cancer awareness
TRANSCRIPT
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Awareness | Early Detection |Patient Care
Insurance |Rehabilitation |Advocacy |
Research
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CPAA’S PHILOSOPHY
• Awareness & Education
• Early Detection
• Insurance
• Patient Care
• Rehabilitation
• Research
• Advocacy
Total Management of Cancer
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A realistic picture Encourage prevention Promote early detection Remove stigma Integrate cancer patients normal life
Awareness Lectures: 300,000 people educated atSchools, Colleges, Offices, Factories & Residential locations
Awareness & Education
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Diagnostic Check-up at clinics and on-site Camps
2,40,283 healthy individuals screened
6279 camps and clinics498 cancer patients detected
Prevention & Early Detection
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Medical aid Counseling Prostheses Home visits Accommodation Travel abroad Diet supplement Special investigations Free transportation Blood requirements Bone marrow transplant Playgroup for children
Support to patients
Cancer Insurance Policy
12,233 policy holders 208 cancer patients 162 survivors Rs. 44.2 million disbursed
Complete Support given to 3,00,000 cancer patients
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Rehabilitation25,000 patients and families rehabilitated since 1987Products Stationary T-shirts Cards Candles
5-star Hotel linen Breast Prosthesis Jute bags Terracotta statues
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Facts: Cancer Burden: India’s burden is 7.8% of global cases
2012:World: 14.1 million Incidence8.2 mi. death32.6 mi. prevalence19.3 mi. 2025India : 1.1 million incidence682830 deaths1.8 mi. prevalence
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CANCER MYTHS
…IT’S CONTAGIOUS…ONLY AFFECTS OTHERS…ARE ALL THE SAME …CAUSES PAIN…RESULTS FROM INJURY …IS INCURABLE
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CANCER FACTSA realistic picture
about cancerEncourage prevention
wherever possible
Promote early detection at curable stagesRemove stigma and help integrate cancer
patients into a normal life with families
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CANCER IS…
Uncontrolled Autonomous division of cells Resulting in an abnormal growth
Curable if detected early and treated in time
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What Increases Risk of Cancer?
You can’t help it ! Age Sex Race Family History
You can !!Tobacco/ SmokingAlcoholSedentary LifestyleUnhealthy dietObesityInfectionsSun Exposure
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CANCER CAUSATIVE FACTORS» Tobacco Smoking, Smokeless Tobacco
lung, oral cavity, larynx, pharynx, stomach» Alcohol mouth, throat, larynx, breast, bowel, liver,
upper digestive system» Infections - liver, cervical, stomach cancer, lymph/leuk» UV Rays - skin » Diet - bowel & stomach cancer» Obesity - uterus, kidney, oesophagus, stomach, colon,
breast, prostate, gall bladder and pancreas cancer» Lack of exercise – breast, colon » Continuous irritation at the same spot ?? Kangri Cancer
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STAGESNORMAL SKIN TRAUMA
NORMAL
NORMAL CELLS
RECOVERY
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STAGES:ROGUE CELL CANCER CELLS
METASTATICCANCER CELLS
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GenesChromosomes
Nucleus and Cell
What is cancer ?
Little changes can make a big difference!
DNANORMAL CELLS REGULATED GROWTHCANCER CELLS GROWTH
AUTONOMOUS CHROMOSOME ABERRATIONS
NUMERICAL & STRUCTURAL GENES
POINT MUTATIONSDELETIONSINVERSIONS
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CANCER CELLSWhat is cancer ?
Cumulative Damage
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ABNORMAL GROWTH: TUMORS
CONFINED GROWTH
BENIGN MALIGNANT
SPREADS UNCONTROLLABLY
INVADES SURROUNDING TISSUE
METASTASES
GENERALLY – NO RECURRENCE AFTER REMOVAL
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… Does it really make a difference?
Why all the fuss about…
Early Detection of Cancer
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EARLY DETECTION Of Critical Importance
EARLY DETECTION CURABLE DISEASE
LESS INVASIVE TREATMENT LESS TRAUMA LESS PAIN LESS COST
EARLY STAGE 80 – 90 % CURELATE STAGE 20 – 30 % CURESO IT PAYS TO BE VIGILANT!
