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History

Hippocrates coined the word carcinos


meaning a tumor that spread and destroyed
the host
However, Galen was the first to describe
cancer as being crab like in nature

Treatment was based on thehumor theory of


four bodily fluids (black and yellow bile,
blood, and phlegm). According to the
patient's humor, treatment consisted of diet,
blood-letting, and/or laxatives.
Through the centuries it was discovered that
cancer could occur anywhere in the body, but
humor-theory based treatment remained
popular until the 19th century
Celsus (ca. 25 BC - 50 AD)
translated carcinos into the Latin cancer, also
meaning crab.
Galen (2nd century AD) called benign
tumours oncos, Greek for swelling, reserving
Hippocrates' carcinos for malignant tumours.
He later added the suffix -oma, Greek for
swelling, giving the name carcinoma
CURRENT SCENARIO?
Problem Statement

World
Every year- 10 million diagnosed
6 million die

Worldwide - Lung Cancer (12.3 %)


Breast Cancer(10.4%)
Colorectal Cancer(9.4%)

Death from cancer - Lung (17.8%)


Stomach (10.4%)
Liver (8.8 %)
India
Cancer is the second most common disease in India.
3.4 % of all deaths cancer
7 lakh new cases detected every year

Males - mouth/oropharynx
oesophagus
stomach
Lower respiratory tract

Females - Cervix
Breast
mouth/oropharynx
oesophagus
Cancer Yearly Morbidity & Mortality by Sex
& Site
LEADING SITES OF CANCER ARE ORAL CAVITY,
prostate, LUNGS, OSEOPHAGUS AND STOMACH
AMONG MEN AND CERVIX ,BREAST AND ORAL
CAVITY AMONG WOMEN

CANCERS IN ORAL CAVITY AND LUNGS IN MEN AND


BREAST IN FEMALES ACCOUNT FOR OVER 50% OF
CANCER DEATHS.

40% of the cancers in the country are related to


tobacco use.
DEFINITION

Cancer (medical term: malignant neoplasm)


is a class of diseases in which a group of
cells display uncontrolled growth (division
beyond the normal limits), invasion (intrusion
on and destruction of adjacent tissues), and
sometimes metastasis (spread to other
locations in the body via lymph or blood).
Agent factors

organism Related cancer


Helicobacter pylori Stomach cancer

Aspergillus flavus liver cancer

Herpes simplex virus Cervical cancer

Epstein-barr virus Naspharyngeal cancer

Hep B &C virus Primary hepatocellular


cancer
CAUSES and RISK FACTORS
OF CANCER
Environmental Genetic
Tobacco Eg
Alcohol Retinoblastoma in
Dietary Factors Children
Occupational exposures Leukemia in Mongols
Viruses
Parasites
Customs ,habits, Lifestyles
Others sunlight, pollution,
drugs
STAGES OF CARCINOGENESIS

initiation
promotion
malignant conversion
progression
METASTASIS

Metastasis can occur through


vascular
lymphatic
angiogenesis
CLASSIFICATION

Based on invasive nature: BASED ON THE TISSUE


Benign OF ORIGIN
Malignant Benign neoplasms
Malignant neoplasms
Benign neoplasms
Fibromas
Lipomas

others Leiomyomas

Germ cell tumor( testes & Malignant neoplasms


ovary) Carcinoma
Blastic tumor or blastoma Sarcoma
Lymphoma ( hematopoetic)
Diagnosis
DIAGNOSTIC STUDIES
Cytology studies ( pap smear)
Chest x-ray
Complete blood count
Proctoscopic examination
Liver function studies
Radiographic studies
Computed tomography
Presence of oncofetal antigens( CEA, AFP)
Bone marrow aspiration
Lymphangiography
Biopsy
MANAGEMENT

surgery
chemotherapy
radiation therapy
immunotherapy
monoclonal antibody therapy-anti- HERZ
used in breast cancer.
hormonal therapy
complimentary & alternative therapies
CANCER CONTROL

Premodial prevention:
inhibit the establishment factors
(environmental, economic, social,
behavioural, cultural) known to increase the
risk of disease.
establishing healthy communities,
promoting a healthy lifestyle in childhood (for
example, through prenatal nutrition
programs and supporting early childhood
development programmes),
CANCER CONTROL

