This presentation is made in accordance with the view as a public health worker like explaining a current status of cancer its burden in India.

1. PADMASHREE SCHOOL OF PUBLIC HEALTH

2. INTRODUCTION
 The last 50 years has seen a better
understanding of the causes and treatments of
cancer. Hence, the stigma, early detection and
technology has improved the prognosis of cancer
patients to an unprecedented level.

3. DEFINITION
 “Uncontrolled growth and spread of abnormal cells.”
 Cancer is a term used to describe a large group of
diseases that are characterized by a cellular malfunction.
 Healthy cells are programmed to “know what to do and
when to do it”.
 Cancerous cells do not have this programming and
therefore grow and replicate out of control. They also
serve no physiological function.
 These cells are now termed a Neoplasm.
 This neoplasmic mass often forms a clumping of cells
known as a Tumor.

5.  Cells represent the
smallest, functional unit of
our existence which
contains cytoplasm and a
nucleus (i.e. metabolism,
reproduction, day to day
functions)
 Cells have a specialized
function depending on
their location in the body.
 Cells grow, replicate and
repair body organs.
 The genetic material
(DNA/RNA) and your
immune system regulate
this process.

6. TYPES OF CELLS
 Blood cells
 Muscle cells (smooth, striated, cardiac)
 Nerve cells
 Bone cells
 Cartilage cells
 Liver (hepa) cells

7. CLASSIFICATION OF
TUMORSBenign Tumors
(noncancerous)
 Enclosed in a fibrous shell
or capsule.
 Take up space
 Concerned if they interfere
with surrounding tissues or
vessels or impede the
function of the body.
 Encapsulated; Do not
invade neighboring tissue
or spread.
 Malignant Tumors
(cancerous)
 Malignant tumor of
potentially unlimited growth
that expands locally by
invasion and metastasis.
 Not encapsulated;
Readily invade
neighboring tissues.
 May also detach and
lodge in distant places –
metastasis

8. CANCEROUS CELLS
 The division (mitosis) of normal
cells is precisely controlled.
New cells are only formed for
growth or to replace dead
ones.
 Cancerous cells divide
repeatedly out of control even
though they are not needed,
they crowd out other normal
cells and function abnormally.
 They can also destroy the
correct functioning of major
organs.

9. CANCER CYCLE &
CHARACTERISTICS
 Carcinogenesis – development of cancer
 Tends to be gradual, takes years.
 Undergo metastasis
 Original tumor easily fragments
 New tumors appear in other organs
 Undergo angiogenesis
 Formation of new blood vessels
 Lack differentiation (control)
 Have abnormal nuclei
 Form tumors
 Mitosis controlled by contact with neighboring cells –
contact inhibition
 Cancer cells have lost contact inhibition

10. OVERVIEW
 Cellular Change/Mutation Theories
 Spontaneous errors
 External agents
 Oncogenes
 Risks for Cancer-Lifestyle
 Smoking among greatest
 Nutrition/exercise

11. WHAT CAUSES CANCER ?
 Biological Factors
 Genetic predisposition
 Reproductive and hormonal risks
 Occupational and Environmental Factors
 Asbestos, nickel, chromate
 Radioactive substances

12.  Social and Psychological Factors
 Stress
 Decrease negative emotions
 Chemicals in Food
 Sodium nitrate
 Clostridium botulism
 Viral Factors
 Herpes-related virus and human papillomavirus
 Medical Factors
 Diethylstibestrol (DES)
 Chemotherapy

13. STAGES OF CANCER
 Stage I cancers are localized
to one part of the body;
usually curable.
 Stage II cancers are locally
advanced.
 Stage III cancers are also
locally advanced.
 Stage IV cancers have often
metastasized, or spread to
other organs or throughout
the body.

14. BACKGROUND
 553,400 Americans died of cancer 2001
 1.3 million new cases diagnosed
 1 in 4 deaths from cancer
 Early detection / improvements in technology have
improved prognosis for many.

15. GLOBAL CANCER
STATISTICS (WHO,2001)

16.  The current Indian population is 1,270,272,105 (1.27
billion). The incidence of cancer in India is 70-90 per
100,000 population. and cancer prevalence is
established to be around 2,500,000 (2.5 million) with
over 800,000 new cases and 5,50,000 deaths occurring
each year. More than 70% of the cases present in
advanced stage accounting for poor survival and high
mortality. About 6% of all deaths in India are due to
cancers which contribute to 8% of global cancer
mortality.

17. EPIDEMIOLOGIC TRENDS
 According to Indian Council of Medical Research
(ICMR) data on site specific cancer burden, in males,
the most common are cancers of mouth/pharynx,
esophagus, stomach, lung/bronchi while as in females,
the common cancers are cervix, breast,
mouth/oropharynx and esophagus.

