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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