1. GLOBAL PROBLEM

2. PRESENTED BY DR.RAMESH KUMAR SAHARIA (Consultant Onco- Surgeon) Sridhar Cancer care Center Srimanta Sankerdev Hospital and Research Institute. DIBRUGARH

3. INTRODUCTION CANCER Problem is Universal 12% Death worldwide. Developed Countries ranks 2nd (2.5million) while in Developing Countries ranks 3rd(3.8million) as commonest cause of death

4. INDIA 2.5million suffering from cancer at any given time. 7 lacs new cases each year. Incidence rate 44-122/lac males; & 52- 128/lac females. Mortality rate 61/lac males;& 58/lac females

5. HABIT RELATED CARCINOGENS CIGERATTE Smoking/ TOBACCO Contains about 800 ingredients About 70 are Pro-carcinogens Aromatic, NNK, Polonium210, Arsenic, Nickle Cadmium Alpha-and beta-naphthylamine. Various Promoters –Acetaldehyde/phenol Nicotine is not carcinogen;but ADDICTER

6. BETAL NUT Direct irritant on Buccal Mucosa ALCOHOL Acetaldehyde acts as promoter Causes Oro-pharynx,Oesophagus, Stomach, Liver Ca.

7. PATHOGENESIS Five classes of genes are involved in normal growth : 1)Proto-0ncogenes 2) Tumor suppressor genes. 3)Genes that regulate apoptosis. 4)Gene that regulate DNA repair 5)Gene that act on proof reading enzymes

8. CARCINOGENESIS Multistep Process of Carcinogenesis Genetic (point) mutation,Chromosomal translocation. Results in changes Hyperplasia ---Dysplasia--- Carcinoma in situ---Invasive Ca. Loss of Tumor Suppressor Gene P16, P53 & RbAmplification of proto-oncogene Cyclin D1 Expression of Epidermal Growth Factors Receptors Increased expression of cHA-ras oncogene, p21 has been noted

9. Procarcinogens ---Chemical transformation to be carcinogens To convert normal cell into neoplastic cell INITIATOR Permanent DNA damage Mutation incell PROMOTER Additional Mutation initiated cell

10. TOBACCO AND CANCER Tobacco-smoking /nonsmoking form can cause cancer of various organs/part of body : Lungs,oral cavity, larynx,esophagus, stomach, breast, urinary bladder.kidney, pancreas Smoking is primary etiology in more than 80% of LUNG cancer. Environmental tobacco smoke(ETS) has increased risk of lung cancer as lighted end of cigarette can eliminate carcinogenic compounds with smoke to the atmosphere Smoking and alcohol increases risk for ca esophagus as much as 44 times.

12. Tobacco use is leading preventable cause of cancer disease. Approximately 90% of Head &Neck cancer occurs after exposure to known carcinogen, tobacco in any form, Betal nut, gutka, khani, alcohol

13. TOBACCO KILLS Tobacco use the primary risk factor for leading cancer killer, ranked fourth most preventable health risk behind malnutrition, unsafe sex, high B.P. Overall Smoking appears to have been linked to > 70% of cancer death >Passive smokers are at increased risk (30%) to develop cancer when living with a smoker. Cigarette smoking accounts for 50% bladder cancer in man&31% in woman.. Tobacco use a leading GLOBAL Cancer Risk

14. The world is living dangerously, either because it has little choice or because it is making the wrong choices about consumption and activity. Smoking cannot be rational. If you smoke just 1-2 cigarette/day, you are not at a lesser risk because all it takes to trigger an event is just one

15. TARGET POPULATION Vast majority of smoker start before the age of 19yrs.So it is crucial that young people and teenager are discouraged from smoking.& tobacco Diseases starts & progression depends on number of yrs. of smoking or tobacco chewing. If one start at very young age, by the time he reach adult hood he/she may develop disease leading to many premature death.

16. MYSTERY This painful disease is always painless to start with. Unfortunately, majority found at late stage, account very high death rate of about 45% at 5 yrs. High treatment related morbidity Poor prognosis. Late diagnosis is not it is hard to diagnosed. Because of lack of Public awareness and lack of nation programme for opportunistic screening...

17. Quitting Smoking Affect The Risk Of Developing CANCER Major & immediate health benefit. Quitting smoking decreases the risk of lung & other cancer diseases. Earlier a person quit, the greater the health benefits. If one quit before 50yrs reduces the risk of dying in next 15yrs by half compared with those who continue smoking.

18. LAW AND LEGISLATION 1)Smoking prohibited in public placeses. 2)Picturial Warning about cancer on cigrette packets and tobacco pouch. 3)Punishment in form of fine or imprisonment or both.

19. TOBACCO COMPANIES

20. TAKE HOME MESSAGE