2. INTRODUCTION:-
📍 CANCER may be regarded as a group of diseases
characterized by an:
1. Abnormal growth of cells
2. Ability to invade adjacent tissue and even distant organs
3. The eventual death of the affected patient if the tumor has
progressed beyond that stage when it can be successfully
removed
📍 Cancer can occur at any site or tissue of the body and may
involve any type of cells.
3. •📍 MAJOR CATEGORIES OF CANCER ARE:-
• CARCINOMAS- which arises from epithelial cells lining the
internal surfaces of the various organs ( eg- mouth,
oesophagus, intestines,uterus) and from the skin epithelium.
• SARCOMAS- which arise from mesodermal cells constituting
the various connective tissues (eg- fibrous tissue,fat,bone)
• LYMPHOMAS,MYLEOMA, LEUKAEMIAS- arising from the cells
of bone marrow and immune systems.
•📍 The term primary tumor is used to denote cancer in the
organ of origin,while secondary tumor denotes cancer that has
spread to regional lymph nodes and distant organs.
•📍 When cancer cells multiply and reach a critical size,the
cancer is clinically evident as a lump or ulcer localised to the
organ of origin in early stages,as the disease advance, symptoms
and signs of invasion and distant metastases become clinically
evident.
4. Problem statement:-
📍WORLD - IN 2012, the world wide burden of cancer rose to an
estimated 14million new cases per year, a figure expected to rise
to 22 million annually within the next two decades .
◦ Over same period ,cancer deaths are predicted to rise from an
estimated 8.2million annually to 13million per year.
◦ Globally during 2012,
Organs affected Cases diagnosed
Lungs 1.8million
Breast 1.7million
Colorectal 1.4million
Liver 0.8million
Stomach 0.7million
5. 📍INDIA- According to the, NATIONAL CANCER REGISTRY
PROGRAM of ICMR provides data on incidence, mortality &
distribution of cancer from 25population based registries & 5
hospital based registries.
◦ It is estimated that during the year 2012, 10.15lac new cancer
cases occurred,in the country, of these 4.77lqc were males
&5.37lac females.
◦ It gives incidence rate of 92.4 per lac population.
◦ Same year 6.83 lac person died of cancer (3.57 lac males, 3.26
lac females).
◦ Mortality rate of 69.7per lac population.
6. • Cancer in males were mostly tobacco related.
• The five most frequent cancer in men were lung cancer,
lip and oral cavity, stomach, colorectal and other.
• In women, cervical cancer is closely associated with
poor genital hygiene, early consummation of marriage,
multiple pregnancies,& contact with multiple sexual
partners.
• In women, breast cervix uteri, colorectal,ovary,lip &oral
cavity.
• It is reported that breast cancer is proportionately on
the increase in the metropolitan areas of India.
• This appears to be related to late marriage,birth of first
child at late age ,fewer children and shorter periods of
breast feeding which are increasingly common practice
among the educated urban women.
7. Cancer patterns:-
◦ There are wide variations in the distribution of cancer throughout
the world,that cancerof stomach is very common in Japan and
low in US.
◦ Cervical cancer is common in Colombia and low in Japan.
◦ In South East Asia region of WHO the great majority are cancers
of oral cavity,uterine cervix.
◦ These and other international variations in the pattern of cancer
are attributed to multiple factors such as environmental,food
habits, lifestyle,genetic,or eben inadequacy in detection and
reporting of cases.
8. CAUSES OF CANCER:-
• 📍 ENVIRONMENTAL FACTORS-
•• Tobacco- in various forms of its usage (eg – smoking, chewing) is the major environment cause
of ca lung,larynx,mouth, oesophagus,bladder, pancreas.
•- In the world as a whole, cigarette smoking is now responsible for more than 1 million premature
deaths each year.
•• Alcohol- Excessive intake of alcoholic beverages is associated with oesophageal & liver cancer ,
some studies suggested that beer consumption may be associated with rectal cancer.
