CANCER:CANCER: Prevention and Early Prevention and Early DetectionDetection

From the National Cancer InstituteFrom the National Cancer Institute

Presented By:Presented By:Kelly S. Salvador, MD.Kelly S. Salvador, MD.

Medical OncologistMedical OncologistPhilippine Cancer SocietyPhilippine Cancer Society

Understanding CancerUnderstanding Cancer

Cancer Cancer CELLS CELLS TISSUES TISSUESORGANS ORGANS

Normally, cells grow and divide Normally, cells grow and divide new cells new cells cells grow old, they die and new cells cells grow old, they die and new cells

New cells form when the body does not need New cells form when the body does not need them, and old cells do not die when they them, and old cells do not die when they should. These extra cells can form a mass of should. These extra cells can form a mass of tissue called growth or TUMOR.tissue called growth or TUMOR.

Understanding CancerUnderstanding Cancer

Tumors may be BENIGN or MALIGNANTTumors may be BENIGN or MALIGNANT

Benign tumorsBenign tumors are not cancer are not cancer

Rarely life-threateningRarely life-threatening

After removing it, they usually do not grow back.After removing it, they usually do not grow back.

They do not invade the tissues around them.They do not invade the tissues around them.

They do not spread to other parts of the body.They do not spread to other parts of the body.

Understanding CancerUnderstanding Cancer

Malignant tumorsMalignant tumors are cancer. are cancer.

May be life-threatening.May be life-threatening.

If tumor is small, may be removed, but sometimes they If tumor is small, may be removed, but sometimes they grow back.grow back.

They may invade and damage nearby tissues or organs.They may invade and damage nearby tissues or organs.

They can spread (metastasize) to other parts of the They can spread (metastasize) to other parts of the body. body.

Understanding CancerUnderstanding CancerRisk FactorsRisk Factors

Doctors often cannot explain why one person develops Doctors often cannot explain why one person develops cancer and another does not. But research shows that cancer and another does not. But research shows that certain RISK FACTORS increase the chance that a certain RISK FACTORS increase the chance that a person will develop cancer. These are the most common person will develop cancer. These are the most common risk factors for cancer:risk factors for cancer:

Growing Older - higher risk for people over 65 Growing Older - higher risk for people over 65 TobaccoTobaccoSunlightSunlightIonizing radiationIonizing radiationCertain chemicals and other substancesCertain chemicals and other substancesSome viruses and bacteriaSome viruses and bacteriaFamily history of cancer – could not be avoidedFamily history of cancer – could not be avoidedAlcoholAlcoholPoor diet, lack of physical activity, or being overweightPoor diet, lack of physical activity, or being overweight

Risk FactorsRisk Factors

Cancer Facts - 2005Cancer Facts - 2005

Cancers are curable if detected Cancers are curable if detected EARLYEARLY and treated and treated PROPERLYPROPERLY..

106,844 – New Cases

72,846 – Deaths

Reference: Philippine Cancer Facts and Estimate 2005

Estimated Ten Leading Cancer Estimated Ten Leading Cancer (in Both Sexes)(in Both Sexes)

Philippines, 2005Philippines, 2005

1.1. LUNGLUNG 17238 17238

2.2. BREASTBREAST 14043 14043

3.3. COLON / RECTUMCOLON / RECTUM 8585 8585

4.4. LIVERLIVER 7629 7629

5.5. CERVIX UTERICERVIX UTERI 7277 7277

6.6. PROSTATE 4254PROSTATE 4254

7.7. LEUKEMIA 4202LEUKEMIA 4202

8.8. STOMACHSTOMACH 3932 3932

9.9. THYROID THYROID 3521 3521

10.10. OVARY OVARY 3283 3283

Estimated Ten Leading Cancer Estimated Ten Leading Cancer (in MALE) (in MALE)

