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Pre-Cancerous Lesions: Red Flags for future Cancers

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Presentation on theme: "Pre-Cancerous Lesions: Red Flags for future Cancers"— 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 1 out of 1,000 Filipinos has cancer 114:103 Females to Males, Filipino Incidence rates increase w/ Age: 0-14 yr.: 3.6% of cancers >35 yr.: 91% of cancers >=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 Clinical Manifestations
Environment Genetics CANCER Metastasis Anaplasia Proliferation Clinical Manifestations Biopsy DIAGNOSIS Preventive Curative Supportive Staging MANAGEMENT

9 THE NINE WARNING SIGNS C Change in bowel or bladder habits. A U
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 CELLS NORMAL CELLS Frequent mitoses Nucleus Blood vessel Abnormal heterogeneous cells Normal cell Few mitoses 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

12 Cancer Genes 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. DNA repair genes – when faulty, result in an accumulated rate of mutations.

13 ONCOGENES

14 Multistage Carcinogenesis

15 CARCINOGENS Occupation related causes Lifestyle related causes
Tobacco Diet Sexual practices Multifactorial causes Viral carcinogens Chemical carcinogens Ionizing radiation This slide lists the different carcinogenic agents identified. By far, chemical carcinogens are the most common. More significant though are lifestyle carcinogens such as the following: Cigarette smoking Diet – high fat, high sodium, low fiber diets have predisposed populations to increase rates of gastrointestinal cancers. Sexual practices – multiple sexual partners can result in the spread of the human papilloma virus (causes cervical cancer), the Hepatitis B virus (causes liver cancer), and the HIV virus (causes AIDS related malignancies) Knowledge of these carcinogens are important because cancer may be prevented if these are avoided. Also, lifestyle related cancers are important to consider because of the role of behavior modification in their avoidance.

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

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

18 Diet-Related Risk Factors
Nitrates Salt 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
Sexual promiscuity Multiple partners Unsafe Sex Human Papillomavirus Cervical Cancer

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

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

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

25 Viral Carcinogenesis 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.

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 – 24 14 or lower + 50 + 25
+ 10 1 or more cigars the past year + 5 3 or more vegetables a day - 5 Parent, brother or sister w lung cancer Lived with a smoker Live near a large city for 10 years Asbestos worker without protection yrs/ >20 +25 /50 Radon, Cadmium, aluminum, silica, sulfur />20 +10 / 25 Eats 3 or more servings of fruits per day

29 Risk Chart Score Your risk is: Less than 0 Very much below average
0 - 6 Much below average 7 - 10 Below average Average Above average Much above average 54 or higher Very much above average

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

31 BREAST CANCER Signs and symptoms at presentation
Mass or pain in the axilla Palpable mass Thickening Pain Nipple discharge Nipple retraction Edema or erythema of the skin 16. Breast Cancer: Signs and Symptoms at Presentation Although the use of mammography is increasing, more than 80% of all breast cancers are still diagnosed as a result of symptoms, most often a painless mass. However, as many as 10% of patients present with breast pain and no mass. Less common symptoms include nipple discharge, nipple erosion or ulceration, diffuse erythema of the breast, axillary adenopathy, and symptoms associated with distant metastases.

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

33 BREAST CANCER Mammography
This mammogram shows a confirmed breast carcinoma. This lesion is a 2 cm dense nodule with spiky borders and microcalcification.

34 BREAST CANCER Signs and symptoms at presentation
Mass or pain in the axilla Palpable mass Thickening Pain Nipple discharge Nipple retraction Edema or erythema of the skin 16. Breast Cancer: Signs and Symptoms at Presentation Although the use of mammography is increasing, more than 80% of all breast cancers are still diagnosed as a result of symptoms, most often a painless mass. However, as many as 10% of patients present with breast pain and no mass. Less common symptoms include nipple discharge, nipple erosion or ulceration, diffuse erythema of the breast, axillary adenopathy, and symptoms associated with distant metastases.

35 BREAST CANCER Signs and symptoms at presentation
Mass or pain in the axilla Palpable mass Thickening Pain Nipple discharge Nipple retraction Edema or erythema of the skin 16. Breast Cancer: Signs and Symptoms at Presentation Although the use of mammography is increasing, more than 80% of all breast cancers are still diagnosed as a result of symptoms, most often a painless mass. However, as many as 10% of patients present with breast pain and no mass. Less common symptoms include nipple discharge, nipple erosion or ulceration, diffuse erythema of the breast, axillary adenopathy, and symptoms associated with distant metastases.

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

37

38 RECTAL CANCER Sigmoidoscopy
Sigmoidoscopy, in conjunction with barium enema examination or colonoscopy, is appropriate for the evaluation of patients who present with complaints of rectal bleeding and/or changes in bowel activity. All rights reserved. Dr Ligoury, CNRI.

39 COLON CANCER Flexible sigmoidoscopy
Flexible sigmoidoscopy can detect one third of CRC (mainly at distal locations). The increased use of flexible sigmoidoscopy and colonoscopy in average-risk individuals older than 50 years is likely to reduce considerably the risk of late-stage CRC. All rights reserved. Dr Larpent, Clermont-Ferrand; CNRI.

40 Precancerous Lesions G-E Junction Kidney
GERD / Acid reflux Intratubular epithelial dysplasia H. Pylori infection

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

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

43 THANK YOU!


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