This document discusses cancer in general and in India. It defines cancer and describes the major categories. Worldwide, over 10 million new cancer cases and 6 million cancer deaths occur annually. The most common cancers worldwide are lung, breast, and colorectal cancers. In India, the most common cancers are oral, esophageal, stomach and lung cancers in men and breast, cervical, oral, and esophageal cancers in women, largely due to tobacco use. Environmental factors like tobacco, alcohol, diet, occupation, and viruses can increase cancer risk. Genetic factors also play a role. Cancer control involves prevention, early detection, treatment and rehabilitation. Breast cancer is the most common cancer in women worldwide. Cervical cancer is

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…