smoking and cancer 2
TRANSCRIPT
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Smoking and Cancer
An overview of theRisk
By
Allan R. Handysides, M.B., Ch.B.. FRCPc ,FRCSc, FACOG.
Director, GC Health Ministries Department
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Cancer Male Female
Lip & Oral 27.5 5.6
Lung 22.4 11.9
Larynx 10.5 17.8
Esophagus 7.6 10.3Kidney 3.0 1.4
Bladder 2.9 2.6
Pancreas 2.1 2.3
Relative Risk in the smoking
community
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Attitude of the Patient with
Cancer
Patient feels he or she is diseased
not just a body part
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Declining cancer incidence
in the USA
Declining by 2% annually since1992 This is the number of new
cancers per unit of the population
In 2000,1,220,000 new cases of
invasive cancer
In 2000; 552,200 deaths from
cancer4
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Smoking related deaths
Cancer Males % Females %
Lung 89,000 14 74,600 12
Oral 20,000 3
Bladder 38,300 6 14,900 2
Pancrea
s
13,700 2 14,600 2
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Cancer is the second Leading
cause of death
After 70 years of increasing smokingcancer deaths, the rate began to
decrease in 1997, ie 5 years after theincidence of smoking in the USA began
to decline.
5 year survival rates 39% in 1960-1963went to 61% in 1989-1995 in whites, but
only to 48% in blacks, the racial or
ethnic factors are not clear.
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Diagnosis
Must be tissue based
Staging clinical P/E, Xrays, U/S,C/T etc.
Surgical
T.N.M. systemIncreased use of biological
features, eg. oncogenes, drug
resistance genes,receptors etc. 7
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The number one cancer
reducing activity
Smoking
cessation
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Potential Harvest
400,000 Americans die prematurelyannually
The risk is 1 in3 of dying
prematurely20% of 12-18yr olds smoked a
cigarette in the last month
80% of American smokers started
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Process of cessation
Precontemplat
ion
Contemplation
Activecessation
Precontemplation
Contemplation
Active
cessation
Maintenanc
e
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Cigar vs Cigarette vs
Smokeless
Cigarette smokers tend to
inhale more than cigar smokersSmokeless relates strongly to
oral cancers
systemically absorbedchemicals such as the
nitrosamines cause cancer in
the laboratory animal
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Lung Cancer
Affects 90,000 males and 75,000
females annually 86% of whom willbe dead within 5yrs of diagnosis
THIS IS THE LEADING CAUSE OFCANCER DEATH IN ALL GENDER AND ALL
RACES IN THE USA
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Lung cancerPeak age is 55-65yrs
Accounts for33% of all malecancer deaths and 25% of all
female cancer deathsSmoking cessation efforts have
slowed the rate of cancer deaths in
men now down to 70/100,000males/year
The rate in women continues torise now it is35/100,000 female
population per year.
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Lung Cancer
15% localized to the lung atdiagnosis
25% is spread to the local lymphnodes
55%+ have distant metastases at
diagnosis
SURVIVAL= 50% if localized
20% if regional
14% overall
These poor figures are 100% betterthan 30yrs ago14
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Lungcancer
A Majorhealth
problem
with agrim
Prognosis15
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Major types of Lung cancer
Squamous (epidermoid)
carcinomaSmall cell (oat cell)
Adenocarcinoma
Large cell carcinoma
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Changes in type
Adenocarcinoma has overtaken
squamous as the most prevalent
Small cell carcinoma is most
likely to be spread at the time ofdiagnosis though if caught early
respond well to surgery, radiation
and chemotherapy
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90%OF ALL TYPES OFLUNG CANCER OCCUR INCURRENT OR FORMER
SMOKERS
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Lung Cancer
Concept of PACK YEARS is morerelated to cancer risk
2 packs a day for 20 years = 40 packyears which = a 60-70 fold increasedrisk for carcinoma
Women have a relative risk higherthan men when they get intoheavier smokin patterns 19
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Lung cancer and genetic
changes in pulmonary cellsRegulator genes are damaged by smoking
so that perhaps 10 segments in the DNA
are damaged before a cancer shows up.
Chromosome 3p is involved in nearly all
lung cancers and p53 and rb genes are
damaged in more than 90% of small cell
lung cancers( possibly inherited defects)
Nicotine itself seems to play a strong
carcinogenic role
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Detection requires
Routine Chest X-ray
Awareness that infection may
occur in persons with CA
Tumor may cause dysfunction in
adjacent organsMetastasis may be from the lung
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Para neoplasticsymptoms
AnorexiaCachexia
Weight loss
Fever
Suppressed
immunity 22
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Endocrine syndromes
Hypercalcemia PTH
Hypophosphatemia
Hyponatremia ADH
Electrolyte disturbances ACTH
CoagulopathiesNeurologic/myopathic syndromes
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Oral cancers
Alcohol and Tobacco themajor determinants
Smokeless tobacco
Marijuana, factors likenickel refining, textilefibers, and woodworking
may also play a role
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Chewing tobacco andLeukoplakia
MetaplasiaDysplasia
Leukoplakia
In situ changes
Frank Neoplasia
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Smoking cessation a major
health benefitRates fall in nearly all situations where
smoking cessation is implemented
Prevention even better hence the need towork with the youth.
At risk behavior best modified in a
MENTORsituation
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Smok ing and Cance
Live Longer
Breathe- Free
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