cancer - dr.rahul shrivastava
TRANSCRIPT
BY- DR. RAHUL SHRIVASTAVABDS, MPH
PADMASHREE SCHOOL OF PUBLIC HEALTH
INTRODUCTION The last 50 years has seen a better
understanding of the causes and treatments of cancer. Hence, the stigma, early detection and technology has improved the prognosis of cancer patients to an unprecedented level.
DEFINITION “Uncontrolled growth and spread of abnormal cells.” Cancer is a term used to describe a large group of
diseases that are characterized by a cellular malfunction. Healthy cells are programmed to “know what to do and
when to do it”. Cancerous cells do not have this programming and
therefore grow and replicate out of control. They also serve no physiological function.
These cells are now termed a Neoplasm. This neoplasmic mass often forms a clumping of cells
known as a Tumor.
Cells represent the smallest, functional unit of our existence which contains cytoplasm and a nucleus (i.e. metabolism, reproduction, day to day functions)
Cells have a specialized function depending on their location in the body.
Cells grow, replicate and repair body organs.
The genetic material (DNA/RNA) and your immune system regulate this process.
TYPES OF CELLS Blood cells Muscle cells (smooth, striated, cardiac) Nerve cells Bone cells Cartilage cells Liver (hepa) cells
CLASSIFICATION OF TUMORS
Benign Tumors (noncancerous)
Enclosed in a fibrous shell or capsule.
Take up space Concerned if they interfere
with surrounding tissues or vessels or impede the function of the body.
Encapsulated; Do not invade neighboring tissue or spread.
Malignant Tumors (cancerous)
Malignant tumor of potentially unlimited growth that expands locally by invasion and metastasis.
Not encapsulated; Readily invade neighboring tissues.
May also detach and lodge in distant places – metastasis
CANCEROUS CELLS The division (mitosis) of normal
cells is precisely controlled. New cells are only formed for growth or to replace dead ones.
Cancerous cells divide repeatedly out of control even though they are not needed, they crowd out other normal cells and function abnormally.
They can also destroy the correct functioning of major organs.
CANCER CYCLE & CHARACTERISTICS
Carcinogenesis – development of cancer Tends to be gradual, takes years.
Undergo metastasisOriginal tumor easily fragmentsNew tumors appear in other organs
Undergo angiogenesisFormation of new blood vessels Lack differentiation (control) Have abnormal nuclei Form tumors Mitosis controlled by contact with neighboring cells – contact
inhibition Cancer cells have lost contact inhibition
OVERVIEW Cellular Change/Mutation Theories
Spontaneous errorsExternal agentsOncogenes
Risks for Cancer-LifestyleSmoking among greatestNutrition/exercise
WHAT CAUSES CANCER ?
Biological FactorsGenetic predispositionReproductive and hormonal risks
Occupational and Environmental FactorsAsbestos, nickel, chromateRadioactive substances
Social and Psychological FactorsStressDecrease negative emotions
Chemicals in FoodSodium nitrateClostridium botulism
Viral FactorsHerpes-related virus and human papillomavirus
Medical FactorsDiethylstibestrol (DES)Chemotherapy
STAGES OF CANCER Stage I cancers are localized
to one part of the body; usually curable.
Stage II cancers are locally advanced.
Stage III cancers are also locally advanced.
Stage IV cancers have often metastasized, or spread to other organs or throughout the body.
BACKGROUND 553,400 Americans died of cancer 2001 1.3 million new cases diagnosed 1 in 4 deaths from cancer Early detection / improvements in technology have
improved prognosis for many.
GLOBAL CANCER STATISTICS (WHO,2001)
The current Indian population is 1,270,272,105 (1.27 billion). The incidence of cancer in India is 70-90 per 100,000 population. and cancer prevalence is established to be around 2,500,000 (2.5 million) with over 800,000 new cases and 5,50,000 deaths occurring each year. More than 70% of the cases present in advanced stage accounting for poor survival and high mortality. About 6% of all deaths in India are due to cancers which contribute to 8% of global cancer mortality.
EPIDEMIOLOGIC TRENDS According to Indian Council of Medical Research
(ICMR) data on site specific cancer burden, in males, the most common are cancers of mouth/pharynx, esophagus, stomach, lung/bronchi while as in females, the common cancers are cervix, breast, mouth/oropharynx and esophagus.