Primary Prevention Secondary Prevention


Control of tobacco & alcohol Cancer Registration
consumption Hospital based registries
Personal Hygiene Population based
Radiation registries
Occupational Exposures Early detection of cases
Immunisation Treatment
Foods & drugs
Tertiary prevention:
Air pollution
Rehabilitation of the client
Treatment of precancerous
lesion Emotional support

Legislation Family support

Cancer Education
screening
Cancer Screening

Pre malignant lesion can be identified


Most cancers are localized in initial stages
75% occurs at accessible body sites

Methods
Mass Screening by comprehensive cancer detection
examination
Mass Screening at single sites

Selective screening - for those at special risk


Screening of cancer cervix Pap Smear

Screening of breast cancer


Breast self examination(BSE)
Palpation
Thermography
Mammography
Screening-Breast Cancer

Yearly mammograms are recommended starting at age 40 and


continuing for as long as a woman is in good health.

Clinical breast exam (CBE) should be part of a periodic health


exam, about every 3 years for women in their 20s and 30s and
every year for women 40 and over.
Breast self-exam
(BSE) is an option for
women starting in
their 20s.
Thermography

Thermography is a way to measure and map


the heat on the surface of the breast using a
special heat-sensing camera.
Risk Factors Of Female Breast Carcinoma: A case
control study at Puducherry
Objective: To identify and quantify various demographic, reproductive, socio-economic
and dietary risk factors among women with breast cancer. Study Design: Case control
study. Study Period: February 2004 to May 2005. Study Setting: Departments of
Surgery, Medicine and Radiotherapy (JIPMER), Pondicherry
Materials and Methods: Cases were women with pathologically confirmed breast
cancer. Controls were age-matched women from medicine and surgery wards without
any current breast problem or previous breast cancer. A total of 152 cases and 152
controls were enrolled. They were interviewed for parity, breast feeding, past history of
benign breast lesion, family history and dietary history with a pre-tested interview
schedule after obtaining informed written consent.

Results: The significant risk factors were (odds ratios with 95% CI)
previous history of biopsy for benign breast lesion 10.4 (1.3-86.3),
nulliparity 2.4 (1.14-5.08),
consumption of fats more than 30 g/day 2.4 (1.14-5.45) and
consumption of oils containing more of saturated fat 2.0 (1.03-4.52).

Conclusions: Nulliparity, past history of benign breast lesion, high fat diet and
consumption of oils with more saturated fats were the risk factors
Screening - Cervical Cancer

Pap smear: to detect the prolonged early phase


of cancer in situ.
All women should have pap test at the beginning
of sexual activity, and then every 3 years
thereafter.
A periodic pelvic examination also
recommended
visual inspection with acetic acid
(VIA)
low level health facility
instant results
precancerous lesions using cryotherapy
This see and treat method
visual inspection with Lugol's iodine
(VILI):
Schillers test, uses Lugols iodine instead of
acetic acid
can be done with the naked eye (also called
cervicoscopy or direct visual inspection
iodine results in brown or black color staining
colorless or turn yellow
Test characteristics of visual inspection with 4% acetic acid (VIA)
and Lugol's iodine (VILI) in cervical cancer screening in Kerala,
India
cross-sectional study involving 4,444 women aged 25 to 65 years in Kerala,
India. While detection of any acetowhite area constituted a low-threshold
positive VIA, detection of well-defined, opaque acetowhite lesions close to
or touching the squamocolumnar junction constituted a high-threshold
positive VIA test.
All screened women were evaluated by colposcopy and biopsies were
directed in 1,644 women (37.0%) which allowed the direct estimation of
sensitivity, specificity and predictive values.
The sensitivities of low-threshold VIA, high-threshold VIA, VILI and cytology
to detect worse disease were 88.6%, 82.6%, 87.2% and 81.9%,
respectively; the corresponding specificities were 78.0%, 86.5%, 84.7% and
87.8%.
Our results indicate that VIA and VILI are suitable alternate screening tests
to cytology for detecting cervical neoplasia in low-resource settings.
Screening of lung cancer

Chest radiograph
Sputum Cytology
Screening- Colon and Rectal Cancer

Beginning at age 50, both men and women should follow 1 of


these 5 testing schedules:

yearly fecal occult blood test (FOBT)* or fecal immunochemical


test (FIT)
flexible sigmoidoscopy every 5 years
yearly FOBT* or FIT, plus flexible sigmoidoscopy every 5 years**
double-contrast barium enema every 5 years
colonoscopy every 10 years
Screening - Prostate Cancer

Both the prostate-specific antigen (PSA) blood


test and
digital rectal examination (DRE)
should be offered annually, beginning at age 50, to
men who have at least a 10-year life expectancy.

