Cancer overview

1. 1
AARUNI HOSPITAL…..AN OASIS
FOR CANCER PATIENTS

2.  CANCER OVERVIEWCANCER OVERVIEW
 BREAST CANCERSBREAST CANCERS
 CERVICAL CANCERSCERVICAL CANCERS
 TOBACCO ANDTOBACCO AND
CANCERCANCER
 MESSAGEMESSAGE
CONTENT OF MY TALK…..

3. Cancer - Overview

4. Cancer – How old the disease is?Cancer – How old the disease is?
 Even in Bones of DinosaursEven in Bones of Dinosaurs
 Even in calcified mummiesEven in calcified mummies

5. Abnormal proliferation of abnormal cells with no fixed
growth pattern and no useful function
Spread locally
Invade and damage nearby tissues and
organs
Spread to other parts of the body
- Lung, Liver, Brain, Bones
WHAT IS CANCERWHAT IS CANCER

6. Advanced cancer

7.  Any Age
 Any Sex
 Any Race
 Any Caste
 Any Religion
Cancer -Cancer -Who Can Be Victims ?Who Can Be Victims ?

8. CancerCancer
What Can It Do?What Can It Do?
 Damage Organ of OriginDamage Organ of Origin
 Dysfunction of OrganDysfunction of Organ
 InvasionInvasion && Damage Surrounding TissueDamage Surrounding Tissue
 InvasionInvasion && Damage Distant TissueDamage Distant Tissue
 Worsened Quality of LifeWorsened Quality of Life
 Ultimately Death if Not Treated In TimeUltimately Death if Not Treated In Time

9. A FEW MYTHS ABOUTA FEW MYTHS ABOUT
CANCERCANCER
……ITS CONTAGIOUSITS CONTAGIOUS
……ONLY AFFECTS OTHERSONLY AFFECTS OTHERS
……IS TOTALLY INCURABLEIS TOTALLY INCURABLE
……ALL CANCERS ARE THEALL CANCERS ARE THE
SAMESAME

10. LEADING SITES OF CANCERLEADING SITES OF CANCER
•H & N
•Esophagus
•Gastric
•Lung

11. •Cervix
•Breast
•H & N
•Esophagus
LEADING SITES OF CANCERLEADING SITES OF CANCER
60%

12. By 2015By 2015
2/3rd of all cancers2/3rd of all cancers
willwill
be in the developingbe in the developing
world !world !

13.  Future of cancer burden in India
Expected to increase 3 times by 2020
 Longer survival
 Improved life style
 Better control of infectious diseases
 Early diagnosis
 cancer screening
 Better treatment modalities
Cancer (Burden in India)

14. SEVEN WARNING SIGNS OF CANCERSEVEN WARNING SIGNS OF CANCER
CC hange in bowel or bladder habits.hange in bowel or bladder habits.
AA Sore that does not heal.Sore that does not heal.
UU nusual bleeding or discharge.nusual bleeding or discharge.
TT hickening or lump in breast or elsewhere.hickening or lump in breast or elsewhere.
II ndigestion or difficulty in swallowing.ndigestion or difficulty in swallowing.
OO bvious change in wart or mole.bvious change in wart or mole.
NN agging cough or hoarseness of voice.agging cough or hoarseness of voice.

15. CancerCancer
…… Does it really make aDoes it really make a
differencedifference??
Why all the fuss about…Why all the fuss about…

16. TIME IS OF ESSENCETIME IS OF ESSENCE

17. Importance of Early DetectionImportance of Early Detection
 EARLY DETECTION MEANSEARLY DETECTION MEANS
LESS INVASIVE TREATMENTLESS INVASIVE TREATMENT
LESS TRAUMALESS TRAUMA
LESS PAINLESS PAIN
LESS COSTLESS COST
 EARLY STAGEEARLY STAGE
CUREABLE DISEASECUREABLE DISEASE
 SO IT PAYS TO BE VIGILANT!SO IT PAYS TO BE VIGILANT!

