CANCER

by
Prof. Mohamed El-AWADY
 Intended Learning
Outcomes (ILOs)
Students should be able to:
•Identify cancer process
•Recognize cancer initiators and promoters
•Distinguish between modifiable and non-
modifiable risk factors in cancer
•Identify microorganisms causing cancer
•Relate environmental factors with cancer
•Summarize risk factors of fatal cancers
•Design preventive program for cancer
 What is Cancer ?
Cancer is the general name for a
large group of diseases. It occurs
when the cells in the body grow and
divide out of control.

Normal cells grow , divide, and die in

an ordinary way. This process helps
keep our bodies healthy.
 Cancer process

The process usually starts when

something damages the genetic structure
(DNA) inside the cells. Instead of dying in
an orderly way , cancer cells keep growing ,
lump together and form an extra mass of
tissue. This mass is called a Malignant
Tumor .
 Cancer process (cont.)

- Cancer can begin in one part of the body

and spread to others .This is called
Metastasis .

- Not all tumors are malignant . Some are

Benign , which means they are not
cancerous. They are not life threatening .
 Pathogenesis of Cancer
• Initiators: carcinogens attack the
genetic material of the cells and alter
their constituents.
• Promoters: carcinogens stimulate the
growth of abnormal ( altered ) cells.
• Initiators have long latent period while
promoters have short latent period.
 Magnitude of the problem in
EGYPT
• Neoplasms account for 5.2% of deaths
10-19 years
• Neoplasms account for 6.4% of deaths
20-34 years
• Neoplasms account for 7.1% of deaths
35-64 years
• Mortality from Cancer in Egypt is
doubled in the last 10-15 years
 What causes Cancer ?

We are not exactly sure about what

causes cancer. However, we do know a lot
about the risk factors for cancer .
The more we know about risk factors , the
more we can do to protect ourselves.
 What is a Risk factor ?

A Risk Factor is any thing that increases the

person chance of getting a disease.

Non Modifiable Risk Factors include :

•Age: most cancers develop in old age, in adults
most cancers arise from ectodermal or
endodermal cells (carcinomas). In children most
cancers arise from mesodermal cells (sarcomas)
 Common childhood Malignancies

-Leukemia
-CNS tumors
-Lymphomas
-Wilms tumor
-Neuroblastoma
-Bone tumors ( Ewings sarcoma )
-Retino blastoma
 Non Modifiable-Risk Factors (cont.)

•Sex: most cancers of non-sexual sites are

common in males except G. bladder and thyroid.
Occupational cancers are common in males.
•Race: Japanese have the higher rates of
stomach cancer while in USA cancer colon has
the highest incidence. Black men in USA have the
highest rates of cancer prostate in the world.
 Non Modifiable-Risk Factors (cont.)

•Genetic factors: susceptibility to cancer

depends on individual variation in enzymes
that activate and detoxify pro- carcinogens
and carcinogens, and repair of DNA.
 Modifiable Risk Factors

•Tobacco
•Occupational exposure
•Air pollution
•Drinking polluted water
•Alcohol
•Diet and nutrition
 Modifiable Risk Factors (cont.)

•Ionizing radiation
•Hormones
•Non-hormonal drugs
•Infectious agents
•Reproductive factors
 Normal Body Cells

In all living cells , the activity of genes

are controlled by other genetic elements
that turn genes On or OFF. These control
elements in turn respond to signals from
outside or inside the cells. In this way ,
the overall activity of genes is tightly
orchestrated, ensuring normal control.
 Cell and viral infection
When viruses penetrate cells, they must
coordinate the function of viral genes with
those of the cell, turning viral genes On or
OFF to match the level of activity within
the cell to ensure their successful
replication.
Some viruses ( Oncoviruses ) can stop the
genetic rhythms of cells driving them
toward uncontrolled division .
 Cell and infection (cont.)
So the cells can be ordered to divide and
grow because it is no longer under cellular
control ( will not be turned OFF) .Many
cellular genes are changed to Proto-
oncogenes and any of them can be turned
on by the control elements of
oncoviruses.
 Viruses as catalysts for
Cancer

