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PREVENTION

CANCER
PROGRAM

ABDULLA, ASNIAH H.
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The Department of Health -
Philippine Cancer Control Program
DOH National Cancer Control Beginnings prior 1987

As cancer rose to become the 5th leading cause of death in the country, initial efforts by
the Department of Health for cancer control were effected through the creation of an autonomous
unit called the National Cancer Control Center. Other positive developments in the past included
the establishment of a population-based cancer registry that gathers cancer incidence data, and a
Community Cancer Control Program in the Province of Rizal (1973), under the auspices of
the Rizal Medical Center.

Executive Order 119 in 198 – The Philippine Cancer Control Program

By virtue of Executive Order 119 in 1987, the National Cancer Control Center (NCCC) was
abolished. The NCCC Manila building and Quezon City office went to Jose R. Reyes Memorial
Medical Center and East Avenue Medical Center, respectively. Its function related to the planning
of the cancer control program was transferred to the then newly-created NonCommunicable
Disease Control Service under the Office for Public Health Services. To assist this Office, the
Secretary of Health, in May 1987, formed a Cancer Core Group. The members, from the private
as well as the government sectors, developed the framework for the present Philippine Cancer
Control Program (PCCP). The Cancer Core Group was later reconstituted to become the
Advisory Council of the Program (1991), which met from DOH Secretary Alfredo Bengzon up to
DOH Secretary Carmencita Reodica's term.

Administrative Order No. 89-A s 1990

AO No 89-A s 1990 provided the guidelines of the PCCP. It specified the program policy,
components, implementing guidelines and timetable.

The first phase of the program implementation was the orientation training in 1988 of
Regional PCCP Core Trainers in four selected provinces which had the capability for
cancer management: National Capital Region-Jose R. Reyes Memorial Medical Center
(JRRMMC) and East Avenue Medical Center (EAMC); Benguet - Baguio General Hospital; Rizal -
Rizal Medical Center; Cebu - Vicente Sotto Memorial Medical Center; Davao del Sur Davao
Medical Center. These selected Regional Core Trainers in turn trained the field health
implementers in the provinces and the communities.

For 1992, the program’s coverage of implementation gradually expanded to include the
other regions. It is also in 1992, that the operationalization of the Specific Cancer-Site Cancer

Control Programs of the PCCP was started. It is implemented in all the regions of the country
through the designated Regional/Municipal Cancer Control Coordinators.

The DOH-PCCP was initially under the Degenerative Disease Control Cluster of the Department of
Health.

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The Department of Health – Philippine Cancer ControlProgram is a
systematic, organized, integrated approach to the control of cancer that can
significantly alter or reduce mortality and morbidity utilizing primary and
secondary prevention at the community level, and tertiary prevention and
rehabilitation at both the community and hospital levels, in all regions of
the country.

The aim of cancer prevention is to develop methods, plans or policy for interventions that will
benefit the population, as well as develop systems for monitoring and evaluating these interventions in
the future. The purpose of interventions is to reduce the incidence, morbidity, mortality rates of cancer
and cost of cancer management. Because the modes of interventions that will be employed involve
changes in lifestyles, behavior, and environment, it is logical to assume that complex psychological,
physiological and cultural problems may arise. In cancer prevention and control, priority should be
given to those that cause the greatest morbidity and mortality, those for which substantial risk is
associated with certain exposures, and for which apparently effective interventions are available. A
realistic and relevant cancer prevention and control program must utilize Primary Prevention,
Secondary Prevention, Tertiary Prevention (Definitive Diagnosis & Management and
Supportive Care Rehabilitation and Pain Relief) and Research.

It is on the premise that cancer can be largely prevented mainly as a public health effort that
the Philippine Cancer Control Program was established. The goal of the PCCP is to establish and
maintain a system that integrates scientific progress and its practical applications into a
comprehensive program that will reduce cancer Morbidity and Mortality in the Philippines.

http://www.doh.gov.ph/content/philippine-cancer-control-program.html

The Six Specific Objectives, also called the “6 PILLARS” of the PCCP are:

➳ Cancer Epidemiology & Research - To assess the impact of cancer in the community, elucidate
causal factors, identify high risk groups, and assess the effects of preventive and therapeutic
programmes. To conduct relevant research on the Prevention, Diagnosis, and Treatment of cancer
as well as Supportive Care and Rehabilitation of cancer patients.

