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Cancer
The document discusses the epidemiology of cancer, identifying it as a leading cause of morbidity and mortality worldwide with significant regional variations. It outlines various types of cancer, their incidence rates, and contributing factors such as tobacco and alcohol use, dietary habits, occupational exposures, and genetics. Moreover, it emphasizes the importance of prevention strategies, including primary and secondary prevention efforts, as well as national initiatives in India aimed at cancer control and education.
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Cancer
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- 2. Cancer • Cancer isa group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body.
- 3. CATEGORIES OF CANCER Carcinoma •Arises from the epithelial cells lining the internal surface of various organs (e.g. mouth, esophagus, 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
- 4. Signs/symptoms 1. Lump orhard area in the breast 2. Persistent change in digestive and bowel habits 3. Persistent cough or hoarseness 4. Excessive loss of blood at the monthly period or loss of blood outside the usual dates 5. Blood loss from any natural orifice 6. A swelling or sore that does not get better 7. Unexplained loss of weight 8. A sore that doesn’t heal. 9. Coughing up blood; 10. Blood in urine;
- 5. Burden of thedisease- WORLD • Cancer is one of the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases in 2012. • The number of new cases is expected to rise by about 70% over the next 2 decades. • Cancer is the second leading cause of death globally, and was responsible for 8.8 million deaths in 2015. Globally, nearly 1 in 6 deaths is due to cancer. • Approximately 70% of deaths from cancer occur in low- and middle-income countries. • The overall age standardized cancer incidence rate is almost 25% higher in men than in women, with rates of 205 and 165 per 100,000, respectively
- 6. Conti… • In termsof incidence, the most common cancers world-wide are those of lung (12.3% of all cancers), breast (10.4%) and colon rectum (9.4%). • Lung cancer is the largest single cancer in the world (1.1 million annually). • By 2020, the new cases are expected to reach at least 15 million a year and deaths 10 million. The projection of new cases of cancer per year, for 2020, is 6 million and 9.3 million respectively from developed and developing countries.
- 7. Burden of thedisease-INDIA • Approximately 8lakh new cases of cancers are expected to occur every year. Large majority of these are tobacco related and hence potentially preventable. • It has been estimated that 48% of cancers among men and 20% in women are due to tobacco. • Cancer incidence in India is estimated to be around 70 - 90 per 100,000 populations with 700,000 - 900,000 new cases of cancer every year.
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- 9. LUNG CANCER • Lungcancer is the most common tumor worldwide, with 900,000 new cases each year in men and 330,000 in women. It is leading causes of death from cancer. In India also, it is the commonest form of cancer among males. • In men more then 80% of lung cancer cases are caused by smoking; in women the attributed risk is less (45% worldwide). • Some occupational exposures and air pollution (including passive tobacco smoke) make a minor contribution to incidence.
- 10. BREAST CANCER • Breastcancer is the second most common cancer, affecting women, with more than 1 million cases occurring worldwide annually. • Belgium had the highest rate of breast cancer, followed by Denmark and France. • In India, it is the second commonest cancer among females.
- 11. COLORECTALCANCER • Colorectal canceris the third most common cancer, with 1.4 million new cases diagnosed in 2012. • In India, the annual incidence rates for Colorectal in men 4.1 per 100000And in women is 3.9 per 100000. • Colon cancer ranks 8th and rectal cancer ranks 9th among men.
- 12. PROSTATE CANCER • Prostatecancer is the fourth most common cancer, with 1.1 million new cases diagnosed in 2012. • France had the highest rate of prostate cancer, followed by Norway and France. • Prostate Cancer Is The Leading Cancer In India. The 5-year survival rate for prostate cancer in India is 64%. • Prostate cancer is one among the top ten leading cancer in India. It usually affects men in the age group of 65+ years
- 13. STOMACH CANCER • canceris the fifth most common cancer, with 952,000 new cases diagnosed in 2012. • The Republic of Korea had the highest rate of stomach cancer, followed by Mongolia and Japan. • The incidence of Stomach cancer in India is low compared to developed countries.
- 14. LIVER CANCER • Livercancer is the sixth most common cancer, with 782,000 new cases diagnosed in 2012. • Mongolia has the highest rate of liver cancer. • Liver cancer is emerging as one of the fastest spreading cancers in India. India sees about 3-5 cases of liver Cancer per 1,00,000 people.
