National Cancer Control Program

2. WORLD
 Cancer -12% of deaths throughout the world. In the
developed countries cancer is the second leading
cause
 21% of deaths in the developing countries
 Cancer ranks third as the cause of death an accounts
for 9.5% of all deaths
MAGNITUDE OF PROBLEM

3.  Otis W. Brawley, MD, chief medical officer, of the
American Cancer Society,
 2.6 million of the 7.6 million cancer deaths that
occurred in 2008
 About 7,300 cancer deaths per day

4.  International Agency for Research on Cancer (IARC) in
2008
 12.7 million new cancer cases
 5.6 million-economically developed countries
 7.1 million in economically developing countries
 7.6 million cancer deaths
 2.8 million in developed countries
 4.8 million in developing countries

5. INDIA
Metric Count
Incidence Male 477,482
Incidence Female 537,452
Mortality Male 356,730
Mortality Female 326,100
Prevalence Male 664,538
Prevalence Female 1,125,960

6.  By 2030, the global cancer burden is expected to nearly
double, growing to 21.4 million cases and 13.2 million
deaths.

7. CANCER EPIDEMIOLOGY
 70- 90% - Environmental.
 Tobacco & smoking- 50%
 Dietary practices, reproductive and sexual practices -20-30%

8. Tobacco
 40 to 50% men
 20% to women
 Oral cancers and oral precancerous conditions..

9. DIET
 10-70% of cancers
 Cancers of the upper aero digestive tract (mouth,
throat, oesophagus and lungs), stomach, large
intestine, and breast cancer in women.
 Diet rich in animal proteins
 Smoking and alcohol

10. CANCER OF THE HEAD AND NECK
 Tobacco and alcohol
 Green and yellow vegetables will protect against
oral cancer

11. CANCER OF THE STOMACH
Japanese had the highest rate
Dietary pattern is a risk factor
 Consumption of large amounts of
 red chillies
 food at very high temperatures
 alcohol consumption
Tobacco extract 'Tuibur' cause high rates of
Stomach cancer in Mizoram.
Primary prevention
India

12. CANCER OF THE LARGE INTESTINE
Heavy consumption of red meat can lead to
risk of colon cancer

13. CANCER OF THE BREAST IN WOMEN
 leading cancer in women
Risk factors
 Late age at first pregnancy (greater than 30 years)
 single child
 late age at menopause
 High fat diets during the pubertal age and obesity in the
post-menopausal age are risk factors for breast cancer.

14. CANCER OF THE UTERINE CERVIX
 most common cancer among women in India.
Risk factors
 Early age at first intercourse
 Multiple sexual partners
 Poor sexual hygiene
 Repeated child birth
Prevention
 Regular cervical cytology examination (papsmear) by all
women who have initiated sexual activity

15. RISK FACTORS
 A) Environmental and Life style Factors:
 Tobacco-Lung Ca, Oral Ca
 Alcohol
•Breast cancer in women
• Primary liver cancer
• Ovarian cancer
• Prostate cancer
• Thyroid cancer

16.  Dietary factors
Smoked fish - stomach cancer
lack of dietary fibre- intestinal cancer
beef consumption- bowel cancer
high fat diet to breast cancer
Food additives and contaminants may also be the
causative agents

17.  Occupational exposures
Accounts for 1-5 % of cancers.
Exposure to benzene, arsenic, cadmium, chromium,
asbestos, polycyclic hydro carbons.
 Viruses
HepB & C -hepatic cancer.
HIV- Kaposi Sarcoma.
Ebstein Barr -Burkitt's lymphoma and nasopharyngeal
carcinoma
Hodgkin disease is also believed to be caused by virus.

18.  Parasites- Schistosomiasis in Middle East producing
carcinoma of the bladder.
 Customs, habits & life styles
 Others-sunlight, radiation air pollution and water
pollution, medication; pesticides etc are related to
cancer.