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PREVENTION STRATEGIES
Common lifestyle related cancers Japan Stomach cancer Scotland Lung cancer Australia Skin cancer India Oral and Cervical cancers
Lifestyle Habits Changes Reduces Cancer Risk
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Common cancers in India
Breast cancer Cervical cancer Oral cancer Lung Cancer Prostate cancer
These are also the cancers with Early Warning Signs
EARLY DETECTION STRATEGIES
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ORALCANCER
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ORAL CANCER
• 90% of oral cancers are lifestyle induced
• ~10% Virus (HPV) induced
• No tobacco habit and tobacco cessation reduces risk of contracting oral cancer
• Unfortunately the habit is rampant in India and finds social sanction
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Early warning signs:
• Red, White or Black patches
• Difficulty in opening the mouth or swallowing
• Persistent sore throat
• Change in voice
ORAL CANCER
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ORAL CANCERAVOIDABLE RISK FACTORS
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ORAL CANCERAVOIDABLE RISK FACTORS
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PAN MASALA
ORAL CANCERAVOIDABLE RISK FACTORS
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SOCIO CULTURAL PRACTICES
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ORAL CANCER AVOIDABLE RISK FACTORS
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ORAL CANCER AVOIDABLE RISK FACTORS
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ORAL CANCER & LUNG CANCERS TOBACCO AVOIDABLE RISK FACTORS
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Healthy Lung
Smoker’s Lung
ORAL CANCERAVOIDABLE RISK FACTORS
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WHAT A CIGARETTE CONTAINS 1000 CARCINOGENS
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TIME IS OF ESSENCE
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CORRELATION BETWEEN SMOKING AND LUNG CANCER
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CIGARETTES & CANCEROralLung LarynxBladderOesophagusPancreas KidneyBreastHeart conditions Peptic ulcers Chronic bronchitisEmphysema
World-wide almost 5 million die prematurely each year as a result of smoking
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ADVOCACY: PACK WARNINGS
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STOP SMOKING NOW!
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BREAST CANCER
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Early Detection : A Saviour !!!
Breast Cancer Not a Preventable Cancer
Early Detection 80-90% cure rate Cervical Cancer
Preventable Cancer!!
Time is of
essence
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Breast Cancer is the most common cancer in urban India
1 in 8 women in the US will get breast cancer
1 in 30 women in Indian metros will get breast cancer
1 in 60 women in rural India will get breast cancer
90% + cure rates in the west 40% cure rate in India
BREAST CANCER: STATISTICS
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Breast Cancer: Increased Incidence
Women > 50 years Obesity Early menarche Late menopause
Late Diagnosis Poor Prognosis
Family history of breast cancer Diet rich in animal fat Late child bearing age Women who have not borne children
Educated Talented Career oriented Stress Desk jobs
Minimal breast feeding Western diet Couch Potatoes Late Marriages Late first child
Risk Factors
Modern Indian women
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Breast Cancer: Detection in Early stages
SELF Personal alertness for changes in breast Monthly breast self examination Women over 20 years
CLINICIAN Annual routine examination Physician for women over 35
yrs MAMMOGRAPHY
Women 40-50 years of age As advised for higher risk groups
BREAST EXAMINATION
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Early Onset Breast Cancer: < 45 years 5 – 12 % breast cancers: women below 45 years Increased risk for Ovarian Cancer: Hereditary
Hereditary Breast and Ovarian Cancer • Genes BRCA1 / BRCA2
Mutation in BRCA1 / BRCA2 genes • 85% lifetime risk Breast Cancer• 67% lifetime risk Ovarian cancer
Ovarian Cancer: Silent Killer• A lethal
cancer in females
• 80% cases: late presentation
• 20% - 5 yr survival rate
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When should I do BSE ?