CURRENT SCENERIO Cancer is a deadly disease, responsible for 2-3% deaths
worldwide annually. There were 10.9 million new cases, 6.7 million deaths and 24.6 million persons living with cancer around the world in 2002. In women, breast cancer is most widespread and its incidence in Pakistan is reported highest among South-Central Asian countries. About 7.6 million people died due to cancer in the world during 2007.
According to World Health Organization’s recent estimate, the cumulative death toll due to cancer will be 12 million by 2030. A total of 16, 38, 910 new cancer cases and 5, 77,190 deaths from cancer occured in United States in 2012. In India, around 5, 55,000 people died of cancer in 2010. Cancer cases related deaths on rise in J&K during past four years with the total of 11,815 cancer cases and 5,198 mortality cases have been reported in the state during the current year.
Cancer has remained a major cause of death and the number of individuals living with cancer is continuing to expand, but most of the drugs used in cancer chemotherapy exhibit cell toxicity and can induce genotoxic, carcinogenic and teratogenic effects in non tumor cells. Despite the recent advances in surgery, endocrine therapy, radiotherapy and chemotherapy, it is considered that the management of cancer is still not up to the mark and we are in emergent need of drugs for the treatment of cancer having no side effects. Therefore, the research for alternative drugs of natural origin, which are less toxic, endowed with fewer side effects and more potent in their mechanism of action, is an important research line.
RISK FACTORS The predominant risk factors associated with cancers are,
1. Genetic
2. Environmental
3. Life style factors which include tobacco, alcohol, infections (HIV,HPV,HBV,HCV,H. Pylori) and dietary factors which overall are involved in 80-90% cases.
Tobacco contributes directly to about 50% of cancers in males and 10-15% cancers in females.
Most of the cancers have some relationship with diet. Predominant among them are cancer of oesophagus, stomach, colon & liver.
Consumption of large amounts of red chillies, food at very high temperatures and alcohol consumption are the main risk factors for stomach cancers in India. Consumption of a tobacco extract “tuibur” and smoked meat have been linked to a high rates of stomach cancers in Mizoram.
In recent times there has been increase in incidence of cancer in India as nearly two people are diagnosed every minute with cancer.
This is mainly attributed to urbanisation, industrialisation, life style changes, population growth and increase in life span.
In India, life expectancy at birth has risen from 45 years in 1971 to 62 years in 1991 to 71 years expected by 2021-25 and so has the risk to harbour cancer.
TYPES OF CANCER Breast Cancer
One in 8 womenRisk increases with ageRisk factors supported by
researchPrevention (self-exam and
mammography)See figure for self-
examination procedureTreatment
Colon and Rectum Cancer3rd most common in men and
women135,400 in 2001 diagnosedWarning signals, e.g. blood in
the stool, rectal bleeding.
Prostate CancerMost common in males today189,000 new cases was
diagnosed in 2002Estimated 30,200 men died.
Skin Cancer: Sun Bathers Beware1.3 million cases of skin cancerTreatable: basal or squamousVirulent: malignant melanoma
Testicular CancerAges 17-34 at greatest riskCause is unknownUndescended testicles present a
great riskHow and when should men
examine their testicles?
Ovarian Cancer4th leading cause of death in young
womenEnlargement of abdomen common
signPrevention: annual pelvic exams
Endometrium (Uterine) CancerPap test for early detectionRisk: early onset of intercourseWarning: abnormal bleeding
Cancer of the Pancreas“Silent” disease29,700 cases in 2002Only 4% surviveContributors: inflammation, diabetes, high-fat diet
LeukemiaCancer of blood-forming tissuesLeads to the creation of immature white blood cellsSymptoms: fatigue / paleness / weight lossCan be acute or chronic
Lung CancerKilled 164,000 in 2000Prevention-researchers theorize: 90% of all lung cancers
could be avoided by not smoking
Cancer of the Mouth• Oral or oropharyngeal cancer is the eleventh
most common cancer worldwide with over 300,000 new cases annually.
• Tobacco use, including smokeless tobacco and excessive alcohol consumption are estimated to account for about 90% of oral cancers.
• Usually cancer begins with white patches, leukoplakia or red patches, erythroplakia, associated with risk factors such as tobacco or/and alcohol.
• Tobacco users – smoked, chewing or both – developed most oral lesions with an annual incidence rate ranging from 5.2/1,000 to 30.2/1,000, whereas non-user develop the fewest oral lesions ranging from 0.6/1,000.
