Common Cancers in Women
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Transcript of Common Cancers in Women
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COMMON CANCERS IN WOMEN
Presented by-Dr Garima Gupta
MBBS, MD (Post Graduate Resident)University College of Medical Sciences and GTB
HospitalDelhi
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Contents Cancer – Introduction -- Pathology -- Incidence and Mortality of cancers worldwide -- Prevention aspect for cancer -- Treatment layout
Breast Cancer - Incidence and Mortality - Summary Statistics - Signs & Symptoms Cervix uteri Cancer - Risk Factors - Prevention & Management
NPCDCS - Introduction -History - Objectives - Services available - Cancer prevention under NPCDCS
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What is Cancer?• Cancer is a group of diseases characterized by:
– Uncontrolled growth and spread of abnormal cells– Ability to invade adjacent tissues and distant organs– If the spread is not controlled, it can result in deathCausative factors: Tobacco Infectious organisms Unhealthy diet Internal factors such as inherited genetic mutations,
hormones and immune conditions.
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Types Of Cancer
• Epithelial cells• Example: Mouth,
oesophagus, intestine, uterus and skin epithelium
Carcinomas
• Mesodermal cells• Example: fibrous
tissues, fat & bones
Sarcomas
• Myeloma & Leukemia
Lymphomas
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Estimated New Cases-World
Source: American Cancer Society(2012)
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Estimated Deaths-World
Source: American Cancer Society(2012)
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Estimated New cases-Females
Source: American Cancer Society(2012)
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Estimated Deaths-Females
Source: American Cancer Society(2012)
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Most Common Cancer Sites Worldwide
Source: American Cancer Society(2012)
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Most Common Cancer Sites Worldwide
Source: American Cancer Society(2012)
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Cancer Incidences in India
Source: World Health Organization - Cancer Country Profiles, 2014.
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Cancer Mortality in India
Others-Larynx, prostate, liver, leukaemia (males)Others-lung, stomach, oesophagus, corpus uteri, leukaemia (females)Source: World Health Organization - Cancer Country Profiles, 2014.
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Can Cancer Be Prevented?
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Treatment Layout for cancer
Cancer Treatment
Surgical
ChemotherapyRadiotherapy
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BREAST CANCER
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Summary Statistics-Breast CancerREGION INCIDENCE MORTALITY
World (2012) 25.2 % (out of the total cancers in world)
14.7 % (out of the total mortality due to cancers in world)
SEARO (2012) 14.4 % (out of the total newly diagnosed breast cancer cases)
21.1 % (out of the total mortality due to breast cancer)
India (2012) 27 % (out of the total cancers in India)
21.5 % (out of the total mortality due to cancers in India)
Delhi (2008-09) 26.78 % (out of the total cancers in Delhi)
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GLOBOCAN 2012 (IARC)
National centre for disease informatics and research
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• hx-history • bx-biopsy • LCIS- Lobular carcinoma in situ• DCIS- Ductal carcinoma in situ
Prevention and Management
• Primary Prevention1.Average age at menarche – can be increased through a reduction in childhood obesity and an increase in strenuous physical activity.
2.Decrease the frequency of ovulation – by increasing the strenuous physical activity
3.Reduce fat intake in diet.
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• Secondary Prevention1.Breast cancer screening2.Follow up: to detect recurrence as early as possible. to detect cancer in opposite breast at an early stage. to generate research data which might be useful.
No major improvement in survival rate has yet been shown by current treatment modalities, however, in general the removal of tumor early is more likely to be curative than removal at a later stage.
