Cancer and tb


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Cancer and tb

  1. 1. Cancer and tuberculosis – a continuous challenge Sandrina Maria Dăscălescu1 Scientific coordinator: Maria Pănescu21University of Medicine and Pharmacy “Gr.T.Popa” 2Clinic of Pneumology Iaşi
  2. 2. Smoking Globally, smoking causes about 71% of lungcancer, 42% of chronic respiratory disease and nearly10% of cardiovascular disease. It is responsible for12% of male deaths and 6% of female deaths in theworld. Tobacco caused an estimated 5.1 milliondeaths globally in 2004, or almost one in every eightdeaths among adults aged 30 years and over. 2
  3. 3. Percentage of deaths over age 30 caused by tobacco, 2004
  4. 4. Deaths attributed to 19 leading risk factors, by country income level, 2004
  5. 5. Cancer Is a leading cause of death worldwide and accounted for 7.6 million deaths in 2008.The main types of cancer are:• lung (1.37 million deaths)• stomach (736 000 deaths)• liver (695 000 deaths)• colorectal (608 000 deaths)• breast (458 000 deaths)• cervical cancer (275 000 deaths) 5
  6. 6. • About 30% of cancer deaths are due to the five leading behavioral and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, alcohol use.• Tobacco use is the most important risk factor for cancer causing 22% of global cancer deaths and 71% of global lung cancer deaths. 6
  7. 7. Lung cancer - risk factorsI. smoking2. secondhand smoke3. tuberculosis4. COPD5. exposure to asbestos, radon, industrial substances, radiation, air pollution6. genetics 7
  8. 8. Histological typesA. Non-small cell lung cancer (NSCLC) I. squamous cell lung carcinoma II. adenocarcinoma III. large-cell lung carcinomaB. Small cell lung cancer (SCLC) 8
  9. 9. Symptoms Local disease• Coughing (most common, 50% of cases)• Blood in sputum (hemoptysis)• Shortness of breath (dyspnea)• Wheezing• Pain in the chest• Fatigue• Pneumonia 9
  10. 10. Locally advanced disease• dysphagia• hoarseness• stridor• pleural effusion• pericardial effusion 10
  11. 11. Distant metastases BoneBrain • Bone pain• Headaches• Seizures Liver• Nausea • Stomach pain• Vomiting • jaundice• Weakness • Fatigue• Confusion • Weight loss• Visual disturbances • Nausea 11
  12. 12. Diagnosis- physical examination- chest X-ray- CT- PET scan- MRI- sputum citology- bronchoscopy- biopsy- immunology - CA-125, Carcinoembryonic antigen, neurofilament, neuron-specific enolase, vimentin, tumor M2-PK, tyrhoid transcription factor-1 12
  13. 13. Tuberculosis• Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis, typically affecting the lungs, but other sites as well. 13
  14. 14. Risk FactorsI. Weakened immune system• HIV/AIDS• Diabetes• End-stage kidney disease• Cancer patients undergoing treatment• Drugs to prevent rejection of transplanted organs• Some drugs used to treat rheumatoid arthritis, Crohns disease and psoriasis• Malnutrition• Advanced age 14
  15. 15. II. International connections TB risk is higher for people who live in or travel to countries that have high rates of tuberculosis, such as:• Sub-Saharan Africa• India• China• Mexico• The islands of Southeast Asia and Micronesia• Parts of the former Soviet Union 15
  16. 16. III. Poverty and substance abuse• Lack of medical care.• Substance abuse. Long-term drug or alcohol use weakens your immune system and makes you more vulnerable to tuberculosis. 16
  17. 17. IV. Where you work or live• Health care work. Regular contact with people who are ill increases your chances of exposure to TB bacteria. Wearing a mask and frequent hand-washing greatly reduce your risk.• Living or working in a residential care facility. People who live or work in prisons, immigration centers or nursing homes are all at risk of tuberculosis. Thats because the risk of the disease is higher anywhere there is overcrowding and poor ventilation.• Living in a refugee camp or shelter. Weakened by poor nutrition and ill health and living in crowded, unsanitary conditions, refugees are at especially high risk of tuberculosis infection. 17
  18. 18. Signs and Symptoms• a bad cough that lasts 3 weeks or longer• pain in the chest• coughing up blood or sputum (phlegm from deep inside the lungs)• weakness or fatigue• weight loss• no appetite• chills• fever• sweating at night 19
  19. 19. Diagnosis• Microbiological examination - Mycobacterium tuberculosis• Chest X-ray• Tuberculin skin test• ASL Assay• Surgical biopsy 21
  20. 20. Background• Romania is still a country with an increased TB incidence.• In the period between 1998 and 2010 in Iaşi County (an area with 831282 inhabitants), 16510 TB cases were registered.• The neoplastic disease is a risk factor for TB. 22
  21. 21. Aims• The main goal was to analyze certain aspects of the association between cancer and TB.• The impact between the TB and cancer, concerning the diagnosis, treatment and evolution of the two diseases was studied.• From the total amount of TB patients registered in the period 2007-2010 (4930 ) this study considered a random sample of 365 TB patients. 24
  22. 22. Material and method• A retrospective study was carried out taking into account 365 patients with tuberculosis. From these, 18 patients presented both TB and cancer.• As study materials, data of the district TB electronic registers, patients’ individual files of treatment (TB01) and observation files were used. 25
  23. 23. Results 15 males, 3 females age between 36-80 years old56% smokers, 20-40 packets/years 23% non-smokers 21% ex-smokers 60 m ale 50 fem ale 40 sm okers 30 ex-sm okers 20 non-sm okers 10 0 26
  24. 24. Neoplasm’s localization 10 pulmonary cancer 1 pleural localization 4 colon cancer 2 skin neoplasms 1 urinary bladder neoplasm 27
  25. 25. Diagnosis in the patients with bronchopulmonary cancer • computer tomography • fibrobronchoscopy with brushing and biopsy• excise of the tumoral mass, followed by cytology and anatomopathalogical exam 28
  26. 26. Pulmonary cancer - anatomopathalogical types• 3 squamous cell carcinoma• 2 adenocarcinoma• 2 tumoral smear• 1 undifferentiated carcinoma• 2 unknown 29
  27. 27. EvolutionTB100% succes rate - BK negative sputum smearsCancer12 patients died Alive Dead 30
  28. 28. Conclusions• The diagnosis, treatment and evolution of TB did not pose special problems in the studied group, the success rate being similar to the case of patients that did not have cancer.• The cancer was diagnosed late in the case of TB patients (2-8 months in those diagnosed with cancer during the treatment for TB) because of the severe TB forms.• The death rate in the studied group was high: 12 patients out of 18 are dead. 31
  29. 29. •The association between cancer and TB risesimportant issues for an early diagnose of thecancer.• It is very important to always consider thepossibility of the association between TB andcancer when dealing with a smoker patientolder than 40. 32
  30. 30. Bibliography• T. Mihăescu - Tuberculoza: o introducere in pneumologie, 1999• M. Pănescu, M. Archip, C. Vasilescu - Certain Aspects of the Association between Tuberculosis and Cancer, 2011• Centrul pentru Politici si Servicii de Sanatate - Monitorizarea si evaluarea in controlul tuberculozei in Romania, 2010• Baum’s Textbook of Pulmonary Diseases, 7th edition• World Health Organization - Electronic recording and reporting for tuberculosis care and control, 2012• World Health Organization - Global Tuberculosis Control, 2011 Thank you!