• An increasing number of young people are being affected and 25% of the cases have no associated risk factors.
OTHER TYPES OF CANCER
Cancers of Blood and Lymphatic Systems:• Hodgkin's Disease• Leukemias• Lymphomas• Multiple Myeloma• Waldenström's Disease
Cancers of Digestive Systems: • Head and Neck Cancers• Esophageal Cancer• Stomach Cancer • Cancer of Pancreas• Liver Cancer • Colon and Rectal Cancer• Anal cancer
Cancers of Urinary system: • Kidney Cancer• Bladder Cancer • Testis Cancer• Prostate Cancer
Miscellaneous cancers: Brain Tumors Bone Tumors Nasopharyngeal Cancer Retroperitoneal sarcomas Soft Tissue Tumors Thyroid Cancer Cancers of Unknown Primary Site
DETECTING CANCERMagnetic Resonance Imaging (MRI)Computerized Axial Tomography scanning (CAT
scan)Prostatic ultrasound (rectal probe)Self-exam and check-ups
TREATMENT Traditional medicine refers to the application, approach, knowledge
and belief in incorporating plant based properties in remedies, singularly or in combination, for the purpose of treating or preventing disease as well as to maintain the well-being of an individual.
About 80% of the world population relies on the use of traditional medicine, which is predominantly based on plant material. Natural products or related substances or extracts of folk medicine accounted for 30% of the top 35 worldwide natural product-based drugs sold.
As has been estimated that > 50% of all patients diagnosed with cancer explore complementary and alternative medicine – especially herbal medicine. Current evidence suggests that garlic, green tea, tomatoes and soy intake as part of the diet may be useful in preventing various cancers.
RESEARCH ON TREATMENT A number of exciting researches suggest that vegetables, fruits, whole
grains, herbs, nuts and seeds contain an abundance of polyphenolic compounds, terpenoids, sulphur compounds, pigments and other natural antioxidants, that have been associated with protection from or treatment of conditions such as cancer.
The foods and herbs reported to have highest anti-cancer activity include garlic, soybeans, cabbage, ginger, licorice root and the umbelliferous vegetables.
Therefore, we can say that medicinal plants have played a key role in world health.
Plants have been a prime source of highly effective conventional drugs for the treatment of many forms of cancer.
Out of total 250,000 plant species existing on earth approximately one thousand have anticancer potential.
A large number of plant species have been screened through bioassays for search of novel plant based anticancer drugs.
PREVENTING CANCER !
IMPACT OF CANCER IN INDIA The impact of cancer in India is far greater than mere number of
cancer cases. Its diagnosis causes immense emotional trauma and its treatment
a major economic burden. The initial diagnosis of cancer is perceived by many patients as a
grave event with more than one-third of them suffering from anxiety and depression.
Cancer is equally distressing for family as well. It could affect both family’s daily functioning and economic situation.
The economic shock often includes both loss of income and increase of expenses because of treatment and health care.
This disease is associated with a lot of fear & despair in our country.
CANCER MANAGEMENT A CHALLENGE IN INDIA !!!
According to Boston Consulting Group Study, 60-80% cancer cases in India are diagnosed late and 60% patients do not have access to quality treatment.
There are only 300+ cancer centres in India while as 600 more required to meet the demand.
About 400 radiotherapy machines are available and 1200 more are required to cover the cancer population adequately.
Moreover, about 40% centres not equipped with all modern facilities.
The group also estimated that India needs 500 PET-CTs and 1000 cancer units by year 2020.
Doctor patient ratio is 1 in 2000 and currently aim is to achieve 1 in 1000 by 2021.
There is also disproportionate skilful manpower and technology in India with cancer specialists, trained staff and specialized cancer centres available in very few cities across India.
For most patients in India, there is no insurance cover and treatment cost out of reach .
Thus delivery of equitable, quality and affordable cancer care in India is a big challenge.
REFERENCES http://www.dailyexcelsior.com/cancer-scenario-india/ http://www.dailyexcelsior.com/jammu-botanicals-
management-cancer/ http://ocf.org.in/professional/IncidenceAndPrevalence.aspx http://www.ncdc.gov.in/ http://www.ccdcindia.org/ http://www.cdc.gov/cancer/ http://www.who.int/cancer/en/ http://globocan.iarc.fr/Default.aspx http://www.wcrf.org/int/cancer-facts-figures/worldwide-data