18. COMMON LIFESTYLE RELATED CANCERS
JAPAN-STOMACH CANCER
SCOTLAND-LUNG CANCER
AUSTRALIA-SKIN CANCER
INDIA-ORAL AND CERVICAL CANCERS
CHANGE IN FAULTY HABITS CAN REDUCE THE RISK
PREVENTION STRATEGIESPREVENTION STRATEGIES

19. COMMON CANCERS IN INDIA
-ORAL CANCER
-BREAST CANCER
-CERVICAL CANCER
THESE ARE ALSO THE CANCERS WHICH GIVE
EARLY WARNING SIGNS
EARLY DETECTION STRATEGIESEARLY DETECTION STRATEGIES

20. Breast Cancer

21. What causes breast cancer?What causes breast cancer?

22. Who is At Risk ?
Early Menarche
(Onset of periods)
16 Years
V/S
12 Years
30% More Risk

23. Who is At Risk ?
Late Menopause
45 to 55 Reference Group
> 55 50% Higher Risk
< 45 30% Lower Risk

24. Who is At Risk ?
Age At First
Pregnancy
Before Age of 20
Reduces the Risk
After Age of 31
& Nulliparity
Increases the Risk

25. dd
Who is At Risk ?
Estrogen:
The Villain

26. dd
Who is At Risk ?
Personal or Family
History

27.  22ndnd
Commonest cancer in femalesCommonest cancer in females
 Usually in 50-60 years ageUsually in 50-60 years age
 Not uncommon in young ageNot uncommon in young age
 In India mostly advanced stageIn India mostly advanced stage
 Ignorance –cause of advanced stageIgnorance –cause of advanced stage
 Curable in early stageCurable in early stage
 Very poor response in stage IVVery poor response in stage IV
 Screening in developed countriesScreening in developed countries
Breast CancerBreast Cancer

28.  Breast Lump
 Nipple discharge
 Nipple retraction
 Dimpling/ puckering of breast skin
 Lymph node / swelling in armpit
Breast cancer-
When should doctor be consulted?

29.  Depends on age & StageDepends on age & Stage
 Lump removal (BCT)Lump removal (BCT)
 Mastectomy (Breast removal)Mastectomy (Breast removal)
 ChemotherapyChemotherapy
 RadiotherapyRadiotherapy
 Hormonal therapyHormonal therapy
What are treatment options for breast cancer?

30. Can the breast be saved after cancer?
 If diagnosed earlyIf diagnosed early
 Radiotherapy is mustRadiotherapy is must
 Regular check upRegular check up

31. WHY EARLYWHY EARLY
DIAGNOSISDIAGNOSIS
ISIS
DESIRABLE?DESIRABLE?
LESS DEFORMINGLESS DEFORMING
LESS EXPENSIVELESS EXPENSIVE
FASTER & SHORTER TREATMENTFASTER & SHORTER TREATMENT
VERY GOOD OUTCOMEVERY GOOD OUTCOME

32. HOW TO DETECT EARLY?

33. 33
Breast Cancer Screening Methods ForBreast Cancer Screening Methods For
Healthy WomenHealthy Women
1. Breast Self Exam1. Breast Self Exam
2. Clinical Breast Exam2. Clinical Breast Exam
 Age 20-39: every 3 yearsAge 20-39: every 3 years
 Age after 40: every yearAge after 40: every year
3.3. MammographyMammography
 Age after 40: every yearAge after 40: every year

34. 34

35. 35
MammogramMammogram

36. Can breast Cancer be prevented?

38. MODERN INDIAN WOMANMODERN INDIAN WOMAN
 EDUCATEDEDUCATED
 TALENTEDTALENTED
 CAREER ORIENTEDCAREER ORIENTED
 MARRIES LATERMARRIES LATER
 POSTPONES CHILDPOSTPONES CHILD
BEARINGBEARING
 MINIMAL BREASTMINIMAL BREAST
FEEDINGFEEDING
 STRESSSTRESS
 WESTERN DIETWESTERN DIET

39. dd
Lifestyle
Modification
Diet
Various Indirect Evidences
Less than 30% Calories should
be from Fat

40. dd
Lifestyle
Modification
Obesity
Fat is the principle source of
ESTROGEN in postmenopausal
women hence increased incidences in
postmenopausal women

41. dd
Lifestyle
Modification
Exercise
Enhances Immune Function
Lowers Body Fat
Effect on Ovulatory cycle

42. dd
Lifestyle
Modification
Alcohol
Increases Circulating levels
of Estrogen
Facilitates transport of
carcinogens to breast tissue

43. dd
Lifestyle
Modification
Smoking
A Cigarette has at
one end smoke and at
other end a fool !

