Easy undergraduate medical teaching

1. 9/7/2023
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AHMED
MANGI
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3. What is Cancer?
Cancer may be regarded as a group of diseases
characterized by:
1. An abnormal growth of cells
2. Ability to invade the adjacent tissues and even
distant organs
3. The eventual death of the affected patient if the
tumor has progressed beyond the stage when it can be
successfully removed.
The cancers can occur at any site or tissue of the body and
may involve any type of cells.
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4. Key Facts
• Cancer is one of the leading causes of morbidity and
mortality worldwide, with approximately 14 million
new cases in 20121 *8.8 million deaths in 2015.
• The number of new cases is expected to rise by about
70% over the next 2 decades.
• Around one third of deaths from cancer are due to the
5 leading behavioral and dietary risks: high body mass
index, low fruit and vegetable intake, lack of physical
activity, tobacco use, and alcohol use.
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5. Key Facts
• Tobacco use is the most important risk factor for cancer
and is responsible for approximately 22% of cancer
deaths.2.
• Cancer causing infections, such as hepatitis and human
papilloma virus (HPV), are responsible for up to 25% of
cancer cases in low- and middle-income countries3.
• The economic impact of cancer is significant and is
increasing. The total annual economic cost of cancer in
2010 was estimated at approximately US$ 1.16 trillion4. 5
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6. Most common Cancers
• Lung (1.69 million deaths)
• Liver (0.788 million deaths)
• Colorectal (0.774 million deaths)
• Stomach (0.754 million deaths)
• Breast (0.571 million deaths)
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7. Introduction
Cancer is a leading cause of death worldwide and
accounts more 13% of all deaths.
About 70% of all cancer deaths occurred in low- and
middle-income countries.
Deaths from cancer worldwide are projected to
continue to rise to over 13.1 million up to 2030.
Tobacco use is the single greatest avoidable risk
factor for cancer mortality worldwide, causing an
estimated 22% of cancer deaths per year.
About 70% of the lung cancer burden can be
attributed to smoking alone.
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9. Types of Cancer
A. Carcinoma:
These arise from epithelial cells lining the
internal surfaces of the various organs,
Ex. Mouth. Esophagus. Intestine. Uterus.
and from the skin epithelium.
B. Sarcomas:
These arise from mesodermal cells constituting
the various connective tissues
Ex. Fibrous Tissues. Fat. Bones.
C. Lymphomas, Myeloma and Leukemia:
These arise from the cells of bone marrow and
immune systems.
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10. Terms used in Cancer
A. Primary Tumor:
“This term is used to denote cancer in the organ of
origin.”
B. Secondary Tumor :
“This term is used to denote cancer that has spread to
the regional lymph nodes and distant organs.”
When cancer cells multiply and reach the critical size,
the cancer is clinically evident as lump or ulcer
localized to the organ of origin in early stages.
As the disease advances symptoms and signs of
invasion and distant metastases becomes clinically
evident.
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11. CANCERs in Men
Worldwide, the 5 most common types of cancer that kill
men are (in order of frequency):
1. Lung ,
2. Stomach,
3. Liver,
4. Colorectal and
5. Esophagus.
The burden of the cancer is distributed
unequally b/w developed and developed
countries with particular cancers types
exhibiting different patterns of distribution.
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12. Smoking & Lung Cancer
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13. CANCER in Women
Worldwide, the 5 most common types of cancer that
kill women are (in the order of frequency):
1. Breast Cancer
2. Lung Cancer
3. Colorectal Cancer
4. Cervical ( In many developing countries, cervical
cancer is the most common cancer).
5. Cancer of Stomach.
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14. Breast Cancer
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15. Incidence of Cancers Worldwide
The most common cancers worldwide are:
 Lung Cancer 12.3%
 Breast Cancer 10.4%
 Colorectal Cancer 9.4%
 Lung Cancer accounts for the most deaths from
cancers in the world estimated 1.1 million
annually.
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16. Cancers Worldwide
 The total cancer burden is highest in effluent
societies, mainly due to high incidence of tumors
associated with smoking and western lifestyles.

 Ex. Cancer of lung. Colorectal Cancer. Breast
Cancer. Prostate Cancers.
 In developing countries up to 25% of tumors are
associated with chronic infections.
 Ex. Hepatitis B Liver Cancers.
• Human Papilloma Virus Cervical Cancer
• Helicobacter pylori Stomach Cancer
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17. South-East Asia
 In South-East Asia Region Cancer accounts for a
significant proportion of Morbidity and Mortality.
 It is estimated that 0.5 million people die every
year from Cancer.
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18. Trends of Cancers
 At the beginning of this century, cancer was the 6th
number as a cause of deaths in industrialized
countries. Today it is 2nd leading cause of death.
 The reasons are:
• Longer life expectancy.
• More Accurate Diagnosis.
• Rise in cigarette smoking especially among males.
 Cancers associated with the use of tobacco
constitute 44.6% of cancers in men and 20% of
cancers in women.
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19. Cancer Pattern
There are variation in the distribution of pattern of
cancers throughout the world:
 Cancer of stomach is very common in Japan and low
incidence in United States.
 Breast cancer is more common in USA than in Japan.
 Cervical cancer is more common in Colombia and has
a low incidence in Japan.
 In South-East Asia Region great majority of cancers are
oral cavity and uterine cervix.
 These and other international variations in the
pattern of cancers are attributed to multiple factors
such as environmental factors, food habits, life style
and genetic factors.
