Cancer - Introduction, Burden, Causes, Control, Screening Danger signals of cancer Screening of Cervical cancer, Breast cancer and Lung cancer

1. Dr. Animesh Gupta
MD,FDM,FAGE
Associate professor
Dept. of Community medicine, NMCH, Sasaram

2. ▪Group of diseases characterized by:
▪An abnormal growth of cells
▪Ability to invade adjacent tissues and even distant organs
▪The eventual death of affected patient if the tumor has
progressed beyond that stage when it can be successfully
removed
▪Cancer can occur at any site or tissue of the body and may
involve any type of cells.
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3. ▪ Increasing trend
▪ World
▪ Male – Lung, Stomach, Oesophagus, Liver
▪ Female - Breast, Cervix, Lung.
▪ India
▪ Male – Mouth/oropharynx, Oesophagus, Stomach, Lungs
▪ Female – Cervix, Breast, Mouth/oropharynx, Oesophagus
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4. ▪Sarcomas
▪arise from mesodermal cells constituting the various
connective tissues [e.g. fibrous tissue, fat and bone].
▪Carcinomas
▪arise from epithelial cells lining the internal surfaces of
various organs [e.g. mouth, oesophagus, intestine, uterus]
and from the skin epithelium.
▪Lymphomas, Myelomas, Leukaemias
▪arise from the cells of bone marrow and immune system.
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5. ▪Primary tumour” denotes cancer in the organ of origin,
▪Secondary tumour” denotes cancer that has spread to
regional lymph nodes and distant organs.
▪Benign – non cancerous and do not spread
▪Malignant – cancerous and spread to other tissue/ organ
via bloodstream or lymphatic
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6. Environmental
▪ Tobacco
▪ Alcohol
▪ Dietary Factors
▪ Occupational exposures
▪ Viruses
▪ Parasites
▪ Customs, habits, Lifestyles
▪ Others – sunlight, pollution, drugs
Genetic
▪ Retinoblastoma in Children
▪ Leukemia in Mongols
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7. ▪ Tobacco – cancers of lung, larynx, mouth, pharynx, oesophagus,
bladder, pancreas and probably kidney.
▪ Alcohol – excessive intake of alcoholic beverages is associated with
oesophageal and liver cancer.
▪ Dietary Factors – smoked fish related to stomach cancer, beef
consumption to bowel cancer, and high fat diet to breast cancer.
▪ Food additives & contaminants have fallen under suspicion as
causative agents.
▪ Occupational Exposure – exposure to benzene, arsenic, asbestos etc.
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8. ▪ Viruses –
▪ Hepatitis B and C virus related to hepatocellular carcinoma
▪ Kaposi’s sarcoma related to HIV infection
▪ EBV related to Burkitt’s lymphoma
▪ Parasites
▪ Schistosomiasis related to bladder cancer
▪ Customs, habits, life styles
▪ tobacco & betel chewing with oral cancers, smoking with lung
cancers.
▪ Others
▪ Sunlight, radiation, air and water pollution, medications, pesticides.
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9. ▪Genetic factors have long been suspected.
▪Retinoblastoma occurs in children of the same parents.
Mongols are more likely to develop leukaemia than
normal children.
▪There is a complex interrelationship between hereditary
susceptibility & environmental carcinogenic stimuli in the
causation of a number of cancers
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12. ▪Consists of series of measures based on
✓present medical knowledge
✓in the fields of prevention, detection, diagnosis, treatment,
after care and rehabilitation
✓aimed at reducing significantly the no. of new cases,
increasing the no. of cures and reducing the invalidism due to
cancer
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13. Primary Prevention
▪ Control of tobacco & alcohol
consumption
▪ Personal Hygiene
▪ Radiation
▪ Occupational Exposures
▪ Immunization
▪ Foods & drugs
▪ Air pollution
▪ Treatment of precancerous lesion
▪ Legislation
▪ Cancer Education
Secondary Prevention
▪ Cancer Registration
▪ Hospital based registries
▪ Population based registries
▪ Early detection of cases
▪ Treatment
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14. ▪Treatment of precancerous lesion
▪Leukoplakia, Erythroplakia
▪Intestinal polyposis
▪Cervical tears, genital warts
▪Legislation
▪COTPA
▪The Air (Prevention & Control of Pollution) Act
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15. ▪Cancer education
▪It is directed at high risk groups.
▪The aim of cancer education is to motivate people to seek
early diagnosis & early treatment.
▪Cancer organizations remind the public of early warning
signs [danger signals] of cancer
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16. ▪ A lump or a hard area in breast
▪ A change in wart or mole
▪ A persistent change in bowel habits
▪ A persistent cough or hoarseness
▪ Excessive loss during menstrual periods or loss of blood
outside usual dates.
▪ Blood loss from any natural orifice
▪ A swelling that does not get better
▪ Unexplained loss of weight
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17. ▪ C – Change in Bowel or Bladder habit
▪ A – A sore that does not heal
▪ U – Unusual bleeding or discharge
▪ T – Thickening or lump in the breast or elsewhere
▪ I – Indigestion or difficulty in swallowing
▪ O – Obvious change in wart or mole
▪ N – Nagging cough or hoarseness
▪ S – Significant weight loss (more than 10%)
Source: American Cancer Society
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18. Early detection of cases
▪ Cancer screening is the main weapon
for early detection of cases at a pre-
invasive or pre-malignant stage.
▪ It has to be conducted on a large
scale.
▪ It requires mobilization of all
available resources and development
of a cancer infrastructure starting at
the level of primary health care,
ending with complex cancer centers
or institutions at the state or national
levels.
Treatment
▪ Treatment facilities should be
available to all cancer patents.
▪ Certain forms of cancer are
amenable to surgical removal, while
some respond to radiation or
chemotherapy or both.
▪ For those who are beyond the curable
stage, goal must be to provide pain
relief.
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19. Hospital Based
▪ All patients treated by a
particular institution
included and is
considerable value in
evaluation of diagnostic &
treatment programmes.
Population Based
▪ To cover complete cancer situation in a
geographical area.
▪ Size – 2 to 7 million
▪ It provide the incidence rate of cancer
& serve as a useful tool for initiating
▪ Epidemiological enquiries into causes
of cancer,
▪ Surveillance of time trends,
▪ Planning & evaluation of operational
activities in all main areas of cancer
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Cancer- Introduction, Control & Screening Dr. Animesh Gupta