Testicular self-examination: Recommended


annually, starting at the age of 18 years
Genetic Testing for Hereditary Cancer

BRCA1 and BRCA2 genes that cause hereditary breast and ovarian
cancer, and
now offers the most accurate clinical tests available to determine
predisposition to cancer:

BRAC Analysis for hereditary breast and ovarian cancer,


COLARIS for hereditary colon and endometrial cancer,
COLARIS AP for hereditary colorectal polyps and cancer,
and MELARIS for hereditary melanoma and pancreatic cancer.

Being aware of a genetic risk means patients are more likely to


either avoid cancer or detect it at an earlier stage when
treatment is more likely to be successful.
cell-free DNA concentration and integrity as a screening
tool for cancer:

Aim of the Study: This study aims to evaluate cell-free


DNA (CFDNA) concentration and integrity in patients with malignant
and nonmalignant diseases and in controls to investigate their value
as a screening test for cancer
Materials and Methods: The study included three groups; group I:
120 cancer patients, group II: 120 patients with benign diseases and
group III: 120 normal healthy volunteers as control. One plasma
sample was collected from each subject. CFDNA was purified from
the plasma then its concentration was measured and integrity was
assessed by PCR amplification of 100, 200, 400, and 800 bp
bands. Results: There was a highly significant difference in CFDNA
levels between cancer group and each of benign and control groups
Conclusion: The combined use of CFDNA concentration and
integrity is a candidate for a universal screening test of cancer. Upon
setting suitable boundaries for the test it might be applied to identify
cancer patients, particularly among subjects with predisposing
factors. Being less expensive, CFDNA concentration could be
applied for mass screening and for patients with values overlapping
those of normal and benign subjects, the use of the more expensive,
yet more specific, integrity test is suggested.
The value of testing

Genetic testing may help you to:


Make medical and lifestyle choices.

Find out you do not have an altered gene.

Cope with your cancer risk.

Decide whether to have prophylactic, or preventive,


surgery such as prophylactic mastectomy (removal
of a breast) or oophorectomy (removal of one or both
ovaries).
Provide useful information to other family members
(if you decide to share your results).
Contribute to research.
The disadvantages of testing
There is no proven way to reduce genetic cancer risk,
except through periodic examination and/or surgery.

There is no guarantee that test results will remain private.

You may face discrimination in health insurance, life


insurance, or employment.

You may find it harder to cope with your cancer risk


knowing the results.

Negative results may provide a false sense of security


because you think you have no chance of getting cancer,
which is not true.

Genetic testing requires genetic counseling.

It is costly and may not be covered by your insurance.


Jolie revealed she underwent a
preventive double mastectomy in February
after doctors discovered she carried the
"'faulty' gene" BRCA1 and had roughly
an 87 per cent chance of developing breast
cancer and a 50 per cent chance of ovarian
cancer.
8/25/2017 3:34:11 AM
INTRODUCTION

STARTED IN 1975-76

RENAMED AS NATIONAL CANCER


CONTROL PROGRAM(NCCP)IN 1985
Revised in 2004

49
Evolution of NCCP

1975-76 National Cancer Control Programme was


launched
1984-85 The strategy was revised and stress was laid on
primary prevention and early detection of cancer
1990-91 District Cancer Control Programme was started
in selected districts
2000-01 Modified District Cancer Control programme
initiated.
2004 Evaluation of NCCP was done by National Institute
of Health & Family Welfare, New Delhi.
2005 The programme was further revised after
evaluation
IX Plan focuses on

Identification of IEC activities


Provision of diagnostic facilities
Filling up of the existing gaps in radiotherapy
units
NCCP

PRIMARY SECONDARY TERTIARY


PREVENTION PREVENTION PREVENTION
OBJECTIVES

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PRIMARY
PREVENTION-
HEALTH EDUCATION
SECONDARY
PREVENTION- EARLY
DETECTION
STRENGTHENING OF
EXISTING CANCER
TREATMENT
FACILITIES
PALLIATIVE CARE IN
TERMINAL STAGE
CANCER
53
STRATEGIES

