Medical education

1. Dr. Rahul Netragaonkar
Professor
Dept. Of Community Medicine
Zydus Medical College,
Dahod
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2. Contents…
•Introduction
•Problem statement
•Cancer pattern
•Environmental factors
•Genetic factors
•Cancer control
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3. Introduction
•Its a group of diseases
characterized by
•Abnormal Uncontrolled
growth of cells
•Ability to invade adjacent
tissues and even distant
organs
•Cancer can occur at any
site or tissue of the body
and may involve any type
of cells.
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4. Characteristics Of Cancers
•Clonality (arise from a single stem cell that
clones into carcinomatous cells),
•Autonomy (the cell division and growth is
uncontrolled),
•Anaplasia (lack of cell differentiation) and
•Metastasis (distant spread)”
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5. Problem statement
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6. Geographical Distribution of Cancers
Mortality Incidence Rate
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8. Cancer situation: Future Projections
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9. Time Trends…
•Few decades ago, cancer was the sixth
leading cause of death in industrialized
countries;
•Today, it is the second leading cause of
death
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10. India
•Prevalence of cancer in India is estimated to be 3. 9
million and reported incidence to be about 1.1 million.
•The age standardized incidence is estimated to be
about 150-200 per 100,000 population
•Five most frequent cancers in men were cancer lung,
lip and oral cavity, stomach, colorectum and other
pharynx,
•In women, cancer breast, cervix uteri, colorectum,
ovary, lip and oral cavity.
•91% cases of oropharynx is due to Tobacco use
•60% cases in female are breast, cervix and ovary cancer
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11. Top Ten Cancers in India
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14. Types Of Cancers
•Carcinomas: Arise from epithelial cells lining
the internal surfaces of the various organs
(e.g. mouth, oesophagus, intestines, uterus)
and from the skin epithelium
•Sarcomas: which arise from mesodermal cells
constituting the various connective tissues
(e.g. fibrous tissue, fat and bone)
•Lymphomas: myeloma and leukaemias
arising from the cells of bone marrow and
immune systems.
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15. •The term “Primary tumour" is used to denote
cancer in the organ of origin,
•while “Secondary tumour" denotes cancer
that has spread to regional lymph nodes and
distant organs.
•When cancer cells multiply and reach a
critical size, the cancer is clinically evident
as a lump or ulcer localized to the organ of
origin in early stages.
•As the disease advances, symptoms and
signs of invasion and distant metastases
become clinically evident
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17. •Respiratory tract cancer is most
common site of cancer in India,
Indonesia, srilanka and Thailand
•Cancer of cervix is most common in
India and Indonesia
•Cancer associated with tobacco
constitute 44.6% of cancer in men and
20% in female
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18. Cancer Patterns
•There are lot of international variations in the pattern of
cancer which are attributed to a number of factors such as
•Environmental factors
•Food habit
•Lifestyle
•Genetic factor
•Inadequacy in detection and reporting of cases
•Cancer in males were mostly tobacco related.
•In women, cervical cancer is closely associated with
poor genital hygiene, early consummation of
marriage, multiple pregnancies, and contact with
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19. Environmental factors
•Tobacco
•Tobacco in various forms of usage can cause cancer of
lungs, larynx, mouth, pharynx, esophagus, bladder,
pancreas and probably kidney
•Cigarette smoking is now responsible for more than 1
million death each year
•Alcohol
•Excess intake of alcohol can cause esophageal and
liver cancer
•Beer consumption may be associated with rectal
cancer
•Alcohol contributes about 3 % of all cancer deaths
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20. Dietary Factors
•Smoked fish is related to stomach cancer
•Dietary fiber to intestinal cancer
•Beef consumption to bowel cancer
•High fat diet to breast cancer
•Food additives and contaminants have fallen under
suspicion as causative agents
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21. Occupational Exposures
•These includes exposure to
•Benzene, Cadmium, Arsenic, Chromium,
Vinyl Chloride, Asbestos, Polycyclic
hydrocarbons, etc.