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21. ▪ It means the “search for unrecognized malignancy by means of
rapidly applied tests”.
▪ It is possible because
▪ Precancerous or premalignant lesions
▪ malignant disease is preceded for a period of months or years by
a pre-malignant lesion
▪ Localized lesions initially
▪ most cancers begin as localised lesions
▪ 75% of cancers are at accessible body sites
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22. Selective
screening
Mass
screening of
single site
Mass
screening by
comprehens
ive cancer
detection
examination
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23. ▪ 21 to 29Years Old
▪ Start getting Pap tests at age 21.
▪ If Pap test result is normal, then wait three years for next Pap test.
▪ 30 to 65Years Old
▪ Pap test
If result is normal, then wait three years for next Pap test.
▪ HPV test (primary HPV testing)
If result is normal, wait five years for next screening test.
▪ HPV test along with the Pap test (co-testing)
If both results are normal, wait five years for next screening test.
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24. ▪ Older Than 65
▪ No need to be screened anymore if —
▪ Screening test results was normal for several years, or
▪ Cervix removed (total hysterectomy for non-cancerous conditions, like
fibroids)
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26. ▪ Breast self examination (BSE)
▪ Only feasible approach to wide population coverage
▪ Once a month after 20 years of age
▪ Recommend for raising awareness among women at risk rather than
as a screening method.
▪ Palpation by physician / Clinical Breast examination (CBE)
▪ Once in every 3 years after 30 years of age
▪ Thermography
▪ Not sensitive tool
▪ Not exposed to radiation
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29. ▪ Most sensitive & specific
▪ Best available population-based method to detect breast
cancer at an early stage
▪ Recommended after 35 years of age
▪ Limitation / Drawbacks
▪ Exposure to low dose of radiation
▪ Requires technical equipment along with experienced
Radiologist
▪ Difficult to interpret in younger woman (dense breast tissue -
more glands and ligaments)
▪ False positive or not accurate all the time. 4/29/2020
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30. ▪Chest radiograph
▪Sputum cytology
▪Low-dose Spiral CT Scan (LDCT scan)
▪Series of very detailed pictures of areas inside the Lung
▪Indications
▪ Aged 55 to 74 years and in fairly good health, and
▪ Currently smoke or have quit within the past 15 years, and
▪ Have at least a 30-pack-year smoking history, and
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31. Cancer Screening test / Tumor marker
Colorectal cancer Colonoscopy, Sigmoidoscopy, Fecal
occult blood test, Barium enema
Prostate cancer Prostate specific antigen (PSA) test
Digital rectal examination
Hepatocellular carcinoma Alpha- fetoprotein (AFP)
Germ Cell tumor Human Chorionic gonadotropin
(HCG)
Pancreatic CA19-9 antigen
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33. ThankYou
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