CANCER:
Prevention and Early Detection
From the National Cancer Institute
Presented By:
Kelly S. Salvador, MD.
Medical Oncologist
Philippine Cancer Society
Understanding Cancer
Cancer
CELLS
TISSUES
ORGANS
Normally, cells grow and divide
new cells
cells grow old, they die and new cells
New cells form when the body does not need them,
and old cells do not die when they should. These extra
cells can form a mass of tissue called growth or
TUMOR.
Understanding Cancer
Tumors may be BENIGN or MALIGNANT
Benign tumors are not cancer
Rarely life-threatening
After removing it, they usually do not grow back.
They do not invade the tissues around them.
They do not spread to other parts of the body.
Understanding Cancer
Malignant tumors are cancer.
May be life-threatening.
If tumor is small, may be removed, but sometimes they
grow back.
They may invade and damage nearby tissues or organs.
They can spread (metastasize) to other parts of the body.
Understanding Cancer
Risk Factors
Doctors often cannot explain why one person develops cancer and
another does not. But research shows that certain RISK FACTORS
increase the chance that a person will develop cancer. These are
the most common risk factors for cancer:
Growing Older - higher risk for people over 65
Tobacco
Sunlight
Ionizing radiation
Certain chemicals and other substances
Some viruses and bacteria
Family history of cancer – could not be avoided
Alcohol
Poor diet, lack of physical activity, or being overweight
Risk Factors
Cancer Facts - 2005
106,844 – New Cases
72,846 – Deaths
Cancers are curable if detected EARLY and
treated PROPERLY.
Reference: Philippine Cancer Facts and Estimate 2005
Estimated Ten Leading Cancer
(in Both Sexes)
Philippines, 2005
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
LUNG
BREAST
COLON / RECTUM
LIVER
CERVIX UTERI
PROSTATE
LEUKEMIA
STOMACH
THYROID
OVARY
17238
14043
8585
7629
7277
4254
4202
3932
3521
3283
Estimated Ten Leading Cancer
(in MALE)
Philippines, 2005
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
LUNG
LIVER
COLON/RECTUM
PROSTATE
STOMACH
LEUKEMIA
NASOPHARYNX
ORAL CAVITY
NON-HODGKIN LYMPHOMA
LARYNX
13273
5660
4737
4254
2368
2243
1990
1563
1468
1464
Estimated Ten Leading Cancer
(in FEMALES)
Philippines, 2005
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
BREAST
CERVIX ; UTERI
LUNG
COLON/RECTUM
OVARY
THYROID
LIVER
LEUKEMIA
CORPUS UTERI
STOMACH
14043
7277
3965
3848
3283
2766
1969
1959
1777
1564
SOME VIRUSES AND BACTERIA
 Human Papillomaviruses (HPVs) -- may cause Cervical Cancer
 Hepatitis B and Hepatitis C – may cause Liver Cancer
 Human T-Cell Leukemia/Lymphoma virus – increase risk for
Lymphoma and Leukemia
 Human Immunodeficiency virus -- HIV is the virus that causes
AIDS and in turn, AIDS patients may be at risk to get Lymphoma
and Kaposi’s Sarcoma.
 Epstein-Barr virus (EBV) -- at risk to get Lymphoma and
Nasopharyngeal Carcinoma
 Human Herpesvirus 8 (HHV8) – risk factor for Kaposi’s Sarcoma
 Helicobacter pylori – may cause stomach ulcers, stomach cancer and
lymphoma in the stomach lining.
SCREENING
 Breast : A Mammogram is the best tool doctors have to
find breast cancer early. NCI recommends that women
above age of 40 should have mammograms every 1 to 2
years. Those at high risk should speak to their doctors
if they should have a mammogram before the age of 40
and how often they should be doing it.
 Cervix: The Pap Test or Pap Smear is used to check
cells from the cervix. Women should begin having Pap
tests 3 years after they begin having sexual intercourse
or when they reach age 21, whichever comes first. Most
women should have a Pap test at least once every 3
years.
 Colon and Rectum:
Fecal Occult Blood Test: Sometimes cancer or polyps bleed.
Sigmoidoscopy: This lighted tube may see inside the rectum and
lower part of the colon and may remove polyps.
Colonoscopy: This lighted tube may see inside the rectum and
entire colon and may also remove polyps.
Double-contrast barium enema: This procedure involves several
x-rays of the colon and rectum. The patient is given an enema
with a barium solution and air is pumped into the rectum. The
barium and air improve the x-ray images of the colon and rectum.
Digital Rectal exam: This is often part of a routine physical exam.
The doctor inserts a lubricated, gloved finger into the rectum to
feel for abnormal areas. A digital rectal exam allows for
examination of only the lowest part of the rectum.
Prevention of Lung Cancer
 There is no screening
procedure that can effectively
prevent Lung Cancer.
 To prevent Lung Cancer, one
must STOP SMOKING.
Prevention of Liver Cancer
 Hepa-B Vaccination
 Regular check-up on
Hepa-B virus
 Regulate intake of
alcohol
Early Detection for Cervical Cancer
 Pap smear can detect early Cervix cancer and precancerous lesions.
 Pap Smear should be done 3 years after the first
vaginal intercourse.
 After the initial Pap Smear, it should be done
every year for 3 years, if the result from
consecutive test is negative, if not, it should be
done yearly.
 Women without sexual experience should have
Pap Smear after reaching the age of 35.
Prevention of Cervical Cancer
 Delay on the first sexual intercourse
 One partner relationship between
partners
 Use of barrier contraceptives like
condoms during sexual intercourse
WARNING SYMPTOMS
OF CANCER
 A thickening or lump in the breast
or any other part of the body
 A new mole or a change in an existing mole
 A sore that does not heal
 Hoarseness or a cough that does not go away
 Change in bowel or bladder habits
 Discomfort after eating
 A hard time swallowing
 Weight gain or loss with no known reason
 Unusual bleeding or discharge
 Feeling weak or very tired
DIAGNOSIS
 Lab Tests
Tests of the blood, urine or other fluids can help
doctors make a diagnosis.
 Imaging Procedures
X-rays
Ultrasound
CT Scan
Radionuclide Scan
MRI
PET Scan
BIOPSY
The doctor removes a sample of tissue and
sends it to a lab.
A pathologist looks at the tissue under a
microscope. The sample may be removed in
several ways:
 With a needle
 With an endoscope
TREATMENT
1.
Team Involved




