Dr. Lahiri's document discusses tobacco use and its health risks. It covers the history of tobacco, forms of tobacco consumption, tobacco facts and statistics, the Indian scenario, health risks of smoking and passive smoke, benefits of quitting, tobacco and cancer, treatment of cancer, and consequences of cancer. The key points are that tobacco use is the leading preventable cause of death globally and causes over 6 million deaths per year, smoking increases the risk of various cancers and other diseases, and quitting smoking provides significant health benefits even years after quitting.

1. Dr. DEBARSHI LAHIRI, MD

4. Common forms of Tobacco
Consumption

5. Tobacco Smoked and Smokeless

6. From 1st May 2004, selling tobacco products to
persons under 18 years has been banned

7. History
 Tobacco plant is a native of North/South American
Continents.
 Christopher Columbus landed in America in 1492 and
brought this plant to European countries.
 Portuguese traders brought tobacco plants to India
during 1600s to Goa and Indians started cultivating it.
 Thus, the tobacco use spread from Americas to rest of
the world.
 In India, initially restricted to royal people, but in late 17th
century, even common people started using it.
 East India Company grew tobacco in India as a cash
crop.

8. Tobacco Facts
 Tobacco use is the single greatest cause of preventable
death globally. Largest preventable cause of cancer.
 WHO estimates: Each year tobacco causes more than 6
million deaths with 10% (600,000) of these occurring in non
smokers due to second hand smoke.
 10 crore died from tobacco related causes in 20th century. 100
crore will die in 21st century (based on current use projections)
 Approx. 50% users of tobacco will die of a tobacco related
disease.
 Data from 14 Low/middle income countries (Global Adult
Tobacco Survey): 41 % men and 5% women across these
countries currently smoke.

9. Tobacco Facts contd.
 Smokers are 3 times as likely to die before the age
of 60 or 70 as non-smokers.
 2/3rd of world smokers live in 10 countries led by
China (30%), and India about 10%.
 Unless urgent action is taken, the annual death toll
could rise to more than one crore by 2025.
 The prevalence is decreasing in developed countries
but increasing in developing countries.

10. Indian Scenario
 India is the world’s third largest producer of
tobacco (Next to China and Brazil). The second
largest exporter of unmanufactured tobacco.
 800, 000 to 900, 000 deaths per year due to all
forms of tobacco use/exposure.
 There are currently about 24 crore tobacco users
aged 15 years and above.
 54% smoke beedies, 19% Cigarette and 27% Pan
masala, snuff, chewing tobacco.

11. Smoking and Health Risks
 Chemicals in Tobacco are Carcinogens
 Smokers under 40 are 5 times more likely to have a heart
attack.
 Smokers are 12 to 13 times more likely to die from COPD
than non-smokers.
 Depresses the body’s immune system.
 The risk of developing type 2 diabetes is 30–40% higher for
active smokers than non-smokers.
 Affect men’s sperm, which can reduce fertility and is a key cause
of erectile dysfunction (ED)
 Impacts the health of teeth and gums and can cause tooth loss.
 Smoking can increase risk for cataracts and can cause AMD

12. Passive smoke
 Inhalation of smoke, called second-hand smoke (SHS),
or environmental tobacco smoke (ETS), by persons
other than the intended "active" smoker.
 Has the same harmful chemicals that smokers inhale.
 ETS exposure during pregnancy have been shown to cause
lower infant birth weights, preterm delivery, risk of
still births.
 Evidence suggests that nonsmoking women married to
smokers experience an excess risk of developing lung
cancer in the order of 20%
 Affected children more likely to suffer from Lung
infections, bronchitis, trigger asthma attacks, ear
infections, increased risk of SIDS in infants.

13. Immediate and Long term Benefits of
Quitting
 12 hours, the carbon monoxide level in your blood drops to
normal.
 2-12 weeks, your circulation improves and your lung
function increases.
 1-9 months, coughing and shortness of breath decrease.
 1 year, your risk of coronary heart disease is about half that
of a smoker's.
 5 years, your stroke risk is reduced to that of a non-smoker
(5-15)
 10 years, your risk of lung cancer falls to about half that of
a smoker and your risk of cancer of the mouth, throat,
oesophagus, bladder, cervix, and pancreas decreases.
 15 years, the risk of coronary heart disease is that of a non-
smoker's.

14. Smoking related health problems
can still benefit from quitting
Benefits of quitting in comparison with those who
continued:
 At age 30: gain almost 10 years of life expectancy.
 At age 40: gain 9 years of life expectancy.
 At age 50: gain 6 years of life expectancy.
 At age 60: gain 3 years of life expectancy.
 After the onset of life-threatening disease: rapid
benefit, people who quit smoking after having a heart
attack reduce their chances of having another heart
attack by 50%.

