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Disease Prevention and Management
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Transcript of Disease Prevention and Management
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STRATEGIES for DISEASE PREVENTION
AND MANAGEMENT
• Submitted by,• Shani ….BSM/12/15• Preeti …..BSM/12/14• Bikash ….BSM/12/16• Arshia ……BSM/12/17
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cancer
• Cancer is one of the most common diseases in the developed world:
• 1 in 4 deaths are due to cancer• 1 in 17 deaths are due to lung cancer• Lung cancer is the most common cancer in men• Breast cancer is the most common cancer in
women• There are over 100 different forms of cancer
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• Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells.
• Cancer is caused by external factors and internal factors which may act together to initiate or promote carcinogenesis.– External Factors – chemicals, radiation, viruses,
and lifestyle– internal Factors – hormones, immune condition,
and inherited mutations
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Factors Believed to Contribute to Global Causes of Cancer
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PREVENTION IS BETTER
THAN CURE
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Cancer prevention?
• Cancer prevention is defined as active measures to decrease the risk of cancer.
• Cancer is considered as the largely preventable disease.
• Prevention offers the most cost-effective long-term strategy for the control of cancer as 30-40% of cancers can be prevented, and one-third of cancers can be cured through early diagnosis and treatment.
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Preventable risk factors
• Tobacco• Obesity• Physical inactivity• Alcohol• Sun exposure• Infections• Pollution
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STRATEGIES FOR CANCER PREVENTIONAND
MANAGEMENT
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What Is Chemoprevention?
• The science of trying to apply natural and synthetic compounds to interfere with the earliest stages of carcinogenesis, before
invasive cancer appears
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The Ideal Chemo preventive Agent
• Is effective• Easily administered• Preferably once/twice day• Little or ideally no toxicity• Affordable
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Strategy#1-dietary strategy for cancer prevention
• 30% to 40% of all cancers may be prevented by changes in diet and physical activity.
• Increase antioxidants by eating a variety of anti-oxidant rich fruits and vegetables including nuts, seeds , herbs and spices.
• Antioxidants supplements mainly contain:-1.Vitamin a,c,e,d and k2.alpha-lipoic acid3.co-enzyme q104. Falvanoids from plants including lycopene, resveratrol and quercetin.5. Carotenoids6.selenium
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Foods that contain antioxidants:
• VITAMIN A- CARROTS, SWEET POTATOES, MEAT• VITAMINC- CHERRIES, PEPPERS, BERRIES, CABBAGE,
BROCOLI, CITRUS • VITAMIN E-WALNUTS, SESAME SEEDS• VITAMIN D- COD LIVER OIL, SALMON, EGGS, FORTIFIED
FOODS• VITAMIN K-CAULIFLOWER, SPROUTS, BEANS• SELENIUM-INCLUDES SEAFOODS• ALPHA LIPOIC ACID-SPINACH, BROCOLI• CO-ENXYME Q10-MEAT, SEAFOOD
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FLAVONOIDS
• CLASS OF PLANT SECONDARY METABOLOITIES• HAVE ANTIOXIDANTL ACTIVITY• Knowns as vitamin p• Found in fruits and vegetables
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classification
• Flavonols- compounds:- quercetin , kaempferol (e.g- cherry tomato, apple, blueberry)
• Flavones-compounds:- apegenin, tricetin, heptamethoxyflavone (e.g-parsley, celery)
• Flavanones-compounds:-dihydroquercetin, hesperetin (e.g-orange juice)
• Flavanols-compounds-taxifolin (e.g-cocoa, chocolates)• Catechins-compounds-egcg(epigallocatechin gallate) (e.g-tea,
apricot)• Isoflavones-compounds:- genistein (e.g-soy, cheese)• Anthocyanins-componds-cyaniding (e.g-grapes, strawberry)
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Strategy#2 lifestyle strategy for cancer prevention
• Maintain a healthy body weight.• Be active, whether you walk with friends or sign up for
yoga class, set a fitness goal.• Don’t miss regular check –ups with doctor• Reduce your sodium intake.• Switch to whole grains. Instead of white rice go for
brown rice.• Choose water when you are thirsty. Reduce intake of
sweet drinks such as iced tea• Avoid smoked or grilled food
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• Quit smoking• Protect your skin• Limit red meat and animal fat• Know your personal and family medical
history• Get screened for cancer regularly• Increase your physical activity
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Modalities of treatment:• 1-local therapy:– -surgery.– -radiation therapy.
