بسم الله الرحمن الرحيم

CANCER Cancer is a group of diseases! It can occur at any site or tissue of the body, may involve any type of cells. Cancer is a group of diseases! It can occur at any site or tissue of the body, may involve any type of cells. Three main reasons are: Three main reasons are: i Being a longer life expectancy, i Being a longer life expectancy, ii More accurate diagnosis, ii More accurate diagnosis, iii The rise in cigarette smoking, iii The rise in cigarette smoking, especially among males especially among males

Characteristics of cancer A cancer is characterised by an : A cancer is characterised by an : (i) abnormal growth of cells (i) abnormal growth of cells (ii) ability to invade adjacent tissues and (ii) ability to invade adjacent tissues and even distant organs, even distant organs, (iii) eventual death of the affected patient if (iii) eventual death of the affected patient if that tumour has progressed beyond the that tumour has progressed beyond the stage wherein it can be successfully removed. stage wherein it can be successfully removed.

Categories of cancer The major categories of cancer are : Carcinomas: Carcinomas: which arise from epitheial cells lining the internal surfaces of the various organs (e.g. mouth, oesophagus, intestines, uterus and from the skin epithelium; which arise from epitheial cells lining the internal surfaces of the various organs (e.g. mouth, oesophagus, intestines, uterus and from the skin epithelium; Sarcomas: Sarcomas: which arise from mesodermal cells constituting the various connective tissue; (e.g. fibrous tissue, fat and bone); which arise from mesodermal cells constituting the various connective tissue; (e.g. fibrous tissue, fat and bone); Lymphomas myeloma and leukaemias: Lymphomas myeloma and leukaemias: arising from the cells of bone marrow and immune systems. arising from the cells of bone marrow and immune systems.

PREDOMINANT CANCERS In males predominant cancer is lung cancer. Stomach, esophageal and bladder cancer are also much more common in males. In males predominant cancer is lung cancer. Stomach, esophageal and bladder cancer are also much more common in males. Among women of underdeveloped countries, the cancers of cervix and breast account for nearly 60 percent of all cancers. Among women of underdeveloped countries, the cancers of cervix and breast account for nearly 60 percent of all cancers.

Incidence Approximately, 10 million people are diagnosed with cancer and more than 6 million die every year. Approximately, 10 million people are diagnosed with cancer and more than 6 million die every year. The most common cancers worldwide are: The most common cancers worldwide are: L ung cancer; % of all cancers. L ung cancer; % of all cancers. Breast cancer 10.4 %. Breast cancer 10.4 %. Colorectal cancer 9.4 %. Colorectal cancer 9.4 %.

Mostly involved Organs The two organ sites are most commonly involved; The two organ sites are most commonly involved; (i) the uterine cervix in women (i) the uterine cervix in women (ii) the oropharynx in both sexes (ii) the oropharynx in both sexes

ENVIRONMENTAL FACTORS TOBACCO: ca. lung, larynx, mouth, pharynx, oesghagus, bladder, pancreas. TOBACCO: ca. lung, larynx, mouth, pharynx, oesghagus, bladder, pancreas. ALCOHOL: ca esophageal, liver, beer associated with ca rectal. 3% of all cancer deaths. ALCOHOL: ca esophageal, liver, beer associated with ca rectal. 3% of all cancer deaths. DIETARY FACTORS: DIETARY FACTORS: Smoked fish related to ca. stomach, dietary fibers – intestinal, beef - bowel ca, fat- breast ca. Smoked fish related to ca. stomach, dietary fibers – intestinal, beef - bowel ca, fat- breast ca. OCCUPATIONAL EXPOSURES: Exposure to benzene, arsenic, cadmium, chromium, vinyl chloride, polycyclic hydrocarbon and asbestos. 1-5 % OCCUPATIONAL EXPOSURES: Exposure to benzene, arsenic, cadmium, chromium, vinyl chloride, polycyclic hydrocarbon and asbestos. 1-5 % VIRUSES: Hepatitis B & C -- hepatocellular carcinoma, Kaposi ‘s sarcoma -- HIV. HPV -- ca cervix, VIRUSES: Hepatitis B & C -- hepatocellular carcinoma, Kaposi ‘s sarcoma -- HIV. HPV -- ca cervix, PARASITES. Schistosomiasis -- ca bladder. PARASITES. Schistosomiasis -- ca bladder. Others: sunlight, radiation, air & water pollution, medication – estrogen and pesticides. Others: sunlight, radiation, air & water pollution, medication – estrogen and pesticides.

