smoking and cancer 2

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Smoking and Cancer

An overview of theRisk

By

Allan R. Handysides, M.B., Ch.B.. FRCPc ,FRCSc, FACOG.

Director, GC Health Ministries Department
http://www.amazon.com/exec/obidos/ASIN/0811814491/thesmokingsectio


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Cancer Male Female

Lip & Oral 27.5 5.6

Lung 22.4 11.9

Larynx 10.5 17.8

Esophagus 7.6 10.3Kidney 3.0 1.4

Bladder 2.9 2.6

Pancreas 2.1 2.3

Relative Risk in the smoking

community


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Attitude of the Patient with

Cancer

Patient feels he or she is diseased

not just a body part


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Declining cancer incidence

in the USA

Declining by 2% annually since1992 This is the number of new

cancers per unit of the population

In 2000,1,220,000 new cases of

invasive cancer

In 2000; 552,200 deaths from

cancer4


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Smoking related deaths

Cancer Males % Females %

Lung 89,000 14 74,600 12

Oral 20,000 3

Bladder 38,300 6 14,900 2

Pancrea

s

13,700 2 14,600 2


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Cancer is the second Leading

cause of death

After 70 years of increasing smokingcancer deaths, the rate began to

decrease in 1997, ie 5 years after theincidence of smoking in the USA began

to decline.

5 year survival rates 39% in 1960-1963went to 61% in 1989-1995 in whites, but

only to 48% in blacks, the racial or

ethnic factors are not clear.


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Diagnosis

Must be tissue based

Staging clinical P/E, Xrays, U/S,C/T etc.

Surgical

T.N.M. systemIncreased use of biological

features, eg. oncogenes, drug

resistance genes,receptors etc. 7


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The number one cancer

reducing activity

Smoking

cessation


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Potential Harvest

400,000 Americans die prematurelyannually

The risk is 1 in3 of dying

prematurely20% of 12-18yr olds smoked a

cigarette in the last month

80% of American smokers started


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Process of cessation

Precontemplat

ion

Contemplation

Activecessation

Precontemplation

Contemplation

Active

cessation

Maintenanc

e


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Cigar vs Cigarette vs

Smokeless

Cigarette smokers tend to

inhale more than cigar smokersSmokeless relates strongly to

oral cancers

systemically absorbedchemicals such as the

nitrosamines cause cancer in

the laboratory animal


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Lung Cancer

Affects 90,000 males and 75,000

females annually 86% of whom willbe dead within 5yrs of diagnosis

THIS IS THE LEADING CAUSE OFCANCER DEATH IN ALL GENDER AND ALL

RACES IN THE USA


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Lung cancerPeak age is 55-65yrs

Accounts for33% of all malecancer deaths and 25% of all

female cancer deathsSmoking cessation efforts have

slowed the rate of cancer deaths in

men now down to 70/100,000males/year

The rate in women continues torise now it is35/100,000 female

population per year.


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Lung Cancer

15% localized to the lung atdiagnosis

25% is spread to the local lymphnodes

55%+ have distant metastases at

diagnosis

SURVIVAL= 50% if localized

20% if regional

14% overall

These poor figures are 100% betterthan 30yrs ago14


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Lungcancer

A Majorhealth

problem

with agrim

Prognosis15


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Major types of Lung cancer

Squamous (epidermoid)

carcinomaSmall cell (oat cell)

Adenocarcinoma

Large cell carcinoma


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Changes in type

Adenocarcinoma has overtaken

squamous as the most prevalent

Small cell carcinoma is most

likely to be spread at the time ofdiagnosis though if caught early

respond well to surgery, radiation

and chemotherapy


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90%OF ALL TYPES OFLUNG CANCER OCCUR INCURRENT OR FORMER

SMOKERS


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Lung Cancer

Concept of PACK YEARS is morerelated to cancer risk

2 packs a day for 20 years = 40 packyears which = a 60-70 fold increasedrisk for carcinoma

Women have a relative risk higherthan men when they get intoheavier smokin patterns 19


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Lung cancer and genetic

changes in pulmonary cellsRegulator genes are damaged by smoking

so that perhaps 10 segments in the DNA

are damaged before a cancer shows up.

Chromosome 3p is involved in nearly all

lung cancers and p53 and rb genes are

damaged in more than 90% of small cell

lung cancers( possibly inherited defects)

Nicotine itself seems to play a strong

carcinogenic role


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Detection requires

Routine Chest X-ray

Awareness that infection may

occur in persons with CA

Tumor may cause dysfunction in

adjacent organsMetastasis may be from the lung


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Para neoplasticsymptoms

AnorexiaCachexia

Weight loss

Fever

Suppressed

immunity 22


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Endocrine syndromes

Hypercalcemia PTH

Hypophosphatemia

Hyponatremia ADH

Electrolyte disturbances ACTH

CoagulopathiesNeurologic/myopathic syndromes


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Oral cancers

Alcohol and Tobacco themajor determinants

Smokeless tobacco

Marijuana, factors likenickel refining, textilefibers, and woodworking

may also play a role


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Chewing tobacco andLeukoplakia

MetaplasiaDysplasia

Leukoplakia

In situ changes

Frank Neoplasia

25


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Smoking cessation a major

health benefitRates fall in nearly all situations where

smoking cessation is implemented

Prevention even better hence the need towork with the youth.

At risk behavior best modified in a

MENTORsituation


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Smok ing and Cance

Live Longer

Breathe- Free

smoking and cancer 2

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