Dr.

R n i m e s h G u p t a
MD, FDM, FAGE
Associate professor
Dept. of Community medicine, NMCH, Sasaram
• Group of diseases characterized by:
• An abnormal yowth of cells
• Ability to invade adjacent tissues and even distant organs
• The eventual death of affected patient if the tumor has
progressed beyond that stage when it can be successfully
removed

• Cancer can occur at any site or tissue of the body and may
involve any type of cells.
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• Male - Lung, Stomach, Oesophagus, Iãver
• Female Beast, Cervix, Litng.

• Male - Mou o pharynx, Oesophagus, Stomach,

Lung
• Female — Servix, Beast, Mou o p ,
•SaECO S
• arise from mesodermal cells constituting the various
connective tissues [e.g. fibrous tissue, fat and
bone].

• arise from epithelial cells lining the internal surfaces of

various organs [e.g. mouth, oesophagus, intestine, uterus]
and from the skin epithelium.
•L phoras,hIyeIoras,Leukaenüas
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• Primary tumour” denotes cancer in the organ of ori
n,
• Secondary tumour” denotes cancer that has spread to
regional lymph nodes and distant organs.
• Benign — non cancerous and do not spread
Environmental Genetic
• Tobacco • Retinoblastoma in Children
• Alcohol • leukemia in Mongols
• Dietary Factors
• Occupational exposures
• Viruses
• Parasites
• Customs, habits, lifestyles
• Others sunlight, pollution, drugs
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• Tobacco - cancers of lung, larynx, mouth, pharynx, oesophagus,
bladder, pancreas and probably kidney.
• Alcohol - excessive intake of alcoholic beverages is associated with
oesophageal and liver cancer.
• Dietary Factors - smoked fish related to stomach cancer, beef
consumption to bowel cancer, and high fat diet to breast cancer.
• Food additives & contaminants have fallen under suspicion as
causative agents.
• Occupat onal Exposure - exposure to benzene, arsenic,
asbestos etc.
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• Vlzoseg
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• Hepatitis B and G virua related to hepatocellular carcinoma
• Kapoai$ sarcoma related to HIV infection
• EBV related to Burkitt$ lymphoma
• Parasites
• Schistosomiasis related to bladder cancer

cancers.
• Othezs
• Sunlight, radiation, air and water pollution, medications,
 • Genetic factors have long been suspected.
• Retinoblastoma occurs in children of the same parents.
Mongols are more likely to develop leukaemia than
normal children.
• There is a complex interrelationship between hereditary
susceptibility & environmental carcinogenic stimuli in
the causation of a number of cancers

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• Gonsists of series of measures based on
>present medical knowledge
in the fields of prevention, detection, diagnosis,
treatment, after care and rehabilitation
 CRXCER
Primary Prevention COXTROL Secondary Prevention
• Control of tobacco & alcohol • Cancer Registration
consumption • Hospital based zegistzies
• Personal Hygiene • Population based zegistzies
• Radiation • Early detection of cases
• Occupational Exposures • Treatment
• Immunization
•Foods &dzugs
• Air pollution
• Treatment of pzecancezous lesion
• Legislation
• C ancez Education
• treatment of precancerous lesion
• Leukoplakia, Erythroplakia
• Intestinal polyposis
• Cervical tears, genital warts
•LegisaGon
•COTPA
 • C a n c e r education
• It is directed at high risk groups.
• The aim of cancer education is to motivate people to seek
early diagnosis & early treatment.
• Cancer organizations remind the public of early warning
signs [danger signals] of cancer

