UNDERSTANDING FACTS & MYTHS OF CANCER & ITS CUREDR SUNITA POLAMPALLI, MD PathDirectorSNP Molecular Genetics Diagnostic & Research Centre

Email id: drsunitap@gmail.com

Phn no: +919004674321

What does the word

cancer mean to you?

Cancer stigmasDISBELIEFPANICUNCURABLE DISEASEDEPRESSIONGRIEFFEAR OF DEATHFINANCIAL STRESSEMOTIONAL STRESS

Common views on cancer

“in the popular imagination cancer equals death”

(Susan Sontag,1977)

“Cancer forces us to confront our lack of control over our own or others death”Kleinman (1988)

What is Cancer ??

What is Cancer ??

How cancer occurs..?MUTATION IN ONE GENE OR MULTIPLE

GENES

Which leads to ……

Uncontrolled cell growth Problem in removing damaged cells –

(defective apoptosis)

Basic understanding of cell & genes…..helps to understand cancer pathology better

From phenotype (external appearance) to genotype (internal apperance)

Nucleus Chromosomes DNA Genes

Each cell has 23 pairs of chromosomes + 2 sex chromosomes (X/Y)Male- 46 + X,YFemale- 46 + X,X

DNA made of multiple genes….similar to pearls on string

Pearls on string

What are genes ?

Bunch or cluster of nucleic acid sequences - A=T,G=C

Genes are store house of all cellular information – like a “Janampatri of you life”

Genes carry information/codes in them to carry out various activities or functions of the cells.

Genes consists of codonsEach codon made of 3 nucleic acids– ATG, TGC, etc

Genetic coding similar to binary coding of computer (1,0)

COMPUTER CODING

Genetic coding similar to binary coding of computer (1,0)

GENETIC CODING

What is mutation?

Change or defect in normal genetic (amino acid) sequence which leads to formation of new proteins with new functions which may be beneficial or harmful to normal functioning of cells.

Effects of mutation

Effects of mutation – analogy

Just like by adding, deleting or substituting one letter, the expression of word changes to new word

Similarly by adding, deleting or substituting one amino acid, the expression of protein changes to new proteins

Mutations can be harmful or helpful

Mutations are normal physiological phenomenon… Our body is subjected to several

mutations during the process of formation of new cells – CELL CYCLE.

Continuous turn over of cells ….new cells formed & old cells die

Defense Mechanism during cell cycle

Help to destroy these mutated or damaged cells.

Strong Defense mechanism…to repair damaged cell & DNA

Regulatory genes of cell cycle

DNA Repair mechanism

Immunity

Regulatory genes of cell cycle

Proto Oncogenes…promotes cell activation

Tumor Suppressor Genes…inhibits cell growth of damaged cells

DNA Repair genes…repairs damaged DNA during cell cycle

Immune Surveillance..

What prompts a cell to turn cancerous ?

Defective defense mechanism leads to disease or cancer

Imbalance immune responseIncreased exposure to Free radicals

Defective DNA repair mechanismAccumulation of mutations or mutated genes which leads to imbalanced cellular functions

Imbalance immune response…very important reason

Poor nutrition

Stress

Infections

Exposure to Free radicals …cause cell damage & DNA damage

Free radicals …

Free radicals causing many diseases..

Abnormal expression of Mutated genes

Abnormal expression of Mutated genes

Defective DNA Repair Mechanism

Cancer is multifactorialMultiple mutations in one gene or many genes

required to cause cancer

Points to remember… There is continuous turn over of cells in our body daily

– old cells die and new cells born -CELL CYCLE

Number of mutations take place during this cellular turn over.

Balanced immunity , DNA repair mechanism along with tumor suppressor genes and oncogenes helps to maintain cell cycle in proper process and destroy mutated cells.

But sometimes because of stress and decreased immune functions, mutations get accumulated and can lead to cancer.