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➳ Public Information & Health Education - To conduct continuing public information campaign
on the prevention and early detection of cancer. Under this pillar, the National Cancer
Consciousness Campaign year-round is the primary strategy, which includes the development
and maintenance of an e-campaign against cancer
➳ Cancer Prevention & Early Detection - To carry out a multi-sectoral activity that will aim to
promote relevant Cancer Prevention Programmes, as well as the early detection of specific
cancer types/ sites. Under this pillar, the Cervical Cancer Screening Program is an example
➳ Cancer Treatment & Training (Strengthening Cancer Treatment Capabilities of Regional
Medical Centers) - To carry out a well-coordinated treatment program by the various medical
disciplines involved in the treatment, supportive care and rehabilitation of cancer patients.
To design and implement Training Courses related to all aspects of Cancer Control for the
personnel of the DOH and other institutions. Under this pillar, the oncology training programs
in medical oncology and radiotherapy were set up in Jose R. Reyes Memorial Medical Center
(a DOH hospital), Manila, to complement the training programs similarly given by the
University of the Philippines-Philippine General Hospital (a non-DOH hospital). This pillar
includes provision of radiotherapy facilities in strategic places over the country (Baguio &
Cabanatuan in the North; Metro Manila; Cebu & Tacloban in Visayas; Davao & Zamboanga in
Mindanao). There is also a plan to strengthen pain clinics and hospice care facilities in DOH
hospitals in the country, for the implementation of the DOHCancer Pain Control Program. This
also includes provision of anti-cancer drugs in oncology capable DOH hospitals. This also
provides for the strengthening of screening & early detection facilities of DOH hospitals.
➳ Hospital Tumor Board & Tumor Registries - Under this pillar, the Manila, Rizal, Davao, Cebu
population-based cancer registries are currently ongoing. There is a mandate for development
of Hospital Tumor Registries of DOH hospitals. Hospital Tumor Boards are a
must in surgery-training accredited hospitals in the Philippines
➳ Cancer Pain Relief & Palliative Care - DOH provides free morphine for indigent patients of its
hospitals, in addition to palliative and rehabilitation care beds within the medical wards of the
hospitals
➳ Public Information & Health Education - To conduct continuing public information campaign
on the prevention and early detection of cancer. Under this pillar, the National Cancer
Consciousness Campaign year-round is the primary strategy, which includes the development
and maintenance of an e-campaign against cancer
➳ Cancer Prevention & Early Detection - To carry out a multi-sectoral activity that will aim to
promote relevant Cancer Prevention Programmes, as well as the early detection of specific
cancer types/ sites. Under this pillar, the Cervical Cancer Screening Program is an example
➳ Cancer Treatment & Training (Strengthening Cancer Treatment Capabilities of Regional
Medical Centers) - To carry out a well-coordinated treatment program by the various medical
disciplines involved in the treatment, supportive care and rehabilitation of cancer patients.
To design and implement Training Courses related to all aspects of Cancer Control for the
personnel of the DOH and other institutions. Under this pillar, the oncology training programs
in medical oncology and radiotherapy were set up in Jose R. Reyes Memorial Medical Center
(a DOH hospital), Manila, to complement the training programs similarly given by the
University of the Philippines-Philippine General Hospital (a non-DOH hospital). This pillar
includes provision of radiotherapy facilities in strategic places over the country (Baguio &
Cabanatuan in the North; Metro Manila; Cebu & Tacloban in Visayas; Davao & Zamboanga in
Mindanao). There is also a plan to strengthen pain clinics and hospice care facilities in DOH
hospitals in the country, for the implementation of the DOHCancer Pain Control Program. This
also includes provision of anti-cancer drugs in oncology capable DOH hospitals. This also
provides for the strengthening of screening & early detection facilities of DOH hospitals.

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➳ Hospital Tumor Board & Tumor Registries - Under this pillar, the Manila, Rizal, Davao, Cebu
population-based cancer registries are currently ongoing. There is a mandate for development
of Hospital Tumor Registries of DOH hospitals. Hospital Tumor Boards are a
must in surgery-training accredited hospitals in the Philippines
➳ Cancer Pain Relief & Palliative Care - DOH provides free morphine for indigent patients of its
hospitals, in addition to palliative and rehabilitation care beds within the medical wards of the
hospitals

The Specific Cancer Programs of the DOH-PCCP are:

1. LUNG CANCER CONTROL PROGRAM - this refers to the systematic, organized and
integrated approach towards the control of lung cancer reducing its morbidity and mortality
utilizing primary prevention at the community level (smoking control), secondary and tertiary
prevention at special medical centers, and rehabilitation activities at both the community and
hospital level.
- focus on anti-smoking campaign (which covers 85% of all cancer site control campaign)

• Specific Objectives
• To inform/ educate school children and adults on the hazards of smoking and its known
risk of developing cancer
• To prevent the onset of smoking and decrease the number of smokers
• To identify among Filipinos those at high risk of developing lung cancer (40 years old and
above smokers)

• Anti-smoking campaign - this is carried out through the following components:


• Public Information & Health Education - focus on increasing public awareness on the
hazards of smoking and changing the attitude and behavior among primary and secondary
school children. To reach out to the general public through mass communication
approaches dealing with specific target audiences through interpersonal communications
in an individualized process or group activity. Social mobilization is important to generate
and sustain participation from all sectors of society: governmental, professional
organizations, religious and industrial establishments.
• Legislation measures - This has a critical role in the elimination of the smoking habit,
elimination of advertisements and promotion of tobacco products, sales to minors. with
labeling, tax and price policies on cigarettes. All interested sectors (GOs and NGOs) shall
support legislative measures against tobacco. Initially, this activity can be started through
local ordinances that is acceptable to policy makers and the public at large.
• Intervention - Smoking Counseling Clinics in strategic localities will provide service to the
identified smokers behavior, degree of tobacco addiction, and type of social environment.
These clinics will use both pharmacological and non-pharmacological approaches
• Research & Epidemiology - Generation and collection of data on all aspects of smoking is
carried out through research in the light of meager information. Lead agencies for this
activity will be the DOH-Essential National Health Research, the lung Center's Research
and Development Section, the PCHRD, the academe like the UP-PGH, and the Colleges
of Medicine and Public Health.