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•A
•A
lump or a hard area in breast
change in wart or mole
•A persistent change in bowel habits
•A persistent cough or hoarseness
• Excessive loss during menstrual periods or loss of blood
outside usual dates.
• Blood loss from any natural orifice
• A swelling that does not get better
• Unexplained loss of weight
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• G— Change in Bowel or Bladder habit
•R A sore that does not heal
• U — Unusual bleeding or discharge
• T — Thickening or lump in the breast or
elsewhere
• I — Indigestion or difficulty in swallowing
• O — Obvious change in wart or mole
• N— Nagging cough or hoarseness
• S Significant weight loss (more than 10%)
 Early detection of ca se s
• Cancex screening is the main weapon
for eaxly detection of cases at a pre -
invasive ox pxe-malignant stage.
• It has to be conducted on a large
scale.
• It requires mobilization of ali
available Peso urces and development
of a cancex infrastructure starting at
the level of primary health caxe,
ending with complex cancex centers
ox institutions at the state ox national
levels.
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• Treatment facilities should be
available to all cancex patents.
• Certain foxms of cancex axe
amenable to surgical removal, while
some respond to radiation ox
chemotherapy ox both.
• Fox those who axe beyond the cuxable
stage, goal must be to provide pain
xelief.
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Hospital Based
• All patients treated by a • corer complete cancer situation in
particular institution a geographical area.
included and is • Size 2 to 7 million
considerable value in
evaluation of diagnostic & • It provide the Incidence rate of
treatment programmes. cancer & s e r e aa a uaefnl tool for
Initiating
• Epidemiological enquiries into
causes
of cancer,
• Surveillance of time trends,
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• It means the “search for unrecognized malignancy by means of
rapidly applied tests”.
• It is possible because
• Precancerous or premalignant lesions
• malignant disease is pmceded for a period of months or years by
a pte-malignant lesion
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screening by
compzehena
roe cancer rescuing of
detecaon single site
examination
• 21 to 29 Years Old
• Start getting Pap tests at age 21.
• If Pap test result is normal, then wait three years for next Pap test.
• 30 to 65 Years Old
• Pap test
If result is normal, then wait three years for next Pap test.
• IIPV test (primary HPV testing)
If result is normal, wait five years for next screening test.
• IIPV test along with the Pap test (co-testing)
If both results are normal, wait five years for next screening test.

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• No need to be screened anymore if
• Screening test results was normal for several
years, oz
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• Breaat aelf examination (BSE)
• Only feasible approach to wide population corerage
• Once a month afier 20 years of age
• Recommend for raising awareness among women at riak rather than
as a screening method.
• Palpatlon by physician / Clinical Breaat examination (GBE)
• Once in every 3 years after 30 years of age

• Not sensitive tool

- Not exposed to radiation
 A Breast Self-Examination is as easy as 1-2-3
Breast s eIf e xamination BSE) shou Id be done once a month duri ng av ulation
preferably at the same time of day).

1. In the mirror
• In of a mirror, check for any changes in the normal look and feel
of your breasts, such as dimpling, size difference or nipple discharge
• lnspect four ways: arms at sides; arms overhead; firmly pressing
hands ”
on hips
2. Lying and bending forward
down
die on your back with a pillow under your ri8ht shoulder and your right
hand under your head
• With the four fingers of your left hand make small circular motions,
follow an up and down pattern over the entire breast area, under the
arms and up to the shoulder bone, pressing firmly
• Repeat using right hand on left breast
3. W hile bathe 0
•ng With your right arm raised, check your right breast with a soapy left
hand and fingers flat using the method described under step 2 (‘Lying
down’). Repeat on the othet side
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• Most sensitive & specfic
• Best available populaäon-baaed method to detect bzeaat
cancer at an early stage
• Recommended after 35 years of age
• Wmitntîon Z Drawbncka
• Exposure to low dose of radiation
• Requises technical equipment alonp with experienced
Ü ÎOlOQÎ8t
- Difficult to internet in younger woman (dense bzeast tisaue
- mon glande and ligaments)
• Fhlse positire or not accuzate all the time.
• Chest radiograph
• Sputum cytolo
• Low-dose Spiral CT Scan (£DCT scan)
• Series of very detailed pictures of areas inside the hung
• I nd i c a t i o ns
• Aged 55 to 74 years and in fairly good health, and
• Currently smoke or have quit within the past 15 years, and
• Have at least a 30-pack-year smoking history, and

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Prostate cancer Pzoatate specific antigen (PSA) test
Digital rectal examination

Germ Gell Human Ghorio c

tumor (HGG) gonadotrop

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 Thank You
C:uioer-In!roducaonConœoÆSmconlng