Human viruses act as carriers in causing

cancer by interacting with cancer-causing
chemicals that are present in too small
quantity.
 Relation between Micro-
organisms and Malignancy
- It is difficult to prove CAUSAL
RELATIONSHIP (due to length of time).
- Criteria for deciding if cancer is caused by
a micro-organism: (Sir B.Hill)
• Strong statistical association
• Consistency in different populations.
• Specific association between Factor and
disease.
• Dose-Response relation
 Micro-organisms as a Cause of
Cancer
- Some articles and researches
documented that cancer is an infectious
disease caused by pleomorphic cell wall
deficient bacteria . In the absence of a
protective immune response, these
bacteria may become pathogenic and lead
to CANCER .
 Micro-organisms as a Cause of
Cancer
- All patients with prostate cancer have been
found to be heavily infested with intestinal
parasites. Therefore, it has been suggested
that parasites are probably a cause of cancer
prostate .
- Skin Cancers are forms of Fungus growth
and a simple application of OIL of Cloves is
recommended for treatment.
 List of cancer Causing
Micro-organisms
Type of Cancer Micro-organism

Liver Cancer Hepatitis B & C & G viruses

Liver Cancer Helicobacter hepaticus
Liver Cancer Liver Flukes
 List of cancer Causing
Micro-organisms (cont.)
Type of Cancer Micro-organism
Stomach Cancer. Helicobacter Pylori
Burketts Lymphoma Epstein – Barr virus
+Nasopharyngeal
cancer.
Cervical cancer +Skin Human Papiloma Virus
Anogenital+prostate
+Tonsil+Nailbeds + oral
cavity + tongue + larynx
+ Head&Neck
 List of cancer Causing
Micro-organisms (cont.)

Type of Cancer Micro-organism

Urinary Bladder Schistosomiasis
caner
Human T-cell Leukemia
Leukemia Virus - 1

Skin + Breast Lyme Disease bacteria

B. Burgdorferi
 List of cancer Causing
Micro-organisms

Micro-organism Type of Cancer

HIV >>>>>>> Kaposi Sarcoma

Herpes Viruses >>>>> Cervix + skin
 Mechanism of S. heamatobium
induced Carcinogensis

Certain changes at the cellular level

following Egg deposition :
1- inducing inflammation and DNA
damage
2- Increasing cell proliferation and DNA
replication
 Mechanism of HBV induced
Carcinogensis
Direct :
Insertion of viral DNA into Host DNA
Cell necrosis and death leading to mutation
and DNA damage

Indirect :
Inflammation per se leads to local production
of oxygen-free radicals that may be
mutagenic and damage DNA.
 Mechanism of Epstein-Barr
induced Carcinogensis

Direct :
Inserting an oncogene it self or activating a
protooncogene.

Indirect :
Host cell produce oxidants which are toxic to
virus and host cells , in turn leads to damage of
DNA .
 Possible co-factors with
infection

U V Rays / X -Rays
Genetic
Cigarette smoking
Pollutants in air, food and drink
Personal factors (age, hygiene )
 Environment and Cancer

Causes of fatal Cancers :

Tobacco smoke ----------------------- 40 %
Diet …………………… 20 %
Infection ……..…………. 15 %
Work (asbestos , benzene etc.)…. 5%
Radiation ……………………... 3%
Medical treatment ……………. 3%
Pollution ……..……………….. 2%
Others (age-genetic. parity etc) … 12 %
 Steps to prevent Cancer

1- Primary Prevention

2- Secondary prevention

3- Tertiary Prevention
 Primary Prevention

- Health education: to modify life style,

diet, alcohol, smoking….etc.
- Avoid or reduce exposure to known risk
factors e.g. drugs, hormones, radiation
- Occupational preventive measures
 Secondary Prevention

- Screening for different types of cancer:

* Mammography
* Cervical smear
* PSA
* Blood film
* CEA
* Alpha fetoprotein
 Tertiary Prevention

a) Physical rehabilitation
b) Psychological rehabilitation
THANK YOU