BASIC INFORMATION ABOUT CANCER

3. BY BRIG DR HEMANT KUMAR

6. CATEGORIES OF CANCER
 Carcinoma
 Arises from the epithelial cells lining the internal
surface of various organs (e.g. mouth, esophagus,
uterus)
 Sarcoma
 Arises from the mesodermal cells constituting the
various connective tissues (e.g. fibrous tissue, bone)
 Lymphoma, myeloma and leukemia
 Arising from the cells of the bone marrow and immune
system

7. Signs/symptoms
1. A lump or hard area in the breast
2. A change in a wart or mole
3. A persistent change in digestive and bowel
habits
4. A persistent cough or hoarseness
5. Excessive loss of blood at the monthly period or
loss of blood outside the usual dates
6. Blood loss from any natural orifice
7. A swelling or sore that does not get better
8. Unexplained loss of weight

8. PROBLEM STATEMENT
 Cancers figure among the leading causes
of morbidity and mortality worldwide, with
approximately, 32.5 million cases, 14
million new cases and 8.2 million cancer
related deaths in 2012 .
 The number of new cancer cases will rise
from 14 to 22 (by 70%) million within the
next two decades.

9. Contd…
More than 60 percent of the world’s
new cancer cases occur in Africa,
Asia, and Central and South America.
70 percent of the world’s cancer
deaths also occur in these regions.

10. CANCER FREQUENCY
Combined 182 per 100,000 in 2012.
The rate was higher for men (205 per 100,000)
than women (165 per 100,000).
REGION : BOTH SEXES
 The highest cancer rate for men and women
together was found in Denmark with 338
people per 100,000 being diagnosed in 2012.
 The countries in the top ten come from
Europe, Oceania, Northern America and Asia.

11. Age-Standardised Rate per
100,000 (World)(Both Genders)
1. Denmark -338.12
2. France (metropolitan)-324.63
3. Australia-323.04
4. Belgium-321.15
5. Norway-318.36
6. United States of America-318.0

12. MEN
 The highest cancer rate was found in
France with 385 men per 100,000 being
diagnosed in 2012.
 The age-standardised rate was at least
350 per 100,000 in eight countries (France,
Australia, Norway, Belgium, Martinque,
Slovenia, Hungary and Denmark).

13. MEN
1. France (metropolitan)385.32
2. Australia373.93
3. Norway368.74
4. Belgium364.85
5. Slovenia358.27
6. Hungary356.18
7. Denmark354.39
8. United States of America347.0

14. WOMEN
 The age-standardised rate was at least 280 per
100,000 for Denmark, United States of America,
Republic of Korea, The Netherlands and
Belgium.
1. Denmark328.82
2. United States of America297.43
3. Korea, Republic of293.64
4. The Netherlands289.65
5. Belgium288.9

15. COMMON CANCERS
 Lung cancer is the most common cancer, with 1.8
million new cases diagnosed in 2012.
 Hungary had the highest rate of lung cancer,
followed by Serbia and Democratic People's
Republic of Korea.

16. BREAST CANCER
 Breast cancer is the second most common
cancer, with 1.7 million new cases diagnosed
in 2012.
 Belgium had the highest rate of breast cancer,
followed by Denmark and France.

17. COLORECTAL CANCER
 Colorectal cancer is the third most common
cancer, with 1.4 million new cases diagnosed in
2012.
 Republic of Korea had the highest rate of
colorectal cancer, followed by Slovakia and
Hungary.

18. PROSTATE CANCER
 Prostate cancer is the fourth most common
cancer, with 1.1 million new cases diagnosed in
2012.
 France had the highest rate of prostate cancer,
followed by Norway and France.

19. STOMACH CANCER
 Stomach cancer is the fifth most common cancer,
with 952,000 new cases diagnosed in 2012.
 The Republic of Korea had the highest rate of
stomach cancer, followed by Mongolia and Japan.

20. LIVER CANCER
 Liver cancer is the sixth most common cancer,
with 782,000 new cases diagnosed in 2012.
 Mongolia has the highest rate of liver cancer,
followed by Lao PDR and The Gambia.

21. CERVICAL CANCER
 Cervical cancer is the seventh most common
cancer, with 5,28,000 new cases diagnosed in 2012.
 Malawi had the highest rate of cervical cancer,
followed by Mozambique and Comoros.About
84 per cent of cervical cancer cases occurred in
less developed countries.

22. The overall incidence rate is almost 25% higher
in men than in women, with rates of 205 and 165
per 100,000, respectively.
Male incidence rates vary almost five-fold across
the different regions of the world, with rates ranging
from 79 per 100,000 in Western Africa to 365 per
100,000 in Australia/New Zealand .
There is less variation in female incidence (three-
fold) with rates ranging from 103 per 100,000 in
South-Central Asia to 295 per 100,000 in USA.

