CANCER HEALTH EDUCATION

CLASSIFICATION
CAUSES
MECHANISUM OF CA SPREAD
TREATMENT
PREVENTION
PALLIATION
CHEMOTHERAPY
RADIATION
SURVEY AND RESEARCH


BY STEPHIN GEORGE THOMAS, MANIPAL HOSPITAL, GOA

1. ONCOLOGY

2. CONTENTS

3. CANCER Cancer (malignant neoplasm) is a class of diseases in which a group of cells display uncontrolled growth, invasion and sometimes metastasis. Cancer is the world’s second leading cause of death. Tumor, is any abnormal swelling, lump or mass. - Neoplasm, is the scientific term to describe an abnormal proliferation of genetically altered cells. - Neoplasm's can be benign or malignant .

4. Benign neoplasm or benign tumors: Tumors that lacks the ability to metastasize. Malignant neoplasm or malignant tumors: Synonymous with cancer. Cells invades and metastasize to spread rapidly.

5. Hippocrates used the Greek words carcinos and carcinoma to describes tumors thus calling cancerkarkinos. World’s oldest documented case of ancient Egypt in 1500 b.c Treated by cauterization, a method to destroy tissue with a hot instrument called “the fire drill”.

6. Rudolph Virchow in late 19 th century recognized that even cancerous cell were derived from other cells. Marie Curie and Pierre Curie discovered radiation by the end of the 19th century, the first effective non- surgical treatment. Cancer chemotherapy was started by Louis Goodman and Alfred Gilman in the 1940s with the use of nitrogen mustared. Sidney Farder targeted cancer using folic acid antagonist as drugs. Cont…

7. Cancer Type Estimated New Cases Estimated Deaths Bladder 70,530 14,680 Breast (Female – Male) 207,090 – 1,970 39,840 – 390 Colon and Rectal (Combined) 142,570 51,370 Uterine 43,470 7,950 Kidney (Renal Cell) Cancer 53,581 11,997 Leukemia 43,050 21,840 Lung (Including Bronchus) 222,520 157,300 Pancreatic 43,140 36,800 Prostate 217,730 32,050 Thyroid 44,670 1,690 E stimated numbers of new cases and deaths for each common cancer type in 2010

8. Factors believed to be the causes of cancer

9. Causes of cancer Chemicals Diet and exercise Unknown causes Infection Radiation Heredity Physical agents Physical trauma and inflammation Hormones Cont ..

10. Characteristics of cancer cell

11. Mechanism of cancer cell formation

12. Signs and symptoms Local symptoms Hemorrhage Ulceration Pain Systemic symptoms Weight loss Fatigue Sweating Immunological Symptoms of metastasis Lymph nodes Hepatomegaly Splenomegaly Fracture Neurological Other symptoms Chills Fever Loss of appetite Malaise

13. Classification of cancer Uterine

14. Breast cancer Breast cancer is a malignant tumor that starts from cells of the breast. The most common form of cancer among women. The second most common cause of cancer related mortality. Incidence and Risk factors Female (1% male) Aging Relative (mother /sister) Obesity Menstrual history - early on set - late menopause Child birth - After the age of 30yrs

15. Differential diagnosis Treatment Non surgical intervention - Chemotherapy - Radiation therapy - Hormonal therapy Surgical Intervention - Breast reconstruction - Oophorectomy - Ablative therapy Prevention - Reduction of fat in diet - Self breast examination - Mammogram after age 40 (with family history at age 30 ).

16. Uterine cancer Uterine cancer (Endometrial cancer ) develops when the cells that make up the inner lining of the uterus become abnormal and grow uncontrollably. Incidence and Risk factors 4 th most common type of cancer among women. Age Obesity Diabetes Hypertension Irregular menstrual periods Estrogen replacement therapy

17. Differential diagnosis Treatment Endometrial biopsy Dilatation and curettage Transvaginal ultrasound Hysteroscopy Hysterectomy Laparotomy Radiation Chemotherapy Hormonal therapy Prevention Report any abnormal vaginal bleeding in postmenopausal women. Controlling obesity, blood pressure, diabetes.

18. Cervical cancer Cancer of the cervix (the lower end of the uterus or womb). The human papilloma virus (HPV) is thought to be a co-factor in the development of cervical cancers. Cervical cancers develop more rapidly in HIV +ve than in HIV -ve women. About half of the sexually transmitted HPVs are associated with cervical cancer. These “high-risk” HPVs produce a protein that can cause cervical epithelial cells to grow uncontrollably.

