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Contents…


Introduction            Breast cancer
Problem statement       Cervical cancer
In India
Cancer pattern
Environmental factors
genetic factors
Cancer control
Introduction


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
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
Problem statement


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%)
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
India…


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
Cancer patterns


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
Environmental factors


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
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 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
Cancer control


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
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
Secondary Prevention


Cancer registration
  Hospital-based registries
  Population based registries
Early detection of cases
Treatment
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
Risk factors


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
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
Prevention


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
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
Natural History


The disease (a progressive course)
                 Normal epithelium

                    Dysplasia

         Cancer in situ (persists for 8yrs)

                 Invasive cancer
Causative agnt
  Human papiloma virus-sexually transmitted-cancer
  This virus is found in more then 95% of the cancers
Risk Factor


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
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
Prevention


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
Thank you…

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Cancer.ppt

  • 1.
  • 2. Contents… Introduction Breast cancer Problem statement Cervical cancer In India Cancer pattern Environmental factors genetic factors Cancer control
  • 3. Introduction 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
  • 4. 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
  • 5. Problem statement 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%)
  • 6. 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
  • 7. India… 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
  • 8. Cancer patterns 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
  • 9. Environmental factors 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
  • 10. 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
  • 11. 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
  • 12. 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
  • 13. 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
  • 14. Others Sunlight, radiation, water and air pollution, medication and pesticides These are related to cancer as environmental factors
  • 15. Genetic 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
  • 16. Cancer control 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
  • 17. 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
  • 18. 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
  • 19. 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
  • 20. Secondary Prevention Cancer registration Hospital-based registries Population based registries Early detection of cases Treatment
  • 22. 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
  • 23. Risk factors 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
  • 24. 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
  • 25. 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
  • 26. 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
  • 27. 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
  • 28. Prevention 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
  • 29. 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
  • 30. Cancer Of The Cervix
  • 31. 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
  • 32. Natural History The disease (a progressive course) Normal epithelium Dysplasia Cancer in situ (persists for 8yrs) Invasive cancer
  • 33. Causative agnt Human papiloma virus-sexually transmitted-cancer This virus is found in more then 95% of the cancers
  • 34. Risk Factor 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
  • 35. 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
  • 36. Prevention 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