• Some example regulations were written as follows:

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• In 28 January 1993, DOH Administrative Order No. 8 s. 1993 prohibited smoking in the
Department of Health and its premises.
• In 2001, the Department of Interior & Local Government likewise prohibited smoking in its
offices and premises. More specific campaigns were initially done in government hospitals,
which are given incentives or awards given how actively implemented their nosmoking
drive is. Also, the application form of job applicants includes information on his smoking
habit.
• In 22 March 1993, DOH Administrative Order No. 10 s. 1993 laid out the rules and
regulations on labeling and advertisement of cigarettes.
• The DOH has joined multi-sectoral groups in the lobby for the anti-smoking Bill #358 in the
Senate. The DOH is the implementing agency of Chapter IV, Labeling and Fair Packaging
of RA 7394 or the Consumers Act of 1992 with respect to hazardous substances. Article
94 of Chapter IV of RA 7394 provides that all cigarettes for sale or distribution within the
country shall be contained in a package which shall bear the following statement or its
equivalent in Filipino - ‘Warning: Cigarette Smoking is Dangerous to your Health’. An
amendment to this regulation came out with the label on the sides of the package and not
in front and back panels. The cigarette warning also appeared on television after a
cigarette ad. Quezon City was the 1st city to issue a no-smoking policy in public places
ordinance.

2. BREAST CANCER CONTROL PROGRAM - this refers to the implementation of a nationwide


anti-breast cancer scheme, i.e. public information and health education, case finding
(secondary prevention) and treatment (tertiary prevention) integrated into the community
health structure and equipped to control breast cancer in a systematic sustained manner.
- focus on early detection and treatment, and healthy lifestyle
• Specific Objectives
• To inform or educate all women 30-60 years old on breast self-examination and the
importance of doing a regular monthly breast self-examination (BSE)
• To detect the maximum number of early stage breast cancer by offering yearly breast
examination to all 30-60 years women attending a health institution  To treat and/ pr
rehabilitate all detected cases

• Program Strategies
• Full integration of the basic cancer control measures, i.e. public information and health
education, case finding and treatment, with the government's basic medical health
services and other non-governmental organizations through the primary health care
approach
• Operationalization of a bilateral referral system
• Making more intensive use of information, education, and communication activities
• Standardization recording and reporting with a built-in monitoring and evaluating system
• Establishment of regular and frequent supervision
• Adopting post-surgical adjuvant chemotherapy regimen for six months for all
premenopausal and hormonal receptor-negative post-menopausal patients as well as
adjuvant hormonal regimen for 2-5 years for hormonal receptor positive postmenopausal
patients
• Provision of adequate logistical support for public health and hospital services

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• Making available breast examination training programs, residency and post-residency
training programs, hospital service sand anti-cancer drugs

• Case Finding - Breast Examination


In the Philippines, only a few have had the opportunity to learn about the possible benefits of
regular BSE, physician examination and or even mammography. Investigation in literature
indicates that screening appears to protect against dying from breast cancer (relative risk of 0.30
to 0.48) especially for elder women and women who have been screened twice. In the unscreened
group, cancer tends to be detected at a later stage than the screened group. The stage of the
disease at diagnosis affects the prognosis and thus mortality. A 1/3 reduction in mortality for breast
cancer has been attributed to screening.

As screening procedures, physical examination and mammography both detect cases not
detected by the other, but the contribution of mammography is substantially greater.
Mammography however, is not easily available or financially feasible for most of the Filipino
populace. Therefore, breast examination is implemented as a secondary prevention method in the
Philippines. For women who do BSE on a regular monthly basis or for those who undergo yearly
physician breast examination, the sensitivity reported for detecting cancer ranges from 35% to
85%. For levels of 65% to 85% sensitivity, studies show benefit in terms of earlier disease
detection.

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3.

CERVIX UTERI CANCER CONTROL PROGRAM


- focus on early detection and treatment, and healthy lifestyle

• Specific Objectives
• To educate people about cervical cancer, its symptomatology, methods of early detection and
preventive measures
• To screen at least 85% of women 25-55 years of age every 3 years using acetic acid wash
• To identify early lesions of cervical cancer
• To establish a practical/ applicable referral system
• To implement appropriate treatment protocol for the different stages of cervical cancer

• Program Activities
• Public Information & Health Education
• Professional Education
• Primary prevention
• Case-finding with use of acetic acid wash
• Diagnosis with use of Pap smear and colposcopy
• Treatment
• Research

 Some example regulations were written as follows:


• From DILG CAR – Memo Circ No. 99-28 (Feb 10, 1999) = The Department of Health,
through the Philippine Cancer Control Program, will be implementing the Cervical cancer
Screening Project with the view to provide opportunities toward the early detection and control
of cervical cancer.
• The cervical cancer prevention advocacy program was initiated through Proclamation No.
368, s.2003 which celebrates Cervical Cancer Awareness Month during the month of May.
• Department of Health, Philippines. Administrative Order No. 2005-2006:
Establishment of a Cervical Cancer Screening Program 10 February 2005.

