Cancer scenario - India

 2 – 2.5 million cases of cancer

 900,000 new cases detected every
year
 3 – 3.5 lakhs die each year due to
cancer.
 1/3 can be detected early & cured by
appropriate measures.
 100 new cases every day in Kerala
Different Kinds of Cancer

Carcinomas, the
most common types of
cancer, arise from the
cells that cover external
and internal body
surfaces.

Sarcomas

Lymphomas

Leukemias
 What is Cancer?

The term "cancer" refers to a group of diseases

in which cells grow and spread unrestrained
throughout the body.
Tumors (Neoplasms)
Invasion and Metastasis
 Why Cancer Is Potentially Dangerous

A malignant tumor, a "cancer,"

is a more serious health
problem than a benign tumor
because cancer cells can
spread to distant parts of the
body.
What causes cancer?
What Causes Cancer?
Virus as causative factor
 Carcinoma cervix: HPV
 Burkitt’s lymphoma: EB virus
 Liver cancer : HBV virus
 HPV Causes More Than Cervical Cancer
Cervical ~100%
Cancer1,3
Penile
45% Cancer3 Vulvar ~40%
Cancer1

12-70% Oropharynge
al Cancer3 Vaginal 60-90%
Cancer1

~100% Genital
Warts1,3 Anal
Cancer1-3 80+%

Percentages represent cases atrributable to HPV infection

Braaten KP et al. Rev Obstet Gynecol. 2008;1:2–10.
• Hoots BE et al. Int J Cancer. 2009;124:2375–2383.
• IARC. IARC monographs on the evaluation of carcinogenic risks to humans. Human papillomaviruses. Vol 90. Lyon, France: IARC, 2007.
Cancer Detection and Diagnosis
Biopsy

To diagnose the presence

of cancer, a doctor must
look at a sample of the
affected tissue under the
microscope
AIMS OF CANCER
TREATMENT
 PREVENTION
 EARLY DETECTION
 CURE
 PROLONGATION OF SURVIVAL
 PALLIATION
Site distribution

 32% in lung - in males

 28% in Head & Neck - in males
 34% in Breast - in female
 20% in Uterine cervix - in female
 Prostate cancer, colorectal cancer and
Thyroid cancer increasing
 30 -50% are tobacco related
Action for cancer control-
NCCP
 Tobacco
 Diet
 Alcohol
 Occupational/enviornment factors
 Combating Bilharziasis to prevent bladder ca
 Avoidance of excessive sun exposure
 General education relating to sexual &
reproductive factors
TOBACCO – FACTS AND
FIGURES
 Tobacco in any form is hazardous to health.
 Tobacco related diseases are many and affect almost
all the systems in the body.
 Tobacco smoking is the cause of 90% of all lung
cancer deaths and 30-40% of deaths from cancer in
general.
 Prevalence is highest among 25-44 years.
 Smokeless tobacco is carcinogenic for the upper
aerodigestive tract.
 Passive smokers have 15% increased risk of Lung
cancer.
Normal Lung Smokers Lung
Tobacco & Cancer
Major cause
 Lung
 Larynx & pharynx
 Oral cavity
 Esophagus

Contributory factor
 Pancreas

 Bladder

 Kidney

 Stomach

 Uterine cervix
Blum A, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;545-557.
DIET
What factors increase risk of developing
colorectal cancer?

 Physical inactivity
 Diet: Limit Fats and Calories

Limiting fat consumption and calorie intake appears to be

one possible strategy to decrease risk of some cancers,
because people who consume large amounts of meat
(which is rich in fat) and large numbers of calories exhibit
an increased cancer risk, especially for colon cancer.
Obesity and Physical inactivity
 Breast
 Endometrium
 EOC
 CRC
 RCC
 Esophagus
 GB
 Pancreas
 NHL, Prostate, Lung
% of cancer incidence attributed to obesity
and physical inactivity(IARC 2002 )
Type of cancer obesity Physical
inactivit
y
colon 11% 13 –14%

breast 9% 11%
Endometrium 39% ? 11%
Esophageal adeno 37% no studies
Kidney 25% no studies
Consume Fruits and Vegetables

Consumption of fruits &

vegetables shows a
reduction in cancer risk
Although the chemical
components in these foods
responsible for this
protective effect are yet to
be identified, eating at least
five servings of fruits and
vegetables each day is
recommended by many
groups.
Cancer Fighting Foods
Eat Healthy to Stay Well
 Cancer Fighting Foods!
 There are many beneficial foods but there is no
ONE food or food substance that can prevent or
cure cancer.
 Include many plant foods in your diet to get the
most benefit of cancer fighting foods!
 Aim for 4 to 5 cups of fruits + vegetables EVERY
DAY!
 Super Diet!
A cancer fighting diet will include many foods that
include cancer protective nutrients like:
 Vitamins
 Minerals
 Phytochemicals
 Fiber

 Phytochemicals are plant compounds (there are

more than 900 of them!) that promote healthy
tissue in the body and support the immune
system!
 Phytochemicals

Types of phytochemicals: Foods that have the most

(You probably recognize some of them!)
Phytochemicals include:

 Beta Carotenes  Beans (black beans, kidney

 Leutein beans, black –eyed peas, etc.)
 Lycopene  Berries (blueberries, blackberries,
raspberries, strawberries)
 Isoflavones  Cruciferous Veggies (broccoli,
 Beta Carotenes cabbage,kale, collards, brussel
sprouts, etc.)
 Quercetin
 Dark Green Leafy Veggies
 Ellagic Acid
 Tomatoes
 Saponins
 Whole Grains
 Phytic Acid
 Green Tea
 Soy
WHAT TO EAT?

