Prevention and early detection of cancer

1. Prevention and Early
Detection of Cancer

2. What is cancer?
• Cancer is a group of diseases characterized by uncontrolled
growth and spread of abnormal cells.
• Cancer can be caused by both external factors and internal
factors

3. Cancer Progression
3
Benign Tumour
In situ cancer
Invasive cancer
Metastatic
cancer
Mutations in multiple cancer genes are required for the
development and progression of a single cancer
Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition

4. Stats…
4
Siegel et al: CA Cancer J Clin 2014
http://www.neeman-medical.com/sites/default/files/files/Cancer%20in%20India.pdf Accessed on 28.4.16

5. Good News…
“Two-thirds Of Cancer Deaths Can Be
Prevented”
--JohnSeffrin, CEO
American CancerSociety

6. Prevention and Early Detection
• If people would just do four things -- engage in regular
physical activity, eat a healthy diet, not smoke and avoid
becoming obese – they could slash their risk of diabetes,
heart attack, stroke or cancer by 80%, a new report has
found.
• But less than 10% of the 23,153 people in the multiyear
study -- published in Monday’s Archives of Internal Medicine
-- actually lived their lives this way.
Los Angeles Times, August 11, 2009, Shara Yurkiewicz

7. Prevention & Early Detection
Cancers that can be prevented or detected early by screening
account for at least 50% of all new cancer cases.
Cancer Facts & Figures 2009

8. Cancer Risk Factors
• What is a risk factor?
• Anything that increases a person’s risk for getting a disease
• What is a modifiable risk factor?
• Anything that increases a person’s risk for getting a disease that
can be changed
American cancer society, www.cancer.org

9. Factors Believed to Contribute to Global
Causes of Cancer
9
Kasper et al, Harrison's Principles of Internal Medicine, 19th Edition (2015)
DeVita, Hellman, and Rosenberg’s, Cancer Principles & Practice of Oncology 10th Edition

10. Cancer Risk Factors
• While you can’t change your genetics, there are many things
you can do to lower your risk for cancer
American cancer society, www.cancer.org

11. Reduce Your Risk
• Five lifesaving things you can do:
• Don’t use tobacco
• Maintain a healthy weight and adopt a physically active lifestyle
• Consume a healthy diet with an emphasis on fruits and vegetables
• Protect yourself from the sun
• Get recommended screening tests
American cancer society, www.cancer.org

12. Tobacco Use
• Cigarette smoking is a major cause of cancer
• Smoking may be – active or passive – both are harmful
• Consumption of tobacco in form of khaini, zarda and ghutka
also causes cancer
• Tobacco not only causes cancer but also other diseases
American cancer society, www.cancer.org

13. Tobacco And Cancer: Alarming Facts
• Cigarettes are smoked by over 1 billion people, which is nearly
20% of the world population in 2014. About 800 million of these
smokers are men
• Cigarette smoke contains over 4,800 chemicals, 69 of which are
known to cause cancer
• Tobacco consumption is the second leading cause of death and
fourth leading cause of disease worldwide
• 6 million people die each year because of tobacco consumption,
1.5 million of them in India
• One death every 6 seconds – each year
• Over one in two people in India are exposed to second hand
smoke at home and 29% at public places
• If current smoking patterns continue, it will lead to about 10
million deaths each year by 2020

14. Betelnut use
• Betelnut contains carcinogens
• The nuts kept buried in the ground for lond period leads to
the growth of fungus which is carcinogenic
• People consuming betelnut also have the habit of
consuming tobacco
American cancer society, www.cancer.org

15. Alcohol Use
• Alcohol consumption leads to cancer of oral cavity, pharynx,
larynx, esophagus, stomach, liver
• People who drink also smokes further increasing the risk of
developing cancer
American cancer society, www.cancer.org

16. Maintain a Healthy Weight
• Balancecaloric intakewith physicalactivity
• Avoid excessive weight gainthroughout life
• Achieve and maintaina healthy weight if currently overweight or obese
American cancer society, www.cancer.org

17. Adopt a Physically Active Lifestyle
Adults:
• Engage in at least 30 minutes of moderate to vigorous
physical activity on five or more days a week (45-60 minutes
is preferable)
Children:
• Engage in at least 60 minutes per day on five or more days a
week
American cancer society, www.cancer.org

18. Consume a Healthy Diet
• Watch portion sizes
• Eat 5 or more servings of fruit and vegetables each day
• Chose whole grains
• Limit consumption of processed and red meats
• Barbequed Food
• High fat and high protein food when grilled at high temperature
produces a chemical known to be having carcinogenic effect
• Highly brown and charred food has cancer
causing compounds
American cancer society, www.cancer.org

19. Protect Yourself from the Sun
• Avoid direct exposure between 10am and 4pm when UV rays are the most
intense
• Wear hatsthat shade the face, ears and neck and clothing that covers arms,
legs and torso
• Cover exposed skin with sunscreen of SPF15 or higher
• Avoid tanning beds and sun lamps
American cancer society, www.cancer.org

20. Pollution
• Air Pollution
• May also cause cancer (asbestos)
• Industrial workers are exposed to various chemicals which are
known to be carcinogen
• Water Pollution
• Water may contain a number of cancer causing substance as the
industries dump chemical directly into water or burry them in the
ground
American cancer society, www.cancer.org

21. Virus
• Certain viruses may cause cancer
• Hepatitis –b & c
• Epstein barr virus
• Human Papilloma Virus
• CMV
• These viruses can be transmitted by
• Blood Transfusion
• Use of contaminated needles
• From mother to child during pregnancy or breast feeding
• Sexual intercourse
American cancer society, www.cancer.org