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4. LIVER CANCER CONTROL PROGRAM - focus on hepatitis B vaccination, in collaboration with
Immunization Program of the DOH

• Several Governmental Legislations and Department of Health Circulars have been passed
towards the fight against hepatitis B:

• DOH Circ No 242s 10 Dec 1990 “Implementing Guidelines on the Integration of


Hepatitis B into the Expanded Program on Immunization” o Hepatitis B vaccine was
introduced in 1992 targeting 40% of infants, with planned coverage by 10% every
year thereafter until 100% coverage by 1999 is reached – not fulfilled due to
insufficient funds

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The model indicates that unhealthy lifestyles (the 'Sinful Styles or SSs' - smoking to some
unknown risky lifestyle) can lead to degenerative or late onset diseases on a background
of vulnerable genes (self) of the individual. One of these diseases is cancer, particularly of
the skin, oral, thyroid, etc.

Health Care Intervention Strategies in the diseases associated with risky lifestyles are:

• Information dissemination & Education campaign - avoidance of lifestyle


• Counseling
• Screening
• Case-finding and Treatment
• Disease-specific clinical management
• Rehabilitation
• Supportive care

7. CANCER PAIN RELIEF PROGRAM - started in 1989, leading the way to Hospice-At-Home
concept.
- focus on cancer pain relief and support groups, rehabilitation & hospice care
This program primarily implemented the WHO analgesic Ladder, in a modified way cutting the
ladder to a 2-step (skipping 2nd ladder - weak opioid) from an original 3-step. The main
analgesic concepts implemented are:
• Use of oral drugs, allowing hospital discharge and home care
• Analgesics are given on a regular basis - 'by the clock'
• Choice of analgesic agent given is 'by the ladder'

 The Dangerous Drugs Board on October 19, 1989 through Board regulations No. 6, 6-A, 7,
8 have changed the regulations on the use of morphine exclusively for cancer patients,
effectively achieving the following
 Facilitated the process of obtaining an official prescription (DDB Form No. 1-72) and a
local purchase form (DDB Form No. 8-72). Regional Health Directors as agents of the
Board to approve applications of the above forms.
 Assigned dispensing to duly-licensed Hospital Pharmacies
 Increased the number that can be obtained at one time to – I) for official prescription = 840
mg morphine oral, 448 mg morphine iv, ii) for local purchase = 1.68 gm morphine oral, 896
mg morphine iv
 The Philippine quota for the annual importation of morphine has been increased by the
International narcotics Control Board from 1 kilogram to 25 kilograms. There is a current
move to increase the quota further to 50 kgs. The morphine consumption nationwide in
1990 was 6 kgs, in 1991 – 1 kg, in 1992 – 5 kg, in 1993 – 18 kgs, and in 1994 – 38 kgs.
The government hospitals consumed only 30 kgs in 1991-1994; only 18/ 53 hospitals
submit regular reports on morphine consumption
 The Bureau of Foods & Drugs had approved new formulations of morphine sulfate tablets
that now include 10, 20, 30, and 50-mg tablets.
 Regular budget for the purchase of morphine sulfate tablets was identified in 1990
 The National Drug Council in 1992 approved the inclusion of morphine tablet sustained
release in the National Drug Formulary.

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HEALTHADVISORY
National Center for Health Promotion
National Center for Disease Prevention and Control

AboutCancer
CANCER
Cancer is a group of many related diseases that begins in cells. Normally, cells grow and divide to
produce more cells only when the body needs them. This orderly process helps keep the body healthy.
Sometimes, however, cells keep dividing even if new cells are not needed. These extra cells form a
mass of tissue,usually called a lump, swelling or tumor.

Tumors can be classified as: BENIGN TUMORS which are not cancerous. Theyoften can be
removed, and in most cases, do not come back; and MALIGNANT TUMORS which are cancerous.
Cells in these tumors are abnormal and they divide without control and they can invade and damage
nearby tissues and organs.

RiskFactors
Cancer is a result of complex mix of factors related to heredity, diet, physical inactivity and
prolonged, continuousexposuretocertainchemicalsandothersubstances.

A number of factors that increase a person’s chance of developing cancer has been identified and
are called “riskfactors”.

Cigarette Smoking
Smoking accounts for more than 85% of lung cancer deaths. Smokers are more likely to develop
lung cancer compared to non-smokers. Overall, smoking has been linked to cancers of the mouth,
larynx, pharynx, esophagus,pancreasandbladder.

Excessive AlcoholIntake
Heavy drinkers have an increased risk of cancers of the mouth, throat, esophagus, larynx and liver.
Somestudiessuggestthat even moderatedrinkingmay slightly increase therisk of breastcancer.

Unhealthy Diet
Diet plays an important role in the development of many cancers, particularly in the digestive and
reproductive organs. Long-term habit of not eating a healthy diet has been linked that increases
incidence ofcancer.Likewise,beingseriouslyoverweighthasbeenlinkedtobreastcancer.

