DR'Loraine Kalra SR'CONSULTANT SURGICAL ONCOLOGY

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DR.Loraine KalraSR.CONSULTANT SURGICAL ONCOLOGY
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• Because there are as yet no ways of predicting
  who will and who will not develop cancer, All
  should be considered at risk and should be
  evaluated before there are any signs or symptoms
  that suggest the presence of disease

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CANCER MENACE MYTHS AND REALITIES

• CANCER REMAINS A SERIOUS HEALTH PROBLEM
• INDIA WITH ITS DIVERSE SOCIO ECONOMIC STRUCTURE
  PRESENTS PECULIAR PROBLEMS
• ILLITERACY BESIDES POVERTY

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CANCER BURDEN-FACTS AND FIGURES

• 8 LAKH NEW PATIENTS EVERY YEAR
• 3 LAKH DIE EACH YEAR
• 1 OUT 12 MALES AND 1 OUT OF 10 FEMALES ARE LIKELY
  TO DEVELOP CANCER IF THEY LIVE FOR MORE THAN 7
  DECADES
• 12 MILLION NEW CANCER CASES ARE DETECTED WORLD
  WIDE EVERY YEAR AND AROUND 7 MILLION DIE DUE TO
  THE DISEASE

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WHAT EXACTLY IS CANCER

• THE CELLS OF A PARTICULAR PART GROW IN AN
  UNCONTROLLED FASHION
• UNCONTROLLED GROWTH LEADS TO PILING UP OF CELLS
  WHICH INITIALLY CAUSE LOCAL EFFECTS AND LATER
  SPREAD TO DISTANT AREAS AND FINALLY CAUSES DEATH
• THIS CAPACITY TO SPREAD TO DISTANT AREAS CAUSING
  SEEDLING AND LATER DEATH IS THE HALL MARK OF
  CANCER

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WHAT CAUSES CANCER

• EXTERNAL ENVIRONMENTAL CARCINOGENS
• INTERNAL GENETIC DERANGEMENTS
• COMBINATION OF BOTH

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EXTERNAL CARCINOGENS

• TOBACCO
• DIETARY FACTORS
• VIRUSES
• OTHER CHEMICAL CARCINOGENS
• OCCUPATIONAL
• RADIATION

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INTERNAL FACTORS

• GENETIC FRAME WORK AND SUSCEPTIBILITY
• TUMOR PROMOTING GENES
• TUMOR SUPPRESOR GENES
• INHERITENCE OF SUSCEPTIBILITY TO CANCER
• EXTERNAL AGENTS CAN INDUCE GENETIC MUTATIONS

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TOBACCO AND CANCER

• SMOKING-ACTIVE AND PASSIVE
• SMOKE LESS TOBACCO-
• CHEWABLE
• INHALABLE
• 60CANCERS ARE CAUSED BY TOBACCO
• 10 PACK YEARS INCREASE CANCER RISK BY 5 TIMES
• EACH CIGARETTE DECREASES LIFE SPAN BY 5 MINUTES

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DIET AND CANCER

• DIET REMAINS THE MOST IMPORTANT FACTOR AFTER
  TOBACCO
• LIFE STYLE AND DIET ACCOUNT FOR MOST CANCERS IN
  NON TOBACCO USERS

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DIET AND CANCER

• CARCINOGENIC DIETS
• HIGH FAT
• ANIMAL FAT
• RED MEAT
• CHARRED FOODS
• SALTED FOODS
• PROCESSED STARCH FOOD
• STALE FUNGI CONTAMINATED FOODS

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DIET AND CANCER

• RECOMMENDATIONS(AICR)
• 5 SERVINGS OF FRUIT AND VEGETABLE PER DAY(400-800
  GMS)
• 7 SERVINGS OF CEREALS, PULSES TUBERS.
• RED MEAT CONSUMPTION lt80 GMS PER DAY
• AVOID PICKLED AND SALTED FOODS
• ALCOHOL lt2 DRINKS PER DAY

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LIFE STYLE AND CANCER

• SEDENTARY LIFE STYLE
• HIGH FAT AND LOW FIBRE DIET
• STRESS AND SMOKING
• WEIGHT GAIN
• RECOMMENDED
• I HOUR BRISK WALK DAILY AND RIGOROUS EXERCISE
  ONCE WEEKLY
• LIMIT WEIGHT GAIN IN ADULTHOOD NOT EXCEEDING 5
  KGS.