Philippines, 2005Philippines, 2005

1.1. LUNG LUNG 13273132732.2. LIVERLIVER

566056603.3. COLON/RECTUMCOLON/RECTUM 4737 47374.4. PROSTATEPROSTATE 4254 42545.5. STOMACHSTOMACH 2368 23686.6. LEUKEMIA LEUKEMIA 2243 22437.7. NASOPHARYNXNASOPHARYNX 1990 19908.8. ORAL CAVITYORAL CAVITY 1563 15639.9. NON-HODGKIN LYMPHOMANON-HODGKIN LYMPHOMA 1468 146810.10. LARYNXLARYNX 1464 1464

Estimated Ten Leading Cancer Estimated Ten Leading Cancer (in FEMALES) (in FEMALES)

Philippines, 2005Philippines, 2005

1.1. BREASTBREAST 14043140432.2. CERVIX ; UTERI CERVIX ; UTERI

727772773.3. LUNGLUNG 3965 39654.4. COLON/RECTUMCOLON/RECTUM 3848 38485.5. OVARYOVARY 3283 32836.6. THYROIDTHYROID 2766 27667.7. LIVERLIVER 1969 19698.8. LEUKEMIALEUKEMIA 1959 19599.9. CORPUS UTERICORPUS UTERI 1777 177710.10. STOMACHSTOMACH 1564 1564

SOME VIRUSES AND SOME VIRUSES AND BACTERIABACTERIA Human Papillomaviruses (HPVs) -- may cause Cervical CancerHuman Papillomaviruses (HPVs) -- may cause Cervical Cancer

Hepatitis B and Hepatitis C – may cause Liver CancerHepatitis B and Hepatitis C – may cause Liver Cancer

Human T-Cell Leukemia/Lymphoma virus – increase risk for Human T-Cell Leukemia/Lymphoma virus – increase risk for Lymphoma and LeukemiaLymphoma and Leukemia

Human Immunodeficiency virus -- HIV is the virus that causes Human Immunodeficiency virus -- HIV is the virus that causes AIDS and in turn, AIDS patients may be at risk to get AIDS and in turn, AIDS patients may be at risk to get Lymphoma and Kaposi’s Sarcoma.Lymphoma and Kaposi’s Sarcoma.

Epstein-Barr virus (EBV) -- at risk to get Lymphoma and Epstein-Barr virus (EBV) -- at risk to get Lymphoma and Nasopharyngeal CarcinomaNasopharyngeal Carcinoma

Human Herpesvirus 8 (HHV8) – risk factor for Kaposi’s Human Herpesvirus 8 (HHV8) – risk factor for Kaposi’s SarcomaSarcoma

Helicobacter pylori – may cause stomach ulcers, stomach Helicobacter pylori – may cause stomach ulcers, stomach cancer and lymphoma in the stomach lining. cancer and lymphoma in the stomach lining.

SCREENINGSCREENING

BreastBreast : A Mammogram is the best tool doctors : A Mammogram is the best tool doctors have to find breast cancer early. NCI have to find breast cancer early. NCI recommends that women above age of 40 should recommends that women above age of 40 should have mammograms every 1 to 2 years. Those at have mammograms every 1 to 2 years. Those at high risk should speak to their doctors if they high risk should speak to their doctors if they should have a mammogram before the age of 40 should have a mammogram before the age of 40 and how often they should be doing it.and how often they should be doing it.

CervixCervix: The Pap Test or Pap Smear is used to : The Pap Test or Pap Smear is used to check cells from the cervix. Women should begin check cells from the cervix. Women should begin having Pap tests 3 years after they begin having having Pap tests 3 years after they begin having sexual intercourse or when they reach age 21, sexual intercourse or when they reach age 21, whichever comes first. Most women should have whichever comes first. Most women should have a Pap test at least once every 3 years.a Pap test at least once every 3 years.

Colon and Rectum:Colon and Rectum:

Fecal Occult Blood Test: Sometimes cancer or polyps Fecal Occult Blood Test: Sometimes cancer or polyps bleed.bleed.

Sigmoidoscopy: This lighted tube may see inside the Sigmoidoscopy: This lighted tube may see inside the rectum and lower part of the colon and may remove rectum and lower part of the colon and may remove polyps.polyps.

Colonoscopy: This lighted tube may see inside the Colonoscopy: This lighted tube may see inside the rectum and entire colon and may also remove polyps.rectum and entire colon and may also remove polyps.