Chemicals and OtherSubstances


Exposure to substances such as chemicals, metals or pesticides can increase the risk of cancer.
Asbestos, nickel, cadmium, uranium, radon, vinyl chloride and benzene are well-known cancer-
causing agents (carcinogens). These may act alone or together with other carcinogens, like cigarette
smoke, to increase the risk ofcancer.

Prevention
There is no 100% guarantee that cancer can ever be prevented. However, being aware of the
cancer risk factors will help in reducing the possibility of cancer. Early detection and proper treatment
plays a big role in controllingcancer.

Tolessenthe risk of developingcancer:


Quit Smoking
Limit Drinking Alcoholic Beverages
Watch Your Diet
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National Center for Disease Prevention and Control

ConsultYourDoctorRegularly
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BONECANCER
Incidence
Bone cancer is the 24th leading site overall, 18th in males and 21st among
females. In 1998, an estimated 769 new cases will be seen, 479 cases
among males and 290 among females. Osteosarcoma is the most
common of all malignant bone tumors. Incidence increases at age 60.

Riskfactors
Areas of rapid bone growth, such as long bones in children and
adolescents, as well as prolonged growth or overstimulated metabolism,
such as chronic osteomyelitis and hyperparathyroidism. External
radiation and bone-seeking isotopes have also been implicated.

Warningsignals
Pain that is worse atnight.

Earlydetection
Early detection is extremely difficult in asymptomatic patients. Patients
with persistent and progressive bone pain should have an x-ray study of
the bone.

Treatment
Although amputation has been the standard treatment of most bone
cancer, limb-sparing surgery has been developed for both malignant and
aggressive begin tumors. Advances in orthopedics, bioengineering,
radiographic imaging, radiotherapy, and chemotherapy have contributed
to safer, more reliable surgical procedures. Paralleling these advances,
adjuvant chemotherapy has dramatically increased overall survival.
HEALTHADVISORY
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National Center for Disease Prevention and Control

BreastSelf-
Examination
Breast Self-Examination (BSE) is important in the early detection of breast cancer. It is done once a
month, a week after a woman’s monthly period. Through BSE, a woman becomes familiar with the usual
appearance and feel of her breast. So she can easily tell any change on it and can consult a doctor
immediately.

BeforeAMirror
1.Stand before a mirror with your arms at your side. Inspect your breast for any
changes in the size, shape and contour. Check for swelling, dimpling or puckering
of the skin. Gently squeeze each nipple and check for any discharge.
2.Put your hands on your hips and press down firmly, elbows out. Repeat the
inspection.
3. Raiseyour arms over your headandrepeatthe inspection.
Normally, your left and right breast will not be exactly the same. It is very often
that a woman’s breast are totally the same. Through regular inspection, you will
know what is normal for you.

In The Shower
Your handswill moveeasier over wet skin. It is therefore easier for you to examine
your breast during a bath or shower.
Use your right hand to examine your left breast, and your left hand for your right
breast.
Keepyour fingersflat. Move them gently in circularmotionsover every part of each
breast. Check for any lump, hard knot or thickening.

Lying Down
Lie flat on your back. Place a pillow or folded towel under your left shoulder. Put
your left arm underyour head.
Press gently but firmly your flatten fingers to breast and move in circularmotions.
Check for any lump, hard knot or thickening.

Breast Clock Examination


The Breast Clock Examinationis a methodicalway of checkingyour breastfor any
lump, hard knot orthickening.
Step 1
Imagine your breast as a clock. Start at the outermost part of your breast or 12:00
position. Then move on to 1:00 position and so on around the imaginary clock face
until you are back to 12:00position.

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National Center for Disease Prevention and Control

Step 2
Examine every part of your breast. You will need to make at least three circles to completethe
examinationon onebreast.
Step 3 Step 4
Movehandover breastin downwardandupwardmotion.Checkforanyirregularity.
Squeeze the nipple of each breast between thumb and first finger. Any discharge should be reported to
a doctor right away.

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National Center for Disease Prevention and Control

Incidence
CANCER inCHILDREN
In 1998, cancer among children will compromise 3.7% of all cancer among males and 2.6% of all female cancer.
There will be around 2,707 new cases, 1,536 cases in boys and 1,171 among girls. Leukemias are the most
common, compromising 47.8% of cancers among boys and 48.0% among girls. There will be around 735 new
leukemia cases among boys and 563 new cases among girls. Other sites include brain and nervous system, retina,
lymph nodes, kidney, bone and soft tissues, gonadal and germ cell sites.

Earlydetection
Malignancies in children are difficult to detect because they may present similarly as other common childhood
diseases. Parent should have their children undergo regular medical check-up and be alerted to the following
symptoms which may be associated with cancer in children: prolonged, unexplained fever or illness; unexplained
pallor; increased tendency to bruise, unexplained localized pain or limping; unusual masses or swelling; frequent
headaches, often with vomiting; sudden eye or visual changes; sudden or progressive weight loss.

Some of the main childhood cancers are:


Leukemias: The most common, compromising 47.8% of all childhood cancers. Leukemias may either be acute
(with uncontrolled proliferation of immature or “ blastic” cells) or chronic (proliferation of the more mature or
differentiated cells). Leukemias may vary in presentation. Some are detected on routine physical examinations.
Some, however, present with pallor, easy bruisability, malaise, anorexia, intermittent fever, bone pains, abdominal
pain or bleeding.

