Basic idea about the epidemiology, types and causes of cancer, prevention of cancer if any.

1. WE CAN FIGHT
CANCER
World Cancer Day
04.02.22
PROF (DR) VIYATPRAJNA ACHARYA
MD,
PHD
KIMS & PBMH, BHUBANESWAR

2. Close the care gap
(Theme for world cancer day-2022)
 The theme aims to raise awareness about the vast difference in cancer care and
prevention that people from different sections of society can avail.
05-04-2022

3. 05-04-2022
In 90’s cancer was still a rare disease…everyday the incidence is increasing exponentially

4. 05-04-2022
Can we call cancer epidemic???
Found so many cancer cases popping around
me…coincidence or the prevalence was
increasing???

5. 05-04-2022

6. What is cancer?
A group of diseases in which cells grow
abnormally
Malignant neoplasm
Simply “Malignancy”
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7. Tumour and cancer are not synonymous
Tumour– Abnormal, excessive, uncoordinated, autonomous and
purposeless proliferation of cells
Benign– Doesn’t spread to distant sites and destroy the tissue of
origin
Malignant– Destroys the tissue of origin and spreads to distant sites
via blood stream and lymphatic system
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8. 05-04-2022

9. World burden
 18.1 M new cases and 9.6M deaths in 2018
 1 in 5 men and 1 in 6 women develop CA in their lifetime
 1in 8 men and 1 in 11 women die of the disease
 The total number of people who are alive within 5 years of a
cancer diagnosis, called the 5-year prevalence, is
estimated to be 43.8 million.
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10. Cancer burden of World Vs India
 Good news: India not in top most 50 countries in the world!
 The National Cancer Registry Programme Report 2020, released by the Indian
Council of Medical Research (ICMR) Tuesday, estimates there will be 13.9 lakh
cases of cancer in India in 2020, and that this number is likely to rise to 15.7 lakh by
2025.
 The projected incidence of patients with cancer in India among males was 679,421
(94.1 per 100,000) and among females 712,758 (103.6 per 100,000) for the year
2020. One in 68 males (lung cancer), 1 in 29 females (breast cancer), and 1 in 9
Indians will develop cancer during their lifetime
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11. Cancer burden in Odisha–
no population based cancer registry!!!
2 studies on AHRCC data only
• mean age of 47.5 ± 15.5 years,
• 44% males.
• The most common cancers among males were oral (14%), gastric
(13%) and lung (10%) cancers.
• For females, among the most common cancers were breast (26%),
cervix (21%), ovary (11%) gastric (5%) and gall bladder (3.7%).
• 7% cancer patients were aged ≤ 20 years. Acute lymphoblastic
leukemia, Non-Hodgkin's lymphoma, Hodgkin's lymphoma and
brain tumors were most common in this age group.
• Cancer index is better than other states
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12. The many colors of cancer
• Lung cancer: white
• Brain cancer: grey
• Breast cancer: pink
• Liver cancer: emerald green
• Lymphoma: lime green
• Prostate cancer: light blue
• Stomach cancer: periwinkle blue
• Bone cancer: yellow
• Leukemia: orange
• Colon cancer: dark blue
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13. What happens at cellular /molecular level,
how we diagnose??
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14. Diagnosis
 Histopathological studies-
Biopy/FNAC
 Biochemical markers
 Genetic markers
 Radiology
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15. CARCINOMA VS SARCOMA
• Carcinoma – CA of skin or
epithelium
• Sarcoma - cancer of connective
tissues such as bones, muscles,
cartilage, and blood vessels.
• Leukemia -cancer of bone
marrow, which creates blood
cells.
• Lymphoma and myeloma -cancers
of the immune system.
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16. What are the causes??
 Multifactorial
 Familial/ Genetic factors—5% of all CA
 Racial or geographical factors
 Environmental factors
 Age –Older age
 Gender—M>F
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17. Carcinogenesis & Carcinogens
Carcinogenesis– Induction of cancer
Carcinogens– Agents that cause cancer
1.Chemical carcinogens
2. Physical carcinogens
3. Biological carcinogens
4. Hormonal carcinogens
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18. 1. Chemical carcinogens
 Initiators– initiate the process
 Promoters– Lack carcinogenic potential but
help in proliferation of initiated cells
Initiating carcinogens
Direct acting Indirect acting (Procarcinogens)
Metabolic activation
Ultimate carcinogens
Reactive electrophiles
No metabolic activation
Interact with neutrophiles (DNA)
Mutation in DNA
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19.  Direct acting carcinogens– Alkylating agents e.g.
anti- cancer drugs
Aceylating agents e.g. acetyl imidazole
 Indirect acting carcinogens (Procarcinogens)–
Aromatic hydrocarbons, aromatic amines
 Promoters of carcinogenesis– Phenols, hormones,
Phenobarbital, artificial sweeteners
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20. Xenoestrogens
 4-Methylbenzylidene camphor (4-MBC) (sunscreen lotions)
 Butylated hydroxyanisole / BHA (food preservative)
 Atrazine (weedkiller)
 Bisphenol A (monomer for polycarbonate plastic and epoxy resin)
 BPS- insecticides and pesticides
 Antioxidant in plasticizers
 Dieldrin (insecticide)
 DDT (insecticide)
 Endosulfan (insecticide)
 Erythrosine / FD&C Red No. 3
 Heptachlor (insecticide)
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• Phenosulfothiazine (a red dye)
• Phthalates (plasticizers)
• DEHP (plasticizer for PVC)
emulsion polymerization; laboratory
detergents; pesticides)
• Polychlorinated biphenyls / PCBs (in
electrical oils, lubricants,
adhesives, paints)
• Parabens (lotions)
• Lindane / hexachlorocyclohexane
(insecticide)
• Methoxychlor (insecticide)
• Nonylphenol and derivatives
(industrial surfactants; emulsifiers for