18. CURRENT SCENERIO
 Cancer is a deadly disease, responsible for 2-3% deaths
worldwide annually. There were 10.9 million new cases,
6.7 million deaths and 24.6 million persons living with
cancer around the world in 2002. In women, breast
cancer is most widespread and its incidence in Pakistan
is reported highest among South-Central Asian
countries. About 7.6 million people died due to cancer in
the world during 2007.

19.  According to World Health Organization’s recent
estimate, the cumulative death toll due to cancer will be
12 million by 2030. A total of 16, 38, 910 new cancer
cases and 5, 77,190 deaths from cancer occured in
United States in 2012. In India, around 5, 55,000
people died of cancer in 2010. Cancer cases related
deaths on rise in J&K during past four years with the
total of 11,815 cancer cases and 5,198 mortality cases
have been reported in the state during the current year.

20.  Cancer has remained a major cause of death and the
number of individuals living with cancer is continuing to
expand, but most of the drugs used in cancer
chemotherapy exhibit cell toxicity and can induce
genotoxic, carcinogenic and teratogenic effects in non
tumor cells. Despite the recent advances in surgery,
endocrine therapy, radiotherapy and chemotherapy, it is
considered that the management of cancer is still not up
to the mark and we are in emergent need of drugs for the
treatment of cancer having no side effects. Therefore, the
research for alternative drugs of natural origin, which are
less toxic, endowed with fewer side effects and more
potent in their mechanism of action, is an important
research line.

21. RISK FACTORS
 The predominant risk factors associated with cancers are,
1. Genetic
2. Environmental
3. Life style factors which include tobacco, alcohol, infections
(HIV,HPV,HBV,HCV,H. Pylori) and dietary factors which
overall are involved in 80-90% cases.
 Tobacco contributes directly to about 50% of cancers in
males and 10-15% cancers in females.
 Most of the cancers have some relationship with diet.
Predominant among them are cancer of oesophagus,
stomach, colon & liver.
 Consumption of large amounts of red chillies, food at very
high temperatures and alcohol consumption are the main risk
factors for stomach cancers in India. Consumption of a
tobacco extract “tuibur” and smoked meat have been linked
to a high rates of stomach cancers in Mizoram.

22.  In recent times there has been increase in incidence of
cancer in India as nearly two people are diagnosed
every minute with cancer.
 This is mainly attributed to urbanisation, industrialisation,
life style changes, population growth and increase in life
span.
 In India, life expectancy at birth has risen from 45 years
in 1971 to 62 years in 1991 to 71 years expected by
2021-25 and so has the risk to harbour cancer.

23. TYPES OF CANCER
 Breast Cancer
 One in 8 women
 Risk increases with age
 Risk factors supported by
research
 Prevention (self-exam and
mammography)
 See figure for self-
examination procedure
 Treatment

24.  Colon and Rectum Cancer
 3rd most common in men and
women
 135,400 in 2001 diagnosed
 Warning signals, e.g. blood in
the stool, rectal bleeding.
 Prostate Cancer
 Most common in males today
 189,000 new cases was
diagnosed in 2002
 Estimated 30,200 men died.

25.  Skin Cancer: Sun Bathers
Beware
 1.3 million cases of skin cancer
 Treatable: basal or squamous
 Virulent: malignant melanoma
 Testicular Cancer
 Ages 17-34 at greatest risk
 Cause is unknown
 Undescended testicles present a
great risk
 How and when should men
examine their testicles?

26.  Ovarian Cancer
 4th leading cause of death in young
women
 Enlargement of abdomen common
sign
 Prevention: annual pelvic exams
 Endometrium (Uterine) Cancer
 Pap test for early detection
 Risk: early onset of intercourse
 Warning: abnormal bleeding

27.  Cancer of the Pancreas
 “Silent” disease
 29,700 cases in 2002
 Only 4% survive
 Contributors: inflammation, diabetes, high-fat diet
 Leukemia
 Cancer of blood-forming tissues
 Leads to the creation of immature white blood cells
 Symptoms: fatigue / paleness / weight loss
 Can be acute or chronic
 Lung Cancer
 Killed 164,000 in 2000
 Prevention-researchers theorize: 90% of all lung
cancers could be avoided by not smoking

28.  Cancer of the Mouth
• Oral or oropharyngeal cancer is the
eleventh most common cancer worldwide
with over 300,000 new cases annually.
• Tobacco use, including smokeless tobacco
and excessive alcohol consumption are
estimated to account for about 90% of oral
cancers.
• Usually cancer begins with white patches,
leukoplakia or red patches, erythroplakia,
associated with risk factors such as
tobacco or/and alcohol.
• Tobacco users – smoked, chewing or both
– developed most oral lesions with an
annual incidence rate ranging from
5.2/1,000 to 30.2/1,000, whereas non-user
develop the fewest oral lesions ranging
from 0.6/1,000.
• An increasing number of young people are
being affected and 25% of the cases have
no associated risk factors.