Brain and spinal cancer: These rank 2nd, compromising 9.7% of all cancers. In the early stages of brain tumors
these may cause headaches, dizziness, (often with nausea or vomiting), blurring of vision, double vision, difficulty in
walking or handling of objects.

Lymphomas (Hodgkin’s Disease or non-hodgin Lymphoma): These rank 3 rd, compromising 9.0% of all cancers.
These usually involve the lymph nodes but may at times arise from other organs rich in lymphoid tissue. They
cause swelling of lymph nodes in the neck, chest axilla and groin. They may also present as generalized weakness
and fever.

Retinoblastoma: This ranks 4th, compromising 7.5% of all cancers. This is an eye cancer which usually occurs in
children below four years old. The more common presenting signs include the cat’s eye reflex (a whitish
appearance of the pupil) or squint. A red and painful eye, limitation of vision or proptosis are noted in the late
stages.

Wilm’s tumor: This is a cancer of the kidney occurring in very young children. Usual presentation is an abdominal
or flank mass. It compromises 3.4% of all childhood cancers.

Osteogenic sarcoma: A type of bone cancer which usually presents with pain, with or without swelling or a mass
overlying the involved bone. It compromises 2.3% of all cancers in children.

Rhabdomyosarcoma: This is the most common soft tissue cancer in children, often presenting as a mass which
may be painful. It usually occurs in the following sites: head and neck, genito-urinary tract, trunk, and extremities. It
compromises 2.2% of all childhood cancers.

Gonadal and germ cell sites: These usually present as a testicular mass, or a pelvic mass among girls. They are
9th most common diagnostic group, compromising 3.6% of all cancers in children.

Treatment
Management of childhood cancers is usually by a combination of the different modalities of treatment (surgery,
radiotherapy, chemotherapy), coordinated by a team of experts including pediatric oncologists, surgeons, nurses,
social workers, psychologists and others who assist children and their families.

Survival
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HEALTHADVISORY
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National Center for Disease Prevention and Control

5-years survival rates markedly vary according to the sites of origin of the tumor.

COLON CANCER
Incidence &morality
Colon cancer ranks 6th overall, 5th among males and 7th among females. An estimated
2,963 new cases, 1,548 in males 1,415 in females, together with 1,567 deaths will be
seen in 1998. Colon cancer increases markedly after age 50.

Risk factors &prevention


Personal or family history of colon cancer; personal or family history polyps in the
colon; inflammatory boweldisease.

Evidence suggest that colon cancer may be linked to a diet high in fat and deficient in
wholegrains,fruitandvegetables.

Warningsignals
Achange in bowel habits such as recurrent diarrhea and constipation, particularly with
the presence of abdominal discomfort, weight loss, unexplained anemia, and blood in
the stool.

Earlydetection
Unfortunately, early colon cancer is asymptomic, and there is still no efficient
screening method for early detection. The aim should be earlier diagnosis of
symptomatic patients who complainof changes in bowelhabits,
vagueabdominalpains,andunexplainedweight loss and anemia,
particularlyamongpatients 50 years old and above, by means of barium enema
orcolonoscopy.

The mistakenobsessionof ourphysician withamoebiasisandotherformsof inflammatory


bowel disease had for decades been a major factor that had delayed diagnosis of
colon cancer. The wider availability of antidiarrheals, antibiotics and amoebecides
may have worsened the situation. Too many physicians still insist in giving vitamin
preparations and hematinics for chronic unexplained weight loss and anemia without
carefully looking for the cause.

Treatment
Earlycoloncanceriscurable,andsurgeryisthemosteffectivemethodoftreatment.

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HEALTHADVISORY
National Center for Health Promotion
National Center for Disease Prevention and Control

LIVER CANCER
Incidence &mortality
Liver cancer is the 3rdleading sites for both sexes. It rank 2 ndamong males and
9thamong females. In 1998, an estimated 5,249 new cases, 3,906 cases in males and
1,343 cases in females, and about 4,403 deaths are expected to occur every year.
The incidence in malesispractically2 ½ thatoffemales.Incidenceincreasesatage40.

Risk factors &prevention


Studies point to a causal relationship between Hepattits B virus carrier state and liver
cancer. Primary Liver Cancer is much more common in countries where HBV carriers
are prevalent, such as the Philippines and other Southeast Asian countries, as
compared to mostdevelopedcountrieswhereHepatitisB islessprevalent.

HepatitisC infection,thoughless prevalent,canalsoleadtoliver cancer.

Otherfactorsimplicatedareheavyalcoholconsumption,prolongedheavyintakeofaflatoxin
andotherchemicalcarcinogens.

Emphasisshouldbetowardsprevention,byloweringtheprevalenceofHepatitisB
throughinfantvaccinationandimprovingsanitationnationwide.

Warningsignals
Abdominal pain, constitutional symptoms such as weight loss, weakness, and loss of
appetite.Anabdominalmassoranenlargedliverarenoted.

Earlydetection
Unfortunately,thereisnoefficientearlydetectionmethodforliver cancer.

Treatment
For theoccasionalpatientseenin an earlystage,surgerycanbe curative.For the majority
of cases, who are usuallyseen inan incurable stage, judiciousand cost-effective
palliative carecanprovide anacceptable qualityoflife.