44. • Commonest cancer in females
• More Than 100,000 Females Diagnosed Every Year
• 30% of all female cancers in india
• Commonest cause of cancer related death in females
• Preventable to a large extent
Cancer CervixCervix

45.  Early age of marriage (< 18 years)
 Early first pregnancy (< 20 years)
 Multiple pregnancies at short interval
 Multiple partners
 Poor genital hygiene/Infection in male partner
 Genital tract infections (HPV/HSV)
 Tobacco addiction
Causes of Cancer Cervix

46.  Pap smear testPap smear test
 Clinical examinationClinical examination
 BiopsyBiopsy
 UltrasonographyUltrasonography
Cancer Cervix
Is early diagnosis possible?

47. I do not have any problems.
Do I need a check-up?

48. Cancer Cervix
Pap Smear Test - Who should have it ?
• All women between 18-60 years age
• Who have been sexually active
• Even for females without symptoms
• Impossible for country like India
• At-least screen once around 35 years
• Maximum chances of early stage disease
•Don’t wait for symptoms
•Ideally every 3-5 yearly from 30-55 years

49. • Lack of awareness
• Lack of knowledge
• Lack of health consciousness
• Lack of priority for self/ self neglect
• Preference for husband & children
• Fear/ embarrassment/ Ignorance
• Poor socio-economic status
• Poor medical facilities
•Insignificant symptoms
Cancer cervixCancer cervix
If detection is so simple, why is itIf detection is so simple, why is it
diagnosed in advanced stage?diagnosed in advanced stage?

50. • Inter menstrual bleeding
• Post coital bleeding
• Post menopausal bleeding
• Abnormal vaginal bleeding
• Persistent vaginal discharge
(white/bloody)
Cancer cervixCancer cervix
What are earliest symptoms?What are earliest symptoms?

51. Cancer Cervix
What are treatment options?
 Surgery
 Radiotherapy
 Chemotherapy
 Combination

52. Cancer CervixCancer Cervix
Is it preventable ?Is it preventable ?
 Delaying age at marriageDelaying age at marriage
 Postpone first childbirthPostpone first childbirth
(age>20)(age>20)
 Few and properly spacedFew and properly spaced
pregnanciespregnancies
 Barrier contraceptivesBarrier contraceptives
 Good hygieneGood hygiene
 Avoid tobacco addictionAvoid tobacco addiction
 Fresh fruits and vegetablesFresh fruits and vegetables
YesYes

53. ORAL CANCERSORAL CANCERS

54. What causes oral cancer?What causes oral cancer?
 TobaccoTobacco
 Gutkha,Gutkha,
 Pan masalaPan masala
 BidiBidi
 CigaretteCigarette
 AlcoholAlcohol

55. TOBACCO & CANCERTOBACCO & CANCER
90 % OF HEAD & CANCERS90 % OF HEAD & CANCERS
ARE TOBACCO RELATEDARE TOBACCO RELATED
& ARE THEREFORE& ARE THEREFORE
PREVENTABLEPREVENTABLE

56. WHAT A CIGARETTE CONTAINSWHAT A CIGARETTE CONTAINS

57. TOBACCO CONSUMPTION IN INDIA
 Smoked tobaccoSmoked tobacco ::
Cigarette, Cigar, Beedi,Cigarette, Cigar, Beedi,
Dhumti, Chutta, Hookah,Dhumti, Chutta, Hookah,
Cheroot, ChillumCheroot, Chillum
 Chewed tobaccoChewed tobacco ::
Paan, Paanmasalas, Khaini,Paan, Paanmasalas, Khaini,
Mawa, SupariMawa, Supari
 Applied FormsApplied Forms ::
Masheri, Snuff, Creamy Snuff,Masheri, Snuff, Creamy Snuff,
Tobacco Based ToothpasteTobacco Based Toothpaste