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BENEFITS IN REGULATING DIET AND LIFE STYLE

• BENEFITS PROVED IN MORE THAN 4500 RESEASRCH
  STUDIES WORLD WIDE
• DIETARY REGULATION-RISK REDUCTION BY 30-40
• DIETARYLIFE STYLE REGULATION-RISK REDUCTION
  BY60-70
• FRUITS EVERYDAY-20RISK REDUCTION

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CANCER CAUSING VIRUSES

• HEPATITIS-B AND C(LIVER CANCERS. COMMON IN CHINA
  AND FAR EAST)
• EBSTEIN BARR VIRUS-NASOPHARYNGEAL CANCERS
• PAPILLOMA VIRUS-CERVICAL CANCERS
• HIV-AIDS RELATED CANCERS
• LYMPHOMAS
• KAPOSI SARCOMAS
• FULMINATING CANCERS ELSE WHERE

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OTHER ENVIRONMENTAL AGENTS

• RADIATION EXPOSURE
• ENVIRONMENTAL POLLUTION-NOT PROVED CARCINOGENIC
• OCCUPATION
• ASBESTOS WORKERS-LUNG CANCERS
• DYEING INDUSTRIES AND PAINTING INDUSTRIES-BLADDER
  CANCERS
• TOXIC SMOKE INHALATION-LUNG CANCERS

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SYMPTOMS OF CANCER

• SYMTOMS ARE DUE TO LOCAL AND DISTANT EFFECTS
• ARE RELATED TO SITE
• ARE TRIVIAL AND VAGUE IN EARLY STAGES
• LESS PRONOUNCED IN CANCERS OF INTERNAL ORGANS
• MAY EASILY BE MISTAKEN FOR GENERAL ILLNESS

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SYMPTOMS OF CANCER

• LUMP
• ULCER
• BLEEDING
• LOSS OF APPETITE
• LOSS OF WEIGHT
• GENERAL SICKNESS
• SITE RELATED SYMPTOMS
• CANCERS WARNING SIGNALS

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CANCEREarly diagnosis

• Avoiding delay when symptoms occur
• To seek professional help whenever any symptoms
  occur
• Screening
• To have regular check ups to detect disease that
  is not causing symptoms

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CANCEREarly diagnosis

• Fear of diagnosis
• Often avoid going to the doctor
• Often avoid testing when advised
• Often seek help from homeopaths/other such
  specialists who do not diagnose disease

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CANCERS MISTAKEN AS OTHER DISEASES

• LUNG CANCER AS TUBERCULOSIS
• BONE TUMORS AS BONE INFECTIONS AND TRAUMATIC
  SWELLINGS
• BREAST CANCERS AS NON CANCEROUS LUMPS
• RECTAL CANCERS AS PILES
• STOMACH CANCERS AS ULCER PROBLEM AND INDIGESTION

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DIAGNOSING CANCERS

• CANCEROUS LUMPS FEEL HARD
• DO NOT HEAL AND BLEED OFTEN
• PAIN IS A LATE PRESENTATION IN CANCERS
• SYMPTOMS ARE PROGRESSIVE AND PERSITANT

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DIAGNOSTIC TESTS

• CLINICAL EXAMINATION
• DIAGNOSTIC IMAGING
• X-RAY
• ULTRASONOGRAPHY
• CT/MRI
• NUCLEAR MEDICINE STUDIES
• CONTRAST X RAYS

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DIAGONOSTIC TESTS

• BLOOD TESTS-TUMOR MARKERS
• BIOPSY
• NEEDLE ASPIRATION BIOPSY-IS OPD PROCEDURE
• THICK NEEDLE BIOPSY , INCISION AND EXCISION
  BIOPSY
• FROZEN SECTION BIOPSY
• BIOPSY UNDER CT/USG GUIDANCE
• BIOPSY DOESNOT LEAD TO TUMOR SPREAD

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ROLE OF ENDOSCOPIC EXAMINATIONS

• INACCESSIBLE AREAS REQUIRE ENDOSCOPIC
  EXAMINATION, ASSESSMENT AND BIOPSY
• ENDOSCOPIES
• GASTROSCOPY FOR STOMACH CANCERS
• COLONOSCOPY FOR LARGE BOWEL CANCERS
• BRONCHOSCOPY FOR LUNG CANCERS
• COLPOSCOPY FOR CERVICAL CANCERS