19. B) GENETIC FACTORS
 Retinoblastoma occurs in children of the same
parent
 Mongols are more likely to develop cancer
(leukemia) than normal children.
 However genetic factors are less conspicuous and
more difficult to identify.

20. PATHOPHYSIOLOGY OF THE
MALIGNANT PROCESS
 Disease process that begins when an abnormal cell
is transformed by the genetic mutation of the
cellular DNA
 This abnormal cell forms a clone and begins to
proliferate abnormally,
 The cells acquire invasive characteristics, and
changes occur in surrounding tissues. The cells
infiltrate these tissues and gain access to lymph
and blood vessels, which carry the cells to other
areas of the body.

21. SIGNS AND SYMPTOMS
 LOCAL SYMPTOMS
 Lump or swelling
 Haemorrhage
 Pain or ulceration

22.  SYMPTOMS OF METASTASIS
 Enlarged lymph nodes
 Cough
 Haemoptysis
 Hepatomegaly
 Bone pain
 Fracture
 Neurological symptoms

23. SYSTEMIC SYMPTOMS
 Weight loss
 Poor appetite
 Fatigue
 Cachexia
 Diaphoresis
 Anaemia

24. CAUTION
 C: Change in bowel or bladder habits
 A: 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 a wart or mole
 N: Nagging cough or hoarseness

25. CLASSIFICATION
BSED ON THE TISSUE PRESUMED TO BE
THE ORIGIN OF THE TUMOR…..
 Carcinoma: Malignant tumors derived from epithelial
cells. This group represents the most common cancers,
including the common forms of breast, prostate, lung
and colon cancer
 Sarcoma: Malignant tumors derived from connective
tissue, or mesenchymal cells.
 Lymphoma and leukemia: Malignancies derived from
hematopoietic (blood-forming) cells

26.  Germ cell tumor: Tumors derived from totipotent cells.
In adults most often found in the testicle and ovary; in
foetuses, babies, and young children most often found
on the body midline, particularly at the tip of the
tailbone
 Blastic tumor or blastoma: A tumor (usually malignant)
which resembles an immature or embryonic tissue.
Many of these tumors are most common in children.

27. BASED ON INVASIVE NATURE:
Benign
Malignant

28. BENIGN MALIGNANT
 Grows slowly
 Enlarging and expanding
growth
 Capsule present
 Well differentiated cell
 Recurrence not common
 Metastasis never occur
 Neoplasm is not harmful to
host
 Prognosis is very good
 Grows rapidly
 Infiltrating surrounding
tissues
 Capsule absent
 Poorly differentiated cell
 Recurrence is common
 Metastasis is very common
 Neoplasm is harmful to the
host
 Poor prognosis

29. BASED ON THE TISSUE OF
ORIGIN..
Benign neoplasms
Fibromas ( uterus)
Lipomas ( adipose tissue)
Leiomyomas ( smooth muscle)
Malignant neoplasms
Carcinoma ( epithelial tissue)
Sarcoma ( mesenchyma)
Lymphoma ( hematopoetic)

30. DIAGNOSIS
 Determine the presence of tumor and its extent
 Identify possible spread (metastasis) of disease or
invasion of other body tissues
 Evaluate the function of involved and uninvolved
body systems and organs
 Obtain tissue and cells for analysis, including
evaluation of tumor stage and grade

31. TNM CLASSIFICATION

32. •Cytology studies ( pap smear)
•Chest x-ray
•Complete blood count
•Proctoscopy examination
•Liver function studies
•Radiographic studies
•Computed tomography
•Presence of onco-fetal antigens( CEA, AFP)
•Bone marrow aspiration
•Lymphangiography
•Biopsy

33. MANAGEMENT OF CANCER
 surgery
 chemotherapy
 radiation therapy
 immunotherapy
 monoclonal antibody therapy
 hormonal therapy
 biologic response modifier (BRM) therapy
 complimentary & alternative therapies

34.  CHEMOTHERAPY
Drugs that can destroy cancer cells. It
also referred as ‘ cytotoxic drugs’ which
affect rapidly dividing cells by interfering
with the DNA duplication or the separation
of newly formed chromosomes.