- 15. CERVICAL CANCER • Cervicalcancer is the seventh most common cancer, with 5,28,000 new cases diagnosed in 2012. • About 84 per cent of cervical cancer cases occurred in less developed countries. • In India, cervical cancer contributes to approximately 6–29% of all cancers in women. • incidence rate of cervical cancer is highest 23.07/100,000 in Mizoram state and the lowest is 4.91/100,000 in Dibrugarh district (Assam)
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- 17. ETIOLOGY OF CANCER 1.ENVIRONMENTAL FACTORS • Tobacco - Tobacco in various forms of usage can cause cancer of lungs, larynx, mouth, pharynx, esophagus, bladder, pancreas and probably kidney. • Cigarette smoking is now responsible for more than one million death each year • Alcohol: Excess intake of alcohol can cause esophageal and liver cancer. • Beer consumption may be associated with rectal cancer. • Alcohol contributes about 3 % of all cancer deaths 2. 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
- 18. 3. OCCUPATIONAL EXPOSURES •These includes exposure to benzene, cadmium, arsenic, chromium, vinyl chloride, asbestos, polycyclic hydrocarbons, etc. • Occupational exposure is usually reported 1-5% of human cancer 4. VIRUS – Hepatitis B & C - hepato-carcinoma – 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
- 19. 5. Parasite Schistosomiasis canproduce Cancer of bladder 6. Customs, habits and life style May be associated with an increased risk of cancer. 7. Genetic factors • 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 8. Others • Sunlight, radiation, water and air pollution, medication and pesticides
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- 21. CANCER CONTROL • THEW.H.O. PUBLIC HEALTH MODEL FOR CANCER CONTROL 1. Assess the magnitude of the cancer problem 2. Evaluate possible strategies for cancer control 3. Choose priorities for initial cancer control activities of prevention, screening, therapy and palliative care 4. Set measurable cancer control objectives
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- 23. 1. PRIMARY PREVENTIONOF CANCER • Tobacco Control • Control of Alcohol Consumption • Occupation and Environment • Diet • Infections (viruses and parasites) • Reducing Sunlight Exposure • Sexual and Reproductive Factors
- 24. • 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
- 25. CANCER EDUCATION To motivatepeople for early diagnosis and treatment & Remind early warning symptoms 1. A lumpor hard area in the breast 2. A change in a wart or mole 3. A persistent change in digestive and bowel habits 4. A persistent cough or hoarseness 5. Excessive loss of blood at the monthly period or loss of blood outside the usual dates 6. Blood loss from any natural orifice 7. A swelling or sore that does not get better 8. Unexplained loss of weight
- 26. SECONDARY PREVENTION • Secondaryprevention aims at diagnosing the condition at a very early, preferably asymptomatic stage and effectively treating it. In context of cancer prevention, it takes two forms • firstly by educating the community at large regarding “Early danger signs” so that they could report to medical facility for further evaluation, should these signs appear. • Secondly, secondary prevention uses certain well established Screening procedures for early detection.
- 27. CANCER SCREENING • Cancerscreening aims to detect cancer before symptoms appear. This may involve blood tests, urine tests, other tests, or medical imaging. • The benefits of screening in terms of cancer prevention, early detection and subsequent treatment must be weighed against any harms. • Universal screening, mass screening or population screening involves screening everyone, usually within a specific age group. • Selective screening involves people who are known to be at higher risk of developing cancer. • Screening tests must be effective, safe, well-tolerated with acceptably low rates of false positive and false negative results. • Screening for cancer can lead to cancer prevention and earlier diagnosis. Early diagnosis may lead to higher rates of successful treatment and extended life.
- 28. Examples of Screening •Screening for cancer Cervix • Pap smear • Visual inspection based screening tests such as- – Visual inspection with 5 per cent acetic acid {VIA} – VIA with magnification {VIAM} – Visual inspection post application of Lugol's iodine • Screening for Breast cancer • breast self-examination (BSE) by the patient • palpation by a physician • Thermography. • mammography
- 29. TERTIARY PREVENTION • Tertiaryprevention is also quite important in cancers. • It consists of proper treatment of disease, especially advanced disease. • The available options are Surgery, Radiotherapy and Chemotherapy. • It also involves specialized issues as palliative care, terminal care and pain relief and reassurance / advise to the patient and family.
- 30. National Cancer Registry Program (NCRP) NationalCancer Control Programme (NCCP) Government initiatives to fight Cancer
- 31. National Cancer RegistryProgram (NCRP) • NCRP was commenced by the Indian Council of Medical Research (ICMR) with a network of cancer registries across the country in December 1981. • The main objectives of this Programme were: 1. To generate reliable data on the magnitude and patterns of cancer 2. Undertake epidemiological studies based on results of registry data 3. Help in designing, planning, monitoring and evaluation of cancer control activities under the National Cancer Control Programme (NCCP) 4. Develop training Programmes in cancer registration and epidemiology.
- 32. National Cancer Control Programme •In 1975-76 -National Cancer Control Programme was launched with priorities given for equipping the premier cancer hospital/institutions. • In 1984-85 The strategy was revised and stress was laid on primary prevention and early detection of cancer cases. • 1990-91 District Cancer Control Programme was started in selected districts (near the medical college hospitals).
- 33. GOALS & OBJECTIVESOF NCCP 1. Primary prevention of cancers by health education specially regarding hazards of tobacco consumption and necessity of genital hygiene for prevention of cervical cancer. 2. Secondary prevention i.e. early detection and diagnosis of cancers, for example, cancer of cervix, breast and of the Oro-pharyngeal cancer by screening methods and patients’ education on self examination methods. 3. Strengthening of existing cancer treatment facilities, which are woefully inadequate. 4. Palliative care in terminal stage of the cancer.