•The risk of occupational exposure is said to be
increased if the individual also smokes cigarette
•Occupational exposure is usually reported 1-5% of
human cancer
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22. Viruses
•Hepatitis B & C Virus- Hepatocarcinoma
HIV infection – kaposi’s carcinoma
AIDS – non Hodgkin’s lymphoma
•Epstein – barr virus – Burkitts lymphoma and naso –
pharyngial carcinoma
•Cytomegalovirus – Kaposi’s Sarcoma
•Human Pappiloma virus – cervix
cancer
•Human T cell leukemia virus – T cell leukemia
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23. Parasites
•May be a cause of cancer
•Schistosomiasis can produce Ca. of bladder
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24. Customs, habits and life style
•May be associated with
an increased risk of
cancer Smoking and lung
cancer
•Tobacco and beetle
chewing and oral cancer
•Paan Masaala
•Alcohol consumption
itself is a risk factor
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25. Genetic Factors
•Genetic influences have long been suspected
Retinoblastoma occurs in children of the same
parent
•Mongols are more likely to develop leukemia
•There is probably a complex relationship
between hereditary susceptibility and
environmental carcinogenic stimuli in the
causation of cancer
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26. Others
•Sunlight, radiation, water and air pollution,
medication and pesticides
•These are related to cancer as environmental
factors
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27. Cancer Control
•It consists of
•Prevention,
•Early Detection,
•Diagnosis, Treatment,
•after care and Rehabilitation,
•Reducing incidence and Prevalence
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28. Primary control
•Reducing the exposure to the risk factors
• CONTROL OF TOBACCO AND ALCOHOL CONSUMPTION
•Control of these two will reduce the total burden of
cancer by 1 million cases per year
Personal Hygiene
•Improvement in hygiene may decline the
incidence of certain types of cancers like Ca. Cx
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29. Radiation
•Effort should be made to reduce the amount of
radiation received by each individuals to a
minimum without reducing the benefits
Occupational Exposure
•Should protect workers from exposure to industrial
•Carcinogens
•IMMUNIZATION : Against Hepatitis B virus and
for prevention of cancer cervix immunization
against HPV
Prevention
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30. •Food Drugs & Cosmetics
•Should be tested for carcinogens
•Air pollutions
•Control of air pollution is a preventive measure
•Treatment of pre cancerous lesions
•Early detection and prompt treatment of precanerous
lesions such as cervical tears, intestinal
polyposis, warts, chronic gastritis, chronic
cervicitis, and adenomata is one of the
cornerstones of cancer prevention
•Legislation
•It comes under primary prevention Tobacco &
alcohol restrictions
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31. Cancer Education
• Should be directed in high risk groups
• To motivate people for early diagnosis and treatment
Remind early warning symptoms
•Lump or hard area in the breast
•Change in a wart or mole
•Persistent change in digestive and bowel habits
•Persistent cough or hoarseness
•Excessive loss of blood at the monthly period or loss
of blood outside the usual dates
•Blood loss from any natural orifice
•Swelling or sore that does not get better
•Unexplained loss of weight.
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32. Secondary Prevention
•Cancer registration
•Hospital-based registries
•Population based registries
•Early detection of cases Treatment
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33. CANCER SCREENING
•a) Mass screening by comprehensive cancer detection
examination: A rapid clinical examination, and
examination of one or more body sites by the physician is
one of the important approaches for screening for cancer.
•(b) Mass screening at single sites : This comprises
examination of single sites such as uterine cervix, breast
or lung.
•(c) Selective screening : This refers to examination of
those people thought to be at special risk, for example,
parous women of lower socio-economic strata upwards of
35 years of age for detection of cancer cervix, chronic
smokers for lung cancer, etc.
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34. •Screening for cancer cervix: By PAP
Smear
•Screening for breast cancer – By
BSE method
•Screening for lung cancer By X ray
chest or Cytology
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36. Oral Cancers
• Oral cancer is one of the ten most common cancers in the world.
• Its high frequency in Central and South East Asian countries
(e.g. , India, Bangladesh, Sri Lanka, Thailand, Indonesia,
Pakistan)
• In year 2018 (September), about 246,420 men and 108,444
women were having oral cancer. About 119,693 men and 57,691
women died of oral cancer worldwide with a mortality rate of
2.2 per 100,000 population
• Alcohol : Data indicates that oral cancer can also be caused by
high concentrations of alcohol, and that alcohol appears to have
a synergistic effect in tobacco users
• High-risk groups: These include tobacco chewers and smokers,
bidi smokers, people using tobacco in other forms such as betel
quid; people who sleep with the tobacco quid in the mouth
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37. Breast cancer
•Commonest cause of death in middle aged women
Causes 5,19,000 deaths a year worldwide
•About 9 lakh women are diagnosed every year
Mortality rates have increased during the past 60
years in all countries
•Breast cancer is proportionately on the
increase in a few metropolitan areas of India.
