Download NEO-ML3- FINAL Gastrointestinal CA

TOBACCO AND CANCERS
OF THE DIGESTIVE TRACT
Mini Lecture 3
Module: Tobacco Effects and Neoplasia
Objectives of the Mini Lecture
GOAL OF MINI LECTURE: Increase students’ knowledge
of the risks of developing cancer associated with tobacco
use.
LEARNING OBJECTIVES:
Students will be able to:
• Identify carcinogens in cigarette smoke and
mechanisms of carcinogenesis
• Understand how tobacco is a risk factor for digestive
cancers, lung cancer, and urogenital cancer
• Appreciate the adverse effects of smoking on cancer
management and the need for smoking cessation
Contents
Core Slides
1.
2.
3.
4.
5.
6.
Tobacco and Digestive Cancers
Tobacco and Digestive Cancer Risk (1)
Tobacco and Digestive Cancer Risk (2)
Smokeless Tobacco and GI Cancers
Alcohol and Smoking: Combined Effects
Alcohol and Smoking: Combined Rehabilitation
CORE SLIDES
Tobacco and Gastrointestinal Cancers
Mini Lecture 2
Module: Tobacco Effects and Neoplasia
Tobacco and Digestive Cancers
Types of digestive cancers caused by tobacco use are:
1. Oral cancers
2. Pharynx
3. Larynx
4. Oesophagus
5. Liver
6. Pancreas
7. Stomach
8. Large intestine
9. Rectum
1. Polesel et al. 2008
Tobacco and Digestive
Cancer Risk (1)
• Smoking is a strong risk factor for
oesophageal squamous-cell
carcinoma and cardia
adenocarcinoma.1
• Individuals who smoke 25 or more
cigarettes per day have a seven-fold
increased risk of oral and pharyngeal
cancer compared with nonsmokers.2
• There is a direct association
between smoking and the risk of
hepatocellular carcinoma.2
1. Lagergren et al. 2000;
2. Pelucchi et al. 2006
www.stjohn.org/MacombIR/Chemoemb/
Tobacco and Digestive
Cancer Risk (2)
• Smoking greatly increases the
risk of dying from stomach
cancer.1
• Even smoking just 2 cigarettes
per day increases the risk of
oral, pharyngeal and
oesophageal in smokers.2
• Those who stopped smoking
remained at increased risk of
colon cancer even if they
stopped over 10 years ago.3
http://www.elements4health.com/images/stories/conditions/digestive-system.jpg
1. American Cancer Society 2002; 2. Polesel et al. 2008; 3. Slattery et al.1997
India
Smokeless Tobacco and
GI Cancers in India
• Over 90% of oral cancer in
India is attributable to tobacco
use.1
• Chewers are also at risk for
stomach cancer.2
www.drugsandpoisons.com/2006_11_01_archive.html
1. Dikshit and Kanhere 2000; 2. Phukan et al. 2005
Alcohol and Smoking:
Combined Effects
• Alcohol is a cancer promoter via one or more of the
following mechanisms:
• Increased permeability of mucosal cells to tobacco
smoke carcinogens due to solubilization by
alcohol;
• Presence of low levels of carcinogenic substances
in alcoholic beverages; or
• Cellular injury produced by ethanol metabolites.
• Alcohol, when combined with cigarette smoke,
significantly increases the risk of cancer in the upper
aero-digestive tract.
1. Schlecht et al.1999
Alcohol and Smoking:
Combined Rehabilitation
• The dramatic added cancer morbidity and
subsequent mortality associated with smoking
and drinking provides a strong argument for
targeting public health campaigns to curb the
effect of both exposures simultaneously.
1. Schlecht et al.1999
The most important health message a doctor
can give to patients is to quit smoking.