19. Differential diagnosis Pap smear (above 25yrs) Colposcopic biopsy Schiller test Endocervical curettage Cryosurgery Cauterization or diathermy Laser surgery Radial hysterectomy pelvic exenteration (extensive surgery) Chemotherapy Radiation Treatment Preventive measures Avoid sex in early age, avoid numerous partners, practice the use of condom, regular screening in high risk case.

20. Ovarian cancer Ovarian cancer is cancer of the ovaries, the egg releasing and hormone-producing organs of the female reproductive tract. Ovarian cancer can develop at any age, but is most likely to occur in women 50 years or older. Ovarian cancer is the fifth most common cancer among women. Risk factors Idiopathic High fat diet Family History Have never been pregnant. Early menstruation (before age 12) and late menopause. The use of talcum powder in the genital area. (contains particles of asbestos, a known carcinogen.)

21. Differential diagnosis Complete medical history and assess all the risk factors Through bi-manual pelvic examination CA-125 assay CT and MRI Colour Doppler Lower GI series, barium enema Diagnostic laparoscopy Chemotherapy Radiation Surgery to remove tumour (called tissue debulking) Removal of the ovary is called Oophorectomy Hysterectomy. Prevention Since the cause of ovarian cancer is not known, it is not possible to fully prevent the disease. Treatment

22. Prostate cancer Prostate cancer is a disease where cells of the prostate become abnormal and start to grow uncontrollably, forming tumours. Prostate cancer is a malignancy of one of the major male sex glands, along with the testicles and the seminal vesicles. Incidence and Risk factors Cause of prostate cancer is not known. Age over 55. African-American heritage. Family history of the disease. High fat diet Men with high plasma testosterone levels. Occupational exposure to cadmium or rubber.

23. Differential diagnosis Digital rectal examination (DRE) prostate-specific antigen(PSA) Transrectal ultrasound Prostate biopsy Transurethral Resection of the prostate (TURP) Computed tomography (CT) Magnetic resonance imaging (MRI) Radical Prostatectomy Cryosurgery Hormone Therapy Orchiectomy Watchful Waiting Radiation Therapy Treatment Prevention Because the cause of the cancer is not known, there is no definite way to prevent prostate cancer.

24. Leukemia Leukemia is a cancer of white blood cells. The cancerous cells are immature forms called blasts that cannot properly fight infection; and patient become ill. A rapidly progressing cancer that starts in the blood forming cells of the bone marrow. May be acute or chronic with a slow onset and persistent symptoms over a period of years. Leukemia affects the bone marrow causing anemia, leukopenia, the production of immature cell, thrombocytopenia and a decline in immunity.

25. Prevention This cancer is very rare and its causes are also largely unknown, no specific preventive measures can be recommended. High doses of radiation and exposure to the chemical benzene. Bone marrow transplantation Radiation therapy Chemotherapy Microscope to identify abnormal red cells. Bone marrow aspiration Biopsy Differential diagnosis Treatment

26. Colorectal cancer Cancer of the colon is the disease characterized by the development of malignant cells in the lining or epithelium of large intestine. Causes of colon cancer is environmental in the sporadic cases(80%), and genetic in the heredity predisposed cases (20%). Colon cancer is more common in industrialized nations and diets high in fat, red meat, total calories, and alcohol. The incidence increases substantially after age 50 and doubles with each succeeding decade. Ulcerative colitis and Crohn’s colitis are at increased risk.

27. Differential diagnosis Colonoscopy(direct visualization) Digital rectal exam (DRE). Fecal occult blood test (FOBT) Double contrast barium enema (DCBE) – X rays Biopsy of suspicious tissue. Colostomy Radiation therapy Chemotherapy Alternative and complementary therapies (Large doses of vitamins, fibre, and green tea). Prevention Diets high in fibre. Avoiding obesity, cigarettes and alcohol. Treatment

28. Lung cancer Lung cancer is a disease in which the cells of the lung tissues grow uncontrollably. Primary lung cancer starts in the lung itself, and is divided into small cell lung cancer and non-small cell lung cancer. The tumor can reduce the capacity of the lungs, or block the air movement as result, patient gets less oxygen into the blood and patients feel short of breath. Risk factors Tobacco smoking accounts for nearly 90% of all lung cancers. Smoking marijuana cigarettes. Second hand smoke cause lung cancer among non-smokers.

