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INTRODUCTION
Cancer may be regarded as a group of diseases characterised
by an
(i) abnormal growth of cells
(ii) ability to invade adjacent tissues and even distant
organs, and
(iii) the eventual death of the affected patient if the tumour
has progressed beyond that stage when it can be
successfully removed.
Cancer can occur at any site or tissue of the body and may
involve any type of cells.
Contd...
related to late marriage, birth of the first child at late age, fewer
children, and shorter period of breast feeding which are increasingly
common practice among urban women
TIME TRENDS
Previously ca 6th cause of death in industrialised countries now 2nd
cause of death
This is due to longer life expectancy, more accurate diagnosis and the
rise in cigarette smoking, especially among males since World War I.
The overall rates do not reflect the different trends according to the
type of cancer.
For example, there has been a large increase in lung cancer incidence
since the 1930s; the stomach cancer has shown a declining trend in
most developed countries for reasons not understood.
Cancer patterns
There are wide variations in the distribution of cancer throughout the
world.
The cancer of the stomach is very common in Japan, and has a low
incidence in United States.
Others:
There are numerous other environmental factors such as sunlight,
radiation, air and water pollution, medications (e.g., oestrogen) and
pesticides which are related to cancer.
GENETIC FACTORS
Major risk factors have been identified for a small number of cancers
only and far more research is needed.
SECONDARY PREVENTION
1.CANCER REGISTRATION
Cancer registration is a sine qua non for any cancer control me. It
provides a base for assessing the magnitude of the problem and for
planning the necessary services. 2 types:
A.HOSPITAL BASED REGISTRIES
includes all patients treated by a particular institution, whether in-
patients or out-patients.
should collect the uniform minimum set of data recommended in the
"WHO Handbook for Standardized cancer Registers"
lf there is a long-term follow-up of patients hospital based registries
can be of considerable value in the evaluation of diagnostic and
treatment programmes.
Since hospital population will always be for selected population, the
use of these registries for epidemiological purposes is thus limited
SECONDARY PREVENTION
b.Population BASED REGISTRIES
Right step is to start hospital based entry and extend it into population
based entry
Aims to cover the complete cancer situation ina given geographic area
The optimum of base population for a population based cancer
registry is in the range of 2-7 million
Data from such registries alone provide incidence rate & serve as
useful tool for initiating epidemiological inquiries into causes of
cancer, surveillance of time trends, planning & evaluation of
operational activities in all areas of cancer control
Established at mumbai, bhopal, delhi, barshi chennai under national
cancer registry project of ICMR
SECONDARY PREVENTION
2.EARLY DETCTION OF CASES
Cancer screening is the main weapon for early detection of cancer at a
pre-invasive (in situ) or pre malignancy stage
Effective screening programmes have been developed for cervical
cancer, breast cancer and oral cancer
early diagnosis has to be conducted on a larger scale;
however, it may be possible to increase the efficiency of screening
programmes by focusing on high risk groups
Clearly, there is no point in detecting cancer at an early stage unless
facilities for treatment and aftercare are available
detection programmes will require mobilization of all available
resources and development of a cancer infrastructure starting at the
level of primary health care, ending with complex cancer centres or
institutions at the state or national levels
SECONDARY PREVENTION
2.TREATMENT
Treatment facilities should be available to all cancer patients.
Certain forms of cancer are amenable to surgical removal, while some
others respond favourably to radiation or chemotherapy or both
multi modality approach to cancer control has become a standard
practice in cancer centres all over the world.
For those beyond the curable stage, the goal must be to produce pain
relief .
A largely neglected problem in cancer care is management of pain.
The WHO has developed guidelines for relief of cancer pain
"Freedom from cancer pain" is considered a right for cancer patients
CANCER SCREENING
early detection & prompt treatment of early cancer and precancerous
condition provide the best possible protection against cancer for
individual and the community.
cancer screening may be defined as "search for unrecognized
malignancy by means of Laboratory & applied tests
Cancer screening is possible because :
(a) in many instances, malignant disease is preceded for a period of
months or years by a premalignant lesion, removal of it prevents
subsequent development of cancer:
(b) mosr cancer begin as localised lesions and if found at this stage a
high rate of cure is obtainable: and
(c) as much as 75 % of cancers occur in body sites that are accessible.
CANCER SCREENING
METHODS OF CANCER SCREENING
(a) Mass screening by comprehensive cancer detection Examination.
A rapid clinical examination, and examination of one or more body
sites by the physician is one of the important approaches for screening
for cancer.
Women under 35 years of age should not have X-rays unless they are
symptomatic or a family history of early onset of breast cancer
SCREENING FOR LUNG CANCER
At present there are only two techniques for screening for lung cancer,
viz.
chest radiograph and
sputum cytology.
Mass radiography has been suggested for early diagnosis at six
monthly intervals, but the evidence in support of this is not
convincing. So it is not recommended
It is doubtful whether the disease satisfies the criteria of suitability for
screening
ORAL CANCER
EPIDEMIOLOGICAL FEATURES
Tobacco
Alcohol
Precancerous lesion- erythroplakia, leukoplakia
High risk groups- smokers, tobacco quid in mouth
Cultural patterns- indigenous form of tobacco use
PREVENTION
PRIMARY PREVENTION
Public education and motivation for changing life styles
Legislation- banning / restricting tobacco
ORAL CANCER
SECONDARY PREVENTION
Easily available for inspection allowing early detection
Precancerous lesion can be detected upto 15 years prior to their
change to invasive ca
Main treatment- surgery, radiotherapy
Primary health care workers detect cancer at early stage during hme
visits
CANCER CERVIX
NATURAL COURSE
A.Disease
Cancer cervix seems to follow a progressive course from epithelial
dysplasia to carcinoma in situ into invasive carcinoma
There is good evidence that carcinoma in situ persists for a long time,
more than 8 years
The proportion of cases progressing to invasive ca from preinvasive
stage is not known - it may average 15 years or longer
There is evidence that some in situ case spontaneously regress
without treatment.
Once the invasive stage is reached, the disease spreads by direct
extension into Iymph nodes and pelvic organs
CANCER CERVIX
NATURAL COURSE
b.CAUSATIVE AGENT
HPV sexually transmitted
RISK FACTORS
AGE- 25 TO 45 years
Genital status
Marital status- mutiple sexual partners
Early marriage
OCP
Low socio economic status
CANCER CERVIX
PREVENTION AND CONTROL
PRIMARY PREVENTION Education, birth control
SECONDARY PREVENTION- Early diagnosis, screening, treatment
BREAST CANCER
RISK FACORS
Age- >35 yrs
Parity-nulliparous
Family history
Age at menarche early
Age at menopause-late
Hormonal factors-hiogh estrogen and progesterone
Diet
Prior biopsy
Socioeconomic status-high
Radiation
OCP
BREAST CANCER
PREVENTION AND CONTROL
PRIMARY PREVENTION Education elimination of risk factors
SECONDARY PREVENTION- Early diagnosis, screening, treatment
LUNG CANCER
RISK FACTORS
Age-<65 YRS
SEX-male
Smoking
Radiation
Asbestos exposure
Air pollution
LUNG CANCER
PREVENTION AND CONTROL
PRIMARY PREVENTION Education elimination of risk factors
Public information and education
Legislative and restrictive measures
Smoking cessation activities
National and international coordination
SECONDARY PREVENTION- early diagnosis and treatment
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