my seminar( 2003) sri
TRANSCRIPT
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Definition
Epidemiology
Classification
Signs & Symptoms
Causes
Pathophysiology
Prevention
Diagnosis
Management
Prognosis
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Cancer
Cancer is a class of diseases in which a group of cellsdisplay
Uncontrolled Growth
Invasion
Metastasis
These three malignant properties of cancersdifferentiate them from benign tumors, which areself-limited, and do not invade or metastasize.
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The branch of medicine concerned with the study,diagnosis, treatment, and prevention of cancer isoncology
oncos describes all tumours- coined by Galen.
Oncology
Oncology is concerned with:
Diagnosis Therapy Follow-upPalliative
care
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Death rate from malignant cancer
in 2004
The death rate from malignant neoplasm in India in the year 2007 was105-130 per 100,000 inhabitants
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Most common cancers in males, by occurrence in males, by mortality
in females, by occurrence in females, by mortality
Current status of cancer occurrence and mortality
in males and females
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As of 2004, worldwide cancer caused 13% of all
deaths (7.4 million).
The leading causes were: Lung cancer (1.3 million deaths/year) Stomach cancer (803,000 deaths) Colorectal cancer (639,000 deaths) Liver cancer (610,000 deaths) Breast cancer (519,000 deaths).
In the developed world, one in three people willdevelop cancer during their lifetimes.
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Difference between a normalcell and cancer cell.
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Classification
Cancers are classified by the type of cell thatresembles the tumor and, therefore, the tissuepresumed to be the origin of the tumor.
These are the histology and the location,respectively.
Examples of general categories include:
Carcinoma Sarcoma Lymphoma and Leukemia Germ cell tumor(Totipotent cells) Blastic tumor or blastoma
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Benign tumors (which are not cancers) are named
using -oma as a suffix with the organ name as the
root.
For instance, a benign tumor of the smooth muscle
of the uterus is called leiomyoma
Benign tumors
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Large cell carcinoma Basal cell carcinoma
Kaposis sarcoma Osteosarcoma
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Germ cell tumor
LymphomaLeukemia
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Signs & Symptoms
Roughly, cancer symptomscan be divided into threegroups:
Symptoms of cancermetastasis depend on thelocation of the tumor
:
Unusual swelling
Hemorrhage (bleeding) Pain and/or ulceration
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:
Weight loss
Poor appetite
Fatigue and cachexia (wasting) Excessive sweating (night sweats) Anemia Specific paraneoplastic phenomena
Thrombosis
:
Enlarged lymph nodes
Cough Hemoptysis Hepatomegaly (enlarged liver) Bone pain, Fracture of affected bones
Neurological symptoms.
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Every symptom in the above list can be caused bya variety of conditions (a list of which is referred toas the differential diagnosis).
Cancer may be a common or uncommon cause ofeach item.
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Causes
Research about cancer causes often falls into the
following categories:
Mutation:Chemical carcinogensIonizing radiation
Infection
Hormonal imbalances
Immune system dysfunction
Heredity
Other causes
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Pathophysiology
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Cancer Process
There are four scientific theories that are the basisfor the alternative and complementary therapies.
1.Formation of blood vessels by cancer cells
2.Encapsulation process
3.Signaling process
4.Deficiencies in cancer patients
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1
2
3
Cancer Process
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Prevention
Cancer prevention is defined as active measures todecrease the incidence of cancer.
Primary preventionSecondary prevention
Modifiable ("lifestyle") risk factors Diet Vitamin supplementation
Chemoprevention Genetic testing Vaccination Screening
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Modifiable ("lifestyle") risk factors
Majority of cancer risk factors are environmental orlifestyle-related. Examples of modifiable cancer risk factors
Alcohol consumption Smoking
Physical inactivity Being obese/over weight Sexually transmitted diseases(human papilloma virus)
Use of exogenous hormones Exposure to UV and ionizing radiations Certain occupational and chemical exposures
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Diet
Obesity increases the risk of developing the cancer Substantial link between diet and cancer in case ofimmigrants Dietary interventions for primary cancer risk
reduction generally gain support from epidemiologicalassociation studies. Examples
Meat consumptionCoffee consumption
Primary risk factors
A secondary prevention study showed thatconsumption of a plant-based diet and lifestylechanges resulted in a reduction in cancer markers
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Recommendations of WCRF/AICRExperts
(1)Reducing intake of foods and drinks thatpromote weight gain, namely energy-densefoods and sugary drinks,
(2)Eating mostly foods of plant origin,(3)Limiting intake of red meat and avoiding
processed meat,(4)Limiting consumption of alcoholic beverages,
and(5)Reducing intake of salt and avoiding mouldy
cereals (grains) or pulses (legumes).
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Anti-cancer effect of mushrooms
Medicinal mushrooms upregulate the immune system.
Examples Agaricus blazei
Maitake
Trametes versicolor
Anti-cancer effect is due to the presence of -glucans( known as biological response modifiers .
Specifically, beta-glucans stimulate the innate branch ofthe immune system.
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Vitamin Supplementation
Has not been proven effective in prevention of cancer. Patients are increasingly advised to consume fruitsand vegetables for maximal health benefits.
Low levels of vitamin D is correlated with increasedcancer risk. Beta-carotene supplementation has been found toincrease slightly, risks of lung cancer. Folic acid supplementation has not been foundeffective in preventing colon cancer and may increasecolon polyps
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Chemoprevention
Many high-quality clinical trials support the use ofsome medications in defined circumstances.
Examples:
Tamoxifen( SERM )
Raloxifene ( SERM ) Finasteride( 5- alpha reductase inhibitor )
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Genetic testing
Available for certain cancer-related genetic mutations.
Carriers of genetic mutations that increase risk forcancer incidence can undergo enhanced surveillance,chemoprevention, or risk-reducing surgery.
Early identification of inherited genetic risk for cancer,along with cancer-preventing interventions such as
surgery or enhanced surveillance, can be lifesaving forhigh-risk individuals.
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Gene Cancer types Availability
BRCA1, BRCA2 Breast, ovarian, pancreaticCo erciall availa le
for clinical speci ens
MLH1, MSH2,
MSH6, PMS1, PMS2
Colon, uterine, s all owel,
sto ach, urinar tract
Co erciall availa le
for clinical speci ens
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Vaccination
Prophylactic vaccines have been developed.
Examples : Human Papilloma virus Vaccines
(Gardasil and Cervarix are commercially
available )
Hepatitis B vaccine
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Screening
To detect unsuspected cancers in an asymptomaticpopulation Can lead to earlier diagnosis in some cases Examples of some screening procedures
Colonoscopy Prostrate specific antigen test Prostrate biopsy Medical imaging
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