2.
Surgical Oncologist
Medical Oncologist
Radiation Oncologist
Hematologic Oncologist
Methods
Primary Goal: is to cure the cancer
Other cases: to control the disease or to remove symptoms as
long as possible

Surgery – neoadjuvant, adjuvant, palliative

Chemotherapy – neoadjuvant, adjuvant, palliative

Radiation – external beam or internal like implant

Hormonal therapy

Stem cell transplantation
NUTRITION & PHYSICAL
ACTIVITIES
Recommendations for Individual Choices:
 Maintain a healthy weight throughout life.
 Balance caloric intake with
physical activity.
 Avoid excessive weight gain
throughout life.
 Achieve and maintain
a healthy weight if currently
overweight or obese.
 Adopt a physically active lifestyle.
Adults: Engage in at least 30mins. of moderate to
vigorous physical activity, above usual activities,
on 5 or more days of the week; 45 to 60 mins. of
intentional physical activity are preferable.
Children and Adolescents: Engage in at least 60
mins. per day of moderate to vigorous
physical
activity at least 5 days per week.
 Eat a healthy diet, with an emphasis on plant
sources.
Choose food or beverages in amounts that help achieve and
maintain a healthy weight.
Eat 5 or more servings of a variety of vegetables and fruits
everyday.
Choose whole grains in preference to processed (refined) grains.
Limit consumption of processed and red meats
If you drink alcoholic beverages, limit consumption.
Drink no more than 1 drink per day for women, and 2 per day for
men.
COMMON QUESTIONS
ABOUT DIET AND CANCER
INCREASE RISK
1. Alcohol – limit to 1 drink per day for
women and 2 drinks per day for men.
A drink is defined as
12 ounces of beer or
5 ounces of wine or
1.5 ounces of 80-proof distilled spirits
Increase risk of the mouth, pharynx, larynx,
esophagus, liver and breast. More risk if combine
drinking and tobacco.
2. Aspartame – does not show increased risk
3. Bioengineered Foods – are made by adding genes from
other plants or organicms to increase a plant’s
resistance to pest or other spoilages, are not found to
increase nor decrease cancer risk.
4. Little evidence that the total amount of fat consumed
affects cancer risk. But diets high in fat tend to be high
in calories and may contribute to obesity, which in turn
is linked with an increased risk of several types of
cancer.
5. Flourides – not found to increase cancer risk
6. Food Additives – No evidence to increase cancer risk.
7. Irradiated food – do not increase cancer risk
8. Processed meat or Meat preserved by methods involving smoke or
salt increase colorectal and stomach cancer.
9. Frying, broiling, grilling meat may increase cancer risk.
10. Obesity – increase risk in breast, colon, endometrial, esophagus
and kidney cancer.
11. Pesticides & Herbicides – no increased risk for cancer if used in
small amounts enough to protect vegetables from pests.
12. Saccharin – not carcinogenic
13. Soy Supplement – no evidence to reduce
cancer risk, high doses of soy increase risk of
breast and endometrial cancer
14. Supplement – high dose may actually increase
cancer risk
Decreased Risk
1.
Antioxidants which include Vitamins C and E,
carotenoids and other phytochemicals (from food
sources) and not from food supplements.
2.
Beta-carotene, an anti-oxidant chemically realted to
Vitamin A found in vegetables and fruits may be
helpful, but in high doses of this supplement given to
smokers may actually cause increase risk of lung
cancer.
3.
Calcium may reduce risk for colorectal cancer but
there is evidence that the high calcium intake
through supplements may increase risk of prostate
cancer.
4. No evidence that low fasting blood cholesterol may
decrease cancer risk.
5. Drinking coffee does not increase risk of breast cancer
but may heighten symptoms of fibrocystic breast
lumps.
6. Eating high amounts of fiber may help reduce cancer
risks.
7. Little evidence that omega 3 fatty acid, olive, canola oil
reduce cancer risk.
8. Fish not found to decrease cancer risk.
9. Folate, which is Vitamin B found in vegetables, fruits
and enriched grain products decrease cancers of the
colon, rectum and breast.
10. Garlic – no evidence that it can reduce cancer risk.
11. Lycopene – not sure if it is the substance that reduce
cancer risk.
12. Organic food – no evidence that it reduces cancer risk.
13. Physical activity – lowers the risk to develop cancer of
the colon and breast
14. Selenium – decreases risk of cancer of the lung, colon
and prostate.
15. Tea – not proven to decrease cancer risk.
16. Cruciferous vegetables – cabbage family including
brocolli, cauliflower, brussels sprout and kale reduce
the risk for colorectal cancer.
17. Vitamin D – reduce risk for cancers of the colon,
prostate and breast.
18. Vitamin E – lowers risk for prostate cancer.
TUMOUR GRADING AND
STAGING
 Tumour grading is usually of importance in assessing
prognosis. It refers to the degree of malignancy or
differentiation of tumour tissue based on histological
evaluation, and is often expressed in 4 categories:
 Grade 1(G1) --- Well differentiated (about a quarter of
cells undifferentiated)
 Grade 2(G2)--- Moderately undifferentiated (about half
of cells undifferentiated)
 Grade 3(G3)--- Markedly undifferentiated (about three
quarters of cells undifferentiated)
 Grade 4(G4)--- Undifferentiated (almost all cells
undifferentiated)
 Tumour staging is determined by a
comprehensive evaluation using diagnostic
tools for categorising the growth and spread of
tumours. It involves classifying the extent of the
malignant tumour.
 One classification is known as the TNM
system. T stands for primary tumour, N is
regional nodes whereas M represents
metastasis.
TNM






