This document discusses the history and current state of cancer. It notes that cancer occurs when cells grow out of control and details some key events in cancer's history such as the first descriptions in ancient Egypt and Greece. The document outlines several causes of cancer like tobacco, viruses, and radiation. It discusses how cancer spreads and common screening tests for early detection of breast, cervical, prostate, colon, and lung cancers. The takeaway message is that cancer has affected humanity for millennia but screening and research into molecular mechanisms can help control and potentially cure cancer at early stages.

1. Cancer and its Types
Dr. Ashish Jawarkar M.D.
Pathologist
Parul Sevashram Hospital

2. OVERVIEW
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How common is cancer
Understand cancer
History
How cancer starts
How cancer spreads
Stop cancer

3. How common is cancer
• According to national cancer control
programme – there are nearly 2.5 million
cancer patients in India
• About 0.7 million new cases are
diagnosed each year, and nearly half of
them die
• More than 60% of these patients are in
the age of 35-60, prime of their life
• It is expected that with improved life
expectency – the number of cases will
triple in the coming years

4. • About 1 in 4 of us will get cancer
• About 1 in 5 of will die due to
cancer

6. Normal cell division
• There are trillions of cells in our body
• Healthy cells are programmed to
“know what to do and when to
do it”.

15. What is Cancer
• Cancer is a general name for more
than 100 different diseases
• The common point about all these
different diseases is that a particular
cell of the body is growing out of
control
• Cancer cells donot know “what to
do, and when to do”
• This division uses up all the
resources required by other cells of
the body

16. Some commonly used terms
• Neo-plasm – new growth
• Tumor – swelling caused by
neoplasm
• Benign neoplasm – one which is
restricted by its capsule – doesnot
spread to other areas of body
• Malignant – one which spreads to
different parts of the body

18. History
• The oldest description of cancer
dates back to 1600 BC in Egypt

19. • Papyrus described 8 cases of ulcers
of breast treated by cauterization by
a tool he called – the fire drill
• He had said – the disease has no
cure

21. History
• Hippocrates – 460-370 BC
• Described several types of cancers –
called them carcinos (crab)
• Cut surface of tumors with veins in all
directions

22. The father of
Western Medicine

23. CELCUS AND GALEN
• Celcus (25 BC) translated carcinos
into latin – cancer
• Galen suggested the word oncos for
swelling – Oncology thus was named

24. Cause of cancer Humoral theory
• Though Hippocrates, Celcus and Galen
described cancer, they did not know the
cause
• Cause of cancer was said to be
imbalance of body fluids
• black/yellow bile,blood and phlegm
• Cancer was said to be caused by excess of
black bile
• Accordingly treatment was change of
diet/blood letting /laxatives

26. Morgagni
• In 1761, Morgagni first performed
autopsies
• He studied postmortem findings and
suggested causes of diseases
• This lead the foundation of
scientific study of cancer oncology

28. On the sites and causes of diseases

29. Era of cancer surgery
• The famous Scottish surgeon John
Hunter (1728−1793) suggested
that some cancers might be cured
by surgery.
• If the tumor had not invaded nearby
tissue and was “moveable,” he said,
“There is no impropriety in removing
it.”
• He conducted a lot of autopsies and
studied cancer

30. Body snatching

31. Upcoming TV show – knife man

32. Primitive surgery
• No asepsis / anaesthetic techniques
were available
• Mortality was more due to
secondary infections that cancer
per se

33. RECURRED
• It took nearly a century for the
development of anesthesia and
asepsis
• This allowed surgery to flourish and
classic cancer operations such as the
radical mastectomy could be done
effectively
• Any and every cancer was removed
– this prolonged life somewhat – but
cancer recurred

34. • Till this time – no one had
actually seen cancer cells!!!

35. Birth of microscopic
pathology
• The 19th century modern microscope
was invented and cancerous tissue
could be studied.
• Rudolf Virchow, often called the
founder of cellular pathology,
linked microscopic findings with
cancer types.

37. First actual cause of cancer
discovery
• In 1713, Bernardino Ramazzini, an Italian
doctor, reported the virtual absence of
cervical cancer and relatively high
incidence of breast cancer in nuns
• This was linked to their celibate life style
• This observation was an important step
toward identifying and understanding the
importance of hormones and cancer risk

39. Scrotal cancer
• In 1775, Percival Pott of Saint
Bartholomew’s Hospital in London
described an occupational cancer in
chimney sweeps, cancer of the scrotum
• was caused by soot collecting in the skin
folds of the scrotum.

