Dr Sreekumar Pillai MS Mch

1
THE BIG C

• Dr Sreekumar Pillai MS Mch
• Consultant Surgical Oncologist
• Amala Institute of Medical Sciences

2
INTRODUCTION

• CANCER IS PREVENTABLE
• 80 90 CANCER ARE DUE TO OUR HABITS AND
  ACTIVITIES
• CANCER INVOLVES ALMOST EVERY PARTS OF THE BODY
• CANCER CELLS MULTIPLY IN AN UNCONTROLLABLE
  HAPAZARD MANNER

3
SCENARIO

• CANCER IS THE CAUSE OF 12 OF ALL DEATHS
• IN INDIA 1.5 2 MILLION ESTIMATED CANCER CASES
  AT ANY POINT OF TIME
• EVERY YEAR 8 LAKHS NEW CASES ARE DETECTED IN
  INDIA
• EVERY YEAR 5.5 LAKHS CANCER PATIENTS DIE IN OUR
  COUNTRY

4
FACTS ABOUT CANCER

• 70 80 CANCER CASES ARE DETECTED AT LATE STAGE
  WHEN TREATMENT IS NOT POSSIBLE
• EARLY DETECTION OF CANCER HELPS IN COMPLETE CURE
  OF SOME CANCER
• PREVENTION BY TAKING SOME PRECAUTIONARY MEASURES
  IS THE BEST WAY TO PREVENT CANCER

5
DEFINITION
6
GENES

• PROTO ONCOGENES
• TUMOR SUPPRESSOR GENES

7
CELL CYCLE APOPTOSIS

• G0

8
NATURAL HISTORY OF CANCER

• LATENT STAGE
• CLINICAL STAGE
• premalignant
• malignant
• LOCAL SPREAD
• SYSTEMIC SPREAD (METASTASIS)
• lymphatic
• blood

9
ENVIRONMENTAL CAUSES

• PHYSICAL
• CHEMICAL
• VIRAL

10
CAUSES - POLLUTION

• AIR POLLUTION MAY ALSO CAUSE CANCER (ASBESTOS)
• INDUSTRIAL WORKERS ARE EXPOSED TO VARIOUS
  CHEMICALS WHICH ARE KNOWN TO BE CARCINOGEN

11
CAUSES WATER POLLUTION

• WATER MAY CONTAIN A NUMBER OF CANCER CAUSING
  SUBSTANCE AS THE INDUSTRIES DUMP CHEMICAL
  DIRECTLY INTO WATER OR BURRY THEM IN THE GROUND

12
CAUSES - TOBACCO

• CIGARETTE SMOKING IS A MAJOR CAUSE OF CANCER
• SMOKING MAY BE ACTIVE OR PASSIVE BOTH ARE
  HARMFUL
• CONSUMPTION OF TOBACCO IN FORM OF KHAINI, ZARDA
  AND GHUTKA ALSO CAUSES CANCER
• TOBACCO NOT ONLY CAUSES CANCER BUT ALSO OTHER
  DISEASES

13
CAUSES BETELNUT

• BETELNUT CONTAINS CARCINOGENS
• THE NUTS KEPT BURIED IN THE GROUND FOR LOND
  PERIOD LEADS TO THE GROWTH OF FUNGUS WHICH IS
  CARCINOGENIC
• PEBPLE CONSUMING BETELNUT ALSO HAVE THE HABIT OF
  CONSUMING TOBACCO

14
PHYSICAL CAUSES

• IONISING RADIATION
• natural
• human
• UV LIGHT UVB
• ASBESTOS

15
CAUSES X-RAY

• X-RAYS MAY STIMULATE THE DEVELOPMENT OF CANCER
• REPEATED X-RAYS SHOULD BE AVOIDED
• X-RAY DONE ON PREGNANT WOMEN MAY INCREASE THE
  FREQUENCY OF CHILDHOOD CANCER

16
DIET CANCER

• ENERGY
• ALCOHOL
• FAT

17
CAUSES - ALCOHOL

• ALCOHOL CONSUMPTION LEADS TO CANCER OF ORAL
  CAVITY, PHARYNX, LARYNX, ESOPHAGUS, STOMACH,
  LIVER
• PEOPLE WHO DRINK ALSO SMOKES FURTHER INCREASING
  THE RISK OF DEVELOPING CANCER

