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CANCERS[PROSTATE, LIVER & COLON]:
PREVENTION AND CONTROL IN
PRIMARY HEALTHCARE PRACTICE
Dr. Abraham Idokoko
Department of Community Health,
Lagos University Teaching Hospital, Idiaraba
Wednesday, 24th August, 2016.
Cancer is one of the most critical health issue
confronting 21st century populations.
*In 2012 about 14.1 million new cases of cancer
occurred globally and It caused about 8.2 million
deaths or 14.6% of human deaths.
*Rates are increasing as more people live to an
old age and as lifestyle changes occur in the
developing world.
*The financial costs of cancer were estimated at
$1.16 trillion US dollars per year as of 2010.[?
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 2
Learning Objectives:
• Help participants recall general knowledge of
NCDs/cancers from prior lectures.
• Enumerate the epidemiology of prostate
cancer relevant to CHO’s.
• Discuss the liver cancer control interventions
of primary healthcare importance.
• Describe to participants the best practices for
colon cancer control in primary healthcare
practice.
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com
3
First,
Let’s recall our
knowledge of
NCDs ?
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com
4
Non Communicable Diseases
• An impairment of bodily structure and
function that necessitates a modification of
the patient’s normal life, and has persisted
over an extended period of time.
Xteristics
• Permanent
• Leave residual disability
• Caused by non reversible pathological alteration
• Requires rehabilitation
• Require a long period of care
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
5
The Burden of NCD
Assuming increasing importance in both developed and
developing nations because of:
• Increase in life expectancy
• life styles and behaviour are changing
• Modern care enables many to survive
• impact is serious in terms of DALYs, family hardship, poverty
and economic loss
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
6
Gaps In Natural History
• Absence of a Known agent
• Multifactorial causation
• Long latent period
• Indefinite onset
The Concept of Risk and
Risk factors:
• Cigarette use and other forms of
smoking
• Alcohol abuse
• Failure to obtain preventive
health services
• Life style changes
• Environmental/occupational risks
• Genetic
• Stress
The prime value of Prevention in
NCDs:
• Primary Prevention including
primordial
• Secondary Prevention
• Tertiary Prevention
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
7
Now..!!
Respond
to this quiz!
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com
8
True or False?
Smoking causes lung cancer
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
9
True or False?
Large percentage of cancers are
preventable
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
10
True or False?
In the past 20 years tremendous
improvements in the treatment
of all cancers have been
achieved
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
11
True or False?
Preventing cancer is easier than
treating cancer
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
12
True or False?
Screening tests are available for
most cancers
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
13
So??
Let’s do a
quick overview:
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com
14
Overview of Cancers
• A group of diseases characterized by abnormal growth of
cells, ability to invade adjacent tissues/organs, and eventual
death of cells
Burden
• Accounts for about 12% of deaths
• 2nd leading cause of deaths in the developed world
• Incidence rising due to increase in life expectancy and
changes in life style and environmental factors.
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
15
Biology & Classification
• Though many diseases, the disease process is the same
• The underlying pathology being the rapid and continuous
production of abnormal cells that invade and destroy other
tissues
• May arise from any type of cell in the body.
Several classifications exist but, according to the tissues and type of cells, there are 3
main types cancers:
• Sarcomas – connective and supportive tissue e.g. bone, cartilage, nerve, muscle,
fat, blood vessels
• Carcinomas – epithelial tissue such as skin and the lining of cavities and organs,
and glandular tissue such as the breast or prostate
• Leukemias and lymphomas – cancers of the of blood forming tissues and immune
system
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
16
Distribution
• Wide variations in the distribution
worldwide
• Environmental factors, food habits,
lifestyle, genetic factors, etc are
responsible
Common Risk Factors/Causes:
• Environmental factors
– Tobacco
– Alcohol
– Dietary
– Occupational exposures
– Viruses
– Parasites
– Customs
• Genetics
Control:
• Primary
– Tobacco and alcohol
– Personal hygiene
– Cancer education
• Secondary
– Cancer registration
– Cancer screening
– Cancer treatment
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
17
Cancer prevention is action
taken to lower the risk of
getting cancer. This can
include be:
• Maintaining a healthy
lifestyle,
• Avoiding exposure to
known cancer-causing
substances, and
• Taking medicines or
vaccines that can prevent
cancer from developing.
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 18
Epidemiology
of Prostate
Cancer..
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 19
Male
Reproductive
System.
The organs of the male reproductive system
enable a man to have sexual intercourse and
to fertilize female sex cells (eggs) with sperm.
The gonads, called testicles, produce sperm.
Sperm pass through a long duct called the vas
deferens to the seminal vesicles, a pair of sacs
that lies behind the bladder. These sacs
produce seminal fluid, which mixes with
sperm to produce semen. Semen leaves the
seminal vesicles and travels through the
prostate gland, which produces additional
secretions that are added to semen. During
male orgasm the penis ejaculates semen.
© Microsoft Corporation. All Rights Reserved.
Microsoft ® Encarta ® 2008. © 1993-2007 Microsoft
Corporation. All rights reserved.