• It is estimated that alcohol contributed to about 3% Of all cancer deaths.
••Dietary factors- smoked fish is related to Ca stomach
• Dietary fibre 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.
• • Occupation Exposures- These include exposure to benzene ,arsenic,cadmium, chromium,vinyl
chloride,abestos,polycylic hydrocarbons.
• Risk of occupational exposure is considerably increased if the individual also smoke cigarettes.
• Occupational exposure are usually reported to account for 1to 5 percent of all human cancers
9. •VIRUSES- hep B&C virus usually related to hepatocellular carcinoma.
- HIV infection- kaposis carcinoma
- AIDS- Non Hoddgkin’s lymphoma
- Epstein-Barr virus- burkitts lymphoma & nasopharyngeal carcinoma
- HPV- cancer cervix
- Human T – cell leukaemia virus- T – cell lymphoma.
• PARASITES- schistosomiasis – producing carcinoma of bladder.
• CUSTOMS,HABITS,AND LIFESTYLE-
- May be associated with an increased risk of certain cancers
- smoking- lung cancer.
- betel chewing- oral cancer.
•OTHERS- there are other environmental factors such as sunlight, radiation, air &water
pollution,medications, pesticides etc.
10. 📍 GENETIC FACTORS- Retinoblastoma occurs in children of the
same parents.
- Mongols are more likely to develop cancer (luekaemia).
- There is probably a complex interrelationship between
hereditary susceptibility and environmental carcinogenic stimuli
in the causation of a number of cancers.
11. CANCER CONTROL:-
◦ It is consist of Prevention, detection, diagnosis, treatment,after
care and rehabilitation, reducing incidence and prevalence.
📍 PRIMARY CONTROL-
•Reducing the exposure to the risk factors.
•Control of tabacco and alcohol consumption.
•Control of this 2 will reduce the total burden of cancer by
1million cases per year.
12. • Personal hygiene- Improvement in personal hygiene may decline the incidence of certain
types of cancer.
• Radiation- Efforts should be made to reduce the amount of radiation received by each and
every individual to a minimum without reducing the benefits.
•Occupational Exposure- Should protect the workers from the exposure to industrial
carcinogens.
• Cancer Education- Should be directed in high risk groups.
- To motivate the people for early diagnosis and treatment.
- Remind early warning Symptoms.
◦ A lump or hard areas in the breast.
◦ A change in a wart or a mole.
◦ A persistent cough or hoarseness.
◦ Excessive loss of blood during monthly periods or Loss of blood Out side the usual dates.
◦ Blood loss from any natural orifices.
◦ A swelling pr sore which does not get better.
◦ Unexplained weight loss.
13. •Food ,Drugs & Cosmetic – should be tested for carcinogens.
•Air pollution- air pollution control is a preventive measures.
•Treatments for precancerous lesions- Early detection and prompt treatment of
precancerous lesions.
📍 SECONDARY PREVENTION-
• CANCER REGISTRATION-
- Hospital based registries.
- Population based registries.
• Early detection of cases.
•Treatment- surgery+ chemotherapy.
14.
15. • Oral cancer is one of the most common cancer in the
world.
Problem Statement
Worldwide :- High frequency in central and south Asian
countries
In year 2012,
Incidence :- 1.98 lac
Mortality :- 98,000
Problem in India :-
For the year 2012,
Incidence :- 77,003 cases
Mortality :- 52,067 deaths
17. PREVENTION
A. Primary prevention
1. Tobacco habit remove from the community .
2. Public education and motivation for changing the lifestyle.
3. Banning or restricting sale of tobacco .
18. B. Secondary Prevention
1. Oral cancer can be cured at early stage (precancerous stage)
2. Leukoplakia can be cured by cessation of the tobacco use
3. Main treatment :- Surgery
Radiotherapy
19. CA CERVIX
Worldwide , second most common cancer in woman.