18
CAUSES FAT/FIBRE

• HIGH INTAKE OF FAT (ANIMAL) INCREASES THE RISK OF
  DEVELOPING CANCER (BREAST AND COLON)
• DIETARY FIBRE OF PLANT ORIGIN HAS A PROTECTIVE
  ROLE AGAINST CANCER

19
CAUSES - VIRUS

• CERTAIN VIRUSES MAY CAUSE CANCER
• THESE VIRUSES ARE HEPATITIS B C, EPSTEIN
  BARR VIRUS, HUMAN PAPILLOMA VIRUS, CMV. Etc.

20
CANCER SUSCEPTIBILITY

• UNUSUALLY YOUNG AGE OF PRESENTATION
• MULTIFOCAL INVOLVEMENT IN ORGAN
• BILATERAL INVOLVEMENT IN PAIRED ORGAN

21
EARLY DETECTION OF CANCER

• CANCER DEVELOPS IN THE BODY VERY SILENTLY
• UNTIL IT COMES TO CERTAIN STAGE PATIENTS LEAD A
  NORMAL LIFE WITHOUT ANY COMPLAINTS
• INITIALLY IT PRODUCES MILD SYMPTOMS AS FOUND
  IN OTHER AILMENTS

22
HOW TO DETECT DISEASE EARLY

• SEVEN DANGER SIGNALS
• CHANGE IN BLADDER BOWEL HABITS
• SORE THROAT NOT HEALING
• UNUSUAL BLEEDING OR DISCHARGE
• THICKENING OR LUMP IN BREAST OR ANYWHERE
• INDIGESTION AND DIFFICULTY IN SWALLOWING
• OBVIOUS CHANGE IN WAT OR MOLE
• NAGGING COGH OR HOARSENESS OF VOICE

23
LARYNGEAL CANCER WARNING SIGNS

• PERSISTENT HOARSENESS
• SORENESS IN RHE NECK
• FELLING OF HAVING A LUMP IN THE THROAT
• DIFFICULTY IN SWALLOEING
• RISK FACTORS TOBACCO CONSUMPTION AND
  ALCOHOL INTAKE

24
ORAL CANCER WARNING SIGNS

• PERSISTENT WHITE OR RED PATCHES, USUALLY PAINLESS
• ANY PERSISTENT LUMP OR SWELLING
• RISK FACTORS TOBACCO CONSUMPTION AND
  ALCOHOL INTAKE

25
LUNG CANCER WARNING SIGNS

• CHRONIC COUGH
• COUGHING OUT OF BLOOD
• CHANGE IN THE VOICE
• CHEST PAIN
• SHORTNESS OF BREATH
• RISK FACTORS SMOKING, EXPOSURE TO ASBESTOS,
  COAL TAR DERIVATIVES AND RADIATION

26
BREAST CANCER WARNING SIGNS

• FIRM LUMP
• SMALL CHANGES IN THE NIPPLE
• DISCHARGE FROM THE NIPPLE
• RISK FACTORS EARLY MENSTRUATION
• LATE MENOPAUSE
• FIRST CHILD AFTER 35 YRS OF AGE
  CHILDLESSNESS
• FAMILY HISTORY - BREAST CANCER
• HIGH FAT LOW FIBRE DIET

27
CERVICAL CANCER WARNING SIGNS

• ABNORMAL BLEEDING BETWEEN PERIODS
• BLEEDING AFTER INTERCOURSE
• PROLONGED HEAVY BLEEDING DURING MENSTRUATION
• RISK FACTORS - FREQUENT SEXUAL INTERCOURSE AT AN
  EARLY AGE, MULTIPLE SEX PARTNERS, MANY CHILDREN