Double-contrast barium enema: This procedure involves Double-contrast barium enema: This procedure involves several x-rays of the colon and rectum. The patient is several x-rays of the colon and rectum. The patient is given an enema with a barium solution and air is pumped given an enema with a barium solution and air is pumped into the rectum. The barium and air improve the x-ray into the rectum. The barium and air improve the x-ray images of the colon and rectum.images of the colon and rectum.

Digital Rectal exam: This is often part of a routine Digital Rectal exam: This is often part of a routine physical exam. The doctor inserts a lubricated, gloved physical exam. The doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas. A finger into the rectum to feel for abnormal areas. A digital rectal exam allows for examination of only the digital rectal exam allows for examination of only the lowest part of the rectum.lowest part of the rectum.

Prevention of Lung Prevention of Lung CancerCancer

There is no screening There is no screening procedure that can procedure that can effectively prevent Lung effectively prevent Lung Cancer.Cancer.

To prevent Lung Cancer, one To prevent Lung Cancer, one must must STOP SMOKINGSTOP SMOKING..

Prevention of Liver Prevention of Liver CancerCancer

Hepa-B Hepa-B VaccinationVaccination

Regular check-up Regular check-up on on

Hepa-B virusHepa-B virus Regulate intake of Regulate intake of

alcoholalcohol

Early Detection for Cervical Early Detection for Cervical CancerCancer

Pap smear can detect early Cervix cancer Pap smear can detect early Cervix cancer and pre-cancerous lesions. and pre-cancerous lesions.

Pap Smear should be done 3 years after Pap Smear should be done 3 years after the first vaginal intercourse. the first vaginal intercourse.

After the initial Pap Smear, it should be After the initial Pap Smear, it should be done every year for 3 years, if the result done every year for 3 years, if the result from consecutive test is negative, if not, it from consecutive test is negative, if not, it should be done yearly. should be done yearly.

Women without sexual experience should Women without sexual experience should have Pap Smear after reaching the age of have Pap Smear after reaching the age of 35.35.

Prevention of Cervical Prevention of Cervical CancerCancer

Delay on the first sexual Delay on the first sexual intercourseintercourse

One partner relationship between One partner relationship between partnerspartners

Use of barrier contraceptives like Use of barrier contraceptives like condoms during sexual intercoursecondoms during sexual intercourse

WARNING SYMPTOMS WARNING SYMPTOMS OF CANCEROF CANCER

A thickening or lump in the breast A thickening or lump in the breast or any other part of the bodyor any other part of the body

A new mole or a change in an existing moleA new mole or a change in an existing mole A sore that does not healA sore that does not heal Hoarseness or a cough that does not go awayHoarseness or a cough that does not go away Change in bowel or bladder habitsChange in bowel or bladder habits Discomfort after eatingDiscomfort after eating A hard time swallowingA hard time swallowing Weight gain or loss with no known reasonWeight gain or loss with no known reason Unusual bleeding or dischargeUnusual bleeding or discharge Feeling weak or very tiredFeeling weak or very tired

DIAGNOSISDIAGNOSIS Lab TestsLab Tests

Tests of the blood, urine or other fluids can help Tests of the blood, urine or other fluids can help doctors make a diagnosis.doctors make a diagnosis.

Imaging ProceduresImaging Procedures

X-raysX-raysUltrasoundUltrasoundCT ScanCT ScanRadionuclide ScanRadionuclide ScanMRIMRIPET ScanPET Scan

BIOPSYBIOPSYThe doctor removes a sample of tissue The doctor removes a sample of tissue and sends it to a lab.and sends it to a lab.