32. OTHER TYPES OF CANCER
 Cancers of Blood and Lymphatic
Systems:
• Hodgkin's Disease
• Leukemias
• Lymphomas
• Multiple Myeloma
• Waldenström's Disease
 Cancers of Digestive Systems:
• Head and Neck Cancers
• Esophageal Cancer
• Stomach Cancer
• Cancer of Pancreas
• Liver Cancer
• Colon and Rectal Cancer
• Anal cancer
 Cancers of Urinary system:
• Kidney Cancer
• Bladder Cancer
• Testis Cancer
• Prostate Cancer
 Miscellaneous cancers:
 Brain Tumors
 Bone Tumors
 Nasopharyngeal Cancer
 Retroperitoneal sarcomas
 Soft Tissue Tumors
 Thyroid Cancer
 Cancers of Unknown Primary Site

33. DETECTING CANCER
 Magnetic Resonance Imaging (MRI)
 Computerized Axial Tomography scanning (CAT
scan)
 Prostatic ultrasound (rectal probe)
 Self-exam and check-ups

35. TREATMENT
 Traditional medicine refers to the application, approach,
knowledge and belief in incorporating plant based properties
in remedies, singularly or in combination, for the purpose of
treating or preventing disease as well as to maintain the well-
being of an individual.
 About 80% of the world population relies on the use of
traditional medicine, which is predominantly based on plant
material. Natural products or related substances or extracts
of folk medicine accounted for 30% of the top 35 worldwide
natural product-based drugs sold.
 As has been estimated that > 50% of all patients diagnosed
with cancer explore complementary and alternative medicine
– especially herbal medicine. Current evidence suggests that
garlic, green tea, tomatoes and soy intake as part of the diet
may be useful in preventing various cancers.

36. RESEARCH ON TREATMENT
 A number of exciting researches suggest that vegetables, fruits, whole
grains, herbs, nuts and seeds contain an abundance of polyphenolic
compounds, terpenoids, sulphur compounds, pigments and other
natural antioxidants, that have been associated with protection from or
treatment of conditions such as cancer.
 The foods and herbs reported to have highest anti-cancer activity
include garlic, soybeans, cabbage, ginger, licorice root and the
umbelliferous vegetables.
 Therefore, we can say that medicinal plants have played a key role in
world health.
 Plants have been a prime source of highly effective conventional drugs
for the treatment of many forms of cancer.
 Out of total 250,000 plant species existing on earth approximately one
thousand have anticancer potential.
 A large number of plant species have been screened through bioassays
for search of novel plant based anticancer drugs.

37. PREVENTING CANCER !

38. IMPACT OF CANCER IN INDIA
 The impact of cancer in India is far greater than mere number
of cancer cases.
 Its diagnosis causes immense emotional trauma and its
treatment a major economic burden.
 The initial diagnosis of cancer is perceived by many patients
as a grave event with more than one-third of them suffering
from anxiety and depression.
 Cancer is equally distressing for family as well. It could affect
both family’s daily functioning and economic situation.
 The economic shock often includes both loss of income and
increase of expenses because of treatment and health care.
 This disease is associated with a lot of fear & despair in our
country.

39. CANCER MANAGEMENT A
CHALLENGE IN INDIA !!!
 According to Boston Consulting Group Study, 60-80% cancer
cases in India are diagnosed late and 60% patients do not
have access to quality treatment.
 There are only 300+ cancer centres in India while as 600
more required to meet the demand.
 About 400 radiotherapy machines are available and 1200
more are required to cover the cancer population adequately.
 Moreover, about 40% centres not equipped with all modern
facilities.
 The group also estimated that India needs 500 PET-CTs and
1000 cancer units by year 2020.
 Doctor patient ratio is 1 in 2000 and currently aim is to
achieve 1 in 1000 by 2021.

40.  There is also disproportionate skilful manpower and
technology in India with cancer specialists, trained staff
and specialized cancer centres available in very few
cities across India.
 For most patients in India, there is no insurance cover
and treatment cost out of reach .
 Thus delivery of equitable, quality and affordable cancer
care in India is a big challenge.

41. REFERENCES
 http://www.dailyexcelsior.com/cancer-scenario-india/
 http://www.dailyexcelsior.com/jammu-botanicals-management-
cancer/
 http://ocf.org.in/professional/IncidenceAndPrevalence.aspx
 http://www.ncdc.gov.in/
 http://www.ccdcindia.org/
 http://www.cdc.gov/cancer/
 http://www.who.int/cancer/en/
 http://globocan.iarc.fr/Default.aspx
 http://www.wcrf.org/int/cancer-facts-figures/worldwide-data