CanCer : Can be CanCer : Can be Conquered Conquered

Dr. kundan Surgical Oncologist

Rajiv Gandhi Cancer Institute & Research Centre,Niti Bagh Delhi

What is cancer?

• All cancers derive from single cells that have acquired the characteristics of continually dividing in an unrestrained manner and invading surrounding tissues.

Human melanoma cell undergoing cell divisionCredit: Paul Smith & Rachel Errington, Wellcome Images

MISGUIDEDCELL

Cancers develop because of a complicated interaction between our genes the environment and the chance.

Cancer can affect people of all nationalities and age groups

but 60% of cancer deaths occur in people older than 60 years

Lifetime Probability of Developing Cancer for Men

Lifetime Probability of Developing Cancer for Women

The image of the normal colon tissue, at left, shows well-formed oval-shaped glands, evenly lined with a single, organized layer of cells indicated by arrows. The image of the cancerous colon tissue, in contrast, shows highly disorganized cancer cells stacked upon each other in

an apparently random fashion.

What does cancer look like?

Cancer is contagious!?!

Cancer can be caused by a blow to the body!?!

Burden of Cancer

• One in eight deaths worldwide is due to cancer. Worldwide, cancer causes more deaths than AIDS, tuberculosis, and malaria combined

• 12.4 million incidence of cancer was estimated and 7.6 million deaths estimated due to cancer in 2008 worldwide

Burden

– Carcinoma

• Arises from the epithelial cells lining the internal surface of various organs (e.g. mouth, oesophagus, uterus)

– Sarcoma

• Arises from the mesodermal cells constituting the various connective tissues (e.g. fibrous tissue, bone)

– Lymphoma, myeloma and leukemia

• Arising from the cells of the bone marrow and immune system

Major categories of cancer

Cancer progression

Benign Tumour

In situ cancer

Invasive cancer

Metastatic cancer

Mutations in multiple cancer genes are required for the development and progression of a single cancer

Risk Factors

• Non Modifiable- Age- Sex- Genetic factor

• Modifiable- Tobacco- Chronic infection- Alcohol drinking- Occupational exposure- Dietary factors- Obesity and physical

exercise- Radiation

Tobacco Consumption

- Main single cause of human cancer worldwide

- Accounts for 30% approx of all human cancer in developed countries

- Responsible for 13 types of cancer: lung, oral cavity, nasal cavity and nasal sinuses, pharynx, larynx, oesophagus, stomach, pancreas, liver, urinary bladder, kidney, uterine cervix and myeloid leukaemia

- Any form of tobacco are risk( smoking, SHS, chewing)

- Benefit of quitting tobacco in adulthood for all kind of major cancer

worldl cancer report, 2008 IARC

Alcohol Drinking

- Global burden of cancer attributed to alcohol -3.6%

- A causal association has been established between alcohol drinking and cancers of the oral cavity, pharynx, larynx, esophagus, liver, colon, rectum and, in women, breast

- For all cancer sites, risk if the function of amount of alcohol consumption

oxford text book of public health, 5th edition

Dietary Factors, Obesity and Physical activities

- Responsible for 25% of human cancers in high income countries but exact role of dietary factors for causing cancer remains largely obscure

- Increased weight gain is associated with cancer of colon, gall bladder, postmenopausal breast, endometrium, kidney and esophagus

- Increasing physical activities decrease the risk of the breast and colon cancer

oxford text book of public health, 5th edition

• Dietary factor– 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

• 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

Genetic factors

Biological factor: virus

• HPV is a cause of cervical cancer

• Proteins from the virus activate and deactivate cancer genes

• The role of HPV in cervical cancer has led to the development of vaccines HPV in cervical epithelium

Credit: MRC NIMR, Wellcome Images

• Virus– Hepatitis B & C - hepatocarcinoma– HIV infection – kaposi’s carcinoma– AIDS – non Hodgkin’s lymphoma– Epstein – bar virus – Burkitts lymphoma and naso

– pharyngial carcinoma– Cytomegalovirus – Kaposi’s Sa– Pappiloma virus – cervix cancer– Human T cell leukemia virus – T cell leukemia

• 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

• Others– Sunlight, radiation, water and air

pollution, medication and pesticides– These are related to cancer as

environmental factors

The Seven Warning Signs of CancerThe Seven Warning Signs of Cancer

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• It consists of prevention, detection, diagnosis, prevention, detection, diagnosis, treatment,treatment, after care and rehabilitation, reducing incidence and prevalence

• Primary control – Reducing the exposure to the risk factors– Control of Tabaco and alcohol consumption• Control of these two will reduce the total burden of

cancer by 1 million cases per year

Cancer control

• Personal hygiene– Improvement in hygiene may decline the incidence of

certain types of cancers

• 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

• Food, drugs, and 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• Legislation– It comes under primary prevention

• Cancer registration– Hospital-based registries– Population based registries

• Early detection of cases• Treatment

Secondary Prevention

Screening/Early Detection Techniques

• Screening should begin approx. 3 years after marriage, but no later than 21 years old.

• Pelvic Exam• PAP Test

Treatment

• Multimodality• Surgery• Chemotherapy• Radiotherapy

Take Home Message

• Cancer affects everyone • Prevention and early

detection are key

• Keeping eye on sign & symptoms

• Discuss with health care providers

• Screening• Get involved