Prevention and early detection of cancer


Encouraging public private partnership.
Promote research in cancer
Promote innovation in cancers care
To augment comprehensive cancer care
facilities
Capacity building and training
Health education of the general public
SCHEMES
1) RCC.
2) ONCOLOGY WING DEVELOPMENT
SCHEME.
3) DISTRICT CANCER CONTROL
PROGRAMME.
4) DECENTRALISED NGO SCHEME.
5) IEC ACTIVITIES AT CENTRAL LEVEL.
6) RESEARCH AND TRAINING.
RCC

27 regional cancer research centres in India


Coordination with the medical colleges and
the general health infrastructure is the
essential feature
One time grant of rs.3 crores for further
strengthen under revised programme
COBALT THERAPY INSTALLATION

1 CRORE FOR NON-GOVT


1.5 CRORE FOR GOVT
30 LAKH FOR MAMOGRAPHY UNIT

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ONCOLOGY WINGS IN
MEDICAL COLLEGES
link between the regional centres on one
hand, and the more peripheral health
infrastructure on the other hand
Financial assistance has been released for
medical colleges / hospitals for installation of
cobalt therapy facilities. For that Rs. 2 crore
per institution has been provided under this
scheme
DISTRICT CANCER CONROL
PROGRAM
LAUNCHED IN 1990-91
Cobalt therapy installation and mamography
has been strengthened
Morphine tablets, and pap smear kits RCC
12 training prog were held for medical officer
at PHC/CHC in 1999
MODIFIED DISTRICT CANCER

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CONROL PROGRAM
LAUNCHED IN 1990-91
15 LAKHS ONE TIME ASSISTANCE AMOUNT
90 LAKHS FOR 5YRS
FIVE ELEMENTS:
1. PRIMARY PREVENTION-HEALTH EDUCATION
2. SECONDARY PREVENTION-EARLY DETECTION
3. TRAINING OF MEDICAL & PARAMEDICAL
PERSONNELS
4. PALLIATIVE TREATMENT AND PAIN RELIEF
5. COORDINATION AND MONITORING

60
Other members

District- one district cancer society chaired by


local collector/ chief medical officer
Dean/ principal of md
Zila parisad representative
NGO rep
FINANCIAL ASSISTANCE TO VOLUNTARY
ORGANIZATION

5 LAKH RUPEES FOR UNDER TAKING IEC AND EARLY DETECTION


the coordination of the Nodal Agency, which will be an RCC or an Oncology
Wing
A grant of Rs. 8000 per camp

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Implementation
NEW INITIATIVES:

The pap smear kits and can-scan software


supplied to 12 RCC
Onconet India: telemedicine project to
connect 27 RCCs and 4 to 5 peripheral
centers
Training of cytopathologists and
cytotechicians
HEALTH MELAS AND EDUCATION KITS
National cancer awareness day is celebrated
on the birth anniversary of Nobel laureate
madam curie, 7th nov.
Telecast of health magazine kalyani
Broadcast of health education audio material
developed by CNCI, kolkatta, through FM
radio.
ORGANIZATIONAL STRUCTURE

8/25/2017 3:34:12 AM
TWO LEVELS:CENTRAL GOVT. AND
STATE GOVT. LINKAGE THROUGH
THE CENTRAL GOVT
66
NATIONAL CANCER REGISTRY

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PROGRAM

Launched in 1982 by Indian Council of Medical


Research (ICMR) to to provide true information on
cancer prevalence and incidence

OBJECTIVES:
1.To generate authentic data on the magnitude of
cancer problem in india
2.undertake epidemiology investigation and
advice control measures
3.promote human resource development in cancer
epidemiology 67
8/25/2017 3:34:12 AM
Population Based Cancer Registry
Hospital Based Cancer Registries

68
8/25/2017 3:34:12 AM
Population based registries:
There are six in number ; 5 in urban areas ( delhi
, Bhopal, Mumbai, Bangalore,Chennai) and
one in rural areas ( barshi in Maharashtra).
Hospital based registries:

At Chandigarh, dibrugarh, thiruvanathapuram,


Bangalore, Mumbai, and Chennai , six hospital
based registries are maintained

69
CANCER ATLAS

National cancer registry prog


Developed by WHO-Indian Council of
Medical Research since 2003
To have an idea of the pattern of cancer
across the country
Based on information collected for the
year 2001-02
CANCER VACCINE:

