Awareness | Early Detection |Patient Care

Insurance |Rehabilitation |Advocacy |

Research

CPAA’S PHILOSOPHY

• Awareness & Education

• Early Detection

• Insurance

• Patient Care

• Rehabilitation

• Research

• Advocacy

Total Management of Cancer

A realistic picture Encourage prevention Promote early detection Remove stigma Integrate cancer patients normal life

Awareness Lectures: 300,000 people educated atSchools, Colleges, Offices, Factories & Residential locations

Awareness & Education

Diagnostic Check-up at clinics and on-site Camps

2,40,283 healthy individuals screened

6279 camps and clinics498 cancer patients detected

Prevention & Early Detection

Medical aid Counseling Prostheses Home visits Accommodation Travel abroad Diet supplement Special investigations Free transportation Blood requirements Bone marrow transplant Playgroup for children

Support to patients

Cancer Insurance Policy

12,233 policy holders 208 cancer patients 162 survivors Rs. 44.2 million disbursed

Complete Support given to 3,00,000 cancer patients

Rehabilitation25,000 patients and families rehabilitated since 1987Products Stationary T-shirts Cards Candles

5-star Hotel linen Breast Prosthesis Jute bags Terracotta statues

Facts: Cancer Burden: India’s burden is 7.8% of global cases

2012:World: 14.1 million Incidence8.2 mi. death32.6 mi. prevalence19.3 mi. 2025India : 1.1 million incidence682830 deaths1.8 mi. prevalence

CANCER MYTHS

…IT’S CONTAGIOUS…ONLY AFFECTS OTHERS…ARE ALL THE SAME …CAUSES PAIN…RESULTS FROM INJURY …IS INCURABLE

CANCER FACTSA realistic picture

about cancerEncourage prevention

wherever possible

Promote early detection at curable stagesRemove stigma and help integrate cancer

patients into a normal life with families

CANCER IS…

Uncontrolled Autonomous division of cells Resulting in an abnormal growth

Curable if detected early and treated in time

What Increases Risk of Cancer?

You can’t help it ! Age Sex Race Family History

You can !!Tobacco/ SmokingAlcoholSedentary LifestyleUnhealthy dietObesityInfectionsSun Exposure

CANCER CAUSATIVE FACTORS» Tobacco Smoking, Smokeless Tobacco

lung, oral cavity, larynx, pharynx, stomach» Alcohol mouth, throat, larynx, breast, bowel, liver,

upper digestive system» Infections - liver, cervical, stomach cancer, lymph/leuk» UV Rays - skin » Diet - bowel & stomach cancer» Obesity - uterus, kidney, oesophagus, stomach, colon,

breast, prostate, gall bladder and pancreas cancer» Lack of exercise – breast, colon » Continuous irritation at the same spot ?? Kangri Cancer

STAGESNORMAL SKIN TRAUMA

NORMAL

NORMAL CELLS

RECOVERY

STAGES:ROGUE CELL CANCER CELLS

METASTATICCANCER CELLS

GenesChromosomes

Nucleus and Cell

What is cancer ?

Little changes can make a big difference!

DNANORMAL CELLS REGULATED GROWTHCANCER CELLS GROWTH

AUTONOMOUS CHROMOSOME ABERRATIONS

NUMERICAL & STRUCTURAL GENES

POINT MUTATIONSDELETIONSINVERSIONS

CANCER CELLSWhat is cancer ?

Cumulative Damage

ABNORMAL GROWTH: TUMORS

CONFINED GROWTH

BENIGN MALIGNANT

SPREADS UNCONTROLLABLY

INVADES SURROUNDING TISSUE

METASTASES

GENERALLY – NO RECURRENCE AFTER REMOVAL

… Does it really make a difference?

Why all the fuss about…

Early Detection of Cancer

EARLY DETECTION Of Critical Importance

EARLY DETECTION CURABLE DISEASE

LESS INVASIVE TREATMENT LESS TRAUMA LESS PAIN LESS COST

EARLY STAGE 80 – 90 % CURELATE STAGE 20 – 30 % CURESO IT PAYS TO BE VIGILANT!

