Cancer Causes Preventions Treatments Presentation By Dr. Bhavani Nair. MBBS;DGO;FRCP(C) Retired Radiation Oncologist University of Ottawa

Cancer Causes Preventions Treatments Presentation By Dr. Bhavani Nair. MBBS;DGO;FRCP(C) Retired Radiation Oncologist University of Ottawa

In Ontario, someone is diagnosed with cancer every eight minutes Cancer continues to be the number one cause of premature death in Ontario As Ontario s population ages and grows, the number of people diagnosed with cancer will increase. An estimated 45% of males & 40% of females in Ontario are likely to develop cancer in their lifetimes.

More than 200 different types of cancer. Four most common types Lung Prostate Breast Colorectal Account for 54% of all cancers in Ontario.

What is cancer? Cell mutations affecting normal cell growth and division Tumor : An abnormal mass of tissue formed by a new growth of cells. - Benign - Malignant

Smoking. Lung,Oral,Oesophageal,Colon,Breast, etc. Infections. Human papilloma virus infection-cervix,mouth,penis,anus Hepatitis B&C - Liver Epstein Barr virus - Burkitt s lymphoma Helicobactor Pylori - Stomach Cancer Radiation exposure Thyroid,Breast,Lung

Alcohol intake Mouth,Throat,Oesophagus,breast,Colorectal,Liver. Immune suppression Organ transplant patients have increased incidence. Taking hormones HRT-oestrogens alone - Uterine Cancer Combined hormones(oc) Breast Cancer. Environmental. Second hand smoke, chemicals in certain dyes, asbestos, sun exposure, etc.

Obesity Increased risk for Breast Cancer, Colon cancer, Uterine cancer etc. Family history (in some cancers) Breast,Colon, Ovary, Prostate

PROVEN METHODS Reduction in smoking - reduced rates of lung cancer dramatically. Increased screening - reduced colon cancer in men and women; Cervical cancer in women deaths from breast cancer. Changes in lifestyle People who are active have reduced risk of some malignancies.( reduced incidence of colorectal cancer for both men and women )

PROVEN METHODS Protect from excessive sun and X-ray exposure. Treat or prevent infections like Hepatitis B&C vaccines for high risk. To prevent cervical cancers Limiting number of sexual partners Using condoms regularly and properly Vaccinating against HPV Those who took Aspirin for more than 4 yrs had reduced death rates not reduced incidence of cancer.

SCIENTIFICALLY UNPROVEN METHODS Dietetic modifications- Low fat, High fibre, and Vitamins Studies still underway

Biopsy Removal of a small portion or whole of the tumor or bone marrow examined under microscope makes the DIAGNOSIS

History & Physical examination Fever,anaemia in some cancers indicate advanced stage Blood tests Blood counts and liver function tests Xrays,CT scans,mri,nuclear scans etc Bone marrow biopsy Find distant spread Can help assess involvement in Lymphomas, Leukaemias,etc

Examination under anaesthesia Cancer of Cervix, uterus etc Intra operative staging Cancer of Ovary Pathological (post operative) depth or extent of invasion and grade- Colon Cancer

SURGERY First and important in most could be Curative or palliative Radiation Therapy done alone added to surgery or chemotherapy(adjuvant) for cure or palliation Chemotherapy Single drug or multidrug in addition to Surgery or Radiation therapy alone for cure or Palliation.

Complete removal of the cancerous growth plus an acceptable amount of normal tissue Depending on organ involved Cancer alone Part of the organ or Whole organ removal Submit for pathological examination Surgeonexperienced in cancer surgery Pathologist experienced in Cancer pathology

Radiation therapy Preoperative Intra operative Post operative Radiation therapy alone after biopsy for cure or palliation Along with chemotherapy for cure or palliation before, during, or after

Radiation therapy - high-energy radiation used to kill cancer cells by damaging their DNA. It can damage normal cells as well as cancer cells(treatment planning done carefully to minimize side effects.) May be from machine outside the body, from radioactive material placed in the body near tumor cells(brachytherapy) or injected into the bloodstream or taken orally

Radiation therapy planning

Drugs inhibiting or killing cancer cells at a sensitive stage of cell cycle. It also hurts normal cells like bone marrow cells,intestinal and mouth mucosal cells. But given time -normal cells recover by repair and cancer cells don t due to defective repair capacity

Use of medication to treat any ailment (Penicillin.Aspirin) Term used more for Cancer treatment Can be given By mouth Intra-venous Intra-arterial Intra-thecal Intra-peritoneal Intra-vesical Intra-lesional

Types drugs in use Alkylating agents (Cyclophosphamide,thiotepa etc) Antimetabolites(5FU,Methotrexate.etc) Antitumour antibiotics(adriamycin,epirubicin,irinotican.et Mitotic Inhibitors(Taxol,Vinca alkaloids like Vincristine. etc) Corticosteroids(Prednisone,Decadron.etc)

Hormone therapy Antioestrogens-Tamoxifen,Faslodex,Torimefine Aromatase inhibitors-arimidex,femara Oestrogens Antiandrogens-Casodex,Eulestin Gonadotropin releasing Hormone- Lupron,Zoladex

IMMUNOTHERAPY-(BIOLOGIC THERAPY) Still new form of treatment Given by stimulating one s own immune system or by giving man made immune system proteins Monoclonal antibody- Rituximab,Campath,Conjugated mab Herceptin,radiolabelled mab.etc Non specific immunotherapy-interlukin-2,bcg, Cancer vaccines investigative for treatment

New in treatment Gleevec(Imatinib) for Chronic Myelogenous Leukaemia more commonly used. Most in study stages

Symptom Management & Palliative Care

Cancer Care Ontario Canadian cancer society NCI Canada NCI USA UICC