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STAGING THE CANCERS

• ALL CANCERS REQUIRE PROPER STAGING
• TNM STAGING SYSTEM IS THE COMMONLY USED
• STAGING HELPS TO PLAN TREATMENT AND CALCULATE
  PROGNOSIS

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TREATING CANCERS

• MYTHS
• CANCERS ARE NOT CURABLE
• TREATMENT IS ONLY SYMPTOMATIC
• ALL PATIENTS SUCCUMB TO CANCERS
• CANCER SPREADS FAST AFTER HANDLING IT BY SURGERY
• ARE CONTAGIOUS

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SURGERY IN CANCERS

• IS A LOCAL TREATMENT
• REMOVES ALL GROSS CANCER IF CARRIED OUT IN A
  CURATIVE SETTING
• IS NOT A TREATMENT FOR HAEMOTOLOGICAL
  MALIGNANCIES

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PROS AND CONS OF SURGERY

• ITS A IMMEDIATE TREATMENT
• BEST TREATMENT FOR ALL SOLID TUMORS
• MORBIDITY AND MORTALITY ARE RARE NOW A DAYS
• OTHER TREATMENTS FOLLOWING SURGERY ARE MORE
  EFFECTIVE

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RADIATION THERAPY

• DELIVERED - EXTERNALLY OR INTERNALLY
• KILLS CANCER CELLS BY RADIATION EFFECTS
• QUITE EFFECTIVE AND IS AN ALTERNATIVE FOR
  SURGERY IN SELECT CIRCUMSTANCES
• CAN BE GIVEN IN ADDITION TO SURGERY

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RADIATION THERAPY

• SIDE EFFECTS ARE MINIMAL
• BETTER MACHINES ARE NOW AVAILABLE.
• USUALLY GIVEN IN FRACTIONS OF FIVE DAYS A WEEK
  FOR 4-5 WEEKS
• INTERNAL THERAPY CALLED BRACHYTHERAPY IS
  COMPLETED IN TWO OR THREE SITTINGS

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CHEMOTHERAPY

• CYTOTOXIC DRUGS GIVEN-IV, INTO BLOOD STREAM
• EFFECTIVE THERAPY MAINLY FOR HAEMATOLOGICAL
  MALIGNANCIES LIKE LEUKEMIAS
• EFFECTIVE IN SOLID CANCERS AS AN ADJUNCT TO
  RADIATION AND SURGERY

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CHEMOTHERAPY

• MAIN SIDE EFFECTS INCLUDE
• NAUSEA
• VOMITING
• HAIR LOSS
• DECREASE IN BLOOD COUNT
• INFECTIONS
• LOTS OF ADVANCES HAVE TAKEN PLACE IN CHEMOTHERAPY
  OF LATE

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EARLY DETECTION OF CANCERS

• IS BY UNDERGOING SCREENING FOR CANCERS AFTER A
  PARTICULAR AGE
• CANCERS AMENABLE FOR EARLY DETECTION
• BREAST CANCER
• UTERINE CERVICAL CANCERS
• HEAD AND NECK CANCERS
• COLON CANCERS

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SCREENING EXAMPLE IN WOMEN

• BREAST CANCER
• ANNUAL MAMMOGRAPHY AFTER 40
• BREAST SELF EXAMINATION AFTER 30
• ANNUAL EXAM BY A SPECIALIST AFTER 40
• UTERINE CERVICAL CANCERS
• GYNAECOLOGICAL CHECK UP EVERY YEAR FOR 3 YEARS IN
  MARRIED LIFE
• PAP SMEAR AT EVERY VISIT TILL 3 CONSECUTIVE TESTS
  ARE CLEAR
• OTHER TESTS LIKE COLPOSCOPY IF REQUIRED

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PREVENTION OF CANCERS

• DIET
• TOBACCO
• LIFE STYLE CHANGES
• CANCERS AMENABLE FOR PREVENTION
• UTERINE CERVIX
• ORAL CANCERS
• LUNG CANCERS ETC

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CONCLUDING ADVICE

• DONT BE AFRAID, HAVE YOUR CHECK UPS DONE,
  REGULARLY!
• BECAUSE THIS IS THE ONE ONLY WAY TO ACHEIVE
  CURE