cancer

2. Contents…
 Introduction
 Problem statement
 In India
 Cancer pattern
 Environmental factors
 genetic factors
 Cancer control
 Breast cancer
 Cervical cancer

3.  Cancer may regarded as a group of diseases characterized by an
 Abnormal growth of cells
 Ability to invade tissue and even distant organs
 The eventually death of the affected patient if the tumor has
progressed beyond the stage when it can be successfully
removed
Introduction

4.  Major categories of cancer are
 Carcinoma
 Arises from the epithelial cells lining the internal surface of
various organs (e.g. mouth, oesophagus, uterus)
 Sarcoma
 Arises from the mesodermal cells constituting the various
connective tissues (e.g. fibrous tissue, bone)
 Lymphoma, myeloma and leukemia
 Arising from the cells of the bone marrow and immune system

5.  Worldwide
 Every year 10 million people are diagnosed and more
then 6 million die
 22.4 million peoples were living with cancer in 2000
 Most common cancer worldwide are
 Lungs cancer (12.3%)
 Breast cancer (10.4%)
 Colorectal cancer (9.4%)
Problem statement

6.  Respiratory tract cancer is most common site of
cancer in India, Indonesia, srilanka and Thailand
 Cancer of cervix is most common in India and
Indonesia
 Cancer associated with tobacco constitute 44.6% of
cancer in men and 20% in female

7.  The four most common cancer in India are
 Male-oropharynx, esophagus, stomach and
lower respiratory tract
 Female-breast, cervix, oropharynx and
esophagus
 Tabaco is used widely used in India
 91% cases of oropharynx is due to Tabaco use
 60% cases in female are breast, cervix and
ovary cancer
India…

8.  There are lot of international variations in the
pattern of cancer which are attributed to a
number of factors such as
 environmental factors
 food habit
 Lifestyle
 genetic factor
 inadequacy in detection and reporting of
cases
Cancer patterns

9.  Tobacco
 Tobacco in various forms of usage can cause cancer of lungs,
larynx, mouth, pharynx, esophagus, bladder, pancreas and
probably kidney
 Cigarette smoking is now responsible for more than 1 million
death each year
 Alcohol
 Excess intake of alcohol can cause esophageal and liver
cancer
 Beer consumption may be associated with rectal cancer
 Alcohol contributes about 3 % of all cancer deaths
Environmental factors

10.  Dietary factor
 Smoked fish is related to stomach cancer
 Dietary fiber to intestinal cancer
 Beef consumption to bowel cancer
 High fat diet to breast cancer
 Food additives and contaminants have fallen under
suspicion as causative agents

11.  Occupational exposures
 These includes exposure to benzene, cadmium, arsenic,
chromium, vinyl chloride, asbestos, polycyclic
hydrocarbons, etc.
 The risk of occupational exposure is said to be increased
if the individual also smokes cigarette
 Occupational exposure is usually reported 1-5% of human
cancer

12.  Virus
 Hepatitis B & C - hepatocarcinoma
 HIV infection – kaposi’s carcinoma
 AIDS – non Hodgkin’s lymphoma
 Epstein – bar virus – Burkitts lymphoma and naso –
pharyngial carcinoma
 Cytomegalovirus – Kaposi’s Sa
 Pappiloma virus – cervix cancer
 Human T cell leukemia virus – T cell leukemia

13.  Parasite
 May be a cause of cancer
 Schistosomiasis can produce Ca of bladder
 Customs, habits and life style
 May be associated with an increased risk of cancer
 Smoking and lung cancer
 Tobacco and beetle chewing and oral cancer

14.  Others
 Sunlight, radiation, water and air pollution, medication
and pesticides
 These are related to cancer as environmental factors

15.  Genetic influences have long been suspected
 Retinoblastoma occurs in children of the same parent
 Mongols are more likely to develop leukemia
 There is probably a complex relationship between
hereditary susceptibility and environmental
carcinogenic stimuli in the causation of cancer
Genetic factors

16.  It consists of prevention, detection, diagnosis,
treatment, after care and rehabilitation, reducing
incidence and prevalence
 Primary control
 Reducing the exposure to the risk factors
 Control of Tabaco and alcohol consumption
 Control of these two will reduce the total burden of cancer
by 1 million cases per year
Cancer control

17.  Personal hygiene
 Improvement in hygiene may decline the incidence of certain
types of cancers
 Radiation
 Effort should be made to reduce the amount of radiation
received by each individuals to a minimum without reducing
the benefits
 Occupational Exposure
 Should protect workers from exposure to industrial
carcinogens