24. INDIAN SCENARIO
 According to ICMR in 2016 the total number of
new cancer cases are expected to be around
14.5 lakh and the figure is likely to reach nearly
17.3 lakh new cases in 2020.
 Over 7.36 lakh people are expected to succumb to
the disease in 2016 while the figure is estimated to
shoot up to 8.8 lakh by 2020.
 Data also revealed that only 12.5 per cent of
patients come for treatment in early stages of the
disease.

25. CONTD…
“ Cancer of breast with estimated 1.5 lakh
(over 10 per cent of all cancers) new cases
during 2016, is the number one cancer
overall.
Cancer of the lung is the next with
estimated 1.14 lakh (83,000 in males and
31,000 in females) new cases during 2016
and 1.4 lakh cases in 2020.

26.  "Cancer of the cervix is the third most
common cancer with estimated 1 lakh
new cases in 2016 .
Cancers associated with the use of
tobacco account for about 30 per cent
of all cancers in males and females,"
the ICMR said.

27.  The northeast reported the highest number of
cancer cases in both males and females.
Aizawl district in Mizoram reported the highest
number of cases among males while
Papumpare district in Arunachal Pradesh
recorded the highest number among females.
 It also stated there was a "significant"
increase in cancers of rectum and colon in
males in the PBCRs at Bangalore, Chennai,
and Delhi and in females in Barshi and
Bhopal.

29. ETIOLOGY OF CANCER

30. ENVIRONMENTAL FACTORS
 TOBACCO
Tobacco in various forms of usage can cause
cancer of lungs, larynx, mouth, pharynx,
esophagus, bladder, pancreas and probably
kidney.Cigarette smoking is now responsible for
more than one million death each year
 ALCOHOL:
Excess intake of alcohol can cause esophageal
and liver cancer.Beer consumption may be
associated with rectal cancer.Alcohol contributes
about 3 % of all cancer deaths

31. Dietary factor
 Smoked fish is related to stomach cancer
 Dietary fiber to intestinal cancer
 Beef consumption to bowel cancer
 High fat diet to breast cancer
 Food additives and contaminants have
fallen under suspicion as causative agents

32. OCCUPATIONAL EXPOSURES
 These includes exposure to benzene,
cadmium, arsenic, chromium, vinyl
chloride, asbestos, polycyclic
hydrocarbons, etc.
 The risk of occupational exposure is said
to be increased if the individual also
smokes cigarette.
 Occupational exposure is usually reported
1-5% of human cancer

33. Virus
 Hepatitis B & C - hepato-carcinoma
 HIV infection – kaposi’s carcinoma
 AIDS – Non Hodgkin’s lymphoma
 Epstein – bar virus – Burkitts lymphoma and
naso – pharyngial carcinoma
 Cytomegalovirus – Kaposi’s Sa
 Pappiloma virus – cervix cancer
 Human T cell leukemia virus – T cell leukemia

34. Parasite
 May be a cause of cancer
 Schistosomiasis can produce Ca of bladder
Customs, habits and life style
 May be associated with an increased risk of
cancer.
 Smoking and lung cancer
 Tobacco and beetle chewing and oral cancer

35. GENETIC FACTORS
 Genetic influences have long been suspected
 Retinoblastoma occurs in children of the
same parent
 Mongols are more likely to develop leukemia
 There is probably a complex relationship
between hereditary susceptibility and
environmental carcinogenic stimuli in the
causation of cancer

36. Others
Sunlight, radiation, water and air
pollution, medication and pesticides

37. Cancer control

38. THE AIM OF CANCER
CONTROL
Reduction of
Cancer Incidence, Morbidity
& Mortality

39. THE W.H.O. PUBLIC HEALTH MODEL
FOR CANCER CONTROL
1. Assess the magnitude of the cancer problem
2. Evaluate possible strategies for cancer control
3. Choose priorities for initial cancer control
activities of prevention, screening, therapy
and palliative care
4. Set measurable cancer control objectives

40. Primary prevention
Secondary prevention
Tertiary prevention

41. 1. PRIMARY PREVENTION OF CANCER
 Tobacco Control
 Control of Alcohol Consumption
 Occupation and Environment
 Diet
 Infections (viruses and parasites)
 Reducing Sunlight Exposure
 Sexual and Reproductive Factors

42.  Personal hygiene
 Improvement in hygiene may decline the
incidence of certain types of cancers
 Radiation
 Effort should be made to reduce the amount of
radiation received by each individuals to a
minimum without reducing the benefits
 Occupational Exposure
 Should protect workers from exposure to
industrial carcinogens

43.  Food, drugs, and cosmetics
 Should be tested for carcinogens
 Air pollutions
 Control of air pollution is a preventive
measure
 Treatment of pre cancerous lesions
 Early detection and prompt treatment of
precanerous lesions
 Legislation