Once a month Takes about 10 minutes Menstruating women:
1-2 days after menstruation period is over Menopausal women:
same date each month Pregnant women:
same date each month
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Breast Cancer: Treatment Options
Early detection5 year relative survival rate > 90%
Surgery : - Lumpectomy - Mastectomy
Chemotherapy Radiation Therapy Hormone Therapy Targeted / Personalized
Therapy
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CERVICAL CANCER
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Cervical Cancer: World incidence
< 9.3 < 16.1 < 23.8 < 35.8 < 93.9
High Risk Oncogenic Virus HPV: Causative Agent of Cervical Cancer
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CERVICAL CANCER Most common cancer in Indian
women Caused
Human Papilloma virus (HPV) infection
Preventable by simple meansEarlier PAP test
Cervical Cancer Risk Screening HPV DNA PCR Testing Preventable Cancer High Cure Rates with Early Detection
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Screening: Why not just Do PAPs ?
PAP smears / HPV detection Pap smears are not sensitive (52% Sensitivity) Pap smears: Poor reproducibility Most women with an abnormal PAP only:
No cancer indication HPV detection 99.7 % cervical cancer
HPV Indicates Risk
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Cervical Cancer: Risk Factors Early marriage Tobacco Smoking Multiple pregnancies Multiple sexual partners History of sexually transmitted disease Partners with multiple sexual partners Partners with sexually transmitted disease Low socioeconomic status ?
(Poor genital hygiene; more infections; low immunity) Suppression of the immune system steroids,
diseases, HIV
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Cervical Cancer: Symptoms Abnormal vaginal bleeding between periods,
after intercourse or after menopause Persistent white, brown
or blood stained, foul smelling vaginal discharge
Loss of appetite Unexplained weight loss Involuntary loss of urine or fecal matter
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Cervical Cancer: PreventionScreening: HPV Test
Individual: Once in 3 years (5 - 10 years)Masses: One time screening test
Single PartnerAvoid smokingMaintain good hygiene
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HPV vaccines: Beginning of the end2 VACCINES AVAILABLE IN INDIA
Gardasil (MSD) Cervarix (GSK)
Quadrivalent VaccineHPV 16/18 – OncogenicHPV 6/11 – Non-Oncogenic (warts)
Bivalent VaccineHPV 16/18 – Oncogenic
AGE9 -12 years 13 - 26 years > 26 years
(before sexually active)
(after checking for HPV)
(after checking for HPV)
Validated Validated To be validated
DOSAGE• Month 0; Month 2; Month 6• Rs. 10,000/-• Contraindicated: Pregnant women
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PROSTATE CANCER
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PROSTATE CANCER• A sex gland in men• Size of a walnut• Responsible for producing
fluid that sperm travels • Located in front of the
rectum, below the bladder
• Wraps around the urethra
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PROSTATE CANCER: Risk factorsAGE•If you live long enough Prostate cancer
RACE•African-American men 60% Increased Risk•Asian men Low Risk
FAMILY HISTORY•2 relatives with prostate cancer: 5 fold incr. risk•3+ relatives with prostate cancer: 100% life time risk
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PROSTATE CANCER: SymptomsEarly Stages: CAN BE ASYMPTOMATIC• Aching pains in genitals, lower abdomen, lower back• Problems with sexual function• Painful, frequent, urgent urination• Slow urine stream and retention• Blood in the urineAdvanced Stages: • Loss of energy• Persistent swelling in legs• Pain in the back, spine, rib or hip• Hard growth on prostate• Enlarged lymph nodes
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PROSTATE CANCER: Early detection
• Physical Examination Insertion of a gloved, lubricated finger into rectum
• Check for enlargement, lumps and tenderness of the prostate
Digital Rectal Examination
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PROSTATE CANCER: Screening / Early detection
Prostate Specific Antigen (PSA) Testing
• Higher than average PSA levels in the bloodstream is a sign of abnormal cell multiplication in the prostate?
• Is an Indication – Hyperplastic Prostate?
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PROSTATE CANCER: Prevention
Lifestyle Choice
•Obesity•Little physical activity•Smoking•High intake of fatty foods
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WARNING SIGNS OF CANCERChange in bowel habits
A sore that does not heal, particularly in the mouth
Unusual bleeding or discharge, especially in the women after menopause
Thickening or lump in the breast or any part of the body
Indigestion or difficulty in swallowing
Obvious change in size and color of a mole or a wart
Nagging cough or persistent hoarseness
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CANCER PREVENTION TIPS
Do not use tobacco in any formAvoid unnecessary X-raysDrink alcoholic beverages in moderationUse personal protective
clothing/devices in the jobAvoid too much sunlightWatch your diet
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Eat a variety of fruits and vegetables every day. Eat different colored vegetables and fruitsEat a variety of grain products
LOOK BEFORE YOU EAT!