18.  Food, drugs, and cosmetics
 Should be tested for carcinogens
 Air pollutions
 Control of air pollution is a preventive measure
 Treatment of pre cancerous lesions
 Early detection and prompt treatment of precanerous
lesions
 Legislation
 It comes under primary prevention

19.  Cancer Education
 Should be directed in high risk groups
 To motivate people for early diagnosis and treatment
 Remind early warning symptoms
 A lump or hard area in the breast
 A change in a wart or mole
 A persistent change in digestive and bowel habits
 A persistent cough or hoarseness
 Excessive loss of blood at the monthly period or loss of blood
outside the usual dates
 Blood loss from any natural orifice
 A swelling or sore that does not get better
 Unexplained loss of weight

20.  Cancer registration
 Hospital-based registries
 Population based registries
 Early detection of cases
 Treatment
Secondary Prevention

21. Breast cancer

22.  Commonest cause of death in middle aged women
 Causes 5,19,000 deaths a year worldwide
 About 9 lakh women are diagnosed every year
 Mortality rates have increased during the past 60
years in all countries

23.  Age
 Uncommon below the age of 35
 Incidence increased rapidly between ages of 35 and 50
 There is a dip in incidence at the time of menopause
 A secondary rise in frequency occurs after the age of 65
 Women who developed their first breast cancer under
the age of 40 have 3 times the risk of developing a
second breast cancer
 Mean age of occurrence in Indian women is 42
Risk factors

24.  Family history
 High in those with positive history in their family
 Esp. if mother or sister has developed breast cancer when
premenopausal
 Parity
 Related to age at which women bear their first child
 Those who had their first child in the late thirties are at a
higher risk than multiparous women
 Unmarried women tend to have more breast tumors than
married
 Single women and nulliparous women have the same risk
1

25.  Age at menarche and menopause
 Early menarche and late menopause are risk factors
 Risk is reduced for those with surgically induced
menopause
 Forty or more years of menstruation doubles the risk of
breast cancer as compared with 30 years

26.  Hormonal factor
 Elevated levels of estrogen and progesteron are
important factor in increasing breast cancer risk
 Prior breast biopsy
 Prior breast biopsy for beningn breast diseases is
associated with increased risk of breast cancer
 Diet
 Breast cancer can be linked with high fat diet and
obesity

27.  Socio-economic status
 It is higher in socio-economic groups
 Age factor
 Other
 Radiation
 Women exposed to radiation may develop breast cancer
 Oral contraceptic pills
 Prolonged use of pills before first pregnancy and before
the age of 25yrs can cause breast cancer

28.  Primary Prevention
 Aim should be towards elimination of risk factors
 Promotion of cancer education
 Increase the average of menarche by reducing
childhood obesity and increased stannous physical
activities
 Or decrease the frequency of ovulation by increased
stannous physical activities
Prevention

29.  Secondary Prevention
 Screening leads to early diagnosis which influences
treatment
 To detect recurrence as early as possible
 To detect cancer in opposite breast at an early stage
 To generate research data that might be usefull

30. Cancer Of The Cervix

31.  Second most common disease in women
 5,24,000 estimated new cases in in 1995
 Most common in developing countries
 Which accounts around 80% of cases
 Cases and death rates are declined markedly in the
last 40 yrs due to reduction of the risk factors and
extensive screening programs

32.  The disease (a progressive course)
Normal epithelium
Dysplasia
Cancer in situ (persists for 8yrs)
Invasive cancer
Natural History

33.  Causative agnt
 Human papiloma virus-sexually transmitted-cancer
 This virus is found in more then 95% of the cancers

34.  Age-
 Affects relatively young women
 Age of 25-45 yrs has increased incidence
 Genital warts
 Past or present occurrence of clinical genital warts has
been found to be a important risk factor
 Early marriage
 Early marriage, early coitus, early childbearing and
repeated childbirth have increased risk
Risk Factor

35.  Oral contraceptive pills
 Using of pills can cause cancer of cervix
 It is because of high level of estrogen
 Socio-economic class
 More common in lower socio-economic groups
 It is because of poor genital hygiene

36.  Primary Prevention
 Personal hygiene and birth control
 Secondary Prevention
 Early detect of cases through screening
 Treatment by radical surgery and radiotheropy
 It is difficult to cure once the symptoms are develop
Prevention

37. Thank you…