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
20
PROSTATE CANCER (CaP)
• Most common male cancer but, Incidence varies worldwide
• Prevalence ↑ with ↑age.
• Life time risk of 50yr-old man is 9.5% & death is 2.9%, for clinical disease.
• Age @ onset : 50yrs(x7), 60yrs(x5) & 70yrs(x4).
• Prevalence among African America men (blacks) > whites.
• Late presentation in blacks > whites.
• Similar findings in Nigerian males as in african Americans
• Higher in developed countries particularly Scandinavian countries
• Low incidence and mortality in Asia
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
21
PROSTATE CANCER 2
• Now diagnosed as a local regional disease in developed countries
because of screening
• Metastatic disease is seen commonly in Nigeria due to late
presentation
• Mortality amongst African-American and whites is decreasing
• In Europe and Africa mortality has not decreased
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
22
PROSTATE CANCER 3
• CaP is a disease of the elderly most being diagnosed in men beyond 65
years
– Incidence in the middle age is increasing because of screening PSA
– When diagnosed in younger age the mortality is higher
• +ve Family history ↑
• High dietary fat intake ↑ x2.
• Cadmium found in cigarette, alkaline batteries, & welding industries ↑.
• Previous Vasectomy ↑.
• High levels of Vit. D and IGF ↑
• low levels of selenium, Vit. E and Lycopene.
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
23
PROSTATE CANCER 4 –Risk Factors Explained
• No specific risk factors
• However age, genetic and environmental factors play a role in the evolution
of the disease.
• Age is the strongest risk factor incidence and mortality increase with age
• Hereditary case control studies have shown that first degree relations of
men with CAP have higher risk of developing CAP (Steinberg et al, 1990)
• Another study reported a higher risk of relapse in familial cases of CAP than
sporadic type
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
24
PROSTATE CANCER 5 –Risk Factors Explained
• Androgen – high circulating levels of testosterone increase incidence
of CAP as in African Americans (Ross et al 1986)
– Role of testosterone and its metabolite in the development of CAP
contentious
• Also high levels of 5 alpha reductase type 2 as seen in African
Americans cause higher incidence CAP
• Vit D, insulin like growth factor 1(IGF) have been postulated to higher
risk of CAP compare with men low levels
• Environment and diet –migrants from Asian countries have higher
incidence of CAP than their relations back home
– This may be due to increase in westernised foods rich in fat and protein
– Fat may increase the incidence of CAP by increasing androgens levels, free
radicals and proinflammatory fatty acid which may be carcinogen.
– Lycopene found in cooked tomatoes, selenium reduce the incidence of CAP
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
25
PROSTATE CANCER 6 –Risk Factors Explained
• Vasectomy -there is probable high risk of CaP in men who have vasectomy
• Cigarette smoking- no role in the incidence of CaP
• Heavy alcohol use in known to increase oestrogen and decrease
testosterone level hence lower level of CaP
• Obesity may be permissive if not causative
• Tall men known to have more IGF have higher risk of developing CaP
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
26
PROSTATE CANCER – Clinical Features & Diagnosis
• Asymptomatic in most.
• Symptoms of local dx- Obstruction & Irritation, voiding
difficulties
• Symptoms of Metastases –depends on site of metastasis
SCREENING/DIAGNOSIS
• DRE –yearly after 50years.
• PSA : >4ng/ml. PSA Velocity, PSA Density –yearly after 50years
• Prostate Biopsy –definitive diagnosis
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
27
PROSTATE CANCER –Treatment & Control
• Treatment Options:
– Watchful waiting,
– Radical Prostatectomy,
– Radiation therapy
– Cryosurgery
• Prevention of CaP:
– Adequate Health Education for everyone to know and
avoid all modifiable risk factors
– Diet modifications
• Low fat –plant fat instead of animal fat sources
• Increase Vegetables and fruit intakes
• Fish consumption is helpful
• Reduce dairy food consumption
– Maintain healthy weight – a BMI >=30 is risky
– Prevention and early treatment of sexually transmitted
infections
– Avoid multiple sexual partners but, ensure regular
sexual intercourse
– Early uptake of regular medical checkup
including Digital rectal exam and PSA
test (most important)
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
28
CAP:
A QUICK RECAP.., PLEASE!
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 29
Control of
Liver Cancers..