LUNG CANCER
In the Philippines, Lung Cancer is one of the leading cancer deaths among men and women. The
steadyincrease in rates of people developing and dying from lungcancer is the delayed effects of
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increased smoking by the Filipinos. An estimated 17,238 new cases of, and 15,881 deaths due to lung
cancer are expectedto occureveryyear.

Lung CancerFacts
• Almost 100% of all lung cancer cases are caused bysmoking.
• Smokers reach the “cancer age” at least 15 years earlier than non-smokers.
• Non-smokers who are continuously exposed to tobacco smoke in enclosed spaces also run
the risk of getting lung cancer.
• Tobaccosmokingbeforeandduringpregnancymay causebirth defects.
• Tobacco smoking reduces lifeexpectancy.

Causes
• Cigarette Smoking
Smoking causes 75% to 90% of lung cancer. Risk of developing lung cancer increases with the
number of cigarettes smoked each day and the tar and nicotine contents. Smoking even one-half pack
a day of low-tar and nicotine cigarette is risky. There is no such thing as safe cigarette.

• Involuntary Smoking
Also called “passive smoking”, it is breathing in of harmful substances contained in tobacco smoke
by non-smokers.

• Pollution
This includes air pollutants such as combustionof diesel and other fossil fuels.

Symptoms
• Persistent dry cough that gets worse over time
• Constant chestpain
• Blood-stained sputum(phlegm)
• Extremeshortnessof breath, wheezingor hoarseness
• Repeatedpneumoniaorbronchitis
• Swelling of the neck andface
• Weight loss
• Fatigue
• Difficulty inswallowing

Prevention
Unfortunately, there is no effective way of detecting lung cancer on its early stages. That is why the
best approachto lungcancerpreventionis to STOP SMOKING!

Theyouthshouldbediscouragedfromstartingthehabitofsmoking.BESMART,DON’TEVERSTART.

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OVARIANCANCER
Incidence
Cancer of the ovary is 12th overall, and ranks 5th among females. An
estimated 2,032 cases will occur in 1998. Incidence increase starting at
age 40.

Riskfactors
Few specific risk factors have been defined – nulliparity, history of breast
or endometrial cancer and of menstrual difficulties. Increased familial
incidence has also been reported. Pregnancy and oral contraceptives
are possibly protective. The role of exogenous hormones as a protective
factor is still being studied.

Warningsignals
Ovarian cancers are usually asymptomatic at the outset and many case
are detected late. It is usually detected because of an abdominal mass,
or mass felt during pelvic examination.

Earlydetection
Thorough annual pelvic examinations may detect early ovary cancer.
This is recommended to start at age 40.

Treatment
For early cancer of the ovary, surgery is curative. In some cases of
advanced cancer, surgery followed by chemotherapy may increase
survival. Advanced cancer requires judicious and cost effective palliative
care.

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RECTUMCANCER
Incidence &mortality
Rectum cancer ranks 11thoverall, 9thamong males and 11thamong
females. An estimated 2,085 new cases, 1,142 cases in males and 943
cases in females, and 551 deaths will be seen in 1998. Rectum cancer
increases markedly at age 50.

Riskfactors
Personal or family history of rectal cancer, personal or family history of
polyps in the rectum.

While a diet high in fat and fiber deficient is also implicated, the evidence
is not yet strong as that for colon cancer.

Warningsignals
Change in bowel habits, transanal bleeding, unexplained weight loss and
anemia, blood in the stool.

Earlydetection
There is insufficient evidence that a specific screening method had
reduced mortality.

Earlier diagnosis of symptomatic patients should also be aimed for.


Males and females 50 years and above who complain of blood in the
stool, change in bowel habits, unexplained weight loss and anemia
should all undergo a rectal examination and proctoscopy.

Treatment
Early rectum cancer is curable by surgery. For advanced cases, judicious
and cost-effective palliative care can offer an acceptable quality of life.

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STOMACH
Incidence&mortality
CANCER
Cancer of the stomach is the 8 th leading site overall. 6th among males and
10th among females. In 1998, an estimated 2,563 new cases 1,511
among males and 1,052 among females, will be seen. About 1,484
deaths will occur. The incidence begins to rise starting at age 50.

Riskfactors
Pernicious anemia, atrophic gastritis. Evidence suggest that gastric
cancer may be linked to diet, such as salty food, smoked fish, pickled
vegetables. The incidence that had changed to a healthier diet.

Warningsignals
Gastric cancer progresses silently to an advanced stage before
symptoms alert the physician or the patient. Early symptoms include
indigestion, dyspepsia, loss of appetite, and anemia. Weight loss,
difficulty in swallowing, vomiting, abdominal mass suggest an advanced
stage.

Earlydetection
Unfortunately, there is neither an effective method primary prevention
nor early detection of stomach cancer. In order to increase survival,
earlier diagnosis of symptomic patients should be the goal.

Patients over age 50 with vague epigastric symptoms, unexplained


anemia, and weight loss should undergo upper gastrointestinal series or
endoscopic studies.

Treatment
Surgery remains the most effective method of treating gastric cancer.