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20. Causes of Cancer
1. ENVIRONMENTAL FACTORS:
“Environmental factors are generally held
responsible for 80 to 90 percent of all human
cancers.” The major environmental factors are:
A. Tobacco:
“Tobacco in various forms of its use (e.g: smoking,
chewing is the major environmental cause of the
cancers of Lung, Larynx, mouth, pharynx, esophagus,
bladder, pancreas and probably kidney.”
In the world as whole only cigarette smoking is now
responsible for more than one million premature
death each year.
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21. Causes of Cancer
B. Alcohol:
Excessive intake of alcoholic beverages is
associated with esophageal, liver cancer and
rectal cancer.
It is estimated that alcohol contributes about 3%
of all cancer deaths.
C. Dietary Factors:
Dietary factors also produce cancers.
 Smoked fish is related to stomach Cancer.
 Dietary fiber related to Intestinal Cancer,
 Beef consumption to Bowl Cancer and
 High fat diet to Breast Cancer.
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22. Causes of Cancer
D. Occupational Exposure:
These include exposure to benzene, arsenic,
cadmium, chromium, vinyl chloride asbestos,
polycyclic hydrocarbon etc.
Occupational exposure are usually reported to
account for 1 to 5 percent of all human cancers.
E. Viruses:
Hepatitis B and C virus is casually related to
Hepatocellular Carcinoma.
Kaposi Sarcoma occurring in patient with HIV
Infection.
Non-Hogkin’s Lymphoma, cancer of lymph nodes and
spleen is late complication of AIDS. Human Papilloma
Virus (HPV) is related to Cancer of cervix.
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23. Causes of Cancer
F. Parasites:
Schistosomiasis producing carcinoma of urinary
bladder.
G. Customs Habits and Life Styles:
These may be associated with an increased risk of
for certain caners.
Ex. Association b/w smoking and lung cancer
Tobacco and betel chewing and oral cancer
H. Others:
Radiations, sun light, air and water pollutions and
pesticides.
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24. Causes of Cancer
2. HERIDITERY/ GENETIC FACTORS.
 Genetic influences have long been suspected.
 The exposure of an individual to the
carcinogenic substances present in the
environment poses a great threat of
development of cancer in that person, specially
if he is susceptible to a particular carcinogen.
Ex. Retinoblastoma occurs in children of same
parent.
Mongols are likely to develop blood cancer
(Leukemia) than normal children.
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25. Control of Cancers
 Cancer control consist of series of measures based on
present medical knowledge in the field of prevention,
 detection,
 diagnosis,
 treatment, after care and rehabilitation aimed at
reducing significantly the number of new cases and
increasing the number of cure.
The basic approach to the control of cancer is through Primary
and Secondary prevention.
 It is estimated that 1/3 of all cancers are preventable.
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26. Cancer Control
1. PRIMARY PREVENTION:
Advancement knowledge has increased our
understanding of causative factors of some cancers
and it is now possible to control these factors in the
general population as well as in particular
occupational groups. They are following:
A.Control of Tobacco and Alcohol Consumption:
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27. Cancer Control
B. Personal Hygiene:
Improvements in personal hygiene may lead
decline in certain types of cancers.
Ex: Cancer Cervix
C. Radiation:
Special efforts should be made to reduce the
amount of radiation( including medical radiation)
received by each individual to a minimum level.
D. Occupational Exposure:
Measures to protect workers from exposure to
industrial carcinogen should be enforced in
industries.
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28. Cancer Control
E Immunization:
Vaccination against Hepatitis B can protect against
Hepatocellular carcinoma.
F. Air Pollution:
Control of Air pollution is another preventive
measures.
G. Foods and cosmetics:
These should tested for carcinogen.
H. Treatment of precancerous lesions:
Early detection and prompt treatment of
precancerous lesions such as cervical tears, chronic
cervicitis, intestinal polyposis, warts, chronic gastritis
and adenoma in one of the important step of cancer
prevention.
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29. Cancer control
I. Legislation:
Legislation to control the known environmental
carcinogens Ex. Tobacco. Alcohol. Air pollution is
inadequate or only moderately enforced in number
of countries including Pakistan.
J. Cancer Education:
An important area of primary prevention is Cancer
Education. It should be directed at “high risk” groups.
The aim of cancer education is to motivate people to
seek early diagnosis and early treatment.
Cancer organizations in many countries remind the
public of early warning signs ( danger signs) of
cancers.
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31. Cancer Control
2. SECONDARY PREVENTION:
A. Cancer Registration:
(i) Hospital based Registration
(ii) Population based Registration
B. Early Detection of Cases:
Cancer screening is the main weapon for the early
detection of cancers at pre-invasive or pre-malignant
stage.
Effective screening programs have been developed for
the cervical cancer, breast cancer and oral cancer.
Like primary prevention, early diagnosis by screening
has to be conducted on large scale by focusing on
high risk groups.
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32. Treatment
• The goal of Treatment is to cure the disease or
considerably prolong life and improving the
patient's quality of life.
• Some of the most common cancer types, such as
breast cancer, cervical cancer and colorectal
cancer have higher cure rates when detected
early and treated according to best practices.
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33. Treatment
Cancer treatment requires a careful selection of
one or more intervention, such as:
1. Surgerical Intervention.
2. Radiotherapy.
3. Chemotherapy.
Surgical excision (removal) of the tumor is usually
recommended if the tumor is small enough.
Radiation therapy with or without chemotherapy is
often used in combination with surgery, especially
if the tumor is inoperable.
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34. Silent message
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35. Thank You
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