Cancer

Presented by;
Prajita Puri
1st year student
14th batch, KMCTH
CONTENTS
• Introduction
• Types
• Cancer Worldwide
• Incidence and mortality worldwide
• Prevalence worldwide
• Latency Period
• Causes and Risk Factor
• Sign & Symptoms
• Management
• Preventive Measures
› Primordial
› Primary
› Secondary
› Tertiary
 Introduction
• Cancer is regarded as a group of diseases
characterized by an;
Abnormal growth of cells

Ability to invade tissue and even distant organs

The eventually death of the affected patient if the tumour

has progressed beyond the stage when it cannot be
successfully removed.
 Contd….
• Most cancers develop as a result of exposure to modifiable
risk factors.

• Cancer can occur at any age, but 67% of cancer deaths occur
in people older than 65 years.

• Most cancers have a long detectable preclinical phase which

allows for early detection and effective treatment!

• WHO estimates that 40% of all cancer deaths are

preventable.

• Tobacco and harmful alcohol use are among the most

important risk factors for this disease.
 Types
There are two types of tumours:

• Malignant tumors spread to other areas in the body.

• Benign tumors stay in one place.

Malignant Benign
Rate of growth Rapid Slow
Nature of growth Invades surrounding Expands in the same
tissue tissue

Spread Metastasizes via the Does not spread

bloodstream and the
lymphatic system

Cell differentiation Usually poor Nearly normal

Cancer World Wide
Cancer Incidence and Mortality
Rate World Wide
Cancer Incidence and Mortality
Rate World Wide
Cancer Incidence Rate World
Wide

• There were 18.1 million new cases of cancer worldwide in 2018.

• The four most common cancers occurring worldwide are lung,
female breast, bowel and prostate cancer.
Cancer Mortality Rate World
Wide

• There were 9.6 million deaths from cancer worldwide in 2018.

• Lung, liver, stomach, and bowel are the most common causes of
cancer death worldwide,
 Prevalence
• 43.8 million people diagnosed with
cancer within the five years previously
were alive at the end of 2018.

• Most were women after their breast

cancer diagnosis (6.8 million), men
after their prostate cancer
diagnosis (3.6 million), and men and
women after their colorectal cancer
diagnosis (4.8 million)
Cancer Incidence Rate in Nepal

Incidence Rate
26184
Cancer Mortality Rate in Nepal

Mortality Rate
19413
Cancer Prevalence Rate in Nepal
ages

Prevalence Rate
43816
 Latency Period

• The latency period for cancer is defined as the amount of time

that elapses between the initial exposure to a carcinogen
(cancer-causing substance) and the diagnosis of cancer.
 Contd….
• According to the WTC Health Program Administrator held on November
7, 2014, it has determined minimum latencies for the following five types
or categories of cancer :
 Causes and Risk Factors of
Cancer
• According to epidemiological studies,

 80-90% of all cancers are due to environmental factors

of which, lifestyle related factors are the most important
and preventable.
 The major risk factors for cancer are tobacco, alcohol
consumption, infections, dietary habits and behavioral
factors.
Common environmental factors
leading to cancer death include

Diet and Obesity

Tobacco and Radiation
cigarette Stress
Infections Lack of physical activity
Environmental pollutants
 Contd….
• Alcohol (Harmful alcohol use causes 351 000 cancer deaths)

• Smoking (Of the 8.2 million annual cancer deaths, 40% are
preventable. Of these avoidable cancer deaths, tobacco
accounts for 60%.)

• Genetic factors (BRCA1, BRCA2, FAP)

• Infectious agents
o Hepatitis B, C, HPV, H. pylori etc.

• Obesity and overweight (Collectively, overweight and obesity,

and physical inactivity account for 159 000 colorectal cancer
deaths each year, and 88 000 breast cancer deaths each year.)
 Contd….
• Occupational and environmental agents
o Asbestos, arsenic etc.