• 2-systemic treatment:– chemotherapy.– Monoclonal antibodies.– Radioactive material.
• 3-supportive care.• 4-non-conventional therapy.
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Surgery:
• Surgery was the first modality used successfully in the treatment of cancer.
• It is the only curative therapy for many common solid tumors.
• The most important determinant of a successful surgical therapy are the absence of distant metastases and no local infiltration.
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Cont:
• Microscopic invasion of surrounding normal tissue will necessitate multiple frozen section.
• Resection or sampling of regional lymph node is usually indicated.
• Surgery may be used for palliation in patients for whom cure is not possible.
• Has significant role in cancer prevention.
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Surgery for prevention:
• Patients with conditions that predispose them to certain cancers or with genetic traitsAssociated with cancer can have normal life span with prophylactic surgery.
-colectomy .-oophorectomy.-thyroidectomy.-removal of premalignant skin lesion .
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Radiation therapy:
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Radiation therapy:
• Radiation therapy: is a local modality used in the treatment of cancer .
• Success depend in the difference in the radio sensitivity between the tumor and normal tissue.
• It involves the administration of ionizing radiation in the form of x-ray or gamma rays to the tumor site.
• Method of delivery: External beam(teletherapy).Internal beam therapy(Brachytherapy).
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BRACHYTHERAPY
• Internal radiation treatment achieved by implanting radioactive material directly into the tumor or very close to it.
• Sometimes called internal radiation therapy.
• Prefix “brachy” – from Greek for “short range”
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WHY BRACHYTHERAPY
• Delivering the high dose of radiation to the
tumor
• Sparing of the surrounding normal tissues
• Delivered in a short period of time
– Tumor repopulation
• Limited to localized tumors
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It is used to treat cancers of the:
• Head and neck, including mouth and lip • Breast cancer• Lung cancer• Oesophagus , rectum, and bile duct • Prostate • Cervix, womb and vagina
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TELETHERAPY
• Teletherapy or External Beam Radiation
Therapy" involves delivery of therapeutic
radiation from a source
• that is placed away
• from the body.
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Cont:
• Radiation therapy is planned and performed by a team of nurses, dosimetrists,physician and radiation oncologist.
• A course of radiation therapy is preceded by a simulation session in which low-energy beam are used to produce radiograghic images that indicate the exact beam location.
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Cont:• Radiation therapy is usually delivered in fractionated
doses such as 180 to 300 cGy per day,five times a week for a total course of 5-8 weeks.
• Radiation therapy with curative intent is the main treatment in limited stage Hodgkin’s disease,some NHL,limited stage of prostate,gynecologic tumors&CNS tumor .
• Also can use in palliative &emergency setting.
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Depending on the type and stage of your cancer, radiotherapy has different goals:
• Curative treatment – to cure cancer and reduce the risk of it recurring.
• Palliative treatment – to relieve symptoms such as pain, pressure or bleeding.
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DOSE• The amount of radiation used in photon radiation
therapy is measured in gray (Gy), • A unit of absorbed radiation equal to the dose of
one joule of energy absorbed per kilogram of matter, or 100 rads.
• For curative cases, the typical dose for a solid epithelial tumor ranges from 60 to 80 Gy, while lymphomas are treated with 20 to 40 Gy.
• Preventive (adjuvant) doses are typically around 45–60 Gy in 1.8–2 Gy fractions (for breast, head, and neck cancers.)
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Complication of radiation:
• There is two types of toxicity ,acute and long term toxicity.
• Systemic symptoms such as Fatigue,local skin reaction,GI toxicity,oropharyngeal mucositis&xerostomia.myelosuppression.