Tis---Pre-invasive carcinoma (carcinoma in situ
T0---No evidence of a primary tumour
T1---Small tumour, restricted to organ of origin
T2---Large but restricted to organ of origin
T3---Some invasion of adjacent tissue
T4---Massive invasion of adjacent tissue and/or
organs
 TX---Unable to assess primary tumour
 N0---No regional lymph node involvement
 N1, N2, N3---Increasing involvement of
regional lymph nodes
 N4---Involvement of juxta-regional lymph
nodes
 NX---Unable to assess regional and/or juxtaregional lymph nodes
 M0---No distant metastases
 M1---Distant metastases present
 MX---Unable to assess distant metastases
 Sometimes, the tumour staging has an additional letter
“p” before TNM. This indicates post-surgical
histopathological staging.
 C FACTORS
 The letter C placed before TNM provides information on
which type of diagnostic instrument was used to
diagnose the tumour and the extent of its growth.
 C1Using an X-Ray examinationC2Using special
equipment, for e.g. endoscopyC3Using exploratory
surgery C4 using histopathological results C5 using
autopsy results
ALTERNATIVE STAGING
 Stage I---Tumour is localised
 Stage II---There is presence of adjacent
tissue invasion
 Stage III---Some regional lymph nodes
involved
 Stage IV---Distant metastases present
Some specific tumour stagings
consist of:
(a)Hodgkin’s and/or Non-Hodgkin’s diseaseAnn Arbor
(b) Malignant melanomasClark and Breslow systems
(c)Cervical cancerCIN
(d)Colorectal cancersDukes
(e) Gynaecological tumours FIGO (Federation
Internationale de Gynecologie et d’Obstetrique)
 (f)Prostate carcinomaFlocks/VACURG
 (g)Urinary bladderMarshall
 (h)Chronic lymphatic leukaemia RAI





TUMOUR MARKERS
 Tumour markers are substances found in the blood, urine or body
tissues created by the tumour itself or as a result of the body’s
reaction to the tumour. However, it should be remembered that
tumour markers are not to be used alone as a diagnostic tool because
they can also be elevated in people without tumours. Not all affected
cancer patients have raised tumour markers. In the early stages, the
levels could be normal.
 They are more useful in monitoring the progress of cancer once
diagnosed.
 Among the tumour markers:
(a) Alpha-foetoprotein (AFP) for ovarian, liver, testis cancer
(b)Carcinoembryonic antigen (CEA) for breast, colon, lung cancer
(c)Human chorionic gonadotropin (HCG) for uterine choriocarcinoma,
ovarian cancer, testicular cancer(d)Prostate Specific Antigen (PSA)
for prostate cancer
HOW INSURABLE ARE THE
FOLLOWING CANCERS?
 There are four main types of thyroid cancer:
1.
Papillary carcinoma
2.
Follicular carcinoma
3.
Medullary thyroid carcinoma
4.
Anaplastic carcinoma
 Carcinoid tumors :
 Gastro-intestinal
 Lung
End of Presentation
Q & A:
Discussion
Thank You Very Much!!!