• Ionizing and non-ionizing radiation

o Ionizing radiation is a well established carcinogen for certain cancers like
lung, breast and thyroid cancer and most types of leukemia.
o Radon is the second most important risk factor for lung cancer after
tobacco.
o Non-ionizing radiation (UV, sunbed) is risk factor for skin cancers.
 Contd….
• Medical procedures and drugs
o Chemotherapy (leukaemia)

o Immunosuppressive therapy (Non-Hodgkin lymphoma)

o Radiotherapy (cancer in the irradiated organs)

o Replacement estrogen therapy (endometrial cc)

o Phenacetin-containing analgesics (cancer of the renal pelvis )

• Others
o Sunlight, radiation, water and air pollution, medication and
pesticides
o These are related to cancer as environmental factors
Contd….
 Contd….
Certain viruses or bacteria may increase the risk of
developing cancer

Microorganism Cancer
Human papilloma virus Cervical cancer
Helicobacter pylori Stomach cancer
Hepatitis B and hepatitis C viruses Liver cancer

Human T-cell leukemia/lymphoma Lymphoma and leukemia

virus
Human immunodeficiency virus
Epstein-Barr virus
Human herpes virus 8
Lymphoma and a rare cancer
called Kaposi's sarcoma
Lymphoma
Kaposi's sarcoma
 Sings and Symptoms
• Early cancer no symptoms
• Change in bowel habits or bladder functions
• Sores that do not heal
• Unusual bleeding or discharge
• Lumps or thickening of breast or other parts of the body
• Indigestion or difficulty swallowing
• Recent change in wart or mole
• Persistent coughing or hoarseness
 Management
• Surgery

• Chemotherapy

• Radiation therapy

• Cell Based Immunotherapy

• Gene Therapy
 Contd….
Surgery therapy

o In localized cancer surgery typically attempts to remove the

entire mass. Biological therapy/immunotherapy

o Monoclonal antibodies, interferon, interleukin-2, and colony-

stimulating factors.

• Side effects - Temporary flu-like symptoms such as fever and

chills, muscle aches and weakness, loss of appetite and
diarrhea.
 Contd….
Chemotherapy

o Drugs used to kill cancer cells; disrupt some aspect of cell

division.

o Toxic to healthy cells; hair, bone marrow, lymphocytes, and

epithelial cells of intestinal lining .

• Side effects include hair loss, nausea, vomiting, and reduced

immune responses.
 Contd….
Radiation therapy

o High-energy rays are used to kill cancer cells

o Stop them from growing and dividing.

o Radiotherapy is a local treatment; it can affect cancer cells

only in the treated area.

• Side effects-

o Tiredness, skin reactions such as rash or redness, and loss of

appetite.

o Temporary lowering of the WBC count.

 Contd….
Immunotherapy of Cancer
o Potentially Highly Tumor-Specific

o Can be Effective Against Disseminated Disease Including

Unrecognized Micro-metastases
o Probably of Limited Value Against Extensive Advanced
Disease
o Can Involve Severe, Sudden Onset Life-threatening
Treatment-limiting Side-Reactions
o Limited by Tumor Heterogeneity, Selection for Unresponsive
Variants, and Emergence of Immune-Escape
 Contd….
Gene Therapy for Cancer
o Potentially Highly Tumor-Specific

o Accessibility of Cell Targets Is a Major Obstacle for

General Application
o May Have Great Value in Combined Modality Approaches

o Potentially Dangerous Side-Reactions from Viral Vector

Delivery Agents
 Contd….
Recently launched drugs-

o Axitinib (Inlyta) for advanced kidney cancer.

o Vismodegib (Erivedge) for advanced basal cell carcinoma.

o Carfilzomib (Kyprolis) for multiple myeloma.

o Ziv-aflibercept (Zaltrap) in combination with chemotherapy

for metastatic colon cancer.

o Regorafenib (Stivarga) for metastatic colorectal cancer .

 Prevention…
Primordial Prevention

• Minimizing environmental carcinogens (environment, workplace, food)

₰ Providing protection

o Vaccination ( HPV Vaccine, Hepatitis B vaccine)

₰ Early detection

o Organized population screenings

₰ Increasing knowledge on cancers

o Education

o Research

o Cancer registries
 Contd….
₰ PRIMARY PREVENTION

• Is when there is NO ABNORMALITY

o Avoiding smoking

o Moderate alcohol consumption

o Safe sex

o Moderate sun-bathing / tanning

o Healthy diet

o Regular physical exercise

o Adaptive coping strategies and stress management

₰ SECONDARY PREVENTION Contd….
•  Is when Abnormality is found
1. Cancer registration
• Hospital based.
• Population based
2. Early detection of cases
• Mass screening—Multisite (comprehensive cancer detection
by clinicians by a thorough check-up of whole body).
• Selective screening of risk groups.
3. Treatment
• Chemotherapy, Radiation, Surgery, Immunotherapy.
• Regular self-examinations
• Investigations for Abnormality .
 Screening
• Screening means testing for a disease when there are
no symptoms or history of that disease give a
screening test to find disease early on, when
treatment may work better.

