your skin to look like an orange peel), thickening, redness, or scaliness of the skin on your breast

Pain in your breast or nipple

Nipple discharge that isn’t breast milk


Attention

Stomach Cancer

•Poor appetite

•Weight loss (without trying)

•Abdominal (belly) pain

•Vague discomfort in the abdomen, usually above the navel

•Feeling full after eating only a small meal

•Heartburn or indigestion

•Nausea

•Vomiting, with or without blood

•Swelling or fluid build-up in the abdomen

•Blood in the stool

•Feeling tired or weak, as a result of having too few red blood cells (anaemia)


Attention

Colorectal Cancer

•Constipation

•Diarrhoea

•Alternating diarrhoea and constipation, or other changes in bowel habits

•Rectal bleeding or blood in the stool

•Abdominal bloating, cramps or discomfort

•A feeling that the bowel doesn't empty completely

•Stools that are thinner than normal


Attention

Lip, Oral Cavity Cancer

•A sore on the lip or in the mouth that does not heal.

•A lump or thickening on the lips or gums or in the mouth.

•A white or red patch on the gums, tongue, or lining of the mouth.

•Bleeding, pain, or numbness in the lip or mouth.

•Change in voice.

•Loose teeth or dentures that no longer fit well.

•Trouble chewing or swallowing or moving the tongue or jaw.

•Swelling of jaw.

•Sore throat or feeling that something is caught in the throat.


Attention

Oesophagus Cancer

•Trouble swallowing

•Chest pain

•Weight loss

•Hoarseness

•Chronic cough

•Vomiting

•Bone pain (if cancer has spread to the bone)

•Bleeding into the oesophagus. This blood then passes through the digestive tract, which may turn the stool black. Over time, this blood loss can lead to anaemia (low red blood cell levels), which can make a person feel tired

Common Symptoms Needs

Immediate Attention

Cervix uteri Cancer

•Blood spots or light bleeding between or following periods

•Menstrual bleeding that is longer and heavier than usual

•Bleeding after intercourse, douching, or a pelvic examination

•Increased vaginal discharge

•Pain during sexual intercourse

•Bleeding after menopause

•Unexplained, persistent pelvic and/or back pain

•Difficult or painful urination

•Unintentional weight loss


Attention

Ovary Cancer

•Bloating

•Pelvic or abdominal (belly) pain

•Trouble eating or feeling full quickly

•Urinary symptoms such as urgency

Treatment of cancer

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• Single treatment modality

• combination treatment (frequently used)

– Surgery

– Chemotherapy

– Radiation therapy

– Immunotherapy

– Targeted therapy

– Hormone therapy

Chemotherapy

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• Uses the drugs to kill cancer cells• Effects based on action of drugs on cell cycle• affect both normal and tumor cells

• Cure• Control• Palliative care

Identifying treatment intent

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a. Curative– Aim: long term disease-free survival– Appropriate for local or loco-regionally confined tumors

b. Palliative– NO hope of cure with any option of therapy– Locally advance or widespread malignancy– Treatment priority:

i. Remove symptoms

ii. Improve quality of life

iii. Prolongation of life

Busting The Myths

Fact

Cancer is not contagious. However, some cancers are caused by viruses and bacteria e.g. Human Papillomavirus (cervical cancer), Hepatitis B and Hepatitis C (liver cancer),

Epstein Barr virus (lymphomas, nasopharyngeal cancers and stomach cancer) or Helicobacter pylori bacteria (stomach cancer.

1. MYTH: Cancer is contagious.

Fact

If no one in your family has ever suffered from cancer it does not guarantee that you will not get cancer. Only 5-10 % of the cancers are familial or hereditary. The rest are

caused by genetic changes that occur throughout a person’s lifetime by chance, natural result of aging and exposure to environmental factors, such as tobacco, smoke

and radiation.

2. MYTH: If no one in your family has had cancer, you will not get cancer.

Fact

Although having a family history of cancer increases your risk of developing the disease, it is not a definite predictor. Only about 5 to 10 % of cancers are caused by

harmful mutations that are inherited from a person’s parents.

3. MYTH: If you have a family history of cancer, you will surely get cancer.

Fact

Cancer is not a death sentence. Advances in cancer detection and treatment have increased survival rates for most common types of cancer. In fact, many people with

cancer survive five years or more after their initial diagnosis.

4. MYTH: If you are diagnosed with cancer, you will probably die in a

short time.

5. MYTH: Cancer treatment is usually worse than the disease.

Fact

Cancer treatments such as chemotherapy and radiation therapy are known to cause side effects that can be unpleasant and sometimes serious. However recent

improvements have resulted in better tolerance to many chemotherapy drugs and radiation treatments. The adverse symptoms like severe nausea and vomiting, hair

loss, and tissue damage are much less common these days; however, managing side effects remains an important part of cancer care. Your doctor along with a palliative or

supportive care team, can help a person to manage and control side effects of treatment at any stage of illness.

Fact

Many cancer patients are treated on an outpatient basis or require short hospital stay only, and can often continue with their day-to-day activities. They can work part-time or full-time, care for their children, and attend social activities, even while undergoing

cancer treatment.

6. MYTH: People being treated for cancer can’t participate in their usual activities.

Fact

The cancer may not be painful in the early stages. However, as it grows and spreads to other parts it may become painful. In the majority of cases cancer pain can be successfully treated with medications and other pain management techniques.

7. MYTH: Cancer is always very painful.

8. MYTH: Older people are not fit for cancer treatment.

FactThere is no age limit for cancer treatment. Many elderly

patients may respond as well to cancer treatment as younger patients. People with cancer should receive the

treatment that is best suited to their condition, regardless of age.

10. MYTH: Herbal products can cure cancer.

Fact

Although some studies suggest that alternative or complementary therapies, including some herbs, may help patients cope with the side effects of cancer

treatment, no herbal products have been scientifically proven to be effective in treatment of cancer.

Fact

According to most studies conducted so far, cell phones have not been found to be causative for cancer. Cancer is caused by genetic mutations, and cell phones emit a type of low-frequency energy that does not damage genes. However, whether cell

phones and cell phone towers cause cancer still remains controversial

11. MYTH: Use of cell phones and presence of cell phone towers in your vicinity can cause cancer.

Thank You…

Documents

Common Cancers in India, their increasing incidence