A pathologist looks at the tissue under a A pathologist looks at the tissue under a microscope. The sample may be removed microscope. The sample may be removed in several ways:in several ways:

With a needleWith a needle With an endoscopeWith an endoscope

TREATMENTTREATMENT1.1. Team InvolvedTeam Involved

Surgical OncologistSurgical Oncologist Medical OncologistMedical Oncologist Radiation OncologistRadiation Oncologist Hematologic OncologistHematologic Oncologist

2.2. MethodsMethodsPrimary Goal: is to cure the cancerPrimary Goal: is to cure the cancerOther cases: to control the disease or to remove Other cases: to control the disease or to remove symptoms as long as possiblesymptoms as long as possible

Surgery – neoadjuvant, adjuvant, palliativeSurgery – neoadjuvant, adjuvant, palliative Chemotherapy – neoadjuvant, adjuvant, palliativeChemotherapy – neoadjuvant, adjuvant, palliative Radiation – external beam or internal like implantRadiation – external beam or internal like implant Hormonal therapyHormonal therapy Stem cell transplantationStem cell transplantation

NUTRITION & PHYSICAL NUTRITION & PHYSICAL ACTIVITIESACTIVITIES

Recommendations for Individual Choices:Recommendations for Individual Choices:

Maintain a healthy weight throughout life.Maintain a healthy weight throughout life. Balance caloric intake with Balance caloric intake with

physical activity.physical activity. Avoid excessive weight gain Avoid excessive weight gain

throughout life.throughout life. Achieve and maintain Achieve and maintain

a healthy weight if currently a healthy weight if currently overweight or obese.overweight or obese.

Adopt a physically active lifestyle.Adopt a physically active lifestyle.

Adults: Engage in at least 30mins. of Adults: Engage in at least 30mins. of moderate to moderate to vigorous physical activity, vigorous physical activity, above usual activities, above usual activities, on 5 or more days of the on 5 or more days of the week; 45 to 60 mins. of week; 45 to 60 mins. of intentional intentional physical activity are preferable.physical activity are preferable.

Children and Adolescents: Engage in at Children and Adolescents: Engage in at least 60 mins. per day of moderate to vigorous least 60 mins. per day of moderate to vigorous

physical activity at least 5 days per week.physical activity at least 5 days per week.

Eat a healthy diet, with an emphasis on plant Eat a healthy diet, with an emphasis on plant sources.sources.

Choose food or beverages in amounts that help achieve Choose food or beverages in amounts that help achieve and and maintain a healthy weight.maintain a healthy weight.

Eat 5 or more servings of a variety of vegetables Eat 5 or more servings of a variety of vegetables and and fruits fruits everyday.everyday.

Choose whole grains in preference to processed Choose whole grains in preference to processed (refined) grains.(refined) grains.

Limit consumption of processed and red meatsLimit consumption of processed and red meats

If you drink alcoholic beverages, limit consumption.If you drink alcoholic beverages, limit consumption.

Drink no more than 1 drink per day for women, and 2 Drink no more than 1 drink per day for women, and 2 per day for per day for men.men.

COMMON QUESTIONS COMMON QUESTIONS ABOUT DIET AND ABOUT DIET AND

CANCERCANCERINCREASE RISKINCREASE RISK

1.1. Alcohol – limit to 1 drink per day for Alcohol – limit to 1 drink per day for women and 2 drinks per day for men.women and 2 drinks per day for men.A drink is defined asA drink is defined as

12 ounces of beer or12 ounces of beer or

5 ounces of wine or5 ounces of wine or

1.5 ounces of 80-proof distilled spirits1.5 ounces of 80-proof distilled spirits

Increase risk of the mouth, pharynx, larynx, Increase risk of the mouth, pharynx, larynx, esophagus, liver and breast. More risk if combine esophagus, liver and breast. More risk if combine drinking and tobacco.drinking and tobacco.

2. Aspartame – does not show increased risk2. Aspartame – does not show increased risk

3. Bioengineered Foods – are made by adding 3. Bioengineered Foods – are made by adding genes from other plants or organicms to genes from other plants or organicms to increase a plant’s resistance to pest or other increase a plant’s resistance to pest or other spoilages, are not found to increase nor spoilages, are not found to increase nor decrease cancer risk.decrease cancer risk.

4. Little evidence that the total amount of fat 4. Little evidence that the total amount of fat consumed affects cancer risk. But diets high in consumed affects cancer risk. But diets high in fat tend to be high in calories and may fat tend to be high in calories and may contribute to obesity, which in turn is linked contribute to obesity, which in turn is linked with an increased risk of several types of with an increased risk of several types of cancer.cancer.