PREVENTION STRATEGIES

Common lifestyle related cancers Japan Stomach cancer Scotland Lung cancer Australia Skin cancer India Oral and Cervical cancers

Lifestyle Habits Changes Reduces Cancer Risk

Common cancers in India

Breast cancer Cervical cancer Oral cancer Lung Cancer Prostate cancer

These are also the cancers with Early Warning Signs

EARLY DETECTION STRATEGIES

ORALCANCER

ORAL CANCER

• 90% of oral cancers are lifestyle induced

• ~10% Virus (HPV) induced

• No tobacco habit and tobacco cessation reduces risk of contracting oral cancer

• Unfortunately the habit is rampant in India and finds social sanction

Early warning signs:

• Red, White or Black patches

• Difficulty in opening the mouth or swallowing

• Persistent sore throat

• Change in voice

ORAL CANCER

ORAL CANCERAVOIDABLE RISK FACTORS

ORAL CANCERAVOIDABLE RISK FACTORS

PAN MASALA

ORAL CANCERAVOIDABLE RISK FACTORS

SOCIO CULTURAL PRACTICES

ORAL CANCER AVOIDABLE RISK FACTORS

ORAL CANCER AVOIDABLE RISK FACTORS

ORAL CANCER & LUNG CANCERS TOBACCO AVOIDABLE RISK FACTORS

Healthy Lung

Smoker’s Lung

ORAL CANCERAVOIDABLE RISK FACTORS

WHAT A CIGARETTE CONTAINS 1000 CARCINOGENS

TIME IS OF ESSENCE

CORRELATION BETWEEN SMOKING AND LUNG CANCER

CIGARETTES & CANCEROralLung LarynxBladderOesophagusPancreas KidneyBreastHeart conditions Peptic ulcers Chronic bronchitisEmphysema

World-wide almost 5 million die prematurely each year as a result of smoking

ADVOCACY: PACK WARNINGS

STOP SMOKING NOW!

BREAST CANCER

Early Detection : A Saviour !!!

Breast Cancer Not a Preventable Cancer

Early Detection 80-90% cure rate Cervical Cancer

Preventable Cancer!!

Time is of

essence

Breast Cancer is the most common cancer in urban India

1 in 8 women in the US will get breast cancer

1 in 30 women in Indian metros will get breast cancer

1 in 60 women in rural India will get breast cancer

90% + cure rates in the west 40% cure rate in India

BREAST CANCER: STATISTICS

Breast Cancer: Increased Incidence

Women > 50 years Obesity Early menarche Late menopause

Late Diagnosis Poor Prognosis

Family history of breast cancer Diet rich in animal fat Late child bearing age Women who have not borne children

Educated Talented Career oriented Stress Desk jobs

Minimal breast feeding Western diet Couch Potatoes Late Marriages Late first child

Risk Factors

Modern Indian women

Breast Cancer: Detection in Early stages

SELF Personal alertness for changes in breast Monthly breast self examination Women over 20 years

CLINICIAN Annual routine examination Physician for women over 35

yrs MAMMOGRAPHY

Women 40-50 years of age As advised for higher risk groups

BREAST EXAMINATION

Early Onset Breast Cancer: < 45 years 5 – 12 % breast cancers: women below 45 years Increased risk for Ovarian Cancer: Hereditary

Hereditary Breast and Ovarian Cancer • Genes BRCA1 / BRCA2

Mutation in BRCA1 / BRCA2 genes • 85% lifetime risk Breast Cancer• 67% lifetime risk Ovarian cancer

Ovarian Cancer: Silent Killer• A lethal

cancer in females

• 80% cases: late presentation

• 20% - 5 yr survival rate

When should I do BSE ?