29. Exposure to radon (colourless, odourless gas that sometimes accumulates in the basement of homes, cause lung cancer). Asbestos, coal products, and radioactive substances. Air pollution Differential diagnosis Chest x ray Sputum analysis Lung biopsy Bronchoscopy CT scan MRI

30. Treatment Wedge resection Lobectomy Pneumonectomy Radiotherapy Chemotherapy Alternative therapies (Shark cartilage and mistletoe) - Clinical trials are going on Giving up tobacco can prevent most lung cancers. Second hand smoke from other people’s tobacco should also be avoided. Appropriate precautions should be taken when working with carcinogens. Testing houses for the presence of radon gas. Remove asbestos from buildings. Prevention

31. Pancreatic cancer It is the most common neoplasm affecting the pancreas. The occurrence of pancreatic cancer has been linked to diabetes mellitus, alcohol use, history of previous pancreatitis, smoking, ingestion of high fat diet and exposure to environmental chemicals. Symptoms usually do not occur until the tumor is large; therefore the prognosis is poor.

32. Differential diagnosis Treatment Axial CT image with IV contrast Liver function tests Computed tomography (CT scan) Endoscopic ultrasound (EUS) Endoscopic needle biopsy ACS recommends keeping a healthy weight, and increasing consumption of fruits, vegetables, and whole grains, while decreasing red meat intake, although there is no consistent evidence this will prevent or reduce pancreatic cancer. Whipple procedure Pancreatectomy Chemotherapy Radiation therapy Prevention

33. Oral cancer Cancer of the mouth or the oral cavity and the oropharynx. Oral cavity includes the mouth including the lips, lining on the lips and buccal mucosa, teeth, tongue, floor of the mouth, hard palate. The oropharynx includes the back of the tongue, the soft palate, and the tonsils. More than 90% of malignant tumours of the oral cavity and oropharynx are squamous cell carcinoma. The major risk factors for oral and oropharyngeal cancers are smoking and alcohol consumption.

34. Differential diagnosis Pharyngoscopy Laryngoscopy Panendoscopy Fine-needle aspiration (FNA) biopsy CT scan MRI Panorex Maxillectomy Moh’s surgery Laryngectomy Tracheotomy Radiation therapy Chemotherapy Smoking cessation and elimination of alcohol, and maintaining a balanced diet with fruits, vegetables, and whole grain are key to returning to a normal life for patients suffering from oral cancers. Treatment Prevention

35. Skin cancer Skin neoplasm's are skin growths with differing causes and varying degrees of malignancy. Types of skin cancer: basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma. Exposure to ultraviolet light and X rays, suppression of the immune system, and genetic factors seem to increase the risk that this will happen. However the exact cause, is not known.

36. Differential diagnosis Skin biopsy Moh’s surgery Electrodessication and curettage Cryosurgery, Laser surgery Radiation therapy Chemotherapy. Wear protective clothing and a wide-brimmed hat in the sun. Stay out of the sun from 10 A.M. to 4 P.M. Use a sunscreen that has a sun protection factor (SPF) of at least 15. Avoid sun tanning booths. Treatment Prevention

37. Testicular cancer Testicular cancer is a disease in which cancer cells are discovered in one or both testicles. Testicular cancer accounts for less then 2% of all cancers in men, it is the most commonly seen cancer in young men aged 15 to 35. It is also one of the most curable. The exact causes of testicular cancer are unknown Cryptorchidism or undescended testicles. Men infected with HIV. Risk factors

38. Ultrasound Tumor markers CT scan Lymphangiography Orchiectomy Retroperitoneal lymph node dissection Radiation therapy Chemotherapy Prevention The main risk factors cryptorchidism, family history of the disease, are unavoidable since they are present at birth. In addition, many men diagnosed with the disease have no known risk factors. Because of these reasons, it is not possible to prevent most incidences of testicular cancer. Differential diagnosis Treatment

39. Stage Description Treatment Options Stage 0 Absence of invasion of surrounding tissues Excision / laser therapy Stage I Localized metastasis present Surgery Stage II Cancers are localized to one part of the body and involvement of lymph nodes Surgery + Chemotherapy/ Radiation Stage III Cancers are locally advanced and spread to adjacent tissues Combination of chemotherapy and radiation after surgery Stage IV Cancers are metastasized or spread to other organs or throughout the body Chemotherapy and/or palliative (maintenance) care Treatment and Staging

40. Radiation Radiation treatment, also known as radiotherapy, destroys cancer by focusing high-energy rays on the cancer cells. This causes damage to the molecules that make up the cancer cells and leads them to commit suicide. Radiotherapy utilizes high-energy gamma rays that are emitted from metals such as radium or high energy x-rays that are created in a special machine. Early radiation treatments caused severe side-effects because the energy beams would damage normal, healthy tissue, but technologies have improved so that beams can be more accurately targeted. Radiotherapy is used to shrink a tumor or destroy cancer cells.