•This appears to be related to late marriage,
birth of the first child at a late age, fewer
children, and shorter periods of breast-feeding
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38. Risk factors
•Age
•Uncommon below the age of 35
•Incidence increased rapidly between ages of 35
and 50 There is a dip in incidence at the time of
menopause
•A secondary rise in frequency occurs after the age
of 65
•Women who developed their first breast cancer
under the age of 40 have 3 times the risk of
developing a second breast cancer
•Mean age of occurrence in Indian women is 42
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39. Family History
•High in those with positive history in their family
•Esp. if mother or sister has developed breast cancer when
premenopausal
•Parity
•Unmarried women tend to have more breast tumors than
married
•Single women and nulliparous women have the same risk
•Related to age at which women bear their first child
Those who had their first child in the late thirties are at a
higher risk than multiparous women
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40. Age at Menarche and menopause
•Early menarche and late menopause are
risk factors
•Risk is reduced for those with surgically
induced menopause
•Forty or more years of menstruation doubles
the risk of breast cancer as compared with 30
years
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41. Hormonal Factors
•Elevated levels of estrogen and progesteron are
important factor in increasing breast cancer risk
•Prior breast biopsy
•Prior breast biopsy for beningn breast diseases is
•associated with increased risk of breast cancer
•Diet
•Breast cancer can be linked with high fat diet and
•Obesity
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42. • Socio Economic Status
• It is more common in higher socio-
economic groups
• Age factor
• Other
• Radiation
• Women exposed to radiation may develop
breast cancer
• Oral contraceptic pills
• Prolonged use of pills before first pregnancy
and before the age of 25yrs can cause breast
cancer
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43. Treatment
•External Beam Radiation
•A beam of radiation is focused onto the affected
area by an external machine. The treatment is
usually given five days a week for five to six
weeks.
•Brachytherapy
•This form of radiation involves radioactive seeds
or pellets that are implanted into the breast next
to the cancer.
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44. Prevention
•Primary Prevention
•Aim should be towards elimination of risk factors
Promotion of cancer education
•Increase the average of menarche by reducing
childhood obesity and increased stannous physical
activities
•Or decrease the frequency of ovulation by increased
stannous physical activities
•The ‘Angelina Jolie Gene’ Breast Cancer (BRCA)
Gene Test
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45. Preventative surgery (prophylactic
mastectomy)
• Preventative surgery
(prophylactic mastectomy) may
also prevent breast cancer.
• Bilateral prophylactic
mastectomy is the removal of
both breasts in order to prevent
breast cancer.
• Women with a strong family
history and BRCA1 or BRCA2
mutations may choose to have
bilateral prophylactic
mastectomy in order to lower
their risk of developing breast
cancer.
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46. Secondary Prevention
•Screening leads to early diagnosis which
influences treatment
•To detect recurrence as early as possible
•To detect cancer in opposite breast at an
early stage To generate research data that
might be usefull
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47. Cancer Of The Cervix
•Second most common disease in women 5,24,000
estimated new cases in in 1995
•Most common in developing countries Which
accounts around 80% of cases
•In India, cancer cervix constitutes 14 % of all cancer
incidence among women
•Cases and death rates are declined markedly in the last 40
yrs due to reduction of the risk factors and extensive
screening programs
•Cervical cancer is closely associated with poor genital
hygiene, early consummation of marriage, multiple
pregnancies, and contact with multiple sexual
partners
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48. Natural History
• The disease (a progressive course)
• Normal epithelium
• Dysplasia
• Cancer in situ (persists for 8yrs) Invasive cancer
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49. Causative agent
•Human papiloma virus-sexually
transmitted-cancer This virus is
found in more then 95% of the
cancers
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50. Risk Factors
•Age-
•Affects relatively young women
•Age of 25-45 yrs has increased incidence
•Genital warts
•Past or present occurrence of clinical genital warts
has been found to be a important risk factor
•Early marriage
•Early marriage, early coitus, early childbearing and
•repeated childbirth have increased risk
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51. •Oral Contraceptive Pills
•Using of pills can cause cancer of
cervix It is because of high level of
estrogen
•Socio-economic class
•More common in lower socio-economic
groups
•It is because of poor genital hygiene
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52. Prevention
•Primary Prevention
•Personal hygiene and birth control
•Secondary Prevention
•Early detect of cases through screening
•Treatment by radical surgery and
•Rradiotherapy
•Chemotherapy
•It is difficult to cure once the symptoms are
develop
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53. Lung cancer
•In India 8.4 per 100,000
population;
•For men 12.6 per 100,000
population and
•women 4.3 per 100,000
population.
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54. Stomach cancer
•Stomach cancer remains an important
cancer worldwide and is responsible for
over 1 million new cases in 2018 and
•An estimated 783,000 deaths, equating
to one in every 12 deaths globally,
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59. Thank
You!
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