• Screening is tool for early detection.

 Contd….

• Recommended
o Breast cancer • Not recommended
o Cervical cancer o Ovarian cancer

o Colorectal cancer o Prostate cancer

o Lung cancer o Skin cancer
Breast Cancer
•  Early diagnosis of breast cancer, by promoting breast
awareness among all women and clinical breast
examinations for women, preferably in the age group 40-
69 years, should be encouraged.

• Women should be educated and encouraged to inspect

and manually examine all quadrants of the breasts with
the flat of hand, and the axillae, once a month, ten days
after the menstrual period.
 Contd….
• Every woman should also be made aware of the following signs –

• A change in size

• A nipple that is pulled in or changed in position or shape

• A rash on or around the nipple.

• Discharge from one or both nipples

• Puckering or dimpling of skin

• Lump or thickening in the breast

• Constant pain in the breast or armpit

Breast Self Examination
 Contd….
• Mammograms are the best way to find breast cancer early,
when it is easier to treat.

• Having regular mammograms can lower the risk of dying from

breast cancer.

• If you are 50 to 74 years old, be sure to have a screening

mammogram every two years.

• If you are 40 to 49 years old, talk to your doctor about when

to start and how often to get a screening mammogram.
 Cervical Cancer
• The Pap test can find abnormal cells in the cervix which may turn

into cancer. Pap tests also can find cervical cancer early, when the

chance of being cured is very high.

• The Pap test (or Pap smear) looks for precancers, cell changes on

the cervix that might become cervical cancer if they are not

treated appropriately.

• The test is recommended for all women between the ages 21 and

65 years old.
 Colorectal Cancer
• Colorectal cancer almost always develops from precancerous
polyps in the colon or rectum.

• Screening tests can find precancerous polyps, so they can be

removed before they turn into cancer and also can find colorectal
cancer early, when treatment works bets. .

• Colorectal cancer screening is recommended for men and women

aged 50–75 using high-sensitivity fecal occult blood testing
(FOBT), sigmoidoscopy, or colonoscopy.

• (The decision to be screened after age 75 should be made on an

individual basis. If you are older than 75, ask your doctor if you
should be screened.)
 Lung Cancer

• The U.S. Preventive Services Task Force recommends yearly

lung cancer screening with low-dose computed
tomography (LDCT) for people who have a history of heavy
smoking, and smoke now or have quit within the past 15
years, and are between 55 and 80 years old.

• The most important thing you can do to lower your lung

cancer risk is to quit smoking and avoid secondhand smoke.
₰TERTIARY PREVENTION
oTertiary prevention is also quite important in cancers.
1. Rehabilitation (after amputation/ laryngectomy /
colostomy/facial surgery).
2. Palliative care.
• Palliative care is treatment to relieve, rather than cure,
symptoms caused by cancer.
• Palliative care can help people live more comfortably; it is
an urgent humanitarian need for people worldwide with
cancer and other chronic fatal diseases.
 Reference….
• K. Park Preventive and Social Medicine, 22nd Edition, Jabalpur, India. M/S
Banarsides Bhanot Publishers, 2013, Unit 1; Epidemiology, pg. 332-340

• BRS Pathology, 5th Edition, Arthur S. Schneider, Philip A. Szanto, Integra

Software Services Pvt. Ltd.

• Essentials of Medical Pharmacology, 7th edition, KD Tripathi, Jaypee

Brothers Medical Publishers (P) LTD. Pg. 857-877
 Retrieved from…
• https://www.cdc.gov/cancer/dcpc/prevention/screening.htmhttps
://www.google.com/search?hl=en-NP&biw=1920&bih=920&tbm=
isch&sa=1&ei=TNM9XYD_B4novgSA76OgBg&q=
test+for+lung+cancer+&oq=test+for+lung+cancer+&gs_l
=img.3..35i39j0i30j0i24l2.22225.22225..23862...0.0..0.129.129.0j1...
...0....1..gws-wiz-img.NXY-2ql-tyI&ved=0ahUKEwiA1ZGLitjjAhUJtI
8KHYD3CGQQ4dUDCAY&uact=5#imgdii=PnBJLw_V4kGbyM:&
imgrc=C39fKa9muSFDEM:
https://en.wikipedia.org/wiki/Treatment_of_cancer

• https://www.iarc.fr/wp-content/uploads/2018/09/Globocan_03.jpg
Thank You