44. CANCER EDUCATION
To motivate people for early diagnosis and treatment
& Remind early warning symptoms
1. A lump or hard area in the breast
2. A change in a wart or mole
3. A persistent change in digestive and bowel habits
4. A persistent cough or hoarseness
5. Excessive loss of blood at the monthly period or loss of
blood outside the usual dates
6. Blood loss from any natural orifice
7. A swelling or sore that does not get better
8. Unexplained loss of weight

45. SECONDARY PREVENTION
A. Cancer registration
Hospital-based registries
Population based registries
B. Early detection of cases/Screening

46. National Cancer Registry
Programme was launched in 1981
by INDIAN COUNCIL OF
MEDICAL RESEARCH
With an aim to provide authentic
information on cancer prevelance
and incidence.

47. OBJECTIVES:-
1. To generate reliable data on the magnitude and
patterns of cancer
2. Undertake epidemiological studies based on
results of registry data
3. Help in designing, planning, monitoring and
evaluation of cancer control activities under the
National Cancer Control Programme (NCCP)
4. Develop training programmes in cancer
registration and epidemiology

48. POPULATION BASED REGISTRIES
 With these objectives three Population Based
Cancer Registries (PBCRs) at Bangalore, Chennai
and Mumbai and three Hospital Based Cancer
Registries (HBCRs) at Chandigarh, Dibrugarh and
Thiruvananthapuram were commenced from 1
January 1982.
 The PBCRs have gradually expanded over the years
and as of now there are 23 PBCRs under the NCRP
network.

49. THESE REGISTRIES PROVIDE
INFORMATION ON
1.COMMON CANCERS IN INDIA,
2.GEOGRAPHICAL VARIATION OF
OCCURENCE OF CANCER
3.NATURE OF CANCERS FOR
EFFECTIVE CONTROL MEASURES

50. HOSPITAL BASED REGISTRIES
These are located in within identified
hospitals.
Cancer extent,stages,therapy and survival rate
information are more reliable on such data
The existing programme through Mobile
Cancer Detection Unit and Hospital Based
Cancer Detection unit is based on
opportunistic screening

51. Mode of data collection for cancer registries
 Active Methods: developing countries including
India, the provision of information is on voluntary
basis. Exact methodology of data collection would
necessarily depend upon the local circumstances.
 Passive method: The hospitals in areas with
compulsory notification and the hospital cancer
registries, abstract the information from the patient
records on a specified proforma and send it to the
registry.

52. CANCER SCREENING
 Cancer screening aims to
detect cancer before symptoms
appear. This may involve blood tests, urine
tests, other tests, or medical imaging.
 The benefits of screening in terms
of cancer prevention, early detection and
subsequent treatment must be weighed
against any harms.

53. Contd…
 Universal screening, mass
screening or population screening involves
screening everyone, usually within a
specific age group.
 Selective screening involves people who
are known to be at higher risk of
developing cancer.

54.  Screening tests must be effective, safe,
well-tolerated with acceptably low rates
of false positive and false negative results.
 Screening for cancer can lead to cancer
prevention and earlier diagnosis. Early
diagnosis may lead to higher rates of
successful treatment and extended life.

55. Screening tests
Screening for Breast, Cervical, Colorectal and Lung
Cancers
Breast Cancer
 Mammograms are the best way to find breast cancer
early, when it is easier to treat.
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

56. Contd..
Colorectal (Colon) Cancer
 Colorectal cancer almost always develops from
precancerous polyps (abnormal growths) in the
colon or rectum. Screening tests can find
precancerous polyps, so they can be removed
before they turn into cancer.
Lung Cancer
Yearly screening with low-dose computed
tomography (LDCT) for people who are smokers ,
have a history of heavy smoking, and are between
55 and 80 years old.

57. Ovarian Cancer
 There is no evidence that any screening
test reduces deaths from ovarian cancer.
Prostate Cancer
 The U.S. Preventive Services Task Force
recommends against prostate specific
antigen (PSA)-based screening for men
who have no symptoms.

58. National Cancer Control Programme
 1975-76 National Cancer Control Programme was
launched with priorities given for equipping the
premier cancer hospital/institutions.
 In 1984-85 The strategy was revised and stress was
laid on primary prevention and early detection of
cancer cases.
 1990-91 District Cancer Control Programme was
started in selected districts (near the medical college
hospitals).

59. GOALS & OBJECTIVES OF NCCP
 1. Primary prevention of cancers by health education
specially regarding hazards of tobacco consumption
and necessity of genital hygiene for prevention of
cervical cancer.
 2. Secondary prevention i.e. early detection and
diagnosis of cancers, for example, cancer of cervix,
breast and of the oro-pharyngeal cancer by screening
methods and patients’ education on self examination
methods.
 3. Strengthening of existing cancer treatment facilities,
which are woefully inadequate.
 4. Palliative care in terminal stage of the cancer.