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THYROIDCANCER
Incidence
Thyroid cancer ranks 7th overall, 4th in females and 17th in males. An
estimated 2,584 new cases, 2,068 in females and 516 in males, will
occur in 1998. The incidence is three times more in females than that in
males. Thyroid cancer is the most common cancer of women at age 15-
24.

Riskfactors
History of neck radiation during childhood.

Warningsignals
A hard mass in the anterior neck; nodules of the thyroid in men; rapid
enlargement of a long-standing goiter in older patients; cervical lymph
node enlargement; hoarseness, difficulty of swallowing, and difficulty of
breathing associated with goiter.

Earlydetection
Fineneedleaspirationbiopsyofsolitarynodules,orofunusuallyprominent,
hard or rapidly growing nodules in multinodular goiter.

Treatment
Almost 95% of thyroid cancer in the Philippines are well differentiated
carcinoma, and are highly curable by appropriate surgery alone.
Radioactive iodine is the main mode of treatment for metastatic lesions.

UTERINE CERVIX
CANCER
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Cervical Cancer
Thecervix is partofthefemalereproductive system locatedatthejunctionofthevaginaandtheuterus
(womb). It is often called the neckof the womb.

In the Philippines,Cervical Cancer is the 2nd leadingcancersite among women.An estimated 7,277
new cases of, and 3,807 deaths due to, cervical cancer are expected to occur every year.

Generally, all womenwho havehadsexualintercourse areatrisk ofcervix cancer. However, raretypes


ofcervicalcancercanoccureveninwomenwhoneverhadanysexualintercoursein theirlife.

Cause
In recentstudies,therehadbeenoverwhelmingevidencethatan infectiousagent particularlyhuman
papilomavirus (HPV) thatis transmittedthroughsexualintercoursecausescancerofthecervix.

The following had been established as possiblecauses of cervix cancer:


• havehadmultiplesexualpartners
• havehadsexualpartners(regularorcasual)whothemselveshadseveralsexualpartners
• havehadsexualpartnerwhois infectedwith humanpapillomavirus
• had first sexual intercourse at a very early age, possibly 15 or 16 years old

Symptoms
Generally, cervix cancer do not have symptoms. Often, the disease is detected during its advance
stage.However, the followingimpressionsoftenleadtocervix cancer:

• Unusualbleedingfrom the vaginaat anytime


• Unpleasant vaginaldischarge

EarlyDetection
Cervical cancer when detected early is curable. At present, the most reliable and practical way to
diagnose early cervical cancer is through Pap smear.

A woman’s first Pap smear should be done 3 years after the first vaginal intercourse. After that, it
should be done every year for 3 years. If the Pap smear test is negative for the consecutive 3 years,
then it can be done every two or three years. In unmarried women who never had sexual activity in
their life, Pap smear should be done at age 35.

EarlyDetection
Sincethereis almostuniversalacceptancethatcervicalcancerisprimarilytransmittedthroughsexual
intercourse,thefollowingpreventivemeasuresshouldbefollowed:

• aone-partnersexualrelationshipbetweenpartnersshouldbeobserved
• a delay on the first sexualintercourse
• useof barriercontraceptiveslikecondomsduringsexualintercourse

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LEUKEMIA
Incidence &mortality
The leukemia’s rank 5th overall, 4th among males and 6th among females.
Estimated number of new cases in 1998 are 1,659 in males and 1,488 in
females, giving a total of 3,147 cases, of these 735 cases will occur in
boys and 563 cases will be among girls.

Risk factors &prevention


Exposure to high doses of radiation; and continuous and prolonged
exposure to certain chemicals have been blamed for increasing the risk
of getting leukemia.

Warning &signals
Easy fatiguability, pallor, weight loss, easy bruising, frequent nosebleed,
or repeated infections, especially among children. Symptoms of acute
leukemia appear suddenly. Chronic leukemia may progress slowly with
few symptoms.

Earlydetection
There is no practical screening method for leukemia. Early detection of
symptomatic patients, particularly children, should be aimed for.
Peripheral blood smears and bone marrow examination confirm the
diagnosis in suspicious cases.

Treatment
Some forms of leukemia, particularly Acute Lymphocytes Leukemia in
children, are highly curable by chemotherapy.
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LYMPHOMAS
( Hodgkin’s disease and non-hodgkin lymphoma )

Incidence
Lymphomas are the 10th overall, 8th in males and 14th in females. An
estimated 2,088 new cases, 1,253 cases among males and 875 among
females, will be seen in 1998. Incidence increases at age 55.

Riskfactors
Cause is still unknown but a viral factor is considered since certain
lymphomas have been shown by epidemiologic, electron microscopy,
cell
cultureandimmunologicstudiestohavefeaturesimplicatingviraletiologies.

Warningsignals
Usual presentation is painless, enlarged lymph nodes which may be
associated with fever, night sweats, itching and weight loss. Other
organs like the oropharynx, skin, gastrointestinal tract and bone may be
involved.

Earlydetection
Recognition of lymphadenopathy and careful histologic evaluation of a
lymph node biopsy.

Treatment
A multidisciplinary approach offers the most cure rates. Chemotherapy is
the primary treatment, with adjunct radiotherapy in some instances.
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