5. Flourides – not found to increase cancer risk5. Flourides – not found to increase cancer risk

6. Food Additives – No evidence to increase cancer risk.6. Food Additives – No evidence to increase cancer risk.

7. Irradiated food – do not increase cancer risk7. Irradiated food – do not increase cancer risk

8. Processed meat or Meat preserved by methods involving 8. Processed meat or Meat preserved by methods involving smoke or salt increase colorectal and stomach cancer.smoke or salt increase colorectal and stomach cancer.

9. Frying, broiling, grilling meat may increase cancer risk.9. Frying, broiling, grilling meat may increase cancer risk.

10. Obesity – increase risk in breast, colon, endometrial, 10. Obesity – increase risk in breast, colon, endometrial, esophagus and kidney cancer.esophagus and kidney cancer.

11. Pesticides & Herbicides – no increased risk for cancer if 11. Pesticides & Herbicides – no increased risk for cancer if used in small amounts enough to protect vegetables from used in small amounts enough to protect vegetables from pests.pests.

12. Saccharin – not carcinogenic12. Saccharin – not carcinogenic

13. Soy Supplement – no evidence to 13. Soy Supplement – no evidence to reduce cancer risk, high doses of soy reduce cancer risk, high doses of soy increase risk of breast and endometrial increase risk of breast and endometrial cancercancer

14. Supplement – high dose may actually 14. Supplement – high dose may actually increase cancer riskincrease cancer risk

Decreased RiskDecreased Risk1.1. Antioxidants which include Vitamins C and E, Antioxidants which include Vitamins C and E,

carotenoids and other phytochemicals (from food carotenoids and other phytochemicals (from food sources) and not from food supplements.sources) and not from food supplements.

2.2. Beta-carotene, an anti-oxidant chemically realted Beta-carotene, an anti-oxidant chemically realted to Vitamin A found in vegetables and fruits may to Vitamin A found in vegetables and fruits may be helpful, but in high doses of this supplement be helpful, but in high doses of this supplement given to smokers may actually cause increase risk given to smokers may actually cause increase risk of lung cancer.of lung cancer.

3.3. Calcium may reduce risk for colorectal cancer but Calcium may reduce risk for colorectal cancer but there is evidence that the high calcium intake there is evidence that the high calcium intake through supplements may increase risk of through supplements may increase risk of prostate cancer.prostate cancer.

4. No evidence that low fasting blood cholesterol 4. No evidence that low fasting blood cholesterol may decrease cancer risk.may decrease cancer risk.

5. Drinking coffee does not increase risk of breast 5. Drinking coffee does not increase risk of breast cancer but may heighten symptoms of cancer but may heighten symptoms of fibrocystic breast lumps.fibrocystic breast lumps.

6. Eating high amounts of fiber may help reduce 6. Eating high amounts of fiber may help reduce cancer risks.cancer risks.

7. Little evidence that omega 3 fatty acid, olive, 7. Little evidence that omega 3 fatty acid, olive, canola oil reduce cancer risk.canola oil reduce cancer risk.

8. Fish not found to decrease cancer risk.8. Fish not found to decrease cancer risk.

9. Folate, which is Vitamin B found in vegetables, 9. Folate, which is Vitamin B found in vegetables, fruits and enriched grain products decrease fruits and enriched grain products decrease cancers of the colon, rectum and breast.cancers of the colon, rectum and breast.

10. Garlic – no evidence that it can reduce cancer 10. Garlic – no evidence that it can reduce cancer risk.risk.

11. Lycopene – not sure if it is the substance that 11. Lycopene – not sure if it is the substance that reduce cancer risk.reduce cancer risk.

12. Organic food – no evidence that it reduces 12. Organic food – no evidence that it reduces cancer risk.cancer risk.

13. Physical activity – lowers the risk to develop 13. Physical activity – lowers the risk to develop cancer of the colon and breastcancer of the colon and breast

14. Selenium – decreases risk of cancer of the lung, colon 14. Selenium – decreases risk of cancer of the lung, colon and prostate.and prostate.