58. TOBACCO & CANCERTOBACCO & CANCER
 Tobacco kills between 8-9 lakh people each yearTobacco kills between 8-9 lakh people each year
in India i.e. 2220 deaths a day (in India i.e. 2220 deaths a day (1 death every1 death every
40 seconds40 seconds))
 Burden of disease due to tobacco smoke in IndiaBurden of disease due to tobacco smoke in India::
• 400,000 cases of cancers400,000 cases of cancers
• 1.3 million cases of coronary artery1.3 million cases of coronary artery
diseasedisease
• 7 million cases of chronic pulmonary7 million cases of chronic pulmonary
diseasedisease

59. Public Health SuccessPublic Health Success
Smoking may cause lung cancerSmoking may cause lung cancer
Industry ResponseIndustry Response
Filters make it safer

60. Public Health SuccessPublic Health Success
Smoking is harmful to healthSmoking is harmful to health
Industry ResponseIndustry Response
Low tar and nicotine cigarettes are
safer

61. The Role of Film, Fashion and MediaThe Role of Film, Fashion and Media

62. CancerCancer

63. Quit tobaccoQuit tobacco

64. Cancer – Can we prevent it?Cancer – Can we prevent it?
 Cancer awarenessCancer awareness
 Risk FactorsRisk Factors
 Early SymptomsEarly Symptoms
 Early SignsEarly Signs
 Preventive stepsPreventive steps
 educating publiceducating public
health workershealth workers
 educating doctorseducating doctors

65. Whose responsibility?
Government / Our own

66. More than 50 % of patientsMore than 50 % of patients
diagnosed with cancer candiagnosed with cancer can
achieve cure with modern therapyachieve cure with modern therapy

67. CANCER TREATMENTCANCER TREATMENT
MULTIMODALITY APPROACHMULTIMODALITY APPROACH
CONVENTIONALCONVENTIONAL
• SurgerySurgery
• ChemotherapyChemotherapy
• Radiation therapyRadiation therapy
• Hormonal therapy (e.g. tamoxifen in Ca breast)Hormonal therapy (e.g. tamoxifen in Ca breast)
NOVELNOVEL
• Biological Response ModifiersBiological Response Modifiers
• Gene therapyGene therapy
• Targeted drug therapyTargeted drug therapy

68. STATE OF ART RADIATIONSTATE OF ART RADIATION
TREATMENT CENTERTREATMENT CENTER
 Aaruni Hospital Pvt Ltd is a state-of-the-artAaruni Hospital Pvt Ltd is a state-of-the-art
Radiation Oncology facility.Radiation Oncology facility.
 It is designed to provide quality care with ultraIt is designed to provide quality care with ultra
modern radiotherapy machines.modern radiotherapy machines.

69. CONCEPT BEHIND AARUNICONCEPT BEHIND AARUNI
 OUR AIM WAS TO BRING THE LATESTOUR AIM WAS TO BRING THE LATEST
& THE BEST IN THE FIELD OF& THE BEST IN THE FIELD OF
RADIATION ONCOLOGY TO THERADIATION ONCOLOGY TO THE
PEOPLE OF GUJARAT ANDPEOPLE OF GUJARAT AND
ULTIMATELY TO THE NATIONULTIMATELY TO THE NATION
 ITS NOW BEEN 4 YEARS SINCE WEITS NOW BEEN 4 YEARS SINCE WE
TREATED OUR 1TREATED OUR 1STST
PATIENTPATIENT

70. HOSPITAL &HOSPITAL &
FACILITIESFACILITIES

71. THE TEAMTHE TEAM

72. VIRTUAL TOURVIRTUAL TOUR

74. ENTERANCEENTERANCE

75. PLANNING ROOMPLANNING ROOM

77. RECEPTION DESKRECEPTION DESK

78. WAITING LOUNGEWAITING LOUNGE

80. CONSULTING ROOMCONSULTING ROOM

81. RT DEDICATED CTRT DEDICATED CT
SCANNERSCANNER

82. HDR BRACHYTHERAPYHDR BRACHYTHERAPY

83. DAY CAREDAY CARE

84. HOMELY ACCOMODATIONHOMELY ACCOMODATION

85. SIEMEN’S LINEARSIEMEN’S LINEAR
ACELERATORACELERATOR

87. Pt Immobilization
Imaging Contour target vol. &
normal structures
Select beam geometry
& energy
Inverse plan
optimization
Plan evaluation &
Approval
Patient Set – up & RxPt position
verificationMachine QA Plan specific QA
IMRT PLANNING
PROCESS