35.  MONOCLONAL ANTIBODY THERAPY
In this, therapeutic agent is an
antibody which specifically builds to a
protein on the surface of the cancer cells.

36.  IMMUNOTHERAPY
It refers to a diverse set of therapeutic
strategies designed to induce the patient’s own
immune system to fight tumor.
Example, intravesical BCG therapy for cancer
bladder

37.  STEM CELL TRANSPLANTATION
A stem cell transplant also called a blood or
marrow transplant is the injection or infusion of
healthy stem cells into your body to replace
damaged or diseased stem cells.
 A stem cell transplant may be necessary if your
bone marrow stops working and doesn't produce
enough healthy stem cells.
 leukemia, lymphoma, multiple myeloma or sickle
cell anemia.

38. PREVENTION OF CANCER
 A) Primordial prevention
 B) Primary prevention of cancer
 C) Secondary prevention of cancer
 D) Tertiary prevention

39. PRIMORDIAL PREVENTION
 Minimize future hazards to health
 Inhibit the establishment factors known to
increase the risk of disease (environmental,
economic, social, behavioural, cultural)
 -Combating tobacco smoking
 -Healthy diets
 -Preventing obesity, supporting sports and
exercise
 -Reducing alcohol consumption
 -Providing vaccination against the Hepatitis B
virus
 -Avoiding the effects of excessive sunbathing

40.  Information on prevention through the schools,
and to promote media coverage, through articles
and programmes, of knowledge on risk factors
and on ways of controlling them.
 Anti- tobacco groups and other NGOs and social
organizations in their educational and
information dissemination efforts.

41. B) PRIMARY PREVENTION OF CANCER
 Control of Alcohol & Tobacco consumption
 Personal Hygiene
 Radiation
 Occupational exposures
 Immunization

42.  Foods, Drugs & Cosmetics
 Air Pollution
 Treatment of Precancerous lesions
 Legislation
 Health Education
 Cancer vaccine

43. C) SECONDARY PREVENTION OF
CANCER
Cancer Registration
Early Detection of cases
Treatment

44. D) TERTIARY PREVENTION
 Aimed at detecting complications and
second cancers in long-term survivors.
 To improve their quality of life.

45. CANCER PREVENTION AND
TREATMENT STRATEGIES FOR INDIA
 Formulated a National Cancer Control
Programme
 control of tobacco related cancers
 early diagnosis and treatment of uterine
cervical cancer
 distribution of therapy services, pain
relief and palliative care

46. PRIMARY PREVENTION AND SCREENING
PROGRAMS
 Most cost effective prevention
 Aims to reduce the incidence of cancer by
risk factor modification

47. ORAL CANCER
 Fifty percent of all cancers in males are tobacco
related and can be prevented by anti-tobacco
programs
 Teen age students need to be targeted
 Legislation has to be enforced for prohibiting
tobacco advertisement and sale of tobacco to
youngsters
 Importance of a healthy diet rich in green and
yellow vegetables and fruits has to be
highlighted.

48. CANCER OF THE UTERINE CERVIX
 Proper genital hygiene and safe sexual practices.
 Cervical cytology (pap smear) screening
 35 to 64 years should undergo regular pap smear
screening.

49. BREAST CANCER
 Mammographic screening
 Regular breast self-examination needs to be
promoted for early detection of breast
cancer.
 Breast self-examination can be propagated
through print and electronic media as well
as through health care personnel in various
settings

50. STRATEGIES FOR EARLY DETECTION
OF COMMON CANCERS IN INDIA
 Pap smear
 Mammography
 Periodic examination

51. APPROACHES TO CANCER CONTROL
 There are four principal approaches to
cancer control:
 1. Prevention
 2. Early Detection
 3. Diagnosis and Treatment
 4. Palliative Care

52. increasing with age
National Cancer Control
Programme

53. EVOLUTION OF NCCP
 1975-76 National Cancer Control Programme was
launched with priorities given for equipping the
premier cancer hospital/institutions. Central
assistance at the rate of Rs.2.50 lakhs was given to
each institution for purchase of cobalt machines.