HOW TO EAT?
The Plate Method

Whole Protein
Grain

Fruits and/or Vegetables

EARLY DETECTION

 Breast

 Head and Neck

 Cervix

 Prostate and colorectal also

BREAST CANCER
 How common is breast
cancer?
The most common cancer in women

1 in 3 cases of CA in women is breast CA

Women have a 1 in 8 chance of getting

breast CA during their life
 SAVE YOUR MOTHER

BREAST CANCER

is PREVENTABLE,
is SCREENABLE,
is CURABLE.
What are the warning signs?
Who is at greatest risk?
 Women
 Over the age of 50 (40?)
 Have mom or sisters w/ breast
cancer
 Early menarche, late menopause
 Have no children and or delaying
child bearing until after age 30
 Not breast feeding
 Overuse of oral pills
 History of breast cancer in the past
 Overweight
How To Reduce The Risk
 Increase physical activity
 Limit fat intake
 Control weight
 Have children early, and breastfeed
them
 Rationalise use of pills
 Limit alcohol consumption
What are the recommended
screenings/prevention?
 Age 20-39:
– Monthly self exams of the breast
– Clinical breast exam every 3 years
 Age 40 and over:
– Annual mammogram
– Clinical breast exam by health
professional EVERY YEAR
– Monthly breast self exam
BREAST SELF EXAMINATION
 Begin by looking at your breasts
in the mirror with your shoulders
straight and your arms on your
hips.
Here's what you should look for:
Breasts that are their usual size,
shape, and color.
Breasts that are evenly shaped
without visible distortion or
swelling.
If you see any of the following
changes, bring them to your
doctor's attention:
Dimpling, puckering, or bulging of
the skin.
A nipple that has changed
position or become inverted
(pushed inward instead of sticking
out).
Redness, soreness, rash, or
swelling.
What are the warning signs?
 Discharge or bleeding from nipples,
or change in nipple shape/location
 Changes in size, shape, or contour of
breast
 Lumps, flattened areas, or
indentations in breast
 Puckered skin on breast
 Moles or sores that have grown,
darkened, or changed shape
Finally, feel your
breasts while you are
standing or sitting.
Many women find that
the easiest way to feel
their breasts is when
their skin is wet and
slippery, so they like
to do this step in the
shower.
 Feel your breasts while
lying down, using your
right hand to feel your
left breast and then
your left hand to feel
your right breast. Use a
firm, smooth touch with
the first few fingers of
your hand, keeping the
fingers flat and
together.
Cover the entire breast
from top to bottom, side
to side—from your
collarbone to the top of
your abdomen, and
from your armpit to your
cleavage.
BREAST CANCER
Horizontal mammography
BREAST CANCER
Mammography
Breast Ca - Diagnosis
Mammography
FNAC
Biopsy
In Out

Suction End
Suction

Back and Forth

CANCER OF THE UTERINE CERVIX
( CERVICAL CANCER )
CAUSES OF CERVICAL
CANCER
 Poor sexual hygiene
 Multiple partners
 Early sex
 Smoking

HPV virus responsible

 What you should know about
vaccination
 There are two vaccines available
today:
 Quadrivalent (“four type”)
 Protects from 6,11,16,18
 Bivalent (“two type”)
 Protects from 16, 18
Vaccine dose
‘0’ month
2nd month
6th month
WARNING SIGNALS OF
CERVICAL CANCER
 Bleeding following sexual contact
 Inter menstrual bleeding
 Vaginal discharge
 Back ache
SCREENING IN CERVICAL
CANCER
 PAP smear
In sexually active age group once in 3
years

 COLPOSCOPY
 Pap Test

A screening technique
called the Pap test (or Pap
smear) allows early
detection of cancer of the
uterine cervix.
 recommendation

 After 35yrs WHO

 ACA & GOG

 After 30yrs
 Pap smear+ HPV
DNA testing
Photo source: IARC
ORAL CANCER
PROSTATE CANCER
PROSTATE CANCER

 Serum PSA level

 Examination by a doctor
COLORECTAL CANCER
COLORECTAL CANCER

 Fecal occult blood test

 Colonoscopy

 Serum CEA level

 TREATMENT
TREATMENT

 SURGERY

 RADIATION

 CHEMOTHERAPY
ONCOLOGY TODAY

 Surgical oncology

 Radiation oncology

 Medical oncology
SURGICAL ONCOLOGY

 Organ conservation

 Less mutilations

 Reconstructive techniques

 Aggressive approach
Is this
avoidable ?
RADIATION ONCOLOGY

 NEWER MACHINES

 NEWER TECHNIQUES

 PRECISION
 Woman in position for radiation
treatment, from the front.
Middle radiation beam is
shown.
A bright yellow indicates breast
being treated
B light yellow part of the beam,
beam in air, not touching
woman
C opening of the linear
accelerator
D arm holder supports
woman's right arm

Radiation Treatment Front View

MEDICAL ONCOLOGY

 New drugs – more active, less toxic

 Targeted therapy
 Monoclonals
 EGFR blockers
 Anti Angiogenesis agents
 Signal transduction inhibitors
TARGETED CHEMOTHERAPY
Is cancer curable

Yes, Yes, YES

Cure rate depend on

 Stage of cancer

 Type of cancer
Your slogan is ………

 Early diagnosis

 Proper treatment
 FOLLOW UP
Side effects of radiation

 Acute
 Nausea, vomiting

 Chronic
Side effects of
chemotherapy
 Acute
 Nausea,vomiting
 Hair loss
 Marrow suppression

 Chronic
Advise to patients

 Isolation

 Food

 Routines

 Mental make up