The document discusses cancer, including its causes, characteristics, prevention strategies, and screening methods. Some key points: - Cancers are among the leading causes of death worldwide, with lung, liver, stomach, colorectal and breast cancers causing the most deaths. - Environmental factors like tobacco, alcohol, diet, viruses and pollution are responsible for 80% of cancers. Genetic factors also play a role. - Prevention strategies include controlling carcinogens, vaccinations, screening high-risk groups, and promoting healthy lifestyles. - Common screening methods exist for breast, cervical, colorectal, prostate and other cancers to detect cancers early. - World Cancer Day on February 4th

2. CANCER
Dr Hira Shoaib Hashmi
Lecturer CHS Dept.

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.

22. WORLD CANCER DAY WAS OBSERVED ON 4TH
FEB 2015

23. Together we can make a world
where cancer no longer means
living with fear, without hope, or
worse.