Once a month Takes about 10 minutes Menstruating women:

1-2 days after menstruation period is over Menopausal women:

same date each month Pregnant women:

same date each month

Breast Cancer: Treatment Options

Early detection5 year relative survival rate > 90%

Surgery : - Lumpectomy - Mastectomy

Chemotherapy Radiation Therapy Hormone Therapy Targeted / Personalized

Therapy

CERVICAL CANCER

Cervical Cancer: World incidence

< 9.3 < 16.1 < 23.8 < 35.8 < 93.9

High Risk Oncogenic Virus HPV: Causative Agent of Cervical Cancer

CERVICAL CANCER Most common cancer in Indian

women Caused

Human Papilloma virus (HPV) infection

Preventable by simple meansEarlier PAP test

Cervical Cancer Risk Screening HPV DNA PCR Testing Preventable Cancer High Cure Rates with Early Detection

Screening: Why not just Do PAPs ?

PAP smears / HPV detection Pap smears are not sensitive (52% Sensitivity) Pap smears: Poor reproducibility Most women with an abnormal PAP only:

No cancer indication HPV detection 99.7 % cervical cancer

HPV Indicates Risk

Cervical Cancer: Risk Factors Early marriage Tobacco Smoking Multiple pregnancies Multiple sexual partners History of sexually transmitted disease Partners with multiple sexual partners Partners with sexually transmitted disease Low socioeconomic status ?

(Poor genital hygiene; more infections; low immunity) Suppression of the immune system steroids,

diseases, HIV

Cervical Cancer: Symptoms Abnormal vaginal bleeding between periods,

after intercourse or after menopause Persistent white, brown

or blood stained, foul smelling vaginal discharge

Loss of appetite Unexplained weight loss Involuntary loss of urine or fecal matter

Cervical Cancer: PreventionScreening: HPV Test

Individual: Once in 3 years (5 - 10 years)Masses: One time screening test

Single PartnerAvoid smokingMaintain good hygiene

HPV vaccines: Beginning of the end2 VACCINES AVAILABLE IN INDIA

Gardasil (MSD) Cervarix (GSK)

Quadrivalent VaccineHPV 16/18 – OncogenicHPV 6/11 – Non-Oncogenic (warts)

Bivalent VaccineHPV 16/18 – Oncogenic

AGE9 -12 years 13 - 26 years > 26 years

(before sexually active)

(after checking for HPV)

(after checking for HPV)

Validated Validated To be validated

DOSAGE• Month 0; Month 2; Month 6• Rs. 10,000/-• Contraindicated: Pregnant women

PROSTATE CANCER

PROSTATE CANCER• A sex gland in men• Size of a walnut• Responsible for producing

fluid that sperm travels • Located in front of the

rectum, below the bladder

• Wraps around the urethra

PROSTATE CANCER: Risk factorsAGE•If you live long enough Prostate cancer

RACE•African-American men 60% Increased Risk•Asian men Low Risk

FAMILY HISTORY•2 relatives with prostate cancer: 5 fold incr. risk•3+ relatives with prostate cancer: 100% life time risk

PROSTATE CANCER: SymptomsEarly Stages: CAN BE ASYMPTOMATIC• Aching pains in genitals, lower abdomen, lower back• Problems with sexual function• Painful, frequent, urgent urination• Slow urine stream and retention• Blood in the urineAdvanced Stages: • Loss of energy• Persistent swelling in legs• Pain in the back, spine, rib or hip• Hard growth on prostate• Enlarged lymph nodes

PROSTATE CANCER: Early detection

• Physical Examination Insertion of a gloved, lubricated finger into rectum

• Check for enlargement, lumps and tenderness of the prostate

Digital Rectal Examination

PROSTATE CANCER: Screening / Early detection

Prostate Specific Antigen (PSA) Testing

• Higher than average PSA levels in the bloodstream is a sign of abnormal cell multiplication in the prostate?

• Is an Indication – Hyperplastic Prostate?

PROSTATE CANCER: Prevention

Lifestyle Choice

•Obesity•Little physical activity•Smoking•High intake of fatty foods

WARNING SIGNS OF CANCERChange in bowel habits

A sore that does not heal, particularly in the mouth

Unusual bleeding or discharge, especially in the women after menopause

Thickening or lump in the breast or any part of the body

Indigestion or difficulty in swallowing

Obvious change in size and color of a mole or a wart

Nagging cough or persistent hoarseness

CANCER PREVENTION TIPS

Do not use tobacco in any formAvoid unnecessary X-raysDrink alcoholic beverages in moderationUse personal protective

clothing/devices in the jobAvoid too much sunlightWatch your diet

Eat a variety of fruits and vegetables every day. Eat different colored vegetables and fruitsEat a variety of grain products

LOOK BEFORE YOU EAT!

