CANCER

[By sriloy

Mohanty,BNYS]

Contents…

Introduction Problem statement In India Cancer pattern Environmental

factors genetic factors Cancer control

Breast cancer Cervical cancer

Cancer may regarded as a group of diseases

characterized by an

Abnormal growth of cells

Ability to invade tissue and even distant organs

The eventually death of the affected patient if the

tumor has progressed beyond the stage when it

can be successfully removed

Introduction

Major categories of cancer are Carcinoma

Arises from the epithelial cells lining the internal surface of various organs (e.g. mouth, oesophagus, uterus)

Sarcoma Arises from the mesodermal cells constituting the

various connective tissues (e.g. fibrous tissue, bone)

Lymphoma, myeloma and leukemia Arising from the cells of the bone marrow and

immune system

Worldwide Every year 10 million people are diagnosed

and more then 6 million die 22.4 million peoples were living with cancer

in 2000 Most common cancer worldwide are

Lungs cancer (12.3%) Breast cancer (10.4%) Colorectal cancer (9.4%)

Problem statement

Respiratory tract cancer is most common site of cancer in India, Indonesia, srilanka and Thailand

Cancer of cervix is most common in India and Indonesia

Cancer associated with tobacco constitute 44.6% of cancer in men and 20% in female

The four most common cancer in India are Male-oropharynx, esophagus, stomach and

lower respiratory tract Female-breast, cervix, oropharynx and

esophagus Tabaco is used widely used in India 91% cases of oropharynx is due to Tabaco

use 60% cases in female are breast, cervix and

ovary cancer

India…

There are lot of international variations in the pattern of cancer which are attributed to a number of factors such as environmental factors food habit lifestyle genetic factor inadequacy in detection and reporting of cases

Cancer patterns

Tobacco Tobacco in various forms of usage can cause cancer of

lungs, larynx, mouth, pharynx, esophagus, bladder, pancreas and probably kidney

Cigarette smoking is now responsible for more than 1 million death each year

Alcohol Excess intake of alcohol can cause esophageal and liver

cancer Beer consumption may be associated with rectal cancer Alcohol contributes about 3 % of all cancer deaths

Environmental factors

Dietary factor Smoked fish is related to stomach cancer Dietary fiber to intestinal cancer Beef consumption to bowel cancer High fat diet to breast cancer Food additives and contaminants have fallen

under suspicion as causative agents

Occupational exposures These includes exposure to benzene,

cadmium, arsenic, chromium, vinyl chloride, asbestos, polycyclic hydrocarbons, etc.

The risk of occupational exposure is said to be increased if the individual also smokes cigarette

Occupational exposure is usually reported 1-5% of human cancer

Virus Hepatitis B & C - hepatocarcinoma HIV infection – kaposi’s carcinoma AIDS – non Hodgkin’s lymphoma Epstein – bar virus – Burkitts lymphoma and

naso – pharyngial carcinoma Cytomegalovirus – Kaposi’s Sa Pappiloma virus – cervix cancer Human T cell leukemia virus – T cell leukemia

Parasite May be a cause of cancer Schistosomiasis can produce Ca of bladder

Customs, habits and life style May be associated with an increased risk of

cancer Smoking and lung cancer Tobacco and beetle chewing and oral cancer

Others Sunlight, radiation, water and air pollution,

medication and pesticides These are related to cancer as environmental

factors

Genetic influences have long been suspected Retinoblastoma occurs in children of the

same parent Mongols are more likely to develop leukemia There is probably a complex relationship

between hereditary susceptibility and environmental carcinogenic stimuli in the causation of cancer

Genetic factors

It consists of prevention, detection, diagnosis, treatment, after care and rehabilitation, reducing incidence and prevalence

Primary control Reducing the exposure to the risk factors Control of Tabaco and alcohol consumption

Control of these two will reduce the total burden of cancer by 1 million cases per year

Cancer control

Personal hygiene Improvement in hygiene may decline the incidence

of certain types of cancers Radiation

Effort should be made to reduce the amount of radiation received by each individuals to a minimum without reducing the benefits

