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Pre-Cancerous Lesions: Red Flags for future Cancers Gerardo H. Cornelio.MD, FPCP, FPSMO, FPSO.

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Presentation on theme: "Pre-Cancerous Lesions: Red Flags for future Cancers Gerardo H. Cornelio.MD, FPCP, FPSMO, FPSO."— Presentation transcript:

1 Pre-Cancerous Lesions: Red Flags for future Cancers Gerardo H. Cornelio.MD, FPCP, FPSMO, FPSO

2 Magnitude of Cancer Problem in the Philippines INCIDENCE 3rd in incidence after communicable & cardiovascular diseases 3rd in incidence after communicable & cardiovascular diseases 1 out of 1,000 Filipinos has cancer 1 out of 1,000 Filipinos has cancer 114:103 Females to Males, Filipino 114:103 Females to Males, Filipino Incidence rates increase w/ Age: Incidence rates increase w/ Age: yr.: 3.6% of cancers 2 >35 yr.: 91% of cancers 2 >=50 yr.: 76% of cancers

3 THE TEN LEADING CANCER SITES IN THE PHILIPPINES Philippine Cancer Facts and Estimates, 1998

4 ESTIMATED LEADING CAUSES OF CANCER DEATHS Philippine Cancer Facts and Estimates, 1998

5 TEN LEADING CANCER SITES IN MALES LUNG(1) LIVER(2) ORAL(10) RECTUM(9) LYMPHOMA (8) NASOPAHRYNX(7) STOMACH(6) COLON(5) LEUKEMIA(4) PROSTATE (3) Philippine Cancer Facts and Estimates, 1998

6 TEN LEADING CANCER SITES IN WOMEN BREAST(1) UTERUS(10)STOMACH(9) LIVER(8) COLON(7) LEUKEMIAS(6) OVARY(5) THYROID(4) LUNG(3) CERVIX(2) Philippine Cancer Facts and Estimates, 1998

7 What are the Top Ten Cancers in the Philippines?

8 CANCER MANAGEMENT Environment Genetics Clinical Manifestations Metastasis Anaplasia Proliferation DIAGNOSIS Biopsy Staging Preventive Curative Supportive

9 THE NINE WARNING SIGNS CAUTIONUSCAUTIONUS Change in bowel or bladder habits. A sore that does not heal. Unusual bleeding or discharge. Thickening of a lump in breast or elsewhere. Indigestion or difficulty in swallowing. Obvious change in a wart or mole. Nagging cough or hoarseness. Unexplained anemia. Sudden, unexplained weight loss.

10 What is Cancer?

11 CANCER CELLS AND NORMAL CELLS CANCER CELLSNORMAL CELLS Loss of contact inhibition Increase in growth factor secretion Increase in oncogene expression Loss of tumor suppressor genes Oncogene expression is rare Intermittent or co-ordinated growth factor secretion Presence of tumor suppressor genes NormalcellFewmitoses FrequentmitosesNucleus Blood vessel Abnormal heterogeneous cells

12 Cancer Genes Proto-oncogenes – normally promote normal cell growth; mutations convert them to oncogenes. Proto-oncogenes – normally promote normal cell growth; mutations convert them to oncogenes. Tumor suppressor genes – normally restrain cell growth; loss of function results in unregulated growth. Tumor suppressor genes – normally restrain cell growth; loss of function results in unregulated growth. DNA repair genes – when faulty, result in an accumulated rate of mutations. DNA repair genes – when faulty, result in an accumulated rate of mutations.

13 ONCOGENES

14 Multistage Carcinogenesis

15 CARCINOGENS Occupation related causes Occupation related causes Lifestyle related causes Lifestyle related causes Tobacco Tobacco Diet Diet Sexual practices Sexual practices Multifactorial causes Multifactorial causes Viral carcinogens Viral carcinogens Chemical carcinogens Chemical carcinogens Ionizing radiation Ionizing radiation

16 Occupational Risk Factors EtiologyArsenicAsbestosBenzeneBenzedine Chromium cpds Radiation (mining) Mustard gas Polycyclic hydrocarbons Vinyl Chloride Site of Malignancy Lung, skin, liver Mesothelium, lung Leukemia Bladder Lung Numerous locations Lung Lung, skin Angiosarcoma of liver

17 Lifestyle Risk Factors Tobacco-related: Lung cancer Lung cancer Pancreatic cancer Pancreatic cancer Bladder cancer Bladder cancer Renal cancer Renal cancer Cervical cancer Cervical cancer

18 Diet-Related Risk Factors NitratesSalt Low vitamins A, C, E Low consumption of yellow-green vegetables Gastric Cancer Esophageal Cancer

19 Diet-Related Risk Factors High fat Low fiber Low calcium High boiled or fried foods Colon Cancer Pancreatic Cancer Prostate Cancer Breast Cancer Uterine Cancer Mycotoxins Liver Cancer

20 Sexual Practices Risk Factors Cervical Cancer Sexual promiscuity Multiple partners Unsafe Sex Human Papillomavirus

21 Multifactorial Factors Tobacco + Alcohol Oral Cavity Cancer Esophageal Cancer Tobacco + Asbestos Tobacco + mining Tobacco + uranium + radium Respiratory Tract Cancer Lung Cancer