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 30
• Primary liver cancer is the fifth most common cancer in the world and the
third most common cause of cancer mortality
– Hepatocellular carcinomas (HCCs) are malignant tumors of liver parenchymal cells
• In the US,
– 1.3% of estimated incident cancer cases are in the liver and intrahepatic bile duct
– Incidence rates are higher for males than females (2-4:1)
– Higher incidence for African Americans and Asians than whites
– 5 year survival rate is approximately 6.9%
• One of the most common malignancies in eastern Asia and sub-Saharan
Africa
• Incidence up to 90.0/100,000 in some parts of the world
• 44% of the world’s cases occur in China
Liver Cancer
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
31
• Incidence increases with age and the peak is reached, around
55 to 65years old in the United States
• Ethnic and familial clustering have been reported
• Possible interaction between Hepatitis infection and a major
gene for HCC
•80-95% of HCCs are associated with chronic
infection with Hepatitis B or C
Liver Cancer 2 -RISK FACTORS
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
32
HOST FACTORS
• Cirrhosis
• Immune Function
• Genetic Susceptibility
• Hemochromatosis
• Other Inherited Metabolic
Disease
• Diabetes Mellitus
• Non-alcoholic Steatohepatitis
• Primary Sclerosing Cholangitis
Liver Cancer 3 -RISK FACTORS
OTHER RISK FACTORS
• Aflatoxins
• Thorotrast (X-ray contrast
material)
• Vinyl Chloride
• Steroid Hormones
• Schistosomiasis
• Liver flukes
• Iron
• Tobacco
• Alcohol
• Diet
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
33
• Implicated as the probable cause of HCC in at least
80% of cases worldwide
• About 5% of the world’s population(350 million
people) is chronically infected with HBV
• Lifetime risk of HCC for these individuals is estimated
at 10-25%
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
34
• It is spread mainly by exposure to contaminated blood
through IV drug use or sexual contact with an HBV
carrier
• In highly endemic areas, about half of chronic infections
result from perinatal transmission
• Can also be transmitted through household contacts,
contaminated blood or blood products, organ
transplantation, or needle-stick
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
35
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
36
 Areas of the world with high mortality rates for HCC also have high HBV
infection rates
 Cirrhosis is closely related with chronic HBV infection, at least 80% of liver
cancers occur in cirrhotic livers
 Case control studies in all regions of the world have shown that chronic
HBV infection is much more common in HCC cases than controls
› OR ranged from 5:1 to 65:1
 Prospective studies of chronic HBV carriers have shown very high relative
risks for HCC
› 400 and 500 /100,000 compared with 5/100,000
› Prevention of HBV reduces risk of subsequent HCC
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
37
• Major viral cause of liver cancer in areas with
low HBV prevalence
• About 3% of the world’s population (170
million people) is chronically infected with
HCV
– 3-4 million new infections each year
– 2-4% with chronic HCV develop HCC
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
38
• Transmitted by parenteral route
– Intravenous drug use
– Hemodialysis
– Blood transfusion
– Exposure to blood of infected patient
• Other routes probably exist but have not been
identified
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
39
• Many epidemiological studies have indicated
association
• Detection of HCV RNA in tumor and nontumor
cirrhotic liver tissue of patients with HCC
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
40
• Alcohol is a significant risk factor for liver
cancer in areas with low HBV and HCV
incidence
– Evidence indicates that alcohol causes cirrhosis
which in turn increases risk of HCC
• In high incidence areas, alcohol may
exacerbate viral liver damage and promote
tumor development
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
41
• Health Education and proper nutrition
• Limit exposure of the general populations and workers in certain
industries to hepatocarcinogens
• Reduce transmission of hepatitis viruses through sex and by IV
drug use through counseling about risks
• Prevent HBV infection by vaccination
• 90% preventable with proper use of hepatitis B vaccine
• Universal immunization of newborns in Taiwan is associated with at least a 50%
reduction in incidence of HCC among adolescents
• Part of WHO and Nigeria’s universal childhood vaccination –HBV and PENTA
Liver Cancer Prevention
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
42
• Routine Screening of Patients with HBV and HCV infection
for:
– Serum alpha-fetoprotein (AFP)
– Ultrasonography of the liver
• HCV is preventable through abstinence, avoiding IV-drug use
or sharing infected sharp objects and by not taking
unscreened blood products
– If all opportunities for intervention are acted upon, HCC could
become a minor cause for cancer mortality in the future
Liver Cancer Prevention 2
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
43
HCC:
A QUICK RECAP.., PLEASE!
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 44
Preventing
Colon Cancer..
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 45
THE COLON (LARGE INTESTINE)
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 46
Colorectal Carcinoma
• Colorectal cancer is the third most common cancer among Americans,
and the second most frequent cause of cancer-related deaths.
• Risk of colorectal cancer increases significantly with age. About 90% of all
colorectal cancers are diagnosed in people over the age of 50.
• Other Risk factors include:
– family history of colorectal cancer,
– the presence of polyps (abnormal but usually benign growths) in the large
intestine, or
– a history of chronic inflammatory bowel disease such as ulcerative colitis or
Crohn’s disease. ©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
47
Colorectal Carcinoma 2
• Risk Factors Cont’d
– Smoking
– Obesity,
– Physical Inactivity,
– Alcohol
– Processed red meat
– Low fibre diet
– Vitamin D/Calcium/Folate deficiency
– Genetic mutation e.g. MSH2, MLH1, PMS1, and PMS2
• Some studies have suggested that certain drugs may lessen the risk of
developing colorectal cancer e.g. hormone replacement therapy for
women after menopause and nonsteroidal anti-inflammatory drugs
such as ibuprofen. ©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
48
Colorectal Carcinoma 3
• Symptoms
– Usually asymptomatic at early stages
– blood in their bowel movements (faeces).
– persistent constipation or diarrhoea, other changes in bowel habits,
– abdominal pain,
– unexplained weight loss.