88. IMMOBILIZATIONIMMOBILIZATION
88

89. KNEE & FOOT RESTKNEE & FOOT REST
89
Foot
rest

90. VACCUM CUSHIONSVACCUM CUSHIONS
(VAC-LOK)(VAC-LOK)
90

91. PELVIC CASTPELVIC CAST
91

92. HEAD & NECKHEAD & NECK
92

93. TREATMENT DELIVERYTREATMENT DELIVERY

94. 94

95.  WE HAVE SEEN MORE THAN 3500 CASESWE HAVE SEEN MORE THAN 3500 CASES
SO FAR IN THE OPDSO FAR IN THE OPD
 WE HAVE TREATED 3000 PATIENTS ONWE HAVE TREATED 3000 PATIENTS ON
LINACLINAC
 WE HAVE DONE MORE THAN 300WE HAVE DONE MORE THAN 300
INSERTION OF HDR BRACHYTHERAPYINSERTION OF HDR BRACHYTHERAPY

96. WE HAVE TRIED OUR BESTWE HAVE TRIED OUR BEST
TO DELIVER QUALITY……..TO DELIVER QUALITY……..
 WEEKLY TUMOUR BOARD MEETINGSWEEKLY TUMOUR BOARD MEETINGS
(WHERE ALL CASES ARE DISCUSSED(WHERE ALL CASES ARE DISCUSSED
WITH SURGICAL AND MED ONCO/WITH SURGICAL AND MED ONCO/
PATHOLOGISTS/ RADIOLOGISTS /PATHOLOGISTS/ RADIOLOGISTS /
UROLOGISTS AND OTHER SPECIALISTUROLOGISTS AND OTHER SPECIALIST
DOCTORS)DOCTORS)

97. LEVEL OF EYESLEVEL OF EYES
97

98. LEVEL OF BRAIN STEMLEVEL OF BRAIN STEM
98

99. NPX—SPARING PAROTIDS /NPX—SPARING PAROTIDS /
SPINAL CORDSPINAL CORD

100. CA MAXILLA—SPARE EYESCA MAXILLA—SPARE EYES

101. 3DCRT IMRT
2D RT
101

102. THORAX / BREASTTHORAX / BREAST

103. TANGENTIAL PLAN BY COBALTTANGENTIAL PLAN BY COBALT
103

104. 3D VERSUS IMRT3D VERSUS IMRT
104

105. ABDOMINAL CASESABDOMINAL CASES

107. PELVIC CANCERSPELVIC CANCERS

108. PELVIC 2 D PLANPELVIC 2 D PLAN

109. PELVIC IMRTPELVIC IMRT

110. SO WE HAVE EVOLVEDSO WE HAVE EVOLVED

111. ACHIEVEMENT WITHACHIEVEMENT WITH
PRECISION RADIOTHERAPYPRECISION RADIOTHERAPY
111

112. WE HAVE COVERED EXACTWE HAVE COVERED EXACT
SHAPE OF TUMOURSHAPE OF TUMOUR
112
IMRT
3DCRT
2D

113. WE HAVE BEEN ABLE TO HITWE HAVE BEEN ABLE TO HIT
TARGET MORE ACCURATELYTARGET MORE ACCURATELY
113

114. WE HAVE PROTECTEDWE HAVE PROTECTED
NORMAL TISSUESNORMAL TISSUES
114

115. THEREBY INCREASINGTHEREBY INCREASING
CURE RATESCURE RATES
115

116. AND IMPROVING QUALITYAND IMPROVING QUALITY
OF LIFEOF LIFE
116

117. Morbidity
Cost
QUALITY
OF LIFE

118. CONCLUSIONCONCLUSION
 WE HAVE DELIVERED QUALITY CAREWE HAVE DELIVERED QUALITY CARE
TO ALL PATIENTS TO THE BEST OFTO ALL PATIENTS TO THE BEST OF
OUR KNOWLEDGEOUR KNOWLEDGE
118

119. JOURNEY POSSIBLEJOURNEY POSSIBLE

121. 121