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CERVICAL AND UTERINE CANCER
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Cancer of The Cervix
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GLOBOCAN 2012 (IARC)26
GLOBOCAN 2012 (IARC)
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Summary Statistics-Cervix uteri CancerREGION INCIDENCE MORTALITY
World (2012) 7.9 % (out of the total cancers in world)
7.5 % (out of the total mortality due to cancers in world)
SEARO (2012) 33.1 % (out of the total newly diagnosed breast cancer cases)
35.3 % (out of the total mortality due to breast cancer)
India (2012) 22.9 % (out of the total cancers in India)
20.7 % (out of the total mortality due to cancers in India)
Delhi (2008-09) 12.6 % (out of the total cancers in Delhi)
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GLOBOCAN 2012 (IARC)
National centre for disease informatics and research
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Risk factors
Age
Genital Warts
Early MarriageOCP
Socio-economic
class
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• Primary PreventionPromoting legal age of marriagePersonal hygiene and birth control
• Secondary PreventionEarly detection of cases through screening Treatment by radical surgery and radiotherapy
Prevention
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Endometrial Cancer
• Cancer of the uterine endometrial lining• Most of these malignancies are adenocarcinoma
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Risk factors
Age
Obesity
Family history
Diet high in animal Fat
Prior radiation therapy
Infertility/Nulliparous
Tamoxifen/HRT
Early menarche /
late menopause
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Endometrial Carcinoma
Etiology• Unopposed estrogen
hypothesis: exposure to unopposed estrogens
Pathology• Spreads through uterus,
fallopian tubes, ovaries and out into peritoneal cavity– Metastasizes via blood and
lymphatic system
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Symptoms ofEndometrial cancer
Non-menstrual bleeding or discharge (mainly post-menopausal bleeding)
Heavy bleedingDysuriaPain during intercoursePain and/or mass in pelvic areaWeight lossBack pain
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Endometrial cancer• Diagnosis
– Pelvic examination– Pap smear (detect cancer spread
to cervix)– Endometrial biopsy– Dilation and curettage– Transvaginal ultrasound
• Treatment– Surgery
• Hysterectomy• Salpingo-
oophorectomy• Pelvic lymph node
dissection• Laparoscopic lymph
node sampling– Radiation therapy– Chemotherapy– Hormone therapy
• Progesterone• Tamoxifen
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Reduced Risk• Oral Contraceptives
– Combined OC => 50% reduced rate– Actual reduction number small because uncommon in
women of child bearing age– Long term offers protection – Reduced risk presumably => progesterone
• Tobacco Smoking– Some evidence that it reduces the rate– Smokers have lower levels of estrogen and lower rate of
obesity
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Prevention and Survival• Early detection is best prevention• Treating precancerous hyperplasia
– Hormones (progestin)– D&C– Hysterectomy– 10 ~ 30% untreated develop into cancer
• Average 5 year survival– Stage I => 72 ~ 90%– Stage II=> 56 ~ 60%– Stage III => 32 ~ 40%– Stage IV => 5 ~ 11%
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NATIONAL PROGRAMME FOR CONTROL AND PREVENTION CANCER, DIABETES,
CARDIOVASCULAR DISEASES AND STROKE
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IntroductionNPCDCS aims at integration of non communicable diseases
with NRHM.The following diseases have been incorporated :• Cancer• Diabetes• Cardiovascular Diseases• Stroke
These diseases are also called lifestyle associated diseases.39
History of programme
1975-76• National cancer control programme was launched
1984-85• Programme was revised.
2004• Programme further revised.
2010
• National cancer control programme was integrated with national programme for prevention and control of diabetes, cardiovascular diseases and stroke
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NPCDCS
Prevention through
behaviour change
Early diagnosis
Medical Treatment
Capacity building
Supervision, monitoring
& evaluation
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Objectives of NPCDCS1) Prevent and control common NCDs through behavior and life style changes,
2) Provide early diagnosis and management of common NCDs through opportunistic screening
3) Build capacity at various levels of health care for prevention, diagnosis and treatment of common NCDs
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4) Train human resource within the public health setup via doctors, paramedics and nursing staff to cope with the increasing burden of NCDs
5) Establish and develop capacity for palliative & rehabilitative care
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Prim
ary
Pre
vent
ion
•Modification of risk factor by providing health education and screening programs.•Educating about safe sexual practice , practicing genital hygiene. This is carried out by ASHA , AWW , SHG, YOUTH CLUB
Sec
onda
ry P
reve
ntio
n
• Early detection and diagnosis of common cancer by screening and self diagnosed method. Eg of screening programs
• Cervical cytology screening programs
• Mammographic screening programs
Terti
ary
Pre
vent
ion
• Strengthening of the existing institutions of comprehensive therapy including palliative care.
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Control of cancer under NPCDCS• Facilities at 100 Districts- Common diagnostic services, basic surgery, chemotherapy
and palliative care for cancer cases Support for Chemotherapy drugs Day care Chemotherapy facilities. Facility for laboratory investigations including Mammography Home based palliative care for chronic, debilitating and
progressive cancer patients. Support for contractual manpower and equipment for
management of cancer cases. Strengthening of 65 centre Tertiary Cancer Centres (TCCs)
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SCHEME UNDER REVISED PROGRAMME
• Regional cancer centre scheme• Oncology wing development scheme• Decentralize NGO scheme• IEC activities at central level• Research and training
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THANKYOU
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