28
COLORECTAL CANCER WARNING SIGNS

• BLOOD IN STOOL
• FEELING OF BEING BLOATED
• CHANGE IN BOWEL HABITS
• CONSTIPATION

29
COLORECTAL CANCER RISK FACTORS

• AGE OVER 40
• FAMILY HISTORY
• H/O INFALMATORY BOWEL DISEASE
• FAMILIAL POLYPOSIS
• PAST H/O OF BREAST OR OTHER REPRODUCTIVE ORGAN
  CANCER IN FEMALE
• HIGH CONSUMPTION OF RED MEAT AND LOW FIBRE DIET

30
ESOPHAGEAL CANCER WARNING SIGNS

• DIFFICULTY IN SWALLOWING
• RECURRENT INDIGESTION
• RISK FACTORS
• SMOKING
• ALCOHOL
• DEFICIENCY OF VITAMINS AND MINERALS

31
DIAGNOSIS

• GOOD HISTORY
• METICULOUS CLINICAL EXAMINATION
• SCOPY
• IMAGING MODALITIES
• BIOPSY

32
SCOPY

• DIRECT LARYNGOSCOPY
• ENDOSCOPY
• BRONCHOSCOPY
• LAPROSCOPY
• COLONOSCOPY
• CYSTOSCOPY

33
IMAGING MODALITIES

• XRAY
• USG
• CT SCAN
• MAMMOGRAM
• GAMMA IMAGING
• PET SCAN
• PET CT

34
BIOPSY

• FNAC
• FNNAC
• PUNCH BIOPSY
• INCISION BIOPSY
• EXCISION BIOPSY
• LAPROSCOPIC BIOPSY
• LAPROTOMY

35
PATHOLOGY

• GENERAL PATHOLOGY
• CELL ORIGIN
• GRADE
• IMMUNOHISTOCHEMISTRY
• ELECTRON MICROSCOPY

36
TREATMENT MODALITIES

• SURGERY
• RADIATION
• CHEMOTHERAPY
• HORMONE THERAPY
• IMMUNOLOGICAL THERAPY
• BIOLOGICAL RESPONSE MODIFIERS
• GENE THERAPY
• VACCINES

37
TREATMENT - SURGERY

• OLDEST TREATMENT
• LOTS OF ADVANCEMENT HAVE TAKEN PLACE OVER LAST
  FEW YEARS
• SURGERY HAS ROLE IN PREVENTION OF CANCER
  REMOVAL OF NON-VITAL ORGAN
• DIAGNOSIS ASPIRATION, BIOPSY, LAPAROTOMY

38
SURGERY

• DIAGNOSTIC
• PREVENTIVE
• THERAPEUTIC
• RECONSTRUCTIVE
• PALLIATIVE

39
TREATMENT - RADIOTHERAPY

• WIDELY USED
• TELETHERAPY WHEN THE TUMOR IS AT A DISTANCE
  FROM THE SOURCE, THESE INCLUDE COBALT-60 AND
  LINEAR ACCELERATOR
• BRACHTHERAPY SOURCE OF RADIATION IS CLOSE TO
  THE TUMOR OR WITHIN TUMOR

40
TREATMENT - CHEMOTHERAPY

• CHEMOTHERAPY MEANS TREATMENT OF CANCER WITH DRUGS
• CHEMOTHERAPY INTEREFERS WITH CELL DIVISION
• USED ALONE OR IN COMBINATION WITH RADIATION
  OR SURGERY

41
Different Emotions

• Individuals with cancer have a lot of different
  emotions
• Fear of death.
• Dont want to be an outcast.
• Loss of Hope( if treatment is not working).
• Want to live a normal life without pain.
• Have received inadequate information from
  physicians.

42
Treatment Guidelines

• Dont bet your life on any method that has not
  been FDA-approved for marketing or research.
• Go after the best possible treatment offered by
  known cancer experts.
• Avoid any FAD treatment promoted by a
  crusading group of laypersons.

• Stick with prescribed treatment even if results
  are not immediate.
• Have faith in experts who are devoting their
  careers to cancer research and treatment.
• If a specialist gives up look for another, a
  good physician does not abandon a patient to
  hopelessness.

43
Reliable Information

• The American Cancer Society
• Http//www.cancer.org
• National Cancer Institute(NCI)
• Http//cis.nci.nih.gov
• Http//cancernet.nci.nih.gov
• Http//cancertrials.nci.nih.gov

44
THANK YOU