ASSOCIATED FACTORS: CUSTOMS, CUSTOMS, HABITS HABITS LIFE –STYLES, LIFE –STYLES, increase risk of cancer i e smoking associated with lung cancer and tobacco & betel chewing with oral cancer. increase risk of cancer i e smoking associated with lung cancer and tobacco & betel chewing with oral cancer.

GENETIC FACTORS There is probably a complex interrelationship between hereditary susceptibility and environmental carcinogenic stimuli in the causation of a number of cancers. There is probably a complex interrelationship between hereditary susceptibility and environmental carcinogenic stimuli in the causation of a number of cancers. Retinoblastoma occur in children of same parent. Retinoblastoma occur in children of same parent.

Control of cancer Consist series of measures based on : Consist series of measures based on : Present medical knowledge in the field of prevention, detection, diagnosis, treatment, aftercare and rehabilitation. Present medical knowledge in the field of prevention, detection, diagnosis, treatment, aftercare and rehabilitation. The basic aim is to reduce significantly the number of new cases and reduce the invalidism due to cancer. The basic aim is to reduce significantly the number of new cases and reduce the invalidism due to cancer. It is estimated that at least 1/3 of all cancers are preventable. It is estimated that at least 1/3 of all cancers are preventable.

PRIMARY PREVENTION It is concerned with early diagnosis of disease in pre cancerous stage. It is concerned with early diagnosis of disease in pre cancerous stage. CANCER EDUCATION: CANCER EDUCATION: (a) CONTROL OF TOBACCO AND ALCOHOL CONSUMPTION; (a) CONTROL OF TOBACCO AND ALCOHOL CONSUMPTION; (b) PERSONAL HYGIENE (b) PERSONAL HYGIENE © Protection from RADIATION: © Protection from RADIATION: (d) OCCUPATIONAL EXPOSURES : (d) OCCUPATIONAL EXPOSURES : (e) IMMUNIZATION : (e) IMMUNIZATION : (f) FOODS, DRUGS AND COSMETICS: (f) FOODS, DRUGS AND COSMETICS: (g) AIR POLLUTION (g) AIR POLLUTION (h) TREATMENT OF PRECANCEROUS LESIONS (h) TREATMENT OF PRECANCEROUS LESIONS (i) LEGISLATION (i) LEGISLATION

PRIMARY PREVENTION Danger signals of cancer: a. lump are hard areas in breast. a. lump are hard areas in breast. b. Change in wart or mole. b. Change in wart or mole. c. persist change in digestive and bowel habits. c. persist change in digestive and bowel habits. d. persistence cough or hoarseness. d. persistence cough or hoarseness. e. Excessive loss of blood during menstruation / otherwise. e. Excessive loss of blood during menstruation / otherwise. f. Blood loss from any natural orifice. f. Blood loss from any natural orifice. g. Swelling or sore that does not get better. g. Swelling or sore that does not get better. h. Unexplained loss of weight. h. Unexplained loss of weight.

SECONDARY PREVENTION i) CANCER REGISTRATION: (a) HOSPITAL -BASED REGISTRIES: (a) HOSPITAL -BASED REGISTRIES: (b) POPULATION-BASED REGISTRIES (b) POPULATION-BASED REGISTRIES ii) EARLY DETECTION OF CASES: Iii) Treatment of cases.

TREATMENT Treatment facilities should be available to all cancer patients. Treatment facilities should be available to all cancer patients. Certain forms of cancer are amenable to surgical removal, while some others respond favorably to radiation or chemotherapy or both. Certain forms of cancer are amenable to surgical removal, while some others respond favorably to radiation or chemotherapy or both. Since most of the known methods of treatment have complementary effect on the ultimate outcome of the patient, multi-modality approach to cancer control has become a standard practice in cancer centers all over the wordlists. Since most of the known methods of treatment have complementary effect on the ultimate outcome of the patient, multi-modality approach to cancer control has become a standard practice in cancer centers all over the wordlists.