Causes and Prevention of Cancers
Learning Resources:
Park’s Textbook of Preventive and Social Medicine
Public Health and Community Medicine (Shah, Ilyas, Ansari, Irfan’s)
Learning Outcomes:
The students should be able to:
1. Identify epidemiological determinants of common cancers
2. Suggest preventive measures for cancers in at-risk individuals and populations
3. Impart health education to prevent cancers.
Neoplasia means abnormal new growth which may be benign or malignant
Cancer is a term used to describe a group of diseases characterized by:
* An abnormal growth of cells
* Ability to invade adjacent tissues and even distant organs
* Eventual death of the affected patient if the tumor has progressed beyond the stage when it can be removed
Categories of cancer:
1. Carcinomas: Which arise from epithelial cells lining the internal surfaces of the various organs (e.g.
mouth, intestine, and uterus) and from the skin epithelium.
2. Sarcomas: Which arise from mesodermal cells constituting the various connective tissues (e.g. fibrous
tissue & bone).
3. Lymphomas, myeloma and leukemia: Arising from the cells of bone marrow and immune systems.
Primary tumor: The term primary tumor is used to denote cancer in organ of origin.
Secondary tumor: The term denotes cancer that has spread to regional Lymph nodes and distant organ.
Benign: Benign tumors represent the accumulation of cells which have been transformed to reproduce
cells in abnormal numbers but they remain within the tissue of origin.
Malignant: Malignant tumors are composed of cells which are capable of invading adjacent tissues and
form metastasis.
Causes of Cancers
Genetic factors: For example, retinoblastoma occurs in children of the same parent. Mongols are more
likely to develop cancer (leukemia) than normal children.
Environmental factors: (Tobacco, Alcohol, Dietary factors, Occupational exposure, Viruses, Parasites,
Customs, habits and life-styles)
Tobacco is the major cause of cancers of the lung, larynx, mouth, pharynx, esophagus, bladder, pancreas and
probably kidney.
Alcohol: Excessive intake of alcoholic beverages is associated with esophageal and liver cancer.
Dietary factors: Smoked fish is related to stomach cancer, beef consumption to bowel cancer, high fat diet to
breast and colorectal cancers and dietary fiber has protective role in intestinal cancers.
Occupational exposure: These include exposure to benzene, arsenic, cadmium, chromium, vinyl chloride,
asbestos, polycyclic hydrocarbons, etc.
Viruses
Few examples are:-
H. Pylori in stomach cancer
Hepatitis B or C in Hepatocellular carcinoma
HIV infection in Non-Hodgkin's lymphoma
Epstein Barr virus in Burkitt’s lymphoma and nasopharyngeal carcinoma
Human papilloma virus in carcinoma cervix
Cytomegalovirus (CMV) in Kaposi's sarcoma
Parasites: Schistosomiasis is associated with carcinoma of bladder.
Customs, habits and life-styles: The familiar examples are association between smoking and lung cancer,
tobacco and betel chewing and oral cancer etc.
Others: There are numerous other environmental factors such as sunlight, radiation, air and water pollution,
medications (e.g., estrogen) and pesticides which are related to cancer.
Prevention
Primary Prevention: Previously it was concerned with the early diagnosis of the disease but now there
are few causative factors which can be controlled. These are:
a. Control of tobacco and alcohol consumption: Smoking cessation is an important area for continued
education, as control of tobacco smoking would reduce the total burden of cancer by over a million
cancers each year.
b. Personal hygiene: Improvements in personal hygiene may lead to decline in the incidence of certain
types of cancers for example cancer cervix.
c. Diet: Diet is an important area of intervention for primary cancer prevention. By avoiding high intake of
fats and specific fatty acids the risk of breast, colon, prostate and lung cancer can be reduced.
d. Radiation: Special efforts should be made to reduce the amount of radiation received by each individual
to a minimum without reducing the benefits.
e. Occupational exposure: Most important example is asbestos related mesothelioma, measures to protect
workers from exposure to industrial carcinogen should be enforced in industries.
f. Immunization: In case of primary liver cancer immunization against hepatitis B virus presents an
exciting prospect.
g. Treatment of precancerous lesions: Early detection & prompt treatment of precancerous lesions such
as cervical tears, intestinal polyposis, warts, chronic gastritis, chronic cervicitis & adenomas is one of
cornerstone of cancer prevention
h. Legislation: Legislation has also a role in primary prevention for example legislation to control known
environmental carcinogens (for example tobacco, alcohol, air pollution), can reduce cancers
i. Cancer Education: This is an important area. It should be directed at high risk. Cancer organizations in
many countries remind the public of early warning signs of cancer.
Early warning signs of cancer:
i. A lump or hard area in the breast
ii. A change in a wart or mole
iii. A persistent change in digestive & bowel habits
iv. A persistent cough or hoarseness
v. Excessive loss of blood during monthly periods or loss of blood outside the usual dates
vi. Blood loss from any natural orifice
vii. A swelling or sore that does not get better
viii. Unexplained weight loss
Secondary prevention
a. Cancer registration: (Hospital based registries, Population based registries)
b. Early detection of cases
c. Treatment
a. Cancer registration: Cancer registration provides a base for assessing the magnitude of the problem
and for planning the necessary services. Cancer registries are basically of two types.
1. Hospital based registries: It includes all patients treated by a particular institution, whether in patients
or out patients.
2. Population based registries: The aim is to cover the complete cancer situation in a given geographic
area.
b. Early detection of cases:
Cancer screening is the main weapon for early detection of cancer at a pre invasive stage or pre
malignant stage. Cancer screening may be defined as search for unrecognized malignancy by means of rapidly
applied tests. Cancer screening is possible because; Malignant disease is preceded by pre malignant lesion,
Most cancer begins as localize cancer, and 75% of all cancers occur in body sites that are accessible.
c. Treatment:
Treatment facilities should be available to all cancer patients, certain cancers are amenable to surgical
removal, while some respond to radiation or chemotherapy, or both. Multi modality approach to cancer control
has become a standard practice.
For those who are beyond the curable stage, the WHO has developed guidelines on relief of cancer pain.
“Freedom from cancer pain” is now considered a right for cancer patients.