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
49
Colorectal Carcinoma -PREVENTION
• Health Education
• SCREENING! SCREEENING!! SCREENING!!! SCREENING!!!!
• No Smoking –absolutely NO
• Maintain healthy weight –No overweight and obesity
• Proper Nutrition
– Reduce red meat –particularly processed meat e.g. hotdogs, etc.
– Adequate Vit. D, Calcium and Folate intake
– Increase fibres/roughages in diet to increase bowel movement
• Reduce Alcohol intake
• Increase physical activity and exercise
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
50
Faecal Occult
Blood test
–every year
Flexible
Sigmoidoscopy
–every 5years
Screening for Colon Cancers… after 50years
Colonoscopy
-every 10years
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com
Virtual
Colonoscopy
–every 5years
51
CA COLON:
A QUICK RECAP.., PLEASE!
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 52
Let’s talk:
• Have you taken your HBV
vaccine?
• Do you know your HCV status?
• Do you consume excessive/Illicit
Alcohol?
• Is cigarette smoking your hobby?
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 53
Let’s talk: (2)
• Have you or your
husband/brothers/father
ever done a digital rectal
exam or PSA test?
• Colonoscopy??? What will
you do about it?
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 54
Cancer prevention is action taken to
lower the risk/chance of getting
cancer. This include:
• Maintaining a healthy lifestyle,
• Avoiding exposure to known
cancer-causing substances, and
• Taking medicines or vaccines
that can prevent cancer from
developing.
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com
In conclusion..,
"It's what you learn after you know it
all that counts." - John Wooden
55
Further Resources & Bibliography
• Cancer Epidemiology, 3rd ed. 2006. Oxford University Press
• US Centers for Disease Control. | www.cdc.gov
• American Cancer Society. | www.cancer.org
• WHO, Cancer Prevention.|
http://www.who.int/cancer/prevention/en/
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
56
Merci beaucoup.!!
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
57
QUESTIONS?
COMMENTS?
REMARKS?
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
58
©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com
“Words on Marble."
59
APPENDIX
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
60
Leading cancers in Males in Africa
• The top six cancers in males were the following:
– Kaposi's sarcoma (15.9 percent)
– liver (13.3 percent)
– prostate (10.7 percent)
– oesophagus (6.0 percent)
– non-Hodgkin's lymphoma (5.8 percent)
– stomach (4.5 percent).
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
61
Leading cancers in females
• In females, the following were the leading cancers:
– cervix (25.4 percent)
– breast (17.4 percent)
– Kaposi's sarcoma (6.2 percent)
– liver (5.5 percent)
– stomach (3.8 percent)
– non-Hodgkin's lymphoma (3.8 percent).
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
62
Causes
• Multi-factorial; include:
• Environmental factors –
– Tobacco – lung, larynx, mouth, esophagus, bladder, pancreas, etc.
– Alcohol – esophageal and liver
Diet – smoked fish & ca stomach, High fat diet and ca breast
– Occupational exposures to benzenes, arsenic, cadmium, chromium, vinyl
chloride, asbestos, polycyclic hydrocarbons, etc.
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
63
Causes - 2
• Viruses:
– Hepatitis B & C - hepatocellular Ca
– HIV - Kaposi sarcoma, non H-lymphoma
– HPV – Ca cervix
– EB virus – Burkitts, nasopharyngeal ca
• Parasites:
– Schistosomiasis
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
64
Causes of cancers - 3
• Genetic and hereditary factors
• Less conspicuous and more difficult to identify
but retinoblastoma tend to occur in children of
same parents.
• Inherited or familial breast ca. account for 5 –
10% of breast ca
• Mutation of BRCA 1 and BRCA 2 are thought to be
responsible for 90% of familial breast ca
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
65
Cause of cancers - 4
• Radiation – by causing changes in DNA
including breaks in chromosomes, and
chromosome transposition.
• Radiation causes normal cells to become
cancerous after many years.
• Common sources include: UV-B rays from
sun, radon gas
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
66
Risk factors
Smoking –
• accounts for 30% cancer deaths
• 90% of lung cancers
• Associated with cancers of :
mouth, pharynx, larynx, esophagus, pancreas, renal pelvis,
bladder, cervix
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
67
Risk factors
Diet: Linked to 30 – 35% of cancers
• Food such as: fruits, vegetables, dietary fibre and vitamins are
protective
• High fat, excess of meat, salt cured, smoked food and alcohol
– increase risk
• Alcohol linked with cancers of mouth, throat, esophagus.
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
68
Risk factors
Infections:
• HIV – Kaposi sarcoma
• Helicobacter pylori – ca. of stomach
• HPV 16, HPV 18 – ca. of cervix
• Hepatitis B – ca. liver
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
69
Risk factors
Hereditary factors:
• gene BRCA 1 and BRCA 2 linked with hereditary breast cancer.
• BRCA 1 also linked with ovarian cancer
• Androgen receptor gene aHR and Glutathione s-transferase
(GST) – linked to prostate cancer
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
70
Other risk factors
• Radiation and Radon
• Sunlight – skin cancer
• Chemicals – asbestos
• Obesity- breast cancer
©Idokoko A. B. | 24th August, 2016 |
abrahamidokoko@gmail.com
71

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Cancers [Prostate, Liver & Colon] Prevention and Control in Primary Healthcare Practice by Dr. Idokoko A. B.

