3. OBJECTIVES
To know etiology of cancer
To know preventive measures
To know common cancers and cancer
burden in Pakistan
World Cancer Day
4. WHAT IS CANCER?
Defined as uncontrolled growth and spread of cells.
Cancers figure among the leading causes of death worldwide,
accounting for 8.2 million deaths in 2012.(WHO)
Lung, liver, stomach, colorectal and breast cancers cause
the most cancer deaths each year.
5. CHARACTERISTICS OF CANCER
Evading apoptosis
Self-sufficiency in growth signals
Insensitivity to anti-growth signals
Sustained angiogenesis
Tissue invasion and metastasis
Limitless replication potential.
6. DETERMINANTS OF CANCER
Enviromental Factors:
- responsible for 80% of all human cancers
Tobacco: major cause of lung,nasopharynx,
oropharynx, oesophagus, bladder
7. Alcohol: oesophageal and liver cancer
Dietary Factors: Smoked fish- Stomach
cancer
beef-bowel cancer
High Fat diet-Breast cancer
DETERMINANTS OF CANCER
8. Exposure to benzene, arsenic, cadmium, polycyclic
hydrocarbons etc.
Viruses: Hep B & C, HIV, EBV, CMV virus, HPV
virus.
Parasites: Schistosomiasis causing bladder cancer
Habits and Lifestyles:
- smoking and lung cancer
-betel chewing and oral cancer
Others: sunlight, radiation, pollution and medications.
Time dose relationship
DETERMINANTS OF CANCER
9. GENETIC FACTORS:
Retinoblastomas
Mongols develop leukemias more than
normal children.
DETERMINANTS OF CANCER
10. PREVENTIVE STRATEGIES
Primary Prevention:” nip the evil in the bud”
1.Control of tobacco and alcohol abuse.
2.Personal Hygiene.
3.Minimise Radiation Exposure
4.Minimise ocuupational exposure to carcinogens
5.Immunization for Hep B & C
6.Test food drugs and cosmetics for carcinogens
7.Reduce exposure to Air Pollution
8.Treat pre cancerous lesions
9.Legislation to control environmental carcinogens.
10.Health Education:Cancer education regarding signs and
symptoms and when to contact your health care provider.
11. Secondary Prevention:
1.Cancer Registeries:
-Hospital based
-Population based
2. Early case detection of a pre invasive(Carcinoma in situ) Lesion
-programmes that aid diag in symptomatic population
-Programmes aimed at screening high risk population
3.Treatment
-Radiation
-Chemotherapy
-Surgery
Tertiary Prevention:
-Palliative care
-Pain Management.
“Freedom from cancer pain” right of the cancer patient according to
WHO.
12. CANCER SCREENING
Defined as “search for unrecognized
malignancy by means of rapidly applied
tests”
Screening methods
1. Mass Screening by comprehensive cancer
examination
2. Mass Screening of a single site
3. Selective screening in high risk individuals.
13. BREAST CANCER
Three approaches to screening:
1.Self Examination
2.Examination by a health professional
3.Mammography and Usg.
People at high risk need to get a
mammograph done on regular basis.
14. CERVICAL CANCER
Annual Pap Smears for all sexually active
females.
Visual Inspection of cervix of married
woman 25 and over annually.
If 3 consecutive Pap smears are normal
screening can be done five yearly
15. COLORECTAL CANCER
Screening should begin at the age of 50
1.DRE (digital rectal Examination)
2.Faecal occult blood screening
3.Flexible Sigmoidoscopy
16. HEAD AND NECK TUMORS
30,000 cases annually in Pakistan
Self Examination
Examination by a health care provider
Biopsy
17. CA PROSTATE
DRE men above age 50 years
PSA (prostate specific antigen) screening
annually in high risk individuals with a
positive family history and exposure to
cadmium.
Fine Needle Biopsy.
18. HEPATOMA
Reduce Alcohol abuse
Prevention of Hepatoma formation.
HepB Vaccination
Screening for cirrhosis via usg.
19. CA GALL BLADDER
Usg screening for stones
Surgical removal of diseased Gall Bladder.
20. CANCER CONTROL
Four basic steps in any Cancer Control
Protocol (CCP)
1.Assesing the magnitude of country’s
cancer problem
2.Setting up measureable cancer control
objectives
3.Evaluating the possible strategies for
control
4.Choosing priorities for initial cancer
control activities.
21. GEOGRAPHICAL VARIATIONS IN
PAKISTAN
Oral Cavity and Lung Cancers- Indus Plain
area of areca nut chewing and smoking.
CA Esophagus- Balouchistan Plateau due to
dietary factors affecting the population in
equal proportions of males and females.
Breast Cancer reported from all over
pakistan except the cancer belt of baluchistan
plateau
Lymphoma and colorectal cancer
increases northwards with greatest incidence
In Peshawar.