Etiological factors which …cause cancer

Causes of cancer Irregular lifestyle (most neglected etiology):

stress, sedentary & tech savy lifestyle

Improper diet: junk food, diet rich in saturated fats, refined sugars, vitamins(Vit D) deficiency

Harmful chemicals: pesticides, food additives/preservatives, pollutants (smoke, plastic,), cosmetics

Addictions: smoking (nicotene), ghutka, pan masala, heavy alcohol consumption, etc

Causes of cancer Ionising Radiation: X’rays , gamma rays, TV

& mobile towers (cell phones, electric appliances – not so

much of a threat)

Occupational hazards : asbestos, coal tar, benzene, arsenic, etc, exposure to radiation

Infections: HPV (cervical cancer), H.Pylori (stomach cancer), HBV (liver cancer), EBV (Blood cancer-lymphoma) etc

Different etiological factors cause DNA damage which leads to cancer..

Types of tumors in body Benign – e.g. polyps, fibroids

Not always due to genetic mutations but due to functional / physiological reasons

Controlled over growth of cells localized curable

Malignant – e.g cancers

Due to genetic mutations Uncontrolled over growth of cells spreads to other organs difficult to cure

Cancer occurrence

Is cancer a inheritable disease? Sporadic ? contagious disease?

Cancer occurrence Sporadic – occurrence by chance by external

etiology - 70 to 80% Hereditary – cancer genes inherited from one of

the parents – 15 – 20%

Sporadic cancers ….due to acquired genetic mutations

Blood cancers Lung cancer Stomach cancer Brain cancer Bone cancer Soft tissue cancer (muscle) Cancer in head & neck part (tongue, jaws, etc) Urinary bladder cancer Kidney cancer Thyroid cancer Prostate cancer

Hereditary Cancers ….due to inherited genetic mutations

Points to remember…

70-80% cancers are sporadic occurring because of different kind of stress.

15 – 20% are hereditary because of inherited genes from parents.

Patients with family history of cancer are at high risk of developing cancer with increasing age

Cancer symptoms Symptoms depend on site of cancer

General symptoms – fever, loss of appetite, weight loss, weakness,

jaundice

Specific symptoms – Unexplained Blood in cough (hemoptysis),

blood in urine (hematuria), blood in stools Lump in abdomen or any part of body, Cough,Diarrhoea, Ulcer present for long

duration and not getting cured.

Investigations Pathological tests (study of cancer related

markers in blood )

Blood test for blood cell count Liver & kidney function tests Tumor marker studies

Radiological tests (study of size, shape & location of lump in body)

X’ray, Ultra-sonography CT Scan, MRI Endoscopy, colonoscopy

Investigations Biopsy tests (study of cells in tumor tissue) Fine needle aspiration cytology (FNAC) Histopathology examination of excised tumor/lump

Genetic tests (study of defective chromosomes or mutated genes in tumor tissue) – gaining importance as more cancer genes identified

Chromosomes - Cytogenetics (karyotyping, FISH) DNA or genes – Molecular Genetics (PCR,

Sequencing)

Importance of genetic testing in Hereditary Cancers

BRCA gene mutation testing in Breast Cancer

Inherited doesn’t mean he/she will develop cancer

Points to remember… Pay attention to your symptoms and do

not ignore them if they are sustaining for long time inspite of antibiotic or other treatment.

Get a thorough check up done.

Early detection of cancer is very important for better cure.

Regular health check ups important especially after age of 40yrs

Points to remember… People with family history of cancer need to

get genetic testing done for those cancers.

If test comes positive ..not to panic. Test only tells about susceptibility of cancer but does not confirm that u have or will have cancer.

Precautionary measures can be taken in such cases to prevent cancer.

Treatment Chemotherapy

Radiation therapy

Targeted therapy (monoclonal antibodies)

Immuno therapy (modified immune cells) – under research and clinical trials

Chemo drugs are cytotoxic…kills cancer cells & normal cells

Radiation therapy…. destroys cancer & surrounding tissue

Side effects of chemo therapy & radiation….decreases IMMUNITY

Side effects of chemo therapy & radiation….decreases IMMUNITY

Cytotoxic..kills cancer as well as normal cells.