15. Tea – not proven to decrease cancer risk.15. Tea – not proven to decrease cancer risk.

16. Cruciferous vegetables – cabbage family including 16. Cruciferous vegetables – cabbage family including brocolli, cauliflower, brussels sprout and kale reduce brocolli, cauliflower, brussels sprout and kale reduce the risk for colorectal cancer.the risk for colorectal cancer.

17. Vitamin D – reduce risk for cancers of the colon, 17. Vitamin D – reduce risk for cancers of the colon, prostate and breast.prostate and breast.

18. Vitamin E – lowers risk for prostate cancer.18. Vitamin E – lowers risk for prostate cancer.

TUMOUR GRADING AND STAGINGTUMOUR GRADING AND STAGING

Tumour gradingTumour grading is usually of importance in assessing is usually of importance in assessing prognosis. It refers to the degree of malignancy or prognosis. It refers to the degree of malignancy or differentiation of tumour tissue based on histological differentiation of tumour tissue based on histological evaluation, and is often expressed in 4 categories:evaluation, and is often expressed in 4 categories:

   Grade 1(G1) --- Well differentiated (about a quarter of Grade 1(G1) --- Well differentiated (about a quarter of

cells undifferentiated)cells undifferentiated) Grade 2(G2)--- Moderately undifferentiated (about half Grade 2(G2)--- Moderately undifferentiated (about half

of cells undifferentiated) of cells undifferentiated) Grade 3(G3)--- Markedly undifferentiated (about three Grade 3(G3)--- Markedly undifferentiated (about three

quarters of cells undifferentiated)quarters of cells undifferentiated) Grade 4(G4)--- Undifferentiated (almost all cells Grade 4(G4)--- Undifferentiated (almost all cells

undifferentiated)undifferentiated)

Tumour stagingTumour staging is determined by a is determined by a comprehensive evaluation using diagnostic comprehensive evaluation using diagnostic tools for categorising the growth and spread of tools for categorising the growth and spread of tumours. It involves classifying the extent of the tumours. It involves classifying the extent of the malignant tumour. malignant tumour. 

One classification is known as the TNM One classification is known as the TNM system.  T stands for primary tumour, N is system.  T stands for primary tumour, N is regional nodes whereas M represents regional nodes whereas M represents metastasis. metastasis.

TNMTNM

Tis---Pre-invasive carcinoma (carcinoma in situTis---Pre-invasive carcinoma (carcinoma in situ T0---No evidence of a primary tumourT0---No evidence of a primary tumour T1---Small tumour, restricted to organ of originT1---Small tumour, restricted to organ of origin T2---Large but restricted to organ of originT2---Large but restricted to organ of origin T3---Some invasion of adjacent tissueT3---Some invasion of adjacent tissue T4---Massive invasion of adjacent tissue and/or T4---Massive invasion of adjacent tissue and/or

organsorgans TX---Unable to assess primary tumourTX---Unable to assess primary tumour    

N0---No regional lymph node involvementN0---No regional lymph node involvement N1, N2, N3---Increasing involvement of N1, N2, N3---Increasing involvement of

regional lymph nodesregional lymph nodes N4---Involvement of juxta-regional lymph nodesN4---Involvement of juxta-regional lymph nodes NX---Unable to assess regional and/or juxta-NX---Unable to assess regional and/or juxta-

regional lymph nodesregional lymph nodes M0---No distant metastasesM0---No distant metastases M1---Distant metastases presentM1---Distant metastases present MX---Unable to assess distant metastasesMX---Unable to assess distant metastases

Sometimes, the tumour staging has an additional letter “Sometimes, the tumour staging has an additional letter “pp” ” before TNM. This indicates post-surgical histopathological before TNM. This indicates post-surgical histopathological staging.staging.

   C FACTORSC FACTORS   The letter The letter CC placed before TNM provides information on placed before TNM provides information on

which type of diagnostic instrument was used to diagnose which type of diagnostic instrument was used to diagnose the tumour and the extent of its growth.the tumour and the extent of its growth.