22 Chemical Carcinogenesis Chemical Carcinogen Promoter(s) Initiator(s) (electrophilic, mutagenic) Normal Cells Inactive Metabolites Initiated Cells Tumor Cells Clones Gross Tumors

23 Radiation Carcinogenesis Radiation-induced mutation in the host cell Radiation-induced mutation in the host cell Transmits irreversible changes in gene expression to cell progeny Transmits irreversible changes in gene expression to cell progeny

24 Sources of Potentially Carcinogenic Radiation Sunlight Sunlight Artificial sources of UV light Artificial sources of UV light X-rays X-rays Radio-chemicals Radio-chemicals Nuclear fission Nuclear fission

25 Viral Carcinogenesis Viral carcinogens are classified into RNA and DNA viruses. Viral carcinogens are classified into RNA and DNA viruses. Most RNA oncogenic viruses belong to the family of retroviruses that contain reverse transcriptase mediates transfer of viral RNA into virus specific DNA. Most RNA oncogenic viruses belong to the family of retroviruses that contain reverse transcriptase mediates transfer of viral RNA into virus specific DNA.

26 Sequence of Disease Progression Leukoplakia / Erythroplakia Dysplasia Carcinoma in situ Invasive Carcinoma Regional / Distant Metastasis

27

28 Lung Cancer Profile Smoke: 25 or more 15 – – or lower 14 or lower or more cigars the past year 1 or more cigars the past year or more vegetables a day 3 or more vegetables a day Parent, brother or sister w lung cancer Parent, brother or sister w lung cancer Lived with a smoker Lived with a smoker Live near a large city for 10 years Live near a large city for 10 years Asbestos worker without protection 5-20 yrs/ >20 Asbestos worker without protection 5-20 yrs/ > / /50 Radon, Cadmium, aluminum, silica, sulfur 5-20 /> / / 25 Eats 3 or more servings of fruits per day

29 Risk Chart Score Your risk is: Less than 0 Very much below average Much below average Below average Average Above average Much above average 54 or higher Very much above average

30 Lung Cancer Bronchial intraepithelial lesions Bronchial intraepithelial lesions Squamous metaplasia or dysplasia in former smokers Squamous metaplasia or dysplasia in former smokers Loss of retinoic acid receptor-B expression Loss of retinoic acid receptor-B expression

31 BREAST CANCER Signs and symptoms at presentation Mass or pain in the axilla Mass or pain in the axilla Palpable mass Palpable mass Thickening Thickening Pain Pain Nipple discharge Nipple discharge Nipple retraction Nipple retraction Edema or erythema of the skin Edema or erythema of the skin

32 Non Invasive Breast Cancer Lobular Carcinoma in situ (LCIS) Lobular Carcinoma in situ (LCIS) Premalignant Premalignant 20% develop IBC over 15 years 20% develop IBC over 15 years 30% bilateral 30% bilateral Annual mammography / Tamoxifen risk reduction (56%) – NSABP P1 Annual mammography / Tamoxifen risk reduction (56%) – NSABP P1 Ductal Carcinoma in situ (DCIS) Ductal Carcinoma in situ (DCIS) Malignant Malignant Recurs in 35% in yrs if biopsy alone Recurs in 35% in yrs if biopsy alone >25% develop IBC >25% develop IBC

33 BREAST CANCER Mammography

34 BREAST CANCER Signs and symptoms at presentation Mass or pain in the axilla Mass or pain in the axilla Palpable mass Palpable mass Thickening Thickening Pain Pain Nipple discharge Nipple discharge Nipple retraction Nipple retraction Edema or erythema of the skin Edema or erythema of the skin

35 BREAST CANCER Signs and symptoms at presentation Mass or pain in the axilla Mass or pain in the axilla Palpable mass Palpable mass Thickening Thickening Pain Pain Nipple discharge Nipple discharge Nipple retraction Nipple retraction Edema or erythema of the skin Edema or erythema of the skin

36 Colorectal Cancer Philippines Philippines 3 rd leading cancer site 3 rd leading cancer site 3 rd in males 3 rd in males 4 th in females 4 th in females 4rth leading cause of death 4rth leading cause of death

37

38 RECTAL CANCER Sigmoidoscopy All rights reserved. Dr Ligoury, CNRI.

39 COLON CANCER Flexible sigmoidoscopy Dr Larpent, Clermont-Ferrand; CNRI. All rights reserved.

40 Precancerous Lesions G-E JunctionKidney G-E JunctionKidney  GERD / Acid refluxIntratubular epithelial dysplasia  H. Pylori infection

41 Genital Warts Human Papilloma Virus Human Papilloma Virus Main risk factor for cervical cancer Main risk factor for cervical cancer Treatment: Treatment: Vaccine Vaccine Early detection Early detection

42 Skin Actinic keratosis Actinic keratosis Atypical or dysplastic nevi Atypical or dysplastic nevi Premalignant Lentigo Premalignant Lentigo Causes: Causes: UV radiation UV radiation Genetics Genetics Exposure to carcinogens like Arsenic, Tar, X-ray Exposure to carcinogens like Arsenic, Tar, X-ray

43 THANK YOU!


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