CANCER

[By sriloy Mohanty,BNYS]

Contents

Introduction
Problem statement
In India
Cancer pattern
Environmental
factors
genetic factors
Cancer control

Breast cancer
Cervical cancer

Introduction
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

 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

Problem statement
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%)

 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

India
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

Cancer patterns
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

Environmental factors
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

 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

 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 15% of human cancer

 Virus

Hepatitis B & C - hepatocarcinoma

HIV infection kaposis carcinoma
AIDS non Hodgkins lymphoma
Epstein bar virus Burkitts lymphoma and
naso pharyngial carcinoma
Cytomegalovirus Kaposis Sa
Pappiloma virus cervix cancer
Human T cell leukemia virus T cell leukemia

 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

 Others
Sunlight, radiation, water and air pollution,
medication and pesticides
These are related to cancer as environmental
factors

Genetic factors
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

Cancer control
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

 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

 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

 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

Secondary Prevention
Cancer registration
Hospital-based registries
Population based registries

Early detection of cases

Treatment

Breast cancer

 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

Risk factors
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

 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

 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

 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

 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

Prevention
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

 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

Cancer Of The Cervix

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

Natural History
The disease (a progressive course)
Normal epithelium
Dysplasia
Cancer in situ (persists for 8yrs)
Invasive cancer

 Causative agnt
Human papiloma virus-sexually transmittedcancer
This virus is found in more then 95% of the
cancers

Risk Factor
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

 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

Prevention
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

Thank you