   C1Using an X-Ray examinationC2Using special equipment, C1Using an X-Ray examinationC2Using special equipment,

for e.g. endoscopyC3Using exploratory surgery C4 using for e.g. endoscopyC3Using exploratory surgery C4 using histopathological results C5 using autopsy resultshistopathological results C5 using autopsy results      

ALTERNATIVE STAGINGALTERNATIVE STAGING  

   Stage I---Tumour is localisedStage I---Tumour is localised Stage II---There is presence of adjacent Stage II---There is presence of adjacent

tissue invasiontissue invasion Stage III---Some regional lymph nodes Stage III---Some regional lymph nodes

involvedinvolved Stage IV---Distant metastases presentStage IV---Distant metastases present

Some specific tumour stagings Some specific tumour stagings consist of:consist of:  

(a)Hodgkin’s and/or Non-Hodgkin’s diseaseAnn Arbor(a)Hodgkin’s and/or Non-Hodgkin’s diseaseAnn Arbor (b)(b)  Malignant melanomasClark and Breslow systemsMalignant melanomasClark and Breslow systems (c)Cervical cancerCIN(c)Cervical cancerCIN (d)Colorectal cancersDukes(d)Colorectal cancersDukes (e)(e)  Gynaecological tumours FIGO (Federation Gynaecological tumours FIGO (Federation

Internationale de Gynecologie et d’Obstetrique)Internationale de Gynecologie et d’Obstetrique) (f)Prostate carcinomaFlocks/VACURG(f)Prostate carcinomaFlocks/VACURG (g)Urinary bladderMarshall(g)Urinary bladderMarshall (h)Chronic lymphatic leukaemia RAI(h)Chronic lymphatic leukaemia RAI

TUMOUR MARKERSTUMOUR MARKERS  

Tumour markers are substances found in the blood, urine or body tissues Tumour markers are substances found in the blood, urine or body tissues created by the tumour itself or as a result of the body’s reaction to the created by the tumour itself or as a result of the body’s reaction to the tumour.  However, it should be remembered that tumour markers are not to tumour.  However, it should be remembered that tumour markers are not to be used alone as a diagnostic tool because they can also be elevated in be used alone as a diagnostic tool because they can also be elevated in people without tumours.  Not all affected cancer patients have raised people without tumours.  Not all affected cancer patients have raised tumour markers.  In the early stages, the levels could be normal.tumour markers.  In the early stages, the levels could be normal.

They are more useful in monitoring the progress of cancer once diagnosed.They are more useful in monitoring the progress of cancer once diagnosed.   Among the tumour markers:Among the tumour markers:

(a)(a)  Alpha-foetoprotein (AFP) for ovarian, liver, testis cancerAlpha-foetoprotein (AFP) for ovarian, liver, testis cancer(b)Carcinoembryonic antigen (CEA) for breast, colon, lung cancer(b)Carcinoembryonic antigen (CEA) for breast, colon, lung cancer(c)Human chorionic gonadotropin (HCG) for uterine choriocarcinoma, (c)Human chorionic gonadotropin (HCG) for uterine choriocarcinoma, ovarian cancer, testicular cancer(d)Prostate Specific Antigen (PSA) for ovarian cancer, testicular cancer(d)Prostate Specific Antigen (PSA) for prostate cancerprostate cancer

HOW INSURABLE ARE THE HOW INSURABLE ARE THE FOLLOWING CANCERS?FOLLOWING CANCERS?

There are four main types of thyroid cancer:There are four main types of thyroid cancer:1.      Papillary carcinoma1.      Papillary carcinoma2.      Follicular carcinoma2.      Follicular carcinoma3.      Medullary thyroid carcinoma3.      Medullary thyroid carcinoma4.      Anaplastic carcinoma4.      Anaplastic carcinoma

Carcinoid tumors :Carcinoid tumors : Gastro-intestinalGastro-intestinal LungLung

End of PresentationEnd of Presentation

Q & A:Q & A:DiscussionDiscussion

Thank You Very Much!!!Thank You Very Much!!!