54.  1984-85 The strategy was revised and stress was
laid on primary prevention and early detection of
cancer cases.
 1990-91 District Cancer Control Programme was
started in selected districts (near the medical
college hospitals).
 2000-01 Modified District Cancer Control
programme initiated.

55.  2004 Evaluation of NCCP was done by
National Institute of Health & Family
Welfare, New Delhi
 2005 The programme was further revised
after evaluation

56. GOALS & OBJECTIVES OF NCCP
 1. Primary prevention of cancers by health
education specially regarding hazards of
tobacco consumption and necessity of genital
hygiene for prevention of cervical cancer.

57.  2. Secondary prevention i.e. early detection and
diagnosis of cancers, for example, cancer of cervix,
breast and of the oro-pharyngeal cancer by
screening methods and patients’ education on self
examination methods.
 3. Strengthening of existing cancer treatment
facilities, which are woefully inadequate.
 4. Palliative care in terminal stage of the cancer.

58. STRATEGIES
1. Prevention and early detection of cancer through
district cancer activities and strengthened IEC
campaign.
2. Development of early diagnostic capacities in
district hospitals.
3. Encouraging public private partnership.
4. Increase capacity for palliative are in cancer

59. 5. Promote research in cancer that would be
relevant to cancer control in India
6. Promote innovation in cancers care and
indigenization of cancer treatment equipment.
7. To promote ‘centers of excellence’ in the field of
cancer management with support to existing RCC
of 20 years of proven track record by providing
financial assistance.

60. 8. To augment comprehensive cancer care facilities
across the country through institutional capacity
building in new and existing regional cancer
centers and through new and existing oncology
wings.
9. Capacity building and training of all personnel in
cancer prevention and early detection to be done for
all categories in phased manner.

61. 10. Health education of the general public
through use of audio, video and print media
regarding prevention and early detection of
cancers.

62. EXISTING SCHEMES UNDER NATIONAL
CANCER CONTROL PROGRAMME (NCCP)

63. 1. RECOGNITION OF NEW REGIONAL
CANCER CENTRES (RCCS)
 To enhance the cancer treatment facilities across
the country and reduce the geographical gap in
the country in the availability of cancer care
facilities, A one-time grant of Rs. 5.00 crores is
being provided for New RCC’s.

64. 2. STRENGTHENING OF EXISTING
REGIONAL CANCER CENTRES
 A one-time grant of Rs.3.00 crores is provided to
the existing Regional Cancer Centres to further
strengthen the cancer care services.

65. ROLE OF THE RCC
 a. The RCCs should provide Comprehensive
cancer treatment services.
 b. There should be a mechanism in place or
proposed, to spread awareness in the community
and among health personnel regarding common
cancers and their early detection/ prevention.

66.  c. The institution should undertake training of
medical officers and health workers, in early
detection and prevention of cancers and
supportive care.
 d. Training of medical officers and health
workers, in early detection and prevention of
cancers and supportive care should be
undertaken by the institution.

67.  e. A referral linkage should be developed between
the RCC and the hospitals under the DCCP so as to
ensure continuity in the treatment chain.
 f. Outreach and research activities in prevention
and treatment of cancers should also be carried
out.
 g. The RCC will have to undergo periodic
monitoring and evaluation to ensure satisfactory
functioning.

68. 3. DEVELOPMENT OF ONCOLOGY WING
 Objective- reducing the geographical gaps in
cancer treatment facilities in the country by
establishing cancer treatment centres in areas
where these are deficient. Government Hospitals
& Government Medical Colleges are provided with
a grant of Rs.3.00 crores for the development of
Oncology Wing.

