Download Cancer - Yengage

Basic information
• PowerPoints in Yengage: Community Medicine : III
Year MBBS- 2013 Regular
• Assignments
• Chapters to be covered:
Non-Communicable Diseases (Lecture+Tutorials)
Demography, Family Planning
Preventive medicine in obstetrics, paediatrics,
geriatrics
Mental Health
Genetics
Disaster
Cancer
Dr. Pracheth R,
Department of Community Medicine
Outline
• What is cancer ?
• Important types
• Causes
• Prevention
• Screening
Definition
• Abnormal growth of cells
• Invade adjacent tissues, distant organs
• Carcinomas: arise-epithelial cells : internal
surfaces of organs
• Sarcomas: mesodermal cells-connective tissues
• Lymphomas, myelomas, leukaemias
Problem Statement: World
• 12.7 million people., 7.6 million deaths
• Large variation: different regions
• Lung cancer: most deaths
• Highest : affluent societies
India
• 9.4 lakh new cases
• Men: lung, oral cavity, pharynx, oesophagus,
stomach
• Women: cervical, breast
• Screening, management: limited
Time trends
• Earlier: sixth leading cause death
• Second leading cause now
• Longer life expectancy
• Rise in cigarette smoking
Causes
Environmental: tobacco
Continued….
• Alcohol
• Dietary factors
• Occupational: benzene, arsenic, cadmium,
asbestos
• Viruses: Hepatitis B, C, HPV, EBV
• Parasites: schistosomiasis-bladder
• Lifestyle
• Radiation
Continued…..
Genetic:
• Retinoblastoma
• Leukaemia: Mongols
• Difficult to identify
Cancer Control
• Primary prevention:
Control of tobacco, alcohol
Personal hygiene
Radiation
Occupational
Immunization
Treat Pre-cancerous lesions
Legislations
Continued……
Cancer education: motivate-early diagnosis,
treatment *
Lump/hard area
Change: wart/mole
Persistent change: bowel, bladder
Persistent cough/hoarseness
Excessive/unexplained bleeding
Sore: does not heal
Unexplained weight loss
Continued……
• Secondary prevention:
Cancer registration:*
Assess magnitude, plan services
Incidence
Time trend
1. Hospital based
2. Population based: area
Continued…..
Early detection
Treatment
Cancer screening
• Search: unrecognized malignancy-rapidly applied
tests
• Best possible protection
• Pre-malignant lesions
• Begin: localized lesions
• 75%: accessible body parts
Methods of cancer screening
• Mass screening: comprehensive cancer
detection examination
• Mass screening of single sites
• Selective screening
Screening for Cancer Cervix
• CA-in-situ: Pap Smear: beginning, every 3 years
• Periodic pelvic examination
• Visual Inspection: 5% Acetic Acid
• With Magnification
• Well-defined opaque aceto-white lesions near
squamo-columnar junction
• Hospital: investigation, management
• Colposcopy: same visit
• Pap- smear, biopsy: back up
Breast cancer screening
• Breast self examination:
Start: 40 years
One fixed day every month
How to perform ?
When to consult a doctor
Painless Lump
Skin dimpling
Skin changes
Inverted nipple
Nipple discharge
Armpit swelling
Continued…..
• Palpation by physician
• Mammography: yearly starting at 50 years
• Most sensitive
Exposure to radiation
Equipment, skills
Biopsy: false positive
Oral Cancer
• One of the ten most common cancers
• India: 9.8/1 lakh
• Males> Females
• Epidemiology:
Tobacco: 90%, side of the mouth
Alcohol
Pre-cancerous stage
High-risk group
Continued….
Cultural: bidi, hookah, snuff
Most common: betel quid: betel leaf, arecanut,
lime, tobacco
Mixture (khaini): mouth-small amounts
AP: epidermoid carcinoma of hard palatereverse smoking cigar (chutta)
Prevention
• Primary: education, legislation
• Secondary: early detection, surgery,
radiotherapy
• Primary health workers : link
Cancer cervix
• Second most: women
• Developing countries: most common: 88%
• India: number one killer-women
• Disease:
Normal epithelium-dysplasia-CA in situ-Invasive
cancer
• HPV: 90%, multiple partners, personal hygiene,
necessary but not sufficient
Risk factors
Continued….
• Age: increases from 25 to 45, falls off
• Genital warts:
• Prevention and control:
Primary: personal hygiene, education
Secondary: Radical surgery, chemotherapy
Prognosis: depends on stage
Breast cancer
• Most frequent cancer: women
• Developed, developing
• India: 1 lakh new cases; 12%: malignant
Risk factors
• Age: 35 and above, bimodal
Suppose under 40: second- three times
Indian: decade earlier
• Family history: mother/sister-premenopausal
• Parity: Delayed late thirties-high risk
Unmarried
Continued…..
• Early menarche, late menopause
Elevated oestrogen, progesterone
• Diet: high fat, obesity
• High socio-economic status
Prevention
• Primary:
Age at menarche increased: reduce obesity,
increase physical activity
Diet, weight control
• Secondary:
Early diagnosis, treatment
Follow-up: recurrence
Lung cancer
• Most common: men
• High fatality
• India: 58,000 new cases (90% men): 51,000 died
Risk factors
• Age and sex: 1/3 deaths below 65 years
• Smoking:
Number, age of starting, nicotine, tar content,
length of cigarettes
Passive smoking
Tar, carbon monoxide, nicotine
Interfere: myocardial oxygen delivery-CVD
Bidi: more carcinogens
Continued…
• Air pollution
• Occupational: asbestos, arsenic
Prevention
• Primary:
Education
Legislation: COTPA
Smoking cessation
• Secondary:
Early detection: chest X-ray, sputum cytology
Less attractive , most expensive
NPCDCS- Cancer component
• Launched: 1976
• Integrated: 2010
• Objectives:
Primary: education
Secondary
Tertiary: strengthen institutions
Schemes
• Regional Cancer Centre Schemes
• Oncology Wing Development Scheme
• NGO involvement
• IEC activities
• Research, training
Services
• Diagnostic, surgery, chemotherapy, palliative
care
• Each district: Rs.1 crore:
Chemotherapy drugs
Facilities: investigation, treatment
Questions
• Short essays (3 marks):
Warning signs of cancer
Primordial prevention of cancer
Cancer registries and uses
Early detection of cancer
Screening for cancer cervix
Screening for cancer breast
Passive smoking
Measures to prevent smoking