  • 1. CANCERS[PROSTATE, LIVER & COLON]: PREVENTION AND CONTROL IN PRIMARY HEALTHCARE PRACTICE Dr. Abraham Idokoko Department of Community Health, Lagos University Teaching Hospital, Idiaraba Wednesday, 24th August, 2016.
  • 2. Cancer is one of the most critical health issue confronting 21st century populations. *In 2012 about 14.1 million new cases of cancer occurred globally and It caused about 8.2 million deaths or 14.6% of human deaths. *Rates are increasing as more people live to an old age and as lifestyle changes occur in the developing world. *The financial costs of cancer were estimated at $1.16 trillion US dollars per year as of 2010.[? ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 2
  • 3. Learning Objectives: • Help participants recall general knowledge of NCDs/cancers from prior lectures. • Enumerate the epidemiology of prostate cancer relevant to CHO’s. • Discuss the liver cancer control interventions of primary healthcare importance. • Describe to participants the best practices for colon cancer control in primary healthcare practice. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 3
  • 4. First, Let’s recall our knowledge of NCDs ? ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 4
  • 5. Non Communicable Diseases • An impairment of bodily structure and function that necessitates a modification of the patient’s normal life, and has persisted over an extended period of time. Xteristics • Permanent • Leave residual disability • Caused by non reversible pathological alteration • Requires rehabilitation • Require a long period of care ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 5
  • 6. The Burden of NCD Assuming increasing importance in both developed and developing nations because of: • Increase in life expectancy • life styles and behaviour are changing • Modern care enables many to survive • impact is serious in terms of DALYs, family hardship, poverty and economic loss ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 6
  • 7. Gaps In Natural History • Absence of a Known agent • Multifactorial causation • Long latent period • Indefinite onset The Concept of Risk and Risk factors: • Cigarette use and other forms of smoking • Alcohol abuse • Failure to obtain preventive health services • Life style changes • Environmental/occupational risks • Genetic • Stress The prime value of Prevention in NCDs: • Primary Prevention including primordial • Secondary Prevention • Tertiary Prevention ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 7
  • 8. Now..!! Respond to this quiz! ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 8
  • 9. True or False? Smoking causes lung cancer ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 9
  • 10. True or False? Large percentage of cancers are preventable ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 10
  • 11. True or False? In the past 20 years tremendous improvements in the treatment of all cancers have been achieved ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 11
  • 12. True or False? Preventing cancer is easier than treating cancer ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 12
  • 13. True or False? Screening tests are available for most cancers ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 13
  • 14. So?? Let’s do a quick overview: ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 14
  • 15. Overview of Cancers • A group of diseases characterized by abnormal growth of cells, ability to invade adjacent tissues/organs, and eventual death of cells Burden • Accounts for about 12% of deaths • 2nd leading cause of deaths in the developed world • Incidence rising due to increase in life expectancy and changes in life style and environmental factors. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 15
  • 16. Biology & Classification • Though many diseases, the disease process is the same • The underlying pathology being the rapid and continuous production of abnormal cells that invade and destroy other tissues • May arise from any type of cell in the body. Several classifications exist but, according to the tissues and type of cells, there are 3 main types cancers: • Sarcomas – connective and supportive tissue e.g. bone, cartilage, nerve, muscle, fat, blood vessels • Carcinomas – epithelial tissue such as skin and the lining of cavities and organs, and glandular tissue such as the breast or prostate • Leukemias and lymphomas – cancers of the of blood forming tissues and immune system ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 16
  • 17. Distribution • Wide variations in the distribution worldwide • Environmental factors, food habits, lifestyle, genetic factors, etc are responsible Common Risk Factors/Causes: • Environmental factors – Tobacco – Alcohol – Dietary – Occupational exposures – Viruses – Parasites – Customs • Genetics Control: • Primary – Tobacco and alcohol – Personal hygiene – Cancer education • Secondary – Cancer registration – Cancer screening – Cancer treatment ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 17
  • 18. Cancer prevention is action taken to lower the risk of getting cancer. This can include be: • Maintaining a healthy lifestyle, • Avoiding exposure to known cancer-causing substances, and • Taking medicines or vaccines that can prevent cancer from developing. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 18
  • 19. Epidemiology of Prostate Cancer.. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 19
  • 20. Male Reproductive System. The organs of the male reproductive system enable a man to have sexual intercourse and to fertilize female sex cells (eggs) with sperm. The gonads, called testicles, produce sperm. Sperm pass through a long duct called the vas deferens to the seminal vesicles, a pair of sacs that lies behind the bladder. These sacs produce seminal fluid, which mixes with sperm to produce semen. Semen leaves the seminal vesicles and travels through the prostate gland, which produces additional secretions that are added to semen. During male orgasm the penis ejaculates semen. © Microsoft Corporation. All Rights Reserved. Microsoft ® Encarta ® 2008. © 1993-2007 Microsoft Corporation. All rights reserved. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 20