69.  Provisions under the scheme
 1. Priority for sanction of grant-in-aid would be
given to institutions located in areas where there
are no treatment facilities. First-time grantees will
be given priority over institutions that have
already received grants earlier.
 2. Institutions, which had earlier availed of the
grant at the rates prevailing then, would be
eligible to get the differential amount between the
grant received earlier and the grant admissible
under the revised scheme.

70.  3. Financial Provisions:
a. The selected government institute will be
provided one-time financial assistance of Rs.3 crore
for procurement of any equipment from the list
appended with the document.
b. A part of the grant, not exceeding 30% of the total
grant may be used if required, for construction of
building to house the radiotherapy equipment’s,
patient care units, etc.

71. 4. DISTRICT CANCER CONTROL PROGRAMME
 Launched in 1990-91
 The district programme has five elements:
1. Health education.
2. Early detection.
3. Training of medical & paramedical personnel’s.
4. Palliative treatment and pain relief.
5. Coordination and monitoring.

72.  The District programmes are linked with
 Regional Cancer Centres
 Government Hospitals
 Medical Colleges
 For effective functioning started have one
District Cancer Society..
 that is chaired by local Collector/Chief Medical
Officer.
 Other members are Dean of medical college, Zila
parishad representative, NGO representative
etc.

73. 5. DECENTRALIZED NGO SCHEME
 This scheme has been devised to promote (IEC)
prevention and early detection of cancers.
 NGO will implement these activities under the
coordination of the Nodal Agency, which will be
an RCC or an Oncology wing
 A grant of Rs.8000/- per camp will be provided to
the NGOs for IEC activities.

74. ACHIEVEMENTS
 Regional Cancer Centres:
As of now, there are 27 Regional Cancer
Centres, including 6 NGOs, providing
comprehensive cancer care services. Outreach and
research activities in prevention and treatment of
cancers are carried out by these centres.

75.  Oncology wing:
Support has been given to 82 institutes in
both Government Medical Colleges and
Government Hospitals for development of Oncology
wing. At present there are 246 institutions with
radiotherapy facilities across the country,
including the 27 Regional Cancer Centres.

76.  District Cancer Control Programme:
The District Cancer Control Programme,
which has been developed to initiate awareness
and early detection activities at the district level;
are in place in 28 districts at present.

77.  IEC Activities:
 The programme supports activities of health
magazine ‘Kalyani’ and telecast by Prasar Bharti
targeting especially those living in the most
populous States.
 It is an interactive programme which provides
an interface to the people with experts on
various health and social issues.

78. NEW INITIATIVES:
 India has become the member of international
agency for research on cancer(IARC)
 The pap smear kits and can-scan software
supplied to 12 RCC.
 Onconet India: telemedicine project to connect 27
RCCs and 4 to 5 peripheral centers is being
operationalized.
 Training of cytopathologists and cytotechicians in
the quality assurance in pap smear.
 Participation in health mela and distribution of
health education material.

79.  Postage stamp depicting ‘breast self-examination’
was brought out by department of post on national
cancer awareness day.
 National cancer awareness day is celebrated on the
birth anniversary of Nobel laureate madam curie,
7th November
 Telecast of health magazine ‘kalyani’ in the current
year with cancer and anti tobacco items under the
agreement with prasar bharti & MOHFW.
 Broadcast of health education audio material
developed by CNCI, kolkatta, through FM radio.

80.  Community based Cancer Control Program
carried out with help of WHO:
 Training of health care personnel at district level in
early detection and awareness of cancer.
 Telemedicine in cancer
 IEC activities including National Cancer Awareness
Day celebrated on 7th November.

81. NATIONAL CANCER REGISTRY PROGRAMME
 National Cancer Registry Programme was
launched in 1982 by Indian Council of Medical
Research (ICMR) to provide true information on
cancer prevalence and incidence. Cancer
registration is the process of systematically and
continuously collecting information on
malignant neoplasm.

82. Objectives
1. To generate authentic data on the magnitude of
cancer problem in India;
2. To undertake epidemiological investigations and
advice control measures; and
3. Promote human resource development in cancer
epidemiology.