This decreases immunity of patients.

Because of decreased immunity patient is susceptible to infections.

Tolerance not good..patient becomes non complaint.

Response to treatment not good – re occurance possible.

Targeted therapy …targeting cancer proteins

Targeted therapy….targets cancer genes

With newer genetic techniques, more and more cancer genes identified.

Drugs manufactured to target these specific cancer genes in cancer cells.

These specific drugs destroy only specific cancer cells and does not kill normal cells.

This prevents toxic side effects and helps to maintain immunity.

Tolerance to such therapy is good with good response.

Pros & Cons of chemo & radiation therapy Easily available & affordable

Highly cytotoxic and many side effects. Patient compliance not good.

Not targeting specific cancer genes…cancer cells might survive even after treatment and can cause re occurance of disease.

Pros & Cons of targeted therapy Not cytotoxic and patient compliance is

good.

Targeting specific cancer genes & kills all cancer cells..so chances of re-occurance is rare.

Treatment is costly

Knowledge of all cancer genes important in order to detect these genes and design a drug for them…difficult task.

How to build up immunity during cancer therpay

Integration of Holistic approach to combat cancer..very very important

DietYogaMeditationExerciseMindful activitiesCounseling

Importance of well balanced diet during treatment

Importance of well balanced diet during treatment

Proteins Fibre Vitamins Anti oxidants Minerals

In cancer & during treatment- cells are damaged which decreases immunity.

Well balanced diet very important.

Importance of water & anti-oxidant supplements

Importance of exercise, yoga & meditation…very important

Pranayam or simple yoga techniquesVery helpful

Even meditation alone can reduce stress and pain.

Importance of exercise, yoga & meditation…very important Activates dopamine & serotonin, natural

pain relievers

Improves oxygenation of organs Provides anti oxidants to combat free

radicals

Improves immunity

Importance of mindful activities

Engaging patients in activities of their interest.

Do not leave them alone !!!

Do not let them have any negative thoughts.

Need of the hour for treating cancer patients besides chemo or radiation

Counseling centres – counsel patients & their family to allay fear of cancer, proper treatment guidance.

Emotional support - Family members and friends have to provide all kind of emotional support to the patient to help fight the disease.

Rehabilitation centres: Patients are helped to adopt and revive healthy lifestyle and continue to live their lives positively.

Need of the hour for treating cancer patients besides chemo or radiation Group therapies – patients can gain insight

about each other’s conditions. This will prevent patients from being isolated and give them the feeling that they are not the only unfortunate ones.

Testimonies of cancer survivals to boost moral of other patients

Holistic approach – proper nutrition guide, yoga, mediation, mindful activities.

Integrated approach… Very effective to cure internal physical

disease as well as psychological problems.

Better cure and survival rate, improving overall patient’s quality of life.

Changing trends in cancer survival ….from glim to hopeful

Changing trends in cancer survival

Many cancers are now completely cured like certain blood cancers, breast cancers, gastro intestinal and genito-urinary cancers.

Some cancers are lethal like lung cancer, liver cancer, pancreatic cancer, few of the blood and brain cancers.

Please remember…Do not believe in cancer survival statistics.

Treatment response varies from patient to patient.

Believe on your own body and in yourself.

Doctors only treat but…

You are your own HEALER !

Take home message...

Cancer is not as deadly as it seems.

Cancer is curable.

Do not fear it but fight it .

Believe in urself & your body.

How to prevent cancer ??….billion dollar question !!

Cancer cannot be prevented but can be constrained..

With the ever advancing technology , man has made lot of progress.

But we are paying a big cost for it.

We are becoming more dependant on machines and robots.

Destroying our environment and isolating ourselves from nature.

We cannot avoid harmful radiation and chemicals in our day to day lives.

But we can constrain it by adopting a healthy & holistic lifestyle.

Adopting holistic lifestyle

Cancer related information… http://www.cancer.gov/about-cancer