  • 21. PROSTATE CANCER (CaP) • Most common male cancer but, Incidence varies worldwide • Prevalence ↑ with ↑age. • Life time risk of 50yr-old man is 9.5% & death is 2.9%, for clinical disease. • Age @ onset : 50yrs(x7), 60yrs(x5) & 70yrs(x4). • Prevalence among African America men (blacks) > whites. • Late presentation in blacks > whites. • Similar findings in Nigerian males as in african Americans • Higher in developed countries particularly Scandinavian countries • Low incidence and mortality in Asia ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 21
  • 22. PROSTATE CANCER 2 • Now diagnosed as a local regional disease in developed countries because of screening • Metastatic disease is seen commonly in Nigeria due to late presentation • Mortality amongst African-American and whites is decreasing • In Europe and Africa mortality has not decreased ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 22
  • 23. PROSTATE CANCER 3 • CaP is a disease of the elderly most being diagnosed in men beyond 65 years – Incidence in the middle age is increasing because of screening PSA – When diagnosed in younger age the mortality is higher • +ve Family history ↑ • High dietary fat intake ↑ x2. • Cadmium found in cigarette, alkaline batteries, & welding industries ↑. • Previous Vasectomy ↑. • High levels of Vit. D and IGF ↑ • low levels of selenium, Vit. E and Lycopene. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 23
  • 24. PROSTATE CANCER 4 –Risk Factors Explained • No specific risk factors • However age, genetic and environmental factors play a role in the evolution of the disease. • Age is the strongest risk factor incidence and mortality increase with age • Hereditary case control studies have shown that first degree relations of men with CAP have higher risk of developing CAP (Steinberg et al, 1990) • Another study reported a higher risk of relapse in familial cases of CAP than sporadic type ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 24
  • 25. PROSTATE CANCER 5 –Risk Factors Explained • Androgen – high circulating levels of testosterone increase incidence of CAP as in African Americans (Ross et al 1986) – Role of testosterone and its metabolite in the development of CAP contentious • Also high levels of 5 alpha reductase type 2 as seen in African Americans cause higher incidence CAP • Vit D, insulin like growth factor 1(IGF) have been postulated to higher risk of CAP compare with men low levels • Environment and diet –migrants from Asian countries have higher incidence of CAP than their relations back home – This may be due to increase in westernised foods rich in fat and protein – Fat may increase the incidence of CAP by increasing androgens levels, free radicals and proinflammatory fatty acid which may be carcinogen. – Lycopene found in cooked tomatoes, selenium reduce the incidence of CAP ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 25
  • 26. PROSTATE CANCER 6 –Risk Factors Explained • Vasectomy -there is probable high risk of CaP in men who have vasectomy • Cigarette smoking- no role in the incidence of CaP • Heavy alcohol use in known to increase oestrogen and decrease testosterone level hence lower level of CaP • Obesity may be permissive if not causative • Tall men known to have more IGF have higher risk of developing CaP ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 26
  • 27. PROSTATE CANCER – Clinical Features & Diagnosis • Asymptomatic in most. • Symptoms of local dx- Obstruction & Irritation, voiding difficulties • Symptoms of Metastases –depends on site of metastasis SCREENING/DIAGNOSIS • DRE –yearly after 50years. • PSA : >4ng/ml. PSA Velocity, PSA Density –yearly after 50years • Prostate Biopsy –definitive diagnosis ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 27
  • 28. PROSTATE CANCER –Treatment & Control • Treatment Options: – Watchful waiting, – Radical Prostatectomy, – Radiation therapy – Cryosurgery • Prevention of CaP: – Adequate Health Education for everyone to know and avoid all modifiable risk factors – Diet modifications • Low fat –plant fat instead of animal fat sources • Increase Vegetables and fruit intakes • Fish consumption is helpful • Reduce dairy food consumption – Maintain healthy weight – a BMI >=30 is risky – Prevention and early treatment of sexually transmitted infections – Avoid multiple sexual partners but, ensure regular sexual intercourse – Early uptake of regular medical checkup including Digital rectal exam and PSA test (most important) ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 28
  • 29. CAP: A QUICK RECAP.., PLEASE! ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 29
  • 30. Control of Liver Cancers.. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 30
  • 31. • Primary liver cancer is the fifth most common cancer in the world and the third most common cause of cancer mortality – Hepatocellular carcinomas (HCCs) are malignant tumors of liver parenchymal cells • In the US, – 1.3% of estimated incident cancer cases are in the liver and intrahepatic bile duct – Incidence rates are higher for males than females (2-4:1) – Higher incidence for African Americans and Asians than whites – 5 year survival rate is approximately 6.9% • One of the most common malignancies in eastern Asia and sub-Saharan Africa • Incidence up to 90.0/100,000 in some parts of the world • 44% of the world’s cases occur in China Liver Cancer ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 31
