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Cancers

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Characteristic :A group of diseases characterized by

Abnormal growth of cells Ability to invade adjacent tissues and

even distant organs

The eventual death of the patient if the

tumour has progressed beyond that stagewhen it can be successfully removed.

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Types Carcinomas

Sarcomas

Lymphomas ,myeloma, leukamia

Primary tumor

Secondary

At least one third of the cancers arepreventable.

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Problem statement Incidence

lung 12.3 %

Breast 10.4 %

Colorectal 9.4 %

Mortality

Lung 17.8%

Stomach -10.4 %

Liver 8.8%

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IndiaMale 57-79 /100,000

Mouth, oropharynx, oesophagus,

stomach, LRT

Female 56-91/100,000

Cervix, breast , Mouth, oropharynx,oesophagus, stomach, LRT

Time trend second cause of death

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Causes of cancerEnvironmental factors- 80-90%

Tobacco: 90 %Cancers of lung, larynxmouth, pharynx, esophagus, bladder,pancreas, and probably kidneys.

Alcohol: 3 % Esophageal and liver Beer with rectal

Occupational exposures1-5 %tocarcinogenic agents like benzene, arsenic,

cadmium, chromium, etc.

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Dietary factors:

Smoked fish related to stomach cancer,

high fat diet to breast.Dietary fibre intestinal

Beef consumption bowel

Additive and contaminants intestine

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Viruses: e.g.

Hepatitis B and C viruses hepatocellular ca,

HIV Kapposis sarcomaNHL, spleen

Schistosomiasis bladder.

CMV Kapposis sarcomaHPV cervix

HTLV Adult T cel leu/ lymphoma

Schistosomiasis bladder

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Customs, habits and lifestyles: e.g.Betalnut chewing and oral cancer.

Other : sunlight , radiation, air ,waterpollution, medication, pesticides

Genetic factors: e.g. Mongols

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Cancer controlPrimary prevention

a. Control of tobacco and alcohol consumption

b. Personal hygine

c. Reduce the amount of exposure to radiation

d. Protection against occupational exposuree. Immunization

f. Foods, drugs and cosmetics

g. Control of air pollution

h. Treatment of precancerous lesions

i. Legislation

j. Cancer education

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Early warning signs or Danger signals ofcancer

1. a lump or hard area in the breast

2. a change in a wart or mole

3. a persistent change digestive or bowelhabits

4. a persistant cough or horseness

5. excessive loss of blood at monthly periods

or loss of blood outside usual dates6. blood loss from any natural orifice

7. a swelling or sore that does not get better

8. unexplained loss of weight

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Secondary prevention

Cancer registration

1. Hospital based registration2. population based registration

Early detection of cases by CancerScreening Methods such as

Mass screening by comprehensive cancerdetection examination

Mass screening at single sites

Selective screening

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Importance preceded by premalignant lesion,

removal prevent the subsequent devl

Begin as localised lesion high cure

75 % of cancer on accessible bodysite

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Screening Cervical CaPap smear

Problems

the disease ca in situ invasive ca

abnormal smear invasive

The test : response rate sensitivity 80%

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Breast caBSE

Palpation

ThermographyMammography very sensitive and specific

Exposure to 500 mr compared to 30 mr by

XrayHigh std equipment and radiologist

False positive 5-10 case for each ca

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Lung caNot recommended :Chest radiography

Sputum cytology

Treatment: Multimodality approach.

Right of cancer patient freedom from

cancer pain

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