Choose nonfat or low-fat products.Use less fat White meats- chicken, fish.Switch to fat-free milk-skimmed milk
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Several malignancies Prevented
ExercisingEating right, maintaining a healthy weight, no smokingAnd no alcohol
CANCER PREVENTION STRATEGIES
Be proactive, get an annual cancer screening
Don’t wait to get sick before taking action!
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CREATIVE STRATEGIES - DO NOT WORK!
Never had a test!Never been to Doctor! I hate them!Never take medicines!Now all is normal, so stopped medicines!Miracle men and Miracle Medicines! So many of them!I am my own doctor! No fees too!
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Genetic Cancer Etiology
Sporadic [70-75% ]
Strong hereditary component [5-10% ]
Familial orMultifactorial [15-20%
]
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One of the major barriers to
diagnosis and treatment is
STIGMA
STIGMA
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• Global Issue• Cancer = death great social
costs• Not go for diagnosis or talk about it• Ashamed and humiliated• Malignant offensive
STIGMA
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Fears of being blamed for the diagnosisOstracized by friendsFear being left by a loved oneSociety labels someone as
tainted less desirable handicapped
STIGMA
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PSYCHO-ONCOLOGY
Need
Deal
Stigma
Consequences
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THANK YOU
CANCER PATIENTS AID ASSOCIATIONAnand Niketan, King George V Memorial,
Dr. E. Moses Road, Mahalaxmi, Mumbai - 11
Contact: 022- 24924000 E-mail: [email protected] | Website: www.cancer.org.in
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CANCER TREATMENT OPTIONS
• Surgery
• Chemotherapy
• Radiation Therapy
• Biologic or Targeted Therapy
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SURGERY
Important Treatment ModalityCancer Localised
May Prevent, Stage & Confirm Diagnosis
Removes tumors or as muchof the cancerous tissue as possible
Often performed in conjunction with chemotherapy or radiation therapy
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CHEMOTHERAPY
Use of drugs to eliminate cancer cells
Unlike surgery, chemotherapy affects the entire body
Targets rapidly multiplying cancer cells and other types of cells like hair follicle cells, Gastero-intestinal lining, Bone marrow
Side effects include hair loss, Vomiting, Diarrhea
Single modality chemotherapy
Neoadjuvant – Before Surgery
Adjuvant - in conjunction with radiation therapy or biologic therapy
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CHEMOTHERAPY
Oral – Pill or capsules Intravenously (IV)
Generally combination of drugs
Several Cycles
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RADIATION THERAPY
High-energy x-rays kill cancer cells and shrink tumors
Local therapy- only affects cancer cells in the treated area
It works by damaging a cancer cell's DNA, making it unable to multiply. Cancer cells are highly sensitive to radiation and typically die when treated. Nearby healthy cells can be damaged as well, but are resilient and are able to fully recover.
Radiation therapy may be given alone, along with chemotherapy, and/or with surgery.
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RADIATION THERAPY
The total dose delivered to the tumor into a number of daily fractions over a number of weeks.
The primary systems used are Accelerators which deliver a radiation dose of a specific energy, electrically generated, to a depth in the tumor site.
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BIOLOGIC / TARGETED THERAPY
Drugs that target characteristics of cancerous tumors
Some work by blocking the biological processes of tumors that allow tumors to thrive and grow
Others cut off the blood supply to the tumor, causing it to basically starve and die because of a lack of blood
Used in select cancers and not applicable for everyone
Given in conjunction with other cancer treatments
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BIOLOGIC / TARGETED THERAPY
Glivec (imatinib mesylate – VEENAT) for CML
Rituxan or Rituximab treats non-Hodgkin's lymphoma
Herceptin or Trastuzumab treats breast cancer
IL-2 or Interleukin-2 treats certain types of cancer
Interferon alpha treats certain types of cancer
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Thank You