21. 05-04-2022

22. 5 April 2022
If we don’t have the attitude

23. LET’S START THE
CHANGE WITH
OURSELVES
5 April 2022

24. Plastic alternatives- Milk protein, chicken feathers,
Liquid wood, PLA polyesters (lactic acid)
The contemporary milk-based plastic doesn’t crack easily, and it is less toxic

25. 2. Physical carcinogens
 UV rays, ionizing radiations
 Non-radiation physical agents– various injuries
 UV radiations– pyrimidine dimers in DNA, elimination of bases or
breaking or cross-linking of single or double strands of DNA
 Ionizing radiations– directly alter cellular DNA or generate free radicals

26. 3.Biologic carcinogens
 Viruses, bacteria & parasites
 Viruses are more important
 DNA and RNA viruses
 DNA viruses– HPV, EBV, HBV
 RNA viruses– Rous sarcoma virus, HTLV-I & II

27. 4. Hormonal carcinogens
 Estrogens
 Contraceptive hormones
 Anabolic steroids

29. Stress and immunity
 ↑ stress- ↑risk for cancer
 Stress is related to risky behaviours
like Gutkha chewing, smoking,
boozing
 ↑ stress- ↓immunity
 Immune system -protects us against infectious non-
self (pathogens) but also against malignant self
(cancer).
 Many cell types belonging to both the innate (NK cells
and macrophages) and the adaptive (T and B cells)
immune systems seem to be involved in cancer control
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30. Strangest notion: It won’t happen to me!!!
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31. Altered lifestyle & nutrition
 Disrupted biological clock
 Smoked food
 Junk food
 Dyes
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32. What is 5 year cancer survival rate?
 After detection of cancer how many years a patient will
survive is counted in 5 years
 Lowest survival rate- mesothelioma (7.2%), pancreatic
cancer (7.3%) and brain cancer (12.8%)
 highest five-year survival estimates are seen in patients
with testicular cancer (97%), melanoma of skin (92.3%)
and prostate cancer (88%).
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33. What is cancer staging? What is TNM??
 Clinical
 Pathological
 Post-cancer staging
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34. Treatments available
 Surgery
 Chemotherapy
 Radiotherapy
 Genomic therapy
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35. Over-treatment? Under treatment?? Myths
and facts
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36. 05-04-2022

37. “
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More PPT on medical Biochemistry
on
www.vpacharya.com
05-04-2022