41. Tobacco
• Thomas Venner of London was
one of the first to warn about
tobacco dangers in his Via Recta,
published in London in 1620.
• He wrote that “immoderate use of
tobacco hurts the brain and the
eye and induces trembling of the
limbs and the heart.”

42. • And 150 years later, in 1761, only a
few decades after recreational
tobacco became popular in London,
John Hill wrote a book entitled Cautions Against the Immoderate
Use of Snuff.

43. • Inspite of this, tobacco use continued
unabeted
• Lead to an epidemic of sorts, of
tobacco related cancers

44. • These first observations linking
tobacco and cancer led to
epidemiologic research many years
later (in the 1950s and early 1960s)
which showed that smoking causes
lung cancer and led to the US
Surgeon General’s 1964 report
Smoking and Health.

45. • This report lead to some regulations
on tobacco companies
• They had to affix warnings on their
products

46. Powerful tobacco lobby
• Still they avoided the word - CANCER

47. Genetic cause
• The genetic basis of cancer was
proposed by German zoologist
Boveri in 1902
• He suggested the mutations of
chromosomes lead to cancer

48. Radiotherapy
• Marie curie discovered radium, and
radiation at the end of 19th century
• This marked the discovery of first
non surgical mode of cancer
treatment

49. Brachytherapy

51. Complete cancer cure
• During World war II, the nuclear
bombings of Hiroshima and Nagasaki
took place
• It was observed that the radiation of
the bombings destroyed the marrow
of the victims
• This in turn gave a hope of curing
cancer completely by radiation

54. How cancer starts
• Cancer starts with damage to the DNA

55. Causes of DNA damage

57. Tobacco

58. Fast food (fibre free)

59. Hormonal causes

60. Due to viruses (HPV)

61. UV rays – sun tanning

62. Signs and symptoms of
cancer
• Depends on the location
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Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty in swelling
Obvious change in wart or mole
Nagging cough or hoarseness

63. Spread of cancer
• Local spread
• Lymphatic spread
• Metastasis

64. Local spread

65. Lymphatic spread

66. Lymphatic spread

67. Lymphatic spread

68. Spread via blood

69. Can we treat cancer??
• Cancer cells are our cells –
• killing them = killing ourselves
• Main treatments available
– Surgery – Recurs
– Chemotherapy – damages normal cells
– Radiotherapy – damages nearby areas

70. Newer treatments
• Imatinib – revolutionized treatment
of CML
• Herceptin – for treatment of breast
cancer
• Rituximab – against NHL

71. Still… Prevention is cure
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Limiting tobacco exposure
Limiting alcohol intake
Modifying diet
Limiting exposure to UV rays
Screening programs

72. What is screening??
• looking for cancer before a person
has any symptoms
• When abnormal tissue is found early
stage, it may be possible to treat it
completely
• Following cancers are amenable to
screening
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Breast
Prostate
Cervix
Colon and rectum
Lung

73. Breast cancer screening

74. Breast cancer screening
• Has lead to a 15-20% reduction in
deaths due to breast cancer
• American cancer society
recommends breast cancer
screening for all women more
than age 40 , every year
• Includes
– Mammography
– Clinical breast examination
– Breast self examination

75. Mammography

76. Clinical breast examination

77. Breast self examination

79. Cervical cancer screening

80. Pap test

82. Prostate Cancer screening
• Screening can be started for
– Moderate risk males – age 50
– High risk males – age 45
– Very high risk males – age 40
• Screening consists of
– Digital rectal examination
– PSA examination

84. Colon cancer

85. Colon cancer screening

88. Lung cancer screening
• Guidelines recommending annual
low-dose CT lung cancer
screening have been approved by
the US Preventive Services Task
Force.
• The recommendations apply to
individuals aged between 55 and
80 who are at high risk for lung
cancer as a result of heavy
smoking.

90. Take home message
• Cancer is a group of diseases affecting
human kind since ages
• It is controllable – not yet completely
curable at early stages
• Screening programs help in reducing
morbidity and mortality from cancer
• Gearing cancer research towards knowing
the molecular mechanisms of cancer can
help in developing treatment modules

91. References
• The Emperor of all maladies - by
Siddhartha Mukherjee
• Robbins pathology
• A lot of wikipedia
• Google baba ki Jai Ho!!