Choose nonfat or low-fat products.Use less fat White meats- chicken, fish.Switch to fat-free milk-skimmed milk

Several malignancies Prevented

ExercisingEating right, maintaining a healthy weight, no smokingAnd no alcohol

CANCER PREVENTION STRATEGIES

Be proactive, get an annual cancer screening

Don’t wait to get sick before taking action!

CREATIVE STRATEGIES - DO NOT WORK!

Never had a test!Never been to Doctor! I hate them!Never take medicines!Now all is normal, so stopped medicines!Miracle men and Miracle Medicines! So many of them!I am my own doctor! No fees too!

Genetic Cancer Etiology

Sporadic [70-75% ]

Strong hereditary component [5-10% ]

Familial orMultifactorial [15-20%

]

One of the major barriers to

diagnosis and treatment is

STIGMA

STIGMA

• Global Issue• Cancer = death great social

costs• Not go for diagnosis or talk about it• Ashamed and humiliated• Malignant offensive

STIGMA

Fears of being blamed for the diagnosisOstracized by friendsFear being left by a loved oneSociety labels someone as

tainted less desirable handicapped

STIGMA

PSYCHO-ONCOLOGY

Need

Deal

Stigma

Consequences

THANK YOU

CANCER PATIENTS AID ASSOCIATIONAnand Niketan, King George V Memorial,

Dr. E. Moses Road, Mahalaxmi, Mumbai - 11

Contact: 022- 24924000 E-mail: webmaster@cancer.org.in | Website: www.cancer.org.in

CANCER TREATMENT OPTIONS

• Surgery

• Chemotherapy

• Radiation Therapy

• Biologic or Targeted Therapy

SURGERY

Important Treatment ModalityCancer Localised

May Prevent, Stage & Confirm Diagnosis

Removes tumors or as muchof the cancerous tissue as possible

Often performed in conjunction with chemotherapy or radiation therapy

CHEMOTHERAPY

Use of drugs to eliminate cancer cells

Unlike surgery, chemotherapy affects the entire body

Targets rapidly multiplying cancer cells and other types of cells like hair follicle cells, Gastero-intestinal lining, Bone marrow

Side effects include hair loss, Vomiting, Diarrhea

Single modality chemotherapy

Neoadjuvant – Before Surgery

Adjuvant - in conjunction with radiation therapy or biologic therapy

CHEMOTHERAPY

Oral – Pill or capsules Intravenously (IV)

Generally combination of drugs

Several Cycles

RADIATION THERAPY

High-energy x-rays kill cancer cells and shrink tumors

Local therapy- only affects cancer cells in the treated area

It works by damaging a cancer cell's DNA, making it unable to multiply. Cancer cells are highly sensitive to radiation and typically die when treated. Nearby healthy cells can be damaged as well, but are resilient and are able to fully recover.

Radiation therapy may be given alone, along with chemotherapy, and/or with surgery.

RADIATION THERAPY

The total dose delivered to the tumor into a number of daily fractions over a number of weeks.

The primary systems used are Accelerators which deliver a radiation dose of a specific energy, electrically generated, to a depth in the tumor site.

BIOLOGIC / TARGETED THERAPY

Drugs that target characteristics of cancerous tumors

Some work by blocking the biological processes of tumors that allow tumors to thrive and grow

Others cut off the blood supply to the tumor, causing it to basically starve and die because of a lack of blood

Used in select cancers and not applicable for everyone

Given in conjunction with other cancer treatments

BIOLOGIC / TARGETED THERAPY

Glivec (imatinib mesylate – VEENAT) for CML

Rituxan or Rituximab treats non-Hodgkin's lymphoma

Herceptin or Trastuzumab treats breast cancer

IL-2 or Interleukin-2 treats certain types of cancer

Interferon alpha treats certain types of cancer

Thank You