83. 2 TYPES OF REGISTRIES
1. Population Based Cancer Registry and
2. Hospital Based Cancer Registries

84.  Population based registries:
There are six in number ; 5 in urban areas
( delhi , Bhopal, Mumbai, Bangalore,Chennai) and
one in rural areas ( barshi in Maharashtra).
 Hospital based registries:
At Chandigarh, dibrugarh, thiruvanathapuram,
Bangalore, Mumbai, and Chennai , six hospital based
registries are maintained.

85. CANCER ATLAS
 To bridge the gap, a project of atlas of the cancer
in India was started under WHO-ICMR since 2003
mainly to have an idea of patterns of cancer in
several parts of the country.
 Under this programme ICMR has developed an
Atlas of cancer in India based on the information
collected for the year 2001-02 from 105
collaborating centres to have an idea of the
pattern of cancer across the country.

86. Main objectives:
(i) To obtain an overview of patterns of
cancer in different parts of the country;
(ii) To calculate estimates of cancer
incidence wherever feasible.

87. JOURNAL PRESENTATION
 Indian Journal of cancer
 Title:- Risk factors of female breast carcinoma: A case
control study at Puducherry
 Investigators:-SM Balasubramaniam, SB Rotti, S
Vivekanandam
 Objective: To identify and quantify various demographic,
reproductive, socio-economic and dietary risk factors
among women with breast cancer.
 Study Design: Case control study.
 Study Period : February 2004 to May 2005.
 Study Setting: Departments of Surgery, Medicine and
Radiotherapy of JIPMER

88.  Materials and Methods: Cases were women with
pathologically confirmed breast cancer. Controls
were age-matched women from medicine and
surgery wards without any current breast
problem or previous breast cancer. A total of 152
cases and 152 controls were enrolled. They were
interviewed for parity, breast feeding, past history
of benign breast lesion, family history and dietary
history with a pre-tested interview schedule after
obtaining informed written consent.

89.  Results:The significant risk factors were previous
history of biopsy for benign breast lesion 10.4,
nulliparity 2.4 (1.14-5.08), consumption of fats more
than 30 g/day 2.4 (1.14-5.45) and consumption of oils
containing more of saturated fat 2.0 (1.03-4.52).
 Conclusions: Nulliparity, past history of benign
breast lesion, high fat diet and consumption of oils
with more saturated fats were the risk factors.

90.  Journal name:- Journal of Physiology and Pharmacology
Advances
 Title:- A Case Control Study to Assess Impact of Risk
Factors on Trends of Lung Cancer
 Investigators:- Arunima Gupta, Siddhartha Das,
Shatarupa Dutta, Santu Mondal, Krishnangshu Bhanja
Choudhuri, Sumana Maiti.
 Objective:- Identify impact of risk factors on changing
trends of lung cancer in a case control study

91.  Duration:- 2006 to 2010 included newly diagnosed
patients of histological proven lung carcinoma
attending the radiotherapy department
 Methodology:- For each case, one control was
identified and matched with same sex, age ± 5
years, and unmatched for residence, smoking
status and socioeconomic condition. For
categorical variables, Chi Square and Fisher’ test
and for numerical variables t test and Mann
Whitney tests were used. All univariate analyses
used ANOVA test.

92.  RESULT:-
 During the study period 1524 cases and their controls
were accounted. Change in trend was observed in
patients diagnosed at younger age of 57.48 ± 0.56 years
in 2010 with adenocarcinoma unlike 62.89 ± 1.21 years
in 2006. Females show increase in incidence of lung
cancer in 2010, p value < 0.001 . The “active” smokers
and years of smoking were significantly high among
cases. The incidence of squamous cell carcinoma declined
from 47.4% in 2006 to 15% in 2010 whereas
adenocarcinoma increased, p value 0.001. Significant
change in trend involving younger age at presentation
specially for female who also show increased incidence of
lung cancer has been observed. This hypothesis needs
confirmation through further studies.

93. HEALTH PROMOTION MODEL