• Long-term sequelae:may occur many months or years after radiation therapy.
• Radiation therapy is known to be mutagenic,carcinogenic,and teratogen,and having increased risk of developing both secondary leukemia and solid tumor.
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Chemotherapy:
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Chemotherapy:
• Systemic chemotherapy is the main treatment available for disseminated malignant diseases.
• Progress in chemotherapy resulted in cure for several tumors.
• Chemotherapy usually require multiple cycles.
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Classification of cytotoxic drug:
• Cytotoxic agent can be roughly categorized based on their activity in relation to the cell cycle.
phase nonspecific . phase specific
cyto toxic drug
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Cont :
• What is the difference between phase specific & phase non specific?…..
• Phase non-specific: – The drugs generally have a linear dose-response
curve( the drug administration ,the the fraction of cell killed).
• Phase specific:– Above a certain dosage level,further increase in
drug doesn’t result in more cell killing.but you can play with duration of infusion.
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What are the chemotherapeutic agent…..
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Chemotherapeutic agents:
• Alkylating agents: Cyclophosphamide• Antitumor antibiotic• Antimetabolites
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Antitumor Antibiotics
Cell cycle non-specific agentsVariety of mechanisms: prevents DNA replication,
RNA production,or both
Anthracyclines AnthracenedionesActinomycin D (dactinomycin) – DNA intercalator, inhibits topoisomerase II alsoBleomycin – inhibits DNA synthesis, G2-phase specificMitomycin C – functions as alkylator
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They interfere with DNA and RNA growth bysubstituting for the normal building blocks of RNA and DNA.
These agents damage cells during the S phase
Commonly used to treat...... •leukemias, •cancers of the breast•ovary, •intestinal tract, as well as other types of cancer.
Antimetabolites
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Cell-cycle Directed Anti-neoplastic Drugs
Cell Cycle Phase Drug Target
Go – G1 Taxol Microtubules (stabilize)
S-Phase Ara-C (Cytosine arabinoside)
DNA synthesis
S- G2 VP-16 (Etoposide) Topoisomerase II
M Vinca-alkaloidsTaxol
Microtubule disruptersMicrotubule stabilizer
Non-cell-cycle specific Alkylating agents:Cis-platinumCyclophosphamide
Nucleophiles (e.g. DNA)
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Complication of Chemotherapy:
• Every chemotherapeutic will have some deleterious side effect on normal tissue .
• E.G; Myelosuppression,nausea&vomiting,Stomatitis,and alopecia are the most frequently
observed side effects.
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• Chemotherapy targets cells which are dividing rapidly.
• Chemotherapy cannot distinguish between normal cells and cancer cells
• Healthy Cells which have a high rate of growth and multiplication include cells of the bone marrow, hair, GI mucosa and skin.
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Combined Modality Therapies for Cancer
Surgery and Radiation
Adjuvant Chemotherapy: Surgery and Chemotherapy
Radio-sensitizers: Chemotherapy and Radiation
Chemotherapy and Host-Response Modification• Induction of Differentiation by Chemotherapeutic Agents• Induction of Apoptosis by Chemotherapeutic Agents
Immunotherapy and Gene Therapy
Genetically Engineered T-Cells
Combined
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Immunotherapy of Cancer
• Potentially Highly Tumor-Specific• Can be Effective Against Disseminated Disease Including
Unrecognized Micro-metastases
• Three main group of immunotherapy use to treat cancer –• Cell based therapy• Antibody therapy• Cytokine therapy
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Host-Response Modification in Cancer Management
Potentially Less Intrusive than Other More-Aggressive Modalities
Treating Host Supporting Cells to Reduce their ability to promote tumor growth (e.g. anti-angiogenesis)
Host stromal cell interactions supporting tumor growth:
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Gene Therapy for Cancer
• Potentially Highly Tumor-Specific• Accessibility of Cell Targets Is a Major Obstacle
for General Application• May Have Great Value in Combined Modality
Approaches• Potentially Dangerous Side-Reactions from Viral
Vector Delivery Agents
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THANK YOU FOR YOUR
KIND ATTENTION