(CDC) recommended for girls and boys ages


11 to 12,
girls and women through age 26 and boys
and men through age 21 receive the vaccine
a series of three injections over a six-month
period
CANCER VACCINE:
Tobacco control:
In India, more than 2000 person die everyday
and about 8 lakh people die every year due
to tobacco-related diseases.
In India, prevalence of tobacco use is 23.2
% to 69.3 % males and 4.0 % to 50 %
females
Tobacco use can cause spontaneous
abortion,
premature delivery, and intrauterine growth
retardation
Even passive smoking can cause lung
cancer, respiratory illness, heart diseases,
nasal sinus cancer, premature aging and
intrauterine effects.
Comprehensive anti- tobacco
program:
STRATEGIES:
Education of the public.
Practice of tobacco control
Advocacy of tobacco control.
MAJOR EFFORTS FOR
TOBACCO CONTROL IN INDIA:
Warning on cigarette packages/
advertisments
cigarette act 1975
cigarette smoking is injurious to health
parliament committee in December 1995
direct /indirect advertisement of tobacco
products,
prohibition of smoking in public places
Persuasion of farmers to switch over
alternative crops
warning on smokeless tobacco
products:
food adultration rules(1995)
chewing of tobacco is injurious to health
Package of areca nut
chewing of supari may be injurious to health
cabinet guidelines for smoking in
public places:
cabinet secretariat by an administrative order
in 1990 , prohibited smoking in certain places
Comprehensive legislation on
tobacco control:
COTPA act,2003

, "The Cigarettes and other Tobacco


Products (Prohibition of Advertisement and
Regulation of Trade and Commerce,
Production, Supply and Distribution) Act,
2003" on 18 May, 2003.
came into force from 1st May, 2004 where:-
Relating to prohibition of smoking in a public
place
Prohibition of advertisements and sponsorship
of cigarettes and other tobacco products
Prohibition of sale of cigarette and other tobacco
products to a person below the age of 18 years.
Violation of any of these provisions is be a
punishable offence, whose punishment includes
fine or / and imprisonment.
multi-sectoral approach for tobacco
control:
association of a large number of sectors like
health, agriculture, finance, mass media,
labor, education, industry, welfare,
Community education on tobacco:

no tobacco day (31st may)


in books brought by NCERT
ICMR carried out operational research
studies on anti-tobacco community education
Expert committee on health hazards
of pan masala containing tobacco:
Banned the sale and production of such
products as short term measure.
TOBACCO CONTROL CELL:

It Has Been Established In The Department


of health since aug 2000, under deputy
secretary,

Educational programs through mass media and schools


Startegy papers for alternate crops and bidi workers
Advocacy workshops for non health sectors, and
Establishment of tobacco cessation clinics.
TOBACCO FREE INITIATIVES

WHO established the Tobacco Free


Initiatives (TFI) in 1998
Role of nurse in prevention of
cancer:
Community health nurse:
Risk factor identification: lifestyle eg., tobacco, diet,
alcohol, sunlight exposure, and sexual practices.

High risk families, especially those at risk for breast and


lung cancer should be given health education on early
detection and treatment.
Case finding is the responsibility of community health
nurse
Participation in cancer control programme.
Nurse counselor:
The nurse must be able to counsel and direct
patients to proper sources of help
To give information about those conditions
that are known to predispose individuals to
the development of disease.
Nurse educator:
Educate the public about predisposing factors
Be sensitive to the needs of patients who
may be afraid and embarrassed when
confronted with the possibility of cancer
new Anti-Tobacco health spots for
Tobacco-Free Film Rules
The spots have been developed by World Lung
Foundation (WLF).
under COTPA
With effect from 2nd October 2012, two spots
Mukesh and Sponge depicting harmful effect
of usage of smokeless and smoking forms of
tobacco, were used.
The Ministry of Health and Family Welfare is
replacing these spots with two new spots titled
Child and Dhuan to be effective from 2nd
October 2013. These spots have been dubbed
in 16 Indian languages for a pan India coverage.
Child and Dhuan are developed to warn
smokers about the health costs of smoking
and of the penalties to be faced by violating
the smoke free law.
Child focuses on the health risks of
smoking and passive smoke, while dhuan
models the behaviour expected of business
managers, advocates, enforcement officials,
smokers and non-smokers.
Quit smoking if you want a
government job in Rajasthan
In November 2012, state-level coordination
committee for tobacco control had
recommended an undertaking from
candidates before giving them government
jobs. Such an undertaking would help young
smokers to quit the habit in the initial stages,
which otherwise would result in cancer,
never to smoke cigarettes and chew gutka.
Theory application: HEALTH BELIEF MODEL
Conclusion
Thank u

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