  • 32. • Incidence increases with age and the peak is reached, around 55 to 65years old in the United States • Ethnic and familial clustering have been reported • Possible interaction between Hepatitis infection and a major gene for HCC •80-95% of HCCs are associated with chronic infection with Hepatitis B or C Liver Cancer 2 -RISK FACTORS ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 32
  • 33. HOST FACTORS • Cirrhosis • Immune Function • Genetic Susceptibility • Hemochromatosis • Other Inherited Metabolic Disease • Diabetes Mellitus • Non-alcoholic Steatohepatitis • Primary Sclerosing Cholangitis Liver Cancer 3 -RISK FACTORS OTHER RISK FACTORS • Aflatoxins • Thorotrast (X-ray contrast material) • Vinyl Chloride • Steroid Hormones • Schistosomiasis • Liver flukes • Iron • Tobacco • Alcohol • Diet ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 33
  • 34. • Implicated as the probable cause of HCC in at least 80% of cases worldwide • About 5% of the world’s population(350 million people) is chronically infected with HBV • Lifetime risk of HCC for these individuals is estimated at 10-25% ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 34
  • 35. • It is spread mainly by exposure to contaminated blood through IV drug use or sexual contact with an HBV carrier • In highly endemic areas, about half of chronic infections result from perinatal transmission • Can also be transmitted through household contacts, contaminated blood or blood products, organ transplantation, or needle-stick ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 35
  • 36. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 36
  • 37.  Areas of the world with high mortality rates for HCC also have high HBV infection rates  Cirrhosis is closely related with chronic HBV infection, at least 80% of liver cancers occur in cirrhotic livers  Case control studies in all regions of the world have shown that chronic HBV infection is much more common in HCC cases than controls › OR ranged from 5:1 to 65:1  Prospective studies of chronic HBV carriers have shown very high relative risks for HCC › 400 and 500 /100,000 compared with 5/100,000 › Prevention of HBV reduces risk of subsequent HCC ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 37
  • 38. • Major viral cause of liver cancer in areas with low HBV prevalence • About 3% of the world’s population (170 million people) is chronically infected with HCV – 3-4 million new infections each year – 2-4% with chronic HCV develop HCC ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 38
  • 39. • Transmitted by parenteral route – Intravenous drug use – Hemodialysis – Blood transfusion – Exposure to blood of infected patient • Other routes probably exist but have not been identified ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 39
  • 40. • Many epidemiological studies have indicated association • Detection of HCV RNA in tumor and nontumor cirrhotic liver tissue of patients with HCC ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 40
  • 41. • Alcohol is a significant risk factor for liver cancer in areas with low HBV and HCV incidence – Evidence indicates that alcohol causes cirrhosis which in turn increases risk of HCC • In high incidence areas, alcohol may exacerbate viral liver damage and promote tumor development ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 41
  • 42. • Health Education and proper nutrition • Limit exposure of the general populations and workers in certain industries to hepatocarcinogens • Reduce transmission of hepatitis viruses through sex and by IV drug use through counseling about risks • Prevent HBV infection by vaccination • 90% preventable with proper use of hepatitis B vaccine • Universal immunization of newborns in Taiwan is associated with at least a 50% reduction in incidence of HCC among adolescents • Part of WHO and Nigeria’s universal childhood vaccination –HBV and PENTA Liver Cancer Prevention ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 42
  • 43. • Routine Screening of Patients with HBV and HCV infection for: – Serum alpha-fetoprotein (AFP) – Ultrasonography of the liver • HCV is preventable through abstinence, avoiding IV-drug use or sharing infected sharp objects and by not taking unscreened blood products – If all opportunities for intervention are acted upon, HCC could become a minor cause for cancer mortality in the future Liver Cancer Prevention 2 ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 43
  • 44. HCC: A QUICK RECAP.., PLEASE! ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 44
  • 45. Preventing Colon Cancer.. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 45
  • 46. THE COLON (LARGE INTESTINE) ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 46
  • 47. Colorectal Carcinoma • Colorectal cancer is the third most common cancer among Americans, and the second most frequent cause of cancer-related deaths. • Risk of colorectal cancer increases significantly with age. About 90% of all colorectal cancers are diagnosed in people over the age of 50. • Other Risk factors include: – family history of colorectal cancer, – the presence of polyps (abnormal but usually benign growths) in the large intestine, or – a history of chronic inflammatory bowel disease such as ulcerative colitis or Crohn’s disease. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 47
  • 48. Colorectal Carcinoma 2 • Risk Factors Cont’d – Smoking – Obesity, – Physical Inactivity, – Alcohol – Processed red meat – Low fibre diet – Vitamin D/Calcium/Folate deficiency – Genetic mutation e.g. MSH2, MLH1, PMS1, and PMS2 • Some studies have suggested that certain drugs may lessen the risk of developing colorectal cancer e.g. hormone replacement therapy for women after menopause and nonsteroidal anti-inflammatory drugs such as ibuprofen. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 48