22. Early detection of cancer
• Cancer develops in the body very silently
• Until it comes to certain stage patients lead a normal life
without any complaints
• Initially it produces mild symptoms as found in other
ailments
American cancer society, www.cancer.org

23. Why Early Detection Is Important ?
• Disease detected at early stage produces better results on
treatment and even cure
• Advanced disease shows poor result on treatment
• Advanced disease leads to financial and psychological
burden
American cancer society, www.cancer.org

24. How To Detect Disease Early
• Seven danger signals
• Change in bladder & bowel habits
• Sore throat not healing
• Unusual bleeding or discharge
• Thickening or lump in breast or anywhere
• Indigestion and difficulty in swallowing
• Obvious change in wat or mole
• Nagging cough or hoarseness of voice
American cancer society, www.cancer.org

25. Oral Cancer

26. Oral Cancer – Warning Signs
• Persistent white or red patches, usually painless
• Any persistent lump or swelling
• Risk factors
• Tobacco consumption and alcohol intake
American cancer society, www.cancer.org

27. Treatment of oral cancer
• High cure rates in Stage I and early Stage II by surgery and
radiotherapy alone
• Stage III and IV fare poorly with any treatment
• Treatment modalities:
• Surgery
• Radiotherapy
• Chemotherapy

28. Oral Cancer treatment-Surgery
• Type of surgery depends on the type and stage of the tumor.
• Surgical techniques to treat oral cancer and deal with the side effects
of treatment include:
• Removal of the tumor or a larger area to remove the tumor and surrounding
healthy tissue
• Removal of part or all of the jaw
• Maxillectomy (removal of bone in the roof of the mouth)
• Removal of lymph nodes and other tissue in the neck
• Plastic surgery, including skin grafts, tissue flaps or dental implants to restore
tissues removed from the mouth or neck
• Tracheotomy, or placing a hole in the windpipe, to assist in breathing for
patients with large tumors or after surgical removal of the tumor
• Dental surgery to remove teeth or assist with reconstruction

29. Oral Cancer treatment-Radiation Therapy
• In cancer of the mouth, radiation therapy may be used
alone to treat small or early-stage tumors. More often,
radiation therapy is used after surgery, either alone or with
chemotherapy for more advanced tumors. The method of
radiation treatment used depends on the type and stage of
cancer.
• External-beam radiation therapy
• Internal radiation or brachytherapy

30. Complications of Treatment
• Dry mouth
• Cavities
• Oral communication
with the sinuses
• Difficulties speaking,
drinking and eating
• Malocclusion
• Facial deformities
• Isolation from society

31. Lung Cancer – Warning Signs
• Chronic cough
• Coughing out of blood
• Change in the voice
• Chest pain
• Shortness of breath
• Risk factors
• Smoking
• Exposure to asbestos
• Coal tar derivatives
• Radiation
American cancer society, www.cancer.org

32. Breast Cancer – Warning Signs
• Firm lump
• Small changes in the nipple
• Discharge from the nipple
• Risk factors
• Early menstruation
• Late menopause
• First child after 35 yrs of age
• Childlessness
• Family history - breast cancer
• High fat & low fibre diet
American cancer society, www.cancer.org

33. Breast Cancer-Screening
• Women at average risk should begin annual mammograms
at age 40.
• Clinical breast exams should be part of a periodic health
exam – every 3 years for women in their 20s and 30s and
every year for women 40 and older.
• Women should know how their breasts normally feel so
they can promptly report any changes to their physician.
• Women at increased risk (family history, genetic tendency or
past breast cancer) should talk with their physician about
their options.
American cancer society, www.cancer.org

34. Cervical Cancer – Warning Signs
• Abnormal bleeding between periods
• Bleeding after intercourse
• Prolonged heavy bleeding during menstruation
• Risk factors
• Frequent sexual intercourse at an early age
• Multiple sex partners
• Many children
American cancer society, www.cancer.org

35. Cervical Cancer
• Screening should begin approximately 3 years after a woman begins to
have vaginal intercourse, but no later than 21 years of age.
• Cervical screening should be done every year with regular Pap tests or
every two years using liquid-based Pap tests. At or after age 30,
women who have had three normal test results in a row may get
screened every two to three years. But a physician may suggest
getting the test more often if a woman has certain risk factors such as
human immunodeficiency virus (HIV) infection or a weakened immune
system.
• Women 70 years of age and older who have had three or more normal
Pap test results and no abnormal results in the last 10 years may
choose to stop cervical cancer screening.
American cancer society, www.cancer.org

36. Colorectal Cancer – Warning Signs
• Blood in stool
• Feeling of being bloated
• Change in bowel habits
• Constipation
• Risk factors
• Age over 40
• Family history
• H/o inflammatory bowel disease
• Familial polyposis
• Past h/o of breast or other reproductive organ cancer in female
• High consumption of red meat and low fibre diet
American cancer society, www.cancer.org

37. Colorectal Cancer
• Beginning at age 50, men and women of average risk should
follow one of these screening options:
• Tests that detect polyps and cancer:
• Flexible sigmoidoscopy every 5 years
• Colonoscopy every 10 years
• Double contrast barium enema every 5 years
• Computed Tomographic (CT) colonography every 5 years
• Tests that primarily detect cancer:
• A guaiac-based fecal occult blood test (gFOBT) or fecal
immunochemical test (FIT) every year
• Stool DNA test (interval uncertain)
American cancer society, www.cancer.org

38. Prostate Cancer
• The American Cancer Society recommends that men discuss the
potential benefits and limitations of prostate cancer early
detection testing with their health care provider beginning at
age 50
• Men at high risk should have this conversation at age 45.
• Men at high risk include
• African-Americans
• Men who have a close relative who had prostate cancer before age 65
American cancer society, www.cancer.org

39. Questions?

40. Thank You