Problem statement
Worldwide :- new cases :- 5,27,624
Mortality :- 2,65,653
India
Estimates during 2012,
Incidence :- 1,22,644
Mortality :- 67,477
20. NATURAL HISTORY
A. The disease
Normal Dysplasia Cancer Invasive cancer
Epithelium in situ
(Hypothetical model of natural history of cancer cervix )
21. B. Causative Agent
Human papilloma virus (HPV)
Sexuality transmitted
The virus found 95% of CA Cervix cases.
22.
23. Risk factor
1. Age :- 25 to 45 year
2. Genital wart
3. Marital status
4. Early marriage
5. Oral contraceptive pill
6. Socio economic class
24. PREVENTION
Primary prevention
Improve perianal hygiene
Birth control
Secondary prevention
Easy selection of the case by screening
Treatment :- surgery
Radiotherapy
Prognosis :- dependent upon the stage of disease at
detection and treatment
26. PROBLEM STATEMENT
World wide
o Most frequent cancer among woman
o Now most common cancer in both developed
[7,94,000 cases] & developing [8,83,000 cases ]
India
o Estimates during the year 2012,
Incidence :- 1,44,9737 cases
Death :- 70,218 cases
27. RISK FACTOR
1. Age :35-50 year
2. Family history
3. Parity
4. Age at menarche and menopause
5. Hormonal factors
6. Prior breast biopsy
7. Diet
8. Socioeconomic status
9. Others :-
A. radiation
B. oral contraceptive
28.
29. PREVENTION
Primary prevention
- the average age of menarche increase through a reduction
of childhood obesity and increase exercise .
- reducing fat instant in diet.
Secondary prevention
-detect recurrence as early as possible .
- to detect breast cancer on opposite sides early as possible.
- no major improvement in survival rate has yet been shown
by current treatment modalities .
31. PROBLEM STATEMENT
Worldwide :-
o Lung cancer has been known in industrial worker from 19th
century.
o It came in prominence as public health in 1930, first man after
woman
o In 2012,
Incidence:- 1.82 milion
Mortality:- 1.58 million
o Worldwide , second most common cancer which causes death.
32. o The developing country having majority case of lung cancer.
o The highest incidence rate in the norther America and lowest
in the middle Africa.
India :-
o In the year 2012
Incidence :- 70,279 cases
Mortality :- 63,79 death
33. EPIDEMIOLOGY FEATURE
1. Age :: below 65 year
2. Sex :: More common in male
Risk factor
1. Smoking
2. Other factor :-
Occupational hazard
Radioactivity
Air pollution
34.
35. PREVENTION
1. Primary prevention
A)Public information and education
B)Legislative and restrictive measure
-Control of sale & promotion
-Warning on citrate packet & advertisement
-Restriction of smoking in public place
-The government of India provide legislative support
anticampaign cessation of smoking
36. "The cigarette act of 1975" which came into force 1976.
Give Warnings“cigarettes smoking is injurious to health”
C)smoking cessation activity
D)national & international coordination
2. Secondary prevention
Early detection of case
Two procedure to early detect the cancer
1. X ray
2. Sputum cytology
Treatment :- chemotherapy
37. STOMACH CANCER
Stomach cancer is fifth most common malignancy in
world, behind cancers of lung , breast , colorectum and
prostate .
Stomach cancer is the third leading cause of cancer death
in both sexes worldwide.
38. Problem statement
World :- 70% of cases occur in developing countries and
half the world total occurs in Eastern Asia , and lowest in
north America .
India :-
Estimated during 2012,
Incidence :- 63,097
Mortality :- 59,041
39.
40. Constant decline of stomach cancer in industrialized
countries is linked improved In stomach cancer because
food preservation , better nutrition , more rich vitamins ,
fresh vegetables and fruits .
Symptoms not specific which explain bccause of thatmost of
the cases are diagnosed when the diseases is advanced
stage.
Patient may explain weight loss, fatigue, gastric discomfort.
Diagnosis :- x-ray
Biopsy
Prognosis :- poor
No more than 20% survival after 5 years.
if the tumor is localized to the stomach,60 patient
survive years.