41. Chemotherapy Chemotherapy utilizes chemicals that interfere with the cell division process, damaging proteins or DNA, so that cancer cells will commit suicide. These treatments target any rapidly dividing cells (not necessarily just cancer cells), but normal cells usually can recover from any chemical induced damage while cancer cells cannot. Chemotherapy is generally used to treat cancer that has spread or metastasized because the medicines travel throughout the entire body. Chemotherapy treatment occurs in cycles so the body has time to heal between doses. Common side effects such as hair loss, nausea, fatigue, and vomiting.

42. Vaccination Human papillomavirus vaccine (Gardasil and Cervarix) decreases the risk of developing cervical cancer. The hepatitis B vaccine prevents infection with hepatitis B virus and thus decreases the risk of liver cancer. Cervarix which protects against the more dangerous HPV 16,18 strains only. In 2009, Gardasil was approved for protection against genital warts. In 2010, the Gardasil vaccine was approved for protection against anal cancer. Vaccines have been developed that prevent some infection by some viruses that are associated with cancer, and therapeutic vaccines are in development to stimulate an immune response against cancer specific epitopes.

43. USPSTF Recommendations The U.S. Preventive Services Task Force (USPSTF) strongly recommends cervical cancer screening in women who are sexually active at least until the age of 65. Routine screening is recommended for bladder cancer, pancreatic cancer, ovarian cancer in women, or prostate cancer and testicular cancer in men below 75. Americans to be screened for colorectal cancer via fecal occult blood testing, Sigmoidoscopy, or colonoscopy starting at age 40 until age 75. Mammography for breast cancer screening every 2 years for those 40 - 74 years. There is insufficient evidence to recommend for or against screening for skin cancer, oral cancer, lung cancer, or prostate cancer in men under 75.

44. Gene Cancer types BRCA1, BRCA2 Breast, ovarian, pancreatic HNPCC, MLH1, MSH2, MSH6, PMS1, PMS2 Colon, uterine, small bowel, stomach, urinary tract Genetic testing Genetic testing for individuals at high-risk of certain cancers is recommended. Carriers of these mutations may than undergo enhanced surveillance, chemoprevention, or preventative surgery to reduce their subsequent risk.

45. Palliation Palliative care is a specialized area of healthcare that focuses on relieving and preventing the sufferings of patients. Unlike hospice care, palliative medicine is for patients in all disease stages, including treatment for curable illnesses which is chronic, as well as patients who are nearing to the end of life. Multidisciplinary approach allows the palliative care team to address physical, emotional, spiritual and social concerns that arise with advanced illness.

46. Cancer research Cancer research is the intense scientific effort to understand disease processes and discover possible therapies. Research about cancer causes focuses: Agents (e.g. viruses) and events (e.g. mutations) The consequences of those genetic changes which lead to further progression of the cancer. The precise nature of the genetic damage, and the genes which are affected . Leading cancer research organizations and projects - American Association for Cancer Research - The American Cancer Society (ACS) - The American Society of Clinical Oncology - The National Cancer Institute - National Comprehensive Cancer Network - Cancer Genome Atlas project at the NCI - The European Organization for Research and Treatment of Cancer.

47. Vegetables & Fruits in cancer – A review An research in 206 human and 22 animals done in Chicago on Oct 1996 by World Cancer Research, London. The evidence for protective effect of greater vegetable and fruit consumption is consistent for cancer of stomach, esophagus. lungs, oral cavity and pharynx, endometrium, pancreas and colon. Raw vegetables, allium vegetables, carrots, green vegetables and tomatoes. Dithiolthion, Isothiocynates, Isoflavones, Phytosterols, Vitamin C & E, Lutine, Folic Acid, Beta- carotine , Lycopine, Selenium, Flavonoids, Dietary Fiber, Proteases Inhibitors, Indole-3-carbinal are some substances present in fruits and vegetables.

48. CONCLUSION Presented to u by Stephin George Thomas, Kerala. Mob:[phone] Manipal Universal Learning