Occupational Exposure Should protect workers from exposure to industrial

carcinogens

Food, drugs, and cosmetics Should be tested for carcinogens

Air pollutions Control of air pollution is a preventive measure

Treatment of pre cancerous lesions Early detection and prompt treatment of

precanerous lesions Legislation

It comes under primary prevention

Cancer Education Should be directed in high risk groups To motivate people for early diagnosis and treatment Remind early warning symptoms

A lump or hard area in the breast A change in a wart or mole A persistent change in digestive and bowel habits A persistent cough or hoarseness Excessive loss of blood at the monthly period or loss of

blood outside the usual dates Blood loss from any natural orifice A swelling or sore that does not get better Unexplained loss of weight

Cancer registration Hospital-based registries Population based registries

Early detection of cases Treatment

Secondary Prevention

Breast cancer

Commonest cause of death in middle aged women

Causes 5,19,000 deaths a year worldwide About 9 lakh women are diagnosed every

year Mortality rates have increased during the

past 60 years in all countries

Age Uncommon below the age of 35 Incidence increased rapidly between ages of 35 and 50 There is a dip in incidence at the time of menopause A secondary rise in frequency occurs after the age of 65 Women who developed their first breast cancer under

the age of 40 have 3 times the risk of developing a second breast cancer

Mean age of occurrence in Indian women is 42

Risk factors

Family history High in those with positive history in their family Esp. if mother or sister has developed breast cancer when

premenopausal Parity

Related to age at which women bear their first child Those who had their first child in the late thirties are at a

higher risk than multiparous women Unmarried women tend to have more breast tumors than

married Single women and nulliparous women have the same risk

Age at menarche and menopause Early menarche and late menopause are risk

factors Risk is reduced for those with surgically

induced menopause Forty or more years of menstruation doubles

the risk of breast cancer as compared with 30 years

Hormonal factor Elevated levels of estrogen and progesteron are

important factor in increasing breast cancer risk Prior breast biopsy

Prior breast biopsy for beningn breast diseases is associated with increased risk of breast cancer

Diet Breast cancer can be linked with high fat diet

and obesity

Socio-economic status It is higher in socio-economic groups Age factor

Other Radiation

Women exposed to radiation may develop breast cancer

Oral contraceptic pills Prolonged use of pills before first pregnancy and

before the age of 25yrs can cause breast cancer

Primary Prevention Aim should be towards elimination of risk

factors Promotion of cancer education Increase the average of menarche by reducing

childhood obesity and increased stannous physical activities

Or decrease the frequency of ovulation by increased stannous physical activities

Prevention

Secondary Prevention Screening leads to early diagnosis which

influences treatment To detect recurrence as early as possible To detect cancer in opposite breast at an early

stage To generate research data that might be

usefull

Cancer Of The Cervix

Second most common disease in women 5,24,000 estimated new cases in in 1995 Most common in developing countries Which accounts around 80% of cases Cases and death rates are declined markedly

in the last 40 yrs due to reduction of the risk factors and extensive screening programs

The disease (a progressive course)Normal epithelium

Dysplasia

Cancer in situ (persists for 8yrs)

Invasive cancer

Natural History

Causative agnt Human papiloma virus-sexually transmitted-

cancer This virus is found in more then 95% of the

cancers

Age- Affects relatively young women Age of 25-45 yrs has increased incidence

Genital warts Past or present occurrence of clinical genital warts

has been found to be a important risk factor Early marriage

Early marriage, early coitus, early childbearing and repeated childbirth have increased risk

Risk Factor

Oral contraceptive pills Using of pills can cause cancer of cervix It is because of high level of estrogen

Socio-economic class More common in lower socio-economic groups It is because of poor genital hygiene

Primary Prevention Personal hygiene and birth control

Secondary Prevention Early detect of cases through screening Treatment by radical surgery and radiotheropy It is difficult to cure once the symptoms are

develop

Prevention

Thank you…