15. Precancerous conditions may be
made static or reversed but some
progress
Once Cancer develops, it is
irreversible.
But patients who continue to
smoke or use smokeless tobacco
during cancer treatment do
much worse than patients who
quit.

17. Tobacco and Cancer
 Doll and Hill & Wynder and Graham studies in
1950 established association between smoking and
Lung cancer.
 The 2004 Surgeon General’s (US) report added
more evidence to previous conclusions that smoking
causes cancers of the oral cavity, pharynx, larynx,
oesophagus, lung, and bladder. Identified other
cancers caused by smoking, including stomach, cervix,
kidney, pancreas and acute myeloid leukemia.
 IARC has classified both cigarette smoke and
smokeless tobacco as Group 1 carcinogens.
 72 measurable carcinogens in cigarette smoke.

19. Nicotine is Addictive
 Nicotine is a highly addictive psychoactive chemical.
 It is a stimulant and is one of the main factors leading to
continued tobacco smoking.
 The IARC indicates that nicotine itself does not cause
cancer.
 Nicotine addiction involves drug-reinforced behaviour,
compulsive use, and relapse following abstinence. It causes
both physical and psychological dependence.
 Nicotine withdrawal symptoms include depressed mood,
stress, anxiety, irritability, difficulty concentrating, and
sleep disturbances

20. What causes cancer?

21. Carcinogenesis.
Some factors to consider…
 Heredity
 Immunity
 Chemical
 Physical
 Viral
 Bacterial
 Lifestyle

22. DNA Structure

26. Cancer
 Neoplasm/Tumor: A disorder of cell growth that is
triggered by a series of acquired mutations (a
permanent alteration in the DNA sequence that
makes up a gene) affecting a single cell and its clonal
progeny.
 Malignant neoplasms/Tumors: Referred to as
cancers. Can invade and destroy adjacent structures
and spread to distant sites( metastasize) to cause
death.

28. How Tobacco use leads to cancer
 Carcinogen exposure leads to formation of carcinogen-
DNA adducts→ causes mutations→ cell
transformation process leading to cancer.
 Persistent DNA adducts can cause miscoding during
DNA replication.
 Via repeated smoking of multiple cigarettes per
day/prolonged smokeless tobacco use over decades, a
mixture of numerous carcinogens is administered.

29. Some common carcinogens in
tobacco smoke

30. Normal and abnormal cell growth

31. Cancerous growth

32. Malignant versus benign tumours

33. Metastatic cancer

35. Cancer’s Seven Warning Signals
Table 16.5

36. A Thorough oral examination is enough in most of
the cases to diagnose an oral cancer

37. FNAC

39. CT Scan and MRI

42. Major Treatment Modalities &
Treatment intent
 Surgery
 Radiation Therapy
 Chemotherapy
 Biologic Targeted Therapy/Immunotherapy
Treatment Intent:
Radical/Curative
Palliative

43. Radiation Therapy
 Uses Ionizing Radiation (X-ray/Gamma Rays)
 External Beam:
Radiation source outside the body. Patient lies at a
distance from the radiation source.
 Brachytherapy:
Radiation source lies close to the tumour (implanted
within the tumour or in the body cavities).

44. Radiation Therapy

47. Chemotherapy

48. Biologic Therapy

49. Outlines of Therapy in few cancers
 Locally Advanced oral tongue cancer- Surgery
(Hemiglossectomy/near total glossectomy, neck
dissection)→ Radiotherapy with/without Chemotherapy
 Locally Advanced Lower Jaw Cancer- Removal of large
part of Mandible and neck dissection followed by
radiotherapy
 Locally Advanced Larynx Cancer- Removal of voice box
(Larynx)/ concurrent chemo-radiation
 Lung Cancer- Surgery (lobectomy)/ Radiation therapy-
chemotherapy
 Urinary Bladder Cancer- Chemotherapy and removal of
urinary bladder (cystectomy) and urinary conduit

50. Consequences of Cancer for the
patient
 Morbid surgery (permanent loss of functions)
 Radiotherapy and its complications
 Chemotherapy and its complications.
 Complications of combined modality treatment.
 Untreatable cancer and complications.
 Psychological impact for the patient and family.
 Painful death.

58. Stop Tobacco
 Contact Tobacco cessation clinics
 Contact social welfare sections in Regional Cancer
Centres
 Show Will Power
 Improve your quality of life, improve your chances of
healthy life and also save the community, especially the
children.
 Help to make the world a better place to live…..

59. THANK
YOU