  • 49. Colorectal Carcinoma 3 • Symptoms – Usually asymptomatic at early stages – blood in their bowel movements (faeces). – persistent constipation or diarrhoea, other changes in bowel habits, – abdominal pain, – unexplained weight loss. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 49
  • 50. Colorectal Carcinoma -PREVENTION • Health Education • SCREENING! SCREEENING!! SCREENING!!! SCREENING!!!! • No Smoking –absolutely NO • Maintain healthy weight –No overweight and obesity • Proper Nutrition – Reduce red meat –particularly processed meat e.g. hotdogs, etc. – Adequate Vit. D, Calcium and Folate intake – Increase fibres/roughages in diet to increase bowel movement • Reduce Alcohol intake • Increase physical activity and exercise ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 50
  • 51. Faecal Occult Blood test –every year Flexible Sigmoidoscopy –every 5years Screening for Colon Cancers… after 50years Colonoscopy -every 10years ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com Virtual Colonoscopy –every 5years 51
  • 52. CA COLON: A QUICK RECAP.., PLEASE! ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 52
  • 53. Let’s talk: • Have you taken your HBV vaccine? • Do you know your HCV status? • Do you consume excessive/Illicit Alcohol? • Is cigarette smoking your hobby? ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 53
  • 54. Let’s talk: (2) • Have you or your husband/brothers/father ever done a digital rectal exam or PSA test? • Colonoscopy??? What will you do about it? ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 54
  • 55. Cancer prevention is action taken to lower the risk/chance of getting cancer. This include: • Maintaining a healthy lifestyle, • Avoiding exposure to known cancer-causing substances, and • Taking medicines or vaccines that can prevent cancer from developing. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com In conclusion.., "It's what you learn after you know it all that counts." - John Wooden 55
  • 56. Further Resources & Bibliography • Cancer Epidemiology, 3rd ed. 2006. Oxford University Press • US Centers for Disease Control. | www.cdc.gov • American Cancer Society. | www.cancer.org • WHO, Cancer Prevention.| http://www.who.int/cancer/prevention/en/ ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 56
  • 57. Merci beaucoup.!! ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 57
  • 58. QUESTIONS? COMMENTS? REMARKS? ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 58
  • 59. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com “Words on Marble." 59
  • 60. APPENDIX ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 60
  • 61. Leading cancers in Males in Africa • The top six cancers in males were the following: – Kaposi's sarcoma (15.9 percent) – liver (13.3 percent) – prostate (10.7 percent) – oesophagus (6.0 percent) – non-Hodgkin's lymphoma (5.8 percent) – stomach (4.5 percent). ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 61
  • 62. Leading cancers in females • In females, the following were the leading cancers: – cervix (25.4 percent) – breast (17.4 percent) – Kaposi's sarcoma (6.2 percent) – liver (5.5 percent) – stomach (3.8 percent) – non-Hodgkin's lymphoma (3.8 percent). ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 62
  • 63. Causes • Multi-factorial; include: • Environmental factors – – Tobacco – lung, larynx, mouth, esophagus, bladder, pancreas, etc. – Alcohol – esophageal and liver Diet – smoked fish & ca stomach, High fat diet and ca breast – Occupational exposures to benzenes, arsenic, cadmium, chromium, vinyl chloride, asbestos, polycyclic hydrocarbons, etc. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 63
  • 64. Causes - 2 • Viruses: – Hepatitis B & C - hepatocellular Ca – HIV - Kaposi sarcoma, non H-lymphoma – HPV – Ca cervix – EB virus – Burkitts, nasopharyngeal ca • Parasites: – Schistosomiasis ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 64
  • 65. Causes of cancers - 3 • Genetic and hereditary factors • Less conspicuous and more difficult to identify but retinoblastoma tend to occur in children of same parents. • Inherited or familial breast ca. account for 5 – 10% of breast ca • Mutation of BRCA 1 and BRCA 2 are thought to be responsible for 90% of familial breast ca ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 65
  • 66. Cause of cancers - 4 • Radiation – by causing changes in DNA including breaks in chromosomes, and chromosome transposition. • Radiation causes normal cells to become cancerous after many years. • Common sources include: UV-B rays from sun, radon gas ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 66
  • 67. Risk factors Smoking – • accounts for 30% cancer deaths • 90% of lung cancers • Associated with cancers of : mouth, pharynx, larynx, esophagus, pancreas, renal pelvis, bladder, cervix ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 67
  • 68. Risk factors Diet: Linked to 30 – 35% of cancers • Food such as: fruits, vegetables, dietary fibre and vitamins are protective • High fat, excess of meat, salt cured, smoked food and alcohol – increase risk • Alcohol linked with cancers of mouth, throat, esophagus. ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 68
  • 69. Risk factors Infections: • HIV – Kaposi sarcoma • Helicobacter pylori – ca. of stomach • HPV 16, HPV 18 – ca. of cervix • Hepatitis B – ca. liver ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 69
  • 70. Risk factors Hereditary factors: • gene BRCA 1 and BRCA 2 linked with hereditary breast cancer. • BRCA 1 also linked with ovarian cancer • Androgen receptor gene aHR and Glutathione s-transferase (GST) – linked to prostate cancer ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 70
  • 71. Other risk factors • Radiation and Radon • Sunlight – skin cancer • Chemicals – asbestos • Obesity- breast cancer ©Idokoko A. B. | 24th August, 2016 | abrahamidokoko@gmail.com 71